Patient Related Quotes

A sense of duty is useful in work but offensive in personal relations. People wish to be liked, not to be endured with patient resignation.

The essence of trauma is that it is overwhelming, unbelievable, and unbearable. Each patient demands that we suspend our sense of what is normal and accept that we are dealing with a dual reality: the reality of a relatively secure and predictable present that lives side by side with a ruinous, ever-present past.

Openness to human relationality does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can.

I always wondered if the good people who send us bibles really think that hookworm and hunger are healed by scripture? Our patients are illiterate.

Anxiety, as we know, is always connected with a loss…with a two-sided relation on the point of fading away to be superseded by something else, something which the patient cannot face without vertigo

The young and the old are defenseless against relatives who want to get rid of them by casting them in the role of mental patient,and against psychiatrists whose livelihood depends on defining them as mentally ill.

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.

I naively believe that self-love is 80 percent of the solution, that it helps beyond words to take yourself through the day as you would with your most beloved mental-patient relative, with great humor and lots of small treats.

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.

Changes in Relationship with others: It is especially hard to trust other people if you have been repeatedly abused, abandoned or betrayed as a child. Mistrust makes it very difficult to make friends, and to be able to distinguish between good and bad intentions in other people. Some parts do not seem to trust anyone, while other parts may be so vulnerable and needy that they do not pay attention to clues that perhaps a person is not trustworthy. Some parts like to be close to others or feel a desperate need to be close and taken care of, while other parts fear being close or actively dislike people. Some parts are afraid of being in relationships while others are afraid of being rejected or criticized. This naturally sets up major internal as well as relational conflicts.

So here we have found a means of a) alienating even the most flexible and patient Palestinians; while b) frustrating the efforts of the more principled and compromising Israelis; while c) empowering and financing some of the creepiest forces in American and Israeli society; and d) heaping ordure on our own secular founding documents. When will the Justice Department and the Congress and the Supreme Court become aware of this huge and rank offense, which is designed to bring us ever nearer to holy war?

It is exhausting explaining over and over again that yes, I am doing great and I feel fantastic, but I still cannot do the things I once did. My new normal with Cancer Related Fatigue.

Complex PTSD consists of of six symptom clusters, which also have been described in terms of dissociation of personality. Of course, people who receive this diagnosis often also suffer from other problems as well, and as noted earlier, diagnostic categories may overlap significantly. The symptom clusters are as follows: Alterations in Regulation of Affect ( Emotion ) and Impulses Changes in Relationship with others Somatic Symptoms Changes in Meaning Changes in the perception of Self Changes in Attention and Consciousness

the top reason doctors give for not counseling patients with high cholesterol to eat healthier is that they think patients may “fear privations related to dietary advice.”65 In other words, doctors perceive that patients would feel deprived of all the junk they’re eating. Can you imagine a doctor saying, “Yeah, I’d like to tell my patients to stop smoking, but I know how much they love it”?

He had altered his method of matching books to readers. He often asked, "How would you like to feel when you go to sleep?" Most of his customers wanted to feel light and safe. He asked others to tell him about their favorite things. Cooks loved their knives. Estate agents loved the jangle made by a bunch of keys. Dentists loved the flicker of fear in their patients' eyes; Perdu had guessed as much. Most often he asked, "How should the book taste? Of ice cream? Spicy, meaty? Or like a chilled rose?" Food and books were closely related. He discovered this in Sanary, and it earned him the nickname "the book epicure.

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

Anger could be seen on Lan Xichens face, "If it were not related to you, could he have don't those to himself without a reason?!" ZeWu-Jun had always been an extremely patient person, but now that Lan Wangji was involved, he was truly angered.

Parts of you are phobic of anger and generally terrified and ashamed of angry dissociative parts. There is often tremendous conflict between anger-avoidant and anger-fixated parts of an individual. Thus, an internal and perpetual cycle of rage-shame-fear creates inner chaos and pain.

The hardcore drug addicts that I treat, are, without exception, people who have had extraordinarily difficult lives. The commonality is childhood abuse. These people all enter life under extremely adverse circumstances. Not only did they not get what they need for healthy development; they actually got negative circumstances of neglect. I don’t have a single female patient in the Downtown Eastside of Vancouver who wasn’t sexually abused, for example, as were many of the men, or abused, neglected and abandoned serially, over and over again. That’s what sets up the brain biology of addiction. In other words, the addiction is related both psychologically, in terms of emotional pain relief, and neurobiological development to early adversity.

My gentle Reader, I perceive / How patiently you’ve waited, / And now I fear that you expect / Some tale will be related. / O Reader! had you in your mind / Such stores as silent thought can bring, / O gentle Reader! you would find / A tale in every thing.

There is a saying that "paper is more patient than man";it came back to me on one of my slightly melancholy days,while I sat chin in hand,feeling too bored and limp even to make up my mind whether to go out or stay at home. Yes, there is no doubt that paper is patient and as I don't intend to show this cardboard-covered notebook,bearing the proud name of"diary",to anyone,unless I find a real friend,boy or girl,probably nobody cares.And now I come to the root of the matter,the reason for my starting a diary:it is that I have no such real friend. Let me put it more clearly,since no one will believe that a girl of thirteen feels herself quite alone in the world,nor is it so.I have darling parents and a sister of sixteen.I know about thirty people whom one might call friends--I have strings of boy friends,anxious to catch a glimpse of me and who,failing that,peep at me through mirrors in class.I have relations,aunts and uncles,who are darlings too,a good home,no--I don't seem to lack anything.But it's the same with all my friends,just fun and joking,nothing more.I can never bring myself to talk of anything outside the common round.We don't seem to be able to get any closer,that is the root of the trouble.Perhaps I lack confidence,but anyway,there it is,a stubborn fact and I don't seem to be able to do anything about it.

Alterations in regulation of affect (emotion) and impulse: Almost all people who are seriously traumatized have problems in tolerating and regulating their emotions and surges or impulses. However, those with complex PTSD and dissociative disorders tend to have more difficulties than those with PTSD because disruptions in early development have inhibited their ability to regulate themselves. The fact that you have a dissociative organization of your personality makes you highly vulnerable to rapid and unexpected changes in emotions and sudden impulses. Various parts of the personality intrude on each other either through passive influence or switching when your under stress, resulting in dysregulation. Merely having an emotion, such as anger, may evoke other parts of you to feel fear or shame, and to engage in impulsive behaviors to stop avoid the feelings.

We will meet people on the way: patients, relatives and staff - people you may recognize already. Because we are all nursed at some point in our lives. We are all nurses.

Dissociative parts of the personality are not actually separate identities or personalities in one body, but rather parts of a single individual that are not yet functioning together in a smooth, coordinated, flexible way. P14

Changes in the Perception of Self: People who have been traumatized in childhood are often troubled by guilt, shame, and negative feelings about themselves, such as the belief they are unlikable, unlovable, stupid, inept, dirty, worthless, lazy, and so forth. In Complex Dissociative disorders there are typically particular parts that contain these negative feelings about the self while other parts may evaluate themselves quite differently. Alterations among parts thus may result in rather rapid and distinct changes in self perception.

