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Double Suicide ~ Medical Student & Her Mom

Discussion in 'Pre-Medical Allopathic [ MD ]' started by PamelaWibleMD, 09.22.14.

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  1. PamelaWibleMD

    PamelaWibleMD Banned Banned

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    In case you all have not heard, Rhonda Elkins, mother of MS3 Kaitlyn Elkins R.I.P., has also taken her life. She found me through an SDN thread and reached out to me. We became friends and spoke often on the phone. She wanted so much to save other medical students and their families from the grief she and her family endured.


    Other threads on SDN that reference Kaitlyn & her mother:
    http://forums.studentdoctor.net/search/3460480/?q=kaitlyn elkins&o=relevance

    I will be speaking in Newark, Scranton, Philadelphia, and Washington DC next month on physician and medical student suicide prevention. Would love to meet up with anyone on the forum.
     
    Last edited by a moderator: 09.26.14
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  3. EMDO2018

    EMDO2018 Banned Banned

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    .
     
    Last edited: 09.22.14
  4. PamelaWibleMD

    PamelaWibleMD Banned Banned

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    Oh! I am still learning how SDN works. Slight confusion. Just temporary.
     
  5. dbeast

    dbeast Neurorectal surgeon 5+ Year Member

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    I have an honest question since this is being posted on a pre-med message board, and I hope it'll help anybody here who's struggling with depression. It seems that there have been a number of medical student and intern suicides in the recent past, yet we don't hear anything about pre-med suicides. What part of medical education specifically (as opposed to undergrad) do you think pushes people to the ultimate breaking point? Have you noticed any patterns that could predict people who should seek counseling even prior to starting medical school? Early recognition seems to be the key here.

    I'd hypothetically imagine that failing to get into medical school could be just as hurtful as feeling the pressure of medical school itself.

    Thank you for joining SDN- as much as we joke and complain about it, this site really can be a great way to reach a large amount of people, and it's generally a pretty cool place to spend some time.
     
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  6. EMDO2018

    EMDO2018 Banned Banned

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    I think pre med suicides probably happen a lot but aren't talked about as much. Med student suicides just stand out more because med students are such a small subset of the population. I'm a first year and med school is more time consuming than I thought it would be, the risk is greater 1yr~40k loans so the pressure to succeed is a lot greater, and if you are the type of person that likes having a vibrant social life and doing stuff- the time constraints of med school could mean you have problems adjusting. Most people cope and find a way, and there is help at every LCME accredited medical school.
     
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  7. PamelaWibleMD

    PamelaWibleMD Banned Banned

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    There are many factors and it appears that students who enter med school are on par with their peers in mental health status which then declines during med school. I will be posting a lengthy blog after my presentation "Physician Suicide: Secrets, Lies & Solutions" that will give much detail; however, I do feel that for bright, sensitive, compassionate people, med school can be a brutal experience. Besides the destabilizing effects of lack of sleep, and other physiologic stresses (see Maslow's Hierarchy of Needs - med students live on the bottom rung), there are 3 forces at play that further destabilize students.

    1) Reductionist medicine (the basis of our education) is fatally flawed. While we've made incredible strides in understanding physical disease, reductionism dis-integrates our mind-soul from our body and rather than create resilience, it further destabilizes students.

    2) Similarly, professional distance is supposed to protect us, but it does the reverse. We are to maintain professionalism to the point of losing our emotional connection to ourselves & our patients. I believe that professional closeness is a better and healthier option.

    3) Many medical students experience bullying, hazing, and other abuses as well as economic distress from accumulated educational debt.
    (Watch this -->
    )

    Medical students then graduate (with less empathy & connection with self & others) and are funneled into assembly-line medical residencies and jobs in which fear-based teaching and control tactics are the norm (please read this --> http://thehealthcareblog.com/blog/2014/09/18/how-to-discourage-a-doctor/ )

    One's original dream to become the doctor once described on one's personal statement is squashed. The call to be a doctor at its core is a spiritual one. When we lose touch with the meaning—our soul's purpose—we become a shell of who we once were and hopelessness sets in.
    That is the theme in many of these letters from suicidal physicians --> http://www.kevinmd.com/blog/2014/04/physician-suicide-letters.html )

    I know that there are lots of links, but this is a complex topic that deserves more discussion. And I believe that a few simple changes in medical education CAN prevent these suicides.
     
