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 re
search, 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.”
November of the Soul Page 39