Battling IBS and stress ... and their residual effects

(Editor's note: I'm republishing this column as I deal with the residual effects of a stomach virus or salmonella poisoning ... not sure which).

First came the burps, followed by the gurgles and the cramps. Then came the long, lonely, seemingly endless trips to the bathroom.

Seventeen years ago, I swallowed tablespoons of antacid and chewed on antacid tablets like candy, hoping these feelings would go away. They never really did.

Oh, well, it hasn't been all bad. Six months to three years can pass by without anything happening. But when it hits, it hits hard.

For 17 years, doctors have provided the same diagnosis: irritable bowel syndrome, a physical disease with, apparently, a psychological cause. Stress is believed to be the root problem, but no one knows for sure what really causes the bloating, the burps and the cramps that seem to spring out of nowhere.

Nonetheless, IBS has become one of the most common stress-related disorders in the nation. More than 30 million Americans have been diagnosed with some form of IBS, which is also known as spastic colon.

Because it could lead to a variety of other disorders, health experts say there's a growing awareness of the illness that's spurring people to seek medical attention.

"Most people rarely talk about their bowels. But the fact is that it's a widespread problem," said Edward Blanchard, a researcher at the University at Albany, State University of New York, who has written about IBS.

The symptoms are typically pain and cramping, diarrhea, constipation, bloating, flatulence and belching. Usually, a physician diagnoses the disorder when all other possibilities are ruled out.

The first step toward recovery is admitting there's a problem, some say. Blanchard estimates that 18 percent of the population suffers from IBS, but probably half never seek medical attention. Many people just live with it, keeping a container of antacid at the ready.

Ironically, those who seek treatment are typically a little more psychologically distressed than those who never do, studies have shown.

"It may be they're more desperate," Blanchard said. "They gave routine medical care a try, and it didn't work."

Many who suffer from it, however, have found ways to channel their frustration. Internet blogs and bulletin boards are devoted to the topic.

Blanchard has written a 373-page book called "Irritable Bowel Syndrome: Psychosocial Assessment and Treatment." The book looks at IBS' association with psychological distress and provides techniques for psychological treatments. Many times, he notes, it takes just one stressful event or crisis to trigger it.

In 1988, IBS hit me after a breakup with a girlfriend. It likely contributed to a decade-long battle I had with bulimia and other eating disorders, although Blanchard said studies have not established a link between IBS and bulimia.

I had it in college, and when I announced to my friends that I had "irritable bowel syndrome," most reacted by smiling or just letting out a big laugh. It was like some "Beavis and Butt-head" experience. "Huh," they'd say. "You said, 'bowel?'-"

Ashamed, I never really discussed it with anybody again. Luckily, over the past decade, it mostly disappeared.

Then in November 2004, I was involved in a car accident. Weeks later, my intestines started to feel as tight as guitar strings. While on assignment in Texas, I lay on a stiff hotel mattress for an entire day, afraid to move. Every slight twitch made my stomach feel like it was ready to bounce and roll out of my body.

Surprisingly, a week of fiber laxative use ultimately helped. It was the only time any medication or therapy proved to be useful. But I always live in fear of a recurrence. Research has associated hypersensitivity to IBS, and such psychological disorders are pervasive in my family.

Blanchard said there is a series of steps people can take to alleviate the symptoms. He recommends going to a primary care physician to help rule out more serious illnesses. He suggests maintaining a healthy diet.

Many are helped by education, research or changes in dietary habits - or even just the reassurance that they don't have a more serious illness, Blanchard said.

If push comes to shove, seek help from a mental health professional. "See if you calm yourself,," Blanchard said.

Lord knows I've tried.

Originally published in the The Record of Bergen County, N.J. on March 29, 2005.

Blog aids its bipolar author

Liz Spikol writes a blog called The Trouble With Spikol. But, she says, it's not she who's the problem.

The Philadelphia Weekly magazine managing editor, who suffers from bipolar disorder, says the real trouble with mental illness is its stigma.

That's why Spikol is using the Internet as a vehicle to destroy the myths and stereotypes about schizophrenia, bipolar disorder and other illnesses.

Opening up to the world is never easy — even for Spikol, who freely discusses her 20-year battle with bipolar disorder on the blog.

But the 39-year-old says it's time for people with mental illness to present themselves to the world as functional.

"I just kind of thought that the blog would be a good way to talk about mental health and engage younger people," she said.

The blog — trouble.philadel phiaweekly.com — is an eclectic mix of mental health news and information, mixed with Spikol's whimsical musings about culture and society.

She began one entry, for instance, with a stream-of-consciousness assessment of a press release titled, "Many Suicidal Adults Aren't Getting Mental Health Treatment." The article stated that many adults who consider suicide may find it difficult to obtain adequate treatment or medication.

"This is a short article that I'd like to file under: What Else Is New?" she wrote.

Some entries steer clear of mental illness entirely, or barely touch the subject. In "What I Didn't Do on My Fourth of July Vacation," she wrote: "I didn't see big fireworks. I didn't wave a flag. ... I didn't go to a barbecue. ... But ... I did think about our troops."

"I'm trying to show people you can have a chronic mental illness and still have a life," she said.

Many journalists write about their personal struggles with bipolar disorders, schizophrenia and other disorders. But few personalize it in a way that presents mental illness as acceptable.

Wray Herbert, for example, writes a column for Newsweek's Web site called "Mind Matters" that delves into the quirks of human behavior — including his own.

But, unlike Spikol's blog, it doesn't address personal medication intake, nor does it deal with personal breakdowns.

Spikol won't give advice; in fact, she often seems to be asking for it.

"As everyone is painfully aware by now, tonight is my book club," she wrote in one entry. "I'm having such anxiety about the event, I took two Ativan last night and am now pretty groggy. How will I make sure everyone gets in through our locked doors? When will I buy the cookies?

"What if I have nothing to say? Oy vey. I could do with a little more mania today. At least I'd get stuff done."

Most of the time, however, she holds it together — with the help of readers and the so-called experts.

Reader feedback has been tremendous, she said. But Spikol says she's a fan of the blog, too. As someone with personal demons, the experience has been cathartic, she says.

She was raped in the Dominican Republic when she was 18 years old. The incident triggered her 20-year battle with bipolar disorder, she believes. Hospitalization and treatment followed.

For Spikol, opening herself up and talking about her issues has been a freeing and educational experience.

She also believes she's helped connect people who share many of the same experiences.

