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More than 80% of Nagorno-Karabakh's population flees as future uncertain for those who remain.
The exodus of more than 80% of the population of Nagorno-Karabakh raises questions about Azerbaijan's plans for the ethnic Armenian enclave following its lightning offensive last week to reclaim the breakaway region.

The Armenian government said Friday evening that more than 97,700 people, from a population of around 120,000, had fled to Armenia since Azerbaijan attacked and ordered the region's militants to disarm. The enclave's separatist government said it would dissolve itself by the end of the year after a three-decade bid for independence.

Some people lined up for days to escape Nagorno-Karabakh because the only route to Armenia — a winding mountain road — became jammed with slow-moving vehicles.

Armenian Health Minister Anahit Avanesyan said some people, including the elderly, had died while on the road to Armenia, because they were “exhausted due to malnutrition, left without even taking medicine with them, and were on the road for more than 40 hours.”

On Thursday, Armenian Prime Minister Nikol Pashinyan alleged that the exodus of ethnic Armenians from Nagorno-Karabakh amounted to “a direct act of an ethnic cleansing and depriving people of their motherland.” Azerbaijan’s Foreign Ministry strongly rejected Pashinyan’s accusations, saying the departure of Armenians was “their personal and individual decision and has nothing to do with forced relocation.”

Laurence Broers, an expert on the Caucasus with the London-based think tank Chatham House, said it was unlikely that significant numbers of Armenians would remain in Nagorno-Karabakh and that “the territory will become homogenous.”

“If you define ethnic cleansing as actions by force or through intimidation to induce a population to leave, that’s very much what the last year or so has looked like,” he said.

During the three decades of conflict in the region, Azerbaijan and separatists inside Nagorno-Karabakh, alongside allies in Armenia, have accused each other of targeted attacks, massacres and other atrocities, leaving people on both sides deeply suspicious and fearful.

While Azerbaijan has pledged to respect the rights of ethnic Armenians in the region, most are now fleeing, because they don’t believe that Azerbaijani authorities will treat them fairly and humanely or guarantee them their language, religion and culture.

In December, Azerbaijan blocked the only road connecting Nagorno-Karabakh with Armenia, accusing the Armenian government or using it for illicit weapons shipments to the region’s separatist forces.

Armenia alleged the closure denied basic food and fuel supplies to Nagorno-Karabakh. Azerbaijan rejected the accusation, arguing that the region could receive supplies through the Azerbaijani city of Aghdam — a solution long resisted by Nagorno-Karabakh authorities, which called it a strategy for Azerbaijan to gain control of the region.

In the 1990s, the Azerbaijani population was itself expelled from Nagorno-Karabakh and hundreds of thousands of people were displaced within Azerbaijan. As part of its “Great Return” program, the government in Baku has already relocated Azerbaijanis to territories recaptured from Nagorno-Karabakh forces in a 2020 war.

Analysts believe Azerbaijan could expand the program and resettle Nagorno-Karabakh with Azerbaijanis, while stating that ethnic Armenians could stay or exercise a right to return in order to “refute accusations that Karabakh Armenians have been ethnically cleansed,” Broers said.

A decree signed by the region’s separatist president, Samvel Shakhramanyan, cited a Sept. 20 agreement to end the fighting under which Azerbaijan would allow the “free, voluntary and unhindered movement” of Nagorno-Karabakh’s residents to Armenia.

Some of those who fled the regional capital, Stepanakert, said they had no hope for the future.

“I left Stepanakert having a slight hope that maybe something will change and I will come back soon, and these hopes are ruined after reading about the dissolution of our government,” 21-year-old student Ani Abaghyan told The Associated Press.

“I don’t want to live with the Azerbaijanis," said Narine Karamyan, 50. “Maybe there are some people who will return to their homes. I don’t want that. I want to live as an Armenian.”

After six years of separatist fighting ended in 1994 following the collapse of the Soviet Union, Nagorno-Karabakh came under the control of ethnic Armenian forces, backed by Armenia. Then, during a six-week war in 2020, Azerbaijan took back parts of the region in the south Caucasus Mountains along with surrounding territory that Armenian forces had claimed earlier. Nagorno-Karabakh was internationally recognized as part of Azerbaijan’s sovereign territory.

Armine Ghazaryan, who crossed into Armenia from Nagorno-Karabakh with her four young children, told the AP that it was the second time she had been displaced from her home, saying she had previously sheltered with her children in her neighbors' basement during the war in 2020.

“At least we live in peace here. At least we stay in Armenia," she said upon arriving in the Armenian town of Goris.

