Swimming Upstream

Fighting the current of life.

adventures

The trip to Toronto was fine, though tiring. I walked a lot, I’m guessing 7-8 miles in 2 days. I also rode transit of course, but you experience a city more while walking through it. I stopped at a couple of museums, rode the terrifying elevator on the CN tower, took the stadium tour and watched the baseball game at Rogers Centre. San Francisco lost, so the 100 or so Giants fans in attendance were disappointed, but the home crowd was quite happy. I also stopped at Niagara Falls on the way home. I didn’t go to any of the schlocky and tacky places, I just went straight to the falls (that’s the point, isn’t it?). The canal locks were kind of stupid, there was nowhere to really see very well, and no ships were making the transit while I was there. Finally, I got a huge blister on my foot from all the walking, and a sore back from favoring the right foot all day. Still enjoyable, however; any mini-vacation like that makes me feel good.

On the other hand, the next adventure will be more of a working vacation. Next Friday I will be flying to California to meet up with the Fish-in-laws, then in the following week I will drive their stuff cross-country in a rental van. That’s right, I will be a truck driver again for one week. At least I will get to stay in hotels this time, rather than sleeping in the truck. I am taking 6 days to drive 2700 miles from California to Ohio; I could do it in 5 days, but there is no time pressure to do so. I’ll wave if I drive by your town.

It has been almost 8 years since we moved here, and this trip will be basically retracing the same path we took at that time. The only difference is that I will be alone, on my own schedule, not worrying about kids or cats or the in-laws (they are driving several days later). Hopefully I can stay awake better this time, not make a biker gang mad, not make a u-turn in a construction zone, and find good parking places.

the sometimes-annual baseball trip

I am a huge baseball fan, and every year I try to get to a new city to watch a game, preferably when the San Francisco Giants are visiting. In 2002 I went to New York (Yankee Stadium) and Boston; In 2006 I went to Pittsburgh and Cincinnati; in 2008 I went to Detroit; in 2010 I made it to games in Chicago (Wrigley) and Baltimore; I didn’t see any games in 2011; I had my trip planned for Washington and Philadelphia last year but spent that money on dental care instead.

Next week I am going to Toronto to watch the Giants vs. the Blue Jays. Not only is it the first time the Giants have played there, it will be my first time seeing the city as a tourist rather than as a truck driver being stuck in traffic on the 401 freeway. I have two days of sightseeing planned in addition to the ball game, and I will stop by the Welland Canal and Niagara Falls on the way home.

Why the Welland Canal? Locks. I’m an engineer, and I have always been fascinated by the simple yet ingenious way of moving ships uphill. Also, I am drawn by flowing water, whether in rivers, over falls, gutters, storm drains, or canals.

Unfortunately I will have no one to share the fun with. My family doesn’t like baseball, Mrs. Fish and the Man-Child have to work, The Girl has school, and nobody but me has a passport. I don’t mind doing the trip by myself, but it would be nice to have someone along to talk to.

Anyway, If anybody has any suggestions of something I absolutely have to do in Toronto (besides the obvious stuff like the CN Tower) or Niagara or Buffalo, let me know quickly.

scones and smoothies

I told the previous story about The Girl so I could tell this one:

During those darkest times when I was convinced I was destroying my daughter’s life, I was certain that I had ruined our future relationship together. I tried to imagine how we would be when she was an adult, and if she would hate me for all the pain I caused. What I wanted is for us to be like friends who could meet and talk casually about life without being too tense or emotionally charged. I just wanted a good father-daughter relationship to last into the future, and I was afraid I had jeopardized that beyond repair.

Fast forward … over the past two years we have been more stable and have been able to grow into a more healthy relationship. We are able to have those conversations, she doesn’t hate me, I haven’t permanently screwed up her life. Sometimes I forget she is not yet 16, because the other day I was reminded of the vision I hoped was not lost forever. The Girl and Mrs. Fish and I went on a shopping and dinner night, then afterward Mrs. Fish went to her quilt meetup at a local café. The Girl and I sat away from the group, talking about stuff while enjoying a scone. She had a fruit smoothie, and I was drinking coffee while we talked, and suddenly that vision of the future popped into my head.

