Should Kaci Hickox, the nurse who treated Ebola patients in Sierra Leone with Doctors Without Borders, be free to move about as she pleases or is it right that restrictions be placed upon her until it is beyond a doubt that she doesn’t have the disease?

Yes, from a legal point of view. No, from a moral point of view. Here’s why:

Upon returning to the US she was placed in quarantine when she exhibited an elevated temperature when tested at the New Jersey airport. She threatened to sue when the quarantine wasn’t lifted even after she tested negative for Ebola. Gov. Christie was unsympathetic and practically dared her to sue. “Whatever,” he said. “I’ve been sued lots of times before. Get in line. I’m happy to take it on.”

A few days later Hickcox was driven to Maine, where the governor there ordered her to be quarantined. Once again she challenged the decision to isolate her when the state filed a court order requiring her to a 21-day-quarantine, citing “concerns about the lack of reliability and lack of trustworthiness of the information that has been received.” Maine’s health commissioner considered the isolation commonsense. “This is a reasonable request to ensure, out of an abundance of caution, that we are protecting the people of this state.”

The judge hearing the case sided with the nurse, overturning the order saying that the state was violating her rights and she did not have to remain confined to her home until the incubation period was over. District Court Judge Charles LaVerdiere said that “people are acting out of fear and that this fear is not entirely rational.”

Gov. Paul LePage said the court decision was unfortunate and that Hickox was being unreasonable in her refusal to isolate herself.

For her part, the Hickox said, "I know that Ebola is a scary disease. I have seen it face-to-face. I know we are nowhere near winning this battle. We'll only win this battle as we continue this discussion, as we gain a better collective understanding about Ebola and public health, as we overcome the fear and, most importantly, as we end the outbreak that is still ongoing in West Africa today."

Science seems to favor Hickox. As the judge noted, “According to the information presented by the court, Respondent currently does not show any symptoms of Ebola and is therefore not infectious.” The CDC, WHO, Doctors Without Borders and all other medical professionals familiar with the disease agree: without symptoms, a person isn’t contagious.

The law seems to agree with Hickox: without very good reason, the right to be free trumps everything. Restrictions can be imposed for considerations of public health. According to the best of anyone’s knowledge, Hickox doesn’t pose a public health threat. A quarantine is disproportionate to the risk she poses.

Isolating Hickox for no compelling medical reason also risks discouraging others from volunteering to fight the disease in Africa. As she said, “It scares me to think how they're going to be treated and how they're going to feel." If Ebola isn’t contained in Africa, it certainly will reach our shores.

So on the one side there is the constitution and science and on the other there is public perception and politics. The choice should be clear but it isn’t, for politics cannot be ruled out of public policy and irrationality cannot always be dismissed with better reasons.

Kaci Hickox is a hero for volunteering to fight Ebola in West Africa but she also threatens to undermine confidence in the health profession by not being more sensitive to public opinion. Whatever her motives, it does strike many as cavalier for her to be about when the incubation period hasn’t passed.

The judge was correct in ruling the Hickox’s rights need to be protected but the governor was also right in stating that Hickox was unreasonable in not isolating herself.

People are frightened by the unknown and there is still much that isn’t known about Ebola. Hickox would do more for public education by self-isolating and continuing to provide accurate information about the disease. As it is, she is undermining the credibility of the medical community. Rather than promoting good science and reason, she may be contributing to fear and irrationanlity.

A recent study of Effective Teaching, published by the Sutton Trust and Durham University in the UK, identified a number of commonly supported practices for which there was little or no evidence.

Among the report’s examples of practices whose use is not supported by research evidence were the widely discredited idea of learning styles, as well as commonly used practices like ability grouping and discovery learning.  Even more surprising for many readers, perhaps, was the inclusion of 'Use praise lavishly’ in the list of questionable strategies.  It is likely to be surprising because praise for students may be seen as inherently affirming and positive by many people, and a core element of a ‘positive’ philosophy of  teaching, coaching and parenting.  And in a similar way, criticism is now frequently condemned for being ‘negative’ and harmful.

There are schools progrms and sports organisations premised explicitly on the dual premises of lots of praise and minimal criticism.  And the rationale for this is usually that praise bolsters self-esteem and criticism harms it.  In effect, this is the ‘gas gauge’ theory of self-esteem, in which praise fills up the tank with good feelings and social approval, and criticism drains it.

How can one not applaud the movement towards more positive approaches to education and sport?  Especially for young people, these settings should be joyous, exciting experiences, and we know from vast amounts of research evidence from the US and elsewhere that this is not always the case (link) (link).

We know, for example, that bullying, harassment and abuse still hide in dark corners, and that far too many parents, coaches and teachers confuse infant needs with adult wants, and infant games with professional competitions.  We also know that such behaviors drive children away from engagement and enjoyment in activities because young people, if not some adults, know that learning and playing sports and other activities are supposed to be fun.

Consider sports specifically for a moment.  Research from the US suggests that sports participation drops by 30 percent for each year of age, after ten years of age.  According to a report from the National Alliance for Sports, over 70% of children drop out of organized sports by age 13.

Numerous studies report that many children are put off participating in sports by an over-emphasis on winning, and this effect is especially strong with girls. Children are too-often presented with a narrow and uninspiring range of opportunities, and while many children love team games and athletic events, others find these traditional forms of activity physical activity either irrelevant, boring or upsetting.

Remember: these patterns of dropout from sports are happening as the health and happiness of young people are being compromised by unprecedented levels of physical inactivity.  With activity levels low, and predicted to go even lower, we cannot afford to turn children of sports, and the movement towards more positive sporting experiences is undoubtedly a movement in the right direction.

There is a danger, though, in embracing praise as wholeheartedly and unconditionally as some parents, coaches and teachers seem to have done.



Praise for students may be seen as affirming and positive, but a number of studies suggest that the wrong kinds of praise can be very harmful to learning.  Psychologist Carol Dweck has carried out some of the most valuable research in this regard.  In one study from 1998, fifth graders were asked to solve a set of moderately difficult mathematical problems, and were given praise that focused either on their ability (such as ‘you did really well, you're so clever’), or on their hard work (‘you did really well, you must have tried really hard’).  The children were then asked to complete a set of more difficult challenges, and were led to believe that they had been unsuccessful. The researchers found that the children who had been given effort-based praise were more likely to show willingness to work out new approaches. They also showed more resilience, and tended to attribute failure to lack of effort, not lack of ability. The children who had been praised for their intelligence tended to choose tasks that confirmed what they already knew, displayed less groups and resilience when problems got harder, and worried more about failure.



What many might consider a commonsense approach - praising the child for being smart, clever or a natural - turned out to be an ineffective strategy.  The initial thrill of a compliment soon gave way to a drop in self-esteem, motivation and overall performance.  And this was the result of just one sentence of praise.

Some researchers have argued that praise that is intended to be encouraging and affirming of low attaining students actually conveys a message of low expectations. In fact, children whose failure was responded to with sympathy were more likely to attribute their failure to lack of ability than those who were presented with anger.  They claim:

“Praise for successful performance on an easy task can be interpreted by a student as evidence that the teacher has a low perception of his or her ability. As a consequence, it can actually lower rather than enhance self-confidence. Criticism following poor performance can, under some circumstances, be interpreted as an indication of the teacher's high perception of the student's ability.”

So, at the least, the simple distinction between praise being good for children and criticism being bad needs a serious rethink: praise can hinder, rather than help development and learning, if used inappropriately.  Criticism, used cautiously and wisely can be empowering.

These findings would seem to call for a reconsideration of a very widely held belief among teachers and coaches that they should avoid making negative or critical comments, and if they must do so, then they are guided to counter-balance a single criticism with three, four or even five pieces of praise.  This assumption is clearly based on the "gas gauge" model of self-esteem described earlier, viewing any negative comments as necessarily damaging, and requiring positive comments to be heaped around it in order to offset the harm.

I am unaware of any convincing evidence that criticism or negative feedback necessarily causes any harm to children's self-esteem.  Of course, abusive comments and personal insults may well do so, but these are obviously inappropriate and unacceptable behaviours.  Well-chosen criticism, delivered in an environment of high expectations and unconditional support, can inspire learning and development, whilst poorly judged praise can do more harm than good.  Even relatively young children can tell the difference between constructive and destructive criticism, and it is a serious and unhelpful error to conflate the two.

We actually know quite a lot about effective feedback, and that is summarised nicely by the educational researcher John Hattie:

"To be effective, feedback needs to be clear, purposeful, meaningful and compatible with students’ prior knowledge, and to provide logical connections.”

I suggest that it would be extremely difficult to deliver feedback that is clear, purposeful, etc. in the context of voluminous praise.  Eventually, the parent, teacher or coach simply ends up making vague, meaningless or tenuous platitudes.  And this can cause more damage to the learner-teacher relationship then criticism.

The psychoanalyst Stephen Grosz describes a conversation he had with a school teacher called Charlotte Stiglitz - the mother of the Nobel prize-winning economist Joseph Stiglitz:

"I don't praise a small child for doing what they ought to be able to do.  I praise them when they do something really difficult - like sharing a toy or showing patients. I also think it is important to say "thank you” … but I wouldn't praise a child who is playing or reading.”

Grosz watched as a four year old Stiglitz showed her a picture he had been drawing.  She did not do what many would have done, including myself when I taught this age group, and immediately give praise for such a lovely drawing.  Instead, she had an unhurried conversation with the child about his picture.  “She observed, she listened.  She was present”, Grosz noted.

I think Stephen Grosz’s conclusion from this seemingly everyday events is correct and important: being present for children builds their confidence by demonstrating that they are listening to.  Being present avoids an inherent risk with excessive praise, as with any type of reward, that praise becomes the end in itself, and the activity is merely a means to that end.  And when that happens, learning, achievement and the love of learning are compromised.

Praise is like sugar. Used to too liberally or in an inappropriate way, and it spoils. But used carefully and sparingly, and it can be a wonderful thing!

