Patient Experience Quotes

We die containing a richness of lovers and tribes, tastes we have swallowed, bodies we have plunged into and swum up as if rivers of wisdom, characters we have climbed into as if trees, fears we have hidden in as if caves. I wish for all this to be marked on by body when I am dead. I believe in such cartography - to be marked by nature, not just to label ourselves on a map like the names of rich men and women on buildings. We are communal histories, communal books. We are not owned or monogamous in our taste or experience.

One thing I do know about intimacy is that there are certain natural laws which govern the sexual experience of two people, and that these laws cannot be budged any more than gravity can be negotiated with. To feel physically comfortable with someone else's body is not a decision you can make. It has very little to do with how two people think or act or talk or even look. The mysterious magnet is either there, buried somewhere deep behind the sternum, or it is not. When it isn't there (as I have learned in the past, with heartbreaking clarity) you can no more force it to exist than a surgeon can force a patient's body to accept a kidney from the wrong donor. My friend Annie says it all comes down to one simple question: "Do you want your belly pressed against this person's belly forever --or not?

Love is . . . Being happy for the other person when they are happy, Being sad for the person when they are sad, Being together in good times, And being together in bad times. LOVE IS THE SOURCE OF STRENGTH. Love is . . . Being honest with yourself at all times, Being honest with the other person at all times, Telling, listening, respecting the truth, And never pretending. LOVE IS THE SOURCE OF REALITY. Love is . . . An understanding so complete that you feel as if you are a part of the other person, Accepting the other person just the way they are, And not trying to change them to be something else. LOVE IS THE SOURCE OF UNITY. Love is . . . The freedom to pursue your own desires while sharing your experiences with the other person, The growth of one individual alongside of and together with the growth of another individual. LOVE IS THE SOURCE OF SUCCESS. Love is . . . The excitement of planning things together, The excitement of doing things together. LOVE IS THE SOURCE OF THE FUTURE. Love is . . . The fury of the storm, The calm in the rainbow. LOVE IS THE SOURCE OF PASSION. Love is . . . Giving and taking in a daily situation, Being patient with each other's needs and desires. LOVE IS THE SOURCE OF SHARING. Love is . . . Knowing that the other person will always be with you regardless of what happens, Missing the other person when they are away but remaining near in heart at all times. LOVE IS THE SOURCE OF SECURITY. LOVE IS . . . THE SOURCE OF LIFE!

But ... but what if I hit you?” A snort. “You’re not going to hit me.” “How do you know?” I bristled at his amused tone. “I could hit you. Even master swordsmen make mistakes. I could get a lucky shot, or you might not see me coming. I don’t want to hurt you.” He favored me with another patient look. “And how much experience do you have with swords and weapons in general?” “Um.” I glanced down at the saber in my hand. “Thirty seconds?” He smiled, that calm, irritatingly confident smirk. “You’re not going to hit me.

No pain that we suffer, no trial that we experience is wasted. It ministers to our education, to the development of such qualities as patience, faith, fortitude and humility. All that we suffer and all that we endure, especially when we endure it patiently, builds up our characters, purifies our hearts, expands our souls, and makes us more tender and charitable, more worthy to be called the children of God . . . and it is through sorrow and suffering, toil and tribulation, that we gain the education that we come here to acquire and which will make us more like our Father and Mother in heaven.

Cognitive robotics can integrate information from pre-operation medical records with real-time operating metrics to guide and enhance the precision of physicians’ instruments. By processing data from genuine surgical experiences, they’re able to provide new and improved insights and techniques. These kinds of improvements can improve patient outcomes and boost trust in AI throughout the surgery. Robotics can lead to a 21% reduction in length of stay.

Depression is a painfully slow, crashing death. Mania is the other extreme, a wild roller coaster run off its tracks, an eight ball of coke cut with speed. It's fun and it's frightening as hell. Some patients - bipolar type I - experience both extremes; other - bipolar type II - suffer depression almost exclusively. But the "mixed state," the mercurial churning of both high and low, is the most dangerous, the most deadly. Suicide too often results from the impulsive nature and physical speed of psychotic mania coupled with depression's paranoid self-loathing.

Think of the patience God has had for you and let it resonate to others. If you want a more patient world, let patience be your motto

Ladies and gentlemen of the class of '97: Wear sunscreen. If I could offer you only one tip for the future, sunscreen would be it. The long-term benefits of sunscreen have been proved by scientists, whereas the rest of my advice has no basis more reliable than my own meandering experience. I will dispense this advice now. Enjoy the power and beauty of your youth. Oh, never mind. You will not understand the power and beauty of your youth until they've faded. But trust me, in 20 years, you'll look back at photos of yourself and recall in a way you can't grasp now how much possibility lay before you and how fabulous you really looked. You are not as fat as you imagine. Don't worry about the future. Or worry, but know that worrying is as effective as trying to solve an algebra equation by chewing bubble gum. The real troubles in your life are apt to be things that never crossed your worried mind, the kind that blindside you at 4 pm on some idle Tuesday. Do one thing everyday that scares you. Sing. Don't be reckless with other people's hearts. Don't put up with people who are reckless with yours. Floss. Don't waste your time on jealousy. Sometimes you're ahead, sometimes you're behind. The race is long and, in the end, it's only with yourself. Remember compliments you receive. Forget the insults. If you succeed in doing this, tell me how. Keep your old love letters. Throw away your old bank statements. Stretch. Don't feel guilty if you don't know what you want to do with your life. The most interesting people I know didn't know at 22 what they wanted to do with their lives. Some of the most interesting 40-year-olds I know still don't. Get plenty of calcium. Be kind to your knees. You'll miss them when they're gone. Maybe you'll marry, maybe you won't. Maybe you'll have children, maybe you won't. Maybe you'll divorce at 40, maybe you'll dance the funky chicken on your 75th wedding anniversary. Whatever you do, don't congratulate yourself too much, or berate yourself either. Your choices are half chance. So are everybody else's. Enjoy your body. Use it every way you can. Don't be afraid of it or of what other people think of it. It's the greatest instrument you'll ever own. Dance, even if you have nowhere to do it but your living room. Read the directions, even if you don't follow them. Do not read beauty magazines. They will only make you feel ugly. Get to know your parents. You never know when they'll be gone for good. Be nice to your siblings. They're your best link to your past and the people most likely to stick with you in the future. Understand that friends come and go, but with a precious few you should hold on. Work hard to bridge the gaps in geography and lifestyle, because the older you get, the more you need the people who knew you when you were young. Live in New York City once, but leave before it makes you hard. Live in Northern California once, but leave before it makes you soft. Travel. Accept certain inalienable truths: Prices will rise. Politicians will philander. You, too, will get old. And when you do, you'll fantasize that when you were young, prices were reasonable, politicians were noble, and children respected their elders. Respect your elders. Don't expect anyone else to support you. Maybe you have a trust fund. Maybe you'll have a wealthy spouse. But you never know when either one might run out. Don't mess too much with your hair or by the time you're 40 it will look 85. Be careful whose advice you buy, but be patient with those who supply it. Advice is a form of nostalgia. Dispensing it is a way of fishing the past from the disposal, wiping it off, painting over the ugly parts and recycling it for more than it's worth. But trust me on the sunscreen.

An algorithm that expedites care to a stroke patient in a chaotic emergency room (ER) has a good chance of adoption. An algorithm that reads a routine scan and provides some quantification of what the physicians can already estimate won’t be in as much demand. There are good reasons for algorithms to parse patient records to look for signs of rare diseases, but there are fewer good reasons for using them to evaluate clinical symptoms. It’s cool that AI tools can make diagnoses from scratch, but for most clinical encounters doctors are already pretty good at it.

I was able to shake off the near-death experience, and whether it was true or not, I was able to use it as some sort of moral validation as to the importance of my existence, or at least the importance of me completing this job, because clearly God, the universe or whoever understood that there was no other human being alive on this earth stupid enough to take this job.

Perfect love is perfectly patient.

As our life is our main provisional value, ‘taking the time’ to interpret our experiences is a momentous choice. Time, life and choice outline a trilogy that can solve and unite so as to vanquish the powerlessness which we might face on our path. (Could time be patient?)

