William Lynes, MD, had a flourishing medical practice and a fulfilling family life with three children when he first attempted suicide in 1999 at age 45. By 2003, depression and two more suicide attempts led to his early retirement.
In a session at the recent virtual American Psychiatric Association (APA) 2021 Annual Meeting, Lynes talked about the challenges of dealing with depression while managing the stresses of a career in medicine. The session in which he spoke was called, "The Suicidal Physician: Narratives From a Physician Who Survived and the Physician Widow of One Who Did Not."
By writing and speaking about his experiences, he says, he has been able to retain his identity as a physician and avoid obsessive thoughts about suicide. He hopes conversations like these help other physicians feel less alone and enable them to push past stigma to get the help they need. He suspects they do. More than 600 people joined the APA session, and Lynes received dozens of thankful messages afterward.
"I love medicine, but intrinsically, the practice of medicine is stressful, and you can't get away," says Lynes, a retired urologist in Temecula, California. "As far as feedback, it made me feel like it's something I should continue to do."
A Way to Heal
For Lynes, his "downward spiral into darkness" began with a series of catastrophic medical events starting in 1998, when he came home from a family vacation to Mexico feeling unwell. He didn't bother to do anything about it — typical of a physician, he says. Then one night he woke up shaking with chills and fever. Soon he was in the hospital with respiratory failure from septic shock.
Lynes spent 6 weeks in the intensive care unit (ICU), including 4 weeks on a ventilator. He underwent a tracheostomy. He lost 40 pounds and experienced ICU-related delirium. It was a terrifying time, he says. When he tried to return to work 10 months later, he didn't feel as though he could function normally.
Having once been a driven doctor who worked long hours, he now doubted himself and dreaded giving patients bad news. Spontaneously, he tried to take his own life.
Afterward, he concealed what had happened from everyone except his wife and managed to resume his practice. However, was unable to regain the enthusiasm he had once had for his work. Although he had experienced depression before, this time it was unrelenting.
He sought help from a psychiatrist, received a diagnosis of bipolar disorder, and began taking medication. Still, he struggled to fulfill his responsibilities. Then in April 2002, he had a snowboarding accident that caused multiple facial fractures and required five operations. When he returned to work this time, he felt like a failure but resisted asking colleagues for help.
A few months later, Lynes again attempted suicide, which led to another stay in the ICU and more time on a ventilator. Doctors told his family they didn't think he would survive. When he recovered, he spent time as an inpatient in a psychiatric ward, where he received the first of a series of electroconvulsive therapy sessions. Compounding his anxiety and depression was the inability to come to terms with his life if he were not able to practice medicine.
The next fall, in September 2003, his third suicide attempt took place in his office on a weekend when no one was around. After locking the door, he looked at his reflection in the frame of his medical school diploma. The glass was cracked. "It was dark, it was black, it was cold," he says. "I can remember seeing my reflection and thinking how disgusted I was."
For years after that, Lynes struggled with his sense of self-worth. He hid from the medical system and dreaded doctors' appointments. Finally in 2016, he found new meaning at a writing conference, where he met a fellow physician whose story was similar to his. She encouraged him to write about his experience. His essay was published in the Annals of Internal Medicine that year. "Then I started speaking, and I feel like I'm a physician again," he says. "That has really healed me quite a bit."
Why Physicians Die by Suicide
Working in healthcare can be extremely stressful, even in the best of times, says Michael Myers, MD, a psychiatrist at SUNY Downstate Health Sciences University in New York City and author of the book, Why Physicians Die By Suicide: Lessons Learned From Their Families and Others Who Cared.
Years of school and training culminate in a career in which demands are relentless. Societal expectations are high. Many doctors are perfectionists by nature, and physicians tend to feel intense pressure to compete for coveted positions.
Stress starts early in a medical career. A 2016 systematic review and meta-analysis of 183 studies from 43 countries showed that nearly 30% of medical students experienced symptoms of depression and that 11% reported suicidal thoughts, but only 15% sought help.
A 2015 review of 31 studies that involved residents showed that rates of depression remained close to 30% and that about three quarters of trainees meet criteria for burnout, a type of emotional exhaustion and sense of inadequacy that can result from chronic stress at work.
The stress of medical training appears to be a direct cause of mental health struggles. Rates of depression are higher among those working to become physicians than among their peers of the same age, research shows. In addition, symptoms become more prevalent as people progress through their training.
