men with depression

It takes effort. Jens Büsing stands in front of the mirror every day and says this sentence: “I’m a great guy.” Is he right? The 37-year-old nods. “Yeah, I’m starting to believe it again.” He smiles and squints in the sun. The daily concert of countless songbirds sounds from the ancient trees. The large garden of the “Day Clinic for Men” in Sehnde near Hanover, which belongs to the Wahrendorff Clinic, should be a place to relax . Jens Büsing is trying to do that. Little by little, his self has blossomed again in Germany’s first day clinic for depressed men.
“My marriage too,” says the plant controller happily. “It’s almost as if we just met.” The amateur martial artist wears his hair combed back and a three-day beard. In his short-sleeved shirt he looks full of energy. “I want to do more at home again,” he says. “Renovating our daughter’s room, that’s what I’m doing now.” Time will tell how much the nine-year-old noticed of her father’s depression. “I tried not to show so much in front of her,” says Jens Büsing. Because how do you explain to a primary school student what a “ specialist hospital for the soul ” is – according to the clinic’s slogan ?

That answers Markus Wagner, qualified psychologist and therapist in the men’s clinic. He sits with his patient, but keeps the distance that signals without words: you can do it on your own. The 34-year-old exudes calm. He recommends a comparison for parents: If someone breaks their leg, they get a cast and everyone can see that they are ill. You don’t see it with dad because his soul needs a bandage.

The ordeal

Jens Büsing fought alone and with increasing desperation against his depression for eight years . “Typical behavior in men,” behavior therapist Markus Wagner would later say. “Admitting that I have a problem is the biggest hurdle.” Because this admission contradicts everything that those affected learn as children: Pull yourself together! Indian heart knows no pain! Psychologists call this “ orientation towards norms of masculinity ”. Not only does it mean that men go to the doctor much later than women. It also triggers completely different depression symptoms in them. Experts like Markus Wagner know that. Many doctors in private practice, on the other hand, spend a long time looking for physical causes – and thus delay the correct diagnosis.

This has fatal consequences: around 75 out of 100 suicide victims in Germany are men. “At the same time, about 80 percent of all suicides have to be traced back to depression,” says Prof. Anne Maria Möller-Leimkühler, senior social scientist at the Clinic for Psychiatry and Psychotherapy at the University of Munich.
“A high suicide rate with a low depression rate suggests that there are many unreported cases among men.” Such statistics are all the more alarming: the number of days off work due to mental illness rose by 82 percent among men between 1994 and 2003. This is what it says in the Men’s Health Report, which was published for the first time in 2010 (published by the Men’s Health Foundation). And according to the AOK, this absenteeism increased by almost 40 percent from 2004 to 2010.

The everyday

Jens Büsing felt well prepared for life. “I had a great family home,” he says beaming. There he learned to approach people openly, to accept different opinions, to address problems. Such behavior is well received by his bosses, who support him. “I had very good contact with some of them.” With such motivation, the system controller takes on additional tasks in a factory and is always fully committed.

His colleagues react with bullying. “Nudibranch” they christen him because he supposedly “slimes” at superiors. He is not invited to parties.

If he wants to have new work steps explained to him, the team deliberately starts without him. Even his family life is being questioned. “‘Whoever works here doesn’t need a family,’ I was told,” remembers Jens Büsing. Every day his colleagues let him feel it again: you don’t fit in with us. You won’t be able to find your way around here anyway. “Imagine being told all the time: your work is complete filth!” snorts the man from Lower Saxony. But taking sick leave is out of the question for Jens Büsing. Not even when his self-doubt and fear of failure keep growing. He questions everything. Himself. His life. Mrs. Büsing tries to cheer up her husband. “Let them babble. Don’t put the shoe on,” says the 40-year-old to him. But she hardly ever reaches her husband. “He seemed totally absent and was constantly escaping to do sports.” Today she knows that this behavior is typical of depressed men. Some train to the point of total exhaustion to get rid of the inner pressure. Jens Büsing does Taekwondo, a Korean martial art. “I got a little bit of recognition there,” he says. At some point even that is no longer enough. Jens Büsing breaks down crying at home. “I felt like it was all over. My life no longer had any meaning,” he says openly and searches for a suitable image for his feelings. “It crushes you – like a car on your chest. There was only this crying creature inside me, trembling all over and unable to make any decisions at all.” Some train to the point of total exhaustion to get rid of the inner pressure. Jens Büsing does Taekwondo, a Korean martial art. “I got a little bit of recognition there,” he says. At some point even that is no longer enough. Jens Büsing breaks down crying at home. “I felt like it was all over. My life no longer had any meaning,” he says openly and searches for a suitable image for his feelings. “It crushes you – like a car on your chest. There was only this crying creature inside me, trembling all over and unable to make any decisions at all.” Some train to the point of total exhaustion to get rid of the inner pressure. Jens Büsing does Taekwondo, a Korean martial art. “I got a little bit of recognition there,” he says. At some point even that is no longer enough. Jens Büsing breaks down crying at home. “I felt like it was all over. My life no longer had any meaning,” he says openly and searches for a suitable image for his feelings. “It crushes you – like a car on your chest. There was only this crying creature inside me, trembling all over and unable to make any decisions at all.” Jens Büsing breaks down crying at home. “I felt like it was all over. My life no longer had any meaning,” he says openly and searches for a suitable image for his feelings. “It crushes you – like a car on your chest. There was only this crying creature inside me, trembling all over and unable to make any decisions at all.” Jens Büsing breaks down crying at home. “I felt like it was all over. My life no longer had any meaning,” he says openly and searches for a suitable image for his feelings. “It crushes you – like a car on your chest. There was only this crying creature inside me, trembling all over and unable to make any decisions at all.”

