Dennis L Peck. Handbook of Death and Dying. Editor: Clifton D Bryant. Volume 1. Thousand Oaks, CA: Sage Reference, 2003.
A noted thanatologist has observed that death has cultural, economic, medical, and social implications and effects (Blacher 1987). This is no less true of events caused by those who intentionally take their lives. As a subarea of thanatological study, suicide, or selfinduced death, has a different connotation from those deaths that result from natural processes, accident, or even homicide. All the ingredients, such as emotional pain, grieving, and sense of loss are the same among survivors, but suicide represents a death form that in many ways continues to be shrouded in mystery.
Long the subject of scholarly analysis, suicide remains a matter of vexation. Identified as one of the most researched topics of the past 275 years, suicide continues to be intensely scrutinized and remains a subject of considerable and varied community reaction and debate. As we progress well into the new millennium, suicide undoubtedly will remain a controversial topic on which social, religious, medical, legal, and scientific perspectives will continue to provide important albeit conflicting perspectives.
These conflicting perspectives are brought to bear on the definition of suicide as well, as discussed long ago by Émile Durkheim ( 1951:41-46), who defined suicide as “all cases of death resulting directly or indirectly from a positive or negative act of the victim himself, which he knows will produce this result” (p. 44). Although he was not completely satisfied with this working definition, Durkheim was quick to point out that it humanizes such behavior and takes the behavior out of the category of, to use Durkheim’s words, “the monstrous phenomena” because this definition “gives us at once an idea of the place of suicide in moral life as a whole” (p. 45). More recent support for the lack of consensus or an agreed-upon definition emanates from Jack D. Douglas (1967:350-83), who observes that interested students of suicide frequently disagree on how to define this concept. From an extensive review of the pertinent literature, Douglas identifies six fundamental dimensions of meaning to be found in definitions of suicide found in the Western world (p. 351):
- The initiation of an act that leads to the death of the initiator
- The willing of an act that leads to the death of the willer
- The willing of self-destruction
- The loss of will
- The motivation to be dead (or to die), which leads to the initiation of an act that leads to the death of the initiator
- The knowledge of an actor that the actions he or she initiates tend to produce the objective state of death
In light of all the methodological implications involved, one could also make a quick reference to Christine Quigley’s Death Dictionary (1994), which defines suicide as “an act of active or passive self-destruction; one who kills oneself … suicidal behavior is self-destructive activity” (p. 147).
Although committers may determine the manner, the time, and the place at which they will die, the living are always affected in some way, whether the death is attributed to emotional stress, economic problems, health-related matters, supposed contagion, or even intense emotions such as anger. On the social level, suicide inflicts grief and remorse on survivors. The issues of church burial, social stigma, and pity also represent pragmatic considerations with which the living must contend. However, it would seem that society is the greatest loser, for the act of suicide deprives the body politic of valuable members.
Such issues are not new; suicide has long been a subject of great debate. Concerning philosophical, theistic, social, and legal issues, the debate pertains, on the one hand, to whether or not one is entitled to take one’s own life. But there also exists the strongly held belief that one who commits suicide commits a sin, an immoral and antisocial act. In this view suicide is considered a form of individual expression that Western society is reticent to condone. The moral questions that arise are tied to religious dogma and, in addition, involve legal definitions that have far-reaching consequences for those left behind. Observations based on published works indicate that social reactions to suicide vary from glorification to indifference to severe societal condemnation. In this regard, it may be stated that suicide rates vary inversely with the degree of social condemnation of such behavior.
Although suicide has been and probably always will be a part of the human condition, moral philosophers of the past argued against suicide because they believed this act degraded human worth. Thus a suicidal person was once classified as “a felon against himself” (Quigley 1994:3). As Margaret Pabst Battin (1982) observes:
Suicide was treated as a felony offense in early English and continental law; it was subject to harsh civil as well as religious penalties….France relaxed its sanctions against suicide at the time of the 1789 revolution; suicide remained a felony in England until 1961, and has been a criminal offense in many states of the United States. (P. 17)
In this area, the view was that the public good should take precedence over the individual, and anything that harmed the public good was considered immoral. Immanuel Kant, for example, believed that suicide is morally wrong, stating that “to use the power of a free will for its own destruction is self-contradictory” (quoted in Dobrin 1988:194). According to Kant, suicide is morally wrong because it annuls the condition of all other duties. That is, a dead person is unable to fulfill his or her responsibilities to others. Some may reason that people commit suicide because of an inappropriate moral conception, believing that the purpose of life is to live in a happy state. Kant, who believed otherwise, presented another perspective:
It is not necessary that whilst I live I should live happily; but it is necessary that so long as I live I should live honorably….as a rule, those who labor for this happiness are more liable to suicide….having been deprived of [pleasure] only given way to grief, sorrow and melancholy. (Quoted in Dobrin 1988:194)
Thomas Aquinas condemned the act of suicide as contrary to natural law, which established that each person should engage in a love of self. Augustine likewise condemned the act of suicide as contrary to God’s Sixth Commandment, whereas Aristotle thought suicide is wrong because it is harmful to the social entity superior to the individual, namely, the state (see Dobrin 1988:193-95; see also Battin 1982:49-53). These moral philosophers believed in natural law; events such as suicide are either right or wrong based on how they fit into the unfolding natural scheme of things. Thus the goals of society are inherent in nature, based on God’s scheme. Citing a publication from 1824, Leonard (2001) states, “Nineteenth-century religious writings opposed suicide, equating such deaths with an imperfect acceptance of God’s will” (p. 462). Drawing from early analysts of this problem, Leonard refers to the suicidal act as “self-murder,” such as during periods of profound “passion, anger, pride, resentment, revenge, [or] disappointment” (p. 462). It is therefore important to constrain those who would engage in an act of self-murder and thereby serve as improper examples for others (e.g., the problem of contagion).
Such condemnations are not restricted to those who hold Christian beliefs. According to Andriolo (1998:47), ancient Hinduism condemned suicides committed by individuals who were viewed as motivated by worldly, self-centered desires or fears. On the other hand, suicides committed as expressions of religious sacrifice and selftranscendence were glorified (suicides by those who had achieved enlightenment or an understanding of the true reality and their placement or position within this reality). In general, this accepted second view of suicide was accorded to adult males. According to Andriolo, only those women who followed their husbands in death by committing suicide were accorded noble status. Known as sati or suttee, this practice involved the self-immolation of a widow on her husband’s funeral pyre.
But members of contemporary society are not bound to natural law, nor do they currently appear to be committed to reestablishing what Durkheim ( 1951) viewed as the diminished bonds of traditional society. Indeed, the evolution of industrialization and the birth of modern society encouraged a breakdown of the bonds of traditional life and the enhancement of individual expression; the emphasis on individualism continues to hold sway in postmodern society. Yet, and despite the historic cultural changes that have led to the present emphasis on individualism, the state nonetheless maintains an interest in the well-being of its citizens, especially in matters involving life and death (Battin 1982; Szasz 1999; Leonard 2001).
Uses of Official Statistics: The Beginning
Other than a reliance on church documents, the recording of births and deaths and other forms of official record keeping conducted in European cities and states can be traced as far back as the early 1500s (Vold 1958:162-65). The first numerical study of death records is attributed to John Graunt, whose 1662 work Natural and Political Observations Upon the Bills of Morality laid the foundation for the establishment of an empirically based science. The efforts of these data recorders, known in England as political arithmetic and in Germany as moral Statistiks, also began what was destined to become a continuing effort to standardize procedures for the recording of vital statistics. Thus what became known as moral statistics were first employed by analysts who were interested in the study of social problems such as poverty, juvenile delinquency, and crime (Vold 1958). Given the historical interest in the morality of such behavior, the moral philosophers also cast their attention toward the suicide problem.
