Clinic Time Quotes

About a third of my cases are suffering from no clinically definable neurosis, but from the senselessness and emptiness of their lives. This can be defined as the general neurosis of our times.

The reality is that the lives of the smallest patients are in our hands, and their clinical condition can change in an instant. No matter how many times you are involved in situations such as this, the physical stress and anxiety as well as the emotional and psychological effects of being immersed in that environment are dramatic and lasting on the human body, mind, and central nervous system. These effects are severe, and I firmly believe that they are cumulative over your lifetime.

In short, physicians are getting more and more data, which requires more sophisticated interpretation and which takes more time. AI is the solution, enhancing every stage of patient care from research and discovery to diagnosis and therapy selection. As a result, clinical practice will become more efficient, convenient, personalized, and effective.

Read! When your baby is finally down for the night, pick up a juicy book like Eat, Pray, Love or Pride and Prejudice or my personal favorite, Understanding Sleep Disorders: Narcolepsy and Apnea; A Clinical Study. Taking some time to read each night really taught me how to feign narcolepsy when my husband asked me what my “plan” was for taking down the Christmas tree.

It’s estimated that AI could free up to 25% of clinician time across different specialties. This increased amount of time could mean less hurried encounters and more humane interactions, including more empathy from happier doctors. This is important because empathy has been shown to improve outcomes by boosting patient adherence to the prescribed treatments, increasing motivation, and reducing anxiety and stress.

I’m a modern man, a man for the millennium. Digital and smoke free. A diversified multi-cultural, post-modern deconstruction that is anatomically and ecologically incorrect. I’ve been up linked and downloaded, I’ve been inputted and outsourced, I know the upside of downsizing, I know the downside of upgrading. I’m a high-tech low-life. A cutting edge, state-of-the-art bi-coastal multi-tasker and I can give you a gigabyte in a nanosecond! I’m new wave, but I’m old school and my inner child is outward bound. I’m a hot-wired, heat seeking, warm-hearted cool customer, voice activated and bio-degradable. I interface with my database, my database is in cyberspace, so I’m interactive, I’m hyperactive and from time to time I’m radioactive. Behind the eight ball, ahead of the curve, ridin the wave, dodgin the bullet and pushin the envelope. I’m on-point, on-task, on-message and off drugs. I’ve got no need for coke and speed. I've got no urge to binge and purge. I’m in-the-moment, on-the-edge, over-the-top and under-the-radar. A high-concept, low-profile, medium-range ballistic missionary. A street-wise smart bomb. A top-gun bottom feeder. I wear power ties, I tell power lies, I take power naps and run victory laps. I’m a totally ongoing big-foot, slam-dunk, rainmaker with a pro-active outreach. A raging workaholic. A working rageaholic. Out of rehab and in denial! I’ve got a personal trainer, a personal shopper, a personal assistant and a personal agenda. You can’t shut me up. You can’t dumb me down because I’m tireless and I’m wireless, I’m an alpha male on beta-blockers. I’m a non-believer and an over-achiever, laid-back but fashion-forward. Up-front, down-home, low-rent, high-maintenance. Super-sized, long-lasting, high-definition, fast-acting, oven-ready and built-to-last! I’m a hands-on, foot-loose, knee-jerk head case pretty maturely post-traumatic and I’ve got a love-child that sends me hate mail. But, I’m feeling, I’m caring, I’m healing, I’m sharing-- a supportive, bonding, nurturing primary care-giver. My output is down, but my income is up. I took a short position on the long bond and my revenue stream has its own cash-flow. I read junk mail, I eat junk food, I buy junk bonds and I watch trash sports! I’m gender specific, capital intensive, user-friendly and lactose intolerant. I like rough sex. I like tough love. I use the “F” word in my emails and the software on my hard-drive is hardcore--no soft porn. I bought a microwave at a mini-mall; I bought a mini-van at a mega-store. I eat fast-food in the slow lane. I’m toll-free, bite-sized, ready-to-wear and I come in all sizes. A fully-equipped, factory-authorized, hospital-tested, clinically-proven, scientifically- formulated medical miracle. I’ve been pre-wash, pre-cooked, pre-heated, pre-screened, pre-approved, pre-packaged, post-dated, freeze-dried, double-wrapped, vacuum-packed and, I have an unlimited broadband capacity. I’m a rude dude, but I’m the real deal. Lean and mean! Cocked, locked and ready-to-rock. Rough, tough and hard to bluff. I take it slow, I go with the flow, I ride with the tide. I’ve got glide in my stride. Drivin and movin, sailin and spinin, jiving and groovin, wailin and winnin. I don’t snooze, so I don’t lose. I keep the pedal to the metal and the rubber on the road. I party hearty and lunch time is crunch time. I’m hangin in, there ain’t no doubt and I’m hangin tough, over and out!

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

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 sorror, 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.

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.

I want a dyke for president. I want a person with AIDS for president and I want a fag for vice president and I want someone with no health insurance and I want someone who grew up in a place where the earth is so saturated with toxic waste that they didn’t have a choice about getting leukemia. I want a president that had an abortion at sixteen and I want a candidate who isn’t the lesser of two evils and I want a president who lost their last lover to AIDS, who still sees that in their eyes every time they lay down to rest, who held their lover in their arms and knew they were dying. I want a president with no air-conditioning, a president who has stood in line at the clinic, at the DMV, at the welfare office, and has been unemployed and laid off and sexually harassed and gaybashed and deported. I want someone who has spent the night in the tombs and had a cross burned on their lawn and survived rape. I want someone who has been in love and been hurt, who respects sex, who has made mistakes and learned from them. I want a Black woman for president. I want someone with bad teeth and an attitude, someone who has eaten that nasty hospital food, someone who crossdresses and has done drugs and been in therapy. I want someone who has committed civil disobedience. And I want to know why this isn’t possible. I want to know why we started learning somewhere down the line that a president is always a clown. Always a john and never a hooker. Always a boss and never a worker. Always a liar, always a thief, and never caught.

You have to be out of your mind. What kind of clinic lets people operate on themselves?” “Well, Suture Self.”  

The Director's Role: You are the obstetrician. You are not the parent of this child we call the play. You are present at its birth for clinical reasons, like a doctor or midwife. Your job most of the time is simply to do no harm. When something does go wrong, however, your awareness that something is awry--and your clinical intervention to correct it--can determine whether the child will thrive or suffer, live or die.

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.

That dead-eyed anhedonia is but a remora on the ventral flank of the true predator, the Great White Shark of pain. Authorities term this condition clinical depression or involutional depression or unipolar dysphoria. Instead of just an incapacity for feeling, a deadening of soul, the predator-grade depression Kate Gompert always feels as she Withdraws from secret marijuana is itself a feeling. It goes by many names — anguish, despair, torment, or q.v. Burton's melancholia or Yevtuschenko's more authoritative psychotic depression — but Kate Gompert, down in the trenches with the thing itself, knows it simply as It. It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self's most elementary levels. It is a nausea of the cells and soul. It is an unnumb intuition in which the world is fully rich and animate and un-map-like and also thoroughly painful and malignant and antagonistic to the self, which depressed self It billows on and coagulates around and wraps in Its black folds and absorbs into Itself, so that an almost mystical unity is achieved with a world every constituent of which means painful harm to the self. Its emotional character, the feeling Gompert describes It as, is probably mostly indescribable except as a sort of double bind in which any/all of the alternatives we associate with human agency — sitting or standing, doing or resting, speaking or keeping silent, living or dying — are not just unpleasant but literally horrible. It is also lonely on a level that cannot be conveyed. There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. This anhedonic Inability To Identify is also an integral part of It. If a person in physical pain has a hard time attending to anything except that pain, a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution. It is a hell for one. The authoritative term psychotic depression makes Kate Gompert feel especially lonely. Specifically the psychotic part. Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who's being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who's not being tortured, however, is psychotic, since the outside parties making the diagnoses can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. Thus the loneliness: it's a closed circuit: the current is both applied and received from within.

I realize that if love were the cure, I would have been healed a long time ago.

