The Portrayal of Depression in Magazines Designed for Men (2000-2007) JUANNE N. CLARKE Wilfrid Laurier University

This paper offers an investigation of the portrayal of depression in magazines whose audience is primarily North American males of young middle ages ranging between medians of 37 and 42.5. It is based on a content analysis of articles indexed under the topic of depression from 2000-2007 in Esquire, Men’s Health and Sports Illustrated magazines. Findings suggest that depression in men’s magazines is encapsulated in stereotypical male discourses of success at work, ignorance of feelings, and reluctance to seek help. Violence is another, although less prevalent theme. Depression is described as largely as having biochemical and/or genetic cause. A few articles mention the possible effects of the socio-economic and gendered experiences of maleness or masculinity. The possible theoretical explanations of this portrayal are discussed. Keywords: depression, magazines, men, middle age men, young men

The purpose of this paper is to describe and analyze the portrayal of depression in three popular mass media magazines directed specifically towards young middle-aged men, Sports Illustrated, Esquire and Men’s Health, during the years 2000-2007. Depression is the largest overall cause of nonfatal disease internationally. About 12 percent of all years lived include depressed years (Ustun, Ayuso-Mateos, Chatterji, Mathers, & Murray, 2004). Approximately 9.5 percent of the population in the United States 18 years of age and over were diagnosed with a mood disorder in 2006 (NIMH, No. 06-4584). Gender differences in the incidence of depression in adults at a ratio of approximately 2:1 (female to male) have been documented for the past thirty years or so in the United States, Canada and the United Kingdom (The Daily, September 3, 2003; Goodwin, Gould, Blanko, & Olfson, 2001; Kornstein & Schatzberg, 2000; Weissman & Klerman, 1977). There are a variety of ways of understanding and explaining the differences in the rates of depression among men and women (Simon & Nath, 2004). Normative theory proposes that emotional expression results from specific socio-cultural contexts

Juanne N. Clarke, Wilfrid Laurier University Correspondence concerning this article should be addressed to Juanne N. Clarke, 75 University Ave. West., Waterloo, Ontario, Canada N2K4G8. Email: [email protected] International Journal of Men’s Health, Vol. 8, No. 3, Fall 2009, 202-212. © 2009 by the Men’s Studies Press, LLC. http://www.mensstudies.com. All rights reserved. jmh.0803.202/$14.00 • DOI: 10.3149/jmh.0803.202 • Url: http://dx.doi.org/10.3149/jmh.0803.202

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PORTRAYAL OF DEPRESSION (Hochschild, 1975; Thoits, 1989). Men and women inhabit different but overlapping gender cultures with corresponding norms for behavior, feelings and attitudes. Women’s culture encourages both the experience and the expression of emotion more than does that of men (Simon & Nath, 2004). Women are expected to be more likely to express sadness and men are expected to be more likely to express anger (Simon & Nath, 2004; Umberson, Anderson, Williams, & Chen, 2003). In fact, aggression is one of the more acceptable ways for men to express unhappiness and to demonstrate masculinity in Western societies (Umberson et al.). Kemper (1978, 1981, 1990, 1991) argues that the “normative” expression of emotion corresponds to social position. Thus, happiness is more likely to be experienced by those with more power and status, and unhappiness is more common among those who are relatively powerless and have lower social status. The relatively higher social status of men, according to this theory and the research confirming it, explains the lower rates of depression among men. Along with these explanations of gender differences in occurrence of depression are those that focus on the differential power of medicalization among men as compared to women. Medicalization is thought to be particularly problematic for women because medicine’s control of women was believed to be central to the logic and growth of its power (Riska, 2003). Through medicalization, it has been argued, a great deal of women’s lives and “ordinary physical and psychological functions” including moods (Reissman, 2003[1983], p. 57) have become defined as pathological. Gendered medicalization has also led to differences in help-seeking behaviors, so that women have been more likely to seek medical assistance than men (Nazroo, 2001). More recently, however, the growing rates of ADHD among boys and the diagnosis of erectile dysfunction, balding and aging among men, point to an increasing medicalization of masculinity (Rosenfeld & Faircloth, 2006). Artifact explanations for gender differences in depression rates point to the biases resulting from different definitions and measurements of depression (Nazroo, 2001; Sigmon et al., 2005). Thus, the meaning of the experience of depression appears to differ for men and women (Laitinen & Ettorre, 2004). Men tend to “act out” and express their sadness and frustration through anger and opposition to others, while women “act in” and express anger towards themselves and become depressed (Kilmartin, 2005; Laitinen & Ettorre, 2004; Nazroo, 2001). Women are also more able or likely to notice and identify feelings of sadness than men. Doctors are more likely to identify the same symptoms as depression in women and something else in men (Curry & O’Brien, 2006). Parallel feelings of sadness and despair that lead women to be diagnosed with depression appear to lead men to commit suicide 3-4 times more often than women (Hawton, 2000; Moscicki, 1995). Depression appears to contribute to 50-90 percent of suicides (Kochanek, Murphy, Anderson & Scott, 2004; Moller-Leimkuhler, 2003). Likely in response to feelings akin to depression, men abuse alcohol and drugs at least twice as frequently as women (Sue & Chu, 2003) and commit the majority (about 86 percent) of violent crimes (Greenfield & Snell, 1999). Male domestic violence may be connected to the tendency for men to repress emotion (Umberson et al., 2003). 203