Fanatics, ideologues and absolutists, are society’s greatest scourge. Whether they’re the leaders or the followers, fanatics are people who indulge in a heady, intoxicating and toxic concoction of self-affirming, know-it-all confidence that they have unique access to absolute truths, truths so perfect that they have to impose them on everyone.

The absolute truths that fanatics latch onto might be religious or political, right wing or left wing, Christian or Islamic, libertarian or communist, new age spiritual or old-time religious.

It’s not what they believe that makes them fanatics but how they believe it, that they have final word, no need to consider further evidence, no need to ever wonder or doubt themselves again.

Fanaticism is a drug. Let loose on society it’s more ruinous than crack cocaine, or alcohol, drugs whose effects are like fanaticism’s, making their addicts crass, belligerent, self-righteous criminals. Fanatics drive through life like alcoholics driving under the influence. They think they’re perfectly fine driving. They kill innocent bystanders.

We’ve learned though, that treating alcoholics as criminals doesn’t help us or them. Alcoholics Anonymous has been so successful in part because it gives the addict a graceful way out of the corner he or she has painted himself into. It’s hard to kick a drug, if sobriety means admitting that you’re a vile person through and through. It’s easier to kick it if you recognize that you’ve become host to a virulent disease that can attack any of us. No one is exempt from the risk. It’s not your fault, but it is your responsibility to kick it.

Shaming the addict makes him dig in his heals. The better therapeutic response is firm discernment (political and religious fanaticism is decidedly toxic) with compassion (It's not your fault that you fell for it. History shows that we are all susceptible.)

What's needed is an AA-style safe-haven for recovering political and religious fanatics ideologues and absolutists. It’s message is, "Yes, you’re a wreck and have done real damage. But don't beat yourself up over it. Like so many of us, you became host to a powerful parasite that mutates quickly and has taken over minds throughout human history. Don't blame yourself. You are not alone. Join us. Together we can lick this thing."

Here’s a rough draft for the 12 Steps of Fanatics Anonymous

1. We admitted we were powerless over fanaticism—that our lives had become unmanageable. 

2. Came to believe that Reason, a power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of Reason.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have Reason remove all these defects of character.

7. Humbly invoked reason to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory, and when we were wrong, promptly admitted it.

11. Sought through inquiry, debate, conversation, curiosity and doubt to improve our conscious contact with Reason seeking for better understanding of the human tension between what we want to believe and what’s most likely to be true.

12. Having had an awakening to Reason as the result of these steps, we tried to carry this message to fanatics of all kinds, and to practice these principles in all our affairs.

Of course, the peculiar move here is replacing god with Reason, and more peculiar perhaps to repurpose the AA model for fanatics anonymous, what with AA’s surrender to god’s will, the most notorious excuse for fanaticism in fanaticism’s long and sordid history.

And what is Reason anyway?

Reason is nature’s gift to humankind and to the humanitarian impulse. It’s also called rationality, which comes from the same root as ratio, to compare, discern, evaluate, judging carefully and humbly in our efforts to find the better bets on how to live.

Reason is also related to logos, a word with diverse implications over the millennia but related to language, and logic, uniquely human gifts for our ongoing effort to understand the true ways of the world.

Ongoing--that’s how science practices reason. Where fanatics say “I reasoned once, came to the absolute truth and don’t have to reason again,” science, a practical practice we can learn to apply well beyond the lab, admits that there’s no last word, just today’s best guesses, to be improved upon through ongoing inquiry.

Sustained reason is just the hard work that an addiction to fanaticism frees us from. No wonder fanaticism is so intoxicating. Being a know-it-all provides such powerful pain relief. Reason is a much harder master than god. Humbling ourselves to it is painful.

No wonder so many of us fall off the wagon.

In 1988, the artist Cynthia Pannucci founded Art and Science Collaborations, Inc. (ASCI), a non-profit organization that gave a community to creators in the blossoming art and technology movement. Twenty-six years later, she remains the director, and ASCI is considered a pioneer of the space where Art and Science meet, often referred to as ArtSci or SciArt. What has emerged is a new culture encompassing a growing number of people that have experienced what Arthur Miller describes as a “coalescence of processes”—a merging of artistic and scientific practices. Speaking about how alike artists and scientists are, Pannucci said, “I do believe the curiosity quotient is so similar and the processes of trial, error, and experimentation…it’s all there.”

Deep in our brains are areas where we experience the emotion of pleasure. It is there, in the orbitofrontal cortex and the nucleus accumbens, aided by neurotransmitters such as dopamine, opiates, and cannabibens, that we also have aesthetic experiences. “We evolved our responses to beauty because they were useful for survival,” says neuroscientist Dr. Anjan Chatterjee, the Elliott Professor Chief of Neurology at Pennsylvania Hospital at the University of Pennsylvania, Philadelphia. He and Stephen Nowlin, the Director of the Williamson Gallery at the Art Center College of Design in Pasadena, co-curated The Brain, the 16^th annual art-science juried exhibition organized by Art & Science Collaborations, Inc. (ASCI) at the New York Hall of Science.

At a time when two large-scale research projects using advanced neurotechnologies are underway delivering breakthroughs in our understanding of the human brain, ASCI has mounted this compelling new exhibition of otherwise marginalized works that navigate from what is scientifically known about the brain to engaging us with the unknown.  But how did this thought-provoking exhibition come about?

The Brain presents single digital works of 29 artists that blur the boundaries of art and science. The exhibition, however, only serves as a taste of the bigger story. Behind each small image on view, is a potential treasure trove, an extensive and important body of work developed by each artist over the past decades and defines this hybrid field. These works are, for the most part, invisible to the larger art world. To some extent, although engaging, this exhibition is like a symbolic decontextualized poster for the in-depth journeys of these creators. This exhibition is just a touchstone for the magnificence left in the studios. Multimedia installations, moving collages, films, animations, still images, paintings, prints and weavings inspired by the roles different areas of our brains play in thinking, memory, and learning, but also probing sensations, movement and emotion. These artists utilize brain-imaging data to illuminate and provoke questions about the centrality of brain connections and how they shape our lives. Visualization is a big part of science study and the heart of visual arts. Today's advances in brain imaging technologies and other data landscapes are redefining the how we view the nature of creativity, consciousness, and perception.

For example, take the work of Valeriya N-Georg who, in part, creates monotype prints on a layered gel medium. Her work in the show looks only at the Axon, a basic part of the human’s brain structure.  Standing in front of the image, she talked to me about the work’s relationship to her larger practice where she explores the area between the physical human body and the invisible human spirit. She explained, “I’m interested in exploring the boundaries between the inner and outer body; between the physical and metaphysical; tangible and intangible, by exploring the tactile and the optical image.  My process of printing on layered gel has been born in my experiments and references the gradual peeling of human skin, exposing and suggesting the materiality inside the human body.” When she told me this, I felt I wanted to know and see more, and it was a shame that there wasn’t a more encompassing representation of her explorations.

Should we consider Chatterjee’s posit that aesthetics is a means of survival? That images contain the behavioral narrative of everything we are? A range of advanced brain imaging techniques allows doctors and artists to view activity, processes and neurological maladies of the living brain. It is not surprising that there is aesthetic fascination with the brain. It may be here more any anywhere that science and art have common ground.  

With regard to this bridging of art and science, Arthur Miller says in Colliding Worlds, “Its creators are artists and scientists working together to create images and objects of stunning beauty, along the way redefining the very concept of ‘aesthetic’—of what we mean by ‘art’ and, eventually, by ‘science.’”

The various fields must be bridged to solve the problems we face today. Organizations such as ASCI, Brown University, and the Rhode Island School of Design see the overwhelming benefits of art and science integration. They champion evolving the STEM curriculum (Science, Technology, Engineering, and Math) to include art, turning it into STEAM. ASCI’s achievements have not only helped support interdisciplinary and multidisciplinary art and science, their website continues to provide an index of examples of innovative thinking that has benefitted all disciplines.

Pannucci explains, “My favorite works in the exhibition are those that use metaphor.  For instance, Roger Ferragalo’s piece envisions the cosmos. There’s a large brain floating in space amongst the planets as if it is the ruling force of this whole cosmic universe. There’s a shining light that comes from the brain onto a primordial sea. Many scientists believe that cosmic dust came to the earth somehow creating life in the oceans.  I like his juxtaposition of all of these different images together into this one big cosmic brain.”

Again The Brain exhibition offers only a glimpse into this rich and varied terrain unseen by the public sphere. Organizations like ASCI require more support to mount in-depth, extensive, and nuanced exhibitions that can illuminate the importance of multidisciplinary and interdisciplinary artwork. Major contemporary art institutions should be looking here, at the intersection of art and science, for their next big blockbuster. It is in bridging this gap that we may discover the true depth and value of this work. It begins with really looking at the large bodies of work that art-science individuals have created and bringing that work to the public in a substantial way. Now, with rapid advancements of science and technology, an abundance of digital data and images everywhere, we need art-science individuals as guides, interpreters, and creators to lead our evolution into the next era.

To find more information on the artists and artworks from The Brain exhibition, click here: http://www.asci.org/artikel1361.html

To see the full interview with Cynthia Pannucci, Finding Digital Common Ground, click here: http://youtu.be/_RnMkgcZQ-Q

Gayil Nalls, Ph.D., is the author of "The Sensuous Immortal" featured in the book, Rendezvous with the Sensuous: Readings on Aesthetics.

Find her at www.gayilnalls.com, @olfacticinkblot and @themassinglab

© 2014 Gayil Nalls

It is not uncommon to hear patients complain about cognitive problems after being hospitalized in an intensive care unit (ICU). What is known about brain function following such hospitalizations? If there are changes in brain function, do these changes persist?

Clinical investigators from Vanderbilt University assessed the cognitive function of over 800 patients who had been hospitalized in an ICU for acute respiratory disease, cardiogenic shock (the heart has trouble pumping enough blood), or septic shock (overwhelming infection leading to low blood pressure). They reported their findings in the New England Journal of Medicine.

