Review from: Choice July 2008
This is among the most compelling books on the topic of men and depression this reviewer has ever encountered. Kantor uses his deep professional insights and vast experience to tease apart and explain the complexities involved in the diagnosis and treatment of men suffering from depression. The book covers such topics as guilt, paranoia, sexuality, violence, and passive dependency, and many of the chapters conclude with the differences in the way these difficulties play out in men and women....Clinicians will particularly appreciate a chapter on "therapeutic errors," which maps out many mistakes and misperceptions that are common in treating depressed men, e.g., urging the client to take a vacation or increase physical activity. Chapters on self-help and coping with depressed men are also excellent. Readers should profit from Kantor's expansive understanding of this complex topic. Highly recommended. Graduate students through professionals.
Here is the Preface from my book on Depression in Men. A while ago, I did a book on the human dimension of depression. This newest book incorporates some of that material, and adds a whole lot more. It is a crossover book, for therapists, depressed men, and those who are in their orbit and the target of depressive fallout.
The topic of depression in men is so extensive that one book on the disorder can only hope to have limited goals and deal with selected highlights. My goal for this book is therefore a specific and modest one: to focus on the human dimension of depression as it appears in men in order to give the reader an underlying sense of what it feels like to be a man who is depressed, and so an intimation of how to help him get over a current depression and avoid experiencing another one in the future. I certainly hope that my book will give the depressed man himself some ideas on how to get his depression to lift so that he can crawl out from under his burden and find relief from his suffering. My method has been to focus on the personal details that some texts in their emphasis on research and formal theory omit. I therefore emphasize the microscopic doings of the depressed man’s inner and outer life, going beyond such generalities as “depression is both an interpersonal and an auto-aggressive disorder” to describe exactly what happens when men develop the red hot blues—precisely how they beat themselves up, often over little or nothing, and find (and keep) others to help them do just that. My belief is that if I retrace the details of the often baby steps a man takes to get into his depression I can help him take a giant step forward out of it—off the path of danger, and onto higher, safer, ground.
I have not avoided unveiling some of the darker sides of depression in men, aspects of the disorder that the more politically sensitive clinicians generally do not even mention. The navel of the underbelly of depression is often painful for all concerned to contemplate. Depressed men who complain that people abandon them have often in fact driven these people away. Some are too self-preoccupied to be accepted by and acceptable to others, and some are mean and angry guys who even delight in torturing other people the same way they seem to delight in torturing themselves. For such depressed men unfavorable character traits are more than just byproducts of their depression. They are some of its prime movers. I cannot just ignore these, even if it seems that by including them I appear to be criticizing men who are not bad but ill. It is true that depressed men are stigmatized to the point that they need favorable public relations. But it is even truer is that depressed men have an illness that needs not only a better press but also a more favorable therapeutic outcome.
My theoretical stance is an eclectic one, for I do not believe that one school of thought contains all the clinical wisdom and provides all the answers. Mine is a holistic approach to understanding and treating depression that does not prematurely discount anything that could in any way help its sufferers. I strive to intervene psychodynamically, cognitively, behaviorally and interpersonally, and to do so in a supportive interpersonal context, for in my experience all depressed men—no matter how much they deny it—are at bottom needy individuals—babies in a sense, who, longing to have their hands held, predictably respond negatively to purely psychodynamic and cognitive approaches if these are realized in a way that makes therapy into more of the same remote disdainful controlling critical interpersonal engagement (or lack thereof) that created their depression in the first place.
I advocate avoiding therapeutic approaches that I believe can and do make depression worse, and can even turn a “merely” serious into a fatal illness. I especially avoid those methods that if only in spirit resemble primal scream techniques, where keeping it all in is bad, and getting it all out is good. Such approaches may not adequately respect a man’s depression and how it is there for a purpose. For example, Terrance Real’s suggestion to “crack [the depressed man] open”1 implies a philosophy that is generally antithetical to mine, which has as its goal putting the depressed man together, so that he heals, and does so as naturally as possible. That he cannot do if I render him asunder, as his therapist constantly opening up old wounds, then pouring salt into them.
What follows is based more on my clinical experience than on pure research. This is in part because the pure research I have encountered is often too inconsistent to guide me reliably. For example, I have not been able to determine how to reconcile two opposing ideas frequently found in much of the literature: women are more, and women are less, sensitive than men.
The book to follow is in three parts. In Part I, on description, I discuss the general manifestations of depression as they occur in both sexes and attempt to contrast the clinical features of a man’s and a woman’s depression.
In Part II, on causation, I detail some of the important causes of depression in both men and women, with a focus on the factors that foment depression
in men.
In part III, on therapy, I describe some general remedies that apply to both men and women, and outline some specific remedies geared to treating depression in men. I also offer the man struggling with depression some ways to feel better using self-help approaches involving:
• Self-contemplating, e.g. “Why do I get so depressed, and what can I do about it?” in preparation for self-understanding based on working out psychodynamics within a self-affirmative context—accepting the need to self-criticize, but balancing that with the need to self-sooth.
• Coming to grips with past traumata that are difficult to shake.
• Reducing guilt, leading to a less punitive self-evaluation involving being a little kinder to oneself and giving oneself a vote of confidence—“chilling out” by accepting that “I am no more or less flawed than most everyone else.”
• Becoming less interpersonally hypersensitive, especially distinguishing negative fantasy from positive reality in order to ascertain others’ true attitudes and actual motives.
• Learning to become less irrationally angry and, after reducing anger to a minimum, smoothing over what anger remains and, when indicated, expressing it not in the form of tantrums but in a healthy, socially-acceptable, relationship-saving way.
• Correcting cognitive errors about oneself, one’s existence, and one’s plight.
In many cases, as I point out, relief from depression may not require a radical revision of a man’s inner and outer life. For so often when it comes to depression, and especially depression in men, a small amount of change can create a large amount of improvement.
I also advance some ideas on how family and friends in the depressed man’s orbit can help him feel less depressed while helping themselves cope with the often difficult and draining fallout from his disorder. So often friends, family and partners who are the targets, or “victims” of depressed men—people in the path of depression fallout—try to tolerate the man’s depression, telling themselves, “He is sick” and “He cannot help himself.” But that neither helps the depressed man’s targets do better nor heals the man himself, and the overpermissiveness may even make things worse for all concerned. Generally speaking, people who try to heal the depressed man intuitively, no matter how well-meaning and altruistic their intent, often find that the results they get from doing what comes naturally are unexpectedly and stunningly bad. Therefore one of my goals is to offer these “targets” or “victims” of a man’s depression fallout a framework for responding to depressed men in a productive fashion through understanding their depression scientifically. With this in mind I try to answer such questions as, “How exactly should you talk to a depressed man? Should you be sympathetic and hand-hold, or set limits instead? Do you give a depressed man advice or do you let him find his own way out of his quagmire, and if so, what kind of advice do you give him, and what kind of advice do you withhold?” My goal is to help a depressed man’s loved ones develop a considered, effective, precise and theoretically-based healing interaction with the depressed men in their lives—sparing the depressed man some of the pain, while also sparing themselves some of
the burden. |
LIFTING THE WEIGHT: UNDERSTANDING DEPRESSION IN MEN, ITS CAUSES
AND SOLUTIONS
Buy Book from Amazon.com |
