"I'm not suggesting that we don't use words like ' child' as a shorthand way of letting people know we're talking about people of a certain age. I'm t"I'm not suggesting that we don't use words like ' child' as a shorthand way of letting people know we're talking about people of a certain age. I'm talking about when we allow labels like this to keep us from seeing the other person as a human being, in a way which leads us to dehumanize the other person because of the things our culture teaches us about 'children.'"
"So strong is our need to protect our autonomy, that if we see that someone has this single-mindedness of purpose, if they are acting like they think that they know what's best for us and are not leaving it to us to make the choice of how we behave, it stimulates our resistance."
"They taught me that any use of coercion on my part would invariably create resistance on their part, which could lead to an adversarial quality in the connection between us."
"What do we want to child's reason to be for acting as we would like them to act? It's that question that helps us to see that punishment not only doesn't work, but it gets in the way of our children doing things for reasons that we would like them to do them."
"I'd like to suggest that reward is just as coercive as punishment. In both cases we are using power over people, controlling the environment in a way that tries to force people to behave in ways that we like. In that respect reward comes out of the same mode of thinking as punishment."
"All human beings, when they're in pain, need presence and empathy. They may want advice, but they want that after they've received the empathetic connection."
"I've talked to a lot of other parents who have had similar experiences, who, when they are trying to relate in more human ways with their own children, instead of getting support, often get criticized. People can often mistake what I'm talking about as permissiveness of not giving children the direction they need, instead of understanding that it's a a different quality of direction. It's a direction that comes from two parties trusting each other, rather than one party forcing his or her authority on another."
"When people hear demands, it looks to them as though our caring and respect and love are conditional. It looks as though we are only going to care for them as people when they do what we want."
"To communicate this quality of unconditional love, respect, acceptance to other people, this doesn't mean we have to be permissive and give up our needs and values. What it requires is that we show people the same quality of respect when they don't do what we ask, as when they do."
"So when might we sometimes have to use a form of force with our children? Well, the conditions calling for this would be when there isn't time to communicate, and the child's behavior might be injurious to themselves or other people. Or it could be that the person isn't willing to talk. So if a person isn't willing to talk, or there isn't time to talk, and meanwhile they are behaving in a way that is in conflict with one of our needs, such as a need to protect people, we might have to use force. But we have to see the difference between the protective and the punitive use of force. And one way that these two uses of force differ is in the thinking of the person who is engaging in the force."
"One way of remembering the purpose of the protective use of force, is to see the difference between controlling the child, and controlling the environment. In punishment we're trying to control the child by making the child feel bad about what they've done, to create an internal shame, guilt or fear for what they have done. In the protective use of force, our intent is not to control the child; it's to control the environment."
"So in closing I offer you that reassuring advice given to me by my daughter, that nobody's perfect, to remember that anything that's worth doing is worth doing poorly. And the job of parenting, of course, is extremely worth doing, but we're going to do it poorly at times. If we're going to be brutal with ourselves when we're not perfect parents, our children are going to suffer for that."
"So the goal I would suggest is not to be perfect parents, it's to become progressively less stupid parents."
Full of valuable information. My highlights: ------- Well-established environmental triggers for developing Hashimoto's in those who are genetically preFull of valuable information. My highlights: ------- Well-established environmental triggers for developing Hashimoto's in those who are genetically predisposed include iodine intake, bacterial and viral infections, hormonal imbalances, toxins, and therapy with certain types of medications.
In people with Hashimoto's, only 50 percent of their identical twins presented with thyroid antibodies, meaning genes alone are not the single defining factor and environmental triggers play a critical role. - - - When scientists set the "normal" ranges of TSH for healthy individuals, they inadvertently included elderly patients and others with compromised thyroid function in the calculations, leading to an overly lax reference range. (see more regarding this on page 23) - - - Some clinicians may only test for T4, but it is also important to test T3 as some individuals may not be properly converting T4 to the active T3. Some people may have a normal T4 but a low T3 level. -more on this on p24 - - - High concentration of TPO antibodies has been associated with distress, obsessive-compulsive symptoms, and anxiety. This is like due to the increased amount of thyroid hormone being rushed into the bloodstream, causing a transient hyperthyroidism. Anyone who has experienced symptoms of hyperthyroidism can describe how agitating this feels. People with anxiety, depression, or other mood disorders should have their thyroid function checked, especially for TPO antibodies. Some individuals with lifelong psychiatric diagnoses have been able to recover after receiving proper thyroid care. --- Lifestyle interventions can also help with reducing TPO antibodies, reversing hypothyroidism and Hashimoto's, and preventing other diseases - and they make most people feel better. Some may be able to reduce and eliminate the need for thyroid medications when the autoimmune attack ceases and the thyroid gland is able to regenerate. - - - "Autoimmune disease: because the only thing tough enough to kick my ass is me." - Unknown (header to chapter 4) - - - The theory goes like this: 1) Thyroid cells are damaged by a trigger such as a toxin or an infection. 2) Dying thyroid cells send out a stress signal. 3) Immune cells rush in to "save" the thyroid from attackers. 4) Immune cells attack the thyroid instead. 5) More thyroid cell damage occurs. 6) Body runs out of resources to regenerate thyroid cells. 7) Thyroid is no longer able to produce enough hormone. - - - When the intestinal wall becomes permeable, the body loses its ability to recognize benign substances such as our own cells and the foods we eat, instead treating them as though they were foreign invaders such as bacteria and viruses.
Zonulin is a recently discovered human protein that reversibly increases intestinal permeability. This protein in measured in excessive amounts in individuals with autoimmune conditions such as rheumatoid arthritis, Hashimoto's, multiple sclerosis, type 1 diabetes, and celiac disease. p39 - - - Hashimoto's has been classified as a type IV hypersensitivity, which is called a delayed type hypersensitivity ("self-allergy"). Unlike other types of immune reactions, the damage to the thyroid tissue is not antibody-mediated; instead, the antibodies "mark" the thyroid cells, and then antigen-specific cytoxic T-lymphocytes (lymph cells) attack the targeted thyroid cells. - - - However, examples of autoimmune recovery have discredited the "irreversible" aspect of this theory. It has been shown that continuous environmental triggers are necessary to perpetuate the process. This means the autoimmune process can be stopped and reversed when the triggers are eliminated. One example of this is celiac disease, an auto-immune condition in which gluten, and environmental trigger, has been identified. In most cases of classical celiac disease, all symptoms resolve when the environmental trigger (gluten) is removed. - - - As we cannot change our genes, our approach to addressing the root cause of Hashimoto's is threefold: 1. Reducing triggers 2. Eliminating intestinal permeability 3. Providing the body with nutrients to regenerate
- - - Most antibiotics do not know the difference between the bad bacteria causing your infection and the good bacteria helping you with digestion and vitamin extraction as well as keeping peace within your intestinal track. . . . Since beneficial bacteria make up our immune system, antibiotic use is a suspected cause of increasing cases of allergies, chronic disease, autoimmune conditions, digestive issues, and even cancer. - - - People with Hashimoto's are also five times more likely to be diagnosed with celiac disease. Recently, gluten intolerance has been described as a spectrum, with only the most severe cases of damage being diagnosed with celiac disease.
