Thursday, April 9, 2009

Mood Disorders in Men: My New Paper

For the full document, including cover, abstract, references and appendix, click here. The following is the body of the paper.

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Mood Disorders in Men:

Gender Constructs and Diagnostic/Treatment Failures

There is no question that women are diagnosed with affective mood disorders at much higher rates than men. Granted the absolute rates of depression in women are a source of contention, but multiple studies show that women are diagnosed with major depression and dysthemia at rates double those of men. A great deal of study has gone into investigating the reasons for this, from biology to oppression and other social conditions, even certain personality factors. Yet the causes of these higher rates of depression and mood disorders have continued to elude researchers (Blehar & Oren, 1997, p.2). It is not unreasonable to assume, based on these findings, that there simply must be something unique to women, causing this disparity.

Very few psychologists and fewer researchers have considered the idea that rather than being a women's issue, this disparity might just be a men's issue. It would seem rather difficult to figure out just what's fueling this disparity, without looking at why men aren't diagnosed with depression at nearly the rates women are. It would be incredibly hard to find the causal relationship that explains higher rates of depression in women, if the base assumptions driving that research are mistaken in the first place. But given the disparate focus of most gender studies on women and women's issues, it's unsurprising that this seemingly obvious avenue of investigation is mostly lost in the mix.

The Gender Gap Fallacy

The sentiments expressed by Drs. Blehar and Oren are very consistent with the assumptions of mainstream, modern psychology and women's studies. In their 2003 paper, The Depression Gender Gap, Ronald Immerman and Wade Mackey actually claim that there is a consistent evolutionary history at work in these higher rates of depression in women. Because they found that the median ratio of depression between men and women, in several countries was close to 2:1, they claim this is just a part

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of what it means to be human. Yet when we look at their own table, we see that while the figures do come to that median, the ratio is far from consistent.

Figure 1. Site of survey and female to male ratio of prevalence of depression across nations and communities. Note that three communities listed are expatriate communities in the UK. Note. From Immerman, R. S., & Mackey, W. C. (2003, February). The depression gender gap: a view through a biocultural filter. Genetic, Social, and General Psychology Monographs, 129(1), 5-35. Retrieved March 8th, 2009 from the Michigan E-Library,

Avoiding the obvious logical fallacies that drive the entire notion of evolutionary psychology that Immerman and Mackey dive into, there remains the important question of how men fit into this equation. Because the underlying assumption that women experience depression at such significantly higher rates than men, is called into question by Berger, Levant, McMillan, Kelleher and Sellers (2005), finding that “ men who score higher on measures of gender role conflict and traditional masculinity

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ideology tend to have more negative attitudes toward psychological help seeking.” This is probably due the higher rates of alexythima (difficulty experiencing, thinking about and expressing emotions) in men with high rates of gender role conflict (A. R. Fischer & Good, 1997). When the population of comparison, in this case men, are unlikely to seek help for or even recognize that they have a problem, they are also unlikely to be diagnosed with affective mood disorders. While these papers don't indicate rates of depression in men, they certainly call into question the disparity in the rates of depression between women and men.

The Problem of Help Seeking and Diagnosis

More disturbing than the tangential impact these papers have on the question of gender disparity and mood disorders, are the implications for men and help seeking. The evidence indicates that there is a substantial segment of the population that has serious problems even recognizing they might have psychological problems, much less seeking help. The problem is further complicated by generalized diagnostic criteria which are predicated on the understanding that the patient can identify and describe their various emotional states. Without compensating for undiagnosed alexythima, or gender conflict induced emotional disassociation, patients with potentially serious mood disorders will inevitably be misdiagnosed, undiagnosed or the severity of the diagnosis may be seriously understated.

Mariola Magovcevic and Michael E. Addis , of Clark University have taken the initial steps in the development of a masculine depressive index (appendix) to help diagnose depression in men who tend to adhere closely to masculine norms (2008). The methodology is a significant improvement over that of previous studies because the subjects were screened in for a recent (last three months) depressogenic events, but the authors are also very clear about the limitations of this study. There is a great deal more work to be done to develop a coherent and comprehensive diagnostic criteria for depression in men and this study didn't look at any other affective mood disorders.

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The obvious isn't always so obvious and therein lies a great deal of trouble when it comes to dealing with the problems of encouraging help seeking, improving diagnostic criteria and treatment protocols – this is very new territory. While traditionally the ratio of depression from men to women has been assumed to be about 2:1, the ratio of bipolar diagnosis, for example, has been fairly even ( Blehar & Oren, 1997, p.2). The implications of higher rates of unipolar depression in men than previously thought, would imply that the rates of bipolar disorder are also higher than previously thought. Yet none of the articles cited in this paper and few of the articles read while preparing to write this paper discuss the possibility of higher rates of any affective disorders besides depression.

