This week the NBCC and organizations nationwide are recognizing Medicare Mental Health Week. Dr. Kerri Schroder shares some insight on this topic.

“Loneliness and the feeling of being unwanted is the most terrible poverty.” ~ Mother Teresa

These words describe the feeling of many of the elderly in our country. Despite longer life expectancy, increased facilities and technology that medical and social systems provide to elderly, loneliness and depression are all too common.

Loneliness is not a new concept only beginning during senior years.  Loneliness is not synonymous with being alone, nor does being with others guarantee protection from feelings of loneliness. Loneliness has been described as a complex set of feelings that occurs when intimate and social needs are not adequately met and that drives individuals to seek the fulfillment of these needs. It is a universal phenomenon found in the humans and is closely associated with changing life circumstances.

We can also distinguish emotional and social loneliness. Emotional loneliness is missing an intimate partner, such as a spouse or sibling and is accompanied by feelings of isolation and insecurity, and of not having someone close.  Social loneliness is lacking a circle of friends and acquaintances that can provide a sense of belonging, of companionship and of being a member of a community.

Studies have found that increased age, absence of partner, dependency; institutionalization and health impairment were associated with increased risk of loneliness.  And loneliness is linked to depression, lower quality of life and increased vulnerability to both physical and mental health problems of the elderly. Factors like cognitive function and limitations in activities of daily living were not related to loneliness. Other factors: education, income, marital status, and perceived stress are not predictive of loneliness.

Coping mechanisms are cognitive and behavior efforts to manage perceived overwhelming demands, whether external or internal. The way these difficulties are faced directly influences levels of health and psychological well-being They can be divided into two categories.  Adaptive coping mechanisms are fairly active, and include instrumental and emotional support, planning, acceptance, humor, positive re-framing and religion.  Mal-adaptive coping mechanisms are more passive and include behavioral disengagement, denial, self-distraction, self-blame, substance abuse and venting.  Often time seniors react to feelings of loneliness with sad passivity, distancing, and denial as a way to cope due to a sense that this is what is expected at their stage of lie.

Not surprisingly the use of adaptive coping strategies are associated optimism and active engagement and result in less loneliness and less depression.

Engaging in therapy to learn and practice adaptive coping skills is a pathway to overcome loneliness.  Practical strategies are offered:  how to distinguish between loneliness and solitude, volunteering & teaching opportunities, finding other sources of nurturing (caring for pets, plants), figuring out what is missing from your life, and taking steps to connect with others.

Kerri Schroder is a licensed psychologist who specializes in geriatric mental health. 

Being newly single can be quite challenging during the holiday season. You feel bombarded with images of budding romance and happy families.  You realize that the traditions you had participated in will change. Overall, your expectation is that you will be lonely, restless, and maybe even depressed. As challenging as it may seem, consider this as an opportunity to learn how to be single again….and perhaps, even to embrace it.

Here are 11 things you can do to make the holiday season brighter.

Play It Forward: remind yourself that how you are feeling during this season is NOT how you will be feeling for the rest of your life. We all go through cycles and changes in life. This may be a low point for you, but there will be an upswing.

Do A Reality Check: don’t assume that everyone else is doing better than you. You never know what an individual or family might be struggling with. And, the idea of a happy traditional family setting might be more of a marketing tool than reality.

Seek Wisdom: talk to people who have gone through the holidays as a single person. Ask for their advice on how to cope. You will find comfort and support in their responses.

Create New Traditions: find new ways to celebrate the holidays. If you always had turkey for a holiday meal, try something different. Attend a different holiday religious service. There are many creative ways to start new traditions.

Learn To Say “No”: if you receive an invitation and you’re just not ready to go out socially, or the situation might make you uncomfortable, it is okay to say “thanks for the invite. I’m going to take some time out for now”. It is also okay to accept invitations, attend the event, and leave early. In other words, give yourself permission to set limits.

Go Public: if, on the other hand, you are someone who enjoys chatting and connecting (most women do), then accept invitations and approach each one as an opportunity to feed your need for connection. Research has found that one way to treat depression is to put yourself in a public setting in order to be around people and enhance your mood.

Practice Altruism: it is a proven fact that acts of kindness improve our mood. In addition, exposure to the hardship of others gives us a meaningful perspective on our own problems. The holidays are a perfect time to get out and volunteer or organize donations for those in need.

Reclaim An Interest: is there something you neglected or gave up entirely while you were in your previous relationship? Now if a great time to reclaim it. Set aside time and space dedicated to doing something you enjoy, especially if it is creative or offers the opportunity to meet new people.

Try Something New: there’s probably something you’ve been wanting to “try” but have held back. Use this season to “just do it”. Not only are you likely to enjoy yourself, but imagine how good it will feel to have stepped outside of your comfort zone. You’re likely to feel proud and confident which will add to the sense of reclaiming your life.