Additionally, some people with Hashimoto's may present with a celiac-like intolerance to milk proteins (whey and/or casein), egg proteins (ovalbumin), or soy proteins.
Many of these cases are undiagnosed, and when people continue to east foods they are sensitive to, they damage their intestines. - - - The co-occurrence of Hashimoto's and celiac disease has been clearly established. I would even venture to say one does not need to have full-blown celiac to have impaired absorption of selenium.
Selenium plays a crucial role in thyroid function: 1. Acting as a catalyst to convert the inactive T4 to the biologically active T3 2. Protecting thyroid cells from oxidative damage from hydrogen peroxide by forming selnoproteins p68 - - - One in four individuals in the general population may be zinc-deficient, and most people with hypothyroidism are. Zinc deficiency prevents the conversion of T4 into the active T3 version. This results in a slowed metabolism of proteins. Zinc is also needed to form TSH and may become depleted in those with hypothyroidism who are constantly producing more TSH. - - - Genetic Causes of Nutrient Depletions
Some individuals with Hashimoto's may have a gene variation that prevents them from properly activating folic acid. This gene variation is present in up to 55 percent of the European populations and appears more commonly in those with hypothyroidism.
The gene involved in the MTHFR (methylenetetrahydrofolate reductase) gene, and genetic testing is available to show whether someone has this gene variation. The MTHFR gene codes for the MTHFR enzyme, which converts the amino acid homocysteine to methionine, a building block for proteins. - - - Soy is one particular goitrogen that is especially detrimental for Hashimoto's patients. The isoflavones genistein, daidzein, and glycitein in soy reduce thyroid output by blocking activity of the TPO enzyme.
Soy has been linked with the development of autoimmune thyroid conditions, and children fed soy formula were almost three times more likely to develop anti-thyroid antibodies as compared with breast-fed children. - - - Hashimoto's was not recognized in the United States before the nationwide salt iodization program began in 1924. In many other countries, studies have shown rates of autoimmune thyroiditis increased drastically after salt iodization programs. - - - Researchers in Iran were able to document the rates of thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb) before and after a national salt iodization program started in 1994. In 1983-84, postiive TPOAb and positive TgAb were found in 3.2 percent and 4 percent of the 465 adults selected for random sampling in Tehran.
This sampling was repeated with 1,426 adults in Tehran in 1999-2000, this time showing 12.5 percent positive for TPOAb and 16.8 percent positive for TgAb. The addition of iodine quadrupled the rate of Hashimoto's within a six-year span!
Studies in Greece, China, Sri Lanka and Italy reported similar increases in Hashimoto's after the addition of iodine to salt. - - - Considering that iodine increases the rate of Hashimoto's incidences - and even small doses of iodine can lead to the progression of thyroid abnormalities over a short period of time - it is no surprise that one in five women will have a thyroid dysfunction at some time in her life in the presence of iodized salt. - - - The Standard American Diet exceeds the threshold of safe iodine consumption for those with autoimmune thyroid conditions. - - - Many vegetable oils are made from genetically modified crops and contain large amounts of pesticides. When diets high in polyunsaturated fats were tested on animals, it was concluded that they can cause problems with learning, are toxic to the liver, trigger immune system malfunction, slow mental and physical growth, cause chromosomal damage, and induce premature aging. In addition, diets high in polyunsaturated fats are responsible for increased rates of cancer, heart disease, and weight gain. - - - A variety of bacterial infections have been implicated in triggering autoimmune thyroiditis, including Helicobacter pylori (the same bacteria that causes ulcers), Borrelia burgdorferi (associated with Lyme disease), and Yersinia enterocolitica. - - - Researchers have identified Mycoplasma, Candida, and Epstein-Barr virus as the infections most commonly associated with Hashimoto's. - - - In the case of infections, once the infection is removed, TPO should cease to be a trigger when the immune system recognizes the infection is gone. Thus, treating infections may help heal Hashimoto's. In other cases, the infection may already be gone, but the immune system may need a reboot. - - - Th1 and Th17 were both found in the thyroid cells of mice with Hashimoto's, and it is proposed that IL-17 cells are critical to the development of Hashimoto's.
New research suggests Th17 - rather than TH1 - may be causing the damage involved in the pathogenesis of Hashimoto's. This would explain why some Hashimoto's patients present with a mix of Th1 and Th2 dominance as well as with no clearly defined dominance. - - - Dr. Fasano has identified that in the presence of leaky gut, we secrete excess zonulin, a protein that modulates the permeability between the right junctions. An excess of this protein has been found in every autoimmune condition, including Hashimoto's. - - - These gram-negative bacteria are normally present in small amounts in the human intestine, but some individuals may have too mnay of them and not enough of the beneficial gram-positive bacteria. This produces and imbalance in bacterial gut flora known as gut dysbiosis. - - - According to Elaine Gotschall, the author of Breaking the Viscious Cycle, a diet rich in refined carbohydrates can lead to a compromised GI flora. Anecdotal evidence shows that people who become affected with intestinal disorders are more likely to eat a diet high in simple carbohydrates compared with those who were unaffected. - - - Stool tests are available to check microbial balance. These tests can tell us whether there is a lack of beneficial bacteria or an overabundance of pathogenic organisms such as potentially pathogenic gram-negative species or Candida. p 142 - - - Symptom improvement in many autoimmune conditions has been reported after the initiation of a gluten-free diet. Length of gluten exposure is positively associated with the development of autoimmune conditions. This means the longer you eat gluten, the more likely you are to develop an autoimmune condition! - - - Glutamine dosed daily (orally) at 0.5 grams/kg ideal* body weight for two months was shown to reduce intestinal permeability in subjects with Crohn's diease. Dr. Maes used a more conservative does of 7 grams a day. - - - N-Acetyl Cysteine (NAC)
Hashimoto's patients are deficient in the antioxidant glutathione. It helps prevent free radical damage to the thyroid but isn't well-absorbed if taken orally. N-acetyl cysteine (NAC) is a precuror to glutathione and can be taken orally. NAC has been used for healing intestinal permeability. Be aware it can cause stomach upset if taken on an empty stomach and thus should be taken with food. Dr. Maes used a dose of 1.8 grams a day with chronic fatigue patients. - - - Saccharomyces Boulardii
IgA levels can be increased by taking the beneficial yeast Saccharomyces boulardii, which helps clean up the intestines. S. boulardii does not take up residence in the intestines, but it does a lot of great work while passing through. S. boulardii can also help with clearing out yeasts, pathogenic bacteria, and parasites. - - - Endotoxin from gram-negative bacteria can promote inflammation through the stimulation of Th1 pro-inflammatory cytokines (TNFa) in the intestine as well as in the rest of the body, especially in those with intestinal permeability. . . . Pro-inflammatory cytokines are seen with many autoimmune conditions, including Hashimoto's, type 1 diabetes, inflammatory bowel disease, and celiac disease. Endotoxin is thus being considered a promoter of autoimmune conditions. p 157 - - - Intestinal damage due to gluten and other intolerances; low stomach acid; and other conditions commonly present in Hashimoto's put people at risk for malnutrition because of poor protein assimilation. - - - Glycemic Burden
Researchers in Poland have found that up to 50 percent of patients with Hashimoto's have an impaired tolerance to carbohydrates. This means that after consuming carbohydrate-rich foods, their blood sugar levels spike, causing a substantial insulin release. The role of insulin is to clear blood sugar out of our cells, so a large insulin release is followed by a rapid blood sugar drop (hypoglycemia). . . Hypoglycemia necessitates the release of cortisol to help maintain the glucose supply to the brain and counteracts insulin, causing insulin resistance (this is also linked to the type 2 diabetes epidemic). p171 - - - Inflammation
Chronic inflammation may result from joint pain, obesity, toxic burden, GI tract inflammation, irritable bowel disorder, pathogens in the GI tract, or food allergies. These conditions signal cortisol for its anti-inflammatory effect.
