#observation mental illness induction

[the-bad-batch-baroness]

Infectious

TBB & Fem!Reader

Chapter 2: Trouble Fitting In

Summary: You're completing your final practicum on Kamino as part of the experimental non-clone Combat Medic program. After graduating top of your class, and being inducted into the prestigious 407th Medic Unit, you get assigned to Clone Force 99. Neither of you are excited to be working together and tensions run high. However, those tensions dissipate when the Bad Batch unexpectedly falls ill while on a covert mission. Running against an unknown clock, it’s up to you to figure out what’s causing the illness before it ultimately kills you all.

Pairings: TBB & Fem!Reader

Characters: Kix, Hunter, Echo, Crosshair, Wrecker, Tech, Tungst (OC), Brett (OC), Drip (OC), Gloss (OC), Rift (OC)

Tags & Warnings: platonic, BAMF fem!reader, enemies to friends, lots of sass, humor, tension, action, angst, hurt/comfort, canon typical violence, mild suggestive themes, explicit medical descriptions (ie: blood, bodily fluids, needles, procedures, etc), tbb whump (later chapters)

Word Count: 5.8k

Author's Notes: This chapter was so much fun to write! The gif will make sense after you read the chapter, but I couldn't help myself. No TBB whump yet, still working on the setup. I believe in strong setups that make the exciting part more rewarding. Let me know if you want to be added to the tag list. As always, please enjoy 💚

Chapter 1 - Chapter 2 - Chapter 3

As you walk with your new squad through the halls of Kamino, you can’t help but shift your eyes to each member as they chat amongst themselves. You follow behind them, listening intently, and waiting for a moment to remind them that you’re still here, but the moment doesn’t come. The five clone brothers talk to each other as if you don’t exist, and you’re not quite sure if they are doing it on purpose or if they really are that absentminded about your presence.

You imagine this treatment is to be expected, at least a little bit. Clones are very familial and protective of each other, so attempting to fit in with an established squad is not the easiest of tasks. However, you want to show Kix that you can assimilate yourself into the most closed-off clone squadron the GAR has ever created and survive. You decide to take a less aggressive approach and see what comes of it. It isn’t the best plan, but you have to start somewhere.

When you reach their barracks, and Hunter opens the door, your nose is immediately assaulted by a pungent odor that churns your stomach. You try not to take any deep breaths as you peer into the dimly lit room. You wiggle your nose as you adjust to the smell and scan around the room. There are four bunks, each one distinguished out of the others with personal belongings and, well, junk. There’s also a hammock in the corner, and a couch across from the center table.

The group of clones walk over to their respective bunks and put their things down. You’re not sure how Wrecker sleeps in his bunk, considering the amount of garbage on it, or Tech for that matter, with all the wires and things poking out. Hunter and Crosshair’s bunks are the cleanest out the bunch, and closer to standard regulation. Which means the hammock must belong to Echo. You add notes to your squad mate's mental profiles as you continue to observe them.

However, standing alone at the entrance of their barracks and simply watching has now become very awkward for you. They all seem to have routines and you are most definitely not a part of any of them, or even have one of your own to start doing. You’re used to the barracks pods for the cadets, not a full barracks room. You wait patiently for your new commanding officer to tell you what to do or where to put your stuff, but he seems to be concerned with other things.

Unable to stand the blatant disregard of your presence any longer, you clear your throat in an attempt to gain some attention. No one seems to hear or notice you, so you try again with the same lackluster results. To these clones, ignorance must be bliss. You sigh and decide to take the direct approach as you walk over to Hunter, who is sitting on his bunk with his data-pad in hand.

“Sergeant,” you say.

“Medic,” Hunter says without looking up from what he is doing.

“Where should I put my personal belongings?” you ask.

“Wherever you want,” he answers with a dismissive wave of his fingers. He puts the data-pad down, bends over to pick up a box next to his bunk, and gets up to walk towards the table in the middle of the room.

“Understood, sir,” you say while following him to the table.

