GENDER DIFFERENCES AND THE MANIFESTATIONS OF DEPRESSION
Depression affects developing men and women differently. According to Prinstein et al., “by late adolescence, girls are two to three times more likely to experience depression than boys” (2005, p. 676), and this statistic holds true for nearly every country in the world (Ingram, Scott, & Siegle, 1999). Women are also more likely than men to attempt suicide, but “men (are) more often successful” (Beck & Alford, 2009). This may have to do with the lethality of means employed. Women are more likely to use poison or carbon monoxide poisoning (Denning et al., 2000), or to cut their wrists, whereas men are more likely to use a firearm, hang themselves, or jump from a height (Sarma & Kola, 2010); these latter methods are more likely to result in death. Slater illustrates this sex difference:
I wish I were a man. I wish I were a woman with the mind of a man. . . . Men, in general, are more successful at pulling off a suicide. Women botch it, leave the bathtub bloody. Maybe women don’t really want out of the world, just out of their gender, released to a place dry and white. (Slater, 2001, p. 88)
The study conducted by Prinstein et al. (2005) found that high levels of depressive symptoms, feeling rejected by peers, and the perception that friendship quality is actually more negative than it is objectively were correlated with an increased tendency among girls to engage in reassurance-seeking behaviors. Furthermore, they found that excessive reassurance seeking led to a decrease in friends’ perceptions of relationship quality. This would suggest a seemingly self-reinforcing cycle; depressive feelings lead the person to question the quality of their relationships, the ways in which they are perceived, and to attend to rejection more easily than acceptance. This self-doubt manifests itself as reassurance-s eeking behavior, which in turn leads to a decrease in friendship quality because when done excessively, it undermines the existing core of trust and positive regard held by others in the relationship.
Reassurance seeking may more easily lend itself to the development of depressive symptoms in girls than in boys because of women’s societal and biologically rooted methods of communication. According to Brizendine (2006), women are built to take in information from others by reading their facial expressions, and the areas of their brains designated to do so are actually different from men. This necessity dates back to the days when women’s evolutionary survival depended on being accepted by the group and protected by men. Brizendine says, “Little girls do not tolerate flat faces. They interpret an emotionless face that’s turned toward them as a signal they are not doing something right” (2006, p. 15). Therefore, the proclivity of young women to participate in reassurance-seeking behavior and, in turn, to develop depressive symptoms when they backfire may be biologically hard-wired.
Some other reasons for this inclination toward depression in women may be cultural. In the United States, women are bombarded with images of the “ideal” woman: tall, emaciated, big perky breasts, a supple bottom, and not an ounce of fat anywhere. Flawless. Smiling. Accommodating. Generic. Natural feminine characteristics are described in commercials and the media as shameful flaws that should be rectified, and in this way capitalism creates and exploits insecurities for profit. What is unique is labeled different, and what is different is translated to mean bad or inferior, a tendency that can be drawn back to differentiating between self and other. What makes this particularly difficult is that just as young girls enter puberty, their bodies start preparing for reproduction. They develop fat where none was before, and their bodies become more curvaceous. Although this is the natural course of development, they are often made to feel uncomfortable in their own skin, as healthy weight gain is regarded by society as a sign of obesity. In addition, this shift in focus onto physical appearances means that there is often societal pressure to be more “feminine,” and femininity is unfortunately defined in ways that tend to suppress individual characteristics in favor of conforming to group norms (Hazler & Mellin, 2004).
Media images and commercials challenge female adolescents to look their best, which often means looking similar to others. Parents often begin to compliment daughters on their weight and looks. Female friends isolate them from groups or spread rumors about their sexual orientation for not taking interest in liking boys and putting on makeup. (Hazler & Mellin, 2004, p. 21)
These cultural messages contribute to an array of psychological difficulties that can be manifested in a number of self-destructive behaviors, including eating disorders, self-mutilation, experimentation with alcohol and drugs, and reckless sexual activity. Underlying many of these is often a deep-rooted depression, which may very well be a reaction to the loss of self. In Reviving Ophelia, Pipher says of the particular manifestations of depression in adolescent girls: “the inward form is the grieving for the lost self, the authentic girl who has disappeared with adolescence. There’s been a death in the family” (1994, p. 150).
Cookie-cutter images of how women are supposed to be are forced on young girls just as they are developing their sense of self. The media in the United States has a tendency to impose on them the idea that physical appearances are everything; others’ evaluations of them will be much more heavily based on bra size, weight, and physical appearance than on character or anything they have to say. Social justice issues and political coverage are replaced in the news with information about popstars and sexist propaganda. Women are taught to be accommodating, submissive, and deferential. Assertiveness is often interpreted as aggression in women, as it represents an attempt to exert control that they are not perceived to legitimately have, and ambition is perceived to be a distinctly male quality (Carli, 1999). When attempting to contribute to task-oriented (rather than social) goals in a group, Meeker and Weitzel-O’Neill (1977) found that women needed to demonstrate their competence and positive/cooperative (rather than competitive) intentions, whereas men needed to demonstrate only one of these qualities.
