Contemporary Psychotherapy

I wanted to share some comments from Healing Plots, a book by Amia Lieblich, et al, with which I very much resonate. They write that psychotherapy and counseling are unique and distinctive modern cultural inventions which resonates true to me. These forms could have never existed before in history and may never exist again. At least, I hope/think that we are evolving away from these structures toward a more indigenous healing template. Lieblich, et al write that therapy arose to fill the gaps left behind as traditional forms of problem solving and meaning-making dissolved. "Therapy provided meaning bridges between the compartments of increasingly fragmented modern lives." What John McLeod, in the first chapter in this anthology, writes, that means so much to me, is his description of how the key values of psychotherapy match the key values of rational modernity. Psychotherapy of the 20th century was all about rationality and a detached approach to the world. It was about controlling the expression of feeling. People who feel too much are labeled as are people who feel different from the established norm. These people gain diagnosis and are the subject of a system of "care" which purports to channel their expression of emotion into acceptable forms by any means possible, even electroconvulsive thrapies, or previously, lobotomies. The goal of 20th century psychotherapy was control. It is based upon the idea of continual self-improvement through the progression of science, which, in my estimation, has not apparently been borne out. McLeod writes about the explosion of possibilities of identity construction inherent in a capitalistic system of consumption in which we attempt to construct or purchase an identity of our choice based upon the stories rampant within the culture about what is desirable.

Neurobiology Learning Society of Honolulu: learning, mirror neurons, and dreams.

In April, the Neurobiology Learning Society met in Honolulu at 1601 Kapiolani Ave (Intercultural Communication College offices). Argosy University student Janalle Kaloi-Chen (see http://groups.google.com/group/argosypsychopharmacology) summarized the meeting. I reproduce parts of her summary and add my comments about the meeting, which I attended as well. (The group meets on the first Wednesday of every month at the above location).

The first speaker (Joli Malone) presented on Stress and Learning.  She
spoke about the structures of the limbic system that are involved in
learning including the thalamus, hypothalamus, amygdala, and
hippocampus. The hippocampus helps to encode important information
from short-term memory into long-term memory. The hippocampus is
connected to the amygdale in such a way that hypervigilence leaves little energy or
attention for learning. In keeping with Dan Janik's writing, it appears that the fear-based learning environments that are all too common in North American and Hawai'ian education from grade 1 through graduate school actually interferes with learning. Perception of the learning event affects what gets remembered and
with how much detail. Threat triggers a survival instinct and may
prevent or hinder learning. Joli spoke about the kinds of stress that
a student has including: bullying, negative-evaluations from the
teacher, poor peer interactions, lack of support or nurturing
environment, fear for personal safety, not speaking the dominant
school language, and prejudice or discrimination. She concluded by
going over various ways we can decrease stress of our students
including: providing a safe school environment and providing supports
to children and families.  And finally, having children exercise, play
music, and engage in positive social interactions increase endorphin
levels which tend to off-set the negative effects of cortisol.

The second speaker (Marissa Moon) spoke about how the Mirror Neurons
Systems help us diagnose autism. She explained that it mirror neurons allow us to
directly match actions of others and to generate explanations for their behavior based on what our motivations would be if we were engaging in those same behaviors. They were discovered in the brains of adult
primates.  The quote she used to describe them was, "When the
observation of an action performed by another individual evokes a
neural activity that corresponds to that which, when internally
generated, represents a certain action, the meaning of it should be
recognized, because of the similarity between two representations.
Mirror Neurons (MNS) appear to be important to many areas of human
development such as language acquisition, imitation of actions,
empathy, and theory of mind.  Thus impairments in the MNS may play a
role in psychopathologies, especially those with Autism spectrum
disorders, who appear to lack empathy.

The last speaker, Leslie Kunimura spoke about dreams and
schizophrenia.  The ability to generate rational thoughts is greatly
weakened in dreaming.  She spoke about the similarities between schizophrenia and
normal dreaming since both involve hallucinations, delusions,
cognitive abnormalities, heightened emotionality and a loss of
reality.  Her topic seemed to resound with many of us who have worked
with individuals with schizophrenia.

