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Prakash Chandran (Host): Bullying is an epidemic. It is widespread and the effects are so much more serious than people realize. It occurs in our communities, in our schools and even in our workplaces. Let’s talk about it with Dr. Stuart Green, the Associate Director of the Overlook Family Medicine Residency Program.

This is Building Healthier Communities, the podcast from Atlantic Medical Group. I’m Prakash Chandran. So, first of all Dr. Green, I’d love to understand what kind of behavior is considered bullying.

Stuart Green DMH, LCSW, MA (Guest): Well in order for a behavior to be bullying it really needs to have three characteristics. One is that it’s a pattern of negative acts. The negative acts can be physical, or psychological. But it is virtually always a pattern of such acts. In other words, it’s behavior that repeats over time, almost never a single incident. Also, when it’s bullying, it’s occurring – the behavior is occurring in a relationship in which there is what’s called an imbalance of power. In other words, the person being targeted has less ability to defend themselves from what’s happening. So, it’s a relationship again with an imbalance of power as a key characteristic and we can talk more about how to define these things.

And the third characteristic is that the intent is to harm the targeted person. That may seem obvious but it’s an important distinction. It’s primarily what distinguishes bullying for example from playful teasing in which you can also get behavior that ends up hurting another person but there isn’t the intent to harm the other person. In other words, if it was just teasing and somebody actually gets hurt; there is usually some remorse expressed on the part of the people involved because it ends the play. But in bullying, the whole point of it is to harm the other person, to diminish them, to hurt them.

Host: It’s so interesting that you say that because as you were talking, I was thinking about that playful teasing and it is a pretty fine line, isn’t it, because sometimes you just think that you’re joking with someone and they take it more seriously. I imagine though that that’s still a small form of bullying especially if I the person potentially doing that playful teasing, I am like why are they being so sensitive about this. wouldn’t you say?

Dr. Green: Actually no. We talk about people understanding what bullying is and then being easily able to distinguish playful teasing from bullying. Because if you think about the characteristics, when people are teasing each other say in a group or in a relationship, it’s not always the same person being the target of the teasing. And again, if a person really shows that they are hurt and it’s playful teasing; there is some remorse expressed or at least there’s an end to the behavior. Because the point of it is not really to hurt the other person and again, bullying is virtually always a pattern, a repeated behavior.

For example, in the 20 years that I’ve been taking phone calls from parents of children hurt in this way on a hotline in my office; I almost never have gotten a call in which somebody says you know my child got hurt yesterday in this way and before that everything was perfect. This is the first time that every happened and I’m upset about it. I have virtually never gotten that kind of call.

All the phone calls, an average of one a day sometimes several on a bad day, are calls in which somebody says this behavior, this targeting of my child has been going on for months, sometimes even for years. So, it’s actually pretty easy to distinguish playful teasing from bullying. Bullying is violence for sure. And violence is quite noticeable.

Host: I’m really glad that I asked that question and we made that distinction. So, it’s something that’s repeated, it’s directed and there is no remorse felt. So, I am actually a brand new parent and it’s something that I think about a lot and I wonder how do I identify if I for example, expect that my child is being bullied? Like what are the signs that I should look for as a parent?

Dr. Green: For one thing, you are going to see expressions of some anxiety, some fear, sometimes especially among boys; there’s stolen objects, things the kid had that now disappear or torn clothes. So, it’s noticeable in that way. The one thing though that – let me just see if I’m covering – yeah fear, unhappiness, the child maybe avoidant in regard to going to school or other settings. There could be injuries that aren’t well explained, missing money and you also may find a child who is bullied becoming increasingly isolated, less social, more withdrawn or showing mood changes, increased irritability or other changes in appetite or sleep that we associate with depression. So, it’s noticeable.

The one thing however, that you cannot count on as a parent is that the child will report it. that they will tell you what’s happening. Most kids in these situations do not tell parents or teachers or anybody else about it for many reasons we can go into.

Host: Yeah, I imagine there’s a whole gamut of reasons including maybe there’s a little bit of pride there. They don’t want to tell their parents that they are experiencing something. So, if you do notice something as a parent, what is the right course of action that a parent might take?

