Physician Suicide: The Role of Hopelessness, Helplessness and Defeat.

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Although no reliable statistics yet exist, anecdotal reports suggest a marked rise inphysician 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.

Perceived Helplessness, Hopelessness, Bullying and Defeat

Perceived helplessness is significantly associated with suicide as is9Hopelessness10,11  Bullying is known to be a predominant trigger for adolescent suicide12-14   One study found that adolescents in custody who were bullied were 9.22 times more likely to attempt suicide than those were not bullied.15

Heightened perceptions of defeat and entrapment are known to be powerful contributors to suicide.16,17

The “Cry of Pain” model 18,19 specifies that people are particularly prone to suicide when life experiences are interpreted as signaling defeat which is defined as a sense of “failed struggle” or loss of social position and resources.. The person is unable to identify an escape from or resolution to a defeating situation, a sense of entrapment proliferates with the perception of no way out, and this provides the central impetus for ending ones life. There is a helplessness and hopelessness that precipitates the descent from ideation, to planning, and then to finality.

Organizational Justice Important Protective Factor

In a study on Italian and Swedish female physicians, degrading experiences and harassment at work were found to be the most powerful independent variables contributing to suicidal thoughts.20 Degrading work experiences harassment, and lack of control over working conditions were found to be associated with suicidal thoughts among Italian and Swedish male university physicians.21

Evidence exists for the role of rescue factors (i.e. social support) as buffers against suicide in the face of varying degrees of life stress.22,23 The study of female physicians revealed meetings to discuss stressful work experiences as a potential protective factor, 20 and support at work when difficulties arose appeared to be a protective factor for the male physicians.21   In line with this, studies of Finnish physicians found that control over one’s work and organizational justice were the most important determinants of work-related wellbeing.24,25 Organizational justice has been identified as a psychosocial predictor of health and wellbeing. 26 27  Low organizational justice has been identified as a notable risk factor for psychological distress and depression.28,29

Historical Precedent-the Suicides at Ridgeview

Could these factors be playing a role in physician suicide?  They evidently did at the Ridgeview Institute, a drug and alcohol treatment program for impaired physicians in Metropolitan Atlanta created by G. Douglas Talbott.

Talbott helped organize and served as past president of the American Society of Addiction Medicine (ASAM) and was a formative figure in the American Medical Association’s (AMA’s) Impaired Physician Program. He has owned and directed a number of treatment facilities for impaired professionals, most recently the Talbott Recovery Campus in Atlanta, one of the preferred referrals for physicians ordered into evaluation and treatment by licensing boards.

After creating the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia, Talbott founded the Georgia Disabled Doctors Program in 1975 in part because “traditional one-month treatment programs are inadequate for disabled doctors.” According to Talbott, rehabilitation programs that evaluate and treat the rest of the population for substance abuse issues are incapable of doing so in doctors as they are unlike others. He bases this uniqueness on “incredibly high denial”, and what he calls the “four MDs,” “M-Deity”, “Massive Denial” “Militant Defensiveness”, and “More Drugs.”30

Contingency Management = Extortion Using Medical License

According to Talbott, “impaired doctors must first acknowledge their addiction and overcome their ‘terminal uniqueness’ before they can deal with a drug or alcohol problem.” “Terminal uniqueness “ is a phrase Talbott uses to describe doctors’ tendency to think they can heal themselves. “M-Deity” refers to doctors “being trained to think they’re God,”31 an unfounded generalization considering the vast diversity of individuals that make up our profession. This attitude, according to some critics, stems from the personal histories of the treatment staff, including Talbott, who are recovering alcoholics and addicts themselves. One such critic was Assistant Surgeon General under C. Everett Koop John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care and “assume every physician suffering from substance abuse is the same lying, stealing, cheating, manipulating individual they were when they had the illness. Certainly some physicians are manipulative, but it’s naïve to label all physicians with these problems.”32

American Society of Addiction Medicine (ASAM) President (1981-1983) LeClair Bissell was also highly critical of Talbott’s approach. Bissell, co-author of the first textbook of ethics for addiction professionals 33 when asked if there was any justification to the claim that doctors are sicker than other people and more vulnerable to addiction replied:

