Hmmmm . . . . Faulty headline in my opinion. Depression is a rational response to a really messed up world. No one, male or female, gets depressed for no reason.

Psychologists: Masculinity Can Lead to Depression

27/09/2014

Masculinity has been found to play a significant role in causing depression among men, psychologists from the National Institute of Mental Health (NIMH) say. © Flickr/ Victor

MOSCOW, September 27 (RIA Novosti) – Masculinity has been found to play a significant role in causing depression among men, psychologists from the National Institute of Mental Health (NIMH) say.

About six million American men suffer from depression every year, yet few of them are likely to seek help from medical professionals. Traditional masculine traits, which confine emotional expression and encourage ideas of success, power and competition, often compel men to hide their emotions and avoid seeking help. This, in turn, can lead to depression, according to researchers from the NIMH.

Traditional signs of depression, such as sadness, worthlessness and excessive guilt, may not always characterize many men’s depressive periods. Instead, researchers have coined the term “male-based depression” to signify a type of depression which is reflected in symptoms including irritableness and anger, a loss of interest in work and hobbies, insomnia, and a higher likelihood of drug and alcohol abuse. When coupled with substance abuse, these symptoms can mask more commonly-recognized signs of depression, making them harder to detect and effectively treat, said Dr. Aaron Rochlen, a Psychologist from the University of Texas.

Untreated depression can result in personal, family and financial problems; in the worst cases it can even lead to suicide. Four times as many men as women commit suicide in the United States, which psychologists believe happens as a result of a higher prevalence of untreated depression among men.

Luckily, some men have started to re-interpret and expand traditional ideas about what it means to be a man. Instead of seeing the idea of seeking help as unmanly behavior, they have started to consider it proactive and responsible, breaking out of the masculine “straightjacket”, says Jason Spendelow, a Clinical Psychologist from the University of Surrey, as quoted by The Conversation. By re-framing the masculine narrative and getting support from others, men can effectively combat depression, especially when they experience severe symptoms, such as suicidal thoughts.

Spendelow believes that seeking professional help when depression persists for more than a few weeks is a good idea. Some men say more traditional “talking treatments” are not suited for them. Currently, however, there are a variety of therapeutic techniques that can be used to approach depression from different angles and are better suited to men. At the end of the day, psychologists say that it is important for men not to suffer in silence.

A.O. Scott on Robin Williams - "An Improvisational Genius, Forever Present in the Moment"

Via film critic, A.O. Scott for the New York Times.

It's sad to see another talented and tormented man succumb to depression and end his life in what appears to have been a suicide.

Below the NYT obituary, there is an article from The Moderate Voice that addresses Williams' issues with depression and addiction.

Robin Williams, an Improvisational Genius, Forever Present in the Moment

By A. O. SCOTT
AUG. 11, 2014


Robin Williams was an irrepressible performer, on stage and off. Credit Gary Settle

Some years ago, at a party at the Cannes Film Festival, I was leaning against a rail watching a fireworks display when I heard a familiar voice behind me. Or rather, at least a dozen voices, punctuating the offshore explosions with jokes, non sequiturs and off-the-wall pop-cultural, sexual and political references.

There was no need to turn around: The voices were not talking directly to me and they could not have belonged to anyone other than Robin Williams, who was extemporizing a monologue at least as pyrotechnically amazing as what was unfolding against the Mediterranean sky. I’m unable to recall the details now, but you can probably imagine the rapid-fire succession of accents and pitches — macho basso, squeaky girly, French, Spanish, African-American, human, animal and alien — entangling with curlicues of self-conscious commentary about the sheer ridiculousness of anyone trying to narrate explosions of colored gunpowder in real time.

Very few people would try to upstage fireworks, and probably only Robin Williams could have succeeded. I doubt anyone asked him for his play-by-play, an impromptu performance for a small, captive group, and I can’t say if it arose from inspiration or compulsion. Maybe there’s not really a difference. Whether or not anyone expected him to be, and maybe whether or not he entirely wanted to be, he was on.


Robin Williams | Credit: Jay Paul for The New York Times

Part of the shock of his death on Monday came from the fact that he had been on — ubiquitous, self-reinventing, insistently present — for so long. On Twitter, mourners dated themselves with memories of the first time they had noticed him. For some it was the movie Aladdin. For others Dead Poets Society or Mrs. Doubtfire. I go back even further, to the “Mork and Mindy” television show and an album called “Reality — What a Concept” that blew my eighth-grade mind.

Back then, it was clear that Mr. Williams was one of the most explosively, exhaustingly, prodigiously verbal comedians who ever lived. The only thing faster than his mouth was his mind, which was capable of breathtaking leaps of free-associative absurdity. Janet Maslin, reviewing his standup act in 1979, cataloged a tumble of riffs that ranged from an impression of Jacques Cousteau to “an evangelist at the Disco Temple of Comedy,” to Truman Capote Jr. at “the Kindergarten of the Stars” (whatever that was). “He acts out the Reader’s Digest condensed version of ‘Roots,’ ” Ms. Maslin wrote, “which lasts 15 seconds in its entirety. He improvises a Shakespearean-sounding epic about the Three Mile Island nuclear disaster, playing all the parts himself, including Einstein’s ghost.” (That, or something like it, was a role he would reprise more than 20 years later in Steven Spielberg’s “A.I.”)

Onstage, Mr. Williams’s speed allowed him to test audience responses and to edit and change direction on the fly. He simultaneously explained and acted out this process in Come Inside My Mind, a two-and-a-half-minute tour de force of manic meta — “I’m doing great! I’m improvising like crazy! No you’re not, you fool! You’re just doing pee-pee-ca-ca, no substance!” But if Mr. Williams was often self-aware, commenting on what he was doing as he was doing it, he was rarely arch or insincere. He could, as an actor, succumb to treacliness sometimes — maybe more than sometimes — but his essential persona as an entertainer combined neediness and generosity, intelligence and kindness, in ways that were charming and often unexpectedly moving as well.

In his periodic post-“Mork and Mindy” television appearances (on “The Larry Sanders Show” and more recently on Louie), he often played sly, sad or surprising versions of himself, the Robin Williams some of us had known and loved since childhood, which means an entertainer we sometimes took for granted or allowed ourselves to tire of. Many of his memorable big-screen performances were variations on that persona — madcap, motor-mouthed, shape-shifting jokers like the genie in “Aladdin,” the anti-authoritarian D.J. in “Good Morning Vietnam,” Parry in The Fisher King and even the redoubtable Mrs. Doubtfire herself.

That was a role within a role, of course, and Mr. Williams’s best serious movie characters — or maybe we should say the non-silly ones, since an element of playfulness was always there — had a similar doubleness. Watching him acting in earnest, you could not help but be aware of the exuberance, the mischief, that was being held in check, and you couldn’t help but wonder when, how or if it would burst out. That you knew what he was capable of made his feats of self-control all the more exciting. You sometimes felt that he was aware of this, and that he enjoyed the sheer improbability of appearing as the straight man, the heavy, the voice of reason.

He was very good at playing it cool or quiet or restrained as other actors in his movies — Nathan Lane in The Birdcage, Robert DeNiro in Awakenings, Matt Damon in Good Will Hunting — brought the heat, the noise or the wildness. He was an excellent and disciplined character actor, even as he was also an irrepressible, indelible character, a voice — or voices — that many of us have been hearing for as long as we can remember.


