The core paradox of men and depression is this: women are more likely to be depressed; men are more likely to kill themselves. This makes literally no sense. Unless one is assuming a giant epidemic of men who wake up bright and early one morning, whistling a jaunty tune and thinking cheerfully about the day ahead, who then commit suicide because it seems like the thing to do, it’s simply bizarre.

One of the most obvious explanations for the paradox is that, for whatever reason, men who are depressed are much less likely to be diagnosed with depression.

Of course, one major factor affecting whether men get diagnosed with depression is that men in general far less likely to go to a doctor and get diagnosed with an illness. Where women are likely to go to the doctor when they’re suffering a mysterious pain, men are more likely to tough it out and be macho and endure. This is particularly true of emotional pain: if you believe boys don’t cry, you are not going to go to a psychologist because you feel sad and empty and hopeless all the time.

However, another reason is that many of the diagnostic criteria for depression are symptoms primarily shown by women, not symptoms primarily shown by men. Dr. Christopher Kilmartin describes women as tending to act in and men as tending to act out. That is, women tend to express their depression internally (crying, self-injury, worrying, fatigue, taking about sad feelings), while men tend to express their depression externally, through “chronic anger, self-destructiveness, drug use, gambling, womanizing, and workaholism.”

A study of young men by the Samaritans, a British anti-suicide group, provided some interesting results:

Half of suicidal boys had been in trouble with the police.

Suicidal boys are four times more likely to smoke than non-suicidal boys.

Suicidal boys are three times more likely to drink than non-suicidal boys.

Suicidal boys are ten times more likely to take illegal drugs than non-suicidal boys.

Suicidal boys are four times more likely to smash something up when stressed than non-suicidal boys.

A third of suicidal boys withdraw (i.e. “keep it to themselves,” “stay in their room”) when stressed.

59% of suicidal boys, as opposed to 33% of non-suicidal boys, believe boys are expected to cope with problems themselves.

58% of suicidal boys believe men are losing rights, compared to 39% of non-suicidal boys.

52% of suicidal boys believe a helpline can’t do anything to improve their lives, compared with 22% of non-suicidal boys.

Of course, correlation is not causation. For instance, getting in trouble with police may cause depression to the point of wanting to kill oneself or both getting in trouble with police and suicidal ideation may be caused by a certain personality trait (impulsiveness?). However, in total, these statistics create a portrait of “male-pattern” depression.

Powerlessness may be externalized, such as by blaming it on “feminism going too far,” in order to resolve the contradiction between the male gender role (which is supposed to always have control over others) and the lack of power characteristic of depression. Depressed men may self-medicate through alcohol, drugs and cigarettes in order to make themselves feel better in a socially acceptable way. Depressed men may withdraw and isolate themselves. Depressed men may channel their emotions into anger, since that’s more acceptable than crying or sadness.

And they will not seek help, because men don’t seek help.

I don’t mean to be gender-essentialist here. Many women express their depression through self-medication and anger; many men express their depression through crying and talking about being sad. However, in aggregate, there do seem to be tendencies for men to express their depression in a different way from women in order to express their masculinity properly.

Unfortunately, this leads to many men not receiving the treatment they need. Half of all prison inmates in the United States have at least one mental illness; the vast majority of prison inmates are male. Men are twice as likely as women to become alcohol dependent at some point in their lives. In Europe, women are only 20% of users of drug treatment centers which is impressive, given the general socialized tendency for men to not seek mental health help. Men who are depressed may find themselves in the prison or drug treatment system instead of seeking the help they need.

How can we fight this? There are three steps, I think:

1) Raise awareness among mental-health professionals and the public of male-pattern depression. Anger, withdrawal and self-medication may be serious signs of depression among men. Mental-health professionals should take these symptoms as seriously as they take typically feminine symptoms such as self-reported depression.

2) Encourage men to seek help by redefining seeking mental health help as masculine. Taking advantage of masculinity may help more men seek the help they need. Positively depict men getting mental health help as courageous, assertive, taking control of one’s life and being a leader. If I were running the world, I’d start an ad campaign with prominent masculine celebrities “coming out of the closet” about their experiences with mental illness and saying that seeking help is manly.

3) Get rid of toxic cultural ideas of masculinity. It is fuckstupid that two of the most prominent coping mechanisms for men are “taking illegal drugs” and “smashing stuff.” Seriously? That’s the best our culture can do? Women are encouraged to cry, talk to their friends and seek mental health help, and men are encouraged to cause harm to themselves, others and innocent inanimate objects? What the hell? The current cultural construction of masculinity is a mental health crisis.