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Posts Tagged ‘mental-health’

My area of work was health. I worked as a doctor over four decades and I learned a lot about what made for a healthy environment and what was a more toxic or harmful one. I reckon the characteristics of healthy environments are pretty universal. We all need to breathe clean air, drink clear water, eat nutritious food, have nourishing and caring relationships. There’s a lot of evidence about the positive healing effects of natural environments. I say “natural” but what I mean is, as opposed to built environments. Trees and forests stimulate healthy changes in body and mind, but busy six lane motorways, not so much. But even within these universalities we are all different, so, for some, it’s healing to walk by the shore, or to gaze out at the ocean, breathing in the salt air. For others, the most healing environments are in the mountains and lakes, breathing the clear, fresh air of a little altitude, surrounded by birdsong and wildflowers (“and not or” remember…..both these environments can be good for the same person) 

I read a section of Rick Rubin’s “The Creative Act” this morning (I’m working my way through, reading and meditating on, one section a day just now. It’s such a rich resource)….this morning’s section was “Setting” where he discusses what environments are creative, illustrating how very different ones allow us access to different flows from the universe, each of which can stimulate our intuition. He points out how tranquil natural environments allow us to appreciate the direct information from the universe, whereas, busy peopled places, like cafes, town centres etc, can allow us to tune in to the universe as filtered through human beings. In all situations it’s a question of detached awareness, so that we can notice patterns, but not allow ourselves to be overwhelmed by them. That made me think of the phenomenon we call doomscrolling, where we get caught up in social media feeds. They too can be sources of creative stimulation if we allow ourselves to notice the patterns and themes, and not get caught up in them. In fact, Rick also suggests cultural environments where we focus on reading, music, visual art, etc to pick up the information from the universe filtered through culture. 

The most important point he makes is that we are all different. His conclusion is that we need to “hear the chimes of the cosmic clock ring, reminding [us] it’s time. Your time to participate.”

It is.

It’s your time to participate, to become aware, to trust your intuition and to engage. 

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Identity

I find “identity” a tricky concept. In my work as a doctor, I’d often encounter a patient who had identified with their illness so much that it had become the primary identity they presented to the world. They might introduce themselves by saying “I’m John, I’ve got MS”, or, “I’m a cancer survivor”, or “I’m a diabetic”…..in some ways, this is a phenomenon driven by the medical profession which, way too often, focuses on a patient’s illness or pathology, rather than on the individual patient. 

I would start a consultation with an open question, like “Tell me about yourself”, or “Tell me your story”. A very common response would involve the patient telling me their diagnosis, perhaps some of the tests they’d had done, and procedures and treatments they’d had, or were still having. Then they’d stop. I’d stay silent, because at that point they hadn’t told me anything about themselves at all. I’ve no doubt this was because they were giving the response they expected doctors wanted. Sometimes I’d need to follow with something like “Tell me, then, what’s been your experience of [x]?” or “When were you last completely well?” followed by “Tell me what was happening in your life at that point?” The personal story, the individual experience, was always more complex and nuanced than the reduced, medicalised one. 

Identity is used as a shorthand way of saying “This is me”, but there are several big problems with that. 

It seems to me that behind the issue of identity, and, in particular, “identity politics”, lies a desire to be seen, to be acknowledged, accepted and treated fairly. All, perfectly reasonable, and important goals. But I still find it problematic because I’m not a fan of categorisation and labelling. I don’t want to be reduced to either one main label, or even a small set of them. 

Too often, identity is reduced to gender, ethnicity, sexuality and/or age. Some wear these labels proudly, and if that suits you, then fine, but it comes with a huge risk – the risk of not being seen, not being acknowledged, accepted or treated fairly as the individual you are. 

Adopting an identity can be a way of belonging. It can be like a membership of a club where all the members share the same identity. But such grouping also comes with the creation of “in” groups and “out” ones. Whilst it may give a sense of belonging to the members, it can create a sense of “the other”, both from the group towards those not in the group, and from those not in the group, towards the group. 

Identities, in other words, tend to be simultaneously inclusive and exclusive, supporting the creation of relationships with others who recognise the same identity, whilst separating and dividing them from others who don’t.

