Gay Men and Suicidality: The Development and Nature of the Critical Superego

National research studies report elevated suicide rates amongst gay men, particularly those under the age of 26. Much of the current health and psychiatric literature on suicide tends to focus on the external world impacting on the suicidal individual. Although valuable, it is not enough to understand the specific circumstances that could contribute to gay men's suicidality. This paper focuses on the relationship between the external and internal dynamics at play in the suicidality of gay men, with particular emphasis on the development, influences, and nature of a cruel and punishing superego. The author provides some contemporary psychoanalytic theories on same-sex desire as a useful framework to understand minority sexuality. Some influential classic and contemporary psychoanalytic theories regarding suicidality and the development and character of a cruel and punishing superego are presented. The concept of internalized homophobia and the impact of heteronormative masculinity on the gay man's psyche are explored as drivers for suicidality. A composite case study from clinical experience with suicidal gay men in an NHS setting is presented to illuminate the discussion. This paper could add new perspectives and important dialogue for psychoanalytic psychotherapists working with this patient population.