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Postpartum Depression and Men (feat. Pierre @braver.man)
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In EPISODE 42 I am joined by Dr. Pierre Azzam; he is a psychiatrist turned professional coach and founder of Braver Man (@braver.man), which is a platform for coaching men at times of big life change, and for building awareness of topics related to men's personal development and mental health.
Our conversation focuses masculine traits and how those can be a barrier in seeking help around mental health issues, how not just women but men can also experience PPD (Postpartum depression), and how our diagnostic criteria, namely the DSM 5, needs a massive overhaul, and finally some ideas around change.
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Transcript
Introduction to Fathers' Mental Health
00:00:00
Speaker
Postpartum depression in men is a little different than in moms. The way it shows up is a little different. We know it impacts about 10% of fathers in the first year, that about 10% of men in the first year postpartum will experience a major depressive episode.
Meet Travis: Focus on Fatherhood and Mental Health
00:00:20
Speaker
This is a therapy for dads podcast. I'm your host. My name is Travis. I'm a therapist, a dad, a husband here at therapy for dads. We're reclaiming the narrative of fatherhood one story at a time. You can follow the journey on Instagram at therapy for dads and our website, www.therapy for dads.com. Welcome.
Introduction of Dr. Pierre Azam: Men's Mental Health Advocate
00:00:46
Speaker
Welcome to this week's episode and we have a very special guest on. We have Dr. Pierre Azam. He is a psychiatrist who turned professional coach and founder of Braverman. As a physician, Pierre sought training in professional coaching to augment his work with new fathers. And he has since started Braverman as a platform for coaching men at times of big life change and for building awareness to topics related to men's personal development and mental health. While he's not a dad, the core of his mission is to
00:01:14
Speaker
help men to thrive at early fatherhood. He's got a passion. He's got a heart. He has expertise. He has training as a psychiatrist. He knows his stuff. And so I'm very, very excited to welcome on Pierre to this week's conversation on therapy
Travis and Pierre's Shared Passion for Men's Mental Health
00:01:28
Speaker
for dad. So good morning, Pierre. Good morning. Good to see you. Good to see you too. Um, gosh, it always sounds so like overly professional. I do it that way, but
00:01:39
Speaker
Cause it sounded great. Yeah. Was it a good, do we need to take two? I could fix it. It's perfect.
00:01:48
Speaker
Pierre and I are relatively new friends connected through Instagram and reached out and started having a conversation, I'm not sure, maybe a month ago, give or take, and really connected and actually found we know some similar people. In fact, he knows an old professor of mine who I had in graduate school, you know, that focuses on, you know, men's mental health and
Challenges and Education in Men's Mental Health
00:02:13
Speaker
masculinity. And it was kind of a small big world because actually Pierre does not live
00:02:18
Speaker
anywhere near where I live, you know, I'm out in California and here, how about you, you're in Florida. So we're a little far here, but yeah, small world. And then we connected and hit it off, you know, talking about mental health and research. And he's done a lot of research and understanding men and kind of where we get stuck and how we operate and some of the, some of the stuff that men struggle with within mental health and that sphere.
00:02:44
Speaker
Yeah, we just hit it off and it was a great conversation and he was willing to jump on and have a conversation. And I think it's a really good topic we're going to talk about today.
Balancing Fatherhood and Professional Life
00:02:52
Speaker
I think an important topic, one to better understand, have a good education about, as well as some, I think some paths we could take to kind of help ourselves. So welcome Pierre in Florida. Looks like it's very sunny for you right now over there.
00:03:07
Speaker
I can see the sun coming right in the window. It looks nice and bright and warm and welcoming. It's still dark this over here in California. I have some lights, but it's still pretty, well, it's dark. Thanks for having me Travis in California, where it's still very dark.
00:03:25
Speaker
Yeah, absolutely. Well, being
Pierre's Transition from Psychiatry to Coaching
00:03:28
Speaker
a dad and finding times to record, I have to sacrifice something. So it's either when the kids are asleep still or when they're either in the morning or at night. So depending on where the guests are, I try to help make it easier for them as best I can, but they're still often to sacrifice. So I appreciate you coming on. Oh, I appreciate you. You're early 8 a.m. So welcome.
00:03:52
Speaker
You're earlier 5 a.m. Thanks. So yeah, let's just jump into it. What do you want to talk about today? Yeah. But let's jump in. Share a bit about yourself actually. Sure, sure. So my name is Pierre. My background is as a psychiatrist, I trained to work in mental health, not really intending to work with dads initially. I was really interested in working with people
00:04:21
Speaker
in the medical hospital, people who are ill from medical conditions, and people at the end of life. And I did that for about 15 years. And a small chunk of my work involved supporting moms during pregnancy. And that reignited the strong interest for me in what mental health looks like for men at transition.
00:04:50
Speaker
points in life and especially in times of early fatherhood. I think there were very few but present services for moms, but there really weren't any services for dads. And so I became really interested in what it would be like, what it would look like to help support dads at times of early fatherhood and support men in the transition to becoming a dad.
Men's Mental Health: Isolation and Stigma
00:05:17
Speaker
And so I sought training in professional coaching in large part to augment my work. I didn't expect to change my career path, but this felt and feels like a really strong passion for me. And so in 2020, I made the decision to, to pursue my work at Braverman full-time and in essence to create a platform for working with men on a one-to-one basis.
00:05:48
Speaker
at usually at times a big change, often in early fatherhood, not certainly not at that time, everything and it's still been sort of life has been a big transition in and around COVID. And so that has looked like all sorts of pivot points in life for men, but often it is around what it means to be a father and what it means to build a family.
