May 29, 2011

ideological hygiene

It's impossible to be a purist on eating disorder information, I find. It's too rich and complex a topic. If you want to only read, recommend, spend time with, and be seen with those whose beliefs align completely with your own you are likely to spend your high-minded time in a corner alone. Plus, it doesn't bring about change.

It's sticky, though. I'd like to "fall on my sword" on any of a number of ideological sharp points, but I'd be dead in so many horrible ways. I sometimes picture taking all of the people and thinkers in the eating disorder world and herding them into chalked off areas like "don't blame families," "use the term brain disorder," "don't use average BMI as a recovery marker," "worry about the word 'prevention' in EDs," "don't believe in an 'obesity crisis'," "understand and believe in using evidence where available," "give individual parents the benefit of the doubt on their parenting," "believe re-feeding is the first best medicine for eating disordered thinking," "consider clinicians consultants rather than bosses on the treatment team," "actually USE these beliefs in clinical practice," "use the word anosognosia," and "love Laura Collins." I dream of the day that I could make an circle that includes all of the above and there'd be anyone in it. But there ain't.

In advocacy work, this is okay, because I can continue to try to herd allied cats together, and keep learning and changing myself. In fact, as soon as I don't think I need to do that I get to go back to regularly scheduled life, and paid employment.

In helping parents, however, this lack of ideological hygiene is perilous. I quail at recommending ANY treatment provider because I feel every family has to do their own homework on which set of beliefs and methods is best for their situation - as none of them are the same and none of them even include all the same elements - some of my favorites actually do mutually exclusive stuff. Some of my favorite books on eating disorders include information I wish I could mark out with a black pen and annotate "ignore this part! nothing to see here!" Yet I DO want parents to read those books for the elements that are essential and found nowhere else. I do want parents to go to those providers instead of the wilderness of well-meaning but demonstrably harmful ones instead.

Parents: there is no Yellow Brick Road here. We're still coming out of the Dark Ages and even some of the finest thinkers disagree with one another. Our job is to light the path for OUR family with our own compass of good information and good judgment and the trust our children have in our loving protection.

When I grow up, I'll go for flamenco

Okay, so I stick to tap dancing because it's hard enough to organize myself below the ankles - but if I were to take up another form it would be Flamenco. A gorgeous link shared by one of my dance class friends:

Iron and Wine - "Boy with a Coin"

May 28, 2011

New Forum for Carers

I started the Around the Dinner Table forum in 2004. At that time it was the only parent-led, parent-moderator, parent-focused online forum (in English) focused on eating disorders. Still is, as far as I know. It isn't expensive to do, can be done for free, actually - and isn't technically difficult. I have always wished, and continue to, that other such forums would sprout up. There should be many, with different atmospheres, rules, cultures.

There are a few out there that are part of other organizations that have forums for patients as well, and I am always glad to see more:

New: BEAT Carers Forum

Cleveland Center looking for Family Based Therapist

posting by request:

Senior FBT Position

 The Cleveland Center for Eating Disorders (CCED) is looking to hire a trained Family Based Therapist to work in our adolescent eating disorder program. CCED aims to provide FBT in the context of multiple levels of care, including classically adherent outpatient FBT as well as both Intensive Outpatient and Day Treatment models that strive to maintain fidelity to the model throughout care.  Our treatment team includes FBT informed pediatricians, psychiatrists, office staff, and family support groups.  Our FBT program is led by Jorey Beegun, PhD a FBT certified psychologist.  CCED is led by Lucene Wisniewski, PhD and Mark Warren, MD both of whom are FBT trained and dedicated to developing and utilizing the FBT model as widely and effectively as possible.  

This position will entail providing FBT to adolescents suffering from eating disorders in both outpatient and higher level of care setting.  Depending on experience, responsibilities may also include supervision of interns as well as consultation/outreach to staff.   Opportunities to become involved in research are also available. Competitive salary. Qualified applicants must be eligible for licensure in the State of Ohio. Deadline for  receipt of applications is July  01, 2011 or until filled.

TO APPLY: Please send your CV, letter of interest, and three letters
of references to:

May 27, 2011

Anorexia Might Be a Disease Like Diabetes

More on this later, but in case you haven't seen:
Anorexia Might Be a Disease Like Diabetes, Scientists Say

Stop genderizing eating disorders!

