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A Scandalous Situation Has Existed at the Official Publication of The American Association of Suicidology: Suicide and Life-threatening Behavior

My study of gay and lesbian youth suicide problems began in the early 1990s and important questions were soon being asked. Why had mainstream suicidologists not yet ventured into doing the research needed to confirm or refute the Bell and Weinberg (1978) findings? To the ages of 25 and 20 years, respectively, homosexually oriented males had been 6-times and 13.6-times more likely to have been suicide attempters than heterosexually oriented males. Why had mainstream youth (and adult) suicidology research generally ignored "sexual orientation" issues?

As a result of the Bell and Weinberg (1978) study results and the 1989 Gibson paper which synthesized the research available on gay and lesbian youth suicidal problems (US Dept. of Health & Human Service), the mainstream media began to report the findings. The US Congress (with its own history of being anti-homosexual) became troubled by these reports, and especially by the related activism. The National Institute for Mental Health (NIMH), the Centers for Disease Control (CDC), the American Association of Suicidology, and others were asked to investigate the problem, the outcomes being a June 1994 workshop, followed by the related first "sexual orientation" issue of Suicide and Life Threatening Behavior (25: Supplement, 1995). It came to my attention in the fall of 1995, one week before I was to present "The Homosexuality Factor in the Youth Suicide Problem" at the Sixth Annual Conference of the Canadian Association for Suicide Prevention (http://www.qrd.org./qrd/www/youth/tremblay/).

The "sexual orientation" issue of SLTB was long overdue, but it was disappointing for a number of reasons. The emphasis of the editors was on dismissing the available research findings from "convenience samples" of gay, lesbian, and bisexual youth; they are deemed "biased" because they had generally been taken only in gay communities throughout North America. Twelve studies available by 1994 (many are not mentioned in the "sexual orientation" issue) reported a 20 to 50 percent attempted suicide rate for gay and bisexual male youth who had become linked to gay communities (notes2.htm) and were therefore available for study. The criticism of the "bias" nature of these studies was akin to criticizing similar Aboriginal American studies for being "biased" because researchers had only taken their study sample on reservations. The 12 studies nonetheless reveal that all gay, lesbian, and bisexual adolescents and youth who have become available for sampling in North American gay/lesbian communities have consistently reported high levels of suicidal behaviors. Furthermore, the sampling procedures involved in the Bell and Weinberg (1978) study were far from what is generally implied by the expression "convenience sample."

At best, the "sexual orientation" issue of Suicide and Life Threatening Behavior (SLTB) was telling the ones in youth suicide prevention/intervention work that "homosexuality" can continue to be ignored (as the majority had been doing) because there was no scientific proof that gay, lesbian, and bisexual youth were more at risk for suicide attempt problems. They were also not at higher risk for suicide as the available research (such as the David Shaffer et al., 1995 results) indicated. A random sampling study would apparently be needed to convince mainstream suicidologists (such as Eve Moscicki and Peter Muehrer who are both intimately associated with the US Department of Health and Human Services, as well as being editors of the "sexual orientation" issue of SLTB) that homosexually oriented people are overrepresented in adolescent/youth suicidal problems.

The flawed methodology research result by David Shaffer et al. (1995) was published in the "sexual orientation" issue of SLTB, probably because it supported the traditional assumptions that gay and bisexual male adolescents were not more at risk for suicide than heterosexual adolescents. After reading the paper not addressing a major methodological flaw (Tremblay, 1995: http://www.qrd.org./qrd/www/youth/tremblay/app-c.html), it became obvious that SLTB peer reviewers were probably appropriately homo-ignorant, especially of gay and bisexual male children and adolescent realities; this is a legacy of most mental heath professionals having been highly ignorant of homosexual realities, with a history of also being homo-lethal. (The "cure" for homosexuals was rooted in the ideology that such people should not exist.) Therefore, a significant anti-homosexual agenda appeared to exist at SLTB, and the hypothesis was to be tested by submitting for publication in SLTB a shorter version of the Bagley & Tremblay August 16, 1996 "suicidality" paper.

The anti-homosexual agenda was also believed to exist because the editors of the "sexual orientation" issues of SLTB included a paper by David A. Brent. He is a youth suicide researcher who had always avoided/ignored "sexual orientation" issues in his widely published research work, and the submitted (probably solicited) paper by Brent was not an exception to the rule as revealed by its "silence" about homosexuality factors, also reflected in the paper's title: "Risk factor for adolescent suicide and suicidal behavior: mental health and substance abuse disorders, family environmental factors, and life stresses." What was the not so subtle message being given by publishing Brent's paper - silent about "homosexuality" - in a special issue of SLTB dedicated to examining the "homosexuality factor" in youth suicidality problems? What would Aboriginal Americans have thought if a "special issue" of any professional journal devoted to exploring Aboriginal American issues (about which the journal had been quite indifferent in the past) had included a paper which did not even mention the existence of Aboriginal Americans?

