Most people prefer happy lyrics but a perhaps too-ignored group enjoys sad ones. Such lyrics often provide insight and an odd sort of pleasure.

It is for such people that I’ve assembled this collection. Except for Cat’s in the Cradle, which appears in its entirety, these are selections.

At Seventeen, written by Janis Ian.

I learned the truth at seventeen,
that love was meant for beauty queens.
And high school girls with clear skinned smiles
who married young and then retired.
The valentines I never knew.
the Friday night charades of youth
were spent on one more beautiful
at seventeen I learned the truth.

And those of us with ravaged faces,
lacking in the social graces,
desperately remained at home,
inventing lovers on the phone
who called to say "come dance with me"
and murmured vague obscenities
It isn't all it seems at seventeen...

To those of us who knew the pain
of valentines that never came
and those whose names were never called
when choosing sides for basketball.
It was long ago and far away,
the world was younger than today,
when dreams were all they gave for free
to ugly duckling girls like me.

Climbing Uphill, written by Jason Robert Brown, from the show, The Last Five Years.

I'm climbing uphill, Daddy
Climbing uphill.

I'm up every morning at six
and standing in line
with two hundred girls
who are younger and thinner than me,
who have already been to the gym.

I am a good person.
I'm an attractive person.
I am a talented person.
Grant me Grace.

Going Nowhere, written by Phil Cody and Neil Sedaka.

Considering
so many folks, dissatisfied with everything,
who need someone to understand they're lonely, they're lonely.
And they're not alone.

And everywhere
they shrug their shoulders, tell themselves that they don't care,
and all the while they make believe they're happy, oh they're happy,
but not really.

And they're asked to hold the world together,
make it happen, give it children,
Who in turn are turning on to going nowhere.

The I Love You Song, writtenby William Finn, from The 25^th Annual Putnam County Spelling Bee.

We always knew you were a winner.
We saw it when you smiled.
Start from the beginning
when you were a beginner,
you were the perfect child.
We always knew,
we always knew
you were a champion.
Your sadness filled my room,
dear if you should feel my gloom,
blame it on me,
blame it on your Daddalee and Mammalee
‘Cause depression runs in our family.

I love you.
I love you.
I love everything about you dear,
and I swear it’s true:
I love you

Cat’s in the Cradle,  written by Harry Chapin.

My child arrived just the other day.
He came to the world in the usual way.
But there were planes to catch and bills to pay.
He learned to walk while I was away
and he was talking 'fore I knew it and as he grew,
He'd say, "I'm gonna be like you, dad,
you know I'm gonna be like you."

And the cat's in the cradle and the silver spoon
little boy blue and the man in the moon.
"When you coming home, dad?""I don't know when
but we'll get together then.
We'll have a good time then."

My son turned ten just the other day.
He said, "Thanks for the ball, dad, come on let's play.
Can you teach me to throw?" I said, "Not today,
I got a lot to do." He said, "That's ok."
And he walked away but his smile never dimmed.
Said, "I'm gonna be like him, yeah,
you know I'm gonna be like him."

Well, he came from college just the other day.
So much like a man I just had to say,
"Son, I'm proud of you. Can you sit for a while?"
He shook his head and he said with a smile,
"What I'd really like, dad, is to borrow the car keys.
See you later. Can I have them please?"

I've long since retired and my son's moved away.
I called him up just the other day
I said, "I'd like to see you if you don't mind."
He said, "I'd love to, dad, if I could find the time.
You see, my new job's a hassle and the kid's got the flu
but it's sure nice talking to you, dad
it's been sure nice talking to you."
And as I hung up the phone, it occurred to me
he'd grown up just like me.
My boy was just like me.

Rose’s Turn, written by Stephen Sondheim, from the play, Gypsy.

Why did I do it?
What did it get me?
Scrapbooks full of me in the background.
Give 'em love and what does it get ya?
What does it get ya?
One quick look as each of 'em leaves you.
All your life and what does it get ya?
Thanks a lot and out with the garbage,
They take bows and you're battin' zero.

I had a dream.
I dreamed it for you, June.
It wasn't for me, Herbie.
And if it wasn't for me
then where would you be,
Miss Gypsy Rose Lee?

Well, someone tell me, when is it my turn?
Don't I get a dream for myself?
Starting now it's gonna be my turn.
Gangway, world, get off of my runway!
Starting now I bat a thousand!
This time, boys, I'm taking the bows and

everything's coming up Rose!
Everything's coming up roses!
Everything's coming up roses
this time for me!
For me! For me! For me! For me! For me!
For me!

For Good, written by Stephen Schwartz, from the play Wicked.

It well may be
that we will never meet again
in this lifetime.
So let me say before we part:
So much of me
is made of what I learned from you.
You'll be with me
like a handprint on my heart.
And now whatever way our stories end,
I know you'll have rewritten mine
by being my friend.

Marty Nemko's bio is in Wikipedia.

Arianna Huffington latest book, Thrive, captures the signs of our times. As a heavyweight social media channel, the Huffington Post has changed the way we consume news. In some ways, Arianna is single-handedly responsible for speeding up our lives with constant information. Yet one day she also realized as she collapsed in her office from sheer exhaustion that the pace of her own life was not sustainable.

Oftentimes we have to fall down in order to rise to new heights. Arianna is doing just that.

It is not as if she says anything new in her book, but reading it is like getting a whole year's supply of self-affirmations in one sitting. In essence, she tells the reader: "You are not crazy to feel overwhelmed. I was too. And I decided to do something about it."

I have long known that Arianna is a great champion of sleep. So am I. The trouble is getting the kind of quality sleep we need to keep pace in our 24/7 world. Technology and our ambition to keep up often leave us feeling depleted. But it's our own fault really. Why keep our iPhones next to our beds? Why check emails in the middle of the night when we can't sleep?

Technology's temptations are sometimes very hard to resist. Anyone with a teenager will confirm how invasive smartphones, tablets and all those gadgets have become in our daily lives.

When it comes to our digital diets, less really is more.

Arianna's premise is we must redefine the meaning of success to include well-being, wisdom, wonder and community. As my book The Power of Slow boils down to one word - 'choice' - hers boils down to one too -- 'love'. The more I think of it, the more I realize the limits of our minds. We have no love in our minds, only thoughts. When we react from the mind, we are entangled in the web of our own making. In fact, every stressor we feel comes down to one thing -- our reaction. Stress comes from a lack of trust that everything is going to be alright.

The truth is if we define "alright" to be That Which Is, then yes, everything will be alright. In fact, everything is alright all the time. Everything is indeed in alignment with the Universe. Our trouble begins when we ourselves are not.

Love can change that. When we come from our hearts' center, we are free.

Thrive is a smart piece of work that cites Greek and modern-day philosophers alike. She even quotes Carl Honoré, whose thinking about the Slow Movement greatly influenced mine.

My favorite part of her book is her discussion about time. She speaks of it in terms of physics. Time, in the physicist's view, is a landscape in which past, present and future can be seen. Like a mountain and a meadow and a wildflower all converging into one big thing. If that is true, than we needn't rush. All of time rests on a single canvas.

This book insists that we can not only survive, but actually thrive, even in our 24/7 world. As with all things, the quality of our lives is not informed by our bank account of Facebook fans or Twitter followers.

The beauty of our existence is informed solely by the depth of our hearts. 

A fit and attractive man in  his mid-twenties begs off an evening of drinks with friends. Instead, he goes to his apartment, swallows a few Tylenol, and pulls the old vise his father left him from the bottom of his closet. He puts a rubber bit in his mouth. A few deep breaths later, he places his slippered left foot into the vice and starts turning the crank. He focuses on the pain, turning the crank harder and cursing the inner voice telling him to stop. He concentrates, needing to hear the moment his foot breaks.

An intelligent thirty-six year old woman weighs about fifty pounds more than is healthy and knows what she needs to do to hit her target weight. During the day she counts calories, logs her meals, and monitors her pedometer to assure she's getting ten thousand steps. She works out four lunch hours a week at the local gym. She drives home every night along a special route; one that takes her past seven fast food restaurants where she will use the drive-thru to order a greasy meal from each. Her goal is to have each completely eaten before she passes the next restaurant on the route. She disposes of the bags and wrappings at a gas station three blocks from the middle-class home she shares with her husband and kids. Once home, she cooks a dinner they'll all share that evening.

