These are the paragraphs I have highlighted.

I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression (1999) by Terrence Real

Depressed women have obvious pain; depressed men often have “troubles.” It is frequently not they who are in conscious distress so much as the people who live with them.

As a society, we have more respect for the walking wounded—those who deny their difficulties—than we have for those who “let” their conditions “get to them.”

Partners of depressed men often express fear that naming the man’s condition will only make matters worse. It is better just to “get on with it” and “not dwell on the negatives.” But when we minimize a man’s depression, for fear of shaming him, we collude with the cultural expectations of masculinity in a terrible way. We send a message that the man who is struggling should not expect help. He must be “self-reliant.”

A therapist would speculate that in Narcissus’s early development he was not cherished, never took the warmth of unconditional regard deep inside. Rather than an internal sense of worth, he becomes obsessed with his own adoration reflected back to him from without.

When a covertly depressed man’s connection to the object of his addiction is undisturbed, he feels good about himself. But when connection to that object is disrupted—when the cocaine runs out, the credit cards reach their limit, the affair ends—his sense of self-worth plummets, and his hidden depression begins to unfold. Such “withdrawal” drives him back to the drug, the achievements at work, or the next sexual conquest.

Most of us are thrilled if we win an award, find out about a financial windfall, or arouse interest in someone attractive. But in normal circumstances we do not rely on such things in order to feel good about ourselves. We begin from a baseline feeling about ourselves that is reasonably positive or at least neutral. The covertly depressed man, in contrast, relies on such external stimulants to rectify an inner baseline of shame.

Nondepressed men turn to mood-altering behaviors like drinking, gambling, or sex for relaxation, intimate sharing, or fun. Covertly depressed men turn to such substances or activities to gain relief from distress.

Just because a supplement for self-esteem is socially rewarded does not mean that it will not have disastrous consequences for the individual who relies on it.

Lots of bench presses...

In theory an addictive relationship can be established with just about anything, so long as the substance, person, or activity relieves the threat of overt depression. To accomplish this, the defense must transform one’s state from shame to grandiosity, from feelings of worth-less-ness to feelings of extraordinary worth and well-being. In common language, this sudden shift in consciousness is called intoxication. Along with the obvious effect of drugs or alcohol, one can also get “high” from the rush of physical violence, the applause of an audience, a sexual conquest, a killing in the stock market.

Defensive compensations for underlying depression can never move one directly from shame to healthy self-esteem, because such a shift requires confrontation with, rather than avoidance of, one’s own feelings.

The only real cure for covert depression is overt depression. Not until the man has stopped running. This is why the “fix” of the compulsive defense never quite works. First, the covertly depressed man must walk through the fire from which he has run. He must allow the pain to surface. Then, he may resolve his hidden depression by learning about self-care and healthy esteem.

These two forms of addictive intoxication differ in that merger gives the illusion of fusion with a force that is larger than life, while elevation gives the illusion of becoming such a force oneself.

Most people expect more than the bare necessities of living now. And crofting is not a livelihood. It’s an existence.”

Between the inordinate shame of depression and the relative shamelessness of grandiosity, there lies appropriate shame, feeling proportionately bad about something one has done wrong. Men who offend must first be brought from shameless behavior into the experience of their forgotten, appropriate shame. They must be thawed out. If not, the addictive defenses pull them toward behaviors that are at best disconnected and at worst irresponsible.

The defenses one chooses to avoid shame often afford relief while breeding more shame. Addiction experts have termed this pattern a “shame cycle.” The covertly depressed man’s defensive maneuvers or addictions can be experienced by the man as shameful in themselves or else they can create difficulties in his life that intensify his sense of inferiority, leading in either case to an increased craving for the defenses.

Addictions do to shame what saltwater does to thirst.

Only after the shame cycle has stopped, after the addictive pattern itself has been broken, and after the person has moved into “sobriety” can the pain of covert depression be addressed.

But while the capacity to externalize pain protects some men from feeling depressed, it does not stop them from being depressed; it just helps them to disconnect further from their own experience.

Covert depression, prevalent in men, can be viewed as internalized disconnection—the experience of victimization warded off through grandiosity, perhaps through victimizing.

But from a purely psychological perspective, we must understand that internalized pain and externalized pain are two faces of the same experience. We may find externalized pain more difficult, or even repugnant, but that does not make it a different condition, merely the same condition expressed in the ways men have been taught to express it.

For the covertly depressed man, what lies at the center of the defense or addiction is the disowned overt depression he has run from. And in the center of the overt depression lies trauma.

These slight instances of abandonment, in which we withdraw from that part of the boy that does not conform to our expectations, accumulate to great effect.

If traditional socialization takes aim at girls’ voices, it takes aim at boys’ hearts.

Most often, though, after the first few blows, the pain would mean nothing to me at all, until the numbness and disassociation wore off a few hours later.

