Two themes were developed through the analysis: Reasons or triggers for the suicidal act and Attributed responsibility for the suicidal act. They are described and substantiated by quotations in the following.
Perceived reasons or triggers of the suicidal act
All the men in the “not to die” group reported problems with or loss of partner/wife as main triggering factor for their suicidal act. Even though they admitted that problems had accumulated for some time, they pointed to the relational problem as the last straw that broke the camel’s back: “It was her that triggered it. And I mean it, that it was her that triggered that this happened. The way that she made me look like a fool in that situation” (middle-aged man). The situation that triggered his suicidal act was that his partner in the presence of friends tried to change some plans they had made as a couple, and instead wanted to plan things that included the friends. His narrative pointed at the situation rather than the partner as the trigger, even though his way of expression was equivocal. He even repeatedly expressed sympathy with his partner’s situation after his suicidal act. In the situation he felt let down, excluded, and ridiculed, and then harmed himself. He felt he had lost face in the situation and could not bear the shame. This man was the only one in the “not to die” group who still lived together with his partner (at the time of the interview).
All the other men in the “not to die” group were separated or divorced, and reported feeling lonely or let down. One found it problematic to describe a reason or trigger for his self-harm, but finally ended up saying: “But I went through a separation, which was pretty hard and was much unexpected” (middle-aged man). Before the separation, his parents-in-law had promised to support his business financially on the condition that his wife divorced him. He refused to separate, but his wife divorced him anyway and he did not receive any financial support. He consequently ended up alone with financial problems, felt deceived by his in-laws, and abandoned by his wife. Another middle-aged man had led a life dominated by alcohol and illness that ended up with impotence and a separation from his wife. One young man met a previous girlfriend, who had dumped him earlier, as a pregnant woman in a new relationship. Although the circumstances of these two latter men were quite different, both struggled with loneliness and the loss of relationship and were unable to accept the separation.
As the men illustrated above, a breakdown in relationships involved many different issues, such as impotence, loneliness, betrayal, abandonment, and shame.
Half of the larger “to-die” group also reported relationship problems as main reason or trigger for their suicidal act, and again this covered very different issues. Of the 10 men, four lived alone and three of these four were currently undergoing separation/divorce. One of the other five still lived with his parents, whereas the rest lived in stable relationships. Two of the men still living with their partner mentioned infidelity or suspicion of infidelity as a triggering factor. One man reported having been institutionalized and helpless when his wife took all their valuables and went away with another man. His helplessness deepened the feeling of being betrayed by his wife. He describes himself as wanting to be independent and able to manage his problems by himself, but admits that there is a limit to what one can take. Another participant was the victim of rumors regarding his wife’s infidelity; rumors that eventually turned out to be false. Both reported perceived infidelity as the factor that triggered their suicide attempt, although the circumstances were very different.
Three men mentioned illness/pain and, not surprisingly, the two oldest participants were among them. The third was a young man with serious health problems. All three experienced no quality of life and were without hope for improvement of their condition. The two elderly men expressed explicitly that they did not want to be a burden. They seem to adhere to the traditional masculine values of independence and autonomy, and for one of them death became almost a practical solution in order to take care of the wife: “And have talked about it [with wife] that maybe it is easier for you if I was gone. You could just have sold everything and then bought a flat, easy” (elderly man). He was worried that his wife was overwhelmed by the workload since he could not contribute the way he wanted anymore, and she had to take care of him in addition. At the same time, he insisted that he was not depressed, because he did not see himself as the “depressive type”. Another elderly participant also suffered from severe illness, which would increasingly disable him and make him dependent on others. He described himself as a modest person, who did not like to ask for continuous assistance and as a consequence he could not bear the thought of the future based on dependency.
The younger man who mentioned pain as a trigger for his suicide attempt had completely lost hope in the health care system, whose lack of ability to understand and help he found scandalous:
“I just get more and more sick and become a larger and larger problem for the health care system (…) and I feel totally ignored and overlooked. Everything that has been found out I have found out myself.” (…) You know, I know a lot about bodily processes and then, then the doctors get grumpy (…) Then you get pushed like a thing, well, like a hot potato, which nobody wants to hold in his hands (young man).
The pain and the treatment from the health care system seemed too much and he attempted suicide twice. He felt that there was no hope left and that life was nothing but pain.
The last two men reported being tired of life as the reason for their suicide attempt. Their life situation and history were, however, very different. One was a young man living with his parents, with whom he felt he had nothing in common. He claimed to have no friends, no interests and no energy and insisted that he would not change. In his opinion, he did not fit into his family or into the world as such. Without a prospect of change, he had no hope for the future:
“I tell you that I will take my life regardless what happens in the future and I will do it as soon as … .well, as soon as possible. And that is nothing people can do anything about. (…) The way I see it is that if you are going to live, you must have something to live for or at least something to look forward to, and that I have never had and will never get. So I see no reason why I should stay here then” (young man).
