Category Archives: Mental Health

High Modernism and Network Science

It seems appropriate, somehow, that I’m reading James C. Scott’s Seeing Like a State before beginning my Ph.D. studies.

Scott warns against the dangers of a state which undertakes “utopian social engineering.” He sees a recipe for disaster comprised of four elements. The first seems innocuous: “the administrative ordering of society…by themselves, they are the unremarkable tools of modern statecraft.”

But those unremarkable tools, combined with an authoritarian state and a prostrate civil society, can lead to disaster.

The final element Scott warns of, the one that seems most relevant as I begin my studies, is a high modernist ideology. As Scott explains, high modernism is:

…a faith that borrowed, as it were, the legitimacy if science and technology. It was accordingly, uncritical, unskeptical, and thus unscientifically optimistic about the possibilities for the comprehensive planning of human settlement and production.

High modernism is a faith that goes far beyond supporting the scientific process. It is the unwavering belief that humans have the capacity to design utopia.

 

Of course, not just any humans have this capacity, high modernists would have us believe. It is only those who are properly educated, trained, and credentialed. In this technocratic utopia, experts need no local knowledge. Everything can be standardized to translate from one community to the next.

“‘Fiasco’ is too lighthearted a word for the disasters” caused by high modernism, Scott argues. “The Great Leap Forward in China, collectivization in Russia, and compulsory villagization in Tanzania, Mozambique, and Ethiopia are among the great human tragedies of the twentieth century, in terms of both lives lost and lives irretrievably disrupted.”

The high modernism which rocked the last century may be behind us. The world is to complex, too interwoven to believe in simple, standard, solutions.

Yet even as we accept the complexity of the world, we find ways to unravel it. I’m thrilled to be studying networks, an approach which allows for examining and understanding the complex systems which surround us.

So it is with the warning of Scott ringing in my head that I recently read these words about how a network understanding of biology could influence and improve medical practice:

If you suffered from manic depression in recent years, your first visit to the doctor probably started with an hour-long discussion to carefully examine your thoughts and feelings…Twenty years from now things could look quite different. Facing the same doctor, you will have a five minute discussion, just as you do in cases of simple influenza. An assistant will take a few drops of blood and you will walk home empty-handed. In the evening you will pick up the medicine from the nearest pharmacy. The next day you will wake up fresh and happy, as you did before the symptoms appeared. Both the manic and the depressive you will have been washed away.

That doesn’t sound like utopia to me. In fact, it sounds vaguely horrifying.

While there are no doubt many people with serious mental illnesses who would benefit from such an effective treatment, I’d hope it would take more than a five minute conversation before any major personality traits are simply “washed away.”

Furthermore, with such technology at our disposal, we’d be faced with serious dilemmas about what traits to live with and which to wash away. How much depression should a person accept before they undergo such drastic treatment? How soon before authoritarian states started to remove traits of outspokenness and disobedience?

None of this is to say that we should not pursue the science. It is important, fascinating work that is helping to make a little more sense of this mysterious world.

But embracing the science doesn’t mean embracing high modernism – indeed, as Scott argues, that is something we should be very wary of.

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Agency

Social psychologist Geert Hofstede is perhaps most well known for his construction of cultural dimensions. Hofstede considers culture as “the collective programming of the mind distinguishing the members of one group or category of people from others.”

Among his six dimensions of culture, Hofstede evaluates a society’s “Individualism versus Collectivism (IDV).” Hofstede explains:

The fundamental issue addressed by this dimension is the degree of interdependence a society maintains among its members. It has to do with whether people´s self-image is defined in terms of “I” or “We”. In Individualist societies people are only supposed to look after themselves and their direct family. In Collectivist societies people belong to “in groups” that take care of them in exchange for unquestioning loyalty.

The United States, as conventional wisdom would indicate, is more individualistic than collectivist.

I’ve been thinking about this recently, because in some ways that finding seems at odds with the lack of agency experienced by so many Americans – particularly people of color, those living in poverty, and others who are marginalized in our society.

As Kelly Oliver argues in The Colonization of Psychic Space: “One’s sense of oneself as a subject with agency is profoundly affected by one’s social position.”

