Gay / Bisexual Male Youth Suicide Problems The San Diego / Boulder Paper Colorado Paper ('97) - - Banff Paper ('95) - - 1997-98 Papers

The Paper  was Presented by Pierre Tremblay at The 11th Annual Sociological Symposium: "Deconstructing Youth Suicide," San Diego State University - March, 2000 (Cover Page). A part of the present updated paper was presented at the Gay Men's Health Summit in Boulder, Colorado - July, 2000 (Cover Page).

Abstract

When the psychiatric definition of "the homosexual male" became the socially constructed norm, male homosexuality became the perceived rarity so often encountered in reports of adolescent HOM (homosexually oriented male) self-perceptions within the context of their schools or community. HOM adolescents generally believe they are “the only one," or part of a tiny minority if they are lucky. They do not feel they belong to the greater human world. Alone and often feeling like they are "freaks" - even the likely product of the rare genetic anomaly many gay-identified males have believed and publicly asserted - they end up in a state of anomie, exacerbated by homophobic reactions of others, including themselves at times. Heterosexist and homophobic messages affirm not only that one is a rarity and  "does not belong," but that hatred, marginalization, and even exclusion will apply if one’s homosexual secret is known or suspected. Related problems, including the internalization of acquired homohating perceptions, often associated with gender nonconformity issues, now turned against the self, have been linked to suicide problems in HOM youth. The learned "Better Be Dead Than Gay" perception is implicated in self-killings and murders of gay individuals.

The North American youth suicide rate has risen 3- to 4-fold since the 1950s, with males accounting for more than 80 percent of the problem, and more than 90 percent of the additional youth suicides since 1950. Recent evidence strongly indicates that HOM youth could account for at least 50% of the most serious male youth suicide attempters. Strengthened by replication research showing HOM youth to be more at risk for the most serious suicide behaviors, they are likely to be at even greater risk of death from their attempts; however "the homosexuality factor" has generally been ignored in mainstream male youth suicidality research. This oversight may explain a significant part of the ongoing enigma related to increasing youth suicide problems.

Empirical data indicates that, to the age of 16 or 17 years, the lifetime "suicide attempt" incidence for HOM youth has risen about six-fold, from about 5 to 30 percent from the 1950s to the 1990s. A number of explanations may apply, but one has not yet been advanced. The 1950s and 1960s marked a transition from a past when about 40 percent of adult males reported participation in homosexual activity to the present 10 to 15 percent. Most people, however, believe the methodologically flawed research that indicate a demographic rate ranging from 1 to 5 percent. The latter figures contribute significantly to the “rarity” belief about male homosexuality in spite of the fact in some cultures, that the male enjoyment of same-sex sexual activities has been common, sometimes being the rule.

Recommendations in this paper call for an extensive analysis of existing Youth Risk Behavior Survey data sets, most reporting results in violation of a cardinal rule in suicidology that male and female results should be separated for analysis. Research must also be carried out using the best available methodologies, including particular sociological methodologies. Factors associated with suicidality after individuals make contact with gay communities must also be studied. Relationship problems have been linked to suicide attempts, and the same may apply for the common use and abuse of drugs and alcohol by young gay-identified males.

Contemporary research does not exist, however, on suicide problems of HOM youth after they make contact with gay communities where a majority of gay-identified males are also known for lying in numerous ways when meeting each other for sexually motivated reasons, as reported in one ethnomethodology study. The author has often observed some gay-identified youth being distressed when experiencing this fact, while many youth apparently become what they are expected(?) to be, possibly at a price that factors into suicide problems for themselves and others. In addition, the more "feminine" HOM youth experience sexist anti-feminine attitudes in gay communities, often after having been subjected to a lifetime of anti-sissy abuses in public schools, in peer groups, and even in their families. Gay environments may therefore exacerbate their suicide problems reported to be experienced by more of these males than their more "masculine" gay and bisexual identified male counterparts.

A Grounded Theory approach as well as ethnomethodology studies are recommended to explore the suicide problems of homosexually oriented male youth, and insightful methodologically sound studies are needed to determine the extent of their suicide-related problems and their often interrelated nature. The study of suicide problems reported for gay and bisexual identified male youth, and the presentation of additional relevant information, make a convincing case for the proposed 50 percent representation of homosexually oriented males in the youth suicide problem.

Introduction

Fortunately, not everyone experienced male homosexuality as a rarity because some males grew up in worlds where male homosexuality was common. Others even grew up in communities where male homosexuality was a majority status and boys were rediscovering what Ancient Greek males also experienced as a part of their enjoyment potential. These documented realities are therefore important to know before it is possible to better understand how the modern social construction of male homosexuality is likely implicated in elevated male youth suicide problems, and especially in the five-fold increase in adolescent male suicide rates since 1950.

Understanding this problem is very much related to also understanding the modern concept of "sexual orientation" and the related issues becoming increasingly apparent to many professionals. Those most annoyed by this development, however, are the ones wanting to believe that males who recognize their same-gender sexual desires form a separate species distinct from another species: the 100 percent apparently genetically created heterosexual males forming more than 95 percent of the male population. Reality, however, may be very different from what most people believe and act out, as it has been repeatedly experienced throughout human history.

Sexual Orientation: Binaries and Definition Problems

Sexual Orientation is an enduring emotional, romantic, sexual or affectional attraction to another person... Sexual orientation exists along a continuum that ranges from exclusive homosexuality to exclusive heterosexuality and includes various forms of bisexuality. Bisexual persons can experience sexual, emotional and affectional attraction to both their own sex and the opposite sex. Persons with a homosexual orientation are sometimes referred to as gay (both men and women) or as lesbian (women only). Sexual orientation is different from sexual behavior because it refers to feelings and self-concept. Persons may or may not express their sexual orientation in their behaviors.

These definitions, categories, and related labels, however, were not always so, as asserted by Michel Foucault (1976) and as strongly emphasized in  "The Invention of  Homosexuality" (Katz, 1995): the words "homosexual" and "heterosexual" were invented at the end of the 19th century, and heterosexuality was perceived to be abnormal until the 1930s. Although bisexuality is often spoken about in terms of "bisexualities," as implied in the above APA definition, the words "homosexualities" (Bell and Weinberg, 1978), "heterosexualities," and "asexualties" should also be used given the diversity of human sexualities documented to have existed over time (Dorais, 1994); Note 2). On the basis of this knowledge of human sexualities, Dorais therefore warned against potentially serious problems stemming from current reductionist definitions for "sexual orientation" generally used to select study samples by researchers exploring genetic associations for homosexuality. One result of this research, according to Dorais, would be the likely production of a bad piece of science fiction.