"It's been great," she said. "I just started adding videos."

This column was originally published in The Record of Bergen County on Aug. 1, 2006.

After many ups and downs, life nearing 40 is peaceful

[Sunday was my birthday - this is a column I wrote last year to recognize my 40th birthday]

At 21, while mired in eating disorders, I never thought I'd live to see 40 — or even 30. Just before hitting the milestone in March 2007, I was a little unprepared.

Once you hit middle age, what do you do? Dye your hair? Take a Caribbean cruise? Learn to square dance?

Indeed, many at this age seek a life renewal.

Aging, however, brings physical changes - and for many, they're changes for the worse.

The irony is that, approaching 40, I felt better than I did when I was 30 — and, certainly better than I did at 21. After years of setbacks and successes in my life and career, I felt as though I had finally found mental peace.

Though some may dismiss it as a cliché, it really was the power of positive thinking that carried me through. Some time ago, I found a way to take a deep breath in stressful situations and put things in perspective. I got help through therapy and educated myself on the mind and the brain.

I found a way to feel better about my body and what I put in it. I came to some understanding of my abilities as well as my limitations. I treated my mistakes as gifts, not setbacks, and learned from them.

Most important, I found a way to not worry. With a family of five and a job that offers some rewards, I felt a sense of security that once seemed so elusive. Attitude is the foundation of a successful and healthy lifestyle, mental health advocates say.

"You have people who look at the cup half-full, and the cup half-empty," said Debra Wentz, chief executive officer of the New Jersey Association of Mental Health Agencies. "I'm just happy that I'm happy and healthy."

It's hard to pinpoint what changed the direction of my life for the better. Perhaps it was a series of life changes that caused me to look in the mirror and reevaluate.

For years, I treated life as a nuisance. I hated waking up in the morning, but I hated going to sleep at night even more. While others partied in their early 20s, I hid mostly in my apartment, where the only light came from a TV. My diet consisted of canned ravioli and TV dinners.

I often fell asleep after eating a bag of pretzels and drinking a gallon of milk.

Stability first came through marriage, in 1996. Until then, relationships were rarely healthy — only headaches. The woman who became my wife was a rock, but with an open mind. She tolerated my idiosyncrasies but was ready to challenge me if I made a mistake.

She also educated me about survival. Having lost her father in the Vietnam War, she knew it as well as anybody. It was through her that I learned to pause, to restrain my impulses and to evaluate each life decision as though it was my last.

Next came therapy, in 1998, and a few more sessions in 2000. The latter visits ultimately led to a diagnosis of eating disorders. While it was a long wait for a diagnosis, it confirmed what I knew was true for some time. I felt validated, and I developed coping strategies for managing the problem.

This column also helped me put things in perspective.

Writing, mental health professionals say, often gives people an outlet for their emotions. For me, the column gives me an opportunity to write about others who have had similar experiences. I've felt not only validation, but also a feeling that I'm not alone.

Writing also has given me experience that helps educate me on how to handle life's obstacles. That means being humble enough to admit to a problem, and seeking help for it. Or taking care of myself and maintaining a positive attitude.

I no longer live my life dreading what's going to happen next. Now I embrace the future as much as the past. Things that once seemed so scary now seem trivial. I watch my waistline grow, and laugh.

[This column was originally printed in The Record of Bergen County, N.J. on March 13, 2007]

Rosalynn Carter works for change any way she can

Rosalynn Carter fawns over her fellow "fellows."

The former first lady talks about how they're making the world a better place. These journalists, each of whom is a part of her Mental Health Journalism Fellowship program, are "reducing stigmas" and promoting the cause of mental health advocacy.

"They're sending a message that many people with mental illness can live normal lives," she says.

That's why September may be her favorite time of year, she says. It's when she meets the newest 10 fellowship recipients - which, in the 2004-05 class, included me - who go to Atlanta every year to launch projects that dig into the tangled world of mental health.

Many public figures disdain media attention, because reporters may sensationalize and misinterpret whatever it is they represent. But Carter embraces it and believes her fellowship program advances a cause she's promoted for the past 30 years.

"We're getting more and more attention," she said when she met my class of fellows in 2004. "It's just been wonderful."

The Carter Center - led by her husband, former President Carter - has fought to reduce the spread of Guinea worm in Africa and Asia. It's monitored elections throughout the world and built foundations for democracy in countries once ruled by oppressive dictators. Her husband once won the Nobel Peace Prize for his efforts.

But the Mental Health Journalism Fellowship program, she says, is one of the best and most effective programs offered by the Carter Center. Those who have participated say it provides inspiration that helps get seemingly complex projects off the ground.

"It's something I wouldn't have been able to offer a commitment to without the help of the Carter Center," said Alex Spence, a New Zealand freelance journalist who published a magazine article on poverty and mental illness.

"It's the first magazine story I know of that deals with a person with mental illness, but that person wasn't involved in a crime," he added.

The Carter Center provides a stipend to fellows to pay for their projects. Each journalist has a year to finish it. During that period, each fellow is assigned mentors - some of whom are nationally renowned experts in mental health - who provide guidance and resources for the work.

As we did in 2004 and 2005, the fellows sit in meetings with Rosalynn Carter and her volunteer advisers. In these sessions, Carter is polite, encouraging and can even get a little teary-eyed as she listens to the journalists describe their projects.

Her staff, however, is tough, and they prod - and in some cases even pound - each fellow as they offer suggestions and encourage the journalists to produce the best work they can.

Her husband will participate in some of the discussions. He'll hear his wife talk - in her genteel, Southern way - and flash that famously big smile of his. He hears about these "fellows" all the time, he says.

"I think she loves the fellows more than she loves me!" he jokes.

But the approach works, the Carters say. Since the program began nearly a decade ago, it has produced work that has earned Pulitzer Prize nominations. More important, they say, the work has produced tangible results and changed lives.

"Robert Landauer, a 2000-2001 fellow, covered mental health issues for The Oregonian that contributed to increased public support for reform of the state's mental health service delivery system," said Thom Bornemann, director of the Carter Center's Mental Health Program.

Rosalynn Carter doesn't apologize for using her status to promote the program. If anything, she says, it was her public career that got her interested in mental health.

She first became interested in the early 1970s, when her husband was governor of Georgia. At a time when the de-institutionalization of people with mental illness was taking shape, the governor was deluged with requests from citizens who wanted something done to improve mental health care.