A happily married woman with a wide circle of friends is out for a day of shopping. She's just gone through the checkout line, gathers her purchases, and carries the change handed her by the cashier. She finds the closest free bench in the mall and sits. She pulls out her wallet and organizes her money. Nickels go in one zippered compartment, heads facing the interior of her purse. Dimes and quarters have their own section, all with heads facing front. The paper money goes in her wallet. She arranges those not in order of denomination, but by each bill's serial number. Once every piece of money is in place, she picks up her packages and heads to the next store.

What compels these high-functioning adults to engage in behaviors that seem to make no sense? Why would our first young man willfully hurt himself? Or our overweight mother sabatoge all the good work she puts into her health each day? And what's the deal with our money lady? Why do they do these things?

It's easy to figure out the "why" behind adaptive behavior, isn't it? We eat because we're hungry. We sleep because we're tired. We spend time with our friends because they make us smile and we clean our toilets to avoid unpleasant odors. But what about those behaviors that don't have such an obvious cause-and-effect? We all have them. Ranging from quirky to self-destructive, we each have those things we do that seem on the surface to have no benefit at all. When those behaviors get in the way of our being able to function at the level we or society thinks we ought to, we label them as compulsions. We can't explain why we do them, but there's a certain discomfort if we don't. Some of us may display our gently eccentric behaviors and proclaim "That's just how I roll". Our more destructive behaviors we do in secret and explain them to no one.

Yet still we wonder why.

Here's the answer: we do the things we do because they work for us. It's as simple as that. Every behavior we repeat offers a reward. It doesn't matter if the reward isn't obvious. Nor does it matter that the consequences appear to cause pain or misery. The reward is there. And as anyone who's ever trained a puppy or raised a child knows: behavior that is rewarded will be repeated. Behavior that is ignored will go away. Compulsions, those anxious behaviors driving us to do all kinds of seemingly crazy things, carry their own reward.

Perhaps an example will serve to illustrate. Let's take the nervous flyer who has a certain ritual he follows every business trip. He always sits on the aisle. He double-checks the exit row to make sure the people there seem competent to manipulate the emergency door. He hangs on every word of the flight attendant's safety announcement...despite his familiarity from so many previous trips. During lift-off he recites the names and birthdays of each of his children and takes sugar in his in-flight coffee, though he drinks it black at home.

Seem bizarre? What could be the "win" here? Simple: the plane lands safely. All his ritualized behavior is rewarded. His brain doesn't care that planes take off, fly, and land safely thousands of times every day. His brain has linked the two (his rituals and the safe landing) and thinks he made it happen. It's like that old joke about the man standing on a busy Wall Street corner hopping on one foot. A guy asks him what's up. The hopper says "I'm keeping the polar bears away". The guy responds "There are no polar bears on Wall Street!" The man smiles and says "Yeah, I'm doing a great job.

THAT'S the link our brain makes. Our guy on the plane just wants the plan to land in one piece. He wants to feel safe. He's allowed to want that. That's his win and he's chasing it. There's nothing crazy about it.

But what do we make of those compulsive behaviors far more sinister than our fellow with his in-flight rituals? What about the people whose compulsions interfere with their functioning...or perhaps even their health?

We look for the win. We find what it is they're chasing and replace it with another, less costly, way for them to get it. The question isn't "why", but "what". What is the win?

The woman with the money organized so peculiarly had a father who arranged his own coins and bills that way. She often teased him about it. When her father died she missed him and yearned for the fun they'd shared. One day, on a whim, she sorted her money just like Dad. It felt good. It harmed nothing, eased her grief, and let her feel closer to a man she loved dearly. So she kept it up until it became uncomfortable not to sort her money like that. She deserved those wins. The "cost" of her behavior is minimal and no respectable psychologist would suggest she change that compulsion.

It took a while for the woman with the seven fast food stops each night to discover her particular win. She came to realize food had always been the way her family celebrated achievement. Got an A on that term paper? Let's go for pizza. Played Chopin's sonata flawlessly at the recital? Ice cream for everybody! She was now married to a quiet man who withheld his praise. She worked as a marketer in a high-tech firm where no sale was ever big enough nor any contract long enough. No one marked her good and hard work. She yearned to have her accomplishments recognized so her brain served up the very activity it had been taught all those years ago. It wasn't the food she was chasing, it was the win of recognition. She learned to ask her husband and family to listen and comment on her successes. She got her win in a way that didn't cost her the calories, grease, guilt, and salt of the drive thru.

And our fellow who crushed parts of his body? He was a tough one, but some old-fashioned detective work with his therapist led him to his win. He came from a family of high achievers. Private prep schools, Ivy League colleges, long and accomplished careers. He wasn't moving up the corporate ladder as fast as he imagined his parents would have hoped.  Any attempt to discuss this with his mother and siblings led to abrupt admonitions to do better, work harder, and make the family proud. The only time he could recall his parents being tender with him was when he was eleven. He'd fallen off a horse and broken some bones, cracked a couple of ribs, and was bruised over one entire side of his body. He was allowed to come home to heal. His parents set up a place on the sofa for him and checked in several times a day to make sure he was on the mend. He felt warm and connected to his family in a way he hadn't before. That was his win. So, when he found himself, now an adult, yearning for that closeness and support, his brain served up the very thing that had brought it to him before. It wasn't the pain or the injury he was chasing. It had nothing to do with self-punishment or distraction. He wanted to feel connected. He learned to develop alternate behaviors to give him the win his brain was chasing and was able to set aside the need to self-harm.

So how about you? What are you compelled to do that you can't understand or don't want anyone to know about? Let's talk about it here. Search out your win and see how you can get the reward you're chasing in a less costly way.

A recent study highlights the difference between “talking the talk” and “walking the walk” when it comes to religion and moral behavior. It’s not what you say you believe, it’s how often you show up for church that really makes a difference. Or, as the good book says: Faith without works is dead.

In the study, over 750 Spaniards were tested on three different measures assessing generosity, trust, and sense of fairness. The participants were divided into groups based on religious denomination (including none), intensity of religiosity (how often they attended church), and whether or not they had abandoned the religion (or non-religion) of their upbringing (either for another faith or for no faith).

Economic games (frequently used in these sorts of studies) were employed to measure subjects on virtuous behavior. For example, in one game – called the ultimatum game – one player (called the proposer) is given a sum of money that he or she is free to share with a second player (called the responder). If the responder accepts the amount offered by the proposer, then both players get to keep their money. If the responder refuses the offer, then neither player keeps any money. From a purely rational perspective, proposers should offer as little as possible and responders should accept any non-zero offer. So if the proposer is given $10 but only offers the responder $1, the responder should still accept the offer since it is $1 more than what the responder had when the game started. The ultimatum game measures fairness: How willing is the proposer to split the money evenly? How willing is the responder to reject unfair offers even when it forces him or her to forgo a selfish gain? Similarly, other games such as the dictator and trust games measure generosity and trust. 

At first blush, the results showed little differences between believers (in this case overwhelmingly Catholics) and non-believers. But then the researchers plunged a little deeper. It was actually the non-active Catholics (attended Mass less than once month) who looked indistinguishable from the non-believers. Active Catholics (attended Mass at least once a month), however, were more generous and fair than non-believers (no differences on trust). Also of note was the fact that among those claiming the label “Catholic,” over two-thirds were actually non-active, thus skewing the over-all Catholic sample in a direction more like non-believers. Thus, as people drop out of ritual practice, their behavior becomes increasingly indistinguishable from the secular norm, regardless of their professed “belief.” The secular norm in this case can be described as “rational self-interest.”

Dawkins-brand belligerent atheism is enamored with the idea that less religion would make the world a more rational place. Studies such as this should give pause: more rational does necessarily mean more virtuous.

Ref:

Branas-Garza P, Espin AM, Neuman S (2014) Religious Pro-Sociality? Experimental Evidence from a Sample of 766 Spaniards. PLoS ONE 9(8): e104685.doi:10.1371/journal.pone.0104685

In positive psychology happiness is a four letter word. Positive psychology, as you may know, is a relatively new movement within psychology that seeks to shift the focus of research and interventions from psychological maladies to human flourishing. When I teach this topic at the university I ask my students what concepts they would like to see included under the umbrella of positive psychology. A few topics such as happiness, optimism and resilience are the clear winners time and again. One notable absence: intelligence. Intelligence is something that most of us would want for our children and we often admire intelligence in others and yet it seems overlooked.

Why would students overlook the idea that intelligence might be related to high functioning or to success? It turns out that the students are not alone; positive psychologists seem to be neatly side-stepping this topic even though it is one of the oldest and best researched in all of psychology. In fact, a search of the leading professional database shows that only two articles have ever been published in the flagship Journal of Positive Psychology with “intelligence” in the title and both of those were about emotional intelligence!