The moral issues relating to suicide soon experienced a drastic new phase of analysis. With the increasing availability of various forms of official statistics during the late 18th century, those with a moral interest in the suicide phenomenon found these statistics increasingly useful for research and theory development (Douglas 1967:7-12). It was within this cultural context that suicide was considered as a moral problem, and this moral premise was to serve for a time as the foundation for all understanding on which the moral statisticians operated for much of the 18th and 19th centuries. And it was within this moral cultural climate that the sociologist Émile Durkheim was to create and then publish his classic treatise Suicide: A Study in Sociology in the year 1897, as he sought to examine the issue of free will versus determinism. It was through his study of suicide that Durkheim was to argue convincingly on behalf of the scientific study of human behavior. As Pfohl (1994) notes, “Durkheim’s work on suicide represents what might be considered the intellectual culmination of the moral statistics tradition begun during the eighteenth century” (p. 256).
Since Durkheim’s time, social scientists have argued that the usefulness of official statistics is generally limited outside of the specific purposes for which they are gathered. However true this assessment may be, perhaps the most difficult problem for behavioral and social scientists is that suicide data mirror the limitations found in all kinds of officially recorded statistics. That is, given ongoing efforts to improve the reporting of data, the recorded categories used over time are not consistent. In the United States, for example, although all states were not admitted to the death registration until 1933, in 1929, the federal government printed a specific table in the Statistical Abstracts that included rates for both sex and race. Then, in 1930, the mortality data published by the U.S. Bureau of the Census were at the time categorized as “white” and “colored.” By 1931, the Census Bureau had refined these statistics even more, reporting “white,” “Negro,” “Indian,” “Chinese,” “Japanese,” “Mexican,” and “other” race categories. By the 1980s, enhancement of the categories recorded included “Asian,” “American Indian/Pacific Islander,” and “Hispanic.” Table 1 displays Census Bureau data from 1900 forward, but for the reasons cited above, some of the information presented in Tables 2 and 3 covers the period beginning in 1930.
Comparisons of data reported over the past two decades present similar challenges. A recent example can be drawn from data reported by the National Center for Health Statistics, which changed the recording categories for its annual Health, United States publication in 2001 from those found in the year 2000 publication. This particular change is rather dramatic, given that in the 2000 publication “Asian” is listed as a single category, whereas the 2001 publication includes the category “Asian or Pacific Islander.” Similarly, in Health, United States, 2000, “American Indian or Pacific Islander” appears, whereas in the 2001 publication the category is “American Indian or Alaska Native.” Because of this categorical switch, significant changes appear in the data reported for both crude and age-adjusted suicide rates. Moreover, in addition to the “Hispanic” category found in the year 2000 publication, the more recent publication includes the category “white, non-Hispanic,” thereby creating another noteworthy change in the categorical data.
The moral, philosophical, social, legal, and religious issues surrounding self-destructive behavior continue to be debated during the early portion of the new millennium. In the following sections, I present an overview of historical and contemporary suicide trends in the United States, along with a series of tables that show how official recording patterns are reflective of social change.
Historical Documentation of the Suicide Problem: 100 Years
Table 1 displays general data recorded during a 100-year period; with the exception of the final decade of the 20th century, the table shows the beginning and midpoint of each decade as a matter of parsimony. These early data clearly point to where the major problem lies: Suicide is primarily a male problem.
During the 1930s, suicide continued to be primarily a white problem, especially among males. In 1930, for example, the overall suicide rate was 15.6 (n = 17,383); 600 of these deaths were minority, or “colored,” as they were recorded in the mortality statistics (U.S. Bureau of the Census 1930:252). Of this total, 454 were “colored” males, compared with the 13,865 events documented for white males.
The suicide rate for males was highest in 1931; for females the highest rate occurred during the early 1940s. Combined for both sexes, the recorded suicide rate reached an early-20th-century peak in 1908 and 1932, when a crude rate of 18.6 was recorded. From this peak, the crude suicide rate declined to a low of 9.6, recorded in 1957. After that time, however, the rate of suicide increased upward, to 12.7 in 1975; since 1975, it has been at a lower and often declining rate.
But, as the data in Table 1 indicate, the crude rate of recorded suicide is, with few exceptions, markedly consistent. At the end of the 20th century, for example, the crude suicide rate for 1999 (10.6) was not significantly different from that recorded in 1900 (10.2). However, the suicide rate does show dramatic variations, especially around 1905, 1910, 1915, the 1930s, and for 1940. With the exception of these periods, the suicide rate has been fairly consistent, ranging between 10.2 and 12.7.
|Year||Rate||Male Number (Rate)||Female Number (Rate)||Total Number|
|SOURCES: U.S. Bureau of the Census (1975:58, 414; 1977, 1999, 2000), National Center for Health Statistics (1978, 2000), and Hoyert et al. (2001).|
|a. Data reported in U.S. Bureau of the Census (1921) indicate the number of deaths by suicide for the years 1900, 1910, and 1915, respectively, are as follows: 1900, 3,534 deaths; 1910, 8,590 deaths; 1915, 11,216 deaths.|
|1950||11.4||13,297 (17.8)||3,848 (5.1)||17,145|
|1955||10.2||12,961 (16.0)||3,799 (4.6)||16,760|
|1960||10.6||14,539 (16.6)||4,502 (4.9)||19,041|
|1965||11.1||15,490 (16.3)||6,017 (6.1)||21,507|
|1970||11.6||16,629 (16.8)||6,851 (6.6)||23,480|
|1975||12.7||19,622 (18.9)||7,441 (6.8)||27,063|
|1999||10.7||23,458 (17.6)||5,741 (4.1)||29,199|
|Table 1 Crude Suicide Rates for Males and Females, Selected Years, 1900 to 1999|
Throughout the final decade (1990-99) of the 20th century, suicide rates steadily declined for males (20.4 to 17.6) and females (4.8 to 4.1), whites (13.5 to 11.7), nonwhites (7.0 to 6.0), and blacks (6.9 to 5.6) (McIntosh 2001). One consistent pattern, however, has been that throughout the entire 100-year period, the suicide rates for males have far exceeded those for females.
Overview of the Contemporary Suicide Problem
Throughout the 1990s, suicide was consistently one of the leading causes of death for many age-specific categories in the United States. In 1998, suicide was ranked among the 10 leading causes of death, and among males it was the eighth leading cause of death. In 1999, according to the National Center for Health Statistics, suicide was the tenth leading cause of death; among white males grouped by age-specific categories (15-19, 20-24, and 25-34), suicide was the second leading cause of death (Anderson 2001). Such forms of intentional self-harm were ranked somewhat lower as a causal factor for older age categories, ranking as the fourth, fifth, and eighth leading causes of death among the age groups 35-44, 45-54, and 55-64, respectively. In the area of death cause counting, with the exception of 1999, when it was the eleventh leading cause of death among Americans, suicide has ranked among the 10 leading causes of mortality in the United States since 1975.
In reviewing the data reported in Tables 1, 2, and 3, the most obvious observation is that white males experience the highest rate of suicide. This holds without exception. The same is true for the second observation: That is, black males always rank second, followed by white females and, finally, black females. This sequence has been seen without exception over a 100-year period.
Looking at the specific rates reported in Tables 2 and 3, the highest rates of suicide were recorded for 1930, 1935, and 1940; this observation holds for males of both races as well as for white females. Suicide rates declined significantly for white males during the years following the Great Depression and the period encompassing World War II. Of interest are the high rates recorded during the 1940s, a time when lower rates might be expected given the vast number of individuals who served in the U.S. military forces during this period.
Although the social gender gap may be narrowing in many aspects of life, as many analysts have suggested, the suicide rates for males far exceed those for females in the United States and in all English-speaking Western societies. Most suicides are committed by males, and, with some variation, suicide rates tend to rise as age increases, with rates highest among elderly white males. White males die at their own hands at almost twice the rate of black males (U.S. Bureau of the Census 1997:102). In the United States, since 1980, suicide rates have increased in only two age groups: among those 15-19 years old and among those 65 years and older.
|Total (Rate)||White||Black and Other|
|SOURCES: Adapted from National Center for Health Statistics (1978:40) and U.S. Bureau of the Census (1978).|
|Table 2 Suicide Rates by Race and Sex, Ages 15 and Over, Selected Years, 1930 to 1975|
Historically, age-specific rates of suicide in the United States have been highest among the elderly, especially older males. However, suicidal behavior has increased among elderly persons and terminally ill individuals regardless of gender. During the 1980-99 period, males accounted for 81% of the suicides among elderly persons 65 years of age and older.
