Recent events in our mid-west region prompted us to bring the topic of physician suicide forward with our residents and fellows. They received this information in a weekly mindfulness email they receive as part of our internal coaching program:
Losing a colleague or friend to suicide is a tragedy to those who survive and it can be devastating. With such tragedy can come feelings of sadness, grief and confusion. The feeling of loss that can accompany losing “one of our own” can be terrible. And then many questions often follow. Was the individual depressed or mentally ill. What was the trigger? How much stress were they under? Were there any signs? How could suffering like this have been missed? These will be unanswered questions, forever.
Where does this leave the rest of us? A tragedy like this is a prompt to reflect and do a self check. Ask yourself, “How am I really doing? How am I managing my stress? Is anything more creeping in like depression, fatigue, anxiety?”
Being both human and a physician is indeed a strange combo and can create its own set of challenges. For instance, physicians often perceive stigma attached to having mental health challenges. We are not supposed to look vulnerable, are we? We are not even supposed to look less “put together” than our colleagues. Stigma fuels denial and can be a threat to our identity. Because our lives are often very defined by achievement, being perceived as less than perfect can be difficult.
In addition, our work is both rewarding and tiring. This fact should cause us to do a self-check on how we are meeting our own self-care needs. When we do not feel like we are meeting those needs, feelings of bitterness and anger might arise. The more we put our own needs on the back burner the more resentment can creep in. Sure, we can power through one or two months of a crazy schedule and still come out ok. Are you able to disconnect from work and come back feeling rested?
Consider our loss of connection this past year with the pandemic, and the importance of collegial interaction, of family support, of just having a friend to hang with. Most of us feel a bit better, even hopeful, when someone extends a hand to us. How are you connecting with others? How easy or hard is it to be a bit vulnerable and share how you are doing in the moment?
What about those who survive a suicide attempt or those who might be thinking of doing it? In such circumstances a burden of shame may be present; a feeling of guilt for having tried to die or for making plans to die. What does one do with these weighty feelings? The antidote for shame begins with reaching out for support and with learning self-compassion. Dr. Kristen Neff, psychologist at the University of Texas and pioneer in the field of self-compassion describes the three elements of self-compassion as including 1) self-kindness, not self-judgement, 2) recognition of our common humanity and that we need not suffer alone, and 3) being mindful about taking a balanced approach toward our negative emotions. Once again we see the importance of the themes of self-care and connection. We are not meant to live in isolation.
Many myths exist about suicide. It is much more complex than simply saying it was an act of selfishness, cowardice or a cry for help. Dr. Thomas Joiner, professor at Florida State University and suicide expert describes three factors that mark those most at risk for death by suicide: the feeling of being a burden on loved ones, the sense of isolation; and, perhaps chillingly, the learned ability to hurt oneself. Being aware of contributing factors like these adds to our knowledge and understanding of how suicide might occur and can help us be alert to looking for signs of suffering in those we know.
The bottom line is that suicide is a terrible tragedy, and the pain and suffering those left behind may experience is real. We are all challenged in times like this and there is opportunity for each of us to listen, to reach out and to share compassion. None of this is simple and we can work collectively to care for one another.
If any of these comments strike a chord or if you are desiring to talk further about this topic, please reach out to a colleague, your program director, or local employee assistance program. If you think you might hurt yourself please call the National Suicide Prevention Lifeline, 1-800-273-8255.
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