AT THE OPPOSITE END of the investigative spectrum from clinicians who look at suicide on an individual basis are the statisticians and sociologists who churn out graphs and charts in pursuit of a broad, external perspective. What they tell us may at first seem esoteric (for instance, that from 1928 to 1932 males in Minneapolis were more apt to kill themselves on Tuesday, females on Thursday) or even trivial (that, in metropolitan areas, the greater the airtime devoted to country music, the greater the white suicide rate). But they are trying to answer the question—why people kill themselves—not by examining case histories of individuals but by examining case histories of entire groups.
According to the World Health Organization, about 1 million people take their own life during an average year: as many as are killed in murders and wars combined. Although no countries or cultures are immune to suicide, some are more prone than others. In the nineteenth century, when statistics were first employed to measure various societal ills, a country’s suicide rate served as an index of national pride or embarrassment. So, too, in the twentieth century, when Sweden acquired an international reputation for suicide. In 1960, President Eisenhower provoked a fuss when, during a speech at the Republican National Convention, he attributed Sweden’s high rate to the country’s liberal welfare policies, intimating that socialism had left its citizens with nothing to struggle for. Eisenhower overlooked the fact that in 1960 Sweden had about the same suicide rate as it had in 1910, long before its welfare policies were introduced. (Today, Sweden ranks thirty-third among the one hundred nations that report suicide statistics to the WHO.)
Scandinavia, however, presents an interesting paradox. While the suicide rates of Denmark and Sweden have long been among the highest in the Western world, Norway, also a welfare state, has consistently ranked far lower. A six-year study undertaken by the four Scandinavian nations suggested that the reasons had little to do with politics. Focusing on Norway and Denmark, the Nordic Planning Group on Suicidology devised a complex system of calculating “social integration” and found that Norwegians had far stronger ties to family, neighborhood, social clubs, and church, bonds that Émile Durkheim and other sociologists have long believed reduce the likelihood of suicide. (During the 1970s and 1980s, the Norwegian rate approached that of its Scandinavian neighbors—boosted by a surge in suicides among young men, whose degree of social integration was reported to be in decline. Over the next decade, however, the rate fell again.) Why are Norwegians more apt than Danes—or Swedes or Finns—to form such bonds? Herbert Hendin, who spent two years studying suicide in Scandinavia, found that suicidal people were psychologically quite different in each of three Scandinavian countries and that the difference reflected their cultural backgrounds. In Denmark, Hendin was struck by how often suicidal behavior was used to arouse guilt. Danish mothers often discipline their children by letting them know how hurt they are by their behavior, and the child learns how to use his own suffering to arouse guilt in others. Young Danes are also taught to suppress aggressive feelings. Dependence on the mother is encouraged far more than in America, Hendin said, making them especially vulnerable to what he called “dependency-loss” suicides.
Swedes encourage their children to be independent, but they also foster an intense concern with competition and achievement. “Among the men, success or failure has a life-or-death meaning,” wrote Hendin. “Expectations for performance are rigid and self-hatred for failure is great.” At the same time Hendin found that Swedish children are taught not to express emotions; they deal with their anger by withdrawal and detachment. This response is exemplified in a common Swedish phrase, tiga ijhal, to kill someone by silence. Their psychological profile encourages what Hendin characterized as a “performance” type of suicide, triggered by a failure to live up to perceived expectations.
By contrast, Norwegian mothers tend to be warm and emotionally involved with their children without having rigid expectations. The child is encouraged to express his feelings, and as he grows, he is less concerned with performance and more able to show his emotions. Norwegians, said Hendin, are better able to communicate their anger and frustration in ways short of suicide.
According to Hendin, to understand suicide we must take a “psychosocial perspective”; that is, we must investigate its meaning within its cultural group, synthesizing psychological, social, and cultural factors. Suicide for a Norwegian differs in meaning and motive from suicide for a Korean. Similarly, within the United States, suicide for an urban black differs from suicide for a suburban white or a Native American. “On some level all suicidal people are united by some common denominator of unhappiness,” said Hendin. “But what makes them unhappy and why they want to die is a function of the time and place in which they live.”
If the suicide rate is any barometer, Lithuania, with a rate hovering around 45 suicides per 100,000 people—four times the U.S. rate—is the unhappiest nation in the world. It wasn’t always thus; indeed, the suicide rate in the former USSR over the last few decades offers a dramatic illustration of psychosocial influences. In its Communist heyday the Soviet Union did not report suicide statistics to the WHO; suicide, Party spokesmen asserted, was a “bourgeois activity.” Western suicidologists, however, suspected the rate was high, as is often true of groups experiencing excessive social regulation. In fact, from 1984 to 1990, under the more relaxed policies of perestroika, the suicide rate for Russian males declined by 32 percent, nearly four times the decline for males in other European countries. (The drop was not solely attributable to the life-affirming properties of freedom; it also coincided with a vigorous national antialcoholism campaign.) Following the breakup of the Soviet state in 1990, with its cataclysmic economic, political, and social changes, the Russian suicide rate soared—as did the rates for Lithuania, Belarus, and most other former Soviet states and Eastern European satellites. Many of the victims were middle-aged men unable to readjust and find a new career in the shambles of the Soviet economy. Today, these countries report the highest suicide rates in the world, eclipsing Hungry, Denmark, Austria, Finland, Switzerland, West Germany, Japan, Sweden, and other nations with traditionally high rates.
Among the countries at the other end of the scale are Italy, Spain, and Mexico, which have suicide rates consistently under 10 per 100,000. Although their low rates are often attributed to the preponderance of Roman Catholics in these countries, Costa Rica and Northern Ireland, which are predominantly Protestant, have low rates, while Catholic Austria has one of the highest rates in the world. (For centuries it has been traditional wisdom that Protestants have a higher suicide rate than Catholics, Catholics a higher rate than Jews. Actual figures are difficult to procure—death certificates in the United States do not record religious affiliation—but several European studies show that although the rates for all three groups increased over the twentieth century, the rate for Jews rose more rapidly.) Of course, some of the disparity is the result of reporting techniques. Industrialized countries, which tend to have higher rates, also tend to have more sophisticated methods of gathering statistics and fewer taboos against doing so. Reported rates in predominately Catholic or Muslim countries may be artificially low; greater stigma surrounding suicide usually begets greater reluctance to certify a death as suicide. A few countries may, like the former Soviet Union, underreport—or not report at all—for political reasons. In 1985, for instance, a Nicaraguan newspaper reported that Sandinista censors objected to the publication of a story about a ninety-six-year-old woman who had killed herself. The story, said the Sandinistas, was “an attack on the psychic health of the people and, therefore, an attack against the security of the state.”
