Clinic Day Quotes

I love you more than a hooker loves free VD testing day at the clinic

It kills me how these days everyone has clinical justification for their strangeness.

In those pamphlets that they give at mental health centers where they list the ten or so symptoms that would indicate a clinical depression, 'suicide threats' or even simple 'talk of suicide' is considered cause for concern. I guess the point is that what's just talk one day may become a real activity the next. So perhaps after years of walking around with these germinal feelings, these raw thoughts, these scattered moments of saying I wish I were dead, eventually I too, sooner or later, would succumb to the death urge. In the meantime, I could withdraw to my room, could hide and sleep as if I were dead.

Some catastrophic moments invite clarity, explode in split moments: You smash your hand through a windowpane and then there is blood and shattered glass stained with red all over the place; you fall out a window and break some bones and scrape some skin. Stitches and casts and bandages and antiseptic solve and salve the wounds. But depression is not a sudden disaster. It is more like a cancer: At first its tumorous mass is not even noticeable to the careful eye, and then one day -- wham! -- there is a huge, deadly seven-pound lump lodged in your brain or your stomach or your shoulder blade, and this thing that your own body has produced is actually trying to kill you. Depression is a lot like that: Slowly, over the years, the data will accumulate in your heart and mind, a computer program for total negativity will build into your system, making life feel more and more unbearable. But you won't even notice it coming on, thinking that it is somehow normal, something about getting older, about turning eight or turning twelve or turning fifteen, and then one day you realize that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live. In my case, I was not frightened in the least bit at the thought that I might live because I was certain, quite certain, that I was already dead. The actual dying part, the withering away of my physical body, was a mere formality. My spirit, my emotional being, whatever you want to call all that inner turmoil that has nothing to do with physical existence, were long gone, dead and gone, and only a mass of the most fucking god-awful excruciating pain like a pair of boiling hot tongs clamped tight around my spine and pressing on all my nerves was left in its wake. That's the thing I want to make clear about depression: It's got nothing at all to do with life. In the course of life, there is sadness and pain and sorrow, all of which, in their right time and season, are normal -- unpleasant, but normal. Depression is an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature's part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead. And the scariest part is that if you ask anyone in the throes of depression how he got there, to pin down the turning point, he'll never know. There is a classic moment in The Sun Also Rises when someone asks Mike Campbell how he went bankrupt, and all he can say in response is, 'Gradually and then suddenly.' When someone asks how I love my mind, that is all I can say too

Sometimes when I’ve felt despondent for several days, it helps to discipline myself by saying, ‘I’m going to think only positive thoughts.’ Enough is enough!

Did you ever hear one of those corny, positive messages on someone's answering machine? 'Hi, it's a great day and I'm out enjoying it right now. I hope you are too. The thought for the day is share the love. Beep.' 'Uh, yeah, this is the VD clinic… speaking of being positive, your test is back. Stop sharing the love.

There is probably no better or more reliable measure of whether a woman has spent time in ugly duckling status at some point or all throughout her life than her inability to digest a sincere compliment. Although it could be a matter of modesty, or could be attributed to shyness- although too many serious wounds are carelessly written off as "nothing but shyness"- more often a compliment is stuttered around about because it sets up an automatic and unpleasant dialogue in the woman's mind. If you say how lovely she is, or how beautiful her art is, or compliment anything else her soul took part in, inspired, or suffused, something in her mind says she is undeserving and you, the complimentor, are an idiot for thinking such a thing to begin with. Rather than understand that the beauty of her soul shines through when she is being herself, the woman changes the subject and effectively snatches nourishment away from the soul-self, which thrives on being acknowledged." "I must admit, I sometimes find it useful in my practice to delineate the various typologies of personality as cats and hens and ducks and swans and so forth. If warranted, I might ask my client to assume for a moment that she is a swan who does not realzie it. Assume also for a moment that she has been brought up by or is currently surrounded by ducks. There is nothing wrong with ducks, I assure them, or with swans. But ducks are ducks and swans are swans. Sometimes to make the point I have to move to other animal metaphors. I like to use mice. What if you were raised by the mice people? But what if you're, say, a swan. Swans and mice hate each other's food for the most part. They each think the other smells funny. They are not interested in spending time together, and if they did, one would be constantly harassing the other. But what if you, being a swan, had to pretend you were a mouse? What if you had to pretend to be gray and furry and tiny? What you had no long snaky tail to carry in the air on tail-carrying day? What if wherever you went you tried to walk like a mouse, but you waddled instead? What if you tried to talk like a mouse, but insteade out came a honk every time? Wouldn't you be the most miserable creature in the world? The answer is an inequivocal yes. So why, if this is all so and too true, do women keep trying to bend and fold themselves into shapes that are not theirs? I must say, from years of clinical observation of this problem, that most of the time it is not because of deep-seated masochism or a malignant dedication to self-destruction or anything of that nature. More often it is because the woman simply doesn't know any better. She is unmothered.

Astounded—and indifferent—for he was a man who, in effect, had no ‘day before’.

Lately, though, he'd just been tired in general. Tired of people. Tired of books and TV and the nightly news and songs on the radio he'd heard years before and hadn't liked much in the first place. He was tired of his clothes and tired of his hair and tired of other people's clothes and other people's hair. He was tired of wishing things made sense. He'd gotten to a point where he was pretty sure he'd heard everything anyone had to say on any given subject and so it seemed he spent his days listening to old recordings of things that hadn't seemed fresh the first time he'd heard them. Maybe he was simply tired of life, of the absolute effort it took to get up every goddamned morning and walk out with into the same fucking day with only slight variations in the weather and food. He wondered if this was what clinical depression felt like, a total numbness, a weary lack of hope.

I mean, I ignore plenty of stuff, like school spirit days and the dirty looks I get from the Detentionheads while I try to slink through the halls unnoticed. But there's something about telling other people what to ignore that just doesn't work for me. Especially things we shouldn't be ignoring. Hear that girl in your class is being abused by her stepfather and had to go to the clinic? Hear she's bringing her mother's pills to school and selling them to pay for it? Ignore. Ignore. Ignore. Mind your own business. Don't make waves. Fly under the radar. It's just one of those things, Vera. I'm sorry, but I don't get it. If we're supposed to ignore everything that's wrong in our lives, then I can't see how we'll ever make things right.

On the day I turn seventeen, there is a meeting to decide whether I should have the baby or if sneaking me to a clinic for an abortion is worth the PR risk. I am not invited, which is just as well, since my being there might imply that I have some choice in the matter and I know that I have none.

I love you more than a hooker loves free VD testing day at the clinic," she told me drunkenly.

It hadn't occurred to me that my mother would die. Until she was dying, the thought had never entered my mind. She was monolithic and insurmountable, the keeper of my life. She would grow old and still work in the garden. This image was fixed in my mind, like one of the memories from her childhood that I made her explain so intricately that I remembered it as if it were mine. She would be old and beautiful like the black-and-white photo of Georgia O'Keeffe I'd once sent her. I held fast to this image for the first couple of weeks after we left the Mayo Clinic, and then, once she was admitted to the hospice wing of the hospital in Duluth, that image unfurled, gave way to the others, more modest and true. I imagined my mother in October; I wrote the scene in my mind. And then the one of my mother in August and another in May. Each day that passed, another month peeled away.

None of the patients could say the experiments didn't yield some benefits. It was the way the experiments were conducted that grated: with cold, clinical detachment. Masks, gloves, and carbolic acid were the order of the day fora ll staff, and while this may have been prudent it only made isolated people feel even more isolated.

Of course she’s right. How bad are things when your clinically insane mother is more rational than you are?

A pill mill was a pain-management clinic, staffed by a doctor with little more than a prescription pad. A pill mill became a virtual ATM for dope as the doctor issued prescriptions to hundreds of people a day.

Every patient who was prescribed the drug stood a chance of soon needing it every day. These people were willing to pay cash. They never missed an appointment. If diagnosis wasn’t your concern, a clinic was a low-overhead operation: a rented building, a few waiting rooms, some office staff. And bouncers. These clinics did require bouncers.

He could not believe that ordinary people in the Culture really wanted the war, no matter how they had voted. They had their communist Utopia. They were soft and pampered and indulged, and the Contact section’s evangelical materialism provided their conscience-salving good works. What more could they want? The war had to be the Mind’s idea; it was part of their clinical drive to clean up the galaxy, make it run on nice, efficient lines, without waste, injustice or suffering. The fools in the Culture couldn’t see that one day the Minds would start thinking how wasteful and inefficient the humans in the Culture themselves were.

For folks who have that casual-dude energy coursing through their bloodstream, that's great. But gays should not grow up alienated just for us to alienate each other. It's too predictable, like any other cycle of abuse. Plus, the conformist, competitive notion that by "toning down" we are "growing up" ultimately blunts the radical edge of what it is to be queer; it truncates our colorful journey of identity. Said another way, it's like living in West Hollywood and working a gay job by day and working it in the gay nightlife, wearing delicate shiny shirts picked from up the gay dry cleaners, yet coquettishly left unbuttoned to reveal the pec implants purchased from a gay surgeon and shown off by prancing around the gay-owned-and-operated theater hopped up on gay health clinic steroids and wheat grass purchased from the friendly gay boy who's new to the city, and impressed by the monstrous SUV purchased from a gay car dealership with its rainbow-striped bumper sticker that says "Celebrate Diversity." Then logging on to the local Gay.com listings and describing yourself as "straight-acting." Let me make myself clear. This is not a campaign for everyone to be like me. That'd be a total yawn. Instead, this narrative is about praise for the prancy boys. Granted, there's undecided gender-fucks, dagger dykes, faux-mos, po-mos, FTMs, fisting-top daddies, and lezzie looners who also need props for broadening the sexual spectrum, but they're telling their own stories. The Cliff's Notes of me and mine are this: the only moments I feel alive are when I'm just being myself - not some stiff-necked temp masquerading as normal in the workplace, not some insecure gay boy aspiring to be an overpumped circuit queen, not some comic book version of swank WeHo living. If that's considered a political act in the homogenized world of twenty-first century homosexuals, then so be it. — excerpt of "Praise For The Prancy Boys," by Clint Catalyst appears in first edition (ISBN # 1-932360-56-5)

During World War II, the British spy agency MI8 secretly recruited a crew of teenage wireless operators (prohibited from discussing their activities even with their families) to intercept coded messages from the Nazis. By forwarding these transmissions to the crack team of code breakers at Bletchley Park led by the computer pioneer Alan Turing, these young hams enabled the Allies to accurately predict the movements of the German and Italian forces. Asperger’s prediction that the little professors in his clinic could one day aid in the war effort had been prescient, but it was the Allies who reaped the benefits.

