WHERE HAVE ALL THE OLD MEN GONE?
GONE TO GRAVEYARDS EVERYWHERE
(with a nod to Paul Simon)
(originally published in The Westchester Psychiatrist and reproduced with permission)
by Edward M. Stephens, M.D.
Chair, Committee on Men's Issues
The Psychiatric Society of Westchester
(a district branch of The American Psychiatric Association)
- and -
President, NCFM, Greater New York Chapter
Why are males killing themselves at an alarming rate? Suicide, in every age group, is higher for males than females with a peak ratio of 8 to 1 in the over 65 category.
In my earlier newsletter message, “The Death of John -- Age 16 -- Suicide,” I paid tribute to an adolescent who simply needed counseling. He didn’t get it. He had some reverses in school and was upset over the fighting between his mother and father. His reported experience, in his suicide note, was that he was “tired of life.”
In the week before he shot himself, he was acting up in class and offered his apologies to his teacher in the suicide note. If only someone had seen his depression instead of seeing him as an obstreperous boy, he would still be alive.
As physicians, we have to ask ourselves about our awareness of depression in males with such alarming rates of suicide and clear categories of risk. Are we routinely screening our male patients for depression? Do we recognize the different ways depression shows up in men and boys as opposed to women and girls? Do we have referral resources for distressed boys and men?
For many years, we have known that there are genetic links to depression that are not gender referenced. If depression occurs in first degree relatives, it can usually be traced back through the family history with other markers such as alcoholism, suicide, antisocial behavior and mental illness. The genetic predisposition for depression is equally divided between the genders.
After a positive history for depression and its equivalents in a patient and other family members, our index of suspicion about the seriousness of the case in front of us should rise appreciably. What we are more than likely looking at is a depression that is potentially life threatening; even if it is only presenting as lowered energy, sleep disturbance, increased use of alcohol or back pain.
We probably all remember the axiom, “You don’t diagnose what you don’t know.” One of my suspicions in regard to the low rate of diagnosis and treatment of depression in men is that we have been brainwashed out of seeing depression as a disorder of men. Every drug ad that comes through my office has a woman prominently displayed on the material, and the commonly held and promoted wisdom is that women become depressed twice as often as men. We don’t diagnose what we don’t know or don’t suspect.
I cornered a drug rep and asked point blank about this preponderance of advertising about depression in women. Her response: “I guess that’s where the manufacturers feel the market share is.” That may be so, but we are not dealing with market share in our offices.
In all fairness, while I was in training, the ideal control patient was an attractive, intelligent young woman with a touch of depression, dependency and awe of her brilliant young male doctor. We certainly didn’t want angry, depressed men with a potential for acting out aggressively as our control case. In effect, we were institutionalizing our prejudice against the recognition of depression in men in our own psychiatric training.
After recalling the death by suicide of 16-year-old John, the son of my patient, I am glad to have intervened effectively in the case of a patient of mine, John, age 54. In the latter situation, realizing that he was suicidally depressed, I was determined not just to continue with antidepressants and a prayer. I called his wife and told her to get his sons, in their late twenties, to descend on him and take him to the hospital until he was on the mend.
Hospitalization worked. Stronger doses of antidepressants, mood stabilizers and some hard-hitting bedtime sedation turned him away from the sure path of suicide. Two years and at least two grandchildren later, his is a happy senior who did not leave the devastating legacy of his own self-inflicted death to his boys.
While my emphasis has been on recognition of depression in men and boys, it is important to keep in mind that, despite popular belief, there is a one third higher cancer rate in men than in women. Boys in school and men in the workplace and life place are having a tougher time than is known without the same sense of sympathy and support that is being extended to girls and women. Any perusal of services for women, across a broad spectrum of difficulties, nets a long list of resources while the same inquiry for services for men may come up with a zero.
The Committee on Men’s Issues of The Westchester Psychiatric Society is on a consciousness-raising mission about boys’ and men’s needs in both the medical and psychiatric realms. The Committee encourages participation of both male and female physicians and leaders from the community. Meetings regularly have general physicians, social workers, psychologists and school personnel who have seen the need first hand and are searching for ways to make a difference.
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The following is an article written by Edward M. Stephens, M.D., Chair, Committee on Men's Issues, The Psychiatric Society of Westchester (a district branch of The American Psychiatric Association [APA]) and President, NCFM, Greater New York Chapter (NCFM, GNY). The article, published in The Westchester Psychiatrist,, was also published in The Male Voice, e-newsletter of NCFM, GNY.