Love begets joy. Joy begets peace. Peace begets patience. Patience begets kindness. Kindness begets goodness. Goodness begets faithfulness. Faithfulness begets gentleness. Gentleness begets self-control.

Corunda Base Hospital itself continued to function on doctors, nurses, domestic staff, food preparers, and ancillary staff in the same old way, so that the patients lived (or died) in relative ignorance of the drama going on at an executive level. Indeed, it was a rare patient even knew that a hospital had executives.

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.

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'm a patient man, though. And I have the feeling that everything related to Grace Allen will be worth the wait.

I’m a patient man, though. And I have the feeling that everything related to Grace Allen will be worth the wait.

You as a whole person are thus unable to reconcile conflicts about anger and learn to tolerate and express anger in healthy ways. Inner turmoil and dissociation are maintained.

Bruce Miller, a neurologist at the University of California, San Francisco, studies elderly patients with a relatively common form of brain disease called frontotemporal dementia, or FTD. He’s found that in some cases where the FTD is localized on the left side of the brain, people who had never picked up a paintbrush or an instrument can develop extraordinary artistic and musical abilities at the very end of their lives. As their other cognitive skills fade away, they become narrow savants.

She has never understood, nor been able to relate to a herd mentality. She doesn't get along with followers and avoids the bandwagon. She marches to her own tune and does it alone. She's despised by the weak-minded and respected by the strong. She ruffles the feathers of the flock because she champion's the defenseless and pick's on the mob. Does she wish she could not give a damn and live an ordinary life surrounded by nodding and needy ordinary people? At times...but she'd be bored out of her mind when she's never bored alone, and because of that she's patient because a couple of times in a lifetime she's lucky enough to come across a memorable, magnetic and remarkable person - one worth knowing, even if just for the brevity of a conversation.

This reinforced Rivers’s view that it was prolonged strain, immobility and helplessness that did the damage, and not the sudden shocks or bizarre horrors that the patients themselves were inclined to point to as the explanation for their condition. That would help to account for the greater prevalence of anxiety neuroses and hysterical disorders in women in peacetime, since their relatively more confined lives gave them fewer opportunities of reacting to stress in active and constructive ways. Any explanation of war neurosis must account for the fact that this apparently intensely masculine life of war and danger and hardship produced in men the same disorders that women suffered from in peace.

In schizoid illness, object-relating goes wrong; the patient relates to a subjective world or fails to relate to any object outside the self. Omnipotence is asserted by means of delusions. The patient is withdrawn, out of contact, bemused, isolated, unreal, deaf, inaccessible, invulnerable, and so on. In health a great deal of life has to do with various kinds of object-relating, and with a ‘to-and-fro’ process between relating to external objects and relating to internal ones. In full fruition this is a matter of interpersonal relationships, but the residues of creative relating are not lost, and this makes every aspect of object-relating exciting.

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.

Specific parts of you personality may be angry and are usually easily evoked. because these parts are dissociated, anger remains an emotion that is not integrated for you as a whole person. Even though individuals with dissociative disorder are responsible for their behavior, just like everyone else, regardless of which part may be acting, they may feel little control of these raging parts of themselves. Some dissociative parts may avoid or even be phobic of anger. They may influence you as a whole person to avoid conflict with others at any cost or to avoid setting healthy boundaries out of fear of someone else’s anger; or they may urge you to withdraw from others almost completely.

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.

Dr. Bone Specialist came in, made me stand up and hobble across the room, checked my reflexes, and then made me lie down on the table. He bent my right knee this way and that, up and down, all the way out to the side and in. Then he did the same with my left leg. He ordered X rays then started to leave the room. I panicked. I MUST GET DRUGS. "What can I take for the pain?" I asked him before he got out the door. "You can take some over the counter ibuprofen," he suggested. "But I wouldn't take more than nine a day." I choked. Nine a day? I'd been popping forty. Nine a day? Like hell. I couldn't even go to the bathroom on my own, I hadn't slept in three weeks, and my normally sunny cheery disposition had turned into that of a very rabid dog. If I didn't get good drugs and get them now, it was straight to Shooter's World and then Walgreens pharmacy for me. "I don't think you understand," I explained. "I can't go to work. I have spent the last four days with my mother who is addicted to QVC, watching jewelry shows, doll shows and make-up shows. I almost ordered a beef-jerky maker! Give me something, or I'm going to use your calf muscles to make the first batch!" Without further ado, he hastily scribbled out a prescription for some codeine and was gone. I was happy. My mother, however, had lost the ability to speak.

The great majority of men and women, in ordinary times, pass through life without ever contemplating or criticising, as a whole, either their own conditions or those of the world at large. They find themselves born into a certain place in society, and they accept what each day brings forth, without any effort of thought beyond what the immediate present requires. Almost as instinctively as the beasts of the field, they seek the satisfaction of the needs of the moment, without much forethought, and without considering that by sufficient effort the whole conditions of their lives could be changed. A certain percentage, guided by personal ambition, make the effort of thought and will which is necessary to place themselves among the more fortunate members of the community; but very few among these are seriously concerned to secure for all the advantages which they seek for themselves. It is only a few rare and exceptional men who have that kind of love toward mankind at large that makes them unable to endure patiently the general mass of evil and suffering, regardless of any relation it may have to their own lives.

Especially when we are afraid, angry, or confused, we may be tempted to give away bits of our freedom—or, less painfully, somebody else’s freedom—in the quest for direction and order. Bill Clinton observed that when people are uncertain, they’d rather have leaders who are strong and wrong than right and weak. Throughout history, demagogues have often outperformed democrats in generating popular fervor, and it is almost always because they are perceived to be more decisive and sure in their judgments. In times of relative tranquility, we feel we can afford to be patient. We understand that policy questions are complicated and merit careful thought. We want our leaders to consult experts, gather as much information as possible, test assumptions, and give us a chance to voice our opinions on the available options. We see long-term planning as necessary and deliberation as a virtue, but when we decide that action is urgently needed, our tolerance for delay disappears. In those moments, many of us no longer want to be asked, “What do you think?” We want to be told where to march. That is when Fascism gets its start: other options don’t seem enough.

Most dissociative parts influence your experience from the inside rather than exert complete control, that is, through passive influence. * In fact, many parts never take complete control of a person, but are only experienced internally. * Frequent switching may be a sign of severe stress and inner conflict in most individuals.

And pain is relative; My particulars may be "better" of "worse" than the patient next to me, but individually our biological framework limits our ability to tolerate suffering; that is what brings us to out knees, flips the switch of our depression, and forces us to retreat from the rest of the world. That is what we have in common.

or to what we hope they are. The more we work through our family of origin issues, the less we will find ourselves needing to work through them with the people we’re attracted to. Finishing our business from the past helps us form new and healthier relationships. The more we overcome our need to be excessive caretakers, the less we will find ourselves attracted to people who need to be constantly taken care of. The more we learn to love and respect ourselves, the more we will become attracted to people who will love and respect us and who we can safely love and respect. This is a slow process. We need to be patient with ourselves. The type of people we find ourselves attracted to does not change overnight. Being attracted to dysfunctional people can linger long and well into recovery. That does not mean we need to allow it to control us. The fact is, we will initiate and maintain relationships with people we need to be with until we learn what it is we need to learn—no matter how long we’ve been recovering. No matter who we find ourselves relating to, and what we discover happening in the relationship, the issue is still about us, and not about the other person. That is the heart, the hope, and the power of recovery.

