Introduction
I write an article series called “One Man, One Mountain: A Man’s Struggle with Depression.” It’s about my personal journey with depression and what it’s like to be a man in America dealing with this condition. The main reason I wanted to write this series is because we do a horrible job as a culture treating men for depression. Our medical institutions don’t do a good job either. This leads to a lot of unnecessary suffering.
There’s a lot of stigma that goes with being a man who’s depressed. I experienced a lot of suffering in my life because I wasn’t aware of what depression was. When I first went to get help because of some encouragement from my wife, the healthcare system didn’t handle me properly. The healthcare system was an impediment or an obstacle to overcome when it should have been the opposite. We don’t talk about this enough.
I hope that other men can hear this, or women who have men in their lives who struggle with depression will hear this. Maybe it will make that journey to treatment easier. Maybe other men won’t have to suffer as long as I did.
I’ve been racking my brain about what to discuss next. In this article, I want to talk about why depression can sometimes be complicated to diagnose. Based on my own personal experience, I want to explain why my depression was difficult to diagnose, even though it was severe. I also want to discuss why it’s still sometimes a challenge for me to fully understand which behaviors and symptoms in my own life are a direct result of depression and which are a result of other things. I’ve mentioned before in previous articles that it’s not always easy to disentangle those things.
I deal with some other things that have happened to me that can complicate depression and make it worse. I want to talk about these factors because I think there will be other men who also have complicating circumstances, and those circumstances can make depression more difficult to diagnose and treat.
Here’s what I want you to understand: The same factors that made my depression hard to diagnose are the same factors that make it hard to treat. And even after you get diagnosed and start treatment, you’ll probably discover—like I did—that medication alone won’t fix everything. Because depression doesn’t happen in isolation. It’s tangled up with everything else in your life. Let me explain what I mean.
I’m going to talk about two things in this article. First, I’ll explain why my severe depression went undiagnosed for 15 years—the cultural blind spots and personal factors that kept me from getting help. Second, I’ll explain why even after 20 years of treatment, I still can’t always tell what’s depression and what’s all the other damage from my childhood, my autism, my poverty, and everything else. These two problems are connected, and if you’re a man struggling with depression, or if you love someone who is, you need to understand both of them.
How Severe Was My Depression?
If you haven’t read my other articles, let me tell you how severe my depression was. It was extremely severe. I was suicidal as a young teenager, severely depressed with extreme anti-social behavior. That self-destructive compulsion got progressively worse until it peaked in my late teens. Then finally, I got married in my early 20s. After a few years, my wife recognized that there was something wrong, that I had depression, and she encouraged me to get treatment.
My depression was severe, and despite that severity, I probably went 10 or 15 years with pretty severe suicidal depression before I finally got treatment. If you’ve read my other articles, you know that when I initially reached out to get help, things did not go smoothly. I was persistent in my desire to get treatment despite the healthcare system, not because of it.
The point is, I had severe depression. You would think that would make it easier to diagnose and treat. But in my situation, even though I had severe depression, I still didn’t get treated for a long, long time.
Why Was My Depression Hard to Diagnose?
Reason One: I’m a Man
The first thing I had going against me is that I was a man. In America, I believe we struggle to recognize and property treat depression in men. When I say treat, I don’t want you to hear drugs. I think prescription drugs can be a part of that treatment, and for some people like me with severe depression, they can be an important part. But treatment should be more than just drugs.
I think if I’d have been a woman, I’d have been treated much sooner.
Reason Two: I Was Young
The second reason my depression was difficult to treat is because I was young. We don’t typically treat depression in young men. We say, “Oh, he’s just being a teenager. He’s hormonal. This is normal.” When I was young, people said, “He’s shy. He’s a workaholic. He’s just uncomfortable around young women because he’s been rejected. He’s just awkward, he’s a dork, he’s a nerd, he’s a bookworm.” People had all these reasons why my behavior wasn’t something that needed significant attention and treatment.
We do this to young men. I watch it happen. I see young men in my own life that don’t get treated for depression because people aren’t looking for depression in young men. It’s like a cultural blind spot we have.
Depression runs in my family, and I have nephews that I worry about. I’ve told my cousins and my brother that they have to watch their sons. That doesn’t mean every young man in my bloodline will have depression, but there’s a really high probability that they will at some point in their life deal with depression. It runs very strongly in our gene pool. I don’t want my nephews to go 15 years undiagnosed.
