The internet has made information about nearly everything accessible with phenomenal ease. Nonetheless, many of us still hold on to myths and perpetuate stigmas surrounding issues that would be much easier to tackle in the warm light of openness, understanding, and compassion. One such issue that continues to defy tireless myth-busting attempts is that of mental health. Not only do stigma and ignorance of mental health issues lead to prolonging the suffering of those who have them and their loved ones, but they also prevent entire societies from reaching their full potential in terms of productivity and quality of life.
One of the most prevalent mental health issues today is depression. Survivors of acute depression have struggled to find words to describe it to those who have never experienced anything beyond “feeling down” for a few days. Some describe it simply as the most terrifying and hopeless feeling they ever felt. Depression is like waking up to find a giant invisible boulder sitting on your chest, making it impossible to get up or perform even the simplest daily tasks. Some describe it as a “demon” that takes over, alters your being, and “disappears” with alarming speed. You find yourself not just feeling constantly sad, but also no longer interested in anything that used to bring you joy, unable to take care of yourself, do your work, or connect with any of your loved ones. In fact, some of the things that used to bring you joy might turn into sources of inexplicable terror! People, pets, and things you used to love might start to seem deeply hateful to you. The sufferer may start to panic at the feeling that they can no longer recognize themselves, that they must be “losing their minds”. This panic, in turn, makes the situation worse. But nothing intensifies this desperation more than the strong conviction that comes with it – the conviction that this feeling is never going away, that you are never going to experience joy or relief ever again. If you are a Harry Potter fan, imagine trying to go through life with an invisible Dementor hovering over your head all day long, every day. This is often why some sufferers of acute depression commit suicide out of hopelessness. The distress of acute depression is so serious that, in fact, people who have survived both cancer and depression have claimed they would rather have cancer again than experience another depressive episode.
What I describe above is only one form of depression. Acute depressive states, sometimes known medically as “major depression”, are so debilitating and threaten the sufferer’s life, they usually do not last very long without the person receiving help (if they are lucky) from family, friends, or professionals. But there are many other forms of depression. There is, for example, mild but chronic depression, sometimes medically referred to as “dysthymia”, which can remain undiagnosed and unnoticed while it limits the happiness and potential of the person who suffers it, as if they are going through life dragging heavy chains that they don’t even know are there. It might look to an outsider like laziness, lack of ambition, passivity, or oversensitivity. The sufferers themselves might come to believe this false self-image, thus living in shame and never seeking help.
The title of this article may be somewhat deceptive in its simplicity. There is no clear-cut dichotomy between depression experienced by women and by men. Any person of any gender might experience depression in any of the forms I present here or in a way that combines elements of different forms. However, the research shows that, generally speaking, women and men tend to experience depression differently, and the primary reason for this pattern seems to be the rigid gender expectations of our modern patriarchal societies. In such cultures, including Sudanese & South Sudanese, women are typically silenced, and men are emotionally stunted. Women are mostly expected and are relatively free to be emotionally vulnerable, while men are discouraged from being vulnerable. Vulnerability is (falsely) equated to weakness, and it is acceptable, in fact expected, for women to be “weaker”, but manhood forbids it. Regardless of these differences, both men and women struggle to recognize depression in themselves and experience the stigma of admitting to themselves or others that they are seriously depressed or that they may need professional help. Many people still consider resorting to therapy or medication as “giving up”, “failing”, and being “weak”.
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In both genders, shame plays a major role in initially causing depression. Women and men are typically shamed for different reasons, but the end result of accumulated or constant shame is usually some form of psychological distress. Women are often expected to please and accommodate others even to the detriment of their own welfare, and they often place themselves under the stress of being able to “do it all perfectly” while making it “look easy” (school, career, family, motherhood, physical beauty, etc.). They end up beating themselves up for their inability to achieve impossible standards or for the inability to please everyone, largely neglecting their own welfare. They also experience sexism in the form of discrimination, having their voices silenced, and not being taken as seriously as men, which can be internalized into a belief in one’s own unworthiness (at least relative to men). The shame experienced by men, however, generally revolves around one theme: that of not being “tough enough”. The privileges experienced by men in patriarchal societies and all the advantages they receive over women are in fact conditional. In order for a man to receive these social advantages and be accepted by other men, he must conform to the silent codes of manhood, meaning he must be strong (both physically and mentally), powerful, in control, and simply “not feminine” in any way. So, even if he experiences major psychological trauma or stress at any age, a man or boy must simply “take it like a man” and keep going, otherwise, he is weak.
These differences lead to women and men manifesting depression in different ways. Based on current research, the main differences can be summarized in one sentence: women internalize depression, while men externalize it. Generally speaking, women tend to blame and punish themselves for their own feelings and the traumas they experience, while men blame other people or external circumstances and tend to “act out”. Both tendencies ultimately lead to tragic patterns and cycles of pain and suffering that affect entire family lineages and, by extension, society as a whole.
