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Treating Male Suicide & Depression
Male Suicide & Depression continuing education psychology CEUs

Manual of Articles Sections 15 - 27
Section 15
Male Depression & Suicide:
A Counselor's Perspective

CEU Question 15 | CE Test | Table of Contents | Depression
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

Suicide and Pepper Spray
Jack was a 23-year-old Caucasian male, arrested for the second time in two months on drug charges. He was booked in and cleared by the nurse before being transported to his cell. When he arrived he was not sad, not withdrawn, not intoxicated, and gave no indication that he was contemplating suicide. Rather, he was angry, belligerent, and oppositional/defiant. Correctional officers were unsympathetic, intolerant, and harsh. The stress of incarceration manifested also in a severe outbreak of a skin rash on his entire body. Medical response to this painful and irritating condition was equally unsympathetic and unhelpful. Two weeks after his arrival he attempted to dive over the second floor railing onto the concrete below. He was caught just as he jumped by a couple of inmates who had been walking by. The correctional officers pepper sprayed him and aggressively cuffed him before literally dragging him to the medical unit. Once in Medical he was stripped, given a paper gown, and placed in an observational cell. The prevailing attitude was one of ridicule and intolerance; the opinion of the majority being that Jack was playing a game and any act of kindness or compassion would 'reinforce' his unacceptable behavior.

Greg was a 28-year-old Caucasian male, arrested for assault charges. He had a history of substance abuse, a previous suicide attempt, and was now involved in a bitter divorce. When booked in he denied any suicidal ideations, was calm, yet defiant and irritable. Failing to procure a bond after nine days in jail he attempted to hang himself and was found in time, again, by other inmates. Like Jack, he was pepper sprayed as he attempted to fight the correctional officers from transporting him to medical, and subsequently stripped and placed in an observational cell. Again, no compassion could be found for this young man.

Men Versus Women
Jack and Greg were not the exception to the rule. This was the standard. Men simply presented differently when they were contemplating suicide. While women tended to be more unmistakably distraught and routinely treated with compassion, men often presented with behaviors that discouraged concern and elicited harsh judgment and treatment. In addition, the means by which men will attempt suicide (e.g., hanging) are more readily available in jail whereas instruments for cutting or overdosing (i.e., that which is more typical of women) are typically less accessible.

Understanding and Observation
When I became the Director of Mental Health, these types of scenarios were occurring far too frequently. One of the interesting factors that quickly became apparent was that the first responders were often the other inmates. After numerous interviews I realized that proximity was not the explanation; rather, understanding and observation was. In other words, there was clearly an unspoken rule against approaching another inmate to see how he's "feeling" because of correctly interpreting aggressive behavior as a defense against deeper fears. Thankfully, most often I would receive word from one inmate, based on his observations that a fellow inmate was not coping very well.

This ability to cope became an effective way to gauge the likelihood of a suicide attempt. It appeared that regardless of the number of "risk factors" a man had stacked against him, if he was able to cope with confinement he did well. Alternately, if confinement became intolerable then surely death, in his mind, was the lesser of two evils.

Reversing the Trend
Obviously, I would not be able to observe each and every inmate in this large county jail; nor could I rely on the other inmates to be consistent in their disclosures. Therefore, I knew the only way to reverse this trend would be through training. I knew the amount of time I had to impact the caretakers of these men was relatively limited. Therefore, I focused on instilling empathy, teaching about transference, teaching about compassion, and discussing the effects of confinement relative to one's ability to cope with such. The training was successful and correctional officers and nursing staff readily referred those men who exhibited these atypical signs of suicidal risk. Suicidal attempts decreased dramatically.

Relatively speaking, these scenarios are probably less conspicuous in the general population. However, this does not cancel out the ability to generalize. On the contrary, a jail setting provides an intensified version of the complex dynamics that occur in every day 'freedom'. After leaving that position I moved on to work with men who batter their families who were NOT in jail. What I had learned about men and depression from the inmates proved to be indispensable in the general population, and particularly in this population of violent offenders who were being in essence confined. That is, the typical strategy of utilizing power and control in order to cope with underlying fear, hurt, humiliation, etc.… was no longer an option and again, assessing the ability to cope with this "confinement" proved to be the best predictor of suicidal ideations.

