Why do male suicides outnumber female in every country in the world?

Will Storr 

What is it about being male that leads to this? Why are middle-aged men most at risk? And why is it getting worse?

Finally, Drummond had everything he’d ever dreamed of. He’d come a long way since he was a little boy, upset at his failure to get into the grammar school. That had been a great disappointment to his mother, and to his father, who was an engineer at a pharmaceutical company. His dad had never showed much interest in him as a child. He didn’t play with him and when he was naughty, he’d put him over the back of a chair and wallop him. That’s just the way men were in those days. Your father was feared and respected. Dads were dads.

It was difficult, seeing the grammar boys pass by the house in their smart caps, every morning. Drummond had always dreamed of becoming a headteacher in a little school in a perfect village when he grew up, but he was only able to get a place at the technical school learning woodwork and bricklaying. The careers tutor almost laughed when he told him of his dreams to teach. But Drummond was ambitious. He earned a place at college, became president of its student union. He found a teaching job, married his childhood sweetheart, and slowly climbed his way to a headship in a Norfolk village. He had three children and two cars. His mother, at least, was proud.

And he was sitting alone in a small room, thinking about killing himself.

Many vulnerabilities

Impulsivity, brooding rumination, low serotonin, poor social problem-solving abilities – there are many vulnerabilities that can heighten the risk of suicide. Professor Rory O’Connor, President of the International Academy of Suicide Research, has been studying the psychological processes behind self-inflicted death for over 20 years.

“Did you see the news?” he asks when I meet him. The morning’s papers are carrying the latest numbers: 6,233 suicides were registered in the UK in 2013. While the female suicide rate has remained roughly constant since 2007, that for men is at its highest since 2001. Nearly eight in ten of all suicides are male – a figure that has been rising for over three decades. In 2013, if you were a man between the ages of 20 and 49 who’d died, the most likely cause was not assault nor car crash nor drug abuse nor heart attack, but a decision that you didn’t wish to live any more.

In every country in the world, male suicides outnumber female. The mystery is why? What is it about being male that leads to this? Why, at least in the UK, are middle-aged men most at risk? And why is it getting worse?

Those who study suicide, or work for mental health charities, are keen to press upon the curious that there’s rarely, if ever, a single factor that leads to any self-inflicted death and that mental illness, most commonly depression, usually precedes such an event. “But the really important point is, most people with depression don’t kill themselves,” O’Connor tells me. “Less than 5 per cent do. So mental illness is not an explanation. For me, the decision to kill yourself is a psychological phenomenon. What we’re trying to do in the lab here is understand the psychology of the suicidal mind.”

We’re sitting in O’Connor’s office on the grounds of Gartnavel Royal Hospital. Through the window, the University of Glasgow’s spire rises into a dreich sky. Paintings by his two children are stuck to a corkboard – an orange monster, a red telephone. Hiding in the cupboard, a grim book collection: Comprehending Suicide; By Their Own Young Hands; Kay Redfield Jamison’s classic memoir of madness, An Unquiet Mind.

O’Connor’s Suicidal Behaviour Research Lab works with survivors in hospitals, assessing them within 24 hours of an attempt and tracking how they fare afterwards. It also carries out experimental studies, testing hypotheses on matters such as pain tolerance in suicidal people and changes in cognition following brief induced periods of stress.

After years of study, O’Connor found something about suicidal minds that surprised him. It’s called social perfectionism. And it might help us understand why men kill themselves in such numbers.

The perfect husband

At 22, Drummond married his brown-eyed girlfriend Livvy. Eighteen months later he became a father. Before long there were two boys and a girl. Money was tight, of course, but he was true to his responsibilities. He taught during the day and worked behind the bar in a pub at night. On Fridays he’d do the night shift in a bowling alley, 6pm until 6am. He’d sleep in the day and go back to do the overnight again on Saturday. Then a lunchtime shift in a pub on Sunday, a bit of rest, and back to school Monday morning. He didn’t see much of his children, but the thing that mattered most to him was keeping his family comfortable.

