After Kate Spade and Anthony Bourdain, it’s time to shift on suicide

Surviving suicide loss is difficult. And in some sense, the resulting grief is open-ended. I am a mother and doctor whose two sons died by suicide associated with psychotic bipolar disorder. My ever-present sensitivity to the fierce loss of death by suicide is again touched when I hear of death by suicide. The suicides of Anthony Bourdain and Kate Spade triggered in me a renewed feeling of grief. Like so many, I felt I knew Anthony Bourdain. “No Reservations” was my introduction to Bourdain. As a fellow traveler and foodie, I fell in love with his eccentric style. Later, he drove me crazy when he was drunk and had an alcohol-induced blackout during the “Sicily” episode of Parts Unknown. But, afterward, I worried about him. Now, I will miss him.

Yes, Bourdain himself fit into categories for increased suicide risk: a white man in his 60s, divorced, with a history of addiction. Although, as I live with daily, somehow the rational explanations are not entirely satisfying for the loss.

Brain illness, mental illness is the underlying factor in 90 percent of suicides. As physicians, we are fortunate to understand this intrinsic vulnerability better than most. Therefore, I believe we have a particular responsibility to help destigmatize these brain illnesses.

It seems suicide is on the front burner of our collective attention. Appropriately, in the media and in many personal conversations, there is a call for people at risk for suicide to seek treatment. Those of us in medicine know first hand the profound barriers to appropriate treatment. Even as a physician who understood the severity of my son’s illnesses and how to operate within medical bureaucracy, it was challenging to find treatment. Days were spent in the hospital ED waiting for a psych bed to open. Psychiatry facilities offered substandard therapy in dirty, antiquated facilities. Tens of thousands of dollars of uncovered costs accrued due to inappropriate insurance denials. We struggled with absent post-hospitalization care structures and limited, ineffective medications with significant side effects.

Brain science, in many ways, remains in its infancy. We flood the body with drugs that have adverse effects for every cell when only a portion of the brain is the intended treatment target. Where are the precise, elegant treatments? More research and better science are needed.

Furthermore, these treatments are not needed just for “our” patients, as many physicians are patients with psychiatric illness. The pressures of our jobs are unique and increasing. We are working through disruption of our “industry” which, many of us experience as a vocation, not just a job. The resulting conflicts are evident in our psyches and personal lives, which in some of us, manifests or exacerbates psychiatric illness.

I find myself alternating between sadness and outrage about the lack of treatment of chronic and acute mental illness in our country. After the deinstitutionalization movement of the 1960s, the promised community mental health care system has not materialized.

As we advocate for our patient’s mental and brain health, we also advocate for our own health because we use the same health care system and suffer from the same social stigma. We are all connected, and perhaps stigma is even more intense for physicians.

I hope we answer the call for improved mental health care with a demand for true parity of mental health reimbursement and insurance coverage. We are called to speak, both in our work and personal lives, in a way that decreases stigma. Expansion of treatment access to emergent inpatient care will save lives. Our citizens and citizens of the world long for the benefits of more research and improved treatment for brain illness.

The public dialogue and reaction to the deaths of Spade and Bourdain suggest that we are on the precipice of a shift, a systemic reorganization, about brain health. Let us move it forward. In conjunction with patient advocacy groups, scientific organizations and other invested groups, let us not just participate but lead a societal shift about mental illness and suicide.

C. Ann Conn is a pain management physician and can be reached at her self-titled site, C. Ann Conn.

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