By Andre Picard, Globe and Mail, September 6, 2011
Take a close look at the statistics and a trend becomes clear: The No. 1 risk factor for suicide is being male.
Of the 10 people who die by suicide daily in this country, about eight are men and two are women.
There are libraries full of research examining this phenomenon, which is not unique to Canada. There are many possible explanations but few easy answers.
We know that suicide is a vast societal problem that affects all age groups – in Canada, suicides have been recorded in children as young as 8 and in seniors over the age of 90 – and all socioeconomic groups....
The vast majority of suicides result from underlying mental illness coupled with profound emotional pain, and they are often triggered by some external event, such as a job loss, failing an exam, the breakup of a relationship or the death of a loved one. In other words, stress is the big trigger.
Yet, only a tiny proportion of those who suffer from depression die by suicide. (On the other hand, close to half of people with untreated schizophrenia will take their own lives.) There are also factors that increase the risk of depression and suicide, including a history of head injuries and alcohol/drug abuse.
Women are about twice as likely as men to suffer from depression. They are also far more likely to attempt suicide but tend to be less “successful” (and, yes, that is a horrific notion of “success.”) Still, the stats tell us that, in women, there are 20 attempts for every completed suicide while, in men, the ratio is 4:1.
One reason is that men use far more violent means to kill themselves, principally hanging and firearms, while women generally use poisoning (drug overdoses). Death though is just the tip of the iceberg: Another 48 people daily are hospitalized with self-inflicted injuries, most of them women.
The principal reason more men than women die by suicide is that men do not seek help and spiral into despair, hopelessness and self-harm.
Men also self-medicate, largely with alcohol, which tends to make their symptoms worse. When they are depressed, they don’t retreat into a shell, but act out, often violently. (Perhaps we should consider that the depressed are drawn to being hockey enforcers rather than the reverse?) Women, on the other hand, tend to self-medicate with food and sleep; they also cry out for help – literally and figuratively. They talk to friends, they talk to counsellors and they talk to physicians about their depression and suicidal thoughts.
One of the main enduring stigmas about mental illness, particularly for men, is that it is a sign of weakness. From an early age, boys are taught – or socialized – to be tough, to not cry. They internalize their pain. They repress their feelings and their fears.
This silence can be fatal. Yet the continuing carnage that results – more men die by suicide than in motor vehicle collisions – is largely hidden away and invisible.
When we have a rare glimpse of this grim reality, as we have had with the death of Mr.(Wade) Belak (formerly of the Toronto Maple Leafs of the NHL), we owe it to ourselves to not be distracted by peripheral concerns like fighting in hockey and zero in on big issues like how to treat depression and prevent suicide in males. Obviously our current approach is not working.
When the black dogs of depression come growling, when the suicidal thoughts become overwhelming, boys need not be boys and men need not be men.
They need to learn – from an early age and regardless of how macho their profession – that they can seek help, they can be vulnerable, they can be sick and get better.
The hoary myths we cling to about toughness and manhood too often leave us with young men dangling by a rope.
Sadly, I recall the names of several males who took their own lives when I was a young boy growing up in a small Ontario town. A pharmacist, a wholesale, a men's clothing retailer, a retired gentleman, all come to mind, and all of them I knew personally, without even suspecting their outcome. Guns and a hose attached to the exhaust of the car in an enclosed garage were the methods I recall. I also recall, when I was twelve, one night being wakened around 3:00 a.m. by my mother and told to to the basement "right away!" I had no idea why, and did not bother to inquire.
When I arrived in the basement, I found my own father behind the charcoal-fired jacket heater used to generate hot water, holding a .22 calibre rifle to his head.
"Give me the gun!" I recall saying as calmly as I could.
He handed it to me and I took it upstairs, although I have no recollection where I placed it, or even whether or not it was loaded. I never checked. That was in 1954; he died in 1996, some forty-two years later, and in that time I never heard a word uttered about the incident from either my mother or my father.
What I did hear about many times, however, were allegations that my father's father, my grandfather, in my mother's words, "was crazy" because he attempted to take his own life, a story recounted by one of his adult daughters in a letter to me in the mid 1990's, yet when I attempted to confirm its veracity through my own father, he denied it ever happened.
