Clinical Quotes

The spell. Victor said you had to want me... to care about me... for it to work." When he didn't say anything, I tried to grip his shirt, but my fingers were too weak. "Did you? Did you want me?" His words came out thickly. "Yes, Roza. I did want you. I still do. I wish... we could be together." "Then why did you lie to me?" We reached the clinic, and he managed to open the door while still holding me. As soon as he stepped inside, he began yelling for help. "Why did you lie?" I murmured again. Still holding me in his arms, he looked down at me. I could hear voices and footsteps getting closer. "Because we can't be together." "Because of the age thing, right?" I asked. "Because you're my mentor?" His fingertip gently wiped away a tear that had escaped down my cheek. "That's part of it," he said. "But also... well, you and I will both be Lissa's gaurdians someday. I need to protect her at all cost. If a pack of Strogoi come, I need to throw my body between them and her." I know that. Of course that's what you have to do." The black sparkles were dancing in front of my eyes again. I was fading out. "No. If I let myself love you, I won't throw myself in front of her. I'll throw myself in front of you.

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.

sarcasm and jokes were often the bottle in which clinical depressives sent out their most plangent screams for someone to care and help them.

If a man has lost a leg or an eye, he knows he has lost a leg or an eye; but if he has lost a self—himself—he cannot know it, because he is no longer there to know it.

Imperialism leaves behind germs of rot which we must clinically detect and remove from our land but from our minds as well.

It's a well-known fact. All women are clinically insane, but especially ballet dancers. Psycho. extremely psycho. Trust me.

There is a certain clinical satisfaction in seeing just how bad things can get.

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.

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

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.

If we only see things through the cold-eyed lens of factuality and don’t listen to the yearning and screaming of unexpressed feelings, life may remain bleak in a mire of clinical hollowness, sodden in apathy and indifference. ("Morning after")

Man (and woman) has an infinite capacity for self-development. Equally, he has an infinite capacity for self-destruction. A human being may be clinically alive and yet, despite all appearances, spiritually dead.

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

What I want you to know: Dying is easy. Comedy is hard. Clinical depression is no fucking picnic.

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

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!

Literacy is a bridge from misery to hope. It is a tool for daily life in modern society. It is a bulwark against poverty, and a building block of development, an essential complement to investments in roads, dams, clinics and factories. Literacy is a platform for democratization, and a vehicle for the promotion of cultural and national identity. Especially for girls and women, it is an agent of family health and nutrition. For everyone, everywhere, literacy is, along with education in general, a basic human right.... Literacy is, finally, the road to human progress and the means through which every man, woman and child can realize his or her full potential.

I've been clinically diagnosed with sociopathy,' I said. 'Do you know what that means?' 'It means you're a freak,' he said. 'It means that you're about as important to me as a cardboard box,' I said. 'You're just a thing - a piece of garbage that no one's thrown away yet. Is that what you want me to say?' 'Shut up,' said Rob. He was still acting tough, but I could see his bluster was starting to fail. He didn't know what to say. 'The thing about boxes,' I said, 'is that you can open them up. Even though they're completely boring on the outside, there might be something interesting inside. So while you're saying all of these stupid, boring things I'm imagining what it would be like to cut you open and see what you've got in there.

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

I left the clinic in a daze that had nothing to do with my head injury. Clear up in a week or so? How could Dr. Olendzki speak so lightly about this? I was going to look like a mutant for Christmas and most of the ski trip. I had a black eye. A freaking black eye. And my mother had given it to me.

Love is a kind of dementia with very precise and oft-repeated clinical symptoms. You blush in each other's presence, you both hover in places where you expect the other to pass, you are both a little tongue-tied, you both laugh inexplicably and too long, you become quite nauseatingly girlish, and he becomes quite ridiculously gallant. You have also grown a little stupid.

If we wish to know about a man, we ask 'what is his story--his real, inmost story?'--for each of us is a biography, a story. Each of us is a singular narrative, which is constructed, continually, unconsciously, by, through, and in us--through our perceptions, our feelings, our thoughts, our actions; and, not least, our discourse, our spoken narrations. Biologically, physiologically, we are not so different from each other; historically, as narratives--we are each of us unique.

