Tough guise

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      When a friend I'd known since high school killed himself a few years ago, we were all shocked. He was an even-tempered, feet-on-the-ground kind of guy whom people depended on and who never lost his cool. The business he owned and ran was thriving. He'd recently married a dynamic woman and they seemed happy. He didn't smoke, drink, or do drugs of any kind. Then came the day his assistant arrived at the office and found my friend dead. He'd hanged himself using a necktie. It was premeditated. They found a piece of paper on which he'd made a list of different suicide methods.

      Just prior to this, my friend had been prescribed antidepressants, which no one knew about. He didn't take them. I now know that he manifested several telltale symptoms of depression (see sidebar), the cause of about 90 percent of all suicides among both men and women.

      Depression and bipolar disorder, a seesaw of extreme highs and lows previously called manic depression, are the main mental illnesses that cause about 90 percent of all suicides among men and women. Antidepressants may have helped to save my friend, but we'll never know.

      “There are three predominant themes accompanying depression in men,” counsellor Lee-Joseph Lourdeaux says in his West End office. “They are perfectionism, self-criticism, and isolation.”

      That describes my friend to a T. A workaholic who strove for perfection, not once in the 25 years that we knew one another did he admit to self-doubt or uncertainty. He kept such thoughts to himself; in other words, he isolated them and, consequently, himself.

      “Isolation—not talking to other people about what's going on in your life—is a major ally of almost any [depression-related] problem you can name,” says Lourdeaux, an American expat who holds a PhD in English literature and a master's in social work, and has been counselling professionally for 10 years. “Isolation works with depression to keep problems a secret.”

      According to Lourdeaux, society has conditioned men to view depression as a sign of weakness. So they handle it “like a man” and suck it up, masking what they perceive to be a character flaw by overworking, abusing drugs and/or alcohol, and putting on a brave face.

      “Men often tell me that the person people see on the outside is not the person on the inside, that everyone thinks they're happy and self-confident when they're really not,” Lourdeaux explains.

      Results from a nationwide 2002 community health survey by Statistics Canada found that 10 percent of men experienced symptoms of mental-health disorders and substance dependencies. According to the Web site Child & Family Canada, from the 1960s to the 1990s the suicide rate quadrupled among male teenagers, from 5.3 to 23.0 per 100,000. The Canadian Health Network reports that suicide is the second leading cause of death among boys and young men aged 15 to 24. CHN figures from 2001 show that the Canadians with the highest suicide death rate (28.7 per 100,000) are men aged 40 to 44. Rates for aboriginal men are about four to five times higher.

      Depression among men is a serious problem. We need to start talking about it. Lourdeaux, who specializes in what is called narrative therapy, is all ears.

      “There are hundreds of different kinds of therapy, but after a decade of counselling I find this to be the most effective,” he says. He doesn't like to cloud his client sessions with medical jargon or assumptions, or to come across as an authority figure. “My position is one of curiosity—I don't see myself as an expert. After all, the client has more knowledge of the problem than I do. The fundamental human expression is the story, and by story I mean a sequence of events in time. We [Lourdeaux and his client] investigate the problem together so they can see how it operates in their lives.”

      Lourdeaux claims that narrative therapy is a way of objectifying depression (or grief, or sadness) as a problem separate from the individual. In other words, as with HIV/AIDS, the person is not the disease.

      Three excellent books by men who talk candidly about their personal experiences of depression are The Noonday Demon: An Atlas of Depression by Andrew Solomon (Touchstone, 2001); Darkness Visible: A Memoir of Madness by William Styron (Vintage, 1992); and In The Jaws of the Black Dogs: A Memoir of Depression (HarperCollins, 1999) by John Bentley Mays.

      I found them very helpful because I too suffer from depression. But that's another story.