Physician Suicide and Organizational Justice: The Role of Hopelessness, Helplessness and Defeat

Physician Suicide and Organizational Justice: The Role of Hopelessness, Helplessness and Defeat

Michael Langan, M.D.

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They can be a terror to your mind and show you how to hold your tongue
They got mystery written all over their forehead
They kill babies in the crib and say only the good die young
They don’t believe in mercy
Judgement on them is something that you’ll never see
They can exalt you up or bring you down main route
Turn you into anything that they want you to be–Bob Dylan, Foot of Pride

In  F. Scott Fitzgerald’s  The Great Gatsby, Nick Carraway observes that “the loneliest moment in someone’s life is when they are watching their whole world fall apart, and all they can do is stare blankly”      In 1896 Émile Durkheim described “melancholy suicide” as being “connected with a general state of extreme depression and exaggerated sadness, causing the patient no longer to realize sanely the bonds which connect him with people and things about him. Pleasures no longer attract.”     Heightened perceptions of defeat and entrapment are known to be powerful predictors of suicide. According to the “Cry of Pain” model people are particularly prone to suicide when life  experiences are interpreted as signaling defeat, defined as a sense of a “failed struggle.” Unable to find some sort of resolution to a defeating situation, a sense of entrapment proliferates and the perception of no way out provides the central impetus for ending one’s life.

Although no reliable statistics yet exist, anecdotal reports suggest a marked rise in physician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved.  What acute and cumulative situational and psychosocial factors are involved in the descent from suicidal ideation to planning to completion?   What makes suicide a potential option for doctors and what acute events precipitate and trigger the final act?

Depression and Substance Abuse no Different from General Population

The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria indicate that physicians have the same rates (8-14%) of substance abuse and dependence as the general population,3 and slightly lower rates compared to other occupations.4,5  Epidemiological surveys reveal the same. Hughes, et al.6 reported a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

Job Stress and Untreated Mental Illness Risk Factors

Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 8 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”8

Few studies have evaluated the psychosocial stressors surrounding physician suicide but there is no reason to believe they are any different from the rest of the population. Although the triggering life events and specific stressors may vary outside, the inner psyche and undercurrent of thoughts and feelings should remains the same.   Perhaps the same drivers of suicide identified in other populations are contributing to physician suicide.

Continue reading

Professional Health Program (PHP) Survey

Physician Suicide and Organizational Justice: The Role of Hopelessness, Helplessness and Defeat

Physician Suicide and Organizational Justice: The Role of Hopelessness, Helplessness and Defeat

Michael Langan, M.D.

screen-shot-2016-10-06-at-7-27-51-pm

They can be a terror to your mind and show you how to hold your tongue
They got mystery written all over their forehead
They kill babies in the crib and say only the good die young
They don’t believe in mercy
Judgement on them is something that you’ll never see
They can exalt you up or bring you down main route
Turn you into anything that they want you to be–Bob Dylan, Foot of Pride

In  F. Scott Fitzgerald’s  The Great Gatsby, Nick Carraway observes that “the loneliest moment in someone’s life is when they are watching their whole world fall apart, and all they can do is stare blankly”      In 1896 Émile Durkheim described “melancholy suicide” as being “connected with a general state of extreme depression and exaggerated sadness, causing the patient no longer to realize sanely the bonds which connect him with people and things about him. Pleasures no longer attract.”     Heightened perceptions of defeat and entrapment are known to be powerful predictors of suicide. According to the “Cry of Pain” model people are particularly prone to suicide when life  experiences are interpreted as signaling defeat, defined as a sense of a “failed struggle.” Unable to find some sort of resolution to a defeating situation, a sense of entrapment proliferates and the perception of no way out provides the central impetus for ending one’s life.

Although no reliable statistics yet exist, anecdotal reports suggest a marked rise in physician suicide in recent years. From the reports I am receiving it is a lot more than the oft cited “medical school class” of 400 per year.

This necessitates an evaluation of predisposing risk factors such as substance abuse and depression, but also requires a critical examination of what external forces may be involved.  What acute and cumulative situational and psychosocial factors are involved in the descent from suicidal ideation to planning to completion?   What makes suicide a potential option for doctors and what acute events precipitate and trigger the final act?