The United States ranks near the middle of the nations reporting to the WHO. Although its rate of 11.0 in 2002 was close to what it was at the turn of the twentieth century (10.2), it has fluctuated over time. During periods of economic depression there is more suicide; during times of war, when, as Durkheim pointed out, personal woes are overshadowed by the larger conflict, there is less. During World War I the rate dipped from 16.2 in 1915 to 11.5 in 1919 before rising steadily in the twenties. The suicide rate crested during the Depression, reaching its apex in 1932 at 17.4. As the economy stabilized, so did the suicide rate, and by 1936 it had dropped to 14.3. During World War II the rate sank to a low of 10.0. After the war it rose slightly, and ever since it has remained fairly constant, ranging from a low of 9.8 in 1957 to a high of 13.1 in 1977. (Not all wars have an ameliorative effect on the rate. Although the rate of suicide among Vietnam veterans has been high, the war itself had little impact on the country’s rate, perhaps because it was so controversial, fragmenting rather than uniting the citizens as did the more “popular” world wars. Similarly, the war in Iraq will likely have little effect on the national rate, although at least twenty army men and women serving in Iraq took their own lives during the first year of the war and seven others killed themselves not long after returning home—a rate of suicide nearly a third higher than the army’s historical average.)
Many studies have shown that suicide rates fluctuate according to the economy. When the United States rate is graphed against economic indicators over time, the two lines nearly reverse each other. A growing body of research links unemployment and ill health, suggesting that the stress of joblessness triggers problems in marriages, conflicts with children, and physical and mental difficulties among vulnerable people. Examining data from 1940 to 1970, sociologist M. Harvey Brenner of John Hopkins University estimated that when unemployment rises one percentage point, 4.1 percent more people complete suicide.
Within the United States the suicide rate varies widely. Nevada has long had the highest rate of any state, consistently twice that of the nation as a whole. Las Vegas and Reno are a magnet for the transient, the divorced, and others hoping to reverse their fortunes. Other states with consistently high rates are Florida, Arizona, Colorado, Wyoming, Alaska, Montana, New Mexico, Oregon, and California—all Western states with the exception of Florida, whose high rate can probably be accounted for by its unusually high proportion of elderly citizens. Some attribute high Western rates to the stereotypical image of the Western male as tough, unemotional, and willing to use violence as a solution (and, with the West’s high rate of gun ownership, to a speedy, lethal means of effecting it). Others hypothesize an “end of the road” theory, suggesting that people often move West with the expectation of changing their life, but when their problems persist, they may become disappointed, hopeless, and suicidal. Indeed, ever since the early nineteenth century, statistics have shown that Americans who move within the United States are at higher risk of killing themselves. “The suicide rate seems to mirror American migrations,” writes psychiatrist Howard Kushner in Self-Destruction in the Promised Land. “. . . It is a historical rule of thumb that wherever the in-migration is the greatest as a percentage of the total population, so is the overall suicide rate.” (Over the past several decades, in fact, with increased migration to the sun belt, rates in the South and Southwest have been rising, although this is attributable in part to the advanced age of many of those sun-seekers.) Indeed, the lowest rates are generally found in the relatively more stable Northeast. New England has had a consistently low rate, which some credit to “Yankee fortitude,” although this explanation has been contradicted by the recent appearance among the states with the highest rates of Vermont, where Yankee fortitude had been thought to be of a particularly potent strain.
Migration affects the suicide rate; immigration may have an even greater effect, adjusting to a country being even more disorienting than adjusting to a new state. First-generation immigrants have rates more proportionate to those of their homelands—albeit two or three times higher—than to those of their adopted country, although the rates converge toward that of the host nation over time. For instance, German, Austrian, and Scandinavian immigrants to the United States have extraordinarily high rates, while Italian, Irish, and Greek immigrants have relatively low rates. Danish psychiatrists have pointed to the high rate of Norwegian emigration to the USA as the cause of Norway’s low suicide rate compared to Denmark or Sweden. They have argued that depressed and suicidal Norwegians emigrated and became subsumed in American statistics. Among Scandinavian immigrants, however, the Danish and Swedish rates remain two or three times the Norwegian rate.
Ever since statistics on suicide were first kept, researchers and reformers have suggested that the rate of suicide is lower in the country than in the city, where, as one sociologist put it in 1905, “the struggle for existence is carried on with the greatest keenness, and . . . nervous tension reaches its highest pitch.” Chief blame for the rising suicide rates of the nineteenth and twentieth centuries was placed on “urbanization.” But in this country the difference between urban and rural rates has become less pronounced in recent decades, and studies from around the world now show higher rates of suicide in rural than in urban areas. (In China, for example, the rate is two to five times greater in rural regions than in cities.) In the United States, the change may in part be due to the increasingly hard-pressed economy in rural areas—dramatically expressed by the rash of suicides among bankrupted farmers in the eighties and nineties—as well as by limited access to mental health services and emergency care, greater availability of firearms, and a reluctance by a traditionally self-reliant population to reach out for help.
Just as it was long assumed that higher suicide rates were to be found in the city, it was also assumed that the larger the city, the higher the rate. This is not always true. As early as 1928, sociologist Ruth Cavan pointed out that the suicide rate depends less on a city’s size than on its age. Rates tended to be highest in relatively new cities like San Francisco, Oakland, Los Angeles, and Seattle, where traditional social institutions—church, family, schools—were more fragmented. Indeed, in well-established Eastern cities such as Chicago and Philadelphia, the rates are moderate, and people are often surprised to learn that New York City’s rate is far lower than that of the country as a whole, leading some to suggest that the grit of that city cultivates a survival mentality. Rates vary not only from city to city but within cities themselves, being most prevalent in extremely wealthy sections and neighborhoods with shifting populations. A study of Minneapolis suicides from 1928 to 1932 found them concentrated in the center of the city, an area of rooming houses and cheap hotels that the researcher called “a land of transiency and anonymity.” Studies of Seattle and Chicago yielded similar results. In his 1955 district-by-district survey of London, Peter Sainsbury found that “social isolation” was a more important factor than poverty in determining high-risk areas. In the poor but close-knit working-class sections of London’s East End, the rate was far lower than in prosperous suburbs like Bloomsbury, whose comfortable houses were interspersed with one-room flats, transient hotels, and boardinghouses. He also found high rates around railroad stations and areas settled by immigrants and the newly rich, both of whom, he suggested, faced problems of adjustment. Twenty-seven percent of London suicides had been living alone, while only 7 percent of the general population lived alone. (One cannot, of course, conclude from these results whether suicidal people are drawn to living in lodging houses or whether living in lodging houses drives people to suicide.)