Much of clinician burnout is due to spending time writing notes, placing orders, generating referrals, writing prior authorization letters, and creating patient communication. In other words, burnout is caused by physicians having to generate output! With the emergence of large language models that are used to train generative AI solutions, these use cases will be at the frontier of AI’s applications in healthcare.

Calmness of mind is one of the beautiful jewels of wisdom. It is the result of long and patient effort in self-control. Its presence is an indication of ripened experience, and of a more than ordinary knowledge of the laws and operations of thought.

A faith without some doubts is like a human body with no antobodies in it. People who blithely go through life too busy or indifferent to ask the hard questions about why they believe as they do will find themselves defenseless against either the experience of tragedy or the probing questions of a smart skeptic. A person's faith can collapse almost overnight if she failed over the years to listen patiently to her own doubts, which should only be discarded after long reflection.

In my experience, men who respond to good fortune with modesty and kindness are harder to find than those who face adversity with courage. For in the very nature of things, success tends to create pride and blindness in the hearts of men, while suffering teaches them to be patient and strong.

My old therapist used to say intimacy requires the repeated experience of being responded to—and that doesn’t happen overnight.

There is a great market for religious experience in our world; there is little enthusiasm for the patient acquisition of virtue, little inclination to sign up for a long apprenticeship in what earlier generations of Christians called holiness.

The brain-disease model overlooks four fundamental truths: (1) our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being; (2) language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning; (3) we have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching; and (4) we can change social conditions to create environments in which children and adults can feel safe and where they can thrive. When we ignore these quintessential dimensions of humanity, we deprive people of ways to heal from trauma and restore their autonomy. Being a patient, rather than a participant in one’s healing process, separates suffering people from their community and alienates them from an inner sense of self.

No beating yourself up. That’s not allowed. Be patient with yourself. It took you years to form the bad habits of thought that you no longer want. It will take a little time to form new and better ones. But I promise you this: Even a slight move in this direction will bring you some peace. The more effort you apply to it, the faster you’ll find your bliss, but you’ll experience rewards immediately.

Top 10 Deathbed Regrets: 1. I wish I'd had the courage to live a life true to myself, not the life other people expected of me. 2. I wish I took time to be with my children more when they were growing up. 3. I wish I had the courage to express my feelings, without the fear of being rejected or unpopular. 4. I wish I would have stayed in touch with friends and family. 5. I wish I would have forgiven someone when I had the chance. 6. I wish I would have told the people I loved the most how important they are to me. 7. I wish I would have had more confidence and tried more things, instead of being afraid of looking like a fool. 8. I wish I would have done more to make an impact in this world. 9. I wish I would have experienced more, instead of settling for a boring life filled with routine, mediocrity and apathy. 10. I wish I would have pursued my talents and gifts. (contributed by Shannon L. Alder, author and therapist that has 17 years of experience working with hospice patients)

Leave the dishes. Let the celery rot in the bottom drawer of the refrigerator and an earthen scum harden on the kitchen floor. Leave the black crumbs in the bottom of the toaster. Throw the cracked bowl out and don't patch the cup. Don't patch anything. Don't mend. Buy safety pins. Don't even sew on a button. Let the wind have its way, then the earth that invades as dust and then the dead foaming up in gray rolls underneath the couch. Talk to them. Tell them they are welcome. Don't keep all the pieces of the puzzles or the doll's tiny shoes in pairs, don't worry who uses whose toothbrush or if anything matches, at all. Except one word to another. Or a thought. Pursue the authentic-decide first what is authentic, then go after it with all your heart. Your heart, that place you don't even think of cleaning out. That closet stuffed with savage mementos. Don't sort the paper clips from screws from saved baby teeth or worry if we're all eating cereal for dinner again. Don't answer the telephone, ever, or weep over anything at all that breaks. Pink molds will grow within those sealed cartons in the refrigerator. Accept new forms of life and talk to the dead who drift in though the screened windows, who collect patiently on the tops of food jars and books. Recycle the mail, don't read it, don't read anything except what destroys the insulation between yourself and your experience or what pulls down or what strikes at or what shatters this ruse you call necessity.

The patient cannot remember the whole of what is repressed in him, and what he cannot remember may be precisely the essential part of it.. He is obliged to repeat the repressed material as a contemporary experience instead of remembering it as something in the past.

In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come- not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul. So the decision-making of daily life involves not, as in normal affairs, shifting from one annoying situation to another less annoying- or from discomfort to relative comfort, or from boredom to activity- but moving from pain to pain. One does not abandon, even briefly, one’s bed of nails, but is attached to it wherever one goes. And this results in a striking experience- one which I have called, borrowing military terminology, the situation of the walking wounded. For in virtually any other serious sickness, a patient who felt similar devistation would by lying flat in bed, possibly sedated and hooked up to the tubes and wires of life-support systems, but at the very least in a posture of repose and in an isolated setting. His invalidism would be necessary, unquestioned and honorably attained. However, the sufferer from depression has no such option and therefore finds himself, like a walking casualty of war, thrust into the most intolerable social and family situations. There he must, despite the anguish devouring his brain, present a face approximating the one that is associated with ordinary events and companionship. He must try to utter small talk, and be responsive to questions, and knowingly nod and frown and, God help him, even smile. But it is a fierce trial attempting to speak a few simple words.

He favored me with another patient look. “And how much experience do you have with swords and weapons in general?” “Um.” I glanced down at the saber in my hand. “Thirty seconds?” He smiled, that calm, irritatingly confident smirk. “You’re not going to hit me.

Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

To those waiting on love, be patient. Love is a total drama queen. It’s just waiting to make an entrance.

Yes, movies! Look at them — All of those glamorous people — having adventures — hogging it all, gobbling the whole thing up! You know what happens? People go to the movies instead of moving! Hollywood characters are supposed to have all the adventures for everybody in America, while everybody in America sits in a dark room and watches them have them! Yes, until there's a war. That's when adventure becomes available to the masses! Everyone's dish, not only Gable's! Then the people in the dark room come out of the dark room to have some adventures themselves — Goody, goody! — It's our turn now, to go to the south Sea Island — to make a safari — to be exotic, far-off! — But I'm not patient. I don't want to wait till then. I'm tired of the movies and I am about to move!

Somewhere in the heart of experience there is an order and a coherence which we might purprise if we were attentive enough, loving enough, or patient enough.

Fear and anxiety affect decision making in the direction of more caution and risk aversion... Traumatized individuals pay more attention to cues of threat than other experiences, and they interpret ambiguous stimuli and situations as threatening (Eyesenck, 1992), leading to more fear-driven decisions. In people with a dissociative disorder, certain parts are compelled to focus on the perception of danger. Living in trauma-time, these dissociative parts immediately perceive the present as being "just like" the past and "emergency" emotions such as fear, rage, or terror are immediately evoked, which compel impulsive decisions to engage in defensive behaviors (freeze, flight, fight, or collapse). When parts of you are triggered, more rational and grounded parts may be overwhelmed and unable to make effective decisions.

Realize that life is more than meets the eye. Life goes beyond our five senses. Be receptive to new knowledge and to new experiences.

Falling in love is not an act of will. It is not a conscious choice. No matter how open to or eager for it we may be, the experience may still elude us. Contrarily, the experience may capture us at times when we are definitely not seeking it, when it is inconvenient and undesirable. We are as likely to fall in love with someone with whom we are obviously ill matched as with someone more suitable. Indeed, we may not even like or admire the object of our passion, yet, try as we might, we may not be able to fall in love with a person whom we deeply respect and with whom a deep relationship would be in all ways desirable. This is not to say that the experience of falling in love is immune to discipline. Psychiatrists, for instance, frequently fall in love with their patients, just as their patients fall in love with them, yet out of duty to the patient and their role they are usually able to abort the collapse of their ego boundaries and give up the patient as a romantic object. The struggle and suffering of the discipline involved may be enormous. But discipline and will can only control the experience; they cannot create it. We can choose how to respond to the experience of falling in love, but we cannot choose the experience itself.

No pain that we suffer, no trial that we experience is wasted. All that we suffer and all that we endure, especially when we endure it patiently, builds up our characters, purifies our hearts, expands our souls, and makes us more tender and charitable.