I gave examples from my clinical practice of how love was not wholly a thought or feeling. I told of how that very evening there would be some man sitting at a bar in the local village, crying into his beer and sputtering to the bartender how much he loved his wife and children while at the same time he was wasting his family's money and depriving them of his attention. We recounted how this man was thinking love and feeling love--were they not real tears in his eyes?--but he was not in truth behaving with love.

Yet Irina had once tucked away, she wasn't sure when or why, that happiness is almost definitionally a condition of which you are not aware at the time. To inhabit your own contentment is to be wholly present, with no orbiting satellite to take clinical readings of the state of the planet. Conventionally, you grow conscious of happiness at the very point that it begins to elude you. When not misused to talk yourself into something - when not a lie - the h-word is a classification applied in retrospect. It is a bracketing assessment, a label only decisively pasted onto an era once it is over.

In 1965, a psychologist named Martin Seligman started shocking dogs. He was trying to expand on the research of Pavlov--the guy who could make dogs salivate when they heard a bell ring. Seligman wanted to head in the other direction, and when he rang his bell, instead of providing food, he zapped the dogs with electricity. To keep them still, he restrained them in a harness during the experiment. After they were conditioned, he put these dogs in a big box with a little fence dividing it into two halves. He figured if the dog rang the bell, it would hop over the fence to escape, but it didn't. It just sat there and braced itself. They decided to try shocking the dog after the bell. The dog still just sat there and took it. When they put a dog in the box that had never been shocked before or had previously been allowed to escape and tried to zap it--it jumped the fence. You are just like these dogs. If, over the course of your life, you have experienced crushing defeat or pummeling abuse or loss of control, you convince yourself over time that there is no escape, and if escape is offered, you will not act--you become a nihilist who trusts futility above optimism. Studies of the clinically depressed show that they often give in to defeat and stop trying. . . Any extended period of negative emotions can lead to you giving in to despair and accepting your fate. If you remain alone for a long time, you will decide loneliness is a fact of life and pass up opportunities to hang out with people. The loss of control in any situation can lead to this state. . . Choices, even small ones, can hold back the crushing weight of helplessness, but you can't stop there. You must fight back your behavior and learn to fail with pride. Failing often is the only way to ever get the things you want out of life. Besides death, your destiny is not inescapable.

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.

It is also lonely on a level that cannot be conveyed ... If a person in physical pain has a hard time attending to anything except that pain, a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell.

I make them feel like they’re still part of life, part of some grand nutty scheme instead of alone with their diseases, which, most of the time and especially in the Clinic, don’t hardly exist at all. With me, they feel they’re still part of the human race.

I learned a long time ago in the outpatient clinic to make no distinction –as some condescending doctors still do –between ‘real’ or ‘psychological’ pain. All pain is produced in the brain, and the only way pain can vary, other than in its intensity, is how it is best treated, or more particularly in my clinic, whether surgery might help or not.

It was a long time since he'd done any actual clinical work, and obviously his sojourn among the academics at Saro University had attenuated the professional detachment that allows members of the healing arts to confront the ill without being overwhelmed by compassion and sorrow. He was surprised at that, how tenderhearted he seemed to have become, how thin-skinned.

I don't want these clinical, awkward setups. I don't feel like doing this twenty more times. I can't imagine meeting my soulmate through an interview process. I want to know without words. I want fall so violently that I risk breaking into a million pieces. I want to love so desperately it's indecent. I want it to be wild and fated and forever. A no choice connection.

The depressed person’s therapist was always extremely careful to avoid appearing to judge or blame the depressed person for clinging to her defenses, or to suggest that the depressed person had in any way consciously chosen or chosen to cling to a chronic depression whose agony made her (i.e., the depressed person’s) every waking hour feel like more than any person could possibly endure. This renunciation of judgment or imposed value was held by the therapeutic school in which the therapist’s philosophy of healing had evolved over almost fifteen years of clinical experience to be integral to the combination of unconditional support and complete honesty about feelings which composed the nurturing professionalism required for a productive therapeutic journey toward authenticity and intrapersonal wholeness. Defenses against intimacy, the depressed person’s therapist’s experiential theory held, were nearly always arrested or vestigial survival-mechanisms; i.e., they had, at one time, been environmentally appropriate and necessary and had very probably served to shield a defenseless childhood psyche against potentially unbearable trauma, but in nearly all cases they (i.e., the defense-mechanisms) had become inappropriately imprinted and arrested and were now, in adulthood, no longer environmentally appropriate and in fact now, paradoxically, actually caused a great deal more trauma and pain than they prevented. Nevertheless, the therapist had made it clear from the outset that she was in no way going to pressure, hector, cajole, argue, persuade, flummox, trick, harangue, shame, or manipulate the depressed person into letting go of her arrested or vestigial defenses before she (i.e., the depressed person) felt ready and able to risk taking the leap of faith in her own internal resources and self-esteem and personal growth and healing to do so (i.e., to leave the nest of her defenses and freely and joyfully fly).

We often told ourselves off for wasting time in chairs, fully dressed, talking, when we could be doing the same, lying down in bed, face to face and naked. That precious time before love-making is ill-served by the pseudo-clinical term, ‘foreplay’. The world would narrow and deepen, our voices would sink into the warmth of our bodies, the conversation became associative and unpredictable. Everything was touch and breath. Certain simple phrases came to me which I didn’t say out loud because they sounded so banal - Here we are, or, This again or Yes, this. Like a moment in a recurring dream, these spacious, innocent minutes were forgotten until we were back inside them. When we were, our lives returned to the essentials and began again. When we fell silent, we would lie so close we were mouth to mouth, delaying the union which bound us all the more because of this prelude.

The ‘secret’ of Shostakovich, it was suggested—by a Chinese neurologist, Dr Dajue Wang—was the presence of a metallic splinter, a mobile shell-fragment, in his brain, in the temporal horn of the left ventricle. Shostakovich was very reluctant, apparently, to have this removed: Since the fragment had been there, he said, each time he leaned his head to one side he could hear music. His head was filled with melodies—different each time—which he then made use of when composing. X-rays allegedly showed the fragment moving around when Shostakovich moved his head, pressing against his ‘musical’ temporal lobe, when he tilted, producing an infinity of melodies which his genius could use.

Not having money is time consuming. There are hours spent at laundromats, hours at bus stops, hours at free clinics, hours at thrift stores, hours on the phone with the bank or the credit card company or the phone company over some fee, some little charge, some mistake

If you submit an article to a major refereed clinical journal and it is accepted upon first submission without a single revision, let me know and I will take you to dinner the next time you are in Portland, Oregon.

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.

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.

The old man suddenly became intent, his brows knitted, his lips pursed. He stood motionless, in deep thought, presenting the picture that I love to see: a patient in the actual moment of discovery — half-appalled, half-amused — seeing for the first time exactly what is wrong and, in the same moment, exactly what there is to be done. This is the therapeutic moment.

Dr. Sacks treats each of his subjects—the amnesic fifty-year-old man who believes himself to be a young sailor in the Navy, the “disembodied” woman whose limbs have become alien to her, and of course the famous man who mistook his wife for a hat—with a deep respect for the unique individual living beneath the disorder. These tales inspire awe and empathy, allowing the reader to enter the uncanny worlds of those with autism, Alzheimer's, Tourette's syndrome, and other unfathomable neurological conditions. “One of the great clinical writers of the 20th century” (The New York Times), Dr. Sacks brings to vivid life some of the most fundamental questions about identity and the human mind.

Enslavement could not have existed and certainly could not have persisted without medical science. However, physicians were also dependent upon slavery, both for economic security and for the enslaved “clinical material” that fed the American medical research and medical training that bolstered physicians’ professional advancement.

This time, after a moment, he called her bluff. “Perhaps Philippa and I should be thrown together a little more. She might become attached to me if she knew me better.” Kate, brightening visibly, ignored the gleam in his eye. “That would make her sorry for you?” “It might. The object of any sort of clinical study deserves compassion, don’t you think?” “Snakes don’t,” said Katherine inconsequently. “I hate snakes.” “And yet you feed them on honey cakes and forbid them to defend themselves.” “Defencelessness is not a noted characteristic of serpents. Anyhow, I can’t have them lying rattling about the house. It gets on the nerves.” “It does if you handle it by rattling back.

