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Archive for February, 2010

My patient sounded bewildered.

“It was like I was watching myself going through the motions – repeating the same old pattern.”

He’d just broken up for the umpteenth time with a woman he’d been dating for over a year.

“It’s always the same thing.  I do something nice for her.  Then she tries to do something for me, but I freak out, and insist she doesn’t like me.  Then I do something mean, like flirt with someone else in front of her, just to prove she doesn’t like me,  and she gives up and we break up again.  So we’re back where we started, and I do something nice again, and off we go.  Eventually, even the women who hang on give up.  Then I find someone else and start over.”

He was caught in an endless loop – around and around and around.  The same thing had played out with every women before this one.

Freud might have called this a “repetition compulsion.”  I’ve heard other therapists refer to it as a “learned behavior.”

Whatever it is – it’s very common.  Left to your own devices – in other words, acting unconsciously – you will keep doing the same thing over and over again.

What you’re doing is replaying a pattern you learned as a child – clinging to it because no one has woken you up and made you ask yourself what on earth you’re doing.

My patient’s father was a frustrated scientist, trapped in a humiliating job, deeply insecure, very unstable.  My patient tried to please him by doing well in school, winning science prizes, trying to be the son he wanted.

Initially, the father would seem pleased and proud.

Then, once my patient allowed himself to relax in his father’s acceptance, disaster would strike.

The father would swing back into a frustrated rage – and take it out on his son.

It probably had nothing to do with the boy – it was the father’s own anger at his work situation – but the effect was devastating.

The pattern played out over and over again.  The son would over-achieve, and believe he’d won his father’s approval – then, as he relaxed into acceptance, the old man would turn on him with vicious criticism.

My patient learned it was okay to give his father – or any person – what they wanted.  But he could never relax and let down his guard.  That’s when the inevitable turn-around came.  He expected it – and braced himself for it – so he’d never again get caught by surprise.

You’ve probably heard of “Pavlov’s dogs.”

Ivan Pavlov was a Russian psychologist who performed a series of experiments on dogs at the end of the 19th century.  One of his chief discoveries was the “conditioned response.”  When a dog – or a person – is trained through repetition to expect an outcome from a certain set of variables, it is difficult to un-train that expectation.  It becomes a reflex.

Pavlov trained his dogs to expect to be fed when he rang a bell.  Eventually, just ringing the bell would make the dogs salivate, as they came to predict food was coming when they heard it.  The bell and the food were firmly linked in their brains.

That’s what happens with people when they get stuck in a loop, like my patient.

He learned he could please his father briefly, but his father’s acceptance would soon be followed by a mood reversal and attacks.

Now, with his girlfriends, he once again sought to please, but then shut down.  He was certain the old pattern would play out, so he refused to let them get close.

The problem was obvious: my patient was not a dog – and his girlfriends were not his father.

The instinct that once protected him from the pain of his father’s rages now sabotaged his chances at a healthy relationship.  To shed this old conditioned response, he needed to become aware of it.

A psychotherapist doesn’t change you.  He creates awareness.  If I show you a pattern of behavior that’s not working for you, you’ll figure out how to change it on your own.

If I tell you that you’re standing in a pot of water over a fire, you’ll jump out of the pot.

I show you the situation – you handle the fix.

There’s something psychotherapists call “the observing ego” – it’s like a little guy who sits on your shoulder and watches you from the outside.  He represents self-awareness.

My patient was developing an observing ego.  He kept having “deja vu” moments.  He’d been down this path before, and he knew it.

Now he wanted to change the old pattern – and try going someplace new.

I’ve worked with enough patients over the years to recognize that human beings are flexible – they change.  When I meet someone I haven’t seen in a long time, I suspend expectations, because I know people are moving targets.

You can change, too.  You don’t have to walk in circles forever.

If you spot a pattern that feels like a loop, take a turn and head someplace new.  At least you’ll know it’s really you at the controls – not one of Pavlov’s dogs.

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Sarah Palin’s nickname in high school was “Sarah Barracuda.”

Supposedly, this reflected “her competitive streak.”

Charming.

How did this happen?  How does a child grow up with a grasping nature so extreme that she becomes nicknamed after a vicious carnivorous fish?

