The most important piece I’ve ever written.
· This article first appeared in the now-shuttered Stand magazine in September, 2016.
Suicide; it’s the background music of my life. My uncle, my best friend in college. My dad. Roberto
I contemplate suicide every day. I see this slow motion bullet, blood spattering, brains on the wall. Lorne
I don’t know that I’ve ever been so pissed. “If you were alive right now, I’d kill you.” Spike
It was a gunshot. He seemed fine the night before. Look, I’m a fixer. How could I miss this? Do I have a bent antenna? Nathan
I’ve always entertained suicide. Each day’s just another day for me to mess things up. Brian
My brother left a note on a white board. I never read it. Isom
Suicide. It can be statement, an act of despair, of defiance, or a plea for help. If you are a millennial man, broadly defined as having been born between 1978 and 1998, the rate at which you and your friends kill themselves has risen 39% since 1999.
Suicide knows no boundaries. Men, women, young, old, regardless of skin color or spiritual beliefs — in 2014, 42,773 people killed themselves. Every thirteen minutes, someone died by his/her own hand. Four times more likely to die in the attempt than women, three-quarters of the dead are men. Good men, men who tried to be better men, men who didn’t want to die; all men who saw no other way out.
13,300 men in the prime of their lives killed themselves in 2014. For men in the Millennial Generation, suicide is the second most common cause of death. More than homicide, more than cancer, more than HIV/AIDS; only accidents kill more young men in the US. If suicide were an infectious disease, the CDC could declare it an epidemic.
The causes are a complex web of factors; social, emotional, environmental, and biochemical. Head trauma, PTSD, chronic illness and pain issues. Financial stress. The answers are as deep as the minds of those who struggle with suicidal thoughts.
Adam was one of many who pointed a finger at social media:
It’s like going to a party and seeing only the fun.
Everyone active on social media understands exactly what Adam means. We celebrate our successes on line. We post photos of marvelous meals and great concerts and raucous nights of fun in the pubs and clubs. Whilst we also share a few down moments, when was the last time you saw a photo of a man crying in his bathroom because his ex-spouse denied him visitation with his kids and he knows he won’t see them for another two weeks?
A sad-faced panda hug emoji doesn’t help. In a study conducted by Prof. Larry Rosen, Cal State-Dominguez Hills, it was found that online support was equivalent to 1/6 of real-world support. That’s right, a real body to body hug is worth 6 times that of an online acknowledgement. Diminished social integration is just one of the prices we pay for a highly connected world. We need real contact with real people to ensure our mental health.
Casey reminds us that undiagnosed health issues are in play: I was depressed and I had ADD. Only I didn’t know it. When I turned 24 and found out that the world wouldn’t bend my way, I became so angry and despondent, I thought pills and alcohol were the answer to all my lost hopes.
We need to get to men long before they get to the point of no return. When you are in so much despair, in such pain, that no options are above the horizon, we have a problem. Casey was lucky. Out of work and living with his brother’s family, he drank heavily, washed down a handful of pills, and laid down on the bed to die. His brother’s family arrived home unexpectedly and Casey heard the gurgling and giggling of his brother’s baby. The sound of new life was enough to raise Casey from his bed. He fell through the doorway and collapsed in the hall. A call to 9–1–1, a stay in the hospital, and twenty years later, Casey and his husband are now parents themselves.
Regret about attempting suicide and a deep awakening like Casey’s is not unknown. Dr. Jared Wood, a psychologist born in 1974, spoke to me of a 1975 follow-up study with seven people who survived suicide attempts. All spoke of ‘transcendence’ and an instantaneous sense of overwhelming regret. Many who attempt suicide do not wish to die. They want the pain to stop, and can see no other choice.
Access to mental health care is an issue that must be addressed. The 2008 Domenici-Wellstone Mental Health Parity Act requires coverage of services for mental health, behavioral health and substance-use disorders to be comparable to physical health coverage. But more importantly, access to effective programs is a must.
Jill Harkavy-Friedman, Ph.D. is the vice-president of research for the American Foundation for Suicide Prevention. I spoke with her at length for this article.
“In 2005, we had few evidence-based programs in place to assist people with suicidal ideation and behavior. In 2016, we have at least ten new strategies. We can’t just talk about suicide. We have to have treatments that work.”