To be ourselves we must have ourselves – possess, if need be re-possess, our life-stories. We must “recollect” ourselves, recollect the inner drama, the narrative, of ourselves. A man needs such a narrative, a continuous inner narrative, to maintain his identity, his self.

What is the difference between a living thing and a dead thing? In the medical world, a clinical definition of death is a body that does not change. Change is life. Stagnation is death. If you don't change, you die. It's that simple. It's that scary.

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

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.

If you are clinically insane, by which I mean you wake up in the morning, and you think you are an onion, this is your car, (about the BMW X3).

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.

Hang me upside-down and fuck me in both ears. You pulled yourself out of a clinical depression by being a freaking hero.

Death left its old tragic heaven and became the lyrical core of man: his invisible truth, his visible secret.

he wanted to do, to be, to feel- and could not; he wanted sense, he wanted purpose- in Freud's words, 'Work and Love'.

Multiple personalities. Don't freak out but I'm pretty sure I have them. Not a clinical thing, not a disease. But a distraction to be sure. There are maybe six or seven pretty concrete versions of myself knocking around in here and I mean it gets fucking crowded when everybody is drunk or talking at once.

Then why was his tongue in your mouth? Was he conducting a clinical test of your gag reflex?" He smiled, but not nicely. "How is your gag reflex, Ms. Lane? Are you a hair trigger?" Barrons likes to use sexual innuendo to try to shut me up. I think he expects the well-raised southern belle in me will think eew and back off. Sometimes, I do think eew, but I don't back off. "I'm a spitter, if that's what you're asking." I flashed him a too-sweet smile. "Didn't look that way to me. I think you're a swallower. His tongue was halfway to China and you were still taking it." "Jealous?

There is in fact a category of people who get unusually close to the truth about themselves and the world. Their self-perceptions are more balanced,they assign responsibility for success and failure more even-handedly, and their predictions for the future are more realistic. These people are living testimony to the dangers of self-knowledge. They are the clinically depressed.

In the pit of red You hid from the bone-clinic whiteness But the jewel you lost was blue.

... and Lynn is dead inside, like a corpse. She Instagrams methodically, clinically, as if she's gathering evidence for defense, like her entire life is dedicated to proving that she has a life.

Very young children love and demand stories, and can understand complex matters presented as stories, when their powers of comprehending general concepts, paradigms, are almost nonexistent.

Forget he never wanted this in the first place. Forget he was convinced she might be clinically insane and definitely feral. The bottom line was, she ran. She didn't even stop to shower. She woke up, saw Zach lying next to her, and took to the Texas hills. Not a good sign when one was just starting out in a relationship.

The first task of the doctor is ... political: the struggle against disease must begin with a war against bad government." Man will be totally and definitively cured only if he is first liberated...

Dangerously well’— what an irony is this: it expresses precisely the doubleness, the paradox, of feeling ‘too well

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

The pleasure we obtain from music comes from counting, but counting unconsciously. Music is nothing but unconscious arithmetic.

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.”  

With all this talk about taking my life, why have I never attempted it? Answer: I have an overwhelming desire to live.

Is Donald Trump getting his brain frozen? asks Ron. Max explains that the brain has to be fully functioning at clinical death.

For here is a man who, in some sense, is desperate, in a frenzy. The world keeps disappearing, losing meaning, vanishing - and he must seek meaning, make meaning, in a desperate way, continually inventing, throwing bridges of meaning over abysses of meaninglessness, the chaos that yawns continually beneath him.

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.

There's still always the possibility that I've gone totally, clinically cuckoo. But somehow I don't think so anymore. An article I once read said that crazy people don't worry about being crazy - that's the whole problem.

But who was more tragic, or who was more damned—the man who knew it, or the man who did not?