Another interesting feature of the SLTB "sexual orientation" issue was a paper by Rotheram-Borus and Fernandez" Sexual orientation and developmental challenges experienced by gay and lesbian youths" (pp. 26-34). Maybe Rotheram-Borus had been chosen to [ineffectively] address related "GLB youth suicide issues" based on her record. "After all," it may have been thought, "she did publish the paper Suicidal behavior and risk factors among runaway youths (American Journal of Psychiatry, 150(1), 103-7) and, although she referenced her previous research work related to runaway gay/bisexual youth, she had carefully avoided any mention of a possible homosexuality factor in suicidal problems of runaway youth. She had also not reported any sexual orientation data related to her study of these youth, just like mainstream researchers had been doing. In fact, she has stated: 'We selected the suicidal risk factors of interest on the basis of a review of the literature' (p. 103), meaning that she was the kind of person to challenge mainstream suicidologist in new ideas." It seems, however, like she and Fernandez had crossed the line; it was therefore only their paper which was challenged with another paper titled Gay and lesbian self-identification: a response to Rotheram-Borus and Fernandez (p. 35-9). Rotheram-Borus and Fernandez had certainly violated the spirit of what the editors had wanted the SLTB "sexual orientation" issue to be (Note 6). They had dared to place GLB youth in an "at risk" category for a number of problems, including suicide, and doing this was deemed unacceptable.

Much has been at stake for mainstream youth suicidologists if, for example, gay and bisexual males do form the majority of male youth suicide attempters and suicide victims. Basically, the suicidality-related factors they have been studying would be interpreted quite differently if "the homosexuality factor" applies. Almost all major problems gay and lesbian youth are at high risk for experiencing, such as drug and/or alcohol use/abuse, conduct disorders (running away from home, truancy, delinquent behaviors, etc), life stresses, family problems, etc., are predictable (and understandable) outcomes related to societal homophobia negatively affecting homosexually oriented youth in many interrelated ways. Most of these adolescents have also internalized society's rampant homophobia (producing self-hatred) and many have felt hated (to varying degrees) by most of their peers, and often enough their parents. Another predictable outcome of society's homophobia and the related stigmatization of homosexuality is the mental disorder called "depression." Their "depression," however, is quite different than the "depression" most often interpreted (diagnosed) to exist by mainstream mental health professionals, including suicidologists. These youth are not experiencing "depression" for "internal" or "biological" reasons; they are experiencing a predictable outcome of the negative life situation being inflicted on them in our traditionally homohating society. This situation is rendered for example, in article titles such as gay, lesbian, and bisexual adolescents: providing esteem-enhancing care to a battered population. (Nurse Practitioner, 22(2), p. 94, 99, 103. )

On the basis of the evidence, it was hypothesized that the rulers of Suicide and Life-Threatening Behavior would be greatly threatened by the proposition that "homosexuality issues" may be very significant (maybe the most significant) in the most serious male adolescent and youth suicide problems. Being ignorant of such a factor certainly makes mainstream youth suicidology 'experts' the opposite of what they have claimed (and are believed) to be; one implication would be that they have been wasting society's money on mindless research work and corresponding (possibly harmful) youth suicide prevention/intervention efforts. Furthermore, the often emphasized ideology that no one is responsible for youth suicidality problems (the most common belief rendered in youth suicide-related bereavement programs) is a fallacy when society's "homophobia" (includes family homophobia generally at its worst in fundamentalist Christian families) is implicated in youth suicidal problems. Gibson's 1989 paper emphasized this and therefore challenged the status quo in mainstream youth suicidology.

On the basis of the evidence, it was expected that mainstream suicidologists (who have traditionally ignored or avoided "homosexuality issues" in their work) would probably respond in "interesting" ways if presented with the Bagley and Tremblay male suicidality research results. For the first time using random sampling techniques, it was demonstrated that homosexually oriented male youth are overrepresented in suicidal behaviors and that they form the majority of male adolescent and youth attempting suicide. Would they behave in an irrational manner and refuse to publish the paper because the criteria used to determine the "homosexually oriented" nature of male studied was based on being "currently homosexually active" overlapping to a high degree with these male "outing" themselves to the researchers by self-labelling as "homosexual" and/or "bisexual?" Males defined to be homosexually oriented in our study also included currently celibate males self-identifying as "homosexual," all with a history of having been homosexually active.

