Originally published in the November 2014 issue of Veterinary Practice News When discussing severe mental health issues, a veterinary friend of mine likes to say there’s almost no problem so grave he couldn’t outrun it. Suicide is fundamentally incomprehensible to people like him, as it is for the preponderance of humanity. Why would anyone elect a permanent solution to a temporary problem? This constitutional aversion stands to reason, of course. Self-preservation is not just a normal instinctual response but a biological imperative, too. How else do we expect to succeed as a species? Nonetheless, there’s a significant minority among us who’ve had cause to think about ending our own lives. Psychiatric diagnoses of mood, anxiety and personality disorders, among others, can occasion suicidal ideation and lead to the profound, almost physical, sensation of hopelessness typical of those who elect it. It’s common enough. In fact, the Centers for Disease Control and Prevention counts suicide as the 10th leading cause of death in the U.S., about 12 deaths in 100,000. Which is not surprising, really. We all know people kill themselves every day; every 13 minutes, to be precise. It becomes more alarming, however, when these casualties hit closer to home. Hence, why we get to feeling squirrelly when we hear that one of our own has thought through the unthinkable and deemed it an acceptable option. Apart from recently departed Dr. Sophia Yin, with whom I’ve had the pleasure to share a long-distance friendship over the past six years, I’ve known five other veterinarians who felt it necessary to take their own lives. I worked for one as a teen. I went to class every day with one. I was mentored by one. I worked alongside one while in early practice. I sent my patients to one at a nearby referral facility. They were all pretty normal. A couple could be described as top-of-the-class types, another was a struggler, but the other two landed right where the bell curve seemed to want them. It was an impressive distribution for such a teensy sample size. Small as it is, however, it’s way too many colleagues. I thought so a couple of decades ago when my list had only three names on it. Back then, when some of us had just started comparing notes, it seemed pretty clear there was more to this picture than meets the eye. Anecdotally speaking, we’d concluded, veterinarians are predisposed to suicide. In case you’ve been hiding out in a vet media-free zone for the past few years, you probably know by now that some researchers have pegged veterinarians as the next dentists. In fact, according to U.K. population studies, we’re four times more likely as the general population and twice as likely as our human healthcare counterparts to die by suicide. These gloomy stats were brought to you by a series of Veterinary Record studies (2005, 2008, 2010). Others out of California (1992, 1995) and Washington (2005, 2010) weigh in similarly. So does the harder evidence finding higher suicide rates for veterinarians back the anecdotal? Sure. But for all the chatter, the evidence remains weak. While it lends the argument some support, it’s of a fairly low quality sort. What’s more interesting to this veterinarian, however, isn’t the science itself, but rather the discussions surrounding the whys. Here, of course, is where researchers are prone to putting their foot in it. Among the more reasonable explanations, the various authors have proposed that suicide rates among veterinarians are higher because we have access to drugs and are therefore prone to “convenience-based” drug abuse; we suffer compassion fatigue at higher rates than other professionals; and we share a higher comfort level with the concept of hastening death. These explanations make sense. While circumstantial and tenuous, at best, these connections are logical. Others I’ve read, however, tend toward the offensive. Among these, I count the discussion of “personality” traits that make veterinarians want to kill themselves: We share tendency toward the kind of high-achievement and perfectionism that can culminate in personal dissatisfaction with our careers. As animal lovers, we’re purportedly more sensitive than others, self-selecting for nurturing careers but failing to adequately prepare for or handle its inherent strains. Some even propose that … As a group, we are “emotionally immature,” having spent so much of our early lives enjoying academic success in cloistered environments (among other dubious blessings). Ergo, we’re given to wading into rivers with rocks in our pockets. There is no real and true conclusion to be reached, of course, and the authors do dutifully concede glancing platitudes to the limitations of their research. But after they have shockingly downplayed the role of mental health in veterinary suicide, I’ll argue the damage has been done. Indeed, despite the impressive prevalence of mental illness in the U.S. population at large (reportedly between 10 and 25 percent, depending on who’s counting), the issue seems to have been studiously dismissed in favor of the “sexier” questions raised by veterinary suicide. Given the slant, is it any wonder that the media coverage on this issue has also tended toward the banal? That the prevailing veterinary discussion on the subject also seems to skirt the delicate bits—as if talking about them were like crying “Dog flu!” in a crowded kennel? Or worse, that it blames the victim—because it’s so hard to believe that a woman as self-possessed as Sophia couldn’t “just ask for help”? This isn’t Marburg, after all. It isn’t even kennel cough. It’s just garden-variety mental health. And we need to talk about it. While it makes sense that we’d prefer not to touch the tender spots, that we’d be apprehensive to do so or even afraid to get too close, perhaps, to do so does more than dismiss the disease. It feeds it. Maybe I’m being too “sensitive.” But then, perhaps I should be forgiven. After all, I’m not just a veterinarian, I’m a recovering alcoholic and addict with a penchant for expressing her “emotionally immature” opinions in print. In any case, I don’t pretend to understand what, if any, mental health disorder Sophia was suffering any more than we know how Robin Williams or Dr. Shirley Koshi truly felt. Nevertheless, I know for sure that the problems that lead to suicide are more multifaceted and heterogeneous than many of these studies and much of the current conversation on the subject reflects. My point is that suicide isn’t a simple matter that can be explained by circumstances, prevented by treatment or dealt with if only the sufferer would “reach out.” It didn’t happen because we were weak, unhappy children who sought animals as a refuge and failed to find satisfaction in caring for things that died by our hands. These story lines may be compelling to our reality-TV-addled sensibilities, but they’re as trite and insulting as they are unhelpful. What we really need now isn’t more dissection of the dead or any emotional hand-wringing over our innate susceptibility as veterinarians. Instead, we should invest our energies on this issue in our role as scientists, not as voyeurs. I’m not saying we shouldn’t mourn. It would be inhuman if we didn’t. I’m just saying that if we really care about suicide in veterinary medicine we should worry more about ensuring that all our colleagues have a nurturing, supportive and judgment-free profession to work in. Now that would be a just tribute to Sophia and all the other colleagues we’ve lost to suicide.