“Well, based on my treatment experience, I think they are less sick and much easier to treat than many other groups. I think one reason for that is that in order to become a physician…one has to have jumped over a great many hurdles. One must pass the exams, survive the screening tests and the interviews, be able to organize oneself well enough to do examinations and so on, and be observed by a good many colleagues along the way. Therefore I think the more grossly psychotic, or sicker, are frequently screened out along the way. The ones we get in treatment are usually people who are less brain-damaged, are still quite capable of learning, are reasonably bright. Not only that, but they are quite well motivated in most cases to hang on to their licenses, the threat of the loss of which is frequently what puts them in treatment in the first place. So are they hard to treat? No! Are they easy patients? Yes! Are they more likely to be addicted than other groups? We don’t know.”34

I’m not much for the bullying that goes along with some of these programs,” Bissell commented to the Atlanta Journal and Constitution in 1987.31

The Constitution did a series of reports after five inpatients committed suicide during a four-year period at Ridgeview.35  In addition there were at least 20 more who had killed themselves over the preceding 12 years after leaving the treatment center.32

Bissell, the recipient of the 1997 Elizabeth Blackwell Award for outstanding contributions to the cause of women and medicine remarked: “When you’ve got them by the license, that’s pretty strong leverage. You shouldn’t have to pound on them so much. You could be asking for trouble.” 31

According to Bissell: “There’s a lot of debate in the field over whether treatment imposed by threats is worthwhile…To a large degree a person has to seek the treatment on his own accord before it will work for him.”31

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,36 and other lawsuits initiated on behalf of suicides were settled out of court.35

The Constitution reported that doctors entered the program under threats of loss of licensure “even when they would prefer treatment that is cheaper and closer to home.” 37

The paper also noted that Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” “licensing boards often seek recommendations from such groups in devising an approved treatment plan,” and those in charge are often “physicians who themselves have successfully completed Ridgeview’s program.”37

The cost of a 28-day program for nonprofessionals at Ridgeview in 1987 was $10,000 while the cost was “higher for those going through impaired-health professionals program,” which lasted months rather than 28 days.32

In 1997 William L. White interviewed Bissell whom he called “one of the pioneers in the treatment of impaired professionals.” The interview was not published until after hear death in 2008 per her request.   Noting her book Alcoholism in the Professions 38 “remains one of the classics in the field”, White asked her when those in the field began to see physicians and other professionals as a special treatment population. She replied:

“When they started making money in alcoholism. As soon as insurance started covering treatment, suddenly you heard that residential treatment was necessary for almost everybody. And since alcoholic docs had tons of money compared to the rest of the public, they not only needed residential treatment, they needed residential treatment in a special treatment facility for many months as opposed to the shorter periods of time that other people needed.”39


Talbott claimed a “92.3 percent recovery rate, according to information compiled from a five-year follow-up survey based on complete abstinence and other treatment.”40

“There is nothing special about a doctor’s alcoholism,” said Bissel

“”These special facilities will tell you that they come up with really wonderful recovery rates. They do. And the reason they do is that any time you can grab a professional person by the license and compel him or her into treatment and force them to cooperate with that treatment and then monitor them for years, you’ll get good outcomes—in the high 80s or low 90s in recovery rates—no matter what else you do.”39

“The ones I think are really the best ones were not specialized. There were other well-known specialty clinics that claimed all the docs they treated got well, which is sheer rot. They harmed a great many people, keeping them for long, unnecessary treatments and seeing to it that they hit their financial bottom for sure: kids being yanked out of college, being forced to sell homes to pay for treatment, and otherwise being blackmailed on the grounds that your husband has a fatal disease. It’s ugly.”39

Stanton Peele’s “In the Belly of the American Society of Addiction Medicine Beast” describes the coercion, bullying, threats and indoctrination that are standard operating procedure in Talbott’s facilities.41 Uncooperative patients, “and this covers a range of sins of commission or omission including offering one’s opinion about one’s treatment,” are “threatened with expulsion and with not being certified-or advocated for with their Boards.”41 The cornerstone of treatment is 12-step spiritual recovery. All new patients are indoctrinated into A.A. and coerced to confess they are addicts or alcoholics. Failure to participate in A.A. and 12-step spirituality means expulsion from the program with the anticipated result being loss of one’s medical license.