As well as the work, Drummond was studying, determined to earn the extra qualifications to become a headteacher. More ambition, more progress. He got new jobs at bigger schools. He was leading his family to better places. He felt like a successful leader. The perfect husband.

But he wasn’t.

Social perfectionists

If you’re a social perfectionist, you tend to identify closely with the roles and responsibilities you believe you have in life. “It’s not about what you expect of yourself,” O’Connor explains. “It’s what you think other people expect. You’ve let others down because you’ve failed to be a good father or a good brother – whatever it is.”

Because it’s a judgement on other people’s imagined judgements of you, it can be especially toxic. “It’s nothing to do with what those people actually think of you,” he says. “It’s what you think they expect. The reason it’s so problematic is that it’s outside your control.”

O’Connor first came across social perfectionism in studies of American university students. “I thought it wouldn’t be applicable in a UK context and that it certainly wouldn’t be applicable to people from really difficult backgrounds. Well, it is. It’s a remarkably robust effect. We’ve looked at it in the context of the most disadvantaged areas of Glasgow.” It began in 2003 with an initial study that looked at 22 people who had recently attempted suicide, as well as a control group, and assessed them using a 15-question quiz that measures agreement with statements such as “Success means that I must work even harder to please others” and “People expect nothing less than perfection from me”. “We’ve found this relationship between social perfectionism and suicidality in all populations where we’ve done the work,” says O’Connor, “including among the disadvantaged and the affluent.”

What’s not yet known is why. “Our hypothesis is that people who are social perfectionist are much more sensitive to signals of failure in the environment,” he says.

I ask if this is about perceived failure to fulfil roles, and what roles men feel they should fill? Father? Bread-winner?

“Now there’s this change in society,” O’Connor replies, “you have to be Mr Metrosexual too. There are all these greater expectations – more opportunities for men to feel like failures.”

Perceived expectations

The power of the perceived expectations of others, and the sense of cataclysm when you believe you’ve failed them, emerges in an accelerated form in Asia, where suicide rates can be devastatingly high. Worst-affected in the region is South Korea, which has, by some counts, the second-highest suicide rate in the world. Around 40 South Koreans take their own lives every day, according to 2011 reports. A 2014 poll by the government-linked Korea Health Promotion Foundation found that just over half of all teenagers had had suicidal thoughts within the previous year.

Professor Uichol Kim, a social psychologist at South Korea’s Inha University, believes much of this can be explained by the great miseries that have been unleashed by the country’s rapid move from rural poverty to rich city life. Sixty years ago, it was one of the poorest countries in the world, he says, comparing its postwar situation to Haiti following the 2010 earthquake. From a majority living in agricultural communities in the past, today 90 per cent of people live in urban areas.

That change has blasted the foundations of a culture that, for 2,500 years, has been profoundly influenced by Confucianism, a value system that made sense of subsistence life in small, often isolated farming communities. “The focus was on cooperation and working together,” Kim explains. “Generally, it was a caring, sharing and giving culture. But in an urban city, it’s very competitive and achievement-focused.” For a great many, what it means to be a successful self has transformed. “You’re defined by your status, power and wealth, which was not part of traditional culture.” Why did it change in this way? “A Confucian scholar living on a farm in a rural village might be very wise, but he’s poor,” Kim says. “We wanted to get rich.” The result, he argues, has been a kind of amputation of meaning for the people. “It’s a culture without roots.”

It’s also a culture whose pathways to success can be demanding – South Korea has the longest working hours in the OECD group of rich nations – and rigidly codified. If you fail as a teenager you could easily feel you’ve failed for life. “The most respected company in South Korea is Samsung,” says Kim. He told me that 80–90 per cent of their intake comes from just three universities. “Unless you enter one of the three, you cannot get a job in one of the major corporations.” (I couldn’t confirm these statistics through English-language sources, but according to the Korea Joongang Daily there have been allegations of bias toward particular universities.)