These were great topics for discussion because they allow us to see how our social relationships, social context, and social environment affect our brains. It gave me pause for thought. I notice that some students at Argosy, where I teach, are more comfortable with the fear-based learning system in which the teacher passes out information, the students learn it, and regurgitate it back on exams for a grade. My wish is for us to be less fear based – for us to, in essence, contract for grades in a system in which the students sees what the work needs to be for obtaining a particular grade and has the opportunity to get the grade he or she desires. Of course, this means that we become less "regurgitating information" based and more "process based" in which we learn how to learn about the particular subject matter and not necessarily learn all the same facts, but do all learn where to find those facts and what the controversies are in the field, and where the cutting edges might lie. I'm going to modify my approach next term, to have more small, frequently rewarded, creative learning tasks instead of asking students to pace themselves to turn in material (since they always turn it in at the end and then can't work together with me to boost their grade to what they want).

Regarding the last discussion, Argosy student Laura Epstein, posted a quote on our class discussion from Oliver Sacks that I want to share. In "The Last Hippie", he described someone who was stuck in the 60's due to a large tumor that had been removed, causing considerable brain. He then wrote,"Dreaming and waking, for us, are usually distinct-dreaming is enclosed in sleep and enjoys a special license because it is cut off from external perception and action; while waking perception is constrained by reality.  But in Greg the boundary between waking and sleep seemed to break down, and what emerged was a sort of waking or public dream, in which dreamlike fancies and associations and symbols would proliferate and weave themselves into the waking perceptions of the mind.  These associations were often startling and sometimes surrealistic in quality.  They showed the power of fancy at play and, specifically, the … characteristic of dreams."

A number of us at the meeting remarked at how our schizophrenic patients seemed to be living within a dream, and I speculated that schizophrenia (or whatever it is) would have to be some exaggeration or inappropriate expression of something we all already do rather than a qualitatively different brain phenomenon. I think living partially or fully within a dream sums up many of our experiences with schizophrenia-like symptoms. Also, it helps us to explain the lack of narrative coherence and ability often found among the schizophrenically diagnosed – they cannot tell stories about their experience because, to tell a story, one has to step out of the experience and reflect upon it and edit it and restructure and shape it. If one is lost in the experience that won't happen.

Lewis

Drug Vs. Social Factors Binary Thinking

An article on drug development for anorexia caught my attention. See it at:

http://www.telegraph.co.uk/health/healthnews/5068308/Anorexia-drugs-o...

Here's the short version:

"Drugs to treat anorexia could be developed following research which
found physical changes to the brain in the womb may be partly
responsible for the condition.

"Researchers found that 70 per cent of anorexic children and young
people they studied showed signs of problems with neurotransmitters,
chemicals which help brain cells communicate.

"Their report, to be unveiled at a conference at the Institute of
Education in London this week, suggests that these developmental
changes meant the patients were particularly vulnerable to eating
disorders, prompting its authors to propose screening children at the
age of eight and experts to claim it could "pave the way for the first
drugs".

"'Arguments that social factors such as girls feeling under pressure to
lose weight in order to look like high-profile women in the media
contain logical flaws because almost everyone is exposed to them, yet
only a small percentage of young people get anorexia.'

"Susan Ringwood, chief executive of Beat, an eating disorder charity,
said the research could 'pave the way for the first drugs to be
developed to treat eating disorders, similar to the way that anti-
depressants help rebalance the brain of people with depression'.

"'Parents always blame themselves,' she said, 'but what we are learning
more and more is that some people are very vulnerable to anorexia and
that is down to genetic factors and brain chemistry and not them
trying to look like celebrity models or suffering a major traumatic
even early in their lives.'

This piece clearly illustrates the social construction of "mental disorders." First, ignore the question as to whether or not eating disorders or depression exist or not. That's the topic of another blog.

Look at this paragraph:

"Parents always blame themselves," she said, "but what we are learning more and more is that some people are very vulnerable to anorexia and that is down to genetic factors and brain chemistry and not them trying to look like celebrity models or suffering a major traumatic even early in their lives."

The implicit message is that "mental disorders" (specifically eating disorders, depression) are caused by "genetic factors and brain chemistry" and that these changes "happen in the womb."

The authors imply, if something is caused by "genetic factors and brain chemistry", then it cannot be caused by social factors or family factors ("not trying to look like celebrity models or suffering a major traumatic event early in their lives." Of course, the other implication is that there is one cause and that the most proximate cause is brain changes that occur during fetal development.

