New Ideas in Psychology 60 (2021) 100836 Available online 20 November 2020 0732-118X/© 2020 Elsevier Ltd. All rights reserved. Discussion Conducting a qualitative research on suicide in Ghana using Interpretative Phenomenological Analysis (IPA): A reflection after a decade Joseph Osafo Department of Psychology, University of Ghana, Centre for Suicide and Violence Research (CSVR), Ghana A R T I C L E I N F O Keywords Qualitative research Interpretative phenomenological analysis Ghana Suicide A B S T R A C T Interpretative Phenomenological Analysis (IPA) set of guidelines allow a researcher to gain access to the meaning of a phenomenon (e.g. suicide) through the individual person’s lived and personal experiences. In this paper I have discussed that the ethical challenges that confront researching suicide in Ghana the challenges of pursuing an idiographic rigor using the IPA may arise from the pervasive normative self-construal within Ghanaian communities. Though I admit the IPA has been useful in various studies within the African context, I have also interrogated such idiography within the normative social arrangement of such setting where sociocentric per- spectives abound. This essay is a reflexivity on the IPA in a normative context after a decade, where suicidal behaviour is strongly proscribed and personhood is deeply shared. I have recommended that one way of addressing this challenge is to use a ‘funnel’ approach in interviewing from the general: the community, to the particular: the individual. 1. Brief overview of suicide in the Ghanaian cultural context Suicide is culturally and legally proscribed in Ghana (Hjelmeland, Akotia, Owens, Knizek, Nordvik et., al. 2008; Osafo, Akotia, Boakye, & Dickson, 2018). Several studies from various groups of people have consistently reported generalized negative attitudes towards the act and the suicide attempt survivor (Osafo, Akotia, Quarshie, Boakye, & Andoh-Arthur, 2017b; Eshun, 2003; Hjelmeland et al., 2008; Osafo, Akotia, Andoh-Arthur, & Quarshie, 2015; Osafo, Akotia, Ando-Arthur, Boakye, & Quarshie, 2017a; Osafo, Akotia, Boakye, & Dickson, 2018), Suicidal death brings serious social consequences to families through social stigma (Osafo, Knizek, Akotia, and Hjelmeland, 2011b; Osafo, Hjelmeland, Akotia, and Knizek, 2011c; Hjelmeland et al., 2008). Accordingly, there is an abysmal burial and funerary rites accorded to persons who die by suicide (Adinkrah, 2016). Families thus generally do not report suicidal death as a measure to safeguard their reputation (Adinkrah, 2012). Two major meanings of suicide have been observed in Ghana: moral transgression and life crisis (Osafo, Akotia, Hjelmeland, & Knizek, 2017c). Adinkrah (2016) has opined that the preponderance of the former is strong and deep, and that any effort toward decriminal- ization of attempted suicide, will be dependent on a fundamental change in the cultural attitudes towards the act in the country (Figs. 1 and 2). This paper is a reflection on suicide research in Ghana after a decade, using Interpretative Phenomenological Analysis (IPA). In qualitative research, the reflective capacity of the researcher about the fieldwork is an essential part of the discovery rather than a source of disturbance (Flick & von Kardoff, 2004). This reflection is thus placed within the purview of ethical and theoretical reflexivity of using IPA to examine a socially sensitive topic in a largely proscriptive cultural setting. 2. Epistemological and methodological groundings of qualitative study of suicide in Ghana The meaning of suicide, a key aspect in the definition of suicide acknowledged by most suicidologists, has been viewed as dynamic, culture-driven and thus crucial in suicide prevention (Boldt, 1988; Hjelmeland, 2011; (e.g., Boldt, 1988; Canetto, 2008; Colucci, 2006; Hjelmeland, 2011). Setting out to pursue ‘the meaning of suicide’ from a cultural perspective indisputably establishes an epistemological preference-qualitative approach over quantitative approach (Hjelme- land & Knizek., 2010). This is because the epistemological principle of qualitative research is the understanding of complex relationships rather than cause-and –effect relationships(Flick & von Kardoff, 2004). Suicide is a complex issue (Silverman, 2006), and since the researcher is not interested in how many and what kinds of people share certain char- acteristics, but aims to gain access to the cultural categories and as- sumptions according to which one culture construes the world (in this context, interprets suicide), the qualitative method was considered most E-mail addresses: josafo@ug.edu.gh, josaforo@gmail.com. Contents lists available at ScienceDirect New Ideas in Psychology journal homepage: http://www.elsevier.com/locate/newideapsych https://doi.org/10.1016/j.newideapsych.2020.100836 Received 7 April 2020; Received in revised form 30 October 2020; Accepted 4 November 2020 mailto:josafo@ug.edu.gh mailto:josaforo@gmail.com www.sciencedirect.com/science/journal/0732118X https://http://www.elsevier.com/locate/newideapsych https://doi.org/10.1016/j.newideapsych.2020.100836 https://doi.org/10.1016/j.newideapsych.2020.100836 https://doi.org/10.1016/j.newideapsych.2020.100836 http://crossmark.crossref.org/dialog/?doi=10.1016/j.newideapsych.2020.100836&domain=pdf New Ideas in Psychology 60 (2021) 100836 2 appropriate. According to Hjelmeland and Knizek (2010), if we want to understand suicide as a phenomenon, then qualitative methodology is very relevant. 3. IPA guidelines and ethical dilemmas in the Ghanaian cultural context The use of semi-structured interviews as data collection instrument was consistent with the IPA epistemological grounding that posits that the individual’s lifeworld can be explored. A flexible data collection instrument such as the semi-structured interview, ties in well with the IPA (Smith and Osborn, 2003) as it facilitates rapport, empathy, flexi- bility of coverage and ultimately leading to the production of richer data. However, the cultural context which proscribed suicide, coupled with the IPA idiographic perspective through the use of semi-structured interviews engendered unique ethical dilemmas in this cultural context which are discussed below. First, was the situation whereby some informants used the interview as a means of ventilating an emotional problem. They thus seemed to have provided their informed consent in order to get interviewed so they can share their problems. During interview, they expected a solution from the researcher who was also a health professional. According to (Johnson & Clarke, 2003) in such a situation, training and experience will provoke a need in the researcher to intervene; and this was my experience. Attempting to intervene however, further muddied the ethical domain, as it placed the interview within a doctor-patient rela- tionship, breeding power asymmetry problems. Closely linked to the above was the issue of seeing the researcher as a ‘first-time-caregiver’ by some informants who have suffered emotional distress in intimate relationships (especially young women; the researcher was a male) and have as a result attempted suicide and suf- fered stigma. To such, offering a tissue as they sobbed, reflecting feel- ings, and informing them of an arrangement to help them discuss their emotional problems with a qualified counselor/psychologist was mis- construed as emotional cues of fondness from the researcher. Consistent with the IPA epistemological guidelines, to foster empathy during interview, the researcher had attempted to develop close ties with informants in order to understand their lifeworld (Flick & von Kardoff, 2004), but at the same time maintained a degree of social distance. Nevertheless striving to maintain this balance was a great challenge (Scott et al., 2008) given the socially vulnerable condition of some informants in this context. For instance satisfying the full requirement of ethics of care which focuses on care, compassion, and relationships (Israel & Hay, 2006) became difficult in such a cultural context. Second, during debriefing, some informants indicated that the interview had exhumed painful memories. This further throws open the debate of the implicit assumption that informants might find it benefi- cial to talk about their experiences when someone is listening (Johnson & Clarke, 2003). What was worse was the refusal of some of such dis- tressed informants to seek help from an already arranged psychological care service because of social stigma. The ethical dilemma then was “how helpful has this research been to some informants?” Beyond the ethical challenges, the heuristic value that emerged from the seeming clash of the use of the IPA (with its idiographic proclivity) in a cultural context with a normatively driven self-construal was revealing. This is further discussed in the next section. 