HPA Dysfunction and Autoimmunity
Some researchers believe HPA axis dysfunction and prolong cortisol elevation may be the cause, rather than the consequence, of autoimmune diseases. A natural steroid, cortisol suppresses cellular immunity (Th1), preventing tissue damage from excessive inflammation. [See more on page 172] - - - Subclinical Addison's
People with Hashimoto's and other autoimmune conditions are more likely to develop Addison's.
Co-occurring Addison's and Hashimoto's is known as Schmidt's disease, and any person with Hashimoto's who has anti-adrenal antibodies should be considered to have both conditions. p 177-8 - - - It is unclear whether the cause of adrenal insufficiency or subclinical Addison's is due to depletion, down-regulation, or autoimmune origin, but it is evident adrenal and thyroid function have an impact on one another. p178 - - - Chronic Viral Infections Western Lifestyle and Autoimmune Coniditions The "old friends" hypothesis proposes that Treg cells do not develop correctly because they are not exposed to parasites and other benign organisms that have coexisted with humans and coevolved with us to "teach" our immune system how to respond to threats.
In our modern-day world, where we receive vaccines, use antibacterial soaps, and take antibiotics, we are exposed to far fewer forms of bacteria, viruses and parasites. This, of course, has many benefits, especially in the case of becoming affected with serious infection. It appears, however, that we may also be missing out on exposure to organisms that may perhaps have had a beneficial effect on our immune system. -read more on page 212 - - - Animal fat, broths, soups and stews support the body's ability to suppress the viruses. Monolaurin/lauric acid, one of the components of coconut oil, hasbeen found to be active against the Epstein-Barr virus. Replication of many viruses, including Epstein-Barr, is inhibited by glycyrrhizic acid, an active component of licorice root. Quercetin, co-enzyme Q10, n-acetyl cysteine, and glutathione were also reported to help fight chronic fatigue syndrome because of their antiviral properties. - - - The most accurate test for allergies is a skin test in which an allergist scratches the surface of the skin with the allergen and observes for rashes to see if the person is reactive to the substance. Blood tests are also available but are less sensitive. This type of allergy is often called a "true allergy" by medical professionals.
This terminology is a misnomer, however, and suggests only IgE allergies exist and that reactions mediated by different parts of the immune system are nonexistent. Challenge any medical professional to review their Immunology course notes, and they will find that there are additional types of hypersensitivies just as "true" and "real" as IgE anaphylactic reactions. The two relevant hypersensitivies are mediated by immunoglobulins A and G, IgA and IgG respectively. -read more on page 218 - - - IgA food intolerances may be asymptomatic, or they may present with the following symptoms: diarrhea, loose stools, constipation, acid reflux, malabsorption of nutrients from foods, and increased intestinal permeability.
They may cause IBS, gas, nausea, skin rashes (including eczema), acne, respiratory conditions such as asthma, nasal congestion, headache, irritability, and vitamin or mineral deficiencies. - - - Accounting for 90 percent of food reactions, the most common food antigens are milk, eggs, peanuts, tree nuts (e.g. almonds, cashews, walnuts), fish, shellfish, soy and wheat.
Nightshades (e.g tomatoes, potatoes, peppers and eggplant), beef, citrus, corn, and pork may also be problematic. p 222 - - - Starting in 1945, most American communities began adding fluoride to drinking water in an effort to prevent tooth decay. While various studies show fluoride reduces the incidence of dental cavities and tooth decay, fluoride is an endocrine disruptor. Studies confirm fluoride is directly toxic to thyroid cells and causes thyroid cell death, suppressing thyroid activity.
In fact, fluoride was actually used to treat hyperthyroidism up until the 1950s, prior to the development of other thyroid-suppressing medications. Fluoride is effective as a thyroid suppressor at doses of 0.9 to 4.2 mg per day for hyperthyroidism. Most adults in fluoridated communities are ingesting between 1.6 and 6.6 mg of fluoride per day from water, inadvertently suppressing their thyroid function. - - - Fluoridation partially began as a collaborative effort between dental associations, the US government, and sugar lobbyists who wanted to find a solution that would allow people to have fewer cavities while continuing to consume the same amount of sugar. - - - The United States is one of the only countries that adds fluoride to its water system. Almost all (97 percent) European countries have rejected water fluoridation due to the toxicity associated with it. Austria, France, Germany, Spain, and Switzerland, however, do allow the addition of fluoride to salt. - - - Acid-Alkaline Food Balance
Creating a more alkaline environment in the body may help with the detoxification process and can improve alkaline phosphatase function. While this initially seems to contradict the previous recommendation to increase stomach acidity, it does not. Keeping the stomach acidic and the rest of the body alkaline is the key to optimal health and can be achieved through diet and digestive enzymes. p 246 - - - One thing to remember about overcoming Hashimoto's is it takes years to develop the perfect storm to produce Hashimoto's thyroiditis. In the same way, healing won't happen overnight. ...more
Mindfulness for Beginners Jon Kabat-Zinn ISBN: 978-1-60407-658-5
"...resting in the awareness of not knowing is incredibly important in seeing with any cMindfulness for Beginners Jon Kabat-Zinn ISBN: 978-1-60407-658-5
"...resting in the awareness of not knowing is incredibly important in seeing with any clarity, with any creativity, and for living with integrity." P 125
"Beginner's mind is an attitude. It doesn't mean you don't know anything. It means that you are spacious enough in that moment to not be caught by what it is that you do know or have experienced in the face of the enormity of what is unknown." P 125
"Although it might seem that there is plenty 'to do' on these guided mediation programs, none of it is about doing anything or getting somewhere else. It is all about being. It is about giving yourself over to the present moment and to your own experience, over and over again, day in and day out, moment by moment, and even year by year. After awhile it becomes a way of being that you would no more give up than you would give up brushing your teeth every day or being present with your children. The discipline can even become effortless. But I would give it ample time to take root, perhaps a few decades... at least." P 139
"We are very much in the habit of thinking of ourselves in small, contracted ways - and of identifying with the content of our thoughts, emotions, and the narrative we build about ourselves - based on how much we like or dislike what is happening to us. This is our default mode. The power of mindfulness is the power to examine those self-identifications and their consequences and the power to examine the views and perspectives we adopt so reflexively and automatically and then proceed to think are us. The power of mindfulness lies in paying attention in a different, larger way to the actuality of life unfolding moment by moment by moment. It allows us to shift from mindlessness to mindfulness." P 153 ...more
Good. Particularly agreed with her stance on power struggles (p 146). Especially enjoyed the following chapters: Chapter 8 - Celebrate the Child You'vGood. Particularly agreed with her stance on power struggles (p 146). Especially enjoyed the following chapters: Chapter 8 - Celebrate the Child You've Got, Chapter 11 - Being Present and Mindful, and Unwinding Without Electricity, and Chapter 12 - Empowering Kids to Create Their Very Best Lives. Solid information and advice. ...more
An absolutely excellent read. I picked this new book up at my library specifically because a decent chunk of the book dealt with the "Sun Corridor" ofAn absolutely excellent read. I picked this new book up at my library specifically because a decent chunk of the book dealt with the "Sun Corridor" of Arizona, which includes Tucson, where we lived for seven years. So I was particularly drawn into chapters 5, 6, 7, and 8. They were, in fact, the main reason I read this book.
