Jason reluctantly came to my office for marital therapy. His wife insisted that he attend or she would be calling a divorce lawyer. His ambivalence about being in my office came across loud and clear. Jason did not speak unless directly asked a question. Even then, his answer was as short and staccato as possible. He slumped as far into the arm of the couch as he was able and gave no retort or act of affection in response to his wife's tears or distress.
"He comes home from work--and I know he's tired--but all he wants to do is sit in his recliner and watch hours of television," Jason's wife complained to me through her tears. "He has trouble sleeping and worries constantly about what is going on at work. But work is where all his energy goes. I feel like I don't matter at all to him any more, because he never wants to do anything with me or even hold my hand. I don't even remember the last time we had sex!"
I looked at Jason. No response. When asked to respond, he acknowledged that yes, work does take up all his time and energy, and yes, he is tired every day, but no, it's not that he doesn't care about his wife. No further explanation. Just more slumping and staring off into space.
At first glance, many therapists might take Jason's distancing from his wife as a sign that he is having an affair or wants out of the marriage. At the very least, it appears he resents her insistence that he come to therapy and maybe he is being passive aggressive to punish her or make her change her mind about seeking marital help.
Jason is a busy man, a high-paid executive with a lot of responsibility. He manages teams of people and can handle huge budgets and deadlines. Some therapists might see Jason as arrogant, maybe narcissistic, and that he doesn't want to waste his valuable time in a therapist's office when there are more important things to accomplish with his life.
But digging a little deeper, I learned more about Jason. A few years back, when he was only in his 40s, Jason had a stroke. It was a long fight back to full health. During his recovery, his son got involved in drugs and was arrested and his father died. Jason, the oldest child in the family, took full responsibility for the funeral arrangements and settling the estate afterward. Jason was successful at his job, but more and more demands were being placed on him in the current tough economy and he was increasingly becoming unhappy at work. However, it would be difficult to walk away from a salary like his, especially since Jason and his wife recently bought their dream house. Jason felt "boxed in."
So, let's look at Jason again. He was feeling overwhelmed and stressed, he wasn't sleeping well, he was withdrawing from others including his wife of 28 years, he had lost interest in sex, he had given up his passion for golf, and he was zoning out in front of the TV every night. Maybe Jason is not narcissistic nor passive aggressive. It is possible that Jason is depressed.
The symptoms of depression are:
- feelings of sadness or emptiness most of the day, nearly every day
- markedly diminished interest in activities once found pleasurable
- significant weight loss or weight gain
- marked increase or decrease in need for sleep
- feeling agitated or irritated
- decreased energy or feeling slowed or weighed down
- feelings of worthlessness, powerlessness, helplessness
- a false sense of guilt
- unexplained aches and pains
- inability to concentrate or focus or make decisions
- recurring thoughts of death or suicide
Depression in men often goes undiagnosed because it can manifest itself differently in men than in women. For example, women will often withdraw into sleep, self-medicate with food, and will cry often, even several times daily. But men, typically still go to work and function pretty well on the job, but doing so saps all their energy. They often experience depression with irritation or agitation, not with tears, because men, in general, are socialized that crying is not "manly" or acceptable, but that anger is. Both depressed men and women might lose interest in sex, but again, our society leads us to believe that men will seek out sex at all costs. Therefore, when men withdraw from their wives sexually, we often think of infidelity, when in actuality, depression may be to blame.
A diagnosis of depression may be harder for men to accept about themselves than for women. It can be more difficult to get a man to talk to his doctor about medication or to seek out therapy. In Jason's case, he is used to being in charge and is highly respected on the job and in his community. He might be worried about the stigma of depression, which unfortunately seems worse for men than for women. He may even be fearful that a diagnosis could wreck his career. Jason, like many men, may think depression only happens to women and therefore, couldn't possibly be what is afflicting him.
But depression is an equal opportunist. It is an brain-chemistry illness that affects both men and women. Likewise, treatment is effective for both genders. Jason may hope that his depression will simply go away if he zones out enough in front of the TV after work, or if his wife would just stop making demands on him and find other people to occupy her time, or if his work load could just get a little lighter. It might be challenging for Jason to accept a diagnosis of depression. I hope not, because help is available for Jason and men like him.