From Chapter One: Men's Hidden Depression When I stand beside troubled fathers and sons I am often flooded with a senseof recognition, All men are sons and, whether they know it or not, most sons areloyal. To me, my father presented a confusing jumble of brutality and pathos. Asa boy, I drank into my character a dark, jagged, emptiness that haunted me forclose to thirty years. As other fathers have done to their sons, myfather-through the look in his eyes, the tone of his voice, the quality Of histouch-passed the depression he did not know he had on to me, just as surely ashis father had passed it on to him -- a chain of pain, linking parent to childacross generations, a toxic legacy. In hindsight, it is clear to me that, among other reasons, I became atherapist so I could cultivate the skills I needed to heal my own father -- to healhim at least sufficiently to get him to talk to me. I needed to know about hislife to help understand his brutality and lay my hatred of him to rest. At firstI did this unconsciously, not out of any great love for him, but out of aninstinct to save myself. I wanted the legacy to stop.

One might think that I would have brought to my work a particular sensitivityto issues of depression in men, but at first I did not. Despite my hard-wonpersonal knowledge, years passed before I found the courage to invitemy patients to embark upon the same journey I had taken. I was not prepared, bytraining or experience, to reach so deep into a man's inner pain -- to hold andconfront him there. Faced with men's hidden fragility, I had been tacitlyschooled, like most therapists-indeed, like most people in our culture -- to protectthem. I had also been taught that depression was predominantly a woman's disease,that the rate of depression was somewhere between two to four times higher forwomen than it was for men. When I first began my clinical practice, I had faithin the simplicity of such figures, but twenty years of work with men and theirfamilies has lead me to believe that the real story concerning this disorder isfar more complex. There is a terrible collusion in our society, a cultural cover-up aboutdepression in men. One of the ironies about men's depression is that the very forces that helpcreate it keep us from seeing it.

Men are not supposed to be vulnerable. Pain issomething we are to rise above. He who has been brought down by it will mostlikely see himself as shameful, and so, too, may his family and friends, even themental health profession. Yet I believe it is this secret pain that lies at theheart of many of the difficulties in men's lives. Hidden depression drivesseveral of the problems we think of as typically male: physical illness, alcoholand drug abuse, domestic violence, failures in intimacy, self-sabotage incareers. We tend not to recognize depression in men because the disorder itself is seenas unmanly. Depression carries, to many, a double stain -- the stigma of mentalillness and also the stigma of "feminine" emotionality. Those in a relationshipwith a depressed man are themselves often faced with a painful dilemma.

They caneither confront his condition -- which may further shame him -- or else collude withhim in minimizing it, a course that offers no hope for relief. Depression in men -- acondition experienced as both shamefilled and shameful -- goes largelyunacknowledged and unrecognized both by the men who suffer and by those whosurround them. And yet, the Impact of this hidden condition isenormous. Copyright copy; 1997 by Terry Real.