Tag: suicide

Reading of the Week: The Suicidal Doctor

January 21, 2016 /

From the Editor

In December, the Readings included the Mata et al. paper from JAMA considering depression and residents. The review – which included more than 50 papers – found that the prevalence of depression or depressive symptoms among resident physicians was 28.8%.

Dr. David Goldbloom’s comment on the paper is worth repeating: “it is a sobering reminder that the white coat is not Kevlar against the illnesses we treat, and our professional culture still has a long way to go in recognizing, accepting and supporting that we get sick, too.”

This week we look again at physicians and mental health. The first selection is an essay by a doctor in which he discusses his suicidal thoughts. Then, with an eye on practical interventions to help doctors at risk, we consider the JAMA Psychiatry study on CBT for interns (with a modern twist).

DG Continue reading

Reading of the Week: Suicide and Religion

July 2, 2015 /

The relationship between religion and suicide was first established in Emile Durkheim’s 19th-century seminal treatise. This has since been corroborated in different countries,most recently by Swiss researchers who used a year 2000 census-based cohort study to show that such risk patterns still persisted, with risk highest for those with no religious affiliation, lowest for Roman Catholics and intermediate for Protestants. Why religion should exhibit this protective effect is less clear: Durkheim attributed it to the sense of community that arises from active church membership, with attendance the most commonly cited attribute. Others, however, emphasise the moral and religious objections to suicide,although Durkheim was at pains to rule this out as an explanation. Perhaps a more pertinent question is why, given increasing societal secularisation, does the relationship between religion and suicide still seem to persist? Increasing secularization is also evident in Switzerland, where by the end of the 1990s nonpractising Christians made up almost half the population, and a further 11% cited no religious affiliation. This has led many social researchers, including some in Switzerland, to conclude that affiliation bears little correspondence to religious belief or practice but is more likely to reflect a diverse set of traditions or social convenience.

So begins a new paper from the British Journal of Psychiatry looking at what seems to be a very old and established relationship: religion and suicide. This is heavily treed ground, as the above quotation suggests, with work going back to Durkheim’s 1897 book.

Emile Durkheim

I remember medical school and residency conversations on this topic of religion and suicide, referencing Durkheim. Though people debated the reasons, this much seemed to be taken for granted: religion bestows a protective quality on its followers. For Durkheim, the thinking was that church attendance – highest among the Catholics – provided the advantage.

In “Religion and the risk of suicide: longitudinal study of over 1 million people,” Dermot O’Reilly and Michael Rosato focus on Northern Ireland, drawing on census data.

Dr. Dermot O’Reilly

It’s a short, clever study. It also raises a simple question: is Durkheim’s thinking dated?

Continue reading

Reading of the Week: The New Yorker Essay on De Troyer (and Carter v. Canada)

June 25, 2015 /

In her diary, Godelieva De Troyer classified her moods by color. She felt “dark gray” when she made a mistake while sewing or cooking. When her boyfriend talked too much, she moved between “very black” and “black!” She was afflicted with the worst kind of “black spot” when she visited her parents at their farm in northern Belgium. In their presence, she felt aggressive and dangerous. She worried that she had two selves, one “empathetic, charming, sensible” and the other cruel.

She felt “light gray” when she went to the hairdresser or rode her bicycle through the woods in Hasselt, a small city in the Flemish region of Belgium, where she lived. At these moments, she wrote, she tried to remind herself of all the things she could do to feel happy: “demand respect from others”; “be physically attractive”; “take a reserved stance”; “live in harmony with nature.” She imagined a life in which she was intellectually appreciated, socially engaged, fluent in English (she was taking a class), and had a “cleaning lady with whom I get along very well.”

So begins this week’s reading, an essay by writer Rachel Aviv that was just published in The New Yorker.

It’s a moving and tragic story of a woman who struggles with low mood. If she dreams of fluent English and a cleaning lady, her life takes a turn for the worse: after a breakup, she “feels black again.” Loss and estrangement replace hope and love. After years of struggling, the near elderly woman ultimately chooses to end her life. But she doesn’t die by her own hand; she dies in a clinic at the hands of a physician. To us Canadians, this is a story that is both familiar – involving psychiatry and medications – and unfamiliar – euthanasia and state-sanctioned doctor-assisted suicide.

De Troyer’s life and death occurs an ocean away, in Belgium. But, in light of a recent Supreme Court of Canada ruling in Carter v. Canada, a question to ask: how will doctor-assisted suicide reshape psychiatry in this country? Continue reading

Reading of the Week: Recession and Suicide

March 5, 2015 /

This is all I have left.

My patient, faced with significant financial issues, reached into his pocket and pulled out some change. “Everything else is gone,” he said.

The year was 2010. My patient had spent decades managing a GM dealership but, with widespread company problems, he lost his job and the dealership closed. He described to me walking out one evening with an appointment book filled with future meetings only to realize the next day that he had nothing to do. “I’m an adrenalin junkie.” The long 12-hour work days were replaced by the uncomfortable monotony of unemployment. My patient was lost — and depressed and suicidal. Continue reading