OPINION
Appellant, Joseph E. Hancock, appeals from a judgment entered in a defamation action in favor of Appellee, Easwaran P. Variyam, following a jury trial. In support, Hancock presents three issues: (1) whether the trial court erred in finding as a matter of law that Hancock’s written statements were libel per se; (2) whether Variyam’s evidence of damages is legally and factually insufficient; and (3) whether the trial court erred in admitting an anonymous letter at trial. We affirm.
Background
At all relevant times, Hancock and Vari-yam were physicians practicing internal medicine and gastroenterology at the Texas Tech University Medical Center in Lubbock, Texas. Both men were on the faculty of Texas Tech. Variyam was formerly the Chief of the Gastroenterology Division from September 2000 until January 2006, and as such, he was Hancock’s supervisor when the following events occurred.
On the morning of January 2, 2006, a dispute arose between the two physicians related to the transfer of patients from Hancock’s care to Variyam’s care. After Variyam wrote a letter to Hancock alleging he had disregarded patient care, Hancock responded with a letter of resignation wherein he stated, in pertinent part, as follows:
Please find a copy of letter from Dr. Variyam letter (sic) which I received today. Due to Dr. Variyam’s reputation for lack of veracity, a majority of my communications and interactions is (sic) *162 recorded or witnessed and subsequently verified as in this case.
My telephone conversation was over the speakerphone and witnessed by a third party who will dispute Dr. Variyam’s position. The interaction by and through the Department of Internal Medicine this morning is again refutable.
Dr. Variyam deals in half truths, which legally is the same as a lie.
It is Dr. Variyam’s ethical behavior that should be challenged.
Hancock addressed his letter to Bern-hard Mittemeyer, Dean of the School of Medicine, and copied Donald Wesson, Chair of Internal Medicine, David Hodges, Associate Professor and Director of the UMC Endoscopy Center, Variyam and the Accreditation Council for Graduate Medical Education (ACGME) in Chicago, Illinois. 2 In February of 2006, Variyam was removed as Chief of the Gastroenterology Division.
In December 2006, Variyam filed an original petition alleging that Hancock’s letter had defamed him. Variyam sought special damages for loss of past and future income as well as general damages for injury to his reputation and mental anguish. He also sought exemplary damages. In November 2008, Variyam and Hancock filed an agreed order wherein Variyam agreed to forego special damages arising out of his removal as Chief of the Gastroenterology Division, but retained his defamation claim under a per se theory. Hancock continued to assert truth as an affirmative defense.
In May 2009, a three day jury trial was held. At its conclusion, the trial court found that the statements in Hancock’s letter were libel per se. The jury rejected Hancock’s affirmative defense by finding that his statements 3 regarding Variyam were not substantially true at the time they were made and that, by clear and convincing evidence, the harm to Variyam resulted from malice on Hancock’s part. The jury awarded Variyam actual damages of $90,000 4 and exemplary damages of $85,000. Variyam was also awarded prejudgment interest of $6,455.68 and court costs. This appeal followed.
Discussion
Hancock contends the trial court erred by finding, as a matter of law, that his statements were libel per se because the statements were ambiguous and did not injure Variyam in his office or occupation as a physician. He also asserts that *163 the evidence is legally and factually insufficient to justify any award for mental anguish or injury to reputation. He contends Variyam failed to prove that Hancock’s statements caused him any damage and, alternatively, that the trial court erred by not issuing a jury instruction on proximate cause. Lastly, he asserts the trial court erred by admitting an anonymous letter at trial.
Issue One — Libel per se
Defamation is generally defined as the invasion of a person’s interest in his or her reputation and good name. Prosser & Keeton on Torts § 111, at 771 (5th ed. 1984 & Supp. 1988). Defamation claims are divided into two categories depending on how the defamatory statement was communicated: libel for written communications and slander for oral communications. 5
Defamation claims are also divided into two categories, defamation per
se
and defamation per
quod,
according to the level of proof required in order to make them actionable.