It felt really nice to be in that moment compared to where I feared the future would take us. I’m not afraid anymore.

depression progression

6:00 – I don’t think I’m depressed, I’m just tired …

10:00 – the weather matches my mood: cold, rainy, gloomy. I don’t get depressed by poor weather, I actually enjoy it when other people are miserable with me. … I’m so tired of work and people and traffic. I just want to be alone in a dark place, sleeping or reading, drinking tea, bundled in blankets that weigh me down …

12:30 – I’m not depressed, I’m just sad that lunchtime is so short, and I can’t recharge or take time to be alone. I have to go right back to work, but it is really difficult to walk back into the office …

14:00 – does my face really look like the cat died? I better pull it together before someone sees something is wrong …

15:30 – fuck I want to go home and drink, then sleep for a week … maybe I am a little depressed, I just don’t want to admit that the pills might not be working again, which means more unstable days ahead, and that would open a whole can of “bipolar eats your dreams for lunch” …

17:30 – I guess I have to pretend to be the responsible parent now, cooking and talking and acting like I care. Oh well, drink and sleep later …

21:00 – I feel like shit. I feel so alone, even at home, and no one pays attention to me on the blog or on Fakebook. I doubt anyone would miss me if I disappeared for a while …

23:59 – I can’t sleep. I think I’m depressed.

a reason to stay alive

I think the darkest time of my life was when I was on the road, when my daughter was dealing with her bipolar and mine was crushing me. The Girl was struggling with sleep cycles and depression and thoughts of self-harm and failing in school. In the meantime I was suffering from months of near-suicidal depression fueled by guilt and self-pity and anger with myself over the mess I had created between us. When I came home for a few days we did nothing but fight and argue and make each other worse. Mrs. Fish and I had a rough time also, because she was just not prepared to deal with one bipolar person let alone two.

I knew my behavior was hurting The Girl, and the only way out seemed to be either running away, or suicide. But in between the arguments, one day we were having a deep conversation where she was questioning why I cared about her and why it mattered to me that she felt okay. I don’t remember what I actually said at the time, but her question stuck with me for a long time. After I went back on the road, I wrote the following post.


You asked me why I care, why I love you, why it matters if you’re alive.

I can’t describe how sad it makes me when you are hurting so much that you need to ask. I’m worried for you, and I want to make it better, even when you won’t let me help. I want to fix everything, but I can’t. I wish I could take those feelings away from you and put them on me instead; I’ve had enough experience to withstand the crushing pressure. I know these hopeless and empty feelings, I’ve been down this path, I’ve almost given up. I have asked the same questions.

The short answer is this: when I felt like there was nothing left to live for, I thought of you. Not anyone else (and I hope they can understand and forgive me for saying that). My love for you kept me alive.

I thought about how you need me (though you’ll probably never admit it); about how much you love animals; about the camping trip by the river; about how smart and creative and funny you are; about you saying “that’s what she said”, or just looking at me without having to say it. I thought about how we seem to share so many feelings or talents or jokes or ideas, discovering something new when one of us says exactly what the other was thinking. I thought about how I want to be a better person for you and not ever hurt you (though I fail much too often). I thought about our deep conversations, now and in the future. I thought about you laughing so hard you couldn’t breathe, and how incredibly happy and free you were in that moment.

I thought about you crying helplessly in the dark, feeling like you were abandoned by the person who understands what you’re going through.

I chose to stay because I couldn’t put you through that pain. I chose to stay because I wanted one more day with you, then another, then another. No matter what you say or do, I still love you that much, and I know I will survive if you’re there. Helping you through the storm is the single most important purpose in my life. If you were gone, the best part of my soul would disappear, leaving nothing but bitter sadness, and there would be nothing left for me.

That’s why I care. That’s why it matters. The words seem so inadequate, but I hope you will understand.

(December 2010)


I still get emotional when I re-read this. I hope other bipolar parents see this and can take some comfort when they are hurting.

tired, but stable

The past two weeks have been very tiring for me due to work hours and stuff to do at home. However it’s not like I have been working real hard, especially at home; procrastinating is very exhausting! No, it’s the familiar feeling of being overwhelmed with so many tasks that wears me down. Not only do I have things at this house to do, we have to do springtime work at the fish-in-laws’ house while we wait for them to move here at the end of May.

