Suicide and hope, Dave Shuey
Black and white headshot of Dave Shuey
Words by:
Dave Shuey — IndeVets Veterinarian Social Worker

*Content warning: This blog discusses suicidality. If you start to experience any signs of distress and require emotional assistance, help is available by calling or texting 988.

Realities

One of my dearest colleagues (we’ll call her “L”) and I used to trade poetic and linguistic absurdities all shift long when we worked together as anesthesia technicians in a university veterinary teaching hospital. It was how we coped with the long shifts, complex cases, temperamental attending clinicians, and impossible workload. She cared deeply for her coworkers and the meaning of the work we were doing. When I learned on November 6, 2021, that this beloved colleague, had taken her own life, I became immovably sure of two things.

First, I learned that none of us humans are immune to the possibility of suicidal thoughts and behavior. And second, that there is no inherent quality of character we can lean on or develop to protect us from sometimes wishing to stop the deep pain that comes with the regular performance of our veterinary duties. Sometimes the desire to make the pain go away can become overwhelming. Sadly, the rate of suicide in the veterinary profession (1) has been pegged as close to twice that of the dental profession, more than twice that of the medical profession, and 4 times the rate in the general population. When confronted with these realities, non-veterinarians are shocked to find that the image of happy and fulfilled animal doctors playing with kittens and puppies is just dangerous illusion.

Six months after losing L., I was a behavioral health clinician working with an outpatient therapy client in a state-run behavioral health clinic that treated individuals with severe and persistent mental illness. She was a former business owner struggling with housing instability, financial ruin, social isolation, and the dual diagnoses of Bipolar and Opioid Use Disorder.  She also had recent active suicidal ideation, which meant I had to monitor her mental and emotional state more intensively than other clients and be ready to summon emergency services if she became a danger to herself or others. I provided her with resources for every concern she mentioned. I fought with other departments in the clinic to reach out to her when they claimed she’d “burned bridges.”

Over the course of several months, “R” and I built rapport and trust through our conversations. Every session , I would ask if she’d been having suicidal thoughts, intentions or plans, which she consistently denied. She named trusted members of her support system. She listed coping skills to avoid relapse. She showed up to each session expressing the desire to endure as she worked to make the necessary changes in her life. Safety plans were confirmed and re-confirmed.

Then I learned that R had died of a fatal overdose on the evening after a session I’d had with her. I was likely the last person she talked to. In this state of despair, guilt and terror, I knew I had to seek out a variety of supports to deal with surviving a loss like this. In addition to medication, I sought the help of a seasoned EAP counselor. She told me that it is entirely possible to do everything right, to miss none of the warning signs, and still the worst happens. It took a lot more sessions with my counselor and the passing of time but acceptance of that finally came to me. That acceptance saved me from my own abyss of self-condemnation and despair. It allowed me to share that experience with other clinicians who’d gone through similar experiences and in so doing, gain crucial support.

 

Myths

The story of suicidality in veterinary medicine parallels the story of other calamities of human experience and suffering. Writing about epilepsy, the neurologist Rajendra Kale describes what might as well be our profession’s attitude toward suicide: “4,000 years of ignorance, superstition, and stigma, followed by 100 years of knowledge, superstition, and stigma.” The veterinary profession carries some of the highest suicide risk in the world. And yet we persist in the delusion that burnout, compassion fatigue, suicidality and whatever other disorder labels we can think of signify something wrong with us and not something that happened to us. We’re told that a person who has taken their own life “lost their battle” with depression. We are told to do more self-care and to seek work-life balance. We do the work but the environment that makes us so troubled and sick stays the same. We blame ourselves (the victim).