Texas Disposal Sys. Landfill, Inc. v. Waste Mgmt. Holdings, Inc.,
A communication is considered libel
per se
when it is so obviously hurtful to the person aggrieved that no proof of its injurious character is required to make it actionable.
Clark v. Jenkins,
Whether a given statement is reasonably capable of a defamatory meaning is a question to be decided by the trial court as matter of law.
See Musser,
Standard of Review
The standard of review applicable to alleged error concerning a question of law is
de novo. El Paso Natural Gas Co. v. Mineo Oil & Gas,
Analysis
Hancock contends the statements at issue were not libelous per se because they were ambiguous and extrinsic evidence was required to interpret them. Alternatively, he contends the statements did not injure Variyam in his office or occupation as a physician. 6 We disagree.
The trial court found that Hancock’s written statements that Variyam had a “reputation for lack of veracity” and “deal[t] in half truths, which legally is the same as a he” were libelous
per se. See Lartigue v. Southern Mut. Ben. Ass’n,
265 5.W. 742, 743 (Tex.Civ.App.-Beaumont 1924, no writ) (printed circular held libelous
per se
where it “unquestionably charged appellant with untruthfulness-with being a liar-that he was telling lies”);
Hibdon v. Moyer,
The trial court’s determination is supported by the fact that Hancock imputes dishonesty to Variyam in his profession or occupation by addressing the letter to Va-riyam’s superiors at Texas Tech and ACGME.
See Bradbury v. Scott,
Hancock asserts that the term “veracity” is ambiguous because it is subject to two interpretations. In support he cites the parties’ testimony, i.e., Hancock testified “veracity” means accuracy while Variyam testified “veracity” means truthfulness. It is well settled that “the meaning of a publication, and thus whether it is false and defamatory, depends on a reasonable person’s perception of the entirety of the publication and not merely on individual statements.”
Bentley,
Hancock next asserts that he was merely expressing an opinion
8
when he stated that Variyam had a “reputation for lack of veracity.” We disagree. However, even where statements may be characterized as opinions, the statements may be defamatory nonetheless if they clearly imply the existence of undisclosed facts that the person engaged in conduct which would adversely reflect on his reputation.
Shearson Lehman Hutton, Inc., v. Tucker,
*167
Hancock also contends that his statement “deals in half truths” is ambiguous because of the phrase “deals in.” The entirety of Hancock’s statement is “Dr. Variyam deals in half truths,
which legally is the same as a lie.”
(Emphasis added). Considering the entire publication objectively, we believe a reasonable person of ordinary intelligence would understand that Hancock is using the terms “half truths” and “lies” interchangeably and the phrase “deals in” means that Variyam “tells” half-truths or lies.
10
This is particularly so given Hancock’s prior statement that Variyam has a “reputation for lack of veracity.” In addition the phrase, Vari-yam “deals in half truths, which legally is the same as a lie,” also implies knowledge of facts that lead to Hancock’s conclusion.
See Milkovich,
Lastly, Hancock cites a string of slander cases for the proposition that merely calling someone a “liar,” “thief,” or “crook,” by itself, is not defamatory.
See Gateway Logistics Group, Inc. v. Dangerous Goods Management Australia Pty, Ltd.,
No. H-05-2742,
The law has long recognized a difference between written charges of falsehood or lack of veracity and oral charges in the area of
per se
liability.
Billington,
Therefore, applying a de novo review, we find the trial court did not err in finding that the defamatory statements in question were libel per se. Accordingly, issue one is overruled.
Issue Two — Damages
Hancock next asserts there is no evidence supporting the jury’s award of damages for mental anguish or injury to reputation. He also asserts there is no evidence his statements proximately caused Variyam any injury and the trial court erred by failing to instruct the jury on proximate cause. Further, he contends Variyam’s damages should be denied because Variyam self-published Hancock’s letter when he was aware it was defamatory.