On the other hand, I cannot believe how well the bipolar is treating me lately. The meds are working, and I have not had any mood swings up or down for a couple of months now since increasing my dosage. I don’t remember the last time I felt that I was not in danger of sliding precipitously one way or the other. I really appreciate not looking over my shoulder and seeing the black balloon shadowing me. Not that I’m terribly happy either, just in the middle, and I’ll take that any day.

I wish I had more to say. I wish I had something deep and meaningful that I could place in the “blog for mental health” category, but I don’t right now. Maybe I will look for something in the archives to post.

I have been looking for a replacement for Google Reader to keep on the blogs. I guess I have settled on Feedly, which works at home and on my phone. Still working out the kinks, so hopefully I don’t lose any bloggers I care about.

Finally: I’ve had it with Fakebook. They have changed it too much, and I can’t get rid of all the crap people like or share. I want to read original, thought-provoking content, which is why I gravitate to blogs instead. My Fakebook friends will never miss me anyway.

zip, zilch, nada

Nothing interesting is going on right now. Work is the same, home is the same, my mood swings have (thankfully) stayed away … in other words, life is okay for now.

Still, there are things to worry about. I still have my daily anxieties about almost everything. The onset of the springtime thunderstorms has me concerned once again for our large trees looming near the house. I have become more nervous while driving, which does not bode well for upcoming road trips. My daughter seems to be going through another poor sleep phase because she won’t take better care of her bipolar, no matter how much bitching I do.

Looking forward, the fish-in-laws will arrive in May, while I will be driving their truckload of stuff across the country. In the meantime, I have my mini-vacation to Toronto to plan. I will get busier at work with the construction season beginning, and I will need to work some more overtime. Oh well, nothing special happens at home anyway.

So there is a summary of life at the moment. I hope you are as bored as me.

ode to bathroom genius

I was in a bathroom in a truck stop in 2010, reading the various graffiti and illustrations on the wall. I was suddenly inspired by what I saw, believe it or not, and I ran to the truck to write down a few quick thoughts. This evolved into the following …

mental giants of the bathroom stall
your writing career has yet to start
you post your thoughts on the lavatory wall
for the world to read when they shit or fart.

you try to inform, or shape opinions
or simply entertain us
your demonstrate your intellect
as you fixate on your anus.

you discuss your fears about other races
scrawl your comments on the news
draw phalluses near smiling faces
as you try to drop a deuce.

no matter the topic, the writer delves
into topics like the fate of the nation
and what people should do to themselves –
while engaged in defecation.

your political views are eloquent,
well-reasoned and debated
with passion, fury, and discontent –
while sitting, constipated.

your scholarly erudition rivals
the brightest of our species
our finest minds are best engaged
when expounding on their feces.

your literary greatness reaches the heights
of Chaucer, Faulkner, Keats, and Poe.
I’ll anticipate your thoughtful musings
when next I have to go.

(January 2010)

escaping the inner dialog

When I’m depressed (which is often), I do a lot of ruminating about failures, losses, and mistakes over the years. The next step is to silently beat myself up, the internal critic repeating everything I’ve ever done wrong and telling me how stupid or lazy or inadequate I have been over my whole life. The inner critic has been nasty since I was a child, and it is a constant battle trying to quiet that voice.

The inner critic takes breaks during the times between depressive spirals, but when my mood plummets the damaging voice returns in full force. I wrote this in 2006:

… it is interesting but not really surprising that my inner critic, the beast, can lash back so viciously and accurately after taking several weeks of vacation … almost as if it knows that it hurts worse to savagely rip things apart after I had started to feel hope or accomplishment or self-compassion or understanding again, for the first time in years. That is a well-established formula for its success, lying in wait and collecting evidence, but waiting to tear me down just at the point where things are starting to look positive.

Often the inner critic speaks with the voice of the Old Bitch, the toxic and damaging she-devil I lived with for 14 years. Sometimes it is just my own voice, speaking quietly but forcefully, sharing intimate details only I know about. Either way, the inner voice likes it when I am sad and alone, making the depression that much worse and making me feel so solitary.

I can’t really say I have made progress in silencing the inner critic, because I still don’t know how to turn it off. The only thing I can think of is to minimize the depression, which for me means having the right dosage of mood-stabilizing drugs. The other thing I have done is to reduce the large pile of things that cause depressing thoughts and memories from childhood. In the past year or so, I reached a point where I was able to just stop feeling sad about many things that happened in the past (see this post).

