Thanks for nothing, General

So, as recommended, I went to see General Psychiatrist.  The appointment wasn’t as perfunctory as I’d assumed it would be – it lasted 45 minutes instead of 10 – but was as much of a waste of time as I’d feared.  No, actually, scrub that.  It was more of a waste of time than I’d feared.  You see, it turns out I’m not mentally ill.  That’s a direct quote straight from the General’s mouth.  He did go on to qualify a little.

It seems that I presented him with a problem, because, and I quote, ‘you don’t fit any of my criteria’.  He performed a handy interpretative mime as he told me this, mapping out a sequence of imaginary boxes on his desk, to signify the diagnostic criteria, and then waving his hands in an amorphous, not-fitting-into-a-box, kind of way, to signify me.   Clearly, it is this wilful refusal to squeeze myself into a handily pre-labelled mentalist box which means that I’m not mentally ill.

‘You don’t have schizophrenia,’ he said.  Well, thanks, but I never thought I did, what with the whole obviously not being schizophrenic thing.  As it happens, I’m not a 17th-century milkmaid called Marie-France either.

‘I don’t believe you have psychosis,’ he said.  Interesting shift of language there, I thought.  I definitely don’t have schizophrenia, but he doesn’t believe I have psychosis.  So, what does that mean, exactly?

Does it mean that he thinks I’ve been stringing him a line trying to get myself diagnosed as psychotic, but he has, with his all-penetrating PsychVision, seen through my pathetic attempts at fraud?  I don’t see quite how that fits with the fact that, last appointment, it was him trying to persuade me I was suffering from an illness that could be treated with antipsychotics, not me trying to persuade him.

Or does it signify that he is less certain?  That I might be psychotic, but he doesn’t himself think it likely that I’m psychotic at the moment?  Certainly he’s never seen me in the grip of, for example, believing I can see or hear things that probably aren’t there, or becoming convinced that I’m under surveillance, or becoming worried that my thoughts aren’t my own.  I wonder how many patients are able to produce these symptoms to order during an outpatient appointment?  I’ll never be among their number, anyway – when I feel like that, I’m barricaded into my flat, not out travelling for 90 minutes each way to attend an appointment in a Victorian horror show of a mental hospital.

The nub of the problem, I think, is that I can talk about my experiences rationally.  Loonies just aren’t supposed to be able to do that.  We’re not supposed to be able to say about our unusual experiences, ‘Well, I know they’re not very likely to be true’.  Mental illness is, it would seem, an either/or.  Either you’re completely irrational, in which case you’re mad and won’t you please come into the mentalist inner circle and would you like to try some of these delicious pills, or you’re completely rational in which case you’re sane and get the fuck away from here you malingering hypochondriac.  Somehow or other I managed to shift from one group to the other between my two appointments.

I think part of the reason for that (and I hope you don’t think I’m bragging when I say this – I do think it needs to be mentioned) is that I’m reasonably bright.  And, of all of the different kinds of intelligence there are, I seem to have an analytical intelligence. Added to that I’ve had several years of reasonably high-powered academic training.  I’m good at asking and answering the questions why and how, in all circumstances.

Now, the General seems to work to a model in which being mentally ill equals being stupid.  Maybe he’s right – phrases like ‘cognitive deficit’ seem to get bandied around quite often in discussions of schizophrenia particularly.  For what it’s worth, I think some psychiatrists like to believe their charges are thick, because the alternative – that they’re drugging into drooling incoherence people who otherwise would be sharp, and vibrant, and funny (as well as being distressed and disturbed, of course) – is too morally uncomfortable.

But, anyway, leaving aside the larger picture, my feeling is that if I was less intelligent, and, especially, if I was less well-educated, I wouldn’t have been told that I’m not mentally ill.  Being articulate about some things seems to mean that, if you run up against something that’s just so scarily weird you can’t put it into words, its significance is discounted.  Because, if it really bothered you, well, you’d be describing it in a scintillating array of exquisitely apposite adjectives lifted straight from the pages of Roget’s Thesaurus, wouldn’t you?

