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Thoughts on Suicide

Severe depression and suicide are, in my considered opinion, the hidden epidemic of our time. Hidden, because very few people are comfortable talking about it in a way that gets to the heart of the matter. Below are some thoughts on the subject, written in response to some ignorant views expressed by some of my colleagues.

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"Many [depressed/suicidal vets] have chosen the wrong profession and see no way out."

In my experience and understanding, it's exactly the opposite: we have chosen the right profession for us, but we've found ourselves operating in a profoundly dysfunctional society that, as a general operating principle, treats animals as mere objects, so there is a constant tension, an inability to reconcile the competing demands on us.

For vets in particular, our love and respect for animals is juxtaposed against the economic constraints so often imposed on us, and against the current scientific paradigm of medicine by numbers (my name for "evidence-based medicine"), which is as ruthless as broken glass.

So, in my view the rate of suicide in veterinarians in particular is a symptom of a cultural disease. We are simply the canaries in the coal mine. (Well, we and teenagers, who I see also struggling to reconcile the irreconcilable.) At a certain point, it becomes so exhausting that we can't go on trying to hold it all together, because nothing we try is working anymore. For some, it ends in depression/suicide; for others, some sort of stress-related physical disease or career-ending injury. But it's all the same thing really.

And I must add that, had I never gone through it, I would have been utterly unable to understand the suicidal ideology. I would have had all the fears, misconceptions, and judgements about it (that it's weak, selfish, short-sighted, immature, etc.) that are so prevalent in our culture. It's utterly inexplicable - until you're in it, and then suicide is the most rational, even attractive option for dealing with the suffocating, unrelenting pain.

I think these vets in crisis have chosen the right profession for them. If we can only keep them alive and working as vets, then maybe they'll be instrumental in effecting the cultural shift in the way animals are viewed and managed that we're crying out for and, dare I say it, that we're dying for.

"Suicide rates are higher in veterinarians [than in other people] because we have to perform euthanasia."

That may be true for some suicidal vets, but not all. I haven't had to perform euthanasia in many years, and I believe that euthanasia is one of the kindest and most humane things we can do for animals, so it seldom troubled me.

I think the specific triggers are different for every individual who has suicidal thoughts. The trigger is not the cause.

I would venture to say that most feeling people have felt depressed at least once during their lives, and that in almost all cases the depression was both situational and temporary (e.g. death of a spouse or child, divorce, loss of a job, business failure). While depression and suicide probably do belong on the same spectrum of distress, I think we should take care not to lump the two together. I don't have the stats to hand, but relatively few depressed people seriously consider suicide.

Recurring thoughts of suicide are a particularly extreme distress signal and, at least in my experience, they have foundations that run much deeper than situational depression. And as the consequences of acting on such thoughts can be fatal, I think it's important to distinguish the two (depression and suicidal thoughts), even while discussing them as a spectrum of disorder that may be particularly prevalent in our profession.

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"I choose to be happy. Sometimes it is hard work, and it was definitely a learned skill."

That's another misconception about severe depression and suicide. It's got nothing to do with whether or not one chooses or learns to be happy. A severely depressed or suicidal person can't just "buck up" or choose to be happy or focus only on the good or the positive. We've already tried that - desperately so - and found it laughably wanting as a coping strategy. And when that's the only advice we receive, it's even more isolating (and even more depressing).

Severe, unrelenting depression and suicidal thoughts are essentially about finding ourselves in a society where we so don't fit that we couldn't possibly fit without changing ourselves so much we might as well not exist anymore. There can be no choosing/learning to be happy in response to such a predicament. For want of a better term, it's a spiritual crisis. Nothing to do with religion, but with the human spirit (a term I don't care for, but as I don't have a better substitute, on we'll go): the whole bally lot of delusions we were brought up believing has come crashing down around us... with nothing worth believing in to take its place. "Happy" yourself out of that!

Again, I don't fault anyone who doesn't get it for not understanding it (and thus getting it horribly, horribly wrong). I never could have understood it had I not gone through it myself. I just couldn't have wrapped my mind around it, as I had no frame of reference for it whatsoever. So, rather than waste more words that can't be properly digested, let me just finish by suggesting what one can do for someone they suspect might be severely depressed to the point of suicidal thoughts:

Admit that you don't get it, but that you see that your friend/spouse/sib/whoever is going through a hard time, and you'd like to know what you can do to help. The inevitable answer will be "nothing." But, in fact, you'll already have done vastly more than nothing; what you'll have done just by broaching the subject is to let that person know you care about them and sincerely hope they'll stick around. You'll just have to take my word for it that having such people around can be a veritable life-saver. Don't be a nuisance, and don't keep going on about it, but don't do the opposite and withdraw, thinking that you're giving the person needed space or privacy. Even if you're doing it out of love and respect, your withdrawal will make the at-risk person feel even more alone, abnormal, worthless... hopeless. I repeat: don't be a nuisance, but also don't let go! Lean in, when your tendency may very well be to reel back in horror. Be that brave, and you may help save a life.

Oh, and don't assume that, when we're smiling or cracking jokes, we're all better, that we're over it. Another misconception about severe depression and suicidal thoughts is that it's a persistent or static state. Perhaps it is for some, but for me it was an intermittent but relentlessly recurring thing that went on for years.

In between the black periods (when typically I would withdraw and you wouldn't have seen me to know what was going on), I would have seemed completely normal (well, as normal as I ever am ;-). The fatality of it lies in its chronicity: it never fully goes away until it's been fully processed (for want of a better word), which doesn't happen in one blindingly glorious epiphany. And in the meantime, we remain at risk for that ridiculously inadequate euphemism, "self-harm." (That one has got to go!)

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