In 1980, suicide was the tenth leading cause of death among Americans (n = 26,869); in 1999, a total of 29,199 persons were officially known to have died as a result of their own actions. Depending on the source cited, in 1999 suicide was ranked as either the tenth or eleventh leading cause of death. Among males, suicide was ranked seventh and eleventh among the top causes of death in 1980 and 1999, respectively. However, this act of self-destruction is not listed among the highest-ranked causes of death among white women. The same is true for blacks of either sex as well as for American Indian/Alaska Native females (Kramarow et al. 1999; Hoyert et al. 2001).
According to the U.S. government’s Annual Summary Reports, during the first half of the 1990s the numbers of suicides recorded each year increased while the rates remained relatively stable. For example, during the 1990-95 period, the rates of suicide for all races and sexes were 11.5, 11.4, 11.1, 11.3, 11.2, and 11.0, respectively (U.S. Bureau of the Census 1997:95, table 128). During 1996, 29,280 persons (rate = 11.6) died in self-inflicted episodes, and in 1997, the number of suicides increased to 30,535 (rate = 11.4); 19,491 homicides were committed during that same year. In 1998, 30,575 suicides (rate = 11.4) were officially recorded, 24,538 of which were male; 22,174 of the male committers were white (Murphy 2000:59). These numbers are substantial when compared with those related to other social problems, such as homicide; in 1998, there were 1.5 times as many suicides (n = 30,575) as there were homicides (n = 18,272; rate = 6.8). In 1999, of the 29,199 officially reported suicides (rate = 10.7), a total of 21,107 were white males. The 1999 data indicate a similar comparison situation, with the number of suicides officially recorded as 29,199 (rate = 10.7) and the number of homicides 16,889 (rate = 6.2) (Anderson 2001:10).
Suicide and Age
The data on suicide mortality by age are particularly interesting. For the period 1950-70, for example, in descending order, the highest rates for white males were in the 65 and over age group; for the black and male category, the age groups 55-64 and 65 and over had the highest rates for 1950 and 1960, but the rates declined considerably in 1970, a time during which the 35-44 age group was at greater risk. For white females, the age categories 45-54 and 55-64 were at greatest risk during the 1950-70 period, a time when black and other females had the lowest risk of all race and sex groups; the 45-54 age group recorded the highest rate during 1950 and 1970—during 1960 this distinction fell to the 65 and over group (U.S. Bureau of the Census 1974).
This pattern of age and race continues to the present, although some variation occurs within age groups. Although it is well established that the suicide rates increase with age, according to the National Center for Injury Prevention and Control (2000), the period 1980-90 was the first decade since the 1940s that the suicide rate among the elderly rose. Nevertheless, older adult males have consistently had the highest suicide rate of all age groups since 1933, the first year all states reported mortality data.
For the 1990-97 period, a total of 42 suicides were officially recorded for the 5-9 year age group. This is a highly unusual documentation, given the cultural bias and aversion in the United States to any consideration that suicide may occur within the youngest age groups as well as among members of particular religious groups. By the ages 10-14, however, the figures increase dramatically throughout the ascending age ranks. Taking cultural factors into consideration, most recent recording techniques collapse the 5-9 age group with the 10-14 group, making a 5-14 age category.
In 1998, suicide was the eighth leading cause of death in the United States and the third leading cause of death among young people. As the National Center for Injury Prevention and Control (2000) has noted, suicide is a serious public health problem among young people: Between 1990 and 1997, the rate of suicide increased 109% for 10- to 14-year-olds and 11% for 15- to 19-year-olds.
|Table 3 Death Rates for Suicide by Race and Sex, 1930-99|
Suicide ranked as the third leading cause of death among the young ages 15-24 in 1999 (n = 3,901; rate = 10.3), placing this youthful age category slightly lower than the national rate (10.7) for all age groups. Only accidents (n = 13, 656; rate = 36.2) and homicides (n = 4,998; rate = 13.2) ranked higher. Still, the well-documented idea that suicide is a leading cause of death among youth may be somewhat misleading, particularly for those under the age of 14. The public health revolution and improvements in medical care have contributed to a significant decline in youthful mortality previously attributable to infectious diseases, and this trend, in turn, has increased the relative importance of violent forms of death such as suicide. This same explanation may hold for other age groups as well.
Nevertheless, recorded increases in age-specific death rates for suicide under the age of 24 for most categories by race and gender have been noted during the past several decades. In addition, the age category 25-34 has shown marked increase in suicide rates for both race and sex categories since 1950. Although the official rates for youthful suicide may be in part an artifact of recording procedures, the age-specific rates indicate that suicide risk is directly correlated with advancing age. As noted, suicide is nonexistent under the age of 5, virtually nonexistent at 5-9 years of age, and rare at ages 10-14. However, for the years of late adolescence and early adulthood, white male suicide in particular increases with frequency about 8 to 10 times at ages 15-19, doubles in frequency in the 20-24 year age group, and is 1.5 times as great in the 25-34 age group (Peck 1979:3-4). A similar conclusion can be made for the final years of the 20th century. Beginning with the 15-24 age group, the rate of suicide ranges between 18.5 and 24.0 for youth, young adults, and adults; the rate modestly declines among the middle adult age groups and then dramatically increases among the elderly.
Refinement of the data allows us to appreciate more fully the magnitude of the suicide problem, as the information in Table 2 shows. Rather than crude suicide rates, Table 2 displays data for the 1930-75 period that clearly demonstrate that the suicide problem is better understood through age-specific categories of 15 years of age and older. Although these kinds of data have not been a regular feature of official reporting publications such as the Statistical Abstracts of the United States, even more refined age-specific data are currently available in the National Vital Statistics Reports published by the National Center for Health Statistics, which provide final data for given years. One example of this important adjustment to the reporting procedure is shown in Table 5, in which a larger number of racial, gender, and age categories are documented.
That the highest rates of suicide are recorded among males, especially young adult and older males, also is consistent with recorded gender differences in attitudes toward suicide. In general, younger males are more likely than younger females to engage in impulsive behavior, and this impulsivity has been linked to self-destructive types of behavior, such as cigarette smoking, alcohol use, and risk taking (Langhinrichsen-Rohling et al. 1998). The Centers for Disease Control and Prevention apparently supports this contention, suggesting that family-related problems and ease of access to alcohol, illicit drugs, and firearms are major factors in the rising rates of suicide among the young, especially young black males.
|SOURCES:U.S. Bureau of the Census (1973, 1974, 1999); National Center for Health Statistics (1991:99-100, table 35; 1994, 2001); Murphy (2000); Peters, Kochanek, and Murphy (1998); and Anderson (2001).|
Such behaviors also are thought to be significant predictors of suicide ideation and attempts. That is, males appear to be more accepting of suicide than are females, and males are more likely than females to agree that an individual has the right to commit suicide. Moreover, young adults and adults over the age of 60 are more likely to be tolerant of suicide than are middle-aged people (for a review of this literature, see Parker, Cantrell, and Demi 1997).
Social Factors Associated With Suicide
The first and perhaps most notable sociological theory developed to explore social factors as these relate to suicidal behavior was that proposed by Émile Durkheim ( 1951). Strong social ties such as those created through work, marriage, having children, religious affiliation, and engaging in community activities and commitments protect against suicide, according to Durkheim, who demonstrated that suicide rates are relatively low and even decrease during the stages of the life cycle between late adolescence and old age.