It’s more than just job prospects that the young of the nation are working towards. “If you’re a good student, you’re respected by your teachers, parents and your friends. You’re very popular. Everybody wants to date you.” The pressure to achieve this level of perfection, social and otherwise, can be immense. “Self-esteem, social esteem, social status, everything is combined into one,” he says. “But what if you fail?”

Spousal trouble

As well as all the part-time work he did for money, and the studying for his career, Drummond took on volunteering positions, which stole even more time from his children and his wife. Livvy would complain that he was working too much. She said she felt neglected. “You’re more interested in your career than you are in me,” she’d say. The constant upheaval of moving from place to place with every new school didn’t help.

He was volunteering at a hospital in King’s Lynn when he found out about the first affair. A woman handed him a bundle of papers. “These are the letters your wife’s been writing to my husband,” she said. They were highly sexual. But what made it worse was the extent to which Livvy had apparently become besotted with the man.

Drummond went home to confront his wife. Livvy couldn’t deny it. It was all there in her own handwriting. He found out there’d been all sorts of scenes in her lover’s street. She’d been driving up and down, outside his house, trying to see him. But Drummond couldn’t leave her. The children were young, and she promised it would never happen again. He decided to forgive her.

Drummond used to go away for weekend training courses. One day, he came back to find Livvy’s car had had a puncture and the village policeman had changed the wheel. That, he thought, was extremely generous of him. Some time later, his 11-year-old daughter came to him in tears. She’d caught her mum in bed with the policeman.

Livvy’s next lover was a salesman for a medical firm. She actually left that time, only to return a fortnight later. Drummond dealt with it all in the only way he knew – hold it in. He was never one for breaking down in tears and rolling around on the floor. He didn’t have any close male friends he could talk to, and even if he had, he probably wouldn’t have said anything. It’s not the sort of thing you want to admit to people, that your wife’s screwing around. Then Livvy announced she wanted a separation.

When they finally divorced, Livvy got the house, the children, the lot. Once the maintenance was paid, there wasn’t much left for Drummond. No one at the school knew anything. To them, he was still the impressive man he’d spent years trying to become: the successful headteacher, married with three blossoming children. But then, of course, it got out. A midday supervisor said to him, “I hear your wife has moved?”

By then he was living in a freezing rented room on a farm ten miles outside of King’s Lynn. As a man, he felt diminished. He was broke. He felt like a failure, the cuckolded man, not the person everyone expected him to be. The doctor prescribed him some pills. He remembers sitting in that place on the fens, and realising that the easiest way out would be to take the whole perishing lot and be done with it.

Failed personal projects

If you’re a social perfectionist, you’ll have unusually high expectations of yourself. Your self-esteem will be dangerously dependent on maintaining a sometimes impossible level of success. When you’re defeated, you’ll collapse.

But social perfectionists aren’t unique in identifying closely with their goals, roles and aspirations. Psychology professor Brian Little, of the University of Cambridge, is well known for his research on ‘personal projects’. He believes we can identify so closely with them that they become part of our very sense of self. “You are your personal projects,” he used to tell his Harvard class.

According to Little, there are different kinds of projects, which carry different loads of value. Walking the dog is a personal project but so is becoming a headteacher in a lovely village, and so is being a successful father and husband. Surprisingly, how meaningful our projects are is thought to contribute to our wellbeing only slightly. What makes the crucial difference to how happy they make us is whether or not they’re accomplishable.

But what happens when our personal projects begin to fall apart? How do we cope? And is there a gender difference that might give a clue to why so many men kill themselves?

There is. It’s generally assumed that men, to their detriment, often find it hard to talk about their emotional difficulties. This has also been found to be true when it comes to discussing their faltering projects. “Women benefit from making visible their projects and their challenges in pursuing them,” Little writes, in his book Me, Myself and Us, “whereas men benefit from keeping that to themselves.”

