Increasing Awareness of Gay, Lesbian, Bisexual, Transgender, Two Spirit, Queer... Suicide Issues

Notes

Note 1

Sexual Minorities in Psychiatry, Psychology, Community Psychology, Family Therapy, Social Work, Health / Medicine, and Suicidology: A History of Slow Changes from Outright “Harm” to Harmful “Avoidance” & “Indifference.”

“Outright and Indifference” Harm by Mental Health Professions: to 1973/1992

The profession of psychiatry decreed adult homosexuality as a “Mental Disorder”, sanctioning unquestioned harmful practices for many decades until it was finally declassified as a disorder from the DSM (Diagnostic Statistical Manual of Mental Health Disorders in 1973/74 and completely removed in 1986. However, it remained a mental disorder until 1992 for those using the ICD: WHO’s International Classification of Diseases and Related Health Problems (Herek, 1998-2007). Adolescent homosexuality, on the other hand, had been viewed as a normal part of adolescence that was not pathologised nor minoritised by developmental psychologists. By the early 1970s, however, “silence” about this subject became the rule (Spurlock, 2002), almost as if the attribute should NOT exist, or that its place in human development applied to so few (giving it a rare “sexual minority” status) that it could be ignored. This outcome left for psychologists and other mental health professions to foster harmful practices of avoidance and indifference.

Avoidance & Indifference: 1973-2000

American/Canadian Psychology (1994): What contemporary psychology had been doing to advance the knowledge and understanding of homosexual development is best summed up in the title of a paper “"I only read about myself on bathroom walls": the need for research on the mental health of lesbians and gay men” (Rothblum, 1994). Some recent improvements have been described by Phillips et al. (2003) and Morrow (2003), the latter noting that serious problems still exist: “Lesbian, gay, and bisexual (LGB) concerns continue to be underrepresented in the counseling literature, although progress was made in the 1990s in the content and quantity of literature dealing with these issues. Despite progress in several areas, the scholarship on specific marginalized groups within the LGB community is particularly sparse: LGB people of color, bisexual women and men, lesbian women, LGB people with disabilities, and transgendered individuals.” Phillips et al. (2003) also noted the lack of “attention to within-group differences (e.g., bisexual people and LGB people of color).”

Family Therapy (1997): “Twenty years and still in the dark?” by Clark & Seovich in the Journal of Marital and Family Therapy, 1997. This was a content analysis of articles pertaining to gay, lesbian, and bisexual issues in marriage and family therapy journals. Very little published on “gay/lesbian” issues (0.6% of articles). Bisexuality was almost totally ignored. This reflects the recent common (hegemonic?) belief that sexual orientation is binary in nature. On individuals is either heterosexual or homosexual.

Social Work (2001): Coverage of Gay and Lesbian Subject Matter in 12 mainstream Social Work Journals by Van Voorhis & Wagner in the Journal of Social Work Education, 2001. The most coverage (two-thirds) in four major social work journals from 1988 to1997 was AIDS-related. Heterosexism is the rule as Voorhis & Wagner (2002) noted in a paper with a telling title: “Among the Missing: Content on Lesbian and Gay People in Social Work Journals.” Bisexuality is almost totally ignored. In a 1998 Interview, Ann Hartman reports: “"I remember one of my friends overheard several of the male deans at a social work Dean's meeting communicating with each other saying, 'The lesbians are taking over the field.' I am sure there is still plenty going on underground, as you can imagine. For instance five or six years ago there was a concerted, but rather quiet effort led by some of the deans to keep homosexuality out of the Council on Social Work Education guidelines" (Miller, 1998).

Community Psychology (2003): Special GLBT Issue in American Journal of Community Psychology, 31(3/4). D'Augelli (2003: 345) describes the lack of coverage of GLB issues in community psychology: "...little work was done by community psychologists on LGB issues until the very late 1990s. Harper and Schneider (2003: 244-5) reported on two studies of GLB content in major community psychology journals: no more than one percent of published articles had been related to GLB issues. Bisexuality is almost totally ignored.