    Last edited: 09.23.14
  8. PamelaWibleMD

    PamelaWibleMD Banned Banned

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    To answer your other questions:

    1) I feel mental health services should be available and used by every medical student during medical school. And Balint groups should be a mandatory part of rotations. We witness an incredible amount of trauma and we just can't suck it up and move on. We must have a release valve for the pain and suffering that we witness

    2) Highest risk students are those with underlying mental health issues. I think OCD and perfectionism (most of us) can create issues when we are unforgiving with ourselves after making the inevitable mistakes we will make with patients. But those with anxiety and depression should receive therapy/counseling of some sort throughout college and med school (and depending on state laws may not want to report this - part of the problem here!!). Also those who isolate (unmarried, no friends in med school) are at high risk as are those who drink or use drugs.

    I could obviously go on and on about this . . .
     
    Last edited by a moderator: 09.26.14
  9. DermViser

    DermViser 5+ Year Member

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    Premed is a list of prerequisites. It's not a major, it's not a degree. There are many avenues to take after undergrad if one doesn't get into medical school both in medicine and outside of medicine. You can have a very fulfilling and happy life not being a doctor (and I'm not talking about financially). Once you get into medical school - that's your life. You are officially on the pathway towards becoming a doctor. Premed is just the talk before the walk.

    It's much, much, much harder to jump off the merry-go-round during medical school or during residency, when you can no longer backtrack. It's essentially a merry-go-round that never stops and doesn't have many breaks (outside of the summer after M1). You're essentially caught, if you all of a sudden realize you don't like medicine, didn't realize what it was like, etc. and you pretty much have no choice but to continue - unless you or your family are very wealthy and can pay off.

    I would say a huge contributor now to suicide is student debt. If you look here: https://services.aamc.org/tsfreports/, as an example, the tuition at Harvard Medical School back in 1996-1997 was $25,760. Taking into account, inflation (http://www.bls.gov/data/inflation_calculator.htm), that number today in 2014 would be $39,050. The actual tuition and fees for Harvard in 2014: $53,580.

    Due to revised bankruptcy laws, student loans are nondischargeable debt. They can't be erased. You can't declare bankruptcy and have them disappear. So imagine, realizing that medicine wasn't what you thought it was, and you no longer like it, and now you're nearly 150K-200K in the hole so far, with no avenue to pay off that debt with accruing interest if you quit. Quite a precarious position that could affect any normal human being's mental health.
     
  10. Lucca

    Lucca Will Walk Rope for Sandwich 2+ Year Member

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    Mrs. Elkins posted on her blog the day before she took her own life:

    http://welding81.wordpress.com

    It was just Sagan's "Pale Blue Dot" section from the end of his book and "Angel" by Sarah McLachlan.

    A week before she wrote:

    "At least on my dying day, if I have time to think before I go, I will have known that though I have not done great feats in this world I have no doubt that I did do some of the most important things a person can do; I have loved my children, my husband and family with all my heart and did the best I could for them, though I was far from perfect. Love has always been given freely in my house. I have loved my family. And I have written this book and if one person can be saved from it, it will have served its purpose. But I hope my book spurs on more action in some way."

    I'm deeply saddened by the news of her passing. As someone who has lost friends to suicide I know it can be very confusing and it is always impossible to retroactively try to put the pieces together because other people just seem so unknowable - but it seems that she felt she had accomplished what she set out to do and that, at least, gives some relief.

    Just talk to eachother more and listen to eachother more. We know from this forum that all the med students and residents have a shared experience in what they feel is unfair, frustrating and deeply unjust but also in what makes them happy and fulfilled. Share that more often OFF the site - but not in a sarcastic kind of way, more in a venting sort of way. Group therapy is very cathartic.
     
