Medication Related Quotes

The most traumatic aspects of all disasters involve the shattering of human connections. And this is especially true for children. Being harmed by the people who are supposed to love you, being abandoned by them, being robbed of the one-on-one relationships that allow you to feel safe and valued and to become humane—these are profoundly destructive experiences. Because humans are inescapably social beings, the worst catastrophes that can befall us inevitably involve relational loss. As a result, recovery from trauma and neglect is also all about relationships—rebuilding trust, regaining confidence, returning to a sense of security and reconnecting to love. Of course, medications can help relieve symptoms and talking to a therapist can be incredibly useful. But healing and recovery are impossible—even with the best medications and therapy in the world—without lasting, caring connections to others.

This has been the century of strangers, brown, yellow and white. This has been the century of the great immigrant experiment. It is only this late in the day that you can walk into a playground and find Isaac Leung by the fish pond, Danny Rahman in the football cage, Quang O’Rourke bouncing a basketball, and Irie Jones humming a tune. Children with first and last names on a direct collision course. Names that secrete within them mass exodus, cramped boats and planes, cold arrivals, medical checks. It is only this late in the day, and possibly only in Willesden, that you can find best friends Sita and Sharon, constantly mistaken for each other because Sita is white (her mother liked the name) and Sharon is Pakistani (her mother thought it best — less trouble).

It was already getting dark out, but I kept my sunglasses on. I didn't want to have to look anybody in the eye. I didn't want to relate to anybody too keenly. Plus, the fluorescent lights at the drug store were blinding. If I could have purchased my medications from a vending machine, I would have paid double for them.

Health is normal. The human body is a self-repairing, self-defending, self-healing marvel. Disease is relatively difficult to induce, considering the body's powerful immune system. However, this complicated and delicate machinery can be damaged if fed the wrong fuel during the formative years. ... Healthy living with nutritional excellence throughout life can slow the decline of aging. It can prevent the years and years of suffering in ill health that is so common today as people get older and become dependent on medical treatments, drugs, and surgery. Nutritional excellence is the only real fountain of youth.

Racism is both overt and covert. It takes two, closely related forms: individual whites acting against individual blacks, and acts by the total white community against the black community. We call these individual racism and institutional racism. The first consists of overt acts by individuals, which cause death, injury or the violent destruction of property. This type can be recorded by television cameras; it can frequently be observed in the process of commission. The second type is less overt, far more subtle, less identifiable in terms of specific individuals committing the acts. But it is no less destructive of human life. The second type originates in the operation of established and respected forces in the society, and thus receives far less public condemnation than the first type. When white terrorists bomb a black church and kill five black children, that is an act of individual racism, widely deplored by most segments of the society. But when in that same city - Birmingham, Alabama - five hundred black babies die each year because of the lack of proper food, shelter and medical facilities, and thousands more are destroyed and maimed physically, emotionally and intellectually because of conditions of poverty and discrimination in the black community, that is a function of institutional racism. When a black family moves into a home in a white neighborhood and is stoned, burned or routed out, they are victims of an overt act of individual racism which many people will condemn - at least in words. But it is institutional racism that keeps black people locked in dilapidated slum tenements, subject to the daily prey of exploitative slumlords, merchants, loan sharks and discriminatory real estate agents. The society either pretends it does not know of this latter situation, or is in fact incapable of doing anything meaningful about it.

The Sackler empire is a completely integrated operation,” Blair wrote. They could develop a drug, have it clinically tested, secure favorable reports from the doctors and hospitals with which they had connections, devise an advertising campaign in their agency, publish the clinical articles and the advertisements in their own medical journals, and use their public relations muscle to place articles in newspapers and magazines.

During the Qin Dynasty, all books not relating to practical concerns such as agriculture or construction were ordered burned by the emperor to guard against "dangerous thought." Whether accounts of zombie attacks perished in the flames will never be known. This obscure section of a medical manuscript, preserved in the wall of an executed Chinese scholar, might be proof of such attacks.

Somatic Symptoms: People with Complex PTSD often have medical unexplained physical symptoms such as abdominal pains, headaches, joint and muscle pain, stomach problems, and elimination problems. These people are sometimes most unfortunately mislabeled as hypochondriacs or as exaggerating their physical problems. But these problems are real, even though they may not be related to a specific physical diagnosis. Some dissociative parts are stuck in the past experiences that involved pain may intrude such that a person experiences unexplained pain or other physical symptoms. And more generally, chronic stress affects the body in all kinds of ways, just as it does the mind. In fact, the mind and body cannot be separated. Unfortunately, the connection between current physical symptoms and past traumatizing events is not always so clear to either the individual or the physician, at least for a while. At the same time we know that people who have suffered from serious medical, problems. It is therefore very important that you have physical problems checked out, to make sure you do not have a problem from which you need medical help.

If a relative has suffered Ovarian or Breast Cancer, get the genetic screening. It saves lives.

Anxious and angry relatives are a burden all doctors must bear, but having been one myself was an important part of my medical education.

I go from Wikipedia to a government page about C-PTSD as it relates to veterans. I read the list of symptoms. It is very long. And it is not so much a medical document as it is a biography of my life: The difficulty regulating my emotions. The tendency to overshare and trust the wrong people. The dismal self-loathing. The trouble I have maintaining relationships. The unhealthy relationship with my abuser. The tendency to be aggressive but unable to tolerate aggression from others.

Once a patient goes brain dead and relatives sign his organ donation consent form, he will get the best medical treatment of his life. A hospital code blue may be a call for doctors to rush to the bedside of a beating heart cadaver who needs his or her heart defibrillated.

Doctors estimate that seventy to eighty percent of their business is non-health-related. People aren’t sick, they’re self-dramatizing. Sometimes the hardest part of a medical job is keeping a straight face.

What do we mean by poverty? Not what Dickens or Blake or Mayhew meant. Today no one seriously expects to go hungry in England or to live without running water or medical care or even TV. Poverty has been redefined in industrial countries, so that anyone at the lower end of the income distribution is poor ex officio, as it were-poor by virtue of having less than the rich. And of course by this logic, the only way of eliminating poverty is by an egalitarian redistribution of wealth-even if the society as a whole were to become poorer as a result.

Chronic illness, with its invisible symptoms of fatigue and pain, is largely the burden of women. And it's worth considering to what extent its relative neglect by the medical system is because it mostly affects women, whose complaints are so often heard not as a roar but as a whine.

Auntie Phyl's last months in the care home were extra pieces. Age is unnecessary. Some of us, like my mother, are fortunate enough to die swiftly and suddenly, in full possession of our faculties and our fate, but more and more of us will be condemned to linger, at the mercy of anxious or indifferent relatives, careless strangers, unwanted medical interventions, increasing debility, incontinence, memory loss. We live too long, but, like the sibyl hanging in her basket in the cave at Cumae, we find it hard to die.

When a worker is injured at an IBP plant in Texas, he or she is immediately presented with a waiver. Signing the waiver means forever surrendering the right to sue IBP on any grounds. Workers who sign the waiver may receive medical care under IBP's Workplace Injury Settlement Program. Or they may not. Once workers sign, IBP and its company-approved doctors have control over the job-related medical treatment - for life. Under the program's terms, seeking treatment from an independent physician can be grounds for losing all medical benefits. Workers who refuse to sign the IBP waiver not only risk getting no medical care from the company, but also risk being fired on the spot...Injured workers almost always sign the waiver. The pressure to do so is immense. An IBP medical case manager will literally bring the waiver to a hospital emergency room in order to obtain an injured worker's signature. When Lonita Leal's right hand was mangled by a hamburger grinder at the IBP plant in Amarillo, a case manager talked her into signing the waiver with her left hand as she waited in the hospital for surgery. When Duane Mullin had both hands crushed in a hammer mill at the same plant, an IBP representative persuaded him to sign the waiver with a pen held in his mouth.

by the year 2020, depression is projected to be the second leading cause of medical disability on earth.

When people recover from depression via psychotherapy, their attributions about recovery are likely to be different than those of people who have been treated with medication. Psychotherapy is a learning experience. Improvement is not produced by an external substance, but by changes within the person. It is like learning to read, write or ride a bicycle. Once you have learned, the skills stays with you. People no not become illiterate after they graduate from school, and if they get rusty at riding a bicycle, the skill can be acquired with relatively little practice. Furthermore, part of what a person might learn in therapy is to expect downturns in mood and to interpret them as a normal part of their life, rather than as an indication of an underlying disorder. This understanding, along with the skills that the person has learned for coping with negative moods and situations, can help to prevent a depressive relapse.

Very different thought styles are used for one and the same problem more often than are very closely related ones. It happens more frequently that a physician simultaneously pursues studies of a disease from a clinical-medical or bacteriological viewpoint together with that of the history of civilization, than from a clinical-medical or bacteriological one together with a purely chemical one.

In war it is not just the weak soldiers, or the sensitive ones, or the highly imaginative or cowardly ones, who will break down. Inevitably, all will break down if in combat long enough […] As medical observers have reported, “There is no such thing as ‘getting used to combat’ … Each moment of combat imposes a strain so great that men will break down in direct relation to the intensity and duration of their experience.” Thus – and this is unequivocal: ‘Psychiatric casualties are as inevitable as gunshot and shrapnel wounds in warfare.

I have asked them to pay attention to what they have just said. In particular to their use of the phrase “mental illness”. While it is true, i continued, that people in deprived situations are likely to suffer a great deal more than those who are more affluent, on what grounds are we correct to use medical language to describe that suffering? Do we use it because we have simply been taught to use it or because we have objective that it is somehow better to medicalise such suffering than it is to view it as many social scientists might as non-medical, non-pathological yet understandable human response to harmful social, relational, political and environmental conditions?

Over the past couple of months, Chantel had become a pro at leading book discussions and inventing fun games and trivia questions that all related to that particular month's book selection. Although, last month's theme, dystopian and the book selection "Matched" by Allie Condie, had the retirement home director a little concerned when everyone wanted to stop taking their medications. Not... a good... thing!

People want to believe these research studies are about something simple that they can relate to like winning a contest. They don’t want to think about why a government would want to experiment on its citizens. They do it because they can, I said. Because you don’t see us as people.