However, my biggest objection to identity really is the fact that no human being can, nor should, be reduced to single feature, characteristic or category, not least because no human being remains the same throughout a lifetime. 

Rick Rubin writes – .”…we are always changing, growing, evolving. We learn and forget things. We move through different moods, thoughts, and unconscious processes. The cells in our body die and regenerate. No one is the same person all day long. Even if the world outside were to remain static [which it can’t] the information we took in would still be ever-changing.”

The fact is, the universe had never created a life identical to yours before you came along, and it will never create another, identical to yours, after you die. Your uniqueness is a complex, ever changing blend of molecules, energies, and information, in constant co-creation with others and with the rest of the world. You can’t be truly understood, truly seen, acknowledged, accepted and treated fairly if your individuality is reduced. 

Reduction opens the door to control, and the tech giants, the corporations and governments want control, not by seeing you and treating you fairly, but by categorising you and manipulating you. By limiting and monitoring you.

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A key theme of “heroes not zombies” is waking up and becoming aware. It’s too easy to drift through a day in a state of semi-consciousness, doomscrolling social media, following routines, swallowing the stories corporations and governments want you to swallow. The Romans used “bread and circuses” to control the population. Modern capitalism uses algorithms.

But there’s a way to break out of these mind-numbing loops….paying attention to what strikes you.

In homeopathy, there’s a teaching about looking out for the “Strange, rare and peculiar”, the symptoms a patient relates which strike you, which stand out, which seem particularly relevant, or particularly unusual. These symptoms might be the key to understanding the patient and finding the right remedy for them. It’s a practice which is the opposite of seeking what is “usual” or “typical”. The thing is, in diagnosis you need to grasp both – the typical symptoms can point to a pathology, but it’s the particular, the personal, and striking ones which point to the patient who has that pathology, which open the path to understanding what the patient is experiencing, how this disease emerged in their life and how it’s affecting them.

I’ve often written here about the power of wonder and awe. I experience wonder and awe when something strikes me. I’ll be wandering through the forest and suddenly see a flower I’ve never seen before, or I’ll hear a bird call I’ve never heard before (or, certainly, not around here). The important thing is to follow that noticing. When something strikes me, I’m drawn to it, I slow down, stop, and explore further. I allow myself to pass a few moments appreciating whatever it is.

We can do the same through the day with lines we read in books. I’m sure you have the experience of reading a novel, or a non-fiction book, and a particular phrase or sentence leaps it out at you. It strikes you. When that happens, why not note it down? Why not slow down, and consider it? I use a mix of methods in this situation. In some books I’ll underline the particular phrase. In others, I’ll get out my phone and take a photo of the passage, then save that photo to my Notes app. Or I’ll get out my notebook and copy it down. “And not or” is my motto. I’ll often do a combination of those things.

Sometimes we’ll be struck by coincidences, or by a feeling of deja vu. These moments can be gold. They can stop us in our tracks and inspire some wonder, some reflection. They are worth noting down too.

Other times I’m struck by a phrase I hear, maybe just a snippet of a conversation, or a remark in the cafe, or in a queue. Again, it’s worth noting these down, taking a moment to consider them, to enjoy then, to reflect.

When I visit a gallery I’ll move fairly quickly through a room, scanning the works of art, then, almost always, some particular painting strikes me, grabs my attention, and stops me. Those always become my favourite paintings.

Wherever you are, whatever you are doing, noticing what strikes you changes your day. It jolts you out of zombie mode, and gives you an opportunity to make the day your own, to make the day special.

Try it out….notice what strikes you today, and explore it.

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One way to understand how deeply interconnected we are, and how change, not statis, is the norm, is to think of three flows – flows of materials, substances, atoms, molecules, and other particles; flows of energy, electromagnetic, gravitational, sounds, and other energy waves; and, information, language, symbols, ideas, and thoughts? You might have other examples for each of these three flows. You might dispute one or more of the ones I’ve chosen, but let’s stick with the general idea here – there are flows of materials, energies and information which swirl around this planet. The flow around, into and through us, for the most part, invisibly. And they flow out of, and beyond, us…changed.