There aren’t many clues in Palin’s early biography, which reads like a carefully pruned and polished star cheerleader’s resume…which, of course, it is.

Sarah was born the third of four children.  That’s our one clue.  Perhaps she had to compete for attention with older and younger siblings.

At some point in Sarah’s life – I’d guess the first five minutes – she decided there wasn’t enough out there for her.  At least, not enough out there for her if she was going to share any of it with anyone else.

Maybe it was a sense of poverty.  Maybe the Palins were poorer than their neighbors.  Or maybe competing with those siblings was enough.  But somewhere during that childhood, profound feelings of deprivation developed in Sarah’s psyche, and a famine mentality set in.

After that, all we can do is sit back and watch a mighty appetite gobble everything in its path.

When people are subjected to a severe deprivation, like a famine, they hoard and deny others and generally act in ways they aren’t proud of.  During the famine in China that occurred as a result of Mao’s Great Leap Forward campaign in the late 1950’s, widespread starvation led to cannibalism among the rural peasantry.  Hunger can drive people to do terrible things.  They can turn vicious.

A bit like a barracuda, tearing off hunks of flesh to gulp down its maw.

A bit like Sarah Palin.

Here’s a charming quote from the Barracuda herself:  “I love meat. I eat pork chops, thick bacon-burgers, and the seared fatty edges of a medium-well-done steak. But I especially love moose and caribou.”

The mental image is of a gaping mouth, with sharp teeth.

How about her politics?  Could they even be considered politics?  Mostly, it boils down to Sarah, Sarah, Sarah – and making money for Sarah.

She quit her job as governor to give speeches to the highest bidder, write a book and work on tv – all for enormous sums of cash.

She was willing to speak (and no doubt thrill and inspire) the Tea Party wackos – for many, many thousands of dollars.

Even when she was working for John McCain, it was clearly all about Sarah – her expensive clothes, her big family (she has five children), her gigantic super-church, her enormous state – even the humongous “big box” stores she enticed to the little town of Wasilla to replace its now-moribund downtown.

Something in Sarah’s background left her feeling hungry – deeply hungry – and she is still grabbing up everything at the table.  Her “politics” are a philosophy of greed.  She can get married – but gay people can’t.  She doesn’t want to pay taxes – even to help other Americans survive.  She’s got her healthcare – if you don’t have yours, well, tough luck.  She’ll drill for every drop of oil in a nature sanctuary until her giant SUV is purring like a kitten, slurping it all down, belching, and demanding more. Immigrants can stay out – this country is Sarah’s, securely stolen from indigenous peoples and guarded with guns guns guns and more guns, wonderful guns.  Sarah doesn’t like government – she wants to go it alone, because she’s got hers, and you can worry about yourself, thank you very much.

Sarah wants to get a gun and go out in nature and kill something beautiful and devour it.

A couple more charming quotes:

“If God had not intended for us to eat animals, how come He made them out of meat?”

“I always remind people from outside our state that there’s plenty of room for all Alaska’s animals – right next to the mashed potatoes.”

Sarah is a predator.  She’s earning a lot of money chomping her way through a frightened minority of mostly older, white Americans who are terrified of the future and will buy all the double-cheeseburgers, super-size fries and giant cokes they need to maintain a secure perimeter of human fat cells.  Hunkered down in their gated retirement communities, clinging to their beloved guns, they crouch by the glow of their wall-size flat-screen plasma tv’s and defend what’s rightfully theirs – which is to say, everything.

Sarah represents insecurity in love.  Somewhere along the way, early on, she decided there wasn’t any love out there for her.  So she had no love to spare for anyone else.

Kill or be killed.  Eat or be eaten.

There’s room for you next to the mashed potatoes.

That’s the barracuda’s creed.

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My patient, a senior associate doing IP litigation at a downtown firm, brought me the bad news.

“I got a terrible review last week.”

She seemed calm about it, considering. That’s because she knows how law firms work.

“I’m expensive, and they’re preparing for lay-offs. So they told me I’m terrible. It was ridiculous. They made stuff up off the top of their heads.”

I had to hand it to her. I wish I could have been so cool when the same thing happened to me.