At the railroad station he noted that he still had thirty minutes. He quickly recalled that in a cafe on the Calle Brazil (a few dozen feet from Yrigoyen's house) there was an enormous cat which allowed itself to be caressed as if it were a disdainful divinity. He entered the cafe. There was the cat, asleep. He ordered a cup of coffee, slowly stirred the sugar, sipped it (this pleasure had been denied him in the clinic), and thought, as he smoothed the cat's black coat, that this contact was an illusion and that the two beings, man and cat, were as good as separated by a glass, for man lives in time, in succession, while the magical animal lives in the present, in the eternity of the instant.

Because cells are surrounded with a lipid membrane, essential oils are attracted to and able to penetrate the cell membrane to deliver nutrients to the cell nucleus.[103],[104],[105],[106],[107] This suggests that essential oils can affect cell function and behavior, thus influencing overall well-being. At the same time, the aroma of the essential oil that is inhaled travels to the limbic system where a cascade of psychophysiological effects is triggered in response.

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

You have to begin to lose your memory, if only in bits and pieces, to realise that memory is what makes our lives. Life without memory is no life at all . . . Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing . . . (I can only wait for the final amnesia, the one that can erase an entire life, as it did my mother’s . . .) LUIS BUÑUEL This moving and frightening segment in Buñuel’s recently translated memoirs raises fundamental questions – clinical, practical, existential, philosophical: what sort of a life (if any), what sort of a world, what sort of a self, can be preserved in a man who has lost the greater part of his memory and, with this, his past, and his moorings in time?

Doctors, soldiers, and mothers encounter it routinely; I had, any number of times. Unable to respond to an immediate emergency while clouded by fatigue, the mind simply withdraws a little, separating itself fastidiously from the body’s overwhelming self-centered needs. From this clinical distance, it can direct things, bypassing emotions, pain, and tiredness, making necessary decisions, cold-bloodedly overruling the mindless body’s needs for food, water, sleep, love, grief, pushing it past its fail-safe points.

Sink,” I mumbled.“What?” the nurse asked.“I think she said ‘drink,’” Preya said.“Sink!” I yelled.They hurried me to the small washing area near the rear of the clinic just in time for the stainless steel sink to catch the chicken soup that refused to stay eaten. I heaved and heaved until I had nothing left to heave, and then some. Preya held up my hair while the nurse rubbed circles on my back. My entire body convulsed. After the trembling stopped, I lifted the tap and washed out my mouth.“When did I eat carrots?

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.

Logotherapy bases its technique called “paradoxical intention” on the twofold fact that fear brings about that which one is afraid of, and that hyper-intention makes impossible what one wishes. In German I described paradoxical intention as early as 1939.11 In this approach the phobic patient is invited to intend, even if only for a moment, precisely that which he fears. Let me recall a case. A young physician consulted me because of his fear of perspiring. Whenever he expected an outbreak of perspiration, this anticipatory anxiety was enough to precipitate excessive sweating. In order to cut this circle formation I advised the patient, in the event that sweating should recur, to resolve deliberately to show people how much he could sweat. A week later he returned to report that whenever he met anyone who triggered his anticipatory anxiety, he said to himself, “I only sweated out a quart before, but now I’m going to pour at least ten quarts!” The result was that, after suffering from his phobia for four years, he was able, after a single session, to free himself permanently of it within one week. The reader will note that this procedure consists of a reversal of the patient’s attitude, inasmuch as his fear is replaced by a paradoxical wish. By this treatment, the wind is taken out of the sails of the anxiety. Such a procedure, however, must make use of the specifically human capacity for self-detachment inherent in a sense of humor. This basic capacity to detach one from oneself is actualized whenever the logotherapeutic technique called paradoxical intention is applied. At the same time, the patient is enabled to put himself at a distance from his own neurosis. A statement consistent with this is found in Gordon W. Allport’s book, The Individual and His Religion: “The neurotic who learns to laugh at himself may be on the way to self-management, perhaps to cure.”12 Paradoxical intention is the empirical validation and clinical application of Allport’s statement.

I watch these kids. They don't seem entirely unhappy. A few times I've even circled the Free Clinic on foot, trying to catch a closer glimpse of these kids and their lives as they pop in and out of the clinic's Sputnik-era, gone-to-seed building--Lancaster's future trolls and Popeyes loitering out back having hushed paranoid conversations. And once I even went to have a look where they hang out in a big way, out in the delivery bay behind the now-closed Donut Hut, the delivery bay grotto out back with a floor spongy with pigeon shit, chewing gum, cigarette ashes, and throat oysters--dank and sunless. I went to visit this place once when all the druggies were away, having their druggy lives downtown doing their druggy things: yelling at parked cars and having conversations with amber lights. I visited this place and I was confused: confused and attracted. Who do these people think they are? How can they not care about the future or hot running water or clean sheets or cable TV? These people. And on the walls down at the delivery bay, do you know what they had written? Written in letters several hands high, letters built of IV needles attached to the cement with soiled bandages and wads of chewing gum? They had written the words WE LIKE IT.

It’s my first time in a therapist’s waiting room and not at all what I expected. Aren’t these places supposed to be clinical? This room is anything but. It’s cozy and inviting. Granted, Laura is a therapist-slash-life coach, so maybe therapists that are multi-hyphenates do more decorating. I’m skeptical.

What are you saying?” “I want to try.” He wanted clarification on that. “You want to try what?” There it was, that deep flush. “You know.” Yes, he knew, but he wasn’t going to let her off the hook so easily. She was going to be his. For a brief time, she would belong to him and he would have everything he wanted, and he wanted her to start talking dirty. Yes. He wanted to teach her, to train her to accept pleasure so she would expect it. “No, I don’t know. You’ll have to be plain.” Avery blushed a little. “I want to be intimate with you.” So sweet. So polite. So not happening. “That sounds like you want me to get into my pajamas and exchange secrets with you. I’m not your girlfriend, Avery. Tell me what you want. That’s lesson number one. Communication and honesty are the keys to the relationship I want. I need to hear you say plainly what you want.” She hesitated, but only for a moment. He wasn’t surprised. Deep in her heart, she was a brave girl. She’d faced so much and still was open with her heart. Damn, but he didn’t understand that. “I would like for us to sleep together.” “I’m not very sleepy.” He wasn’t going to let her get away with anything. She groaned a little in obvious frustration. “You know that’s not what I’m talking about.” “Yes. I do. So say what you want.” “I want to have sex.” “So clinical. I’ll have to think about that.” “I want to make love.” “Sweet, but not what I’m looking for.” Her face crinkled into the cutest pout. “Damn it, Lee. I want to fuck.” Just like that he was primed and ready. She’d said fuck with such a sweet little heat, her eyebrows forming a V over her face as though the entire incident had offended her polite sensibilities. She would learn there wasn’t room for politeness between them. He growled just a little. “I want to fuck, too, baby. I want to fuck all night long.

I offered to pass along information about NEHSA to Heidi so she can let her patients know about it. I don’t have any scientific or clinical data to back this up, but I think snow-boarding is the most effective rehabilitative tool I’ve experienced. It forces me to focus on my abilities and not my disability, to overcome huge obstacles, both physical and psychological, to stay up on that board and get down the mountain in one piece. And each time I get down the mountain in one piece, I gain a real confidence and sense of independence I haven’t felt anywhere else since the accident, a sense of true well-being that stays with me well beyond the weekend. And whether snowboarding with NEHSA has a measurable and lasting therapeutic effect for people like me or not, it’s a lot more fun than drawing cats and picking red balls up off a tray

Take childcare for example, an issue that never gets much support beyond lip service in the feminist world, despite it being something that would benefit the majority of women. Once you reach a certain income level, it’s easier and more convenient for you to take care of your own childcare needs than to pay the taxes or contribute to a system that would help all women. If your child is in a failing school, it’s much more convenient to place your child in a private or charter school than to organize ways to improve the situation for the entire community. This also applies to expanding social welfare programs, supporting community clinics, and so on. As a woman’s ability to take care of herself expands thanks to feminist efforts, the feminist goals she’s willing to really fight for, or contribute time and money and effort to, shrink.