The staying and doing it, in spite of everything. In spite of the bears and the rattlesnakes and the scat of the mountain lions I never saw; the blisters and scabs and scrapes and lacerations. The exhaustion and the deprivation; the cold and the heat; the monotony and the pain; the thirst and the hunger; the glory and the ghosts that haunted me as I hiked eleven hundred miles from the Mojave Desert to the state of Washington by myself. And finally, once I’d actually gone and done it, walked all those miles for all those days, there was the realization that what I’d thought was the beginning had not really been the beginning at all. That in truth my hike on the Pacific Crest Trail hadn’t begun when I made the snap decision to do it. It had begun before I even imagined it, precisely four years, seven months, and three days before, when I’d stood in a little room at the Mayo Clinic in Rochester, Minnesota, and learned that my mother was going to die.

By the time he was twenty Asclepius had mastered all the arts of surgery and medicine. He embraced his teacher Chiron in a fond farewell and left to set up on his own as the world’s first physician, apothecary and healer. His fame spread around the Mediterranean with great speed. The sick, lame and unhappy flocked to his surgery, outside which he hung a sign – a wooden staff with a snake twined round it, seen to this day on many ambulances, clinics and (often disreputable) medical websites.

Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. When a great ship steams across the ocean, even tiny ripples can accumulate over time, precipitating a dramatic shift in course. There are many Tertius Lydgates, male and female, inhabiting the lecture halls, laboratories, and clinics of today’s medical schools. Like latter-day Lydgates, many of them eventually find themselves expressing amazement and disgust at how far they have veered from their primary purpose.

One in two recently evicted mothers reports multiple symptoms of clinical depression, double the rate of similar mothers who were not forced from their homes. Even after years pass, evicted mothers are less happy, energetic, and optimistic than their peers. When several patients committed suicide in the days leading up to their eviction, a group of psychiatrists published a letter in Psychiatric Services, identifying eviction as a “significant precursor of suicide.” The letter emphasized that none of the patients were facing homelessness, leading the psychiatrists to attribute the suicides to eviction itself. “Eviction must be considered a traumatic rejection,” they wrote, “a denial of one’s most basic human needs, and an exquisitely shameful experience.” Suicides attributed to evictions and foreclosures doubled between 2005 and 2010, years when housing costs soared.

American housewives have not had their brains shot away, nor are they schizophrenic in the clinical sense. But if … the fundamental human drive is not the urge for pleasure or the satisfaction of biological needs, but the need to grow and to realize one’s full potential, their comfortable, empty, purposeless days are indeed cause for a nameless terror.

This was something new. Or something old. I didn’t think of what it might be until after I had let Aubrey go back to the clinic to bed down next to her child. Bankole had given him something to help him sleep. He did the same for her, so I won’t be able to ask her anything more until she wakes up later this morning. I couldn’t help wondering, though, whether these people, with their crosses, had some connection with my current least favorite presidential candidate, Texas Senator Andrew Steele Jarret. It sounds like the sort of thing his people might do—a revival of something nasty out of the past. Did the Ku Klux Klan wear crosses—as well as burn them? The Nazis wore the swastika, which is a kind of cross, but I don’t think they wore it on their chests. There were crosses all over the place during the Inquisition and before that, during the Crusades. So now we have another group that uses crosses and slaughters people. Jarret’s people could be behind it. Jarret insists on being a throwback to some earlier, “simpler” time. Now does not suit him. Religious tolerance does not suit him. The current state of the country does not suit him. He wants to take us all back to some magical time when everyone believed in the same God, worshipped him in the same way, and understood that their safety in the universe depended on completing the same religious rituals and stomping anyone who was different. There was never such a time in this country. But these days when more than half the people in the country can’t read at all, history is just one more vast unknown to them. Jarret supporters have been known, now and then, to form mobs and burn people at the stake for being witches. Witches! In 2032! A witch, in their view, tends to be a Moslem, a Jew, a Hindu, a Buddhist, or, in some parts of the country, a Mormon, a Jehovah’s Witness, or even a Catholic. A witch may also be an atheist, a “cultist,” or a well-to-do eccentric. Well-to-do eccentrics often have no protectors or much that’s worth stealing. And “cultist” is a great catchall term for anyone who fits into no other large category, and yet doesn’t quite match Jarret’s version of Christianity. Jarret’s people have been known to beat or drive out Unitarians, for goodness’ sake. Jarret condemns the burnings, but does so in such mild language that his people are free to hear what they want to hear. As for the beatings, the tarring and feathering, and the destruction of “heathen houses of devil-worship,” he has a simple answer: “Join us! Our doors are open to every nationality, every race! Leave your sinful past behind, and become one of us. Help us to make America great again.

Thank you so much, baby. I love you more than a hooker loves free VD testing day at the clinic," she told me drunkenly.

His days were full of nights.

While play-acting grim scenarios day in and day out may sound like a good recipe for clinical depression, it’s actually weirdly uplifting. Rehearsing for catastrophe has made me positive that I have the problem-solving skills to deal with tough situations and come out the other side smiling. For me, this has greatly reduced the mental and emotional clutter that unchecked worrying produces, those random thoughts that hijack your brain at three o’clock in the morning. While I very much hoped not to die in space, I didn’t live in fear of it, largely because I’d been made to think through the practicalities: how I’d want my family to get the news, for instance, and which astronaut I should recruit to help my wife cut through the red tape at NASA and the CSA. Before my last space flight (as with each of the earlier ones) I reviewed my will, made sure my financial affairs and taxes were in order, and did all the other things you’d do if you knew you were going to die. But that didn’t make me feel like I had one foot in the grave. It actually put my mind at ease and reduced my anxiety about what my family’s future would look like if something happened to me. Which meant that when the engines lit up at launch, I was able to focus entirely on the task at hand: arriving alive.

You might be scared to start. That’s natural. There’s this very real thing that runs rampant in educated people. It’s called “impostor syndrome.” The clinical definition is a “psychological phenomenon in which people are unable to internalize their accomplishments.” It means that you feel like a phony, like you’re just winging it, that you really don’t have any idea what you’re doing. Guess what: None of us do. Ask anybody doing truly creative work, and they’ll tell you the truth: They don’t know where the good stuff comes from. They just show up to do their thing. Every day.

Randomisation is not a new idea. It was first proposed in the seventeenth century by John Baptista van Helmont, a Belgian radical who challenged the academics of his day to test their treatments like blood-letting and purging (based on ‘theory’) against his own, which he said were based more on clinical experience: ‘Let us take out of the hospitals, out of the Camps, or from elsewhere, two hundred, or five hundred poor People, that have Fevers, Pleurisies, etc. Let us divide them into half, let us cast lots, that one half of them may fall to my share, and the other to yours … We shall see how many funerals both of us shall have.

THE GREAT IRONY is that in the beginning, the gut was all there was. “We’re basically a highly evolved earthworm surrounding the intestinal tract,” Khoruts commented as we drove away from his clinic the last day I was there. Eventually, the food processor had to have a brain attached to help it look for food, and limbs to reach that food. That increased its size, so it needed a circulatory system to distribute the fuel that powered the limbs.

The Correspondence-School Instructor Says Goodbye to His Poetry Students Goodbye, lady in Bangor, who sent me snapshots of yourself, after definitely hinting you were beautiful; goodbye, Miami Beach urologist, who enclosed plain brown envelopes for the return of your very “Clinical Sonnets”; goodbye, manufacturer of brassieres on the Coast, whose eclogues give the fullest treatment in literature yet to the sagging breast motif; goodbye, you in San Quentin, who wrote, “Being German my hero is Hitler,” instead of “Sincerely yours,” at the end of long, neat-scripted letters extolling the Pre-Raphaelites: I swear to you, it was just my way of cheering myself up, as I licked the stamped, self-addressed envelopes, the game I had of trying to guess which one of you, this time, had poisoned his glue. I did care. I did read each poem entire. I did say everything I thought in the mildest words I knew. And now, in this poem, or chopped prose, no better, I realize, than those troubled lines I kept sending back to you, I have to say I am relieved it is over: at the end I could feel only pity for that urge toward more life your poems kept smothering in words, the smell of which, days later, tingled in your nostrils as new, God-given impulses to write. Goodbye, you who are, for me, the postmarks again of imaginary towns—Xenia, Burnt Cabins, Hornell— their solitude given away in poems, only their loneliness kept. Galway Kinnell

It’s normally agreed that the question “How are you?” doesn’t put you on your oath to give a full or honest answer. So when asked these days, I tend to say something cryptic like, “A bit early to say.” (If it’s the wonderful staff at my oncology clinic who inquire, I sometimes go so far as to respond, “I seem to have cancer today.”) Nobody wants to be told about the countless minor horrors and humiliations that become facts of “life” when your body turns from being a friend to being a foe: the boring switch from chronic constipation to its sudden dramatic opposite; the equally nasty double cross of feeling acute hunger while fearing even the scent of food; the absolute misery of gut–wringing nausea on an utterly empty stomach; or the pathetic discovery that hair loss extends to the disappearance of the follicles in your nostrils, and thus to the childish and irritating phenomenon of a permanently runny nose. Sorry, but you did ask... It’s no fun to appreciate to the full the truth of the materialist proposition that I don’t have a body, I am a body. But it’s not really possible to adopt a stance of “Don’t ask, don’t tell,” either. Like its original, this is a prescription for hypocrisy and double standards. Friends and relatives, obviously, don’t really have the option of not making kind inquiries. One way of trying to put them at their ease is to be as candid as possible and not to adopt any sort of euphemism or denial. The swiftest way of doing this is to note that the thing about Stage Four is that there is no such thing as Stage Five. Quite rightly, some take me up on it. I recently had to accept that I wasn’t going to be able to attend my niece’s wedding, in my old hometown and former university in Oxford. This depressed me for more than one reason, and an especially close friend inquired, “Is it that you’re afraid you’ll never see England again?” As it happens he was exactly right to ask, and it had been precisely that which had been bothering me, but I was unreasonably shocked by his bluntness. I’ll do the facing of hard facts, thanks. Don’t you be doing it too. And yet I had absolutely invited the question. Telling someone else, with deliberate realism, that once I’d had a few more scans and treatments I might be told by the doctors that things from now on could be mainly a matter of “management,” I again had the wind knocked out of me when she said, “Yes, I suppose a time comes when you have to consider letting go.” How true, and how crisp a summary of what I had just said myself. But again there was the unreasonable urge to have a kind of monopoly on, or a sort of veto over, what was actually sayable. Cancer victimhood contains a permanent temptation to be self–centered and even solipsistic.

