Better Life Lab is a partnership of Slate and New America

According to the most recent Centers for Disease Control and Prevention data on suicide, men are 77 percent of the 45,000 people who kill themselves every year in the United States. Similarly at the global level, according to the World Health Organization, men die by suicide at a higher rate than women do everywhere in the world—with a ratio ranging from 1.5:1 to 3:1—making up a majority of the more than 800,000 persons who kill themselves every year. Globally, suicides represent half of male violent deaths.

For obvious reasons, understanding why an individual takes his or her life is difficult to study. But if we hope to prevent suicide, we need to talk about why it is predominantly affecting men.

In a survey my organization, Promundo, carried out with support from Axe, of 1,500 young men aged 18–30, we found that nearly 1 in 5 thought about suicide in the past two weeks. Which young men were more likely to think about suicide? Those who believed in a version of manhood associated with being tough, not talking about their problems, and bottling up their emotions were twice as likely to have considered suicide. Studies in other countries have found the same, namely that men with more restrictive ideas about manhood are more likely to think about suicide than young men who aren’t so stuck in the “man box.”

So what gives? Being a man in the U.S., and around the world, too often means learning to suppress our emotional experience, so much so that we as men often lack even the language to express or understand our emotions. Some psychologists have called this alexithymia—the inability to connect with and communicate one’s emotions—and identified it as more prominent in males. Quite simply, if men can’t recognize negative or troubling emotions, and can’t or don’t seek help or talk about them, we don’t know what to do when we face them.

Here’s an example of how this works. In Promundo’s work with young men and young women to question and challenge harmful ideas about manhood, we use an activity we call, “Expressing my Emotions.” We ask young men which of five emotions they feel the most comfortable expressing, and which they can’t express. Consistently, young men say that anger and happiness are the easiest emotions to express. Affection, sadness, or fear? No way, they say. Real men can’t show those.

Being a man in the U.S., and around the world, too often means learning to suppress our emotional experience, so much so that we as men often lack even the language to express or understand our emotions.

Our ideas about manhood mean that asking for help is seen as weak, feminine, or even gay. Seeking medical support and mental health support by men is not only frowned upon, but also seen as unmanly. To even recognize pain—physical or emotional—is to risk being told by your male friends or family that you’re not a “real man.”

The CDC’s recent analysis of factors contributing to the increase in suicide rates in the U.S., released June 7, reads like a list of disproportionately masculine traits: mental health problems (often untreated or undiagnosed); alcohol or drug use (higher for men than women and often a solace for failed manhood); social or personal problems (for which men are not supposed to seek help); and access to firearms (again, mostly men).

Suicide is far more common among white men in the U.S., the same category of men who feel the world owes them a well-paying stable job, and the respect that comes with that. They have lost employment or face a personal stress, often divorce or estrangement from their families. Current data show that between 1 in 4 and 1 in 5 working-age men—about 20 million—aren’t working, three to four times what it was during the 1950s. Many men among those feel a sense of what sociologist and masculinities expert Michael Kimmel calls “aggrieved entitlement.”

We also know that men over the age of 60 are those most likely to die by suicide. Some of this may be a response to chronic pain and declining health. But many of these deaths are no doubt an indictment of how we treat older men and older people in general. Namely that as their bodies and virility are in decline, they feel unwanted in a world that wants and privileges young, able bodies. Add to that the social isolation of elderly men in many parts of the world relative to women. An AARP national survey in the U.S. indicates that 1 out of every 3 adults over the age of 45 now report feeling lonely, whereas only 1 out of every 5 adults reported feeling lonely 10 years ago; another study in Germany finding single men more likely to report feeling lonely than single women—an increasing challenge given decreasing rates of marriage and cohabitation. In short, the trend is for men to become even lonelier or at least more likely to live alone, factors that also influence suicide outcomes. The conclusion we can take from this is that men, by being emotionally cut off from themselves and others, are at risk.

Women are more likely to attempt suicide, nearly twice as likely according to some research. But men are two to four times more likely to carry it out. That’s due to the way they attempt suicide: Unlike women, men tend to use guns. It might be tempting to say that men are more likely both to own and use firearms for suicide and thus more likely to kill themselves. But the association between manhood and gun ownership is a problem in itself.

The headlines have been filled in recent months and years with the stories of the few angry men, mostly younger white men, who carry out mass killings. These are often in schools, workplaces, or churches where they seek revenge on people they believe have wronged them. Some of these mass shooters leave behind accounts making it clear they want to kill people who they perceived slighted them and that they, the shooters, want or expect to die in the process. But far more men, more than 30,000 every year in the U.S., take their own lives without telling us why. But the fact that they are men tells us a lot about why.

And it turns out there is plenty we can do about it. There are targeted mental-health and suicide-prevention efforts like Making Connections implemented across the country by the Prevention Institute and Movember Foundation. There are educational films like “Tough Guise” and “The Mask You Live In” that provoke discussions with young men, parents, and teachers about how we raise our sons in emotional straitjackets. There are educational curricula that promote healthy, connected ideas about masculinity like Manhood 2.0 (which Promundo created), and Live Respect from the organization A Call to Men. When implemented well, these approaches show evidence of changing young men’s ideas about manhood—changes that in turn have been shown to lead to less violence and more help-seeking.

Women are more likely to attempt suicide, nearly twice as likely according to some research. But men are two to four times more likely to carry it out.

There is also a field of public health practice called “gender-transformative interventions,” which promotes changing harmful or restrictive ideas about what it means to be men or women. And the evidence base shows that they can work in improving health outcomes, including encouraging greater use of health services.

We know from another study we recently carried out with Axe that young men who are bullied—including those bullied for their sexual orientation—are more likely to have depressive symptoms, a major risk factor for suicide. Bullying has distinctly male characteristics: that is, it is often carried out by young men against other young men as a way to police their behavior or their appearance and to reinforce power.

This much we know: There is no single driver or cause of suicide. To be sure, it is far more complex than simply linking it to harmful societal norms about manhood. Access to adequate health care, support services, and social support from family, friends, and neighbors are essential in preventing suicidal ideation and behavior in men. Yet, men’s emotional isolation often means that men are unlikely to pursue formal health care, or even to seek help and support from family and friends when they need it. Parents can talk to sons and daughters about seeking help when they need it. Fathers can model showing emotions other than anger.

We shouldn’t stop doing any of the other things we are already doing to prevent suicide. But all of those things would work even better if we take the brave step of talking about the connection between suicide and our social ideals about manhood. That doesn’t mean we need a conversation telling men they are bad or damaged just for being men. Manhood is not a mental health disorder. But raising our sons to repress their authentic connected selves, not to seek help, to use violence to resolve their problems, and to think that showing weakness or admitting depression or other mental health problems is unmanly is a problem.

It’s time we talked more about suicide. And about what it has to do with the harmful ways we raise our sons. Their lives literally depend on it.