Thursday, November 26, 2009

A Different Thanksgiving Story


Lodz ghetto, circa 1939.

Hard to believe that anyone would be sitting around on Thanksgiving reading blogs, but here I am, writing one, so there are probably a few of you reading. Mostly recipes.

Last Saturday I was a little down. And sometimes, when things are going wrong for me, when life feels more than out of control, I like to read about the Holocaust.

Crazy coping strategy, I know, but it works every time. There are many collections of stories about the Holocaust, and I happened to have had one on hand, a survival story. Here's a mini-review, not on the level of one you might find at Jew Wishes, but it is what it is.

Sisters of the Storm, (from the Holocaust Diaries series), by Anna Eilenberg-Eibeshitz is the story of two young teens trapped in Lodz, Poland, a ghetto established by the Gestapo in 1939, a home to approximately 200,000 Jews, surrounded by barbed wire. According to DeathCamps.org
". . . inhabitants vegetated in wretched wooden houses comprising 31,271 apartments. Sanitary conditions were disastrous. Apart from the lack of food, only 725 apartments had running water. There was no sewerage, no coal or wood for heating the rooms, no warm clothes and shoes. As a consequence, 21% of the ghetto population died in various epidemics, of starvation or were frozen to death."
No turkey, baby.

Those who survived only survived to be deported to concentration camps, Auschwitz in particular, and the gas chambers. An estimated 6 million Jews were murdered in this war, another 6 million non-Jews fell to the Nazis, as well.

Here are a few hungry people on the way to Auschwitz in a rare photograph ostensibly to die.

Anna witnessed the torture and murder of family and friends, including her mother and brother. She survived the ghetto to be shipped like cattle, in a cattle car, hundreds to a car, little air to breathe, no room to move, certainly no bathroom facilities. From the crowding of Lodz to Auschwitz. You must know what happened there. I can't go into it now. It's a holiday.

It's hard to read these things, stories of survivors, but hard not to. On page 90 the author describes how her 22 year-old brother, before his death from tuberculosis, married knowing that the Germans intended to eradicate the Jews. Anna's brother contracted tuberculosis on the job, an occupational hazard, carrying human waste. He married with the intent to have a child, to stick it to the Nazis, to say, "You can't stop us. We shall survive, we will continue."

Ms. Eilenberg-Eibeshitzs writes (italics in parentheses are mine) :
My father came home one day with a very pale face. I tried to talk to him, but it took him a long time before he was able to speak to me. It seemed that he had seen Brocha (Anna's new sister-in-law)walking in the street, and she was obviously pregnant. I understood why my father was so firghtened; pregnant women were a favorite target for the Nazis. I offered up a silent tefillah (meaning prayer) that everything would be all right.

I grew more and more worried as the days passed by. . .I gradually came to understand that Brocha had been taken for deportation. (The Nazis killed mother and child as a matter of course. Babies filled in the gaps in mass burials before the Nazis came up with the Final Solution.)
Generally you hear a woman is pregnant and the response is joyous, gleeful. Happy.

Sisters of the Storm becomes more and more violent, more and more impossible to read, gut-wrenching. You wonder, you really do, when you read about such torturous conditions, starving people sleeping, if you can call it sleep, on dirty floors, punished with dirty (yellow) water for days at a time. Their simple crime? Genetics, race. You wonder how anyone can survive such conditions, always at the other end of the boot, slapped, beaten, waking to new corpses in the barracks. Grieving, fearful.

Do you become immune? I don't think so. Do you become skeptical? Suspicious of others? Jaded. Certainly. But many survivors kept their religion, stayed observant even within the camps, to the degree it was possible. Their faith somehow kept them going.

Survivor stories are told less often these days. The survivors of World War II are in their 70's, 80's and 90's. They are leaving us. We go to museums to hear them speak to us from videos, through headsets, or we read books to remember them. My cousin works for the Wiesenthal Center in Los Angeles, travels all over the world to tell the story of the Holocaust, tells people that history can and will repeat itself. He recently spoke in Mumbai, a city on the watch for terrorism, bombs. It is the most heavily populated city in the world, the trains are mobbed at all hours of the day. We must not forget. Everyone is vulnerable to hatred.

Everyone takes something different from survivor stories. For me it's how amazingly little we need to survive (when it comes to food) and how precious survival, life, really is.