And that is why it is so important to be solitary and attentive when one is sad: because the apparently uneventful and static moment when our future comes upon us is so much closer to life than that other noisy and accidental point when it happens to us as if from the outside. The quieter, the more patient and open we are in our sadness, the deeper and more unerringly the new will penetrate into us, the better we shall acquire it, the more it will be our fate, and when one day in the future it ‘takes place’ (that is, steps out of us towards others) we shall feel related and close to it in our inmost hearts. And that is necessary. It is necessary – and little by little our development will tend in this direction – that nothing alien should happen to us, but only what has long been part of us.

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.

It was Freud's ambition to discover the cause of hysteria, the archetypal female neurosis of his time. In his early investigations, he gained the trust and confidence of many women, who revealed their troubles to him.Time after time, Freud's patients, women from prosperous, conventional families, unburdened painful memories of childhood sexual encounters with men they had trusted: family friends, relatives, and fathers. Freud initially believed his patients and recognized the significance of their confessions. In 1896, with the publication of two works, The Aetiology of Hysteria and Studies on Hysteria, he announced that he had solved the mystery of the female neurosis. At the origin of every case of hysteria, Freud asserted, was a childhood sexual trauma. But Freud was never comfortable with this discovery, because of what it implied about the behavior of respectable family men. If his patients' reports were true, incest was not a rare abuse, confined to the poor and the mentally defective, but was endemic to the patriarchal family. Recognizing the implicit challenge to patriarchal values, Freud refused to identify fathers publicly as sexual aggressors. Though in his private correspondence he cited "seduction by the father" as the "essential point" in hysteria, he was never able to bring himself to make this statement in public. Scrupulously honest and courageous in other respects, Freud falsified his incest cases. In The Aetiology of Hysteria, Freud implausibly identified governessss, nurses, maids, and children of both sexes as the offenders. In Studies in Hysteria, he managed to name an uncle as the seducer in two cases. Many years later, Freud acknowledged that the "uncles" who had molested Rosaslia and Katharina were in fact their fathers. Though he had shown little reluctance to shock prudish sensibilities in other matters, Freud claimed that "discretion" had led him to suppress this essential information. Even though Freud had gone to such lengths to avoid publicly inculpating fathers, he remained so distressed by his seduction theory that within a year he repudiated it entirely. He concluded that his patients' numerous reports of sexual abuse were untrue. This conclusion was based not on any new evidence from patients, but rather on Freud's own growing unwillingness to believe that licentious behavior on the part of fathers could be so widespread. His correspondence of the period revealed that he was particularly troubled by awareness of his own incestuous wishes toward his daughter, and by suspicions of his father, who had died recently. p9-10

Mrs. Pocket was at home, and was in a little difficulty, on account of the baby's having been accommodated with a needle case to keep him quiet during the unaccountable absence (with a relative in the Foot Guards) of Millers. And more needles were missing than it could be regarded as quite wholesome for a patient of such tender years either to apply externally or to take as a tonic.

Research has also revealed that women who have developed PTSD in relation to early childhood sexual abuse often develop borderline personality disorder. Some severe cases will result in the development of dissociative identity disorder or depersonalization disorder. Patients who have been exposed to protracted and repeated sexual abuse may also develop schizophrenia simultaneously with PTSD.

IFS can be seen as attachment theory taken inside, in the sense that the client’s Self becomes the good attachment figure to their insecure or avoidant parts. I was initially amazed to discover that when I was able to help clients access their Self, they would spontaneously begin to relate to their parts in the loving way that the textbooks on attachment theory prescribed. This was true even for people who had never had good parenting in the first place. Not only would they listen to their young exiles with loving attention and hold them patiently while they cried, they would firmly but lovingly discipline the parts in the roles of inner critics or distractors. Self just knows how to be a good inner leader.

It is no coincidence then that doctors and patients and the entire Lyme community report—anecdotally, of course, as there is still a frustrating scarcity of good data on anything Lyme-related—that women suffer the most from Lyme. They tend to advance into chronic and late-stage forms of the illness most because often it's checked for last, as doctors often treat them as psychiatric cases first. The nebulous symptoms plus the fracturing of articulacy and cognitive fog can cause any Lyme patient to simply appear mentally ill and mentally ill only. This is why we hear that young women—again, anecdotally—are dying of Lyme the fastest. This is also why we hear that chronic illness is a women's burden. Women simply aren't allowed to be physically sick until they are mentally sick, too, and then it is by some miracle or accident that the two can be separated for proper diagnosis. In the end, every Lyme patient has some psychiatric diagnosis, too, if anything because of the hell it takes getting to a diagnosis.

Phosphatidylserine is a natural constituent of the cell membrane but is found in especially high concentrations in the brain. Supplementing with phosphatidylserine slows down memory loss and has been shown to reverse memory loss in some patients with age-related memory decline. It also lowers levels of cortisol, a principal hormone of aging.

Some dissociative parts of the personality, living in trauma time, may experience the same emotion no matter the situation, such as fear, rage, shame, sadness, yearning and even some positive ones just as joy. * Other parts have a broader range of feeling. Because emotions are often held in certain parts of the personality, different parts can have highly contradictory perceptions, emotions, and reactions to the same situation.” * This explains many feelings, emotions, and doubts about the unknown haunting us at times. * Awareness and discovering the inner world may help, tremendously.

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.

Brain scans prove that patients who’ve sustained significant childhood trauma have brains that look different from people who haven’t. Traumatized brains tend to have an enlarged amygdala—a part of the brain that is generally associated with producing feelings of fear. Which makes sense. But it goes further than that: For survivors of emotional abuse, the part of their brain that is associated with self-awareness and self-evaluation is shrunken and thin. Women who’ve suffered childhood sexual abuse have smaller somatosensory cortices—the part of the brain that registers sensation in our bodies. Victims who were screamed at might have an altered response to sound. Traumatized brains can result in reductions in the parts of the brain that process semantics, emotion and memory retrieval, perceiving emotions in others, and attention and speech. Not getting enough sleep at night potentially affects developing brains’ plasticity and attention and increases the risk of emotional problems later in life. And the scariest factoid, for me anyway: Child abuse is often associated with reduced thickness in the prefrontal cortex, the part of the brain associated with moderation, decision-making, complex thought, and logical reasoning. Brains do have workarounds. There are people without amygdalae who don’t feel fear. There are people who have reduced prefrontal cortices who are very logical. And other parts of the brain can compensate, make up the lost parts in other ways. But overall, when I looked at the breadth of evidence, the results felt crushing. The fact that the brain’s cortical thickness is directly related to IQ was particularly threatening to me. Even if I wasn’t cool, or kind, or personable, I enjoyed the narrative that I was at least effective. Intelligent. What these papers seemed to tell me is that however smart I am, I’m not as smart as I could have been had this not happened to me. The questions arose again: Is this why my pitches didn’t go through? Is this why my boss never respected me? Is this why I was pushed to do grunt work in the back room?