The "definition" problem in genetic research was highlighted by Billings (1993) in his examination of methodological problems related to various types of genetic research related to homosexuality:

[Although] traditionally genetics has been most successful in explaining dichotomous traits, sexual orientation is a continuous characteristic of human populations. Males and females can be defined as heterosexual, homosexual, bisexual, asexual or otherwise. The range of behaviours within any two groups created for research purposes will either reflect selection (and thus not be representative), or will overlap substantially... Thus, it may be impossible to conduct research on homosexuality using genetic methods, or to genetically analyze any human characteristic, when the studied traits cannot be reliably ascertained in a large number of individuals, across a broad range of environments (p. 20).

Many reports also emphasized the highly negative implications for the postulated "gay gene" that many gay-identified males believed to exist (Chamberlain, 1999). Over the years, comments such as "I have been gay ever since I can remember" have been endlessly repeated to justify "essential" thinking, but I have also been French Canadian ever since I can remember, none of it being biological, except for having a biological system which made the acquisition of my cultural attributes possible. By 1999, however, papers were still being published such as Rahman (1999) which emphasized that there was considerable evidence that gay males were more like females, all based on unreplicated research results, and that the research results of the Dean Hamer research team offered a good explanation for this phenomenon. No one has noted, however, that if gay males are more like females, would this not imply that two such males in a relationship are therefore more like a third gender and very similar, and that such relationships may not work if the Bem (1996) theory - Exotic becomes erotic:  a developmental theory of sexual orientation - is correct?

A significant problem with the current world view that "100% heterosexuality" is the majority "sexual orientation" is the exceptionally common manifestations of bisexuality in the Ancient World (Cantarella, 1992). In this respect, the Ancient Greek practice of pederasty is of special significance. In a certain social class of boys, all of them were expected to have loving relationships with older males who were available to certainly enjoy their more than "sexual" relationships with boys. However, some commentators have suggested otherwise, indicating that the boys may not have enjoyed these relationships. "In the case of classical Greek practice there is a strong current of scholarship which sees the same-sex relations as pretty well universal in the male population, but limited in time and context: the relic of an initiation rite. (One detects a sense that being an initiation rite somehow makes homosexuality acceptable -- boys will be boys, and moreover, they'll get over it!)" (Thorp, 1992, p. 59).

This highlighted thought was nonetheless contradicted by Thorp's citations indicating that, as a rule, love without a hint of abuse was a major attribute in these relationships, and the well known Sacred Band of Thebes illustrates this fact (Carpenter, 1917) and also challenges the idea that these highly venerated "love" relationships were just an initiation rite. The younger males in these relationships were often ready for battle; thus not being the often assumed highly vulnerable and naive boys, and they certainly were not the equivalent of the modern "feminine" stereotype gay male (containing some truth) reflecting the 20th century professional and social belief that homosexual males are inverts, meaning "like women" (Ellis, 1906; Hekma, 1994). This belief, often propagated at the end of the nineteenth century by influential effeminate homosexual males such as Magnus Hirschfeld and Karl Heinrich Ulrichs (Hekma, 1994),  then became the rule in the American military by the early 1940s (Purkiss, 1997), and it continued to be taught well into the 1960s as the title of Judd Marmor's 1965 book indicates: Sexual Inversion: The Multiple Roots of Homosexuality.

The purpose of Thorp's 1992 paper was to argue that, in addition to the universal expression of male homosexuality in the form of pederasty in Ancient Greece, there were apparently some males who preferred other males all their lives, and they were perceived to have accept a role "analog[ous] with the role of women in copulation" (p. 61). Given this perception, it is possible that these men were similar to present day transsexual males and, if this applies given the rarity of these males, they should probably not be called "homosexual." Later, I will address this common perceptual link between modern homosexual males (males sexually attracted to other males) and males having a high degrees of femininity, but an important realization must be made at this point. On the basis of the Ancient Greece fact of life for male citizens, it is apparent that human males have the potential to not only greatly enjoy same-gender sexual activity, but they may also experience great love for another male in association with sexual desires.

Some individuals today also appear to have acquired this knowledge as implied in a report on some individuals by Kenji Yoshino, the author of the paper The Epistemic Contract of Bisexual Erasure:

Some people have this really utopian vision of bisexuality: Twenty years from now, we're all just going to wake up and realize that we're all bisexual (Bass, 1999).

Male Homosexuality: From Common to a Rarity

As a young adult, I ventured into learning more about male homosexuality and encountered the Kinsey et al. (1948) study which contained data not at odds with my experiences (Note 3), nor with the similar experiences of my youngest brother who grew up in the same neighborhood. Although he did not engage in homosexual activity, when asked what our neighborhood was like in the 1970s, he explained the male homo-sex situation as follows: "You know, Pierre, when the tent was set up and most boys came to have a sleep-out, well, I was the only one not having sex" (Bagley, 1997, p. 185). Without doubt Freud would have been happy to learn about this reality because it would have supported his belief that all individual were capable of acting in accordance to his postulated "bisexuality" norm for humans (a fact Freud recognized possibly because of his knowledge of the Ancient Greek males), and especially because he had also situated homosexuality as the first manifestation of a person's sexual desires that may or may not be acted upon (de Kuyper, 1993).

When I ventured in gay communities in 1978, a major new experience involved the learning about so-called "gay-identified" males, many still being teenagers, and they often were gender nonconformable. As a rule, they had also grown up thinking themselves to be the only ones with homo-sex desires in their neighborhoods, their school, or even in their town or city. Their feelings of isolation had been extreme, resulting in their belief that male homosexuality was exceptionally rare, and many had grown up perceiving themselves to be "freaks." In recent books and papers dealing with gay youth, and on related internet pages, these stories are repeated, and similar life situations were highlighted in the Australian 'Here for Life' Youth Sexuality Project Final Report.

The process of realising a same sex orientation, and either hiding this or being open, often results in:

damaged self esteem; distancing from family and peers; attempts to avoid disclosure; distortion of nearly all relationships; increasing sense of isolation; and, sense of inferiority and self loathing

This sense of isolation and negative reinforcement has been shown to increase the incidence of mental health issues in young people, resulting in emotional disorders, self harm and suicide. (Goldfram et al. 1999)

...in important respects, the hetero-homosexual binarism, the sexual regime now hegemonic in American culture, is a stunningly recent creation (p. 13).

