Op-Ed: The Suicidologist Signs Off

“Discard your misperceptions. Stop being jerked like a puppet. Limit yourself to the present. Understand what happens – to you, to others. Analyze what exists, break it all down: material and cause. Anticipate your final hours. Other people’s mistakes? Leave them to their makers.” — Emperor Marcus Aurelius, The Meditations

I live on a pond. This time of year, I often greet the sunrise by knee paddling across the mirror smooth surface. As I go, my board cuts the undisturbed water. Soft lapping echoes and bird calls awake. Rounding the point to home, small bubbles highlight my return home. This is serenity, total calm, “safe anchorage.” These moments exist. Nature prescribed this.

Yet, as my readers will attest, my journey in medicine has been a titanic contradiction to this peace; a battlefield where some of the fiercest fights have been waged.

I rigorously trained as a graduate student, medical doctor, and emergency department psychiatrist. I committed to an arduous four-decade career and contributed a publication record in peer-reviewed journals where documented results have rationally reduced mortality and contributed to the APA’s DSM-5 advanced suicide definition and the FDA’s “black box” warnings on youth suicidology.

I have enumerated the CDC’s suicide statistic fact sheets to this audience over, and over, and over again. The U.S. adult and youth fact patterns are grim. 50-year U.S. historical highs. A 50% increase in women and 35% increase among occupational populations in the last decade. These awful events cannot be willed away. They cannot be assigned away. The aforementioned dreadful facts cannot be twisted into hopeful outcomes, for facts are the foe of their perceived truth.

So far, has the agenda established by leaders in the field even slightly reduced these tragic deaths across occupational and age groups? No. Again, a resounding and ringing no.

My ability to construct difficult methodology and enroll persons where death was a potential outcome directly confronted and threatened the long-held beliefs of contemporary knowledge in suicidology. Often, my work was considered neither convincing nor understandable. I likely threatened the security, autonomy, and financial interests of the status quo. Debate in science is productive. Communications of spurn, humiliation, and denouncement are not.

I have offered acceptable scientific explanations for my findings. My work is not disingenuous or misleading. I have stated that prediction models in suicidology have made little sense. I have confronted these accepted theories and old laws. I have asked new questions and formulated new hypotheses. I have not pretended to answer questions while not answering them.

How, then, can the field be improved? I would like the reader to know that suicide research and reasonable reductions in lives lost will only improve through the disciplined use of an organized and open system to exchange innovative work and become familiar with it. It will require adequate expertise of psychiatric mentors in emergency psychiatry to become at least acquainted with the literature, devote time and energy to mentees above and beyond normal faculty responsibilities, and indeed, take emergency calls from which the majority of psychiatrists pardon themselves. When approachable and accessible valid and reliable objective evidence and teaching fall through the cracks, or even worse, are intentionally disregarded, dismissed, or minimized, real-person care will tragically suffer.

Perhaps the lofty among us should once again take time to learn to read and to listen. It is about learning vocabulary and understanding it, not describing it. In particular, scientific reading should be approached as a progressive unfolding of the basic introduction to denser, less biased stuff. It is often not easy or entertaining. But the effort is essential. Remain focused. Intellectual honesty gives a firm basis for the smoother execution of thinking, to connect observations, and confirm or redirect life-saving investigations. Research success is the domain of the well-prepared.

What then am I now prepared to do? I will advocate when asked. However, I will no longer write. I can no longer be caught in the crossfire. I will return to the “safe anchorage” and control my experiences and perceptions. I will round the point to home.

Russell Copelan, MD (Ret.), lives in Pensacola, Florida. He graduated from Stanford University and UCLA Medical School. He trained in neurosurgery and completed residency and fellowship in emergency department psychiatry. He is a reviewer for Academic Psychiatry and founder of eMed International Inc., an originator and distributor of violence assessments. One of Copelan’s four sons is an EMT/paramedic in Colorado Springs, and his daughter is a Denver-based physician assistant. Read more of his posts here.