Paimi rocks: bringing light to the dark side of the mental health system

September 22, 2014 by

In Tennessee the Disability Law and Advocacy Center is the home of the Paimi program.  I have been a member of the Paimi council for several years.  Below is a post a couple of years old that shows the importance of the paimi program Murphy is trying to destroy.

From the archives
There are many, many real and important criticisms of the mental health system.  One of the ones that affects many mental health consumers is rarely made.  When it is made it is seldom afforded the importance it merits.

That is on the subject of adult group homes  ( or whatever they are called in your state) for those with mental illness.  Recent reports on the system in Florida reveal a system ripe with abuse, neglect, and abuse.  Some programs described there are little more than criminal activities victimizing the mentally ill.  Other states report similiar problems.  It seems to be a widely known secret in virtually every state.  But it does not seem known enough or compelling enough to motivate much action for improvement.

The Disability Law and Advocacy Center recently  released its report on the group home system in Tennessee.  Quoting from the report:  “

The following report is presented to address unacceptable operating practices of licensed board and care homes (supportive living facilities) for persons with mental illness in Tennessee. Issues and recommended solutions found within are drawn from numerous monitoring visits, policy reviews, and dialogue with residents and owners/operators. The current lack of  compliance with licensure rules and oversight create a
risk of potentially dangerous consequences for some of Tennessee’s most vulnerable citizens – persons with mental illness residing in board and care homes. Occurrences of physical and emotional abuse, neglect, and financial exploitation may remain undetected due to inadequate supervision and monitoring and failure to take actionwhen compliance is lacking.
Residents may feel disempowered to change these situations or self advocate under such circumstances. Many lack the ability to protect themselves while others believe that they have no choices or options. All too often, residents’only alternatives to board and care homes include institutions, hospitals, shelters, jails, prisons, and even homelessness. Limited financial resources, lack of supportive family, few safe alternative living arrangements, and insufficient community resources frequently result in helplessness and passivity.”

Later on the paper adds, “Overall, the provision of services in board and care homes was found to be an illusion with many issues representing an alarming potential for harm, including abuse, neglect, and financial exploitation. During DLAC’s monitoring visits, investigators observed that persons with mental illness (residents) living in board and care homes
experience poor living conditions, lack of oversight, and greater opportunities for exploitation.”

One of the most alarming things to me is that many of these people are the same people being served in Tennessee’s peer support centers during the day.  Considerable work, planning, and effort has gone into trying to make sure that these centers met the needs of their clients.  The state puts a lot of effort into oversight and regulation to at least try to insure that programs work for the clients they serve.  If we are trying to serve the needs of people and insure their safety and chances for a better life how can we manage their days without giving the same kind of care to the places where they live?  As the report states many of these folks feel like they have no choice or options about where to live and are afraid to speak up or dont know who to speak up to.  How in the world can we let this happen?


When life is hard: recovery and tragedy

September 21, 2014 by


From the archives

Originally posted on Hopeworks Community:

I know people who hate talk of recovery.  Often they have a long history of mental health issues. Professionals have told them in many ways, not all spoken, that they lack the motivation and ability to make changes. Often for them treatment seems increasingly irrelevant to the conduct of their daily lives.

  Everything is hard for them.  It doesnt seem to matter how hard they try or what they try.  They hear recovery and wonder why it aint so for them.  They hear tales of how good it can be as an indictment of how bad it is for them.  The promise of joy seems hollow when your only constant companion is misery and distress.

They try to be what other people expect them to be, but are cautious about ever letting anyone else see them as they are.   One lady told me straight up.  “I dont need to…

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Getting ready for the new Murphy Bill

September 19, 2014 by

Congress has left for the election.  A lame duck session will occupy the remainder of the year.  The Murphy Bill didn’t make it over the hump.  With the new Congress will come the new Murphy Bill and with the next Congress an even newer Murphy Bill and so on. 

Several things seem obvious to me:

1.  Unless another Bill of some kind is passed there will be a Murphy Bill each year until he leaves Congress.  It will be a perpetual battle. 

2.  Perpetual battles wear people out and the odds favor him in the long run. Dr. Torrey, Mr. Jaffe and company will not wear out.  They live for stuff like this and anything that gives them a chance to get some press and some attention will find them endlessly motivated.

