Physicians Are Talking: 'Happy Doctors' and Suicide

Keith L. Martin

Disclosures

October 22, 2018

Dealing With a Culture of Shame

An emergency physician added that it is critical for doctors to find a way to make it safe to be human—not only in their own eyes, but to others in healthcare as well.

[There is] the very real fear of help-seeking by most physicians, based on stories and observations of others who have been shunned as "inadequate" by peers, lost professional advancement or career opportunities due to stigma, and perhaps worst, have had their very livelihood threatened by overzealous regulatory boards that, through ignorance, equate any form of mental illness in physicians with danger to patients. [There] you have a recipe for attempts at self-treatment, sometimes with drugs or alcohol, leading to yet another set of problems, or ineffective treatment because of "VIP syndrome," or (most common) no treatment, followed by despair that can lead to suicide.

An internist commented that the "culture of medicine and medical education" grew from a culture of shame and blame, leading to the high rate of physician suicide.

Guilt, I made a mistake; shame, I am a mistake. Guilt, I did something wrong; shame, there's something wrong with me. Guilt, I did something bad; shame, I am bad. Shame is about identity and who I am. Guilt is related to an action. We often conflate these two ideas and it is devastating. Shame is an emotion that we rarely talk about and is amplified in silence, secrecy, and judgment.

Do Potentially Suicidal Doctors Receive Appropriate Care?

A number of comments addressed the care—or perhaps lack of appropriate care—given for ongoing anxiety, especially in the days leading up to suicide.

Many psychologists noted the switch of Shaffer's medications as well as his change in care providers as possible contributing factors. Several also mentioned a possible shortcoming in Shaffer's treatment: the lack of psychotherapy.

One psychologist suggested that the combination of appropriate medication and therapy can often provide patients with the tools to deal with shame and guilt.

No one should be on medication for mental health issues without being in psychotherapy as well. Medication can be invaluable for addressing symptoms that persist despite psychotherapy, but medication alone cannot alleviate all the issues, including the shame associated with having a mental health issue in this culture. The type of supportive, non-judgmental, educative relationship developed in the context of psychotherapy is equally as important.

In noting the need for psychotherapy, many mental health professionals said they believe that talking through his suicidal thoughts perhaps could have helped Shaffer.

The vast majority of surgeons, anesthesiologists, and high-risk physicians live in urban areas where access to private psychologists or other mental health therapists is readily available. These professionals highly value confidentiality and are not connected to hospital systems. Don't just talk to your colleagues, get them to someone who can help!

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