The miracle is that, in most cases, he succeeds - for the powers of survival, of the will to survive, and to survive as a unique inalienable individual, are absolutely, the strongest in our being: stronger than any impulses, stronger than disease.

Yes, it would be worthwhile to study clinically, in detail, the steps taken by Hitler and Hitlerism and to reveal to the very distinguished, very humanistic, very Christian bourgeois of the twentieth century that without his being aware of it, he has a Hitler inside him, that Hitler inhabits him, that Hitler is his demon, that if he rails against him, he is being inconsistent and that, at bottom, what he cannot forgive Hitler for is not crime in itself, the crime against man, it is not the humiliation of man as such, it is the crime against the white man, the humiliation of the white man, and the fact that he applied to Europe colonialist procedures which until then had been reserved exclusively for the Arabs of Algeria, the coolies of India, and the blacks of Africa.

إذا فقد رجلٌ رجلاً أو عيناً ، فهو يعرف أنه فقد رِجلاً أو عيناً. ولكن إذا فقد نفساً - نفسه- فليس بإمكانه أن يعرف ذلك، لأنه لم يعد موجوداً هناك ليعرف

Clinical psychology tells us arguably that trauma is the ultimate killer.Memories r not recycled like atoms and particles in quantum physics. they can be lost forever. It’s sort of like my past is an unfinished painting and as the artist of that painting,I must fill in all the ugly holes and make it beautiful again.

(Let’s face it, if men had to give birth, there would probably be only a total of about 47 people living on the face of the earth today as opposed to billions, and abortion clinics would be just another department in Walmart alongside auto parts, golf gear, and firearms.)

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.

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.

إذا فقد رَجُلا رِجلا أو عَينا، فهو يعرف أنه فقد رِجلا أو عَينا، و لكن إذا فقد نفسا-نفسه-فليس بإمكانه أن يعرف ذلك، لأنه لم يعد موجودا هناك ليعرف

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

As a counterpoint to sociopathy, the condition of narcissism is particularly interesting and instructive. Narcissism is, in a metaphorical sense, one half of what sociopathy is. Even clinical narcissists are able to feel most emotions are strongly as anyone else does, from guilt to sadness to desperate love and passion. The half that is missing is the crucial ability to understand what other people are feeling. Narcissism is a failure not of conscience but of empathy, which is the capacity to perceive emotions in others and so react to them appropriately. The poor narcissist cannot see past his own nose, emotionally speaking, and as with the Pillsbury Doughboy, any input from the outside will spring back as if nothing had happened. Unlike sociopaths, narcissists often are in psychological pain, and may sometimes seek psychotherapy. When a narcissist looks for help, one of the underlying issues is usually that, unbeknownst to him, he is alienating his relationships on account of his lack of empathy with others, and is feeling confused, abandoned, and lonely. He misses the people he loves, and is ill-equipped to get them back. Sociopaths, in contrast, do not care about other people, and so do not miss them when they are alienated or gone, except as one might regret the absence of a useful appliance that one has somehow lost.

All this is simply to say that all life is interrelated. We are caught in an inescapable network of mutuality; tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. As long as there is poverty in this world, no man can be totally rich even if he has a billion dollars. As long as diseases are rampant and millions of people cannot expect to live more than twenty or thirty years, no man can be totally healthy, even if he just got a clean bill of health from the finest clinic in America. Strangely enough, I can never be what I ought to be until you are what you ought to be. You can never be what you ought to be until I am what I ought to be.

According to studies, clinically depressed individuals have a more accurate grasp of reality than the average person. We tell ourselves lies and layer falsehoods and self-assurances over one another in order to cope with a world colored by pain and suffering. We put blinders on. If we lose that illusion, we crumble into depression or we crack and go mad. So perhaps I’m crazy, but only because I see things too clearly?

Daytime television, you can tell who’s watching by the three kinds of commercials. Either it’s clinics for drying out drunks. Or it’s law firms who want to settle injury suits. Or it’s schools offering mail-order vocational degrees to make you a bookkeeper. A private detective. Or a locksmith. If you’re watching daytime television, this is your new demographic. You’re a drunk. Or a cripple. Or an idiot.

