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Mark Goulston M.D., F.A.P.A.

Male Suicide vs. Female Suicide

Women can't stand the pain, men can't stand the shame.

Women kill themselves when they can't stand the pain; men kill themselves when they can't stand the shame.

I am writing this in hope that it might help some people better understand what they might be feeling, to feel less out of control and to feel less alone.

After intervening with and treating suicidal people for nearly forty years, I have recognized one pattern that frequently distinguish women who are suicidal from men who are suicidal. It is not based on research or evidence based findings, so please take this as an experience based observation rather than a firm scientific conclusion.

For years a number of my female patients (suicidal and non-suicidal) have come in and told me they can't find their warmth. And when they don't feel it towards their children it can make them feel very abnormal and defective. One woman told me that a woman without warmth is not a woman. Warmth is very much mediated by oxytocin which is what helps women to bond to children and to their others.

Alternatively a number of my male patients have come in to tell me they feel cowardly. And one man told me that man without courage is not a man (no, he and the woman were not married). Courage is very much related to testosterone.

What's the connection between oxytocin and testosterone and suicide?

When I have worked with suicidal women, mostly what they felt was that they couldn't stand the pain. This pain was not infrequently connected to the loss of child or a marriage or relationship. The loss of a relationship possibly felt like a death blow to their oxytocin and consequently feeling like a woman or even a person.

Certainly in many of the above cases depression also compounded the pain they felt. However there is so much overlap between loss and depression that the once firmly held distinction between Mourning and Melancholia seems to have been largely lost with modern psychiatry in that both can demonstrate symptoms (crying, sadness, depressed mood, sleep and appetite disturbances, etc.) that often respond to anti-depressants.

When I have worked with suicidal men, shame has very frequently been a significant cause of what drove them to think of killing themselves. It may be that when men are running high on testosterone they feel powerful, in control and proud. In contradistinction when an event or events occur that cause a man to feel powerless, out of control and humiliated, if they don't have other things to buttress themselves, the shame that they feel can be overwhelming and with it they possibly experience a testosterone crash (not unlike the crash off adrenaline that superstar athletes feel that is intolerable to them).

In a separate but possibly related matter, it has been generally thought that unstable or untreated bipolar patients often commit suicide after coming off a high because they know that what lies ahead is plummeting into a dark hole that they do not think they can tolerate. They kill themselves just after the high, because they have the energy to do so which some think they won't have when they hit rock bottom.

Interestingly when women see the bottomless hole in front of them, it is filled with pure pain that they don't think they will be able to endure (think Sylvia Plath), whereas when men see the bottomless hole it is filled with humiliation, failure, weakness and shame (think Ernest Hemingway).

How are we to use such information to help people?

If the above speaks to you or someone you know reach out to others for help and/or read stories of people who lived with and through it. They will help you and them to feel less alone and see that you can make it through. There are many books, but two classics and very brave books that come to mind are An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison and Darkness Visible: A Memoir of Madness by William Styron.

And most of all keep in mind what Phil Donahue once said, i.e. that suicide is a permanent solution to a temporary problem.


About the Author

Mark Goulston, M.D., the author of the book Just Listen, is a Clinical Assistant Professor of Medicine at UCLA's Neuropsychiatric Institute.