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NIMH Launches 'Real Men. Real Depression.' Campaign

By Constance Burr

In April, NIMH launched "Real Men. Real Depression." — a campaign to educate the public about depression in men. Men who live with the illness, not actors, talk candidly about their symptoms, treatment and recovery in public service announcements. A fire fighter, an Air Force sergeant, a police officer, a student, a lawyer and a diving champion are all men who voice their struggles with depression, revealing the courage it takes to get treatment. In a time of war in Iraq, rumors of bioterrorism and the threat of SARS, the campaign may well have been released at the perfect moment.

Dr. Thomas Insel

Although it mirrors the current climate, the campaign began to take shape on Sept. 10, 2001. NIMH Communications Director Clarissa Wittenberg and staff were meeting with documentary filmmaker Leslie Wiener in Manhattan on filming men from all walks of life talking to other men about their experiences with depression. On the morning of Sept. 11, the NIMH staffers were stalled on the JFK Airport tarmac and ended up being forced to spend a week in New York. In the ensuing months, the campaign would take on new urgency.

The men's stories, filmed from hundreds of hours of conversation, show depression as a pervasive, serious, but highly treatable medical condition that involves body, mood and thoughts. Personal accounts from a male perspective confirm that, without treatment, symptoms can last a long time and alter lives.

On 9/11, Jimmy Brown, a fire fighter who worked at Engine 10 across from the World Trade Center, climbed to the 24th floor of the South Tower, when it began to collapse. Hit with debris, he feared being buried, but he made his way to street level walking through dust so thick he couldn't see or hear anything. After a hospital stay, dogged by numbness and loss of interest in life, he spent days at home doing nothing, consumed by survivor's guilt and despair.

"There's a huge stigma in admitting any problem," Brown said at the National Press Club launch. "They think I'm a big, tough fireman. I'm supposed to be able to deal with anything…to be able to just pick up, carry on, like the old commissioner said, 'Just be able to suck it up. And just keep going.' It's not that easy. No, when you're in the middle of it, you just don't know if it's gonna end, where it's gonna end, how it's gonna end. There were days when I thought I'd never be myself again."

Surgeon General Richard Carmona (c) meets with campaign spokesmen (from l) Jimmy Brown, Shawn Colten (a national diving champion who aspires to the Olympics despite recurrent periods of depression that began in early childhood), writer Steve Lappen and former Air Force Sgt. Patrick McCathern.

Researchers estimate that more than 6 million men in the United States have a depressive disorder in a given year. Although women are more likely to be depressed, they are more apt to get treatment. Symptoms include persistent sad or anxious feelings, feeling hopeless, fatigue, insomnia, irritability, having less energy, appetite loss and suicidal thoughts. Men may not recognize the disorder and turn to alcohol or drug abuse. Carrying the potential for fatal consequences, depression is a strong risk factor for suicide, and men die by suicide at four times the rate of women.

"The campaign aims to empower men who have depression," said NIMH director Dr. Thomas Insel, at the launch. "Men often feel they can overcome feelings of helplessness and depression by themselves. We sometimes wonder whether the gene for asking for help is on the same chromosome as the gene for asking for directions. It's an illness that precludes its own treatment. But we have very good treatment with a high success rate — more than 80 percent — for people who seek help."

NIH deputy director Dr. Raynard Kington applauded the campaign's effort to "assure that the important scientific advances we have made are actually used to help real people live healthier lives. 'Real Men. Real Depression.' joins important public education campaigns aimed at promoting healthy behaviors, such as the National High Blood Pressure Campaign of the National Heart, Lung and Blood Institute; the National Cancer Institute's 'Eat 5 a Day for Better Health'; and the National Institute of Child Health and Human Development's 'Back to Sleep' campaign to fight sudden infant death. We also have campaigns about diabetes, eyesight and other topics."

Surgeon General Richard Carmona, recalling his former roles in Army Special Forces, as a police officer, paramedic and a trauma surgeon, said: "For generations men like me have been told that we have to 'act tough.' Today we are attacking the stigma that tough guys can't seek help. They can, and they should. When real men step up and get help for depression, you're paving the way for our sons, and their sons. You're making it easier for the next generation of boys and men to not have to suffer in silence."

Lydia Lewis, president of the Depression and Bipolar Support Alliance, praised "these very macho guys for their courage to speak out."

Fire fighter Jimmy Brown (r) speaks at the campaign kick-off as Dr. Raynard Kington (l) NIH deputy director, and Carmona listen to him.

The men filmed gave permission to use their full names and professions and continue to be active participants as the campaign unfolds.

Patrick McCathern, a retired Air Force sergeant, describes the disorder's spiral in a public service spot: "It starts slowly and the only person you're talking to is yourself. You're lost. It's dark, the pain is 24-7…you just want it to end. I'd drink and…I tried to numb my head…but you have to deal with it. It doesn't go away."

Going public about this hidden disorder, Rene Ruballo, an urban police officer for over 20 years, speaks of a "loss of interest in basically everything that I like doing — martial arts, comic books, toys, things like that. I just didn't really feel like doing anything any more."

A culture that equates asking for help with weakness can make guys cower at the very thought of seeking a medical diagnosis. Furthermore, "being a Latino made it harder," explains recent college graduate Rudolfo Palma-Lulion, "because there is a silence over things. There are just things you don't talk about."

The men explain how different their lives are with treatment and after emerging from the illness. Jimmy Brown is developing a peer counseling program to help police and fire fighters deal with stress and depression. Patrick McCathern is devoting most of his time to helping others. Rene Ruballo is hoping to attend culinary school and open a restaurant. Rudolfo Palma-Lulion has joined his family in Chile, his birthplace.

Campaign resources include TV and radio PSAs, publications, a web site and a toll-free information number. Materials highlight the importance of diagnostic evaluations, depression symptoms, types of medication and psychotherapy and how to get help. The web site, is also accessible from the NIMH home page at A program to notify psychiatrists, psychologists and primary care physicians is in development.

Hundreds of emails about "Real Men. Real Depression." suggest that it has struck a responsive chord. Some samples: "This issue has been shrouded in silence and neglect for far too long"; "Finally. Awareness that men also suffer from this killer disease!"; "Are there any volunteer needs around this campaign? As a sufferer myself, I know what it's like to hide the feelings"; and "It will help save many lives."

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