Another, related issue is that longevity itself, and healthspan in particular, doesn’t really fit into the business model of our current healthcare system. There are few insurance reimbursement codes for most of the largely preventive interventions that I believe are necessary to extend lifespan and healthspan. Health insurance companies won’t pay a doctor very much to tell a patient to change the way he eats, or to monitor his blood glucose levels in order to help prevent him from developing type 2 diabetes. Yet insurance will pay for this same patient’s (very expensive) insulin after he has been diagnosed. Similarly, there’s no billing code for putting a patient on a comprehensive exercise program designed to maintain her muscle mass and sense of balance while building her resistance to injury. But if she falls and breaks her hip, then her surgery and physical therapy will be covered. Nearly all the money flows to treatment rather than prevention—and when I say “prevention,” I mean prevention of human suffering.

Complaints of feeling cut off, shut off, out of touch, feeling apart or strange, of things being out of focus or unreal, of not feeling one with people, or of the point having gone out of life, interest flagging, things seeming futile and meaningless, all describe in various ways this state of mind. Patients usually call it 'depression', but it lacks the heavy, black, inner sense of brooding, of anger and of guilt, which are not difficult to discover in classic depression. Depression is really a more extraverted state of mind, which, while the patient is turning his aggression inwards against himself, is part of a struggle not to break out into overt angry and aggressive behaviour. The states described above are rather the 'schizoid states'. They are definitely introverted. Depression is object-relational. The schizoid person has renounced objects, even though he still needs them.

My reading had now shifted strongly to existential thinkers in fiction as well as philosophy: such authors as Dostoevsky, Tolstoy, Beckett, Kundera, Hesse, Mutis, and Hamsun were not dealing primarily with matters of social class, courtship, sexual pursuit, mystery, or revenge: their subjects were far deeper, touching on the parameters of existence. They struggled to find meaning in a meaningless world, openly confronting inevitable death and unbridgeable isolation. I related to these mortal quandaries. I felt they were telling my story: and not only my story, but also the story of every patient who had ever consulted me. More and more I grasped that many of the issues my patients struggled with — aging, loss, death, major life choices such as what profession to pursue or whom to marry — were often more cogently addressed by novelists and philosophers than by members of my own field.

The uneducated relatives of our patients—persons who are impressed only by the visible and tangible, preferably by such procedure as one sees in the moving picture theatres—never miss an opportunity of voicing their scepticism as to how one can "do anything for the malady through mere talk." Such thinking, of course, is as shortsighted as it is inconsistent. For these are the very persons who know with such certainty that the patients "merely imagine" their symptoms. Words

To restore the human subject at the center—the suffering, afflicted, fighting human subject—we must deepen a case history to a narrative or tale; only then do we have a “who” as well as a “what,” a real person, a patient, in relation to disease—in relation to the physical. The patient’s essential being is very relevant in the higher reaches of neurology, and in psychology; for here the patient’s personhood is essentially involved, and the study of disease and of identity cannot be disjoined.

I think it is cruel to expect the constant presence of any one family member (to tend to the ill). Just as we have to breathe in and breathe out, people have to "recharge their batteries" outside the sickroom at times, live a normal life from time to time; we cannot function efficiently in the constant awareness of illness. I have heard many relatives complain that members of the family went on pleasure trips over weekends or continued to go to the theater or movie. They blamed them for enjoying things while someone at home was terminally ill. I think it is more meaningful for the patient and his family to see that the illness does not totally disrupt a household or completely deprive all members of any pleasurable activities; rather, the illness may allow for a gradual adjustment and change toward the kind of home it is going to be when the patient is no longer around...The family too has a need to deny or avoid the sad realities at times in order to face them better when their presence is really needed.

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Ignore the conventional wisdom about what you should or should not be doing. It may make sense for some, but that does not mean it bears any relation to your own goals and destiny. You need to be patient enough to plot several steps ahead—to wage a campaign instead of fighting battles. The path to your goal may be indirect, your actions may be strange to other people, but so much the better: the less they understand you, the easier they are to deceive, manipulate, and seduce. Following this path, you will gain the calm, Olympian perspective that will separate you from other mortals, whether dreamers who get nothing done or prosaic, practical people who accomplish only small things.

I’m also relieved, because I’ve been waiting for this shoe to drop. His patient and unwavering commitment is superhuman. It’s not normal. For the first time, I got a flash of him being a regular insecure human and I find that relatable. I know how to react. This happy, sunny, constantly upbeat person is lovely, but I feel like it’s . . . a facade.

From the perspective of archetypal psychology, the survivor-perpetrator gains a unique vantage point on life. The devastation of the patient’s early life is juxtaposed with possession of a rare possibility of transforming his or her relationship to self, spirituality, and the human community in a way that non-traumatized individuals may never attain.

Tales of ordinary characters would appeal to a larger class , but I have no wish to make such an appeal . The opinions of the masses are of no interest to me , for praise can truly gratify only when it comes from a mind sharing the author's perspective . There are probably seven persons in all , who really like my work and they are enough . I should write even if I were the only patient reader , for my aim is merely self expression . I could not write about ' ordinary people ' because I am not in the least interested in them . Without interest there can be no art . Man's relations to man do not captivate my fancy . It is man's relations to the cosmos - to the unknown - which alone arouses in me the spark of creative imagination .

Accordingly, identification, or the formation of composite figures, serves different purposes: first, to represent a feature both persons have in common; secondly, to represent a displaced common feature; but thirdly, to find expression for a common feature that is merely wished for. Since wishing it to be the case that two people have something in common is often the same as exchanging them, this relation too is expressed in the dream by identification. In the dream of Irma's injection, I wish to exchange this patient for another, that is, I wish that the other were my patient, as Irma is; the dream takes account of the wish in showing me a figure who is called Irma, but who is examined in a posture in which I have only had occasion to see the other.

But how do you develop your intent? “You become extremely clear about what it is you want to do. Why is it you want to do what you do? How is it a reflection of your values? How does it relate to your unique purpose in life? What is it that you want to accomplish in society? Think about all of the inherent contradictions that are there, and then, if possible, reconcile them. This could take anywhere from a week to decades. This process of refinement—thinking about your intention many, many times—is, in a sense, a broadcast of intention. When you broadcast such an intention, there’s very little else you have to do. The broadcast of intention goes out and makes it happen. Your role is to remain keenly aware, patiently expectant, and open to all possibilities.

External relationships seem to have been emptied by a massive withdrawal of the real libidinal self. Effective mental activity has disappeared into a hidden inner world; the patient's conscious ego is emptied of vital feeling and action, and seems to have become unreal. You may catch glimpses of intense activity going on in the inner world through dreams and fantasies, but the patient's conscious ego merely reports these as if it were a neutral observer not personally involved in the inner drama of which it is a detached spectator. The attitude to the outer world is the same: non-involvement and observation at a distance without any feeling, like that of a press reporter describing a social gathering of which he is not a part, in which he has no personal interest, and by which he is bored. Such activity as is carried on may appear to be mechanical. When a schizoid state supervenes, the conscious ego appears to be in a state of suspended animation in between two worlds, internal and external, and having no real relationships with either of them. It has decreed an emotional and impulsive standstill, on the basis of keeping out of effective range and being unmoved.