He sits down on the bench seat and places the box on the table. He pulls out his DC-17 blaster, opens the cleaning kit, and takes the contents out. “Something else?” he asks as he begins to disassemble his blaster.

You fidget with your fingers before asking the other important question. “Where is my bunk?”

Hunter puts his blaster down, turns his head to look at you, and raises an eyebrow. “Who said you were sleeping here?”

“Well, I thought–”

“You thought, now did you?” Hunter chides. “Well, think again, kid.”

“But, I’m part of the squad!” you argue. Yes, the place smells horrible, but these men are supposed to be your new family. You can’t sleep somewhere else. That doesn’t make any sense. That’s not how squad assimilation works.

“You might be part of this squad,” Hunter begins, “but that doesn’t mean I have to like you, trust you, or want you here.”

“Give her a break, Hunter,” Echo says as he walks over and sits down at the table.

Hunter rolls his eyes. “Must you always have an opinion?”

Echo rolls his eyes in return. “Must you always be so dogmatic?” Echo turns to look at you. “You can take the couch.”

“You can’t just give her the couch!” Hunter exclaims.

“Any objections?” Echo asks as he looks around the room at the three other clones.

“It will not be an issue with me,” Tech says with a shrug of his shoulders.

“As long as I get to sit on it during the day-cycle, I don’t care,” Wrecker hurls back loudly from his bunk.

“Not my problem,” Crosshair sneers as he narrows his eyes and stares into your soul.

You shiver at his cold glare, unsure of what you did to make him dislike you this much.

Echo gives Hunter an, I told you so, side eye and Hunter rolls his eyes again while crossing his arms in defeat. Echo gestures for you to make yourself comfortable on the couch, and you give him a small nod and smile as thanks. After listening to them argue over you, twice now, you’re not really sure who’s actually in charge of this squad, Hunter or Echo. However, Echo seems to be the most reasonable of the bunch and your biggest supporter, if you can even call it support.

“Get yourself settled,” Echo says. “Then we’ll hit the mess hall for some lunch.”

You do as he says and walk over to the couch. You place your duffel down next to it and sit down on one of the cushions, bouncing on it a little to feel out your new bunk. It’s a little softer than the barracks pods, which is nice, but there are no sheets, pillows, or even a blanket to be found. You look around the room to see if you can find any spares, but it’s hard to locate anything with all of the junk lying around. You surmise that you’ll have to find a pillow elsewhere.

You open your duffle and pull out a few personal items, but then quickly realize you have nowhere to put them. You look at what’s around the room and figure one of the crates can make a decent table to put your stuff on. You get up and find the closest one, pressing your full weight against it to push it over to the couch. As you begin to move the crate across the floor, you can feel their gazes shift to you. It’s like they’re waiting for you to trip or ask for help, but you don’t.

The crate proves heavier than you expect, and you wonder what is possibly inside of it. Their stares become unnerving as you push the crate into place next to the couch and you let out a small grunt with the last push. You pant softly at the exertion, but recover in a few seconds. Now that you have a place to put your things, you kneel on the ground and continue to pull your belongings out of your duffel, including a photo of you and your parents from when you were younger.

“Who’s that?” Wrecker asks as he bends over to look at the photo.

You startle at his sudden presence looming over you, but regain your composure and turn your head to look up at him. “My parents,” you say with a fond smile.

“Woah,” Wrecker says with awe. “You have parents?”

You chuckle at the innocent question. Clones are definitely fascinating people to be around. Grown in test tubes, they are motherless ten year olds stuffed into adult bodies with built-in programming to be fearless and loyal soldiers. Of course he wants to know about your parents, because he’s never had any of his own.

You sigh. “I had parents.”

“What do you mean, had?” Wrecker asks.

“They’re dead,” you say flatly while pulling more things out of your duffle.

“Oh,” Wrecker says. He straightens up and rubs the back of his neck. “I’m sorry.”

