This Too Shall Pass (E.282)

[00:00:00] Regan Robertson: 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. Alright, today’s topic really was born, um, from, uh, when we brought unintentionally when we brought on Dr. 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  premier episode, it was 263 of Everyday 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 a dentist’s mental wellbeing? 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 pinned an article with such courageous and vulnerability, uh, titled The Silence That Nearly Cost Me Everything, why I didn’t Reach Out Before Attempting Suicide Twice and it’s on dentistrytoday.com. We’ll put it in the show notes if you wanna read it. Uh, 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 a few thousand impressions and some engagement. She’s popular in dentistry. However, this one, uh, shot up pretty quickly to around 20,000 and received I think, hundreds of engagements, if not thousands. It was quite popular, um, which is a terrible thing to say around such, um, 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, Dr. Will Carrado, 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. Dr. Chad Johnson is with us today as well. Dr. Chad wanted to give you a special shout out. Thank you for, uh, pausing dentist thing for a bit and joining us again.

[00:03:06] Dr. Chad Johnson: Yeah, glad to be here. Dr. Rado, good to see you again.

[00:03:09] Dr. Will Corrado: Thank you. I’m glad to be here also,

[00:03:13] Regan Robertson: Maggie, um, it is my absolute pleasure and honor to, uh, hand this microphone, this virtual microphone over to you, uh, to take it from here, introduce our guest and kick off this very critical conversation.

[00:03:24] Dr. Maggie Augustyn: Well, I am very honored to once again be sitting in person next to our favorite therapist, Dr. Will Corrado, who is going to help us, um, well manage some of these feelings that we have around suicide and one of the things that Dr. Carrado 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, um. 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 extraordinarily healing for us. Um, 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% just between the years 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, um, and we are at a loss, at a loss of, of words, at a loss for the people who are suffering and, um, at a loss of people that we have lost and can continue to lose. Dr. Carrado, why, why is this happening? Why are suicide rates increasing?

[00:05:22] Dr. Will Corrado: Well, hi, Dr. Maggie. Um, you’re right. All of those figures are pretty much on the nose. Uh, in fact, I drew from, uh, 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. Uh, also the National Library of Medicine, suicide Rates for 2024, the National Institute of Mental Health Suicide Rate for 2020. Research done by the Boston University. Uh. Student, uh, suicide rate statistics in 2024, uh, as well as my own 22 years or so as a practicing, uh, clinical psychologist in both California and Illinois. Um, why, why, why have we seen this since, since, uh, 2019? Uh, almost a, a 33% jump in nationwide suicides. Um. Even if we take out the, the, the pandemic numbers, which, you know, has its own kind of feel and reason, uh, set of reasons, um, it’s still an extraordinary spike and, uh, aside from that small 5% or so drop that, uh, Dr. Maggie spoke of a moment ago, um, the figures are still soaring high. Um, I mean, there’s so many reasons. Okay? So many reasons. Um, I mean, the number, we can’t really even have a, a, a discussion about suicide unless we talk about, um, the prevalence of, uh, guns in the United States. Huh uh, it is still the number one, um, source reason, um, cause of suicide is by gunshot, by self, mm-hmm uh, inflicted gunshot. and yet. You know, we wanna 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, uh, to any of the other, uh, gun lobbies, um, you know, there’s tremendous commercial benefit from a profit. Um, and yet, uh, when these guns, uh, which are supposedly purchased for self protection, um, are turned against the person bought them, um, by themselves, um, that’s a pretty serious issue. How do you control that? Um, and so it’s still the number one reason, the number one cause of death, uh, across the board is due to self inflated gunshot wounds. Hmm. Uh, with respect to the. Uh, health professions, uh, strangely enough, uh, well, let me back up for a moment. Nationwide, there is a four to one 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, uh, of women doctors of all kinds, uh, committing suicide or attempting to commit suicide, um, 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, uh, and difficulties than of the financial commitment, uh, employing people, hiring the right people, um, having the right, uh, supplies and the licenses and the permits and the legal issues and all of that tremendous amount of stress, huh? 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. Um, and, uh, it takes a lot of work and it’s a lot of magic, uh, especially in dentistry to do that. Um, so. All of these things, uh, kind of conspire, uh, to create an enormous amount of pressure, uh, especially with people in, at the doctoral level of healthcare. Okay. Um, that’s just the numbers, that’s what it is. Uh, financials.

