Male suicide rates four times higher than females nationally; problem seems to have cultural roots in stoic Midwest
Kurt Schreiner was many things. A fun uncle who faithfully attended his nephew's football games. A charming ladies' man who loved to travel. A kind-hearted soul who made you feel like his best friend and doled out the perfect advice.
That was on the outside.
On the inside, Schreiner struggled. With drugs and alcohol. With his rightful place in the world. With an engagement that broke off.
"Kurt wore the depression mask better than anyone I have ever met in my life," says Kursten Dienert, his oldest sister. "What we came to find out was that, behind closed doors, he had lost hope in himself and belief in himself."
On Jan. 26, 2009, the Bismarck man visited a tattoo shop to finish the final phase of a huge tattoo on one arm. He went out for dinner with his sisters and their families, and they all laughed, visited and teased each other. They asked about his tattoo, still covered by a bandage.
Afterward, he returned to the home of his parents, who were out of town, and he shot himself.
He died on his 27th birthday.
Stories like this are all too common. Locally, suicides this month of high-profile men such as Fargo attorney Steven M. Light and the Rev. David Syverson, a Fargo priest, have shocked the community.
Nationally, suicide rates are four times higher in men than they are in women across all age groups, says Dr. Paula Clayton, medical director of the American Foundation for Suicide Prevention.
"It's alarming at this point," Clayton says.
And they are on the rise. Male suicides have risen from a rate of 17.5 per 100,000 people in 2000 to 19.2 per 100,000 in 2009, according to statistics from the AFSP and Suicide.org.
The reason for the upswing is complex. The Department of Defense reports more suicides from post-traumatic stress-affected veterans. Unemployment and economic downturns historically boost suicide rates, Clayton says.
And men tend to use more lethal methods, such as firearms, than women do. In fact, 80 percent of all firearm-related suicides involve white males, according to the National Alliance on Mental Illness.
Factors like mental illness and alcohol also play a powerful role. Over 60 percent of people who die by suicide suffer from major depression. If you factor in alcoholics who are also depressed, that number jumps to 75 percent, according to the AFSP.
But masculine suicide seems to have deeper cultural roots, especially in the traditional, stoic Midwest. From an early age, most men are conditioned to take care of others, suppress their emotions and figure out problems on their own.
'Believing the lie'
It was only after his death that Schreiner's family saw the tattoo. It included koi fish, a large open rose and a theatrical mask with a disturbingly sad face.
The mask made sense. Kurt, everyone's fun, happy-go-lucky friend, had worn one for years.
Dienert, who has since become an advocate for suicide prevention, knows many men are like her brother, hiding emotional pain under a façade.
"I hear more and more from those who have lost a male to suicide that they hide their depression so well under this mask," says Dienert. "They appear outwardly happy. They aren't the typically depressed person who is lying on the couch all day and is not involved in the outside world."
Dienert thinks her brother hid his depression because he believed it made him seem weak.
"Although depression is never a sign of weakness, we as a society had made it out to be that. But it's a chemical imbalance, it's an illness. And just like women, men need our support just as much," she says.
Dr. Danial Sturgill, a Sanford psychologist, seconds that thought. As parents, he says, we comfort and support the little girl who cries, but we tell little boys to "be a big boy," or "walk it off."
"We tend to grow up believing that men are not supposed to show or feel emotion, which isn't true. We grow up believing that lie," Sturgill says. "So men's depression tends to go underground."
The pressure to be the strong, silent type is even greater for independent Midwesterners from stoic Northern European stock. "I think with agrarian families in general, there's a lot of encouragement to suck it up and do it yourself," he says. "There's some fabulous things about those traits, but if you're dealing with clinical depression, this is a situation you need to handle differently."
Suffering in silence
Gender differences in friendships also can play a part. Women confide their problems and vulnerabilities to their female friends, while men tend to limit their social interactions to less personal topics.
"It's more difficult for men to talk about their concerns and things that are meaningful and difficult in their lives," Sturgill says.
Tom and Audrey Richmond of Fargo say their son, Roy, had a circle of male friends who would rally around him when he struggled with depression or the alcohol dependency that had plagued him since his 20s. They'd take him fishing or work on cars together.
Even so, Roy was a reserved, fiercely independent man who remains an enigma to his family even after his 2009 suicide.