He was breathing, which is always a good sign. As gently as I could I picked him up, placed him on the towel, wrapped it around him, and put him in my car. I drove to the emergency clinic, the cat purring on the seat beside me. “What’s his name?” the young man at the front desk asked as my towel and cat were whisked to a back room. “Uh…John Tomkins,” I said. “That’s different,” the receptionist said, writing it down. “He was a pirate,” I said. “I mean Tomkins. I don’t know about the cat.

Are you a censor? Do you tell people not to say “girl”? Shame on you! If nothing offends you, you’re a saint or you’re psychotic. If a few things offend you, deal with them--fairly. If you’re often offended by things, you’re probably a self-righteous asshole and it’s too bad you weren’t censored yourself--by your mother in an abortion clinic.

Perhaps the strangest thing about this illusion of control is not that it happens but that it seems to confer many of the psychological benefits of genuine control. In fact, the one group of people who seem generally immune to this illusion are the clinically depressed, who tend to estimate accurately the degree to which they can control events in most situation.

I can't reconcile the way that the world is jolted by events that are wonderful and terrible, the gorgeous and the tragic. Except that I am beginning to believe that these opposites do not cancel each other out. I see a middle aged woman in the waiting room of the cancer clinic, her arms wrapped around the frail frame of her son. She squeezes him tightly, oblivious to the way he looks down at her sheepishly. He laughs after a minute, a hostage to her impervious love. Joy persists somehow and I soak it in. The horror of cancer has made everything seem like it is painted in bright colors. I think the same thoughts again and again. Life is so beautiful. Life is so hard.

A sociopath is often described as someone with little or no conscience. I’ll leave it to the psychologists to decide whether Holmes fits the clinical profile, but there’s no question that her moral compass was badly askew. I’m fairly certain she didn’t initially set out to defraud investors and put patients in harm’s way when she dropped out of Stanford fifteen years ago. By all accounts, she had a vision that she genuinely believed in and threw herself into realizing. But in her all-consuming quest to be the second coming of Steve Jobs amid the gold rush of the “unicorn” boom, there came a point when she stopped listening to sound advice and began to cut corners. Her ambition was voracious and it brooked no interference. If there was collateral damage on her way to riches and fame, so be it.

But the saddest difference between them was that Zazetsky, as Luria said, 'fought to regain his lost faculties with the indomitable tenacity of the damned,' whereas Dr P. was not fighting, did not know what was lost. But who was more tragic, or who was more damned -- the man who knew it, or the man who did not?

Doctors kept stressing that mental disease was the same as physical disease. Telling someone who was clinically depressed, for example, to shake it off and get out of the house was tantamount to telling a man with two broken legs to sprint across the room. That was all well and good in theory, but in practice, the stigma continued. Maybe, to be more charitable, it was because you could hide a mental disease.

كان هناك نوع من العاطفة المرتجفة التواقة، وحنين غريب، لعالم مفقود، نصف منسيَ، ونصف متذكّر

Perhaps there is a philosophical as well as a clinical lesson here: that in Korsakov’s, or dementia, or other such catastrophes, however great the organic damage and Humean dissolution, there remains the undiminished possibility of reintegration by art, by communion, by touching the human spirit: and this can be preserved in what seems at first a hopeless state of neurological devastation.

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.

Rank asked why the artist so often avoids clinical neurosis when he is so much a candidate for it because of his vivid imagination, his openness to the finest and broadest aspects of experience, his isolation from the cultural world-view that satisfies everyone else. The answer is that he takes in the world, but instead of being oppressed by it he reworks it in his own personality and recreates it in the work of art. The neurotic is precisely the one who cannot create—the “artiste-manque,” as Rank so aptly called him. We might say that both the artist and the neurotic bite off more than they can chew, but the artist spews it back out again and chews it over in an objectified way, as an ex­ternal, active, work project. The neurotic can’t marshal this creative response embodied in a specific work, and so he chokes on his in­troversions. The artist has similar large-scale introversions, but he uses them as material.