  11. Goro

    Goro 5+ Year Member

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    What a blasphemy this is! My heart is sick and sad at this news.
     
  12. Promethean

    Promethean Syncretist 2+ Year Member

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    It is terrible news, but I am really grateful that Dr. Wible is here to share it with us. It is something that we need to talk about.

    We need to support one another. There is so much competition leading up to medical school that continues throughout residency that I worry that we don't do a great job of taking care of one another. We are all so focused on excelling in our own studies (and covering up anything that could be seen as a weakness) that we fail at being vulnerable and taking care of each other.

    It is no wonder that mental illness still carries so much stigma. Even the people who treat it in others are stigmatized by the least suggestion of it themselves. Physicians will continue to hurt and to hurt themselves so long as it remains unacceptable for doctors admit that they are humans, too.
     
  13. 403710

    403710 Guest 2+ Year Member

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    This is heart wrenching. I truly hope they're together now in a better place. It's crazy how quickly everything can come crashing down. Thank you for sharing this story, I hope more people will read this and listen to and support one another.


    Posted using SDN Mobile
     
  14. Rady Ruck

    Rady Ruck

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    I had not heard of this until now, and have no words for how tragic this is.

    Thank you Dr. Wible for speaking out for mental health. Who knows how many people will listen and be saved because of those who have courage?
     
  15. PamelaWibleMD

    PamelaWibleMD Banned Banned

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    A lot will be saved. Several docs have told me that I've saved them—just by answering my phone and talking
    to them (complete strangers). Heck on September 8th, I got an e-mail from a dentist who quit his job and
    planned to die by suicide that afternoon—until he stumbled upon my TEDx talk!

    But then again I've had a few select docs claim that if I keep talking about doc suicide we'll have copycat suicides.
    Which I obviously do not believe. We can not cure an illness if we don't talk about, know it exists, track numbers,
    and have a basic curiosity as in "I wonder why so many medical students and doctors are jumping off roofs?"
     
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  16. type12

    type12 2+ Year Member

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    Did the doctors mean by your talks, or just merely by the fact memes, by definition, are infectious? You know, like the Columbine shootings. Isn't that the case with suicides? And didn't Japan have that issue?

    EDIT: Sample study regarding the Werther effect: http://www.ncbi.nlm.nih.gov/pubmed/18989499
    In short, sensationalistic reporting can actually increase suicide rates; "responsible" reporting can decrease.
     
    Last edited: 09.23.14
  17. Silent Cool

    Silent Cool Member Banned 10+ Year Member

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    Yup.

    Imagine being in residency with ~500K of debt and getting fired as an intern, or ending up in FM, Peds, etc..., and living everyday with the stress of having to pay that back.

    F***ing sick.

    What's even worse is private schools charging Harvard prices, and not offering Harvard opportunities. What a scam.
     
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  18. DermViser

    DermViser 5+ Year Member

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    Yes, there are certain schools (I would even say both private AND public) that have absolutely no business charging the level of tuition that they do, with no greater value, and I'm only talking about tuition and fees. There are tons of medical students who take loans for room and board as well.
     
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  19. PamelaWibleMD

    PamelaWibleMD Banned Banned

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    I think one doc in particular who doesn't favor me for other reasons felt that I was giving too many details say in an opening paragraph here: http://www.idealmedicalcare.org/blog/sorry-your-doctor-died-suddenly-3/ as in this particular graph:

    "But a few weeks ago, one of our beloved pediatricians shot himself in the head in a public park. Earlier this year, one of our surgeons was found dead in his car from carbon monoxide poisoning. And just before him, a urologist shot himself in the head in his backyard. Before him, a local anesthesiologist was found dead of an overdose in a hospital closet and a family physician walked in front of a train."

    Now if I glorified and went into gory isn't-this-cool-that-the-human-body-looks-this-way detail, I can see how that might be weird and counterproductive and disrespectful, but I think basic facts are necessary (and I never name the individuals without family consent). The other issue is whether the gist of the article is solution oriented. I always give actionable solutions.

