Thursday, April 3, 2014

When Bankers and Physicians Commit Suicide

Apparently, the media finds stories about Wall Street bankers killing themselves to be compelling. The prevalent narrative suggests that big, bad bankers are so troubled by their oppressive practices that they cannot live with themselves.

Sally Satel effectively debunked this story in a recent column. In truth, doctors and lawyers are more likely to commit suicide than are finance professionals.

White privilege notwithstanding, white males are three times more likely to commit suicide than are blacks and twice as likely as Hispanics and Asians. Moreover, they are four times more likely than females to commit suicide. Thus, bankers belong to a cohort that is more inclined to commit suicide.

Within the medical profession, however, the male/female ratio levels out. Women physicians are just as likely as male physicians to commit suicide.

Satel compared bankers with other professionals:

So how does finance compare with other professions in frequency of suicides? Data are hard to find. Fortune magazine asked the U.S. Centers for Disease Control and Prevention for the latest statistics from its National Occupational Mortality Surveillance database. Numbers from 2007 indicate that "sales representatives for financial and business services" -- which includes various banking positions, including investment advisers, brokers and traders -- are 39 percent more likely to kill themselves than people in the workforce as a whole.

But some other white-collar professionals are at even greater risk: Lawyers are 54 percent more likely than average to die by suicide, for example, and doctors are 97 percent more likely.

This suggests that the finance profession isn't causing people to kill themselves, rather that banking has high concentrations of workers in the demographic group at greatest risk for self-harm. In the U.S., men are four times as likely as women to take their lives; white males are three times more likely than blacks and twice as likely as Asians and Hispanics. The overall suicide rate increased by 30 percent in the last decade. The jump was most pronounced among men in their 50s; their suicide rates jumped by nearly 50 percent, to about 30 per 100,000 nationwide.

Satel defines the problem well:

Suicide is a bewildering act, often precipitated by a profound sense of humiliation, failure and hopelessness. There seems no way out. Bankers are susceptible to the same miasma of despair that can befall anyone -- failed relationships, loss, rejection, terminal illness, severe clinical depression. The computer's unblinking eye, the hard-charging boss and sleepless art of the deal aren't themselves driving people over the ultimate brink.

But, why should medical professionals be so vulnerable to despair? They are in the ultimate caring profession. They are not burdened by the need to close the deal. They are not being driven by the hard-charging boss. They are not chained to their computer screens.

The problem is not new. It has been extensively researched. One report defined some of the problems that beset physicians:

Many of the risk factors for suicide in physicians correspond to risk factors in the general population. Suicide rates have been found to be higher among physicians who are divorced, widowed, or never married. The high-risk physician has been described as driven, competitive, compulsive, individualistic, ambitious, and often a graduate of a high-prestige school. He often has mood swings, a problem with alcohol or other drugs, and sometimes a non- life-threatening but annoying physical illness.

Of course, physicians have very easy access to medication. They also live in a world where all problems are presumably biochemical. Thus, they are more likely to try to solve their problems, even their psychological problems, with medication.

In addition, they are more likely to have consulted with a mental health professional and, perhaps for that reason, more likely to blame themselves for their problems:

 More than one third of the physicians who committed suicide were believed to have had a drug problem at some time in their lives, as opposed to 14% of controls. Another difference was in personality styles. Those in the suicide group were perceived as more likely to be critical of others and of themselves. They also were perceived as more likely to blame themselves for their own illnesses. Of the physicians who committed suicide, 42% had been seeing a mental health professional at the time of death, whereas 7% of controls had.

Ironically, working with a mental health professional seems to greatly increase the risk of suicide.

The report adds that physicians often have a great deal of difficulty forgiving themselves for mistakes. In part, it must have something to do with the influence of malpractice laws, but one suspects that a breakdown in camaraderie also contributes:

Perfectionism may lead to conscientiousness during medical school and to a thorough clinical approach, but it may also breed an unforgiving attitude when mistakes inevitably occur. Fear of medicolegal consequences may exacerbate this distress about clinical errors. Christensen et al conducted in-depth interviews with physicians about the impact of making clinical mistakes. They found physicians experienced great distress over making mistakes. 

It is true that medical training imposes “workaholic standards,” but, as Satel points out, young bankers and lawyers are subjected to the same rigors.

If physicians lack a sense of belonging to a group, of being part of an honorable profession, of enjoying camaraderie with other physicians, clearly this psycho-social factor creates anomie and fosters depression.

One suspects that the same problem exists in other professions, where  people used to be able to work together but where they now believe that they are working against each other.


JP said...

One medical professional around here was kind enough to kill himself in his backyard where his teenage daughter could find him. That was ego and money related, I think. His old group refused to let him back in when his venture failed in another state.

At least the lawyer, who was interviewing in my group some years ago, was kind enough to go to the woods to kill himself (a few days after he interviewed at the firm I was at). In that case it was failure to make partner at a prestigious firm, I think. He had failed at age 35 or so and had been thrown onto the associate scrapheap.

Partnerships are extremely money-focused, in both medicine and law. There really isn't any camaraderie. If you don't make $$$ targets, you will be out the door.

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