Author Archives: Nathen

10 Things Parents Can Do to Help Prevent Eating Disorders

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This is a handout I got in my Medical Family Therapy class. The copyright at the bottom says “(c) 2005 National Eating Disorders Association. Permission is granted to copy and reprint materials for educational purposes only. National Eating Disorders Association must be cited and web address listed. www.NationalEatingDisorders.org Information and Referral Helpline: 800.931.2237.” I think that covers me. I’m willing to take the risk, anyway, because eating disorders are a huge problem. The most conservative estimates, using the most strict definitions, are that six million people in the US struggle with disordered eating. Estimates using less strict definitions (including Eating Disorder Not Otherwise Specified in the DSM-IV-TR), but still very realistic, are at about 20 million. And eating disorders are the most deadly mental disorder. If not treated, 20-25% of those with serious eating disorders die from them. You won’t find that statistic in many official sources, though, because for some very strange reason, coroners will not list Anorexia or Bulimia Nervosa as a cause of death. They prefer “Cause of death unknown” in those cases. Plus, eating disorders are learned behavior. Don’t let your kids learn the values that encourage disordered eating from you!

OK, here it is. It’s by Michael Levine, PhD:

1. Consider your thoughts, attitudes, and behaviors toward your own body and the way that these beliefs have been shaped by the forces of weightism and sexism. Then educate your children about (a) the genetic basis for the natural diversity of human body shapes and sizes and (b) the nature and ugliness of prejudice.

*Make an effort to maintain positive attitudes and health behaviors. Children learn from the things you say and do!

2. Examine closely your dreams and goals for your children and other loved ones. Are you overemphasizing beauty and body shape, particularly for girls?

*Avoid conveying an attitude which says in effect, “I will like you more if you lose weight, don’t eat so much, look more like the slender models in ads, fit into smaller clothes, etc.”

*Decide what you can do and what you can stop doing to reduce the teasing, criticism, blaming, staring, etc. that reinforce the idea that larger or fatter is “bad” and smaller or thinner is “good.”

3. Learn about and discuss with your sons and daughters (a) the dangers of trying to alter one’s body shape through dieting, (b) the value of moderate exercise for health, and (c) the importance of eating a variety of foods in well-balanced meals consumed at least three times a day.

*Avoid categorizing and labeling foods (e.g. good/bad or safe/dangerous). All foods can be eaten in moderation.

*Be a good role model in regard to sensible eating, exercise, and self-acceptance.

4. Make a commitment not to avoid activities (such as swimming, sunbathing, dancing, etc.) simply because they call attention to your weight and shape. Refuse to wear clothes that are uncomfortable or that you don’t like but wear simply because they divert attention from your weight or shape.

5. Make a commitment to exercise for the joy of feeling your body move and grow stronger, not to purge fat from you body or to compensate for calories, power, excitement, popularity, or perfection.

6. Practice taking people seriously for what they say, feel, and do, not for how slender or “well put together” they appear.

7. Help children appreciate and resist the ways in which television, magazines, and other media distort the true diversity of human body types and imply that a slender body means power, excitement, popularity, or perfection.

8. Educate boys and girls about various forms of prejudice, including weightism, and help them understand their responsibilities for preventing them.

9. Encourage your children to be active and to enjoy what their bodies can do and feel like. Do not limit their caloric intake unless a physician requests that you do this because of a medical problem.

10. Do whatever you can to promote the self-esteem and self- respect of all of your children in intellectual, athletic , and social endeavors. Give boys and girls the same opportunities and encouragement. Be careful not to suggest that females are less important than males, e.g., by exempting males form housework or childcare. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to dieting and disordered eating.

[This post first appeared on Nathen’s Miraculous Escape, March 16, 2010.]

What Makes a Good Food Day?

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I just had my last Medical Family Therapy lecture. It was on eating disorders. My professor, Deanna Linville, is a specialist. One of the questions she recommended asking clients dealing with eating disorders was “What’s a good food day for you?” Also, “What’s a bad food day?”

I think those are good questions for anyone. Here are my answers:

A good food day is when I eat plenty and take the time to really enjoy the food. It usually means I’ve eaten real meals, not just snacked through the day. It means I wait long enough to feel hungry and then eat enough to feel full. It means I haven’t fixated on any food to the point where I ate it until I didn’t feel good.

