Homosexuality and Suicide: A Case Report

Original link http://ams.cu.edu.tr/January2001Vol10No1/suicide.htm

Lut Tamam¹, MD, Nurgül Özpoyraz¹, MD, Rasim S. Diler², MD.

Despite the inconsistency in data concerning the higher prevalence of mental disorders among homosexuals than heterosexuals, suicidality in homosexuals, particularly among adolescents and young adults have been consistently reported to be higher over the past 25 years . It has been recently stated that gay youth are 2 to 3 times more likely to attempt suicide than other young people which may comprise up to 30% of completed youth suicides annually. In this case report, we presented a young gay patient who attempted suicide and discussed the major causes of this attempt, primarily sexual prejudice of the society and possible therapeutic approaches. Ann Med Sci 2001;10:41-44

Key words: Homosexuality, homophobia, suicide, sexual prejudice

Despite the long-time stigmatization of homosexuality as a deviation from normal by different cultures throughout history, in 1973 American Psychiatric Association decided to eliminate homosexuality as a diagnostic category leading to a change in view of world psychiatry society about homosexuality¹. Although the official view on homosexuality within psychiatry profession no longer approves any opinion linking homosexuality with mental illness, the attitudes and beliefs of individuals among societies continue to reflect the predominantly negative and ambivalent views toward all forms of variant sexuality, including homosexuality². Besides most mental health practitioners still continue to present homosexuality as abnormal and dysfunctional ². These assertions that were primarily made for American people are also valid for most of the other countries and societies including developing countries like Turkey.

Major pioneer studies on incidence of homosexuality among general population reported figures of 10% in males, and 5% in females, however these numbers were later revised downward to less than 1% for both sexes in several large scaled researches³. On the other hand, it has been clearly defined that the number of people who had a lifetime history of homosexual experiences without a definite homosexual orientation were much higher than the numbers estimated for homosexuality prevalence ³.

The assumption that the range of psychopathology that may be found among homosexual individuals (male or female) are higher than heterosexuals have not been confirmed in several controlled studies. Distress resulting only from conflict between gay men and lesbians and the societal value structure is not classifiable as a disorder. Nevertheless, homosexuals both male and female have been reported to display increased vulnerability to depression and adjustment disorders when they encounter severe psychological and emotional difficulties ⁴. This increased vulnerability may result in prominent increase in suicide and suicide attempt rates among homosexuals ⁵.

Suicidality in homosexuals, particularly among adolescents and young adults have been consistently reported to be higher over the past 25 years ⁶. In a recent overview, it has been concluded that gay youth are 2 to 3 times more likely to attempt suicide than other young people which may comprise up to 30% of completed youth suicides annually ⁷.

In this case report, we presented a young gay patient who attempted suicide and discussed the major causes of this attempt, primarily sexual prejudice of the society and possible therapeutic approaches .

Case Report

Mr A, 20 years old man, a high school graduate, single. After a suicide attempt in which he had ingested high doses of analgesics and antibiotics, he was brought to University emergency clinics by his family. After appropriate medical intervention and two days of follow up in emergency inpatient service, he was sent for consultation to our outpatient clinics in good health condition. His mother told that he had homosexual trends found out by his family members long ago. He had an effeminate appearance which also could easily be observed from his clothing, actions and speech. In his first interview he accepted his homosexual orientation. He told that he had a boy friend with whom he had a sexual relationship for about 1,5 years, the longest relationship period he had with someone. He also stated that he had deep troubles in his relationship with his partner as his partner did not want to disclose his sexual orientation. The night he attempted suicide, he and his friend were physically attacked by some people when they were leaving a night-bar, being humiliated and devaluated because of being a gay at the same time. Except small hemorrhages in his lip and pain in his left arm, there were no apparent wound or any other damage occurred as a result of this assault to our patient. When he returned home, his father saw his situation and started to quarrel with him. He accused our patient because of his sexual orientation and told that he deserved this and these kind of actions. After this argument, A entered his room, locked the door and did not speak with anyone at home for about two hours. His mother suspected from this condition thereafter and broke into the room finding his son confused and drowsy, several empty drug bottles near him and then brought him to hospital.

His personal history has revealed that he was the only son and the last child of a traditional family with four children. He was an expected and wanted baby. His birth was welcomed cheerfully especially by the father who has been yearning for a boy for a longer time. His father was a dominant and feared man, hardly expressing his feelings towards children. Despite his primary positive reactions to our patient, he then kept distant emotionally and physically to A. On the contrary to his father, his mother was a caring and loving one who endeavor to share and solve the problems of her children at once. According to A, similar behavior patterns were exhibited by his elder sisters towards him which lead him to adore them. Since his childhood he has been behaving as a girl such as playing girl roles in child plays, willing to dress as a girl despite their family’s objections. He defined a chronic sexual abuse by one of his family members but refused to talk about . A noted that he has always sexually felt closer to males than females . His first sexual experience was with a boy in high school which he described as a nice experience. He later had several anal intercourses with some other men. No sexual intercourse or experience with females have been defined. At the age of 17, he told his mother that he felt like a gay and pleased to be a gay. Except his father, his family got used to his sexual choice, no more accused or argues with him concerning this subject after one year. However, time-to-time his father still with rage reacted his homosexuality, wanted to oust him from house -which he never did- saying that he was ashamed of him. The primary statement the father made was that he ruined all his expectations and hopes from future, leaving him alone and helpless. After the graduation from high school, he was not able to succeed university entrance examinations. Then he started to work in a market as a cashier in which he did pretty well with no adjustment problems with other workers or job. Several suicide threats were made by A towards his family at the times several conflicts come out, however no prior suicide attempts were present, known to family. He sometimes use alcohol with his friends no other illegal substance abuse were noted. He regularly gave blood samples for routine check for HIV virus and hepatitis, all of which were negative at the time of hospitalization.

