Elder Suicide

Preface
Acknowledgments

Chapter 1: Durkheim’s Suicide in the 21st Century

Chapter 2: Fatalistic Suicide

Chapter 3: Anomic Suicide

Chapter 4: Egoistic Suicide

Chapter 5: Altruistic Suicide

Chapter 6: Assessment and Measurement

Chapter 7: Miscellaneous, Conclusion, and Summary

Appendix: Suicide Assessment Protocol

References
About the Author
Index

Stephen M. Marson, PhD, received a BA from Ohio Dominican University, an MSW from The Ohio State University, and a PhD (in sociology) from North Carolina State University; he also obtained a minor in social work from the University of North Carolina at Chapel Hill. For decades, he has been intensely interested in combining sociological theory with gerontological social work practice and has published and presented numerous papers. In addition, he is the founder and editor of the Journal of Social Work Values and Ethics. After 40 years, he retired from his professorship at the University of North Carolina at Pembroke and is a professor emeritus.

Elder Suicide was reviewed by Brandi Jean Felderhoff for the journal Social Work.

In the United States suicide rates among the top 10 leading causes of death, beginning at the 10- to 14-year age range, and remaining in the top 10, through to the oldest old. It is no secret among practitioners and providers working with the elderly that elder suicide is not an infrequent occurrence, especially among men over the age of 65. In the United States, this population subgroup has a suicide completion rate of 31 per 100,000, which is the highest completion rate of any age- or gender-related cohort. What is even more concerning about this population is that they tend to show fewer, if any, “risk factors” or warning signs, and generally complete suicide on their first attempt. In his book, Elder Suicide: Durkheim’s Vision, Stephen M. Marson provides a clear depiction of Durkheim’s theory through recounting social histories to identify circumstances that create suicide potential. Marson is a professor emeritus from the Sociology and Criminal Justice Department at the University of North Carolina at Pembroke. He spent over 40 years in gerontological social work and has focused on studying sociological theories for suicide intervention of elderly clients.

Read the full review. Available to subscribers of Social Work.

“The reasoning and emotion that go into the ominous decision to commit suicide makes us ponder. To help us understand this process, Stephen Marson presents poignant and provoking observations that do not fit neatly into the myths of suicide, aging, and life satisfaction. He provides the stimulus for professionals and laypeople to reexamine practice strategies and ethical underpinnings when working with aging adults.”

Daniel Pollack, JD, MSSA, MSW
Professor, School of Social Work
Yeshiva University, New York

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“This is a novel modern development of classic theory – the text provides a set of applied social work and geriatric care practices to prevent suicide among elders; practices that are informed by experience, modern geriatric and social work practices and classical theory. Marson’s development of Durkheim’s theory provides for both identification of suicidal risk and theoretically informed intervention. The seemingly, patently individual act of suicide is a result of social phenomena – and the burgeoning geriatric population is at risk. This text provides theoretically informed methods for detection and prevention of suicide. A very well researched book perfect for social work, sociological theory, and gerontology courses; human services practitioners; and fans of Durkheim.”

J. Porter Lillis, PhD
Assistant Chair and Gerontology Director
Department of Sociology and Criminal Justice
University of North Carolina at Pembroke

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“Deconstructing the taboo that is suicide requires the willingness to understand, and exploration of the human psyche. Marson’s book explores practice issues that practitioners may encounter when working with elders. This easy-to-read book provides considerations when identifying and preventing suicide in a population struggling with social and physical changes. Marson highlights interventions framed by Durkheim’s suicide theory to guide readers. Case studies detail diverse life experiences that lead up to the disconsolate decision to end one’s own life. An insightful read for health care workers and human services practitioners working with this vulnerable, yet dynamic group.”

Mara Hunt RN-BSN, MSW
Oncology Nurse, FirstHealth Moore Regional Hospital
Pinehurst, NC

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“In this authoritative work, Marson tackles the silent epidemic of suicide among America’s older adults. With readable and engaging prose he explicates Durkheim’s theory of suicide, demonstrating how its application can inform both assessment and intervention with this vulnerable population. Case studies from his practice offer rich illustrations of key principles. By raising awareness and deepening our understanding of late-life suicide, this book will be valuable for anyone who works with or cares for older adults.”

Amanda Barusch, PhD
Professor Emeritus
Department of Sociology, Gender & Social Work
University of Otago, New Zealand

Elder Suicide was reviewed by Brandi Jean Felderhoff for the journal Social Work.

