The Productive Dentist Academy Podcast Network. Welcome to the Everyday Practices Dental podcast. I'm Reagan Robertson and my co-host Doctor Chad Johnson. Doctor Maggie Gustin and I are on a mission to share the stories of everyday dentists who generate extraordinary results using practical, proven methods you can take into your own dental practice if you are ready to reclaim your time, so you can focus on great patient care without sacrificing yourself along the way. Buckle up and listen in.
if you're having a horrible day, remember this too shall pass. And I can I have I have really, gained great comfort and a great amount of strength, but just repeating that to myself, you know, because not all cases are and you can't figure all of them out. You just can't. And it can really work on you when you choose this as a profession, because it's like, I'm a doctor, why can't I make this person better, Listeners, before we begin today, I want to give you some listener discretion.
This episode contains sensitive discussions around suicide and mental health. If you are sensitive to any of these topics, please consider tuning into one of our many other episodes that have different topics discussed. I'll give you a second. All right. Today's topic really was born, from, when we unintentionally when we brought on Doctor Maggie as our third podcast co-host.
It was with great intention and care that we invited her to be on our podcast, because we believe in shining a light on a lot of the shadows within dentistry. And that is something that Maggie is known for in the dental world. She has a real passion for shining a light in those dark areas of dentistry, so that we can all benefit and grow together in a positive way. One topic in particular that's particularly sensitive is mental health.
And after we aired her premiere episode, it was 263 of every practices how to bridge Dentistry with humanity. The next day, I received an email. I need a piece of paper to crinkle hair in it. The subject was all knowing and addressed to me. It said, how did you release a podcast about dentists mental well-being? On the exact day a famous oral surgeon would leap out of his high rise to his death? Spooky. But maybe you should have been a day sooner.
To me, when I read that, it was a painful underscore of how much the dental industry at large, and I think people are impacted by mental health struggles and suicide. And not that long after that episode, maybe a couple of weeks. Maggie also penned an article with such courageous and vulnerability, titled The Silence that Nearly Cost Me Everything. Why I didn't reach out Before Attempting suicide twice, and it's on dentistry. TODAY.com will put it in the show notes if you want to read it.
In this powerful and deeply moving personal story, Maggie sheds light on the hidden struggles behind the alarming suicide rates in dentistry and explains why reaching out in moments of darkness can feel nearly impossible. Regularly, Maggie's articles do garner a few thousand impressions and some engagement. She's popular in dentistry. However, this one, shot up pretty quickly to around 20,000 and received, I think, hundreds of engagements, if not thousands. It was quite popular.
Which is a terrible thing to say around such, a sad topic. And we all feel here today that this is such an important topic. We've invited our previous Everyday Practices dental podcast guest doctor Will Corado to join us today to unpack this very heavy topic and shed light so that hopefully, if you or someone you know can feel less isolated and more connected within our industry, that was a lot to unpack, you guys. Doctor Chad Johnson is with us today as well.
Doctor Chad wanted to give you a special shout out. Thank you for, pausing dentists for a bit and and joining us again. Yeah. Glad to be here. Doctor Otto, good to see you again. Thank you. I'm glad to be here also. Maggie. It is my absolute pleasure and honor to, hand this microphone, this virtual microphone over to you, to take it from here, introduce our guest, and kick off this very critical conversation.
Well, I am very honored to once again be sitting in person next to our favorite therapist, doctor Will Corado, who is going to help us, well, manage some of these feelings that we have around suicide. And one of the things that Doctor Corado has taught us and will continue to teach us is this idea that as we continue to shed light about these darkest, darkest parts of us, that light actually ends up being a disinfectant. And, and it helps us heal.
It helps us create a community in which we feel that we are not alone. And that sense of community is extraordinary, nearly healing for us. Suicide rates are not going down. They are going up. And a quick search on Google will show you that they have increased by 37% in just between the year 2000 and 2018, and then they slipped a little bit by about 5% between 2018 and 2020, and they have returned to an all time peak in 2022. And they continue to rise.
And, and we are at a loss at a loss of of words, at a loss for the people who are suffering and, at a loss of people that we have lost and can continue to lose. Doctor Corado why why is this happening? Why are suicide rates increasing? Well, hi, doctor Maggie. You're right, all of those figures are pretty much on the nose. In fact, I drew from, the following main sources myself. The National vital statistics System of the United States, which is a division of the center for Disease Control.
These were numbers published in 2021. Also the National Library of Medicine. Suicide rates for 2020 for the National Institute of Mental Health. Suicide for 2020. Research done by the Boston University, student. Suicide rate, the 2024, as well as my own 22 years or so as a practicing, clinical psychologist in both California and Illinois. Why why why have we seen this in since 2019? Almost in a 33% jump in nationwide suicides?
