Get out of town and head for the hills. TRUE NATURE
This week I took a short work-related trip to Scotland. When I got out of the car, something was different. Immediately I felt the crisp, perfumed caress of something strange, something that city-dwellers have long had to live without: fresh air. I filled my lungs with this exotic elixir and instantly felt stronger, happier, fitter. I slept better in Scotland. I became more alive, more human.
If only you could bottle this extraordinary intoxicant, you could make a fortune. (Actually someone did that already, in China, whose cities bring pollution to a whole new level.)
Even though we may not understand all the reasons, it makes intuitive sense that metropolitan living can be detrimental not only to our physical health, but to our very psyches, too. The research findings are not a huge surprise: Urbanites have higher rates of anxiety and depression. We’re more frazzled, more sensitive to criticism. Schizophrenia, too, is much more common in cities. And since 2009, more than half the world’s population lives in cities, according to the United Nations. That’s almost 4 billion souls potentially denied the oxygen of a healthy environment, one free of pollution, car alarms, and armies of sharp-elbowed impatient people rushing to the next meeting—or away from themselves. The Hopi call it Koyaanisqatsi or “life out of balance" (and if you haven't seen the mind-blowing 1982 film of that name, please stop reading this or whatever else you are doing and order it now).
This week I took a short work-related trip to Scotland. When I got out of the car, something was different. Immediately I felt the crisp, perfumed caress of something strange, something that city-dwellers have long had to live without: fresh air. I filled my lungs with this exotic elixir and instantly felt stronger, happier, fitter. I slept better in Scotland. I became more alive, more human.
If only you could bottle this extraordinary intoxicant, you could make a fortune. (Actually someone did that already, in China, whose cities bring pollution to a whole new level.)
Even though we may not understand all the reasons, it makes intuitive sense that metropolitan living can be detrimental not only to our physical health, but to our very psyches, too. The research findings are not a huge surprise: Urbanites have higher rates of anxiety and depression. We’re more frazzled, more sensitive to criticism. Schizophrenia, too, is much more common in cities. And since 2009, more than half the world’s population lives in cities, according to the United Nations. That’s almost 4 billion souls potentially denied the oxygen of a healthy environment, one free of pollution, car alarms, and armies of sharp-elbowed impatient people rushing to the next meeting—or away from themselves. The Hopi call it Koyaanisqatsi or “life out of balance" (and if you haven't seen the mind-blowing 1982 film of that name, please stop reading this or whatever else you are doing and order it now).
| So what to do if, like me, you’re one of the stressed majority, living in a state of such un-nature? How to combat the growing global scourge of “nature deficit disorder”? How to reconnect with our natural state, the one out there and the one within? • Walk. A recent piece of research suggests that walking in nature results in less rumination and negative thinking and thus improved mental health. You don’t have to hike through Yosemite National Park to awaken your spirit, or even move to Scotland (although both sound appealing)—a stroll around your local city park works just fine. Check out city farms, nature reserves and wildlife centres, too; even a trip to your local natural history museum will soothe the soul. • Gardening has been shown to relieve stress and is enormously therapeutic for all kinds of people (for example pop star Kim Wilde). There’s something so elemental about the ancient satisfaction of getting your hands into the earth and making things grow. We are nurtured by nurturing. If you don’t have a garden, go and help a neighbour who does, apply for an allotment, support community gardens, volunteer with a gardening charity or join a Green Gym. • Fill your living space with greenery, and photographs or artwork depicting the great outdoors. Research shows that having a pot plant and even looking at scenes of nature can significantly improve your mental health. The upcoming Edinburgh Fringe play “Garden” is about an office worker who revives a pot plant and in so doing revives herself. Don't just get plants, commune with them, too. Buddha once gave a famous wordless sermon to his disciples: he simply held up a white flower. By saying nothing, the disciples were free to experience the flower fully and appreciate its tathātā, which might loosely be translated as “suchness." |    Slow down, you move too fast. Top to bottom: Tokyo commuters; London's epicenter, Oxford Circus; Lower Manhattan, New York. |
Always in a hurry, off-balance. • Relieve stress. Whatever works for you. Mindfulness. Music. Exercise. Take up golf—a way of being among greenery and it might make you live five years longer (or, depending on how you play and who you play with, it might just make you feel five years older). If the stress of city life gets really bad, or even if it doesn’t, get some help.
