A Subtle Misunderstanding in Suicide Prevention: The Relationship Between Sexuality and Religion

I'm a big supporter of suicide prevention efforts. I sometimes get the feeling, however, that there is a subtle misunderstanding of religious conservatives in some prevention communication. Kids Health, for example, has a really good article on its website about teen suicide. The section on risk factors says:

A teen with an adequate support network of friends, family, religious affiliations, peer groups, or extracurricular activities may have an outlet to deal with everyday frustrations. But many teens don't believe they have that, and feel disconnected and isolated from family and friends. These teens are at increased risk for suicide.

Factors that increase the risk of suicide among teens include:

-a psychological disorder, especially depression, bipolar disorder, and alcohol and drug use (in fact, approximately 95% of people who die by suicide have a psychological disorder at the time of death)
-feelings of distress, irritability, or agitation
-feelings of hopelessness and worthlessness that often accompany depression (a teen, for example, who experiences repeated failures at school, who is overwhelmed by violence at home, or who is isolated from peers is likely to experience such feelings)
-a previous suicide attempt
-a family history of depression or suicide (depressive illnesses may have a genetic component, so some teens may be predisposed to suffer major depression)
-physical or sexual abuse
-lack of a support network, poor relationships with parents or peers, and feelings of social isolation
-dealing with homosexuality in an unsupportive family or community or hostile school environment

I wonder what that last risk factor means. Does it mean that families or communities with conservative religious values are uniquely to blame if one of their members dies by suicide? Or is there a distinction to be made between conservative values and homophobic, oppressive ones?

In 2007, the American Foundation for Suicide Prevention organized a conference to explore LGBT suicide risk and prevention. A summary of its findings includes the following statement:

Over the last two decades, research findings have pointed to disproportionately high rates of suicidal behavior among LGBT adolescents and young adults. Suicide attempts in this population have been linked to a variety of factors including gender nonconformity, lack of support, family problems, violence/ victimization, early sexual debut and mental health problems, notably depression and substance abuse or dependency. How these factors converge to produce suicidal behavior among different groups of sexual minority youth, however, remains only partially understood.

While some research suggests that LGBT adults are not at substantially higher risk for suicidal ideation or attempts compared to comparably aged heterosexuals, other recent population-based studies have found higher lifetime rates of suicide attempts among homosexual men, in particular, that could not be explained solely on the basis of higher psychiatric morbidity. Few studies have looked at LGBT older adults, although many in this group share characteristics that make the elderly overall particularly vulnerable to suicide risk, such as chronic illness. LGBT elders may have additional risk factors related to sexual orientation or gender identity.

Because official suicide statistics do not include information on sexual orientation or gender identity, firm data are lacking on whether rates of completed suicide are higher among LGBT youth, adults or older adults, compared to the general population. Lacking clear data on the prevalence of suicide among these individuals, and clear understanding of the underlying causes, few suicide prevention programs have focused specifically on this population.

It is true that, historically, religious conservatives have done a poor job of dealing with homosexuality, but it's also true that the causes of any given suicide are often complex and elusive. This same data could be turned back against homosexuals and probably already has been. Likewise, one can easily imagine how inner conflict between one's sexuality and one's spiritual convictions and/or heritage could torture a person.

There is another factor to consider when it comes to sexuality and suicidality. Bipolar Disorder often includes distressing hypersexuality as a symptom. A psychiatrist explained it to me like this: a man who would ordinarily never cheat on his wife does so repeatedly when he is in a manic state. BiPolar Disorder Magazine ran a thorough article on this topic in its spring 2009 issue. Here's a bit of what it says:

Hypersexuality may be the last frontier in bipolar disorder. Even now, despite everything that has been learned about the illness, it's hard to put a finger on how big a problem it really is. The research is limited. Only seven studies have ever been published on the subject and their findings diverge: According to these studies, hypersexuality occurs in 25 to 80 percent of all patients with mania. After reviewing the literature, Manic-Depressive Illness (the 2007 text by Frederick K. Goodwin, MD, and Kay Redfield Jamison, PhD) settled on an average of 57 percent...

Of course, not everyone who has extramarital affairs or indulges in pornography has bipolar disorder. But people with bipolar are at special risk of hypersexuality or -- what's more or less the same thing -- sexual addiction, according to Louis J. Cozolino, PhD, a professor of psychology at Pepperdine University in southern California.

Cozolino attributes their vulnerability to a "disinhibition" of social restraints during manic periods. In other words, they are unable to act with an eye toward future consequences of their behavior.

"It's like the CEO in their brain goes off to Bermuda," says Cozolino, author of the 2006 book The Neuroscience of Human Relationships: Attachment and the Developing Social Brain.

Cozolino defines the brain's attachment circuitry as the area that helps soothe emotions and tamp down fear. An important part of that is due to the amygdala, an almond-shaped structure deep inside the cerebral hemisphere that regulates fear and panic, and controls the endorphin receptors related to a feeling of well-being.

Numerous MRI studies have confirmed that bipolar patients have significantly greater cerebral blood flow to the left amygdala, suggesting that abnormalities in this brain structure may be implicated in the illness.

"We know that in bipolar the homeostatic regulation between the amygdala and other areas of the brain are out of balance," Cozolino explains. He adds that during sexual arousal and orgasm, biochemicals are activated that generate a feeling of safety and calm.

"It doesn't last long, it's not the real thing, but it's a really pleasant substitute," says Cozolino. "So think of hypersexuality as an addiction. As an addict you never get enough of a drug. ... With bipolar disorder you have people who are more vulnerable to using sex as an addiction because they use it for soothing."

We who are religious would do well to make sure our houses of worship are safe places for young people grappling with their emerging sexuality. No children should ever be made to feel that God hates them or their families will reject them if they come out as gay. Others would do well to remember that numerous studies indicate that religious affiliation is a barrier to suicide. And all of us must recognize that sexual promiscuity can be a symptom of a problem that transcends culture, parenting, faith, sexual identity and a whole lot more that we think we know.