You know, even if we take out the pandemic numbers, which, you know, has its own kind of feel and reason, set of reasons, it's still an extraordinary spike. And, aside from that small 5% or so drop that, Doctor Maggie spoke of a moment ago. The figures are still soaring. The high. I mean, there's so many reasons. Okay. So many reasons. I mean, the number we can't really even have a discussion about suicide. Must we talk about, the prevalence of, guns in the United States?
Oh, it is still the number one, source reason, cause of suicide is by gun shot by self, inflicted gunshot. And yet, you know, we want to fight that number. But look at look at how many people are buying guns today. More people are buying guns today than any other time. And, you know, thanks to the National Rifle Association, to any of the other, gun lobbies, you know, there's tremendous commercial benefit from a profit.
And yet, when these guns, which are supposedly purchased for self-protection, are turned against the person who bought them and live in the cells, that's a pretty serious issue. How do you control that? And so it is still the number one reason, the number one cause of death, across the board is due to self-inflicted gunshot wounds. With respect to the, health professions, strangely enough, well, let me back up for a moment.
Nationwide, there is a 4 to 1 ratio of males committing more suicide than females. That's nationwide. However, in the health professions, especially at the doctoral level, the last few years have seen a slight increase, of women doctors of all kinds, committing suicide or attempting to commit suicide. This could simply be a function of more women entering into the professional fields, becoming doctors, having practices, and so on.
And with all of the related stressors, and difficulties and the financial commitment, employing people, hiring the right people, having the right, supplies and the licenses and the permits and the legal issues and all of that tremendous amount of stress. In addition to that, you have the expectations of your patients. You know, they want, especially in dentistry. Everybody wants to be beautiful. Everybody wants to have this gleaming, you know, thousand watt platinum white smile.
And, it takes a lot of work and it's a lot of magic, especially in dentistry to do that. So all of these things, kind of conspire, to create an enormous amount of pressure, especially with people in, at the doctor level of health care. Okay. That's just the numbers. That's what it is. Financials. Doctor. Corrado, I have a question. Along those lines, the job market levels of loneliness, which have changed dramatically in this country, even if we factor out, the pandemic.
So, you know, it's, it's a changing world that we're living in. The other factor, especially in health care professionals, is their access to prescription medications, specifically narcotics, barbiturates, anesthesia. Okay. It's that ease of access, in, the health care professions, including, by the way, registered nurses, they're also in that statistic of elevated suicides. So, you know, combining that with, a firearm or any other means of, doing oneself in and, you know, there you have it.
It's like a super boom. It's extraordinary. Can you hear me? Okay, okay. Yeah. Can can you as well. Maggie. Doctor. Corrado. Previously, when we when we've talked, you have mentioned that there are four different types of suicide, which, I was very surprised to to find to find out. Could you, could you tell us what they, what they are? Because I found that to be incredibly fascinating. Sure. It's actually no new news.
It was, from the, this I do this from the Developmental Institute of Singapore. Actually, I was all over the place, but, these, definitions were, dismissed by a Frenchman by the name of Émile Durkheim in 1897. Okay. And he was a dear doctor, you know, what can I tell you? But he said there is, you know that the number one is the ego egoistic. Suicide. And that's from feelings of isolation, from, society. And It went on from there. Okay. Feelings of suicide from society. I'm sorry.
I mean, in our time reading this. The second, form of suicide is the altruistic. And that's sacrifice life to fulfill the obligation of a group, or club. Because kamikazes, for instance, the suicide bombers, you know, people who have, an issue or a public, a political issue just to put forward. The third is can excuse me, is, anomic suicide. And this is, when there's a breakdown of social norms and values, that, kind of diminish a person's purpose in life.
Okay. We're seeing this now, in the overarching themes, we're struggling with in our society, the dereliction of duty of public officials, the deception involved in political campaigning, the cheating, the lying, the outright deception, the, alternative views or alternative facts. It's becoming crazier and crazier and it's taking on a life of its own. And then we have the fatalistic suicide.
And these are individuals who are, overwhelmed when placed under conditions of extreme rules and high expectations. I kind of think that, that's probably the hot button for the dental profession in the health profession. It pretty much sets the seal. Wow. Chad, did you have a question in there? Yeah. So, Doctor Corrado, my question was, and it's almost, you know, a secondary issue to our practitioners. But, do you think as well that, there could be a spike in suicides from veterans issues?
I mean, I think the I think the answer is probably yes, but the question is how much does it play into that 37%? But when I saw 2000 to 2018, I'm just thinking after, you know, nine, 11 2001, you know, like that that was, you know, a probably an increase to women in the military, you know, like that's increased. And, and so that would play on both sides of the genders. Possibly. Yes. And then regen along those lines. That was just a side question. Regen. You had a question about medications.
I think this is absolutely fascinating. And I really love doctor Will how you broke down the four different areas of suicidality and kind of the, the triggers that can that can push it, especially that like you said, that last one of of the overwhelming pressures. And I think health care by and large has overwhelming pressures placed on it, especially in the United States.