"I’m looking forward to the day when titles like ‘Guys Have Eating Disorders, Too’ aren’t necessary." says my friend, Matt.

And, I look forward to the day that it doesn't have to be guys who say this. We do a disservice to all eating disorder patients when we treat this as a woman's issue or think that using the female pronoun is "more convenient."

We all need to stop genderizing eating disorders or thinking that because the percentage is somewhat lower that the illness is somehow less important when it strikes males.

Interview: “Guys Have Eating Disorders, Tool”

Here's another reason, though we shouldn't need one: girls with eating disorders need to know this, too.

May 26, 2011

Why am I writing a check?

Wait, Laura, why are you writing a check for registration for The Map Ahead: F.E.A.S.T. Symposium in Old Town Alexandria, November 3-4 2011?

Aren't you the Executive Director of F.E.A.S.T.? Why don't you get a discount, or free registration? Shouldn't you get in free?

Well, here's the thing. I am paying because that's what it costs to feed me and pay my share of the costs of the conference. We don't have sponsors, or advertisers, or exhibitors - because F.E.A.S.T. is committed to financial independence from service providers. We don't have an endowment. F.E.A.S.T. is entirely paid for by individual donations by our members and those funds pay for F.E.A.S.T., not for any of us to be part of this conference. Even our speakers are paying their own way. We've calculated the charges for this conference to be pretty much exactly what the event costs us to put on: food, supplies, insurance. No profit, no charging our members.

We have calculated in a discount for parents, though, and I'm taking that!

The Early Bird Rate for the conference ends June 1. If you've registered already, please send your check to F.E.A.S.T. or go to the DONATE page on the site to pay. (sorry, you can't log back in and pay there, but we'll make sure it's reconciled.

May 25, 2011

Medication Research Study for Adults with Anorexia Nervosa in Westchester, NY

posting by request:

The Center for Eating Disorders at Weill Cornell Medical College’s Westchester campus is seeking participants to help with a research study.

Are you between the ages of 18-55 suffering from Anorexia Nervosa? You may be eligible to participate in a National Institute of Mental Health sponsored study.

This study is looking at a medication treatment for Anorexia Nervosa. You will receive weekly medical monitoring and research medication at no cost in return for your participation. Additionally you will be compensated $250 for completing the 16-week medication trial and 8-week follow-up. Study is located in White Plains, NY.

For more information please call Melanie Lipton at 914-682-5475 or email at

May 24, 2011

Virginia Currents on PBS, segment on F.E.A.S.T.

It is completely freaky to watch myself on T.V., but I did, last week. I went down to Richmond to tape a segment at WCVW PBS on Wednesday and then on Thursday night sat with my son and husband and mother-in-law and saw it air. Gulp!

Being in a field where appearance is a taboo topic - for good reason - is it okay to admit that I struggled a lot with how much I hoped I wouldn't "look" weird and how much I wished I didn't think about it and how it didn't matter and then - on seeing it - how relieved I was that my hair cooperated and I'd chosen appropriate colors (thanks to my Facebook coaches who even had tips on my underthings!) and my worst fears were naught. I found it really interesting to see how the set I had been sitting in translated to the tape - and how having seen the interviewer on T.V. before meeting her made her feel so familiar when we sat on the set. But there isn't anything natural about being in a big dark room on a little stage with three cameras and a director and lots of pressure to think quick and seem relaxed!

Lee told me afterward that I did a good job and seemed at ease. I told her I quelled my nervousness by focusing on all the parents out there who want someone to speak up for them. I certainly couldn't go through all this tsores to sell soap or raffle tickets! But I'm also enjoying the feeling that I faced my fears and had this experience. The best part, though? My son's reaction. "You mean on real T.V.?" To which someone there said, "Just PBS."

Trust my family to "keep it real."

Enjoy: Virginia Currents start at 15:35 minutes

**P.S. PBS *is* real T.V.!

Brain research new 'moon shot,'

Wish I was there!!

Brain research new 'moon shot'

More information: here.