My first year review at Sullivan & Cromwell went fine. Mostly, they didn’t seem to notice me. I wasn’t important enough to review.

Then, in the second year, it was suddenly a horror show. Nothing I did was right. The partners didn’t fool around at S&C – they give it to you with a sledgehammer.

Even then, I remember wondering about that one partner who seemed to like me. Of course, he wasn’t mentioned at the review.

Years later, after I’d given up on a legal career, I realized the truth. They’d probably given identical reviews to ten or fifteen percent of my class that year. We were the ones who left. It was a lay-off. Those terrible reviews were the partners’ way of creating a paper trail in preparation for letting us go – covering their tracks in case we sued.

My patient – an experienced senior associate at her second law firm job – knew how to handle this sort of thing. You don’t let them throw you.

(more…)

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When gay people come out of the closet, they usually run into some variation of the “but that’s unnatural” argument.  This is the apparently sensible claim that it doesn’t make sense to be gay.  Isn’t sex for procreation?  Why would two males or two females become romantically involved if they can’t have a child together?

It seems like a reasonable argument.  You can point out that some sort of gay behavior occurs in every species in the animal kingdom – which is true – or that gay sex is simply fun – also true.  But that only begs the question.  Why?  Why are there so many gay animals, and people, in the world when reproducing your own kind is the basis for a species’ success?  Having fun doesn’t seem to explain this apparent contradiction.

The answer is that gay people help nature hedge its bets.  A successful species typically keeps extra cards up its sleeve because the rules of the game can change without warning.  Gay people represent some important extra cards.  They are a natural, genetic variation that helps guarantee the successful raising of young.

Many species show wide genetic variation.  Dogs, for example.  You can breed a chihuahua that weighs 2 pounds.  Or you can breed an Old English Mastiff that weighs 300 pounds.

Why should canine genetic material be so mutable?  Because being tiny – or being huge – might come in handy.  You never know.

The ultimate disaster for a species – extinction – happens when its members fail to adapt to an altered environment.  That’s why you want to have as much flexibility as possible to respond and survive when something unexpected occurs.

It could be a meteor striking the Earth.  Or a volcano erupting.  Or a pandemic disease wiping out three-quarters of the population.  The game can change – and a species has to change too – sometimes a lot – in challenging new circumstances.

Having gay members of your species could make the difference between survival and extinction.  Gays are unique – and vitally important -because they do something no other members of that species will do.

I don’t mean have gay sex.

I mean raise other people’s children.

Gay animals are perfectly happy to pair-bond and mate with members of their own sex,  so their sexual relations are non-procreative.  They do not have children with their partner.  That means they are available to raise another animal’s children.

Say a heterosexual zebra, or otter, or muskrat or human is killed and leaves behind a helpless child.  Heterosexual animals, who can have  children of their own, will probably refuse to raise this other animal’s child, or at best do so grudgingly.  They have their own children, who are a higher priority because they will pass on their genetic material.  But a gay member of the species will happily step in and raise that helpless child.

He has no reason not to.  He is not caught up in the battle to mate and reproduce.  His preoccupation is caring and nurturing within a relationship.

If a male animal loses a female partner and is left with children who need care, he might have trouble locating another female willing to raise these children.  But a gay male would happily accept the job.

If a female animal loses her male partner and is left with young to raise, another male might reject the task of raising those children.  But a gay female would, similarly, be happy to help out.

Gays play a role in increasing the success rates for child-rearing in all species.  In the event of a large-scale disaster, resulting in many adult deaths, gays could fill an especially vital role in helping to raise the young.  They would not compete for sexual partners.  But they would help out with the kids.

It could make the difference to a species’ survival.

That’s what’s happening right now, with humans.

Many heterosexual human couples have children they are unable or unwilling to raise.  These children are put up for adoption – but there are too many of them to be cared for solely by heterosexual volunteers, who usually prefer to raise their own children.

That’s why, throughout the world, gays are the unofficial backbone of the adoption system.  Without them, many children would suffer terribly, never finding wiling, dedicated adoptive parents.

It is an open secret that in most states, the adoption system would collapse without the participation of gays and lesbians.  In 2007 it was estimated that there are 270,000 children living with same-sex couples in the USA.  Of these, one-quarter, or 65,000, have been adopted.  Gays are a small minority, perhaps as few as 4% of the general population.  But there is no question that gay people do a lot of adopting and provide loving homes for hundreds of thousands of children who desperately need them.

