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 CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 

The Limits of Social Capital: Durkheim, Suicide,


and Social Cohesion
Recent applications of so- | Howard I. Kushner, PhD, and Claire E. Sterk, PhD
cial capital theories to pop-
ulation health often draw on
classic sociological theories PUBLIC HEALTH SCHOLARSHIP protective strategy against these lation health.”4(p59) Challengers
for validation of the protec- often cites classic social theorists modernizing forces. However, warn that “an emphasis on social
tive features of social cohe- to demonstrate the link between as other studies have shown, cohesion can be used to render
sion and social integration. social capital—the collective civic Durkheim’s conceptualization of communities responsible for their
Durkheim’s work on suicide value of social networks—and suicide and the interpretation of mortality and morbidity rates:
has been cited as evidence population health. Kunitz1 the data were framed by his own a community-level version of
that modern life disrupts so- showed that classic theory is biases and by those of his early ‘blaming the victim.’”4(p59) Recent
cial cohesion and results in most often cited to authenticate 20th century contemporaries.9,10 research indicates that specific
a greater risk of morbidity a current assertion rather than Social capital advocates have mortalities among working class
and mortality—including self-
to test the validity of a public made their debt to Durkheim ex- populations, even in wealthy
destructive behaviors and
health maxim. As a result, the plicit.11–16 Although social capital countries, show that increased
suicide.
We argue that a close work of the same theorist is has a variety of contested defini- social capital is unrelated to im-
reading of Durkheim’s evi- often used to support contradic- tions,4,17,18 there is general con- proved health.4,22 In their evalua-
dence supports the oppo- tory arguments.1,2 We examined sensus that the required condi- tion, Muntaner et al.23 demon-
site conclusion and that the the extent to which Durkheim’s tions for social capital include strated that social capital is much
incidence of self-destructive claims about the link between so- the existence of community less important than economic and
behaviors such as suicide is cial disintegration and suicide networks, civic engagement, social status for predicting infant
often greatest among those have lent support to current as- civic identity, reciprocity, and and coronary disease mortality.
with high levels of social in- sumptions that social capital is a trust.19,20 One of the most well Despite ongoing critique, the
tegration. A reexamination protective factor in population known works, Putnam’s Bowling number of studies claiming a rela-
of Durkheim’s data on fe-
health.3,4 Durkheim tied modern Alone,20 identifies social associa- tion between social capital and
male suicide and suicide
urban life to declining birth rates, tions and networks, norms of rec- improved population health
in the military suggests
that we should be skeptical increasing alienation, and exac- iprocity, and trust as 3 key com- seems undiminished. In part, this
about recent studies con- erbated gender role tensions, ponents of social capital. reflects a wider pressure on US
necting improved popula- which, he believed, had negative Social capital constructs have public health practitioners to
tion health to social capital. health consequences, evidenced had a great impact on recent ex- downplay class in favor of culture.
(Am J Public Health. 2005; by increased suicide rates.5–8 aminations of population health, By contrast, studies that examine
95:1139–1143. doi:10.2105/ Durkheim distinguished be- particularly on studies concerned the role of class or institutional so-
AJPH.2004.053314) tween egoistic, anomic, altruistic, with health disparities.21 As cial capital have shown that it is a
and fatalistic suicide, broad clas- Kawachi et al. argued, citing Put- more powerful predictor of posi-
sifications that reflect then-pre- nam, social capital is “the glue tive health outcomes than com-
vailing theories of human behav- that holds society together.”14(p57) munitarian social capital.2,23
ior. Dismissing altruistic and In this context, a growing body Drawing on Durkheim,
fatalistic suicide as unimportant, of public health investigators hy- Kawachi et al.14 defined social
he viewed egoistic suicide as a pothesize that diminished social capital as synonymous with social
consequence of the deterioration capital contributes to an in- cohesion and linked it to health
of social and familial bonds and creased risk for an array of ill- outcomes. Kawachi et al. cited
linked anomic suicide to disillu- nesses, ranging from chronic Wolf and Bruhn,24 who exam-
sionment and disappointment.8 heart disease and diabetes to de- ined the impact of the decline of
His claims about suicide among pressive disorders and suicide. social cohesion on the 1600 resi-
women and suicide in the mili- Others have challenged this dents of Roseto, Pennsylvania. In
tary are emblematic of his asser- view, arguing that social capital the 1950s, death rates in this
tion that increasing moderniza- theorists ignore class relations, as- small, close-knit Italian American
tion and urbanization led to the suming instead that “social cohe- community were lower than in
breakdown of social cohesion. sion rather than political change neighboring communities even
He viewed social integration as a is the major determinant of popu- though there was no significant