A version of this article appears in print on August 12, 2014, on page A14 of the New York edition with the headline: Improvisational Genius, Forever Present in the Moment. Order Reprints|Today's Paper|Subscribe

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From The Moderate Voice

Comedy, substance abuse and depression: reflecting on Robin Williams’ life and death

Posted By KATHY GILL, Technology Policy Analyst on Aug 11, 2014

I learned about Robin Williams, 63, the old-fashioned way. My husband walked in the house and announced, “The world is a sadder place today.”

“Mom and dad just heard on the TV. Robin Williams has died.”

A quick search of Twitter confirmed the sad news.

And then the double-whammy: suicide.

According to news reports, Williams had been “battling severe depression”. Last month he had checked himself back into rehab “to fine-tune and focus on his continued commitment” to sobriety.

In 2006, he talked publicly about substance abuse and treatment.

A Good Morning America interview hints at the darkness of his depression:

“It’s the same voice thought that … you’re standing at a precipice and you look down, there’s a voice and it’s a little quiet voice that goes, ‘Jump,’” Williams told Sawyer.

He continued:

“The same voice that goes, ‘Just one.’ … And the idea of just one for someone who has no tolerance for it, that’s not the possibility.”

He elaborated in a People magazine interview:

“Cocaine for me,” Williams told PEOPLE in 1988, “was a place to hide… It slowed me down… And I was so crazy back then – working all day, partying most of the night – I needed an excuse not to talk. I needed quiet times and I used coke to get them.”

Depression + Substance Abuse Too Often = Suicide

Clinically, the two — depression and substance abuse — increase the risk of suicide.

We don’t know if there are “genetic as well as social or environmental factors that predispose an individual to an increased risk for both disorders” — substance abuse and depression.

But we do know that one increases the risk of the other:

The analysis revealed that the presence of either disorder doubled the risks of the second disorder…Further evidence suggests that the most plausible causal association between AUD [alcohol use disorders] and MD [major depression] is one in which AUD increases the risk of MD, rather than vice versa

Dark comedy

Last year the Express (UK) explored the relationship between comedians and depression. The Mail (UK) followed up in January: Why comedians ARE a little bit mad: Funnymen’s personalities are similar to those with mental health conditions.

What does it mean, that a celebrity as gargantuan as Robin Williams could talk publicly about depression and substance abuse … and yet succumb to suicide?

That it is still a mark of bravery to talk about depression (your own)? Despite a long list of notable depressives?

How do we, as a culture, begin talking about mental illness and alcohol abuse with the goal of helping, coping, preventing (rather than blaming)?

We can hear/see commercials for Erectile Dysfunction, for pete’s sake. It’s past time we talked openly about depression.

Can we find a silver lining in Robin’s death?

PBS Nova - Mind of a Rampage Killer

This is an excellent documentary focused on some of the rampage killers (almost all teenagers) over the last decade or so. PBS assembles quite a group of psychologists and neuroscientists to help us understand (as best we can at this point) why and how they young men become killers.

Mind of a Rampage Killer

Can science help us understand why some people commit horrific acts of mass murder?

Aired February 20, 2013 on PBS

Program Description

What makes a person walk into a theater or a church or a classroom full of students and open fire? What combination of circumstances compels a human being to commit the most inhuman of crimes? Can science in any way help us understand these horrific events and provide any clues as to how to prevent them in the future? As the nation tries to understand the tragic events at Newtown, NOVA correspondent Miles O’Brien separates fact from fiction, investigating new theories that the most destructive rampage killers are driven most of all, not by the urge to kill, but the wish to die. Could suicide–and the desire to go out in a media-fueled blaze of glory–be the main motivation? How much can science tell us about the violent brain?  Most importantly, can we recognize dangerous minds in time—and stop the next Newtown?



Transcript (scroll down)

Participants

• Paul Appelbaum, Columbia University
• Joshua W. Buckholtz, Harvard University
• Cynthia Ebsen, Mendota Mental Health Institute
• Paul Frick, University of New Orleans
• John Keilp, Columbia University
• Liza Long, Mother of "Michael"
• Karlen Lyons-Ruth, Harvard Medical School
• Michael Meaney, McGill University
• Katherine Newman, Johns Hopkins University
• Miles O'Brien, NOVA Correspondent
• Steven Pinker, Harvard University
• Andrew Solomon, Author, Far from the Tree
• Moshe Szyf, McGill University
• Martin Teicher, Harvard Medical School
• Gregory Van Rybroek, Mendota Mental Health Institute
• Jeff Williams, Andy Williams' Father

Danny Baker - 13 Myths Surrounding Mental Illness (Good Men Project)

Danny Baker offers an important post on the myths of mental illness over at the Good Men Project. For a lot of us, especially readers of this blog, these are common sense and we know better - but there are a lot of people who hold these beliefs or variations of them, especially men (it's weak to ask for health, we should just get over it, and so on).

13 Myths Surrounding Mental Illness

December 13, 2013 by Danny Baker

From the belief that mental illness doesn’t exist to being able to just “get over it,” Danny Baker lists 13 myths surrounding mental illness that can hinder recovery.

—   In no particular order, here are 13 of the most widespread myths surrounding mental illness in the 21st century.

1. Mental illness doesn’t exist. Just because mental illnesses are invisible on the surface, it doesn’t mean that they aren’t real. We can’t see gravity, either – does that mean that that’s made up? Furthermore, through various brain image technology, it’s actually now possible to observe differences in the brain between people with certain mental illnesses and people without them.
2. Mental illness is rare. On the contrary, approximately 1 in 4 people suffer from a mental illness.
3. You don’t know anyone with a mental illness. Again, since mental illness affects 1 in 4, then unless you live by yourself on a raft in the middle of the ocean, then it’s almost certain that you do.
4. If you have a mental illness, then it means you’re crazy. No! If you have a mental illness, then all it means is that you have a mental illness – a condition that can be treated just like physical illnesses can.
5. Mental illnesses are lifelong and impossible to treat. I kind of gave the truth away in myth 4, but it’s worth emphasizing: treatments today are more refined than ever before, and as a result, most mental illnesses are able to be recovered from, or at the very least managed.
6. If someone has a mental illness, than they’re to blame for it. While I do believe that sufferers need to take responsibility for their illness and be proactive in trying to recover, it’s critical to note that absolutely anyone can fall victim to a mental illness. Mental illnesses tend to be caused by a combination of genetics, brain chemical imbalances, psychological trauma and environmental stresses; since so much of this is out of a person’s control, then blaming them for developing a mental illness is extremely unfair.
7. Only people who are weak ask for help. It’s really the complete opposite – it takes self-awareness to admit that you have a problem, and given the stigma surrounding mental illness, it takes a lot of courage to ask for support. And on a more fundamental level, seeking help is just the smart, logical thing to do. Just like physical illnesses, mental illnesses require treatment in order for the sufferer to recover – so if you want to get better and return to living a healthy life, then you have to get help. Otherwise your illness will always impair you.
8. People with a mental illness can “just get over it”. Again, mental illnesses are illnesses. You can’t “just get over them”, in the same way you just can’t get over a physical illness like cancer.
9. People with a mental illness are violent. This is nonsense perpetrated by the media and television shows. Numerous studies have shown this to be blatantly untrue. For example in the US, a nationwide study by NIMH showed that only 4% of violent crimes are committed by people with a diagnosed mental illness. Additionally, the study showed that people with a mental illness are 11 times more likely to be the victim of a violent crime than the general population.
10. People with a mental illness are incompetent. Because mental illnesses are treatable, then most sufferers who are getting help are able to work and live productive lives. In fact, it’s well known that depression rates are particularly high in the legal profession, which is proof that people with a mental illness can still be extremely high functioning. Furthermore, since mental illness affects 1 in 4 people, chances are that you work with one or multiple sufferers, even if you don’t know it.
11. Mental illnesses don’t affect teenagers – any problems they’re experiencing is just part of going through puberty. Granted that one’s adolescent years tend to be more of a roller coaster than most, but it’s ludicrous to assume that this is the root of all their problems and that it’s impossible for them to suffer from a mental illness. In fact, studies show that across Australia, the UK and the US, as many as 1 in 5 teens will experience depression before they reach adulthood – and that’s just one of a myriad of mental illnesses.
12. People with a mental illness – particular those suffering from depression – are attention seekers or drama queens. In fact, it’s usually the opposite, which is why the majority of sufferers hide their pain with a smile, and why their most common response to “how are you” is “I’m fine”.
13. I can’t do anything for someone with a mental illness. While it’s true that you can’t snap your fingers and make them recover, you can help immensely by being a good friend – by doing your best to understand them instead of judging them, by showing them respect, by listening to them when they need someone to talk to, and by putting your arm around them when they need your support.

