Dr. R. L. Wysong
February 1991
Skin Cancer
    With summer upon us and everyone seeking that bronze glow, it’s time for me to put a damper on al this fun in the sun.
    The lifetime risk of an individual developing malignant melanoma, a neoplosm of the brown pigment producing melanocytes within the skin has reached one in 105, and is expected to reach one in 75 by the year 2000. This increase in incidence is twice as high as it was only a decade ago, even though the population in the United States has increased only by about 11%. The risk is a full 12 times higher than it was for people born 50 years ago.
    Melanomas will claim approximately 6500 lives this year. The annual increase in melanomas of approximately 7% per year is higher than any other cancer in the United States. An additional 2000 deaths are expected in 1991 from basal and squamous cell carcinomas, although these are less deadly than malignant melanomas.
    Evidence seems to suggest that 95% of all of the 600,000 per year skin cancers detected are due to exposure to ultraviolet radiation.
    If such an increase in skin cancer is the result of ultraviolet radiation, is this somehow linked to the loss in our ozone canopy?     The ozone shield does help shield the more carcinogenic UVB rays, which are in the wavelength between 290 and 320 nanometers. The ozone layer is estimated to have been thinned by four to five percent over the past 12 years. This could result in as much as a ten percent increase in UVB radiation reaching the ground with resultant increase of 200,000 additional deaths from skin cancer in the next 50 years.
    Although it may sound like Chicken Little crying,  “The ozone shield is falling!”, some scientists argue there has been no detectable increase in UV radiation at ground level except at the poles. Evidence does, however, show that the shield is thinning, and that the potential certainly exists for an increase in UV radiation. This is particularly dangerous in the more highly populated mid-latitudes, where much of the world’s agricultural products are grown.
    So, then, what is the cause of the increased incidence in skin cancers? Perhaps underlying causes exist which we have discussed before in the Review which have increased cancer rates of many different types. The departure from our natural context perhaps lies at the root of the upsurge.
    But some now argue that the increased use of sunscreen agents may result in a false sense of security, causing individuals to remain in the sun much longer than they normally would. Although many sun screen products have protectants in them that help shield against UVB, the shorter wavelength radiation, few have little, if anything, to protect against UVA, which are longer wavelengths in the 320 to 400 nanometer range, and may also cause serious skin damage, including cancers and premature aging.
    The confidence from the public that UVBs are the only rays we need to worry about is evident by a million people a day visiting UVA tanning booths. The danger of UVA is, perhaps, that it is only l/1000th as effective in producing erythema and only 1/500th as efficient at tanning skin as the shorter wavelength UVB. This, then, can result in longer exposure to the light than would be possible if the light were a combined spectrum, with UVB present, which would result in much more rapid sunburning and pain, resulting in the natural pain reflex, namely get out of the sun.
    Although UVA has not been directly linked to malignant melanomas, it has been linked to skin carcinomas of other types. And this is to be expected since UVA has the ability to cause reactive free radicals with the resultant lipid peroxidative cell membrane damage, cross linking of skin proteins and DNA damage.
    An Interesting twist suggested by some researchers is that some screens that shield out UVB may Indirectly promote cancer.     The argument goes that since UVB, not UVA, is responsible for the production of vitamin D in the skin, and vitamin D has a protective action against cancer, that by shielding out UVB decreased Vitamin D may result an increased cancer rates.
UVB, the more energetic, carcinogenic wavelength is believed to be a cancer initiator, whereas UVA may be a promoter. This may mean that serious sun burns during childhood and intermittent overexposure, even though using sunscreens which permit UVA promoters to come through, may result in cancer later in life.
    Some site the relative rates of melanoma seen in the United States and other affluent countries using abundant sunscreens compared to poorer nations not using these products as further evidence of this hypothesis.
    There is much controversy as to the exact cause of the increased incidence of melanoma. Whether it is linked to a decreased ozone layer, increased use of sunscreens resulting in massive doses of the sun which would not be possible without these screens, to altered lifestyles with more out of doors leisure, or to immigration to the sun belt is all uncertain. All researchers do agree, however, that decreased sun exposure is very important, and that wearing protective clothing, broad brimmed hats, and common sense may be good preventive measures.