In the nineteenth century, differing rates among countries were often attributed to climate. (As late as 1930, San Diego’s high rate was blamed on “too much sunshine”; more likely the real culprit, as in Florida, was the concentration of elderly people.) These days climate’s effect is said to be negligible—studies by psychiatrist Alex Pokorny in the 1960s exploring the relationship between suicide and temperature, wind speed, barometric pressure, relative humidity, and seven other meteorological variables found no significant effect. Time of year, however, plays a role. Although Ishmael, in Herman Melville’s Moby-Dick, described suicidal depression as “a damp, drizzly November in my soul,” T. S. Eliot was a more accurate emotional weatherman: for suicides, April is the cruelest month, its rate some 12 percent above the average for the rest of the year. In November, in fact, the rate is near its nadir. The winter months generally have the lowest rates, and contrary to conventional wisdom, there is no increase around Christmas, New Year’s, or any other major holiday, although a British study found an increase in attempts on Valentine’s Day. Perhaps the rate rises in the spring and early summer because a person’s despair may be heightened by the regeneration around him. “A suicidal depression is a kind of spiritual winter, frozen, sterile, unmoving,” wrote A. Alvarez. “The richer, softer, and more delectable nature becomes, the deeper that internal winter seems, and the wider and more intolerable the abyss which separates the inner world from the outer. Thus suicide becomes a natural reaction to an unnatural condition.” (In Girl, Interrupted, a memoir of her stay in a psychiatric hospital, Susanna Kaysen put it more drily: “It was a spring day, the sort that gives people hope: all soft winds and delicate smells of warm earth. Suicide weather.”) More than two thousand years ago, Hippocrates observed that melancholia was more likely to occur in spring and autumn; contemporary research has found that while many depressive episodes begin in winter, they reach their greatest intensity in spring, with a smaller, secondary peak in the fall. This variation may have biological roots, as there are pronounced seasonal fluctuations in neurotransmitter levels (including serotonin), as well as in certain hormonal activity, which can cause disruptions in mood, energy level, sleep patterns, and behavior.
Ever since 1833, when M. A. Guerry examined 6,587 French suicides and found that a disproportionate number took place on the first day of the workweek, Monday has been the most popular day for suicide—perhaps because people are returning to the “real world” of school and jobs after the exhilaration of the weekend. The beginning of a new week may seem to promise a new beginning, a rebirth; when it turns out to be no different it can be depressing, a dynamic reflected in popular songs such as “Blue Monday” and “Stormy Monday.” (In Guerry’s time, when the work week lasted six days, Sunday was the least popular day for suicide; today, Saturday is.) Time of day? Though it is commonly assumed that most suicides take place in the dark recesses of the night, they are more likely to occur in the morning, which may constitute a sort of miniature version of spring: The world is getting up and starting anew—why can’t I? This pattern, too, may be driven by chemistry: most depression is circadian, and depressed people commonly feel especially anxious on waking.
Conventional wisdom has long held that police, doctors, and dentists kill themselves at abnormally high rates. “If a person works in an occupation which brings him in close contact with death and provides him with convenient means to end his own life, suicide poses a greater danger than in more innocuous professions,” wrote the authors of Traitor Within: Our Suicide Problem, in 1961, noting that executioners, whose careers are devoted to killing others, also appeared to have a high rate of killing themselves. Early studies of suicide by occupation were confounded, however, by demographic variables, including age, gender, and marital status, all of which affect suicide rates independently. Sociologist Steven Stack points out, for instance, that suicide rates for elementary-school teachers are 44 percent lower than for the working-age population in general, but when one controls for gender—the majority of elementary-school teachers being women and women having a much lower rate than men—there is no significant difference. In his 2001 study, “Occupation and Suicide,” Stack controlled for such factors and found health professionals to be at highest risk: dentists topped the list with a rate 5.4 times higher than expected, followed by physicians and nurses. (“Dentists suffer from relatively low status within the medical profession and have strained relationships with their clients—few people enjoy going to the dentist,” Stack has suggested.) Mathematicians, scientists, artists, and social workers also appear to be at increased risk, while police have a rate only slightly higher than expected, when compared to other working-age men. (Executioner was not among the thirty-two occupations considered by Stack.)
Other researchers have parsed the medical field still further to find that surgeons, who may feel directly responsible for the life and death of their patients, tend to have high rates, while obstetricians, pediatricians, and radiologists have lower ones. Psychiatrists may have the highest rate of any medical specialty—six times that of the general population, according to some studies. Estimating that one in three psychiatrists suffers from depression—three times the rate in the general population—the authors of a study of psychiatrists and suicide suggest that the field attracts troubled people seeking to understand their own problems. Noting that eight of Freud’s closest disciples had killed themselves, the neurologist Walter Jackson Freeman, who, as the gung ho promoter of prefrontal lobotomy in this country no doubt had some complicated reasons for his own career path, called suicide “a vocational hazard for the psychiatrist.”
To account for the elevated rate of physician suicide in general, experts point to the high stress level of the work and the tendency of doctors to keep their feelings inside. The type of personality often attracted to the field of medicine, they say, may be especially vulnerable. “It draws workaholics, overly conscientious people who take failure poorly, and idealists, who are frequently disappointed during their careers,” psychiatrist Robert Litman has observed. In addition, physician suicide is encouraged by the ready availability of lethal drugs and the knowledge of how to use them. (More than half of physician suicides overdose, while only 12 percent use guns—numbers that are nearly reversed in the general population.) Physicians, who have a hard enough time recognizing depression in their patients, are slow to recognize depression in themselves and, even when they do, may be reluctant to seek help—hardly surprising given that medical licensing boards forbid them from practicing if they are being treated for any psychiatric condition. The suicide rate is especially high among female physicians, lending support to research suggesting that women who enter male-dominated professions, such as female chemists and soldiers, may be at increased risk.
The challenges of assimilating into an entrenched culture may also play a part in African-American suicide. For many years it was believed that suicide was, as one researcher put it, “a white solution to white problems.” Indeed, despite facing poverty, violence, and two hundred years of oppression, blacks in this country have historically had a suicide rate about half that of whites. Attempts to explain this were based on Durkheim’s suggestion that the greater a person’s status, the greater the potential fall and the greater the chance of suicide. Suicide, it was said, was a luxury blacks couldn’t afford because they were too busy trying to survive. “Black folks have so many problems they don’t even have time to think about committing suicide,” went the old saw. (Comedian Dick Gregory quipped, “You can’t kill yourself by jumping out of the basement.”) A more psychologically sophisticated explanation for the low black rate derived from Freud’s belief that suicide is the result of murderous impulses toward a lost love object turned inward. In dealing with frustration and aggression, social groups were said to turn either to homicide or to suicide, and rates varied inversely in a given community. Sociologists pointed to the high homicide and low suicide rates among American blacks (as well as to the low homicide and high suicide rates in Sweden and Denmark) as evidence. The generally held—if rarely expressed—opinion was that blacks killed other people while whites killed themselves.
Although the black homicide rate is indeed high—seven to ten times higher than that of whites—suicide is also a significant problem for blacks, particularly among young males. From 1980 to 1995, while the rate for white males age ten to nineteen increased only slightly, the rate for young black males more than doubled. The increase was especially precipitous—233 percent—among blacks age ten to fourteen. (Like the overall adolescent rate, the youthful black rate plateaued and dipped in the midnineties; by 1998, the rate had subsided to what it had been in the early eighties.) Throughout this time, the rate of elderly blacks has remained low, about one-third that of whites, putting in sharp relief the distinctive age pattern of black suicide. The rate peaks in youth (47 percent of black suicides occur among ages twenty to thirty-four, although this group comprises only 22 percent of the black population), then levels off after age thirty-five while the white rate rises. Why is the young black male rate so high? Why is the elderly black rate so low? Until relatively recently these questions went unexplored.
