6 Mental Health Benefits of Exercise

1) Raise endorphin levels

Endorphins are brain chemicals that create feelings of euphoria. Exercise releases endorphins as well as sex, certain foods (chocolate, chili peppers), stress, and pain.

2) Decrease stress and anxiety

Exercise triggers the release of endorphins which generate happy feelings. Physical activity also increases norepinephrine, a stress hormone that strengthens the mind and body's response to stress.

3) Improve memory and cognition

Exercise raises levels of brain-derived neurotrophic factor (BDNF), a protein involved in learning and memory. Exercise also increases the production of new nerve cells (neurogenesis) in the hippocampus, a part of the brain involved in forming and storing memories and emotions.

4) Improve sleep

Exercising 3 to 4 hours before bedtime is a natural sleep remedy.  Exercise increases the core temperature of the body.  Following a workout, the body's core temperature returns to baseline, signaling that it is time for sleep. Disrupted sleep is often seen in many psychiatric conditions including depression, anxiety, and ADHD.

5) Boost self-confidence

A svelte physique, big muscles, weight loss, improved flexibility and strength - these are obvious benefits of regular physical activity. Even outside of these well-known benefits, exercise boosts self-esteem, self-confidence, and one's general feelings of attractiveness.

6) Increase pain tolerance

Similar to strong opiate pain medication like morphine and codeine, endorphins decrease pain perception without the devastating effects of addiction.

Surviving the Holiday Blues

The holiday season is "the most wonderful time of the year" for many but not for everyone. The stress and anxiety of the holidays is often a difficult time. Some struggle with:

  • the hustle and bustle and overall busyness - holiday parties, shopping for gifts, limited vacation time
  • isolation and loneliness - physical separation from loved ones who live far, family conflict, strained relationships
  • financial pressures that are often worsened by going into debt to buy gifts for family and friends
  • grief and loss
  • the stark contrast that exists between fantasy and reality during the holidays - what we imagine vs. how the season truly unfolds
  • too much "merry" as a means to cope with stress - overeating, overspending, and excessive drinking

According to the Hi-Health Holiday Stress Facts

www.hihealth.com/blog/holiday-stress-facts-you-need-to-know

  • 8 out of 10 Americans anticipate stress during the holiday season
  • A few of the top cited holiday stressors include - minimal time, lack of money, commercialism of the holiday season, pressure of giving and getting gifts, travel, adhering to a diet/healthy eating, amassing credit card debt, children

Sometimes what individuals perceive to be stress from the holidays is actually much more serious as can occur with Seasonal Affective Disorder, abbreviated SAD. A few facts about Seasonal Affective Disorder include:

  • SAD is a subtype of Major Depressive Disorder (MDD) - the depressive episodes occur during a specific time of the year and typically during the winter months
  • The prevalence is between 4 - 6%
  • Symptoms typically occur during the fall and winter months when shorter days fewer hours of sunlight and longer nights
  • Seasonal episodes outnumber non-seasonal depressive episodes
  • Depressive symptoms generally remit the during the spring and summer months
  • Seen most often in women in their 20s
  • Symptoms - sad or irritable mood, anhedonia (inability to experience pleasure from activities that one usually finds enjoyable), changes in sleep and appetite, fatigue, difficulty concentrating, worthless and hopeless feelings, thoughts of suicide
  • Treatment options consist of psychotherapy, medication, and lightbox therapy

So how do we avoid a Blue Christmas? Here are 5 strategies to combat the holiday blues named after some of my favorite holiday music

  1. Give Love on Christmas Day / Joy to the World - help those in need by volunteering at a nursing home or homeless shelter, granting a wish for a family from an angel tree, reading stories to children at a local hospital or nearby preschool to spread holiday cheer
  2. What Child is This - focus on the reason for the season, practice kindness and gratitude, set aside familial differences in the name of love
  3. Silent Night - take time to rest and forego the urge to overdo it at holiday parties, when shopping for gifts, or when decorating your home for the season; set a budget and stick to it or implement creative solutions to minimize costs (handmade gifts, gift exchange); create a schedule for various events and activities that won't overwhelm you or your family
  4. Rockin' Around the Christmas Tree - get moving and exercise, get enough rest, don't overindulge in sweets and too much eggnog
  5. Deck the Halls - establish new holiday traditions such helping to decorate a local church or hospital floor, watch holiday programs like Home Alone or Charlie Brown Christmas; take part in free or cheap activities such as driving around neighborhoods to view holiday lights or baking cookies to share with friends and neighbors

Remember it is okay to acknowledge difficult or sad feelings. And if you need help, please get it. Don't face the holiday season alone.