An interesting aspect of suicide is the male/female difference. Although females are more likely to attempt suicide, males commit suicide more frequently than females for all age groups. The difference between males and females is greatest in the 15-24 age category; female suicides reach their highest proportion (relative to male suicides) in the 25-39 age group. Among 20- to 24-year-olds, males are four times more likely than females to commit suicide. Although the white male ratio of suicide to that of minority males and females is considerably higher, the rates for females and nonwhites have risen more sharply than those of white males, especially since 1960.
In the wake of documented increases in the rates of suicide among nonwhites, females, and young persons, efforts at explanation tend to identify low self-esteem, shame, status worth, goal commitment, personal responsibility, low achievement, and role conflict as factors contributing to abnormal behavior. In one interesting study, Cumming, Lazer, and Chrisholm (1975) found that for all age categories, employed married women are more protected against suicide than are unemployed women who are single, widowed, or divorced. Such findings are contrary to the hypothesized role conflict or role overload model proposed by some analysts. Cumming et al. state, “These findings are compatible with the proposition that for married women the benefits of working far outweigh the costs, and that these benefits increase somewhat when the climate of opinion favours married women entering the labour market” (p. 467).
Consistent with the history of this phenomenon in the United States, however, white males and, more recently, white, non-Hispanic males represent the groups at greatest risk of suicide. Moreover, the data do not support the assertion that the current trend in the increase in suicide rates is not as great for males as it is hypothesized to be for professional women. This hypothesized relationship is based in part on the multiple roles that women in professional positions must play (Carlson and Miller 1981). The stress of a career, role and status conflict, caring for a family, and lack of personal time are all issues that professional women contend with on a daily basis. Other analysts suggest that the suicide rate for older women is changing more than that for males, especially when socioeconomic factors such as labor force participation in nontraditional occupations are controlled (e.g., Newman, Whittemore, and Newman 1973; Yang and Lester 1988; Alston 1986; Lester and Yang 1992). Recently, Mayer (2000) found additional evidence in support of the hypothesized relationship between women’s attainment of greater education and professional advancement and the suicide rate. He states, “With increased equality for men and women in white-collar employment and political representation, female suicide rates are rising” (p. 372).
Beginning with Durkheim’s ( 1951) analysis, it is noteworthy that the least advantaged members of society experience more modest rates of suicide than do those who hold greater advantages in the areas of education and labor force participation. Although U.S.-based research findings in this area appear to be quite mixed, there is some evidence that the highest rates of suicide occur among individuals, both males and females, who occupy high-status occupations. For example, research has found that among single female psychologists (Mausner and Steppacher 1973), physicians (Rose and Rosnow 1973; Frank and Dingle 1999), chemists (Li 1969), and nurses (Hawton and Vislisel 1999), rates of suicide are at least equal to if not greater than rates for males.
Various lifestyle factors have also been cited as contributing to suicidal behavior, especially among males. Examples of these factors include increased rates of divorce, unemployment, and alcohol and drug use and abuse (Appleby 2000). In addition, some analysts assert that suicide may be statistically underrepresented, because some suicides—such as “autocides” (Quigley 1994:3), or suicides disguised as vehicle accidents—are not identified as suicides. Selzer and Payne’s (1962) research on alcohol use and autocide provides some support for this contention, and Peck and Warner (1995) report that some of the deaths attributed to vehicle accidents, especially single-car accidents, may result from suicidal intent on the part of the drivers.
Since Durkheim ( 1951) conducted his seminal work, analyses of the effects of marital status on the suicide rate have focused on the buffering effect of marriage, especially for males. Research findings in this area have shown consistent patterns since the time of Durkheim, thereby firmly establishing his initial sociological efforts as a road map for all others to follow. Although one may argue that contemporary efforts do not offer major sociological insights beyond Durkheim’s contributions, some scholars have made significant refinements to the original ideas presented in Durkheim’s seminal research effort. Examples of these efforts include the work of Stack (1996-97, 1998) and Appleby (2000), among others.
As Stack (1998) notes, research that has explored the relationship between marriage and emotional well-being has found that men benefit more from marriage than do women. Again, such findings support those first reported by Durkheim ( 1951), who recognized the buffering effect of the marital social bond. But divorce affects as many women as it does men. The same is true of whatever financial problems are attendant to unemployment or underemployment. Still, none of these factors seems to affect the female suicide rate in the same manner as it does for males. The problem of alcohol and drug abuse, a major contributing factor in male suicide, also provides an interesting comparison. Although female consumption of both alcohol and drugs is believed to have increased during the recent past, female suicide rates have remained relatively stable (Appleby 2000).
Newman et al. (1973) and Steffensmeier (1984) suggest that the increases in female labor force participation and female suicide during the 1970s may be related, given the role conflict experienced by employed, career-oriented women as well as the vast and varied changes in sex roles in the home and the workplace. Stack (1978) asserts that such changes may lead to status and role conflict stemming from the responsibilities inherent in the roles of homemaker, spouse, parent, and employee. Thus enhanced labor force participation may diminish rather than enhance status integration for females, leading, in turn, to a higher suicide rate.
Many analysts also argue that women’s full-time involvement in the labor market serves as a buffer against suicide (e.g., Appleby 2000). Certainly, significant changes took place in the economic, political, and social structure of American society over the course of the final decades of the 20th century. These changes generally have been applauded within the context of the gains achieved by women and members of racial minority groups. The employment structure opened, leading in turn to opportunities previously unavailable to most members of such groups. Challenges to this structure were supported by increased educational achievement and changing social perspectives toward opening career opportunities. Such would be the situation, it is argued, for understanding an increased rate of suicide among professional females and racial minorities. Such factors may also include the notion of cultural scripts as these affect the current suicide rates and the potential any change in these traditional scripts may hold for female and minority suicide rates.
Perhaps it is true that along with social change and enhanced exposure to other less desirable situations, life chances may have evolved for those previously relegated to less challenging positions in the labor force. A society with diminished opportunities for employment may be a causal factor in enhancing the levels of individual stress among the unemployed as well as the employed. This may be particularly true in an unsteady economic climate in which job loss becomes a major concern. As Henry and Short (1954) note, dramatic economic change leads to significant social change and diminished life chances.
The reporting of suicide and compilation of suicide rates for and among racial groups did not begin in the United States until 1929. As Table 3 shows, the crude rates for minorities were at the time collapsed into a single “black and other” category. However, by 1950, more refined categories became common (see Table 4), and by the 1980-85 period, “Asian/Pacific Islander” and “American Indian/Alaska Native” categories were documented. By 1985, the suicide rates for Hispanics served notice of yet another significant change in both the composition of the American population and subsequent recording procedures (see Table 5). The elaboration of the recording procedures, as shown in Tables 4 and 5, is a clear demonstration of the changing composition of the population of the United States. Perhaps more important, these data suggest that an important social transformation has again occurred in the mixture of individuals who actively participate in the American experience. This experience may include positive aspects as well as some not so positive, such as an increased rate of suicide. The data shown in Table 4 are noteworthy, especially the high suicide rates recorded for the white, American Indian/Alaska Native, and white, non-Hispanic male categories. However, in any given year white males have accounted for as much as 73% of all suicides and, combined, white males and females may account for 90% of the total number of suicides.
Although data for a 1- or 2-year period cannot be taken to suggest a trend, the data for 1998-99 are instructive for placing the suicide problem within a public health context. In Table 5, the suicide rates and rankings of cause of death are displayed for age-specific groups by race and sex. As the table shows, for males, suicide is ranked among the 10 leading causes of death, especially among the youngest age-specific categories. However, youthful females also are well represented, especially for the 5-14, 15-24, and 25-44 age categories. If we disregard ages 5-14, the age categories that might be of greatest interest with regard to educational achievement and, more specific to these data, occupational achievement would be cause to review the rankings of cause of death more closely for ages 15-24 and 24-44. Again, and without exception, suicide is highly ranked as a cause of death for white, black, and white, non-Hispanic as well as Hispanic males.
