Anthony Bourdain’s best known book, Kitchen Confidential, was widely praised for exposing the difficult, often brutal work of chefs and restaurant workers, and the toll the industry took on them. Since his suicide, a small but growing number of people are speaking out about how these conditions are affecting the mental health of restaurant workers. This month, a bartender and a cook in Miami have taken their own lives.

In January of 2016, the food writer Kat Kinsman started the website Chefs With Issues, after observing the restaurant industry had no way of talking about mental health or supporting employees who may be struggling with mental illness. Chefs are expected to “shut up and cook,” said Kinsman, who soon heard from many chefs suffering from depression or anxiety but didn't know what to do about it.

Restaurant work can be a haven for people who have a hard time fitting into mainstream society, and an industry where the formerly incarcerated can find jobs. “There’s a tremendous amount of dignity or inclusion” in restaurant work, said Kinsman. “You become part of this incredible organism. A lot of people find salvation in that. I’ve heard from more than one person who deal with OCD that it’s a really great environment for them because you do this repetitive task perfectly, and it suits your mindset.”

Yet the restaurant environment can also contribute to increased stress, isolation, and destructive behavior. Pay is low, health benefits are rare, and the hours can cut people off from their family and friends. It’s a potentially toxic mix that can contribute to depression and self-harm. “There’s nobody in restaurants who doesn't know somebody who killed themselves,” Kinsman told Gothamist.

Tampa based Chef Greg Baker described how his working hours affected his mental health in an essay for Food and Wine's website

My wife is typically already in bed by the time I’m getting off work. Our dogs are asleep and no good to hang out with. The cats haven’t proven particularly good company. I’m faced with that empty hour that I always hid from: the time between getting off of work and coming down from the adrenaline rush enough to do something normal like eating dinner, maybe watching TV or reading a book. That’s the loneliest time of day for me. I’m completely wired and there’s no one around. And it’s also the best time for those dark thoughts come a-calling….I was getting home later than normal quite frequently and that empty hour was crushingly lonely and desperate for those couple of months. I resorted to drinking heavily on the daily and trying to use social media for any tie to humans who might still be awake, because I was truly terrified to be alone with my thoughts. It had such a handle on me that it almost cost me my life.

A month after Kinsman started the Chefs with Issues website, the French-Swiss chef Benoît Violier committed suicide. His restaurant in Switzerland, Restaurant de l'Hôtel de Ville, earned 3 Michelin stars and was named one of the best in the world. Like Bourdain’s suicide, Violier’s death stunned the restaurant community. Even the pinnacle of success doesn’t protect someone from suicidal thoughts or actions. In fact, achieving and maintaining success can in some cases make things worse.

Elise Kornack experienced it firsthand. In 2013 she opened the Brooklyn restaurant Take Root with her fiancée at the time, now her wife. The restaurant received glowing reviews and Michelin stars and Kornack received three James Beard nominations. She became focused on maintaining the prestige of her restaurant, while ignoring her health, and began suffering panic attacks.

“I pushed myself even further, right into a complete nervous breakdown” she said at the Food on the Edge symposium last December. She closed the restaurant in March of last year, and is now looking to open a new restaurant in the Catskills.

These pressures don’t just affect the head chef or owner, they can trickle down to the rest of the staff. “If the chef is already someone who is in the public eye...the chef’s name is everything. They take their reputation personally and everybody working for them is technically representing them,” said Kornack. “I worked for some chef who took that so personally, when somebody did something wrong.”

This kind of environment can lead to aggression in the kitchen, and even brutality. Kinsman said she heard from chefs and cooks about times when they had gotten punched while working a service. One person told her about getting fingers broken in the kitchen. More than one person told the story of a hazing ritual where a chef would heat up a spoon on a burner, and stick it down the pants of unsuspecting cooks.

Adriana Urbina, the chef at De Maria in Nolita, recalled a time working at a three Michelin starred restaurant in Spain when she brought out a tray of a ham and cheese dish she cooked for the staff's family meal. The chef thought her food was a little too browned, and he spilled it on her face. She was humiliated.

But this cycle of aggression and abuse is slowly changing, with a new guard of chefs and leaders in the restaurant world who are taking workplace culture, and mental health, seriously. Women chefs seem to be leading this change. “When women are just together in an environment where they feel safe, they open up,” said Kornack. Kinsman said she's generally noticed that “kitchens run by women are more emotionally healthy.” And Urbina explained, “With my employees, I want to make sure they are taken care of...I don't want people being miserable.”

High profile chefs, like David Chang and Daniel Patterson, are opening up about their own struggles with mental health. Kornack wants to provide therapy services for all employees at her next restaurant. And the Chefs with Issues Facebook group is providing a forum for people to speak openly. Before the news of Anthony Bourdain’s death, the group had 800 members; it now numbers more than 1,600.

If someone you know exhibits warning signs of suicide: do not leave the person alone; remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt; and call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) or take the person to an emergency room or seek help from a medical or mental health professional.