Ministry & the Mentally Ill

“Turning Your Back,” Russian Folk Art

Religious people love to hide behind religion. They love the rules of religion more than they love Jesus. With practice, the Condemners let rules become more important than the spiritual life. “

— Michael Yaconelli

Mentally ill people are rarely seen in our Churches.  We are pushed into hiding our true identity;  we can come out into the open, but only if we agree to play according to the rules–their rules.  We are expected to censor ourselves, and say proper things at the right time.  Pharisees [who are alive and well] insist on a level of purity that all must maintain. [Hey, I am not picking on anyone, it’s just a generality.]

If I say that I am depressed, paranoid, manic or desperate, I will upset the apple cart and muddle up everything.  “Truth?  You can’t handle the truth?”, [from the movie, “A Few Good Men”.] 

But– if we use our shortcomings as credentials– we have the ability to speak about grace, love and of self-acceptance, with real authority.

Christians with mental illnesses, have been given a gift that we are to share with the Church.  The Holy Spirit has sprinkled us into each fellowship of believers.  He places us who are presently afflicted and suffering into strategic places.

We are “sprinkled” throughout the Body. Our “gifts” are to speak to the Body, spiritually about a lot of things, but especially grace. We are bearers of grace. We’re the audio/visual department of the church.

If our fellowships become religious, it might be because we in our weaknesses, have allowed ourselves to be silenced into submission by the “interpreters” of scripture.  If we don’t like the rules, we are told to go elsewhere.  We are not welcome, they say with a thin smile.

But don’t you see, that is our moment to shine!  Our “unsightly” presence shouts out to the “wonderful” people, proclaiming grace in weakness.  Those who receive us, in a way, receive Him.  Those who turn from us, muffling us, are doing that to Jesus. Frightening, isn’t it?

I would strongly suggest that we take our illnesses into the open. 

That we become transparent before others.  As we do this, we can ‘oh-so-gently’ guide our fellowships into true grace and love.  They look at me and they see Jesus.  And that is our ministry as mentally ill people to the Church.  Our weaknesses are really our strengths.

9″ But He said to me, “My grace is sufficient for you, for power  is perfected in weakness.”  Therefore, I will most gladly boast all the more about my weaknesses, so that Christ’s power may reside in me.” 

10 “So because of Christ,  I am pleased in weaknesses, in insults, in catastrophes, in persecutions, and in pressures. For when I am weak, then I am strong.” 

                               2 Corinthians 12:9-10, NLT

 

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[This is a re-blog of one of our core teachings, originally posted 11/20/2009. I felt it was time to bring out of our musty old closet and set it before you again. I hope that it resounds deep within, and that it encourages those who must mix their discipleship with disability.]

 

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Tigger Goes to a Therapist

A Therapists Consultation: TIGGER

(Winnie the Pooh’s Irrepressible Friend.)

Diagnosis:

Attention deficit hyperactive disorder (ADHD): Tigger’s continual bouncing, hyperactivity and irresponsible attitude cause problems for him and those with whom he lives, as well as those he interacts with in the wider community.

Physical presentation:

Rarely sits still. He’s always running, climbing, or fidgeting.

Diet:

Having tried – and firmly rejected – honey, haycorns and thistles, Tigger settles on extract of malt as his food of choice. While this particular substance is unlikely to exacerbate his condition, a more balanced diet would almost certainly benefit him and perhaps contribute to an improvement in his behaviour.

Family background:

No information is available on Tigger’s life before his arrival at Pooh’s house. Nothing is known of his previous address or his family of origin, although it has been said that he is the only Tigger.

Patient notes:

Tigger’s arrival at Pooh’s house in the middle of the night is evidence of his inability to control his impulses. A less disordered individual would have known that it is more appropriate to visit people during the day, especially when dropping in on someone one scarcely knows or has never met.

Impulsive behaviour, interrupting and intruding are at the heart of Tigger’s problems. Soon after their first meeting, for example, Tigger suddenly interrupted Pooh, climbed on to the table, wrapped himself in his host’s tablecloth and brought everything crashing to the floor.

When questioned by Pooh about his behavior, rather than accepting responsibility for his actions, Tigger accused the tablecloth of trying to bite him. Tigger makes bold statements, such as declaring that he is only bouncy before breakfast. He proclaims impulsively that whatever food he is offered is what Tiggers like best, then gulps down large mouthfuls of the food in question, only to find he dislikes it very much.