July 2005, Vol 95, No. 7 | American Journal of Public Health Kushner and Sterk | Peer Reviewed | Critical Concepts for Reaching Populations at Risk | 1139
 CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 

difference in risk factors. How- A review of his discussion on vided a measure of social pathol- in the family and the community,
ever, as younger residents began female suicide and military sui- ogy. According to Durkheim, were more immune to suicide
exploring employment outside cide shows the enormous dis- anomie and egoism resulted than men.8 Yet Durkheim’s asser-
Roseto, social ties weakened. By tance that Durkheim traveled to from the collapse of traditional tion of the immunity of women
the mid-1960s, “expensive auto- reconcile his theory with his evi- restraints, and thus their inci- to suicide owed more to his as-
mobiles began to appear in the dence. This has not been evident dence could be used as an index sumptions about the socially dis-
streets . . . families had joined because most social scientists for social pathology. In his view, integrative impact of urban life
country clubs, [and] . . . occa- share 3 of Durkheim’s assump- the rate of anomic suicide mea- and modernity than it did to his
sional visits to Atlantic City were tions. The first is the belief that sured alienation, whereas the data. Durkheim asserted that
replaced by weekends in Las modernity breeds alienation and rate of egoistic suicide measured “mental illnesses go hand in
Vegas and luxury cruises.” 24(p122) egocentrism. The second is the the decline of self-restraint. Al- hand with civilization” and that
Wolf and Bruhn tied these be- assumption that women, as most truistic suicide, on the other insanity was more common “in
haviors to increases in heart dis- socially integrated in family life, hand, reflected socially sanc- towns than the countryside,
ease in Roseto. By contrast, the are the most protected against tioned self-sacrifice.8 Although and in large rather than small
examination by Lynch and suicide. Finally, social integration the construct of altruistic suicide towns.”7(p215)
Davey Smith25 revealed that the is assumed to be socially protec- makes theoretical sense, such In an 1888 essay entitled
original empirical results were tive. The acceptance of these as- acts (heroism) were never re- “Suicide et natalité: étude de statis-
weaker than often is claimed by sumptions among scholars can ported as suicides. There could tique morale,” Durkheim linked
social capital experts and also partly be explained by their re- be almost no fatalistic suicides low birth rates to increased sui-
were open to more plausible al- liance on Durkheim’s definition because Durkheim claimed that cide rates.5 “A low birthrate led
ternative interpretations. They and typology of suicide. In what “it has so little contemporary im- to the weakening of the fam-
pointed out that the original in- follows we reexamine these as- portance and examples are so ily,”5(p462–463) and Durkheim
vestigators had rather conserva- sumptions through an explo- hard to find . . . that it seems claimed those areas with the
tive preconceptions of what con- ration of 2 issues that Durkheim useless to dwell upon it.”8(p276) least population growth experi-
stitutes the “right” way to live addressed—women’s suicide and As a result, subsequent studies enced the highest rates of sui-
and what formed “healthy” indi- suicide in the military—and 1 ignored fatalistic suicide.28 cide.5 Because, according to
vidual, family, and community issue that he failed to take into Durkheim, the health of society
relationships. Others26 have account—attempted suicide. First, DURKHEIM AND THE depended on the density of fami-
pointed out that improvements in however, we must review how PUTATIVE IMMUNITY lies, women were expected to be
health historically occurred inde- Durkheim constructed his defini- OF WOMEN mothers of many children. By ex-
pendently of social capital. tion and typology of suicide. tension, he said, women were
“The notion that social cohe- Durkheim’s definition and healthiest and least prone to sui-
sion is related to the health of a DEFINITION AND typology of suicide reinforced his cide themselves to the extent
population,” Kawachi et al. wrote, TYPOLOGY claim that the breakdown of tra- that they were subsumed in tra-
“is hardly new. One-hundred ditional social order was the rea- ditional roles: “Woman is less
years ago, Emile Durkheim Durkheim defined suicide as son for an increase in suicide. concerned than man in the civi-
demonstrated that suicide rates “death resulting directly or indi- Durkheim pointed to the puta- lizing process,” Durkheim as-
were higher in populations that rectly from a positive or negative tive low rates of female suicides, serted in 1893, “she participates
were less cohesive”14(p57) For act of the victim himself, which which he tied to women’s less in it and draws less benefit
Durkheim, social cohesion, es- he knows will produce this re- greater social integration. In from it. She thus resembles cer-
pecially traditional family life, sult.”8(p44) However, Durkheim’s no case did Durkheim view tain characteristics found in
provided the best protection analysis relied on official suicide women’s suicide itself as a cate- primitive cultures.”7(p192) These
against self-destructive behav- statistics that were collected gory for systematic analysis.30 presumptions alone go far in ex-
ior.27,28 Nevertheless, a reading without regard to his definition. Instead as we demonstrate later, plaining why Durkheim assumed
of Durkheim’s evidence sup- For instance, those who sacri- Durkheim’s classificatory system that women were “naturally” im-
ports the opposite conclusion, ficed their lives for others were contributed to and sustained an mune to suicide.
that is, that the incidence of sui- never recorded in official statis- underreporting of women’s com- Durkheim’s assertion in Le
cide is greatest among those tics; those whose deaths resulted pleted suicides. Suicide that “in all the countries
most subsumed in social groups. only “indirectly” from their acts Durkheim’s claim that social of the world, women commit sui-
Durkheim’s data revealed that generally did not appear in the disintegration led to an increase cide less than men,” was based
the highest suicide rates were statistics either.28,29 in suicide, especially among not only on the statistical data
found among those who were Durkheim wanted to demon- women, was based on his belief of his predecessors, but also on
most socially integrated.29 strate that the suicide rate pro- that women, because of their role their gendered assumptions.9(p471)

