September, National Suicide Prevention Month, is coming to a close. National Physician Suicide Awareness Day was September 17. What happens now that September’s over?
All month, I’ve wanted to write this post. I’ve been hesitant because I’ve been grieving the loss of a dear friend who took his own life on August 30. He wasn’t even 50 years old. If you’d met him, you’d have never suspected in a billion years he was depressed. A smart physician with a riotous sense of humor who knew so many lines from Seinfeld episodes and myriad movies, he could hold an audience captive with his stories. He was a loving, devoted spouse, supportive and proud of his two high school daughters, always present at dance performances. He attended church and taught Sunday school for 13 years. He hadn’t just been an internist or a pediatrician; he’d been both, and chief resident.
A sadly familiar story, isn’t it? Another solid person who looks so put together on the outside, always doing more than anyone ever asked him to do. Never just settling for good enough.
What feelings and thoughts did he have that convinced himself that the world and those who love him would be better off without him? That the pain of death was less than the pain of living?
Our community has been shocked by this news, not only because none of us had any idea he struggled with depression, but because such an event sends out aftershocks, triggering personal memories for everyone who hears the story. Even those who didn’t know him, who’ve struggled with depression themselves or lost a loved one to suicide, re-experience their own pain hearing this story. I’d be willing to bet there’s not a single person out there who hasn’t also experienced this kind of loss.
When I was 25 and had my major depressive episode, I experienced suicidal thoughts. It’d all started in med school with the B- I got on the first test one month into training. No matter what I did, what metrics I used to prove my self-worth, I never felt enough. I was scared all the time that I couldn’t handle adult life. How could I be a doctor and take care of others when my mind was constantly distracted by ruminations of self-doubt, self-loathing, rehashing of past mistakes (i.e., not meeting my own or other’s unrealistic expectations, wrong answers, reading a CT scan overnight on-call and having my attending ask, “Ummm … you didn’t say that, did you?”).
I took three months off from medical training to care for myself. I read Darkness Visible by William Stegner to help me understand what was happening to me. The book convinced me that it was depression creating my thoughts, not me. I took Prozac and saw a psychiatrist regularly, which helped me pull myself out, but eventually, anxiety would again burn through my serotonin stores, and insomnia would come back; my clues to resume the meds.
With uncharacteristic self-compassion, I chose to work part-time, never becoming a partner in private practice. Professionals acknowledge imposter syndrome, but I actually was an imposter, living an exhausting secret life that I had to manage privately. My group thought I was at home tending to my kids, and I was, but I needed those days off to replenish myself.
It’s been three years since I left that job. I still take 1/4 tablet a day. I’m so grateful for SSRIs and that I loved myself enough to not let the stigma keep me from taking care of my emotional life. I also took the meds because I love my family and prioritized taking care of my emotional self over scarring them with my own suffering. I have no shame about it. Zero.
If my story resonates with you, keep this in mind: You aren’t f*cked up. The system is f*cked up. Awareness of the deep emotional struggles health care providers experience is increasing … but we need more. More willingness to recognize that, like it or not, doctors are human. With so much negative cultural meta-emotion (the feelings about our feelings) around feeling anything but happy or in control, the intense shame around feeling sad or lonely is the judgment that holds people hostage. This is true for the general population, even more true in medicine, where shame is used frequently as a motivator to work harder and never make mistakes.
There’s so little talk about our low emotions. Yet feelings run the show in our lives and inside our minds. It’s not our emotions that bring us the worst pain. It’s pretending we don’t have heavy feelings that hurts the most.
If you really want to make a dent in physician suicide, talk about your own feelings, not just with a therapist, but with the people in your daily life. Share your hardships. You spend all waking hours trying to ensure the longevity and well-being of everyone around you. It’s time to take a long, hard look inward.
The medical establishment will never tell you to do it — although I am deeply committed to changing this status quo. You must grant yourself permission and follow your own rules of what is and is not okay for you in order to maintain your sanity and truly save your own life.
Hiding unwanted emotions is exhausting and impacts everything. If you aren’t sharing your difficult feelings, you’re reinforcing an environment that keeps others from sharing theirs. Talking about your struggles creates opportunities and grants others permission to do the same. When you share what’s really true, in a radically honest way, what’s true changes. When you acknowledge your sadness, anger, or anxiety, you release some of the tension that comes with trying to appear unaffected. Speaking what you really feel is a crucial way to prevent further suicides.
Shame grows in the dark. Shame, when spoken, heals. Now that October is here, I hope I’m not too late to make a difference.
The author is an anonymous physician.
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