Many important and familiar issues were addressed in these chapters, from the O'odham people of today, the issues of state land reform in Arizona, water shortage, climate change, and the phenomenon of the "urban heat island" that describes what is happening in Phoenix, water used for crops being diverted to supply mains of subdivisions, the foreclosure rate and the impact of the recession, the border wall a.k.a. "billion-dollar speed bump", and the impact on the natural environment.
"So this used to be a farming community," says Propst, "and now its last harvest is these homes, but the crop, for the time being, has failed." page 202
"Look at it," he said. "It's an ugly damn thing, it makes a lot of noise, it does a lot of damage, it costs way too much, and it doesn't work - that's how you know it's a federal project!" - Odle on the Border Wall page 228...more
Good book. Pretty much the same core idea behind it as Raising Our Children, Raising Ourselves, but probably a better main-stream pick for the harder-Good book. Pretty much the same core idea behind it as Raising Our Children, Raising Ourselves, but probably a better main-stream pick for the harder-to-convince parents, especially those who came from and swear by a brickwall kind of family. Brickwall? You know: 'Our way or the highway' parents who gave out spankings and groundings freely. It actually describes the three common types of families: Brickwall (just mentioned), Jellyfish (there are two sub-types), and Backbone (the one you should strive for). It was interesting to compare these styles with my own upbringing, and even the bit I know about my parents upbringings. Not my favorite parenting book, but a good one, and I value it in the fact that it might get the message across to folks who may be too rigid or too warped themselves from their own childhoods to open their minds to How to Talk So Kids Will Listen, and Listen so Kids Will Talk; Raising Our Children, Raising Ourselves; Liberated Parents, Liberated Children; Unconditional Parenting; and books of the like.
- - - - A Few Quotes:
A good check of a parenting tool is "Would I want it done to me?" As simple a question as it appears to be, it can make the difference in how we parent this next generation. I believe that for the first time in our history we have the tools necessary to break the cycles of dysfunction, abuse, and neglect. We now have the individual and collective awareness of the damages that physical and emotional abuse can cause a child, a family, and a society. I am not naive enough to believe that it will be simple to make the necessary changes. There will be strong opposition from those who believe children are property to be owned and controlled. Some will fight to the bitter end to assert their "right" to abuse their children physically, emotionally, and sexually. I also know that those of us committed to making a change must also fight the demons from within, for we carry in our mental toolboxes destructive tools that are well-worn family heirlooms, passed on from generation to generation. page 15
Jellyfish families of both types have little external or internal structures. A permissive, laissez-faire atmosphere prevails. Children are smothered or abandoned, humiliated, embarrassed, and manipulated. They become obnoxious and spoiled and/or scared and vindictive. Since they receive no affirming life messages from their parents, they view themselves and the world around them with a lack of optimism. They end up being afraid of expressing themselves. They keep their feelings under guard and spontaneity in check; or they swing to the other extreme and become reckless, uncaring, uncontrollable risk takers. page 49
Many attempted suicides are not failed attempts but desperate cries for help. Both the brickwall family and the jellyfish family can set the stage for these desperate cries. The brickwall parent has told the child for years to stifle his feelings of hurt, anger, and frustration. ("Don't cry." "Don't walk away from me. You will listen to me." "Do what I tell you to do, and no arguments, please.") Solutions for problems are dictated by the parent to the child, with no opportunity for discussion or dialogue. ("You will bring your test scores up by studying every night for two hours." "You will replace Mr. Smith's planter, and tell him you are sorry." "Share that toy with your brother, right now.") Love is held out as a reward for behavior the parent approves of, and withheld for behaviors the parent doesn't like. ("If you are well behaved, I love you. If you are not, I won't." "Get away from me. You are a bad girl." "Let Mommy give her big girl a big kiss for winning the spelling bee.") Perfection is good. Mistakes are bad. (For example, an honor student gets a B and thinks his whole world should come to an end. A young girl starves herself to become like the model waifs who are the "ideal" weight.) The jellyfish parent has been inconsistent in his own expression of feelings, one moment flying off the handle for a minor infraction, the next laughing at something his child got punished for yesterday. The child's feelings are ignored ("Go to your bedroom right now and stay there until morning. That should teach you to talk to me like that." "Did you hear how he told his teach off? What guts he has." "He's not sad. He has nothing to be sad about.") Problems are not solved. They are ignored or glossed over. ("Don't worry about Mr. Smith. He'll get over his anger. It was only an old planter, and I know you didn't hit it on purpose." "Three D's and four F's. That's not as bad as it looks. You should have seen my report card when I was your age.") Love is also highly conditional. However, in a jellyfish family the conditions for it are inconsistent. One day a hug is given, "just because I wanted to give you a hug." The next day a hug is withheld because the child "upset Dad." Reaching adolescence with a sense of learned helplessness, coupled with hurt and anger, a teen from either family can become depressed and self-destructive when faced with the normal frustrations of the age. Wanting help, but not knowing how to ask for it, he physically hurts himself to get someone to notice his real pain. If the anger is greater than the hurt, the teen might attempt suicide to punish his parents. "See what you did to me? I'm going to make you suffer now." If the hurt, the anger, and the depression become chronic, a teen may see no way out of the pain except death. Then the attempt is not a cry for help; it is really a botched suicide. Suicide is the third leading cause of teen deaths, with accidents and acts of violence being first and second. Some accidents are actually veiled suicide attempts. Taking drugs can be a slow form of suicide. A backbone family is rarely confronted with attempted suicides. The environment the child grows up in where his feelings are accepted, his ideas count, his basic needs met, and his mistakes seen as learning opportunities provides the structure to flesh out a sense of his true self and the tools necessary to help him solve the myriad problems he will face. Nevertheless no cry for help is ignored, laughed at, or dismissed as foolish. pp 124-6
It's going to take example, guidance, and instruction from us to impart to our children the wisdom of peacemakers: Violence is "the knot of bondage"' aggression only begets more aggression; passivity invites it; and assertion can dissipate it. Peace is not the absence of conflict. It is the embracing of conflict as a challenge and an opportunity to grow. page 148 ...more
A physician-patient relationship thrives in a socially rich environment; it withers when market-style interactions supplant the social and care devol A physician-patient relationship thrives in a socially rich environment; it withers when market-style interactions supplant the social and care devolves into a pure business transaction metered by the minute (Hartzband and Groopman 2009). Like marriage, primary care is there in sickness and in health. To know my patients well, I must see them in good times and bad, be there for their trivial complaints and their tragic events. Primary care is a package deal, not divisible by degree of profitability. page 5
The person who answers the telephone in the doctor's office must be a sensitive detector, responsive to that which is novel, not an automaton. The telephone is a medical device; answering it is a medical procedure best performed by an executive health professional. page 17
The HIPAA privacy law trumps the authority of the local Division of Motor Vehicles. As a physician, I am prevented from notifying the local authorities of an illegal or potentially dangerous situation on the road involving my patient. As the law stands, patient privacy comes before public safety. page 30
One unintended consequence of NCLB is that a school system can potentially game the system by "teaching to the test." Why spend class time on a more advanced or challenging math problem that the teacher knows will not be on the exam? Like the Heisenberg uncertainty principle in quantum physics, the very process of making a measurement alters that which is being measured. page 36