The challenge for many women lies in the fact that they may believe the inner voice that tells them they are weak or less worthy of love or respect than others. Why would you seek help for feeling a certain way if you believe you deserve to feel it? This is also why some women tolerate the intolerable and accept the unacceptable. For example, if a woman comes to believe that she is less worthy of respect than others, she is likely to tolerate verbal or physical abuse from others. After all, if she believes she is unworthy and someone treats her as such, then, in her mind, what’s wrong with that? Even in the absence of direct abuse, living with this internalized sense of unworthiness eventually has serious consequences on a woman’s wellbeing and on her life. If she is lucky, symptoms of severe depression may start to appear at any point, making it impossible to ignore any longer, and, if she is luckier still, this may force her to seek help and make some much-needed changes in her life and her relationships with herself and others. Less fortunate women may live out their entire lives with chronic depression, possibly passing it on to their daughters in the same form. However, because there is less stigma around women being emotional and talking about their feelings, women are actually more likely than men to end up seeking and receiving help in dealing with depression. Whether they end up in a therapist’s office or get help from supportive friends, women’s chances of healing seem to be higher than men’s, at least in an educated society. Naturally, poverty and poor education & awareness lower these chances.
Men, on the other hand, tend to manifest depression in a markedly different way. From a very young age, boys are typically discouraged from expressing certain types of emotions, specifically those that are considered “feminine” and, therefore, “weak”. It might be acceptable for a man to show anger or aggression for example, but not to cry or say that his feelings were hurt. Depression itself is falsely considered a form of weakness, and thus, it is pushed away, redirected, and covered up until it is unrecognizable. Men often turn to addictive behaviors and “acting out” in order to numb their depression. Such actions include excessive dependency on a partner, substance abuse, addiction of any kind (including work addiction), violent outbursts, or regular abusive behavior towards others (usually spouses or children). According to Dr. Terrence Real, a therapist who spent decades working with depressed men and author of the book “I Don’t Want to Talk About It”, such addictive and abusive behaviors allow the depressed man to move from a position of being “one-down” to being “one-up”. They give him the illusion of power and control, and he no longer feels “weak”. However, as Dr. Real explains, while these behaviors may keep a man from “feeling” depressed, they do not keep him from “being” depressed, and everyone who is close to such covertly depressed men end up suffering sometimes even more than the men themselves do. Too often, especially in cases where this covert depression is caused by past childhood abuse, the suffering is passed down through the generations, father to son, until someone has the courage and support to break the cycle.
The main difficulty with treating male depression is that it is covert and unseen, and the only way to treat it is to bring it to the surface, which is usually a very scary process. Covertly depressed men tend to end up in jail, fired, or divorced much more often than they end up in a therapist’s office, and those who do end up in therapy are usually sent there by their bosses, spouses, or court orders. When they are diagnosed with depression by a capable therapist, they often do not believe or accept their diagnosis but may go along with the treatment for fear of consequences (e.g., losing their jobs or families). Dr. Real explains that the only way to bring a covertly depressed man’s depression to the surface and convince him of its existence is to put a complete stop to the addictions and numbing activities that were being used to suppress it. Once a man courageously accepts the responsibility and stops himself from acting out, the depression that longed to be recognized for years comes rushing out. The man consciously experiences the typical debilitating symptoms of acute depression in his body and mind, and treatment can finally begin, often with remarkable results.
For both women and men, the process of healing from depression often requires a major shift in self-awareness and in the way the depressed person treats him/herself. The process is also sped up by developing a good understanding of shame and learning the skills needed to beat it. One of the most well-known shame researchers of today is Dr. Brené Brown, author of several popular books on shame: “I Thought It Was Just Me”, “The Gifts of Imperfection”, and “Men, Women & Worthiness”. Her work and that of other shame researchers shows that shame is one of the most dangerous and damaging emotional states. Being ashamed means believing that you are “bad”. If you believe you are inherently “bad”, then you believe you are unworthy of love, kindness, connection, forgiveness, or anything good. In this light, there is no room for growth or healing. However, if you believe you are a good person who made some mistakes or is going through a difficult experience, you are more likely to be kind to yourself, make amends, and improve yourself and your circumstances. Being self-compassionate is a skill that requires practice for anyone who is in a lifelong habit of beating themselves up even when they may have been victims. Dr. Kristin Neff explains how to develop this skill through practice in her book “Self-Compassion” as well as on her website.
It is important to understand that mental health is a priority and that good care of others cannot be done if good self-care is non-existent. It is time to put an end to mental health stigma and to be supportive and compassionate to those in our lives who may be suffering. If you are suffering, know that you are not alone and that it is okay to ask for help and support, and, if you know someone close to you who may be suffering, consider offering a listening ear or gently encouraging them to seek the help they need. It is time to break the cycles of abuse and suffering in our society and live more joyful and healthier lives.