The patients were in the hospital for an average of 10 days. Most were on a respirator for several of those days, and about 60% were comatose for about 3 days.  While only about 5% had cognitive impairment at baseline, nearly 75% of these patients developed a delirium that lasted 3 to 4 days, on average, while in the hospital. A delirium is a condition in which a patient is awake but disoriented and confused. Delirious patients have memory problems and often experience hallucinations and/or delusions; some become agitated.

About 60% of these critically ill patients survived the hospitalization and were alive one year later. Not unexpectedly, those 65 and older had a higher death rate than those 50 to 64 years old and a much higher death rate than those younger than 50.

Did the patients exhibit cognitive consequences a year after hospitalization? About 25% of the survivors demonstrated substantial cognitive deficits both 3 months and 12 months after discharge. These deficits included problems with memory and attention. Age did not seem to affect these results as the same percentage of younger, previously healthy patients had substantial cognitive deficits 3 months and 12 months after discharge as did older patients (65 and older).

Were specific factors associated with these persistent cognitive deficits? Yes, the longer patients experienced a delirium the more likely they were to have memory and attentional deficits after discharge. Exactly why this relationship exists isn’t known. It is possible that something about a delirium sets the stage for more long-term brain changes. It is also possible that the delirium is not causative of longer term cognitive dysfunction, but that some other unidentified mechanism leads to both short term delirium and longer term cognitive deficits.

This study only followed patients for 12 months, and it remains unknown what happens years later. Does improvement occur? Or do the deficits remain and do they increase a person’s risk for developing age-related disorders like dementia that can lead to further cognitive impairment?  What role do the specific illnesses that led to the hospitalization play?

Little is known about treatments for acute delirium or these persistent cognitive changes.  Would cognitive rehabilitation after discharge help reverse the cognitive deficits? Would starting such rehabilitation shortly after discharge lead to greater improvement than waiting several months?

This important study should sensitize us to the fact that a significant number of patients who require treatment in an ICU for serious illnesses may be left with memory and attentional changes. 

This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.

Our self-esteem is not a static thing, it fluctuates over the day, the week, and indeed, over our entire lifespan. I’ve previously written about how having higher self-esteem is beneficial to our ability to manage stress and anxiety as well as how it aids our recover from psychological injuries such as rejection and failure (read Does Your Self-Esteem Function as an Emotional Immune System).

Now a new study demonstrates that boosting your self-esteem could also benefit your relationship, and surprisingly, even your relationship partner. The study, reported in the journalDevelopmental Psychology, examined how changes in self-esteem over time affected a couple’s satisfaction with their relationship. The study used two data sets that included hundreds (in one) and thousands (in the other) of couples. The data sets included assessments of the individuals self-esteem as well as their relationship satisfaction, taken several times over a period of twelve and fifteen years respectively.

Since life events can strongly influence both self-esteem and happiness in a relationship, the researchers used statistical methods to control for factors such as age, health, and employment status (which can impact both self-esteem and couple satisfaction).

The researchers reported that the higher a couple’s initial self-esteem was, the happier they tended to be in their relationship. They also found that changes in self-esteem over time were strongly related to changes in relationship satisfaction. Specifically, increases in individual self-esteem heralded improvements in relationship satisfaction while drops in individual self-esteem predicted drops in the couple’s relationship satisfaction.

Of note, there was no gender difference between men and women in how changes in their self-esteem impacted the relationship satisfaction for both members of the couple. That is, the self-esteem of women was no more 'important' to relationship satisfaction that that of men and vice versa.

Another interesting finding was that self-esteem similarity between members of the couple (whether they both had high or low self-esteem, or whether one was high and the other low) did not influence the development of their relationship satisfaction either.

These findings provide an interesting confirmation of a phenomenon observed by many psychotherapists, namely that when individual clients report improvements in self-esteem, they often report being happier in their relationship as well, and that their partner seems happier too. Similarly, when life events conspire to decrease an individual's self-esteem, such changes are often accompanied by reports of them experiencing their relationship as being less satisfying.

This link between individual self-esteem and relationship satisfaction is an interesting one because it means couples therapy is not the only venue by which a couple might improve their relationship. As the study illustrates, if one member of a couple can improve their self-esteem, it is likely to benefit the couple as a whole. In other words, individual psychotherapy and other self-improvement programs can benefit not just the participant but their partners as well.

For those interested in learning more about science-based techniques for improving self-esteem, check out Emotional First Aid: Healing Rejection, Guilt, Failure and Other Everyday Hurts (Plume, 2014).

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Copyright 2014 Guy Winch

Images by freedigitalphotos.net      

For our Pathways Institute Ask the Expert blog, we asked parents for their stories, with the idea that it would be helpful for parents to hear from other parents about their struggles and transformations. We asked:  What has this journey of parenting kids with learning differences meant to you?  How has it transformed you? This is the response from one of our parents. She requested to remain anonymous out of respect for her children.

I grew up in an alcoholic family system where there was one crisis after another. In-between there was a fair amount of numbness and once in a while good times. I spent time in therapy, at first trying to get control of my own self-destructiveness, then surrendering to the reality of needing help. I learned to be able to deeply think, wonder and take the time that I needed to understand myself. I was challenged to understand that drama, and emotional upset were different from being present and being in real contact with myself.  I learned to meditate and continue to do so daily -  I highly recommend it.

When I turned 30,  I was no longer terrified of intimacy. I got married and by 32 had a daughter and a son. I couldn’t have asked for more, I was truly happy and felt on the right path for life.

Then, when my son was young, he was diagnosed with dyslexia.  I was told he should go to a school that specialized teaching dyslexic boys. This was hard to hear but thankfully the school was in the same town we lived! I told myself, “This dyslexia thing is just a little hiccup. Things will be fine.” I thought my son would beat this thing called dyslexia and perhaps be the next Steve Jobs, Charles Schwab or Sir Richard Branson.  

During my son’s first year in the special school, my mother was diagnosed stage 3 breast cancer while caring for my father who was in the late stages of ALS. I believed I would be fine and I could handle all of it.  But I just couldn’t. My family was fractured and I felt completely out of control about everything and kept wanting to scream:  “WHY ISN’T ANYONE LISTENING TO ME AND LETTING ME BE IN CONTROL?” Somehow, in the middle of all it all and in a moment of grace, I was reminded of Al Anon something I had done before and I went to a meeting.

It took a while for me to get clear-headed in Al Anon and watch my self-righteousness cool down, soften and slowly peel away by listening to the wisdom, generosity of spirit and great humor of the group members.  I started to realize I needed to surrender the “people, places, and things” I couldn’t control, and a shift happened: things greatly improved for me with my siblings and parents.  

But as things got better with my family, I realized I was not done with my work in Al Anon. I was still in a battle of wills: my will versus reality regarding my son and dyslexia. I realized I needed to stay in Al Anon years after the family crisis had abated because I was treating dyslexia like alcoholism and my son as if he were an alcoholic.  I was trying be in control an uncontrollable situation.

My son was making progress in school but it was slow and no one was telling me he was going to be the next Steve Jobs.  The experts were saying that he was struggling to accept his learning difference, which is why he is so angry and anxious all the time. He needed therapy, additional tutoring and massive amounts of patience from his parents. I wasn’t very good at patience; I would get upset, angry and anxious.  I would try to force solutions.  

There were times when my son behaved like a PTSD survivor. He would be given an assignment in math and by the time he got home he couldn’t remember how to do the problems.  He would descend into anger, escalate, perseverate and explode in rage, because his brain was having a brown-out and sometimes a full black-out. I would panic and think, “I have to do more of this and more of that, find people who can help him.” I would email the teacher, upsetting my son and creating serious problems in my relationship with him.

Gratefully, in Al Anon I learned to not talk to the dyslexic kid when the dyslexic kid is doing homework. I learned to breathe, walk away, and stay calmly, “I’m sorry homework is so hard for you.” I have learned to calm down because there  is nothing I can “do” and more importantly I now have faith that my son is okay and going to be okay even in the middle of his struggle. Our son has the help he needs, is allowed to appropriately express his feelings and thoughts about how hard having dyslexia is at times, and is loved no matter what. I have begun to understand that I can never protect both my child from the suffering and struggles that come with life, including this one.

I am also now learning that I need to come to terms with being OKAY even if others in my life are struggling or suffering.  Being okay doesn’t mean I am uncaring about another’s struggles, in fact there are times that I am involved in trying sort out my son’s learning problems and participate in the process supporting or finding a solution. It just means that I don’t have to join the suffering.

The 11th step in Al Anon is "Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out." Meditation has given me an important coping and resiliency tool, and where I have learned about and practice detachment. Detachment isn’t disconnection or disinterest.  Detachment is the ability to say to myself, “Let go. There is nothing to carry, nothing to become distraught about.”

I use to think that I wasn’t allowed or entitled to experience real joy, freedom or happiness if others and in particular if my son was struggling.  What kind of parent would have a good day while their kid was struggling with reading? I would sink into GUILT. But I now realize not only am I allowed to be free of guilt and experience the good stuff in life, my son who struggles with learning needs to see that I  am okay. In fact he deserve to see that I am not taking on his learning struggles psychologically and emotionally. He needs to experience me creating positive interactions with him.  Otherwise, if I’m an anxious mess, a negative downward cycle begins to corrode our relationship - we are on a sinking ship together. When I keep a sense of humor and my deep sense of gratitude, and keep moving forward, it gives him the feeling that he’s just a teenager and I’m just his mom, and everything will be okay. It gives him hope, and the balance we both need.

We may not be consciously aware of it, but we all agree on what beauty is. Beauty is hardwired in our brains. We even see evidence of newborns reacting to beauty, and core traits of beauty are found across cultures and generations. While the “beauty” topic may appear to be just for women, we’re really talking about how we are all controlled by ancient hardware, and how to take advantage of, or more importantly not be sabotaged by, our design. We hope our male readers will hang in there and learn a few things about themselves.

