"I don't want to talk about it" by Terrence Real
By popular demand!
I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression, by Terrence Real. (Mr. Real, the back of the book tells me, was co-director of the Harvard University Gender Research Project and also worked for the Family Institute of Cambridge.) This is a Simon & Schuster book, aimed at a popular audience, but it’s more than 300 pages long and has some pretty extensive end notes citing the psychological literature.
Overt Depression, Covert Depression
The central idea in the book involves the distinction between overt depression and covert depression. Overt depression is the kind that’s easy to see: it’s dramatic and obvious. You cry a lot and you’re miserable and you have a hard time getting out of bed — the usual suspects. Covert depression is depression pretending to be something else.
If overt depression in men tends to be overlooked, covert depression has been rendered all but invisible. (page 41)
The idea is that depression is under-diagnosed in men — and not only because therapists tend not to look for it, but also because even very depressed men will often reject the diagnosis. Out of touch with their feelings and living in a culture that presumes depression is primarily a feminine issue, depressed men are not likely to realize that they are depressed, and if presented with the idea would likely laugh it off.
One of the ironies about men’s depression is that the very forces that help create it keeps us from seeing it. Men are not supposed to be vulnerable. Pain is something we are to rise above. He who has been brought down by it will most likely see himself as shameful, and so, too, may has family and friends…. Depression carries, to many, a double stain — the stigma of mental illness and also the stigma of “feminine” emotionality. (22)
Yes and yes and yes. Endorse.
Traditional gender socialization in our culture asks both boys and girls to “halve themselves.” Girls are allowed to maintain emotional expressiveness and cultivate connection. But they are systematically discouraged from fully developing and exercising their public, assertive selves…. Boys, by contrast, are greatly encouraged to develop their public, assertive selves, but they are systematically pushed away from the full exercise of emotional expressiveness and th eskills for making and appreciating deep connection. (23)
True.
Depressed women have obvious pain; depressed men often have “troubles.” It is frequently not they who are in conscious distress so much as the people who live with them. (31)
This really spoke to me. If you’re cut off from your emotions, they’re going to come out in your life in surprising ways. You may remain blissfully unaware of your own pain, but those around you are not so lucky.
Alcoholism, workaholism, marital problems, anger issues, whatever it might be: all of these can be masks behind which depression hides itself. Not only the depressed person but even an intelligent and sensitive therapist may believe that the problem is the marriage, or the work, or the alcohol, or whatever.
It is time to conceptualize depression in men as a wide-ranging spectrum, with many variations and differences…. The common denominator linking them all is violence. All of these [overtly and covertly depressed] men are violent toward themselves … or violent toward others…. And the origins of so much violence can be traced to the ordinary, everday violence our boys are immersed in as a central part of their socialization. (84-85)
I think the centrality of violence to men’s depression is the second most central thesis of the book. I’d never thought seriously about this link, but Mr. Real gives some pretty good evidence for it. Disturbing.
Trauma and its limits
Like many books on mental health aimed at popular audiences, I Don’t Want to Talk About It is structured around specific stories about particular people. These are real life stories that stem from the author’s history of treating men with depression. A note at the beginning of the book says that all the examples are composites of various stories, so that the people can remain anonymous. But the point of the stories is to illustrate the general ideas with real (or mostly real) examples.
The stories go something like this: “John Doe struggles with depression. This is what he was like when we met. Here are some stories he told about his childhood. Here are some things that happened in therapy. Here’s what he took from therapy, how learned to cope better and be a better person. Finally, here are some general lessons we can learn from all of this.”
A lot of these men have gone through some horrific shit! A father’s constant physical abuse. A mother who was literally unconscious from alcoholism all day every day, the son sitting alone by her side, nothing to do but watch over her and imagine he’s keeping her safe. Fellow students beating up “the fat kid” on the playground, every single day, while teachers watch and do nothing about it. A mother who chased her child around the house with a knife, saying she was going to kill him, and then put her hands over his nose and mouth so that he couldn’t breathe.