00:06:15
Speaker
And the other element of my work is one about which I feel really strongly, and that is helping to build some awareness around mental health and mental illness for men, particularly around the stigmas that we face in defining, experiencing, and seeking help for mental health conditions. And so Forever Men's really sort of
00:06:44
Speaker
growing organically, but sort of growing in a way to help support awareness around men's mental health and also awareness around men's connection and building
00:06:59
Speaker
community targeting isolation and loneliness, which I think is really endemic for men. Yeah. Everything you just said, it's part of why I started therapy for dads in a different, you know, unique path in that sense, that seeing the need
00:07:20
Speaker
while the services for women and mothers always could be more. There could always be more services. I don't think we'll ever have enough services to meet, I think, the true demand, the true need. So there's always more, but there is
00:07:38
Speaker
Generally speaking more for mothers and women and just in general and men tend to have it's just for which I'm sure they'll bring up in this episode and I've talked about is very students why this is not enough for men and then even more down more or less for fathers and So that's where we really kick, you know, really aligned is that hey, we really want to help fathers, you know and men but that that father piece is just another layer of just it can create another layer of his separation or isolation or
00:08:03
Speaker
Um, some of those kind of stereotypical things that men struggle with, some of those endemic problems of isolation, lone, you know, lone wolfiness and just getting through life and functioning. You know, I need to be strong. I don't want to be, you know, men don't cry. I mean, all those things are so prevalent that I, I mean, I just had an intake with a new gentleman. What's today? Wednesday?
00:08:23
Speaker
last week guy in his early 40s surfer dude you know grew up surfing and stuff and but he's fully having some panic attack stuff but he finally came in because he just he he kept going to the ed the emergency room and kind of kept having his panic attacks and finally as he came in and his wife's been like gently suggesting it but all those things
00:08:42
Speaker
all those barriers are being seen as weak and a burden and I gotta just muscle through it and but he got to a breaking point and thankfully he called in and called in and I saw him but he all those barriers has kept him from years from coming in so it's still it's still prevalent it's not gone which is really sad that it's still so prevalent
00:09:05
Speaker
Yeah, I think I think it's it's near universal and and guys especially American men, but I think.
00:09:16
Speaker
throughout much of the West, certainly, and much of the world. And I think, too, we're not immune as men and mental health professionals. So in many ways, it's been so valuable to be able to look into this area, to be able to talk about this.
00:09:37
Speaker
and recognize how it shows up in myself and how it's shown up in myself before. And, you know, I, and in that way it's, it's almost relieving that it's so not just me. And at the same time as it's kind of heartbreaking too.
Masculinity Norms and Mental Health
00:09:56
Speaker
Cause it does keep men from seeking help, maybe using resources that are around to, to really thrive, to get stronger.
00:10:07
Speaker
to be more well, to be more present, to be more available to their families. All the things that most of us really want in a lot of ways are on the other side of asking for help. And asking for help is not ceding control. It's not sort of giving up the power to do the work yourself. It's just a start point. You still got to do a lot of work thereafter. And so it is,
00:10:37
Speaker
The stigma can seem like if I don't just muscle through, then I'm weak and I haven't done anything myself. We know that's not the case. Especially engaging in therapy, it's important work. It's not a cakewalk. It's not easy.
00:11:00
Speaker
you're working on and doing that is very powerful, is very strong. It's going to push you. And there's certainly nothing that is weak or incapable about it. If anything, it's quite the opposite. Yeah. Yes. Yeah. Yeah. I think that's part of the stigma and misconception big time is that it is the exact opposite of weak. It takes a lot of work. I mean, I've done, I've done my own therapy before being a therapist and
00:11:28
Speaker
Yeah, it was hard. I mean, it was it was good. In the end, it was great. And there was definitely moments of like, this feels it feels good to be able to talk about this stuff in a space and, you know, feel heard. However, comma, that's one piece. The other part is then, like you said, is there's a lot of work outside of that therapy. In fact, most of the work comes out of the therapy outside of the therapy office. It's what you do outside and you come back. And then, you know, I remember my therapist, it's like she's like, you got to you have to put in the work.
00:11:55
Speaker
outside like it's you can't just do it here and I'm like okay and so and I was very committed at the time and and I was doing it I mean I was like okay I'm I'm working on myself and I just pretty much every day and then do it come back and like yep this is what I realized and this is what ending kind of challenging but it was is anything but weak it takes it takes endurance it takes tenacity it takes strength a lot of strength I mean cuz that's what you're doing is it's you're using this to kind of propel yourself but in the end it's very effective but again those those misconceptions that's the problem it keeps them stuck
00:12:24
Speaker
And so what are some of the other ones in your research and in your experience that you're seeing that are the, you know, the big three that you find are some of those barriers or misconceptions? And yeah, well, I think a lot of it sort of stems around stigma and maybe going to extremes around the stuff that we see as indicative of manliness. And often that is being strong, being competent, being self-sufficient.
00:12:50
Speaker
None of those three is implicitly bad. If anything, they're areas of strength to shore up. But when taken to extreme, they can become
00:13:03
Speaker
this expectation of being totally self-sufficient, totally like a lone wolf that's just got a muscle through and never asked for help. They can be seen as someone who always has to have his stuff together rather than just focusing on competence or proficiency or knowledge or wisdom. It can go to an extreme of never falling short.