Note to self: Try to extend positive feelings associated with Scratch-Off win into all areas of life. Be bigger presence at work. Race up ladder (joyfully, w/smile on face), get raise. Get in best shape of life, start dressing nicer. Learn guitar? Make point of noticing beauty of world? Why not educate self re. birds, flowers, trees, constellations, become true citizen of natural world, walk around neighborhood w/kids, patiently teaching kids names of birds, flowers, etc. etc.? Why not take kids to Europe? Kids have never been. Have never, in Alps, had hot chocolate in mountain café, served by kindly white-haired innkeeper, who finds them so sophisticated/friendly relative to usual snotty/rich American kids (who always ignore his pretty but crippled daughter w/braids) that he shows them secret hiking path to incredible glade, kids frolic in glade, sit with crippled pretty girl on grass, later say it was most beautiful day of their lives, keep in touch with crippled girl via email, we arrange surgery here for her, surgeon so touched he agrees to do surgery for free, she is on front page of our paper, we are on front page of their paper in Alps? Ha ha. Just happy.

This was fresh, rich, heavenly, succulent, soft, creamy, kiss-my-ass, cows-gotta-die-for-this, delightfully salty, moo-ass, good old white folks cheese, cheese to die for, cheese to make you happy, cheese to beat the cheese boss, cheese for the big cheese, cheese to end the world, cheese so good it inspired a line every first Saturday of the month: mothers, daughters, fathers, grandparents, disabled in wheelchairs, kids, relatives from out of town, white folks from nearby Brooklyn Heights, and even South American workers from the garbage-processing plant on Concord Avenue, all patiently standing in a line that stretched from the interior of Hot Sausage’s boiler room to Building 17’s outer doorway, up the ramp to the sidewalk, curling around the side of the building and to the plaza near the flagpole.

I have always been more violent in my negative than in my positive demands. Thus, in personal relations, I could forgive much neglect more easily than the least degree of what I regarded as interference. At table I could forgive much insipidity in my food more easily than the least suspicion of what seemed to me excessive or inappropriate seasoning. In the course of life I could put up with any amount of monotony far more patiently than even the smallest disturbance, bother, bustle, or what the Scotch call "kerfuffle". Never at any age did I clamor to be amused always and at all ages (where I dared I hotly demanded not to be interrupted.

In perhaps the most revealing of all the health-related studies, a group of subjects who had contracted malignant melanoma received traditional treatment and then were divided into two groups. One group met weekly for only six weeks; the other did not. Facilitators taught the first group of recovering patients specific communication skills. (When it's your life that's at stake, could anything be more crucial?) After meeting only six times and then dispersing for five years, the subjects who learned how to express themselves effectively had a higher survival rate--only 9 percent succumbed as opposed to almost 30 percent in the untrained group.

I want to use this practice: Whenever I express my views, thoughts or anything I deeply believe, I will welcome any opposing view or thought. I will listen with caring attention to what the other says, accepting it no matter how different or antagonistic it seems to be. I will also deeply and sincerely thank them. I will abstain from feeling accused or judged. I will acknowledge the other as my shadow, an integral part of me who has accepted to relate with me. I believe that a vision in order to manifest requires its opposite, the other polarity. If my vision is truly holistic, I am not in a condition to oppose any alternative vision. I intend to learn to accept what appears to be opposite, no matter how unpleasant or contrary it is. I believe that only in the paradox of this acceptance, in releasing the urge to be right, unity can be experienced and manifested. I have tried all other options, and they have not worked, and this is the only I have left. And for this purpose I am open to be patient, promoting the gestation of this healing process, for I know that all is one.

Instead of showing visibly distinct alternate identities, the typical DID patient presents a polysymptomatic mixture of dissociative and posttraumatic stressdisorder (PTSD) symptoms that are embedded in a matrix of ostensibly non-trauma-related symptoms (e.g., depression, panic attacks, substance abuse,somatoform symptoms, eating-disordered symptoms). The prominence of these latter, highly familiar symptoms often leads clinicians to diagnose only these comorbid conditions. When this happens, the undiagnosed DID patient may undergo a long and frequently unsuccessful treatment for these other conditions. - Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, p5

Words are never frail. They have all the powers to change the personality and features of a man. The way he relates and depicts the things are based on the words he discovers. At one point where words portray happiness for someone, it also counts for the tears to some. The day we comprehend the strength of words, we would choose them more closely and patiently. Where we would prefer silence more over words. If words are our strength, they are our weakness too.

first started therapy, I found it very hard to cry. I feared I’d be carried away by the flood, overwhelmed. Perhaps that’s what it feels like for you. That’s why it’s important to take your time to feel safe, and trust that you won’t be alone in this flood – that I’m treading water here with you.’ Silence. ‘I think of myself as a relational therapist,’ I said. ‘Do you know what that means?’ Silence. ‘It means I think Freud was wrong about a couple of things. I don’t believe a therapist can ever really be a blank slate, as he intended. We leak all kinds of information about ourselves unintentionally – by the colour of my socks, or how I sit or the way I talk – just by sitting here with you, I reveal a great deal about myself. Despite my best efforts at invisibility, I’m showing you who I am.’ Alicia looked up. She stared at me, her chin slightly tilted – was there a challenge in that look? At last I had her attention. I shifted in my seat. ‘The point is, what can we do about this? We can ignore it, and deny it, and pretend this therapy is all about you. Or we can acknowledge that this is a two-way street, and work with that. And then we can really start to get somewhere.’ I held up my hand. I nodded at my wedding ring. ‘This ring tells you something, doesn’t it?’ Alicia’s eyes ever-so-slowly moved in the direction of the ring. ‘It tells you I’m a married man. It tells you I have a

Trust of others is in short supply for many adult survivors, as complex trauma generally involves major relational betrayal. It is, therefore, expectable (although paradoxical) that clients with these histories are predisposed to be mistrustful at the outset of therapy, precisely because of (and in proportion to) the actual trustworthiness of the therapist. When past experiences have thought hard lessons, namely, that one can least afford to trust the people who should be most trustworthy, it stands to reason that confusion about trust results. The therapist must understand and not take offense either personally or professionally and not react judgmentally or defensively. Practically speaking, this involves the therapist being prepared to patiently and empathically respond to active or passive tests or challenges to trustworthiness as legitimate and meaningful communication that deserves a respectful reply in action as well as in words.

thought,’ he said presently, with patient mildness, ‘you knew I have a mother and sisters.’ ‘Mothers and sisters aren’t women—they’re merely relations,’ said Christopher; and from that time Lewes’s inquiries were less frequent and more gingerly, and mixed with anxiety. He was fond of his friend. He disliked the idea of possibly losing him. He seemed to him to be well on the way to being in love seriously; and love, as he had observed it, was a great sunderer of friendships.

