M.D. Suicides

Some crack under the strain

William Garcia was a successful California anaesthesiologist when his life began to disintegrate at 40. He had a serious automobile accident, then marital problems surfaced, leading him and his wife to separation and divorce. Feeling depressed and guilty, Garcia turned to drugs. He checked into a psychiatric hospital in Arizona but stayed only six weeks before returning to California--and to drugs. Although he managed to keep practicing medicine, his professional reputation suffered. At 42, totally strung out on narcotics and with his career in ruins, Garcia checked into a motel and deliberately overdosed on heroin.

Garcia's suicide attempt failed. But each year a disturbing number of physicians do manage to kill themselves. Accurate statistics are hard to come by because many suicides go unreported, but different experts estimate that from 36 to 77 of every 100,000 physicians die by their own hand every year, at least three times the rate for the population at large. Put another way, almost as many doctors commit suicide annually--upwards of 130--as graduate from Harvard Medical School. Of all professionals, doctors may be the most self-destructive.* Says Garcia, now on the staff of Los Angeles' Suicide Prevention Center: "With the statistics the way they are for physicians, I feel very fortunate to have made it."

Although blessed with challenging work, social position and comparative wealth, doctors contend with long hours and the knowledge that a single mistake can maim, disable or even kill. These pressures often carry over into their personal lives. Says Los Angeles Psychiatrist Robert Litman: "By and large, doctors are not good, steady companions. They're good providers but lousy lovers."

Medicine appears to attract personalities especially vulnerable to stress. Says Litman: "It draws workaholics, overly conscientious people who take failure poorly, and idealists, who are frequently disappointed during their careers." Compounding the problem is the feeling of omnipotence that many doctors develop after they save their first lives. Later on, this can make it difficult for them to admit they need help. "They believe themselves to be omnipotent," says Litman, "semi-deities in a white smock." Finally, doctors have easy access to drugs. Says Psychologist Louis Wekstein of Boston's Tufts University: "Psychotherapy is almost a last resort. They've exhausted their own knowledge and used every strategy--such as minor tranquilizers and alcohol."

Surgeons and other specialists in frequent contact with suffering or dying patients tend to have very high suicide rates; obstetricians, radiologists and pediatricians have lower ones. The most suicidal, perhaps, are psychiatrists. Explains Psychiatrist Jerome Motto of the University of California in San Francisco: "What makes a person a good psychiatrist can be a double-edged sword. A high degree of sensitivity is necessary, but psychiatrists without psychological toughness suffer when exposed to a patient's miseries."

Typically, the strains of medicine are felt most acutely after ten to 15 years. Early signs of distress are extramarital affairs and physical upsets, including insomnia and diarrhea. Some suicidal physicians may also avoid social contact, draw up wills or make unexpected gifts. Says U.C.L.A. Thanatologist Edwin Shneidman: "If a colleague offers you his prized microscope, you might want to sit down with him and try to identify his problem."

Alarmed by medicine's casualties, the American Medical Association and the American Psychiatric Association have launched a joint study of these suicides. Professional organizations are intensifying efforts to reach troubled physicians. The California Medical Association, for example, urges doctors to call a hot line for counseling. The group also runs weekend workshops for physicians and their spouses on how to cope with stress. Such programs have had some success but are limited because doctors are reluctant patients. Says Wekstein: "We have to teach them that they are not just doctors but also human beings." qed

*Others with high suicide rates include dentists, lawyers and police officers.

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