My prior post on this site, “Why Older Gay Men Are Attempting Suicide at a Higher Rate,” received a lot of attention. Because of that, Dr. Patricia Salber, the editor of the site, asked that I do a follow-up. I would like to broaden the focus of this essay beyond the LGBTQ community.
Here are some basic facts about suicide that I included in that first essay:
- Suicide in the United States has surged to its highest level in nearly thirty years.
- This rise was particularly steep for women, it increased substantially for all middle-aged Americans, a group whose suicide rate had been stable or falling since the 1950s.
- The majority of gay/bi men maintain good mental health. However, compared to other men they are at greater risk for mental health problems.
- 12% of urban gay and bisexual men have attempted suicide. This is a rate that three times greater than the overall rate for American men, nearly half of whom make multiple attempts.
- At whatever age a person first begins to seriously question their sexual orientation, the coming out conflict has been implicated in the lead up to the suicide attempt.
- Those from a racial minority or living in poverty have poorer outcomes and higher risks of a completed suicide.
- Strict conformity to masculine norms has implications for negative mental health outcomes. These include depression, anxiety, substance abuse, and poor body image.
- People who seek counseling from religious advisors who consider homosexuality sinful have a higher risk of suicide than those who counsel with affirming religious groups.
- Therapists who are knowledgeable and affirming provide helpful therapeutic experiences, while counseling from therapists who focus on changing sexual orientation or encourage hiding it are unhelpful and sometimes damaging.
Loneliness and hopelessness
I hear from a lot of (mostly) men who are despairing. Two common themes emerge:
They frequently occur together, and unfortunately, they also feed on each other. Here are two rather typical comments left on my earlier essay [edited for brevity]:
I feel a sense of having completed the challenges of life and am grateful for those experiences. I see being able to choose to end my life as a reward for having made it this far. Am I just afraid of facing one more new challenge, namely, learning how to face the final stages of my life alone? … I can’t see what I would gain by learning how to remain independent until I’ve reached some arbitrary age when it would be ‘acceptable’ to society for me to die. …If there was a sure-fire way that I could end my life quickly and predictably, I’d go for it.
Or this one:
I think that suicide can be rational. I’m not depressed, but I have no desire to continue to live either. … I spend almost all my time alone. … If anyone cared about me or needed me in any way I might feel differently. I don’t see the point in struggling with my health and finances just to reach some arbitrary number of years. Isn’t it better that I control the circumstances of my death while I’m still able to do so?
The comments I receive originate from men in various situations. Some are married and struggling with their same-sex attractions. Some are men who have been in long-term relationships and have lost their partners. Others are men who have been unsuccessful in finding a partner and are giving up on the idea they ever will.
Is suicide ever a rational choice?
The question, “Is suicide ever a rational choice?” comes up frequently. The ethical question boils down to this:
Is this state of despair temporary or permanent?
I think there can be times when suicide is rational. For example, when someone is facing a terminal, painful malignant condition with no hope of recovery.
Many of us would agree that a person suffering like that might justifiably begin to think of suicide as a way to end that awful pain.
Loneliness and depression often occur together
Loneliness and depression often occur together but they are not the same thing. I wrote about this in an article for Psychology Today called, “Loneliness is a Killer.”
Here is what I said:
Loneliness means [we feel] we’ve failed in one of the most fundamental human domains: relationships with other people.
Loneliness is epidemic in the United States. It carries with it risks to our mortality [that] are comparable to smoking and alcoholism and exceed those of physical inactivity and obesity.
Loneliness affects chronic health problems such as diabetes, hypertension, and coronary artery disease, as well as sleep, mobility, and even dental problems.
It can impact our cognitive processes and lead to reduced resistance to disease. It is associated with higher rates of hospitalization and nursing home admission.
Denial of loneliness can be horribly self-defeating.
Loneliness and depression need not be permanent
But loneliness and depression are not chronic illnesses for which there is nothing that can be done.
I often describe depression as if we’ve gotten Vaseline on our glasses. Our vision is distorted and we cannot bring things into focus until the Vaseline is removed.
This is why, in these situations, suicide may look rational. But it is not rational because neither loneliness nor depression needs to be permanent and, therefore, as hopeless as they feel.
These conditions only appear that they will go on forever. But if one can hold on and make some changes, the pain can subside.
Here are things that you can do
The three things one must do are:
- Become identified with a larger group – social, religious, political, Alcoholics Anonymous or anything that gives your life meaning
- Become a part of a smaller group with frequent, unplanned interactions – The sexual orientation of the group is far less important that they are accepting of you.
- Find a chum, someone with whom you can bare your soul and share your secrets. In some cases, it may mean a therapist, at least for a while.
Medications may help
Medications may be indicated particularly if there is significant insomnia or a failure to function in most areas of one’s life.
Counseling may be helpful but choose carefully. A good therapist will not impose their values on their counselees. You have a right to interview the therapist about their attitudes and training before making a commitment to therapy.
One recurring theme
As I read through these correspondences, one theme keeps recurring. That is, finding a sexual partner and a soul mate will give my life meaning. But having a supportive group of family and friends is very important.
When families are not accepting, developing a “family of choice” may be essential.
The Internet has helped LGBTQ men and women who are isolated in rural areas or cultures with strong prohibitions against homosexuality find membership in a larger community. It also allows for an anonymous discussion of questions concerning sexuality.
But far too many never come out from behind their computers to have face-to-face interaction with others.
Financial and medical problems are one of the major sources of difficulty for us as we grow older. I’ve been both poor and financially secure. And, I can tell you that financial security does not guarantee happiness.
I am absolutely convinced that happiness during our later years depends primarily (after our basic needs are met) upon having something that gives your life meaning and having friends (gay or straight) who accept us as we are.
A nation of weavers
As I was working on this essay, I read an opinion piece in the New York Times by David Brooks, “A Nation of Weavers.”
“These different kinds of pain share a common thread: our lack of healthy connection to each other, our inability to see the full dignity of each other, and the resulting culture of fear, distrust, tribalism, shaming, and strife.”
He started Weave: The Social Fabric Project. The first core idea of the project was that social isolation is the problem underlying a lot of our other problems.
The second idea was that this problem is being solved by people around the country, at the local level, who are building community and weaving the social fabric.
Brooks believes, as I do, that there is too much emphasis in our culture on the idea that life is an individual journey toward personal fulfillment. But Weavers share an ethos that puts relationship over self. And emphasizes that the measure of our life is in the quality of our relationships.
I believe that many of these men and women who are so desperately lonely and unhappy could find a sense of meaning by focusing less on their personal needs and looking for ways to serve others.
Brooks writes of “radical mutuality”:
We are all completely equal, regardless of where society ranks us.
Some final thoughts
I’m nearly 76 now. I write, speak and continue to see patients because these things give my life meaning.
At this point in my life, I can say that there is “an emptiness in striving,”
When I’m climbing that ladder of success it is far more meaningful to me to pull someone up instead of putting all my efforts in seeing how high I can climb.