Why Men Suffer in Silence: Male Depression
The Underlying Problem
One afternoon when I was a young doctor I was at a routine administrative meeting with a senior physician when he unexpectedly opened up to me. Overweight and red-faced, he paced his office smoking the cigarette he was seldom without. He started telling me of his concern for his daughter, whom he feared was an alcoholic. At the end of our conversation he commented on how physically tired he felt. There was something about his voice that made me hesitate at the door, wondering if I should ask more. But I decided it would be intrusive, even presumptuous.
I still regret that I was so timid. The next day I learned that he had lain down on the couch in his office after I left and died of a heart attack at age 58. I was the last person who ever saw him alive. I'll never know if I could have at least postponed that tragedy.
That experience and others I've had since with men who were patients or friends have made me think long and hard about how men process the inevitable pressures we all face and how their responses affect their health.
At a dinner party a few years ago I proposed to the men at the table that depression was more common among males than we were aware of. "Of course it is," one of them answered instantly. "That's why we die first."
He was referring to the well-known fact that men tend to predecease women by an average of five years. Over the 40 years that I have practiced medicine with special training in cardiovascular health I have tried to understand why this is so. Why, for example, are men about 10 years younger than women when they develop cardiovascular problems -- and also have their first heart attacks at an earlier age? Why, by the age of 45, are they significantly more likely to develop coronary artery disease (CAD)? I helped pioneer the discipline of gender-specific medicine to explore these differences and to ensure that medicine develops information that enables us to treat both sexes effectively.
The significance of one male-female difference that has become increasingly clear to me is that men are notably reluctant to discuss the emotional issues that often underpin health problems. For example, a male patient will come in upset that he has accumulated fat in his midsection and complain that he cannot lose the weight no matter how he tries. Upon examination it's found that he has high blood pressure and diabetes. There's no doubt he has physical ailments. But when I dig deeper and talk to him, I find that an underlying depression is at the root of his problems.