Male suicide a growing concern in tough times

By Jeff O'Connell

updated 9:07 a.m. ET Dec. 4, 2008

John Kevin Hines had been pacing on the Golden Gate Bridge for 40 minutes in anguish, crying. If one person asks me what's wrong, I won't go through with this, he thought, over and over.

Eventually, a woman wearing giant sunglasses approached him. "Would you take my picture?" she asked. The 19-year-old accepted the camera from her and clicked it five times. Then he snapped. The moment Hines released his hold on the 4-foot-high railing, he regained his grip on reality.

During the 4 seconds between jump and splashdown, he could think clearly. All the problems that had made him want to die moments earlier? Those seemed less overwhelming than a 220-foot plunge into San Francisco Bay. Oh, my God, I don't want to die, he thought. What have I done? God, please, save me. It's a prayer seldom answered. Since the bridge opened in 1937, someone has jumped from it every 2 weeks on average. Out of roughly 2,000 attempts, only 28 "failed."

The psychologist Edwin S. Shneidman, Ph.D., a pioneer in suicide research, once said that it's a bad idea to kill yourself when you're feeling suicidal. That's no joke: You're not solving problems well. You're unable to step outside your troubled mind. And those things make you a very, very dangerous man. Realization of the risk comes too late for many, from bottom-rung stragglers to men whose lives and achievements seem worthy of celebration, not self-termination.

Their final act perplexes family and friends. It saddens them, sickens them, and even angers them. And in the end, it worries the rest of us, too. Because any of us could be walking that bridge one day. The numbers are so gut-churning, it's like looking over a bridge railing. Nearly 26,000 men took their own lives in 2005. That's nearly four times the number of women who did the same thing, even though three times more women than men attempt suicide. (For every completed suicide by a man or woman, 25 attempts fail.)

Whereas a woman might swallow pills halfheartedly, a man is four times more likely to complete the act, mostly because men tend to use guns — and their aim is true. As grim as that sounds, it gets worse. Mark S. Kaplan, Dr.P.H., who researches suicide at Oregon's Portland State University, believes the suicide death toll may be up to 25 percent higher than officially recorded. Many single-car accidents seem mysterious. When an overdose occurs and toxicology results are ambiguous, as in the case of Heath Ledger, was it a tragic accident or an exit strategy? Some medical examiners will certify a death as suicide only if the victim leaves a note, and yet only about 20 percent of people who kill themselves do so. Sometimes insurance companies pay the survivors less, or nothing at all, in cases of suicide. The denial of friends and family is a factor, too: It's less painful to think a loved one didn't die by his or her own hand.

The Centers for Disease Control and Prevention's National Violent Death Reporting System, which tracks the circumstances surrounding violent deaths (including suicides), might be able to sort all this out — if it were funded in more than 17 states.

'Uniquely dangerous moment'
There's always an internal detonator with suicide, but an external spark helps light the fuse. One factor that comes along every few generations is economic distress. During the Great Depression, when banks went bust and people's life savings vanished, suicide rates soared. Another instigator: large numbers of veterans returning from armed conflict, many of them with troubled (or injured) minds, lousy job prospects, and fractured families. Which begins to explain why suicidologists, who study the phenomenon, are feeling a little edgy themselves these days. "For those who serve in the military, the suicide risk may be even greater considering multiple deployments, possible brain trauma from concussive blasts, and combat-relatedpost-traumatic stress," says David A. Jobes, Ph.D., a professor of psychology at the Catholic University of America. "This may be a uniquely dangerous moment for young American men and suicide, given the recent economic upheaval."

As a cause of death, suicide is different from disease; the ripples from each event extend much further than a single splash in San Francisco Bay.

At the Boston Park Plaza Hotel & Towers, the 20th-anniversary "Healing After Suicide" conference is under way. The room is dark except for candlelit tables surrounded by survivors — an umbrella term for friends and family members of the deceased. (Currently, nearly 5 million people in the United States have had a suicide in their family.) I stroll among large bulletin boards covered with photographs of faces: smiling, serious, shy, handsome, nondescript, friendly, distant. This isn't a gallery of misfits; these are the kinds of expressions that fill all of our family albums.

Getting help SUICIDE HOTLINES 1-800-273-TALK (8255): The National Suicide Prevention Lifeline will connect you confidentially to a counselor at a suicide crisis center 24/7. (Veterans: Dial 1.) 211: This FCC dialing code provides links to mental health hotlines. 911: If someone is currently attempting to kill himself, call. WEB SITES suicidology.org The American Association of Suicidology (AAS) serves as a clearinghouse for suicide info. afsp.org The American Foundation for Suicide Prevention focuses on research and education. glendon.org Offers a variety of suicide-prevention resources. psychalive.org Provides self-help tools for those who may be feeling suicidal, or who know someone who's feeling that way.