Rejecting the paper for such a reason would certainly be "irrational" given that the aforementioned Shaffer et al. 1995 paper reported that male adolescent victims of suicides were deemed to be gay or homosexual if they had "outed" themselves to someone interviewed by the researchers (one male victim out of 95), or if it had become known that they were relating sexually with other males (two male victims out of 95). This method is a good way to determine the "homosexually oriented" nature of males older than 18 years, but it is a very poor way to make such a determination for teenagers given what is known about gay and bisexual male adolescents, their often highly closeted nature, and the "coming out process" they are experiencing (Note 7). SLTB was nonetheless prepared to publish Shaffer et al.'s 1995 research results. The paper we submitted was rejected by perhaps one of the "special issue" editors for using a homosexual orientation definition almost identical to that used by Shaffer.

An important reason why we submitted the paper to SLTB, however, was to have it criticized (in the most severe way available) by suicidologists who might have a vested interest in not publishing the efforts to measure homosexual suicidality based on random sampling technique, especially when the results do not support the widely held beliefs of mainstream suicidologists. On the other hand, papers such as the methodologically flawed Shaffer et al. (1995) study - producing results homophobes (such as Tony Marco) would greatly appreciate - were published, and the Shaffer's et al.'s 1995 result was used to challenge the Bagley and Tremblay proposition that homosexually oriented males would be overrepresented in the male youth suicide problem. The not so hidden objective of homophobes has been to continue seeing gay and lesbian people (often blatantly) abused: the Tony Marco agenda. The major problems of gay and lesbian adults and especially adolescents (and their causes) are also to be ignored so that a maximum casualty status (such as their serious suicide problems) will be maintained: the Tony Marco and the mainstream suicidology agenda. Suicidology is a part of the mental health field which has a history of harming homosexual people, followed by a history of ignoring them (Note 3).

Another reason given for our paper not being acceptable was that our research had not solicited the kind of information mainstream suicidologists solicited, such as drug and/or alcohol use/abuse problems. This reason therefore revealed a policy existing at SLTB: suicide behavior research is not published if only "sexual orientation" information is solicited and correlated to suicidality, but research results will certainly be published if "sexual orientation" information is not solicited. If, however, "sexual orientation" is implicated in the majority of male youth suicidal problems, this would mean that SLTB policy is counterproductive to understanding youth suicide problems. Given the facts of the case, SLTB should have been refusing to publish all youth suicidality research which did not solicit "sexual orientation" information, but the majority of research papers published by SLTB on youth suicidal problems have been in this category.

The Bagley and Tremblay "suicidality" results are a product of a secondary data analysis which sought to answer a very important questions in male youth suicidal behavior. Have homosexual/bisexual male youth been overrepresented in the male youth suicide attempt problem, as indicated by the methodologically sound Bell and Weinberg (1978) data and in all gay community based samples of gay/bisexual male youth? The Bagley and Tremblay results not only replicated the Bell and Weinberg results, but the nature of the sample also produced a "first-time" data-based estimate for the proportion of homosexually oriented male youth with a suicide attempt history: more than half (62.5%). This monumentally important result was largely ignored by the reviewers at Suicide and Life-Threatening Behavior, the journal with a history of generally dismissing the widely reported at risk status of gay, lesbian, and bisexual youth. It also does not have a history of advocating the inclusion of "sexual orientation" in youth suicide research and prevention work.

As a result of the SLTB reviewers' criticisms - at least the valid ones - the "suicidality" paper was edited, thus resulting in one version located at this website. The book in which the paper will be published was available by June, 1997. When Dr. Bagley (now at the University of Southhampton, England) received the SLTB reviewer's and editor's comments, he used the world "hostility" (in an email message) to describe the response to me. He felt bad that his colleagues - mainstream suicidologists - had behaved as they did, or as they had been analyzed and described to be since my investigative and research work began. I comforted him, noting that the response was "wonderful" and that it would become an important part of his "memoirs," should he decide to write them. His memoirs would probably also include the research scandal or sham - again related to the omission/neglect of "the homosexuality factor" - which has also been the status quo in the field of child sexual abuse. This especially applies in male child sexual abuse, and a preliminary investigation of the problem suggests that "the homosexuality factor" may also be very significant in female problems previously only attributed to having been sexually abused as children.

The story related to male (and female) youth suicidality problems (and related problems) is far from ended. To date, the experts at Suicide and Life-Threatening Behavior (the official publication of the American Association of Suicidology) have ignored and/or dismissed:

1. The more than 100 years of anecdotal history (including reports by experts on homosexuality at the turn of the century and contemporary experts) relating the high risk for suicidal problems in the homosexually oriented male and female populations existing in many traditionally homophobic countries (http://www.qrd.org./qrd/www/youth/tremblay/).