Soon after Carter left the presidency in 1981, she helped form a mental health task force that's helped reduce stigma, her advisers say. Her gentle and honest but selfless stewardship also has helped turn the fellowship into a nationally prestigious program.

Recently, I saw it myself. In 2003, I felt too many of the fellowship recipients were from large, national media like The Washington Post and "60 Minutes." So I wrote a letter that suggested the Carter Center consider that the negative stigma of mental illness is most pervasive in rural and suburban communities. Maybe the program should consider more papers like my own, I argued.

When I met Mrs. Carter in 2004, she praised me for the "great letter" I wrote. I apologized, saying I have a "big mouth" that sometimes gets me into trouble. I didn't mean to criticize, I said.

"No, no," she said. "You were right."

This article originally appeared in The Record of Bergen County, N.J. on Oct. 12, 2004.

*****************************************************************************

The Carter Center is currently taking applications for the Mental Health fellowship. The deadline is April 28, 2008. Anyone interested should contact Rebecca Palpant at (404) 420-5169 or rpalpan@emory.edu.

Rescued from a self-destructive downward spiral

This story pays tribute to National Eating Disorders Awareness Week, which began Sunday and runs through March 1

That red Rutgers University yearbook from 1989 (left) contains a lot of good memories.

Too bad I can barely look at the picture of myself.

I was a 6-foot-2, 145-pound stick, worn practically to the bone. My face was pale, and my hair was flat and lifeless. My suit jacket was so big on me that the shoulders looked like mountain peaks. I certainly wasn't smiling - my lips were so thin and my frown so straight, it was as if a cartoonist had drawn a line across my face.

I was 21 when this picture was taken in October 1988. Only two months earlier, I was 185 to 190 pounds and enjoying the typical youthful excesses. But by fall, after days and weeks of starving myself, I descended into a shell of a human being, living in a virtual, self-imposed hell, with little will to continue.

Doctors diagnosed me as having anything from hypoglycemia to an ulcer. They gave me X-rays and prescribed medication, but nothing helped. If anything, I refused to be cured, because I was so focused on wallowing in my own misery.

Some years later, it became pretty clear to me what this was, even if the diagnosis was never official. It's been suggested to me - by people with the sort of degrees that specialize in this kind of thing - that I exhibited some of the textbook symptoms of bulimia. And I've learned that certain mental illnesses associated with this disease, such as obsessive-compulsive disorder, are hereditary, and as much a part of my family history as hazel eyes and premature gray hair.

I now consider myself "recovering," although in many ways, I still suffer from it. And rarely does a meal go by without a thought back to that time, when eating was the hardest thing I could do.

People have said to me, "Isn't that something that happens to teenage girls? How can a man suffer from bulimia?"

Well, I tell you, that man was me.

It's one of the reasons I began writing a column called "Coping" for The Record of Bergen County, N.J. five years ago.

It's why whenever I think back to that time - a summer of romance that ended in a breakup, followed by my failure to accept it - I still get chills. When the breakup happened, I cried like a baby. The loss, however, really didn't hit me until days later, and after the crying finally stopped.

I got this attack of chronic nausea that just refused to go away, and the acid in my stomach and throat was ripping up my insides like a weed-whacker. Virtually anything I ate caused acid reflux, and the mere sight of a cheese steak was cause for panic. For a college student whose very livelihood depends on where his next beer is coming from, it was more than an inconvenient disruption from the routines that gave me life.

Doctors didn't help me at all. In fact, they looked at everything way too clinically and practically made up physical diagnoses for me, since they couldn't find anything on an X-ray. They put me on a bland diet, and that was the worst thing they could have done. For two months, I obsessed over every little crumb of food that entered my body. If I ate it, and it wasn't on the "safe" list, I'd go into such a panic that I would fast for two, maybe three days, hoping to reverse whatever wrong I did to my body.

By the time the yearbook photo was taken, however, even fasting wasn't good enough for me - and I don't think I need to tell what I mean. Just think of bulimia, and what it is, and what people do when they have it. Let's just say that when I entered this stage, my weight took it's biggest nosedive. And not until a friend literally pulled me out of the bathroom and talked some sense to me did I finally dust myself off and return to reality.

Within the next month, I quickly gained the weight back. I reached a "leveling-out" point, about 11 years ago, when the old obsessions finally began to fade from consciousness and life got a little easier.

The passing of time certainly helped, but I also credit marriage for helping bring that all about. It brought structure to my very unstructured life, and it alleviated the stresses and insecurities I felt about myself and my future.

And certainly, therapy helped, too, something that was urged by my wife. Ironically, the two psychologists I visited were not very good - one had a bad habit of answering personal telephone calls in the middle of our sessions. But they did make some keen observations about me that I found to be useful.

Ultimately, it allowed me to look in the mirror and be objective about myself, and I learned to manage my stress in ways that I never thought I could.

Me, with NBC anchor Brian Williams (right)

Apparently, I'm not alone in feeling this way. Ask Rob Schoenbach, whose wife, Gail, has had bulimia for 30 years and whose family started a foundation to fight the illness. Over the past eight years, Gail has been to inpatient and outpatient therapy and nutrition counseling. Her husband is trying to raise money for the foundation, and in a letter to potential donors, he makes a rather relevant observation:

"Like any other 'addiction,' Gail is not cured but has made incredible strides toward the management of her disease and has now learned how to tap into the numerous resources available to make her (and our families') life better," he wrote.

I guess the bottom line is, I, like Gail, am a survivor. But being one requires more than taking medicine. It requires discipline, willpower, and a little humility.

Eating disorders also never really leave you. To this day, I still obsess a bit over fatty foods and other things I put into my body. I still get a bit panicky when I get acid reflux.

But at least I can manage it. And most important, I'm here to write about it.

This Coping column was originally published in The Record of Bergen County, N.J. on Sept. 29, 2003.

Stigmas of mental illness remain

Five times he called her a "loon" or "lunatic." Each time, the peace activist reacted to Bill O'Reilly's name-calling with a shrug or smirk. But this encounter on "The O'Reilly Factor" raised the question: Who was more outrageous?

Was it O'Reilly for using words that some might interpret as slurs? Or was it the activist for not taking him to task?

For a long time, words and images that define mental illness have been used to describe a person who holds a differing opinion as out of line or evil.