Unfortunately, in a few states, right-wing religious zealots have persuaded politicians to ban gay adoption.  It is not clear whether this misguided attack on children and the rights of gay people is constitutional.  A court battle is raging in Florida.

Meanwhile, these laws prevent gay people from playing a role nearly as ancient as life itself.  That is a tragedy, which could result in a calamity.

It’s also unnatural.

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Inevitably, a few times a year, a new patient refers to me as “doctor.”

I always flinch.

First of all, I’m not a doctor.  I don’t have an MD, which would make me a medical doctor – or even a PhD, which would make me a “Doctor of Philosophy” like a college professor.

Well, actually, I am sort of a doctor, kind of.  I have a JD, which makes me a Juris Doctor, or Doctor of Law – which means I’m a lawyer.  But I don’t think that’s what you mean when you call your psychotherapist “doctor.”

The fact is, people with a lot of different educations, backgrounds and degrees practice the art of psychotherapy.  Here’s the run-down of the most common professionals in my business, at least in the New York area:

1.  A psychiatrist. This is a medical doctor, who went to medical school and got an MD, and could, I suppose, probably remove your appendix.  In the mental health field, psychiatrists are the people who handle medication.  I occasionally refer one of my patients to a psychiatrist colleague when I think he might benefit from an anti-depressant or anti-anxietal or some other type of psychiatric medication.  Some of my patients get psychiatric drugs from their regular family doctor, but psychiatrists are the experts in this area.  They also work with patients who are very ill, such as those suffering from severe cases of schizophrenia, depression and bi-polar disorder.  Often these patients are seen in a hospital setting, due to the severity of their illness.

2. A Psychologist. A psychologist has a PhD, and many of them are affiliated with universities, where they may do research.  When you read an article in the newspaper on the results of a “study” – something like “people who have sex after 60 are more content with their marriages” or “teenagers who watch less television have higher reading scores” – that kind of social science study would be done by a psychologist.

Psychologists also work in Human Resources at corporations, advising on how best to manage employees, and they do psychological testing.  For example, if you want to give someone a test to see if they have Attention Deficit Disorder, you might send him to a psychologist for a set of tests.

3.  A Social Worker. This is the degree I hold.  Social workers are people who work with people in all kinds of settings.  “Clinical social workers” are social workers who, perhaps in addition to helping people navigate their way through social services, obtaining housing and so forth, also do psychotherapy with their patients.

It might seem like this is a list in order of quality.  After all, if you can get a “real” doctor – why settle for a mere PhD posing as a doctor or some measly social worker?

Freud was plagued by just such questions.  When his trusted protege, Theodor Reik, came to America and tried to practice psychoanalysis (which was more or less another word for psychotherapy), he was attacked by a group of medical doctors, who accused him of illegally practicing medicine.  Freud ended up, in 1926, writing an entire book in Reik’s defense, “The Question of Lay Analysis.”  In it, he said essentially that there’s no reason a psychotherapist needs to be a doctor, unless he’s doing something – like working with a severely mentally ill patient, or prescribing medication, which would draw on medical training.

I agree with Freud (which is convenient, I admit, since I’m a social worker.)

But there is a deeper issue here.

Anyone can do psychotherapy.  It is an art, and there are many different schools of thought regarding the details of how one works with a patient in a psychotherapeutic way.

The truth is I didn’t learn most of what I know about psychotherapy from Social Work School – I learned it from my own work with other therapists, both as a patient and as a student.  I worked with two excellent psychotherapists in psychotherapy institutes, which is where young therapists (psychiatrists, psychologists and social workers) sometimes go to train.  Both had doctorates, but (I found out later) one’s doctorate was in Theater and the other’s was in Education.

I guess my point is that it doesn’t matter all that much what education you have.  Psychotherapy is experiential – you don’t learn it in a classroom or from a book so much as from doing it yourself.

I also believe it is an innate skill, like playing the piano or being good at math.  At some level, you’re just born able to work as a therapist, or you’re not – and it doesn’t matter if you’re a dentist or a fireman – you might be a good therapist, or you might not.