Being an individualistic society, then, puts oppressed people in a double-bind. While Hofstede finds that American society expects “that people look after themselves and their immediate families only and should not rely (too much) on authorities for support,” the message to oppressed people consistently undermines their own sense of agency and self-efficacy.

Frankly, I was always somewhat skeptical of Hofstede’s anaylsis, and not only because he also has a masculinity/femininity scale defined as “wanting to be the best (Masculine) or liking what you do (Feminine).”

But the idea of America as an individualistic place, where everyone’s expected to pull themselves up by their bootstraps…that just sounds like the line you’d get out of the ol’ boys network.

Surely, that has long been an element of our culture, and has often been a strongly expressed element of our culture, but it doesn’t speak for all of us and it doesn’t speak for me.

Oliver argues that “by resisting oppression, one regains a sense of oneself as an agent,” and that the process of resistance can be healing insofar as it can help build agency.

So let’s all, collectively, reject the narrative of an individualistic America. Let us collectively lift each other up and work together to change the dominant narrative. This is our country and we can shape it.

Happy Fourth of July.

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The Dangling Conversation

It can be easy to be overwhelmed by the ills of the world.

For years, I worked on efforts to end genocide in Darfur. Or, perhaps more accurately, I worked to raise awareness of genocide as a real problem. A problem that, perhaps, someone ought to do something about. People were dying.

We raised money for on-the-ground and advocacy organizations. We held events with survivors of genocides from the Armenian genocide to the present. We pointed to the dark history of humanity and the shameful inaction of our forefathers.

We questioned why there was always a reason for the U.S. not to get involved, for the world not to get involved.

There’s always a reason not to act.

But the people keep dying.

I’m reminded of that song by Simon and Garfunkel:

And we sit and drink our coffee
Couched in our indifference
Like shells upon the shore

You can hear the ocean roar
In the dangling conversation
And the superficial sighs,
The borders of our lives.
Yes, we speak of things that matter,
With words that must be said…

I long ago stopped engaging in anti-genocide work. I, like so many others, simply shake my head and heave the windy sigh.

I’ve moved on to other issues, other causes, other problems which also demand to be solved.

There are too many ills to take on them all.

And the dangling conversation remains the borders of our lives.

We each do our own work, focus on the accomplishable, perhaps, or simply tack into the wind for other causes. We each have our strategies for staying sane while we desperately try to bend the arc of the universe towards justice.

It is not easy work.

And there is always more work to do.

And there is always a reason not to act.

The best we can do, I think, is to constant question ourselves. To push to understand our own true goals an motivations.

When you throw up your hands and say, “well, what can be done?” are you genuinely too busy with other work or are you more or less comfortable with the status quo?

Do you genuinely think that nothing can change, or are you simply willing to accept things as they are?

You don’t have to announce your answer to the world, but you deserve to be honest with yourself.

There is too much work in this world, far too much, for any of us to do it alone.

No one person can do it all.

So forgive yourself for embracing some issues while being lukewarm on others, forgive yourself for preferring advocacy to direct service, or favoring one type of work for another.

Follow your strengths and your passions, but know there is always more work to be done.

And be skeptical of yourself when you find your dangling conversations, when you walk away from an issue rather than engage. There is only some much we can take on, sure, but we should push those borders back as far as possible.

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So Much Potential

It’s graduation season, and that means that young people around the country will gather to reflect on all they have accomplished and to look forward towards all that is to come.

First at colleges, and then at high schools and even middle schools, solemn celebrations will pass on words of wisdom, providing guidance to young people entering the next phase of their lives.

Pursue your passions, they may be told. Or perhaps, find something you love that can also support you financially.

They will be told of their potential, that they can accomplish more than they might think.

They will be told that perseverance and passion can bring about remarkable outcomes, or perhaps, that pursuing happiness is a worthwhile goal.

It’s a miraculous time. Young minds on the verge of greatness.

You have your whole lives in front of you, they will be told.

But there are too many empty chairs for that to be true.

Graduation is a remarkable accomplishment, one that is worthy of celebration and reflection.

But for too long we’ve said these words and for too long we’ve listened to them, and for too long we have believed them.