Once a client was assessed through observations in interviews or group to be a risk for suicide I would schedule an individual session. Of course direct confrontation of their acting out behavior and the implications was met with steadfast denial of any depression or suicidal ideations. However, when I would begin with a compassionate discussion regarding the differences between men and women relative to depression, followed by an interpretation of his behavior as indicative of a sadness that comes with loss, I would often encounter a cathartic release of emotions that took safety and courage from the client to accomplish.

Reframing Their Child
Over time I have found that the most effective means of guiding my male clients away from that ledge of self-annihilation is to address the child who was denied the freedom of expressing, of possessing, the full range of emotions. I have found that by helping them to reframe those earlier experiences and to teach them that hurt and fear are no better or worse than joy and courage they become more open, more aware, and more alive.

However, I am also painfully aware that for those who have decided to take their own lives, for reasons that go beyond depression and hopelessness, no words or actions can prevent the completion of this goal. Paul was such a soul. Twenty-four years of age, he was bright, handsome, giving, kind, likeable, lovable, talented and a host of other character strengths. Unfortunately, he also had been given an utterly horrific legacy of witnessing his own father's suicide five years previous. During the last six months of treatment he had grown and become stronger. He was well aware of the risk factor given his fathers' actions yet determined that he would never succumb to such a fate. He had friends, was in love, was close to his family, and involved in his church. Yet as he walked out the door after the last session there was something imperceptible that told me what was to come nearly a year later.

From time to time he would call just to check in and give an update on his life. He didn't want an appointment and he continued to deny any suicidal ideations. The Friday before the fifth anniversary of his fathers' suicide he called again. I tried to get him to come in for an appointment and we talked at length about the anniversary date coming up. He reported an increase in drinking behavior, sounded more irritable, almost angry, yet continued to deny any suicidal intent. He had alienated most of his friends and family and had long broken up with his girlfriend. The joy once heard in his voice was gone. Before ending the phone call, he softened enough to thank me for my help and encouragement and said that he would stop by the following week just to say hi.

Two days later I received a phone call from the person who had referred him initially for counseling. He had repeated his father's actions at the exact same time, on the exact same day, in the exact same manner - a gunshot to the chest.

Moving Away from the Unspoken Rules Mandating Secrecy
I realize that no one could have prevented this young man from completing his goal. I believe that for a time he truly experienced a sense of wholeness and freedom from the actions of his father. Yet it is clear that at some point those memories, hurts, and other emotions placed him in an intolerable predicament; He was confined to the constant memory. Perhaps techniques such as EMDR or more intensive psychodynamic treatment could have forestalled this act; perhaps not. It is my hope that the more aware those in the helping professions become regarding the unique dynamics of men and suicide, the more lives we can save. My hope is that as a culture we can move away from the unspoken rules mandating secrecy and denial for men who are depressed and move toward giving our sons, husbands, and fathers' permission to be fully human.
- Danielle Balletto, LPC, LBP A licensed professional counselor (LPC) and a licensed behavioral practitioner (LBP) in the State of Oklahoma. A graduate of The University of Tulsa. Graduated Magna Cum Laude with a Bachelors' in 1996 and graduated with a Masters' in Clinical Psychology in 1998. Batterer's counselor working with offenders and severely mentally ill for eleven years. Currently working on a Doctorate in Criminal Justice through Capella University.

Depression Management Tool Kit

- The John D. & Catherine T. MacArthur Foundatin's Intiative on Depression & Primary Care and 3CM, LLC. (2004). Depression Management Tool Kit.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 250 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about male depression and suicide. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 15
According to Balletto, what is the most effective means of guiding male clients away from the ledge of self-annihilation? Record the letter of the correct answer the CE Test.

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