I can't speak for the world, but but what I've heard editorially, I was I was wondering and over here, ChatGPT on this side, we see in my family, we watch TV at night, and I always see the ads and it's we always make jokes about the it's it's a pharmaceutical ad and it's always what the side effects are. We see more and more that say suicidality specifically that term, which I don't think I'd ever even heard before, or thoughts of suicide is a potential side effects.
And I noticed that SSRI, which is antidepressant medication, which has that known side effect, not necessarily common, but that has shot through the roof as well. So I know we're doing a little bit of science in here in a very dirty way, which scientists would be immediately offended at me. But I'm not necessarily saying correlation, but I'm trying to paint a picture. If you're nodding well, that sounds like that's something that you've heard of that that could contribute to it.
It sounds like a complex web with lots of different factors playing it here. The factor that stands in relief most, the one that's probably the thing that we need to be the most careful about is, when a person gets a prescription for an antidepressant to an SSRI, the selective serotonin reuptake inhibitors.
But we have to be careful of is if a person has been, first of all, in order to have a diagnosis of, depression, and a severe depression that you have to, have symptoms for at least two weeks, and they're unabated. Okay. Loss of, hope, helplessness, hopelessness. Feeling like you're in a hole, feeling as if you have no agency over yourself. Almost as if you can't breathe. A, and hiddenness Donia is is a big factor.
That's a fancy word for that not being able to feel joy or any kind of happiness, even with activities that once provided you with such, feelings. So all of that can create quite a deep hole. And what the SS our eyes do, of course, is that they, they assist in enhancing, one of the, neurotransmitters that is, responsible for us being happy, actually, two, it would be, serotonin and dopamine.
So what happens is, if a person has been depressed for a while and they go in and they get a prescription for an SSRI by the physician, what can happen and what has happened in the past? The reason, the reason why we have new guidelines on prescribing is that after a short period of time, somebody taking one of these medications can feel such a relief of symptomatology that it it becomes it evolves into almost a manic state.
In other words, there's such a dramatic sense of relief and a lifting of these symptoms, especially inertia, lack of energy, you know, sleepiness, wanting to go to bed, not wanting to really be up and doing anything because you get your motivation back. A number of people who were planning on suicide now have the energy to carry it out. And so that's the the one big area that we've got to be very careful about. And, you know, I would I would spread the word about this.
It's the reason, for instance, where we have new instructions on prescriptions for young people, especially those 18 and under, for any SSRI, most often they are prescribed not only half of the recommended, therapeutic dose in order to just titrate the experience, to watch them, observe them and make certain that they don't, step into kind of a manic recovery phase and then act on something that they, you know, had planned on acting on but didn't have the energy.
It's just absolutely fascinating to me the seriousness of that, because at the time, it was editorial that my family and I were seeing it on TV and I thought, how can how can an antidepressant have a side effect of that or, you know, make that that makes sense now, like it puts context around it. Call your health care provider if you have that. I mean, it's to me, it blows my mind. I mean, it is it's it's incredible.
And at the same time, concerning to see such an, a stark increase in usage since, since, you know, the pandemic as well. Yeah. So Doctor Corrado. Yeah. Secondary to Regan's point, I saw something that said the United States and New Zealand are the only two countries that allow for manufacturers to market prescription drugs, to the public on television and whatnot. And you can decline to comment, but would you be in favor of a policy that that either limited or eliminated that?
Well, I mean, I, I actually think it's, it's for the highest good of all concern to be informed about it. You know, why not why not know about that, nuance? Because, you know, somebody aside from a prescribing physician might catch it, before them even, you know, people make mistakes. Sure. So, I think just kind of having that awareness. Okay. So, I mean, I start my son or my daughter on an antidepressant and they're young.
And by the way, what is the normal dosage and what dosage are they being given as a beginning? Their therapy with this medicine. And so, if you can just pay attention to that. And, and now, for all intents and purposes, everybody should really start out of that instead of that half of the prescribed, the recommended prescribed therapeutic dose and you can always build on it. You know, it takes a while for some of these medicines to actually kind of, get traction.
Body has to kind of recognize what it is, what's going on, where to put it, and and then how to metabolize it. So that's why these pesky side effects, as they say, usually diminish after the first couple weeks of, of taking the medicine. But if we back it up even before then, the number one thing that we have to rule out before we look at any kind of therapy, whether it be pharmacy or psychotherapy, is, checking a person's thyroid rates. Okay. It's the number one lab, that needs to be, done.
It needs to be drawn in order to rule out that it isn't from, a malfunction scanning thyroid, the depression that it is, because, when we don't have enough thyroid, of course, we become lethargic. We become inattentive. We want to sleep. We want to, eat more, we want to not exercise, etc.. Yeah. So regarding, mental health or the stigma of mental illness, you know, as, as people through the years have called it, various things for practitioners is are thoughts of suicide common?
I mean, is this a listener, you know, that's listening to this podcast right now and might be thinking, I mean, am I alone in this or is this, prevalent? You know, how do I know that not only that there's help for me, but that there's, other people that might be experiencing what I'm experiencing? And when is it? When is it too much? I mean, you know, just, you know, have a bad day. And I heard you explain.