3.  It is essential to articulate the changes we are for, and not rely on opposing what we find objectionable.  We are much more effective if we have a viable, concrete option that we can point to as an alternative answer.  Give people something to vote for.  Give them a vision of what the mental health system can be.  Murphy portrays anyone who is against him as being against mental health reform.  We need to say we are for a better reform.

4.  This means people who are against Murphy must find some common ground from which to proceed from.  Murphy’s greatest strength is our lack of that common ground.  I think there are a lot of common agreements.  Part of the problem is that the people who seek common ground are not as verbal as those who think their way is the only real way.

5.  Murphy’s greatest strength is the stories he marshalls to prove his points.  We need to develop and share stories that show he misses the point.  In some ways it will be a competition of anecdotes.

6.  We need to ruthlessly fact check his claims.  As I have tried to show in several posts his claims just don’t pan out.  His Bill is not a fundamental reform of the system.  It is just a rewind of strategies already tried and largely discarded.

7.  Particular attention needs to be paid to the cost of his proposals.  AOT and psychiatric hospitalization in particular are big ticket items and must necessarily subtract from spending elsewhere.  The dollars matter and they will really matter in Congress.

8.  It will not be enough for us to say we want the mental health system to operate in a more ethical fashion.  We must say we want it to be more effective.  Murphy will try to dismiss the ethical argument as people who are against real change.  We have to be for “real change”.

9.  There is not nearly enough attention to the fact that state mental health budgets in last year’s have been cut past the bone.  Every state is struggling to hold its head above water.  Murphy never mentions that.  Instead he tries to blame the “worried well” and say we are trying to help people who don’t need help.  It is a classic attempt to blame the victim.  We could do a lot more to highlight the utter absurdity of his position and his immense distortion of reality.

10.  The issues he talks about like “mental illness and the jails” resonate with legislators because those issues resonate with their constituents.  To not address or to not treat them as real leaves the debate to Murphy and gives him leverage we don’t want to give him.

11.  We need to do a better and louder job articulating the vital role of Paimi.  In Tennessee it plays a vital role in the system.  Again confront the distortions of reality that Murphy makes time after time.

12.  Murphy is a political opportunist.  Confront him every time he shamelessly uses a tragedy to glorify himself or his Bill. He seems to be chronically first in line to proclaim how his Bill would have saved the lives of people tragically lost.

13.  Dr. Torrey is a ventriloquist.  Every time Murphy opens his mouth Dr. Torrey talks.  More attention needs to be given to how little professional backing Dr. Torrey has.  He is not exactly in the forefront of psychiatric thought.  And the Treatment Advocacy Center has certainly shown no reluctance to impose its vision in state after state.

14.  Murphy continually talks about AOT as if every state is New York.  It is basically dead or irrelevant in most states. It is time he be asked to explain that irrelevancy.  It is time more legislators are aware of it.

15.  Seek allies.  There are many people who agree with you about Murphy that may disagree on many other things.  Murphy is trying to seek allies.  In the end bigger tents normally beat smaller tents.

Just some thoughts.

Does it matter??

September 18, 2014 by

I really struggle sometimes with whether or not anything I do matters.  I really do and I swing all over the pendulum.  Some times I am sure that it does.  Sometimes I am sure it doesnt.  Mostly I hope.

More and more I realize the only thing I really control is whether or not it matters to me.  Does what I do say about me what I want to say about me?  Are the things I think are important the things I treat important? 

Doing better in many ways.  I still hope though.

Think I always will.

More on Cecil

September 18, 2014 by

from 2010

Cecil Cook (see “The living of Cecil Cook” on this blog) was finally put to rest today.  Close to 400 people crowded into an auditorium  intended for 225 to say their final goodbyes and celebrate the life of a man who had touched virtually everyone of them in special ways.  Cecil died in a plane crash about a week ago and for a week we have all cried and bled, each in his own ways.  The gash has been deep and painful.  A community has been changed.