Mental health professionals recoil when they hear such talk or see such pictures. Now they're speaking out to stop the use of words and images that stigmatize people who suffer from schizophrenia, bipolar disorder, obsessive-compulsive disorder and depression.

Otto Wahl, a psychology professor at the University of Hartford, says that despite years of advances in mental health awareness, the media still rely on stereotypes to sell books, magazines, news-papers, movies and TV shows.

In his book, "Media Madness," Wahl displays movie posters that make light of mental illness.

One for "Crazy People," for instance, shows a cracked egg that appears to be sticking its tongue at people.

"The stereotypes of people with mental illnesses have just these qualities — they are extremely dangerous, outstandingly different, and/or excessively ridiculous," Wahl writes in his book. "They are, in other words, entertaining and profitable."

The media have even created myths, Wahl and others say. The so-called "psycho killer," for example, has become a mystery-novel slasher-movie trademark. It even is the title of a hit song by the Talking Heads.

Not only does the term stigmatize people with mental illness, mental health professionals say the labeling is incorrect. They point to studies that show only 4 percent of people who commit murder are mentally ill.

But the media are making some progress, mental health professionals say.

Hollywood has achieved some measure of critical and commercial success by using likable or sympathetic characters to portray mental illness.

Gary Morris, a lecturer at the University of Leeds in the United Kingdom and author of the textbook "Mental Health Issues and the Media," cited Russell Crowe in "A Beautiful Mind" as an example of a box-office star taking on a sensitive role of a mentally ill professor.

Even Jack Nicholson's cranky Melvin Udall in "As Good as It Gets," Morris says, could be considered a favorable portrayal.

"It is helped to some degree because we, as an audience, largely admire the actor Jack Nicholson, and his character's warm side begins to emerge, enabling a more positive attraction to be formed," Morris writes.

This Coping column was originally published in The Record of Bergen County.

Why America is jailing people with mental illness

You may not know Jacquie, personally. But if you've been in a northern New Jersey restaurant, you may have seen or heard her.

She's known for her scratchy, high-pitched voice, and she has a habit of going into dining places, eating a meal, and not being able to pay.

"She'll eat a big meal and say, 'I don't have any money,' and they arrest her," said Robin Reilly, an advocate for the homeless who has helped Jacquie.

That's about as dangerous as Jacquie gets. But if that's true, then why has she been to jail nearly 30 times?

Because Jacquie has mental illness. Plain and simple.

There are thousands more who live this kind of vicious cycle. When they show the most extreme symptoms of schizophrenia, bipolar, or obsessive-compulsive disorder, they don't go to a nice clean hospital room, with a window and TV, for treatment. They end up in a concrete cell with bars, a bed, and a toilet.

If they don't go there, many end up dead - like Stephen Kazmierczak, the man responsible for killing five people and himself at Northern Illinois University last week.

The Human Rights Watch organization recently issued a report that said there are three times more mentally ill people in prisons than in mental health hospitals in the United States, and prisoners have rates of mental illness that are two to four times greater than the rates of members of the general public.

The bottom line, the report says, is there aren't enough mental health hospitals that can adequately provide for the mentally ill. And with cold, steely jails as their only real alternative, many of them cycle right through, and like Jacquie, end up back in the street.

Worse yet, the group notes, elected officials have failed to provide adequate funding, support, and direction for the community mental health systems that were supposed to replace the mental health hospitals shut down as part of the "deinstitutionalization" effort that began in the 1960s.

"Prisons were never intended as facilities for the mentally ill, yet that is one of their primary roles today," the report states. "While there has been extensive documentation of the growing presence of the mentally ill in prison, little has been written about their fate behind bars."

The report, of course, merely confirmed what many already know. The bigger, more complicated question is what to do about it.

Jacquie was finally able to get help - she was recently committed to the Ann Klein Forensic Center in New Jersey, and she still corresponds with Reilly. But what about the people out there who haven't quite reached the end of their rope, as Jacquie did?

And that's the real issue, some say - one that politicians and others have shied away from for years, because the obvious answer is politically lethal.

Former Bergen County, N.J. Sheriff Joel Trella said he's helped create a diversion program in his jail in which mental health professionals evaluate certain prisoners and determine whether they're better off in a treatment center.

It seems to be working, he says, although the program mostly focuses on prisoners who commit minor, non-violent crimes.

"In spite of what you do, you can't help everybody you serve," he said. "Some people are not going to be affected by it."

The obvious answer is to get more money and build more mental health hospitals. But what are the chances that any governor will say: "I am requesting a 3 percent hike in the income tax to help pay for the construction of three new psychiatric facilities"?

Perhaps the only real answer, according to Human Rights Watch, is this: Give it time, be patient, and sooner or later, enough people will realize that the cause of the mentally ill is not just the problem of law enforcement. It's everybody's problem.

That means, perhaps, if there had been a program for Jesse Timmendequas, who had a lifelong history of mental illness and abuse, maybe he wouldn't have killed 7-year-old Megan Kanka a decade ago.

Or if New Jersey's budget cutters hadn't slashed programs for troubled youth, maybe Sam Manzie's parents could have gotten him help, too. Instead, in 1997, he killed Eddie Werner when the 11-year-old was selling candy for a school fund-raiser.

Or if Andrew Goldstein, a man with schizophrenia, had received treatment after numerous failed attempts, maybe he wouldn't have pushed a 32-year-old woman to her death in front of a Manhattan subway train nearly a decade ago. Like Timmendequas and Manzie, Goldstein may spend the rest of his life in prison.

"What we need today is, we need to think smarter," Trella said. "Jails and prisons have now become something other than what they were intended for. I have people in the Bergen County jail who have dialysis. We have people in wheelchairs. You have the entire spectrum that you see in the general population."

This Coping column was originally published in The Record of Bergen County.

Our young boys are coming of age - at an early age

Now that he's 9, my son comes up with questions I have trouble answering.

"Daddy, why do people smoke pot?"

"Daddy, why do people get divorced?"

More than half-way through fourth grade, he's seeing things happen to his friends that he's never had to face in his own life. Like any smart child, he wants to explore.

One family, in particular, has had its share of problems. The 17-year-old son has had legal troubles. The father has had substance-abuse issues. The parents are divorcing. The mother is overwhelmed. The 10-year-old boy — my son's friend — is often confused and sad.

We've tried to help, giving the 10-year-old a place to stay for two weeks while the family sorted things out. We signed him up for karate and soccer.