00:13:28
Speaker
always being the alpha and then certainly never being involved or never being vulnerable, which is just not possible. It's not human. And frankly, it's not all that in line with.
00:13:43
Speaker
being and showing your own strength to yourself or to others in many ways, the biggest moments of strength are the moments of vulnerability that you've got to work through. And so often the stigma rises when we take these extremes of the norms of masculinity, of traditional masculinity, and we, we amplify them to a point where there isn't a wiggle room rather than just focusing on being,
The Role of Fathers in Mental Health Conversations
00:14:13
Speaker
strong, being capable, being self sufficient. We've come to a point where we can never be weak, never show weakness, never ask for help or never work with another person always got to be sort of the lone wolf. And then this idea that that I can never showcase vulnerability.
00:14:38
Speaker
I can never appear to be weak, whether that's crying or acknowledging a failure or admitting fault or saying sorry. These are things that are actually quite strong. They take some balls to do. And so I'd say it's often when the
00:14:59
Speaker
when the sort of traditional expectations of what it means to be a man go to an extreme, when they're taken to a place where there's no room for error, that most of us naturally fall short because we're human as well. And so often that ends up interfering with connecting to other men with communicating needs, communicating experiences, communicating emotion,
00:15:29
Speaker
and asking for help. I think those are sort of at the core of many of the barriers to doing this work. For dads in particular, that's an important one, especially early on. First time dad has never done this before.
00:15:52
Speaker
how can we expect the first time dad to be completely proficient at being a dad, completely strong and capable and not in need of help. And it doesn't help either that we don't really support the connection, the importance of fathering publicly. So a lot of emphasis on
00:16:19
Speaker
the parenting experience from the mothering end, but also not very much from what it means to be a dad in a strong and capable and really valuable way. And I think that's missing. Certainly it's missing in
00:16:38
Speaker
Mental health spaces and so what you're doing is so terrific for for that reason and for many but it's missing in the Medical spaces it's missing in the social spaces in the medical space we screen mom and we ask about mom and mom is a part of the the postnatal well child visits, but that is really not and
00:17:04
Speaker
In the social space, we really emphasize ensuring and asking about mom appropriately. So I think this is not about a sort of zero sum game where the more we help mom, the less we help dad or the more we help dad, the less we
Postpartum Depression in Fathers: Awareness and Challenges
00:17:25
Speaker
help mom. That's really not the case.
00:17:27
Speaker
And so in a lot of ways, it feels like there's a very strong need to just to change the tenor of the conversation a bit around parenting to include all parents. And particularly an emphasis on data is so important for the family unit at large.
00:17:47
Speaker
to quickly speak on those initial character traits that you spoke about men kind of being quote unquote strong and self-sufficient. Like those things in and of themselves are actually good qualities for men and women. But you're absolutely right off what happens as we take these maybe traditional masculine qualities and then they're kind of extrapolated out and hyper focused and maybe swung so far to the extreme that then those things can create for sure unhealthy byproducts,
00:18:17
Speaker
that creates the stereotypes, creates the stigmas. It creates issues in, I think, men's personal life, their inner, you know, within relationships. And so those are some of the things that we tend to see as part of the stigma, because if I'm not being overly self-sufficient, you know, and strength has a very narrow view, right? It tends to be very narrowed in, like, this is what strength looks like, it's very this, it's like these three things, and that's it. It gets us into trouble.
00:18:41
Speaker
it creates these problems and then fast forward to you were sharing about men and kind of the postpartum postnatal follow-up visits of a baby women are part of the kind of check how you doing and traditionally and at least in my experience we and I don't know I can't speak for all people but I know and
00:19:01
Speaker
there's my daughter um i think we had a midwife so we did um so those of you hearing my daughter woke up and she's just being fed by mom so because it is 5 30 so we'll see she goes back down the best part of being a dad um so in part of the post natal follow-up our midwife asked how i was doing she did
00:19:21
Speaker
But I don't think that's common. She would say, hey dad, how are you? And so she would ask. But I don't think that's common in most spaces. That was my experience. So I had that. She was asking how I was doing, which is great. But for my friends who were in more traditional medical kind of outpatient follow-up, even dads aren't even going to those appointments, you know, that's moms are going by themselves and dads are kind of in the background, they're blurred and not focused on.
00:19:46
Speaker
Yeah, in the background is a great way to describe, I think, how many fathers feel around the period of early parenthood, sort of marginalized or taken aback seat.
00:20:01
Speaker
It adds this extra element of challenge or struggle, especially when you're undergoing a big role transition. You're going from taking on really a pretty amazing task, that of caring for a kid, that of being a parent, being a father. And on top of that, there's a sense that when the role is undermined in a more sort of public
00:20:29
Speaker
more private setting. And certainly we see this a lot in situations in which dad doesn't have the opportunity to forge the one-on-one bonding with kids. And that's a huge part of being a new parent. And so, yeah, I'm with you. I don't think it's a common thing in the medical arena to check in on dad. Certainly not.
00:20:56
Speaker
maybe at the stage of labor and delivery, but not frequently post that. We know that screening bothers for conditions like postpartum depression for PPD is hugely valuable. It's been certainly validated. The screening tools that are commonly used for moms have been validated in dads.
00:21:23
Speaker
it's been a sort of slow process to get that awareness out, even that fathers can experience postpartum depression. Right. Because what are men typically, what are some of the initial comments you've heard that men say when you, when maybe they've heard postpartum depression, what do they tend to say? Uh, when they first hear about postpartum depression, they say, I had no idea. And also, uh, I had this and no one knew.
