Maintaining professional boundaries with patients also can help you cope. “We don’t want to put so much into our work with our patients that if it goes bad, we get overwhelmingly devastated,” he said. “Finding that middle ground between blurring boundaries and being too detached is something that every mental health professional should do. Distinguishing between clinical and personal failure is critical. I made a decision some time ago that I want to work with people with prominent psychiatric difficulties. We have some difficult patients, but the philosophical and cognitive relief that I give myself when bad things happen is that I say to myself, ‘I chose to work with sick people. Some of them will die of their illness. I’ll save some, but I can’t save them all.’ There’s a natural mortality rate with mood disorders that is related to suicide, just like 5%-10% of anorexics die from anorexia nervosa. That’s the natural mortality rate of the disease.”
Dr. Gitlin ended his presentation by underscoring the importance of establishing support systems in your workplace or teaching institution. For example, he gives lectures to second-year psychiatry residents at UCLA on the topic of psychiatrist reactions to patient suicide, “because I’m giving them the lecture I wish somebody had given me when I was their age. I and others at UCLA make ourselves available to the residents if and when this happens to them.
“Within our field, most training programs do not deal with this issue as forthrightly as they should. It is our job as the grown-ups in the room to make sure that we do it better. We should be talking with the residents early on about it. Every training institution should have a system set up that when it happens, senior residents help junior residents and faculty is available if a resident is really having trouble dealing with it. Some residencies do this well, and others don’t do it at all.”
Dr. Gitlin reported having no financial disclosures.