Whipping Post: Is Suicide Painless?

February 20, 2015

Foreshadowing: In junior high school, I gave a promotional speech on “the little black capsule”. My teacher was horrified, but still gave my presentation an A. The one-minute commercial, complete with prop, was based on the attempted suicide of Painless Waldowski (the best equipped dentist in the army) in the movie M*A*S*H. Of course, Painless did not really kill himself. The act was a ploy on the part of Hawkeye and Trapper to help Painless get back his sexual mojo. I think awakening with a comely nurse at your side greatly improves one’s motivation. I digress. M*A*S*H the movie is a classic, but M*A*S*H the TV series is one of my favorites. I grew up as the 11 seasons unfolded. I wanted to be the dashing, wise cracking but thoughtful, medically adept Hawkeye Pierce. It some respects I got my wish. I wonder now if I am just as broken as Hawkeye was at the end of the series.

M*A*S*H The last supper

”Nothin’ seems to change, bad times stay the same, and I can’t run. Sometimes I feel, like I’ve been tied to the whipping post,Good lord I feel like I’m dying’” Gregg Allman

I thought of suicide last night: not my personal suicide, but the effects of suicide in general. Bullshit. That is not true. I was thinking of my own suicide. Let us say, for the moment, that my interest is purely academic. I am not to the point where taking my life seems like a good idea. Does the victim ever hear his or her own cry for help? Who commits suicide, and why? I will not ask how; half of all successful suicides use a firearm. Humans use the tools that they have at hand.

Supposedly, Doctors have a higher than average risk of suicide. Good thing I am no longer a Doctor. Physician suicide is probably not a big deal to you. Annually, 200–300 American Doctors kill themselves. That is about 20–30 doctors per 100,000, or in Oregon, 2–3 doctors a year in a state of four million people. There were 771 suicides in Oregon in 2016; the addition of a couple of doctors seems trivial.

Except this is America: Reveling in the individual, while ignoring the masses, is our way of life. A small girl falls down a hole in Texas, and the nation pauses. A hiker gets lost in the woods, and we dispatch search teams at a cost of tens of thousands of dollars. Individuals seem to matter to Americans. Never leave a comrade, or a child, behind is a theme we all recognize. A doctor’s death resonates, particularly in a small community (and every community in Oregon is small), because physicians are supposed to be healers. After all, Doctors have rich, perfectly scripted, respected lives. Why would such a privileged soul take his or her life?

Because everyone does it. Suicide, depression, and other mental health problems are common in the United States. There were about 41,000 suicides in the United States in 2013. Only one out of 33 suicide attempts is successful. I attribute this to a lack of commitment. Come on people! Doctors may have a higher rate of success due to their knowledge and access to medications, but the data is hard to find. Overall, the numbers suggest that 1.3 million American adults (0.6%) a year will move from thinking about suicide to actively trying to kill themselves. That is a real number. As an aside, many web articles put the suicide rate at 1–2% and the rate for Doctors at 2–4%. Clearly, our educational system fails to teach mathematics.

Doctors successfully commit suicide at almost twice the rate of the other folks. Admittedly, those statistics suffer from small numbers. Physicians can be proud of being the number one profession for suicide. We are such overachievers. However, male farmers, fisherman, and foresters are much more serious about ending their lives than doctors. The medical profession takes a leadership role in gender equity however. Male and female doctors are equally adept at killing themselves. Smart people those Doctors. The good news is that physician rates of divorce, drug and alcohol abuse are no worse (or better) than the population as a whole. The bad news is that divorce and substance abuse are not risk factors for physician suicide.

Are some personality types more prone to suicide? Maybe suicides are just more likely to have mental health problems. Suicide is more common in people suffering from depression or psychosis. Good thing I am not depressed. Semantics, suicide, by definition, is insane. A normal person has trouble imaging circumstances so dark and desperate as to justify killing themselves. Insanity though, seems common in modern society. Doctors are particularly unlikely to seek out or follow through with treatment for mental illness. We are lousy patients. Unfortunately, “Physician heal thyself” is always a poor prescription for success.

I fit the profile of a successful Doctor suicide all too well: Mid-career, a male over the age of fifty, not white, and currently watching my professional career auger into the ground. I am achievement oriented, overly self-reliant, and I emphasize my professional identity above all else. None of this is surprising; I am a surgeon after all. To be fair, this is no fleeting moment of despair. To paraphrase, with great reward comes great stress. Physicians hold a special place in society. That position is not easy to maintain, and in spite of the current whining about the state of the medical profession, stress and dissatisfaction are a part of the job. A 1973 article, entitled “Physicians who kill themselves” found that older, divorced white male doctors had a higher rate of suicide than the general population. To be sure, there were no nonwhite or female physicians in the 1970s. The author of a 1979 communication, “Satisfactions, dissatisfactions, and the causes of stress in Medical Practice”, identified time pressures, patient interactions, and paperwork as the main sources of physician malaise. Sound familiar? The more things change, the more they stay the same.

There is much written today about physician wellness and the high rate of burnout in the profession. Some physicians, including the American Medical Association, want to add a measure of professional happiness to healthcare reform. The Quadruple Aim? Really? Spare me. When did we, as a profession, become so weak and ineffectual? You cannot separate the financial and professional rewards of Medicine from the stress and responsibility. Deal with it, or do something else.

Everything that I have built over the last 30 years is in flames. Gone is my professional life, along with the patient and colleague relationships that filled my days. Never mind that my income is a fraction of what it was; bankruptcy is a real option. Moreover, my sense of self is in tatters. I was a physician and a surgeon. Now I am not sure what I am, except maybe another statistic. Is there enough of me remaining to justify the next 30 years of life? I have no idea when, or how this bitter downward spiral will end. Most importantly, I do not know who, or what I will be when I hit the ground.