Suicide is a major public health concern (Naghavi, 2019) and continues to be a significant risk for men. It is estimated that 700,000 people die each year by suicide (World Health Organisation, 2021) and approximately 135 people could be directly exposed to each suicide death (Cerel et al., 2019). It has been found in the UK, US and Australia that the male suicide rate is three times higher than women (Cleary, 2019; WHO, 2014).
This highlights the need for targeted suicide prevention campaigns for men. The author of a recent qualitative research study (Dr Amy Chandler, 2021) has noted the worth of these campaigns but has also said “the suggestion that men as a group are less able to talk about their emotions or problems with others reflects a simplistic interpretation of the way in which gender shapes experiences of and responses to distress”.
Previous research has shown that men should not be considered as a homogenous group regarding help-seeking and communication (Cleary, 2019; Farrimond, 2012; Galasiński, 2004; McQueen, 2017; O’Brien et al., 2005; Seidler et al., 2017). We also need to consider the contexts in which men live, and communicating about problems may further entrench inequalities regarding gender, race, class and dis/ability (DeBoise and Hearn, 2017; River & Flood, 2021).
The aim of this study was to further understand the link between suicidal behaviour in men and practices of emotional communication. As well as understand the complexities behind this association (Chandler, 2021).
The suggestion that men as a group are less able to talk about their emotions or problems is too simplistic to explain how gender shapes experiences of and responses to distress.
Methods
Participants
Ten men (aged between 35-61) with experience of self-harm or suicidal thoughts were recruited via a community-based mental health organisation in Scotland (UK). Self-harm was deliberately defined broadly, to include self-poisoning, self-injuries, or acts framed as ‘attempted suicide’. All the participants were white, 9/10 were unemployed and all described some extent of socioeconomic difficulties. Nine men identified as heterosexual, and all the men were cis-gendered.
Interviews
The author described a “life-story” approach to the interviews, which were deliberately unstructured to allow the men to talk about what they wanted to. Participants were also able to use a “life grid” to help them tell their story, which some of the men used (it was not stated how many used this in the study). The author did recognise that the men were aware of the research and what they were investigating so some likely tailored their accounts to include alcohol use and/or mental health experiences.
Analysis
The interviews were based on narrative and thematic approaches (Riessman, 2008). The anonymised interviews were recorded digitally and transcribed by a professional transcription service. Transcripts were read multiple times by members of the study team which generated several themes. The coding, generation and refinement of themes was an iterative process whereby the authors considered the interactions between themes, existing research, and relevant social theory (Tovory & Timmermans, 2014).
Results
Four main themes were identified:
1. Maintaining silence
The men described difficulties talking about emotions or problems and many of them admitted they had “remained” silent for many years regarding their mental health difficulties.
One participant described the masculine notions of emotional suppression by referencing the need to seek help earlier, rather than attempting to self-manage problems which often lead to worsening mental health.
2. Benefiting from talk
The men detailed a process of staying silent over many years regarding their depression, anxiety and alcohol use. Even when accessing services (often in crisis) the men struggled to open up about their problems.
However, participants highlighted the importance of talking to help cope with depression, anxiety and alcoholism. One participant detailed that he was able to access support through his previous job in the armed forces and involvement in the criminal justice system, which would have been difficult for him otherwise due to the financial costs. This highlights the importance in understanding the content of what men talk about and the context in which it occurs.
3. Benefiting from silence
The men explained how and why they maintained their silence. Some men struggled to remember things they had done when experiencing a suicidal crisis or using substances. Despite highlighting the importance of talking, men did struggle to speak about certain subjects, particularly with close relatives.
4. Contexts of talk
The contexts in which men talk is important to consider, particularly in situations where they find it difficult to talk. Participants spoke of remaining silent on some issues, even within safe sharing spaces. This may be to avoid feelings of shame regarding suicide attempts, betrayal against family members or alcohol use.
The men recognised that talking is beneficial but emphasised the importance of the social bonds that facilitated this.
Conclusions
Overall, the findings of this study highlight the importance of talking in men, particularly more often and sooner, which is set out in suicide prevention campaigns. Chandler (2021) asked:
Is it ‘talk’ that is important here, or is it – equally – the social bonds that might a) make such talk possible; and b) in themselves offer some amelioration to feelings of suicidality, shame, anxiety or distress?
