Rise Up And Hear The Bells

My last scheduled blog post didn’t make it to The Daily Grind because, to be honest, I thought I had run out of things I could write about that had any relevance to dentistry. Compared to some of the other AGD bloggers, I don’t feel like I have enough experience to be able to make a wide range of definitive statements on dental education, research, or practice.

A few days ago, a terrible tragedy changed all that. Now, I have something I want to say.

Like so many others around the globe, I am utterly shocked and heartbroken over the loss of Robin Williams. His talent and personality brought so much light, laughter, and inspiration to the world.

If there is any silver lining to the somber cloud that has settled over all of us who mourn his passing, it’s that his death has alerted the public to the very real existence of depression and mental illness in our society, and the very serious need to help those who suffer from these debilitating afflictions.

Many dentists, in some way or another, have been affected by depression. Whether we have personally experienced it ourselves, witnessed its effects on our classmates and colleagues, or treated a patient with a history of mental health issues, I doubt there is one doctor out there who can claim to be untouched by the magnitude of its potentially devastating consequences.

Our day-to-day reality is filled with multiple risk factors for the development of mental instability. Though the widely-circulated myth that dentistry has the highest suicide rate of any profession is still as alive as it is false, the unique stressors of our profession can easily lead to depressive symptoms and can start even before we’ve begun performing treatment on others.

Dental school can be a breeding ground for depression. Take a bunch of highly sensitive people with perfectionist tendencies, saddle them with debt of astronomical proportions, command them to commit an extraordinary amount of information to memory at lightning speed, and have them live in constant fear of expulsion for four years. Now, throw them all together and make them compete with each other as they hustle to execute tasks designed to test their coordination, smarts, and endurance, pitting those who are out for blood and glory against those who just want to survive and go home. It’s “The Hunger Games,” minus a few battle sequences.

This hyper-stressful, freakishly warped bubble of reality that dental students inhabit while training to be doctors can be exceedingly difficult to explain to people outside our profession, which can make our pursuit of an education all the more isolating. When my classmates and I weren’t studying through the night, catching up on sleep, or struggling to remember what the light of day looked like, we were being judged on our ability to shape chunks of wax into anatomically correct dentition, practicing our skills in a mannequin’s head for hours on end, and trying very hard not to unintentionally do irreversible harm to our patients. Now that we’re all practicing dentists, we’re still doing a lot of the same things, with the added bonus of having clients who can actually sue us and/or publicly ruin our reputations on the Internet.

If it sounds like I’m ungrateful for the education I’ve received and the life I live now, I’m not. Even though I hated being in dental school at the time, this profession has given me the gift of some of my most cherished memories, dearest friends, and unforgettable mentors. Now that I’m in practice, I understand the urgency with which my instructors insisted I internalize the information they presented in their lectures because I’m forced to recall their teachings every time I examine a patient, evaluate an FMX, or perform a procedure. I am a better dentist today because of the handful of people who believed in my potential to succeed and pushed me to strive for excellence in the face of self-doubt and adversity.

But as a student, I observed a distressing pattern of behavior that I have come to recognize as a universal problem, both within our field and beyond. I realized that, generally speaking, nobody wants people to know that they are struggling didactically, clinically, or emotionally. Nobody wants their friends to suspect that they feel mentally unfit to bear the weight of their personal challenges and professional obligations. Nobody wants to say, “I need help.” That is, not if someone they know might be close enough to overhear it.

Because on some level, conscious or subconscious, we all understand that within the culture of dentistry—and, by extension, the folly of human nature—lies the instinctive tendency to show more love to those who have it together than those who are falling apart, when it's the latter who need it the most. It's a classic example of how natural selection compels us to gravitate towards the stronger of our species and ostracize the weaker links to drive their less desirable traits into extinction.

Somehow, we have been conditioned to view our flaws as something to be ashamed of. Failure is spoken of in hushed tones. Remediation and academic counseling take place quietly behind closed doors. If we make mistakes, we scramble to cover them up as quickly as possible and pray that no one will ever find out.

Nobody wants a dentist who can't promise total confidence and complete satisfaction 100% of the time. We train ourselves early on to pretend that everything is turning out exactly how we always intended, even when we sense that we may be losing control. Many of us want to be heroes in the eyes of our patients and rock stars in the eyes of our colleagues, because even the slightest hint of weakness makes it a lot harder to earn their business and respect. Ironically, the survival skills we've honed over the years to protect our careers are the very same behaviors that prevent us from seeking help when we find ourselves feeling hopeless, overwhelmed, and alone.

This is a cry for reform, a desperate plea to dental schools and professionals alike to eliminate the stigma of imperfection from our field. We should all work harder to be kinder towards individuals who've stumbled and need help getting back on their feet. Don't just write them off and say, "I can't help this person," or, "It's not my job to make the situation better." Those who are struggling to stay afloat need empathy and friendship. If you see or know of someone who's exhibiting signs of depression or mental illness, reach out to offer them a sympathetic ear and encourage them to speak to a professional. Indifference is more dangerous than you know.

In the study and practice of dentistry, perhaps nothing is more important than understanding our limitations, and that includes recognizing when we or our colleagues are in need of support. We devote so much time and effort to demonstrating altruistic compassion for our patients. Is it too much to ask that we extend the same courtesy to each other and ourselves?

Diana Nguyen, DDS