To date, an interesting body of research work has reported that in the first half of 20th century male same-gender sexual activity was much more extensive than during the last third of the century (Nilsson, 1998; Chauncey, 1994, 1985; Dowsett, 1994; Carbery 1992, Brighton Ourstory Project, 1992; Humphreys, 1975; Kinsey et al., 1948). In fact, not all that long ago, about 40 percent of American males had been homosexually active at least at some point in their lives after the onset of adolescence (Kinsey et al,, 1948), but something happened which caused the elimination of the majority of homosexually active males from the world of male homosexuality. Nilsson (1998) supplied the likely explanation for this event occurring in Europe and in other countries with populations of European origins.

Marshall (1981), Newton (1993), and Chauncey (1994) argue that there has been a slow [homosexuality] redefinition process in the western world in this century, from a definition based on 'gender'  - a homosexual man desires men because he is like a woman - toward a universal 'sexual' definition: a homosexual man, however "feminine" or "masculine" he is, is homosexual because he desires men... It is interesting that this change, and the concomittant separation of men who were "so" from "real men," occurred at the same time as, and was indeed influenced by, a growing openness of male homosexual life toward and visibility from society.

A major demographic change has occurred with respect to males participating in homosexual activity to orgasm since Kinsey et al. (1948) reported that 37 percent of males had these kind of experiences since adolescence, with that another 13 percent reporting related desires not acted upon, for a total of 50% in the study sample reporting some degree of homosexuality. This is a minimum, however, as Kinsey et al. (1948) emphasized because, with respect to taboo sexual activities and thoughts, some males will always withhold such information from investigators no matter how skilled they may be, and Alfred Kinsey is recognized to have been an expert in terms of gaining the confidence of interviewed subjects. Furthermore, for working-class males in the Kinsey sample, the incidence of homosexuality was higher than 50 percent given that manifestations of male homosexuality was greatly influenced by social class, producing incidence differences ranging from 200 to 500 percent, with working-class males manifesting the highest incidence of homosexual activity (Note 3).

Recent demographic studies, however, have consistently reported lower incidence of male homosexuality than the Kinsey et al. (1948) results, the inference often being that the study was seriously flawed. Yet, would similar data obtained from Ancient Greek times - reporting that maybe 100% of male citizens enjoyed (had enjoyed) male homosexuality activity (probably including love responses in most cases) - be in error because a modern study of males produced radically different results?  Basically, the above cited research reporting the withdrawal of working-class "real men" from the world of male homosexuality serves to highlight the fact that the Kinsey et al (1948) data is not wrong. Instead, it reflects the degree to which male homosexuality existed in the western world during the first half of the 20th century. Furthermore, the evidence indicates that extreme homophobic social pressures were being applied to minimized the extent to which male homosexuality existed, leading to its increasing rarity - the "freak" situation - that many gay-identified adolescents have been coding it to be.

The degree of reduction in homosexually active male youth is indicated by Bagley and Tremblay (1998) data obtained via random sampling in Calgary, and then using a highly effective computer technology methodology to solicit information of a sensitive sexual nature, including information about young adult males who had been sexually involved with children (1%) and the ones having related desires (4%) (Bagley et al., 1994). Bagley and Tremblay (1998) reported only 11.2 percent of males had related sexually with at least one other male since the age of 15 years (14.0% since the age of 12 years), and 9.2 percent were currently homosexually active (in the six months preceding the data intake). On the basis of self-identification as homosexual or bisexual (11.1%) and /or being currently homosexual active (9.2%), minus bisexual-identified males who were not currently homosexually active, a study sample of homosexually oriented males (10.9%) was produced and analyzed for a number of attributes to be compared with heterosexually oriented males, including their history of self-harm and suicidality (Bagley and Tremblay, 1997).

An important result of the Bagley and Tremblay (1998) demographic study was support for the hypothesis that flawed methodology was responsible for current demographic studies which had reduced the percentage of homosexually oriented males to one or two percent. The proposed underestimates for these studies were in the range of 400 to 800 percent for homosexuality-related behavior and self-idenfication, respectively. In the same year, the results of the Turner et al. (1998) study, based on a large random sample of 16- to 19-year-old males, confirmed that, on average, a 400% underestimating error could be expected with respect to adolescent males reporting their homosexual activities on pencil-and-paper questionnaires compared to using the computer technology to solicit sensitive sexual information (Bagley and Tremblay 1997, 1998).

The validity of demographic studies using face-to-face interviews or telephone interviews may be inferred by a wise researcher foreseeing what the results would be if middle aged men were asked: "Are you relating sexually with adolescent males, or even younger males." A predictable "zero" (or near zero) percent response to this question would not reflect reality. Although the question requests highly taboo information, underestimates are also predictable if similar methodology is used to solicit information from males who have been homosexually active with males of varying ages. Such behavior remains in a taboo category (still illegal in about 20 American states), and significant underestimates are predictable if confidentiality issues are not addressed in a manner deemed credible by the study subjects who have engaged in such sexual activities (Bagley and Tremblay, 1998).

Unfortunately, face-to-face interviews continue to be used as in the NHANES III study of 17- to 39-year-old males. Only 2.2 percent of males acknowledged having "any male sex partners in their lifetime" (Cochran and Mays, 2000, p. 575), and similar methodologically flawed studies are then cited (given range of study results: "2% to 7%") to conclude that "this is consistent with the prevalence observed in NHANES III" (p. 577), thus creating the illusion of validity for their results. Not mentioned, however, is that this range of demographic results suggests a possible 350 percent underestimating error for lowest results. Instead, it is asserted that "the willingness of men to report same-sex partners in a population-based survey such as NHANES is unknown; thus, the extent to which homosexually experienced men... declared no male sex partners cannot be determined" (p. 577). This assertion, however, is only made possible by not citing studies (e.g. Bagley and Tremblay, 1998; Turner et al., 1998) indicating the likelihood of producing scientifically scandalous underestimates when researchers use highly flawed methodology.

