Category: Thinking out loud

Are you surviving, or thriving? Building your resilience.

2020…do we need to say more? COVID-19 has flipped our world up-side-down and changed a world that was safe, secure and known, even with all its life challenges, overnight to one of unfamiliarity, chaos and an enormous amount of discomfort and additional stressors. 

The pandemic, and the significant impact it has had and continues to have, on all aspects of our lives, contributes to many feelings of uncertainty and anxiety. We have all had to adapt, at rapid speed, the past couple of months whilst facing adversity   – working from home, physical distancing, tolerating financial hardships and embracing technology, or even dealing with illness and loss related to health, finances,  have become our ‘new normal’.  These overnight changes and challenges have left most people despondent. However, despite facing similar stressors, there are many who seem to have “glided” through it all, unaffected. How is that possible, you might ask.

“The truth is that our finest moments are most likely to occur when we are feeling deeply uncomfortable, unhappy, or unfulfilled. For it is only in such moments, propelled by our discomfort, that we are likely to step out of our ruts and start searching for different ways or truer answers.” (Peck, 1978).

The message here is that we should not shy away from stress – stress can be a powerful motivator and fertiliser for growth. However, we need to manage our stress and build our resilience. According to the American Psychological Association (2014), resilience is “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat”.

But what makes some more resilient than others?

Prevention includes a wide range of activities — known as “interventions” — aimed at reducing risks or threats to health. Primary prevention specifically refers to preventing disease or injury before it occurs. In the context of resilience, primary prevention refers to limiting exposure to work-related hazards that contributes or cause disease (workplace intervention), altering unhealthy and unsafe behaviours (improving selfcare and healthy lifestyle choices), and increasing resistance to illness, should exposure occur.

The most effective prevention is therefore building resilience through strengthening your internal resources and focussing on selfcare.

Ten habits of resilient people

1. Be optimistic

Optimism is a future-oriented attitude, involving hope and confidence that things will turn out well. Positive emotions reduce physiological arousal and broaden our visual focus, our thoughts, and our behaviour. Although we may feel overwhelmed by the current situation and our anxieties (health, financial, etc.), our thinking is more creative, flexible, holistic, effective and future-focussed, when we are optimistic.

2. Face your fear

Mandela said “I learned that courage was not the absence of fear, but the triumph over it. I felt fear myself more times than I can remember, but I hid it behind a mask of boldness. The brave man is not he who does not feel afraid, but he who conquers that fear”.

Fear can be a warning and a guide – it helps us to focus on what we need to address and to master the skills necessary for conquering the “enemy”.

3. Have moral courage

Actively identifying your core values, assessing the degree to which you are living by these values, and challenging yourself to adopt a higher standard can strengthen character and build resilience. To be morally courageous, we must be willing do what we know to be right, even if it means loss, disapproval, or shame.

Kidder (2006) describes moral courage as the “willingness to take a tough stand for right in the face of danger…the courage to do the right thing…the quality of mind and spirit that enables one to face up to ethical challenges firmly and confidently without flinching or retreating”.

4. Have faith

Religion and spirituality draw on faith. Not only is faith associated with better physical and mental health, but also with longevity. In a meta-analysis of 42 studies (n = 126000), those who actively practiced a religious faith lived slightly longer than those who did not (McCullough et al., 2000).

We can include the practice of meditation and mindfulness here. Mindfulness is a state of active, open attention on the present – observing your thoughts and feelings from a distance, without judging them as good or bad. Mindfulness means living in the moment and awakening to the experience. Mindfulness have been associated with an increase in the areas of the brain regulating mood, anxiety memory and wellness – through increasing the size of the hippocampus and reducing the size of the amygdala.

5. Get social support

Social connectedness decreases perceived stress depression, ischaemic heart disease and mortality. The effect of social support on life expectancy may be as strong as the effects of obesity, cigarette smoking, hypertension, or level of physical activity (Salpolsky, 2004).

Fowler and Christakis (2008) have also found that social connectedness improves our happiness by up to 40%. This is one of the biggest challenges for us during the current COVID-19 pandemic and the call for social distancing. I would strongly recommend that we replace “social distancing” with “physical distancing” – and ensure that we remain socially connected.

