Nov 282016
 

Loren A Olson MD  73-year-old semi-retired, gay psychiatrist. Author of “Finally Out”, http://www.lorenaolson.com

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Gay and bisexual men seek mental health care more frequently than heterosexual men but are more likely to have attempted and succeeded at suicide.

Suicide in the United States has surged to its highest level in nearly thirty years. Although this rise was particularly steep for women, it increased substantially for all middle-aged Americans, a group whose suicide rate has been stable or falling since the 1950s.

The majority of gay/bi men maintain good mental health, but compared to other men they are at greater risk for mental health problems. One group of researchers found that 12% of urban gay and bisexual men have attempted suicide, a rate three times higher than the overall rate for American men. Almost half reported multiple attempts.

One common theme underlies most successful suicides: a sense of hopelessness.

Some psychiatrists have described predicament suicide, circumstances from which a person cannot find an acceptable escape such as financial loss or forced marriages. A decision to come out in midlife might represent such a predicament; older men may feel they are sacrificing everything they once valued and feeling there is no one with whom they can speak about it.

Dr. Whitney Carlson, a Seattle based geriatric psychiatrist says, “Some individuals decide this is as far as they want the road to take them. Many of them are completely rationale and accurate in their assessment of their situations. If they are lucky, they will cross paths with someone who can offer hope. For some, this does not represent depression but perhaps, rational choice.”

Most research on suicide has been done on youth with an increasing emphasis in recent years on bullying, but very little research has explored gay, middle-aged men and suicide.

Several things account for mental health issues for older gay men:
• Homophobia, stigma and discrimination
• Social isolation
• Lack of trust in healthcare providers
• Lower income
• Alcoholism and illegal drug use
• HIV

One study found that the age of serious suicide attempts by gay/bi men coincided with major coming out milestones. At whatever age a person first begins to seriously question their sexual orientation, that conflict has been implicated in the lead up to the suicide attempt. When coming out milestones are reached at a later age, the first suicide attempt for gay/bi/questioning men occurred at an older age.

Most gay and bi men can cope successfully if they have access to the right resources. Therapists who are knowledgeable and affirming provide helpful therapeutic experiences, while counseling from therapists who focus on changing sexual orientation or encourage hiding it are unhelpful and sometimes damaging. People who seek counseling from religious advisors who considered homosexuality sinful have a higher risk of suicide risk than those who counsel with affirming religious groups.

A recent study found that strict conformity to masculine norms had implications for negative mental health outcomes, including depression, anxiety, substance abuse and poor body image. The three characteristics most closely associated with poor outcomes were self-reliance, power over women and sexual promiscuity. Boys are taught to be self-reliant by gender police who continuously remind them to take it like a man when they transgress from this norm. For gay men, this is often accompanied by a sense of shame: I am bad therefore I don’t deserve help.

A consistent correlation exists between race and socioeconomic factors. Those from a racial minority or living in poverty have poorer outcomes and higher risks of successful suicide.

Many of the challenges that lead gay/bi/questioning men to consider suicide are not immutable. As more and more people have come out in recent years, social attitudes toward homosexuality have changed albeit with significant backlash. One of the most necessary changes is to deconstruct the requirement for self-reliance and reconstruct a new sense of masculinity.

Coming out is not an event but a process. Not everyone has to come out to every person in every circumstance. Having a supportive group of family and friends is very important. When families are not accepting, developing a “family of choice” may be essential. The Internet has helped men isolated in rural areas or cultures with strong prohibitions against homosexuality, and it allows for an anonymous discussion of questions concerning sexuality.

Medications may be indicated particularly if there is significant insomnia or a failure to function in most areas of one’s life. Counseling may be helpful, but choose carefully. A good therapist will not impose their values on their counselees. Care-seekers are often intimidated by their perception of an imbalance of power in the counseling relationship, but you have a right to interview the therapist about their attitudes and training before making a commitment to therapy.

For those struggling with conflicts about sexual orientation, reach out to someone who can offer hope.

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