Now, let me just say, because I’m trying to be objective here, I do think some depression, some melancholy or feeling down, some of that is a normal part of being a teenager. It’s a normal part of being young. One of the things you have to learn as a young man is what it’s like to be rejected by young women that you are attracted to. That’s just part of being a young man that you got to learn to deal with. I mean, hopefully you deal with it in a healthy way.
I mention that specifically because for me, that had some very unpleasant experiences with young women in my late teens and early 20s that had a profound effect on me, and that depressed me. Now, I don’t know if that pattern is typical, but it’s one of the things that happened to me. But there were other things I was dealing with. Poverty. I was working two jobs and trying to put myself through college. So I was high stress. I was working a lot. I was exhausted. On top of that, I was dealing with rejection from young women, and rejection sometimes from my peers. Not just from young women my age, but also social rejection from young men my age. I was just trying to process all that and it was hard.
I think dealing with some of that could make a young man depressed, even though it might not be clinical depression per se, like something necessarily wrong with brain chemistry. So I don’t think if your teenage son’s having a rough patch, you got to rush him to the emergency room and put them on an antidepressant. But I think you should monitor. You got to be aware. If he’s on year two or year three of that melancholy, that might be a problem that demands some more serious attention potentially.
So to review, the first reason was I was a man. Second reason, I was a young man. Those are cultural blind spots in the diagnosis and treatment of depression.
Reason Three: I Was High Functioning
The third thing that made my depression difficult to diagnose and treat is I was high functioning. Functional to a compulsive degree. Working two jobs, going to college. Not doing drugs, not sleeping around, not vandalizing or painting graffiti, not driving drunk. I was a highly capable, highly functional young man. So people saw that and thought, “How could this kid be depressed?” I was a 3-day student, but pretty close. And I was a hard worker. I excelled at work.
Reason Four: I Lacked Awareness
I didn’t understand what depression was, or that I could get depression as a young man. I didn’t understand that my desire to kill myself and the pain that I felt when I was around other people was unnatural or unhealthy. I just didn’t understand that. I just thought it was a normal part of dealing with my messed up life. I don’t know why I was unaware at 19 or 17 or 20. Nobody ever told me.
I was aware that there were mental health issues in my family. My mom was one of the most mentally ill people I’d ever met. She had a compulsive shoplifting disorder. So I was aware of mental health issues, but I just didn’t know a lot about depression or understand that it could potentially impact me. I didn’t understand the pattern with depression that was present in my family and in my gene pool. There was just some lack of awareness on my part.
Now, you might be thinking: “Okay, but you eventually got diagnosed and treated. Problem solved, right?” That’s what I thought too. But here’s where it gets more complicated.
The Broken Safety Nets
When you put all four of those or five of those things together, it’s actually not surprising that I went 15 years without treatment. The other part of this was, I love my parents. I love my mom and dad. My mom and dad love me. When I was in my mid to late teens, I was still living at home. I moved out when I was 17, but from age 13 to 17, my household was highly dysfunctional. I mean, I don’t need to get into all the details of that, but extreme dysfunction.
I wasn’t in a household where normal, healthy, responsible parents could look at my behavior and identify, “Hey, something’s wrong with our son. Maybe we need to talk to a doctor or counselor or psychologist.” They just couldn’t. I don’t blame them for that. There’s part of me that wishes things would have been different, but I understand why they were where they were at at that point in life.
I just didn’t have the safety net. For other reasons, my parents had basically cut us off from all extended family, so we were in Northwest Montana. We had no contact with extended family. I dropped out of high school. I dropped out of school after second semester eighth grade, so there were no counselors, no teachers, no coaches, no aunts, no uncles that had any kind of ability to catch what was going on and get me help.
Essentially, my primary safety net, my parents, was fundamentally broken. And my secondary safety net, teachers, coaches, counselors, aunts, uncles, grandparents, that secondary safety net didn’t exist. It’s not surprising, I don’t think in hindsight, that I went 15 years with severe depression that didn’t get treated.
Even After Treatment Started
Even after I got treatment, treatment was difficult. The right treatment was difficult. A lot of that I had to figure out on my own. I didn’t ever really get a doctor or a therapist or a psychologist who helped me manage my depression. I read about it. I researched it, and I kind of put the pieces together like pieces of a jigsaw puzzle.
