The National Institute of Mental Health is responsible for researching the causes and prevention of suicide. The NIMH has also developed a web page that answers Frequently Asked Questions on this topic (1).

One question on the website addresses the key question: "Why Do Men Commit Suicide More Often Than Women Do?" This is the verbatim answer from the NIMH:

"More than four times as many men as women die by suicide; but women attempt suicide more often during their lives than do men, and women report higher rates of depression. Several explanations have been offered:

a) Completed suicide is associated with aggressive behavior that is more common in men, and which may in turn be related to some of the biological differences identified in suicidality.

b) Men and women use different suicide methods. Women in all countries are more likely to ingest poisons than men. In countries where the poisons are highly lethal and/or where treatment resources scarce, rescue is rare and hence female suicides outnumber males.

More research is needed on the social-cultural factors that may protect women from completing suicide, and how to encourage men to recognize and seek treatment for their distress, instead of resorting to suicide."

Unfortunately, this statement is misleading, one-sided, and based on a discredited psychological theory:

The NIMH Answer is Misleading

The NIMH response is misleading for two reasons:

A. "More than four times as many men as women die by suicide; but women attempt suicide more often during their lives than do men, and women report higher rates of depression."

Critique: Many believe that the medical criteria used to diagnose depression are slanted to pick up the type of symptoms that women often experience (2). Also, some have criticized mental health programs as not being adequately attuned to men's psychological needs. As a result, men are less likely to seek help when they do experience psychological distress, and male depression is widely under-diagnosed.

- First, highly lethal poisons are available in all countries of the world.

- Second, a listing of the areas with the very lowest female suicide rates include many of the poorest countries in the world with scarce treatment resources. These countries include Colombia, Panama, Paraguay, the Philippines, Puerto Rico, and Venezuela (3).

- Third, in countries where treatment resources are scarce, this would certainly increase male suicides, as well.

- Fourth, according to the World Health Organization (3), there is only one country in the world -- China -- where female suicides slightly outnumber male suicides. So refering to "countries" in the plural is misleading.

The NIMH Response is One-Sided

"More research is needed on the social-cultural factors that may protect women from completing suicide, and how to encourage men to recognize and seek treatment for their distress, instead of resorting to suicide."

Critique: While this statement may be true as far as it goes, the recommendation leaves out any mention of the need for research on the social-cultural factors that affect men. This omission is troubling because of the growing evidence that divorce and loss of child custody is associated with high rates of suicide in men (4).

The NIMH Response is Based on a Discredited Theory

"a) Completed suicide is associated with aggressive behavior that is more common in men, and which may in turn be related to some of the biological differences identified in suicidality."

Critique: The most widely-accepted theory to explain suicide is that suicide arises from chronic depression that is associated with problematic interactions with the person's total environment (5,6).

But the NIMH response is based on a very different concept: suicide represents aggression turned inwards. But the "aggression turned inwards" theory cannot begin to account for the wide differences in suicide found among various countries, age groups, races, and marital status groups. And if suicidal behavior is a result of aggression turned inwards, then why are women 2-3 times more likely to engage in suicide attempts than men?

Since persons are incapable of altering their genetic make-up, biological arguments also have the effect of justifying the social and political status quo (7). In this instance, the status quo is to ignore the problem of male suicide. Hence, the NIMH response is based on a discredited psychological theory that is fundamentally sexist in nature.

Action Response

Biological differences, lethal poisons, and the scarity of treatment resources have little or nothing to do with understanding why men are four times more likely to commit suicide.

Instead, the focus of the NIMH response should be on understanding the unrealistic burdens that society places on men, the unequal treatment by divorce courts, and the social isolation that men experience.

While only 7 sentences long, the NIMH response is so replete with misleading, one-sided, illogical, and discredited claims that it represents more fabrication than truth.

Every person who reads this message should immediately contact Clarissa Wittenberg, Director of the NIMH Office of Communications. Ask her to remove the flawed response, and use a factually-accurate answer instead. Her e-mail is wittenbc@mail.nih.gov

And be sure to send a copy of your e-mail to Thomas R. Insel, MD, Director of the NIMH. His e-mail address is ti4g@nih.gov.

-Carey Roberts

---

References

1. www.nimh.nih.gov/research/suicidefaq.cfm

2. Cochran SV et al. Men and Depression: Clinical and Empirical Perspectives. Academic Press, 2000.

3. Krug E: WHO Report on Violence and Health, Geneva: World Health Organization, 2002. Table 7.1.

4. Men's Health America: Dads Who Take Their Lives. December 3, 2002.

5. Henderson D and Batchelor IRC: Henderson and Gillespie's Textbook of Psychiatry. London: Oxford University Press, 1962.

6. Meerloo JAM. Suicide, menticide, and psychic homicide. AMA Archives of Neurology and Psychiatry 1959; 81: 360-362.

7. Men's Health America: Refuting the Myth of Biological Advantage. July 29, 2002.