Depression and Substance Abuse no Different from General Population

The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks critically at the evidence based literature, substance abuse in medical professionals approximates that of the general population.  Controlled studies using DSM diagnostic criteria indicate that physicians have the same rates (8-14%) of substance abuse and dependence as the general population,3 and slightly lower rates compared to other occupations.4,5  Epidemiological surveys reveal the same. Hughes, et al.6 reported a lifetime prevalence of drug or alcohol abuse or dependence in physicians of 7.9%, markedly less than the 14.6% prevalence reported in the general population by Kessler.7

Job Stress and Untreated Mental Illness Risk Factors

Job stress coupled with inadequate treatment for mental illness may be factors contributing to physician suicide according to one recent study. Using data from the National Violent Death Reporting System, Gold, Sen, & Schwenk, 2013 8 compared 203 physicians who had committed suicide to more than 31,000 non-physicians and found that having a known mental health disorder or a job problem that contributed to the suicide significantly predicted being a physician.

Physicians were 3.12 times more likely to have a job problem as a contributing factor. In addition, toxicology testing showed low rates of medication treatment.  The authors concluded that inadequate treatment and increased problems related to job stress are potentially modifiable risk factors to reduce suicidal death among physicians. They also warned that the database used likely underestimated physician suicides because of “underreporting and even deliberate miscoding because of the stigma attached.”8

Few studies have evaluated the psychosocial stressors surrounding physician suicide but there is no reason to believe they are any different from the rest of the population. Although the triggering life events and specific stressors may vary outside, the inner psyche and undercurrent of thoughts and feelings should remains the same.   Perhaps the same drivers of suicide identified in other populations are contributing to physician suicide.

Continue reading →

If you like this blog please donate $5 to buy me a coffee so I can continue producing updated and important content!

Donate $5 to buy me a coffee so I have the fuel I need to keep producing up-to-date and important content!

Disrupted Physician was started in 2013 as an informational website, discussion forum and blog focused on the systemic and unchecked fraud and abuse reported by physicians referred to state physician health programs (PHPs). I created this website to: 1. Expose the fraud and abuse 2. Act as a resource for physicians who may find themselves experiencing PHP fraud and abuse. Since 2013 over 1200 physicians, residents, medical students, nurses and a dozen or so airline pilots have contacted me seeking guidance, discussion and advice. I have had many call in crisis and some suicidal. Many have told me the website saved their lives and in two cases literally. Both were feeling hopeless, helpless and defeated and having gone through suicidal ideation and planning they were close to completion when they discovered the website and changed their minds. They called to tell me the website had just stopped them from ending their lives and say thank you. Finding out they were not alone was enough to instill hope. Disrupted Physician may have started as an informational website, discussion forum and blog but as it has evolved it has become a sort of makeshift crisis management/suicide hotline niche service for physicians, medical students and others who may find themselves coerced into the so-called medical-regulatory-therapeutic complex (MRTC). Disruptedphysician.blog is a one-person voluntary unfunded endeavor. So please buy me a coffee so I can renew and revitalize the website and start adding new content. The donation button below is for just $5.

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Post scriptum (P.S.)to Disrupted Physician

Disrupted Physician Stats 2020

The latin term “post scriptum” (P.S.) literally means “written after” as in that which is after the writing.

This postscript to Disruptedphysician.com is 14-months after I abandoned the website and blog because of the abysmal support of those requesting guidance.

. I have not visited this website during the year 2020 but 9,608 visitors have visited the abandoned blog. In February 2021 many of them contacted me in a flurry of concerned calls, texts and phone calls. The website for Disrupted Physician no longer existed and the 448-blog posts on Disruptedphysician.blog were vanishing into oblivion within days. The domain for Disruptedphysician.com was lost but the blog-posts are intact. The website needs work and would also like to update this blog and keep it up to date. Am going to request donations and have set up below.

I am repeatedly told the website is saving lives and a valuable service to the community. I have been told by many people the website saved their lives and a few from imminent suicide yet no one was donating?

If that is the case why was no one donating? I am requesting donations to support this blog. PLEASE MAKE DONATION BELOW.

March 2013 > December 20, 2019 (448-Blog posts over 5 yrs 9 months) Status = Active Blog.

Disrupted physician was created in March. 2014 to shine a light on physician health program (PHP) abuse and because I created it those abused shine a light on me. Disruptedphysician.com = informational and discussion website and blog. Rapid following by physicians, medical students and others from around country and Disruptedphysician.com >”Go to Guy”for PHP issues. From 2015 > 2019 I am contacted by 4-6 new people seeking help.

