Toward a Cultural-Structural Theory of Suicide: Examining Excessive Regulation and Its Discontents

Abstract

Despite its enduring insights, Durkheim’s theory of suicide fails to account for a significant set of cases because of its overreliance on structural forces to the detriment of other possible factors. In this paper, we develop a new theoretical framework for thinking about the role of culture in vulnerability to suicide. We argue that by focusing on the cultural dynamics of excessive regulation, particularly at the meso level, a more robust sociological model for suicide could be offered that supplements structure-heavy Durkheimian theory. In essence, we argue that the relevance of cultural regulation to suicide rests on the (1) degree to which culture is coherent in sociocultural places, (2) existence of directives related to prescribing or proscribing suicide, (3) degree to which these directives translate into internalized meanings affecting social psychological processes, and (4) degree to which the social space is bounded. We then illustrate how our new theory provides useful insights into three cases of suicide largely neglected within sociology: specifically, suicide clusters in high schools, suicide in the military, and suicides of “despair” among middle-aged white men. We conclude with implications for future sociological research on suicide and suicide prevention.

Keywords

suicide Durkheim cultural sociology regulation mental health

Introduction

For over a century, the sociological study of suicide has been indebted to Durkheim’s classic, Suicide. At its core are two central principles: that the structure of suicide rates in a society are a function of the structure of social relationships and that these vary in terms of integration and/or regulation. Despite the enduring brilliance of these two insights, Suicide has received plenty of theoretical (Abrutyn and Mueller 2014c; Johnson 1965; Pope 1976), methodological (Douglas 1967), and empirical (Breault 1994; Kushner and Sterk 2005) criticism. Although these critiques have ranged in their fairness and accuracy, a recent review of the sociological literature on suicide concluded that the conventional Durkheimian approach to suicide—namely, one that is macro-structural—is no longer tenable if sociology is to contribute to both the social scientific study and the prevention of suicide and suicidality (Wray, Colen, and Pescosolido 2011). This is not to say that efforts to reconceptualize Durkheim’s Suicide have been nonexistent. To the contrary, insights drawn from the integration of Suicide with network principles (Bearman 1991; Pescosolido and Georgianna 1989), emotions (Abrutyn and Mueller 2014a, 2014c), and social psychology (Abrutyn and Mueller 2016; Mueller and Abrutyn 2016) all present serious efforts toward a more robust, Durkheimian-inspired sociology of suicide. Yet work still remains, particularly in elucidating how culture shapes suicide.

In this spirit, this paper asks: How do we bring cultural sociology into dialogue with the structuralism of Durkheim’s theory to better understand the social roots of suicide? Although Jack Douglas (1967) first called attention to the importance of cultural meanings for understanding suicide, thinking about culture and suicide has been largely undertaken by anthropologists (Baechler 1979; Chua 2014; Farberow 1975; Kitanaka 2012; Kral 1998; Niezen 2009; Stevenson 2014), undermining efforts to generate generalizable, sociological theory. Recently, however, the need for considering culture has grown louder in other disciplines (Colucci and Lester 2012; Hjelmeland 2010) as well as a few sociological studies (Barbagli 2015; Mueller and Abrutyn 2016). At the heart of these arguments are some basic principles: (1) Suicide is a choice predicated on the meanings individuals use to make sense of their own situation (Kral 1994); (2) even when done privately, suicide is a social act because it has meaning not only for the person who dies but also for those they leave behind, including unintended audiences (Mueller 2017; Neimeyer, Klass, and Dennis 2014; Stack and Abrutyn 2015); (3) moreover, all social acts require shared meanings, acquired via interaction with real, imagined, and generalized others (Blumer 1969), which amplify, reinforce, and deepen them (Collins 2004). As such, a structural explanation of suicide will always be lacking as it cannot account for essential, cultural aspects of suicidality.

To address this limitation, this paper develops a cultural-structural theory of suicide. We take Durkheim as our starting point for two important reasons. First, Durkheim’s study of suicide is a seminal piece of scholarship in both sociology and suicidology, and a plethora of research builds off his insights. Second, though Durkheim is more recognized for his insights into the structural foundations of suicide, in Durkheim’s concept of “moral” regulation and his broader body of scholarship, we can find elements of cultural mechanisms like collective conscience or external representations that offer important clues into how culture may matter to suicide (Abrutyn and Mueller 2016; Mueller and Abrutyn 2016; Poggi 2000). However, we also go beyond Durkheim, elaborating how culture may condition suicide using insights from a variety of more recent scholarship primarily in cultural sociology but also in research focused on meso-level groups (Fine 2010) or places (Coser 1974; Goffman 1961). Finally, we conclude by discussing the relevance of our theoretical model to three pressing issues in current suicidology: namely, high school suicide clusters, suicide in the military, and the relationship between masculinity and suicide.

Culture, Regulation, and Suicide

We begin this project with some important definitional work. Specifically, what do we mean by culture? Although a wide array of definitions and elements often fall under the umbrella of culture, we define culture for our purposes as the material (e.g., physical objects, buildings) and symbolic (e.g., values, ideologies, beliefs, and norms) elements a group shares such that they intersubjectively believe in a collective origin, rely on a collective memory, and have a sense of collective destiny (Abrutyn 2014; Fine 2010). The coherence or homogeneity of a specific cultural “system,” toolkit, framework, configuration, or whatever other metaphor one chooses to employ depends on the extent to which the social unit sharing the cultural system is bounded. Durkheim ([1893] 1997) recognized this long ago, but it was more fully articulated by Parsons and Bales (1955): the smaller the social unit, the more specific and concrete the elements constituting a cultural system, whereas the larger the social unit, the more general and abstract the elements. (This basic proposition will play a significant role in our how culture and structure are related, but for now, we accept this premise as is.) Importantly, culture is both public and external as well as private and internal (Patterson 2014). This distinction is worth emphasizing because much of the research on culture today relies on intrapersonal cognitive mechanisms (Lizardo and Strand 2010; Vaisey 2009), which take for granted the need for externality if culture is to place similar pressures on members of a given social unit (Fine 2010). To be sure, individuals must internalize culture, and of course no one individual has complete access to all culture, yet there is also no doubt that cultural codes are shared or at least believed to be shared such that what individuals feel (Hochschild 1983), think (Blumer 1969), and do (Fine 2010) conform to local, if not broader global, standards.

Culture and Suicide

Though the sociology of suicide has generally neglected the idea of culture, there is some evidence both within sociology and other disciplines that culture matters to suicide. In 1967, sociologist Jack Douglas was one of the first to advance an argument for analyzing culture with regard to suicide. Specifically, he argued that the efficacy of studying suicide rates in the Durkheimian tradition was undermined by our lack of understanding of how society makes sense of suicide. His evidence for this were the substantial (and currently well documented; Rockett, Samora, and Coben 2006; Timmermans 2006) inconsistencies in official statistics for suspicious deaths like suicides.

Though Douglas’s critique may be extreme, the fact that suicide and its meanings vary across time and space has been clearly illustrated by a wide range of scholars (Baechler 1979; Cha and Nock 2014; Farberow 1975; Hecht 2013). Indeed, suicide is a decision (Kral 1994) that is impossible to make “without reference to the prevailing normative standards and attitudes of the cultural community” (Boldt 1988:106). Thus, we cannot talk about underlying motivation (Hjelmeland 2010), choice in method of suicide (Lester and Stack 2015), or patterns of suicidality (Colucci 2006) without paying attention to the underlying cultural meanings of suicide. For instance, whereas female suicidality in the United States is generally interpreted (somewhat pejoratively) as “a cry for help” (Canetto 1997), research reveals that this interpretation of female suicidality is not universal. For example, the Chinese typically understand female suicide as a protest against existing coercive social relationships and a symbolic act of justice and thereby a means by which one could punish the living (Fei 2010). Likewise, suicide means different things in modern Japan (Kitanaka 2012) and India (Chua 2014), and it certainly had significantly different meanings in Medieval Christendom (Barbagli 2015; Cha and Nock 2014). Perhaps surprising and despite Douglas’s call, there is little research on American meanings attributed to suicide, though there is evidence that most U.S.-based people think of suicide in medicalized terms as caused by mental illness (Jamison 2001; Sudak, Maxim, and Carpenter 2008). In addition, a growing body of literature considers how different gender norms or scripts shape differences in how men and women view suicidality (Canetto 1997) as well as how different types of motives rooted in gender—more often masculinity in particular—may impact differential rates of suicide lethality (Adinkrah 2012; Cleary 2012).