[00:10:13] Dr. Chad Johnson: Dr. Corrado, I have a question along those lines.

[00:10:14] Dr. Will Corrado:  The job market levels of loneliness, uh, which have, have changed dramatically in this country, even if we, we factor out, uh, the pandemic. Um, so, you know, it’s, uh, it’s a changing world that we’re living in. Uh, the other factor, especially in the healthcare professions, is their access to prescription medications, specifically narcotics, barbiturates, anesthesia. Okay. It’s that ease of access, uh, in, uh. The healthcare professions, including by the way, uh, registered nurses. Uh, they’re also in that statistic of elevated suicides. So, um, you know, combine that with, uh, a firearm or any other means of, uh, uh, doing oneself in and, um, you know, there you have it. It’s like a super bloom. It’s extraordinary.

[00:11:16] Dr. Chad Johnson: Can you hear me real quick? Okay. Yeah. Can, can you as well, Maggie,

[00:11:22] Dr. Maggie Augustyn: Dr. Carrado, previously, uh, when we, when we’ve talked, you have mentioned that there are four different types of suicide, which, uh, 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?

[00:11:41] Dr. Will Corrado: Sure. Um, it’s actually no new news. It was, um, um, from the, um. Uh, this, I, I drew this from the Developmental Institute of Singapore. Actually, I was all over the place, but, uh, these, uh, definitions were, uh, smithed by a Frenchman by the name of email Durkin in 1897. Okay, and he was a dear doc door. You know, what can I tell you? Uh, but he said there is, you know, the, the number one is the ego egoistic, uh, suicide and that’s from feelings of isolation from, uh, society. Um, and, um, it went on from there. Okay? Uh, feelings of suicide from society. I’m sorry, I’m having a hard time reading this. Well, the second, uh, form of suicide is the altruistic and that sacrifice life to fulfill the obligation of a group, um, or club the cause kamikazes, for instance, the suicide bombers. Um, you know, people who have, uh, an issue or a public, uh, a, a political issue just to put forward. Uh, the third is econ, excuse me, is, uh, anoma suicide. And this is, um, when there’s a breakdown of social norms and values, um, that, uh, kind of diminish a person’s purpose in life. Okay? Um, we’re seeing this now, uh, in the overarching things we’re struggling with in our society. Uh. The dereliction of duty of public officials. Um, the deception involved in political campaigning. Uh, the cheating, the lying, the outright deception, the, uh, alternative views, alternative facts. Um, it’s becoming crazier and crazier and it’s taking on the life of its own. Uh, and then we had the fatalistic suicide, and these are individuals who are, uh, overwhelmed when placed under conditions of extreme rules and high expectations. Um, I kind of think that, uh, that’s probably the hot button for the dental profession and the health profession. Um, it pretty much sets the seal.

[00:14:20] Regan Robertson: Wow. Chad, did you have a question in there?

[00:14:23] Dr. Chad Johnson: Yeah. So Dr. Corrado, my question was, and it’s almost a, you know, a secondary issue to our practitioners. Mm-hmm. But, um, do you think as well that, uh, there could be a spike in suicides from veterans issues? I mean, I, 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, 9/11/2001, you know, like that, that  was, you know, a probably an increase to mm-hmm. Women in the military, you know, like that’s increased and, and so that would play on both sides of the genders, um, possibly. Yes, and then Regan, along those lines, that was just a side question. Uh, Regan, you had a question about medications.

[00:15:19] Regan Robertson: I think this is absolutely fascinating and I really love Dr. Will, how you broke down the four different areas of suicidality and, 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 healthcare by and large has overwhelming pressures placed on it, especially in the United States. Can’t speak for the world, but, but what I’ve heard editorially, I was, I was wondering and overhear chat, GPT on the side, uh. 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 far, 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 effect and I notice that SSRI, which is antidepressant medication, which has that known side effect, not necessarily common, but that has shot through the roof as well. Mm-hmm. So I know we’re doing a little bit of silencing here in a very dirty way, which scientists would be immediately offended at me because I’m not necessarily saying correlation, but I’m trying to paint a picture. If you’re nodding, will 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 in here.

