Almost every day we have ups and downs in mood. How can we distinguish the everyday blues from clinical depression?

Nights I could handle. I fell asleep easily, and sleep allowed me to forget. But my mornings were unmanageable. To wake up each morning was to remember once again that the world by which I defined myself was no more. Soon after opening my eyes, the crying bouts would start and I’d sit alone for hours, weeping and mourning my losses.

(Williams, 2008, p. 9)

I woke up one morning with a knot of fear in my stomach so crippling that I couldn’t face light, much less day, and so intense that I stayed in bed for three days with the shades drawn and the lights out.

Three days. Three days not answering the phone. Three days not checking my e-mail. I was disconnected completely from the outside world, and I didn’t care. Then on the morning of the fourth day there was a knock on my door. Since I hadn’t ordered food I ignored it. The knocking kept up and I kept ignoring it. I heard the sound of keys rattling in my front door. Slowly the bedroom door opened and in the painful light from the doorway I saw the figures of two old friends. “Terrie, are you in there?”

(Williams, 2008, p. xxiv)

The Crying Game: Male Versus Female Tears

By Jocelyn Noveck, The Associated Press

“Please, please, please, just give the dog back,” Ellen DeGeneres wept on national TV. … It was a moment that quickly established itself in the pop-culture firmament, less for the plight of Iggy the adopted terrier than for the copious crying itself.

(To recap: DeGeneres had adopted Iggy from a rescue organization, then given it to her hairdresser’s family when the dog didn’t get along with her cats. That was against the rules, and the rescue group took the dog back. …)

Setting aside the question of whether those sobs were 100 percent genuine, tears are a natural human response, and public figures are obviously not immune. But some who study this most basic expression of feeling will tell you that in this day and age, it can be easier for a crying man to be taken seriously than a crying woman.

In politics, it’s a far cry … from 1972, when Sen. Ed Muskie’s presidential campaign was derailed by what were perceived to be tears in response to a newspaper attack on his wife. But decades later, an occasional Clintonesque tear is seen as a positive thing.

Bill Clinton, that is.

“Bill could cry, and did, but Hillary can’t,” says Tom Lutz, a professor at the University of California, Riverside, who authored an exhaustive history of crying. … [T]he same tearful response that would be seen as sensitivity in Bill could be seen as a lack of control in his wife.

But there are additional rules for acceptable public crying. “We’re talking about dropping a tear,” Lutz notes, “no more than a tear or two.” And it all depends on the perceived seriousness of the subject matter. Thus Jon Stewart or David Letterman could choke up with impunity just after 9/11. But a dog-adoption problem is a whole other matter.

In a recently published study at Penn State, researchers sought to explore differing perceptions of crying in men and women, presenting their 284 subjects with a series of hypothetical vignettes. Reactions depended on the type of crying, and who was doing it. A moist eye was viewed much more positively than open crying, and males got the most positive responses.

“Women are not making it up when they say they’re damned if they do, damned if they don’t,” said Stephanie Shields, the psychology professor who conducted the study. “If you don’t express any emotion, you’re seen as not human, like Mr. Spock on ‘Star Trek,’” she said. “But too much crying, or the wrong kind, and you’re labeled as overemotional, out of control and possibly irrational.”

That comes as no surprise to Suzyn Waldman, a well-known broadcaster of Yankee games on New York’s WCBS Radio. Earlier this month, she choked up on live radio after the Yankees had just been eliminated from the playoffs. She was describing the scene as [the] coaches choked up themselves.

… Her tearful report quickly became an Internet hit, and she was mocked far and wide, especially on radio. …

“When men express anger they gain status, but when women express anger they lose status,” [says] Yale social psychologist Victoria Brescoll. …

For a little historical perspective, says Lutz, author of “Crying: The Natural and Cultural History of Tears,” it’s helpful to look back to the 19th century, when skillful politicians like Abraham Lincoln used tears as a natural part of their oratory.

The tide later shifted against male crying, but in the past 30 to 40 years male crying has gained in acceptability. “Every president since Ronald Reagan has used tears at some point,” says Shields, the Penn State psychologist. … Military figures have cried at critical moments. Gen. Norman Schwarzkopf cried at a Christmas Eve ceremony in front of his troops, and when interviewed by Barbara Walters, Lutz notes.