Though these studies represent important advances, most of them rely on highly generalized society-wide cultural codes or scripts. As Lester (2012) points out, several cultural meanings for suicide can coexist at any given time, some complementary, others contradictory. Additionally, these studies generally fail to articulate how cultural meanings about suicide or even life or death become normative such that behavior is regulated and suicide is facilitated under certain circumstances. Thus, their relevance to suicidology and suicide prevention is limited.

Durkheim and the Question of Culture and Regulation

To examine the role of culture in why people die by suicide, we begin by extracting insights from Durkheim. Durkheim’s theory of suicide was notably a structural theory. In essence, he argued that suicide rates were a positive function of the existing structure of social relationships, and social relationships varied according to their level of integration or regulation. The former, integration, has been well studied in its association with suicide (Baller and Richardson 2002; Pescosolido 1990, 1994), whereas regulation has been less successfully leveraged as a possible social root of suicide (cf. Breault 1994). This may be because we generally have been conceptualizing regulation incorrectly, focusing on anomie at the individual level rather than recognizing regulation as tapping into cultural process related to how groups and places come to impose meanings that are concomitantly internalized through social interaction (Blumer 1969). Indeed, this may be precisely what Durkheim meant, though he was restricted from using the term culture as it was the domain of anthropology during his time. Poggi (2000), for instance, points out that while Durkheim only explicitly used the term culture twice in The Division of Labor in Society (1893 [1997]:251, 297), when he did, he used it to refer to manières d’agir and de penser, or collective ways of thinking and acting, concepts that are quite close to current thoughts about culture. And although Durkheim conceptualized the conscience collective as an integrative force, it was also a moral and therefore regulative force. Ultimately, at this early stage of his thinking, Durkheim sees humans as “cultural animals” and culture as “the totality of socially produced and transmitted arrangements, artefacts [sic], designs for living, [and] characteristics of the group” (Poggi 2000:60). As his ideas matured, his thoughts on culture and regulation became more concrete.

In The Elementary Forms, for instance, Durkheim ([1912] 1995) essentially argues that when the same people assemble frequently, they create real and imagined ecological boundaries, become mutually oriented in attention, and generate powerful positive affect that feeds back, in turn, on their mutual orientation and boundaries. Durkheim is essentially picking up on something that is now well known: that humans always seek to attribute the source of positive or negative emotions (Lawler 1992) and when emotions emerge within the same collective assemblies, proximate sources—for example, individuals or the group itself—eventually come to be recognized as the source (Lawler, Thye, and Yoon 2009). Thus, the relationship or group becomes a thing sui generis, replete with a common biography, history, shared destiny, and ethos; emotions crystallize into external representations, infusing social (others), physical (places and totems), and ideational (names, classifications, etc.) objects with external, coercive power. In turn, these objects serve as reminders of the collective and the moral order, become capable of drawing mutual attention and emotion in future ritualized interaction, and ultimately, serve as material anchors embodying abstract collective ideas (Collins 2004). Durkheim correctly asserted that when individuals plunge themselves in the collective during assembly, they are also compelled to submerge their individual conscience and consciousness in the waters of collective conscience and consciousness. As a result, the more frequently collectives assemble, the more salient their microculture becomes. And sticking with the material side of Durkheim, the more public and palpable collective representations and effervescence are, the more powerful cultural forces of regulation are as well. In short, for Durkheim, we can see that culture is a force of regulation rooted in frequency of interaction, moral density (how close sets of people are, how visible their behavior is, and how easily sanctioned people are because of this), and the shaping of collective ways of thinking and acting (and feeling). It is for these reasons, among others, that Durkheim’s neglect of the cultural side of regulation in Suicide is surprising and why a cultural reading of excessive regulation within local spaces or collectives has so much promise (Mueller and Abrutyn 2016).

Indeed, there are hints in Durkheim’s Suicide that suicide as a social act is eminently cultural in that it cannot be divorced from collective ways of feeling, thinking, and acting. This is perhaps most apparent in Durkheim’s critique of Tarde’s (1903) imitation thesis. Durkheim adamantly rejects imitation and contagion as social forces, arguing that mere aping of behavior makes little sense. Rather, he argues, “mass suicides . . . spring from a collective resolve, a genuine social consensus rather than a simple contagious impulse. The idea does not spring up in one particular person and then spread to others; but it is developed by the whole group which . . . collectively decides upon death” (Durkheim [1897] 1951:131–32). Admittedly, Durkheim does not shed much light in Suicide on the process by which a group can become a site of mass suicide, but he does recognize the fact that the spread of suicide in a physically bounded space is not due to an individual passively “catching” an idea like the flu spreading in a dorm hall; instead, it must become a part of the collective conscience of the group such that the action itself becomes meaningful to the group, an idea we will build on shortly.

Durkheim provided some remarks about the types of collectives where suicide is most likely to become meaningful that further support our quest for a cultural-structural theory of suicide. He noted that places like guard towers, regiments, villages, prisons, and monasteries are all examples of places in which “moral” epidemics of suicide have been reported. Two things are notable about these examples that highlight the role of culture. First, they are all characterized by relatively small, dense populations: a precondition for (a) being able to observe the relationship between culture and micro-level processes and (b) the existence of a micro- or idioculture in Fine’s (2010) terminology. Second, not all small villages or prisons have had contagious outbreaks of suicide despite the fact that villages and prisons share similar structural characteristics with each other. Structure, then, is a key contextual factor but not enough to explain suicide contagion or clustering. Indeed, it will be necessary to consider the relationship between structure and culture in positing a robust theory of suicide. But for now, we feel we have made a solid case that Durkheim would (at least) not disagree with our assessment that suicide is shaped by cultural forces. It is puzzling then why sociological analyses using Durkheim have largely ignored the role of culture (for criticisms, see Barbagli 2015; Mueller and Abrutyn 2016). We turn now toward contemporary accounts of culture as a force of regulation so that we can supplement and extend the insights sketched previously from Durkheim.

Toward a Cultural-Structural Theory of Suicide

Beyond Durkheim: Culture and Regulation

We begin our move toward a cultural theory of suicide by articulating more fully the general dynamics of cultural regulation. When we say culture regulates, we mean that culture is the source by which a group patterns feeling, thinking, and doing; it is the source of expressive and moral-evaluative meanings about emotions, attitudes, and behavior. And while it is tempting to think about culture at large, we believe the greatest contributions to theory have come from studies of culturally, socially, and/or geographically bounded social collectives (e.g., Small 2004; Tousignant 1998; Whyte 1969) or organizational spaces (Coser 1974; Goffman 1961; Kanter 1968). Several key factors make local culture so powerful. First, unlike task groups studied under experimental conditions, ethnographies of place offer naturalistic settings in which the historical, political, economic, and cultural conditions are more easily ascertained, cross-referenced, and verified. Second, local spaces also exhibit the characteristics of Durkheim’s ([1893] 1997) mechanical societies in that members share a single location, have an easier time building up and maintaining a common collective identity, share similar cultural elements, and repeatedly interact. In turn, recurring interactions reinforce the local culture regardless of how objectively consensual the culture is, whether cultural configurations (Patterson 2014) or idiocultures (Fine 2010) are fewer in number, and whether they are highly available and accessible, easily applied, frequently and publicly enacted, or displayed in dispositions and rituals—often reinforced by influential and official agents of socialization and order. Hence, local cultures are far more likely to have actors believe that culture is shared, and therefore, its objectivity, externality, and internalization are more unquestioned. Hence, the pressure to conformity is higher in these places since monitoring and sanctioning are cheaper and the consequences more salient to group members (Coleman 1988; Hechter 1987). As such, we suggest that four “ingredients” go into making regulation toxic such that suicide may be one recurring outcome of high levels of regulation: (1) cultural coherence, (2) the content of cultural directives, (3) identity dynamics, and (4) cohesive social structure. While much has already been said about the first of these four ingredients, a few brief comments are warranted before turning to the other three.