Like I said then, I still have many insecurities and flaws and issues, but at least I have reduced the impact of that hateful little voice, at least until the next wicked mood swing plummets me back into misery.

for a few dollars more

I had my first experience with being independent when I left home to go to the University of Nevada in Reno. I had a nice 4-year, almost full-ride academic/music scholarship to play in the band and study engineering and music. When I said good-bye to my adopted mom and started my college career, I knew she was going to feel mixed emotions. I’m sure she was sad to see me leave home, and her constant fear of abandonment was pulling her down. In the meantime, I was happy to leave Goldville behind, and not really sad at all about leaving home. (I was depressed due to leaving my friends, but I made new friends.)

We didn’t have a lot of money at the time, but we were doing okay, so I thought. I was working to pay for expenses that the scholarship didn’t cover, but of course Mom helped me out with money now and then. As November rolled around, we had to spend a bunch of money to repair my little green car after the water-pump/losing a girlfriend incident. When December approached, I knew my housing bill was coming due, and I didn’t have enough money. I talked to A-mom, and she said she didn’t have the money to help. Really, none? Not after spending money on the car, she said.

Despite my begging, she said she could not come up with $600 more, and I missed the deadline for paying my housing bill. This meant I was kicked out of the dorms; freshmen were required to live in the dorms, and since I could not pay my bill I was told I could not come back for the spring semester. As a further result, my scholarship was gone in a flash, and I crawled back to Goldville as a failure, sad and depressed and bitter at having lost so much, so quickly. The worst part was having to explain to people what had happened.

After thinking about this off and on for 25 years (you know I tend to dwell on things), I settled on a very unsatisfying question: did A-mom really not have $600 at the time to save my scholarship? Was she honest, and couldn’t scrape up enough money to help me? Was she punishing me for breaking the car and making her tow it home? Or, did she “not have the money” so I would have to come back home and she wouldn’t be as lonely? Did her fear of abandonment cause me to lose out on the opportunity I had earned by working so hard through high school?

Of course I will never know the answer to these questions. A-mom died two years later, chased to the grave by her fears and insecurities. I could ask her best friend from that time, but even if she remembered the situation, I don’t think I could trust her answer. Besides, what good does it do me to keep digging up old skeletons? I should let these things lie in the past where they belong … but I’m not good at doing that. This was perhaps the biggest of those turning points that change your entire life, and I can’t help thinking about what might have happened had I been able to pay my bill.

I do know one thing: if the same situation occurred with one of my kids, and I recognized the opportunity they would lose? I would goddamn sure find the money somewhere. I would run up a credit card and worry about paying it off later, if it gave my kid a chance to do something great, rather than watch them fail.

silencio

I’m being quiet today. I’m not down or depressed (I guess), I just don’t want to be noticed or bothered by anyone. I know I’ll have to put on the smiley-mask at some point today, but I’ll deal.

I had a quick but positive visit with my psych yesterday. I told him the truth, that since the dosage increase I am feeling better than I have in about a year. I’ve had minor down days, but nothing significant in the past month. I’ll take that, it makes life so much easier when I don’t have the depression wighing me down.

Speaking of weight, exercise is the next thing I need to face. While I’m not depressed, I need to get the nerve to exercise near other people, something as simple as walking or bike riding. Something, anything. I’m a goddamn bloated whale, and that makes me depressed also.

Finally, I have two interesting trips in May. I’m going to Toronto to see the city and a Giants/Blue Jays baseball game. Later, I’m going to California to help the fish-in-laws move here. More details as those events get closer.

comfort zone

We are programmed to avoid pain whatever its nature, physical or emotional. If that pain is unavoidable we cope as best we can. One of those coping mechanisms is hiding or retreating into a safe place, a comfort zone where you feel like the world can’t get you. It might not be a happy place, but any mental and physical place will fill that need in times of crisis.

During a depression episode, people like me get lost inside their head, wallowing in self-pity, and hide in bed as much as possible. I usually tend to withdraw from other people, isolating myself and hiding my feelings behind a mask. Even when I’m feeling okay, I tend to avoid new or uncomfortable activities, restricting myself to something familiar and finding “safe” places where I can be alone. When I am at work, I often try to not get noticed for anything, quietly doing my work but not striving for promotions or additional responsibility.