Lo aleinu
, we say in Hebrew. Such things should not happen to us. We mean, really, that these things should not happen, and we're thankful, that we're not suffering, not like they did in the camps. We feel better somehow, telling ourselves, whispering some kind of talisman, a quick nod of thanksgiving. No one, none of us, should ever have to be hungry like that, should ever have to suffer like that. No one should. Lo aleinu. The downside of life can get pretty down.

My favorite journalist, Peggy Noonan, writes for the Wall Street Journal, and last Saturday she wrote a piece about being thankful. We're Still Here After a Rough Year--We're serving up a new gratitude this Thanksgiving. I liked it very much and am copying it below because we are thankful this week, as Americans. Last year was a difficult year. Our country, once a super power, is less super, we all agree. We don't trust, we are afraid of the future. But it's better now, today, than it was a year ago. We survived, she's suggesting.

And all I can think is,

Survival is surely relative.

Happy Thanksgiving.

therapydoc

*For those of you new here, shul is Yiddish for synagogue. I wrote this last Saturday night.

Here's Ms. Noonan's piece.

Last Thanksgiving, it looked as if a hard year was coming, and it was and it did. The holiday was shadowed by a sense of economic foreboding—Wall Street failing, companies falling and layoffs coming. It isn't over—no one thinks it's over. But the mood of this Thanksgiving looks to be different.

An unofficial poll of a dozen friends yields two themes: "We're still here," and, "I am so grateful." Almost all experienced business reverses, some of which were deep, and some had personal misfortunes of one kind or another: "I am thankful that my mother's death was fast and that she did not have to suffer," wrote a beloved friend. But something tells me that a number of Thanksgiving dinners will be marked this year by a new or refreshed sense of gratitude: We're still here. I am so grateful.

I felt it the other night, unexpectedly, in a way that reminded me of the anxieties of last year. I had been away from the city. I was in a cab going down Fifth Avenue. I hadn't been there in months. I looked up and suddenly saw, looming in the darkness to my right, the white-gray marble and huge windows of the Bergdorf Goodman building—tall, stately, mansard-roofed. Its windows were covered, but some lights were on, and there seemed to be people inside. They were preparing its Christmas windows. Something about the sight of it caught me—proud Bergdorf's, anchor of midtown commerce. It looked exactly as it looked 10 years ago, 20, only better. Because it's there. New York has been so damaged by the crash, and last year at this time small shops, the ones with the smallest margin for error, were closing. And now I see more that are opening, and Bergdorf's is preparing its Christmas windows. The sight of it came like an affirmation. We're still here. I am so grateful.

What are you most thankful for in 2009? I asked an old friend, a brilliant lawyer who lives in a New York suburb. "I saw my 6-year-old son run a mile, and catch a bunch of fish," he immediately replied. He saw his wife, a journalist, "dodge the firings" in her office. He still has a job, too. All of this sounds so common, so modest, and yet, he knows, it is everything. A child caught a fish, he ran, his father saw it. "Broadly," he added, "I am grateful to America for its freedom, for its yeastiness and, at times, its noise. Dee Snider belting out 'I Wanna Rock' is so America."

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My friend Robert wrote, "I am thankful that I lived to see a person of color sworn into the office of President." He takes heart that America has set a new face toward the world. "I am thankful and proud when I am in London and people ask me about my president and show great interest in him." And, "I am thankful that my friends survived the global financial disaster. I am thankful America survived it."

A real estate lawyer in Washington emailed, "Whether you agree with the policy decisions made by the new administration or not, let's be thankful that our economy did not fall apart since last Thanksgiving."

A Washington journalist: "I am thankful that this is still a normal country, with predictable common-sense reactions to excesses. The American people served as a counterweight to the excesses of the Bush years, and are now serving as a counterweight to the excesses of the Obama years."

A friend who emigrated from Nicaragua 21 years ago and lives now in New York knew right away what she was thankful for: her still-new country. "I'm mainly grateful that I could raise my son in freedom. I could vote for the first time in my life. I could express my opinions without being shot on the spot, jailed, or exiled like my grandfather. I could sleep through the night without fearing for my life. I could work and buy food without rationing."

My friend Stephanie is grateful that she got health insurance despite a pre-existing condition. Another friend, an academic, was grateful to have been raised in America that taught well the rules of survival—perseverance, discipline.