It’s almost like we are a wave, or a vortex. A whirlpool perhaps, a coalescence, an efflorescence, transforming these flows into something which has self-integrity, something which appears separate, and consistent over the course of a lifetime. We, like everything else on this little planet, are transient, and exist only as a temporary flux. Some writers describe us as being like a wave which appears briefly on the surface of the ocean, a wave which can be pointed to, a wave which can located, even named. Waves don’t leave the ocean, and they don’t last for long, soon dissipating and disappearing back into the vast waters from which they came.

The chapter I read in Rick Rubin’s, The Creative Act, today, describes the idea of data, entering us, filling our inner vessel, where it is changed, not least by the relationships which from between it, and what was already there. He says these relationships produce our beliefs and stories, and, ultimately, our world view.

We can choose what we want to make with all of this – our unique stories, our art, our creations – and then we can choose to share them, where they set off, hopefully, to encounter others, other stories, other creations, other people.

I don’t like the word “data”. I’m sure it’s just a personal thing, but I have a feeling or disgust, or repulsion, when I come across the word “data”. I know, for many others, “data” is the stuff of their daily existence, maybe even what gives their lives meaning. But, I just don’t like it. I prefer the word “information”. I prefer “stories”. I prefer “encounters” and “relationships” and “patterns”. But, as I say, maybe that’s just me. I’m also not a great fan of the idea of a “vessel” inside us…..just as I’m not a fan of the idea of memory being like a filing cabinet in the brain somewhere. So, I prefer this concept of flows, flows of materials, energies and information, which we alter as they enter our inner “vortex”, and emerge changed as we breathe, or act, or talk them out into the world again.

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There’s been a shift in social media channels. Not long ago many people presented themselves as “Influencers”, but now, not so much. Increasingly I’m seeing the term “Content creator” instead. Or, sometimes, “Digital content creator”. I must say, the first time I noticed this shift I wondered mainly about the word “content” – I don’t find it appealing, but I understand it will cover anything from text, images and videos, to the spoken word or music (and maybe more, I’m not sure!). I do think of myself as a photographer and a writer. I do both of those things frequently…..pretty much every day. But, I guess none of that is “content” unless I publish it (or upload it) somewhere, like here on my blog, or on a social media platform like Bluesky (or Facebook, Threads, Mastodon, Substack, or whatever). However, having wondered for a while about what constitutes “content” I shifted my attention to the second word….”creator”.

A few years ago when thinking about health, and how did I know a patient was becoming more healthy, I hit on a three word acronym – ACE – for Adapation, Creativity and Engagement. Briefly, for me, the healthier someone became the better I saw their ability to cope, to deal with whatever they had to deal with, to adapt and change. In addition, I’d notice they were becoming more creative, more able to solve problems, to come up with new ideas and ways of living, to be better able at expressing themselves. And, finally, I’d see they were becoming more engaged, building connections and relationships, deepening connections and relationships, paying better attention to the here and now.

It struck me then, and it continues to strike me, that we humans are naturally creative creatures. Maybe you learned from a religious teacher that God created us in His likeness? I always thought that meant He created us as creative creatures. (We are more than simply creative creatures, and there are several other factors we can consider which contribute to our “human-ness”, but I’ll explore that another time.

Rick Rubin’s “The Creative Act: A Way of Being”, begins with a chapter entitled “Everyone is a Creator”. He writes –

To create is to bring something into existence that wasn’t there before. It could be a conversation, the solution to a problem, a note to a friend, the rearrangement of furniture in a room, a new route home to avoid a traffic jam.

He goes on to explore how through our senses and our brain/body processes, we create experiences for ourselves, we create our internal reality, from the undifferentiated external reality. In other words, just being alive is a creative act.

Finally, he writes –

To live as an artist is a way of being in the world. A way of perceiving. A practice of paying attention……your entire life is a form of self-expression. You exist as a creative being in a creative universe. A singular work of art.

I couldn’t agree more.

It’s not just “content creators” who are creative, it’s you and it’s me and it’s everyone you know. How does it change your perception of someone once you start to explore their creativity? What do you notice when you start to ask yourself, “in what ways is this person creative?”