Gene patents are the point of greatest concern in the debate over ownership of human biological materials, and how that ownership might interfere with science. As of 2005—the most recent year figures were available—the U.S. government had issued patents relating to the use of about 20 percent of known human genes, including genes for Alzheimer’s, asthma, colon cancer, and, most famously, breast cancer. This means pharmaceutical companies, scientists, and universities control what research can be done on those genes, and how much resulting therapies and diagnostic tests will cost. And some enforce their patents aggressively: Myriad Genetics, which holds the patents on the BRCA1 and BRCA2 genes responsible for most cases of hereditary breast and ovarian cancer, charges $3,000 to test for the genes. Myriad has been accused of creating a monopoly, since no one else can offer the test, and researchers can’t develop cheaper tests or new therapies without getting permission from Myriad and paying steep licensing fees. Scientists who’ve gone ahead with research involving the breast-cancer genes without Myriad’s permission have found themselves on the receiving end of cease-and-desist letters and threats of litigation.

...his condition in Roanoke is a strong testament that lassitude, indifference and the peculiarities of his thought were primarily the consequences of his illness and not of the early attempts to treat it. The popular view that anti-psychotics were chemical straight jackets that suppressed clear thinking and voluntary activity seems not to be borne out in Nash's case. If anything, the only periods when he was relatively free of hallucinations, delusions and the erosion of will were the periods following either insulin treatment or the use of anti psychotics. In other words, rather than reducing Nash to a zombie, medication seemed to reduce zombie like behavior.

Many survivors of relational and other forms of early life trauma are deeply troubled and often struggle with feelings of anger, grief, alienation, distrust, confusion, low self-esteem, loneliness, shame, and self-loathing. They seem to be prisoners of their emotions, alternating between being flooded by intense emotional and physiological distress related to the trauma or its consequences and being detached and unable to express or feel any emotion at all - alternations that are the signature posttraumatic pattern. These occur alongside or in conjunction with other common reactions and symptoms (e.g., depression, anxiety, and low self-esteem) and their secondary manifestations. Those with complex trauma histories often have diffuse identity issues and feel like outsiders, different from other people, whom they somehow can't seem to get along with, fit in with, or get close to, even when they try. Moreover, they often feel a sense of personal contamination and that no one understands or can help them. Quite frequently and unfortunately, both they and other people (including the professionals they turn to for help) do misunderstand them, devalue their strengths, or view their survival adaptations through a lens of pathology (e.g., seeing them as "demanding", "overdependent and needy", "aggressive", or as having borderline personality). Yet, despite all, many individuals with these histories display a remarkable capacity for resilience, a sense of morality and empathy for others, spirituality, and perseverance that are highly admirable under the circumstances and that create a strong capacity for survival. Three broad categories of survivorship, with much overlap between them, can be discerned: 1. Those who have successfully overcome their past and whose lives are healthy and satisfying. Often, individuals in this group have had reparative experiences within relationships that helped them to cope successfully. 2. Those whose lives are interrupted by recurring posttraumatic reactions (often in response to life events and experiences) that periodically hijack them and their functioning for various periods of time. 3. Those whose lives are impaired on an ongoing basis and who live in a condition of posttraumatic decline, even to the point of death, due to compromised medical and mental health status or as victims of suicide of community violence, including homicide.

Discrimination is the most polite word for abuse aka denying equal opportunity by anyone in power based on age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

Next is diet or nutrition—or as I prefer to call it, nutritional biochemistry. The third domain is sleep, which has gone underappreciated by Medicine 2.0 until relatively recently. The fourth domain encompasses a set of tools and techniques to manage and improve emotional health. Our fifth and final domain consists of the various drugs, supplements, and hormones that doctors learn about in medical school and beyond. I lump these into one bucket called exogenous molecules, meaning molecules we ingest that come from outside the body.

KNOWLEDGE IS POWER The first step of the healing process is to know the cause of your suffering is Epstein-Barr—and to realize it’s not your fault. Your EBV-related health problems

Our analyses of the FDA data showed relatively little difference between the effects of antidepressants and the effects of placebos. Indeed, the effects were so small that they did not qualify as clinically significant. The drug companies knew how small the effect of their medications were compared to placebos, and so did the FDA and other regulatory agencies. The companies found various ways to make the data seem more favorable to their products, and the FDA helped them keep their negative data secret. In fact, in some instances, the FDA urged the companies to keep negative data hidden, even when the companies wanted to reveal them. My colleagues and I hadn't really discovered anything new. We had merely revealed their 'dirty little secret'.

Facebook without friends is like a hospital with no relative and a few medical attendants to ask about you at scheduled time.. Life without friends is like the coffin about to get buried into the graveyard..

Other research shows antianxiety medication use rises a relative 28 percent for every 10-decibel increase a neighborhood experiences, and people who live near loud roads are 25 percent more likely to be depressed.

FLEISCHMANN: Since the days of Sigmund Freud and the advent of psychoanalysis the interpretation of dreams has played a big role in Austria[n life]. What is your attitude to all that? BERNHARD: I’ve never spent enough time reading Freud to say anything intelligent about him. Freud has had no effect whatsoever on dreams, or on the interpretation of dreams. Of course psychoanalysis is nothing new. Freud didn’t discover it; it had of course always been around before. It just wasn’t practiced on such a fashionably huge scale, and in such million-fold, money-grubbing forms, as it has been now for decades, and as it won’t be for much longer. Because even in America, as I know, it’s fallen so far out of fashion that they just lay people out on the celebrated couch and scoop their psychological guts out with a spoon. FLEISCHMANN: I take it then that psychoanalysis is not a means gaining knowledge for you? BERNHARD: Well, no; for me it’s never been that kind of thing. I think of Freud simply as a good writer, and whenever I’ve read something of his, I’ve always gotten the feeling of having read the work of an extraordinary, magnificent writer. I’m no competent judge of his medical qualifications, and as for what’s known as psychoanalysis, I’ve personally always tended to think of it as nonsense or as a middle-aged man’s hobby-horse that turned into an old man’s hobby-horse. But Freud’s fame is well-deserved, because of course he was a genuinely great, extraordinary personality. There’s no denying that. One of the few great personalities who had a beard and was great despite his beardiness. FLEISCHMANN: Do you have something against beards? BERNHARD: No. But the majority of people call people who have a long beard or the longest possible beard great personalities and suppose that the longer one’s beard is, the greater the personality one is. Freud’s beard was relatively long, but too pointy; that was typical of him. Perhaps it was the typical Freudian trait, the pointy beard. It’s possible.

My interest in spiritual approaches to medical problems should not, however, be construed as a dismissal of science; rather it is a call for more integrated relations between science and humanities in order to transform medical cultures.

Maternal/child attachment is mostly eroded in increments. The separation begins in hospitals, where mothers are not only made to feel inferior to medical professionals in relation to their infants, but regularly separated from their infants.

Illness in this society, physical or mental, they are not abnormalities. They are normal responses to an abnormal culture. This culture is abnormal when it comes to real human needs. And.. it is in the nature of the system to be abnormal, because if we had a society geared to meet human needs.. would we be destroying the Earth through climate change? Would we be putting extra burden on certain minority people? Would we be selling people a lot of goods that they don't need, and, in fact, are harmful for them? Would there be mass industries based on manufacturing, designing and mass-marketing toxic food to people? So we do all that for the sake of profit. That's insanity. It is not insanity from the point of view of profit, but it is insanity from the point of view of human need. And so, in so many ways this culture denies and even runs against counter to human needs. When you mentioned trauma.. given how important trauma is in human life and what an impact it has.. why have we ignored it for so long? Because that denial of reality is built in into this system. It keeps the system alive. So it is not a mistake, it is a design issue. Not that anybody consciously designed it, but that's just how the system survives. Now.. the average medical student to THIS DAY (I say the average.. there are exceptions) still doesn't get a single lecture on trauma in 4 years of medical school. They should have a whole course on it, Because I can tell you that trauma is related to addiction, all kinds of mental illness and most physical health conditions as well. And there is a whole lot of science behind that, but they don't study that science. Now that reflects this society's denial of trauma, the medical system simply reflects the needs of the larger society, I should say, the dominant needs of the larger society.

It is hard to understand how a compassionate world order can include so many people afflicted by acute misery, persistent hunger and deprived and desperate lives, and why millions of innocent children have to die each year from lack of food or medical attention or social care. This issue, of course, is not new, and it has been a subject of some discussion among theologians. The argument that God has reasons to want us to deal with these matters ourselves has had considerable intellectual support. As a nonreligious person, I am not in a position to assess the theological merits of this argument. But I can appreciate the force of the claim that people themselves must have responsibility for the development and change of the world in which they live. One does not have to be either devout or non devout to accept this basic connection. As people who live-in a broad sense-together, we cannot escape the thought that the terrible occurrences that we see around us are quintessentially our problems. They are our responsibility-whether or not they are also anyone else's. As competent human beings, we cannot shirk the task of judging how things are and what needs to be done. As reflective creatures, we have the ability to contemplate the lives of others. Our sense of behavior may have caused (though that can be very important as well), but can also relate more generally to the miseries that we see around us and that lie within our power to help remedy. That responsibility is not, of course, the only consideration that can claim our attention, but to deny the relevance of that general claim would be to miss something central about our social existence. It is not so much a matter of having the exact rules about how precisely we ought to behave, as of recognizing the relevance of our shared humanity in making the choices we face.

Many of the Chinese medical texts dating back from 2,000 years ago lament the ills of 'modern times' and allude to the traditional 'good old days' another 3,000 years before that. A common theme in these texts is the decline in human health due to careless lifestyles and the deterioration in human relations due to lack of love: degenerative conditions that Taoist alchemy as well as psychoneuroimmunology would link as symptoms of the same syndrome. In his essay entitled 'Loving People' Chang San-feng, the thirteenth-century master, summed it up by saying: 'Therefore to those who want to know the way to deal with the world, I suggest, Love People.' This is a potent description for health and longevity that generates positive healing energy throughout the human system by stimulating the internal alchemy of psychoneuroimmunology.