Suicidology: Remafedi, G. (1994a), in his book Death by Denial, reported on a part of the story related to mainstream suicidologists often denying that sexual minority youth are at risk for suicide: "Fueling the intrusion of politics into the science, well-funded scholars sometimes oppose new perspectives in their own field of research. Writing in the New Yorker magazine, a prominent suicidologist dismissed existing data on the risk for suicide for homosexual youth based on his perception that the participants [suggesting an "at risk" suicide situation for homosexually oriented people, including youth] status had been 'unusual groups of gays' and criticized activists for using the data to justify social tolerance. He concluded; 'Suicide is usually a story of misperceptions and misunderstandings, of feelings of despair and lack of control; it cannot be attributed simply to having a difficult life. And it has no place in anyone's political agenda, no matter how worthy.' It is ironic that such critiques of peer-reviewed, published research are aired in popular magazines, rather than submitted to comparable scientific scrutiny. Even more disturbing is the fact that scholars themselves try to foreclose discussion of promising new ideas in defense of their own viewpoints and interests (p. 8-9)."

Emslie (1996) summarized the situation existing in mainstream suicidology with the title of the paper "Ignored to death: representations of young gay men, lesbians and bisexuals in Australian youth suicide policy and programs" and, more recently, McAndrew & Warne (2004) spoke to similar problems existing in the United Kingdom. However, all review papers on the subject have expressed concerned about the "at risk" status of homosexually oriented people for lifetime suicidal behavior, and especially by youth (See: Bibliography: Review Papers). However, "word on paper" - or in review papers - does not necessarily mean that related "actions" will be taken. For example, the vast majority of mainstrean suicidology studies continue to ignore homosexuality when soliciting information from study participants. The CDC (Centrers for Disease Control) also continues to produce "official" Youth Risk Behavior Survey questionnaires that avoid sexual orientation issues (CDC, 2007).

Health/Medicine: Healthy People 2010 (USA): In 1998, “outrage at the exclusion of lesbian, gay, bisexual, and transgendered health issues in an 800-page federal health plan, the Gay and Lesbian Medical Association [GLMA] has announced a plan of action…” When inclusion happened: "This marks the first time, LGBT health concerns, other than HIV, have been addressed in any significant way," said Patricia Dunn, GLMA policy director. "This is a major step forward in national health policy. Such issues as the lack of adequate research, barriers to quality health care, and insensitivity to LGBT people within the medical community, are finally being addressed" (GLMA News Release, 1998, 2000) Canada: The first Health Canada sponsored meeting of invited individuals concerned about GLBT health issues (T = Two-Spirited, Transgender Issues Not Included) occurred in 2001 at McGill University.

Inclusion in Healthy People 2010 eventually occurred as reported in GLMA News Release (2000), which reported on the publication of a related White Paper (Dean L, et al., 2000): “Both Dunn and Carter believe that the GLMA-Columbia white paper begins to address the serious deficit of public knowledge about the health care needs of LGBT people. The GLMA-Columbia white paper is a precursor to an even more comprehensive companion piece on LGBT health that will follow the final Healthy People 2010 document to be published by the Department of Health and Human Services (DHHS) later this year.” For a companion document, see: Gay and Lesbian Medical Association and LGBT health Experts (2001). Many problems, however, still are to be overcome as indicated in the title of O'Hanlan’s paper “Advocacy for Women's Health Should Include Lesbian Health” (O’Hanlon, 2004) that maybe should have been titled “Advocacy for Women's Health Should Include Health Issues for Lesbian and Bisexual Females” to make sure the whole continuum of Women’s Health is included.

Note on Bisexuality: The avoidance/exclusion/erasure of bisexuality issues was reported by Yoshino (2000) in the109-page law paper “The epistemic contract of bisexual erasure.” For relevant quotations, see Tremblay (2000a). For a summary of the “bisexuality” situation, see Tremblay & Ramsay (2000). For the “at risk” status of adolescents and adults in the “bisexual” categories presented in a Power Point presentation form and within the context of other “at risk” population (including the “at risk” situation of Multi-Race people) who are category/boundary violators/criminals in our all-too-common “binary” perceptions of things, see Tremblay & Ramsay (2003). Researchers often have the same harmful biases of populations they may be studying and collaborating with, and they may therefore participate in harming certain minority groups. For example, using the word “gay” to describe all sexual minority individuals is a way that those who describe themselves as “gay” privilege themselves over homo-oriented individuals or sub-groups they have marginalised and harmed. In an attempt to prioritise “bisexuality” with respect to some “at risk” issues such as mental health and suicidality, Tremblay & Ramsay (2003a) gave the following title to the male sexual minority suicidality information pages: “Bisexual / Gay / Queer Male Suicidality” as a highlighted contrast to the title at the companion web site by Tremblay (1996-2007): “Youth Suicide Problems: Gay/Bisexual Male Focus!”