Depression puts blinders on our lives. We cannot see that others also suffer. We cannot summon the strength to reach out to help others in a way that would make us feel better about ourselves. We cannot summon the strength to reach out for the help we need. Our vision becomes so short-sighted that we cannot see beyond the now, beyond today, that tomorrow will indeed arrive. Depression, as Lorne says, prevents you from seeing outside your own head.
According to many mental health experts, the effects of depression are often a root cause of suicide. Dr. Harkavy-Friedman had this to say about the blinders that depressed men wear.
“When people are in a higher risk state they tend to read emotions and social cues differently. Their problem solving ability is more limited due to less flexible thinking. We know that they do not have access to their usual problem solving abilities, and their experience of rewards is different.”
In other words, the emotional tools that most of us take for granted are not a part of the susceptible man’s toolkit. When I’m overwhelmed, I might seek out my wife or a friend. I might break my emotional and real-world to-do list down into manageable items. I might get on my bike or prune trees in the yard. When someone in a severely depressed state is overwhelmed, those options do not exist. When this happens again and again, even the toughest rock is eventually worn down by the stream.
Dr. Wood often works with young men in his practice. He spoke of misbegotten child-rearing:
“This is the ‘self-esteem’ generation. They got big trophies for showing up. They’ve been told ‘you can do anything.’ It might be that a generation of kids was raised with unrealistic expectations. When they got out in the world and found out they might fall short, maybe they’ve taken it hard, way too hard. I hear from clients that it’s crushing, that you’ve let everyone down.”
In a susceptible man, the lack of mastery in the adult world can make a tough circumstance overpowering.
Contagion and acceptance might also be in play. Contagion is especially notable with celebrity deaths. As far back as Marilyn Monroe, suicide rates in the months following her death increased 12%. While contagion is most strongly seen in teens, this group of men have grown up with an increasing incidence and awareness of suicide. Moreover, this generation has come of age with an overload of information available in the palms of their hands.
We cannot discuss suicide in the US without a reference to firearms. There are more gun-related suicides than gun-based homicides in the US. More than 60% of the people who die by gunfire in this country are suicides. In states with the highest proportions of gun ownership, deaths by firearms suicide are four times higher. About 85 percent of suicide attempts with a gun are fatal, whereas 2 percent of drug overdoses, the most widely used method in suicide attempts, end in death.
The Israel Defense Force was faced with a large uptick in weekend suicides amongst its younger men in the early 2000s. When the IDF halted a practice which allowed soldiers to take weapons home on weekends, they found a 40% decrease in suicide rates in the ranks.
If anyone in your home is wrestling with depression, make 100% they do not have access to any firearms in the home. If you are gun-owner who is himself holding any suicidal thoughts, get your weapons out of the home.
Where do we start?
The answers begin with a conversation. Every paradigm shifting movement begins with conversation. Wozniak and Jobs wondered how they could impress the members of the Homebrew Computing Club and we ended up with Apple. Plato chatted with Socrates and we ended up with the bedrock of Western philosophical thought. Brian said, men need to learn how to say ‘My place is not a safe place right now. How do I get to a safe place?’ We have to give up the ego attached to that ‘always be strong’ mentality.
What holds us back, gentlemen?
Shame. It is a common and bogus theme that mental health issues in men are a sign of disgrace. When we consider that we have no more control over the DNA that controls our brain chemistry than we do over the DNA that controls our physical health, it’s clear that shame is a creeping weed that must die. Until men are as willing to state that “I fight depression every damn day” with the same courage that has them say “I survived cancer,” it is a weed that will continue to encroach on our lives.
Stigma. The way to remove the stigma is for brave men to stand together. One way is through programs like This Is My Brave. TIMB brings people on stage to share their stories of depression and survival through spoken word, poetry, and song. To see a TIMB event is to rejoice at the courage and strength of the spirit. Yet, even in that safe space, men are in short supply. Lorne serves as a producer of the New York show and he shared that at the auditions, only four of the forty participants were men. At the Washington, DC show, no men stepped forward.
Survivor anger and guilt. In one form or another, every man I spoke with said of those who died, “How the hell could he do this to me?”