Some of the men are hurting from stuff that isn’t obviously the same Trauma with a Capital T. The author seems almost to want to apologize for bringing up the pain of these people. I wish he wouldn’t. Pain hurts, no matter the source: big or small, it all matters. (Some of the stuff he says “seems like no big deal” … seems like a huge deal to me. One guy’s parents were never physically affectionate with him, ever, after he was 6 or 7 years old. Yikes! Please don’t think you need to make excuses for why that guy didn’t grow up to be emotionally healthy!)
What has changed since the book came out?
I Don’t Want to Talk About It came out in 1997, which somehow is now 26 years ago — an entire generation. How much of what it says about gender roles remains true for the kids today? Not all of it, I hope! But probably more than one would prefer.
“My first therapist told me to reach out to people,” said Steven, a patient of mine in his thirties. [So he reached out and told his friends he suffered from depression.] “Boy, was I naive! Reach out and get crushed by someone. I think my friends would have stayed closer to me if I’d said I had AIDS. My brother decided he was too busy to talk to me for the next seven months.” (38)
That’s changed, right? Most of us can be at least mostly OK with the idea of men being depressed?
We begin sending boys the message that they have fewer emotional needs than girtls in the very first moments of life. One research team studied parents’ responses to newborns in the first twenty-four hours after delivery…. [The babies were more or less physically identical, but] mothers and fathers perceived newborn sons as “more alert, stronger, larger features, more coordinated, and firmer.” They saw baby daughters as “less attentive, weaker, finer featured, less coordinated, softer, smallre, more fragile and prettier.” In a classic study in the field of gender research, John and Sandra Cundry videotaped the reactions of a nine-month-old infant to various stimuli: a teddy bear, a jack in the box, a buzzer, and a doll. They played the ten-minute tape for 204 male and female adults who were asked to interpret what they had seen. Some were told the baby was male, others were told it was female. The adult subjects saw the crying “girl” baby as frightened, but when they thought they were watching a boy they described “him” as angry. (121-122)
Would that study result still reproduce? Or has our society learned enough about gender nonconformity, so that we could do at least a little bit better?
From the same chapter:
Janie and her son sit at the dining room table. Janie’s husband, Robert, who is fatigued and somewhat depressed, joins them after a long day at the office…. Janie wants to talk to Robert and the boys about their days and hers. Robert wants to “relax,” that is, to be left alone. After a few abortive efforts, Janie gives up and … compensates for his lack of interest with redoubled efforts toward the kids. The boys … pick up Dad’s cue and freeze out their mothers with monosyllabic responses. Janie … eventually, amiably withdraws. The putters about the kitchen and cleans up while Robert listens to the news and the boys go off to sports or video games or hoousework…. What have Janie’s sons learned about what it means to be a man?
They have learned not to expect their father to attend to them or to be expressive about much of anything. They have come to expect him to be psychologically unavailable. They have also learned that he is not accountable in his emotional absence, that Mother does not have the power either to engage him or to confroont him…. (133-134)
I think, and hope, that this specific gender dynamic is less normal than it used to be. Doesn’t mean things are great! But they’re maybe better.
In general, I hope that the violence that I grew up with, and found normal, is less common these days. That would bode well for the kids who are growing up today. But men my age still need to cope with the traumatic violence that informed our early lives.
It seems weird to call the stuff I grew up with “traumatic violence.” And yet it’s much weirder that we could possibly have thought, at the time, that all that violence was normal!
A few things in the book really resonate with themes that I write about
(Example 1)
While depression may carry some sense of stigma for all people, the disapprobation … is particularly acute for men. The very definition of manhood lies in “standing up” to discomfort and pain. It is sadly predictable that David [one of the case study people] would be more likely to react to depression by redoubling his efforts at work than by sitting still long enough to feel his own feelings. (35)
Feel your feelings, people!! Even in 1997 they knew this shit. (Much more on this later….)
(Example 2)
I call depression … an auto-aggressive disease. Like those rare conditions which cause a person’s own immune system to assault itself, depression is a dosorder wherein the self attacks the self. …
[Quoting Freud]: “The patient represents his ego to us as worthless, incapable of any achievement and morally despicable; he reproaches himself, vilifies himself and expects to be cast out and punished. He abases himself before everyone and commiserates with his own relatives for being connected with anyone so unworthy.” (54)
Or as I like to put it: unhappiness is a loop. One of the loops in depression is that you are unhappy and so you revile yourself for being unhappy: you attack yourself for your own failure, and thus unhappiness builds on itself.