    Considering our synorgonic contextual philosophy we could argue, indeed, that treating skin cancer as if it were a result simply of a particular part of the spectrum of light, namely UVB, is very narrow sighted. Blocking  out UVB rays with a synthetic chemical applied to the skin in order to be exposed to the sun for hours on end without protective clothing flies in the face of our synorgonic logic. Light is healthy, but as with everything else, dose makes the poison. To simply shield one part of the spectrum of light, and allow massive overdose of other parts of the spectrum predictably will result in harm. Perhaps an immediate consequence, such as a sunburn, will be averted, but long term damage, even cancer, may eventually balance the ledger.
        Medical news & Perspectives: Skolnick, Andrew A., “Revised Regulations for Sunscreen Labeling Expected Soon From FDA,” “Melanoma Epidemic Yields Grim Statistics,” “Is Ozone Loss to Blame for Melanoma Upsurge?.” The Journal of the American Medical Association, Volume 265, Number 24, June 26, 1991, pp. 3217-3218.
Rectal Exams and Cancer
    This is another instance of what is assumed to be so is not necessarily so.
    The incidence of prostatic cancer ranges from l58 per 100,000 to a lifetime risk as much as 14%.
    Although it is commonly thought that rectal exams for prostatic cancer is an effective method for screening and control of this disease, a recent case control study indicates this may not be so. One hundred thirty-nine men with metastatic stage-D prostatic cancer compared to 139 men free of this condition were examined historically for up to an average of 23 years before the initial diagnosis of prostatic cancer. The number of examinations were similar between cancer and cancer free controls. After statistical adjustment for racial differences it was found that the risks in both groups were essentially the same. The northern California researchers concluded that there is a small, if any, benefit to routine rectal examinations.
    The reason for this failure can be attributed to many things, Including faulty diagnostic technique, since detecting subtle prostatic changes can be quite subjective. It may also be that the cancer has spread beyond the prostatic capsule by the time it is able to be detected. But most importantly, it may be the inadequacy of prostatic cancer therapy, even if diagnosis is made. It is Interesting that no biochemical or cytological screening has been found to be more effective than rectal examination in diagnosis either. This ,then, reinforces the conclusion that it may be the inadequacy of therapy to do anything about the condition, even if it is found, rather than the ability to determine if the condition is present;
    This, then, again emphasizes the theme we have repeated in the Review. Prevention is key in an effective approach to cancer.     Putting the body in its proper synorgonic context offers the most hope for preventing the disease from occurring and reversing it once it has.
        Friedman, Gary D., et. al., Lancet, June 22, 1991, pp. 1526-1529.
SIDS and Bedding
    Sudden Infant Death Syndrome continues to be a perplexing problem A variety of causes have been proposed, including post-vaccination reaction, genetic or congenital defects, food allergic reactions, infectious disease, toxicities and others.
    A study of 25 deaths of young infants, 20 with a diagnosis of SIDS, compared the evidence for death by suffocation with that of death by SIDS. Pathologists argue that SIDS. and suffocation create indistinguishable post-mortem effects. It has been generally assumed, however, that a healthy infant, even though asleep, will simply move to a more comfortable position to breathe if suffocation is occurring.
    Researchers at Washington University School of Medicine have shown what they believe to be convincing evidence that many SIDS cases are, in fact, cases of suffocation induced by sleeping on polystyrene filled cushions. Twenty-two of the infants who died were found face down in a low resistant bedding material. If an infant is lying face down and they attempt to raise their head, which occurs with same difficulty in infants up to 24 weeks of age the age group most at risk for this condition, they will simply fatigue after a time and fall back into the same pocket in the soft bedding. If they turn their head, they may simply deepen the pocket.
    The 950,000 bead-filled cushions that have been sold primarily for infants have the ability to create a lasting pocket that deepens as the head moves and tends to mold to the contour of the head. The cushions may encourage rebreathing in this pocket of an increasing reservoir of expired gases leading to eventual suffocation.
If true, this theory argues yet another danger of the modern home environment and the modern style of living. It is truly a shame that parents would be victimized by this tremendous tragedy, when the choices they have made they have made seemingly with the best interest of the child at heart, specifically that the child should be in its own room, in its own bed, and in as soft and luxurious bedding as is possible.
