Pamela Wible: I’m sitting here today with mental health expert Sydney Ashland, who co-facilitates our physician retreats. We just came back from our 20th retreat and I’m reading through some e-mails and I’ve got one that I want to discuss with you.
“I’m a male anesthesiologist. I have been battling suicidal ideation for seven years and eight months. I vividly remember the day I was admitted. A colleague came into my locked office and saw me sitting at the desk with induction meds and an IV. My career was over and nearly my life. I know seven colleagues that have committed suicide, all male anesthesiologists.”
What’s unique about men in medicine that puts them at high risk? Obviously, anesthesiologists have access to lethal meds, but it’s got to be deeper than that. What do you think?
Sydney Ashland: I think that our men in general in society are experiencing a lot of double binds and unrealistic expectations, and then when you have a high-level expert, like a physician who is trained for so many years and who is under so much pressure and has so much responsibility, the idea that a physician is going to manage that and succeed professionally and personally is just ludicrous. We’ve set them up to fail and the fact that this anesthesiologist writes about his attempt to self medicate in order just to survive, I hear this all the time from physicians who get into addiction cycles, whether that’s medication, whether it’s alcohol, illicit relationships. It’s all a way of trying to cope and manage unbelievable amounts of stress.
Pamela Wible: Recently more men (& specialists) have attended retreats and asked for help. I’m so glad because I’ve been realizing just through the informal registry that I run now with the 949 names of suicide doctors that for every one female we lose in medicine to suicide, we lose seven men. It’s just been such a struggle for me to figure out how to encourage these men to reach for help instead of reaching for propofol, to call me instead of picking up a shotgun, instead of jumping from a hospital roof. I would love to be able to have these men actually reach out for help in advance. It’s great that I’m seeing more and more men at retreats. We had a radiologist recently, we’ve had surgeons.
Sydney Ashland: Surgeons. Yes.
Pamela Wible: The surgeon that came, we did a private retreat with him. I know a lot of men don’t want to reveal what’s going on with themselves in a small or large group of doctors, and so there’s something that happens when we can kind of sit with them alone and hear their full story. What have you noticed from the men that we’ve had recent contact with?
Sydney Ashland: Well, what I’ve noticed is that it usually takes a level of desperation for them to get vulnerable enough and release enough of their indoctrination to be able to ask for help. They believe that they’re supposed to have all the answers, that they’re the person that everybody comes to for all the answers. When they finally get desperate enough to say help, I don’t have it anymore, I can’t do this anymore, then it’s an act of desperation signing up for the retreat whereas with women it’s less of an act of desperation and more of an act of changing course, modifying the direction they were headed, and really changing the direction of their lives.
Sydney Ashland: For men, it’s incredibly difficult for them to ask for help and we’ve put them in that position because it’s perceived as weakness. Men are supposed to have the answers, they’re not supposed to be the ones asking for help.
Pamela Wible: It’s a lot of pressure, especially for people who are not given the ability to cry or emote freely in society like women. You have boys. You have several boys.
Sydney Ashland: Yes, I do. I know the energy it takes to raise young men in our current society, but this is reminding me of an orthopedic surgeon who I worked with recently who had this tremendous pressure, not only to do so many surgeries a week and to show up for his family and to make sure he didn’t get any malpractice suits, but he also was supposed to maneuver the politics of his hospital administration and his group practice. The politics in both areas were very different and that was his undoing. That was the final straw that allowed him to reach out for help was that he could no longer provide for his family, be there for his wife and children, execute seamless perfect surgeries, not get sued for malpractice, and maneuver politics. It was too much.
Pamela Wible: This is reminding me of the recent conversation I had with Dr. Oz where even on national television the whole vilifying physicians and holding physicians, especially male physicians, to such a high standard of performance where if they lose their temper in an operating room . . . maybe you want to share a little bit about what we heard from a recent surgeon who lost his temper in the operating room because . . . Wasn’t it because the chief RN in the OR was distracted.
Sydney Ashland: She was on the Internet using the monitor for her own personal shopping.
Pamela Wible: As a result this surgeon lost his temper and became frustrated and maybe said a curse word or something like that and so what do you think happened? Well, the hospital came down on him, frequently punishing male doctors who are losing their temper for legitimate reasons in the operating room without addressing the core issue that causes the frustration.
Sydney Ashland: Exactly. In this particular situation you’re referencing, it was not extreme. It wasn’t anything you could even call abusive. That’s the crazy making part. We hear stories all the time about men in administration who are actively abusive and denigrating and intimidating to students, and yet you have a male physician who graduates and who is successful who then just tries to set a boundary, who then just tries to be assertive, who is immediately punished in such a way that it causes them to retract their energy, to isolate, to internalize the experience, so that then they’re no longer able to express their feelings and it puts them at a higher risk for heart disease and ulcers and other autoimmune disease processes—and mental health issues—even suicide. It’s absolutely insane.