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I read an article recently about Cognitive Behavioural Therapy and its “evidence base”. The term “Evidence Based” is thrown around these days as a kind of label of approval. You might think it means “proven” or that scientists have examined the therapy and found that it works – well, when they say it works they mean they found it to be statistically superior to the control group. What they don’t say is whether or not the patients actually get well. And here’s the problem with CBT – a recent review found that 75% of people with depression treated with “CBT” did not become well, even though the statistical findings applied by the researchers led them to conclude it was “effective”. Can it be called effective if it doesn’t make people well?

CBT researcher Alan Kazdin put it bluntly in the flagship journal of the American Psychological Association:

“Researchers often do not know if clients receiving an evidence-based treatment have improved in everyday life or changed in a way that makes a difference. It is possible that evidence-based treatments with effects demonstrated on arbitrary metrics do not actually help people, that is, reduce their symptoms and improve their functioning.”

It’s strange really. The second half of my career was spent working at Glasgow Homeopathic Hospital, which developed into the NHS Centre for Integrative Care. We worked exclusively with patients with long term conditions, and, for the most part, with those who had failed to find relief through the orthodox approaches of drugs and surgery….or at least, who had failed to become well again.

We used an in-house assessment tool to measure the patients’ progress. It was a simple scale, 0 to 4, where 0 represented no change, 1 a change which had not made an impact on daily living, 2 a change which had made an impact on daily living, 3 a change which had made a major impact on daily living and 4 for completely well (there was a corresponding scale 0 to negative 4 for people who got worse). The person who assessed the change was the patient. The important point about this simple measure was that it was focused on the question…..has this therapy been of value to the patient in their daily living. That’s quite a different question from what percentage of the patients had a change in their blood lipid levels, their blood pressure, or whatever.

Time and time again our reviews showed that around two thirds of the patients rated a 2, 3 or 4 – in other words, two thirds of the patients experienced a change with had impacted on their daily living.

Yet, our approach, our tools and our therapies were rated as “not evidence based”, and year, after year, the Service was cut back and cut back, whilst at the same time online cognitive therapy programmes expanded on the back of their being “evidence based” (even though most patients didn’t become well again)

It’s a great idea to look at evidence, relevant evidence, but the pioneers of EBM said the clinician should take into account the research evidence, their clinical expertise and the preferences and values of their patients. How often does that happen?

It’s long past the time we should stop rubber stamping an approval on treatments which haven’t been shown to make a difference in most patients’ lives.

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Rebecca Solnit, in her “No straight road takes you there”, quotes the environmental writer, Chip Ward, as referring to “the tyranny of the quantifiable”.

There’s an obsession with numbers in our world. From measurements to statistics, there is a determination to quantify every aspect of life. Yet, Life, itself, is not quantifiable. Neither is Love, Beauty, Goodness, Happiness, Self esteem or self worth, despite the attempts by psychologists to attribute numbers and scales to any invisible phenomena.

This is an issue I had to deal with every day of my working life, because neither “health”, nor the most troublesome of symptoms such as pain, nausea, dizziness, fatigue, itch or breathlessness, can be observed objectively and be measured. Many people used proxies to measure the invisible – scales, such as “from 0 to 10, where 0 is the least troublesome and 10 the most, what number would apply to your “X” today”?

I remember the story of a dentist who ran a facial pain clinic. He insisted that every patient begin the consultation by telling him a figure from 0 to 10 related to how much pain they were experiencing. If they started to describe their symptoms, he’d interrupt, and insist “The next thing to come out of your mouth should be a number”. His successor in the clinic was baffled when the first patients would sit down and rather than say “hello” or start to describe their symptoms, they would say “7”, or “5”, or whatever. The old chief had trained them so well! “The tyranny of the quantifiable” indeed!

But let me return to health, because we all seek that, and doctors, surely, would hope to improve the health of their patients. But health, as Gadamer describes so vividly, in his “Enigma of Health” essays, is not visible, and not quantifiable. Rather, it’s pathology which makes an appearance….in the form of a rash, a swelling, an irregular heart beat, or a restriction of function. When the pathology recedes, health reappears….the painful hand becomes unnoticeable again.