It could therefore be said that, since the Kinsey et al.'s 1948 study, about 70 percent of the males who once enjoyed being homosexually active (most often as adolescents and young adults) were to not to be anymore, apparently because the definition of who was "homosexual' was changing. As Foucault and others noted, homosexuality was taking on a "species" meaning which was also implemented by the American military by 1941 (Purkiss, 1997). Instead of homosexuality simply having been something all males could enjoy, the new "meaning" became infinitely more negative. In addition to the psychiatric decree that all homosexual males were "mentally disordered," many psychiatrists liberally propagated additional negative beliefs about homosexual individuals. Purkiss (1997) summarizes the outcome of (malignant?) psychiatric indoctrination in the American Military:

[In addition to defining homo-sex desiring males to be "inverts," or "like women, military administrators] therefore expanded upon the concept of the homosexual by adding components of violence, immorality, uncontrollable sexual impulses, and a potential threat to society. But woven into these new fabrications were the central ideas proposed by psychiatrists: homosexuals were sick, morally vacant, predatory, and in need of help.

The word "faggot" has never merely meant homosexual. It has always carried the extrasexual connotation of being unmanly [being like a female]. But these days, the implications of that insult have expanded. To say that a certain behavior is "so gay" can apply to anything stupid, clumsy, or outré. It’s probably the most effective way to call a guy a loser, and in this age of sexual candor, when high school students know that some of their peers may actually be gay, the accusation has an even more fearsome ring.

Male Youth Suicide Problems: Worsening Since 1950, Higher Rates for Homosexually Oriented Males, and Greater Risk for Suicide.

Tremblay (1995) proposed that up to 50 percent of male youth suicide deaths may involve homosexually oriented males. This proposal contrasted with the results from two methodologically flawed postmortem studies (Rich et al., 1986; Shaffer et al., 1995) commonly used to suggest that homosexually oriented adolescents are not at greater risk for suicide than their heterosexual counterparts (Muehrer, 1995; Moscicki, 1995). On the basis of suicide risk indicators, however, including their research results, Bagley and Tremblay (1997a) speculated that more than half of male suicide deaths may involve homosexually oriented males. Given that the greatest increase in suicides has been in the 15- to 19-year-old category, that males form the vast majority of additional youth deaths from suicide since 1950, and that the greatest amount of male suicidality information based on sexual orientation criteria for this age group is available, a survey of the available information and related implications is warranted. 

The trend in mainstream youth suicidology to assume that sexual orientation factors are not significantly different in suicide rates or suicide problems has created a general lack of awareness that homosexually oriented males may be greatly overrepresented in the worsening suicide problems (Gibson, 1989; Remafedi, 1994; Savin-Williams, 1994; Tremblay, 1995). This assumption persists in spite of the Bell and Weinberg (1978) study data indicating that white predominantly homosexual males, by the age of 20 years, were 14 times more at risk for a "first time" suicide attempt than their heterosexual counterparts. Bagley and Tremblay (1997) replicated this factor (to the average age of 22.7 years) for a large random sample of 18- to 27-year-old Calgary males, and a further analysis of the "suicide attempt" data for males 17 to 29 years of age in the Cochran and Mays (2000) NHANES III (National Health and Nutrition Examination Survey) study produced Odds Ratios similar to the two previously noted studies (OR range for the three studies: 12-15, Note 8). Given the average age of the Bell and Weinberg (1978) sample (37 years), the suicidality results for homosexual males best represent the situation existing in the early 1950s. At that time, "first time" suicide attempt incidence to the age of 17 years for white predominantly homosexual males was 4.9% percent: 28/575 (Bell and Weinberg, 1978).

The studies reporting on the suicidality of homosexually oriented male youth have used varied methodologies, thus creating interpretation problems and making it difficult to be absolute about the numbers, but a general trend is apparent from the available data and reported results. The lifetime suicide attempt incidence for homosexually oriented male adolescents has greatly increased over the years (about 6 times) given the Bell and Weinberg (1978) data (a 4.9% "first time" suicide attempt incidence by the age of 17), and the more recent study results. Studies based on varied North American volunteer community samples of gay and bisexual males report lifetime suicide attempt incidences averaging 30 percent (Bagley and Tremblay 1997), with a range of 20 to 42 percent for ten published American studies (Remafedi et al., 1999). These results have also been replicated in school based random sampling YRBS (Youth Risk Behavior Surveys, or similar surveys), and two of these studies specifically report suicidality results for male adolescents based on sexual orientation.

Based on a 1987 Minnesota study of grade 7 to 12 students, Remafedi et al. (1998) report a lifetime suicide attempt incidence of 28.1 percent for males identified as gay or bisexual by the average age of about 15 years, compared to 4.2 percent for heterosexual identified males. Using the same sample data, Saewyc et al. (1998) report that older gay and bisexual male adolescents (15- to 19-years-old) have a lifetime suicide attempt incidence of about 33% by the average age of about 17 years. Garofalo et al (1999) does not specifically give the suicide attempt rate (based on a 12-month period) for males identified as gay, bisexual, and "not sure" about their sexual orientation (GBN), but an estimate of 33 percent was determined on the basis of the information given (Note 6). Other studies (some not yet published, but the data is available) report similar results on average for homosexually oriented adolescents not differentiated on the basis of gender (Table 2).

Result from Youth Risk Behavior Surveys have also repeatedly indicated that homosexually oriented male and female adolescents are generally more at risk for the more serious suicide behavior: (1) considered suicide, (2) planning a suicide, (3) attempting suicide, and (4) attempting suicide with resulting medical attention (Table 2). In the category of "suicide attempt associated with having received medical attention," it is assumed that, as a rule, the most life threatening suicide attempts, or suicide attempts with a definite intent to die, would have a greater likelihood of resulting in the individual having receiving medical attention, but this may not always be the case, at least for gay and bisexual males (Remafedi et al. 1991).

The YRBS study results listed in Table 2 include homosexually oriented females, and female data tends to reduce major differences existing between males as indicated from the Garofalo et al. (1999) and Remafedi et al. (1998) study results. In the two studies, statistical significance was eliminated between homosexual and heterosexual female suicide attempters in the multivariate analysis, but great differences for suicide attempts incidence were reported for homosexually oriented males compared to their heterosexual counterparts. In the Garofalo et al. (1999) study, LBN females are 2.0-times more likely to report a suicide attempt than heterosexual females, while the factor is 6.5-times for GBN males compared to heterosexual males. In the Remafedi et al. (1998) study, the higher risk factor is 1.4 times for LB females and 7-times for GB males compared to their heterosexual counterparts. Therefore, it is suspected and predicted that an analysis of only the male data in other YRBS studies would likely show more serious suicidal behaviors than their heterosexual counterparts, compared to results generated from the combined male and female data (Table 2).