One particular reason I think my intelligence and education got in the way is that that the general did give me an alternative ‘diagnosis’.  I am, it would seem, officially ‘odd’.  I have a ‘unique sense of myself and the world’.  In the same way that rich people used to be ‘eccentric’, it seems as though people with an education and an enquiring mind are ‘odd’.  I can’t help but feel that, had I gone into the appointment dressed in trackies, and spoken in a thick local accent about seeing people who then disappear, I would probably not have been ‘congratulated’ on my ‘unique way of seeing’.

Certainly it seems as though my ‘oddness’ is going to prove as debilitating as a mental illness might.  I can, apparently, look forward to my life being ‘a struggle’.  I will struggle to relate to other people, and they will struggle to relate to me.  I am likely to spend much of my life isolated and withdrawn from social contact (except for the ‘inadequate replacement’ of email).  The General hopes that I will move back towards an ‘average existence, not a normal one,’ over time, but that hope seems rather like a politician’s ‘aspiration’ – not planned for, and unlikely to ever materialise.

Because that’s the other thing about ‘oddness’ – there’s no treatment plan for it.  I have, as a special favour, been granted permission to re-attend the General at his consulting room in the summer, although, for obvious reasons, I will be cancelling this appointment in due course.  (This time the matter is, I’m afraid, not open to public consultation.)  But there is no programme of rehabilitation, no services I can access, no help I can receive.  The offer of calling the General’s secretary for an appointment should I feel I need one has been ostentatiously withdrawn.  All of these bounteous ‘gifts’ are dependent on the almighty diagnosis, and that has been ruled inappropriate in my case.

My guess is that I may get some comments on this post telling me I need to fight, that I shouldn’t take no for an answer, that the General was obviously wrong, and so on.  I know those kinds of comments spring from a caring motive, and, if I get them, I will be very grateful for the kindness that motivates them.  If I was minded to fight, I think I would begin by going to see my GP – I’m pretty sure she’d be on my side.  But the truth is I don’t really want the treatments that are available, and so there seems little point in fighting.

I just don’t believe, and I never have, in either of those twin gods, Psychoanalysis and Medication.  I saw through CBT within about 10 minutes of arriving in the therapist’s office.  Art therapy would, for me, be a pointless and humiliating ordeal.  With these attitudes, it’s not surprising that the ways of helping me have been exhausted.  Much of this is my own fault.  I know that it is, and I do not look for undeserved sympathy or consolation.

Still, it doesn’t matter what I think about any of this.  As someone who’s not mentally ill, I didn’t need treatment in the first place.

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24 Responses to Thanks for nothing, General

  1. loopykate says:

    I hope you don’t mind – I laughed heartily at this post. I have experienced very similar with the psychiatrist and doctor who all seem rather puzzled and perturbed and then dismissive by my capacity to talk intelligently about my mental machinations. It just doesn’t seem to suit them or fit easily into any of their diagnostic categories.
    ‘Oddness’ is a curious one. I guess technically it’s not a mental illness. But it can have the potential to provoke much psycic distress. Oddness would seem to indicate an existential bearing so core and intransigent as to be resistent to any ‘treatment’. It sounds like he’s given up. I also think these people get pissed off with anyone smarter than them.
    I don’t have any advise and besides, you seem pretty clear in your head. I wouldn’t have any confidence in this guy. I tend to dodge treatment. I’m skeptical about therapy. I’m also one of the odd. I’m not sure what it is but I don’t like the idea of an ‘average existence’ either.
    You’ve gone and confounded them with clear and rational thinking. What an odd thing to do.
    K.x

  2. J. Wibble says:

    I concur that it looks like your shrink has given up. To be quite frank I don’t believe a word of this ‘oddness’ bullshit, and there’s something in the back of my mind saying that if you were female you’d have a similar but blunter cop-out label of ‘borderline personality disorder’. I am also inclined to be suspicious of anyone who instructs others to aspire to an ‘average’ or ‘normal’ life – how are they different anyway, I thought normal meant average? Then again, I’m an individual who speaks English, not a psychiatrist.

    Being odd does not cause chronic depression and paranoia. Well, that’s not techincally true, though it depends on your definition of ‘odd’, and in any case most of the distress caused by being ‘odd’ is not endogenous but as a result of other supposedly less ‘odd’ people treating you like shit and can be identified as such. Reactions which may be paranoid but are simply an exaggeration of a fear for which there is a good reason are not pathological, but having to maintain a constant state of anxiety and analysis can induce pathological paranoia which must then be dealt with separately. Pathological depression can develop in the same way.