In the United States suicide rates among the top 10 leading causes of death, beginning at the 10- to 14-year age range, and remaining in the top 10, through to the oldest old. It is no secret among practitioners and providers working with the elderly that elder suicide is not an infrequent occurrence, especially among men over the age of 65. In the United States, this population subgroup has a suicide completion rate of 31 per 100,000, which is the highest completion rate of any age- or gender-related cohort. What is even more concerning about this population is that they tend to show fewer, if any, “risk factors” or warning signs, and generally complete suicide on their first attempt. In his book, Elder Suicide: Durkheim’s Vision, Stephen M. Marson provides a clear depiction of Durkheim’s theory through recounting social histories to identify circumstances that create suicide potential. Marson is a professor emeritus from the Sociology and Criminal Justice Department at the University of North Carolina at Pembroke. He spent over 40 years in gerontological social work and has focused on studying sociological theories for suicide intervention of elderly clients.

Read the full review. Available to subscribers of Social Work.

Who Is Emile Durkheim and Why Study His Work in Gerontology?

Each victim of suicide gives his act a personal stamp which expresses his temperament
—Emile Durkheim, Suicide: A Study in Sociology

I was first introduced to Emile Durkheim when I was enrolled in a sociological theory course at Ohio Dominican College (since renamed Ohio Dominican University). The professor, Lynn D. Nelson, adopted the first edition of Coser (2003) as our textbook. Coser is a master of the English language and a very creative writer. Unlike writers of other theory textbooks, Coser used a biographical sketch of each theoretician to create a connection between the student and the theory. The strategy was quite successful in laying the foundation to learn theory. For the class, Professor Nelson assigned each student the name of a theoretician addressed from Coser’s book and required the students to make a presentation and submit a research paper. I was not assigned Durkheim but rather was presented with Thorstein Bunde Veblen, the author of The Theory of the Leisure Class. At my impressionable age, Veblen’s writing provoked a strong interest in conflict theory. That interest in conflict theory lasted for decades and even influenced my doctoral dissertation, which focused on Karl Marx.

My interest in conflict theory created a bias against theoreticians such as Durkheim. I had a closed mind. Thus, while an undergraduate learning about Durkheim and his work, I was unimpressed. I was briefly reintroduced to Durkheim at The Ohio State University during my work toward a master’s degree, and I continued to be unimpressed. When I started my PhD at North Carolina State University, I was re-reintroduced to Durkheim. I continued to have a conflict theory bias, but it was softened when I read Durkheim’s Suicide: A Study of Sociology. I read Durkheim (1897) while sitting on the beach, feeling the sea breeze, and listening to the waves. Perhaps the influence of the beach opened my mind to the idea that non–conflict theoreticians might have something worthwhile to contribute to social intervention.

While studying for the dreaded exams at the end of my doctorate program, I requested tutoring for my theory exam. My theory professor, L. Richard Della Fave, had me read J. C. Alexander’s (1986a, 1986b, 1986c, 1986d) four-volume set. Della Fave and I spent hours discussing these wonderfully written books. I recall the second volume (J. C. Alexander, 1986b) as being particularly thought provoking. Studying and discussing these volumes with Della Fave facilitated a great deal of intellectual growth and maturity within me. The assignment opened my mind to a greater theoretical world.

Several years prior to these readings, I had a private practice where I acquired contracts for nursing home consultations. It was during this time that I experienced the aftermath of Mr. Smith’s suicide (addressed in chapter 1). After reading Durkheim (1897) and Alexander (1986a, 1986b, 1986c, 1986d), my mind wandered back to the events involving Mr. Smith. Very slowly, I began to see the great value in the work of non–conflict theoreticians. Since that time and in the 20 years that followed, I had been thinking about the practicality of Durkheim (1897) as a tool for addressing self-maltreatment among the elderly population. To address my preoccupation with elderly self-maltreatment and suicide, I enlisted my good friend Rasby Powell to coauthor two papers on the subject (Marson & Powell, 2011, 2012). Later, I made a conference presentation that quantified Durkheim’s four suicide concepts by using factor analysis (Marson, Hong, & Bullard, 2017). With all the criticism leveled against Durkheim, I have found his work on suicide quite amazing. It fits the elderly population like a hand in a glove. Drawing on my reading and practice experience in nursing homes, I have concluded that Durkheim’s work on suicide is probably more applicable to the elderly population than to the general population.

In terms of nearly meaningless sociological categories, Durkheim would be best considered a “functionalist.” That is a dirty word if you happen to be a conflict theorist. The more I read and reread Durkheim, the more I came to believe he was an intellectual giant—much more of a giant than any conflict theorist I had read. Frankly, and most sociologists would strongly disagree with me, I see Durkheim as the Einstein of sociology. Some of the research tasks he performed in the late 1800s and early 1900s are quite striking, and I wonder how he was able to accomplish this work without the aid of a computer. I am profoundly impressed with Durkheim.