And I do, god, how I do love playing live, it's the most primal form of energy release you can share with other people besides having sex or taking drugs. So if you see a good live show on drugs and then later that evening have sex, you're basically covered all the bases of energy release, and we all need to let off steam. It's easier and safer than protesting abortion clinics or praising God or wanting to hurt your brother; so go to a show, dance around a bit and copulate.

The porn films are not about sex. Sex is airbrushed and digitally washed out of the films. There is no acting because none of the women are permitted to have what amounts to a personality. The one emotion they are allowed to display is an unquenchable desire to satisfy men, especially if that desire involves the women’s physical and emotional degradation. The lightning in the films is harsh and clinical. Pubic hair is shaved off to give the women the look of young girls or rubber dolls. Porn, which advertises itself as sex, is a bizarre, bleached pantomime of sex. The acts onscreen are beyond human endurance. The scenarios are absurd. The manicured and groomed bodies, the huge artificial breasts, the pouting oversized lips, the erections that never go down, and the sculpted bodies are unreal. Makeup and production mask blemishes. There are no beads of sweat, no wrinkle lines, no human imperfections. Sex is reduced to a narrow spectrum of sterilized dimensions. It does not include the dank smell of human bodies, the thump of a pulse, taste, breath—or tenderness. Those in films are puppets, packaged female commodities. They have no honest emotion, are devoid of authentic human beauty, and resemble plastic. Pornography does not promote sex, if one defines sex as a shared act between two partners. It promotes masturbation. It promotes the solitary auto-arousal that precludes intimacy and love. Pornography is about getting yourself off at someone else’s expense.

It’s funny – you don’t think of doctors getting ill.’ It’s true, and I think it’s part of something bigger: patients don’t actually think of doctors as being human. It’s why they’re so quick to complain if we make a mistake or if we get cross. It’s why they’ll bite our heads off when we finally call them into our over-running clinic room at 7 p.m., not thinking that we also have homes we’d rather be at. But it’s the flip side of not wanting your doctor to be fallible, capable of getting your diagnosis wrong. They don’t want to think of medicine as a subject that anyone on the planet can learn, a career choice their mouth-breathing cousin could have made.

Food, Ivan Arnoldovich, is a subtle thing. One must know how to eat, yet just think – most people don’t know how to eat at all. One must not only know what to eat, but when and how.’ (Philip Philipovich waved his fork meaningfully.) ‘And what to say while you’re eating. Yes, my dear sir. If you care about your digestion, my advice is – don’t talk about bolshevism or medicine at table. And, God forbid – never read Soviet newspapers before dinner.’ ‘M’mm . . . But there are no other newspapers.’ ‘In that case don’t read any at all. Do you know I once made thirty tests in my clinic. And what do you think? The patients who never read newspapers felt excellent. Those whom I specially made read Pravda all lost weight.

Studies of cancer patients show that attitudes of mind have very little effect on clinical outcome. We may say we are fighting cancer, but cancer is merely fighting us; we may think we have beaten it, when it has only gone away to regroup. It is all just the universe doing its stuff, and we are the stuff it is being done to. And so, perhaps, with grief. We imagine we have battled against it, been purposeful, overcome sorrow, scrubbed the rust from our soul, when all that has happened is that grief has moved elsewhere, shifted its interest.

Thus the feeling I sometimes have - which all of us who work closely with aphasiacs have - that one cannot lie to an aphasiac. He cannot grasp your words, and cannot be deceived by them; but what he grasps he grasps with infallible precision, namely the expression that goes with the words, the total, spontaneous, involuntary expressiveness which can never be simulated or faked, as words alone can, too easily.

In the year of the sun was sun eclipse, the sun of piety, knowledge and divinity. The establisher of the path of Tijaniyya, the reviver of the traditions of the chocest of Adnan. The servant of Allah, the Imam of the Maliki law, and affairs are for Allah for he is the possessor. He added that Sufism is a spritual clinic with doctors who have knowledge of attending to ailments of the soul. For a sick patient who requires cure and dosses of medicine from the clinic, there is the need for him to make declaration of his sickness and acceptance of patienthood.

