I'm Not Sad, I'm Angry: What Depression Sounds Like When You Don't Use That Word
When mental health outreach falls short
Imagine someone sitting in a doctor's office. They are sleeping poorly, drinking more than usual, snapping at people they care about, and taking unnecessary risks. They are constantly on edge. Asked whether they feel sad or depressed, they immediately grumble, “No.”
They leave believing they are stressed, burned out, frustrated, angry. Anything but depressed.
They may be wrong, and the doctor may have missed it.
This kind of thing happens more often than you may think. There is often a disconnect between public mental health campaigns and the people they are supposed to reach. On one hand, some people don’t recognize depression when it is happening to them, especially when what they are experiencing is not just sadness, such as a teenager who feels anger at the surface without realizing what is going on deeper down.
On the other hand, public health campaigns can fail to speak to the experiences of the people they are targeting and they can also use language that does not resonate with their audience. If you struggle to recognize that something is wrong, it makes it hard to know when and how to ask for help. If you don’t know when to ask for help, you are at greater risk of a common mental health condition escalating into a crisis.
Treatment shouldn’t have to wait until the problem has gotten so severe that the ability to function has shut down. It’s more effective when these things are caught early.
Maybe this disconnect between outreach and help-seeking speaks to you. Maybe it reminds you of someone you know who you think needs help, but hasn’t sought it out yet. Today, I want to talk about the alternative behaviors and language surrounding depression outside of what you will find in the actual diagnostic criteria. I also want to highlight that disconnections in mental health language and experience disproportionately affect men and cultural minorities.
Other ways that depression shows up
The most typical signs of depression that clinicians are trained to look for include hopelessness, low mood (sadness), low energy, and loss of interest in activities. We can call these “internalized” symptoms—they point to the inner experiences of the person. You can imagine a person literally drawing into themselves, closing themselves off from the world by going inward—into their mind, locked in their room, trapped in a cycle of rumination and despair.
However, there are people who express their struggle in other ways through parts of themselves they may not be aware are acting from a place of depression. These are externalized symptoms, and we see these in men especially. Anger and irritability, lashing out for seemingly no reason. Risk-taking, like driving recklessly or adrenaline-seeking without a concern for safety. Drugs and alcohol. Distraction through extreme dedication to work. These are behaviors that are directed outward through actions and through external methods. These behaviors help distract from the hidden sadness or helplessness that someone feels. Some of these presentations of depression are not officially recognized as clinical markers of depression, but they are equally real and valid.
If any of this sounds familiar, if life has been feeling like something is wrong you can’t quite name, then let me be even more clear: Depression does not just look like crying in bed, especially if you were raised and socialized to hide emotions and present a strong image.
There are also cultural variations in how it shows up. For example, in cultures where having mental health struggles are highly stigmatized, depression can show up in the body. As heartburn. As chronic tension. As headaches. As many kinds of somatic complaints. Often, it is more socially acceptable, especially for men, to get help for a physical concern rather than a mental concern, and the internalized stigma can be so powerful that this all happens subconsciously—your body carries the pain because you have unknowingly exiled it from your mind.
What “depression” can feel like when you don't use that word
Other times, men and others along the gender spectrum know that what they are experiencing is some kind of depression, but they feel a conscious or unconscious pressure to find alternate ways of talking about it. Words like “depressed” and “sad” can carry a stigma that goes against the narrative of someone who feels a need to be self-reliant, stoic, and strong. Research shows that such people prefer to use terms like “stressed,” “tired,” “irritated,” or that “something is wrong.”
The same pattern shows up across cultures. People who don't see their experience in clinical vocabulary find other words for it. Across Latin America (Mexico, Puerto Rico, Guatemala) the conditions of susto and nervios are correlated with diagnoses of depressive disorders, yet distinct from them. Susto is characterized by problems such as indifference to food and self care, shaking, irritability, nightmares, body aches, and gastrointestinal issues. Nervios is characterized by problems such as headaches, chest and stomach pain, high or low blood pressure, intense anger, and a loss of control. In one study from Guadalajara, 81% of people who seemed to fit the criteria for a depressive disorder reported susto and a whole 96% reported nervios.
If public mental health messaging or even the doctor or therapist interviewing a client doesn’t use language or frameworks that that patient identifies with, serious concerns can be missed at a crucial juncture. Professionals need to cast a wide net by considering gender and other cultural differences in mental health terminology.
What action looks like when you don’t have the words
While professionals need to consider alternate ways of communicating and asking questions, the other half comes down to personal responsibility. But let’s be clear: There is nothing wrong with reaching out and talking with a therapist even when you struggle to name what is happening. After all, that’s what a mental health professional can help with. In other words, the first step isn’t always admitting you are “depressed.” Sometimes it’s simply recognizing that something is wrong and it doesn’t have to be this way.
If you only take one thing away from this post, I hope it is this: Depression can look like a lot of things. Men don’t always recognize it. Professionals don’t always ask the right questions. It takes on different meanings across different cultures. It’s okay to not know what’s going on, but please reach out even if you don’t have the words for it, and match with a therapist who is going to be respectful and mindful of your culture. I saw this pattern often enough on the crisis line to want to write about it. People calling in who didn't have the word "depressed" for what they were experiencing, but knew something was wrong enough to pick up the phone. Part of what I do in my work is recognize what someone is carrying before they have the language for it.
If any of what I described in this post sounds like you or someone you love, that recognition is the first step. The next step is a conversation. You can reach out to me here, or to any therapist who feels like the right fit.
If you're reading this for someone you love
Send it. Sometimes the right words from the right place is the tipping point.
Matthew Sooby, MS, is a therapist at InPowered Therapy in Lincoln Square, Chicago. He is accepting new clients, in-network with BCBS, and offers a free 20-minute consultation. Reach out at inpoweredtherapy.com.
Research informing this post
This post draws on multiple areas of research, including…
Alternative gendered and cultural presentations of depressive disorders, as listed in the DSM-5-TR (in content outside of the actual list of diagnostic criteria).
Patterns in men’s mental health help-seeking, depression, and “mental health literacy.”
Seminal research by professionals in Mexico and the Southern US examining links between the medical definitions of depression and “folk” conceptions of distress.
Full citations available on request.