*168 Legal and Factual Sufficiency
In conducting a legal sufficiency review, we must consider the evidence in the light most favorable to the challenged finding, indulge every reasonable inference to support it;
City of Keller v. Wilson,
In reviewing a factual sufficiency challenge, we consider all the evidence and set aside a finding only if it is so against the great weight and preponderance of the evidence as to be clearly wrong or unjust.
Ortiz v. Jones,
General Damages — Defamation
Compensatory damages allowable for defamation are divided into two categories: general and special.
Peshak,
Because Hancock’s statements were determined by the trial court to be defamatory
per se,
Variyam is entitled to recover general damages without proof of other injury.
Leyendecker,
Further, because the damages are purely personal and cannot be measured by any fixed rule or standard, the amount of general damages suffered in a defamation case is difficult to determine.
First State Bank of Corpus Christi v. Ake,
Mental Anguish
An award of mental anguish damages will survive a legal sufficiency challenge when the plaintiff has introduced (1) “direct evidence of the nature, duration, or severity of [plaintiffs] anguish, thus establishing a substantial disruption in the plaintiffs daily routine”; or (2) other evidence of “a high degree of mental pain and distress that is more than mere worry, anxiety, vexation, embarrassment, or anger.”
Parkway Co. v. Woodruff,
Hancock relies on two cases in asserting that Variyam’s testimony portrays nothing more than common anxiety, embarrassment and anger.
See Parkway Co.,
Here, Variyam testified to mental anguish that substantially affected his mental state at home and at work. He testified that he was devastated, very distraught, and disappointed. The defamation disrupted his family and distracted *170 him at home. He acted differently at home and was more introspective — spending time looking at the information. He considered moving his family from Lubbock. Work was also disrupted and stressful. He was distracted, uncomfortable returning to work, embarrassed when he saw his colleagues, and paranoid that people might be talking behind his back. He still thinks about the defamatory statements — the accusations “are still stuck in his mind.” He fears that others who saw the letter will communicate the statements further, worries how the letter will affect his future ability to practice medicine, fears how the communication to ACGME will affect him in the future practice of his profession, and continues to suffer from sleeplessness. Because of Hancock’s statements, he testified he has suffered emotional difficulties and has seen “an institutional person who has supported [him].”
We agree with Variyam that his circumstances are more like the plaintiffs circumstances in
Bentley
where the Texas Supreme Court held that the plaintiff satisfied his burden of proof in proving mental anguish. In
Bentley,
the plaintiff testified at trial that the defamation cost him time, deprived him of sleep, embarrassed him in the community, disrupted his family life, distressed his children at school, depressed him, impugned his honor and integrity, was the worst experience in his life and caused his family to suffer.
Bentley,
Having reviewed all the evidence, we find that the record in this case does not indicate that the jury’s award of past and future mental anguish damages in the amount of $80,000 is either excessive, or the result of passion, prejudice, or other improper influence. The amount was within the jury’s discretion and we will not substitute our judgment for that of the jury.
See Peshak,
Loss of Reputation
In support of his contention that the evidence supporting Variyam’s award for past and future injury to his reputation, $60,000, is legally and factually insufficient, Hancock again cites Exxon Mobil Corp., supra. Hancock asserts that, although Variyam felt paranoid, there is no evidence his colleagues believed Hancock’s statements and Dr. Wesson, who demoted Vari-yam, did not receive Hancock’s letter and had no opinion about Variyam’s reputation for truthfulness.
Because the trial court correctly determined that Hancock’s statements were libel
per se,
“the law presumes that [Variyam’s] reputation has been injured thereby.”