Declare A “Me Day”: be a little selfish and spend a day focused on yourself, whether you stay home in PJ’s watching TV reruns or movies, or go out for a nice meal, get a massage; whatever makes YOU feel good.

Follow the Sun: exposure to natural light is known to be a mood enhancer. If you don’t have the resources to travel someplace warm and sunny, try a full-spectrum light. If you can’t get natural light, use environmental cues to enhance your 5 senses: look at sunny climate images, rub suntan lotion on yourself, play uplifting music, burn a candle, eat some strawberries.

Take this list and track your use of it. Having a plan that offers choices gives you a sense of taking control of your life. Tracking your behavior and emotions gives you accurate feedback about your successful transition from “we” to “me”.

For anyone who is struggling….you do not need to be alone. Reach out to a support group and/or seek counseling.

Kerri Schroder, PhD is a licensed psychologist who finds passion in helping people through life transitions. 

Whether you call Maggie my “animal companion” or my “pet” doesn’t really matter to either of us. All I know for sure is that I love my dog Maggie. When I’m feeling down she puts a smile on my face. She’s always glad to see me and is entertained by everything I do. The therapeutic value of animals in the lives of humans is well known and supported through scientific research. They soothe us, aid our healing, make us laugh, lower our blood pressure and can motivate us to exercise! For most families, their pet is a member of the family. For children, their relationship with a pet might be the first time they share love with someone other than their parents. Many of us even feel our pet understands us better than our human friends. We love our animals.

It can be hard to understand why people have unhealthy relationships with animals or even abusive interactions with animals. There was a television show that portrayed this extreme by interviewing “animal hoarders” and then attempting to provide therapeutic interventions. These peoples’ homes had been taken over by the animals that they collected regardless of their ability to care for them. They substituted social interactions and family involvement for relationships with their pets who love them unconditionally. Clearly this a good thing gone too far, more so it illustrated how emotional dysfunction can negatively affect the animals around us. Is there a perfect number of pets for an individual or a family? Probably not, but standards of hygiene and care should never be sacrificed because there are too many pets. There is no excuse for neglecting the basic needs of a dependent animal.

It’s even more difficult to understand what goes on with a person who becomes abusive towards animals. Animal abuse involves intentionally harming an animal, sometimes out of anger or frustration, but often as a detached act of violence or expression of dominance. This past year Wilmington saw a call to action to change animal cruelty laws after a puppy, Axel, had been beaten to death. Such cases are upsetting on many levels. Initially we are saddened that a vulnerable creature was injured on purpose. As that shock settles in, we are alarmed because we know that most people who harm animals, lack empathy for others and are at risk to repeat the violent behavior.

Empirical research has demonstrated an association between animal abuse, violent behavior towards humans, and family violence. In addition we know that: both perpetrators and victims of bullying are more likely to abuse animals; witnessing animal abuse has a damaging traumatic effect on some children and “teaches” other children to use violence to solve interpersonal problems; and the same issues of control and dominance underlying spousal abuse are often operative in animal abuse.

The abusive treatment of animals can not be tolerated in children or adults. If your child mistreats your pets, then your pets need protection and your child needs limits and supervision around animals. When children have grown up influenced by adults who use violence to solve problems they are at a greater risk to use violence to express difficult emotions. Sometimes those same children feel so powerless in their lives that they feel driven to dominate others but can only find success expressing their angry control over animals. These children (and their parents) need to develop improved skills to communicate their needs, resolve conflicts and appreciate the impact of their behavior on others. Adults who mistreat animals need specialized interventions and to be held accountable for their actions.

If you take on the responsibility of owning an animal, hopefully you will also see the rewards of a blossoming love relationship between yourself, your animal and your family; but never forget you have an obligation to ensure that animal’s well- being. Having an animal entrusted in your care is a privilege. A pet is a loved living being never to be treated as an object that is owned.

The decision to pursue Bariatric Surgery is usually not an impulsive one. Some consider it for years; others for several months. The last straw may be the recommendation of primary care doctor; weight loss in order to have an orthopedic operation; the shame of being denied a ride at an amusement park; seeing the success of a friend, coworker or loved one after their surgery. The decision comes from many sources, but it is almost never an impulsive or lighthearted one. So the call to the bariatric surgeon is made: whether with excitement or dread that important first step is often filled with ambivalence and regret that one has got to this stage.

It is not surprising given how difficult the first step is that it is frustrating after having considered and then reconsidered the decision to be told that one must complete a series of tests before being seen or setting a surgery date : medical tests, psychological tests and nutrition sessions. It seems like once the decision is made it should be full steam ahead, let’s get the surgery over with and on to the new life. The medical and nutrition education make sense and seem to be straight forward, maybe frustrating to schedule but doable.

