Lonely Man

Depression’s Male Victims: In Each Successive Generation, the Stigma Is Declining

Depression’s Male Victims: In Each Successive Generation, the Stigma Is Declining

By David Holzel of Baltimore Style Mag
June 7th, 2024

Read on Baltimore Style Here

When he was in his 20s, Lester Hopkins underwent open heart and spinal surgery. The experience left the Baltimore native traumatized.

“I was in a deep depression for quite some time,” he says.

“Growing up, mental health wasn’t talked about, especially among men,” Hopkins says, recalling the atmosphere in a house full of brothers. Depression was stigmatized, a sign of weakness. “Even today, we don’t have these conversations.”

Eventually, Hopkins realized that he couldn’t power through the debilitating illness on his own. He sought counseling, but the anti-depression medication recommended to him sounded like a crutch. So he turned it down. It wasn’t until his 30s that Hopkins agreed to add meds to his treatment.

Despite his original hesitation, at 46, Hopkins is managing his depression and anxiety. He shares what he has learned about the illness in his job as outreach coordinator for NAMI Metropolitan Baltimore. NAMI, the National Alliance on Mental Illness, offers support groups, classes, mental health hubs, community education and advocacy.

Unlike in Hopkins’ younger days, information about depression and its treatment is now more widely disseminated.

Lester Hopkins , Outreach Coordinator, NAMI Baltimore (Photo by Nova Getz)

“The stigmas are falling,” he says. “But there’s still work to be done.”

Much of that work involves convincing men that depression isn’t a failure of masculinity or a moral weakness. That you don’t pull yourself up by your bootstraps. That there aren’t any bootstraps.

The ways that boys and men are socialized can obscure, misdirect and render depression invisible, experts say. That can make the illness more lethal for males.

The differences between depression in men and women are striking: About 9.5% of Americans ages 18 and over suffer from a depressive illness each year, according to Johns Hopkins Medicine. And some 6 million of them are men, the National Institute of Mental Health reports.

Although women are nearly twice as likely as men to suffer from major depression, the disease is more fatal to men.

The reason is that death by suicide is four times higher among men than women, according to the Centers for Disease Control and Prevention. While women attempt suicide more often than men do, men are more likely to die from the attempt. Why?


Suicide is the leading cause of gun-related deaths in the United States. Guns are a more lethal means to commit suicide than overdose or poisoning, and men are more likely than women to have a gun handy.

Dirty Harry and Don Draper

Jodi Frey, Associate Dean for Research, University of Maryland Baltimore School of Social Work. (Photo by Matt Conn)

What does depression—a common but serious mood disorder—look like? Women who seek treatment report feelings of sadness, guilt and hopelessness, fatigue, changes in appetite and a loss of interest in things they once enjoyed.

In other words, they seem depressed.

Men experience these symptoms, too. But what often stands out among depressed men is not ennui, says Michael Fell, a licensed clinical professional counselor with Baltimore Men’s Counseling.

“A lot of times depression manifests as anger,” Fell says. “Men are told that that’s one of the acceptable emotions.”

Anger is the emotional palette of Gary Cooper and John Wayne, of Dirty Harry Callahan and Don Draper—the American ideal of the strong, silent type: Don’t look weak, don’t be a quitter, don’t be vulnerable, don’t cry and, for heaven’s sake, pull yourself up by your bootstraps.

“That’s how a lot of men report experiencing and thinking about depression,” says Jodi Frey, associate dean for research at the University of Maryland Baltimore School of Social Work.

Other behaviors mask the vulnerabilities caused by depression, says Aaron Herman, a psychotherapist and owner of Baltimore Men’s Counseling.

“It will look like workaholic-ism,” he says. “It will look like substance use. It will look like this never-ending quest for, ‘I am this, but I need to be that.’ This constant chasing of this unrealistic standard and internalized shame. If we look at ourselves as not enough and then we say, ‘OK, well, I’ll be enough when I have six-figure salary.’ And then we get there and it’s not enough.”