[00:16:37] Dr. Will Corrado: The factor that stands in relief most, the one that’s probably the thing that we need to be the most careful about is uh, when. A person gets a prescription for an antidepressant, uh, an SSRI, the selective serotonin reuptake inhibitors. Um, what we have to be careful of is if a person has been, uh, first of all, in order to have a diagnosis of, uh, uh, depression, uh, and a severe depression, is that you have to, uh, have symptoms for at least two weeks and they’re unabated. Okay, loss of, uh, hope, uh, helplessness, hopelessness, um, feeling like you’re in a hole, feeling as if you have no agency over yourself. Um, almost as if you can’t breathe, huh? Uh, uh, a, uh, anhedonia is, is a big factor. That’s a fancy word for, uh, not being able to feel joy or any kind of happiness, even with activities that once provided you with such, uh, feelings. Um, so all of that can create quite a deep hole and what the, uh, SSRIs do, of course, is that they, uh, they assist in enhancing, uh, one of the, uh, neurotransmitters that is, uh, responsible for us being happy. Actually, two, it would be, uh, serotonin and dopamine. I. Um, 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, this reason why we have new guidelines when 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, there’s such a dramatic sense of relief and a lifting of these symptoms, especially inertia, lack of energy, you know, sleepiness, um, 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 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, why we have new instructions on prescriptions for young people, especially those 18 and under, uh, for any SSRI most often, they are prescribed not only half of the recommended, uh, therapeutic dose in order to just titrate the experience, to watch them observe them and make certain that they don’t, uh, step into kind of a, a manic recovery phase and then act on something that they, you know, had planned on acting on, but didn’t have the energy.

[00:19:50] Dr. Chad Johnson: Hmm.

[00:19:52] Regan Robertson: That’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, or, you know, make that, that makes sense now. Like it puts context around it. Call your healthcare 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, uh, a stark increase in usage. Mm-hmm. Since, since, uh, you know, the pandemic as well.

[00:20:26] Dr. Chad Johnson: Mm-hmm. Yeah. So Dr. Corrado secondary to Reagan’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, um, to the public on television and whatnot, um, and you can decline to comment, but would you be in favor of a policy that that either limited or eliminated that?

[00:20:55] Dr. Will Corrado: Well, I, I mean, I, I actually think it’s, it’s for the highest good of, of all concerns would be informed about it. You know, why not? Why not know about that, uh, nuance? Because, uh, you know, somebody aside from a a a prescribing physician might catch it, um, before them even, you know, people make mistakes.

[00:21:17] Dr. Chad Johnson: Sure.

[00:21:18] Dr. Will Corrado: So, uh, I think just kind of having that awareness. Okay, so I’m gonna start my son or my daughter on an antidepressant, and they’re young and by the way, what is the normal MO dosage and what dosage are they being, uh, given, uh, as, uh, a beginning, uh, their therapy with this medicine and so, um, if you can just pay attention to that and, and, and know, for all intents and purposes, everybody should really start out at that, start out at 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, uh, get traction. The body has to kind of recognize what it is, what’s going on, where to put it, uh, and um, 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, uh, of taking the medicine. Um, 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 pharmaceutical or psychotherapy, is, uh, checking a person’s thyroid rates. Okay? It’s the number one lab that needs to be, uh, done to, it needs to be drawn in order to rule out that it isn’t from, uh, a, uh, malfunctioning thyroid, uh, the depression that is because, uh, when we don’t have enough thyroid, of course, we become lethargic, we become inattentive. We wanna sleep, we wanna, uh, eat more. We want to not exercise, uh, et cetera.  Mm-hmm. Um, yeah.

[00:23:04] Dr. Chad Johnson: So regarding, um, 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, are thoughts of suicide common? I mean, is this a listener, you know, that’s listening to this podcast right now? Mm-hmm. I might be thinking, I mean, am I alone in this or is this. Uh, prevalent. Um, you know, how do I know that not only that there’s help for me, but that there’s, um, other people that might be experiencing what I’m experiencing and when is it, when is it too much? I mean, you know, just to, you know, have a bad day and I, 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?”