Note 2

The early years of suicide prevention in Los Angeles.

Excerpts from Norman Farberow (1968): "Suicide Prevention: A View From The Bridge":

"The future of suicide prevention activities is seen in terms of developments over the past decade. Seventy-four suicide prevention services have been established since the Los Angeles Suicide Prevention Center was opened in I958. While many models have developed, principles of crisis therapy, transfer of patients rather than referral, use of the telephone in therapy, integration of the center into the community network of helping agencies, and use of nonprofessional volunteers are present as common elements in all."

"When the Los Angeles Suicide Prevention Center was established in 1958, there was no field of suicide prevention and there were no precedents from which it could develop. The Center emerged from the need to provide some resource for persons who had attempted suicide and had entered a hospital where they had received medical treatment, but were then returned to the environment and conflicts that had contributed to and produced their suicidal crisis (Farberow & Shneidman, 1961).

In its development the Center underwent many changes. The first concept of the Center was as a bridge, which attempted suicides could not cross
on their discharge without being interviewed and recommended to a treatment plan. The first major change in the functioning of the Center occurred with the development of the telephone as the primary means of contact with persons needing help, a procedure much different from the staff wandering through the wards of the County Hospital looking for patients admitted for a suicide attempt. With the acceptance of the telephone, the Center was able to focus on people who were calling for help before they hurt themselves rather than after the suicidal acting-out had occurred. As the case load zoomed, it forced a basic conceptualization of a suicide prevention center: the center best serves as an emergency, crisis-oriented community agency, focusing on the immediate stressful situation and offering crisis therapy, not long-term rehabilitative care. This developed another basic concept: that the center is but one agency in the community in the web of helping resources for emotionally disturbed individuals, and that it can function only in dose liaison with them all (Litman, Farberow, Heilig, Shneidman, & Kramer, 1965).

Note 3

The Institute in Suicidology

Under the heading "Future For The Los Angeles Center" Farberow (1968) announced plans for and institute that might be called "The Institute for the Study of Self-Destruction" and its role in suicide prevention:

:The Los Angeles Suicide Prevention Center, primarily through the development of its research activities, will evolve into an institute, probably named "The Institute for the Study of Self-Destruction." The title will reflect not only the involvement of many related disciplines but also the broadening of the subject area to include many pertinent topics, ranging from overt suicidal behavior to indirect self-destructive behavior seen in diabetes, circulatory and heart syndromes, alcoholism, drug addiction, obesity, traffic accident, violence and aggression, risk-taking behavior, and others. It becomes apparent that some familiar indirect self-destructive behavior is well within the scope of usual, normal behavior. The training activities of the Center will also increase. The Los Angeles Suicide Prevention Center is, as of now and probably for the next several years, the primary source in this country for training in suicide prevention. The Center is even now expanding its program of training of professionals, semiprofessionals, nonprofessionals, and related groups in the community, coordinating in the training of fellows in suicidology, and assisting in the development of films, training tapes, manuals, and other training aids. A complete library is being developed, and a continuing active role is planned in educational activities directed primarily to the general public."

By 1971, the institute has been named "The Institute in Suicidology" and "suicide education" announcements were being place in journals such as The Community Mental Health Journal (Vol 7(4), 1971, page 279:

ANNOUNCEMENT: INSTITUTE IN SUICIDOLOGY
WEST LOS ANGELES, CALIFORNIA
January 27, 28, and 29, 1972

Comprehensive training for people interested in the practice and study of suicide prevention and crisis services will be stressed.
Scheduled for January 27th, 28th and 29th at the Wilshire Hyatt House, the Institute is sponsored by the Los Angeles Suicide Prevention Center and the Center for Studies in Suicide Prevention of the National Institute of Mental Health.
Staff members of the Los Angeles and Washington, D.C. Centers will conduct training sessions in such areas as: Prediction of Lethality, Epidemiology, Current Research, Other Life-Threatening Behaviors, Community Involvement, Special Risk Populations, Telephone Interviewing and Training of Volunteers.
A special focus on the problems of "SELF-DESTRUCTIVE BEHAVIOR AMONG LEADERS IN GOVERNMENT AND INDUSTRY," will be
highlighted. The registration fee is $20.00.