"We could go four to six weeks and he wouldn't call," says Tom Richmond, a retired Concordia professor. "I think he just didn't want to bother us."
His parents saw their only son as a bundle of contradictions. He had learning disabilities, but was a natural writer. He didn't make much money, but was unfailingly generous to others. He suffered from a painful, autoimmune disease for decades, yet rarely asked anyone for help.
Like any parent would, they've wondered what made him give up hope. They ask if his self-esteem problems came from being bullied in grade school and junior high because he was small for his age. They discovered he had stopped refilling his depression medication, as a stubborn protest against his insurance's high co-pay. They wonder if he'd just been playing around with his gun and didn't mean to shoot himself.
But in Roy's death, as in his life, it was hard to know what he was thinking.
Getting him to get help
The Clint Eastwood mask - the belief that men need to be tough, reserved and self-reliant - also prevents males from seeking help when it's needed most.
"Men are less likely to engage in treatment for any condition, whether it's cancer or a lump or a skin rash or whatever," Clayton says. "It's just harder to get men to go to the doctor."
But if husbands or significant others are acting strangely, it's important to say something.
Men can show classic depressive symptoms (hopelessness, pessimism, etc.), but they may also talk of physical complaints such as headaches or stomach trouble. Depressed males are more likely to act out with irritability and angry outbursts, Sturgill says.
In fact, studies have shown a significant link between increased impulsivity and aggression and suicide risk.
"If your husband punches walls when he gets mad, he's in more danger," Clayton says.
Another risk factor for suicide is alcohol or drug abuse. Although Kurt Schreiner was clean and sober for 2½ months before his suicide, authorities found his blood alcohol level was extremely high at the time of his death.
"That is a really deadly combination in terms of people who have depressive symptoms. You mix in these substances and their inhibitions are down and their judgment is down," Sturgill says.
A wife may hesitate to say anything, for fear she'll offend her husband or even plant thoughts of self-harm into his head. But speaking up has the opposite effect.
"Just asking the question makes it less likely that the person will do something," Sturgill says.
One should never assume that people are talking about death or self-harm simply to get attention.
"People should take that very seriously," Sturgill says. "If someone is trying to get your attention, it means there's an unmet need of some sort."
Clayton believes the best medicine is to talk compassionately and honestly.
A typical opener might be: "I love you and I'm concerned about you." That can lead to specific worries, such as: "You've stopped going to church, you're not eating, and you've isolated from friends."
The help doesn't stop there. The concerned party should set up an appointment with a doctor or counselor, then accompany them to the appointment to make sure the patient mentions it, Clayton says.
And they need to monitor the situation for a while, because depression can be episodic and recurrent.
The first medication doesn't always work, but there is hope for those who are willing to set aside their masks and seek help.
"The other thing we know about suicidal thoughts is that if we can get someone through those times, it does go away," Sturgill says. "I find that once people come in the door, they realize they're not going to be told that there's something terribly wrong that they can't get help for. It's just getting through that door."
'If I knew then'
The years following Kurt Schreiner's death have been difficult. Her parents' marriage did not survive their son's death, Dienert says.
Yet there have been hopeful, happy days. Dienert's sister, Delaine Ballard, had a baby girl two years ago. And the loss of their brother drove home the importance of loved ones so much that they now call each other daily.
Dienert and Ballard are both involved in the North Dakota chapter of the American Foundation for Suicide Prevention, for which Ballard helped start an "Out of the Darkness" tribute walk in Jamestown.
As her own tribute, Dienert had Kurt's tattoo redrawn and placed on her back. She says it's a way to keep her beloved little brother with her always.
"If I knew then what I know now, which is way too much about suicide, I may have been able to say, hey do you need help? Is there more I can do to help you?" she says. "Serious depression is no different from someone diagnosed with cancer. We really need to step up and make people aware that something needs to be done."
Suicide warning signs
Suicide can be prevented. While some suicides occur without any outward warning, most people who are suicidal do give signs, such as:
* Observable signs of serious depression (unrelenting low mood, pessimism, hopelessness, desperation, anxiety, withdrawal, sleep problems).
* Increased alcohol and/or other drug use.
* Recent impulsiveness or taking unnecessary risks.
* Threatening suicide or expressing a wish to die.
* Making a plan (giving away prized possessions, sudden purchase of firearm).
* Unexpected rage or anger (more common in men).