 

3 Things I Learned From My Toddler

My youngest daughter, Khloe, turned 3 a few months ago, and she embodies all things "I am three" in her adorable pint-sized form. Multiple times a day she reminds me of how fiercely independent she is as she repeatedly chants, "I can do it!" She is confident. She is sassy. She is persistent. And I've learned a few things from her.

1) Remove the limits

For Khloe, the rules and societal norms do not apply. It matters not that her preschool-aged peers wear typical school attire for she dons a tutu and princess crown to school almost every day. She wants to be Wonder Woman, Rapunzel, and Princess Elsa simultaneously as she sees no need to choose just one powerful female character. If you say she "can't", she believes otherwise and makes it her business to show you that she indeed "can." The limits her daddy and I impose are suggestions at best in my 3-year-old's mind.

Khloe life lesson #1 - It always seems impossible until it's done. So dream big, do the work, and turn those dreams into reality.

2) Embrace your inner princess

First Khloe demands, "Mommy, let me see myself," moving the step stool from the closet to the bathroom. Then, she places the stool squarely in front of the mirror, gazes adoringly at her beautiful reflection, and proudly announces, "I'm a pretty princess, mommy. I look so pretty."

She is proud. She is bold. She is fierce, sure of her identity and unapologetic. And I'm enamored with her.

Khloe life lesson #2 - Confidence is beautiful. Cultivate your identity, determine your purpose, and share your gift with the world. In the immortal words of William Shakespeare from A Midsummer's Night Dream, "Though she be but little, she is fierce!"

3) Persistence pays off

Children will wear you down like no one else. Armed with repeated name calling and an endless barrage of demands, my defense strategies weaken to the point of defeat. I mean who can resist a fresh faced, chubby cheeked cutie singing, "mommy, mommy, mommy" as she asks for milk or yogurt or my assistance during a search and rescue mission for a lost toy. Khloe will not stop asking until I give in to her requests or offer a suitable alternative.

Khloe life lesson #3 - Don't give up. Don't stop striving. Keep asking, keep pushing, and keep grinding until you get what you want!

Depression in the Eyes of Our Youth

As a board certified child, adolescent, and adult psychiatrist, I treat youth with depression almost every day.  Major Depressive Disorder, the medical term for clinical depression, is a debilitating illness that affects 12.5% of US youth aged 12 to 17 according to the National Institute of Mental Health. This means that, in 2015, 3 million teens had experienced at least one major depressive episode.

The signs and symptoms of depression include

  • sad mood and/or irritability
  • crying spells
  • too much or too little sleep
  • weight loss or weight gain secondary to changes in appetite
  • worthless and hopeless feelings
  • fatigue
  • difficulty concentrating
  • thoughts of suicide

Many young people also become much more withdrawn and isolative, no longer wish to hang out with their friends or do the things they used to enjoy, seem more irritable and easily agitated than sad and down, engage in risky behaviors (drugs, alcohol, sex), start cutting themselves as a way to cope with their emotional pain, miss school because they just "feel bad," or struggle academically.

A few weeks ago, I saw a teenage girl at my practice who shared with me a very beautifully written and poignant letter that she penned to her "depression."  I am sharing this letter with you today, with her permission, to illustrate the agony of depression:

"Dear Depression,

You need to leave me alone already. Everyday you're screaming at me and telling me how terrible I am. You make me replay every mistake I've ever made, and you humiliate me on a daily basis. You've made it impossible to be happy or have any connection with my friends and family. I am sick of you controlling me. The sooner you leave, the better off I'll be. Don't come back either. I never want you to be a part of my life again. I hate you, and I hate myself for every letting you in my head"

As a parent and child psychiatrist, I implore you - pay attention to your children. Don't chalk up their negativity and irritability to just a "bad attitude," especially if you see any of the other warning signs. Talk to your children. Ask them what's going on. Let them know you are interested and available to talk. And, most importantly, get help.