Jim, who owns a small business, told me that as 2009 began, with all its troubles, "the number of frowns" he saw on the street "was overwhelming." He decided to take action. "I now make a conscious effort to smile at people in the street, in a bus, while waiting in line. It's such a simple form of connection, and it only takes one smile returned to make a difference in my day, and I hope the same is true for the other person smiling back." He hopes to start "a smiling epidemic" in Chicago.

My friend Vin said, when I asked him what he was most grateful for in 2009, "I remember reading that survival rates for breast cancer have been improving. I remember thinking: Thank God."

I am grateful for a great deal, especially: I'm here. I'm drinking coffee as I write, and the sun is so bright, I had to close the blinds to keep the glare from the computer. When I open the blinds, I will see the world: people, kids, traffic, dogs. Too many friends have left during the past few years, and it reminds us of what death is always trying to remind us: It's good to be alive.
More Peggy Noonan

Read Peggy Noonan's previous columns

click here to order her new book, Patriotic Grace

And after that, after gratitude for friends and family, and for those who protect us, after that something small. I love TV, and the other day it occurred to me again that we are in the middle of a second golden age of television. I feel gratitude to the largely unheralded network executives and producers who gave it to us. The first golden age can be summed up with one name: "Playhouse 90." It was the 1950s and '60s, when TV was busy being born. The second can be summed up with the words "The Sopranos," "Mad Men," "The Wire," "Curb Your Enthusiasm," "ER," "24," "The West Wing," "Law and Order," "30 Rock." These are classics. Some nonstars at a network made them possible. Good for them.

I leave it to others to dilate on why TV now is so good and movies so bad, since both come from the same town, Hollywood, in the same era. But there is a side benefit to televisions's excellence, and that is the number of people who follow a show so closely, and love it so much, that after it's aired they come together on long threads on Web sites and talk about what happened and what it means. People use their imaginations and unfocused creativity to add new layers of meaning and interpretation. "You know that was a reference to 'Chinatown.'" "Did anyone notice what it meant when Peggy told Mr. Sterling 'no' when he asked for the coffee? A whole revolution captured in one word!"

Those threads are golden. We rightly discuss the fact that media now is fractured, niched and broken up, that we no longer watch the same shows or have the same conversation. But what's happening now on the Internet after a good show is a conversation, a new one, and it's sprung up from the technology that helped do in the old one. How ironic and predictable, and another cause, however small, for gratitude.

Thursday, November 19, 2009

Your Depression and Your Kids


My mother always tells me, when I go back to the year my brother passed away, We acted like we were fine so we could have a life, so we could still have friends. We didn't want to lose them, too, our friends, being sad all the time, and we didn't want it to affect you. We still had other children.

And of course we, my younger brother and I didn't want to upset them, our parents, so confused and aggrieved, so we didn't talk about it, either. As a result there was very little family grieving or overt depression.

The silver lining, if there can be such a thing, is that we did make some family resolutions about how we needed to interact with one another in the future. We upgraded the family intimacy with these rules, and held by them, honor them to this day. They're mostly about showing affection.

I think a lot of families handle loss the way we did, don't talk about it. I would venture to say, most.

Whenever I share personal things on the blog, there's a reason, and it's not so you should think you should do things my way. Any ersatz personal solutions you read about here (usually involving dinner) might have been right for me, the right way at the time, but maybe could have been the wrong way, let's talk. A family coping strategy is only as good as what follows the enactment.

We suggest coping strategies in therapy all the time, knowing that sometimes they work, sometimes they don't. Sometimes a therapist knows something will work (we just know), and sometimes we know that it's a long-shot and we'll tell you It's a long-shot. Or sometimes it's a sure thing, but something gets in the way, like life.

Let's move on, get away from grieving, move over to feeling sad, tired, teary, and withdrawn, typical symptoms of depression. What's a mother or a father to do, what's a a parent to do, when depression is crushing? Disabling? What do you do when active parenting becomes very, very hard?

Are you supposed to be honest with your kids about your feelings? Maybe. How honest? Answers are based upon the circumstances, and certainly upon the ages of the children. A five year old who sees his mother napping is likely to be good with
She's tired.
Spare the kid the details if you can get away with it.

