New West Feature

Death by Suicide: Exposing the Soft, White Underbelly of the West

By Clarence Worly, Guest Writer, 9-22-10

	If all else fails, the Western way tells us to drown our sorrows around a campfire with buddies or uncork a few bottles of Merlot with girlfriends. The problem with the cowboy approach to mental wellness is the high casualty rate it creates. Photo by Alabama Worly.

I attended my first funeral at the age of 15. It was for my friend and teammate who passed away in the spring of 1977 due to a self-inflicted gunshot wound. He just turned 16.

This was my first experience dealing with the death of someone with whom I was close. I couldn’t get my mind around the fact he was gone.  We wouldn’t be taking cheap shots at one another during football practice the next fall. We wouldn’t be shot-gunning beers stolen out of his dad’s garage fridge. We wouldn’t be grab-assing in the halls or lying to each other about all the girls from other schools.

He was gone, stuck in time as a standout high school half-back and all around good dude. After 33 years, I still feel the initial shock and emotional devastation when I dwell on it too long.

There were no warning signs, no telltale “I-should-have-seen-it-coming” behavior. I remember the last thing I said to him as we walked out to the parking lot after school like it was yesterday, “Let’s get shit-faced this weekend.” He yelled back over his shoulder, “Sounds good, call me.”

He died that night.

I wish I could say this was an isolated incident: Chalk it up to teenage angst and blame the mental health community for letting one rare case fall through the cracks. But I know better.

I attended my next funeral at the age of 22. It was for my friend and fellow musician who died the summer of 1983 due to a self-inflicted gunshot wound. He was 21.

Source: CDC website using the WISQARSTM (Web-based Injury Statistics Query and Reporting System) database.

I saw my friend for the last time in Sun Valley. He had driven three hours to lend some badly needed moral support for a crappy ‘80s cover band I played in and he was ready to whoop it up. We had a blast and before we went our separate ways I asked him if he needed a place to stay that night. “Naw, I’m gonna camp out somewhere,” he replied. I wish I’d gone with him. He was gone five days later. Again, I remember that conversation like it was yesterday.

I managed to get through the rest of my 20s and 30s without losing any more close friends. Oh, I went to more funerals, but they were held for relatives who’d lived full lives. Contrary to popular belief, there’s nothing terribly tragic or heartbreaking about a 72-year-old heavy smoker dying of a stroke. It’s expected; losing someone who was apparently healthy and had many years ahead is not.

I found myself standing next to another closed casket during the winter of 2005. It held my friend and fellow fisherman, who died due to a self-inflicted gunshot wound. He was 44. I always respected him as a no-bullshit, take-charge Idahoan who proved himself to be a fine outdoorsman and a good provider for his family.

Yet he left behind a wife of 20 years and a teenage daughter who were counting on him. His death took me right back to the emotional state I was in at 15. Once again, I just couldn’t get my mind around the fact he was gone and had left his wife and daughter to fend for themselves.

There is nothing more uncomfortable and unsettling than attending a funeral for a victim of suicide. The clergy tactlessly expose the white elephant in the room by referencing sin and damnation connected to the circumstances surrounding the death. Oh yes, the officiate will pray for their forgiveness, but it’s obvious mental illness is not recognized as a legitimate disease by organized religion. At least, not at the funeral.

If someone is killed in a car wreck or dies of leukemia that, too, is tragic but, apparently, all is going to be wonderful in the afterlife. Somehow, that message never comes across at the funerals of people who take their own lives, at least not the ones I have attended. During a time when family and friends are trying to make sense of what went wrong, the last thing they need to hear are judgmental eulogies based on biblical rhetoric and medical ignorance. 

Thankfully, time has a way of softening the emotional blows received and, years later, I find I can look back on the deaths of my old pals with less anger and more logic. People in their right minds do not kill themselves; they are sick, just as if they had cancer or diabetes. They died because they suffered from a life-threatening disease called depression that went undiagnosed.

This map (Source: Centers for Disease Control and Prevention, National Injury Mortality Data) illustrates the age-adjusted suicide death rate across the United States. Note the brown band running from the border of Mexico north to Canada, which represents the highest rate: 14.94-23.37 per 100,000 people.

DOES THIS HAPPEN ALL OVER THE WEST? YES

If you grew up in the Mountain West, you probably know someone who has taken his or her own life. It’s really that common. Based on my experience, depression isn’t truly taken seriously by the indigenous population out here where the buffalo roam.

We live in a culture that requires a do-it-yourself—no pissing, no moaning—cowboy-up mentality if you want to be accepted socially. The public perception is that only the weak-minded and emotionally unstable would ever consider getting professional treatment for depression. Most Westerners don’t think of depression as a serious medical condition caused by a chemical imbalance in the brain. The fact is we largely don’t consider depression at all.

The image of John Wayne or Clint Eastwood lying on a couch, sobbing like a schoolgirl and spilling their guts to a shrink because they’re in mental anguish just doesn’t gel with the national persona of how the West should be.

