Pierre J. Tremblay B.Sc., B.A., B.Ed. (25 Nov 1995)
Presented at the Sixth Annual Conference of the
Canadian Association for Suicide Prevention,
Banff, Alberta, October 11-14, 1995, (c) Oct 1995.
HTML version by Sean, packed & optimized by The One Phoenix.
[Note the Addendum.]
"I was both astonished and saddened to find that in her recent editorial, 'Youth Suicide: The Physician's Role in Suicide Prevention,' Blumenthal did not discuss the impact of the repression of emerging awareness of homosexuality on the incidence of suicide among young people." After describing the hate-ridden environments in which GLB youth often live, and their related problems, she stated: "If alleged experts on suicide prevention cannot include issues relevant to gay youth in their discussions of counselling strategies, I suggest that these youth are not only hated, but also at risk of being ignored to death by medical professionals. Denying the needs of these young people - or worse, ignoring their very existence - only confirms that we in the medical profession do not consider them important..." (7:2806)]By 1993 a few professionals in the field of adolescent suicide prevention were taking note of this increasingly visible debate. In American Psychologist, Garland & Zigler(1993) wrote the following lines about GLB suicide problems. "The humiliation and frustration suffered by some adolescents struggling with conflicts over their sexual orientation may precipitate suicidal behaviour(Harry,1989 [38]), although there is considerable debate over whether homosexuality is a risk factor for suicide (see Blumenthal 1991; Snelling, 1991)." (8:173) In the same issue of American Psychologist, the authors of Depression in adolescence also alerted professionals about problems affecting GLB youth. "Gay and lesbian youth have a two- to threefold risk of suicide (Gibson, 1989[24]), and they are probably at greater risk for depression."(9:158)
By 1995, little was yet to be noted with respect to the GLB suicide problems in the field of Suicidology. In a Spring 1995 Special Issue of SLTB (Suicide and Life Threatening Behaviour) titled Suicide Prevention Toward the Year 2000, the existence of GLB youth was not mentioned in the articles discussing youth aged 12-18 and 18-30(10,11). Neither was the issue raised in the SLTB Summer 1995 paper Research in adolescent suicide: Implication for training, service delivery, and public policy(12), nor in the SLTB Fall 1995 paper Psychosocial correlates of suicide attempts among junior and senior high school students(13).
In the Spring Special Issue of SLTB, however, the GLB suicide issue was addressed by Eve K. Moscicki, but not in a positive way. "A second misconception is that gay and lesbian youth account for a large proportion of suicides, and that sexual orientation is a major risk factor. This hypothesis has not been tested in carefully designed studies." Noting some of the problems related to doing this, she went on to dismiss the idea that gay males are more at risk for suicide, as based on the result of the 1986 San Diego Suicide Study (to be discussed later in this paper). A few research papers about the GLB youth suicide problem were cited with the conclusion: "[I]t is not clear, however whether it [sexual orientation] independently contributes to increased risk. Unfortunately, no information is available from unbiased samples."(14:32)
Are GLB people in general, and GLB youth in particular, at higher risk for manifesting suicide behaviours than their heterosexual counterparts? A brief summary of suicide-related observations recorded over the last 150 years does suggest that such a problem has existed in gay communities, the causes being either unique to gay males, or predominantly applying to them.
Although this information is anecdotal, such life experiences were reported throughout the twentieth century, and especially during the last 30 years in North America. Del Martin and Phyllis Lyon(1972) described the prominence of the suicide problem in the American lesbian community by reporting on a group of "twenty lesbians between the ages of twenty-five and thirty-two" who had been involved in a discussion. There were "only two [who] had not attempted suicide when they were teenagers."(18:27)
Concerning suicide in the gay community, Allen Young(1972,1977) noted: "Most of us in gay liberation don't hear about a suicide without automatically assuming there's a good chance the person is homosexual."(19:23) More recently, Gens Hellquist (Gay and Lesbian Health Services, Saskatoon) reported that "AIDS is not the only thing that is killing our friends. While I'm not aware of any statistics on the subject I believe we've lost more lives to suicide than to AIDS. I certainly know more people in our community who have taken their own lives than I know who have died from AIDS."(20)2
Reports of significant suicide problems have a long history in gay and lesbian communities, but this reality has not been recognized by most suicidologists. To this day, however, openly gay males do commit suicide, as do closeted homosexually active males. In some cases the latter commit suicide following an arrest related to their homosexual activities, or following the threat of an arrest. Related information is available at SIEC (The Suicide Information and Education Centre, Calgary, Alberta.), in gay literature, and from me and others. For example, in 1988, a married male high school teacher in a Calgary Catholic high school committed suicide after a male student complained to police about a sexual advance. Suicides of gay males and lesbians also occur for other reasons but it is often not known that the victim was homosexually active, and that he/she may have been wrestling with wholly or partially recognized and unwanted gay/lesbian desires and/or identity. This intra-psychic situation is well recognized factor (among others) in the suicide attempts of GLB youth(24-25).