In 2014, there were over 1,000 deaths from Heroin and other opioid in Massachusetts alone. The majority of these deaths are among 24-35 year olds. These are my peers.

In 2013, CDC data shows that over 11,000 people age 15-34 committed suicide, making it the second most common cause of death among that age group. Not far behind, over 8,500 people in that age group died in homicides. And that’s to say nothing of the many deaths cited only as “unintentional injury.”

And if that wasn’t enough, homicide is the third most common cause of death for those 1-4, claiming 337 lives in 2013, and suicide is the third most common cause of death for 10-14, claiming 386 lives.

10-14. With razor blades pressed against their skin.

And yet, come May, we look out at those fine graduates – who have accomplished so much, who have achieved so much just by making it as far in life as they have, and we, as society, have the audacity to tell them:

Be happy – you’ve got your whole life ahead of you.

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The Dangers of Empathy

Today I attended a talk on “Generative Empathies,” part of the Tisch Talks in the Humanities hosted by Tisch College.

The talk focused on exploring the question, “What does empathy produce?”

While you might imagine possible answers to that question – empathy produces shared understanding, it acknowledges another’s experience, it expresses our shared humanity – I was most taken with some of the concerns raised about empathy.

That is to ask, is empathy always “good”?

What if you are empathetic towards someone or something that is justifiably “bad”? What if you choose the wrong side of an issue because your empathy is misguided?

Perhaps more fundamentally – does feeling empathy relieve you of further ethical work? Does empathy soften a critical eye?

I am reminded, for example, of a recent story in Slate about the research efforts of a group of women incarcerated in the Indiana Women’s Prison to look at that institution’s history.

The traditional story of the prison’s 1873 founding went something like this: after shocking allegations of sexual abuse in a unisex prison, two angelic women fought for the creation of the first all-female prison in the country to protect their incarcerated sisters.

In this simple retelling, the two well-to-do women felt empathy towards wayward women, establishing a women’s prison to rectify their tragedy.

Of course, the story is much more complicated than that.

And empathy is more complicated than that.

There is evidence that the two women each had moral failings of their own. That it was their virtue of wealth more than anything that kept them on the right side of the law. By modern standards their crimes were worse than some of the inmates they oversaw.

There are indications that terrible things happened in their prison. That at least one of the women knew about and even instigated abuse.

Yet they are remembered as angels who saw fit to save the fallen women of their day.

Just who should one feel empathy for in this story?

And importantly, was it appropriate for the prison’s founder’s to claim empathy towards the inmates?

Their empathy was a resource of privilege. Left unjudged for their own crimes, it was easy for them to find empathy for those “less fortunate.”

And perhaps what’s most remarkable about this story that I’m left with little doubt that those two women thought they were doing the right thing. Regardless of their own failings, they thought they were doing what was best for incarcerated women.

Enshrined in empathy, they thought they were the angelic saviors history remembers them to be.

And that is, perhaps, one of the rockiest shoals of empathy – that it might be treated as a free pass, an escape hatch, an all-encompassing rebuttal to any challenge:

I can do no wrong, because I truly care.

Perhaps empathy can be used as such a shield, but it shouldn’t be.

Empathy does not relieve the need for a critical eye, does not lessen the burden to constantly question what is right and what is wrong, does not change your moral obligations.

It simply helps you see more…by demonstrating that you understand nothing.

As one speaker put today, quoting Leslie Jamison in the Empathy Exams, “Empathy requires knowing you know nothing.”

All we can ever really understand, all we can ever really know, is our own experience. Empathy helps us feel around the edges of what we know, comparing our own experiences to others, touching the similarity and feeling for the differences.

Assuming nothing, knowing nothing. Just groping for common ground across a dark chasm of difference.

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Resilience

This morning I ran across an intriguing opinion piece by

In it, Chadburn argues, ” …normalizing the idea that residents in low-income communities can simply bounce back in response to a lack of resources…is handicapping our ability to help those truly in need.”

She recognizes the focus on resilience as an asset-based approach, yet expresses concern that projects which promote resiliency “valorize the idea that we should remain unchanged, unmoved and unaffected by trauma.”

Resilience, she says, is an antonym for broken.

