by Cina, Joshua A. Perper, Stephen J. ; Cina, Joshua A. Perper, Stephen J.
Conscious self-destructive behavior may result in self-centered acts such as suicide or in heroic efforts by channeling the death drive toward actions that save the lives of others. The latter, positive use of the psyche must be employed by military medics in the field in combat situations. Some physicians also display this type of heroic behavior to a somewhat lesser degree in that they are willing to forego sleep, food, and sex to treat perfect strangers in emergency rooms and operating suites for hours on end. We have discussed in depth what happens when doctors direct their inner hostilities toward their patients and experimental subjects throughout this book. Now let us consider what happens when physicians unleash the primitive drive back to inorganic matter on themselves.
An increased tendency for physicians to commit suicide was noted as early as the 1860s but it took about a hundred years until scientific research provided concrete data to verify this trend. Most studies have documented an increased frequency of suicides in physicians, particularly female physicians, as compared to their counterparts in the general population and other professional groups. Between 250 and 400 physicians, the size of a couple of medical school graduating classes, lose their lives to suicide every year in the United States. Like the rest of society, the most common means involve drug overdose, hanging, or firearms. There are no striking differences in the choice of suicidal methods between the various medical specialties except for anesthesiologists. Half of the time, they kill themselves with drugs including anesthetic agents.
A 2004 compilation of studies done over the past 50 years disclosed that male physicians were at a 1.4 times risk to kill themselves compared to their patients. More startling is that women physicians were 2.3 times more likely to commit suicide that the general population. A National Occupational Mortality Survey of a database of physicians classified by race and gender between 1984 and 1995 confirmed this Physicians and Suicide
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worrisome pattern. White male physicians showed a higher risk rate of 2.9 times that of the general male population while white female physicians carried a 3.6 times greater risk for suicide than the rest of society. Whereas black male physicians showed a 2.3 times higher risk than the general population, there were no reported suicides among black female physicians. Other studies have reported that the relative frequency of suicide for male physicians was as much as three times higher than that of the general male population; there was a six times larger frequency for female physicians compared to women in general and to other professionals. Medical students and residents show a comparable but even worse pattern with suicide being the most common cause of death after accidental fatalities. In fact, a study by Dyrbe of 4,300 of medical students from seven medical schools between 2006 and 2007
revealed that 30% of them experienced burnout and 10% had suicidal ideation.
Chances are many of your doctors feel worse about themselves than you do.
The increased tendency of physicians to commit suicide has been attributed to a conglomerate of genetic and developmental factors, medical culture stressors and professional circumstances. It has been suggested that some of the suicide com-pleters are so-called “wounded healers,” attracted to the medical field as a moth is to a flame. These doctors may have entered medicine following traumatic family experiences including abuse, episodes of psychiatric illness, or to overcompensate for parental or peer belittling. Once the physician has entered practice, the stress of the job can magnify any simmering, underlying mental illness. Dealing with terminal illnesses, death, and suffering can also weigh heavily on the practitioner.
Studies have shown that 75% of healthcare providers experience severe emotional stress or depression upon learning of the death of one of their patients. Throw on top of that governmental regulation of healthcare, the constant fear of malpractice litigation, and increasing insurance premiums with diminished reimbursement for services and you have a recipe for disaster in predisposed individuals.
Physicians are, by and large, perfectionists – this is a good thing if you are a patient. In order to provide quality care to patients, they often sacrifice their own well-being. In fact, some physicians have a well-developed “martyr complex.”
They will not sleep and live off of coffee and candy bars to monitor a patient on the brink of death. When and if they go home, some require drugs or alcohol to forget their day. Their work may consume them; many have lost their families while tending to their charges. In the end, Medicine has become their spouse – and she/he can be an unpredictable lover.
Unfortunately, a good part of the medical establishment still sees suicide as carrying a repulsive stigma. Colleagues attempting or completing suicide may be considered weak-willed or virtual traitors in Medicine’s war against disease and death. Physicians choose to see themselves as the cure rather than part of the problem. To acknowledge the overwhelming pain and despair of a suicidal compatriot may entail a deep gaze into a mirror. And many doctors don’t want to see a flawed human being staring back at them. Doctors must compartmentalize in order to function – the frailty of others cannot be allowed to permeate their shell. When the seal corrodes, however, and the human within the healer is exposed the shell often doesn’t crack; it explodes.
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11 Physician Kill Thyself: The Story of Dr. Gwinn E. Puig
Studies have shown that 12% of all male physicians and 18% of all female physicians suffer from depression. In recent years, local medical societies and the National Psychiatric Association have initiated educational programs and seminars directed at recognizing the signs of depression and changes in behavior that often lead up to physician suicides. Efforts are also being made to remove the stigma of suicide as it should be viewed as the ultimate symptom of a fatal disease rather than a character flaw. The importance of prompt treatment of depressed doctors and other caregivers is being stressed at a national level. These all appear to be steps in the right direction. On the other hand, statutory provisions in over 30 states subject physicians to possible penalties if they report mental diseases, such as depression, on medical license applications. This is hardly incentive for the physician applicant to disclose this serious medical condition and seek appropriate treatment. Similarly, if a physician voluntarily admits that they have a substance abuse problem (and we have all heard that admitting that you have a problem is the first step toward a cure) they may face restrictions on their license. Some doctors have the courage to address these problems, even at the risk of forfeiting their livelihood. Others do not and risk forfeiting their lives.