He lived in a social vacuum and without interests or energy to make a change, he felt tired of life. He was the only participant reporting having been diagnosed with any mental disorders (depression and anxiety).
The other participant being tired of life was middle-aged and had lived an active life with a lot of interests and engagements. Despite a turbulent upbringing, he managed to get an education and a family. He had been politically engaged and had strong ideals for how the world should be. Now his children had grown up, he and his wife had divorced amicably, and he was not happy with the changes in the world. He felt that the world had become cold and cynical: “I don’t like the world we live in today (…) I don’t feel at home in the world, we live in” (middle-aged man). For the last 10 years, he had not wanted to live anymore and felt burned out. He had attempted suicide before, but in the last moments of consciousness, “a spark of life” emerged and then he got ambivalent. He underlined that it is not necessary to be depressed for not wanting to live in the world as it looks now. He saw his decision as a conscious choice.
In summing up the reasons or triggers, the men mentioned for their suicide attempts, it is evident that their stories are very different. Even when it is possible to categorize them as, for instance, having relationship problems or physical pain, the differences in these categories seem larger than the similarities.
Attributed responsibility for the suicidal act
Most of the men explicitly allocated responsibility for their suicidality. In the “not-to-die” group, only one man felt entirely responsible for the suicidal act himself. He was, however, ambivalent as he found the telephone number for the emergency services before harming himself. The others in this group insisted on not having been in possession of their faculties, for instance, because of alcohol:
“I have sleeping problems during night or rather always. Thus, I got sleeping pills from my doctor … and …. I took all of them at once. Ninety pills. And that was after a large consumption of alcohol, so … I don’t think I knew that I took them” (middle-aged man).
One of the other participants in this group only drinks occasionally, while another one admitted having problems with “King Alcohol”, which makes him crazy. Another man mentioned that the brain had “clicked” in the moment of the suicidal act:
It did not hurt. Because I was gone. I was - it was not me who did this. It was not I, who took the rope in the staircase and put it up. It was not me. It was a different side of me, it was a “click” up in my brain, which made it happen. As simple and easy as that (middle-aged man).
He distanced himself entirely from the act. This made it possible for him to sympathize with the reactions of his partner and even to admit that the purpose of the act probably had been to scare his partner, without displaying any guilt. He emphasized that his case shows that suicidality can happen to “completely normal people”: “It was not I who was that person obviously, because I remember nothing.”
The picture in the “not-to-die” group differed significantly from the one in the “to-die” group; only one in the latter group was not ready to take responsibility for the suicidal act, whereas the rest took full responsibility. The youngest one of the participants, who was tired of life, distanced himself completely from the act and underlined that he did not do it of his own free will:
“I would never have a serious suicide attempt, because an attempt is not what I stand for. I mean that if you have to do it, you do it. And therefore I think it is a bit embarrassing what happened, because that, that was a thing that goes against everything I stand for. But as I said, I would never have done it if I had been conscious of what I was doing. So, I don’t know what happened or why it happened, but it is probably some blackout, as they have called it. But I shall not discuss that” (young man).
He felt his honor tainted, because if he had been in possession of his full faculties, he would have been dead. The suicidal act was for him an embarrassing failure and he was ashamed because of it. He ascribed the failure to a blackout.
Some of the other men in the “to-die” group reported having thought about it a long time in advance, while others spent some time contemplating about it in the course of the suicidal act, for example: “… .and then it was, it was totally calm, it was precisely as it should be when I had done it. It was entirely appropriate” (middle-aged man). This participant lost hope when he lost both partner and job and as a result felt worthless and unwanted. He did not regret the attempt at that moment and seemed content with his fate and he emphasized that a theme in his life was to think that he probably did not deserve anything better.
For all men in the “to-die” group, suicide seemed to be a deliberate choice and the best option in their situation. The men reported that they were sure they wanted to die, but for three of them ambivalence came into play when the pain became intolerable or right after the attempt, and they called for help themselves:
“When I did it, I was very clear; very conscious. But then I lost courage (…) So … a part of you will die and a part of you will live and then you become very ambivalent and then you telephone and get things going. So, it is really about getting over the threshold that you are not afraid anymore: this time I make it” (middle-aged man).
The challenge for this middle-aged man was to get beyond the fear of death. Like the other two men who had second thoughts, he seemed unable to carry out his wish/intent to take his life. However, this inability appears in different shapes: whereas one had the telephone number of the emergency department ready before the suicidal act, the two others found it and called after the act. For one of them, it was the first time he had attempted suicide and he seemed ambivalent. For the other, it was his third suicide attempt and he called because he, in his own words, lost the courage after having swallowed sleeping pills. Another participant could not bear the pain after having drunk a diluent, which had also been the problem with his previous (first) suicide attempt. Part of some of the stories was a regret at having disrupted the suicide attempt.