In a study of people in senior management positions, Little uncovered another salient gender difference. “A clear differentiator is that, for men, the most important thing is to not confront impedance,” he tells me. “They’re primarily motivated to charge ahead. It’s a clear-the-decks kind of mentality. The women are more concerned about an organisational climate in which they’re connected with others. You can extrapolate that, I think, to areas of life beyond the office. I don’t want to perpetrate stereotypes but the data here seem pretty clear.”

Additional support for this comes from a highly influential 2000 paper, by a team lead by Professor Shelley Taylor at UCLA, that looked at bio-behavioural responses to stress. They found that while men tend to exhibit the well-known ‘fight or flight’ response, women are more likely to use ‘tend and befriend’. “Although women might think about suicide very seriously,” says Little, “because of their social connectedness, they may also think, ‘My God, what will my kids do? What will my mum think?’ So there’s forbearance from completing the act.” As for the men, death could be seen as the ultimate form of ‘flight’.

But that deadly form of flight takes determination. Dr Thomas Joiner, of Florida State University, has studied differences between people who think about suicide and those who actually act on their desire for death. “You can’t act unless you also develop a fearlessness of death,” he says. “And that’s the part I think is relevant to gender differences.” Joiner describes his large collection of security footage and police videos showing people who “desperately want to kill themselves and then, at the last minute, they flinch because it’s so scary. The flinch ends up saving their lives.” So is the idea men are less likely to flinch? “Exactly.”

But it’s also true, in most Western countries, that more women attempt suicide than men. One reason a higher number of males actually die is their choice of method. While men tend towards hanging or guns, women more often reach for pills. Martin Seager, a clinical psychologist and consultant to the Samaritans, believes this fact demonstrates that men have greater suicidal intent. “The method reflects the psychology,” he says. Daniel Freeman, of the University of Oxford’s department of psychiatry, has pointed to a study of 4,415 patients who had been at hospital following an episode of self-harm; it found significantly higher suicidal intent in the men than the women. But the hypothesis remains largely uninvestigated. “I don’t think it’s been shown definitively at all,” he says. “But then it would be incredibly difficult to show.”

For O’Connor, too, the intent question remains open. “I’m unaware of any decent studies that have looked at it because it’s really difficult to do,” he says. But Seager is convinced. “For men, I think of suicide as an execution,” he says. “A man is removing himself from the world. It’s a sense of enormous failure and shame. The masculine gender feels they’re responsible for providing and protecting others and for being successful. When a woman becomes unemployed, it’s painful, but she doesn’t feel like she’s lost her sense of identity or femininity. When a man loses his work he feels he’s not a man.”

It’s a notion echoed by the celebrated psychologist Professor Roy Baumeister, whose theory of suicide as ‘escape from the self’ has been an important influence on O’Connor. “A man who can’t provide for the family is somehow not a man any more,” says Baumeister. “A woman is a woman no matter what, but manhood can be lost.”

Shame and disgrace

In China, it’s not uncommon for corrupt officials to kill themselves – partly so their family can keep the dishonestly acquired bounty, but also to avoid prison and disgrace. In South Korea, former President Roh Moo-hyun did so in 2009 after being accused of taking bribes. Uichol Kim says that, as Roh saw it, “He committed suicide to save his wife and son. [He thought] the only way he could stop the investigation was to kill himself.”

Kim stresses that shame isn’t actually a major factor in suicides in South Korea. This can differ in other countries, though. Chikako Ozawa-de Silva, an anthropologist at Atlanta’s Emory College, tells me that in Japan, “The whole idea is that by one individual taking his or her life, so the honour is restored or the family member would be spared the shame.”

“Other people’s evaluation adds an additional burden,” says Kim. A person’s shame could leak and stain those around them. Under past Confucian law, three generations of a criminal’s family would be executed.