Herbert Hendin’s study of youth suicide in Harlem in the late sixties was one of the first close looks at African-American suicide. He learned that the rate for black New York males age twenty to twenty-five was higher—in some years twice as high—than that for white males of the same age. This had been true since 1910, when detailed records were first kept in New York City. His findings contradicted conventional thinking on the relationship between suicide and violence. Interviewing young black men and women who had made serious suicide attempts, he found a direct relationship, not an inverse one, between suicide and homicide. Almost all had a history of violence in their childhoods—fathers who were physically violent or who died violent deaths, mothers who were abusive—and violence became a part of their lives. They had often thought of killing someone else—sometimes it didn’t seem to matter whom—before they attempted to kill themselves. “Many of these subjects came to life only through acts or fantasies of violence,” wrote Hendin. “In merely talking of past fights or brutality they became far more animated than usual. They see living itself as an act of violence, and regard death as the only way to control their rage.”
For suicidal young blacks, parental rejection and abuse are compounded by rejection from society and by the realization that discrimination limits their opportunities for advancement. “It does not seem surprising that suicide becomes a problem at such a relatively early age for the black person,” Hendin wrote. “A sense of despair, a feeling that life will never be satisfying, confronts many blacks at a far younger age than it does most whites. For most discontented white people the young years contain the hope of a significant change for the better. The marked rise in white suicide after forty-five reflects, among other things, the decline in such hope that is bound to accompany age.” If, as suicidologists say, hopelessness is a central ingredient of the suicidal equation, many young African-Americans are at perpetually high risk. A black man who hanged himself in a juvenile detention center left this note: “I haven’t got nothing. And I ain’t never going to be nobody. Tell my mother good-bye, if you can find her.”
“To be a Negro in this country and to be relatively conscious is to be in a rage almost all of the time,” wrote James Baldwin. Statistics can only hint at the sources and consequences of that rage. Adolescents lacking a parent are more likely to attempt suicide; today 68 percent of black children are born to single mothers, more than half of all black children have no father at home, and divorce among blacks is twice as frequent as among whites. Unemployment, as Brenner pointed out, is correlated with suicide; for much of the eighties and early nineties, joblessness among black men hovered around 30 percent, nearly three times higher than among white men; for black teens the rate exceeded 40 percent. Although the boom of the 1990s brought black unemployment down, it is still twice the white rate. In 2002, boom over, one-third of black families were in debt or had no assets, three times the rate of white families. High school dropouts are at higher risk for suicide; some 18 percent of black males drop out of high school. Rates of suicide among the incarcerated are shockingly high; one in three African-American males will be behind bars at some point in their lives. Given that blacks also suffer from poor housing, disproportionately poor education, and poor access to quality health care, it is remarkable that the black youth suicide rate is not far higher.
Perhaps it should not be surprising that many young urban blacks treat violence, including murder, with nonchalance. “They believe they have nothing to lose,” social worker James Evans Jr. told Time magazine. “Even if they should lose their own lives, they feel as if they will not have lost very much.” Homicide or suicide may seem the only way of making a dent in a world that is repressive, contemptuous, or, at best, indifferent to their presence. In Invisible Man, Ralph Ellison described violence as a way for blacks to reassure themselves of their existence: “You ache with the need to convince yourself that you do exist in the real world, that you’re a part of all the sound and anguish.” Social worker Ruth Dennis, who has studied black suicide and homicide for several decades, points out that such violence has become an accepted cultural tradition for young urban blacks. “His group may demand that he prove his manhood by not ‘backing down’ from a life-threatening encounter even if it means his own destruction,” she told the audience at a National Symposium on Black Suicide. “This behavior is demanded by the only group that accepts him.” Dennis compared it to the behavior of eighteenth-century European gentlemen who felt obliged to challenge someone to a duel at the slightest insult.
Social scientists suggest that some young urban blacks express a combination of suicidal and homicidal impulses by provoking someone else into killing them. They may consider it a more acceptable form of death than suicide per se, which is perceived as unmanly. And so they engage, kamikazelike, in shootouts with police against overwhelming odds, often triggering their own death. One young black man, for instance, brandished a pistol he knew to be unloaded at policemen and was shot. It has been suggested that 10 percent of fatal shootings by police in this country may, in fact, be cases of what has been called “suicide by cop.” In one of the few studies of the subject, researchers analyzed 437 shootings by police officers in the greater Los Angeles area and determined that, although they had been recorded as homicides, 46 fit the description of what, in a cumbersome but descriptively precise phrase, they dubbed “law-enforcement-forced assisted suicide.” Twenty-nine percent of the victims had histories of psychiatric treatment; 65 percent had talked of suicide to family or friends; 100 percent had brandished a weapon and shown evidence that they wanted the police officers to shoot them. A few psychologists have suggested that radical groups like the Black Panthers, one of whose slogans was Revolutionary Suicide, have deliberately courted death at the hands of authorities, or that rioting by African-Americans following incidents of police brutality is a form of collective self-destruction, given that most of the damage is usually suffered by black-owned property. “The problem with such speculations is that they often arise out of unconscious and sometimes conscious attempts to blame the victim for the brutal acts of another,” writes psychiatrist Alvin Poussaint, professor of psychiatry at Harvard Medical School. “According to this rationalization, violence among blacks is suicidal behavior, a black who resists a white policeman is trying to commit suicide: so the policeman who murders is morally absolved of homicide. Such assumptions imply that blacks who rise up and rebel against an unjust system are crazy rather than courageous, insane rather than incensed. Many institutional authorities refuse to acknowledge the willingness of black youth to risk their lives because they want a better life.”
In Lay My Burden Down: Understanding Suicide and the Mental Health Crisis among African-Americans, Poussaint and coauthor Amy Alexander suggest that suicidal blacks of all ages may suffer from what they call posttraumatic slavery syndrome, a state of low self-esteem and internalized racism inculcated by a system that, long after the end of legal segregation, continues to discriminate against them. They say that many black suicides are what Durkheim called fatalistic. “There is a type of suicide the opposite of anomic suicide,” wrote Durkheim. “. . . It is the suicide deriving from excessive regulation, that of persons with futures pitilessly blocked and passions violently choked by oppressive discipline.” Durkheim believed that fatalistic suicide was rare, relegating it to a footnote in Le Suicide and citing as an example the suicides of very young (and presumably beleaguered) husbands. Nevertheless, he wrote, “Do not the suicides of slaves . . . belong to this type, or all suicides attributable to excessive physical or moral despotism?”