We're often silent. We don't yell and we don't complain. We're patient, as always. Because we don't have the words yet. We're afraid to talk about it. We don't know how. It's not an ordinary experience, and the questions it raises are not ordinary. The world has been split in two: there's us, the Chernobylites, and then there's you, the others. Have you noticed? No one here points out that they're Russian or Belarussian or Ukrainian. We all call ourselves Chernobylites. "We're from Chernobyl." "I'm a Chernobylite." As if this is a separate people. A new nation.

I've spoken of the patient Peter who was obsessively forced to make conquests with women, to seduce and then to abandon them, until he was at last able to experience how he himself had repeatedly been abandoned by his mother.

But after a while, she began to experience the new reality of each person as being as strong and as weak as anyone else. Slowly, she learned that each of us grown-ups has as much and as little power as the other, and that we had best learn to take care of ourselves.(83)

Some things you can't find out; but you will never know you can't by guessing and supposing: no, you have to be patient and go on experimenting until you find out that you can't find out.

The lack of literature on the topic was a handicap, but my great teacher, Elvin Semrad, had taught us to be skeptical about textbooks. We had only one real textbook, he said: our patients. We should trust only what we could learn from them—and from our own experience.

Refusal to hope is nothing more than a decision to die.

Most inexperienced cooks believe, mistakenly, that a fine cake is less challenging to produce than a fine souffle or mousse. I know, however, that a good cake is like a good marriage: from the outside, it looks ordinary, sometimes unremarkable, yet cut into it, taste it, and you know that it is nothing of the sort. It is the sublime result oflong and patient experience, a confection whose success relies on a profound understanding of compatibilities and tastes; on a respect for measurement, balance, chemistry and heat; on a history of countless errors overcome.

The World is trying the experiment of attempting to form a civilized but non-Christian mentality. The experiment will fail; but we must be very patient in awaiting its collapse; meanwhile redeeming the time: so that the Faith may be preserved alive through the dark ages before us; to renew and rebuild civilization, and save the World from suicide.

I’ve been trying to educate people for years and it’s exhausting. I’m tired of being patient with bigots. I’m tired of trying to explain why I don’t deserve to be treated like a piece of shit all the time. I’m tired of begging everyone to understand that people of color aren’t all the same, that we don’t all believe the same things or feel the same things or experience the world the same way.’ I shook my head, hard. ‘I’m just– I’m sick and tired of trying to explain to the world why racism is bad, okay? Why is that my job?

And all the names of the tribes, the nomads of faith who walked in the monotone of the desert and saw brightness and faith and colour. The way a stone or found metal box or bone can become loved and turn eternal in a prayer. Such glory of this country she enters now and becomes a part of. We die containing a richness of lovers and tribes, tastes we have swallowed, bodies we have plunged into and swum up as if rivers of wisdom, characters we have climbed into as if trees, fears we have hidden in as if caves. I wish for all of this to be marked on my body when I am dead. I believe in such cartography—to be marked by nature, not just to label ourselves on a map like the names of rich men and women on buildings. We are communal histories, communal books. We are not owned or monogamous in our taste or experience. All I desired was to walk upon such an earth that had no maps.

While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability - or your mother's - to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand's function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

Be patient. Don't force your experiences on others. The moving of spirit is a great mystery, and how or why or when certain people wake up is beyond us. Let people have their own experiences.

At the root of all emotions patients of depression experience, there are three primary feelings: first, a sense of insecurity; second, a sense of vulnerability; and finally, a sense of isolation. They

Haven’t you got an organ to weigh, people to annoy, or notes to scribble down for Uncle Jonathan? Or perhaps you’ve got another patient to experiment on.” “Dr. Wadsworth was called away on more urgent matters. It’s just the two of us and I’m quite bored of your moping about. We could be taking full advantage of our time together. But no,” he sighed dramatically. “You’re intently reading rubbish.

The people we love and those who raised us live inside us; we experience their emotional pain, we dream their memories, we know what was not explicitly conveyed to us, and these things shape our lives in ways that we don’t always understand.

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

Changes in Meaning: Finally, chronically traumatized people lose faith that good things can happen and people can be kind and trustworthy. They feel hopeless, often believing that the future will be as bad as the past, or that they will not live long enough to experience a good future. People who have a dissociative disorder may have different meanings in various dissociative parts. Some parts may be relatively balanced in their worldview, others may be despairing, believing the world to be a completely negative, dangerous place, while other parts might maintain an unrealistic optimistic outlook on life

…it seemed to Kirsch that the most reliable guide to the mental landscape of a patient was the patient himself. He was better placed to explain his behaviour and his experiences than anyone else. Yet wherever Kirsch went, the patient was the very last person anyone thought to consult. Because, of course, the patient was insane.

...some patients resist the diagnosis of a post-traumatic disorder. They may feel stigmatized by any psychiatric diagnosis or wish to deny their condition out of a sense of pride. Some people feel that acknowledging psychological harm grants a moral victory to the perpetrator, in a way that acknowledging physical harm does not.

At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability--or your mother's--to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for the small possibility of a fatal brain hemorrhage? Your right hand's function to stop seizures? How much neurological suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient, and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

The Stoics can teach you how to find a sense of purpose in life, how to face adversity, how to conquer anger within yourself, moderate your desires, experience healthy sources of joy, endure pain and illness patiently and with dignity, exhibit courage in the face of your anxieties, cope with loss, and perhaps even confront your own mortality while remaining as unperturbed as Socrates.

Through all this, patients were getting used to demanding drugs for treatment. They did not, however, have to accept the idea that they might, say, eat better and exercise more, and that this might help them lose weight and feel better. Doctors, of course, couldn’t insist. As the defenestration of the physician’s authority and clinical experience was under way, patients didn’t have to take accountability for their own behavior.

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

The scientific study of suffering inevitably raises questions of causation, and with these, issues of blame and responsibility. Historically, doctors have highlighted predisposing vulnerability factors for developing PTSD, at the expense of recognizing the reality of their patients' experiences… This search for predisposing factors probably had its origins in the need to deny that all people can be stressed beyond endurance, rather than in solid scientific data; until recently such data were simply not available… When the issue of causation becomes a legitimate area of investigation, one is inevitably confronted with issues of man's inhumanity to man, with carelessness and callousness, with abrogation of responsibility, with manipulation and with failures to protect.

Never underestimate the power of kindness. It is very contagious. A person whose heart is saddened by the troubles of this world, the loss of a friend or family member, a hard days work, or the struggle of provision can experience joy through a simple act of kindness. Romans 12: 10-12, Be kindly affectionate to one another with brotherly love, in honor giving preference to one another, not lagging in diligence, fervent in spirit, serving the Lord, rejoicing in hope, patient in tribulation, continually steadfastly in prayer.

When a patient says he feels stuck and confused, and through good intentions he struggles to become loose and clear, he only remains chronically trapped in the mire of his own stubbornness. If instead he will go with where he is, only then is there hope. If he will let himself get deeply into the experience of being stuck, only then will he reclaim that part of himself that is holding him. Only if he will give up trying to control his thinking, and let himself sink into his confusion, only then will things become clear. (64)

Many patients may confess that they feel “strange” or “confused” during a migraine aura, that they are clumsy in their movements, or that they would not drive at such a time. In short, they may be aware of something the matter in addition to the scintillating scotoma, paraesthesiae, etc., something so unprecedented in their experience, so difficult to describe, that it is often avoided or omitted when speaking of their complaints. Great

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.

Recent experiments in neuroscience support the view that it is our physical brain, following the known laws of science, that determines our actions, and not some agency that exists outside those laws. For example, a study of patients undergoing awake brain surgery found that by electrically stimulating the appropriate regions of the brain, one could create in the patient the desire to move the hand, arm or foot, or to move the lips and talk. It is hard to imagine how free will can operate if our behaviour is determined by physical law, so it seems that we are no more than biological machines and that free will is just an illusion.

The psychoanalyst W. R. Bion came up with the term containment to describe a mother’s ability to manage her baby’s pain. Remember, babyhood is not a time of bliss; it’s one of terror. As babies we are trapped in a strange, alien world, unable to see properly, constantly surprised at our bodies, alarmed by hunger and wind and bowel movements, overwhelmed by our feelings. We are quite literally under attack. We need our mother to soothe our distress and make sense of our experience. As she does so, we slowly learn how to manage our physical and emotional states on our own. But our ability to contain ourselves directly depends on our mother’s ability to contain us—if she had never experienced containment by her own mother, how could she teach us what she did not know? Someone who has never learned to contain himself is plagued by anxious feelings for the rest of his life, feelings that Bion aptly titled nameless dread. Such a person endlessly seeks this unquenchable containment from external sources—he needs a drink or a joint to “take the edge off” this endless anxiety. Hence my addiction to marijuana.

