What happens when the structures that hold men together disappear?
I have been reading Jon Ronson’s new book The Castle. Much of the book is about masculinity and the strange places some men are now going in search of identity, purpose and control, but one section sent me off in a slightly different direction. Ronson talks about the rise in suicide in the United States since the 1990s and asks what else was changing in the lives of men over the same period. Factory jobs disappeared from communities that had depended on them. Organised religion declined as a regular part of people’s lives. In many places, the institutions around which generations of men had built their working and social lives became weaker. He also contrasts the American experience with parts of Europe, where stronger public services and social protections may have provided more of a cushion when work disappeared.
I found myself thinking about that long after I had put the book down, because we tend to discuss these things separately. We talk about male suicide. We talk about unemployment. We talk about loneliness, declining communities, the fall in church attendance, remote working, the disappearance of pubs and clubs, and men being reluctant to seek psychological help. What happens if some of these are not separate problems at all? What if we have slowly removed quite a lot of the structures that gave men connection, status, routine and purpose, and then wondered why asking them to “talk more” has not solved the problem?
Something changed in America
The starting point is the data. Between 1999 and 2018, the age-adjusted suicide rate in the United States increased by 35%, from 10.5 to 14.2 deaths per 100,000 people. Male suicide remained dramatically higher than female suicide throughout the period; in 2018 the male rate was 22.8 per 100,000, around 3.7 times the female rate. This was not simply a continuation of a worldwide pattern. WHO data covering 2000 to 2021 show that age-standardised suicide rates fell by 48% across its European region while the Americas was the only WHO region in which the rate increased, rising by 17%. [1][2] (CDC)
That comparison needs care. America is not Europe, the Americas is a wider region than the United States, countries record suicide differently and there are other significant factors, including the opioid epidemic and much greater access to firearms in the US. But there is enough of a divergence to make the question worth asking: why did outcomes move so differently across otherwise wealthy societies?
Anne Case and Angus Deaton provided one of the most influential attempts to understand part of the American story. Their research documented increasing deaths from suicide, drug overdoses and alcohol-related disease among sections of the US population, particularly middle-aged white Americans without a university education. They described these collectively as “deaths of despair”. Their later work showed that the deterioration sat alongside falling labour-force participation, lower marriage rates, poorer reported health, more pain and worsening mental health. It was not a story about suicide in isolation. It was a story about a broader deterioration in people’s lives. [3] (PubMed)
That distinction matters. If suicide were simply the result of untreated mental illness, the answer would largely sit within healthcare. If economic position, relationships, community, purpose and status are also involved, then the answer becomes much wider.
What happens when work disappears?
This is where the research on manufacturing becomes particularly interesting. Economists Justin Pierce and Peter Schott studied American communities that were differently exposed to the enormous increase in international competition faced by US manufacturers. The beauty of this research is that it gets closer to a natural experiment than simply comparing employed and unemployed people. Some communities were hit far harder than others by a large external economic shock.
The areas that were more exposed experienced greater deterioration in manufacturing employment and increases in deaths associated with despair. Earlier versions of their research also identified increases in suicide and related mortality concentrated particularly among white men. [4] (National Bureau of Economic Research)
David Autor, David Dorn and Gordon Hanson approached the same economic transformation from another direction. Their paper has a title that tells you a great deal: When Work Disappears: Manufacturing Decline and the Falling Marriage Market Value of Young Men. They found that trade shocks reduced employment and earnings among young men, but the effects went well beyond the payslip. Male economic inactivity and premature mortality increased, while marriage and fertility fell. The researchers also found increases in children living in poverty and in single-parent households in affected communities. [5] (AEA Publications)
None of this means that losing a factory job automatically causes suicide. Research is much more complicated than that. A meta-analysis looking at unemployment and suicide found a 58% higher suicide risk among unemployed people before researchers adjusted for previous mental-health problems. Once they did so, the additional risk reduced substantially, to around 15%, although the association was greater among men. That tells us that some of the relationship works in both directions: mental ill health can make losing or finding work more likely, while unemployment itself can compound the problem. [6] (PubMed)
What interests me is what disappears alongside the job. A traditional factory did not just provide income. It provided somewhere to go on Monday morning. It gave people colleagues they might have known for years, an occupational identity, shared experiences, status in their community and the knowledge that other people depended on them. Often there were clubs, unions, sports teams and social networks wrapped around the workplace as well.
