Suicide, suicidal ideation and mental health problems among men.
Several years ago I listened in to a podcast concerning the high rate of suicide among men except that it was narrated or argued about by a strident feminist whom actually had the gall to use the line “women most affected”. If my memory is working as it should today then it was a radio 4 broadcast – possibly women’s hour but then radio 4 is almost all women’s hour – I was only there because I was waiting for a very truncated shipping forecast which again, if I remember it correctly the forecast kicked off with a line that iv’e never heard either before or after : ‘Gales all areas’. At the time I remember being outraged by a feminist immediately trying to make a male problem all about women although later on I reflected that possibly it does affect women more in that it’s the wives, mothers and girlfriends left behind that suffer the long term loss. What nearly happened next is my radio almost ended up as a man (radio) overboard incident as it made me so mad that it almost went ‘by the board’.
The fact of the matter is that we had one actual, for real, suicide locally and one that I think was suicide but was more like suicided (self suicided) but done in such a way that the coroner might have given the verdict of accidental death, death by misadventure or unclear : i’m not particularly clear on the inquests and law surrounding non medical deaths. At that time, as a specialist nurse, one of my many roles was to perform verification of expected death but that could only be done when end of life was clear and well documented.
One of the odd things about my role as a senior/specialist nurse is that we were part of the rapid response to medical emergencies and several times I was ‘fast bleeped’ (paged) to attend a patient whom had either made a suicide attempt or what was most likely a parasuicide attempt – the last one and the one before that were both to adult age women that had self harmed with broken up parts of ‘safety’ razors – a bit messy but not life threatening.
In a recent draft post which I never completed I almost made the mistake of claiming that this end of the country is not only the poorest but has the worst record for alcohol and low grade recreational drug abuse. I was wrong on both counts because, while definitely being a poor region, it only ranks about 4th behind other regions – the north east being the poorest and both Devon and Cornwall only have an average rate of alcoholism and drug use. I think it just seemed that way based on my experience in healthcare but the statistics show that it’s not the case.
When it came to writing a post about suicide I went straight to statistics because our experience in healthcare is that we never (usually) have direct dealings with suicides because the bodies don’t usually appear in the hospital. In my memory it only happened twice in my whole career and only because the victim had vestigial signs of life and was rapidly declared deceased either in the back of the ambulance or the one I remember which was about 15 minutes after getting to my ICU.
What the statistics show us is that suicide happens about 3-4 times as often in men as it does in women. Sadly, I have known several men whom committed suicide and so far only one woman although in her case the entire female side of the family had severe endogenous depression and suicided* one by one.
If you’re wondering why i’m covering this now, after all it’s not exactly a new problem, it’s because I was writing about yet another man that I knew whom also committed suicide – the eccentric/irascible sailor/skipper that became a hotel owner and then a user of home prepared explosives. As I think back on him it didn’t and still doesn’t surprise me that he took his own life although it made me ask the question ‘what was it about him that made it not a surprise’ ?. In a way it’s a bit like the period when I was actively engaged in hospital risks and safety and I was asking the same kind of questions about risks, errors and personality.
The other reason that i’m here and covering this subject is because it seems like our liberal (read communist) governments are progressively accepting and then promoting medically assisted dying and I want to offer a different take on that in this post – in a way the logical conclusion of the ‘boomer’ generation.
With my work in clinical risks and safety I was basically asking the wrong questions in the wrong place but I ended up taking a deep dive into the world of psychometrics via Dr Jordan Peterson’s work on personality : I made the mistake of thinking (assuming) that clinical error was maybe a personality problem and in fact it seems little to do with personality and not even the individual most of the time. Having studied personality psychology at some length I wondered if suicide and suicidal ideas might be more prevalent with certain psychological traits although as yet iv’e found nothing to support that idea.
To keep it short the TLDR (too long – didn’t read) of that whole idea is that while academically interesting (iv’e even provided the link to a research paper) it isn’t hugely useful to know what someone’s Big 5 personality traits are in an attempt to predict their likelihood of committing suicide. A few examples here : of the 6 men that iv’e known who went on to end their own lives one was a vet and two were medical consultants and only one of the later ones had obviously poor mental health and a big problem with alcohol consumption.
Link : https://pmc.ncbi.nlm.nih.gov/articles/PMC6127810/
The standard and normal way of understanding suicide is that it seems to be more about factors other than personal traits : for example it’s often said that a combination of poor mental health, low cognition, a poor socio- economic (status state) coupled with high alcohol consumption all lead to a higher risk of male suicide. In my experience though that hasn’t always been the case as, of the several suicides that I have known, one was a veterinary surgeon and two were consultant anaesthetists – all of them intelligent and hard working men with status and settled marriages. Only one suicide that I knew of recently definitely had an alcohol and mental health problems and with him the verdict was unclear (to those that knew him) whether it was a deliberate or accidental death.