[00:24:10] Dr. Will Corrado: Mm-hmm. Mm-hmm Um, yeah. Clinically and legally what we have to pay attention to is at least two weeks. Um, but all of those other conditions certainly, uh, could be present. You know, all of those other reasons, uh, could, could in fact be there. Um, I think, uh, you know, if a person is crying every day, if they are feeling helpless, feeling hopeless, feeling as if, uh, iso isolation is a big, uh, piece of the picture also.

[00:24:40] Dr. Chad Johnson: Tell me about that. What does that mean?

[00:24:42] Dr. Will Corrado: The isolation. A lot of that has to do with feeling toxic because you have these thoughts about maybe wanting to end your life, huh? Um, feeling that you will never be understood that somehow you are defective. Huh? That you have some deep characterological disorder, you know, that would make you wanna think of doing something like that. As a matter of fact, suicidal ideation happens to pretty much everybody. Um, there’s two distinction there. There’s, 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. Uh, 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 a modern man, right? It’s like, oh god, not another thing, right? Sure. But, um, I, when we start to develop a plan, Dr. Chad, that’s when we’ve got to see the flags go up right away. The means how are we gonna do it and the more elaborate the plan is, uh, the more, uh, ob obviously the more suicidal ideation there is, but it’s the more likely it’s going to be successful and they’re gonna carry it out.

[00:26:06] Dr. Chad Johnson: So is that in your armamentarium of questions when someone were to say, you know. I’ve been thinking about this and, uh, you know, at some point for the right person, I’m not trying to give away your trade secrets and all this, or, 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 all, if you have at all. I mean, is is that kind of where you would go with that?

[00:26:32] Dr. Will Corrado: Oh, sure. Open it up, open it up, open it up. As Dr. Maggie said a moment ago, light is the greatest, uh, of all antiseptics, right? And so you just want to open that up so that it’s no longer this kind of, um, uh, lonely and, and, uh, encapsulated kind of thought loop that’s going around and around in this one in, 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 or psychologist, a health, a mental health professional, um, that’s opening a window. Okay. That’s opening a window for oxygen and air. And that is at the very beginning of the possibility, the potential for, um, significantly decreasing ameliorating, uh, the suicidality.

[00:27:24] Dr. Maggie Augustyn: People likely to share that.

[00:27:27] Dr. Chad Johnson: Like, yeah, bring it on over.

[00:27:29] Dr. Maggie Augustyn: Are people likely to share that? Like if, if, if someone is really serious about committing suicide and they’re seeing, and they’re seeing a therapist, but they’re really serious about committing suicide,

[00:27:44] Dr. Chad Johnson: mm-hmm.

[00:27:44] Dr. Maggie Augustyn: Would they share their plan with somebody else or would they, would they, would they keep it secret so that they could actually carry it out?

[00:27:56] Dr. Will Corrado: So that’s, that’s a knot that is, it’s a difficult question to address because you could only hope that your skills as a mental health practitioner are. Uh, developed enough so that you can suss out the nuances and, uh, get the client to trust you enough to open up about that, huh? Because I mean, that is a big, big burden to be carrying, uh, on one’s own. Um, and so once it is broached, once, uh, the person takes that leap of faith to, to, to place some trust in another human being, uh, this time being, um, a mental health professional, um, you know, you’re gonna increase hope for averting suicide significantly. However, uh, Dr. Augustyn’s, uh, question I think goes to, um, the fact that approximately 50 to 55% of all suicides, uh, 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 that 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 a horrible diagnosis at a doctor’s office, you know, um, or lost their job or face some kind of, uh, catastrophic loss. So you want to just kind of, uh, go easily, step easily, be gentle. You never know. You never know what’s going on with somebody.

[00:29:48] Dr. Maggie Augustyn: I, I can’t speak to that because in, in my experiences, there’s times that depression would be present and there would be moments where I, I mean within, and I had people ask me about that fairly frequently. Where, how do you know? 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, uh, 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 that. I remember when I was young, and this was my first time dealing with it, I was 21. Um, this was around the, my first suicide attempt. I mean, I was fantasizing about suicide every single day. I would be running red lights all the time, just praying somebody would hit me. Um, no, nobody did. I mean, but, but you make these decisions, uh, they come out of nowhere. You’re just, these thoughts take over. You lose hope, and you just pray for it all to end. Um, so, so, so this is, I think, where that 50%, there is no plan. There is no plan. It has, and there’s been,

[00:31:45] Dr. Will Corrado: And 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.