    As we have mentioned before in the Review, others would argue that the best place for infants is in the parents arms, in the parents bed, and that suspicion, until proven otherwise, must rein over any unnatural circumstance, such as surrounding a baby’s head with soft polysytrene filled pillows.
        Kemp, James S., M.D., et. al., New England Journal of Medicine, June 27, 1991, pp.1858-1864.
Fiber as a Nutrient
    Evidence continues to accumulate supporting the health benefits of dietary fiber But we normally think of these benefits in terms of the chemical or physical properties of the fiber itself since it has been generally assumed that fiber is, in effect, indigestible by monogastrics, including humans.
    Thus, fiber is known to increase the bulk of the intestinal contents, decreases transit time, as well as increase intraluminal water retention, and absorption of certain chemicals, such as toxins, and even cholesterol laden bile acids. So fiber has kind of been seen as a sponge that helps increase regularity, decrease afflictions, such as hemorrhoids and constipation, and remove potential toxins, which may initiate neoplasia within the digestive tract. The removal of cholesterol, as well, is believed to decrease cardiovascular disease due to hypercholesterolemic states.
    Recent studies, including that from The University of Illinois at Urbana, now suggest that certain forms of fiber are capable of being anaerobically fermented in the colon, yielding short-chain fatty acids. such as acetate propionate, and butyrate. Butyrate , a four carbon fatty acid, for example, has been shown to be a primary energy substrate for the colonic mucosa in humans. Some suggest, therefore, that conditions such as ulcerative colitis may be due  to mucosal cells, in effect, starving from lack of sufficient quantities of this short-chain fatty acid derived from fiber fermentation. Evidence in certain animals has shown a trophic effect of short-chain fatty acids. Enhanced healing of both the intestine and the colon have result from the consumption of short-chain fatty acid yielding fiber sources. Even blood cholesterol levels may be regulated by the fermentative production of propionic acid in the colon due to altering liver metabolism. Some research has also shown that short-chain fatty acids may play an important role in absorption of sodium and water, as well.
    This is yet another testimony to the value of whole ingredients in the diet, and of the salutary effect of the billions of microbes that reside within our digestive tract.
    I might mention before ending this topic that not all fibers are equally capable of yielding short-chain fatty acids with these putative beneficial effects, For example, pea fiber, oat hull fibers, and corn bran were pretty much refractory to degradation by human autochthonous bacteria. On the other hand, pectin, as found in apples, guar gum and gum arabic, as well as sugar beet fiber, were much more readily fermented, yielding the short-chain fatty acids. Researchers have also found that the ability to ferment various fibers varies from species to species. It is therefore not possible to always extrapolate from the beneficial effects of a fiber in one species to like beneficial effects in another.
        Titgemeyer. Evan C., et. al., The American Journal of Clinical Nutrition, Volume 53, Number 6. June 1991,pp. 1418.
Colorectal Cancer Screening
    Colorectal cancer is now the leading cause of death from cancer in the United States with over 60,000 deaths per year, and 140,000 new cases arising each year. A fifty year-old person has about a 5% risk of having colorectal cancer by the age of 80.     I mention this as a follow-up to the previous topic on fiber.
    Many argue the preventive approach to cob rectal cancer is screening and early detection. As a side note here I might mention that the currently popular view that prevention equals diagnostic tests is logically flawed. Prevention means not getting the disease. Diagnostic tests are designed to detect existing disease. The media is pervaded with advertising showing individuals dutifully visiting physicians and health centers to have such things as chest radiographs, mammary examinations, prostate palpations, yearly physical exams, and urine, blood, and fecal tests as appropriate approaches to preventative health care. This misses the mark both from the standpoint I just mentioned, namely that such tests detect disease and do not prevent it, and secondly, virtually all of these tests have not been shown to effect morbidity or mortality for the conditions they are designed to detect or prevent.
    The case in point, here, is the current methods for screening for colorectal cancer. The National Cancer Institute, the American Cancer Society, the American College of Physicians all endorse screening strategies for colorectal cancer, Including for people over the age of 50 an annual fecal occult blood test, and a sigmoidoscopy every three to five years.