00:21:53
Speaker
or I didn't share it, or I didn't even know it was a thing. And in fairness, I didn't know it was a thing. I mean, that sort of speaks either to my being oblivious, but I think it sort of speaks more to the sort of training and medical profession being relatively oblivious itself, that there really was no focus on the fact that
00:22:23
Speaker
dads can also experience postpartum depression. In fairness, there's a lot that is wrong about postpartum depression in the classic books that we use and diagnostic criteria that we use to identify postpartum depression, both in moms and in dads. And there's no mention of
00:22:46
Speaker
this being a universal experience, meaning that it's not specific to mothers. Well, there's no mention of necessarily moms only. The fact that there's not a mention of the possibility that this can emerge in fathers within the diagnostic criteria within the DSM sort of sends this message that it's only a maternal thing.
00:23:13
Speaker
It's also kind of got it wrong in terms of the timing, and that's important, especially for fathers, because the timing of postpartum depression in men is a little different than in moms. The way it shows up is a little different. We know it impacts about 10% of fathers in the first year, that about 10% of men
00:23:38
Speaker
in the first year postpartum will experience a major depressive episode.
Diagnosing Depression in Men: Issues and Solutions
00:23:45
Speaker
And there's a lot of reason to believe that that's an under-representation or an underestimate, just based on the fact that we don't often share our experiences openly, but also based on the way in which men experience depression. It's slightly different and sometimes means that
00:24:03
Speaker
Those of us who experience depression don't get identified in sort of the classic, the classical ways, but about one in 10 men will experience postpartum depression in the first year. If mom is experiencing depression, then that rate goes up substantially. It becomes.
00:24:25
Speaker
somewhere around one in three. It's somewhere between 25 and 50%. Wow. So significant, significant increase in. Huge. That's massive. Yeah. Jeez.
00:24:37
Speaker
Let's kind of break a couple of these things down. You said, you know, in the down the research and kind of how it's defined, right? Can you speak a bit more about that? Like in the DSM for those that don't know that are listening is that's the diagnostic and statistics manual for mental disorders, which we use as part of our training as part of our criteria for
00:24:55
Speaker
diagnosing quote-unquote mental illness and what we use to kind of identify and PPD actually at least in the DSM is defined as it's actually a major depressive disorder with a postpartum onset and this is all like scientific mumbo-jumbo but essentially there's clear definitions and clear criteria that has been laid out that we as clinicians would use to diagnose a particular individual with symptoms but
00:25:21
Speaker
what I'm hearing Pierre say, and I agree, is that there's some things here that are missing, even though we're seeing when the real world, this kind of postpartum depression symptoms in men, but in the manual, it's how we're trained. There's a big gap, and as I even mentioned, it's not part of the criterion process. So can you speak a bit more about what it might be and what you're seeing there?
00:25:47
Speaker
For sure. It's a disservice to fathers, but it's even more so a disservice to moms. And that is that the criteria indicate that a major depressive disorder has to happen within
00:26:05
Speaker
four weeks of the birth of a kid. And we know that that's really not the case, that research supports an increased risk for depression and also for anxiety disorders within the first year.
00:26:19
Speaker
many researchers are actually extending that period of risk to 18 to 24 months. But by and large, and that's still sort of questionable, but by and large, most of the research and literature that supports looking at the time period of risk is in the first year postpartum. Now for fathers, this is particularly a problem because the period of greatest risk for fathers is months three to six.
00:26:48
Speaker
that tends to be the period of greatest incidents of major depression. Now, it's hard to say that is the time period during which men come to the fore in terms of awareness and identification of a depressive episode, whether it takes longer for us to even articulate it or longer for anyone to notice it. But in many men, the symptoms sort of start really
00:27:17
Speaker
Slowly, gradually, the onset is really insidious. And so many times it's described almost like a personality change. Dad's shifting in his personality. Well,
00:27:30
Speaker
understandable because it's not the classical, I'm okay one day and then the next day or the next week I'm in at the peak or at the valley of my depression. Um, it's relatively slow and steady and tends to peak pretty late on. And so a lot of the features as well, and that's clearly outside of this sort of four week timeframe, but that's also the case for moms for moms.
00:28:01
Speaker
It tends to be less insidious. It tends to be earlier in the first year.
00:28:08
Speaker
the risk is still within that first year period. And so that diagnosis might miss postpartum depression in moms and fathers. Um, and the experience of depression, and this is something I think too, we can speak about the experience of depression tends to look a little bit different for men. And so even the diagnostic criteria alone can be problematic when it comes to identifying depression in all men.
00:28:33
Speaker
Yeah, and I 100% agree, and I'm great that the research, what we're seeing is that there, one, it's good that there's ongoing research with this, that even though the new DSM just came out recently, the TR, which had like nothing changed. No, really, it definitely didn't change this.
00:28:51
Speaker
No, no. And those of you, again, that don't know is there are these updates that come with our what we use as our coding. And there's a recent one, I think. And how long was the gap between the original release of the DSM-5 and the TR? The TR came out recently and the five came out in 2013. And this one is all about.
00:29:08
Speaker
Almost ten years. Nine years, always. And there's not much difference. Nothing. I don't even use the book. I have to because of my job, but I don't use the book at all. And now for a short break.
00:29:27
Speaker
So if you're looking for ways to support the show and my YouTube channel, head on over to buy me a copy.com forward slash therapy for dads. There you can make a one time donation or join the monthly subscription service to support all that I'm doing at the intersection of fatherhood and mental health.