Fraud, Malpractice, False Diagnoses and False imprisonment

In May 1999 Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for fraud, malpractice, and the novel claim of false imprisonment.42  The fraud finding required a finding that errors in the diagnosis were intentional. After being accused of excessive prescribing of narcotics to his chronic pain patients, Masters was told by the director of the Florida PHP that he could either surrender his medical license until the allegations were disproved or submit to a four-day evaluation. Masters agreed to the latter, thinking he would have an objective and fair evaluation, but was instead diagnosed as “alcohol dependent” and coerced into the Talbott recovery program. He was forced to stay in the program under threat of his medical license as staff would routinely threaten to report any doctor who questioned any aspect of their diagnosis or treatment to their state medical boards “as being an impaired physician, leaving necessary treatment against medical advice”42  which would mean the loss of his licensure.

However, Masters was not an alcoholic. According to his attorney, Eric. S. Block,  “No one ever accused him of having a problem with alcohol. Not his friends, not his wife, not his seven children, not his fellow doctors, not his employees, not his employers, No one.” 43   He was released 4 months later and forced to sign a five-year “continuing care” contract with the PHP, also under continued threat of his medical license. Talbott faced no professional repercussions and no changes in the treatment protocols were made. Talbott continued to present himself and ASAM as the most qualified advocate for the assessment and treatment of medical professionals for substance abuse and addiction up until his death last year.44

Same System Imposed on Doctors Today—Institutional Injustice Worse due to Laboratory Developed Tests. Fortified Scaffold and Tightened the Noose.

In almost all states today any physician referred for an assessment for substance abuse will be mandated to do so in a facility just like Ridgeview. There is no choice. There is one difference however.   When the Ridgeview suicides occurred the plethora of laboratory developed tests were not yet introduced.

A decade ago Dr. Gregory Skipper introduced the first laboratory developed test for forensic testing and used it on doctors in physician health programs.   These non-FDA approved tests of unknown validity presented a new unpredictable variable into the mix with a positive test necessitating another assessment at an out of state treatment facility—a “PHP-approved” assessment facility. The addition of this laboratory Russian Roulette renders the current system much worse than it was at the time of the Ridgeview suicides.

And if a positive test occurs there are no safeguards protecting the donor. LDTs are unregulated by the FDA. There is no oversight and no one to file a complaint with.

In addition state PHPs have no oversight or regulation.  They police themselves. Medical boards, departments of public health and medical societies provide no oversight.  Accountability is absent.

Moreover they have apparently convinced law enforcement that when it comes to doctors it is a “parochial issue” best handled by the medical community. I have been hearing from doctors all over the country who have tried to report crimes to the local police, the state Attorney General and other law enforcement agencies only to be turned back over to the very perpetrators of the crimes. “He’s a sick doctor, we’ll take care of him.”

The “swift and certain consequences” of this are an effective means of keeping the majority silent.   Likewise doctors have been going to the media only to have the door slammed in their faces because the media has generally bought in to the “impaired” and “disruptive” physician construct these same people developed through propaganda, misinformation and moral panics.

Urgent Need to Admit to the Problem

There has been an increase in physician suicide in the past decade.   By my estimate the numbers are going to be far higher than the oft-cited 400 per year. The speculation as to cause has been unenlightening and in fact frustrating.   Knowledge of anatomy, access to dangerous drugs, increased workload and even student loans have been proposed as contributing factors. Although there has been some tangential mention of physician health programs it has been indirect.

Direct and defined discussion is necessary and state PHPs need to be named as a possible contributor to suicide.  Admitting the possibility there is a problem is the first crucial step in defining and addressing the problem.    The 1980s historical precedent is correlated with physician suicide.  The current system is not only based on Ridgeview but has been fortified in scope and power.  The physician health movement has effectively removed due process from doctors while removing answerability and accountability from themselves.

