Abstract
In his preface to this comprehensive textbook on suicidology, David Jobes writes that Ronald Maris, a younger contemporary of Edwin Shneidman, stands alongside all the scholars and clinicians who created the discipline of suicidology. Certainly, Maris brings a breadth of knowledge to this text. His background in philosophy, religion, logic, history, and social psychology provided a solid grounding for a year of study at the Los Angeles Suicide Prevention Center (1965–1966), and his subsequent studies in psychiatry, sociology, behavioral sciences, research methods, clinical psychiatry, suicidology, and forensic psychiatry bring yet another level of expertise and content knowledge. Maris brought his master teacher’s expertise in organizing the content, leading to the creation of a textbook around which a college or graduate course in suicidology can be organized.
Ronald Maris, PhD is Distinguished Professor Emeritus of Psychiatry, Family Medicine, and Sociology at the University of South Carolina. A forensic suicidologist, Maris has offered investigation and testimony on civil and criminal cases as an expert witness. He taught psychiatry, behavioral science, suicidology, and sociology for over 50 years and wrote or edited 27 books. In addition to his considerable content knowledge in suicidology, his capacity as a master teacher shines through this book. The book is balanced and thorough, offering educators a solid core text for suicidology courses in higher education.
For Maris, the definition of suicide is straightforward: Suicide is “intentional self-destruction resulting in your own death by your own action” (p. 3). He then goes on to discuss the ways this is not straightforward at all. Rather, suicidal action and behaviors and ideas are part of a vast continuum ranging from a fleeting thought of suicide through living a risky lifestyle to a lethal plan to death – and everything in between. He moves next to theory and key concepts such as lethality, suicidal careers, intent, risk factors, commonalities, and differences, ending chapter two with his model of suicide originally described in 1992 and further developed over the years.
Moving through the book, Maris examines data, research, and assessment, arguing that empirical research is critically important. He discusses the major types of suicide research and stresses the importance of evidence-based approaches to theory and practice. Then, acknowledging that the number of suicide risk factors is too large for most of us to rememberand that there are considerable measurement problems in identifying them, Maris urges caution. He asserts (rightfully) that suicide is statistically rare and reminds his reader that statistical association (with one or more risk factors) is not the same as causation – and most people with multiple suicide risk factors usually die of natural causes.
The chapter on international variation is welcome and needed, since far too many publications on suicide in the United States focus mostly on Western perspectives and contexts. He reminds us that, globally, there are 800,000 suicides every year. This means that the suicides in the United States comprise only 6%, while China and India together have 68% of the world’s suicides. That said, this section is incredibly brief at 17 pages. He asserts that due to space constraints he was forced to examine some countries and not others. His chapter offers a list of the suicide rates for 40 countries and examines part of Europe (Hungary, Austria, Germany), part of Eastern Europe (Russia, Lithuania, Kazakhstan), Scandinavia, Africa (Mozambique, Tanzania, Sudan), part of Asia (Japan, China, India, South Korea), and Australia. He wraps it up with a consideration of countries that have low suicide rates, such as Egypt, Mexico, and the Philippines. It is a valuable chapter if for no other reason than it asks the reader to leave ethnocentric notions of suicide behind.
Throughout the rest of the book Maris examines sociodemographic issues including age, lifespan, social relations, religion, culture, history, and ethical issues (such as euthanasia and what Maris calls “rational suicide”). A section on special topics examines suicide in the military, the issue of murder-suicide, and suicide in prisons. Treatment, prevention, postvention (care of the grieving after suicide), and forensic suicidology are covered in some detail, yet the length is appropriate for a textbook used in a course introducing suicide and suicidology.
There are some weaknesses to the book. I wished the brief chapter on global suicide had been expanded to a full section, because suicide in many other cultures and countries is different and cannot (and should not) be assumed to have the same risk factors and contexts as suicide in the Western world. I also wished there had been attention paid to the importance of qualitative research in teasing out the nuances of what happens in suicide and suicidal thinking.
This book has many strengths. For example, Maris brings together and closely examines ideas, notions, and concepts, demanding readers to think through the content, apply critical reflection, and challenge their own biases and assumptions. For example, on pages 21–22 he compares and contrasts Edwin Shneidman (a clinical psychologist) with John Mann (a research neuropsychiatrist) in an elegant examination of their approaches to the theory of what causes suicide, their disciplinary biases, and their ways of collecting data. For Shneidman, suicide was a drama in the mind, the psyche. For Mann, suicide was the result of a dysfunctional serotonergic system. But at the end of the day, Maris embraces a distinctly biopsychosocial model of suicide: a robust theory of suicide must consider the entire lifespan of an individual, because suicide usually represents an accumulation of risk factors over a period of years (p. 35).
Another strength is the final chapter that summarizes the book and asks, rhetorically and actually, “what have we learned?” The epilogue, for me, is especially meaningful. These three paragraphs offer a window into Maris the person, as well as Maris the author, thinker, scholar, clinician, researcher, and teacher. Here the reader can grasp Maris’ passion for his journey writing this important book, and be reminded that he is handing us the baton to carry on the important work of understanding and preventing suicide, because “no one should have to throw away their one and only life to get relief from pain” (p. 502).