The other implications is that psychological causes are equated to trauma and that parents are responsible for any trauma that children experience and will blame themselves (should, could, would) if suffering is due to trauma experienced.

What an interesting world view -- that we are robots to genetics and brain chemistry and that this is somehow preferable.

Do you see the binary thinking? Also, I wonder why parents would torture themselves about brain changes that happen in the womb.

In my view, of course, social relationships and social constructions (collective representations as well) create brains and modify genetics (epigenetics) and this type of binary thinking is simplistically dangerous in the sense that modifying brain chemistry without modifying social networks and relationships may short-term reduce symptoms but is long-term doomed to failure.

Thoughts?

Lewis

I'm recommending Judith Orloff's new book to my friends and colleagues. It's called Emotional Freedom.

For more information, see Judith's website for the book.

I wish I could do what Judith has done. She has distilled insights from the world's philosophies and psychologies into simple insights and stories that anyone can follow. This is a really valuable self-help book for lots of people in these times of fear and dread, because the techniques, used as she instructs and illustrates, have worked for people for centuries and are so necessary in today's frenetic times.

Way to go, Judith, for writing another really great book.

Lewis

Psychiatry and Aboriginal North America

Native American culture and psychiatry


Native American people are typically diagnosed with higher rates of “mental illness” than white North Americans. Similar findings occur in Australia and New Zealand. Historically Native American people were viewed by psychiatry as primitive, narcissistic, and withdrawn, among a host of pejorative attributes. Early psychoanalytic research leaned heavily on Native Americans to demonstrate primitive defense mechanisms and the inherent deficiencies of being on the margin of civilization. Gustafson (1976), for example, wrote that Lakota people were to primitive to engage in psychoanalysis, being unable to consider that lying on a couch and talking to someone who doesn’t answer might seem ridiculous to members of another culture who had not learned to value this procedure.
Higher rates of depression, anxiety, and other illnesses have been documented among North America’s aboriginal people. However, when Mansur and colleagues (2007), for example, looked at the rates of anxiety and depression on reservations in Montana, they were actually lower than the white communities around the reservation. They explained their findings by the much greater social support and family connectedness existing on reservations than in white communities. Therese O’Nell (2000) went to a Flathead community in Montana, expecting to find high rates of depression. Instead she found a cultural and linguistic mismapping of what Flathead people consider to be a highly desirable state (“to be worthy of pity”) onto what mainstream psychiatry calls “depression.” Flatheads who were worthy of pity did not appear to be depressed in the DSM sense of the word, at least to her.
Native Americans are also accused of having more alcoholism than white Americans, though research shows actual lower levels of alcoholism and higher levels of binge drinking on reserves than their neighboring white communities. Nevertheless, the stereotype of the drunken Indian has become a cultural icon, for both aboriginal and non-aboriginal people. O’Nell describes drinking and being drunk as being a potential source of Indian pride and ethnic identification among Flathead people in Montana. Thacker (2006) describes the historical origins of binge drinking in laws that put an Indian in jail for one day for being drunk and for 90 days for being in possession of alcohol. The law conspired to produce a motto of “when you drink, drink it all”. Dry reserves and still existent laws limit opportunities to learn and practice more responsible, low level consumption of alcohol. Psychiatry has attempted to paint a picture of aboriginal people being genetically susceptible to alcoholism, when poverty actually serves as a sufficient explanation. Social determinants of emotional pain and suffering are readily appreciated on aboriginal reserves (high unemployment, crowded housing, poverty, little social enrichment or recreational opportunities), though psychiatry searches for genetic, deterministic explanations for higher rates of suffering and pain. Given the stewardship of the mental health profession by psychiatrists, resources are directed toward increased access to biomedical care, hospitalizations, 28 day treatment programs, and medications, than to solving the social problems which contribute toward substance abuse on reserves. Certainly, during my four years of working on reserves in rural and remote Saskatchewan, I encountered unlimited funds to send people by themselves to 28 day substance abuse treatment programs and no funds to develop community resources for when they came home. Apparently alcohol policies were managed by competing departments. Health Canada would pay for an unlimited succession of 28 day hospitalizations, but very little in the way of community development and social resources for maintaining a healthy lifestyle.
Historical reports by early explorers and missionaries of North American peoples call forth images of happy, sociable, gregarious people. While we do not want to overly romanticize pre-contact culture, we can say that generosity and hospitality were seen as virtues (see Potlatch cultures). Suicide, except in situations of grave dishonor, was rare. Children were raised in a manner that promoted healthy attachments, as is common in tribal cultures. War, of course, existed, but not on the scale of European battles. Food was relatively plentiful unlike the famines of Europe. Some degree of interpersonal conflict existed, but police are relatively unnecessary in extended kinship systems because relatives keep their relatives in line. Indeed, beliefs about reincarnation and not being able to escape from one’s difficulties through death probably contributed to people working out difficulties in the present, as well as keeping the suicide rate low. Additionally, practices in which