Cultural coherence

Since Parsons, many sociologists have argued that culture is not very consensual, fragmented, and in some cases, highly contested. Undoubtedly, there is truth to this assumption: No one has access to all the cultural elements available in a given culture. Cultural values, beliefs, and norms are subject to contestation and resistance, and research has demonstrated that people’s beliefs and practices are often inconsistent. But when we train our lens on smaller slices of social organization, like neighborhoods (Anderson 1999; Small 2004), informal recurring groups (Becker 1963; Fine 2010; Whyte 1969), or relatively bounded bureaucratic spaces (Goffman 1961), we find increasingly coherent cultural systems. Coherence, in short, implies higher levels of clarity and rigidity concerning values, beliefs, and norms; cheap and easy monitoring; swift and severe informal and sometimes formal sanctioning; and seemingly ever-present agents of authority. These “external” features impose what Goffman (1961) described as commitment, or the expectations real, imagined, and generalized others thrust upon the self. Despite contemporary sociology’s adherence to a belief that moral relativism is superior to coherence, Durkheim was clearly aware of the protective benefits of cultural coherence: plausible, social order external to the individual that (in Peter Berger’s [1969:26] more elegant terms) “provides [humans the] ultimate shield against the terror of anomy.” And because something so healthy and protective on its own cannot be the source of suicidality, we turn to the other three ingredients.

Cultural directives

Culture manifests itself in patterns, and these patterns are rooted in what we call directives that channel emotions, attitudes, and actions in prescribed or proscribed ways. To be sure, it is a metaphor, but one with power. Consider Romeo and Juliet: It is a play that has a script that exists outside of any one actor and because of its exteriority, can make certain demands obligatory on role performers; these obligations are cultural directives. Additionally, directives become powerful not only because they are external but because they appear to have influenced past performances. These recurring performances reinforce the crystallized directives first laid out by the writer but also infuse them with contextual meanings that are both general and local, the former because there is only so much latitude offered a given performance before innovation and interpretation go beyond the delimitations set and the latter because within these directives are freedoms for interpretation and reinterpretation that account for temporal, physical, cultural, and social differences in the actual performance and the one laid out by the author. In addition to the exteriority of the directives, directives are also internalized by actors. During rehearsal, actors can visibly read the script, but through rehearsal, their attempt at authenticity leads to the embodiment of obligations. Importantly, it is the space between constraint and latitude that gives local performances their uniqueness, and it is this uniqueness that allows us to argue that culture can be coherent even if not all of it is coherent.

In short, we can see that directives provide (1) generalized meanings about how one ought to feel, think, and act under certain circumstances that are accessible to everyone who has access to the script; (2) implicit and explicit sanctions for violating the expectations that emerge around these meanings; and (3) some freedom to actors to manipulate and make their roles but within a delimited space. How much freedom and how intense the sanctions depends on the context: Failing to play Romeo correctly may cost someone a part in play or elicit ridicule during rehearsal, whereas failing to produce a child, in some times and places, may elicit powerful shame. And the ritualized sequence for repairing these violations varies too. Because of this last point and the fact that culture is internalized, we need a third ingredient: the social psychological dynamics of cultural regulation, which brings us to a discussion of identity.

Identity Dynamics

A significant body of social psychological theories begins with the process of control (cf. Turner 2010). That is, individuals internalize “standards” or sets of meanings about identity, status, situational elements, and so forth that are constantly being evaluated vis-à-vis external information about these phenomena. When internal standards and external information are congruent, interactions and performance go as planned; when incongruent, we experience negative affect and work to create congruence. Though most of these theories are useful for thinking about cultural regulation, those that are particularly relevant to our theory are those centered on identities—or meaning-sets anchored in specific relationships, groups, or social categories (e.g., gender, race, student) (Burke and Stets 2009; Hogg 2006; Ridgeway 2001). Each of these analytically distinct yet empirically overlapping sociocultural anchorages points to different sources of regulation and therefore different ways in which too much regulation may matter.

Some theoretical points are worth examining. First, unlike cultural coherence, identity turns our attention to what Goffman (1961) called attachment, or what social psychologists refer to as prominence (McCall and Simmons 1978) and salience (Stryker 1980). Prominence refers to the rank-ordering of identities based on personal preference, while salience refers to the rank-ordering of identities based on which identities are most likely to be activated. Both of these dimensions vary situationally and globally. Yet although attachment may shift from encounter to encounter, there are “master” identities to which each person tends to attribute the most meaning. As such, we work hardest at meeting the obligations we feel bring congruence between our internal standards and the external responses to our performance (Burke and Stets 2009; Serpe 1987).

Second, we may be attached to real others (role identities) (Burke and Reitzes 1981), the generalized other representing a real group we belong to (group identity) (Lawler 1992), or a generalized other representing a categorical distinction like gender, race, occupation (social identity) (J. Berger, Cohen, and Zelditch 1972).¹ We regulate our behavior according to the most prominent and salient identity or identities in a situation because of both external monitoring and sanctioning and the positive, intrinsic rewards felt when “doing” identity “right.” Because some identities are more important—they have been rewarded, invested in, and/or activated the most—self-sanctioning varies according to importance. That is, a person is less likely to feel guilt or shame for violating obligations when those obligations are attached to an identity with lower levels of emotional valence and moral evaluation (Turner 2007).

Third, attachment and self-regulation are rooted in cultural directives we learn to associate with a role, group, or social identity. A large body of research, for example, reveals how status beliefs condition our emotions, attitudes, and actions across situations (Ridgeway 2006a, 2006b); because we anticipate the influence, reward, performance, and evaluation we deserve in a given situation, we feel pressured to ensure that we meet our obligation. These obligatory feelings derive from beliefs that we feel are shared not just by our self or a real other that we may have learned them from but from “most” or “all” people. Ultimately, these lead to distinct styles of feeling, thinking, and acting for those with high and low status (Hochschild 1983; Ridgeway and Correll 2004). So much so, that attempts to renegotiate obligations or others’ expectations, especially when identity is prominent and salient and commitment is intensely expected, are met with moral indignation and severe sanctioning (Goffman 1967). We work hard, ultimately, to avoid negative self-conscious emotions like guilt and especially shame (Lewis 1971; Scheff 1997; Tangney and Dearing 2002). Though Durkheimian theories often neglect the role of identity and social psychology, one key advantage to bringing it in is that it allows us to imagine how highly regulated spaces transmit psychological vulnerabilities to individuals; thus, it is an essential part of any sociological theory of suicide.

Social Structure

Though thus far we have emphasized the cultural underpinnings of regulation, to ignore the co-occurring role of social structure as an ingredient in regulation would be a mistake. The importance of structure can be described at both the meso level of social reality, where cultural coherence is the central dimension of cultural regulation, and the micro level, where identity processes operate. Let’s consider the former first.

Previously, we argued that cultural coherence was most prominent in the smaller, bounded sociocultural environments like neighborhoods or informal groups. These types of environments reveal specific structural characteristics that facilitate higher levels of coherence. First, research has shown that cohesive networks contribute to cultural expectations becoming more salient, coherent, and enforceable (Coleman 1988; Friedkin 2004). Cohesive networks are in part a product of social closure, or the erection of physical and/or cultural exclusivity that in turn reduces the costs of monitoring and sanctioning while also heightening the demand that individuals show commitment to the expectations imposed by membership (Hechter 1987). Second, bounded spaces tend to increase what Durkheim termed moral density, or the rate of social interaction between group members; greater moral density is characterized by more frequent, intense, and accelerated recurring interactions, all of which generate greater amounts of intimacy and multiplex exchange relations and therefore far more salient expectations and obligations (Lawler et al. 2009). Third, bounded spaces also heighten the extant status hierarchy (Whyte 1969). On the one hand, bounded spaces necessarily delimit the number of statuses available as well as what statuses bring individuals the most prestige and power (J. Berger et al. 1998). On the other hand, these types of environments are most effective at crystallizing the status hierarchy in ways that make violating expectations far more consequential than in other places. Thus, the one common denominator tying together the few empirical efforts to test Durkheim’s fatalism—or, his type of suicide based on too much regulation—is a focus on structurally oppressed categories of people such as immigrant women (van Bergen et al. 2009), rural women in highly patriarchal societies (Aliverdinia and Pridemore 2009), Palestinian suicide bombers (Pedahzur, Perliger, and Weinberg 2003), or extreme political oppression (Stack 1979). As we will show in the following, excessive regulation does not just lead to suicides of the oppressed: These types of structured environments also put high status people at risk.

