International Journal of Qualitative Studies on Health and Well-being ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/zqhw20 “Paradoxes of Interdependence and Dependence”: A qualitative study of economic difficulties and relational encounters prior to men’s suicide in Ghana Johnny Andoh-Arthur To cite this article: Johnny Andoh-Arthur (2023) “Paradoxes of Interdependence and Dependence”: A qualitative study of economic difficulties and relational encounters prior to men’s suicide in Ghana, International Journal of Qualitative Studies on Health and Well-being, 18:1, 2225935, DOI: 10.1080/17482631.2023.2225935 To link to this article: https://doi.org/10.1080/17482631.2023.2225935 © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Published online: 22 Jun 2023. Submit your article to this journal Article views: 395 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=zqhw20 INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING 2023, VOL. 18, 2225935 https://doi.org/10.1080/17482631.2023.2225935 EMPIRICAL STUDIES “Paradoxes of Interdependence and Dependence”: A qualitative study of economic difficulties and relational encounters prior to men’s suicide in Ghana Johnny Andoh-Arthur a,b,c aDepartment of Psychology, University of Ghana, Legon, Accra, Ghana; bCenter for Suicide and Violence Research (CSVR), University of Ghana, Legon, Accra, Ghana; cCommunity and Life Empowerment Advocacy Network, Accra, Ghana (CLEAN-GH) ABSTRACT ARTICLE HISTORY Purpose: This study aims to explore the relational encounters that are shaped by economic Received 25 May 2022 difficulties prior to the suicides of men in Ghana. Accepted 13 June 2023 Method: Using a qualitative study design, and with the aid of a semi-structured interview guide, data were collected from 21 close relatives of nine men who took their lives in Ghana. KEYWORDS Results/Findings: A Reflective Thematic analysis (RTA) showed themes reflecting four rela- Suicide; Men; Economic challenges; Dependence; tional tensions corresponding to unique demographic profiles and circumstances of eco- Ghana nomic dependence on others: from dependence to independence; from control to living with and on others; from provider to dependence; and regaining control in a dependent relational context. Conclusion: The men’s economic challenges produce paradoxes of interdependence and dependence in that the interdependent social ethic enjoins persons in crises to disclose or seek help from close relations, yet for some men, doing so often draws social taunts, which further taint the social image of these men and contribute to suicides. Increased public education is needed to change unhealthy gender norms that affect men in social and economic adversity. Provision of practical economic support for men in economic and financial adversities is highly recommended. Introduction Gender and suicidal behaviour Suicide is a complex behaviour that is widely regarded Across most countries, male suicides are up to between as a significant public health issue across the globe 3 and 7.5 times that of females even though suicide (Global Burden of Disease Self-Harm Collaborators, ideation and attempt are highly frequent for females Naghavi, 2019). It occurs at the juncture of multiple (Bilsker, Fogarty, and Wakefield, 2018, Global Burden of factors: psychiatric, psychological, biological, social, cul- Disease Self-Harm Collaborators, Naghavi, 2019, WHO, tural, economic, and existential, among others (Franklin 2014). The term gender paradox has been coined to et al., 2017; O’Connor and Nock, 2014; Platt, 2017; describe the differential prevalence of suicide mortality Shneidman, 1985). Despite its multifaceted nature, psy- and morbidity for males and females, respectively chiatric factors have received much attention as far as (Canetto and Sakinofsky, 1998). Accounting for the understanding, treating and preventing suicidal beha- phenomenon of gender paradox in suicidal behaviours viours are concerned. Recent years have seen an includes biological differences between males and upward trend of scholarly interest in the roles non- females, differences in early life experiences, social/cul- psychiatric factors play in suicides towards a deeper tural norms guiding emotional experience and emo- understanding of effective remediation. For example, tional expression, coping, help seeking, and differences suicide is viewed by some as a deeply gendered phe- in suicide method selection between the two genders nomenon (Chandler, 2021, Meissner, Bantjes, and (Chandler, 2019, Moscicki, 1994). On the biology, it is Kagee, 2016, Ramesh et al., 2022, Richardson, Robb, suggested that testosterone, which is linked to impul- O’Connor, 2021). This view now prompts the treatment sivity and aggression, is about ten times more in males of gender as an explanatory variable in suicide studies than in females. The high propensity for males to away from the tendency in previous studies to treat engage in risky behaviours including aggression gender merely as a descriptive factor (Payne, Swami, towards others and to themselves is therefore attribu- and Stanistreet, 2008, Platt 2017) ted to high testosterone levels in males (Sher, 2015). CONTACT Johnny Andoh-Arthur johnnyandoharthur@gmail.com Department of Psychology, School of Social Sciences, College of Humanities, University of Ghana, LG 84, Legon, Accra, Ghana This article has been republished with minor changes. These changes do not impact the academic content of the article. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 J. ANDOH-ARTHUR Within the non-biological explanations is a perspective concepts, which have meaning in relation to each that connects high male suicide mortality to gender other, as a social demarcation and a cultural opposi- stereotypes and role socialization. The prevailing view, tion” (p. 44). Accordingly, the author postulated three according to this perspective, is that males are socia- structures that characterize the gendered relation- lized to live according to what society expects of ships between men and women, namely the sexual “men”. Ironically, the very societal expectation that division of labour (gendered allocation of men and seemingly connect to mens’ valued social identities women to work and occupational roles), the sexual also presents risk for suicide in some men who may division of power (inequalities between men and find it difficult to meet such expectations (Kong, 2021). women in the exercise of power and authority), and For example, studies have highlighted “stoicism” as the structure of cathexis (the structure of affective a masculine norm that acts as a barrier to help seeking attachments and social norms). In the opinion of in traditional masculine environments (Broadbent and Connell, the three structures exist at the societal and Papadopoulos, 2014). Furthermore, stoicism and self- institutional levels with these social structures firmly reliance have been found to contribute to Australian embedded at the societal level through numerous men’s experiences of social isolation, which in turn, historical and sociopolitical forces. Later work of connected to their health problems including suicidal Connell saw the addition of a fourth structure called behaviours (Player et al., 2015). Similarly, dominant symbolization, which depicted men’s control of social masculinity discourses, according to past and recent institutions and higher status given to their roles studies, reveal how help-seeking, for some men, is within social institutions (Connell, 2002). Connell also only contemplated following pain, endurance, stoicism argued for the existence of collectively held under- and visible injury’ (Johnson, et al., 2012, O’Brien et al. standing of ideal male practices in social settings. The 2005). In her study of 52 Irish men, Anne Cleary (2012) author used the concept hegemonic masculinity, to implicated the prevailing masculinity of the context in describe an idealized form of masculinity at a given the men’s inability to identify symptoms and making place and time (Connell, 1995). Notwithstanding, disclosures despite emotional pains they experienced. there is the acknowledgement of more than one Barriers to help seeking in men are found in other kind of masculinity existing concurrently in societies studies to be linked to fear of stigma, intense shame (Connell and Messerschmidt, 2005). What is consid- and perceived feelings of weakness (Rasmussen, 2017, ered “masculine” may be different according to race, Richardson et al, 2021). Thus, the degree to which class, ethnicity, sexuality, and even gender. When males subscribe to such socially prescribed rule about desirable, some men adopt an idealized form of mas- what it means to be a man influences behavioural culinity that is salient in a specific context; when outcomes such as suicides. A longitudinal study has undesirable, same men can distance themselves stra- for instance reported a likely 34% greater odds of tegically from a previously adopted masculinity form. suicidal ideation among men who strongly identified The talk of masculinity, according to Connell and with a key Western masculine role norm of being “self- Messerschmidt (2005), “represents not a certain type reliant” (Pirkis et al., 2017). Strongly held gender norms of man but, rather, a way that men position them- manifesting as restricted emotionality, conflict between selves through discursive practices” (p.841). relations have been found in previous studies to pose Hegemonic masculinity has been investigated largely risks for depression and low help seeking (Good, Dell, within the area of men’s health and men’s suicide in and Mintz, 1989, Leong and Zachar, 1999); two key risk particular and scholars have implicated male role factors for suicides. socialization process in risk behaviours among men. For instance, conformity