The Final Diagnosis Quotes

The traumatized person is often relieved simply to learn the true name of her condition. By ascertaining her diagnosis, she begins the process of mastery. No longer imprisoned in the wordlessness of the trauma, she discovers that there is a language for her experience. She discovers that she is not alone; others have suffered in similar ways. She discovers further that she is not crazy; the traumatic syndromes are normal human responses to extreme circumstances. And she discovers, finally, that she is not doomed to suffer this condition indefinitely; she can expect to recover, as others have recovered...

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

I am truly crazy, I told myself. It's over. I am not fixable. I cannot tell Tom. I cannot even tell Francisco. So I won't tell anyone. My brain seemed out of control. Tom does not deserve a crazy wife and my children do not deserve a crazy mother. I finally get it. This is not just repressed memory. This is dissociative identity disorder.

Does it make you feel superior to give them a diagnosis, to file them away in a little drawer? You know they’re bigger than that. If it were just a psychological problem we could find a cure.

Finally, at age seventy, Goodman was able to get the diagnosis and access to services he needed. Joining a support group for adults run by the Asperger’s Association of New England, he says, was “like coming ashore after a life of bobbing up and down in a sea that seemed to stretch to infinity in all directions.

It is no wonder that I had tears of relief, to find out, finally, the truth - to discover an explanation, a diagnosis that explained not one or two of my symptoms or behaviours but ALL of them. Finally, someone saw me

Finally, those who do not meet the SCID-D-R standard for "distinct identities or personality states," but who do meet the SCID-D-R's other four standards (for DSM-IV's Criterion A and Criterion B) for DID, receive a SCID-D-R diagnosis of DDNOS-1a.

The patron saint of lost causes,' adds Julia, taking the statue from Harold, and the words come to him at once; Pray for us, Saint Jude, helper and keeper of the hopeless, pray for us – when he was a child, it was his final prayer of the night, and it wasn't until he was older that he would be ashamed of his name, of how it seemed to announce him to the world, and would wonder if the brothers had intended it as he was certain others saw it. as a mockery; as a diagnosis; as a prediction. And yet it also felt, at times, like it was all that was truly his, and although there had been moments he could have, even should have changed it, he never did.

The diagnosis of the human plight is then not simply that humans have broken God’s moral law, offending and insulting the Creator, whose image they bear—though that is true as well. This lawbreaking is a symptom of a much more serious disease. Morality is important, but it isn’t the whole story. Called to responsibility and authority within and over the creation, humans have turned their vocation upside down, giving worship and allegiance to forces and powers within creation itself. The name for this is idolatry. The result is slavery and finally death.

Sentimentality, he reflected, was an aid and comfort to the opponents of progress.

shrugging

Whenever I hear of someone else's tragedy, I do not dwell on the accident or diagnosis, or even the initial shock waves or aftermath of grief. Instead, I find myself reconstructing those final ordinary moments. Moments that make up our lives. Moments that were blissfully taken for granted--and that likely would have been forgotten altogether but for what followed. The before snapshots.

При патологията имаше и нещо друго. Тук твърде лесно можеше да изгубиш чувството си за реалност, убедеността си, че медицината е призвана да служи на хората. Ето този мозък например... Та само преди броени часове той е бил център на съзнанието на един човек. Координирал е усещанията му - докосване, мирис, вкус... Имал е мисли, познавал е любовта, страха, победата... Вчера, дори днес, този мозък е карал очите да плачат, устата да говори... Човекът е бил строителен инженер. Следователно този мозък е боравел с математически категории, понасял е умствено натоварване, строил е жилища или пък пътища, язовири, катедрали... Помагал е на други човешки същества да живеят по-добре. А какво представлява сега? Известно количество тъкан, която ще бъде нарязана на филии, изследвана и после изгорена.

life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close. I was physically debilitated, my imagined future and my personal identity collapsed, and I faced the same existential quandaries my patients faced. The lung cancer diagnosis was confirmed. My carefully planned and hard-won future no longer existed. Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-to-face, and yet nothing about it seemed recognizable. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.

The root of disaster means a star coming apart, and no image expresses better the look in a patient’s eyes when hearing a neurosurgeon’s diagnosis. Sometimes the news so shocks the mind that the brain suffers an electrical short. This phenomenon is known as a “psychogenic” syndrome, a severe version of the swoon some experience after hearing bad news. When my mother, alone at college, heard that her father, who had championed her right to an education in rural 1960s India, had finally died after a long hospitalization, she had a psychogenic seizure—which continued until she returned home to attend the funeral.

The implication that the change in nomenclature from “Multiple Personality Disorder” to “Dissociative Identity Disorder” means the condition has been repudiated and “dropped” from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association is false and misleading. Many if not most diagnostic entities have been renamed or have had their names modified as psychiatry changes in its conceptualizations and classifications of mental illnesses. When the DSM decided to go with “Dissociative Identity Disorder” it put “(formerly multiple personality disorder)” right after the new name to signify that it was the same condition. It’s right there on page 526 of DSM-IV-R. There have been four different names for this condition in the DSMs over the course of my career. I was part of the group that developed and wrote successive descriptions and diagnostic criteria for this condition for DSM-III-R, DSM–IV, and DSM-IV-TR. While some patients have been hurt by the impact of material that proves to be inaccurate, there is no evidence that scientifically demonstrates the prevalence of such events. Most material alleged to be false has been disputed by someone, but has not been proven false. Finally, however intriguing the idea of encouraging forgetting troubling material may seem, there is no evidence that it is either effective or safe as a general approach to treatment. There is considerable belief that when such material is put out of mind, it creates symptoms indirectly, from “behind the scenes.” Ironically, such efforts purport to cure some dissociative phenomena by encouraging others, such as Dissociative Amnesia.