We should not romanticise industrial work. Plenty of those jobs were dangerous, monotonous or badly managed, and many traditional workplaces were hardly models of inclusion or psychological safety. The point is different. Work is capable of providing things that human beings need in addition to money, and when employment disappears those things do not necessarily reappear somewhere else.
That may be particularly important when thinking about men. For generations, a large part of male identity was tied to occupation and the ability to provide. We have rightly challenged some of the restrictive ideas about masculinity that went with that, but changing the model does not remove the human need to feel useful, valued and connected.
Then there is the church
The religious part of Ronson’s argument initially struck me as harder to test. It turns out that there is some remarkable research here too.
A 2020 study in JAMA Psychiatry followed 66,492 female nurses and 43,141 male health professionals in the United States. Among the men, those attending religious services at least weekly had a 33% lower subsequent hazard of dying from suicide, drugs or alcohol than those who never attended. When suicide was considered separately, weekly attendance was associated with a 48% lower hazard among the men. The researchers adjusted for factors including psychological distress, health behaviours and other measures of social integration. [7] (JAMA Network)
That does not mean going to church prevents suicide, and the researchers themselves do not claim that it does. This is observational research involving a particular group of relatively affluent health professionals, and people who regularly attend religious services may differ from those who do not in ways that are difficult to measure completely.
What I find fascinating is the possible mechanism. The authors discuss social integration, healthier behaviours, hope, meaning and purpose. A church can provide all of those things at once. It gives you somewhere to be at a particular time each week. It puts you in contact with people from different generations. It creates opportunities to contribute rather than simply receive support. It provides rituals around significant moments in life and, for believers, a framework through which hardship and loss can be understood.
It also creates something much more basic. If you stop turning up, somebody may notice.
Again, this is not an argument for returning Britain or America to church. It is an argument for being curious about what disappeared with it. In a more secular society, what institutions have taken over the job of giving people regular face-to-face contact, a community that expects something of them, opportunities to help others and a sense that their absence would be noticed?
For some people there are excellent answers: family, sports clubs, volunteering, friendship groups, community organisations and all sorts of modern networks. For others, particularly people whose world has shrunk following unemployment, divorce, retirement or relocation, there may be surprisingly little.
Perhaps Europe tells us something too
Ronson’s other observation was that the pattern has been different in Europe, where stronger public healthcare and social protections can catch people when things go wrong. There is something in this, although the research suggests the explanation is broader than simply having an NHS.
A landmark Lancet study looked at 26 European countries between 1970 and 2007. Every one percentage point increase in unemployment was associated with a 0.79% increase in suicide among people under 65. When unemployment increased by more than three percentage points, the associated increase in suicide was much greater. Yet the effect differed between countries. Importantly, governments that invested more heavily in active labour-market programmes designed to keep people connected to employment and help them return to work appeared to reduce the effect of unemployment on suicide. [8] (PubMed)
Research following the financial crisis produced a similar message. Reeves, McKee and Stuckler estimated at least 10,000 additional “economic suicides” across Europe, Canada and the United States between 2008 and 2010, but there were substantial differences between countries experiencing comparable economic shocks. The increase was also much greater among men. Their conclusion was not that recession automatically produces suicide, but that policy choices can influence what happens next. [9] (Cambridge University Press)
That changes the way I think about the comparison. A welfare state does more than pay for treatment once somebody becomes mentally ill. At its best, it can stop an economic shock turning into complete social dislocation. Income support matters. Healthcare matters. Retraining matters. Getting somebody back into meaningful employment matters. The speed at which someone is allowed to fall from employee, provider and colleague into isolation and financial distress matters too.
This does not explain the entire difference between America and Europe, and it would be irresponsible to pretend that it does. Suicide is influenced by a complicated mix of psychological, social, economic and cultural factors, as well as access to lethal means. But it does suggest that our economic and social systems are part of suicide prevention whether we call them that or not.
What does any of this have to do with the workplace today?
Quite a lot, I think.
Most employers understandably place their mental-health investment downstream. We train Mental Health First Aiders. We provide employee assistance programmes. We offer counselling, apps and helplines. All of those things can be useful, but they largely come into play when somebody is already struggling.
The research Ronson led me towards made me wonder whether we spend enough time upstream. What is it about work that helps keep people well in the first place? Do people feel useful? Do they belong to a team? Does anyone notice when they withdraw? Are there relationships that go beyond transactions on Teams? Do people have some control over their work and understand why it matters? Does a manager know enough about their people to recognise when somebody who was normally engaged has gone quiet?