to some masculine norms is Theoretical considerations found to lead to problem behaviours including sub- stance use and suicides (Chandler, 2021, Lash, Suicide is a multidimensional phenomenon that is not Copenhaver, & Eisler, 1998). reducible to a single explanation (Shneidman, 1985). Joseph Pleck’s gender role strain paradigm helps to For men’s suicide, in particular, theoretical positions accentuate the nexus between gender norms and have largely coalesced around the concepts of gen- problem behaviours including suicides. To Pleck der, power, sex role, and masculinities. Critical ana- (1995), the gender norms for men could yield three lyses of masculinity have implicated the sociocultural different role strains: men’s failure to live up to inter- context in the disturbingly higher rates of suicide nalized manhood ideal which among contemporary among men in many societies (Khan, Ratele, & men is often a close approximation of the traditional Arendse, 2020). This article focusing on the relational code (the discrepancy strain); negative side effects dynamics in the aftermath of job losses, and how they men themselves and their close relations face when shaped the suicide of men is grounded mainly in men fulfil the requirement of the male code due to Connell’s gender theory. According to Connell (1995) desirable qualities they perceive in the male code (the “[m]asculinity and femininity are inherently relational dysfunction strain). Pleck proposes the third, trauma INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING 3 strain, which to him, results from the ordeal of the Australia found that employment and work enable male role socialization process. Krugman (1995), in his men to assert control in arenas of occupation and reflections on Pleck’s work, categorized male-role reproduction of patriarchal domestic structure such strain, with its grounding in feelings of inadequacy that tensions in these arenas inscribed the suicidal and inferiority, as a shame-based experience—“an behaviours of some men (River, 2014). experience emanating from a judgement against the self, which can provoke anxieties and lead to avoidant Communitarian system, patriarchy, behaviours including isolation and suicide” (Andoh- unemployment and suicides in Africa and Arthur, 2019). Recent evidence has shown that shame- Ghana proneness uniquely predicted concurrent social anxi- eties (Carpenter, Stebbins, Fraga, & Erickson, 2022), Societies in Africa, especially those south of the which some scholars have long drawn its connection Sahara are intensely communitarian with an ethical to suicide (Hastings, Northman, & Tangney, 2000). In system that is also interdependently driven. his Interpersonal Psychology Theory of Suicide, Personhood within such systems is conceived to Thomas Joiner (1999) proposed two main constructs: have social intentionality and is attainable through desire to die and ability to die as underlying suicides. one’s relations with others (Adjei, 2019, Gavi et al., On desire to die, the theory connects it to two psy- 2022, Menkiti, 1984). This ethical system is thought to chological states: thwarted belongingness/social alie- foster mutuality, reciprocal obligations, and help seek- nation and perceived burdensomeness. He implicates ing since individuals are enjoined to relate with others acquired capability to die as a motive underlying the and to disclose problems to others in order to receive ability to die. The theory hypothesizes that when indi- help. In Ghana, mutuality and reciprocal obligation viduals have a weakened sense of social belonging are captured in the Akan language through such and also perceived themselves to be a burden on axioms as Hu me ni so ma me nti na atwe mienu others, their desire to die can be heightened. Suicide, nam. (To wit: it is for the purpose of helping each according to this theory, is likely to happen in the other that antelopes move in pairs). Help seeking context of a desire to die when people have acquired through interdependent living is also expressed in the capability to die through prior engagement in an Akan language as “sε etƆn woyare a, ennya n’ano self-injurious and destructive behaviours such as sui- edur” (To wit: if you disclose your sickness, you will get cide attempts, substance use, violence, etc. the right medication for it). While these are ingrained within the socializing system as key values in Africa Patriarchy, employment, control and suicide and in Ghana in particular, patriarchy, which is deeply in men embedded in Africa, appears to shape how to become a man as well as delimit emotional expression and the Patriarchy connotes authority: men in control of operationalization of the values of disclosure of pro- others. Patriarchy is a widespread social system across blems differently for men. The patriarchal nature of cultures. Men’s aspiration to be in control, coupled societies in Africa, makes being economically inde- with societal expectation for men to be in control pendent a key social expectation of being a man. often puts some men in situations of extreme anxi- Key requirements for attaining valued social identity eties especially when there is a direct or indirect as a man in most societies in Africa include attaining threat to being in control (Kong, 2021). For men some level of financial independence, being who are married and have children, the immediate employed, having a regular income, and subsequently family context provides a vital arena for testing, exer- starting a family (Barker and Ricardo, 2005). These cising and maintaining control. A study by Gibbs, gender norms are well ingrained within the socializa- Sikweyiya, and Jewkes (2014) among young men liv- tion practices of Africans which starts right from the ing in urban informal settlements in South Africa family. As a major institution, the family is essential for revealed, for instance, that young men’s aspiration “carrying out essential production, consumption, to traditional masculinity was closely tied to provision reproduction, and accumulation functions that are for a family and partner and control over them. associated with the social and economic empower- Impliedly, potential threats to control might usually ment of individuals and societies” (Mokomane, 2012, originate from and impacts closest dependents. p. 2). Key pathways to these functions, according to Success at work and employment domains is funda- the author, include family capital and family resilience. mental for achieving control quests as it enables men There exists traditional division of labour along gen- to fulfil a critical masculine norm of providing for their der lines within the socialization processes of children dependents. in African societies (Shefer et al., 2007). These pro- Especially for working-class men, meeting the cesses engender gender specific roles for boys and needs of immediate family is central to “being girls as far as family capital and family resilience build- a man” (Milner et al., 2017). Rivers’ (2014) study in ing processes are concerned. Usually, rites of passage 4 J. ANDOH-ARTHUR are used to reinforce clear demarcation between chil- a precondition for marrying a woman. Ability to pay dren, or boys, and men, and between men and bride price is symbolically tied to economic and/or women. In most traditional societies of Africa, there financial independence as well as indexes a man’s is the expectation for boys to be separated from their readiness to meet the needs of a potential spouse mothers, from female confines and quarters, and even and the children who may be born within the to refuse to take on tasks that are considered female- marriage. Lack of ability to pay bride price before home chores like washing, fetching water etc. (Barker marriage or to meet the needs of spouse and chil- and Ricardo, 2005). The refusal to undertake some dren while in marriage destabilizes most men while household chores by boys likely produces tensions exposing them to crisis including suicides. Studies between boys and their parents as far as boys’ quest have illuminated the roles unemployment, loss of for independence and their obligations to family income, and financial difficulties play in men sui- duties are concerned. Boys were expected rather to cides in Africa. A qualitative study in Uganda found engage in social apprenticeship with their fathers to loss of ability to work as a critical factor that heigh- understudy the rudiments of farming, hunting, fishing tened distresses and preceded the suicides among that are essential to family capital building men displaced in wars (Kizza, Knizek, Kinyanda, & (Nsamenang, 2006). Home bound activities are Hjelmeland, 2012). “The WHO (2020) reports that reserved for girls and as revealed by Adomako approximately 1993 suicides occur in Ghana Ampofo and Boateng (2007) in their study of boys in annually. A 4-year suicide attempt trends in Ghana Ghana, the concept of male role in housework as one have also revealed that 707 suicide attempts of helping, as doing a favour or kindness to a woman, occurred in 2018, 880 attempts in 2019, and 777 was firmly lodged in the ideology of many boys they attempts in 2020 with 417 attempts recorded as of studied. An extract from one of the boys in Adomako June 2021 (Akotia, 2023). Studies continue to reveal Ampofo and Boateng’s (2007) work was quite illustra- a disproportionate higher number of males in both tive of the gender demarcation within Ghanaian suicide and attempted suicides in Ghana which socialization of children thus: “I am a boy so I do not makes suicidal behaviour in Ghana carry rubbish to the dumpster or cook in the kitchen; a predominantly male problem (Abdulai, 2020, my sister however, can carry rubbish to the dumpster Adinkrah, 2012, Quarshie, Osafo, Akotia, & Peprah, and she can cook” (p.62). These gender demarcations 