the family was responsible for the deeds of its members mitigated against bad deeds lest all in the family suffer. For example, in some communities, if one family member murdered a member of another family, that family had the right to pick a member of the murderer’s family to kill, to maintain balance. In this case, perhaps the threat of retribution was prohibitory. Additionally, the absence of alcoholic beverages over 5 or 6% alcohol probably helped, since current violent deeds are more often than not associated with intoxication. The lack of other substances of abuse and the cultural taboos of using substances outside of ceremony were also contributory to the social fabric remaining intact. The cultural emphasis on healing, balance, and harmony, and the dramatic opportunities for enactment of illness in ceremonies and rituals contributed to keeping the people psychologically healthy. Additionally, the lifestyle of hunter-gathering people was indeed much less stressful than the agricultural lives of peasants in Europe. Some anthropologists have calculated a 16 hour work-week for aboriginal people in North America, with the remainder of their time spent in ceremonial pursuits or social relationships. The social standard of life, including participatory democracy, enlightened childrearing practices, and awareness of the public health importance of hygiene, were much further advanced in the Americas in 1492 than in Europe, with the exception of the empires of Meso-America and South America, in which forced servitude and mass executions on a scale comparable to England of the same time, existed. Life under the Aztec, Incan, or Mayan emperors was not necessarily much better than life in feudal France, England, or Spain. Nevertheless, North Americans enjoyed a reasonably good standard of life, superior in my view to conditions existing in Europe at the same time.
Historical aboriginal views of mind and mental health were quite different from those of contemporary psychiatry (Mehl-Madrona & Pennycook, 2009). These views are being pieced together through interviews with contemporary elders and through written materials collected by ethnologists, physicians (notably Walker and Eastman for the Oglala), missionaries (Father Beuchtel for the Lakota) and explorers. These views as currently reconstructed were more similar to those of the Russian psychologist, Mikhail Bakhtin, and are compatible with much of what is now being called narrative psychology, which, not surprisingly, is the only branch of psychology to have arisen from ethnic and Native studies, women’s studies, and cross-cultural literary disciplines. Aboriginal views held people as fundamentally healthy and whole. Difficulties emerged from learning and living the wrong stories (for the situation at hand). Self was viewed as relational in the sense of multiple selves existing, one for each relationship in which the person found him or herself. No one self was true or primary. Each self had its own voice, which was mingled with the voices of nature, ancestors, spirits, and the like, to produce a veritable symphony of the mind. The community was considered the basic unit of distress when problems emerged and the individuals expressing distress were likened to our now famous metaphor of canaries in the mine. These people were thanked for suffering for the community and bringing into the open the need for the community to heal. Contemporary Dene ceremonies in northern Arizona continue to display this philosophy in which the entire community feels responsible for the sickness of the individual and all contribute to the enactment of a 9 to 14 day ceremony to restore harmony, balance, and health to the individual and simultaneously to the community.
Contemporary North American aboriginal communities retain elements of the above, which is how we are able to piece together their pre-contact views in an archaeology of psychological perception. Nevertheless, the stories of modern culture have infiltrated every aspect of current aboriginal life. Saskatchewan Cree poet Louise Halfe illustrates this in her poetry in which almost every poem has some reference to the dominant white group. Culture has changed. Our working definition of culture consists of all the stories told or having been told in a locale coupled with the results of their performance or enactment. Through contact, colonization, residential schools, education, and commerce, aboriginal people are slowly absorbing the internalizing the stories of the mainstream culture. Pockets of resistance occur as when traditional cultural healers attempt to maintain their practices or scholars piece together a picture of a world view from the past. Nevertheless, contemporary aboriginal culture with regards to mental health is a hodge podge of old views and those of psychiatry (Mehl-Madrona, 2010). When peoples mingle, their stories mingle, thereby co-mingling their cultures, and reducing the possibility of finding a “pure culture” to virtually zero. Waldram (2004) has written about the attempts of psychiatrists and psychiatric anthropologists to fit their definitions of culture onto North American aboriginal people. Mann (2007) tells a sobering story of anthropology defining a South American people as the most primitive on earth, holding the view that they had made no progress from the stone age, when actually these people were contemporary refugees, almost completely eliminated by the Bolivian government and landholders, who were not living their traditional way, but were moving in hiding and in fear of annihilation. Both Mann and Waldram make the point that scholars see what they want to see, that aboriginal people are a means to an end in scholarship, and that people are twisted in every which way to support theories that are probably unsupportable.
Within contemporary North America, indigenous writers are attempting to construct an indigenous theory of mind and mental health (Duran & Duran, 2000; Duran, 2006, Mehl-Madrona, 2003, 2005, 2007; 2008). The effort is to say, if aboriginal people had continued to develop contemporary theories of mind and mental health, what would those be? The challenge to psychiatry is to wonder if some of these theories might be more useful than contemporary psychiatric theory.