An indication of the magnitude of differences in suicidality of males based on sexual orientation was reported by Bagley and Tremblay (1997) on the basis of a large random sample of males ranging in age from 18- to 27-years-old. Their suicidality results are presented in two categories of self-harm behaviors based on previous epidemiological studies: "self-harm" (often called suicide attempts by adolescents, but without the intent to die, and the behavior is usually not life threatening), and "suicide attempts" representing a definite attempt at self-killing (Note 7). Compared to heterosexual males, homosexually oriented young adult males were 3 times more likely to report "self-harm" in their lifetime; this is remarkably similar to the reported differences, based on sexual orientation, for "suicide attempts" reported in YRBS studies (Table 2). For strictly defined "suicide attempts," however, Bagley and Tremblay (1997) reported that young adult homosexually oriented males were 14 times more likely to have attempted suicide than their heterosexual counterpart; and the magnitude of risk increases four to five times from their relative risk for for having engaged in "self-harm" activities, to their relative risk for a "suicide attempt" (Note 8).

Homosexually oriented male adolescents are also at risk for serious suicide attempts as reported by Remafedi et al. (1991) from their sample of 137 gay and bisexual male youth ranging in age from 14- to 21-years-old : "Fifty four percent of all suicide attempts (37/68) received risk scores in the 'moderate to high' lethality range." In the 45 attempted suicide cases where the rescuer was not the victim (76% of cases), 58% "received scores in the 'moderate to least' rescuable range. In other words, the predicted likelihood of rescue was moderate to low despite the actual occurrence of an intervention" (p. 871). Unfortunately, since 1991, studies reporting on the suicidality of homosexually oriented youth have only reported "suicide attempts" (with a related analysis) without investigating their degree of  lethality, nor were "suicide attempts" rigorously evaluated to separate the ones best classified as "self-harm" from the ones best classified as deliberate attempts to take one's life (Note 7). The Remafedi et al. (1991) and YRBS data (Table 2), however, suggests that maybe more than 25 percent of suicide attempts by gay or bisexual identified adolescent males result in medical interventions, thus indicating a higher likelihood for suicide for these males.

The high proportion of homosexually oriented male adolescents who attempt suicide places them at higher risk for an eventual suicide either as adolescents or later in life  (Lewinsohn et al., 1993; Kotila and Lonnqvist, 1989; Sellar et al., 1990; Shafii et al., 1985; Otto, 1972). In this respect, Garland and Ziegler (1993) reported that the "best single predictor of death by suicide is probably a previous suicide attempt" (p. 172).  Community samples of homosexually oriented youth have also produced high rates for repeat suicide attempters, six study samples producing a 44.2 percent average for the proportion of gay and bisexual male suicide attempters who became repeat suicide attempters (Table 3), the suggestion being that suicide is an ongoing problem for many of these youth.  A similar percentage (39.9%) resulted from the Bell and Weinberg (1978) data, thus indicating consistency in this respect over time. Unfortunately, published studies have not been located on the risk for an eventual suicide by adolescents with a history of repeated suicide attempts. It is possible that such individuals, especially males, are at much higher risk for committing suicide than males with a history of only one suicide attempt.

The lifetime incidence of "suicide attempts" for homosexually oriented male adolescents has increased about 6-fold since 1950, from about 5 to 30 percent. Of significant  interest are the YRBS study result producing a "suicide attempt" average about about 30 percent for a 12-month period: 32.3% for the 5 studies (Table 2). Given that these rates coincide with lifetime estimates from community samples (Table 3), this similarity likely reflects, at least in part, the possibility that adolescents in school define a "suicide attempt" in a more liberal way; a minor injury may be interpreted to be a suicide attempt. Another possible contributing factor is the high likelihood of homosexually oriented adolescents to be repeat suicide attempters (Table 3). It is important to recognize, however, that the random sampling YRBS studies likely solicits data from a wider spectrum of homosexually oriented adolescents than the representation obtained from volunteer community based samples. If this applies, the suicide problems of homosexually oriented adolescents may actually be more serious than proposed in the worst case hypotheses.

At issue, however, has been their representation in youth suicide problems, and especially their representation in suicide statistics. Mainstream suicidologists have often criticized suicidality results from gay community based samples because of their assumed biased nature (Moscicki, 1995;  Muehrer, 1995), and always to counter efforts to have homosexuality issues addressed in youth suicide education and prevention programs where indifference to homosexuality was the rule, as it had been in mainstream youth suicidality research (Remafedi, 1994; Savin-Wiliams,1994; Tremblay, 1995). Tremblay (1995) also suggested that a mean spirited objective had motivated the production of the 1995 Suicide and Life Threatening Behavior special issues on "Sexual Orientation" edited by Muehrer, Moscicki, and Potter (1995) who are from the National Institute of Mental Health (NIMH) and the Centers for Disease Control (CDC).

Tremblay (1995) felt that the document was not created by individuals who really wanted to see homosexuality issues addressed in mainstream youth suicidality education and prevention programs, and that maybe mainstream youth suicidality researchers were not to be encouraged to begin soliciting sexual orientation information in their research. By 1999-2000, this outcome was the ongoing research behavior that the CDC was modeling as a part of its boldly emphasized "Leadership Role." Apparently, the CDC's role is "to ensure the availability of accurate and current information on health risk behaviors among young people, [to provide] funding and technical support to states and major cities to conduct a Youth Risk Behavior Survey" (CDC, 1999), but it is not to model any research behavior such as soliciting "sexual orientation" information from adolescents.

The CDC's official YRBS questionnaire does not solicit "sexual orientation" information (CDC, 1999a), meaning that the CDC does not recognize this factor in adolescent problems in spite of the wealth of information indicating otherwise, nor does the CDC apparently believe that such information should be solicited. Although the questionnaire does solicit information about "sexual intercourse," generally assumed to mean "penis-vagina" sex, anyone thinking the requested information may apply to same-sex sexual intercourse would be in error given the confirmation of its heterosexist definition in Question #63. "The last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy?" Therefore, to the year 2000, the CDC has continued to ignore "sexual orientation" issues in youth suicide problems, which can have only one result. When any "at risk" group of adolescents are ignored, their concerns are also ignored, and the ones responsible for this are essentially working to maintain a maximum casualty status in the ignored sector of the adolescent population.