    It also seems unprofessional to me that a psychiatrist would make such damning personal comments in relation to someone who supposedly is not mentally ill, especially as such statements tend to form self-fulfilling prophecies. I would like to say I am surprised, but unfortunately I am not.

    I completely understand not wanting to jump on the med-go-round and not buying into art therapy and other CBT-based activities I tend to refer to as ‘useless hippie cack’. What I do hope is that you don’t just take from this a sense of hopelessness or guilt about how you feel, or start thinking that it must be your fault because you’re not really mad so you’re just not trying hard enough or whatever. Just because you don’t fit into a little box in the DSM doesn’t mean you don’t have issues, and it also doesn’t mean they can’t be solved or that they’re all your fault. I’m sure there are things that can help, they just require some creativity and imagination – and I am certain that you have more imagination and creativity than the NHS.

  3. Lucy McGough says:

    I hate doctors.

  4. rb says:

    Have you been diagnosed with a personality disorder without him explaining this to you? It sounds like the doctor could fit you into one of the “eccentric” type A thingies – paranoid, schizoid etc.

    Something similar happened to me. I was treated for anxiety/depression for a while. Then I had a period of suicide attempts. The cmht were quite helpful for a while, then all of a sudden things changed. I was told I didn’t need to take my anti-depressants any more, but could do if I liked. I was given 1-2 times/year outpatient appointments only, where I was regularly shouted at for being a nuisance with my problem behaviour. I moved to another area and found out I had been diagnosed with anxious/avoidant pd – although my notes mostly just called it “pd” because, of course, the method of treatment is exactly the same for all of them!

  5. jessa says:

    So, I guess you are male, based on the above comment that if you were female, you would be labeled with borderline pd (I always thought female, probably because “Aethelread” made me think “Ethel”).

    Anyway, I am female and reasonably bright and, having had a fairly similar experience to yours, been labeled with borderline. No one ever suggested that I wasn’t actually mentally ill, though this may have been because I was visibly mentally ill because I self-injured and was anorexic. But in situations where my intelligence manifested itself as something unexpected for the professionals, as in using the word “inconspicuous” when coming out of a panic attack, they would accuse me of being manipulative. Because no one who has a panic attack is able to pull themselves together enough to use the word “inconspicuous” so soon. (I suspect that “inconspicuous” is a word that simply isn’t in their working vocabularies, none of them seemed able to spell it, so it was, for them, a very difficult word to think to use. Having a larger working vocabulary than them, which they knew because they were always complimenting my word choices, apparently didn’t make any difference. Real panic attacks apparently mean being a puddle of incoherence. Nevermind the possibility that panic attacks do reduce my working vocabulary like they assume, but that even my reduced working vocabulary is still larger than their full working vocabulary, which is what I suspect the case to be.)

    I also have a passionate hatred for CBT. I guess that isn’t actually what you said, but I’m guessing it is true based on what you did say. But since they never dismissed me as not mentally ill, I seem to have gotten quite a bit more of it that you. Eventually, a psychiatrist, who I saw in the hospital when I was very sick and frustrated with CBT and still see, admitted that I was “too smart for my own good.” I suspect my life may have been easier if I had been able to play along with CBT.

  6. cellar_door says:

    Hmm. What a cock.

    I think at least by going you have clarified something; namely, that you definitely don’t want to see him again (completely understandable).

    I really wish people would focus more on treating the symptoms/experiences than the diagnosis. I can understand why a diagnosis could be helpful to people, but if there were systems in place to help those like yourself who don’t fit into the neat little boxes then the diagnosis wouldn’t be necessary for treatment. In fact, I just wish there were better treatments altogether…

  7. Lucy McGough says:

    I agree with Cellar Door.

    This bloke has totally undermined you – he’s told you that you can expect to have a substandard life, and then he’s told you that you’re not mentally ill so you have no REASON for this state of affairs and no hope of recovery.

  8. Christ, that really resonates, especially about us loonies not supposed to be able to talk properly.

    I agree with above, if you were female you might have got the BPD diagnosis.

  9. Lucy McGough says:

    It’s so IRRITATING being treated by a doctor who is less clever than you are, and having to put up with plastic smiles and plastic words and being told that the way you see the world is wrong, and they are right.