In Japanese and Korean the word for ‘human being’ translates as ‘human between’. The sense of self is looser in Asia than in the West, and more absorbent. It expands to include the various groups an individual is a member of. This brings a profound sense of responsibility for others that stirs deeply in those who feel suicidal.

In Japan, self-concept is so intensely enmeshed with roles that, according to Ozawa-de Silva, it’s common for people to introduce themselves with their job titles before their names. “Instead of saying, ‘Hi, I’m David,’ in Japan you say, ‘Hello, I’m Sony’s David,’” she says. “Even when you meet people at very informal parties.” In times of failure, the Japanese impulse to take professional roles this personally can be particularly deadly. “Suicide has been morally valorised for years or maybe centuries. It probably goes back to the Samurai.” Because people tend to view their company as their family, “a CEO could say, ‘I’ll take responsibility for the company,’ and take his life. That would probably be reported by the media as being a very honourable act,” says Ozawa-de Silva. In Japan – estimated to have the ninth-highest suicide rate in the world – in 2007 around two-thirds of all self-inflicted deaths were male. “In a patriarchal society of course it’s the father who takes responsibility.”

Masculine gold standard

From having one of the highest rates of suicide in the world in 1990, China now has among the lowest. Last year, a team led by Paul Yip, at the Centre for Suicide Research and Prevention at the University of Hong Kong, found that the suicide rate had dropped from 23.2 per 100,000 people in the late 1990s to 9.8 per 100,000 in 2009–11. This astonishing 58 per cent drop comes at a time of great movements from the countryside to the city, of just the same kind that South Korea saw in the recent past. And yet, apparently, with the opposite effect. How can this be so?

Kim believes China is experiencing a “lull” caused by a tide of hope as thousands charge towards new lives. “The suicides will definitely increase,” he says, noting that South Korea saw similar drops in the 1970s and 1980s, when its economy was rapidly expanding. “People believe when you’re richer you’ll be happier. When you focus on the goal you don’t commit suicide. But what happens when you get there and it’s not what you expect?”

Indeed, hope in hopeless places can sometimes be hazardous, as Rory O’Connor discovered back in Glasgow. “We asked the question: are positive future thoughts always good for you? Our hunch was yes.” But when his team looked at “intra-personal future thoughts”, which are those that focus solely on the self – such as “I want to be happy” or “I want to be well” – they had another surprise. O’Connor assessed 388 people in hospital who’d tried to kill themselves, then tracked them over the next 15 months to see whether they tried again. “In previous studies, people who reported high levels of intra-personal future thoughts reported lower suicidal ideation,” he says. “We found the best predictors for repeat attempts were past behaviour – not rocket science – but the other one is this intra-personal future thinking. And it’s not in the direction we thought.” It turned out that people who had more of these self-focused hopeful thoughts were much more likely to try to kill themselves again. “These thoughts might be good for you in a crisis,” he says. “But what happens over time when you realise, ‘I’m never going to achieve those goals’?”

What Asia and the West have in common is a relationship between gender roles and suicide. But in the West, beliefs about masculinity are far more progressive – aren’t they?

In 2014, clinical psychologist Martin Seager and his team decided to test the cultural understanding of what it means to be a man or woman, by asking a set of carefully designed questions of women and men recruited via selected UK- and US-based websites. What they found suggests that, for all the progress we’ve made, both genders’ expectations of what it means to be a man are stuck in the 1950s. “The first rule is that you must be a fighter and a winner,” Seager explains. “The second is you must be a provider and a protector; the third is you must retain mastery and control at all times. If you break any of those rules you’re not a man.” Needless to say, as well as all this, ‘real men’ are not supposed to show vulnerability. “A man who’s needing help is seen as a figure of fun,” he says. The conclusions of his study echo, to a remarkable degree, what O’Connor and his colleagues wrote in a 2012 Samaritans report on male suicide: “Men compare themselves against a masculine ‘gold standard’ which prizes power, control and invincibility. When men believe they are not meeting this standard, they feel a sense of shame and defeat.”

