Stress, Anxiety, Burnout and Looking After yourself
A personal perspective on turning anxiety into an asset
Background
I believe in quality care, good standards, consistency and effective regulation. In accordance with my values, I blew the whistle at a university dental hospital and experienced the complete opposite to what ought to have happened. Thereafter, I became infamous for publishing The Philosophy Fridge in which I exposed the consequences of following regulatory guidelines.
In the year after my book was published, I would occasionally receive an enquiry from a member of the dental team in distress - searching for advice. I’d inform them that I’m not a therapist and suggest they consider finding one. The enquiries came from across the dental workforce from individuals who’d reached breaking point and had typically been through online and in-person professional mental health support and often coaching. They often reported sessions as generic, unreflective of reality, but a welcome break from their dental practice.
The number of enquires has steadily risen to between 155-160 enquiries a year. This is something I’ve recently pointed out to the Chief Dental Officer, Dr Jason Wong. I’ve also pointed out to him that the rising numbers are directly linked to the concerns I raised in The Philosophy Fridge. As my concerns were brushed under the carpet and never addressed, I’ve asked Dr Wong to consider an Independent Review into the handling of my concerns and assured him there is an ample document trail for a meaningful review towards potential reform.
In the meantime, I feel sorry for the desperate colleagues who reach out to me. I engage with them as a fellow dentist and they usually want to know what my trick to survival was and I tell them. I’ve written this article as an insight into my thinking behind what I tell them. The article is not, however, a dispassionate discovery of psychological science. It’s a targeted presentation of an ideology of interpreting anxiety in a positive way, and essentially, how it makes sense to me. Specifically, it’s my interpretation of anxiety being an instrument designed to be conditioned into an asset.
The article is not a criticism of mental health support services, although, as an insight to anyone considering reaching out to a professional for mental health support, it does mention some of the specific concerns being raised by professionals from within the field.
Throughout the article anxiety, psychological distress, stress, and burnout are conflated because this is how it is in life.
Common features
Invariably, the ‘real’ struggle starts when a person loses control over negative thoughts, fear becomes a driver, and worry dominates. A person entering ‘crisis’ usually doesn’t realise that it’s due to every moment of their life up to that moment and that work related issues merely expose the underlying deficiencies. The common desire is to reverse these features, and to awaken ‘feeling fulfilled’ pathways.
Ambition and Hope
Eliminating undesirable behaviours and practices from the workplace is a great ambition. The ambition has been active and ongoing across the 34 years I’ve been practicing. Sadly, in those 34 years, the situation has steadily slipped in the wrong direction. In the meantime, it helps to be able to deal with things as they are, and this requires hope. In this respect, hope is designed not to make the outside world a better place but to prevent us from crumbling on the inside less often.
Strategy and Action
Should you wish to consider taking the approach I took, it begins with 7 fundamental shifts in mindset:
1. Align your understanding of anxiety to respect that nature placed the instrument in us for a reason and a purpose.
2. Accept that occasionally feeling unsure, uneasy, awkward, and nervously intrigued is transient and happens naturally – probably as a consequence of our mind and body being in a constant state of flux, growth and change, repair and renewal. It doesn’t result in any harm - unless it’s misunderstood.
3. Accept that feeling unsure, awful, awkward, and nervously intrigued can also occur as a consequence of injustice or suboptimal conditioning and/or unrealistic expectations. In the case of injustice, it needs to stop; as for suboptimal conditioning and/or unrealistic expectations, they need correcting.
4. Accept that some stress and some emotional fluctuations are unavoidable and even necessary for resilience.
5. Accept that integration into society happens by getting along with anyone and everyone, anywhere and everywhere exactly as you find them, avoidance and withdrawal isn’t advisable and usually results in isolation and harm.
6. Accept that during assimilation and correction, granting yourself a pardon, when you falter, which you will, is a necessary kindness.
7. Accept that professional mental health support works on a ‘trial and error’ basis and a belief that it will be beneficial. The medications also work on the same basis, ‘trial and error’, and belief and hope. Immediate effect is rare.
Once you’ve internalised these policies, they are not a quick fix. You have to maintain an active effort of enforcing them. The action is to accept all emotions, thoughts, feelings and behaviours and to gently fade out the unhelpful ones without overly amplifying the desirable ones.
Over time, you realise that the longer you stick at it, the easier it gets. The more you accept the realities of humanity and history the easier it gets, until, the breakthrough moment, when you no longer begrudge reality for it is.
Over time, you realise that the key to happiness is balance, and balance requires a broad experience of a full spectrum of emotions, good and uplifting versus cruel and deflating. Avoiding the negative ones with sights set on only chasing positive ones is a perfect set up for 'emotional fragility', and disaster.