When viewed from an evolutionary perspective, our ancestors experienced a far stricter division of labor, and male and female brains were designed to accomplish radically different tasks. The hunters needed to be driven by vision and situational awareness and the gatherers had to spend their days multitasking and cooperating.

Moreover, procreating presented very different challenges to men and women. For a man, with a very small investment, he could hit the genetic lottery so why not play as often as possible. For a woman, her investment was going to be enormous and she had better be very choosy about her mate.  The number of times she was going to be able to roll the dice was exponentially lower than her male counterparts. Women are, and always will be, the rate-limiting step in reproduction.

Over the course of millions of years, these gender-specific drivers left their mark in our genes. They have become the hardwiring that directs many of our seemingly inexplicable behaviors in the modern world.

The Hardware: Why do we even have built-in wiring for beauty?

The whole purpose of primal attraction is to maximize the chances of healthy offspring. It is a complex but licketysplit mind game that is dedicated to minimizing genetic risk and maximizing the odds for the next generation.

Viewing attractive faces triggers the reward pathways in our brain. These are the same pathways that fire up when we are eating, spending money, having sex, and using cocaine.  We feel compelled to act. Men have the desire to connect sexually and women have the desire to make themselves more beautiful. This readily explains the male penchant for pornography and fashion magazines for women. Our built-in beauty wiring is clearly still a powerful driver in society today.

According to Dr. Nancy Etcoff, we all love to look at smooth skin, shiny hair, curved waists and symmetrical bodies because over the course of evolution, the people who noticed these signals and desired their possessors had more reproductive success. I call this our beauty hardware, and although some might find it distressing, I believe that understanding our wiring is empowering. Once we understand beauty hardware, we can then evolve and expand our concept of beauty and make choices from a much more modern and powerful place.

By hardware, I mean the beauty archetypes we are born with. Yes, we really do come preprogrammed knowing what is and what is not beautiful. Our ancestors’ survival depended on it. Back in the hunter gatherer days when our brains were first evolving, only about half of the babies survived at all. Of those, only about 60 percent made it to an age where they could reproduce. We of course are all descendants of those few successful hunter gatherers.  

So who made it and who didn’t? The ones who made it were the ones who were physically strong and well cared for by the group. Not only did they need to be strong enough to conceive and carry a child, but they also needed to stay alive long enough to raise their incredibly dependent young. Human infants have by far the longest period of total dependency on a maternal figure compared to other mammals or our non-mammalian friends. Because of this prolonged dependency, men had to choose women who were young and in excellent health if they wanted their offspring to survive.

Also due to the long dependency, women were most successful at passing on their genes if they confined their childbearing years to their middle ones. Human females are one of the few species that have such a sharp rise and decline in fertility. It makes no evolutionary sense to bring a child into the world if you won’t be alive long enough to raise him or her to independence. Ah, menopause finally makes sense. Don’t keep procreating! Concentrate on what you have already produced.

Men don’t have the same dramatic and early peak as women, as it’s typically easier to replace the paternal rather than the maternal role. Men have a much easier time looking attractive as they age. In fact, they often get better looking with age, because while their fertility isn’t declining as rapidly, their ability to take care of the young is often increasing, making them an even better mate choice. Hence, the popularity of the May-December romances and websites like Sugar Baby Sugar Daddy. This makes sense from a strictly evolutionary survival standpoint, and the trend endures to modern times.

The truth is that we cannot alter our hardware. On average, a 20 something year old woman will be seen as more beautiful than a 44 or 66 year old woman, at least when judged and processed by our beauty hardware. There is no escaping our ancient hardwiring when it comes to our primal responses to archetypes of beauty.

We are, however, completely able to update our software. But to successfully update our beauty software, we must further understand our beauty hardware.

What is the Beauty Archetype that triggers our beauty hardware?

The brain is remarkably simple and complex all at the same time. Our brains are wired to look at pretty women, and whether it’s on TV, magazines, or the internet, the women we find attractive have much in common. We watch the Miss World pageant and may disagree on who should win, but only rarely would a viewer say anyone of the contestants wasn’t beautiful.

A massive study, called the International Mate Selection Project by David Buss, showed that in 10,047 people surveyed in 34 out of 37 cultures from 6 different continents and 5 islands, men valued appearance more than women.  In every culture studied, Buss found common traits associated with: “Clear skin, smooth skin, lustrous hair, long hair, symmetrical features, absence of open sores, pustules, or lesions, relatively small waist, relatively large breasts, and a low waist-to-hip ratio.” These characteristics, along with symmetry and averageness, signal good health and are now called “beautiful.”  Collectively, these traits form a sort of universal beauty archetype, and it is this archetype that our brains are hardwired to search for.

The beauty archetype is powerful and pervasive in our brains. Did you know that:

• Babies as young as a few hours old will stare longer at attractive faces?

• By one year they will play longer with attractive dolls and cooperate better with attractive sitters?  

• Men can accurately tell if a woman is ovulating, even if they have no idea how they could know such a thing and study after study has documented that they consistently find ovulating women more attractive?

• Strippers make twice as much money while ovulating, earning around $53/hour?

• Strippers on oral contraceptives earn about as much ($37/hour) as those who are menstruating ($35/hour)?  

• Women (at least those not on hormonal birth control) can even detect genetic compatibility, completely unconsciously?

• Men are subconsciously aware of the subtle scents characteristic of early pregnancy, and avoid those women?

Clearly, we are driven by ancient hardware connected to fertility, whether we know it or not.

Sometimes, we find the hardware drives us to engage in risky behavior. Multiple studies have shown that women are more extroverted, more risk-taking, and travel greater distances while ovulating. Driven by ancient urges, women are wired to engage in behaviors that make it more likely to find a mate outside one’s usual social group. In ancient times, the farther you traveled, the greater the chances of finding new genes. The closer you stayed to home, the more likely a woman was to encounter a relative.

Even though the modern world is packed with extraordinary genetic diversity across billions of people, our hardware is from an era when our genetic universe only consisted of hundreds. The urge to wander (which peaks during ovulation) was essential for the survival of our species. And speaking of wandering, women are more likely to cheat while ovulating.

As much as we like to think we are fully in control of our behavior, these examples should make it clear that there is much more going on in this complicated game of attraction.   

An archetype is an original model of a person, ideal example, or a prototype after which others are copied, patterned, or emulated; a symbol universally recognized by all. Archetypes put context to a situation. 

Archetypes are used in many domains. Marketers, for example, create archetypes to attach a personality to a brand.  In politics, it's useful to understand whether a commentator is an "archetypical democrat" or an "archetypical republican." Religion, business, education: all use archetypes in some form.

Creative activity can be defined by four archetypes:

The Creativity Doer: This is a practitioner of creativity, day in and day out. They innovate on a regular basis. The Creativity Doer is usually on the front lines of a problem and feels both accountable and motivated to come up with new and useful ideas.  They likely use a systematic approach to generate ideas, possibly without realizing it. They approach situations with a natural inclination to change the status quo rather than preserve it.

The Creativity Watcher: This is someone who has a strong interest or obsession with the creative output of  other people. They are fascinated by novelty. They consume it, read about it, and report on it. They marvel at what others create but stop short of practicing serious creativity.  They report useful insights about creativity and innovators. They add value by commenting on trends and milestones in the world of creativity. Entire websites such as Gizmodo and Engadget fit this archetype.

The Creativity Preacher: They inspires others of the need to innovate. They make the case for creativity and change. They relate creativity to our everyday lives as well as to the global economy.  They create both hope and fear - hope in terms of what can be created through creativity, and fear from the consequences of not innovating. The end is near in the form of being "disrupted."

The Creativity Teacher: They help others learn methods and techniques of creativity. They infect others with tools to create new ideas. Teachers are interventionalists. Their students become Doers (if they have taught them well). A number of university professors and creativity consultants fit this archetype.

Organizations need all four archetypes. Those that preach create the mandate for change. They mobilize the leadership and staff to focus on creativity as a source of organic growth. The Doers and Teachers tend to put things into motion.  Watchers are the "sense makers." They are trend spotters. They have a unique perspective on external creativity to give useful context to internal creativity.  A lot of corporate mergers and acquisition departments fall into this category. They are "hunters" of opportunity.

Ashley Madison’s New TV Spot

A few weeks ago I had a quiet Saturday evening at home, for which I was extremely grateful. Sitting on the couch in my PJs with a glass of milk, I found myself channel surfing before turning in, landing on Comedy Central and a few minutes of standup. Between bits of wit that I can’t remember, a new commercial aired that I can’t forget. The advertiser: Ashley Madison, the now infamous website/app designed for and used by married people looking to cheat.

This new AM ad opens with a clean-cut and very attractive young man singing revised lyrics to the erstwhile Climax Blues Band hit, “Couldn’t Get It Right.” Soon he is joined by a second, equally clean-cut and handsome young man, also singing. Pretty soon the entire screen is filled with good-looking, happily singing guys. On the surface, it’s pretty darn wholesome, reminiscent of Coca-Cola’s famed “I’d Like to Buy the World a Coke” ad, first aired in 1971, with one, then another, and then hundreds of beautiful people singing a song about peace, love and soda pop. But instead of singing I’d like to buy the world a house and furnish it with love, AM’s chorus is singing I’m looking for someone other than my wife, other than my wife, other than wife.

Yup, these grinning guys-next-door are gleefully touting the joys of sexual infidelity. If you watch the ad closely, you can see that the first guy is playing his laptop computer like a piano keyboard, but instead of producing music he’s typing the song lyrics, “I’m looking for someone other than my wife,” into his AM profile. And the second guy is playing his iPad like an air guitar, with each new swipe producing imagery of an incredibly hot (and apparently hot to cheat) female. And I can’t help but think the choice of “Couldn’t Get It Right” offers some sort of subliminal commentary on marriage, as does choosing a band with the word “Climax” in its name.

Why Is This So Disturbing?