A document related to The Institute in Suicidology - "Summary and Commentary on the Institute in Suicidology in Los Angeles" - was written by Meyer Moldeven in 1971, as reported in "Memoir: Suicide Prevention, The Viet Nam War, 1969-1974" (Moldeven, 2002):

"Later that same year (1985), I secured copies of studies, plans, directives, motivational guides and other documents published by NIMH, the American Association of Suicidology (AAS), and the Army on their in- house suicide prevention programs and which they provided to me in response to my appeals. I published in book form the material that I received, and marketed it on a not-for-profit basis to cover my printing and related costs. My initial report, printed on Feb 26, 1971 (during Viet Nam) was 'Summary and Commentary on the Institute in Suicidology in Los Angeles January 23-27 1971' and had limited distribution within the Air Force, and the next compilation was in June 1985, 'Military-Civilian Teamwork in Suicide Prevention.' A subsequent update was published in 1988 'Suicide Prevention Programs in the Department of Defense', and the last update, in 1994, returned to the original title 'Military-Civilian Teamwork in Suicide Prevention.'"

Note 4

In the documents...

Ramsay RF, Tanney BL, Tierney RJ, Lang WA. (1987, 1991). Suicide Intervention Skills Workshop: Trainer's Handbook. CA: State of California Department of Mental Health.

The following was written:

1987: "Sexual identity issues are now recognized as stressful events that may precipitate suicidal behaviors. Several studies have shown that homosexuals of both sexes are up to six times more likely to attempt suicide that comparable control group of unmarried heterosexuals (Bell & Weinberg, 1978; Saghir & Robins, 1973; Jay & Young, 1979). Recent clinical studies report similar results (Marten, Cleninger, Guze & Clayton, 1985). Comparable data on completed suicide among homosexuals is not available. These studies indicate that adolescence is highly stressful for young people who are struggling to accept their homosexual identity. Gay men are reported to more likely attempt suicide in their adolescent years during the time when they are trying to “come out”. Lesbian womens’ attempts occur at a later age and are more commonly related to breakup of relationships. The recent epidemic of AIDS and the stress of dealing with the multiple losses associated with the disease have increased case reports of attempted and completed suicide among homosexuals (Harry, 1986). "

1991: "Sexual orientation issues are now recognized as stressful events that may precipitate suicidal behaviors. Several studies have shown that homosexuals of both sexes are up to six times more likely to attempt suicide than a comparable control group of unmarried heterosexuals (Bell & Weinberg, 1978; Saghir & Robins, 1973; Jay & Young, 1979). Recent clinical studies report similar results (Marten, Cloninger, Guze & Clayton, 1985). Comparable data on completed suicide among homosexuals is not available. These studies indicate that adolescence is highly stressful for young people who are struggling to accept their homosexual orientation. Gay men are reported more likely to attempt suicide in their adolescent years during the time when they are trying to “come out”. Lesbian women’s attempts occur at a later age and are more commonly related to breakup of relationships. The recent epidemic of AIDS and the stress of dealing with the multiple losses associated with the disease have increased case reports of attempted and completed suicide among homosexuals (Harry, 1989).

Note 5

Suicide In Canada (Health Canada, 1994): Section on Sexual Orientation (pp. 24-25)

Gay men and Lesbians

"Several studies have found male and female homosexuals to be up to six and two times, respectively, more likely to attempt suicide than comparable control groups of unmarried male and female heterosexuals (Bell & Weinberg, 1978; Saghir & Robins, 1973; Jay & Young, 1979). The U.S. Secretary’s Task Force Report on Youth Suicide reviewed more recent studies and found similar results (Gibson, 1989). Gay men are reported to be more likely to attempt suicide during their adolescent years, in the context of the stresses associated with acknowledging their sexual orientation to their families, their communities and themselves. Lesbian women are reported to be more likely to attempt suicide at a later age, in the context of the breakup of a relationship.