On Monday night, a fuel reservoir exploded at a gas station where people lined up for gas to fill up their vehicles to flee to Armenia. At least 68 people were killed and nearly 300 others were injured, with more than 100 others still considered missing after the blast, which exacerbated fuel shortages that were already dire after the blockade.

On Friday the State Emergency Service of Nagorno-Karabakh's interior ministry said 170 remains and body fragments had been collected and would be sent to Armenia for DNA identification.

Avanesyan, the Armenian health minister, said 142 people who were injured after the fuel tank exploded were taken to Armenia for treatment and that some of them were in very serious condition.

On Thursday, Azerbaijani authorities charged Ruben Vardanyan, the former head of Nagorno-Karabakh’s separatist government, with financing terrorism, creating illegal armed formations and illegally crossing a state border. He was detained on Wednesday by Azerbaijani border guards as he was trying to leave Nagorno-Karabakh for Armenia along with tens of thousands of others.

Vardanyan, a billionaire who made his fortune in Russia, was placed in pretrial detention for at least four months and faces up to 14 years in prison. His arrest appeared to indicate Azerbaijan’s intent to quickly enforce its grip on the region.

Another top separatist figure, Nagorno-Karabakh’s former foreign minister and now presidential adviser David Babayan, said Thursday that he would surrender to Azerbaijani authorities who ordered him to face an investigation in Baku.

Cultures Around the World....

"Culture is the bedrock, the final wall, against which one leans one’s back in a godforsaken chaos".

Southeast Asian Cultures:

Thai Culture: Thailand's culture is known for its warm hospitality, Buddhism, ornate temples (like Wat Arun and Wat Phra Kaew), traditional dance (such as Thai classical dance and Khon), Muay Thai (Thai boxing), traditional festivals (like Songkran and Loy Krathong), and delectable cuisine with flavors like sweet, sour, and spicy.

“Culture is a way of coping with the world by defining it in detail.”

Indonesian Culture: Indonesia is a diverse archipelago with over 17,000 islands, each contributing to the country's cultural mosaic. Indonesian culture is characterized by its traditional dances (like Javanese and Balinese dance), shadow puppetry (wayang kulit), Gamelan music, batik art, diverse culinary traditions, and cultural celebrations like Galungan and Nyepi.

"The triumph of culture is to overpower nationality"

Vietnamese Culture: Vietnamese culture is heavily influenced by Confucianism, Buddhism, and indigenous beliefs. Vietnamese culture is known for its traditional clothing (ao dai), water puppetry, Vietnamese folk music, Vietnamese cuisine (such as pho and banh mi), and important cultural festivals like Tet Nguyen Dan (Lunar New Year).

"Our cultural diversity has most certainly shaped our national character".

These descriptions provide just a glimpse of the rich and diverse cultures across Asia. Each country and region within Asia has its own unique traditions, customs, and history, contributing to the fascinating cultural tapestry of the continent.

TRANSGENDER-
What Is Rapid Onset Gender Dysphoria?
When teens seek to transition.
Reviewed by Vanessa Lancaster

KEY POINTS-
Gender dysphoria occurs when a person's biological sex doesn’t match their perceived gender identity.
In the last two decades, there has been a significant rise in gender dysphoria in adolescents.
The rise in gender dysphoria in teens could be due to better detection, but some researchers suspect social contagion instead.
Although various names have referred to it, the phenomenon of gender dysphoria has been well-studied for over a century. Gender dysphoria occurs when a person's biological sex doesn’t match their perceived gender identity. The scientific consensus is that this likely occurs due to anomalies in fetal development that lead persons to experience preferences for social roles and personal identity that are more typical of the opposite sex.

Early- and Late-Onset Gender Dysphoria
Traditionally, two forms of gender dysphoria have been recognized. The first is early-onset gender dysphoria, which appears in early childhood. For instance, a boy may prefer the company of girls and the play activities typical of that gender. Likewise, a girl may prefer hanging out with the boys and doing boyish things.

Such children are often teased as “sissies” and “tomboys,” but they typically maintain their transgender identity into adulthood. Many of them cross-dress or seek gender-affirming surgery and live their adult lives as members of the opposite sex.

The second form of gender dysphoria is known as late-onset gender dysphoria because it first appears in early to mid-adulthood. Furthermore, persons who experience late-onset gender dysphoria are almost exclusively male. This may simply involve experiencing sexual arousal through dressing and acting as a woman, but it can also lead to surgery and living as a female.