Proper and dignified women, who came of age long before the sexual revolution of the 1960s, are not willingly going to discuss matters that originate below the waist... page 45
The polypharmacy of OTC supplements, or "neautraceuticals," thrives today because of the relaxation of FDA regulations, which put consumerism ahead of drug safety and efficacy. page 61
I would argue that, as a patient, your true specialist is the doctor who knows you, and your family, best and who can weave a plan of care that incorporates specialty consultations along with other diagnostics and treatments. The patient is far more than the sum of his parts. Organ for organ, fragmented care is bad medicine, and, as patients well know, it is easy today to become to overdoctored. page 75
Such dispersed delivery of health care has the obvious disadvantages of poor coordination, duplication of efforts, excessive testing and procedures, and polypharmacy, with its attendant risk of serious drug interactions. Even more troubling to me, this is a fragmented system of care devoid of the warmth of relationship, and it can be a soulless process that doesn't see the big picture. To the patient it may appear that nobody is driving. page 75
The problem (talking about radiation) is compounded when the neurologist is scanning the patient's brain, the nephrologist is scanning the patient's kidneys, and the pulmonologist is scanning the patient's lungs. Each specialist may be quite correct in doing so, but the net effect is a patient who has been overexposed. No one is counting CT scans. No one is coordinating care to prioritize scans and see where the radiation burden to the patient might be reduced. page 82
In the course of medical school and subsequent training, physicians are introduced to the ethical concept that, as a doctor, one can do too much. Amid the gallows humor of medical training, I often heard the term "flogging the patient," meaning delivery of undue and excessively aggressive care with little to be gained but with much pain and anguish inflicted. Patients were said to "die the Harvard death" when they underwent every imaginable blood test, biopsy, scope, scan, or surgery before passing, leaving behind a challenging case study worthy of publication in the New England Journal of Medicine but ending in a tragically miserable and coldly technological death. page 88
Although there always may be one more drug to try or test to do, that does not mean that it is the wisest thing. The poly-doctored patient must have a primary physician to add a dose of compassion to the treatment regimen, to supply some patient-specific wisdom, and to be a voice of reason. page 89
Considered beyond the scope of Medicare's mission, long-term in-home nursing care goes un-reimbursed. The absence of good nursing, medical supervision, and supportive services at home creates a gaping hole in geriatric care that has been termed by Carroll Estes and James Swan the "No-Care Zone." page 121
If we cannot expand the supply of primary physicians sufficiently by promoting volunteerism among retired doctors, and if we cannot attract newly trained medical graduates to general medicine, then we must give serious consideration to a third alternative: a government-imposed period of mandatory medical service by young physicians in the delivery of good basic primary care. Shocking as this option may seem in the land of free enterprise, the concept of a civilian physician draft is not at all new; we just haven't yet been forced to give it the serious consideration it deserves. page 143
A two-year period of mandatory medical service would have far-reaching beneficial consequences for our nation and for doctors as well. When medicine became a commodity, a generation of physicians came along who lacked the important sense of altruism in their craft. Medicine as public service was replaced by a corporate model that is cold, aloof, and more pecuniary than personal. Restoration of a sense of humility to all physicians would be a good thing for everyone involved. A service commitment would restore honor, dignity, and the sense of calling to a tarnished profession. Participation in a two-year draft would be an enforced stop on the road to the superspecialized, highest-paying care to which today's medical trainees aspire. It could be an opportunity for doctors to establish new and more humane priorities. page 149
Like cross-training for athletes, doctors cross-trained in primary care will give us the flexibility we need when it is demanded of us. page 150
Caregiving to the elderly is gender biased. Daughters far outnumber sons in direct hands-on personal care. Largely, it is "women's work." Bathing, dressing, medicating, and hauling an aged parent to the doctor's office represent a daughter's socially expected discharge of her filial duty. As with rearing children of her own, an adult daughter typically "takes responsibility for tasks that are unrelenting, repetitive, and routine" (Bleiszner and Hamon 1992). Remarkably, even some daughters who were childhood victims of parental abuse, alcoholism, or abandonment may maintain a strong sense of obligation to a mother or father who was a far less than adequate parent. Nurturing and the female socialization of caregiving run deep. Some women tell me that they find it satisfying to show an now aged, but once abusive, father the proper way to care for another family member, accepting a heroic task of exemplary personal care. Adult sons focus on financial affairs, household repairs, and other forms of assistance that are episodic and clean. Rarely will an adult son perform personal hygiene or assist with dressing an elderly parent, especially his mother. Male offspring appear on the scene when a big decision is to be made, such as consenting to a major surgery for dad or nursing home placement for mom. Daughters are more like to suffer from filial anxiety, a nagging sense that they never have done enough. Such gender differences are deeply engrained on a societal scale. Filial role enactment is a sex-linked trait. page 153
HIPAA, albeit written with the good intention of preserving privacy, is a legalistic product that stands in the way of the family. Reams of paper have been printed outlining the statute's regulations, implementation, compliance, and the penalties for its violation. It is bread and butter for attorneys who practice health law (Rovner 2004, 399). HIPAA is, however, inherently antifamily. Typically, there is but one designated communicator, authorized to speak to the doctor as proxy for the patient, but serving indeed as family spokesperson. The doctor's view of the patient's situation at home is seen through the eyes of a single observer, who may well suffer from tunnel vision or have an old axe to grind with a sibling. Just as history books are written by the victors, the "story" of the ailing parent is told by the one child with the closest relationship: the one whose name is on the HIPAA form. page 161-2
It is an essential but underappreciated role of the primary care physician to know an aging patient within the context of the family and not as a subject in isolation. It does not suffice for me to listen only with my stethoscope. The doctor who does so risks missing the message. How does this family function? Are they attentive or detached? Do they instinctively offer affection, affirmation, and the emotional aid that is a natural remedy and the best medicine, albeit no cure? "Helicopter" adult children may hover over a sick parent's hospital bed, demanding that the doctor be summoned at once or barking that a picked at dinner tray be removed immediately, but doing so offers no solace and makes no meaningful contribution to a parent's care. It is a poor substitute for emotional engagement and the quiet comfort of mere presence. page 164
No one possesses the luxury of choosing his birth family. You go through life with the family you have. Ethicists argue that biology alone does not mandate any special obligation of an adult child for the care of an older parent who is faltering. Elder care can be unrelenting, particularly for a parent with alcoholism, a disease the carries a strong social stigma and the frustration of frequent relapses. Resentment, repressed anger, and a fervent wish to unload a difficult parent may lead to a maladaptive and dysfunctional use of a physician's services. page 168
The common assumption is that physicians conceal their errors and avoid apologizing for mishaps because we fear that an admission of fallibility will trigger a suit for medical malpractice, transforming patient into plaintiff. While only a small percentage of those patients victimized by physician error actually do sue, a pervasive paranoia exists among us that an admission of error will become admissible evidence one day in a court of law. Several states have adopted apology laws, designed to isolate the ethical imperative of a proper apology from any legal liability that it may establish (Wei 2006, 107), but we still worry. page 178