Durkheim’s theory was supported by Warren Breed’s 1970 study of suicide in New Orleans. He found that more than half of suicides by blacks occurred in the context of conflict with authorities—landlords, lawyers, tax officials, and police—compared with only 10 percent of white suicides. Many had a great (and perhaps justified) terror of the police, like the young man who had always expressed such a fear although he had never been arrested. One night, during an argument, he shot and wounded his girlfriend; when he heard police sirens, he turned the gun on himself. In many cases blacks completed suicide in the face of problems that could easily have been resolved had they had some basic knowledge of community resources—legal aid services, housing authorities, tax agencies, and so on. “The Negro is subject to the imperatives of two communities,” wrote Breed, “and when his difficulties extend outside of the Negro sphere, he is faced with authorities who are white—to him an alien force. He bears a double burden of social regulation. A white man can feel trapped, too, but the data demonstrate a much lower frequency of the ‘authority’ stress factor in white male suicide.”
With so much against them, why have blacks had such a low rate of suicide? Ironically, their very history of struggle against discrimination may play an important role, by forcing them to cultivate an inner strength that offers protection against self-destruction. “Their expectations of life have been different from those of whites,” says Alvin Poussaint. “Thus, tragedy that might drive a white man to self-murder might be accepted by a black man as one more incident in a life of hard times.” (“Black Poets should live—not leap / From steel bridges, like the white boys do. / Black Poets should live—not lay / their necks on railroad tracks, like the white boys do,” as poet Etheridge Knight puts it in “For Black Poets Who Think of Suicide.”) This may help explain the astonishingly low rate of elderly black suicide. In 2000, the rate for black males over sixty-five was 12 per 100,000—three times lower than that of their white counterparts. The rate for elderly black women has hovered around 2 per 100,000 for many decades—perhaps the lowest rate of any demographic group in this country. Elderly blacks, it is theorized, have made a certain peace with their lives in a racist society, scaling down their hopes to fit reality more closely. (One psychologist offers a more practical explanation, suggesting that the majority of violent black males are removed from the population before they reach old age, having killed themselves, been murdered, or been imprisoned.) In the face of adversity, blacks have developed a strong network of family, religious, and community ties—ties that, as Durkheim pointed out, offer protection against suicide. In a study of marital status and suicide, Steven Stack found that while the divorce or death of a spouse raised the risk of suicide significantly among African-Americans, as it does among whites, being single did not. The association between marital status and suicide was less operative for blacks than for whites, which the author suggested was attributable to traditionally stronger family ties. The extraordinarily low rate among elderly black women may further be encouraged by the matriarchal tradition in African-American families. Black grandmothers play an important role in family life (caring for children, cooking, keeping house), which may give them a sense of purpose that many elderly whites say they lack. Older blacks are also bolstered by their strong sense of spirituality and their immersion in religious traditions with powerful taboos against suicide.
If the bonds forged during segregation offered African-Americans some protection against suicide, what effect has integration had? In 1938, psychoanalyst Charles Prudhomme predicted that as blacks in America entered the white-dominated mainstream, their suicide rate would approach the white rate (just as the rates of immigrants grow more similar over time to those of the majority population and less similar to those in their countries of origin). The black suicide rate has indeed risen since 1938—although no faster than the white rate. Prudhomme’s theory was lent credence by a 1965 study that found that while Harlem’s suicide rate was half that of New York City as a whole, there were three middle-class Harlem communities in which the suicide rates equaled those of the entire city. Ruth Dennis has suggested there may be two forms of black suicide: the angry urban suicide Hendin described and the suicide of those trying to assimilate, to succeed in a world dominated by whites. Success in the white-dominated world may be a double-edged sword. As blacks move, geographically and socioeconomically, they are less likely to be part of tight-knit communities; indeed, over the past several decades, the involvement of blacks, especially young males, in social and religious organizations, has declined. A 1998 study traced the rise in African-American suicide—of youth suicide in particular—to a decline in religious beliefs and practices. (Given that in-migration has historically led to a rise in the suicide rate, the massive twentieth-century flow of black Americans from the South to the North, from rural to urban areas, where they were exposed to unfamiliar stresses, may in some measure be responsible for the rising rate. Rates are higher for blacks in the North; in the South they have remained traditionally low.) Just as women’s suicide rates grew as they entered the mainstream of society, so, too, have black rates risen as their status—and their expectations—has risen. Durkheim was the first to observe that poverty may protect people from suicide because those who expect little are not disappointed when they receive little. Psychologist Richard Seiden writes, “Perhaps these unifying social ties are destroyed as personal aspirations are realized. Could increased suicide be the ticket of admission to the middle-class American dream?” This view was supported by a study by Alton Kirk, a psychologist at Michigan State, who found that blacks who attempted suicide had less racial pride and less sense of black identity than blacks who did not attempt suicide. Kirk believes that black consciousness, in giving one a more positive self-concept, offers a protective shield against suicide. Those who “try to become more assimilated into the contemporary white American society,” he says, will “find themselves in ‘the ethnic twilight zone,’ belonging to neither the white or the black world.”
While the rate has risen, it remains comparatively low. The low rate is especially surprising given African-Americans’ consistent underutilization of mental health services. Part of the reason is financial: only about 25 percent have health insurance. Part is historical: often denied medical care or offered substandard treatment in segregated facilities or poorly funded and understaffed hospitals, blacks may have an understandable skepticism of the medical community in general and of mental health professionals in particular. Part may be cultural: in a 2000 National Mental Health Association survey, two-thirds of blacks considered depression to be a “personal weakness” treatable by prayer and faith; only a third recognized it as an illness for which they’d take a prescribed medication—nearly the reverse of the figures for the general population. Many African-Americans describe depression as “the blues” or “being down” and may think of it as an almost inevitable part of life—something to suffer through, not something to see a therapist about. “The internal strength which allowed blacks to endure centuries of hardships has, it seems to us, morphed over the decades into a form of stoicism that provides little room for acknowledging and addressing mental health problems,” write Poussaint and Alexander. (Poussaint, whose brother died of a heroin overdose, and Alexander, whose brother jumped to his death, cowrote Lay My Burden Down in part to break the silence about depression and suicide in the African-American community.) The shame associated with mental illness was poignantly expressed in a suicide note, quoted in Lay My Burden Down, left by a twenty-three-year-old black man who shot himself to death: “Mom, don’t tell anybody I killed myself. Just tell them somebody killed me because I don’t want people to think I’m crazy.”