In spite of the ongoing modeling of indifference to homosexuality issues in youth problems by the CDC, results from relatively rare school-based studies which had solicited "sexual orientation" were being peer reviewed and published: Remafedi et al. (1998) and Saewyc et al., (1998) for a 1987 Grade 7 to 12 Minnesota student sample, Garofalo et al. (1998, 1999) for a 1995 Grade 9 to 12 Massachusetts student sample; Faulker et al. (1998) for a 1993 Grade 9 to 12 Massachusetts student sample; and Durant et al. (1998) for a 1995 Grade 8 to 12 Vermont student sample. It was only for the Garofalo et al. (1999) study, however, that information was made available to permit an estimate of the proportion of male suicide attempters who are homosexually oriented.

Given the 12-month period 33 versus 5.1 percent attempted suicide rate for GBN (gay, bisexual, and "Not Sure" about their sexual orientation) males forming 4.7% of the male population, it was then possible to calculate that about one quarter (24.3%) of male suicide attempters are in the GBN category (Note 6). Therefore, 4.7% of the students of GBN males account for about 25% of the male suicide attempt problem. Given, however, that the study is based on an amended form of the pencil-and-paper Youth Risk Behavior Survey questionnaire from the Centers for Disease control (CDC, 1999a), and that these surveys likely underestimate the numbers of homosexually oriented individuals by a factor of 3 to 4 (Bagley and Tremblay, 1998; Turner et al., 1998), it is therefore postulated that all homosexually oriented male adolescents, had they been identified by Garofalo et al. (1999), would account for maybe 60 to 80 percent of male suicide attempters. This estimated correction would be consonant with the Bagley and Tremblay (1997) results: 62.5% of young adult male suicide attempters (lifetime incidence) were in the homosexual or bisexual category, defined on the basis of self-identification and/or being currently homosexually active.

The probability that homosexually oriented male youth account for at least 50 percent of suicide attempters, and the fact that these males are more at risk than heterosexual males for the more serious suicide behaviors, such as more serious forms of suicide attempts (Bagley and Tremblay, 1997, 1997a; Remafedi et al., 1991; Table 2), leads to the informed proposition that more than 50 percent of male youth suicides (maybe up to 75 percent) involve males for whom homosexuality issues are, or have been, a significant factor in their lives. It is also known that some males do commit suicide for reasons expressed by Nicolas and Howard (1998) in their study, "Better Dead Than Gay!" and as outlined by Tremblay (1998-1999) in a web page titled "Better to be Dead Than Gay."

Homosexually Oriented Male Youth: Ongoing Suicide Problems?

In addition, 39 percent of the male suicide attempters (7% of the sample) were repeat attempters, thus indicating consistency over the last 50 years given that, in recent studies, 44.2 percent of homosexually oriented male youth who attempted suicide (13.3 percent of the sample populations) are repeat attempters (Table 3). The doubling of the percentage of repeat suicide attempters is indicative of increasing ongoing suicide problems, likely of the most serious kind, with implication yet to be studied. My experience in gay communities has revealed that male suicides and suicide attempts remain as a fact of life after homosexually oriented youth have made contact with gay communities. However, researchers have not explored this aspect of the problem, except for Bell and Weinberg (1978) reporting that homosexual relationship problems were associated with about 27 percent of first time suicide attempts.

The Remafedi et al. (1991) study of 137 gay and bisexual male (14- to 21-years-old) reports data indicating that 39 percent of studied youth had been runaways, 39 percent sexually abused, 35 percent arrested, and 20 percent had engaged in prostitution. The associated attempted suicide incidences for males having these often overlapping attributes are 37 (20/54), 47 (25/53), 44 (21/48), and 43 (12/28) percent respectively, the average for the sample being 30 percent. With respect to gender attributes, 23 percent of the males were classified "feminine," 26 percent were "undifferentiated," 31 percent were "androgynous," and 20 percent were rated as "masculine," and their respective suicide attempt incidences are 48 (15/31), 34 (12/35), 26 (11/42), and 11 (3/28) percent. There is therefore a general "suicide attempt" risk decrease from males being feminine, to males being masculine, the former having a 4.4 times greater likelihood for having attempted suicide than their "masculine" counterparts (48% vs 11%).

Many gay and bisexual identified adolescent males with a history of being runaways or throwaways, and especially the ones venturing into prostitution, form a sector of the more visible "gay communities" given that they are relating sexually with homosexually oriented men; Bell and Weinberg (1978) reported that 27 percent of predominantly homosexual males studied had paid for sex, and 25 percent had been paid for sex (p. 311). Not all gay and bisexual male adolescents making contact with gay communities, however, are in these categories, and little had been studied or written about their experiences and problems, including their ongoing risks for suicide problems and suicide. Real life story segment are nonetheless occasionally encountered within the context of researchers reporting on significant problems for which gay and bisexual male adolescents are at risk:

...[Y]outh who received the intervention [a lengthy safer sex education program] said that they would engage in unsafe sex when they felt particularly distressed because they thought it was hopeless for them to protect themselves from becoming HIV positive. In addition, youths who were overwhelmed by emotional distress would bring to the group problems regarding their latest crisis, for example, being involved with a partner who was suicidal or who was being threatened by a previous partner; for these youth these problems took precedence over making behavior changes toward less unprotected sex (Rotheram-Borus, 1995, p. 593).

The "sugar daddy" usually present himself to the youth in a loving caretaker manner. For street youth who have a past history of rejection and/or abuse, the promise to be loved and cared for is a compelling one. [These youth usually have many of these relationships and] each of these is a cycle of falling in love, believing that life will now be wonderful forever and that this older adult truly loves the young person, discovering that in fact it is just sex that the adult wants, feeling the impact of one more betrayal, and ending up on the streets again. This whole cycle lasts an average of 1-2 months, and the youth often becomes extremely suicidal at the end of each cycle (Kruks, 1991, p. 518).

But when I came out, the closeness I was looking for wasn't what I found. Instead, I fell into the gay community's 'if you're gay, young and cute, you have to be one of those guys who sleeps around' stigma... And I learned from all the wonderful people I met that sex was just sex and that the whole closeness thing was merely a pipe dream - certainly unattainable [if not via sex]... My problem arises when people just coming out see our community as only sexual. That affects me. They learn, like young people in every culture, from their peers and elders. What they see, hear and experience is what they are going to assume the gay community is. With this type of base, they are going to have a very difficult time making their love lives flourish... There are some people who want more than sex and don't feel "sex is just sex" (Weldon, 1997, p. 53).