I’m not sure her definition there is accurate, but she’s right to raise concerns about praise for the unbroken – as if all it takes to recover is to pull yourself up by the bootstraps.

Perhaps resilience should be seen more like Kintsugi – the Japanese art of repairing a broken dish with gold lacquer. Perhaps the places where we are broken should not be something to hide, but rather something to cherish.

Or perhaps that, too, puts too much focus on the whole, too much focus on the way things ought to be – and doesn’t pay enough respect to the dreary way things actually are.

I’ve been told that people who make it through difficult and traumatic experiences often do so by developing certain coping mechanisms – mechanism which might serve them well in one context while being entirely socially unacceptable in the next.

Perhaps, then, we should imagine people with resilience not as whole and unscathed, but rather as world-weary warriors, deeply scarred and wounded. Broken, perhaps, but beautiful all the same.

says resilience claims: “I am not broken. I can take more.”

Perhaps we should say: “You can not break me. I’m already broken.”

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Morality for the Broken

I often call myself broken.

I don’t mean that as a bad thing. It’s just a part of who I am. To be honest, I suspect we are all broken. All not quite right. All wounded and scarred from our past, present, or future.

So forgive me if I use that word cavalierly. I use it to refer to any person – or, perhaps, a given moment – where we aren’t quite the person we want to be. Where the traumas of our past impact the realities of the present.

Perhaps you aren’t good at opening up to people. Perhaps you over share. Perhaps you are terrified by loud noises, inexplicably moved to tears, overcome by violent anger, controlled by addictions, paralyzed by fear.

I don’t know how you are broken, but I suspect you probably are.

I know I am.

Mental health issues are serious, and we should take them seriously.

But to remove the stigma of mental health, we also need to normalize mental health issues. We need to give morality back to the broken. Or perhaps we broken need to take morality back.

And make no mistake, there is a moral component to mental health. Michel Foucault traces this well in his work. Sanitoriums were places where the mentally ill were incarcerated with criminals – eventually separated for the protection of criminals, who were seen as morally superior to the mad.

The mentally ill were left exposed in the cold and put out on display for entertainment. The mentally ill were less than human, and the perceived causes of their madness were inextricably linked to the morality of the day.

Perhaps our modern sensibilities have refined since then, but this implication of immorality has not yet faded from view.

There is nothing wrong with you if you are broken. There is nothing wrong about you.

Friedrich Nietzsche argues that aristocrats invented morality. That they created “the good” to be synonymous with their tastes. Eventually, this paradigm shifted, with those who came to power from lower social rungs declaring blessed are the meek.

But if the moral path is consistently reinvented by those in power, who will speak for the broken? Who will define morality for us?

Guilt as a personal check can be good. Guilt as a crippling response seems unhelpful. Grief can be a healthy process, but depression can be devastatingly paralyzing. Anger, too, has value, but undirected rage can be dangerous.

Who is to tell us what feelings are Right?

I am not prepared to be judged immoral for any of my many faults, nor would I presume to judge others for theirs. And yet, giving everyone a pass to determine what is best for them seems dangerous – perhaps there are some deeds we really ought not to condone.

I don’t know what the answer is, but I do know this – there is a morality for the broken, one that embraces us for who we are and accepts our many flaws. A morality that doesn’t judge how our brokenness manifests, but which understands that it does. A morality that questions what is Right without damning us for our flaws.

A morality for the broken. And we are all of us broken.

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Terrible People

Earlier this week, someone told me she worried that she was a horrible person. Some minor thing had gone wrong. So she thought she might be horrible.

Don’t worry, I told her. Everyone is terrible.

I’m pretty sure that’s not the answer I was supposed to give, but…well, I wouldn’t have said it if I didn’t think she was prepared for my unusual brand of support.

But, seriously, though – while everything, of course, is a matter of definition it’s fairly simple to argue that everyone is terrible, or at the very least, that the vast majority of people are terrible and that, should any non-terrible people exist, there numbers are so small as to be negligible.

What, you may ask, is a terrible person?

Well, by other definitions a terrible person is just a person. A terrible person has imperfections. A terrible person makes mistakes, A terrible person makes choices they know they shouldn’t make and a terrible person has a litany of regrets.

