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Suicide, Older Men, and Masculinity

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Suicide, Older Men, and Masculinity Society and Mental Health 2018, Vol. 8(2) 157–173 “If You Were Like Me, You Ó American Sociological Association 2017 DOI: 10.1177/2156869317725890 Would Consider It Too”: journals.sagepub.com/home/smh Suicide, Older Men, and Masculinity Ester Carolina Apesoa-Varano1, Judith C. Barker2, and Ladson Hinton1 Abstract Rates of suicide are far higher for older men than for any other age or gender group. However, we know relatively little about how depressed older men think about suicide. This study addresses this gap by exploring how Latino and white non-Hispanic elderly men discuss why they would or would not contem- plate suicide. Men, aged 60 and older, were screened and assessed using standard instruments for clinical depression. Those meeting criteria were invited to participate in a 1.5 to 2.5-hour in-depth interview, in either English or Spanish. Interview data come from 77 men and included men with treated and untreated depression. Men linked depression to losing their economic role, sense of productivity, and familial respect. Their narratives of suicide highlighted central tenets of hegemonic masculinity. Men from both ethnic groups asserted that “being a man” involved strength and independent choice. For some men, sui- cide exemplifies these ideals; for most men suicide violates them. The majority of men who felt that suicide further violated their already fragile manhood either reclaimed a decisive masculine self or embraced a car- ing self, especially in relation to children and family. The latter pattern raises a theoretical question regard- ing the symbolic boundaries of hegemonic masculinity. Keywords suicide, masculinity, older men, self, emotional suffering The epidemiological data on suicide have been of the strongest risk factors for suicide-related quite consistent throughout the 19th and 20th cen- behavior (Crump et al. 2014), is more commonly turies. With the exception of China’s, data from reported in older women than in older men across the globe continue to show that men have higher rates of suicide than do women (Bertolote and Fleischmann 2002; National Center for Injury 1University of California, Davis, Sacramento, CA, USA Prevention and Control 2016; World Health Orga- 2University of California, San Francisco, San Francisco, nization 2001). In the United States white men CA, USA exhibit higher rates than nonwhite men, with those 65 years of age and older completing suicide eight Corresponding Author: Ester Carolina Apesoa-Varano, Associate Professor of times more often than any other group (Sachs- Sociology, Betty Irene Moore School of Nursing, Ericsson, Van Orden, and Zarit 2016). Further, University of California, Davis, 2450 48th St., men older than 75 years are at the highest risk of Administrative Support Building, Suite 2600, UC Davis suicide in the United States (Centers for Disease Medical Center, Sacramento, CA 95817, USA. Control and Prevention 2015). Depression, one Email: [email protected] 158 Society and Mental Health 8(2) (Charney et al. 2003; Unu¨tzer 2007), and older and linked to their views on suicide. Some older men experience substantially lower rates of treat- men’s views of suicide reflect a masculine ethos ment for depression than do older women (Hinton that has been undermined. Yet for other men, sui- et al. 2006). cide represents the antithesis of masculinity, and There are also differences between men and they reverse the gender codes in ways that reject women regarding suicide attempts. In most coun- suicide. Further, our interviews suggest that the tries men die by suicide at higher rates while view of fatherhood of those who opposed suicide women attempt suicide at higher rates (Kerkhof marked a selective reconstruction of hegemonic 2000; Mann 2002). Notably, women’s attempted masculinity, thus providing further evidence of suicide rate appears to decline with age, whereas its malleability and durability. men’s suicide rate rises with age cohort. Men are more likely to use a method that is more lethal, and they seek to avoid detection, whereas women MASCULINITIES, MEN’S HEALTH, tend to use less lethal means in attempts that are AND SUICIDE more likely to be discovered (Mann 2002). These lethality and intention aspects of men’s and wom- There are various explanations of suicide’s con- en’s suicidal behavior indicate significant gender nection with gender, social order, and mental differences in how men and women view suicide and physical health (Canetto and Sakinofsky and its consequences. If women’s attempted sui- 1998). Scholars have proposed that there are cide may be seen as an “appeal for help” (Mann both benefits and serious costs or “hazards” to 2002:303), might older men’s suicides be seen as having male privilege (Canetto 1995; Jaworski a statement—but a statement of what exactly? 