“I used to get so excited when the meth was all gone.”
This is my friend Jeremy.
“When you have it,” he says, “you have to keep using it. When it’s gone, it’s like, ‘Oh good, I can go back to my life now.’ I would stay up all weekend and go to these sex parties and then feel like shit until Wednesday. About two years ago I switched to cocaine because I could work the next day.”
Jeremy is telling me this from a hospital bed, six stories above Seattle. He won’t tell me the exact circumstances of the overdose, only that a stranger called an ambulance and he woke up here.
Jeremy is not the friend I was expecting to have this conversation with. Until a few weeks ago, I had no idea he used anything heavier than martinis. He is trim, intelligent, gluten-free, the kind of guy who wears a work shirt no matter what day of the week it is. The first time we met, three years ago, he asked me if I knew a good place to do CrossFit. Today, when I ask him how the hospital’s been so far, the first thing he says is that there’s no Wi-Fi, he’s way behind on work emails.
“The drugs were a combination of boredom and loneliness,” he says. “I used to come home from work exhausted on a Friday night and it’s like, ‘Now what?’ So I would dial out to get some meth delivered and check the Internet to see if there were any parties happening. It was either that or watch a movie by myself.”
Jeremy is not my only gay friend who’s struggling. There’s Malcolm, who barely leaves the house except for work because his anxiety is so bad. There’s Jared, whose depression and body dysmorphia have steadily shrunk his social life down to me, the gym and Internet hookups. And there was Christian, the second guy I ever kissed, who killed himself at 32, two weeks after his boyfriend broke up with him. Christian went to a party store, rented a helium tank, started inhaling it, then texted his ex and told him to come over, to make sure he’d find the body.
For years I’ve noticed the divergence between my straight friends and my gay friends. While one half of my social circle has disappeared into relationships, kids and suburbs, the other has struggled through isolation and anxiety, hard drugs and risky sex.
None of this fits the narrative I have been told, the one I have told myself. Like me, Jeremy did not grow up bullied by his peers or rejected by his family. He can’t remember ever being called a faggot. He was raised in a West Coast suburb by a lesbian mom. “She came out to me when I was 12,” he says. “And told me two sentences later that she knew I was gay. I barely knew at that point.”
Jeremy and I are 34. In our lifetime, the gay community has made more progress on legal and social acceptance than any other demographic group in history. As recently as my own adolescence, gay marriage was a distant aspiration, something newspapers still put in scare quotes. Now, it’s been enshrined in law by the Supreme Court. Public support for gay marriage has climbed from 27 percent in 1996 to 61 percent in 2016. In pop culture, we’ve gone from “Cruising” to “Queer Eye” to “Moonlight.” Gay characters these days are so commonplace they’re even allowed to have flaws.
Still, even as we celebrate the scale and speed of this change, the rates of depression, loneliness and substance abuse in the gay community remain stuck in the same place they’ve been for decades. Gay people are now, depending on the study, between 2 and 10 times more likely than straight people to take their own lives. We’re twice as likely to have a major depressive episode. And just like the last epidemic we lived through, the trauma appears to be concentrated among men. In a survey of gay men who recently arrived in New York City, three-quarters suffered from anxiety or depression, abused drugs or alcohol or were having risky sex—or some combination of the three. Despite all the talk of our “chosen families,” gay men have fewer close friends than straight people or gay women. In a survey of care-providers at HIV clinics, one respondent told researchers: “It’s not a question of them not knowing how to save their lives. It’s a question of them knowing if their lives are worth saving.”
I’m not going to pretend to be objective about any of this. I’m a perpetually single gay guy who was raised in a bright blue city by PFLAG parents. I’ve never known anyone who died of AIDS, I’ve never experienced direct discrimination and I came out of the closet into a world where marriage, a picket fence and a golden retriever were not just feasible, but expected. I’ve also been in and out of therapy more times than I’ve downloaded and deleted Grindr.
“Marriage equality and the changes in legal status were an improvement for some gay men,” says Christopher Stults, a researcher at New York University who studies the differences in mental health between gay and straight men. “But for a lot of other people, it was a letdown. Like, we have this legal status, and yet there’s still something unfulfilled.”