OK, it’s hardly a secret that nighttime advertising often caters to the male sexual ego, and that Ashley Madison’s usually hilarious ads are now a significant part of this semi-misogynistic oeuvre. In the past, AM’s spots have typically focused on the misery of being married to an unattractive and/or unpleasant person, or the secret thrill of forbidden fruit. As such, the ads have fit nicely into the “1-800-Call-Me” seediness to which we’ve grown accustomed. But this new spot is very, very different in both tone and intent.

Previously, AM’s general message was: “OK, we know that cheating on your spouse is not the best thing to do because it breaks your vow of monogamy, but we also know that lots and lots of people do cheat, and they want to keep this activity a secret, and this is a great way to accomplish that.” Meanwhile, the new ad screams: “Cheating is fun and everybody does it and there’s absolutely nothing wrong with it and nobody ever gets hurt by it so you should definitely be using our website and/or our app.” Whatever the message being conveyed, it’s clear that AM’s ads are working, as the site now has almost 30 million members.

At this point you might be wondering if I’m some sort of prude or if I’m trying to bury my head in the sand about marital infidelity. Let me assure you that neither is the case. In my twenty-plus years as a psychotherapist specializing in relationship and sexual issues, I’ve seen and heard it all, and I have without doubt learned that “the monogamy box” is not right for every relationship. In fact, as I’ve told many cheating clients, “If you and your spouse can agree that extramarital sex is fine, and neither of you is bothered by it, and it doesn’t diminish your relationship, then more power to you both.” Frankly, there are plenty of people who live quite happily in open marriages, and I profess no judgment on the matter either way.

Nevertheless, after working with hundreds (probably thousands) of cheating spouses and their betrayed partners, I can tell you that infidelity is rarely a mutually agreed upon endeavor. Instead, one partner values and works hard to uphold his or her pledge of sexual monogamy while the other cheats and keeps that behavior a secret, nearly always justifying the behavior with some form of the following lie: “I’m not hurting anyone.”

Unfortunately, though, secretive sexual infidelity does cause a great deal of pain to the cheated-on partner. In fact, one study looking at the wives of serial cheaters (and most cheaters do engage in the behavior repeatedly) found that many of these women, upon learning about their husband’s infidelity, experienced acute stress symptoms characteristic of posttraumatic stress disorder. If you’re unfamiliar with PTSD, it’s a very serious disorder with potentially debilitating and long-lasting consequences. Secretive infidelity can even cause emotional and psychological pain to the cheated-on spouse before it’s uncovered. This is because secretive cheaters tend to pull away from their partners, both emotionally and physically, and the betrayed spouse nearly always senses this, usually rather acutely.

And then there’s all the secret-keeping, lying, and manipulation to deal with! Put simply, secretive cheaters typically go to great lengths to keep their infidelity under wraps – partly because they don’t want to hurt their spouse, but mostly because they don’t want to have to stop what they’re doing. Much of the time, this is the worst part for the cheated-on spouse. In fact, most betrayed partners tell me that it’s not any specific sexual act that has caused the most pain and created the most carnage; instead, it’s the lying and the resultant loss of relationship trust.

Of course, AM’s new ad seems to be tossing “secrets and lies” out the window....

Is Monogamy Finished?

It is rather clear to me that AM’s new ad signals a change in the marital paradigm, and that the spot does indeed mesh with what’s happening in the world at this moment. In short, infidelity is no longer an act that occurs only in shadow. While cheating is still somewhat frowned upon, it is growing ever-more culturally acceptable. And this means the rulebook of marriage has altered, with relationships now much more sexually open than in the past. As such, activities like porn use can sometimes be viewed within relationships as acceptable and non-hurtful, as can social media flirting, webcam mutual masturbation, and even in-person sexual encounters – so long as the people in the relationship are not keeping secrets about these behaviors.

Once upon a time, in the pre-Internet days of yore, monogamy in marriage was a given, and sexual infidelity was very definitely frowned upon. Spouses who cheated were gossiped about viciously, and even their non-cheating spouses and kids were sometimes made pariahs. Nowadays, however, in our highly digitally sexualized, divorce-accepting world, infidelity is no longer such a big deal culturally – a fact that is well-evidenced by AM’s blithe new ad – though it may still be a huge deal within a particular relationship.

So it seems to me that the new marriage paradigm is this: In today’s world, extramarital sex is something that can potentially be negotiated prior to or even during a marriage. This means the idea of extramarital sex is no longer an automatic nonstarter. That said, infidelity that occursin secret (i.e., secretive cheating) is nearly always problematic to a relationship and to the betrayed partner’s emotional and psychological wellbeing, and couples need to fully understand this. Yes, extramarital sex (in-the-flesh and/or purely online) may now be OK, so long as it is discussed and mutually agreed to before it occurs. But it should not be unilaterally or secretively undertaken.

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. He has developed clinical programs for The Ranch outside Nashville, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles.An author and subject expert on the relationship between digital technology and human sexuality, Mr. Weiss has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times and the Today Show, among others. He has also provided clinical multi-addiction training and behavioral health program development for the US military and treatment centers throughout the United States, Europe and Asia. For more information you can visit his website, www.robertweissmsw.com.

How do you live your life? Do you proactively make the most of your talents and seek out fulfilling experiences and relationships? Or is your focus avoiding pain, confrontation and embarrassment — in other words, making yourself as small a target as possible so the world won’t shoot you down?

Putting yourself out there can be unsettling, but it feels worse to wonder what might have been.

Are you giving yourself the chance to be your best and to experience all that you can? Or are you living a miniature life? Here are five signs you’re living too small for your inherent bigness:

      1. You wait to be asked …

… to speak in the meeting, to go to the movies, to have a turn with the karaoke mike, to join the conversation at a party, to share your opinion. Putting yourself forward is just not in your DNA. What if you speak up and say something stupid? What if you ask someone to the movies and they say no? Better to sit back and wait until someone practically begs you to join in. That way, if things go wrong, you can say, “Hey, it wasn’t my idea.”

The reality: If you wait to be asked, the invitation may never come. Yes, that might mean you sometimes avoid embarrassing yourself, but it also means you are going to miss chances to grow, learn and just have fun.

      2. You’ll do anything to avoid confrontation.

No matter how big or legitimate your complaint, you can’t bring yourself to actually confront a person with your grievance. What if they get mad? What if they come up with some complaints about you in return? Instead, you live with the problem and complain about your boss to your spouse, and about your spouse to your friend, and about your friend to your sister, and ...

The reality: It can be hard to stand up for yourself, but doing so in a diplomatic way is much more respectful to everyone involved than venting behind his or her back. It’s also your best hope for bringing about real change. Give the person a chance to make things better or explain. You will both be better off for it.

     3. You make room for the little stuff in your life before the big.

Life seems full of minutia – errands, chores, emails, to-do lists. But despite all the busyness, it doesn’t seem to add up to much at the end of the day. You often feel as though you’re missing the big picture.

The reality: The oft-told story of the rocks in the jar applies here: If you put the little stuff in the jar first – the pebbles and the sand – you won’t have room for the rocks. But add the rocks first – the important things, such as family, health, faith and relationships – and the pebbles and the sand can be worked into the empty spaces. The point is not that there’s a way to squeeze everything into your life, but that you should prioritize the things that really matter.

      4. Criticism lays you low rather than helping you grow.

When discouraging words come your way, you see it as confirmation of what you knew all along – I’m a loser. And it doesn’t even need to be words. A single disgusted look can make you wither. That’s why you wear a heavy coat of armor whenever you deal with people, whether at home, at work or out in the world. You are eternally, exhaustingly, braced for attack.

The reality: People usually mean a lot less by their criticism than we hear. Pay attention to your reaction the next time you are at the receiving end of a negative comment. Does your pulse race, does your face go red, are you hearing the outraged or anguished commentary in your head rather than really listening to what the person is saying? Try to stop yourself and listen as though you were taking notes for another person. Is the criticism valid? Is there something to learn from this? If so, great! You’ve had a positive experience, albeit a painful one. If not, say, “I see your point but I disagree, and here’s why.” Then move on.

      5. You plan more than you produce.

You have ideas, maybe lots of them. You spend hours, weeks, months, even years thinking about them, planning them, and examining the pros and cons from all angles. But when push comes to shove, you find a million reasons not to do them. They probably won’t work anyway, you tell yourself. And what if you put your heart and soul into one of these projects and then it’s met with ridicule or, even worse, silence? Better to wait until everything is perfect.

The reality: Yes, it would hurt if your brainchild were met with indifference or derision, but what’s the alternative? Never taking a chance, never seeing what you can really do? Stripping away the layers of creativity until all that’s left is an inoffensive shell? Perfection is an illusion, of course, and virtually every success story is preceded by a string of failures, sometimes spectacular ones. Be willing to have your own. Even if nothing turns out as you planned, you’ll learn plenty about what to do next time. At the very least, you’ll be able to look yourself in the mirror and say, “I gave it my best shot.”

David Sack, M.D., is a triple board-certified psychiatrist and addiction specialist who serves as CEO of Elements Behavioral Health, a network of programs that includes Promises Austin luxury rehab in Texas, Journey Healing Centers, The Ranch treatment center in Tennessee, and Right Step. 

Does your teen break the rules and not want to face the consequences? Do you feel like everything you ask your teen to do becomes a battle? Has “no” lost its power? Do you find yourself giving in because it’s easier than constantly arguing?

Simply stated, a consequence is the result, either negative or positive, of a person's action. Consequences measure our behavior and for the most part we strive to achieve positive outcomes and avoid negative outcomes.

Teens can certainly discern the difference between the two. So, when dealing with discipline and teens, the goal of consequences is to teach your child responsibility and appropriate behavior.

There are two types of consequences: natural and logical. Natural consequences, the ones we are addressing now, happen as a result of behavior that are not planned or controlled. Nature, society, or another person, without parental involvement, imposes natural consequences. Parents neither determine nor deliver natural consequences. Instead, you allow nature or society to impose the consequence on your child by not interfering. Logical consequences do not occur “naturally” as a result of behavior, they are determined and delivered by the parent.

