Every now and again you see a report in a newspaper. There was one a few years ago that always comes to mind for me, a seemingly happily married and successful lawyer with three young children who threw herself in front of a tube. I had children of much the same age at the time. There was another similar one, a few years earlier, when a partner in a top City of London practice drowned herself in the Thames shortly after having her third child. I suppose they are the ones that are most easily remembered because of the children – though actually, it is more commonly men who kill themselves. Perhaps the most high profile case recently was John Jones QC, a renowned barrister working in the field of war crimes, extradition and terrorism. A man who had represented Julian Assange in his fight against extradition and who worked with Amal Clooney, but who jumped in front of a train just over a year ago at the age of 48.

We read about them with a combination of feelings – sorrow and pity – for those left behind, with their lives torn apart and forever more coloured by this tragedy; disbelief that someone with so much could actually be in such despair….. and a guilty prurience – wanting to know more – what were the details – what went wrong? The newspapers examine every external detail, seeking clues, giving hints, showing pictures of their lovely big houses and seemingly perfect lives, giving us all a chance to try to peer through the cracks and wonder….

So how could such a highly paid, highly successful, highly qualified professional, living in a multi-million-pound mansion, end up doing such a thing? and so often with little in the way of showing any significant risk prior to the act…..

Work stress

The high levels of work stress are usually identified as being a major factor: long working hours, huge responsibilities, strict deadlines, a competitive, achievement led, goal orientated work culture, lots of peer pressure, and a terrible fear of failure – all putting a strain on one’s psychological well-being while also limiting the time that can be spent with family, friends and on pursuing other hobbies – or doing anything but that all consuming job – the feeling of being trapped on a treadmill, with no way out.

Then comes the personality profiles of some of the people in these sort of professions – an achiever; highly driven, perhaps a perfectionist, but maybe finding it more difficult to tolerate uncertainty than others and, perhaps, unused to lowering their sights when things don’t quite go to plan.

Perhaps there could also be the work culture where one might celebrate successes or meet clients in a pub or for boozy meals, alcohol becoming part of what just happens every day. So maybe that then becomes a tendency to start to self medicate by falling into a bottle when that long and stressful day is finally over, just to relax, just to stop thinking about it. In case you didn’t know, alcohol is a depressant, negatively affecting the quality of sleep and mood and also severely limiting the effectiveness of any antidepressant medication if someone is taking them while still drinking heavily. Sometimes there is also a growing use of other stimulants and relaxants – and perhaps sleeping pills – all taken in increasing quantities, just to keep the show on the road – to keep going – and to hide the problem.

In the end, that is the essential point. The fact that it is hidden – or that they feel that they have to hide it – which is why it is sometimes so hard to pick up the signs that someone is really struggling. That fear of the labelling and the loss of status – and perhaps the income – if they are found out. Mental health and substance misuse problems are seen as a signs of weakness by many, and fear of exposure – and the denial of there really being anything wrong, means that how wrong things really are is not then discovered until….. too late.

It is perhaps unfair to pick out the legal profession. Doctors and dentists are actually more at risk of successfully completing a suicide attempt. We have a much better understanding of how to perform the desperate task; but perhaps there is less interest from the newspapers when there is less money involved so there is less media attention. Actually, the problem is increasingly being recognised by many employers, including the big law firms, and many of them are now putting far greater resources into improving employee well-being – both at work and in personal life. Unfortunately, it just isn’t easy to reach people – especially when you are their employer – and even more so when those at risk are so often in denial themselves.

For many it is partly a cultural problem. It is a lot harder to reach someone who, for instance, has grown up in a society which encourages a rigid control of emotional expression; perhaps where, as children, they learnt that weaknesses would be picked on in their boarding schools and where the pressure to conform and achieve in certain fields – not to cry – not to complain – and not to fail, has been passed on for generations.

Privacy when it’s needed most

I’m glad to say that general attitudes to mental health are slowly changing in society as a whole, and, hopefully, it will continue to grow easier for any of us to admit it when we need help, whatever our background. However, a culture is not something that can be changed easily. Luckily, there are some other reasons to have hope for the future. One of these is the growth of online mental health services such as the one that we provide at Psychiatry-UK.

The discretion and privacy that accessing support over the internet gives as well as the convenience of being able to do so from home, in the evening, or even during a lunch break, means that many who would not otherwise consider taking the step can do so, almost on a whim, knowing that they can easily end a consultation at the press of a button. Some more enlightened employers have the sense to pay to allow their staff to access such services without insisting on receiving information as to who it was and why the employee needs help. Hopefully, the availability of this sort of discreet, independent confidentiality will allow their employees to get the sort of high quality and effective help that they need and which really is there, at the click of a button, before it all gets too much to handle.

 

Dr Wiktor Kulik is a psychiatrist with Psychiatry UK – you can view his profile here.