The other day I looked back at a couple of posts by Therese Borchard at Beyond Blue about the behaviors that distinguish men and women in their responses to depression. She quoted two different studies in posts she published about a year apart, and that’s how long I’ve been mulling over writing about this subject.
I’m less interested these days in explanations and studies than in looking directly at experience, but in this case important questions come to mind. What would set men and women apart in their behaviors? How much of the difference is due to our being conditioned to behave in certain ways to fit the social role of a man or a woman?
One of the basic contrasts is that men are more likely to blame other people or external circumstances for inner turmoil and to act out in overt, often violent or abusive ways. They self-medicate with alcohol, sex or other addictions and feel they aren’t loved or appreciated enough. Women are more likely to blame themselves and ask how they can be better as a spouse, parent or worker. They tend to self-medicate with food, friends and love and ask themselves how they can be more lovable.
Why are these behaviors and inner thoughts about depression so different in men and women? While I can’t begin to capture the richness and depth of his books, I’d like to explore in abbreviated fashion the approach of Terence Real, whose classic book is I Don’t Want to Talk About It. He has probed this question deeply through his clinical experience and developed a concept of depression and its remedies that has little to do with a medical or disease model. Instead it is based on addressing the fundamental relationships each person needs to develop when growing up and to sustain throughout life. He calls his approach Relational Therapy.
He believes that the distortion of healthy emotional relationships through child rearing is at the root of later disorders. Despite changes in thinking and cultural practices about gender differences over the last few decades, he finds that most upbringing even now perpetuates the essentially sexist roles of men and women. During childhood, boys learn three critical lessons, each destructive.
– They are compelled by a shaming process to separate from their mothers’ emotional support as early as possible. This cuts boys off from a close relationship with a key nurturing person in their lives. No mama’s boys allowed.
– They are shamed into controlling their emotions, especially crying, because expressing a lot of emotion is unmanly, something that only girls are encouraged to do. This leads to a break in the ability of a boy to relate to his own emotional nature in all its complexity.
– Independence and competitiveness are heavily favored for boys, as well as the cultivation of physical strength, toughness and assertive, aggressive behavior. The effect is to cut a young male off from building sound relationships with others. He will likely form close friendships, but then he and his buddies comprise their own group and regard other peers with suspicion and competitiveness. A boy may also come to look on others in a manipulative way, as a means to achieving his own goals.
Shaming and contempt are the primary mechanisms pushing boys into the conventional masculine role. Real points out that if a boy fails the test of manhood, he is branded as feminine, a sissy, a coward. But if he passes, he is encouraged to dream about his future in a grandiose way. Here is how Real describes the outcome of this process in How Can I Get Through to You?:
“It is this unacknowledged superimposition of grandiosity on shame, this burying of hurt boy inside hurting man, the sweet vulnerable self wrapped in the armor of denial, walled off behind business, work, drink, or rage, the hidden “feminine” inside the bluff “masculine,” that is the truth about men which dare not be uttered.”
In families, women and children fear even naming the shame and grandiosity they sense lest those qualities become even more exaggerated and so threaten the life they now depend on. Hence, his phrase about the truth that dare not be uttered.
So a typical boy will lose basic relationships with mother, with self and with others or else form those relationships in distorted ways because of the early emotional damage. He may search for a female partner as a means of compensating for these losses – someone who will bring emotion back into his life through her behavior, not his own, who will support and care for him in a mothering way and who will handle the social relationships he no longer even tries to form.
Girls are encouraged in just the opposite ways: to stay close to the mother and eventually assume the nurturing, supportive role; to show emotion and form relationships; to avoid being pushy or aggressive – in other words to be fundamentally disempowered and to curb or hide their natural diversity of personality and inner life. Real sees this upbringing as leading to a tendency to move into victimhood and to feel continuing resentment at not being heard or matched by a man in sensitivity to relationships. The disempowerment is abuse.
The gender roles may sound old-fashioned and no longer characteristic of contemporary child rearing, but studies Real cites demonstrate that parents’ reactions to infants and toddlers follow the old assumptions. Even parents who claim to disavow the stereotypical roles and to treat boys and girls equally show unconscious, instinctive reactions that demonstrate treatment that conforms to traditional models.
So what does this theory have to do with depression?
In this view, depression begins in the trauma of youth, but that trauma is not necessarily an unusually overwhelming or shocking event. The suppression of key relationships and feelings through shaming and contempt is itself an ongoing trauma of childhood. Because the essential relationships with nurturing parent, self and others are damaged and the true inner nature of a child distorted, a boy or a girl predisposed to depression through genetic heritage or family experience is likely to develop into an adult ready to sink into this illness.
Since a major source of the depression comes from damaged relationships, the remedy is to work with an individual or, more often, a couple to restore a healthy and conscious bonds to oneself and others. The undoing of such depression does not depend on medication but rather on an approach to therapy that focuses on restoring full humanity to these relationships. The powerful stories in Real’s books demonstrate the hard work and the breakthroughs that may be possible. I’m sure this approach isn’t for everyone, but I find it well worth exploring.
I know that many readers of this blog have suffered far more overwhelming traumas of abuse and loss than the more common experiences Real focuses on. But I’m interested to know if his ideas resonate with you and capture any part of your boyhood or girlhood. Do you think treating the distorted relationships is a path to relief from depression?