• Join or get involved with local wildlife organisations like the London Wildlife Trust, or global ones like Friends of the Earth, the World Wildlife Fund, or Greenpeace.
• Join or get involved with local wildlife organisations like the London Wildlife Trust, or global ones like Friends of the Earth, the World Wildlife Fund, or Greenpeace.
Places like the Rose Garden in London's Regent's Park offer psychic soothing. • Take regular daytrips beyond the city limits (and beyond your comfort zone). Hopefully this will be more successful and uplifting than the legendary, foul-mouthed scene from “Trainspotting” when “Tommy” drags his sceptical city pals to the beautiful, desolate Rannoch Moor (“This is not natural man,” says one.)
• Use your vacations, too, to get back to basics. Head for the hills: camp in the Lake District for instance, and “walk in blessedness” there as Wordsworth did all those years ago.
As the wandering, wondering wordsmith said: “Nature never did betray the heart that loved her.”
—John Barton
U.K. NEWS
Large UK trial to ask if mindfulness boosts teenage mental health
From Reuters:
Nearly 6,000 British school children are to take part in a major trial designed to assess whether mindfulness training for teenagers can improve their mental health.
Mindfulness is based on the idea of being more aware of the present by intentionally focusing on emotions, thoughts and sensations and viewing them with acceptance. Advocates say this understanding helps people to respond in ways that are more purposeful, rather than reacting on "automatic pilot".
The three-part study will include the first large randomized control trial of mindfulness training compared with teaching as usual in 76 schools.
Further parts of the study include experimental research to establish whether and how mindfulness improves mental resilience of teenagers, and an assessment of the most effective way to train teachers to deliver mindfulness classes to pupils.
Brain scientists know that teenage years are a crucially vulnerable time for mental health, particular in brain regions responsible for decision-making, emotion regulation and social understanding. More than three-quarters of all mental disorders begin before the age of 24, and half by the age of 15.
U.S.A. NEWS
Even mild mental health problems in children can cause trouble later
From NPR:
It's not easy for a child who has had mental health issues to make a successful transition into adulthood. But even children who have symptoms that are mild enough that they wouldn't be diagnosed are more likely to struggle with life as adults, a study finds.
Children and teenagers with a psychiatric disorder had six times higher odds of having at health, legal, financial and social problems as adults, according to a study published Wednesday in JAMA Psychiatry. Those with milder symptoms were three times more likely to have problems as adults.
We already know from previous studies that most adults with mental health issues had a previous psychiatric disorder during childhood – it doesn't have to be the same exact condition. But this study shows mental health problems that occurred during childhood can make it more likely that someone will struggle as an adult, making it more likely that they won't graduate from high school or commit a felony, for instance.
Judge orders counseling for Obama critic Dinesh D'Souza
From India West:
A New York judge has ordered Dinesh D'Souza, an Indian American conservative scribe and Obama critic filmmaker, to do community service for four more years for breaking campaign-finance laws and undergo further counseling.
Judge Richard Berman clarified July 13 that under the sentence he handed down after D'Souza pleaded guilty last year, he has to do eight hours each week for the entire five years he is on probation and not just the eight months he was confined to a halfway house.
The Manhattan federal court judge also read aloud a report from a court-appointed psychologist who called D'Souza "arrogant" and "intolerant of others' feelings," according to the New York Post.
"In my mind it was never contemplated that the eight hours only applied to the period of home confinement," Berman was quoted as telling defense attorney Ben Brafman.
He later read out a report from a psychologist who saw D'Souza, the maker of the anti- Obama film "2016: Obama's America,” and then ordered him to continue attending weekly sessions, the Post said.
• Use your vacations, too, to get back to basics. Head for the hills: camp in the Lake District for instance, and “walk in blessedness” there as Wordsworth did all those years ago.
As the wandering, wondering wordsmith said: “Nature never did betray the heart that loved her.”
—John Barton
U.K. NEWS
Large UK trial to ask if mindfulness boosts teenage mental health
From Reuters:
Nearly 6,000 British school children are to take part in a major trial designed to assess whether mindfulness training for teenagers can improve their mental health.
Mindfulness is based on the idea of being more aware of the present by intentionally focusing on emotions, thoughts and sensations and viewing them with acceptance. Advocates say this understanding helps people to respond in ways that are more purposeful, rather than reacting on "automatic pilot".