To those clinicians who increasingly tout the link between mental illness and suicide—and promote psychopharmacology as a panacea—the low rate of African-American suicide is baffling. (One can’t help playing devil’s advocate: Might blacks actually have a higher rate if they turned more to medication and mental health professionals? Might whites have a lower rate if they spent less time with pill-dispensing physicians and more with family, church, and community?) Certainly the paradox offers intriguing territory for exploration. Things have changed since I attended the 1985 NIMH Youth Suicide Conference and was surprised to find that of the more than four hundred attendees, only sixteen showed up for the presentation on black youth suicide. Yet there remain relatively few rigorous studies of African-American suicide. (For several years, in fact, the American Association of Suicidology was unable to award its annual prize for research on minority suicide.) Although an increasing number of prevention centers train volunteers, most of whom are white, in how to deal with callers whose ethnic and cultural backgrounds differ from their own, few people could argue with Alton Kirk’s observation that “Blacks view suicide among blacks as a rare occurrence; whites see black suicide as a black problem. Too many people, black and white, fail to see that black suicide is symptomatic of more general societal problems—societal problems which we must work together to solve before they destroy us all, both black and white.”
One of the reasons that sophisticated research on black suicide has been scarce is that until 1964, the National Center for Health Statistics lumped all “nonwhites” into a single statistical category. At that point, the office began subdividing this group into blacks and “all others,” which still left Native Americans, Asians, and dozens of other groups in one category. Until 1997, Hispanic-Americans were buried within the “white” statistical category, ensuring that research on Hispanic-American suicide would be virtually nonexistent. One of the few large-scale studies surveyed the five Southwestern states (Arizona, California, Colorado, New Mexico, Texas) where the majority of all Hispanics in America live and where, since 1975, death certificates have distinguished between Anglos and Hispanics. The study showed that the suicide rate of Hispanics (9.0) was less than the national rate for whites and one-half that of Anglos living in that area. This was true for both males and females. Almost 70 percent of Hispanics who completed suicide were under age forty, and 33 percent were under twenty-five (compared with only 17 percent of Anglos). For women the rate peaked early, then fell off sharply; for men the rates were highest in the twenties and after age sixty but still much lower than for Anglos. (It must be remembered, however, that this study was primarily of Mexican-Americans and did not reflect cultural differences among various Hispanic groups.) In 2002, the rate among Hispanics (which includes persons of Mexican, Puerto Rican, Cuban, and Central and South American origins) was 5.0, slightly less than half the overall national rate. As with black suicide, the Hispanic rate peaks in youth. Hispanic high school students are nearly twice as likely as their white or black classmates to say they have attempted suicide.
Research on Native American suicide is similarly sparse, a fact underscored during a six-week period in 1985 when nine young Native Americans (eight Arapaho and one Shoshone) killed themselves on the Wind River reservation in Wyoming. All were young men, and all chose hanging—using rope, socks, bailing twine, sweatpants, and the drawstring from a sweatshirt. Over the following months, psychologists and counselors held weekly suicide prevention sessions in the reservation schools, discussing clues, warning signs, alcohol abuse, and so on. A task force delivered family counseling. A teen suicide hotline was established. But there was another, less clinically orthodox response. The community’s young Arapaho took part in a tribal rite last performed in 1918 to ward off an outbreak of Spanish influenza. Four feathers, each decorated with a red ribbon and blessed with the Arapaho sacred pipe, were placed near the tribal sun-dance ground to mark the points of the compass and purge the unhappiness that might have caused the suicides. Inside a tepee, an elder cleansed members of the tribe by tapping on the ground, painting their faces with scarlet paint, and having them step over a burning herb. Hundreds of young people waited their turn outside. There would not be another suicide for almost six months.
Although the two approaches may have combined effectively in this case, they demonstrate the cultural gap that many say led to the suicides. In pre-reservation days, each Indian tribe developed its own attitude toward self-destruction. Chippewa, for instance, believed suicide was a foolish but not deplorable act; the Alabama tribes considered it cowardly; Creeks were said to kill themselves “after the slightest disappointment.” Many tribes released aggression and frustration in other ways. Among the Cheyenne, for instance, suicide was rare but not unknown. When a warrior grew depressed or lost face, a war party was often organized. In battle he would take some heroic risk that resulted either in a renewal of his self-esteem or in his death. Another outlet for masochistic aggression was the sun dance, in which warriors engaged in various kinds of self-mutilation.
“After they were confined to the reservation, the Indians were forbidden to hold their Sun Dance or carry out any other ‘primitive and barbaric rituals,’” wrote Larry Dizmang in his study of suicide among the Cheyenne. “They could no longer hunt the nearly extinct buffalo, and of course fighting between tribes was outlawed. A Government program designed to improve health conditions forced the Indian men to cut their long hair, a prized symbol of their strength; and, because the Indian could no longer support himself or his family on the reservation, the Government was forced to set up welfare programs, which only added to the rapid downward spiral of increasing dependency and loss of self-esteem.”
Today, the Cheyenne are one of many tribes to have found new ways to vent aggression: alcoholism, homicide, and suicide. The suicide rate for Native Americans is the highest of any racial or ethnic group in this country. In 1995, the rate of 19.3 was nearly twice the rate of the nation as a whole. As with blacks, the rate is especially high for young males: 54.0 for adolescents and a whopping 67 for those aged twenty-five to thirty-four. (Although the rate for young Indian females is substantially lower than for young Indian males, the rates are still about three times higher than for the general population.) But while the suicide rate for American Indians as a whole is high—fueled in part by high rates of drug and alcohol abuse—there is tremendous variation among the nation’s four hundred tribal groups. The tribes with the highest rates are generally the ones in which traditional values have been most eroded. Trying to fit into a dominant new culture while maintaining traditional values may result in what social scientists call marginality—the inability to form dual ethnic identification because of bicultural membership.
A similar pattern is found among the Inuit of Alaska, Greenland, and especially Canada, who have one of the world’s highest suicide rates. Suicide has always played an important role in Inuit culture, but it used to be the “economic” suicide of the elderly and ill who walked off to die during times of scarcity to conserve the tribe’s resources. Today, suicide among the Inuit is largely a problem of the young, especially men between the ages of fifteen and twenty-nine. While the overall Canadian suicide rate is 12.9 deaths per 100,000, rates in the largely Inuit Nunatsiavut, Nunavik, and Nunavut regions average 80 per 100,000. In a 2001 survey in one small arctic community, one in three respondents had attempted suicide during the previous six months.
Over several years in the 1990s, Canada’s Royal Commission on Aboriginal Peoples held public hearings in ninety-two communities and concluded, in a widely discussed 1995 Special Report on Suicide, that the causes were numerous and catastrophic: disruptions of family life from enforced attendance at distant boarding schools; drugs; alcohol; brain damage or psychosis from sniffing solvents; poverty; limited employment opportunities; substandard housing; inadequate sanitation; and cultural stress from loss of land, loss of language, suppression of belief system, and the decline of subsistence hunting and fishing. Other researchers have concluded that, like certain American Indian tribes, those Inuit communities that have retained more cultural traditions have lower suicide rates, as do communities that, for various reasons, have been isolated from or resistant to governmental attempts to impose assimilation. In 2003, the Canadian national Inuit organization Inuit Tapiriit Kanatami passed a resolution identifying suicide prevention as the Inuit’s number one health priority; in 2004, the National Inuit Youth Council published a National Inuit Youth Suicide Prevention Framework. The NIYC’s president, Adamie Padlayat, said, “Inuit culture is rooted in values such as resilience, survival, and adaptiveness. We need to articulate to Inuit that these traditional values are important today for our survival in contemporary Canadian society.”