 

You are NOT CRAZY

The dreaded "C" word ... No one wants to see a psychiatrist or therapist for fear that he or she will be deemed crazy. Even the Merriam-Webster dictionary app defines the word "crazy" within its stigmatizing framework as one who is "not mentally sound: marked by thought or action that lacks reason." But I am here to tell you that I don't treat crazy people. I treat children and adults struggling with profound sadness and despair, paralyzing anxiety, difficulties at school or on their job, in the aftermath of devastating trauma, or reeling from failed relationships. Sometimes the individuals I treat suffer from serious mental illness like schizophrenia, a neurodegenerative disease characterized by hallucinations, delusions, and disordered speech or behavior. But never do I treat crazy people.

Here are 5 reasons why seeking mental health services makes you courageous not crazy:

1) Your brain is part of your body

Sometimes we create an imaginary line between our head and neck as if to separate our brain from the rest of our body - like our thoughts and emotions are somehow cut off from our heart, lungs, and limbs. However, our brains our incredibly powerful. We can live without some parts of our bodies like our appendix and gall bladder; and, through organ transplantation, physicians can replace almost every organ in our body (skin, kidneys, liver, heart, lungs, even cornea).  But you cannot live without your brain and brain transplants do not yet exist. Our brains function as big computers controlling everything we do from speaking and reading to walking and breathing. Our brains also control our emotions, our memories, and our sensory perceptions. Each of these neurobiological tasks are accomplished through an intricate array of neurons (nerve cells) and synapses that transmit information between the brain and other parts of the body. The brain and body are inexplicably linked which means that our thoughts and feelings are as integral to our existence and identity as the beating of our hearts, breathing, and eating.

2) Ignoring emotional symptoms rarely leads to their resolution

Stress happens. Negative emotions arise - sadness, disappointment, anger, rage, frustration, guilt, fear, worry ... they happen to the best of us. While I certainly don't advocate losing control and allowing our emotions to dictate our responses to life's challenges, I also don't recommend burying painful feelings either. With patients, I often compare stuffing our emotions to a volcano that swells and swells until it explodes, pouring molten lava onto the surrounding expanse, scorching everything in its path. The stress that comes from the difficult situations we experience in life tends to build rather than dissipate if you don't properly address it; and, at some point, you will explode and the fallout could have devastating consequences.

3) Mental illness is a complicated interaction between genetics and the environment

In healthcare, we often discuss risk factors. A risk factor, as defined by the World Health Organization, is "any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury." Common risk factors for mental illness include genetic predisposition or family history of psychiatric illness and environmental factors such as childhood trauma (physical or sexual abuse, neglect), poverty, substance abuse, medical illness and poor physical health, poor nutrition, lack of access to healthcare services, exposure to violence, gender inequalities, and discrimination and racism.

We can't choose to whom we are born, no one decides to develop a mental illness, and the circumstances in which we may find ourselves are sometimes completely outside of our control. Don't blame those struggling with Major Depressive Disorder, Autism, Schizophrenia, or other psychiatric disorders for their illness. Poor choices alone rarely lead to the disease state.

4) Prolonged and/or recurrent emotional instability is never a normal response to life stressors

In an attempt to normalize agonizing emotional responses or perhaps even to avoid difficult conversations, people often say things such as, "Of course you're depressed, you just got _______________ ." Fill in the blank - divorce, cancer, job loss, etc. This notion is frankly incorrect. The development of a mental illness is not an expected response to life's challenges. You might feel sad or disappointed or even anxious in the face of struggles, but that does not constitute Major Depressive Disorder or Generalized Anxiety Disorder.  Bad feelings and psychiatric diagnoses ARE NOT synonymous.

Conversely, recognizing the difference between an expected reaction to a stressful event such as grief vs. a mental illness like Major Depressive Disorder is critical.  Crying at a funeral is strikingly different from the inability to maintain employment because you cannot get out of bed, no longer bathe, and are having suicidal thoughts after the death of a loved one. Failure to acknowledge these discrepancies can lead to a lack of appropriate treatment, worsening symptoms, and debilitating outcomes.

