In Pursuit of Questions

“Can we talk about suicide?”

– was the title of an email in my work inbox.

What I opened was one of the most beautiful, poignant, norm challenging, unobtrusive emails I’ve ever received. And what made it so powerful, was that it was a mass email, to members of one of those institutions where the stigma on the topic is high and even coming close to the topic on a personal level is taboo: the email was addressed to physicians.

The authors of the email are in a department to where, to some extent, they are authorized address this topic of mental health and suicide: they promote wellness for physician residents. However, only by understanding the culture of doctors would the boldness of the action of sending this email be fully understood. Doctors know best; doctors are strong; it is the patients who are weak and need help. Classic splitting and projection, which may be situationally useful on occasion in the work role[1] but dangerous when carried into the personal life. Residents, who are doctors in their training period after medical school, whose socialization into this culture began during rotations in medical school, if not before, are particularly prone to the pressures of showing confidence and correctness in order to “pass” and be deemed capable of handling the career they chose. As a non-clinician, I have had disproportionate interaction on a back-stage level with medical students and physicians through my social networks and work roles over the last several years. I have been in a role of confidant, hearing and coaching on fears and frustrations. So when I say this email in my inbox was wonderfully stunning, it is because I know the context into which it was launched.

The authors of the email rode on conversational wave surfaced by Dr. Pranay Sinha’s Op-Ed piece in the New York Times, “Why Do Doctors Commit Suicide?”, reflecting upon two recent resident suicides in New York and the frequency of self-doubt and potentially mental illness triggered by the stressors in the jobs of physicians and particularly residents. In their email to the residents, the authors highlighted the statements of vulnerability in Dr. Sinha’s piece, and ended with the welcoming reminder that they care, they are there, please reach out.

What these residency wellness staff did was brilliant. And I evaluate this based upon my own academic studies on stigma, mental health, and human relations; as well upon my own experiences in this realm, trying to challenge mental health stigma, give voice to the issue, and give voice back to those undergoing the stigmatized experiences.

First, the issue was surfaced. Once one person brings up a topic, others feel more comfortable identifying with the topic, self-disclosing, and being part of the conversation. Second, the voice of a fellow resident physician was utilized; these situations feel very isolating, very alone, and pointing to the story of someone in the same “group” as the audience is an added layer of safety, comfort, identity, and cohort. By doing these things, a precedent was set, challenging norms of silence around the topic; a statement was made that feelings of inadequacy and suicide are discussable. That email exploded a boundary and proclaimed that the community norm would allow these conversations. As another added layer, that Dr. Sinha was a male willing to be vulnerable in his Op-Ed piece, means the general silence of men on these topics of self-doubt and feelings of inadequacy was being challenged by a successful male, and will hopefully only further open conversation within the gender group that typically lacks the social support or acceptance of such conversations.

The question, now, is whether the culture among the residents and physicians in this particular institution can be further opened up and sustained around these topics of self-doubt, inadequacy, mental health, and suicide. From the work I have seen of the staff who sent the email, I believe that it can be. In the immediate future, resident physicians have reached out in response to the email, even the statistically silent ones.

[1] Main, T. (1985). Some psychodynamics of large groups. In Colman, A.D. & Geller, M.H. (Eds.), Group Relations Reader 2. Jupiter, Florida: A.K. Rice Institute.