Once we understand that “masculine identity” is not about an internal structure but rather a socially accepted definition of what it means to be male, then the processes by which we impose those definitions on boys sharpens in clarity.

But the true meaning of psychological “separation” is maturity, and we humans stand a better chance of maturing when we do not disconnect from one another. But what maturity truly requires is the replacement of childish forms of closeness with more adult forms of closeness, not with dislocation.

A truly isolated, small, and creative society will never again be possible on this planet … .

Perhaps the single most important discovery that has come from my work with men and their families is the realization that most boys and men have been subject to a preponderance of neither disempowering nor falsely empowering abuse, but to alternations between the two. This sudden switch from “one down” to “one up” and back again leaves boys and men in a perpetual state of anxiety about their status. No matter how “up” a man may be today, there is always tomorrow.

In modern culture, heroism has been stripped of virtually all of its spiritual significance. Removed from morality as well as from human community, heroism in our society has become a secular, individual achievement. Most often, it simply means winning big, whether on the baseball diamond or in the stock exchange. In the same way that we used to speak of a man’s valor, meaning both his worth and his bravery, we now speak of his value, meaning both his worth and the weight of his assets. We now celebrate corporate raiders, not buccaneers. But the old stirrings still speak to us, no matter how degraded their form. Both in our own lives and in the spectacles around us, we still search for higher meaning in achievement. We still equate performance with virtue.

The discomfort of the shame state sets the stage for overt depression and is defended against by intoxication and grandiosity in covert depression. Shame hounds boys and men throughout most of their lives for two reasons. First, since the standard of masculinity against which most boys and men measure themselves is unrealistically narrow and perfectionist, virtually no one feels he sufficiently measures up. Second, since masculinity is conferred more than won, since it represents membership, not a state of being, it is always in danger of being revoked. One can always “go over the side without a ripple.”

It isn’t that men have fewer relational needs than women, but that they have been conditioned to filter those needs through the screen of achievement.

If the choice is between success and connection, many boys simply refuse to play. We usually call these boys delinquents.

If overtly depressed men are paralyzed, men who are covertly depressed, as I was, cannot stand still. They run, desperately trying to outdistance shame by medicating their pain, pumping up their tenuous self-esteem, or, if all else fails, inflicting their torture on others.

Overt depression is violence endured. Covert depression is violence deflected.

In depression, the childhood violence that had been leveled against the boy—whether physical or psychological, active or passive—takes up permanent habitation within him. The depressed man adopts a relationship to himself that mirrors and replicates the dynamics of his own early abuse. This phenomenon, which I call empathic reversal, is the link connecting trauma to depression. To understand the mechanism of empathic reversal, we must accept a disturbing truth—that trauma intrinsically involves fusion between the offender and his victim. In the very moment of damage, some form of unholy intimacy occurs, in part because trauma always involves a failure of boundaries. In active trauma, a child’s boundaries are violated. The parent is uncontained, out of control. In passive trauma, the parent neglects the child’s needs; the boundary between parent and child is too rigid, impenetrable. Both are instances of boundary dysfunction.

When a child is traumatized—by a parent who is either negligent or out of control—his first and most profound response will be to take responsibility for the failing parent. When a child comes face to face with a caregiver’s pathology, that child will do whatever he must to reinstate the caregiver’s psychological equilibrium. A child’s need to preserve his attachment, his willingness to contort himself into whatever shape the parent needs him to be in during such moments represents one of the least recognized, most pervasive, and most powerful psychological forces in human development.

The child’s need to regulate his parent is as fundamental as his own instinct for survival. In fact, it is a direct manifestation of that instinct, for the simple reason that each child relies on his parents’ capacity to function in order to survive.

Projective identification is the term modern psychiatry has given to the phenomenon of carried feeling.

Psychoanalytic theory emphasizes the projecting person’s repudiation of his own feelings. The process is described as one wherein a person injects into another the disowned aspects of his own personality.

All traumatic acts are simultaneously disempowering and falsely empowering.

No matter how badly a caregiver treats a child, he also models, through example, a shameless way of being in the world. His actions say to the boy: “You, too, can behave as I do when you become a man.” In this tragic moment, the very forces that betray the boy, forces he most often finds abhorrent, come to live inside him.

The unpleasant fact that must be faced about trauma is that, in the very moment of victimization, a version of the same violence that hurts the child from without comes to “scream out its birth” from within.

If the anger and pain are directed away from the self, as is usually the case in covert depression, the addictive defenses and the irresponsible behaviors must stop, allowing the underlying depression to surface.

A depressed person is endlessly caught in the chains of his rehearsed inadequacies.

These outwardly accomplished men, running from inward emptiness, often reap ever greater rewards from the culture the more out of touch they become. The more they acquire, the bigger their deals, the more society reinforces their performance-based esteem.

