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Most people associate death by gunfire with urban areas. According to this article, the rate of shooting deaths (as a % of the population) is at least as high in rural areas.

There is one difference: in rural areas, the victim is more likely to also be the killer.

February 13, 2005
Social Isolation, Guns and a 'Culture of Suicide'
By FOX BUTTERFIELD

STEVENSVILLE, Mont. - Patrick Spaulding, 17, was the star of his basketball team, an honor student and one of the most popular boys in his class at Stevensville High School here in western Montana.

Bill Tipps, 83, was devoted to his wife of 62 years, Louise, who had developed diabetes and who he feared would need to have her leg amputated.

Ron Malensek, 42, owned several small businesses, collected guns and called his wife "Princess."

All three died of a single gunshot wound to the head in this valley below the snow-covered Bitterroot Mountains. All three pulled the trigger themselves.

Death by gunfire is typically thought of as an urban plague, fueled by crime, poverty and drugs.

But rural America also has such an affliction. "Americans in small towns and rural areas are just as likely to die from gunfire as Americans in major cities," said Charles Branas, an assistant professor of epidemiology at the University of Pennsylvania School of Medicine. "The difference is in who does the shooting."

No matter the method, suicides occur at a higher rate in rural areas than in cities or suburbs, with the rate rising steadily the more rural the community. With homicides, the trend works in reverse, with higher rates in more urban areas.

Researchers have long known the statistics, but new research illuminates the substantial role of firearms in suicide.

When Professor Branas examined data from the federal Centers for Disease Control and Prevention, he found that the risk of dying by gunshot was the same in rural and urban areas from 1989 to 1999, findings that were published in The American Journal of Public Health. He has also concluded that in the most rural counties, the incidence of suicide with guns is greater than the incidence of murder with guns in major cities.

Many of the cases in Stevensville and in other rural areas have common threads, professors and epidemiologists say. People who see themselves as rugged frontiersmen are often reluctant to reach out for help, particularly for mental health treatment. If they do, they may see a physician instead of a psychiatrist or another trained mental health expert.

Suicide risk factors like depression, economic worries and alcohol use are, of course, prevalent in urban areas, said Dr. Alex Crosby, an epidemiologist in the National Center for Injury Prevention and Control at the Centers for Disease Control. But they are heightened in rural areas by social isolation, lack of mental health care and the easy availability of guns.

"People say, 'How could people living in such beautiful places commit suicide?' " said Nels Sanddal, a psychologist in Bozeman, Mont., and president of the Critical Illness and Trauma Foundation, which works to prevent suicides. "We have a culture of suicide."

As far back as 1890, soon after Montana became a state, statistics from the Census Bureau show that it had the highest suicide rate in the nation, Mr. Sanddal said.

"When you have seen other people exercise it as an option in a difficult situation, it becomes easier for you to exercise it as an option," he said. "So now suicide is condoned or tolerated in Montana, even if people don't talk about it."

Surprise Over Statistics

Stevensville is in Ravalli County, which has a suicide rate more than twice the national average. Since 1990, the county has had 103 suicides, more than three quarters of which involved a firearm. By comparison, there have been just 13 homicides in the county, whose population has swelled 44 percent in that time, to 36,000 people.

The youngest to commit suicide in the county was 13 and the oldest was 92. Reflecting a national pattern, suicides rise sharply with age among men in the county.

The editor of The Ravalli Republic, the local daily newspaper, said that it is against the paper's policy to report on suicides and that he was unaware of a sizable number of incidents in the county.

When asked about the high suicide figures, Sheriff Chris Hoffman said, "This shocks me," even though he is also the coroner and signs all death certificates. Since the 1890's, Sheriff Hoffman's family has raised cattle in the Bitterroot area, which Lewis and Clark traversed in 1805 and described as the most difficult part of their journey.

"People here are not aware of all the suicides," he said. "It's not something people here talk about."

Professor Branas said he encountered similar surprise when he conducted field studies in rural counties in Iowa, Ohio and Pennsylvania.

Most families of those who committed suicide around Stevensville in the last year declined to be interviewed. But relatives and friends of several people who died in previous years agreed, often reluctantly, to talk.

Mary Lee Rush, whose son committed suicide at 29 and who lives in Grantsdale, an unincorporated town in Ravalli County, said: "People here are very rural. They do for themselves. They won't go for help."

Suicide, she said, "is an acceptable way of dying if you feel desolate or you can't handle things anymore."

A Young Life Ended

Patrick Spaulding, a 6-foot-4-inch senior, was the leading scorer on his high school basketball team and had set a school record with 28 rebounds in a single game. "He lived for basketball," said his mother, Paulette Spaulding, who lives in the family house with her husband about five miles outside Stevensville. Patrick was consistently on the honor roll.

