Medical Associates Clinic

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     A recent issue of Newsweek was devoted to issues and problems that men have.  One of several fascicles of the issue was devoted to problems of depression in men.  The article pointed out that statistics show women are depressed about twice as often as men.  These statistics were based upon how often the depressed individual sought medical help. The point was that the statistics are probably very inaccurate and, instead, reflect how often the depressed individual is willing to seek help and acknowledge the problem.  It seems that our society feels that it is o.k. for a woman to be depressed but it is unmanly and weak for a man to be depressed.  Therefore, men do not acknowledge the problem and don’t seek medical help.

     I thought the article was very well done using Terry Bradshaw as the example.  The article pointed out that he had been highly successful as a quarterback for the Pittsburgh Steelers in the 1970’s, having won four NFL Championships.  He was the MVP in several of those games.  The article pointed out that he retired smoothly to be a TV commentator and was equally successful at that; yet his life seemed joyless in spite of his fantastic success and material wealth.  The article stated that this very manly man was diagnosed with depression and had the courage and wisdom to deal with it.  Depression is too broad and complicated a topic to be addressed in one column.  In this column, I want to tell two stories that exemplifies the mismatch of expectation and reality.

     The first story is by and about a professional baseball player, Joe Garagiola.  He spent most of his career playing with the St. Louis Cardinals in the 1950’s. He was then traded to the New York Yankees as a second string catcher behind the very famous baseball catcher Yogi Berra.  As some may have read or remembered, this was the Yankee team that had Mickey Mantle and Roger Maris. Joe Garagiola tells the story of how sad he felt for those two famous baseball players, one of who held a home run hitting record for many years.  Joe describes going to Yankee stadium and entering the locker room.  Joe would open his locker and his uniform was still there. This meant that he was still on the team, which for him was a magnificent thrill.  Joe knew he was not essential to the success of the team. He was just thrilled to be a part of the New York Yankee team.

     Joe then notes that poor Roger Maris and Mickey Mantle really didn’t have the same thrill that Joe Garagiola did.  They would go their locker, open the locker and their uniforms would still be there too.  But that was no thrill for Mickey Mantle or Roger Maris.  In order for them to have the same thrill that Joe Georgiola did, they would have to hit four home runs in one game, a very infrequent event.

     Here were three baseball players, one of whom was very, very happy.  As some may remember, eventually Mickey Mantle became an alcoholic and died of liver failure.  Joe Garagiola lived happily ever after.  One had a match of reality and expectation. The other did not.  Roger Maris remained troubled the rest of his life because his homerun record had an asterisk by it.  Roger Maris's record was achieved in 162 games whereas Babe Ruth's record of 60 homeruns was achieved in fewer games.  There was always the implication that Roger Maris's record was really real because it took longer.  Roger Maris's expectation of respect never quite measured up to to the media reality.

     As an additional story, I am reminded of my sophomore year in college.  A fellow student was very, very bright and through his first three semesters in schools had straight A’s.  He was very compulsive and a perfectionist.  In the second semester of his sophomore year, he made one B among his many A’s.  On morning they found him hanging from the spiral staircase in the library.  He left a note stating that he could not live with the shame of having not made all A’s. The mismatch of reality and expectation can impair health slowly as it did for Mickey Mantle or very quickly as it did for my fellow student.

     Depression is not easy to define.  It is generally diagnosed based upon a constellation of symptoms that the individual expresses, as listed on the National Institute of Mental Health website (www.nimh.nih.gov):
  1.  Persistent, sad, anxious or empty mood
  2.  Feelings of hopelessness, pessimism
  3.  Feelings of guilt, worthlessness, helplessness
  4.  Loss of interest or pleasure in hobbies and activities
  5.  Decreased energy, fatigue, being slowed down
  6.  Difficulty concentrating, remembering or making decision
  7.  Difficulty sleeping, early morning awakening, oversleeping
  8.  Appetite and/or weight changes
  9.  Thoughts of death or suicide; suicide attempts
10.  Restlessness, irritability
11.  Persistent physical symptoms

     While the above list of symptom may describe many individuals at certain times in their lives, the diagnosis of depression depends upon how these symptoms impair the person’s overall function and health.  When these symptoms become pervasive and impair the person’s function, the diagnosis of depression can be entertained.

     The thinking pattern that leads to depression will be discussed in the next column. A third column will deal with potential treatment steps that can be taken to help individuals who have depression problems.

     As mentioned above, women are more accepting of the concept that they are depressed and are generally more willing to deal with solutions. Trying to help men has not been nearly as successful thus far.  On Saturday, July 12th at the Medicine Rock Café in Gettysburg, there will be a conference on depression in general and specifically how men can deal with this problem.