In December of 2023, the Centers for Disease Control published a report that few people in the massage therapy field are aware of. The report, about suicide rates by industry and occupation for 2021, revealed something alarming: the profession of massage therapy ranked fourth highest for female suicide rates in the United States.
Out of nearly 500 occupations, our profession—centered on care, connection, and well-being—has one of the highest suicide rates for females. The rate was 25.8 per 100,000- nearly double the national average and four times the average rate for females.
If you or someone you know is experiencing suicidal thoughts or a crisis, call or text 988 to reach the suicide hotline in the United States. For international helplines go to findahelpline.com. You can also skip to the next blog post, which has actions you can take for yourself right now.
Why This Matters
The massage therapy profession is predominantly female identified (at least 80%), making this sex-specific finding particularly significant. Most of us entered this profession with a desire to help others, to provide healing touch, to make a positive difference. However, the structure of our profession and the conditions of our work is creating profound suffering.
The problem exists whether we talk about it or not. Healwell’s hope is that by acknowledging these statistics, we can begin building a community that better supports its members and works to solve its problems.
The data raises uncomfortable questions we need to confront: What is it about our profession that contributes to such risk? How many of our colleagues are suffering silently? What systems and structures within massage therapy need to change? And perhaps most urgently, what can we do to protect ourselves and each other?
Understanding Suicide Risk
Dr. Rory O’Connor, Chair of Health Psychology at the University of Glasgow developed the Integrated Motivational Volitional (IMV) model of suicidal behavior. This model helps us understand suicide as a series of happenings that we can identify, understand, and potentially interrupt; not as a dark, mysterious fog of the unknown.
The IMV model describes three phases:
1. Vulnerability (Pre-Motivational Phase)
This first phase covers background reasons and past experiences that can increase risk of suicidal behavior—things that make you vulnerable. These are factors including, but not limited to:
Adverse Childhood Experiences (ACEs)
Family history of suicidal behavior
Certain personality traits like perfectionism
History of mental health conditions
These vulnerability factors don't add up in a simple 1 + 1 = 2 kind of way. There is no "risk scoring system." But they do create the conditions that can make someone more susceptible to entering the cycle of suicidal thoughts.
2. Motivation
The second phase is primarily driven by feelings of inescapable defeat. These feelings of defeat lead to a feeling of entrapment—the sensation that there is no way out of your situation. Entrapment can then lead to thoughts of suicide.
Defeat → Entrapment → Suicidal Ideation
Suicide isn't about wanting to die; it is about wanting to escape unbearable pain. When all potential futures condense into a single, unbearable pathway—what researchers call "cognitive constriction" or tunnel vision—that's when suicidal ideation forms.
Factors that increase feelings of defeat include struggles with:
Coping mechanisms
Memory bias (tendency to remember bad experiences and forget good ones)
Problem-solving
Rumination
When these psychological processes are functioning well, they decrease feelings of defeat. When they're not, the sense of defeat grows.
3. Action
The third phase involves factors that increase the likelihood of suicidal ideation turning into a suicide attempt. These factors include:
Access to means
Having a specific plan
Exposure to suicide
Impulsivity
Reduced fear of death
Mental imagery of suicide
Lowered sensitivity to physical pain
Past self-harm or attempts
It is critical to understand that having vulnerability factors doesn't mean someone will experience suicidal thoughts. And having thoughts doesn't mean someone will make an attempt. At each stage, protective factors can interrupt the progression.
Known Occupational Risk Factors
The CDC report included occupational factors that can cause suicide risk. Massage therapy scores high on all of them except one.*
Lower absolute and relative socioeconomic status: We’re poor. How poor? We don’t know, because we don’t have that data. But there are spatial, temporal, mental, and physical limitations on how much a massage therapist can earn without participating in “the hustle:” selling crystals or oils, having a second or third job, or teaching a class of some kind.
Economic instability with inconsistent income: Massage therapists don't get PTO. They often don't get paid if they don't have clients booked. They don't get paid for time that isn't spent with their hands on a client. Demand waxes and wanes with seasons and events, creating a financial rollercoaster.