CLARKE The influences of hegemonic masculinities and femininities may also help explain gender differences in emotion. Some men’s studies scholars have argued that the characteristics of depression, as described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), are not compatible with the demands of hegemonic masculinities (Connell & Messerschmidt, 2005; Warren, 1983). It is difficult for men to admit to symptoms such as depressed mood, tiredness and a lack of energy because these experiences lie outside of the acceptable boundaries of socially desirable masculinities (Connell & Messerschmidt; Emslie, Ridge, Ziebland, & Hunt, 2006; Kilmartin, 2005). This is reinforced by the cultural assumption that part of being a man is to be not feminine and to eschew feminine traits (Brannon, 1985), including emotional and other vulnerabilities (Emslie et al.). Thus, denying their own depression is fundamental to men for the demonstration of “masculinity” (Courtenay, 2000; Smith, 1999). Some scholars have found that most men were willing to admit to being stressed but not depressed (O’Brien, Hunt & Hart, 2005). Others have noted that recovery from depression for most men involved the re-establishment of hegemonic masculinity through the use of such narratives as “being one of the boys,” “re-establishing control” and demonstrating “responsibility to others” (Emslie et al., p. 2246). One contribution to understanding the diagnosis of depression is study of mass media. The media’s portrayal of mental illness has been the subject of a substantial amount of study (Allen & Nairn, 1997; Beveridge, 1996; Diefenbach, 1997; Francis et al., 2004; Gattuso, Fullagar, & Young, 2005; Hazelton, 1997; Nairn, 1999; Nairn, Coverale & Claasen, 2001; Olstead, 2002; Parslow, 2002; Philo, ed., 1996; Rose, 1998; Rowe, Tilbury, Rapley & O’Ferrall, 2003; Sieff, 2003; Signorelli, 1989; Ward, 1997). While there has been a great deal of research on mental illness in the media there has been less on the specific case of the most common diagnosis, depression (Rowe et al.). One study, Rowe et al. (2003), found that the focus in depression stories was not on the potential for crime and violence against others but on the costs of the illness to the one who suffers. Blum and Stracuzzi (2004) found that depression was portrayed as primarily a women’s disease. Metzl and Angel (2004) found an increase in gendered non-medical or non-DSM referents as symptoms of depression after the introduction of the new and highly popular selective serotonin reuptake inhibitor (SSRI) drugs. They observed that stories about SSRI anti-depressants medicalized women’s lives and bodies by broadening the types of female behaviours that required treatment with anti-depressants. Men were seldom described as depressed, and when they were it was in terms that were restrictive and narrowly associated in published medical (DSM) terms. The Study Data Collection and Analysis This study was based on a search of all full-text articles (without graphics) indexed by the term “depression” in The Readers Guide to Periodical Literature for 2000-2007 in three English-language magazines directed primarily towards men, Sports Illus204

PORTRAYAL OF DEPRESSION Table 1 Sport’s Illustrated, Men’s Health and Esquire: Audience Characteristics1 Magazine