Rapid-Onset Gender Dysphoria
However, as American sexuality researchers Suzanna Diaz and J. Michael Bailey pointed out in an article recently published in the Archives of Sexual Behavior, the last two decades have seen the rise of a third type of gender dysphoria.

This type occurs in adolescents, and those who experience it are overwhelmingly female. These teens showed no signs of gender dysphoria before puberty but reported a fairly sudden shift in gender identity, so the condition has been dubbed rapid-onset gender dysphoria.

The fact that there has been a recent surge in gender dysphoria in adolescents, especially females, is uncontroversial since these cases are clearly documented. However, explaining what causes rapid-onset gender dysphoria is the subject of a heated debate.

Some researchers maintain that there has been no real increase in gender dysphoria in youth. Rather, it’s just that the condition is better diagnosed and documented now than it was in the past.

Through analogy, they pointed to the supposed “autism epidemic.” While it’s true that the recorded cases of autism have increased considerably over the past few decades, we also understand that this has happened because doctors now have a better understanding of the nature of autism and how to detect it.

However, proponents of the “better detection” hypothesis have difficulty explaining why there hasn’t been a similar increase in reports of early- and late-onset gender dysphoria. They also can’t explain why we’ve been regularly diagnosing and documenting cases of gender dysphoria in childhood and adulthood for at least half a century now but not cases occurring in adolescence.

The Social Contagion Hypothesis
Other researchers argue that rapid-onset gender dysphoria is a form of social contagion. Such an assertion flies in the face of overwhelming evidence that gender dysphoria is biological. However, proponents of the “social contagion” hypothesis contend that this condition is really a misdiagnosis of gender dysphoria and that its real cause lies elsewhere.

Two lines of evidence support the “social contagion” hypothesis. The first comes from reports of parents whose children transitioned as teens. While many parents support their children’s desire to transition, others are hesitant to do so. It could be that these parents are transphobic, but research shows this is not the case.

Rapid-onset gender dysphoria often occurs in adolescents growing up in well-educated, reasonably affluent families with fairly liberal social values. These parents aren’t anti-trans. It’s just that they don’t think gender dysphoria is the right diagnosis for their child.

According to parental reports, these teens were already experiencing mental health issues, and it wasn’t until after they started interacting with trans groups on social media that they began to attribute their psychological problems to gender dysphoria. Furthermore, their online friends convinced them that the only way to overcome their feelings of depression and anxiety was to transition.

It could very well be the case that gender dysphoria is the root of the mental health issues these teens are experiencing. After all, it can take time to diagnose some psychological disorders properly. For instance, bipolar disorder can easily be misidentified as depression at first. However, in the case of rapid-onset gender dysphoria, patients may get diagnoses from untrained amateurs with a political agenda rather than trained professionals with expertise in the field.

The second line of evidence for the “social contagion” hypothesis is the observation that a fairly high proportion of teens who transition seek to de-transition a few years later. They decide for themselves that their psychological issues weren’t really due to gender dysphoria. Or, at least, they find that transitioning hasn’t resolved those issues.

Political Arguments vs. Scientific Evidence
As Diaz and Bailey pointed out in their article, research on rapid-onset gender dysphoria has been hampered by political activism. The lay public and healthcare professionals are split in their support for the “better detection” and “social contagion” hypotheses. Those who believe we’re just getting better at detecting gender dysphoria in adolescence generally advocate for rapid transition, while those who believe that rapid-onset gender dysphoria likely has a social origin urge for a wait-and-see approach.

At this point, we just don’t know which hypothesis is correct. If transitioning will help these teens regain their mental health, we should definitely pursue this course of action. However, if many of these adolescents will eventually de-transition, early transitioning may be a treatment that causes more harm than good.

We need a dispassionate approach that examines the full range of evidence without bias. This includes comparisons of trans adults who choose to de-transition with those who don’t and studies of those who transition early versus those who transition later. We also need to consider parents' reports, both those who supported their teen’s transition and those who didn’t. Only in this way can we understand the true nature of rapid-onset gender dysphoria and the best way to treat it.

SELF-HELP-
Making the Most of Our Cognitive and Social Limitations.
What our shortcomings tell us about ourselves.
Reviewed by Vanessa Lancaster

KEY POINTS-
After studying our limitations, we often discover that the ways we compensate for these limitations constitute strengths in themselves.
Some limitations can be confronted directly, opening new opportunities and providing a new sense of mastery.
Understanding our limitations allows us to know ourselves better, while removing unnecessary barriers to a more fulfilling life.
Many of us are aware of our physical and artistic limitations, and we're able to acknowledge them and even make light of them. We readily admit that we will never play professional basketball or achieve greatness as sculptors or singers.