Leyendecker,
Furthermore, contrary to Hancock’s argument that Dr. Wesson did not receive Hancock’s letter and had no opinion about Variyam’s reputation for truthfulness, the record indicates that Dr. Wesson testified that he did “not remember receiving the letter” although he “remembered the issues.” Further, in addition to being listed as a recipient of Hancock’s letter on its second page, Dr. Wesson appeared very familiar with the letter’s contents in subsequent e-mails between Dr. Wesson, Vari-yam, and other Texas Tech officials in January 2006 and testified that he recalled consulting with Variyam on Hancock’s letter and its potential harm to the application for reinstatement. 14 Although Dr. Wesson may not have had an opinion on Variyam’s reputation for truthfulness, he testified that, from his personal interactions with Variyam, he found Variyam to be a truthful person and disagreed with Hancock’s statements that Variyam had a “reputation for lack of veracity,” “deals in half truths,” and his “ethical behavior should be challenged.” He indicated that anyone from the University Medical Center, Physician Network Services or any physician who complained of having personality issues with Variyam never complained that Variyam was untruthful or dishonest.
Hancock’s citation to
Exxon Mobil Corp., supra,
is also unavailing. The portions of
Exxon Mobil Corp.
cited by Hancock were relevant only to the
Exxon Mobil
Court’s analysis of whether there was sufficient evidence to support the plaintiffs award of damages for mental anguish, not injury to reputation.
Exxon Mobil Corp.,
Accordingly, we find the evidence is legally and factually sufficient to support the jury’s award of $60,000 in damages for past and future injury to Variyam’s reputation as a result of Hancock’s letter.
Causation — Self-Publication
Hancock next asserts that, because Vari-yam self-published Hancock’s statements a week after Hancock published the statements,
15
Variyam can recover no damages
*172
because he suffered no harm or the trial court should have issued a charge that sought a jury determination of proportionate fault, i.e., did Variyam cause some of his damages due to self-publication. In support he cites the cases of
Doe v. Smith-Kline Beecham Corp.,
In
Doe,
an employment applicant, Doe, asserted that SmithKline libeled or slandered her by placing her in a situation in which she felt obligated to disclose to other prospective employers the circumstances of a drug test and the revocation of SmithKline’s offer of employment.
Doe,
Here, the circumstances are quite dissimilar. First, the trial court determined that Hancock’s statements represented libel
per se.
Hence, there was no need to show Hancock’s statements proximately caused the injury to Variyam’s reputation or mental anguish.
See Fox,
Neither does
Glenn v. Gidel, supra,
have any application here. On appeal it was determined that the trial court properly instructed a verdict favorable to all defendants where the record was devoid of any evidence that the alleged defamatory statement was overheard or communicated to a third party.
Glenn,
To resolve what Hancock asserts to be equal inferences that Variyam’s injury resulted from his own self-publication rather than Hancock’s publication, he asserts the trial court should have issued a jury instruction which proportioned fault
*173
between Variyam and Hancock, i.e., asked the jury whether Variyam’s injuries were caused by Hancock’s publication or Vari-yam’s publication. A party objecting to a charge must point out distinctly the objectionable matter and the grounds of the objection to the trial court.
See Wilgus v. Bond,
Exemplary Damages
In reviewing whether an exemplary damages award is constitutional, we consider three “guideposts”: (1) the nature of the defendant’s conduct, (2) the ratio between exemplary and compensatory damages, and (3) the size of civil penalties in comparable cases.
Tony Gullo Motors I. L.P. v. Chapa,
We find that the exemplary damages awarded to Variyam were not excessive because the ratio of general damages to exemplary damages was less than 1 to 1;
see Bennett,
Hancock’s wrongful conduct involved the simultaneous publication of his defamatory statements to two of Variyam’s superiors, a colleague and ACGME. His conduct was also “the result of intentional malice
*174
rather than mere accident.”
Bennett,
In addition, the exemplary damages award is comparable in size to other defamation cases.
