The anniversary reaction and doctor suicide. Why it matters

To remember those we have lost, who live in our memories and come back to remind us how important they were to us

This time of the year, and for the few months preceding Christmas I am usually helping patients come to terms with painful memories and themes of grief and loss around the festive season. And yes, while this work was undertaken in abundance, I couldn’t help but be drawn to the loss and suffering endured among colleagues within the medical profession due to doctor suicide. In 2017, a number of families spoke openly and candidly about losing a loved one to suicide, demanding answers, offering clarification to counter rumours and to beg that ‘something must change’ These actions became more common, unlike years gone by. And I have continued to wonder how they were, as we commiserate their loss and face anniversaries.

As human beings, we are hard wired to feel a range of emotions from despair, sadness, loneliness, anger and panic leading up to the anniversary of losing a loved one. And maybe we are hard wired like this for a reason. Maybe to actively forget, which appears appealing on the surface and in the moment of utter despair, may pay disrespect of the magnitude of how much somebody or something that we no longer have shaped our very being. That to be able to forget someone after a short while would mean their sudden disappearance would allow us to forge along with little consequence or impact.

A number of episodes of the Netflix® series, Black Mirror® attempt to examine ways of manipulating memories, often traumatic and repetitive, with horrific consequences. In reality we know, that for many of us living with memories and being changed forever because of loss is part of our make up as humans beings.

This article is dedicated to the concept of living with painful memories after loss, and in particular, the anniversary reaction, and how it manifests in the context of doctor suicide. This is because in the past week I am acutely aware a number of families would be struggling with this. In early January 2017 we lost four doctors in training to suicide, and in 2015, at the same time, another four. So that is eight families known about. With countless relatives, colleagues and friends affected. It makes me wonder if we can do more than commiserate and pay respect but to use anniversaries and the emotions attached to them to keep buoyant in this battle to stop doctors taking their lives.

It is also written in sincere respect to honour very significant recent anniversaries. The death of Dr Chloe Abbott, who died on January 9th 2017, days before her 30th birthday, her recent birthday on January 31st, 2018 and the ongoing grief and sorrow those who know her and loved her demonstrated via social media this past week. It also serves as a tribute to the four Victorian doctors (three psychiatry trainees) we lost 3 years ago. The article about the suicides was written by Julia Medew and published on this day in The Age in 2015.

At this time in 2019, we will be remembering the anniversary of Dr Frith Foottit, who according to his wife’s report in The Morning Bulletin took his life on Jan 1 2018.

We cannot comprehend how families continue on after any loss, let alone sudden losses that seem inexplicable to others. Death by suicide is particularly difficult to reconcile, as often those who suicide conceal their feelings, set a date in their minds, and appear well, to either ‘trick’ others they are OK and can’t be stopped, or because they are genuinely relieved their pain will stop. They are long past seeing themselves and their world they same way as others around them, and cannot be convinced otherwise. This compounds the terror for those left behind who cannot comprehend that their beautiful loved one couldn’t see they were special, meaningful and unique, and that nothing mattered more than them being alive.

Anniversary reactions are often not talked about, but are very real. The understanding is often derived from those with post traumatic stress disorder and who have survived traumatic events. Tragic and horrific events often capture media attention at the times of recent anniversaries, and one wonders whether paying such public attention to them traumatises those involved more or offers some peace – a collective bringing together of those who all experienced something somebody never should. This is particularly pertinent as we have just remembered and paid respect to the “Bourke St Tragedy” which occurred in January 2017.

What I have learned about anniversary reactions is that they might not always be so obvious, can be triggered by other memories and affect ones’ feelings and emotions out of the blue. Patients often ask for permission to feel a sense of panic, loss of profound distress on a day that has no ‘calendar’ relevance to the event of losing a loved one. They are often relieved to hear that the way our memories are stored and retrieved, particularly around negative events may be more random than that.