Much of what bureaucrats do, after all, is evaluate things. They are continually assessing, auditing, measuring, weighing the relative merits of different plans, proposals, applications, courses of action, or candidates for promotion. Market reforms only reinforce this tendency. This happens on every level. It is felt most cruelly by the poor, who are constantly monitored by an intrusive army of moralistic box-tickers assessing their child-rearing skills, inspecting their food cabinets to see if they are really cohabiting with their partners, determining whether they have been trying hard enough to find a job, or whether their medical conditions are really sufficiently sever to disqualify them from physical labor. All rich countries now employ legions of functionaries whose primary function is to make poor people feel bad about themselves. (p. 41)

Working simultaneously, though seemingly without a conscience, was Dr. Ewen Cameron, whose base was a laboratory in Canada's McGill University, in Montreal. Since his death in 1967, the history of his work for both himself and the CIA has become known. He was interested in 'terminal' experiments and regularly received relatively small stipends (never more than $20,000) from the American CIA order to conduct his work. He explored electroshock in ways that offered such high risk of permanent brain damage that other researchers would not try them. He immersed subjects in sensory deprivation tanks for weeks at a time, though often claiming that they were immersed for only a matter of hours. He seemed to fancy himself a pure scientist, a man who would do anything to learn the outcome. The fact that some people died as a result of his research, while others went insane and still others, including the wife of a member of Canada's Parliament, had psychological problems for many years afterwards, was not a concern to the doctor or those who employed him. What mattered was that by the time Cheryl and Lynn Hersha were placed in the programme, the intelligence community had learned how to use electroshock techniques to control the mind. And so, like her sister, Lynn was strapped to a chair and wired for electric shock. The experience was different for Lynn, though the sexual component remained present to lesser degree...

Medicine was religion. Religion was society. Society was medicine. Even economics were mixed up in there somewhere (you had to have or borrow enough money to buy a pig, or even a cow, in case someone got sick and a sacrifice was required), and so was music (if you didn't have a qeej player at your funeral, your soul wouldn't be guided on its posthumous travels, and it couldn't be reborn, and it might make your relatives sick). In fact, the Hmong view of health care seemed to me to be precisely the opposite of the prevailing American one, in which the practice of medicine has fissioned into smaller and smaller subspecialties, with less and less truck between bailiwicks. The Hmong carried holism to its ultima Thule. As my web of cross-references grew more and more thickly interlaced, I concluded that the Hmong preoccupation with medical issues was nothing less than a preocupation with life. (And death. And life after death).

What the data show: the fewer social relationships a person has, the shorter his or her life expectancy, and the worse the impact of various infectious diseases. Relationships that are medically protective can take the form of marriage, contact with friends and extended family, church membership, or other group affiliations.

when it comes to the bread and butter of human misery, try a major depression. It can be life-threatening, it can destroy lives, demolish the families of sufferers. And it is dizzyingly common—the psychologist Martin Seligman has called it the common cold of psychopathology. Best estimates are that from 5 to 20 percent of us will suffer a major, incapacitating depression at some point in our lives, causing us to be hospitalized or medicated or nonfunctional for a significant length of time. Its incidence has been steadily increasing for decades—by the year 2020, depression is projected to be the second leading cause of medical disability on earth.

We don't live in a world of perfect non-violent beauty. If we don't do the trials on animal specimens first, would you rather give yourself or a relative of yours up for experimentation! Some may say, why don't we avoid experimentation on live specimens all together - to them I say, modern medicine is not magic to work without errors - and hard and cruel as it may sound, a live animal specimen is expendable, but not a live human being. You may say, that's not fair - and indeed, it is in no way fair, but that's the reality. The only fairer alternative is to let humans suffer and die from diseases, like they used to, until about a few centuries ago.

Interestingly, it’s possible that practices related to the observance of Passover helped to protect Jewish neighborhoods from the plague. Passover is a week-long holiday commemorating Jews’ escape from slavery in Egypt. As part of its observance, Jews do not eat leavened bread and remove all traces of it from their homes. In many parts of the world, especially Europe, wheat, grain, and even legumes are also forbidden during Passover. Dr. Martin J. Blaser, a professor of internal medicine at New York University Medical Center, thinks this “spring cleaning” of grain stores may have helped to protect Jews from the plague, by decreasing their exposure to rats hunting for food—rats that carried the plague.

Poor people smoked, poor people ate Krispy Kreme doughnuts by the dozen. Poor people were made pregnant by close relatives. Poor people practiced poor hygiene and lived in toxic neighborhoods. Poor people with their ailments constituted a subspecies of humanity that thankfully remained invisible to Gary except in hospitals and in places like Central Discount Medical.

Type A reactions are dose dependent, common, and related to the pharmacological effects of the drug. Type B reactions are allergic or idiosyncratic reactions; they are not dose dependent and are usually not predictable or preventable. Type C reactions are related to the cumulative dose of the medication; they are dose and time related, and they are relatively uncommon.

In those early years, the federal government viewed AIDS as a budget problem, local public health officials saw it as a political problem, gay leaders considered AIDS a public relations problem, and the news media regarded it as a homosexual problem that wouldn’t interest anybody else. Consequently, few confronted AIDS for what it was, a profoundly threatening medical crisis.

It is a relatively recent phenomenon that human beings worry about old age, social security, medical bills, and long-term care. But you can only plan so much. In general, things either work out or they don’t, and if they don’t, you figure out something else, a plan B. There’s nothing wrong with plan B. Most of life, as I have learned, is a plan B. Or a plan C. Or plans L, M, N, O, P.

A black intern at the County Hospital now watched Mary Young die of pneumonia. The intern did not know her. He had been in Midland City for only a week. He wasn't even a fellow-American, although he had taken his medical degree at Harvard. He was an Indaro. He was a Nigerian. His name was Cyprian Ukwende. He felt no kinship with Mary or with any American blacks. He felt kinship only with Indaros. As she died, Mary was as alone on the planet as were Dwayne Hoover or Kilgore Trout. She had never reproduced. There were no friends or relatives to watch her die. So she spoke her very last words on the planet to Cyprian Ukwende. She did not have enough breath left to make her vocal chords buzz. She could only move her lips noiselessly. Here is all she had to say about death: "Oh my, oh my.

Participatory Medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual’s health. Participatory medicine is an ethical approach to care that also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and improve the cost of care.

My wife reports these problems to me, because we are a modern enlightened couple who have divided up our household responsibilities equally along non-gender-stereotypical lines: My wife’s responsibilities: Cleanliness, food, décor, clothing, medical care, houseguests, parties, holidays, relatives and all other activities involving human interaction, such as talking. My responsibilities: Things that break, lizards.

This is related to the phenomenon of the Professional Smile, a national pandemic in the service industry; and noplace in my experience have I been on the receiving end of as many Professional Smiles as I am on the Nadir, maître d’s, Chief Stewards, Hotel Managers’ minions, Cruise Director—their P.S.’s all come on like switches at my approach. But also back on land at banks, restaurants, airline ticket counters, on and on. You know this smile—the strenuous contraction of circumoral fascia w/ incomplete zygomatic involvement—the smile that doesn’t quite reach the smiler’s eyes and that signifies nothing more than a calculated attempt to advance the smiler’s own interests by pretending to like the smilee. Why do employers and supervisors force professional service people to broadcast the Professional Smile? Am I the only consumer in whom high doses of such a smile produce despair? Am I the only person who’s sure that the growing number of cases in which totally average-looking people suddenly open up with automatic weapons in shopping malls and insurance offices and medical complexes and McDonald’ses is somehow causally related to the fact that these venues are well-known dissemination-loci of the Professional Smile? Who do they think is fooled by the Professional Smile?

Shall I stop in to check on Bella before I go?” “Not dressed like that. You would give her palpitations if she knew you were going into danger for her benefit.” “Luckily, I am mostly immune to Bella’s powers and could cure such palpitations with a thought,” Gideon mused. Jacob raised a brow, taking the medic’s measure. He could not recall the last time he had heard the Ancient crack wise about anything. It was not a wholly unpleasant experience, and it amused the Enforcer. “I . . . am aware of what is occurring between you and Legna, as you know,” Jacob mentioned with casual quiet. “I am only recently Imprinted myself, but should you require—” He broke off, suddenly uncomfortable. “Of course, you probably know far more about Imprinting than I ever will.” He is reaching out to you. Legna’s soft encouragement made Gideon suddenly aware of that fact. It was one of those nuances he would have missed completely, rusty as he was with matters of friendship and how to relate better to others. “I am glad for the offer of any help you can provide,” Gideon said quickly. “In fact, I had wanted to ask you . . . something . . .” What did I want to ask him? he asked Legna urgently. I do not know! I did not tell you to engage him, just to graciously accept his offer. Oh. My apologies. Still, you are clever enough to think of something, are you not? Legna knew he was baiting her, so she laughed. Ask him why it is you seem to constantly irritate me. I will ask him no such thing, Magdelegna. Well then, you had better come up with an alternative, because that is the only suggestion I have. “Yes?” Jacob was encouraging neutrally, trying to be patient as the medic seemed to gather his thoughts. “Do you find that your mate tends to lecture you incessantly?” he asked finally. Jacob laughed out loud. “You know something, I can actually advise you about that, Gideon.” “Can you?” The medic actually sounded hopeful. “Give up. Now. While you still have your sanity. Arguing with her will get you nowhere. And, also, never ever ask questions that refer to the whys and wherefores of women, females, or any other feminine-based criticism. Otherwise you will only earn an argument at a higher decibel level. Oh, and one other thing.” Gideon cocked a brow in question. “All the rules I just gave you, as well as all the ones she lays down during the course of your relationship, can and will change at whim. So, as I see it, you can consider yourself just as lost as every other man on the planet. Good luck with it.” “That is not a very heartening thought,” Gideon said wryly, ignoring Legna’s giggle in his background thoughts.

Think about it,” Pastor Pete said, deciding to give more concrete examples they could relate to before going into the theology of it. “They voted for people promising them ‘free’ medical care, ‘progressive’ tax rates where, pretty soon, they weren’t paying any taxes, but getting lots of free goods and services. They convinced themselves that the little bit they paid into Social Security entitled them to the much bigger amounts they took out of the system.

supervisors force professional service people to broadcast the Professional Smile? Am I the only consumer in whom high doses of such a smile produce despair? Am I the only person who’s sure that the growing number of cases in which totally average-looking people suddenly open up with automatic weapons in shopping malls and insurance offices and medical complexes and McDonald’ses is somehow causally related to the fact that these venues are well-known dissemination-loci of the Professional Smile?

Poor people smoked, poor people ate Krispy Kreme doughnuts by the dozen. Poor people were made pregnant by close relatives. Poor people practiced poor hygiene and lived in toxic neighborhoods. Poor people with their ailments constituted a subspecies of humanity that thankfully remained invisible to Gary except in hospitals and in places like Central Discount Medical. They were a dumber, sadder, fatter, more resignedly suffering breed. A Diseased underclass that he really, really liked to keep away from.

Incurable — that is, after all, only a relative, not an absolute, concept. For a progressive science such as medicine incurable cases are only so for the time being, within the time-limits of our own age, within the compass of our present knowledge, that is to say, within the limits of our restricted perspective. But it’s not a question merely of the moment. In hundreds of cases where today we know of no cure, tomorrow, the day after, a cure may be found, for medical science is, after all, making tremendous strides.