    (Why yes, this post has touched a nerve…)

  10. Pingback: Mental Nurse · This Week in Mentalists (68)

  11. jessa says:

    A couple thoughts, which I will go research at a nearby college to use their PsychInfo database access, but I will ponder aloud for those here as well:

    Have there been any studies done to find out how well CBT works according to the intelligence of the patient? I would guess that CBT doesn’t work very well with patients with below average intelligence, that it works the best for those of average intelligence, and doesn’t work well for those of above average intelligence.

    I also wonder if there have been any studies to find out how effective therapy is depending on the intelligence relationship between patient and professional. Does therapy work better when the therapist and patient are of comparable intelligence, when the therapist is more intelligent than the patient? Is it a recipe for disaster when the patient is more intelligent than the therapist?

    I wonder if there is any relationship between therapy effectiveness and patient/professional satisfaction with the current social status quo. If the patient and therapist are comparably satisfied with the status quo or comparably dissatisfied with the status quo, does that lead to better therapy outcomes than if patients and therapists are at odds in this area?

  12. NiroZ says:

    Reminds me of the time when I was in hospital after my first suicide attempt. The psych nurse that visited me told me that it was all about control, which at the time I bought it, but later on I realised that it was simplistic bullshit intended for me because I didn’t fit any of their boxes.

    That isn’t to say I hold it entirely against her for saying that. She was really overworked and it was 5 in the morning, but it does go to show how poor mental health resources are.

    You could not have possibly have seen through cbt in 10 minutes. You may have understood the crux of it, but you wouldn’t have picked up the finer points, nor would you have learnt how to use it. Its just not that simple.

  13. aethelreadtheunread says:

    Thanks for all the comments.

    First of all, it’s interesting to me that several of you have raised the ‘personality disorder’ possibility. It’s something i’ve been wondering about for a while, actually, and certain things the General said – particularly that i had a chronic, debillitating condition that was like a mental illness but wasn’t a mental illness – do seem to lean in that direction. Definitely something to think some more about about, i think.

    loopykateI hope you don’t mind – I laughed heartily at this post.

    Not at all. Laughter is one justifiable response… ;o)

    J. WibbleWhat I do hope is that you don’t just take from this a sense of hopelessness or guilt about how you feel, or start thinking that it must be your fault because you’re not really mad so you’re just not trying hard enough or whatever.

    But how can i take it any other way? I am trying to remain free of hopelessness, however. :o)

    Lucy McGough – Thanks. I’m inclined to agree… ;o) Also i hope nothing i’ve written has touched off anything too deep or difficult for you. :o)

    jessa – i’d read about your ‘inconspicuous’ debacle somewhere else. It still takes my breath away. And yes, i think you’re absolutely right in your point about relative vocabulary size. Also, i remember reading somewhere an opinion that full-on psychoanalysis only really works if the analyst is of greater or equal intelligence to the analysand. I’m not sure of the position vis-a-vis CBT. My gut feeling about that is that the amount of common sense someone has is likely to be more relevant than their intelligence.

    cellar_doorWhat a cock.

    Ah now, come on, be fair – i quite like cocks. The farmyard creatures, that is. How could you possibly imagine i meant anything else…? ;o)

    I really wish people would focus more on treating the symptoms/experiences than the diagnosis. I can understand why a diagnosis could be helpful to people

    See, that gets to the heart of one of my biggest dilemmas. I don’t really want treatment, whether it’s for a specific diagnosis or just for symptoms. But i do want a diagnosis, for some reason. I think probably because i’m always inclined to think of myself as a fraud, and a diagnosis would help me justify to myself that i’m not making a big fuss over nothing.

    I know, i know, i need to be less needy and more self-assured.

    Pole to Polar &c. – It’s strange, isn’t it? It’s really the only context where i’ve come across people actually appearing to feel threatened by intelligence.

    NiroZ – sorry to hear about your bad experiences. It speaks to your strength of character (and general niceness) that you’re so willing and able to see why you were told what you were told, while still knowing that what you were told was wrong.

    You could not have possibly have seen through cbt in 10 minutes.

    I was exaggerating for effect. What actually happened during my first (and only) 45 minute session is that, following discussion, the therapist told me that i was already using the techniques that she had been intending to teach me (identifying why a thought is irrational etc), and that in that context she felt unable to help me. To me, CBT is just good old-fashioned common sense. The decision not to proceed was a mutual one.