If you feel down, think happy thoughts. If you’re miserable, pray about it. If all else fails, drown your sorrows around a campfire with your buddies or uncork a few bottles of Merlot with your girlfriends. This approach seems to work for the majority of folks living out here.

The problem with the cowboy approach to mental wellness is the high casualty rate it creates. The Center for Disease Control has been tracking self-inflicted death statistics for 60 years. Guess which states consistently carry the notorious distinction of having the highest suicide rates in the nation? Montana, Nevada, Idaho, Wyoming, Utah and Colorado jockey for pole position and do so every year.

By contrast, East Coast states like New Jersey, New York and Massachusetts are ranked as having the lowest suicide rates. On a side note, the 2009 CDC database shows Alaska had the nation’s highest rate, followed closely by Montana. Washington, D.C., had the lowest. All of the Mountain West states were at the top of the 2009 death rate data—as usual.

Between 1999 and 2007 there were nearly as many suicides as highway fatalities in the mountain west states. In the case of Colorado, Utah and Nevada, there were more self-inflicted deaths than traffic deaths. Am I the only person west of the Mississippi to see a problem here?

To put these data in better perspective, as of Sept. 17, 2010, there have been a total of 6,816 coalition military fatalities during our nine years supporting Operation Enduring Freedom in Afghanistan and seven years supporting Operation Iraqi Freedom (source: casualty.org). In our little six-state region, we have had roughly three times the number of deaths due to suicide than both wars combined during the same nine-year period.

I ran this search three separate times using different parameters for each search to confirm these data because I did not believe it could be correct. I assumed the WISQARSTM data base on the CDC website to be a reliable source. For now, I argue the data I have presented is accurate. I hope readers will find enough interest to do perform their own investigations. The numbers presented here show a trend nothing short of an epidemic.

WHAT CAN BE DONE?

The mental health community is aware of the problem we have in our beloved Rocky Mountains. There have been many research studies conducted in the past 30 years. The following four factors seem to be the overall conclusions as to why our suicide rates are so high, based on the half dozen studies I read in preparing this column.

From “Ranking America’s Mental Health: An Analysis of Depression Across the States” by Thomson Healthcare:

Mental health resources: The more mental health professionals in the state (specifically, the higher the number of psychiatrists, psychologists or social workers per capita), the lower the suicide rate.

Barriers to treatment: The analyses indicate that the greater the percentage of the population reporting they could not obtain healthcare because of costs, the higher the suicide rate. The portion of the population reporting unmet mental healthcare need was positively associated with suicide rates, although the connection did not quite reach conventional levels of statistical significance.

Mental health utilization: Holding the baseline level of depression in the state constant, the higher the number of antidepressant prescriptions per capita, the lower the state’s age-adjusted suicide rate. In addition, there was a trend showing that the higher the percentage of the population receiving mental health treatment, the lower the suicide rate.

Socioeconomic characteristics: The more educated the population, the lower the suicide rate. The greater the percentage of the population with health insurance, the lower the suicide rate. Median household income was negatively associated with suicide rates but, again, the connection did not quite reach conventional levels of statistical significance.

The most important factor about depression and suicide in the Mountain West seems to have been overlooked in these conclusions. It’s one I mentioned earlier, essentially: We all have reputations to keep up and no self-respecting Westerner is going to bellyache about having the blues once in a while.

No one I know is going to seek professional help for depression, regardless of how many psychiatrists, psychologists or social workers we have per capita. No one I know is going to replace a campfire and a bottle of whiskey with Prozac or Wellbutrin or Depakote. Above all, no one I know will ever bear their soul to anyone and admit they’re feeling suicidal. We grew up in the West; we just don’t do that.

To prove my point, the Idaho legislature dropped our suicide hotline in 2007, due to budget cuts and lack of utilization. That move makes Idaho the only state in the union without a similar service. Meanwhile, Idaho was ranked No. 6 for self-inflicted death in 2007. But in our state government’s defense, no one I know would ever pick up a phone and call the hotline, especially now that we don’t have one.

When I began writing this piece I had planned to conclude by offering links to mental healthcare sites, federal and state suicide prevention programs and suicide hotlines. But on further reflection, I realize those actions are futile, at least out here.

We spend our time and tax dollars squabbling over issues like wolf reintroduction, grizzly habitat, public land use and Yellowstone cutthroat populations instead of saving our citizens from self-destruction. I’m not sure why, but our priorities seem to be skewed. 

As much as I dislike the cliché term “raising awareness,” I guess that’s what I’m trying to accomplish here. I don’t see a solution at the moment; I’m just sick of so many of us dying by our own hand and having the deaths swept under a rug of shame by a culture entrenched.

Until we break down the Western stigma surrounding mental health and start treating depression as a real life-threatening disease, nothing is going to change and we can look forward to another 17,853 deaths over the next nine years.

Clarence Worly blogs about life and other topics at Clarence Worly’s Southeast Idaho.

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