A bad food day usually means I didn’t eat enough, or enough variety, usually because I let myself get too busy. It’s easy to eat nuts and raisins instead of a meal, or sometimes just forget to eat a meal, and I always regret it. I get weak, irritable, and stupid. If I eat too much on a bad food day, it’s most often because I fixated on a food (usually sugar, sometimes bread and/or cheese, occasionally meat at a BBQ or something) and ate it until I was uncomfortable. Sometimes it’s because I didn’t space my meals out enough and piled new food on top of old. Sometimes it’s a bad food combination, at a potluck or something, that gets me feeling uncomfortable. A random, moldy raisin made yesterday a bad food day.

How about you?

[First published on Nathen’s Miraculous Escape, March 14, 2010.]

Headlines From Psychology, Part 5

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Here’s part 5 of the stuff I learned in my undergrad in psychology that I thought should have been headlines. If you missed them, here are part 1, part 2, part 3, & part 4. As always, if you are interested or skeptical, leave me a comment and I’ll give you my sources.

If You Punish Your Kids, Use the Mildest Effective Punishment: Do the mildest thing you can that stops the behavior you don’t want. The reason is that a punishment that is harsher than necessary takes the child’s initiative for stopping the behavior out of the picture. If you say “Hey, don’t do that,” and the child responds, they come to think that they didn’t really want to do that thing anyway, since such a mild rebuke got them to stop. Psychologists call these principles “insufficient punishment” and “self-persuasion.” These are research findings, not just speculation. If you sit on and beat your child to get them to stop doing something (as suggested by Mike & Debi Pearl), they will believe something more like “That activity was so great that I’ve only stopped because of that horrible punishment.” In other words, the form of the punishment affects the identity of the child–do they behave well because they think of themselves as well-behaved, or do they behave well only because they fear punishment?

You May Want Your Kids To Be Less Blindly Obedient Than Most People: One of themost famous psychological experiments of all time found that most people risked killing someone they barely knew, given an institutional setting and an authority telling them to do it. The Nazis were mostly not evil, just obedient, like most of us.

Humans Can Be Conformist to the Point of Doubting Their Own Senses:

Each Ethical Decision You Make Affects Your Future Ethical Decisions and Your Identity: If you, say, decide to cheat on a test, you will be more likely to cheat on tests in the future, think of yourself as someone who cheats on tests, and form permissive attitudes about cheating. The opposite is true if you decide not to cheat on a test.

Complement Your Kids For the How Hard They Work, Not How Smart They Are:Getting attention for being smart tends to make kids want to appear smart, which makes them choose easier challenges and lighter competition; it’s the success that matters. Getting attention for hard work does the opposite. This means that these kids will end up smarter than the kids who got attention for being smart.

Teach Your Kids to Think About Intelligence as a Fluid Property: That is, teach them that they can become more intelligent by trying. The more they believe it, the more it will be true for them.

If Your Kids Read, Don’t Reward Them For Reading: They will be more likely to stop, if you do, because they will start to think of reading as something they do to be rewarded, not because they like it. If they don’t read, reward them for reading. This goes for other activities, too.

[First published on Nathen’s Miraculous Escape, March 4,2010.]

Murray Bowen on Funerals

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“I think the best function of funerals is served if it brings relatives and friends into the best possible functional contact with the harsh fact of death and with each other in this time of high emotionality. I believe that funerals were probably more effective when people died at home with the family present, and when the family and friends made the coffin and did the burial themselves. Society no longer permits this, but there are ways to bring about a reasonable level of contact with the dead body and the survivors.”

Murray Bowen, in Walsh & McGoldrick’s Living Beyond Loss: Death in the Family

[Reblogged from Nathen’s Miraculous Escape]

Weigh In On the DSM-V

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The Diagnostic and Statistical Manual of Mental Disorders is revised every decade or so, and a revision is under way right now. Up until recently, there has been criticism that the proceedings were taking place in secret. This is not unusual, as I understand it, but it is significant for many people. Mental-health clinicians, for example, have to use the diagnostic categories in the DSMto label their clients, and if the categories and descriptions listed don’t coincide with their experiences or beliefs, this can be quite difficult. It is significant for mental-health clients, too, for complementary and even more personal reasons. What will happen to your diagnosis? In? Out? Changed? These decisions have a big impact on social issues, like stigma, and economic issues, like what insurance companies will pay for.