High responsibility paired with low job control: We hold people's bodies and wellbeing in our hands, but we often have limited say in how we structure our work environment, scheduling, or practice parameters. This combination of elevated responsibility with restricted autonomy creates a well-studied recipe for dangerously chronic stress.
Effort-reward imbalance: Rewards in the work world come in three forms: money, recognition, and career opportunities. We strike out on all three. Massage therapists pour immense physical and emotional energy into their work while typically receiving inadequate financial compensation, limited professional recognition (while being labeled a sex worker by the public and the government), and few advancement opportunities. For many massage therapists, the only "advancement" path is to manage other therapists—a role requiring entirely different skills and one that many have no interest in pursuing.
Poor supervisory and colleague support: We are massively isolated. Our foundational education classes are made up of typically 2-20 people. We work one-on-one with clients in closed rooms. Spa and franchise owners are given advice to stagger our break times, so our interactions with colleagues are often limited to passing in hallways between sessions. Our supervisors aren’t trained in supervision or management.
Lower educational attainment: The only educational requirement to attend massage therapy school is a high school diploma. Many therapists have a bachelor’s degree, but our data collection is unreliable so it is difficult to confidently state how many. This means it is difficult to tell how much of a risk factor our education environment or attainment truly is.
Low-skilled job: This one is odd, because massage therapy is not a low-skilled job, but it is treated like one. Our foundational education requirements hover around 600 hours, and a state license may or may not include a continuing education requirement. This does not prepare workers for the real stress and complications of the work.
*The risk factor we don’t meet is “work-related access to lethal means of suicide.” This is usually associated with healthcare professionals who can prescribe medications or people who work with dangerous chemicals.
Special Challenges for Massage Therapy
Trauma exposure: When people do care work that puts them in constant contact with trauma experiences, they can develop a condition known by many names: “provider fatigue,” “caregiver stress,” “secondary trauma,” and more. These conditions show up in many ways, such as:
A sense that you can never do enough
Feeling helpless and hopeless
Inability to empathize
Deliberate avoidance
Other professions have programs and education to provide support and teach practitioners coping skills. Massage therapists are unaware the condition exists, applies to them, and is prevalent.
Unrealistic expectations set by industry marketing: Our educational system sells dreams of prosperity through magic hands-on techniques. This creates a cycle:
This one new technique will make you rich and successful.
Wait, you didn’t become rich and successful?
You must have done it wrong.
Lack of education leeway: Because massage therapists have so little money to spend on their education, they cannot afford to take classes that don’t have at least the possibility of increasing their income. This means that educators have to sell “one new technique” classes, regardless of what they might be passionate about teaching or what massage therapists truly need to practice sustainably.
The happy face: We pretend we’re all successful. We pretend we’re all content. Nobody wants to speak up first. Our happy front is even replicated in academic literature.
How much we love our job: We love it so much we feel like it is a betrayal to complain or ask for more. We believe what we do is sacred, and that you can’t put a price on that. But you can’t eat or pay rent without assigning a price.
Breaking the Silence
Being a massage therapist is a rough gig. The public is remarkably unaware of this fact, but every massage therapist reading this just nodded their head. We talk a good game about body mechanics and self-care, but we quietly avoid discussing the profound psychological and emotional toll of our work.
The first step toward addressing any problem is acknowledging it exists. By bringing these statistics into the open, Healwell hopes to start a conversation that has been long overdue in our profession.
In the next posts, we’ll delve deeper into the specific risk factors that make massage therapists vulnerable to mental health struggles and suicidal thoughts, and what individuals and our profession could do to change them.
If you're struggling, you're not alone. The statistics prove that. And if you're doing okay, chances are someone in your professional circle isn't. Awareness is the first step. Action comes next.
If you or someone you know is experiencing suicidal thoughts or a crisis, call or text 988 to reach the suicide hotline in the United States. For international helplines go to findahelpline.com. You can also read the next blog post, which has actions you can take for yourself right now.
Resources:
This article was shared on Facebook which is where I read it. I cried reading the article, because it put into words what I’ve experienced for the last 18 years.
It is important and validating to feel "seen" by this article. I've shared it and will be a part of this conversation in my community.