2. The fact that all study samples of gay, lesbian, and bisexual youth taken in many North America gay/lesbian communities have consistently reported very elevated suicide attempt rates: 12 studies reporting a 20 to 50 percent attempted suicide rates. Their suicide reattempter rates are also elevated (notes2.htm).

3. The important suicidality results of the methodologically sound Bell and Weinberg (1978) study. Their data indicates that homosexually oriented male adolescents and youth have been much more at risk for having suicide attempt problems (14- to 6-times more at risk to the ages of 20 and 25 years, respectively) than their heterosexually oriented male counterparts.

4. The first random sampling study to ever replicate/confirm the Bell and Weinberg results: the Bagley and Tremblay study. On the basis of the SLTB response to this study, it is likely that the four American school-based study results on adolescent suicidal problems may also be ignored or dismissed.

5. Other research-based information.
 

They have also ignored and/or dismissed:

6. The fact that mainstream suicidology has generally manifested a monumental indifference to the reported suicidal problems of gay, lesbian, and bisexual children/adolescents/youth. The proposition that these individuals are at high risk for suicidal problems has typically been responded to with denial and the use of science in much the same way that cigarette companies used science to deny the negative effects of smoking tobacco: there is no absolute proof supporting these propositions.

7. The fact that mainstream suicidologists have generally been indifferent to soliciting "sexual orientation" information in the various adolescent and youth samples studied. This situation existed before the Bell and Weinberg (1978) study was published, and it has continued to this day. The reason(s) for this indifference have not been studied. The message repeatedly rendered by the widespread silence about "sexual orientation" in mainstream research papers on youth suicidal problems, however, has been that "sexual orientation" is essentially perceived to be irrelevant in understanding and/or addressing adolescent and youth suicidality problems. The consequences of this situation have been counterproductive and also lethal if, in fact, homosexually oriented adolescents and youth have been overrepresented in suicidal problems, as it is repeatedly indicated by the empirical evidence.

8. The role mainstream suicidology has played in maintaining a general indifference to the health and welfare of gay, lesbian, and bisexual youth in most professional fields addressing children, adolescent, and youth problems. Typically, mainstream professionals have placed their efforts in avoiding these issues (Note 3) and, like mainstream suicidologists, they have continued to ignore sexual minority youth because: "there is no absolute proof of their at risk status." They are also able to quote mainstream suicidologists such as Moscicki, Muehrer, and others in this respect, so they can continue their traditional ongoing indifference toward "homosexuality" issues. Yet, the problems of these youth, including suicidality problems, are well known, as is the fact that most mental health professionals have not been educated and trained to effectively help these youth whenever serious problems have occurred, including suicide attempts.

It must also be noted that the special issue of SLTB on "sexual orientation" - a product of the 1994 workshop on the subject - was not the result of any interest in the subject manifested by the American Association of Suicidology. The "workshop" investigation was done at the request of the US Congress (as noted in the Introduction of the SLTB Suppl. 25, 1995), and it is likely that the ones requesting the investigation may have had an unspoken (or maybe spoken) mandate; maybe something like: "Get these activists off our backs. We don't want to do anything to help gay and lesbian adults, especially not gay and lesbian children, adolescents, and youth. This is a very sensitive topic which will cause great problems for us. Do what is necessary, even if you have to compromise your scientific integrity. This should not be difficult because mental health professionals have a history of compromising their practice and research integrity with respect to "homosexuality" issues. We are not unhappy that gay and lesbian issues continue to be generally ignored in most mental health fields, including suicidology. In the American military, we emphasize that gay and lesbian people do not exist and demand that they behave accordingly. We would be happy if mainstream suicidologists continued to respond to gay and lesbian issues in a similar way, as they have done by generally not identifying gay/lesbian/bisexual people in their studies. A major problem would certainly develop if it was ever determined that they figure predominantly in adolescent and youth suicidal problems."

