Retirement may be dangerous to your health—especially if you're a man.
A growing body of research has found that retirement significantly increases the risk of clinical depression and even suicide among men.
As an advisor working with retirees, you may be a witness—and sometimes an unwitting accessory—to lives whose joy is sapped by depression. If these afflicted clients are men, you will probably have to take the lead in encouraging them to seek help because they won't volunteer that they need it.
There are an estimated 11 million depressed men in America at any given time, according to psychotherapist Terrence Real, LICSW, author of "I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression." That's about 9% of the adult male population. "But we have to take that number with a huge grain of salt," Real added, "because so many men don't come forward. They are just not built to talk about these sorts of issues."
The most typical cause of depression in older men is loss, according to Alan Berman, Ph.D., ABPP, who is executive director of the American Association of Suicidology in Washington, D.C. He explained that men who have attached their sense of identity and value to their work can become depressed in retirement if they can't successfully transfer that attachment to new interests. Other losses—the death of a spouse or peers, loss of work relationships, moving away from lifelong attachment to home and friends—often lead to loneliness and sadness. A man confronting a serious illness or signs of mental decline may become depressed by the prospect of dependency.
When this kind of crisis hits a man, not only does the masculine agenda he's lived by his whole life fail him, but he often has no network of support to lean on. As Real pointed out, "Many men on the road to success have worked very hard, sometimes at the expense of their family, friends, recreation, health. So when the man turns to these relationships, he may be troubled, or he simply may not have the richness of social connection." Apathy or negativity can become chronic or turn into an ever-deepening spiral.
Why Men Tend to Hide Depression
"A man is about as likely to ask for help for depression as to ask for directions, and for much the same reason," said Real, who struggled with his own depression issues. "It's part of the male code, part of masculine culture."
The essence of traditional masculinity, he suggested, is invulnerability. The more vulnerable you are, the less manly you are.
"This sets up what I call compound shame," he said. "Men get ashamed about feeling ashamed, about feeling depressed. A depressed man is not only 'weak enough' to be overwhelmed, which is unmanly, but he's overwhelmed by his own feelings. So there's the double stigma of having an emotional disorder and being weak." By contrast, a depressed woman has to deal with the stigma of having a disorder, but it's not considered unwomanly.
As a result, many men hide depression from their family members and others. "This is a great tragedy because depression is one of psychiatry's success stories," Real said. "Studies show that 90% of people who get help with depression through therapy and often medication report substantial relief. But fewer than three out of five depressed people get help." Tellingly, only about 20% of therapy clients are men.
Clues to Depression
Some of the classic signs of depression are feeling blue, losing one's sense of pleasure and joy in life, changes in sleeping or eating habits (too much or too little) and fatigue. Men may also express depression through signs that aren't as common among women, such as increased drinking, a marked increase in irritability and aggression, or what Real calls "radical isolation": a significant withdrawal from other people and life.
Depression may also manifest itself in changes in a client's personality, personal hygiene and ability to make financial decisions, in sexual dysfunction and sometimes in memory problems. Women tend to be more outwardly emotional, while men tend to internalize their feelings.
Ken Donaldson, a licensed mental health counselor in Seminole, Fla., who is a certified relationship coach, warned that while symptoms like memory loss, confusion, social withdrawal, loss of appetite, weight loss, sleeping disturbances and bothersome aches and pains could be due to depression, they may have another physical cause.
"A number of things can mimic depression as a man gets older," he said. "It could be the beginning of dementia or Alzheimer's; it could be many things." In particular, he pointed out, men go through hormonal changes as part of andropause. When testosterone levels drop, the symptoms can resemble depression, but treatment for depression won't produce the desired improvement in mood. Donaldson advised that men who feel depressed should ask their general practitioner for a check of their testosterone levels. "Sometimes taking prescribed testosterone can raise the levels and remove the symptoms," he observed.
Berman's experience in the suicide prevention field prompts him to broaden the symptomology for older men with depression. They may also show evidence of a "depletion syndrome," he said: lack of interest in previously enjoyed activities, self-medication with alcohol, hopelessness and thoughts of death. In concert with signs of increased anxiety such as agitation, fidgetiness or insomnia, depletion symptoms are of particular concern since they are associated with increased risk for suicide.
What to Do If You're Concerned
"The first thing advisors need to do is to stop colluding with the shame around depression," Real said firmly. "We get afraid to confront a depressed man. We're afraid we're going to make him even more fragile, or that he'll blow up." He urged that advisors imagine themselves dealing with a depressed friend or relative. Wouldn't it be a great service to open up the conversation?
"So first of all, be his friend—a sympathetic listener," Real said. "If the issues are serious enough, there's no shame in suggesting the possibility of talking to a professional therapist, counselor or pastoral advisor."
"If they come in with feelings of hopelessness or suicidal ideation, even if it's really vague, you don't want to waste any time before you take action," emphasized mental health counselor Donaldson. "If they're married, get the spouse involved. Sometimes she will be in denial too, and other times she won't know what to do. If there's no spouse, call in one of the adult children for more feedback and help."
This is a good reason, he believes, for advisors to build relationships with one or more of their clients' adult children. "Not every advisor is open to this, and not every elderly client wants it to happen," he said. "But where it's possible, I would contact an adult child and make the request."
Getting a Troubled Client to Open Up
When a male client is worried that admitting to depression will make him seem unmanly, how can an advisor get him to open up about what's going on?
"This takes delicacy," Real answered. "It's a combination of being diplomatic, yet specific." He suggested starting a conversation with something like "Bill, you've told me in our last few meetings that you've been feeling really unhappy." Or, "You've said you're feeling really stressed out, and you just don't seem to be your old self." Add any other specifics that you've heard or observed. Then you might say, "I'm wondering if you might be struggling with some kind of depression."