But the boy came to resent our help. He wants his mother, his father. He wants no more of us. Now you can add my son to the list of people suffering.

My son is a sensitive child who absorbs the pain of others, forcing us to expand our role from supportive parent to patient psychologist. The older he gets, the more complicated and abstract the child-rearing decisions become.

Like many children in their prepubescent years, he's getting a sense of a world that can be unforgiving and ugly. His sense of innocence is fading. Now it's our job to guide him through it, so he doesn't fall victim to the same pressures and pitfalls that his 10-year-old friend — as well as his 17-year-old brother — are facing.

In the PBS documentary "Raising Cain," Michael Thompson, a nationally renowned psychologist who co-hosted the film, talked about how the most challenging years for boys are between the ages of 9 and 13. It is during this time that their perspectives on life are shaped, he says.

They begin to discover things about themselves and their world that they find interesting, puzzling and even embarrassing. But their ways of dealing with these issues often differ. Many reject the negative influences and become independent — or completely isolated.

In my son's case, we have our fears. The more he deals with reality, the more he's become more isolated in his thoughts. His listening skills have diminished. The Wii game system has become his oasis.

At the same time, he's gotten angrier and more disrespectful. He's modeling the behavior of other boys from whom he used to keep some distance.

Many boys, like my son, often give in to the outside pressures — either because they're exciting, or because they feel they have no choice. They're raised to be society's leaders, but many of them are too insecure to accept the role.

Thompson says that American boys are 15 times more likely than girls to abuse drugs and alcohol, and twice as likely to die in a car crash. Boys are 30 percent more likely than girls to drop out of high school.

"All of these statistics suggest that a significant percentage of American boys are troubled psychologically," Thompson said. "They are not finding either success or peace of mind."

For many parents — including myself and my wife — the prevailing wisdom has been to shelter them from this ugliness. We've limited his exposure to news events — such as Sept. 11, 2001. We've tried to steer him away from friends who might be trouble.

Thompson, however, suggests that too much limiting of exposure to reality could have the reverse effect.

He says that boys become more interested and intrigued by things that are beyond their reach. They tend to copy the behavior of people they can't have access to, or they simulate exciting and even scary events that happen well beyond the confines of home.

On PBS' website for the documentary, Thompson cited the words of a kindergarten teacher who said, in her class, kids played Hurricane Katrina by hanging from the monkey bars and pretending the water was getting higher.

He viewed this as a positive activity. "They were reassuring themselves, saying 'What I saw on the news won't happen to me. I can protect myself.' "

Thompson, who also co-wrote the book "Raising Cain: Protecting the Emotional Life of Boys," suggests a list of strategies for dealing with a boy's transition from innocence to reality.

* Give boys permission to have an internal life, approval for the full range of human emotions and help in developing an emotional vocabulary so that they may better understand themselves and communicate more effectively with others.

* Recognize and accept the high activity level of boys and give them safe boy places to express it.

* Teach boys that emotional courage is a form of courage, and that courage and empathy are the sources of real strength in life.

* Model a manhood of emotional attachment. "Boys imitate what they see," Thompson said. "If what they see is emotional distance, guardedness and coldness between men, they grow up to emulate that behavior."

* Teach boys that there are many ways to be a man.

"We have to teach boys that there are many ways to become a man; that there are many ways to be brave, to be a good father, to be loving and strong and successful," he said. "We need to celebrate the natural creativity and risk-taking of boys, their energy, their boldness."

This Coping column was originally published in The Record of Bergen County, N.J.

As the holidays pass, our lives move on

As we took the ornaments and lights off of our Christmas tree, we asked ourselves, "Was it worth it?"

We paid $50 for something that we threw away after two weeks. We watched in horror as each of our kids dropped ornaments on our tile floor, smashing them into pieces. We felt pain as our 1-year-old daughter screamed because we wouldn't let her dance on the smashed ornaments. We felt empty as the 5-foot tree shed tiny green needles as we squeezed it through the door, en route to the curb.

While the perfectly dressed tree is the perfect symbol of Christmas joy, the spent, ready-to-be-recycled version represents the empty ending of a holiday season that sometimes brings more sorrow than celebration.

It could be worse, of course. Many spend the holidays alone, or live in a cramped apartment where the only decorations they can hang are taped to their eighth-floor balcony. Many don't have a tree -- or they make do with a miniature version that once sat on the shelf at a discount store.

Once the holidays are over, the feeling of loneliness can be magnified by the succession of long, cold, dreary winter days. Whatever Christmas spirit one had gets lost in the winter breeze.

More than 19 million Americans of all ages suffer from depression, but they're likely to have even more severe symptoms during the holidays and when they end, according to the New Jersey Association of Mental Health Agencies.

Mental health professionals say it is essential to recognize the difference between holiday blues and serious depression, and to know that support is available -- even when the cold, dark days of January can add to the sense of helplessness.

"Anyone could experience holiday blues," said Debra Wentz, chief executive officer of the NJAMHA. "Perhaps they are not able to be with family members or they experience high levels of stress, which could be related to having unrealistically high expectations for the holidays."

Symptoms of holiday blues are similar to signs of depression: sleep disturbances, changes in appetite, agitation, anxiety, feelings of guilt, difficulty concentrating and decreased interest in activities that are usually enjoyable.

Holiday blues can last for weeks after the holiday season, when people return to daily routines and no longer feel the joy that is common around the holidays, professionals say.

Wentz says that having at least one friend or family member to provide support during this period is important. And there are other steps that people can take to help them cope:

# Eat well to build energy and reduce cravings.

# Relieve stress with sleep, exercise, music, scheduled down time and avoiding arguments.

# Have realistic expectations for how much money was spent on gifts and how much time is dedicated to family and social obligations.

# Seek professional help when needed to cope with depression or stress, not only during the holiday season but anytime throughout the year.

Symbolic gestures help, too.

There's nothing more depressing than watching a rotting Christmas tree sit on the curb for days until a recycling truck shows up. But one simple maneuver may help: Throw a cover over that tree, and move on.

This column was originally published in The Record of Bergen County, N.J. on Jan. 1, 2008.

The seasons change ... and so do the moods

When the weather's bad, Martha calls me.

Usually, it's after a big rain floods her New Jersey neighborhood. Or when the temperatures drop to single digits, and her heater is broken.

Typically, relief comes in the form of a sunny day or a sudden jump in the temperature. But lately, that hasn't happened much. Now when Martha calls, she's sniffling, she's almost sobbing, and she's down.