May 23, 2011

Outreach to pediatricians

Why F.E.A.S.T. has an exhibitor's table at the American Academy of Pediatricians National Conference  2011:

10. The first place most parents bring their child when they seem unwell is the family doctor or pediatrician.
9. The best possible time to intervene is at that first appointment.
8. Failure to validate a parent's concerns at that first appointment and provide appropriate information and referrals is a lost opportunity to save a life.
7. It is time for the eating disorders community to speak directly to the front line doctors.
6. F.E.A.S.T. will have the opportunity to distribute the AED's new document FOR DOCTORS.
5. 15,000 pediatricians eager for information is the right place for F.E.A.S.T. to provide it.
4. We can learn more about the state of pediatrics and eating disorders in two days than in years of second-hand reports.
3. The eating disorders world needs to get out of its cul-de-sac of discussion with itself and start talking with others.
2. The F.E.A.S.T. Medical Education Task Force is helping families by actively reaching out to all medical professionals.
1. Because of all the families who don't know today that in the next year they will be bringing an ill, strangely irrational, resistant child to the pediatrician to be given - or not - a diagnosis that will change the course of their life. If we can help that first appointment be the path to successful treatment instead of the first of lost opportunities, we want to be there!

May 20, 2011

My daughter graduates today

My dear, wonderful, talented, funny, fierce, charming, beautiful, clever, kind, BELOVED daughter graduates today from college. I am surely the proudest mother EVER, having the finest day EVER, and so happy to share!

Congratulations, my love. We are all so happy for you, so proud, so tickled to see what you'll do next! Is there a limit on how many exclamation points I can use?


May 19, 2011

Does Eating Give You Pleasure, Or Make You Anxious?

Does Eating Give You Pleasure, Or Make You Anxious?

"a paradoxical response to food"

I'm so glad to see, and share, this press release and this new article. We need to understand that anorexia involves very powerful biological mechanisms that tend to be explained as other things, like "fear of being fat" or "disgust with unhealthy foods," "feeling unworthy," or "wanting to feel control in one's life. Surely, most people have reasons they might diet or avoid foods - but can those reasons alone cause an aversion to eating that overpowers the most basic of survival mechanisms and defies logical thought?

I do want to note that this release misses something important: that while this predisposition to respond to low nourishment may pre-exist, it doesn't always persist. I know lots of patients, and their families, who recover fully and lose this phobic aversion and go on to normal lives - especially when the intervention is early and thorough and involves full, optimal and sustained weight restoration - supported by others.

May 18, 2011

Shop For A Psychotherapist To Avoid The Lemons

I'm a big fan of psychotherapy. I do, however, believe that not all psychotherapy is equal. It takes good training, good skills, and unique qualities that can't be boiled down to a formula. FINDING good psychotherapy can be the difference between misery and the freedom to live a fulfilling life. Patients and their families must be be deliberative and well-informed as they search for the right treatment.

*assuming they HAVE a choice, which of course is not true in some countries or for people without money or insurance or proximity to qualified treatment - or the mental wellness THEY need to "shop for a psychotherapist as they would a flat-screen."

Shop For A Psychotherapist To Avoid The Lemons

"Some therapists fear that the push for evidence-based techniques will restrict their ability to connect with their clients on a deeply human level, that they'll be doing cookbook therapy.

Scott Lilienfeld, a clinical psychologist at Emory University, says a good psychotherapist can do both."

May 14, 2011

Medical transference

Odd thing:

To avoid getting freaked out by watching Alien with the guys in the living room I ended up watching House in the den... which is much more graphic and disturbing and yet, totally acceptable.

May 10, 2011

six shots would not go very far against 400 people

A fascinating account, in one of my favorite blogs, Look Me In The Eye, where he describes an unexpected event he observed in Brooklyn in which a "crowd of unarmed men faced down two guys with guns, and won"

Also, avoid radium.

May 9, 2011

Organizing principle

If I was to sum up my approach to eating disorders - and the main way I differ from the mainstream, it is this:

The agent of change needs to be those around the patient, not the patient.

The parents need to keep treatment going, and the clinicians need to use the parents to do so as well. The school, the community, the family's friends, the faith community, everyone around the patient needs to stand together to keep the patient moving toward recovery. Eating disorders thwart motivation and insight and clarity - but by focusing on supporting the patient by creating a firm support system that does not depend on the patient's motivation or insight or judgment we have the chance to put ED away and let the patient free.

Carrie with an, as usual, excellent description of the rabbit hole.

One family looking for help

Paying for treatment for an eating disorder - in some countries - is an enormous additional burden to a family already struggling with "how, with whom" as well.

