Society’s ‘man up’ message fueling suicide among men

Justina Nakimuli, a psychiatric specialist based in Manchester, United Kingdom, who also runs a private practice in Kampala, says men are more prone to suicidal behaviour because their lives are driven a lot by testosterone. “An average man never discusses his feelings of failure or pain,” she says.
Study
According to a 2011 study, ‘Ugandan Men’s Perceptions of What Causes and What Prevents Suicide’, “…the rates of both suicide and nonfatal suicidal behaviour are higher for men than for women.” The study was conducted by Professor Eugene Kinyanda, the head of Mental Health Project at Medical research council and Uganda Virus Research Institute (MRC/UVRI) and was supported by three Norwegian professors.

“Ugandans are squeezed by poverty, unemployment, high rates of premature death, and insecurity regarding prospects for the future. According to the World Health Report (WHO, 2001), people in East Africa are some of the poorest in the world. Almost every Ugandan is affected by the situation of family instability and/or poverty and struggles for a decent living. This also affects Ugandan men as many of them have problems in finding adequate jobs and maintaining their traditional position as the breadwinners of the family,” the study reads.

The study goes on to note thus: “…young men perceive multiple and sometimes conflicting ideas about what it means to be a man and generally perceive that they are constantly judged and evaluated for their actions as men. These pressures, arising from a clash of ideologies, westernisation trends, socioeconomic change and the challenges to traditional masculinity, may lead to feelings of humiliation, both in a man’s sense of self, as well as in his sense of how he is perceived by others (Dolan, 2002) and might impact on Ugandan men’s suicidal behaviour and attitudes towards suicide.”

Participants in a  study who were all male, were asked if they had ever thought about suicide. 34 per cent expressed having had suicidal ideation, 22.5 per cent had made a suicide plan during the last year, 38 per cent had thought about suicide and 28 per cent had made a suicide plan earlier in life.

According to the study, 316 men responded to the question: “What do you think is the most important cause of suicide?” The causes were ultimately categorised into three: interpersonal, intrapersonal and extra personal causes. The highest cause according to the participants was illness or disease, an answer given by 169 members. The second highest cause was disharmonic relationships with 158 participants citing it, while stress came in third with 65 participants citing this cause. 

Cultural pressures
Suicidal behaviour in Ugandan is more often than not connected with how a man is perceived culturally, according to Nakimuli. The feeling of falling short of what a real man should be tends to disturb a number of men. So, they cover their pain by taking alcohol and living extreme sexually driven lives.

“A man has been given a certain position in the community.  From childhood, a boy is taught to be strong while a woman is expected to be vulnerable.  When they fall down, young boys are always told; “men do not cry. ’’ Such upbringing, which is prevalent in the country, tends to force men to only take in pain with no exit channel, which creates a mountain of anger and frustration for many,” Nakimuli says.
So, while women will meet their mother or girlfriend or sister to cry over their pain and frustrations, men tend to release their frustrations through sex and alcohol, among others. Unfortunately, this causes more frustration accruing from the varied consequences of this behaviour.
 
Shame
According to Paul Waluya, a psychotherapist, many possible factors that could lead to suicidal behaviour in men have their roots in social, economic, emotional and spiritual circumstances. However, anything that takes the shape of shame hits men the hardest. 

“Shame is a silent pain caused by emotional and psychological wounds and it plays a key role in the onset of suicidal thoughts and behaviour. For so long, men are known for holding tight and not pouring out their emotions; all in the name of avoiding shame. In some parts of Africa, Uganda in particular, holding back emotions is perceived as a qualification to being a man. The greater the ability to hide emotion the higher measure of a strong man, which I find to be a leading cause of suicidal behaviour among men.” 
Waluya adds that suicidal thoughts start the moment a man feels they are of no value. 

Impotence
In the study cited above, only one man mentioned impotence even though virility and sexual performance is one of the crucial arenas for the social construction of masculinity. A study in Eastern Uganda from as far back as 1960 (Fallers and Fallers) reported impotence as a significant contributor to suicide. More recently, Kinyanda et al. 

(2005c) also observed that sexual problems were a significant contributor to repetition of suicidal behaviour in a study in urban Uganda. 
“If sexual performance is that important, it is striking that it is not mentioned more often. This could indicate that this arena might have lost its priority or that it is taboo to talk about it,” the study reads. “Another explanation might be that this sample is relatively young and thus has not felt the pressure of this issue yet.”

Alcohol
According to Nakimuli, men tend to commit suicide when they are intoxicated with alcohol. She says: “We get alcohol related referrals but once you probe further into the actual cause [of the behaviour] they dis-engage. Social drinking becomes a problem if you cannot regulate the amount you drink.” 
Nakimuli adds that lately, there is also an increase in the number of young men having suicidal tendencies that are surprisingly relationship-related.

Change in upbringing
Nakimuli says the traditional way of bringing up boys needs to change. “From childhood, a boy should be supported to develop emotional intelligence, something we teach the girl child. Families need to illustrate the concept of emotional regulation in a man. A man needs to feel loved and cared for. This way, they are helped to develop empathy,” she says. 

Self help measures
In psychiatry, Nakimuli says, talking about your problems is as good as taking medicine. 
“Discussing your problem and being emotional is not a sign of weakness. If you have no one close to you such as a wife or family member you trust, then seek counselling,” she says, adding that it is about men knowing who they are and not doing things to impress the society.  

The Eugene Kinyanda study found out that suicidal behaviour is a considerable public health problem within the country.  And because there are no reliable suicide statistics in Uganda, the exact sex ratio of suicide is unknown. But from several other studies cited in the research, there is reason to believe that more men than women engage in suicidal behaviour in this country. 

Preventive measures

According to Prof E Kinyanda, the male to female ratio of suicide is 4:1 in Uganda which is 10.7 per 100,000 males according to the World Health Organisation (WHO). Uganda takes the 68th position in terms of suicide prevalence at 9.9 per cent, according to the WHO estimates 2018, translating into one death every 40 seconds.

Derrick Kizza Mbuga, the executive director at Mental Health Uganda, says most suicide cases still go unreported. “That means the prevalence could even go higher but many fear or hate the repercussions of speaking out. For example, suicide is condemned by religion. It is a crime punished by lashes of the cane, and family members never get to bury their loved one who dies by suicide,” he says.
Dr Benedict Akimana, a psychiatrist, says stigma surrounding suicide leads to underreporting of data.

Protective
Aware that stress inducing circumstances are unavoidable, Dr Akimana says there are things that protect people from suicide. “Restricted access to means of suicide means one will not give them much thought even when pushed to the wall.

Counselling
However, it is crucial that help is sought such as counselling in case one feels they need help with coping with stress. That means there is need for easy access to quality care for mental and physical illnesses,” Dr Akimana shares. More to that, personal, social, cultural and religious beliefs that discourage suicide and support self-preservation also ensure suicide is not given much thought. 

Strong connections
Another coping method could be developing strong connections to family and community support as these comes in handy in case one has a problem. “Skills in problem solving, conflict resolution, and non-violent handling of disputes will also help to avoid matters from escalating to suicide,” he shares.

Prevention 
When one shows signs of being suicidal such as getting drawn to songs of death, preferring to be by themselves or making threats of taking their lives, prevention from carrying out their intentions is a great course of action.
Most men are not given to sharing their problems, something common among women. However, Dr Akimana says creating an environment where men can talk about what they are going through is important in the fight against suicide. That is because a problem shared is a problem solved.

Additional reporting by Joan Salmon