I had found medical school difficult – I was not a natural academic like so many others in my year – but hoped that my intern year might prove better. I was wrong. Halfway through 1988, I felt overwhelmed with inadequacy. I had a patient die and felt responsible. My consultants and registrars were not exactly glowing in their feedback. My junior doctor colleagues all seemed to be more capable and were thriving. I had an all-pervasive sense of failure, that so many years of struggle at medical school had been a complete waste and that I was little short of dangerous. I could see no way out. Loading So, one night, I made careful plans to kill myself. I won’t go into detail but suffice to say that I stole some supplies from the wards. Incredibly, a work colleague arrived unexpectedly and began knocking on the door of my small hospital unit. That person – I won’t reveal the gender – called: “I know you’re in there.” I will never know what made this person visit me. Perhaps my emotional state wasn’t as well disguised as I thought. Perhaps it was just plain good luck. That impromptu visit saved my life. I won’t pretend I had an epiphany or that I suddenly was better. I did seek help. Rather than put my career, for what it was worth, further in jeopardy by talking to one of my hospital colleagues, I made an appointment with a GP in town. To this day, I remember the GP’s advice: Under no circumstances tell anybody or see a psychiatrist. (I only knew of one in Rockhampton, and was about to become his intern.) If I had a record of suicidality or mental illness, I would never be able to buy income-protection or life insurance, and I would probably never get a good job.

I was bonded to the Royal Australian Navy. What if I was rejected from serving and had to pay back my return-of-service? I couldn’t afford it. What if they were so worried about me jumping overboard that I was banned from the fleet? Steve Robson as a young naval officer. He has revealed that he planned to kill himself when he was a medical intern 30 years ago, hoping to help doctors in mental distress. I tried antidepressant treatment, but I remember it being very unpleasant. The options were more limited 30 years ago. The GP warned me that if anyone found out about prescriptions for antidepressants, I might be in trouble with the Queensland Medical Board, perhaps struck off until I could prove myself. The episode left me with two key messages, both very wrong. First, not thriving as an intern meant I would never be appointed to a training program. Second, seeking help was a sign of weakness, something to be ashamed of and hidden. Today, I am president of my college. I have had a good career. There was light at the end of the long, dark tunnel. I just couldn’t see it at the time.

Today, I am not ashamed of how I felt or what I did 30 years ago. I am ashamed that I have not used my position to advocate more strongly for colleagues in difficult emotional circumstances. I am ashamed that I was embarrassed and ashamed. Doctors commonly are under pressure, are more prone to mental health problems, and often have access to the means of killing themselves. These are occupational hazards. In the same way that pilots are exposed to simulated decompression and hypoxia so they recognise the warning signs, we should recognise the debilitating and potentially lethal effects of psychological decompression. When trainees of the college of which I am president took their own lives, I stayed silent. When a junior doctor took his life while working at the same hospital where I tried the same thing, I stayed silent. When I met Geoff Toogood, I stayed silent. Even after the shock realisation that CrazySocks4Docs day was almost exactly 30 years after I tried to kill myself, I stayed silent. Enough silence. If you feel the way I did 30 years ago, seek help as soon as you can. Who knows where you might end up. Professor Steve Robson is president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and is a member of the Australian Medical Association federal council.

This is an edited version of his article first published in MJA Insight. If this article has raised issues for you, help is available at: Australian Doctors’ Health Network Lifeline on 13 11 14 beyondblue on 1300 224 636