Medscape Editor takes interest in website and blog > 2015 Medscape article Physician Health Programs- More Harm Than Good?  which broke new ground as the FIRST article critical of PHPs in the mainstream medical news. Medscape then opens door for BMJ article “Physician health programs under fire” and others. Disruptedphysician.com directly sparked the Medscape article and acted as catalyst for all that followed. Disruptedphysician.com caused 2015 article that broke new ground.

I start a GoFundMe to help support Disruptedphysician.com but > 95% of those seeking assistance do not contribute anything. In 4-cases I was able to help medical students and physicians circumvent the PHP and avoid signing a contract and not one of these individuals ever contributed a dime to my fund.

December 20, 2019 Disruptedphysician.com is abandoned as no support from those seeking help. Deadbeat group.

Blog-post published on December 20, 2019 requesting donations to GoFundMe. No response to my requests. I ask a physician who had contacted me 2-weeks earlier and had spent a considerable amount of time hearing his story in addition to several conference calls with his lawyer and others. He said no and I asked him “so you can’t contribute 20 bucks to this fund?” to which he replied “no, were all in the same boat.” That is when I said “F’ this” and abandoned disruptedphysician.com.

February 2021– Abandoned blog for 14-months. Disrupted physician website no longer exists as lost domain.

I receive flurry of concerned messages and phone calls informing me that the website Disruptedphysician.com no longer exists and Disruptedphysician.blog will no longer exist in 2-days if do not pay fees. They all offer support and offer to pay and blog is safe for now.

I am told this website is invaluable and saving lives and must be kept up. Need to improve Need funding.

Please Donate Below

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Donate $5 to buy me a coffee so I have the fuel I need to keep producing up-to-date and important content!

Disrupted Physician was started in 2013 as an informational website, discussion forum and blog focused on the systemic and unchecked fraud and abuse reported across the country by physicians referred to their state physician health programs (PHP) I started this website to: 1. Expose the fraud and abuse ( have made significant progress but a long way to go) 2. Act as a resource for those referred to or having problems with their state PHP Since over 1200 physicians, residents, medical students, nurses and a dozen or so airline pilots have contacted me seeking guidance, discussion or advice. I have had many call in crisis and some suicidal. Many have told me the website saved their lives and in two cases literally. Both were feeling hopeless, helpless and defeated and having gone through suicidal ideation and planning they were close to completion. They were having serious problems involving a common setback with their PHPs and when searching for answers on the internet came across the website and changed their minds. They called to tell me the disruptedphysician.blog had just literally stopped them from ending their lives and say thank you. Finding out they were not alone was enough to instill hope. So please buy me a coffee so I can renew and revitalize this website and start adding new content.

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This is an Important Public Service Announcement (PSA): Physician health programs (PHPs) are not causing physician suicides: Illegitimate authority is.

Illegitimate power and abusive authority cannot be bargained with.  They must be called out and removed.  As one of my personal hero’s Dietrich Bonhoeffer said:

“We are not to simply bandage the wounds of victims beneath the wheels of injustice, we are to drive a spoke into the wheel itself.”

So here is the deal–I want to keep this up and I want to keep doing this.  I have gotten this far but without your help but it all vanishes very soon and a lot of other bad things are going to happen. So if you have enjoyed reading my blog, or if I have ever helped you in the past or if you want to help remove this illegitimate power currently controlling the profession of medicine and help me finish what I started then please contribute! The link is below:

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This is an Important Public Service Announcement (PSA): Physician health programs (PHPs) are not causing physician suicides: Illegitimate authority is.

Please Donate to Fund Below

So here is the deal–I want to keep this up and I want to keep doing this.  I have gotten this far but without your help but it all vanishes in 6-days. So if you have enjoyed reading my blog, or if I have ever helped you in the past or if you want to help remove this illegitimate power currently controlling the profession of medicine and help me finish what I started then forGod’s sake please help me out here.!