For centuries poets, some poets, have tried to give a voice to the animals, and readers, some readers, have felt empathy and sorrow. If animals did have voices, and they could speak with the tongues of angels--at the very least with the tongues of angels--they would be unable to save themselves from us. What good would language do? Their mysterious otherness has not saved them, nor have their beautiful songs and coats and skins and shells and eyes. We discover the remarkable intelligence of the whale, the wolf, the elephant--it does not save them, nor does our awareness of the complexity of their lives. Their strength, their skills, their swiftness, the beauty of their flights. It matters not, it seems, whether they are large or small, proud or shy, docile or fierce, wild or domesticated, whether they nurse their young or brood patiently on eggs. If they eat meat, we decry their viciousness; if they eat grasses and seeds, we dismiss them as weak. There is not one of them, not even the songbird who cannot, who does not, conflict with man and his perceived needs and desires. St. Francis converted the wolf of Gubbio to reason, but he performed this miracle only once and as miracles go, it didn’t seem to capture the public’s fancy. Humans don’t want animals to reason with them. It would be a disturbing, unnerving, diminishing experience; it would bring about all manner of awkwardness and guilt.

People tend to forget they are patients. Once they leave the doctor’s office or the hospital, they simply put it out of their minds. But you are all permanent patients, like it or not. I am the doctor, you the patient. Doctor doesn’t cease being doctor at close of day. Neither should patient. People expect doctor to go about things with the utmost seriousness, skill and experience. But what about patient? How professional is he?

A faith without some doubts is like a human body without any antibodies in it. People who blithely go through life too busy or indifferent to ask hard questions about why they believe as they do will find themselves defenseless against either the experience of tragedy or the probing questions of a smart skeptic. A person's faith can collapse almost overnight if she has failed over the years to listen patiently to her own doubts, which should only be discarded after long reflection. Believers should acknowledge and wrestle with doubts — not only their own but their friends' and neighbors'. It is no longer sufficient to hold beliefs just because you inherited them. Only if you struggle long and hard with objections to your faith will you be able to provide the grounds for your beliefs to skeptics, including yourself, that are plausible rather than ridiculous or offensive. And, just as important for our current situation, such a process will lead you, even after you come to a position of strong faith, to respect and understand those who doubt.

No one can heal by maintaining or fostering illusion. The paradise of preambivalent harmony, for which so many patients hope, is unattainable. But the experience of one’s own truth, and the postambivalent knowledge of it, make it possible to return to one’s own world of feelings at an adult level—without paradise, but with the ability to mourn. And this ability does, indeed, give us back our vitality. It is one of the turning points in therapy when the patient comes to the emotional insight that all the love she has captured with so much effort and self-denial was not meant for her as she really was, that the admiration for her beauty and achievements was aimed at this beauty and these achievements and not at the child herself. In therapy, the small and lonely child that is hidden behind her achievements wakes up and asks: “What would have happened if I had appeared before you sad, needy, angry, furious? Where would your love have been then? And I was all these things as well. Does this mean that it was not really me you loved, but only what I pretended to be? The well-behaved, reliable, empathic, understanding, and convenient child, who in fact was never a child at all? What became of my childhood? Have I not been cheated out of it? I can never return to it. I can never make up for it. From the beginning I have been a little adult. My abilities—were they simply misused?

Though not necessarily aware of when we feel purpose and meaning, we are nearly always aware of the sickening feeling when we don't possess them. This isn't an intellectual misapprehension; it is a gut sense of disorientation and a loss of personal direction. Rarely are brute mental effort and self-help pep talks able to rekindle the missing feeling. For most of us, we simply wait patiently, knowing from past experience that the feeling will return in its own sweet time . . . Of particular interest is [Tolstoy's] conclusion as to the inability of science and reason to provide a personal sense of meaning.

Dear sisters, many of you are endlessly compassionate and patient with the weaknesses of others. Please remember also to be compassionate and patient with yourself. In the meantime, be thankful for all the small successes in your home, your family relationships, your education and livelihood, your Church participation and personal improvement. Like the forget-me-nots, these successes may seem tiny to you and they may go unnoticed by others, but God notices them and they are not small to Him. If you consider success to be only the most perfect rose or dazzling orchid, you may miss some of life’s sweetest experiences.

People with Complex PTSD suffer from more severe and frequent dissociation symptoms, as well as memory and attention problems, than those with simple PTSD. In addition to amnesia due to the activity of various parts of the self, people may experience difficulties with concentration, attention, other memory problems and general spaciness. These symptoms often accompany dissociation of the personality, but they are also common in people who do not have dissociative disorders. For example everyone can be spacey, absorbed in an activity, or miss an exit on the highway. When various parts of the personality are active, by definition, a person experiences some kind of abrupt change in attention and consciousness.

Schizophrenia is a cruel disease. The lives of those affected are often chronicles of constricted experiences, muted emotions, missed opportunities, unfulfilled expectations. It leads to a twilight existence, a twentieth century underground man. The fate of these patients has been worsened by our propensity to misunderstand, our failure to provide adequate treatment and rehabilitation, our meager research efforts. A disease which should be found, in the phrase of T.S. Eliot, in the "frigid purgatorial fires" has become through our ignorance and neglect a living hell.

Although, in principle, the psychoanalytical theory of borderlines is not punitive, in practice 'borderline' is almost always used to indicate that the patient is hostile, demanding, unpleasant, manipulative, attention-seeking, and prone to regression and dependency if admitted to hospital; in other words patient is a witch by Malleus Maleficarum criteria. The term 'borderline' functions to rationalize sadistic counter-transference, and to legitimize rejecting triaging decisions within the health-care system. Actually, most of the time, in my experience, the splitting is coming from the staff, not the patient, and it is the mental-health professionals who are using projection and denial. This is an example of 'blaming the victim,' which is a fundamental borderline psychodynamic.

Most men are more interested in their erection, and what they will get afterwards to be focused enough to stay in tune with their woman’s needs while pleasuring them,” I explained. “Because women are stimulated so differently, and because their arousal and release begins at a different place to a man’s, the man needs to be totally committed and patient. This is not a miracle solution for millions of frustrated women – it’s just common sense. But with the right attitude a man who knows this technique has within him the ability to sexual enslave a woman. It’s been my experience that once a woman has enjoyed this kind of an orgasm, they become desperate for more of the same.

Patients with complex trauma may at times develop extreme reactions to something the therapist has said or not said, done or not done. It is wise to anticipate this in advance, and perhaps to note this anticipation in initial communications with the patient. For example, one may say something like, "It is likely in our work together, there will be a time or times when you will feel angry with me, disappointed with me, or that I have failed you. We should except this and not be surprised if and when it happens, which it probably will." It is also vital to emphasize to the patient that despite the diagnosis and experience of dividedness, the whole person is responsible and will be held responsible for the acts of any part. p174

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

Of all the intoxicants you can find on the road (including a "national beer" for nearly every country in the world), marijuana deserves a particular mention here, primarily because it's so popular with travelers. Much of this popularity is due to the fact that marijuana is a relatively harmless diversion (again, provided you don't get caught with it) that can intensify certain impressions and sensations of travel. The problem with marijuana, however, is that it's the travel equivalent of watching television: It replaces real sensations with artificially enhanced ones. Because it doesn't force you to work for a feeling, it creates passive experiences that are only vaguely connected to the rest of your life. "The drug vision remains a sort of dream that cannot be brought over into daily life," wrote Peter Matthiessen in The Snow Leopard. "Old mists may be banished, that is true, but the alien chemical agent forms another mist, maintaining the separation of the 'I' from the true experience of the 'One.'" Moreover, chemical highs have a way of distracting you from the utterly stoning natural high of travel itself. After all, roasting a bowl might spice up a random afternoon in Dayton, Ohio, but is it really all that necessary along the Sumatran shores of Lake Toba, the mountain basins of Nepal, or the desert plateaus of Patagonia? As Salvador Dali quipped, "I never took drugs because I am drugs." With this in mind, strive to be drugs as you travel, to patiently embrace the raw, personal sensation of unmediated reality--an experience for more affecting than any intoxicant can promise.