Consistent with the thesis of the inadequacy of official data, some observers contend that among American blacks in particular, rates of suicide may be substantially higher than the official records indicate (see, e.g., Peck 1983-84). To augment this argument, some analysts suggest that an upward trend in suicide exists among minorities, especially blacks. Indeed, Burr, Hartman, and Matteson (1999) assert that this may be the case, based on their finding that higher economic status among black males and suicide appear to be significantly related. In 1998, the Centers for Disease Control and Prevention reported that suicide is increasingly a problem among black youths 10-19 years of age. According to the CDC, for the 1980-95 period, the rate of suicide among black youths increased 114%, from 2.1 to 4.5 per 100,000. Note that the official data mprovide some support for this claim, as shown in Tables 3, 4, and 5. However, it is also noteworthy that the suicide rate for black males increased up to the year 1990 and then declined throughout the 1990s. As shown in Tables 4 and 5, the data for white, non-Hispanics are rather dramatic, demonstrating that the suicide rate was highest among this racial group throughout the entire decade of the 1990s.
Durkheim ( 1951) considered the institution of religion to be an important mechanism of social influence and control that exercises integrative effects on individuals to a greater or lesser degree. Accordingly, differences are observed in the suicide rates of different religious groups, with Protestant, Catholic, and Jewish victims ranking in that order. When the information is known, religion is a recorded category on the certificate of death. However, such data are difficult to secure from the public record, so little information on this important topic is available. An exception is one of my own studies, in which the findings were consistent with those first reported by Durkheim (Peck 1979). If the greater or lesser effects of religion and the interactive effect of level of education combine, thereby discouraging life-destructive behavior based on the strength or weakness of the social bond afforded by religious institutions, the data suggest that suicide rates are highest among Protestants, followed by Catholics and Jews, in that order. More recently, Burr et al. (1999) found that church membership appears to have some positive effects for African Americans, but church membership does not seem to offer the same protection against selfdestructive behavior among young black males.
Social Status and Occupation
In a review of the literature published in 1982, Arthur G. Bedeian noted that the research findings on occupation and suicide available up to that time were mixed and so inconsistent as to be almost useless. The problems he identified in the studies he reviewed included small sample sizes and, perhaps more important, numerous methodological problems. Contemporary analysts suggest that such problems continue to the present. The issue they raise concerns the valid assessment of the social status concept and the occupation variable, and the relationship of these terms to suicide. Analyses of comparable data sets are certainly useful, but the analysis of trends and bringing cumulative insight and knowledge to bear on issues relating occupation to suicide are no less critical to this understanding.
|Both||White||Black||Asian/Pacific Islander||American Indian/Alaska Native||Hispanic||White, Non-Hispanic|
|SOURCE: Adapted from National Center for Health Statistics (1978:40; 2000).|
|NOTE: Preliminary data reported for 1999.|
|Table 4 Crude Death Rates by Race and Sex, Selected Years, 1950 to 1999|
|Age Group (in years)||Rank||Number||1998||1999a|
|1. All races, both sexes||All ages||8||30,575||11.3||10.7|
|65 and older||—||—||16.9||15.9|
|2. All races, males||All ages||—||—||18.6||17.6|
|65 and older||—||—||34.1||32.1|
|3. All races, females||All ages||—||—||4.4||4.1|
|4. White, both sexes||All ages||8||27,771||12.4||11.7|
|5. White males||All ages||8||22,174||20.3||19.1|
|6. White females||All ages||—||—||4.7||4.4|
|7. Black, both sexes||All ages||—||—||5.7||5.6|
|8. Black males||All ages||—||—||10.2||10.0|
|Table 5 Death Rates for Suicide for the 10 Leading Causes of Death in Specified Age Groups by Race and Sex, 1998 and Preliminary 1999 Data|
|Age Group (in years)||Rank||Number||1998||1999a|
|SOURCES: Adapted from Hoyert et al. (2001:26-40, tables 8-9, July 24, 2000 [see also errata with revised p. 45]) and National Center for Health Statistics (2001:217-19).|
|a. Preliminary data for 1999 refer to the rate per 100,000; N = 29,199.|
|9. Black females||All ages||—||—||1.8||1.7|
|10. Hispanic, both sexes||All ages||—||—||—||—|
|11. Hispanic males||All ages||9||1,429||9.4||9.1|
|12. Hispanic females||All ages||—||—||1.8||1.7|
|13. White, non-Hispanic males||All ages||—||—||21.5||20.2|
|14. White, non-Hispanic females||All ages||—||—||5.2||4.8|
|15. American Indian/Alaska Native males||All ages||7||—||21.1||19.6|
|16. American Indian/Alaska Native females||All ages||—||—||5.4||4.8|
|17. Asian/Pacific Islander males||All ages||7||—||9.1||9.0|
|18. Asian/Pacific Islander females||All ages||—||—||3.3||3.4|
The literature on the relationship between social status/occupation and suicide can be traced back at least as far as the work of Durkheim. Durkheim ( 1951) evaluated the relationship of occupation to suicide within the European experience and found that the suicide rate had a direct relationship with social class. This finding strongly suggests that the higher the socioeconomic status, the higher the suicide rate. That is, suicide rates are highest among the highest-income groups. As Durkheim notes:
The liberal professions and in a wider sense the well-to-do classes are certainly those with the liveliest taste for knowledge and the most active intellectual life. Now, although the statistics of suicide by occupations and classes cannot always be obtained with sufficient accuracy, it is undeniably exceptionally frequent in the highest classes of society. (P. 165)
Durkheim also found that for a number of European nationstates the suicide rates were relatively high among professional groups devoted to letters, members of the army, and an intellectually elite group of public officials (p. 166).
Two generations after Durkheim’s work was published in Europe, the empirical assessment of the occupation and social status relationship to suicide was well under way in the United States. For example, Elwin H. Powell (1958) posed the following:
Based on the postulate that self-destructiveness is rooted in social conditions, the argument . . . is that occupation provides function and determines the individual’s social status which is an index to his conceptual scheme. The conceptual system is the source of anomie, which is a primary variable in suicide. Therefore, suicide is correlated with occupation. (P. 133)
Schmid and Van Arsdol (1955) conducted a 5-year study (1948-52) of completed and attempted suicide in Seattle, Washington, but in their published report they are vague concerning the important effect of occupation on suicide. According to these analysts, “‘White collar’ occupations and professions have lower suicide rates of both completed and attempted suicide than persons employed in ‘blue collar’ occupations.” However, they also state that “because of incompleteness of data on occupations, additional comparisons and conclusions are not warranted” (p. 280).
Powell’s (1958:134) analysis of data from Tulsa, Oklahoma, for the 1937-56 period does offer support, however. For some reason, Powell combined professional-managerial and sales-clerical groups, and thereby reported a higher annual rate of suicide (24.6) for these combined groups than was found for manual workers (19.6). Taking this unique assessment further, Powell’s study data indicate the average rate of suicide during this 20-year period was 35.1 for the professional-managerial category, whereas the rate for unskilled laborers was 38.7. Only the retired had a higher rate of suicide (83.4). Within the white-collar category, pharmacists had the highest rate of suicide (120), followed by physicians (83), nurses (38), lawyers (36), engineers (15), and accountants (7). Among blue-collar occupations the highest rate of suicide was found among cab drivers (86.9), followed by welders (25), machinists (17), truck drivers (12), mechanics (10), and carpenters (5).
During this same time period, Durkheim’s contention pertaining to social class and suicide received some support from Henry and Short’s (1954) study and from Ruth S. Cavan’s earlier Chicago study, which was reported in 1965 (as cited in Maris 1969:120). Both these projects demonstrate the existence of high suicide rates among professionals and those of higher education.
