Covert depression in men (Terry Real)
Depression in men that doesn't look like sadness. The low mood is defended against through action and numbing (irritability, overwork, drinking, withdrawal into screens or hobbies, risk-taking, affairs), with shame underneath. Real calls it covert because the man often doesn't know he is depressed, and it can turn overt.
What drives it
Masculine norms treat sadness and need as weakness, so the pain goes into what Real calls addictive defences (work, alcohol, sex, exercise), isolation, or rage directed at others. The defences keep up the image of coping.
How it shows
Work
Works later and longer while the quality of his output drops. Short-tempered over small things; newly cynical. Stops socialising after work, drinks more at events, takes a sudden big bet. Complains of tiredness, back pain or poor sleep. Says 'I'm fine, just busy' or 'stressed', never 'down'.
Relationships
His partner says he is 'angry all the time' or 'not there'. Retreats into the garage, the phone, the gym or the office. Irritable with the children. Sex drops off, or an affair appears. Refuses help: 'I don't need to talk to anyone.'
Self
Nothing feels good unless it is intense; you are more irritable than sad; you need the drink, the deal or the workout to feel normal, and stopping leaves you flat.
What tells it apart
Major depression: Overt depression shows sadness, tearfulness and talk of hopelessness; in the covert form he denies feeling low and the evidence is behavioural. Asking what he still enjoys often reaches it when asking about mood doesn't.
Burnout: Burnout is tied to work and lifts with real time away; covert depression comes on holiday with him, and the irritability and drinking carry on.
Substance addiction: In addiction the substance drives the cycle; in covert depression the mood change came first and remains when he cuts down. Ask what he was like before the drinking rose.
A test
Ask about pleasure and sleep rather than sadness ('What do you still enjoy? How are you sleeping?') and ask his partner what has changed; if any hopelessness or talk of being a burden comes up, ask directly about suicidal thoughts and connect him with professional help.
Questions to carry
- In place of sadness, what has changed in sleep, temper, work hours, drinking or screens, and what does a partner say?
- Which busy habit of mine keeps a low feeling from catching up with me?
How strong the research is
clinical. Partial support: in US national survey data, depressed men reported more anger attacks, aggression, substance use and risk-taking, and counting these symptoms closed the gender gap in prevalence (Martin, Neighbors and Griffith, 2013); whether this is a distinct male form of depression or comorbidity is disputed, and 'covert depression' is not a diagnosis.
Where it comes from
Terry Real, I Don't Want to Talk About It, 1997; related work on 'male depression' by Wolfgang Rutz and colleagues, 1990s (Gotland Male Depression Scale)
Sources
- Terrence Real, I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression (1997)