00:29:44
Speaker
and all the proceeds go right back into all the work that I'm doing, into production, and to continue to grow the show to bring on new guests. So again, head on over to buymeacoffee.com forward slash therapy for dads. Thanks and let's get back to the show.
00:30:00
Speaker
Let's then go quickly to find out what are some of the things that men and fathers should be looking for. And I love that the onset is often three to six months. And that kind of, again, makes sense when I'm working with dads and new fathers as well, is that one, because it is more insidious. They're not aware. They're just kind of, they're just trying to survive half the time. One just, you know, is it just sleep deprivation?
00:30:18
Speaker
Is that all it is? Because sometimes it's just sleep deprivation, right? Because they haven't slept. So that could also look like that. And once they sleep, it's like, oh, everything kind of goes away. You know, what are some of the things that we look for that men should be paying attention to if they're in that phase of like, oh, here's what I'm experiencing. And this is it could possibly be then postpartum depression or PPD. What are some of those things just to kind of put language to it and
00:30:40
Speaker
So they know to look for what are those things that you're seeing and then maybe also talk about maybe some of the uniqueness That men be expressed or manifested men that might differ from the current standard criteria. Sure Yeah, absolutely. And so by the book, I think it's important to acknowledge what a major depressive episode looks like it's two or more weeks of a change in symptoms and mood usually involving a
00:31:05
Speaker
decline in mood or irritability of mood alongside a reduced experience of joy, not finding pleasure in things that you might normally. And that's typically associated with a slew of additional symptoms that are in line with sleep deprivation and changes to
00:31:28
Speaker
changes to sleep rather too much or too little changes to appetite again too much or too little feelings of guilt or worthlessness decline in interest again that's a pretty common one change to energy
00:31:42
Speaker
Usually that's a decline, in some cases it can be a bit of restlessness, changes to concentration, difficulty staying focused, slowing of movement, or restlessness, so basically a change to this feeling of motor activity or psychomotor activity where you might feel more sluggish.
00:32:03
Speaker
or you might feel more restless. And then in more significant cases, a sense of hopelessness or even suicidal thinking. And often you need some combination. Usually it's about five symptoms over the course of two weeks. Important. So
00:32:20
Speaker
It is important to know and also too, it's you're experiencing it most of the time over that two week period. Yep. Right. So it's not just limited to certain periods of time, certain periods of the day or certain experiences.
00:32:34
Speaker
And it's not just limited to the context of something like a major loss or grief. Right. So that's important. That's important to differentiate because some of these things we can experience from loss and grief and that's we could have a whole other show talking about. Yes.
00:32:54
Speaker
But coming back to this, since this is our topic for today, so that's pretty some of the standard criteria. Which is good because that's been widely researched, tons of studies backing data to show this is kind of what we're seeing. And it's a great place to start to understand and ask questions. And I would say a lot of men, if they're experiencing depression, for sure will fall under these criteria.
00:33:18
Speaker
Absolutely. But I'm wondering, in your professional experience, and maybe even some of the newer research and data that hasn't come into more of a standardized criteria, but the stuff that you work, the stuff you're passionate about, what are some of those maybe more unique expressions of depression, you know, PPD in men? And again, this is gonna apply, I know, not just to fathers, but just men in general. Yeah, it does. So what are some of those things that you're seeing? Yeah. So for starters,
00:33:46
Speaker
I would say maybe the biggest area or the biggest experience that interferes with identifying depression in men is that often we don't describe this feeling of sadness or this feeling of depressed mood that quite often it feels more like numbness or depletion or fatigue.
00:34:10
Speaker
And so many guys may not, sure there may be some stigma around or some hesitation to share the experience of depression, because in many ways, it sort of violates the sense of having it all put together, being strong, not being vulnerable. On the other hand, the actual experience may be very different from it. And so important that we recognize that. And because it's such a linchpin of making the diagnosis,
00:34:35
Speaker
If a man doesn't acknowledge experiencing depressed mood, then you're probably not going to have the diagnosis of depression. In many cases, men are more likely to experience irritability or more likely to experience attacks of anger. On top of that, we often think about tearfulness or
00:34:55
Speaker
episodes of crying as common to depression. But obviously there are many stigma barriers and stigmas and barriers to expressing emotion for many of us guys. And I would say on top of that, it's research has shown that in men, there's often an experience of numbing of avoidance of emotion and not necessarily volitionally, not willingly.
00:35:21
Speaker
but sort of feeling devoid of emotion. And so important to recognize that too. But there are a number of additional ones like restless irritability, this feeling of needing to move, feeling easily angered or frustrated over little things.
00:35:37
Speaker
We tend to experience a tremendous amount of self-criticism, flogging, guilt, which is common in dads, a change to decisiveness, or guys might experience this as a change to my level of confidence. There may be a sort of even slight sense of indecisiveness, difficulty making simple decisions. Additionally, we have a tendency to externalize,
00:36:07
Speaker
to try to use other things to reduce the sense of numbness. That might be in using substances. It might be in gambling. It might be in risky sex. You may find ways to reduce that kind of sense of feeling numb or wanting to escape. So those are quite common to men. In fact, several researchers historically have described this
00:36:34
Speaker
construct of male type depression, where in place of some of the common symptoms that we might see, we're more likely to see irritability and restlessness and attacks of anger and externalizing and
00:36:49
Speaker
rigid demands for autonomy, wanting to be left alone. Um, and, and the sort of feeling of indecisiveness, loss of self-confidence and self-worth. Um, those are also really common in postpartum depression.
