Aman Rihal explores the concept of mental health, how it manifests in dentistry and the importance of sincere listening.
‘Sometimes I have kept my feelings to myself, because I could find no language to describe them in.’ – Jane Austen, Sense and Sensibility.
‘Everything we see hides another thing, we always want to see what is hidden by what we see.’ – René Magritte.
In this article I will briefly cover the concept of mental health and personality psychology. I will then show how acquiring more refined listening skills can be used to help one another in the profession.
The definition and concept of mental health
Mental health is integral to human functioning. The World Health Organization defines it as ‘a state of mental wellbeing that enables people to cope with the stresses of life, realise their abilities, learn well and work well, and contribute to their community. It has intrinsic and instrumental value and is integral to our wellbeing.’
In the UK, around one in six have a common mental disorder (CMD), such as anxiety or depression. In addition, 39% of adults in England between the ages of 16-74 are accessing mental health treatment (Adult Psychiatric Morbidity Survey, 2014).
There are various issues that can impact dentists and dental professionals. They must maintain high levels of professionalism, manage actual or potential threat of regulatory intervention, a demanding patient population, maintain functional working relationships, maintain clinical knowledge, maintain their own health, interpersonal relationships, and other incessant demands.
It’s unclear to me whether mental health issues are exacerbated by a career in dentistry, or if a career in dentistry ruthlessly exposes inherent self-doubt, and other self-perceived character deficits. It is likely that it’s a combination of both.
In addition, contemporary culture, as shown by the proliferation of social media such as Instagram, often values what is ‘seen’ which can impact mental health. ‘All actual having must draw its prestige and ultimate utility from appearances.’ (Debord, 1967)
Psychodynamic theory of human personality – why we are who we are
Sigmund Freud developed the topographical model of the mind. It consisted of the conscious mind (our immediate awareness), the preconscious mind (information you can easily recall) and the vast yet influential unconscious mind.
Freud believed the unconscious mind was a collection of primitive fears, repressed thoughts that are better off outside of conscious awareness, and things that we know but prefer not to deal with. We all know how it feels when you suppress something; it can lead to feelings of anxiety which can influence how we behave around others, and how we manage this ourselves.
The unconscious mind has been fertile ground for literature. Both Dostoevsky and Shakespeare understood how much occurs outside of conscious awareness yet impacts our actions. The unconscious mind also manifests in various other ways, like our dreams, or the ‘Freudian slip’ (also known as a ‘slip of the tongue’ in speech).
Psychodynamic theory is also interested in how ‘we experience, regulate and express our emotions in an interpersonal context (marriage, parent-child etc), including the therapeutic relationship’ (Abrahams and Rohleder, 2021).
Freud’s model of the mind
By 1923, Freud had formulated his structural model of the mind. He proposed the mind is composed of three components.
Firstly, the ‘id’ which is our primitive drives and our impulses, which demand instant gratification. This operates through what is known as the ‘pleasure principle’. In modern neuroscience, this would be located in the amygdala.
The second component is the ‘ego’. This is how we manage the demands of the id, based upon embedded familial and cultural norms, through what is known as ‘defences’. The defence of rationalisation is applying rationality to make a situation you find concerning easier to deal with.
Or sublimation – here you transform an aggressive impulse into a more societally acceptable manner, playing sport for example. We may make a joke to make light of something that troubles us – here, humour can be a ‘defence’ against psychological distress.
Another good example of a defence is displacement, in which we may worry about our health, yet we are angry to everyone around us. Or projection where we ‘project’ a negative element of our behaviour, perhaps anger, and say another person is always angry as a defence against dealing with our own anger issue.
There are also primitive defences such as denial, which are often used during childhood to manage overwhelming experiences. Defences are useful but, long term, they can be maladaptive. From a neuroscience point of view, the ego would be located in the prefrontal cortex. Here is where we exert control over the instinctual drives of the id.
The final component of the mind according to Freud is the ‘superego’, which is morality, or our concept of good and bad, and is influenced by our parents/caregivers. A harsh superego can manifest as unhealthy levels of perfectionism in an individual.
Understanding reactions and feelings
Alongside his colleague Josef Breuer, Freud developed the concept that talking about an issue helps relieve psychological distress, now known as modern ‘talking therapy’ or psychotherapy. Through meaningful psychotherapy or by observing how you react in situations, you can begin to understand why you do things. This is also known as metacognition or ‘thinking about thinking’.
Later psychoanalysts like Karen Horney introduced the ‘tyranny of the shoulds’ concept which means when we feel we are not good enough or can’t fulfil these ‘shoulds’ (imposed by society/parents etc), this can lead to feelings of low self-esteem and anxiety, and it can impact our self concept.
In addition, we develop ‘internal working models’ about relationships based upon our interactions with early life caregivers. This is the basis of ‘attachment theory’ (Bowlby, 1969). Through these internal working models we develop mental representations of ourselves, and others. We carry these into adult life, and this influences future relationships, and concept of self.
Listening and social cognition – how we can relate to others more effectively
Carl Rogers was a humanistic psychologist who believed that we all have an actualising tendency, and can choose a path towards growth if provided with the correct social environment. This approach is primarily phenomenological (our own subjective experience).
While Rogers’ principles are used in ‘person centred counselling’, his approach can be used in our interactions with colleagues, family, friends etc.
Rogers believed we need to cultivate three core conditions (Yao and Kabir, 2023) to enable a person to have a conducive environment for genuine psychological growth.
- Empathy: we can all relate to this. When we feel someone understands what we are saying, we are likely to feel better. We already know this when we see an anxious patient, or a relative who has struggled with an issue
- Congruence: this is also known as genuineness. Many times when we interact with others, we are preoccupied with ourselves; we give the illusion to another that we are listening, but our body language suggests otherwise. When listening, it is essential to make an individual feel that the time you have with them is entirely about them. The use of ‘mirroring’ as used in therapy is useful here, so if someone is standing, you stand too. Also, try to pick up on facial affect (emotion shown on the face frowns, gestures etc). Mentalisation or the ability to imagine what another person experiences is a component of social cognition
- Unconditional positive regard (UPR): try and understand things from their point of view. It is crucial that you do not give your opinion or thoughts on what they should be doing. In order for the genuine self to emerge, it’s important you just listen and paraphrase back what you have heard just to confirm to them that they are being listened to.
Sincere listening
Rogers also proposed three further conditions. Although more relevant to the therapeutic situation, they are nevertheless useful to know:
- Therapist-client relationship: most psychological work in therapy relies on a ‘therapeutic alliance’ meaning that both parties get on with each other. I would add that being of the disposition that people feel comfortable with you and can be themselves around you is the hallmark of a successful career clinically and personally. It is also important to develop self-awareness of your facial affect and body language
- Client incongruence: at its core incongruence is the gap between what an individual wants to be, or their ‘ideal self’ and their ‘perceived self’ which is what they show to the world
- Client perception of empathy and unconditional positive regard: this means that when you are listening to someone, you are completely present and transmit a genuine desire to listen.
I would emphasise this is not about becoming a therapist for someone, since some psychological issues are complicated and have roots in early childhood trauma, dysfunctional households, later life trauma etc.
In addition, we all have personalities organised in different ways and operate on various levels of defence. Overall, our personality is the interplay of complex biological, social, psychological factors, and early life experience.
Meaningful psychotherapy is about listening. A good therapist listens and doesn’t tell you what to do, but they can increase your capacity to understand more about yourself and to not live life in an automated way.
By listening sincerely to another person, we can potentially transform their life.
For references, please contact [email protected].
