Dentistry, Suicide and the Stephen Hawking of Shred
This week Swords Orthodontics interrupted its usual activities on Friday, with a full day of training for all the team, except Brenda (who’d been on a similar day’s course last year) who stayed back at base to look after patient enquiries and get all the work done that can’t happen when the practice is in its normal busy mode.
When I parked the car, I saw a message in on my phone and checked it before getting out. Grim news from a colleague: a friend’s son had taken his own life.
He was 20 years old.
I talked about it with the team before the event kicked off and of course they all knew a family affected by suicide, it has been a scourge of the Irish experience. In all the other places I have lived or worked I was never as aware of it, or been as close to it, as I have been since I moved to Ireland. Given the recession that the country had experienced, it had become much more to the fore in headlines and even more so in private conversations, never making the news except in statistics.
One of my crew asked the question that I imagine gets asked every day in Ireland. Why did they do it? I have no expertise in the matter but my answer is simple, even though I have no idea if it’s correct. “They thought this was a better thing to do than the alternative.”
Statistics can be a little confusing on the matter, but National Suicide Research Foundation (NSRF) and Central Statistics Office (CSO) and Health Services Executive (HSE) publish some details on it. It would appear that this is something experienced by at least one family every day – there were 400 deaths by suicide in 2016. For every suicide, there are about 30 attempted suicides, about 12,000 each year in Ireland.
By coincidence, the records online are almost exactly the same time period that I have been in Ireland since completing my orthodontic training in England. Over that time, the incidence of male suicides appear to have increased over the recession and then reduced, but female suicide rates are depressingly constant. As a nation, we’re in the lower third of European countries for suicide (and since everyone feels the need to compare us to the UK, suicide is more of a problem for us than them), but for suicides in young people, Ireland is one of the worst countries. It’s the most common cause of death in young men after accidents.
Suicide and Dentists
Suicide is a spectre that for years was believed to hang over the dental profession in particular, and anytime I get that email from the Dental Association announcing the death of a colleague – particularly if he (and it’s always a he) is known to be anything other than of advanced years, there’s always the suspicion that it wasn’t physical illness and “foul play was not suspected”. Against – I presume - the law of averages, since I took over at Swords Orthodontics I have attended the funerals of two young colleagues, one younger than I was, who have died of natural causes. One from cancer, one from cardiac arrest. But I still wonder about the story behind professional bereavements when I hear about them.
Research on the matter from 1995 (S Stack, Suicide risk among dentists: a multivariate analysis) concludes that when you balance out other factors like gender and marriage status then dentists have a significantly higher risk of suicide than other professions, though more recent (2016) research in New Zealand (LM Jones et al, A review of occupationally-linked suicide for dentists) would conclude that although in the past they may have been more likely to die by suicide, currently dentists have similar rates of suicide to other health professionals. Roger Alexander’s literature review in the June 2001 issue of the Journal of the American Dental Association made a similar conclusion.
SE Roberts et al in 2013 (High-risk occupations for suicide) reviewed suicide in the UK over many years and listed denistry as the one of the highest risk professions - but still less than half as many suicides reported amonst dentists as vets - in the early 1980s, but this was much improved by the early 2000s with a reduction in dental suicides of about 59%,
Suicide and Irish Dentists
The Irish experience in the matter was assessed in an article by Dr Cathryn Rogers and Prof Kevin Malone from St Vincent’s Hospital and UCD in the Journal of the Irish Dental Association in 2009/2010. They had no evidence that dentists were more at risk of suicide compared to other professions, but reported that suicide rates in Ireland had trebled over the previous 20 years and the stress levels in dentists had increased over the previous 5 years. In 2008 it was reported (Irish Times August 22nd) that vets had double the suicide rate of dentists.
Although I would take some comfort in those studies related to my own profession, we are aware that the healthcare professions have their own risks and challenges to mental health. In the last couple of years I have been at two conferences (one from Irish Dental Association, one from Dental Protection Society) where Harry Barry addressed the profession on mental illness.
Harry’s take home message for me was that a huge proportion of the population has some form of mental illness at any given time. Even though this may be of limited duration, it may not seem that way to the person suffering at the time and if you think another person may be at risk you should ask them have they ever thought about harming themselves. It may be the conversation that stops them going through with plans that irreparably hurt the people that love them.
After the day’s training with 7 other orthodontists and their teams from around the country, I went back into Swords Orthodontics to collect my thoughts and write some notes on the meeting. And in a break from this I saw a message in on my phone. Although we’ve met a few times, I couldn’t describe the sender as someone who knows me, but I know him.
A Brief History of Shred
Steve Vai is probably the world’s premier guitarist-apiarist, but it wasn't his bee-keeping skills that brought him to prominence. I’ve followed his work since he left Frank Zappa’s band and joined David Lee Roth’s band shortly after Roth left Van Halen. I once was driven across the south of England with my brother at the wheel of a borrowed Mazda MX-5 to buy a second hand guitar that was designed by Vai using his mother’s curtains. When we returned to the car after the deal we realised that there wouldn’t be room for both me and the guitar on the return journey.
Google, it its wisdom, figured I’d want to hear his new message on YouTube to his fans and send it to me. Google was right, but had no idea of how right it was that day.
Vai was wishing best of luck to his friend Jason Becker on his new album release Triumphant Hearts, on which Vai and his own former guitar teacher, Joe Satriani, are guest performers. Becker came to my attention in the mid-80s in a guitar magazine (which I bought because Vai was on the cover) when he was in a band called Cacophony with Marty Friedman. Their specialist area was a neo-classical, very high speed heavy metal guitar playing, big on sweeping notes and arpeggios, like Paganini turned up to eleven, known to devotees as “shred”.
When Cacophony split, Friedman joined Megadeth, and Jason Becker became the guitarist who replaced Steve Vai in David Lee Roth’s band (Vai had moved on to Whitesnake). And then, while Roth was goofing around in front of 50-feet-high Marshall Stacks, Becker was diagnosed with Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease , or as it’s more commonly known, “that thing that Stephen Hawking had”.
He was 20 years old.
(You may remember a few years ago there was a social media craze called “The Icebucket Challenge”. The crew at Swords Ortho poured a bucket of water and ice cubes over me. With some enthusiasm, I may add. That was to raise funds for ALS charities.)
As his nervous system shut down, Becker was given a prognosis of about 3 years to live, maybe 5 if he was “lucky”. That was in 1989. For the last couple of decades, he can’t move, speak or even breathe on his own. He communicates by moving his eyes and because his mind hasn’t deteriorated as his body has, he continues to transcribe and compose music which is then played by guitarists of the calibre of Vai. A truly inspiring story to us all.
Last night, I couldn’t help but reflect on these two lives. Two men at the same age faced with the perspective of their existence and the enormity of their mortality and the removal of their futures in a way that most of us can never personally comprehend or experience, and none of us should ever have to, and taking completely different decisions.
For most of the rest of us, 24 hours will pass and we’ll be in the full of our health and have no reason to doubt tomorrow will be any different. It falls on us, I think, to make the most of our potential because so many people will not have that opportunity and it seems to me the best way to show respect and gratitude for the gift.
And bookended by these two stories was the course. Which seems mundane, but sometimes we need to be grateful for the mundane. In the simplest terms, this was about getting us to achieve more and make more of our own potential as orthodontic teams. Not so much about moving teeth, but about how we engage with the people around us and ultimately what we do for them.
It’s up to us to do something great with what we learn.