On a Friday night in January 1997, Patrick went out and drank a few beers, his friends said, and on the way home apparently fell asleep at the wheel, entangling his pickup truck in barbed wire. A sheriff's deputy gave Patrick a citation for illegal possession of alcohol.

"Under school rules, that would have meant he would be suspended from the team for the rest of the season," his mother said. "He was such a perfectionist, always harder on himself than on anyone else, he felt he had let his family and teammates down." He did not discuss the situation with his parents. The next morning, the day of a big game, alone in his bedroom, Patrick shot himself.

"Teenagers don't live for tomorrow, they live for today," Mrs. Spaulding said.

At Stevensville High School, the guidance counselor, Linda Mullan, was concerned about how other students would respond to Patrick's death and was worried about the possibility of copycats. Many students own guns and hunt, often starting in junior high school. "Guns and hunting are a rite of passage in Montana," Ms. Mullan said.

Two seniors in the same class as Patrick were so distraught by his death that they turned down appointments to the Air Force Academy, preferring to concentrate on trying to heal the wounds of grief among their classmates and prevent any further tragedy, Ms. Mullan said.

A few families of those who have taken their own lives have begun organizing themselves to better understand what happened. Pat Kendall, whose son, Josh, shot himself in the Blue Mountains in 2000, when he was 23, has opened a resource center with a lending library in a small house in Missoula, at the northern end of the valley. She has also helped get the Missoula County Health Department to start a suicide prevention program, the first of its kind in the area.

What Mrs. Kendall has come to believe is that her son probably had bipolar disorder. When he finally went to a doctor, not long before he killed himself, the doctor, who was not a trained psychiatrist, prescribed the antidepressant Prozac. But Prozac can make mood swings worse for some people with bipolar disorder. Mrs. Kendall believes that in a region with few mental health resources, Josh's problem was mistaken for depression.

'A Mercy Killing'

Bill Tipps and his wife, Louise, moved to Stevensville from a suburb of Las Vegas to be close to their adult son, Dennis Tipps, who was the high school football coach and onetime police chief.

Dennis Tipps found a site for a home for his parents nearby in an area of small farms and new houses. One of his sons, Dennis Jr., a contractor, built them a simple ranch-style home.

But Bill Tipps grew depressed. "My dad hated the cold and the winter," Dennis Tipps said.

He was also becoming increasingly concerned about the health of his wife, who was 80. She had undergone several heart surgeries, and the local doctor said her toes might have to be amputated because of diabetes.

Dennis Tipps now surmises that when the doctor pointed with a sweeping gesture to Louise Tipps's foot, and then her knee and hip, Bill Tipps assumed the doctor was suggesting that his wife's leg would also have to be taken off.

His father hated doctors and would not seek their advice, Dennis Tipps said. So his father never clarified his wife's prognosis or sought help for his apparent depression.

His father "never displayed his emotions," Dennis Tipps said. "He kept everything inside, and he was very stubborn. He wouldn't change his mind."

One morning in September 1999, at 8:05 a.m., Bill Tipps called his son at his home.

"I just shot and killed your mother so they can't take her leg off," said the elder Mr. Tipps, who was 83. "Now I'm going to shoot myself."

Dennis Tipps jumped in his truck, and as he approached his parents' house, he heard what he thought was his engine backfiring. It was his father shooting himself.

"In my dad's mind, this was a mercy killing," Dennis Tipps said. "He would never leave her side. He thought he was doing the right thing, but he overreacted."

'He Just Quit'

Debbie Miller describes the gentle side of her husband, Ron Malensek. "He called me Princess and treated me like a princess," she said.

But Mr. Malensek had been diagnosed with depression as a child, she said.

In early 2000, he called all his friends, told them goodbye and then tried to commit suicide by overdosing on pills. He survived, and she urged him to see a doctor, who prescribed Prozac.

In the summer of 2003, Mr. Malensek stopped taking the medication.

Mr. Malensek had always worked seven days a week at various jobs: he had owned two bars, a gas station and a bingo parlor, and then had a business installing rain gutters. That summer, he started neglecting customers who called for estimates, Ms. Miller said. He became angry and could not sleep, and he had no energy, she said. It was as if "he just quit," said Ms. Miller, a speech therapist at Stevensville High School.

On Aug. 5 last year, they went to a favorite bar, the Rustic Hut, in the town of Florence. It was the anniversary of his father's death.

When Ms. Miller left to go home, her husband stayed at the bar. Then he walked out back, retrieved a handgun that he had stashed there earlier, and shot himself.

After his death, Ms. Miller discovered that he had not shared other pressures with her.

"It turned out there were a lot of financial issues I didn't know about," she said. Bill collectors bombarded her and repossessed his pickup truck. She had to sell his business.

She also learned that he was a "gun freak," she said. "I'm still finding guns he had stashed all over the house."

Ms. Miller does not know the statistics about rural suicides, but she knows enough. Her father and her first husband also killed themselves.

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