Personal talents and aspirations are often de-emphasized, as increasing pressure to conform to the media’s and society’s image may leave young girls feeling like they have betrayed a major part of themselves. Thus gender inequities within the culture can create a backlash, resulting in the development of a depressive reaction. Pipher says of the culture of cutting among depressed teens in the United States:
As a metaphorical statement, self-mutilation can be seen as an act of submission: “I will do what the culture tells me to do”; an act of protest: “I will go to even greater extremes than the culture asks me to”; a cry for help: “Stop me from hurting myself in the ways that the culture directs me to” or an effort to regain control: “I will hurt myself more than the culture can hurt me.” (1994, p. 158)
Social norms and gender expectations perpetuated by the media do not affect women alone; men have also been shown to manifest depressive symptoms differently than women, to be more negatively evaluated and rejected socially for their depressive symptoms than are women, and to be less likely to seek professional help. For example, Pollack (2006) describes the indoctrination of young boys into something he calls the “boy code,” which entails societal pressures placed on young boys to embody autonomy, toughness, an ease of premature separation, and emotional self-containment that results in a diminished capacity for emotional expression and can lead to “increased school failure, depression, suicide, lonely isolation, and . . . violence” (p. 190). Pollack (2006) further describes this as a “socialization system” that “shames boys away from their emotional vulnerability and basic need for human connection, just when they need it most” and characterizes these socially imposed norms as a form of “gender straitjacketing” (Pollack,
2006, p. 190).
As a result, depression often manifests itself in men in less immediately apparent ways. Symptoms typical of depression—including tearfulness, low self-esteem, and sad affect—are often not visible in men, despite deep feelings of emotional pain. Funabiki et al. (1980) found that on a self-report, depressed men “tended to endorse items such as inability to cry, social withdrawal, a sense of failure, and somatic complaints,” (p. 194) many of which are aligned with traditional gender expectations. Zamarripa, Wampold, and Gregory (2003) also found that “men showed higher levels of restrictive emotionality than did women,” and this was shown to be correlated with depression (p. 336). This tendency toward emotional restriction has been well documented (Good & Mintz, 1990; Good et al., 1996; O’Neil, 1981; O’Neil et al., 1986; Sharpe & Heppner, 1991). Boys are taught from early on to be strong, to achieve, and to “act like a man,” and they are frequently teased with terms that suggest femininity, homosexuality, or that seriously call into question their masculinity when they fail to meet these standards.
Therefore, it makes sense that depression manifests in these ways. Being independent is not traditionally seen as unmasculine (i.e., socially withdrawn—although these are clearly not the same thing), and complaints in terms of achievement (i.e., sense of failure) or physical ailments (i.e., somatic complaints) are much more readily accepted. As Pollack (2006) says, “Indeed, the same kind of shame that silences girls from expressing their voice as adolescents takes a toll on boys at a much earlier age” (p. 191). Several interviews that were conducted as a part of Pollack’s study support this. During one interview, a boy said, “You just keep it inside, don’t tell anybody about it, feel sick inside, and then maybe after a while it just sort of goes away” (Pollack, 2006, p. 193). Yet another boy articulated very clearly the restrictive expectations placed on him:
If something happens to you, you have to say, “Yeah, no big deal,” even when you’re really hurting. When it’s a tragedy—like my friend’s father died—you can go up to a guy and give him a hug. But if it’s . . . [anything less] . . . you have to punch things to brush it off. I’ve punched so many lockers in my life, it’s not even funny. When I get home, I’ll cry about it. (Pollack, 2006, p. 193)
Indeed, this example is illustrative of the way that depression is more typically manifested in boys as aggression. Whether this is a defense to ward off the internalization of negative self-appraisals or a compensatory one in order to not feel further threatened by members of their peer group when emotionally vulnerable, depression in men is frequently disguised by more overt symptoms and behaviors. In a discussion of Sroufe and Rutter’s work, Gjerde, Block, and Block (1988) state, “Depression in young boys often is embedded within the context of conduct disturbances—an externalizing pattern of symptom expression” (p. 475). For example, depression has been linked to doing poorly academically, getting into fights, and getting into trouble at school among men during early adolescence (see Ebata and Peterson, 1988, as cited in Gjerde et al., 1988). This was further supported by a study conducted by Gjerde et al., who found that “male adolescents with depressive tendencies appear more likely to act on their world with aggressive, externalized behaviors” (1988, p. 482). What appears as conduct disorder, opposition, or aggression may actually mask an underlying depression that is missed because the other signs are much more immediately apparent.
These problems are exacerbated by the fact that the men themselves are often unaware of the underlying causes of their behavior and are less likely to pursue help due to fears of stigmatization. In a study conducted by Rochlen, McKelley, and Pituch (2006) that investigated the effectiveness of promotional mental health material geared toward men, the National Institute of Mental Health (NIMH) stated that “men are less likely than women to recognize, acknowledge, and seek treatment for their depression” (p. 1). Unfortunately, there is also evidence that there is a strong social gain that reinforces men’s inclination toward concealing depressed feelings. Hammen and Peters (1977) found that depressed men were evaluated more negatively by participants than were depressed women within their study. In subsequent research (Hammen & Peters, 1978), they found that participants were more rejecting of depressed men and they rated them as more feminine; female participants, in particular, reacted with more negativity to depressed men than they did to depressed women (although this was also found in reverse, with men evaluating depressed women more negatively than they evaluated depressed men). Thus men and women both experience a form of gender role restriction, silencing, and emotional suppression in light of extremely painful experiences, thereby perpetuating the cycle of unarticulated and unacknowledged darkness within subjectivity.