But then there are other cases… Cases in which the narrative of disease strays off the expected path, where the usual suspects all seem to have alibis, and the diagnosis is elusive. For these, the doctor must don her deerstalker cap and unravel the mystery. It is in these instances where medicine can rise once again to the level of an art and the doctor-detective must pick apart the tangled strands of illness, understand which questions to ask, recognize the subtle physical findings, and identify which tests might lead, finally, to the right diagnosis.

So when people like the folks you’ll read about in the next few chapters healed themselves using the placebo effect, what did they do differently? First, they didn’t accept the finality of their diagnosis, prognosis, or treatment. Nor did they believe in the most probable outcome or future destiny that their doctors had authoritatively outlined. Finally, they didn’t surrender to the diagnosis, prognosis, or suggested treatment. Because they had a different attitude from those who did accept, believe, and surrender, they were in a different state of being.

Once I had found the courage to tell Rebecca about the children in my head, it wasn't so hard in the coming months to tell Roberta. On the train from Huddersfield one day in May I made a roll call of the usual suspects: Baby Alice; Alice 2, who was two years old and liked to suck sticky lollipops; Billy; Samuel; Shirley; Kato; and the enigmatic Eliza. There was boy I would grow particularly fond of named limbo, who was ten, but like Eliza he was still forming. There were others without names or specific behaviour traits. I didn't want to confuse the issue with this crowd of 'others' and just counted off the major players with their names, ages and personalities, which Roberta scribbled down on a pad. Then she looked slightly embarrassed. 'You know, I've met Billy on a few occasions, and Samuel once too,' she said. 'You're joking.' I felt betrayed. 'Why didn't you tell me?' 'I wanted it to come from you, Alice, when you were ready.' For some reason I pulled up my sleeves and showed he my arms. 'That's Kato,' I said, 'or Shirley.' She looked a bit pale as she studied the scars. I had feeling she didn't know what to say. The problem with counsellors is that they are trained to listen, not to give advice or diagnosis. We sat there with my arms extended over the void between us like evidence in court, then I pushed down my sleeves again. 'I'm so sorry, Alice,' she said finally and I shrugged. 'It's not your fault, is it?' Now she shrugged, and we were quiet once more.

Within this narrative, creation itself is understood as a kind of Temple, a heaven-and-earth duality, where humans function as the “image-bearers” in the cosmic Temple, part of earth yet reflecting the life and love of heaven. This is how creation was designed to function and flourish: under the stewardship of the image-bearers. Humans are called not just to keep certain moral standards in the present and to enjoy God’s presence here and hereafter, but to celebrate, worship, procreate, and take responsibility within the rich, vivid developing life of creation. According to Genesis, that is what humans were made for. The diagnosis of the human plight is then not simply that humans have broken God’s moral law, offending and insulting the Creator, whose image they bear—though that is true as well. This lawbreaking is a symptom of a much more serious disease. Morality is important, but it isn’t the whole story. Called to responsibility and authority within and over the creation, humans have turned their vocation upside down, giving worship and allegiance to forces and powers within creation itself. The name for this is idolatry. The result is slavery and finally death. It isn’t just that humans do wrong things and so incur punishment. This is one element of the larger problem, which isn’t so much about a punishment that might seem almost arbitrary, perhaps even draconian; it is, rather, about direct consequences. When we worship and serve forces within the creation (the creation for which we were supposed to be responsible!), we hand over our power to other forces only too happy to usurp our position. We humans have thus, by abrogating our own vocation, handed our power and authority to nondivine and nonhuman forces, which have then run rampant, spoiling human lives, ravaging the beautiful creation, and doing their best to turn God’s world into a hell (and hence into a place from which people might want to escape). As I indicated earlier, some of these “forces” are familiar (money, sex, power). Some are less familiar in the popular mind, not least the sense of a dark, accusing “power” standing behind all the rest. Called

If she was gone when I got back, I’d lose my fucking mind. She’d said she’d stay, and she usually did what she said she would. But this thing had her shaken, and I couldn’t wait forty-eight hours to run after her if she took off on me again. I’d go insane. My mind was exhausted. I hadn’t slept last night. I didn’t fully absorb everything she’d said in the kitchen and some of it began to catch up to me now. I didn’t come here to tell you so you could decide whether you want to date me. That’s not even on the table. If Kristen thought I was going to let her go, she was fucking nuts. Not now that I knew she loved me. Not ever. I finally understood the kind of love that made men give up everything. The kind that made someone change religions or go vegan or move to the other side of the world to be with the woman they loved. If someone had told me six months ago that I’d choose a woman who couldn’t have kids, I’d have called him crazy. But being with her wasn’t even something I had to think about. I did want kids. But I wanted her first. Everything else was just everything else. Sure, a part of me grieved a life I knew I wouldn’t have now. Kids that I’d never meet, a future different from the one I’d spent the last few years wanting. But I processed it like I’d been the one who just got a diagnosis. Because in a way, I had. This thing didn’t feel like her problem. It felt like our problem, to figure out together. It was as much mine as it was hers.