Due to a number of homophobic social factors, among them the nature of the closet, it may not be possible to establish the exact representation of gay, lesbian, and bisexual people in the suicide problem. The same problem applies to a lesser extent with respect to suicide attempts. People who commit suicide cannot tell us why they did it, unless they left a suicide note, reported their problems in a diary, or confided in a friend or therapist who can tell an investigator the facts of the case. For some GLB individuals, we learn that they often committed suicide for reasons wholly or partly related to their unwanted homosexual identity, and the same factor is also often implicated in GLB youth suicide attempts(23-38).
The result of the Bell & Weinberg(1978) study are often noted in research papers and articles, usually by stating that gay males are six-times more likely to attempt suicide than heterosexual males, and that lesbian are two-times more likely to attempt suicide than heterosexual females. Occasionally, it is mentioned that the risk for suicide attempts is highest during adolescence, but the risk is not quantified. Figures 1-3 show the attempted suicide rates to the ages of 17, 20, and 25, respectively, for all groups studied, yielding the conclusion that, to the age of
17 20 25predominantly homosexual males were
16 TIMES 13 TIMES 6 TIMESmore likely to have attempted suicide than their heterosexual counterparts randomly chosen and matched on the basis of age and education level.
The Bell & Weinberg data therefore suggests that, to a significant degree, predominantly gay males have been over-represented in the population of male suicide attempters from 1930 to 1970, and that the proportion varies depending on the estimate for predominantly homosexual males in the male population. For example, to the age of 25, homosexual males would account for 40%, 25%, or 14% of male suicide attempters if these males are assumed to form 10%, 5%, or 2.5% respectively of the male population; 56%, 41%, or 26% of male suicide attempters to the age of 20, and 64%, 46%, or 29% of male suicide attempters to the age of 17 depending on the same percentage of population estimates. For reasons noted in Appendix A, it is estimated that about 5% of the male population is predominantly homosexual and it is therefore concluded, on the basis of the Bell & Weinberg data, that predominantly homosexual males have formed 46% (to the age of 17), 41% (to the age of 20), and 25% (to the age of 25) of males who have attempted suicide.4
Since 1970, a number of studies of gay and bisexual male youth (23-33, 36-37), with or without lesbian and bisexual females, have consistently reported high attempted suicide rates ranging from 20 to 50 percent (Table 1, 2, 3, and 4) for these youth. As a rule, the samples were community based, thus representing some of the North American GLB youth who have made a direct connection with GLB communities and related services. Therefore, as it was emphasized by Savin-Williams(1994), "[s]ocial science research does not allow us to generalize these findings to all bisexual, gay males, and lesbian youth, primarily because most of these youths are not 'out' to themselves and to others."(35:367)
This caveat is important, and the same has been said about the Bell & Weinberg(1978) study. In this case, however, the total volunteer sample [The "biased" samples referred to by Moscicki, 1995(14:32)] of white male homosexuals was large, from which a smaller sample of 575 white males was selected(23:11). Many facts were taken into considerations in this process, including the reality that the gay community was (and still is) very cellular in nature. I was therefore able to conclude, on the basis of my own extensive knowledge of gay communities, that their sample was probably the most representative one ever taken of a large gay community.
Many problems have been noted with respect to all research results on GLB people, ranging from the representative nature of samples studied to their actual percentage of the population. These problems, however, should not be an issue for all professionals working with youth such as teachers, school counsellors, mental health professionals, pediatricians, or other professionals working in youth problem prevention/intervention fields such as drug and alcohol abuse and suicide. Beyond any doubt, it is a fact that GLB youth (and adults) exist, although their exact percentage of the total population remains to be determined (Appendix A).
Many GLB youth do attempt suicide, and some succeed. Like heterosexual youth with suicide problems, GLB youth also have elevated rates of substance abuse problems, but with a difference. The recurring single most important factor implicated in GLB youth problems (including drug and alcohol abuse) is the acknowledgement of their homosexual desires/nature/orientation and the multiple problems predictably resulting from this, and from also "coming out" to others, because they have grown up and are living in a traditionally homophobic, homohating, and homo-punitive society.5
In spite of having such information, researcher of youth suicide problems have always avoided obtaining sexual desire/behaviour/ orientation data from samples of youth studied, even when all the cumulating research, especially with respect to attempted suicides, has strongly suggested that GLB youth are at high risk for having suicide problems. The same indifference has also existed in most suicide prevention programs which have typically excluded any mention of GLB youth and what is known about them. This knowledge is now available in books, articles, and research papers largely written by professionals who have worked with these often highly distressed and suicidal youth. Therefore, it would appear that factors other than scientific principles are implicated in Suicidology's general indifference to GLB youth.
In the final analysis, it would seem that most suicidologists will continue to ignore sexual orientation issues for as long as it is believed that GLB youth are not at higher risk for suicide attempts and suicide, compared to heterosexual youth. So what percentage of the attempted suicide problems will it take before suicide prevention experts begin to note, in a comprehensive manner, in their papers and books,6 and in booklets and pamphlets written for youth and their parents,7 that homosexual orientation is a factor in the youth suicide problem? 10%? 20%? 30%? 40%? 50%?