[00:31:57] Regan Robertson: This, 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 mm-hmm, and it helps just to hear you say that Maggie helps me at least put some context around, um, 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, um, how fast the tides can turn and even without your own cognizant, like awareness to that. And, and that to me is, um, shedding light makes things less scary. Uh, 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, Meg, you have a thought around this. You have a question. You’re, you’re. You’re the first person here.

[00:32:57] Dr. Maggie Augustyn: So, Dr. Carrado, and this is a question that actually someone from the audience that I don’t know, uh, send me a message about, because, you know, someone, one of her friends, uh, 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 wanna take my own life.” Um, they talked about it for, for a, for a moment the next day. She, she basically said, “I, I take it back. You, I, I, I forget I said that. I, I didn’t mean it.” Um, 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?

[00:33:48] Dr. Will Corrado: Rule number one, always take it seriously. Always. Um, that’s the, that’s your, you know, kind of the soft landing, right? You just, you wanna 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. Um, most importantly, for instance, are these hotlines, you know, why do we have these hotlines? Why does the government have these hotlines because human contact talking to another person, just not being stuck in your own nain, you know, with these loops, these, these suicidal, uh, thought loops that just keep going around and not unless they’re broken, unless that it’s like a pain pattern. It has to be broken in order for it to reconfigure and let those neurons go.

[00:34:45] Dr. Chad Johnson: So, Dr. Corrado, 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 mm-hmm. 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-P-T-S-D kind of thing where I would wake up, um, was I awake in my dream? I was, I would, I would be in the fire and I would get outta the fire and then like I would turn around and I’d be back in the fire. So I, 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 sit? Like my mind was trying to work on it, but like Exactly. Couldn’t figure it out.

[00:35:39] Dr. Will Corrado: That’s the 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, um hmm. There. Merit. You know, it’s, it’s, it’s kind of a decent thing to do when you think of it. You Yeah. Want to figure it out, you know, it’s, it’s,

[00:35:56] Dr. Chad Johnson: Yeah. Well, and a good thing on, on the lightest level, I mean, I, 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, wartime stuff, you know, deep stuff. You all did you stern

[00:36:15] Dr. Will Corrado: Doctor, did you, did you?

[00:36:15] Dr. Chad Johnson: Yeah. Yeah. It was a gasoline fire, and so when I was in the brush pile for that, like I, I’d have these dreams and I’d, but like I, I, I thought I was waking up, but then I’d turn around and I’d be back in it and. The, the, I 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. Mm-hmm. Um, 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 busing down the road and I’d be like, why, why am I doing this? And I, I don’t know. I, 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 talked to anyone except casually about this, but that, I don’t know why is 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 I, oh, I also wondered if it was physiologic that I, that I was like almost craving that rush again. So

[00:37:20] Dr. Will Corrado: Driving. So, uh, forgive me, Dr. Chad driving so fast in the dream or

[00:37:24] Dr. Chad Johnson: no, in real life afterwards, after the accident? After. Yes, and it, 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, ’cause what I was also trying to weigh out was, I mean, I could have died then, right? Mm-hmm. So like, I, there was part of me that was just like, you know, trying to weigh out the what’s it matter?

[00:37:51] Dr. Will Corrado: Yeah, and, um, you after while becomes exhausting

[00:37:55] Dr. Chad Johnson: Yeah. And so like, I, I kind of identify in some regard because I, I don’t think that was like, it had it come to fruition that it was. Um, 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? Mm-hmm. Uh, that was really weird, but I can identify with that. Uh, you were talking about the loops and the patterns and, and I kind of just wanted to 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. Um, but in our own ways, hopefully today, Maggie, you know, like we, that we can identify, you know, that there are times when we’ve, um, 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, uh, that I’ve had those struggles and feelings and that, you know, talking it through. Though, admittedly I did not, um, you know, except to my wife, like, I’m having these feelings. Like, and, and it was just weird, you know, but like, uh, that hopefully that helps people know that it, it, it might, 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. Dr. Corrado, your thoughts without, uh, coming to a, a full diagnosis of me within 20 seconds? Like your pre brain probably already did, so