Asperger survived the war, but his concept of autism as a broad and inclusive spectrum (a “continuum,” his diagnostician Georg Frankl called it) that was “not at all rare” was buried with the ashes of his clinic and the unspeakable memories of that dark time, along with his case records. A very different conception of autism took its place.

To think that melancholy--which seems a natural response to the coexisting realities of beauty and mortality--is the same as clinical depression is tragically mistaken. Words like "sad," "gloomy," and "depressed" leave no room for the rich, dark quality of melancholy, which I've always seen as a sensitive appreciation that change is happening every second of our lives, that everything and everyone we love will die, and that in knowing this we have the opportunity to share our gratitude while we still do have time.

physicians, Drs. Bill Castelli, Bill Roberts and Caldwell Esselstyn, Jr., that in their long careers they had never seen a heart disease fatality among their patients who had blood cholesterol levels below 150 mg/dL. Dr. Castelli was the long-time director of the famous Framingham Heart Study of NIH; Dr. Esselstyn was a renowned surgeon at the Cleveland Clinic who did a remarkable study reversing heart disease (chapter five); Dr. Roberts has long been editor of the prestigious medical journal Cardiology. BLOOD CHOLESTEROL AND DIET

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.

I never even got your name in my back,” V said. “I thought it was stupid and a waste of time . . . but how can you feel like we’re mated without it—especially when every single male at the compound has been marked for his shellan?” God, she hadn’t thought of that. V shook his head. “You’ve given me space . . . to hang with Butch and fight with my brothers and do my shit on the Internet. What have I given you?” “My clinic, for one thing. I couldn’t have built it without you.” “Not exactly a bouquet of roses.” “Don’t underestimate your carpentry skills.

In the notoriously fickle drawing rooms of Delhi, I had often heard Rahul being described as not-too-bright (in far less charitable terms). But the few times I had spoken with him I had thought otherwise. He was well read, respectful of academic expertise, and keen to meet specialists to mine their minds. His problem was not that he had read too few books—it was that he had a clinical, statistical approach to a profession that was often about instinct and human connections. He was like a man looking for the exactitudes of mathematics in the mysteries of poetry.

This was never supposed to happen. Sleeping with Tyler was supposed to be a one-time thing – a means of scratching an itch and quelling the boredom that has consumed my life lately. The first time we had sex and he sang the theme song from My Little Pony while he went down on me should have sent me running for the hills like my ass was on fire. He’s immature, he constantly pisses me off and he’s twenty-five years old and can’t hold a job to save his life. But dammit, sex with Tyler was the biggest high I’ve ever had in my life. It’s Official: I am clinically insane.

The pressures of the current neoliberal capitalist system of health care and its financing force health professionals into a double bind. Either they spend the time and energy necessary to listen to and fully treat the patient and put their job and clinic in economic jeopardy, or they move at a frenetic pace to keep their practice afloat and only partially attend to the patient in their presence.

The default to studying men at times veered into absurdity: in the early sixties, observing that women tended to have lower rates of heart disease until their estrogen levels dropped after menopause, researchers conducted the first trial to look at whether supplementation with the hormone was an effective preventive treatment. The study enrolled 8,341 men and no women. (Although doctors began prescribing estrogens to postmenopausal women in droves - by the midseventies, a third would be taking them - it wasn't until 1991 that the first clinical study of hormone therapy was conducted in women.) An NIH-supported pilot study from Rockefeller University looked at how obesity affected breast and uterine cancer didn't enroll a single woman. While men can develop breast cancer - and a small number of them do each year - as Rep. Snowe noted drily at the congressional hearings, 'Somehow I find it hard to believe that the male-dominated medical community would tolerate a study of prostate cancer that used only women as research subjects.

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.

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?

Tell me something true about you.” “Okay …” She mentally rifled through birthplace (Portland, Oregon), college major (sociology), astrological sign (Virgo), favorite movie (The Apple Dumpling Gang—don’t judge), until she hit a fact that wasn’t completely mundane. “One of my favorite things in the world are those charity events where everyone buys a rubber ducky with a number and the first person’s duck to get down the river wins.” “Why?” “I like seeing the river teeming with all those outrageously yellow and orange ducks. It’s so friendly. And I love the hope of it. Even though it doesn’t matter if you win, because all that wonderful, candy-colored money is going to something really important like a free clinic downtown or cleft palate operations for children in India, you still have that playful hope that you will win. You run alongside the stream, not knowing which is your duck but imagining the lead one is yours.” “And this is the essence of your soul—the ducky race?” “Well, you didn’t ask for the essence of my soul. You asked for something true about me, and so I went for something slightly embarrassing and secret but true nonetheless. Next time you want the essence of my soul, I’ll oblige you with sunsets and baby’s laughter and greeting cards with watercolor flowers.” He squinted at her thoughtfully. “No, so far as I’m concerned, the yellow duckies are the essence of your soul.

Over time, there would be less and less of him and more of the tumor. His brain was being eaten by God. He left the clinic in fine spirits. He had no intention of removing the tumor. It was the perfect solution to his dilemma: how to feed his body's desire for intimacy. He was delusional, of course. There was no higher presence filling him with love, connecting him to all things. It only felt that way. But that was fine. That was ideal. He would not have trusted a God outside his head.

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.

During one of these lectures, our teacher imparted a morsel of clinical wisdom. This is what he told us: “You will from time to time meet a patient who shares a disturbing tale of multiple mistakes in his previous treatment. He has been seen by several clinicians, and all failed him. The patient can lucidly describe how his therapists misunderstood him, but he has quickly perceived that you are different. You share the same feeling, are convinced that you understand him, and will be able to help.” At this point my teacher raised his voice as he said, “Do not even think of taking on this patient! Throw him out of the office! He is most likely a psychopath and you will not be able to help him.” Many years later I learned that the teacher had warned us against psychopathic charm, and the leading authority in the study of psychopathy confirmed that the teacher’s advice was sound. The analogy to the Müller-Lyer illusion is close. What we were being taught was not how to feel about that patient. Our teacher took it for granted that the sympathy we would feel for the patient would not be under our control; it would arise from System 1. Furthermore, we were not being taught to be generally suspicious of our feelings about patients. We were told that a strong attraction to a patient with a repeated history of failed treatment is a danger sign—like the fins on the parallel lines. It is an illusion—a cognitive illusion—and I (System 2) was taught how to recognize it and advised not to believe it or act on it.

It would have been helpful if there was a Mayo Clinic chapter about the topic of "leaving." Man, I would have read that chapter over and over -- leaving your wailing baby in the morning without wanting to slit your wrists; leaving your desk even though you are only a half hour away from completing something that would feel so good to wrap up; leaving the building so no one notices that you are actually leaving. I was much more interested in honing that skill than learning how to puree apples and carrots to freeze in ice-cube trays (not that I ever did that either). As long as I was a full-time working mother with a clock to punch or a train to catch -- as I would be for eight more years -- I never figured out how to leave with grace or with so-called conviction.

and only much later, when Mascha wanted a child, did I realize that love is a deadly poison, a vice, a vice that one wants to see shared, & that if one of the two involved is smitten, the other is often no more than a passive participant, or vixxtim, or possessed. And Moravagine was possessed. Love is masochistic. These cries & complaints, these sweet alarms. this anguished state of lovers, this suspense, this latent pain that is just below the surface, almost unexpressed, these thousand & one anxieties over the loved one's absence, this feeling of time rushing by, this touchiness, these fits of temper, these long daydreams, this childish fickleness of behavior, this moral torture where vanity & self-esteem, or perhaps honor, upbringing & modesty are at stake, these highs & lows in the nervous tone, these leaps of imagination, this fetishism, this cruel precision of senses, whipping & probing, the collapse, the prostration, the abdication, the self-abasement, the perpetual loss & recovery of one's personality, these stammered words & phrases, these pet-names, this intimacy, these hesitations in physical contact, these epileptic tremors, these successive & even more frequent relapses, this more & more turbulent & stormy passion with its ravages progressing to the point of complete inhibition & annihilation of the soul, the debility of the senses, the exhaustion of the marrow, the erasure of the brain & even the desiccation of the heart, this yearning for ruin, for destruction, for mutilation, this need of effusiveness, of adoration, of mysticism, this insatiability which expresses itself in hyper-irritability of the of mucus membranes, in errant taste, in vasomotor or peripheral disorders, & which conjures up jealousy & vengeance, crimes, prevarications & treacheries, this idolatry, this incurable melancholy, this apathy, this profound moral misery, this definitive & harrowing doubt, this despair--are not all these stigmata the very symptoms of love in which we can first diagnose, then trace with a sure hand, the clinical curve of masochism?