4. The epistemology of the IPA in a normatively- oriented cultural context Following the IPA theoretical guidelines, the epistemological stance of the researcher stemmed from the fact that the individual person was seen as having a stock of subjective knowledge (Schutz, 1964) about suicide that needed to be explored. This knowledge corresponds to what (Flick, 2006) has called the subjective theory that posits that informants have a complex stock of knowledge about the topic under study. For instance, informants have their own ‘theory’ of the meaning of suicide and can express this in a face-to- face interview. The IPA was developed with the aim of exploring how a person makes a sense of his/her personal and social world, and the meaning/s particular events hold for them (Smith, 2004; Smith & Osborn, 2003). Its theoretical grounds are rooted in Husserl’s phenomenology that at- tempts to construct a philosophical science of consciousness, with her- meneutics and symbolic-interactionism which hypothesizes that the meanings given by a person to events are of paramount concern, but can only be accessed through an interpretative process (Biggerstaff & and Thompson, 2008). The IPA is rigorously idiographic; starting with a detail examination of an individual case and reaching a gestalt (Smith, 2004), before moving to analysis of other cases. Thus to understand a phenomenon, in this case-suicide, one needs to have an individual or pool of interviewees to share their experiences about the phenomenon (Fade, 2004), and explore what it means to each of them. The meaning (s) each individual assigns to suicide, will then be constructed and categorized to represent the groups’ view. In that sense the IPA assumes epistemological stance that, through careful interpretative methodol- ogy, we can delve deeper into the cognitive world of the individual. Thus, the researcher examines the individual’s view as doorway to the groups’ view. Diagrammatically, the epistemology might look like this: (Fig. 1). However, during interview, and the process of analyzing transcripts, a normative response to issues concerning suicide emerged. Informants tended not to speak their ‘personal’ view, but the view of the ‘social group’ on what suicidal behaviour means to them. Thus the individual as rational, conscious agent whose view on suicide was needed from the first-person perspective (Ashworth, 2003) was not seen much. For instance. questions such as “how do you as a person view suicide?” [ to wit, Twi: kyerϵme wadwen fa akomfohyϵ ho] received a response such as “in Ghana we detest suicide” (emphasis mine) [to wit, Twi: Ghana ha deϵ yekyi akomfohyϵ]. If the IPA epistemological orientation is aimed at understanding the individual, then this finding may reflect a fundamental divergence in the way an interdependent cultural group (i.e. Ghanaians) views a person in relation to issues that are perceived as culturally negative or sensitive- suicide. A parallel finding has been reported by Mugisha et al. (2014) in their study on attitudes towards suicide among the Baganda in Uganda. In this report they argued that throughout the four discourses on suicide: long-term illness, failed love affair, death of a loved one and loss of property, informants struggled to articulate the individual view as the communal view often superseded the former. The concepts of self and identity have increasingly received attention in the social psychology literature, with theory development and empirical research springing from both psychological and sociological social psychology (Dietz, 2006).Through cross-cultural work of an- thropologists and psychologists, a distinction has been created between the independent self and the interdependent self. People who are raised in cultures with highly individualistic values are hypothesized to tend to develop a view of self as an independent agent, while those raised in cultures with highly collectivist values are hypothesized to develop a view of self as interdependent with others (Dietz, 2006). The interde- pendent self cannot be separated from others and the social context; it is the self-in- relation-to- other that is central in the individual experience (Kitayama & Markus, 1994). In an interdependent context, conformity is necessary and important as personal thoughts and opinions are sub- merged for the purposes of promoting group harmony (Kitayama & Markus, 1994). Individuals in such context are motivated to adjust to and fit with the expectations of socially meaningful others (Morling, Kitayama, & Miyamoto, 2002). African philosophers (e.g. Ikuenobe, 2006; Gyekye, 1996) have expressly indicated that the African sense of personhood is the moral person who is normatively driven, and upholds the communal ethos, and not just the rational, liberal, individualistic person. Ikuenobe (2006) J. Osafo New Ideas in Psychology 60 (2021) 100836 3 explicitly captures it by saying that: “it appears, therefore, that in African cultures, the moral or social account of a person is logically or conceptually prior to the meta- physical account of a person, as opposed to the modern Western philosophical tradition where the metaphysical account of a person as the thinking, rational, autonomous, free individual is logically prior to the moral account as someone who may be shaped by