When we finally left the storms of the Midwest behind us, I turned to the man beside me, a Boeing engineer, and asked him if he had been afraid. “No. I’ve already been there.” It was a strange answer. He explained that he had been clinically dead as a youth, crushed beneath a car after he and several friends had hit a utility pole. “I watched from somewhere up above and saw the troopers lift the car off someone. Then I saw that it was me lying there. I wasn’t afraid, and I didn’t feel any pain—not until I woke up in the hospital three days later. Since then, I’ve known that the soul doesn’t die, only the body, and I’ve never been afraid.” I

Our world is in turmoil. It is aging toward senility. It is very ill. Long ago it was born with brilliant prospects. It was baptized by water, and its sins were washed away. It was never baptized by fire, for that is still to come. It has had shorter periods of good health, but longer ones of ailing. Most of the time there have been pains and aches in some parts of its anatomy, but now that it is growing old, complications have set in, and all the ailments seem to be everywhere. The world has been ‘cliniced,’ and the complex diseases have been catalogued. The physicians have had summit consultations, and temporary salve has been rubbed on afflicted parts, but it has only postponed the fatal day and never cured it. It seems that while remedies have been applied, staph infection has set in, and the patient’s suffering intensified. His mind is wandering. It cannot remember its previous illnesses nor the cure which was applied. The political physicians through the ages have rejected suggested remedies as unprofessional since they came from lowly prophets. Man being what he is with tendencies such as he has, results can be prognosticated with some degree of accuracy.

In a modern twist to the classic overeating experiments, Feltham decided that he would eat 5794 calories per day and document his weight gain. But the diet he chose was not a random 5794 calories. He followed a low-carbohydrate, high-fat diet of natural foods for twenty-one days. Feltham believed, based on clinical experience, that refined carbohydrates, not total calories, caused weight gain. The macronutrient breakdown of his diet was 10 percent carbohydrate, 53 percent fat and 37 percent protein. Standard calorie calculations predicted a weight gain of about 16 pounds (7.3 kilograms). Actual weight gain, however, was only about 2.8 pounds (1.3 kilograms). Even more interesting, he dropped more than 1 inch (2.5 centimeters) from his waist measurement. He gained weight, but it was lean mass.

It was a bad day for viruses,” Moderna’s chair Afeyan says about the Sunday in November 2020 when he got the first word of the clinical trial results. “There was a sudden shift in the evolutionary balance between what human technology can do and what viruses can do. We may never have a pandemic again.

The Conservative government decided to “merge” John’s clinic with a new health trust, run by evangelical Christians who opposed prescription on principle. The patients panicked, because they knew what being cut off would mean—a return to abscesses and overdoses and scrambling for drugs from gangsters.

The two psycho-analytic theories were in a different class. They were simply non testable, irrefutable. There was no conceivable human behav­iour which could contradict them. This does not mean that Freud and Adler were not seeing certain things correctly: I personally do not doubt that much of what they say is of considerable importance, and may well play its part one day in a psychological science which is testable. But it does mean that those ‘clinical observations’ which analysts naively believe confirm their theory cannot do this any more than the daily confirmations which astrologers find in their practice. And as for Freud’s epic of the Ego, the Super-ego, and the Id, no substantially stronger claim to scientific status can be made for it than for Homer’s collected stories from Olympus. These theories describe some facts, but in the manner of myths. They contain most interesting psychological suggestions, but not in a testable form.

It might not be a common practise to placebo oneself, but why not try? Weren’t we all doing it to some extent every day anyway? Telling ourselves mind over matter, think positively, visualize, manifest, fake it till you make it. Delusion was an accepted part of life. So why not take a more formalized, clinical approach?

When I behold other people, who are of course the children of some family or other, and think of my own children, and of myself...I am astonished at how sensible, well-behaved, practical, courteous, and predictable these other children are. The other children are so easy about the whole business of being who they are, being in the world, and getting along. Whereas with us it is an awful fight, all the way. I am left with the conclusion that we are quite probably crazy, but somehow not in a way that compels commitment. We get over our rampages before society or clinical insanity charges in on us. I can think of very few of us who are not nuts. And that's not at our worst, that's pretty much as we always are. We find fault with everything. The world stinks, and even long after we have reconciled ourselves to that truth, we still regret it, and now and then even rage against it. Running through the various branches of the family I fail to find one branch which might be said to be nice- ordinary, sober, adjusted, willing, courteous, undemanding, charming, practical, predictable, and all of the other things nice people are. Lunacy runs straight down the middle of every branch of my family. We have nobody who is not some kind of nut. What did it? How did it happen? Well, there's no answer, of course.

In our co-lecturing days, Flo Kennedy and I were sitting in the back of a taxi on the way to the Boston airport, discussing Flo’s book Abortion Rap. The driver, an old Irish woman, the only such cabbie I’ve ever seen, turned to us at a traffic light and said the immortal words, “Honey, if men could get pregnant, abortion would be a sacrament!” Would she have wanted to own her words in public? I don’t know, but I so wish we had asked her name. When Flo and I told this taxi story at speeches, the driver’s sentence spread on T-shirts, political buttons, clinic walls, and protest banners from Washington to Vatican Square, from Ireland to Nigeria. By 2012, almost forty years after that taxi ride, the driver’s words were on a banner outside the Republican National Convention in Tampa, when the party nominated Mitt Romney for president of the United States on a platform that included criminalizing abortion. Neither Flo nor the taxi driver could have lived to see him lose—and yet they were there.

Over time, the grueling job of a mother requires one to learn everything from patience to clinical psychology. When you are "in the fire," it is sometimes hard to recognize the value of what you are learning. But the da-to-day refining process--the problem solving, crisis resolution, mental stretching, mess clean-ups, sleep deprivation, and loving more than you thought possible truly makes you into a smart, aware, beautiful refined individual. The great secret is appreciating the refined person you are becoming through your trials.

How bad are things when your clinically insane mother is more rational than you are?

If you don’t talk to your cat about catnip, who will? —SIGN AT DEL SOL VETERINARY CLINIC

In former days, people frustrated in their will to meaning would probably have turned to a pastor, priest, or rabbi. Today, they crowd clinics and offices. The psychiatrist, then, frequently finds himself in an embarrassing situation, for he now is confronted with human problems rather than with specific clinical symptoms. Man’s search for a meaning is not pathological, but rather the surest sign of being truly human. Even if this search is frustrated, it cannot be considered a sign of disease. It is spiritual distress, not mental disease.

And this is as good a picture as any of how counterculture communities like the Haight took care of the war’s mangled souls: a doctor from a hippie clinic carrying a dying, emaciated soldier in his arms. For decades after the war, up to this very day, right-wing politicians and pundits have spread the libel about how peace activists and hippies greeted returning Vietnam vets with gobs of spit and contempt.

Filth, filth, filth, from morning to night. I know they're poor but they could wash. Water is free and soap is cheap. Just look at that arm, nurse.' The nurse looked and clucked in horror. Francie stood there with the hot flamepoints of shame burning her face. The doctor was a Harvard man, interning at the neighborhood hospital. Once a week, he was obliged to put in a few hours at one of the free clinics. He was going into a smart practice in Boston when his internship was over. Adopting the phraseology of the neighborhood, he referred to his Brooklyn internship as going through Purgatory, when he wrote to his socially prominent fiancee in Boston. The nurse was as Williamsburg girl... The child of poor Polish immigrants, she had been ambitious, worked days in a sweatshop and gone to school at night. Somehow she had gotten her training... She didn't want anyone to know she had come from the slums. After the doctor's outburst, Francie stood hanging her head. She was a dirty girl. That's what the doctor meant. He was talking more quietly now asking the nurse how that kind of people could survive; that it would be a better world if they were all sterilized and couldn't breed anymore. Did that mean he wanted her to die? Would he do something to make her die because her hands and arms were dirty from the mud pies? She looked at the nurse... She thought the nurse might say something like: Maybe this little girl's mother works and didn't have time to wash her good this morning,' or, 'You know how it is, Doctor, children will play in the dirt.' But what the nurse actuallly said was, 'I know, Isn't it terrible? I sympathize with you, Doctor. There is no excuse for these people living in filth.' A person who pulls himself up from a low environment via the bootstrap route has two choices. Having risen above his environment, he can forget it; or, he can rise above it and never forget it and keep compassion and understanding in his heart for those he has left behind him in the cruel upclimb. The nurse had chosen the forgetting way. Yet, as she stood there, she knew that years later she would be haunted by the sorrow in the face of that starveling child and that she would wish bitterly that she had said a comforting word then and done something towards the saving of her immortal soul. She had the knowledge that she was small but she lacked the courage to be otherwise. When the needle jabbed, Francie never felt it. The waves of hurt started by the doctor's words were racking her body and drove out all other feeling. While the nurse was expertly tying a strip of gauze around her arm and the doctor was putting his instrument in the sterilizer and taking out a fresh needle, Francie spoke up. My brother is next. His arm is just as dirty as mine so don't be suprised. And you don't have to tell him. You told me.' They stared at this bit of humanity who had become so strangely articulate. Francie's voice went ragged with a sob. 'You don't have to tell him. Besides it won't do no godd. He's a boy and he don't care if he is dirty.'... As the door closed, she heard the doctor's suprised voice. I had no idea she'd understand what I was saying.' She heard the nurse say, 'Oh, well,' on a sighing note.

