Smiling Behind The Mask

As a dental hygienist, I know only too well that dentistry is a stressful profession – seeing multiple patients a day (some of whom don’t want to be there) and managing their oral health as well as their expectations can be physically, mentally and emotionally exhausting.

 

Studies show approximately 50% of dental professionals report low levels of happiness and 20% experience thoughts of suicide. Often healthcare professionals are reluctant to seek help for mental health problems. There is still a persistent sigma associated with mental health challenges and dental professionals may fear that seeking help is a sign of weakness or inadequacy. Dentistry demands precision and perfection coupled with the pressure to meet high standards and the fear of falling short may prevent them from acknowledging their own struggles.

 

Fortunately, there has been an increase in awareness in society around mental health and its impact.  A lot of this work is to tackle the stigma associated and to enable and encourage people to seek help, without fear of judgement or embarrassment. 

 

I have had my own struggles with my mental health, and I want to share my story in the hope that it will raise awareness.

Patients and colleagues always comment on my bubbly personality and ‘can do’ cheerful outlook – the latter inherited from a stoic Northumbrian working class upbringing and my Royal Navy days. I’m someone you can depend on, empathetic and a good listener and I like to chat!  I love being a hygienist (even though my dream job was to be a fighter pilot - I blame Top Gun!), I give it my all, but in 2020 life became overwhelming and I cracked.

 

In October 2018 I lost my Mum to alcoholic liver disease three days after her 62^nd birthday.  Three months later I also lost my Dad (my absolute hero) also due to alcohol abuse, he was 63.  Following this period I just shut off and went into autopilot.

 

Bereavement impacts people in different ways. For me, I threw myself into work, treating patients was a welcome distraction and because most of them didn’t know what had happened to me, I could pretend all was normal. I would enter the surgery, put on my ‘pocket smile’ and continue as if I didn’t have a care in the world.

 

I have always portrayed myself as strong and capable to others, I hide behind a mask, dentistry has made me a good actress.  I think as dental professionals we regularly do this.  There’s the expectation for us to always remain professional, to maintain standards and we often put a lot of pressure on ourselves.

 

In the months following my loss, my work life became more challenging.  I found myself becoming irritated and frustrated during appointments. I felt guilty that my waiting list was so long, I took on extra hours to see the patients I had to cancel during the short time I was off work.  I started working 12-hour days which became 14-hour days with the commute.  I kept my pain buried from everyone, even my family and friends.  I started to withdraw, at work I would have short lunches and I stopped attending social occasions as it was becoming increasingly difficult to keep up the façade.

 

As time went on my days became darker, my pocket smile started to fade. I started hating being a hygienist and patients were starting to irritate me.  I felt anxious every day and eventually this led to me vomiting before work on a regular basis.  I was tired all the time, but sleep would not find me.  On my working days I would have to drag myself out of bed, shower and pretend everything was ok.  On my days off I would take my daughter to school and the rest of the day would just pass me by. I would spend hours scrolling on my phone and I couldn’t concentrate on anything for long periods of time.  There were days, I am sad to say, I contemplated taking my own life just to quieten the noise.

 

Things finally came to a head in January 2020. I had, as usual, dragged myself out of bed and carried out my commute to work. I dusted off my 'Oscar' and put on my ‘pocket smile’. My day started with two difficult patients, and I could feel the physical symptoms of stress already. During the opening conversation with my third patient, she simply asked if I was OK as I was not my usual self. I broke down and months of pain started to escape. My heart was rushing, my head was pounding, the world went dark, and I collapsed.  Fortunately, my patient (unbeknown to me at the time) was a retired mental health nurse. I couldn’t have asked for anyone better to be with me at that time.  But what followed was a 9-month absence from work.

 

The hardest part for me was asking for help.  Looking back, I think I had been struggling with my mental health long before bereavement, but my generation didn’t really talk about it.

 

The day after I collapsed, I emailed my GP. I found it easier to write down my feelings than to verbalise them. I felt guilty for taking up his time and was sure he would think I was making a fuss, or I was being a bother, I felt weak and vulnerable. I saw him that same day.  My GP could not believe that I had let myself get so bad.  I was suffering with anxiety, depression and burn out.  After a joint appointment with my GP and the practice mental health nurse I was prescribed Citalopram; an antidepressant and within a week, I had an assessment with the NHS mental health team.

Initially, I went through a period of self-care. I was encouraged to talk about my thoughts and feelings with those close to me, I found this extremely difficult, it was like I had let them down through me being weak.

 

I tried to do things I enjoyed – reading, listening to music and long baths, but I felt guilty every day. I felt lazy and because of this I continued to push myself, which made my recovery difficult and prolonged. I felt permanently exhausted.