    These recommendations are made in spite of the fact that there is no objective controlled data to show that such screening reduces mortality from colorectal cancer. For example, the fecal occult blood test will not detect a neoplasm that does not bleed, or that bleeds intermittantly, or if the colon’s natural bleeding exceeds that which would indicate neoplasia. The normal gastrointestinal tract blood loss is from about ½ to 2 milliliters per day. There is also no good information to indicate how often or how much asymptomatic precancerous polyps bleed before progressing to incurable cancer.
    Sigmoidoscopy is more sensitive than the fecal occult blood test to detect polyps, but this can only occur within the reach of the sigmoidoscope. It is possible for the instrument to not reach, or to miss, more proximal colonic neoplasms.
    It is for these reasons that the U.S. Preventive Services Task Force concludes, and a recent article in The New England Journal of Medicine by authors from Yale University conclude that “colorectal cancer screening of asymptomatic persons without known risk factors is not justified at this time.”
    It might also be mentioned that adjuvant therapy for colorectal cancer, combinations of chemotherapy and radiotherapy, have failed to show statistically significant differences between treated and control patients.
    So the most rational approach to this disease is to alter our life style such that we hopefully prevent the development of this neoplasia in the first place and naturely on diagnosis of existing disease or trust that current therapies will make everything all better should we contract it.
    The low colon sterols in Asians are believed linked, for example, to low rectal cancer in this population. Sterols are particularly rich in high fat animal based foods as commonly found in so-called developed nations. Thus, decreasing animal products in the diet and increasing plant materials rich in fiber and, as we mentioned in the previous article, short-chain fatty acids may, indeed, maintain the health of the mucosa of the digestive tract and prevent the occurrence of this scourge.
        JAMA,259-24, pages 3571 and 3611.
        Ransohoff, David. F., M.D. and Lang, Christopher A., M .D., “Screening for Colorectal Cancer,” The New England Journal of Medicine, Volume 325, Number 1, July 4, 1991, page 37.
Eponyms and Immortality
    The labeling of instruments and functions and anatomical parts with physician’s or other scientist’s names is common. Consider the following illustrative case report by Dr. Martinez of Stanford University:
    A 47-year-old, previously healthy man presented with Killip and Kimball class 4 cardiac failure. An aortic regurgitant murmur was heard just to the right of the angle of Louis. Both Corrigan’s pulse and Duroziez’s sign were present to confirm the diagnosis. Cheyne-Stokes respriratians were present. Neurologic examination revealed obtundation and a Glasgow coma score of 6. The Babinski signs were negative. There was a deformity of the left wrist indicating a possible Colles’ fracture. Central venous access was obtained with the Seldinger technique, and a Swan-Ganz catheter was introduced. The decision was mode to intubate the patient with a no. 8 Murphy-eye endotracheal tube, with the use of a no. 4 Macintosh blade.
    Could it be that just as a father wants a son to carry his name to give him a sense of immortality, that physicians like to attach their names to things to give them a sense of immortality in medicine? This may very well be. Let’s call it the Wysong phenomenon.
        Martinez, Ricardo, M.D., Medical Eponyms,
        The New England Journal of Medicine, Volume 325, Number 1, July 4, 1991 page 68.
Missing Carbon
    Fossil fuel burning adds about 6 billion tons of carbon to the atmosphere each year in the form of carbon dioxide. Deforestation and top soil erosion may add 3 billion tons more to this. Yet, the amount of extra carbon that appears in the atmosphere is only 3½ billion tons. Another 1½ billion tons dissolves in the ocean. That makes 9 billion tons added to the atmosphere, but only 5 billion tons accounted for. How has this remaining 4 billion tons vanished without a trace?
    Researchers now believe that trees may be the missing link to the puzzle. It’s argued by some that increased carbon dioxide in the air may actually increase the rate of forest growth resulting in the absorption of the carbon dioxide into the tree/earth biomass. Some scientists have noted that there appears to be a loss of about 3 billion tons of carbon dioxide into some unknown terrestrial sink that lies in the northern temperate latitudes. Others say that there’s not enough above ground forest growth to account for the absorption of this much carbon dioxide.