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First post on disrupted physician.com October 22, 2014

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She likes a rigged game, you know what I mean?”
— R.P. Murphy in Ken Kesey’s One Flew Over the Cuckoo’s Nest

Published  in the March 17, 2014 newsletter Alcoholism and Drug Abuse Weekly, an article  entitled “Physician group urges focus on spiritual and psychosocial” describes a group of doctors who “emphasize that for all addictions, the psychosocial and spiritual interventions, including 12-step interventions must be included in the treatment process and,” according to founding board member Dr. Ken Thompson, M.D., “to not do so falls short of practicing good addiction medicine.”

With a “significant percentage” in 12-step recovery themselves, “they have formed a  group called “Like-Minded Docs,which has more than 150 physicians, many of whom are medical directors of top treatment programs and also members of the American Society of Addiction Medicine (ASAM).” Dr. Thompson is in fact the Medical Director of Caron treatment center in Pennsylvania. The group also includes the medical directors of Hazelden, Talbott, Marworth, Promises, and other assessment and treatment centers used by state regulatory agencies to evaluate and treat referred physicians.    The President of the American Society of Addiction Medicine is a Like-Minded Doc as is former White House Drug Czar (1973-1977) Robert Dupont. In addition, the physician who introduced the long-term alcohol biomarkers Ethyl-glucuronide (EtG),  Ethyl-sulfate (EtS), and Phosphatidylethanol (PEth) is a like-Minded Doc as is  Wayne Gavryck, The Medical Review Officer for the Massachusetts Physician Health Program PHS, Inc.  How does he reconcile his 12-step belief system with fraud and misconduct?   It is either doublethink or the A.A. spirituality persona is just a front.

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Although I  applaud the ideal of addressing the psychosocial and spiritual aspects of addiction and acknowledge that 12-step recovery is a treatment tool that can provide great benefit to some people, I do believe there is an inherent conflict-of-interest here. Having no strong feelings for or against A.A, I  view it through the same pluralistic and open-minded lens as I do religion or philosophy;  there are many paths to salvation and none superior. I have referred patients to A.A. myself  and see it as an option and a personal choice, one tool in the toolbox  that can provide great benefit to some people, do absolutely nothing for others and, in fact, harm some.   If it works for you good for you. Knock yourself out.  If not then let’s try something different.

So although the ideals of Like-Minded Docs are ostensibly laudable, the framework is not necessarily so.  What is  most concerning is a confluence of currents that preclude option and choice. It is a scaffold that can be used for coercion, control, and imposition. And this is exactly what is being done in many of the State Physician Health Programs (PHPs).

Originally funded by state medical societies and staffed by volunteer physicians, PHP’s were designed to help sick doctors and protect the public. But over the past decade these programs have undergone a sweeping transformation due to the influence of the American Society of Addiction Medicine (ASAM). Unlike Addiction Psychiatry, ASAM is not recognized by the American Board of Medical Specialties (ABMS). They created their own “board certification” (ABAM)  in 1986 and most physicians do not know that the only requirement is an M.D. in ANY specialty and some sort of experience in substance abuse.

Trumpeting the false dichotomy that addiction is a “brain disease” and not a “moral failing” while portraying themselves as altruistic advocates of the afflicted, the ASAM has cultivated an organization that exudes authority, knowledge, respectability, and advocacy. They have set forth definitions of addiction, shaped diagnostic criteria, dictated assessment protocols, and shaped public policy all under the guise of scholarship and compassion.

They introduced junk science such as the EtG and PEth alcohol biomarkers through Greg Skipper, FSPHP, ASAM, and another Like-Minded Doc.

They created the “moral panic” of a hidden cadre of drug addled and besotted doctors protected by a “culture of silence” disguised as some of the best workers in the hospital and in fact look “just like us.”  They introduced and promulgated the nebulous “disruptive physician” and successfully fostered a moral crusade to attack this huge hidden threat. And if you do a little searching you will find that their  next target is the “aging physician,”  demented doctors causing unseen mayhem and assailing the public good.  They are now  fomenting a call to arms to root out senility in medicine. It is the same tactic they used in the substance abusing and disruptive physician.  Social entrepreneurs.  Moral panic. Moral crusade.   With no evidence base and the use of  propaganda and disinformation they have convinced regulatory and administrative medicine that witches are real, witches are evil,  and they are the authority when it comes to witches and know how to identify and root them out with our witchpricking instruments.  And you know what?. It worked.