In sum, cultural regulation operates outside of us, in the form of a milieu and its actors’ senses of homogeneous, coherent culture, and inside of us, in the form of identity and the self-motivated efforts to control our feelings, thoughts, and behaviors. In between these two distinct levels of social reality, cultural directives trickle down from the milieu through interaction into our identities, providing the content from which we are able to self-regulate. Conversely, directives emanate outward as individuals knowingly and unknowingly impose expectations on others, monitor each other, and when authorized, sanction violations. Though there is something distinctly cultural about regulation, it is also deeply intertwined with social structure in that cohesive social structures facilitate cultural regulation and cultural coherence. Our final task is to elaborate when excessive regulation translates into suicidality and why this idea matters to understanding suicide.

How Culture Amplifies Vulnerability to Suicide

At this point, armed with our new understanding of cultural regulation, we can turn to the question of how high levels of cultural regulation translate into vulnerability to suicide. We argue that much of the answer comes from considering cultural directives in culturally coherent and socially cohesive environments. Because directives are the link between (the externally imposed, monitored, and sanctioned) expectations of real, imagined, and generalized others and (the internally imposed, monitored, and sanctioned) obligations we believe we must meet, situations can arise when cultural directives may compel an individual to suicide.

First, when violations occur between who we are relative to who we believe significant others think we should be, individuals may be at significantly higher risk of suicide. One example of this is when LGBT youth are rejected by their families because of their sexual orientation or gender identity, their risk for suicide ideation and attempts is significantly and substantially higher (Ryan et al. 2010). Given the dependency of children on their families, it is likely incredibly difficult for these youth to reconcile who they are with how their family perceives them. When social groups (like families) constrain an individual’s or a class of individuals’ (e.g., LGBT youth) ability to earn the respect and honor they believe they are owed or they violate cherished moral norms, they become vulnerable to the most painful of social emotions: shame. As clinical research has shown, shame is often framed in terms of wanting to hide and feeling small; it is the figurative death of the social self. The death of the social self may lead to the purposive gradual or sudden literal death of the biological self—for example, acute drug abuse or suicide, respectively.

This idea is related to an idea embedded in Durkheim’s original thesis. Externally imposed directives that appear to be moral imperatives and carry severe sanctions but morally and ethically violate one’s internalized standards create a difficult situation: Continue to be immoral and find some coping techniques that allow one to accept this position or suicide. Where we disagree with Durkheim is in the presumed motive that may motivate suicide in this case. Because we are not in the business of psychologization, there is no reason to choose one motive over any others. Hence, escapism may arise in some cases of suicide predicated on high levels of regulation, but as Baechler (1979; see also Manning 2012) has shown, revenge, guilt, shame, social control/grievance, and other motives also fit these particular structural and cultural conditions.

Second, as Abrutyn and Mueller (2016) argued, the content of cultural directives may very well matter to suicide. Suicide is, in most cases, prohibited; but at times, certain classes of people are authorized and even encouraged to choose self-destruction. One classic example of this is sati, or the ritual self-immolation of a Hindu woman on her husband’s funeral pyre. Durkheim labeled sati self-sacrificial or altruistic suicide, but its emergence and spread closely correlate with increasingly severe gender stratification (Barbagli 2015). Moreover, the act is not commonly practiced in every village or region but is overrepresented in certain locales (Thakur 1963). Finally, recent research has dispelled the earliest accounts by various European travelers and traders that believed widows happily jumped to their death, showing that in fact, emotional and sometimes physical coercion was key to women becoming sati (Vijaykumar 2004). Thus, a more plausible explanation suggests that some villages are structurally and culturally constraining such that widows have no options other than sati because there are few competing alternative directives shaping womanhood, motherhood, or widowhood, whereas other villages, where sati is rare, likely have alternative directives allowing for latitude in identity and status performances. Another example in which directives can deliberately promote suicide can be illustrated in cult group suicides: Excessive regulation creates a group-think in which threats from the outside—whether real or imagined—that lead to the belief that the cult is under siege may generate the directive to suicide; this directive easily spreads as it becomes a common sentiment and common solution prescribed by the group and not by its leader (Pescosolido 1994). Thus, to summarize, high degrees of regulation can translate into suicide when real, imagined, or potential failure to meet expectations or obligations results in severe mental, emotional, physical, and social risks.

Why This Matters

Our final task, now, is to examine why this theory matters to sociology and suicidology. Because our argument in many ways highlights what sociologists (and other disciplines) have failed to do, systematic empirical evidence is difficult to obtain. However, we do believe there are some obvious applications for this theory that will help address several types of suicides previously unaccounted for by Durkheim and very poorly understood in the broader literature on suicide.

High school suicide clusters

Recent years have seen an increase in attention—by the media (e.g., Mohney 2016), but more importantly by the Centers for Disease Control and Prevention (2016; Spies et al. 2014)—to suicide clusters that have been emerging particularly in schools and communities around the United States. A suicide cluster is generally defined as two or more successive suicides delimited by time—and oftentimes also space—that occur beyond the probability of chance (Niedzwiedz et al. 2014). For the most part, sociologists have avoided studying clusters, leaving this task to epidemiologists and occasionally anthropologists. Epidemiologists, while systematically demonstrating that clustering happens on a statistically significant and discernable level, have largely provided descriptive analyses predicated on the aggregate-level data they employ. Perhaps unsurprisingly, clusters happen most frequently in bounded spaces, particularly high schools and psychiatric wards (Haw et al. 2012). Indeed, teenagers are two to four times more likely to die by suicide in a cluster than any other age group (Gould, Wallenstein, and Kleinman 1990). The question, then, is why?

We posit that our cultural framework for suicide may help shed light on why high schools are particularly vulnerable to these tragic events and potentially how clusters emerge and persist. First, while cliques and other divisions (e.g., grade levels, tracking) exist in schools, dividing student populations into subcultures, school cultures can be extremely important to youth (Coleman 1961). Not being fully developed cognitively, emotionally, or social psychologically, teens look to each other for the construction of identity. Depending on how small the community the high school draws from is, the number of high schools in the community, and size of the student population, cultural regulation in schools may be quite powerful. Second, kids spend the vast majority of their waking lives “in” school, occupying their student identity and heightening its salience (Crosnoe and Johnson 2011). Not only do they go five days a week for eight or more hours a day, but most students participate in extracurricular activities and bring the identity home in the form of homework. Additionally, with social media, the student identity is difficult to compartmentalize as school friends, gossip, and other facts of school life bleed into non-school time. In short, the student identity is prominent and salient for teens, especially considering the pressure that testing and college prep put on their imagination of the future and their success. Failure in this identity, depending of course on the boundedness of the community and the school itself, can be tantamount to the failure of self.

Given school cultures’ potential to be homogeneous and highly salient to youths’ senses of self, when schools develop or house cultural directives that permit suicide in some circumstances, we may expect a disproportionate vulnerability to suicide in that school. Cultural directives that encourage suicide as an option are likely a necessary condition for the emergence of a suicide cluster, though these alone are not enough to cause a cluster or even an individual student’s suicide death. As Patterson (2014) notes, cultural elements must be available, accessible, and applicable. Thus, drawing from the literature on diffusion (Abrutyn and Mueller 2014b; Henrich 2001), we suggest three possible overlapping paths through which a compelling cultural directive for suicide can form in a high school and contribute to the formation of a suicide cluster. The first is through personal, intimate role models. Research has found that teens with no prior history of suicidality who are exposed to an intimate other’s suicidality are at risk of developing new suicidal thoughts and in the case of teen girls, behaviors (Abrutyn and Mueller 2014a). The second conduit is high status models. Schools are notorious for their distinct, sharp status hierarchies, and thus popular kids are often those with visibility (Eder, Evans, and Parker 1995). Research has long found that status varies positively with influence (Fine 2010; Sherif and Sherif 1953), and thus the suicidality of a high status kid may be a powerful trigger for others to talk about the meaning of the suicide (Mueller 2017), for directives concerning suicide to be reframed and diffuse, and for successive suicides emerge. The third conduit follows some basic principles of network theory: As more and more people adopt a cultural practice or set of directives, the spread of these ideas grows geometrically instead of arithmetically in the shape of an S-curve (Henrich 2001). Thus, some adopters of the directives—even those who may never apply them—do so because of the sheer number of people they know or suspect they know who also adopt them; Henrich (2001) calls this a “conformist” bias in which people simply take for granted the objective truth of the cultural practice because “everyone” accepts it.