But how well do we know our cognitive and social limitations? We notice some of them because we can compare what we manage with difficulty to what others accomplish with ease and grace. There are also tests that measure specific cognitive and interpersonal abilities. But in general, we are more aware of limitations of the body than limitations of the mind.

Identifying cognitive and social limitations requires introspection, self-evaluation, and resolve. It means focusing on what we consistently have difficulty doing.

When asked to evaluate ourselves, we mostly list positive qualities–not because we’re boastful, but because we’re shaped into that favorable response by such influences as college applications, career counseling, job interviews, and online dating platforms. Our elevator pitch doesn’t emphasize the negative.

How Shortcomings Motivate Us
Alfred Adler, a psychotherapist and contemporary of Freud, said that the motivation to compensate for our shortcomings begins in childhood when we are physically and cognitively less skilled than the older people in our lives. As children, we mature out of being smaller, weaker, and less knowledgeable, but the motivation to overcome or compensate for our limitations stays with us for the rest of our lives.

Defining Our Abilities and Inabilities
Our natural limitations are probably subsets of Gardner’s nine categories of multiple intelligence: linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, intrapersonal (knowing one’s self), interpersonal (knowing others), naturalistic, and existential.

We may have shortcomings in verbal fluency or math or finding our way around or holding a tune, or taking the perspective of others.

Working With Our Limitations
Confronting
Some limitations can be confronted directly. Early in his career, the noted psychotherapist, Albert Ellis, shed his awkwardness with public speaking by signing up to speak in public twice a week. By doing so, he learned to improve his verbal fluency while overcoming his fear.

Tom Dempsey was born without toes on his right foot, but with strong motivation and a special shoe, he became a placekicker in the NFL. For 43 years, he held the record for the longest field goal ever kicked in the NFL.

Other limitations can be placed in perspective and managed. I had a friend in college who stuttered.1 He worked on reducing his stuttering but also accepted it as a fact of his current life and did not allow it to limit him. He was a DJ on his own radio show and ran for student body president, with one of his slogans being, “No More Fast-Talking Politics.”

Compensating
We usually learn to live with our cognitive and social limitations by compensating.

One of my weaknesses, for example, is finding my way around. GPS has largely removed that problem, but before that, I pored over maps of unfamiliar places prior to visiting these places, committing the major roads to memory and making notes on specific choice points. (GPS still doesn’t help me navigate an unfamiliar building with multiple hallways.) Another of my weaknesses is translating verbal instructions into physical movements, such as dance moves. I compensate by practicing with YouTube videos before going public.

Avoiding
We can also try to avoid difficult activities. But, avoidance leaves us unprepared when called upon to engage in the very activity we’ve been avoiding, and it also hides associated abilities we do have.

An Exercise to Increase Awareness of Our Limitations
In my class on the Self, I ask students to describe an activity they have consistent difficulty with–something they’ve been dealing with most of their lives.

They focus on the activity itself, their difficulties with this activity, their strategies for compensating, and the possible sources of the difficulties. For many of them, this is the most focused thinking they’ve ever done about this specific limitation.

With every class, students present a diverse set of limitations: awkwardness talking to people they don’t know, problems with math, not feeling emotionally supportive with friends, an inability to spell, setbacks with standardized tests, clumsiness in flirting or small talk, a poor sense of direction, a lack of singing ability.

Personal Benefits
Many students discover that how they compensate for their limitations constitutes strengths in themselves. If they get others to help, they learn that graceful persuasion is a strength. If they memorize phrases to manage interpersonal awkwardness, they value their resourcefulness.

Some students discover that what they thought was a limitation is actually an activity they can do, but one that creates anxiety. They then work on ways to reduce their anxiety.

Other students learn that describing a limitation in detail circumscribes the problem. Someone with difficulty expressing himself said he realized the difficulty was not with good friends and family–or with strangers, but with acquaintances in between. Focusing specifically on our limitations can limit the limitations.

Sometimes, directly confronting a limitation vanquishes it while also opening opportunities.
One student joined the debate team to provide a structured setting for overcoming her unease with disagreement. She then became an accomplished collegiate debater, which brought about a feeling of mastery and new friendships and travel opportunities.

Professional Benefits
Most of us choose careers that draw on our strengths. But, sometimes, professional interests can overlap with natural limitations: actors who can’t remember lines, dental students unable to work in the mirror image world, and people devoted to helping animals but lacking the mathematical talent for veterinary medicine.