Read the following chain of events and see whether a similar pattern might apply to other toxic products that were reported in the news during your lifetime: 1. Workers were told that the paint was nontoxic, although there was no factual basis for this declaration. The employers discounted scientists. The workers believed their superiors. 2. Health complaints were made in ever-increasing frequency. It became obvious that something was seriously wrong. 3. U.S. Radium and other watch-dial companies began a campaign of disinformation and bogus medical tests - some of which involved X-rays and may even have made the condition worse. 4. Doctors, dentists, and researchers complied with U.S. Radium's and other companies' requests and refused to release their data to the public. 5. Medical professionals also aided the companies by attributing worker deaths to other causes. Syphilis was often cited as the diagnosis, which had the added benefit to management of being a smear on the victims' reputations. 6. One worker, Grace Fryer, decided to sue U.S. Radium. It took Fryer two years to find a lawyer who was willing to take on U.S. Radium. Only four other workers joined her suit; they became known as the "Radium Girls." 7. In 1928, the case was settled in the middle of the trial before it went to the jury for deliberation. The settlement for each of the five "Radium Girls" was $10,000 (the equivalent of $124,000 in 2009 dollars), plus $600 a year while the victim lived and all medical expenses. Remember the general outline of this scenario because you will see it over and over again: The company denies everything while the doctors and researchers (and even the industrial hygienists) in the company's employ support the company's distorted version of the facts. Perhaps one worker in a hundred will finally pursue justice, one lawyer out of the hundreds of thousands in the United States will finally step up to the plate, and the case will be settled for chump change.

When the time comes, & I hope it comes soon, to bury this era of moral rot & the defiling of our communal, social, & democratic norms, the perfect epitaph for the gravestone of this age of unreason should be Iowa Senator Chuck Grassley's already infamous quote: "I think not having the estate tax recognizes the people that are investing... as opposed to those that are just spending every darn penny they have, whether it’s on booze or women or movies.” Grassley's vision of America, quite frankly, is one I do not recognize. I thought the heart of this great nation was not limited to the ranks of the plutocrats who are whisked through life in chauffeured cars & private jets, whose often inherited riches are passed along to children, many of whom no sacrifice or service is asked. I do not begrudge wealth, but it must come with a humility that money never is completely free of luck. And more importantly, wealth can never be a measure of worth. I have seen the waitress working the overnight shift at a diner to give her children a better life, & yes maybe even take them to a movie once in awhile - and in her, I see America. I have seen the public school teachers spending extra time with students who need help & who get no extra pay for their efforts, & in them I see America. I have seen parents sitting around kitchen tables with stacks of pressing bills & wondering if they can afford a Christmas gift for their children, & in them I see America. I have seen the young diplomat in a distant foreign capital & the young soldier in a battlefield foxhole, & in them I see America. I have seen the brilliant graduates of the best law schools who forgo the riches of a corporate firm for the often thankless slog of a district attorney or public defender's office, & in them I see America. I have seen the librarian reshelving books, the firefighter, police officer, & paramedic in service in trying times, the social worker helping the elderly & infirm, the youth sports coaches, the PTA presidents, & in them I see America. I have seen the immigrants working a cash register at a gas station or trimming hedges in the frost of an early fall morning, or driving a cab through rush hour traffic to make better lives for their families, & in them I see America. I have seen the science students unlocking the mysteries of life late at night in university laboratories for little or no pay, & in them I see America. I have seen the families struggling with a cancer diagnosis, or dementia in a parent or spouse. Amid the struggles of mortality & dignity, in them I see America. These, & so many other Americans, have every bit as much claim to a government working for them as the lobbyists & moneyed classes. And yet, the power brokers in Washington today seem deaf to these voices. It is a national disgrace of historic proportions. And finally, what is so wrong about those who must worry about the cost of a drink with friends, or a date, or a little entertainment, to rephrase Senator Grassley's demeaning phrasings? Those who can't afford not to worry about food, shelter, healthcare, education for their children, & all the other costs of modern life, surely they too deserve to be able to spend some of their “darn pennies” on the simple joys of life. Never mind that almost every reputable economist has called this tax bill a sham of handouts for the rich at the expense of the vast majority of Americans & the future economic health of this nation. Never mind that it is filled with loopholes written by lobbyists. Never mind that the wealthiest already speak with the loudest voices in Washington, & always have. Grassley’s comments open a window to the soul of the current national Republican Party & it it is not pretty. This is not a view of America that I think President Ronald Reagan let alone President Dwight Eisenhower or Teddy Roosevelt would have recognized. This is unadulterated cynicism & a version of top-down class warfare run amok. ~Facebook 12/4/17