And they have not only fortified the scaffold but widened it from substance abusing doctors to all doctors. “Potential impairment” and “relapse without use” were introduced without any meaningful resistance and they are now using a panoply of non-FDA approved laboratory developed tests of unknown validity to test for substances of abuse in a zero-tolerance abstinence based monitoring program.

With no regulatory oversight the stage is set not only for error but misuse as witch-pricking devices for punishment and control.  Doctors across the country are complaining of the very same abuses Leonard Masters did–false diagnoses, misdiagnosis, unneeded treatment and fraud.

In summary, any doctor who is referred to their state PHP today is required to have any assessment and treatment at a “PHP-approved” facility based on Ridgeview.  It is mandated.  There is no choice.  Coercion, control and abuse at Ridgeview was associated with multiple suicides in doctors in the 1980s.  

The use of non-FDA approved tests of unknown validity worsens the abuse and fits the “cry of pain” model of hopelessness, helplessness and despair.

Locus of control is  lost.  Organizational justice is absent. The temporal relationship is clear.

Why is this still the elephant in the room?

This needs to be named, defined and openly discussed and debated.  How many more must die before we speak up?

Please help me get the conversation going.  I need allies.

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31 thoughts on “Physician Suicide: The Role of Hopelessness, Helplessness and Defeat.

  1. The “Truth” has been revealed. The PHP has become source of income, unlimited power and control. False diagnosis produced anxiety, hatred of self and others and produces very poor outcomes. We must have a system that also protects us from the recovery centers and special treatment centers. Never allow anyone to be sent to Florida Recovery Center. A narcissistic and angry man named Scott Teitelbaun is the Nazi commander.

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  2. Reblogged this on Knowledge, Essays, Opinions and Curated News for Savvy Doctors … and their Financial Advisors and Business Management Consultants … and commented:
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      • Hi;I did think aboutwhat you posted.Those researchers that you referenceced were dull! We partied at a wonderful wedding in Virginia. What a blowout!So4 generations had fun and it went well and no on was hurt. Why can’t we celebrate! People-get over it! Beth