Untreated depression can worsen over time, says Jason Noel, associate professor of practice, sciences and health outcomes research at the University of Maryland Baltimore School of Pharmacy.

“I think there’s a pretty significant understanding that men are much less likely to seek out treatment,” he says. “And so by the time someone with depression does present to treatment, it’s probably going to be in a more severe state.”

Aaron Herman, Psychotherapist and Owner, Baltimore Men’s Counseling. (Courtesy of Aaron Herman)

Retired and Depressed

For men, the dream of retirement with its promise of doing anything and nothing can lead to depression. After a lifetime of being worker, father and spouse, of calling the shots and being identified by a career, many men are unprepared for adapting to a new identity, Herman says.

“If we don’t define ourselves as individuals at this point, as a human, rather than as a professional, or a husband or father—we’re lost,” he says. “We don’t know how to make friends. We don’t know how to find a new hobby. We don’t know how to fill our day with something that is nurturing us. It can lead to a lot of isolation and loneliness. I ask men, ‘What do you do for fun?’ ‘I don’t know.’ I hear that all the time.”

Contributing to loneliness, older men have fewer friends than older women. What do women do that men don’t?

“Talk about their feelings,” Herman says.

“For men who are heterosexual, from the time they’re little, they are often taught to be distant from other men,” Fell says. “Other men are competition. And there’s the whole fear of being gay or being labeled that. Men can’t have intimacy. But we are creatures that are wired for intimacy.”

Older men whose wives die are more likely to die sooner themselves than a woman who loses her spouse, Fell says. “For a lot of men, their intimacy is their wife.”

Jason Noel, Associate Professor of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy (Courtesy of Jason Noel)

Millennials and Gen-Z

The demographic group with the highest suicide rate is white men age 85 and older. They have nearly four times the number of self-inflicted deaths as the country as a whole, according to the CDC.

Those 85-year-old men belong to the Silent Generation, born between 1928 and 1945, whose childhoods were marked by the Great Depression and World War II. In the midst of catastrophes bigger than any individual’s problems, they learned to be seen and not heard.

Millennials (born 1981-1996) and members of the Gen-Z cohort (1997-2012) grew up in a time of accelerating “crisis after crisis” — mass shootings, 9/11, the Great Recession and the coronavirus pandemic with its social isolation and death of loved ones. All amplified by social media.

But these generations are not silent.

“Younger adults are much more open to talking about mental health and well-being,” Frey says. As job seekers, they “often ask about the [mental health] resources and bringing your whole self to work. They’re much more open to seeking help. Like it’s not something to hide.”

Frey says women have their own biases about how a man is supposed to act. Even a sympathetic spouse may not be prepared when a man opens up.

“A lot of times women can be really uncomfortable when a man talks in a way that makes him more vulnerable, sharing emotions that you don’t normally hear about, or even crying,” she says.

Still, even though the stigma against depression is beginning to fade, therapists will continue to look for the unique expressions in men.

“I compare men to working with kids in therapy,” Herman says. “What you see really isn’t what’s going on. With men, whether it’s sadness or guilt or shame or fear, it gets transmuted into anger.”


If you need help now
The National Suicide & Crisis Lifeline
You’ll be connected with a trained counselor. They can also connect you to mental health services in your area. The line is available 24/7 and is for people in crisis and those who support people in crisis.

Baltimore Men’s Counseling
Focuses on psychotherapy primarily, but not exclusively, for men.
3600 Clipper Mill Road. Ste. 222 Baltimore, MD 21211

Better Help
Provides professional, individual therapy online.

Man Therapy
Website that reminds men that taking care of their mental health is the manliest things a man can do.

NAMI Metropolitan Baltimore
NAMI is the National Alliance on Mental Illness, Offers support groups, classes, mental health hubs, community education and advocacy.
410 435-2600

Veterans Crisis Line
Dial 988 and press 1
If you’re a veteran in crisis or concerned about one, crisis chat is available 24 hours a day, 7 days a week.