Suicide clusters in high schools, communities, and colleges are a significant and challenging social problem and one that sociology is uniquely situated to take on. Importantly, our theoretical model moves us away from a simplistic notion of suicide “contagion” as a passive dyadic process of mimickry or aping and toward a focus on the diffusion of cultural meaning and directives around suicide (Mueller 2017). Additionally, failure to live up to broadly shared cultural expectations likely amplified in the high school context can generate the psychological pain that more proximately preceeds suicide (Shneidman 1993). Importantly, our theory is compatible with individualistic psychological models of suicide (Klonsky and May 2015; van Orden et al. 2010). Indeed, we do not deny the importance of psychological pain (or what Shneidman 1993 terms “psycheache”) in suicide. But we do recognize the complex multilevel processes that (1) enable suicide to become a more salient option for youth when they experience psychological pain and (2) may be a social root of the psychological pain itself. Thus, considering how high levels of regulation relate to youths’ risk of suicide in schools may offer additional insights into why suicide happens and identify additional places for effective interventions (Mueller and Abrutyn 2016).

Suicide in the Military

Another type of suicide that may be informed by our theory concerns military suicides. Though there is some debate and inconsistencies in estimates of suicide in the military (cf. Miller et al. 2012; Reger et al. 2015), historically, military personnel have reported a lower suicide rate than the general U.S. population (e.g., in the Vietnam and the Gulf wars) (Eaton et al. 2006). However, since the start of U.S. military operations in Iraq and Afghanistan, the military suicide rate appears to have risen such that it equals the rate in the general population (Kang and Bullman 2009). This increase in the military suicide rate has generated substantial concern and prevention efforts (Hoge and Castro 2012). Many existing studies of suicide in the military have treated suicide as an individual-level phenomenon, focusing on why particular soldiers complete suicide (for a review, see Braswell and Kushner 2012). Help-seeking behavior (or the lack thereof); economic and/or marital problems; active-duty, wartime stress; and other factors have been identified as risk factors for suicide in the military.

Taking a tack complementary to our own, Braswell and Kushner (2012) focused on the collective military culture, highlighting the role that excessive integration plays in increasing the vulnerability of soldiers. Most studies of suicide in sociology assume integration is protective (Kushner and Sterk 2005), an assumption bolstered by conventionally received sociological wisdom (McPherson, Smith-Lovin, and Brashears 2006; Putnam 2000; Umberson and Montez 2010). Braswell and Kushner’s argument, then, rested on the idea that fatalism—which they defined as excessive integration—could help explain high rates of military suicides that had existed before even Durkheim’s time. Like most totalistic organizations, the military emphasizes hierarchical control, with an express interest in disculturation (Goffman 1961)—or the eradication of preexisting socialized patterns in favor of organization-specific values, beliefs, and norms. Germane to our argument, the military imposes a particular form of masculinity, termed masculine fatalism by Braswell and Kushner (2012:4): “It is by emphasizing masculinity—and rigidly separating male from the female—that the military creates social capital from a group of soldiers whose economic statuses, ethnicities, and ideologies might otherwise place them in conflict with each other.”² In place of American individualism, fatalistic “devaluation of individual life dovetails with the meaning of manhood.” Consequently, the highly structured, integrated military environment pushes individuals (likely of all genders) to internalize “their anger [and] not lash out against the social order because [members share] its fundamental values. Instead, they understand failure to be the result of personal shortcomings” (p. 3). Thus, help-seeking is a sign of weakness in this hyper-masculine context, leading to the internalization of both the trauma of disculturation and an unbelievably coherent culture of masculinity, the promotion of controlled agression, and the fear of failure and the consequences of failure for the self.

Braswell and Kushner (2012) highlight many critical aspects about the structure and culture of the military that likely have sociological implications for suicide. However, they overemphasize integration and miss an opportunity to detail the more generalizable role of culture in suicide. Indeed, our theoretical approach points to additional ways that social forces may shape suicide in the military. First, the collectivist orientation of the military may, like high schools, render military units particularly vulnerable to the formation of cultural directives that promote suicide as an understandable option in some circumstances. Additionally, given the relatively closed nature of the military and relatively high rate of suicide, military service members are also more likely to know someone or know of someone who has died by suicide, again potentially reifying the cultural directives through intimate role models. Second, as Braswell and Kushner highlight, the military is a totalistic organization; as such, the social psychological dynamics of such an institution likely inform the organization’s generalized higher risk of suicide. Goffman (1961), for instance, highlighted the process of role dispossession in total organizations, or the concerted effort by prisons or militaries to strip individuals of their biographies to impose the organization’s coherent culture. Soldiers, ultimately, come to possess a single dominant role-identity intimately tied to the sources of status they derive inside the military and when not actively serving. The longer they play the soldier role, the harder it is to transition to a civilian status, making threats to their self ever-present and cross-situational; indeed, as Ebaugh’s (1988) work on former nuns illustrates, these roles are not only difficult to leave because of one’s personal attachment to them, but others often continue to define us and orient their emotions, attitudes, and actions toward us as though we were still actively embedded in the totalistic organization. As such, when an active-duty military person or veteran feels a threat to their deeply internalized sense of self, their experiences in the military as a totalistic organization may render them disproportionately vulnerable to suicide. In sum, if we ignore how groups and individuals come to understand actions in ways that may reinforce or encourage certain behaviors and focus only on the individual risk factors for suicide (though without a doubt they too play their role), we will be without a full toolkit with which to approach this important social problem.

Masculinity and Its Discontents

The regulation of masculinity and its potential tie to suicide is actually an interesting case beyond the specific instance of the military. An entire class of individuals, for example, American men, may be subjected to a set of homogeneous cultural directives that can be hard to escape while preserving a sense of self. Research has found that hegemonic-masculine directives are prevelant in U.S. society, which may help explain the so-called gender paradox of suicide (men complete suicide three to four times more often than women) and the recent substantial increase in suicide among middle-age white males (Canetto 2017; Granato, Smith, and Selwyn 2015). Indeed, this argument matters as social scientists have begun investigating so-called “deaths of despair,” or the high rate of white male deaths due to extrinsic causes, particularly among lower socioeconomic status individuals (Case and Deaton 2015; Masters, Tilstra, and Simon 2017). To date, these explanations turn to a classic Durkheimian argument: The breakdown of industrialization has loosened the small town bond and led to a sort of normlessness; that is, these suicides are posited as egoistic/anomic suicides. But it may also be useful to examine the role of excessive regulation in the form of narrow views about what it means to be a man (or a white man) and what is expected.

Here, the social psychological component of our theory may be particularly relevant in that in many corners of the United States, masculinity is the only or most dominant identity; any threats to it or real or perceived failures to meet directives generate shame. In this way, shame is often tied to directives about male honor/dishonor (Adinkrah 2012) as well as the performance of masculinity (Cleary 2012). And while Americans do not handle shame well (Cohen 2003), men are particularly vulnerable to it as hegemonic-masculinity precludes help-seeking. Consequently, men are more likely to perpetrate violence against others and themselves (Gilligan 2003), whereas women are more likely to seek help (Rosenfield 1982; Thoits 2013). The case of masculinity highlights that while cases of fatalistic suicide may be more common in bounded social contexts, the role of regulation and culture in suicide is not necessarily limited to meso-level or local social milieus.

Final Thoughts

Despite the enormous intellectual debt sociology and suicidology owe to Durkheim for his largely structural insights in Suicide, the sociology of suicide is hindered by failing to consider the role of culture in suicide. To remedy this gap, this paper provides a new cultural-structural theory of suicide that examines when and how culture plays a role in fomenting vulnerability to suicide in some places or collectives. By thinking about the cultural dynamics of excessive regulation, we offer a more powerful theoretical model for suicide that supplements the structure-heavy Durkheimian theory. In essence, we argue that cultural regulation rests on the (1) degree to which a social unit or milieu is bounded or integrated, (2) degree to which culture is coherent and homogeneous for these actors or places, (3) types of directives related to prescribing or proscribing suicide present in this coherent culture, and (4) degree to which these directives translated into internalized meanings about identity and status performance that when violated result in intense psychological pain and negative social emotions (e.g., shame). Using this model, we suggested suicide clusters like those found in high schools, the high rate of military suicides, and the recent spike in white male suicides could be better explained by incorporating cultural mechanisms into empirical research. Indeed, by shifting our lens to how culture regulates externally (e.g., its coherence) and internally (e.g., identity meanings), new strategies for prevention that rely on sociological tools may be put into place. That is, the goal of suicide prevention should be expanded to include finding ways to disrupt extant cultural patterns, reframe directives, and offer alternative meanings for identity and status performances to decrease the sting of failure and increase avenues for the preservation of identy.