Most of the degree and licensing stuff is pointless.  It would probably be better – as in the old days – to let anyone go to an institute, study with some therapists, and – if they feel the urge – hang a sign and practice psychotherapy.  If they’re good, they’ll flourish.  If they’re not, they won’t.

That might sound crazy, but that’s how Taoist fortune tellers get started.

A few years ago, visiting Hong Kong with a friend, we happened to wander into a Taoist temple, and he suggested we visit a fortune teller.  This is very common in Hong Kong – some people visit a fortune teller regularly, some just when there’s something troubling them that they want to work out.

First, you shake some bamboo sticks from a cup.  The ones that fall to the ground have numbers written on them.  Those numbers somehow guide the work of the fortune teller, who sits in the back of the temple in a special booth (there may be many fortune tellers working in a large temple.)

So, I shook my sticks, recorded my numbers and went with my friend for a consultation.  It was entirely in Cantonese, so my friend had to translate.  We paid a small fee (there’s always a small fee.)

The fortune teller turned to me first, eyed me curiously, and said “You are kind to your former lovers.”

I was staggered.  My first partner died young, many years ago.  I’ve always made it a point to reach out in affection and friendship to former partners, after having lost someone who was so precious to me.

Then he turned to my friend.  “You act confident at work, but you are not so confident inside.”  Of course, my friend had started a new job that month, with a major promotion.  He was demolished by this insight.  “How did he know?”  he kept asking for days afterward.  It was the first time he’d admitted to himself that he was feeling overwhelmed by his new responsibilities and needed support.

I had the clear sense that this “fortune teller” – an old man in a silk jacket at a Taoist temple – was a colleague.  Clearly a skillful psychotherapist, he was working in a different modality, but essentially doing what I do – observing, listening, and offering insights intended to create awareness.

He offered us longer, weekly sessions – for a slightly larger fee.  We had to decline.  I think we were both tempted, but we had to fly home the next day.

It doesn’t matter what degrees you have.  What I do – psychotherapy – is practiced in one form or another by fortune tellers, palm readers, priests, shamans and people holding every other crazy title you could imagine.

We’re all doing the same job, which is as old as humanity itself.

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Last October, a law school placement director friend of mine forwarded me an email with a juicy piece of big law gossip. A former associate at Sullivan & Cromwell had offed himself. He was 39.

The body was discovered beneath a highway bridge in Toronto. A few days earlier, it was revealed that since the mid-90’s, he and a co-conspirator made ten million dollars on an insider trading scheme. He’d stolen insider information from S&C, arriving early in the morning to dig through waste baskets, rifle partners’ desks and employ temporary word-processor codes to break into the computer system.

“You can’t make this shit up,” was my friend’s comment. “Wasn’t he from around your time?”

It took a minute to locate the face. Gil Cornblum. Jewish, a bit pudgy, with big round glasses. Gil, in that ridiculous little office two doors down from mine.

What was Gil like? Mild-mannered, pleasant, always smiling.

I should have known something was wrong.

The pieces fit together.

Gil kept weird hours. He used to chuckle that he liked to get in early so he didn’t have to stay late. It turned out he was in at 5 am, combing the firm for insider tips.

The lavish wedding, too. A mutual friend was invited up to Canada to watch Gil tie the knot, and was blown away.

As people do in these situations, I stopped for a moment to contemplate Gil’s death. His body was discovered at the bottom of a highway bridge. He was still breathing, according to the bits of news I found online.

So far as I could tell, that meant portly, lovable Gil Cornblum threw himself off a bridge on a Canadian highway in the middle of the night and lay on the bottom – of what? A rocky riverbed? – shattered and dying.

Suicide amounts to punishing whoever is supposed to take care of you because you feel their care is inadequate.

Certainly, the care we all received at S&C was inadequate, and we committed suicide a little each day just by staying there and putting ourselves through that abuse as our lives passed us by. Our slow suicide manifested in other ways as well. Most of us mistreated ourselves by neglecting our health, letting our friendships die off, ignoring our families, our hobbies, our lives.