I think some of the standoffishness is the result of our common attitudes about intelligence. Intelligence, like extroversion or left handedness, is seen as a trait. There is a trend, both among experts and lay people, to preference topics in psychology that are malleable. In short: we want to learn about stuff that we can change and improve.

It was with all this in mind that I was surprised to see a recent publication on intelligence. A piece of research that wasn’t just focused on how is smart or how they got that way but, instead, took aim at a positive psychology pillar: happiness. That’s right, the author of the study was curious as to whether intelligence is associated with happiness. In fact, he focused his lens a bit further and asked not about overall levels of happiness (boring!) but about overall stability of happiness.

Here’s how the researcher conducted his study and here’s what he found: First, he used a sample of almost 10 thousand British people for whom he had childhood IQ scores. He also happened to have happiness data for them at ages 33, 42, 47 and 51. He also had data on personality, income, job satisfaction and marital status so that he could control for all of these other possible complicating factors and just look at the pure relationship between intelligence and happiness stability.

It turns out that IQ—even intelligence assessed in childhood—predicts the emotional ups and downs a person will have over the course of her life. People who were below average in intelligence experienced significantly more variability in their life satisfaction than did those who were above average. Importantly, this was not due to differences in education, income or job (although it was, in part, due to differences in health).

Here’s where I think this research gets interesting: when this basic research result interacts with you, the person reading this. There may be a tendency to say “So what?” or perhaps something about the finding just rubs you the wrong way, regardless of the relative merits of the methodology. If you find that you have an aversive reaction to this I would encourage you to reflect on your own basic attitudes about intelligence. Perhaps intelligence, to the extent that it is a stable trait, feels somehow undemocratic or unfair to many people. Even so, the way that people learn, process, remember, recall and solve problems is a worthy topic of study. And if we view it as a skill then it might not be so surprising that it has some small association with happiness. 

While you’re learning to say “no” to second helpings, or “no” to certain foods, you may also have to learn to say “no” to certain people and situations that can sabotage your efforts to develop and maintain a healthier relationship with food. The most well-meaning people in our life are often the ones who prevent you from reaching your goals. They can also be the hardest people to say “no” to.

You have to be strong enough to say “No, thanks, Grandma, I don’t want any more lasagna,” even if you’re afraid she’ll take it personally. At times, you’ll have to say “No, sweetie, I’d rather eat at home tonight,” when your partner wants to go out to a restaurant. If you normally go out with friends on Friday night, you might have to decide to stay home alone. While you’re learning to eat normally, you have to say “no” to people and situations that trigger emotional eating behavior or overeating. You won’t always have to say “no” to everything, but while you are trying to change your eating habits and stay in control of what and how much you eat, you must be firm when it comes to destructive situations or you’ll never reach your goals. You know just how easy it is to fall back into old eating habits or fool yourself into thinking “just this once.”

When you’re low on self-confidence, it might be especially difficult to say “no” to people and situations that can throw you off the wagon. You might feel guilty saying “no” but sometimes you have no recourse. If you try to please someone else by doing what you don’t want to do you’ll only end up feeling resentful.

If an outright “no” is too difficult, there are other ways to say it: “I’m sorry, I can’t”; “Not right now”; “I can’t make it this time”; “I’d rather not”; “I don’t like that idea” or “No thanks, but maybe next time” are all softer variations of a flat-out “No.” You can also delay your response by saying “I have to think about that” or “Can I get back to you on that?” or “I’m not sure I can do it but I’ll let you know.” Smile when you say “no” to remind yourself you’re doing something positive. It might help to practice what you’re going to say before a situation arises. Sometimes all you need is to have the right answer at the ready.

Grandparents in Need of Help: Addiction and the Elderly

We often ignore troubling behavior in older people, letting these behaviors slide as signs of aging. Forgetfulness, falls or an inability to live alone may come with age, but they don’t have to. They can also be symptoms of substance abuse. Many, many of our aging and elderly family members and friends need help with substance abuse and misuse. The problem of substance abuse among the elderly is only expected to grow in the coming years.

Consider some disturbing conclusions from one study:

Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002–06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups.

Why does substance abuse become a problem as people get older? As people age, our bodies metabolize substances differently. An individual that has had a nightly glass of wine for years will eventually not be able to tolerate the same amount of wine because our aging organs have increasing difficulty metabolizing the alcohol. This can be dangerous because the process is slow and we may not recognize that a change is occurring.  Yet with time, we will realize that a change has happened. For example, one glass of wine that was previously enjoyed with impunity could after time have the same effect as three or more glasses of wine, with falls resulting. The problem is, instead of recognizing a changing metabolism and an issue with drinking, the falls will likely be blamed on old age and no help will be given to the elderly person.

Is it retirement and perhaps boredom that causes higher rates of substance abuse among the aging? The issue is more complicated than being able to identify a single source of the problem. Peter A. Bamberger and Samuel B. Bacharach, coauthors of “Retirement and the Hidden Epidemic,” conducted a ten year study funded by the National Institutes of Health on substance abuse in older adults. Mr. Bamberger stated:

“The impact of retirement on substance abuse was anything but clear cut, with the conditions leading to retirement, and the economic and social nature of the retirement itself, having a far greater impact on substance use than simple retirement itself.”

A number of circumstances can encourage substance abuse in later life. The home may feel too large and quiet after retirement. Loneliness and depression can occur due to loss of a spouse or friends, the end of a career, fewer social interactions, limited mobility, and children living at a distance. Boredom and loss of purpose in life are also triggers for substance abuse.

What are some of the signs we might be missing? Disorientation and memory loss are usually associated with growing older. Very often chemical dependency has similar side effects to dementia. Some medications for diabetes, blood pressure, sleep, pain and anxiety can all affect aging patients more than younger patients. As we grow older and need to take medications for various conditions, these medications in combination with one another, over the counter drugs, nutritional supplements, and/or alcohol, can cause interactions that put a person’s health at risk. All substance use needs to be closely monitored as we age. This means that medical professionals need to ask probing questions about all substance use, particularly with older patients.

For more information on the aging population and substance abuse, watch a lecture I gave at the Jewish Theological Seminary in New York this past June to learn the latest information on addiction in the elderly.    

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2008.02411.x/abstract

http://www.nytimes.com/2014/10/04/business/more-older-adults-are-struggling-with-substance-abuse.html?smid=nytcore-iphone-share&smprod=nytcore-iphone&_r=1

"Eh leg Hammer."

That was the response I once got to a question that I asked a conductor on a train trying to figure out what the stop for the airport was.

"Sorry, what was that?" I asked. "Eh leg Hammer," was the response I got again. The fact the airport was found was a miracle.

I still have a chuckle when I think of that day. It was proceeded by trying to buy a train ticket and not at all understanding the person behind the glass, so random amounts of money were placed in the bin until she took it and gave a ticket. Who knows to this day what it really cost?

Sometimes these little misunderstandings can lead to smiles and laughters later on in life. At the time they were confusing, but now they are quite funny.

We all experience misunderstandings in our daily life. Some are slight like these, while others are major, life changing events. No matter what it is, it can be stressful to people who believe that they have to always get everything correct and it can be really frustrating to people who think that they need to know and understand everything. You would be surprised how many people I treat who have an issue with not knowing everything - they believe that not knowing something would be dangerous because it leaves them vulnerable.

Let me challenge you - go back to being like you were when you were a kid. If you did not understand things, then you just made things up. What would it be like to have a day of being care free again like you were as a kid? What if we were to just take things that they come - just for a day? No need to know all the why's and how's. Just take things as they are. Maybe best to not do this at work, but it could make for a fun weekend. If you try it out, let me know.

On any given day, you can find numerous blogs or so-called topical "news" sites offering recent stories about research claiming to show groundbreaking findings that accelerate problems related to aging. The ones that seem to get the greatest attention are those showing how this food or that food is a magical solution to all of your problems. They often go on to say something like:

"New research shows that eating chocolate daily will increase your life span by fifty years."

Of course, being told to eat more chocolate is just about the best thing ever. But here's the thing, there's only one way to know if chocolate makes you live even 5 years longer -- carefully select two groups of babies at birth, assign one to be the chocolate group, the other to have none and observe them until they die, and make sure to measure every bit of chocolate in the chocolate group because how much you eat is obviously really important, and the type of chocolate... Oh, and make sure to control EVERY other factor that could influence how long they live. In other words, there aren't any studies that can show this...yet.