At the beginning of my illness, hospital visits couldn’t be avoided. I needed tests, I had to have my diet and insulin regulated, and once I fainted at school and went into insulin shock and the ambulance came and took me to St. Luke’s. If one of my friends got that sick, I would have called her in the hospital and sent her cards and visited her when she went home. But not Laine. She seemed almost afraid of me (although she tried to cover up by acting cool and snooty). And my other friends did what Laine did, because she was the leader. Their leader. My leader. And we were her followers. The school year grew worse and worse. I fainted twice more at school, each time causing a big scene and getting lots of attention, and every week, it seemed, I missed at least one morning while Mom and Dad took me to some doctor or clinic or other. Laine called me a baby, a liar, a hypochondriac, and a bunch of other things that indicated she thought my parents and I were making a big deal over nothing. But if she really thought it was nothing, why wouldn’t she come over to my apartment anymore? Why wouldn’t she share sandwiches or go to the movies with me? And why did she move her desk away from mine in school? I was confused and unhappy and sick, and I didn’t have any friends left, thanks to Laine. I hated Laine.

The first time I visited the famed Tavistock Clinic in London I noticed a collection of black-and-white photographs of these great twentieth-century psychiatrists hanging on the wall going up the main staircase: John Bowlby, Wilfred Bion, Harry Guntrip, Ronald Fairbairn, and Donald Winnicott. Each of them, in his own way, had explored how our early experiences become prototypes for all our later connections with others, and how our most intimate sense of self is created in our minute-to-minute exchanges with our caregivers.

Erwin Strauss, in his brilliant monograph on obsession, similarly earlier showed how repulsed Swift was by the animality of the body, by its dirt and decay. Straus pronounced a more clinical judgment on Swift's disgust, seeing it as part of the typical obsessive's worldview: "For all obsessives sex is severed from unification and procreation....Through the...isolation of the genitals from the whole of the body, sexual functions are experienced as excretions and as decay." This degree of fragmentation is extreme, but we all see the world through obsessive eyes at least part of the time and to some degree; and as Freud said, not only neurotics take exception to the fact that "we are born between urine and feces." In t his horror of the incongruity of man Swift the poet gives more tormented voice to the dilemma that haunts us all, and it is worth summing it up one final time: Excreting is the curse that threatens madness because it shows man his abject finitude, his physicalness, the likely unreality of his hopes and dreams. But even more immediately, it represents man's utter bafflement at the sheer non-sense of creation: to fashion the sublime miracle of the human face, the mysterium tremendum of radiant female beauty, the veritable goddesses that beautiful women are; to bring this out of nothing, out of the void, and make it shine in noonday; to take such a miracle and put miracles again within it, deep in the mystery of eyes that peer out-the eye that gave even the dry Darwin a chill; to do all this, and to combine it with an anus that shits! It is too much. Nature mocks us, and poets live in torture.

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.

It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self’s most elementary levels. It is a nausea of the cells and soul. It is an unnumb intuition in which the world is fully rich and animate and un-map-like and also thoroughly painful and malignant and antagonistic to the self, which depressed self It billows on and coagulates around and wraps in Its black folds and absorbs into Itself, so that an almost mystical unity is achieved with a world every constituent of which means painful harm to the self. Its emotional character, the feeling Gompert describes It as, is probably mostly indescribable except as a sort of double bind in which any/all of the alternatives we associate with human agency—sitting or standing, doing or resting, speaking or keeping silent, living or dying—are not just unpleasant but literally horrible. It is also lonely on a level that cannot be conveyed. There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. This anhedonic Inability To Identify is also an integral part of It. If a person in physical pain has a hard time attending to anything except that pain, 282 a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution. It is a hell for one.

For almost a year, Opal Koboi had languished in the padded-cell wing of the J. Argon Clinic, showing no response to the medical warlocks who tried to revive her. In all that time, she spoke not a single word, ate not a mouthful of food, and exhibited no response to stimuli. At first the authorities were suspicious. It is an act! they declared. Koboi is faking catatonia to avoid prosecution. But as the months rolled by, even the most skeptical were convinced. No one could pretend to be in a coma for almost a year. Surely not. A fairy would have to be totally obsessed. . . . CHAPTER 1 TOTALLY OBSESSED

One thing should be clear, but apparently it is not: if this were indeed our nature, we would be living in paradise. If pain, humiliation, and physical injury made us happy, we would be ecstatic. If being sold on street corners were a good time, women would jam street corners the way men jam football matches. If forced sex were what we craved, even we would be satisfied already. If being dominated by men made us happy, we would smile all the time. Women resist male domination because we do not like it. Political women resist male domination through overt, rude, unmistakable rebellion. They are called unnatural, because they do not have a nature that delights in being debased. Apolitical women resist male domination through a host of bitter subversions, ranging from the famous headache to the clinical depression epidemic among women to suicide to prescription-drug tranquilization to taking it out on the children; sometimes a battered wife kills her husband. Apolitical women are also called unnatural, the charge hurled at them as nasty or sullen or embittered individuals, since that is how they fight back. They too are not made happy by being hurt or dominated. In fact, a natural woman is hard to find. We are domesticated, tamed, made compliant on the surface, through male force, not through nature. We sometimes do what men say we are, either because we believe them or because we hope to placate them. We sometimes try to become what men say we should be, because men have power over our lives.

A similar concern about using the web to provide just-in-time information shows up among physicians arguing the future of medical education. Increasingly, and particularly while making a first diagnosis, physicians rely on handheld databases, what one philosopher calls “E-memory.” The physicians type in symptoms and the digital tool recommends a potential diagnosis and suggested course of treatment. Eighty-nine percent of medical residents regard one of these E-memory tools, UpToDate, as their first choice for answering clinical questions. But will this “just-in-time” and “just enough” information teach young doctors to organize their own ideas and draw their own conclusions?

I call it your source-fracture wound, the original break in your heart from long ago. It may have happened in an instant--a little rejection, a shocking abandonment, or a slight misattunement that suddenly made you realize how alone you were in this world. Or perhaps it was a bit-bu-bit splintering as over the years you met with an intermittent meanness, an unpredictable but repetitive abuse, or a neglect that stole your childhood inches at a time. Wherever, however, or whenever it happened, one thing we can assume is that no adult helped you make accurate meaning of your confusing and painful experience. No grown up sat you down and lovingly said, "No, honey, it's not that you're stupid. It's that your big brother is scared and insecure." "It's not that you don't matter, angel. It's that Daddy has a drinking problem and needs help." "It's not that you're not enough. It's that Mommy has clinical depression, dear, and it's neither your fault nor yours to fix." Without this mature presence to help explain to you what was happening to your little world, you probably came to some pretty strong and wrong conclusions about who you were and what was possible for you to have in life. And those conclusions became a habit of consciousness, a filter through which you interpret and then respond to the events of your life, making your grief all the more complex.

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.