The people who are suffering don’t ever intend to or want to have suicidal thoughts. And the people around those who are suffering, whether a loved one or colleague, can find it very scary to talk about it, even if done with incredible caring and sympathetic candor. We worry that bringing it up can push someone over the edge or increase their risk of self-harm. As someone who can be considered an “expert” in the field of mental health, I am here to tell you that when done with compassion, many people find relief and validation when given the opportunity to share their “darker” thoughts freely. This points out the dangers of stigma and superstition surrounding suicidal thoughts, not the thoughts themselves. Thoughts and feelings become dangerous when they stop being mentionable, when they isolate us instead of bringing us together.

Veterinary professionals have reported that demands of the job, the expectations of clients, fear of mistakes, and patient loss contributed most to having suicidal thoughts (Nett et al, 2015). Veterinarians often have little control of these factors in their work environments. However, much can be done by the leadership in clinics to create an environment conducive to the reduction or, better yet, the removal of these stressors. Sadly, the focus falls too often on victim-blaming interpretations based on personality theories and perfectionism (Silva et al, 2023, Stoewen, 2015). If diversity means anything, it ought to mean that any personality should be able to feel safe wherever possible. That feeling of safety, or lack thereof, is determined predominantly by our relationships.

 

Hope: It Comes From Each Other

I’ve been a licensed veterinary technician with specialized training in end-of-life care. I have euthanized animals, including my own. I am also a human behavioral health clinician who has worked with hundreds of people with suicidal thoughts, intentions, plans, and attempts. I have survived the loss of colleagues and clients in both fields to suicide. I have learned that there is no way to prevent the worst from happening, nor any way to avoid the exposure to suffering as a veterinary or mental health professional. But, where there is a caring, trusting connection between people, and the freedom and safety to tell the truth about how we’re feeling, there is comfort in and protection from the abyss of our own pain. We emerge from the abyss when we have faced it and let it have its say, when we have embraced it and heard its questions, and when we have told somebody about it. There is meaning and relief, and the possibility of healing, in shared pain.

In the end, it is not just about self-care, resilience, skills, specialized training, wellness programs bestowed from the heights of the industry, or even prevention programs. It is only ever about each other. It is about extending and accepting the helping hand, because this profession brings pain. Pain is painful, and pain that is shared is pain reduced. To push against suicide as the final answer to intractable suffering, the powerful and life-saving option that we strive to keep open to all our beloved colleagues is, “I’m here, and I see you.”

 

Practical Suggestions

  • Plain language is best: “Are you thinking about killing yourself?” builds more trust and connection than “You’re not thinking about killing yourself, are you?”
  • Use the questions in the first resource listed to help you and your colleagues understand the nature and level of risk. Suicidal thoughts without intent or plan can be a person’s normal baseline. Thought, intent, and plan are separate.
  • Consider reaching out to Not One More Vet, the leading non-profit in the veterinary industry focused on mental health. They offer many programs, including anonymous peer support, that are rooted in an unmatched empathy for what we face in vet med.
  • The Coalition of Clinician Survivors is a community of experts in the helping professions whose lives have been touched by suicide.

 

Further Reading and Resources

  • A Common Sense Assessment Tool
  • QPR
  • 988
  • AVMA Prevention Guide
  • AVMA Postvention Guide
  • Nett, R. J., Witte, T. K., Holzbauer, S. M., Elchos, B. L., Campagnolo, E. R., Musgrave, K. J., Carter, K. K., Kurkjian, K. M., Vanicek, C. F., O’Leary, D. R., Pride, K. R., & Funk, R. H. (2015). Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. Journal of the American Veterinary Medical Association, 247(8), 945-955. Retrieved Feb 26, 2024, from https://doi.org/10.2460/javma.247.8.945
  • Silva CR, Gomes AAD, Santos-Doni TR, Antonelli AC, Vieira RFC, and Silva ARS (2023) Suicide in veterinary medicine: A literature review, Veterinary World, 16(6): 1266–1276.
  • Stoewen, D.L. (2015). Suicide in veterinary medicine: Let’s talk about it. Canadian Veterinary Journal, 56(2015), 89-91. Retrieved Feb 26, 2024 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266064/