I once knew a physician. He was a colleague and a friend. He was an easy going and jovial individual and someone I was always happy to run in to. He made me laugh. I recall trying to be polite and sampling some strange appearing dishes at a party. I recall him saying to me “Wow, you eat that? Even I don’t eat that. You know what that is?” He stopped by my home as we left the party. We talked about old movies. Blue Hawaii. I only knew that Elvis Presley was in it. He knew who the whole supporting cast were. As I said, "I once knew a physician." I said it that way because he no longer is with us. He took his own life. I saw the beauty within him. I suspect that he did not.
Suicide rates are notoriously difficult to report. The cause of death is not always so obvious. It is not so easily determined. Physician suicide rates are even more nebulous. Their knowledge of medicine allows physicians to more adeptly cover their tracks. Their knowledge of medicine also enables them to be more successful. Despite these limitations, it is important to try and understand the magnitude of the suicide problem in physicians. What has become apparent is that physicians are much more susceptible to suicide. Physician suicide rates have been reported as 28 to 40 per 100,000 as compared to 12.3 per 100,000 in the general population (Miller and Mcgowen. South Med J. 2000;93(10).) Medscape reports that 13% of physicians have had suicidal ideation and 1% have attempted suicide. Thatʻs 1 in 7 physicians who have had suicidal thoughts or attempts.
The culture of physicians is that they are heroic and flawless. “Physicians are expected to be the people who never get exhausted and never complain about themselves” said George Abraham, President of the American College of Physicians. They feel shame in admitting to mental health issues. They are concerned that having these types of diagnoses will later disqualify them from licensure.
To maintain this superhero facade, physicians are very good at hiding. In Pamela Wibleʻs book, Physician Suicide Letters, 3rd year medical student Kaitlyn wrote “I am sorry for hiding from you that I was so deeply sad. I am sorry for not letting you know that I felt like I simply no longer wanted to live my life. I am sorry that I did not let you in on my perpetual despair that I lived in. . . .”
Stanford University Professor Abraham Verghese in his book, The Tennis Partner, chronicles the painful journey of his student and friend that culminated in suicide. He writes, “Despite all our grand societies, memberships, fellowships, specialty colleges, each with its own annual dues and certificates and ceremonials, we are all horribly alone. The doctor’s world is one where our own feelings – particularly those of pain, and hurt – are not easily expressed, even though patients are encouraged to express them. We trust our colleagues, we show propriety and reciprocity, we have the scientific knowledge, we learn empathy, but we rarely expose our own emotions.” Medscape reports that approximately 40% of physicians have not revealed their suicidal thoughts to others.
Child suicide rates have been increasing in Japan. It is not uncommon for young students to throw themselves in front of trains. Reasons claimed for these suicides include family disagreements, parental reprimand, worries over future prospects, mental disorders, issues with the opposite sex, despair, and academic underachievement. Efforts have been made to combat this situation through mental health services, help lines, and teacher training.
Kumu and kahu Pono Shim expressed concerned about the high rate of child suicide in Japan. He believed that the answers lay in Aunty Pilahi Paki’s prophecy, “The world will turn to Hawaiʻi as they search for world peace because has the key...and the key is aloha.” Pono was the keymaster. He held the key to aloha. He was struck by how the Japanese revered the Hawaiian culture. He recognized the significance of the fact that there are millions of hula dancers in Japan. He saw the similarities in the structure of the Satoyama in Japan to the Ahupuaʻa in Hawaiʻi; the only difference being the presence of rice paddies instead of taro patches. Japan and Hawaiʻi culture and life were both built on the same values. They were both built on the principles and values of aloha. He told the people of Japan that "the reason you love Hawaiʻi so much is you think the way we live and who we are is the most beautiful thing in the whole world because we remind you of you.” “You forgot how beautiful you were."
Our modern society has caused us to forget who we are. We have forgotten the values that formed the basis for the life that we live. We have forgotten the heritage that established our culture. The beautiful values that formed our foundation are still there. They are just covered over. We are searching for peace. We are searching for our inner beauty. Finding peace is finding the beauty that is already within us. If we can see our own beauty, maybe we can avoid the tragedy of suicide.
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