Psychiatrists and suicide

Why do psychiatrists have one of the highest suicide rates among physicians? This question was troubling me, so I spoke to Dr. Michael Myers about this by phone. He is a New York City psychiatrist and the author of Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared. Michael was born in Chatham, Ont., and was a professor of psychiatry in Vancouver. He has treated doctors, medical students and residents for 50 years. First, he pointed out that there are some common risk factors for psychiatrists and mental illness, including: Pre-existing conditions. They may have had depression, panic attacks, eating disorders, or bipolar disease before residency, and may have chosen psychiatry because it would be more supportive if they relapsed. Plus, they are able to control workload, hours and on-call better. With lived experience and self-selection, they are empathically attracted to psychiatry. Michael told me that a common misconception is that treating depressed patients all the time leads to depression. This is not true. Internalized stigma. Some are ashamed of themselves if they feel suicidal, so they don’t seek help. They often self-medicate. Family physicians are intimidated in trying to treat them. Tragically, they may fall through the cracks, dying of illnesses they so carefully treat in others. Fear. They fear their provincial or territorial college of physicians and surgeons (or state medical licensing board in the U.S.) will revoke their licence if they ask for help. Also, they may be vulnerable to complaints by patients with personality disorders about sexual assault or failure to predict suicide or criminal acts. This can be devastating with public shaming before a fair trial. The plaintiff can allege anything and the doctor can say nothing. The accusations can be in the headlines, and the verdict of innocence can be on the back page of the newspaper years later. This can also be hard on the family. Being female. Women psychiatrists, like women doctors in general, have higher rates due to the extra burdens of running a home, childcare and eldercare. They often have more guilt than men about not being superwomen and doing it all. Sexism, microinequities in training and practice, shame attached to substance use disorders, and higher rates of depression in women are additional variables. How to stay well Michael advises that all physicians pay attention to their mental health, including concerns and observations of family, loved ones, colleagues and friends. He says to make sure you have a family physician and cultivate a trusting relationship with them. This should be someone who lets you be the patient and is comfortable treating you with the objectivity and kindness you deserve. This physician can diagnose and treat the illness that could put you at risk of suicide—and refer you to a psychiatrist, addiction medicine specialist, and other mental health professionals. Regarding work and stress, Dr. Myers advises breaking up your day. You can go to the hospital in the morning and have a private clinic in the afternoon. Also, he recommends the things that everyone should do such as eating a healthy diet, getting eight hours of good sleep a night, lots of vacations with no contact to medicine, daily exercise like walking or swimming. Advice you’re so used to giving out applies to you too! Also friends and family come first. Hobbies help as well. How to treat a psychiatrist if you are their family physician: Don’t assume anything. Be thorough, treat them like all your other patients and ask about suicidal ideation. How to treat a psychiatrist if you are a psychiatrist: See above—plus, you are in charge. You do the diagnosis and prescribe appropriate counselling and medications. Dr. Myers had a psychiatrist as a patient who was a war veteran and was depressed and suicidal. He had to force him to go to a U.S. veteran’s hospital psychiatric ward. The patient was angry but eventually thanked Dr. Myers for doing this. He found the other patients were wonderful in group therapy and really understood him and empathized with him as no non-veteran could. If you are suicidal, please call 911 or go to your nearest ER. Canadian Medical Association Hotline: 1 800 851 6606. Or Google: Canadian Medical Association/wellness support. Get my free audio or ebook on physician stress by emailing me at drjohncrosby@rogers.com, and share your thoughts below.

Psychiatrists and suicide

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