Different people talked about the gifts Cecil had given to them.  In little ways he had given them big things.  One lady talked about how Cecil had shown up at her house with a lawnmower and told her he was ready to mow the grass she had never been able how to figure out how to get done.  She had no money and no mower.  He told her there was one catch.  She had to agree to let him buy her pizza before he could go ahead and mow.  Her eyes glistened when she talked.  He showed her the reality of kindness in a world that for her had shown little.  One former colleague talked about how hard it was for Cecil to get to meetings.  Anytime he passed someone having a hard time he stopped to talk.  Sometimes he just never made the meetings.  One pastor said it simply.  “Cecil taught me the secret of being a good pastor.  Never close your door.”  And in the deepest and most substantial ways Cecil never closed his.

I spoke for a minute.  And I hadnt opened my mouth and I had started to cry.  Cecil I tried to explain taught me kindness and wisdom were the same thing.  Anyone he touched learned that lesson.  I hope someday to lead the kind of life that might teach the same lesson to someone else.

I think we have to give credit to the most substantial change.  Have we been changed by Cecil’s passing…. Sure.  But we have been changed in a much more substantial way though.  We have been changed by his coming.  And that is a change that can survive his death.  Someone once told me they wanted to live for a purpose that survived his death.  We are all part of Cecil’s purpose… all those he has met and all those we meet.  In our living we keep Cecil alive.  And our stories, our living, our loving in a very real sense is the real story we tell about Cecil Cook.

May God bless.  Cecil you will be missed, but may the seeds you planted grow to be far more than the flower you were.


September 17, 2014 by

I like the term transformation much better than I like the term recovery.  Recovery has an implication of regaining something lost but when I consider recovery I am talking about so much more than that.  I am talking about new creation.  I am talking about stepping above and finding a truth, a place maybe not really known before.  Transformation means taking what is and changing it into something so much better.  And there is no limit… No this is too bad to make better.

That is the lie of the Murphy Bill, of E Fuller Torrey, and DJ Jaffe.  They deny the possibility of transformation and if you point to them the reality of living, breathing transformed lives they dismiss with “they must have never been that bad off to begin with.”  Their vision is people who are maintained at best, that will ways be dependent on the system.  Life for them is about minimizing trouble and pain.  It is not about gain or living a life of meaning and connection and purpose. It is about adapting to your chronic biochemical insufficiency.

We need to talk much more about the reality of transformation and the ability of the human spirit in the worst of times to go above and define the circumstances rather than be defined by them.  We need to talk about life defined, not by what is hard or difficult for us, but by what is important for us and about us.  We need to say to Murphy, Torrey, and Jaffe you are wrong and I am the proof, because if you were right I would be impossible.  We need to say that fundamental mental health reform is not about attacking or imprisoning the people poorly served by the system but in creating a system that offers the tools and experience to help people transform and manage their lives in a way that affirms their worth as human beings. 

Our real impact must be more than what we are against.  The mental health system needs a vision that sings of the reality of hope and better life.  Share that vision with everyone.

The Living of Cecil Cook

September 16, 2014 by


Cecil died several years ago. He was a best good friend. We are fast approaching the anniversary of hia death. This post was about his life.

Originally posted on Hopeworks Community:

You meet very few incredible people in this life.  My good and great friend Cecil Cook was such a person.

They called this afternoon.  He died in a plane crash yesterday.  He was the only one aboard a small plane.  They dont know what happened, dont know when they will.  They said he was literally minutes away from a safe place to land.

Today has been numbness and tears, both without warning, in moments forever, like a terrifying dance. I try to tell myself that he is in a better place and how lucky I was to know him, when so many didnt have the honor, but I feel ripped and torn and life a little less in some important way I dont understand.

Cecil was a good person in a way that goodness really means something.  Kindness was for him not an affectation like it is for some people. …

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If the mental health system was sane…

September 15, 2014 by


From the archives. Seems appropriate right now

Originally posted on Hopeworks Community:

There would be a range of services availible reflecting the human needs of those it serves.

Those services would be availible to those that need them.

Those services would be based on what works, not what makes money, reflects any particular philosphy or interest, and not because it is what we are used to doing.

Asking for help would not label someone, brand them, be a cause of shame, a source of discrimination. Asking for help should not be a problem.

It would realize that lack of a place to live, lack of food, lack of adequate clothing, lack of a job are frequently barriers and problems for the people they serve and address them in a direct and effective manner.

It would know that inadequate health and inadequate health care are common problems for the people they serve and be part of an effort to serve the entire person…

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What are we for?