    Researchers now argue that the below ground root growth of trees may be greatly enhanced by increased atmospheric carbon dioxide, and this is where the carbon dioxide is being deposited.
    In any case. though. there is at present no absolute answer to the dilemma, evidence does seem to point to the effect of increased atmospheric carbon dioxide on increased vegetation growth. This is another testimony to the ability of the Earth to heal itself, to make adjustments when balances are threatened. This is not to say that such balance can occur indefinitely since sufficient lopsidedness may cause dramatic ecological revisions which may not be compatible with life as we know it today. For example, as forests continue to be cut, there will be a point reached where there are not sufficient forests available to grow. regard less of how fast they grow, to absorb the carbon dioxide which is being generated.
    This is, however, another argument to become active in reforestation. The Institute can be your partner in helping to do this.     Remember the free trees which are available through the institute. Also, look for possibilities locally for sources of seedlings and land, which can be forested. It is a very tangible, worthwhile activity all of us should engage in.
        Scientific American, April 1991, page 16.
Bad News and Touching
    An interesting and compassionate article in the Lancet by a physician in Australia once again emphasizes the role of touching in medicine.
    Doctor Graham argues that when bad news is conveyed to a patient it is very important to grip the hand in a friendly, but firm, manner. He argues that in this way the physician can convey instantly that there is true compassion and commitment to truthfulness in what is about to be told.
    He also argues that touching between the physician and the ill eliminates the “Leper complex” which can easily mar the doctor-patient relationship. It shows the patient that the doctor is close and is a part of the situation, and is willing to do something about it rather than being cold and detached.
    All of us know the comfort of the touch of a mother, or a father in our youth. We know the comfort and closeness that results between friends hugging. or shaking hands, and patting on the back. mentioned sometime ago in a previous Review how that life was even extended in mice who were touched, as opposed to mice who were not. Dentists, physicians, chiropractors, and all health care professionals can do much for patients by touching to impart warmness friendliness, confidence, and sincerity. Even veterinarians touching their animal patients, or comforting by touch their owners can ease pain, anguish, and build confidence, comfort, and trust, and a feeling of hope.
    The bottom line is all of us probably could benefit much by both giving and receiving more touch, whether it be within medicine, or within our personal lives.
        Lancet, Volume 337, June 29, 1991, page 1608.
Making Marriage Rational
    When I was a child and it was time to play ball, us kids would come to some agreement as to who would be on what team, who would be up first, where the goal lines were, and what we were playing to.
    Around the house I got along with my brother and sister as long as we had either stated or understood agreements. We had to do the dishes on alternate nights, we had schedules for feeding the dog, mowing the lawn, and so forth. When these agreements were broken, invariably everything broke down, arguments resulted, parents had to intercede and restore order and fresh agreements may have had to be made - of course some of these so-called agreements were in the either you do or you’ll get your butt tanned - mode of communication. Not much room for negotiation there.
    Then, as I was becoming a young adult I can remember parents and others cautioning me about making sure I had clear, written if possible, agreements before purchasing items, contracting for work, or beginning employment. In business I began under the assumption that a handshake and trust was more decent and friendly than requiring written formal agreements. As time went on, however, I found almost invariably that if specific written agreements were not made, misunderstandings arose, and what started as positive, trusting and friendly relationships broke down.
    Early in a business relationship emotions as well as expectations are high. The seller is excited about the possibility of a sale, and receiving fair compensation for whatever it is he or she is selling. The buyer is excited about finding what they wanted and believing that they are paying a fair and. perhaps, even, a bargain price for the goods. If an agreement is not made at this early point in the relationship it is very difficult to make it later on. Early in the relationship both parties are usually negotiable, they are often excited, perhaps even relieved about consummating the arrangement -the buyer is happy at last to have found what they wanted, and the seller is happy to have at last sold what they wanted to get rid of.
