What’s the point in talking when nobody is listening?
Guys don’t like to talk about it. We’d rather suffer in silence until it’s unbearable. We just “man up” and get used to our misery. Like good men are supposed to do… we shut the f*ck up. Just ask Tony.
“What happened to Gary Cooper? The strong, silent type. That was an American. He wasn’t in touch with his feelings. He just did what he had to do. See, what they didn’t know, was once they got Gary Cooper in touch with his feelings they wouldn’t be able to shut him up! And then it’s dysfunction this, and dysfunction that, and dysfunction vaffancul!” – Tony Soprano
Remember Brave Heart, William Wallace? What a bad ass. Us Scots have a reputation of being tough mofos. And yet the suicide rate in Scotland for men is 73% higher than England and Wales. Strong and silent. Oh, and miserable. And whilst we might feel like we are alone, turns out we are in great company. In Germany, the UK and Spain prescriptions for anti-depressants have doubled in the last ten years. Meanwhile our friends in Iceland top the charts at almost twice the OECD average with 15 to 25% of the population expected to experience depression at some point.
At what stage do you think the average man asks for help? When he’s a little under the weather? When it feels like it all might be getting too much? No, he asks at the point he’s hanging off the ledge and ready to fall. And with everything he can muster, he’ll sit there, despite his best effort and still say that actually” it’s okay.” Here in Scotland, sitting in the waiting room at the doctors, we receive advice on how to make the most of our ten minute appointment (Please don’t be upset if we can’t address all your issues… an additional appointment may be required). So as the world crashes down around you, you get to work on the elevator pitch. By the time you’ve addressed the fact that you can’t sleep and your not eating too well…
With time constraints and a quota to reach is it little wonder then that the cookie cutter approach to health has become the norm? All you wanted to do was talk, it took all you had to get here and now the clock is ticking. Are you familiar with SSRI’s? Here’s your prescription. Ding! Time’s up. Thank goodness we didn’t have to get into any of the tricky stuff.
I am pissed off that the knee jerk reaction to life’s downs is to anesthetize the problem. There’s no question that sometimes swift and powerful intervention is the answer. But meanwhile, back in the nine to five daily grind, becoming comfortably numb strikes me as a completely unsatisfactory solution. What you tolerate, you accept.
We need to talk. And Tony is right, once those floodgates open we won’t shut up. It’s embarrassing, it’s shameful, it’s just not manly. That’s what we are led to believe. But in truth, vulnerability is the flip side of strength. The ability to feel, deeply, to stay with that, to explore and express it and not run away, that is real strength. What was it about Tony Soprano that struck such chord with the average man? We simply wanted to talk without being judged or made to feel less of a man.
The Journal of Psychiatric Practice recently provided guidance for clinicians on prescribing exercise for depressed patients. What’s really interesting about this most recent study is it actually provides a prescription, the effective dose, for the treatment of Major Depressive Disorder. “Despite the substantial evidence supporting the use of exercise in the treatment of MDD, previous studies have not provided a clear indication of the proper dose of exercise needed to elicit an antidepressant effect,” wrote Chad Rethorst, PhD, and Madhukar Trivedi, MD, of the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas. To fill this gap, the authors reviewed available data from randomized controlled trials, with the goal of developing specific and detailed recommendations for clinicians on how to prescribe exercise for their patients with MDD.
It might be the last thing you want to hear, that getting up, getting moving, getting out is the first step towards feeling better. But it’s a message that needs to be shared.
Based on the available data, aerobic exercise is the preferred form of exercise for patients with MDD—although there is also support for resistance training, Rethorst and Trivedi note. In terms of session frequency and duration, they recommend that patients participate in three to five exercise sessions per week, for 45 to 60 minutes per session.
In terms of intensity, for aerobic exercise, they recommend achieving a heart rate that is 50 to 85 percent of the individual’s maximum heart rate (HRmax). For resistance training, they recommend a variety of upper and lower body exercises―three sets of eight repetitions at 80 percent of 1-repetition maximum (RM—that is, 80 percent of the maximum weight that the person can lift one time).
Data suggest that patients may experience improvement in depressive symptoms as little as four weeks after starting exercise. However, Rethorst and Trivedi emphasize that the exercise program should be continued for at least ten to twelve weeks to achieve the greatest antidepressant effect.
You can’t address all of life’s problems by running a mile or lifting a kettlebell. But it’s a very positive start.