Suicide – A Silent Epidemic

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In Montréal recently, there has been a great deal of talk about both suicide among male youths and, in the light of its new cinematic treatment^[1]The film Polytechnique, by Quebec filmmaker Denis Villeneuve, was released in 2009, twenty years after the tragic events. Read more on Wikipedia, the tragedy at the Ecole Polytechnique. The two events are not unrelated. Magazines regularly mention male violence towards women, and this aggressivity, often fatal, is also visited by men on themselves, as indicated by the current global epidemic of suicide among men in particular. In our part of the world, this situation is broadly interpreted as a reaction to female emancipation, incomplete and unequally distributed though the latter may be. Our point of view is quite different…

Clinical practice in psychiatric epidemiology shows clearly that men are today weakened by an environment over which they have lost control and which has altered their self-image. Faced with a threatening spatial reality that concerns us all, they seem to react more impulsively and more violently. It is this environmental dimension that we have chosen to emphasize as we investigate a strange masculine epidemic that appears as an effect not so much of the battle of the sexes as of the war of “the worlds”.

Eco-Psychiatry Of A Silent Epidemic

Looking at the Quebec suicide statistics reported by the media, one notices that 80% of the cases concerned involve men. Lying just above road accidents, suicide is the primary cause of death among male youths of 15 – 19 years old, and it very often involves a game of Russian Roulette. To this sinister list, one could also add violence by street-gangs, with its share of young victims.

As a psychiatrist dealing with the general public, particularly in emergency situations, I have noted with increasing frequency the critical importance of environmental factors in understanding and treating mental crisis and instability. Such factors are relevant to the present murderous epidemic of suicide, even if there is a widespread ideological tendency in the media to lay the problem at the door of female emancipation and the various negative effects it has had on men. Rather than attach significance to men’s role in the gender wars, eco-psychiatry emphasizes men’s particular sensitivity to spatial disorder as the main cause of this now-planetary epidemic.

A Territorial Epidemic

The W.H.O. has noted, not only in the West but also in China and Japan, the occurrence of three male suicides for every female one, with a peak occurring between 18 and 39 years of age. The murderous epidemic raging throughout our modern landscape is not equitably distributed geographically. In Quebec, if one excludes certain Amerindian “reserves”, where the risk of suicide can be as high as five times the average, the regions most affected are the outlying ones, struggling for their survival, such as Gaspesia and Abitibi.

The same territorial pattern is to be found in Scotland, where the University of Aberdeen’s “Centre for Rural Health” has defined the isolated rural areas as those primarily “at risk”^[2]C. Stark, P. Hopkins, D. Gibbs. « Population density and suicide in Scotland ». July 2007.. In Spain, studies show that, in Galicia, for the past 30 years, the rate of suicide amongst young adults has risen by 15% in the poorest regions^[3]C. Vidal-Rodeiro, M. Santiago-Pérez, J. Paz-Esquete, M. López-Vizcaíno, S. Cerdeira-Caramés, X. Hervada-Vidal, E. Vázquez-Fernández. « Space-time distribution of suicide in Galicia, Spain … Continue reading. As a matter of facts, a W.H.O. study indicates that the suicide rate among Estonians of Russian origin has increased by 39% since Estonian independence in 1991, when this previously stable and dominant population was brutally destabilized^[4]K. Kõlves, M. Sisask, L. Anion, A. Samm, A. Värnik. « Factors Predicting Suicide among Russians in Estonia in Comparison with Estonians: A Case-Control Study ». December 2006..

This rise in suicide rates in stagnant or deteriorating regions is also in evidence in urban regions. Thus a recent study by Statistics Canada reveals that adolescents in the poorer areas of Montréal are four times more likely to commit suicide than are those in the wealthy neighbourhoods.

An Urban Problem

The principal author of the Montréal study^[5]V. Dupéré, T. Leventhal, É. Lacourse. « Neighborhood poverty and suicidal thoughts and attempts in late adolescence ». October 2008., Mrs. Véronique Dupéré, notes that, independent of income or family influences, the neighbourhood itself has a harmful effect: “the poverty of the neighbourhood is a risk factor in itself”. A similar topographical distribution of suicides is found in all of the metropolises of our globalized world, where it is the impoverished ghettos, neighbourhoods and suburbs that are most at risk. “Suicide there appears as an easier option, when one is faced with a difficult event”, concludes Mrs. Dupéré.

The death impulse that reigns in certain fragile or damaged regions always and everywhere strikes the male populations. They are the most sensitive and most disturbed in an adverse environment that is becoming murderous. In downtown Montréal, among the itinerant youth faced with the rigours of life on the streets, the median rate of suicide is usually three times higher; and even five times in the case of those adolescents who, during childhood, were removed several times from their host family or structure and failed to develop a feeling of protective attachment.

That feeling can also be lost in the Montréal suburbs: after the closure of GM at Boisbriand, Seagram at Lasalle and Alcatel in the eastern suburbs of Montréal, there were suicides among employees and workers who had previously functioned normally and who suddenly found themselves in disarray when confronted with the local effects of a newly globalized economy over which they had no control.