2015) Studies in Ghana have revealed how job are also seen in the experience, expression, and dis- losses in particular exact heavy tolls on men’s well- closure of emotional problems in males. Thus in being and contributes to suicides (Adinkrah, 2012, Ghana, there exists local scripts that highlights male Kong, 2021). power (e.g., Ɔbarima na enom eduro a εye nwono; it’s Thus far, a rich corpus of evidence has been built a real man who drinks a bitter medicine), male invin- to emphasize the problem of male suicide in and cibility (e.g., etuo toa esi Ɔbarima bo- it’s a real man out of Ghana and the critical role job losses, unem- who uses the chest to face the bullet), male super- ployment and lost financial control play in men’s iority over female (Ɔbaa tƆ etuo a, esi Ɔbarima suicide both within and outside Africa. However, danmu-when a woman buys a firearm, she keeps it much is not known in terms of how the loss of in a man’s room), male non-disclosure (e.g., Ɔbarima job and income by men (some of whom are mostly nkasa bebiree- a real man does not talk much), and breadwinners/providers) shape the relational con- emotional restriction in males (Obarima nsu- a real texts of these men and their close relations, and man does not cry). These and many others are exam- subsequently create a dynamic shaping their sui- ples of male-related scripts that appear to emphasize cides. One of the closest studies to this line of male norms and yet have grave implications on male research is the work of Gibbs et al., (2014) that wellbeing and health. Typically, a male child who runs examined how black men in informal urban settle- home to complain of having been beaten by another ments in South Africa constructed respect and mas- male is likely to be punished or taunted for not being culinity from their closest dependents in the able to fight back against the aggressor. context of poverty and unemployment. However, The transition from being a single boy to the study did not have a focus on suicides. This a married man is a status enhancer for men. It article, being a part of a main study on men’s provides among other things means for offsetting suicide in Ghana, explores the experiences of nine perceived feminine attributes and household duties men and their relational encounters following during boyhood and thus becoming independent unemployment and job crisis prior to their suicide. and being in control, taking on responsibilities for, It is anticipated that such knowledge will help and affirming oneself as a real man (Adjei, 2015). guide intervention for men who lose employment The concept of “bride price”, in some African socie- as well as their dependents towards early risk iden- ties including Ghana, for instance, requires men to tification and effective help for these men and their pay some amount of money to would-be in-laws as close relations. INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING 5 Materials and methods a suicide occurs, the police investigate the death, and working closely with the coronal system, they certify This study was part of a qualitative study exploring suicidal deaths (Adinkrah, 2012). The unique role of cultural meanings of suicide among men in Ghana. the police in the investigation and certification of Situated within a social constructionist perspective, suicides, created a prior relationship with the the study adopted a critical perspective and viewed bereaved family. The author therefore contacted the the account of close relations of the deceased men as police, introduced the study to them and solicited key sites for uncovering the men’s experience and their support in accessing data and also relatives relational encounters following unemployment, job and friends of the deceased. The social context of losses and crisis prior to their suicides. suicide in Ghana makes it extremely culturally insen- sitive as an outsider to access suicidal information directly from the families. Research on suicides have Sampling mostly relied on suicide reports that get to the atten- For the purpose of the study, accounts of 21 close rela- tion of the police. The police are the main institution tions of nine men who took their lives between 2014 and in Ghana for any recorded information on suicides, 2015 were analysed. In keeping with the research ques- which makes them also the main repository for infor- tion; what are the relational experiences of men following mation connecting deceased persons to families. The financial difficulties, unemployment and job crises prior to author accessed the relatives and friends of the their suicide? data of nine men who took their lives were deceased through the police. However, aware of the analysed because they were information-rich sample sensitivity of the topic, potential ethical matters to be (Malterud, Siersma, & Guassora, 2016) that illuminated raised with the involvement of the police, how financial difficulties, prolonged unemployment or a sensitization session was done with the personnel experiences of job loss had influenced their lives, rela- of the homicide unit. The session was to improve the tional encounters with their close relations, and their knowledge and attitudes of the police as far as suici- suicides. These nine were aged between 19 and 47; five dal behaviour is concerned while the author also had were single while four were married with children. See the opportunity to know at first hand the challenges Table I for their sociodemographic information. In Table some personnel go through when investigating sui- I and throughout the manuscript, pseudonyms are used cides. A key outcome of this collaborative effort was instead of real names of the deceased persons to protect the design of a culturally sensitive protocol for acces- their identities. sing families to introduce the study to them. The 21 participants were aged between 24 and 80 According to the protocol, the author could meet and comprised four spouses, two parents, 6 each for individual families after they had agreed to participate family relations and siblings, and 3 friends (See demo- after being contacted first by the police. For those graphic information of participants in Table II. that were interested, the researcher met them and The recruitment of the participants for the main gave detailed explanation of the study and its study was facilitated by the Homicide Unit of the purpose. Ghana Police Service. The resort to the police, for The police involvement posed some challenges such a sensitive study, was occasioned by reasons such as initial fear and apprehension in some partici- including absence of national registry for suicide in pants during the study. Nonetheless, it also provided Ghana and stigma against suicidal behaviours. When therapeutic avenues, assured the bereaved of the Table I. Sociodemographic information of the deceased. Occupational Marital Number of Educational Suicide Name Age Ethnicity Occupation status Status Children Level method Lived with Odai 19 Akan High School Unemployed Single None High School Hanging Mother and Sibling graduate Waja 22 Akan High school Unemployed Single None High School Hanging Senior brother and graduate his family Tei 27 Ga-Adangbe Factory Unemployed Single None Junior High Hanging Maternal Aunties Assistant and cousins Saba 29 Akan High School Unemployed Single None Junior High Hanging Paternal graduate Grandmother Nunoo 34 Ga-Adangbe Administrative Unemployed Single None Tertiary Hanging Mother and sibling Officer Danso 40 Ewe Businessman Unemployed Married 5 High School Hanging Wife and children Kwabena 44 Ewe Businessman Unemployed Married 3 Junior High Hanging Wife and children Gbortei 47 Ga-Adangbe Financial Crisis with Married 4 Tertiary Self Wife and children Officer current job immolation Kwasi 36 Ewe Auto Crisis with Married None Primary Stabbing Wife Mechanic current job 6 J. ANDOH-ARTHUR Table II. Sociodemographic background of participants. Relation Males Female Total Age Range Religion Occupation Education Spouses 4 4 24–50 All Christans 3 petty traders 1 Tertiary 1 civil servant 3 Elementary Parents 2 2 50–80 All Christans 1 retired public servant 1 Tertiary 1 Petty Trader 1 Elementary Family relations 5 6 29–46 All Christians 3 Traders 1 Tertiary 1 Pensioner 4 Elementary 2 Busineman/woman 1. No school Siblings 3 3 6 28–59 All Christians 1 Physician 1 Tertiary 5 businessmen/women 5 Elementary Friends 2 1 3 24–56 All Christians 2 Businessmen 1 High school 1 Trader 1 No School 1 Elementary TOTAL 21 credibility of both the research and the field insights into suicides in other countries (Kiamanesh, researcher, as well as created a viable means of con- Dieserud, and Haavind, 2015; Kizza, Hjelmeland, ducting such a study in the context. The process Kinyanda, and Knizek, 2012). Guided by the type of enhanced trust and confidence building and fostered data, the Author used the Reflexive Thematic Analysis disclosures on a topic that is tabooed and criminalized (RTA) (Braun and Clarke 2012) to analyse the accounts in the study context. Bereaved relations who volun- of the bereaved. teered to be interviewed provided oral consent after RTA was chosen because it is an easily accessible as which times and venues that were convenient for well as a theoretically flexible interpretative approach them were agreed on and the interview scheduled. that facilitates the identification and analysis of pat- Given the sensitivity of the topic, the author made terns or themes in a given data set (Braun and Clarke prior arrangement with a professional Clinical 2012). Accordingly, RTA is viewed as reflecting Psychologist to handle potential distresses that researcher’s interpretive analysis of data conducted could likely emerge from the interviews. Even though at the intersection of the dataset, the theoretical this arrangement was made known to all