Parents tend to worry about their child’s ability to cope with life’s natural “negative” consequences. In fact, today’s parents, in an effort to be helpful and involved, actually impose themselves to minimize natural negative consequences so that their teen can avoid the subsequent discomfort, pain, and shame of his actions.

Our culture holds a faulty belief that effective parenting means protecting your child from uncomfortable emotions and experiences. As parents, we often feel emotionally depleted because we do too much in the wrong areas (over-parenting, rushing in to “fix” things, micromanaging) and too little in the right areas (role-modeling, allowing your child to have his own struggles and feelings, stepping back and breathing).

Many parents believe that if their child is uncomfortable or suffering the normal pains of life, they are failing as a parent. Parents ask themselves, “What more can I do?” instead of asking, “What more can my child do?” Rather than provide support for the child as he moves through his issue, the parent attempts to rush in and fix whatever is troubling him so both the parent and their child can be happy again and the parent can feel like a good parent.

The problem is, while their efforts may provide a temporary Band Aid over their child’s emotions, the damaging messages their actions send mitigate any of the discomfort their child may have endured.

Here are some of the messages parents give their children when they attempt to fix things for them:

You are special so normal rules don’t apply to you.

You are weak and incapable of dealing with this; so let me fix it for you.

Failure is bad and must be avoided at all costs.

You are incapable of coming up with a solution yourself.

First we need to reframe the way our society views things like mistakes and failure. If your child chooses to not do their homework and consequently fails the exam, he must face the natural consequences of his actions, which may be frustration, shame, and fear over receiving a failing grade. If you rush in to explain to his teacher that he deserves another chance because he was sick, or had a sports practice, you may think you are doing something noble by advocating for your child and giving him the opportunity to get a better grade (and feel better about himself). But the truth is, there is a great benefit in letting your child feel discomfort. And discomfort can mean fear, anger, anxiety, loneliness, in other words; these are all natural consequences to your child’s actions. In his discomfort, you can guide him towards self-reflections about his part in the situation, his priorities in his life, and how he might want to behave differently the next time.

As your child faces natural consequences, they are learning important coping skills. They build up a tolerance for discomfort, which is an important part of life. If your child doesn’t learn to tolerate discomfort, he will become, at the very least, an unhappy and frustrated adult, and at the worst, a self-involved, entitled human who lacks self-awareness and empathy.

Prescription Opioid Abuse: A Gateway to Heroin and Overdose

Opioid-involved overdoses in the United States have dramatically increased in the last 15 years, largely due to a rise in prescription opioid (PO) use. Emerging evidence suggests the increase is linked to unintentional PO misuse that easily turns into addiction.

Individuals who regularly use opioid analgesic medications do not often recognize that they are using a medication that can be a gateway to heroin use.

“According to the National Survey on Drug Use and Health, the number of individuals reporting past year heroin use almost doubled between 2007 (373,000) and 2012 (669,000). Emerging evidence suggests the increase may be linked to prescription opioid (PO) users who transition from oral and/or intranasal PO use to heroin use, with POs providing the entryway to regular opioid use, and ultimately, heroin injection.”

Switching from POs to heroin is only one problem. Overdose is another concern. New York University's Center for Drug Use (CDUHR) and HIV Research and the NYC-based National Development Research Institutes (NDRI) published a recent study examining the overdose knowledge and experience of nonmedical PO users. Researchers found that people who abuse POs fail to educate themselves on the risks of overdose.  Dr. Pedro Mateu-Gelabert, lead investigator with CDUHR and NDRI, said in a statement:

“We found that despite significant overdose experiences, nonmedical prescription opioid users were uninformed about overdose awareness, avoidance, and response strategies.”

Most of the users in this study were generally uniformed about the benefit of naloxone treatment for overdose recovery. Naloxone comes in pre-filled auto-injection devices and is used along with emergency medical treatment to reverse the life-threatening effects of opioid overdose. Having this medication on hand can save lives when PO or heroin users overdose.

PO users in the study tended to see themselves as distinct from traditional heroin users. Today the average PO abuser is more likely to be young, white and middle class. They are also unlikely to utilize harm reduction services that address drug users’ health and safety. This is because PO abusers don’t usually see themselves as substance abusers or addicts. PO misuse often leads to long-term opioid dependence, as well as transition to less costly heroin.

Nora D. Volkow, M.D. at a hearing of the US Senate Caucus on International Narcotics Control stated:

“To address the complex problem of prescription opioid and heroin abuse in this country, we must recognize and consider the special character of this phenomenon, for we are asked not only to confront the negative and growing impact of opioid abuse on health and mortality, but also to preserve the fundamental role played by prescription opioid pain relievers in healing and reducing human suffering. That is, scientific insight must strike the right balance between providing maximum relief from suffering while minimizing associated risks and adverse effects.”

The US is seeing an increase in the number of people who are dying from overdoses, predominantly after abuse of prescribed opioid analgesics. This disturbing trend appears to be associated with a growing number of prescriptions in and diversion from the legal market. People from all walks of life are being prescribed addictive painkillers.  This trend must stop.

http://www.ijdp.org/article/S0955-3959(14)00206-0/abstract

http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2014/americas-addiction-to-opioids-heroin-prescription-drug-abuse

http://www.samhsa.gov/data/sites/default/files/NSDUH-SR200-RecoveryMonth-2014/NSDUH-SR200-RecoveryMonth-2014.htm

America is Voting on Marijuana

A recent poll from The Huffington Post and YouGov claimed that more respondents were in favor of legalizing marijuana than were opposed to it. Results showed a favorable public bias, with 70% of respondents supporting the legalization of medical marijuana compared to 17% that opposed it. Legalizing marijuana as a whole saw a slightly tighter vote, though 51% of respondents were still in favor of making it legal, compared to just 34% who said it should not be legal.

Just because the public's perception of marijuana is rapidly evolving does not mean we necessarily have all of the pertinent facts about the drug. It is not hard to find conflicting reports on whether marijuana is a drug that helps or hinders users. There is a dangerous misconception that researchers have a handle on marijuana’s risks versus benefits profile.

Although anecdotal reports abound, few randomized controlled studies support the use of medical marijuana for psychiatric conditions. The meager evidence for benefits must be carefully weighed against the documented risks, particularly for young people who use marijuana.  

A Harvard Mental Health Letter points out a number of psychiatric risks associated with marijuana use, including addiction, anxiety, mood disorders, and other forms of psychosis. The letter also alludes to studies that have suggested long-term marijuana use can lead to "persistent cognitive problems."

However, some studies have suggested that medical marijuana could be a critical component to affordable healthcare. A consensus exists that marijuana may be helpful in treating certain carefully defined medical conditions. An abstract published by JAMA Internal Medicine in August found that in the states where medical marijuana was considered legal through 2010 exhibited a nearly 25% reduction in opioid-induced overdose deaths. This is a significant number of saved lives.

The truth is we really just do not know a lot about marijuana's benefit versus risk profile because, as a schedule 1 drug, there simply has not been any reason for the U.S government to support ongoing research into its effects, be they good or bad. This will change in the future.

In Oregon, Alaska, and Washington, D.C., voters will decide whether to approve marijuana for recreational use, while Floridians will weigh in on whether it will become the 24th state to approve marijuana for medical purposes. Clearly, marijuana use is here to stay and science needs to be allowed to catch up with research for the benefit of all.

http://jama.jamanetwork.com/article.aspx?articleid=1874073&resultClick=3

http://www.huffingtonpost.com/2014/08/07/legal-marijuana-poll_n_5659602.html

http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2010/April/medical-marijuana-and-the-mind

In Part I of this two-part blog post, I surveyed the robust finding in the science of religion that men are less religious than women. I then reviewed the competing biological, psychological, and social explanations for this well-known, but poorly understood phenomenon.

My goal in this blog is to help readers wrap their minds around how the unified approach works to generate a consilient physical-bio-psycho-social frame, which is in stark contrast to thinking about biological, psychological, and social explanations as competing against one another in a horse race. What the unified theory allows one to do is to look at the “gestalt” of gender and then see how the various theories and empirical findings line up.

Those familiar with the unified approach know that it divides the universe up into for dimensions of complexity: Matter, Life, Mind and Culture. These dimensions of complexity correspond to the physical, biological, psychological and social dimensions of understanding in science. The dimensions of complexity emerge out of matter because of the emergence of novel information processing systems (genetic/Life, neuronal/Mind, linguistic/Culture). For more detail on how the unified approach maps the unfolding wave of Energy-Information, see here.

In addition to providing an overview of the dimensions of complexity via the Tree of Knowledge System, the unified approach offers three other ideas, Behavioral Investment Theory, the Influence Matrix, and the Justification Hypothesis to ‘knit’ together these dimensions in a way that allows for a coherent picture of human psychology. To understand human gender differences, one needs to look at gender through the lens of these three ideas. Note that, in human psychology, Behavioral Investment Theory roughly corresponds to biological/neuro/evolutionary explanations, the Influence Matrix to personality/motivational/psychological level explanations; and the Justification Hypothesis to social, human cognitive, and cultural explanations.

Gender Differences from the Vantage Point of Behavioral Investment Theory

Behavioral Investment Theory links psychology to biology. It does so by claiming the nervous system is an “investment value system" that coordinates animal behavior in accordance with evolutionary and learning history. If we want to know about gender differences from the vantage point of BIT, we ask the question: Would evolutionary pressures shape “the investment value system” of males and females in the same or different ways? This is basically synonymous with the way that evolutionary psychologists (EP) think of gender. 

We would expect the “investment value system” of males and females to be similar in many ways. Both need to acquire the basics for survival, avoid dangers, manage temperature fluctuations, and so forth. So we would expect generally similar food preferences (although may be different for pregnant women, see here), both sexes should have pain in response to bodily injury which they seek to avoid, both should have sweat glands, and so on.

Although the pressures for survival are similar for the two sexes, the reproductive game is very different. The facts of physiology are such that human females invest much more in their offspring than males. This is so at the level of calories, time, effort, risk of child bearing, etc. Because human females are the more investing sex, we can make many predictions about how the two genders will differ in their basic architecture toward sex and pair bonding.