Additionally, while this paper focuses primarily on the consequences of regulation, we believe future theoretical and empirical efforts should heed Douglas’s (1967) call to take seriously the role that meaning and thereby culture play in suicidality. Abrutyn and Mueller’s (2016; also Mueller and Abrutyn 2016) work on altrustic suicide has already begun some of this project, but we think that revisiting egoistic and anomic suicides and adding insights from cultural, social psychological, and emotions scholarship would go a long way toward making sociology relevant to suicidology and even more important, toward effective suicide prevention. By charting a path to reenvision regulation, we present a way forward that radically shifts our focus away from testing and retesting Durkheim’s nineteenth-century hypotheses and toward bringing the full methodological and empirical tool box that sociology has to bear on a classic and still serious social problem like suicide. Furthermore, in doing so, new light may be shed on other mental health issues including depression and anxiety, stress and coping, and other-/self-harm behaviors.

Footnotes

Notes

About the Authors

Dr. Seth Abrutyn is an assistant professor in the Department of Sociology at the University of British Columbia. As a theorist, Abrutyn examines the intersection of meso-level structure and culture and the micro-level dynamics such as identity and emotions. His research on suicide provides a fundamental social phenomenon through which he can shed light on this theoretical puzzle. His work on suicide with Anna Mueller has won several awards for its contributions to knowledge and has been published in journals such as the American Sociological Review, Sociological Theory, and the Journal of Health and Social Behavior. For more about Dr. Abrutyn, visit .

Dr. Anna S. Mueller is an assistant professor in the Department of Comparative Human Development and the College at the University of Chicago. Mueller’s research examines the sociocultural foundations of suicide diffusion, particularly in adolescence. To do this, she integrates insights from social psychology, cultural sociology, sociology of emotions, and social network theories. Her research on suicide with Seth Abrutyn has won several awards for its contributions to knowledge and has been published in journals such as the American Sociological Review, the Journal of Health and Social Behavior, and Sociological Theory. For more about Dr. Mueller, visit .

References

Abrutyn

Seth

. 2014. Revisiting Institutionalism in Sociology: Putting the “Institution” Back in Institutional Analysis. New York: Routledge.

Abrutyn

Seth

Mueller

Anna S.

2014a. “Are Suicidal Behaviors Contagious? Using Longitudinal Data to Examine Suicide Suggestion.” American Sociological Review 79(2):211–27.

Abrutyn

Seth

Mueller

Anna S.

2014b. “Reconsidering Durkheim’s Assessment of Tarde: Formalizing a Tardian Theory of Imitation, Contagion, and Suicide Suggestion.” Sociological Forum 29(3):698–719.

Abrutyn

Seth

Mueller

Anna S.

2014c. “The Socioemotional Foundations of Suicide: A Microsociological View of Durkheim’s Suicide.” Sociological Theory 32(4):327–51.

Abrutyn

Seth

Mueller

Anna S.

2016. “When Too Much Integration and Regulation Hurt: Re-envisioning Durkheim’s Altruistic Suicide.” Society and Mental Health 6(1):56–71.

Adinkrah

Mensah

. 2012. “Better Dead Than Dishonored: Masculinity and Male Suicidal Behavior in Contemporary Ghana.” Social Science and Medicine 74(4):474–81.

Aliverdinia

Pridemore

W. A.

2009. “Women’s Fatalistic Suicide in Iran: A Partial Test of Durkehim in an Islamic Republic.” Violence Against Women 15(3):307–20.

Anderson

Elijah

. 1999. Code of the Street: Decency, Violence, and the Moral Life of the Inner City. New York: W.W. Norton.

Baechler

Jean

. 1979. Suicides. New York: Basic Books.

10.

Baller

Robert D.

Richardson

Kelly K.

2002. “Social Integration, Imitation, and the Geographic Patterning of Suicide.” American Sociological Review 67(6):873–88.

11.

Barbagli

Marzio

. 2015. Farewell to the World: A History of Suicide. Cambridge, UK: Polity.

12.

Bearman

Peter S.

1991. “The Social Structure of Suicide.” Sociological Forum 6(3):501–24.

13.

Becker

Howard S.

1963. Outsiders. New York: Free Press.

14.

Berger

Joseph

Cohen

Bernard P.

Zelditch

Morris

Jr.

1972. “Status Characteristics and Social Interaction.” American Sociological Review 37(3):241–55.

15.

Berger

Joseph

Ridgeway

Cecilia L.

Fisek

M. Hamit

Norman

Robert Z.

1998. “The Legitimation and Delegitimation of Power and Prestige Orders.” American Sociological Review 63(3):379–405.

16.

Berger

Peter

. 1969. The Sacred Canopy: Elements of a Sociological Theory of Religion. New York: Anchor Books.

17.

Blumer

Herbert

. 1969. Symbolic Interactionism: Perspective and Method. Berkeley: University of California Press.

18.

Boldt

Menno

. 1988. “The Meaning of Suicide: Implications for Research.” Crisis: The Journal of Crisis Intervention and Suicide Prevention 9(2):93–108.

19.

Braswell

Harold

Kushner

Howard I.

2012. “Suicide, Social Integration, and Masculinity in the U.S. Military.” Social Science & Medicine 74(4):530–36.

20.

Breault

K. D.

1994. “Was Durkheim Right? A Critical Survey of the Empirical Literature on Le Suicide.” Pp. 11–29 in Emile Durkheim: Le Suicide 100 Years Later, edited by Lester

Philadelphia, PA: The Charles Press.

21.

Burke

Peter J.

Reitzes

Donald C.

1981. “The Link between Identities and Role Performance.” Social Psychology Quarterly 44(2):83–92.

22.

Burke

Peter J.

Stets

Jan E.

2009. Identity Theory. New York: Oxford University Press.

23.

Canetto

Silvia Sara

. 1997. “Meanings of Gender and Suicidal Behavior during Adolescence.” Suicide and Life-Threatening Behavior 27(4):339–51.

24.

Canetto

Silvia Sara

. 2017. “Suicide: Why Are Older Men So Vulnerable?” Men and Masculinities 20(1):49–70.

25.

Case

Anne

Deaton

Angus

. 2015. “Rising Morbidity and Mortality in Midlife among White Non-Hispanic Americans in the 21st Century.” Proceedings of the National Academy of Sciences 112(49):15078–83.

26.

Centers for Disease Control and Prevention. 2016. “Suicide Facts at a Glance.” Retrieved January 20, 2018 (http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf).

27.

Cha

Christine B.

Nock

Matthew K.

2014. “Suicidal and Nonsuicidal Self-injurious Thoughts and Behaviors.” Pp. 317–42 in Child Psychopathology. 3rd ed., edited by Mash

E. J.

Barkley

R. A.

New York: The Guilford Press.

28.

Chua

Jocelyn Lim

. 2014. In Pursuit of the Good Life: Aspiration and Suicide in Globalizing South India. Berkeley: University of California Press.

29.

Cleary

Anne

. 2012. “A Suicidal Action, Emotional Expression, and the Performance of Masculinities.” Social Science and Medicine 74(4):498–505.

30.

Cohen

Dov

. 2003. “The American National Conversation about (Everything but) Shame.” Social Research 70(4):1073–108.

31.

Coleman

James S.

1961. The Adolescent Society: The Social Life of the Teenager and Its Impact on Education. Glencoe, IL: The Free Press.

32.

Coleman

James S.

1988. “Social Capital in the Creation of Human Capital.” American Journal of Sociology 94(Supplement):S95–120.

33.

Collins

Randall

. 2004. Interaction Ritual Chains. Princeton, NJ: Princeton University Press.

34.

Colucci

Erminia

. 2006. “The Cultural Facet of Suicidal Behaviour: Its Importance and Neglect.” Australian e-Journal for the Advancement of Mental Health 5(3):234–46.

35.

Colucci

Erminia

Lester

David

eds. 2012. Suicide and Culture. Cambridge, MA: Hogrefe.

36.

Coser

Lewis

. 1974. Greedy Institutions: Patterns of Undivided Commitment. New York: Free Press.

37.

Crosnoe

Robert

Johnson

Monica Kirkpatrick

. 2011. “Research on Adolescence in the Twenty-first Century.” Annual Review of Sociology 37:439–60.

38.

Douglas

Jack D.

1967. The Social Meaning of Suicide. Princeton, NJ: Princeton University Press.

39.

Durkheim

Émile.