The Gender Gap in Gender Studies

Though there have been several solid studies that have indicated these higher rates of depression in men, there has been very little popular discussion of the findings. The assumption that women experience significantly higher rates of depression than men is still a fundamental premise of most women's studies programs. Not because the studies indicating otherwise are flawed, or because they are being willfully ignored. Rather, they just haven't been noticed. This really shouldn't come as any surprise to those involved in gender studies, especially men's studies. While virtually every college with a psychology department has a women's studies program, there are very few that have a specific men's studies program and there are no graduate men's studies programs in the U.S. An exhaustive web search for men's studies texts, yields less than a dozen academic journals. In contrast, a cursory web search turns up more than fifty core women's studies journals.

The most important implication of this evidence is the critical need for more focus on men's studies for the sake of the mental health of a large segment of society. But there is a secondary implication here. The findings discussed here have significant relevance to the study of depression in women. First, it provides evidence that the disparity in diagnosis is considerably different than

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traditionally considered. Second, this research points to the importance of gender specific diagnostic and treatment models for depression and other affective mood disorders. It also makes a reasonable argument for investigating whether gender specific approaches might be appropriate for other neurological issues.

Men's Studies and Society

There is a broader social implication to the studies discussed here. Archetypal male gender constructs and gender role conflicts are just as abusive to men, as they often are to women. They foster emotional repression, health care problems, obsession with achievement and power, problems with sexual and affectionate behaviors, and homophobia. GRCs often create an outright fear of anything that could be mistaken as feminine in nature ( Magovcevic & Addis, 2008, p118; Blazina, Settle & Eddins, 2008, p70). Aside from the impact of archetypal male gender constructs and GRCs on the mental health and wellbeing of some men, there is also the impact on the rest of society to consider.

Yet while there are a great number of women studying female gender constructs and developing methods for women to transcend archetypal female gender constructs, very few men are studying masculine gender constructs. There are unfortunately, more women involved in men's studies than there are men. This is not to speak poorly of the women who are working in the fields of men's studies or to disparage their work. It ultimately speaks poorly of men for not stepping up and dealing with problems of masculinity and men.

The same gender conflicts that drive many men to emotional disassociation are probably largely responsible for this gender gap in men's studies. It is important to recognize that the underlying archetypal male gender constructs are a continuum, not a dichotomy (Tremblay & L'Heureux, 2005, p56). Even though most men avoid the extremes of GRCs, most men still fall somewhere along that spectrum and experience to some degree many of the problems discussed above. This means that while

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the manifestation may not be as extreme as those discussed above, they are often prohibitive nonetheless.

Deconstructing Gender

Women's studies are very important and the focus of gender studies on women's studies is understandable – most of the people involved in gender studies are women. But it is important to recognize that the lack of focus on men's studies affects women and even impacts feminine gender constructs and the socialization of women. The ramifications of masculine gender constructs have a profound affect on everyone, as do gender constructs across the spectrum. From the health and mental wellbeing of men, to the impact of GRCs and even the average masculine norms on society as a whole. The time has long since passed for an increased focus on male gender constructs that goes beyond looking at whats wrong and focuses on how to make it right.


JLK said...

Great paper, DB. I suggest reading it out loud to yourself because there are a couple spots that don't flow as well as they could, and you're still pretty comma-happy! lol

Also, toward the end you abbreviate "gender role conflicts" as "GRCs" - you need to specify the acronym in your first mention, example

"and gender role conflicts (GRCs),....."

My other suggestion would be to eliminate some of the stuff about women's programs and the need for them, and add more about Michael Addis' new depression inventory. You drive a lot of intrigue, but then don't quite deliver. It's like being stroked. lol

But otherwise, I think it's very good. :)

Peggy said...

Interesting paper. I'm still digesting the points you made, but I wanted to point out that a couple of sentences were confusing to me:

"Because they found that the median ratio of depression between men and women, in several countries was close to 2:1, they claim this is just a part of what it means to be human."

"While traditionally the ratio of depression from men to women has been assumed to be about 2:1 [...]"

Looking at the table of data on the full version of the paper, it looks like you actually mean that the female to male ratio is 2:1, rather than vice versa (which is how I read "ration from men to women").

It's also unclear to me that the disparity in the diagnosis of "depression" would necessarily result in a similar disparity of diagnosis of "bipolar disorder". From what I've observed (so totally anecdotal) while mere depression is often considered something that a "real man" can handle, BD is considered a more serious problem meriting medical intervention. But that's difficult to know without further study.

I also know absolutely nothing about women's studies programs, but it seems odd that issues of gender difference in diagnoses would only be looked at within the context a gender studies program and not addressed in the research of the main psychology department. Is that the norm?

Peggy said...

And by "ration" I meant "ratio". Stupid typo.