When professional aspirations overlap with persistent limitations, this assignment can encourage people to seek specific training in their area of difficulty or to consider shifting their academic studies to a related area that allows professional satisfaction without implacable struggle.

Continuing Efforts
If we choose, we can develop a comprehensive program for managing more pervasive limitations we want to compensate for.

One resonant example is David Finch’s collection of advice to himself for overcoming anti-social behaviors with his wife due to Asperger’s syndrome. He focused on specific matters (Don’t change the radio station when she’s singing along), more general rules (Apologies don’t count when you shout them), and larger advice (Be her friend, first and always).

His journal of best practices continues to guide him as a husband and father in ways large, small, and in between.

Thriving With Our Limitations
Literature provides countless examples of lives dramatically short-circuited by personal limitations: Othello's jealousy, Jon Snow's stubbornness, and Veruca Salt's selfishness. If these characters had identified their limitations and focused on how to compensate, they would have lived less troubled and more fulfilled fictional lives. Ebenezer Scrooge eventually managed to overcome his greed and miserliness, and he was happier for it.

Closely examining our limitations allows us to know ourselves better while removing unnecessary barriers to a more fulfilling life. More broadly, it encourages humility and can ultimately bestow wisdom.

LONELINESS-
6 Ways to Design for Social Connection and Community.
How the built environment can help heal and prevent loneliness.
Reviewed by Vanessa Lancaster

KEY POINTS-
Where we live, work, play, and learn impacts our social health and how connected we are as a society.
As cities invest in infrastructure, paying attention to how they impact loneliness and community well-being can benefit everyone.
Design guidelines that can help you advocate for better design wherever you are include accessibility, nature, and a sense of place.
In a time of hyper-connection and communication, recent surveys find that approximately half of U.S. adults are experiencing loneliness and lacking connection. This can increase risks of premature illness and death at levels comparable to smoking 15 cigarettes a day.

For this reason, the U.S. Surgeon General, Vivek Murthy, has issued a public advisory calling the American people to this “urgent public health issue.” Murthy lists “design the built environment to promote social connection” as a part of the first pillar of his advisory.

Julianne Holt-Lunstad was the scientific chair of Murthy’s report, "Our Epidemic of Loneliness and Isolation." Nearly two years ago, Holt-Lunstad and I published a piece, "Is Your Environment Making You Lonely?" In it, we explored ways to cultivate connection using the built environment, policies, and programming.

Today's post focuses on one of the central themes we discussed then–shared spaces, or what Ray Oldenburg called third places open to all people to gather, such as cafes, parks, and libraries. I discuss why shared space is so essential and offer six design guidelines to help any built environment feel more conducive to fostering social connection.

Six Design Guidelines for Social Health
When I think of design for connection, I often think of the Italian piazzas I visited with my mother after my first year of architecture school. They are open to all people (accessibility), an inviting hub of activity (activation), with warm natural clay bricks and stones, often ivy tracing the walls (nature), with the choice of whether you want to sit in the center by a fountain (choice) perhaps, or under an umbrella on the edges (human scale); and they have a history and sense of place unique to each one (sense of place), carved into the place itself.

Taken together, those make the six design guidelines for social health, below I discuss these in more detail:

Accessibility
Creating places that are inclusive, safe, and walkable (stroller-able, wheelchair friendly, etc.) for the people who will use it is the essential first ingredient. This includes creating libraries, pocket parks, and gathering spaces that are an easy-to-reach part of the local social fabric.

Nature
We are hardwired to be drawn to and soothed by nature, a phenomenon called biophilia. Nature, specifically urban green space, has been linked to reducing loneliness, increasing sociability, and improving mental health. Infusing nature, greenery, and park space into our neighborhoods are essential to getting people outside their homes, lingering with one another.

Activation
Ideal shared spaces are vibrant and have some type of activation. By placing seating, refreshments, and amenities in the path of natural travel and circulation, we can create liveliness through purposeful collisions.

Choice
We each have different set points for our need for simulation or mental rest, and these needs change throughout our days, and lives and based on our tasks or activities. We can customize our space to our needs by providing options and adaptability.

Human Scale
We evolved in community with others, using our space to keep ourselves and the collective safe, so we are naturally drawn to places that provide a sense of scale or fit with our bodies. This includes a preference for edge conditions, such that we’re drawn to booth seating or leaning against the wooden porch railing. This includes creating nodes or nooks within a larger space, such as a front porch, as a welcome place before entering a home or a small waiting area to ease you into your child’s daycare and allow you to bump into other parents.