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      • A Parent’s Perspective on the Need for Pediatric Clinical Research
        By Paul M. Glaser Washington, DC
        …When Larry Moss asked me to address a group of surgeons, my first reaction was what could I possibly tell these men and women who deal with life and death every day-these doctors who have the power to go inside the human body and remove, repair, replace, and restore. I have had my experience with surgeons-one in particular, a plastic surgeon at Boston’s Massachusetts General Hospital by the name of Edgar Holmes. Dr Holmes was a tall, austere man with two sons in the Marines. This no-nonsense Yankee, rebuilt my shattered orbital rim and floor and surrounding fractures. He operated twice, inserting a coil of rubber tubing to support the puzzle of pieces of bone he had put back together. And he fashioned a basket of a face guard out of surgical tape and tongue depressors so I wouldn’t roll onto my face as I tossed about in my morphine-induced sleep. He was a master craftsman, a surgeon who believed in his ability to impact trauma in the human body and make it right. And in my case he did. I wonder about the times when he didn’t. When he couldn’t make a difference. Or when he lost a patient. How did that feel? That moment when, despite all his training, all his faith in the power and possibility of surgery, he failed. The patient failed. Life failed. Then I wonder about his first cut. The first time ever that he put knife to flesh, be it as a boy dissecting a frog, or his first cut in medical school. That moment when the vulnerability of flesh, even his own, for one poignant and irrefutable moment was a visceral experience of his own mortality. That moment when his own vulnerability allowed fear to raise its head, or simply lift the covers and whisper and cause his stomach to turn or tighten, his mouth to dry up, his heart to race. I’ve heard that some pass out, and some throw up. I remember as a boy going hunting and shooting a squirrel with an arrow. I remember picking up the arrow as the squirrel bit and clawed at the wooden shaft that pierced his innards. I remember how that felt. In that moment, I remember the power, the shared vulnerability. I wanted to throw up. Hunter or surgeon, when that moment, big or small, occurred, where did the fear go? How was it defended against? How did Dr Edgar Holmes harden his resolve to wield his scalpel and his knowledge and continue on his quest to remove, repair, replace, and restore? I have to believe that one side of his brain said, “Look what you can do. Look what you can fix, look at this opportunity for mastering not only the body and all its regions, but for mastering the fear.” The promise of control, of the ability to impact the world became a mantra for the mind, for the ego. “I can do, I can control, I can fix, replace, remove, repair. I am causal. I am in control.” There is nothing to fear. And perhaps from that perverse promise, there arose degrees of invulnerability to counter the fear. Maybe from the moment we’re born, the “animal” in us knows at a cellular level the inevitably of death. And the mind, the ego, finds such a lack of control, lack of power an anathema: “What do you mean that I cannot do anything, affect anything about the inevitably of my death?” Therein is all the motivation needed to attach any and all mythologies, thought systems, causal behavior, such as building and owning a world of things and ideas that will afford and buttress the illusion that we are in control. This, it seems to me, is a root condition of mankind’s need to make sense of this life.
        Then I ask myself the question: In the world of medicine, what specialty offers this potential for illusion better than surgery? What offers the opportunity for independence and separation? And mastery in the face of such frailty?
        Recently, I was discussing my thoughts about today’s talk with a good friend and teacher, and we found ourselves remarking on how the September 11 th attack at the World Trade Centers seemed, in the context of all this, like that first incision, that separating of the flesh. On how this intrusion on our virginal shores suddenly rendered us as a nation and as individuals, vulnerable; vulnerable to violence and attack, and most basically, vulnerable to our fear. The mythologies of capitalism and democracy cannot find or create what we all felt was our unique “American ingenuity” to protect us from our fear. We can amass, build, own, control, and police as we have never done before and our fear will not go away. We are too close to each other in this world not to smell our brother’s sweat. As a nation we are experiencing this in a way that we never have before. As individuals, it is no longer possible to turn away, hide our heads in the comforting illusions that have given us a sense of invulnerability, however transitory. Now more than ever before, we are confronted with what to do with this fear that won’t go away.
        I am reminded of my own journey, when, at one point my friend and teacher said that I had a choice in my life. I could acknowledge my fear, forgive myself for my inability to affect anything in my situation, find some compassion for myself in this difficult journey we all share as human beings, and then, by extension, find compassion for others. If I could do that, it would open my heart and help me find my capacity to love while acknowledging my fear. Then, I would not end up a victim. The other choice was to make no choice, to hide and protect myself from the fear, and become a victim, become a bitter old man.