See Clark,
Issue Three — Anonymous Letter
Hancock next asserts the trial court erred in admitting testimony of the existence of an anonymous letter mailed nearly two weeks after Hancock’s January 2nd letter that complained to ACGME about the Fellowship Program. Hancock asserts the testimony was irrelevant; see Tex.R. Evid. 402, and the original writing was required to prove the content of the anonymous letter. See Tex.R. Evid. 1002.
Evidentiary rulings admitting or excluding evidence are committed to the trial court’s sound discretion;
Bay Area Healthcare Group, Ltd. v. McShane,
Hancock asserts the trial court should have excluded any and all evidence of the anonymous letter sent to ACGME. 20 At trial, Variyam acknowledged, when testifying about the continuing process related to the ACGME reinstatement application, that ACGME had received a letter “from an anonymous source” and he wrote a letter “basically [responding] to the anonymous complaints” received by ACGME against Drs. Farooq and Parupudi. Vari-yam’s letter to ACGME, admitted as an exhibit, referenced an “unnamed complainant” and summarized the anonymous complaints made against Drs. Farooq and Parupudi in a single paragraph. The remainder of Variyam’s five-page letter addressed the qualifications and actions of Drs. Farooq and Parupudi, and Variyam’s efforts to assure ACGME that the Fellowship Program had sufficient key clinical faculty to maintain the program. In the second to last paragraph, the letter stated that “[w]e suspect that the complaint came from a disgruntled person who has some, but incomplete knowledge of our division.” Dr. Hancock’s name was not mentioned in connection with Variyam’s testimony regarding the anonymous letter sent to ACGME.
Without specifically stating how the case, or any material issue, turned on this particular evidence, Hancock simply asserts that this testimony caused the rendition of an improper judgment because the jury was permitted to
speculate
whether Hancock authored the anonymous letter. Because Hancock’s statements in his January 2nd letter were found by the trial court to be libel per
se,
the anonymous letter was wholly irrelevant to the issue of whether Hancock’s prior letter defamed Variyám.
See Allen,
Conclusion
The trial court’s judgment is affirmed.
QUINN, C.J., not participating.
Notes
.At all times relevant to this case, Hancock knew that ACGME was an independent organization that accredits institutions where medical training takes place nationwide. When Hancock wrote his letter, he was aware that an application for reinstatement of Texas Tech's Gastroenterology Fellowship was pending with ACGME and that Texas Tech and ACGME were scheduled to meet toward the end of January 2006 to decide the fate of Texas Tech's Fellowship Program of which Variyam was the Program Director. Hancock was also aware that the letter would be received by ACGME's Residency Review Committee, a committee comprised of physicians who were national experts in the field of gastroenterology or internal medicine. In addition to Hancock’s letter, ACGME received an anonymous letter dated January 19 complaining about two doctors, Farooq and Paru-pudi, participants in the gastroenterology training program.
. From the Charge of the Court, question 1 addressed the statement "reputation for lack of veracity”; whereas, question 2 addressed the statement "deals in half truths, which is legally the same as a lie.”
. The jury awarded Variyam $30,000 for loss of reputation in the past, $30,000 for future loss of reputation, $15,000 for past mental anguish and $15,000 for future mental anguish.
. Libel is defined by statute as "defamation expressed in written or other graphic form that tends to ... injure a living person’s reputation and thereby expose the person to ... financial injury or to impeach any person’s honesty, integrity, virtue, or reputation....” Tex. Civ. Prac. & Rem.Code Ann. § 73.001 (West 2005). Although slander is not statutorily defined, at common law a slanderous statement is one that is orally communicated or published to a third person without legal excuse.
Randall’s Food Markets v. Johnson,
. Hancock does not challenge whether the evidence was sufficient to establish that his statements were false, published, or made with malice.
. "There can be no doubt that, at common law, to publish of a person in writing that he was mendacious, or that he had uttered a falsehood, was libelous
per se." Fleming,
. If Hancock’s statements were constitutionally protected opinion speech, his statements would not be actionable.
