Discussion

It has often been reported (and verified by myself as I do my educational work) that most mental health professionals have not been educated about human sexuality in general, and homosexuality in particular. Studies confirm this, and a summary paper on the subject emphasized that "[e]ducation for mental health professionals on gay and lesbian topics is desperately needed."(52:242) Worse than this, however, are the common reports that heterosexism and homophobia continues to be a significant factor in the education of mental health professionals, including family therapists who are "still not getting the training they need to equip them for [dealing with GLB clients, as well as families who have GLB offspring]."(53:8) Predictably, the operating belief in this neglect has been that GLB people do not exist, as also made apparent in most suicidological discourses. Not long ago, most mental health professionals also believed that GLB people should not exist and acted accordingly, as manifested by their (professional?) mandate to 'cure' gay and lesbian people.

GLB people do exist and qualified mental health services must be made available to them, but more important is the great need for qualified crisis services, especially for GLB youth. However, many American professionals working with these youth report that such services are rare, and often nonexistent. In Canada, only Toronto appears to have such services in the form of the sexual orientation program at CTYS (Central Toronto Youth Services).

Two studies carried out by CTYS18 reveal that GLB youth sheltered in the youth residence system, and those seeking services in drug and alcohol abuse treatment programs (two youth group at high risk for having suicide problems), are often faced with worse than simply not receiving appropriate services. They are usually in highly homophobic and homohating environments, tacitly approved by those entrusted to help youth with problems; and many GLB youth are therefore being harmed in places where help should be available to them(54,55). Both studies also emphasized that professionals in both fields were not educated about GLB youth, nor trained to effectively help those having problems. CTYS has not yet produced a study reporting what happens to suicidal GLB youth when they access available services, but similar results are expected.

Generally, professionals in suicide prevention/intervention appear to have been content ignoring the existence of GLB people in general, and GLB youth in particular: a deadly situation.19 Given that GLB youth are at a very high risk for having suicide problems, this response can only exacerbate their problem. In attempting to understand and effectively address a serious social problem, such as the worsening youth suicide and suicide attempt problem,20 nothing is more counterproductive than ignoring a human group over-represented in the problem, ignoring their special needs, and only making inappropriate services available which may actually harm them and even worsen the problem. What should suicidologists do with respect to this reality?

Recent papers related to the suicide problems of youth and the prevention of these problems, have emphasized, as Tanney(1995) did, that the "most popular clusters linked to youthful suicide involves depression, substance abuse, truancy, and other legal involvements,"(73:118) to which can be added a history of suicide attempts and a history of antisocial aggressive behaviour(8:171). These "risk factors," however, are of little help in terms of understanding why GLB youth will attempt or commit suicide, nor why they will often become drug and/or alcohol abusers, truant, school dropouts, delinquents, clinically depressed, and be at high risk for another major life-threatening problem for GB youth: AIDS.21

With respect to GLB youth being at high risk for drug and/or alcohol abuse, their homosexual desires and identity, combined with being negatively affected by socially induced self-hatred (internalized homophobia), may all factor into their substance abuse problem(55-58) in a way that "being heterosexual" never would. The situation is described by Shiflin & Solis(1992).

"Before proceeding to a discussion of treatment we would like to briefly describe the issues that underlie the gay youth's use of chemicals. As many authors have stated, the development of a homosexual or gay identity occurs in the context of stigma (Martin 1982[59]; Troiden, 1989[60]). Prior to adolescence, the gay and lesbian adolescent has a 'sense of being different' from his or her peers (Minton and McDonald, 1984[61]). As homosexual impulses emerge, the youth begins to associate these previous feeling of being different with sexuality (Troiden, 1989[60]). As children, homosexual youth have been exposed to the homophobia of the larger culture. During adolescence they realize that these feelings place them in a devalued group (Hetrick and Martin, 1987[62]). This stigmatization role produces hiding and isolation, maladaptive sexual patterns and attempts to change one's orientation (Hetrick and Martin, 1987[62]; Martin, 1982[59]; Troiden, 1989[60]). Thus alcohol and drug usage for the lesbian and gay youth is multifunctional; it medicates the anxiety caused by the need to conceal one's identity; helps to discharge sexual impulses more comfortably; decreases the depression and dissonance that is generated by the adolescent's discovery of his or her sexual identity; acts as an antidote to the pain of exclusion, ridicule and rejection of the family and peer group; provides a feeling of power and self-worth to counteract the youth's sense of being devalued; and offers a sense of identity, wholeness and a soothing that is missing in his or her daily experience. (56:68-69)]

Similarly, suicidal GLB youth will not be helped by intervention efforts which do not address their many predictable problems linked to their sexual orientation. To help them will therefore require identifying them as GLB youth. The problem here, however, is the identification when they are suicidal because they don't want to be gay, and especially when they have attempted suicide because they would rather be dead than be gay or lesbian. When they are not ready to accept this fact about themselves, and they have opted for death instead, they will certainly not be prepared to acknowledge this aspect of themselves to others, including mental health professionals. Often enough, youth who have acknowledged they are gay or lesbian, but are struggling with this inner reality, and have attempted suicide, will also often not reveal their homosexual orientation to therapists(28,37). Commonly, these youth do not want to experience the anticipated disapproval of therapists as such responses will aggravate their serious problems.