Maybe insider trading was Gil’s grand suicidal gesture, his protest against the abuse he received. He put his entire life on the line, knowing he might well be caught, end up in jail and lose everything. He was playing Russian roulette, and maybe he knew he’d kill himself if he got caught.

And all for what? Money.

(more…)

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Gerald Lucas, a psychotherapist who runs an institute in New York City, used to tell his patients he regretted he couldn’t make the world a better place – he could only make them better able to handle it the way it is.

Sometimes the key to happiness is a little like the key to Weight Watchers – learning to stay away from things that are bad for you.

Luck certainly plays a role.  My relatives fled to the United States from Poland and Lithuania because the Czar and other nasties were oppressive, violent rulers.  Forty years later, Hitler rolled in and committed the worst crimes in human history.  It could have been my relatives in those Nazis death camps, but for dumb luck and the determination to leave the bad behind and seek something better.

The world can seem like an unpleasant place sometimes.  If you need evidence, open this morning’s paper and take a look.

As a psychotherapist, patients bring plenty more proof that evil exists.  It’s a good wake up to some harsh realities.  As with everything else in psychotherapy, awareness is all.

One of my patients was violently raped in her early twenties.  Working with a rape survivor taught me a lot about human dignity and the process of recovery from trauma.  It also taught me about rape.  Knowing someone who has been victimized by violence introduces you the fact that it really happens, to real people, all too often.

This woman gave me a book to read about rape, “Lucky,” by Alice Sebold, the author of “The Lovely Bones.”  It is a memoir of Sebold’s own experience of rape, and a book I shall never forget.  My patient taught me another important lesson:  if something like that happens to you, you will do everything in your power to avoid letting it happen again.  She took a self-defense class, carried a can of mace, and never again walked home alone late at night.  There are predators out there, and at very least, you can take all available precautions.

So this week, when a beautiful young female patient complained to me about what she’d been through recently, I wasn’t surprised.  In the past year she’d had a guy slip a drug into her drink, an older man – a professor, no less – approach her inappropriately for sex, countless construction workers whistle at her, and a best friend fall victim to domestic violence, then return to the boyfriend who beat her up.  It was quite a list, but I believed every word.  We talked about how she could be careful – and stay away from people who mean her no good.

Another patient I saw recently had a run in with a sociopath, a person who lacks a conscience.  A sociopath will tell you whatever you want to hear, take pleasure in lying to you and generally not give your feelings a thought as he pursues his own agenda.  “Sociopath,” or the technical term, “Anti-social Personality Disorder,” are arguably just mental health lingo for a criminal.  Many of the people who populate our prisons – the hard-core law-breakers – are socipaths.

The sort of run-in that happened to my patient could happen to anyone, and all too often it does.  It’s not a nice experience.  This guy was very charming, and appeared to have a successful career.  He moved in with her and said he wanted to marry her and have a child.  What he didn’t mention was that he already had a family – a wife and children – who knew nothing about this other relationship.  The “business trips” were spent with this family, 20 blocks away.

My patient asked what she could do now that she’d discovered the truth.  I gave her my blanket advice for dealing with sociopaths:  stay far away.  She moved somewhere else, and hasn’t seen him since.

Obviously, women aren’t the only people who are victimized by evil deeds – although they do seem to receive more than their fair share.  Children are victimized in terrible ways each and every day, and  I’ve worked with adult men who have survived domestic violence, sexual abuse and other ills.  Bad things can happen to anyone.

My point here isn’t that the world and everyone and everything in it are bad.  There is plenty of good out there, too.  It’s just that you need to keep what is bad far away – and, at the same time, pull the good nice and close.

In everyday life, that means more than just staying away from predators and sociopaths.

It also means:

Don’t date someone if he doesn’t treat you with kindness, consideration and respect.  He should be grateful and appreciative to have you in his life – or you can find someone who will be.

Don’t work in a setting that is hostile or toxic.  Your workplace should make you feel appreciated for the work you do.  You should look forward to coming in to work each day – or you should work someplace else.

Don’t consider someone a friend unless he’s got your back.  “Friend” is a powerful term – it means someone you can say anything to and who can say anything to you.  It implies loyalty, caring, trust and respect.  Anything less is an “acquaintance.”

Breathe in the good.  Breathe out the bad.

Sometimes it’s that simple.

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