… But in DeGeneres’ case, along with the strong support from fans and many dog lovers, she also endured some criticism and mockery. …

Jocelyn Noveck, “The Crying Game: Male vs. Female Tears,” The Associated Press, October 25, 2007. Used with permission of The Associated Press Copyright© 2014. All rights reserved.

At first I didn’t notice the change. Then things got worse. I always hated waking up, but slowly it was turning into something deeper; it was less like I didn’t want to wake up, and more like I couldn’t. I didn’t feel tired, but I had no energy. I didn’t feel sleepy, but I would have welcomed sleep with open arms. I had the sensation of a huge weight, invisible but gigantic, pressing down on me, almost crushing me into the bed and pinning me there.

(Williams, 2008, p. xxii)

major depressive disorder A severe pattern of depression that is disabling and is not caused by such factors as drugs or a general medical condition.

persistent depressive disorder A chronic form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression.

premenstrual dysphoric disorder A disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation.

Sadness at the Happiest of Times

Women usually expect the birth of a child to be a happy experience. But for 10 to 30 percent of new mothers, the weeks and months after childbirth bring clinical depression (Guintivano et al., 2014; Kendall-Tackett, 2010; Mauthner, 2010). Peripartum depression, popularly called postpartum depression, typically begins within four weeks after the birth of a child; many cases actually begin during pregnancy (APA, 2013). This disorder is far more severe than simple “baby blues.” It is also different from other postpartum syndromes such as postpartum psychosis, a problem that is examined in Chapter 14.

The “baby blues” are so common—as many as 80 percent of women experience them—that most researchers consider them normal. As new mothers try to cope with the wakeful nights, rattled emotions, and other stresses that accompany the arrival of a new baby, they may have crying spells, fatigue, anxiety, insomnia, and sadness (Enatescu et al., 2014). These symptoms usually disappear within days or weeks (Kendall-Tackett, 2010; Horowitz et al., 2005, 1995).

In postpartum depression, however, depressive symptoms continue and may last up to a year or more. The symptoms include extreme sadness, despair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, feelings of inability to cope, and suicidal thoughts. The mother–infant relationship and the psychological and physical health of the child may suffer as a result (Kendall-Tacket, 2010; Monti et al., 2004). Women who have an episode of postpartum depression have a 25 to 50 percent chance of developing it again with a subsequent birth (Stevens et al., 2002).

Many clinicians believe that the hormonal changes accompanying childbirth trigger postpartum depression. All women go through a kind of hormone “withdrawal” after delivery, as estrogen and progesterone levels, which rise as much as 50 times above normal during pregnancy, now drop sharply to levels far below normal (Horowitz et al., 2005, 1995). Perhaps some women are particularly influenced by these dramatic hormone changes (Mehta et al., 2014). Other theorists suggest that some women may have a genetic predisposition to postpartum depression (Guintivano et al., 2014; Comasco et al., 2011). A woman with a family history of mood disorders appears to be at high risk, even if she herself has not previously had a mood disorder (Phillips, 2011; APA, 2000).

At the same time, psychological and sociocultural factors may play important roles in the disorder (Mauthner, 2010). The birth of a baby brings enormous psychological and social change. A woman typically faces changes in her marital relationship, daily routines, and social roles. Sleep and relaxation are likely to decrease, and financial pressures may increase. Perhaps she feels the added stress of giving up a career—or of trying to maintain one. This pileup of stress may heighten the risk of depression (Phillips, 2011; Kendall-Tackett, 2010). Mothers whose infants are sick or temperamentally “difficult” may be under yet additional pressure.

Fortunately, treatment can make a big difference for most women with postpartum depression. Self-help support groups have proved extremely helpful for many women who have or who are at risk for postpartum depression (Dennis, 2014; Evans et al., 2012). In addition, many respond well to the same approaches that are applied to other forms of depression—antidepressant medications, cognitive therapy, interpersonal psychotherapy, or a combination of these approaches (Hou et al., 2014; Kim et al., 2014; Phillips, 2011).

However, many women who would benefit from treatment do not seek help because they feel ashamed about being sad at a time that is supposed to be joyous and are concerned about being judged harshly (Bina, 2014; Mauthner, 2010). For them, and for the spouses and family members close to them, a large dose of education is in order. Even positive events, such as the birth of a child, can be stressful if they also bring major change to one’s life. Recognizing and addressing such feelings are in everyone’s best interest.

World Count

More than 350 million people suffer from depression worldwide (World Health Organization, 2012).