The three-part study will include the first large randomized control trial of mindfulness training compared with teaching as usual in 76 schools.
Further parts of the study include experimental research to establish whether and how mindfulness improves mental resilience of teenagers, and an assessment of the most effective way to train teachers to deliver mindfulness classes to pupils.
Brain scientists know that teenage years are a crucially vulnerable time for mental health, particular in brain regions responsible for decision-making, emotion regulation and social understanding. More than three-quarters of all mental disorders begin before the age of 24, and half by the age of 15.
U.S.A. NEWS
Even mild mental health problems in children can cause trouble later
From NPR:
It's not easy for a child who has had mental health issues to make a successful transition into adulthood. But even children who have symptoms that are mild enough that they wouldn't be diagnosed are more likely to struggle with life as adults, a study finds.
Children and teenagers with a psychiatric disorder had six times higher odds of having at health, legal, financial and social problems as adults, according to a study published Wednesday in JAMA Psychiatry. Those with milder symptoms were three times more likely to have problems as adults.
We already know from previous studies that most adults with mental health issues had a previous psychiatric disorder during childhood – it doesn't have to be the same exact condition. But this study shows mental health problems that occurred during childhood can make it more likely that someone will struggle as an adult, making it more likely that they won't graduate from high school or commit a felony, for instance.
Judge orders counseling for Obama critic Dinesh D'Souza
From India West:
A New York judge has ordered Dinesh D'Souza, an Indian American conservative scribe and Obama critic filmmaker, to do community service for four more years for breaking campaign-finance laws and undergo further counseling.
Judge Richard Berman clarified July 13 that under the sentence he handed down after D'Souza pleaded guilty last year, he has to do eight hours each week for the entire five years he is on probation and not just the eight months he was confined to a halfway house.
The Manhattan federal court judge also read aloud a report from a court-appointed psychologist who called D'Souza "arrogant" and "intolerant of others' feelings," according to the New York Post.
"In my mind it was never contemplated that the eight hours only applied to the period of home confinement," Berman was quoted as telling defense attorney Ben Brafman.
He later read out a report from a psychologist who saw D'Souza, the maker of the anti- Obama film "2016: Obama's America,” and then ordered him to continue attending weekly sessions, the Post said.
WORLD NEWS
Global health workforce, finances remain low for mental health
From the World Health Organization:
Worldwide, nearly 1 in 10 people have a mental health disorder, but only 1% of the global health workforce is working in mental health. This means, for example, that nearly half of the world’s population lives in a country where there is less than one psychiatrist per 100,000 people.
Huge inequalities in access to mental health services exist depending on where people live. On average globally, there is less than one mental health worker per 10,000 people, according to the World Health Organization’s Mental Health Atlas 2014, released today. In low and middle-income countries rates fall below 1 per 100,000 people, whereas in high-income countries the rate is 1 per 2,000 people.
Spending on mental health is still very low
The report states global spending on mental health is still very low. Low and middle-income countries spend less than US$ 2 per capita per year on mental health, whereas high-income countries spend more than US$ 50. The majority of spending is going to mental hospitals, which serve a small proportion of those who need care. High-income countries still have a far higher number of mental hospital beds and admission rates than low-income countries at nearly 42 beds and 142 admissions per 100,000 population.
Training of primary care staff in mental health is critical to building capacity for recognizing and treating persons with severe and common mental disorders. Since 2011, the number of nurses working in mental health has increased by 35%, but shortages still exist in all disciplines, particularly in low and middle-income countries.
The Atlas finds countries are making progress on creating policies, plans, and laws for mental health, which provide the bedrock for good governance and service development. Two-thirds of countries have a policy or plan and half have a stand-alone mental health law. However, most of the policies and laws are not fully in line with international human rights instruments, implementation is often weak, and persons with mental disorders and family members are frequently only marginally involved in their development.
Mental health professionals demand cancelation of Israel conference
From The Electronic Intifada:
More than 200 leading mental health professionals from around the world have signed an open letter calling for the cancellation of a European psychotherapy conference scheduled to be held in Jerusalem in August.
In the letter, published in the UK newspaper The Independent, the psychologists and psychoanalysts, many from the UK, France and the United States, urge their colleagues to respect the Palestinian call for boycott and stay away from the conference should it go ahead as planned.
