When you are depressed it’s obvious, surely.  The simple answer is no: not always and when it comes to men then the answer is no, not very often.

You will have come across the hidden face of male depression at home, in your relationship, in your family and at work but you may not know it. Male depression is hidden because depression presents in men differently to women in most cases. Often men are unaware they are depressed and may even exhibit destructive behaviours. There is a reason for this.

My interest came from working in the business world for over 20 years and observing behaviour that I did not really connect with which seemed unhelpful, counterproductive and unnecessarily aggressive. This behaviour seemed acceptable, and in some places expected and I could not understand it. It got me curious and began to look behind it to see what could be driving it.

One in four of us will have a mental health issue in our lives. Only 25% of people who seek help for depression in the UK are men and yet recent studies conclude that the actual number of depressed men is over 30%.

The DSM-IV diagnostic criteria for a major depressive disorder 

• Depressed mood – most of the day, nearly every day;
• Markedly diminished interest and pleasure in all, or almost all, activities most of the day, nearly every day;
• Significant weight loss or gain;
• Insomnia;
• Agitation nearly every day;
• Fatigue or loss of energy nearly every day;
• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
• Diminished ability to think or concentrate or indecisiveness, nearly every day;
• Recurrent thoughts of death (not just fear of dying) with or without a specific plan

If a mental health professional was assessing someone against this criteria, he would depend mainly on self-disclosure which raises two key problems for men with depression – the first is they are less likely to seek the help of a mental health professional;  and secondly their upbringing and the shame associated with talking about or expressing feelings means that they may not talk about it even if they go.

Many boys are raised to be tough, remember that ‘Big boys don’t cry’ mentality? It’s OK for boys to be assertive, strong, rough and tumble. It’s not OK for boys to be vulnerable, to show sign of apparent weakness or not being able to cope. This is often the behaviour I witnessed in the business world.  Men were expected to ‘suck it up, get on with it or deal with it’ which is nonsense, unproductive for a business profitability perspective and from a health perspective, damaging. You only have to watch a playground reaction to a boy bursting into tears to see this in evidence even today. Be a Hollywood hero is the message, you may be riddled with bullet holes and have one arm hanging off – but whatever you do don’t show you are hurting and do not slow down for a second. We may be exaggerating and yet in the business world, only a little.

The drive to be ‘more than human‘ is a problem for both men and women, but it shows up differently. Generally, for women it is seen as an obsession with being perfect, slim, looking good, being helpful and nice. In contrast, men often experience a strong drive to be strong, to be the protector, to be tough. Both of these ‘more than human’ states are unhealthy, not to mention, impossible. But sadly society still covets them to some degree, and this has to change.

Often the shame of expressing emotion is so deep-seated that many men – and we see this a lot in men aged 40–60 in senior positions in organisations – repress their feelings so much that even with the best will in the world, they would be unable to answer questions related to the DSM criteria above. This is the reason why suicide is the number one cause of death in men under 50. It’s a sad state of affairs that some men chose this course of action rather than face the apparent shame and get help.

It’s not just a men’s problem

Men tend to act out their emotional issues rather than express them. In depressed men, these behaviours can range from unhelpful to destructive. Women tend to go inward when depressed, unable to control their emotions and maybe even feel overwhelmed by them. Men, on the other hand, unable to handle any more repressed emotion do things that they hope will help them feel better, even if just for a moment. They act out.

Men are no less emotional than women; it’s upbringing and social conditioning that forces them to lock their emotions away. Because expression of emotion is shamed in many boys, admitting to feeling down, scared or lonely is out of the question, so instead they suffer in silence, put on bravado. And because emotion can’t completely be locked away, it comes out in their behaviour:

Men who are depressed are more likely to behave mainly in two ways when depressed: (1) Resort to addictive behaviours which constitute alcohol problems, affairs, gambling, eating, not eating and similar and more obvious things. Less obvious and equally important are the addictive behaviours that are all too often viewed as acceptable like excessive exercise or working very long hours.  When these become obsessions it can be an indication of a deeper problem; (2) ‘Leaking’ of inappropriate behaviours. This could be sexually inappropriate behaviours, inappropriate banter, teasing or bullying, outbursts, even stealing or criminal behaviour.

The key difference between an indication of depressive tendencies and other issues is that a depressed man will feel bad about them afterwards, and it will just add to his feelings of worthlessness. They may go to some lengths to cover this up so that their behaviour stays hidden.

These behaviours not only impact the men themselves, they impact their family, loved ones and work colleagues. You can see how this all link together from a workplace, societal and relationship perspective. We should add that these behaviours are not always a sign of depression and they could also be symptomatic of other issues but if we add them to the DSM list we get a better overall picture. If we can help men to be more open about how they feel, reduce the shame they feel and stop labelling them weak or demonising them, the positive impact on business, relationships and the world could be huge.

John McLachlan is a clinical hypnotherapist with a particular interest in depression in men. He is the co-founder of Monkey Puzzle Training.