What are some of the other mental illness myths you’ve heard? If you suffer from a mental illness, what are some you’ve heard that are specific to that particular illness?

Jed Diamond - Why Men Commit Suicide: The Three Warning Signs Most People Miss

This article by Dr. Jed Diamond was posted at the Good Men Project back in July - but it is an important topic that bears repeating and re-posting.

Why Men Commit Suicide: The Three Warning Signs Most People Miss

July 13, 2013 by Jed Diamond Ph.D

Jed Diamond, P.h.D, looks at suicide in men from both an individual and societal vantage point and gives ways to prevent it from happening.

_____

Recently I received a review copy of the book, Lonely at the Top: The High Cost of Men’s Success by Thomas Joiner, Ph.D. I was happy to offer a review. Dr. Joiner is one of the world’s leading experts on suicide and has published two previous books, Myths about Suicide (Harvard University Press 2010) and Why People Die by Suicide (Harvard University Press 2005).

Dr. Joiner and I share a professional interest in suicide prevention. Suicide is a major world-wide epidemic taking the lives of over 1,000,000 people a year, according to the World Health Organization. Estimates suggest that 10 to 20 times more individuals attempt suicide.

Self-harm now takes more lives than war, murder, and natural disasters combined.

Our personal lives have also been touched by suicide. My mid-life father tried to commit suicide when I was 5 years old. Although he lived, our lives were never the same. I grew up wondering what happened to my father and was terrified that the same thing would happen to me. My life-long interest in men’s health grew from my desire to help men, and the women and children who love them, to understand what causes men to give up on life and what we can do to keep them engaged.

Dr. Joiner’s father, also named Thomas, killed himself when Dr. Joiner was in his third year of graduate school. Although the senior Thomas was depressed, he didn’t seem like a suicide risk. As reported by Tony Dokoupil in a recent article, The Suicide Epidemic, “the 56-year old Joiner was gregarious, the kind of guy who was forever talking and laughing and bending people his way. He wasn’t a brittle person with bad genes and big problems. Thomas Joiner Sr. was a successful businessman, a former Marine, tough even by Southern standards.” As it turned out, these “manly” traits may have contributed to his demise.

Joiner remembers the day his father disappeared. “Dad had left an unmade bed in a spare room, and an empty spot where his van usually went. By nightfall he hadn’t been heard from, and the following morning my mother called me at school. The police had found the van. It was parked in an office lot about a mile from the house, the engine cold. Inside, in the back, the police found my father dead, covered in blood. He had been stabbed through the heart.”

The investigators found slash marks on his father’s wrists and a note on a yellow sticky pad by the driver’s seat. “Is this the answer?” it read, in his father’s shaky scrawl. They ruled it a suicide, death by “puncture wound,” an impossibly grisly way to go, which made it all the more difficult for Joiner to understand.

Suicide is a Primarily Male Problem

In his latest book, Lonely at the Top, Joiner asks, “which cause of death stands out as affecting men far more than women? Given their privileged financial and society status, perhaps it has something to do with the dark side of wealth and power such as the cardiac or stroke-related consequences of influential but stressful jobs, or a taste for expensive but unhealthy foods?”

“No,” he says, “It’s suicide.” Approximately 30,000 people commit suicide each year in the U.S. and 80% were men. Overall, males kill themselves at rates that are 4 times higher than females. But in certain age groups men are even more vulnerable. The suicide rate for those ages 20-24 is 5.4 times higher for males than for females of the same age.

In the older age groups suicide is even more a “male problem.” After retirement, the suicide rate skyrockets for men, but not for women. Between the ages of 65-74 the rate is 6.3 times higher for males. Between the ages of 75-84, the suicide rate is 7 times higher. And for those over 85, it is nearly 18 times higher for men than it is for women.

A New Understanding of Why People Die by Suicide

Joiner is 47 now, and a chaired professor at Florida State University, in Tallahassee. He’s made it his life’s work to understand why people kill themselves and what we can do to prevent them from taking their lives. He hopes to honor his father, by combating what killed him and by making his death a stepping stone to better treatment. “Because,” as he says, “no one should have to die alone in a mess in a hotel bathroom, in the back of a van, or on a park bench, thinking incorrectly that the world will be better off without them.”

Dr. Joiner has proposed a new theory of why people commit suicide which he believes is more accurate than previous formulations offered by writers like Edwin Schneidman, Ph.D. and Aaron Beck, MD. According to Schneidman’s model, the key motivator which drives people to suicide is psychological pain. In Beck’s understanding, the key motivator is the development of a pervasive sense of hopelessness. Dr. Joiner suggests that these are correct understandings but are also too vague to be useful for predictive purposes and not capable of offering a complete motivational picture.

Joiner proposes that there are three key motivational aspects which contribute to suicide. These are: 1) a sense of not belonging, of being alone, 2) a sense of not contributing, of being a burden 3) a capability for suicide, not being afraid to die. All three of these motivations or preconditions must be in place before someone will attempt suicide.

Although women, too, can take their own lives when they suffer at the intersection of “feeling alone, feeling a burden, and not being afraid to die,” this is clearly a more male phenomenon. Throughout our lives males take more risks and invite injury more often. We are taught that “winning isn’t everything, it’s the only thing” and “no pain, no gain.”

We often invest so much of our lives in our work, when we lose our jobs or retire we feel worthless, unable to contribute. It’s a short step to feeling we are a burden on those we love. We also put less effort into developing and maintaining friendships so we can come to feel more and more alone.

Preventing Suicide In Men

I’ve found that Joiner’s model, what he calls the Interpersonal Theory of Suicide, can be very helpful in understanding suicide risk in men. The three overlapping circles help alert us to the kinds of questions we might ask ourselves if we want to prevent suicide. Joiner and his colleagues have developed a questionnaire that addresses these issues. Here are a few of the items they assess:

Thwarted Belonginess:

• These days, I feel disconnected from other people.
• These days, I rarely interact with people who care about me.
• These days, I don’t feel I belong.
• These days, I often feel like an outsider in social gatherings.