How about when you feel as if you are at a treacherous crossing, facing an area of life that hasn’t even been on the map until recently. Suddenly there it is, right in front of you. And so the time and space in between while you first get over the shock of it, and you have to figure out WHAT must be done feels excruciating. It’s a nightmare you can’t awaken from. You might remember this time as a kind of personal D-day, as in damage, devastation, destruction, damnation, desolation – maybe a difficult divorce, or even diagnosis of some formidable disease. These are the days of our lives that whole, beautiful chapters of life go up in flames. And all you can do is watch them burn. Until you feel as though you are left only with the ashes of it all. It is at this moment you long for the rescue and relief that only time can provide. It is in this place, you must remember that in just 365 days – you're at least partially healed self will be vastly changed, likely for the better. Perhaps not too unlike a caterpillar’s unimaginable metamorphosis. Better. Stronger. Wiser. Tougher. Kinder. More fragile, more firm, all at the same time as more free. You will have gotten through the worst of it – somehow. And then it will all be different. Life will be different. You will be different. It might or might not ever make sense, but it will be more bearable than it seems when you are first thrown, with no warning, into the kilns of life with the heat stoked up – or when you get wrapped up, inexplicably, through no choice of your own, in a dark, painfully constricting space. Go ahead, remind yourself as someone did earlier, who was trying miserably to console you. It will eventually make you a better, stronger person. How’d they say it? More beautiful on the inside… It really will, though. That’s the kicker. Even if, in the hours of your agony, you would have preferred to be less beautiful, wise, strong, or experienced than apparently life, fate, your merciless ex, or a ruthless, biological, or natural enemy that has attacked silently, and invisibly - has in mind for you. As will that which your God feels you are capable of enduring, while you, in your pitiful anguish, are yet dubious of your own ability to even endure, not alone overcome. I assure you now, you will have joy and beauty, where there was once only ashes. In time. Perhaps even more than before. It’s so hard to imagine and believe it when it’s still fresh, and so, so painful. When it hurts too much to even stand, or think, or feel anything. When you are in the grip of fear, and you remember the old familiar foe, or finally understand, firsthand, in your bones, what that actually means.

The first step in retracing our way to health is to abandon our attachment to what is called positive thinking. Too many times in the course of palliative care work I sat with dejected people who expressed their bewilderment at having developed cancer. “I have always been a positive thinker,” one man in his late forties told me. “I have never given in to pessimistic thoughts. Why should I get cancer?” As an antidote to terminal optimism, I have recommended the power of negative thinking. “Tongue in cheek, of course,” I quickly add. “What I really believe in is the power of thinking.” As soon as we qualify the word thinking with the adjective positive, we exclude those parts of reality that strike us as “negative.” That is how most people who espouse positive thinking seem to operate. Genuine positive thinking begins by including all our reality. It is guided by the confidence that we can trust ourselves to face the full truth, whatever that full truth may turn out to be. As Dr. Michael Kerr points out, compulsive optimism is one of the ways we bind our anxiety to avoid confronting it. That form of positive thinking is the coping mechanism of the hurt child. The adult who remains hurt without being aware of it makes this residual defence of the child into a life principle. The onset of symptoms or the diagnosis of a disease should prompt a two-pronged inquiry: what is this illness saying about the past and present, and what will help in the future? Many approaches focus only on the second half of that healing dyad without considering fully what led to the manifestation of illness in the first place. Such “positive” methods fill the bookshelves and the airwaves. In order to heal, it is essential to gather the strength to think negatively. Negative thinking is not a doleful, pessimistic view that masquerades as “realism.” Rather, it is a willingness to consider what is not working. What is not in balance? What have I ignored? What is my body saying no to? Without these questions, the stresses responsible for our lack of balance will remain hidden. Even more fundamentally, not posing those questions is itself a source of stress. First, “positive thinking” is based on an unconscious belief that we are not strong enough to handle reality. Allowing this fear to dominate engenders a state of childhood apprehension. Whether or not the apprehension is conscious, it is a state of stress. Second, lack of essential information about ourselves and our situation is one of the major sources of stress and one of the potent activators of the hypothalamicpituitary-adrenal (HPA) stress response. Third, stress wanes as independent, autonomous control increases. One cannot be autonomous as long as one is driven by relationship dynamics, by guilt or attachment needs, by hunger for success, by the fear of the boss or by the fear of boredom. The reason is simple: autonomy is impossible as long as one is driven by anything. Like a leaf blown by the wind, the driven person is controlled by forces more powerful than he is. His autonomous will is not engaged, even if he believes that he has “chosen” his stressed lifestyle and even if he enjoys his activities. The choices he makes are attached to invisible strings. He is still unable to say no, even if it is only to his own drivenness. When he finally wakes up, he shakes his head, Pinocchio-like, and says, “How foolish I was when I was a puppet.

Phlebotomy. Even the word sounds archaic—and that’s nothing compared to the slow, expensive, and inefficient reality of drawing blood and having it tested. As a college sophomore, Elizabeth Holmes envisioned a way to reinvent old-fashioned phlebotomy and, in the process, usher in an era of comprehensive superfast diagnosis and preventive medicine. That was a decade ago. Holmes, now 30, dropped out of Stanford and founded a company called Theranos with her tuition money. Last fall it finally introduced its radical blood-testing service in a Walgreens pharmacy near the company headquarters in Palo Alto, California. (The plan is to roll out testing centers nationwide.) Instead of vials of blood—one for every test needed—Theranos requires only a pinprick and a drop of blood. With that they can perform hundreds of tests, from standard cholesterol checks to sophisticated genetic analyses. The results are faster, more accurate, and far cheaper than conventional methods. The implications are mind-blowing. With inexpensive and easy access to the information running through their veins, people will have an unprecedented window on their own health. And a new generation of diagnostic tests could allow them to head off serious afflictions from cancer to diabetes to heart disease. None of this would work if Theranos hadn’t figured out how to make testing transparent and inexpensive. The company plans to charge less than 50 percent of the standard Medicare and Medicaid reimbursement rates. And unlike the rest of the testing industry, Theranos lists its prices on its website: blood typing, $2.05; cholesterol, $2.99; iron, $4.45. If all tests in the US were performed at those kinds of prices, the company says, it could save Medicare $98 billion and Medicaid $104 billion over the next decade.

