Social and familial risk factors in suicidal behavior

The private experiences usually thought to be the proximate causes of suicide have only the influence borrowed from victim's moral disposition, itself an echo of the moral state of society…his sadness comes to him from without.EMILE DURKHEIM Ernest Hemingway, his father Clarence, brother Leicester, sister Ursala, and granddaughter Margaux all committed suicide (Fig. 1). Ernest's son, Gregory, had seven "nervous breakdowns" [sic], ninety-seven electroconvulsive therapy (ECT) treatments (he was bipolar), and three marriages and divorces. Son, Patrick, also had ECT treatments and a severe head injury from a car accident. Most recently (July 31, 1996), granddaughter Margaux (her father was John or "Jack") overdosed at age 41 years and died, as yet another family suicide, after a history of alcoholism, bulimia, and epilepsy. Margaux described her family as "very very dysfunctional." Of course, the question we have to answer is how much of the Hemingway family pathology is the result of social relations and how much is from biologic or genetic factors, or even psychological forces. The author has written about social factors in suicide on numerous previous occasions. 26,31,32,33,34 The focus in all of these works as well as in this article is the presence or absence of external and constraining social facts (see Durkheim, 1897, 14 on anomie, agoism, altruism, and fatalism), as reflected in indicators like divorce rate, marital status, the number of close friends, loss of crucial significant others, or sometimes having no one who cares if the person lives or dies, feelings of shame or intolerable guilt, the belief of sacrificing one's life for a higher cause or another person, military suicide, and so on. When we concentrate on the social relations of suicides, the implicit contrast is usually with the individual. For example, Durkheim, in the opening quote, draws attention to social facts outside the individual and even then examines how social integration and social structure affect group suicide rates, not on individual cases. The concept of "the social" involves numbers greater than one and some interaction or exchange among the individual or units considered. The "social" always has an emergent or even transcendent property to it; such that the social sum is not equivalent to its individual parts (e.g., a working clock is more than its disorganized heap of component parts or water is qualitatively different from two units of hydrogen and one unit of oxygen). Thus, most suicidologists argue that suicide rates never can be explained by individual cases of suicide. Among the types of "social suicides" that suicidologists examine are mass suicides, organizational self-destruction, suicide clusters (including by extension suicides in families like the Hemingways), military suicides and war, murder followed by suicide, suicide pacts, and witnessed suicides among others. 35 The social relations of suicides tend to be one of two broad types, either absent or negative. By "absent" social relations, we refer to social characteristics like the loss of support (especially in the early socialization years of one's mother), absent parents, disrupted social relations like anomie, being never married or divorced, having few close friends (e.g., Maris 31 found that about 50% of Chicago suicides had zero close friends—a statistically significant difference from the control groups), having no informant to help fill out a suicide's death certificate, or even no one to identify the body. "Negative" social relations or "negative interaction," 31 on the other hand, is not being socially isolated but rather having suicidogenic social relations. Here we refer not to absent parents, but to "bad" parenting (such as giving a child a parental suicide to model or copy or child abuse). Another example of negative social relations would be suicide cults like those seen at Jonestown, Waco, the Order of the Solar Temple, or Heaven's Gate. In such cases, one's social relations actually promote, cultivate, or in some cases even "practice" group suicide (as in Jonestown, Guyana). This type would encompass what Durkheim called "altruistic suicides"—like the Japanese kamikaze pilots in World War II (WWII) or the more current Muslim terrorists. Within sociology there is a rich tradition in the study of the social relations of suicide. 34 One trend is largely quantitative and grows out of the early research of French social scientist Emile Durkheim (1857/1951). 14 Included here would be the work of Henry and Short, 20 Gibbs and Martin, 18 Phillips, 46 Maris, 31 Stack. 45 A second trend is mainly qualitative and originated primarily with the "ethnomethodology" of Douglas 13 and Garfinkel. 16 Among other things, social suicidologists examine social risk factors in general models of suicide outcomes, such as those listed in Maris et al 30 (suicide in one's family, social isolation, marital disruption, stress and life events, loss of social support, living alone, rejection, unemployment, and negative life events). Other aspects of the social relations of suicides investigated by social scientists include work and the economy; sexuality and the family; culture and religion; legal and ethical considerations of euthanasia and death assistance; imitation; socioeconomic status (SES) and suicide; community, organizational, and ecologic studies; vital statistics (especially of demographic factors like age, gender, race, marital status, and occupation); temporal variations in suicide rates; mass and cult suicides; military suicides; witnessed suicides 37 ; and social analogues of individual suicides, such as industrial pollution as a social overdose. In this article, we concentrate on four aspects of the social relations of suicides: (1) a brief history of the sociologic study of suicide, (2) social isolation, (3) contagion or imitation, and (4) social stress and negative interaction. We begin with a review of the highlights in the history of social suicidological thought and investigation.