5) There is no health without mental health

Numerous studies document the bi-directional relationship between physical illness and mental health, especially with chronic medical illnesses such as diabetes, cancer, cardiovascular disease, and Chronic Obstructive Pulmonary Disease (COPD). Individuals with chronic medical illnesses have a higher risk of depression compared to the general population. People with chronic disease and co-morbid depression often have worse health outcomes secondary to poor adherence to treatment and self-care practices, greater symptom burden, and more problematic lifestyle choices (smoking, lack of consistent exercise, poor nutrition). The Centers for Disease Control (CDC) published an issue brief in October 2012 that noted 3 findings I found striking:

  • Depression co-occurs in 17% of cardiovascular cases, 23% of cerebrovascular cases, 27% of people with diabetes, and >40% of those with cancer
  • The cost to treat chronic diseases makes up around 75% of the total national health expenditure
  • Depression leads to 200 million lost work days annually and costs employers from $17 - $44 billion

My charge to you is PRESERVE YOUR MENTAL HEALTH! Get help - this does not make you crazy.  The preservation of your mental health allows you to take care of yourself and your family, work and make a meaningful contribution to society, find purpose for your life, and engage in fulfilling relationships.

Taming the Mood Monster: The Curious Chameleon

A chameleon possesses the unique ability to change the color of its skin.  Color change aids in camouflage, heat regulation, and light absorption; but, a chameleon also changes its color in response to its mood. Brightly colored male chameleons more easily attract females while a chameleon donning black coloring may be stressed. Similarly, youth with anxiety behave differently depending on the child and the setting. This is why I often refer to anxiety as the “the great imitator.”

We all have the image of an anxious kid – fretful, pacing, and pensive.  He asks 20 questions while biting his fingers or twirling her hair. The classically anxious child appears scared, fearful, and worried. But what about the child who is irritable and easily agitated or tense and on edge, who is so sick he cannot attend school for days on end, or who is whiny and cloying.  Well that might be anxiety, too!

A child with separation anxiety might complain of daily headaches or nausea and belly pain so severe that they miss school frequently. However, appointments with the pediatrician or family physician never uncover a medical explanation for his symptoms.  It could be social anxiety if your child gets visibly upset when you suggest he introduce himself to the neighbor’s kids or when you want to drop her off at a birthday party. Or what about the kid who cries and says he is afraid something bad is going to happen when you ask him to ride the 3rd floor on the elevator. Anxiety often mimics an array of feelings.

A common emotional response to stress, anxiety is an emotion characterized by fear, apprehension, and worry. What you see as an ordinary life event such as starting a new school year, making new friends, or going on a field trip, your child truly perceives as frightening or threatening.  He loses sleep because of fear and worry or she misses out on sports and other social activities; and, all your efforts aimed at reassuring your child prove futile.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), “anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is the anticipation of future threat.” There are several different anxiety disorders outlined in the DSM-V including Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder, Selective Mutism, Specific Phobia, Social Anxiety Disorder (Social Phobia), and Panic Disorder. Obsessive Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) were previously classified as anxiety disorders but not fall into their own respective categories.

Here are 5 tips for when your child might be anxious:

1) Consider that your child might be anxious

Rather than assume that your child is simply angry or frustrated when she refuses to set foot on the school bus, consider that she might be worried. Ask her if he has something on her mind that is bothering her. Ask her if she wants to share her feelings with you.

2) Acknowledge and validate his feelings

Clearly this tip is a recurring theme, so pay attention. While our natural inclination is to say, “Don’t worry … you’ll be fine,” we risk invalidating our children’s feelings. We don’t want to shame or ridicule them when they experience emotional distress as it teaches them to either hide how they feel or exaggerate the expression of those negative emotions so that you understand the magnitude of their fear.