Ethnicity has an effect on suicide; so, too, does sexuality. The history of homosexuality is strikingly similar to the history of suicide. Over the millennia both were viewed as a natural act, then as a sin and a crime, then as a disease. Just as suicides were dragged through the streets, hanged upside down, and burned, homosexuals were imprisoned, beaten, castrated, burned at the stake, and hanged in public squares. For centuries, exposure in a homophobic society—and the attendant public humiliation, possible imprisonment, and loss of friends, family, and career—almost literally meant the end of one’s life. Many homosexuals saw no option but to make that figurative end literal. Newspapers of the 1940s and 1950s were filled with accounts of men who killed themselves after being arrested on a “morals charge.” Many more suicides went unreported, including those who killed themselves after being blackmailed and those who killed themselves in shame as they acknowledged their feelings. “Prior to the development of the gay movement, public identification as a homosexual was, almost by definition, linked to scandal, social ostracism, blackmail and suicide,” wrote Eric Rofes in “I Thought People Like That Killed Themselves”—Lesbians, Gay Men and Suicide, in which he discusses “the myth of the suicidal homosexual.” As the title of Rofes’s book suggests, for many years homosexuality and suicide were seen as synonymous. “I remember in the fifties it was almost understood that you weren’t really queer if you didn’t feel the melancholia that would cause you to attempt self-destruction,” observed Pat Norman, director of the San Francisco Gay/Lesbian Health Service, at the 1986 National Conference on Gay and Lesbian Suicide. Novels, plays, and films reinforced that myth, frequently portraying homosexuals as miserable, guilt-ridden individuals who ended up killing themselves. In Lillian Hellman’s 1934 play The Children’s Hour, a schoolteacher accused of lesbianism is driven to suicide by the homophobic citizens of a small Southern town. “Homosexuality used to be a sensational gimmick,” Mart Crowley, author of the play The Boys in the Band, told an interviewer in 1969. “The big revelation in the third act was that the guy was homosexual, and then he had to go offstage and blow his brains out. It was associated with sin, and there had to be retribution.”
For many years the medical profession reinforced that myth. In the late nineteenth century, homosexuality, like suicide, was reinterpreted as a disease to be “cured.” As with suicide, homosexuality’s evolution from a moral to a medical problem merely changed the nature of the stigma. Well into the second half of the twentieth century, in fact, some mental health professionals insisted that homosexuality was a form of suicidal behavior: “The homosexual act in itself may already represent a suicidal tendency, an inner fury against prolonging the race, or an unconscious need to merge with the stronger person of the same sex,” wrote the distinguished psychiatrist Joost Meerloo in 1962. It wasn’t until 1973 that the American Psychiatric Association, under duress, dropped homosexuality from its roll call of mental illnesses in the Diagnostic and Statistical Manual of Mental Disorders. Nevertheless, it would be hard to disagree with Myron Mohr, former director of the Baton Rouge Crisis Intervention Center, who has observed, “Regardless of what the APA has said, there are still therapists who believe that homosexuality is a disease they must try to cure.”
“Have lesbians and gay men internalized the myth of homosexuals as suicidal and engaged in massive self-destruction?” asks Rofes. Not surprisingly, given the highly politicized environment of gay rights and the fiercely territorial nature of mental health research, the answer has been a subject of controversy. Although accurate statistics are difficult to compile because sexual orientation is not listed on death certificates and because many gays, especially during more closeted eras, have chosen to keep their sexual orientation secret, various studies have concluded that gays and lesbians attempt suicide two to seven times more often than heterosexuals. A 2000 survey of 3,648 men between the ages of seventeen and thirty-nine found that nearly 20 percent of those who had same-sex partners had attempted suicide, compared with 3.5 percent of the heterosexuals. Although studies of completed suicide are few, a 1986 study concluded that gay men accounted for 10 percent of male suicides in San Diego County. A study of male twins, one of whom was gay and the other straight, found that the gay twins were nearly four times as likely to have attempted suicide, twice as likely to have considered it.
Several suicide researchers have attacked some of the earlier studies for their alleged lack of scientific rigor and their predilection for political posturing. A 1978 Kinsey report, for instance, which found that 35 percent of gay men had attempted or considered suicide, was criticized for recruiting many of its subjects from bars and bathhouses, a “biased” sample likely to include a disproportionate number of alcoholics. (A gay suicidologist likened this to criticizing “Aborginal American studies for being ‘biased’ because researchers had only taken their study sample on reservations.”) Indeed, in 1978, when the vast majority of gays were still closeted and gays in the streets were still being beaten and arrested merely for being gay, where else might researchers find a population sufficient for their study? If they had confined their search to the usual places—college newspapers and psychology department bulletin boards—suicidology might still be waiting for the first study on gay and lesbian suicide. A few of the critics produced studies of their own, calling the earlier findings into question. Yet this supposedly more rigorous research may itself have been flawed because of their authors’ apparent ignorance of gay life. One frequently cited paper that found no significant difference in completed suicide rates for gay versus straight adolescents relied for information about sexual orientation on a parent and a friend, the author apparently being unaware that many closeted gay adolescents live double lives in which parents and “straight” friends are often the last to know the truth, or the least likely to admit it.
Whether or not the data on gays and suicide is airtight, even the most scientifically stringent suicidologists could hardly deny that gay and lesbians face conditions likely to increase suicide risk. Numerous studies show higher rates of depression, panic disorder, and anxiety disorder among gays than among straights, encouraged, no doubt, by the stress of having to live life on the margins of society. Among gays and lesbians, rates of alcohol and drug abuse—risk factors for suicide among any group—are estimated to be about three times higher than in the general population, not surprising given that for many years gay and lesbian socializing revolved around bars: one of the few places where they were able to gather comfortably. (Alcohol and drugs are also, of course, a way of dealing with oppression and social stigma.) Yet why is the suicide rate among blacks, who have also suffered centuries of persecution, lower than that of the general population, while the gay rate seems to be higher? Unlike blacks, gays often lack traditional supports that may act as a buffer against suicide. They are vulnerable to what Durkheim called “egoistic” suicide, the final refuge of those who don’t belong to cohesive social groups. Many have been rejected by their families, friends, and religions. In Is the Homosexual My Neighbor? a man comments, “Less than two months ago I was told by a sincere Christian counselor that it would be ‘better’ to ‘repent and die,’ even if I had to kill myself, than to go on living and relating to others as a homosexual.” To attribute gay suicide solely to discrimination, as some gays have done, is absurdly reductive; but to deny that homophobia is a factor, as some mainstream suicidologists have done, is equally ludicrous. And though in recent decades the gay rights movement has made it more acceptable to live openly gay lives, gay men and lesbians still face discrimination in employment, immigration, the military, and the ministry. The National Gay Task Force found that more than 90 percent of two thousand gay males and lesbians surveyed had experienced abuse at some point in their lives because of their sexual orientation.