6. Find role models

The mirror neurons in our brain enable us to learn through observation. Identify resilient role models and imitate and practice their best qualities. Rosen (2014) and Sharma (2018) give good examples of resilient people and their practices.

7. Train diligently

Physical exercise directly benefits the brain. Not only does is improve immunity, positive emotions (e.g. happiness, joy and pleasure) and concentration, but it also creates new cells in the hippocampus which underlies learning and memory. Aim to exercise five times per week for at least 30 minutes.

8. Sleep regularly

Various studies have confirmed the health benefits of sleep. It improves your immunity, stabilises hormones directly linked with metabolism, improves emotional resilience and is necessary to consolidate information during learning for memory formation.

9. Cultivate a growth mindset and never stop learning

The more we think, the better our brain functions – regardless of age. An active brain produces new connections between neurons, so-called neuroplasticity. Even if we train one cognitive skill, it can improve performance of other cognitive skills and protect us against cognitive decline later in life.

However, it is important that we cultivate a growth mindset in which we see failure and challenges as opportunities for growth – both at personal and organisational levels. Resilience also requires us to think creatively and with flexibility.

10. Find meaning

Nietschze famously said “He who has a why can endure almost any how”. In Man’s search for meaning, Frankl (2008) emphasised that finding meaning is an active pursuit: “It must be searched for, found and discovered in the concrete experiences of our daily lives”.

We need to make sense of our circumstances and believe that we have the ability to exert influence over it. This underlies one of the core requirements of resilience: our consistent and deliberate practice of resilience and the engaging in work that is “excellent in quality, socially responsible, and meaningful to its practitioners” (Gardner, Csikszentmihalyi, & Damon 2001). This will help us to translate the benefit of the inner work we are doing to the external challenges we are facing. Siebert (2005) stated that “we are most resilient when we scan new circumstances with curiosity, not knowing in advance what we will do, but confident that we will interact in ways that lead to things working well.”

The COVID-19 pandemic has transformed our lives – and it has the potential to transform us. It is crucial that we accept and embrace change as part of living, and that we avoid seeing crises as insurmountable problems. Stress can be good for you. It can compel you to thrive and not merely survive  if you commit to setting aside time to work on your resilience, keep things in perspective, focus on your goals and take care of yourself.

CBD oil – be careful of this ‘wonder-drug’

Every time I read a Facebook post or a WhatsApp on a support group, where a mother asks where she can find CBD oil for her child with ADHD (or as a colleague of mine remarked “for everything from asthma to hemorrhoids”), I cringe. Not only do we see the devastating effects on individuals’ mental health in clinical practice which ranges from amotivational syndrome (similar to depression), mood disorders, cognitive difficulties (which can mimic ADHD), and even psychosis, but we, as psychiatrists, are also fully aware that there is no evidence for the benefits of using cannabis in any form.

Although the use of cannabis has been legalised and decriminalised in South Africa, this does not mean it is good for you, or even safe! Cigarette smoking is legal. Drinking alcohol is legal (above a certain age of course). Very few people will still argue that it is “good” for you and even less will ever encourage a child to use it. Yet there is a sudden misinformed hype about cannabis, and specifically the use of cannabidiol (CBD) oil.

Complementary and alternative medications (CAMs) have never been more popular. Unfortunately, this hodgepodge of practices can leave patients and healthcare providers bewildered and confused, misguided by ill-informed information doing the rounds on especially social media.

What are CAMs?

  • Health and wellness products and techniques not presently considered to be part of conventional Western medicine
  • Complementary: used along with conventional medicine
  • Alternative: used in place of conventional medicine
  • CAMs includes mind-body medicine (such as meditation, acupuncture, and yoga), manipulative and body-based practices (such as massage therapy and spinal manipulation), and natural products (such as herbs and dietary supplements)

Is CBD oil a safe option?