1140 | Critical Concepts for Reaching Populations at Risk | Peer Reviewed | Kushner and Sterk American Journal of Public Health | July 2005, Vol 95, No. 7
 CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 

In explaining the immunity of were less “socially integrated.” must be considered suicidal be- found that women living in the
women to suicide, Durkheim Even accepting the equivocal havior. Yet suicidologists since most socially integrated societies
concluded that “being a more data that women completed sui- Durkheim have relied on statis- had a greater incidence of sui-
instinctive creature than man, cide less frequently than men, tics that, by defining only com- cide than men. Johnson40 sug-
woman has only to follow her the high rate of attempted suicide pleted suicide as suicide, have ef- gested that women most sub-
instincts to find calmness and by women suggested that suici- fectively eliminated the majority merged in the family display
peace.”8(p272) dal behavior was a common way of suicidal behavior from their the greatest female suicidal be-
Durkheim’s definition of fatal- for women to express their pro- analysis of suicidal behavior. havior. Her views have been
ism described the psychological found unhappiness.31–33 The pri- Women attempt suicide at a rate affirmed by recent reports that
and social condition of many mary reason that female suicidal approximately 2.3 times greater the highest rates of suicide in
women, perhaps the majority of behaviors have been underval- than that of men.29,34,35 Had the world are found among
women who inhabit the globe ued is that explanations of the Durkheim included attempted rural Chinese women.41–43 Simi-
today. He chose instead to define causes of suicide are almost al- suicides, women rather than men larly, Hasegawa44 found that
women in traditional families as ways based on completed sui- would have emerged as the improved population health—
socially integrated, despite the cides. Although Durkheim admit- group at greatest risk of self- declining infection rates and
fact that, by any measure, most ted that attempted suicide fit destructive behavior. The data rising life expectancy—in Japan
women’s lives actually more his definition of suicide as a be- on attempted suicide could have today can be traced to broaden-
closely fit his definition of fatal- havior, he excluded it from his been used to demonstrate that ing of access to social resources
ism, that is, an excessively regu- typology because attempted women were less content with for Japanese women at the be-
lated existence, “with futures piti- suicide fell “short of actual their social roles than were men. ginning of the 20th century.
lessly blocked and passions death.”8(p44) Estimates since the Thus, although suicidologists This reinforces the conclusion
violently choked by oppressive early 19th century have indi- continue to refine their statisti- of historian Roger Lane,45 who
discipline.”8(p276) Durkheim never cated that for every completed cal methods, they rarely have found that contrary to Durkheim’s
questioned the supposition that suicide there have been at least questioned the assumption that assumptions, increases in suicide
those most subsumed in the fam- 6 to 8 attempts.29,34–36 only completed or successful rates were linked to social inte-
ily (women and children) would Reliable data on an ex- suicides should constitute the gration. Lane found that as
be most immune to suicide.5 panded definition of suicide database for suicidal behavior. 19th-century Philadelphia ur-
Given this paradigm, suicide and were available to Durkheim. Although various ex post facto banized, its suicide rate grew
integrative (women’s) behavior— For instance, beginning in explanations have been offered proportionally greater than its
what Durkheim labeled fatalism— 1826 (until 1961) the French justifying the exclusion of at- homicide rate. Lane reasoned
were opposites. Because social Criminal Justice Ministry pub- tempted suicides from measures that the increasing incidence
integration was alleged to be the lished suicide statistics that of suicidal behavior, none of of suicide in late-19th-century
cure for suicidal ideation, there made no distinction between these have any logical basis cities served as a barometer of
was no way for Durkheim to sup- attempted and successful sui- other than one of convenience— social integration because sui-
pose that suicide could be a fe- cides. In the 19th century these that is, completed suicides are cide, unlike homicide, indicated
male behavior. The category of were published in the Annales readily available to researchers internalization of social anger.45
fatalistic suicide was constructed d’hygiène, which recorded the as part of national vital statistics Kunitz’s study1 on the effect of
mainly for purposes of symmetry incidence of suicide (including, on death rates. In retrospect, it overintegration in the family
(as contrasted with egoistic sui- but not separating out at- seems curious that suicide at- among Navajos in the south-
cide) and because it would un- tempted suicides) by age and tempts were excluded from all western United States supports
dercut his central claims about by sex. Although these statistics considerations of the incidence the views of Johnson and Lane.
the role of modern urban life as suffered from the same weak- of suicide just as sophisticated Social relations within extended
increasing the incidence of sui- nesses as data on completed statistical methodologies allow- Navajo families, Kunitz found,
cide, Durkheim could never seri- suicides, there was no “objec- ing the inclusion of suicide at- often resulted in negative health
ously examine the possibility that tive” reason why they could not tempts became available. outcomes, including significantly
social integration could result in have been considered.28,37 The high rate of attempted higher rates of depression and
suicide. The decision to exclude at- suicide among women alerts us self-destructive behaviors.
Data available to Durkheim tempted suicide from considera- to the fact that submersion in
reveal what he failed to examine. tion was peculiar because the en- the family provided women with SUICIDE IN THE MILITARY
Those most subsumed in tradi- tire enterprise of the sociological no special protection from suici-
tional social institutions were at study of suicide was aimed at de- dal behavior.38 Although his evi- The greatest challenge to the
as great, if not greater, risk of scribing social behavior. Cer- dence was no more “value free” belief that social integration pro-
suicidal behavior than those who tainly, attempting to kill oneself than Durkheim’s, Steinmetz39 vides protection from suicide,

July 2005, Vol 95, No. 7 | American Journal of Public Health Kushner and Sterk | Peer Reviewed | Critical Concepts for Reaching Populations at Risk | 1141
 CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 

