But Names Will Always Hurt Me: School Bullying, Educator-Induced Post-Traumatic Stress Disorder, and Implications for Family Medicine

Ilene Abramson, PhD

Ilene Abramson, PhD

International estimates of overweight/obese youth currently approach 43 million, a figure expected to rise in the coming years. However, pertinent research overwhelmingly addresses physiological aspects of corpulence yet, by contrast, only modestly acknowledges concomitant emotional scars, especially those from bullying.

By definition, bullying is a cluster of actions encompassing name-calling, ridicule, social exclusion, and other forms of harassment instigated by classmates, instructors, and family members toward portly children and adolescents. The psychological effect of this phenomenon is tremendous, as evidenced by the derided student’s toxic coping mechanisms:  dangerous crash diets, suicide ideation, and the victim becoming a bully himself. 

Because of the role of both school personnel and family members in the dilemma described above, the work of the healthcare provider caring for obese, taunted youngsters may be especially challenging. For example, a likely suggestion to increase exercise may spark recollections of recent humiliation from a coach with a “tough love” approach- i.e., name-calling, ridiculing, or other forms of “motivation” in front of peers. Such staff also tend to favor intensive training, regardless the weather conditions, even if the student is obviously exhausted. A practitioner informed of such occurrences can always advise the youth to speak with parents or older relatives.  Regrettably, the suggestion may prove ineffectual if the family doesn’t see the seriousness of the humiliation and responds to their child’s laments with advice such as”cowboy up!”

As a result, the humiliated youth exists in two destructive settings, the school where he or she is powerless before an insensitive instructor and the home where the educator-figures (parents) defend such faculty. Together, both places form fertile ground for permanent psychological scarring.

This emotional aftershock, also referred to as Educator-Induced Post-Traumatic Stress Disorder (EIPTSD), constitutes an under-researched area of the childhood obesity-school bullying link and abusive behaviors related to other vulnerabilities (i.e., poor grades, ethnicity). Investigations done by the late Irwin Hyman, published in his book, Dangerous Schools: What We Can Do about the Physical and Emotional Abuse of our Children, indicate that nearly 60 percent of adults in any group recalls at least one negative school occurrence – usually inadvertent humiliation from a teacher. The most extreme examples of emotional impact are reported by 1-2% of former K-12 students.

Though a seemingly small number, this 1-2% from a district the size of the Los Angeles Unified School District (694,288 enrollees) equals nearly 14,000 traumatized youngsters, future adult patients in today’s family medicine practices.  Later in life, these emotionally scarred men and women are apt to choose part-time jobs without insurance rather than return to the dreaded school environment and re-train for a new career. Unprotected and with limited funds, semi-employed workers avoid medical appointments and thus lose the opportunity to meet the clinician, upgrade their health literacy, and improve their overall wellness.  Moreover, the missing patient will forego needed shots and put his neighbors at risk.

Unfortunately, the current literature rarely addresses the tenacious impact of bullying (including the obesity-bullying dyad) on the part of educators.  Since the situation does exist, what can providers do to better recognize and communicate with victimized children before they become tomorrow’s EIPTSD cases?

Julie Lumeng, MD, Assistant Research Scientist, Center for Human Growth and Development, University of Michigan, offers some suggestions. Depending on the child’s age and family dynamics, try starting the dialogue with open-ended questions such as: “how’s everything at school these days?’  Depending on the patient’s response, tactfully continue with “‘Does anyone there say anything that makes you feel bad?”  Should he answer yes and should the subsequent conversation reveal the presence of bullying, immediately validate the child’s feelings and let her know that such behaviors are unacceptable. Also attempt to learn how the girl has been coping so far and who the instigators are in the situation. When the abuser is an instructor, strongly urge the parents to speak with the offending party and if needed, his/her superiors.

Avoiding “all the fuss” and waiting for the child to “lose some baby fat and move on” can prove deadly.   In the interim, a taunted pupil—perhaps their own son—may become a statistic who crushes his agony with the ultimate weapon: suicide.

As family medicine professionals, it is our duty to look at all elements affecting our patients. A dilemma of this magnitude necessitates refined clinical communication skills, partnering with other advocates of children and adolescents, and updated university curricula to recognize preliminary signs of both bullying among youngsters and EIPTSD among previously-vilified adults.

 

Global Health: It’s Not About Becoming Worldly, It’s About Becoming Better Doctors

Heidi Chumley, MD

Heidi Chumley, MD

As we continue to evolve how we prepare medical students to join the US physician workforce, we should continue to create global health experiences that will impact how we approach clinical practice—whether that be when managing a diverse patient population or when addressing the global health issues that are now on our doorstep.

When I was in medical school, we often saw the term international health in the context of faraway villages where issues like access to clean water, sanitation, and basic understanding of the spread of disease were at the heart of figuring out how to improve a community’s well-being.

As medical students, we viewed short-term medical mission trips as our way of getting a glimpse of the world outside our environment and gaining exposure to not just tropical diseases that we would never see at home, but also to the ways that healthcare providers in these settings coped in order to care for their patients.

Things changed somewhere along the way, and what we used to call international health became global health, the term much more indicative of a connected world where diseases–and physicians–crossed borders. A decade ago it was SARS and later the avian flu. Recently we had our first cases of Ebola in Dallas and New York City. Global health, it seems, has come home.

In the journal Family Medicine, Dr John Frey III of the University of Wisconsin writes that global health experiences can be “a treatment for [US] medical myopia,” referring to a seeming inability for the US clinical and educational systems to learn from other cultures and systems. “At its best,” he writes, “global health offers a perspective based on humility rather than arrogance and on an openness and generosity of thought that changes thinking and practice in all directions.”

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