In Warren Breed’s (1963) New Orleans study of white male suicide (n = 105) for the 1954-59 period and Ronald W. Maris’s (1969) Chicago study (n = 2,153) covering 1959-63, an inverse relationship was found between social status and suicide; that is, the higher the social class status, the lower the suicide rate, and the lower the social class status, the higher the suicide rate. Breed was interested in occupational status mobility, especially downward mobility, with its attendant problems associated with reduced income, unemployment, and other occupation-and business-related problems. Only half of the subjects in his sample (n = 52) were employed at the time of their deaths. It may be noteworthy that Breed concludes his occupational mobility and suicide commentary by stating that his findings support the anomie thesis suggested by Powell. In Breed’s words, “Anomic suicide can and does occur during integrated conditions as well as during anomie, and lowachievement [work] performances promote suicide in good [economic] times or bad” (p. 188).
Breed’s findings warrant some support from others, according to Ira M. Wasserman (1992), who conducted a review of the economy, work, and suicide literature and concludes that it must be assumed that certain groups of people are more prone to suicide. And it is this assumption that bears directly on the relationship between suicide and occupation or unemployment. Some social groups experience increases in their suicide rates when shortor long-term economic changes occur. These changes, in turn, affect certain occupational and work groups and individuals with high levels of psychological and psychiatric morbidity.
Maris (1969:121-35) applied a socioeconomic status (SES) score to his Chicago data in addressing the relationship between occupation and suicide, and found suicide rates to be highest among lower-status occupational groups. For example, the suicide rate per 100,000 for laborers was 50.6; among service workers the rate was 46.4, and for operatives and kindred workers the rate was 23.3; the rate was moderate among middle-status groups, such as craftsmen, foremen, and kindred workers (20.9) and sales workers (19.8), and lowest among upper-status groups—professional, technical, and kindred workers (14.8), managers, proprietors, and officials (15.8).
The findings reported by these early analysts are distinguished from those reported by contemporary scholars who address the occupation and suicide relationship in that earlier analyses were more comprehensive in their assessment of socioeconomic status. The early analysts established SES by including occupation as well as an occupational prestige score, a score that takes amount of income and level of education into consideration. Using 1950 census data and a detailed occupational classification scheme, Labovitz and Hagedorn (1971) identified the suicide rates for numerous specific occupations, of which the 15 with the highest rates are listed in Table 6.
|SOURCE: Adapted from Labovitz and Hagedorn (1971:68).|
|1. Managers, officials, and proprietors (manufacturing)||64.8|
|2. Policemen, detectives, sheriffs, bailiffs, marshals, and constables||47.6|
|3. Managers, officials, and proprietors (wholesale and retail trade)||47.3|
|5. Cooks, except private household||42.2|
|6. Mine operatives and laborers||41.7|
|7. Guards and watchmen||38.2|
|9. Authors, editors, and reporters||37.0|
|10. Barbers, beauticians, and manicurists||36.0|
|11. Machinists and job setters, metal||34.5|
|12. Locomotive engineers||34.2|
|14. Insurance agents and brokers||32.4|
|15. Physicians and surgeons||31.9|
|Table 6 Fifteen Occupations With Highest Suicide Rates, 1950|
It is interesting to note that the lowest rate among the 15 job categories shown is for physicians and surgeons, who had a suicide rate of 31.9; the five highest rates are for managers, officials, and business proprietors (manufacturing, 64.8; the trade industry, 47.3), law enforcement personnel (47.6), dentists (45.6), and cooks (42.2). The remaining categories represent a combination of professional and blue-collar occupations.
The significance of these data from 1950 may easily be dismissed given that the Labovitz and Hagedorn study is dated. However, contemporary analysts have also criticized the occupation-related research studies conducted since the time of Bedeian’s (1982) literature review, arguing that the general occupation categories are not specific enough or study samples are too small for the findings to warrant serious consideration or to enhance our understanding of the suicide problem (for a review of these criticisms, see Stack 2001). Refinement of the rates of suicide by occupational categories offers more specific information, and it is toward this issue that I now turn.
Specificity of Occupation
As indicated above, gender-based research findings confirm that for both males and females in the United States, the highest rates of suicide occur among individuals in high-status occupations. Among female psychologists (Mausner and Steppacher 1973), physicians (Rose and Rosnow 1973; Frank and Dingle 1999), chemists (Li 1969), and nurses (Hawton and Vislisel 1999), rates of suicide are equal to if not greater than rates among males. Bedeian’s (1982) review of the literature pertaining to three occupational categories—health care providers, managerial and professional workers, and military and paramilitary personnel—is useful to any discussion of this issue.
Bedeian found that among health care providers, such as physicians, dentists, pharmacists, and nurses, the research data lead to mixed conclusions. For example, the belief that physicians have a high suicide rate can be attributed to a few published county- and statewide studies that have received extensive coverage from the news media. Attempting to lay to rest misconceptions pertaining to physician suicide, Bedeian provides a survey of the literature and argues that although psychiatrists might have a higher-than-expected rate of suicide, physicians in general do not commit suicide at higher rates than other males. Thus medical specialty appears to be a significant variable, especially among psychiatrists.
Bedeian further asserts that similar arguments can be made in the cases of dentists, pharmacists, and nurses. Only limited data are available, and these come from only a few studies, each of which concludes that dentists and pharmacists experience high suicide rates. Bedeian argues that only one thorough study of the suicide problem among dentists had been conducted, and the conclusion based on the findings of that study was that the suicide rate for dentists was comparable to that of the general white male population. This conclusion is not supported by Stack (1996), who, using the 1990 National Morbidity Detail File, reports a high suicide rate among dentists (for a table of selected occupation data based on information gathered by the U.S. government for the 1990 21-state morbidity file, see Stack 2001:501). Nurses, according to Bedeian, rank lowest of any occupational group investigated up to the time of his review. However, and again based on a limited sample size and time period, suicide was found to be higher than expected for female Air Force personnel, psychologists, physicians, and chemists.
Wasserman (1992) reports occupational data for white males who died in the state of Washington from 1950 through 1979. As shown in Table 7, Wasserman calculated these data using a proportionate mortality ratio (PMR = tabulated deaths for an occupation, divided by the expected deaths for an occupation, times 100). According to Wasserman, the PMR measure standardizes the age, sex, and racial characteristics of occupational groups. Based on the PMR, Wasserman speculates that the high suicide rates found for health care professionals may be related to their ready access to drugs and other methods of self-destruction, whereas the high rates of suicide among sheepherders, wool makers, and students may be attributed to the stress and isolation these individuals experience. Wasserman also attributes the low rates of suicide for occupational categories such as the military (86) and clergymen (25) to selection factors and the procedures employed to screen individuals with psychiatric problems. Although no empirical support was available for Wasserman’s contentions, he nevertheless hypothesizes that strong religious beliefs among clergymen may explain the low rate of suicide found in this occupational category.
|Occupation||Proportionate Mortality Ratio|
|SOURCE: Adapted from Wasserman (1992:533).|
|Sheepherders and wool workers||264|
|Hairdressers and cosmetologists||227|
|Tool and die workers||194|
|Medical and dental technicians||163|
|Body and fender repairmen and auto painters||152|
|Army/Air Force/Marine Corps personnel||86|
|Cooks, candy makers, and chefs||79|
|Navy/Coast Guard personnel||78|
|Road graders, pavers, machine operators||76|
|Building and construction contractors and foremen||64|
|Lumber/log/sawmill truck drivers||63|
|Purchasing agents and buyers (not inclusive category), sales managers||41|
|Airplane pilots and navigators||40|
|Disabled, retarded, institutionalized, and unemployable||31|
|Table 7 Proportionate Mortality Ratios for Selected Occupations|
One important advance beyond the limitations of single-state studies such as Wasserman’s is found in the work of Kposowa (1999), who used the National Longitudinal Mortality Study 1979-89 to estimate the effects of occupation and industry on suicide deaths. In this evaluation Kposowa notes:
It was found that employees in mining, business and repair services, wholesale and retail trade, and construction had the highest risks of suicide. Those employed in transportation, manufacturing, and personal services had intermediate risks. Persons in administration and in the professions had smaller risks. (P. 650)
Apparently, the standard was set by Labovitz and Hagedorn’s (1971) publication on occupational suicide. Despite the passage of several decades, this standard has yet to be replicated. It is also of interest that comparable national data sets have not been forthcoming since that time. The recent proliferation of more sophisticated statistical analyses of data such as those contained in the National Longitudinal Mortality Study 1979-89 and the 21-state 1990 National Morbidity Detail File aside, contemporary analyses of the effects of occupation on the rate of suicide appear to offer little additional information that leads to a greater understanding of this long-standing problem. Yet, and despite the conceptual and methodological issues and problems related to small sample sizes identified in the literature, the reporting of occupation and the relationship of this variable to suicide continues to generate considerable interest. Still, it may be stated that however noteworthy current efforts are, their significance can be recognized only when the findings are cast within a framework of implications, such as those reported by Alston (1986) for the nursing profession, and social policy recommendations. Some scholars have taken up this evaluative effort in the past (e.g., Bedeian 1982; Alston 1986); more of this kind of effort is undoubtedly needed.