There is no way to help everyone, but it touches my heart when people reach out on the behalf of others:
Hi Laura! I wanted to contact you, I am a part of the around the dinner table forum, although i do not post much anymore as my daughter has been in recovery for quite awhile now (AMEN!!) But I wrote to for a friend in desperation. Her daughter, Sarah, has struggled with an eating disorder for awhile now. She started with anorexia as a teenager and her mother helped her recovery through FBT. Sarah is now struggling with severe bulimia and is desperatly trying to recover but is unable to stop the binge purge cycle, she is 22 years old, still young but in a hard place with the changes of becoming a young adult. She has agreed to go into treatment to stop the binge purge cycle and get on track and hopefully learn to cope with being an adult now, and then her mother plan to have her come live home for awhile and help her in her journey through FBT and support. The problem is that Sarah's insurance company will not help for treatment past 1 or 2 weeks at this point, they have done multiple appeals and even hired an attorney with no luck. Sarah and her mother are both drained and feel defeated. Sarah and some supportive friends started a fundraiser for her through give it forward. They are having trouble getting people aware of it and getting donations because she has been so isolated throughout her illness. I was wondering if I could pass the link along to you to try and get some more donations going on. They have made a short term goal of 5,000 because that will be enough to at least get her started at treatment and then the goal will be raised once she can get there to hopefully keep her there for a sufficent amount of time. Here is the link.     
Also, thankyou so much for everything you have done and continue to do, it has certainly helped me and helped sarah and her family.

May 7, 2011

Talk is cheap

Honestly, when I posted about prevention I expected to get very negative feedback. But by email and in the comments I see that not only did I strike a raw nerve but that there are people who actually agree with me. This is really welcome news, and a great relief. Blogging is odd because the impulse to speak up is not done with the expectation that I'll be heard or agreed with. I say it because it itches, and I want to shout.

So, but, then... what to do about this issue? As nice as it is to know I'm not alone I still feel quite helpless in the tide of things going in the other direction. The AED conference in Miami last week, which is arguably the biggest collection of experts on EDs, featured plenty of prevention talk (less than the other more consumer and therapy-oriented events). I mostly fight it by refusing to join it, but that doesn't bring change. Prevention talk is cheap. So is anti-prevention talk. What about action? I honestly don't know what to do about it. Aside from getting it straight in my head, and speaking up when spoken to, and not participating in it -- is there something more I can do?

I honestly feel that the "prevention" tide is a new version of the older ideas, more palatably and better marketed recycling of the idea that eating disorders are about being victimized by someone or something. While it is less common these days to cite parents as that "someone" the new "somethings" are media and a social pressure to be thin.

A while back an author asked me why I did not review and talk to parents about her book for parents - one that talks so much about many of the same things I do. (I try to stick to positive reviews of things I think are helpful to parents and stay silent on the ones I do not) I explained that the section on prevention, in a book for parents whose loved ones already have eating disorders, was a back-handed way of saying "these are the things you did wrong or failed to stop." As positive as it sounds to say "Mom, don't diet" and "Give your daughter's praise for their accomplishments, not their looks," the corollary is that your daughter's eating disorder came about because you didn't. This is not to say that we should NOT be doing those good things or that failing to do them helps, but if those things prevent an eating disorder (and I know of no evidence to say they do) then yes, we would need to hold ourselves responsible for helping cause the eating disorder. If that was true then yes, we do need to change those things in order for our loved ones to recover. And apologize. Profusely.

Listen: I dieted as I got older and pregnancies changed my shape. I talked about healthy foods. I bought into every foolishness out there, and even remember whining in front of a mirror in front of my daughter. That was stupid. I regret it, deeply. It hurts me to think of. But I don't believe it caused my daughter's eating disorder and not having done all that or had those attitudes would not have prevented it. Doing penance for it would not have treated it either. I did change, and thank goodness - for my own sake and for my family and friends (who think I'm a nut for criticizing dieting and refusing to join in the "you're so pretty and I'm so fat" parties.

But this prevention talk is a witch hunt searching for easy targets. Our whole society is off on an pro-dieting tear, and pressures to be thin and gorgeous and young and upper class and virtuous and have small feet.... these are ubiquitous. If we went on another tear in another direction - and we will - it will have effects on mental health as well. But soap commercials don't cause OCD. Banning death won't prevent depression. Anxiety disorders aren't a sign of something dark and hidden in someone's past. And I worry that what we're preventing is a genuine understanding of eating disorders.