The DSM committee is proposing, for example, to subsume the diagnosis of Asperger’s Disorder into Autism Disorder. This seems to make a lot of sense, unless you or your child is benefiting from the existence of Asperger’s because of insurance company rules, state regulations, or other regulatory factors.

The content of the DSM is important to people for political reasons, too. For example, the third revision of the DSM eliminated homosexuality as a mental disorder. That was in 1973, for theDSM-III. (We’ve since had the DSM-III-R, DSM-IV, and DSM-IV-TR. They are currently working on the DSM-V.) It may be hard to believe that being gay was an official Mental Disorder, but it was. People were even lobotomized for it: Here, let me “help” you with that unnatural sexual attraction by forcing an icepick in over one of your eyes, through your skull, to twist it in your brain. The removal of homosexuality from the DSM was very controversial in its day, but no one credible is fighting for it to go back in.

That is to say, the DSM can reflect the changing mores of society, which in turn influences the way society sees mental health and illness. This process can effect the quality of a lot of our lives. And now the DSM committee has revealed the changes they are contemplating and is asking for feedback. This is from their website:

“Your input, whether you are a clinician, a researcher, an administrator, or a person/family member affected by a mental disorder, is important to us.  We thank you for taking part in this historic process and look forward to receiving your feedback.”

You almost certainly fall into one of those categories. Take part in this opportunity! Of course, our input being “important” to them does not mean they will pay attention to it, but it can’t hurt to try. The worst that can happen is that you will be better informed about your mental-health system. Here are the categories that they are considering changes in. Click on them to read the proposed changes. To submit feedback, you have to register with them, but it only takes a minute:

Structural, Cross-Cutting, and General Classification Issues for DSM-5
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
Other Conditions that May Be the Focus of Clinical Attention

[First published on Nathen’s Miraculous Escape, 23, 2010.]

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Headlines From Psychology, Part 4

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Psychology hit the actual headlines last week, with Sharon Begley’s “The Depressing News About Antidepressants” in Newsweek. The story is that, if you look at all the evidence, not just the “successful” trials, SSRIs like Prozac and Paxil do not work better than a placebo for mild and moderate depression. Begley also tells the story as if she’s sorry to break the news and spoil the placebo effect. Here’s my version of the headlines from this story:

Pharmaceutical Companies Have Known For At Least Ten Years That SSRIs Work No Better Than Placebos: At least, anyone there who understood statistics and paid any attention to their research.

The Idea That SSRIs Are Better Than Placebos Was Propagated By Publishing Only the “Successful” Trials: This, obviously, was quite unethical.

The FDA Almost Certainly Knew That SSRIs Were No Better Than Placebos, Too: They had all of the research. Perhaps they did not read it.

People Who Read Psych Journals Knew SSRIs Were No Better Than Placebos Two Years Ago: The news caused a stir in my undergrad psych lab in 2008.

We Do Not Know What Causes Depression: The idea that depression has to do with the neurotransmitter serotonin was based largely on the (incomplete) evidence that SSRIs (selective serotonin re-uptake inhibitors) cured depression. In fact, we have pretty limited knowledge of what goes on inside a living brain. In fact, we have no ethical way to measure how much serotonin or any other neurotransmitter is where inside anyone’s living brain, so when a doctor tells you something like, “You are depressed because you have overactive serotonin re-uptake mechanisms,” they are passing on speculation, not science.

If You Recovered From Mild to Moderate Depression While On An SSRI, It Was Probably Your Own Hope That Lifted You Out: The thing about placebos is that they work pretty well. If you benefited from the placebo effect, it was your own strength, your own hope, that made the difference. You overcame that challenge. I think that’s pretty cool.