This article explores the significance of talking in many ways particularly regarding the contexts and content of the talk:
- The situations where certain subjects are “off limits” due to feelings of shame e.g. accusations of sexual assault, theft from family members, attempted (“failed”) suicide and ongoing thoughts of death. This may be to maintain their power and status as a man
- The feeling of being silent was not fixed, there were situations where the men felt more comfortable sharing their experiences e.g. if they felt a connection with a therapist
- The contexts in which men talk is also important, particularly the power dynamics e.g. in relationships where a partner is relied on for support whereas this could also be turned on its head where women are framed as “cold and uncaring”
- The broader environment in which men live also needs to be considered as this “may shape men’s distress”. Social support and talking may provide some comfort but cannot help men with situations like unemployment or lack of work, which was noted by the men in this study.
Encouraging men to talk is important but we need to recognise and respect men’s boundaries with certain subjects, particularly due to the long-lasting impact of shame.
Strengths and limitations
The “life story” method of interviewing allowed the men to construct their own narrative and talk about what they wanted to.
The interviews were deliberately unstructured and informal to allow the participants to feel comfortable with the interviewer, placing the role of the researcher as central to the interviews. It is recognised that different interviewers may evoke different answers from participants.
The results were well presented with two quotes for each theme to illustrate the findings.
The interviews were conducted in private rooms in community centres, which may have helped the men to feel comfortable.
The quotes were analysed thoroughly which helps the reader understand the context and how they link with other quotes/themes.
The transcripts were read multiple times by two members of the research team, which adds credibility to the results.
This sample includes Scottish men, who are predominantly white and have survived a suicide attempt, thence the findings may not be generalisable to other genders, ethnicities or those who have died by suicide.
By interviewing men using a “life story” approach the men were empowered to discuss what was important to them.
Implications for practice
It’s important that we continue to encourage men to talk, but we also need to provide avenues and support services where they feel comfortable to open up and share.
Shame can have a long-lasting impact on men, making them reluctant to talk and seek help. Public mental health campaigns should work towards reframing talking or help-seeking as courageous.
We must also recognise the power dynamics in the contexts where men may open up, e.g. if men are involved in the benefits system or criminal justice system where they feel the practitioner can’t “really hear, or indeed care, about what they have to say”.
Talking is important for men, but we must recognise the structural, economic or political conditions that impact men’s distress, e.g. many of the men in this study were out of work and receiving benefits. Practical support, alongside emotional support, would also be beneficial.
Suicide prevention campaigns should also focus on economic and housing security, access to welfare/disability support, programmes promoting gender equality and community-based services in relation to mental health and substance use.
Statement of interests
The authors report no conflicts of interest.
Links
Primary paper
Chandler, Amy. Masculinities and suicide: Unsettling ‘talk ‘as a response to suicide in men. (PDF) Critical Public Health (2021): 1-10.
Other references
Cerel, Julie, Margaret M. Brown, Myfanwy Maple, Michael Singleton, Judy Van de Venne, Melinda Moore, and Chris Flaherty. “How many people are exposed to suicide? Not six.” Suicide and Life‐Threatening Behavior 49, no. 2 (2019): 529-534.
Cleary, Anne. The gendered landscape of suicide: Masculinities, emotions, and culture. Springer, 2019.
De Boise, Sam, and Jeff Hearn. “Are men getting more emotional? Critical sociological perspectives on men, masculinities and emotions.” The Sociological Review 65, no. 4 (2017): 779-796.
Farrimond, Hannah. “Beyond the caveman: Rethinking masculinity in relation to men’s help-seeking.” Health: 16, no. 2 (2012): 208-225.
Galasinski, Dariusz. Men and the Language of Emotions. Basingstoke: Palgrave Macmillan, 2004.
McQueen, Fiona. “Male emotionality:‘boys don’t cry’versus ‘it’s good to talk’.” Norma 12, no. 3-4 (2017): 205-219.
Naghavi, Mohsen. “Global, regional, and national burden of suicide mortality 1990 to 2016: systematic analysis for the Global Burden of Disease Study 2016.” bmj 364 (2019).
O’brien, Rosaleen, Kate Hunt, and Graham Hart. “‘It’s caveman stuff, but that is to a certain extent how guys still operate’: men’s accounts of masculinity and help seeking.” Social science & medicine 61, no. 3 (2005): 503-516.
Riessman, Catherine Kohler. Narrative methods for the human sciences. Sage, 2008.
River, Jo, and Michael Flood. “Masculinities, emotions and men’s suicide.” Sociology of Health & Illness (2021).
Seidler, Zac E., Simon M. Rice, Jo River, John L. Oliffe, and Haryana M. Dhillon. “Men’s mental health services: The case for a masculinities model.” The Journal of Men’s Studies 26, no. 1 (2018): 92-104.
Tavory, Iddo, and Stefan Timmermans. Abductive analysis: Theorizing qualitative research. University of Chicago Press, 2014.
World Health Organisation. (2021). Suicide.
Photo credits
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