Tom Golden, LCSW is the author of a book on men' s unique paths to heal titled Swallowed by a Snake: The Gift of the Masculine Side of Healing. Tom has given workshops on this topic in the U.S., Australia, Canada and Europe. His work has been featured in the NY Times, the Washington Post, on CNN, CBS Evening News, ESPN, the NFL Channel and others. Tom serves on the Maryland Commission for Men' s Health and lives outside Washington DC.webhealing.com
This is one of four reports that were submitted by the Maryland Men's Health Commission in 2010 to Governor Martin O'Malley.
Men and boys comprise nearly 80% of all completed suicides in the United States. With this sort of number one would assume that there would be services that focus specifically on suicidal males. Surprisingly, there are almost no programs that focus on helping men and boys who might be suicidal. Sadly, Maryland is no exception to this rule. Maryland traditionally has very active programs to address the issues of suicide but does not seem to have any programs specifically addressing men or boys.
Even more surprising is how difficult it is to secure funding to study this disparity. Lanny Berman, the Executive Director of the American Association for Suicidology, made the following statement in the San Francisco Chronicle in 2006: "As much as I would love to lead the charge [in finding out why boys kill themselves], try to go out and get funding for it." Berman's statement expresses his frustration that funders aren't interested in studying boys and men. Berman is not alone; organizations such as the National Association of Social Workers (NASW) have voiced similar sentiments. NASW ran a study on suicidal girls in 2008. When asked about their reasons for studying girls rather than boys, Elizabeth Clarke, the NASW Executive Director, stated that the funder specified the money was dedicated to studying girls. In the U.S. Department of Health and Human Services 200+ page document titled "National Strategy for Suicide Prevention: Goals and Objectives for Action," they only mention men and boys once: in a sidebar that indicates: "Over half of all suicides occur in adult men ages 25-65." Even this important document seems to negate the stark reality of the 80% of suicides completed by males; there simply seems to be very little interest in learning about men and boys and why they are more prone to kill themselves or how we can help them.
There is a common misconception that men die from suicide much more frequently than women do due to their choice of more lethal means. At first this seems to be a reasonable assumption. In 2004, 20,500 men committed suicide using the lethal means of fireams and hanging, but that same year, only 3,583 women used the same lethal means in completing suicide. At first glance, this data seems to indicate that men must choose more lethal means and therefore are more likely to commit suicide. Looking a little bit closer, one finds that men choose lethal means to end their own lives in 79% of male suicides. However, what most people seem to miss is that women choose the same lethal means to end their own lives in 51% of female suicides. While the difference between 79% and 51% is significant, it in no way is a strong enough difference to account for the four to one ratio for overall suicide rates. There is obviously something else at work and we are simply not aware of this difference, nor is anyone making any efforts to examine what it might be.
Maryland has been hosting an annual conference on issues of suicide for many years. From my observations, the conference hasn't had workshops that focused on men and boys and their unique issues related to suicide with the exception of one recent workshop that focused on veterans. This seems very perplexing since men and boys are the overwhelming majority of competed suicides. In fact, Maryland boys comprise 86% of the suicides between the ages 15-24 and yet there are no programs or resources that directly address their needs.
Why do men die more often from suicide?
Why could it be that boys and men comprise such a large percentage of completed suicides? Some, as we have heard, assume that the reasons are related to men being more violent. Others speak of men's reluctance to seek help. These are likely partial answers, but if we want to better understand this question, we will need to start thinking outside the box. One of the boxes we are in is our assumption that men and women heal in the same way. There is a good deal of information becoming available that suggests the possibility that men and women have markedly different ways of healing and this difference may play a major role in the reasons that men predominate in completed suicides. Below are some very brief ideas about these differences.
Emotional Processing -- Scientists are uncovering some fascinating differences between the strategies men and women typically use when under stress. According to the research of Shelly Taylor, Ph.D., of UCLA, when women are stressed, they are more likely to move towards interaction and being with other people. This movement obviously puts women into a position of sharing their problems with others, which then increases the likelihood that one of these people will help a woman connect with therapeutic emergency services. Men, on the other hand, have been shown to move less towards interaction and more toward action or to inaction. Both of these tendencies, action and inaction, move men away from others who might connect them with services and move them toward a more solitary solution. This is a much more dangerous position if you are feeling hopeless and helpless and likely plays into men's tendency to avoid treatment and to see suicide as an alternative.
Societal Roles -- No one is mandated to care for men. Men have been responsible for the safety and care of women and children for thousands of years. However, there is no third sex that is held responsible to care for the safety of men! Men are keenly aware of this and have developed a strong sense of independence and self-reliance. Both independence and self reliance will hamper the likelihood of a man seeking "help" for suicidal urges.