Those who do not turn to face their pain are prone to impose it.

A covertly depressed man cannot afford to be fully responsive to those around him because his primary need lies in maintaining his defense, his emotional “prosthesis.” It is not uncommon for a man’s need for performance-based esteem to become so compulsive that it not only gets in the way of his relationships, it even gets in the way of his performance.

What the defenses in covert depression medicate is the pain of the man’s poor relationship to himself.

He learns to bring the strengthened “functional adult” part of him out to nurture and contain those younger aspects of self.

Relational heroism occurs when every muscle and nerve in one’s body pulls one toward reenacting one’s usual dysfunctional pattern, but through sheer force of discipline or grace, one lifts oneself off the well-worn track toward behaviors that are more vulnerable, more cherishing, more mature.

Thinking of maturity as a daily practice is a radical departure from traditional psychotherapy in which the man’s difficulties in relating to himself is envisioned as character pathology, ego dysfunction, or structural deficits.

“Whether I am accepted or rejected, right now, the person whose job it is to cherish me is me.”

Underneath the covertly depressed man’s addictive defenses lies the pain of a faulty relationship to himself. And at the core of this self-disorder lies the unresolved pain of childhood trauma. Healing from depression unpeels these three layers in three phases:

  1. sobriety
  2. the practice of relational maturity
  3. trauma release.

Unlike the other therapists I had previously tried, and dropped in short order, Paolito—despite my numerous, clever invitations—refuses to engage with me in intellectual pirouettes. Like an immovable plumb line, he simply beams his affection for me, over and over again. And no matter how convoluted or complex I present myself as being to him, he simply smiles, a little wistfully, and loves me. I find the touch of his love excruciating.

The essence of recovery lies in the art of bringing a learned and practiced maturity (the functional adult) into relationship with immature, injured aspects of the self (both the vulnerable child and the harsh child). By acknowledging trauma and by repudiating identification with the aggressor, the internalized dynamic of violence is mended; the frozen state of depression breaks up, and simple, healing grief thaws the heart.

The goal of treating post traumatic stress disorder is to help people live in the present, without feeling or behaving according to irrelevant demands belonging to the past. Psychologically, this means that traumatic experiences need to be located in time and place and differentiated from current reality.

Recovery from covert depression must involve three layers—the addictive defense; the underlying relational immaturity or disorder of self; and the childhood trauma that set the whole process in motion.

Until a man has halted the acting out of his distress, dealt with his relationship to himself, and brought his mature self to acknowledge and deal with early wounds that remain very much alive within him, he will be inescapably impaired in his capacity to sustain a fully satisfying relationship.

I believe that one first changes the behaviors, then, if one is lucky, the feelings follow.

Society teaches neither member of the couple how to deal with the raw pain that is a part of any real relationship, because it does not even acknowledge the existence of that pain.

Women, in this culture, have been taught to be indirect, manipulative, and silent, while men have been taught to ignore their women, punish them, or feel wounded by them if they dare speak out.

A huge number of phobic women’s husbands begin to show signs of addiction, pathological jealousy, violence, and, most commonly, overt depression, when their wives’ level of functioning rises.

Any woman knows that few strategies serve to “build up” a male more effectively than her own appearance of helplessness. Some women seem willing to keep their covertly depressed men strong by becoming less functional than their partners.

When I am faced with a family in which there is a depressed woman, my first move is to empower the woman. When I am faced with a family in which there is a depressed man, before beginning work with the man, my first move is to empower the woman. To help a depressed woman means facilitating her rise against the forces of oppression that surround her. To help a depressed man, one needs to invite him to step up to increased relational responsibility, a move he may not be inclined to make if his partner allows him to avoid it.

Just as the beam of contempt, the internalized dynamic of violence, may sometimes turn inward in overt depression, sometimes outward in covert depression, the regenerative force of recovery must turn inward toward increased maturity, increased self-regulation, and outward toward increased relational skill. Recovery, at its deepest level, evokes the art of valuing, caring for, and sustaining. The relationship one sustains may be toward oneself, toward others, or even toward the world itself.

The essential shift in question that marks a depressed man’s transformation is the shift from: What will I-get? to: What can I offer? Entering into a fathering relationship—to a child, a mate, an art, a cause, to the planet entire—means to become a true provider. Recovery demands a move into generativity.

The word discipline derives from the same root as the word disciple. Discipline means “to place oneself in the service of.” Discipline is a form of devotion. A grown man with nothing to devote himself to is a man who is sick at heart. What a great many men in this culture choose to serve is their own reflected value, which they often believe serves the needs of their family, even while their families may be crying out for something different from them.

Our interconnectedness to nature, and to one another, can no longer be denied. We live in a global economy. We share global resources. We face global threats. The paradigm of dominance must yield to an ethic of caretaking, or we simply will not survive.

Curriculum Vitae (CV)