[1897] 1951. Suicide: A Study in Sociology. Glencoe, Il: Free Press.

40.

Durkheim

Émile.

[1912] 1995. The Elementary Forms of Religious Life. New York: Free Press.

41.

Durkheim

Émile.

[1893] 1997. The Division of Labor in Society. New York: The Free Press.

42.

Eaton

K. M.

Messer

S. C.

Garvey Wilson

A. L.

Hoge

C. W.

2006. “Strengthening the Validity of Population-based Suicide Rate Comparisons: An Illustration Using US Military and Civilian Data.” Suicide and Life-Threatening Behavior 36(2):182–91.

43.

Ebaugh

Helen R. F.

1988. Becoming an Ex: The Process of Role Exit. Chicago: The University of Chicago Press.

44.

Eder

Donna

Evans

Catherine Colleen

Parker

Stephen

. 1995. School Talk: Gender and Adolescent Culture. New Brunswick, NJ: Rutgers University Press.

45.

Farberow

Norman L.

, ed. 1975. Suicide in Different Cultures. Baltimore, MD: University Park Press.

46.

Fei

. 2010. Suicide and Justice: A Chinese Perspective. London: Routledge.

47.

Fine

Gary Alan

. 2010. “The Sociology of the Local: Action and Its Publics.” Sociological Theory 28(4):355–76.

48.

Friedkin

Noah E.

2004. “Social Cohesion.” Annual Review of Sociology 30:409–25.

49.

Gilligan

James

. 2003. “Shame, Guilt, and Violence.” Social Research 70(4):1149–80.

50.

Goffman

Erving

. 1961. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Garden City, NY: Anchor Books.

51.

Goffman

Erving

. 1967. Interaction Ritual: Essays on Face-to-face Behavior. New York: Pantheon Books.

52.

Gould

Madelyn S.

Wallenstein

Sylvan

Kleinman

Marjorie

. 1990. “Time-space Clustering of Teenage Suicide.” American Journal of Epidemiology 131(1):71–78.

53.

Granato

Stephani L.

Smith

Phillip N.

Selwyn

Candice N.

2015. “Acquired Capability and Masculine Gender Norm Adherence: Potential Pathways to Higher Rates of Male Suicide.” Psychology of Men and Masculinity 16(3):246–53.

54.

Haw

Camilla

Hawton

Keith

Niedzwiedz

Claire

Platt

Steve

. 2012. “Suicide Clusters: A Review of Risk Factors.” Suicide and Life-Threatening Behavior 43(1):97–108.

55.

Hecht

Jennifer Michael

. 2013. Stay: A History of Suicide and Philosophies Against It. New Haven, CT: Yale University Press.

56.

Hechter

Michael

. 1987. Principles of Group Solidarity. Berkeley: University of California Press.

57.

Henrich

Joseph

. 2001. “Cultural Transmission and the Diffusion of Innovations: Adoption Dynamics Indicate That Biased Cultural Transmission Is the Predominate Force of Behavioral Change.” American Anthropologist 103(4):992–1013.

58.

Hjelmeland

Heidi

. 2010. “Cultural Research in Suicidology: Challenges and Opportunities.” Suicidology Online 1(1):34–52.

59.

Hochschild

Arlie

. 1983. The Managed Heart: Commercialization of Human Feeling. Berkeley: University of California Press.

60.

Hoge

Charles W.

Castro

Carl A.

2012. “Preventing Suicides in US Service Members and Veterans Concerns after a Decade of War.” JAMA 308(7):671–72.

61.

Hogg

Michael A.

2006. “Social Identity Theory.” Pp. 111–36 in Contemporary Social Psychological Theories, edited by Burke

P. J.

Stanford, CA: Stanford University Press.

62.

Jamison

Kay Redfield

. 2001. Night Falls Fast: Understanding Suicide. New York: Vintage.

63.

Johnson

Barclay

. 1965. “Durkheim’s One Cause of Suicide.” American Sociological Review 30(6):875–86.

64.

Kang

Han K.

Bullman

Tim A.

2009. “Is There an Epidemic of Suicides among Current and Former U.S. Military Personnel?” Annals of Epidemiology 19(10):757–60.

65.

Kanter

Rosebeth Moss

. 1968. “Commitment and Social Organization: A Study of Commitment Mechanisms in Utopian Communities.” American Sociological Review 33(4):499–51.

66.

Kitanaka

Junko

. 2012. Depression in Japan: Psychiatric Cures for a Society in Distress. Princeton, NJ: Princeton University Press.

67.

Klonsky

E. David

May

Alexis M.

2015. “The Three-step Theory (3ST): A New Theory of Suicide Rooted in the ‘Ideation-to-action’ Framework.” International Journal of Cognitive Therapy 8(2):114–29.

68.

Kral

Michael

. 1994. “Suicide as Social Logic.” Suicide and Life-Threatening Behavior 24(3):245–55.

69.

Kral

Michael

. 1998. “Suicide and the Internalization of Culture: Three Questions.” Transcultural Psychiatry 35(2):221–33.

70.

Kushner

Howard I.

Sterk

Claire E.

2005. “The Limits of Social Capital: Durkheim, Suicide, and Social Cohesion.” American Journal of Public Health 95(7):1–5.

71.

Lawler

Edward J.

1992. “Affective Attachments to Nested Groups: Choice-process Theory.” American Sociological Review 57(3):327–39.

72.

Lawler

Edward J.

Thye

Shane

Yoon

Jeongkoo

. 2009. Social Commitments in a Depersonalized World. New York: Russell Sage.

73.

Lester

David

. 2012. “The Cultural Meaning of Suicide: What Does That Mean?” Omega 64(1):83–94.

74.

Lester

David

Stack

Steven

eds. 2015. Suicide as a Dramatic Performance. New York: Transaction.

75.

Lewis

Helen

. 1971. Shame and Guilt in Neurosis. New York: International Universities Press.

76.

Lizardo

Omar

Strand

Michael

. 2010. “Skills, Toolkits, Contexts and Institutions: Clarifying the Relationship between Different Approaches to Cognition in Cultural Sociology.” Poetics 38(2):205–28.

77.

Manning

Jason

. 2012. “Suicide as Social Control.” Sociological Forum 27(1):207–27.

78.

Masters

Ryan K.

Tilstra

Andrea M.

Simon

Daniel H.

2017. “Mortality from Suicide, Chronic Liver Disease, and Drug Poisonings among Middle-aged US White Men and Women, 198022013.” Biodemography and Social Biology 63(1):31–37.

79.

McCall

George J.

Simmons

J. L.

1978. Identities and Interactions. New York: Free Press.

80.

McPherson

J. Miller

Smith-Lovin

Lynn

Brashears

Matthew

. 2006. “Social Isolation in America: Changes in Core Discussion Networks Over Two Decades.” American Sociological Review 71(3):353–75.

81.

Miller

Barber

Young

Azrael

Mukamal

Lawler

2012. “Veterans and Suicide: A Reexamination of the National Death Index-linked National Health Interview Survey.” American Journal of Public Health 102(51):S154–59.

82.

Mohney

Gillian

. 2016. “Disturbing Suicide Cluster Prompts CDC to Start Investigation in Palo Alto.” ABC News, February 16. Retrieved January 20, 2018 (http://abcnews.go.com/Health/disturbing-suicide-cluster-prompts-cdc-start-investigation-palo/story?id=36953874).

83.

Mueller

Anna S.

2017. “Does the Media Matter to Suicide?: Examining the Social Dynamics Surrounding Media Reporting on Suicide in a Suicide-prone Community.” Social Science and Medicine 180:152–59.

84.

Mueller

Anna S.

Abrutyn

Seth

. 2016. “Adolescents under Pressure: A New Durkheimian Framework for Understanding Adolescent Suicide in a Cohesive Community.” American Sociological Review 81(5):877–99.

85.

Neimeyer

Robert A.

Klass

Dennis

Michael Robert

. 2014. “A Social Constructionist Account of Grief: Loss and the Narration of Meaning.” Death Studies 38(6–10):485–98.

86.

Niedzwiedz

Claire

Haw

Camilla

Hawton

Keith

Platt

Stephan

. 2014. “The Definition and Epidemiology of Clusters of Suicidal Behavior: A Systematic Review.” Suicide and Life-Threatening Behavior 44(5):569–81.

87.