Let me give you one classic example. Given that human females must invest so much more in off-spring, we can make the clear prediction--without ever looking at any actual society or learning theory--that, on average, human males will be much more willing to engage in casual sex (i.e., sex without investment) than human females. As extensions of this claim, we can say that human males should have faster levels of sexual arousal, be willing to sacrifice and invest for sexual access, and be willing to take more risks to engage in casual sex. Notice how things like prostitution and pornography usage immediately begin to make sense through this lens.

One of the most famous studies in the history of gender differences examined this prediction. The researchers had men and women who were independently rated as highly attractive go up to members of the opposite sex on a college campus who were complete strangers and ask one of three questions, all of which had the same stem, but different endings: “Hi, I have noticed you around campus and think your are attractive and I was wondering if you would…” 1) “go out on a date with me?” or 2) “go back to my room with me?” or 3) “have sex with me?” Here are the data: 

Whereas equal numbers of men and women said "yes" to going out on a date, almost 75% said they would have sex, whereas not a single woman said yes to that question. The gender differences here are truly remarkable and directly consistent with basic predictions derived from a view informed by parental investment theory. There is a huge literature on gender differences from an evolutionary perspective. (For a good academic review, see here).

To fully understand gender and religion we need to consider men and women through a relational lens. And to do that, we need the Influence Matrix.

Gender Differences from the Vantage Point of the Influence Matrix

The Matrix is an extension of BIT and functions to map the human relationship system. The central variable that organizes human relating according to the Matrix is the black line. This is the Relational Value-Social Influence (RVSI) line. It refers to the extent to which an individual feels known and valued by important others. It is seen as the core human psychosocial need.

In addition to the RVSI Black line, there are three relational process dimensions, marked by the blue, red, and green lines. The blue line is the “power” line, marked by the poles of dominance and submission. The red line is the “love” line, marked by the poles of affiliation and hostility. The green line is the “freedom” line, marked by the poles of autonomy and dependency.

What does this have to do with gender differences? Look at the upper left quadrant. It is marked by the poles of dominance, autonomy and hostility, as well as the emotions of anger, hate and pride. Now look at the lower right quadrant. It is marked by the poles of affiliation, submission, and dependency, and the feelings of love, guilt and shame. Now think about archetypes of masculinity and femininity. Notice anything? The upper left quadrant, the “self” quadrant, overlaps enormously with the masculine archetype. That is someone who is powerful, independent, confident, and self-assured (and also can be angry, defiant and mean). In contrast, the feminine archetype is someone who is loving, nurturing, sensitive, and kind (and also can be dependent, vulnerable and weak). For more on how the Matrix elaborates on this, see this blog on self and other orientation.

The Justification Hypothesis

Am I saying that all human males are powerful, independent jerks and all human females are sensitive and caring but vulnerable waifs? (OF COURSE NOT!) And what about where those ideas of “masculinity” and “femininity” come from? Isn’t the case that we are all imbedded in a society that legitimizes social roles and tells us that a man is "strong" if he is defiant and he is a “stud” if he sleeps around, but a woman is a “bitch” if she is bossy or a “slut” if she sleeps around?

This is the standard caricature of the rhetorical position of those who take a gender role socialization approach to understanding gender differences.

Just as BIT assimilates and integrates evolutionary perspectives, and the Matrix clarifies archetypal relational differences, the Justification Hypothesis integrates the gender role socialization perspective. It achieves this by pointing out that people build systems of justification that coordinate and legitimize their actions and investments. Thus social groups will develop norms for men and women and reward and punish them accordingly. The flexibility and power of these systems is easy to see. Consider how different the gender roles are in Canada and the US from Saudi Arabia and Afghanistan. Or consider how much gender roles have changed in this country over the past 50 years. Or think about how much change has taken place in the “justifiability” of homosexual and transgendered orientations in the last decade.  In short, the “context of justification” plays a huge role in how gendered patterns are expressed and felt. And how they develop in each individual. Whether someone develops a self or other orientation for example, has EVERYTHING to do with their lived experiences. The adult form is always a transaction of initial pre-dispositions that are shaped by rewards and punishments. And in human societies, justification systems set up and deliver rewards and punishments.   

Back to Religiosity

All of this allows us to return to the issue of religiosity. Now the question becomes, given these lenses through which to understand gender, we can now ask the following: What are the broad and general dynamics that might be associated with gender differences in being religious? Staying within the Judeo-Christian Western frame for now, let’s ask the question of what are the key dynamics that would lean someone toward or away from being religious?

Religion provides conventional norms, so we would predict that the gender that was more defiant and risk-taking to be less religious. Religion supports the community, legitimizes sexual restrictions, and a family focus, so we would expect that the gender that is more nurturing, more sexually choosy, and more family-focused to be more religious. The religious experience is relational, meaning that it is the experience of relating to God that drives the subjective dimension of religion, thus we would expect the gender that is more relational in their thinking style to be more religious. There is a strong social element to religion, thus the more one participates, the more friends and social connections via one’s church community one will have, thus it is a reinforcing cycle.

Put in this light, is there really such a mystery that men tend to be less religious than women? I encourage folks to go back to the first blog and consider how the current literature looks in light of this discussion. If you are like me, you will see modern researchers clinging to parts of the “elephant” and claiming partial truths as being the whole. The unified approach starts with the meta-view of the physico-bio-psycho-social elephant and allows one to see how the parts are all inter-related.  

Making healthy food choices on a regular basis can be hard. Most of us are busy with work, family, or other important endeavors, so when it comes time to eat we often make quick decisions in the moment. Unfortunately, quick decisions are often based on either convenience, taste, or both. Sometimes I find that I’ve worked through my normal lunch time, but I still feel like I have a ton of work to do. I need something now, and something tasty wouldn’t hurt because I’m stressed! Sadly, as I know all too well, there just so happens to be a BBQ place within shouting distance that is all too happy to help me with this dilemma. A recent study tried to address this common problem in two ways.

The study took place at a hospital and recruited workers who ate at the cafeteria on a regular basis. They were given access to a preordering system online so they could make their lunch choice at any time in the morning (they were required to do it at least 45 minutes in advance of lunch to minimize the kind of quick decision making I just described). They were also given brief mindfulness training. Mindfulness is the act of focusing your attention on the present moment both internally (how you feel, what you are thinking) and externally (what is going on in the world around you). It is a wonderful way to slow down your decision making process and allow you to orient to important factors to consider, such as your long-term health. Workers who were given access to this intervention ate about 150 calories and 9 grams of fat less per meal over the course of two months. That equates to roughly a pound of weight lost per month (or a pound of weight not gained).

It is impossible to say which piece of the intervention was most important, as they were not evaluated separately. But both ideas already have strong support in the research literature and so it seems safe to assume you can use some of these strategies to help your own decision making.

If your workplace has a cafeteria, you can follow this strategy almost as designed. You may not have access to an online ordering system, but you can keep a menu on hand and give yourself prompts to choose your lunch before lunch time (try setting a daily alarm or reminder in your calendar). Then simply go to the cafeteria and buy what you decided earlier. Your choice earlier in the day is much more likely to be healthier than a choice in the moment.

I don’t have a cafeteria at work, so here’s my plan: prepare at least 4 lunches per week at home and bring them to work. Yes, it will take a little forethought and effort, as well as a bit of time. But the benefits- losing a couple of pounds, more energy, less of that sluggish feeling after overeating- more than pay for themselves.

Regardless of what you do in terms of meal planning, everyone can benefit from practicing mindfulness before eating. Even 30-60 seconds could be helpful. Just close your eyes, take a few deep breaths, label how you are feeling (e.g. hungry, stressed, fine, happy), notice any cravings you might have, think about your health and why it is important to you, and then proceed with making a food choice. A little pause can go a long way.

Source Article: http://www.sciencedirect.com/science/article/pii/S0195666314004759

Dr. Jason Lillis is author of The Diet Trap: Feed Your Psychological Needs and End the Weight Loss Struggle available on Amazon and where all books are sold.

A wonderful example of a dog telling us what she wants and needs

I'm a fan of positive dog training, valuable lessons that I prefer to call dog teaching. While I'm not a dog teacher, I talk with many people around the world who work with a wide variety of dogs displaying various behavior problems, and across the board they agree that positive training is the way to go for getting the best, most consistent, and long-term results.

I recently received a video of Holly, a dog, being hit -- cuffed in the neck -- by, and later biting, Cesar Millan. I had not seen it before. In this video, Mr. Millan moves closer to Holly while she's eating. Holly eats faster as he moves in and immediately moves away as he continues to approach her. Holly gives him plenty of warnings -- don't come any closer -- because she needs her space to feel safe. Mr. Millan ignores these warnings then cuffs her in the soft part of her neck; you can see this at 0:44 of the video.

After talking briefly with Holly's human companion, and with Holly appearing to be relaxed but still stressed, Mr. Millan swipes at her face and Holly then snaps at and bites him on the hand, drawing blood; you can see this at 3:44 of the video. Mr. Millan admits he "didn't see that coming." He goes on to back her into a corner. 

Dog behavior 101

This short video is a wonderful example of dog body language. I think of it as a crash course in canid ethology -- dog behavior 101. I highly recommend those people who want to see what happened to study this video very closely. I've watched countless hours of video of a wide variety of social encounters in various canids -- members of the dog family -- and I still learned a lot from this encounter. I watched it more than a dozen times and I'm sure I'll go back to it. 

There are many lessons in this video about how dogs communicate what they're feeling using all parts of their body and various vocalizations. There also are valuable lessons for the need to respect what a dog is telling us, what they want and what they need. Holly was very clear about her state of mind, what she was feeling, and what she needed. 

The teaser image can be seen here. 

Marc Bekoff's latest books are Jasper's story: Saving moon bears (with Jill Robinson; see also), Ignoring nature no more: The case for compassionate conservation (see also), Why dogs hump and bees get depressed (see also), and Rewilding our hearts: Building pathways of compassion and coexistence. The Jane effect: Celebrating Jane Goodall (edited with Dale Peterson) will be published in 2015. (marcbekoff.com; @MarcBekoff) 

If I had to define myself, being a person with nonverbal learning disorder (NLD) would be far far down the list.

