The Killer of Men

On the epidemic of male suicide

Photo by Vignesh Moorthy on Unsplash

Last year, late one night, my friend Erick¹ texted me that he was in the bathtub with his gun ready to kill himself. He had just gone through a horrible breakup and was facing financial ruin, a job he hated, deep loneliness, and a history of hardship.

I called him immediately.

"Talk me out of it," he whispered, "talk me out of killing myself."

"Ok, brother," I told him, swallowing the panic that was clutching my throat like an ape, "I love you. You're not alone, I know what this feels like, and I'm right here with you. Can you do me a favor? Can you unload your gun?" He paused, and then did so.

"Ok, I'm here with you,” I told him. “I'm right here. Can you put on the lock?"

He got out of the bathtub and did so.

"Ok, good, can you put your gun in the safe?"

He did so.

And then, I listened. He told me how unbearable his life had become. He told me that he couldn't face another day. He told me that he had lost everything and felt powerless and useless. Meanwhile, as I listened, I frantically texted everyone I could think of whom he trusted. Help was dispatched, we got him to safety, and checked him into a mental hospital.

Erick is still alive, but I know five men who are not. That is more than the men I know who have died of cancer, heart attack, or stroke. When I tally up the numbers and look at all the men I know who've passed away, suicide is the biggest killer of men in my life. And, like Erick, I could have been one of them. At many points in my life, I could have been number six.

Suicide is one of the highest risk factors for being a man in the developed world. It is the number one cause of premature death, and 80% of all suicides are men. This fact is rarely recognized, in part because it complicates narratives of privilege and power.

If any other demographic were suffering this deeply, untold millions of dollars would be funneled into state and private programs to help them. I have been a direct beneficiary of similar programs for LGBT mental and physical health. Because I have benefited from these programs, like The Trevor Project and programs for STD testing, I want men—ordinary, cisgender, straight men—to have services catered to their unique needs, too.

I’ve watched the gears in people’s heads grind to a halt when this and other facts about men’s health are brought up. These aren’t just queer men and men of color who are feeling so hopeless that they are dying of suicide. These are white cis straight guys, too: men who, by all accounts, are on top of the world. I suspect that, for many progressives, caring about the suffering of men feels like bailing out banks and billionaires who caused a financial crisis.

But a baby boy born into conditions he did not choose is not an accomplice in the conspiracies of his forefathers to oppress the helpless. That baby boy will suffer in ways unique to his sex as he grows up: he will be at greater risk of suicide, overdose, and homelessness. He, like many millions of other men, might retreat from the world to an online shadowland of gaming and addiction. He is less likely to have close friends and more likely to flounder in the job market and academia. This and more await that boy.

If any demographic is struggling, we are all struggling. Our lives are all bound up in the well-being of others. I was that young man who struggled: I failed all my classes, dropped out of high school, and barely made it through college. I spent my entire young life feeling inferior. I battled alone with addictions, suicide, social isolation, and bipolar disorder. I carry the direct consequences of struggling as a man, and I’ve seen the ripple effect through all my social interactions: I was less resilient, a dead weight to others, financially less dependent, and can now contribute less to the world. Those who love me — my parents, my sisters, my friends, my pastor — were kept awake at night by my failure to launch and troubled life. Now, multiply me by millions, and perhaps you will begin to understand why we should care about men’s health as a unique subject worthy of compassion.

I've thought a lot about Erick ever since that night and what went wrong in his life that led him to that bathtub. That night, I realized, was the destination of a long, silent journey through multiple crises that he had faced alone. The intervention of love, support, and care should have happened about a thousand crossroads earlier, when he lost his father as a teenager, when he faced financial ruin, when he lost his Christian faith, when he faced one romantic disappointment after another. Each checkpoint, like a lonely toll booth, was confronted without another person at his shoulder. But the support wasn’t there. Why not?

Every instance of pain is complicated, a warp and woof of social pressures and expectations, personal decisions and conditions, all woven together into a near-incomprehensible tapestry. I can't speak for the other men in my life who have struggled with suicide, but I know what had led me to those darkest moments, and I suspect they are universal: two poisonous words, a mental health system that fails men, and a lack of emotional intimacy. I'm not a clinician, or an expert, or a social scientist. I can only speak from my own experience as someone who has lived with the demon of suicide and walked with many men as they confronted it, too.

Two Poisonous Words

I’m willing to bet money that, through it all, Erick said the words that I said all through my teens and 20s when confronting any challenge, like a mantra of anti-life: "I'm fine."