September 15, 2014 by

I have written many, many posts about why I think the Murphy Bill is harmful and ultimately fraudulent in the figures it uses and claims it makes.  I have read very persuasive pieces from others.  Yet Murphy/Torrey/Jaffe have a strength that very few of its critics have.

They are for something.  They have a vision, however appalling I find it, of a system they think will work.  They have been able to articulate it in concrete terms and convince large groups of people it is a possible solution to the problems they or their loved ones face.  They have convinced legislators in state after state that something like AOT is needed in their state.  Now they are on the national level and they may win.  It does not matter the law is nonsense.  This is the Congress.  When has that mattered?

People know what we are against.  We are very clear about that.  But destroying the Murphy argument is not the same as presenting our own argument.  We need a vision that can be presented as a more humane, more effective option.  Partly because of our own divisions we lack that.  And because we lack that Murphy moves on.  It is much easier to find a place in a vacuum and he is trying to fill a vacuum.

Quite simply we need to articulate something better and we havent.  Murphy/Torrey/Jaffe are consumate salesman and eventually if we dont show we have something better to sell we will lose again.  We are often not too kind to each other and I sometimes wonder if our greatest obstacle is not Murphy, but each other.

The 108 letter: You need to write a letter

September 12, 2014 by

Old hospitals, New hospitals, AOT….and the Murphy illusion

September 11, 2014 by

Our jails we are told are the new psychiatric hospitals.  They are packed with people they are not equipped to deal with and with whom they don’t do well.  If anything they make things a lot worse and help leave an entire population of people stuck in an ever entrenched pattern of repeat incarceration.  We seem to solve problems by diminishing the people who have them.

If you listen to Murphy it is simple:

1. People are in jail with “mental illness” are there because they have not had effective treatment for their “illness.”

2. Many of them do not even accept that they are “ill.” They refuse to accept the treatment they need.

3. We feed into the problem by allowing people who don’t have the capacity to make informed decisions control over the decisions that affect their lives.

4. The answer is to force them to accept treatment rather they want it or not for the long term good of all of us.

5. This coercive treatment would come in two forms: Assisted outpatient training and psychiatric hospitalization.

There are only about a million problems with this view. Chief among them:

1. The assumption that criminal behavior is the result of a lack of effective treatment is naive to the max. It ignores things like poverty, homelessness, drugs, gang affiliations, racism, unemployment, past history of trauma, poor education and other things. It makes crime a medical issue instead of a human one. It makes it a response to illness instead of a response to life. And it drastically overestimates the effect of treatment far past anything there is proof of. The best way to address the choices of desperate people in the long run is to address the factors that make life desperate.

2. Murphy says that 5% of the population has a serious mental illness and that 50% of them don’t know it. This is a major part of his justification for the need for coercive treatment. If this is not true the case he makes for coercive treatment is suspect on the very grounds he chooses to argue on. These figures are sacred myth supposedly well grounded in scientific truth according to the Treatment Advocacy Center. It literally astonished me the gullibility with which so many people accept them. If you do the math in Tennessee there are 162,399 people with severe mental illness who don’t know they have it, who need treatment because of the negative life impacting symptoms of their illness. They also seem to be invisible since no one seems to know they exist. You would think 162,399 disruptive people would make somewhat of a splash but there seems to be none. There is a pilot AOT program in East Tennessee I guess to find as many of the 162,399 as possible. They served one person last year.

3. People according to Murphy can’t make informed decisions because they don’t know they need help. And again he is not talking about a few people although he sometimes tries to soften criticism by saying he is. 50% of 5% is what he is talking about. A lot of people. If you could find the missing 162,399 people in Tennessee and add them to the mental health system you would increase the people served by 50%. In New York if you do the math 368,000 anosognesiacs are running around missing somewhere. (Many of the numerical claims Murphy makes are just not given close enough scrutiny. He gets a free ride on way too many things.) This is a critical point of argument. If Murphy can’t prove that a large substantial group of people can’t make decisions then his argument for coercion as an integral part of major mental health reform falls according to his own terms.