Meanwhile, leading actors, authors, academics and architects in the UK have put their names to an open letter to David Cameron, urging the UK prime minister to push for immediate EU sanctions on Israel until it abides by international law and ends its occupation and siege of Palestinian territories.
The two letters, with their diversity of signatures, highlight how the boycott, divestment and sanctions movement (BDS) is growing in range and scale.
Iran changes law to make divorce harder; makes counselling compulsory
From Daily News & Analysis:
Iran has changed a law to make divorce by mutual consent invalid unless couples have first undergone state-run counselling, the country's latest move to tackle a rise in broken marriages.
The measures, reported by media at the weekend, are contained in a new family law that a top official said would be implemented by Iran's judiciary.
"A decree of divorce by mutual consent, without counselling, is forbidden," Parnian Ghavam, head of the judiciary's social work and counselling office, was quoted as saying by Tasnim news agency.
All Iranians filing for divorce would be obliged to go to a counsellor, she said. "From now on, without this it will not be possible to register divorces of mutual consent." Iran's average divorce rate peaked at 21 per cent last year, with big cities showing far higher rates.
Time to tackle Australia's mental health crisis, Tony Abbott told
From The Guardian:
Mental health, welfare and medical groups have intensified their call for a fully funded mental health agreement, warning the system remains in crisis.
Mental Health Australia has penned an open letter to the prime minister, Tony Abbott, and the premiers and chief ministers calling for action ahead of next week’s “leader’s retreat” in Sydney.
The chief executive of Mental Health Australia, Frank Quinlan, said the federal health minister, Sussan Ley, had indicated the country needed a national, coordinated and binding agreement on mental health.
“We have waited too long for such and agreement,” Quinlan said. “The system is in crisis right now, and we need action, not after the next budget, not after the next election, but starting now with a commitment from our leaders.”
Abbott will meet the premiers next week for a Council of Australian Governments meeting which will discuss the division of service delivery responsibilities between Canberra and the states.
VIEWPOINTS
I came out of a teenage mental health unit worse than when I went in
From Fern Brady in The Guardian:
For us, a typical day would be spent bickering with support staff in the morning over petty, ever-changing rules, followed by group therapy, doing strange artwork-cum-trust exercises with the occupational therapist and watching telly. Despite the known curative properties of watching repeats of Jeremy Kyle, I selfishly replaced them with “school time”, where my justifiable panic over how I’d ever study for my highers in a mental unit were mistakenly interpreted as part of my illness.
There was no sharing of information between services (the small matter of me trying to top myself was never passed from A&E to the referring psychiatrist), there was never any explanation of a structured care plan, or if there was, no one told me. I received one hilarious session of what I think was meant to be cognitive behavioural therapy, where the unit manager dramatically pushed a tissue box askew (“How does THAT make you feel, Fern? Hmm?”) as I tried not to laugh.
We were spoken about with disdain and in oddly clinical terms – “the young people” and “service users” – instead of treated as real people with valid feelings. There was always the vague sense that I’d done something wrong, that we’d all done something wrong, even though we hadn’t.
Psychiatry's identity crisis
From Richard A. Friedman in the New York Times:
It seems that leaders in my field are turning their backs on psychotherapy and psychotherapy research. In 2015, 10 percent of the overall National Institute of Mental Health research funding has been allocated to clinical trials research, of which slightly more than half — a mere 5.4 percent of the whole research allotment — goes to psychotherapy clinical trials research.
As a psychiatrist and psychopharmacologist who loves neuroscience, I find this trend very disturbing. First, psychotherapy has been shown in scores of well-controlled clinical trials to be as effective as psychotropic medication for very common psychiatric illnesses like major depression and anxiety disorders; second, a majority of Americans clearly prefer psychotherapy to taking medication. For example, in a meta-analysis of 34 studies, Dr. R. Kathryn McHugh at McLean Hospital found that patients were three times more likely to want psychotherapy than psychotropic drugs.
Finally, many of our patients have histories of trauma, sexual abuse, the stress of poverty or deprivation. There is obviously no quick biological fix for these complex problems.
Still, there has been a steady decline in the number of Americans receiving psychotherapy along with a concomitant increase in the use of psychotropic medication in those who are treated in the outpatient setting. These trends are most likely driven by many factors, including cost and the limited availability that most Americans have to mental health practitioners. It is clearly cheaper and faster to give a pill than deliver psychotherapy.