Big data is based on the feedback economy where the Internet of Things places sensors on more and more equipment. More and more data is being generated as medical records are digitized, more stores have loyalty cards to track consumer purchases, and people are wearing health-tracking devices. Generally, big data is more about looking at behavior, rather than monitoring transactions, which is the domain of traditional relational databases. As the cost of storage is dropping, companies track more and more data to look for patterns and build predictive models".

It’s unnecessary and undesirable to limit our readings to medically related texts (she notes that when reading Ivan Ilyich doctors get bogged down arguing about whether the title character of Tolstoy’s novella had gastric cancer or pancreatic cancer, missing the point entirely); that literature helps dismantle the “hidden curriculum,” the teaching that our patients are somehow fundamentally different from us and we from them; that immersing ourselves in imaginary worlds populated by imaginary people and investing emotionally in their problems is excellent training for empathy.

Army studies indicate that if a wounded soldier arrives alive at a combat support hospital where surgeons and nurses can treat him, the chances of his surviving are extremely high—greater than 90 percent. “Surviving,” of course, doesn’t necessarily entail keeping arms or legs or retaining the ability to function independently back home. The leading cause of preventable death on the battlefield is bleeding. Having a leg blown off by an IED, for instance, can be fatal if quick steps are not taken to control the blood loss. Even deadlier is internal bleeding, a problem for which medics generally don’t have a good answer. A soldier who is bleeding internally needs to be evacuated and delivered to a surgeon immediately if he is to have any hope of survival. The second-leading cause of preventable death is something called tension pneumothorax. If a bullet punctures a soldier’s lung, air can leak from that hole into the “pleural space,” or cavity outside the lungs. That air can build up and eventually interfere with the functioning of the heart. This can be a relatively simple problem to correct: a medic can simply stick a big needle in the soldier’s chest to relieve the pressure in the pleural space.

Sexual-patriarchal relational systems overwhelm, from media glorifying sexual connection above other forms of intimacy and interaction, to medical, economic, and legal structures that automatically privilege sexual/domestic/romantic dyadic partnerships and genetic family bonds over other chosen platonic relationships and support systems. Oppressive social structures and micro-aggressive interpersonal interactions constantly grate on us, damaging our health and maybe even pushing us to seek care, but often available formal assistance is part of the same harmful system and populated by the same privileged persons.

For the rest of Kat’s childhood, she moved from one relative’s house to another’s, up and down the East Coast, living in four homes before entering high school. Finally, in high school, she lived for a few years with her grandmother, her mom’s mom, whom she called “G-Ma.” No one ever talked about her mom’s murder. “In my family, my past was ‘The Big Unmentionable’—including my role in putting my own father in jail,” she says. In high school, Kat appeared to be doing well. She was an honor student who played four varsity sports. Beneath the surface, however, “I was secretly self-medicating with alcohol because otherwise, by the time everything stopped and it got quiet at night, I could not sleep, I would just lie there and a terrible panic would overtake me.” She went to college, failed out, went back, and graduated. She went to work in advertising, and one day, dissatisfied, quit. She went back to grad school, piling up debt. She became a teacher. Kat quit that job too, when a relationship she had formed with another teacher imploded. At the age of thirty-four, Kat went to stay with her brother and his family in Hawaii. She got a job as a valet, parking cars. “I’d come home from parking cars all day and curl up on my bed in the back bedroom of my brother’s house, and lie there feeling desperate and alone, my heart beating with anxiety.

But when you actually break down the amount of time, energy, skill, planning, and maintenance that go into care tasks, they no longer seem simple. For example, the care task of feeding yourself involves more than just putting food into your mouth. You must also make time to figure out the nutritional needs and preferences of everyone you’re feeding, plan and execute a shopping trip, decide how you’re going to prepare that food and set aside the time to do so, and ensure that mealtimes come at correct intervals. You need energy and skill to plan, execute, and follow through on these steps every day, multiple times a day, and to deal with any barriers related to your relationship with food and weight, or a lack of appetite due to medical or emotional factors. You must have the emotional energy to deal with the feeling of being overwhelmed when you don’t know what to cook and the anxiety it can produce to create a kitchen mess. You may also need the skills to multitask while working, dealing with physical pain, or watching over children. Now let’s look at cleaning: an ongoing task made up of hundreds of small skills that must be practiced every day at the right time and manner in order to “keep going on the business of life.” First, you must have the executive functioning to deal with sequentially ordering and prioritizing tasks.1 You must learn which cleaning must be done daily and which can be done on an interval. You must remember those intervals. You must be familiar with cleaning products and remember to purchase them. You must have the physical energy and time to complete these tasks and the mental health to engage in a low-dopamine errand for an extended period of time. You must have the emotional energy and ability to process any sensory discomfort that comes with dealing with any dirty or soiled materials. “Just clean as you go” sounds nice and efficient, but most people don’t appreciate the hundreds of skills it takes to operate that way and the thousands of barriers that can interfere with execution.

connection between skin color and sunlight. The results were as clear as the sky on a cloudless day—there was a near-constant correlation between skin color and sunlight exposure in populations that had remained in the same area for 500 years or more. They even produced an equation to express the relationship between a given population’s skin color and its annual exposure to ultraviolet rays. (If you’re feeling adventurous, the equation is W = 70-AUV/10. W represents relative whiteness and AUV represents annual ultraviolet exposure. The 70 is based on research that indicates that the whitest possible skin—the result of a population that received zero exposure to UV—would reflect about 70 percent of the light directed at it.)

At the weekend, I asked Niem to show me the monument to the Vietnam War. “You mean the ‘Resistance War Against America,’” he said. Of course, I should have realized he wouldn’t call it the Vietnam War. Niem drove me to one of the city’s central parks and showed me a small stone with a brass plate, three feet high. I thought it was a joke. The protests against the Vietnam War had united a generation of activists in the West. It had moved me to send blankets and medical equipment. More than 1.5 million Vietnamese and 58,000 Americans had died. Was this how the city commemorated such a catastrophe? Seeing that I was disappointed, Niem drove me to see a bigger monument: a marble stone, 12 feet high, to commemorate independence from French colonial rule. I was still underwhelmed. Then Niem asked me if I was ready to see the proper war monument. He drove a little way further, and pointed out of the window. Above the treetops I could see a large pagoda, covered in gold. It seemed about 300 feet high. He said, “Here is where we commemorate our war heroes. Isn’t it beautiful?” This was the monument to Vietnam’s wars with China. The wars with China had lasted, on and off, for 2,000 years. The French occupation had lasted 200 years. The “Resistance War Against America” took only 20 years. The sizes of the monuments put things in perfect proportion. It was only by comparing them that I could understand the relative insignificance of “the Vietnam War” to the people who now live in Vietnam.

Needless to say, elderly people taking steroids may also experience the same side effects as younger persons. So, if you are a senior and need to be on a long course of steroids, what should you do? We would suggest a practical approach—which could apply to anyone on steroids, regardless of age, but may be particularly relevant for seniors because they are particularly vulnerable to side effects: • Understand and verify the need for steroids in your own situation, weighing the anticipated benefit with the possible risks. This means that you should explore the range of other treatments that may be available for your particular condition. You need to learn about the benefits and risks of any other treatment suggested. In other words, get all the information you can prior to going on treatment, be it with steroids or other medications. • Be sure that your health is well-assessed before or at the start of therapy. If you have underlying, separate health conditions, those should be noted and followed while you are on steroids. • Assess bodily systems that might particularly be affected by being on steroids. This means an assessment of your skeletal health, your eyes, your teeth, and your internal organs. • Request guidance about staying active. Physical therapy should be planned, to minimize the chances that your muscles and joints will be overtaxed or that any existing damage might get worse. • Ask to reassess the length and dose of your medication course at various intervals. A reasonable interval is every couple of months, if you are on a long course of steroids.

Maybe 99.99% of our lives will be spent stuck trudging down the narrow sidewalks afforded to us by capitalism. Roads have taken away our land, our right to roam and play. Artificial scarcity forces us to work ourselves sick at shitty, soul-crushing jobs or we risk death from starvation, homelessness, or medical neglect. Environmental destruction has severed us from our nurturing nonhuman relatives. Colonization has erased our ancestors and histories. Step out of line, raise your voice against the state, make a mistake, and you’ll be crushed with swift and brutal violence. But once in a while, for a brief bubble in time, enough of us get together to defy the ruling classes. To step out in the street and carve our own path. And even if I get to experience that for less than 0.01% of my time on this earth, I’ll take it.

In the late twentieth century democracies usually outperformed dictatorships because democracies were better at data-processing. Democracy diffuses the power to process information and make decisions among many people and institutions, whereas dictatorship concentrates information and power in one place. Given twentieth-century technology, it was inefficient to concentrate too much information and power in one place. Nobody had the ability to process all the information fast enough and make the right decisions. This is part of the reason why the Soviet Union made far worse decisions than the United States, and why the Soviet economy lagged far behind the American economy. However, soon AI might swing the pendulum in the opposite direction. AI makes it possible to process enormous amounts of information centrally. Indeed, AI might make centralised systems far more efficient than diffused systems, because machine learning works better the more information it can analyse. If you concentrate all the information relating to a billion people in one database, disregarding all privacy concerns, you can train much better algorithms than if you respect individual privacy and have in your database only partial information on a million people. For example, if an authoritarian government orders all its citizens to have their DNA scanned and to share all their medical data with some central authority, it would gain an immense advantage in genetics and medical research over societies in which medical data is strictly private. The main handicap of authoritarian regimes in the twentieth century – the attempt to concentrate all information in one place – might become their decisive advantage in the twenty-first century.

In an effort to justify the prohibition of 186 species of mushroom, including the ‘offending’ psilocybin containing mushrooms sold to the public through smart shops, Dutch Minister of Health, Dr. Ab Klink, refers to the high instance of anxiety and ‘even paranoia’ experienced by those who use them. He makes no mention of the very low incidence of harm (social or otherwise) involving fresh psilocybin containing mushrooms, or the disproportionate number of alcohol and tobacco related deaths, injuries and social disruptions. We are left with an impression that the Minister believes the state has a duty to banish fear itself. This exemplifies the degree to which scientific and medical rationales may become confused with moral and ideological commitments that undermine the ‘wall of separation between Church and State,’ a fundamental tenet of modern democracy.