I want you to hear I heard you say, you know, if it's more than two weeks and the hopelessness. So I was listening. But, like, does someone, you know, like, at some point just go, man, I've had a bad day to I've had a bad week to. Oh my goodness, I've had 104 bad weeks. It's like two years now you know. Yeah. Clinically and legally what we have to pay attention to is at least two weeks.
But all of those other conditions certainly could be present, you know, all of these other reasons, could, could in fact be there. I think, you know, if a person is crying every day, if they are feeling helpless, feeling hopeless, feeling as if, I isolation is a big, piece of the picture. Also, tell me about that. What does that mean about the isolation?
A lot of that has to do with feeling toxic, because you have these thoughts about maybe wanting to end your life, feeling that you will never be understood, that somehow you are defective. That you have some deep character or logical disorder. You know, that would make you want to think of doing something like that. As a matter of fact, suicidal ideation happens to pretty much everybody. There's two distinct. There's one differential, I should say one big one. There's passive suicidal ideation.
That's. Oh, God, I wish I could just die. I could just if I could just not wake up tomorrow, that'd be so great. Okay, how many of us and how many times a day do we do that? Come on. You know, it's the scourge of, modern man, right? It's like, oh, God. Not another thing. Sure, but, when we start to develop a plan, doctor Chad, that's when we've got to see the flags go up right away. The means. How are we going to do it?
And the more elaborate the plan is, the more, obviously the more suicidal ideation there is, but it's the more likely it's going to be successful and they're going to carry it out. So is that in your armamentarium of questions?
When someone were to say, you know, I've been thinking about this and, you know, at some point for the right person, I'm not trying to give away your trade secrets and all this or make it prescriptive, but is that a question that you'd ask is tell me more about, you know, like how you've thought this through at or if you have at all. I mean, is that is that kind of where you would go with that? Oh, sure. Up. Open it up, open it up, open it up.
As Victor Maggie said a moment ago, light is the greatest, of all antiseptics. Right. And so you just want to open that up so that it's no longer this kind of, lonely and, and, encapsulated kind of thought loop that's going around and around and this one in a patient's head. Right. Once you break that open and share it with somebody, just the act of sharing it with somebody who is a psychotherapist, a psychologist, a health, mental health professional, that's opening a window.
Okay. That's opening a window for oxygen and air. And that is the very beginning of the possibility, the potential for, significant, internally decreasing, ameliorating, suicidality. People likely to share that? Yeah. Bring it on over. Are people likely to share that? Like, if someone is really serious about committing suicide and they're seeing and they're seeing a therapist that they're really serious about committing suicide. Would they share their plan with some. Nobody else.
Or would they, would they, would they keep it secret so that they could actually carry it out. So that's, that's a not that is it's a difficult question to address because you could only hope that your skills as a mental health practitioner are, developed enough so that you can suss out the nuances and, get the client to trust you enough to open up about that, Because, I mean, that is a big, big burden to be caring on one's own.
And so once it is broached, once, the person takes that leap of faith it to, to play some trust in another human being and this time being a mental health professional. You know, you're going to increase hope for averting suicide significantly. However, Doctor Augustine's, question, I think, goes to, the fact that approximately 50 to 55% of all suicides, are never talked about. Nobody knows about them. They happen just within the moment.
Just one of those moments where despair takes over and the means are there to do it, and you just do it. So it's kind of scary to realize, you know, you never know. There's a bumper sticker. You never know what somebody else is going through, that person in front of you that you're honking at might have just lost their mother or father or child or, you know, gotten that horrible diagnosis at a doctor's office, you know, or lost their job or face some kind of, catastrophic loss.
So you want to just kind of, go easily, step easily, be gentle. You never know. You never know what's going on with somebody. I, I can't speak to that because in my experiences, there's times that depression would be present and there would be moments where I mean, within and I had people ask me about that fairly frequently. Where how do you not? Well, I mean, at noon you could be totally fine.
And then by 1230 you are driving down the street and then there's some force within you that where you've lost hope and you're ready to to drive your car into a pole. And it happens very violently and it happens very quickly. And as much as I've been dealing with this my entire life, I can't always predict when those thoughts will happen.
And if and if you are living through your first severe depression that is, that has suicidal ideation as a part of it, this just takes over and it's I, I don't I almost don't know how to combat. I remember when I was young and this was my first time dealing with it. I was 21, this was around of my first suicide attempt, and I was fantasizing about suicide every single day. I would be running red lights all the time just praying somebody would hit me. Nope.
Nobody did. I mean, but but you make these decisions. You they come out of nowhere. You're just. Did these thoughts take over? You lose hope, and you just pray for it all to end. So, so, so this is, I think, where that 50%. There is no plan. There is no plan. And there's been there's been no warning. There's, you know, no loved one could have picked it up either, because it's just so in the moment. It's just a very unfortunate statistic.