To sum it up, doctors face all of the usual stressors that lead other people in all walks of life to kill themselves. They have financial troubles, broken relationships, personal losses, and problems on the job. To compound this, they are in the business of making life and death decisions, some right, some wrong, which can save or cost lives. They are surrounded by a world of illness, suffering, and, sometimes, death.
Following 4 years of college, 4 years of medical school, and additional years of indentured servitude called residency, they get to try to start-up a practice while paying off hundreds of thousands of dollars of debt. Many work to the point of physical exhaustion, others give in to physical addictions. Malpractice lawyers see them as “cash cows;” their families see them hardly at all. It is no wonder that many of us physicians know someone who has committed suicide; those of us who don’t probably one day will.
Section 4
Politics and Medicine
Chapter 12
Libel Plots Against Physicians (Who Killed
Dr. Zhivago?)
The death of a man is a tragedy; the death of millions is a
statistic.
– Josef Stalin
In the freezing, early morning hours of March 13, 1953 Pravda, the official newspaper of the Communist Party of the Soviet Union, greeted its readers with strident, bold headlines of a murderous plot against the highest levels of the communist leadership.
The would-be k
illers were none other than a band of malevolent doctors. Western observers, who wryly noted that Pravda (ironically meaning “truth” in Russian) and its sister paper Izvestia rarely reported unadulterated news, eyed the dramatic account with a healthy dose of skepticism. The average Russian, however, bombarded with sophisticated and perennial communist propaganda most likely viewed the news as equivalent to the Gospel. Communist parties throughout the world generally toed the Soviet line and turned governmental fiction into reality. Strangely enough, Russian physicians were more frightened by these headlines than the allegedly targeted leaders.
And they had reason to be. This tune had been played before by the leader of Russia.
Plots and Purges
Josef Stalin, the cruel and undisputed dictator of the Soviet Union for more than 30
years, had a habit of periodically uncovering plots to overthrow his regime that had to be countered by “cleansing” blood baths. In fact, a few of them may actually have been based in reality. The others were created to allow Stalin to reach some sort of political end and the means to get there were often gruesome.
In the early 1930s, millions of Russian peasants contemptuously labeled by Stalin as “kulaks” were accused of being anti-revolutionary rural capitalists and exploiters.
The eradication of several million of these insurgents was required to thwart this coup. Many, many thousands more were sent to concentrations camps to work as unpaid serfs, the menial cogs in the State’s rapidly industrializing Communist machine. In 1931, when this murderous campaign was in full swing, Time published an interview of Stalin by Lady Astor, the first woman to be seated in the British J.A. Perper and S.J. Cina, When Doctors Kill: Who, Why, and How, 115
DOI 10.1007/978-1-4419-1369-2_12, © Springer Science+Business Media, LLC 2010
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12 Libel Plots Against Physicians (Who Killed Dr. Zhivago?)
House of Commons and George Bernard Shaw, the famous playwright. When Lady Astor boldly asked Stalin: “When are you going to stop killing people?” Stalin coolly replied: “When it is no longer necessary. Soon I hope.” He was a refreshingly honest politician. Years later, in the midst of World War II, Sir Winston Churchill visited Russia for talks with Stalin who was his ally against Nazi Germany at the time. On the last night before Churchill’s departure, Stalin invited the Englishman to his quarters for drinks (an offer Churchill could not refuse). After a few drinks and an improvised dinner, when the ice was finally broken, Churchill casually asked Stalin about the bloody liquidation of the kulaks 11 years before. Although Western Europeans had heard rumors of the slaughter, no one knew the full scale of the murders. According to Time, Stalin replied, “Ten millions,” and holding up his hands with stubby fingers extended he added, “It was fearful. Four years it lasted.” Clearly, Stalin was peeved at the inefficiency of the operation.
A second wave of major killings engineered by Stalin known as “The Great Purge” (Bolshaya Chistka) in Russia and “The Great Terror” in the West occurred between 1936 and 1938. It was a conglomerate of campaigns of political repression and persecution against allegedly unfaithful members of the Communist Party and others groups branded as spies, saboteurs, opponents of Stalinist policies, anti-revolutionaries, and enemies of the people. It started with three high-profile trials in Moscow ending in the execution of almost all senior Communist Party leaders from the old guard; Stalin perceived them all to be potential competitors or adver-saries. The Salem witches probably had more unbiased juries.
The movement expanded to the rank and file of the party and to specific social groups viewed by Stalin as undesirable or threatening to his power base. Secret mass executions were carried out in style and patterns eerily resembling those carried out by Hitler and his henchmen. Assassinations, deportations to Siberia and internment in Gulags (Russian concentration camps) were carried out mercilessly on an unprecedented scale. In 1937 an increasingly paranoid Stalin started a purge of the Red Army, accusing its leaders of treason and collusion with Nazi Germany.