Sense of Place
A sense of place helps remind us of who we are and what matters to us and fosters a feeling of belonging. This ties to the idea that a place can create a sense of “ambient belonging” about how the built environment signals to others whether or not they are welcome here. The place is imbued with values, culture, and meaning, and a sense of place recognizes that significance.

Understanding Missed Miscarriage and 3 Ways to Move Forward.
How to begin healing from the loss.
Reviewed by Vanessa Lancaster

KEY POINTS-
A missed or silent miscarriage happens early in pregnancy and often has symptoms that can be overlooked.
The most common cause of a missed miscarriage is the embryo having the wrong number of chromosomes because of aging of the eggs.
A missed miscarriage puts stress on the brain and body as the patient tries to figure out what went wrong and if it was preventable.
We were trying to get pregnant for months. I finally went to a fertility doctor and when she examined me with an ultrasound, she said I had been pregnant and miscarried very early. I am in double shock! Because I have irregular periods, I didn’t even realize I was finally pregnant, and I had no symptoms of miscarriage.

None. Now I am so nervous that I am doing pregnancy tests all the time, so afraid I’ll miscarry again that I’m not sleeping, and so very sad thinking about what might have been. I wish I never knew.

My patient was describing what’s often called a missed miscarriage or silent miscarriage. Of course, all miscarriages are traumatic, and sadness, anxiety, guilt, and depression often follow any miscarriage. Since miscarriage is common, at least one in four pregnancies result in a loss. Friends and family often underestimate its emotional impact. Furthermore, there are no established social mourning customs after a miscarriage to help a patient, or her partner, ease the loss.

A missed or silent miscarriage, however, can create additional traumas.

First, the patient may not have a support group in place because the pregnancy might have been unknown or "silent," as well as the miscarriage. This means that the patient often feels alone when they receive the news, and if they choose to share the sad news with friends and family, they will have to relive the shock every time they explain that there was both a pregnancy and a silent miscarriage.

Next, because most missed miscarriages occur early in gestation, usually in the first trimester, friends and family often mistakenly assume the loss will not be as intense as a later loss.

Lastly, because stress goes up when the ability to predict what is coming next goes down, a missed miscarriage puts both brain and body on high alert as the patient tries to figure out what went wrong and whether it was preventable or their fault. Lucky Sekhon, a reproductive endocrinologist at RMA New York and a provider in Progyny’s network, explained that self-blame is misguided because the most common cause is the embryo having the wrong number of chromosomes due to the effects of time and aging on the eggs’ repair mechanisms. Sperm can also contribute the wrong number of chromosomes, but this is less common and usually not age-related unless the paternal age is very advanced (age 50 plus years).

So why were there no early warning symptoms? “It usually means that the ovary hadn't picked up on the embryo not being viable yet and was still producing hormones like progesterone, which stabilized the lining and delayed both bleeding and the uterine cramping triggered by the bleeding,” explained Sekhon.

Sekhon added,
I would not assume that there is an underlying issue beyond the embryo being abnormal, but if two or more miscarriages have taken place, consider testing to look for underlying predispositions to forming genetically abnormal or imbalanced embryos. In fact, at a certain point in the first trimester, everybody should have a scan to ensure the embryo is implanted correctly in the uterus, is viable, and is progressing normally.

Although moving forward on a family-building journey can be difficult after a miscarriage, moving forward is often the most effective way to regain your sense of control and balance the loss with hope.

Three ways to help you move forward include:
Begin acceptance. Start by creating your own memorial or ceremony to honor the pregnancy, or think it will give you some closure after the loss.

Speak to your doctor. Talk with your doctor if your fears about future pregnancies interfere with moving forward. Ask for reassurance that the miscarriage was not the result of anything specific you did or did not do. Ask what information was gained from the miscarriage that may help future treatment be more effective for you.

Find support. If your emotions are overwhelming your ability to heal, seek professional support from those trained to help. The American Society for Reproductive Medicine (ASRM), RESOLVE, the national infertility association, and the Psychology Today are just a few of the organizations that can guide you to them.

Sekhon reassures her patients that it’s “okay not to be okay” and that it takes time to process, heal, and grieve the loss of "what could have been." Also, it’s normal to feel very nervous if you are pregnant again, “especially up until the point where the miscarriage happened in the prior pregnancy.”

This road isn’t easy, and I remind my patients who are afraid to be optimistic because they don’t want to be disappointed again that hoping for success will not jinx their journey. Also, pessimism will not protect them from disappointment if they have another loss. Instead, I encourage them to re-label this period as pre-parenthood, not just post-miscarriage, and to remind themselves that there are many paths to parenthood. It’s important to take what you need to heal and seek professional help when needed.