This makes a lot of sense with the what I've seen on TikTok a lot lately. There's this trend of this is what suicide looks like. And it was, you know, someone happily dancing or, you know, a video of someone having a great time. And they said, you know, less than two hours later, this person was gone.
And and it helps just to hear you say that Maggie helps me at least put some context around, what could potentially have been going through the mind of like, say, Chris Cornell or Anthony Bourdain? So many celebrity people or even people that I know and love, how fast the tides can turn. And even without your own cognizant like awareness to that. And and that to me is, shedding light makes things less scary. And I and I so I'm, I'm grateful to have that, you know, that knowledge.
But what do you. I don't know, Maggie. You have a thought around this? You have a question. You're you're the first person here. So, Doctor Corrado, and this is a question that actually someone from the audience that I don't know, send me a message about, because, you know, someone, one of her friends, they were. It was late at night. They had a few drinks. She came to her. She said, you know, I have moments where I want to take my own life. They talked about it for for, for a moment.
The next day she she basically said, I take it back. Yeah, I, I, I forget I said that I, I didn't mean it. When, when do you take these words seriously? When someone says it. And how do you react if somebody comes back and says, oh, I take it back. How do you what do you do? How do you know when to seek help for someone that you might love? Rule number one always take it seriously. Always. That's that's your, you know, kind of the soft landing, right?
You just you want to make certain that you hear somebody and listen to it and then act on it, you know? And then you you start moving forward with any kind of therapeutic modality. You can most importantly, for instance, are these hotlines, you know, why do we have these hotlines? Right?
It's the government have these hotlines because human contact, talking to another person, just not being stuck in your own noggin, you know, with these loops, these, these suicidal, thought loops that just keep going around and unless they're broken, unless that it's like a pain pattern, it has to be broken in order for them to reconfigure and let those neurons go. So, doctor, corado along those lines, I mean, I'm, I'm trying to relate, you know, to this, but not everyone can.
I think that's fair to say. You know, that some listeners might be like, I don't get that. And that's that's great. I mean, you know, but I do identify I was in a burn accident in late 2016, and I would wake up and it was like kind of a PTSD kind of thing where I would wake up, was I awake in my dream? I was, I would, I would be in the fire and I would get out of the fire. And then, like, I would turn around and I'd be back in the fire. So it was like this loop that you were talking about.
And so that was the thing is, like, I think my mind was trying to process like, how did I get out? And, you know, like, how did I make it? Like my mind was trying to work on it, but like, my sanity figured very reason why we have those loops. We're trying to replay it in order to master it in order to figure it out. So there's really there's a lot of, merit, you know, it's it's it's kind of a decent thing to do when you think of it, you know, want to figure it out, you know.
Yeah. Well, and good thing on the lightest level, I mean my PTSD from that, that was temporary for a few months. Couldn't hold a candle to, you know, people with, you know, really deep stuff that, you know, war time stuff, you know, deep stuff, you know, it's you burn doctor. Did you. Yeah. So yeah, it was a gasoline fire.
And so when I was in the brush pile for that, like, I'd have these dreams and I. But like, I, I thought I was waking up, but then I turn around and I'd be back in it and the I also think because of that fire, like the dopamine rush from that happening, I mean, it's actually quite sensational on a physiological level. Afterwards, there were a few months where I'm like, why in the world in my truck? Like, why am I driving this fast down this country road?
And I would just be just Boston down the road and I'd be like, why? Why am I doing this? And I don't know, I mean, I don't know, like I'll just preface by saying I don't think I, I don't think I really ever talk to anyone except casually about this, but that I don't know why I was driving that fast until I realized I mean, I wonder if this is survivor's guilt or something along those lines where I'm just like, but oh.
I also wondered if it was physiologic that I, that I was like almost craving that rush again and driving. So I forgive me, doctor said, driving so fast in the dream. No, in real life afterwards, after the accident. And yes. And there were there were a couple other examples, but that's the most tangible one that I can recall where I'd be like, why am I doing this? Like, it doesn't rationally make sense, but I'm like, I don't know why I couldn't or shouldn't.
I mean, like, because what I was also trying to weigh out was, I mean, I could have died then, right? So like, I there was part of me that was just like, you know, trying to weigh out the what's it matter? Yeah. And, after a while, like that becomes exhausting. Yeah. And so, like, I kind of identify in some regard because I don't think that was like it had it come to fruition that it was, serious yet, but at the same time, sometimes I'd be like, what am I doing? And I'm like, I don't know.
But like this existential kind of like, what's it matter? You know, that was really weird. But I can identify with that. You were talking about the loops and the patterns, and I kind of just wanted throw that out there.