McKusick's belief in this paradigm-the focus on disability rather than abnormalcy-was actualized in the treatment of patients in his clinic. Patients with dwarfism, for instance, were treated by an interdisciplinary team of genetic counselors, neurologists, orthopedic surgeons, nurses, and psychiatrists trained to focus on specific disabilities of persons with short stature. Surgical interventions were reserved to correct specific deformities as they arose. The goal was not to restore "normalcy"-but vitality, joy, and function. McKusic had rediscovered the founding principles of modern genetics in the realm of human pathology. In humans as in wild flies, genetic variations abounded. Here too genetic variants, environments, and gene-environment interactions ultimately collaborated to cause phenotypes-except in this case, the "phenotype" in question was disease. Here too some genes had partial penetrance and widely variable expressivity. One gene could cause many diseases, and one disease could be caused by many genes. And here too "fitness" could not be judged in absolutes. Rather the lack of fitness-illness [italicized, sic] in colloquial terms- was defined by the relative mismatch between an organism and environment.

Secondary structural dissociation involves one ANP and more than one EP. Examples of secondary structural dissociation are complex PTSD, complex forms of acute stress disorder, complex dissociative amnesia, complex somatoform disorders, some forms of trauma-relayed personality disorders, such as borderline personality disorder, and dissociative disorder not otherwise specified (DDNOS).. Secondary structural dissociation is characterized by divideness of two or more defensive subsystems. For example, there may be different EPs that are devoted to flight, fight or freeze, total submission, and so on. (Van der Hart et al., 2004). Gail, a patient of mine, does not have a personality disorder, but describes herself as a "changed person." She survived a horrific car accident that killed several others, and in which she was the driver. Someone not knowing her history might see her as a relatively normal, somewhat anxious and stiff person (ANP). It would not occur to this observer that only a year before, Gail had been a different person: fun-loving, spontaneous, flexible, and untroubled by frightening nightmares and constant anxiety. Fortunately, Gail has been willing to pay attention to her EPs; she has been able to put the process of integration in motion; and she has been able to heal. p134

Suffering seems to destroy so many things that give life meaning that it may feel impossible to even go on. In the last weeks of his life, my father faced a great range of life-ending, painful illnesses all at once. He had congestive heart failure and three kinds of cancer, even as he was dealing with a gall bladder attack, emphysema, and acute sciatica. At one time he said to a friend, "What's the point?" He was too sick to do the things that made his life meaningful- so why go on? At my father's funeral, his friend related to us how he gently reminded my father of some basic themes in the Bible. If God had kept him in this world, then there were still some things for him to do for those around him. Jesus was patient under even greater suffering for us, so we can be patient under lesser suffering for him. and heaven will make amends for everything.

Our inner experience is that which we think, feel, remember, perceive, sense, decide, plan and predict. These experiences are actually mental actions, or mental activity (Van der Hart et al., 2006). Mental activity, in which we engage all the time, may or may not be accompanied by behavioral actions. It is essential that you become aware of, learn to tolerate and regulate, and even change major mental actions that affect your current life, such as negative beliefs, and feelings or reactions to the past the interfere with the present. However, it is impossible to change inner experiences if you are avoiding them because you are afraid, ashamed or disgusted by them. Serious avoidance of you inner experiences is called experiential avoidance (Hayes, Wilson, Gifford, & Follettte, 1996), or the phobia of inner experience (Steele, Van der Hart, & Nijenhuis, 2005; Van der Hart et al., 2006).

I tend to interpret that whole 'everyone's wife is a Mossad agent' thing in a more sort of metaphorical way--that people you're intimate with might be, like, 'double agents,' y'know? It's a weird kind of paranoia you get about people you love--that they might turn out to be completely different from who you think they are, that it's all been some sort of diabolically patient plot against you. I think that's a pretty normal fear you have in any serious relationship. And that's why it's such a popular part of the epic, because so many people can relate to that fear. But personally, I don't really worry about it too much.

In these pages, we keep returning to one foundational principle: providing the possibility of emotional/relational safety for our people, be they patients, children, partners, friends or strangers. We are able to make this offer when they are experiencing their own neuroception of safety, not continuously, but as the baseline to which we return after our system has adaptively moved into sympathetic arousal or dorsal withdrawal in response to inner and outer conditions. When we neuroceive safety, we humans automatically begin to open into vulnerability, and the movement of our "inherent treatment plan" (Sills, 2010) has a greater probability of coming forward. When we have a neuroception of threat, we adaptively tighten down at many levels, from physical tension to activation of the protective skills we have learned over a lifetime (Levine, 2010). In that state, our innate healing path will often wisely stay hidden until more favorable conditions arrive.

Be bigger presence at work. Race up ladder (joyfully, w/smile on face), get raise. Get in best shape of life, start dressing nicer. Learn guitar? Make point of noticing beauty of world? Why not educate self re. birds, flowers, trees, constellations, become true citizen of natural world, walk around neighborhood w/kids, patiently teaching kids names of birds, flowers, etc. etc.? Why not take kids to Europe? Kids have never been. Have never, in Alps, had hot chocolate in mountain café, served by kindly white- haired innkeeper, who finds them so sophisticated/friendly relative to usual snotty/rich American kids (who always ignore his pretty but crippled daughter w/braids) that he shows them secret hiking path to incredible glade, kids frolic in glade, sit with crippled pretty girl on grass, later say it was most beautiful day of their lives, keep in touch with crippled girl via email, we arrange surgery here for her, surgeon so touched he agrees to do surgery for free, she is on front page of our paper, we are on front page of their paper in Alps? Ha ha.

Hello." Her mood deflated as if she'd been pricked with a pin. "Alan." "Shelby." She struggled not to be moved by the quiet,serious tone that should never have moved her.She liked men with a laugh in their voice. "Alan, this has to stop." "Does it? It hasn't even started." "Alan-" She tried to remember her decision to be firm. "I mean it. You have to stop sending me things. You're only wasting your time." "I have a bit to spare," he said mildly. "How was your week?" "Busy.Listen,I-" "I missed you." The simple statement threw the rest of her lecture into oblivion. "Alan, don't -" "Everyday," he continued. "Every night. Have you been to Boston, Shelby?" "Uh...yes," she managed, busy fighting off the weakness creeping into her. Helplessly she stared up at the balloons. How could she fight something so insubstantial it floated? "I'd like to take you there in the fall, when it smells of damp leaves and smoke." Shelby told herself her heart was not fluttering. "Alan, I didn't call to talk about Boston.Now,to put it in very simple terms,I want you to stop calling me, I want you to stop dropping by, and -" Her voice began to rise in frustration as she pictured him listening with that patient, serious smile and calm eyes. "I want you to stop sending me balloons and pigs and everything! Is that clear?" "Perfectly.Spend the day with me." Did the man ever stop being patient? She couldn't abide patient men. "For God's sake, Alan!" "We'll call it an experimental outing," he suggested in the same even tone. "Not a date." "No!" she said, barely choking back a laugh. Couldn't abide it, she tried to remember.She preferred the flashy, the freewheeling. "No,no,no!" "Not bureaucratic enough." His voice was so calm,so...so senatorial, she decided, she wanted to scream. But the scream bubbled perilously close to another laugh. "All right, let me think-a standard daytime expedition for furthering amiable relations between opposing clans." "You're trying to be charming again," Shelby muttered. "Am I succeeding?