I think iv’e long been aware – at least since I got my first computer – that there was a kind of unspoken buzz (in healthcare) regarding a rising rate of unexplained deaths among the elderly population. I think that’s the first time I came across the idea of suicided rather than plain, deliberate suicide. It seemed as though there was a question or tacit understanding that some of the elderly were deliberately ending their lives and some were achieving the same end by some degree of deliberate knowing neglect. This was maybe the case of the man that I knew that was found dead in his living room during a cold winter : he had obviously consumed a load of alcohol and had passed out on his sofa while wearing just a tee shirt. The most obvious cause of death would have been hypothermia but enhanced or caused by his alcohol consumption and perhaps by deliberately not having his heating running.
Actual, deliberate suicide is easier to understand in the elderly when maybe their physical health is poor, when bouts of depression become more serious and when they already have long experience of loss themselves : be that spouse, friends or even long loved pets. Maybe their lives have, in their mind, already become more limited and yet dependent as their grown children move away and their circle of friends and range of interests all declines over time.
https://www.psychologytoday.com/us/blog/understanding-grief/202001/why-do-the-elderly-commit-suicide
The last time I came to this subject recently was while we were having a short break by the seaside in the town of Weymouth (UK). I spent hours each day sitting under one of the beach front shelters just watching the street theater of Brits on holiday at play. During one such session I found that i’d joined an elderly lady doing, apparently, the same kind of thing and for a while I was kind-of entertaining myself with the thought experiment of looking at people, watching what they were doing and asking myself what it is that they really wanted at that moment and in that place.
With the youngest kids it was quite easy because they seemed to want either to in the sea with as few or no clothes as their parents would allow – that or another ice cream. With the teenagers it seemed to vary between boys and girls : the girls seemed to be vying for attention and to look ‘cool’ while the boys of course were mostly shaping up and in a way competing with each other to win the girl’s approval (it seemed to me that it was the teenage girls running the show). With the adults the answer would have been more beer, more food and more trivial dopamine hits via their ‘smart’ phones. The elderly folks were perhaps the most interesting although I may have been using a bit of transferance because i’d been reading about the use of medically assisted dying in the Netherlands.
I think that you can see that the whole subject is an entire rabbit hole except that it seems to have more twists and turns than a local Arsenic maze. In one of my recent posts I had a bit of a pop at my generation as the generation that had it all but is now coming to the end of it’s sell by date. If we take the boomer generation back just a few years to include the 70 and 80 year olds – the immediate post war generation and in certain specific countries, then what we find is that it is the elderly (and sick) that are either turning to medical assisted dying or are doing it for themselves – either with or without direct medical assistance but often medical connivance.
Where this turn in the rabbit hole/Arsenic maze goes is a brief look at why MAID is being chosen as an option by the elderly population in the way and numbers that it is – this only applies (so far) to the Netherlands because (so far) that’s the only country that I came across the data for. Thus far what it looks like is that many of the Dutch elderly that eventually choose either medically assisted dying (lets call it euthanasia) or opt to do it themselves, do so mainly due to one reason over and above the usual reasons for suicide in the elderly. That reason seems to be a fear of suffering a painful or distressing death which I know can and does happen but also that is something that can be prevented or avoided by effective palliative care. Maybe my own question that day in Weymouth – “what do you want” as applied to the many elderly people near to the down trajectory of life is perhaps the answer ‘an easy and pain free death’.
That answer alone has been a a long branch of the same rabbit hole because it’s the side that I was closer to in my own nursing career : our team were deeply involved in pain management plus we had an involvement with end of life care. One odd result in my chain of questions asked is that there is or was active research around the use of psychedelics to help alleviate the fear of suffering : I don’t have a reference for that as it only came up in one of Dr Jordan Peterson’s podcasts.
If I was writing this as a clinical essay then it would be a lot longer and each point would need one or more references, luckily i’m not writing an essay that would be marked and writing in that style was something I dislike back in the day when I did have to write like that. My conclusion is that I don’t one -don’t have a single answer and I don’t exactly remember what the question I started with was……maybe all I have now are some better questions.
Edit/correction.
I have to start the edit and correction with an apology and explanation to my partner (Jackie) in that we were talking about the whole debate of medical assistance in dying ; we’ve both worked in the trenches on the end of life problem in hospital as with both of our careers that’s something we’ve chosen to have as a specialist area of interest, With that as a start and both knowing many of the same people that have committed suicide Jackie asked me if I had ever considered suicide myself given that iv’e had episodes of depression during my nursing career. My answer to her was no but it should have been both yes and no because I have explored the idea of suicide via my attempts at writing a longer work of fiction – in my case it would have been exploring the mindset and ultimate planning and method of a character who ultimately does take his own life.
Now, that was a kind of thought experiment and largely based on a one time conversation with a small group of work colleagues when the subject of medical suicide/euthanasia came up – I don’t remember how it came up except that it might have been the previous time it was debated in the house of Lords (Westminster).
I titled this post so as to include suicidal ideation by which I mean suicidal thoughts and actual plans to commit suicide. I don’t now remember where this important point came from but it might have been Dr Peterson or another psychologist of that level but anyway – thoughts of suicide are apparently regarded as serious when they get to the stage of when, where and how and each part has a viable working plan. In my attempts to write about a character thinking about suicide I felt that I had to create enough veracity in the character that we would find the eventual act inescapable and that’s why I had to spend a lot of reading and research time on the common methods most frequently used…..I hope this explains things somewhat.
Dirty Wet Dog, the great adventure. 