a community” (p. 55). The awareness of a community-driven moral self is readily acces- sible, and thus possibly, the informants in this context, during interviews talked about suicide as moral agents whose sense of community and normative life make them define suicidal behaviour by the moral prin- ciples and expectations of the community. For instance, an extract from one of our studies illustrated the prior status of normative view over personal view thus, “Suicide is a taboo, and if the chief and our leaders see it as a taboo, we are all going to follow that. Me, in my own view, I see it as a taboo” (Andoh-Arthur, Knizek, Osafo, & Hjelmeland, 2019). Thus, it becomes imperative that if suicide is communally abhorred and even leaders of the community-the custodians of communal norms, hold such views, the individuals also have a moral responsibility (as members of community) to also subscribe to the normative view. As observed in Uganda by Mugisha et al. (2011), the decision to remain silenced about suicide among the Baganda is driven by sociocultural understanding surrounding the act. That is an alignment to the communal ethos which defines you as a moral person who fits well into the community. This self-construal could be best described in the words of Battaglia, (1990) as ‘the self-defined and experienced through an array of significant re- lationships with others, past and present, living and dead’ (p.188), and consistent with Mbiti’s (1989), the self-construal of the African can be summed up in this statement “I am because we are, and since we are, therefore I am” (p.106). Within the Ghanaian context, Assimeng (1999) has argued that there is strong probability that the traditional Ghanaian person is probably accomodationist who may “wish things to remain as they are, and exhibit considerable caution in cases of serious disruption of the status quo; the policy here is to adjust oneself to the social order…” (p. 115). Several socio-cultural beliefs, values, and practices foster normative living in Ghana. One of such is belief in ancestors. In traditional Gha- naian cultures (for instance Akan-the dominant ethnic group), reference is made of a community of dead forefathers (ancestors) as exercising a binding force on the life of the community of the living (De Witte, 2001). They are believed to possess some mystical powers and authority to positively or negatively influence the well being of family members. Members within the kinship therefore act in accordance to the believed requirements of the ancestors in order to avoid incurring their displea- sure. The kinship system goes beyond the nuclear family. According to Nukunya (2003) it is the totality of relationships based on consanguin- ity, affinity, and adoption, that determines the rules, duties and obli- gations of individuals and groups in all aspects of life. The Ghanaian family structure is described by (Assimeng, 1999) therefore as an eco- nomic, emotional, and social insurance corporation, and people could opt out of this corporation but at their own risk. Furthermore, a plethora of proverbs extol the relevance of commu- nity way of life and living; justified on grounds of essence of humanness, cooperation, coping and others. Some of such proverbs, culled from Gyekye (1996) are: ‘When a person descends from heaven, he or she de- scends into a human society’. This means that social relationships are essential for every human being and thus no one in isolation can func- tion adequately in the social context. Another is ‘One finger cannot lift up a thing’. This also means that the individual requires the relationship and the cooperation of others for most of his/her pursuits in life. According to Gyekye (1997) how much sensitivity an individual demonstrates to the needs and welfare of the group is a key feature of the normative social arrangement in Ghana. Against the aforementioned, if informants consider suicide as a taboo, with an accompanied oppressive stigma, then within a norma- tively driven interdependent context, they may bracket-off the personal self and rather elevate the moral and social self (Mugisha et al., 2011, 2014). However, this appears not to have been the case in all cases as, in some of our studies, we have found individuals assert a position that is counter to the normative view thus, “We don’t see it as a taboo. We rather see it as something he wished for, did it and died. More so, no one has killed himself [sic] in the family before”. Personal agency is ascribed to the decision to kill oneself even though that decision appears not to have been circumscribed within the communal norms. While this con- stitutes an aberrant behaviour, which, in the conceptual scheme of the community, constitutes a condemnable behaviour, the informant in this extract however, chooses to place the evaluation of the act outside the normative lens, citing the perceived novelty of the act in the community as a justification for the counter position. What is interesting, and yet also illustrative of the aforementioned points, however, is that for rea- sons best known to the informant in question, this counter position is placed within a “we” rather than an “I” discourse. 