00:37:07
Speaker
Those are the ones that tend to be most troubling, I think. This feeling of guilt or feeling like I'm not worthwhile as a father or I'm having trouble with making simple choices around parenting or in my relationship with my wife.
00:37:24
Speaker
I want to be left alone, or I might feel guilty about wanting to be left alone when I've got to take care of a kid and be in relationship with my partner. And so those are commonly the experiences of depression in men, but certainly in the postpartum period. And they deviate from what's in the book very substantially.
00:37:48
Speaker
Very, no, and absolutely they do and I could say from my professional experience as well that I see that numbness as a big one, a big one I see in men, whether it's just a guy with depression, a man or a father who has experienced it and it's right that linchpin meaning that's like the number one criteria within the first two weeks is like it must be depressed or sad mood, that must be included in
00:38:16
Speaker
Yeah, the starting off point of like diagnosing is this must be part of it But you're right a lot of men some do for sure but a lot of men have that numbness any void I can get away from that and veer away quickly even though they have all these other criteria. It's like well, they don't have this it's like so what is it really and
00:38:34
Speaker
We need to definitely expand. The TR, I think, probably should have had that. Why? I don't know. I'm not part of the panel. Again, that could be another private conversation. Tell yourself lucky. Yeah, the DSM makes those decisions. Yeah, I don't understand it, but it sort of tends to lose the forest for the trees. Yeah. And you know, it's common, I think, early on in
00:38:58
Speaker
training and experience to sort of count criteria as the goal from a clinical standpoint. And the reality is sometimes people don't show up with the stuff that's in that book. Nope. It's a little more complex, a little more unique and complex where they hit them. And part of our, I think my job as a clinician is how do I get this one? How do I get this person help?
00:39:21
Speaker
And especially if it's an insurance-based need where they need a diagnosis to help them receive care. I don't lie, but I listen to the complexity and say, okay, what best fits this? And often with men, what I end up diagnosing is to depressive disorder, other specified.
00:39:40
Speaker
So in those that don't know, that's more of a catch all where they have symptoms of depression, but don't meet the full criteria, but they're still depressed. And it's a way of still, it's still a diagnosis. It's still a way of getting care and receiving the care that
Biological and Social Factors in Men's Depression
00:39:53
Speaker
they need. But because they often, it's usually those guys who don't have like the depressed or sad mood, but to have that more numbness.
00:39:59
Speaker
experience where I can't because it doesn't check that box, I go that route. And those are unique expressions I do see. More irritability, more risky behavior, addiction, and different things to kind of maybe find some of that numbness to feel something, but often then it could lead to other problems. Yeah, it is unfortunate. I think the other area that might feel just based on like if someone were to experience depression and kind of look up the criteria
00:40:27
Speaker
I think the other area where it doesn't necessarily miss the boat here, because I don't think that it's wrong necessarily, but it is a little bit deceptive in that, or at least a little bit. It doesn't necessarily paint the full picture of the duration of depression.
00:40:45
Speaker
We think about depression is lasting for several weeks on most days for more than two weeks. The reality of depression for most people when it's untreated is that it lasts more along the order of four to 12 months. And so it's really lengthy. It's a long period of time.
00:41:03
Speaker
For many men, it's a recurrent experience. And so it takes up these huge chunks of a person's life. And I think that's what's often sort of missed in the criteria that we think of it as several weeks. Well, it's really, for most people, several months. And for most guys, it gets sort of several months, but we don't really recognize that it began several months ago. It just feels like,
00:41:31
Speaker
it was slow and steady. And then maybe you hit a point where something big happened, a change in your relationship or a change in your, your job. And then it sort of, you might use that, we might use that as kind of the timeline, the time point for it. But often when guys seek help for depression, they're able to look back
00:41:57
Speaker
and recognize how slow and steady it might have started. Well, that's that that insidious. That's right. Hard to one, hard to pinpoint. And I think too, and you maybe speak a little bit about this is lack of education. Yeah. So they don't really know what to look for. Again, going to some of those maybe.
00:42:16
Speaker
extreme expressions of masculinity like the lone wolf keep you know self-sufficiency you know again those things are just good to them but often it can go to the pendulum and when if that's kind of where a man's operating out of that of those kind of
00:42:30
Speaker
more narrowed unhealthy perspective of those traits of masculinity Well, then it would make sense why men would get would not be able to recognize depression Especially and specifically postpartum depression one of those lack of education and two if they're being overly self-sufficient overly Strong like and and just keep keep functioning keep surviving Well, they're not gonna see the signs at all until it's until often something big does happen because then it's like you
00:42:57
Speaker
you're forced to see it because oh I'm not performing my job and my job I'm going down or sometimes marital things come up because they're not there's a big gap distance and it's been slowly building for months maybe even years because it can last long left untreated which I think is key left untreated because there is treatment
00:43:19
Speaker
Yeah, there is treatment. There is treatment. There definitely is treatment. I want to piggyback on something you said here that feels really important and that is that what you mentioned is actually supported, is quite strongly supported by research. Those of us then who adhere to really rigid rules of masculinity to these norms of being the lone wolf and the alpha and having it all together
00:43:48
Speaker
and never being vulnerable, being strong to the point of never showing weakness. Those of us who adhere to those norms are actually at higher risk to experience depression. And it's hard to tell whether we're at higher, those of us who
00:44:06
Speaker
experience these traditional norms are at higher risk to experience depression or whether it's that depression sort of perpetuates itself and there's no seeking treatment and then you're more likely to show up with some of the really negative outcomes. Discord in a relationship or a loss of a job or
00:44:28
Speaker
something that gets in the way of functioning. Nevertheless, these are often the guys who struggle the most. And sadly, it's an experience of struggling in silence. And you're right, there are treatments. It's also important to acknowledge, too, that there are strong bases for the experience of postpartum depression, that it's not
00:44:53
Speaker
You know, I've talked to guys who are a bit skeptical of the construct of postpartum depression and they say, well, you know, it's a tough time. You're not sleeping. Your sex life might be changing. There are all sorts of reasons why a guy might be depressed. And I think often the reasons why the sort of, I'm using air quotes here,
00:45:20
Speaker
Are can be a little bit misleading because you don't really need a reason in quotes to be To experience depression now. Yes, I think those are big risk factors loss of intimacy loss of closeness Changes to sleep. Certainly. There are also more psychological and biological risk factors for
00:45:45
Speaker
the experience of depression, man experience, many of the same hormonal changes that that moms do. And the place like man experience, hormonal changes. Yeah, that's pretty. Yeah. And like, uh, I, I appreciate that. Cause I think that that's the common experience that like, that's the common response. What?