Eager to defend the civilian control of nuclear weapons from military encroachment, John F. Kennedy and Robert McNamara had fought hard to ensure that only the president could make the ultimate decision. But they hadn’t considered the possibility that the president might be clinically depressed, emotionally unstable, and drinking heavily—like Richard Nixon, during his final weeks in office. Amid the deepening Watergate scandal, Secretary of Defense Schlesinger told the head of the Joint Chiefs to seek his approval before acting on “any emergency order coming from the president.” Although Schlesinger’s order raised questions about who was actually in command, it seemed like a good idea at the time.

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.

With this warning, Mussolini demanded and was given authority to do just about whatever he wanted; but his initial priority, surprisingly, was good government. He knew that citizens were fed up with a bureaucracy that seemed to grow bigger and less efficient each year, so he insisted on daily roll calls in ministry offices and berated employees for arriving late to work or taking long lunches. He initiated a campaign to drenare la palude (“drain the swamp”) by firing more than 35,000 civil servants. He repurposed Fascist gangs to safeguard rail cargo from thieves. He allocated money to build bridges, roads, telephone exchanges, and giant aqueducts that brought water to arid regions. He gave Italy an eight-hour workday, codified insurance benefits for the elderly and disabled, funded prenatal health care clinics, established seventeen hundred summer camps for children, and dealt the Mafia a blow by suspending the jury system and short-circuiting due process. With no jury members to threaten and judges answerable directly to the state, the courts were as incorruptible as they were docile. Contrary to legend, the dictator didn’t quite succeed in making the trains run on time, but he earned bravos for trying.

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.

How long to see results?” Diomedes asked. “I can’t answer that,” I said. “You know that as well as I do. It takes as long as it takes. Six months. A year. Probably longer—it could be years.” “You have six weeks.” Stephanie drew herself up and crossed her arms. “I am the manager of this unit, and I simply cannot allow—” “I am clinical director of the Grove. This is my decision, not yours. I take full responsibility for any injuries incurred upon our long-suffering therapist here,” Diomedes said, winking at me. Stephanie didn’t say anything further. She glared at Diomedes, then at me. She turned and walked out. “Oh, dear,” Diomedes said. “You appear to have made an enemy of Stephanie. How unfortunate.” He shared a smile with Indira, then gave me a serious look. “Six weeks. Under my supervision. Understand?” I agreed—I had no choice but to agree. “Six weeks.” “Good.” Christian stood up, visibly annoyed. “Alicia won’t talk in six weeks, or sixty years. You’re wasting your time.” He walked out. I wondered why Christian was so positive I would fail. But it made me even more determined to succeed. CHAPTER SIX I ARRIVED HOME, FEELING EXHAUSTED. Force of habit made me flick on the light in the hallway, even though the bulb had gone.

I do not think the long-range bullets I fire provide the mark of a man; I am only dimly aware that they are dehumanising me. They are my opium tto see me through my time here. But with each hit they give, they only provide a feeling respite from the past I cannot escape from and thre present I have chosen to mire myself in. And, grounded as I am in the reality of this hill, I do not yet fully appreciate how this addiction is infecting my future with malediction. With this clinical, psychopathically detached behaviour considered as normal, proper and expected on this hall, I cannot yet stop to think - because I cannot allow myself to here - of how hese respites may be blackening my soul in all the time I will have left on my own back Home - should I even live through the remainder of my months here, in some other corner of this Hell of a country.

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.

If you asked me, I’d tell you I’m a fundamentally happy person, someone whose heart is capable of big leaps in the air. Which is a weird thing to say, actually, considering how much of my life I’ve spent depressed. It’s not just that so many shitty things have happened to me, it’s that for the longest time I didn’t know how to make my life better. Finally, as if I were someone discovering a secret door in a secret garden, the future revealed itself to me. But now that I’m here, I still feel the weight of the past. Sometimes it’s like my legs have been bound with anchor chains, and I’ve been thrown off a ship into the cruel ocean, and all I can do is sink. I guess there are different kinds of depression. There’s the kind that just crushes you for no reason, what Mom calls the clinical kind. But this isn’t that. This is the other kind, the kind that comes because the things that have happened to you are actually just unbelievably, heartbreakingly sad.

But another type of life review happens to all of us when we die and our consciousness leaves the physical body at the end of each lifetime. This time it is not done with a therapist, but rather with our spiritual guides or other wise beings; it is not a clinical life review but a karmic one. As we are replenished by the beautiful light, our awareness is directed to review the results of our actions while we were on the physical plane. We see the people we have harmed and we feel their emotional reactions, magnified greatly. Similarly, we feel the emotions, again enhanced, of those we have aided and loved. In this manner, we examine all our relationships, and we deeply experience all the anger, hurt, and despair that we have caused—but also all the gratitude, appreciation, love, and hope that we have elicited. This life review is not done in a spirit of punishment or guilt. By truly understanding the result of our behavior, we learn the importance of loving-kindness and compassion. As

I was already an atheist, and by my senior year I had became obsessed with the question “What is the meaning of life?” I wrote my personal statement for college admissions on the meaninglessness of life. I spent the winter of my senior year in a kind of philosophical depression—not a clinical depression, just a pervasive sense that everything was pointless. In the grand scheme of things, I thought, it really didn’t matter whether I got into college, or whether the Earth was destroyed by an asteroid or by nuclear war. My despair was particularly strange because, for the first time since the age of four, my life was perfect. I had a wonderful girlfriend, great friends, and loving parents. I was captain of the track team, and, perhaps most important for a seventeen-year-old boy, I got to drive around in my father’s 1966 Thunderbird convertible. Yet I kept wondering why any of it mattered. Like the author of Ecclesiastes, I thought that “all is vanity and a chasing after wind” (ECCLESIASTES 1:14) . I finally escaped when, after a week of thinking about suicide (in the abstract, not as a plan), I turned the problem inside out. There is no God and no externally given meaning to life, I thought, so from one perspective it really wouldn’t matter if I killed myself tomorrow. Very well, then everything beyond tomorrow is a gift with no strings and no expectations. There is no test to hand in at the end of life, so there is no way to fail. If this really is all there is, why not embrace it, rather than throw it away? I don’t know whether this realization lifted my mood or whether an improving mood helped me to reframe the problem with hope; but my existential depression lifted and I enjoyed the last months of high school.

An Echo in the Bone. It was a familiar phenomenon. Doctors, soldiers, and mothers encounter it routinely; I had, any number of times. Unable to respond to an immediate emergency while clouded by fatigue, the mind simply withdraws a little, separating itself fastidiously from the body's overwhelming self-centered needs. From this clinical distance, it can direct things, bypassing emotions, pain, and tiredness, making necessary decisions, cold-bloodedly overruling the mindless body's needs for food, water, sleep, love, grief, pushing it past its fail-safe points. Why emotions? I wondered dimly. Surely emotion was a function of the mind. And yet it seemed so deeply rooted in the flesh and this abdication of the mind always suppressed emotion, too. They body resents this abdication, I think. Ignored and abused, it will not easily let the mind return. Often, the separation persists until one if finally allowed to sleep. With the body absorbed in its quiet intensities of regeneration, the mind settles cautiously back into the turbulent flesh, feeling its delicate way through the twisting passages of dreams, making peace. And you wake once more whole.

In 2003, a Dutch clinical psychologist named Christof van Nimwegen began a fascinating study of computer-aided learning that a BBC writer would later call “one of the most interesting examinations of current computer use and the potential downsides of our increasing reliance on screen-based interaction with information systems.”26 Van Nimwegen had two groups of volunteers work through a tricky logic puzzle on a computer. The puzzle involved transferring colored balls between two boxes in accordance with a set of rules governing which balls could be moved at which time. One of the groups used software that had been designed to be as helpful as possible. It offered on-screen assistance during the course of solving the puzzle, providing visual cues, for instance, to highlight permitted moves. The other group used a bare-bones program, which provided no hints or other guidance. In the early stages of solving the puzzle, the group using the helpful software made correct moves more quickly than the other group, as would be expected. But as the test proceeded, the proficiency of the members of the group using the bare-bones software increased more rapidly. In the end, those using the unhelpful program were able to solve the puzzle more quickly and with fewer wrong moves. They also reached fewer impasses—states in which no further moves were possible—than did the people using the helpful software. The findings indicated, as van Nimwegen reported, that those using the unhelpful software were better able to plan ahead and plot strategy, while those using the helpful software tended to rely on simple trial and error. Often, in fact, those with the helpful software were found “to aimlessly click around” as they tried to crack the puzzle.

