Men, Depression, and Sexual Addiction
It’s Pat!
When Pat’s alarm clock goes off in the morning, Pat wants to either scream or cry. Pat hits the snooze button repeatedly, only getting up when Pat is going to be late for work (again!). When Pat finally does get to work, Pat can barely function. At home, Pat is completely disconnected from Pat’s spouse and kids. Pat is short-tempered and quick to anger. Pat suffers from headaches and body aches but Pat’s doctor can’t find anything that’s medically wrong. Pat has lost interest in everything that Pat used to enjoy.
The only relief Pat finds from this ongoing misery is when Pat searches for (and sometimes engages in) extramarital sex via dating sites, social media sites, and the Ashley Madison app. (Ashley Madison’s motto is “Life is short. Have an affair.”) This sexualized behavior pattern lasts many hours each night. After two years of this, Pat’s spouse threatens to leave unless Pat makes some changes. Reluctantly, Pat agrees to see a therapist.
Therapeutically Speaking, Does Pat’s Gender Matter?
Does it matter in therapy if Pat is a man or woman? Surprisingly, it does. If Pat is a woman she will likely be diagnosed with and treated for depression. If her sexual/romantic behaviors persist, she may also be diagnosed with and treated for love addiction. (A sex/love addiction specialist would almost certainly identify Pat’s pursuit of extramarital activity as a means of self-soothing the emotional pain of her depression.)
Conversely, if Pat is a man he will likely be diagnosed with and treated for anger management issues (related to his ongoing irritability) and perhaps sexual addiction. (Again, a sex/love addiction specialist would probably recognize Pat’s pursuit of extramarital sex as a means of self-soothing.) So why does female Pat appear to her therapist to be sad and frightened (depressed) when male Pat appears to his therapist as mean and callous (angry)?
Depression and the Gender Gap
The simple truth is that most mental health clinicians are taught to assess adult depressive symptoms through a female-centric lens. This means that depression is typically viewed (by both the general public and the therapeutic community) as a “female disease.” As such, men who demonstrate adult depressive symptoms are often perceived not as depressed, but as weak, lazy, undisciplined, inadequate, and vulnerable. So instead of recognizing and treating depression in men, we ask them to “cowboy up” in anger management, 12-step meetings, and other venues that only indirectly address their underlying depression. In short, we expect men to just “get over it,” whatever “it” might be.
When similar symptoms show up in women, those symptoms are much more readily interpreted and accepted as emotional challenges rather than character flaws (weakness, laziness, etc.). The prevailing view seems to be that when women feel sad, it’s OK, because they’re women, but when men feel sad they should tough it out on their own. Men are taught from birth onward that they should figure things out for themselves rather than ever asking for help. In other words, we seem to think that if men are going to address their depression they should do it by themselves and in “manly” ways that involve hitting people, drinking a lot, having extramarital affairs (as Pat does), and/or other similar behaviors. Is it any wonder that so many men self-soothe their depression through substance abuse, rage, sex addiction, and the like?
The Incidence of Depression in Men
The common misperception of depression as a female disease does not mean that men don’t suffer from depression as often as women. It merely means that current diagnostic criteria for depression skew toward symptoms that women are more likely than men to admit to and talk about in therapy (such as sadness and loneliness). One recent study that added typically male manifestations of depression (such as anger, substance abuse, and risk taking) to the current female-centric diagnostic criteria found that men and women suffer from depression in relatively equal numbers.
Nevertheless, the currently accepted official diagnostic criteria do skew toward women, meaning a large percentage of depressed men are misdiagnosed and shortchanged in treatment. And sadly, unrecognized and/or untreated depression in men can have devastating consequences. For starters, men are four times more likely than women to commit suicide. And of course many depressed men “treat” their depression by perpetrating abuse (emotional, physical, and/or sexual) on their spouses and kids. Still others “self-medicate” with alcohol, drugs, gambling, compulsive sex, compulsive risk-taking, and a wide variety of other escapist, addictive, and/or self-destructive activities.
Help Is Available
The good news is that there are a growing number of therapists and treatment facilities that recognize this link between male depression and addictive behaviors (including sexual addiction). These clinicians and rehab centers understand that 80 percent or more of people with depression, regardless of gender, can be treated successfully with psychotherapy, pharmaceuticals, or a combination thereof—but only if they are willing to seek professional assistance, which depressed men are often reluctant to do. These treatment providers are trained to recognize the ways in which male depression manifests, even when clients are reluctant to discuss it. Then, in addition to working with clients on their sexual addiction (and any other addictions they have), treatment can address the client’s underlying depression.