Context and some of the figures
The context of the article runs parallel with the fact that dentists are more prone than other professionals to burnout, anxiety, and depression(1). The numbers have continued to rise despite decades of research, awareness campaigns, and well-established coping strategies(2). Although, there are no primary prevention-level studies(3). A 2025 study reported that, in the US male and female dentists exhibited higher suicide mortality than the general population, with a steady increase since 1995(4). A recent study in the UK (5) reported 61% of respondents scoring as ‘high' on the emotional exhaustion scale. Another study looking at dental and dental hygiene students reported that 40% of the dental and 38% of the hygiene students met criteria for burnout(6). It’s also been suggested that the other members of the dental team experience similar levels of distress as dentists, and that mental health factors other than those directly related to occupational stress should also be considered (7).
Looking at anxiety in a positive way
The idea of looking at anxiety in a positive way didn’t happen intentionally nor was it an academic exercise. It came from a mind (and body) in severe distress during a near-debilitating failure to cope with The Philosophy Fridge experience. It was a protracted episode of unrelenting injustice, bullying and toxic stress from within the corridors of the dental profession. Enlightenment came like an epiphany in 2017 with almost all of the meaning coming from this magical string of words which I found in a book (8) by the former heavy weight boxer Mohammed Ali: “If your dreams don’t scare you, they aren’t big enough”.
Anxiety the Instrument and Asset
Anxiety is natural and at the basic level it’s function, in the broadest sense, is to protect us from danger. Beyond that it gets complex – fast.
Anxiety is the pre-emptive feeling which allows us to characterise events as potentially harmful or a potential opportunity. It’s the pre-emptive emotion that subsumes all other emotions, and it suffuses our every perception.
Anxiety is born-in or alternatively the tools for its actuation are richly in place at birth. It links fear, worry and ambition. Anxiety is our interface with the world around us, its genesis is subconscious and the centre of its activity is our gut. It acts much like the wind blowing in our face, providing crucial sensual information about our surroundings. Learning how to interpret its nuances, react to it and respond to it is a skill that has to be learned. Learning moulds our character.
Anxiety is nurtured from birth onwards through an ongoing process of experiences of ever-increasing levels of complexity. Each episode of it is a call to parents for some much-needed assistance, advice and training, it is not a call for denial, suppression, avoidance or protection.
Anxiety is the first part of a two-part chain reaction. This first part is gut feelings, and they cater for the fact that we are physical in nature. When the danger or opportunity is clear, present and physical the gut feelings are acted upon reflexively, with immediate automatic action. Otherwise, our immediate feelings are passed to the second part of the chain reaction, our mind. Our mind caters for our need to integrate and succeed in society; it, subject to our character, modulates, delays, hides, or generally makes our immediate feelings more considerate before having them enacted by our brain.
If Anxiety is perceived through the lens of fear, it creates a sense of fright – which we find worrisome and debilitating. If, however, the same anxiety is perceived through the lens of ambition, it results in a sense of elation – which motivates us to push ahead.
In absolute health and in the absence of clear physical danger the mind has the final say on what actions are taken, ensuring that they won't result in harm or at least that the potential for harm can be off set against the magnitude of opportunity.
Tensions start to rise when, to the gut, it appears as if the mind is continually ignoring its messages; this creates a mind-body dissonance that is recognised as stress or dis-ease. The stress manifests with emotional, mental, psychological, behavioural and physical effects.
The concerns being raised from within the mental health field
In recent years talk of mental wellbeing and mental illness has continued to rise in popularity in the public conversation, almost to the point of distraction. The Diagnostic Statistical Manual of Mental Disorders (DSM) compiled by the American Psychiatric Association is often referred to as the ‘bible’ of psychiatric disorders.
The first edition in 1952 listed 106 disorders while the fifth edition (published in 2013, with its most recent revision in 2022) lists 541 disorders. The continued rise in disorders and the number of people being diagnosed with them has prompted some mental health researchers to argue that instead of continuing to further fragment disorders that there may be more value in looking at dysfunctions common across them.
They’ve been asking if in fact the number of disorders should be reduced to a single disorder(9). The situation has resulted in some mental health experts saying, ‘it would be really helpful if it was more widely understood that the official list of psychiatric diagnoses is essentially a list of ideas and not a catalogue of biological truth’(9). They have also said, ‘it would be really helpful if it was more widely understood that when professional mental health support is successful, it is reliant on the individual believing that the therapy will benefit them, and on them accepting that it works on a ‘trial and error’ basis, as do the medications(9).
‘Mental health care and research are broken’, say The Foundation for Evolution and Mental Health (FEMH) on its official website (https://femh.net/). FEMH is one of many organisations set up by psychiatrists frustrated by the failings of traditional psychiatry. Their opinion, broadly, is: Natural Anxiety needs to be reconsidered. They argue that reconsidering what nature intended the natural purpose of anxiety to be, may hold clues to a potential solution to the never ending rise(10).
Professor Steven Pinker a respected Harvard based cognitive psychologist, and writer, has raised his concerns about the intricacies of communication(11) and the problems this creates in professional mental health support with professionals not saying what they mean, and hearing what they want. No end of projection, assumption, suggestion, inference; whilst mistaking – by accident, intention or ignorance – personal conviviality for sincerity of purpose.