the partici- assumptions of the analysis, and the analytical skills/ pants, all declined this service despite obvious diffi- resources of the researcher (Braun, Clarke, Hayfeld, culties some had when some painful memories were and Terry, 2019, Byrne, 2021). Theoretical assumptions evoked during the interviews (Andoh-Arthur et al., of RTA are conceptualized as a series of continua 2018a, 2018b; Andoh-Arthur et al., 2020). The study along essentialism and constructionism epistemolo- received approval from the Ethics Board of the gies; experiential and critical orientation to data; Author’s Home University (ECH: 069/14–15). All iden- inductive versus deductive analyses, and; semantic tifiable information linked to the deceased persons, versus latent coding of data (Byrne, 2021). The their families and participants were removed in strict approach to analysis was grounded in construction- compliance to anonymity and confidentiality. ism, with a blended experiential and critical stance, even though priority was given to the latter. Giving priority to critical orientation was premised on the Analysis fact that data was attained through third persons Seeking answers to the question Why suicide presents who shared similar sociocultural contexts with the methodological conundrums for researchers because deceased men. These relatives also occupied different the very actors are deceased. For that reason, proxy subject positions in the lives of the deceased and thus accounts present alternative choices even though may be reflecting their own biases in their accounts. such accounts also do not accurately represent the This way, accounts were seen through and inter- actual motives of the deceased. Notwithstanding, preted within socio-historical context. The intention scholars have argued for robust methods that rely was to uncover and disrupt taken-for-granted issues on the accounts of different persons in different shaping the construing of masculinity and at the same close relationships with the deceased such as spouse, time limiting men’s psychological wellbeing. A purely children, parents, friends, other family relatives during inductive analysis at both semantic and latent levels the reconstruction of the suicides (Hjelmeland, et al., was conducted. Subsequently, the author followed 2012). In line with Hjelmeland et al., (2012), this study the six-phased analytic approach proposed by Braun- gathered accounts from persons in close relationships Clarke (Braun & Clarke, 2006, Braun et al., 2019): famil- with the deceased such as spouses, parents, siblings, iarization with the data, generation of initial codes, friends, and some other family members of the searching for themes, reviewing themes, defining and deceased persons. Despite their inherent limitations, naming themes, and report production. At the famil- proxy accounts of this nature have offered some rich iarization stage, the author got intimately familiar INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING 7 with all the transcribed interviews by first engaging in appear to have collided with obligations of depending an active listening of the original audio recordings. within their closest interpersonal domains. For example, Next, he read and re-read all the transcribed data, at a deceased, Waja (aged 22) who was a Senior High some points, verifying some of the written text by School graduate exploited his musical talents to survive listening to the original audio recordings. The aim thus: “He was someone who liked church. He even knew was also to achieve a better contextual understanding how to play drums very early so he had been visiting of the data. At the next stage, generating initial codes, churches playing drums. Sometimes he survived on the author, with the research question in mind, money from professional bands that hired him up for adopted a blend of latent and semantic coding to programmes” (older brother). Waja, thus actively generate key initial codes that were very relevant to worked to salvage his educational ambition. He decided the aims of the research. Multiple codes that were to seek opportunities elsewhere and subsequently lost generated in the previous stage of the analysis were the financial support. He had some conflicts with his critically examined by the author for their underlying older brother on whom he depended over the decision meanings after which they were coalesced into about to relocate to another place. This led to Waja’s open four themes. The naming and defining of the themes threat to harm as revealed by his brother. “He began were facilitated mostly by a discernible, and an encap- threatening me that if I did not give him money to go sulating story of transactional and conflictual social back to where our parents lived, one day on my return exchanges between the men and their closest rela- from work, I would not hear good news”. True to his tions. Depending on the men’s unique social and threat, the deceased left home angrily and subsequently demographic situation, four different outcomes killed himself nearby. (themes) were produced. The analysis took place Another decedent, Odai (aged 19 and a graduate through iterative process of “dialogue” involving the of Senior High School), had a stable dependent sup- author and the data. port from a single mother in meeting his educational needs. He extracted this support to his mother’s dis- comfort, and yet refused to honour familial chores Findings that came with depending; thus, Data revealed that the social image and identity of He pestered me to pay 250 Ghana cedis (About 80 US the men remained defined through a give and take Dollars then) as registration fee for a special class that exchange loop. Within this loop, validation of status is could help him pass an exam for a scholarship award. seen through demonstrable responsiveness to others I wasn’t having money then. I even told him to wait and the wider social context. While the transactional but he did not budge and kept pestering me”. relationship is seen by some of the men as social Education enhances life choices and affords power to insurance against an uncertain future, the loss of people. The quote illustrates a determined young man economic control and its attendant loss of ability to in pursuit of his autonomous quests. Tensions started meet demands of others threatened social status, and mounting between Odai and his mother when autono- eventually contributed to a state of dependency mous quest clashed with obligations in the dependent which many men found challenging to adjust to. relations. To depend implies subjecting oneself to The situation contributed to paradoxes of interdepen- other’s control including being responsive, obedient dence and dependence when the men’s survival and respectful. Contextually, failing to obey the one on hinged on dependence on close family relatives, yet whom a young person depends is perceived to have doing so undermined their social, psychological and serious consequences as captured in a local axiom emotional resources, thereby creating the path for “Abofra a onntsie no, ƆkƆ antseadze kurom”. This literally social withdrawal, avoidant behaviours and eventually translates as “a disobedient child eventually lands in the suicide. These are elaborated below: place of no return”. Odai’s perceived lack of responsive- ness and apparent disobedience created incessant con- flicts with his mother which preceded his suicide. The From depending to independence: tensions mother mentioned: between autonomy and obligations of depending It was a Saturday evening; I came home to realize The experience concerns two young decedents who there was no water. I enquired why he didn’t fetch were depending on their family relations: older brother, the water? In fact that day, I became furious with him. and a mother respectively. The theme captures the ten- I said “I gave you money on Friday you didn’t fetch sions that characterized the decedents’ autonomous water. Saturday too you didn’t fetch water, why?” He pursuits and the obligations circumscribed in the kept assuring me he would fetch but he didn’t. We slept that night but when I woke up, I didn’t see my dependent relations. The decedents attempted some son and I exclaimed “Where is my son?” I rushed out independence quests towards social recognition as and found a table at the balcony. I lifted my eye and boys and men. However, these independent quests saw my son hanging. 