This also adds another dimension to the debate about remote and hybrid work. I do not think the conclusion is that everyone needs to be ordered back into an office five days a week. That would be far too simplistic. For many people, flexible working has transformed their lives for the better. But we should be honest about the fact that the workplace is also a social institution, and for some employees it may be one of the few remaining institutions in their lives.
That means the question should not just be, “How many days should people be in the office?” A better question is, “How are we designing work so that people form relationships, feel part of something and are noticed?” An office full of people wearing headphones on separate video calls is not necessarily providing social connection. Equally, a well-designed hybrid team with strong relationships, mentoring, shared rituals and regular purposeful time together may provide a great deal of it.
There is a similar point about psychological safety. We often think of psychological safety as whether somebody feels able to speak up, challenge an idea or admit a mistake. Those things matter enormously. But perhaps there is a more basic layer underneath them: do I feel that I am part of this group, that my contribution has value and that the people around me would notice if something changed?
The question I think we should be asking
One of the frustrations I have with the conversation about men’s mental health is how quickly it ends up at “men need to talk”. Of course men need to be able to talk, and we absolutely need services that they can access when they are struggling. But it places a huge amount of responsibility on the individual man to recognise what is happening, find the language for it and then put his hand up.
The research here points towards another question. What were the structures that previously gave men belonging, purpose, identity, routine and connection, what has happened to those structures, and what are we building in their place?
The answer is not to recreate the factory floor, revive organised religion or pretend that the social structures of the past were somehow perfect. They clearly were not. It is to understand what functions those institutions performed and make sure that modern life has not accidentally designed them out.
That is an area I want sevenmore to keep exploring, because it moves the conversation about men’s wellbeing away from fixing men once they are unwell and towards thinking about the environments in which men live and work. There is a role here for government, communities, families and individuals, but there is also an enormous role for employers. Work still occupies a huge proportion of adult life, and organisations have far more influence over belonging, status, purpose, relationships and routine than we sometimes acknowledge.
Maybe one of the most important things an organisation can do for men’s mental health has nothing that looks like a mental-health intervention at all. It might be creating a team people genuinely belong to, giving someone work that feels worthwhile, helping somebody whose role is disappearing find the next one, building friendships across generations or having a manager who notices that a person is no longer quite themselves.
Jon Ronson started me thinking about suicide rates and disappearing factories. The research took me somewhere broader. If we want to understand why some men are struggling, perhaps we need to spend less time asking what is wrong with the individual man and more time looking at what has disappeared from the world around him.
References
Hedegaard, H., Curtin, S.C. & Warner, M. (2020). Increase in Suicide Mortality in the United States, 1999–2018. National Center for Health Statistics Data Brief No. 362.
World Health Organization. Suicide Worldwide: Global Health Estimates and Regional Trends. WHO.
Case, A. & Deaton, A. (2015). “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century.” Proceedings of the National Academy of Sciences, 112(49), 15078–15083; Case, A. & Deaton, A. (2017). “Mortality and morbidity in the 21st century.” Brookings Papers on Economic Activity.
Pierce, J.R. & Schott, P.K. (2020). “Trade Liberalization and Mortality: Evidence from US Counties.” American Economic Review: Insights, 2(1), 47–64.
Autor, D., Dorn, D. & Hanson, G.H. (2019). “When Work Disappears: Manufacturing Decline and the Falling Marriage Market Value of Young Men.” American Economic Review: Insights, 1(2), 161–178.
Milner, A., Page, A. & LaMontagne, A.D. (2014). “Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review.” Psychological Medicine, 44(5), 909–917.
Chen, Y., Koh, H.K., Kawachi, I., Botticelli, M. & VanderWeele, T.J. (2020). “Religious Service Attendance and Deaths Related to Drugs, Alcohol, and Suicide Among US Health Care Professionals.” JAMA Psychiatry, 77(7), 737–744.
Stuckler, D., Basu, S., Suhrcke, M., Coutts, A. & McKee, M. (2009). “The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis.” The Lancet, 374(9686), 315–323.
Reeves, A., McKee, M. & Stuckler, D. (2014). “Economic suicides in the Great Recession in Europe and North America.” The British Journal of Psychiatry, 205(3), 246–247.