Sports Illustrated Men’s Health Esquire

Circulation Rate

2.483.208 1.800.000 700.000

Male/Female Median Split Age

87/13 81/19 NA

44.0 37.0 42.4

Median Household Income

$85.643 $70.290 $60.814

Education Level College Professional/ Graduate Managerial

NA NA 38.5

NA NA 30.4

trated, Esquire and Men’s Health, all published in the United States. Magazine stories were selected as data because magazines are circulated widely and are often read more than once. In this way, print media may at times be more permanent than television or radio reports. The magazines were selected as representing three of the most widely circulating magazines available in North America. Table 1 describes the socio-demographic characteristics of the readership of Sports Illustrated, Esquire, and Men’s Health. The years 2000-2007 were selected in order to provide enough data over a long enough period of time to avoid the bias of the selection of one year only when a particular event, such as the announcement of an instance of depression in a sports or other male celebrity, might have occurred. There were nine articles in Sports Illustrated, six in Esquire, and fifteen in Men’s Health indexed by the topic “depression” during the period. Initially all articles were read by the author to categorize them for manifest content, as pertaining to (psychological) depression, and thus worthy of sample inclusion. Subsequently, all articles were reread and summarized as to topics of discussion and (1) types of attitude toward depression, (2) its causes and treatments, (3) the characteristics of the people who were featured in the articles, and (4) any other significant subthemes (Berg, 1989; Clarke & Gawley, 2009; Neuman, 2000). Subsequent readings were for selective coding to identify and label the major emerging themes and to select illustrative quotations. Findings Attitudes towards Depression: Men’s Reluctant and Invisible Feelings The media stories reinforced the idea that most men are reluctant to acknowledge they have feelings, especially “bad” feelings. The following is a typical expression of this theme: “Someone once said that if you ask a man how he feels, he looks inside and 1

Esquire Media Kit (2008). Retrieved October 26, 2009, from http://www.esquiremediakit.com/r5/cob_page.asp?category_id=19106; Men’s Health (2006). Retrieved October 26, 2009, from http://www.menshealth.com/mediakit/online/audience.htm; Sports Illustrated. Retrieved October 29, 2009, from http://www.simediakit.com

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CLARKE sees a deep void. Someone else once said that men are numb from the neck to the crotch. Catchy phrases, but not really true. Men have feelings. We just ignore them” (MH1, 98).2 Acknowledging feelings is portrayed as weakness even as men may be encouraged not to think that way. Articles suggest that most “normal” men do think of feelings as unacceptable. For instance: “You have depression. Shoot. That’s not depression. That’s weakness. That’s how the thinking goes” (SI9, 73). At times, men are described as knowing they have feelings but believing that, as men, they ought not to share them with anyone else. For example: “Most of us feel guilty about everything. We don’t want to tell anyone our negative thoughts because they are shameful, or wrong or cruel” (MH1, 98). Men are portrayed as active and in control and not subject to vulnerabilities and emotional sensitivities even in the face of depression. Note the following two examples. In answer to the question, how do you deal with depression one man responded: “Change my mode of thinking. Instead of dwelling on something in the past that’s beyond my control or something in the future that I can’t predict, now I try to live in the moment” (102, 21) . Another male is quoted as saying: “I hit the gym. It cheers me up knowing that I can do something most people can’t do, like run a few miles or lift weights” (102, 21). Humor is sometimes used to make the point that men don’t want to acknowledge feelings: “Guys love couches—as long as there’s a game on. But put a therapist in the room instead of a TV?” Considering how most men feel about weakness, the subject of mental health can be even touchier than most physical maladies. For instance: “I don’t have time to contemplate my life on a therapists couch, or exercise. I pop a pill every morning, and that’s all I need” (104, 74). Sometimes the point about men’s lack of attention to feelings is made through a contrast with women, as it is in the following statements. “Women are more likely to acknowledge depression and seek treatment for it, but men are just as likely to have it” (MH2, 153). “Sixty-six percent of those in the United States with major depression are still undiagnosed, and most of them are men” (MH2, 153). Causes and Treatments: A Real Disease Some articles stressed that there were biological roots to depression and that it was a real disease. “It helped him realize that his funk was not some embarrassing defect but a bona fide disease. He went to the doctor and got a prescription for anti-depressants. The difference is night and day, he says “I feel better. My life has been renewed. Like a clogged artery or liver disease, your brain requires professional attention” (106, 62). Depression is portrayed as “a real disease that must be fought as tenaciously as cancer or heart disease” (MH2, 153). Various pharmaceutical interventions are recommended for treating this ‘real disease’ as in the following two quotations, “A shrink prescribed an antidepressant/sleep inducer called Trazodone, and it got me through the dark nights” (100, 155). Shea took 2

See Magazines Cited for key to location of passages quoted.