however, comes from Durkheim’s tions. The point is not that those scholars who challenge the phylactic impact of social capital
own data. Official statistics con- women’s and soldiers’ socializa- relevance of social capital to pop- or social cohesion, public health
sistently reported that the highest tion was the same. Rather, ulation health. investigators have been too ac-
rates of suicide were in the mili- Durkheim’s description and dis- In Suicide, Durkheim provided cepting of Durkheim’s typology.
tary. “It is a general fact in all cussions of military suicide fit a symmetrical typology of sui- Much of the current enthusiasm
European countries,” wrote into his category of fatalism more cide in which altruism was con- for social capital as a core con-
Durkheim, “that the suicidal apti- clearly than they fit into the cate- trasted with egoism and fatalism cept in suicide prevention rests
tude of soldiers is much higher gory of altruism. Durkheim could with anomie.8 The impetus for on unexamined nostalgic and pa-
than that of the civilian popula- not admit this because his theory Durkheim’s study, however, was triarchal assumptions, similar to
tion of the same age.”8(p228) of the protective role of social in- a concern with what he per- those that informed Durkheim’s
Durkheim’s definition of fatalistic tegration rested on his assertion ceived to be a breakdown in Suicide. The lesson here is that
suicide as resulting “from exces- that modern urban life (anomy moral order, by which he meant we must remain skeptical about
sive regulation,” whose “passions and egoism) were the killers. If what researchers today have current claims that improved
[were] violently choked by op- military suicides were catego- labeled social capital. Thus, health outcomes and reduced
pressive discipline,”8(p276) seemed rized as fatalistic, Durkheim Durkheim focused on increases mortality will result from in-
to describe 19th-century military would have had to question in egoistic and anomic suicides creased submersion in commu-
life perfectly. Durkheim’s typolog- his basic assumptions. Because because they provided a statisti- nity activity.4,22 Communities,
ical definitions should have led the high rate of military suicide cally viable measure of the de- after all, are heterogeneous, and
him to classify military suicide could not be attributed to cline of social capital. In his involvement alone may mean
as fatalistic. modernity, Durkheim labeled work, altruistic suicide served less than the meaning that any
Durkheim, however, over- it altruistic, which effectively mainly a rhetorical function. Fa- individual brings to an experi-
looked the obvious inconsis- eliminated it from consideration. talistic suicide served as a de- ence. The quality of relationships
tency that military suicide posed Because altruistic suicides were scriptor for suicides in traditional is always paramount, and partici-
for his sociology by arbitrarily socially condoned forms of self- societies, because Durkheim was pation alone does not necessarily
classifying military suicide as sacrifice, they were never re- faced with the issue that even in translate into acceptance, trust,
“altruistic,” even though re- corded as suicides. societies with abundant social or reciprocity. Moreover, the cur-
ported military suicides could capital, individuals nevertheless rent enthusiasm for the health
not be attributed to self-sacri- CONCLUSIONS killed themselves. But, as we benefits of social capital should
fice.8 Given his familiarity with have shown, the data that not serve as an occasion to view
