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Abstract
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"Shame, guilt, it kept me awake at night"; "Like being deeply wounded"; "I feel it's something I'll have to carry forever". The kind of statements that a psychiatrist will hear many times during the course of their career in mental health. These words, however, are not taken from clinical notes, but from doctors quoted in a booklet produced by a multidisciplinary group at the Oxford Centre for Suicide Research, led by Keith Hawton and including London-based psychiatrist Rachel Gibbons. Its title: If a patient dies by suicide.
In the context of the emotional turmoil surrounding death by suicide--the distress of the individual who ends their own life, and of their friends and loved ones--it might seem strange, perhaps even tactless, to focus on the feelings of their mental health team. Nevertheless, it is necessary to do so; it is essential to reject the notion that sympathy and understanding are scarce resources, and that professionals have no right to feel emotional pain, and no need for support. Evidence, if evidence is needed, comes from a survey published in the BJPsych Bulletin in 2019 by Gibbons and colleagues. Although the sample was relatively small and geographically restricted, consisting of 174 psychiatrists in four NHS trusts based in London and the southeast of England, the findings will resonate with clinicians everywhere. The researchers found that after the death of a patient by suicide, doctors were considerably emotionally affected, felt that their clinical practice suffered, and even changed career paths entirely. Despite these potentially profound effects, psychiatrists showed a surprising--even alarming--dearth of self-care. Only six psychiatrists whose patients had died by suicide reported having taken time off work, the duration of which was between 1 day and 1 week.
Do cardiologists experience similar feelings when a patient dies of a myocardial infarction? Do oncologists consider changing career when chemotherapy does not maintain a patient's remission from cancer? No doubt doctors in all specialties feel grief and guilt at the death of a patient. But death by suicide might come with its own unique complex of emotions. This effect is perhaps because of a paradox in the prevalent narrative around suicide. On the one hand, death by suicide is seen as avoidable and unnecessary: this is one of the reasons that it is considered so tragic. On the other, clinicians are all too aware of the limits of their ability to predict and contain risk. These contradictions are impossible to resolve, and can only be exacerbated by the combination of the conscientious personality traits frequently observed in doctors with cultures of blame that still exist within health organisations and society. Furthermore, campaigns that aim for zero suicide could be formulated with the intention of instilling hope and galvanising clinical and public health efforts, but might also have unintended negative consequences on professionals.
Suicide is a complex issue with no single cause, and no simple solution...
Language: en |