5. The epistemological question The sociocentric self-construal of the context of participants as dis- cussed above has implications for the use of the IPA. From the communally driven perspective of self-construal, an IPA approach aimed at exploring the ‘lifeworld of individuals’; the rational, liberal person about the meaning of suicide, may rather end up exploring the ‘life- world of the social group’. This may present a challenge to the idio- graphic theoretical leaning of the IPA. What suicide (a socially sensitive issue) means to the rational individual may not clearly emerge during interviews, but rather what it means to the group, the community as represented diagrammatically below: (Fig. 2). This raises an epistemological question in the IPA as seeing the rational individual as the centre of the social universe, rather than the group. How ‘pure’ can an individual view of suicide be in such Fig. 1. Individual’s view as doorway to the group’s view J. Osafo New Ideas in Psychology 60 (2021) 100836 4 sociocentric context? Though there are many positive aspects of qualitative research, it has suffered many criticisms for lack of objectivity and generalizability (Myers, 2000). Whilst generalizations claims in quantitative methods are explicit, they are less explicit in qualitative methods (Payne & Wil- liams, 2005). The normative meaning of suicide in this study however does resonate with the fact that indeed, generalization in qualitative research is possible. In the context of a cultural study that focuses on the individual (but ends up largely observing normative positions), a per- son’s (‘I’ or ‘my/mine’) view of suicide could actually mean the “we” or “our” view (the community view) of the act or phenomenon. Plausibly, the phenomenon of suicide creates a cultural trauma or moral panic, because they are fundamental to the values that define a people. For such reasons, they can be seen as important and critical to community survival, that asserting an individualistic view against it gives one out as acting counter to norms, with its many ramifications. Further, perhaps the issue may be about people being afraid or being constrained to assert individual views on such perceived extraordinary moral evil (Twi: musuo) that brings suffering to the whole community (Gyeke,1995). If that is plausible, then one can posits, that in the Ghanaian cultural context, views on certain socially sensitive issues (such suicide) are already generalized. As indicated by Smith (2017), certain dominant forms of truth within context can shape particular forms of knowledge. If the few are speaking a ‘dominant view’ then what they say could represent the ‘larger and general view’. As argued by Haug (1987), if “a given experience is possible, it is also subject to universalisation’’ (p. 44). In this instance the given experience is already normative and thus could be generalized. Thus, in the African (and thus Ghanaian) context, the experiences of participants we have engaged with in various suicide interviews can be argued to be fully socially constructed and hence we can agree with Kippax and colleagues that “each individual mode of appropriation of the social … is potentially generalisable” (Kippax et al., 1988: 25). The points made above do not in any way suggest that IPA offers no prospect for suicide research in Ghana or beyond (within the African setting). In fact, on the contrary IPA has been very useful in examining sensitive issues within the region. For instance, IPA has been useful in examining suicide among Acholi men in post conflict central northern Uganda with results showing that psychosocial factors intersected with various paternalistic and hegemonic masculinity to create in men feel- ings of disempowerment, loss of self-worth and social value that influ- enced their suicidal behaviours. This was such an important study that unearthed contextual cultural factors in the scheme of suicide within a sensitive context (Kizza et al., 2012). IPA has also been used to examined couple interview among HIV- serodiscordant couples in South Africa and the need to modify the approach to accommodate IPA as an effective method for data collection (Mavhandu-Mudzusi, 2018). In Ghana, Akotia et al., 2014 used IPA to elucidate