“Huh…what?” I have heard from many of you over the past few weeks with questions regarding my posts on men, male athletes, mental illness, and suicide. Your questions bear repeating and warrant replies.
Sometimes the data are difficult to believe, and sometimes they are difficult to describe. So, here’s some more detail.
1. “Wait a minute, I thought you said exercise was good for my mental health. So how come all these athletes have problems?” Yes, it is absolutely the case that exercise is good for managing not only our weight but also mood and anxiety. Mental illness among male athletes is not necessarily associated with exercise. In fact, it is likely that exercise has had many positive effects on their lives. Extreme athletic competition may increase risk for mental ill health in some way, but that would need further study. What we do know is that individuals with great public success, including world class athletes, may develop cardiac illness or cancer. Same is true for mental illness.
2. “But really, Eating Disorders, Anxiety, Depression. Aren’t these women’s problems?” It is true that women are more likely to develop certain anxiety, mood, and eating disorders. But some kinds of anxiety, mood, and eating disorders are just as likely to be problems for men as they are for women, while some are more likely to be problems for men than they are for women, and for those disorders that are more common for women, men are not immune. The biggest difference in mental health is that women are much more likely to seek help.
3. “What are the most common mental health problems for men?” Men are more likely than women to drink excessively, use illicit drugs, and die from opioid overdose than women in the United States. These gender differences are mostly consistent around the world, although overall rates of substance use problems vary significantly by region. Thus, the top five mental illnesses associated with illicit drug abuse or dependency are particularly common among men. They are intermittent explosive disorder, attention deficit hyperactivity disorder, bipolar disorder, any disruptive behavior disorder, and oppositional defiant disorder.
4. “Is the estimate of 15,120 suicides per week limited to the United States or a global statistic?” Last week I wrote about the high-profile suicides of Kate Spade and Anthony Bourdain in the context of the rising rates of suicide in many parts of the world, including the United States. The estimate of 15,120 suicides per week (or 2,160 per day) is a global estimate based on data provided by the World Health Organization. These data on suicide also tell a story about gender and mental health. Almost everywhere in the world, women attempt suicide more often than men, but men are much more likely to die by suicide.
5. “Honestly, I don’t know how Kate Spade and Anthony Bourdain could have done what they did. Isn’t suicide the most angry and selfish act?” That was the explanation offered by certain schools of psychiatry in days gone by. This is no longer how I understand suicide, nor the prevailing professional explanation. I have heard from too many people who I know and love about how close they have been to suicide and what took them there, and research on suicide has also evolved so this formulation no longer prevails. The reasons for suicide are as complex and diverse as the untold millions who have died this way. For those whose stories I know, three things stand out: 1) Almost always people who die by suicide die alone. 2) Suicidal ideation is associated with the experience of existential pain that will not cease and desist. Pain was meant to be an acute alarm signal to alert the body that something is wrong. But when the pain just won’t quit despite repeated attempts to shut it down, emotional, psychological, and physical reserves become exhausted. 3) This leads to the third factor: a loss of hope that the pain will ever end. Alone, in unrelenting pain, and without hope can feel like a slow painful death. Life becomes pitch black. In the words of Leonard Cohen, the key at this moment is knowing that “there is a crack in everything; that’s how the light gets in.” Finding that light from the abyss of darkness can be the difference between life and death. Take a moment to hear Leonard Cohen’s Anthem.
What do superstar male athletes, a women’s fashion icon, and a superstar chef and storyteller have in common? They are successful. They suffer. They know mental illness personally. They are like the rest of us. The impact of their suffering varies from full recovery to loss of life. My hope personally and professionally is to bring light to the topic so that we increase our understanding and improve our care of individuals with mental illness. You can assist by forwarding this post and inviting a friend to subscribe.