Volume 8 • 2021 • Issue 6

Entryway to the Divine Dr. Friedman’s philosophy on caring for individuals with disabilities has evolved considerably over the years, something he attributes to his own personal growth as much as anything else. He describes his approach to care as something of a spiritual practice that is rooted in a desire to be authentic and not separate his spiritual self from his work self. This authenticity is something he firmly believes can be felt by the individuals he is treating. “I realized that I needed to develop my work as a spiritual practice,” he says. “So many of us make a distinction between work and spirituality. I didn’t want to go to work and have it separate from my spiritual needs. Working with children and individuals with disabilities gives you entry into an authenticity that working with an adult population can’t give you. Individuals with disabilities seldom wear a mask. What you see is what you get. I call it the entryway to the divine.” He also highlights the importance of maintaining a curiosity mindset and learning to let go of judgment so that he can see the individual for who they really are. “I say to my staff that it’s okay to be judgemental.We all have judgements. It’s whowe are as human beings. But what we need to do is acknowledge it. Recognize it and then let it go. Then I can see the person for who they really are and get an understanding of what is happening for them.” The Future of Special Needs Care More than 40 years into a career in pediatrics and special needs care, Dr. Friedman laments that in many ways dental care for those with disabilities has not advanced all that much since he started. At least not when it comes to certain fundamentals, such as access to care. When I ask him how he would like to see special needs care evolve, the first item on his wish list is for it to be recognized as specialty in its own right. He envisions a time when the special needs dentist will receive both the remuneration and prestige that acknowledges the extra training and expertise they have acquired. Until then, he fears that it will continue to be challenging to attract younger dentists to the field. “What we do is very complex, but it is not a single item. It’s not just surgery or endodontics or prosthodontics. It’s treating the whole person and I think that’s where people have great difficulty in recognizing it as a distinct specialty,” he says. Dr. Friedman believes that such recognition would have a knock-on effect on formal dental education, where improvements in training would build awareness and credibility for special needs careover the long term.This is something that has alreadyhappened in countries such as Ireland, England, Argentina, Brazil, Malaysia, and Australia where research and credibility is attracting more young dentists to the field. And yet despite the recent development of comprehensive undergraduate and postgrad curricula by the IADH education committee, upon which Dr. Friedman sits, uptake by dental schools has so far been limited to countries outside of North America. “If we don’t have a specialty, how do we get the general practitioner to engage?” asks Dr. Friedman. “Why do we have so many pediatric dentists still treating adults in their 50s and 60s? When a GP graduates and has no idea how to place an implant or to do orthodontics, they go and take further training. Why can’t they take further training to learn how to work with a patient with disability?” Funding remains a constant challenge. And although Dr. Friedman admits that the funding levels for preventative care are actually quite good, he cites gaps in the system: “If you are 65 years old and you get dementia, how do you access care if you don’t have the means? Who is the dentist who will go and work with you? Where is the training in our institutions for that? It’s not there. Why is it not there?” He refers to the physical process itself as “presencing” — a kind of meditative process that involves becoming fully present to the point that the disability in the individual falls away, allowing Dr. Friedman to deliver the best care possible. It’s a kind of letting go, a distinctly human approach that he considers a gift, something that pushes him to the edge of his comfort zone and constantly challenges him to learn and adapt. “I need to be present for the person where they are,” he says. “I cannot listen at the level where I am worried about what the individual says and how it affects me. I have to be listening at a level where I am fully there for them.” There are a number of ways in which Dr. Friedman achieves this state of presencing, but most commonly he achieves it through breathwork. “I might sit down with them and not say a word. Just put my hand on their shoulder and get myself aligned with their breathing. If they are anxious, they will be breathing fast. If I want them to calm down, I start to slow my own breath and they will mirror me. That’s presencing.” Individuals with disabilities seldom wear a mask. What you see iswhat you get. I call it the entryway to the divine. 34 | 2021 | Issue 6