Grieving Medical Communities After Physician Suicide: Recognition and Outreach

"...any man’s death diminishes me, because I am involved in mankind..."

                  John Donne, Meditation XVII

As members of the mental health field, we can be of great assistance when contacted by someone in leadership that a physician in their midst i.e. one of their own, has died by suicide. You might receive a call from the Chief of Staff of a local community hospital, the director of training of a university residency program, the Chair of a university department or the medical director of a private clinic. The overarching theme is collective grief and confusion. Usually the caller is looking for some direction both in terms of intervention and prevention of further deaths. Our training and experience in suicide aftermath, systems, crisis intervention, and group dynamics can serve us well. Here is what to look for (1):

• Mourning. You can expect to see a wide range of the common symptoms and signs that we see in people who are grieving. However, because the death of their colleague was by suicide, many of the individuals will be struggling with both rational and irrational notions of responsibility (2). See below.
• Systemic anxiety. Suicide is so shocking, confounding, and unexpected, that most survivors feel anxious. They may have a general sense of insecurity about their work and its meaning, a worry about their own health and functioning, or fears of a family member becoming suicidal. Some may worry about another colleague who is going through a rough time (marital separation or divorce, a health problem, a lawsuit) and hope that he/she is not next. These concerns are a form of “contagion fear,” similar to “copycat suicide” seen in teenagers or after the death of a celebrity. To my knowledge, we have no study or scientific research on copycat suicide in the house of medicine, but fears about “who’s next?” are not uncommon, especially in overworked, understaffed, and beleaguered medical communities and departments.
• Guilt and blame. When one loses a medical colleague to suicide, our thoughts can quickly go to whether we might have prevented his/her death. The friends and associates of the decedent who might have had some knowledge that the doctor was struggling or was undergoing treatment usually feel dreadful that they didn’t do more. Even colleagues who knew nothing about the physician’s personal life may feel vague systemic responsibility that they did nothing to ease the workload or lend a hand in some way. Blame may be directed at oneself “for failing the person” or at others—the boss or other authority figure in the workplace or training site, the doctor’s spouse for leaving, the doctor’s kids for getting in trouble, the doctor’s patients for being so demanding, the family of a patient for suing the doctor, and so forth.
• Anger and rage at the deceased. This is more complicated and not all colleagues feel anger or are comfortable with these feelings. Some examples are: (a) “I’m really furious at him for giving up on life. I have always believed that suicide is a ‘cop out’ and he just confirmed it. I had no idea he was so selfish”. (b) “How could she do this to her husband and children? They are the victims here, not her. Poor Bill. She never really treated him very well anyway. She worked so hard and kind of abandoned him and the kids already anyway”. (c) “I’m furious at him for killing himself. He has the biggest practice in this clinic and now we’re stuck with all his patients. And what are we supposed to tell them about how he died?”. (d) “I wish her suicide wasn’t so public. Being a psychiatrist and killing yourself is not cool. Her death sets us back a generation when everyone thought psychiatrists were all screwed up. I’m disappointed in her, really disappointed. She has not only let us down but our entire specialty.”
• Business as usual. These are colleagues who remain cool and composed through the entire aftermath of a doctor’s suicide. They do not seem to miss a beat. A statement that applies is, “Suicide is just an occupational hazard when you’re a doctor. It’s tough work. It’s not for sissies.” These physicians use a triad of defenses—denial, intellectualization, and rationalization.

In my next blog I will write about the many ways that we can help grieving medical communities and how we can assist with the healing and resolution of their loss.

References

1. Myers MF and Gabbard GO. The suicidal physician and the aftermath of physician suicide. In The Physician as Patient: A Clinical Handbook for Mental Health Professionals. American Psychiatric Publishing Inc. Washington, DC. 2008. Page 201,

2. Jordan JR and McIntosh JL. Is suicide bereavement different? A framework for rethinking the question. In Grief After Suicide: Understanding the Consequences and Caring for the Survivors. Editors Jordan JR and McIntosh JL. Routledge. New York. 2011. Pages 19-42,