    Never had objections to my talks. Quite the opposite (standing O). The docs who tend to criticize (I can only think of 2) either disagree that doc suicide rates are high (that I'm blowing things out of proportion) or they want to focus on deaths as isolated cases in people who were mentally ill (blame the victim, the system is fine, medicine is great! no problems here.). 99% of my feedback has been praise.
     
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  20. type12

    type12 2+ Year Member

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    Thanks for the clarification! The paragraph is cringe-worthy, but in the context of the actual post, it wasn't so bad. It's just my two cents, of course.

    Any clue why suicide is preferred over just resigning from being a physician? Like, retiring earlier?
     
  21. DermViser

    DermViser 5+ Year Member

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    If the goal is to learn more about physician suicide, then learning how they do so is part of the discussion. Also let's be clear, going thru medical school, you can easily find out how to carry it out. I'll say it again, I think A LOT of the reason why it's much more prevalent is the level of non-dischargeable student loan debt burden.

    Also with the Internet and social media, we find out about it a lot more when it normally would have been buried in a local newspaper if mentioned at all (med school telling newspaper not to mention it). Medical school is far from being a nurturing place for students.
     
  22. PamelaWibleMD

    PamelaWibleMD Banned Banned

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    We have a spiritual calling to be in this profession. I don't think we can be as happy as bankers or hedge fund managers or whatever. We are literally called from the depth of our souls to do this work and many are injured in the process of our training. The trauma is so bad that it doesn't just disappear on vacation or by switching careers. See blog comment below: (her case is extreme but you get the point)

    “I definitely graduated from med school with PTSD. It has changed me forever. My mom’s friend that I have known since I was born saw me for the first time since I went to med school and she [told my mom], “She has changed so much. Was it worth it?” I wish I could change back but I realize that I will never be the same again and it isn’t in a good way. We had two suicides and one murder—skull crushed with a bat—and one serving life in prison for murder during a delusional episode after not sleeping for almost a month. Yes I went to a hard-core school (old school kind of place). PTSD isn’t benign; it truly affects you to the core—it changes your brain.” ~ Doctor in Philadelphia

    Read other letters here: http://www.idealmedicalcare.org/blog/physician-suicide-letters/

    And BTW I still think medicine is an AWESOME career!! I just think we need to revamp how we train doctors so that they can be healthy, happy, and human.
     
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  23. DermViser

    DermViser 5+ Year Member

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    I think you're too hopeful on this (not that I mind, I like that about you). There are a lot of resources out there now to figure out what medical school and medical education are really like. Medical students get a lot of mixed signals from their medical school administrators.
     
  24. jb94mg

    jb94mg SDN Gold Donor Gold Donor 2+ Year Member

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    Despite increased awareness of the problem, attempts at ameliorating medical student abuse have been largely unsuccessful. The Association of American Medical Colleges graduation questionnaires (AAMC GQs) from 2012 and 2013 reported student mistreatment rates of 47.1 percent and 42.1 percent, respectively [6, 7], similar to the 46.4 percent rate Silver found at a single institution in 1990. And, unfortunately, public humiliation and verbal abuse, the most common forms of mistreatment [8], are at similar or higher levels now than they were in 1999 [9].

    Looking to other countries has not yielded models for addressing this problem. Studies from medical schools across the globe have corroborated the findings of American studies, with schools in Chile [3, 10], Finland [11], Israel [12], Japan [13], Pakistan [14-16], Germany [17], Saudi Arabia [18], Nigeria [19], and Canada [20] reporting medical student abuse. These studies have identified a similar resistance to eliminating the problem, even with an understanding that mistreatment is a “universally wrong tradition in medical culture” [21].

    Student mistreatment is generally understood to stem from the teacher-learner power differential inherent in the hierarchy of medical education, which leads to a “cycle of abuse” in which medical students who are mistreated go on to become doctors who mistreat other medical students [27-29]. Kassebaum brilliantly characterizes this cycle as a “transgenerational legacy” that indoctrinates physicians-in-training into a culture of cynicism and abuse [8]. This culture becomes part of the “hidden curriculum” in medical education which hinders interpersonal communication and negatively impacts patient care [8, 30, 31].