The Economy and Suicide
The empirical findings reported by Henry and Short (1954), as these relate to economic vicissitudes, are especially noteworthy. The economic boom of the 1990s and the apparent bust of the earliest portion of the new millennium may hold some importance for any assessment of suicide rates among those in professional labor force positions, especially females and minority group members. This condition, according to Durkheim ( 1951), became endemic within environs in which industrial-based economic progress freed individuals from all or most social and moral constraints. Durkheim’s explanations of anomic suicide, a society in transition, and the dissolution of the normative constraints as a whole address what appears to be a general social malaise. Although Durkheim’s views pertain to the Western European experience at the end of the 19th century, we may have been witness to a similar social condition at the end of the 20th century. And, as Henry and Short (1954) have noted, suicide rates decline during times of economic prosperity and increase during economic decline. This theoretical explanation may also help us to understand why Burr et al. (1999) found that when measured along multiple dimensions, such as economic and social standing, the racial inequality experienced by black males may place them at an increased risk to engage in self-destructive behavior.
Investigating the relationship between economic cycles and the suicide rate, Henry and Short (1954) hypothesized (a) that the suicide rate is inversely related to the business cycle and (b) that this relationship (correlation) between the suicide rate and the business cycle is higher for highstatus groups than for low-status groups. Although Maris (1969:133) has criticized this theory, the robust economic boom of the 1990s may be described as an egoistic environment, an environment characterized by a lack of civility and major breaches in social decorum. If a robust economic egoism promoted one type of deviance, then the transition to economic bust may, as Henry and Short demonstrated, again be expressed as long-term anomie (see also Powell 1958; Breed 1963; Pfohl 1994:260-61). Thus it may not be surprising that the suicide rates for females remained relatively stable or declined in some racial groups during the final two decades of the 20th century, during which the United States experienced a period of economic prosperity. Only the future will allow us an opportunity to assess whether the appropriate effect predicted by Henry and Short and strongly suggested by Wasserman (1992) is taking place during the early 21st century.
|Firearms and explosives||6,088||647||6,310||763||6,571||806||6,808||955||7,879||1,138||8,457||1,441||9,704||2,068|
|Hanging and strangulation||2,748||520||2,776||778||2,759||833||2,689||902||2,576||790||2,453||744||1,204||837|
|Table 8 Suicides, by Sex and Method, 1930-99|
Lethality of Method/Method of Choice
The lethality of the suicide methods that individuals choose has long been of interest to analysts of the suicide phenomenon. In the contemporary experience, firearms and other forms of explosive devices represent the leading method of choice, but this has not always been the case. From 1900 through 1911, poisoning was recorded as the most commonly used method for 10 years out of this 11-year period. Only during 1910 did firearms emerge as the method of choice. In 1912, firearms were officially recorded as the most common method of suicide, and from that date to the present, firearms and explosives have continued to place first on the list of methods used, with poisoning and gases representing the second leading method of choice for most of the 20th century.
As shown in Table 8, the primary methods of choice are truly lethal, suggesting the strong intent of the committers. Over time, increasingly refined recording procedures have led to greater specificity in the available data about the means individuals select in their attempts to actualize their self-destructive behavior. Noteworthy are the race and sex variables that are currently combined prior to their being reported for general use by the public. This collapsing of race and sex categories is especially important given the difficulty in comparing/controlling the race and sex categories over time, such as comparing the 1990s with the 1930-90 period. However, a Web site coordinated by the American Association of Suicidology currently provides a more consistent set of data, and these are shown in Table 8 for the year 1999. This is not to say that data pertaining to the previously standardized methods of choice are unavailable, but that the reporting refinement now available for the compendium period 1980 to the present makes it difficult to know whether the data listed under such categories are comparable over time. On a yearly basis the Statistical Abstract of the United States now presents suicide methods of choice in a “both sexes” category as well as in “method, white” and “method, black” categories. An example of this new classification schema is shown in Table 8 for the year 1995.
Although females are thought to be more likely to attempt suicide, it is estimated that males are four times more likely to die as a result of their attempts. In 1998, for example, 73% of the recorded 27,648 white suicides were male. During that same year, 57% of suicides (nearly 3 out of every 5) involved the use of firearms. The differences noted for 1998 were not unusual as firearms continued to represent the method of choice. In 1999, firearms were used in 56.8% of total suicides. The specific data are equally noteworthy in that of the 21,107 white males (rate = 19.1) who committed suicide that year (out of 29,199 total suicides), 14,479 chose firearms (61.7%). Among the young (n = 2,315), 59.3% selected firearms as the method of choice; the old used firearms (n = 3,921) in 71.4% of the events and females (n = 2,120) selected firearms 36.9% of the time. In 1999 firearms accounted for almost 57% (n = 16,599) of the 29,199 officially recorded suicides (Hoyert et al. 2001).
Whereas poisoning and gases represented the first suicide method of choice for females recorded prior to and throughout the 1970s, in 1999 the methods that made up this category, now divided into separate categories for solid and liquid poisons (30%) and gas poisons (6%), ranked second and fourth, with the category of hanging, strangulation, and suffocation representing the third method of choice among females. This difference is again noteworthy given that coroners and medical examiners have documented a significant change during the past two decades: That is, females have increasingly selected more lethal methods to commit suicide.
|SOURCE: U.S. Bureau of the Census (1967:168, table 246; 1982-83:81, table 121; 1992:88, table 121; 1996), Hoyert et al. (2001), and McIntosh (2001).|
|a. Handguns (includes 3,700) and other unspecified firearms.|
|b. Includes drugs, medicaments, and biologicals; either solid or liquid substances; gases and vapors.|
|c. Includes suffocation.|
|Firearms and explosives||12,185||2,688||12,937||2,459||14,809||2,554||16,285||2,600||18,147a||14,479||2,120|
|Hanging and strangulation||2,815||846||2,997||694||3,532||732||2,422||756||5,217c||4,490||937|
The lethality of methods of self-harm employed also seems to be useful for understanding the differential rates of suicide. In general, males employ more violent means, such as firearms, piercing instruments, hanging, and jumping, whereas females attempting suicide are more likely to take nonfatal overdoses of drugs (e.g., Peck 1984, 1985-86; Canetto and Sakinofsky 1998; Appleby 2000). Such findings may provide some important insights into the organizational structure of gender role expectations.
Suicide and Region of the United States
In general, suicide rates are higher than the national average in the western states and lower in the midwestern and eastern states. Although it may be important for researchers to explore the interaction of a market economy over time when assessing the fluctuating suicide rates by region of the country, some fluctuations are found in the year-by-year data reported by region. The highest rates of suicide are found in the north-central and western portions of the United States. These regions include Minnesota, Iowa, Missouri, North and South Dakota, Nebraska, Kansas, and the contiguous states of California, Oregon, and Washington as well as Alaska and Hawaii. States in the Mountain region include Nevada, Arizona, and New Mexico, all of which are home to many elderly retirees. Areas that are relatively ecologically and socially isolated, such as Montana and Wyoming, also record rates that far exceed the national average.