May 6, 2011

The Map Ahead: F.E.A.S.T. Symposium in Old Town Alexandria, November 3-4 2011

I'm pinching myself! No, not self-harm: I'm just beside myself that I got to speak today with Ruth Sullivan, a mother who is a role model for us all. Sullivan, who has accepted our invitation to speak at The Map Ahead: F.E.A.S.T. Symposium in Old Town Alexandria, November 3-4 2011, sees, as I do, the parallels between what happened with autism and what needs to happen with eating disorders.

Parents need to not only throw off the guilt and marginalization we need to get active. We need to stand up for our dear loved ones by pressing for more research, better treatment, access to care. We need to stand up for the role of families in treatment and in advocacy.

I look forward to learning from and being inspired by Ruth Sullivan on November 3!!

**Thank you to Jennifer, on our program committee, for making the introduction!

Crowdsourcing medicine

Oh, I know you are going to love this:

Think Like a Doctor: A Litany of Symptoms

May 5, 2011

mutually exclusive respect

This past few months have shown me, in three different spheres, a common clash. Here's the set-up:
  • Well-meaning people
  • Mutually exclusive ideas
  • Muddled vocabulary
  • Feelings
In the ensuing melee, goodwill is eroded in some cases but genuine communication and bonds also forged.
This is how it gets done, I see.

Mutually exclusive ideas:
  • Everything is okay as long as it is meant well.
  • Some things are not okay no matter how they are meant.
  • Data doesn't matter. Too much is unknowable.
  • Data matters. There are truths to be discerned and myths to be called out.
  • Disagreeing is disrespect.
  • You can disagree with someone's ideas without being against that person.
In these interactions I have, until recently, thought that the path to mutual understanding and progress was to establish common terms and facts. But here are the most important incompatible positions:

I do not rely on data and facts to guide my beliefs.
I do not respect those who ascribe to the above.

Here is my radical new idea. I refuse to reject those who do not seek out or are unmoved by empiricism. My prejudice against that point of view has been cold and hard-bitten. It also doesn't work. People are not their ideas - wrong or right. People are people. If I want people to accept my ideas I first have to get their attention as a person. That's a challenge. I'm still working on it.

May 4, 2011

'Treme' season premiere: No vampires or incest, but the music - the music!

I've never had a show before. You know, the kind of show you wait all week for, tape, watch over again. I've never analyzed IMDB over a show, learned the backgrounds of all the actors, Googled for reviews. I've not ever begged friends to watch a show, or stayed up past 10 to watch ANYTHING.

Treme, however, is my show. I even joined a Facebook page about it. I compulsively "like" everything HBO wants to say about it (always too tepid for my taste) in some vain hope that I can keep it from being cancelled. I whined for nine months since the first season ended.

Someone who knows New Orleans dissed Treme as inauthentic and instead of feeling bad about being a fan I have crossed that person off my Christmas list. So there.

I was so upset about a character dying that I can't forgive the guy who plays him - I never will. In weird coincidence, my husband walked by the actor the very next day after that aired, in the streets of New York, and I was annoyed that he didn't go shove him. He said he couldn't think of anything to say to the poor guy but "you made my wife cry last night." I know he didn't really leave his kid and wife behind, I know he didn't write the scene, and I know that it was as it should be for the story, but.

(** added: The saddest part of this anecdote is that I experienced inexplicable relief the guy is alive. Then mad that HE gets to walk around New York and Creigh doesn't.)

That's hooked.

It's not for everyone. In fact, it is for just exactly how many fans it needs to get renewed and not one more, thank you. I love Treme but if it gets too popular I'll be dismayed. This review, in particular, sums it up: "Hey, if it’s possible to enjoy a show about giant wolves and hottie twincest and ice zombies and wigs, isn’t it also possible to enjoy a show about good music, good food, and the death and life of an American city?

gastroparesis and rumination

A reader asked me to write about gastroparesis and rumination. Lots of syllables, important ones, too.

As parents, we have to learn a lot of vocabulary in order to help our kids. One good resource is the F.E.A.S.T. Glossary, where these two topics come up.

Rumination disorder 

No sex in the summer!