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.

إذا أردنا أن نعرف فلاناً فنحن نسأل : " ما قصته - قصته الحقيقية الأعمق ؟ - " لأن كل واحد منا هو سيرة وقصة . كل واحد منا هو حكاية فريدة يتم تركيبها باستمرار ودون وعي بواسطتنا ومن خلالنا وفينا من خلال إدراكاتنا ومشاعرنا وأفكارنا وأفعالنا وليس أقله بواسطة حديثنا وحكاياتنا المنطوقة . نحن لا نختلف عن بعضنا بعضاً كثيراً بيولوجياً وفسيولوجياً ، أما تاريخياً ، كقصص ، فكل من فريد !

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.

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.

44. [...] later that afternoon, a therapist will say to me, "If he hadn’t lied to you, he would have been a different person than he is." She is trying to get me to see that although I thought I loved this man very completely for exactly who he was, I was in fact blind to the man he actually was, or is. 45. This pains me enormously. She presses me to say why; I can’t answer. Instead I say something about how clinical psychology forces everything we call love into the pathological or the delusional or the biologically explicable, that if what I was feeling wasn’t love then I am forced to admit that I don’t know what love is, or, more simply, that I loved a bad man. How all of these formulations drain the blue right out of love and leave an ugly, pigmentless fish flapping on a cutting board on a kitchen counter.

Some people with DID present their narratives of sadistic abuse in a quite matter-of-fact way, without perceptible affect. This may sometimes be done as a way of protecting themselves, and the listener, from the emotional impact of their experience. We have found that people describing trauma in a flat way, without feeling, are usually those who have been more chronically abused, while those with affect still have a sense of self that can observe the tragedy of betrayal and have feelings about it. In some cases, this deadpan presentation can also be the result of cult training and brainwashing. Unfortunately, when a patient describes a traumatic experience without showing any apparent emotion, it can make the listener doubt whether the patient is telling the truth. (page 119, Chapter 9, Some clinical implications of believing or not believing the patient)

And so was Luria, whose words now came back to me: ‘A man does not consist of memory alone. He has feeling, will, sensibility, moral being ... It is here ... you may touch him, and see a profound change.’ Memory, mental activity, mind alone, could not hold him; but moral attention and action could hold him completely.

In Venezuela Chavez has made the co-ops a top political priority, giving them first refusal on government contracts and offering them economic incentives to trade with one another. By 2006, there were roughly 100,000 co-operatives in the country, employing more than 700,000 workers. Many are pieces of state infrastructure – toll booths, highway maintenance, health clinics – handed over to the communities to run. It’s a reverse of the logic of government outsourcing – rather than auctioning off pieces of the state to large corporations and losing democratic control, the people who use the resources are given the power to manage them, creating, at least in theory, both jobs and more responsive public services. Chavez’s many critics have derided these initiatives as handouts and unfair subsidies, of course. Yet in an era when Halliburton treats the U.S. government as its personal ATM for six years, withdraws upward of $20 billion in Iraq contracts alone, refuses to hire local workers either on the Gulf coast or in Iraq, then expresses its gratitude to U.S. taxpayers by moving its corporate headquarters to Dubai (with all the attendant tax and legal benefits), Chavez’s direct subsidies to regular people look significantly less radical.

One must go to Dostoievsky who experienced on occasion ecstatic epileptic auras to which he attached momentous significance, to find an adequate historical parallel. "There are moments, and it is only a matter of five or six seconds, when you feel the presence of the eternal harmony ... a terrible thing is the frightful clearness with which it manifests itself and the rapture with which it fills you. If this state were to last more than five seconds, the soul could not endure it and would have to disappear. During these five seconds I live a whole human existence, and for that I would give my whole life and not think that I was paying too dearly …

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.