3) Help your child differentiate between normal worry and exaggerated worry

Going to a new school, presenting a school project in front of the class, taking a standardized test, cheerleading tryouts – these are all activities that naturally engender some worry. Worry certainly has its place in our lives because it’s the brain’s way of saying, “Uh oh - danger lies ahead.” But sometimes those fears become exaggerated.  Excessive worry leads to paralysis, avoidance, and withdrawal. It controls your child’s life, dictating what he or she can or cannot do. Help them look for clues that would suggest their apprehension is out of proportion to the perceived threat. 

Teach them to identify their “stinkin thinkin.”  This technique is one of the hallmarks of Cognitive Behavioral Therapy or CBT. CBT as defined by the American Academy of Child and Adolescent Psychiatry is type of psychotherapy designed to “improve a child’s moods, anxiety, and behavior by examining confused or distorted patterns of thinking. CBT therapists teach children that thoughts cause feelings and moods which can influence behavior.” By training your child to “check the evidence” when he has bad thoughts, you can help him distinguish normal from exaggerated worry. A child will learn to quickly identify a negative thought when it enters his or her mind, recognizes that thoughts and feelings are NOT facts, and then run through a mental checklist of factors that either support or refute their negative thoughts and feelings.

4) Do not avoid situations that trigger anxiety

Avoidance is the “go to” strategy that many use to combat anxiety. If school makes your kid anxious, the let’s enroll in a home school program. If your daughter is afraid of dogs, never visit anyone’s home who has a dog or go to the park if dogs might be there. Avoidance seems good in theory as you are protecting your child from undue stress – WRONG! Avoidance only reinforces an undesirable behavior and worsens the symptoms over time. You can “dose” exposure to stressors much like you adjust dosages of medications. If you kid has considerable difficulty making new friends, start with striking up a conversation with relatives first with your guidance and then progress to established neighbors and lastly the new family in the neighborhood with and then involve yourself less as he or she gains more confidence and is less fearful.

5) Practice healthy coping skills

Give your child a list of strategies to try to neutralize their anxiety.  A list might include tips like:

  • Slow, deep breaths – Anxiety often manifests physically with a rapid heart rate, shortness of breath, sweaty palms, or nausea and belly pain. Slowing down your breathing helps to minimize the intensity of these symptoms.
  • Progressive muscle relaxation – Progressive muscle relaxation is a technique used to reduce stress. An individual will tense and then relax each muscle group, i.e. furrow your brow then relax, squeeze your face then relax, squeeze your shoulders then relax, etc.
  • Shift your focus from what might happen to what is happening – Many times exaggerated worry involves fear of the future. An anxious child will ask “what if” questions when they are nervous which leads to catastrophizing and fortune telling of all the bad things to come. Such questions negate the power of the present, the beauty in the what is right now. Help your child focus on what is currently happening rather than what could happen by weighing their negative thoughts and feelings against “the evidence.
  • Create a worry corner – Make a corner in the house specifically for worry. In that safe space, give your child 10 to 15 minutes in which they can express their worries by writing a list of all their worries for the day. When the timer goes off, they must fold up their worry list and put in a worry box. Then parents can sort through the list of worries and help their child put their worries into context – is this reasonable worry or exaggerated worry? Then child and parent can discuss tools to reframe and manage their exaggerated worries

Taming the Mood Monster: Gloomy, Blue Eeyore

Many of us recall watching Winnie the Pooh as children. The best of friends, Pooh, Piglet, Rabbit, Tigger, and Eeyore live together in the Hundred Acre Wood. Each character is unique - hunny-loving Pooh, fretful Piglet, persnickety Rabbit, winsome and buoyant Tigger, and gloomy, blue Eeyore. Always sad with his head hung low, Eeyore expects the worst, thinks very little of himself, and struggles to enjoy his friends or his life.

Sometimes our children fall into a bit of a funk. Much like us, they have bad days too.  Even in their youth, they face a myriad of challenges such as making a bad grade despite studying, failing to obtain the lead in the school play, losing the championship football game, finding out that their crush likes someone else, or learning that their parents are getting a divorce. We see them with their tear-stained cheeks, questioning their skills and abilities when they don't make the team, desperately wanting to be "cool" so their peers will like them, or resigning themselves never to try again because the pain of defeat was too much to bear.