Perceived Burdensomeness:

• These days the people in my life would be better off if I were gone.
• These days the people in my life would be happier without me.
• These days I think I have failed the people in my life.
• These days I feel like a burden on the people in my life.

Capacity for Suicide:

• Things that scare most people do not scare me.
• The sight of my own blood does not bother me.
• I can tolerate a lot more pain than most people.
• I am not at all afraid to die.

♦◊♦

Like most people, I’ve had thoughts of suicide at numerous times in my life, but the one time I felt at high risk of actually killing myself was when all three sectors overlapped. I was lucky that my wife was smart enough to remove the guy from the house until I saw a therapist and got into treatment for my depression and my suicide risk subsided.

Some people believe that if a person is going to kill themselves, there’s nothing one can do. If you try to stop them, they’ll just bide their time and do it later. However, we now know that suicidal intention is transient. If we can get support to get through those times when we feel disconnected, a burden to others, and having the means and mind-set to actually kill ourselves, we can begin to develop the social supports to turn things around.

I suspect the difference between James Joiner’s dad and my dad wasn’t their level of “thwarted belongingness” or “perceived burdensomeness” but my father’s lower capacity for suicide. Disrupt one of the risk circles and we buy ourselves more time to heal. Making a connection can be as simple as a smile. I read the report of a man who left a note as he walked across the Golden Gate Bridge. It said, “If one person smiles at me, I won’t kill myself.” The note was found after he had plunged to his death. We can all reach out, in our own way, and touch someone who may feel disconnected, disrespected, and useless.

We can also let in the love when we are feeling down. I remind myself, and my clients, to take heed of the lines from the Eagles song Desperado. “You better let somebody love you, you better let somebody love you, you better let somebody love you…before it’s too late.”

____

photo: jamesackerley / flickr

The Suicide Rate Among College Age Men Is Four Times Greater Than Among Females

 

Suicide is a decidedly "male" problem in a lot of ways. On the whole, more women than men attempt suicide, but more men than women complete suicide. The problem is most obvious in young men and older men.

In this post at his Psychology Today blog Boys to Men (The science of masculinity and manhood), professor Miles Groth, Ph.D., of Warner College (one of the architects of the Male Studies movement, and editor of New Male Studies), examines the situation surrounding suicide among college-aged men.

If this were reversed, and women were 4x more likely to suicide than men, there would be national campaigns to raise awareness, Oprah would do a special, and President Obama would appoint a committee of morons to look into the issue. But it's only our young men - no worries, if weren't this it would be combat or some other cause.


I suspect there are a lot of areas where Dr. Groth and I diverge in our values and perspectives - but this one topic where we are on the same page. Something must be done about this crisis in our young men.

Young Men Who Commit Suicide

The Suicide Rate Among College Age Men Is Four Times Greater Than Among Females

Published on August 29, 2013 by Miles Groth, Ph.D. in Boys to Men

This week, a popular, successful young man beginning his senior year at a small liberal arts college in the Northeast left campus during one of the first days of the new semester after talking cheerfully with friends and participating in activities for new students. The next morning he was found dead, far away from home and campus. Next to him, the police told reporters, they found a suicide note. It was a "first" for the college, but it is a well-known phenomenon around the country.

Suicides among young males are four times more common than among young female, and they are occurring among ever younger males, some in their early teens. Little is understood about what motivates boys and young men to take their lives in such numbers. Of as great concern is another fact: little effort has been made to understand the trend.

The topic is at the top of the agenda of items for consideration at university and college centers for men. It now becomes another reason for stressing the need for such places on campuses. Among other topics at such centers, which are growing in number, are the relationship between fathers and sons, in particular the impact on young males of not having had a father during boyhood. Other common topics are body image and relationships with women -- and, perhaps most to the point here, their perception of how they are seen as males in contemporary culture.

The psychology of male suicide is not at all well understood, but since late adolescence is a time of identity consolidation, it is thought that being unable to answer the question "Who am I, really?" is a critical feature among college age men who consider suicide. It is also known that young males are more impulsive than females and often act without giving the consequences of their acts much thought. This might include taking a drastic decision to leave this world.

In more than 40 years of college-level teaching, I have observed thousands of young men change remarkably, especially during the last two college years. Generally on a somewhat later timetable that female peers, many undergo significant transformations only during the junior and senior years. They change in appearance, revise their persona, and perhaps for the first time make even a preliminary decision about what they want to study -- and this with only a year remaining. Their female peers have done this much earlier. Some find that they need a fifth year to finally put their intellectual, emotional, and even pre-vocational or pre-professional house in order.

Many other young men have still not decided what they want to do by the time they graduate. They return home to live with their parents -- more than ever before. By contrast, most college women know what they want to do by commencement and head into further study, if they have decided to continue with their education, into a career, or into a serious relationship that might lead to parenting children.

Just what prompts a young man to end his young life at a time when his prospects might be expected to be brightest is baffling -- unless we consider that they are facing a world that may seem not to have a place for them. And they are keenly aware of this. And they are hurt by it. Perhaps just having gotten over the fact that they are not especially welcome on college campuses -- something I have discussed in an earlier contribution -- they now face another world, the real world, that also has little good to say about men. They have all read in popular weeklies or on the internet about "the end of men" or heard the question "Are men necessary?"

As I have reported here before, the numbers of males attending college is at an all time low (about 37% nationally) in proportion to their female peers. This trend has been of concern to admissions officers for twenty years. The reasons are not clear, but they include a sense of not being welcome. But what about a young man who is among that group who matriculated, has found a place for himself on a university campus in a major he enjoys, has been engaged in campus life, and has done well academically? We must suppose that another factor is at work when he leaves in all behind on a warm summer day.

Perhaps the most vexing issue is that colleges and universities have not responded seriously to the fact -- not a guess, not a hunch -- the fact that the rate of young male suicides is so much greater than that of females during the college years. Why this has not become a topic for study and simple human concern is troubling.

I am convinced that men's centers on college campuses by their very presence raise awareness of the challenges young men face -- not only at institutions of higher learning but in contemporary culture as a whole. As a footnote to the incident mentioned at the beginning of this contribution, on hearing about that young man's suicide, an anonymous donor made a gift of $800 to the center to support its work in trying to understand, among other matters, why so many young men are ending their lives.

Here I bring issues of importance to discussion and leave it to others to advocate for policy change. In this case, I raise a question I believe is worth investigating:

Why are so many more young men taking their lives -- even young men with the special advantage of being able to afford to attend university -- and at just that moment when they have finally negotiated some of life's most demanding puzzles: Who am I? What do I want to do? Surely, this question deserves eveyone's thoughtful consideration.

This is some seriously bad news for American men, 66% of whom are overweight or obese. One of the most debilitating side effects of obesity is that fats cells create estrogen - the more fat cells, and the bigger the fat cells, the more estrogen in the body. It gets worse, fat cells also support high levels of aromatase, an enzyme that converts testosterone to estrogen. More fat, less testosterone due to the aromatization of testosterone into estrogen .

High fat levels (through increases in estrogen due to aromatase conversion) reduce testosterone, which has its own downside: depression, loss of libido, muscle wasting, bone density loss, heart attacks and other cardiovascular issues, and higher risk of early death.

The evidence has been building for years that many neurodegenerative disorders, such as Alzheimer's Disease and other forms of dementia are linked to neuroinflammation (see this article). More recent evidence is showing that inflammation may play a crucial role in depression, schizophrenia, and bipolar disorder.