suicide statistics, Durkheim Theoretical frameworks are es- Durkheim used was not linked it as a substitute for other forms
must have known that those sential for improving population to his definition of what consti- of capital and status. Camouflag-
who sacrificed their lives for health, but when adopted uncriti- tuted a suicide or to the typology ing the nostalgia that informs
their military comrades in bat- cally they can have unintended he constructed. Moreover, sui- many of these claims with
tle were never categorized as consequences. The recent enthu- cide attempts were excluded, metaphors of “social capital,” or
suicides in any official statis- siasm for social capital is an ex- even though they fit Durkheim’s “social cohesion” should not con-
tics. Indeed, to be reported as ample of a theory whose rhetoric definition. Women’s suicides ceal the traditional assumptions
a suicide, a military death is often more liberating than its were made to fit the typology by and antiurban bias that may un-
would have to have occurred application. The reason for this is assuming that they resulted from derpin such a project.
outside a combat situation. As in part the foundation on which modernity and gender role stress. Although we are persuaded
Besnard30(p339) pointed out, this paradigm rests: a theory of Nevertheless, Durkheim can be that significant contributions
“The only ‘modern’ example social integration that relies on read as demonstrating that so- have been made by social capital
given [by Durkheim] of altruistic Durkheim’s suicide typology. For cial integration can have negative scholars, we fear that a promiscu-
suicide is military suicide, Durkheim, suicide rates were a health consequences. ous application of this approach
which, nevertheless, could also marker for decreasing social cap- A critical reading of Durkheim’s can be harmful. This may ex-
be interpreted in terms of exces- ital. The key conditions for social original text should make re- plain why studies on social capi-
sive regulation” that comes from capital–community networks, searchers suspicious of current tal and health have resulted in
“very strong social integration.” civic engagement, civic identity, claims that social capital is likely equivocal findings. Even advo-
Given his assumption about reciprocity, and trust—appear im- to result in a reduction in mor- cates of a social capital approach
the “nature of women” and the portant to health. Hence, numer- bidity and mortality, especially point out that the concept has its
prophylactic impact of family life, ous studies have identified a pos- among constituents of communi- limitations. For instance, partici-
Durkheim could not acknowl- itive association between social ties with little social and eco- pation in social activities may
edge the parallels between sol- capital and population health.22 nomic power. Because it seems to result in engaging in unhealthy
diers’ and women’s social situa- Less attention has been given to provide confirmation of the pro- behaviors, and the dynamics sur-

1142 | Critical Concepts for Reaching Populations at Risk | Peer Reviewed | Kushner and Sterk American Journal of Public Health | July 2005, Vol 95, No. 7
 CRITICAL CONCEPTS FOR REACHING POPULATIONS AT RISK 

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Research for this article was supported income inequality. BMJ. 1997;314:
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from the National Institute on Drug ization and women’s suicidal behaviors.
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