The COVID-19 pandemic has added stress to an already stressful job. Of more than 2300 physicians surveyed in August 2020 by the Physicians Foundation, a physicians advocacy organization, 50% indicated that they experienced excessive anger, tearfulness, or anxiety because of the way the pandemic affected their work; 30% felt hopeless or lacking purpose; and 8% had thoughts of self-harm related to the pandemic. Rates of burnout had risen from 40% in 2018 to 58%.
Those problems might be even more acute in places experiencing other types of crises. A 2020 study of 154 emergency department (ED) physicians in Libya, which is in the midst of a civil war, found that 65% were experiencing anxiety, 73% were showing signs of depression, and 68% felt emotionally exhausted.
Every Story Is Different
It is unclear how common suicide is among physicians. One often-repeated estimate is that 300 to 400 physicians die by suicide each year, but no one is certain how that number was determined, says Myers, who organized the APA panel.
Studies on suicide are inconsistent, and trends are hard to pinpoint. Anecdotally, he has received just as many calls about physician suicides in the past year as he did before the pandemic started. "What I can tell you is that this is a serious subject," Myers says. "And it's not going away."
Every person is different, and so is every death. Sometimes, career problems have nothing to do with a physician's suicide, Myers says. When job stress does play a role, factors are often varied and complex.
After a 32-year career as a double board-certified ED physician, Matthew Seaman, MD, retired in January 2017. The same month, a patient filed a complaint against him with the Washington State medical board, which led to an investigation and a lawsuit.
The case was hard on Seaman, who had continued to work night shifts throughout his career and had won a Hero Award from the American Red Cross, says his wife, Linda Seaman, MD, a family practitioner in Yakima, Washington, who also spoke on the APA panel. The American Board of Emergency Medicine sent Seaman a pin in recognition of his 30 years of frontline ER service — an honor only bestowed on 1400 ER doctors out of 33,510 practicing at that time.
Linda Seaman said that 2 years after the investigation started, her husband was growing increasingly depressed. In 2019, Seaman testified in a deposition. His wife says he was devastated by the experience. Thirty-six hours later, he died by suicide at age 62.
Looking back at the year leading up to her husband's death, Seaman recognizes multiple obstacles that interfered with her husband's ability to get help, including frustrating interactions with psychiatrists and the couple's insurance company.
His identity and experience as a physician also played a role. A couple of months before he died, she tried unsuccessfully to reach his psychiatrist, whose office suggested he go to the ED. However, because he worked as an ED doctor in their small town, he wouldn't go. Seaman suspects he was wary of the stigma.
Burnout likely set him up to cave in after decades of work on the front lines, she adds. Working in the ED exposes providers to horrific, traumatic cases every day, she says. Physicians learn to suppress their own emotions to deal with what they encounter. Stuffing their feelings can lead to posttraumatic stress. "You just perform," she says. "You learn to do that."
A Real Gift
Whenever Myers hears stories about doctors who died by suicide or who have written about their mental health struggles in order to help others, he contacts them. One goal of his own writing and of the conference sessions he organizes is to make it easier for others to share their own stories.
"I tell them, first of all, their courage and honesty is a real gift, and they're saving lives," he says. "There are so many suffering doctors out there that think that they're the only one."
Public conversations such as occurred in the APA session also offer opportunities to share advice, including Myers' recommendation that doctors be sure they have a primary care physician of their own.
Many don't, he says, because they say they are too busy, they can treat their own symptoms, or they can self-refer to specialists when needed. But physicians don't always recognize symptoms of depression in themselves, and when mental health problems arise, they may not seek help or treat themselves appropriately.
A primary care physician can be the first person to recognize a mental health problem and refer a patient for mental health care, says Myers, whose latest book, Becoming a Doctors' Doctor: A Memoir, explores his experiences treating doctors with burnout and other mental health problems.
Whether they have a primary care doctor or not, he suggests that physicians talk to anyone they trust — a social worker, a religious leader, or a family member who can then help them find the right sort of care.
In the United States, around-the-clock help is available through the National Suicide Prevention Lifeline at 800-273-8255. A psychiatrist-run hotline specifically for physicians is also available at 888-409-0141. "Reach out and get some help," Myers says. "Just don't do it alone."
Lynes advocates setting boundaries between life and work. He has also benefited from writing about his experiences. A blog or a diary can help physicians process their feelings, he says. His 2016 essay marked a major turning point in his life, giving his life meaning in helping others.
"Since I wrote that article, I can't tell you how much better I am," he says. "Now, I'm not embarrassed to be around physicians. I actually consider myself a physician. I didn't for many, many years. So, I'm doing pretty well."
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Cite this: What Brought Me Back From the Brink of Suicide: A Physician's Story - Medscape - May 26, 2021.