By the time I turned 40, I assumed that I would have had life all figured out. More importantly, I thought that I’d have depression figured out. Because even to this day, despite what I have read, been taught, or been told by my treatment team, I still look at depression as a sign of my own weakness. Within my soul, I feel like it is something I should have control over. And contrary to what I believe, this disease isn’t a weakness. However, just like many other people who are plagued by depression, I can’t quite shake the feeling that, if only I were stronger, I wouldn’t have to struggle the way I do.
A Cycle of Daily Struggle
Depression affects our moods, thinking, and general outlooks, and thus, it would seem that a cure might simply entail a more positive attitude toward life; this couldn’t be further from the truth. Not only does this disease force us into a cycle of struggle as we get through each day, but there is a continued feeling of shame and guilt, as if we don’t have our acts together. Sadly, I am not an exception, as mood disorders in dentistry are found to be almost twice as common as in the general population.1
Depressed dentists can find themselves in a cycle of self-deception and self-deprecation and, most of all, hidden behind tears and screams. Self-loathing has to be concealed, and, as with many other depressed individuals, dentists especially excel at hiding this very secret. To everyone else, we appear as very highly functioning individuals. When we attend classes and go into our offices, we put on masks. We laugh and participate in life, while inside, we are holding back tears and feel like dying. Interactions with colleagues, supervisors, patients, or acquaintances are carefully crafted so no one will ever discover our dark secret. We live in what seems like self-invented chambers of torture, which very few people can understand. As we find ourselves barely walking, others perceive us as lacking in the participation skills for social engagements. This causes even the strongest of friendships to go awry, and then, as that happens, isolation becomes inevitable.
What Predisposes Dentists to Depression?
It is alleged that many personality traits that characterize a “good” dentist are also what predisposes us toward suffering from depression. The majority of dentists are perfectionists who frequently set unrealistic goals of producing textbook-like treatment outcomes in a difficult-to-navigate oral environment. Frustration is triggered when standard-of-care-worthy and clinically acceptable restorations are the norm. Further stress is amassed as our “bread and butter” dentistry begins to be compared in our own minds to lecture-circuit-worthy proofs of workmanship. Comparing ourselves to the speakers on the big stage makes us feel inadequate. It can even make some of us feel like complete failures. Under appropriate circumstances, certain stressors can inspire people to make a greater effort and can lead a dentist to practice at an exceptionally high level. However, more often than not, and along with the overstimulated goals and unrealistic expectations, this can be debilitating for a dentist. Its unending intensity can lead to not only burnout but also depression.
As dentists often practice in isolation, the lack of conversations about unrealistic goals or problematic undertakings further deepens the symptoms of depression. What helps facilitate the isolation is the lack of genuine community among dentists practicing within the same geographic area. There appears to be a form of competition, unfoundedly so, among neighboring general dentists, and this seems to solidify that segregation. Lastly, dentists are no different than other human beings and, thus, are dependent on social approval. Patient interactions quite frequently begin with “No offense, but I hate the dentist,” and “It didn’t hurt until you touched it.” This general sentiment from our patient pools reduces the sense of positive collective endorsement. And, as if those weren’t enough, members of our profession, especially as of late, are fraught with crippling debt from both dental school and undergraduate study.
On a personal level, life has certainly changed in the last few decades. The expectation that we should be all things to all people has become our concentration. We ought to be great spouses and cooks, keep our houses tidy and clean, do homework with our kids, and run them to their various activities. We are under pressure to own a great house and a luxury car and to take elaborate vacations. This stress is immense, and it is self-imposed. It brings about a lack of focus on what we want and what makes us happy. It prevents us from having the ability to rest and rebound as time becomes scarce with us trying to meet the unreasonable errands we set out to do ourselves. It becomes an impossible-to-meet burden.