While SSRIs Do Not Treat Depression Better Than Placebos, They Do Have Side Effects: Here’s a list from wikipedia: Decreased or absent libido, Impotence or reduced vaginal lubrication, Difficulty initiating or maintaining an erection or becoming aroused, Persistent genital arousal disorder despite absence of desire, Muted, delayed or absent orgasm(anorgasmia), Reduced or no experience of pleasure during orgasm (ejaculatory anhedonia),Premature ejaculation, Weakened penile, vaginal or clitoral sensitivity, Genital anesthesia, Loss or decreased response to sexual stimuli, Reduced semen volume, Priapism (persistent erectile state of the penis or clitoris)anhedonia, apathy, nausea/vomiting, drowsiness or somnolence, headache, bruxism (involuntarily clenching or grinding the teeth), extremely vivid and strangedreams, dizziness, fatigue, mydriasis (pupil dilation), urinary retention, changes in appetite, changes in sleep, weight loss/gain (measured by a change in bodyweight of 7 pounds), may result in a double risk of bone fractures and injuries, changes in sexual behaviour,increased feelings of depression and anxiety (which may sometimes provoke panic attacks), tremors (and other symptoms of Parkinsonism in vulnerable elderly patients), autonomic dysfunction including orthostatic hypotension, increased or reduced sweating, akathisia, liver or renal impairment, suicidal ideation (thoughts of suicide), photosensitivity (increased risk of sunburn), Paresthesia, Mania, hypomania, sexual dysfunction such as anorgasmia, erectile dysfunction, and diminished libido, a severe and even debilitating withdrawal syndrome, a slight increase in the risk of self-harm, suicidal ideation, and suicidality in children, neonatal complications such as neonatal abstinence syndrome (NAS) and persistent pulmonary hypertension, and platelet dysfunction.

Until Your Medicated Kids Are Old, We Will Not Know What All of the Side Effects of Treatment by SSRIs Are: This is true for any new drug, and it’s worth considering. If your child is on Prozac or other new drug, they are essentially part of a massive experimental trial.

Pharmaceutical Companies Pay for Psychiatric Educations: Why would it surprise anyone that treatment equals drugs in this case?

Most Antidepressant Prescriptions Written by Health Care Providers With No Significant Psychiatric Training: GPs, OBGYNs, pediatricians, etc account for 80% of SSRI prescriptions.

[First published on Nathen’s Miraculous Escape, February 19, 2010.]

The No-Secrets Policy

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Yesterday, I participated in my master’s program’s OSCEs–Objective Structured Clinical Exercises–for the students in the year ahead of me, who are about to graduate. My cohort played clients in specific, challenging scenarios for the second-year-cohort therapists. The activity was adapted from a medical school test of clinical ability.

My scenario was the most challenging of the day. The therapists came in expecting to be doing a goal setting exercise with a couple but found that only one of us (me) had showed up. I was to immediately disclose an affair and request that the therapist not tell my wife about it. I had ended the affair, felt very guilty about it, and was certain that revealing it would destroy our relationship. I was to try and get the therapist to help me with the “things that pushed me to do this.”

I am not a good actor, so it took all my attention just to get my part across in a semi-believable way. When I watched my cohort-mates play the same part, though, it was heart wrenching. They did such a good job showing remorse, almost crying, showing the fear of losing their husbands, and over “a stupid mistake.” (Well, three stupid mistakes with one person.) I really felt for them–and they were just pretending! I can see how much preparation I will need to do to handle this kind of situation effectively. I am certain to have clients who have affairs. I just looked up the statistics, and the lowest numbers I found are that about 15% of married women and 25% of married men have sexual affairs. That means that at least one out of four couples I see will have had or are heading towards an affair.

Our clinic has a “no secrets” policy for couples counseling. It’s something we bring up on the first day of therapy. If one member of a family has an individual session, what is said in that session is not going to be confidential to the rest of the family. The idea is that for this work, it is the relationship that is our primary client, not the individuals, and that secrets (differentiated from privacy) are toxic to relationships. Also, if the we are brought into one person’s secret and keep it, we can no longer serve the relationship without bias.

I think that the no-secrets policy is a good idea and I have been planning to use it in my work, but now, seeing it in practice, I see that it’s not just a matter of having a policy. I will need to thoroughly wrap my head around how it will apply in different scenarios. I will need to talk it through with a lot of people so I feel comfortable and confident in my thinking. I will also need to remember to remind clients about the no-secrets policy the moment I see that a couples client has come in alone. We introduce the policy during the first session, but that may not be what a client is thinking about when they disclose an affair. They may think that I have trapped or betrayed them if their disclosure is followed by, “Remember that no-secrets policy we talked about during our first session?”