But, really, everyone does that.Everyone being terrible would certainly explain why these self-complaints are so common. I regularly call myself a terrible person. And I know I’m not alone in this challenge. On a daily basis, I hear several people use variations of the expression, sometimes electing to modify a different aspect of their identity.Apparently, everyone I know is a terrible mother.Some of them might even be the world’s worst mother, but they’ll clearly need to fight for the honor as so many of them seem ready to claim it.The problem, you see, is that for one moment these women did any less than dote on their child with the sickening love only found in a doped-up ’50s housewife. Perhaps they were worn down from the fact they hadn’t slept in years or showered for days. Perhaps it was just a helping of day-old mac and cheese not siting well. One may never know. But they are clearly terrible mothers. Indeed.I’m pretty sure that’s how it works.The so-called proper response to the concern of being horrible is to reassure someone that they are, in fact, not horrible. That they are being too hard on themselves.And yet this answer seems unsatisfying.Just because it’s normal or natural to do something, doesn’t mean that it’s an okay thing to do. How much historic racism and sexism have sought refuge behind these terms?Even assuming something less inflammatory – is it okay to lie just because that’s a reasonable impulsive reaction?Maybe or maybe not, but it seems like a healthy question to debate.And that’s where the challenge in this self-loathing terrible comes from. Everyone makes mistakes, but writing your mistakes off as something that’s okay because everyone’s doing it…doesn’t really work.So, yes, I suppose, you are a terrible person.But that’s okay because we are all terrible people. Striving every day to be just a little less terrible than the day before. Some days we’re a lot more terrible, and other days we find our better selves.But we’re all pretty much terrible.So, next time you call yourself terrible or horrible or some other presumably self-deprecating term, ask yourself this – what do you wish you could have done instead? What strategies and tactics could you employ to change the way things played out? Would you, really, like to do anything differently next time?And, of course, remember, you will always be a terrible person. Try your best to be better, but you will continue to fail. You will always be imperfect.You will never be a doped-up, TV sitcom, ’50s housewife. And that’s okay, because you probably don’t really want to be that person anyway. I know I don’t.Just be your terrible self. Your terrible, wonderful, broken, strong, challenged and struggling self.And then try again tomorrow.

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Madness as a Social Construct

I was reading an article the other day which expressed a point I’ve often heard:

Depression is an illness.

I’m no mental health expert, but I know I’m supposed to agree with this. And, perhaps, I do. In theory.

Reinforcing depression as an illness is important for a number of reasons:

People shouldn’t feel shame for seeking help. You wouldn’t feel weak for seeing a doctor after a heart attack, for example.

People should know they can’t control depression. You can’t “snap out” of depression the way you might change an outfit. Dedication, determination, effort – these may not make a difference. And that’s no one’s fault.

So it is important to remind people that depression is an illness. An actual issue. It’s far more insidious than a bad day.

Yet, when I read this the other day, it suddenly stuck me as…judgmental.

If depression is an illness, that implies that there is something wrong with people who are depressed.

Someone who is a mental health expert once told me that depression is only a problem for a person who finds it a problem.

That is, every person has the right to be depressed if they choose to be. A person with depression only needs treatment if they feel they need treatment. If they’re not living the life they want to live or being the person they want to be.

I gather this is a contentious idea within the mental health community, and, perhaps, reasonably so.

The right of depression resonates with my support for the unconventional, but this approach raises obvious concerns as well. If someone thinks they don’t deserve to live, is it then their right to act on that belief? Are we obligated to intervene, or should we rather defer to their individual freedom?

If a person feels this way because they are ill – does that change things?

In Madness and Civilization Michel Foucault documents the history of “madness” throughout the modern Western world. Different things have been considered madness at different times, with different explanations, and, of course, different solutions.

The beauty of Foucault’s analysis is that it goes beyond the articulated scientific layer of the day.

Yes, he explores the scientific rational behind the humors, documenting the believed impacts of hard bile or hot blood. But he goes deeper than that, connecting the medical understanding of the day with the moral beliefs that went into it – and the moral implications which come out of the diagnosis.

