Terrence Real

Real calls this covert depression. The man may not feel low at all, or may not admit it, but the pain shows up in what he does: the extra hours, the third drink, the short fuse, the evenings spent somewhere else. Because none of it looks like the textbook picture, family, friends and even doctors can miss it for years.

Real treats many of men's habits as defences against a pain they have not let themselves feel. Work, alcohol, sex, risk and rage all lift a man out of the hurt for a while. The relief is real, which is why the habit holds, but the hurt underneath stays where it is.

In Real's account, covert depression can turn overt when something takes the defence away: a job ends, a marriage breaks, the drinking has to stop, the body gives out. What looks like a sudden collapse has often been building for a long time. Seeing that pattern takes some of the shame out of it.

Real argues that boys are pushed early to stop crying, stop needing and stop leaning on others, especially their mothers. The lesson works: many men grow up unable to name what they feel. The cost is a disconnection from themselves and from the people who love them, which he sees at the root of men's depression.

Real writes about his own father's depression and anger, and about recognising the same pattern in himself. A father who never dealt with his pain passes it on in how he treats his son, and the son is likely to do the same unless he stops and looks at it. Facing it is how the chain breaks.

Real distinguishes active harm, such as being hit or shamed, from passive harm, such as being ignored, left alone with feelings or never comforted. Many men who say they had a fine childhood describe the second kind. Naming it is not about blaming parents; it helps explain where the numbness came from.

A man who feels deep shame may cover it by acting bigger, harder or more right than everyone else. Both ends keep other people at a distance. Real's aim is a steadier middle, where a man can be no better and no worse than the people around him.

Giving up the drink or the eighty-hour week can leave a man face to face with the feeling it was holding back, and that can be hard. Real's view is that recovery means learning to stay with the feeling instead of finding a new way out. It is slow, and it is learnable.

Real is a family therapist, and he treats depression as something that lives between people as well as inside one. Recovery means learning to speak about feelings, to listen, and to stay connected when it is uncomfortable. Partners, children and friends are part of the healing, and so is a good therapist.