Individuality is deeply imbued in us from the very start, at the neuronal level. Even at a motor level, researchers have shown, an infant does not follow a set pattern of learning to walk or how to reach for something. Each baby experiments with different ways of reaching for objects and over the course of several months discovers or selects his own motor solutions. When we try to envisage the neural basis of such individual learning, we might imagine a "population" of movements (and their neural correlates) being strengthened or pruned away by experience. Similar considerations arise with regard to recover and rehabilitation after strokes and other injuries. There are no rules; there is no prescribed path of recovery; every patient must discover or create his own motor and perceptual patterns, his own solutions to the challenges that face him; and it is the function of a sensitive therapist to help him in this. And in its broadest sense, neural Darwinism implies that we are destined, whether we wish it or not, to a life of particularity and self-development, to make our own individual paths through life.

Bodily delight is a sensory experience, not any different from pure looking or the pure feeling with which a beautiful fruit fills the tongue; it is a great, an infinite learning that is given to us, a knowledge of the world, the fullness and the splendor of all knowledge...the individual...can remember that all beauty in animals and plants is a silent, enduring form of love and yearning, and he can see the animal, as he sees plants, patiently and willingly uniting and multiplying and growing, not out of physical pleasure, not out of physical pain, but bowing to necessities that are greater than pleasure and pain, and more powerful than will and withstanding. If only human beings could more humbly receive this mystery---which the world is filled with...

The sentiment behind the golden rule is great (treating others the way we wish to be treated ourselves). But nowadays we don’t even treat ourselves very well! We knowingly consume things that are bad for us, continue working at jobs we hate, and don’t spend half as much time relaxing as we do stressing. Come to think of it, we ARE treating others the way we treat ourselves: poorly! We feed our children junk food, opt for cheap instead of quality even when it matters, rarely give anyone our undivided attention, and demand a lot more from others than what is reasonable or even possible. Let’s try something new: let’s treat everybody as if we just found out they’re about to die. Why? Because it seems that’s the ONLY time we slow down enough to get a new perspective on life—either then or when we have a near-death experience ourselves. Be gentle, patient, kind and understanding. We’re all headed in the same direction, so let’s start treating each other better along the way!

When Ronan was young and didn’t know any better, he thought everyone was like him. He made rules for humanity based upon observation, his idea of the truth only as broad as his world was. Everyone must sleep and eat. Everyone has hands, feet. Everyone’s skin is sensitive; no one’s hair is. Everyone whispers to hide and shouts to be heard. Everyone has pale skin and blue eyes, every man has long dark hair, every woman has long golden hair. Every child knows the stories of Irish heroes, every mother knows songs about weaver women and lonely boatmen. Every house is surrounded by secret fields and ancient barns, every pasture is watched by blue mountains, every narrow drive leads to a hidden world. Everyone sometimes wakes with their dreams still gripped in their hands. Then he crept out of childhood, and suddenly the uniqueness of experience unveiled itself. Not all fathers are wild, charming schemers, wiry, far-eyed gods; and not all mothers are dulcet, soft-spoken friends, patient as buds in spring. There are people who don’t care about cars and there are people who like to live in cities. Some families do not have older and younger brothers; some families don’t have brothers at all. Most men do not go to Mass every Sunday and most men do not fall in love with other men. And no one brings dreams to life. No one brings dreams to life. No one brings dreams to life.

By listening to the “unspoken voice” of my body and allowing it to do what it needed to do; by not stopping the shaking, by “tracking” my inner sensations, while also allowing the completion of the defensive and orienting responses; and by feeling the “survival emotions” of rage and terror without becoming overwhelmed, I came through mercifully unscathed, both physically and emotionally. I was not only thankful; I was humbled and grateful to find that I could use my method for my own salvation. While some people are able to recover from such trauma on their own, many individuals do not. Tens of thousands of soldiers are experiencing the extreme stress and horror of war. Then too, there are the devastating occurrences of rape, sexual abuse and assault. Many of us, however, have been overwhelmed by much more “ordinary” events such as surgeries or invasive medical procedures. Orthopedic patients in a recent study, for example, showed a 52% occurrence of being diagnosed with full-on PTSD following surgery. Other traumas include falls, serious illnesses, abandonment, receiving shocking or tragic news, witnessing violence and getting into an auto accident; all can lead to PTSD. These and many other fairly common experiences are all potentially traumatizing. The inability to rebound from such events, or to be helped adequately to recover by professionals, can subject us to PTSD—along with a myriad of physical and emotional symptoms.

The celebrated opening image of 'The Love Song of J. Alfred Prufrock' is another case in point: Let us go then, you and I, When the evening is spread out against the sky Like a patient etherised upon a table... How, the reader wonders, can the evening look like an anaesthetised body? Yet the point surely lies as much in the force of this bizarre image as in its meaning. We are in a modern world in which settled correspondences or traditional affinities between things have broken down. In the arbitrary flux of modern experience, the whole idea of representation - of on thing predictably standing for another - has been plunged into crisis; and this strikingly dislocated image, one which more or less ushers in 'modern' poetry with a rebellious flourish, is a symptom of this bleak condition.

I chanced on a wonderful book by Marius von Senden, called Space and Sight. . . . For the newly sighted, vision is pure sensation unencumbered by meaning: "The girl went through the experience that we all go through and forget, the moment we are born. She saw, but it did not mean anything but a lot of different kinds of brightness." . . . In general the newly sighted see the world as a dazzle of color-patches. They are pleased by the sensation of color, and learn quickly to name the colors, but the rest of seeing is tormentingly difficult. . . . The mental effort involved . . . proves overwhelming for many patients. It oppresses them to realize, if they ever do at all, the tremendous size of the world, which they had previously conceived of as something touchingly manageable. . . . A disheartening number of them refuse to use their new vision, continuing to go over objects with their tongues, and lapsing into apathy and despair. . . . On the other hand, many newly sighted people speak well of the world, and teach us how dull is our own vision.

Dr. Talbon was struck by another very important thing. It all hung together. The stories Cheryl told — even though it was upsetting to think people could do stuff like that — they were not disjointed They were not repetitive in terms of "I've heard this before". It was not just she'd someone trying consciously or unconsciously to get attention. really processed them out and was done with them. She didn't come up with them again [after telling the story once and dealing with it]. Once it was done, it was done. And I think that was probably the biggest factor for me in her believability. I got no sense that she was using these stories to make herself a really interesting person to me so I'd really want to work with her, or something. Or that she was just living in this stuff like it was her life. Once she dealt with it and processed it, it was gone. We just went on to other things. 'Throughout the whole thing, emotionally Cheryl was getting her life together. Parts of her were integrating where she could say,"I have a sense that some particular alter has folded in with some basic alter", and she didn't bring it up again. She didn't say that this alter has reappeared to cause more problems. That just didn't happen. The therapist had learned from training and experience that when real integration occurs, it is permanent and the patient moves on.

In an essay titled A View From the Front Line, Jencks described her experience with cancer as like being woken up midflight on a jumbo jet and then thrown out with a parachute into a foreign landscape without a map: "There you are, the future patient, quietly progressing with other passengers toward a distant destination when, astonishingly (Why me?) a large hole opens in the floor next to you. People in white coats appear, help you into a parachute and — no time to think — out you go. "You descend. You hit the ground....But where is the enemy? What is the enemy? What is it up to?...No road. No compass. No map. No training. Is there something you should know and don't? "The white coats are far, far away, strapping others into their parachutes. Occasionally they wave but, even if you ask them, they don't know the answers. They are up there in the Jumbo, involved with parachutes, not map-making.

