Depressed Men in Therapy

Depression affects women more than men. And yet, when men become depressed they rarely seek treatment. So explains Elizabeth Bernstein in her Bonds column this week.

Therapists are concerned about male depression, but not sufficiently concerned to see that they might be more the problem than the solution.

After all, no self-respecting man is going to sit in a therapist’s office and try to get in touch with his feelings. It will be worse when the therapist is a woman. The experience is alien to his being. He will do everything in his power to avoid debasing himself in front of a woman, especially a woman therapist. Moreover he will suspect, correctly, that a woman will not understand the extent to which his self-regard depends on his career success.

Most of today’s therapists are female. And they are more likely to want a man to get in touch with his feminine side, to get in touch with his feelings, to express what he is bottling up inside. It’s what they know how to do. About the world of men they know very little.

Worse yet, in many cases today’s therapists are indoctrinating people in politically correct pieties. Today’s female therapists are invariably feminists and they use their practice to pass along the feminist party line. They will tell men to support their wives’ careers and to diminish their commitments to their careers in order to have work/life balance.

Again, it’s what they know. And it’s what they believe.

When men become depressed the reason most often has to do with being less successful in their careers. Not always, but very often. If they bought the notion of work/life balance and have cut back their hours on the job they will most likely fall behind their colleagues who have not done the same. This loss of status, this sense of being second rate cannot be solved with a pill and cannot be solved by getting in touch with anyone’s feelings.

To be fair they might have been persuaded to do as Mark Zuckerberg did, to take time off to play Mr. Mom with their newborn. Their wives might have told them: If Mark Zuckerberg can do it, why can't you? They did not understand that Zuckerberg was pulling an arrogant stunt, and that if a man who is not worth billions and does not own the company does as
Zuckerberg did, his career prospects will decline precipitously.

Of course, men today are subjected to constant male and husband bashing. They are guilt-tripped about being part of the patriarchy. If they are white they are trashed for their white privilege. If they are Asian they are still trashed for their white privilege. They are taken to be potential or actual rapists. They are disrespected and insulted with impunity. If they dare to fight back they are threatened.

Given the cultural climate and given male instinct they are disinclined to see a female therapist.

More than a few men have seen their career success systematically undermined by their wives. And yet, they cannot leave their marriages because they want what is best for their children. They feel trapped and helpless.

If a depressed man goes to see a feminist therapist she will most likely tell him to man up and do the dishes. She will tell him that he needs to get over his patriarchal longings and his white privilege. Then she will tell him that he has control issues and unresolved pathological narcissism.

So, why would he want to go to see such a therapist? Someone who is doling out the party line and pretending that it is science.

Back in the day when women were becoming more prominent in the therapy world they were trolling for female clients. They used to say that no man could ever understand a woman’s experience. No man could feel the proper amount of empathy for a woman… as though such empathy and introspective soul-searching would ever help a woman to get along in the world.

Obviously enough, their argument must also entail that most women do not really understand a man’s experience. Given their predilection to believe that feminist pieties are scientific fact, many female therapists are not going to understand men at any time in the near future.

Besides, keep in mind that most depression today is treated with medication. We can argue about whether the medication is effective, but if talk therapy were really an effective treatment of depression, the nation would not be awash in Prozac.

One understands that therapists are licensed and credentialed professionals, but if you think that it’s easy to treat depression or, for example, addiction, you should think again.

One needs to mention, if only as a public service, that men who are suffering from depression would do better to get a trainer than to get a therapist. Better to get a trainer who conditions them than to find a therapist who will tell them to get in touch with their feelings. By now, everyone knows that exercise is a great treatment for depression, but one needs to keep mentioning it.

Also, when it comes to treatment,  keep in mind the immortal words of Harvard psychiatrist, Dr. Richard Mollica: “The best anti-depressant is a job.” Not just a job of course, but a job in which one is succeeding. If a man compromises his job prospects to find work/life balance, and thus sees others doing better than he, he will have lost face. And lost face is a form of depression.

Work/life balance is becoming the epitaph on the tombstones of many a man’s dead career.

I emphasize again: being in touch with your feelings has very little to do with learning how to function in the world. And no therapist can help a patient learn how to function in the world if the therapist does not know how the world functions.

Most therapists whine about emotion because that’s what they know. It’s their domain. The world of business, commerce and the professions… is not their bailiwick. Instead of trying to make sense out of a difficult work situation or a complex marital negotiation, they are likely to fall back on the idiot question: How does that make you feel?

I promise you, no man has any idea of what that means. If he answers the question he will only be going through the motions.

When therapists get over their mania about feelings they tell their patients that it’s all a control issue. But, what good does that do? Either you can help a patient get control of his life or you cannot. Saying that he has control issues is mindless pabulum.

As it happens, Bernstein uses male therapists in her column. A wise choice, indeed. And yet, the male therapists seem more to be metrosexual. They want you to learn how to express your emotions.

Shouldn’t they know that a man who expresses his emotions openly and freely will lose the respect of his colleagues, his manager and his staff. Most men will think that they are not only being invited to learn how better to whine, and they know that if they go to therapy and develop the bad habit of expressing their emotions, the habit will not remain contained within the walls of the therapist’s office.

So-called experts affirm this assessment. Bernstein explains:

Some men aren’t in touch with their feelings. But the larger problem is that men have been conditioned not to talk about them. “There is that sense that they should be in control of their emotions and that being depressed can be viewed as a sign of weakness,” says Jeffrey Borenstein, a psychiatrist and president of the Brain and Behavior Research Foundation in New York. Men are expected to handle problems on their own, he says.

Actually, it’s not such a bad idea for women to learn how to handle problems. If women and men are taught by therapists to get in touch with their feelings they will be avoiding their problems in favor of soul searching and navel-gazing.

For a man, this emotion centered therapy will feel like an invitation to weakness. They know that it will make them feel more depressed and more ineffectual:

This sense of weakness can make depression worse for men, therapists say. “For women, depression is a signal for getting help, that something needs to be addressed in a fundamental way,” says Nando Pelusi, a clinical psychologist in New York. “For men, it’s a signal that they are a failure and are submitting to defeat.”

As it happens, these insight-oriented therapies are largely a waste of time. Bernstein points out that the most effective treatments for depression are based on cognitive exercises or on changing behavior:

There are several types of psychotherapy that have been shown to successfully treat depression and that focus on changing one’s behavior. These include Cognitive Behavioral Therapy, which helps a person change his thoughts, and Behavioral Activation, which helps him become more engaged in his day-to-day life. These may be more comfortable to many men.

Of course, it’s not really about making this more comfortable for men. It is about getting men more engaged in their jobs and their careers. And yet, in order to help a man to do this one must have a good sense of how the world works, how a business is organized, what demands and requirements are involved.

How many therapists really know much of anything about any of this? Precious few, I believe. The men who refuse to submit themselves to a therapy that will tell them to get in touch with their feelings, that will tell them to express their feelings, that will tell them to accept a reasonable work/life balance, that will tell them to get in touch with their feminine sides, that will disrespect their drive to get ahead in the world and will demean their manliness… are doing the best that they can under the circumstances.