8 J. ANDOH-ARTHUR Gleaning from the above, these young men, by their etc, etc. For Christ sake, he was twenty-seven years. circumstances, depended to meet critical needs. Must I keep on taking care of him? However, fulfilment of obligations circumscribed in At an employable age, and undergoing crisis with the dependent relational context often collided with work, the second quote revealed a state of continued their autonomous pursuits, a situation that gener- dependence on relations beyond socially acceptable ated conflicts in the closest interpersonal dyads age of dependence. Tei was being implicitly perceived prior to the suicides. It is important to underscore as a burden. that the deceased in the case above, according to A similar story is shared on the deceased person the mother, took his life around the time he had called Saba and aged 29 years. For his part, a stable suffered academic setback and also just few days familial support towards success in occupational after an elderly man in his neighbourhood had domain was disrupted through unsuccessful autono- taken his life. Perhaps, it might be reasoned that mous quests. A paternal grandmother said events at the personal level and both within and outside the son-mother dyad had become what He always said he would like to be a doctor. Because Community Psychologists will describe as proximal of that ambition, the father did everything by educat- personal and contextual risk factors to an underlying ing him and placing him in an apprentice work when vulnerability to suicide. it was clear he (the deceased) was not interested in education. Every expense the boy made, the father paid; just to encourage him to realize his dream one day. He was the father’s only child. He was dis- missed from the work. Hmmm. No one understands From control to living with and on others: really what happened. It is all because of marijuana. Threatening social image Consequently, Saba’s dependence became chronic, The experience of three men who were already work- and his choices, increasingly maladaptive as the pater- ing but lost work is highlighted. These men aged nal grandmother further revealed between 27 to 34 years had not married nor had children, and were living with family relations. The Anything he needed, he just asked me then I will ask theme captures distresses that accompanied loss of him to go for money to buy what he needed. But I later realized whenever I gave him the money; he job while living with and on close family relations. rather spent it on the drugs and not food. Sometimes Their experience was threatening to their social too when I asked him to buy me food, he would take image. the money but would rather end up not buying the Narratives from participants are replete with var- food for me but spend on drugs. ious ways the men achieved a sense of control prior to various adversities they suffered in the period just The maladaptive self-management style appeared to before they killed themselves. For three unmarried have also nourished a behaviour that was counter deceased men Tei, Saba, Nunoo (aged 27, 29 to 34 normative; dishonesty to one on whom the deceased years, respectively) work afforded them choice in life depended. This is mostly likely to have sullied a prior and opportunity to pursue autonomous quests. The healthy relationship. period following job loss and unemployment created Concerning Nunoo, aged 34, there was initial suc- tensions between them and close family relatives with cess with work occupation, which created a work life whom and on whom they lived. A maternal Aunty balance: “He woke up early, went to work, and came said this about Tei: back and rested for the next day. He wasn’t trouble- some at all” (Older sibling). Security attained through He was very lazy. He didn’t go to work regularly. You stable work helped create an enabling context for will always see him in the room and when you ask meeting own needs and also for maintaining healthy him why he did not go to work; he would say there is interrelationship with close family members “He no work to be done at the work place. wished to help always. My mother tried to complete Tensions here arose from perceived availability of this house we live in but she could not. My deceased work and perceived non-availability of work on the brother helped. He built his own room in which he parts of relatives and the deceased person, respec- lived” (older brother). As long as Nunoo was able to tively. Herein is “victim blaming” as if to suggest that extend support to family’s project, a healthy interde- the deceased was intentionally refusing to work and pendent relation emerged. His older sibling further that a man should find work to do no matter the revealed “We were very close. We helped each other. situation. Upon Tei’s suicide, another maternal I sometimes bought a gift for him and he also bought Auntie revealed: some for me”. However, job loss undermined personal balance, and contributed to dependency with its I even got angry the day this incident (suicide) hap- attendant distresses as found illustratively in the pened. People even said we have been starving him, words of Nunoo’s biological mother. INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING 9 Everything was fine until he lost his job. I was helping characterized their living situation prior to their him to meet some of his needs. I knew it was hunger suicides. that makes people very disturbed, so I ensured that Men who were married with children lived in he was never hungry as I bought food for him. I had never anticipated that he would kill himself a healthy interdependent relation with their close families and relations until job crisis surfaced and Gleaning from the above, a healthy interdependent they had to depend. To illustrate the importance of relation existed when he was working. However, work as precondition for assuming the role of Nunoo’s downward spiral began just when he lost a husband especially, the spouse of a 40 year old his job and had to rely on others for survival. deceased person named Danso recounted the pro- However, his close relations appeared to have been cesses leading up to her marriage: well disposed to responding to a cry for help as is expected of families within the interdependent “Before he married me, I advised him that if he was social ethic. As illustrated in the quotes, Nunoo doing his own business, my family would see that he was a responsible man. He started his own pub that was provided for in a way as to ease the distresses was doing well, so he came to see my family. My from the job loss, but he went on to kill himself. The family was pleased with him and gave us the go issue of economic control being a critical masculine ahead to marry. norm in the patriarchal systems in Africa is well documented. Silberschmidt (2005), however, reveal Given the precondition of work success before mar- the irony in this system is that male authority is riage, Danso, intent on marrying, had to succeed in grounded materially while male responsibilities are business, presumably, to assure the would-be in-laws normatively constituted” (p. 195). Loss of economic that he was capable of fulfiling a provider role as control contributes to authority and image loss. a man/husband. However, things did not go the way Some studies in Ghana for instance reveal pejorative he expected when, in his bid to protect his business, descriptors that are attributed to men who are not he acquiesced to a family relative’s advice to seek economically and financially dependent (Adjei, spiritual support to boost the business which failed. 2015). Such situation is found to contribute to suici- His friend reveals; dal behaviours especially for men who conform to “He had a successful business in the 1980s. such masculinity norms (Adinkrah, 2012). Nunoo Unfortunately, he followed his female cousin to seek may have identified with traditional masculine spiritual protection to boost the business. It did not norms that are premised on men’s economic provi- work and things started going bad. So it came to sion (so-called benevolent patriarchs) in relation- a point when he was saddled with huge debts. ships. That identification could make it difficult for The friend continued “His relatives visited him a lot him to understand the psychological impact of not when he was doing well in business but they stopped accepting or seeking help during such distresses as visiting when his problems started”. Business success also found in Cleary’s (2012) study. He might have afforded Danso much control and enhanced his sym- interpreted continuous depending as embarrassing bolic capital beyond fulfilment of provider roles. as was found also in Gibbs et al. (2014) study among Seeing that he lost both materially and socially due South African young men living in urban informal to a perceived misdirection from his female cousin, settlements. Danso, in protest, did not attend that cousin’s funeral The theme, illustrate the tensions in the transition when she died: “He was so angry with the cousin that from being in control and falling back on others when he never stepped foot at the cousin’s funeral when job loss or job crisis sets in. Unlike in the previous she died” (spouse) theme, where tensions were more interpersonal, ten- The importance of work success in indexing provi- sions in this theme were more intrapersonal as these der roles and the attendant distress emanating from men perceived a threatening social image with the job loss is seen in the case of Kwabena, a 44 year old dependent living they fell to. deceased. His sister mentioned “My brother sold his car and gave part of the money to the wife as seed capital to start some business”. Selling a personal car, From provider to dependence: Threatened social image from the preceding quote, was Kwabena’s effort at fulfiling breadwinner (provider) roles. That is, he The experience here concerns men who were married resourced his spouse to have a steady stream of and had children. By their social position as husbands income to meet daily needs at home. At some point, and fathers, a duty to provide for others crucially provider role extended into the arenas of affection to defined their social identity. However, the duty to spouse and involved fathering, thus “he loved her provide clashed with the necessity to rather depend (wife) so much and his children. He would bathe the when they lost their means of livelihoods; job. This baby; he will normally carry the baby”. The wife, theme captures vividly the psychosocial tensions that a trader, corroborated “When I tell him I am not 10 J. ANDOH-ARTHUR feeling fine, he would come and sell my wares and demands for sex). He will disturb me until daybreak that would help him to do some exercise and play and when morning breaks, he will sleep all day. with the child”. Unfortunately, ill-health truncated The quotes illustrate attempt by Danso to regain control Kwabena’s continued stay at work leading to through stalking spouse for money and substance use a downward spiral. The wife further recounted that behaviours. Implied in the quote is also the use of sexual “He fell ill and was asked to stop work. Some few days violence to reassert power over the wife. Spouses were to his death, he became very withdrawn. He stopped main sources for displacing existential frustrations and cooking and caring for the children and was very reassertion of power. Dependence had come to mean reserved. The day before that incident (suicide), he survival regardless of its psychosocial impact on spouses was in the room the whole day. He never went out”. and even children. Danso’s spouse further asserts “In Kwabena’s change of fortune affected him psycholo- a way, he had no problem because whether he got gically to the extent that he could not reconcile the a job or not he would always come back to find food in present with the past as recounted by the wife “He the house”. Recounting her encounter with Danso usually said ‘Me of all people?’ then I will encourage moments prior to his death, she revealed in this illustra- him that he was having money previously but had no tive quote, children but today he has a child so he should be happy”. Realizing his situation, I didn’t bother him with school Gbotei, 47, was also helpful to others until he had fees. My children had exams and so I had paid their exams fees. I was on my way to a funeral when my husband job crisis. His spouse revealed that he was the type called asking for money. I told him I was on my way to the who found joy in helping people but was distressed funeral and I did not have money for him. He kept calling when he could no longer help others due to job crisis and I felt his call would disturb the other passengers in “Things were not going so well with his job, it got to the car so I put both phones off. Soon as I put my phone the extent that he could not help people the way he on, I had a call from a neighborhood friend who told me wanted to, and he was worried”. my husband was found hanging in his room! Having economic power to be in control was prior- It is difficult to directly ascertain the actual reason itized over the very persons control was to be exer- for Danso’s suicide. However, the suicide, coming cised on. As seen in the case of Kwabena, having the immediately on the heels of spousal inability to child at a relatively older age was not enough to respond to a financial request, could be construed compensate for the loss of work just as Gbotei was as a controlling behaviour. This is because the equally worried he could not help others any longer spouse recounted previous instances where the even though he had a supportive wife and children. deceased threatened to take his life as a way to extort money for drinking, thus: “He has threa- tened to kill himself before when he needed Regaining control in dependent relational money and I could not give him. Even if you give context: The paradox him money, the sad thing is that he will use it to mess himself in drinking” (spouse). It is documen- The theme captures various ways the men who had ted that when some men are unable to achieve fallen to dependence sought to gain control in that desired results through controlling behaviours, context. Their determined effort to reassert control they seek a way to re-establish both the gender saw them engage in masculine performances that order and respectability through such acts as vio- rather undermined their resources and heightened lence (Gibbs et al., 2014). In this case of Danso, the both intra and interpersonal conflicts. This is mostly found in the situation of those with wives and violence appears to have been turned inwards- children. towards the self. A prolonged stay in joblessness contributed to contin- Another man called Kwesi (aged 36) also fell to ued dependence on economic viable spouse mostly. total dependence on his wife, but had extreme diffi- However, these men engaged in practices which they culty living in that condition. Not only did he openly might have perceived were essential for regaining some voice his disquiet about relying on spousal support, control. Danso’s spouse had this to say he at times lied, or found unorthodox means of extracting cash in attempt to save face. The wife said “Any time I returned from work he would be stalking me to see where I will put my money so he can take it “I gave him money so that he would not be worrying and use for drinking. He would not do any work and too much. One day he wanted to go out and rebuild when you have worked and you give him food, he his collapsed workshop, I searched his pocket and will not eat what you have served him. Even the there was no money so I asked him if he had money that I had kept for the upkeep of the kids, money and he said yes. I asked him to show me the he would take it and go and mess himself with it. At money he claimed he had. He only told me the night too, he would not let me sleep (excessive money was somewhere“ INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING 11 The wife further shares men and close relations prior to the men’s suicides. Findings reveal a transactional social system in which We saved our monies in different banks so some- times, I gave him my money for safe keeping but the men’s social identity crisis was occasioned by because of these problems, he withdrew all the cash changing fortunes in the sphere of economic control. including mine which was with him for safe keeping. The situation paradoxically contributed to a situation The very Friday when he died, he withdrew cash and where total dependence for survival contributed to sent to his mother. So according to those who found emotional difficulties. The men’s attempt to salvage him at the time of the incident, he had 100GHC in his the situation saw them engage in masculine perfor- pocket that was after he had sent either 100 or 200 GHC to the mother. He was the only child of his mum. mances which, in turn, diminished their personal and The bank receipt for that transaction was inside his social resources. pocket when he stabbed himself”. Putting this contextually, the social ethic of socie- Though he underwent extreme financial difficulties ties in Ghana enjoins family members, and most espe- and depended solely on a spouse, his strategy for cially, biological parents to nurture the growth of regaining control included being manipulative of the children through provision of material and emotional wife and taking unilateral decisions in spending family support. The aim, among other things, is to raise finances and even finances belonging solely to the responsible adults, who can competently live on spouse. Prior to his death, and being the only son of their own, as well as being sources of mutual support his mother, he felt a strong need to remit his mother for both older and the younger members of the as a way of reasserting control and preserving image society. Care provision is also seen as social insurance of a provider in that context, and in line with the in that when children are raised and become success- reciprocal obligations children are enjoined to have ful, they will in turn, be obligated to also care for their for their aged parents. benefactors (Andoh-Arthur, 2011). This value, border- For Kwabena, when he realized that wifely depen- ing on reciprocal obligations, is enshrined in the pop- dence was no longer sustainable, due to the precar- ular adage that “wona ahwε wo ma wose efifir a, wo so ious economic situation of his wife at the time, he hwε no ma ne se nfifir.” (if your mother cares for you to compelled the wife to engage in romantic solicitation grow teeth, you are also to care for her till she loses all on social media in order to get money to meet his her teeth). Within the communitarian context, and medical bills. She admitted especially within the matrilineal societies of Ghana, mother, in the above proverb is a metaphor for “We did all these just to get some money for his adult carers since it is believed that a child is every- upkeep. One day, a social media friend I was soliciting one’s child (Nukunya, 2003). Thus, dependence is help from proposed the idea of me joining him in his country. My husband threatened me that I should not a default relational system for every young person leave him and go anywhere. growing up. However, as children grow up, gender role socialization during adolescence guide boys and In the case of Gbotei, 47, his wife alluded to his open girls towards feminine and masculine practices. Key remonstration over his continued dependence and among these practices is an orientation for boys the apparent role reversal that had taken place “He towards shelving dependence to an independence felt that due to the problems he was going through, ethic (Gyekye, 1995; Nukunya, 2003). As alluded to there were some responsibilities I was not supposed earlier, a young boy who returns home to complain to do as a wife that I was doing and all of those things of having being beaten by peers receives opprobrium got him worried” (spouse). and is requested to be a boy by fighting back, an The theme reveals extreme inner struggle in these indication that he should be in control of his own men who perceived limited options as far as existen- affairs. tial survival was concerned within the context of mar- In this study, young men (n = 2) who were riage. They had to live with and on their economically depending on close family members encountered viable spouses, however, the pressure to breakout of problems relating to the collision of autonomous the cycle of dependence appeared to have pushed quests and meeting of obligations inscribed within them to resort to masculine practices, which increas- the dependent relational context such as obeying ingly compounded their inner struggles and also instructions from carers and meeting family chores. heightened interpersonal conflicts with those Gender demarcation in household chores reinforces spouses. an idea in some boys that certain chores are emas- culating, and that boys who go out