Freud was fascinated with depression and focused on the issue that we began with—why is it that most of us can have occasional terrible experiences, feel depressed, and then recover, while a few of us collapse into major depression (melancholia)? In his classic essay “Mourning and Melancholia” (1917), Freud began with what the two have in common. In both cases, he felt, there is the loss of a love object. (In Freudian terms, such an “object” is usually a person, but can also be a goal or an ideal.) In Freud’s formulation, in every loving relationship there is ambivalence, mixed feelings—elements of hatred as well as love. In the case of a small, reactive depression—mourning—you are able to deal with those mixed feelings in a healthy manner: you lose, you grieve, and then you recover. In the case of a major melancholic depression, you have become obsessed with the ambivalence—the simultaneity, the irreconcilable nature of the intense love alongside the intense hatred. Melancholia—a major depression—Freud theorized, is the internal conflict generated by this ambivalence. This can begin to explain the intensity of grief experienced in a major depression. If you are obsessed with the intensely mixed feelings, you grieve doubly after a loss—for your loss of the loved individual and for the loss of any chance now to ever resolve the difficulties. “If only I had said the things I needed to, if only we could have worked things out”—for all of time, you have lost the chance to purge yourself of the ambivalence. For the rest of your life, you will be reaching for the door to let you into a place of pure, unsullied love, and you can never reach that door. It also explains the intensity of the guilt often experienced in major depression. If you truly harbored intense anger toward the person along with love, in the aftermath of your loss there must be some facet of you that is celebrating, alongside the grieving. “He’s gone; that’s terrible but…thank god, I can finally live, I can finally grow up, no more of this or that.” Inevitably, a metaphorical instant later, there must come a paralyzing belief that you have become a horrible monster to feel any sense of relief or pleasure at a time like this. Incapacitating guilt. This theory also explains the tendency of major depressives in such circumstances to, oddly, begin to take on some of the traits of the lost loved/hated one—and not just any traits, but invariably the ones that the survivor found most irritating. Psychodynamically, this is wonderfully logical. By taking on a trait, you are being loyal to your lost, beloved opponent. By picking an irritating trait, you are still trying to convince the world you were right to be irritated—you see how you hate it when I do it; can you imagine what it was like to have to put up with that for years? And by picking a trait that, most of all, you find irritating, you are not only still trying to score points in your argument with the departed, but you are punishing yourself for arguing as well. Out of the Freudian school of thought has come one of the more apt descriptions of depression—“aggression turned inward.” Suddenly the loss of pleasure, the psychomotor retardation, the impulse to suicide all make sense. As do the elevated glucocorticoid levels. This does not describe someone too lethargic to function; it is more like the actual state of a patient in depression, exhausted from the most draining emotional conflict of his or her life—one going on entirely within. If that doesn’t count as psychologically stressful, I don’t know what does.

There is nothing in this world that is more fascinating than human connection. There is something so mysterious about why the people that enter and exit your life are placed the way that they are. There is something so eerie about why your eyes will lock with someone and for some reason your heart unlocks. It could be a complete stranger, the cashier or even your best friend. A lot of times when this happens, you notice it. It’s not a passing thought, or a casual encounter; it takes you aback. It makes you uncomfortable and you don’t know why. The weirdest part is that you know that it’s mutual. You both recognize something in each other and you’re not quite sure what it is. That thing, that entity, it’s called humaneness. Connection can be a strange experience, but more often than not it is an insightful experience. Every person that enters your life is there to leave a mark, and teach a lesson. Every connection in its own association is patient, kind, truthful, protective, trusting and hopeful. Every connection essentially is a connection of love. And every encounter should be handled as an encounter of bless.

The Dialectical Dilemma for the Patient The borderline individual is faced with an apparently irreconcilable dilemma. On the one hand, she has tremendous difficulties with self-regulation of affect and subsequent behavioral competence. She frequently but somewhat unpredictably needs a great deal of assistance, often feels helpless and hopeless, and is afraid of being left alone to fend for herself in a world where she has failed over and over again. Without the ability to predict and control her own well-being, she depends on her social environment to regulate her affect and behavior. On the other hand, she experiences intense shame at behaving dependently in a society that cannot tolerate dependency, and has learned to inhibit expressions of negative affect and helplessness whenever the affect is within controllable limits. Indeed, when in a positive mood, she may be exceptionally competent across a variety of situations. However, in the positive mood state she has difficulty predicting her own behavioral capabilities in a different mood, and thus communicates to others an ability to cope beyond her capabilities. Thus, the borderline individual, even though at times desperate for help, has great difficulty asking for help appropriately or communicating her needs. The inability to integrate or synthesize the notions of helplessness and competence, of noncontrol and control, and of needing and not needing help can lead to further emotional distress and dysfunctional behaviors. Believing that she is competent to “succeed,” the person may experience intense guilt about her presumed lack of motivation when she falls short of objectives. At other times, she experiences extreme anger at others for their lack of understanding and unrealistic expectations. Both the intense guilt and the intense anger can lead to dysfunctional behaviors, including suicide and parasuicide, aimed at reducing the painful emotional states. For the apparently competent person, suicidal behavior is sometimes the only means of communicating to others that she really can’t cope and needs help; that is, suicidal behavior is a cry for help. The behavior may also function as a means to get others to alter their unrealistic expectations—to “prove” to the world that she really cannot do what is expected.

SELFHOOD AND DISSOCIATION The patient with DID or dissociative disorder not otherwise specified (DDNOS) has used their capacity to psychologically remove themselves from repetitive and inescapable traumas in order to survive that which could easily lead to suicide or psychosis, and in order to eke some growth in what is an unsafe, frequently contradictory and emotionally barren environment. For a child dependent on a caregiver who also abuses her, the only way to maintain the attachment is to block information about the abuse from the mental mechanisms that control attachment and attachment behaviour.10 Thus, childhood abuse is more likely to be forgotten or otherwise made inaccessible if the abuse is perpetuated by a parent or other trusted caregiver. In the dissociative individual, ‘there is no uniting self which can remember to forget’. Rather than use repression to avoid traumatizing memories, he/she resorts to alterations in the self ‘as a central and coherent organization of experience. . . DID involves not just an alteration in content but, crucially, a change in the very structure of consciousness and the self’ (p. 187).29 There may be multiple representations of the self and of others. Middleton, Warwick. "Owning the past, claiming the present: perspectives on the treatment of dissociative patients." Australasian Psychiatry 13.1 (2005): 40-49.

THE RETURN OF THE REPRESSED: RELIVING DISSOCIATED EXPERIENCES The reexperiencing of previously dissociated traumatic events presents in a variety of complex ways. The central principle is that dissociated experiences often do not remain dormant. Freud's concept of the “repetition compulsion” is enormously helpful in understanding how dissociated events are later reexperienced. In his paper, "Beyond the Pleasure Principle," Freud (1920/ 1955) described how repressed (and dissociated) trauma and instinctual conflicts can become superimposed on current reality. He wrote: The patient cannot remember the whole of what is repressed in him, and what he cannot remember may be precisely the essential part of it. .. . He is obliged to repeat the repressed material as a contemporary experience instead of remembering it as something in the past. (p. 18) If one understands repression as the process in which overwhelming experiences are forgotten, distanced, and dissociated, Freud posited that these experiences are likely to recur in the mind and to be reexperienced. He theorized that this "compulsion to repeat" served a need to rework and achieve mastery over the experience and that it perhaps had an underlying biologic basis as well. The most perceptive tenet of Freud’s theory is that previously dissociated events are actually reexperienced as current reality rather than remembered as occurring in the past. Although Freud was discussing the trauma produced by intense intrapsychic conflict, clinical experience has shown that actual traumatic events that have been dissociated are often repeated and reexperienced.

The Student" “In America,” began the lecturer, “everyone must have a degree. The French do not think that all can have it, they don’t say everyone must go to college.” We incline to feel, here, that although it may be unnecessary to know fifteen languages. one degree is not too much. With us, a school—like the singing tree of which the leaves were mouths that sang in concert— is both a tree of knowledge and of liberty— seen in the unanimity of college mottoes, lux et veritas, Christo et ecclesiae, sapiet felici. It may be that we have not knowledge, just opinions, that we are undergraduates, not students; we know we have been told with smiles, by expatriates of whom we had asked, “When will your experiment be finished?” “Science is never finished.” Secluded from domestic strife, Jack Bookworm led a college life, says Goldsmith; and here also as in France or Oxford, study is beset with dangers—with bookworms, mildews, and complaisancies. But someone in New England has known enough to say that the student is patience personified, a variety of hero, “patient of neglect and of reproach,"—who can "hold by himself.” You can’t beat hens to make them lay. Wolf’s wool is the best of wool, but it cannot be sheared, because the wolf will not comply. With knowledge as with wolves’ surliness, the student studies voluntarily, refusing to be less than individual. He “gives him opinion and then rests upon it”; he renders service when there is no reward, and is too reclusive for some things to seem to touch him; not because he has no feeling but because he has so much.