As a parent, I wish I could magically resolve their conflicts and erase their heartaches and disappointments; but, I can't.  And frankly, fixing our children's problems for them only teaches them to come to us for solutions when difficulties arise, leaving them ill-equipped for the future and intolerant of emotional distress. So how do we prepare our children to handle sadness and failure?

1) Allow your child to feel sad or disappointed and encourage him to share those feelings with you

Similar to my previous post, "Taming the Mood Monster: The Fiery Dragon," the first strategy I list is for us to give our children permission to experience negative feelings. It is so hard to watch your baby cry miserably because she's upset, but this step is critical to her healthy emotional development. Whether through our words or our actions, when our initial response to their pain is telling them to "just get over it," we fail to acknowledge the hurt that is so real to them. We inadvertently create a space where our children no longer feel safe sharing or being vulnerable around us. We risk making them feel invalidated and silenced.

2) Adopt "the glass is half-full" mentality

Sometimes our children get so caught up in what went wrong and what they don't have that they forget what went right and all things they do have. To combat this tendency, I suggest adopting the "glass half-full" mentality where we intentionally look for the positive rather than focusing on the negative. This skill takes practice but can be quite effective in many circumstances. When your child's best friend decides to find new best friend, frame this as an opportunity to make new friends or hang out with old ones. When your child doesn't make the team, tell him that he now has time to take up another hobby or sport that he's been wanting to try. Reframing their perspective does not negate their disappointment nor does it disavow their feelings - it just shifts the focus.

3) Make a gratitude jar

Hurt and sadness blind our children's reality. They feel unloved, unwanted, empty, disconnected, and like a failure. They wear their gloom like a thick, heavy cloak that weighs them down. They see no good, unable to recognize that their view is distorted. To correct their twisted perspective, I suggest making a gratitude jar and ideally when their mood is good. Have your child write some things on slips of paper - something for which she is grateful, an individual, a blessing, an unexpected gift, a tender memory - then toss the paper into a beautifully decorated gratitude jar. When the blues overwhelm him, he can reach into the gratitude jar as a tangible reminder of all the good that is in his life despite his current circumstances. 

What tips do you use for pulling yourselves or your children out of the blue funk?

 

 

Taming the Mood Monster: The Fiery Dragon

Anger. We all recognize this strong emotion. Clenched fists, stomping feet, loud and harsh words, and a menacing gaze - I envision a wrathful dragon spewing fire that destroys everything in its path. Sometimes anger even manifests as physically aggressive behavior or destruction of property.  Many children find managing their anger quite difficult, particularly if they have a psychiatric diagnosis like Attention Deficit Hyperactivity Disorder (ADHD) or Oppositional Defiant Disorder (ODD). Even children without mental disorders struggle with temper outbursts.

My 6-year-old son is especially prone to such outbursts. While he is all things wonderful most of the time, he is impatient, easily frustrated, and downright cantankerous at others. Most commonly he becomes angry when he does not get his way. When he gets angry, he starts to whine followed by the dreaded (albeit cute) pouty face and bargaining. When I don't give in, then comes the accusations where he repeatedly says, "you're being mean" and "that's not fair" and stares angrily at me.  When he is really upset, he will antagonize the person he believes to hold the blame. He has broken his older sister's toys, taken something that does not belong to him and hid it, brushed up against my arm rather roughly, or written on his bedsheets or walls with a permanent marker. 

His angry outbursts make me feel as if I am losing control. And 'm a board-certified child and adolescent psychiatrist; so, I should be cool, calm, and collected, right? Umm, no, not all the time.

Since anger is a very common emotion that our children experience and one that can escalate quickly, I thought it would be helpful to discuss a few strategies to help our children manage their frustration and anger when those negative emotions arise.

1) Recognize and validate your child's feelings

Anger is a normal human emotion. Parents and children, alike, feel angry sometimes. Let your child know that you understand that X situation triggered his angry feelings and that you can see why that circumstance led to those negative thoughts and actions. Not only does this acknowledge the pain and internal distress bombarding his mind and body but also gives him a specific name for it, anger. In the future, he can use words to describe his feelings rather than relying on acting them out.