This might lead you to conclude that all research about aging is useless, but I can assure you that research has revealed a significant amount about the aging process. We just have to take into consideration the limitations of what we can learn from any individual study. Scientific discoveries are almost always based on piecemeal discoveries, rarely on one study alone. Research is a process designed to produce an accumulation of information about relationships -- relationships between different factors and different outcomes. When a whole bunch of people study the same thing and observe the same outcome, we come to strong conclusions. For example, many studies have examined the effect of exercise on health and longevity. All come to the same conclusion -- exercise is good for you. Many have discovered it's good for your brain, your heart, your bones/muscles, your mental health, etc. In fact, some studies have even assigned some people to start exercising who were previously sedentary and discovered that starting exercising is related to astonishing health gains! So, researchers safely conclude that exercise has a range of health benefits, and as we learn more, we are beginning to figure out exactly how much and which types offer the biggest bang for your buck, so to speak. But we're not there yet.

Here's the kicker, associations between this factor and that outcome, even when observed over and over isn't always evidence of a causal relationship. Let me offer a silly example. Suppose someone was interested in learning whether owning a Prius was related to decreased fertility rates. Such a study would very likely show, even if observed by multiple people over a long period of time, that there is a consistent, negative relationship between owning a Prius and fertility. But, does this mean that hybrid cars cause infertility? Or perhaps that people who own them don't attract mates? Probably not. Here's why: it is more likley the case that people who own a Prius tend to have fewer children than, for example, people who own Suburbans. They also tend to have higher levels of education, which is predictive of lower fertility. This example might seem ridiculous, but it's not very different from other research in which people seem to draw similar conclusions.

Several months ago, a friend of mine posted a link to a natural health site that described results form a recent study about flouride in drinking water and cancer. The study involved several different communities in China. Some of the communities had normal amounts of flouride concentrations added to the drinking water, and some had four times the normal concentrations. The researchers examined overall cancer rates for each community over the last year. They concluded communities with four times the flouride in the drinking water had higher cancer rates. The natural health site reporting these results had the headline "flouride causes cancer" and then went on to point out why no one should consume flouride. Not only did the study authors NOT indicate this in the study, the purpose of the study was to determine if HIGH concentrations might be related to cancer, not whether flouride was good or bad. While it's certainly plausible that flouride causes cancer, that study couldn't have commented on such a relationship.

It's hard though, right? I mean, if you are a person who personally believes that flouride is awful stuff, even if the science doesn't show this, you might be happy to have some evidence to prove it! Aha! See, fellow supporters of flouride! I told you it was bad stuff! But alas, this is irresponsible consumption of information. At a time when aging and health research is splashed all over the news on a daily basis, it is now more than ever important to be cautious about jumping on the bandwagon with "research-based" recommendations presented by the media. If you hear a study that supports your own cause, you might be inclined to believe what you hear, but you should always carefully consider the information presented. Even gold standard research designs -- randomized case control studies -- have limitations.

Be a smarter consumer of information!

Here's how: Look for information that challenges your ideas, not just ones that support them. Consider how the research was done. Did the researchers just look at people who tried the mushroom-banana-mango extract, or did they compare them with people who just ate bananas? How many people did they look at? Was it only 15 people? Heck, if you picked 15 people off the street who said they believe that mushroom-banana-mango supplements were going to make them feel more energetic, the study would probably show this, even though it wasn't really the supplement that made them feel better.

We all need to be just a little more cautious about data, or advice columns, or so called "expert" descriptions of the top 5 reasons why you should eat more chocolate!, particularly in an era when "BIG DATA" is everywhere, and even the timing of our morning bathroom breaks are being measured. And, also trust that the piecemeal accumulation of data that is the scientific process will offer more and more insight with time. But, don't hold your breath. There's probably never going to be a silver bullet pill or super food that is going to reverse aging. You may not want to do the work, but exercise, fruits and veggies, enough sleep...you know, that stuff you've heard over and over but aren't doing?...Yeah, that's probably your best bet! But have some chocolate now and again, just in case!

Everyone gets anxious at times but when it interferes with ability to live a normal life, it requires special attention.

How best to treat anxiety? And is there new hope on the horizon? To address those questions, I turned to Dr. Daniel Pine. He has written over 200 papers on anxiety, mood, and behavior disorders and is Chief of the National Institute of Mental Health (NIMH) section of development and affective neuroscience. I spoke with him yesterday.

Marty Nemko: Anxiety takes different forms, for example, phobias, panic attacks, social anxiety, PTSD, and, most common, generalized anxiety. Is the current thinking that they generally have different etiology?

Daniel Pine: There’s more evidence they’re similar. For example, people with one form of anxiety often have another, if not on the same day, over time. The strongest evidence that forms of anxiety have different causes is that average age of onset is different. For example, phobia and social anxiety typically begin before puberty, generalized anxiety and panic disorder after.

MN: Do we know the extent to which anxiety is caused by genes versus environment?

DP: All mental health problems are caused by a mix. Well over half the variance in bipolar and Attention Deficit Hyperactivity Disorder (ADHD) is genetic, slightly less than half in anxiety.

MN: Is there a definable level of severity of anxiety at which one should seek treatment?

DP: If the person avoids doing important things because of undue anxiety or even simply feels quite anxious doing them, the person should seek an evaluation.

MN: Should different forms of anxiety be treated differently?

DP: In general, all forms of anxiety respond well to cognitive-behavioral therapy (CBT) and/or Selective Serotonin Reuptake Inhibitors (SSRIs) such as Citalopram (Celexa,)  Fluoxetine (Prozac,)  Paroxetine (Paxil,) and Sertraline (Zoloft.) While CBT and SSRIs are also standard treatments for depression, both tend to be more effective for anxiety than for depression, especially in adolescents.

MN: Are those drugs equal in effectiveness?

DP: A discussion with your physician and a trial can help you make the optimal choice.

MN: Are there any differences in SSRIs’ effectiveness across the types of anxiety?

DP: Obsessive-compulsive disorder (OCD) tends to respond somewhat less well and tends to be more persistent than some other anxiety disorders.

MN: If SSRIs and cognitive-behavioral therapy don’t work well enough, what should a person do?

DP: There are many other possible treatments, including other non-pharmacological treatments and medications such as seizure medications or benzodiazopines such as: Alprazolam (Xanax,) Clonazepam (Klonopin,) and Diazepam (Valium.)

MN: Benzodiazepines can create physical as well as psychological addiction within months. In light of that, what’s best advice about their use?

DP: As long as you follow your physician’s advice, they can be used safely, especially for short-term treatment.

MN: What does the data say about alternative treatments: exercise, herbs, meditation, etc.?

DP: The data doesn’t support the use of herbs. Regarding exercise, mindfulness, and computer training, the quality of research is improving and worthy of continued study. We’re seeing promising results with computer apps: games that teach people how to distract themselves from their irrational fears.

MN:  Are you optimistic that we’ll have even better treatments in the future?

DP: Yes. We’ll likely make more progress in developing new treatments for anxiety than for other mental diseases because what works with animals usually works with humans.

MN: Anything else you’d like to share with my readers?

DP: I think we’ve covered it.

Marty Nemko's bio is in Wikipedia.

    I’ve been reading a lot recently about the startle reflex as it applies to folks who suffer with panic disorder and agoraphobia. As you probably suspected, people diagnosed with this wretched curse tend to be more easily startled than those who don’t suffer with this wretched curse.  There is something you can do about that and the solution is based on my experiences as well as Buddhism and science.

   Let’s talk about some of the studies first. Essentially, what all of them observed was that some people are born with quicker startle reflexes than others and that the phenomenon can, statistically, lead to anxiety problems. The same quickened startle response can begin at any time of life with trauma of one kind or another.  Wikipedia cites a Journal of Abnormal Psychology article regarding PTSD and startle reflex in showing that not only is the eye blink response to stimuli speed heightened in someone who has suffered trauma, but the condition worsens with each new trauma.

    A Journal of Psychiatry & Neuroscience cites a 2009 study of teens diagnosed with “anxiety disorder,” in which researchers used measurements of response to stimuli based on eye blink speed, muscle reflex and sweat glands.  I’ll just state its conclusion:  “ASR (Autonomic System Response) is abnormally enlarged in young patients with anxiety disorder.”  Whenever I was at that stage, I felt like a nervous wreck, powerless to do anything about it.