Aboriginal theories predictably focus on relationship and community over individuals and pathology. DSM is foreign to aboriginal thought which looks at every individual as unique, being the result of a unique combination of stories, location, family, relationships, and community. The homogeneity which DSM seeks and purports to have found is rejected. Treatment lies along the lines of restoring harmony and balance to relationships and communities and to providing people with better (more practical, functional, appropriate for the situation) stories to live and to be allowed to live through them. Therapies are spirit guided and relationships with non-physical beings are cultivated to aid in the healing process. This acceptance of magic and supernatural beings in healing is viewed as primitive and primary process thinking by mainstream psychiatry, rejected outright. Nevertheless, aboriginal thought has parallels in the social psychiatry of R.D. Laing, Loren Mosher, John Weir Perry, and others, who described superior results for the treatment of schizophrenia and psychosis using social environments instead of psychopharmacology. Additionally, the importance of community has been highlighted by the World Health Organization’s 20 year schizophrenia study, which found better outcomes in third world countries than developed countries, and mostly in relationship to the intact communities and social support found in India, Nigeria, and Colombia. The hearing voices movement is normalizing voices and voice management techniques over diagnosis of psychosis and psychopharmacology, mostly in the U.K., but to a more limited extent in North America. The positive benefits of elders for mental health problems are being described (Mehl-Madrona, bipolar, 2008), though funding is difficult to obtain for studies, since elders are not capable of being standardized or controlled (Mehl-Madrona, 2010) in the manner demanded for interventions in randomized, controlled trials. Indeed, the politics of evidence production works against elders, since valid evidence is obtained from studies in which all parameters are held constant (so the researchers believe) except for one. Obviously this methodology is best suited to study drugs. Consequently drugs have the most evidence to support them, even if the effect sizes are small.
The future of aboriginal world views in psychiatry is uncertain. Psychiatry has largely directed itself to biology as a means of explanation and treatment. Aboriginal world views explain human biology as a result of the enactment of story and the living of social relationships. Psychiatric epigenetics support these views but have not yet caught hold. Psychiatry attempts to explain unusual behavior as the primary result of damaged or disordered brains, while aboriginal thought seeks to explain brains as being formed by social environments and relationships, leading the primary cause of a disordered brain to be relational and social. Psychiatry has a huge pharmaceutical lobby behind it. In support of aboriginal world views is their sustainability. Drugs are far more expensive in developing countries than are human relationships. Certainly this is true on North American reserves and First Nations communities. Perhaps it is also true for mainstream North America – that the billions of dollars being spent on psychotropic medications would be better spent on jobs – for people to have therapeutic social relationships with those who suffer and are in pain, instead of physicians or physician extenders quickly prescribing very expensive medications of questionable value (see University of Ottawa meta-analysis of antidepressants and CATIE studies).
Certainly the mainstream dialogue of the Obama administration (or the Harper government) has focused upon providing services driven by existing philosophies to everyone (access to care) versus questioning the utility of currently offered services. Especially for aboriginal people, relationship based services may be more beneficial and cost-effective than disease-based services. I suspect this is also true for people of all ethnicities. I suspect that the current health care system is unsustainable in the sense that the headlong rush to develop newer, better, and different drugs is enormously costly, not to mention the manufacturing and marketing of these drugs. I suspect that a relationship model for mental health is far more sustainable and affordable in the long run (though not perhaps in the first three months for psychotic and mood disorders). What if the elders are correct, and that giving people intensive attention and care when they are in crisis is more effective than drugging them and seeing them monthly. What if intensive healing experiences (the enactment and psychodrama of ceremony) is more effective than the professionalism of white-coated doctors and nurses? What if keeping people at home in their communities is more effective (cost and benefit) than hospitalizing people and putting them in mental health care homes, away from family and those who know them. What if those who know us are far more beneficial without any training than those who don’t know us regardless of the depth of training? These are questions that contemporary aboriginal elders pose, which psychiatry ignores (the American Psychiatric Association rejected this year proposed symposia on indigenous models of mind and mental health and on psychiatrists working with traditional aboriginal cultural healers). The power balance currently allows such dismissal. Will this always be the case? I suspect that the health care crisis will have to get much worse for government to begin to question the value of the care we deliver instead of asking the question of how to improve access to the care we give. It will require a late-to-develop understanding that the care as we now deliver it, is unaffordable. It cannot be provided for everyone in either Canada or the United States. Currently Canada solves the problem with high taxes, long waits for elective or semi-urgent procedures, and long waits for specialist care. The U.S. solves the problem by denying care to the uninsured and the under-insured. However, the cost of providing care to everyone will be insurmountable. Here is where aboriginal models of mind and mental health might benefit contemporary society – in providing workable means of providing care than are sustainable and cost-effective, even more beneficial to reducing pain and suffering than the models that are currently dominant.

