Dr. Judy Melinek, a forensic pathologist and co-author with T.J. Mitchell of the medical memoir Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner knows this only too well.(1) Dr. Melinek lost her father Dr. Menachem Melinek, a psychiatrist, to suicide in 1983. He hanged himself 24 hours after being psychiatrically cleared from an emergency room after overdosing on medication. In a telephone interview that I had with Dr. Melinek on February 15, 2016 she conveyed, with vigor and passion, the following:
“Mental health professionals who treat doctors need to realize that if you only see the physician, you’re only getting their side of the story, what they want you to know or what they’re willing to share with you. You must talk with the family members who live with the person, your patient, and have their own particular observations, hunches, ideas and fears. You really have to ask about drug seeking and drug use—and also remember that blood specimens are more accurate for toxic levels than urine specimens. We need to borrow a piece from the early years of the AIDS pandemic and the sign/slogan ‘Silence=Death’. This now applies to suicide. The more we perpetuate the silence surrounding suicide, the more survivors suffer after losing a loved one to suicide and the more isolated that suicidal people themselves feel and the more at risk they are for dying of their suicidality.” (2)
Dr. Melinek’s statements are full of rich messages. One is that suicidal physicians may not be completely truthful and forthcoming with you when they come for assessment and treatment. There are myriad reasons for that: they are afraid of the consequences of sharing information that may prompt you to admit them to hospital, perhaps involuntarily. Their autonomy is precious to them. They don’t want to relinquish the role of doctor and become a patient. They feel embarrassed and ashamed of their self-destructive urges. They are terrified of losing their medical license or hospital privileges. They may not even realize their own degree of suicidality and think they’re safe. This is why the observations and insights of their family loved ones are essential to your evaluation.
Another message is about assessing for your physician-patients’ use of drugs. Alcohol and self-prescribed drugs are two of the first tonics that ailing physicians reach for when they’re trying to cope with feelings of despondency, anxiety and insomnia. For some, this is brief and a wake-up call that they need to contact a mental health professional and get help. But for too many, this behavior becomes a pattern, quickly entrenched resulting in clinical abuse and dependence. Doctors with comorbid conditions like major depression plus substance use disorder are at greater risk of suicide than those fighting a single disorder. And as Dr. Melinek states, we serve our patients better with blood levels of drugs than urine screenings.
But it is her last message that speaks volumes. Silence = death. When we don’t talk openly about suicide—and bring it out of that dark closet—suffering doctors are more isolated and at heightened risk of dying of their actions. Shame compounds their desperate self-harming actions for psychological relief. And after they die, their survivors suffer from silence too. Their families cannot grieve authentically and with the same dignity of those whose loved ones did not die of suicide. And that must change.
Here is an example from Australia that just came up a few minutes ago on my google alert. It is called “We are not ashamed of how he died”. It is about the family of Brisbane gastroenterologist Dr. Andrew Bryant who killed himself in his office last week. They have decided to go public with their story exhorting the profession of medicine to talk more openly about mental illness in doctors. I urge you to read it.(3)
1. Melinek J, Mitchell TJ. Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner. Scribner, New York, 2014
2. Myers MF. Why Physicians Die by Suicide: Lessons Learned From Their Families and Others Who Cared. Amazon, New York, 2017 p 118-119
3. Armstrong C. Wife of Brisbane doctor who died in his office issues note explaining his death to help others. The Courier-Mail, May 11, 2017. http://www.couriermail.com.au/lifestyle/health/wife-of-brisbane-doctor-who-died-in-his-office-issues-note-explaining-his-death-to-help-others/news-story/fc4e29e9e90c666710a1330c66ab0a4a