Uggggh …” groaned Alex, clutching her stomach. She had one more cake left in her pile, but her opponent had one more cake in his pile as well, and he’d already started to eat it. Alex’s eyes were rolling into the back of her head, and her skin was even paler than usual. “Alex, you can give up if you want to,” said Dave. “Don’t make yourself sick.” “Yes, we won’t think any less of you, dear girl,” said Porkins. “I’ll think less of you,” said Carl. “Carl!” said Dave. “What?” said Carl, shrugging. “I’m only being honest.” The elderly cowman was halfway through his last cake, and Alex hadn’t even started hers. It’s all over, thought Dave. There’s no way that Alex can catch up. Alex looked like she was going to pass out at any moment, but then, finding strength from somewhere, she picked up her final cake and opened her mouth wide. FLOOOONCH!!!!!! To Dave’s amazement, Alex shoved the entire cake into her mouth. Her cheeks were so stuffed full of cake that her head was about twice as wide as it usually was. Then, with a large gulp, she swallowed the cake down whole. She opened her mouth to show everyone that the cake was gone. “We have a winner!” The cowman hosting the competition shouted. Everyone in the inn let out an enormous cheer. The elderly cowman dropped the remainder of his cake on the table, admitting defeat. “Well done, dear girl!” Porkins said to Alex. “Yeah, well done, Alex,” said Carl. “If ever I need someone to eat a big pile of cakes, you’ll be the first person I ask.” “I still think this whole competition was completely foolish,” said Spidroth. “Nevertheless, Alex, I congratulate you on your victory. Like a true warrior, you bested all your opponents, showing them no mercy.” “Uggghh …” groaned Alex. Then she fainted, her face hitting the table. “Alex!” yelled Dave, rushing over to her. “Is anyone here a healer?” “I am,” said a cowman with grey fur, rushing over. “What’s wrong with her, Doctor?” asked Porkins. “My diagnosis is that she’s eaten too many cakes,” said the cowman healer, lifting Alex’s head. “I could have told you that,” said Carl, rolling his eyes. “What should we do with her?” asked Dave. “I think a good night’s rest should do the trick,” said the healer. “Are you sure you’re a healer?” said Carl. “None of this advice seems very professional.

Finally the doctor says he will use anesthetic; he applies some lidocaine before exploring with a gloved finger. After a moment of uncomfortable poking around, he pronounces his diagnosis. “You have two hymens. You’re going to need surgery.

When I launched my AI career in 1983, I did so by waxing philosophic in my application to the Ph.D. program at Carnegie Mellon. I described AI as “the quantification of the human thinking process, the explication of human behavior,” and our “final step” to understanding ourselves. It was a succinct distillation of the romantic notions in the field at that time and one that inspired me as I pushed the bounds of AI capabilities and human knowledge. Today, thirty-five years older and hopefully a bit wiser, I see things differently. The AI programs that we’ve created have proven capable of mimicking and surpassing human brains at many tasks. As a researcher and scientist, I’m proud of these accomplishments. But if the original goal was to truly understand myself and other human beings, then these decades of “progress” got me nowhere. In effect, I got my sense of anatomy mixed up. Instead of seeking to outperform the human brain, I should have sought to understand the human heart. It’s a lesson that it took me far too long to learn. I have spent much of my adult life obsessively working to optimize my impact, to turn my brain into a finely tuned algorithm for maximizing my own influence. I bounced between countries and worked across time zones for that purpose, never realizing that something far more meaningful and far more human lay in the hearts of the family members, friends, and loved ones who surrounded me. It took a cancer diagnosis and the unselfish love of my family for me to finally connect all these dots into a clearer picture of what separates us from the machines we build. That process changed my life, and in a roundabout way has led me back to my original goal of using AI to reveal our nature as human beings. If AI ever allows us to truly understand ourselves, it will not be because these algorithms captured the mechanical essence of the human mind. It will be because they liberated us to forget about optimizations and to instead focus on what truly makes us human: loving and being loved. Reaching that point will require hard work and conscious choices by all of us. Luckily, as human beings, we possess the free will to choose our own goals that AI still lacks. We can choose to come together, working across class boundaries and national borders to write our own ending to the AI story. Let us choose to let machines be machines, and let humans be humans. Let us choose to simply use our machines, and more importantly, to love one another.

Dearest April, When I met you, I immediately felt like the sun rose and set in your eyes. I went to bed thinking about you at night, and I woke up with you on my mind in the morning. We had some really good times, didn’t we? I relished the long walks we took. I looked forward to seeing you at night and sleeping with you in my arms. Then I got the diagnosis. I found out that I was sick, and when I needed you to be there for me, you fucked my best friend. You weren’t there to hold my hand through chemo. You weren’t there to help me get to and from doctors’ appointments. You weren’t there when I was so sick I couldn’t hold my head up. You were with him. You were under him and on top of him and with him instead of me. I asked my brothers to give you this letter in the event of my death, so if you’re reading this, I’m gone. I’ve lived out my days, and even though you’ve moved on, I need to tell you how I feel. A good man might want to ease your conscience. A good man might want to give you some peace. But good wasn’t important to you. I fucking hate you. I hate that you’re breathing. I hate that you’re alive. I hate that you’re able to laugh and that you’re going to go on and procreate and make more sorry-ass human beings just like yourself. I hope that your heart leaped when you got this letter. Final words of love from me. Hahahahahaha! I am dead, so I can say whatever I want. And what I want to say is: I fucking hate you. I hope you get exactly what you deserve in life. With the utmost hatred and disdain, Matthew Reed PS – I still hate you.