Dr. Green: The issue is most bullying, most of this behavior occurs in institutional settings. For youth, most commonly that’s school, although it can also occur in youth correctional facilities. In adults, that’s the workplace or the military or correctional institutions. It can occur in families since the family is an institution or an organization itself. But most commonly, it occurs in the places where kids are together and for youth for example, that’s school.

The reason I’m emphasizing that point in response to your question about what parents can do is that parents have very limited control of what goes on in these institutional settings. I mean technically the parent funds the school, you are a taxpayer, or you pay tuition, you would seem to have some power. But in reality, all you are really doing is exercising some choice about who runs these institutions, the administrators, the teachers, et cetera. And it’s really their responsibility primarily to prevent and address bullying.

So, the direct action a parent can take mainly consists of being supportive, of listening and then having the expectation, the very strong expectation that the people who run the school for example, need to be addressing this problem. So, the parents key sort of vector of intervention is to the people who run and staff the institution where their child is being hurt, whether that’s a youth sports team or other sort of institutional setting.

Host: Yeah, that is really good advice. But I’m just curious, how should a parent then approach their children about bullying? Like you said, to be supportive and to listen and hope that the administrators and the people running the place do the right thing. But what do you tell a child?

Dr. Green: Well for one thing, we shouldn’t minimize the listening aspect. When you ask kids what’s helpful, that’s really the number one thing and giving advice and telling a child what to do or telling them to fight back, things like that are really not helpful. All of that kind of advice simply makes the child feel like they are responsible for their own sort of targeting. That if only they had behaved differently or if they were stronger or if they laughed more or were better at making friends then they would be getting hurt. So, advice can really be a sort of hurtful thing in the end.

So, the listening and supportive function is really important. What a parent can also try to be helpful doing is to arrange for the child as much as possible to be in alternative social situations to be with other kids in a way that’s likely to result in some friendships or the development of some positive relationships, new activities, trying new things. In the final analysis though, it’s really the people who run let’s just focus on school, the school who is responsible and we have even said to parents and this is standard advice advocates give; is this is sustained and doesn’t go on and the folks in charge don’t adequately prevent and address it, changing settings, leaving a school, changing to another school would even be recommended. The problem of course is that most families don’t have the resources to readily do that or easily do it. And most schools in the public sector don’t want students to do that because there are financial issues and costs associated with it among other things.

Host: Yeah it really seems like that the importance of really listening and if it’s possible, removing them from that social setting is something that’s going to be important to do if that’s something that is possible. But something that you touched upon earlier, that I found really interesting is that bullying is I guess it can happen in any organization or institution. I think when we think about bullying, we think about bullying with respect to children or our youth. But adults can be bullied just as easily, and I’d love for you to talk a little bit about that.

Dr. Green: Bullying is a common phenomenon across the lifespan and so it occurs, it’s known to occur, studies have shown this, in all adult settings including even in healthcare. It’s an acknowledged big problem in the nursing profession but among physicians as well. It occurs everywhere. And the problem and this is guide to what needs to happen is that bullying arises in institutions because of what is known as the culture and climate of the institution.

So, the culture of a place, is the norms, the normative expectations, the way the place is run, the invisible agenda, the informal rules and the formal ones. But all of that derives primarily from the way the institution is run. So, the culture of it and from the culture of an institution, arises what’s known as the climate. We use climate as a shorthand for the whole thing. So, for example, we say school climate is the cause of bullying. And the climate is the way a place feels to the people in it. How warm, how welcoming, how cold, how cruel, how competitive, how supportive. That’s what the climate of a place is. And if you have an institution that has a culture and climate that is inadequately supportive of the people in it, that has inadequate modelling from the top down being positive and supportive and warm to in the relationships among the people there; you are going to have more bullying take place.

And conversely, you can prevent most bullying by having a very strong positive and supportive culture and climate.

Host: That’s Dr. Stuart Green, Associate Director of the Overlook Family Medicine Residency Program. Thanks for checking out this episode of Building Healthier Communities. For more information on this topic and to access the resources mentioned call Overlook Family Medicine at 908-522-2581 or visit us online at www.atlanticmedicalgroup.org.

For bullying specific information, visit www.stopbullying.gov. If you found this podcast helpful, please share it on your social channels, that would really help us out. And be sure to check out the entire podcast library of topics of interest to you. Thanks and we’ll see you next time.