Men suffer differently

• gloomy mood
• lack of interest
• no joy in everyday life
• loss of appetite
• sleep disorders
• nagging restlessness
• tendency to withdraw
• inhibited thinking
• lack of energy
• low self esteem
• hopelessness, fear
• thoughts about death
• suicidal thoughts

Symptoms of depression in men:

• low stress tolerance
• increased willingness to take risks
• acting out of feelings
• low impulse control
• Outbursts of anger or violence
• irritation, dissatisfaction
• depressive thoughts
• Addictive behavior (alcohol, pills)

When her husband finally drove to the Wahrendorff Clinic in Sehnde – he had read a newspaper article about it – his wife had no idea how great the risk of losing him was. “I didn’t know anything about his suicidal thoughts at the time,” says the business economist quietly. In fact, Jens Büsing already knows exactly which wall he wants to crash into. He keeps his plans to himself. He only talks about it with the doctors in Sehnde. They move him to a “protected” station. When his wife wants to bring him some more things, she has to register and wait for the doors to be opened for her. It looks like a prison.

“What am I doing here?” – that is Jens Büsing’s first thought when he meets his fellow patients. “I had the feeling that they were much, much worse off than I was.” He was prescribed an antidepressant that changed the concentration of certain neurotransmitters in his brain. “That was a problem for me,” he admits. “I didn’t know what that would do to me.” It helps. Eventually, Jens Büsing’s soul catches up to the point that he can continue his treatment at the day clinic for men. In the evenings and at weekends he is now back at home with his wife and daughter, for him a safe haven in the whirlpool of life.

The clinic

Jens Büsing leaves the garden via a beaten path and enters the spacious entrance and common area of ​​the day clinic through a wide door. It is pleasantly cool here. The thick walls of the office building from the 19th century keep the summer heat out. Six men are waiting in black leather armchairs for the rounds, which begin around 2 p.m. on Mondays. Two newcomers are among them.

You are at the beginning of the path that Jens Büsing has almost completed. Their faces still seem absent, they have to learn to smile again. Jens Büsing chooses an armchair with a colorful cushion that stands a little to one side. “I found the idea of ​​only treating men to be getting used to at first,” he says. It’s over. “People here understand you immediately. Nobody has to explain much.”

Psychologist Markus Wagner also found the “men’s clinic” concept strange at first. “I thought there would be a kind of regulars’ table atmosphere,” he explains his concerns. He’s now convinced. “The other patients are the fourth therapist here” – in addition to psychologists, occupational therapists and nurses. Four women belong to the seven-strong team. “But gender doesn’t matter,” says Markus Wagner. “We are seen as ‘therapeutic neutrals’, so to speak.” At his previous employer, Markus Wagner experienced that things work differently when women and men are treated together: “If there are also women in the group therapies, the men withdraw and never address the issues that really bother them.”

Do I have to shave every day? Should I hang up the laundry? How do I meet a woman? What about other fathers who spend a lot of time caring for their children? Such questions only seem banal at first glance. “Behind this lies the conflict between the old and the new image of men,” Markus Wagner knows from numerous conversations. Macho or Softie? “Many men ask themselves: where do I stand? This is not discussed in front of patients.” The associated values ​​and evaluations play a central role in the concept of the day clinic. The therapists go through them with the patients step by step. Diagrams of boxes and arrows grow on the blackboard writing pad: Behavior is written at the bottom of the long piece of paper, and the hidden needs behind it are at the top. Thoughts, trigger emotions and vice versa. In this way, the cycle of the soul becomes visible to men.