A therapist who fears dependence will tell his patient, sometimes openly, that the urge to rely is pathologic. In doing so he denigrates a cardinal tool. A parent who rejects a child's desire to depend raises a fragile person. Those children, grown to adulthood, are frequently among those who come for help. Shall we tell them again that no one can find an art to lean on, that each alone must work to ease a private sorrow? Then we shall repeat and experiment already conducted; many know its result only too well. If patient and therapist are to proceed together down a curative path, they must allow limbic regulation and its companion moon, dependence, to make the revolutionary magic. Many therapists believe that reliance fosters a detrimental dependency. Instead, they say, patients should be directed to "do it for themselves" - as if they possess everything but the wit to throw that switch and get on with their lives. But people do not learn emotional modulation as they do geometry or the names of state capitals. They absorb the skill from living in the presence of an adept external modulator, and they learn it implicitly. Knowledge leaps the gap from one mind to the other, but the learner does not experience the transferred information as an explicit strategy. Instead, a spontaneous capacity germinates and becomes a natural part of the self, like knowing how to ride a bike or tie one's shoes. The effortful beginnings fade and disappear from memory. (171)

Lately, because computer technology has made self-publishing an easier and less expensive venture, I'm getting a lot of review copies of amateur books by writers who would be better advised to hone their craft before committing it to print. The best thing you can do as a beginning writer is to write, write, write - and read, read, read. Concentrating on publication prematurely is a mistake. You don't pick up a violin and expect to play Carnegie Hall within the year - yet somehow people forget that writing also requires technical skills that need to be learned, practiced, honed. If I had a dollar for every person I've met who thought, with no prior experience, they could sit down and write a novel and instantly win awards and make their living as a writer, I'd be a rich woman today. It's unrealistic, and it's also mildly insulting to professional writers who have worked hard to perfect their craft. Of course, then you hear stories about people like J.K. Rowling, who did sit down with no prior experience and write a worldwide best-seller...but such people are as rare as hen's teeth. Every day I work with talented, accomplished writers who have many novels in print and awards to their name and who are ‘still’ struggling to make a living. The thing I often find myself wanting to say to new writers is: Write because you love writing, learn your craft, be patient, and be realistic. Anais Nin said about writing, "It should be a necessity, as the sea needs to heave, and I call it breathing."

Rea­sons Why I Loved Be­ing With Jen I love what a good friend you are. You’re re­ally en­gaged with the lives of the peo­ple you love. You or­ga­nize lovely ex­pe­ri­ences for them. You make an ef­fort with them, you’re pa­tient with them, even when they’re side­tracked by their chil­dren and can’t pri­or­i­tize you in the way you pri­or­i­tize them. You’ve got a gen­er­ous heart and it ex­tends to peo­ple you’ve never even met, whereas I think that ev­ery­one is out to get me. I used to say you were naive, but re­ally I was jeal­ous that you al­ways thought the best of peo­ple. You are a bit too anx­ious about be­ing seen to be a good per­son and you def­i­nitely go a bit over­board with your left-wing pol­i­tics to prove a point to ev­ery­one. But I know you re­ally do care. I know you’d sign pe­ti­tions and help peo­ple in need and vol­un­teer at the home­less shel­ter at Christ­mas even if no one knew about it. And that’s more than can be said for a lot of us. I love how quickly you read books and how ab­sorbed you get in a good story. I love watch­ing you lie on the sofa read­ing one from cover-to-cover. It’s like I’m in the room with you but you’re in a whole other gal­axy. I love that you’re al­ways try­ing to im­prove your­self. Whether it’s running marathons or set­ting your­self chal­lenges on an app to learn French or the fact you go to ther­apy ev­ery week. You work hard to be­come a bet­ter ver­sion of your­self. I think I prob­a­bly didn’t make my ad­mi­ra­tion for this known and in­stead it came off as ir­ri­ta­tion, which I don’t re­ally feel at all. I love how ded­i­cated you are to your fam­ily, even when they’re an­noy­ing you. Your loy­alty to them wound me up some­times, but it’s only be­cause I wish I came from a big fam­ily. I love that you al­ways know what to say in con­ver­sa­tion. You ask the right ques­tions and you know ex­actly when to talk and when to lis­ten. Ev­ery­one loves talk­ing to you be­cause you make ev­ery­one feel im­por­tant. I love your style. I know you think I prob­a­bly never no­ticed what you were wear­ing or how you did your hair, but I loved see­ing how you get ready, sit­ting in front of the full-length mir­ror in our bed­room while you did your make-up, even though there was a mir­ror on the dress­ing ta­ble. I love that you’re mad enough to swim in the English sea in No­vem­ber and that you’d pick up spi­ders in the bath with your bare hands. You’re brave in a way that I’m not. I love how free you are. You’re a very free per­son, and I never gave you the sat­is­fac­tion of say­ing it, which I should have done. No one knows it about you be­cause of your bor­ing, high-pres­sure job and your stuffy up­bring­ing, but I know what an ad­ven­turer you are un­der­neath all that. I love that you got drunk at Jack­son’s chris­ten­ing and you al­ways wanted to have one more drink at the pub and you never com­plained about get­ting up early to go to work with a hang­over. Other than Avi, you are the per­son I’ve had the most fun with in my life. And even though I gave you a hard time for al­ways try­ing to for al­ways try­ing to im­press your dad, I ac­tu­ally found it very adorable be­cause it made me see the child in you and the teenager in you, and if I could time-travel to any­where in his­tory, I swear, Jen, the only place I’d want to go is to the house where you grew up and hug you and tell you how beau­ti­ful and clever and funny you are. That you are spec­tac­u­lar even with­out all your sports trophies and mu­sic cer­tifi­cates and in­cred­i­ble grades and Ox­ford ac­cep­tance. I’m sorry that I loved you so much more than I liked my­self, that must have been a lot to carry. I’m sorry I didn’t take care of you the way you took care of me. And I’m sorry I didn’t take care of my­self, ei­ther. I need to work on it. I’m pleased that our break-up taught me that. I’m sorry I went so mental. I love you. I always will. I'm glad we met.

Over the years I have had much occasion to ponder this word, the intelligentsia. We are all very fond of including ourselves in it—but you see not all of us belong. In the Soviet Union this word has acquired a completely distorted meaning. They began to classify among the intelligentsia all those who don't work (and are afraid to) with their hands. All the Party, government, military, and trade union bureaucrats have been included. All bookkeepers and accountants—the mechanical slaves of Debit. All office employees. And with even greater ease we include here all teachers (even those who are no more than talking textbooks and have neither independent knowledge nor an independent view of education). All physicians, including those capable only of making doodles on the patients' case histories. And without the slightest hesitation all those who are only in the vicinity of editorial offices, publishing houses, cinema studios, and philharmonic orchestras are included here, not even to mention those who actually get published, make films, or pull a fiddle bow. And yet the truth is that not one of these criteria permits a person to be classified in the intelligentsia. If we do not want to lose this concept, we must not devalue it. The intellectual is not defined by professional pursuit and type of occupation. Nor are good upbringing and good family enough in themselves to produce and intellectual. An intellectual is a person whose interests in and preoccupation with the spiritual side of life are insistent and constant and not forced by external circumstances, even flying in the face of them. An intellectual is a person whose thought is nonimitative.

