Silence Strengthens Impact of Depression Among Men Men's Fitness magazine tackles a sensitive subject that is not often discussed: depression and men. In this week's Behind Closed Doors segment, Chris Strauss of Men's Fitness, mental health writer John Head, and Nathaniel Reynolds, who suffered from depression, explain why depression seems to be rising among men, and why it can be challenging for men, especially black men, to accept help.

Silence Strengthens Impact of Depression Among Men

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I'm Michel Martin and this is Tell Me More from NPR News. Coming up, a wedding can be a celebration of love or a festival of bad behavior replete with family strife, pressure for pricey gifts, not to mention the ever rising cost for even more elaborate festivities. But does it have to be that way? Two women calling themselves anti-wedding planners helped one couple flip the script for their big day. We'll tell you what they did in just a few minutes.

But first, we have a far more serious subject, something we talk about in Behind Closed Doors. This is the time when we try to tackle important subjects that many people are reluctant to talk about openly. In the case of today's topic, men and depression, that silence can be deadly. According to the National Institute of Mental Health, American women are twice as likely as American men to be diagnosed with depression each year. But four times as many men as women will commit suicide. Doctors say there's a clear link to undiagnosed and untreated depression among men.

The current issue of Men's Fitness talks about the different challenges men face in dealing with depression. Chris Strauss, features editor of Men's Fitness, joins us now. Also with us is Nate Reynolds, he spoke with Men's Fitness about his struggle with depression, and John Head is the author of "Black Men and Depression: Saving Our Lives, Healing Our Family and Friends." I thank you all so much for speaking with us.

Mr. CHRIS STRAUSS (Features Editor, Men's Fitness): Hi Michel, thanks for having us.

Mr. NATE REYNOLDS: Thank you, Michel.

Mr. JOHN HEAD (Author, "Black Men and Depression: Saving Our Lives, Healing Our Family and Friends"): Thank you, Michel.

MARTIN: Chris, I want to start with you. What prompted Men's Fitness to tackle this subject at this time?

Mr. STRAUSS: Well, it started - there's a woman in New York, her name is Terry Lily(ph), and our editor-in-chief and a freelancer who we use pretty frequently are both acquaintances with Terry. And they were talking and Terry was telling them, she said, you know, this is something that the magazine should absolutely look at. There are six million men who are diagnosed with depression but the issue is that there's actually millions and millions more who are not diagnosed. And I think the big thing for us was that symptoms in men are very different from those in women. And for our magazine, you know, we were looking at this numbers, looking at these symptoms and saying, this is something that absolutely affects our entire readership.

MARTIN: Very briefly, if you would talk about it. I want to talk to Nate about this in just a minute. When you say that the symptoms manifest differently in men and women, what do you mean?

Mr. STRAUSS: For men - you know, for women, I think you have your more traditional symptoms where it would be withdrawing, crying, crawling into bed. At least, you know, the general stereotype of depression. And while these can also manifest themselves in men, men sometimes have symptoms where you wouldn't even think that - to associate them with depression. It can be, you know, attempting to overachieve and do too much. We have one man that spoke to our story who was trying so hard to almost - I don't know if withdraw from his problems is the right word - but to not focus on what was going on inside that he'd be going and working out at 2:00 in the morning after working two jobs and almost not wanting to stop. It would also manifest itself sometimes in aggression, in drugs and alcohol, and also high-risk behavior, you know, numerous sexual partners, unsafe sex. So there's a lot of different ways that men can act out. It's a much more aggressive manifestation for men.

MARTIN: Nate, how about you? How did you come to realize that you were struggling with depression?

Mr. REYNOLDS: You know, it was very similar that - I found myself isolating a lot. I found myself spending more time at work, finding different ways to isolate and withdraw. I had a lot of the classic symptoms of depression, as well, but I just - I had that opinion, as many men do, I believe, that I just needed to get over myself and move on with life. And mine ended up manifesting itself in a long-term affair as a way of isolating myself from my problems, and all I did was create new problems.

MARTIN: And all that time nobody ever said, Nate, gee, do you think there might be something wrong here? Do you think you might be depressed? That never came up?

Mr. REYNOLDS: No. It never came up, and I think that's one of the classic problems with men is we don't have that structure. It's just - it's not common for men to sit around with their friend and say, you know what? I just don't feel right. What should I do about this? You know, I'm constantly sad. I don't know, I think I'm depressed. What should I do? It's just not a common conversation among men.

MARTIN: How did you finally figure it out?

Mr. REYNOLDS: Well, it's - you know, after the affair came to light and I ended up by myself in an empty house, I found I didn't really have any other choice, that doing it my way was not working, obviously, and I needed to ask for help. And so I, you know, I immediately decided that I should be in some kind of therapy, and so that's when my path started.