School and business debt, the lack of social acceptance, the never-ending comparisons, the isolation, the pursuit of unattainable perfection, and our family’s overwhelming routines can all lead to a breakdown in our self-worth and can eventually ignite a mood disorder. Depending on the severity of the negative thinking, the overall condition often needs the intervention of not only a physician or psychiatrist, but maybe also a regimen of medication. And as if nothing can exist without complication, healthcare professionals are less likely to seek care from other medical providers because it is perceived as an embarrassment, perhaps even a weakness of character.
Developing a Different Realization of Life
Life is difficult. The life of a dentist is complicated and still difficult. The life of a depressed dentist is akin to fighting a never-ending war each day, every day, against our thoughts, perceptions, self-esteem, and self-acceptance. The war that our minds wage steals our desire; our energy; and, at worst, our wills to live. I often wonder who could we have become and how far could we have gone if we weren’t always so tired of fighting? If we were to take the energy we spent crying; hoping; praying; self-loathing; bargaining; and, sometimes, sadly, even self-mutilating and put it toward our practices, our patients, and our families, what heights would we have reached? And despite the fact that it may not seem fair, I, for one, have come to realize the most beautiful truth: My life is my own. My grit, my unbeatable strength, and my heavy hand in this fight are my greatest successes. Despite the difficult nature of dental school, dental practice, and dental ownership, I, like many of you, have chosen to stay alive and to keep going, all while depressed. No amount of money, no number of patients, no public speaking engagements, and not even my patients’ photos on a big screen can make my success of having won against this disease count any more.
What Can Be Done?
This realization takes practice and hard work. It takes staying in the moment and practicing gratitude every day. It takes prayer. It takes time, notwithstanding the fact that often—very often—crawling out the depths of our lows needs to be accommodated by medication and, perhaps, therapy. What is missing in the equation is a support that we still need to create in our professional community. Acknowledging and admitting this common problem will help in dispelling shame and the falsity that depression is a weakness. Sharing our stories and relating to one another will lighten the burden when examining our own self-perceived negative identities. We all have to wear a mask in front of our patients, our team members, and sometimes even our families; let’s not wear that mask in front of one another.
In college, I suffered a significant setback on account of my depression. I took some time off. Following my hiatus, I walked back into the university after therapy and multiple medication changes; there were no balloons and there were no streamers, only classmates staring at me. I remember that moment very distinctly; I remember the emotions as raw as ever. I felt ashamed and alone. I felt worthless and humiliated. My peers looked at me like I was a leper; they lined the sides of the hallway as I walked by. And it was that moment that made me decide that my life-long mission would be to bring attention to mental disease and dispel the misinterpretation of it being a flaw or a choice. I have finally grown healthy enough to pursue that mission. I love life. When I am healthy, I can’t wait to live life. And I must force myself to be aware of that, to be grateful for that, and to remember and to count on that. I must find a way to teach that. We all have to remember that it is our lives that are to be envied. Our highs feel so much higher because we’ve known the paralyzing pain when we were at our lowest. Our gratitude for a good day is so much stronger because we can’t afford to take any day for granted, not knowing when it’ll all turn upside down.
CLOSING COMMENTS
So this is it; this is the good news. Here I am standing before you, admitting to “my shortcoming,” as vulnerable as can be, in an effort to make you feel like you’re not alone. Emotions can’t be willed away, and what you’re feeling doesn’t make you delinquent. Just like this is my fight, it’s yours also, and we are stronger for having fought it. Let us stand together, face the world together, and find the courage to be vulnerable together and keep moving forward in dispelling the ugly misrepresentation this disease holds.
Reference
1. ADA Center for Professional Success. Dealing with depression. Accessed April 13, 2020. https://success.ada.org/en/wellness/dealing-with-depression.
Dr. Augustyn earned her DDS degree from the University of Illinois at Chicago. She has also completed the course sequence with the Dawson Academy’s continuum in oral equilibration and cosmetic dentistry. Dr. Augustyn is a general dentist practicing in Elmhurst IL. She lives near Chicago with her husband and daughter. She can be reached via email at maggie.augustyn@gmail.com.
Disclosure: Dr. Augustyn reports no disclosures.
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