However, questions arise. Are there people who aren't naive realists, or special situations in which naive realism disappears? My theory—the self-model theory of subjectivity—predicts that as soon as a conscious representation becomes opaque (that is, as soon as we experience it as a representation), we lose naive realism. Consciousness without naive realism does exist. This happens whenever, with the help of other, second-order representations, we become aware of the construction process—of all the ambiguities and dynamical stages preceding the stable state that emerges at the end. When the window is dirty or cracked, we immediately realize that conscious perception is only an interface, and we become aware of the medium itself. We doubt that our sensory organs are working properly. We doubt the existence of whatever it is we are seeing or feeling, and we realize that the medium itself is fallible. In short, if the book in your hands lost its transparency, you would experience it as a state of your mind rather than as an element of the outside world. You would immediately doubt its independent existence. It would be more like a book-thought than a book-perception. Precisely this happens in various situations—for example, In visual hallucinations during which the patient is aware of hallucinating, or in ordinary optical illusions when we suddenly become aware that we are not in immediate contact with reality. Normally, such experiences make us think something is wrong with our eyes. If you could consciously experience earlier processing stages of the representation of the book In your hands, the image would probably become unstable and ambiguous; it would start to breathe and move slightly. Its surface would become iridescent, shining in different colors at the same time. Immediately you would ask yourself whether this could be a dream, whether there was something wrong with your eyes, whether someone had mixed a potent hallucinogen into your drink. A segment of the wall of the Ego Tunnel would have lost its transparency, and the self-constructed nature of the overall flow of experience would dawn on you. In a nonconceptual and entirely nontheoretical way, you would suddenly gain a deeper understanding of the fact that this world, at this very moment, only appears to you.

Last month, on a very windy day, I was returning from a lecture I had given to a group in Fort Washington. I was beginning to feel unwell. I was feeling increasing spasms in my legs and back and became anxious as I anticipated a difficult ride back to my office. Making matters worse, I knew I had to travel two of the most treacherous high-speed roads near Philadelphia – the four-lane Schuylkill Expressway and the six-lane Blue Route. You’ve been in my van, so you know how it’s been outfitted with everything I need to drive. But you probably don’t realize that I often drive more slowly than other people. That’s because I have difficulty with body control. I’m especially careful on windy days when the van can be buffeted by sudden gusts. And if I’m having problems with spasms or high blood pressure, I stay way over in the right hand lane and drive well below the speed limit. When I’m driving slowly, people behind me tend to get impatient. They speed up to my car, blow their horns, drive by, stare at me angrily, and show me how long their fingers can get. (I don't understand why some people are so proud of the length of their fingers, but there are many things I don't understand.) Those angry drivers add stress to what already is a stressful experience of driving. On this particular day, I was driving by myself. At first, I drove slowly along back roads. Whenever someone approached, I pulled over and let them pass. But as I neared the Blue Route, I became more frightened. I knew I would be hearing a lot of horns and seeing a lot of those long fingers. And then I did something I had never done in the twenty-four years that I have been driving my van. I decided to put on my flashers. I drove the Blue Route and the Schuylkyll Expressway at 35 miles per hour. Now…Guess what happened? Nothing! No horns and no fingers. But why? When I put on my flashers, I was saying to the other drivers, “I have a problem here – I am vulnerable and doing the best I can.” And everyone understood. Several times, in my rearview mirror I saw drivers who wanted to pass. They couldn’t get around me because of the stream of passing traffic. But instead of honking or tailgating, they waited for the other cars to pass, knowing the driver in front of them was in some way weak. Sam, there is something about vulnerability that elicits compassion. It is in our hard wiring. I see it every day when people help me by holding doors, pouring cream in my coffee, or assist me when I put on my coat. Sometimes I feel sad because from my wheelchair perspective, I see the best in people. But those who appear strong and invulnerably typically are not exposed to the kindness I see daily. Sometimes situations call for us to act strong and brave even when we don't feel that way. But those are a few and far between. More often, there is a better pay-off if you don't pretend you feel strong when you feel weak, or pretend that you are brave when you’re scared. I really believe the world might be a safer place if everyone who felt vulnerable wore flashers that said, “I have a problem and I’m doing the best I can. Please be patient!

Despite the intervening six decades of scientific inquiry since Selye’s groundbreaking work, the physiological impact of the emotions is still far from fully appreciated. The medical approach to health and illness continues to suppose that body and mind are separable from each other and from the milieu in which they exist. Compounding that mistake is a definition of stress that is narrow and simplistic. Medical thinking usually sees stress as highly disturbing but isolated events such as, for example, sudden unemployment, a marriage breakup or the death of a loved one. These major events are potent sources of stress for many, but there are chronic daily stresses in people’s lives that are more insidious and more harmful in their long-term biological consequences. Internally generated stresses take their toll without in any way seeming out of the ordinary. For those habituated to high levels of internal stress since early childhood, it is the absence of stress that creates unease, evoking boredom and a sense of meaninglessness. People may become addicted to their own stress hormones, adrenaline and cortisol, Hans Selye observed. To such persons stress feels desirable, while the absence of it feels like something to be avoided. When people describe themselves as being stressed, they usually mean the nervous agitation they experience under excessive demands — most commonly in the areas of work, family, relationships, finances or health. But sensations of nervous tension do not define stress — nor, strictly speaking, are they always perceived when people are stressed. Stress, as we will define it, is not a matter of subjective feeling. It is a measurable set of objective physiological events in the body, involving the brain, the hormonal apparatus, the immune system and many other organs. Both animals and people can experience stress with no awareness of its presence. “Stress is not simply nervous tension,” Selye pointed out. “Stress reactions do occur in lower animals, and even in plants, that have no nervous systems…. Indeed, stress can be produced under deep anaesthesia in patients who are unconscious, and even in cell cultures grown outside the body.” Similarly, stress effects can be highly active in persons who are fully awake, but who are in the grip of unconscious emotions or cut off from their body responses. The physiology of stress may be triggered without observable effects on behaviour and without subjective awareness, as has been shown in animal experiments and in human studies.

It’s no one’s fault really,” he continued. “A big city cannot afford to have its attention distracted from the important job of being a big city by such a tiny, unimportant item as your happiness or mine.” This came out of him easily, assuredly, and I was suddenly interested. On closer inspection there was something aesthetic and scholarly about him, something faintly professorial. He knew I was with him, listening, and his grey eyes were kind with offered friendliness. He continued: “Those tall buildings there are more than monuments to the industry, thought and effort which have made this a great city; they also occasionally serve as springboards to eternity for misfits who cannot cope with the city and their own loneliness in it.” He paused and said something about one of the ducks which was quite unintelligible to me. “A great city is a battlefield,” he continued. “You need to be a fighter to live in it, not exist, mark you, live. Anybody can exist, dragging his soul around behind him like a worn-out coat; but living is different. It can be hard, but it can also be fun; there’s so much going on all the time that’s new and exciting.” I could not, nor wished to, ignore his pleasant voice, but I was in no mood for his philosophising. “If you were a negro you’d find that even existing would provide more excitement than you’d care for.” He looked at me and suddenly laughed; a laugh abandoned and gay, a laugh rich and young and indescribably infectious. I laughed with him, although I failed to see anything funny in my remark. “I wondered how long it would be before you broke down and talked to me,” he said, when his amusement had quietened down. “Talking helps, you know; if you can talk with someone you’re not lonely any more, don’t you think?” As simple as that. Soon we were chatting away unreservedly, like old friends, and I had told him everything. “Teaching,” he said presently. “That’s the thing. Why not get a job as a teacher?” “That’s rather unlikely,” I replied. “I have had no training as a teacher.” “Oh, that’s not absolutely necessary. Your degrees would be considered in lieu of training, and I feel sure that with your experience and obvious ability you could do well.” “Look here, Sir, if these people would not let me near ordinary inanimate equipment about which I understand quite a bit, is it reasonable to expect them to entrust the education of their children to me?” “Why not? They need teachers desperately.” “It is said that they also need technicians desperately.” “Ah, but that’s different. I don’t suppose educational authorities can be bothered about the colour of people’s skins, and I do believe that in that respect the London County Council is rather outstanding. Anyway, there would be no need to mention it; let it wait until they see you at the interview.” “I’ve tried that method before. It didn’t work.” “Try it again, you’ve nothing to lose. I know for a fact that there are many vacancies for teachers in the East End of London.” “Why especially the East End of London?” “From all accounts it is rather a tough area, and most teachers prefer to seek jobs elsewhere.” “And you think it would be just right for a negro, I suppose.” The vicious bitterness was creeping back; the suspicion was not so easily forgotten. “Now, just a moment, young man.” He was wonderfully patient with me, much more so than I deserved. “Don’t ever underrate the people of the East End; from those very slums and alleyways are emerging many of the new breed of professional and scientific men and quite a few of our politicians. Be careful lest you be a worse snob than the rest of us. Was this the kind of spirit in which you sought the other jobs?