Love 2009

My son is struggling with love. He's 15 years old and suffering deeply. I tried to get him to write poetry, but he wouldn't, so I wrote three poems about his situation. I'd love some feedback. I sort of like them. They seem to fit my son's suffering.

Lewis

Autumn Rain Storm

Outside, the rain tumbles down. The leaves
Wash away in its tribulations.
On the far side of the creek, woodchucks shiver
In dream dens – afraid of their homes being flooded
By the deep rain.
On the news, three houses float away on the river,
Disappearing in its raging, but,
Sitting beside my fireplace,
The falling, churning water seems so cozy.

The water tumbles -- submerging, rolling liquid. The rain’s
Great crushing noise is fearsome and powerful.
On the near side of the creek,
Rain is the wrinkled and dissonant tears of the aged,
The sky crying for the newly born,
The sadness of birth and death, the drum beat of the
Songs of death and terror – but in the end
It is just Rain.


Love is a Storm

I have been waiting for the calm in the storm, of
The hush in the pain and loneliness, when you sleep your
Wild dreams, one day closer to the cold graveyard of winter
While snow flakes drift down, circling the trees, in full view of indifferent
Ravens, preening their feathers, basking in the reds and oranges that
Hug the horizon. The sun has retired to its house in the West, the clouds
Appear to be burning; the vanishing tongues of flame, misty fog layers,
shredded pink
Clouds above the heavy glowing sky;
That peculiar smell of
Soon to be falling snow, the air pregnant with the potential of storm. Love
Is a storm waiting to be unleashed and a relentless quest for hate;
The clumsy and slow movements of the prey running out of options.


Ideas of Love

Our ideas of love
Slay us
In the blackness of night,
Like a procession of candles
In a moonless night
Or a single fire
On a moonless beach
Pretends to show us the Way

Instead we plunge into a dark void,
One candle in the darkness,
Perilous descent, along
A long sloping stone wall,
Searching for a name
For this place
That we called love

At the end is a massive silence,
A profound emptiness,
A circular darkness,
A cold and icy void
From which we must ascend
From which we must rescue ourselves
From which we must transform.

Creativity and Madness 2008

I'm here at the Hilton Waikaloa on the Big Island of Hawai'i for the Creativity and Madness conference. I gave two talks about narrative concepts, one about the relation of narrative philosophy to Native North American philosophy, and the other about Narrative Neuropsychology -- how the brain comprehends, processes, stores, recalls, and tells stories. It turns out that stories activate virtually the entire brain. Stories can concatenate in the anterior temporal poles and therefore become smaller units of information for processing in the dorso-lateral preftontal cortex.

Anyway, let's stay in touch on these narrative ideas. They'll eventually reach the west cost of north america where they may chance the worldl