FORGIVENESS-
How to Apologize and Why It Matters.
What makes an apology effective?
Reviewed by Vanessa Lancaster

KEY POINTS-
When it comes to issuing an apology, acknowledging wrongdoing is key.
Saying a version of “I am sorry if you were offended” shirks responsibility and blames the other person for being overly sensitive.
Factors that make an apology effective include taking responsibility and accepting fault, expressing empathy, and willingness to make it right.
“If it means so much to you, then … sorry.” Logan Roy’s apology to his children in episode two of the fourth season of Succession is a masterclass in how not to apologize.

In Logan’s defense, apologies are hard. They often get stuck in our throats or come out the wrong way. Even well-intended apologies don’t always land well. As Randy Pausch, author of The Last Lecture, said, "A good apology is like an antibiotic. A bad apology is like rubbing salt in the wound."

At the risk of sounding like a junior version of Logan Roy, I vividly remember being eight years old, forced to apologize to another child in the playground. “I’m sorry I took the ball, but you were being a ball hog.” Alas, amends were not made, and my nanny took me home. An explanation or justification is unlikely to promote resolution, or as Benjamin Franklin cautioned, “never ruin an apology with an excuse.”

When it comes to issuing an apology, acknowledging wrongdoing is key. Saying a version of “I am sorry if you were offended” shirks responsibility and blames the other person for being overly sensitive. Similarly, “Oops, my bad” is unlikely to resolve a conflict. So is “You have to forgive me,” as Carrie pleaded to Aidan after cheating on him in Sex and the City.

Factors That Make an Apology Effective
While there isn’t a formula for a good apology, there are certain factors, according to research, that make one effective, including:

Using the words “I am sorry” or “I apologize.”
Naming the offense. Saying specifically what you are sorry for.
Taking responsibility and accepting fault.
Empathizing with the other person.
Conveying emotions such as regret or remorse.
Expressing a desire and willingness to make things right.
Sincerity is essential. Even if the words aren’t perfect, if given from the heart and with good intentions, a genuine apology shows the person that you care about them and about making amends.

Cartoonist Lynn Johnston described an apology as “the superglue of life because it can repair almost anything.” While an apology cannot right a wrong, it can begin the reconciliation process. Perhaps Elmer’s glue and Scotch tape are better analogies than super glue. From an unintentionally hurtful joke to more serious situations, saying “I’m sorry” matters. Forty percent of patients say they would not have filed a lawsuit against their doctor if they had received a proper apology, yet we often choose to skip them.

Reasons People Don’t Apologize
For starters, we are highly motivated to maintain a positive self-image. Apologizing requires acknowledging wrongdoing. It’s a whole lot easier to justify our actions and minimize the harm we caused than to take responsibility. Perhaps this explains why some people, like Logan Roy, just “don’t do apologies.”

Another barrier to saying “I’m sorry” is that we underestimate its positive impact on the other person and ourselves. It’s helpful to keep in mind that apologies are less about changing the past than helping shape a less angry and more connected future.

It might be hard to apologize, but we all long to be forgiven at the end of the day, even Logan Roy. A short story by Ernest Hemingway entitled “The Capital of the World” captures this human need. It’s about a father and his rebellious son, Paco. The two had become estranged, and Paco was living on the streets of Madrid. In an effort to repair the rift, the father took out an ad in a local newspaper that said, “Paco, meet me at the Hotel Montana at noon on Tuesday. All is forgiven!” On Tuesday, 800 young men named Paco showed up at the hotel, looking for forgiveness.

I heard that story in church one day, and it reminded me of palliative care physician Ira Byock’s observation that at the end of life, the wish to be forgiven is the chief desire of almost every human being. If we ultimately hope to be forgiven, apologizing is a good place to start.

That Said
While apologizing does not come easily to some, it comes too easily for others. When someone steps on my foot, I am the first to say, “I’m sorry.” I apologize for the weather, terrible traffic, the long line at CVS, and dozens of other undesirable situations I am not responsible for.

I am not the only one inflicted with “sorry syndrome.” Many patients, especially women, tell me they insert “sorry” into any sentence containing a request.

“Sorry, may I have a glass of water?”

“Sorry, can I ask a question?”

“Sorry, where is the bathroom?”