Other looping patterns that are super common in mental illness: I’m sad that I’m sad all the time. I get angry at myself for losing my temper. I am afraid that I will never stop being afraid.
In general, I really like the comparison to an auto-immune disease.
Another example of a loop, from much later in the book:
When a man relies on the defenses employed in covert depression, he places himself in the hazardous position of trying to ameliorate the pain of alienation in ways that leave him more alienated than he was at the start. For some, the overt defenses take on a life of their own, intensifying in a downward spiral.
The good news is that the loops also work in reverse. If you can cure the first unhappiness, you can also cure the second unhappiness (because it resulted from the first unhappiness). Then the downward spiral of pain can turn around and become an upward spiral of hope and renewed life.
(Example 3)
This experience of depression is not about feeling bad so much as losing the capacity to feel at all. (55)
This reminded me of the cartoon by Allie Brosh: the inability to feel anything as a hallmark of (some types of) depression. Feel your feelings, whatever they are! If it seems like there are no feelings to feel … well, keep looking! The feelings are there. They’re just hiding, because you told yourself you didn’t want to feel them. You tried to banish your feelings, and your body is now saying “OK, they’re banished! See, no feelings!” But it’s lying.
I do want to question the fundamental thesis of the book!
Again, the book’s thesis is that overt depression in mean can be masked by covert depression.
As I’ve written before, it’s my belief that mental health professionals don’t actually know what mental illness is. It’s not just that theories of mental illness are just theories. It’s worse than that. They don’t even qualify as theories of the nature of the illness.
Mental health professionals can give you a list of the symptoms of depression, but they don’t have a theory as to the nature of depression. Given that, I find it difficult to know how to respond to the claim that what these men have should be called “covert depression”— in other words, that it’s the same sort of thing as ordinary (“overt”) depression.
Let’s back up a bit. In the DSM-5, “depression” isn’t a single disorder. Rather, there’s an entire class of things called “depressive disorders.” Here’s the text of the DSM as it introduces the depressive disorders:
Depressive disorders include disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode), persistent depressive disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder. The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by related changes that significantly affect the individual’s capacity to function (e.g., somatic and cognitive changes in major depressive disorder and persistent depressive disorder). What differs among them are issues of duration, timing, or presumed etiology.
As usual with the DSM, the definition of the illness is its symptoms. By definition, if you don’t have a sad, empty, or irritable mood, then you’re not depressed.
But most of the men in this book, for most of their lives, don’t manifest that mood! So calling them depressed is technically incorrect! But as the author shows, these men are definitely depressed, by any sane definition. Which means that the DSM definition is not sane.
Maybe it will help to give a specific example.
Chapter 3, “The Hollow Men,” is about addiction, and it includes the story of Damien. (Damien’s story starts on page 70.) Damien, in brief, is a middle-aged sex addict. He’s moderate about it: he’s not out cheating on his wife every week. But he always pressures his wife for sex — and because he’s a controlling and slightly scary person, he gets it. He’s controlling about other things too, but the problem that brings him into therapy is the sex addiction: as our story starts, his wife is on the brink of filing for divorce. Damien, the author tells us,
used sex to soothe himself and, in essence, to medicate bad feelings. Damien said he wasn’t aware of having many bad feelings. I promised him that if he stayed with me long enough, he would be.
The crisis hit about two and a half months into therapy. Damien had been doing splendidly. It was as if he had woken up from a dream. Across the board, he actively tempered his controlling behavior. As his subtle bullying decreased, his receptivity increased, and he found himself, as he put it, “adoring Diane less and loving her more.” … In this atmosphere, Damien was taken by surprise when the anxiety attacks started. They were soon followed by sleeplessness, moodiness, and intense irritability.
“What the hell is all this?” he asked me.
“Withdrawal,” I answered.
Damien was scared. He began to fall apart. I saw him alone to lend support. We considered medication, which he preferred not to take. At the worst point, we even considered a brief hospitalization. Damien sank so deeply into depression that he needed Diane’s help to get up and dress in the morning, even to shave himself. A preoccupation with suicide emerged and grew alarmingly strong.