It is therefore important that all mental health professionals working with youth should be gay/lesbian-affirmative, educated about GLB youth problems and their causes, trained to help these youth understand and cope with their problems, and they should especially be trained in how to access "homosexuality" information from youth since some of their clients will be gay, lesbian, or bisexual. For GLB youth who have attempted suicide, saw a mental health professional, and either omitted or denied their homosexual orientation to them, I have always asked: "Is there a way they could have obtained this information?" The answer has always been "YES".

Suicide prevention efforts which include GLB youth issues can become highly problematic for reasons related to our society's traditional homophobic and homohating nature. In suicide prevention programs directed at youth, targeting "at risk" GLB youth will necessitate speaking positively about their existence, and especially about the many problems they may be experiencing. Such youth will therefore know that someone exists who can understand and maybe help them, and that confidentiality will also prevail. Most GLB youth who are coming to terms with their homosexual orientation are, to various degrees, in the socially created psychological distress described by Martin & Hetrick(1988).

"Many symptoms of emotional disturbance appear related to isolation. Repeatedly, young people come to IPLGY (Institute for the Protection of Lesbian and Gay Youth, or the Hetrick and Martin Institute in New York) showing signs of clinical depression - pervasive loss of pleasure, feelings of sadness, change of appetite, sleep disturbance, slowing of thought, low self-esteem with increased self-criticism and self-blame, and strongly expressed feeling of guilt and failure [with 20% of these youth reporting having attempted suicide]. Again, they repeatedly report they feel they are alone in the world [even in New York which has a very large and visible GLB community], that no one else is like them, and that they have no one with whom they can confide or talk freely. Yet once they are introduced to their peers, once they are given the opportunity to interact with others who are homosexually oriented in a non-threatening, non-erotic atmosphere, many of these feelings disappear. Emotional isolation, of course, is intricately entwined with both cognitive and social isolation. When the young person has an example of adult as well as peer role models, when the adolescent has someone to talk to openly and has access to accurate information, emotional isolation tends to resolve." (28:172)]

On July 4, 1994, a 19-year-old youth committed suicide in Edmonton, Alberta. He also killed himself in the same manner as Kurt Cobain - his hero - who has a history of being effeminate, identified as bisexual, and had related problems. Steele had self-identified (at least tentatively) as gay, had made contact with the gay community, including the editor of a gay/lesbian magazine, and had related sexually with at least one male. For him, a major problem involved knowing he had to come out to his parents as it had been strongly recommended by a gay male friend. Most GLB adolescent greatly fear this event because they are often terrified of being rejected, hated, and even thrown out of their homes by those most significant to them.

Unfortunately, Steele opted for death, for reasons which became more apparent after he shot himself. After learning about his ventures into the gay world and related contacts, parental denial applied with respect to their son being gay, the emphasis being that the "gay" label for their son was "slander." He therefore knew how his parents would probably feel if he had come out to them, and opted for death instead of the hate and rejection he was anticipating.

In his suicide note which did not contain any reference to his homosexual nature, he synthesized the telltale feelings of many GLB youth who have known they were 'different' since early childhood and hid this aspect of themselves. They live a lie, never being themselves; always knowing, especially in intensely homohating families, that the resulting responses would be equivalent to the child abuse noted in the book Toxic Parents. The "cruellest words" parents will use with their child are: "I wish you had never been born!"(72:113) Many GLB adolescents have experienced their parents acting accordingly when their homosexual identity was discovered. They become throwaways or leave home because the hatred and abuse has become unbearable. For Steele, living had been the alienating and deadly experience so many GLB youth have felt before attempting and even committing suicide:

"I am not happy... Never was. Never will be... I just can't live anymore... I'm dead."(63)22

In 1994, the American Academy of Pediatrics formally restated its dedication to having GLB issues effectively addressed by pediatricians(74), and the same must be done by suicidologists. The existence of GLB youth and of their predictable (and verified) high risk for having many socially inflicted problems, must be recognized. Recommendations must be made to all professionals in the youth suicide prevention/intervention fields concerning the knowledge and understanding needed to effectively communicate with, identify (if necessary), and help these adolescents