While studying theology, I took a course entitled, "Death and Dying" from an outstanding pastoral counsellor. During that course, I inquired from the partner of another male suicide what follow-up support seemed to work for her. She confirmed that her deceased partner had returned to excessive alcohol consumption about which she had no idea. I also wrote a thesis on the liturgical suicide of a priest who was clearly depressed and wounded by many pains in his life a most recent rejection for a professional position to which he aspired.
Clearly, the culture of masculinity, not only the expectations of being male (including silence and resilience in the midst of pain, refusal to "talk" about pain to anyone, medicating the pain with whatever the choice of medicine: alcohol, work, drugs both prescription and non-prescription, sex, gambling etc. is more conducive to male suicide, especially to the much lower ratio of attempts to completions (4:1 as compared with women, 20:1)
Some men and women organized a conference on reasons why men do not seek professional help, in Kingston, ON. When I met one of the key-note speakers, I was moved to respond that men are men, are must not apologize for being men, just as a rose need not apologize for being a rose, and not a Lily.
A clinical, psychological approach to men, in my view, is not the answer to depression, nor is it the answer to mental illness, exclusively. Clinical approaches frequently involve one-on-one interactions although group interactions are also part of the available menu.
The clinical approach is to employ the medical model of treatment, as if there were a disease that needs to be made well, less toxic and less influential in a man's life. If he is too aggressive, he must be made to act out less, to repress his emotions and in order to achieve this result, both "talk therapy" and medications are prescribed. If he is too withdrawn, a similar chemical-talk duality is often prescribed.
Our society has become dependent on the medical model of treating most aberrant conditions.
I question the quality of "aberrant" that is allegedly found in many men. Have we not erred much too far in the direction of the "disease" model of defining what is wrong with a person whose attitudes, actions, speech and general demeanour do not conform to our "definition" of what is appropriate.
Using the DSM-IV, for example, the definition of "depression" in that "psychiatric bible" is derived from female patients, not from a cross section of both male and female patients. Consequently, the treatment modalities are also based on their relative success among women patients.
There is considerable evidence that North American society has made men the "scape-goats" for many of our social ills.
Men commit far more acts of violence that do women.
Men drop out of school at higher rates than women.
Men suffer from learning difficulties at a rate higher than women.
Men are considered "dummies," and/or "stupid" and/or "socially maladjusted" much more often than women.
Men do not adapt to a school curriculum that points them toward reading, writing and emotional identification nearly as effectively as do female students.
Men "hide" their shyness in their "tech" gadgets, and in their macho mask, and in their physical prowess whereas women seek out other women who are also shy and find comfort and solace with a comparable peer.
Men do not have a vocabulary for their emotions nearly as early nor as completely as do women, in fact many men consider such a vocabulary to be "effeminate" and therefore to be avoided at all costs.
Men are not taught, either formally or informally, the complexities of human relationships, especially with the opposite gender, when the need is measured in the number of divorces, reaching at least 40% by some studies and as high as 50% in other studies.
The male model of gathering and writing the daily news reports easily trumps the perspective of women: for example, it is the "horse race" of all political competitions that trumps the nuances of policy and their underpinning thought or philosophy. Consequently, a good idea will be far less likely to reach a headline than the score of the most recent poll.
The male model of measuring success in most organizations is seen in the inordinately high use of numbers, size, increased production and profits and dividends, not the drop in absenteeism, nor the rise in philanthropy by the company, nor the decline in frequency of personal conflict. This includes, tragically, the christian church, where, in my experience, a bishop's vision has been touted in corporate vernacular: 10% more people and 15% more money in the coffers. This example, a true story, demonstrates the abandonment of the principles of the gospel, and any attempt at removing gender from the calculations. It also engenders the opposite behaviours from clergy to those needed to grow integrated, and effective community circles when both men and women could and would learn from each other to talk about their spiritual lives, without fearing the embarrassment that often accompanies such a discourse involving both genders.
As our society moves to less and less authentic human contact, and more and more hiding our deepest feelings, including our deepest fears, anxieties and disappointments, men will "fit" into the model being created by both men and women, unconsciously, that not only permits, but actually encourages the cover-up of real pain, and real discomfort. It is as if we are addicted to the "story with the happy ending" as the one we are all pursuing....and look at the death-denying culture we have on our hands, our minds and our spirits.
A small sliver of hope might be seen peeking through the cracks around these three male suicides, as they stories prompt both more stories and more talk around the water cooler.
With profound thanks and encouragement for his insightful piece, to Andre Picard.