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The pain behind the mask: Overcoming masculine depression.
By John Lynch & Christopher Kilmartin. Binghamton, New York: Haworth Press, 1999, 220 pp., $ 19.95.
It warrants mention that there are a plethora of texts in circulation that could be used as valuable resources to supplement the psychotherapy process. One such text is Lynch and Kilmartin’s The pain behind the mask: Overcoming masculine depression. This text, which re-conceptualizes depression in the hope of better addressing the way depression is expressed among certain men, is written in such a way that it seems most relevant for those reasonably well educated, married heterosexual men. In essence, this text argues that the traditional means of diagnosing depression is oftentimes inconsistent with the way in which men tend to experience and express the state of depression. Lynch and Kilmartin’s work, therefore, could easily be used as a helpful resource during the therapeutic experience for those men who may be expressing depression in a “typically” masculine way, such as through dissociation and anger. The text examines the construct of depression, the development of masculine depression, familial and social influences in the expression of masculine depression, and pro-social ways to remedy masculine depression.
Among the considerable strengths of this text is the innovative manner in which it suggests that socialization may affect the way individuals express psychopathology. Lynch and Kilmartin address this point by stating that “men and women tend to display different depressive styles because of gender socialization, a process that encourages individuals to operate in the world according to explicit or implicit rules based on being female or male” (pp. 7-8). Additionally, the authors explain that, unlike women, men tend to dissociate from their feelings and act out in more destructive ways to themselves, others, and in their relationships. As a result of these differences in socialization, the way in which depression is diagnostically categorized may not always capture the ways in which many men express feelings of sadness and hopelessness. By acknowledging both that diagnostic criteria are not always absolute and that gender role socialization may inform the expression of mental illness, this text implicitly suggests the importance of flexibility and openness within the therapeutic process. Additionally, this concept of sensitivity towards the role of gender socialization may be most useful in the diagnosis, understanding, and treatment of mental illness, particularly depression.
An additional strength of The pain behind the mask pertains to the authors’ use of their own past clinical experiences to enrich the text. Case examples help the reader to understand firsthand how depression affects and is manifested in men. Lynch and Kilmartin relate that “appearances can be extremely deceiving when behaviors are profound distortions of underlying problems. Consider the following three cases…” (p. 3). The authors then proceed to weave these case illustrations, as well as many others, throughout the subsequent pages of the text. The use of anecdotal cases to illustrate various themes mentioned in the text helps to convey a sense of realness and immediacy to the discussion of masculine depression. Additionally, the employment of previous clinical experiences makes the text a more engaging, meaningful, and provocative read for those individuals for whom the experience of masculine depression may resonate.
Conversely, a final strength of this text concerns Lynch and Kilmartin’s use of empirical research throughout the text to better support their assertions. Through validating their points with previous research literature on the topic, the text seems more objective and grounded in empiricism, as opposed to fabricated ideas stemming from the authors’ personal conjecture. Lynch and Kilmartin’s use of research is best exemplified in their discussion concerning the acceptable expression of anger and rage in men. In this section, the authors frequently refer to David Lisak’s research. For instance, the authors state that “other research by Lisak has revealed that men who have been abused in some way as children and have accepted masculinity’s traditional values are more likely to become violent adults, in comparison to other men who have been abused as children…” (p. 178). The authors then proceed to examine the research in further detail.
The pursuit for potential limitations in Lynch and Kilmartin’s The pain behind the mask was labored at best. However, the presence of limitations in this text is real and should not be overlooked. While, as previously mentioned, a strength of the text is the use of previous research to support certain claims, the text is ultimately not free of the authors’ personal biases. Lynch and Kilmartin acknowledge this limitation by stating that “…although we include research findings where applicable, this model is not completely derived from empirical sources-controlled experiments, statistical analyses, and a systematic investigation of scientific claims” (p. xvi). While Lynch and Kilmartin’s beliefs concerning masculine depression are appreciated and clinically insightful, it may be more useful to more fully integrate prior research related to the topic within the text. In fact, one could argue that a stronger emphasis on research would lend a more objective, empirically supported, and unbiased account to the discussion of masculine depression.
Additionally, while this text’s discussion of masculine depression represents the experiences of many men, it does not address depression among men universally. The authors of The pain behind the mask recognize this limitation by explaining that “some men show the classic symptoms we have come to associate with depression, and there are also women who have the ‘masculine’ symptom pattern that is the focus of this book” (p. xvi). As a critical reader, one may immediately question the usefulness of this model as it is unable to formulate a more comprehensive assessment of masculine depression. Furthermore, one population immediately excluded from this discussion of masculine depression is homosexual men. In fact, the authors acknowledge, “our work is mainly focused on heterosexual men” (p. xvii). Additionally, the text does not address the experience of masculine depression among men who may also have a co-morbid pathological condition. Perhaps a more inclusive discussion of men and depression would address the comprehensive experiences of men more generally. However, while this text may not universally relate to the experiences of all men, the authors clearly delineate the audience to which this text is best suited.
Despite these limitations, this text may be an invaluable resource to facilitate the therapeutic experience. It should be noted that a keen awareness of one’s patient is crucial, as this text does not collectively address the experiences of all depressed men. This text’s clinical utility resides in the way in which masculine depression is conceptualized. Since the etiology of masculine depression is believed to be a result of gender role socialization, the text suggests that the best method for addressing this issue is through deep introspection and insight. Lynch and Kilmartin address this issue by stating, “…masculine socialization powerfully affects the way a man thinks, experiences the self, constructs values, and interacts with others…the acceptance of masculine social demands is an important ingredient in the recipe for masculine depression” (p. 70). By encouraging a deeper self-awareness of the effects of socialization, a client suffering from masculine depression would better be able to alleviate the beliefs that foster this condition. For this reason, those using insight-oriented approaches may benefit most from this text. However, while insight is proposed as being necessary in the treatment of masculine depression, this text may be helpful in other forms of psychotherapy as well, such as cognitive-behavioral or additional styles where education about the disorder may be beneficial. This text helps to illuminate, justify, and educate about the experience of masculine depression, while the precise means by which the psychotherapist chooses to therapeutically address this disorder is somewhat flexibly left to the discretion of the psychotherapist. One way in which a psychotherapist could promote insight into the ills of gender socialization could be through bibliotherapy. The patient could be assigned to read chapters of this text between sessions that may then be discussed in subsequent sessions in order to assess the ways in which the text may parallel the experiences of the patient. By offering patients the information in this text, the clinician would be allowing patients to actively educate themselves on the oftentimes pervasive, destructive effects that socialization may have on individual men and the people around them and further raise their consciousness about this frequently misperceived disorder.
In conclusion, Lynch and Kilmartin’s The pain behind the mask poignantly explores the concept of masculine depression in an effective, engaging manner. The text challenges the conventional methods of diagnosing depression and promotes therapeutic flexibility in clinical diagnosis. For those men who seek treatment for depression, and for whom this conceptualization seems appropriate, this text may be a useful tool to be integrated into the therapeutic process.