A 2012 article (Maintaining Brain Health by Monitoring Inflammatory Processes: a Mechanism to Promote Successful Aging) in Aging and Disease looked at how inflammation contributes to mental decline, as well as structural and metabolic dysfunctions. The article is freely available at the link above.

Abstract 

Maintaining brain health promotes successful aging. The main determinants of brain health are the preservation of cognitive function and remaining free from structural and metabolic abnormalities, including loss of neuronal synapses, atrophy, small vessel disease and focal amyloid deposits visible by neuroimaging. Promising studies indicate that these determinants are to some extent modifiable, even among adults seventy years and older. Converging animal and human evidence further suggests that inflammation is a shared mechanism, contributing to both cognitive decline and abnormalities in brain structure and metabolism. Thus, inflammation may provide a target for intervention. Specifically, circulating inflammatory markers have been associated with declines in cognitive function and worsening of brain structural and metabolic characteristics. Additionally, it has been proposed that older brains are characterized by a sensitization to neuroinflammatory responses, even in the absence of overt disease. This increased propensity to central inflammation may contribute to poor brain health and premature brain aging. Still unknown is whether and how peripheral inflammatory factors directly contribute to decline of brain health. Human research is limited by the challenges of directly measuring neuroinflammation in vivo. This review assesses the role that inflammation may play in the brain changes that often accompany aging, focusing on relationships between peripheral inflammatory markers and brain health among well-functioning, community-dwelling adults seventy years and older. We propose that monitoring and maintaining lower levels of systemic and central inflammation among older adults could help preserve brain health and support successful aging. Hence, we also identify plausible ways and novel experimental study designs of maintaining brain health late in age through interventions that target the immune system.

Full Citation:
Rosano, C, Marsland, AL, and Gianaros, PJ. (2012, Feb). Maintaining Brain Health by Monitoring Inflammatory Processes: a Mechanism to Promote Successful Aging. Aging and Disease; 3(1): 16–33. PMCID: PMC3320802

Two easy ways to control and reduce inflammation are an anti-inflammatory diet and regular exercise. Over at Integral Options Cafe, I posted information this morning on foods and supplements that reduce inflammation.

Here is the press release:

Obesity Leads to Brain Inflammation, and Low Testosterone Makes It Worse

June 17, 2013 — Low testosterone worsens the harmful effects of obesity in the nervous system, a new study in mice finds.

The results will be presented Monday at The Endocrine Society's 95th Annual Meeting in San Francisco.

"Low testosterone and obesity are common in aging men, and each is associated with type 2 diabetes and Alzheimer's disease," said the study's lead investigator, Anusha Jayaraman, PhD, of the University of Southern California in Los Angeles. "Our new findings demonstrate that obesity and low testosterone combine to not only increase the risk of diabetes but also damage the brain."

The study -- which was conducted in the laboratory of Christian J. Pike, PhD, Professor in the Davis School of Gerontology at USC and funded by the National Institutes of Health's National Institute on Aging -- consisted of three groups of male mice that received a high-fat diet (60 percent of calories were from fat) to induce obesity. Each group had eight mice and varied by testosterone status. One group had normal testosterone levels, and the second group underwent surgical removal of the testes so that the mice had low testosterone levels. The third group also underwent castration but then received testosterone treatment through a capsule implanted beneath the skin.

The high-fat diet, Jayaraman reported, resulted in obesity and evidence of diabetes -- abnormally high blood glucose (sugar) levels and poor glucose tolerance, which is the ability to clear glucose from the bloodstream. Compared with the group that had normal testosterone levels, the testosterone-deficient mice had more body fat, higher blood sugar levels and poorer glucose tolerance, she said.

After blood testing, brain tissues from the mice underwent analysis for changes. The brains of obese mice showed substantial inflammation and were less able to support nerve cell growth and survival, according to Jayaraman. These damaging effects of diet-induced obesity were significantly worse in mice with low testosterone, she said, adding that control groups of mice fed a normal diet did not show these changes.

"Our findings suggest that low testosterone and obesity interact to regulate inflammation of the nervous system, which may increase the risk of disorders such as type 2 diabetes and Alzheimer's disease," she said.

Because many of the negative outcomes of the high-fat diet were eased in the group of mice that received testosterone therapy, Jayaraman said that "testosterone treatment may be useful in reducing the harmful effects of obesity and low testosterone on the nervous system."

NPR - How A Patient's Suicide Changed A Doctor's Approach To Guns

This segment of All Things Considered aired on the local NPR station Wednesday evening. This struck me as a largely male issue -   men are more likely to be treated for depression by the family doctor than women (72-89% of females will see a mental health professional at some point, but only 41-58% of males will do so), men are more successful in committing suicide (by a margin of 4:1, even though more women attempt suicide, by a margin of 3:1), and men are more successful at suicide because they use guns (women tend to opt for overdose or cutting themselves).

When we finally look at the real numbers about guns and suicides, the debate about gun control is really an issue of suicide prevention, as noted by the Boston Globe:

In 2010, the last year for which complete numbers are available, the number of gun deaths by suicide in the United States outnumbered homicides 19,392 to 11,078. If you add up all American gun deaths that year, including accidents, 3 out of 5 people who died from gunshot wounds took their own lives. Those figures are not an anomaly: With just a few exceptions, the majority of gun deaths in the United States have been self-inflicted every year since at least 1920. This is a startling fact, and one that forces us to realize that, no matter what we may believe about the Second Amendment, the debate over how to reduce the death toll from guns is, to a great extent, a debate about suicide prevention.

Maybe if the men's rights folks took up an issue such as this, one that has nothing to do with feminism, more people would take them seriously.

How A Patient's Suicide Changed A Doctor's Approach To Guns

by ERIC WHITNEY
March 20, 2013

from CPR
All Things Considered
6 min 20 sec

Listen to the Story

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Transcript

Dr. Frank Dumont at his clinic in Estes Park, Colo.Barry Gutierrez for NPR

Dr. Frank Dumont knew one of his favorite patients was getting depressed.

When Dumont first started seeing him, the man was in his 70s. He was active and fit; he enjoyed hiking into his 80s. But then things started to change.

"He started complaining of his memory starting to slip," Dumont says. The man would forget where he had placed objects, and he'd struggle to remember simple words and phrases.

Dumont prescribed antidepressants and saw him every eight weeks or so.

Like a lot of people in the small town of Estes Park, 90 miles northwest of Denver, both Dumont and his patient were drawn to the ruggedly beautiful mountains there. One of them, called Longs Peak, is a cherished part of Dumont's life. He and the patient talked often about the picturesque mountain.

"He was one of those people where you see them on the schedule for the day and you just smile," Dumont says. "You just realize you get a chance to chat with someone who feels like a friend."

That's what their last visit was like. Dumont says he did ask the man whether he was having any thoughts of hurting himself, but got a very convincing no.

"What in hindsight struck me about that visit is that he brought me a gift, which was a geological survey marker from the top of Longs Peak," says Dumont. "It was a replica, but it was one of those things that was just another reminder to me of this connection that we had had."

Dr. Frank Dumont holds a gift from a patient who committed suicide with a gun. In hindsight, Dumont sees it as a farewell from the man who was one of his favorite patients.Barry Gutierrez for NPR

"And at the time it just seemed like a very generous gift that touched me," Dumont recalls. "And what I didn't realize at the time was that that was, I think, a farewell gift, or a bit of a parting gift, from him. Because I did not see him again. And the next that I had heard of him was from an emergency phone call from his wife about a month later, and she called needing to be seen. .... She had to come in and talk to me with how to deal with the fact that her husband had committed suicide."