[By the age of 19, he had] had two "official" relationships... lasting no more than a couple of months, [and he has not been impressed with what he learned.] Maybe this pattern simply indicates bad choices on my part. I guess I can see why older men think 19-year-olds have nothing more than sex to offer. But it surprises me that the older crowd want shallow, detached physical contacts while their younger counterparts are searching so very,  very hard for something more substantial (Foster, 1997, p. 21).

Adolescent males who identify as gay or bisexual at the youngest age are at the greatest risk for suicide attempts (Remafedi et al., 1991; Schneider et al., 1989; D'Augelli et al., 1993; Hershberger et al, 1997; Nicholas and Howard, 1998), and they are most likely to be the youngest individuals becoming associated with some aspect of gay communities such as youth groups from which many study samples are obtained (Schneider et al., 1989; D'Augelli et al., 1993; Hershberger et al, 1997; Proctor and Groze, 1994). For many homosexually oriented male adolescents, however, their first contacts is with a well known part of gay communities known as the "public sex" or "anonymous sex" arena which has been participated in by about 50 percent of gay and bisexual males (Tewsbury, 1996). Uribe and Harbeck (1992) report on the related experiences of adolescent males:

Of the 37 males [in high school ranging in age from 16- to 18-years-old], 35 were already sexually active with other males. The average for the first sexual experience was 14 years, and in the majority of the cases this was with an unknown male... None of the males in this sample had his first sexual experience in a 'safe' manner, and none was still with his first sexual partner. [Furthermore], half of the study participants acknowledged engaging in suicide attempts in the year prior to the interview... Fifteen of these boys were living with friends, two admitted to living with 'sugar daddies,' and three were in residential or foster homes for gay adolescents (p. 21-22).

Remafedi et al. (1991) reported high rates of sexual abuse for gay and bisexual male youth (39%), but also noted that sexual abuse generally postdated sexual identification as gay or bisexual. The unspoken implication is that the sexual abuse likely occurred after they made themselves available for sexual experiences often occurring via making contact with some gay community attribute such as the "public sex" arena, as most of the first sexual experiences occurred for the teenage gay males studied by Uribe and Harbeck (1992). Sexual assault and rape after adolescent males have made contact with gay communities, however, remain hidden in all studies reporting such experiences, often assumed to be "child sexual abuse" having occurred before the individual made contact with gay communities. This assumption may be incorrect.

About 20 to 39 percent of homosexually oriented males have experienced unwanted sexual acts (sexual abuse, sexual assault) by the age of 17 (Doll et al., 1992; Caballo-Dieguez and Dolezal, 1995; Holmes, 1997, Lenderking, 1997, Remafedi et al., 1991), and such experiences have been linked to a lifetime higher incidence of suicidal behaviors, including suicide attempts, in adolescent and young adult males (Bagley et al., 1994; Bagley et al., 1995), and in young adult gay males (Nicholas and Howard, 1998). The international incidences for boys being sexually abused ranges from 2 to 11 percent, with up to 16 percent results in Alberta, Canada (MacMillan et al., 1997). Homosexually oriented males may also be at greater risk for sexual abuse at younger ages given that one study reported that boys sexually abused before the age of 13 were 4 times more likely to be homosexual than boys not sexually abused (Finkelhor, 1979).

Substance abuse is also associated with suicide attempts of gay and bisexual male youth (Remafedi et al., 1991), as is alcohol abuse (D'Augelli and Hersberger, 1993), and both these problems are well recognized risk factors for both suicide attempts and suicides in mainstream youth populations (Brent, 1995; Mazza, 1997). Youth Risk Behavior Survey studies have reported that homosexually oriented adolescents (self-identified as gay, lesbian, or bisexual and/ or being homosexually active) are many times more at risk for multiple drug and/or alcohol use and abuse than their heterosexual counterparts (Garofalo et al. 1998; Faulkner et al., 1998; Note 10). Psychiatric symptoms such as depression have also been linked to suicide attempts for homosexually oriented youth (Nicholas and Howard, 1998; Hershberger et al, 1997; D'Augelli et al., 1993), and depression has been linked to suicide attempts and suicide in mainstream adolescent and youth population (Brent, 1995; Mazza, 1997). For homosexually oriented adolescents, however, psychiatric symptoms are likely related to, or exacerbated by, many of their most unfavorable life outcomes, and these symptoms should not be deemed "biological" in origin.

The Seal at al. (2000) qualitative study of seventy-two 16- to 25-year old young men who have sex with men (YMSM) from two midwest American cities reports on the multifaceted socially imposed problems of these youth. "Low self-esteem and self-worth, a lack of self-care and self-love, hopelessness and depression and teen suicide factors were believed to underlie unsafe sexual behavior:

There are time when I wished to God I would have just been dead. I couldn't go through the pain of who I was or the pain of trying to live my life. There was so much hurt. It wouldn't have mattered if I had gotten HIV. To be that would have been the simplest solution. I wouldn't have had to do a thing. I just would have had to lay there. I wouldn't have had to slit my wrists or commit suicide any other way. It's a more painful way, but if you're on a suicide mission it doesn't matter.

When it comes down to it, the guys I talk to just don't care about life. They say life has nothing to offer them. A lot of times their mothers and fathers have disowned them and their family won't deal with them anymore because they are gay. They have no life, no family no future (p. 10).

An association between a history of suicide attempts and practicing unsafe sex by gay males was reported by Lewis (1988), but individual cases of gay males contracting HIV as a way to commit suicide had been reported as early as 1985 (Frances et al., 1985; Flavin et al., 1986). By the late 1990s, the phenomenon was reported in association with gay youth (Tompkins-Rosenblatt, 1997:  "Intentional HIV contraction: implications for direct child and youth care"), and from an analysis of Vancouver's Vanguard Project cohort of young men who have sex with men ranging in age from 18 to 30 years. A history of attempting suicide was the second most statistically significant association differentiating males who were "risk takers" compared to males who were not risk takers with respect to placing themselves at risk for contracting HIV (Martindale, 1997). Seal et al. (2000) report a similar phenomenon as noted above, but another factor is apparently also associated with desires for death by young men who have sex with men (YMSM):

They [YMSM] figure that they will have as much fun as they can now because they see old guys sitting in Venue X who like 40 and 50 and 60 years old and who haven't done anything with their life. Or, if they have, they're single and sitting in Venue X hitting on the young guys. The [YMSM] figure if they die young they wouldn't have to worry about that. It's the fear of age that many kids don't want to face - that they will get old. They figure that they have do do lots of things before their beauty fades (Seal et al., 2000, pp. 10-11).