2) Speak calmly and in a soft voice while talking to your agitated child

I don't know if this happens at your house, but sometimes I find myself shouting "stop yelling" to my children who then respond to me by (gasp) yelling! We are relational creatures and highly responsive to our environments. When someone comes to me appearing tense and on edge, I instantaneously feel tense and on edge and respond accordingly. I am an emotionally mature grown up, and it still requires lot of effort for me to react calmly; so, imagine how difficult this is for children who are still in the throes of development. Practice patience. Speak softly and calmly as you inquire about their feelings. We must model the behaviors we wish for our children to adopt.

3) Give her the time and space to calm down

Talking to your child when she is still pretty riled up is futile. She is likely to be unreceptive, unwilling to listen to what you are trying to communicate to her. At times like this, there is no need to escalate the conflict further by insisting that she talk to you right now when you are both mad. Instead, ask her to find a place of her choosing to sit quietly and calm down.  You an reintroduce the conversation once you both have had an opportunity to allow some of the tension to die down.

4) Teach her self-soothing techniques and healthy coping strategies

Children are born not knowing how to do much at all.  As parents, we teach our little ones to feed themselves, walk, talk, ride bikes, and countless other developmental tasks. Yet development consists of much more than attaining cognitive and motor skills. The continuum of growth also encompasses social and emotional milestones. Learning how to regulate our moods and emotions is an essential developmental task that, if not mastered, can wreak havoc in a child's life. Frequently irritable and frustrated children often have trouble making friends which can lead to social isolation and withdrawal, anxiety, and depression.  Help her learn tools to calm herself when she is rattled, tips like deep breathing, counting to 10 or even 100, listening to music, or prayer and meditation. If she cannot think of a skill to use at the moment, offer one as a suggestion and assist her in putting that practice into place.

 

Celebrating Humanity

Personally, the year 2016 marked a year of milestones for me. Two were pretty big.  I turned the big "4-0," and I saw the manifestation of my hopes and dreams embodied through the formation of my mental health education and consulting company. But 2016 has also been very painful. Our home was vandalized, our garage doors spray painted with hate-filled symbols. Students at my children's elementary school were told that they would be made slaves and that a wall would be built to separate them from others once Donald Trump was elected president. The barrage of hate rhetoric and disturbing, violent images in the media are overwhelming and sometimes feels like too much to handle.  The divide in our country continues to grow, and we seem to have adopted an "us vs. them" mentality that only further propagates hatred and exclusion.

In direct opposition to the current sociopolitical climate, I decided to populate the atmosphere with beautiful quotes about love and the celebration of our humanity.  When the chaos in our world becomes unmanageable, reflect on these thoughts from some of the best poets, authors, activists, and humanitarians of our time.


"Love recognizes no barriers. It jumps hurdles, leaps fences, penetrates walls to arrive at its destination full of hope"

- Maya Angelou

"If we have no peace, it is because we have forgotten that we belong to each other"

- Mother Teresa

"Returning hate for hate multiples hate, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate, only love can do that"

- Martin Luther King, Jr

"Love and compassion are necessities, not luxuries. Without them humanity cannot survive"
- Dalai Lama

"The moment we begin to seek love, love begins to seek us. And to save us"

- Paulo Coelho

"Hate - it has caused a lot of problems in this world, but it has not solved one yet"

- Maya Angelou

"All of our humanity is dependent upon recognizing the humanity in others"

- Archbishop Desmond Tutu

"I have decided to stick with love. Hate is too great a burden to bear"

- Martin Luther King, Jr

"We have before us the glorious opportunity to inject a new dimension of love into the veins of our civilization"

- Martin Luther King, Jr

"Where there is love there is life"

- Mahatma Gandhi

 

Finding the Right Physician

Finding the right physician is no easy task, even for me and I'm a doctor. Over the last several months, I received care from 2 new doctors, a primary care physician (PCP) and a specialist. My experiences were horrible. I waited over an hour for my appointment with the PCP who never once acknowledged my prolonged wait time.  She then spent the bulk of my appointment staring intently at her computer screen while I shared my medical history.  My visit with the specialist was equally appalling.  Though I did not have to wait long, she spent barely 10 minutes with me.  In this short amount of time, she managed to dismiss all my questions and concerns as either silly or unimportant.  She barely smiled and stood with her arms folded tightly across her chest for the entire appointment. 