4. The phrase “accept treatment” implies that there is widespread agreement about what effective treatment is. That is not even close to the truth. The medical model supported by Murphy with a heavy emphasis on the use of psychotropic medication is hotly debated and criticised. Many techniques that are increasingly used and found effective by many providers are regarded by Murphy as being fraudulent. When he uses the term “accept treatment” he means treatment according to his criteria. And if that treatment is still widely debated on the professional level how can there be a law dictating that people must accept a treatment even professionals can’t agree on.

5. Psychotropic medication may help some people and it may help some people a lot but it without question is ineffective for some people, harmful to some people and poses risks to maybe all people. To make it illegal to refuse medication that may cause harm and even life threatening consequences to you seems to me to be a basic violation of human rights. If you start by saying we don’t have the right to question the decisions of our doctors where does it end and who draws the limits. Whatever else doctors are they are not God and to legally have to treat them as they are is an assault on all of us.

6. AOT is portrayed as a basic service for large groups of people. Again remember 50% of 5%. It is already a nationwide program and it’s track record just doesn’t support that. In most state’s it lays unused and irrelevant. Not enough people talk about this. Again Murphy gets a free ride on many numerical claims. In New York were it is supposedly a huge success it serves 1/3 of 1% of the population served by the mental health system (I don’t know what happened to 50% of 5 %). Does the magnitude of the solution match the magnitude of the problem? Not even close.

7. The Murphy Bill in part would have us replace the new hospitals with the old hospitals.  And somehow that would solve the problem.  It is a fraud and a cruel fraud.  Ask a simple question.  Does the magnitude of the problem match the magnitude of the proposed solution?  The figure normally thrown out is about 300,000 people with mental illness in jail.  There are a lot of questions:

A.   How many of these people are supposed to be served in psychiatric hospitals?  50%….25%….maybe just 10%.  Most state hospital beds run about $150,000  a year.  Many run more than that.  At 10% hospitalization you are talking an expense of $4,500,000,000 a year.  Who is paying?

B. The repeal of the IMD exclusion which is floated as one way to pay for all this has its own questions.  Medicaid reimbursement of anything largely never pays the full cost of anything.  Are the state’s to be stuck with the remaining cost?  Even if you make Medicaid funds available it simply means state’s can pay….not that they must.  I find it highly unlikely that in Tennessee for example which is counting every Medicaid penny 4 times before they spend it that they will agree to a huge new expense for something that shows so little evidence that it is effective.  This is particularly true when the Dept of Mental Health and Substance Abuse shows little support for increasing psychiatric hospital beds.

C.   And related again to the IMD exclusion what about the state’s that have not expanded Medicaid. (I find it extraordinary that Rep Murphy would be for increasing the use of Medicaid funds but would vote innumerable times against increasing people’s access to Medicaid).  Does that not mean that for over 20 state’s the entire cost of increased hospitalization for individuals that would be covered in other states be borne by the state’s.  Again where is the money coming from if not from community based programs and if you reduce community programs are you not creating the very problem you claim to be solving?

D.   There is no particular reason that I am aware of to assume that all these people in jail meet the criteria for hospitalization.  That is a huge assumption Murphy makes.  In Tennessee there are no voluntary admissions into state hospitals.  The criteria is danger to self or others and then most people only stay a maximum of 8-10 days.  I don’t see any of this changing.  The ship on psychiatric hospitalization has simply sailed and it isn’t coming back. Murphy, Torrey, and Jaffe just missed the boat. When Tennessee had a psychiatric hospital going full steam in East Tennessee it served about 90-100 people at a time (hardly an answer to jail overcrowding).  When they closed the hospital those funds stayed in the community and served 10 times the amount of people they had before.  When they looked at the “chronically mentally ill” that had been about half the population they found the defining characteristic was not severe mental illness but severe poverty. They had no where to go. They helped find them places to go. In the 2 years since the hospital closed only 2 of the so called “chronic patients” have been rehospitalized.

This is only a very small slice of ways in which the Murphy Bill misses the boat. It probably should be called the Murphy-Torrey-Jaffe- Treatment Advocacy Center Bill since it is just basically a long fax of things the TAC has been saying for years. It is probably, in the end, less about what is done in the mental health system and more about who is in control of what is done. The common thread throughout the Bill is to make anyone who would question TAC influence impotent in opposing It….all the way from dismantling Samsha, disemboweling paimi to changing hippa requirements to institutionalizing coercion as the basic value of the mental health system.