This feeling of emptiness, it turns out, is not just an American phenomenon. In the Netherlands, where gay marriage has been legal since 2001, gay men remain three times more likely to suffer from a mood disorder than straight men, and 10 times more likely to engage in “suicidal self-harm.” In Sweden, which has had civil unions since 1995 and full marriage since 2009, men married to men have triple the suicide rate of men married to women.
All of these unbearable statistics lead to the same conclusion: It is still dangerously alienating to go through life as a man attracted to other men. The good news, though, is that epidemiologists and social scientists are closer than ever to understanding all the reasons why.
Travis Salway, a researcher with the BC Centre for Disease Control in Vancouver, has spent the last five years trying to figure out why gay men keep killing themselves.
“The defining feature of gay men used to be the loneliness of the closet,” he says. “But now you’ve got millions of gay men who have come out of the closet and they still feel the same isolation.”
We’re having lunch at a hole-in-the-wall noodle bar. It’s November, and he arrives wearing jeans, galoshes and a wedding ring.
“Gay-married, huh?” I say.
“Monogamous even,” he says. “I think they’re gonna give us the key to the city.”
Salway grew up in Celina, Ohio, a rusting factory town of maybe 10,000 people, the kind of place, he says, where marriage competed with college for the 21-year-olds. He got bullied for being gay before he even knew he was. “I was effeminate and I was in choir,” he says. “That was enough.” So he got careful. He had a girlfriend through most of high school, and tried to avoid boys—both romantically and platonically—until he could get out of there.
By the late 2000s, he was a social worker and epidemiologist and, like me, was struck by the growing distance between his straight and gay friends. He started to wonder if the story he had always heard about gay men and mental health was incomplete.
When the disparity first came to light in the ’50s and ’60s, doctors thought it was a symptom of homosexuality itself, just one of many manifestations of what was, at the time, known as “sexual inversion.” As the gay rights movement gained steam, though, homosexuality disappeared from the DSM and the explanation shifted to trauma. Gay men were being kicked out of their own families, their love lives were illegal. Of course they had alarming rates of suicide and depression. “That was the idea I had, too,” Salway says, “that gay suicide was a product of a bygone era, or it was concentrated among adolescents who didn’t see any other way out.”
And then he looked at the data. The problem wasn’t just suicide, it wasn’t just afflicting teenagers and it wasn’t just happening in areas stained by homophobia. He found that gay men everywhere, at every age, have higher rates of cardiovascular disease, cancer, incontinence, erectile dysfunction, allergies and asthma—you name it, we got it. In Canada, Salway eventually discovered, more gay men were dying from suicide than from AIDS, and had been for years. (This might be the case in the U.S. too, he says, but no one has bothered to study it.)
“We see gay men who have never been sexually or physically assaulted with similar post-traumatic stress symptoms to people who have been in combat situations or who have been raped,” says Alex Keuroghlian, a psychiatrist at the Fenway Institute’s Center for Population Research in LGBT Health.
Gay men are, as Keuroghlian puts it, “primed to expect rejection.” We’re constantly scanning social situations for ways we may not fit into them. We struggle to assert ourselves. We replay our social failures on a loop.
The weirdest thing about these symptoms, though, is that most of us don’t see them as symptoms at all. Since he looked into the data, Salway has started interviewing gay men who attempted suicide and survived.
“When you ask them why they tried to kill themselves,” he says, “most of them don’t mention anything at all about being gay.” Instead, he says, they tell him they’re having relationship problems, career problems, money problems. “They don’t feel like their sexuality is the most salient aspect of their lives. And yet, they’re an order of magnitude more likely to kill themselves.”
The term researchers use to explain this phenomenon is “minority stress.” In its most direct form, it’s pretty simple: Being a member of a marginalized group requires extra effort. When you’re the only woman at a business meeting, or the only black guy in your college dorm, you have to think on a level that members of the majority don’t. If you stand up to your boss, or fail to, are you playing into stereotypes of women in the workplace? If you don’t ace a test, will people think it’s because of your race? Even if you don’t experience overt stigma, considering these possibilities takes its toll over time.
For gay people, the effect is magnified by the fact that our minority status is hidden. Not only do we have to do all this extra work and answer all these internal questions when we’re 12, but we also have to do it without being able to talk to our friends or parents about it.
1. That’s not his real name. Only a few of the names of the gay men in this article are real.
The text was written by Michael Hobbes for highline.huffingtonpost.com