I would say I was fine, and everyone around me foolishly believed me.

When I was facing debilitating depression in high school: "I'm fine."

When I started self-injuring: “I’m fine.”

When I dropped out of high school because I was failing all my classes and in enormous psychic pain: "I'm fine."

When I lived in the suffocating darkness of the closet: "I'm fine."

When I survived gay conversion therapy and then the disillusionment of realizing that I would be gay, always be gay, and not knowing what that meant in a religious world that heaped contempt on top of me: "I'm fine."

When I got lost in a dark underworld of sexual compulsion, and found myself at a threesome where I was a hair-breadth away from injecting heroin that could blast all the pain I was feeling into oblivion: “I’m fine.”

When I watched my friends get gored to death in a shooting: "I'm fine."

When I woke up screaming in the night from the PTSD nightmares that ravaged me for years: "I'm fine."

When the love of my life broke up with me: "I'm fine."

When I faced the highs and lows of bipolar: "I'm fine."

When I was scared, or lonely, or heartbroken, or stressed, or uncertain about the future: "I'm fine."

Sometimes, the only way to talk about my pain was to do so as a joke. “I threw myself out my window in my sleep,” I would tell my friends. I would laugh about it.

“Jesus fucking Christ dude, are you ok?”

“Yeah, I’m fine.”

"I'm fine" is the battle cry of the lonely warrior, an incantation of anti-life. These words carried me through some dark places, but they were also a lie. I wasn’t fine; I needed help. But I kept saying them, over and over, because I didn’t know any other words to say. One can tell a lie for only so long before it collides, brutally, with reality. For me, that collision took the form of self-injury, compulsion, and suicidal ideation.

Now, when a man tells me he's fine despite all the evidence I see to the contrary, I know the game we are playing."I'm fine" is code for, "I'm hurting, I'm scared, I'm lonely."

Now, when I notice a man is struggling and he tells me he’s fine, I don’t invite him to coffee to tell me what’s going on. Instead, I suggest that we go for a hike with zero pretense of talking about anything. Almost inevitably, with that shoulder-to-shoulder presence, he eventually opens up. Direct eye contact and face-to-face vulnerability often feels threatening and paralyzing, so instead, I offer him my shoulder to walk next to. In that companionable space, free from the pressure to say anything, or perform, or plumb the depths of his soul, he opens up little by little. The face-to-face conversations do eventually come. It just takes time.

I no longer say I’m fine when I’m not, and doing so has saved my life. I have a cohort of friends that I can practice doing this with — friends that I can send a voice message to at 4 AM, friends who will invite me to their apartments to talk or play games or be held, friends who I can text at any time of day or night.

It's tempting to place the blame for “I’m fine” on men themselves. Why don’t they just stop saying it? Why can’t they just get over their toxic masculinity and finally share their feelings? But this overlooks the vast structure of systems working against men. Sometimes, saying “I’m fine” felt like the only option in my life, and I'm grateful that it was there to aid me. Acknowledging my pain without the support to do so felt too dangerous, too uncertain. “I’m fine” was sometimes the best I could do.

The Failure of Therapy

A male therapist — let's call him Dr. M — probably saved my life. “I can’t do the talky bullshit” I told him when I first started working with him. “I can’t just talk about my feelings. That doesn't work for me. I need you to tell me what to do when I’m fucked up, and I’ll do it.”

I’d already done the talky bullshit with innumerable therapists — sitting there spinning my wheels with words and words and words. “You did good work today,” she’d say, but I didn’t feel that way. I felt like I’d just spilled my guts needlessly and that I was left raw and unprepared to deal with any of it. Too many therapists assumed that just talking about it was what I needed. But that isn't what I needed. Talking felt weird and uncomfortable, and often left me feeling worse. When it did work, therapy felt helpful, but nothing to write home about — nothing that I couldn’t have gotten out of a podcast or a book, and certainly not something that justified so much money every week.

I found Dr. M because my life was spiraling out of control. I was socially isolated, dealing with vicious levels of anxiety that made me dry heave over the toilet at work, struggling mightily with sexual compulsion, and experiencing terrifying levels of disordered thinking. I was certain, for no particular reason, that the FBI was after me and that my days were limited — the psychotic features part of my Bipolar II diagnosis were flaring up. I was fighting against powers bigger than me, scarier than me, and my back was against a wall. Suicide felt not only inevitable, but rational.