00:46:15
Speaker
Yeah, but I thought that was a woman thing. Yeah, which it is, but it's also a man thing. It's a man's a human thing. Yeah. And many also experienced hormonal shifts for sure. Big time, big time. And in the, in early parenthood that is in many ways designed to increase baby bonding. Your levels of oxytocin go up, levels of testosterone start to drop.
00:46:41
Speaker
levels of estrogen go up, there are fluctuations in cortisol, the sort of stress related hormone, and all of those can support baby bonding, father baby bonding. They can also put men at risk for depressive episodes. And so important to acknowledge too that there are big shifts in life.
00:47:02
Speaker
There are shifts in priorities and shifts in sleep, intimacy and relationships. Those are all contributors, sure.
Treatments and Support for Fathers
00:47:11
Speaker
But there's a pretty strong biological basis for the experience of major depression in the postpartum period. And it's important to acknowledge because I think often most of us, especially guys, tend to be pretty logical about the construct.
00:47:30
Speaker
or have to find a reason for the why am I depressed? Yeah, which could be a barrier in and of itself. I have to find it. Totally, big one. And then they get lost in the weeds. So, yeah. Yeah. And so I'm wondering, you know, as you kind of start to wrap up this conversation, as I look at the time, a couple final questions. One, what is the current treatment that we can see from then that we can offer them that maybe quick education and what are some of the treatment that we can do to help? Yeah, for sure.
00:47:59
Speaker
I think from an individual standpoint, the treatments for postpartum depression are pretty much the same as for major depression at large. It's any mix of a number of routes. They're usually not independent of one another. They're not necessarily mutually exclusive. Most research supports a mix of medication and psychotherapy, but also there are important
00:48:27
Speaker
changes and optimizations to lifestyle, nutrition and fitness, physical activity, ensuring that other potential contributors to depression are also
00:48:40
Speaker
are also evaluated for changes to thyroid, changes to other vitamin levels. And then in many cases, the work of psychotherapy can involve all sorts of routes. But I think important in the postpartum setting for that to include some focus on interpersonal relationships because they are so important.
00:49:10
Speaker
How do I build community with other men, with other fathers?
00:49:15
Speaker
because loneliness is a really big predictive factor for the severity, the duration of depression.
Call for Systemic Changes and Education
00:49:24
Speaker
And so how do I connect with other people in my life? How do I connect with other fathers in particular? I think that is a big area of need and one that's sort of growing in terms of support, but I think could never grow fast enough to meet the need.
00:49:41
Speaker
Yeah, I think you're transitioning to my final question, which is great is, you know, if Pierre can, you know, looking at some of the systemic changes, I think, and there's a lot of, I think there's quite a few things we need to change. And one, the one you just said is spot on helping men understand the necessity and value of deep intimate, vulnerable relationships with other men. And that it creates a, you know, really that village mentality that we're really wired and connected and built for, you know, relationships and having a community.
00:50:08
Speaker
But I'm wondering if you could fix with, you know, a snap of your finger, the always miracle question, but if you could fix some of the systemic changes around this, what are some changes I think that you would see that can really improve and change your society for the better around this particular topic?
00:50:24
Speaker
Yeah, that's a great question. I think we'd see screening for fathers in the same way that we're seeing screening for moms. I think we'd be seeing screening for moms grow, increase, as well as screening for dads. Because I think that we're falling short in both domains. I think we would also see the expectation that fathers have time to connect with their babies.
00:50:48
Speaker
that it not be so surprising to see men taking care of and loving their children. That it not come across as such a surprise that it be supported, that men be supported in their willingness to and their desire to be good fathers. And I see so many men who want to give everything for their kids and want to show up as
00:51:15
Speaker
really good fathers, but also maybe lose themselves in the process. They're not supported by family members or friends in the process. They may feel isolated. So I think I would see, if I could snap my fingers, we would see more screening, certainly. We'd see more respect and appreciation for the role of dad.
00:51:37
Speaker
We'd see more avenues for men to connect over the experience of fatherhood in ways that feel approachable and masculine. And we'd see a lot of support from the community and from families around dads.
00:51:53
Speaker
caring for their kids. It wouldn't be seen as babysitting. We wouldn't be seeing the sort of tropes of Dudley fathers. This is one of the strongest and most amazing roles a man can have in life. I think we'd be seeing that in a respectful way in society.