And by infiltrating state PHPs they have become the might and main of addiction medicine in the United States. By removing dissenters who disagreed with the groupthink they have taken over most of the state PHPs and organized under the Federation of State Physician Health Programs (FSPHP).

And the State PHPs under the FSPHP are very strict when it comes to choice in rehabilitation facilities for for physicians in need of assessments for substance abuse. In fact there is usually no choice in the matter.  The physician may be given a choice of facilities but that is a ruse as it is a false choice– smoke and mirrors sleight of hand. Deception.

As home to some of the countries top ranked hospitals and most prestigious medical schools Massachusetts is an international healthcare hub with world-class teaching, research, and clinical care. Two of the top three psychiatric hospitals in the United States as rated by U.S. News and World Report are found here in Massachusetts with McLean Hospital earning the top prize and Massachusetts General Hospital ranked number three. However, this medical mecca of learning and research is apparently unable to attract anyone with the competence and skill to assess a physician for addiction or substance abuse.

In Massachusetts if the State PHP, PHS,inc. feels a physician is in need of an assessment the evaluation must be done at “a facility experienced in the assessment and treatment of health care professionals.”  No exceptions. And apparently these esoteric skills are only found in Georgia, Arkansas, Alabama, Kansas, and a half dozen other far-away places.

With over 20 years experience with the Massachusetts PHP, Physicians Health Services, inc., Harvard Medical Schools Dr.’s John Knight and J. Wesley Boyd published an article in the Journal of Addiction Medicine last year concerning Ethical and Managerial Considerations Regarding State Physician Health Programs.

One of the issues they discussed was the conflicts of interest between the state PHPs and the evaluation centers. One comment I was surprised got past editorial review was that the treatment centers may “consciously or otherwise” tailor diagnosis and recommendations to the PHP’s impression of that physician. “consciously” tailoring a diagnosis is fraud. It is political abuse of psychiatry. It is unethical. It is, in fact, a crime.

If you cross-reference the  medical directors of the “PHP-preferred facilities”  with the list of LMD’s it is a perfect match.

Therefore when the PHP refers a physician for an evaluation and gives them a choice of an assessment facility there is no choice. It is three card monte. A shell game. Heads I win tails you lose.

 

 

The ASAM has imposed the prohibitionist chronic brain disease spiritual recovery model of addiction on the field of medicine. It is a system of coercion, control, and indoctrination. And another ASAM Like-Minded Doc, Robert Dupont, is calling this the “new paradigm” of addiction medicine and wants to spread it out to other venues including schools.

Like-Minded Docs solves the final piece of the puzzle. It explains why so many doctors across the country are claiming fabrication and manipulation of personality and cognitive tests to support nonexistent diagnoses. In evaluating a physician this group is not gathering data to form a hypothesis but making data fit a hypothesis that arrived well before the physician did.  And this may be part of the explanation for the recent marked increase in physician suicide. With guilt assumed from the start, no due process, no appeal, and no way out physicians are being bullied, demoralized, and dehumanized  to the point of hopelessness. This needs to end now.

 

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The “Impaired Physician Movement” takeover of state Physician Health Programs (PHPs).

Disrupted Physician

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“The impaired physician movement is characterized by a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”–G.V. Stimson  (1)

Forget what you see; Some things they just change invisibly–Elliott Smith (Between the Bars)

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Physician Impairment

The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence, published by the American Medical Association’s (AMA) Council on Mental Health in The Journal of the American Medical Association in 1973, (2)  recommended that physicians do a better job of helping colleagues impaired by mental illness, alcoholism or drug dependence. The AMA defined an “impaired physician” as “a physician who is unable to practice medicine with reasonable skill and safety to patients because of mental illness or excessive use or…

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“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.”– Thanksgiving Day Proclamation 1963—John F. Kennedy

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.”– Thanksgiving Day Proclamation 1963—John F. Kennedy.

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Let us therefore proclaim our gratitude to Providence for manifold blessings–let us be humbly thankful for inherited ideals–and let us resolve to share those blessings and those ideals with our fellow human beings throughout the world.

On that(this) day let us gather in sanctuaries dedicated to worship and in homes blessed by family affection to express our gratitude for the glorious gifts of God; and let us earnestly and humbly pray that He will continue to guide and sustain us in the great unfinished tasks of achieving peace, justice, and understanding among all men and nations and of ending misery and suffering wherever they exist.

–Thanksgiving Day, 1963