Now, most people aren't going to be able to identify with me saying that, because it's not like a lot of people have, you know, burn accidents that severe, but in our own ways, hopefully today, Maggie, you know, like we would that we can identify, you know, that there are times when we've, felt those human thoughts and that even though it didn't come as far as other people went with it, that I can be like, no, I as a human to identify that,
that I've had those struggles and feelings and that, you know, talking it through, though admittedly, I did not, you know, except to my wife, like, I'm having these feelings like, and and it was just weird, you know, but like, that hopefully that helps people know that it's common, you know, like, we all go through junk and then you're processing. How do you make it happen? I'll stop rambling, doctor. Corrado, your thoughts without, coming to a full diagnosis of me within 20s.
Like your brain probably already did. So. No, that I really. But I do have a few thoughts. And that is, you know, driving fast, and pushing it is actually considered to be a form of passive suicidal. Yes. Eating out. Yes. It's the exhilaration and it's wanting to feel that relief. It's just yes, it is about the dopamine. Yes, certainly a piece of it.
And so, there is that kind of, reaching for that euphoria, The euphoria of taking flight or of everything just ending being released from the pain, You know, a person with, you know, could feel the the gun in their mouth, you know, the pain. Yeah. The desire to. Just because all of this hurts so much to just have it blown away would be such a relief. Because then that bad part would be gone, and we'd be free of our pain and our, you know, the horror, the the torment, which is depression.
Depression is is a it is a it's a cruel disease is what it is. It's really cruel because a lot of it is tied up in, revisiting unearned guilt and taking on responsibility for things that really weren't our fault. But, there is this mechanism in the human psyche to just to be destructive, you know, the catalyst that the death wish, it's just there, you know, and we just have to learn to shine light on that, too, and realize that suicide. There was what was that?
Sticker suicide is a permanent solution to a temporary problem. You know, say that a lot. The one thing that I, I say to myself a lot when I'm having a really hard time, you know, I think of that story from the Bible of, the ring that was given to, King Solomon. He was presented with a ring by another, king, and and the ring was inscribed on one side in Hebrew. This too shall pass. And when he was given the ring, he was instructed by the person who gave it to him, saying, you know, Solomon.
Every once in a while I want you to turn that ring around. One entire revolution or half way to see the other side of the ring and the inscription. And the other said, the ring is this too shall pass. You okay? So it marks next year. We're having a great day. This too shall pass. Remember it. And and just know that they're not all going to be like that. And if you're having a horrible day, remember this too shall pass.
And I can I have I have really, gained great comfort and a great amount of strength, but just repeating that to myself, you know, because not all cases are and you can't figure all of them out. You just can't. And it can really work on you when you choose this as a profession, because it's like, I'm the doctor. Why can't I make this person better, you know? So I try to fight bipolar disorder, which is almost entirely it's biomedical. It's physiological.
You can't there's no this is all about the influx of, hormones and neuronal loops in the body. And they can change, dramatically and precipitously, inside of minutes. And the person can become euphoric or profoundly depressed, you know, we don't know which way it goes. It's just fluctuate. That's why there's so much hope. We've now identified about 40 biological markers alone for bipolar disorder. Biological genetic markers. I mean, that's that's incredible.
And by the way, bipolar disorder is has the highest rate of concordance than any other, mental, illness. Explain what that means to you. That means that if you're, if you're a identical twin, identical twins, if one of them has bipolar disorder, there's a 50% chance that the other one will also have the disorder.
Okay, so the very, very big genetic, the highest level of concordance in any of the other known mental disorders, especially those affecting mood, you know, so we have we have no hand in it. This is largely a genetic endowment. This is just kind of like what we get. And you do the very best with what you get. You know. And so, you know, as we continue to struggle, I know for me, I continue to feel shame around mental illness and I don't think I do. I was just saying my psychiatry just last week.
And my question to her is, why can't I just get off this medicine? And she looked at me and she's like, why do you still feel ashamed? Yeah, yeah. And I'm like, what are you talking about? I don't feel since like your question tells me everything. Absolutely. Why are you still ashamed? Why why do you seek to get off this medicine? You know, and, even though I built a community around it, I have tremendous support in my husband and.
And, that there's still something about mental illness that makes me being completely aware of what it is. It makes me feel like I am less than. Like I am a weaker, defective and unloved, unlovable.
Right. And I, I've worked for the last 30 years with therapists and medicine to get over it, and yet I still, I still haven't I haven't gotten where I need to be, but yet it's important to see where I was five years ago, ten years ago and 30 years ago and the decisions that I've traveled as opposed to to telling her, why can't I just why can't I just, get off of medicine? And so it's a very complicated issue.
It's complicated for people to try and seek help, because admitting that you are defective and may be unlovable is something that they can't coincide. And and and treatment is complicated. You don't always know what medication is going to to work. And then when you've gone through several different medications, you start to lose hope that any medication that is is going to, to work.
And so you, you stare suicide, you know, right into its ugly face and, and and you, you create the fallout of its considerable. And for me, when I wrote that article, the point of writing that article was to write about the fallout that I left behind to see my father's face as he held my hand after I cut my wrists, when I was in my 20s, and to see my husband's face as he caught me, you know, getting getting my card taped up, for the carbon monoxide poisoning. And I broke those two men.