While stress affects all humans, male and female, men are more sensitive to the contemporary territorial insecurity and they do not tolerate well their powerlessness in such a situation. Men have a specific relationship with space which grounds them, and loss of power and control over their environment gives rise to a feeling of impotence that haunts them and to which suicide can appear as a solution.

Of course, in psychiatry we are aware of the mental impact of such spatial disturbance. Thus the profession has reorganized its forms of intervention, bringing them closer to the general public, as in the case of emergency clinics, and insisted upon the role of stress in understanding and treating the problems caused by the patient’s environment.

A Gendered Geo-Mental Clinic

Confronted with a space that is both threatened and threatening, a man expresses his feelings of malaise, not so much in mood-centred symptoms (beyond, that is to say, a vague feeling of the “blues”) as in direct bodily manifestations, which can ultimately go as far as suicide.

The clinical practice in which I have worked for the last 30 years, particularly at the emergency stage, has confirmed what epidemiology has shown us statistically: in men, environmental destabilization provokes the physical equivalent of a seismic tremor, which manifests itself in fatigue, exhaustion, irritability or violence. It can various forms, ranging from professional burn-out to road-rage, and it can extend to committing criminal acts. In men, these physical and impulse-related symptoms often precede the psychic manifestations of their distress, such as sadness or psychological suffering.

This explains both men’s reluctance to seek professional help and the fact that psychiatry is less receptive towards their types of complaint. However, whether because the rope breaks or the gun jams, the men we receive in our clinics are broken and tearful. They suddenly become aware of a loss of control over their lives that has lasted for months without their truly being aware of its devastating effects – effects that could have, in the blink of an eye, proved fatal for them.

In the emergency clinic, we have encountered situations of this kind in their many manifestations, with an increasing number of men of all ages and in less dramatic conditions appearing before us. They are invariably involved in a veritable, unequal “head-to-head” confrontation with a personal environment that is degenerating and over which they seek to regain control.

On the front line, we encounter a vulnerable body expressing the existential malaise. Often in silence, it loses control. It tries to right itself by means of various addictions: alcohol, drugs, sex, gambling… Often associated with the transition to acts of violence, these attempts to hold on accelerate the loss of the subject. In unstable situations, in order to give vent to their difficulties and feelings of malaise, many men turn in various manners to the body as a form of expression. The suffering is not psychologically felt, and when it takes this mental form, it is not always immediately acknowledged.

Thus when we receive men in distress, brought in by friends or colleagues, we sometimes have to turn to mandatory hospitalization in order to protect them against themselves, against their violent impulses. In a state of weightlessness, they are unable to individualize sadness or desperation, which are the last signs of distress, indicating an emergent danger. This risk is even greater, given that the men’s self-esteem is very low: family break-up, unemployment, bankruptcy, etc. They find themselves individually weakened in a context in which the status of men is losing legitimacy, and the masculine image, our modern narcissism, is breaking down or changing.

The sperm banks and the reconstituted families, sometimes involving homosexual couples, all serve to make paternity appear more random, detached from direct procreation, whilst virility, weakened by changing social norms, is incapable of finding expression in today’s rapidly changing communities. The tragic number of male suicides is clearly linked to a hypersensitivity to the transformations and threats that weigh upon our environments, at a time when the status and image of men is changing or breaking down. In such a context, it becomes dangerous to lose control of one’s environment, and this explains, albeit without justifying them, the narcissistic deviations that can result in suicide, and also in violence, the primary victims of which are women.

The Dead-End Of The Gender Wars

The psycho-geographical clinic that is currently emerging allows us to place the supposed decline of men in an environmental context that, rather than emphasizing opposition between the sexes, involves and engages them in a different manner. If men are drastically affected by alterations in their environment, it is because the relationship they develop with space tends to involve mastery, confrontation and sometimes subordination. In short, it is a relationship of exteriority, whereas, in the case of women, it is one of interiority.

Eco-feminism sees the woman as having a closer relationship with nature, encouraged by the processes of gestation and child-bearing, the effect of which is to make the woman’s body a space in which all existence begins. Perhaps this intimate and organic proximity allows women to better prepared to cope with situations of environmental instability, in the course of which they regain the position they occupied in many indigenous societies, particularly the Amerindian ones.

Today, it is women who are largely involved in maintaining spatial harmony, and are increasingly involved in the frontline professions that confront our social malaise, those abandoned by men. For example, the majority of psychiatrists are now women.

No doubt, it would be necessary to probe further the female-male distinction, knowing that, regardless of our biological gender, each sex contains a portion of the other. This métissage should help us endure the storm that threatens humanity and allow us to resolve the economic, political and ecological challenges that face our rapidly globalizing planet.

Knowing that we are all in the same boat, so to speak, weathering the same storm, let us try to row the boat together in the same direction, rather than make the fatal mistake of attributing the current epidemic of suicide among men to the gender wars.

To conclude, faced with a threatening spatial situation of concern to us all, it is important that we adopt common objectives. We should all strive to provide living environments that are secure and comforting, and we psychiatrists must provide healing therapeutic spaces, in which disturbed young men may rediscover themselves and regain their composure, rather than disappear silently from life’s radar-screen.