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What We Aren’t Talking About Is Killing Us

It was about 20 years ago, I was living on my own in Colorado. I was in my mid-twenties, footloose and on my own. Things were going great, until they weren’t. I’m not really sure what happened, because it creeps in on you, or at least it did on me. It wasn’t like one day I woke up and decided I couldn’t leave the house. But that’s where my depression took me, to the point that anything outside of my house seemed like an impossible task. I was convinced I was too ugly and too dumb to be out in public. That I shouldn’t subject anyone to have to look at me or have any sort of interaction with me. I did have to leave the house for work, which some days would make me sick to my stomach or some days leave me contemplating suicide. It was an all day process trying to convince myself that it would be okay to go, that I could somehow make it through a shift. It helped that I worked at an alzheimer’s home, the residents didn’t care what I looked like or how I acted. In fact, that was probably the best job I could’ve had given the circumstances. I also learned during that time, which was probably the better part of a year, that I could go to Subway and get a giant sandwich that I could use for a couple of meals. Although, I would always feel bad for the person at Subway who had to make a sandwich for me.

I remember the day the struggle opened my eyes. I was writing a check (yes, I’m THAT many years old!) and I had asked the cashier what the date was. She told me it was the 16th or something like that and I had to ask the follow-up question… what month is it? I had become so shut down and so shut in I had lost track of time. It was later that evening that I called in sick to work, shoved all the dirty clothes off of my floor into a suitcase and hit the road back to Tulsa, where I was from.

With the help of family and friends, I was able to get help, to find a doctor that understood the situation and the impact it was having on my life… that I wasn’t just “sad” or was having a bad day here and there. I will never forget that time in my life, and I think it’s important not to.  Today it serves me as a reminder to keep my mental health in check. I don’t want to get to the point again where I don’t know what month it is. 

We all know gay men love to talk about a lot of things. We talk about everything from fashion and music to brunches and each other. However there is one thing that we tend to keep our mouths closed about. The elephant in the room that we won’t discuss is depression. We don’t want to talk about the fact that gay men are vulnerable to depression and suicide at a rate that is three times higher than the general adult population. In a world where men are supposed to be strong, admitting to depression or having thoughts of suicide could be perceived as being weak. Maybe weak isn’t even the right word. Maybe because gay men like to pretend we have everything under control, that everything is perfect, depression doesn’t fit into that idyllic scenario we’ve created for ourselves. 

And coincidentally there is not a lot of research available on gay men and depression either. Healthcare providers and researchers have tended to focus on sexual health, specifically HIV. So basically we, as an entire group, have been distilled down to our sexual practices. Rarely has mental health and other determinants like race, where we live, our level of education or socioeconomic status, been taken into consideration with our physical health to create a more well-rounded picture of who we are. 

Like I said earlier (but it bears repeating so those in the back row hear it too!) gay men are three times more likely to experience depression compared to the general adult population. (1) And here’s where it gets scary, follow along with me. Depression is a risk factor for suicide and suicide is a leading cause of death for men. Leading cause of death! That being said it stands to reason that gay men are more likely to kill themselves than their straight counterparts. Depression and thoughts of suicide usually also increase the risk of gay men abusing drugs and alcohol as well as participating in high-risk sex.  (classic self-medicating right?) 

There isn’t one thing in particular causing gay men to be depressed, usually it’s a combination of several things including prejudices, fear of rejection and discrimination, trying to hide one’s sexuality as well as internalized homophobia. Honestly it can be hard living in a world where we are continually bombarded with negative messages about the way we live and who we love. Usually our depression started to grow roots in our adolescent years due to things like being picked on or bullied in school, fear of losing friends or even the very real fear of being disowned by family. 

Another big contributing factor that can increase the likelihood of depression in gay men is whether or not we are accepted or rejected by the gay community as a whole. Ironically for a socially marginalized group, gay men can very often be less than accpeting of others. Within the gay community men often face rejection from others for any number of things including being an ethnic minority, HIV status, weight, whether or not you’re considered “masculine” or “feminine” and the list goes on. We’ve become very good at creating boxes to put each other in. We are “bears” or “otters” or “twinks”, etc. But what we unfortunately have not become very good at is accepting others who don’t necessarily fit into a preset, stereotypical box. Between the possibility of being rejected by family and not being accepted in the gay community can lead to very real feelings of isolation, abandonment and the increased likelihood of depression. 

Suicide and suicde attempts occur more often in gay men than in straight men. In recent years more Canadian-based gay men died from suicde than from HIV. (2) A study of 762 gay men in Switzerland identified three main reasons for suicide attemts. They were; problems with their relationship, accepting their own homosexuality and family rejection. Lack of support from family is actually a very strong predictor of suicidality. Gay men who have been rejected by their parents because of their sexuality have a heightened risk for suicide attempts. (3

Researchers have been getting better at beginning to study the diverse, complex identities beyond sexual orientation and include multiple other social influences in gaining insight to gay men’s suicide. A population study of 8,000 gay, Canadian-based men highlighted education, income levels, and ethnicity as factors implicated in respondents depression and suicidality. (4)  The risk for a suicide attempt was five times higher among men with income under $30,000 and no university education. Suicide was also reported to be higher among minorities than Caucasian men. All this just proves that there is value in studying, as well as addressing, many different social factors on the health disparities experienced by gay men. Just because we might all be gay men, doesn’t mean the rest of our lives are identical. 

Because men are men… both gay and straight men have a hard time asking for help with their mental health. In face, less than a quarter of gay men who attempted suicide actually sought some help. (5) Too many times the reason gay men won’t seek help can be attributed to inadequacies of health care services and a failure to meet our specific needs. All too often we feel invisible and ignored when it comes to medical services. It’s also not uncommon for gay men who do seek help to also experience discrimination in the healthcare sysytem. And when you don’t feel safe with your healthcare provider, there will be a breakdown in honest communication. Sexuality, depression, etc are very heavy topics to talk about with someone you really trust… How are we expected to have these kinds of conversations with someone who is insensitive or worse?

There is good news though for gay men experiencing depression. There are effective treatments available. Antidepressant medication, lifestyle changes which can include exercise, diet, counseling and even our sleeping habits can help us cope with depression. 

I know a lot of people say that life is too short to be unhappy… My grandfather actually had a slightly different take on that, he always used to tell me that “life is too LONG to be unhappy.” Either way you look at it life shouldn’t be spent in a constant state of depression, or worse, end in suicide. We need to stop hiding and start talking about how depression and suicde disproportionately affects gay men. We can still continue to talk about fashion and music and brunches… but when it comes to talking about each other we need to start doing that in a more inclusive and meaningful way. 

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