[00:39:30] Dr. Will Corrado: No, not, not really, but I do have a few thoughts and that is, you know, um, driving fast, uh, and pushing it is actually considered to be a form of passive suicidal Yes. Acting out. Yes, know, it’s the exhilaration. It’s wanting to feel that relief. It’s just yes, it, it is about the dopamine. Yes. Certainly a piece of it and so, um, there is that kind of, um, reaching for that euphoria. Huh? The euphoria of taking flight or of everything Just ending, being released from the pain. Huh. You know, a person with a, you know, can 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 would be free of our pain and our, you know, the, the horror, the, the torment, uh, which is depression. Depression is, is a, is 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 un uh, revisiting unearned guilt and taking on responsibility for things that really weren’t our fault. Huh, but, um, there is this mechanism, uh, in the human psyche to, to, to be destructive. You know, the thanatos, the, 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, uh, there was, what was that sticker? Suicide is a permanent solution to a temporary problem.

[00:41:16] Dr. Chad Johnson: Mm-hmm.

[00:41:17] Dr. Will Corrado: You know, um, say that a lot. One thing that I, I 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, uh, the ring that was given to, uh, king Solomon. Uh, he was presented with a ring by another, uh, uh, 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, “Now, Solomon, every once in a while, I want you to turn that ring around one entire revolution or or halfway to see the other side of the ring,” and the inscription on the other side of the ring is, “This too shall pass.” Okay, so it mocks sneaks. If you’re having a great day. Too shall pass. Remember it. And, and just know that they’re not all gonna be like that and if you’re having a horrible day, remember this too shall pass and I get, I, I have, I have really, um, gained great comfort and a great amount of strength, but just repeating that to myself, you know, because not all cases are, you can’t figure all of them out. You just can’t. Mm-hmm, 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, it’s like trying 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, uh, hormones and neuronal loops in the body and they can change, um. Uh, dramatically and precipitously, uh, inside of minutes, and the person can become euphoric or profoundly depressed, you know? Um, we don’t know which way it goes. It’s just flushes. 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, uh, rate of concordance than any other, uh, mental, uh, uh, illness.

[00:43:50] Dr. Chad Johnson: Explain what that means to you.

[00:43:53] Dr. Will Corrado: That means that if you’re, uh, 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 bipolar disorder. Oh, okay. So there’s 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?

[00:44:39] Dr. Maggie Augustyn: And so, you know, as we continue to struggle, I, I know for me, I continue to feel shame around mental illness, and I don’t think I do. I was just seeing my psychiatrist 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?”

[00:45:00] Dr. Will Corrado: Yeah. Yeah.

[00:45:00] Dr. Maggie Augustyn: It’s, and I’m like, what are you talking about? I don’t feel ashamed. It’s 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 um, even though I’ve built a community around it, I have tremendous support in my husband and, and, um, there, there’s still something about mental illness that makes me being completely aware of, of what it is. It, it makes me feel like I am less than, like I am a weaker, defective, defective, unloved, unlovable, uh, right? Mm-hmm. Uh, and I, I’ve, I’ve worked for the last 30 years with therapists in medicine to get over it, and yet I still, I still haven’t, haven’t gotten where I need to be, but yet it’s important to see where I was five years ago and 10 years ago and 30 years ago and the distance that I’ve traveled as opposed to, to telling her, why can’t I just, why can’t I just, uh, get off of medicine? And, and so it’s a very complicated issue. It 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. Um, 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, uh, is, is going to, to work and, and so you, you stare suicide, you know, write into its ugly face and, and, um, and you, you create the fallout of its consideration. Um, 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, um, when I was in my twenties. And to see my husband’s face as he caught me, you know, getting, getting my car taped up, uh, for the carbon monoxide poisoning and I broke those two men. Um, my husband will never be the same. It took him weeks.

[00:47:30] Dr. Will Corrado: Careful what you’re doing to yourself there. You’re already blaming yourself for this and taking responsibility for, uh, how it affected your husband. That’s not gonna be helpful to you.

[00:47:43] Dr. Maggie Augustyn: But it, but it’s, but, 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 [00:48:00] to my husband to say, “I’m struggling. I need your help,” and instead, I didn’t.

[00:48:05] Dr. Will Corrado: Why?

[00:48:08] Dr. Maggie Augustyn: I don’t know. I, I was, I was, I was angry. It came out of it. These thoughts came out of nowhere.