Dumont's patient shot himself in the head with a rifle. Dumont was stunned, and guilt-ridden.

He says he always asks his depressed patients about suicide, whether they've thought about how they'd do it. But he now regrets not asking this patient specifically whether he had guns in the house.

Suicide prevention researcher Dr. Matthew Miller, at the Harvard School of Public Health, says Dumont sounds like a great doctor. "He was doing everything he could to try to keep this guy from making a suicide attempt, but what he didn't do was the second step, which is make it hard for him to die if he did make an attempt," Miller says.

The second step, Miller says, is asking patients if they have guns in the house or access to guns. If someone tries to commit suicide without using a gun, they probably won't succeed.

"The likelihood of their dying is of an order of magnitude lower," he says. "Instead of there being a 90-plus percent chance of death, there's a greater than 90 percent chance that they'll live."

Miller wants to make it routine for family doctors to ask their patients about guns. One large study found that nearly half of all suicide victims had seen a primary care doctor within a month of killing themselves. So it's important for them to bring up suicide and possible means.

"We have to get people to stop thinking about these discussions as gun control in one way or another, but rather as a way of conveying useful information, so people make decisions that protect their family," Miller says.

There are lots of reasons family doctors avoid bringing up guns with their patients. They may not want to offend a patient, or they may be too busy checking off all the preventive screenings and tests on the list.

Not everybody wants gun advice from a medical professional. Edgar Antillon organized a pro-gun rally at the Colorado State Capitol earlier this year. He says he would resent a doctor bringing it up.

"Tell me to stay healthy, tell me my baby has colic, but I don't think it's their job to tell me about gun safety," he says. "They're not gun experts. They're not NRA members. ... And if they are, then I'll take it as advice from an NRA member."

But Dumont has spent a lot of time second-guessing himself since his patient shot himself. The doctor hopes small measures he can take will reduce the odds, just a fraction, that another one of his patients will die from suicide by gun.

"I have a lower threshold for asking follow-up questions, asking the same thing a different way," he says. "Or if I have any inkling, starting to push a little bit further, and say, 'Well, so you're not really thinking about it, but have you ever thought about how you would go about it if you were going to?' And I have a lower threshold for asking about a weapon in the home as well."

Dumont says he thinks more physicians would talk with their patients about guns if they got information about health risks associated with them. Medical journals and a federal board of experts regularly issue advice on prevention of obesity, car accidents and workplace injuries. But there's been a ban on federally funded gun safety research until President Obama restored it with an executive action.

This story is part of a partnership between NPR, Colorado Public Radio and Kaiser Health News.

Lynn E. O'Connor - Male Dominance and Female Depression: Based on Ideas?

Lynn E. O’Connor, Ph.D. in her Psychology Today blog, Our Empathic Nature, published this interesting look at how our primate relatives might provide insight into our own social construction of gender stereotypes. The research seems to indicate that depression levels in females, both chimps and humans, is relatively identical to that of males, until puberty. Once puberty arrives, the males become more physically dominant and the females become much more likely to experience depression. Food for thought.

Male Dominance and Female Depression: Based on Ideas?

An explanation for cultural differences in orangutans might have relevance

Published on December 31, 2012 by Lynn E. O’Connor, Ph.D. in Our Empathic Nature

Chimpanzee's Emotions Similar to Ours

Over a decade ago I conducted a study with James King and Jack Berry on antecedents to psychopathology in chimpanzees. We used data that King had first collected in a study of personality in Chimps in 12 zoos, maintained under the auspices of the Jane Goodall Institute. Meaning the Chimps were living in as benign circumstances as zoos can provide, with efforts made to provide an interesting environment given the confines. The method used was to have zookeepers and volunteers who knew the Chimps well sit and observe them for hours and hours, and mark down how much they exhibited a variety of behaviors, derived from 43 specific personality attributes (used previously with people). This included behaviors like aggressiveness, friendliness, sociability, intelligence, and other obvious characteristics. King and his colleague Figueredo found the Chimps could be categorized on a scale very close to the most commonly used “Big Five Factor” personality scale used with people. There was one additional factor related to “Dominance” although I questioned its inclusion, as the attributes that went into it were also frequently found in “Extraversion,” one of the “big five factors.”

I began this new study by speaking at length to the zookeepers who had been part of the original study. Some of them had been with their “group” of Chimps for 15 years or longer. They really knew and spoke about their Chimps much as we speak of our children and family members. I heard stories, detailed fantastic stories of the Chimps behaviors. Some sounded quite screwy, along the lines of what, if it had been a person, we would have diagnosed her (yes it’s usually a “her”) as suffering from a “borderline personality disorder.” Others would –had they been people—been called “schizoid (personality disorder)” or “antisocial personality disorder” (we all know some of them, they take what they want, push to the front of the line, and don’t seem to worry whose feelings they hurt in the process). Others seemed to be quite normal, just ordinary, getting along with other Chimps kinds of behavior. After transcribing all of these extensive interviews, I read them over and over. Things just popped out at me, and I went to what was then our “diagnostic bible” the first version of the “DSM-IV” that psychiatrists and psychologists use to diagnose people with mental disorders. I started looking through disorders, characterized by “criteria” otherwise known as specific symptoms. I was limited to behavioral symptoms since I didn’t know what was in the Chimps’ minds, only how they behaved. My colleague Jack Berry joined me on this. Together we came up with five scales that were made up of “criteria” as laid out by the DSM-IV, and considered them antecedents to psychological problems we see in people. A few were the most commonly known psychological problems, like “depression” and “anxiety.” The others were “personality disorders (PD)” and specifically, “borderline PD”, “antisocial PD,” and “schizoid PD.” We then found the attributes from the original personality scales that fit into the characteristics or criteria for these disorders, thereby coming up with “antecedents to psychopathology in chimpanzee scales.”

What happened when we ran the statistics was amazing. Chimps I had thought were “schizoid” actually came out “schizoid” on our scales. One really mean girl, “Lila” sure enough showed up as “antisocial PD” on our scales. But most astounding was that we found that before adolescence, males and females were identical in proneness to depression. Sometime during adolescent however, the females zoomed ahead and became significantly more depressed than the males. What was so striking here was that they followed the exact pattern we have repeatedly found in people.

Our question then was –why did this happen (in Chimps or in our species)? Perhaps it was due to hormones and rising estrogen? Or was it because females were not as quick at metabolizing serotonin which left them more vulnerable. Biological considerations aside we wondered about the role of social environment – In other words - Is male dominance in any way related to the observed differences in proneness to depression between males and females. We wanted to look at Pygmy Chimps, better known as Bonobos. They’re the species that “makes love not war.” When they come upon a tree with ripe fruit, the first thing they do before jumping in – they all make love to one another. Males and females, males and males, females and females, they have a sex orgy. Then, apparently having reduced potentially competitive tension, they all enjoy the fruit together. Furthermore bonobos share often (so do chimps in their natural habitat, but not quite as much as Bonobos). Most striking -- in Bonobos culture, females are dominant because they stick closely together. If a male aggresses upon a female, the females gang up and go after the guy who flees as fast as he can. While there is infanticide among Chimps, there is no such thing with Bonobos. The women really stick together and thus their young are well protected, as well as one another. For all these years since we did this study, I’ve had this question – if we studied Bonobos in zoos, replicating the way we studied the Chimpanzees, would we find the females getting significantly more depressed than the males, around adolescence? Or would the female dominance protect them. Maybe the males would get more depressed. Is it social environment that leads to depression? We have no way to know. Frans de Waal, a world expert on Bonobos, told me he thought we’d be unable to find enough Bonobos to replicate the study, even if we looked at zoos world wide.

