Let's help men kick the sadness

On `Defeat Depression Action Day', Michael Shooter calls for a fresh approach to male sufferers

I was young, I was male; I was going to be a doctor. Young men in the caring professions do not get depressed - or so I thought. In fact, I was on the edge of collapse.

I had always had an up-and-down personality, prone to flying moods that would come and go without reason. This time the blackness stayed with me. When a favourite patient died on me, I plunged into a pit of worthlessness. I was no good as a doctor; I had never achieved anything; I would always be a failure. I had difficulty getting off to sleep and woke early, drenched in sweat. I lost all interest in sex and ate to stave off unhappiness. I went to the dean to tell him I was giving up medicine. I was ready to give up life itself.

This was depression, of course, and he recognised it. His sympathy was the first step in my recovery - from an episode of what I now know to be a continuing vulnerability. I went to see a therapist who treated me with words and drugs. Above all, she helped me to see that this was an illness which was not my own fault.

Mine is not an exceptional story - only, perhaps, in the speed with which I got help. One in five of us will become depressed at some point in our lives. At any one time, one in 10 of us will be struggling with depression of some degree. Men are just as vulnerable as women and may be even more so. We are three times more likely to commit suicide than women and in some groups it is easy to see why. Widowed males "cope" less well with bereavement; divorced males are often separated from home and children. Doctors, vets and dentists work under enormous pressures; farm workers toil in dangerous isolation. Many men have no work at all. The suicide rate among young men between 15 and 24, the most worrying group of all, has risen by over 75 per cent in little more than a decade.

Men are reared in the belief that we should be strong and self-reliant; that it is weak to admit to frailty and beyond the pale to ask for help of any kind. We dislike open talk of our feelings. Confronted by a partner who wants to talk, the depressed man may retreat further into his shell and destroy the relationship in the process. For the young man stripped of self-respect by educational "failure", unemployment and rootlessness, with little family sympathy and isolated by poverty, the very idea of help may be fraught with stigma. How much easier to turn to alcohol and drugs, which only make depression worse.

So how can men be helped in their depression? First, it needs to be recognised. As much as 65 per cent of male depression goes unnoticed - by the general practitioner, male himself perhaps, who fails to see through the aches and pains to the unhappiness underneath or gives it scant attention, if he does see what is going on.

The treatment, when offered, is not always what is needed. Many of us find conventional psychotherapy, involving talking about feelings, just too difficult. Cognitive therapy - which gets clients to reflect on their beliefs and perceptions about the world and gain a sense of logic and perspective without a discussion of feelings - can help men to address their most pessimistic thoughts.

Conventional clinics must be rethought: they are not places in which many men feel comfortable and able to tackle their depression. Psychiatrists should occasionally shift their services to places where men feel less threatened, to leisure centres, for example, which more and more men already use to improve their general health. Just as child psychiatric services have adapted innovatively to the difficulties children experience in expressing themselves, so the adult services must get out of their ivory towers.

We know a lot about the causes and cures of depression, that physical exercise helps, that drugs and drink make it worse, that support from partners - and their involvement in treatment - makes for quicker recovery. The figures should worry us, but we do have the power to help men back from their black, isolated loneliness to happier lives.

The writer is a consultant in child and adult psychiatry with Gwent Community Health Trust. A fact sheet on Depression in Men is available from the Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. (0171-235 2351).