In the late twentieth century democracies usually outperformed dictatorships because democracies were better at data-processing. Democracy diffuses the power to process information and make decisions among many people and institutions, whereas dictatorship concentrates information and power in one place. Given twentieth-century technology, it was inefficient to concentrate too much information and power in one place. Nobody had the ability to process all the information fast enough and make the right decisions. This is part of the reason why the Soviet Union made far worse decisions than the United States, and why the Soviet economy lagged far behind the American economy. “However, soon AI might swing the pendulum in the opposite direction. AI makes it possible to process enormous amounts of information centrally. Indeed, AI might make centralised systems far more efficient than diffused systems, because machine learning works better the more information it can analyse. If you concentrate all the information relating to a billion people in one database, disregarding all privacy concerns, you can train much better algorithms than if you respect individual privacy and have in your database only partial information on a million people. For example, if an authoritarian government orders all its citizens to have their DNA scanned and to share all their medical data with some central authority, it would gain an immense advantage in genetics and medical research over societies in which medical data is strictly private. The main handicap of authoritarian regimes in the twentieth century – the attempt to concentrate all information in one place – might become their decisive advantage in the twenty-first century.

There was a time when the public had an unquestionable faith in biomedicine and the practitioners who translated it into everyday patient care—and physicians believed that the public's trust was justified based on their educational qualifications and training. But today, many patients believe that individual clinicians must earn their trust, just as a close relative has earned it through shared experience. ...Gallop polling over the last several decades that demonstrates how much the public's confidence in most US institutions has deteriorated. Confidence in the medical system in particular fell from 80% in 1975 to 37% in 2015. Statistics from the General Social Survey confirm this troubling trend. Baron and Berinsky explain the historical reasons for this shift in attitudes, but the more pressing question is: How can individual clinicians, and the profession as a whole, regain the patients' trust? 

The most extraordinary story of appendectomy survival that I know of occurred aboard the U.S. submarine Seadragon in Japanese-controlled waters in the South China Sea during World War II when a sailor named Dean Rector from Kansas developed an acute and obvious case of appendicitis. With no qualified medical personnel on board, the commander ordered the ship’s pharmacist’s assistant, one Wheeler Bryson Lipes (of no known relation to the present author), to perform the surgery. Lipes protested that he had no medical training, did not know what an appendix looked like or where it was to be found, and had no surgical equipment to work with. The commander instructed him to do what he could anyway as the senior medical person aboard. Lipes’s bedside manner was not perhaps the most reassuring. His pep talk to Rector was this: “Look, Dean, I never did anything like this before, but you don’t have much chance

In Women and Madness, Phyllis Chesler writes of what she calls “psychiatric imperialism,” whereby normal responses to trauma are methodically pathologized in science and medicine. At the time of the book’s publication in 1972, few women were coming forward about gender biases in the study and practice of psychology. Chesler felt compelled to bring forward a conversation around gender, race, class, and medical ethics because “modern female psychology reflects a relatively powerless and deprived condition.” Of sensitivity she writes: “Many intrinsically valuable female traits, such as intuitiveness or compassion, have probably been developed through default or patriarchal-imposed necessity, rather than through either biological predisposition or free choice. Female emotional ‘talents’ must be viewed in terms of the overall price exacted by sexism.” Regardless of causation, of note here is that women’s internal lives were barely acknowledged or considered.

As with previous “drug crises,” the opioid problem is not really about opioids. It’s mainly about cultural, social, and environmental factors such as racism, draconian drug laws, and diverting attention away from the real causes of crime and suffering. As you’ll discover throughout this book, there’s nothing terribly unique about the pharmacology of opioids that makes these drugs particularly dangerous or addictive. People have safely consumed them for centuries. And, trust me, people will continue to do so, long after the media’s faddish focus has faded, because these chemicals work. Fatal overdose is a real risk, but the odds of this occurring have been overstated. It is certainly possible to die after taking too much of a single opioid drug, but such deaths account for only about a quarter of the thousands of opioid-related deaths. Contaminated opioid drugs and opioids combined with another downer (e.g., alcohol or a nerve-pain medication) cause many of these deaths.

Who will I be when I have fewer patients? When I have no patients at all? It's often noted that "practice" as it relates to medicine has two meanings: the act of caring for patients and the doctor's never-ending process of perfecting his or her craft. But there's a third meaning, too, one I'm only now appreciating as I contemplate the end of my career. Medicine is a practice in the way that yoga or meditation is for many people, an activity repeated so often that it becomes a kind of incantation. I have, for so long, stood to my patients' right sides as physicians have done for centuries, palpated the lymph nodes in their necks, armpits, and groins; auscultated their hearts and lungs; asked the same questions I first learned to ask nearly forty years ago—What makes the pain better? What makes it worse? These rituals are for me an anchor without which I fear I might simply drift away. Of course I suspected all along that what I feared wasn't abandoning my patients, but myself.

[Refers to 121 children taken into care in Cleveland due to suspected abuse (1987) and later returned to their parents] Sue Richardson, the child abuse consultant at the heart of the crisis, watched as cases began to unravel: “All the focus started to fall on the medical findings; other supportive evidence, mainly which we held in the social services department, started to be screened out. A situation developed where the cases either were proven or fell on the basis of medical evidence alone. Other evidence that was available to the court, very often then, never got put. We would have had statement from the child, the social workers and the child psychologist’s evidence from interviewing. We would have evidence of prior concerns, either from social workers or teachers, about the child’s behaviour or other symptoms that they might have been showing, which were completely aside from the medical findings. (Channel 4 1997) Ten years after the Cleveland crisis, Sue Richardson was adamant that evidence relating to children’s safety was not presented to the courts which subsequently returned those children to their parents: “I am saying that very clearly. In some cases, evidence was not put in the court. In other cases, agreements were made between lawyers not to put the case to the court at all, particularly as the crisis developed. Latterly, that children were sent home subject to informal agreements or agreements between lawyers. The cases never even got as far as the court. (Channel 4, 1997)” Nor is Richardson alone. Jayne Wynne, one of the Leeds paediatricians who had pioneered the use of RAD as an indicator of sexual abuse and who subsequently had detailed knowledge of many of the Cleveland children, remains concerned by the haphazard approach of the courts to their protection. I think the implication is that the children were left unprotected. The children who were being abused unfortunately returned to homes and the abuse may well have been ongoing. (Channel 4 1997)

Around that time, Musk was asked by a user on Twitter if he was bipolar. “Yeah,” he answered. But he added that he had not been medically diagnosed. “Bad feelings correlate to bad events, so maybe the real problem is getting carried away for what I sign up for.” One day, when they were sitting in the Tesla conference room after one of Musk’s spells, McNeill asked him directly whether he was bipolar. When Musk said probably yes, McNeill pushed his chair back from the table and turned to talk to Musk eye to eye. “Look, I have a relative who is bipolar,” McNeill said. “I’ve had close experience with this. If you get good treatment and your meds dialed right, you can get back to who you are. The world needs you.” It was a healthy conversation, McNeill says, and Musk seemed to have a clear desire to get out of his messed-up headspace. But it didn’t happen. His way of dealing with his mental problems, he says when I ask, “is just take the pain and make sure you really care about what you’re doing.

Those who nowadays see inconveniences to living in this laboratory often come up against the incomprehension and disapproval of their peers. They are accused of opposing the technological society on which they are nonetheless dependent and the comforts of which they enjoy—even if this argument is losing credence as the effects of the ecological crisis become ever more direct and flagrant. This logic follows the same pattern as attempts to silence patients criticizing the medical system on the pretext that their health and sometimes their lives depend on it. We are thus to be neutralized by guilt and condemned to submission and resignation. Can we be held responsible for the society into which we were born and in relation to which our room for maneuver is inevitably limited? To use this as grounds to ban all critique of our society amounts to tying our hands in the face of disaster, hamstringing thought and, more broadly, stifling imagination, desire and the capacity to recall that things are not doomed to be as they currently are.

On Diversification for Stress Management The below came from me asking, “What advice would you give your 30-year-old self?”: “My 30-year-old self wouldn’t have access to medical marijuana, so I’d have a limited canvas with which to paint. I’ve always made it a top priority since I was a teenager—and had tons of stress-related medical problems—to make that job one: to learn how to not have stress. I would consider myself a world champion at avoiding stress at this point in dozens of different ways. A lot of it is just how you look at the world, but most of it is really the process of diversification. I’m not going to worry about losing one friend if I have a hundred, but if I have two friends I’m really going to be worried. I’m not going to worry about losing my job because my one boss is going to fire me, because I have thousands of bosses at newspapers everywhere. One of the ways to not worry about stress is to eliminate it. I don’t worry about my stock picks because I have a diversified portfolio. Diversification works in almost every area of your life to reduce your stress.

If you can imagine this, perhaps you can understand that someone from another planet who came to visit us would have a similar experience with humans. But it isn’t our skin that is full of wounds. What the visitor would discover is that the human mind is sick with a disease called fear. Just like the description of the infected skin, the emotional body is full of wounds, and these wounds are infected with emotional poison. The manifestation of the disease of fear is anger, hate, sadness, envy, and hypocrisy; the result of the disease is all the emotions that make humans suffer. All humans are mentally sick with the same disease. We can even say that this world is a mental hospital. But this mental disease has been in this world for thousands of years, and the medical books, the psychiatric books, and the psychology books describe the disease as normal. They consider it normal, but I can tell you it is not normal. When the fear becomes too great, the reasoning mind starts to fail and can no longer take all those wounds with all the poison. In the psychology books we call this a mental illness. We call it schizophrenia, paranoia, psychosis, but these diseases are created when the reasoning mind is so frightened and the wounds so painful, that it becomes better to break contact with the outside world. Humans live in continuous fear of being hurt, and this creates a big drama wherever we go. The way humans relate to each other is so emotionally painful that for no apparent reason we get angry, jealous, envious, sad. To even say “I love you” can be frightening. But even if it’s painful and fearful to have an emotional interaction, still we keep going, we enter into a relationship, we get married, and we have children. In order to protect our emotional wounds, and because of our fear of being hurt, humans create something very sophisticated in the mind: a big denial system. In that denial system we become the perfect liars. We lie so perfectly that we lie to ourselves and we even believe our own lies. We don’t notice we are lying, and sometimes even when we know we are lying, we justify the lie and excuse the lie to protect ourselves from the pain of our wounds.