There is a general perception that CBD oil is natural and harmless. However, neither of these is true. The purer the CBD oil with less THC – Tetrahydrocannabinol which is one of at least 113 cannabinoids identified in cannabis and is the principal psychoactive constituent of cannabis- and other harmful components, the more refined it is. In refining the marijuana plant to CBD oil, it goes through various chemical and mechanical processes making it less and less “natural”. Furthermore, there are very few products on the market (despite what the various companies’ marketing proclaim) which pass the stringent criteria for “pure” CBD oil. Many products still contain trace amounts of THC making it unsuitable for use by children, teens, and even adults.

There is clear evidence for the harmfulness of cannabis to the brain. Exposure to phytocannabinoids (cannabinoids derived from plant cannabis) disrupts normal brain development and maturation – and has a (lasting) negative impact on memory, attention, processing speed, and overall intelligence  

 These negative effects may be permanent. There is also strong evidence linking cannabis with adverse effects such as depression (and increasing the risk for suicide with 50%) see, addiction, cognitive impairment, psychosis, and motor vehicle accidents as well as other health complications. This necessitated the South African Society of Psychiatrists (SASOP) to release a position statement warning the public of the potential dangers of cannabis use, and the conclusion that “available evidence does not support the strong positive public opinion and anecdotal reports favouring medicinal cannabis, except for its demonstrated benefits for chronic pain, spasticity due to multiple sclerosis and weight loss associated with HIV” (

If you are considering medicating your child or yourself with CBD oil for the treatment of ADHD please read this!

Six good reasons why not to use CBD oil

  • It is not as natural as you think it is.
  • The products available on the market are unregulated.
  • There are no longer-term studies on the use of CBD oil for children or adults.
  • There are well-researched, safe and effective treatment options – both non-medication such as lifestyle interventions and medication – available for (most) conditions including depression, anxiety, and ADHD.
  • Cannabis and CBD oil have a negative impact on cognition, with younger individuals (children and adolescents) being even more at risk for persistent neuropsychological deficits since their brain, and specifically, their prefrontal cortices (responsible for planning, problem-solving, decision-making, recall and impulse control) are still developing into their early 20s.
  • It is also possible that CBD oil becomes a “gateway” to the use of other substances. If a child has been using CBD oil, they may struggle to see the difference between the oil and smoking cannabis, and even the use of other even more harmful drugs.

Make sure you are informed. We are all pro integrative medicine where we combine and integrate the best of conventional (Western) medical care, with the best of evidence-based CAMs. However, supporting something that lacks evidence for benefit and rather demonstrates evidence of harm, is not only irresponsible, but it is also damaging the long-term health of our youth.

The many faces of bullying

25 November, the International day which marks the onset of the 16 Days of Activism for No Violence Against Women and Children. This worldwide campaign aims to raise awareness of the negative impact that violence and abuse have on women and children and to rid society of abuse permanently. However, the success of the campaign is dependent on our daily individual and collective actions to safeguard our society against the cycle of abuse.


What is abuse?

Abuse is any form of behaviour that can instill fear in a victim, cause emotional, physical or financial damage to a person, or coerce victims in doing something against their will (e.g. engage in sexual activities). Abuse can take place through commission (e.g. visible, physical behaviour), but also omission (the subtle withholding of e.g. care, support, and finances).

In a close relationship, it can be difficult to know whether you are being abused, especially if your partner says they love you, gives you a lot of attention, or pays for the groceries or rent – yet instil fear or emotional trauma through their actions or words. People who are abusive sometimes act loving and supportive as a way to keep you in the relationship. However, a partner’s loving behaviour does not make their abusive behaviour OK.

It makes them a bully.

But adult bullies have many faces: it is not only the controlling romantic partner, but also the intimidating boss or colleague, the difficult neighbour, the pushy sales representative, the condescending family member, or the social acquaintance or friend who shames you. Bullying is a deliberate act with the purpose of harming another – either through using power to instil fear, victimisation, or harassment. A bully (male or female) gains power in a relationship by reducing another’s and shows little regard for the consequences to a victim’s health or well-being. Bullying is abuse.


