Six Tips for Dealing With Bullies

"You're a bully, Mother."

"I am not!"

"Yes, you are. Anyone who makes another feel less of themselves is a bully."

            ~Sue Sylvester, calling the kettle black in 'Glee'.

Bullying. What a stupid word to describe such aggressive, terrorizing, malignant behavior.

Bullies come in all sizes, genders and ages. They can be found in all environments where human interaction takes place. As parents we focus on protecting our children from bullies at school, but that can just as easily be in our workplace, neighborhood, even our place of worship.

When I was a kid I had my share of teasing but not what I would call aggravated bullying. There was a little girl younger than me, though, in my neighborhood who was harassed by her brother. He could be verbally vicious, and that was what I saw. God knows what happened behind closed doors. It still makes me cringe that I did nothing for that child, even though I was a child myself. Where the hell were the parents? Probably confusing run of the mill "sibling rivalry" with the horrible reality of the sibling bullying occurring in their home.

As a grown up I ran into bullying from an unlikely source – my boss. It took years and comparing notes with co-workers to fully comprehend what was going on. Rather than continue to absorb the psychological blows, I quit.  Workplace bullies are not as uncommon as I naively thought. Today sexual harassment and environmental safety laws help but I believe that has only driven the behavior underground.


The Hierarchy of Disease: Whose is Worse, Yours or Mine?

Today I heard from my friend at Heart Sisters, Carolyn Thomas. She was commenting on my article, "Celebrities Talk About Their Illness in Vanity Fair." What she had to say is worth repeating so I reprinted it here in its entirety.

Hi Dr. A,

I had to laugh at Christopher Hitchins writing: "One almost develops a kind of elitism about the uniqueness of one's own personal disorder."

I have found this to be very true for heart disease, which I was diagnosed with two years ago.

I call it the "Hierarchy of Heart Disease". I think I invented the concept, but many heart attack survivors like me have reported experiencing a similar reaction when telling others about their own diagnosis.


My Weight Loss Journey: The Dreaded Plateau!

Today I weighed myself to find I finally broke through the 140 pound Wall of Death. The digital read-out said "139.7" Yes, I realize that is only 3/10th of a pound below 140 but, dear God Almighty, I took it, held it close to my heart and did my happy Snoopy dance anyway!

This achievement is oh soooo sweet! For week after week I vacillated between 141 and 144. Many a weight loss ship is wrecked upon the rocks of the dreaded PLATEAU. Mine has always been at that five-pounds-left-to-go-before-goal phase. It happened many times, the latest a few years ago when I did Weight Watchers. I did fine until I was five pounds away from goal. Then I stopped losing and started gaining again.

It was so frustrating. Like climbing within ten feet of the summit of Mount Everest and turning back for no good reason.

The PLATEAU is generally attributed to biological stuff. Everyone knows that in order to lose weight the number of calories 'In' has to be less than the number of calories 'Out'. If you try to lose weight quickly by going on a super restrictive low calorie diet, the body/brain perceives a famine is going on out there. Result: It does what it needs to do to keep the metabolism from burning the few calories that are coming in. Thus a plateau.

The number one way to avoid a plateau is not lose weight so fast in the first place. Forget The Biggest Loser. Double digit a week weight loss is for idiots! Healthy, permanent, weight loss is no more than two pounds a week (doctor's orders). In order to make my weight loss journey the last one I ever have to take, I decided on targeting one pound a week, and I was happy I did, until the PLATEAU!

If I was losing weight super slowly why was I stalled? If my plateau wasn't biological, could it be psychological?


Fear Masquerading as Anger

"Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned"  ~Buddha

The subject of anger has come up a lot recently, not just in my practice. You can't read the news for very long without running into someone somewhere who is very pissed off, or if you read long enough, getting angry yourself.

Anger can be a healthy response. I haven't hesitated to tell my depressed and anxious patients that getting angry is an evolutionary step up from passively absorbing someone else's abuse. But how to judge when anger is justified or express anger in a regulated manner is tricky and how not to let it consume us once the angry monster is unleashed is trickier still.

A little insight has helped me see anger from another angle.

Elizabeth Kubler-Ross, famous for identifying the five emotional stages of accepting death, wrote that she believed anger was not a primary emotion. A primary emotion is one, like pleasure or fear, that comes directly from the limbic system in our brain, the design of which is to keep the individual safe and therefore the species alive. Dr. Kubler-Ross said that anger is secondary to something else, usually fear.

That got me thinking of all the times I was really, really angry. Like the time I was furious over a seemingly heartless decision made by a ruthless bureaucrat. The anger was so great it nearly blinded me. For days it ate at me because there was no where to put it. It burned my heart like Buddha's hot coal. With the passage of time (and a lot of prayer) it cooled off. Now on reflection I can see how scared to death I was, how terrified that because of a person I never met, my family's well-being had been seriously threatened.

Knowing that fear can mascaquerade as anger has helped me be more compassionate when others become angry. When an elderly relative went off on me over an imagined insult I remembered what Dr. Kubler-Ross said. This person was afraid, afraid of becoming feeble, dependent, afraid of financial insecurity, afraid of death. I was just a handy target. No need for me to get angry back.

