‘The Proclivity towards dying’: Rising Trend of Suicide in Medical Students

By Dr. Debanjan Banerjee and Dr. Mayank Rai

It was a warm afternoon on a bright regular day, working in the Psychiatry Out-patient department (OPD). Patients were sparse and I was reasonably satisfied with the ongoing proceedings. After all as a physician you do feel like a fairly useful form of ‘creation’ on this planet. Just as I had gotten over consulting a patient, a young man barged in through the gate and sank in the chair in front, bereft of any formal greetings and salutations. He appeared dishevelled, seemingly exasperated from his own heavy breathing, his hair was a mess, his clothes belying his well-groomed face. It was as if he was spooked by some horror, not a long time back. Without waiting for me even to ask he started.

– “Pardon me sir for my horrible behaviour, but I couldn’t help it!”

– “It is just okay! Please settle down and tell me what brings you here!”

– “Sir, I am a second-year medical student here and for the past some days, I have been fighting off the idea to kill myself. Trust me sir… I am fighting hard! I have tried to kill myself once by severing my veins but the cut was superficial and I survived! I have a recurring impulse to let go of my useless life! I am a failure!”

– “Oh, I see! That must be so difficult! I understand that you are hurt and in quite some pain! Can you please share with me, why you feel useless and a failure!”

– “Sir! In the first place I never wanted to become a doctor! I love football and I was really good at it! But my parents who brought me up on their modest earnings never truly believed in my sporting potential and wanted me to become a doctor so that I could have a secure and respectable life! Though I never wanted the same but begrudgingly I conceded to their wishes and crammed as heavily as possible for my entrance exams and fortunately got through it. So far so good as everybody in my family seemed to be happy and at peace with my achievement!”

– “Okay. But what about you? How did you feel about it?”

– “I almost could not feel anything apart from a sense of relief that my parents would finally relent and just let me be from now on. It was an obligation sir and I had done it! Knowing certainly that I would have to give up on my passion of football now, it was quite a tumultuous phase for me. But I was helpless, my fate had been sealed and deep inside I could feel myself revolting against it! I had to leave behind my family, my friends and my dreams back in my village and come here. I was torn inside having to choose between what I wanted and what my fate offered! But contrary to all sort of imagined dreariness I had in mind when I arrived here, it was going well for me in the initial few months. I gelled well with my colleagues here and even made some good friends. We would hang out, play football, attend picnics together. But after the initial euphoria died down, and the rigours of the unrelenting academics came to the forefront, it all started going downhill!”

– “Please go on.. Academics? Was that difficult for you?”

– “Back in my village school, I used to be a popular guy. Though not a book worm, I was always above average in my studies and I did not lose my sleep over passing those exams. I was always a ‘within top-five type’ person in my class without having to work as hard as some of my peers did. I was also the captain of my football team, a class-monitor and participated often in dramas and theatres when I got the chance. But after coming here I realised that my extra -curricular abilities, my football skills and high spirit counted for nothing. 

Every student wants good grades and to be lauded by the teachers. Most of them are afraid of failure and this means everybody has to be super competitive to the point of running a ‘rat-race’. Then came the semester exams. I used to study fairly regularly to compensate for my extracurriculars but the voluminous course was gaining ground on me. The harder I tried, the more listless I became. It was as if I was trying to run up a steep incline wearing leaden shoes. I had started to sleep odd hours, stopped playing, eat fairly miserly lest it makes me sleepy. And this was all just to pass the exams, not for even buying tickets for the honors and gold medal shows. I felt more isolated and alienated from my friends and family. Even during the holidays I wouldn’t go back home and stay here mostly all alone trying to make sense of all this pandemonium surrounding me. Then as the exams came nearer I lost all my sleep and appetite. I could not sleep at all. Some seniors would give me some sleeping pills to doze off and that would help me intermittently. To dowse all the fire of uncertainties and all that breeding turmoil inside of me, I took to alcohol and cannabis. It was not as if my whole life depended upon them, but then life was much better with them. Then the exam days arrived. I thought that I had done quite enough to pass, but the reports spoke just otherwise. I had failed in two subjects in spite of everything I withstood. 

