VETERINARY VIEWER’S COMPANION
By Dave Shuey, LMSW, DMA, RVT(ret.), IndeVets Veterinary Social Worker
The story of suicidality in veterinary medicine parallels the story of other calamities of human experience and suffering. Writing about epilepsy, the neurologist Rajendra Kale describes what might as well be our story’s main themes: “4000 years of ignorance, superstition, and stigma, followed by 100 years of knowledge, superstition, and stigma.” Our profession carries some of the highest suicide risk in the world. And yet we persist in the delusion that burnout, compassion fatigue, suicidality and whatever other disorder labels we can think of signify something wrong with us and not something that happened to us. We are told to do more self-care and seek work-life balance, but the environment that makes us sick stays the same.
People don’t ask to have suicidal thoughts, nor do they always necessarily want to die despite having such thoughts. A common worry that prevents some from seeking help is that too much disclosure could mean involuntary hospitalization. It can also be very scary to ask a loved one or colleague, with caring directness, about these thoughts. We worry that bringing it up can push someone over the edge or increase their risk of self-harm, but people often find relief when they’re able to share their “darker” thoughts freely. This points out the dangers of stigma and superstition, not the thoughts themselves. Thoughts and feelings become dangerous when they stop being mentionable, when they isolate us instead of bringing us together.
I’m watching this film as a dual industry professional. I’ve been a licensed veterinary technician with specialized training in end-of-life care. I have euthanized animals, including my own. I am also a human behavioral health clinician who has worked with hundreds of people with suicidal thoughts, intentions, plans, and attempts in their life history. I have survived the loss of colleagues and clients in both fields to suicide. I have learned, and this film shows, that there is no way to prevent the worst from happening, nor any way to avoid the exposure to suffering as a veterinary or mental health professional. But, where there is caring, trusting connection between people, and the freedom and safety to tell the truth about how we’re feeling, there is comfort in and protection from the abyss of our own self-reflection (represented by the dog in the film). We emerge from the abyss when we have faced it and let it have it’s say, when we have embraced it and heard its questions, and when we have told somebody about it. There is meaning and relief, and the possibility of healing, in shared pain.
A couple of uncomfortable truths about veterinary medicine:
Euthanasia and suicide are linked. Both offer a final answer to the problem of intractable suffering in our animal patients, as well as in ourselves.
Veterinary professionals occupy the unique dual role of healer and executioner. It is natural to expect a higher rate of suicide in our profession, where the intentional taking of life is an essential part of our education and training, training which also contains the ethical principle of Do No Harm.
The moral injury created by this paradox at the heart of a job we want to love can become unbearable. How would you respond? For Claire, it comes down to a simple yes or no answer to the dog’s question, “are you ready?”
As you watch this film, think about the emotional content of Claire’s experience, as we join it in mid-crisis. What price does she pay for her excellence, her long years of experience in her environment? How can she possibly let her guard down without letting her responsibilities down? This will hopefully lead to what I consider the primary takeaway: suicidal thoughts are normal. To paraphrase Mr. Rogers, they are human, so they are mentionable. Claire and her student Joe show us the range of factors that can coalesce into suicidal ideation, in countless moments of realization that there is nothing they can do to change the outcome, or how the clients and patients respond.
This brings us to the second of my takeaways from the film, suicide is mentionable. Consider the critical difference between a direct question, “are you thinking about killing yourself?” and what is simultaneously a plea to spare our own discomfort and an admission of our own superstition, “you’re not thinking of killing yourself, are you?” The latter phrasing increases risk, because it tells the sufferer they shouldn’t be thinking what their thoughts are. It tells the sufferer that we’re too afraid to hear the truth, to sit in the pain with them. It isolates them even more, pushing them further into the place where the only option they can see to make the suffering stop is death. Who are we to tell Claire she shouldn’t be thinking and feeling these things? The moral conflation of the “wrongness” of suicide and the ethics of euthanasia thus becomes clear, demanding us to reconcile them, which is far beyond our capability. There is also another option. We could accept the suffering if we trusted others to share it with, whom we believe are happy we exist. We could ask and answer freely and honestly those questions that superstition makes us shy away from. We could discover that we’re not alone. We could find deep, lasting change in the sharing.
Nevertheless, even if we have done everything right, the “inner dog” will still ask its questions, and someone’s answer will be “yes” where Claire’s was “no.”
The first two takeaways combine to form a third - relationships make the difference. This is the significance of Joe. As a student, the character possesses no seasoned skills or wisdom yet, but he is present. He does not look away. He is the first face that Claire sees on the other side of her crisis. \
A digression: it will be natural for some viewers, especially those with more specialized training (like me) or a professional focus on euthanasia to question certain technical and interpersonal aspects of Claire’s portrayal. To focus on these differences in our experience, to automatically say, “I would have done that differently” is to miss the point, which is that exposure to suffering is suffering. There is no way to remove emotional pain from the practice of veterinary medicine. So let us refrain from holding people responsible for their suffering or thinking that our advanced knowledge and skills make us immune to suffering. Claire and Joe do no more or less than the best they can. We should assume the same about our colleagues.
In the end, it is not about self-care, resilience, skills, specialized training, wellness programs bestowed from the heights of the industry, or even prevention programs. It is only ever about each other. It is about extending and accepting the helping hand, because this profession brings pain, pain is painful, and pain that is shared is pain reduced. Between euthanasia and suicide as final answers to intractable suffering, the powerful, life-saving option that we strive to keep open to all our beloved colleagues is, “I’ve got you.”
Postscript: The Columbia Suicide Severity Rating Scale is a proven approach to learning to connect better with ourselves and the ones we work with and care about. It costs nothing to receive training in its use.
