When renowned burn surgeon John Hansbrough, M.D., took his own life
in San Diego in 2001, his family and friends decided to take steps to raise
awareness of the problem of suicide in physicians. Their efforts culminated in
an educational campaign led by the American Foundation for Suicide Prevention
(AFSP) geared to preventing suicide in physicians and medical students.
At the center of the campaign are two films, a longer film targeting
physicians, titled "Struggling in Silence: Physician Depression and
Suicide," and a shorter film targeting medical students, titled"
Out of the Silence: Medical Student Depression and Suicide."
From top to bottom: Robert Lehmberg, M.D., is an Arkansas plastic
surgeon who struggled with depression for years before seeking help.
Alice Flaherty, M.D., Ph.D., a neurologist practicing in Massachusetts,
has been treated successfully for bipolar disorder.
Flaherty sees her patients and conducts research at Massachusetts
General Hospital in Boston.
Lehmberg (left) and treating psychiatrist G. Richard Smith, M.D.,
discuss Lehmberg's experience with depression.
A medical student at the University of California, San Diego, found that
successful depression treatment enabled her to keep up with her
Stills from the film Struggling in Silence: Physician Depression and
"Struggling in Silence" will air on Los Angeles PBS station
KCET in May (check local listings).
The physician depression-awareness and suicide-prevention campaign began in
2002 with a consensus conference that culminated in a statement titled"
Confronting Depression and Suicide in Physicians," which was
published in the June 18, 2003, Journal of the American Medical
The statement concluded, "The culture of medicine accords low
priority to physician mental health despite evidence of untreated mood
disorders and an increased burden of suicide" and barriers to treatment
for physicians, such as discrimination in medical licensing, hospital
privileges, and professional advancement.
According to data posted on the AFSP Web site, physicians die by suicide
more frequently than others of their gender and age in both the general
population and other professional fields.
"Suicide is disproportionately high among physicians, especially
women, and usually related to mood disorders, substance abuse disorders, or
both," Charles Reynolds III, M.D., told Psychiatric News.
Reynolds is the UPMC Professor of Geriatric Psychiatry and a professor of
neurology and neuroscience at the University of Pittsburgh School of Medicine.
Reynolds chaired an advisory committee that offered input and direction on the
making of the film.
Depression often goes unrecognized and untreated in physicians due to"
professional attitudes that discourage admission of health
vulnerabilities," according to psychiatrist Paula Clayton, M.D., who is
the AFSP'S medical director and convened the advisory committee that Reynolds
chaired. "There is a fear of asking for help because some think that by
doing so, they may be hindering their careers," she told Psychiatric
Medical students with depression may be hesitant to seek help because they
believe it will impact their standing in the class or keep them from matching
with the residency program they desire, she noted. "More needs to be
done to educate physicians and medical students about depression."
"Struggling in Silence" features interviews with families,
friends, and a patient impacted by a physician suicide, as well as physicians
dealing with mood disorders themselves.
For instance, Alice Flaherty, M.D., Ph.D., discusses her experiences as a
neurologist who began experiencing significant symptoms of depression after
her twins died during childbirth. When later symptoms of mania occurred, she
sought help after colleagues encouraged her to do so. Her own treatment for
bipolar disorder was successful, and her experiences inspired her to conduct
research on the brain and creativity.
The film also features commentary by Robert Lehmberg, M.D., a plastic
surgeon in Little Rock, Ark., who reveals that he tried to escape from
depression symptoms through his work, which occupied the majority of his time.
When Lehmberg did seek treatment, he found that he was required to have his
psychiatrist submit a form stating that he was capable of practicing
Viewers will also learn about the work of psychiatrist G. Richard Smith,
M.D., who worked to remove language in licensure applications that required
physicians to answer questions about psychiatric and other medical treatment
(Psychiatric News, May 19, 2006).
Though Smith's work helped to destigmatize treatment seeking among
physicians, many physicians with depression are still hesitant to come forward
and seek help, according to Reynolds.
"We need to change the culture of medicine to support appropriate
help seeking by physicians with depression," he said. "Perhaps by
helping ourselves, we will do a better job of recognizing depression in our
APA Medical Director James H. Scully Jr., M.D., served on the advisory
committee and noted that physicians must find a way to overcome the resistance
to seeking help stemming from concerns about the impact it may have on their
careers. "The film is a wonderful tool to adress this issue," he
told Psychiatric News.
Extra footage from the longer film was used to make "Out of the
Silence," a 13-minute film focusing on depression among medical students
and featuring interviews with a medical student being treated for depression
at the University of California, San Diego. In the film, the student is
portrayed interacting with a campus therapist and serving in a peer-mentoring
program in the medical school.
It is Clayton's hope that medical schools will incorporate the film into
curricula to raise awareness about the risk of depression and suicide among
Production of the films was funded by Wyeth Pharmaceuticals, the American
College of Psychiatry, and the AFSP.
More information about the films "Struggling in Silence:
Physician Depression and Suicide" and "Out of the Silence: Medical
Student Depression and Suicide," including purchase information, is