The experiences which make every day seem worthwhile are equally, not quantifiable. Wonder, awe, joy, love, happiness, a sense of connection, of being understood, a feeling of belonging. We can’t measure those with a smart watch, a smart phone, or a fancy scanner.

That’s why our individual stories are so important. Only you can describe what you are experiencing, and only your story helps you make sense of your life. The counter-balance to the tyranny of the quantifiable is appreciation of, and the telling of, our encounters with wonder, joy, love and connection with others.

Your story is unique, and, together, we create a world worth living in by sharing our stories and co-creating the ones which we value the most.

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In his “A Sand County Almanac”, Aldo Leopold writes…..

The last word in ignorance is the man who says of an animal or plant: “What good is it?” If the land mechanism as a whole is good, then every part is good, whether we understand it or not. If the biota, in the course of aeons, has built something we like but do not understand, then who but a fool would discard seemingly useless parts? To keep every cog and wheel is the first precaution of intelligent tinkering.

Now, this language, from the late 1940s is too mechanical for my liking, but, actually it’s still not uncommon today. We humans are not machines. Plants are not machines. No living organism on the planet is “machine-like”. As a result of the dominance of left hemisphere thinking, reductionism, for all its results and benefits, has blinded us to reality.

A human being cannot be reduced, cannot be broken into separate, isolated parts, without, at best, ignoring the consequences of changes in the whole body which come about from changes in a part, and, at worst, without killing the individual human being. Reductionism can only ever be a stage on a journey towards an understanding. The reductionist work of the left hemisphere needs to be integrated back into the holistic perspective of the right in order to understand the connections and consequences.

The same can be said of any living form. There isn’t a plant, an animal, or any other living creature which can be fully understood except by exploring their relationships and connections with the world in which they live.

One of the most unfortunate consequences of reductionism (I don’t know if it results from it, or simply accompanies it), is a focus on utility. What use is this? What use is this plant? What use is this creature? What use is this person? Utility can, or should, only be considered as one aspect, one perspective. We know this instinctively, don’t we? We wouldn’t reduce a loved one to an assessment of their “usefulness”, unless we were suffering from some kind of psychopathy. So why do we allow that to happen when we create businesses and factories? Industrial capitalism has a tendency to reduce human beings to “human capital”, or “Human Resources”, to be weighed, assessed, and judged, only on the criteria of utility. If they aren’t useful towards to the goal of increasing profits, then they are “useless”. A sad, miserable way to view the world.

What’s the utility of music? What’s the utility of art? Of gardens, of beauty, of poetry, of stories? What’s the utility of love, compassion and care? What’s the utility of joy, of wonder, awe and happiness?

Do people think that way?

Actually, it’s not uncommon to find that they do. Have you read anything that tells you about how gardening is “therapeutic”, of how music can improve “your mental health”, of how sharing a meal with a loved one can be “good for your health”?

The thing is, a good life, a life worth living, is full of activities and experiences which we pursue, not for their utility but for joy, for love, and because they touch our souls. Don’t wait for “science” to “prove” that music is beneficial to your neurones, to your immune system, or your hormones. Don’t wait for “science” to “prove” that a walk in the forest modulates your immune system, or stimulates your vagus nerve. Live for the everyday moments of wonder, joy, love and delight. One day, “science” will catch up, and tell you what you already know…..music, nature, poetry, caring relationships, love, wonder and joy are all “good for you”.

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The dominant narrative in our current industrialised society is competition. It’s held up as the key success factor in capitalism, in business, and even, often citing Darwin, in evolution. It’s presented as the main way in which we humans have improved ourselves, succeeding over other species, beating each other to the top. It’s presented as the way to power and wealth. The key to success and happiness.

There is no denying that competition exists, and that its greatest worth is how it pushes people to improve. Sport is all about competition. It’s exciting and it drives human performance constantly to do better than has ever been achieved before.

Clearly, competition has its place.

But putting front and centre of the whole of life seems seriously misguided to me. Throughout history it has brought war, violence, exploitation, abuse and corruption. Because it all depends what you are competing for. If it’s more power and wealth, it too often results in division, xenophobia, racism, selfishness and cruelty. If you’re competing to improve, to achieve your best self, to create the best, fairest, healthiest society, maybe it’ll help.