    Unfortunately agreements are often not made, or if made are very incomplete. Afterwards, each party often will find that the other expected much more than was stated in the original, verbal agreement. The buyer of a used car, being told that the car was serviced regularly, interprets this to mean that the car will require no service. The seller telling the buyer that they had serviced the car believes that they were truthful, but that they do not feel they would be responsible for any problems after the sale closes. But then, perhaps, after the car is purchased it’s discovered that there is a leaky valve gasket, or an alignment problem, or any of a thousand things that could possibly be wrong. The purchaser may then argue that they were misled into believing that the car was maintenance free and approaches the seller with the argument that they are responsible for the repair.      Any of you who have lived long enough to have enough transactions that normally go along with life know what I am talking about. It is easy for disagreements to occur. It is the reason that our judiciary system is bulging and spilling over at the seams.
    Most disagreements could be prevented if there were an appropriate detailed written agreement outlining the responsibilities of all parties involved. Attorneys are trained in these matters, but certainly individuals are often, if thorough and careful, capable of drafting their requirements as well.
    Understanding the need for such detail results in highly complex and exhaustive documents drafted between countries in the political arena, between giant corporations with large staffs of attorneys, between insurers and insurees, basically any place where there are established organizations interacting with others there are exhaustive agreements because such organizations usually have a history of difficulties they understand could have resolved with the appropriate preliminary agreements. Societies are societies of law, which is an agreement between citizen and government - it is follow the law, get out, or be penalized. It is the only way for peace to occur.
    The more complicated our society becomes, the less appropriate are oral or handshake agreements. We often don’t know the people we are doing business with, we don’t live sometimes in proximity to them, and complicated liabilities exist which make it dangerous to transact business or other relationships by intuition rather than specific, agreed upon, itemizations. In times past when the family was more nuclear and self-sufficient and communities were less mobile, handshake agreements were often sufficient since transactions were normally simple and you had to live next door to one another often for a lifetime.
    Now with these preliminaries set, I want to talk about marriage. In times gone past the relative roles of mates were pretty much set and understood before and during marriage. The woman as housekeeper and primary caretaker of the children and the man as wage earner, were fairly clear distinctions that did not leave a lot of room for negotiation or misunderstanding.
    Today, marriage and family life can be far more complex. Marriage can begin with one or both mates going to college, with one or the other supporting the other while this occurs. Children may be cared for by day care centers, or live-in nannies. Options are available for specialized education; responsibilities are laid on parents for college support, and even live-in children after they have reached adulthood. Earnings can exceed that which is necessary for day-to-day subsistence and result in the potential for leisure. Families can have two, three, or four cars, two homes, travel to different parts of the country or the world during different parts of the year, have complex retirement programs, investment strategies, adult education, and on and on. We live in a complex world, a complex world society that has made marriage and family life extremely complex.
    But interestingly, other than premarital contracts defining who owns what assets coming into a marriage, little is ever agreed upon in terms of the complex issues that will come to a marriage and a family.
    Marriage often begins with two people falling in love. The initial infatuation and the biological power over us of gonads acting like mini-volcanoes often clouds judgment, and convinces us that nothing could ever go wrong within the magic of the relationship.
    Each of the mates will enter the marriage with preconceptions about what they expect to do as an adult, and what they expect of a marriage mate. Often these expectations are not openly discussed, but it is simply assumed everything will be taken care of because of love.
    But as time passes, some estimate approximately two years after the initial falling in love. the volcanoes become less active and the reality and the complexity of every day life starts to settle in. The smoke from the volcano starts to clear and we see our mates as they are as independent, free-willed human entities, not simply as extensions of our personal fantasy.
    The pressures of life, including how the bills get paid, how the income is made, who is responsible for what domestic duties, how to rear the children, how to interact with parents in-laws, brothers, sisters, and friends, where vacations are to be taken, how we look, how we dress, how we eat, what we eat, how we sleep, when we sleep, can all become important issues in the relationship.
    But often, rather than discussing and reaching an agreement in all of these various areas, mates will cling to the idealistic notions they had during the love infatuation and develop resentment and grudges when their fantasies don’t come true. The volcanoes cannot only stop erupting, they can turn into polar ice caps, and two individuals who seem to have every thing in common and were ready to face the world against any adversity now can find their greatest adversity-one another.
    Today it is estimated that 50% of marriages end in divorce, and many of those not divorcing are very disappointed, unhappy, and sometimes even violently hate their mate. Abuse, murders, and wife/husband beatings escalate with every passing year in our complicated society.