My husband will never be the same. It took him weeks. Careful what you're doing to yourself there. You're already blaming yourself for this and taking responsibility for, how it affected your husband. That's not going to be helpful to you, but it but it's. But here's here's why I'm reliving it like this. It's it's because in the moment that I decided to attempt suicide, I, I could have just gone up to my husband to say, I'm struggling. I need your help. And instead I didn't. Why?
I don't know, I, I was, I was, I was angry, it came out of the thoughts, came out of nowhere. Anger toward yourself. Yes. They came out of nowhere. So the reason why I wrote the article was because I was attempting to encourage people to seek help before it got to that point, because the fallout that's left behind after a successful suicide. It it is. It just breaks what is left behind. Yeah. So it affects more than the person that leaves us. Most definitely.
But, you know, there's got to be a reason why you didn't let your husband or your father know what you're going through. And my guess is because you're, a doctor and you're a health care professional, and you response stable, and you're a proactive and a doer and all that, a high achiever, all of those things, it's probably because you didn't want to burden them with that, because usually as physicians, you know, we're here to relieve suffering.
That's first do no harm, and then we're here to relieve suffering, or else we shouldn't even be in the profession that we're in. And so, you know, physician heal by self. You know, this isn't something to be laying on anybody like my husband or my father, I've got to take care of this on my own, you know. But that's not a good enough reason, though, right? Because I could have been successful. And so, so so I suppose my my point in all of this is, is no matter how hard it is, right?
No matter how much we don't want to burden other people, saving your own life, you, your worth, you're worth it. And so is there love for you that's worth it. Also, talk more about that.
Well, because you're not just ending your own life, but you're ending the part of you that is alive in them that that lived in them, that got to know you, that you know, knew your story, that knew all of the things about you and your subtleties and your little proclivities and your peccadilloes and what things that you didn't like and so on. You know, that's also, you know, we live in other people know it's not just us. And so, that's a that's something to consider.
Also, even though I'm feeling really crappy, you know what? There's plenty of people in my life that I know love me and care about me a great deal. And you know what? Maybe, it wouldn't be such a bad idea to say. Okay, this too shall pass. Then let's see what happens tomorrow. You know, let's see what happens tomorrow. So it's kind of a nice way to reframe it. Instead of feeling that you are burdening this person. Because if we think that way, then why have other people in our lives at all?
What is the reason, even for having a society or for reaching out or in contact? You know, if we're just isolating ourselves, you know, if everything takes place in a vacuum, I find that would be okay. But it doesn't, you know? So we're all we're all interrelated, you know, we're all part of this whole and the whole needs us.
This whole thing called life needs our dance, our particular little input in order to keep moving forward in this frolicking, kind of gambling kind of crazy thing that is life, right? It just keeps going. But our story is important. And our our tone, our color, the texture that we bring to life is also important because we're a part of it. Doctor Corado are there any other? You dropped two really powerful pattern interrupts.
I call them pattern interrupts or disruptions because as someone who's had I've had anxiety and I've been in those really awful places and it feels like the world is just on my shoulders and nothing is going to help in that moment. This too Shall Pass has been a go. Two of mine. What I see in my brain is, I promise you, this is temporary, Reagan. This is temporary. Give it space, give it space. And it's almost trying to give myself space for whatever is going on in my brain to calm itself down.
So that will create a little bit of space for me. The second thing, the second piece of advice you gave, I've actually had a really close person of mine say specifically what you just said, and that was I was at this point and I was going to do it. And I thought these two people love me, and if I leave, then how I'm going to hurt them really bad if I do this. And so, it was interesting to me because it was almost like a self-sacrificing, okay, I'll keep living.
It was it was kind of it's not humorous. None of it is humorous, but it was. It got them through that hump. And I was really grateful for that. If somebody is in that where the tides change fast, the wind picks up and they're in that, is there anything else somebody could do in that moment to give themselves a little bit of space?
Something that I don't know if I mentioned this the last time or not, but I'll, I'll mention at this time, The United States armed forces, the military spent millions and millions of dollars contracting, dozens of psychologists, at the leading institutes of, of learning all over the United States.
And what the government wanted was, in fact, they even included Buddhist monks, in this particular, contract to teach Navy Seals how to short circuit moments of absolute freefall, terror, horror, depression, you know. Oh, my God, I'm I'm done. And, they came up with this group, came up with a thing called box breathing. I'm sure you've heard it before. I have heard of it. That. Tell our teller, if you're listening, listen in that breathing. Need some money.
So listen, taxpayers, we're really getting our money's worth. Finally, a return on our investment. There. You got package and. But we call it box breathing because it's. We look at a square okay. Square has four sides. Right. And so what happens when we get terribly distressed, suicidal or otherwise PTSD, any number of factors. What happens is there are three, hormones in our body that are being, shot into our bloodstream almost instantaneously because we're in the fight or flight mode. Okay?