   A person with a high startle response just naturally plays tag with the amygdala more often than a “normal” person would, setting up the amygdala to be constantly at a higher alert level than most people experience.   An important thing to know is that the startle signal shoots straight to the amygdala where a quick decision is made about the nature of the stimuli. Do we run? Do we pick up a makeshift weapon? Do we climb a tree? Or, do we realize the stimulus was only a banging screen door and get on with it? Brain business gets very complicated at this point, and includes the role of the hippocampus for memories.

   Suffice it to say, if you are agoraphobic your alarm system is haywire and in desperate need of re-programming. That’s where my Un-Agoraphobic recovery program comes in. Yes you can re-train your amygdala so it isn’t so readily startled.   In the meantime, what this means for agoraphobes is that each time you have a panic attack, your alarm system gets set on even higher alert.  Your body is betraying you by doing the worst possible thing. Being on high alert makes it easier for you to have another panic attack. Duh. Everybody gets it but the amygdala, which apparently thought your last emergency and subsequent panic attack was because of a tiger. You’ve got to admit it, you feel as though it’s something as scary as a wild beast.  Now your alarm system is on the lookout for more tigers. Don’t you wish you could turn your mouth around and shout into your brain, “THERE WEREN’T ANY TIGERS!!! STOP DOING THIS TO ME!!” 

   Unfortunately for you, the amygdala was born at a time in our evolving brain’s history when being alert to many forms of danger meant survival. Being alert still does, of course, but the tiny mid-brain organ needs to turn it down a bit, don’t you think?

   Here’s what I did that worked. First, I started trying NOT to respond to things that would ordinarily startle me or at least get my attention. I remember making a game of it to see how quickly I could return to normal after a startle situation or pretend not to react. I started doing this in my teen years, and found trying not to react at all, luckily, impossible. Slowing my reaction, however, turned out to be helpful in turning down my system a little.

   When I discovered Buddhism, I gathered many tools for my recovery process. The most helpful of all – “mindfulness” – allowed me to place my entire focus on anything I chose, which helped to calm my fear response system.

   The practice of mindfulness allowed me to begin observing things that happened around me rather than reacting to them. Practicing this throughout the day allowed my emergency response system to return to normal: only to be used for absolute emergencies. I’ve read Buddhist monks saying such things as “When washing your hands, wash your hands.” What this means for you is to focus all your attention on each task or situation throughout the day and on nothing else. Focus on your surroundings and their details. This continuing pattern of close observation will tone down your startle response. You are learning to observe and then react.  Your amygdala needs the break.

A recent study showed a link between pesticide use and depression in men exposed to chemicals on farms.  An earlier study was also conducted looking at the effects of pesticides in women, which found links to depression too.  And there have been others producing similar results. 

But there is an even more fundamental question that requires no research, one the chemical companies should address in earnest.  And that is, if you create chemicals to kill, (I don’t care what they are killing – bugs, weeds, bees, whatever) they are made to exterminate life.  The question then becomes, in what quantity are they dangerous and for whom?  You can’t have it both ways.  They can’t be poisonous only sometimes on some forms of life. 

I agree that levels swing the argument one way or another.  A trace amount is much different than a large dose. But, to layer on one small dose after another is to create a large dose. That point seems to be lost on the regulators.  Even though the general population will never receive the same amount of pesticides that farmers like those in the studies did, doses will continue to get larger, stronger and more ubiquitous if the EPA and USDA keep upping the ante on acceptable levels.  And this is where the sustainability argument comes in.  Nature at some point will collapse under the burden of manmade interference. 

The body has its own cleansing, purging and detoxifying system, and depending on its strength and efficiency, will push out the toxins that threaten it.  But only for as long as it can.  The system will eventually succumb to the pressure, particularly if government fails to regulate these chemicals, as it is proving to be the case.

So while I would concede that determining the sum total (and effect) of exposure in a causal, corollary way would be impossible considering we breathe, eat, wear, absorb, apply and touch thousands upon thousands of chemicals every day, at the same time, there is no responsible nor reasonable way to claim safety.

Meanwhile, The U.S. Fish and Wildlife Service’s National Wildlife Refuge System is banning the use of agricultural pesticides that a growing number of scientific studies have shown are harmful to bees, birds, mammals, and fish, and it will prohibit the use of genetically modified seeds to grow crops that feed wildlife.  Why those same considerations are not extended to human beings is a mystery. 

But it’s not just our health we need to worry about.  It’s our happiness.  As summarized by Marcia Angell in The New York Review of Books, depression more than doubled from 1987 to 2007 in adults and increased by 35 times in children over the same period.  That’s not good.

When one feels depressed, how often do doctors suggest first he or she try a diet that is mainly pesticide free?  Not very, and this is when there is research to support the possibility that chemicals are contributing to our mental/emotional well being.  What happens instead?  A prescription.  More chemicals. 

If we care about our health and the health of our loved ones, something has to give.  People are suffering and the answer is not more of the same.

I hope you'll follow me on Facebook.

(This is part one of a two-part article.)

Every parent has been there: what starts as a simple request to your child (e.g., put on your shoes, get ready for bed, get your things so we can leave, start your homework, etc.) is met with resistance or simply ignored.

Then you repeat yourself and start feeling frustrated, and from there the situation escalates into a full-blown power struggle.

What to do?  Here are 7 simple strategies for avoiding power struggles:

1. Pivot. 

Pivoting is the art of saying yes instead of no, and meaning the same thing. 

So instead of saying: “No, we can’t go to the park until after you have a nap,” pivot and say: “Yes, we can go to the park as soon as you’re done with your nap.”  Or:  "Yes, you can borrow the car as soon as you finish your homework."

The message is the same, but the tone is completely different, and saying “yes” gives kids a lot less to argue with.

2. Reframe.

Reframing is engaging kids’ imagination and sense of play in order to create the behavior you would like to see. A fascinating study of four-year-olds shows the power of this strategy.

In the study, the researchers first asked the kids to stand still for as long as they could. The kids didn’t last very long: usually less than a minute. Then the researchers asked the kids to pretend that they were guards at a factory. Now, the kids were able to stand still almost four times as long. Why? Because they were imaginatively engaged in the activity.

You will also see reframing at work in many preschools, when they sing the “clean-up song” while the kids put away toys and organize the room.

Reframing is also good practice for adults because it engages our own creativity to reframe our request (“stand still”) as a more imaginative activity (“pretend you are guarding a factory”).

What are the activities in your kids’ life that often meet with resistance and how can you reframe them more imaginatively?

3. Share your power.

Skillfull parents share their power with kids in age- and development-appropriate ways, with more power and autonomy accruing to children as they demonstrate both ability and responsibility.

In contrast, controlling parents give kids little autonomy to make their own choices, often with the well-intentioned goal of protecting their kids from mistakes or discomfort.

But this approach has hidden perils of its own, since kids in those situations often turn to emotional manipulation to get what they want, such as tantrums and “I hate you’s.” Or they pretend to comply with the controlling parent’s wishes, and then covertly do it their own way.

So if you find yourself dictating to your child how she should do something that she is capable of deciding for herself, back off and let her try. She will learn by trying, making mistakes, and trying again. (See strategy #4).

For example, if it’s raining outside and your daughter insists on wearing her sandals instead of her rain boots, consider letting her.*  Rather than get into a power struggle about the sandals (or whatever the issue is), give your daughter a matter-of-fact “preview” (your best guess about what’s going to happen: cold and wet feet) and also make it clear that she can make the choice. This is a magical combination.

Here's how this could sound in practice:“Sweetie, I can see that you really want to wear your sandals today even though it’s raining outside (empathy). I think if you do that, your feet will get cold and wet so I don’t recommend it (preview), but it’s up to you (power sharing). Please decide and let’s get ready to go.”

If she doesn’t like the experience of cold and wet feet, she will likely not make the same choice again. (Note that her not liking having cold and wet feet is not the same thing as you not liking it for her.)

Part 2 of this article will appear tomorrow, with strategies 4 - 7, plus a wrap-up.

 *Unless you live in a cold-climate, it's wintertime, and said choice may lead to frostbite or worse.  This is an important exception to this principle:  if your child's choice may pose a risk to health or safety, then it's not an option.  Go straight to strategies 5 and 6.  Be authoritative, give a reason, and go straight to empathy (and possibly distraction, which is most effective with younger kids).

Copyright 2014, Erica Reischer, Ph.D.

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Zits were so ugly. We hated them more than anything. We’re so glad they stopped showing up on our faces, so glad our pours stopped getting blocked causing the pressure to mount into those unsightly pustules that we couldn’t resist popping.