Sometimes I forget what it's like to share your fears and concerns with a total stranger. I forget the awkwardness and vulnerability inherent in disrobing during your appointment only to have an outsider inspect your nakedness like you are just a collection of body parts with a problem to be solved.  These 2 doctor appointments reminded me of the intimacy of the doctor-patient relationship and how awful it feels when things go awry - a jarring wake up call for me to examine how my patients experience their encounter with me. The connection between a patient and his/her physician is unique and one that I profoundly respect and cherish.

Physicians, like everyone else, certainly can have a bad day or two.  We get stuck in traffic, our cars break down, our children get sick, and we make mistakes; but, it is our professional obligation to treat all patients with respect and kindness.

So how do you find the right physician for yourself or your family? Well here are 5 tips that I suggest for choosing the right doctor. And if you are wondering, no, I did not follow my own advice when selecting either of these 2 physicians.  At the time, I was in a time crunch and needed quick availability.  I got seen quickly but sacrificed the quality of the relationship.

1) Ask for referrals BUT consider the practicalities - insurance coverage, practice location, wait time for new patient appointments

If your friend, neighbor, co-worker, or another physician suggests a particular doctor, explore this option. Good physicians are popular for a reason - because they are good! Just keep in mind that who you can see is dictated by your insurance coverage unless you are willing and able to pay for an out-of-network provider. Sometimes the next available appointment for new patient time slot is 3 or more months away, especially for specialists and very popular primary care physicians.

2) Do you feel valued? Does he listen to your concerns? Does she understand your needs?

Trust is essential to any healthy relationship, and the doctor-patient relationship is no exception.  By nature, conversations about your health and well-being are personal and private. You may share information about your physical and mental health that only your physician knows. As such, you expect your physician to listen to your concerns fully and without judgement and to address them with sensitivity and tact. She should lend her ear and her expertise.

3) Can she explain medical jargon in layman's terms?

Doctors often use medical jargon to explain what they believe is causing your symptoms, but such language can be quite confusing. She should be able to tell you what she thinks is going on, how she is going to determine the right cause, and outline a plan of action once the problem is identified all using words you can understand. He should be able to point you to online resources or offer handouts and answer your questions to enhance your comprehension.

4) Is he willing to answer your questions and talk to your family? Will she discuss various treatment options with you?

Physicians have spent years in training. First comes medical school, then residency, followed by fellowship training for those who further sub-specialize in their specific field of medicine.  We have amassed a tremendous knowledge base, but you know nothing of that other than perhaps our academic pedigree when you see a doctor for the first time. And, frankly, you don't care. What we are all looking for is a doctor who shows compassion; is willing to take the time to answer our questions, big and small, and does not make you feel rushed; will include your family if desired; and, consider the things you value when discussing treatment options. If you wish to discuss non-pharmacologic treatments for certain ailments, he should be open to reviewing the pros and cons of such an approach so you can make the right decision for you and what you value.

5) Are you treated with respect - respect for your time, respect for your thoughts and opinions?

The specialist I saw made it very clear that she wanted to hear nothing of my previously tried strategies to address my problem and only pushed her own agenda. When I asked her about a controversial product she had recommended, she scoffed and quickly stated that research is done in mice so I had nothing to worry about since I'm a big human. I mean, I am a physician, too, so I totally get that; but, that was not the point. I was concerned and she made me feel stupid for even asking the question. Then  I just became angry and vowed never to return to that practice.  She showed little respect for my valid reservations about the product. On the other hand, the PCP clearly did not respect my time. As I stated earlier, I waited over an hour just to see her and then still had to be seen. I had not planned to need the entire morning for just one appointment and needed to return to work to see my own patients; but, it seems this doctor never once considered what else I may have had going on that day. There was never an apology - nothing. Your physician should always show respect for your feelings even if those feelings do not line up with their belief system or the current medical research.  Now time is a different matter as many physicians often run behind. That being said, good customer service should be a part of the package, and a simple apology for a long wait is always appreciated.