By Kenneth England, MFT, Primary Therapist, Promises Malibu My son was 2 years old when he started preschool. I was astounded when I discovered they were teaching kids that young how to say, \u201cI don't like that.\u201d Both boys and girls were encouraged to speak up for themselves. My son was shown how to express emotions without having to act them out, which was a big change from my childhood.\u00a0 When I was a kid, boys were taught to get aggressive with someone or yell rather than say, \u201cHey, I don't like that.\u201d And we were taught to hide other emotions, like sadness, at all costs. Happily, my son, now 14, is part of a younger generation that is more oriented around feelings. But this is not the case with all guys, and certainly not the generations before him. Men, in our culture and around the world, are taught to hide real feelings and suppress emotions deep down inside, which is one of the major reasons depression in men is underdiagnosed and undertreated. Research shows \u00a0men are less likely than women to ask for help when it comes to depression. Many don\u2019t even realize there\u2019s a problem. Studies show there is a discrepancy between a man\u2019s perception that he may need help and actually seeking it. One of my main jobs as a therapist, especially with men, is to introduce them to the idea that they need a more emotional life. As they develop more emotional familiarity, they can learn to experience feelings, address them and cope more effectively. Why Men Don\u2019t Seek Help Gender stereotyping plays an insidious part in how men learn to deal with their emotions. There are many influences at work. The first is family and immediate caregivers who teach males how men should conduct themselves in family life. Then there are societal pressures around how men are supposed to show up in the world. And then there is the media, which is filled with commercials, movies, TV shows and representations of men who are tough, have things under control and respond with aggression, never with vulnerability. There is the implication that men should not be affected by emotional things. It all adds up to make men feel badly about themselves when they don\u2019t match those expectations and creates a barrier to asking for help. As with everything, awareness is the first step toward healing and it can help men and their partners have a better understanding of depression. Here are a few of the main reasons men don\u2019t ask for help: \tThey don\u2019t know how to ask. Statistically women tend to suffer from depression in larger numbers but they also are more likely to identify symptoms and seek professional and medical help. Diagnosing depression is a process of narrowing things down and eliminating other conditions. A therapist will ask a man how often he\u2019s depressed, to what degree, does he feel sad or hopeless, and for how long. Men may not always have the emotional language to explain what they\u2019re experiencing. Or they may be embarrassed or think it\u2019s unnecessary to report \tSadness is taboo. One of the main criteria for diagnosing depression is sadness. Men are not as likely to talk about \u201csadness\u201d unless there\u2019s been a death, which then makes it acceptable. It's not something that men typically feel comfortable with. It often boils down to gender stereotyping, in that men are more often raised with family and social messages of what is appropriate for boys versus girls. \tCrying is forbidden. Tears are a common expression of the internal pain of depression but a man who cries may be called a wuss or worse. They learn from an early age that shedding tears is unmanly. The United States is not the only place where being an alpha male is celebrated. Many cultures believe males should be tougher than females and this can create many levels of emotional constriction. Showing emotions through tears is often considered unacceptable to men, and to the people around them, so sharing their pain is risky. \tEmotions are not the common vernacular. I notice that men tend to say archaic things about feelings, such as, \u201cYou shouldn't be feeling this, this is not OK.\u201d Or they say nothing at all. Not only are they uncomfortable talking about their feelings, they lack familiarity with the uncharted area of emotions. As a therapist, my number one source of information is my clients. If they are locked into beliefs based on stereotyping, it can be difficult to get them talking. They lack the skillset. They have to develop those skills and practice them. \tThey tell themselves to just get over it. Men often make excuses about reaching out for help because they truly believe their emotions should not be an issue. As one client said, \u201cI\u2019m 45 years old. I don't know why this stuff is bothering me. I should be done with this.\u201d Men often feel stupid about having emotional pain. It takes work to help them realize sadness could be a response to an old trauma that\u2019s been triggered, and that it\u2019s wired in their system through their experiences from the past. \tIt gets masked by addiction. Using alcohol or other drugs or turning to sex or other activities can make people feel good in the moment and take the pain away. Many of the clients I see have co-occurring disorders such as anxiety and depression. We do an exercise that explores the positives of drinking and drugs, as well as the plusses and minuses of being in recovery. Invariably, clients will come to the conclusion that the \u201cbenefits\u201d of drinking and drugs is emotional-coping. It\u2019s a powerful moment when they realize they\u2019ve used drugs and alcohol to self-soothe. It\u2019s the first step toward developing healthier coping skills. Part of the new skill is to learn to express sadness rather than covering it up. Men don't typically choose to put themselves in a place of vulnerability. They're more comfortable with acting out and expressing angry types of emotions. In my work as a therapist, I aim to teach men that there is power in vulnerability and there is certainly no shame in it.