I acknowledge readily that the Grant Study is not the only great prospective longitudinal lifetime study. There are others, three of which are better known than ours. Each has its own strengths and weaknesses. The Berkeley and Oakland Growth Studies (1930–2009) from the University of California at Berkeley include both sexes and began when the participants were younger; they provide more sophisticated childhood psychosocial data but little medical information.5 These cohorts have been very intensively studied, but they are smaller and have suffered greater attrition than ours. The Framingham Study (1946 to the present) and the Nurses Study at the Harvard School of Public Health (1976 to the present) boast better physical health coverage, but they lack psychosocial data.6 These are wonderful world-class studies, invaluable in their own ways, and more frequently cited than the Grant Study. But even in this august company the Grant Study is unmistakable and unique. It has been funded continuously for more than seventy years; it has had the highest number of contacts with its members and the lowest attrition rate of all; it has interviewed three generations of relatives; and, most

There is no guarantee that a socialized economy will always succeed. The state-owned economies of Eastern Europe and the former Soviet Union suffered ultimately fatal distortions in their development because of the backlog of poverty and want in the societies they inherited; years of capitalist encirclement, embargo, invasion, devastating wars, and costly arms buildup; poor incentive systems, and a lack of administrative initiative and technological innovation; and a repressive political rule that allowed little critical feedback while fostering stagnation and elitism. Despite all that, the former communist states did transform impoverished countries into relatively advanced societies. Whatever their mistakes and political crimes, they achieved—in countries that were never as rich as ours—what U.S. free-market capitalism cannot and has no intention of accomplishing: adequate food, housing, and clothing for all; economic security in old age; free medical care; free education at all levels; and a guaranteed income. Today by overwhelming majorities, people in Russia and other parts of Eastern Europe say that life was better under communism than under the present freemarket system.

And, in treating of the social relations with the middle classes which the Prince had at Doncières, it may be as well to add these few words. The lieutenant-colonel played the piano beautifully; the senior medical officer’s wife sang like a Conservatoire medallist. This latter couple, as well as the lieutenant-colonel and his wife, used to dine every week with M. de Borodino. They were flattered, unquestionably, knowing that when the Prince went to Paris on leave he dined with Mme. de Pourtalès, and the Murats, and people like that. “But,” they said to themselves, “he’s just a captain, after all; he’s only too glad to get us to come. Still, he’s a real friend, you know.” But when M. de Borodino, who had long been pulling every possible wire to secure an appointment for himself nearer Paris, was posted to Beauvais, he packed up and went, and forgot as completely the two musical couples as he forgot the Doncières theatre and the little restaurant to which he used often to send out for his luncheon, and, to their great indignation, neither the lieutenant-colonel nor the senior medical officer, who had so often sat at his table, ever had so much as a single word from him for the rest of their lives

Addicts should not be coerced into treatment, since in the long term coercion creates more problems than it solves. On the other hand, for those addicts who opt for treatment, there must be a system of publicly funded recovery facilities with clean rooms, nutritious food, and access to outdoors and nature. Well-trained professional staff need to provide medical care, counseling, skills training, and emotional support. Our current nonsystem is utterly inadequate, with its patchwork of recovery homes run on private contracts and, here and there, a few upscale addiction treatment spas for the wealthy. No matter how committed their staff and how helpful their services may be, they are a drop in comparison to the ocean of vast need. In the absence of a coordinated rehabilitation system, the efforts of individual recovery homes are limited and occur in a vacuum, with no follow-up. It may be thought that the cost of such a drug rehabilitation and treatment system would be exorbitant. No doubt the financial expenses would be great — but surely less than the funds now freely squandered on the War on Drugs, to say nothing of the savings from the cessation of drug-related criminal activity and the diminished burden on the health care system.

Zaphod paused for a while. For a while there was silence. Then he frowned and said, “Last night I was worrying about this again. About the fact that part of my mind just didn’t seem to work properly. Then it occurred to me that the way it seemed was that someone else was using my mind to have good ideas with, without telling me about it. I put the two ideas together and decided that maybe that somebody had locked off part of my mind for that purpose, which was why I couldn’t use it. I wondered if there was a way I could check. “I went to the ship’s medical bay and plugged myself into the encephalographic screen. I went through every major screening test on both my heads—all the tests I had to go through under Government medical officers before my nomination for presidency could be properly ratified. They showed up nothing. Nothing unexpected at least. They showed that I was clever, imaginative, irresponsible, untrustworthy, extrovert, nothing you couldn’t have guessed. And no other anomalies. So I started inventing further tests, completely at random. Nothing. Then I tried superimposing the results from one head on top of the results from the other head. Still nothing. Finally I got silly, because I’d given it all up as nothing more than an attack of paranoia. Last thing I did before I packed it in was take the superimposed picture and look at it through a green filter. You remember I was always superstitious about the color green when I was a kid? I always wanted to be a pilot on one of the trading scouts?” Ford nodded. “And there it was,” said Zaphod, “clear as day. A whole section in the middle of both brains that related only to each other and not to anything else around them. Some bastard had cauterized all the synapses and electronically traumatized those two lumps of cerebellum.” Ford stared at him, aghast. Trillian had turned white. “Somebody did that to you?” whispered Ford. “Yeah.” “But have you any idea who? Or why?” “Why? I can only guess. But I do know who the bastard was.” “You know? How do you know?” “Because they left their initials burned into the cauterized synapses. They left them there for me to see.” Ford stared at him in horror and felt his skin begin to crawl. “Initials? Burned into your brain?” “Yeah.” “Well, what were they, for God’s sake?” Zaphod looked at him in silence again for a moment. Then he looked away. “Z.B.,” he said quietly. At that moment a steel shutter slammed down behind them and gas started to pour into the chamber. “I’ll tell you about it later,” choked Zaphod as all three passed out.

Obsessive-compulsive personality disorder (OCPD) is unhelpfully named, since it is not particularly closely related to the better known obsessive-compulsive disorder (OCD). It does not tend to co-occur with obsessive-compulsive disorder, or even run in the same families. Obsessive-compulsive disorder is an anxiety disorder, in which the sufferer feels compelled to repeat particular thoughts or actions, such as checking or hand-washing. As an anxious condition, it belongs to the same family as depression and generalized anxiety disorder, and thus is related to high Neuroticism and responds to some extent to serotonergic antidepressant medications. Some people have even seen obsessive-compulsive disorder as a low Conscientiousness problem, since the affected individual cannot inhibit the checking or washing response in rather the same manner as the alcoholic cannot inhibit his desire to drink. Whether this is the right characterization or not, it is clear that OCPD is a very different type of problem.16 What, then, does OCPD entail? Psychiatrists define it as ‘a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness and efficiency, beginning by early adulthood and present in a variety of contexts’.

For the longest time, the crucial importance to health of just moving around was hardly appreciated. But in the late 1940s a doctor at Britain’s Medical Research Council, Jeremy Morris, became convinced that the increasing occurrence of heart attacks and coronary disease was related to levels of activity, and not just to age or chronic stress, as was almost universally thought at the time. Because Britain was still recovering from the war, research funding was tight, so Morris had to think of a low-cost way to conduct an effective large-scale study. While traveling to work one day, it occurred to him that every double-decker bus in London was a perfect laboratory for his purposes because each had a driver who spent his entire working life sitting and a conductor who was on his feet constantly. In addition to moving about laterally, conductors climbed an average of six hundred steps per shift. Morris could hardly have invented two more ideal groups to compare. He followed thirty-five thousand drivers and conductors for two years and found that after he adjusted for all other variables, the drivers—no matter how healthy—were twice as likely to have a heart attack as the conductors. It was the first time that anyone had demonstrated a direct and measurable link between exercise and health.

One year later the society claimed victory in another case which again did not fit within the parameters of the syndrome, nor did the court find on the issue. Fiona Reay, a 33 year old care assistant, accused her father of systematic sexual abuse during her childhood. The facts of her childhood were not in dispute: she had run away from home on a number of occasions and there was evidence that she had never been enrolled in secondary school. Her father said it was because she was ‘young and stupid’. He had physically assaulted Fiona on a number of occasions, one of which occurred when she was sixteen. The police had been called to the house by her boyfriend; after he had dropped her home, he heard her screaming as her father beat her with a dog chain. As before there was no evidence of repression of memory in this case. Fiona Reay had been telling the same story to different health professionals for years. Her medical records document her consistent reference to family problems from the age of 14. She finally made a clear statement in 1982 when she asked a gynaecologist if her need for a hysterectomy could be related to the fact that she had been sexually abused by her father. Five years later she was admitted to psychiatric hospital stating that one of the precipitant factors causing her breakdown had been an unexpected visit from her father. She found him stroking her daughter. There had been no therapy, no regression and no hypnosis prior to the allegations being made public. The jury took 27 minutes to find Fiona Reay’s father not guilty of rape and indecent assault. As before, the court did not hear evidence from expert witnesses stating that Fiona was suffering from false memory syndrome. The only suggestion of this was by the defence counsel, Toby Hed­worth. In his closing remarks he referred to the ‘worrying phenomenon of people coming to believe in phantom memories’. The next case which was claimed as a triumph for false memory was heard in March 1995. A father was aquitted of raping his daughter. The claims of the BFMS followed the familiar pattern of not fitting within the parameters of false memory at all. The daughter made the allegations to staff members whom she had befriended during her stay in psychiatric hospital. As before there was no evidence of memory repression or recovery during therapy and again the case failed due to lack of corrobo­rating evidence. Yet the society picked up on the defence solicitor’s statements that the daughter was a prone to ‘fantasise’ about sexual matters and had been sexually promiscuous with other patients in the hospital. ~ Trouble and Strife, Issues 37-43

Outlawing drugs in order to solve drug problems is much like outlawing sex in order to win the war against AIDS. We recognize that people will continue to have sex for nonreproductive reasons despite the laws and mores. Therefore, we try to make sexual practices as safe as possible in order to minimize the spread of the AIDS viruses. In a similar way, we continually try to make our drinking water, foods, and even our pharmaceutical medicines safer. The ubiquity of chemical intoxicants in our lives is undeniable evidence of the continuing universal need for safer medicines with such applications. While use may not always be for an approved medical purpose, or prudent, or even legal, it is fulfilling the relentless drive we all have to change the way we feel, to alter our behavior and consciousness, and, yes, to intoxicate ourselves. We must recognize that intoxicants are medicines, treatments for the human condition. Then we must make them as safe and risk free and as healthy as possible. Dream with me for a moment. What would be wrong if we had perfectly safe intoxicants? I mean drugs that delivered the same effects as our most popular ones but never caused dependency, disease, dysfunction, or death. Imagine an alcohol-type substance that never caused addiction, liver disease, hangovers, impaired driving, or workplace problems. Would you care to inhale a perfumed mist that is as enjoyable as marijuana or tobacco but as harmless as clean air? How would you like a pain-killer as effective as morphine but safer than aspirin, a mood enhancer that dissolves on your tongue and is more appealing than cocaine and less harmful than caffeine, a tranquilizer less addicting than Valium and more relaxing than a martini, or a safe sleeping pill that allows you to choose to dream or not? Perhaps you would like to munch on a user friendly hallucinogen that is as brief and benign as a good movie? This is not science fiction. As described in the following pages, there are such intoxicants available right now that are far safer than the ones we currently use. If smokers can switch from tobacco cigarettes to nicotine gum, why can’t crack users chew a cocaine gum that has already been tested on animals and found to be relatively safe? Even safer substances may be just around the corner. But we must begin by recognizing that there is a legitimate place in our society for intoxication. Then we must join together in building new, perfectly safe intoxicants for a world that will be ready to discard the old ones like the junk they really are. This book is your guide to that future. It is a field guide to that silent spring of intoxicants and all the animals and peoples who have sipped its waters. We can no more stop the flow than we can prevent ourselves from drinking. But, by cleaning up the waters we can leave the morass that has been the endless war on drugs and step onto the shores of a healthy tomorrow. Use this book to find the way.