my eyes make mirrors out of every reflective surface they pass searching for something beautiful looking my ears fish for compliments and praise but no matter how far they go looking nothing is enough for me i go to clinics and department stores for pretty potions and new techniques i've tried the lasers i've tried the facials i've tried the blades and expensive creams for a hopeful minute they fill me make me glow from cheek to cheek but as soon as i feel beautiful their magic disappears suddenly where am i supposed to find it i am willing to pay any price for a beauty that makes heads turn every moment day and night - a never-ending search

As soon as you wake up, before you get out of bed, let your first thought be one of gratitude. Start with a few deep breaths and then think about five people in your life you’re grateful for. While breathing in slowly and deeply, bring the first person’s face in front of your closed eyes. Try to “see” this person as clearly as you can. Then send him or her silent gratitude while breathing out, again slowly and deeply. Repeat this exercise with five people. Avoid rushing through the experience. Relish the few seconds you spend remembering them. This practice will help you focus on what’s most important in your life and provide context to your day. At an opportune time, let your loved ones and friends know about your morning gratitude practice. Won’t it be nice for them to know that even if you are a thousand miles away, your first thought of the day is gratitude for them?

My work as a Meridian Psychotherapist and Clinical Hypnotherapist has taught me that people often feel guilty about the way they feel or think and many do not realise that seasonal changes can have a profound effect on the psyche.

restricting access to abortion—despite the fact that it is legal. In twenty-seven states, women are now forced to wait one, two, or even three days between receiving mandatory “counseling” (which often contains bogus information) and obtaining an abortion, a barrier that puts an undue burden on working women, women with children, and women who live in rural areas, requiring them to take time off work and spend additional money to travel back and forth to a clinic that may be two hundred miles from home.

She has a quiet paroxysm. Now remember that these are the days before digital pornography. There is no cliché of how women are supposed to orgasm, no idea in their heads of how they are supposed to sound when they climax. Mrs. Daldry’s first orgasms could be very quiet, organic, awkward, primal. Or very clinical. Or embarrassingly natural. But whatever it is, it should not be a cliché, a camp version of how we expect all women sound when they orgasm. It is simply clear that she has had some kind of release.

Depression is partly a nocebo effect, in the sense that it can be produced by negative exceptions about oneself and the world. The way in which these negative expectations develop and produce their negative effects provides some clues as to how they can be reversed. Expectancy effects grow, feeding upon themselves. One reason this happens is that our subjective states - our feelings, our moods and sensations - are in constant flux, changing from day to day and from moment to moment. The effects of these fluctuations depend on how we interpret them, and our interpretations depend on our beliefs and expectations. When we expect to feel worse, we tend to notice random small negative changes and interpret them as evidence that we are in fact getting worse. This interpretation makes us actually feel worse, and it strengthens the belief that we are getting worse, leading to a vicious cycle in which our expectations and negative emotions feed on each other, cascading into a full-blown depressive episode. .. Positive expectancies have the opposite effect. They can set in motion a begin cycle, in which random fluctuations in mood and well being are interpreted as evidence of treatment effectiveness, thereby instilling a further sense of hope and countering the feeling of hopelessness that are so central to clinical depression.

I’d walked to school like it was any other day. Like my heart wasn’t breaking. Like my head wasn’t reeling and my feet weren’t weighted down by the sudden and tragic onset of clinical depression, making each breath a trial, each step a struggle. I totally needed a car.

When I was at the rehab clinic in Iowa, they had these quotes in every room by Ram Dass. In the front lobby there was this quote on the wall that said, ‘We’re all just walking each other home.’ I never really understood the meaning until right now. “Because at the end of the day, we’re all lost. We’re all cracked. We’re all scarred. We’re all broken. We’re all just trying to figure out this thing called life, you know? Sometimes it feels so lonely, but then you remember your core tribe. The people who sometimes hate you, but never stop loving you.

Why is the world full of color anyway? Sunlight is white, and when it is reflected, it is still white. And so we should be surrounded by a clinical looking, optically pure landscape. That this is not what we see is because every material absorbs light differently or converts it into other kinds of radiation. Only the wavelengths that remain are refracted and reach our eyes. Therefore, the color of organisms and objects is dictated by the color of the reflected light. And in the case of leaves on trees, this color is green. But why don't we see leaves as black? Why don't they absorb all light? Chlorophyll helps leaves process light. If trees processed light super-efficiently, there would be hardly any left over-and the forest would then look as dark during the day as it does at night. Chlorophyll, however, has one disadvantage. It has a so-called green gap, and because it cannot use this part of the color spectrum, it has to reflect it back unused. This weak spot means that we can see this photosynthetic leftover, and that's why almost all plants look deep green to us. What we are really seeing is waste light, the rejected part that trees cannot use. Beautiful for us; useless for the trees. Nature that we find pleasing because it reflects trash? Whether trees feel the same way about this I don't know, but one thing is for certain: hungry beeches and spruce are as happy to see blue sky as I am.

Mabel went on, and you Petites Cendres, you haven’t forgotten we’re throwing a party for your Doctor Dieudonné, oh yes, soon as he gets back, the entire Black Ancestral Choir’s going to celebrate Dieudonné, man of God taking care of the poor and never asking for one cent, why did he have to go away said Petites Cendres, carefree in the comfort of his bed, wasn’t his clinic enough, he mumbled into the dishevelled folds of his sloth, I mean why go volunteer there when we’re holding a party for him right here, Mabel’s singsong voice cut in, going from deep to nasal, he’s getting the town’s medal of honour for doctoring all you lazy layabouts and lost souls, and running two hospitals and a hospice, our very own choir director’s going to give him his plaque with those same fingers and long thin red nails of hers, the ideal man, says the doctor, is not one who piles up money but one who saves lives, why he’s even helped our Ancestral Choir a whole lot too, he’s going to need a nice black tuxedo, just what he hates, and Eureka, the head of the choir, will be so proud that day when Reverend Ézéchielle invites us all to sing in her church,

From the moment they're recruited to the time they're 'rescued' and deported, trafficked women are terrorized. Every single day they face a world stacked heavily against them. Their only friends are the dedicated women and men who form the thin front line against trafficking--an often thankless job. Those working for nongovernmental aid agencies and organizations are the real heroes in this bleak morass. Still, their work is merely a Band-Aid solution. In the vast majority of cases, NGO workers report that their funding is ad hoc and wholly inadequate to meet even basic needs. If we truly want a fair shot at saving these women, we need to open not only our minds but also our wallets. We need to focus on programs that care compassionately for the victims and we need to implement them immediately, worldwide. The most urgent priorities are safe shelters and clinics equipped and staffed to offer medical and psychological treatment. We need to understand that most of these women have been psychologically and physically ripped apart. And we need to be prepared for the fac thtat most have been infected with various sexually transmitted diseases.

Right now, Janine was not holding a sign with a picture of an unborn child on it. She was not praying for the mothers who were walking past her. She was the person being prayed for. On any given day, she could have told you that, inside this clinic, lives were at risk. Today, the life was hers.

On October 10, 2011, researchers from the University of Minnesota found that women who took supplemental multivitamins died at rates higher than those who didn’t. Two days later, researchers from the Cleveland Clinic found that men who took vitamin E had an increased risk of prostate cancer. “It’s been a tough week for vitamins,” said Carrie Gann of ABC News. These findings weren’t new. Seven previous studies had already shown that vitamins increased the risk of cancer and heart disease and shortened lives. Still, in 2012, more than half of all Americans took some form of vitamin supplements.

You can tell a lot about a country by its prisons. In hippy-dippy Socialist Sweden, rapists and murders (all three of them) while away their days making arts and crafts in what are essentially taxpayer-funded mental health clinics. The Swedes’ theory seems to be that a) anyone who commits such a crime must be crazy and b) with enough art therapy, the individual in question will soon become just another law-abiding, nude-sunbathing pot-smoker. In America, we think people in prison are either the victims of some terrible government conspiracy, the victims of “society”—whatever that means—or heinous evildoers. And if they are heinous enough, we fry them with electricity, unless of course they find Jesus first. The Swedes, in a nutshell, are tolerant and forgiving, verging on the naïve; Americans are religious and vengeful, suspicious of their government, and suckers for tear-jerking tales of redemption.

final day of the original experiment. When the scientists examined the rats’ brains, they saw cocaine-induced changes in the rats’ reward pathways consistent with persistent cocaine sensitization. These findings show that a drug like cocaine can alter the brain forever. Similar findings have been shown with other addictive substances, from alcohol to opioids to cannabis. In my clinical work I see people who struggle with severe addiction slipping right back into compulsive use with a single exposure, even after years of abstinence. This may occur because of persistent sensitization to the drug of choice, the distant echoes of earlier drug use.

And all that time I was lying to my support group. I told the ladies, "Sure! I'm writing!" when I wasn't. Yes, I could have filled all those newfound minutes with actual work, but I had no confidence in myself. I was a fraud. Who was I to pick up a pen and expect anything good to come out of it? I expected perfection as soon as the pencil hit the paper, and since that's impossible, I couldn't get myself to start. Then I felt guilty about not starting, which made me want to start even less. And with no game to bury the feelings, I got very depressed. No wonder I didn't book any acting jobs in the last half of 2006. No one wanted to hire a clinically depressed person to sell snack foods.