In 1990, the eight Mountain states reported the highest overall regional suicide rate (18.5), which was much higher than the national average (12.4). Only Florida (16.1) fell within the range (15.3 to 20.9) recorded for the Mountain region of the United States. The lowest rates were recorded in the Northeast. In 1994, a similar pattern was noted—that is, the Mountain states (rate = 18.3), consisting of Montana (18.5), Idaho (17.7), Wyoming (22.5), Colorado (16.8), New Mexico (18.3), Arizona (18.8), Utah (15.3), and Nevada (23.4), combined for an overall rate of 18.3, compared with 12.0 at the national level. No other state fell within the range of the rate recorded for the Mountain region of the country. Again, the lowest rates were recorded in the Northeast and the Midwest.
In 1996, the Mountain zone states, along with Alaska, South Dakota, and West Virginia, recorded the highest suicide rates in the nation. However, for this same year a total of 30 states had suicide rates higher than the national rate of 11.6. The lowest rates, all below 9.0, were recorded in Connecticut, Rhode Island, Massachusetts, New York, and New Jersey. Washington, D.C., had the lowest rate of all jurisdictions (6.4). This pattern held throughout the decade and up to 1997, the last year for which data are available (U.S. Bureau of the Census 2001).
Gender Role Scripts and Suicide
Historically, as Girard (1993) notes, the ascribed status of women and blacks has impeded the achievement of members of both groups, and, as a consequence, these groups have lower suicide rates than those found in the general population. But “when ascriptive barriers to achievement-oriented careers become less stringent as in the 1960s for blacks and throughout the twentieth century for European women, corresponding race and sex differences in suicide risk decrease” (p. 557). Thus middle-aged women appear to be following what Canetto and Sakinofsky (1998) refer to as “cultural scripts theory,” which suggests that “cultural expectations about gender and suicidal behavior function as scripts; individuals refer to these scripts as a model for their suicidal behavior and to make sense of others’ suicidal behavior” (pp. 19-20). Essentially, Girard asserts that the differential rates of suicide among men and women are related to sex roles. This contention is partially supported by Canetto and Sakinofsky’s analysis of cultural scripts theory.
It is also noteworthy, as Andriolo (1998) points out, that this kind of interpretation directs itself to gender role differences. If sex differences are typecast according to motives and meanings, as Girard (1993) argues, then the meanings attributed may function as a disservice to women. In this context, such analysis is replete with cultural scripts.
Canetto and Sakinofsky (1998) assert that there is a sex paradox in suicide. They argue that females generally experience much more suicidal ideation and are more prone to attempt suicide than males, but females have a much lower rate of suicide than do males. If women are not as inclined to suicide as are males, the question that begs an answer is, Why?
Based on his review of the literature, Stack (1998) notes that there is little or no support for the thesis that the degree of gender inequality in the workplace and politics would moderate the relationship between marriage and suicide acceptability, because such inequality would not likely affect the degree of marital satisfaction. In moving beyond this point, Girard (1993) offers a partial explanation, suggesting that gender differences in suicide rates, especially among older people, are correlated with role identity and the relationship between role identity and vulnerability to threats to an individual’s self-concept. Employing what is referred to as “contingent-identity theory,” Girard argues that the male self is strongly related to occupation, problems related to job performance, and economic security. Although women are increasingly oriented toward developing careers outside the home, Girard asserts, most women’s sense of achievement is based not on occupational success but on “cooperation, social interdependence, and parenthood.”
Although this may explain sex differences in suicide rates among older males and females, middle-aged women up to about age 54 are at high risk for suicide. Girard suggests that this vulnerability may be related not to the stress inherent in women’s involvement in the labor market, but to the stress women feel in relation to the fortunes and misfortunes of their children. Again, the gender paradox in suicidal behavior discussed by Canetto and Sakinofsky (1998) is instructive. To be at risk of suicide may be to hold such an ideation and even to engage in such behavior, but this does not necessarily lead to completion of the suicide act.
Although the study of suicide is encumbered with numerous difficulties of a conceptual and methodological nature, perhaps no other contemporary social problem receives more critical attention. As a result, some important research has been conducted, but there is no consensus that allows for the successful application of the knowledge obtained so far to render a solution to the problem.
At present, and despite more than 275 years of analysis, the subject of suicide continues to elicit intense interest, strong emotions, and social misconceptions. At the same time, one important lingering question has yet to be answered: Should the state have the right to prohibit its citizens from choosing the manner in which they die? At issue is whether a right-to-die law should be enacted, a law that allows suicide to take place. At this time, some countries, such as Great Britain, allow suicide, but in most assisted suicide remains punishable by imprisonment (Ames 2002).
In 1982, Margaret Pabst Battin stated that “recent development in patients’ rights advocacy tend to suggest the reawakening of a stoic or eighteenth-century liberal view of suicides” (p. 30), suggesting that contemporary Western culture was at the time entering a period of renewed interest in issues surrounding the topic of suicide. These issues, according to Battin, included changes in moral attitudes toward self-destructive behavior, professional prevention strategies, and legal determinations of suicide. More than 20 years later, these issues continue to hold the public’s attention.
Perhaps the intensity of this contemporary polemic can be attributed in part to the efforts of Jack Kevorkian, a retired medical examiner whose attempts to bring the issue of assisted suicide to the public’s attention gained national notoriety during the 1990s. More recently, debates in the United States—between the many people who appear to support the establishment of laws allowing assisted suicide or a declared personal choice to commit suicide and representatives of the state who oppose this position—have again demonstrated the moral, legal, social, and religious significance of the suicide event.
The questions Battin raised in 1982 continue to be significant. Is suicide wrong because human life is of intrinsic value, or because the act of suicide is harmful to society, or perhaps because permissive attitudes may lead to abuse? Or is suicide a natural right? That is, should persons have the right to end their lives as they so choose despite whatever objections may be raised by any individual or by the state? Such questions call attention to this statement by Thomas Szasz (1999):
For a long time, suicide was the concern of the Church and the priest. Now it is the business of the State and the doctor. Eventually we will make it our own choice, regardless of what the Bible or the Constitution or Medicine supposedly tell us. (P. xii)
Although these words emphasize the rights of the individual, currently the “right to die” proponents appear to be losing the legal battle to allow individuals to choose the time and manner in which they may select an officially sanctioned alternative to living a less-than-desirable existence. Sometime in the future, however, this social movement may have its intended legal effect, and perhaps an unintended effect on the suicide rate as well.
Clearly, white males continue to dominate the suicide statistics, and, although some variation is observed in the rates among women and minorities, these rates remain relatively constant. Self-destructive behavior does appear to be associated with interpersonal and intrapersonal factors attendant to the committers’ efforts to influence or to control their environment. But this finding, reported extensively in the literature, may not be useful as a powerful explanation specific to suicide because the same kind of information can be used to explain a variety of deviant and nondeviant behaviors. We will be able to understand individuals’ motivations for suicide only when researchers have developed a consistent base of information and when these data are made available to clinicians and public health officials who seek to enhance the personal well-being of all members of the public. When this understanding develops, those who are charged with making the social policies intended to deal with this significant public health problem may be able to perform their work more successfully.
At present, the findings reported on minority and female suicide are mixed. Some occupations appear to expose women to greater risk of suicide, but as increased numbers of women redefine their cultural scripts by relating these scripts to those traditionally reserved to males, the hypothesis to consider is that women will also experience a similar degree of success and failure. A transition from the traditional female cultural script of homemaker and family nurturer could, given women’s evaluation of their success and failure in the labor market, lead to increased rates of suicide.
Although it is clear that the social, political, and economic changes that took place throughout the final 30 years of the 20th century have held important consequences for women and minorities, including enhanced educational opportunities, professional training, and career development, many of the analyses that have been conducted to assess the effects of labor market participation on female and minority suicide rates have produced mixed results. Perhaps scholars need to evaluate cultural factors other than labor market participation to explain the apparent discrepancy between the hypothesized relationships and the available data.