For reasons given in Appendix A, the Bagley et al.(1994) study is deemed to be one of the best available with respect to producing demographic data on the basis of sexual orientation, and especially with respect to determining the percentages of urban males who are homosexually active as young adults. The sample data reveals that 4.3% and 4.9% of these males have been having sex with other adult males on a "regular" to "occasional" basis, for a total of 9.2% of males who may be classified gay or bisexual, and homosexually active(40).
Bagley(1994) also reported that there were 3 suicide attempters in the gay/bisexual category out of the 8 suicide attempters in the Bagley et al. (1994), thus producing the estimate that 37.5% (3/8) of male youth suicide attempters are gay or bisexual (X2= 7.75, p < 0.01, df = 1).8 The results of this study therefore represent a great milestone reached in the field of Suicidology, especially in the debate over whether or not gay and bisexual male youth are at greater risk for having a suicide attempt problem than their heterosexual counterparts.
Although the above result must be replicated in other studies to establish its scientific validity, the study nonetheless begins to answer (in the scientific way most suicidologists seem to demand, as in using random sampling) the hypothesis, or highly informed speculation, that gay/bisexual males (and even lesbian/bisexual females) are at higher risk for at least having an attempted suicide problem. Although the caveats for the Bagley study are many, most suggest that the gay/bisexual representation in the male youth attempted suicide problem may be greater than 37.5%.
The stratified random sampling of males studied by Bagley et al.(1994) was taken in middle- to lower-class neighbourhoods located in the northern half of Calgary, or outside the area (a 20 by 20 block area) predominantly housing Calgary's gay community. Therefore, the sampling missed the highest concentration of young adult gay males living in Calgary, the ones who would have an attempted suicide rate greater than 20% (table 1, table 2, table 3, and table 4). Gay/bisexual/heterosexual street and delinquent youth (and related services) are also concentrated in the same area. This knowledge of Calgary therefore reveals that the Bagley et al.(1994) sampling missed a high concentration of 18- to 25-year-old street youth probably having a history of delinquency and being runaways.
Research work has revealed that adolescent runaways have elevated rates of all the interrelated problems - depression, conduct disorders, family problems, arrests, substance abuse, and a history of suicide attempt(s) - correlated with youth who attempt suicide and commit suicide(41:103). The reported attempted suicide rates for male runaway youth have ranged from 15%-19%(42:157), to 29% (41:105),9 and it has been estimated that 30% of runaway youth and 40% of street youth are gay, lesbian, or bisexual(35:264).10
The sampling of the 750 males was also carried out by using the telephone reverse directory, the implication being that these males were living generally stable lives. To be listed in the telephone directory, they must have been living at the same address for a period greater than about 6 months, and also needed to have a telephone. Because of this sampling limitation, a predictable under-representation of "at risk" populations occurred, such as street youth, young adult males who are in the prison system,11 and other highly distressed youth (with a history of suicidality) who have been institutionalized. This latter factor was noted by Bagley et al.(1994), thus partly explaining why the number of suicide attempters in the sample (8/750, 1.1%) is lower than the anticipated percentage given that studies have produced male youth attempted suicide rates ranging from about 3 to 8 percent.12
A detailed analysis of the available attempted suicide rates for lesbian youth was made in The Gay Lesbian and Bisexual Factor in the Youth Suicide Problem (107), but the limitations placed on this paper make it impossible to render this lengthy, sometimes argumentative, but interesting presentation. Suffice to note, however, that lesbians of colour have higher attempted suicide rates than white lesbians; and that this phenomenon, although not as pronounced, is also noticeable in the attempted suicide rate data for GLB youth. The Remafedi et al.(1991) sample produced an attempted suicide rate of 40% for GB males of colour, compared to a 28% rate for white GB males (Table 1). The Rotheram-Borus(1992) sample produced a 39% rate for a group of mostly GB males of colour, and the Uribe & Harbeck sample of 37 males (67% of colour) had an attempted suicide rate of about 50%(Table 4). This contrasts with an average attempted suicide rate of about 30% for samples of mostly white GLB youth.
Similar differences (Table 2) were also reported by Schneider at al.(1989) who spoke to this. "In general, however, being a stigmatized 'minority within a minority' may contribute to suicidality. Gay members of ethnic minorities are often disenfranchised from both mainstream social institutions that normally provide support and psychological protection from distress symptomatology."(36:391) This factor, responsible for the higher rates of distress for GLB people of colour and also articulated by other professionals (24, 48, 49), is essentially the same one given to explain why GLB people in general are at higher risk for having suicide problems than heterosexual people.
