http://disruptedphysician.com/2014/08/15/robin-williams-melancholy-suicide-hopelessness-helplessness-and-defeat/

Heightened perceptions of defeat and entrapment are known to be powerful predictors of suicide. According to the “Cry of Pain” model people are particularly prone to suicide when life experiences are interpreted as signaling defeat, defined as a sense of a “failed struggle.” Unable to find some sort of resolution to a defeating situation, a sense of entrapment proliferates and the perception of no way out provides the central impetus for ending one’s life.

As in all suicidal tragedies, the role of addiction and mental illness has been posited as the cause. Although depression and substance abuse are the two biggest risk factors for suicide, neither explains completion of the act–the descent from ideation and planning to finality and oblivion. Saying suicide is caused by depression and drugs is like claiming marijuana is a “gateway drug” to heroin. It may be a a common related pre-conditional occurrence but it is not the cause. It is a non sequitur. And just as most marijuana users never develop an inclination to stick an opiate filled needle into their veins, the majority of depressed individuals and substance abusers do not kill themselves. One does not lead to the other…

Attributing suicide to mental illness and substance abuse deflects culpability. It negates the need for further inquiry. It creates an absence of the need to change…

The link between bullying and suicide is well known, especially when combined with entrapment and the feeling there is no way out…

I’ve been bullied by doctors, the medical industry, and insurance companies for 25 years. And I’ve felt trapped, not only by the constant pain, but by the medical industry’s inability to adequately treat it.

But I agree with Pinsky on one point. His comment that addiction and depression can be a deadly combination is true. And this is especially so when treatment of the addiction is the primary focus and consists of imposed 12-step indoctrination and the depression remains untreated or ineffectively treated. That is a deadly combination indeed–and one that can easily lead a person down the road of hopelessness, helplessness, and despair. And it is time the medical field as a whole shined some light on this, and hold addiction medicine to the same standards of conduct and care as the rest of the profession.

And the “addiction medicine and rehabilitation” arm of the medical industry has the same problem as the pain management industry — the treatments they use don’t work.  Oh, but if they fail, then it’s the patient’s fault…

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