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Being the strong silent type can be fatal Add to ...

Every day in Canada there are an average of 10 suicides. Yet, in recent days, the media have fixated on one of those apparent deaths, that of former professional hockey player Wade Belak.

Since the former Maple Leaf player was found dead in a Toronto condominium on Aug. 31, there has been a swirl of rumours and a yearning for explanation.

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Family and friends say Mr. Belak was suffering from depression, and although nobody wants to believe that a seemingly healthy, gregarious 35-year-old who was financially comfortable and had a young family would take his own life, that is likely the case.

In a search for answers, many commentators have zeroed in on the fact that Mr. Belak earned his living as a fighter – an “enforcer” in hockey parlance. The assumption is that he must have suffered a number of concussions and be addicted to painkillers.

This line of reasoning was reinforced by the fact that two other former NHL enforcers also died in the past four months: Rick Rypien (suicide) and Derek Boogaard (drug and alcohol overdose).

Surely a trio of tough guys dying at their own hand in a short period can’t be a coincidence, right?

This has led for calls to ban fighting, to monitor concussions more closely, to address the abuse of prescription painkillers by athletes and to provide more postcareer support to former hockey players.

Those are all legitimate issues but, in our public discussions of Mr. Belak’s death, we seem to be missing the forest for the trees.

Suicide is not a problem confined to enforcers, hockey players or athletes more generally.

Take a close look at the statistics and a trend becomes clear: The No. 1 risk factor for suicide is being male.

Of the 10 people who die by suicide daily in this country, about eight are men and two are women.

There are libraries full of research examining this phenomenon, which is not unique to Canada. There are many possible explanations but few easy answers.

We know that suicide is a vast societal problem that affects all age groups – in Canada, suicides have been recorded in children as young as 8 and in seniors over the age of 90 – and all socioeconomic groups.

Mental illnesses – depression, bipolar disorder, schizophrenia – are brain diseases; they can affect anyone, even hockey players. Mr. Belak, according to his family, suffered from depression. Like many people with the condition, he was quite good at hiding it, at least superficially.

The vast majority of suicides result from underlying mental illness coupled with profound emotional pain, and they are often triggered by some external event, such as a job loss, failing an exam, the breakup of a relationship or the death of a loved one. In other words, stress is the big trigger.

Yet, only a tiny proportion of those who suffer from depression die by suicide. (On the other hand, close to half of people with untreated schizophrenia will take their own lives.) There are also factors that increase the risk of depression and suicide, including a history of head injuries and alcohol/drug abuse.

Women are about twice as likely as men to suffer from depression. They are also far more likely to attempt suicide but tend to be less “successful” (and, yes, that is a horrific notion of “success.”) Still, the stats tell us that, in women, there are 20 attempts for every completed suicide while, in men, the ratio is 4:1.

One reason is that men use far more violent means to kill themselves, principally hanging and firearms, while women generally use poisoning (drug overdoses). Death though is just the tip of the iceberg: Another 48 people daily are hospitalized with self-inflicted injuries, most of them women.

The principal reason more men than women die by suicide is that men do not seek help and spiral into despair, hopelessness and self-harm.

It’s a banal analogy, but we all know the classic scenario where, on a car trip, men will refuse to stop and ask for directions. Likewise, when they suffer from depression (or another mental illness), men are far more likely to wander around aimlessly than reach out for assistance.

Men also self-medicate, largely with alcohol, which tends to make their symptoms worse. When they are depressed, they don’t retreat into a shell, but act out, often violently. (Perhaps we should consider that the depressed are drawn to being hockey enforcers rather than the reverse?) Women, on the other hand, tend to self-medicate with food and sleep; they also cry out for help – literally and figuratively. They talk to friends, they talk to counsellors and they talk to physicians about their depression and suicidal thoughts.

What is striking about the cluster of deaths among NHL enforcers is that they were all tough guys – men’s men, if you will.

One of the main enduring stigmas about mental illness, particularly for men, is that it is a sign of weakness. From an early age, boys are taught – or socialized – to be tough, to not cry. They internalize their pain. They repress their feelings and their fears.

This silence can be fatal. Yet the continuing carnage that results – more men die by suicide than in motor vehicle collisions – is largely hidden away and invisible.

When we have a rare glimpse of this grim reality, as we have had with the death of Mr. Belak, we owe it to ourselves to not be distracted by peripheral concerns like fighting in hockey and zero in on big issues like how to treat depression and prevent suicide in males. Obviously our current approach is not working.

When the black dogs of depression come growling, when the suicidal thoughts become overwhelming, boys need not be boys and men need not be men.

They need to learn – from an early age and regardless of how macho their profession – that they can seek help, they can be vulnerable, they can be sick and get better.

The hoary myths we cling to about toughness and manhood too often leave us with young men dangling by a rope.

Follow on Twitter: @picardonhealth

 

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