Saunders & Valente(1987) emphasized that "empirical evidence, risk factor and Durkheim's theory of anomic suicide... supports the proposition that gay men and lesbians are at higher risk for suicide."(34:01) The concept of "anomie" refers to people who don't feel they belong to society, have been marginalized, and are stigmatized. GLB youth, however, would have fewer problems if it was only a matter of not belonging to society, but the situation is severe for them. Often enough, they feel hated and rejected by almost everyone, including peers, teachers, parents, religious leaders, and even their god. Martin(1988) described the situation. "The truth is that gay and lesbian youth are not like other adolescents. Their difference stems from their status as members of one of the most hated and despised minority groups in the country."(50:59)
In addition, most GLB youth have been socially set up to hate themselves,13 thus producing what could be called internal anomie. When combined with Durkheim "anomie," high levels of distress, attempted suicides, and even suicide can be expected. Unfortunately, with respect to this phenomenon, as noted by Erwin(1993), little research exists. Scientific assumptions prevail, and an important question must be asked: "[But] how does one measure the cumulative effects of multiple oppressions?"(49:448-449)
About 88% of suicide attempters in samples of average youth taken for study do not report that their attempted suicide required medical attention(45), but the rate is lower for gay and bisexual male youth. Remafedi et al.(1991) reported that 21% (about twice the above rate) "of the suicide attempts (14/68) resulted in a medical or psychiatric hospitalization," but that a number of suicide attempts rated as having "high potential lethality" were not in this category. For the 68 suicide attempts performed by 41 suicide attempters in his samples of 137 GB youth, 54% of them "37/68 received risk scores in the 'moderate to high' lethality range. The remaining attempts were in the 'low risk' category... A rescue was initiated by the victim (24%) or by another person (76%) in the remaining 45 cases. Fifty-eight percent (26/45) of these cases received scores in the 'moderate to least' rescuable range. In other words, the predictable likelihood of rescue was moderate to low, despite the actual occurrence of an intervention." (31:871)14
If some of these attempts had resulted in suicide, it is doubtful that an investigating suicidologist would have been able to determine whether any of these victims were gay or bisexual males. This possibility would certainly apply for those males struggling with their homosexual orientation, especially when they are in the process of self-identification occurring at a mean age of 13.75(35) to 14.74(110). It is also known that many GLB suicide attempters, usually in treatment for the more serious suicides attempts, commonly do not reveal their homosexual orientation to therapists.
At the Hetrick and Martin Institute in New York, this reality was noted. "[W]e have had nine clients who were in treatment for suicide attempts but who had not yet told their therapists either that they were homosexual or that that was a factor in the suicide attempt(28:173). Uribe & Harbeck(1992) report that most suicide attempters in their high school based sample had sought help outside school and that, "without exception, those seeking help from private sources denied their sexual orientation to them." (37:22)
My experience with GLB youth suicide attempters in Calgary reveals the same pattern. After the suicide attempt, most of them did not volunteer such information to medical professionals, including mental health experts; and if this factor was broached by the worker, it was denied. As a result, mental health professionals have often not known one of the most important factors in the great distress of some: their sexual orientation.15 For similar reasons, suicidologists studying suicide victims will have great difficulty discovering the victim's possible homosexual orientation, and probably more so if adolescents are being studied. Many GLB survivors of serious suicide attempts often don't talk (until much later), and GLB youth who commit suicide may almost always take their "homosexual" secret to their graves.
Little work has been done to determine the percentage of suicides involving GLB people, and the major study was carried out by Rich et al.(1986). Moscicki(1995) cited this San Diego Suicide Study to dismiss the idea that gay males were more at risk for suicide by noting that "only 13 of the 383 consecutive suicides were gay."(14:32) This is true but, as commented on by Hendin (1995), all the known suicide victims determined to be gay were in the 21 to 42 age range, and it was highly unlikely that older gay males, and those younger than 21, do not also commit suicide(94:129). The implication is that the researchers may not have been highly skilled with respect to determining the homosexual orientation of suicide victims, especially if the [gay] victims were living closeted lives - as most younger and many older gay males would be doing. Therefore, the 13 gay suicide victims reported by Rich et al. would be a minimum, and the number of gay male victims in the 21-42 age group is probably underestimated.
Rich et al.(1986) recognized the above problem and, to at least have some resemblance to being a scientific study, the gay males who committed suicide were compared to the 106 straight victims in the same age range. Therefore, it was concluded that about 10% (11.8%) of suicide victims were definitely gay, which implied to Rich et al., given the assumed 10% figure for gay males, that they were no more at risk for suicide than heterosexual males(51:453). However, if we assume that the percentage of gay males in San Diego is about the same as Calgary (4% to 5%, see Appendix A), and that some of these males would not be gay-identifiable if they committed suicide (unless exceptional investigative work was done), it could be concluded, as a minimum estimate, that gay males are about three-times more likely to commit suicide than heterosexual males between the ages of 21 to 42.
Rich et al.(1986) also recognized the limitations of the analysis done on both group of male suicide victims. "A sample of 13 is hardly adequate to justify highly sophisticated statistical analysis or any major conclusion."(51:453) The results, however, even if deemed not to be statistically significant, do show interesting differences between gay and straight suicide victims.