Green (1996) noted that the official American military policy related to homosexuals has also been "the unofficial policy in many families and in the field of family therapy." He described the "professional" situation: "Don't ask, don't tell, don't teach much about it, don't write about it!" A study result was then cited for the Journal of Marital and Family Therapy from 1990 to 1995: only "approximately 1%" of papers published were related to homosexuality, the same applying for Family Process, in a world where about 10% of clients are "gays and lesbians" in the caseload of 72% of family therapists. (Green, RJ. Why ask, why tell? Teaching and learning about lesbians and gays in family therapy. Family Process, 35(3), 389-400.) The "publishing" situation from 1975 to 1995 was eventually rendered in Clark, WM., and Seovich, JM. (1997) Twenty years and still in the dark? Content analysis of articles pertaining to gay, lesbian, and bisexual issues in marriage and family therapy journals. Journal of Marital and Family Therapy, 23(3), 239-53: "Of the 13,217 articles examined in the 17 journals, only 77 (.006%) focused on gay, lesbian, and bisexual issues or used sexual orientation as a variable. Findings support the contention that gay, lesbian, and bisexual issues are ignored by marriage and family therapy researchers and scholars." The situation is much worse for bisexuality: "only two studies included bisexuals, indicating a dearth of knowledge in this area." (p. 248) Therefore, "bisexuality" has had an most "non-existent" status in Family Therapy.

An investigative report of this situation should be done by the mainstream media. Will this happen?
 

Addendum Notes:

1. Summary of the 1994 workshop on "sexual orientation" issues related to youth suicide problems. "...the NIMH co-sponsored a 1994 research workshop on this topic with the CDC and the American Association of Suicidology. This research meeting brought together a wide range of suicide research experts and representatives from service organizations and advocacy groups serving GLBT people. Organizations represented include the Sexual Minority Youth Assistance League of Washington, D.C., the National Gay and Lesbian Health Association, the Gay and Adolescent Social Services of Los Angeles, the Hetrick-Martin Institute of New York City, the Gay and lesbian Medical Association, the National Gay and Lesbian Task Force, the Association of Gay and Lesbian Psychiatrists, the Office of Gay and lesbian Concerns of the American Psychological Association, and the Homosexual Affairs Committee of the American Academy of Child and Adolescent Psychiatry." (Quoted from a March 21, 1997 letter from Peter Muehrer, Ph.D., Chief , Youth Mental Health Program, NIMH Prevention and Behavioral Medicine Research Branch, to Pierre Tremblay.)

The list looks impressive, almost as if mainstream suicidologists had maybe been prepared to listen to GLBT concerns. Such an event, however, does not appear to have occurred as revealed by information supplied by a peer reviewer of the Bagley and Tremblay "suicidality" paper at Crisis: "The [manuscript] 'Suicidality problems of gay and bisexual males...' presents a most important study. The topic is most important, highlighted by recent debates (See SLTB, 25). One study has been questioned, i.e., Shaffer, who reported a [gay male adolescent suicide] prevalence of 3%. At the meeting [the above noted 1994 workshop], he was confronted about his figures; regrettably, the published text [in SLTB] reflects none of this. Is this homophobia in science?" (Author anonymous due to anonymous nature of peer review process.) The exceptionally poor quality of Shaffer's 1995 study was immediately obvious to me (and so it seems to many others), as detailed in the 1995 paper The Homosexuality Factor in the Youth Suicide Problem" presented at the suicide prevention conference in Banff, Alberta.

It therefore does not appear like mainstream suicidologists were ready to accept informed GLBT criticism of their research work, much less ever have such caveats put in print. It also does not appear like the three editors of the SLTB special issue on "sexual orientation" (Suppl. 25, 1995: Moscicki, Eve, NIMH; Mueher, Peter, NIMH; Potter, Lloyd, CDC; Eds.) were willing to ever accept a concept which may have been presented: GLBT individuals are overrepresented in adolescent/youth suicide problems. Instead, it is likely that mainstream suicidologists had planned to use the occasion to confront (using hard science, of course) anyone believing the "GLBT youth overrepresentation in suicide problems" idea, only to then publish their own related beliefs (already in print, anyway) - with a bonus! They could now even claim that many GLBT professionals collaborated in what was concluded and published.

If the GLBT individuals present at the 1994 workshop ever believed that the situation at NIMH, the CDC, or at the American Association of Suicidology (with respect to almost completed avoiding/neglecting GLBT suicide issues), they would soon be in for a surprise. As a search for information related to GLBT youth suicide issues in the NIMH and CDC Internet sites revealed (see US DHHS section, the status quo has not only been maintained, but all who may have wanted to have GLBT issues incorporated in youth suicide prevention programs may be confronted with homophobic people citing the "sexual orientation" issues of SLTB to say: "The experts agree that there is no real scientific proof that GLBT adolescents and youth are at greater risk for having suicide problems."