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

The trouble is that when we get around to solutions, it always seems to come down to Prozac. Or Zoloft. Or Paxil. Deep clinical depression is a disease, one that not only can, but probably should, be treated with drugs. But a low-grade terminal anomie, a sense of alienation or disgust and detachment, the collective horror at a world that seems to have gone so very wrong, is not a job for antidepressants. The trouble is, the big-picture problems that have so many people down are more or less insoluble: As long as people can get divorced they will get divorced; America=s shrinking economy is not reversible; there is no cure for AIDS. So it starts to seem fairly reasonable to anesthetize ourselves in the best possible way. I would like so much to say that Prozac is preventing many people who are not clinically depressed from finding real antidotes to what Hillary Clinton refers to as 'a sleeping sickness of the soul,' but what exactly would those solutions be? I mean, universal health care coverage and a national service draft would be nice, but neither one is going to save us from ourselves. Just as our parents quieted us when we were noisy by putting us in front of the television set, maybe we're now learning to quiet our own adult noise with Prozac.

And yet, women keep trying. They put off the rent or the utilities to scrape together the $500 for a first-trimester abortion. They drive across whole states to get to a clinic and sleep in their cars because they can’t afford a motel. They do not do this because they are careless sluts or because they hate babies or because they fail to see clearly what their alternatives are. They see the alternatives all too clearly. We live, as Ellen Willis wrote, in a society that is “actively hostile to women’s ambitions for a better life. Under these conditions the unwillingly pregnant woman faces a terrifying loss of control over her fate.” Abortion, wrote Willis, is an act of self-defense.5

A great writer is always like a foreigner in the language which he expresses himself, even if this is his native tongue. At the limit, he draws his strength from a mute and unknown minority that belongs only to him. He is a foreigner in his own language: he does not mix another language with his own language, he carves out a nonpreexistent foreign language within his own language. He makes the language itself scream, stutter, stammer, or murmur.

Because drugs have become so profitable, major medical journals rarely publish studies on nondrug treatments of mental health problems.31 Practitioners who explore treatments are typically marginalized as “alternative.” Studies of nondrug treatments are rarely funded unless they involve so-called manualized protocols, where patients and therapists go through narrowly prescribed sequences that allow little fine-tuning to individual patients’ needs. Mainstream medicine is firmly committed to a better life through chemistry, and the fact that we can actually change our own physiology and inner equilibrium by means other than drugs is rarely considered.

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).

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

We are afraid of what we will do to others, afraid of the rage that lies in wait somewhere deep in our souls. How many human beings go through the world frozen with rage against life! This deeply hidden inner anger may be the product of hurt pride or of real frustration in office, factory, clinic, or home. Whatever may be the cause of our frozen rage (which is the inevitable mother of depression), the great word of hope today is that this rage can be conquered and drained off into creative channels … …What should we do? We should all learn that a certain amount of aggressive energy is normal and certainly manageable in maturity. Most of us can drain off the excess of our angry feelings and destructive impulses in exercise, in competitive games, or in the vigorous battles against the evils of nature and society. We also must realize that no one will punish us for the legitimate expression of self-assertiveness and creative pugnacity as our parents once punished us for our undisciplined temper tantrums. Furthermore, let us remember that we need not totally repress the angry part of our nature. We can always give it an outlet in the safe realm of fantasy. A classic example of such fantasy is given by Max Beerborn, who made a practice of concocting imaginary letters to people he hated. Sometimes he went so far as to actually write the letters and in the very process of releasing his anger it evaporated. As mature men and women we should regard our minds as a true democracy where all kinds of ideas and emotions should be given freedom of speech. If in political life we are willing to grant civil liberties to all sorts of parties and programs, should we not be equally willing to grant civil liberties to our innermost thoughts and drives, confident that the more dangerous of them will be outvoted by the majority within our minds? Do I mean that we should hit out at our enemy whenever the mood strikes us? No, I repeat that I am suggesting quite the reverse—self-control in action based upon (positive coping mechanisms such as) self expression in fantasy.

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.