But should we hide our tears indefinitely? Depression can go on and on and on and on. Even if we want to hide them, the problem, of course, is that hiding tears is rarely possible with children. Most of these creatures are empathic, can sniff the sadness of a turtle. This is why, frankly, the nap concept is a good one, and often does refresh, removes the tears, if soaks the pillow. If you can sleep, it's a gift, try to rest a little, if only to refresh the program if the refresh button still works. Even if it doesn't.

I'm not trying to minimize the pain, as if to say a nap cures depression. I know how debilitating it is. Sometimes there are no tears at all, you know what I'm talking about. Sometimes the cloud is hanging overhead all day long, all week-long, and the burst never happens. There are coping strategies, like CBT, where you try to stay rational, try not to sink into despair and self-pity, and surely the support of a significant other, if one of these is around, is invaluable, as is a good friend. Therapy. Crying on an available shoulder.

But not the child's. The child will think about this, worry about this, find homework meaningless, and carry a parent's depression to school the next day. Or maybe not. But why take the risk?

Spare the kids your tears. Nothing makes one sadder than Mommy or Daddy's tears. And when the tears can't be helped, a quick recovery is best, for sure, a performance is in order, if a performance is possible. If this is a major affective disorder with depression, a 296.23, or .33, recurrent, severe, or a bi-polar disorder, a 296.89, acting may not be possible, minimizing the negativity may be impossible until medication begins to lift the brick off your head.

But if it is possible, when caught by your kid in the act of depression, a nod to Sometimes people just feel like crying, nothing's really wrong is a good nod. You will not always be able to get away with this, but if you can, by all means.

Isn't such emotional dishonesty wrong, you want to know? Shouldn't we be honest with our kids?

Not in my book, not if it's going to make them sad. What do they need this for, our sadness? They'll have their fair share, don't worry, in life.

That said, adult children can handle a lot of sadness from their parents. They feel esteemed, even, depending upon what we tell them, that we trust them with our honesty, our raw emotion. It is a compliment when I share with you. You are trustworthy.

And yet there's such a thing as emotional incest, mostly when it comes to the little ones. When the child is anxious because a parent has disclosed things prematurely, things that are difficult to forget, this can be considered emotional incest, invasive and traumatizing.

It is our job as parents, some of us believe, to sanitize life, to make life feel okay for our children so that they can do their job, which is to play, without distraction, to learn how to make friends, to practice being a friend. (There is surely too much emphasis on academics these days, you know, it should be outlawed, this intensity to achieve, makes children want to kill themselves.) No childhood is worry-free, there will be upsets, but you control what you can.

I saw a movie last night on a DVD AWAY WE GO, starring John Krasinski and Maya Rudolph.

WARNING: SPOILERS COMING RIGHT UP.

Although it's a little too sad for someone like me, I loved the people in this film, the young couples, friends and siblings of the protagonists, especially one couple who adopted a bunch of children and wouldn't let them watch the Sound of Music beyond the Good Night Song. They can learn about the Nazis when they're a little older, is the thinking.

John and Maya look for friends and relatives in different cities. They want to move somewhere, to settle down where they have connections, support. It is lonely, even in a loving, good relationship, without people.

The story (thanks to Sam Mendes, director, and writers Dave Eggers and Vendela Vida) lends an answer to that question,
What do you do when parenting, active parenting, is very, very hard?
It really is about social support. Maybe Mommy ran away, or maybe she's just tired, but if she has this, social support, or if Daddy has it, if someone has it, then there could be an aunt or an uncle, someone who doesn't mind filling in that parenting role. Or a close friend, or a grandmother-- someone the family trusts, emphasis on trusts.

A very social work-y solution, indeed. I'm open to others.

therapydoc

Saturday, November 14, 2009

What Do You Do With a Drunken Pilot?

The Wall Street Journal reminds us that the real terrorists are we.

We spend hours in line at security to reveal our weapons and gels, while a breath away from comatose, there in the cockpit of the airplane, the captain at the controls . . .

is snockered.

I don't know about you, but when I board a plane, I try to catch a glimpse of the pilot, try to reassure myself that this guy has had enough coffee for the flight. He tends to look like a marine, which is reassuring, and once in awhile he will be a she. Sometimes he'll have a drawl, sometimes will have that clip to his speech that says, "I'm all business. Get your laughs elsewhere."

