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.
Suicide in America: Understanding the What and Why
Transgender Suicide is a Public Health Crisis
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.
More by this author: Older Gay Men and the Risk of Suicide
Loren A. Olson, MD
Loren A. Olson, M.D. is a board-certified psychiatrist who obtained his medical degree from the University of Nebraska Medical Center in Omaha, Nebraska, in 1968. He spent four years in the United States Navy as a Flight Surgeon. After his discharge from the military, he completed a psychiatric residency at Maine Medical Center in Portland, Maine.
Awards and Recognitions
• His proudest professional achievement was the patient-nominated Exemplary Psychiatrist Award from the National Alliance on Mental Illness.
• He has received several awards for his writing.
• His book, Finally Out, won the IBPA Ben Franklin Award for BEST LGBT Non-fiction.
His clinical focus has been on the treatment of major mental disorders. His philosophy of treatment includes addressing biological issues, developmental experiences, and current life circumstances. He believes healing occurs when treatment is delivered with genuine warmth, accurate empathy, and unconditional positive regard for everyone.
Associations and Clinical Membership
• Dr. Olson is a Distinguished Life Fellow of the American Psychiatric Association.
Publications and Books
• Dr. Olson’s essays in Psychology Today have been accessed over one million times. He has also written for The Advocate, Huffington Post, Medium, and many other local and national newspapers.
• He has just released another book, Finally Out: Letting Go of Living Straight
Dr. Olson is married to his life-partner Doug, of thirty-four years. Before Doug’s retirement, they raised grass-fed beef on their farm in Iowa. He has two daughters and six grandchildren from his previous marriage. They all continue to expand their definition of family.
Dr. Olson considers himself to be an expert in retiring, “I’ve done it so many times.” During his current “retirement,” he continues to practice psychiatry part-time and writes extensively for various platforms.
It’s hard for me to see sometimes why suicide is not the only rational choice. The world today is a horrible place to live and life hasn’t been particularly kind to me for the past 30 years either. I can’t imagine even being content with my life, let alone enjoying it, and I no longer believe therapists when they say “this is treatable, you don’t have to feel this bad” because so many have tried and failed to cure whatever disease they think I suffer from that prevents me from being happy. The condition of existing in this world is what prevents me from being happy. How do you fix that with therapy?
Not all suicide is caused by depression or loneliness.I’m 50. I have a lovely son and a great partner, a good job. I am not depressed, I am not lonely, I don’t abuse anything, not even food. I’m in great shape and health.
And still I am planning my exit, today. Why? Because this world is just no place to live. Our planet is destroyed to 90%, our future is bleak beyond belief, totalitarian regimes are coming up everywhere, the control of our lives is increasing, smartphones, PCs are a great tool but governments use them to control you, see Snowden and others. Our lives are being monitored and monetized. Were are being told bullshit over and over again to be controlled so that we stay stupid and work for a system that exploits us and then throws us away like used toilet paper. I don’t want to be part of this world and I don’t want to contribute to it, hear it.. you fucks out there, you Trumps and Putins and Bankers and Bosses all of you who think you have power, not over me, I’m done with you!
Chris, please find someone you trust to talk to about this. Although things seem bleak right now, I believe we are going to turn it around and would love to see you be a part of this.
We do not give medical advice on this site, but we do provide links to useful resources. Here is the number for the suicide prevention hotline (please call now!): 1-800-273-8255
I appreciate your comment. And I agree with much of what you have said about the condition of our society.
But if you take your life because of this, you’ve handed those who disagree with us a victory.
We can defeat this if we band together. It is not as hopeless as it seems at times. Please join me in the fight against these things that trouble you and me. We need you.
I have mixed feelings about this. I’m not lonely or in despair, but I’d rather not be here. I haven’t enjoyed my time on earth and I’m quite ready for whatever is next. Suicide seems like a very rational option yo me.
Hi Fred, Please consider getting some help. Talk to a trusted person, a health professional or someone at the suicide hotline.
Sometimes, suicide seems rational, but it rarely is rational.
I often tell patients that depression is like having vasoline on your eyeglasses. It distorts the way you see the world, and no matter how hard you try, you cannot bring the world into clear focus.
Depression leads to making negative assumptions, and then this leads to making more assumptions based on those negative ones. It becomes a downward spiral.
Cognitive-behavioral therapy (CBT) can help. Basically, it says we can think way into a depression so we can also think our way out of it. The task is to acknowledge the way you feel but then to ask yourself, “Do the facts support those feelings.”
When you say, “I haven’t enjoyed my time on earth,” I would ask, “Is that true? Have you NEVER enjoyed ANY of your time on earth? Surely there have been times when you have felt better than you feel now.”
When a person is depressed, they believe they have ALWAYS felt that way and that they ALWAYS WILL feel that way. In the fifty years I have been treating depression, I have never seen one patient for whom that was true, but I have seen many, many patients who believed that it was true.
So, I believe you feel that way, but I would question whether it is a fact.
I repeatedly tell patients, “I don’t know what will work or how long it will take, but I KNOW you don’t have to feel the way you do. What are YOU willing to put into your recovery?” Treatment works, but it can be a slow and painful process.
I am happy to make that change. Thanks for pointing it out, and thanks for your nice comment.
A lovely piece, but Please replace the term “successful suicide” with “completed suicide”.
Thank you for your important work.
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