I want you to imagine that you live on a planet where everyone has a skin disease. For two or three thousand years, the people on your planet have suffered the same disease: Their entire bodies are covered by wounds that are infected, and those wounds really hurt when you touch them. Of course, they believe this is a normal physiology of the skin. Even the medical books describe this disease as a normal condition. When the people are born, their skin is healthy, but around three or four years of age, the first wounds start to appear. By the time they are teenagers, there are wounds all over their bodies. Can you imagine how these people are going to treat each other? In order to relate with one another, they have to protect their wounds. They hardly ever touch each other’s skin because it is too painful. If by accident you touch someone’s skin, it is so painful that right away she gets angry and touches your skin, just to get even. Still, the instinct to love is so strong that you pay a high price to have relationships with others. Well, imagine that a miracle occurs one day. You awake and your skin is completely healed. There are no wounds anymore, and it doesn’t hurt to be touched. Healthy skin you can touch feels wonderful because the skin is made for perception. Can you imagine yourself with healthy skin in a world where everyone has a skin disease? You cannot touch others because it hurts them, and no one touches you because they make the assumption that it will hurt you.

It may seem paradoxical to claim that stress, a physiological mechanism vital to life, is a cause of illness. To resolve this apparent contradiction, we must differentiate between acute stress and chronic stress. Acute stress is the immediate, short-term body response to threat. Chronic stress is activation of the stress mechanisms over long periods of time when a person is exposed to stressors that cannot be escaped either because she does not recognize them or because she has no control over them. Discharges of nervous system, hormonal output and immune changes constitute the flight-or-fight reactions that help us survive immediate danger. These biological responses are adaptive in the emergencies for which nature designed them. But the same stress responses, triggered chronically and without resolution, produce harm and even permanent damage. Chronically high cortisol levels destroy tissue. Chronically elevated adrenalin levels raise the blood pressure and damage the heart. There is extensive documentation of the inhibiting effect of chronic stress on the immune system. In one study, the activity of immune cells called natural killer (NK) cells were compared in two groups: spousal caregivers of people with Alzheimer’s disease, and age- and health-matched controls. NK cells are front-line troops in the fight against infections and against cancer, having the capacity to attack invading micro-organisms and to destroy cells with malignant mutations. The NK cell functioning of the caregivers was significantly suppressed, even in those whose spouses had died as long as three years previously. The caregivers who reported lower levels of social support also showed the greatest depression in immune activity — just as the loneliest medical students had the most impaired immune systems under the stress of examinations. Another study of caregivers assessed the efficacy of immunization against influenza. In this study 80 per cent among the non-stressed control group developed immunity against the virus, but only 20 per cent of the Alzheimer caregivers were able to do so. The stress of unremitting caregiving inhibited the immune system and left people susceptible to influenza. Research has also shown stress-related delays in tissue repair. The wounds of Alzheimer caregivers took an average of nine days longer to heal than those of controls. Higher levels of stress cause higher cortisol output via the HPA axis, and cortisol inhibits the activity of the inflammatory cells involved in wound healing. Dental students had a wound deliberately inflicted on their hard palates while they were facing immunology exams and again during vacation. In all of them the wound healed more quickly in the summer. Under stress, their white blood cells produced less of a substance essential to healing. The oft-observed relationship between stress, impaired immunity and illness has given rise to the concept of “diseases of adaptation,” a phrase of Hans Selye’s. The flight-or-fight response, it is argued, was indispensable in an era when early human beings had to confront a natural world of predators and other dangers. In civilized society, however, the flight-fight reaction is triggered in situations where it is neither necessary nor helpful, since we no longer face the same mortal threats to existence. The body’s physiological stress mechanisms are often triggered inappropriately, leading to disease. There is another way to look at it. The flight-or-fight alarm reaction exists today for the same purpose evolution originally assigned to it: to enable us to survive. What has happened is that we have lost touch with the gut feelings designed to be our warning system. The body mounts a stress response, but the mind is unaware of the threat. We keep ourselves in physiologically stressful situations, with only a dim awareness of distress or no awareness at all.

The personal case histories were the most encouraging. A prominent Los Angeles public relations executive has been living with MM for fourteen years, rides horses, and has an altogether active life on drug maintenance. An Arizona man survived MM and with his wife set up a foundation and website for other families bewildered by the diagnosis. I learned, for the first time, that Frank McGee, host of the Today show from 1971 to 1974, suffered from MM and kept it from everyone despite his ever more gaunt appearance. When he died after putting in another full week on the air his producers and friends were stunned. Sam Walton, founder of Walmart, was another MM casualty, which led many to believe that he had established the high-profile multiple myeloma treatment center in Little Rock, Arkansas. This is a full-immersion process in which MM is the singular target under the commanding title of Myeloma Institute for Research and Therapy. There is a Walton auditorium on the institute’s University of Arkansas medical school campus, but the institute itself was founded by Bart Barlogie, a renowned MM specialist from the MD Anderson Cancer Center in Houston. The institute has an impressive record, running well ahead of the national average for survival for those who are dealing with MM. One number is especially notable. The institute has followed 1,070 patients for more than ten years, and 783 have never had a relapse of the disease. Sam Walton was treated by Dr. Barlogie at MD Anderson before the Little Rock institute was founded, but the connection ended there. Walton, who’d had an earlier struggle with leukemia, didn’t survive his encounter with multiple myeloma, dying in April 1992, a time when life expectancy for a man his age with this cancer was short. I was unaware of all of this when I was diagnosed. I took comfort in the repeated reassurances of specialists that great progress in treating MM with a new class of drugs, your own body’s reengineered immunology system, was rapidly improving chances of a longer survival than the published five to ten years. As I began to respond to treatment the favored and welcome line was, “You’re gonna die but from something else.

I lost my first patient on a Tuesday. She was an eighty-two-year-old woman, small and trim, the healthiest person on the general surgery service, where I spent a month as an intern. (At her autopsy, the pathologist would be shocked to learn her age: “She has the organs of a fifty-year-old!”) She had been admitted for constipation from a mild bowel obstruction. After six days of hoping her bowels would untangle themselves, we did a minor operation to help sort things out. Around eight P.M. Monday night, I stopped by to check on her, and she was alert, doing fine. As we talked, I pulled from my pocket my list of the day’s work and crossed off the last item (post-op check, Mrs. Harvey). It was time to go home and get some rest. Sometime after midnight, the phone rang. The patient was crashing. With the complacency of bureaucratic work suddenly torn away, I sat up in bed and spat out orders: “One liter bolus of LR, EKG, chest X-ray, stat—I’m on my way in.” I called my chief, and she told me to add labs and to call her back when I had a better sense of things. I sped to the hospital and found Mrs. Harvey struggling for air, her heart racing, her blood pressure collapsing. She wasn’t getting better no matter what I did; and as I was the only general surgery intern on call, my pager was buzzing relentlessly, with calls I could dispense with (patients needing sleep medication) and ones I couldn’t (a rupturing aortic aneurysm in the ER). I was drowning, out of my depth, pulled in a thousand directions, and Mrs. Harvey was still not improving. I arranged a transfer to the ICU, where we blasted her with drugs and fluids to keep her from dying, and I spent the next few hours running between my patient threatening to die in the ER and my patient actively dying in the ICU. By 5:45 A.M., the patient in the ER was on his way to the OR, and Mrs. Harvey was relatively stable. She’d needed twelve liters of fluid, two units of blood, a ventilator, and three different pressors to stay alive. When I finally left the hospital, at five P.M. on Tuesday evening, Mrs. Harvey wasn’t getting better—or worse. At seven P.M., the phone rang: Mrs. Harvey had coded, and the ICU team was attempting CPR. I raced back to the hospital, and once again, she pulled through. Barely. This time, instead of going home, I grabbed dinner near the hospital, just in case. At eight P.M., my phone rang: Mrs. Harvey had died. I went home to sleep.

The biology of potential illness arises early in life. The brain’s stress-response mechanisms are programmed by experiences beginning in infancy, and so are the implicit, unconscious memories that govern our attitudes and behaviours toward ourselves, others and the world. Cancer, multiple sclerosis, rheumatoid arthritis and the other conditions we examined are not abrupt new developments in adult life, but culminations of lifelong processes. The human interactions and biological imprinting that shaped these processes took place in periods of our life for which we may have no conscious recall. Emotionally unsatisfying child-parent interaction is a theme running through the one hundred or so detailed interviews I conducted for this book. These patients suffer from a broadly disparate range of illnesses, but the common threads in their stories are early loss or early relationships that were profoundly unfulfilling emotionally. Early childhood emotional deprivation in the histories of adults with serious illness is also verified by an impressive number of investigations reported in the medical and psychological literature. In an Italian study, women with genital cancers were reported to have felt less close to their parents than healthy controls. They were also less demonstrative emotionally. A large European study compared 357 cancer patients with 330 controls. The women with cancer were much less likely than controls to recall their childhood homes with positive feelings. As many as 40 per cent of cancer patients had suffered the death of a parent before the age of seventeen—a ratio of parental loss two and a half times as great as had been suffered by the controls. The thirty-year follow-up of Johns Hopkins medical students was previously quoted. Those graduates whose initial interviews in medical school had revealed lower than normal childhood closeness with their parents were particularly at risk. By midlife they were more likely to commit suicide or develop mental illness, or to suffer from high blood pressure, coronary heart disease or cancer. In a similar study, Harvard undergraduates were interviewed about their perception of parental caring. Thirty-five years later these subjects’ health status was reviewed. By midlife only a quarter of the students who had reported highly positive perceptions of parental caring were sick. By comparison, almost 90 per cent of those who regarded their parental emotional nurturing negatively were ill. “Simple and straightforward ratings of feelings of being loved are significantly related to health status,” the researchers concluded.

