Monday, December 5, 2016

Paths to Pathological Apathy

I got the news that another physician had committed suicide a few days ago. Sadly, this is not surprising, but this time it was a person I knew. There has been a lot written recently about physician and medical student suicide and I will leave the numbers and such for other people. What I do want to address is what I perceive to be the underlying reason -- and again, many other smarter and more experienced people than myself have written about this, too. I feel like the suicide epidemic in our society, including physicians, but also other groups seeing huge increases (veterans and children) shares a common cause.

As I reflected on the latest bad news, a question that was asked of me in an interview came to my mind.

"What is the largest problem facing our society today?"

Of course, this can be taken in many different directions, and I've never been asked that before in an interview (although I love these open ended questions -- my main problem is staying focused -- which is hard when you have so many (good?) things to say!) and as such, I hadn't really thought about this. After a moment's reflection I said: "apathy."

At that moment I was not looking at 'apathy' as a component of the suicide epidemic, but just something that has been on my mind concerning the larger American public in general. But they are tied at a level that I hadn't been able to put together at that moment.

Now, most of my days are filled with people who are filled with passion -- and for this I am thankful. However, I'm not seeing patients these days and I get to select who I spend time with. But even with these people (those lucky enough to see me regularly) and myself feel powerless -- which is the spark for apathy. Many of us feel it in our jobs where the joy and satisfaction that comes from a job well done is often futile, and at worst brings repercussions.

Many veterans have written and spoken about the terrible disillusionment that came from the noble desire to serve their country and protect their fellow citizens only to feel like they were nothing more than a political pawn in a grand money making scheme. A dreadful sense of powerlessness descends and, especially in a rigid power structure like the military, apathy is the safest and most natural reaction.

Humans do not thrive when they are powerless, when they have no hope, when nobleness is usurped by corruption.

Physicians today, in America, especially young, aspiring or in-training physicians are choosing a path which has disparate material rewards per unit-of-effort put forth -- this is why many of our brightest young people choose finance, or even computer engineering. The time, debt and liability that comes with being a physician is unparalleled and unless we can find satisfaction in what we set out to do in the first place, apathy will set in.

I place no claim on understanding why everyone who commits suicide does so -- but one aspect of the act itself that is noteworthy is the inherent self-empowerment (in what could be called a perverted form, to be sure) that comes with such a decision. To what degree this element plays has to be varied and individualized.

Perhaps in future posts a more detailed exploration of what makes physicians feel powerless is warranted. Undoubtedly as the years go by I will have a better understanding, too.

It doesn't mean anything to the suffering loved ones to repeat the mantra that 'suicide is a permanent solution to a temporary problem,' in the face of suffering -- I acknowledge that. But when a young life so full of promise and already acting as a conduit for good into this world is snuffed out, I don't have a lot else to say to the rest of us who are approaching this same threshold.

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