PHP Medical Director Message - Reflections on suicide

By: Jon A. Shapiro, MD, DABAM, FASAM, MRO

I’d like to share some reflections about suicide, both professional and personal. In 1929, my maternal grandmother developed melancholia following the birth of my mother. Today we would diagnose post-partum depression. She died by suicide, hanging herself when she could see no relief from the darkness.

My mother was raised with lots of love, first by an aunt and later by my grandmother, Rose. My mother’s personality was shaped by this foundational event of suicide. Despite therapy and rational thinking, my mother never shook the idea that she contributed to her mother’s death. It caused her to be a strong person, always reaching for control of those she loved. Mentally, she steered us all through the world as if she were a spider in the center of a giant web of caring. She survived my father’s early death. She survived lung cancer and two breast cancers. Through these incredibly strong personality traits, my siblings and I were also molded by the tragedy of our grandmother’s suicide, similar to the children of survivors of any major tragedy.

My niece is a wonderful woman. She has lovingly fostered a child from a family disrupted by substance abuse. She is tough, but she is scarred. When she was an infant, her mother shot herself with a shotgun. No family members were able to care for her, so she was shunted into foster care for years. Foster care was sometimes good, sometimes horrid and never predictable. My brother and sister-in-law were able to adopt her when she was 11 – finally providing her with nurturing stability.

Suicide does not have a single victim. It spreads in waves of grief from the person who dies to family, friends and co-workers. Articles about suicide tote out facts and statistics about physicians’ high rate of suicide and our stressful work environment, but it is hard to capture the second-hand trauma that is so common among us. We lose colleagues and friends. It compounds our already stressful profession.

In my role as a medical director at a Physicians’ Health Program (PHP), I have also been exposed to physician suicides. Whereas the average physician sees one or two colleagues die by suicide, those of us working with PHPs witness them year after year. Perhaps this is expected with the population with whom we work – health care professionals with severe substance use disorders and other psychiatric illness. These horrible few outcomes are offset by our great successes – doctors assisted, doctors re-employed and doctors launched on a lifetime of personal spiritual growth in recovery.

In the America of the 1960s there was an increase in physician suicide. Investigation revealed that doctors addicted to alcohol or drugs were persecuted, prosecuted, defrocked and thrown to the side of the road. This is what led to the development of PHPs. We facilitate a non-disciplinary path to treatment and recovery for our colleagues with mental illness.

There are PHP detractors out there who have seized on anecdotes to blame PHPs for physician suicide. This is like blaming antibiotics for death caused by pneumonia. Of course antibiotics are a marker of high risk, but they aren’t causing the death. Similarly, physicians referred to PHP are already at high risk for suicide by virtue of their mental illness.

As a profession, we need to respond to suicide with education and prevention. We need to normalize and destigmatize mental illness so that people can come forward for treatment without fear of professional repercussions. We need a dose of humanity in the way we train our students and residents. And we need PHPs to monitor, to advocate and to facilitate our recovery.

We are all affected by suicide. It doesn’t stop with the one who dies or their family. Friends, coworkers and even unborn generations are influenced by these deaths. Gratefully, recognition of the problem has begun. Let us embrace all the resources at hand to prevent physician suicide and all its secondary trauma.