the dynamic role of religion in the lives of attempt survivors. They showed in their analysis the doubled-edged role of religion in fostering guilt and self-condemnation on one hand, but also stimulating in survivors a desire to repair a broken relationship with God, thus potentially engendering recovery. In keep- ing with the flexible nature of IPA, another important study on suicide in Ghana explored the psychosocial circumstances underlying suicides among men by interviewing close relations who were bereaved by sui- cides. Interestingly, there were diverse accounts and experiences on the individual suicides. These accounts revealed key underlying factors to the suicides. For example, a parent sharing on the suicide of his son mentioned: My suspicion is based on fear of the surgery and its outcomes. Maybe he thought he might not be able to perform his manly duties with a woman. I mean he was a ‘Man’ so probably he thought after the surgery, it would take a long time for him to go near a woman or perhaps the doctors might have told him that the surgery might destroy his manhood. (Andoh-Ar- thur, Knizek, Osafo, & Hjelmeland, 2019). What this means is that within the general proclivity to subscribe to and to maintain the normative views of suicides as taboo behaviours that are condemnable, a modified IPA oriented towards ascertaining factors underlying the individual suicides from the account of specific in- dividuals who were related to the deceased, helped to reveal unique underlying crises which can be identified and mapped for effective intervention and prevention. 6. Concluding thoughts Though the use of interviews, predicated on the IPA epistemological guidelines, to unearth the meaning of suicide in Ghana posed some ethical challenges, these challenges could also be contingent on the cultural context, and the socially sensitive nature of the phenomenon under study. Knowledge emerging from such cultural context provides grounds for further theoretical examination of the use of the IPA in a normatively driven society in which suicide becomes a moral issue. From an interdependent sociocultural milieu that proscribes suicide, a normative perspective toward suicidal behaviour seemed to obstruct the idiographic rigor of the IPA. This is not to assume that there are no counter currents. In fact, there are such divergences from the prevailing normative ideological enclaves as discussed above. Nevertheless, such discordances are not pervasive. The pervasive view, therefore, may reflect a conception of a self-construal that sees alignment to community norms as an essential aspect of being a person. Analyzing the in- dividual’s perspective on suicide which is perceived to be abhorrence to the culture brings up more of a ‘normative view’ than a ‘personal view’. In conclusion, cultural studies may have unique challenges relative to the epistemological and methodological approach one is adopting to study a specific phenomenon. However, the issues that are raised may pose healthy challenges to theoretical positions that are beginning to cross cultural boundaries. These challenges do not necessarily negate the utility of these methods and theories. Rather, they expose other areas in them which might require careful reflection and consideration in their developmental trajectory and applications in various contexts. In light of this, the epistemological question posed for the theoretical position of Fig. 2. Individual’s view reflecting the Normative view J. Osafo New Ideas in Psychology 60 (2021) 100836 5 the IPA and the set of guidelines it offers for conducting research in proscriptive and normative contexts such as Ghana, become a good test case. I recommend in this paper that within proscriptive and normative contexts, IPA questions should explore not just idiographic perspectives, but also nomothetic views. As I have showed in the preceding para- graphs, the personal can be the communal. Starting interviews from the ‘funnel’ approach (that is from the general to the particular-e.g., how does your community view suicidal behaviours?) to the particular and personal (e.g., now having understood the general view of suicide, tell me your personal view of such behaviour) offer’s a good approach than a ‘cone’s’ approach. References Adinkrah, M. (2012). Better dead than dishonored: Masculinity and male suicidal behavior in contemporary Ghana. Social Science & Medicine, 74(4), 474–481. 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qualitative study of suicide in Ghana 3 IPA guidelines and ethical dilemmas in the Ghanaian cultural context 4 The epistemology of the IPA in a normatively- oriented cultural context 5 The epistemological question 6 Concluding thoughts References