The rest of the story of Damien is it turned out that he had suffered from serious childhood trauma, including repeated sexual abuse, and all the way back in college had experienced seriously depression, and had even tried electroshock therapy way back in college. (Damien had forgotten/repressed all of this.) The author summarizes the situation this way:
Damien’s treatment illustrates the principle that the cure for covert depression is overt depression. First, the addictive defense must be confronted and stopped. Then, the hidden pain emerges. Underneath Damien’s addiction lay depression, and underneath his depression lay trauma.
So the author’s claim is that Damien was depressed, but the depression was buried in his subconscious (for very good reasons), to the point that he had no idea he was depressed, and in fact he had none of the typical symptoms of depression.
Now, all of that seems like a very reasonable diagnosis to me! But by the standards of the DSM-5, until he got therapy, Damien wasn’t depressed! He didn’t have the mood disorder, so by definition he didn’t suffer from depression. By the definitions of the DSM, therapy solved one of Damien’s mental health problems (addiction), and created a different one (depression).
And that’s stupid, right? It’s much more logical to hypothesize that his addiction existed to cover up the symptoms of his depression: that the depression was the real or deep problem all along. But the DSM, precisely because it categorizes mental illness based on symptoms, does not allow us to recognize the actual situation.
What this book is saying is that it is misleading to diagnose mental illness based on symptoms. As the example of Damien shows, sometimes the symptoms that you experience do not reflect your deepest problems. Sometimes your deep problems are buried in your unconscious mind, and unearthing your actual problems will change your symptoms. It’s as if there are true psychological symptoms, and false ones, and we need to be a little bit in touch with ourselves to even manifest the symptoms that truly reflect our problems.
I think that the really important thesis of this book — though unacknowledged — is that the DSM is simply wrong. Men like Damien are, in fact, depressed — despite not having the symptoms of depressive mood disorder. If these men could get in touch with their feelings, they would realize that they are depressed! But they’re not in touch with their feelings, and so what they manifest instead is the symptoms of alcoholism, workaholism, anger issues, etc.
It makes one wonder: has psychology somehow forgotten about Freud and the unconscious? Obviously that’s too strong a conclusion. But it’s not entirely wrong! Freud was interested in the deep realities of the self — he thought of symptoms as merely clues to the underlying disorder, and the underlying disorder was the important thing. How has psychology come to disregard the quest to understand deep realities, and to be content with defining mental health disorders based on symptoms? Very strange!
Now, obviously some psychologists are smarter than this. And thank goodness. Here’s an example of a psychologist who understands that the symptoms of depression and anxiety are just symptoms, not the underlying disease. (His theory of what the underlying disease is, is different from mine, which is fine.) But I still find the situation bizarre.
Feel your f**king feelings!!!
The most important point, for me, is that this book confirms that Kent is correct about everything. (A slight overstatement, but only slight.)
Time and time again, the book tells stories about men who are struggling with their mental health issues in a clinical context. And time and time again, the men attain a level of self-awareness that was not there previously. There is an “Aha!” moment, or series of moments: a process by which the men truly begin the path of healing.
How does the book describe these moments? Every single time, the moments of healing occur when the men are able to feel a feeling that they had been repressing. (I would give examples of this, but I would have to quote most of the book.)
Pretty much all of the patient stories in I Don’t Want to Talk About It go more or less like this: The man comes to the therapist’s office. Often he doesn’t want to be there in the first place, but sometimes he’s a willing participant. He’s often not really sure why he’s there in the first place: he thinks that the way he’s living is perfectly ordinary, perhaps the only or the best way to live. But his life isn’t going well, his relationships are in bad shape, he’s having a hard time sleeping, whatever it might be. Also, he suffering from one or more physical ailments, which he dismisses as unimportant. Then the therapy starts. At first, the man won’t open up about anything important. He’s defensive about his life and his choices. He may get angry at the therapist, or at the others in his life, for suggesting that there is anything wrong. He is often intelligent and knows how to use his words to fend off serious inquiry. As long as he can remain in his rational, defensive self, he does so. But eventually, after months or years of work, he gets to the point where he trusts the therapist — or is just desperate for whatever reason. At that point, he is willing to drop his defenses, go into himself, and (drum roll) … feel his feelings. And at that point — precisely at the moment of feeling his feelings — he has a breakthrough. Memories come back of childhood traumas. He works through the traumas, literally feeling them again as if they were happening to him. And then … he’s better! Not perfect, but better. Later, it turns out that both the man’s physical ailments and his defensive behaviors were reflections of the traumas that he had experienced in his youth.