  14. J. Wibble says:

    You don’t need to take his comments on board in any sense because you don’t need to take them seriously because he is talking utter rubbish. The one thing you do need to remember of what he said was that all the latter comments were preceded by “You don’t fit any of my criteria”. Just because you don’t fit in any of his boxes doesn’t mean there’s nothing wrong – and to be fair, he seems primarily concerned with schizophrenia (as I wasn’t there I don’t know if he discussed other diagnoses with you and dismissed them). This rings a bell with me as I have actually been dismissed by a psychiatrist in the past as making it all up on the grounds that I didn’t have schizophrenia, with absolutely no consideration of any other possible diagnoses. That’s like saying if you don’t have a broken leg there’s no other possible reason why you can’t walk, i.e. total horseshit.

  15. lsnduck says:

    [i]I’m not a 17th-century milkmaid called Marie-France either.[/i]

    Damn it, I’ve been here under false pretences!

  16. aethelreadtheunread says:

    Thanks for the extra comments.

    J Wibble – You’re absolutely right to point out that other diagnoses were skipped over. I wish i’d realised it during the appointment, as i might have asked a few more questions. (I was given an opportunity to ask questions, but i couldn’t think what to ask.) My feeling has always been that i have a fairly severe form of depression with some mild to moderate psychotic elements. On that basis i’ve always wondered about the diagnosis of major depression with psychosis, but that’s never been raised with me. (I’m wary of raising it myself – the one thing all mental health types really can’t stand is a self-diagnoser.)

    But, and this is important, you don’t need to worry about me. You have a lot on your own plate just now, and you need to focus on yourself. I will be just fine, i promise. :o)

    lsnduck – lol If you slip me a couple of quid, i could maybe dress up in the costume… ;o)

  17. beetrootsoup says:

    I read this post with great interest A. It occurs to me that when depressed I am so down on myself that I fail to notice that I am more intelligent than most of the therapists, counsellors etc to whom I am assigned.

    I often find myself struggling to accomodate what they say (including my psych) out of a sense of mingled embarassment and probably misplaced sympathy for them.

    Aspiring to be either normal or average is a deeply sucky idea. Maybe it’s the depression kicking in but I’m not overly impressed by the vast majority of the human race. Sorry.

    I’m glad to find that you and many of your commenters have struggled with the whole concept and practice of CBT, as I have. Makes me feel less alone, and yes, less odd!

    As for you, A, I can immediately think of at least two among my close acquaintance who are meeting much the same kind of blank wall when it comes to getting a clear diagnosis. One is female, she’s been told she has bpd. The other is male, he simply causes them ongoing perplexity resulting in no diagnosis, and no benefits or emotional support.

    I back you one hundred percent in rejecting the meds/therapy-go-round. But I will tell you for nothing that I could not possibly live the way you do. I wouldn’t last one day. I depend on others like the air I breathe. Love, Zoe.

  18. intermezzoftw says:

    “Oddness” and “aloneness” fits quite well into the autistic spectrum thing…

    Thoughts?

  19. aethelreadtheunread says:

    Thanks for the extra comments.

    beetrootsoup – i used to do the ‘trying to fit in with the psych’ thing myself, but then i realised that it was a waste of time, for them as well as me. I do try to give them a fair hearing, but i’ve also tried to train myself to feel comfortable saying that i think they’re talking nonsense when i think they are. Mind you, that’s easier said than done!

    Oh and perhaps we should set up a support group called CBT Survivors… ;o)

    intermezzoftw – the autistic possibility was raised and discussed when i was in my early teens. I never found out directly the results of the test – they reported to my parents, not to me – but what i was told was that certain features suggested that i might be autistic, but others meant that i couldn’t be. That was, mind you, back in the mid 80s, and i think they may have had less of a concept of a spectrum back then, and the diagnostic criteria may have been more rigid. (I’m sure i read something about that somewhere.)

    But, you’re right, preference for being alone and difficulties relating to others do sound like they’re leading in that direction, don’t they?

  20. intermezzoftw says:

    Hi A.,

    The presentation of an autistic spectrum condition (ASC) can be astonishingly varied and varies in an individual, greatly over the lifespan. And can include (believe it or not) full blown psychosis.