"I'm still with the flu. I have allergies," she said. "I just got depressed in the past month."

Martha says she's not depressed because of the weather. "I love the weather, no matter what it is," she says.

Indeed, it's not so much the weather that gets some people down. It's what's associated with it.

Most people call it "the winter blues." But psychologists and psychiatrists have a bigger name for the more extreme cases of it: seasonal affective disorder.

According to the American Academy of Pediatrics, seasonal affective disorder is a pattern of major depressive episodes that occur and remit with changes in seasons. And for psychologists, there's reason to be concerned this winter, because North Jersey has been burdened by bad weather.

"I think there is something like cabin fever or the winter blahs that has an impact on people," said Jay P. Granat, a New Jersey psychotherapist. "People are more sedentary. If they're unable to be active, I think people aren't motivated. I don't look at a couch potato as euphoric."

For many people, the high numbers of flu cases and other illnesses in the region haven't made it any easier, forcing them to stay inside. And when these same people have to deal with annoyances such as broken heaters or flooded streets, or if they're already suffering from a predisposed psychological condition such as bipolar disorder, it doesn't help.

Donald Bernstein, director of professional affairs for the New Jersey Psychological Association, said he's seen the effects of the illness among his patients. "This is not a fly-by-night diagnosis," he said. "The nature of it is unclear in terms of cause. I have a patient with bipolar disorder who gets it."

The most recognized form of SAD is characterized by recurrent episodes of depression, oversleeping, increased appetite, and weight gain that begins in the autumn and continues through the winter, according to the Depression and Bipolar Support Alliance, a national support group.

SAD - in its most extreme form - also has been linked to suicide. In 1997, British newspapers noted that the perpetual gray skies over the United Kingdom may have contributed to the death of a woman who had been treated for SAD. She killed herself rather than face another winter of depression, lethargy, and weight gain, according to The Guardian of London.

In the United States, symptoms usually begin in October or November and subside in March or April, according to the National Alliance for Mental Illness. The depression is usually mild to moderate, the organization says, but it can be severe. A small percentage of patients with SAD seen at the National Institute of Mental Health typically require hospitalization, although very few have been treated with therapy.

For treatment, doctors urge people to exercise. In some cases, however, they also talk about a procedure called light therapy, which involves people literally absorbing the energy of artificial light that resembles sunlight.

The therapy is initiated when a light box is pointed directly toward the patient at a downward slant, according to the AAP. The patient's eyes should remain open throughout the treatment session, although they shouldn't necessarily stare into the light, the AAP says.

Bernstein says he encourages the therapy and has a patient who responded positively after installing a full-spectral light in a room. While she does it, she goes about her normal business. She just doesn't leave the room. "She very definitely gets a release from the use of full-spectrum light. She puts it on for about a half hour," he said.

The Depression and Bipolar Support Alliance offers words of encouragement. In a recent press release, the group encourages people to "focus on the present ... watch what you eat, and relax." The group warned people about light therapy, saying that the procedure could be harmful physically if people abuse it. But the group didn't discourage it.

Originally published in The Record of Bergen County, N.J.

In the cold city streets, Wii can work together

As the hours passed, our toes went numb. We shook our legs from time to time, just to keep the blood flowing. Some of us wondered who'd be the first to suffer frostbite.

For nearly four hours, this New York City street felt like Fargo, N.D. In front of me was a line of 160 shivering people, each of them tired, disgusted and hungry. There was barely any semblance of Christmas spirit. Indeed, with the cold wind hitting my back -- making my coat feel as thin as paper -- I was feeling more of a sense of "I hope they appreciate this."

We were waiting for the Wii, the interactive video game system that comes in a white box, with a slender white controller that will make my two boys go "ooh" and "aah" on Christmas Day. Its special effects and other appealing devices have caused a Beatlemania-like frenzy at stores.

This crowd of shoppers outside Rockefeller Center's Nintendo World on a crisp, cold December morning consisted of fathers, mothers, grandmothers and grandfathers waiting patiently for something they couldn't get anywhere else.

Trying to purchase a Wii has been a turn-off this holiday season for many parents who have grown weary of such holiday-shopping gymnastics every year. When I told some parents my story, they struggled to hide their bewilderment, and some looked at me as if to say, "Are you crazy?"

Even the most rational people, however, have fallen for the hype. My mother-in-law, who has more self-discipline than I'll ever know, once chased after a FedEx delivery person who pulled up to a game store, thinking he possessed the much-coveted toy. He didn't.

But the fact that we're behaving this way over a toy has made us question our sanity, as well as our consciences. Our rationalization -- and many may agree -- is that we're doing this for the kids. My two sons have been asking for a Wii since it was first released more than a year ago. We want them to be as cool as every other kid on the block.

We're also spending a lot of money that could go toward something more important. We're caving to our children's every need and desire, we're telling ourselves -- and I froze my butt off in the process.

When I was a kid, Star Trek walkie-talkies were the rage. My siblings and I begged for them for Christmas (and never got them). Then, when we were older, we asked for Atari.

We never got that, either. But some friend always had it, so we ended up spending more time at our friend's house than anywhere else. We enjoyed the simple designs of the games, like Pac-Man and Asteroids.

Since then, the newer versions of Nintendo as well as Xbox and the various knockoffs have gotten more complicated. Paul Eng, Web senior editor for ConsumerReports.org, said they're more for the "frequent player" who cares more about high-definition graphics and the other technical nuances of Super-Smash Mario Brothers than the casual Pac-Man chomper.

The Wii, however, brings us back to the way things were, Eng said. It's not just for kids, but also for parents who are approaching 40 and appreciate the simplicity and interactive qualities the system has to offer.

It harks back to the days when a video game had a simple joystick that moved a boxer's fist or shot balls of fire that fell from the air.

"You look at PlayStation and Xbox -- those are really good systems, but they appeal to those who have a background in video games," said Eng, who got a Wii system for his 40th birthday this year.

"But with the Wii, you can pick up a controller and say, 'Hey, I swing this like a bat [in the system's baseball game] and it hits the ball."

Next year, the Wii is supposed to get even more adult-oriented, Eng said. Nintendo is introducing a fitness package that could include a scale, a workout regimen and yoga.

"We were always told [when we were younger] that we shouldn't play video games," Eng said. "But there is nothing wrong with having fun."

