A friend of mine here is a psychologist who worked at the suicide hotline for a while as he was getting experience in the early days. He told me about when he would lose people on the other side of the line. It was pretty intense. He always said the adage, “Anger is depression turned outward.” Occasionally, that's rephrased as “Anger is fear turned outward.” Clinicians must separate the possible diagnoses or decide if they're concurrent (comorbid). Often, men will be diagnosed with something else, narcissistic personality, for example, because, as you say, violent outbursts aren't a part of the diagnostic criteria. But you have to wonder where one ends and the other begins. At the end of the day, what matters most in mental healthcare is getting the patient well and while diagnosis is a crucial part of that process, it's not the only part. If the treatment works, it doesn't matter what the diagnosis is on paper.
One big problem, here in America, is economic. We have great access to mental health treatment, contrary to popular belief, arguably better than the rest of the world, but we live in a ruthless, cutthroat economic environment of dog-eat-dog capitalism that's not conducive to healthy, balanced, comfortable living. I've also heard sayings like, “Women turn to therapy, men turn to alcoholism,” and I think that's true and a pretty rigid gender difference we see across cultures and across the animal kingdom, especially if we add a little bit onto the end, “…men turn to alcoholism and, or violence.”
Regarding suicide, testosterone certainly must play a role. Males evolved complex physiology that make some of us rush into battlefields even in cases of near-certain death, to take unbelievable risks, and to hold things like honor in high esteem, high enough to die and kill for. No doubt, this plays a role in the far more successful male suicide rate, just as it plays a role in the more successful male homicide rate, and I think it's not analyzed or discussed enough for fear of being labeled sexist. But it holds true across all cultures that men tend to be more violent by far, committing far more violent crimes and suicides. The discrepancies aren't small. That simply can't be cultural.
- "At the end of the day, what matters most in mental healthcare is getting the patient well and while diagnosis is a crucial part of that process, it's not the only part. If the treatment works, it doesn't matter what the diagnosis is on paper." Yes! Especially for affective disorders, diagnoses are very fuzzy. Just look at different versions of the DSM - depression, anxiety, bipolar, etc. can all be less than straightforward to tell apart *and* they often run in and through each other, sharing symptoms as well as treatment strategies that can potentially help.
- Hypercapitalism ftw. Part of this, I think, is that we are given the myth of meritocracy while it's not always true that skill + work equals success. Dog-eat-dog, as you say. In contrast to libertarian idea(l)s, meritocracy requires a foundation of equity (which we often do not have). Hence not reaching your desired level of 'success' inevitably feels like a personal failure. But that's a whole essay in itself ;). Another (admittedly) stereotypical gender difference that can come into play here is that women tend to be more comfortable/less stigmatized (?) for opening up to friends (and, perhaps, that they - on average - have more friends to do that with?).
- Finally, the testosterone issue is complex and interesting. Too high and too low are both problematic when it comes to mood. For suicidal ideation, a high testosteron/cortisol ratio seems to be a risk factor (https://pubmed.ncbi.nlm.nih.gov/27567115/), possibly by driving aggression and impulsivity. Interestingly, the effect of testosterone levels depends on age - high is a suicide risk in young adults, low in the elderly (https://pubmed.ncbi.nlm.nih.gov/23893672/). Although, as you note, the research on this is sadly lacking.
Everything you said is spot-on here. Do you have Telegram, by the way, or WhatsApp? If so, feel free to reach out @joemduncan (I've also got the same handle on 𝕏). It would be cool to discuss ideas and swap research outside the comments sections of platforms.
An important topic to raise awareness to and discuss more frequently! I hope you are doing well in this regard.
Thanks, Monica.
A friend of mine here is a psychologist who worked at the suicide hotline for a while as he was getting experience in the early days. He told me about when he would lose people on the other side of the line. It was pretty intense. He always said the adage, “Anger is depression turned outward.” Occasionally, that's rephrased as “Anger is fear turned outward.” Clinicians must separate the possible diagnoses or decide if they're concurrent (comorbid). Often, men will be diagnosed with something else, narcissistic personality, for example, because, as you say, violent outbursts aren't a part of the diagnostic criteria. But you have to wonder where one ends and the other begins. At the end of the day, what matters most in mental healthcare is getting the patient well and while diagnosis is a crucial part of that process, it's not the only part. If the treatment works, it doesn't matter what the diagnosis is on paper.
One big problem, here in America, is economic. We have great access to mental health treatment, contrary to popular belief, arguably better than the rest of the world, but we live in a ruthless, cutthroat economic environment of dog-eat-dog capitalism that's not conducive to healthy, balanced, comfortable living. I've also heard sayings like, “Women turn to therapy, men turn to alcoholism,” and I think that's true and a pretty rigid gender difference we see across cultures and across the animal kingdom, especially if we add a little bit onto the end, “…men turn to alcoholism and, or violence.”
Regarding suicide, testosterone certainly must play a role. Males evolved complex physiology that make some of us rush into battlefields even in cases of near-certain death, to take unbelievable risks, and to hold things like honor in high esteem, high enough to die and kill for. No doubt, this plays a role in the far more successful male suicide rate, just as it plays a role in the more successful male homicide rate, and I think it's not analyzed or discussed enough for fear of being labeled sexist. But it holds true across all cultures that men tend to be more violent by far, committing far more violent crimes and suicides. The discrepancies aren't small. That simply can't be cultural.
What an amazing comment, Joe! Thanks.
- "At the end of the day, what matters most in mental healthcare is getting the patient well and while diagnosis is a crucial part of that process, it's not the only part. If the treatment works, it doesn't matter what the diagnosis is on paper." Yes! Especially for affective disorders, diagnoses are very fuzzy. Just look at different versions of the DSM - depression, anxiety, bipolar, etc. can all be less than straightforward to tell apart *and* they often run in and through each other, sharing symptoms as well as treatment strategies that can potentially help.
- Hypercapitalism ftw. Part of this, I think, is that we are given the myth of meritocracy while it's not always true that skill + work equals success. Dog-eat-dog, as you say. In contrast to libertarian idea(l)s, meritocracy requires a foundation of equity (which we often do not have). Hence not reaching your desired level of 'success' inevitably feels like a personal failure. But that's a whole essay in itself ;). Another (admittedly) stereotypical gender difference that can come into play here is that women tend to be more comfortable/less stigmatized (?) for opening up to friends (and, perhaps, that they - on average - have more friends to do that with?).
- Finally, the testosterone issue is complex and interesting. Too high and too low are both problematic when it comes to mood. For suicidal ideation, a high testosteron/cortisol ratio seems to be a risk factor (https://pubmed.ncbi.nlm.nih.gov/27567115/), possibly by driving aggression and impulsivity. Interestingly, the effect of testosterone levels depends on age - high is a suicide risk in young adults, low in the elderly (https://pubmed.ncbi.nlm.nih.gov/23893672/). Although, as you note, the research on this is sadly lacking.
Always a pleasure when you stop by :).
Everything you said is spot-on here. Do you have Telegram, by the way, or WhatsApp? If so, feel free to reach out @joemduncan (I've also got the same handle on 𝕏). It would be cool to discuss ideas and swap research outside the comments sections of platforms.
Just said hi on Telegram.
True (interestingly, that gender difference gets smaller with age). Good thing it isn't just about neuroticism.