I told Dr. M about all this through tears, and then I told him, a therapist I was paying to talk to about my feelings, that I didn’t want to talk about it. He didn’t suggest I push past my resistance when I told him I didn’t want to open up about my feelings or my past. Instead, he nodded, and he delivered. He gave me a battery of mental exercises each week. He tested me regularly to see what was working and what wasn’t. He recognized my passions, like fitness and long-distance running, and taught me how to more effectively utilize them for mental health.

With his ministrations, I felt better. I gradually reconstituted into a man I could recognize. The talky bullshit did eventually happen, but I needed time to get there. When it did, I was finally able to talk to him about things that I had never felt comfortable sharing with a female professional. We talked frankly about sexual health, porn, my complexes about being a man, my desperate need for male friendships, and my raging fury at feeling unseen as a man. I told him about the aggression I felt and ways to manage it. We talked about how painful it was to ask for help, and how to overcome it. We talked through my complexes as a man who self-injures — a typically female form of destruction. He, a military man and trauma specialist, knew how to help me because he could communicate with me as a man.

Mental health is dominated by women, who make up 75% of the profession. This means that men often find themselves communicating about their feelings in ways that feel threatening or contrary to their needs, or hold back from sharing the full breadth of their suffering. In a culture where men struggle to have earnest, face-to-face conversations about their feelings, therapy puts them alone in a room with a woman where they are expected to do exactly that. In my experience, female therapists, while extraordinary and competent, often tend to assume that men process things the same way women process things — face to face, and that it feels good or helpful to do so.

"Men will do anything but go to therapy," goes the meme. Well, yes. Obviously. This is because therapy fails men. I don't want to talk to a female professional about sexual compulsion or violent thoughts, or masculine rage. I don't want to talk to her about my sex drive or compulsions. This is simply because men and women are different on average, with different needs and inner lives. Male pain is ugly and unique, and I don't want to talk to someone smaller than me who might feel threatened by my six-foot-one frame and expressions of masculine darkness. I needed to talk to someone who got it and wouldn't be nervous or afraid. I needed another man who could take the full weight of my masculine dysfunction and not have to put on a poker face to cover their alarm or revulsion. I can recognize a deliberate poker face from a mile away, and it signals that I’m not trusted, I’m not safe, this is too much.

Most of all, I didn’t just want to talk, I wanted to be told what to do, the same way a physical therapist or personal trainer tells me what to do. I'm not going to pay a gazillion dollars an hour to just talk about my feelings — I can do that for free with my friends. My experience of therapy is that male therapists are more willing to tell me what to do than women.

So, like many men, I opted for podcasts, self-help, and exercise, because it tangibly made me feel better in a way therapy didn’t, until Dr. M came along.

This isn't because female therapists are bad, incompetent, or can't help men. They do. But I often wonder how much doesn't get discussed when a man is talking to a female therapist. Will he feel free enough to tell her, without filters, about his raging porn use, sexual confusion, and erectile dysfunction? Probably not.

The net effect of this is a mental health system that doesn’t know how to communicate with men and fails to serve them. Is it any wonder, then, that men who are struggling fail to reach for mental health services? Of course not. The narrative I routinely hear about this is that this is men’s fault — that we sport a stiff upper lip, are mired in toxic masculinity, and believe that therapy is a sign of weakness. This is all probably true. But these conversations progress with the assumption that mental health is an infallible institution and that it is men who need to change to suit the institution. The opposite is true: men’s resistance to therapy is a system failure.

The Loss of Intimate Friendship

Around the same time I started seeing Dr. M, I woke up one morning and had a terrifying realization: I had almost no one local I could call. All my closest friendships were long-distance and maintained by text messages. Almost all my closest local friends had moved away. Those who were local wouldn’t respond to my desperate texts for a week, or not at all.

My long-distance friends provided unfailing support. They were a lifeline that kept me alive, and I’m eternally grateful to them, but this didn’t cut through the intense isolation I physically felt. When the pain and dysfunction reached their upper threshold, I didn’t need more words on a screen. I needed bodies, the way Job needed the physical presence of his friends to sit quietly with him in his suffering.

How did I let this happen? Social media provided me with an illusion of intimacy; our transient culture made connections tenuous; finding friends willing to invest the time and energy I wanted to put into them felt impossible; places to meet and hang out felt rare. This and more compounded my local isolation. Most of all, I assumed that the support and emotional intimacy I got from my partner were enough to sustain me. For years, he had carried my emotional weight. It never occurred to me that, eventually, his strength would fail, because no single person is strong enough to support me.