In a side room at the conference, I see a haunting echo of the smiling victims pinned on the bulletin boards. The last row of academic posters ends with disturbing photographs of men and women striking suicidal poses. These aren't actual suicides; the images are from the International Affective Picture Set, designed to provoke responses in psychology experiments. The researcher, Donald H. Marks, Ph.D., M.D., is the hepatitis clinic director at Cooper Green Mercy Hospital in Birmingham, Alabama. Ten of Dr. Marks's hepatitis C patients became suicidal while they were taking an interferon drug. The drug's prescribing information warns that this could happen. So when Dr. Marks performed functional MRI scans on the brains of these suicidal patients while they looked at the creepy photos, they all showed "activation" in specific brain regions that might be associated with suicidal thoughts. Might there be a self-destruct button embedded in our CPU, one that could be identified and disarmed in at-risk individuals? Jobes, for one, thinks suicide will never be reduced to something so simple.

"After all, we know the brain chemistry of depression, but most depressed people don't take their own lives," he says.

On stage in the other room, a mother is recalling one of her five children, the brightest of her brood. He could have done anything in life, she says, but in high school, with no warning, he shot himself in the head. Suicide is murder for your loved ones. Much of her adult life has been an attempt to find meaning in a devastating loss.

Thomas Joiner, Ph.D, a professor of psychology at Florida State University, is also dealing with that kind of loss. I'd studied his research and prepared my questions on my way to Tallahassee to meet with him, but it's only when we sit down across from each other, alone in a huge, impersonal conference room, that it occurs to me: I need to ask this 43-year-old father of two sons about his own father's death — by suicide.

"I'm comfortable talking about it," says Joiner, who also lost his maternal grandfather to suicide. "It's important to discuss, as a way of learning more about an important public-health problem."

As a kid growing up in Atlanta, Joiner knew his father felt down once in a while. But he suspected nothing more. Even later on, when he studied suicide as a graduate student at the University of Texas at Austin, he didn't make the connection. The day his dad died, his mother called to say he'd disappeared. The police wouldn't find the body until 2 1/2 days later. The cause of death: a self-inflicted knife wound.

"My response was extreme shock," says Joiner. "Just a deep, agonizing sort of loss and sadness — what most people feel in such sudden-death scenarios."

The final page of his father's life would remain blank; there was no note. Only in hindsight does Joiner suspect that his father had a variation of bipolar disorder. The hidden nature of suicidal thoughts makes me wonder if perhaps a lot of men entertain these urges.

"I take your point," says Joiner. "There is this other layer: Why did it happen? How much anguish and pain must he have been enduring? That was there for me, and it remains there for me to this day."

The vague threat, the unvoiced desire for death, is not unusual in men who will eventually kill themselves. They may make an offhand crack or casual remark. "They'll hint that something's wrong and then take it back," says suicide expert Lisa Firestone, Ph.D., coauthor of "Conquer Your Critical Inner Voice." Even doctors don't know what to do half the time. Kaplan randomly chose primary-care doctors in Illinois from the files of the American Medical Association and sent them a survey, asking how they managed depression and suicidal tendencies in their patients. Roughly 50 percent of the doctors said they wouldn't ask those patients if they had access to a gun at home.

Mental health professionals often don't have all the training they need to help at-risk patients, either. As part of his master's degree program in psychology, Jason Spiegelman served an internship as a therapist at the San Fernando Valley Community Mental Health Center, in California. "Learning the theory and actually practicing it are two very different things," he says.

Sitting in a Baltimore restaurant, Spiegelman describes a Monday morning that began for him like any other — until he arrived at work. As he walked in, he says, the secretary glanced up. "One of your clients committed suicide over the weekend," she said, as if announcing the arrival of a FedEx package. A feeling of nausea flooded the young therapist's body as he climbed the stairwell to his boss's office. "I'll never forget it," he says. "The fear. The self-loathing. Am I going to lose my internship? And then, a second later: How can I be thinking of myself?"

Spiegelman instantly knew who was gone. Juan (not his real name), a Latino man in his 30s, had been in therapy for years. The man's case file spilled over with notes outlining years' worth of mental doodling about suicide — what the experts call ideation. For all of his formal education, Spiegelman hasn't taken a single class on suicide. That's the norm, not an exception.

"Most clinicians learn on the fly rather than in school or professional training programs," says Jobes. "It's the most common clinical emergency, and yet clinicians are not typically well trained to deal with it." Spiegelman had done everything he'd been trained to do with such clients, including taking a suicide assessment: He'd asked Juan a series of questions designed to gauge the immediacy of the threat. The more specific the suicidal thoughts are, the greater the chances they'll be acted upon, the theory goes." As often as we did the assessment, he never went beyond a vague fantasy of suicide," says Spiegelman, 35, who today works as an assistant professor of psychology at the Community College of Baltimore County, Maryland. Juan's father would later say his son's mood brightened in the days before he died. When Juan did commit suicide, he hanged himself — an approach he had never mentioned.

Spiegelman doesn't blame himself. His supervisor's review noted that he hadn't missed anything. Mostly, though, he credits Juan's father with keeping the tragic event from destroying the life of a second man. "He was as gracious as you could imagine," says Spiegelman. "He said it wasn't my fault, that his son spoke highly of me. The father took care of me, which was a nice thing, because it doesn't always go down that way."

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