I lost my childhood friend in 1992, when she was 23 years old. We were born 6 months apart, our parents were friends who worked together, and worked out how to raise us together, before our siblings were born. I have photos of the two of us in high chairs with our first solid foods, me with my crimson red hair and a face covered in eczema. Photos of us playing under the sprinkler in summer, going to pantomimes, playing at Queenscliff all summer long, and spending our birthdays and Christmases together. Eyeing off each others’ gifts to see who got the latest Barbie doll, or nicest new shoes, and being happy for each other. We spent all of our holidays and special events together, and for all accounts, she was my cousin. She always received pink carnations for special events. “Hall and Oates” and “Blondie” were always the favourites for rollerskating soundtracks.

My friend was killed suddenly in a motor vehicle accident by an unlicensed driver who was profoundly intoxicated and recently released from prison for drink driving offences. It happened on the weekend of Mother’s day 1992. Her birthday was Valentine’s day. So I suppose I thought I understood why those days, all these years later made me think of her, as they were public days celebrated by Hallmark cards and intense feelings like love. Thanks to consumerism, there were memories everywhere.

However, in May last year, I had a very profound dream about her and woke up with panic and a sense of foreboding. It was 12th May 2017. I immediately began searching the records at the memorial park where she was placed after cremation. Somehow I knew I needed to do this, after never visiting that register  Her funeral was on 12th May 1992, exactly 25 years before. A quarter of a century had passed, her life trapped in a time warp with 80’s music, big hair, shoulder pads, and Christmas holidays at the beach. I drove to the memorial part the next day after hunting for pink carnations everywhere to take her- and I found her plaque and sat with her, placing the carnations next to others of variable freshness, a sign others had remembered too. How or why I was reminded that it was important to mark 25 years since her funeral is not understandable to me. But it didn’t matter, because it allowed me to spend an afternoon with her at her plaque and think about how she would respond to a world post 1992, what she would look like, and how much I missed her.

So I guess I am writing this blog about suicide among the medical profession, to join the countless other articles currently circulating around this very significant topic. But I write it from the perspective of a psychiatrist and as a way of trying to ease some pain that feels quite tangible this week. Also, as a way of examining whether we can take some of the sadness from anniversary reactions and help us in the doctor’s mental health space stay true to the cause.

I also write this for three very different and important audiences:

1. To the families, friends and colleagues of those lost to suicide. Never be afraid, or embarrassed to grieve, stop still or pay respect. Practice kindness and compassion to yourself every day. Don’t try and over-interpret why certain memories may reappear – maybe it was a song from your past, or a recipe, or even a flower. Just pay respect to the fact you can remember. The harder we fight to forget, the louder and more pervasive the memories will be.

 

2. To those who find themselves at a state where the really see no reason for living, get help right now. I can promise you that you are not seeing clearly and you are not seeing yourself the ones who truly matter see you. The ones who will do anything to help you get out of the state you are in, provide practical and emotional support while your point of view takes on a whole new meaning. The ones who will have anniversary reactions forever if they lose you.

 

3. To the administrators, politicians, figureheads and lip-service enthusiasts be warned – we will never give up fighting to prevent suicide among our medical colleagues. For all the reasons above. I personally have not forgotten losing three psychiatry registrars, one a friend, in early 2015, although I see little has changed. But I will always use their anniversaries as a force of strength, to keep me on track, to keep me determined and to keep fighting.

 

This blog has been written by Dr Helen Schultz, a consultant psychiatrist and author. She has worked in private practice with many patients to enable acceptance over traumatic life events.

She sees medical students and doctors in her practice, MindAdvocacy, offering after-hours appointments with utmost confidentiality for medical students and doctors.

She is currently meeting with families who have lost a medical colleague to suicide (whether it be their father, mother, sibling, child), using her knowledge of psychiatry to identify key factors as to why suicides occur at such an alarming rate in the medical profession. She hopes this work will clarify where initiatives and support are best placed to prevent more suicides. If you wish to speak with Dr Schultz, please contact her at her rooms on (03) 9428 8321.

The only way we will make real change in this space is by talking about suicide openly. However, if after reading this, you feel unsafe or need to speak to somebody, please call myself on the number above, your GP, Lifeline on 111314, or BeyondBlue on 1300 22 4636