Problems Gays (n = 13) Other (n = 106)
----------------------------------------------------------------
Drug and/or Alcohol 12/13 (92%) 79/106 (74%)
Abuse
Total Depressive 5/13 (36%) 41/106 (39%)
Total Psychotic 6/13 (46%) 20/106 (19%)
Previous Treatment 10/13 (77%) 55/105 (52%)
Previous Suicide 8/12 (67%) 34/91 (37%)
Attempt(s)
From the above, it can be said that gay male victims of suicide were
about 2.4 times more likely to have received a psychotic diagnosis,
1.5 times more likely to have received psychiatric treatment, and 1.8
times more likely to have attempted suicide. With respect to the
suicide attempt data, an important fact related to this study was
explained by Rich et al.(1986) "It is interesting to note, however,
that only a slightly larger sample size of gays (18 cases) with the
same ratio of attempts (67%) would have produced a significant
difference from the comparisons."(51:456)
To support the idea that gay youth are not at higher risk for suicide, while nonetheless maintaining the possibility that they may be, Hendin(1995) noted the existence of a yet unpublished Shaffer study of adolescent suicide victims noted in a New Yorker magazine article(94:130). The study of 120 out of 170 youth suicides below the age of 20 was ultimately published in the 1995 Supplement of Suicide and Life-Threatening Behavior. One objective of the study was to determine the sexual orientation of victims, as based on "having had homosexual experiences or having declared a homosexual orientation. Three [male] teenagers [out of 120 males and females] and no controls [out of 145 males and females] met these criteria."(104:64) "In addition to the three suicides who were known to have homosexual experience, a further six suicides, including [one who had committed suicide with a known homosexual victim of suicide and were found holding hands], were known to be close friends with other gay teenagers. Three other suicides were reported to have been effeminate in their behavior."(104:69) "All three suicides had evidence of significant psychiatric disorder before death. In spite of opportunities for biased reporting, it is concluded that this study finds no evidence that suicide is a characteristic of gay youth..."(104:64) The study ended with: "It should be reassuring that the data reported here suggest that the painful experience of establishing a gay orientation does not lead disproportionately to suicide."(104:71).
For knowledgeable gay activists who have been struggling for social change in terms of decreasing the very harmful homophobia creating the "painful experience of establishing a gay orientation," the final sentence is not comforting. It is almost as is they are saying: "We understand the situation but, even if these youth may have high attempted suicide rates (which has not been confirmed), their abuse by society is not really bad enough to cause their over-representation in adolescent suicides." Such an attitude immediately raises suspicions concerning these researchers, amply justified with the realization that none of the 145 controls studied reported being gay or bisexual to them, or even reported having had homosexual experiences. Given the studies available on the subject revealing that at least 5% of male adolescents would be in these categories (Appendix C), the Shaffer et al.(1995) researchers certainly cannot be deemed skilled in accessing "homosexuality" information from teenagers. How skilled would they therefore be in determining the possible homosexual realities of dead GLB youth?
The caveats related to this study are located in Appendix C, the conclusion being that many questions related to this study must be answered before it can be granted any validity. However, given that three (out of 95) male suicide victims were identified to be homosexual, three were deemed to have been effeminate (with a high probability of being gay), 6 others were close friends with gay males, and considering it would be almost inconceivable that a heterosexual male would have a suicide pack with a gay male and die with him holding hands as one of the 6 did, suggest that some concealment exists. Therefore, up to 12% of males in this study could have been in the homosexual category, or more for reasons given in Appendix C.
The caveats related to the Shaffer et al.(1995) and Rich et al.(1986) study are many, and one could speculate that good insightful research work on suicide victims may one day produce the predictable over-representation of gay/bisexual males in the male youth suicide problem. There is certainly nothing in either study which would permit concluding that gay males are not more at risk for suicide than heterosexual males. In fact, if we err in favour of what these studies suggest, we would tentatively conclude that gay males are at least 2 to 3 times, and maybe 4 times more likely to commit suicide than heterosexual males.
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)]For GLB youth with substance abuse problems, intervention efforts which fail to recognize their homosexual orientation, and therefore fail to help them effectively cope with factors underlying their many problems (the symptoms), will generally fail to help these youth overcome their substance abuse problem(s)(55). Such problems may also be aggravated because the failure will sometimes convince these youth that no one in the world is available to help them.
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)]Other problems also affect GLB youth, yielding suicidal results.
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)22These youth must be helped, long before they reach the state of hopelessness Robert Steele experienced. One solution to this problem would be to end of society's traditional homophobia/homohatred. Suicide prevention efforts must include tackling homophobic issues in a society where homosexuality is still taboo, and where GLB youth realities are even more sensitive. Suicide, however, also has a history of being taboo, and significant problems continue to exist in this respect(73). The required work must nonetheless be done because ethics demand it, and the same applies with respect to the GLB youth suicide problem.
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.
These males, along with heterosexual males who were sexually abused also form about 90% of the young adult male suicide attempters. Therefore, suicidologists must begin asking and answering an important question: Why have most studies of youth suicide problems not been concerned with identifying sexual orientation, and child sexual abuse in their research work? Is this how truly scientific work should be done? Is it acceptable for suicidologists to have generally avoided doing anything to understand and help gay, lesbian, and bisexual youth despite the taboo nature of their sexuality? Was it ethical for mental health professionals until recently to have deemed all gay and lesbian people to be mentally disordered, and to have behaved accordingly? Has it been ethical, given the facts of the case, for suicidologists to have generally ignored GLB issues? Why did this happen?