Tort liability is our nation's chosen method of physician oversight, quality control, and patient compensation for injurious errors (Danzon 1985). However, it is serving no one optimally and is itself a serious hazard to our public health by poisoning the core of our health care system: the physician-patient relationship. page 183
In a review of medical malpractice in the New England Journal of Medicine, David Studdert and associates reflected that only 2 percent of negligent injuries in New York resulted in claims (2004, 283). Conversely, "only 17 percent of claims appeared to involve a negligent injury." There is scant overlap; rarely do patients who are truly wronged seek legal redress. page 183
The Massachusetts Medical Society recently completed an investigation of defensive medicine as practiced in that state (Massachusetts Medical Society 2008). Based on physician-survey data, they conservatively concluded there was, at minimum, a $1.4 billion cost in that state alone, over the six-month study. We all do it. Precious health care dollars are squandered routinely on unnecessary tests, referrals, medications (such as unnecessary antibiotics), invasive procedures, and hospitalizations, all to shore up defenses and buff the charts. This is no way to practice medicine. page 185
At last we have come to the heart of the matter of physician payment reform for primary care: it is all about a relationship. Just as our eyes register only visible light but fail to detect the longer and shorter wavelengths of the spectrum, P4P and pay for connectedness (P4C) measure only a narrow band of primary care. The full spectrum encompasses a physician-patient relationship and is not amenable to the metrics currently employed in the study of health care economics. page 210
Properly compensated primary care physicians are the key to a rational and successful formula for care or a geriatric Baby Boom. If primary care doctors are well paid and well respected in their profession, the field will attract and retain highly qualified, compassionate, and caring young doctors. If you pay them. they will come. However, we must reprioritize and flip the medical totem pole on its head to "get what we pay for" in health care. page 211-2
Finally, we need to appreciate what primary care is not. It is not, and can never be, a surrogate for a warm and caring, functional family. It is not an anchor for modern, mobile family members who are isolated and adrift, emotionally and geographically. Attachment and family connection are essential to human health. The primary care doctor cannot raise your child, re-establish your ruined relationship with your mother, or cure the loneliness of later life within a dysfunctional family. Like charity, primary care really begins at home. page 217 ...more
Wow. I really enjoyed the chapter in which Ramachandran discussed the roll that mirror neurons possibly play in autism. I truly hope these theories wiWow. I really enjoyed the chapter in which Ramachandran discussed the roll that mirror neurons possibly play in autism. I truly hope these theories will enable more research to be done to help those with the disorder.
There are many fascinating and extraordinary cases in this book. Humans are truly neurologically unique and Ramachandran does a wonderful job at explaining how and why. I loved the diagrams and descriptions of the different regions of the brain and their functions. Absolutely fascinating. ...more
I started it a month ago, perhaps a bit more... and this is the longest it has taken me to finish a book in a long time.I finally finished this book.
I started it a month ago, perhaps a bit more... and this is the longest it has taken me to finish a book in a long time.
However, it is not a bad book. In fact, it is quite good. Bryson is funny. Long winded at times, but laugh out loud funny. He's a genuinely talented writer and chock full of interesting information.
So, why, do you ask, did it take me forever to finish this book?
I have no idea.
Lately I've been a bit burnt out on non-fiction. Perhaps this is it. Or maybe it's because, aside from the thought, "Oh, Australia's nice! It's warm, surrounded by ocean, and they have those cute wallaby creatures!And I'd visit in a heartbeat!" I really don't have a profound interest in the continent. Interest in visiting, yes. But a lot of Bryson's book felt a little too.... long winded? Stretched out? Vague as to where it was leading? It's hard to say that because he really is an entertaining writer. I just had trouble pressing through the book.
How much I learned and will retain from this book I'm not sure either. I did take notes on a few things I found particularly interesting. If afforded the time, I plan on checking out his other works, which people give even better reviews, in the future.
- - - [A TASTE OF HIS HUMOUR...} Downtown Canberra was primarily a series of plazas wandering between retail premises, and devoid of any sign of life but for a noise of slap and clatter that I recognized after a moment as the sound of skateboards. Having nothing better to do, I followed the sounds to an open square where half a dozen adolescents, all in backward-facing baseball caps and baggy shorts, were honing their modest and misguided skills on a metal railing. I sat for a minute on a bench and with morbid interest watched them risking compound fractures and severe testicular trauma for the fleeting satisfaction of sliding along a banister for a distance of from zero inches to a couple of feet before being launched by gravity and the impossibility of maintaining balance into space in the direction of an expanse of unyielding pavement. It seemed a remarkably fooling enterprise. page 88
[INTERESTING TIDBIT OF HISTORY...] Then in 1859, a man named Thomas Austin, a landowner in Winchelsea, Victoria, a little south of where I was now, made a big mistake. He imported twenty-four wild rabbits from England and released them into the bush for sport. It is hardly a novel observation that rabbits breed with a certain keenness. Within a couple of years they had entirely overrun Austin's property and were spreading into neighboring districts. Fifty-million years of isolation had left Australia without a single predator or parasite able even to recognize rabbits, much less dine off them, and so they proliferated amazingly. page 111
The rabbits, meanwhile, hopped on. By the time science finally came up with a solution, almost a century had passed since Thomas Austin tipped his twenty-four bunnies out of the bag. The weapon deployed against the rabbits was a miracle virus from South America called myxomatosis. Harmless to humans and other animals, it was phenomenally devastating to rabbits, with a morality rate of 99.9 percent. Almost at once the countryside filled with twitching, stumbling, very sick rabbits, and then with tens of millions of little corpses. Although just one rabbit in a thousand survived, those few that did were naturally resistant to myxomatosis, and it was resistant genes that they passed on when they began to breed again. It took a while for things to get rolling, but today Australia's rabbit numbers are back up to 300 million and climbing fast. At all events, the damage to the landscape, much of it permanent and irreversible, had already been done. And all so some clown could have something to pot at from his veranda. page 112
[POIGNANT OBSERVATION...] Allan was evidently held by a similar thought, for a half hour later when we met out front he was staring at the same scene. "I can't believe we've just driven a thousand miles to find a Kmart," he said. He looked at me. "You Yanks have a lot to answer for, you know." I started to protest, in a sputtering sort of way, but what could I say? He was right. We do. We have created a philosophy of retailing that is totally without aesthetics and totally irresistible. And now we box these places up and ship them to the far corners of the world. Visually, almost every arrestingly regrettable thing in Alice Springs was a product of American enterprise, from people who couldn't know that they had helped to drain the distinctiveness from an outback town and doubtless wouldn't see it that way anyway. Nor come to that, I daresay, would most of the shoppers of Alice Springs, who were no doubt delighted to get lots of free parking and a crack at Martha Stewart towels and shower curtains. What a sad and curious age we live in. page 250 ...more
While I did strongly agree with a few other reviewers of this book (particularly one named Wendy), I still liked the book very much. I guess I just reWhile I did strongly agree with a few other reviewers of this book (particularly one named Wendy), I still liked the book very much. I guess I just really enjoy hearing other people's perspectives of things. I enjoy memoirs and biographies. And I don't mind when people let it all hang out in books. Call it whining or being self-absorbed or whatever, it's human nature to think about these things to some degree sometimes, and I give credit to people who can fearlessly put it all out there. Yes, Pam Reed is an extraordinary runner, and not an extraordinary writer. But her heart was in this book and I enjoyed it!