“Some look like robots when they come to us,” says Markus Wagner. “You can’t allow any feelings at all.” Others fear being overwhelmed by emotions. The behavioral therapist takes a small basket with a lid from the shelf. Inside is a ball of wool, a bottle of Chinese oil, a yellow hedgehog ball, wide rubber bands, fizzy tablets. “Those are our skills,” explains Markus Wagner. They help men to stay in control of their feelings. Depending on how pronounced these are, the skills set a strong counterstimulus.
A bubbling pill in the mouth, a girlfriend’s perfume or a rubber band snapped against the forearm attracts everyone’s attention and becomes an emergency brake on the tormenting carousel of thoughts.

And: To imagine that the inner executioner (“You’re a loser!”) suddenly has the voice of SpongeBob, to realize that 80 percent of the brain produces such negative thoughts due to evolution, creates distance and averts the danger.
Thinking no longer bites into the past or the future. The men learn to stay in the here and now with their attention and to enjoy these moments. You can be quiet when patients gather in the group room for a relaxation session or imagery exercise. Or loudly, when we are celebrating goals when playing soccer or drumming together in the garden on the “DrumBalls”, large Pezzi balls. Then the depression is far away.

The end

Treatment at the day clinic lasts an average of six weeks.

The men are given homework for their weekends: to meet up with friends again. Asking strangers the time or directions to reduce social anxiety. Implement the tips from the clinic in everyday life. “We don’t do rehabilitation here,” emphasizes the psychologist. “It hurts to work on yourself.” He is all the more pleased about the progress of his patients. At the end of the therapy, one of them, a soldier, gave Markus Wagner a medal that he had received himself. “He said to me, ‘Everything that this Order once meant to me is in me now. I don’t need it anymore’”, remembers Markus Wagner. “It was unbelievable, really great.” A few more days and Jens Büsing’s seven weeks in the day clinic for men will be over. “The imminent end of therapy is already nagging at me,” he admits after his rounds. “Hopefully what I’ve learned here is enough.” He opens a page in a narrow folder in which he has stapled all the clinical documents. On the paper sits a man in a large, yellow bubble. Red flames attack him, but bounce off the bubble. “I painted that when we were supposed to imagine a safe place here,” says Jens Büsing thoughtfully. Is he afraid of a relapse? “Yes, I have them. But the bubble protects me. And I can count on the support of my family.” when we were supposed to imagine a safe place here,” says Jens Büsing thoughtfully. Is he afraid of a relapse? “Yes, I have them. But the bubble protects me. And I can count on the support of my family.” when we were supposed to imagine a safe place here,” says Jens Büsing thoughtfully. Is he afraid of a relapse? “Yes, I have them. But the bubble protects me. And I can count on the support of my family.”

Men should show solidarity

Tolfioow: Why a day clinic for men only?
dr Michael Hettich: The trigger was the men’s health report, which was first published in 2010. As I read, I realized that the current treatment for depression does not reach men because it is tailored to women. The report contained many sentences with “should” or “must”. I thought: Let’s do this now. Of course, not every man has to go to the men’s clinic.

What’s new at the clinic?
The therapy modules that we use here are all well tested and researched. What is new is the environment: men among themselves. This is the experiment. We want the men to show solidarity with one another and to benefit from this as well.

What are the individual therapy components aimed at? Some exercises help to perceive feelings and to improve the handling of stress. The men also learn defusing strategies. It’s emotionally different when I think instead of “I’m a failure”: “Aha, my brain is thinking that I’m a failure right now.” Our range of sports helps patients to stay in the here and now. They should do something positive and experience that they don’t think about their depression for a while

Is the number of depressed men increasing?
Yes, especially among the 20 to 50 year olds. They too experience a double burden. On the one hand they want and should take on more tasks in the family, on the other hand they usually remain the main breadwinner, who has to cope with great professional pressure. The balance falls short.

Why is that?
I believe that we have just arrived at a similar turning point in the world of work as there was once before during industrialization. At that time, the workers had to do an enormous amount of physical work and became physically ill more and more often. Occupational health and safety and other measures were then introduced. We’re back to that now, only now it’s about mental health. That means prevention has to go where men spend most of their time – in the workplace.

Your clinic works very successfully.
Yes, and I’m a little proud of that too. So far we have treated about 250 men. All of their data goes into a study that we are conducting together with the University of Munich. We expect to publish the results next year. 1 Friendships for life are also made in the clinic: Jens Büsing with a fellow patient 2 This is how Jens Büsing imagines his safe place, to which he can mentally flee at any time 3 Jens Büsing’s emergency kit for the soul: effervescent tablets and rubber bands are distracting when feelings explode.