I guess I do this because of my many insecurities, lack of confidence and self-esteem, and my morbid fear of failure or embarrassment. Have you seen that bumper sticker “Dance like no one is watching”? I don’t dance for fear that someone may be watching, even from binoculars at a thousand yards, and laughing with their friends, or posting a video online for my eternal humiliation.

I’ve always been this way, except in the few situations where I had confidence in what I was doing. When I was in the band in high school, I was part of a cohesive group of geeks working towards a common goal, and I was able to be a leader within the group. When I was in college, I didn’t see myself as a genius, but I had the confidence that I would excel at all my classes; I was surprised that many people wanted to study with me to improve their grades.

I wish I knew how to overcome a lifetime of this programmed behavior. I’m sure it’s not impossible, but I think it would be very difficult to change my actions and challenge these deep-rooted fears and insecurities. Where would I start? I don’t know the answer, and I seriously doubt that someone else has the answers for me. I know no (legal) drugs can make me un-learn years of acting this way. Alcohol doesn’t help me change, it only intensifies my depressive personality.

Happy, well-adjusted, confident people are able to put themselves out there with seemingly little effort. They seem naturally born to bee free spirits, risk takers, outgoing and gregarious, and open to new experiences and relationships. How can they behave this way, is it something genetically programmed, something learned, or a combination of both? If that is so, I struck out on both counts; I learned passive and self-conscious behavior as a child, and the genes for mental illness were given to me at conception.

There are very few times I can feel more free to be myself, for example when I go on a baseball trip somewhere, or years ago when I would go hiking in the mountains in the West, or when I am exploring somewhere new where I don’t know anybody. Maybe these are associated with hypomanic phases when I am feeling abnormally alive. Most of the time however, the depression forces me back into that comfort zone where I’m not scared or vulnerable.

depression and friendships

I don’t make friends very easily, and currently I’m not making friends at all. My definition of friendship is probably more stringent than most people. If I don’t trust someone completely, they’re merely acquaintances, relegated to the outer periphery of my emotional universe. It takes someone years to earn my trust, and even then the slightest slip can send someone back outside my defenses, no matter how insignificant their perceived insult. I realize this is a crazy way to determine who I get close to, but that’s how I roll; I’m the square wheel on the bumpy car ride.

There are several reasons I don’t make friendships very easily:

  • I’m lazy and depressed all the time, and it is just too difficult to make the effort to maintain existing friendships, let alone make new relationships to fuck up. It takes a lot of energy to start and maintain friendships, and I can just barely keep myself going as it is.
  • I don’t really care about people very much, and it takes a long time before someone is close enough for me to care about. It’s hard to develop friends when you don’t spend any time caring about people, and I never allow people enough information for them to try to care about me.
  • My insecurities sabotage most potential friendships. I’m afraid I’m not good enough, they won’t like me, or worse yet they will pretend to like me but mock me behind my back. I’m afraid to let myself care too much because someone might not care as much as I do, and they might ignore me or just drop me altogether as a friend.
  • I don’t have common activities with anyone where I might make friends, outside of work. I don’t really care about people I work with, in fact most of them grate on my nerves now, and others I don’t like at all. I don’t really do any outside activities thanks to being depressed all the time and being lazy.

This is not to say I have no friends. Right now, I’d say I have one who I see on a regular basis, one who I never see but occasionally talk with on the phone, and one who I never see or talk to outside an occasional Fakebook message. Right, that’s a huge number, I know. However people I used to know in real life are now just fading away despite the occasional “Like This” or comment. I have mostly lost contact with people from high school, not always by choice. I’ve also lost contact with former co-workers just because we live so far from each other.

In the past, it has been easier to make friends when I have been stable and in a relatively good place in life. This would explain my two friends here in town, because they worked with me in 2009 before I got laid off. When I was not stable, or just constantly depressed, my insecurities always got in the way of friendships. In addition I got burned many times by people who I thought were friends but either hurt me deeply or just drifted away. In other cases, I let myself get too needy or deep with people that were just being friendly. I just don’t have a good sense of interpersonal boundaries.

—–

And this, from David Letterman’s Top Ten list from September 30, 1993, Top Ten Signs You Have No Friends:

3. James Taylor sings the first few bars of "You’ve Got a Friend," notices you in the audience, and stops.

bipolar squared

Newton’s law tells us that any two bodies have an interaction with one another, no matter how far apart they are. I think something similar occurs when two bipolar people live in the same house.