2. When Dr. Bagley and I were about to send our "suicidality" paper to Suicide and Life-Threatening Behavior, I told him and others: "This is like sending a paper to the Vatican for review, approval, and publishing, the emphasis of the paper being that Roman Catholic beliefs are generally wrong. The response was to be very interesting, but predictable. In a special issue of SLTB, Suicide Prevention Toward the Year 2000 (Spring, 1996), the powers that be at SLTB had not only generally ignored "homosexuality" issues in the youth suicide problem, but ignoring these issues was essentially advocated (in a paper by Eve Moscicki) because it was not yet proven beyond doubt that gay, lesbian, and bisexual adolescents/youth were more at risk for having suicidal (especially suicide) problems. With respect to documented evidence that adolescents and youth attempting and committing suicide for reasons related to "homophobia/homohatred" issues, nothing was recommended to help them. This applies with respect to suicide prevention efforts, and even with respect to developing effective intervention strategies, such as having professionals educated about children/adolescent/youth homosexuality issues.

3. Ignoring homosexuality issues in fields addressing adolescent and youth problems has been the rule. For example, in a special issue of The Counseling Psychologist (Vol. 24, No. 3, July, 1996), this was done with respect to the "new" perspective on "optimal development in adolescence." Fortunately, some professionals who are familiar with "homosexuality" issues have recognized the lethal nature of such "mainstream" ideologies and responded. Ruth Fassinger, in "Adolescence: options and optimization," noted that a "double bind is created by imbedding in our models standards of optimization that, by theoretical definition, are impossible for large numbers of the population to achieve (p. 492)." This especially applies to gay and lesbian adolescents who are often denied those elements which make for optimum development in heterosexual youth. Concerning these youth, Fassinger notes that "existing empirical work suggests that many psychologists have limited knowledge and understanding of lesbians/gay/bisexual issues and that homophobic and heterosexist assumptions pervade intervention with these populations (p. 494)." Such interventions can only harm these people, especially during adolescence, and thereby exacerbate the problems for which help had been sought or was offered.

Rothblum, ED. (1994) reports on the gay/lesbian research situation in mental health fields: "However, there has been comparatively little research on the mental health of lesbians and gay men." (I only read about myself on bathroom walls: the need for research on the mental health of lesbians and gay men. Journal of Consulting and Clinical Psychology, 62(2), p. 213.) The situation has been the same in community psychology: "...the concerns of lesbians and gay men have remained largely invisible in community psychology." (Garnets, LD. and D'Augelli, AR. Empowering lesbian and gay communities: a call for collaboration with community psychology. American Journal of Community Psychology, 22(4), 1994, p. 448.) The situation in family therapy has also been similar, as previously described.

4. A group of people with a history of creating lies so they could actively harm another group of people could not be expected to suddenly change and begin actively helping the ones they have traditionally abused. Mental health professionals actively harmed gay, lesbian, and bisexual people up to the mid-1970s by ascribing the "mental disorder" label to all homosexuals and behaving accordingly. The best most of these professionals have done since then is to actively ignore the existence of homosexual/bisexual people and their problems, especially as children, adolescents, and young adults. At best, occasional lip service has been paid to "homosexuality" issues. The unspoken objective may be rendered as: "If we can't actively harm them anymore, we'll do it in other ways, and we are certainly not going to help them." A study of mainstream suicidology (and other disciplines) would uncover this not so hidden underlying attitude manifested in numerous ways. This situation must change.

5. Research results indicating that gay/lesbian/bisexual people are at risk for suicide problems, including completed suicide.

(A) Martin RL et al. (1985) Mortality in a follow-up of 500 psychiatric outpatients. Archives of General Psychiatry, 42, 58-66.
In a six- to twelve-year follow-up of 500 psychiatric outpatients, there were six suicide victims: three males and three females. Two of the six (33.3%) were homosexual. Concerning this, the authors state: "Homosexuals have not been identified in previous mortality series. It should be noted that in this study homosexuality was associated with a history of suicide attempts at the index evaluation [a 1972 paper is referenced], as well as completed suicide during follow-up (p. 65)."

(B) Motto, JA, et al. (1985) Development of a clinical instrument to estimate suicide risk. American Journal of Psychiatry, 142(6), 680-86.
A sample of 2,753 adult subjects (admissions to a hospital for a depressive or suicidal state) were studied to produce a suicide risk scale using the 15 most significant risk items from a list of 101 possible variables. One of the highest risk item was being homosexual/celibate or bisexual/sexually active. This is the same group (at least for males) identified by Bagley and Tremblay to have been at the highest risk for a serious suicide attempt in the recent past; the celibate homosexual young adult males also had the poorest mental health. The celibate group was also identified to have poorer mental health status in the Bell & Weinberg's 1978 study of a 1969 sample of 575 predominantly homosexual males. A two year follow-up of the Motto et al.'s subjects produced a suicide rate of 4.94%: 108 suicide victims.