More evidence of Tigger’s recklessness and poor impulse control is displayed by his belief that he can do anything. He has no sense of fear or responsibility. This was apparent when he climbed up a high tree with Roo on his back before he had ascertained whether he was able to climb a tree in the first place. Inevitably, they then got stuck when he realised he had no idea of how to get down.

On one occasion, Tigger grabbed Roo’s medicine from Kanga, which he proceeded to swallow, almost devouring the spoon as well. Obviously the medicine might have proved dangerous to him. Tigger never learns from his mishaps, bouncing back almost immediately after a frightening and potentially hazardous incident. As a result, Tigger’s behaviour causes concern to those around him.

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Living with someone suffering from ADHD can be trying. Perhaps this is why Rabbit suggested the rather extreme measure of taking Tigger into the forest and losing him in the mist. Rabbit and his friends believed the shock of being lost might cause Tigger to calm down a little on his return, a strategy that backfired, however.

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OCD: Rituals and Obsession

“I couldn’t do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn’t. It took me longer to read because I’d count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn’t add up to a ’bad’ number.”

“I knew the rituals didn’t make sense, and I was deeply ashamed of them, but I couldn’t seem to overcome them until I had therapy.”

“Getting dressed in the morning was tough, because I had a routine, and if I didn’t follow the routine, I’d get anxious and would have to get dressed again. I always worried that if I didn’t do something, my parents were going to die. I’d have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me.”

People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.

For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get “caught” in the mirror and can’t move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.

Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.

OCD affects about 2.2 million American adults, and the problem can be accompanied by eating disorders, other anxiety disorders, or depression.  It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families.

The course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.

OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them.

Source: http://www.nimh.nih.gov/index.shtml

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Relapsing [Without Being a Moron About It]

 A Bumpy Road: Dealing with Relapse

There may not ever be a last episode, but there are ways to fend off and mitigate the next one.

By Jodi Helmer

Doctors never talked to Elly L. about RELAPSE.

Although she was hospitalized during a manic episode and diagnosed with bipolar disorder, doctors never mentioned that it could happen again. Instead, Elly was stabilized, handed a prescription for mood stabilizers and discharged. She had no idea that she’d be battling mania and depression for the rest of her life.

“I was told that as long as I took my medications, I’d be okay,” recalls Elly, a mental health coach in Toronto, Ontario.

Elly experienced at least eight relapses between her diagnosis in 1978 and 1991. Each time, she was hospitalized, often placed in restraints and taken to the psychiatric ward in a police car or ambulance. Upon discharge, Elly always promised herself it would be her last hospital admission-but she had no idea how to stave off future relapses.

In bipolar disorder, relapse is defined as the return of depression or a manic or hypomanic episode after a period of wellness. According to a 1999 study published in the American Journal of Psychiatry, 73 percent of those diagnosed with bipolar disorder experienced at least one relapse over a five-year period; of those who relapsed, two-thirds had multiple relapses.

“You can never say that someone with bipolar disorder has had their last episode; relapse is part of the illness,” explains Alan C. Swann, MD, professor and vice chair for research in the Department of Psychiatry and Behavioral Sciences at The University of Texas Medical School at Houston and director of research for the University of Texas Harris County Psychiatric Center. “Relapse is self-perpetuating; once it happens, the more likely it is to happen again.”

Searching for Answers

It’s possible to do all of the right things- follow a proper medication regimen, eat well, exercise, minimize stress and get enough sleep-and still experience relapse. Unfortunately, there is no clear understanding of why this happens.
“There may be changes in the cellular level that cause cycling but their cause is unknown,” says Joseph R. Calabrese, MD, director of the Mood Disorders Program at the Case Western Reserve University School of Medicine in Cleveland, Ohio.

While the neurological causes of relapse are unknown, a few things are certain: Those who are diagnosed with bipolar II are more likely to relapse than those with bipolar I. Their episodes of depression, mania or hypomania are often shorter than the episodes experienced by those with bipolar I but tend to return more often, according to Calabrese. It’s also far more common to relapse into depression than into mania or hypomania. Calabrese estimates that in bipolar II, there is a 40-to-1 ratio of depression to mania; the ratio of depression to mania drops to 3-to-1 in bipolar I.

“The key to recovery is a low tolerance for relapse,” says Calabrese.

In fact, Dr. Roger S. McIntyre, MD, associate professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit at the University Health Network, believes that even the mildest symptoms of depression and mania should be treated as potentially hazardous.