My daughter Nikki is 15 years old, and we have had a unique relationship since she was about 4. Starting about that time, she had always been difficult, stubborn, and occasionally defiant, but also sweet and intelligent and creative. We would argue about anything and everything, but we would also play and take walks at the beach or in the forest.

Over time, as I became less stable, our relationship worsened. She would regularly act disrespectful and say hurtful things to me, and I was not much better. I would often lash out verbally and punish her for very small transgressions. We both have mixed memories from this time period, because we both remember very good times and bad times with each other. She has always been able to express her feelings clearly, and when she does I feel an immense guilt for the problems my bipolar caused between us.

I have had bipolar for her whole life obviously, but then her bipolar symptoms became evident around age 11. She would have manic periods with anger or extreme happiness, rapid and unending talking, and insomnia. This would be followed by deep depression phases where she refused to get out of bed for school or anything else, sometimes for days at a time. I think she cut herself once, but she won’t admit it or show me. Her mood swings were somewhat rapid, on the order of a few days each way, and increasingly out of control.

At this time our mood swings would sometimes cancel out, but sometimes become amplified and cause a shitstorm of anger and yelling and breaking things. When we were both unstable, it proved to be very bad sometimes. While I was driving, it seemed like being away from home was the best solution, and one time I stayed on the road an extra week to avoid being at home. I really hated myself because of the situation, and thought many times of separating from the family to make things better for her. I thought she would hate me forever. Many old blog posts are about these feelings at the time.

We recognized the symptoms, but by the time she was 12 we went through two doctors who either did not believe us, or refused to diagnose bipolar for a pre-teen. The third doctor believed we were right and understood her symptoms, and gave her a n.o.s. diagnosis. Nikki started taking Lamictal, and amazingly the first medication ended up being the right one; her symptoms were more under control as the dosage increased (she is currently on 250mg/day). She has said over the past few years how she feels much more capable of dealing with the bipolar swings because of the medicine and through ongoing counseling. The counseling seems to be less important now, but they doctor requires at least monthly meetings to discuss her treatment.

As we both became more stable, our relationship has been much improved, and maybe better than anytime in the past. Once again we are able to talk about everything, and I’m no longer afraid of having a permanently damaged relationship. We have both learned how to deal with the breakthrough mood swings without being hurtful and damaging. I hope we continue improving and not go back to that hurtful time when bipolar nearly tore us apart.

blog for mental health 2013

blog_for_mh_2013

The pledge: I pledge my commitment to the Blog For Mental Health 2013 Project.  I will blog about mental health topics not only for myself, but for others.  By displaying this badge, I show my pride, dedication, and acceptance for mental health.  I use this to promote mental health education in the struggle to erase stigma.

This was started by the Canvas Of The Minds collective, and I was pledged by Bipolar 2 Dad. I appreciate the efforts of the Canvas writers to break down the stigmas and misconceptions about mental health issues. Unfortunately I don’t feel safe coming out of the bipolar closet for now, but hopefully I can make a difference here somehow.

I have been suffering from Bipolar Type 2 since my early teens; I was incorrectly diagnosed with unipolar depression in 2004 and diagnosed with bipolar in 2006 when I had a “little breakdown”. In the past 9 years I have been through five doctors, four therapists, and a shitload of drugs. I have been with the same doc for 3 years now, and we keep tweaking the medications in an ongoing attempt to help me stay balanced. Though I do not have a diagnosis, I have had co-morbid depression since I was a kid, and I have always had minor symptoms of anxiety and avoidant personality disorder. This site is not only about my bipolar, but the struggle with balancing my illness with being a husband and father, and having a work life as a civil engineer. In addition, you will hear about my daughter who also has bipolar disorder.

There are so many great sites around Blogworld, but I’m going recommend one: Sarah at bi[polar] curious. She bravely writes under her real name and discusses research, media coverage, and breaking stigmas about mental health.

Finally: I’m not always the most positive person around, and I get stuck wallowing in anger and self-pity way too often. Hopefully the depressive spirals have calmed down for a while, so I can concentrate on more productive writing. As I said in the previous post, I am taking this pledge to help myself improve as a blogger and hopefully contribute something of value to the mental health community.

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