2014; Joiner 2011). While men who are married Our research seeks to address this question are at lower risk for suicide, typically women’s based on in-depth interviews with 30 Latino and “relative immunity” from suicidal behavior has 47 white non-Hispanic (WNH) predominantly been explained by their lack of full participation working-class older men who were screened for in mainstream social institutions, limited auton- depression, an age group that has been under- omy, and primary roles in the domestic social studied despite the members’ being at the highest order (Stack 2000a). Some authors have argued risk for suicidality. As Evans et al. (2011:12) point that this dominant explanation is misguided (Berk- out, “the lives of older men remain mostly unex- man et al. 2000; Douglas 2015; Zhang 2016), and plored, ‘so much so that older men have been cat- given the substantial changes in men and women’s egorized as ‘invisible’ men in contemporary soci- participation in the labor market and the domestic ety.” We hope to remedy this in part by examining spheres, especially in the post-1950s United how older men talk about suicide in relation to the States, others have called for a more critical anal- intersection of masculinity and emotional suffer- ysis of gender, emotional suffering, and suicide ing. Harwood and Jacoby (2000:288) note that (Kposowa 2000; Payne, Swami, and Stanistreet “both physical illness and depression are often 2008; Shiner et al. 2009). present in older people who die through suicide. A fruitful line of inquiry in this regard has However, both these problems are not infrequent focused on how men experience depression and in the older population, and the interesting ques- specifically how their accounts of it are related tion is why some people with these problems to their understanding of masculinity (Addis choose suicide, and some maintain a will to live.” 2008; Emslie et al. 2006; Galasinski 2008; In the same vein, despite the significant difference O’Brien et al. 2005; Ridge et al. 2011). Studies in older men’s and women’s suicide rates, Stanley of men’s narratives of depression based on inter- et al. (2016) never address gender in their other- views point to how norms of masculinity may wise useful review of psychological and sociolog- lead men to “mask” their depression or self-medi- ical theories of why older adults commit suicide. cate through alcohol or substance use (Courtenay Likewise, this work has not addressed how, if at 2000; but see also Addis 2008), complicate their all, views of suicide intersect with conceptions help-seeking efforts (O’Brien, Hunt, and Hart of masculinity in the context of ethnicity and 2005), or reconstruct/resist hegemonic masculinity social class. We argue that a sense of loss (physi- (Emslie et al. 2006). For example, in his nuanced cal, economic, and social) characterizes older sociolinguistic discourse analysis of a small clini- men’s narratives but that this loss is gendered cal sample of Polish men receiving treatment, Apesoa-Varano et al. 159 Galasinski (2008) argues that their depression can- enactments of masculinity have been described not be fully understood and effectively treated as “a defense against the perceived threat of apart from the centrality of masculinity in their humiliation and emasculation in the eyes of other lives and the norms of strength, employment, men” (Kimmel 1994:135; also see Hearn and and their provider status in the family. Related to Kimmel 2006). this line of reasoning is the work of Thomas Joiner Rather than assuming that men are “naturally” (2005), whose model of suicide emphasizes per- prone to worse health, risk-taking behavior, and ceived burdensomeness or failed belongingness reluctance to seek help, this typology emphasizes coupled with the acquired capability for serious the notion that there are not one but many ways self-harm. Though not ignoring psychological in which masculinity is embodied and practiced factors (mental anguish) or genetic components across space and time (Braswell and Kushner (serotonin-system genes), Joiner’s theory does 2012; Creighton and Oliffe 2010; Martin 1998; integrate the importance of how people perceive O’Brien et al. 2005; Wetherell and Edley 1999). their social relations (i.e., men’s feelings of being Two distinct yet compatible approaches illustrat- a burden to the family or being excluded from ing this are the work of Deborah Cameron employment) or whether they perceive any mean- (2005) and Mimi Schippers (2002, 2007). Camer- ingful social relations at all in their lives (Joiner on’s work centers on the relationship of language 2011). Consistent with Joiner’s and Galasinski’s and gender, emphasizing the diversity of gender work, a central issue raised by our analysis of older, performance and display via discourse whereby generally low-income men is that their views of sui- social constructs of “masculine” and “feminine” cide represent a “complexity of subjectivities and are destabilized and can be enacted selectively distress” (Ridge, Emslie, and White 2011:152) by both men and women depending on the context embodying gender codes of masculinity.
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