When I see spouses expressing anger at each other I now ask them to refelct on what are they afraid of. It doesn't take long for them to get to their fear of abandonment, of loss of love. With understanding the hope of compassion is allowed to follow and we can take action. We can let go of the burning coal.

10 Ways to Care for Your Marriage When You have a Chronic Illness

Good Morning! Today I want to address two really good questions I received concerning husbands when I was the Chronic Illness Expert at Cafe Mom. This one is from Debbie:

"I have a question regarding spouses. I imagine that dealing with "us" becomes overwhelming and frustrating for them, however, what is it when you know yourself that they are using you as an excuse, or blaming you…. making it out that they are NOT the ones with an issue or attitude, that it is us (all the time?). That is simply not true.  But it becomes a battle of wits… almost like you are being enticed into an argument for the sake of making them appear right. Why is this?"

 And this from Susan:

"What are some tips for helping our mates cope with this awful spot they are in?  My husband has had to step and take on primary responsibility for work, since I can only work sporadically, care of our son, cooking etc.  We've developed some crafty ways to tell him when I am in pain and how severe it is, like using magnetic numbers for the fridge.  But I mean deeper, he is starting to show signs of wear and tear.  I do my best to make sure he gets some free time, but he has the weight of the world on his shoulders and I want to lift some of that off without plopping it on me in the form of guilt."

 How many of us really know what we are talking about when we take our wedding vows, “in sickness and in health”? Most of us don’t have a clue. Our partners were blind-sided by the illness just like we were and therefore they are vulnerable to similar emotional stress.

Most of us, men in particular, are programmed from birth to fix things. Our healthy spouses hate that in the face of chronic illness, they can’t fix things for you. Their frustration can come out as irritability, sniping, overcompensation, co-dependent, enabling-type behavior, throwing themselves into work (an area where they can feel competant) and/or shutting down emotionally, appearing kind of flat. All of these can be masking depression.

When we are talking about our spouse’s happiness we are often talking about the health of our marriage. Here are a few tips that I hope will help your marriage cope with the stress of chronic illness. Not in order of importance:

1) Be honest with yourself. Only you in your heart can know how much you reasonably can and cannot do. When you know your limits there is no need to be defensive.

2) Remember you are on the same team. Your marriage is a cart being drawn by two horses, you and your spouse. Being a team, when you pull in the same direction with the same speed, your cart goes forward. If you run in opposite directions, the cart falls apart.



Celebrities Talk About Their Illnesses in Vanity Fair

Reading about celebrities and their experience with illness is always interesting to me. Celebrity can be a bully pulpit. People like Michael J. Fox choose to take their story public as a way to inform, educate and inspire. Katie Couric did the same after her husband died of colon cancer, going so far as to broadcast her colonoscopy on the Today Show. Millions are touched and very possibly lives saved because of their efforts.

Today at breakfast I flipped though the latest Vanity Fair magazine which I had swiped from the office (I'm the boss, I can do that! ;-). There was not just one but two articles about illness this month! Barbara Walters with her tale about open heart surgery and Christopher Hitchins's latest chronicle about living with stage four esophogeal cancer.

I find it interesting that people coping with illness are so promenently exposed in a glossy high-end magazine. I mean, this isn't Reader's Digest or the AARP monthly. OK, they are celebrities, but still…

The articles are very different, as different as the individuals who wrote them. Barbara Walters blithely tells about pressure in her chest as the only symptom that anything was wrong; if you don't have an annual check up you are "a dope". She name drops like crazy. Oprah sent her a white blanket rather than flowers, wasn't that thoughtful?

Christoper Hitchins is a writer known for being an atheist and an acerbic critic of just about everybody. He tells of how uncool it is for complete strangers to tell you about how they understand exactly how you feel because Uncle So & So had liver cancer and died a horrible death from it.

I like them both. Barbara is smart and nice. Hitchins is smart and cutting like a razor.

Both inform from an oddly acceptable self-centered place. Hitchens is totally up front about it. He says, "One almost develops a kind of elitism about the uniqueness of one's own personal disorder," and "Cancer victimhood contains a permanent temptation to be self-centered and even solipsistic." He's British so he can say things that way. But it is also true, not only of people with cancer but anyone in chronic pain or living with the ups and downs of chronic illness. We try hard to be in the world while our illness pulls us to conserve our energies by isolating and becoming self-absorbed. It's a tricky thing to balance.

Miss Manners and the Big C, by Christopher Hitchins

Her Change of Heart, by Barbara Walters is not available online yet. You can find it in the December 2010 Vanity Fair. Cher is on the cover looking strangely preserved for a 64 year old woman. To make up for the article, here is Barbara talking about it with her buddies on The View.


Getting Back on the Horse After a Fall

Something happened the other day. I was riding Annie, my excitable mare. Our training was going so well. Ever since the show we've improved steadily, to the point where I was playing with the idea of jumping again. Just little cross rails, nothing big. Happily cantering around the ring, I was thinking how fabulously she felt, how much like flying! Out of nowhere she bolted out of my hands. I thought I had her when she spooked again and that did it, it was time to bale. Out of the saddle and onto the ground – Bam!