I left the practice of law when it became clear that my autistic son needed an advocate. The collective chaos of managing three children, a fourth pregnancy, two nannies, a housekeeper, and a demanding career finally overwhelmed me. My husband and I considered hiring someone to manage our autistic son’s education and therapies, but I simply couldn’t delegate his care. I needed firsthand knowledge of his diagnosis and how to treat it. Leaving professional life was hard. I walked away from friends, a schedule, a salary, and social stature. I plunged into full-time parenting, something at which I was not proficient—something that still perplexes me! However, remaining in the workforce would have been harder. I made a free choice, fully apprised of the risk I took, and I have never looked back. Philosopher Ayn Rand believed there is no such thing as sacrifice. Rather, there are only rational decisions that bring us closer to our ultimate goals. In other words, the choices we make are irrefutable evidence of what we value. Even generous acts reflect a set of values. Living in accordance with those values gratifies us, hence our gain outweighs our loss. In a world of scarcity and competing demands, Rand’s view has a certain hard-nosed rationality. We give up something we want for something we want more. We each have a single life, made up of finite seconds that tick inexorably away. How we choose to spend each day both expresses our values and carries us closer to our ultimate goals, even if we have never articulated precisely what those values and goals are. I was fortunate that my decision to come home had a positive, even miraculous, outcome for my son. Others make similar decisions without such obvious payback. I still have professional aspirations, and I’m pursuing them wholeheartedly, but I will not return to the practice of law. My time at home focused my values and helped me understand what I want to do with my remaining days, months, and years.

One important caveat: it is important for long-term recovery that the approach to food abstinence be aligned with the diagnosis and treatment of addiction as a whole. Thus while this second approach to abstinent eating based on learning—we might call it the introspective method—is often ideal for emotional eaters, it can be a set up for failure for food addicts. Food addiction is progressive, and the food addict becomes progressively unable to distinguish the true from the false. Not only do food addicts develop false starving followed by false thinking and finally a false sense of self, they become powerless to challenge these falsehoods by themselves. As a result, an approach to abstinence and recovery which relies on subjective individual discernment alone is almost always doomed to failure. On the other hand, if the food addict is helped to

Tactical combat actions should be thought out and organized. To build a battle plan is easy only in this case, if the opponent is known in advance, if the boxer knows his way of fighting, his favorite technical means and his personal qualities. But if the boxer does not know the opponent completely, then in the fight with him always have to pose the task of conducting a thorough, preliminary diagnosis. Every fight with any opponent always requires reasonable precautions. In practice, there were quite a few cases that the boxer lost the fight only because he started decisive actions, without first noticing the characteristics and character of the opponent's actions. When planning a fight, the relationship of strength must always be judged soberly; you can neither underestimate nor overestimate your opponent's strength. To fight against a known enemy, prepare yourself to use your abilities with the greatest success. The boxer, depending on how the opponent can act, what his blows are the most dangerous, what technical measures he uses most in combat, should think about the system of defense activities. Knowing what types of defense the opponent uses most effectively, the boxer should avoid using blows that the opponent can easily paralyze. If, finally, the opponent used to fight for a certain distance, the boxer should impose a fight at a distance to which he was not used, and put him in the least favorable conditions.

Yet any statement that starts with “Well, at least…” diminishes the distress and comes across as a lack of caring—or even as a kind of one-upmanship. When I first meet people who are adjusting to a terminal diagnosis, I never try to diminish their emotions. “Yes, this is terrible news and it’s very, very sad,” I say. “You don’t need to make excuses for the way you feel. You have a right to feel this way.” These words identify and recognize the struggle the dying person and family are going through. Validation is one of the first and most important tools for opening a different door.

As I sit on the folding metal chair I begin to fear getting up. As the finale approaches, I experience outright panic. What if my feet no longer move? What if my muscles lock? What if this neuritis or neuropathy or neurological inflammation has evolved into a condition more malign? I once in my late twenties had an exclusionary diagnosis of multiple sclerosis, believe later by the neurologist who made the diagnosis to be in remission, but what if it is no longer in remission? What if it never was? What if it has returned? What if I stand up from this folding chair in this rehearsal room on West Forty-second Street and collapse, fall to the floor, the folding metal chair collapsing with me? Or what if--- (Another series of dire possibilities occurs to me, this series even more alarming than the last---) What if the damage extends beyond the physical? What if the problem is now cognitive? What if the absence of style that I welcomed at one point---the directness that I encouraged, even cultivated---what if this absence of style has now taken on a pernicious life of its own? What if my new inability to summon the right word, the apt thought, the connection that enables the words to make sense, the rhythm, the music itself--- What if this new inability is systemic? What if I can never again locate the words that work?