of their way to Discussion execute them are merely helping rather than see them as duties consistent with observations made This study aimed at examining how loss of economic by Adomako Ampofo and Boateng’s (2007) study. control inscribed the interpersonal relations between From early adulthood to middle adulthood, being 12 J. ANDOH-ARTHUR in control of one’s life is highly valorized and is also 2017). A number of qualitative studies have also a precondition for exerting power and influence in thrown light on this observed link including Stack the immediate family community context (Nukunya, and Wasserman’s (2007) study which found proximal 2003). The status of independence not only grants risks to male suicides to include loss of income and affordances enhancing a man’s social and symbolic job-related problems. The importance of work pro- capital, it also obligates a duty to interconnect with blems to suicides is also highlighted in the sociologi- others in a mutually beneficial ways. In that transac- cal autopsy into men’s suicide in the United Kingdom tional loop, social embeddedness through provision (Scourfield, 2012, Shiner et al., 2009). For societies in of support to others and being dependent on is Africa where strong patriarchal systems exist in the exchanged for social recognition. midst of weak to no welfare policies, the loss of job Work occupation, marriage and family making pro- with attendant loss of income poses much greater vide safe arenas for enacting these practices towards risks for men (Adinkrah, 2012). becoming a real man. Job losses of three men, con- Economic and material provision for one’s family is tributing to continued dependence on family rela- a crucial obligation for men and constitute successful tions in some cases, heightened conflict with close male identity in Ghana. Contrastingly, where women relations due to perceived burdensomeness while in function as economic providers (as in the situation of others, the men socially withdrew prior to suicides. role reversals)—such men are described as “useless For the men who were married and had children, man” (כbarima hunu) and may be subject to social marriage and family life context served as direct are- stigma (Adinkrah, 2012, Adomako-Ampofo, Boateng, nas for achieving ultimate status of masculinity, i.e., 2007). Failure to carry out socially expected obliga- patriarchy: provision, procreation, and power to con- tions and roles are viewed as instances of personal trol others. For these men, accounts of success in their irresponsibility, callousness, or generally vicious char- relational context were framed in the past when they acter and often lead to feelings of shame and even- recorded successes in occupational domains. That is, tually suicides (Adinkrah, 2012, Kong, 2021). these men not only were in control of their own lives Male suicide in Ghana, according to Camilla Kong but also used the economic power derived in occupa- (2021) highlights a complex, potentially contradictory tional successes to support close family members. web of communitarian values that are thought to be They were therefore benevolent patriarchs in the central to African personhood, that is, what it means to past and sought to maintain this social image even be identified and recognized as a person with a certain in the present. However, job losses threatened control moral status. Not fulfiling the criteria of personhood is and weakened support networks for some. morally blameworthy because it is antithetical to nor- It is worth noting that the job loss presented two mative orientation towards oneself and one’s commu- possible outcomes to these men: to either bounce nity (Kong 2021). It appeared that the men in this study back to economic control (regain control) or regress valorized the benevolent patriarch identity and therefore to a state of total dependence on economic viable felt strongly impelled to live it; consistent with interna- relations (lost control). Unfortunately, the former was lized masculine norms to provide. However, the loss of not the case for any of the men whereas the later was job and job crisis occurring prior to their suicides con- the case for all the men; i.e., total dependence on strained them from doing so. The situation might have economically viable relations. This created a paradox presented discrepancy strain to them in line with Pleck because while depending on economically viable (1995). Distresses faced prior to their suicides seemed to spouses had a key existential value, it appeared to have been occasioned by perceived loss of respect, have also created existential angst in the men. The social abandonment, and social anxieties that were all latter pushed the men to attempt regaining control connected to problems with one of the crucial social through substance use, conflicts with spouses and expectation that defined their identity as men: to pro- other close relations, and suicides, some of which vide. Even though ready support was made available for appeared to have been a direct action against spousal some of the men by their families, there were also refusal to acquiesce to their demands, attempt to instances where some of the men felt abandoned dur- reassert power or escape from existential frustrations. ing their crisis. Within such a transactional social sys- These findings of the association between financial tems, the implicit rule for some (such as the families that difficulties, unemployment and job crisis and male abandoned their men) is that men are as important as suicides are consistent with previous studies. At the their ability to provide for others despite their life cir- ecological level, increases in male suicidal behaviour cumstances. Such thinking goes against the grain of the have been linked to periods of economic uncertainty humanistic ethic to support persons in need within (Richardson et al, 2021; Vandoros et al., 2019). Further, communitarian societies (Gyekye, 1995). Consistent a systematic review also found links between job loss, with Kong (2021), male suicide in Ghana reveals the debt and financial difficulties and elevated risk of incoherence within the communitarian conception of mental illness, self-harm and suicide (Moore et al, personhood. That is, the motivation for male suicides is INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING 13 not men’s repudiation of social responsibility or disre- (2005) that more than one kind of masculinity exist gard for the community. Instead, “it is an intense sense concurrently in societies (Connell and Messerschmidt, of personal responsibility towards meeting prescribed 2005). The implication is that depending on the con- social norms and roles associated with gender” (p.89). text of their peculiar experiences, individual men can Seeing the above from the interpersonal theory of sui- be variously defined by the fact of their socioeconomic, cides (Joiner, 2005), the men in the study might have class, sexuality, race, and cultural circumstances in ways perceived being a burden on others given their contin- that may increase or decrease their vulnerabilities to uous dependence. Increased sense of alienation and suicide and not just because they are men. isolation due to their circumstances, and presumably, Men should therefore not be treated as their acquired capability to harm themselves, through a homogenous group and individual men not defined previous suicide attempts, substances use behaviours, by changing economic circumstances of their lives. etc., could have heightened both the desire and ability Rather, they should be defined by the intrinsic worth to die, in line with Joiner (2005). An intense psychologi- of being humans; beings who are not impervious to cal ache might have been unbearable for them for life adversities but can be assisted to overcome adver- which reason they might have resorted to suicide as sities. Societies and families must be there for men in a way to escape (Shneidman, 1985). economic adversities just as men are also expected to It is important thus to view suicides generally, and contribute to the family and societal good in good male suicides more specifically as a crisis requiring help times and should see nothing wrong about depend- rather than a crime requiring punishments. However, ing on close relations in times of economic adversity. within male crisis discourses, conservative narratives This symbiotic relationship ought to remain inviolable position high male suicide rates as a pernicious out- at all times. Perhaps, the finding of this study should come of “threats” to traditional gender roles and inspire the need for critically interrogating the phe- norms, with its prescriptive return to these traditional nomenon of gender paradox of suicidal behaviours gender norms as solution to male crisis. Contrastingly, within cultures. It is documented that prior suicidal progressive crisis accounts use male suicide to demon- attempt is a single most important risk factor to sui- strate that existing gender norms harm some men as cides (WHO, 2014). For many countries, females dom- well as women and argue for alteration of these norms inate in depression and suicide attempts: key risk to address male suicide (Jordan and Chandler, 2019). factors for suicides. One of the explanations for the Following the progressive accounts, Kong (2021) has higher attempts and lower suicides rates in females is suggested Critical Sankofa as an analytical resource for the tendency for females to seek professional help for understanding and addressing disruptive masculine depression, especially mild to moderate depression norms that paradoxically underlies high male suicides (Moscicki, 1994, Shi, Yang, Zhao, et al., 2021). The in Ghana. As an Akan Adinkrah symbol: Sankofa is higher suicide rates in men, particularly in times of often