Opinion: The Silent Epidemic

It was in the fall of 2013 that I found a dear friend seated in the school library surrounded by busybodies trying to pry into his affairs. His posture was consciously congruent to the shape of the chair upon which he sat. Tears meandered mockingly down his gaunt complexion, and his eyes were scarlet with frustration. Perplexed, I approached him with a steady pace, motioned for the interlopers to continue attending to their own affairs, and took a seat beside him. His hair was unkempt and his eyes, as if two unaffected black beads, stared fixedly upon a wall of books ahead so as to conjure a distraction from his current state. “I want to end my life,” he told me. Emotionally bludgeoned by years of domestic abuse, it was almost as if he had been desensitized to any other emotional promptings--his neuroses would now dictate his actions.

In most Western countries, females exhibit higher rates of suicidal ideation and behavior than males, yet death from suicide typically occurs less for females than for males. Much like general mortality rates, mortality rates of suicide and homicide (both of which are classified as forms of lethal violence) demonstrate well-established relationships with age. Whereas the age trajectory for general mortalities is heavily skewed towards deaths resulting from old age and general wear and tear of the body, the age trajectories of mortalities from suicide relate less directly to biology. Instead, they correspond immediately to social conditions involving group integration and interpersonal conflict.

One example of a social condition that can affect the frequency of suicides is gender expectations. The modern male is defined by a machismo that encourages the internalization of feelings and attitudes that would be considered “effeminate” by others. As a result of this behavior, men who feel suffocated by social pressures find that suicide is the only viable method of escape.

Is male predominance among those who commit suicide real or an artifact? According to a study conducted by Emory University, the male population is responsible for 80% of the suicides that occur in the United States. Additionally, 4.2 times more males than females die by suicide. College campuses bear witness to more than 1,000 suicides each year. The silence surrounding male suicides is shocking and warrants comment. Yet while accumulating empirical evidence confirms that men in Western nations consistently die by suicide at higher rates than women, few explanatory frameworks have been developed to account for this persistent trend. When gender is addressed, it is understood as a static demographic variable as opposed to a social construction that interacts with other factors such as race, sexual orientation, and socioeconomic status.

While college counseling services provide healthcare practitioners for the purpose of addressing and “talking through” suicidal thoughts in a preventative context, there are no special protocols or instruments recommended for screening men for suicidal tendencies in primary care. The typical approach concerns screening for depression (which is a common precursor of suicide) using brief questionnaires. One might expect that men’s reluctance to discuss mental health issues or emotional difficulties would call for a more careful screening, but college counseling centers have yet to explore such options.

The question remains: should suicidal men be approached with different treatment modalities to better address the gender pressures they face? A recent review of gender differences in suicide by the Journal of Affective Disorders recommended that “Research on treatments for suicidal behavior should investigate gender differences in response. Gender differences in suicidal behavior clearly merit more research attention to generate information that can guide clinical practice and prevention strategies in ways that will prove most effective for preventing suicidal behavior in both genders.” One line of research could focus on clinical indicators that are predictive for male suicide, given the disinclination of male patients to talk about emotional distress.

The first step in dealing with this epidemic is to increase visibility and awareness. Society needs to understand how gender expectations and pressures can be damaging in the ways that people, especially men, seek help. Second, suicide prevention policy must address views of what it is to ‘be a man’. In doing so, policy makers should recognize that, for young men, suicides are often linked to substance abuse and formative factors in early development. Finally, medical practitioners must be better equipped to recognize signs of distress in men. A refusal to seek help or acknowledge that there is a problem by men might be symptomatic of a much larger issue.

To begin effecting change and protecting the male citizens of our colleges, schools, and nation, we must lobby for policy changes at the local, especially collegiate, level where the expectations on men feel heaviest. Even the smallest improvements can very well go a long way.