Timing is everything when it comes to marriage counseling
From Terry Gaspard in the Huffington Post:
Truth be told, the effectiveness of marriage counseling is directly related to the motivation level of both partners and timing. For some couples, marriage counseling is really divorce counseling because they've already thrown in the towel. For instance, one or both partners may have already decided to end the marriage and he/she uses the counseling as a way to announce this to their partner. Sometimes, the problems in a marriage can be too ingrained and longstanding for the counseling to be effective. For others, they don't honestly share their concerns with the therapist.
Further, it's important to choose a therapist who has experience working with couples and who is a good fit for both you and your partner. If both partners don't feel comfortable with the therapist, this can negatively impact progress; or one person may prematurely drop out.
Timing is an essential element in whether marriage counseling works. Unfortunately, most couples wait much too long to reach out for help repairing their marriage. According to relationship and marriage expert Dr. John Gottman, couples wait an average of six years of being unhappy before getting help. Think about this statistic for a few minutes. Couples have six years to build up resentment before they begin the important work of learning to resolve differences in effective ways.
Global health workforce, finances remain low for mental health
From the World Health Organization:
Worldwide, nearly 1 in 10 people have a mental health disorder, but only 1% of the global health workforce is working in mental health. This means, for example, that nearly half of the world’s population lives in a country where there is less than one psychiatrist per 100,000 people.
Huge inequalities in access to mental health services exist depending on where people live. On average globally, there is less than one mental health worker per 10,000 people, according to the World Health Organization’s Mental Health Atlas 2014, released today. In low and middle-income countries rates fall below 1 per 100,000 people, whereas in high-income countries the rate is 1 per 2,000 people.
Spending on mental health is still very low
The report states global spending on mental health is still very low. Low and middle-income countries spend less than US$ 2 per capita per year on mental health, whereas high-income countries spend more than US$ 50. The majority of spending is going to mental hospitals, which serve a small proportion of those who need care. High-income countries still have a far higher number of mental hospital beds and admission rates than low-income countries at nearly 42 beds and 142 admissions per 100,000 population.
Training of primary care staff in mental health is critical to building capacity for recognizing and treating persons with severe and common mental disorders. Since 2011, the number of nurses working in mental health has increased by 35%, but shortages still exist in all disciplines, particularly in low and middle-income countries.
The Atlas finds countries are making progress on creating policies, plans, and laws for mental health, which provide the bedrock for good governance and service development. Two-thirds of countries have a policy or plan and half have a stand-alone mental health law. However, most of the policies and laws are not fully in line with international human rights instruments, implementation is often weak, and persons with mental disorders and family members are frequently only marginally involved in their development.
Mental health professionals demand cancelation of Israel conference
From The Electronic Intifada:
More than 200 leading mental health professionals from around the world have signed an open letter calling for the cancellation of a European psychotherapy conference scheduled to be held in Jerusalem in August.
In the letter, published in the UK newspaper The Independent, the psychologists and psychoanalysts, many from the UK, France and the United States, urge their colleagues to respect the Palestinian call for boycott and stay away from the conference should it go ahead as planned.
Meanwhile, leading actors, authors, academics and architects in the UK have put their names to an open letter to David Cameron, urging the UK prime minister to push for immediate EU sanctions on Israel until it abides by international law and ends its occupation and siege of Palestinian territories.
The two letters, with their diversity of signatures, highlight how the boycott, divestment and sanctions movement (BDS) is growing in range and scale.
Iran changes law to make divorce harder; makes counselling compulsory
From Daily News & Analysis:
Iran has changed a law to make divorce by mutual consent invalid unless couples have first undergone state-run counselling, the country's latest move to tackle a rise in broken marriages.
The measures, reported by media at the weekend, are contained in a new family law that a top official said would be implemented by Iran's judiciary.
"A decree of divorce by mutual consent, without counselling, is forbidden," Parnian Ghavam, head of the judiciary's social work and counselling office, was quoted as saying by Tasnim news agency.
All Iranians filing for divorce would be obliged to go to a counsellor, she said. "From now on, without this it will not be possible to register divorces of mutual consent." Iran's average divorce rate peaked at 21 per cent last year, with big cities showing far higher rates.