“The takeaway message is that we need to seek complete elimination of symptoms as our treatment objective,” he says…

Click here to read the full article, “A Bumpy Road: Dealing with Relapse”

“bp Magazine” is a wonderful “shot in the arm.”  I would suggest that you get a subscription, and for a friend as well.

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Join NAMI today!

When you become a member of NAMI, you become part of America’s largest grassroots organization dedicated to improving the lives of persons living with serious mental illness. And now you can join online.

http://www.nami.org/template.cfm?section=About_NAMI

Different Ways to Fall Out of a Tree

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Imagine climbing up to the top of a very tall tree. You work your way up to the highest point– you can go no further. The view is completely glorious, it’s more than you hoped for. You want to post it on Facebook, so you dig into your pocket to get your camera-phone. You suddenly slip, and because your arms are occupied getting your camera, you fall. And you fall fast.

As you plummet, you realize that you’re hitting every branch on the way down. The smaller ones break, and the bigger ones, well– you just bounce off. The trip down is very fast, and perhaps even a bit illuminating.

  1. First, you think of death.
  2. Then you think about the pain each branch causes, and wonder about your imminent arrival on terra firma.
  3. Perhaps you consider how stupid you are, and how you are going to explain it.
  4. Lastly, I suppose, you wonder if you have clean underwear on, like your mother always told you to wear.

This is how my life has gone, the last 20 years. This metaphor is a good way for me to process things, and to find some understanding. I now believe that some of us go through life sideways, or horizontal. We careen off of every branch on the way down, and it seems we are hitting branches that we didn’t even know were there. Tree limbs are snapping, as we are dropping.

Others who are wiser (or maybe more experienced,) try to fall more vertically. As they fall, they use their hands to try to slow their descent. (This does work!) They will take their fair share of jolts, no doubt. But their journey to the forest floor is way less traumatic. They may end up in the hospital– but not in emergency surgery like the first guy.

It sometimes seems like every trouble I have faced I have gone into it sideways. I have broken a lot of branches on my way down. I suppose I’ve entertained some who have watched me plummet, and seen me careen and spiral my way to the bottom. These have been some painful times, I have inflicted considerable amount of bruises on myself.

People who go through life sideways will invariably suffer. They seem to hit every obstacle and trial that could be in their flight path. The existence of pain in this life cannot be disputed.

“I have told you all this so that you may have peace in me. Here on earth you will have many trials and sorrows. But take heart, because I have overcome the world.”

John 16:33, NLT

Jesus understands. Especially if you are one of those people who are “trial magnets” going through life horizontal. (You just seem to collect them.) My hope for you that as you break your branches on the way down (for maybe the 100th time). You will try to plummet vertically. Not that it is any easier, life will hurt. But perhaps it won’t be as agonizing. And I suppose that would be a good thing.

“Now unto him that is able to keep you from falling, and to present you faultless before the presence of his glory with exceeding joy,”

Jude 24

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The Frustration of Autism

What are Autism Spectrum Disorders?

Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders (PDDs), cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. These disorders are usually first diagnosed in early childhood and range from a severe form, called autistic disorder, through pervasive development disorder not otherwise specified, to a much milder form, Asperger syndrome. They also include two rare disorders, Rett syndrome and childhood disintegrative disorder.

Signs & Symptoms

Parents are usually the first to notice unusual behaviors in their child. In some cases, the baby seemed “different” from birth, unresponsive to people or focusing intently on one item for long periods of time. The first signs of an autism spectrum disorder can also appear in children who had been developing normally. When an affectionate, babbling toddler suddenly becomes silent, withdrawn, self-abusive, or indifferent to social overtures, something is wrong.

Possible Indicators of Autism Spectrum Disorders

  • Does not babble, point, or make meaningful gestures by 1 year of age
  • Does not speak one word by 16 months
  • Does not combine two words by 2 years
  • Does not respond to name
  • Loses language or social skills

Some Other Indicators

  • Poor eye contact
  • Doesn’t seem to know how to play with toys
  • Excessively lines up toys or other objects
  • Is attached to one particular toy or object
  • Doesn’t smile
  • At times seems to be hearing impaired

Social Symptoms

From the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile.