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PORTRAYAL OF DEPRESSION EffexorXR. “ Right away” says Shea, “I noticed a big change in achieving general day to day happiness” (SI9, 74). There are, however, a few suggestions that people can control depression themselves offered at the same time. Note the following “the doctor himself though has never suffered from depression because he places little spots of joy in his life. Right now it’s his grandchildren” (MH2, 153). ‘Natural’ or non-medical remedies are recommended as in the next quotation. “Fish oil “helps brain cells communicate better, increases the brain’s sensitivity to serotonin, a hormone that produces feelings of happiness” (103, 129). Characteristic of Men Who are Depressed: Success in Work or Sports. When men with depression are described they are usually very successful at work or in sport. For example, one article in claiming that men do get depressed emphasizes this fact by indicating that the types of people include “CEOs and Nobel prize winners” (MH2, 151). Similarly, the following quotation emphasizes first the credentials of the medical expert and then reinforces the notion that it is successful men who get depressed. “Dr. J Raymond de Paulo Jr. M. D. Chairman of the department of Psychiatry at the Johns Hopkins University School of Medicine has treated nearly 8,000 people with depressive disorders, including CEOs and Nobel Prize winners” (MH2,151). Depression is also portrayed as a cost of failed ambition in the story of a man who was attempting to join a space mission and went through sixteen rounds of elimination until he finally had to withdraw because a physical handicap was discovered. This disappointment led to a serious depression (105). The question of depression is raised with, arguably, one of the most successful men of our times, former president Bill Clinton (Paterniti, 2000, p. 2). Clinton talks philosophically about what leaving the office of one of the most important jobs in the world is like and makes the point that it can be and has been the impetus for depression in several previous presidents. “What you have to do is find what you care about and try to apply yourself to it, and not just live with your memories. Some presidents including LBJ, seemed to go through serious and real depressions when they left office” (Paterniti, p. 2). The demand to be successful at work and the possibility of economic or work failure is said to lead to depression in the next quote which provides the following advice. “Here are some ways to get a grip. Know your net worth. Know where you’re going. Figure out where you are right now. Charles Dickens summed up a man’s relationship to money thusly, annual income twenty pounds, annual expenditure nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds six. Result misery” (MH4, 158). The quality of employment is also portrayed as associated with men’s depression in “lack of job security can lead to depressive symptoms that could last up to 2 years, a recent study found” (104, 74). Part of men’s preoccupation with success is said to be women’s expectations as the next quote indicates. “The bottom-line findings: David Buss Ph.D , University of Texas surveyed more than 10,000 men and women in 37 cultures around the world” and found that on average women “prefer men with money, resources, power and status”(MH2,153). 207

CLARKE Violence Another theme that is less prevalent, but still important, is violence. The following quote reflects a violent metaphor for the treatment of depression. “Face it. There are men out there tougher than you who are threatening to break the kneecaps of their problems. Is it a coincidence that they are also big and strong enough to break a real set of kneecaps? I don’t think so” (MH1, 98). Several men were described in the light of personal violence including suicide and self- harm. Note the next two examples. “Demetrius Underwood knifed himself in the neck” (SI3, 76). “He didn’t just beat his wife, he also beat his oldest child Brittany, breaking her nose twice. Andy tried and failed to kill himself with car exhaust. Finally Cory shot his father when he was attacked by him and was attacking his mother” (SI6, 80). Discussion The magazine portrayal emphasizes that men are not to have feelings, particularly negative feelings. They are not to seek insight into or help for emotional pain through psychotherapy. They are to be highly successful in work or sport, even celebrated, and then and only then to be, incongruously, hit with a powerful biologically generated “disease” depression. Depression once acknowledged is to be treated actively and aggressively with anti-depressant medications prescribed by a doctor. Men’s experiences are contrasted with those of women. Women are described, usually by inference, as both weak and as “using” men through their demands that they be highly successful at work and financially. Men are described as engaging in violent behaviours when depressed. For men to acknowledge depression, the present magazine portrayal seems to suggest, they have to repudiate their claims to hegemonic masculinity, which “is primarily characterized by relations of domination, actively performed through competition, aggression, bodily strength, stoicism, heterosexism, homophobia and misogyny” (Gray, Fitch, Fergus, Mykhalovskiy, & Church, 2002). Illness of any sort, but particularly an emotional or mental illness, that prevents the display of these characteristics of hegemonic masculinity especially aggression, competition and stoicism, is likely a potential threat to the mental health of men. These findings also reflect the values of hegemonic masculinity in regard to the focus on individual achievement and competition in the portrayal of depression in men. All of the stories about depression focus on individuals. Virtually all of the individuals are very successful in work or sports. In anonymous references to depressed men, CEOs and Nobel Prize winners are deployed as “the type” of men who get depressed. This representation ignores the empirical reality that depression has been found to be negatively linked to social and economic position. Men who are poorer, lack stable and meaningful employment and social power are more likely to experience depression (Chen, Subramanian, Acevedo-Garcia, & Kawchi, 2005). As a result of the emphases in these stories men who are less successful, may not be able to see their experiences of sadness, anger and frustration as emblematic of a condition that can be treated. One of the manifest messages of the media linking of depression with great success in work 208