Roberto speaks for us all: I am so fucking pissed off. His wife. His kids. I had to do all that shit in the days after he died. I’m so damn furious. He left me.
Guilt. The guilt, men agree, is a sonuvabitch. Guilt is a powerful emotion. It can freeze you into your past. It can halt you as you try to move forward in your grief. Yet, guilt can also be good. It ties us to our community, and used properly, guilt can increase our compassion and our choice to work for the betterment of all.
What can each one of us do?
Dr. Harkavy-Friedman is unequivocal. Early intervention is the key. She points to the well-known Good Behavior Game as an example. First evaluated in 1969, the ‘game’ is played by small teams of students as young as four. The students are rewarded within the group for their good behavior. In short, positive peer pressure is a highly successful tool. The rewards, down the line, are marked decreases in anti-social behaviors. These decreases include a significant decrease in suicide, both in attempts and suicides carried out.
We need to increase the databases to provide more material for suicide experts. At present, the databases are often hit or miss. The responsibility needs to be on the police, coroners, and other professionals. Yet, the burden to claim a death as a suicide often remains on the family when they are in a whirlpool of grief and shame.
We also need to mandate psychological autopsies. Suicide follow-up with psychological evaluations showed that ninety percent of those who committed suicide had mental health issues. In other words, nine of ten men who died by their own hand had diagnosable and treatable illnesses.
What should you do for a friend in a suicidal crisis?
Men will seek help if it is offered and available. Gentlemen, take care of yourselves and your buddies.
First, recall that men in crisis may have difficulty thinking flexibly. Their problem solving may suffer. They may be stuck. At a moment of crisis, no other answer seems tenable. Most in crisis do not actually wish to die. They want the pain to stop and can see no other option. Try to keep them safe and stay with them. Talk with them. Most importantly, listen.
Second, ask two questions. “Do you plan to harm yourself? Do you have a plan?” Just like that- ask those two questions. Get the issue on the table.
Third, eliminate the means. Get the guns out of the house. Not trigger locked. Not in a gun safe. Out of the house. Grab the bag of pills. Get the razor blades.
Fourth, assess and refer. Do not leave them alone. Get them, via 9–1–1 or whatever means necessary, to a safe place. We are not health care professionals. We are caring friends. Your sympathetic ear is useful, but your friend needs the help and supervision of professionals.
Suicide is the second biggest killer of men under 45. Massive amounts of money are spent to battle infectious disease and cancers and cardiovascular disorders. Billions of dollars have been spent to make highways and automobiles and air travel safe and commonplace. As men, we’ve become comfortable talking with our peers about intimate issues; parenthood and marriage, testicular and prostate cancers, and even many aspects of mental health. It is time, as Walt Whitman said, to “sound our barbaric yawp over the rooftops of the world” and halt the self-inflicted slaughter of thousands of our brothers.
Bilsker, Ph.D., Dan and White, Jennifer, EdD, “The Silent Epidemic of Male Suicide,” British Columbia Medical Journal, vol. 53, №10, December 2011.
Cosgrove, Jewelyn, “Suicide is the Third-Leading Cause of Death Among Millennials,” Mic Magazine, Sept. 04, 2013.
Harkavy-Friedman, Ph.D., Jill, American Foundation for Suicide Prevention, personal communications, April, 2016.
Lubin G, Werbe10ffN, Halperin D, Shmushkevitch M, Weiser M, Knobler HY., “Decrease in Suicide Rates after a Change of Policy Reducing Access to Firearms in Adolescents,” Suicide and Life Ihreatening Behavior, October, 2010, American Association of Suicidology.
Marshall, David, “Guns and Suicide: Hidden Toll,” Harvard Public Health Magazine, Harvard T.H. Chan School ofPublic Health, Spring, 2013.
Quick Stats for Suicides by Cause and Age Groups,” Center for Disease Control and Prevention.
Rosen, MD, David, “Suicide Survivors,” Western Journal ofMedicine, April 1975.
Scarborough, Rowan, “U.S. Military’s Millennials at Greatest Risk for Suicide,” The Washington Times, Dec. 06, 2015.
Sanger-Katz, Margot, “Gun Deaths Are Mostly Suicides,” The New York Times, Oct. 08, 2015.