This week a resident asked, “What do you say to suicidal physicians?” Great question! For an expanded version of the three simple things I say to suicidal physicians (applies to anyone who is suicidal), please listen to my podcast here and download MP3 for future reference:
1) I don’t say anything. I listen without judgement.
Our culture doesn’t support physicians asking for help—or revealing their suffering. As a result, physicians fear sharing suicidal thoughts with friends and family because we’re the ones that others rely on for help. Physicians fear speaking to their program directors or employers because of professional retaliation and loss of licensure. Physicians fear sharing mental health struggles with colleagues due to shame, stigma, and loss of their confidentiality. If employers are notified, docs may face potential job loss or be mandated to attend Physician Health Programs (which are essentially 12-step programs for substance abuse that have turned into a dumping ground for any doc with mental health conditions). Physicians need to be able to speak confidentially to other physicians who understand their pain. So that’s what I do. I listen. Confidentially. Without judgement. For as long as they need to talk. For free As a healer and a friend.
Here are two letters I’ve received that demonstrate the need for confidential mental health care for doctors. Maria writes, “I’m having a really tough night tonight. Really just hard sometimes for me but I am happy to know that there is someone out there interested in the world, in the pain that medicine sometimes is. Rough week, lots of deaths in people less than forty.” Watching lots of people under forty die may actually lead to depression—especially when you have no opportunity to debrief from your daily trauma. So what happens when you get depressed? Amy shares her experience:
“I’m amazed at the punitive terms I’ve had to face in recovering professionally from a depressive episode for which I was hospitalized last year. One of my requirements is to be urine tested for substance abuse, despite multiple demeaning assessments that have rendered the clear verdict that I don’t have a substance use problem. I’ve had to attend costly treatments for ‘professionals’ in which I am the only female in a group of male physicians who have had sex with their patients or have become assaultive with staff. Any efforts on my part to point out that I don’t quite ‘fit’ are taken as further evidence of my pathology. I’m a single parent as well, so that each of these ‘treatments’ I’m required to attend takes me away from my two children for extended periods of time. Throughout all of this, nobody has told me how common my feelings are—that a large number of doctors feel depressed and suicidal at times. Rather, I’ve been told that my actions are unheard of for someone in mental health and may preclude me from ever providing therapy again since ‘we tell patients to never give up hope, but you did.’ Hopefully, in the near future this won’t be a taboo subject, and there will be places for those like me to seek responsible and confidential care.”
Yes, substance abuse and mental health struggles are late-stage consequences of inadequate emotional support for the trauma we sustain in our daily work. Blaming and shaming the victim does nothing to eradicate the underlying cause of physician mental health conditions and can even exacerbate suicide risk.
2) Then I say, “You are not alone.”
After years of listening to suicidal and depressed physicians share their suffering with me, I’ve discovered common themes. I outline these themes in my book Physician Suicide Letters—Answered (essentially a print version of the informal physician suicide hotline I’ve ended up running out of my home). Sometimes I share my story of depression and suicide or I read letters from other doctors who have struggled due to the similar circumstances. Suffering in isolation is deadly. When physicians are suffering in isolation, they begin to feel personally defective as if they don’t belong in the profession. They may feel that their family or the world may be better off without them. When I share the common struggles of their peers, docs feel comforted. They realize that they’re not defective. They begin to understand the true origin of their suffering—an inhumane medical system that fails to provide the emotional support that any human being would require when dealing with death and suffering all day long.
Hannah says: “Wow! I thank you for being available. Back in my worse days there was nothing on the web. I appreciate your blog. At least I know I’m not alone.” Jessica echoes her sentiment:
“After my attempt I searched and searched for any literature on near or ‘uncompleted’ suicides. I found one little book with three examples in it in my local bookstore. That was it, and my search was not limited to physician suicides. I read that book over and over. I so understood those stories. Pamela, you will be doing an invaluable thing by collecting and assembling stories of near suicides. For someone like myself, who didn’t think I was even depressed and thought I would never take my life, I had to know if there were others like me. There was something very comforting in knowing there were—even if it was only three.”
Anna has this revelation, “I really think that connecting with you has helped me to realize it is not just me! There is nothing really wrong with me! We have been traumatized!” Many who were helped by sharing their feelings with me, then request that I share their stories to help others.
3) Finally, I say, “Call me anytime.”
I leave the door open for future communication. If I’m particularly concerned, I’ll contact them in a few days to check in. I make sure they’ve got some support (whether a close friend or a local psychiatrist). If more immediate help is required, I arrange for a Skype visit with my own therapist. In other words, we have a clear follow-up plan. Plus I invite them to join my email list so I can be an ongoing supportive presence in their lives on a weekly basis at minimum.
I’ve had no formal suicide prevention training. Just real-life experiences with hundreds of suicidal docs. Sometimes being a sacred witness to another’s suffering is all that is required. How do I know if I’m on the right track? When I read these letters: “You helped me through some of my darkest hours just by being there,” Hannah writes, “Maybe we can start a ‘save the doctors’ movement.” Karyn concurs: Thank you for being there for me and so many others in peril. Those of us who spend our lives on the edge, literally dying to heal.”
In summary it doesn’t take much more than compassion to help a colleague. I hope more people will reach out to others—whether physicians or not. Truth is we can all save lives–even without attending medical school.
Pamela Wible, M.D., is author of Physician Suicide Letters—Answered. Please view her TEDMED talk “Why Doctors Kill Themselves.” Need help? Contact her.