His premorbid personality was described as a friendly, beloved person, usually integrates and adjusts well to his environment. It was also added that because of his effeminate appearance, he was humiliated, devaluated and mocked by others time to time that he mostly could not give any reaction except being silent.

At his first interview he admitted that he reacted quite inappropriate to his father’ words which he believe was a last drop that overflow the water. He added that he felt remorse for this action and told that he sometimes could not stand other’s look on him, expect some support from his family, and the times he could not see this he think about death. At his mental examination, his affect was anxious. In his thought content he had several depressive ideas quite related to his father’s reaction, and remorse he felt. No pathology in any other mental domain was observed. MMPI administered were assessed as within normal limits.

He was diagnosed as adjustment disorder in axis-I with no axis-II diagnosis. Mr A was planned to be followed up for one week, with one-hour supportive psychotherapy including his family members everyday as a crisis intervention in outpatient clinics. He was also prescribed alprazolam 0.5 mg to be used on a if needed basis. After two sessions, he decided not to continue the treatment as he felt himself quite healthy and mentally stable . During the last interview with him, he stated that after his suicide attempt the relationship with his father become well enough to communicate again which relax and calm him down. He had several proposals for future including going on a steady job, try harder for university entrance examinations that he believe he could succeed. His mood was euthymic with no other pathology in his mental examination. He did not come to planned treatment sessions after the second one.

Discussion

Though the acceptance of homosexuals have increased in recent decades, antihomosexual prejudice still remains a considerable problem in many societies and subcultures within societies ⁸. We can easily count Turkey within these societies. This sexual prejudice, took its roots in part from socio-cultural upbringing as in many other cultures. Homosexual acts usually condemned as an unnatural behavior, and seen as a sin or a crime. This approach justifies many homophobic acts taken against homosexuals in the eyes of the society. The homophobic acts vary along a spectrum of severity from devaluation and verbal abuse to physical threat, assault and even homicide ⁸. Our patient also encountered with this kind of act which was perceived by him as an important threat to his ego integrity. The humiliation and frustration experienced by our patient may have a precipitant role in his suicidal behavior.

An important factor in the suicide attempt of this patient might be his traditionally oriented family structure especially the role of his father in this structure . During adolescence and young adulthood, homosexual individuals are almost totally raised in heterosexually oriented , traditional families. And many are exposed to parents, siblings who are overtly homophobic as in our case. So it is nearly impossible to avoid the direct effect of homophobias (sexual prejudice) of the parents (in this case the father) on mental state and emotional stability of gay youth. In addition to immediate effects of homosexual prejudice, chronic traumas resulting from homophobic acts of family members and others may also influence psychological adjustment of the gay youth later in life ^8,9. Mr A also put in words his adjustment difficulties as describing the final words of his father before suicide attempt as “last drop that overflows the water”. Besides, it should be also kept in mind that negative internalizations due to homophobic acts may adversely influence self-esteem of these people leading to deleterious effects on the individual's ability to function in the relationship which may finally result in a depressive state.

Another possible contributing factor to this patient’s suicidality might be the conflict with his partner about the “coming out” process ¹⁰. Coming out is defined as a process by which an individual acknowledges his or her sexual orientation in the face of societal stigma and with successful resolution accepts himself or herself ¹⁰. Successful coming out involves the individual accepting his or her sexual orientation and integrating it into all domains of life. Another point that individuals and couples must eventually confront is the degree of disclosure of sexual orientation to the external world. Difficulty in negotiating coming out and disclosure is a common cause of relationship difficulties ¹⁰. Conflict can also arise within a relationship when there is disagreement on the degree of disclosure between partners which was also the case in our patient. Despite total disclosure of his sexual orientation, his partner rejected to do it so, which might have brought our patient to feel alone and emotionally isolated against external world and contribute to the factors precipitating suicide attempt.

All above-mentioned factors might have a role in suicide attempt of this case. Like all other suicide attempts, his condition was also approached as a crisis situation and treated as so. However in interventions to these gay people some points should be taken into account.

To avoid or abolish the homophobia, or sexual prejudice against homosexuals at the present time is a difficult task to succeed. Nevertheless an affirmative approach towards their sexual orientation along with interventions addressing their many problems linked to their homosexuality will help suicidal gay youths in their efforts adjusting to and coping with a homophobic and homo-hating world. These gay youths who are at risk for suicide may require speaking positively about their existence and especially about the many problems they may be experiencing. This will make these people think that there are someone who can understand and maybe help them in their fight to exist and cope with the world. Such therapeutic approaches might lessen the pain gays suffer and decrease their vulnerability to mental disorders and suicide.

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