00:52:17
Speaker
All three or four of those that you shared, yep, I want all those two. And I think if I were to snap my fingers, because, well, I want to answer too, because, hey, I want miracles to happen. I think for sure, especially with dads and fathers, one is like, yeah, we need to celebrate the healthy masculinity as well. Like, I think sometimes it gets so demonized in our society that we see the toxic masculinity. And so we want to throw all of it out versus, which is not an answer, because these traits are good. These are good traits.
00:52:46
Speaker
How do we celebrate them and teach them to be balanced traits? So I think we need to re-educate that these are good, these are not evil, these are not bad things. Anything taken to extreme is not going to be good. I think that's the thing we got to re-educate and anything we do taken to extreme, most things in life is about balance.
00:53:05
Speaker
And so we need to celebrate the healthy masculinity and say these are good traits and we need to celebrate those in those particular times, but also help round out men and the femininity too. What are the feminine traits that are good that meant it's, that it's part of being, being a guy. We have estrogen, like we, we're going to have some of these traits and that's to be celebrated too, to be part of the conversation. So really to normalize it, I would say, and two, we need to, if I could change something too, is the dialogue between, you know, if it's a partnered couple,
00:53:32
Speaker
The dialogue-grown relationship changes dynamics within that first year or two of becoming a parent, a father, because there are significant changes that happen. I think that's not talked about enough and educated enough. Often it's talked about changing diapers and feeding baby and often I think most even classes are about the birthing process but not so much what happens next. It's here's the day of the hospital, here's your birth plan.
00:53:57
Speaker
Which is great. Well, yeah, I think it's good to talk about because I think we need to prepare and even some of those classes I feel like don't prepare enough because when the stuff hits the fan Certain things are talked about like emergency c-section, you know things are explained enough. It's like here's what you here's your birth plan and and
00:54:13
Speaker
Again, we took a course through a midwife, and they were really good about really trying to talk through, hey, you have a plan, but hey, stuff can hit the fan, and here's what to do if worse comes to worse. So they were really good about that, and so prepared us for, oh, okay, this is what we can do. It's okay. So they were really good about educating us, and ours was a long, it was like we met over, I think, eight weeks. So it was like two hours for eight weeks. It was very intensive, which I'm very appreciative for.
00:54:42
Speaker
But a lot of birth classes are like couple hours for a day and they go over the basics. So I think really good education on the changes, you know, sex life changes because those things are real and I think there's this misconception and we don't talk about it enough. There's going to be a change. There's going to be a difference in how do we equip dads and men wanted to talk about their change.
00:55:04
Speaker
as well as to have a perspective of their partners changing with their wife as the mom is undergoing. And how do we work as a team to have dialogue and teaching them to connect with each other and to talk through this process. So I think education, education, education, education to normalize it because a lot of stuff I'm seeing is just it's simply not discussed or talked about. It's not even on the grid or radar
00:55:28
Speaker
for women even as well, but even more specifically for men and fathers. It's kind of blindsided and they don't know what to do with it. Often they go to self-blame, right? And as I work a lot of women as well with postpartum depression, there's a lot of self-blame as well.
00:55:46
Speaker
I'm failing, and all this stuff, I'm failing as a mother, something's wrong with me, and I'm like, no, no, there's hormonal changes, this is what's happening. You know, often medication's gonna help and you're gonna feel a lot better, but still, community support. So where I work, we have postpartum groups for moms, nothing for dads.
00:56:06
Speaker
Yeah. So I would love that in the company I work for. Well, why don't we have a postpartum group for dads? Why not? What's going on? So there's some systemic things that we need to really revamp and change.
00:56:23
Speaker
And I think the work you're doing, and hopefully the work I'm doing, but the work you're doing, since you're my guest, I think is so needed. And I want you to keep doing it. I want you to keep being that platform and reaching men and educating men and helping men and fathers and really normalizing this conversation. Continue reading the research so you can bring on the most recent information to really help the conversation to say, hey, here's what we're actually seeing.
00:56:48
Speaker
Here's what's happening. Here's what the data is showing and bringing really good education, good information, accurate information, not just the kitschy stuff on all the reels of TikTok, which is fine. Blessings to them. But I want good education to really help people. I'm in the field. I want to help. I will actually want to help and give them the information and the tools so they can actually get better.
00:57:14
Speaker
and I know you are too so I wish I want you to keep doing the work you're doing and reaching the men and and reaching their partners and their wives and their family because that helps them as well see what's going on for their man their dad right because sometimes they don't know right they even women are educated they don't understand as well as how it could express the manifestations of depression men that you talked about about the numbness that and
00:57:34
Speaker
They might just think he's disconnected or doesn't love me. It's like, well, there's something else going on here, right? There's a change in dad, a change in my husband, a change in my partner. So I think all of these things, a lot of it I think comes down to as well as having a healthy dialogue and understanding. We need to come together. And that's what you're doing is you're putting that out there. So I gosh, we're gonna have more episodes. I'm already thinking about it. I already have like two or three more ideas. We're gonna definitely come back on the show. I appreciate your time this morning.
00:58:00
Speaker
Travis, thank you so much. Yeah. This has been such a rich conversation and so needed and more of this needs to happen. So blessings to you. Blessings to my friend and to your day and to your sunny day in Florida. And I'm looking forward to having you on again. So thanks. Thank you. I appreciate you. All right. See ya.
00:58:20
Speaker
Thanks for joining and listening today. Please leave a comment and review the show. Dads are tough, but not tough enough to do this fatherhood thing alone.