I used to be like that once. I never gave anybody a second chance. It’s a very sad way to live your life.” “Do you believe the dragons should provide patternform technology to humans?” “Yes, I do. Denise is convinced that because we didn’t create it for ourselves we won’t be able to handle it properly, that it will be constantly misused. To me it’s completely irrelevant that we didn’t work out every little detail for ourselves.” “Why?” “Other than pride? We know the scientific principles behind technology. If we don’t understand this particular theory, I trust in us to learn it soon enough. There’s very little we can’t grasp once it’s fully explained and broken down into its basic equations. But that’s just the clinical analysis. From a moral point of view, consider this: when the Americans first sent a man to the Moon, there were people living in Africa and South America and Asia who had never seen a lightbulb, or known of electricity or antibiotics. There were even Americans who didn’t have running water to their houses, or an indoor toilet. Does that mean they shouldn’t have been given access to electricity or modern medicine, because they personally didn’t invent it? It might not have been their local community’s knowledge, but it was human knowledge. We don’t have a clue how to build the nullvoid drive that the Ring Empire’s Outbounds employed in their intergalactic ships, but the knowledge is there, developed by sentient entities. Why shouldn’t we have access to that? Because it’s a shortcut? Because we don’t have to spend centuries of time developing it for ourselves? In what way will using ideas other than our own demean and diminish us? All knowledge should be cherished, not denied.” “I believe you would make an excellent dragon, Lawrence.” A

Speak to me about power. What is it?” I do believe I’m being out-Cambridged. “You want me to discuss power? Right here and now?” Her shapely head tilts. “No time except the present.” “Okay.” Only for a ten. “Power is the ability to make someone do what they otherwise wouldn’t, or deter them from doing what they otherwise would.” Immaculée Constantin is unreadable. “How?” “By coercion and reward. Carrots and sticks, though in bad light one looks much like the other. Coercion is predicated upon the fear of violence or suffering. ‘Obey, or you’ll regret it.’ Tenth-century Danes exacted tribute by it; the cohesion of the Warsaw Pact rested upon it; and playground bullies rule by it. Law and order relies upon it. That’s why we bang up criminals and why even democracies seek to monopolize force.” Immaculée Constantin watches my face as I talk; it’s thrilling and distracting. “Reward works by promising ‘Obey and benefit.’ This dynamic is at work in, let’s say, the positioning of NATO bases in nonmember states, dog training, and putting up with a shitty job for your working life. How am I doing?” Security Goblin’s sneeze booms through the chapel. “You scratch the surface,” says Immaculée Constantin. I feel lust and annoyance. “Scratch deeper, then.” She brushes a tuft of fluff off her glove and appears to address her hand: “Power is lost or won, never created or destroyed. Power is a visitor to, not a possession of, those it empowers. The mad tend to crave it, many of the sane crave it, but the wise worry about its long-term side effects. Power is crack cocaine for your ego and battery acid for your soul. Power’s comings and goings, from host to host, via war, marriage, ballot box, diktat, and accident of birth, are the plot of history. The empowered may serve justice, remodel the Earth, transform lush nations into smoking battlefields, and bring down skyscrapers, but power itself is amoral.” Immaculée Constantin now looks up at me. “Power will notice you. Power is watching you now. Carry on as you are, and power will favor you. But power will also laugh at you, mercilessly, as you lie dying in a private clinic, a few fleeting decades from now. Power mocks all its illustrious favorites as they lie dying. ‘Imperious Caesar, dead and turn’d to clay, might stop a hole to keep the wind away.’ That thought sickens me, Hugo Lamb, like nothing else. Doesn’t it sicken you?

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.

Audio of interview - http://www.youtube.com/watch?feature=... "it's not surprising that in that first group I worked with over 20 years ago I had 2 accounts of Jimmy Savile being an abuser where I did support some people to go to the police but it was seen as something impossible to consider at the time." "We have improved a lot as a society in the last 20 years in accepting the reality of abuse, even though it's still so hard for us." "When we look at adults who were abused in childhood we find that nearly all of them had told somebody..." "The culture of the police has changed dramatically but 20 years ago when even counselors and social workers didn't think the abuse could be so widespread the police were obviously part of that culture too. I mean it's hard to realise that in the 1980s there was a point where it was thought that there were only 486 children on the abuse register. Now the government accepts that 1 in 4 adults will have been abused at some point in their lives. That is a huge change." "This is really different for any survivors listening now if a police officer doesn't listen sympathetically and offer a believing response then something has gone wrong because the police really do have this in their guidelines now." - Dr Valerie Sinason, Clinic for Dissociative Studies, London

Now sensitiveness to the state of mind of the public is a difficult thing to achieve or maintain. Any man can tell you with more or less accuracy and clearness his own reactions on any particular issue. But few men have the time or the interest or the training to develop a sense of what other persons think or feel about the same issue. In his own profession the skilled practitioner is sensitive and understanding. lhe lawyer can tell what argument will appeal to court or jury. “The salesman can tell what points to stress to his prospective buyers. The politician can tell what to emphasize to his audience, but the ability to estimate group reactions on a large scale over a wide geographic and psychological area is a specialized ability which must be developed with the same painstaking self-criticism and with the same dependence on experience that are required for the development of the clinical sense in the doctor or the surgeon. The significant revolution of modern times is not industrial or economic or political, but the revolution which is taking place in the art of creating consent among the governed. Within the life of the new generation now in control of affairs, persuasion has become a self-conscious art and a regular organ of popular government. None of us begins to understand the consequences, but it is no daring prophecy to say that the knowledge of how to create consent will alter every political premise. Under the impact of propaganda, not necessarily in the sinister meaning of the world alone, the only constants of our thinking have become variables. It is no longer possible, for example, to believe in the cardinal dogma of democracy that the knowledge needed for the management of human affairs comes up spontaneously from the human heart. Where we act on that theory we expose ourselves to self-deception and to farms of persuasion that we cannot verify. It has been demonstrated that we cannot rely upon intuition, conscience or the accidents of casual opinion if we are to deal with the world beyond our reach.

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

In the course of a short city-block this frantic old woman frenetically caricatured the features of forty or fifty passers-by, in a quick-fire sequence of kaleidoscopic imitations, each lasting a second or two, sometimes less, and the whole dizzying sequence scarcely more than two minutes. And there were ludicrous imitations of the second and third order; for the people in the street, startled, outraged, bewildered by her imitations, took on these expressions in reaction to her; and those expressions, in turn, were re-reflected, re-directed, re-distorted, by the Touretter, causing a still greater degree of outrage and shock. This grotesque, involuntary resonance, or mutuality, by which everyone was drawn into an absurdly amplifying interaction, was the source of the disturbance I had seen from a distance. This woman who, becoming everybody, lost her own self, became nobody. This woman with a thousand faces, masks, personae- how must it be for her in this whirlwind of identities? The answer came soon- and not a second too late; for the build-up of pressures, both hers and others’, was fast approaching the point of explosion. Suddenly, desperately, the old woman turned aside, into an alley-way which led off the main street. And there, with all the appearances of a woman violently sick, she expelled, tremendously accelerated and abbreviated, all the gestures, the postures, the expressions, the demeanours, the entire behavioural repertoires, of the past forty or fifty people she had passed. She delivered one vast, pantomimic egurgitation, in which the engorged identities of the last fifty people who had possessed her were spewed out. And if the taking-in had lasted two minutes, the throwing-out was a single exhalation- fifty people in ten seconds, a fifth of a second or less for the time-foreshortened repertoire of each person. I was later to spend hundreds of hours, talking to, observing, taping, learning from, Tourette patients. Yet nothing, I think, taught me as much, as swiftly, as penetratingly, as overwhelmingly as that phantasmagoric two minutes in a New York street.