Harsh consequences for dependent males -- A dependent male is a male that is judged harshly. Men are in a double bind. If they say they are not in need of services then they are held in high esteem but forfeit the help they need. If men admit they are in need of services, they are seen as worth less. Peter Marin, in an article titled "Abandoning Men: Jill Gets Welfare--Jack Becomes Homeless," states:
To put it simply: men are neither supposed nor allowed to be dependent. They are expected to take care of others and themselves. And when they cannot or will not do it, then the assumption at the heart of the culture is that they are somehow less than men and therefore unworthy of help. An irony asserts itself: by being in need of help, men forfeit the right to it.
A depressed and suicidal man is a dependent man. When we are hopeless and helpless we are far from being independent. Hopelessness and helplessness are the cornerstones of what underlies suicidal ideology. A man who feels hopeless and helpless will likely avoid letting others know his dependency and will avoid exposing his need by asking for help.
Mental Health System -- Our mental health system is based on a face to face mode which favors the interactive nature of most women. Men more frequently move to a "shoulder to shoulder" mode when feeling vulnerable which is profoundly different from the norms of most mental health services which rely on interaction and a face to face environment.
Dominance Hierarchy -- Fascinating research is showing it is likely that human males live within a dominance hierarchy. Most of us are aware of the male big horn sheep that charge each other and ram heads until one of the males backs down. By butting heads they are forming the dominance hierarchy for their flock. The male who comes out on top of this hierarchy will have access to the top ranked females in their group. Evidence is now pointing towards human males having a dominance hierarchy based on status with males competing for status and access to the highest ranked females. This helps explain men's tendency to compete for higher status and their reluctance to disclose information that might negatively impact their status rank. If this is correct, it helps explain a man's reluctance to discuss his suicidality and his attempts to disguise his vulnerability, which would obviously lower his status.
Culture -- Our culture is harsh on men who emote publicly. Men know there is huge judgment placed on them for displaying emotion, and will avoid public emoting at all costs. The fact is that men are placed into a double bind: If they do emote publicly, they are labelled as wimps; if they don't emote publicly they are labelled as cold and unfeeling. It's a lose/lose for men. This impacts a man's reluctance to discuss his suicidality and his tender and vulnerable feelings.
Hormones -- We are beginning to understand that testosterone is a powerful force when it comes to processing emotions. Women who take very large doses of testosterone are reporting that their access to emotional tears becomes markedly diminished and their ability to articulate their emotional state dwindles.[10,11] It's a small jump to assume that testosterone in males will have a similar impact. Men have at least ten times more testosterone than women and would therefore be less likely to access emotional tears and less apt to articulate their emotions as they are feeling them. Both of these qualities have been the standard fare for therapy and may be one more reason that men avoid seeking treatment. This would help explain why women are more likely to seek out therapy than men.
Valuing female lives over male lives -- As hard as it is to believe, we tend to value female lives more than male lives. Why else would we allow men to commit suicide 4 times as often as women and take no action? Why would we allow men to be 93% of the workplace deaths? Why would we allow men to be over 97% of the deaths in wartime and not show any concern? Just imagine that the US Government decided that only females would be allowed on the front lines in Iraq and Afghanistan and all of the sudden over 32 times as many women start dying than men? People would be outraged that so many women were dying. Why are they not outraged now that so many men are dying? Because we value female life more than that of the male.
1. Dedicate next year's Maryland Suicide Conference to the topic of men, boys and suicide. Call in experts from around the country on the topic, and work towards bringing together numerous clinicians and researchers who will be able to share information and ideas on the reasons for men dominating the suicide numbers and ways to start to solve the problem.
2. Designate one interested staff member to investigate the latest treatment ideas and programs for males and suicide around the world. Finland is the first country to have focused on men and suicide and is ahead of most others in this respect. They have been one of the most successful countries in bringing their numbers of suicides down and would likely be a wealth of information. Australia would also be worth checking since they have recently instituted numerous programs specifically for boys, men and suicide. Some are for Indigenous men, others for boys, others for men in general. Lastly, Colorado's Men and Suicide Campaign would be another place to check. This innovative program is the only program to my knowledge in the U.S. that focuses on males and suicide. Unfortunately, the program lost its funding only days before it was to open. There remains a core group of passionate clinicians and administrators who are working to carry the program forward without funding, and I know they would be happy to talk to someone from Maryland about their work and ideas.
3. Provide for the staff member conducting the research outlined above to present this material at the Maryland Suicide Conference. A podcast of the presentation could be available for download.
4. Create interest in the health department around the issue of males and suicide. Send informal notices for voluntary gatherings to discuss this issue in hopes of attracting interested professionals. Gauge the response and determine whether the next step may be to form a group of interested professionals who might facilitate the gathering of information and dissemination of information to interested parties.
5. Create PSA's on this issue that confer a male friendly message that states clearly that men are good and that each man is valuable. Develop podcasts that can be downloaded that offer information and ways to connect to supports.
6. Develop new avenues that men might be more likely to use in reporting possible suicide ideation and severe depression such as email, twitter and texting. Consider alternate arenas to connect with men including barber shops, sports teams, workout facilities and sports events.
7. Work in conjunction with the Maryland Suicide Prevention Commission.