I hope that’s not the experience other people have, that other men have. I hope that you get a doctor or a psychologist or a therapist or a counselor that helps you put together a comprehensive program to treat your depression. If you have severe depression, I think you have to educate yourself. You have to increase your own awareness. You have to try some different things, and you got to build a program for yourself. I don’t think you want to depend on our American healthcare system to do that for you.
The Complexity of Disentangling Causes
Remember those four reasons my depression was hard to diagnose? Being a man, being young, being high-functioning, lacking awareness? Those same factors didn’t magically disappear once I got treatment. They just transformed into a different problem: figuring out what’s actually the depression and what’s all the other stuff that’s messed up my wiring.
So what are some things that made my depression hard to treat? Even at 45, I do a great job of managing my depression, but it’s still hard for me sometimes to disentangle things. When I feel overwhelmed or sad, or I feel self-destructive or hopeless or worthless, it’s still sometimes, even after 20 years of management, hard for me to disentangle. Is this depression? Do I need to exercise more? Do I need to get more sleep? Do I need to think about increasing my medication dose? Do I need to do other things? Or is this Factor X that isn’t depression?
What are the other factors in my life that make that complicated? Your life might be different, but I’m just sharing my experience here.
What are the other factors in my life that make that complicated? Your life might be different, but I’m just sharing my experience here.
Let me give you some specific examples of factors that complicate my depression:
Childhood Sexual Abuse
I was molested and tortured by an aunt from age three to six. That messed my wiring up. I’ve been doing some therapy the last year, and I’ve come to appreciate way more than I realized how much it messed my wiring up. It rewired my mind in ways I don’t fully understand, even yet. Even now, I don’t think there is one area of my life that was not influenced in some way by that trauma.
I tell people, my aunt’s bloody fingerprints are in every part of my mind. There is not a part of my mind that does not have her bloody fingerprints on it.
She hurt me. In an emotional and mental way, she hurt me. She physically tortured me too, but in a way that was almost like causing me to bleed, and then my blood, the blood of my childhood mind, got on her hands, and then she proceeded to grope every part of my mind with those bloody handprints. It’s horrible, but that’s what happened.
Over the last 40 years, the scars of that trauma, washing those bloody fingerprints off my mind, had nothing to do with depression. It just had to do with childhood trauma. And so that makes it difficult. I suspect if you’re a man who is depressed and also experienced childhood sexual abuse, this is going to also complicate your treatment.
Here’s another factor that took me 45 years to identify:
Discovering I’m Autistic
Through therapy, I’ve come to the conclusion that I’m likely autistic. High functioning autistic, but there’s a very high probability that I am probably autistic, and I’ve developed coping mechanisms and behaviors that mask that autism.
What does that mean? That means I think really different from neurotypical people. Why is that important? It means that increased my isolation. It increased my feeling of being different. It increased my sensation of not belonging. It made it more difficult to read social cues.
I think I’m much better at that now because I’ve had 20 years to practice, 25 years to practice. But I think one of the reasons I struggled with young women so much when I was in my teens is I had difficulty understanding when I was being manipulated or being taken advantage of. It took me a while to figure out when a young woman liked my attention in private but was embarrassed to be around me in public. I just misread normal friendliness as romantic attention sometimes because, as a person with autism, I didn’t fully understand yet how to process non-verbal cues.
Now, I don’t have an official diagnosis of autism yet. I’m still undiagnosed as autistic. This is something I just discovered about myself in the last few weeks through my therapy. I haven’t had time to fully process it yet, but I need to research about the interaction between autism and depression. I’m sure there’s research on that. I need to learn more about it. I think it’ll probably help me treat my depression.
How Autism Manifests in Crowds
As another example of why this might be really important and it makes things hard to disentangle sometimes, when I’m around crowds, concerts or anniversary parties or graduation parties or professional conferences or religious conventions, I suffer. I just don’t, I have a deep compulsion to flee crowds. I have a tendency to subconsciously view people as threats, potentially because of my abuse. And so I’m tracking the position of people in a room, and the more people there are in a room, the more exhausting that gets, the more difficult it is to track.