[00:48:14] Dr. Will Corrado: Um, anger toward yourself.

[00:48:17] Dr. Maggie Augustyn: Yes. Mm-hmm. They came out of nowhere. So the, 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, um, it, it, it is, it just breaks what is left behind.

[00:48:50] Dr. Will Corrado: Yeah. So it affects more than the, 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, uh, a doctor and you’re a healthcare professional and you’re responsible and you’re proactive and a doer and all those 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 gotta take care of this on my own, you know?

[00:49:43] Dr. Maggie Augustyn: But that’s not a good enough reason, right, because I could have been successful. Mm-hmm. And so, so, so I suppose my, 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

[00:50:01] Dr. Chad Johnson: Mm-hmm.

[00:50:03] Dr. Maggie Augustyn: Saving your own life, you, you’re worth. You’re worth it.

[00:50:07] Dr. Will Corrado: And so is their love for you. That’s worth it. Also,

[00:50:13] Dr. Maggie Augustyn: Talk more about that.

[00:50:14] Dr. Will Corrado: 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 peccadillos, and what things that you didn’t like and so on. You know, that’s also, you know, we live in other people. We, it is not just us and so, um, that’s, uh, 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, uh, it wouldn’t be such a bad idea to say, okay, this too shall pass, and 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 rearing contact, you know, if we’re just isolating ourselves, you know, if everything takes place in a vacuum, I fine. 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 ing kind of crazy thing that is life, right? That 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.

[00:51:58] Regan Robertson: Dr. Carrado, are there any other, you dropped two really powerful pattern interrupts. I call ’em 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 gonna help in that moment. Mm-hmm. Um, this too shall pass has been a go-to of mine. What I say in my brain is, “I promise you this is temporary Regan, 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,

[00:52:39] Dr. Will Corrado: Exactly,

[00:52:40] Regan Robertson: The, 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 gonna do it and I thought, “These two people love me and if I leave, then how I’m gonna hurt them really bad if I do this,” and so, um, it was interesting to me ’cause it was almost like a self-sacrificing, “Okay, I’ll keep living.” Mm-hmm. Uh, 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. Mm-hmm. Um, if somebody’s 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?

[00:53:25] Dr. Will Corrado: Something that I, I, I dunno if I mentioned this the last time or not, but I’ll, I’ll mention it this time. Um. The United States Armed Forces, the military spent millions and millions of dollars contracting, um, dozens of psychologists, um, at the leading institutes of, of learning all over the United States and what the government wanted was, uh, in fact, they even included Buddhist monks, uh, in, in this particular, uh, uh, uh, contract to teach Navy seals, how to short circuit moments of absolute free fall terror, horror, depression, you know, oh my God, I’m, I’m done. And, uh, they came up with this group, came up with a thing called box breathing.

[00:54:25] Dr. Will Corrado: I’m sure you’ve heard it before

[00:54:28] Regan Robertson: I have heard of it, but tell our, tell our, if you’re listening, listen in. Yeah. Breathing is lots of money.

[00:54:33] Dr. Will Corrado: So listen, taxpayers, we’re really getting our, our money’s worth of it

[00:54:36] Dr. Chad Johnson: Finally, a return on our investment.

[00:54:39] Dr. Will Corrado: Chad. There you go. Tax Chad. But we call it box breathing because it’s 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, um, hormones in our body that are being, uh, 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, uh. Of our stress hormones, the big stress hormones. And, you know, if we were being chased by a saber tooth tiger, you know, in the early days of man, um, it came in very, very, uh, important and a really a good thing because it charged, it 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, um, life satisfaction, like overall, you know, health, you know, ability to change, uh, just opportunities. Um, 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 was that you see a box that’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, huh? So our breathing is obviously disordered. When we are in this, this panic state, we’re like this, right? We can’t do any, we’re freezing up. We’re, we’re freaking, right? We’re melting down and so box breathing says stop and to the count of four, inhale to build the first side of the box. We to the count of four, and then we hold 2, 3, 4, and then we release 2, 3, 4, and then we remain released. 2, 3, 4, back to the starting point and then we draw the box again and we inhale 2, 3, 4. We hold 2, 3, 4. We exhale, 2, 3, 4. We remain exhaled. 2, 3, 1. Do this box, draw this, box it 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 as few as four times, you are almost going to feel an immediate relief because what you physiologically told your body is, uh, uh, uh, emergency aborted. No, I don’t need adrenaline. I don’t need the, 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, uh, the person to a state of normality.