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I’m sure that all people are, to some extent, mysteries to themselves. There are things about myself that I still don’t understand, despite my having invested a lot of time, effort, and pain in trying to figure them out. Page 21
One of the things that bothers me about these criteria is the implication that the “normal” person is someone who’s not too excited about, much less totally committed to, anything. I know some people may want to argue with me about this, but to me, what passes for “normalcy” seems to be the absence of real devotion, not to mention passion. Page 26
In athletics, sometimes – maybe even most of the time – the greatest accomplishments arise from competition between individuals who seem to be working against each other but who are really collaborating to bring out each person’s best. … Athletes are inherently competitive people. Ultimately, though, you compete against yourself. In that sense, any really challenging opponent is also a good friend. Pages 142-3
When I compete in a 100-mile race, for instance, I do it 1 mile at a time. In my own mind, I’m not really running 100 miles. I’m running 1 mile 100 times, which to me, as weird as it may sound, is something very different. Page 148
People make excuses when the reality is something they can’t own up to. If you have respect for yourself, the reality is just what it is. If I don’t do well in a race, I don’t make too much of it because it doesn’t signify anything to me. It doesn’t prove that I’m something different than I thought I was, or something different from the way I’ve presented myself to other people. It just means I didn’t do well in a race, and there’s always another race coming up. Pages 203-4...more
Interesting ideas in this book. It was great learning about brain chemistry and the balance of certain chemicals and how the food you consume effectsInteresting ideas in this book. It was great learning about brain chemistry and the balance of certain chemicals and how the food you consume effects such. I've never been a candy-craving, soda-guzzling sugar-junkie, but I recognize that I was a sugar junkie in another way... i.e. french bread, simple carbs, etc. Over the past few years of my life I have developed a penchant for chocolate as well. So this was a wonderful insight into why a person craves these foods, what they do to the body on a chemical level, why they make us feel good - and bad, and how to help ourselves feel better without relying on them. One of the most important things I learned was getting an adequate intake of protein - something I KNOW I have not been good with my whole life. Half your body weight in grams. Then split it up between the three meals you have each day. So I'm shooting for 20g of protein at each meal. In addition, the obvious: complex carbs, brown things and not white things, and avoid sugars. Common sense, but like many things, easier said than done. This was a good refresher and motivator in eating right. This book will remind you how vital a good diet is as it impacts how you feel and the quality of your life....more
It is dire poverty indeed when a man is so malnourished and fatigued that he won't stoop to pick up a penny. But if you cultivate a healthy poverty a It is dire poverty indeed when a man is so malnourished and fatigued that he won't stoop to pick up a penny. But if you cultivate a healthy poverty and simplicity, so that finding a penny will literally make your day, then, since the world is in fact planted in pennies, you have with your poverty brought a lifetime of days. It is that simple. What you see is what you get. page 15
I'm getting used to this planet and to this curious human culture which is as cheerfully enthusiastic as it is cheerfully cruel. page 41
From even the deepest slumber you wake with a jolt - older, closer to death, and wiser, grateful for breath. page 85
Here is word from a subatomic physicist: "Everything that has already happened is particles, everything in the future is waves." Let me twist his meaning. Here it comes. The particles are broken; the waves are translucent, laving, roiling with the beauty like sharks. The present is the wave that explodes over my head, flinging the air with particles at the height of its breathless unroll; it is the live water and light that bears from undisclosed sources the freshest news, renewed and renewing, world without end. pages 102-3
John Dee, the Elizabethan geographer and mathematician, dreamed up a great idea, which is just what we need. You shoot a mirror up into space so that it is traveling faster than the speed of light (there's the rub). Then you can look in the mirror and watch all the earth's previous history unfolding as on a movie screen. pages 141-1
Our excessive emotions are so patently painful and harmful to us as a species that I can hardly believe that they evolved. Other creatures manage to have effective matings and even stable societies without great emotions, and they have a bonus in that they need not ever mourn. (But some higher animals have emotions that we think are similar to ours: dogs, elephants, otters, and the sea mammals mourn their dead. Why do that to an otter? What creator could be so cruel, not to kill otters, but to let them care?) It would seem that emotions are the curse, not death - emotions that appear to have developed upon a few freaks as a special curse from Malevolence. page 178
The world has signed a pact with the devil; it had to. It is a covenant to which every thing, even the hydrogen atom, is bound. The terms are clear: if you want to live, you have to die; you cannot have mountains and creeks without space, and space is a beauty married to a blind man. The blind man is Freedom, or Time, and he does not go anywhere without his great dog Death. The world came into being with the signing of the contract. A scientist calls it the Second Law of Thermodynamics. A poet says, "The force that through the green fuse drives the flower/ Drives my green age." This is what we know. The rest is gravy. page 181
I am a frayed and nibbled survivor in a fallen world, and I am getting along. I am aging and eaten and have done my share of eating too. I am not washed and beautiful, in control of a shining world in which everything fits, but instead am wandering awed about on a splintered wreck I've come to care for, whose gnawed trees breathe a delicate air, whose bloodied and scarred creatures are my dearest companions, and whose beauty beats and shines not in its imperfections but overwhelmingly in spite of them, under the wind-rent clouds, upstream and down. 242
I think that the dying pray at the last not "please," but "thank you," as a guest thanks his host at the door. Falling from airplanes the people are crying thank you, thank you, all down the air; and the cold carriages draw up for them on the rocks. Divinity is not playful. The universe was not made in jest but in solemn incomprehensible earnest. By a power that is unfathomably secret, and holy, and fleet. There is nothing to be done about it, but ignore it, or see. And then you walk fearlessly, eating what you must, growing whatever you can, like the monk on the road who knows precisely how vulnerable he is, who takes no comfort among death-forgetting men, and who carries his vision of vastness and might around in his tunic like a live coal which neither burns nor warms him, but with which he will not part. page 270
Absolutely wonderful. I'd recommend this to anyone who is human. (Yes, that would be to everyone.) Chock full of wonderful information, poignant case-Absolutely wonderful. I'd recommend this to anyone who is human. (Yes, that would be to everyone.) Chock full of wonderful information, poignant case-in-points, and the appendix is an excellent resource all on its own.