 

As part of my recovery, I attended an NHS eight-week stress and anxiety management course. I was so nervous beforehand I almost didn’t attend. After the first session, I cried all the way home as it had made me realise how much I had neglected my mental health. In the following weeks, we used a cognitive behavioural model to understand how thoughts can affect emotions, physical feelings and behaviours. It felt like an epiphany. I knew this would be life changing for me, but I also knew I needed more help.

 

I needed to invest in myself, I was signposted to a fantastic psychotherapist who, without judgement, gave me a safe space to unpick my life, understand my behaviours and process not only my recent trauma but moments in my life that led to my mental health being so poor.  This was one of the best investments I have made! I worked with him for 2 years during which time I was able to reduce and then completely stop taking the antidepressants.

Self-care is important, I learned this the hard way.  Working in dentistry involves a huge amount of emotional labour and we tend to often put others first before ourselves.  In no way are we selfish for putting our needs first. After all you cannot pour from an empty cup. 

 

Feed your mind, do things that bring you joy and help you relax.  Pay attention to your body and act on what it is telling you.  Be kind to yourself, the dialogue we have with ourselves is important, we can often be our own worst enemies and need to learn to treat ourselves like we would a friend or family member.

Evidence suggests there are five steps you can take to improve mental health and wellbeing:

 

1. Connect with other people:

Dentistry at times can be a lonely profession even though we work with people all day.  Take time to build good relationships.  They can help you build a sense of belonging and self-worth, give you an opportunity to share positive experiences and provide emotional support.  Try not to rely on social media alone to build relationships, human connection is important. Go and find your tribe!

 

2. Be physically active:

Being active isn’t only good for your physical health and fitness, evidence also shows it can improve mental wellbeing by raising self-esteem, helping to set goals and challenges and causing chemical changes in the brain which can help to positively change your mood.  Now I am not saying you need to go and join an expensive gym or plan to run a marathon.  Start small, head out for a lunchtime or early evening walk and enjoy your surroundings.  I found that taking part in CrossFit helped, I love the community aspect working with a diverse group of people who support and encourage.

 

3. Learn new skills

Research shows that learning new skills can improve mental wellbeing by boosting self-confidence, helping you a build a sense of purpose and helping you connect with others.  And this most definitely does not have to be professional skills, try taking a cookery class, do some DIY, or try a new hobby.  I created a veg plot at home and found being outdoors and creating something really helped me get back in touch with myself.

 

4. Give to others

Research suggests that the acts of kindness and giving can help improve your mental wellbeing by creating positive feelings and a sense of reward giving you a feeling of self-worth and helping you to connect with others. It doesn’t have to be anything huge, I volunteered once a week packing boxes of food at my local food bank, but it could be something as simple as paying someone a compliment or thanking them for something they have done.

 

5. Pay attention to the present moment (mindfulness).

My biggest lesson was being self-aware, when you are in tune with your mind and your body it is easier to tap into and control feelings and emotions, in my case anxiety.  This has positively changed the way I feel about life and approach challenges.  When I feel anxious, I try and stay present, making sure I think about my breathing and pay attention to my surroundings.  I cannot change my past and can’t control my future.  So, the only thing I can be in charge of is my present.  I take control of my body rather than letting it take control of me.  Just concentrate on the next breath, then the next one, just like walking and putting one foot in front of the other.

I am lucky that I am ready to again take on the challenge of saving the world of dental disease one patient at a time. If anything, I have fresh eyes and a new vigour. My battle will continue. I know that I am not going to feel good every day, but I now know that this is OK. Just because I have one difficult day does not mean I will feel like that forever.

 

It is only when I reached out that I realised how many other people suffer with mental health challenges as we generally don’t talk about it.  In sharing my story, I hope if you identify with it, it gives you hope.  The hardest thing for me was to ask for help.  If you are struggling speak to someone you trust or your GP.

 

For information on mental health and available help:

Mental Health Awareness Week 2024 will take place from 13^th to 19^th May, on the theme of “Movement: Moving more for our mental health”. www.mentalhealth.org.uk

 

Confidental is a confidential listening ear and signposting helpline available 24/7, 365 days a year. Any member of the dental team can call 03339875158 for support and advice.

 

Mental health - NHS (www.nhs.uk)

www.nhs.uk/conditions/stress-anxiety-depression

www.mind.org

www.samaritans.org

 

And don’t forget to tap into support from your employer and our supporting societies too (BDA, BSDHT, BADT, BADN, SBDN, DTA).

 

Please don’t suffer in silence, better days will come.

 

Written by Laura Thompson, Education & Clinical Programmes Co-Ordinator TePe UK.