Ideally, in this case, we would work together with the client on a palatable way to reveal their actions to their partner and then work with the couple to heal the rifts. We don’t automatically tell the partner about affairs, either. There are some things that we are required by law and ethics to report, like death threats or the abuse or neglect of a child, but affairs are not one of them. If the cheating partner refuses to allow revealing the secret, I would have to refer the couple, for suitably non-specific reasons, to another therapist who could be unbiased, if in the dark.

I think that I need to rid myself of some countertransference when it comes to affairs. That is, as it stands, I think I might favor cheat-ee over cheating clients, because it’s harder for me to relate to cheating. I walked out of our role plays thinking, “Wow, it’s so much simpler and less painful to avoid an affair than it is to deal with the aftermath!” Can anyone recommend a good book or movie that could help me empathize with someone having an affair–especially someone who feels like they are not in control of their actions, or just not thoughtful, in sexual infidelity?

This is interesting and sometimes painful work I am getting myself into!

[First published on Nathen’s Miraculous Escape, February 17, 2010.]

Alexithymia

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Alexithymic describes someone who can’t talk about emotions. They also have trouble knowing when they or others are experiencing an emotion, and trouble distinguishing which emotion it is, if they do notice one. It is not a considered a clinical condition, but it can produce clinical conditions, like somatization, where people develop various body conditions instead of feeling emotions. It becomes a problem when somatizers insist on one medical test or procedure after another for a problem that will never yield to biological intervention. I read one estimate that 20% of money spent on medical services is for these kinds of concerns. (!)

There are social consequences, too, of course. If you can’t recognize that you’re in the grip of an emotion, you can be hard to understand and hard to deal with. It’s also hard for an alexithymic person to relate to others who are having emotions–it’s more difficult to take their perspectives and to have empathy.

It’s not a black-or-white condition, of course. Everyone is somewhere on the spectrum of emotional fluency. It’s not an intractable state, either. You can learn emotional fluency, and most people do, to some extent. It’s part self-awareness, part self-acceptance, and part vocabulary. It’s something you continue learning throughout life, given a supportive environment. Parents can stifle the learning curve in their children by how and when they give them attention. Somatizing children, for example, can come from parents who give them attention for physical pain but not emotional pain. Another problematic parenting technique, called “mystification” by psychologists, works to slow the emotional learning curve; when a child is angry, for example, a parent might say something like, “You’re not angry,” or “You shouldn’t be angry.” That kind of thing goes a long way to confuse people about emotions.

[Fist published on Nathen’s Miraculous Escape, February 15, 2010.]

Headlines From Psychology, Part 3

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This is part 3 of a series of things I learned during my Bachelor’s degree in psychology that I thought should have been headlines in the mainstream news. If you missed them, here’s part 1and part 2. Again, if you’re interested or skeptical, leave me a comment with a specific question and I’ll give you my references.

Egaz Moniz Was Given the Nobel Prize for Medicine in 1949 for Developing the Prefrontal Lobotomy: This “psychosurgery” involved slicing or scrambling the front part of the brain, and tended to produce more manageable behavior in “patients.”

40,000 Human Beings Were Lobotomized in the United States Between 1936 and 1977: These were men, women, and children with “illnesses” like schizophrenia, PTSD, depression, anxiety, homosexuality, criminal behavior, and being hard to manage.

Antipsychotic Thorazine Hailed as “Chemical Lobotomy”: Yes, this was meant as a compliment.

200,000,000 Prescriptions for Antidepressants in the US in 2007: That’s quite a few prescriptions.

80% of Antidepressant Prescriptions in the US Not Written by Psychiatrists:Consider that it may be a good idea to at least see a specialist in mental illness before taking psychotropic drugs or giving them to your kids.

Some Psychopharmaceuticals as Effective as Exercise in Treating Depression: But who wants to exercise when you’re depressed?

Sleep Deprivation the Most Effective Treatment For Depression, By Far: Never heard of this one? Maybe it’ll hit the news when someone figures out how to make money from sleep deprivation.