I worked all my life as a doctor, so my area of knowledge and skill is what makes human beings thrive. If you consider the human body you can see that it contains billions of cells. Billions. Many of those cells grow together to form body organs, like the heart, the lungs, the liver and kidneys. Many grow together to form tissues, like bone, ligaments, skin. Other grow together to form systems of chemicals and cells, like the immune system and the endocrine system. Are all these cells, all these organs, all these tissues in competition with each other to be the best they can be? No, they are not. If our heart was in a continual war with our kidneys, we would be sick. If our immune system was in a continuous race against our endocrine system, we would be sick.

A healthy body is based on collaboration. It’s based on relationships, especially “integrative” relationships. Integrative relationships are defined as “mutually beneficial relationships between two well differentiated parts”. In other words, health, and, life itself, emerges from a vast, interconnected web of collaboration. When it works, we have harmony. We have flow. We have ease. We have growth and maturation. When it doesn’t work we have sickness and death.

I often think of that when I read about society, politics or economics. Why base those systems on something more likely to drive violence and a world of “winners and losers”? The body doesn’t do that.

Not only that, stop for a moment and reflect. Which human being could thrive entirely by themselves? In isolation, with only their themselves to deal with everything? None. There’s not a single baby born who would have made it to adulthood without the care and support of others. There’s not a single human being on this planet who has made it to adulthood without a vast web of “integrative” relationships – between themselves and others, between themselves and other living creatures, between themselves and the rest of Nature.

What would society be like, what would politics be like, what would economics be like, if we based it on the natural reality of life on Earth………not excluding all competition, but putting collaboration, care and sharing at the heart of everything we do?

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I came across a term recently, “suicidal empathy”. Musk talked about it in an interview with Joe Rogan, and it seems to have originated from a man called Gaad Saad. As best I can tell he suggests that a big problem in society these days is an excess of empathy. In fact, in some pieces this concept is put forward as a big “threat to Western civilisation”.

I was pretty shocked when I read this, and explored a bit further to try and understand exactly what they were claiming. They seem to be saying that if we have “too much” empathy for certain people then we risk damaging the lives and values of the great majority. Who are these certain people? The usual suspects I’m afraid, immigrants, minority ethnic groups, trans people and, well, it seems to me, pretty much anyone they don’t actually like.

I don’t buy this. Not at all. Empathy doesn’t determine your actions. But it can, and, I believe, should, influence them. My point is that empathy does not lead inevitably to any particular strategies or policies at a societal level, and whatever an excess of it is, do we seriously believe that having empathy for a minority group actually harms the lives of the majority?

We only have individuals in life. We only have individuals in relationships. There is no “the people”, or “the majority” which has a single view of anything. The claim that there is such a thing is the path to despotism or populist fascism.

I spent an entire career over four decades where the core of my everyday was a sequence of one to one relationships with individual patients. I had empathy for every single one of them. I believe that was the only way to understand them, to really get to know them, and, so to help them. I believe that without empathy for every single person I worked with, I wouldn’t have been as good at my job as a doctor. Can you imagine a doctor who reserves their empathy for select groups of individuals? Well, actually we can imagine that, but it’s not something I’d like to support.

No, it’s not an excess of empathy, or a “misdirected” empathy, which is the biggest threat to our way of life. It’s a deficiency. We don’t care enough.

When immigrants are vilified, treated as less than human, when children are bombed, blown to pieces and killed in pursuit of “terrorists” or in an attempt by one country to grab some of the land occupied by others, then we have an empathy deficiency.

Back when 9/11 happened, the novelist, Iain McEwan, said the greatest failing of the terrorists was a lack of empathy….or did he say a lack of imagination? I’m not sure at the moment, I’ll look it up. Ah, it was both…..

If the hijackers had been able to imagine themselves into the thoughts and feelings of the passengers, they would have been unable to proceed. It is hard to be cruel once you permit yourself to enter the mind of your victim. Imagining what it is like to be someone other than yourself is at the core of our humanity. It is the essence of compassion, and it is the beginning of morality.

We need MORE empathy. Not less.

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