It’s the psychological evaluation that often causes further angst. Patients often come to the psychological evaluation anxious and defensive. It is not unusual for someone who has struggled with obesity to experience some depression, anxiety or difficulty dealing with stress. Feelings of shame over obesity and the stigma that one suffers at the hands of others takes a toll over time. Many of us eat emotionally…not just an obese person. It is not uncommon for patients to feel at fault, that they have failed at this most important thing and to fear they will be told something is “mentally wrong” with them. Fears that all too common symptoms will lead to being denied often lead to the defensive posture that “everything is completely okay, no problems, no stress, no past conflicts, no emotional eating, no, no and no”

Just as hypertension often occurs with obesity, several psychological disorders or symptoms seem to be prevalent. No one would want their bariatric surgeon to perform surgery if their blood pressure was so out of control that they would have severe complications from the operation. The same should be true for psychological issues. It is not the presence of symptoms, whether depression, anxiety, etc; it is how these can be treated either before or after surgery.

The psychological evaluation is to help design an effective treatment plan to address emotional issues that would adversely affect outcome. Many people believe that after the surgery, their lifestyle automatically changes. They will be able to change eating habits because of the surgery or adverse consequences of eating certain foods. Along with the smaller or new stomach, one will no longer want certain foods, will have time to prepare and cook meals, will not eat due to being tired, lonely, anxious, or stressed. Intellectually, we all know this is not true but we operate on this principle.

Keep this point in mind: during the 12-18 months after surgery, the most significant weight loss is to occur. If you think of the surgery as the Olympics, the call to the surgeon is signing up for to be considered for the Olympic team. You would train well before the actual Olympic event. Consider how successful a skier would be if the first time they strapped on skis was on the chairlift going up to that double black diamond. The months between the first call to the surgeon and the operation are your training time. You practice the dietary changes, you plan for exercise or even begin exercising if possible, you address emotional eating patterns, you learn to track intake, give up carbonated beverages, practice the 30/30/30 rule. The list goes on. This period is the time to fail, to recognize where your weakness are. Maybe it’s dining out or eating watching TV or the siren song of a Sundrop. We know that there are different types of hunger: stomach, mouth, eye and head. The surgery will almost eliminate stomach hunger. What about the others? What is the plan? Practicing the plan before surgery is a key to success. If depression and/or anxiety would interfere with success, often a treatment plan can be implemented without a long delay before surgery.

Finally you are cleared for surgery, a date is set. What does one do once they are accepted to the final Olympic team? Do you stop training: go on a food farewell tour, stop tracking your intake, have one last soda, stop practicing all the skills until it’s time to enter the Olympic village? Surgery is an event, like an Olympic contest. But whether you end up at Disney World and on the cover of Wheaties depends much more on your training.

The psychological evaluation is not another hoop to get through before the promised changes. It can hopefully be an honest exchange comprised of education and exploration of what will be the strengths and challenges one will face on their journey. What skills can be added to make that journey a success. As disappointing as delays can be they likely add up to just a moment in your new life, take the time to prepare. It will be well worth getting that Gold Medal.

Me Too! The social media phenomena of women announcing that they too have been subjected to sexual harassment has taken the world by storm. Yes, the world. This is not hyperbole, women from Germany, Italy, the Arab countries even Nairobi have been posting Me Too! Not that anyone should be surprised that women all over the world are subjected to sexual harassment. This abuse extends way beyond celebrity casting or factory work. However, in addition to the global Me Too! response is something that is different. Men are responding. And men are responding positively: not with rationalizations or minimizations. With tweets of “I hear you! “or even “I was guilty!” Guilty of not standing up, of not saying something when they observed another man making a lewd comment, of shaming the victim who dared to say stoop. This is not just the celebrities rallying against Harvey Weinstein. Everyday men are saying “I understand.”
Women have long been united in trying to empower other women. In the marches, the protests or gatherings there is always a small percentage of men who will stand up for women’s rights. Is this a change to more global activism? We can only hope that men and women unite against all forms of abuse. The message needs to change. One recent article noted that we have depersonalized violence to being out there, as if the perpetrators are some alien force, not human. It’s domestic violence not significant others attacking their loved one What if we read, there was X number of men raping women or X number of teenage boys impregnating teenage girls. Can men join women in standing up to other men or calling expressing their own victimization without shame. Can we hope that someday it will not be Women’s empowerment but Human Empowerment? Well, we just might have taken a step. I look forward to the day it is not about men, women, or any other group. May the next blogger be able to comment “We treat all living being with respect”
Sexual harassment is abuse. Often the dynamics are the same as with more physical forms of sexual violence. The same power differential and the same intimidation. Unfortunately, it can lead to the same lasting PTSD difficulties as well as loss of employment, opportunity and potential. Disclosure can be as difficult as the harassment and lead to even further difficulties. Reading the stories of Me Too posts expose harassment for what it is… simply a longer word for abuse.