Niezen

Ronald

. 2009. “Suicide as a Way of Belonging: Causes and Consequences of Cluster Suicides in Aboriginal Communities.” Pp. 178–95 in Healing Traditions: The Mental Health of Aboriginal Peoples in Canada, edited by Kirmayer

L. J.

Guthrie Valaskakis

Vancouver, BC: UBC Press.

88.

Parsons

Talcott

Bales

Robert F.

1955. Family, Socialization and Interaction Process. Glencoe, IL: Free Press.

89.

Patterson

Orlando

. 2014. “Making Sense of Culture.” Annual Review of Sociology 40:1–30.

90.

Pedahzur

Perliger

Weinberg

2003. “Altruism and Fatalism: The Characteristics of Palestinian Suicide Terrorists.” Deviant Behavior 24(4):403–23.

91.

Pescosolido

Bernice A.

1990. “The Social Context of Religious Integration and Suicide: Pursuing Network Explanation.” Sociological Quarterly 31(3):337–57.

92.

Pescosolido

Bernice A.

1994. “Bringing Durkheim into the Twenty-first Century: A Network Approach to Unresolved Issues in the Sociology of Suicide.” Pp. 264–93 in Émile Durkheim: Le Suicide 100 Years Later, edited by Lester

Philadelphia, PA: The Charles Press.

93.

Pescosolido

Bernice A.

Georgianna

Sharon

. 1989. “Durkheim, Suicide, and Religion: Toward a Network Theory of Suicide.” American Sociological Review 54(1):33–48.

94.

Poggi

Gianfranco

. 2000. Durkheim. Oxford, UK: Oxford University Press.

95.

Pope

Whitney

. 1976. Durkheim’s Suicide: A Classic Analyzed. Chicago: University of Chicago Press.

96.

Putnam

Robert D.

2000. Bowling Alone: The Collapse and Revival of American Community. New York: Simon and Schuster.

97.

Reger

Mark A.

Smolenski

Derek J.

Skopp

Nancy A.

Metzger-Abamukang

Melinda J.

Kang

Han K.

Bullman

Tim A.

Perdue

Sondra

Gahm

Gregory A.

2015. “Risk of Suicide among US Military Service Members Following Operation Enduring Freedom or Operation Iraqi Freedom Deployment and Separation from the US Military.” JAMA Psychiatry 72(6):561–69.

98.

Ridgeway

Cecilia L.

2001. “Inequality, Status, and the Construction of Status Beliefs.” Pp. 323–42 in The Handbook of Sociological Theory, edited by Turner

J. H.

New York: Kluwer/Plenum.

99.

Ridgeway

Cecilia L.

2006a. “Expectation States Theory and Emotion.” Pp. 374–67 in Handbook of the Sociology of Emotions, edited by Stets

J. E.

Turner

J. H.

New York: Springer.

100.

Ridgeway

Cecilia L.

2006b. “Status Construction Theory.” Pp. 301–23 in Contemporary Social Psychological Theories, edited by Burke

P. J.

Stanford, CA: Stanford University Press.

101.

Ridgeway

Cecilia L.

Correll

Shelley J.

2004. “Motherhood as a Status Characteristic.” Journal of Social Issues 60(4):683–700.

102.

Rockett

Ian R. H.

Samora

Julie B.

Coben

Jeffrey H.

2006. “The Black-White Suicide Paradox: Possible Effects of Misclassification.” Social Science and Medicine 63(8):2165–75.

103.

Rosenfield

Sarah

. 1982. “Sex Roles and Societal Reactions to Mental Illness: The Labeling of ‘Deviant’ Deviance.” Journal of Health and Social Behavior 23(1):18–24.

104.

Ryan

Caitlin

Russell

Stephen T.

Huebner

David

Diaz

Rafael

Sanchez

Jorge

. 2010. “Family Acceptance in Adolescence and the Health of LGBT Young Adults.” Journal of Child and Adolescent Psychiatric Nursing 23(4):205–13.

105.

Scheff

Thomas

. 1997. Emotions, the Social Bond, and Human Reality. Cambridge, UK: Cambridge University Press.

106.

Serpe

Richard T.

1987. “Stability and Change in Self: A Symbolic Interactionist Explanation.” Social Psychological Quarterly 50(1):44–55.

107.

Sherif

Muzafer

Sherif

Caroline

. 1953. Groups in Harmony and Tension. New York: Harper.

108.

Shneidman

Edwin

. 1993. Suicide as Psychache: A Clinical Approach to Self-destructive Behavior. Lanham, MD: Rowman & Littlefield.

109.

Small

Mario Luis

. 2004. Villa Victoria: The Transformation of Social Capital in a Boston Barrio. Chicago: University of Chicago.

110.

Spies

Erica

Ivey-Stephenson

Asha

VanderEnde

Kristin

Lynch

Sean

Dean

David

Gleason

Brigette

. 2014. “CDC Epi-Aid Report on Youth Suicide in Fairfax County.” Retrieved January 20, 2018. (https://www.sprc.org/resources-programs/cdc-epi-aid-report-youth-suicide-fairfax-county).

111.

Stack

Steven

. 1979. “Durkheim’s Theory of Fatalistic Suicide: A Cross-national Approach.” Journal of Social Psychology 107(1):161–68.

112.

Stack

Steven

Abrutyn

Seth

. 2015. “Suicide by Fire: Ethnicity as a Predictor of Self Immolation in the U.S.” Pp. 193–210 in Suicide as Performance, edited by Lester

Stack

New York: Transaction.

113.

Stevenson

Lisa

. 2014. Life beside Itself: Imagining Care in the Canadian Arctic. Berkeley: University of California Press.

114.

Stryker

Sheldon

. 1980. Symbolic Interactionism: A Social Structural Version. Menlo Park, CA: The Benjamin Cummings Publishing Company.

115.

Sudak

Howard

Maxim

Karen

Carpenter

Maryellen

. 2008. “Suicide and Stigma: A Review of the Literature and Personal Reflections.” Academic Psychiatry 32(2):136–42.

116.

Tangney

June Price

Dearing

Ronda L.

2002. Shame and Guilt. New York: Guilford.

117.

Tarde

Gabriel

. 1903. The Laws of Imitation. New York: Henry Holt.

118.

Thakur

1963. The History of Suicide in India: An Introduction. Delhi: Munshiram.

119.

Thoits

Peggy A.

2013. “Self, Identity, and Mental Health.” Pp. 357–77 in Handbook of the Sociology of Mental Health, edited by Aneshenel

C. S.

Phelan

J. C.

Avinson

W. R.

New York: Springer.

120.

Timmermans

Stefan

. 2006. Postmortem: How Medical Examiners Explain Suspicious Deaths. Chicago: University of Chicago Press.

121.

Tousignant

Michel

. 1998. “Suicide in Small-scale Societies.” Transcultural Psychiatry 35(2):291–306.

122.

Turner

Jonathan H.

2007. Human Emotions: A Sociological Theory. New York: Routledge.

123.

Turner

Jonathan H.

2010. Theoretical Principles of Sociology, Volume 2: Microdynamics. New York: Springer.

124.

Umberson

Debra

Montez

Jennifer Karas

. 2010. “Social Relationships and Health: A Flashpoint for Health Policy.” Journal of Health and Social Behavior 51(1 Suppl):S54–66.

125.

Vaisey

Stephen

. 2009. “Motivation and Justification: A Dual Process Model of Culture in Action.” American Journal of Sociology 114(6):1675–715.

126.

van Bergen

Anton

J. H. Smit

van Balkom

J. L. M.

Saharson

2009. “Suicidal Behavior of Young Immigrant Women in the Netherlands: Can We Use Durkheim’s Concept of ‘Fatalistic Suicide’ to Explain Their High Incidence of Attempted Suicide.” Ethnic and Racial Studies 32(2):302–22.

127.

van Orden

Kimberly A.

Witte

Tracy K.

Cukrowicz

Kelly C.

Braithwaite

Scott R.

Selby

Edward A.

Joiner

Thomas E.

Jr.

2010. “The Interpersonal Theory of Suicide.” Psychological Review 117(2):575–600.

128.

Vijaykumar

Lakshmi

. 2004. “Altrusitic Suicide in India.” Archives of Suicide Research 8(1):73–80.

129.

Whyte

William Foote

. 1969. Street Corner Society: The Social Structure of an Italian Slum. Chicago: University of Chicago Press.

130.

Wray

Matt

Colen

Cynthia

Pescosolido

Bernice A.

2011. “The Sociology of Suicide.” Annual Review of Sociology 37:505–28.