And … that’s the pattern. Over and over again. And this is not unusual to this book. A very similar pattern occurs in most popular psychology books — at least the ones that I’ve read.
What I would argue, of course, is that the emotional healing takes place, not because the psychological theories of the author are correct, but simply because the patients feel their feelings. Feeling their feelings is the breakthrough. But of course Mr. Real — like most authors of this type of book — wants to promulgate his theories as to the nature of the underlying condition that affects these men. And, as usual, his theories do not get down to the marrow of the question.
Let me go back and quote the author’s conclusions about Damien again (and these conclusions are repeated, in various ways, throughout the book):
Damien’s treatment illustrates the principle that the cure for covert depression is overt depression…. Underneath Damien’s addiction lay depression, and underneath his depression lay trauma.
Author’s question: What is the cause of Damien’s problems (and the problems of his other patients)?
Author’s answer: Damien has undiagnosed covert depression. Dig below the covert depression, and you will find overt depression. Dig deeper still, and you will find traumatic experiences.
Kent’s questions for the author:
What, exactly, is overt depression? Not: what are its symptoms. What is the underlying reality?
What, exactly, is traumatic about a traumatic experience? Not: what are the symptoms of such an experience. What is the underlying reality? What makes an experience traumatic?
As we know, the DSM does not have, nor even try to have, an answer for either of these questions. Neither, of course, does Mr. Real. And in a sense, that’s fine. Mr. Real “knows it when he sees it” — as, I think, most of us do: we can tell when someone has been traumatized, and when they’re depressed. But we don’t really understand what it is that makes trauma trauma, nor what it is that makes depression depression.
Here’s my answer as to the nature of depression, in the briefest possible form. Depression is a disorder of the sensations. (The same is true for anxiety, OCD, PTSD, and many more.)
Here’s my briefest possible answer as to the nature of trauma. Trauma is any experience that we very, very strongly prefer not to experience … that we fight against, with every fiber of our being, even as we are experiencing it.
(A very slightly longer, but still much too brief, summary of my ideas can be found here.)
Why do these men’s mental health problems start to be solved precisely in the moment that they are able to feel their feelings? The answer is because not being able to feeling their feelings is the heart of their mental health problems.
This is why I think it’s a terrible idea to call mental health “mental.” If the problem were in the mind, then these men would start to heal their problems when they were able to come to an intellectual agreement with the therapist as to the nature of their problems. But that’s not how it works, is it?
It’s also consistent with another thing I keep harping on, which is that the nature of human happiness is shared with other animals. Other animals lack our ability to think, but they share our ability to feel. Happiness and unhappiness, mental health and mental illness, have to be located precisely in our sensations, the things we share with other animals. If anxiety were mental, dogs and cats and mice wouldn’t be able to suffer from them. But they can and do.
Psychology and the good life
I have said before that there is no real difference between psychological healing and spiritual growth. I also think that there is a very thin line, and perhaps no line at all, between psychological theory and moral theory. Every psychological theory implies a set of claims about what sort of life it is healthy (or sane or wise or otherwise appropriate) for a human being to pursue. Psychologists tell themselves (and us) that they are scientists. But psychology is not value neutral.
The values in I Don’t Want to Talk About It are not hidden. Most fundamentally, Mr. Real thinks that violence is bad, and that inculcating people into a lifestyle in which violence is taken as a normal part of life is also bad. He thinks that most boys, perhaps all boys, suffer tremendously because and to the extent that violence is normalized in our society. Not only because it is bad to suffer violence at the hands of others, but also because it is bad to become the sort of person who sees violence as a normal tool that is available for their use. I find it hard to disagree with any of that!
As a therapist, Mr. Real believes that the badness of these bad things translates into psychological damage to the selfhood of the boys and men affected. If he were a moralist, he could make the same case — and would find himself well within the mainstream of contemporary moral theory! Maybe that’s why I appreciate the book as much as I do.