The dysfunction common across disorders
In my experience, the key underlying dysfunction which is common across disorders isn’t anxiety but a dysfunction of it. The dysfunction emerges from misunderstanding, mismanaging or abusing the instrument of anxiety and/or suboptimal conditioning of the instrument. The instrument of anxiety has to be cultivated within its apparatus from the day we are born, carefully, like a rare plant liable to become extinct at any moment. It’s an exceptionally demanding part of parenting requiring a carefully planned approach.
The role of conditioning is key to formative development, and dysfunction is often passed from parent to child(12), based on the ideology and beliefs of the parent (or lack of the same).
Suboptimal conditioning is typically associated with overprotective parenting and/or neglect and/or abuse and/or being abandoned. Anxiety is naturally associated with aversion, dysfunction occurs when as a consequence of the suboptimal conditioning fear, worry and avoidance are indoctrinated into the formative pathways; usually in association with seeking comfort over discomfort and dis-ease.
It seems right to me that dysfunction doesn’t result suddenly but starts to emerge after an incubation period between birth and ages theorised in Theory of Mind(13). The theory behind which is: between the age 3 and 6 years we develop the cognitive ability to attribute mental states -beliefs, desires, intentions, emotions, and knowledge-to oneself and others, and the ability to recognise that others have perspectives distinct from our own.
The manifestation of dysfunction is an inability to get along with others and a failure to integrate into society.
Related and associated psychological concepts
My perspective on anxiety isn’t the same as what Sigmund Freud theorised in psychoanalytic theory - signal anxiety(14). His theory was that low-level anxiety functions as an internal warning signal. One of the fundamental differences is that Freud's ideas (and those of another group of researchers called behaviourists,) were based on the premise that people are moved by forces largely out of their control.
My perspective aligns better with the ideas and approach of the American Psychologist Dr George Kelly which he theorised in Personal Construct Theory(15). The theory behind which is that psychological disturbance/distress is not caused by what happens to us but by our differing interpretations of events. Its primary strength lies in this holistic, agency-centred approach, which empowers individuals by treating them as active participants in interpreting their reality rather than passive subjects.
Unresolved Dysfunction
Once an individual has been mismanaged or mistreated into dysfunction, the dysfunction has a tendency to behave in a self-perpetuating way, as theorised in Network Theory(16). The theory behind which is that various ‘symptoms’ can trigger a dysfunction, after which being in dysfunction can generate more of the same ‘symptoms’ creating more dysfunction; and, thus, a self-sustaining system. Potentially creating a linear path from dysfunction to disorder and beyond. For example, if dysfunction remains unresolved the official diagnosis shifts up to ‘Clinical Anxiety’ and if this remains unresolved it shifts up again to ‘Anxiety Disorder’ and up again to ‘Personality Disorder’ and/or ‘Behavioural Disorder’ and/or ‘Depression’ and/or ‘Suicidal Ideology’.
Leaving dysfunction unresolved leads to more of the same vulnerability(17) possibly to oblivion (18). Whereas addressing ‘symptoms’ can lead to self-empowerment(19).
Correction and Reconditing
Correction is notoriously difficult because an intrinsic part of Anxiety Dysfunction is the inability to see your way out of it, it feels as if it’s impossible. You need to make a decision and stick to it; this requires a stability of identity which is usually missing and takes time to assimilate.
You have to believe wholeheartedly that thoughts, feelings and behaviours can be controlled. This belief is the umbrella under which Cognitive Behaviour Therapy(20) operates.
Correction relies on reconditing the network. To do so, there are a variety of concepts that essentially recommend something similar. They use a range to words, like, for example, desensitise, recalibrate, reinvent, counter-condition, habituate, reciprocal inhibition, de-conditioning, dampening. The theory behind cognitive behaviour therapy is that your thoughts and behaviours affect how you feel and vice-versa.
Some additional books I recommend for self-directed personal development.
Nosedive – An Unconventional Rescue. Published Anonymously – is the perfect book for stimulating debate and discussion on existential matters of the heart, mind and body, including every taboo there is.
The Chimp Paradox by Professor Steve Peters – is an excellent book. It’s reasonable and logical, and easy to follow.
An Intimate History of Humanity by Theodore Zeldin - helps you realise that: ‘there’s nothing new under the sun’, and it also helps defeat the modern thought: ‘I can’t be right unless there’s something wrong with me’.
The Blank Slate by Professor Steven Pinker, discusses parenting styles by looking at the nature-nurture debate and how it and social policy have been distorted.
Good Reasons for Bad Feelings - Insights from the frontier of Evolutionary Psychiatry. By Randolph M. Nesse. The American Physician who with book Why We Get Sick, established the field of evolutionary medicine.
References
8. Ali H, Ali M, The Soul Of A Butterfly: Reflections on life’s journey. Bantam: 2005
9. Foulkes L, What Mental Illness Really Is (and what it isn’t): Penguin Random House; 2012 (pages 1-69)
15. Butt T. George Kelly - The Psychology of Personal Constructs. Bloomsbury Publishing 2008
16. Borsboom, D A. A network theory of mental disorders. World Psychiatry 16, 5-13 2017