Real’s Men and Depression

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?

You can read the full posts and citations to the studies they draw on here and here. I won’t repeat the differing behaviors of men and women in full.

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?

9 Responses to “Real’s Men and Depression”

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  1. Betty says:

    I am not sure if my ex-husband is depressed, but these articles are shedding some light into his recent, and past, behavior.

    He dropped an emotional bomb on me in January with “I love you, but I’m not in love. We have grown apart. ” We divorced in June. Our loving, trusting, solid marriage lasted 14 years (together 20 yrs).

    My ex husband’s family has a history of bipolar depression, and his half-sister committed suicide 3 years ago. Also, I don’t believe he had an emotionally stable childhood. There was, at one time, 8 kids in a small apartment when he was a small child. I don’t think he ever found an emotional and balanced attachment to his mother. I saw it in their relationship when we were together. Also, his parents’ marriage was so volatile. They would fight, call each other names, so bad to a point where his dad would leave for hours, but would come back.

    I just have to wonder if his upbringing, his adult pain with the grief over his dad’s death last summer, his controlling mother, and enduring the pain of his parents’ relationship contributed to his leaving me. As far as I know, his mother didn’t tell him to fight for our marriage. His sister sympathizes with me, rather than him. I could understand why he chose me as a mate because I was the emotional one in our relationship.

    This is not the first time he has left me, however. He left our relationship, but we stayed attached at a distance, two other times before we got married. His basis for leaving those times was emotional stress brought on by major life events. I realize back then I should have taken the hint to end things for good but it was hard to do when you are young, fresh outta college in a new place, and in love.

    Anyway, I do wish him well and to be happy. I know that it’s best for me to let him go. I’m scared to let go as he’s all I’ve known for half my life and based my decisions. But the man I miss and love is gone. He feels bad for hurting me but I don’t think he truly understands what I’m going through since he wasn’t exposed to what a real loving, emotionally healthy relationship is/was. He wants to be there for me. It’s like the staying connected at a distance, all over again.

    Our big hearts are suffering. May we heal with love and compassion for ourselves, with time and knowing we deserve to have strong, emotionally stable relationships in our lives.

    Any thoughts or other insights?

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  3. John D says:

    Melinda – Thanks so much for that wonderfully clear explanation! What I’ve taken from the different authors is exactly what you describe. Another piece of the puzzle is added by Kramer who believes that chronic depression may start with a traumatic event but then become self-perpetuating because of the cumulative impact of the stress-related hormones. That’s why he is so insistent that depression be treated when it first appears before it gets to a point where that dynamic takes over. I believe you are so right about the difference between situational and chronic depression. That distinction seems lost on many writers these days – perhaps there should be two names to set the conditions apart more clearly. Thanks again for this really helpful comment. (By the way, I don’t know where those strike-through lines came from – they did not appear at all in previewing, and that section is integral to your thought. Sorry about that!)

  4. says:

    Hi John,

    I am a biopsychologist, which means that I look at biological/medical reasons that explain behavior.

    I truly believe that just about every condition or illness is an interaction of two things: nature and nurture. I believe in order for chronic depression to manifest (which is different from episodes of situational depression) a person has to have a genetic predisposition and then an environmental factor that triggers the genetic predisposition.

    We know that there are specific genes involved in depression (as there are in many if not most psychological problems). However, not everyone who has that genetic link actually becomes depressed, which is why environment is key.

    I believe that the gene may lie dormant until some trauma triggers it–and then once that genetic predisposition is triggered, a person will continue to be at high risk for depression.

    Now, situational depression is very different–and this could even be the environmental trigger for chronic depression. For example, a person being fired from her/his job, losing her/his spouse, having her/his house foreclosed could be the environmental trigger that sets off chronic depression. A person that doesn’t have the predisposition will likely still become depressed due to the nature of losing a spouse, or a home, or a job-; however, that person is likely to overcome the situational depression far easier and without medication than the person who has the predisposition. Moreover, I would say it would be rare for chronic depression to occur (without the genetic predisposition).

    I hope that made some sense, John! Great post, as usual.


  5. John D says:

    Thank you, brooke. I hope I can make sense to those who are not depressed, but, of course, I’m writing mostly for those like you and me. If you feel like it some day, it would be helpful to hear more of that story you’re hinting at. My best to you.

    Merely Me – Yes, that’s one question. Terrence Real’s approach is to treat the relationships with a couple or family, and that goes beyond the solo talk therapy. It’s been true for me also that talking about the past is helpful but does not end depression. I believe that achieving the kinds of breakthroughs that can happen in family or couple’s therapy, though, goes a lot deeper. In the present moment, relationships can be transformed when people become truthful with each other in a guided setting. There are other questions about Real’s approach I need to think about. The great value in his books, though, is less the attempt at explanation than the powerful stories he tells.

  6. Merely Me says:

    Your post is excellent…so many points to consider and pursue. You are a wealth of information too.

    Your question is whether or not treating the distorted relationships (I am assuming from childhood) will decrease one’s depression. Well all I know is that I had spent considerable time in therapy talking about these relationships so there must be something to it. I think it does help but it doesn’t totally take away depression as some of those issues …can never fully be resolved. Maybe I need to read more to fully understand what you are asking.

    Great post as usual. I like the paths you take us on.

  7. brooke says:

    i came across your weblog a couple of weeks ago. your writing about this illness describes it in ways that i think that those who don’t deal with it can better understand it. unfortunately i’m one of those who does.

    so point. in my family, at least when it comes to me, i was treated like a boy – at least as you describe it in this post. is it part of my depression? well, yeah and in a fairly large way. and then of course there’s also genetics and such.

  8. John D says:

    Hi Evan – Real does talk about a predisposition through genetics, as does Kramer. The impact of this type of upbringing and the response it triggers will certainly differ from one person to another. But I haven’t seen any explanation of the emotional sources of depression that is very clear. Trauma is cited – but how severe and what does it really do? Real is expanding the idea of trauma by making the distinction between active trauma (something done to a child or involvement in a scarring event) and passive trauma (deprivation), and it is the passive trauma that he emphasizes. He refers to withholding love and emotional bonding from a child or coercing a child into the distorted relationships Real finds in child rearing. Many of the stories he tells – and certainly my own experience – involve something more severe but still short of an “active” trauma like physical or sexual abuse. Hard to tell what it takes to set off decades of dealing with major depression – no one has fully explained it, but Real is pushing explanations in an important direction.

  9. Evan says:

    Real’s stuff makes great sense to me.

    The link with depression? I’m not so sure. This abuse of children is widespread – why is it that some develop depression and others don’t. Perhaps it is genetic predisposition?

    In any case a world where children are allowed to feel their feelings will be a far better and less depressing place I think.

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