But I Don’t Want to Talk About It kind of goes off the rails at the end. Mr. Real isn’t content to have helped some men figure out some things about themselves. He needs to tell us his deep theories about the sorts of lives that all of us need to live. From the Conclusion:
When a depressed man steps up to the task of practicing full relational responsibility, he not only transforms the dynamics of his disorder, he also shifts to a mature stage in his own development…. At the heart of the quest is a question…. The essential shift in question that marks a depressed man’s transformation is the shift from What will I get? to What can I offer? ….
The greatest cost of the … dynamic of traditional masculinity lies in its depreviation of the experience of communion. Those who fear subjugation have limited repertoires of service. But service is the appropriate central organizing force of mature manhood….
What the ethic of man-the-breadwinner has ignored is the wisdom of relationship….
Man-the-breadwinner, woman-the-caretaker may be figures contained within the borders of the twentieth century. it is becoming increasingly apparent that the old paradigm of worth through dominance, of valor, is atavistic. It no longer fits our complex, interdependent world.
And so on, and so on. He goes on to insist that this is all connected with the environmental crisis, even quoting Al Gore’s book Earth in the Balance. There’s a whole plethora of moral / political / psychological nuggets of wisdom packed into the conclusion — all of which Mr. Real appears to have plucked straight out of his butthole. Not that there’s anything wrong with any of his ideas, per se. Just, you know, any other set of vaguely moralistic bromides could have been inserted in the final chapter and it wouldn’t make any difference.
Masculinity
I don’t want to end on that negative note. Because there’s a lot of good stuff here.
Before he gets to his rather pedestrian conclusions, for instance, Mr. Real has a lot of smart things to say about masculinity. Here’s a nice example.
Little boys and little girls start off with similar psychological profiles. They are equally emotional, expressive, and dependent, equally desirous of physical affection. At the youngest ages, both boys and girls are more like a stereotypical girl. If any differences exist, little boys are, in fact, slightly more sensitive and expressive than little girls. They cry more easily, seem more easily frustrated, appear more upset when a caregiver leaves the room. Until the age of four or five, both boys and girls rest comfortably in what one researcher has called “the expressive-affiliative mode.” Studies indicate athat girls are prermitted to remain in that mode while boys are subtly — or forcibly — pushed out of it.
Australian sociologist Bob Connell argues that bland-sounding sociological terms like “gender role acquisition” do not convey the emotional experience of those whoa re the ones being pushed…. The conventional view of socialization portrays boys as only too willing to “learn” the male role. All the emphasis has been on those unfortunate few who lacked fathers or other “male role models” to mimic. No one thought to question the assumption that boys’ squeeze into manhood was anything but eager…. [But] not all boys march off so willingnly into manhood…. [T]he rituals by which boys are taught to conform are often unpleasant…. No man I have treated has fully eluded the taste of the lash one receives if one dares not accept masculinity’s “invitation.” (123-124)
That’s some good shit! Disturbingly consistent with my own experiences.
Here’s one more:
Boys do not internalize either masculinity or femininity. Instead, what many of our sons internalize is a pattern in which women and womanish things — including half of the boy’s own being — are held as inferior. Recovery comes when a man learns to embrace, remember, and cherish his own full humanity. This is neither an easy nor a very popular task. Society rewards self-objectification in men. It gives men privilege. It reinforces their superiority. And it shows little mercy for men if they fail in the performance of their role. But the price of that performance is an inward sickness….
Any substantive healing must address that inward sickness. (226)
It sucks to be a man who was raised with typical masculine values. Not only for the women who have to live with us, but also for us, as we have to live with ourselves.
OK, that’s what I got. Thanks for reading. And thanks for the invitation to read this book, Brian!
_The most important point, for me, is that this book confirms that Kent is correct about everything._
Precisely! 🙂
In earnest, I thought this repeatedly while reading this book. I am primed to notice “feeling one’s feelings” from Beddhism and I was amused to find that the resolution to anecdote after anecdote came down to this.
I also resonate with the author’s point that men often simply cannot recognize the feeling they are experiencing, or that they’re having a feeling at all.