Workplace bullying

Workplace bullying can make life quite miserable and difficult. A 2017 American survey ( found that adults are being bullied at levels similar to adolescents. More than 2000 US adults partook in this online survey. The survey found that 31% have been bullied as an adult, 25% of adults have experienced the “silent treatment” from an individual or group, and 21% have had someone spread lies about them. Unfortunately, it seems that adults are becoming desensitised and complacent: 43% believe that bullying behavior has become more accepted in the past year.

It’s important to note the consequences of bullying. It can make you very ill. From the same study, 71% suffer from stress, 70% experience anxiety and or depression, 55% report a loss of confidence, 39% suffer from sleep loss, 26% have headaches and 22% experience muscle tension or pain, whilst 19% reported a mental breakdown, and 17% called in sick frequently. Emotional stress can also cause or aggravate other gastrointestinal problems, and cardiovascular problems such as hypertension. Victims of workplace bullying also has double the risk of suicidal ideation over the subsequent five years (Nielsen et al, 2015)

Examples of workplace bullying are being ignored (the “silent treatment”), refusing to help you when asked, not responding to your attempts to communicate (phone calls, emails), cutting you off while you’re talking, or even keeping you out of the loop for work-related social events. The bully may also not respect your time by intentionally showing up late to meetings, or missing agreed deadlines deliberately. They may also sabotage your ideas or projects, denying you well-deserved praise, taking credit for your work, or blame you for problems at work. But it may be even worse…


What types of abuse are there?

  • Physical abuse is any intentional and unwanted contact with you or something close to your body, or threats to hurt you, or loved ones (including pets). Sometimes abusive behavior does not cause pain or even leave a bruise, but it’s still unhealthy. Physical abuse may include scratching, punching, biting, strangling or kicking, throwing something at you (a phone, a shoe), pulling or pushing you around, the use of any weapons, grabbing your face to force you to look at them, or grabbing you to prevent you from leaving or to force you to go somewhere.
  • Verbal/emotional abuse may not cause physical damage, but it does cause long lasting emotional pain and scarring. It can also escalate to physical violence if the relationship continues on an unhealthy path. Constantly being criticised and told you aren’t good enough causes you to lose confidence and lowers your self-esteem. You may actually start believing what your partner says (e.g. being ugly, worthless, or useless). As a result, you may start to blame yourself for your partner’s abusive behaviour. Controlling behaviour (e.g. isolating you from family and friends, monitoring what you are doing and where you are throughout  the day, demanding your passwords, or deciding for you what you should wear), extreme jealousy (including constant accusations of cheating), having a quick temper (and then blaming you for the outburst), or demeaning and belittling you. Emotional bullying is also common in the workplace, e.g. gossip or starting rumours about someone or a group of individuals.
  • Sexual abuse refers to any action that pressures or coerces someone to do something sexually they don’t want to do. It can also refer to behaviour that impacts a person’s ability to control their sexual activity or the circumstances in which sexual activity occurs, including oral sex, rape or restricting access to birth control and condoms. It is important to know that just because the victim “didn’t say no,” doesn’t mean that they meant “yes.” When someone does not resist an unwanted sexual advance, it doesn’t mean that they consented. Sometimes physically resisting can put a victim at a bigger risk for further physical or sexual abuse.
  • Financial abuse can be very subtle, although often associated with physical and emotional abuse. and can include behaviour such as giving you an allowance and monitoring closely how you spend it, placing your salary in their account and denying you access to it, using your credit card without permission, keeping you from seeing shared bank accounts or records, controlling the amount of hours you are allowed to work, or making it impossible to go to work (e.g. by taking your car or keys), creating havoc at work (e.g. by harassing you or your co-workers), withholding necessities (e.g. money, food, rent, medicine or clothing), using funds from joint accounts without your knowledge, or using their money to hold power over you because they know you are not in the same financial situation as they are.
  • Technological abuse (“cyberbullying”) is the use of technologies such as texting and social networking to bully, harass, stalk or intimidate another person or partner. Often this behavior is a form of verbal or emotional abuse perpetrated online. Examples are controlling who you are allowed to befriend or not on social media sites, negative, insulting or threatening messages sent via phone or email, stealing your passwords, constantly texting you and making you feel like you can’t be separated from your phone for fear that you will be punished, using technology (such as spyware or GPS in a car or on a phone) to monitor you.
  • Stalking, i.e. when a person repeatedly watches, follows or harasses you, making you feel afraid or unsafe, is another type of abuse. A stalker can be someone you know, a past partner or a stranger. Stalkers may show up at your home or place of work unannounced or uninvited, send you unwanted text messages, letters, emails and voicemails, leave unwanted items, gifts or flowers, spread rumours about you via the internet or word of mouth, or even damage your home, car or other property.


