The qualities, which make a good and caring doctor, are also the qualities, which place us at higher risk of mental illness
I have been a widow for ten months now. My husband Tom Black, a GP, died by suicide on the 14 May last year. I am also a GP and am keen to talk about it to help open up our conversations about mental illness and suicide in doctors. There has been a known excess number of doctor deaths by suicide for many years. I hope that by discussing it we can make a start towards changing this.
I have struggled with what to say, far more than I did when deciding what to say at Tom’s memorial service. This is because I have been through an extremely traumatic experience, but I don’t want to traumatise others. This isn’t about me offloading onto other people. It is about making life better for all of us, so that this pattern doesn’t keep repeating itself. I hope I manage to share sufficiently to be of value, without distressing you.
Tom had depression, which was multifactorial in its causes. He had been actively seeking treatment via a number of modalities for some time. He chose to keep this secret from those around him. He stigmatised himself in the way he hated seeing his patients with mental illness stigmatised. Inevitably I was drawn into this secret web for fear that divulging his depression may worsen his mental state. Unfortunately he had clearly lost hope of ever feeling better.
On the day he died I was at work, hopeful that he was improving—exactly what he wanted me to think. At 4 o’clock I got the call from school telling me that Tom hadn’t collected the children and they couldn’t get hold of him. I knew, I just knew, in that moment that he was dead. I found him at home, he had passed away peacefully for which I am grateful.
I had been with Tom for 26 yrs, we met in the first year of medical school and he was the love of my life. He left me, our 10 year old boy and 8 year old girl as he thought it was best for us, as well as for him, that he leave this world. He couldn’t have been more wrong. He was a fantastic father who tried his very best to protect his children from his illness and successfully hid it from them.
We are trying to find our new normal, even though we don’t want to. We are slowly grieving, each in our own way. It’s very hard to watch your children processing such a profound loss. It’s going to be a lifelong process; this loss will never leave us. The grief of losing a loved one to suicide is in many ways the same as losing a person to any other illness. There are some extra aspects though. The sense of a missed opportunity for a different outcome. The fear, when you look at any of his belongings (or even just go into the shed for the first time) that there may be a surprise lurking. The survivor’s guilt and self-blame which is inevitable. As a doctor and Tom’s partner of 26 years, I of course look to myself to blame. I will have to learn to manage it rather than be consumed by it, for the sake of our children.
I have had lots of thoughts about how doctor suicide could be prevented since Tom passed away.
I would like to start by recommending you read the article titled “We can prevent doctor suicide” published in the Medical Journal of Australia in 2018. This article highlights how we stigmatise other doctors with mental illness, which explains why doctors are reluctant to be open about their mental health and seeking help. It also talks of the “emotional mask” which doctors wear and how removing this mask is important in opening up conversations and support. To quote from the article “we need to do more than ask ‘are you ok?’ or send a superficial sms.” They suggest meeting one on one for mutual support or taking off our “mask” for 10 minutes in the coffee room. Having said that, it is very clear that we all need our own independent doctor for objective assessment and treatment.
I have long thought that doctors would benefit from regular debriefing sessions. I feel this should take the form of psychological support. Think of it as primary prevention for mental health in a high-risk group. The qualities, which make a good and caring doctor, are also the qualities, which place us at higher risk of mental illness. I believe this should be the rule and not the exception, perhaps linked with annual registration requirements. However it would be important that this was not used to exclude mental health on insurance policies.
Finally, let us think of the carers who are a lifeline to the patient. While they may feel unable to reveal the “secret,” if given permission—because you already know—you may find they welcome support and would take the opportunity eagerly. I became anxious during Tom’s illness. In retrospect this was an entirely appropriate response to the situation. I was right to be concerned about his safety; those times I hid his medications, his car keys and considered taking him to the emergency department were not an overreaction. I can only imagine how the deterioration in my coping capacity after many months of living with a severely depressed husband impacted on Tom. He saw it, he knew, and it only confirmed his disordered thoughts that we would all be better off without him. That is not the case. We will all be so much worse off forever for the loss of this beautiful, kind man. I think Medicine, as a discipline, does not adequately address the need of carers of mentally ill patients.At the end of the day I had a terminally ill husband, only no one knew it.
I can personally assure you that this tragic loss of life in such horrific circumstances is worth trying our very best to avoid. It’s truly life changing.
Rebecca Black is a GP who trained in the West Midlands, UK and moved to Australia in 2013