By 1939, he had successfully liquidated most of the Soviet Army’s top staff, including the majority of the generals and other high-ranking officers. Though bad for the morale of the troops, he had successfully eliminated any possible risk that the military might attempt to remove him from power.
The estimated number of killings of the Soviet citizenry in the Great Purge ranges from the official figure of 681,692 to nearly two million throughout all of the Soviet Republic. That’s about 1,000 people a day for 3 years give or take a few hundred thousand. Unfortunately for physicians, they were on Stalin’s hit list.
Stalin and the Doctors
The complete details of Stalin’s plot against the physicians are difficult to ascertain even now, partially due to the insular nature of the Soviet Union. Russian society under Stalin was so tightly self-policed that it remains impossible to clearly identify Stalin and the Doctors
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the major players in this scheme which included spies, counterspies and double agents. Historical documentation of this chapter of Stalin’s reign is exceedingly skimpy. It’s almost like Stalin didn’t want anyone to know that he was killing millions of people.
In 1948, Andrei Zhdanov, one of the major Communist Soviet leaders, died of heart disease at a Moscow health resort reserved for the Soviet elite. A heavy drinker, Zhdanov rarely followed his doctor’s advice and his health deteriorated significantly in the weeks prior to his demise. Days before Zhdanov’s death, Dr. Lidia Timashuk, a junior physician assigned to read Zhdanov’s electrocardiograms, accused the senior treating physicians of criminal negligence for failing to diagnose an obvious heart attack. The chief doctor dismissed her complaints after meeting with multiple senior specialists; a ploy likely intended to neutralize Timashuk’s accusations rather than to actually assist the dying patient. However Timashuk, who apparently was a part-time agent of the Soviet secret police (as many Soviet citizens were at the time), persisted in her complaints. After Zhdanov’s death her accusatory letters reached Stalin’s desk.
The dictator read the letter, placed on it a note for “Into the archives” and did not act upon it until years later. Stalin knew how to conserve ammunition.
It is unclear whether Stalin began to plan the purge of the Soviet doctors at that time or if he retrieved this letter years later to justify a new, brutal, political campaign. We do know that the letter contained the fuel which could be used to burn a group Stalin had come to despise: doctors. Stalin’s anti-Semitic feelings are well known but his grudge against physicians has received far less notoriety. Even before reaching his 70’s Stalin clearly did not like or trust doctors. As a matter of fact, he refused to be treated by doctors and chose to consult only veterinarians for his health. His mistrust ran so deep that he chose to self-treat his hypertension with iodine drops. This is not effective; don’t try this at home.
In the Stalinist system of Justice if the facts were insufficient to convict someone then they were skillfully fabricated and confessions were coerced. This served to ensure that Stalin’s modus operandi, “Sentence first – verdict afterward,” had an air of “legitimacy.” Between October 1952 and February 1953 hundred of doctors were arrested after rumors were started by the government that they had been killing newborns in maternity wards and were poisoning Russian children and infecting them with Diphtheria. The jailed doctors were submitted to lengthy, exhausting and threatening interrogations. Some were beaten and a number of them died in jail.
Stalin was personally involved in the interrogation of some of the Kremlin doctors.
In November 1952, Semyon Ignatiev, the head of the Secret Police, relayed a directive from Stalin to his interrogators: “Beat them! You work like waiters in white gloves. If you want to be Chekists (secret police officers), take off your gloves!”
Another interrogator is reported to have stated to a jailed doctor in November 1952:
“We will beat you every day, we will tear out your arms and legs,
but we will learn
… the truth.” In March 1953, another police officer reported to the Chief of Soviet Security: “Comrade Stalin as a rule spoke with great anger, continually expressing dissatisfaction with the course of the investigation, he cursed, threatened and, as a rule demanded that the prisoners be beaten: “Beat them, beat them, beat them with death blows” he said.”
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By mid-January 1953, Stalin concluded that he had manufactured sufficient evidence to commence with trials for treason involving hundreds of physicians.
He authorized the publication of the results of the investigation of the doctors by Tass, the Soviet News agency, and Pravda. Some of the most prestigious and prominent doctors in the USSR were formally charged with taking part in a vast plot to poison members of the top Soviet political and military leadership. Pravda reported the accusations under the headline “Vicious Spies and Killers under the Mask of Academic Physicians.” All but two of the doctors accused were Jewish.
The major points of the article, written with the usual virulence reserved for targets of the Communist Party, were the following:
– State security agencies had been tracking a group of “saboteur doctors” planning to kill the leaders of Soviet Union by “medical sabotage” for an unspecified period of time
– The “medical sabotage” consisted of intentional and vicious, incorrect diagnoses and inappropriate medical treatments using “very powerful medicines” and
“harmful regimens”
– The accused were branded as “fiends and killers”, “terrorists” and “inhuman beasts” who dishonored “the holy banner of science” and committed “monstrous crimes” by killing high rank Soviet leaders