The political skills of TAC are well tooled and effective. They sell and sell well. Considering the suspect quality of what they sell they are master salesmen.

It is a simple 3 step plan:

1. Identify the problem in dramatic, emotional terms and clearly outline the catastrophe the problem is leading to.
2. Offer deliverance. Offer a plan that will take us from the edge of the cliff, that will restore goodness and justice to a situation lacking both.
3. Deliver up a boogeyman. Make sure people understand that the boogeyman has a personal stake in keeping the problem going. Explain that anyone who disagrees with you has fallen under the influence of evil forces and that anything critical they say is proof of the power of the boogeyman. Anything critical is proof of how bad the problem is and the length evil people will go to prevent it from being solved.

A key element is the boogeyman. And the boogeyman for TAC has been the “psychiatric survivor” movement or at least their caricature of it. They actually have tried to sell the Murphy Bill as an effort to rescue the mental health system from the grips of “psychiatric survivors” and to put it back in the hands of professionals. The total stupidity of that claim has never stopped them from making it loudly. It is called megalomania when you have delusions of your grandeur. I dont know what it called when you have delusions of someone elses grandeur.

The Murphy Bill is a bad thing that will do much damage to people already damaged. Their is no difference that people who oppose this Bill should have between themseves that should or would stop them from working together to defeat this Bill. It is that important.

Ordinary heroes: Drains honored for speaking out for health care equality

September 7, 2014 by

Ordinary heroes: Drains honored for speaking out for health care equality – Community – Mobile
【from Next Browser】

A suicide story

September 5, 2014 by

I read today the statistics have changed.  Someone dies every 40 seconds from suicide.

This is a suicide story.

He was 12 or 13 when his mother died.  She had problems for a long time.  She was in and out of psych hospitals all the time.  There was more than one suicidal gesture.  And finally she was successful.  (Doesnt it sound a little bit obscene to describe death as a successful anything??)  For no particular reason, on no particular night she took enough pills to kill 3 people and died.  Strangely enough after she took the pills she was sorry she did.  She wanted to change her mind.  It took 3 days for all her organ systems to completely shut down.  By then she was in a coma.  They pulled the plug and she died.

But he was never released.  He didnt make it through school.  He learned that if he drunk he didnt always feel better but if he drunk enough he didnt feel anything.  Before he  was 21 he had double digits dui’s.  By the time he was 23 he was in prison.  No crime.  Just drinking.   Just drinking.  Every cop in town knew him on  a first name basis.  It was not a good knowing.

By the time he was 30 the drinking was kind of under control.  He lived with his dad.  He would take jobs for short periods of time but they were hard to find and hard to keep.   Mainly he watched TV all night and slept most of the days.

He was a kind person.  He had a niece he adored.  He smiled and joked and he seemed okay.

One night when he was 32 years old he went out one night walking on the railroad tracks one night.  He laid down in front of a train and died.

He was my nephew and honest to God I did not know he was in trouble.  Since then I have found out he walked the tracks a lot at night and I wonder how many times he came close.  I still remember going to football game with him and the incredible kindness he showed to Linda.  I didnt even know.

Dont ever wonder what you could of said or what you should have said.  Suicide is a relentless, sneaky, deceptive liar.  It convinces people that death is the solution to life and too many people have died that didnt need to.

Learn about it and what you can do.  You will never be sorry. 

Every 40 seconds.  Dont let it be the 40 seconds of someone you know or  care about

Be defiantly hopeful

September 3, 2014 by


From the archives. Thanks to Codi for helping me to remember

Originally posted on Hopeworks Community:


Regardless of how weak you are or how much you mess up believe you can get stronger and become more successful.

No matter how many bad choices you make believe you can learn to make better choices.

No matter how many times you misperceive or misunderstand believe you can come to see clearer.

No matter how many times people let you down believe some people wont.

No matter how important the things you cant do seem believe the things you can do are equally important.

No matter how many times you fail believe you can learn from it.

No matter how much you feel like you have let yourself down believe you can make yourself proud.

No matter how messed up you feel believe you are fully human and not damaged goods.

No matter how much others cut you down believe you are more than what they…

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The 100th letter

September 2, 2014 by


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