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If you are someone who struggles with feelings of deep depression and a profound loss of hope (despair), I beg you to search for someone you consider to be safe and take that important first step and admit how you feel. If you are a person who suspects that someone at work or school or in your extended family, neighborhood, or faith community is experiencing deep depression or despair, I also beg you to reach out to a mental health professional for advice about what to do. If you don’t know where to start your search and you want to do something right now, you can just be a good friend, colleague, or neighbor by giving the person your undivided, nonjudgmental attention. I’ve provided some simple but useful tips below.

I intentionally use the word “beg” in this blog, because I want to convey the seriousness of despair in our contemporary culture. “Deaths of despair” have been on a sharp rise in the United States in the past 20 years. As an addiction psychiatrist with over 25 years of clinical experience, I am all too familiar with this phenomenon not only among patients with co-occurring addiction and mental health conditions but among medical professionals as well.

Remaining silent about very difficult emotions and thoughts does absolutely no good at all! It perpetuates suffering and often leads to very difficult life circumstances, such as broken relationships, unemployment or underemployment, chronic health conditions, as well as suicide and other forms of premature death. I encourage all of us to speak openly about emotional suffering as a way to abolish stigma with honesty, vulnerability, and compassionate connection with each other.

SOME STATISTICS ABOUT DEATHS OF DESPAIR

The term “deaths of despair” was coined in 2015 by Princeton economists Anne Case and Angus Deaton who were trying to understand why life expectancy in the United States dropped for three straight years, beginning in 2014. “Deaths of despair” refers to three specific types of deaths, including drug overdose, alcoholic liver disease, and suicide. For example, in 2018, about 158,000 Americans died from these three causes compared to 65,000 in 1995. That’s a 41 percent increase in just 23 years! The researchers labeled these as “deaths of despair,” because the fatalities are all linked to feeling a profound loss of hope.

Currently, suicide and drug overdose remain serious public health issues in the United States. After two consecutive years of declines in suicide (47,511 in 2019 to 45,979 in 2020), 2021 data indicate an increase to 48,183, with an age-adjusted rate of 14.1 suicides per 100,000 people.

In addition, in 2020, according to the CDC, 91,799, drug-overdose deaths occurred in the United States. The age-adjusted rate of overdose deaths increased by 31 percent from 2019 (21.6 per 100,000) to 2020 (28.3 per 100,000). The CDC data reported 106,699 drug overdose deaths in 2021, representing an age-adjusted rate of 32.4 per 100,000 people.

SILENCE PERPETUATES DEATHS OF DESPAIR

Other authors have described a culture of silence that commonly surrounds deaths by suicide or drug overdose. Common examples of silence include the following:

  • Not mentioning the cause of death in an obituary
  • Under-reporting of suicides by medical examiners
  • Not acknowledging when suicide has played a role in someone’s death

In my role as Associate Medical Director at the Ohio Professionals Health Program (OhioPHP), I oversee the design and delivery of educational and well-being programs for physicians and other healthcare professionals who are experiencing health concerns, emotional conditions, and substance use disorders. OhioPHP is a nonprofit organization that provides a compassionate, supportive, and safe environment for healthcare professionals to receive confidential services to improve their health and well-being. Its goal is to inspire physicians and other healthcare professionals to seek treatment and monitoring for their illnesses to ensure quality patient care and safety.

In this role at OhioPHP, I recently encountered the culture of silence when the medical leadership team from a large urban hospital reached out to us for help with a presentation on “mental health and well-being” for medical professionals. During our exploratory conversation about their needs, they revealed that a well-respected and beloved physician had died by suicide two months earlier. The hospital system was looking for ways to provide support to clinicians directly impacted by the physician’s death and to improve confidential access to mental health services for other healthcare professionals who might be feeling profound depression and despair. Further complicating the issue was that the physician’s family members asked the hospital to keep the cause of death a secret to protect their loved one’s reputation and legacy. When I read an online article memorializing the physician, it only mentioned that he had died suddenly.

I feel so sad on so many levels about this incident. Why did his family feel so ashamed that they had to hide his cause of death? It was as if his death by suicide had somehow diminished decades of accomplishments and service for his patients. I don’t think that to be true at all. If he had died of a heart attack or in a car accident, it seems his death would have been more “respectable.” There is nothing respectable about a tragic loss, no matter how it occurs. I wonder if the family could have used their profound shock and loss of their loved one as a call to others to seek help and not to linger in despair, silent and alone. Perhaps they could have given the medical institution permission to do the same: to sound an important alarm to other medical professionals who might be suffering in silence. It would have been an opportunity to demand that the medical institution begin to change its policies and practices.

It became obvious to me that the culture of silence was clearly operating on a much larger and systemic level at the hospital. After all, why did it take a physician’s death by suicide for the hospital system’s leadership team to become concerned about the well-being of their staff? Why didn’t the medical staff office already have a robust and easily accessible system in place to help suffering colleagues? Perhaps that physician’s death could have been prevented if the culture of silence about despair and other mental health conditions had not been so entrenched in the institution.

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