Still, we ultimately purchased this system with a mixture of glee and guilt. Often, my wife and I find ourselves doing the opposite of what our parents did. We don't want our boys to go to a friend's house to have fun.

But then we look at what we've gone through just to complete a whimsical wish list from a couple of young boys, and we think: Maybe our parents were right.

But it's certainly better to feel good than bad, isn't it?

This column was originally published in The Record of Bergen County on Tuesday, Dec. 18, 2007.

Kids need support, even when they don't deserve it

When I was a kid, my parents seemed to come to my rescue just at the right time - even when I didn't deserve it.

Once, my parents stormed into the principal's office to complain after my seventh-grade music teacher grabbed my hair and dragged me to the hallway.

They were defending the indefensible, really. The teacher had grown tired of my wisecracks and other misdeeds, and my parents knew it. But it made me feel good, so that's why they did it.

Two months ago, I came full circle. My wife and I tangled with the principal of my 9-year-old son's school over his placement in math.

Initially, we thought we were getting the brushoff, and I didn't let it go. I wrote an e-mail to the principal that was full of venom. I got a response - it wasn't nice, but it was a response - that spurred a meeting with the superintendent.

In the days leading up to our meeting, debate raged in our household - especially because the school produced evidence that, in some ways, supported the principal's decision. We asked ourselves: Was this the right plan of attack? Or should we have been more patient and waited to see if our concerns would be addressed?

After much discussion, we're convinced we did the right thing. Indeed, professionals say it's best to show support for the child - even if his performance has been disappointing or behavior inappropriate.

"I don't think there's anything more important for a kid than to know - and to feel - that their parents are going to be there for them," said Tom Kersting, a student assistance counselor for the Ramapo-Indian Hills Regional High School District in New Jersey.

Sticking up for him shouldn't necessarily be interpreted as an endorsement of the child's actions, Kersting acknowledged.

Parents shouldn't refrain from disciplining a child, lecturing him or, at the very least, having him consider what could have been done differently. Children crave structure - even if it comes as discipline.

Kersting, who has written books that deal with children's self-esteem and diet, said some school districts have policies that allow parents to occasionally override the decisions made by administrators and teachers.

Those districts may go too far. But Kersting said parental input is vital, because mothers and fathers may see things in their children that administrators may miss.

"If you see some important variables that the school district doesn't see, then it's very important to stick up for your kids," said Kersting.

And in times of crisis, a child's self-esteem is at risk. Older children tend to have a better grasp of the difference between right and wrong. If they've done something inappropriate, most likely they know it - even if they don't show it.

In my case, I learned my lesson before my parents got to the principal. There was something about standing in the hallway that made that hot-and-stuffy middle school building feel cold and lonely.

My son was angry about not getting into the higher-level math, where he was placed last year. We didn't even know about it until the school year was several weeks old.

Two months ago, I told him about my angry e-mail to the principal. At first, he showed no reaction. Then, later that day, we got word from others that my son was bragging at school about how his dad was sticking up for him.

That night, he just couldn't stop smiling. Every time he looked at me, he'd give me his gapped-tooth grin.

And, oh, by the way - he's back in high math.

This column was originally published in The Record of Bergen County on Dec. 4, 2007.

Giving thanks isn't always so easy to do

The stores were closed, and the streets were empty. Working on Thanksgiving, or so we thought, was an easy way for a journalist to make extra money.

Then, around 7 p.m. or so, the sirens would start blaring. The police scanner would buzz with words like “man down” and “four-alarm fire.” Fire trucks would rumble passed our newspaper office.

“Can you go cover that?” an editor would sheepishly ask. “Of course,” I’d say. It happened so often, I came to expect it.

Next thing I knew, I was spending Thanksgiving evening at the Cranberry Bog restaurant in Manahawkin , N.J., filling my empty belly with pretzels and cheese doodles.

About 10 years ago, I finally got around to asking a police officer why Thanksgiving always transforms itself into one of the busiest days for law enforcement.

“It’s the Hatfields and McCoys,” he said. “You get two brothers who hate each other, and their mother wants to see them both. From there, you can fill in the blanks.”

Year after year, the officer’s words have rung true: Family get-togethers on Thanksgiving often have an atmosphere more befitting “WWE Raw” than “Leave it to Beaver.”

Indeed, the cooking, the entertaining, the socializing and the cleaning up can be stressful enough. But for those who have large extended families — and has relatives who live far apart, and don’t get to see each other often enough to like each other —the stress level is multiplied.

Factor in the ever-present availability of alcohol, which always seems to you add fuel to the fire of an already explosive situation.

On the flip side, it can be a day of isolation for those people who have no one to see or visit.

Mental health professionals say holidays can be more about competing egos and loneliness than giving thanks.

“There are times in my practice when I discuss this with my patients — they feel resentful because they say, ‘So and so makes us go to their house but they never come to our house,’ ” said Nancy Block, a clinical associate professor at UMDNJ. “They say ‘I don’t want to spend time with 17 different relatives.’ ”

Having children changes the dynamic, too. It’s fun to take them to the local parade or, when they get older, wrap them in a warm coat and take them to a high school football game. However, the big deal of the day is supposed to be dinner. As a hard-working adult, you come to appreciate getting an opportunity to sit down to a big meal without having to rush out the door.

But what do you do when your 5-year-old child eats two bites of turkey and sulks? Or how about the 1-year-old who throws touchdown passes with the cranberry sauce?

Block said the situation becomes especially problematic in families that deal with separation and divorce. Resentment may linger between warring factions that can make children feel awkward at family get-togethers.

“Children need a sense of security — they’re entitled to have relationships with relatives and adults even when [the adults are] on the outs with each other,” she said. “They need to have positive relationships.”

Then, of course, there’s the relative who’s always got something to say. Is he eating OK? Why aren’t you giving him more meat? Shouldn’t she be disciplined when she builds sand castles with her mashed potatoes?

Professionals say it’s best to remember the purpose behind the holidays never changes — and “giving thanks” should not be treated as a tired cliché, but more as a rule of law.

At the same time, people should be prepared for the fact that family dynamics change from year-to-year — and everyone needs to find a useful role.

“They need to think ahead, and try to think of the positive aspects of getting together,” Block said. “They need to have a lot of forethought.”

Perhaps Dr. Joyce Brothers summed it up best when she outlined a list of holiday principles during a recent interview on MSNBC.

- Don't fall back into the parent-child roles – everyone needs to get used to the transition to their new role in a growing family.