The problem of gay suicide has been immensely complicated by AIDS. In the 1980s, when a diagnosis of HIV/AIDS was a virtual death sentence, there was almost universal suicidal thinking for persons at risk. One man who was given a tentative diagnosis of AIDS hanged himself in a San Francisco park; the diagnosis turned out to be inaccurate. In 1985, one of the first systematic studies of suicide and AIDS found that AIDS patients in New York City were thirty-six times more likely to kill themselves than other men aged twenty to fifty-nine, and sixty-six times more likely than the general population. Although the development and widespread use of antiretroviral medications have transformed a positive HIV status from a terminal illness into a chronic condition, recent evidence suggests that people with AIDS nevertheless have a risk of suicide up to twenty times that of the general population. A positive test result for HIV has been linked to increased anxiety, depression, suicidal ideation, and suicide attempts, though only a slightly increased risk for completed suicide. Although the new combination therapies have allowed AIDS/HIV patients to live longer, the side effects of those medications (including depression, anxiety, and insomnia), as well as chronic disorders (diabetes, hypertension, and other illnesses and infections that eventually invade an increasingly weakened immune system), often so diminish the quality of life that thoughts may turn to suicide. Gay men may no longer “exchange formulas for suicide as casually as housewives swap recipes for chocolate-chip cookies,” as the late gay activist Randy Shilts put it in 1990, but right-to-die groups that once catered primarily to the elderly continue to report numerous calls from young men with AIDS and HIV/AIDS-related complex. In a survey of 113 men over the age of forty-five who had HIV/AIDS, 27 percent had thought of taking their own lives in the previous week; those who reported suicidal thoughts perceived significantly less social support from friends and family than those who hadn’t. Indeed, although the stigma of an AIDS diagnosis has lessened, the suffering caused by AIDS is still frequently exacerbated by lack of support. AIDS patients may lose their jobs and their apartments; they may be abandoned by family, friends, and lovers—even by hospital personnel. If loss is a key to suicide, gay men—many of whom can no longer count the number of friends they have lost to AIDS—remain at risk.
Stigma, internalized homophobia, and the specter of AIDS are factors that may be especially daunting for gay and lesbian adolescents, for whom suicide seems to be a particular danger. Although the findings are less clear regarding completion, several recent population-based studies have found increased rates of suicidal ideation and behavior among gay and bisexual young people. A 1999 survey of 3,365 students, for instance, found gay males seven times more likely than heterosexual males to have made an attempt. (Most studies of gay and lesbian suicide attempts document elevated risk in young males, but not young females—the reverse of the general population, in which young females attempt suicide far more frequently than do young males.) A 1998 survey of nearly forty thousand junior high and high school students in Minnesota found that 4 percent of straight males had considered suicide, 28 percent of gay males. In an Indiana University study of 979 gay men and women from the San Francisco area, 20 percent had attempted suicide before age twenty.
Despite these statistics, in the attention to adolescent suicide, gay and lesbian suicide has been relatively neglected. “All of the problems that affect youth suicide in general affect gay youth suicide as well,” Paul Gibson, a social worker at a San Francisco shelter for runaways, has said. “But gay young people have the doubly difficult task of not only trying to survive adolescence but of coming to terms with their sexuality and developing a positive identity.” Although many adolescent suicide attempts are made in response to a stressful act, like the breakup of a romance, a study by the Los Angeles Suicide Prevention Center of suicidal behavior in fifty-two gay adolescents found that their attempts were more often the result of longstanding anxieties and fears surrounding their emerging homosexuality. (Some counselors believe that many seemingly inexplicable or so-called outof-the-blue teenage suicides may be the acts of adolescents who are struggling with homosexual feelings, have no one they dare confide in, and decide suicide is the only solution. These deaths, of course, never find their way into studies of gay suicide.) Not surprisingly, the LASPC research found that young gays and lesbians often lacked the social supports generally available to heterosexual teens. “Gay and lesbian youth face total rejection from their family,” according to Gibson. “Many of the young people we work with at Huckleberry House were told to leave home when they came out to their parents. Gay and lesbian adolescents also face the prospect of not having any kind of peer group support. Many gay and lesbian young people lose close friends in coming out to them. Frequently they are harassed, ridiculed, and assaulted at school by their peers, either if they’re open about who they are or if it’s suspected. School becomes a scary place for them.” Even when they seek help, they may not have the support of counselors. Gibson says, “Helping professionals frequently worsen the problems of gay and lesbian youth by failing to accept their orientation.” The one person who accepts the gay adolescent’s sexual orientation may be his or her lover. In that case the relationship can take on a life-and-death intensity. “They put all the energy that’s missing from the relationship with the family that doesn’t want them and from the peer group that rejects them into their relationship with their lover,” says Gibson. “When that relationship ends, they feel as if everything is over.”
Some of the obstacles faced by gay and lesbian youth are exemplified in the short life of Jim Wheeler, whose story was told in the documentary film Jim in Bold. The middle of seven children in a close-knit Quaker family, Wheeler grew up in western Pennsylvania farm country, the son of a family physician and a substitute teacher. From early on, it was clear to his parents that Jim was different—a sensitive child more interested in painting, dancing, and playing with Barbie dolls than in playing football. Jim seemed happy, for the most part, but as he entered high school, his effeminate mannerisms and eccentric preferences made him a target for increasingly vicious teasing. Jim pretended the name-calling—sissy, fairy, faggot, queer—didn’t bother him and became only more determined to flaunt what he called his “punk-rock attitude,” dyeing his hair orange, showing off his multiple piercings, and polishing his persona as an artist. At sixteen, he told his family he was gay. They were not surprised. His mother told him she loved him but said it would be a hard road ahead. But his family wouldn’t know until after his death, when they found the poetry he’d written, just how hard it turned out to be—for instance, that after gym class one afternoon, some of the athletes had pulled him from the shower, thrown him to the floor, and urinated on him. In a rural area where to come out of the closet might well have been considered metaphoric suicide, Jim didn’t know anyone else who was gay. “He wanted to be normal,” one of his sisters later wrote. “And in his eyes I guess being normal meant not being gay. He could not see any future for himself.” When he began to talk of suicide, his family assumed he was being his usual histrionic self. But after Jim cut his wrists, his parents took him to a therapist, who told Jim that homosexuality was an unpardonable sin. The cure? Prayer. In any case, the therapist told Jim’s parents not to worry; Jim was a cutter and cutters never kill themselves. Five months after Jim’s high school graduation, not long after he had gone into therapy, Jim’s mother and older sister found him hanging just inside the door of his apartment. He was nineteen. After his death, they found a sad, defiant poem he’d written describing the shower incident. It ends with words “single gay male that’s me.”