Orangutan culture transmitted by ideas

Then a few weeks ago I read a piece by Jason Goldman, a Scientific American blogger. He is summarizing research that demonstrates that Orangutan’s culture (which differs from group to group) is being passed on by ideas instead of by genetic differences, or some other physical or concrete environmental explanation.

In Orangutans, just seeing a behavior before a child has the physical skills to actually do it, allows them to do it quite easily when they are old enough to develop the skills. But Orangs from a group where the behavior was never done so the children never saw it, have a much harder time learning it, when exposed to the behavior under different conditions, in a shelter where Orangutans from differing cultures are mixed together. Maybe the same is true of male or female dominance, and subsequently, maybe the onset of female depression in adolescence is part of a cultural package, made up of ideas carried from generation to generation. Could this possibly hold an answer to the mystery of the onset of adolescent depression in Chimpanzees and in our own species. Could the cultural habit of male dominance be something the young have to see, long before they can actually do it. Could the cultural habit of females sticking together and chasing off males who grew offensive, thereby establishing a female dominant culture be something youngsters just have to see, in order to later imitate the same pattern? I don’t have the answer but Goldman’s summary of this new research really made me wonder if male dominance is based on cultural ideas and cognitions and thereby possibly subject to change, albeit with effort.

Male dominance at work, still very present

The story of our Chimpanzee research is sadly an example of how the idea of male dominance holds power in our culture. Our study was presented at the APA in 2001, over a decade ago. Then a young alpha male joined King’s group. I’m not naming names. He grabbed the data, began to dominate the show, claimed he added some Chimps to the data, re-analyzed it and came up with the same results. But when I tried to publish our findings, he refused to give me the original data, or the data set to which he’d added. Feeling uneasy at publishing something based on a data set I was unable to review myself, presenting findings while being unable to re-analyze data on my own --well that seemed potentially unethical. Why would I be denied the data set, having been the principal investigator on the study? Must be the pervasive idea of male dominance. I withdrew the piece from the Journal to which I’d sent it. The new alpha male who had nothing to do with the original study is now getting a bigger and bigger name in animal and human personality. I accept it (almost), we live in a culture that’s still unfortunately male dominated at least in science. But I found Goldman’s review of the orangutan research a comfort. If social differences or culturally specific skills are related to cultural ideas, this thing we know as male dominance may all change in the future. Ideas may be far more malleable than something wired into our genetic material.

References

Gruber T., Singleton I. & van Schaik C. (2012). Sumatran Orangutans Differ in Their Cultural Knowledge but Not in Their Cognitive Abilities, Current Biology, 22 (23) 2231-2235. DOI: 10.1016/j.cub.2012.09.041

King JE, Figueredo AJ. (1997). The Five-Factor Model plus Dominance in chimpanzee personality. J Res Pers 31:257–271.

O'Connor, L. E., Berry, J. W., King, J., Landau, V., & Pedersen, A., (2001). Chimpanzee subjective well-being and psychopathology. Presented at American Psychological Association, August, 2001, San Francisco California.

De Waal, F. & Lanting, F. (1998). Bonobo: The forgotten Ape. Berkeley: U. California Press.

Margaret Wehrenberg - Overwork/Underwork—Two Sides of Male Depression

This brief article from Margaret Wehrenberg's Depression Management Techniques blog at Psychology Today looks at how building social connections can ameliorate the depression that comes from (or is hidden with) being overworked or suffering from underwork - both conditions can impair a man's self-esteem and self-compassion (which is the more important area for concern).

Overwork/Underwork—Two Sides of Male Depression

How insistence on social connections can break through low self worth. 

Published on October 14, 2012 by Margaret Wehrenberg, Psy.D. in Depression Management Techniques 

Overwork and Underwork; two sides of worthlessness in male depression. How insistence on social connections can break through.

Al commented: “I have never been a guy who can just take time off without feeling wrong and guilty. So I work 70 hours or more a week. It is killing me, I think, but what in the world would I do with the time if I was not working?” Al represents the kind of depression that hides in overwork and lack of social contact. He feels low self worth and does not believe he is loveable. He is home so rarely that his family takes vacations without him and he has been known to work on holidays. He is a man who cannot fill his life with meaningful connections, so work becomes the point of his existence. He is one short-term illness away from despair: Unable to work, he would succumb to feeling useless or worthless and his depression would well up and swamp him.

Marlin on the other hand was out of work but he was also unwilling to discuss how deeply he feared not getting a job he interviewed for. He had struggled against networking, embarrassed and unwilling to test the strength of friendship among acquaintances he contacted for his job search. Instead, he railed against the rules of unemployment that demanded he had to demonstrate applying for 4 jobs per week. “No one can tell me how to live!” he declared. “I will live on my nest egg until I am out of money rather than knuckle under to the way some agency wants me to conduct my job search.” Being out of work was grinding his self-esteem to a fine powder, and depression’s hopeless and helpless attitude blocked his job hunting. He became increasingly isolated, avoiding people to avoid discussing his unemployment, and thus he limited his options for receiving help and support. Being angry at least gave him a sense of power.

Both of these men with low self-esteem also reflect the problematic low levels of serotonin common to depressed brains. That neurochemistry shows in the persistent negativity and the inflexibility in problem solving that will keep both these men stuck in their unfortunate patterns of behavior. Because most men strongly connect their value and identity with their work, work carries exceptional power to define their worth.  Al’s overwork and Marlin’s embarrassment about unemployment reflected their sense of value. They found ineffective, albeit different, solutions: Al hiding in his work and Marlin using anger to cover his fear of unemployment and defend his inflexibility.

What both these men were missing may have been healthy levels of serotonin, but they were also missing social involvement that might have reversed the pattern. Depression can lead a man to feel worthless and block his understanding of why family and friends want to be with him. However, being with others in pleasant social contexts, whether family or friends, is an automatic lift to the mood and raises energy. Forcing oneself to participate, even though the desire to participate is minimal, can begin to shift intractable behavior. If Al or Marlin had spent time with people who cared about them, they might have been able to get perspective on their value as well as on their options.

It is true that being depressed makes it very hard to reach out to others.  Any person who lives with the over-worker or stalled job hunter can see that their perspective is narrowed and their self-worth is damaged. Broadening perspective can be accomplished in making small connections, putting a wedge into the wall of their disbelief that others see them as more valuable than their work. What gets through? Working from ‘the outside in” can help. Urging, encouraging, even insisting on behavior change can change feelings and that can change the brain to a more balanced brain. If a man can insist with himself, fine, and if not, therapist or family member can push in these directions:

• Insist the man with no worth make a list of people in his life and identify whether they love him (according to what they say, not according to whether the depressed man feels loved.) Then review the list daily.
• Insist he participate in a social activity however much the depressed man resists. Follow up with identifying whether it was pleasurable or unpleasurable. (No middle ground).
• Insist that he identifies 3 blessings a day, every day, in writing. And yes, eating popcorn can be a blessing if you like it. No activity is too small to be a blessing. He should read it to himself every day and read the list to someone else once a week.
• Insist that he spends time with family, participating in an activity together. (And everyone sitting in a restaurant looking at their individual handheld devices does not count as together time.)
• Insist that he reconnects with others. For example, making a list of people he could socialize with, even if it has been a while, and then call or email or text one person per week to set up a contact, such as golf game, drinks after work, bike ride, meet at the gym, have a lunch, etc.