A teenage right of passage maybe. A punishing plague. Anyway, thank heaven the acne is finally over and we can get on with our lives.

Still, for many of us the plague passes to the communications dimension, feedback acne, a vicious cycle we enter into with our partners, friends, associates and loved ones.

One person, wary of being criticized blocks another person’s feedback, which as a result, gets impacted. Pressure mounts until the feedback can’t be held back any longer. It pops out with enough force to break through the blocking person’s defenses, more than enough force, given how long it has been impacted. 

This causes emotional scarring; the blocker more wary than before, which leads to more stubborn blocking as the pressure builds again.

Clearasil is no help with these communications pimples. So what does help?

We’re often told the solution is just to be nicer. That burden falls on the feedback deliverer, which makes some sense. Breaking through the blockage gently and tactfully might make the wary partner less wary, more open to hearing feedback next time. But at best, that’s half the solution, and at worst, holding the feedback provider responsible increases pressure and inflammation.

After all, the blocker may be wary for lots of reasons, not just because the feedback is harshly delivered. Many of us are just plain defensive. Few of us take critical feedback very gracefully however it’s delivered.

It’s easy to blame the messenger for feedback we’d rather not hear. If they supply it directly, you can say, “You’re too harsh.” If they supply it tactfully, you can say, “Your pussyfooting insults me.” No matter how they supply it you can say, “Your feedback is too negative,” “You hurt my feelings,” or “You're mean.”

And you can always blame their tone or timing; their attitude or wording.

Clearing up feedbacne has to be a joint effort. Yes, the popper should deliver feedback as gently as possible, but at least as important, the blocker has to find ways to allow the feedback in so it doesn’t get impacted in the first place.

So you also hear the advice, always be open to critical feedback, and you're given rational reasons why you should welcome feedback.  But aversion is a raw emotion and emotions are rarely responsive to mere reasons.

Reasons or not, openness to feedback simply doesn’t come easy. When we're told we ought to change something we do intuitively it feels like a snubbing mid-stride, a threat, a distraction. 

I’ve written lots about techniques for handling feedback better. (For example ingesting and digesting feedback). 

There’s one technique that I find more fruitful than any other. It’s a simple formula called mirroring.

When you get feedback, repeat it back to its deliverer in your own words, cleanly, in ways that show the feedbacker that you really heard it. Say it as though you were on the feedback-giver’s side. Don’t satirize it, exaggerated it or otherwise criticise it. Set aside whether you agree with the feedback. You can decide that later.

You can’t demonstrate receptivity to feedback by saying a vague “I heard you,” by declaring yourself open-minded or by saying “Yeah, but” as if you gave it an honest listen, quick as lighning assessed it judiciously and decided the feedback was worthless.

None of that works.  All of that will feel like just more blocking.

If you want a clean communications complexion, give feedback as cleanly as possible, and through mirroring, prove that you actually took it in. 

Less emotional scars, less pressure build up, and you’ll have passed the second right of passage into adulthood, a mature form of give and take. 

October 19^th, 2014 – During Domestic Violence Awareness Month

The internet is the angernet.  Research has shown that anger spreads more quickly than joy online.  Anger can divide, but it can also raise awareness, but only if it comes paired with compassion and wisdom.  There’s plenty to be angry about, and plenty of targets for our attention.  I hope to increase awareness of misogyny, domestic violence, and the issues of Asian American women and men with my new book (Asian American Anger:  It’s a Thing!), and with the #dvchallenge, raise funds to combat domestic violence and heal its effects in the Asian American community.  Go to http://bit.ly/APIIDV and find an organization in your area that deals with domestic violence, and make a one-time or recurring donation.  Get, and stay, involved.  Together, we can help improve the lives of women and children around the world.  All proceeds from the sale of these books will go to Narika and Maitri, focused on domestic violence in the South Asian community of the Bay Area, and to Asian American arts and cultural organizations.

Tweet or share this:

#dvchallenge - get "AA Anger - It's a Thing" at http://bit.ly/APIanger and donate against Domestic Violence http://bit.ly/APIIDV

We are beset with tragic news of violence and abuse against women.  From the Jyoti Singh rape case in India, to Steubenville, to Elliot Rodger’s rampage at Isla Vista, to domestic violence in the NFL – there is growing evidence and awareness about the threats that women face. 

This summer, I was asked to give a talk about these issues.  Jarring. Breathtaking. Important. These are the words readers have used to describe the resulting essay, "Asian American Male Anger: The Fast and the Furious”.  I explore anger and domestic violence in the Asian American community from the viewpoint of tragic outcomes, made glaringly clear with statistics and stories. Ultimately, this is a call for a renewal of relationship between Asian American men and women, and for a new level of safety and empowerment for all women and girls. Understanding emotional and cultural pressures is the first step in that renewal.

This talk comprises the lead essay in the volume.  The book also contains two additional essays about anger in the Asian American community, as well as a striking new essay on internet rage, “The Social Network is an IndigNation”.  As a poet, sometimes I find that only poetry can take us to the depths of a powerful feeling – to that end, I’ve included a dozen poems about anger.

Here’s what some advance readers had to say:

Dr. Chandra's thoughtful inquiry into the complexity of factors and forces that shape the ground from which Asian American male gender violence erupts into our lives is an important contribution to addressing the general problem of violence in our society.

Warren Miller, MFT, OTR/L

A fresh and original take on the Asian American male experience.  Recommended, especially to any one who gives a hoot about the inner world of the Asian guy in America.  Because after all, "This is the Asian American man, fast and sometimes furious. We are, in other words, dangerous. Filled with possibility, passion and hard-won pride – yet all too frequently, passed over and dismissed. But you cannot dismiss a dangerous man, can you?"

Tony Nguyen, documentary filmmaker

It is vital that we understand anger in our communities.  Dr. Chandra's article is compelling, and brings us closer to understanding and caring for one another.

Cynthia Tom, Artist and Curator, Asian American Women Artists Association

Join me in starting the #dvchallenge!  I look forward to your comments about the essays.  I hope to further the conversation, and foster change in all our communities.

© 2014 Ravi Chandra, M.D. All rights reserved.  Subscribe by RSS above.  Sign up for a quarterly e-newsletter to be the first to find out about my upcoming book on the psychology of social networks through a Buddhist lens, Facebuddha:  Transcendence in the Age of Social Networks, at www.RaviChandraMD.com.  Facebook page: SanghaFrancisco-The Pacific Heart. Twitter @going2peace. Thanks for your shares on Facebook, etc.!  

Last time, I left you with a question:  Should Tyra keep the engagement ring she got from Sam? If you didn’t read the last post, here’s the skinny. I covered something of the history of diamond engagement rings and gave an example of a modern couple to highlight the question about whether or not Tyra should give the engagement ring back to Sam when the plans for marriage were called off—by him. Sam had unceremoniously dumped Tyra after five years of engagement, leaving her for another woman.

Here’s my answer: I believe that Tyra should keep the ring, if she wants to keep it. Of course, she’d likely prefer to keep it and sell it than keep it for any sentimental reasons. But I can see why she would not return it to Sam. My reasoning is based in the fact that Tyra feels she lost something of value with Sam breaking off their long engagement. What was lost? Valuable time on her biological clock. In this particular case, the value of the engagement ring is in line with how they came to be commonly used in the past: As a promise backed by something of value to follow through on the intention to marry.

A colleague of mine was looking up some case law about what technically may happen with engagement rings after broken engagements these days. Apparently, in most states of the U.S., the default legal position is that the person who has received an engagement ring usually has to give it back to the person who gave it, no matter who broke off the engagement. It’s a kind of “no fault” broken engagement law. I am no lawyer, but I think that’s silly.

Consistent with this trend in legal thought, but for different reasons, a writer specializing in economics had asserted in a piece in the Atlantic that the custom of a woman getting to keep a ring after a broken engagement was outdated. That author, Matthew O’Brian, had asserted that there was no longer any particular rationale for a woman to keep an engagement ring, even if the man broke of the engagement, because there was no longer a special value attached to a woman being a virgin in the marriage market—which lands close to some of the original thinking behind the practice. (See my last post if you want more on that.)

Overall, O’Brian was quite right in noting that some things have changed, but here’s where I think he was wrong. His argument ignores the one thing that has not changed in all of this calculus—that there is an important biological difference between men and women. Before I get myself in hot water with some readers by noting that there are some actual differences between men and women, I want to point out that I personally like the idea of both partners giving an engagement ring—that is if both are doing the “engagement” thing and both are up for it. While that’s unconventional, I can see a lot of merit in that. But I also accept that biology is still very much present, which means there is some sex-based linkage to how one might think about societal customs like the giving of an engagement ring.

