Health 2 May 2013 The uncomfortable truth: why do more men than women commit suicide? The hangover of the "stiff upper lip" years leads directly and frighteningly to the deaths of hundreds of men in the UK. What can we do about it? Sign UpGet the New Statesman\'s Morning Call email. Sign-up In 1997, a book by Marc Etkind called ...Or Not To Be: A Collection of Suicide Notes enjoyed quiet but firm success: quiet, because the buyers themselves often expressed feeling "uncomfortably morbid" about its purchase, even when they left online reviews; firm, because apparently this sort of morbid voyeurism is part and parcel of human nature. Staunch belief in this ubiquitous enjoyment of the gruesome and tragic is presumably why the book’s own editor referred to its content as "pornography". But there are other reasons why people might have clamoured for the contents of Kurt Cobain’s last adieu to the world, or Sylvia Plath’s final explanation for a life of steady masochistic decline. Suicide is one of the most frightening and persistent occurrences in the world. It goes against everything we know about biology and those "natural" instincts which are apparently programmed towards survival. Its continued appearance across all strata of our own society, and all societies resident on our planet, utterly destroys the idea that we can ever centrally control, provide or quantify happiness. We might see patterns in suicidal behaviour periodically emerge - the dramatic spike in people taking their lives in the UK and US during the recession, for instance, certainly indicates a connection with financial hardship - but many, many suicides remain inexplicable. An extremely common response amongst family members who have lost loved ones to suicide is, "I don’t understand why". And so this undeniable interest in the suicide notes of others - those prized letters which, statistically, are hardly ever left - can be seen as a collective exercise in self-protection as well as straightforward morbidity. Reading the notes of others might arm us with some preventative measures, we reason. It might elucidate the mechanics of human drives turning in on themselves. It might even help us to eventually purge suicide from our global community altogether. That’s exactly what a research team at Cincinnati Children’s Hospital had in mind when they compiled "the world’s largest collection of suicide notes" and released the news to the North American media last month. One man, a professor of paediatrics called John Pestion, claimed in USA Today to have read all 1,300 of them in his quest to produce tools for diagnosing an individual’s true suicide risk. Whether the team will be successful remains to be seen, but for western societies, the issue is pressing. According to ONS, suicide is now the single biggest killer of young men in England and Wales; in recent years, it has more than once outstripped the number of deaths from road traffic accidents and assault combined. Which brings us to the uncomfortable truth: that suicide has a clear gender bias. It is an event with a male face, although the specific affliction behind it is murkier. There are certain populations which suffer from the highest rates of all, such as prisoners and those from lower socioeconomic backgrounds. "But what exactly do we achieve when we shift our focus to these?" says Jane Powell, head of the male suicide prevention charity Campaign Against Living Miserably (CALM.) "The simple, numerical fact of the matter is that men are dying by their own hand far more than women. We need to tackle that immediately." Jane Powell is a practical woman with a practical viewpoint. She was brought in as a freelancer to develop an anti-suicide pilot project for men in Manchester in 1997; she had no personal connection with suicide, but the issue quickly became her vocation. When she was asked to wind the pilot up, she decided to develop CALM into a fully fledged independent national charity instead. And she sees nothing strange in the idea of a woman heading up a charity that specifically targets male suicide: the numbers and the people spoke for themselves, she says, and she was in the right place at the right time. She wasn’t willing to walk away. In many ways, an increased risk of suicide for men can be seen as that old foe, the patriarchy, backfiring on itself. Rigid binary structures of gender have led to a cultural expectation that men won’t voice depressive feelings or problems with anxiety, preferring instead to suffer in silence until the suffering becomes unbearable and they remove themselves resignedly from the fold. This conflation of emotional turmoil with weakness combines toxically with social stigma surrounding mental health. Often, the idea of a psychiatric visit literally becomes a fate worse than death. "Men don’t want a diagnosis or an introduction to the mental health system," says Powell, simply, "so what’s the point in campaigning to get them to accept a label? In the here and now, we provide initiatives that acknowledge and normalise depressive feelings in men. We point them towards our helpline. We don’t insist that the man in question has to see his GP. We address the suicidal urge without implying that we might introduce him to a world of further prejudice; that’s how we prevent a man from killing himself. Of course we work to break down destructive expectations about traditional masculinity - but we’re pragmatic when someone is in the throes of a suicidal episode." In other words, she picks her battles. Feminism, Powell believes, has progressed massively in terms of female expression in the last 40 years - she personally recalls once being refused a job for wearing trousers. Assertiveness is now a virtue for the "career woman" rather than a perversion of the "sweet, meek" housewife - and, indeed, trouser suits are the norm - but the parameters of the male identity have remained comparatively narrow. This blinding hangover of the "stiff upper lip" years leads directly and frighteningly to the deaths of hundreds of men in the UK (a number that, according to Powell, is climbing in certain age ranges.) While Powell might see this as feminism forgetting her brothers, however, it seems more likely that "male" attributes, with all their attached prestige, are easier to assimilate than those "female" ones which stink of instability and inferiority. Whatever the reason, people die. And initiatives like CALM - which attempt to frame suicide as something that ‘everyone considers’ rather than a thought which, when voiced, could lead you straight into a hospital bed - are making practical differences. Young male suicide rates during their years of operation have dropped by 55 per cent in Merseyside alone. Discussions about mental health stigma and sexism desperately need to be further explored, but the technique over at CALM is working, and it’s working in difficult conditions. The general erosion of gender barriers, however, must be a society-wide effort - and until it is, Powell believes that we will continue to lose men in their droves. Interestingly, the suicide note itself is one of the only aspects of the act which seems entirely isolated from the sex of the deceased. Men and women are equally likely (or unlikely) to leave behind written accompaniments to their untimely shuffling off the mortal coil - which range from the outright harrowing to such dark comedy as George Eastman’s "Dear friends: my work is done. Why wait?" Faced with the numbers, addressing suicide seems daunting - but a lot can be done through the day-to-day challenging of gender expectations. Because, ultimately, we all have a responsibility to give those like Eastman a reason for the waiting. If any of the content of this story affects you, the Samaritans are available to talk 24 hours a day, 365 days a year. › Labour would reform the state, not just rebuild it Kurt Cobain in 1993. Photograph: Getty Images Holly Baxter is a freelance journalist who writes regularly for The Guardian and The New Statesman. She is also one half of The Vagenda and releases a book on the media in May 2014. 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