— And why At the outset, I will state my purpose: I propose to tell briefly of the tribulations of a once-proud doctor who carries with him the deep personal requirement to be a good man. He now needs considerable stiffening to accept that which he cannot change. Although my work as a suicidologist, it must be confessed, does not appeal to the modern mind, for self-murder is dark, merciless, marvelously cruel, and beats individuals and families "into the sword that yields not," it is essential work. But even now, the U.S., caught in the grip of surging, historically high suicide deaths, continues to drag in a pageant of mental health bureaucratic slough to protect inherent financial, administrative, and personal interests. How does this account begin? A medical hereditary succession was common in my family. Although the practice of medicine was suggested to me, in my early dreams, I yearned to be a history teacher. I hoped to remain a gentleman professor all my life. Initially, graduate school in brain anatomy was concocted mainly to give me some uninspired ties with the medical world and recover from a tragically timed, draft excusing abdominal injury. Unsuspectingly, I became indebted to great teachers at Jesus College, Oxford, and Stanford University, both in detail and general discussion, who presented a wealth of learning and stated lofty views of medical history. Remarkably, the early and basic anatomical essentials of the 17th-century neurologist and psychiatrist Thomas Willis suggested possible thesis subject matter. Who could deny his genius descriptions of the anastomotic Circle of Willis, the drawings of Christopher Wren, and the clinical accounts of akathisia? On the recommendation of my graduate advisor, I sat and passed Part I of the medical boards as a graduate student. Afterward, I looked forward to UCLA medical school and a future in neurosurgery with equal certainty. Although carrying a privileged surgical recommendation from William Longmire, MD, in my pocket, a severe latex allergy truncated my neurosurgery career, limited my specialty choices, and led to an inexorable and sorrowful ride into emergency psychiatry residency and fellowship. But, heavens, of all possible choices, why almost the comprehensive opposite of a surgical career? Perhaps the answer rests in a kind soul and a sensitive spirit as a helpful psychiatric training substrate. I received a good education. I found an abiding love of nature and history, and curiously, a deep empathy with personal wanderings and misfortune. Maybe I overidentified with Sir Thomas? Or, simply, I was too proud to ask for help from trusted friends. Or, terribly, a destructive and codified unconscious drive had kindled a deserved and lifeless destructive ride, compounded again and again, into medical oblivion. Or, likely, some combination. The unremitting toil and strife of emergency psychiatry training and practice were demonstrated again and again, where right and wrong were often confused, and evil had many faces. But even here, there were marvelous and glowing achievements and the reawakening of patient courage, and most importantly, physician hope and confidence encouraging self-realization, no longer idiosyncratic wanderings. However, regardless of consolidating self-confidence, first authorship in youth suicidology, a sole annual 24-hour ED call, worldwide implementation of innovative violence assessments, and overcoming the terrible loss of my wife, my three children's mother, detected in my publicly available and conspicuous license background remained a practice misfortune contrasted with attempts to improve myself and the field. A medical board's extrajudicial and extrapunitive pronouncement in 1998 epitomized a perverse blend of the mythical and the hysterical. I had prescribed, wrongly, an opioid to my live-in girlfriend. The board's uninformed and shameful decision and public record proclamation had run amok. It ravaged and plundered my children and painfully separated me from less fortunate and acutely suffering patients yet to be salvaged. This severe experience of direct, salient interpersonal and professional humiliation, for which I alone was responsible, was sufficient to trigger foreign, shocking, yet fleeting and impermanent thoughts of death. Providentially, the balance of my life's resilience to death's proximity was in my favor. Even so, and years later, no ex post facto benefit was extended to me even as the board revised pointedly applicable policies and procedures for practitioners prescribing to those with whom significant emotional relationships exist. A 2017 writ of certiorari to the state's Supreme Court was referred back to the board and dismissed without prejudice. Again, and again, year after dreadful year, I have attempted to research, publish, present, and convey sufficiently the unremitting toll and suffering experienced by our fellow citizens. I have tried to contribute to dimensional rather than categorical suicidal understanding, contract diagnostic inflation, and minimize the glibly held view that suicidal ideation is the standard of care in evaluation. Now, in closing this article, it is well to note that I have grown weary in the work as a non-clinical educational and research suicidologist. However, should this be left to untried and inexpert others, untrained in emergency presentations for the training specialty of emergency room psychiatry no longer exists? "Who now is left to train the trainers?" I am sadly reconciled to the country's insolvability. Its incapacity to change considerably will present a future that does not look bright toward a hopeful comforting of its residents. Yet, it is not quite time for me to go. In the words of Winston Churchill, "If you are going through hell, keep going." Source