PORTRAYAL OF DEPRESSION and sports is the message that depression can happen to “anyone” even those presumably most admired by men, the “rich and famous.” Paradoxically, the latent message implicit in such ideas may be that depression wouldn’t happen to most of the readers who are, after all, not likely to be unusually successful. Thus ironically this representation emphasizes the differences between most men and those who get depressed. Focus on the individual who is depressed also directs attention away from the possible social precursors or collective preventive actions that might minimize the later occurrence of depressed, angry or other unwanted mood. For example, there is no attention paid to the possibility of prevention through social support, economic and political equality or learning how to express all feelings, both positive and negative in a constructive manner that may serve to enhance individual self-esteem and ability to cope with the everyday challenges of life. Celebrity, another aspect of individualism, is emphasized in stories about depression. As well as stories about sports heroes and even US presidents, there are frequent references to unnamed CEOs and Nobel Prize winners. This serves two, somewhat contradictory, purposes at the same time. On the one hand, it distances the reader from the possibility of identifying with the profiled person and yet paradoxically it holds the person up for emulation and modeling. Contrasting messages are implicit. You are both to strive to look and act like this famous person and you can’t possibly be as successful at work or in sports. Such contradictory presentations may reinforce personal dissatisfaction and an unwillingness to take action in the face of suffering. This research also documents the medicalization of male health or the “discovery” of the widely expanding medical “problems” in men. Alongside the development of pharmaceuticals designed to alleviate male impotence, ADHD, and baldness, is this another example of the medicalization of “lack of” masculinity. The findings presented in this research reinforce the medical model of emotional expression through the emphasis on treating what is called a real disease through pharmaceuticals and thus underscore the medicalization of men and masculinity (Rosenfeld & Fairclough, 2006). Limitations of the Study There are a number of limitations to this study. It was exploratory. We have investigated one sort of medium only-magazines, over a short period of time. Further research should include a larger sample of magazines and more articles over a longer period of time. Other media including television, music, newspapers and movies may have different representation of depression amongst men. In addition, a significant proportion of the population is not literate and thus not directly impacted by mass print media. Thus studies of other mass media are imperative. In addition, this paper is qualitative and the product of one researcher’s analysis and it is likely that different readers and researchers would see some different themes. Magazines Cited Anonymous. (2006). Would you admit to being depressed? Men’s Health, 21,5,42. (102) Anonymous. (2000a). Growth spurt. Sports Illustrated, 93, 54-57. (SI1)

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CLARKE Anonymous. (2000b). Last chance? Sports Illustrated, 93, 76-79. (SI3) Anonymous. (2003). Prisoners of depression. Sports Illustrated, 99, 70-74. (S19) Hobday, E. (2006). The best supplements for men. Men’s Health, 21, 129-130. (103) Kita, J., & Zimmerman, M. (2003). The top doctors for men. Men’s Health, 18, 148-155. (MH2) Klosterman, C. (2004). Toast in the machine. Esquire, 62-62. (106) Moore, P. (2006). Good night, and good luck. Men’s Health, 21, 150-159. (100) Ongaro, L. (2004). Who will beat depression first? Men’s Health, 19, 74. (104) Ramis, H. (2002). Shrink rap. Men’s Health, 17, 98-102. (MH1) Reilly, R. (2007). Wrestling with a demon. Sports Illustrated, 106, 80. (SI6) Thornton, J. (2004). Woe is money. Men’s Health, 19, 154-159. (MH4) Woodrruff, J. (2007). Sea of tranquility. Esquire, 86, 8. (105)

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