Given the toll dementia can have on personal health, often in advanced age, dementia may also be the final chronic disease diagnosed in someone, which raises a whole host of important and unfortunately often overlooked issues related to palliative care. A dementia diagnosis may challenge, change, and strain your family structure in many and unexpected ways, potentially over the course of many years. This is impossible to avoid,

A common source of disappointment and frustration for parents is the letdown that happens soon after diagnosis. Parents seek diagnostic evaluations both to better understand their child and also to have that child be eligile for services. Many, if not most, parents are not aware that it can take months to find and secure these resources and to get an actual appointment. Additionally, the cost of these services is often far greater than anticipated. One parent, who participated in in-depth interviews by researchers interested in the partnership between parents and providers, had this to say, "It felt like you were being taken to the edge of a cliff. You've been given the diagnosis, you got shoved off the end, and then it was, 'Oh by the way, we haven't got the parachute. You'll need to get that for yourself.' You feel like you finally got there, and you're quite happy, you're ready to fly - but then all the sudden you don't have the rest of the equipment you need to fly with.

I watched Sloan die inside that night. They called it a catastrophic stroke. A blood clot moved from the wounds in his leg up to his brain. It had probably happened while Josh sat with him. It was silent and final, and there was nothing anyone could have done. Josh was right. Brandon was gone. Three days after the stroke, an ethics committee made up of Brandon’s doctors, an organization that coordinated organ donations, and a grief counselor called the family in for an 11:00 a.m. meeting at the hospital. I sat outside the conference room, bouncing my knee, waiting for Sloan to come out. I hadn’t left her side once since the stroke. Every night I slept in the chair next to her by Brandon’s bedside. Only now he wasn’t healing in his coma. He was brain-dead. Josh hadn’t been back to the hospital since Brandon’s diagnosis. He wouldn’t answer my calls. The shift was strange. Our text thread went from dozens of unanswered texts from him, begging me to talk to him, to dozens of unanswered texts from me, begging him to talk to me. I wanted to know he was okay. His silence told me he wasn’t. I wore his sweatshirt today. I’d never wear it when I knew he might see it. I didn’t want to encourage him. But based on his absence over the last three days, I didn’t think I had to worry. And I needed to feel him wrapped around my body today. I needed to smell him in the fabric. I just needed him.

The thing I realized doing research for this book—and the truth you might already know if you’re going through this yourself—is that there is no universal story to tell. No two experiences are the same, and any measure of this challenging diagnosis is heartbreaking to endure. What does unify these stories are the feelings of hopelessness, worthlessness, guilt, and despair that come with this very common, but often not discussed, health issue. And so that is what I strove to tell in The Friend Zone. Just one final note. Kristen’s happy ending was never about getting pregnant. It was about her allowing herself to be loved, despite what she felt were shortcomings. It was about her recognizing that she wasn’t defined by her ability to have children, and that her worth went beyond the state of her uterus. That was her happily ever after.

People increasingly can no longer reach out to a friend, change their life, talk to a trusted individual, change their diets, rebel against industrialized and oppressive society, or question those in authority. Just like religion, the people in charge know something no one else can and the evil within us must be quelled. Rather than exorcism, Prozac or Abilify can finally cast out our demons. In addition to these widely discussed problems, so, too, does the mental health field resort to claims of conspiracy and personal attacks against those in disagreement with the status quo and relies heavily on subjective measurement and tautological reasoning. Again, using the example of depression, this subjectivity and circular reasoning becomes evident. If a person seeks help for feeling sad, lethargic, unmotivated, and experiencing changes in sleep, this person might receive a diagnosis of MDD, a purported brain disease requiring life-long treatment. How does one know that this person “has” MDD? Because they feel sad, lethargic, unmotivated, and has changes in sleep. If the person wants to be really sure, a validated measurement might be given to said person which asks, essentially, if the person is sad, lethargic, unmotivated, and has had changes in sleep patterns. This process is akin to saying “I have a headache”, to which a doctor responds “Ah, yes, you have Major Headache Disorder”. If asked “How do you know I have Major Headache Disorder?” the answer is “Because you have a headache”.

I grew up being told that my mother had a nervous problem. Later, I was told it was a nervous breakdown. Then we had a diagnosis, for a brief while, when she was said to be schizophrenic and was treated as one. And finally, everyone settled down to calling her manic depressive. Through it all, she had only one word for herself: mad.

Semi-enclosed within a rampart of books, she was reading intensely, oblivious of everything except the volumes she had gathered around her. Freddy tilted his head and read the titles on the bindings, whispering them as he read. He had assumed that her selection would be heavy on fashion, makeup, and “celebrities,” but he was wrong. With her left hand resting possessively on Who’s Who in Zimbabwe, she was deep in Sources and Methods of Hiccup Diagnosis. She had also chosen the Directory of Polish Hydraulic Fluid Wholesalers; the Encyclopaedia of Angels; the Catalogue of Chuvash Books in German Libraries; Aboriginal Science Fiction; The Register of Non-Existent Churches; A Bibliography of Indonesian Military Poetry; Orators Who Possessed Horses; Lloyds’ Survey of Failed Board Games; A Dictionary of the Efik Language; The Picture Book of Albanian Idioms—a list in her handwriting lay next to the latter, beginning with the entry, “I ka duart të prera, ‘to have one’s hands cut off,’ ”—The Language of the French & Indian War, Vol. I, Obscene Expressions; Glossary of Dead Architects (Freddy couldn’t wait to read the latest entries); and, finally, though not least, Nicknames of Popular Fish. “You see,” he told her, “it’s fascinating.” “Yes, I love it. Now go away.” “I have our press.” “I couldn’t care less about our press.” She held up Who’s Who in Zimbabwe. “There’s a whole world out there, Freddy, that has nothing to do with us.