    The following parts stood out as well: Medical students who report mistreatment were more likely to experience depression, alcohol abuse, low career satisfaction, low opinion of the physician profession, increased desire to drop out of school, and even suicidality [3-5]

    Brainard posits that students who cut corners, cover up minor errors, and unconditionally agree with superiors are seen as efficient and timely, characteristics that are highly valued by the burdened health care system. These students are more likely to be seen as professional than students who display honesty and respect for patients [31]. This environment rewards medical students who act as professional and ethical “chameleons” [31]. In her case commentary, Kimberly A. Kilby identifies ways in which the evaluation and feedback systems used in medical education could be altered to discourage, rather than reward, competitive behavior.

    http://virtualmentor.ama-assn.org/2014/03/fred1-1403.html
     
    Last edited: 09.23.14
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  25. Promethean

    Promethean Syncretist 2+ Year Member

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    And not just how doctors are trained, but how they practice. That is the other priceless aspect of the message that you send. I won't say that your articles about ideal medical clinics and happy doctors breaking free from assembly line medicine are what got me started on the path toward Family Medicine, but they have absolutely inspired me and proven to me that my goals aren't just fantasies.

    So many practicing physicians have lost hope, as they have seen their autonomy and ability to give patients the care they deserve eroded away from all directions. They've been pouring their hearts into a system is increasingly run for the benefit of bureaucrats and bankers rather than patients and their families. You, and others who have pioneered alternative health care delivery models, are proving that the old fashioned doctor/patient relationships are still possible. That people can remember why they went into medicine, and that they can change their practice so that they love their work again.

    If I talked like this without Dr. Wible as an example to point to, people would just tell me that I am just another idealistic pre-med that doesn't know anything about how life is going to be out in the real world. But since you are actually doing it, and helping others open Ideal Medical Care clinics of their own. I might still be an idealistic pre-med, but I am basing my hopes on your real world adventures.
     
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  26. DermViser

    DermViser 5+ Year Member

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    What medical schools value and what should be valued aren't necessarily the same. Medical schools if anything encourage calculating, game-playing, sociopathic behavior more than anything else.
     
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  27. PamelaWibleMD

    PamelaWibleMD Banned Banned

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    What we need in medicine is a civil rights type movement in which medical students and doctors stand up for themselves and demand fair treatment and zero tolerance for abuse of themselves or their colleagues and patients. This is not hard to do. Many schools have anonymous ratings by students of professors in which bullies and abusive instructors are dethroned and not allowed to continue their mistreatment of medical students.

    Please do not succumb to cynicism and defeat. A mass movement depends on people standing up for what is right. I know it may seem scary. But the life you will lead when you are congruent with your values will be so much more fulfilling than if you sell out. Above all do not let anyone take your soul.

    A few docs have told me they feel like I'm running the equivalent of the underground railroad in medicine. Helping doctors practice real medicine without fear of jumping out on their own. We need more station masters on this underground railroad. The answers we so desperately seek will not be handed to us top-down. This is really a grassroots movement to take back our profession.
     
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  28. DermViser

    DermViser 5+ Year Member

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    I don't know many schools that have incorporated that. It's much more from faculty to student than student to faculty. Even if they do, it definitely works more with respect to disciplining students vs. disciplining faculty. There's a reason the House of God quote: "They can always hurt you more" resonates so well.
     
  29. PamelaWibleMD

    PamelaWibleMD Banned Banned

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    I think U Washington does this. Heard from a MS3 that it works well and she never had any bullying or mistreatment as I recall
     
  30. DermViser

    DermViser 5+ Year Member

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    I believe this is true at the more "liberal" schools: U Washington, UCSF, etc. where it works both ways.
     