Time to tackle Australia's mental health crisis, Tony Abbott told
From The Guardian:
Mental health, welfare and medical groups have intensified their call for a fully funded mental health agreement, warning the system remains in crisis.
Mental Health Australia has penned an open letter to the prime minister, Tony Abbott, and the premiers and chief ministers calling for action ahead of next week’s “leader’s retreat” in Sydney.
The chief executive of Mental Health Australia, Frank Quinlan, said the federal health minister, Sussan Ley, had indicated the country needed a national, coordinated and binding agreement on mental health.
“We have waited too long for such and agreement,” Quinlan said. “The system is in crisis right now, and we need action, not after the next budget, not after the next election, but starting now with a commitment from our leaders.”
Abbott will meet the premiers next week for a Council of Australian Governments meeting which will discuss the division of service delivery responsibilities between Canberra and the states.
VIEWPOINTS
I came out of a teenage mental health unit worse than when I went in
From Fern Brady in The Guardian:
For us, a typical day would be spent bickering with support staff in the morning over petty, ever-changing rules, followed by group therapy, doing strange artwork-cum-trust exercises with the occupational therapist and watching telly. Despite the known curative properties of watching repeats of Jeremy Kyle, I selfishly replaced them with “school time”, where my justifiable panic over how I’d ever study for my highers in a mental unit were mistakenly interpreted as part of my illness.
There was no sharing of information between services (the small matter of me trying to top myself was never passed from A&E to the referring psychiatrist), there was never any explanation of a structured care plan, or if there was, no one told me. I received one hilarious session of what I think was meant to be cognitive behavioural therapy, where the unit manager dramatically pushed a tissue box askew (“How does THAT make you feel, Fern? Hmm?”) as I tried not to laugh.
We were spoken about with disdain and in oddly clinical terms – “the young people” and “service users” – instead of treated as real people with valid feelings. There was always the vague sense that I’d done something wrong, that we’d all done something wrong, even though we hadn’t.
Psychiatry's identity crisis
From Richard A. Friedman in the New York Times:
It seems that leaders in my field are turning their backs on psychotherapy and psychotherapy research. In 2015, 10 percent of the overall National Institute of Mental Health research funding has been allocated to clinical trials research, of which slightly more than half — a mere 5.4 percent of the whole research allotment — goes to psychotherapy clinical trials research.
As a psychiatrist and psychopharmacologist who loves neuroscience, I find this trend very disturbing. First, psychotherapy has been shown in scores of well-controlled clinical trials to be as effective as psychotropic medication for very common psychiatric illnesses like major depression and anxiety disorders; second, a majority of Americans clearly prefer psychotherapy to taking medication. For example, in a meta-analysis of 34 studies, Dr. R. Kathryn McHugh at McLean Hospital found that patients were three times more likely to want psychotherapy than psychotropic drugs.
Finally, many of our patients have histories of trauma, sexual abuse, the stress of poverty or deprivation. There is obviously no quick biological fix for these complex problems.
Still, there has been a steady decline in the number of Americans receiving psychotherapy along with a concomitant increase in the use of psychotropic medication in those who are treated in the outpatient setting. These trends are most likely driven by many factors, including cost and the limited availability that most Americans have to mental health practitioners. It is clearly cheaper and faster to give a pill than deliver psychotherapy.
Timing is everything when it comes to marriage counseling
From Terry Gaspard in the Huffington Post:
Truth be told, the effectiveness of marriage counseling is directly related to the motivation level of both partners and timing. For some couples, marriage counseling is really divorce counseling because they've already thrown in the towel. For instance, one or both partners may have already decided to end the marriage and he/she uses the counseling as a way to announce this to their partner. Sometimes, the problems in a marriage can be too ingrained and longstanding for the counseling to be effective. For others, they don't honestly share their concerns with the therapist.
Further, it's important to choose a therapist who has experience working with couples and who is a good fit for both you and your partner. If both partners don't feel comfortable with the therapist, this can negatively impact progress; or one person may prematurely drop out.
Timing is an essential element in whether marriage counseling works. Unfortunately, most couples wait much too long to reach out for help repairing their marriage. According to relationship and marriage expert Dr. John Gottman, couples wait an average of six years of being unhappy before getting help. Think about this statistic for a few minutes. Couples have six years to build up resentment before they begin the important work of learning to resolve differences in effective ways.