MARTIN: John, you've written about African-American men and depression. I'm sure a lot of things we've already talked about are very familiar to you. But what additional factors do you think are at play for African-American men?

Mr. HEAD: Well, when I talk about depression in black men, I say that it's like depression in any other men except more so. I think it can be a heightened and more intense experience. I think there are two things, two factors that make it that way. One is racism, dealing with racism, which is basically psychological warfare. It's intended to make you feel a certain way about yourself, and if you're suffering with depression, it's really difficult to confront and deal with that. The other factor is attitudes toward depression. In mental health issues in general and in society in general, there is stigma attached, and I think that stigma is heightened in black communities. It tends to be something that's viewed more as a character flaw or weakness than an illness.

MARTIN: And you think that the whole question of diagnosis is perhaps even more pronounced? Some of the behaviors that you all have been talking about, this kind of hyper-aggressiveness, something - I just think you very rarely hear that framed in terms of a possible symptom of depression. Do you think that that's perhaps even more so among African-Americans?

Mr. HEAD: Yes, and again, part of it is racism. If you deal - if you look at those behaviors and you look at the stereotype that you apply, that people apply to black men, you see they match. They come together pretty well. And so it tends to be that when black men are exhibiting these behaviors, depression isn't even in the conversation. It's not something that can be done anything about it. It's just the way black men are. That's the stereotype.

MARTIN: Chris, the first thing we talked about here is just the difficulty of even talking about this among men. So how hard was it for you to get men to talk about this for the magazine?

Mr. STRAUSS: Well, the fortunate thing that we had was that we had access to a number of therapists, and the men that we decided to speak with, such as Nate and Trashay McGray(ph), these are men who are, you know, already took the step of talking about it and of realizing that they have a problem and addressing it. And so we wanted to find people who are sort of on their way to recovery, so that was a little bit easier.

So we went to a number of therapists across the country and said, you know, do you have people who'll be willing to do this? And to be honest, I don't believe that it was all that hard to find people to talk about it because there were people who had already talked about it. I think the challenging thing is if you have men who are not quite in that stage where they are open about what's going on, that's - that's probably the more difficult challenge that depression presents.

MARTIN: But Nate, what about the - once you started talking about it, and now the issue has been out on the stands for a little while now, it's still going to be on the stands for a couple of more weeks. Have you had any reaction to your decision to talk about this issue sort of openly? What's it been like for you?

Mr. REYNOLDS: You know, I haven't really had a lot of reaction but it's - I am very open about it. And one of the reasons I am open about it is because nobody was ever open about it with me. And I really believe that if somebody had been open about it with me earlier on, I could have been much happier early on in my adulthood. So it's very important for me to be open and honest about it and to reach out to people that may be in the similar situation that I was. ..TEXT: MARTIN: If you're just joining us, you're listening to Tell Me More from NPR News. We're talking about men and depression with Chris Strauss of Men's Fitness magazine, which just did a major feature about this issue, Nate Reynolds, who's recovering from depression, and writer John Head.

John, we've talked a lot on this program and in other venues about how mental health issues can be even more pronounced in communities of color because of the lack of access to health care, the ways sort of issues get discussed in the community. Now you've heard, you know, Nate talk about his decision to try to talk about this in order to see if he can help other people. You've written about this issue for the same reason. Do you see any sign that we're making any headway and making it easier to disclose, to diagnose, to discuss this issue?

Mr. HEAD: Yeah, I think that is happening. I go out and speak about depression and specifically about depression in black men, and the reaction that I get I see evolving over time. And people are more open, more searching for answers. It tends to be - it used to be that I would go out and there would be very few black men, if any, who would show up. The audience tended to be black women who were trying to figure out how to help someone who won't help themselves, but more and more I'm seeing black men show up, and I'm also having the experience of someone standing up and saying, I've never talked about this before but, and then telling his story. And that's the kind of thing that has to happen, I think. That's kind of thing that's going to open those closed doors that you talked about earlier.

MARTIN: Chris, what are some of the things that would perhaps help make it easier for other people to recognize these situations and to deal with them before they have to go through as much as some of these other man have gone through who you talked about in the article who had to go through, you know, some really serious disruption in their lives before they were able to kind of get the help that they needed?

Mr. STRAUSS: I think the biggest thing is being able to talk about it. You know, one of the signs that we've seen is, you know, well, the guys will only talk about it, and you know, they'll go out to the bar with one of their buddies and get drunk and that's when, you know, they'll end up crying and pouring their emotions out, and then next day, you know, it will be either, you know, (unintelligible), you know, I was drunk, or it'll just not really be spoken of again. And I think the hardest thing for men to do is sort of overcome the barrier of communication, and I think that it's more a matter of just finding someone that you can trust to talk about these symptoms with.