When I’m around crowds of people and I watch them interact socially, it makes me feel lonely. I’m much more aware that I process differently and that I’m not like other people, and that makes me feel lonely.
And that difficulty being around crowds causes pain in my throat and chest sometimes. A crazy compulsion to leave the party, get away from people. I rarely do that. I rarely flee the scene anymore. I’ve learned to control that compulsion. I exercise iron self-control and I manage to contain that desire to isolate, but that doesn’t mean I don’t feel it. I feel the desire to isolate. I know it’s not healthy, and I have to work very hard to control it.
You know, I used to think that was just my depression. Now I realize some of that might be that I’m autistic.
Other Factors That Shaped Me
I grew up in a dysfunctional family. There were other parts of growing up in a dysfunctional family that no doubt shaped my behaviors. My dad was absent. My mom suffered from extreme mental illness. I moved out of the house when I was 17 and lived in poverty and dealt with hunger. All of those things have shaped my behaviors. I know that now that I’ve been doing therapy.
What This Means Practically
From a practical standpoint, what does that mean? What that means is I can’t always disentangle or unwind the root cause of behavior that I know is not healthy or emotions that I know are not healthy. Could it be the depression? Yeah. Could it be dealing with the scars of childhood trauma? Yeah. Could it be the fact that I have insecurity because I went hungry when I was 17 and 18? Yeah, it could be that too. Could it be the way I react to women now is a result of some of the heartbreak I went through when I was an awkward teenager? Yeah, oh yeah.
Are those factors that result in my unhealthy behaviors mutually exclusive? No, they’re not. They’re intertwined. We don’t need to be a psychologist to know that.
When People Ask About Medication
This is where the complexity really shows up in my daily life.
Sometimes people who mean well, people who care about me, friends and family with good intentions, ask me questions like, “Are you taking your medication? Do you need to change your medication? Do you need to increase your dose?” I know they say this because they worry about me. They can sometimes see evidence of unhealthy behavior.
But they have no idea what I’m dealing with, or what I need to cope. They just don’t. They don’t have a frame of reference. Most of them have no frame of reference, and I know they don’t because they think if I just double the dose of my antidepressant, all this goes away.
Part of the reason I wanted to talk about it in this brain dump is because I want people to understand that’s not how this works. Childhood abuse, poverty, hunger, heartbreak at a young age, anti-social autistic behaviors. It’s a complex tapestry. I could fill a book with all the things that happened to me from age three to 20 that shaped the man I am now. Doubling my dose of Zoloft or Paxil is not going to make that go away.
I’ve got to try and manage it. I’ve got to eat healthy. I’ve got to exercise. I have to set reasonable boundaries with the people I love.
I get a little bit offended when people act like if I just took my pill, everything would be better. Because that’s a lie. And it’s a fallacy. And it’s a fantasy. I know they mean well, but when we tell people with my kind of depression that, we’re perpetuating a fantasy and setting them up for disappointment. If you have any kind of history like mine, Zoloft or Paxil or Prozac is not going to fix it.
I’m not saying it won’t help. For the right type of person, it could very well help. It could be essential. It could be life-saving. But it doesn’t get rid of all the other things that have happened in your life or are currently going on in your life that intertwine with your depression and potentially make your depression worse. You have to learn to recognize those other things and figure out how to manage them.
Still Learning at 45
Here I am, 45 years old, at the point where I’m supposed to have life completely figured out, and I don’t. I’m still learning. For God’s sakes, I’m 45 years old. It’s taken me 45 years to figure out that I’m probably on the autism spectrum. It shouldn’t have taken this long, but I’m trying to figure it out. I’m trying to manage it, trying to understand.
It’s not as simple as taking a pill every morning. I don’t know that I’ll ever be able to fully disentangle what parts of my unhealthy behaviors and emotions come from depression, what parts come from growing up in a dysfunctional family, what parts come from being a workaholic and dealing with the insecurity of hunger. I don’t know.
Not being able to completely disentangle those things or unwind those things doesn’t mean that I don’t want to learn about each one of those factors and understand them, because I think understanding them will help me.
The Takeaways
If you’re a young man and you’re high functioning, that doesn’t mean you don’t have depression.
Knowing you have depression and getting treatment does not mean that the other things in your life that have shaped your personality and your emotions are not important. They are important.
I still think you have to do the hard work of understanding how your past shapes your present and your future.