People who are starving and dressed in rags don’t want to hear someone read a list of propositional “good news.” They want to see the good news in action. The church doesn’t hold revival meetings and call it a day — we feed the hungry, clothe the naked, dig wells, and staff medical clinics. Social action isn’t an optional part of evangelism; it is evangelism. This is an important correction to the overspirituality that dominated evangelical Christianity just a generation ago. But the both/and of holistic mission still misses the heart of Jesus if we don’t see that the church needs the poor as much as the poor need the church. Jesus didn’t embrace the poor only because he pitied them or because he knew he had the resources to help them. Jesus embraced the poor because they were rushing into the kingdom ahead of the scribes and Pharisees — those who called themselves God’s people. Jesus welcomed people who knew poverty because they were ready to receive what he had to offer. Religious people, he said, could learn something from them. Our spiritual lives are linked to the material conditions of our life. When we feel like we don’t need much materially, we often have trouble remembering why we need God. We comfortable Americans can go through an entire day without thinking of God. But Jesus gave the poor more than food to eat and relief from their sickness. He restored them to God’s beloved community.

This is kind of insane, isn't it?" I asked. "I've only known you for a few days." "Five days. Six days if you include today." His blue eyes met mine, our foreheads still touching. "It's not insane. Insanity is a state of mind which prevents normal perception and/or behaviours." I chuckled at his clinical reply, but he pulled back so he could see my face properly and shrugged. "Jack, what I perceive of you, and how I've conducted myself in your company is with full mental cohesion." His cheeks stained with colour. "And Einstein would have you believe that insanity is doing the same thing over and over again and expecting different results." He bit his lip and laughed at himself, I think. "But I don't want different results. I wouldn't change a thing.

There is no doubt that creative work is itself done under a compulsion often indistinguishable from a purely clinical obsession. In this sense, what we call a creative gift is merely the social license to be obsessed. And what we call “cultural routine” is a similar license: the proletariat demands the obsession of work in order to keep from going crazy. I used to wonder how people could stand the really demonic activity of working behind those hellish ranges in hotel kitchens, the frantic whirl of waiting on a dozen tables at one time, the madness of the travel agent’s office at the height of the tourist season, or the torture of working with a jack-hammer all day on a hot summer street. The answer is so simple that it eludes us: the craziness of these activities is exactly that of the human condition. They are “right” for us because the alternative is natural desperation. The daily madness of these jobs is a repeated vaccination against the madness of the asylum. Look at the joy and eagerness with which workers return from vacation to their compulsive routines. They plunge into their work with equanimity and lightheartedness because it drowns out something more ominous.

Depression goes through stages, but if left unchecked and not treated, this elevator ride will eventually go all the way to the bottom floor. And finally you find yourself bereft of choices, unable to figure out a way up or out, and pretty soon one overarching impulse begins winning the battle for your mind: “Kill yourself.” And once you get over the shock of those words in your head, the horror of it, it begins to start sounding appealing, even possessing a strange resolve, logic. In fact, it’s the only thing you have left that is logical. It becomes the only road to relief. As if just the planning of it provides the first solace you’ve felt that you can remember. And you become comfortable with it. You begin to plan it and contemplate the details of how best to do it, as if you were planning travel arrangements for a vacation. You just have to get out. O-U-T. You see the white space behind the letter O? You just want to crawl through that O and be out of this inescapable hurt that is this thing they call clinical depression. “How am I going to do this?” becomes the only tape playing. And if you are really, really, really depressed and you’re really there, you’re gonna find a way. I found a way. I had a way. And I did it. I made sure Opal was out of the house and on a business trip. My planning took a few weeks. I knew exactly how I was going to do it: I didn’t want to make too much of a mess. There was gonna be no blood, no drama. There was just going to be, “Now you see me, now you don’t.” That’s what it was going to be. So I did it. And it was over. Or so I thought. About twenty-four hours later I woke up. I was groggy; zoned out to the point at which I couldn’t put a sentence together for the next couple of days. But I was semifunctional, and as these drugs and shit that I took began to wear off slowly but surely, I realized, “Okay, I fucked up. I didn’t make it.” I thought I did all the right stuff, left no room for error, but something happened. And this perfect, flawless plan was thwarted. As if some force rebuked me and said, “Not yet. You’re not going anywhere.” The only reason I could have made it, after the amount of pills and alcohol and shit I took, was that somebody or something decided it wasn’t my time. It certainly wasn’t me making that call. It was something external. And when you’re infused with the presence of this positive external force, which is so much greater than all of your efforts to the contrary, that’s about as empowering a moment as you can have in your life. These days we have a plethora of drugs one can take to ameliorate the intensity of this lack of hope, lack of direction, lack of choice. So fuck it and don’t be embarrassed or feel like you can handle it yourself, because lemme tell ya something: you can’t. Get fuckin’ help. The negative demon is strong, and you may not be as fortunate as I was. My brother wasn’t. For me, despair eventually gave way to resolve, and resolve gave way to hope, and hope gave way to “Holy shit. I feel better than I’ve ever felt right now.” Having actually gone right up to the white light, looked right at it, and some force in the universe turned me around, I found, with apologies to Mr. Dylan, my direction home. I felt more alive than I’ve ever felt. I’m not exaggerating when I say for the next six months I felt like Superman. Like I’m gonna fucking go through walls. That’s how strong I felt. I had this positive force in me. I was saved. I was protected. I was like the only guy who survived and walked away from a major plane crash. I was here to do something big. What started as the darkest moment in my life became this surge of focus, direction, energy, and empowerment.

The antibacterial and anti-inflammatory properties of honey were revealed as a result of clinical observations and research. Honey is exceedingly effective in painlessly cleaning up infection and dead cells in these regions and in the development of new tissues. The use of honey as a medicine is mentioned in the most ancient writings. In the present day, doctors and scientists are rediscovering the effectiveness of honey in the treatment of wounds. Dr. Peter Molan, a leading researcher into honey for the last 20 years and a professor of biochemistry at New Zealand's University of Waikato, says this about the antimicrobial properties of honey: "Randomized trials have shown that honey is more effective in controlling infection in burn wounds than silver sulphadiazine, the antibacterial ointment most widely used on burns in hospitals.

Wilson-Donovan wanted to move ahead as quickly as possible to clinical trials on patients, which was why it was so important to test Vicotec’s safety now before the FDA hearings in September, which would hopefully put it on the “Fast Track.” Peter was absolutely sure that the testing being concluded by Paul-Louis Suchard, the head of the laboratory in Paris, would only confirm the good news he had just been given in Geneva.

It is for such reasons that I always ask my clinical clients first about sleep. Do they wake up in the morning at approximately the time the typical person wakes up, and at the same time every day? If the answer is no, fixing that is the first thing I recommend. It doesn’t matter so much if they go to bed at the same time each evening, but waking up at a consistent hour is a necessity. Anxiety and depression cannot be easily treated if the sufferer has unpredictable daily routines. The systems that mediate negative emotion are tightly tied to the properly cyclical circadian rhythms. The next thing I ask about is breakfast. I counsel my clients to eat a fat and protein-heavy breakfast as soon as possible after they awaken (no simple carbohydrates, no sugars, as they are digested too rapidly, and produce a blood-sugar spike and rapid dip). This is because anxious and depressed people are already stressed, particularly if their lives have not been under control for a good while. Their bodies are therefore primed to hypersecrete insulin, if they engage in any complex or demanding activity. If they do so after fasting all night and before eating, the excess insulin in their bloodstream will mop up all their blood sugar. Then they become hypoglycemic and psych​ophys​iologi​cally unstable.

It's scary, and downing, that I make my best music when I'm going through my depression... At that moment, all i can see is black, darkness and shadows, but in the bigger picture.. it's a blessing. When I look through all my work, my art, I wouldn't change or take away my depression and anxiety for ANYTHING.. because when i get those days of rainbows, and colors.. i know deep down, i'm only honest when i'm at the deepest of the oceans.. so it's like listening to a different side of my mind, that i never realize exists, until i get that little peek through the blinds, and finally see the sunlight.. THEN on those simple moments, even if they only last a few minutes, i know deep down... maybe i do have a talent. Maybe I have got something, a "gift", that some people call... So really, if it wasn't for my depression, i would never, truly believe I have anything worth giving. So I will NOT sit back and wish i wasn't clinically depressed, I will learn to embrace it, live with it, and talk my brain into believing, and fully knowing, I HAVE A GIFT. I AM WORTHY. I DO HAVE SOMETHING TO GIVE THE WORLD. I will not let my depression or anxiety control me. They can live here(in my mind), but they best know, I AM STILL, AND WILL ALWAYS BE IN CONTROL. .. BUT This is my home, and you're just living under it.

Much of the rest of the summer and fall were devoted to the transcription of Invitation to a Beheading, a first draft of which Vladimir had written in a lightning two weeks, on Véra’s return from the clinic. To his dismay the typing seemed to be taking an inordinate amount of time; in November an exhausted Véra was at the machine night and day. From outside the third-floor apartment, recalled Nabokov, “we heard Hitler’s voice from rooftop loudspeakers.

While play-acting grim scenarios day in and day out may sound like a good recipe for clinical depression, it's actually weirdly uplifting. Rehearsing for catastrophe has made me positive that I have the problem-solving skills do deal with tough situations and come out the other side smiling. For me, this has greatly reduced the mental and emotional clutter that unchecked worrying produces, those random thoughts that hijack your brain at three o'clock in the morning.

While play-acting grim scenarios day in and day out may sound like a good recipe for clinical depression, it's actually weirdly uplifting. Rehearsing for catastrophe has made me positive that I have the problem-solving skills to deal with tough situations and come out the other side smiling. For me, this has greatly reduced the mental and emotional clutter that unchecked worrying produces, those random thoughts that hijack your brain at three o'clock in the morning.