MARTIN: Do you - but can you really overcome, I don't know, however many thousands of years of social history and conditioning? How - you know, what would really make a difference? Obviously, maybe if more men were more informed maybe they'd be quicker to help their friends, but what - how do you overcome from the time little boys are little, they're told, don't cry, suck it up, you know, deal with this, that kind of thing? It's just they're just not encouraged to express themselves in that way.

Mr. STRAUSS: Right. And that's - and I think that's the biggest problem that we face is that men normally just will go back into a shell until it gets to that point. So I'm not - you know, I think the biggest thing is really just awareness and getting men, you know - I think the big thing, too, has been that with changing gender roles men are a little bit more confused these days as far as, you know, being able to open up and...

MARTIN: So it's confusing. They're not sure of what rules to play by. Nate, what would have made a difference for you? You said if somebody had talked about it. Who is that somebody who you think could have been helpful in getting you the help you needed sooner? A doctor, if a doctor had said something to you, if a friend, what do you think? Perhaps a boss, an employer?

Mr. REYNOLDS: Probably would have had to have been a friend, you know, another man, in particular. I happen to be now with - through Doctor Rabinowitz(ph), one of the doctors in the article involved in a men's group, which is about 10 men that sit around and discuss day-to-day issues, not just depression, but what you find is that we all suffer real similar problems. It's just a matter of it being OK to talk about it, like you said. We fight, you know, a thousand years of evolution that we're told not to talk about it, but once we sit down and talk about it honestly, we all suffer very similar problems. So, yeah, if I would have had a friend sit down and tell me, you know, something's just not right, maybe something could have been done earlier.

MARTIN: And John, what about you? What are some strategies that might help this problem, particularly in African American - the African-American community and perhaps other communities of color? Are there particular strategies that need to be adjusted to be effective in these communities?

Mr. HEAD: Well, I think for people who are close to men, one of the things to do is to talk about the physical manifestations of the illness and not the emotional. Talk about the lack of energy, talk about not get up and doing things that you used to enjoy doing and, you know, suggest that there might be something wrong physically. And once that guy gets into a doctor, you know, the primary care physician, he's going to see things that may be an emotional problem and he's going to recommend they talk to someone else. And it tends to be that we are more likely to take that advice than to take the advice of people who are close to us.

MARTIN: But what about some of the symptoms that Chris talked about at the beginning of our conversation like the - it seems to me that a lot of thing that are unhealthy are also the things that are rewarded, you know, the work-a-holism, the irritability, you know, aggression? Sometimes men are so rewarded for those thing that, you know, how would you then know to say, gee, is there something really - is this really OK? Are you OK? Do you know what I mean? Is there any way you can sort of help people frame that behavior so that they know when it crosses the line between just being, you know, I don't know, just guys being guys and then something that's really unhealthy?

Mr. HEAD: Sure. I mean, if you see things that basically throws a person's life out of balance, a man's life out of balance, I think that's something to point out and talk about the fact that, you know, you should be getting - if you're doing something that you think is rewarding, you should be getting rewards for it. And if you're working 60 hours, 80 hours a week, but you don't feel any better, you don't feel any sense of accomplishment, then what are you doing? What is that adding to your life? So I think you have to focus on that balance of not only being productive but also feeling the rewards of that.

MARTIN: Chris, I was asking Nate whether he's had any reaction since his story appeared in the magazine. What reaction have you gotten to this information in the magazine? Are you hearing from readers about this?

Mr. STRAUSS: We haven't been hearing anything yet, but the magazine has also only been out on stands a little while. So, you know, I look forward over the next few months, or I guess in the next month is usually when we'll get letters from readers, and I think it'll be interesting to see what our guys have to say because, you know, I think that point of what we were looking to do with this is, you know, if it's not the person reading it who sees some of these symptoms in themselves, maybe it's in their friends, it's in family members. And the big thing for us was, you know, just getting the information out there and you know, if there are so many millions out there who are undiagnosed, maybe this is the first step.

MARTIN: But again, your article points out that often the trigger for getting treatment is women, women who sees symptoms in the men in their lives and they are the ones who prod them into treatment. Did you see any scenario in which you could reverse that trend so that actually men are more able to address these issues for themselves?

Mr. STRAUSS: Like I said, I think it's awareness is probably the biggest thing, and just understanding why people are doing what they're doing.

MARTIN: Chris Strauss is the features editor of Men's Fitness magazine. He joined us from our New York bureau. We were also joined by John Head, he's the author of "Black Men and Depression: Saving our Lives, Healing our Families and Friends." He joined us from the University of California at Berkley. We were also joined by Nate Reynolds. He's featured in the current Men's Fitness article about men and depression. He was kind enough to join us from his home in Moreno Valley, California. I thank you all so much for speaking with us and talking to us about this really important topic.

Mr. STRAUSS: Thank you.

Mr. HEAD: Thank you.

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