    I’m not sure, by any means, that I have the answer to this extraordinarily complex dilemma, since it involves personality and people interaction with all the attendant mix of prejudice, fears, love, jealousy, reason, ignorance… all the complexities of human emotion. But does it not make sense that there should be forthright and open discussion on all of the aspects of a marriage relationship for it to properly succeed, and misunderstandings and resentment not brew if the same is required in every other personal or organizational relationship that exists in our modern world? In other words, if a complex agreement is advisable when one purchases a home, why would it not be advisable when one is trying to negotiate and construct an entire life, including how to rear children, where to live, how much money to make, when to retire, and so forth.
    Perceived faults in another are simply overlooked early in the bliss of a relationship in the belief that it probably doesn’t matter because you love them so much, or that you feel that with time they will change or you will be able to change them to your will. But this usually does not happen and resentment builds. Resentment can be the beginning of the destruction of the relationship.
    So why not meet the issues of the relationship head on and reach an agreement, even if the agreement is to not agree. This could occur at any time in the relationship. It could occur before marriage, during the early years of marriage, or after you’re in the thick of it. It doesn’t really matter when since the agreement should be able to be renegotiated at anytime that it is not working for one party or the other.
    Let me give some examples of specific issues which could be openly discussed to try to reach some sore of agreement. One agreement is met on these then each of the marriage mates knows their respective responsibilities, and cannot, then, be free to judge the other for doing or not doing something which is usually silently expected. Some examples:
    1.              who will work outside of the home and during what hours,
    2.              how will the income be budgeted,
    3.              where to live,
    4.              what size, style of home and furnishings should be purchased,
    5.              how many children to have,
    6.              where would the children be educated,
    7.              what role will each of the parents play in education,
    8.              should the children participate in sports or music,
    9.              who cleans the house,
    10.            who washes the clothes,
    11.            who prepares meals and does dishes, and what kind of foods will we be eaten,
    12.            when to retire,
    13.            how much money do we want before we retire,
    14.            how much interaction is there to be with family and in-laws,
    15.            how much social activity,
    16.            what kind of exercise program,
    17.            where do we vacation and how often,
    18.            should we have a garden and who will plant it, and care for it,
    19.            who cares for the yard and the cars, and the maintenance of the home,
    20.            sex rules: where, when, how much, what kind,
    21.            do we save for college for the kids, or encourage them to work their own way through,
    22.                 individual, private time – when, how much,
    23.                 religious, political, social, academic goals.
    This is only a partial list of things most families must confront. If goals are not set and definitions made, not only will desires perhaps not be achieved but misunderstandings can easily occur. If one mate wants the children to spend most of their leisure time reading and learning music, and the other wants them to play Nintendo and sports, how will each know the other’s views unless it is openly discussed. Discussion can result in the will of one or the other being met by simply concession on the other’s part, or can mean compromise, whereas no discussion has the potential for continuing resentment as one party watches the other do with the kids what they feel is inappropriate. If the budget is openended and one mate desires to have a certain nest egg by the time of retirement and the other spends all excess monies on clothes or recreation, resentment will also brew.
    If an agreement can be made, in a rational sane compromising spirit, much positive good can emerge. The agreement can be in the form of simply an oral meeting, but it would be preferably conducted with a written format with each party bringing to the table all of the issues in the marriage and family life that they would feel needs to be addressed. The agreement should then be stated in writing.
    This does not mean the written agreement needs to be in the form of a contract that needs to be notarized and drafted by an attorney, but can be just notes in a notebook that can be referred to periodically when it is time to renegotiate when there has been a difference of opinion. If each party knows what the other expects and each party performs according to the agreement, this has much potential for building a relationship of trust, and respect, rather than one of secrecy, hostility, resentment, withdrawal and bitterness, which can always come when left to our own mind, our own selfish interests, and the application of personal will against the performance of another.
    Some might argue that a love relationship, an intimate relationship such as marriage, should not be treated coldly by such things as formal agreements. It could also be argued however, that since such agreements are a useful and necessary part of any other relationship in society, that to not do it within the context of marriage is the opposite of love and friendship, and the desire for a lasting, mutually beneficial relationship.