Whether you are contemplating bariatric surgery or are post-surgery, lifestyle changes are the key to optimize your outcome. Having the right team members with you on this journey will ensure a healthier you and make transitions smoother.
Research shows that individuals who remain in touch with their bariatric centers maintain weight loss and are in better health. Follow ups with your surgeon or Primary Care Provider (who is knowledgeable of post- surgery care) are essential over your life time.
Prior to surgery attendance at one or two nutritional seminars is the norm. The information provided invaluable but often overwhelming. Often your handouts end up loss in a drawer and you struggle with how to vary your diet over time or revert to some unhealthy habits. Learning all you need to know before you have surgery is almost impossible. It’s like reading a book on how to swing a golf club and actually hitting the ball straight onto the green. Consider a Bariatric Specialized Dietician to help over the course of weight loss and management as a valuable team member.
Your significant other and family are crucial members of your team. The more they understand your new normal, both changes in diet and exercise, the more support can be provided. Let family members know your needs, be firm that your health is a priority and what they can do concretely to assist.
Friends become team members only when they are included in your journey. Not all friends may remain on your team. Accept new members who support your lifestyle and cut those who are not able to make the transition with you.
A bariatric support group is another member to add. These groups are a resource to gather new ideas, compare experiences and learn about your new lifestyle.
If you are struggling with emotional hunger, depression or anxiety, counselors can provide a safe place to help learn new coping skills, examine new life goals and resolve any unfinished issues before you sabotage your success.
Most importantly is your bariatric surgery itself on your team? Is it your friend or rival? The framework you place your surgery helps determine future behaviors and motivations. If you treat your surgery as a team mate, one who assists you in keeping obesity in remission, who deserves attention and respect; the guidelines and rules are just part of the game. If you see your surgery as an obstacle, barrier to get around or beat, compliance and ultimately optimal results suffer. Make your surgery your MVP.
So, who is on your team? Add those individuals who will assist you on the way to new opportunities and success.

Bariatric surgery can help psychological and emotional problems.  There is well documented evidence of gains in positive self esteem, sense of taking control of one’s life, energy and vitality.   Anyone who has struggled with obesity is aware of its negative impact on the quality of life over time.  These include difficulties arise in social situations due to discrimination, shame and poor self confidence.  Depression, anxiety and even complete withdrawal from social circles are commonly reported.    Unfortunately losing weight doesn’t always translate into an immediate reversal of social anxiety nor of depression.

Some of the most common post bariatric surgery problems include:

• A lingering perception of being obese even after losing weight and falling within normal BMI ranges. Years of convincing oneself that they do not look good does not go away in just a few months.
• Relationships may be affected after bariatric surgery. Most individuals experience an increase in self-confidence.  Good relationships may become stronger while bad relationships may deteriorate further. As the person experiences greater self-confidence and enjoys their new body image, they may improve their sex life. This may strengthen an intimate bond with their significant other.  Those trapped in unhealthy relationships may find the strength to leave or push for changes.
• Prior to bariatric surgery, individual may have eaten to help cope with negative emotions, to celebrate or just to enjoy the flavors of foods.   Foods high in fats and sugars are often “go to” foods for emotional eaters.  Post surgery, that will no longer be possible. As a result, some patients may feel deprived or resentful, particularly when cravings or hunger returns.  The journey to finding the right combination of foods that satisfy often can be eased by the assistance of a qualified bariatric dietitian
• Some individuals, in not being able to cope with the change in diet, may develop other addictions to fill the void that food once did. There is an increased risk for abuse of alcohol that all bariatric patients should be aware of.
• Extra skin after bariatric surgery can be upsetting or depressing. While this is a normal result of weight loss, it can also derail the patient’s journey.

While you will experience challenges after bariatric surgery, there are ways to cope with your changing lifestyle. First, family and friends are important in helping you lose the weight. When family and friends are part of your weight loss solution, you create an intimate group with whom you can brainstorm answers to your problems.

It is also important to attend support groups on a regular basis. You will learn about tips and tricks to lose weight, other people’s experiences and learn what others have done in your position. Support groups have been proven to be a very effective tool in losing weight and keeping the weight off as well as avoiding many psychological issues.

In the end every significant change can affect us. Undergoing bariatric surgery requires a great deal of dedication to your health and diet.  It also opens the door to opportunities for social connectedness,  new interests and passions.  Make sure to take advantage of all the resources and opportunities available to you.