In contrast, most children with ASD seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many do not interact and they avoid eye contact. They seem indifferent to other people, and often seem to prefer being alone. They may resist attention or passively accept hugs and cuddling. Later, they seldom seek comfort or respond to parents’ displays of anger or affection in a typical way. Research has suggested that although children with ASD are attached to their parents, their expression of this attachment is unusual and difficult to “read.” To parents, it may seem as if their child is not attached at all. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of the expected and typical attachment behavior.

Children with ASD also are slower in learning to interpret what others are thinking and feeling. Subtle social cues—whether a smile, a wink, or a grimace—may have little meaning. To a child who misses these cues, “Come here” always means the same thing, whether the speaker is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without the ability to interpret gestures and facial expressions, the social world may seem bewildering. To compound the problem, people with ASD have difficulty seeing things from another person’s perspective. Most 5-year-olds understand that other people have different information, feelings, and goals than they have. A person with ASD may lack such understanding. This inability leaves them unable to predict or understand other people’s actions.

Although not universal, it is common for people with ASD also to have difficulty regulating their emotions. This can take the form of “immature” behavior such as crying in class or verbal outbursts that seem inappropriate to those around them. The individual with ASD might also be disruptive and physically aggressive at times, making social relationships still more difficult. They have a tendency to “lose control,” particularly when they’re in a strange or overwhelming environment, or when angry and frustrated. They may at times break things, attack others, or hurt themselves. In their frustration, some bang their heads, pull their hair, or bite their arms.

Treatment

There is no single best treatment package for all children with ASD. Decisions about the best treatment, or combination of treatments, should be made by the parents with the assistance of a trusted expert diagnostic team.

Transcript of and interview with Dr. Bearman on Autism

Dr. Peter Bearman is the professor of Sociology at the College of Arts and Sciences at Columbia University. He also serves as co- director of the Robert Wood Johnson Foundation Health and Society Scholars program at Columbia. Recently, Dr. Bearman came to the National Institute of Mental Health to talk about the focus of his work, autism prevalence. NIMH’s Director, Dr. Thomas Insel, sat down with Dr. Bearman to discuss autism research and began by referencing recent studies that indicate an increase in autism prevalence.

Dr. Insel:  So, as you look at this that question that everyone is asking is when they see the numbers now from the CDC where it’s gone from 1 in 1500 to 1 in 150 and apparently here in the fall of 2009 the figure that’s emerging is closer to 1 in 100. Meaning, that even since 2002 there has been a very profound increase in the number of children being diagnosed with autism.

Dr. Bearman: And Autism Spectrum Disorders.

Dr. Insel:  Autism Spectrum Disorders?

Dr. Bearman: Well that’s, an important distinction. I mean obviously there’s a profound increase in Autism and Autism Spectrum Disorders.

Dr. Insel: Is there an increase in the number of children with the disorder or with the Autism Spectrum Disorder or does this largely reflect the change in the way the diagnosis is used or some sort of increase in ascertainment?

Dr. Bearman: Well, I think that’s the big million dollar question. Our work which arises from California can, show that changes in diagnostic processing and diagnostic criteria I would say the period from 1992 to 2005 the changes in diagnostic criteria over that period that operate on the border between autism and mental retardation can be associated with about a quarter of the increase prevalence. Over that same period there has been a really fundamental change in the ascertainment, you can see that in lots of ways, but the most obvious way to see the changes in ascertainment, is to see that the social economic status gradient that used to be present for autism, the fact that children living and residing in wealthy communities are more likely to get a diagnosis, and that gradient largely disappears.

Dr. Insel: What seems important Peter in the way you’ve done this rather than you answering the question to say it’s increase, not increased your answering the question by what proportion of increase can be explained by separate factors because everybody’s pointing to changes in diagnosis, changes in ascertainment the way in which services may affect the use of the diagnosis. So what everybody really wants to know at the end of all this, is that actually are more children affected with the disorder or will 100 percent of this increase in prevalence be explained by these other factors?