Knowing how to apologize for something you regret is one thing. Apologizing for basically existing is another. As Time columnist Jessica Bennett wrote:

Sorry is a crutch–a tyrannical lady-crutch. It’s a space filler, a hedge, a way to politely ask for something without offending, to appear 'soft' while making a demand.

So why do we insist on apologizing for no reason?
A Harvard Business School study provides a possible explanation. According to the research, superfluous apologies build trust. In the study, an actor approached strangers in a train station on a rainy day and requested to borrow their phone. Half the time, the actor prefaced his request with “I’m sorry about the rain!”

The other half of the time, the actor went straight to the point and asked, “Can I borrow your cell phone?” Apologizing for the rain made a big difference: forty-seven percent of strangers offered their phone if the actor apologized for the rain. Only nine percent did without an apology. As the authors concluded:

Superfluous apologies represent a powerful and easy-to-use tool for social influence. Even in the absence of culpability, individuals can increase trust and liking by saying ‘I’m sorry’ — even if they are merely ‘sorry’ about the rain.

Building trust is important but does not justify apologizing for every little thing. If you want to reduce the number of superfluous apologies that roll off your tongue, consider replacing “sorry” with “thank you.”

For example, instead of saying, “Sorry for rambling,” you can say, “Thank you for listening.” Instead of saying “Sorry” when you move past someone on a train, you can say “Thank you for making room.”

An article in The Atlantic highlighted the benefits of replacing an apology with gratitude:

'Sorry you had to do that' is not only a rejection of their nice gesture, a lot of times, it makes it weird. 'Thank you for doing that' is recognizing and accepting their kindness.

Bottom Line
Save your apologies for when you have hurt someone, and thank you for reading this post.

Why Mothers Are Our Number One Hero.
Mothers fulfill at least a dozen important psychological functions of heroism.
Reviewed by Vanessa Lancaster

KEY POINTS-
Research consistently shows that people list their mother as their favorite hero.
Mothers fulfill many important psychological functions involving mental and emotional well-being.
Mothers can mentor us through our nostalgic reminiscing even after they are gone.

Each year we celebrate Mother’s Day and for good reason. Our mothers are our number one heroes, according to our surveys. Fathers occupy second place in our hero surveys, but they are a distant second.

Mothers are indeed the mother of all heroes.

How do mothers do it? Over the past decade, psychologists have been able to identify at least 12 functions of heroes and heroism:
Heroes give us hope.
Heroes energize us.
Heroes develop us.
Heroes heal us.
Heroes impart wisdom.
Heroes are role models for morality.
Heroes offer safety and protection.
Heroes give us positive emotions.
Heroes give us meaning and purpose.
Heroes provide social connection and reduce loneliness.
Heroes help individuals achieve personal goals.
Heroes help society achieve societal goals.
Our mothers play a role in fulfilling these 12 functions, either directly or indirectly. This list of hero functions tells us that mothers offer benefits that span many dimensions of human well-being.

First, Mothers confer basic survival benefits (e.g., safety and healing). They protect us when we’re young and vulnerable and are there for us when we get sick or injured. Second, consistent with recent research, mothers give us cognitive benefits, such as intelligence, creativity, and wisdom.

Third, mothers offer motivational benefits. They are our biggest cheerleaders and inspire us to become our best selves. Fourth, mothers provide emotional benefits. Although there are obvious exceptions, mothers are often warmer and more nurturant than fathers.

Fifth, mothers bestow moral and spiritual benefits. Mothers teach us empathy and compassion for others. As children, we watch our mothers’ selflessness and daily sacrifices and learn that we’re all called to perform these acts of kindness for others. Finally, our mothers offer existential benefits such as meaning and purpose. They show us that connection and love for family and friends are the foundation for living a healthy life.

In short, mothers help us survive, and they help us thrive. They help us through our worst times and prepare us for our best times. Fathers do these things, too, but mothers somehow have an edge.

One of the most important research findings about heroes is that they don’t have to be physically present to help us survive and thrive. Research shows that just remembering our heroes can do the job for us. Nostalgia for our mothers, whether they’re alive or gone, can produce these 12 benefits of heroism. We all benefit from the memory of our heroes, often in ways we’re unaware of.

Mother’s Day far exceeds Father’s Day regarding greeting card sales and gift expenditures, and for good reason. Mothers are our Number One Hero because they shape us in the best of ways. They are there for us when we need emotional support. Mothers love us and hug us. They comfort us when we most need it and role model love in countless ways.

Social norms are changing, and we now see more fathers taking on the role of nurturers than in previous generations. But the emerging science of heroism helps explain why we reserve a special place in our hearts for our heroic mothers.