I always knew life was not supposed to be fair and I did not insist upon it, but fate could go easy on me. Just once in a while honors, it could loosen me from its deathly clasp! The results broke me, rendered me spiritless and left me in a realm of despair and agony. I had not felt so low ever! I never told my parents of my results. They wanted me to come and pay them a visit but I insisted on visiting them later. The truth was I could not face them and look them in the eyes. I had let them down. They would be ashamed of me now! I was not the same bright boy who left his home to study medicine with the promise to return with hope and transcendence. I was ‘supposed to be a Winner! Little they knew that here I was a nobody. I was surrounded by people with better grades, better means at their disposal and conversely of a much better future. I altogether stopped mingling with friends who of course had moved on. They still went around, they still attended parties, they still played football, albeit all without me. I would just stay in my room pretending, just pretending to be alive. Some days if the pain became too much too bear I would bang my head in the wall or cut myself. Then one day I decided to end it all and tried to exsanguinate myself by a deep arterial cut! But despite brewing up all the courage I could only make a superficial cut and needed few stitches to get through. All it added to was guilt and shame! But all those thoughts of killing myself, all that gloom and pain still persist. I do not really want to kill myself, may be. I have to take care of my family and that is why I am really here to seek help. The dream of being a doctor is long gone. Now, all I dream of is to have a human-life. Please help me!”

This conversation is one of the many that we have been accustomed to over the years, but only this time it was with a bloke from our own profession. Of all the years we have been working in different areas, we have seen or heard only a handful of medical students coming forward to seek help for their mental perturbation. So are we ‘medicos’ resistant to any kind of mental ailments compared to rest of the population or do we prefer to suffer in silence and bide our time. What happens to us if we admit to our physical or mental frailties? Do we become lesser of a doctor or a human being? Will admitting to our humanness and afflictions reduce us to mere mortals and break through our God complexes? Will it burn away the cloak of invulnerability that we have conjured up in our minds? Research data suggests that of all the people, doctors themselves are at highest need of physical and mental wellbeing. The suicide rates amongst doctors is much higher (almost thrice) than the rest of the population including other professionals. The rates of completed suicide is also much higher than the rest of population owing to their better knowledge about human anatomy and access to lethal drugs.

So what ails this profession, driving the young and bright bunch to their own dooms? There are more questions than answers here but we are inclined to think that all the answers are not grounded in their personalities itself. The all-demanding  and treacherous nature of the gargantuan academics itself can consume  the best of us. Some fall prey to the highly driven and motivated atmosphere here. Most of these students were ‘somebody’ in their primary and secondary schools but here in medical colleges there are just one of the ‘many like them’. There is no way to stand out of the populace, still there is a constantly felt need to stand out! It strips you of your individuality and renders you a nameless and faceless piece of flesh in the crowd. Just to pass examinations, you have to study out of your skins. sleep and eat less leading to mental exhaustion and the feelings of being left in the lurch without a sense of respite. Next comes the stigma surrounding the admission of your failings to colleagues or superiors. Add to that the rampaging indifference of our own kind towards ourselves and it has created a blind-spot towards our own shortcomings. “What kind of a physician you make if you are not in control of your own mental faculties!” is the biggest myth. Where we speak about de-stigmatizing suicide all around, the deepest of it lies within us!

Unfortunately, there are no prescribed guidelines for treating this self-ignorance of the physicians. Admittance of the ever growing burnout, depression in the medical students will be the first step in the right direction. Next would be to make this course more humane emphasizing on the ‘extra-curricular’ aspects of life as well. That a good doctor can also be a good musician, a good writer or a good artist should be a binding message sent throughout the medical fraternity. More emphasis should be lent on the practical side of medicine rather than core theory. There should be counsellors and mental health care experts looking after the well-being of these ‘healers of tomorrow’. Most important of all, the physicians themselves along with others of the profession should be made aware of their own fallibility and shouldn’t turn a blind eye to one of their own. Mental health training can be an active part of the curriculum. Let the student enjoy the process, rather than be consumed by it! The world looks upon us as their saviours and healers, but we should never overlook  the fact that we are, as Nietzsche, a great philosopher says “human, all too human”!  

Authors:

Dr. Mayank Rai (Psychiatry Resident, Department of Psychiatry, Regional Institute of Medical Sciences (RIMS), Imphal)

Dr. Debanjan Banerjee (M.D. Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru)

Disclaimer: The opinions expressed in this article are the personal opinions of the authors. The facts and opinions appearing in the article do not reflect the views of News Sense and News Sense does not assume any responsibility or liability for the same.