Some professionals may respond to these recommendations with fear, believing that suicide prevention programs may suffer if GLB issues are addressed, but this may not happen. Tanney(1994) lamented the fact that "the highly successful campaign to achieve significant funding for intervention in AIDS is out of proportion to the numerical reality and the financial burden associated with the disorder. Proponents of suicide prevention activities have seen suicide disappear from the national agenda of most health and welfare agencies in the past decade." (73:114)

There is obviously much to learn from the AIDS prevention effort, especially with respect to securing funds. In this case gay and lesbian people have proven themselves to be capable of meeting a challenge which, in the past, has even included getting "homosexuality" removed from the DSM categories at a time when most psychiatrists held very harmful anti-homosexual attitudes. Unfortunately, it is suicidologists themselves, or at least some of them, who have placed GLB people in a double-bind with respect to having them address the GLB suicide problem and the required suicide prevention/intervention work.

In the second cover story The Advocate has published about the GLB youth suicide problem,23 it was emphasized that suicidologists' belief that suicide is almost always linked to psychopathology(8:174, 12:223) is causing a serious problem. If GLB youth are at higher risk for suicide, the implications are that they have a higher degree of psychopathology than heterosexual youth. Such a conclusion has unfortunately been used by those in the American Military who have wanted to continue discriminating against GLB people, as Hendin(1995) noted by quoting a New Yorker magazine article in which this issue was raised(94:129).

In Suicidology, the pressure to emphasize that psychopathology is associated with suicide has been great, and also detrimental for more reason than Tanney(1995) noted(73:114). Gay and lesbian communities could become a great ally in the suicide prevention field but they have been kept at bay. Is the attempted suicide problem for GLB youth, and their probable higher risk for suicide, related to psychopathology? I doubt it. These adolescents have a higher risk for becoming depressed, and even attempting suicide, but this is only what can be expected given what is inflicted on them. What they need is help from everyone, including adult GLB people and suicidologist, not a mental disorder label to further stigmatize them.

Savin-Williams(1994) noted that the "empirical documentation is of one accord: The rate of suicide among gay male, bisexual, and lesbian youths is considerably higher than it is for heterosexual youth... The high risk among lesbian, bisexual, and gay male youths to suicidal ideation, attempts, and completions had been brought to the attention of psychiatrists..., social workers..., health educators..., and therapists..." and others(75-81). "Unfortunately and tragically, few have listened."(35:266, emphasis mine.)

Suicidologists must also be added to the list. They, better than anyone, have been mandated to objectively evaluate the situation and make recommendations. To encounter, as was done in Suicide in Canada(1995), a quotation by Tanney(1992) who "argues that the existing data based linking suicidal behaviour with sexual orientation 'is too thin and the studies too overinterpreted to allow meaningful conclusions at present.'"(73:25) does not help the situation. Neither does the same conclusion also essentially made in the 1995 Supplement of Suicide and Life-Threatening Behavior. I not only challenge this view, but refute it. I also propose that such arguments have been made only by those who have sought to maintain the status quo in suicide prevention efforts. That is, to make sure GLB youth issues are not addressed, as it had applied for the majority of suicidologists, and with respect to most working in suicide prevention and intervention programs.

Much research work remains to be done in Suicidology, especially with respect to incorporating the sexual orientation factor in future research work. Youth who attempt and commit suicide have a number of interrelated problems, and theorists must begin to ask what is underlying these problems, maybe as a yet unrecognized cause. The research carried out by Bagley et al.(1994) revealed that 6 out of the 8 young adult male suicide attempters had been sexually abused,24 and that 3 out of the 8 were sexually active gay or bisexual males, 2 of whom had been sexually abuse as children. Therefore, taboo forms of human sexuality - of the male-male kind - is implicated at about the 90% level in male youth suicide problems; and maybe Tanney(1995) was partly in error when he wrote: "Efforts at a grand unifying theory of suicidal behaviors are clearly not within our present grasps."(73:109)

I did not venture into Suicidology with such pessimism. I ventured into it because, for certain reasons, suicidologist were manifesting a great aversion to even consider the existence and problems of GLB youth, much less understand and help them. As a result of my studies, I have acquired a decent understanding of GLB youth, and especially GB males; but I remain a novice, recognizing that I still have much to learn, even if I am gay myself.

My fresh status in the field of Suicidology, however, has yielded other insights, possibly free of some biases existing in all fields of study. For example, I have acquired a good understanding of why some males who were sexually abused as children would be suicidal, attempt suicide, and even commit suicide. Someday I may write a paper on the subject which will demonstrate that understanding the negative effects of child sexual abuse on boys was predicated on understanding the predictable negative effects of boys entering adolescence with sexual desires for males plus/minus their own age - which has been the focus of this paper.