Dr. Bearman: Our strategy is to try to decompose this increase into its constituent elements. Some component of that is increased ascertainment, some component of that is diagnostic change in diagnostic criteria, some component of that arises from already known risk factors, such as increases in parental age are associated with greater probability of genome mutations that could lead to copy errors that are associated with neurodevelopmental disorders. So social demographic changes that are affecting all western countries, the United States, and also California, can express themselves in increased incidence of autism on top of diagnostic ascertainment dynamics. I think the trick to figuring out how to decompose this increase into its constituent elements is to pay attention to the two dimensions that are important. The first dimension is temporal just the fact of temporal change, we are in the period of increased prevalence and if we’re in a period of increased prevalence and at the same time for example there’s also an increase in older parents. The risk associated with older parents will naturally appear to be greater now than it was a decade ago. So paying attention to temporal heterogenic is important. The other part of our work I think that’s  the most exciting is to pay attention to the spacial heterogenic and the fact that we can observe very strong,  very distinct, very stable clusters of increased risks for autism at very fine spacial resolution. For example, in California, there’s a very clear cluster in about 20 kilometers by 50 kilometers in which the relative risk for autism not, Autism Spectrum Disorders but autism itself is significantly higher over every year of observation that we make than any other place in California. That invites a couple of considerations, first, it invites the recognition that if you observe local spacial clustering whatever causes some components of the increased prevalence in autism it is not a global treatment. Secondly, it invites us to ask, well is there something in that local area that is driving an increased prevalence that could be a shared toxicological environment, it could be a virus that moves through and spreads from person to person and affects children in utero. Or it could be a piece of an ascertainment process which would be the diffusion of information from parent to parent as they learn how to recognize some symptoms for autism which have no biological markers.

Dr. Insel: From what you know now when you add all of those together how much of the increase can you explain?

Dr. Bearman: Well that’s a complicated question, but I think we can pretty uniquely associate about a quarter of the increase from the birth cohorts from 1992 to 2001 which is a lot, to diagnostic change on the border between diagnosis and mental retardation in autism. I think we can associate about 16 percent of the increase on the other border between autism and other neurodevelopmental disorders on the spectrum: Asperger’s, PPDNOS etc. And those are largely non over-lapping components of increase, so that’s about 40 percent. I think the spacial clustering itself adds another few percent. I would say I am confident that 40 percent of the increase I think I know what caused that. That leaves a lot of increase left, 50 percent is a lot to look for still.

Dr. Insel: Any ideas about what’s driving that other 50 percent?

Dr. Bearman: Well, some is genetic. I think that the increased parental age accounts were 11 percent of the increase over this period and that’s a lot and the mechanism by which increased parental ages expressing itself I think likely largely genetic. I think the tricky part is going to recognize that it would be harder now to find that 50 percent. It would look like it should be some toxicological environment that’s shared because of the spacial clustering. Because there’s a very strong process of amplification of the understanding of autism that leads to increased diagnosis as parents learn how to recognize symptoms a very, very, small event that would transform the environment five years ago, ten years ago, even you could imagine, 40 years or 50 years ago, when the moms of children with autism now were in utero as eggs- a very small event could cascade into a larger epidemic now.

Dr. Insel: So what do you tell parents who ask about this if you have friends who have autistic children and they say “What’s going on here? Why this epidemic?” What do you say in response?

Dr. Bearman: Well, I think parents are struggling to just enormously difficult to have a child with autism. It makes it very hard. I think parents are naturally searching for explanations, and I think that the message now is the search for a quick and dirty explanation might not be advancing science.

Dr. Insel: Thank you very much.  Good discussion.

Links on Autism

http://www.nimh.nih.gov/health/publications/autism/index.shtml

Words of Life, [Healing]

 

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This is one of the perils of being a writer. I know what I want to say, but seldom am I understood. It comes as a part of the job description and it chafes.

Actually, many experience the same thing. We desire clarity but end up misunderstood. I believe there are quite a few people who can relate to this issue.

We are “communicators” by nature; some do a bang-up job of it, others, not so much. Being misunderstood is the norm of many.

“Gracious words are like a honeycomb,
    sweetness to the soul and health to the body.”

Proverbs 16:24

The book of Proverbs speaks directly on this dilemma. Healthy words cut through the fog and bring light and hope to others. I’m guessing that we shouldn’t want to sound profound, but humble and gentle and gracious. Wisdom fits in here also.

“There is one whose rash words are like sword thrusts, but the tongue of the wise brings healing.”

Proverbs 12:18

Here we read of people whose rash words are compared to a sword thrust. They jab and cut. They are malicious and hurtful. I seem to do this far too often.

Others have the opposite outcome. Their words bring healing. I have known people like this. There seems to be a “superpower” to what they say. They don’t say things to sound profound, yet healing seems to follow them around.

Words are powerful; they pierce or they heal. I want what I say and write to have a healing effect on others. I must remember that the tongue speaks only what is in the heart.

Give us true hearts, O God. I want to carry healing to others.

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