        Liked by 1 person

      • A Parent’s Perspective on the Need for Pediatric Clinical Research
        By Paul M. Glaser Washington, DC
        …When Larry Moss asked me to address a group of surgeons, my first reaction was what could I possibly tell these men and women who deal with life and death every day-these doctors who have the power to go inside the human body and remove, repair, replace, and restore. I have had my experience with surgeons-one in particular, a plastic surgeon at Boston’s Massachusetts General Hospital by the name of Edgar Holmes. Dr Holmes was a tall, austere man with two sons in the Marines. This no-nonsense Yankee, rebuilt my shattered orbital rim and floor and surrounding fractures. He operated twice, inserting a coil of rubber tubing to support the puzzle of pieces of bone he had put back together. And he fashioned a basket of a face guard out of surgical tape and tongue depressors so I wouldn’t roll onto my face as I tossed about in my morphine-induced sleep. He was a master craftsman, a surgeon who believed in his ability to impact trauma in the human body and make it right. And in my case he did. I wonder about the times when he didn’t. When he couldn’t make a difference. Or when he lost a patient. How did that feel? That moment when, despite all his training, all his faith in the power and possibility of surgery, he failed. The patient failed. Life failed. Then I wonder about his first cut. The first time ever that he put knife to flesh, be it as a boy dissecting a frog, or his first cut in medical school. That moment when the vulnerability of flesh, even his own, for one poignant and irrefutable moment was a visceral experience of his own mortality. That moment when his own vulnerability allowed fear to raise its head, or simply lift the covers and whisper and cause his stomach to turn or tighten, his mouth to dry up, his heart to race. I’ve heard that some pass out, and some throw up. I remember as a boy going hunting and shooting a squirrel with an arrow. I remember picking up the arrow as the squirrel bit and clawed at the wooden shaft that pierced his innards. I remember how that felt. In that moment, I remember the power, the shared vulnerability. I wanted to throw up. Hunter or surgeon, when that moment, big or small, occurred, where did the fear go? How was it defended against? How did Dr Edgar Holmes harden his resolve to wield his scalpel and his knowledge and continue on his quest to remove, repair, replace, and restore? I have to believe that one side of his brain said, “Look what you can do. Look what you can fix, look at this opportunity for mastering not only the body and all its regions, but for mastering the fear.” The promise of control, of the ability to impact the world became a mantra for the mind, for the ego. “I can do, I can control, I can fix, replace, remove, repair. I am causal. I am in control.” There is nothing to fear. And perhaps from that perverse promise, there arose degrees of invulnerability to counter the fear. Maybe from the moment we’re born, the “animal” in us knows at a cellular level the inevitably of death. And the mind, the ego, finds such a lack of control, lack of power an anathema: “What do you mean that I cannot do anything, affect anything about the inevitably of my death?” Therein is all the motivation needed to attach any and all mythologies, thought systems, causal behavior, such as building and owning a world of things and ideas that will afford and buttress the illusion that we are in control. This, it seems to me, is a root condition of mankind’s need to make sense of this life.
        Then I ask myself the question: In the world of medicine, what specialty offers this potential for illusion better than surgery? What offers the opportunity for independence and separation? And mastery in the face of such frailty?
        Recently, I was discussing my thoughts about today’s talk with a good friend and teacher, and we found ourselves remarking on how the September 11 th attack at the World Trade Centers seemed, in the context of all this, like that first incision, that separating of the flesh. On how this intrusion on our virginal shores suddenly rendered us as a nation and as individuals, vulnerable; vulnerable to violence and attack, and most basically, vulnerable to our fear. The mythologies of capitalism and democracy cannot find or create what we all felt was our unique “American ingenuity” to protect us from our fear. We can amass, build, own, control, and police as we have never done before and our fear will not go away. We are too close to each other in this world not to smell our brother’s sweat. As a nation we are experiencing this in a way that we never have before. As individuals, it is no longer possible to turn away, hide our heads in the comforting illusions that have given us a sense of invulnerability, however transitory. Now more than ever before, we are confronted with what to do with this fear that won’t go away.
        I am reminded of my own journey, when, at one point my friend and teacher said that I had a choice in my life. I could acknowledge my fear, forgive myself for my inability to affect anything in my situation, find some compassion for myself in this difficult journey we all share as human beings, and then, by extension, find compassion for others. If I could do that, it would open my heart and help me find my capacity to love while acknowledging my fear. Then, I would not end up a victim. The other choice was to make no choice, to hide and protect myself from the fear, and become a victim, become a bitter old man.

        Liked by 2 people

  3. I tend to think there is an element of panic that goes hand-in-hand with many (or maybe all) suicides…one final thing triggers the panic that sets a suicide plan, formulated well in advance of the actual event, into motion.

    Liked by 1 person

  4. Thank for writing this well researched article. Everyone who has read this agreed that this is a serious, but well not well known, abuse of medicine, and a threat to the american doctor.

    Liked by 1 person

  5. I enjoy your work. I think it’s really important and this is a very systemic problem, and the only solution is for these people to get honest and be held accountable. I’m doing something similar now with my experience on notpowerless.com

    Liked by 1 person

    • Thanks Tom, I reviewed your site. I can’t seem to get people to focus any attention on the 12-step facilitators (coercers) which should be the target. It is the same group I am speaking of that is responsible for drug-courts. Both the FSPHP and drug-courts are mandating 12-step on non-addicts by using medicalization and the false dichotomy of punishment vs. treatment. The people behind this are using AA as a business model to support the billion dollar drug and alcohol assessment, treatment and testing industry. It would seem to me that that directly attacking those responsible for 12-step facilitation (both the bad science and conflicts of interest are easy pickings) would be a much easier target and be met with less resistance.

      Like

      • I think when the complaint is raised and people start getting thrown under the bus by these central figures who have no sense of accountability (there is something in it for them personally as narcissists or financially as fraud), change might be made by making sure people are willing to look at 12-step as a source of confusion, and they will get the word out among each other.