We should have sex.” “We will,” he said, giving me a grin. “Not the way you mean.” “Come again?” “And again and again.” Rolling my eyes, I ignored his grin. “Do you want to go somewhere and have sex?” “Sex sounds too clinical.” “Fuck then.” Judd frowned. “No, I fuck other women. I don’t know what it would be called with you. Sex sounds like how my mom whispers the word though.” “So do you want to go somewhere?” “No.” “Why?” “Because you’re not looking at me like you did in the parking lot that day. You’re looking at me like this is an errand you need to run. The Arby’s you need to get out of your system. I want you to look at me like you did that day.” “I don’t know how I looked at you.” “Don’t expect me to imitate the facial expression. I only have three of them and I’m not angry or coming. That only leaves the expression you’re looking at right now.” “You’re too fucking precious with all your sweet talk.” Judd’s eyes narrowed, but I saw him fighting a grin.

creeping fear of madness often accompanies depression. Sufferers wonder if their black moods will ever lift, or if their feelings of alienation from the healthy world will deepen and widen. “These fears are at least fifty percent of what it is to be melancholy,” says Lauren Slater, a clinical psychologist who has written about her struggles with mental illness. “If you were to be really, really depressed but know that it was going to end in five days, it wouldn’t be depression. The terror is in what the future holds.

McCullough points out that early treatment does not just prevent hospitalization; it quickly starves pandemics to death by stopping their spread. “Early treatment reduces the infectivity period from 14 days to about four days,” he explains. “It also allows someone to stay in the home so they don’t contaminate people outside the home. And then it has this remarkable effect in reducing the intensity and duration of symptoms so patients don’t get so short of breath, they don’t get into this panic where they feel they have to break containment and go to the hospital.” McCullough says that those hospital trips are tinder for pandemics, especially since, at that point, the patient is at the height of infectivity, with teeming viral loads. “Every hospitalization in America—and there’s been millions of them—has been a super-spreader event. Sick patients contaminate their loved ones, paramedics, Uber drivers, people in the clinic and offices. It becomes a total mess.” McCullough says that by treating COVID-19 at home, doctors actually can extinguish the pandemic.

In 1923, d’Herelle helped Soviet scientists set up an institute in Tbilisi, present-day Georgia, dedicated to bacteriophage research; at its peak, the institute had over a thousand employees producing tons of phages a year for clinical use. Phage therapy has continued up to modern times in certain parts of the world—about 20 percent of bacterial infections are treated with phages in Georgia today—but after antibiotics were discovered and developed in the 1930s and 1940s, this treatment quickly lost momentum, especially in the West.

And what if many-even if most-of the Slothropian stars are proved, some distant day, to refer to sexual fantasies instead of real events? This would hardly invalidate our approach, any more than it did young Sigmund Freud's, back there in old Vienna, facing a similar violation of probability-all those Papi-has-raped-me stories, which might have been lies evidentially, but were certainly the truth clinically. You must realize: we are concerned, at PISCES, with a rather strictly defined, clinical version of truth. We seek no wider agency in this.

Even without world wars, revolutions and emigration, siblings growing up in the same home almost never share the same environment. More accurately, brothers and sisters share some environments — usually the less important ones — but they rarely share the one single environment that has the most powerful impact on personality formation. They may live in the same house, eat the same kinds of food, partake in many of the same activities. These are environments of secondary importance. Of all environments, the one that most profoundly shapes the human personality is the invisible one: the emotional atmosphere in which the child lives during the critical early years of brain development. The invisible environment has little to do with parenting philosophies or parenting style. It is a matter of intangibles, foremost among them being the parents’ relationship with each other and their emotional balance as individuals. These, too, can vary significantly from the birth of one child to the arrival of another. Psychological tension in the parents’ lives during the child’s infancy is, I am convinced, a major and universal influence on the subsequent emergence of ADD. A hidden factor of great importance is a parent’s unconscious attitude toward a child: what, or whom, on the deepest level, the child represents for the parents; the degree to which the parents see themselves in the child; the needs parents may have that they subliminally hope the child will meet. For the infant there exists no abstract, “out-there” reality. The emotional milieu with which we surround the child is the world as he experiences it. In the words of the child psychiatrist and researcher Margaret Mahler, for the newborn, the parent is “the principal representative of the world.” To the infant and toddler, the world reveals itself in the image of the parent: in eye contact, intensity of glance, body language, tone of voice and, above all, in the day-today joy or emotional fatigue exhibited in the presence of the child. Whatever a parent’s intention, these are the means by which the child receives his or her most formative communications. Although they will be of paramount importance for development of the child’s personality, these subtle and often unconscious influences will be missed on psychological questionnaires or observations of parents in clinical settings. There is no way to measure a softening or an edge of anxiety in the voice, the warmth of a smile or the depth of furrows on a brow. We have no instruments to gauge the tension in a father’s body as he holds his infant or to record whether a mother’s gaze is clouded by worry or clear with calm anticipation. It may be said that no two children have exactly the same parents, in that the parenting they each receive may vary in highly significant ways. Whatever the hopes, wishes or intentions of the parent, the child does not experience the parent directly: the child experiences the parenting. I have known two siblings to disagree vehemently about their father’s personality during their childhood. Neither has to be wrong if we understand that they did not receive the same fathering, which is what formed their experience of the father. I have even seen subtly but significantly different mothering given to a pair of identical twins.

First agriculture, and then industry, changed two fundamental things about the human experience. The accumulation of personal property allowed people to make more and more individualistic choices about their lives, and those choices unavoidably diminished group efforts toward a common good. And as society modernized, people found themselves able to live independently from any communal group. A person living in a modern city or a suburb can, for the first time in history, go through an entire day—or an entire life—mostly encountering complete strangers. They can be surrounded by others and yet feel deeply, dangerously alone. The evidence that this is hard on us is overwhelming. Although happiness is notoriously subjective and difficult to measure, mental illness is not. Numerous cross-cultural studies have shown that modern society—despite its nearly miraculous advances in medicine, science, and technology—is afflicted with some of the highest rates of depression, schizophrenia, poor health, anxiety, and chronic loneliness in human history. As affluence and urbanization rise in a society, rates of depression and suicide tend to go up rather than down. Rather than buffering people from clinical depression, increased wealth in a society seems to foster it.

The researchers tried a clever tactic to overcome this problem. They created a number of recipes for common foods including muffins and pasta in which they could disguise placebo ingredients like bran and molasses to match the texture and color of the flax-laden foods. This way, they could randomize people into two groups and secretly introduce tablespoons of daily ground flaxseeds into the diets of half the participants to see if it made any difference. After six months, those who ate the placebo foods started out hypertensive and stayed hypertensive, despite the fact that many of them were on a variety of blood pressure pills. On average, they started the study at 155/81 and ended it at 158/81. What about the hypertensives who were unknowingly eating flaxseeds every day? Their blood pressure dropped from 158/82 down to 143/75. A seven-point drop in diastolic blood pressure may not sound like a lot, but that would be expected to result in 46 percent fewer strokes and 29 percent less heart disease over time.125 How does that result compare with taking drugs? The flaxseeds managed to drop subjects’ systolic and diastolic blood pressure by up to fifteen and seven points, respectively. Compare that result to the effect of powerful antihypertensive drugs, such as calcium-channel blockers (for example, Norvasc, Cardizem, Procardia), which have been found to reduce blood pressure by only eight and three points, respectively, or to ACE inhibitors (such as Vasotec, Lotensin, Zestril, Altace), which drop patients’ blood pressure by only five and two points, respectively.126 Ground flaxseeds may work two to three times better than these medicines, and they have only good side effects. In addition to their anticancer properties, flaxseeds have been demonstrated in clinical studies to help control cholesterol, triglyceride, and blood sugar levels; reduce inflammation, and successfully treat constipation.127 Hibiscus Tea for Hypertension Hibiscus tea, derived from the flower of the same name, is also known as roselle, sorrel, jamaica, or sour tea. With

The man seemed not to have heard him. ‘At this life-giving time of the year, Professor Scrooge,’ said the pastor, clicking his pen, ‘it is more than usually desirable that we should make some slight contribution to babes and adults, who lie languishing in hospitals and care facilities, standing on street corners and under bridges, or living alone at home during this time. Many are in need of blood transfusions or food or pregnancy care every day in our large community; many others – especially the elderly – are in want of comfort and cheer.’ ‘Are there no abortion clinics?’ asked Scrooge. ‘Plenty of clinics,’ said the pastor, clicking the pen tip in again. ‘And Euthanasia facilities?’ demanded Scrooge. ‘Are they still in operation?’ ‘They are. Still,’ returned the gentleman, ‘I wish I could say they were not.’ ‘Welfare and Food Stamps are in full swing, then?’ said Scrooge. ‘Both very busy.’ ‘Oh! I was afraid, from what you said at first, that something had occurred to stop them in their useful course,’ said Scrooge. ‘I’m very glad to hear it.’ ‘Under the impression that they scarcely furnish Christian cheer of mind or body to the multitude,’ returned the gentleman, ‘a few churches are endeavoring to raise a fund to provide those in need with medical care and food as well as the comfort of a human presence and the message of eternal life through Jesus. We choose this time to sow into others’ lives because it is a time, of all others, when we rejoice in the life God gave to us through His Son. What shall I put down – in time, money, or blood – for you?’ ‘Nothing!’ Scrooge replied. ‘You wish to give anonymously, then?’ ‘I wish to be left alone,’ said Scrooge.

Tertuliano Máximo Afonso is greatly in need of stimuli to distract him, he lives alone and gets bored, or, to speak with the clinical exactitude that the present day requires, he has succumbed to the temporary weakness of spirit ordinarily known as depression. To get a clear idea of his situation, suffice it to say that he was married but can no longer remember what led him into matrimony, that he is divorced and cannot now bring himself to ponder the reasons for the separation. On the other hand, while the ill-fated union produced no children who are now demanding to be handed, gratis, the world on a silver platter, he has, for some time, viewed sweet History, the serious, educational subject which he had felt called upon to teach and which could have been a soothing refuge for him, as a chore without meaning and a beginning without an end.