One of These Things Is Not Like The Other—In One Important Way

What’s the difference between men and women that matters most for this discussion? It’s not complicated. Women can get pregnant and men cannot. Women are also the ones who bear children (which goes with the whole pregnant thing).  While there is a rapidly growing number of exceptions, women are still far more likely than men to be the ones who spend the most time and energy on child care. So, it’s not just the bearing of a child but the rearing of a child where the initial biological difference can come into play.  

What does that mean? Women, on average, have more at stake in how relationships with implications for childbearing and rearing turn out. Are their exceptions to this? Loads and loads and lots. But it isn’t rational to ignore the fact that biology affects societal trends and cultural customs when it comes to dating, mating, marriage, and family development. This is why it’s important for females to accurately decode the commitment levels of their partners as relationships develop. This is important for men as well, but it’s critical for females of childbearing ages to do this well.[i]

Women have made huge advances in careers and earnings, and along with birth control, these changes counter the biological difference to a degree. But there isn’t a way to completely wipe out some fundamental differences that begin with who can and cannot have a baby as result of the sexual activity of two partners. Even where having a child is not possible, the behavioral and psychological patterns are deeply ingrained.

Regardless of sex and gender, there is a perfectly good rationale for the existence of societal customs that push romantic partners, male or female, to produce clear signals of commitment as relationships progress. While such customs are waning in favor of ambiguity (see my earlier post related to that), those who stand to lose the most if things go wrong have the most to gain by looking for clear evidence of commitment—at whatever stage of relationship it starts to matter.

Give Me a Sign!

When it comes to correctly decoding the commitment level in a potential partner, the clearer the signals the better for doing this well. Informative signals of commitment have several characteristics: The signal will be something that is under the volitional control of the one sending it. The signal will be something that is public. Sending the signal will likely involve some cost, in either energy, money, or both. That investment is part of what makes a signal informative about commitment. Whatever else you think about marriage or engagement rings, engagement rings do fit the bill as potent signals of intention about the future. Facebook status is also a serious signal in that it is volitional, public, and comes with some cost (designating one as off the market).

Looking for Lasting Love?

If you are looking for lasting love with long-term commitment, here’s some advice.

1.  Give serious thought to what you would consider valid signals of commitment from a potential partner. Unless you want to live in a sea of ambiguity—which I’ve argued is risky as more time goes by—what will indicate to you that someone is really committed to you?

Note that public displays of commitment beat the snot out of private, ambiguous messages. And DTRs are great but they take a lot of skill and guts to do them right. (I wrote two pieces on all that, here and here.) So, it’s good to have clear ideas about what else to look for when you want to decode commitment. 

2.  If you are a person who can become pregnant and bear children, it’s likely especially important for you to look for, and wait for, clear evidence of a mutual commitment to the future before allowing yourself to get too deeply drawn in with a partner. To be the useful, evidence of your partner’s commitment should be something you and others can see.

3. Whether you are male or female or someone from Mars (or Venus), here’s another question related to the importance of signals about commitment: “Do you attach strongly to people, and often quickly?” If that’s you, you also are at greater risk from failing to properly decode signals of commitment in a partner. Your own desire for connection can lead you to misread the signals about how committed another person is to you.  Lots of people find out, painfully, that they were “over-giving” to a partner who was never going to become more seriously committed. 

4.  If you have a friend who seems wise and knows you well, share what you are thinking about solid signals of commitment and see if they can knock some holes in your ideas. A lot of people look to what are false signals of commitment. If you are getting more serious with a partner, make the gutsy move to ask those you trust what they see in your developing relationship. Can they see something of concern you are not seeing? Don’t ask for honest feedback if you are not able to handle getting it. But if you have true and wise friends, and you can handle it, ask.

Love is blind but you don’t have to be when your future is at stake. 

[i] As an example, David Buss (in The Evolution of Desire, 2003) highlights the importance of acts of love in conveying information about commitment (p. 43). He goes on to suggest that, throughout human history, it has been crucial for women to accurately discern the commitment levels of males because of the comparative advantages to a woman of having the resources of a devoted male given the personal costs of pregnancy and childbirth to women.

The Ineffectiveness of Opioids for Chronic Pain                                                                                      

Let me first say that I am not a medical doctor. However, as the founder and CEO of a leading addiction treatment center, I sit on the front-lines of the prescription painkiller epidemic. From this vantage point, by working with addicts and their families and the physicians who treat addiction, I have come to learn a great deal about opioids, both when they are useful and when they may cause more harm than good. In reading the recent research on the efficacy of opioids for treating non-cancer related pain, I am dismayed at the ease with which these medications are prescribed.

The use of opioids for chronic non-cancer pain has increased dramatically over the past several decades. This has been accompanied by a major increase in opioid addiction and overdose deaths. The evidence does not support the safety and effectiveness of opioids for chronic pain and is causing an epidemic of tragic drug overdoses. The consequences of this abuse have been devastating and are on the rise.

An estimated 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.

The high risks associated with long-term opioid use are clearly shown by the climbing numbers of reported overdoses. Over 100,000 individuals have died, directly or indirectly, from prescribed opioids in the United States since the late 1990s. People aged 35–54 years have higher poisoning death rates involving opioid analgesics as compared with those in other age groups. Furthermore, substance abuse rates in those over the age of 55 are predicted to double in the next few years according to research predicting future trends from past and current research data.

A major reason why opioids are over prescribed is the misinformed belief that addiction is a rare consequence of long-term opioid therapy. The limited data supporting this outdated belief is of poor quality. Dependence arises in virtually all patients who are treated with long-term opioid therapy, and serious addiction occurs in up to one-third of patients.

The long-term use of opioids may not be beneficial even in patients with more severe pain conditions, including sickle-cell disease, destructive rheumatoid arthritis and severe neuropathic pain. The American Academy of Neurologists in a newly released position statement claimed :

Studies show that roughly half of patients taking opioids for at least three months are still on opioids five years later. Research shows that in many cases, those patients' doses have increased and their level of function has not improved. In addition, the premise that tolerance can be overcome by dose escalation is now seriously questioned.

A relationship between prescribed opioid dose and overdose events was verified in three separate high quality studies. A nine time increased risk of overdose was noted in amounts exceeding 100 mg/d compared to doses below 20 mg/d in patients. Unfortunately, prescribed doses are common at 120-200 mg/d. Many patients suffer serious opioid-related harm, including death, despite never misusing an opioid prescription.

Addiction withdrawals from opioids, when not treated by a detoxification specialist, are extremely unpleasant lasting several days, and sometimes compared to severe influenza, including abdominal pain, nausea, diarrhea, and generalized malaise. The emergence of these symptoms following abrupt reductions in the dose of opioids, and their resolution following re-administration of the drug is common. This makes it difficult for even highly motivated individuals who are dependent on opioids to reduce or eliminate use without careful medical oversight and support.

If a patient's pain is not under control, they should seek the help of a pain specialist and consider more successful alternative therapies than opioid medication on its own. Evidence now supports several holistic treatment options that are effective to help alleviate pain. We are able to promote mental, physical and spiritual healing without the need for what are now being regarded as generally ineffective opioid medications. Talk to a medical professional specializing in pain management for help with a long-term personal plan for managing pain.

http://www.neurology.org/content/83/14/1277

http://www.samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.htm

http://link.springer.com/article/10.1007%2Fs13181-012-0269-4

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2008.02411.x/abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) approximately double the risk for venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, according to an article published last month in the journal Rheumatology.

In other words, the medication you may take for pain may cause potentially life-threatening blood clots.

Authors of the article performed a meta-analysis to demonstrate a statistically significantly increased VTE risk among NSAID users. So, it is important to add to the list of potential adverse events this association; NSAIDs should be prescribed with caution, especially in patients at high baseline risk of VTE. In the meantime, prescribers of NSAIDs should not forget the potential for some or all of these drugs to impact cardiovascular risk, cause bleeding, and shut down the kidneys.

No one ever said treating pain was easy.

The investigators note that this is first systematic review and meta-analysis of published observational studies to examine the association between NSAID use and VTE. They used observational studies for their analysis because the complication is too rare to show up reliably in most randomized clinical trials. This, of course, may impact the reliability of the findings, and may allow users of NSAIDs to feel a bit emboldened if it truly is such a rare side effect.