PERIODIC MOOD-CHANGES We have already spoken of the affective concomitants of common migraines—elated and irritable prodromal states, states of dread and depression associated with the main phase of the attack, and states of euphoric rebound. Any or all of these may be abstracted as isolated periodic symptoms of relatively short duration—some hours, or at most two or three days, and as such may present themselves as primary emotional disorders. The most acute of these mood-changes, generally no more than an hour in duration, usually represents concomitants or equivalents of migraine aura. We may confine our attention at this stage to attacks of depression, or truncated manic-depressive cycles, occurring at intervals in patients who have previously suffered from attacks of undoubted (classical, common, abdominal, etc.) migraine.

Twelfthly, there is no reason or sense-perception which, since we accept an infinity undivided, utterly simple and all-embracing, will not permit also a corporeal and extended infinity. Thirteenthly, our own surrounding space which appeareth to us so immense is neither part nor whole in relation to the infinite; nor can it be patient of infinite activity; compared to such activity, indeed, that which can be comprehended by our imbecile minds is merely nonbeing. And to a certain objection it may be replied that we base our argument for infinity not on the dignity of space but on the dignity of the natures [of worlds], since for the same reason that our space doth exist, so also should exist every other possible world; and their power of being is not actuated by our world's being, just as Elpino's power of being is not actuated by the existence of Fracastoro.

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.

Collectively this work suggests that the prefrontal cortex and the amygdala are reciprocally related. That is, in order for the amygdala to respond to fear reactions, the prefrontal region has to be shut down. By the same logic, when the prefrontal region is active, the amygdala would be inhibited, making it harder to express fear. Pathological fear, then, may occur when the amygdala is unchecked by the prefrontal cortex, and treatment of pathological fear may require that the patient learn to increase activity in the prefrontal region so that the amygdala is less free to express fear. Clearly, decision-making ability in emotional situations is impaired in humans with damage to the medial and ventral prefrontal cortex, and abnormalities there also may predispose people to develop fear and anxiety disorders. These abnormalities could be due to genetic or epigenetic organization of prefrontal synapses or to experiences that subtly alter prefrontal synaptic connections. Indeed, the behavior of animals with abmormalities of the medial prefrontal cortex is reminiscent of humans with anxiety disorders: they develop fear reactions that are difficult to regulate. Although objective information about the world may indicate that a situation is not dangerous, because they cannot properly regulate fear circuits, they experience fear and anxiety in these safe situations.

Though diagnosis is unquestionably critical in treatment considerations for many severe conditions with a biological substrate (for example, schizophrenia, bipolar disorders, major affective disorders, temporal lobe epilepsy, drug toxicity, organic or brain disease from toxins, degenerative causes, or infectious agents), diagnosis is often counterproductive in the everyday psychotherapy of less severely impaired patients. Why? For one thing, psychotherapy consists of a gradual unfolding process wherein the therapist attempts to know the patient as fully as possible. A diagnosis limits vision; it diminishes ability to relate to the other as a person. Once we make a diagnosis, we tend to selectively inattend to aspects of the patient that do not fit into that particular diagnosis, and correspondingly overattend to subtle features that appear to confirm an initial diagnosis. What’s more, a diagnosis may act as a self-fulfilling prophecy. Relating to a patient as a “borderline” or a “hysteric” may serve to stimulate and perpetuate those very traits. Indeed, there is a long history of iatrogenic influence on the shape of clinical entities, including the current controversy about multiple-personality disorder and repressed memories of sexual abuse. And keep in mind, too, the low reliability of the DSM personality disorder category (the very patients often engaging in longer-term psychotherapy).

You know, of course, that as prophesied by Moroni, there are those whose research relating to Joseph Smith is not for the purpose of gaining added light and knowledge but to undermine his character, magnify his flaws, and if possible destroy his influence. Their work product can sometimes be jarring, and so can issues raised at times by honest historians and researchers with no “axe to grind.” But I would offer you this advice in your own study: Be patient, don’t be superficial, and don’t ignore the Spirit. In counseling patience, I simply mean that while some answers come quickly or with little effort, others are simply not available for the moment because information or evidence is lacking. Don’t suppose, however, that a lack of evidence about something today means that evidence doesn’t exist or that it will not be forthcoming in the future. The absence of evidence is not proof. . . . When I say don’t be superficial, I mean don’t form conclusions based on unexamined assertions or incomplete research, and don’t be influenced by insincere seekers. I would offer you the advice of our Assistant Church Historian, Rick Turley, an intellectually gifted researcher and author whose recent works include the definitive history of the Mountain Meadows Massacre. He says simply, “Don’t study Church history too little.” While some honestly pursue truth and real understanding, others are intent on finding or creating doubts. Their interpretations may come from projecting 21st Century concepts and culture backward onto 19th Century people. If there are differing interpretations possible, they will pick the most negative. They sometimes accuse the Church of hiding something because they only recently found or heard about it—an interesting accusation for a Church that’s publishing 24 volumes of all it can find of Joseph Smith’s papers. They may share their assumptions and speculations with some glee, but either can’t or won’t search further to find contradictory information. . . . A complete understanding can never be attained by scholarly research alone, especially since much of what is needed is either lost or never existed. There is no benefit in imposing artificial limits on ourselves that cut off the light of Christ and the revelations of the Holy Spirit. Remember, “By the power of the Holy Ghost, ye may know the truth of all things.” . . . If you determine to sit still, paralyzed until every question is answered and every whisper of doubt resolved, you will never move because in this life there will always be some issue pending or something yet unexplained.

Anxiety (loneliness or “abandonment anxiety” being its most painful form) overcomes the person to the extent that he loses orientation in the objective world. To lose the world is to lose one's self, and vice versa; self and world are correlates. The function of anxiety is to destroy the self-world relationship, i.e., to disorient the victim in space and time and, so long as this disorientation lasts, the person remains in the state of anxiety. Anxiety overwhelms the person precisely because of the preservation of this disorientation. Now if the person can reorient himself—as happens, one hopes, in psychotherapy—and again relate himself to the world directly, experientially, with his senses alive, he overcomes the anxiety. My slightly anthropomorphic terminology comes out of my work as a therapist and is not out of place here. Though the patient and I are entirely aware of the symbolic nature of this (anxiety doesn’t do anything, just as libido or sex drives don’t), it is often helpful for the patient to see himself as struggling against an “adversary.” For then, instead of waiting forever for the therapy to analyze away the anxiety, he can help in his own treatment by taking practical steps when he experiences anxiety such as stopping and asking just what it was that occurred in reality or in his fantasies that preceded the disorientation which cued off the anxiety. He is not only opening the doors of his closet where the ghosts hide, but he often can also then take steps to reorient himself in his practical life by making new human relationships and finding new work which interests him.

The most notorious story is the Trovan antibiotic study conducted by Pfizer in Kano, Nigeria, during a meningitis epidemic. An experimental new antibiotic was compared, in a randomised trial, with a low dose of a competing antibiotic that was known to be effective. Eleven children died, roughly the same number from each group. Crucially, the participants were apparently not informed about the experimental nature of the treatments, and moreover, they were not informed that a treatment known to be effective was available, immediately, from Médecins sans Frontières next door at the very same facility. Pfizer argued in court – successfully – that there was no international norm requiring it to get informed consent for a trial involving experimental drugs in Africa, so the cases relating to the trial should be heard in Nigeria only. That’s a chilling thing to hear a company claim about experimental drug trials, and it was knocked back in 2006 when the Nigerian Ministry of Health released its report on the trial. This stated that Pfizer had violated Nigerian law, the UN Convention on the Rights of the Child and the Declaration of Helsinki.