Dedicated also to Virginia Uribe (the founder of PROJECT 10 in Los Angeles) who, after having learned about our world, often by hearing teachers speak about homosexuality in staff rooms, stated: "No wonder the kids commit suicide. I'm surprised they don't all kill themselves. If they really were aware of how much hatred there is, they probably would."(82:86)
I thank my mother and father, Dorothy and Hervey Tremblay, for their ongoing encouragement, and all who have helped to get the GLB reality on many agendas in Calgary. This includes Bill Rutherford (President, Parents/Friends of Lesbians and Gays, Calgary chapter), Gerry Harrington (Director, SIEC), Gloria Wilson (AADAC), Pam Greer (Canadian Red Cross), Bruce Potter (Calgary Birth Control Association), Pat Boyle and Don Andrews (Calgary Board of Education), Bishop Paul O'Byrne and Jim Pender (Roman Catholic Diocese of Calgary), Peter Hodgson (I-DENTITY: GLB youth group), Les Meares and Jim Picken (Integrity: GLB Anglican group), and the individuals listed below.
For this paper, I thank Dr. Christopher Bagley (Faculty of Social Work, University of Calgary) for his support and for the research data which made this paper into a much needed contribution to the field of Suicidology, Dick Ramsay (Faculty of Social Work, U of C), and Dr. Gary Sanders (Faculty of Medicine, U. of C.) for their assistance and editorial comments.
I especially thank Stephen Lock (Gay Lines Calgary) for his greatly appreciated editing work, and for 3 interviews related to GLB youth problems on Calgary's only weekly GLB radio program, Speak Sebastian, on CJSW-FM. Also: SRC-TV (French CBC) in Winnipeg and Calgary for interviews, CBC Radio in Calgary for being on The Home Stretch program, and Alanna Mitchell (Globe & Mail, Calgary) for writing an article (June 23, 1995) about my work in the GLB suicide problem and my proactive work in Calgary's school system. Chris Hooymans, the former publisher of a GLB magazine, designed the cover page for this paper.
The debate around the percentage of the population which would be gay, lesbian, or bisexual has existed for decades, especially since Kinsey(1948) estimated that about 10% of males had been predominantly homosexually active for a period of three years between the ages of 16 and 55(84:651). Other studies have also been done, producing a range of estimates for homosexual, gay, bisexual males ranging from 1% to 17%. Many questions, however, have been asked about definitions(85,86), some writers even noting that "gay" males (a socially constructed identification, but the word is often used as a synonym for male homosexual) form a subset of the homosexual male population(85:42), and the same concept was articulated in a comprehensive manner by Gilbert Herdt in 1992(87). Great problems also exist with respect to identifying, for study purposes, males who are bisexual. Most of these males would be in primary heterosexual relationships and are highly closeted for many reasons.
Diamond (1993) noted many of these problems and summarized the available demographic research results. On the basis of studies done in the recent past (excluding the Kinsey studies), he arrived at the "usable 'round' figure" of 5.5% "for those adult [males] who regularly engage in or have since adolescence at least once engaged in same-sex activities..."(88:306) However, most of the studies yielding the estimate were either obtained from random dialling telephone surveys, or from face-to-face interviews using random samples. Neither method will produce accurate figures, and the latter method was used in the most recent American demographic study which produced the widely reported 2.8% estimate for males who are homosexual.
The study, Sex in America: A Definitive Study(1994), reported that 2.7% of males had same-gender sex in the past year, and that 7.1% had same-gender sex since puberty. The great caveat related to this study, however, was noted by one of its authors, Stuart Michaels, in Time magazine's cover story about the study. "The biggest hot button, he says, is homosexuality. This is a stigmatized group. There is probably a lot more homosexual activity going on than we could get people to talk about."(89:50)
Homosexuality is still a taboo subject, to the point that many GLB individuals fear losing their jobs, friends, and even their families if their homosexual orientation is known; or worse, given that only a little less than 50% of American states have decriminalized homosexual activity. In Canada, homosexual activity is not a crime, provided the ones engaged in homosexual activity do so in private, are of the legal age, and are not in authority over one of the individuals, if such a person is 14- to 17-years-old. Nonetheless, a significant number of homosexually active male Canadians would not want to reveal the "homosexual" part of their lives to most people. Included are individuals requesting such information as part of a random telephone survey, and those requesting the same information in face-to-face interviews. The fear of exposure is too great.
The Bagley et al.(1994) sample data was obtained by having the subjects answer all questions on a portable computer taken to their homes by a male approximately the same age as the respondent. After the computer was set up, and instructions given, it was emphasized that, after the subject began answering questions, help could not be offered. The reason given for this was that everyone involved with the study had to remain blind to all answers given. As a result of this, the subjects knew they would only be giving the requested information to a machine, with a highly convincing assurance that their anonymity was guaranteed.
The Bagley et al.(1994) study therefore eliminated some of the concealment problems, especially predictable when researchers are asking men if they have sexually interacted with children since the age of 18. Requesting such highly taboo sexual information from adult males by telephone, or in face-to-face interviews, would probably yield the non-existence of such men. Yet, given that about 15% of adult males and females report having been sexually abused as children, mostly by men, a significant number of men are sexually involved with children. An analysis of the information has yielded the estimate that about 2% of adult males have been (are) active pedophiles, and another 3% who would act accordingly if certain conditions were met. In the Bagley et al.(1994) study, 1.1% of young adult males (8/750) admitted to having had sex with children (4 with girls, 3 with boys, and 1 with both) since the age of 18(39), and this result leads to the following conclusion.