In March, while people were dying at the rate of 10,000 patients a week, Dr. Fauci declared that hydroxychloroquine should only be used as part of a clinical trial.104 For the first time in American history, a government official was overruling the medical judgment of thousands of treating physicians, and ordering doctors to stop practicing medicine as they saw fit. Boldly and relentlessly, Dr. Fauci kept declaring that “The Overwhelming Evidence of Properly Conducted Randomized Clinical Trials Indicate No Therapeutic Efficacy of Hydroxychloroquine (HCQ).”105 Dr. Fauci failed to disclose that NONE of the trials he had used as the basis for that pronouncement involved medication given in the first five to seven days after onset of symptoms. Instead, all of those randomized controlled trials targeted patients who were already sick enough to be hospitalized.

I’d have Lee too, and Jackson and Albert Sidney Johnston, walking around the midway. Hire some people with beards, you know, to do that. I wouldn’t have Braxton Bragg or Joseph E. Johnston. Every afternoon at three Lee would take off his gray coat and wrestle an alligator in a mud hole. Prize drawings. A lot of T-shirts and maybe a few black-and-white portables. If you don’t like that, how about a stock-car track? Year-round racing with hardly any rules. Deadly curves right on the water. The Symes 500 on Christmas day. Get a promotional tie-in with the Sugar Bowl. How about an industrial park? How about a high-rise condominium with a roof garden? How about a baseball clinic? How about a monkey island? I don’t say it would be cheap. Nobody’s going to pay to see one or two monkeys these days. People want to see a lot of monkeys. I’ve got plenty of ideas but first I have to get my hands on the island.

Patrick Vlaskovits, who was part of the initial conversation that the term “growth hacker” came out of, put it well: “The more innovative your product is, the more likely you will have to find new and novel ways to get at your customers.”12 For example: 1. You can create the aura of exclusivity with an invite-only feature (as Mailbox did). 2. You can create hundreds of fake profiles to make your service look more popular and active than it actually is—nothing draws a crowd like a crowd (as reddit did in its early days). 3. You can target a single service or platform and cater to it exclusively—essentially piggybacking off or even stealing someone else’s growth (as PayPal did with eBay). 4. You can launch for just a small group of people, own that market, and then move from host to host until your product spreads like a virus (which is what Facebook did by starting in colleges—first at Harvard—before taking on the rest of the population). 5. You can host cool events and drive your first users through the system manually (as Myspace, Yelp, and Udemy all did). 6. You can absolutely dominate the App Store because your product provides totally new features that everyone is dying for (which is what Instagram did—twenty-five thousand downloads on its first day—and later Snapchat). 7. You can bring on influential advisors and investors for their valuable audience and fame rather than their money (as About.me and Trippy did—a move that many start-ups have emulated). 8. You can set up a special sub-domain on your e-commerce site where a percentage of every purchase users make goes to a charity of their choice (which is what Amazon did with Smile.Amazon.com this year to great success, proving that even a successful company can find little growth hacks). 9. You can try to name a Planned Parenthood clinic after your client or pay D-list celebrities to say offensive things about themselves to get all sorts of publicity that promotes your book (OK, those stunts were mine).

Circadian rhythms are implicated in some of the symptoms of depression, such as early awakening and diurnal variation in mood. The possible importance of the circadian system in its pathogenesis is suggested by the capacity of experimental alterations in the timing of sleep and wakefulness to alter clinical state." Biological rhythms range in frequency from milliseconds to months or years. Most rhythmic disturbances identified in the symptoms of manic-depressive illness occur over the course of a day-that is, they are circadian rhythms-and are most apparent in the daily rest-activity cycle. The episodic recurrences of the illness, on the other hand, are usually infradian, oscillating over periods of months or years. Episodic mania and depression may also reflect disturbances in ultradian rhythms, those that oscillate more than once a day, which are common at the cellular level and in hormone secretion, as well as in such autonomic functions as circulation, blood pressure, respiration, heart rate, and in the cycles of sleep.

We ought to recognize the darkness of the culture of death when it shows up in our own voices. I am startled when I hear those who claim the name of Christ, and who loudly profess to be pro-life, speaking of immigrants with disdain as “those people” who are “draining our health care and welfare resources.” Can we not see the same dehumanizing strategies at work in the abortion-rights activism that speaks of the “product of conception” and the angry nativism that calls the child of an immigrant mother an “anchor baby”? At root, this is a failure to see who we are. We are united to a Christ who was himself a sojourner, fleeing political oppression (Matt. 2:13–23), and our ancestors in Israel were themselves a migrant people (Exod. 1:1–14; 1 Chron. 16:19; Acts. 7:6). Moreover, our God sees the plight of the fatherless and the blood of the innocent, but he also tells us that because he loves the sojourner and cares for him so should we, “for you were sojourners in the land of Egypt” (Deut. 10:18–19). We might disagree on the basis of prudence about what specific policies should be in place to balance border security with compassion for the immigrants among us, but a pro-life people have no option to respond with loathing or disgust at persons made in the image of God. We might or might not be natural-born Americans, but we are, all of us, immigrants to the kingdom of God (Eph. 2:12–14). Whatever our disagreements on immigration as policy, we must not disagree on whether immigrants are persons. No matter how important the United States of America is, there will come a day when the United States will no longer exist. But the sons and daughters of God will be revealed. Some of them are undocumented farm-workers and elementary-school janitors now. They will be kings and queens then. They are our brothers and sisters forever. We need to stand up against bigotry and harassment and exploitation, even when such could be politically profitable to those who stand with us on other issues. The image of God cannot be bartered away, at the abortion clinic counter or anywhere else.

It's one thing if he wants to ignore it. I guess that's fine. I mean, I ignore plenty of stuff, like school spirit days and the dirty looks I get from the Detentionheads while I try to slink through the halls unnoticed. But there's something about telling other people what to ignore that just doesn't work for me. Especially things we shouldn't be ignoring. Kid bullying you at school? Ignore him. Girl passing rumors? Ignore her. Eighth grade teacher pinch your friend's ass? Ignore it. Sexist geometry teacher says girls shouldn't go to college because they will only ever pop out babies and get fat? Ignore him. Hear that a girl in my class is being abused by her stepfather and had to go to the clinic? Hear she's bringing her mother's pills to school and selling them to pay for it? Ignore, ignore, ignore. Mind your own business. Don't make waves. Fly under the radar. It's just one of those things, Vera. I'm sorry, but I don't get it. If we're supposed to ignore everything that's wrong with our lives, then I can't see how we'll ever make things right.

Yet skill in the most sophisticated applications of laboratory technology and in the use of the latest therapeutic modality alone does not make a good physician. When a patient poses challenging clinical problems, an effective physician must be able to identify the crucial elements in a complex history and physical examination; order the appropriate laboratory, imaging, and diagnostic tests; and extract the key results from densely populated computer screens to determine whether to treat or to “watch.” As the number of tests increases, so does the likelihood that some incidental finding, completely unrelated to the clinical problem at hand, will be uncovered. Deciding whether a clinical clue is worth pursuing or should be dismissed as a “red herring” and weighing whether a proposed test, preventive measure, or treatment entails a greater risk than the disease itself are essential judgments that a skilled clinician must make many times each day. This combination of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is as necessary to the practice of medicine as is a sound scientific base.

Bipolar II disorder is a highly misunderstood form of bipolar illness. By its very designation as type II, clinicians, patients, and the public often assume it is less impairing than bipolar I, “the real thing.” When we examine the diagnostic criteria for bipolar II, they sound very mild. Who doesn’t get sad and happy? Who doesn’t have mood swings? Why would a four-day period of excess energy, which does not affect the ability to function, be of any clinical importance? Several longitudinal studies have found that bipolar II is far more impairing than we once thought. It is characterized by lengthy and recurrent periods of depression, comorbid anxiety disorders, and high rates of substance and alcohol misuse. The occasional hypomanias of bipolar II—in which people experience elation and irritability, exuberance, increased energy, and reduced need to sleep—are not as impairing as the full manic episodes of bipolar I, but they can certainly have a negative impact on family members and friends. Moreover, for the person with the disorder, these high periods are often short-lived, and they do little to alleviate the suffering caused by depressive phases. The hypomanic periods may even overlap with the low phases, resulting in an agitated, anxiety-ridden, and highly distressing period of depression. People with bipolar II often have difficulty maintaining jobs and relationships, and, like people with bipolar I, they are at high risk for suicide.

As the pumping engines for the circulatory system, ventricles must have a particular ovoid, lemonlike shape for strong, swift ejection of blood. If the end of the left ventricle balloons out, as it does in takotsubo hearts, the firm, healthy contractions are reduced to inefficient spasms—floppy and unpredictable. But what’s remarkable about takotsubo is what causes the bulge. Seeing a loved one die. Being left at the altar or losing your life savings with a bad roll of the dice. Intense, painful emotions in the brain can set off alarming, life-threatening physical changes in the heart. This new diagnosis was proof of the powerful connection between heart and mind. Takotsubo cardiomyopathy confirmed a relationship many doctors had considered more metaphoric than diagnostic. As a clinical cardiologist, I needed to know how to recognize and treat takotsubo cardiomyopathy. But years before pursuing cardiology, I had completed a residency in psychiatry at the UCLA Neuropsychiatric Institute. Having also trained as a psychiatrist, I was captivated by this syndrome, which lay at the intersection of my two professional passions. That background put me in a unique position that day at the zoo. I reflexively placed the human phenomenon side by side with the animal one. Emotional trigger … surge of stress hormones … failing heart muscle … possible death. An unexpected “aha!” suddenly hit me. Takotsubo in humans and the heart effects of capture myopathy in animals were almost certainly related—perhaps even the same syndrome with different names.