At the same time that he was devising a response to the Afghanistan incursion, Carter had to confront a much more acute crisis in Iran, where he had brought the greatest disaster of his presidency down upon himself. In November 1977, he welcomed the shah of Iran to the White House, and on New Year’s Eve in Tehran, raising his glass, he toasted the ruler. Though the shah was sustained in power by a vicious secret police force, Carter praised him as a champion of “the cause of human rights” who had earned “the admiration and love” of the Iranian people. Little more than a year later, his subjects, no longer willing to be governed by a monarch imposed on them by the CIA, drove the shah into exile. Critically ill, he sought medical treatment in the United States. Secretary of State Cyrus Vance warned that admitting him could have repercussions in Iran, and Carter hesitated. But under pressure from David Rockefeller, Henry Kissinger, and the head of the National Security Council, Zbigniew Brzezinski, he caved in. Shortly after the deposed shah entered the Mayo Clinic, three thousand Islamic militants stormed the US embassy compound in Tehran and seized more than fifty diplomats and soldiers. They paraded blindfolded US Marine guards, hands tied behind their backs, through the streets of Tehran while mobs chanted, “Death to Carter, Death to the Shah,” as they spat upon the American flag and burned effigies of the president—scenes recorded on camera that Americans found painful to witness.

Some researchers, such as psychologist Jean Twenge, say this new world where compliments are better than sex and pizza, in which the self-enhancing bias has been unchained and allowed to gorge unfettered, has led to a new normal in which the positive illusions of several generations have now mutated into full-blown narcissism. In her book The Narcissism Epidemic, Twenge says her research shows that since the mid-1980s, clinically defined narcissism rates in the United States have increased in the population at the same rate as obesity. She used the same test used by psychiatrists to test for narcissism in patients and found that, in 2006, one in four U.S. college students tested positive. That’s real narcissism, the kind that leads to diagnoses of personality disorders. In her estimation, this is a dangerous trend, and it shows signs of acceleration. Narcissistic overconfidence crosses a line, says Twenge, and taints those things improved by a skosh of confidence. Over that line, you become less concerned with the well-being of others, more materialistic, and obsessed with status in addition to losing all the restraint normally preventing you from tragically overestimating your ability to manage or even survive risky situations. In her book, Twenge connects this trend to the housing market crash of the mid-2000s and the stark increase in reality programming during that same decade. According to Twenge, the drive to be famous for nothing went from being strange to predictable thanks to a generation or two of people raised by parents who artificially boosted self-esteem to ’roidtastic levels and then released them into a culture filled with new technologies that emerged right when those people needed them most to prop up their self-enhancement biases. By the time Twenge’s research was published, reality programming had spent twenty years perfecting itself, and the modern stars of those shows represent a tiny portion of the population who not only want to be on those shows, but who also know what they are getting into and still want to participate. Producers with the experience to know who will provide the best television entertainment to millions then cull that small group. The result is a new generation of celebrities with positive illusions so robust and potent that the narcissistic overconfidence of the modern American teenager by comparison is now much easier to see as normal.

Or when you keep a sex-addiction meeting under surveillance because they’re the best places to pick up chicks.” Serge looked around the room at suspicious eyes. “Okay, maybe that last one’s just me. But you should try it. They keep the men’s and women’s meetings separate for obvious reasons. And there are so many more opportunities today because the whole country’s wallowing in this whiny new sex-rehab craze after some golfer diddled every pancake waitress on the seaboard. That’s not a disease; that’s cheating. He should have been sent to confession or marriage counseling after his wife finished chasing him around Orlando with a pitching wedge. But today, the nation is into humiliation, tearing down a lifetime of achievement by labeling some guy a damaged little dick weasel. The upside is the meetings. So what you do is wait on the sidewalk for the women to get out, pretending like you’re loitering. And because of the nature of the sessions they just left, there’s no need for idle chatter or lame pickup lines. You get right to business: ‘What’s your hang-up?’ And she answers, and you say, ‘What a coincidence. Me, too.’ Then, hang on to your hat! It’s like Forrest Gump’s box of chocolates. You never know what you’re going to get. Most people are aware of the obvious, like foot fetish or leather. But there are more than five hundred lesser-known but clinically documented paraphilia that make no sexual sense. Those are my favorites . . .” Serge began counting off on his fingers. “This one woman had Ursusagalmatophilia, which meant she got off on teddy bears—that was easily my weirdest three-way. And nasophilia, which meant she was completely into my nose, and she phoned a friend with mucophilia, which is mucus. The details on that one are a little disgusting. And formicophilia, which is being crawled on by insects, so the babe bought an ant farm. And symphorophilia—that’s staging car accidents, which means you have to time the air bags perfectly

What are the health effects of the choice between austerity and stimulus? Today there is a vast natural experiment being conducted on the body economic. It is similar to the policy experiments that occurred in the Great Depression, the post-communist crisis in eastern Europe, and the East Asian Financial Crisis. As in those prior trials, health statistics from the Great Recession reveal the deadly price of austerity—a price that can be calculated not just in the ticks to economic growth rates, but in the number of years of life lost and avoidable deaths. Had the austerity experiments been governed by the same rigorous standards as clinical trials, they would have been discontinued long ago by a board of medical ethics. The side effects of the austerity treatment have been severe and often deadly. The benefits of the treatment have failed to materialize. Instead of austerity, we should enact evidence-based policies to protect health during hard times. Social protection saves lives. If administered correctly, these programs don’t bust the budget, but—as we have shown throughout this book—they boost economic growth and improve public health. Austerity’s advocates have ignored evidence of the health and economic consequences of their recommendations. They ignore it even though—as with the International Monetary Fund—the evidence often comes from their own data. Austerity’s proponents, such as British Prime Minister David Cameron, continue to write prescriptions of austerity for the body economic, in spite of evidence that it has failed. Ultimately austerity has failed because it is unsupported by sound logic or data. It is an economic ideology. It stems from the belief that small government and free markets are always better than state intervention. It is a socially constructed myth—a convenient belief among politicians taken advantage of by those who have a vested interest in shrinking the role of the state, in privatizing social welfare systems for personal gain. It does great harm—punishing the most vulnerable, rather than those who caused this recession.

Virtually every version of CBT for anxiety disorders involves working through what’s called an exposure hierarchy. The concept is simple. You make a list of all the situations and behaviors you avoid due to anxiety. You then assign a number to each item on your list based on how anxiety provoking you expect doing the avoided behavior would be. Use numbers from 0 (= not anxiety provoking at all) to 100 (= you would fear having an instant panic attack). For example, attempting to talk to a famous person in your field at a conference might be an 80 on the 0-100 scale. Sort your list in order, from least to most anxiety provoking. Aim to construct a list that has several avoided actions in each 10-point range. For example, several that fall between 20 and 30, between 30 and 40, and so on, on your anxiety scale. That way, you won’t have any jumps that are too big. Omit things that are anxiety-provoking but wouldn’t actually benefit you (such as eating a fried insect). Make a plan for how you can work through your hierarchy, starting at the bottom of the list. Where possible, repeat an avoided behavior several times before you move up to the next level. For example, if one of your items is talking to a colleague you find intimidating, do this several times (with the same or different colleagues) before moving on. When you start doing things you’d usually avoid that are low on your hierarchy, you’ll gain the confidence you need to do the things that are higher up on your list. It’s important you don’t use what are called safety behaviors. Safety behaviors are things people do as an anxiety crutch—for example, wearing their lucky undies when they approach that famous person or excessively rehearsing what they plan to say. There is a general consensus within psychology that exposure techniques like the one just described are among the most effective ways to reduce problems with anxiety. In clinical settings, people who do exposures get the most out of treatment. Some studies have even shown that just doing exposure can be as effective as therapies that also include extensive work on thoughts. If you want to turbocharge your results, try exposure. If you find it too difficult to do alone, consider working with a therapist.