(C) Pattison, JK, and Kahan, J. (1983)The deliberate self-harm syndrome. American Journal of Psychiatry, 140(7), 867-872.
A total of 33 published papers (1960-1980) produced a total of 56 case studies of "self-harm," including single episode events. Twenty-six percent (26%) of these cases (15/56) involved homosexual individuals. This result reveals that homosexuals were overrepresented in published case studies of self-harm which may have reflected the overrepresentation some clinicians encountered in their client populations. A similar homosexual/bisexual overrepresentation in the self-harm category was reported by Bagley and Tremblay.

(D) Reinhertz, HZ et al. (1995) Early psychosocial risks for adolescent suicidal ideation and attempts. Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 599-611.
Result from a longitudinal study of about 400 individuals with testing having occurred at ages 5-6, 9, 14, 18, and 21 years. "Early gender-specific risks for suicidal ideation included preschool behaviors that were counter to typical gender norms, such as aggression in females and dependence in males. Suicidal ideation at age 15 and suicide attempts were both associated with deficits in later adolescence (at age 18) in behavioral and social-emotional functioning."
Gender nonconformity in early childhood has been linked to a high likelihood of being homosexual or bisexual later in life and the above results, including the so-called "deficits" in adolescence and suicidal problems, may (to a significant degree) result from the homosexually oriented segment of the study sample. These youth are likely to be experiencing the often distressing "coming out" process. Remafedi et al. (1991) reported that gender nonconformity for gay/bisexual male youth produced a 3-times risk factor for an attempted at self-killing, compared to their more gender conformable counterparts. Unfortunately, as the situation typically exists in mainstream studies of adolescent problem, the longitudinal study researchers did not (to my knowledge) solicit "sexual orientation" information from their adolescent and young adult subjects. Obtaining such information would certainly help to shed light on the "homosexual" contribution in adolescent problems.

- Reinherz, HZ, et al. (1993)Psychosocial risks for major depression in late adolescence: a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 32(6), 1155-63.
Another paper (out of the five published) on the longitudinal study described above. Gender nonconformity at the age of 5-6 years, but only for males, was associated with depression. Implicated adolescent factors are also noted, such as "anxiety at age 15 years;" this could be associated with "coming out" issues, but nothing about "homosexuality" issues was mentioned by the researchers even if gender nonconformity in childhood has been intimately associated with homosexuality (especially for males) in adulthood. The researchers are with Simmons College School of Social Work, Boston, MA.

(E) Brady, S. and Busse, WJ. (1994) The gay identity questionnaire: a brief measure of homosexual identity formation. Journal of Homosexuality, 26(4), 1-22.
A study of 225 males (average age = 28.8 years; 196 used for a statistical analysis) who reported having "same-sex thoughts, feelings, and/or behavior." A highly significant difference (at the .0000 level) was reported on the "psychological well-being" scale between males in the "tolerance" stage of the "coming out" process, compared to those in the "acceptance" stage. The most significant discriminating variable was the presence of "suicidal feeling" in males who were not self-accepting with respect to their homosexual desires. In the Bagley and Tremblay study, "coming out" problems were postulated to be associated with depression and/or a history of suicidal problems: being bisexual as a transitional part of the "coming out" process and not acting in accordance to ones desires: being a self-labelling celibate homosexual male. Problems for these males may be ongoing, may have begun in childhood, probably became more pronounced in adolescence (includes suicide attempts), and continued into adulthood. A history of mental health problems has also been associated with gay/bisexual males who contracted HIV. Interestingly enough, the Reinherz et al. studies have emphasized the ongoing nature of serious problems and the co-occurrence of other problems; this was also a feature of troubled gay/bi males in the Remafedi et al., 1991 study of 137 gay/bisexual male youth. Reinherz et al. have also emphasized that the often believe "short-term" nature of problems for adolescents is likely incorrect, as strongly suggested by their data. The longitudinal nature of serious adolescent problems may therefore (at least in part) be related to the role "homosexuality" has been playing in these problems. The effect may be significant given that homosexually oriented adolescents are overrepresented in many (maybe most) of the serious adolescent problems.