If you say you're going to be dead by 40, they say, "So what? There's no gay life after 40, anyway." Especially in France, but even here. You can easily be a gay in his 20s and never meet a gay over 40 because you don't see them in the bars. They don't go out, they're not part of your world, and if you do see them, you consider them pathetic (Reitz, 1997).

Feminine Males: A Social Construction of Suicide Problems

By the middle of the 20th century, however, there was a significant exodus of homosexually active males - the males who had been sexually dominant with sexually passive males - from the world of male homosexuality existing in European societies and in societies with population primarily derived from European countries. This recent socially constructed world of male homosexuality therefore produced an predictable outcome. Males who are generally the most feminine became overrepresented in the world of male homosexuality, this being the opposite of the situation existing in the first half of the 20th century.

Bell et al. (1981) reported that gender nonconformity was the single most statistically significant difference between predominantly homosexual males and predominantly heterosexual males, and the reason for this association is evident from their data on the "self-ratings" by males (as they were to the age of 17 years) using a "highly feminine to highly masculine" 7-point Likert scale (Table 4). Although rating on the scale overlap for homosexual and bisexual males, there are major differences, especially with respect to high femininity scores: 28 percent of homosexual males classified themselves in the three highest levels of femininity, compared to only one percent of heterosexual males, and the latter also only placed themselves in the least feminine of the three categories. In the two highest "masculine" ratings (5 and 6), 67 percent of heterosexual males classified themselves as such versus only 18% of homosexual males.

The distribution of homosexual males on the Bell et al. (1981) masculinity to femininity scale produced a similar distribution to the one resulting form the Bem (1974) gender classification used by Remafedi et al. (1991) for their sample of 137 gay and bisexual male youth ranging in age from 14- to 21-years-old (Table 4). For this study, the incidences of suicide attempts associated with each category were then used to determine the Odds Ratio at a 95% confidence interval for a suicide attempt by gay and bisexual male youth who had sufficient femininity attributes to warrant a classification other than "masculine." The more feminine gay and bisexual males, representing 82% of the sample in the feminine, androgynous, or undifferentiated categories, are 3.2 times more likely to attempt suicide than their "masculine" counterparts: Risk Ratio = 1.1 < 3.2 < 9.8 (Note 11). This is basically the same result reported by Remafedi et al. (1991) on the basis of multivariate analysis for the risk of a suicide attempt based on "feminine gender roles" (p. 873).

The association of femininity in males with being homosexually oriented as adults was also reported by Green (1987) in the book Sissy Boy Syndrome. The 44 "feminine" boys studied over many years became young adult men with a 75% probability of being gay or bisexual, as rated by the Kinsey 0-6 fantasy / behavior scale. A control group of 35 "conventionally 'masculine' boys" had only one young adult male in the bisexual category (p. 99-101). It should not be assumed, however, that all "feminine" boys will be homosexual or bisexual given that 25% of feminine boys in the Green (1987) study were heterosexual. On the basis of the Bell et al (1981) data on self-rated masculinity to femininity levels of males when they were children and adolescents (Table 4), and assuming that predominantly homosexual males make up about 5 percent of the population, 58 percent of the males in the 0-3 category would be homosexual (42% heterosexual), but homosexual males form 100% of the two highest - "0" and "1" - feminine categories.

Feminine boys have a long history of being abused in sexists societies and their reported higher risk for suicide problems would be, in part, induced or exacerbated by the ongoing abuse they have been subjected to since early childhood. Although Eric Rofes (1995) is describing his own childhood below, he is also describing a variation of the childhood and adolescent lives of numerous gay males I have met over the years.

I knew I was queer when I was a small child. My voice was gentle and sweet. I avoided sports and all roughness. I played with the girls... Heresy was a boy who cried a lot when he got hurt..., a boy who couldn't throw a baseball..., a boy putting on girls' clothing. Heresy was me. As I got older, and fully entered the society of children, I met the key enforcer of social roles among children... He was... like an evil spirit entering different bodies in different occasions... In any group of three of more boys, the bully was present.

I know a lot about bullies. I know they have a specific social function: they define the limits of acceptable conduct, appearance, and activities for children. They enforce rigid expectations. They are masters of the art of humiliation and technicians of the science of terrorism. They wreaked havoc on my entire childhood. To this day, their handprints, like a slap on the face, remain stark and defined on my soul...

As I entered adolescence... I saw other sissy boys become neighborhood toughs. They formed gangs of bullies that tormented us... Watching the powerless take on the trappings of power, I would shake my head and withdraw into deeper isolation... The abuse I suffered in American public schools, from kindergarten to my senior year of high school, created deep psychic scars with which I have struggled throughout my lifetime.

These same scars are shared by many others. We will never forget that we were tortured and publicly humiliated because we refused to be real boys, acted "girlish," or were simply different. This was the price we paid for being queer. (Rofes, 1995, pp. 79-80)

 First, this study suggests that students’ assumptions about heterosexuality perpetuate a norm of heterosexuality and constrain adolescent gender identity. Not only do students believe that a heterosexual identity is central to their gender identity, but stereotypic notions about femininity and masculinity largely inform their beliefs about who they are and who they cannot be...  Students’ descriptions of masculinity are also stereotypic and are largely defined by an anti-feminine norm. Unlike the ways in which girls can and do value masculinity, boys do not and cannot value femininity.

Second, this study asserts that there is a social and sexual curriculum in the culture of middle and junior high schools by which girls and boys construct their gender identities. This heterosexist curriculum, it is argued, perpetuates gender role stereotypes, limits gender identities, empowers masculine boys and disempowers girls, less masculine boys, lesbians, and gay males. The most pervasive indicators of this curriculum - due to heterosexism - are illustrated in the amount of gender disrespect, peer sexual harassment, homophobic language, and the highly (hetero)sexualized nature of adolescent gender relations in these middle and junior high schools. (Mandel, 1996)

What is unhealthy - and sometimes a source of stress and sickness so great it can lead to suicide - is homophobia, that societal disease that places such negative messages, condemnation, and violence on gay men and lesbians that we have to struggle throughout our lives for self-esteem... It is not by chance that when children approach puberty and increased sexual awareness they begin to taunt each other by calling these names: "queer," "faggot," "pervert." ...It is at puberty that the full force of society's pressure to conform to heterosexuality and prepare for marriage is brought to bear. Children know what we have taught them, and we have given clear messages that those who deviate from standard expectations are to be made to get back in