In any case, you hear a lot as a therapist, so you worry about the shape of the captain. Pilots are people, too, and like everyone else, they work hard and some of them play hard. It can't be easy working hard if you've played hard the night before.

Maybe some of us are neurotic fliers and worry needlessly about dying in an airplane crash, especially because it's a quick and easy way to go. But that's not why we buy our tickets.

Susan Caray tells us the story.
The United Airlines pilot arrested this week in London for alleged drinking before taking the controls of a 767 jetliner to Chicago might have his pilot licenses revoked and could spend two years in jail.
And my kids wonder why I save all of my morning prayers, afternoon prayers, you name it prayers, for air travel. You need a lot of these, you know, if the pilot is going to be impaired.

Ms Caray continues:
The pilot, Erwin Vermont Washington, also could wind up back in the cockpit, through a rehabilitation program run by the Air Line Pilots Association union and a long but well-trod route to redemption blazed by a number of pilots over the years.
This is reassuring, it really is, that the union for the pilots offers rehab for substance-dependent pilots. Perhaps last week's latest wake-up call will wake someone up. All over the country, indeed, I hear pilots telling their loved ones,
"I'm going into rehab! Forget about the holidays. This is more important!"
My guess, however, is that no one will.

This is because a drunken pilot is a pilot in denial. Mr. Washington, last week's drunken pilot, had a swig of the hooch shortly before take-off. That's definitive denial, a pilot with a problem that won't ground him, no sirree.

Does anyone know this song?
"Drunken Sailor"

What do you do with a drunken sailor,
What do you do with a drunken sailor,
What do you do with a drunken sailor,
Earl-eye in the morning!

[Chorus:]

Way hay and up she rises
Way hay and up she rises
Way hay and up she rises
Earl-eye in the morning
The next verse is one from my tribe, I'm pretty sure, although my father denies singing it to me. I thought he learned it in the Navy in the Pacific:
Hit him in the head with a wet salami,
Hit him in the head with a wet salami,
Hit him in the head with a wet salami,
Earl-eye in the morning
Yeah!

Alcoholics at the helm of the family car typically tell their partners on any given night out,
"I drive just fine."
Which makes me think that more people need to buy salamis, and soak 'em well. Don't hit anyone, what responsible clinician could recommend that, for it is futile, but keep the salami around.

We don't want our pilots slowed down, retarded from alcohol, none of us want that. Should we revive this classic song, the salami could serve as an aversive stimulus. Hanging in the kitchen, perhaps the cockpit, too, the sausage might become a symbol of sobriety. Consider this an upgrade.

Rehab would be great, don't get me wrong, but since no one's racing to that solution, we really do need to come up with a better one, something a little more acceptable than deli. Vegans are insulted as we speak. A modest proposal coming right up.

Isn't there a little contraption, a breathalyzer that you can use for your car that won't let Old Red start-up if you have a level?* A level is a blood alcohol level above .08, but states vary. The car won't start until the driver takes the breathalyzer test and passes. Lose the test, lose the keys, or may as well, for they are useless.

The Air Line Pilots Association should consider lobbying management at UAL to install breathalyzers on every plane. They need to protect us, the consumers. We like living. We're not in denial.

Denial means that someone struggling with alcohol dependence may not think he's too drunk to operate a vehicle. Should that someone be a pilot, the vehicle an airplane, this makes him a terrorist, a time bomb.

The FAA ultimately has to do something about this; it's not unique to United Airlines. The industry has to do much more than offer rehab. Something has to bring these guys down to earth.

Oh, and most people avoid rehab, you know, until it's too late.**

therapydoc

*In random conversation I suggested that any official in the organization could administer a breathalyzer test to pilots prior to take-off, de rigeur. Then FD told me about these gizmos you attach to the dash. Much more elegant. Although obviously, it will ground us for who-knows-how- long while the airline scrambles to find a replacement. I, for one, won't mind the wait.

**And until they do, there are plenty of great recovery websites on the Internet.

I found it!

Monday, November 02, 2009

Wanting to Kill Yourself, But Not Wanting to Kill Yourself

This is such a great topic and I've avoided it for too long. But a comment on an old post reminded me that you have to hear the other side of suicidal ideation. This is sanitized a bit. The bold font is mine.

