This article was originally published in Maclean’s magazine on August 28, 2000. Partner content is not updated.The tragedy of Dr. Suzanne Killinger Johnson focused attention on the darkest side of postpartum depression. It also had specialists pondering an anomalous but all-too-common situation: when a depressed patient is a doctor. At 37, Killinger Johnson appeared to have it all.
Psychiatrist Kills Son, Self
The tragedy of Dr. Suzanne Killinger Johnson focused attention on the darkest side of postpartum depression. It also had specialists pondering an anomalous but all-too-common situation: when a depressed patient is a doctor. At 37, Killinger Johnson appeared to have it all. A physician and psychotherapist who often counselled depressed and suicidal people, she was pretty and fit, with a mortgage-free house and a charming new baby. But none of that mattered the morning of Aug. 11 when, at the start of rush hour, she leaped off a Toronto subway platform into the path of a train, her six-month-old son in her arms. The doctor, for all of her training and expertise, was beyond the reach of the help she offered her own troubled patients. She was in the throes of a severe form of postpartum depression, so depressed she did not want to live. Young Cuyler died instantly. At week's end, Killinger Johnson, the daughter of a medical professor and a psychologist, remained in critical condition in hospital, her devastated family at her side.
Wealth, beauty and professional status offer no insurance against depression. "This type of tragedy could happen to any human being," says Vancouver psychiatrist Michael Myers, who treats only doctors. "But when a physician is depressed, he or she suffers an even greater degree of guilt, shame, failure and the isolation that goes with that." Myers, the incoming president of the Canadian Psychiatric Association, says it's "quite possible" the fact that Killinger Johnson was a physician aggravated her depression. While there are no national statistics on suicide by occupational group, studies show that between 25 and 30 per cent of physicians are likely to experience at least one diagnosed bout of clinical depression, compared to 17 per cent of the general population. But mental illness can be elusive. "There's a joke that the M.D. after our name actually stands for Massive Denial," says Myers. "We diagnose all kinds of things in our patients, but when it's our own stuff, we often just don't see it."
The rigour of medical training sets doctors up to believe they must not falter, says Michael Kaufmann, a Toronto family doctor who runs the Ontario Medical Association's Physician Health Program. "Consider it - lack of sleep, food and exercise, lack of a social life, years of self-denial, putting patients and the acquisition of knowledge and skill first. You don't get through that unless you can act as if everything is okay." It works so well that many doctors continue to wear the mask of indestructibility 24 hours a day. The result: U.S. studies have shown the suicide rate for doctors is higher than that of the general population. Says Myers: "I've had doctors hand over handguns they've smuggled, insulin and potassium chloride they've stolen from the hospital, thinking they'd use it if things got really bad."
Medical associations in every province have programs like the OMA's to help physicians suffering from substance abuse or psychiatric problems. Kaufmann has dealt with about 550 cases since 1995. "But there are 25,000 doctors in Ontario," he says. "If they're not getting help on their own, they're suffering in silence." Most doctors don't even have their own family doctor and try to diagnose themselves.
Many experts say the solution lies in instilling better values in medical school. Innovations like the Pieta (for "compassion") program at Dalhousie University and McMaster University's physician self-awareness program seek to make lifestyle assessment and asking for help part of a medical student's thinking. "Self-care," says Kaufmann, "has to be a core value in medical school, modelled by senior students and faculty members." Myers would like to see an academic study done of suicide in the medical profession. "When a doctor kills himself or herself, there's this information blackout," he says. Killinger Johnson's desperate act proved to be an exception. "I just hope this tragedy will be examined by all of us in the profession," says Myers, "and that we will just keep fighting the stigma."
Maclean's August 28, 2000