        Liked by 1 person

        • Thanks Tom- These groups have access to the levers of power and their use 12-step ideology is to support the business model. They are responsible for “12-step facilitation” which is a euphemism for 12-step coercion and introduced it through criminal justice and PHPs by exploiting medicalization and presenting a false dichotomy of “punishment” and “treatmment. This ostensibly benevolent feel-good argument is persuasive and meets no opposition as how can you argue with the premise of care over confinement or rehabilitation over discipline? Stating that these individuals they want to help are helpless with a “chronic brain disease” who can’t think for themselves they argue that imposing treatment on them is necessary. To do so they have introduced “contingency management” – another euphemism for extortion. If you don’t do this then we take away that. 12-step fits the business model as powerlessness enables them to dictate the terms and abstinence allows them to test for any and all substances and a single slip allows them to assess and treat to prevent an inevitable fall into jails,nstitutions or death. By using 12-step ideology they create lifelong customers and a revolving door of testing, assessment and treatment. The target needs to be them. Remove them from the levers of power and coerced AA is no longer an issue.

          Liked by 1 person

      • It’s especially evident as in my case where ‘punishment’/’treatment’ had nothing to do with any breaking of laws or any wrongdoing on my part. The ‘punishment’ was just emotional blackmail.

        Liked by 1 person

  6. Michael:

    I commend you for your bravery and the effort you put into this very well written and researched article. What caught my eye was how “stress” and “avoidance” are important factors in suicide related deaths of Medical Doctors. It is pretty clear cut that a job that demands such overwhelming responsibility, without genuine, humane support mechanisms and the lack of accountability for the mental health professionals, et al. that couldn’t “think outside the manual” are part of a vicious cycle of business expediency. I am completely ignorant to the workings of the medical industry, but you’ve open my eyes to the horrible underbelly that you expose here. If there is anyway I can support your cause, let me know.

    Like

  7. Excellent overview of how and why the system was created and operates in and within itself and how it’s impossible to complain to outside agencies. (Who, as you wrote, assume the PHP and medical community will help the doctors, not them.) To turn the complaint maker back over the wolves they complained about on the grounds the wolves said “see, we told you they’d complain!” Keep this up, and I’ll be sure to share this wherever I can. Thanks!

    Liked by 1 person

  8. Well articulated description of a very serious problem.
    You are correct in stating that few people understand or are even aware that the problem exists.

    As you know, individuals whose experiences may best be able to demonstrate the flaws in this system can be easily intimidated into silence.

    Liked by 1 person

  9. Excellent, well researched article.

    In regards to suicide. hand-in-hand with entrapment is a sense of impending doom that the victim believes or knows will result from the revelation of something unbearably humiliating. Panic sets in. I believe, once this happens an otherwise stable person can dissociate to the point of carrying out a suicide – an act that otherwise runs so counter to a human’s everyday quest for survival. Once the decision has been made, I think suicide victims run on “auto-pilot” until the plan has been carried out.

    Another comment I want to make is that the perversity of the PHP system is paralleled in state medical boards as well. Doctors are pressured to sign “Consent Agreements” which they know are not correct. Sham investigations are par for the course. Doctors are judged by a motley group of “board members”, who vary greatly in their backgrounds, qualifications, and even choice of careers from state to state. Favoritism and nepotism are rampant.

    In beginning to research some state boards myself, I have found whole casts of characters who remain in the shadows while wielding enormous power and control over the careers of doctors. Some belong to special-interest groups that influence their predisposition or lack thereof towards the doctors who find themselves in the cross-hairs of that member.

    Problematic is the fact that doctors, as a group, are not risk-takers. We didn’t choose to open our own businesses or pursue creative interests. We were driven, but driven to get into what we thought would be the cocoon of ‘doctorhood’ where we could devote our entire focus to helping people. It’s a difficult bunch to get to stand up and take a stance. We will fight the fight though with all who support our cause – including other professions licensed by state boards ( and who get caught up in the mess of PHP’s) and patients who are always shocked to find out that this “stuff” goes on.

    Liked by 1 person

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