For demographic research based on sexual orientation, given that adult homosexual activity is still taboo, but to a lesser extent than is adult homosexual activity involving boys, the method to be used should be subjected to an important question. Would it produce a good estimate of the percentage of men who have sex with boys? If the answer is "NO!" because it can be predicted that a "0%" (or close to "0%") estimate will result, the method to be used will therefore produce underestimates for the percentage of males who are homosexually active with other adult males.The supposedly "definitive study," Sex in America, produced an estimate of 2.8% for males who are currently homosexually active, with 7.1% reporting that they had same-gender since adolescence. Bagley(1994), however, by using the above described method, produced the following results:
The Bagley et al.(1994) study has therefore set a desperately needed methodological standard in the field of demographic research based on sexual orientation. Special methods for collecting "homosexuality" information, such as the one described above, will continue to be mandatory for as long as our society retains its traditionally homophobic, homohating, and homo-punitive attributes.
The 1994 book, Suicide and Homicide Among Adolescents, also noted that homosexuality was a factor in the youth suicide problem. "Sixth, gender identity issues, including homosexuality, also appear to represent a risk factor for youth suicide (Remafedi et al. 1991; Judson, 1993)."(95:16) The factor is also noted in the table Risk Factor for Suicide(95:115), but explanations are not given concerning why homosexuality, or even gender identity issues, are implicated in the youth suicide problems. Of the two references given to enlighten the reader about this problem, the "Judson" reference is listed as Research proposal. Unpublished manuscript, 1993."
Some exceptions to the rule occurring before 1991 nonetheless exist. Growing Up Dead: A Hard Look at Why Adolescents Commit Suicide(1978) contained a chapter titled "Colour Me Gay." The author, however, was a journalist, not a suicidologist. Herbert Hendin, a suicidologist, did have a chapter Suicide and Homosexuality in Suicide in America(1982). Clinical data was given to support the idea that homosexuals would be at greater risk for suicide, but little else; not even citing the Bell & Weinberg(1978) study which suggested that GLB people, and especially GLB youth, were at risk for suicide attempts(92:107-124).
In Hendin's 1995 version of the same book, the chapter on homosexuality had changed somewhat, especially at the beginning. Additional information was presented suggesting that GLB people, and possibly GLB youth, may be a higher risk for suicide. Little effort was made, however, to present a convincing argument in this respect. This was expected, however, because Hendin's 1987 and 1991 papers on youth suicide(1,93) did not mention GLB youth and their probable high risk for having suicide-related problems.
Hendin (1995) cites the Rich et al.(1986) study as concluding that "the rate of suicide among homosexuals is not greater than that for heterosexuals"(94:129), but he recognized that the researchers probably did not identify all homosexuals in their sample of suicide victims. (See information related to this study and related conclusions made in this paper.) He nonetheless goes on to note, as was done in 1982, that his "own work has provided some evidence that homosexuals are overly represented in suicide attempts." (94:131)
Canada's official publication on suicide, Suicide in Canada(1987), did not mention anything related to homosexuality, and the same occurred in the unpublished updated version of the same book which became available in 1993(99,100). I was troubled by the omission, contacted Dick Ramsay (Associate Professor, Faculty of Social Work, University of Calgary) early in 1994, and expressed my concerns. As a result of this, given the information presented in the first edition of The Gay, Lesbian and Bisexual Factor in the Youth Suicide problem, and in the greatly expanded second edition(107), an addition was made to the text. The 1995 edition of Suicide in Canada now contains a subsection titled "Gay men and lesbian" in the section High-Risk Groups. (101:24-25)
In October, 1995, a Supplement of Suicide and Life-Threatening Behavior, Research Issues in Suicide and Sexual Orientation, was published. It was the result of a workshop which had been held Atlanta in June, 1994(102:1). "The workshop was convened," not because Suicidologists really wanted to address this issue, so it seems, but because it was a "response to public and Congressional inquiries regarding rates of suicide among gay and lesbian people, and to repeated media reports of a purportedly elevated risk of suicidal behavior in this population."(102:1) Although interesting papers were published and needed research recommendations were made, the ultimate conclusion was that "numerous limitations currently prevent drawing accurate conclusions about the potential relationship between suicide and sexual orientation(102:2,103). Recommendations were not made with respect to having suicide prevention/intervention programs begin addressing GLB youth suicide issues. At best, professionals in these fields were left with the "out" most have used to avoid helping these youth. They were told that nothing is conclusive about the relationship of youth suicide problems and sexual orientation.