It is easier and comforting to think of today’s medicinal understanding as pure science, untainted by the bias of morality. But this interplay is perhaps easier to see when looking back at “medicine” which is pure quackery.

Foucault recounts stories of men whose mania was attributed to “excessive intercourse,” and of women who “invent, exaggerate, and repeat all the various absurdities of which a disordered imagination is capable.” This women’s hysteria, one doctor warns, “has sometimes become epidemic and contagious.”

And, lest you laugh this off as the foolishness of the Victorian era, remember that it wasn’t until 1973 that the American Psychiatric Association declassified homosexuality as a mental disorder.

So, there may be some legitimate science to it, but it seems there’s some social construct to it as well.

Is depression an illness? Well, it seems I don’t know.

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In Defense of Hopelessness

Perhaps it is my field of work or area of interest, but it seems like nearly every day I hear someone proclaim – it’s important to have hope.

Now, as much as the contrarian in me may revel in flippantly calling myself anti-hope, the truth is, I have no qualms with, nor judgements of, people who embrace hope as a core need.

It strikes me as a deeply personal matter: some people have faith, some people don’t. Some people have hope, some people don’t. Some people need that something – whether they call it faith, or hope, or use some other word – some people need that. Many people need that.

But some people don’t.

It’s okay to be hopeless.

I mean, it’s okay to be hopeless if you’re okay with being hopeless. Many people aren’t okay with being hopeless, but find themselves hopeless nonetheless. That is a problem indeed.

But do we need to force hope on everyone? To consider hope a core requirement for whatever moves you as the Good Life?

I don’t think so.

It’s okay to be hopeless.

Of course, a key question here is what it means to have hope.

I often hear the term applied to collective action – to social change. It’s important to have hope that we can make a difference. That we can make the world better.

That sounds a reasonable claim, and yet – this is where I find hopelessness most noble.

Faced with overwhelming injustice and so many wrongs in the world, I select two kinds of battles to fight: those I can win and those worth fighting.

I’ll admit to having a bias for practicality, so I’ve certainly been known to evaluate efforts in terms of probable impacts – to favor a strategy or approach that will work.

But pursuing the fights you can win is not enough. Sometimes it is just as important – perhaps more important – to fight the battles you’ll never win.

Of course, one may hedge here, arguing that even a statement of hopelessness is bolstered by a deeper sense of hope. It’s like the argument that that all altruism is ultimately self-interest.

And yet – is there not something compellingly beautiful in the image of someone fighting for justice, fighting for what’s right, but knowing they’ll never win? Knowing they’ll never move the needle, nor make any difference, nor even be remembered for their efforts? Fighting only because it’s the right thing to do.

There’s something remarkable in passion without hope.

Hope can also be seen at a much more personal level. Hope that your life will have meaning. Hope that you’ll make it through the day.

Questioning the universal need for such individual hope is much less socially acceptable.

And the demand for hope here is reasonable. Terrible things happen to people without hope. They feel terrible things, experience terrible things, perhaps even do terrible things.

Hope should not be denied. No life should be lost to hopelessness.

And yet –

Does a widespread need for hope translate to a universal need for hope? Is hope so essential that hopelessness should be removed as an option? That no person should be welcome to stand up and proudly declare their hopelessness?

It’s the pursuit of that universal hope which worries me.

Hopelessness should always be an option.

Perhaps not the right option for the vast majority of people, but an option nonetheless. There is nothing wrong with people who need hope, and there is nothing wrong with people who need to be without it.

There is, after all, something dangerous in hope. It doesn’t help to proclaim that it gets better if, indeed, it never gets better. Shattered dreams can be worse than no dreams at all.

But I digress. For, really, the conversation about individual hope comes down to one question – imagine that person laying in bed. Staring blankly at the ceiling. Too broken to move and swallowed by that dark cavern of despair. Hopeless.

The real question is what gets that person out of bed. What heals them.

Hope, perhaps.

But, I think, not necessarily. There is power in hopelessness. Not just the power to destroy, but the power to repair. Embracing hopelessness can ease that despair.

Perhaps not for everyone. Perhaps not for the vast majority of people. But, perhaps, for some.

Hopelessness should always be an option.

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