A Lonely Place of Dying

Dentistry can be a lonely profession, they don’t put it in the brochures, they don’t even mention it at dental school but we are trained to operate alone, independent and accountable for our work and those who work with us.  We often go straight from the collaborative, supportive, close knit community of dental school to geographically distanced, small independent clinics.

Isolation and loneliness are just two of the stressors dental clinicians face on a daily basis. That these feelings and their consequences are being associated with dentistry may come as a surprise to those outside the profession looking in.

How can we be isolated in a practice full of people?
How can we feel lonely when we’re working one on one with so many people each day?

However, isolation isn’t just a physical distance and feeling lonely isn’t the same as being alone. Unfortunately though, both isolation and loneliness feed into anxiety and depression, increasing the risk of burnout and suicide.  Dentistry has long been a profession associated with a high risk of suicide, although the quality and consistency of research behind this isn’t great.  That said, most of us knew, know or will know of colleagues who take this path and for all of us within the dental profession, the risk is very real regardless of how it compares to others.

Suicide within the dental profession is still very much the elephant in the room. We know it’s happening, a lot of us have a good idea of the causal factors, but if it’s discussed at all, it’s in hushed voices and private conversations behind closed doors.  Nobody wants to talk about it, it makes us uncomfortable, it forces us to look at our own thoughts around this highly emotive topic.  To ask uncomfortable questions of our profession, our values and our culture both at work and within society as a whole.

This poses a serious problem and an unanswered question around the health and safety of our dental professionals at the best of times.  But what about now? The regular causal factors are still in play but escalating stresses and worries that the management of COVID-19 brings are being heaped on us in exponential increments.  Just like the pandemic, there’s a curve to flatten here too.  Only, we’re not trying to prevent health system overwhelm, we’re trying to prevent personal overwhelm, prevent the sources of stress overtaking the strategies we’re putting in place to cope.  It’s like an arms race between resilience and stress, you just catch up with the levels of stress and then it escalates, the stress overtakes you again.

Sources of stress are all around us at the moment. Loss of income, inability to meet financial obligations, uncertainty for days, weeks, months, even years to come.  All those carefully laid out business plans, retirement plans, holidays, courses and career development fading away as this crisis deepens.  There’s guilt, over-thinking and self-analysis plaguing our problem solving minds:

What can I do?
How can I do best by my patients, staff and family?
Which is the best choice out of all the crappy options laid out before me?
How do I reconcile being at home, feeling benched, feeling the distance between our profession and the medical world more acutely than ever?
How can I feel self-worth when it’s implied that my knowledge and training are of no use in this fight?
Will we ever carry out dentistry in the same way again?

We are hard wired to note and perceive threats, a survival thing, but what might catch us off guard is that whilst we’re focussed on the threats in front of us, behind us the rug is being pulled away. Our healthy coping mechanisms are being taken away exercise opportunities, social connections, relaxation classes, easy access to good nutrition, restorative sleep.  We’re being hit from both directions, making the impact all the worse.

It’s not hard to imagine that in a profession haunted by suicide, this might be the tipping point. From coping to not, from being ok to not, from suicide just being a word to it feeling like a reasonable solution.  As stress overwhelms us, it can unravel us, spiralling down into darkest thoughts, darkening your perspective, mood and decision making.  People who accomplish suicide don’t want to die, they just want it to stop and they can’t see any other way.

Suicide is a permanent solution to a temporary problem.
Robin Williams.

But what do we do? How do we flatten our curve?

1.  Reduce the stress, this can be as simple as:

  • limiting exposure to news and social media.
  • Eating as well as you can, minimising processed foods where you can, hydrating fully, reducing caffeine.
  • Avoiding heavy reliance on addictive medications.
  • Make difficult decisions as quickly as you can, procrastination can be a major stressor.
  • Don’t look too far ahead. That might mean just starting with showering, dressing then breakfast, to planning the day to looking at tomorrow.

2.  Increase our resilience, ramp up our coping mechanisms:

  • Be kind to yourself, don’t set unrealistic expectations or goals
  • Create a new routine, particularly meal times and a reasonable bedtime.
  • Tighten up your sleep hygiene. Winding down, screen free time, dark etc.
  • Read, watch or listen to fiction, to stories that take your mind elsewhere.
  • Try a calming technique such as meditation, mindfulness, tapping (EFT), yoga.
  • Keep a journal.  Gratitude or just pouring all your concerns out onto a page and seeing which are within your control and which are not.
  • Keep or plan something to look forward to both now and when we come out on the other side.
  • Connect with people going through the same thing even if it’s just a text.
  • Help others where you can, this will help you with a sense of purpose and satisfaction.
  • Make those immediately around you aware of your struggles, allow them to help.
  • Reach out for professional help.  Medical and psychological.

Most of us are going through something like this for the first time, so go easy on yourself.  No one gets it all right the first time at anything and none of us have to go through this alone.

If you are experiencing suicidal thoughts please contact a mental health professional today:

Get help – New Zealand
Contact the samaritans – UK
Need help – Australia