Men are crap?

In the UK and other Western societies, it sometimes feels as if we collectively decided, at some point around the mid-1980s, that men are awful. One result of the battle for equal rights and sexual safety for women has been a decades-long focus on men as privileged, violent abusers. Modern iterations of the male, drawn in response to these criticisms, are creatures to mock: the vain metrosexual; the crap husband who can’t work the dishwasher. We understand, as a gender, that we’re no longer permitted the expectation of being in control, of leading, of fighting, of coping with it all in dignified silence, of pursuing our goals with such single-mindedness we have no time for friends or family. These have become aspirations to be ashamed of, and for good reason. But what do we do now? Despite society’s advances, how it feels to be a success hasn’t much changed. Nor how it feels to fail. How are we to unpick the urges of our own biology; of cultural rules, reinforced by both genders, that go back to the Pleistocene?

As we talk, I confide in O’Connor about the time, perhaps a decade ago, that I asked my doctor for antidepressants because I’d become worried about myself, only to be sent away with the instruction to “Go to the pub and enjoy yourself a bit more.”

“Jesus!” he says, rubbing his eyes in disbelief. “And that was only ten years ago?”

“I do sometimes think I should be on medication,” I say. “But, and this is awful to admit, I worry about what my wife would think.”

“Have you discussed it with her?” he asks.

For a moment, I’m so embarrassed, I can’t reply.

“No,” I say. “And I think of myself as someone who’s very comfortable talking about this stuff. It’s only as we’ve been talking that I’ve realised. It’s just typical crap man.”

“But you see it’s not crap man,” he says. “This is the whole problem! The narrative’s become ‘men are crap’, right? But that’s bullshit. There’s no way we can change men. We can tweak men, don’t get me wrong, but society has to say, ‘How do we put in services that men will go to? What would be helpful to men when they’re feeling distressed?’”

He tells me about the time, in 2008, when a close friend killed herself. “That had a really huge impact on me,” he says. “I kept thinking, ‘Why didn’t I spot it? God, I’ve been doing this for years.’ I felt like a failure, that I’d failed her and people around her.”

All of which sounds, to me, like classic social perfectionism. “Oh, I’m definitely social perfectionistic,” he says. “I’m hyper-sensitive to social criticism, even though I hide it well. I disproportionately want to please other people. I’m really sensitive to the idea I’ve let other people down.”

Another risky trait he suffers from is brooding rumination, continual thoughts about thoughts. “I’m a brooding ruminator and social perfectionist, aye, without a doubt,” he says. “When you leave I’ll spend the rest of tonight, and when I’m going to sleep, thinking, ‘Oh Jeez I don’t believe I said that.’ I’ll kill–” he stops himself. “I’ll beat myself up.”

I ask if he sees himself as at risk of suicide. “I would never say never,” he says. “I think everybody has fleeting thoughts at some stage. Well, not everybody. There’s evidence that lots of people do. But I’ve never been depressed or actively suicidal, thank God.”

Staying alive

Back in that cold farmhouse room on the Norfolk fens, Drummond sat with his pills and his urge to take them all. What saved him was the lucky accident of one his personal projects being a Samaritans volunteer. He went in, one day, and instead of listening to clients, he talked for two hours. “I know from personal experience that a lot of people are alive today because of what they do,” he says.

Drummond has since remarried and his children are grown up. It’s 30 years since his first marriage broke up. Even now, he still finds it painful to talk about. And so he doesn’t. “I suppose you bury it, don’t you?” he says. “As a man you’re expected to cope. You don’t tell anyone about these things. You don’t.”

This article was originally published on mosaic.com.

We welcome your comments at letters@scroll.in