depicted as a mythical bird flying forward while economic adversities as found in this study, may looking back, and is denotative of the idea that “going reflect underlying distresses men face in such situa- back to what is forgotten is not morally wrong”. In tions, distresses the symptoms of which might not other words, sankofa communicates the “philosophy directly map onto existing diagnostic criteria for of retrieving lost or forgotten gems from the past as depression. Societal expectation for men to restrict one moves forward; it involves reclaiming parts of emotions embedded in cultural scripts such as “obar- African practice, history, and standpoints that have ima nsu” (a man does not cry) might lead some men been hidden or distorted” (Kong, p.89). Critical to find maladaptive ways to express and cope with Sankofa, according to Kong, is “a process of reclaiming their underlying distresses as Felicia Garcia (2016) also cultural values through the critical evaluation which found in her ethnographic study of Irish men. leads to the reflective endorsement or rejection of This study makes a strong recommendation for clin- past practices or traditions” (p.90). In other words, icians to be innovative and flexible in creating empa- critical sankofa involves the reflective sifting through, thetic relationships with male clients towards getting refining and pruning of, different aspects of the cultural them to disclose and cope with underlying problems. past, to determine whether it warrants a place in the Further, the study strongly argues for a broadening of current scheme of things” (p.90). Guided by Kong’s masculinity conceptions beyond narrow conceptions of thesis, this study calls for social changes in the way material provision, sexual performance, procreation, societies in Ghana and similar contexts construe men, and protection to include norms that give men several masculinity and personhood in general. Worth noting possibilities of being men irrespective of social and life within the progressive crisis discourse is the need to circumstances, including being involved parents, seek- situate suicide generally and men’s suicide more parti- ing help and depending on others when in crisis, dis- cularly within intersectional frameworks. This is closing emotional vulnerabilities among others. While because some men and not all men engage in suicidal all strategies may be helpful, this study also suggests behaviour in keeping with Connell and Messerschmidt the need to introduce or widen existing social welfare 14 J. ANDOH-ARTHUR programmes towards practically assisting men who some men who identify strongly with the traditional may find themselves in economic and financial chal- masculine norm of providing, depending on others lenges. This study, though focused on nine men, and emasculates and heightens distress. Thus, the social may thus not represent the experiences of all the men expectation of men that is connected to men’s social in Ghana who may undergo similar experiences of identity constitutes a key risk factor for suicide for economic challenges, insights shed can prompt action men who may be constrained by life adversity. This that can help prevent suicides among males in such author strongly recommends public health circumstances. approaches to male suicide prevention efforts in Ghana and in similar sociocultural contexts. Particularly, exposing the dangers in prevailing mas- Reflexivity culine norms and promoting broader and yet more The author is a Community Psychologist who values constructive norms including emotional expression, studying human behaviours within contexts. His back- help seeking, alongside practical economic interven- ground may be seen in the foregrounding of the struc- tion for men suffering economic difficulties could be tural challenges and how they shaped relational protective against suicides in men dynamics and the suicides. This perspective, however, does not in any way reduces the deceased men, and the Acknowledgments bereaved persons to cultural sponges who just imbibed what the culture and the social structure imposed on The author wishes to thank the personnel at the Homicide them. Rather, the author ascribes agency to the Unit of Ghana Police Service (Headquarters) for assisting in deceased men and the participants of the study and the data collection. Special thanks go to the family and relations of the deceased persons. Without their voluntary viewed both as active participants who shaped and participation, this study could not have been possible. The were shaped by the social context within which they Author also wishes to express his sincere appreciation to the lived. Again the Author being a Ghanaian just like the Norwegian University of Science and Technology (NTNU), deceased men and the bereaved, his interpretation Trondheim, Norway, for funding the Ph.D. research, not could be bound up in taken-for-granted assumptions forgetting the Author’s Ph.D. Research Supervisors and col- leagues for the invaluable support during the research on on men, masculinity, and suicide. Notwithstanding his men’s suicide in Ghana. To the Anonymous Reviewers of the background, relying on some colleague experts in qua- Article, your painstaking and critical review of earlier ver- litative science (who were both Ghanaians and non- sions of the manuscript cannot be left unacknowledged. I Ghanaians) to put critical questions to the analysis at say Thank you. various stages helped the analytic process considerably. Disclosure statement Conclusion No potential conflict of interest was reported by the author(s). Economic control and power remain the bedrock of the patriarchal systems in Africa. In Ghana, socially Funding prescribed norms for masculinity include provider roles, being in control, and remaining independent. This research received support from Norwegian University The current study has highlighted the transient and of Science and Technology (NTNU), Trondheim, Norway. slippery nature of masculinity in the Ghanaian con- text. The author argues that the transactional social Notes on contributor arrangement in Ghana heighten some men’s distress Johnny Andoh-Arthur is a Social and Community and elevates suicidal risks when such men lose eco- Psychologist and a Senior Lecturer at the Department of nomic control. Failure to regain control contributes to Psychology of the University of Ghana. He researches and the state of depending on others, which in itself publishes on mental health, suicide and suicide prevention appeared to be reinterpreted negatively thus heigh- within cultural contexts (particularly among young persons tening distress. The economic challenges produce and men). He obtained his PhD in Health Science and MPhil paradoxes of interdependence and dependence in in Human Development (with specialisation in Community Psychology) all from the Norwegian University of Science that the interdependent social ethic enjoins persons and Technology (NTNU), Trondheim, Norway. He obtained in crises to disclose or seek help from close relations, his Bachelor’s Degree in Psychology with Political Science yet for some men, doing so often draws social taunts, from the University of Ghana. He is a Research Fellow at the which further taints the social image of these men Centre for Suicide and Violence Research (CSVR), Ghana, and contributes to suicides. While depending has and the Founder of Community and Life Empowerment Advocacy Network, Ghana (CLEAN-GH)- a non-profit organi- existential value for men in such crises, and there zation dedicated to building a network of young persons are some families who are well disposed to providing who transcend the ‘self’ to support persons in various psy- help for men in economic crises, it appears that for chosocial distress. INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING 15 Contribution to the field statement Andoh-Arthur, J., Hjelmeland, H., Osafo, J., & Knizek, B. L. (2018a). Walking a tightrope: reflections on police gate- The link between economic challenges and males suicides is keeping roles in suicide research in Ghana. International documented in the literature, yet, how such challenges influ- journal of social research methodology, 21(3), 289–301. ence men’s relational contexts, and subsequently create https://doi.org/10.1080/13645579.2017.1381820 a dynamic shaping their suicides is often ignored. This study Andoh-Arthur, J., Hjelmeland, H., Osafo, J., & Knizek, B. L. explored the experiences of 9 men and their relational (2020). Substance use and suicide among men in Ghana: encounters following economic challenges prior to their sui- A qualitative study. Current Psychology, 1–13. https://doi. cides in Ghana. Findings reveal that the men’s social identity org/10.1007/s12144-020-00644-0 crisis was influenced by inability to meet their own needs and, Andoh-Arthur, J., Knizek, B. L., Osafo, J., & Hjelmeland, H. in some instances, that of their dependents due to changing (2018b). Suicide among men in Ghana: The burden of economic circumstances. The situation paradoxically contrib- masculinity. Death Studies, 42(10), 658–666. https://doi. uted to a situation where dependence for survival contributed org/10.1080/07481187.2018.1426655 to emotional difficulties. The men’s attempt to salvage the Barker, G., & Ricardo, C. (2005). Young men and the construc- situation saw them engage in performances including inter- tion of masculinity in sub-Saharan Africa: Implications for personal conflicts, substance use, sexual performances and HIV/AIDS, conflict, and violence (p. 27). World Bank. stalking of spouses. These, in turn, diminished their personal Bilsker, D., Fogarty, A. S., & Wakefield, M. A. (2018). Critical and social resources prior to the suicides. This study thus issues in men’s mental health. 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