In those early days at the VA, we labeled our veterans with all sorts of diagnoses—alcoholism, substance abuse, depression, mood disorder, even schizophrenia—and we tried every treatment in our textbooks. But for all our efforts it became clear that we were actually accomplishing very little. The powerful drugs we prescribed often left the men in such a fog that they could barely function. When we encouraged them to talk about the precise details of a traumatic event, we often inadvertently triggered a full-blown flashback, rather than helping them resolve the issue. Many of them dropped out of treatment because we were not only failing to help but also sometimes making things worse. A turning point arrived in 1980, when a group of Vietnam veterans, aided by the New York psychoanalysts Chaim Shatan and Robert J. Lifton, successfully lobbied the American Psychiatric Association to create a new diagnosis: posttraumatic stress disorder (PTSD), which described a cluster of symptoms that was common, to a greater or lesser extent, to all of our veterans. Systematically identifying the symptoms and grouping them together into a disorder finally gave a name to the suffering of people who were overwhelmed by horror and helplessness. With the conceptual framework of PTSD in place, the stage was set for a radical change in our understanding of our patients. This eventually led to an explosion of research and attempts at finding effective treatments

Four months later, I got my diagnosis. And now that my past was spilling over, exploding, a volcano spewing hot toxic waste all over my present life, it was all I could think about. I sent my father an email with the subject line FINALLY GOT AN OFFICIAL DIAGNOSIS. In the body of the email, I attached a link to the Wikipedia page for complex PTSD. At the time, the Wikipedia page read, “Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape.” And then, a paragraph down: “C-PTSD is a learned set of responses, and a failure to compete numerous important development tasks. It is environmentally, not genetically, caused. Unlike most of the diagnoses it is confused with, it is neither inborn nor characterological, not DNA based, it is a disorder caused by lack of nurture.” A lack of nurture. I didn’t write a hello in the body of the email. I didn’t include a sign-off. All I included in the vast expanse of white space was the link. What I didn’t write, but what was implied, what I hoped to convey: You ruined my life. You ruined my life. You ruined my life.

Despite the best efforts of many physicians, Mary died in Vancouver Hospital eight years after her diagnosis, succumbing to the complications of scleroderma. To the end she retained her gentle smile, though her heart was weak and her breathing laboured. Every once in a while she would ask me to schedule long private visits, even in hospital during her final days. She just wanted to chat, about matters serious or trivial. “You are the only one who ever listened to me,” she once said. I have wondered at times how Mary’s life might have turned out if someone had been there to hear, see and understand her when she was a small child — abused, frightened, feeling responsible for her little sisters. Perhaps had someone been there consistently and dependably, she could have learned to value herself, to express her feelings, to assert her anger when people invaded her boundaries physically or emotionally. Had that been her fate, would she still be alive?

About two weeks later, on September 10, 2005, O’Kelly died of a pulmonary embolism. What O’Kelly realized, in the shadow of his final days, was the extraordinary power of a moment. He wrote: I experienced more Perfect Moments and Perfect Days in two weeks than I had in the last five years, or than I probably would have in the next five years, had my life continued the way it was going before my diagnosis. Look at your own calendar. Do you see Perfect Days ahead? Or could they be hidden and you have to find a way to unlock them? If I told you to aim to create 30 Perfect Days, could you? How long would it take? Thirty days? Six months? Ten years? Never? I felt like I was living a week in a day, a month in a week, a year in a month. Now, take a second look at the beginning of O’Kelly’s memoir, especially those final two words: “I was blessed. I was told I had three months to live.” That opportunity to live was why he felt blessed. Shouldn’t we share his zeal for moments that matter? We may have more time to live than he did, but should that be a reason to put them off? This is the great trap of life: One day rolls into the next, and a year goes by, and we still haven’t had that conversation we always meant to have. Still haven’t created that peak moment for our students. Still haven’t seen the northern lights. We walk a flatland that could have been a mountain range. It’s not easy to snap out of this tendency. It took a terminal illness for Gene O’Kelly to do it. What would it take to motivate you to create a Perfect Moment?

In the parking lot, I stared at the slips of paper Dr. Park had handed me. The confirmation of the diagnosis by a second doctor brought with it a grave finality. It was as if the gavel had fallen. And my verdict came with a life sentence. A lifetime of illness without a cure, one which brought isolation, shame, and an endless supply of medication to numb my being. Sure, I had had symptoms of bipolar disorder for as long as I could remember. And looking back now, I could also see symptoms of psychosis at various points in my life. The paranoia, the distorted thinking, the startling images, the occasional voice—they had been there since I was a teenager. However, I never had a name for it. Knowing it was psychosis changed the game completely. It was only a matter of time before I’d be locked up on the psych ward in a hospital gown with the rest of the psychotic people.

It's such a huge relief to finally know without any doubts that there's a real answer to my lifelong struggles. I've cried and celebrated and despite those feelings, it's still not quite real yet.