So, I assumed that I was fine without local friends, and I didn’t realize that I was neglecting a physical need as deep as food, water, and sunlight. I didn’t realize any of this until it was too late.

After that harrowing realization, I put all my effort into making new friends. I attended a men’s group. I got people’s numbers and told them I wanted to hang out with them. I initiated connections with people I met in third spaces. I became a big shaggy sheepdog at a dog park, unapologetically willing to play with other dogs.

And then, when another break came, I wasn’t alone. I was suicidal again, backed against a wall, and unraveling. Bipolar, my old enemy, decided to cause another earthquake. This pain was a psychic icepick lobotomy, and my whole world was fire.

A good friend — let’s call him Jacob — let me stay late at his apartment one night as I shook and couldn’t stop shaking. I battled the cold fire of stress, exhaustion, and anxiety in my body. I’d just switched bipolar meds, and it was wreaking havoc on my body. He sat next to me on the couch and kept his hand on my back as I tremored, offering his quiet presence, strong and supportive as a rock. He didn’t offer to fix it, or change it, or take any of it on himself. He just sat next to me, and that’s exactly what I needed.

The next day, I started crying and couldn’t stop — convulsive sobs that wracked my body. I don’t cry easily or often, but these tears were ripped out of me against my will. I was mentally and emotionally exhausted, and mental illness is no respecter of boundaries, needs, or limitations. I sent up a flare to my support network, asking if someone could spend time with me.

A friend — let’s call him Keith — called me and heard me out as I sobbed. “How can I support you right now?” He asked. I finally admitted what years of masculine programming had blocked me from ever saying: “All I want right now is to just be held,” I told him through tears.

“I’m getting in my car,” he told me. “I will be there in 45 minutes, and I will hold you.”

This heterosexual outdoorsman and surveyor cradled me as heaving sobs shook my body like an earthquake for an hour and a half. He pressed my head against his chest as I soaked his t-shirt with tears and snot. He held me like I was his wounded little brother. Never, in my entire adult life, had I ever been held like that outside of a sexual relationship.

“I don’t know how to thank you,” I told him, over and over again.

“Stephen,” he told me, “there’s nowhere else I’d rather be right now than with you.”

This tender support was made possible by friendship, vulnerability, and trust. It was a long story of reciprocity, mutuality, and care that led to this moment. Keith, Jacob, and I had done the work to build friendship, trust, and emotional intimacy. We had tested each other’s limits and judged each other sound. This process took time, work, and initiation. It also meant that, when I finally needed them, both were there to fully show up.

Most men don’t have these types of friends who can catch them. They have taken the modern romance pill and assume that sexual partnership is all they need. They have been isolated in a culture that shuts men behind masks, armor, and invulnerability, like unwilling superheroes. They are conditioned to assume that they are ok in their isolation. This alienation is like rust that slowly corrodes a building. First, it’s silent, unnoticeable. It seems fine. Then, years pass, and in the blink of an eye, the building collapses.

“The dynamic of friendship is almost always underestimated as a constant force in human life.” Writes poet David Whyte, “A diminishing circle of friends is the first terrible diagnostic of a life in deep trouble: of overwork, of too much emphasis on a professional identity, of forgetting who will be there when our armoured personalities run into the inevitable natural disasters and vulnerabilities found in even the most average existence.”

A man without good friends is a dangerous man, most of all to himself. Life is hard, and inevitably, we suffer. We get sick, we get depressed, we lose something or someone we love. These are catastrophic even in the best of times. Without connection — without friends — they are deadly.

A final word: maybe, as you read this, you are that man: isolated, enraged, frightened, and despairing. I won’t pretend to have words of wisdom for you, beloved suffering stranger, whose circumstances I don’t know and whose suffering is not my own.

In this article, I offer you the only thing I have, which is a written story. A meager offering, certainly, but it is a story of another man who has endured similar cold hells and is still alive—still here to love, and breathe, and dream. You can be that man, too, because we are not so different, you and I. You might not be gay, you might not have my mind or my needs or my history. But we are still alike, because we are both men who know despair. No, I don’t believe that your challenges are insurmountable, no matter how mighty. I’m still here, and you can be, too.

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But that’s just me. What do you think? Let me know in the comments section, and if your comment is excellent, I might feature it in an upcoming post.

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1. Erick is a composite character of several men I have known who came close to dying by suicide.