And that is epinephrine. Adrenaline and cortisol. These are three, of our stress hormones, the big stress hormones. And, you know, if we were being chased by a sabertooth tiger, you know, in the early days of man, it came in very, very, important and a really a good thing because it charged. It's supercharged our bodies so that we could flee from the impending danger. Right. But so many of the things that we're afraid of nowadays are not saber tooth tigers.
They're things like the economy, like job market, like, you know, life satisfaction, like overall, you know, health, you know, ability to change, just opportunities, when those things are limited, that's when we begin to feel this downward trajectory, you know, we start to lose hope. We start to feel hopeless. We start to feel as if we don't count. We start to feel like we're being erased from the book of life, you know?
And so box breathing in a nutshell, what they found is that you see a box, it's four sides. And what we do is life is in the breath. Life is in the breath. Something isn't born until it takes its first breath on its own. Okay, that's the moment of birth. It's the inhalation of the spirit. We inhale. So our breathing is obviously disordered when we are in this, this panic state. We're like this, right? We can't do anything for freezing. If we're we're freaking right. We're melting down.
And so box breathing says step. And to the count of four, inhale. To build the first side of the box. We feel the count of four. And then we hold two, three, four. And then we release two, three, four. And then we remain released two, three, four. Back to the starting point. And then we draw the box again and we inhale to three, four. We hold to three four. We exhale to three, or we remain exhaled to the point. Do this box.
Draw this box to visualize it in front of you so that you have kind of a substrate, kind of like a pattern to follow. And if you do that, this few is four times, you are almost going to feel an immediate relief because what you physiologically told your body is, emergency aborted. I don't need adrenaline, I don't need the epinephrine, and I don't need the cortisol. And you shut down the body. Stop secreting those hormones. And in doing so, it helps to bring, the person to a state of normality.
I have a side question to that. Does, like, would swimmers have something complementary to that? Because there's a rapid inhale, but otherwise it's a controlled exhale. And then, you know, like on flip turns and whatnot. There are times when you're in an exhaled position, but you know that you're not starved for oxygen. And it's it's regulation of your breathing for a controlled period for those that are, you know, like regular. So not just someone that's just like, you swim and I do.
Yeah. Yeah. It's a great I think this just sounds a lot like it's just like this is swimming rhythmic. Yes, yes. And you know what? You could certainly make it. You could build your box breathing into swimming. Just do it. You know, as you're sweating, what you just and then you know, you want to exhale. Obviously when you're, when your face is in the water probably. Right.
Well there there are things called lung busters that we do where, after you've swum down to the, the 25 yard and you push off and then you see how far you can get, and this is all underwater, and then you you flip and you push off, see if you can get to the other end, whether it's halfway or all the way.
But like there's a moment when you're full, like you're getting full of CO2, but if you exhale a little bit, then it gets rid of even though you're getting rid of oxygen, you're also getting rid of the CO2. And so you're depleting your oxygen. But, you know, it's just like there's the wall. I know that I can go ten more seconds. Can I get five more seconds? Can I go three more seconds? And you're just pushing yourself. It's just almost a fun mental challenge.
You know, you're it's a controlled hazard, right? You know, like, it's it's a hazard, but it's controlled. All right. Just decide that. But I thought about the swimmers. It's it's a lot like that. And I can tell you also that you can go further than the four counts, you know, with you doing your box breathing. But the four is absolutely enough. You know, it's it's it works across the board. So but yeah, I've done like to the count of ten, you know, I get I get jiggy with it.
You know, if I can see if I can blow a gasket here. Come on, let's have some fun. Our title topic, getting jiggy with this thing is stigma of suicidality and history. So we've got an idea from Doctor Corado on how to get through some of those really difficult moments.
The Ada, believe it or not, the American Dental Association also has a tremendous amount of resources, that they have put in outside before their membership wall and after their membership wall and will be, putting some of those resources and links to those resources in the show notes, because, they understand what is happening within our profession, and they are here to carry us through it.
I was I was really, very pleasantly surprised after having had a conversation with the Ada, how invested they are in our well-being, and our and our mental mental well-being and how aware they are of of what is happening within ourselves and within our profession. I can't say enough how grateful I am for all three of you for bringing your full selves to this really serious topic. What we've covered today definitely gives away good, tangible advice.
I thank you for we'll put in the Ada link like you said, Maggie. Doctor. Will Corrado, a pleasure, as always. To tackle such a difficult topic. Huge believer in box breathing. I love it. And and listeners might get yourself a carton today. Right. My personal message for you is, is if life is feeling anywhere difficult for feeling the pressures and you're starting to have those hopeless days, you know, one of the things that has helped me is to be my own best friend. As weird as that sounds.
So if you're if you're a recovering people pleaser like myself or you have the world on your shoulders and you know everyone is relying on you and you feel responsible, be your own best friend. You know, you would you would do it for somebody else. And, there is no shame or guilt in seeking out help at all. And I hope that this episode has underlined this for you. You're not alone. We we welcome your continued success and your growth and your vitality. Thank you everyone.
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