  31. jl lin

    jl lin 7+ Year Member

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    On one hand, it seems clear that there is a major problem here, and it must be addressed. On the other hand, well, being in healthcare, I will say that this abuse is not just in medicine and medical education. I think what makes it MORE severe for medical students and physicians is the fact that there is this HUGE financial burden loaded on to them. This burden is by no means insignificant. Is it a factor in all med. student and physician suicides? No. Perhaps a few of them didn't have to worry about the otherwise mounting financial burden--and the added stress of succeeding--and what hazing or bad or less than ideal evaluations from "mentors" would mean for them both in the immediate and the long-term. Another resident here, the moderator Q, was talking the other day about the hard realities of spending so much time at a computer or doing things that really have very little to do with what medicine is supposed to be about. Add the hazing, the huge financial burdens, the lessening job satisfaction from governmental hoops and such--add the loss of free-time and many YEARS in the process of becoming a physician--and not knowing how well each step of the process will go for you--or if when you do see the light of day, you will actually find a position that you truly love or at least like. (There are other things, like people are often putting relationships or things such as having a family on hold.) I mean, really, it a lot--and then to be what I call DE-MENTORED--as there seems to be so many in leadership or teaching positions that haven't a clue how to educate the adult learner with respect and dignity--yet the learners are supposed to lead and teach patients and families and other students of medicine with respect and dignity????? (I call those that cannot or will not grasp how to teach or mentor adults with respect DEMENTORS. There were more than a few of them certainly in nursing school and during nursing preceptor programs. It's actually pitiful.) There is something very twisted here.

    There are many steps in the process towards creating more wellness; but honestly, one of the first ones must include ways to decrease the financial burden of medical school. Financial burdens and debt can and often enough does play a huge factor in depression and suicide.


    Noteworthy Observation from Intelligencer: Are Wall Street Suicide Epidemics Real?


    ~
    According to Occupation and Suicide, a 2001 work by Dr. Steven Stack of Wayne State University, the riskiest groups are dentists, artists, and certain laborers (physicians also rank high in some studies, perhaps because of their ready access to fatal substances). Even then, occupational stress is only one of the four factors known to contribute to suicide risk, the other three being demographics, “preexisting psychiatric morbidity,” and “differential opportunities for suicide” (e.g., doctors’ access to drugs)...When it comes to suicide statistics for the general population, the picture is clearer, if less cheery. The rise and fall of the Dow isn’t the key factor here; the health of the overall economy is. [Emphasis mine.] “We’ve been studying suicide cycles for over a century, and there is a nearly linear relationship between the national suicide rate and GDP,” says Dr. M. Harvey Brenner, a professor at the Johns Hopkins School of Public Health. The overall cycle of suicides, he says, “mirrors the economy.” It does so, it bears noting, with a time lag. While there was no nationwide rash of suicides in 1929, rates peaked in 1932, by the time the Great Depression had set in. Just as the crisis itself takes a while to spread through the system, so does individual misery. [Emphasis mine.] Worse, experts fear that the current financial upheaval could cause more suicides than other downturns. Stack and other researchers suspect that it may be the size of the status change, the mental whiplash, that triggers suicidal behavior. In other words, it’s not where you wind up; it’s how far you fall (Adolf Merckle was still worth over $8 billion, for instance, after the Volkswagen disaster). Given the record number of people who bought homes for the first time and the historic amount of wealth built in the nineties, there could be more mental whiplash than ever this time around as once-fat portfolios thin out and an unprecedented number of people lose their homes.
    Not sufficiently depressed? Let’s go back to bankers. Stack recently chanced upon an obscure piece of government research from 1910 (“I found it a week ago; I’m a connoisseur of dusty papers”) that seems to contradict the idea that bear-market banker suicide rashes are a myth. It’s just one study, a century old, but it did break down U.S. suicide statistics, for the year 1908, by the victims’ occupations. Contrary to the since-established patterns, the study found that a group defined as “bankers, brokers, and officials of companies” was at the top of the list, with twice the average rate of suicide. Stack first dismissed the research as a fluke. Then he learned there was a massive Wall Street panic in October of 1907 (Idov, 2009).~

    Idov, M. (2009, January 11). Are Wall Street Suicide Epidemics Real? Retrieved September 24, 2014, from http://nymag.com/news/intelligencer/53341/
     
    Last edited: 09.23.14
  32. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Lifetime Donor SDN Chief Administrator 10+ Year Member

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