The World Health Organization Found That Schizophrenics Recover, But Only in Countries Without Easy Access to Psychopharmaceuticals: Schizophrenics can recover? Well, yes, it looks like they can. And yes, the WHO data shows a correlation, not necessarily causation, but an interesting correlation!

[First published on Nathen’s Miraculous Escape, January 30, 2010.]

Headlines From Psychology, Part 2

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Here’s part 2. (And if you missed it, here’s part 1.) Again, if you are either interested or skeptical, leave me a comment and I’ll point you to the evidence.

Statistically, Divorce is Not a Good Strategy for Getting a Better Marriage: 50 to 67% of first marriages end in divorce. 60 to 77% of second marriages end in divorce.

Your Brain Has Trouble Giving Information About Probabilities Due Weight, So Pay Attention to Base Rates: We have trouble taking the actual prevalence of events into account when making decisions. For example, people tend to be more afraid of dying in a plane crash (lifetime chance: 1 in 20,000) than dying in a car wreck (lifetime chance: 1 in 100) or even of a heart attack (lifetime chance: 1 in 5). One reason for this is that we confuse the ease with which we can think of an example to be an indication of how likely something is. Try this: What do you think is more common, words beginning with “r” or words with “r” as the third letter?

If You Test Positive For a Very Rare Disease, You Still Probably Do Not Have That Disease: This is a headline that should come from medicine, not psychology, but psychologists are better at probability than doctors, who are no better than laypeople, at least when it comes to thinking about this: Even with a very accurate test, if a disease is very rare, a positive result is still much more likely to be a false positive than an accurate positive. I’m going to explain this, but if you don’t get it, don’t worry. Just remember the headline. It’s true.

The table below shows a hypothetical situation with super-round numbers to make it easier to get. You have gotten positive results on a test that is 99% accurate for a disease that occurs only once in 10,000 people. Most people figure they are 99% likely to have the disease. They are wrong:

 

Test Results
Disease Present? Test Results Positive Test Results Negative Row Totals
Disease Present 99 1 100
Disease Not Present 9,999 989,901 999,900
Column Totals 10,098 989,902 1,000,000

Since your test results are positive, you are somewhere in the left-hand column. You are either one of the 99 who both have the disease and whose test results are positive, called “hits,” or one of the 9,999 who do not have the disease but whose test results are positive, called “false positives.” As you may see, even though your test results are positive, you still are 99% likely to be a false positive and not a hit, simply because the disease is so rare.

Yes, this is counter-intuitive. That’s why it’s important. And that’s why statistics are important. Again, if you don’t understand, don’t worry. If you don’t believe it, though, come up with a specific question, leave it as a comment, and I’ll answer it.

If You Need Help, Ask Someone Specific for Something Specific: Bystanders generally do not help people who are in trouble. The bigger the crowd, the less likely someone will help. It’s not because they are bad or lazy. It’s a specific kind of well-documented confusion. Kind of like in the clip below. What you need to know is, if you need help, even if it seems like it should be completely obvious to anyone around, like you’re having a heart attack, falling to the ground, gasping, whatever, point to a specific person and give them specific instructions: “You, in the red shirt. I’m having a heart attack. Call an ambulance.” Do not assume anything will happen that you did not specifically ask for. A corollary of this headline is, if you think someone might be in trouble, don’t assume they would ask you for help, and don’t assume someone else is helping them. Help them yourself. It could mean the difference between them living or dying.

Get Help For Your Marriage When the Trouble Starts (Or Before): On average, couples wait 6 years after their marriage is in trouble to get help. The average marriages last 7 years. That means that most people who come to couples counseling are deeply entrenched in problems that would have been relatively easy to resolve earlier. It is not uncommon for a couple to come in to counseling with a covert agenda to use the counselor to make their inevitable divorce easier. We can do this, but believe me we’d much rather meet you earlier and help you stay together! Also, I’m not joking about “or before.” Couples counselors are well-trained to give “tune-ups” to couples who are doing well. It’s a good idea.

Anger Is Not Destructive of Relationships, Contempt and Defensiveness Are: Everybody argues. Everybody screws up their communications. It’s the ability to repair things that is the key, and contempt and defensiveness get in the way of that.

[First published on Nathen’s Miraculous Escape, January 24, 2010.]