    You can also have just about any other mental disorder superimposed on top of it as well…

    It all gets very, very complicated, especially by the time someone’s in their middle years (as I am).

    Typical misdiagnoses are:

    schizophrenia – autistic symptoms are often similar to the residual symptoms of S., and the often unusual autistic way of of speaking and expressing ideas is sometimes taken as evidence of thought disorders.

    personality disorders – esp. schizotypal, and for the girls, boarderline.

    Bi Polar – often autistics will be utterly obsessive about a particular topic – i.e. building model aircraft and will work non-stop for literally days on a project, before the inevitable fatigue driven crash.

    It’s really not for me to say, after all I’m just an autistic loony and lifelong mental patient, and I can see autism in any/everyone…

    But your post screams “AUTISM!” to me…

    I mean, let me quote:

    “You see, it turns out I’m not mentally ill. That’s a direct quote straight from the General’s mouth”

    “I’ll never be among their number, anyway – when I feel like that, I’m barricaded into my flat”

    “is that I can talk about my experiences rationally.”

    “seem to have an analytical intelligence”

    “unique way of seeing’

    “Certainly it seems as though my ‘oddness’ is going to prove as debilitating as a mental illness might……………I will struggle to relate to other people, and they will struggle to relate to me. I am likely to spend much of my life isolated and withdrawn from social contact”

    “Still, it doesn’t matter what I think about any of this. As someone who’s not mentally ill, I didn’t need treatment in the first place.”

    I’m a bit speechless really. Any of these could’ve come straight from the mouth of an autistic. This doesn’t make it a diagnosis. But, but, but… It’s food for thought…

    Best Wishes.

    Harry.

  21. Lucy McGough says:

    Dear A,

    FWIW, I agree with Intermezzoftw. You are intelligent, articulate and analytical, but have difficulty interacting with other people and prefer to stick to your own private space. Also, you are depressed. Roughly 65% of people with autistic spectrum thingies are depressed. I myself am on antidepressants.

    Now, although I have Asperger syndrome, I ain’t no psychologist or psychiatrist. But I think that this is an interesting avenue that merits further exploration, should that be your wish.

    Lucy x

  22. mortjo says:

    Interesting post, enjoyed it and it chimed somewhat with my own experiences.
    Through my crisis and recovery I was able to articulate very well the kind of thoughts and experiences I was having and it often drew remarks from the parade of varying qualities of Nurse that visited during home treatment, to the point where more than one suggested I seek out a new career in mental health services.
    I remember vividly the wide eyed stares from the collected ‘board’ of Doctors and social workers when I was sectioned, as I ‘let rip’ with a life times worth of curious observations, thoughts, and actions, from the darkest recess’s of my mind.

    Fast forward then to my one and only appointment with a Consultant Psychiatrist who spoke to me and my wife like we were children, and brushed off with a look of impatient bemusement when I elucidated on some of the more bizarre thoughts and theories that reside in my head. The decision, it seems had already been made, I was to be BPD, and any conversation before drug dispensary was wasting her time.

    The problem is now I’m returning to a state of dissatisfaction with my general diagnosis, and my previous lifelong held view that in actual fact, I’m not ill, just different. So the cycle of frustration continues, although this time I have a pocket full of drugs which I am increasingly unhappy about.

    Quick one on CBT. I saw right through it, it was never ever going to work for me, the mere thought of it makes me angry. I think that’s my non-conformist/paranoid/introvert coming through :o)
    I responded well to Therapy, but that was just talking. My therapist did little to challenge my views, rather we analysed them slightly on a whiteboard. He was also taken aback by some of my more extreme views, but again, filed under ‘odd’ rather than ‘ill’.

    Take Care

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  24. Keith says:

    What a great posting. I’m tempted to offer advice, but if you’re anything like me, you’re not looking for advice, just to be understood. I cope with many of the same issues myself, and also write about them – in fact a struggle with mental illness is the core of my blog, although I cover lots of other subjects. I also had a bad experience with a psychiatrist, but kept on searching for someone more sympatico, and struck gold with a really good, gay psychiatrist.

    By the way, it’s vanishingly rare, during my travels through the blogosphere, to come across a kindred spirit, who probes and bares his own mind in excellent writing. I certainly will come back for me. Cheers, Keith

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