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Cheap Forgiveness is a quick and easy pardon with no processing of emotion and no coming to terms with the injury. It's a compulsive, unconditional, unilateral attempt at peacemaking for which you ask nothing in return. ... Cheap Forgiveness is dysfunctional because it creates an illusion of closeness when nothing has been faced or resolved, and the offender has done nothing to earn it. Silencing your anguish and indignation, you fail to acknowledge or appreciate the harm that was done to you. page 15
What makes it nearly impossible for some peacekeepers to speak up is their uncertainty about whether a violation actually took place. Children of alcoholics and victims of physical or sexual abuse in particular often grow up in a world that tries to convince them that the injury never happened. ... Victims whose recollections are questioned often spend their lives doubting the truth of their own experiences - pretending they were never hurt and learning not to trust their own intuition of their own version of reality. This reaction can be as damaging as the violation itself. page 30
Refusing to Forgive may isolate you not just from the person who hurt you but from those who have done you no harm. Mistrust is like blood seeping from a wound, staining everything it touches. Morbidly absorbed in the injury, you may push everyone away, even those who care for you and want to help you heal. Unable to open up to them, or even admit that you welcome their support, you're likely to stand firm but alone. page 48
With Acceptance, you appreciate the magnitude of the wrong that was done to you and give full voice to the violation. You refuse to let go of your grievance until you've grasped its meaning and understood its effect on you. You may need to replay the injury again and again until the whole truth sinks in. page 56
It helps to create a place within you where your emotions are safe - an empathic, holding environment where you do not judge, deny, or dismiss whatever is going on inside you. Once you acknowledge your feelings and give yourself permission to have them, you can begin to normalize them. All your life you may have been taught that emotions are dangerous, a sign of weakness. You may have learned to cut yourself off from them. But now you need to embrace them, secure in the knowledge that when someone violates you, you are not crazy or alone in responding with intense, even conflicting emotions. page 57
As you trace the offender's story and see how he was damaged, and how he subjected you to the same abuse or neglect he may have experienced himself, you begin to understand why he acted the way he did. You realize that he was born with a deck of cards, that over time he was dealt a few more, and that today he is playing out his hand with you. If you weren't there, he might be playing the same hand with someone else. The more you know about him as a person distinct from you, the less likely you are to take his behavior personally. And the less personally you take his behavior, the less likely you are to experience shame. Shame comes when you think that his behavior is about you - about your unworthiness, your defectiveness, your unlovability. Shame lifts when you realize that his behavior is about him - his innate disposition, his traumatic experiences, his responses to life's stress. You may not have access to this information about him, but in order for you to fight shame, it helps to come up with some hypotheses. page 68
You may ask, "Why should I forgive myself? I did nothing wrong. It was the offender who violated me." But the issue here is not how you wronged him. It's how you may have allowed him to hurt you. How did you do this? What do you need to forgive yourself for? In "After the Affair," I list a number of injuries that pertain to infidelity, including: - trusting blindly, and ignoring your suspicions; - having such a stunted view of yourself that you feel unentitled to loyalty or love; and - making unfair comparisons by idealizing the lover and degrading yourself. You may also want to forgive yourself for such self-effacing, self-destructive behaviors as: - dismissing your suffering and failing to appreciate how deeply you've been wounded; - believing you got what you deserved; viewing your mistreatment as punishment, and allowing it to shatter and shame you; - tolerating the offender's abusive behavior; - refusing to forgive yourself, even when you're innocent; - making peace at any cost, no matter how superficial or spurious it may be, or how unsafe or miserable the offender makes you feel; and - losing time and energy engaging in imaginary, vindictive dialogues with him. page 111
After a traumatic injury, you, the hurt party, are likely to become hypervigilant, patrolling the border between you and the offender, making sure you'll never be violated or fooled again. You may live and breathe the injury, obsessed with its grubby details. The offender, in contrast, may wan to repress, deny, or minimize his wrongful behavior. With Genuine Forgiveness, a profound shift in preoccupation takes place. You, the offender, demonstrate that you're fully conscious of your transgression and intend never to repeat it. You, the hurt party, become less preoccupied with the injury and begin to let go. page 124
As forgiveness expert Terry Hargrave points out, "Forgiveness is accomplished when the victimized person no longer has to hold the wrongdoer responsible for the injustice; the wrongdoer holds himself or herself responsible." page 125
To defend against feeling dependent and vulnerable, she may silence herself in a number of ways. She may forgive you too easily. She may go numb. She may go along to get along, as though she has forgiven you, while inside she continue to storm. Or she may retreat into herself and shut you out. If you're a conflict avoider, her silence will seem preferable to her rage. But don't be fooled. Muffled pain is just as problematic as uncontrollable fury, and perhaps even more dysfunctional. If you don't draw her out and encourage her to talk through the injury, she'll never get close to you or forgive you. I can't stress this point enough: no conflict, no closeness. If you want to rebuild the bond, you, the offender, must regularly invite and embolden her to reveal how deeply you have hurt her. This opening up to you is an act of intimacy, a first step in lowering the barrier between you. Detatchment may be her protection. But what may be protective to her is likely to be a death knell for the relationship. page 136
Each time you bring up the violation, you let the hurt party know that it's on your mind, too - that she's not alone with it. When you demonstrate that you won't forget what you did and will continue to be mindful of its lessons, you help release her from her preoccupation with the injury. I often say, If you want your partner to move on, you must pay attention to her pain. If you don't, she will. page 137
For "surface wounds," a single apology may be enough to win forgiveness. But for more serious injuries, you may need to apologize again and again, particularly if you hope to reconcile. As a patient of mine told her husband after she caught him secretly running up debts on their credit cards, "I don't want you to say you're sorry. I want you to be sorrowful with me. I want you to carry the sorrow the way I carry the sorrow, to walk the walk with me every day." page 152
...when you tell someone what you need from him, you clear the way back to your heart. And so I advise you: Don't set up invisible hoops for the offender to jump through. Be concrete. Tell him, "This is what will help me mend and let my anger go. This will allow me to get closer to you, perhaps forgive you." Specific behaviors you may want to request include: - "I need you to ask me to forgive you." - "I need you to go to your family and tell them that you lied about me." - "I need you to let me talk out everything you've done to hurt me, and for you to listen without getting angry." - "I need you to repeat what I've told you, so I feel that you 'get it.'" When you tell him, "I need nothing from you," you cut yourself off from him and give him no chance to make meaningful repairs. What you are saying, in effect, is, "I need nothing, because I'm committed to hating you and keeping you out in the cold." In contrast, when you map out what you need, you give him direction and create a path to forgiveness. As Gaston Bachelard writes: What is the source of our first suffering? It lies in the fact that we hesitated to speak. It was born in the moment When we accumulated silent things within us. page 203 ...more