Pamela Wible: They’re often then labeled as disruptive, unprofessional, and a number of other terms, sometimes sent to physician health programs. Do you want to comment on that?
Sydney Ashland: Well, physician health programs that are sometimes about just continuing to fund their own survival, and so there’s not a lot of investment in actually seeing the physician make progress.
Pamela Wible: Or be healthy.
Sydney Ashland: Yes.
Pamela Wible: The conflict of interest is that they’re funding themselves off of charging physicians three times the going rate for the public for similar services and they’re geared towards substance abuse, not mental health so I don’t feel like they really are a successful entity anyway in addressing the very deep fundamental mental health issues that have sometimes started at day one of medical school for these highly intelligent brilliant people.
Sydney Ashland: Right and for problem solvers, when they’re in a PHP meeting, which I recently heard this one where the person doing the interview was interrupted by three different phone calls while they were interviewing the doctor who had been referred to PHP, when this physician began to feel as if they were really impinging on this interviewer’s time, he began speaking really quickly in order to get through the questions so as to not monopolize the time and so this interviewer could get to all the phone calls they needed to make, whereupon the interviewer said, “Uh, do you think you might have issues with mania because I’m noticing you’re speaking really quickly?” It was all an attempt to accommodate the interviewer who was interrupting the session with phone calls. I mean, I just was in shock at that one.
Pamela Wible: Yeah, it’s completely pathologic.
Sydney Ashland: Right.
Pamela Wible: Recently, on that national TV spot I was eluding to earlier, I was asked to comment on a surgeon who had “strangled a nurse” with an elastic cord and of course, I wasn’t there and I don’t feel like I’m the right one to comment on national TV about a case that I’m not fully aware of, however, since I was placed on the spot I went ahead and researched what I could and I just want share that in that particular case, you have a surgeon who is overreacting in a way that, of course, nobody condones, strangling a nurse or becoming violent against somebody else, however, those charges were later dropped as unsubstantiated. The issue at play there was that there was a nursing medication error and the surgeon overreacted and so rather than blame somebody who’s overreacting to a life or death threatening situation that could injure a patient, I think the most important thing is for us to look at the system that has created an environment in which people feel that they are so unsupported that they get to that last hour of frustration they can no longer hold back and so they say a curse word or they potentially do this terrible assault maneuver. (View 58-second TV clip below).
The thing to address is the environment that pits us against each other as healers. Rather than placing us in a safe environment where we are supported with infrastructure that helps us, where we can emote safely, because let’s just face it, we are witnessing life and death situations every day and we do need help. We need debriefing sessions, we need time to emote, we need to talk about the difficult things that we see everyday in medicine, and there’s no time to do that.
Sydney Ashland: There’s no time and there are no tools because when we train our students that they need to put up and shut up, and that they need to internalize all their stress and use unhealthy ways of adapting, then those become lifelong habits and lifelong habits die very hard. This is not about demonizing men in medicine and making it impossible for them to be the feeling, compassionate, empathic healers that they are because they are as well. It is not just women who are compassionate and empathic. Some of the most gratifying sessions that I’ve had have been with men who are gifted healers, who are experts in their field, who have spent years and years and years becoming experts, and we need to allow them to be the gifted healers that they are.
Pamela Wible: I want to talk about three things that I believe may put men at higher risk for suicide. First, they’re socialized in a western culture to be the fix-it guy and the guy in charge and perfect and all that. Number two, I think because of high testosterone levels, (higher than women) that men are much easier to kind of get to anger and impulsive behavior. Number three (maybe due to their lower estrogen levels) they’re less likely to cry and emote and reach out for help. Women physicians will often call a friend, cry on the phone, go visit a female relative maybe and have a talk with their girlfriends sort of thing. I don’t think male anesthesiologists are doing this. So they have access to lethal meds, they have impulsivity, and they’re not likely to emote.
Sydney Ashland: Well, I just want to interject a caveat here that we’re not talking about all male physicians. Of course, there are exceptions to the rule and we’re just trying to talk about systemic issue that is generalized, but yes, I think that the cards are stacked against them and the very three real contributing factors that you’ve just listed are the primary cause. What is the answer today? The answer today is to begin to give men permission to assert themselves and to show up in a way that does not mean internalizing and tamping down their natural inclination to speak their truth, to allow their expertise to shine and be accepted and embraced.
Pamela Wible: Sometimes physicians just don’t want to ask for help and I think that’s the take home message today. It’s okay to ask for help.