I needed to understand that the problems I had were neurological and not symptoms of psychosis. (Though I could never understand how bad balance, for example, could in anyway be a "problem of the mind.")

 After meeting many people with NLD and their parents I had to re-examine my life and understand that I hadn't been a tyrannical child so many parents describe.

 I was a child with problems. I also understood the concept of time, loved change---such as traveling, visiting family, friends and places. Almost everything fascinated me. My parents encouraged that never thinking my being so fascinated by life was symptomatic of a disorder but was a great thing. Oh how naive we were back in the early 1960's to assume I was a very smart girl with a lot of quirks that (my parents thought) made me more interesting——except for the mood swings——and I was a girl who bled a lot. (Please don't tell me I have to spell everything out!)

 There never was a time in my life I was without friends. Though we moved to Long Island when I was twelve and I lost every social skill in a matter of days. I was that scared of the girl who told me she was going to beat me up because her best friend's boyfriend was looking at me. Obviously there was much more at play.

A school administrator inverted my bus numbers so I took the wrong bus home the first day. I was dropped off miles away from my house by an uncaring bus driver who ignored me when I told him I didn't live there.

I had to walk miles——somehow I figured out how to get North and walked over both the Northern State and Long Island Expressway until I finally saw a strip mall I recognized and hysterically crying called my parents who were even more hysterical. My father was out looking for me. My mother had to tell the school administrators not to leave. Can you imagine this happening now?

 And the icing was that I must have passed hundreds of adults in their cars or walking in the strip mall. Not one stopped and asked if anything was wrong. I was 5'1" tall and weighed 120 pounds--I would gain 35 pounds in the next six weeks. My face was the face of an immature ten year old.

 I had never had "an accident" in my life. I peed my panties like crazy that day at the phone. As much as I tried I couldn't hold it in. I hadn't used the girls room in school and had been trying to get home for hours.

 It was humilating though my father told me he would have done worse and my mother——well both my parents told me how brave I was. I can't express how involved my parents were in my life. My friends always say that my father invented helicopter parenting. But in the early 1960's even parents listened to older people and authority and the principal was both.

 The principal, a Nixon type Quaker, wasn't even ashamed. When my parents met with him about this he told them it was my fault for not speaking up though they showed him the piece of paper I had been given with the wrong bus numbers. They told me this many years later. And they told me that they argued with him but it was useless. Recently minted twelve year olds who were new students were responsible for being on the right bus. Not the school admin or the bus driver. It was such a horrible event to them neither could speak about it for years and when they finally could they would tear up which wasn't like them.

I realize now that was the day I began taking responsibility for everything that went wrong in my, or anybody I knew, lives. I remember thinking that I should have double checked with the bus driver or not been scared and should have said something when I didn't recognize the houses or street names. I was good at street names. But the bus driver didn't look nice. At the end of the line when I finally told him I didn't know where I was he told me to get off. They wouldn't have let me get on the wrong bus. I must be very stupid not to know where I lived.

 My records didn't arrive for six weeks. In the city I had been eligible to skip Seventh Grade. On Long Island I was doing so badly in regular classes that when the guidance counselor asked me, not my parents, if I wanted to be in the advanced classes I said "no" as I thought that was the answer she wanted me to give. I didn't want to burden my parents with this.

 I blamed my parents for that and brought it up too often as we all knew how different my life would have been had I been in classes with people who thought more like I did. I don't know if it's true or not—how can I? But I felt that if I had been actually learning rather than memorizing random facts I wouldn't have been so anxious.

Though many or most people with NLD are rote learners I'm not. I learn conceptually. I need ideas and stories to hook onto. Ironically until I learned about NLD I thought my problems sprang from having been in rote classes.

 By high school I had a "normal" if small range of friends. I began doing better in school. Not great but....

 College began the "Pia in Wonderland" years. I will never apologize for spending my first two years in college majoring in fun. I deserved it.

 My life was far from perfect but I enjoyed it. More than enjoyed it; I devoured life. I was lucky enough to live in Cambridge, MA then Manhattan for the better part of 35 years.

 Six years ago I moved to South Carolina to write a book. I began to learn a lot about NLD and needed to soak that knowledge up.

 I know I haven't been the most prolific blogger. I began this blog five and a half years after I began Courting Destiny which does have 1300 published posts——most in the first four years!

 I will be focusing on my book and throwing in excerpts that I think are relevant. I have always believed people learn more from being shown than being told (when it comes to the written stories.)

 I wish I had a list of places you could learn about adult NLD from but I don't.

Celebrity divorces make headlines, seemingly every few seconds. But did you ever notice it is usually the announcement that a celebrity is getting divorced that makes the news, and rarely the nitty gritty details of the divorce process and negotiations? Even when interviewed about their divorce, stars or their agents say they are “amicably separating,” or “consciously uncoupling.” They ask for “respect and privacy” for the “sake of our children.” Notably absent in the media in most celebrity divorces is trash talk about the other spouse.

This approach, of course, make good sense for the famous. One or both the spouses have public reputations and personas to uphold. They have to protect their “asset” (them) that makes people want to spend money to go to their movies, or tune into their TV show, or listen to their music. While I am sure they talk to their closest friends and family about the emotions and decisions that inevitably accompany even the best divorce, they must choose wisely as to whom they confide in to avoid a leak to the press. The circle of confidantes must remain small.

Unfortunately this is often the exact opposite of how non-public divorcing spouses act. For many, their reaction to a divorce is to talk, talk, talk. They tell everyone they know about the day-to-day details of their divorce. They tell their kids’ teachers, their hairdresser, even mere acquaintances – just about everybody they know or who asks about it – the nitty-gritty dirt as they see it. They start to rally the troops they think will be on their side. They even take to social media to post and tweet negative things about their soon-to-be-ex. These people totally miss the fact that divorce as a win-and-lose game is a myth. That by pouring so much negative energy into the process of ending their marriage they are missing the opportunity to focus on their divorce as a pathway to a better, more stress-free life. If you have ever run into one of these divorce chatterers, you know they can become quite the bore and someone to avoid. Most of the people they talk to really want them to go back to normal and move on.

The way you portray your divorce to the world is the way you will feel about your divorce. It is the way your friends and family and children will react to your divorce. It will impact how people think about you in the future. Think about what your statements say about you—your reputation, your dignity. Of course you will want to have an emotional outlet with those that are closest to you and perhaps have a counselor. Divorce brings along with it many mixed emotions that deserve to be dealt with. But as you process your own divorce, strategically consider how you want to appear to the world at large. Do you want your attitude to reflect your best traits or your worst?

Take a tip from the celebs, who know everything they say about their own divorce could be broadcast to the world. Pretend your own divorce is being recorded and your words will be out in the world for everyone to hear. Inventory your best traits and bring those to your words, thoughts, and actions as you move through your divorce—and remember there really is a positive and more fulfilling life awaiting you on the other side. Use all that energy to envision your future.

Brittany Maynard’s suicide on Nov. 1 makes her the new face for the “death with dignity” movement. Her decision is so compelling, in part, because she was 29.

Based on case law precedent in the United States, momentum behind this movement often ends up languishing in legislation.

Oregon is one of only a few states that have “death with dignity” laws which make it legal for physicians to administer lethal doses of medications to patients who choose suicide.

Legislation legalizing physician assisted suicide might gain new steam but it will be short lived if history repeats itself. I suggest that our energies can be better directed elsewhere, like “quality of life” in lieu of a focus on death.

In 1997, the U.S. Supreme Court heard the case of Washington v. Glucksberg. This case dealt with physician assisted suicide and our Constitutional right to Due Process. Physicians and patients joined by the non-profit organization, Compassion in Dying, brought suit arguing that a Washington statute criminalizing assisted suicide was not fair.

They argued that there exists‘a liberty interest protected by the Fourteenth Amendment which extends to a personal choice by a mentally competent, terminally ill adult to commit physician assisted suicide.’

The U.S. Supreme Court disagreed. While several fundamental rights have been recognized as protected by the Due Process Clause, legalization of assisted suicide for competent, terminally ill adults is not one of them. In fact, the Court stated that this kind of advocacy could start the state down a slippery slope leading to the practice of euthanasia.

Proponents of physician assisted suicide tried again in New York in the case of Vacco v. Quill. Now the argument was that the prohibition against physician assisted suicide violated the Equal Protection Clause of the Fourteenth Amendment. Once again, the Court disagreed.

The Massachusetts Medical Society, the liberal state in which I practice, has taken a firm stance against physician assisted suicide. They opposed a 2012 state ballot initiative - which failed to pass - that would have enabled terminally ill patients to ask their doctors to prescribe lethal drugs.

The American Medical Association takes the position that prescribing lethal drugs is 'fundamentally incompatible with the physician’s role as healer.'

There is inherent risk in passing laws that allow physician assisted suicide. There is a potential for escalating rates of elder abuse. Not to mention the fact that doctors are only human and sometimes make mistakes. Not everyone given a terminal diagnosis passes away within the estimated time they are given.

There is also a risk that someone opting for suicide might be too depressed to make a competent decision. Legislation, like the one proposed in Massachusetts, did not provide adequate safeguards to protect against these kinds of mistakes.

The answer might not be in passing laws to promote death, I would argue, but rather the answer could be in promoting healthy living. Legislation can do this by investing more in mental health services to help patients and families deal with end of life issues. Enhancing pain management options for those who are suffering (pain is a huge risk factor for suicide) will also be crucially important. Future proposed legislation should at minimum include some safeguards, such as a psychiatric assessment to determine if a patient is suffering from a treatable mental illness that is interfering with their decision-making capacity.

This very important issue is back in the spotlight. Let’s use the momentum to work together and initiate some positive changes!

Follow me on Twitter: https://twitter.com/HelenMFarrellMD