What Is Your Cause?

In the suicide research community, I am presently a “nobody” as measured by existing standards of tenured academic appointment, voluminous publications, or abundant extramural funding. Yet, I am fortunate to have published, to have works cited, and to be recognized as a good teacher. Gratifyingly, I have been a forerunning investigator on “my causes” in suicide screening.

Every closely inspected professional and private life has its ups and downs. Even in the twilight of my research career, here is a personal tale, framed in a parable, that may kindle discussion on “your cause” toward continued achievement.

The Tale: David and Goliath

Goliath was a huge warrior. David, a smaller shepherd, volunteered to fight him in single combat. The giant had a deep-seated voice and David observed his askew eyes and bulky nose. David collected several stones for his sling and from a distance circled to the side of his huge adversary. Alas, as Goliath turned his head to center, David stepped swiftly forward and hurled a stone from his sling. The stone struck Goliath in the forehead, a fatal blow.

On autopsy (permit me a fictional liberty), the antagonist, Goliath, revealed an acute epidural hematoma, pituitary mass, acromegaly, and, as a result of chiasmatic pressure, likely peripheral visual field deficits. Hence the tactical advantage worked for the shepherd. That is, observation favored the well-prepared David.

On a serious note, this parable symbolizes the fight of the underdog, standing alone, wisdom from experience in the face of overwhelming odds, and justice for hard work. These lessons apply to every starter and every innovator. Whether in business, literature, or medicine and scientific research, there will be Goliaths that will stand in our way. Yet, we should know that every giant can be “struck in the forehead” and thrashed. To accomplish some meaningful measure of success, to butcher the giant, let me share personal skills I have learned and applied against ruthless odds.

My Cause and Their Self-Righteousness

A future as a surgeon was mine. I was the rightful inheritor of Dr. Kildare’s legacy. I was told that I looked like the actor Richard Chamberlain. I was the golden boy, and William Longmire, MD, and Eugene Stern, MD, at UCLA were together my estimable Dr. Gillespie. Yet, latex anaphylaxis reared its hideous head. The suffocating spasms of a neurosurgical career loss were too great. I lost all rationality. After leaving the departmental office in literal resignation, I was told later that I had walked into city traffic.

Now, the adaptive lifesaving trick, a broader view of the neurological “geste antagoniste,” was to find something, anything with which I had already had some experience, dare I say success, to survive. I believed in the beauty of brain study in health and disease, and I had worked remarkably hard at it for years prior to medical school. There were also the masterworks of antiquity, including those penetrating and sustaining words of Marcus Aurelius in To Himself, today more popularly titled The Meditations. I would take this book up, or lay it down, as a manual of personal commitment and study.

And, in time, I had developed a purpose with resilience and self-control. I needed to understand the potential beauty of entering a consistently dismissed specialty choice. Psychiatry, particularly in the emergency department (ED), now represented this wider research bridge. It also exhibited a discipline with requirements for unflinching strength, unbiased focus, and the possible convergence of observations across neurological and mental health disciplines.

Even so, every starter has had a Goliath in his or her life. “Dr. Copelan, you will grow to be a sad man.” What a dreadful statement from a prominent faculty supervisor during early journal review. In fact, unknown to me at the time, this particular chairman, a man of alleged prominence across town, had also served as my sister’s residency supervising analyst. Whether this represented an accidental or intentional mental health disclosure of my family’s suspected intrapsychic dynamics, it was a uniformly appalling and unscrupulous announcement.

Nevertheless, and happily, my initial research activities in the department aligned with a reputable and principled professor. I was asked to help correlate classical brain anatomy with an evolving imaging technique. Later on, this study advanced to include the impact of explicit ideation and implicit non-ideation dysexecutive states with neurological screening on atypically ED presenting youth and adult cohorts. My small lab research ideas and methods attempted to contribute to the medical literature and the need to reduce suicide in our society. Some of these unique and modest successes gave me confidence to take on bigger challenges.

However, in charting my own course, I have also taken some research Goliaths by surprise. Some prominent academic and research leaders may have paid less heed to me. More likely than not, this led to their failure to recognize some of my published and accessible words, ideas, and models as mine. I have tried to maintain my distance from this intended or unintentional mistake (or misconduct), but I now step forward to assert my tactical advantage, for “I will not lose this doubleheader to the ivory tower establishment.”

Never Give In

As Winston Churchill expressed, “Never give in. Never. Never. Never.” My professional challenges have been great. Yet, I continue to believe that my deep personal requirement to “make shoestring catches of suffering souls” — routinely taking on seemingly impossible cases, sitting for hours at the bedside of resuscitated suicidal patients, and practicing to the height of my licensure and eclectic training — enhanced me and improved my subspecialty.

Fight with implacable doggedness. Demonstrate the miracles of good sense, connected observations, and strong convictions. Maximize your cause, experience, and knowledge. Understand that the same quality that appeared to give Goliath great strength was also the source of not only his complacency and weakness, but your potential advantage.

Russell Copelan, MD (Ret.), lives in Pensacola, Florida. He graduated from Stanford University and UCLA Medical School. He trained in neurosurgery and completed residency and fellowship in emergency department psychiatry. He is a reviewer for Academic Psychiatry and founder of eMed International, an originator and distributor of violence assessments. One of Copelan’s four sons is an EMT/paramedic in Colorado Springs, and his daughter is a Denver-based physician assistant.