I am a victim of a violent crime by a person in my family. Now I am planning on being a psychologist/counselor. I know that it will be difficult but I want to be there for those who have gone through this situation and I want to let them know that they don't have to let this ruin their lives. Depression is one out of many symptoms, I know, but is it normal to have the desire to kill yourself every time you remember your past? I have had trust issues because of this, so I sympathize with all the victims out there and only wish that I could bring forth justice in all their lives.

I'm not sure where, "Just shoot me," entered my particular vernacular. Some of us say this then put a cocked index finger to one ear, click, pretend to off ourselves, and everyone laughs.

Anyway, I've been saying it a lot when I hear about things in my personal life that leave me speechless, make me shake my head, as in, "What now? What next?" When I'm frustrated with people.

What's interesting about, "Just shoot me" is that the person who says it obviously doesn't mean it, is just signaling frustration with life's impossibilities. We can't control most of it, certainly not the behavior of other people. So we laugh it up, say, Shoot me.

I give up.

Which implies that someone else wins, but it's okay. We concede the victory with relief. Let it go.

I think this happens on a much deeper psychological level in trauma victims. If a person suffers a trauma, even secondary trauma (hears about someone's trauma and feels the pain), it can trigger suicidal wishes and fears.

Immediately after a trauma or during the trauma, the thought, I would be better off dead is seeded in some neuropathway. Then you get the emotion, the fear, the terror, or it's there first, doesn't matter. But the reasoning, the thought processing about the event becomes unconscious, and that happens rather quickly. All that remains for eternity is the conclusion, I want to die. Sort of stuck like a broken record. You can turn off the juice, but someone keeps turning it on when you least expect it.

And the fears remain, associated with the conclusion, better off dead. You never wanted to die, you never wanted to be raped, to use a common example, or sexually harassed, perhaps, but the thought and the fear originated at the same time, under heightened arousal, and became inextricably linked in the brain.

Our brains are simply out of control. You would think they would get a grip.

But no. Get a bad thought, link it with a negative event, and there's your negative thought, warmed over easy again and again with the thought of the event. And then, the evolved negative emotion, the depression that lingers beyond fear. Fear may have burnt itself out. Maybe not. Just shoot me.

If you grow up with someone who is suicidal you are literally fed this thought with every suicidal threat, wish. You could be a happy go lucky kid, someone with a fairly happy little neurotransmitter, and you listen to the gloym and doym and you think, Oh, for crying out loud. You don't get a corner on suicidal ideation, I have my own, damn it. And you do, not because you want it, because you breathed it.

Hard to be tough sometime, hard to have great boundaries, to know,in your heart,
This is not what I want, this is not who I am. This is merely something I thought once, under a great deal of stress.

Or

It's something someone else wanted, under stress. But it has nothing to do with reality, not mine. I really don't want to die, I certainly haven't the guts to kill myself even if I did.
But here are these stupid thoughts, coming home anyway.

So I wrote her back, said something like this:
Not to answer you personally, but hypothetically people do have what I call "normal" suicidal desires and fears, and these mean absolutely nothing, meaning, people who have these desires and fears would never in a million years kill themselves. You might be one of these people, probably are. That said, for sure, you gotta get therapy to work it out and you really can work it out. Reading about it on the Internet probably won't cut it.
So you want to know, don't you, what happens in a therapy that works it out?

You go over the trauma, for there usually is one, even if it is imagined. Some people have amazing imaginations and they make themselves upset with their own creativity. Doesn't matter if it's real or imagined, most of the time it's real. You go over it again and again, line by line, verse by verse, and examine your responses, how they were normal fear generated thoughts under stress and how wanting to kill yourself rather than face others in the shame of it all felt like a normal solution.

Then with your therapist you do a cognitive behavioral therapy. You challenge the date on the inserted thought.
Wait a minute. The date on that thought is August something, 2004! It's now November, 2009! That thought has expired!
And you let it expire, die a natural death.

You challenge your shame, you say,
And I did nothing to deserve this! Why should I kill myself over something that happened to me?
As my daughter is fond of saying, Most of the time things happen to us. And she's right. We can take responsibility, sure, and we should, and we should rectify whatever we can, make whatever amends are necessary, do whatever we can to right life, but owning things to the degree that they make us sick? Forget that.

Be charitable, pass them along.

therapydoc