What, then, is addiction? In the words of a consensus statement by addiction experts in 2001, addiction is a “chronic neurobiological disease… characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.” The key features of substance addiction are the use of drugs or alcohol despite negative consequences, and relapse. I’ve heard some people shrug off their addictive tendencies by saying, for example, “I can’t be an alcoholic. I don’t drink that much…” or “I only drink at certain times.” The issue is not the quantity or even the frequency, but the impact. “An addict continues to use a drug when evidence strongly demonstrates the drug is doing significant harm…. If users show the pattern of preoccupation and compulsive use repeatedly over time with relapse, addiction can be identified.” Helpful as such definitions are, we have to take a broader view to understand addiction fully. There is a fundamental addiction process that can express itself in many ways, through many different habits. The use of substances like heroin, cocaine, nicotine and alcohol are only the most obvious examples, the most laden with the risk of physiological and medical consequences. Many behavioural, nonsubstance addictions can also be highly destructive to physical health, psychological balance, and personal and social relationships. Addiction is any repeated behaviour, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others. Addiction involves: 1. compulsive engagement with the behaviour, a preoccupation with it; 2. impaired control over the behaviour; 3. persistence or relapse, despite evidence of harm; and 4. dissatisfaction, irritability or intense craving when the object — be it a drug, activity or other goal — is not immediately available. Compulsion, impaired control, persistence, irritability, relapse and craving — these are the hallmarks of addiction — any addiction. Not all harmful compulsions are addictions, though: an obsessive-compulsive, for example, also has impaired control and persists in a ritualized and psychologically debilitating behaviour such as, say, repeated hand washing. The difference is that he has no craving for it and, unlike the addict, he gets no kick out of his compulsion. How does the addict know she has impaired control? Because she doesn’t stop the behaviour in spite of its ill effects. She makes promises to herself or others to quit, but despite pain, peril and promises, she keeps relapsing. There are exceptions, of course. Some addicts never recognize the harm their behaviours cause and never form resolutions to end them. They stay in denial and rationalization. Others openly accept the risk, resolving to live and die “my way.

As it turned out, Mary Jo White and other attorneys for the Sacklers and Purdue had been quietly negotiating with the Trump administration for months. Inside the DOJ, the line prosecutors who had assembled both the civil and the criminal cases started to experience tremendous pressure from the political leadership to wrap up their investigations of Purdue and the Sacklers prior to the 2020 presidential election in November. A decision had been made at high levels of the Trump administration that this matter would be resolved quickly and with a soft touch. Some of the career attorneys at Justice were deeply unhappy with this move, so much so that they wrote confidential memos registering their objections, to preserve a record of what they believed to be a miscarriage of justice. One morning two weeks before the election, Jeffrey Rosen, the deputy attorney general for the Trump administration, convened a press conference in which he announced a “global resolution” of the federal investigations into Purdue and the Sacklers. The company was pleading guilty to conspiracy to defraud the United States and to violate the Food, Drug, and Cosmetic Act, as well as to two counts of conspiracy to violate the federal Anti-kickback Statute, Rosen announced. No executives would face individual charges. In fact, no individual executives were mentioned at all: it was as if the corporation had acted autonomously, like a driverless car. (In depositions related to Purdue’s bankruptcy which were held after the DOJ settlement, two former CEOs, John Stewart and Mark Timney, both declined to answer questions, invoking their Fifth Amendment right not to incriminate themselves.) Rosen touted the total value of the federal penalties against Purdue as “more than $8 billion.” And, in keeping with what had by now become a standard pattern, the press obligingly repeated that number in the headlines. Of course, anyone who was paying attention knew that the total value of Purdue’s cash and assets was only around $1 billion, and nobody was suggesting that the Sacklers would be on the hook to pay Purdue’s fines. So the $8 billion figure was misleading, much as the $10–$12 billion estimate of the value of the Sacklers’ settlement proposal had been misleading—an artificial number without any real practical meaning, designed chiefly to be reproduced in headlines. As for the Sacklers, Rosen announced that they had agreed to pay $225 million to resolve a separate civil charge that they had violated the False Claims Act. According to the investigation, Richard, David, Jonathan, Kathe, and Mortimer had “knowingly caused the submission of false and fraudulent claims to federal health care benefit programs” for opioids that “were prescribed for uses that were unsafe, ineffective, and medically unnecessary.” But there would be no criminal charges. In fact, according to a deposition of David Sackler, the Department of Justice concluded its investigation without so much as interviewing any member of the family. The authorities were so deferential toward the Sacklers that nobody had even bothered to question them.

PATTERNS OF THE “SHY” What else is common among people who identify themselves as “shy?” Below are the results of a survey that was administered to 150 of my program’s participants. The results of this informal survey reveal certain facts and attitudes common among the socially anxious. Let me point out that these are the subjective answers of the clients themselves—not the professional opinions of the therapists. The average length of time in the program for all who responded was eight months. The average age was twenty-eight. (Some of the answers are based on a scale of 1 to 5, 1 being the lowest.) -Most clients considered shyness to be a serious problem at some point in their lives. Almost everyone rated the seriousness of their problem at level 5, which makes sense, considering that all who responded were seeking help for their problem. -60 percent of the respondents said that “shyness” first became enough of a problem that it held them back from things they wanted during adolescence; 35 percent reported the problem began in childhood; and 5 percent said not until adulthood. This answer reveals when clients were first aware of social anxiety as an inhibiting force. -The respondents perceived the average degree of “sociability” of their parents was a 2.7, which translates to “fair”; 60 percent of the respondents reported that no other member of the family had a problem with “shyness”; and 40 percent said there was at least one other family member who had a problem with “shyness.” -50 percent were aware of rejection by their peers during childhood. -66 percent had physical symptoms of discomfort during social interaction that they believed were related to social anxiety. -55 percent reported that they had experienced panic attacks. -85 percent do not use any medication for anxiety; 15 percent do. -90 percent said they avoid opportunities to meet new people; 75 percent acknowledged that they often stay home because of social fears, rather than going out. -80 percent identified feelings of depression that they connected to social fears. -70 percent said they had difficulty with social skills. -75 percent felt that before they started the program it was impossible to control their social fears; 80 percent said they now believed it was possible to control their fears. -50 percent said they believed they might have a learning disability. -70 percent felt that they were “too dependent on their parents”; 75 percent felt their parents were overprotective; 50 percent reported that they would not have sought professional help if not for their parents’ urging. -10 percent of respondents were the only child in their families; 40 percent had one sibling; 30 percent had two siblings; 10 percent had three; and 10 percent had four or more. Experts can play many games with statistics. Of importance here are the general attitudes and patterns of a population of socially anxious individuals who were in a therapy program designed to combat their problem. Of primary significance is the high percentage of people who first thought that “shyness” was uncontrollable, but then later changed their minds, once they realized that anxiety is a habit that can be broken—without medication. Also significant is that 50 percent of the participants recognized that their parents were the catalyst for their seeking help. Consider these statistics and think about where you fit into them. Do you identify with this profile? Look back on it in the coming months and examine the ways in which your sociability changes. Give yourself credit for successful breakthroughs, and keep in mind that you are not alone!

The Western medical model — and I don't mean the science of it, I mean the practice of it, because the science is completely at odds with the practice — makes two devastating separations. First of all we separate the mind from the body, we separate the emotions from the physiology. So we don't see how the physiology of people reflects their lifelong emotional experience. So we separate the mind from the body, which is not something that traditional medicine has done, I mean, Ayuverdic or Chinese medicine or shamanic tribal cultures and medicinal practices throughout the world have always recognized that mind and body are inseparable. They intuitively knew it. Many Western practitioners have known this and even taught it, but in practice we ignore it. And then we separate the individual from the environment. The studies are clear, for example, that when people are emotionally isolated they tend to get sick more quickly and they succumb more rapidly to their disease. Why? Because people's physiology is completely related to their psychological, social environment and when people are isolated and alone their stress levels are much higher because there's nothing there to help them moderate their stress. And physiologically it is straightforward, you know, it takes a five-year-old kid to understand it. However because in practice we separate them... when somebody shows up with an inflamed joint, all we do is we give them an anti-inflammatory or because the immune system is hyperactive and is attacking them we give them a medication to suppress their immune system or we give them a stress hormone like cortisol or one of its analogues, to suppress the inflammation. But we never ask: "What does this manifest about your life?", "What does this say about your relationships?", "How stressful is your job?", "To what extent do you lack control in your life?", "Where are you not authentic?", "How are you trying to work so hard to meet your attachment needs by suppressing yourself?" (because that is what you learn to do as a kid). Then we do all this research that has to do with cell biology, so we keep looking for the cause of cancer in the cell. Now there's a wonderful quote in the New York Times a couple of years ago they did a series on cancer and somebody said: "Looking for the cause of cancer inside the individual cell is like trying to understand a traffic jam by studying the internal combustion engine." We will never understand it, but we spend hundreds of billions of dollars a year looking for the cause of cancer inside the cell, not recognizing that the cell exists in interaction with the environment and that the genes are modulated by the environment, they are turned on and off by the environment. So the impact of not understanding the unity of emotions and physiology on one hand and in the other hand the relationship between the individual and the environment.. in other words.. having a strictly biological model as opposed to what has been called a bio-psycho-social, that recognizes that the biology is important, but it also reflects our psychological and social relationships. And therefore trying to understand the biology in isolation from the psychological and social environment is futile. The result is that we are treating people purely through pharmaceuticals or physical interventions, greatly to the profit of companies that manufacture pharmaceuticals and which fund the research, but it leaves us very much in the dark about a) the causes and b) the treatment, the holistic treatment of most conditions. So that for all our amazing interventions and technological marvels, we are still far short of doing what we could do, were we more mindful of that unity. So the consequences are devastating economically, they are devastating emotionally, they are devastating medically.