See Pisharodi v. Ban-ash,
. In Milkovich, the United States Supreme Court stated as follows:
If a speaker says, "In my opinion John Jones is a liar,” he implies knowledge of facts which lead to the conclusion that Jones told an untruth. Even if the speaker states the facts upon which he bases his opinion, if those facts are either incorrect or incomplete, or if his assessment of them is erroneous, the statement may still imply a false assertion of fact. Simply couching such statements in terms of opinion does not dispel these implications: and the statement, "In my opinion Jones is a liar,” can cause as much damage to reputation as the statement, "Jones is a liar.” As Judge Friendly aptly stated: “[It] would be destructive of the law of libel if a writer could escape liability for accusations of [defamatory conduct] simply by using, explicitly or implicitly, the words 1 think.’ ” See Cianci v. New Times Publishing Co.,639 F.2d 54 , 64 (2d Cir.1980).
Milkovich,
. Other courts have not found the term "dealing” ambiguous or troubling in the defamation context.
For example, see Bradbury,
. “In general, oral words, however opprobrious, are not actionable without proof of specific damages, unless they impute to another the commission of a crime or affect a person injuriously in his office, profession or occupation. Written or printed words charging dishonesty, fraud, rascality, or general depravity are generally libelous
per se,
but not so when spoken orally.”
Arant,
. Less than a scintilla of evidence exists when the evidence is so weak as to do no more than create a mere surmise or suspicion of fact.
King Ranch, Inc. v. Chapman,
."A third party is deemed to have understood the defamatory nature of a statement if a reasonable person would have understood the statement under the circumstances.”
In re Petty,
. Dr. Wesson testified that the effect of Hancock’s letter on the pending reinstatement application with ACGME to reinstate the Fellowship Program would have been negative.
. Hancock refers to a letter sent January 9, 2006, by Variyam to Hancock wherein Vari-yam references the defamatory statements made in Hancock’s letter and requests that he make a retraction in the form of a written letter addressed to all the recipients of Hancock's January 2nd letter. With the exception of ACGME, Variyam's letter copied only the *172 recipients of Hancock's letter, Dean Bernard Mittemeyer, Dr. Donald Wesson, and Dr. David Hodges. Thus, Hancock had already published his libelous statements to the recipients of Variyam’s letter at least a week before they received a copy of Variyam's letter.
. The evidence at trial showed that, in addition to the addressees of Hancock's letter, some form of publication of the letter's contents was made to Dr. Eugene Dabezies, then Chairman of the Orthopedic Surgery Department at Texas Tech. He testified at trial that he heard of a controversy in the Gastroenter-ology Department involving an allegation that Variyam had a reputation for not being truthful, but it didn’t make sense to him. To the contrary, Dr. Dabezies testified at trial that Variyam “was a truthful person,” "well respected in the medical community as a person to take care of patients” and "a scholar.”
. Because we have determined Variyam is entitled to recover damages for injury to reputation and mental anguish, we need not consider Hancock’s argument that Variyam is entitled to no exemplary damages because he did not recover actual damages. Under Texas law, generally, the recovery of actual damages is a prerequisite to the receipt of exemplary damages.
Nabours v. Longview Savings & Loan Association,
. Dr. Surendra Varma, Associate Dean for Graduate Medical Education and Chair of the Graduate Medical Education Committee at Texas Tech, testified that it was inappropriate for anyone to communicate directly with ACGME unless they were the Program Director, Variyam, or the Designated Information Officer, Jim Watters. In addition, he testified it was an ACGME requirement that all correspondence with ACGME go through the Graduate Medical Education Committee.
. The fact that Hancock unnecessarily mailed an additional copy of the letter to ACGME reflects a malicious intent.
Leyen-decker,
. We note that record references to an anonymous letter represented isolated statements contained in four pages out of over five hundred thirty pages of testimony over a three day trial. Further, Variyam’s counsel did not mention the anonymous letter in either his opening or closing statements.