6. The spirit of the SLBT "sexual orientation" issue may be described as "anti-the-recognition-that sexual-orientation-would-be-a-factor-in-adolescent/youth-suicide-problems." The major - and only - "research" feature published was the Shaffer, D. et al. paper which strongly indicated that GLB adolescents were not at higher risk for suicide, compared to their heterosexual counterparts. The research, however, appears to have been done by a lead researcher with an agenda as rendered by Remafedi, G. (1994) in his book, Death by Denial: "Fueling the intrusion of politics into the science, well-funded scholars sometimes oppose new perspectives in their own field of research. Writing in the New Yorker magazine, a prominent suicidologist dismissed existing data on the risk for suicide for homosexual youth based on his perception that the participants had been 'unusual groups of gays' and criticized activists for using the data to justify social tolerance. He concluded; 'Suicide is usually a story of misperceptions and misunderstandings, of feelings of despair and lack of control; it cannot be attributed simply to having a difficult life. And it has no place in anyone's political agenda, no matter how worthy.' It is ironic that such critiques of peer-reviewed, published research are aired in popular magazines, rather than submitted to comparable scientific scrutiny. Even more disturbing is the fact that scholars themselves try to foreclose discussion of promising new ideas in defense of their own viewpoints and interests (p. 8-9)." The New Yorker article being quoted from was Political science authored by David Shaffer, the psychiatrist and only suicidologist who would have 'new' GLB suicide research work published in the special 1995 Suicide and Life-Threatening Behavior "sexual orientation" issue.

David Shaffer will certainly be featured in the internet page on psychiatry I will be writing. Only some raw data, mostly in the form of abstracts, is now available on the page. With respect to homosexually oriented people, psychiatry has been an incredibly abusive and harmful 'profession'.

 Remafedi deemed the GLB youth suicide situation to be Death by Denial, but "denial" is often the result of a pathological process. Could it be that David Shaffer has been implementing an unconscious 'agenda' rooted in the not-long-ago psychiatric belief that homosexuals should not exist. If so, the situation would then be best described not as Death by Denial, but as Death by psychoathological Maliciousness.

7. David Shaffer et al. (1995) conducted his postmortem research of adolescent suicide victims in great disregard of knowledge published about GLB adolescents and their closeted status. For example, the victims' parent were asked about the "sexual orientation" of their offspring (when parents are commonly the last to discover such facts about their children), and the individual (assumed-to-be-friend) designated by the parents was also asked the same question. Often enough, however, GLB adolescents live double lives (having 2 sets of friends), and GLB friends (if they have any) are probably not known to their parents.

--A mother who lost her 14-year-old son in 1995 as the result of his second suicide attempt reported that, had he died as the result of his first attempt, no one would have known he was gay - as he himself knew since he was 10-years-old. He was, however, taunted at school because of the telltale indications that he was not heterosexual.

--A 19-year-old Edmonton boy who committed suicide in 1994 would not have been deemed homosexual using the "Shaffer" determination method. A good investigative journalist, however, did find hints on the boy's computer: a link to the editor of the GLB newspaper. It was then discovered that he was known in the GB community, had been sexually active, and had had discussions related to coming out to his parents.

--For two 13- to 14-year old boys who committed suicide in the Calgary Area in 1996, their gender nonconformity (a visible degreee of effeminacy) had been recognized by their mothers since an early age, and they had been abused by other boys (as they have been socially programmed to do) because of this. One had also become a delinquent and hung himself in a detention cell after an arrest.

--A 17-year-old Calgary boy who committed suicide in 1995 (reported on in Update 1996) was also (unknowingly to his parents and most friends)homosexually oriented. A little later, however, after mentioning the "save-the-world-factor" at a meeting, his mother told me that he certainly was in this category. Another mother who lost her 17-year-old bisexual-identified son also noted that this factor could have been implicated in her son's death. He was "out" publicly and had also made formal contact with the GLB community, which included being raped. Unfortunately, these factors have not yet been considered for exploration by mainstream suicidologists.

The difficulty of establishing the "homosexual orientation" of adolescents has nonetheless been well rendered by professionals who have worked with them. "...there are many unrecognized gay adolescents in [social work] client case loads. The number is difficult to determine for several reasons. First, sexual orientation is often ignored, denied, or not considered relevant to the provisions of services, and thus many not be elicited on intake forms or in client interviews... fear of exposure as homosexual often causes many gay and lesbian youth to hide, thus increasing their invisibility within the youth service system," and this includes GLB youth suicide attempters who withhold such information even from mental health professionals who are assigned to such cases. (Martin & Hetrick, 1987.)

A similar situation was also noted by Bob Tremble in Toronto (Canada's largest and most gay-positive city), even with respect to gay-bisexual male street youth (at high risk for having suicide problems) who are repeatedly having homosexual experiences given their prostitution work. "Workers in most of the traditional services don't seem to anticipate that kids may not be heterosexual. Initially, sexual orientation might not be relevant to workers in services which provide financial assistance, clothing and food, but it is relevant when a youth is seeking shelter, counselling and medical care. It is often very difficult for kids to disclose their sexual orientation, even when asked at an intake interview. Not that many kids are that up-front" (p. 44). (Tremble, B. (1993) Prostitution and survival: interviews with gay street youth. The Canadian Journal of Human Sexuality, 2(1), 39-45.)

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