QUIET KILLER

Men are killing themselves way more than women in the US—and we still don’t know how to talk about it

This post has been corrected.

As predictable as the appearance of Santa Claus in the Macy’s Thanksgiving Day parade, the holiday season is a time of well-meaning warnings and hand-wringing about depression and suicides.

But while the stereotype of the lonely relative overcome by emotion during the “most wonderful time of year” has become fairly entrenched in pop culture, it’s also a myth, at least in America. According to the Center for Disease Control’s National Center for Health Statistics, suicides rate are the lowest in December and highest in the spring and fall. These presumably innocuous myths distract us from what is actually a very real and generally underreported problem.

To raise awareness about silent societal epidemics, the media often latches onto a few alarming statistics and hammers them into the public consciousness (think sexual assault coverage in 2014). This isn’t working for suicide. Unless you’re a high-profile celebrity or a tortured artist, there’s nothing very sexy or shareable about suicide. This is especially true for men, who are more likely than women to take their own lives (although women are more likely to have suicidal thoughts). And it’s still not very clear why.

Here are a few facts:

  • Suicide is one of the top 10 causes of death in the United States.
  • Suicides now outnumber deaths caused by automobile accidents.
  • After cancer and heart disease, suicide accounts for more years of life lost than any other cause of death.
  • The suicide rate among Americans between the ages of 45 and 64 years old has jumped 30% in the last decade.

But suicide is not an equal opportunity killer. The suicide rate is and has historically been about four times higher among men than among women. It is currently highest among middle-aged white men, particularly when unemployment and related socioeconomic factors are involved. Why is this?Theories abound.

Dr. Jill Harkavy-Friedman is a clinical psychologist and vice president of research for the American Foundation for Suicide Prevention. Harkavy-Friedman spoke to Quartz via email about the factors that contribute to suicide and why men in the US are currently more likely to take their own lives.

Suicide is “a complex behavior that results from many long-term and short-term contributors coming together in the context of stressful events and enabled by the availability of lethal means,” she explains. These long-term contributors can include chronic medical conditions, a history of mental health challenges, and genetics, among many other factors. Short-term contributors can include depressive episodes, intoxication, and other incidents and conditions.

Harkavy-Freidman adds that men are more likely to have difficulty with alcohol and schizophrenia than women and that men often wait until a mental health emergency to seek treatment. They are also more hesitant to reach out in a suicidal crisis. She says that while societal factors probably do not account for the full differential, “cultural mores contribute to whether or not people see help seeking as a strength or weakness.”

A deadly accuracy

When men do attempt suicide, they also tend to choose more deadly methods. In the US, men used firearms in 56% of suicide attempts, whereas women are more likely to use poison (37.4% of attempts). The trend is similar in the United Kingdom, where men most commonly use hanging, strangulation, or suffocation (58%), and women most commonly use poison (43%). It is not yet clear why men choose more deadly methods, but a “learned fearlessness” might be a factor.

Dr. Thomas Joiner, a professor of psychology at Florida State University, is a leading expert on suicide, specifically its psychological underpinnings. According to Joiner, a person must possess three preconditions before attempting suicide: a feeling of alienation, a sense of being a burden to others, and a sense of fearlessness. These preconditions challenge some of the most prevalent myths surrounding suicide–myths that Joiner is working hard to debunk.

One of the most prevalent, not to mention persistent, stereotypes of suicide is that it is a cowardly or selfish act. That type of thinking might make sense for someone observing the situation from the outside, but, according to Joiner, this stereotype is often off base. “Death is inherently fearsome and daunting,” he tells Quartz. “Therefore, it requires a kind of fearlessness… about physical pain, physical injury and death, in order to enact it.” In fact, suicidal people often view suicide as a selfless act, a backwards sort of altruism: “my death will be worth more to others than my life.”

 One of the most prevalent, not to mention persistent, stereotypes of suicide is that it is a cowardly or selfish act.  Joiner told Quartz over the phone that he is generally not persuaded by the theory that socialized masculinity has a significant role in the higher rate of completed suicide rates among men—with the exception of one factor. “The fearlessness precondition; for sure, that is the clearest. Men have more of that than women, on average,” said Joiner. He theorizes this is mostly due to biological underpinnings, but that men are also raised with more exposure to physical challenges, whether it be through contact sports, hunting, or working in manual labor.

Joiner’s other two factors (alienation and the feeling of being a burden) do not have clear gender divides, but he did note the importance of social connections, or lack thereof. “Men in early life take friendship and relationships for granted (women generally don’t),” he told Quartz. “Over time, they lose those friendships, contributing to loneliness and alienation when they are older.”

Both Joiner and Harkavy-Friedman agree that stigma surrounding mental health continues to contribute to the unacceptably high suicide rate in the United States. As many advocates have pointed out, it is perfectly normal in our society to check in on a friend’s physical illness (“How’s that cold? Are you feeling better?”), but still taboo to ask about mental health challenges. “How is your anxiety?” or “How is your depression?” needs to become just as acceptable.

Certain minority demographics suffer the most from cultural attitudes. Compared to straight youth, LGB youth are more than three times as likely to attempt suicide. Suicide is also the third leading cause of death among young black males ages 15-24—a shocking statistic that Ebony contributor Akiba Solomon attributes to an intense pressure among young black men to be “strong and silent.”

Meanwhile, a study from the Williams Institute at the University of California, Los Angeles also found that a staggering 46% of trans men and 42% of trans women have attempted suicide at some point in their lives, compared to less than 1% of the general population.

These statistics aren’t necessarily new—and so far, repeating them hasn’t been working. But tuning in when the narrative seems particularly compelling isn’t enough. Suicide is not going away—it’s time we began treating it as such.

We welcome your comments at ideas@qz.com.

Correction (Dec. 15): A previous version of this post included a headline that did not accurately report how often an American commits suicide. In fact, a suicide happens once every 13 minutes in the US, but that stat includes both men and women, not simply men.

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