Nine tips on beating the bullies and recovering from abuse

  1. Acknowledge the problem. If you are unsure whether you are being bullied or abuse, try describing the situation as if it were happening to someone else. If a friend told you this story, how would you react? Call it what it is: recognising bullying and abuse as it is happening can provide some comfort by validating your feelings and affirming your reality. Remember, both men and women can be bullies, and so too can both men and women be victims of bullying.
  2. Be safe. The most important priority in the face of an adult bully or abuser is to protect yourself. If you don’t feel comfortable with a situation, leave. Contact the police (and obtain a protection order), an emergency or crisis hotline, social agencies, or a lawyer.
  3. Limit exposure. With adult bullies whom you need to interact with on a regular basis, it’s important to put a stop to any serious, potentially damaging patterns early on. Keep a healthy distance and avoid engagement unless you absolutely have to. Ask to be moved in the office or removed from the specific team. Whenever possible, formalise your daily communication with the bully by either putting things in writing, or having a witness present. Keep a paper trail of facts, issues, agreements, disagreements, and timelines.
  4. Keep calm. Bullies try to provoke you. They project their aggression to push your buttons and keep you off balance. By doing so, they create an advantage from which they can exploit your weaknesses. The less reactive you are to provocations, the more you can use your better judgment to handle the situation. Don’t take the bait. Let them own their own pathology.
  5. Speak up. We all have a part in stopping bullies, so if a peer is being bullied, be their support, and if you are being bullied, find support from co-workers, friends, and professionals. Some victims of adult bullying remain quiet about their experience, due to fear, embarrassment, a sense of helplessness and powerlessness, as well as gender, cultural, social, and/or institutional conditioning. #MeToo spread virally in October 2017 as a hashtag on social media in an attempt to demonstrate the widespread prevalence of sexual assault and harassment, especially in the workplace. Being a silent victim gives the bully more power. No matter how difficult the situation, seek out trustworthy individuals to confide in, whether they be friends, family members, colleagues, HR, or a health care professional. Being supported will strengthen your ability to handle the challenge.
  6. Empower yourself and build confidence. Bullying is not about you. Bullying might be targeted at you, but the first step to handling them is realising that you’re not doing anything wrong. Adult bullies are trying to disempower you, to make up for some shortcoming of their own. Do not take bullying personally. Stop being the victim. You can only be bullied and abused if you allow it. Take a stand. Speak up. Find support.
  7. Seek professional assistance. Recovering from the emotional scars may take longer than recovering from physical scars. Do consult with a qualified professional (psychologist, social worker, psychiatrist) to address the trauma, anxiety, and depression which may be associated with or follow on from being bullied and abused. Although therapy is always indicated, medication might be suggested even if only for a temporary period of time until you are back on your feet and gained controlled back of your life and healed from the emotional scars.
  8. Self care. Take care of yourself. Sleep enough, eat healthy, exercise regularly and socialise. Investing in these activities will make you more resilient to address the situation, and also to recover. You are worthwhile. You deserve this.
  9. Legal action. Harassment and threats are criminal offenses and should never be ignored. Know your rights (to be treated with respect, to express your feelings, opinions and needs, to set your own boundaries and say “no”, to take care of your and protect yourself from being threatened physically, mentally or emotionally, to create your own happy and healthy life). When your boundaries and rights are violated, deploy consequences. Take legal action if needed.

Bullying and abuse are never acceptable. Let us stand together in speaking up, supporting one another and stop the cycle of men and women being abused.