Further research is required to clarify the epidemiology of suicide and parasuicide among gay men and lesbians. Tanney (1992, p. 303) argues that the existing data base linking suicidal behaviour with sexual orientation “is too thin and the studies too overinterpreted to allow meaningful conclusions at present.” Data on completed suicides in these populations are scarce. Established data collection methods do not include sexual orientation as a variable, and the stigma and discrimination associated with homosexual orientation discourage disclosure by persons at risk and by relatives of suicide victims. However, the available data on the prevalence of known risk factors (e.g. previous attempts, substance abuse, interrupted social ties) in gay and lesbian populations suggests that the rate of completed suicide may be quite high. Theoretical models linking suicide risk to stress and alienation tend to support this view (Saunders & Valente, 1987). Gibson (1989) estimates that gay and lesbian youth account for as many as 30 percent of completed youth suicides each year. He attributes the problem to a society which discriminates against and stigmatizes homosexuals, and which fails to recognize that a substantial number of young people have a gay or lesbian orientation. This makes it difficult for gay and lesbian youth
to identify positive role models, obtain appropriate counselling, and maintain the self-esteem, skills and social, family and interpersonal ties that protect against suicide."

Note 6

Using questions 5 and 6:

Lifetime: (Answers Required: Yes / No)

5. Have you ever deliberately harmed your self, but in a way that stopped short of a real intent to take your life?

6. Have you ever (in your whole life time) made an intentional attempt to take your life?

that were initially used in structured interview situations (Ramsay & Bagley, 1985; Bagley & Ramsay, 1985; Bagley & Ramsay, 1993) - proved to be highly effective in separating what some have called "true suicide attempters" from individuals who, for example, might have begun a suicide attempt and then stopped it, or called an ermergency service so that they would be rescued from a potentially deadly outcome. Such suicide attempts have sometimes been called "aborted attempts."

By using questions 5 and 6 in the Calgary random survey of 750 young adult males (Bagley & Tremblay, 1997, 1997a: Anonymous data intake using a computer), there were only 8 males who replied in the affirmative to question # 6. That is, only about one percent (1%) of males (8 / 750) had acknowledged having attempted suicide. Five of these suicide attempters were also homosexual/bisexual self-identified and/or had reported having been homosexually active in the past 6 months. The other three who had attempted suicide were heterosexual self-idendified.

Such a low incidence of true suicide attempters in a young adult male population (8 / 750) also means that very large random study samples would be needed to produce the much greater number of suicide attempters required so that comprehensive statistical analyses can be carried out.

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Ramsay R, Tremblay P (2004). The Changing Social Construction of Western Male Homosexuality: Associations With Worsening Youth Suicide problems. Poster Presentation: 2004 CASP (Canadian Association For Suicide Prevention) Conference held in Edmonton, Alberta in October.

Ramsay R, Bagley C (1985). The prevalence of suicidal behaviours, attitudes and associated social experiences in an urban population. Suicide and Life-Threatening Behavior, 15(3): 151-160.

Remafedi G (1994a). Death by Denial: Studies of Suicide in Gay and Lesbian Teenagers. Boston: Alyson Publication.

Remafedi G, French S, Story M, Resnick MD, and Blum R (1998). The relationship between suicide risk and sexual orientation: results of a population-based study. American Journal of Public Health, 88(1), 57-60.

Robin L, Brener ND, Donahue SF, Hack T, Hale K, Goodenow C (2002). Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students. Archives of Pediatric and Adolescent Medicine, 156(4): 349-55. PubMed Abstract.

Bibliography: Review Papers

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GLBTTsQQA Suicide Issues

Web Site Index

A History of Concern by Calgary Suicidologists About Homosexuality Related Suicidality Risks.

Pioneering Suicidality Research in Calgary, Including Homosexuality & Suicidality Research

Notes

Bibliography

Bibliography: Review Papers

Help Lines

Review Papers Related to GLBT Suicidality and Mental Health. - Papers Available Online Related to GLBT Suicidality.