With respect to the assumed 100 control males studied, statistically some of them should have reported having had same-sex experiences. Bagley(1994) reported that 6 percent of males in the Bagley et al.(1994) sample had experienced repeated but unwanted sexual experiences with a man before the age of 15 (which is average for the male population), with another 8 to 10 percent reporting such experiences as a one-time event. Bagley(1994) also reported that 3% of males had been consensually and repeatedly sexually involved with at least one man before the age of 15.27 Overlapping with these respondents were another 5% of males having sexual experiences with at least one other male approximately their own age before the age of 15. Therefore, from the Shaffer et al.(1995) random sampling for about 100 males, a minimum of 12% (about 12 males) should have reported same-sex experiences as either wanted (6%) and unwanted (6%). None of the control males, however, reported having had any same-gender sexual experiences.
With respect to the 95 adolescent males who committed suicide, only 3 were deemed to meet the criteria set by the researchers, either revealing their gay identity to others (one case), or having had same-gender sex. The methods used to determine such facts about a teenage boy, however, are faulty. I was homosexually active from the age of 5 to 19 with neither parents or teachers knowing anything about this. If I had committed suicide, my friends would never have never revealed what was happening between us sexually. To do this would have required them to admit their own involvement, and only highly skilled researcher could have obtained the required information from them; likewise if the situation was reversed and information was being culled from me if a friend I was having sex with had committed suicide. The Shaffer et. al.(1995) researchers do not appear to have such skills.
Uribe & Harbeck(1992) reported that most of the males in their sample of 37 high school gay/bisexual males, "did what they could to conceal their homosexuality because to affirm it was too painful. They devised elaborate concealment strategies, and the result of these strategies was to cripple them emotionally and socially... Thirty-five out of 37 were homosexually active when interviewed, and had been since the average age of 14. For the majority, their first sexual experiences were "with unknown males"(37:19-22). I have also found such behaviour to be common enough in Calgary with gay boys who were terrified of having their homosexual identity discovered by their classmates, friends, siblings, teachers, and especially their parents.
What, therefore, could a researcher have done to discover that one such teenage males was homosexually active if he had committed suicide? Ask his parents? His teachers? And what if the teacher or counsellor knows the truth because he was having sex with the boys? Would a friend designated by his parents know? I doubt it. And if so, will the friend talk? Obviously, before doing their study, the Shaffer et al.(1995) researchers did not do their homework.
To date, researchers still have not asked gay/bisexual male teenagers who made suicide attempts rated in the "moderate to high lethality" category questions like:
Far more troubling, however, is the conclusion: "...that when suicide does occur among gay teenagers, that it is not a direct consequence of stigmatization or lack of support."(104:64) This conclusion is based only on three suicides of known homosexual male teenagers and is equivalent to concluding - from the Bagley(1994) result indicating 3 homosexually active gay/bisexual males who had attempted suicide, of which 2 had been sexually abused - that gay and bisexual males primarily attempt suicide because of being sexually abused as children. Or, alternatively, that they do not attempt suicide for a particular reason because the factor was not present. The only conclusion which can be made from the Bagley(1994) data is related to the percentage of young adult males who were homosexually active as young adults and had attempted suicide during their youth.
Anything significant about the possible factors related to the suicide attempts for gay or bisexual males - such as a particular problem or the cumulative effects of many interrelated problems - must be studied by obtaining a large enough representative sample of homosexually active gay and bisexual males who have attempted suicide. Only with such samples can the statistical significance or insignificance of postulated factors be determined.
Finally, the Shaffer et al.(1995) study produced four victims in the effeminate category. Remafedi et al.(1991) reported that effeminate gay males were three times more likely to attempt suicide than other gay males(31), thus confirming what gay males have always known. Effeminate males, since early childhood, receive the brunt of society's hatred for gay males, and are therefore the most stigmatized of all male youth. They are also strongly suspected to be homosexually oriented, even though Shaffer et. al opposed this conclusion.
The Bell & Weinberg(1981) study did not have one heterosexual male in their sample rate themselves in the 0 to 2 category on a 0-6 feminine to masculine scale, while 28% of predominantly gay males gave themselves this "label" for the period defined to be "while you were growing up."(113:75) This study also determined that gender nonconformity was the most distinguihing feature between gay and heterosexual males(22:79-81). In the 1987 Sissy Boy Syndrome study, the 44 "feminine" boys studied over many years became young adult men with a 75% probability of being gay or bisexual, as rated by the Kinsey 0-6 fantasy/behaviour scale. A control group of 35 "conventionally 'masculine' boys" only produced one young adult male in the bisexual category(115:99-101).
Therefore, noticeably effeminate males are most likely gay, or they may be (mostly heterosexual) transvestites or transsexuals who form a very small percentage of the male population. That 4 out of the 95 male suicide victims were effeminate suggests that these male are at much higher risk for suicide than other males. Shaffer et al.(1995) were nonetheless silent about this, even if it was noted that not one of the males in the control group was rated to be "abnormally effeminate" using the same scale used to define victims to have been effeminate(104:70).
The closet factor has been so pronounced for GLB youth involved with professionals that the Alberta Alcohol and Drug Abuse Commission's Adolescent Program had never, until September 1995, encountered a youth who revealed his/her homosexual orientation on intake. They have now had their first experience in this respect with two gay youth I know. Their adolescent treatment professionals have not yet been educated and trained to effectively address GLB substance abuse problems, and all the GLB issues which factor into these youths having such problems.