Flat on my back I let others in the ring make sure Annie was OK. I just lay there in the dirt like you’re supposed to, waiting for my breathing to return to something approaching normal. I knew I had hit  the back of my head. I had a good helmet on but you shouldn’t take anything for granted when the fall is hard.

I’ve fallen a lot. Riding requires falling. There is no avoiding it. Annie is sweet but not what you would call bomb-proof. This fall wasn’t my worst, I’d rank it second to the worst. So I lay on the ground, looking up at the sky, assuring my trainer that I could breathe and respond appropriately to her questions. Slowly I moved my hands, arms and legs, everything in working order. Then I rolled over and got up.

Walking around a little, all I could think of was, ‘I’m going to have a headache’ and getting back on. I had to get back on. Why? There wasn’t anything to prove. No one would think less of me if I didn’t.

I’m not sure I know even now. I think it has something to do with not wanting to live with fear. I did not want to be afraid of my horse, afraid that I didn’t have the skills to handle her, of knowing it could happen again. There's a reason why 'getting back on the horse' is a saying for not letting the fear get the best of us.

So I gathered Annie's reins, got back in the saddle (Ouchy! My butt hit the ground, too.) and under the watchful eyes of my trainer we walk-trotted with some degree of grace to end the lesson reasonably intact, body and mind.

Three Reasons to Make Family Meals a Priority

Below is an excerpt of an interview I did about the benefits of families eating together.

Q: What are the top three reasons a family should have at least one meal together?

I hope we are talking about having at least one meal together a week! Study after study has shown that the more often families eat together the healthier the kids are physically and emotionally.

1) Kids who eat regular meals with their family are less depressed and less likely to act out by doing things like smoke or do drugs. That alone is a good enough reason for me to promote more family meals. But the benefits apparently do not stop there.

2) Kids who participate in regular family meals do better in school, are more confident socially and delay having sex longer. It’s not just the kids who benefit, of course.

3) Families who eat together are likely to take more thought into what they are eating and so make better food choices. In other words, they eat more vegetables and less junk.

Q: Families are busy.  How can a family find the time to eat together with packed schedules?


7 Steps When Someone You Care About Is Depressed

  1. Be informed.
  2. Help your friend get help.
  3. Join supportive, informative organizations.
  4. Keep healthy boundaries.
  5. Do not work harder than your loved one.
  6. Take threats or comments about suicide seriously.
  7. Find help for yourself.

You can find the entire, more detailed article by clicking here.

I wrote this piece for Lawyers With Depression, a website founded by Daniel T. Lukasik, Esq, an attorney who has battled depression himself. He "established this site to try to be a loving presence to my fellow attorneys, judges and law students who suffer from this terrible disease.  Part of my attempt to be that loving presence is to establish, in one place, articles, materials and research that may help others in the profession with depression."

How much courage it takes to speak truth to a tradition that is all about showing no weakness, I can only imagine. For that alone I admire Dan a great deal. When he asked me to write an article about depression for the site and I was more than happy to do so. Below is an excerpt:

When I was in college, a close friend of mine went from being a free spirit to confining herself to her bedroom. She ate breakfast, lunch and dinner on her bed, if she ate at all. She stopped going to classes. When I visited she expected me to be happy sitting on her bed with her watching something on TV. She made sure the volume was too loud to allow conversation. When I asked her how she was, she said, “Fine.” When I told her I was worried about her, she got angry, “I told you. I’m fine!” So I shut up. The whole scene made me uneasy but I rationalized my fears by telling myself she was smart, that if something were truly wrong she would get help.

A month later her brother told me my friend was hospitalized after trying to kill herself. Thank God she survived. There was no hiding her depression any longer. Her family became involved and she got proper treatment and recovered.

Could I have done anything differently? Every single person who knew my friend asked themselves that question. We each had to deal with our feelings of anger, guilt and responsibility in our own way. Back then I was young and naïve. Today I know better. That doesn’t make it any easier. In fact, it is hard to face a demon like depression, whether you have it or a law student or lawyer you care about does.

Just know that you do not have to stand by and worry helplessly. There are some helpful things you can do to help yourself and your colleague, friend or loved one. Here are a few tips that I hope will help.

Click here to read the entire article.

5 Tips for Coping with Heart Disease on Heart Sisters

Dr. Elvira Aletta is a clinical psychologist with a unique perspective on what it’s like to live with a chronic illness. In her early twenties, she was diagnosed with nephrotic syndrome, a rare kidney disease that usually affects young boys. Then in her thirties, she came down with scleroderma…


When Carolyn Thomas notified me that an article I wrote on Five Tips For Living Well With Chronic Illness was going to be featured on her blog, Heart Sisters, I was thrilled! I love Heart Sisters and it is a real honor to be mentioned there. Check it out.

Heart Sisters is all about women and heart disease – the #1 killer in North America – from the unique perspective of a Mayo Clinic-trained heart attack survivor. Whether you are coping with heart disease, another chronic illness or are dealing with the chronic issues of living, you will find a caring and understanding voice at Heart Sisters.

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