Well, now we know how to prevent eating disorders: let's re-name the months in the spring!

Spring Babies Face Anorexia Risk

Seriously, this is an important reminder that environment is more than just the thoughts and ideas and upbringing - and that we really just don't know what causes eating disorders. There are many mysteries to examine.

May 3, 2011

Committing the Humblebrag

Have Facebook or Twitter or a tap-happy email account?

You may be a Humblebragger: Humble brag.

My daughter told me when I first got on Facebook that there are really only two activities: bragging and stalking I've tried to add "affirming" but she laughed - "that's just bragging about stalking, mom."

But really, this sums it up: "What I hate about a humble brag is that people try to come off like they aren't bragging. It's people not being honest about their intention. Just tell us you are at an exclusive party. Don't hide it behind a complaint about your dress not fitting."

My husband turned me on to the Humble Brag, and we both were in stitches - and chagrin - as we analyzed ourselves. Yep, some humblebragging going on - it's hard not to. Yet once you recognize what a humblebrag is, it becomes harder to do any more - at least consciously - and I think if we banned it the Internet would collapse in on itself in a little heap of blushing chagrin. If humility falls in the forest and no one hears it, was it humble at all?

Polyglots Might Have Multiple Personalities

From the "I get this!" files: Polyglots Might Have Multiple Personalities. I can't really claim to be fluent in other languages, at least not any more, but I did spend years studying and speaking Mandarin Chinese - and labored endless semesters in French plus a few less formal forays into Spanish and Greek. Enough to have experienced the sense of thinking in - even dreaming in - alternate languages. When I read about people taking on different personalities when speaking different tongues it IMMEDIATELY resonated for me. I feel that!

There is a Laura, a 李淑 that I have almost no access to any more because I can only just eke out a coherent Mandarin sentence, and she was not quite the same as the one writing this in English. She is stuck in being 18-25, for one thing. She was more polite. Less assertive. She was 19 and lived in Taiwan, and then in New York City, and she could only trick people into thinking she spoke Chinese for a few minutes at a time if she was wearing her motorcycle helmet at the night market or on the phone because Mandarin was a second language for so many people around her. She fell back home to the US after two years in a state of cultural exhaustion and alienation. But I liked her. She had good self-esteem - probably because she was an English teacher in a culture where educators are still revered. She was, strangely enough, quite brave: she moved around the world fearlessly, and with curiosity and fascination with the world.

The Greek Laura was far less confident. Risk averse. Δάφνη wasn't able to figure out how to be a girl in a culture that wanted girls to stay home at night if unaccompanied, and stay quiet when men were speaking. So she was quiet all the time and her words stilted. She walked every day for the better part of a year past a beautiful church she was too timid to enter and too prideful to ask anyone to bring her in. I don't miss that Laura. She liked Greek but it had no time for her.

French: I could translate Camus - at least in my Sophomore year at college. It is lost to me now. I think the elegance and coolness of that culture was inaccessible to me. I spent my 24th birthday, alone, in Paris, and my clearest memory is of conceding to the expediency of adding a TV to my bill because I was unable to do an entire day speaking to real people en français.

The Spanish-stumbling Laura lived in Spanish Harlem. She listened, even danced, and smiled, ate well and got along - but again, an outsider. Language is the way in, and without it - without genuine conversation and friendship and even the ability to argue - one is a tourist living in lively silence, and unseen.

English-speaking Laura is a paler version. But I smile as I say that, in English - because even now I can say my name and channel at least that in Chinese, in Spanish, in Greek, and even in college level French. More personalities, even unspoken here in a kitchen in Virginia, enrich my life.

May 1, 2011

The Morning After

At Miami airport waiting for flight home. A bit underslept, and only one cup of coffee into consciousness.

It was a good event. Well run, as always - AED is very skilled at doing a pretty complex event. Could be more real food, and sitting down to eat it, but I know there's a reason these decisions get made.

Enjoyed meeting some people I'd really wanted to know - and of course many unexpected and delightful connections made. Several special people I'd like to spend time with anywhere, anytime. Tickled to intruduce admired people to one another.

A couple of problems, of course. The phrase "why can't we all just get along" came up with both irony and genuine introspection. Lessons learning: relationships, relationships, relationships. Mutual respect, even when opposed. And the inability of mere words to truly communicate.