This neighborhood was mine first. I walked each block twice: drunk, then sober. I lived every day with legs and headphones. It had snowed the night I ran down Lorimer and swore I’d stop at nothing. My love, he had died. What was I supposed to do? I regret nothing. Sometimes I feel washed up as paper. You’re three years away. But then I dance down Graham and the trees are the color of champagne and I remember— There are things I like about heartbreak, too, how it needs a good soundtrack. The way I catch a man’s gaze on the L and don’t look away first. Losing something is just revising it. After this love there will be more love. My body rising from a nest of sheets to pick up a stranger’s MetroCard. I regret nothing. Not the bar across the street from my apartment; I was still late. Not the shared bathroom in Barcelona, not the red-eyes, not the songs about black coats and Omaha. I lie about everything but not this. You were every streetlamp that winter. You held the crown of my head and for once I won’t show you what I’ve made. I regret nothing. Your mother and your Maine. Your wet hair in my lap after that first shower. The clinic and how I cried for a week afterwards. How we never chose the language we spoke. You wrote me a single poem and in it you were the dog and I the fire. Remember the courthouse? The anniversary song. Those goddamn Kmart towels. I loved them, when did we throw them away? Tomorrow I’ll write down everything we’ve done to each other and fill the bathtub with water. I’ll burn each piece of paper down to silt. And if it doesn’t work, I’ll do it again. And again and again and— — Hala Alyan, “Object Permanence

Even as the feminine principle was venerated for its fertile, life-giving properties, there are also many examples of Goddesses who embodied the entire life process: birth, life, death, and regeneration. This is important because it can be tempting to romanticise the Goddess as a sort of angelic Fairy Godmother or abundant Good Mother. The feminine principle is more complex and more powerful than that. There are many stories from mythology that tell of the different faces of the Goddess. One such myth tells of the ancient Sumerian goddess who “outweighed, overshadowed, and outlasted them all . . .Inanna, Queen of Heaven.”[xxvi] This story originated in ancient Mesopotamia, five or six thousand years ago. In the myth, Inanna, who rules as queen over the upper world (birth and life), decides to visit Ereshkigal, queen of the Underworld (death and transformation). As Inanna descends into her sister’s realm, she is stripped of all the symbols of her upper world sovereignty, so that she comes before Ereshkigal naked and bowed low. Her enforced stay in the Underworld and the return after three days predates the Christian story by thousands of years. It is one of the first stories of ritual descent from the realm of life to the realm of death and the return to life after a time of incubation in the Underworld. This is also the theme of most ancient initiation rituals like the Orphic mysteries, the Eleusinian mysteries, and of much of the Egyptian sacred teachings. At the time when the story of Inanna’s journey first appeared, the increasingly male dominated Sumerian culture was separating from earlier matrilineal forms. Before the descent myth, another story tells how Inanna, in order to rule, had to take power from the God, Enki, assuming his symbols of sovereignty as her own. Ereshkigal, queen of the Underworld, represents the archaic feminine, the dark mysteries of the older religion which had been sent underground. The descent story can, therefore, be understood as Inanna balancing her heroic victories in the upper (masculine) world by reconnecting with the rhythms and cycles of the under (feminine) world. Based on clinical experience, one analyst called this a “pattern of a woman’s passage from cultural adaptation to an encounter with her essential nature”.

Their eyes met. For a split second she caught a glimpse of heat in his eyes. Then Jake banked the flame and broke out of her embrace. Marnie felt a hot blush rise from her toes to her nose. It took a moment for her eyes to focus and her brain to function. Bewildered, she looked up to find him watching her. His heavy-lidded eyes held a strange desperation as he reached back and unhooked the vice of her ankles from around his wiast. Her legs dropped. Her heels thumped against the cabinet. Beneath his hawklike gaze she felt stripped bare and vulnerable. He studied her face, seeming to see more than her features. He seemed to delve into her mind, to touch things deep and frightening—parts of herself Marnie was still exploring. The muscles in his jaw knotted and unknotted. After a moment he stepped back and casually, but with difficulty, adjusted his jeans Heat flooded her cheeks. Legs splayed, nipples peaked to his clinical gaze, she’d never experienced such acute embarrassment in her life. Her breath hitched as she jumped off the counter, tugging her top down and her pants up. At a loss for hers, she half laughed. “I have absolutely no idea what to say.” Which was a reasonable start, she guessed. It was rare for her to be speechless. But then, this was a day of firsts. “I told you you weren’t my type.” The brass button on his jeans closed like the clasp of a miser’s purse. Other than a faint flush on the ridge of his cheekbones and what looked like a painful erection, he seemed totally unaffected by what had just happened. She stared at him. “Not your t—What do you call what just happened?” Marnie was confused. It was out of character for her to be sexually aggressive. But now that she’d done it, she wasn’t sorry. “What part of ‘I don’t want you’ didn’t you understand?” He’d wanted her. He might lie about it, but his body had been honest. He was as hard as petrified wood. “Then what”—she pointed—“is that?” He ignored the bulge in his jeans. “Just because I have it doesn’t mean I intend to use it.” Marnie stepped forward and touched his arm. He jerked away from her as if she’d used a cattle prod. “Was it something I said?” she asked quietly, dropping her hand to her side. “Look, I have a tendency to sort of speak without running the words through my brain first. But I know I didn’t give out mixed signals just now. I wanted to make love with you. It was very good. No, darn it, it was excellent. So if you have some sort of medical condition, let’s talk about i—” He moved backward, almost tripping over Duchess sprawled on the floor. The dog rose to hover anxiously between them. Jake’s eyes turned as he said, “I do not have a medical condition.” Marnie backed up—mentally as well as physically. Her hip bumped the counter. “Good.” He scowled and swore under his breath. “That is good, isn’t it?” she asked tentatively.

WHY ADDICTION IS NOT A DISEASE In its present-day form, the disease model of addiction asserts that addiction is a chronic, relapsing brain disease. This disease is evidenced by changes in the brain, especially alterations in the striatum, brought about by the repeated uptake of dopamine in response to drugs and other substances. But it’s also shown by changes in the prefrontal cortex, where regions responsible for cognitive control become partially disconnected from the striatum and sometimes lose a portion of their synapses as the addiction progresses. These are big changes. They can’t be brushed aside. And the disease model is the only coherent model of addiction that actually pays attention to the brain changes reported by hundreds of labs in thousands of scientific articles. It certainly explains the neurobiology of addiction better than the “choice” model and other contenders. It may also have some real clinical utility. It makes sense of the helplessness addicts feel and encourages them to expiate their guilt and shame, by validating their belief that they are unable to get better by themselves. And it seems to account for the incredible persistence of addiction, its proneness to relapse. It even demonstrates why “choice” cannot be the whole answer, because choice is governed by motivation, which is governed by dopamine, and the dopamine system is presumably diseased. Then why should we reject the disease model? The main reason is this: Every experience that is repeated enough times because of its motivational appeal will change the wiring of the striatum (and related regions) while adjusting the flow and uptake of dopamine. Yet we wouldn’t want to call the excitement we feel when visiting Paris, meeting a lover, or cheering for our favourite team a disease. Each rewarding experience builds its own network of synapses in and around the striatum (and OFC), and those networks continue to draw dopamine from its reservoir in the midbrain. That’s true of Paris, romance, football, and heroin. As we anticipate and live through these experiences, each network of synapses is strengthened and refined, so the uptake of dopamine gets more selective as rewards are identified and habits established. Prefrontal control is not usually studied when it comes to travel arrangements and football, but we know from the laboratory and from real life that attractive goals frequently override self-restraint. We know that ego fatigue and now appeal, both natural processes, reduce coordination between prefrontal control systems and the motivational core of the brain (as I’ve called it). So even though addictive habits can be more deeply entrenched than many other habits, there is no clear dividing line between addiction and the repeated pursuit of other attractive goals, either in experience or in brain function. London just doesn’t do it for you anymore. It’s got to be Paris. Good food, sex, music . . . they no longer turn your crank. But cocaine sure does.

As she explained to her students, patients often awoke from very bad illnesses or cardiac arrests, talking about how they had been floating over their bodies. “Mm-hmmm,” Norma would reply, sometimes thinking, Yeah, yeah, I know, you were on the ceiling. Such stories were recounted so frequently that they hardly jolted medical personnel. Norma at the time had mostly chalked it up to some kind of drug reaction or brain malfunction, something like that. “No, really,” said a woman who’d recently come out of a coma. “I can prove it.” The woman had been in a car accident and been pronounced dead on arrival when she was brought into the emergency room. Medical students and interns had begun working on her and managed to get her heartbeat going, but then she had coded again. They’d kept on trying, jump-starting her heart again, this time stabilizing it. She’d remained in a coma for months, unresponsive. Then one day she awoke, talking about the brilliant light and how she remembered floating over her body. Norma thought she could have been dreaming about all kinds of things in those months when she was unconscious. But the woman told them she had obsessive-compulsive disorder and had a habit of memorizing numbers. While she was floating above her body, she had read the serial number on top of the respirator machine. And she remembered it. Norma looked at the machine. It was big and clunky, and this one stood about seven feet high. There was no way to see on top of the machine without a stepladder. “Okay, what’s the number?” Another nurse took out a piece of paper to jot it down. The woman rattled off twelve digits. A few days later, the nurses called maintenance to take the ventilator machine out of the room. The woman had recovered so well, she no longer needed it. When the worker arrived, the nurses asked if he wouldn’t mind climbing to the top to see if there was a serial number up there. He gave them a puzzled look and grabbed his ladder. When he made it up there, he told them that indeed there was a serial number. The nurses looked at each other. Could he read it to them? Norma watched him brush off a layer of dust to get a better look. He read the number. It was twelve digits long: the exact number that the woman had recited. The professor would later come to find out that her patient’s story was not unique. One of Norma’s colleagues at the University of Virginia Medical Center at the time, Dr. Raymond Moody, had published a book in 1975 called Life After Life, for which he had conducted the first large-scale study of people who had been declared clinically dead and been revived, interviewing 150 people from across the country. Some had been gone for as long as twenty minutes with no brain waves or pulse. In her lectures, Norma sometimes shared pieces of his research with her own students. Since Moody had begun looking into the near-death experiences, researchers from around the world had collected data on thousands and thousands of people who had gone through them—children, the blind, and people of all belief systems and cultures—publishing the findings in medical and research journals and books. Still, no one has been able to definitively account for the common experience all of Moody’s interviewees described. The inevitable question always followed: Is there life after death? Everyone had to answer that question based on his or her own beliefs, the professor said. For some of her students, that absence of scientific evidence of an afterlife did little to change their feelings about their faith. For others,