[00:58:15] Dr. Chad Johnson: I have a side question to that. Does like, would swimmers have something complimentary to that because there’s a rapid inhale, but otherwise it’s a controlled exhale and then, you know, like on flip turns and, and whatnot. There are times when you are in an exhaled position, but you know that you’re not starred for oxygen and it’s, it’s regulation of your breathing for a controlled period for those that are, you know, like regular, not just someone that’s just like you swim pond. I do. Yeah.

[00:58:46] Dr. Will Corrado: Yeah. It’s a great thing.

[00:58:47] Dr. Chad Johnson: I mean, this just sounds a lot like, it’s just like this is swimming rhythmic.

[00:58:49] Dr. Will Corrado:  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 swimming along, you [00:59:00] just. And then you, you wanna exhale obviously when your, when your face is in the water, probably.

[00:59:07] Dr. Chad Johnson: Right? Well, there are, there are things called lung busters that we do where a, after you’ve swam down to the, the 25 yard end, you, you push off and then you see how far you can get. And this is all underwater and then you flip, 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, 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 10 more seconds. Can I five more seconds? Can I go three more seconds?” And you’re just pushing yourself. It’s just almost a fun mental challenge. Yeah. But you know, you’re just, it’s, it’s a controlled hazard, right. You know? Mm-hmm. It’s, it’s a hazard, but it’s controlled.

[00:59:51] Dr. Will Corrado: Mm-hmm. Mm-hmm.

[00:59:52] Dr. Chad Johnson: All right. Just aside that, but I thought about the swimmers. It’s, it’s a lot like that.

[00:59:55] Dr. Will Corrado: I can tell you also that you can go further than the four counts, you know, when you’re doing your box breathing but the four is absolutely enough, you know, it’s, it, it works across the board. So, but uh, yeah, I’ve done like to the count of 10. 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.

[01:00:18] Regan Robertson: Our title topic, getting Jiggy with it, A Stigma of Suicidality and History.

[01:00:23] Dr. Maggie Augustyn: So we’ve got an idea from Dr. Corrado on how to get through some of those really difficult moments. Uh, the a DA, believe it or not, the American Dental Association also has a tremendous amount of resources, uh, that they have put in outside before their membership wall and after their membership wall and we’ll be, uh, putting some of those resources and links to those resources in the show notes because, uh, they understand what is happening within our profession and they are here to carry us through it. I was, I was really, uh, very pleasantly surprised after having had a conversation with the ADA, how invested they are in our wellbeing, um, and our, our mental, mental wellbeing and how aware they are of, of what is happening within ourselves and within our profession.

[01:01:24] Dr. Chad Johnson: Professional.

[01:01:24] Regan Robertson: I can’t say enough how grateful I am for all three of you for bringing your full selves to this really serious topic. Um, what we’ve covered today definitely gives away good, tangible advice. Uh, I thank you for, we’ll put in the a DA link like you said, Maggie, Dr. Will Corrado a pleasure as always, uh, to tackle such a difficult topic, A huge believer in box breathing. I love it. And, and listeners, my

[01:01:49] Dr. Will Corrado: Get yourself a carton today.

[01:01:51] Regan Robertson: Right? My personal message for you is, is if life is feeling. Anywhere difficult if you’re feeling the pressures and you’re starting to have those hopeless days. Um, 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 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, um, be your own best friend, you know, you would, you would do it for somebody else and, um, there is no shame or guilt in, in seeking out help at all. And I hope that this episode has underlined this for you. You’re not alone. Um, we, we welcome your continued success and your growth and your vitality. That’s right. Thank you everyone.

[01:03:40] Regan Robertson: Thank you for listening to another episode of Everyday Practices Podcast. It would mean the world if you can help spread the word by sharing this episode with a fellow dentist and leave us a review on iTunes or Spotify. Do you have an extraordinary story you’d like to share or feedback on how we can make this podcast happen? even more awesome. Drop us an email at podcast@productivedentist.com and don’t forget to check out our other podcasts from Productive Dentist Academy at productivedentist.com/podcasts. See you next week.