Here lie two critically important lessons for all of us. First, all theories in the social sciences have strengths and weaknesses. Some theories are quite robust in explaining social inequality but offer no value when a practitioner is holding the hands of an elderly person who is contemplating suicide. My experience tells me that I must keep an open mind when I seek theoretical explanations for my work. When using a good theory, I can successfully guide a client through life’s minefields. Without a good theory, I can easily misstep. In the case of suicide prevention, the misstep is fatal.

Second, the strength of a social science theory is also its weakness. Thyer (2008) offered a compelling argument against the use of theory in providing services for others. Professors, students, and practitioners who cling tightly to a beloved theory will lack the ability to comprehend and analyze behavioral dimensions that lie beyond the scope of their treasured theory. When a theory becomes intricately interwoven into the fabric of a professional’s worldview, a huge amount of critically important observations will go unnoticed. In my experience, I ignored the importance of Durkheim’s contribution because I had an uncompromising worldview within a conflict theory perspective. Gradually, my mind opened to view the world from a variety of perspectives. I developed a clearer understanding of the world around me. The use of theory for producing social change requires an open mind and balance. An uncompromising commitment to one theory compels a professional to miss critical features of reality. Theoretical temperance is required.

As an undergraduate, I had a double major in sociology and social work with a minor in psychology. I have always had an internal struggle over which academic major provided the fountainhead of theory best suited for problem solving. Was it sociology or psychology? In terms of the study of suicide, the greatest amount of raw material has been offered by psychologists. However, over the years, I have come to believe that psychology does not have all the answers—particularly among elderly populations. Among elders, we have a cohort of people who have successfully negotiated through life’s emotional traumas. I think it is time for us to systematically examine the social forces propelling elders in the late sector of life.

As a gerontologist prior to my doctoral studies, I was very distressed by the data on self-maltreatment among elders. There was a vast warehouse of data but no conceptual framework to provide meaning for the data (Marson, 1991, 1992). The lack of theory goes beyond elder abuse; it extends to the entire field of gerontology. Many years ago, Maddox and Campbell (1985) envisioned the study of aging as “atheoretical.” In the first edition of The Handbook of Theories of Aging, Bengtson, Rice, and Johnson (1999) continued to tactfully lament the lack of theoretical rigor in gerontological research. In the most recent edition of the same volume, Bengtson and Settersten (2016) continued to stress the lack of theoretical rigor found in gerontological publications. Basically, the use of theory in gerontology has made very little progress. Why do I stress this? At least one empirical social gerontologist (who will remain unnamed) angrily denies that gerontology lacks theoretical rigor.

I disagree. To demonstrate this point, over the past years, I have made efforts to connect theory-free empirical findings to theory. For example, in Marson and Della Fave (1994), we examined the empirical findings in the gerontological literature through the eyes of Marxian theory. In Marson and Powell (2012), we examined suicide with Durkheim’s theoretical eyes. In Marson and Powell (2014), we interpreted the infantilization of elderly people with the view of Goffman’s theories. If data-driven studies in gerontology were truly embedded in theory, these papers could have never been published. This book explores and interprets the theory-barren gerontological research in the arena of suicide through the lens of Durkheim’s work—which represents a balance between theory and empiricism. The balance between theory and empiricism is the best platform for social intervention.

Over the years, I have learned that without a framework to provide meaning to data,* practitioners have little guidance for directing successful interventions. It is rare to find an academic theory that provides a meaningful platform to enhance the lives of people. This book illustrates how Durkheim’s work can be helpful in gerontology. Durkheim’s work provides a framework that makes sense out of the incoherent jumble of data in the arena of elder self-maltreatment. In addition, beyond merely providing an abstract framework to make sense of the elder abuse world, Durkheim’s work can facilitate positive action for gerontological practitioners in the field.

Who is the audience for this book on suicide? The book speaks with several different voices. Gerontological practitioners who are employed by institutions or community agencies that provide social or health care will benefit. They may emerge with an expanded worldview. Much of what practitioners have learned about suicide comes from the writings of psychologists. This book offers a fresh perspective but not a panacea. This book works well as supplemental reading for a social gerontology course. Last, the book can be used as supplemental reading for a sociological theory course. It is sad that sociologists have a tradition of pursuing science for the sake of science rather than using sociological findings for the betterment of humankind. This book illustrates the richness of Durkheim’s theory in an applied arena. A consequence of writing with many voices makes the chapters appear as if I am going off on tangents. I am not. Rather, I am including analysis for the various audiences that will read this book.

*As a doctoral student, I learned all about data dredging. A researcher with little experience and skill can find statistical significance and identify a quantitative finding as important when it is not an accurate reflection of social reality. Statistical significance does not necessarily indicate practical significance. Here is the problem: too many people do not have an intimate understanding of p values.