Over the years I have seen the power of taking an unconditional relationship to life. I am surprised to have found a sort of willingness to show up for whatever life may offer and meet with it rather than wishing to edit and change the inevitable...When people begin to take such an attitude, they seem to become intensely alive, intensely present. Their losses and suffering have not caused them to reject life, have not cast them into a place of resentment, victimization, or bitterness. From such people, I have learned a new definition of the word 'joy.' I had thought joy to be rather synonymous with happiness, but it seems now to be far less vulnerable than happiness. Joy seems to be part of an unconditional wish to live, not holding back because life may not meet our preferences and expectations. Joy seems to be a function of the willingness to accept the whole, and to show up to meet with whatever is there. It has a kind of invincibility that attachment to any particular outcome would deny us. Rather than the warrior who fights toward a specific outcome and therefore is haunted by the specter of failure and disappointment, it is the lover drunk with the opportunity to love despite the possibility of loss, the player for whom playing has become more important than winning or losing. The willingness to win or lose moves us out of an adversarial relationship to life and into a powerful kind of openness. From such a position, we can make a greater commitment to life. Not only pleasant life, or comfortable life, or our idea of life, but all life. Joy seems more closely related to aliveness than happiness. The strength that I notice developing in many of my patients and in myself after all these years could almost be called a form of curiosity. What one of my colleagues calls fearlessness. At one level, of course, I fear outcome as much as anyone. But more and more I am able to move in and out of that and to experience a place beyond preference for outcome, a life beyond life and death. It is a place of freedom, even anticipation. Decisions made from this perspective are life-affirming and not fear-driven. It is a grace.

Appendix 1 Seven Points and Fifty-Nine Slogans for Generating Compassion and Resilience POINT ONE Resolve to Begin 1. Train in the preliminaries. POINT TWO Train in Empathy and Compassion: Absolute Compassion 2. See everything as a dream. 3. Examine the nature of awareness. 4. Don’t get stuck on peace. 5. Rest in the openness of mind. 6. In Postmeditation be a child of illusion. POINT TWO Train in Empathy and Compassion: Relative Compassion 7. Practice sending and receiving alternately on the breath. 8. Begin sending and receiving practice with yourself. 9. Turn things around (Three objects, three poisons, three virtues). 10. Always train with the slogans. POINT THREE Transform Bad Circumstances into the Path 11. Turn all mishaps into the path. 12. Drive all blames into one. 13. Be grateful to everyone. 14. See confusion as Buddha and practice emptiness. 15. Do good, avoid evil, appreciate your lunacy, pray for help. 16. Whatever you meet is the path. POINT FOUR Make Practice Your Whole Life 17. Cultivate a serious attitude (Practice the five strengths). 18. Practice for death as well as for life. POINT FIVE Assess and Extend 19. There’s only one point. 20. Trust your own eyes. 21. Maintain joy (and don’t lose your sense of humor). 22. Practice when you’re distracted. POINT SIX The Discipline of Relationship 23. Come back to basics. 24. Don’t be a phony. 25. Don’t talk about faults. 26. Don’t figure others out. 27. Work with your biggest problems first. 28. Abandon hope. 29. Don’t poison yourself. 30. Don’t be so predictable. 31. Don’t malign others. 32. Don’t wait in ambush. 33. Don’t make everything so painful. 34. Don’t unload on everyone. 35. Don’t go so fast. 36. Don’t be tricky. 37. Don’t make gods into demons. 38. Don’t rejoice at others’ pain. POINT SEVEN Living with Ease in a Crazy World 39. Keep a single intention. 40. Correct all wrongs with one intention. 41. Begin at the beginning, end at the end. 42. Be patient either way. 43. Observe, even if it costs you everything. 44. Train in three difficulties. 45. Take on the three causes. 46. Don’t lose track. 47. Keep the three inseparable. 48. Train wholeheartedly, openly, and constantly. 49. Stay close to your resentment. 50. Don’t be swayed by circumstances. 51. This time get it right! 52. Don’t misinterpret. 53. Don’t vacillate. 54. Be wholehearted. 55. Examine and analyze. 56. Don’t wallow. 57. Don’t be jealous. 58. Don’t be frivolous. 59. Don’t expect applause.

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

The last refuge of the Self, perhaps, is “physical continuity.” Despite the body’s mercurial nature, it feels like a badge of identity we have carried since the time of our earliest childhood memories. A thought experiment dreamed up in the 1980s by British philosopher Derek Parfit illustrates how important—yet deceiving—this sense of physical continuity is to us.15 He invites us to imagine a future in which the limitations of conventional space travel—of transporting the frail human body to another planet at relatively slow speeds—have been solved by beaming radio waves encoding all the data needed to assemble the passenger to their chosen destination. You step into a machine resembling a photo booth, called a teletransporter, which logs every atom in your body then sends the information at the speed of light to a replicator on Mars, say. This rebuilds your body atom by atom using local stocks of carbon, oxygen, hydrogen, and so on. Unfortunately, the high energies needed to scan your body with the required precision vaporize it—but that’s okay because the replicator on Mars faithfully reproduces the structure of your brain nerve by nerve, synapse by synapse. You step into the teletransporter, press the green button, and an instant later materialize on Mars and can continue your existence where you left off. The person who steps out of the machine at the other end not only looks just like you, but etched into his or her brain are all your personality traits and memories, right down to the memory of eating breakfast that morning and your last thought before you pressed the green button. If you are a fan of Star Trek, you may be perfectly happy to use this new mode of space travel, since this is more or less what the USS Enterprise’s transporter does when it beams its crew down to alien planets and back up again. But now Parfit asks us to imagine that a few years after you first use the teletransporter comes the announcement that it has been upgraded in such a way that your original body can be scanned without destroying it. You decide to give it a go. You pay the fare, step into the booth, and press the button. Nothing seems to happen, apart from a slight tingling sensation, but you wait patiently and sure enough, forty-five minutes later, an image of your new self pops up on the video link and you spend the next few minutes having a surreal conversation with yourself on Mars. Then comes some bad news. A technician cheerfully informs you that there have been some teething problems with the upgraded teletransporter. The scanning process has irreparably damaged your internal organs, so whereas your replica on Mars is absolutely fine and will carry on your life where you left off, this body here on Earth will die within a few hours. Would you care to accompany her to the mortuary? Now how do you feel? There is no difference in outcome between this scenario and what happened in the old scanner—there will still be one surviving “you”—but now it somehow feels as though it’s the real you facing the horror of imminent annihilation. Parfit nevertheless uses this thought experiment to argue that the only criterion that can rationally be used to judge whether a person has survived is not the physical continuity of a body but “psychological continuity”—having the same memories and personality traits as the most recent version of yourself. Buddhists