- Let the children participate – it’s important to create a feeling of involvement for everyone, especially children.

- Describe what you're grateful for – one activity that helps put the holiday in perspective is having each person at Thanksgiving dinner tell others what they are thankful for.

- Swallow your pride and forgive – it's important not to hold grudges, especially during this time of the year.

“To swallow your pride and forgive somebody — this is a good time to do it,” Brothers said.

Originally published in The Record of Bergen County, N.J.

A loss by any other name is still a loss

Their burning homes turned into ash, melted steel and crumbling concrete. Their possessions, their memories and their lives went up in smoke as wildfires raged for weeks near San Diego.

Like Hurricane Katrina, the recent California wildfires exposed life's fragility - even if the death toll was nowhere near that of the 2005 storm that flooded New Orleans.

But a person doesn't have to experience death to feel loss, health experts say.

Steve Resnick, a New Jersey psychiatrist, says many people associate their home with their personal identity. When that's lost, it can feel like someone is "losing a part of themselves," he said.

When people watch their home burn to the ground, they may ask, what can I save? More important, they may ask, how do I save myself -- physically and emotionally?

It's especially traumatic, he said, if there is loss of photos, videos or family heirlooms, "which might have been passed down for generations, adding a component of guilt for breaking the chain."

"Losing a home can feel like you've lost the memories that occurred there, the important milestones in your life," he added

For many, losing a home can destroy one's sense of complacency and cause additional shock and horror, Resnick said. Some may convert their sadness into anger toward others. Some may suffer biological depression or other mental illnesses. And some may resort to unhealthy coping styles -- such as drinking or using drugs.

"Many people I see in my practice [who have lost a home] say that they feel ignored, dismissed, or that people don't understand, or they say they 'just don't get it,' " he said. "It is crucial that, in addition to the financial, shelter and food needs of these victims, that we also address the psychological needs."

The victims can use healthy coping styles, such as channeling their energy into helping their friends and neighbors recover and rebuild their lives. Indeed, helping others requires "creativity" that can energize people, Resnick said.

"Feeling someone understands and cares can be very powerful," he said.

Showing courage and generosity in such a time, he said, can also educate people on the importance of survival and having an impact.

Take Larry Himmel, a reporter for San Diego's Channel 8, who did a live video shot of his house burning to the ground. He told Fox News that when he, his wife and son evacuated, they took little with them.

When they found shelter, Himmel said, he and his family asked each other: Where are our family photos? "They were gone," he said, as were the video tapes, jewelry and furniture.

They had nothing but themselves. But even in their time of grief, Himmel thought it was important to give back. So he left his wife and son behind and returned to the scene so he could provide a "live" report on the fire.

He had gone to so many houses over the years to talk to people about death in their families, or about fires or other tragedies, he said. Now it was time for him to show people how he was surviving.

Originally published in The Record of Bergen County, N.J.

On Halloween, don't ever underestimate the power of Elmo

His laugh sounds like a broken car horn. He could use a haircut - all over his body. And he has this habit of talking in the third person.

I'm speaking of Elmo, of "Sesame Street." But to my 1-year-old daughter, there was something about this big, red hairball that was sweeter than a gummy bear.

Anna's crying? Pop in an Elmo DVD.

Anna's hungry? Well, Elmo to the rescue.

Anna hurt herself? Well ... yes, him, again.

Shockingly, after 20-some months of this, the furry monster seems to have lost his magic touch -- in our household, at least. And it happened just when we needed Elmo the most.

You see, Elmo's a gas when he's dancing and singing behind a 21-inch glass screen, banging on an imaginary piano and talking to a goldfish that doesn't talk back. But to Anna, he isn't so cuddly when Mom and Dad - in the Halloween spirit - try to fit her in his three-foot-long body suit.

In fact, the thing makes her scream and shriek. His big red mouth covers her head like he's swallowed her whole. Now she and Elmo are on the outs.

Something like this happens every year, and it's part of what I call "Halloween gymnastics." It's an annual ritual that can be frustrating, tiresome, complicated but, ultimately, rewarding -- once it's all over.

It doesn't matter how "cool" the costume is, or how cute. If it isn't the right fit, or if it's too itchy, or if it's scarier than Darth Vader, it's a bust.

We're not the only ones experiencing this frustration, of course. There are Internet blogs devoted to such stress. For instance, writers on holyshnikes .com talked recently about how finding the right costume is a problem for adults, too - especially for parties.

Nicole Grace, a therapist from Englewood,, N.J., said the situation could be worse depending on what the individual, family or parent is going through at the time.

"They're reminded of their own family history, or if there is a problem in the current family or if they're feeling isolated, that could be an issue," she said.

Indeed, the gymnastics ritual doesn't end with our daughter. Our 9-year-old has aged out of "Star Wars" -- or so he told us initially.

We then suggested that he should make his own costume. We had dreams of saving ourselves $50. But, now, he says, maybe he hasn't had enough of Luke, Darth and Han. He can't decide. Aaargh.

Right: Anna

Then we ask the 5-year-old to go through the costume catalog and circle what he wants. He circles 10 costumes that would cost us $500, if we bought them all. And he wants them all.

Our final costume decisions won't be made until a few days before Halloween, probably, which adds to the stress of planning and preparing for this holiday. We often look at how the kids get big bags of candy and say, "Where's our reward?"

Reuben Gross, a Teaneck, N.J. psychologist, says if people are struggling to find peace on such holidays, they should "team up" with others who can provide some support.

That could involve a friend or a family member they feel comfortable with, or somebody who is experiencing the same issues and can share in the joy -- or pain.

Every year, my family always finds someone to share the day with. There's always another mother or father who is willing to accompany us as we watch our kids as they run from house to house.

"A lot of it [the stress] is accepting it as a short-term issue, and keeping things in perspective, and knowing there is a light at the end of the tunnel," Grace said.

Overall, we've learned to find balance, and routine.

We don't let the kids go by themselves, or with other people, for example. We go with them -- but not just to provide them security. We remind ourselves of what it was like 25 years ago when we wore our homemade costumes and grabbed little chocolate bars from complete strangers.

Later that evening, we'll check our candy inventory, and share.

The last act of the night is the picture. Since he was 1, my 9-year-old has known just what to do when he sees the camera. He gives my wife a kiss on the cheek.

That's the best reward of all.

Originally published in The Record of Bergen County, N.J.