The studies, one cohort (involving over 19,000 patients and 215 events) and five case-control studies (involving over 21,000 subjects and over 100,000 controls), were conducted in the United Kingdom, France, the Netherlands, Denmark, and Sweden between 2007 and 2013.

The pooled risk ratio among NSAID users was 1.8-fold, the researchers write, because aspirin, a COX-1 inhibitor, has been shown to be effective in VTE prevention.

The mechanism for risk for VTE remains unclear, however.

Inhibition of the COX-2 enzyme has been shown to inhibit the synthesis of prostacyclins, potent platelet activation inhibitors, while stimulating the release of thromboxane, a potent platelet aggregation facilitator, from the activated platelets. (Platelets are one of the first lines of defense to halt bleeding.) The activation and aggregation of platelets might, in turn, induce a coagulation cascade and clotting, according to the researchers.

Limitations of the results include a possible publication bias, heterogeneity among the studies, and an inability to show cause and effect from observational studies (versus, say, longitudinal controlled protocols).

Nevertheless, the researchers conclude that, considering the widespread use of NSAIDs, this increased risk may have important public health implications: Rare outcomes stop being rare when there is a large enough population to experience them.

What do you say to a group of homeless 10-to-17-year-olds living with their single mothers at one of the largest homeless shelters in the country, in one of the most drug and crime infested parts of Los Angeles?

That was my challenge when entrepreneur, Christopher Kai, asked me to come speak at Mondays at the Mission at the Union Rescue Mission. "You'll be great with these kids," he said. "Just do something to inspire them."

I thought to myself, "What the heck do I tell teenagers who are living in one of the worst situations imaginable, many personally affected by filth, crime, rape, mental illness and drugs?" I decided to follow my own advice from Just Listen, which has a chapter about calming yourself down, called "Oh F#%^ to Okay." I reminded myself to first notice...and then just listen.

In this calmer state, the first thing I noticed was the Skid Row section of Los Angeles that surrounded me, which then triggered flashbacks of my visit to Mumbai and Delhi years before. It struck me that while the poverty in Mumbai and Delhi easily dwarfed Los Angeles, the Indians had seemed noticeably happier. The people I saw before me were anything but happy, and looked as if they were barely surviving. While I had seen plenty of Indians who were barely surviving, there was a kind of bond there, a deeper connection, that I didn't see here.

Each homeless person I saw in L.A. was trying to stake out their 10-15 square feet of space, which was marked by an unfolded sleeping bag, or maybe a shopping cart for the more fortunate ones. I didn't remember ever seeing such fiercely guarded territoriality among the throngs of homeless in India.

As I entered the Union Rescue Mission, it seemed like an oasis in the middle of an entirely rundown and desperate area. Walking down a corridor to the 4th floor Rec Room where I was scheduled to speak, I saw single mothers corralling their children so they wouldn't wander too far. Early evening was approaching and there was danger everywhere.

I'd arrived early, before their team of impassioned and compassionate volunteers, just as the first few teens were coming in. They seemed well-schooled in etiquette, as each one came up to me, shook my hand and told me their name, some of which I repeated back to them since it was hard for me to understand them.

The entrepreneur and founder of this program, Chris Kai, came in to deliver a brief orientation. All of this was voluntary, he said. Anyone who didn't want to be there, or wanted to be disruptive, could go back to their rooms with their moms.

As I quietly looked and listened, I couldn't help but feel the fear, pain and sadness in the group behind their "game faces." Chris was doing a great job of pumping them up, but I still had no clue what I would say to them when my turn came.

I suddenly recalled a sermon the day before by Pastor Jimmy Bartz at THAD's, an inclusive Episcopal church with the simple mantra of living in the "God love life."

He'd shared the story of Anna Runs America, where Anna Judd had run across America to draw attention and support for foundations supporting veterans. Pastor Jimmy had asked Anna how she'd managed to persevere in running literally cross country and not quit. Anna had explained that she'd focus on looking at things she passed as if it were the first time she'd ever opened her eyes and seen anything.

That reminded me of something my late (and dearly missed) mentor, Warren Bennis, used to say: "Try to be a first class noticer." By that Warren meant that noticing is different than watching, looking and seeing. When you notice something, it takes you out of your internal experience (and anxiety) and bonds you with something outside of yourself that you then become curious about.

Not knowing where it would lead, but "noticing, listening and feeling my way into these teens," I began to talk about noticing, and how it can take you away from feeling very upset inside.

I then proposed the following exercise: "Close your eyes for ten seconds and pretend you have lost the ability to see. When you open them, feel the excitement as if you are 'seeing' for the first time, and then 'notice' something you hadn't noticed before."

After closing their eyes for ten seconds, they opened them and, one by one, shared something they noticed. One girl said she noticed a crack in the wall she hadn't seen before. Another girl noticed a clock in the room that wasn't moving. I also had the six volunteers try the exercise. I asked them if it had taken away some of their upset feelings inside, even if only for a few moments. They all agreed it had.

I then told them that, as a psychotherapist who works with very sad, very frightened and very angry people, I had learned to look deeply into my patients' eyes and focus on noticing that there was probably something going on underneath what they were saying or doing. I explained that I'd learned to hold onto people's eyes with my eyes and silently say: It's okay. I'm not going to hurt you. I'm not going to judge you. Just tell me where it hurts most (or is most scary) and how much.

I told these teens why I'd needed to develop this skill -- many of the people I'd seen over the years, especially the ones who didn't want to live, didn't have words to tell me what they felt.

I didn't know what I was going to do next, but this seemed to have a life of its own. I just let it take me where it wanted to.

The next thing I did was look into and lock onto the eyes of ten of the teenagers one by one with the look I described above. When I did that, even with these brief glances, I was struck by the fear, confusion and pain I picked up coming from each of them.

That led me to direct them to do a second exercise. I told them to pair up and then look into each other's eyes the way I had looked into theirs. I told them that I was going to have one person ask the other a particular question, and then I instructed the other person to answer it as honestly as they could. And while they were answering it, I told the first person to look into their eyes with caring as if they were saying, "It'll be okay to tell me. I'm not going to laugh or get angry at you." After they did that, they were to reverse roles.

I then instructed the first one to ask their partner, "What's the toughest thing about your life?"

At that point more than a few of their partners began to cry. The volunteers and I stepped in where necessary to reinforce that it was okay and safe to answer, whereupon several teenagers answered with emotion in their voice, "being here I noticed and felt the room flex into a different energy that was calmer, kinder and more caring and relieving.

I just went with the flow because something told me inside that we weren't finished. I then told them they had a homework assignment. I said that when I had first walked into the Rec Room, I'd noticed how many of the moms seemed upset or tense.

"Now that you've practiced this exercise in here, I want you to go out, and don't do this immediately, but pick a time when you're with your mom and say to her, 'Mom, what's the toughest part of being here for you?'"

I explained, "Some of your mothers also need to feel relief and will start crying, especially because of how afraid and ashamed they are of being here. Crying will be good for your moms and good for you. And if your moms cry, don't get nervous. Because you're actually showing love and caring for them.

Finally, I want you to let your moms cry and then reach out and hug them and say, 'It's okay mom. We're going to be okay and I love you.'"

That got a lot of the room tearing up, just as it's doing to me as I share this story with you.

Finally I told them, "For some of you this may be one of the best conversations you've ever had with your mom. And for some of you and your moms, it may even change your lives for the better."

Now here's YOUR homework assignment.

Reach out to someone you care about who is having a very rough time in their life, look into their eyes with all the love and caring you can muster and say to them, "Mind if ask you a question which is kind of personal, that's been on my mind lately?" Hopefully they'll say, "Okay."

Then ask them, "What's the toughest part of your life right now?" If they open up, make it a chance for them to get a lot off their chest by just noticing the most emotionally charged words they use: "awful, horrendous, scary" etc. Wait for them to finish, pause for a couple of seconds so they'll feel what they've said has sunk in with you, and keep looking into their eyes with a "I want to know how and what you're feeling just so you don't have to feel it alone" look.

If it feels right, you can use "conversation deepeners" (which I also describe in my book Just Listen) like: "Say more about awful (horrendous, scary, etc.)"; or pause after they finish, and in an inviting, empathetic tone just say, "Really..."

If you do the above homework assignment, report back in the comments on what your experience was like, because you have just joined the mission of our global community, Heartfelt Leadership: "Healing the world one conversation at time, by daring to care."

And we're honored to have you.

(Greatful appreciation for editorial assistance to Peter Petro)