Always follow up with evaluating how the connection felt. When men are depressed, they are slow to acknowledge that something made them feel good. They do not easily credit the pleasurable aspects of the connection. And reviewing that it felt good makes it harder for him to ignore the good feeling and re-stimulates the pleasure of the experience strengthening its value as an antidepressant. 

Connection is the way out of depression, in part because it contradicts worthlessness. Once an Al or Marlin believes he is not worthless in the eyes of others, he might be more balanced about work and separate his identity from his job status.  As his sense of value increases, the hold of depression decreases.

This article ran in the New York Times back in August. Men are suffering from all types of eating disorders at higher levels than ever before (although part of this might be a more tolerant atmosphere than in the past in which to come forward, so the numbers have rapidly increased), and binge eating is no exception.

In fact, I would suggest that binge eating disorder in men (which means without purging) has been much more common than anyone has known - but it was just seen as having a "manly" appetite. The article acknowledges that men and women are about equal in their experience of binge eating.

Binge Eating Among Men Steps Out of the Shadows

By ABBY ELLIN

FIRSTHAND Andrew Walen, a recovering binge eater, now counsels others.

After downing 70 chicken wings in about an hour, Andrew Walen realized he had a problem.

Oh, he had known something was wrong over the years. Normal people don’t consume 4,500 calories worth of food in one sitting, or order takeout for four when dining alone. But it took a maniacal feeding frenzy for him to finally accept the reality: He was a binge eater, and he had absolutely no control around food.

“Ultimately, it was about numbing out and self-loathing,” said Mr. Walen, now 39 and a therapist in Columbia, Md. “There was this voice in my head that said, ‘You’re no good, worthless,’ and I turned to food.”

Mr. Walen is one of an estimated eight million men and women in the United States who struggle with binge eating, defined as consuming large amounts of food within a two-hour period at least twice a week without purging, accompanied by a sense of being out of control.

While about 10 percent of patients with anorexia and bulimia are men, binge eating is a problem shared almost equally by both sexes. A study published online in October and then in the March issue of The International Journal of Eating Disorders found that among 46,351 men and women ages 18 to 65, about 11 percent of women and 7.5 percent of men acknowledged some degree of binge eating.

“Binge eating among men is associated with significant levels of emotional distress, obesity, depression and work productivity impairment,” said Richard Bedrosian, a study author and director of behavioral health and solution development at Wellness and Prevention Inc., which works with employers and health plans.

But while binge eating is challenging for women who suffer from it, the perils are perhaps greater for men, who rarely seek treatment for what many believe is a “women’s disease.” Unlike bulimia and anorexia, binge eating does not even have a distinct listing in the current D.S.M., as the diagnostic guide for mental health professionals is known.

“Guys generally don’t come forward for any reason,” said Ron Saxen, 49, author of “The Good Eater,” a memoir of his struggle with binge eating, which began when he was about 11. At his worst, Mr. Saxen was consuming 10,000 to 15,000 calories’ worth of Big Macs, French fries, chocolate milkshakes, candy bars, ice cream and M & Ms, often within an hour-and-a-half window.

Those men who do seek treatment often have difficulty finding a facility or therapist to work with them — even the literature is predominantly female-centric. Before Vic Avon was given a diagnosis of anorexia in 2006, for example, he scoured the Web for information relating to men and eating disorders. “Everything I saw was written for and by women,” said Mr. Avon, 29, a building contractor in Brick Township, N.J.

Mr. Avon seesawed between anorexia and binge eating (not uncommon), at one point weighing 300 pounds. “I was so ashamed because it was a girl’s illness, I thought. I didn’t have any guys to look to.”

Many binge-eating men do not even recognize that anything is wrong. About 70 percent of people with binge eating disorder are overweight or obese, but a higher weight is generally more culturally acceptable for men than for women.

“There’s nothing wrong with a college guy eating a whole pizza by himself, but with women they would be horrified,” said Roberto Olivardia, a clinical psychologist who specializes in the treatment of body image disorders and eating disorders in men and is an author of “The Adonis Complex.”

Even if they are disturbed by their food intake, few men make the connection between gorging and emotional distress. “With men it’s usually a disconnect,” said Mr. Walen, the former binge eater turned therapist. “It’s about ‘I want to eat,’ not ‘I’m coping with an emotional trauma.’ ”

Adam Lamparello’s binge eating was both physical and psychological, the result of the starvation that ensued during his six-year bout with anorexia, and his attempt to fill the “emptiness, loneliness and emotional void” that he felt in his life.

“Those with binge eating disorder often do not have meaningful relationships with other people, are isolated, believe that life has no purpose or have suffered prior traumatic events and turn to food for emotional comfort,” said Mr. Lamparello, 36, a lawyer in Hasbrouck Heights, N.J., who recently published “Ten-Mile Morning: My Journey Through Anorexia Nervosa.”

Men like Mr. Avon and Mr. Walen often struggle to find help. But the tide may be slowly turning as awareness about men and binge eating grows. Chevese Turner, founder and chief executive of the Binge Eating Disorder Association, said about 20 percent of the calls she receives are from men, up from 5 percent when she started the organization in 2008.

In general, cognitive behavioral therapy is the most successful treatment for binge eaters, said Sarah J. Parker, the director and a founder of the Reeds Center, an outpatient mental health center in New York that treats men and women who have anxiety and eating disorders. Treatment often begins with efforts to recognize distorted, all-or-nothing thinking and to begin monitoring one’s eating, sleeping and exercise patterns. Since many binge eaters restrict food intake during the day and binge at night, the goal is to get them to eat three meals a day and a snack.

Whether or not one can be fully cured of binge eating depends on one’s definition of “cured.” An October 2011 study in The Journal of Consulting and Clinical Psychology reported a 51 percent remission rate for patients a year after using cognitive behavioral therapy. Therapy did not lead to weight loss, however.

“Do people stop binge eating and basically not binge eat again? Yeah,” Ms. Parker said. “Is it O.K. to have an episode once a month? For some people that might be a cure.”

Mr. Saxen finally went to a therapist at age 40. While he no longer binges, “I’m in the camp of A.A. — you’re always recovering,” he said. “There are times when bad things are happening, and I have my moments.”

After the chicken wing incident, Mr. Walen also sought treatment. He has not had a full-on, out-of-control “big B” binge since 2006 — but he has had “little B” moments. “I would say that most people have ‘little B’ binges where they go, ‘I know I overate, but it didn’t come with a lot of guilt shame stuff.’ I think almost everyone goes through that a few times a year,” he said.

Perhaps the greatest challenge, experts say, is to persuade more men to come forward and seek treatment. “You have to have alternative means of getting men to acknowledge the problem,” Dr. Bedrosian said. “We need to find alternative ways for men to get screened, we have to encourage the screening for all eating disorders in primary care,” with an emphasis on making sure men as well as women receive attention.

He added, “If I were training medical students today I would say, ‘When you’re discussing weight loss programs with an obese patient, make sure you ask them about binge eating behavior.’ ”