The workplace is treacherous at present. From job loss threatened by AI, to scapegoating truth-tellers, to funds being funnelled to the top of corporations while workers can hardly stay afloat in a cost-of-living crisis, it’s too easy for employees to internalize the stress and the injustice. Workers may believe their suffering is a personal defect, rather than recognizing a systemic failure of modern society that benefits the wealthy and abandons workers.
Drawing on the research of trauma expert Dr. Heliana Ramirez, who studies suicides among healthcare workers, we see that it could be life-saving to assess one’s workplace for potential risk factors that negatively impact mental health. Considering that in America “suicide is the second leading cause of death for medical residents in training,” as Ramirez highlights, being proactive about one’s work environment and conditions is a critical safety issue.
When Ramirez notes that suicide for “registered nurses, healthcare support workers, and mental health technicians” is even higher than it is for medical residents and physicians, we realize how necessary it is for employees to be informed and trained to assess dangers to themselves at work.
Ramirez encourages us to reframe extreme work stress and work trauma-related mental “illness” as mental “injury.” Instead of asking what’s wrong with employees, we should ask “how were employees injured at work?” By focusing on the working conditions causing workplace trauma, we identify the source of the injury, which allows us to better protect those at risk.
What to do when the workplace itself is the source of harm
A documentary film led by physicians on the healthcare crisis, Suck it Up, Buttercup, was released this year with a focus on workplace conditions. The documentary does not fault victims. It is laser-focused on occupational hazards: “The U.S. healthcare system is unraveling, burdened by corporate greed, overwhelming bureaucracy, and a work environment that is driving clinicians to exhaustion and patients to harm.”
Ramirez is clear that suicide prevention too often focuses on coping and self-care rather than zoning in on “occupational hazards,” and this is where a gaslighting approach insinuates itself into this extreme crisis. Healthcare employees are misrepresented as failing to utilize employee wellness programs when a suicidal crisis is triggered by moral injury and institutional betrayal. Garrick and Buck (2022) report in “The Psychosocial Impacts of Whistleblower Retaliation” that 50% of whistleblowers who experience retaliation for reporting illegal and unethical behavior in the workplace experience suicidal crisis.
The Suck it Up, Buttercup film removes the gaslighting veil that covers up toxic workplace conditions, and gives voice to those suffering in psychologically unsafe workplaces: “The film lifts the veil on a dangerous dysfunction that has remained hidden for far too long, from unsafe staffing to financial pressures to the moral injury felt by those trying to provide care in a broken system.” When systems are broken at work, it may lead to mental injuries.
Assess whether your workplace has invisible toxins
Imagine a workplace that makes employees ill or leads to their death from asbestos, lead, or carbon monoxide. You can’t see these toxins, but they are dangerous for your health. Would you be safer consulting prevention manuals about coping and self-care? When the source of illness is covered up because it has not been identified, employees’ nervous systems may crash in the freeze trauma response. After attempts to address the problem (i.e., fight) are thwarted and employees are unable to flee the danger of a workplace they sacrificed years of study and exorbitant student loans to afford, they may collapse into suicide. These are the preventable tragedies that drive the physicians’ documentary Suck it Up, Buttercup.
What are some workplace dangers that employees might identify as potentially leading to suicidal crisis? Focusing on healthcare, Ramirez lists institutional risk factors that could activate suicidal crisis that workers can use to assess their own safety:
- hostile patients
- extreme work hours
- collegial bullying
- sleep deprivation
- inadequate resources
- licensure reporting requirements
- understaffing
For women health workers of colour, add these:
- racial battle fatigue
- sexism
Ramirez highlights “[p]hysicians’ culture of ‘medical exceptionalism, medicalization, and individual responsibility’ as sources of burnout. Not only are doctors trained to be ‘self-negating,’ they are ‘stigmatized for disclosing work-related mental injury.’”
Gaslighting Essential Reads
Ramirez notes that “systemic racism” is an additional psychosocial workplace hazard facing clinicians of color. Injury from medical culture can be fatal, as exemplified by Dr. Nakita Mortimer, a Haitian-American anesthesiology resident who died by suicide in 2023. Ramirez notes: “Dr. Mortimer’s death epitomizes occupational demoralization syndrome” which is acquired from what the Association of Black Women Physicians calls the “diseased system for which we work.”
How does gaslighting lead to self-blame?
As documented in my bookThe Gaslit Brain, focused specifically on workplace harm, gaslighting’s insidious trick is to fault the one injured, creating an internal belief that they are mentally weak or unstable. Ramirez and the many physicians involved in Suck It Up, Buttercup expose gaslighting and its dangerous deception. In The Gaslit Brain, two employees who became suicidal noted that they did not even know the term “gaslighting,” let alone the way the behaviour was leading them into possible self-harm. They internalized the psycho-social injuries being done to them, and believed they were to blame.
Documentary film Suck it Up, Buttercup asserts that it “is more than a film. It is a movement calling for transparency, accountability, and a future where healthcare works for the people it was built to serve.” Gaslighting is transparency’s and accountability’s greatest enemy. Gaslighting pulls the veil over unsafe workplaces and occupational hazards, making employees believe their problems are due to mental illness, when in fact, they could be due to mental injury.
Ramirez explains that “systemic suicide prevention is needed at the micro-employee nervous system and macro-employer healthcare system levels with resources that avoid professional barriers to care, increase a sense of safety in one’s body, and reduce isolation and shame.” The final section of her article details brain-informed and nervous system-informed strategies that employees can apply to stay safe and healthy at work.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