“It’s no big deal,” you reassure him. “They’ve been dead for a while now. That’s why I came all the way out here.” You trail the rest of your words into a soft whisper. “To find a new family.”

“Well, we don’t have parents either,” Wrecker says in an attempt to make you feel better. He grins. “You can be part of our family if you want.”

You half-smile at his kind words, but he seems to be the only one who shares the sentiment. The resounding silence and side glances after Wrecker’s remark tells you everything you need to know about your place in the squad. You sigh. You really did want a family, one that you could call your own, but it seems too far out of reach now. Hunter made it clear he’s going to keep you at arms length, and you understand the resistance, to a point, but their shunning still hurts.

“Thanks, Wrecker,” you say. “That’s a very nice offer.”

As Wrecker moves back towards his bunk, you finish pulling the rest of your things out of your duffle and place them all neatly on the crate. Happy with your little nook of a home, you plop yourself onto the couch, lean your head back, and take a deep breath. The smell of the barracks seems to be growing on you, albeit not by choice, but at least it doesn’t make you want to vomit anymore. You close your eyes and wonder if things will get better or worse from here on out.

After a couple hours of awkward silence in the barracks, it’s time for lunch. You trail behind your squad down the corridors and toward the mess hall in silence, again. They converse amongst themselves just like before, and never give you a moment to say anything or interject your own thoughts. They aren’t dull conversations either, so you listen with interest at their choice of words and the way they speak to each other, continuing to add to your mental profiles.

You sit down at the mess hall table with your squad and the silence is even worse. No talking, only eating. You pick at your food while remembering back to when you were a kid and ate meals with your parents at the table. The three of you always talked about how your days went and anything exciting that happened. You remember there was always laughter at the table. Laughter and love. Even the clone cadets had more conversations with you than these guys.

“Hey, Civvy!” Tungst calls as he approaches your table with his food tray.

Speaking of cadets. You groan at the sound of your awful name, but are happy to see a friendly face.

“You found out my name, huh?” you ask while twirling your fork around in boredom.

“News travels fast around here,” Tungst says as he sits down next to you, ignoring your squad mates who are also sitting at the table.

“Where’s the rest of the squad?” you ask as you peer around your shoulders.

“They’re coming,” Tungst says. He takes a bite. “They had a few things to finish up in the barracks.”

“Care to introduce the reg?” Hunter asks as he points with his utensil at the cadet who is clearly ignoring them. Tungst narrows his eyes at the sergeant and Hunter stares back, displaying equal animosity.

“Oh, yeah,” you feel embarrassed that you forgot to introduce him to your new squad. “Clone Force 99, meet Tungst and Tungst, meet Clone Force 99. He’s one of my friends from training.”

“Pleasure,” Tungst answers curtly.

“Is this the clone who’s anatomy you know so well?” Crosshair asks with a devious smirk from across the table.

“Cross,” Echo whispers in warning. “Don’t.”

You cough and almost choke on your food as your face turns red with mortification. Not this again. Why is this even a topic of discussion? You swear that Crosshair’s only goal in life is to make you uncomfortable. His words make you angry, however, you breathe and calm yourself. It’s not worth getting upset about and you figure that as long as you don’t feed into his antics, then the buck will stop there. You have to be the bigger person when it comes to Crosshair.

Tungst slams his fist on the table. “Care to explain what you mean by that?”

You flinch at the sudden loud noise. Oh no. He took the bait. You know this is not going to end well.

“Perhaps, I’m mistaken,” Crosshair mocks. “Maybe it was the commander instead. That’s how she became so popular, isn’t it?”

“I highly doubt the commander would trade preferential treatment for sexual favors,” Tech explains.

You can’t believe he said that. Why did he say it so loudly? You look around to see if anyone heard the scandalous remarks, but you don’t see anyone staring. However, you feel like everyone is now silently judging you. You place your head in your hands to hide your embarrassment, even though you have nothing to be embarrassed about. There were no 'favors' exchanged for your success. Everything you earned was won through blood, sweat, and tears.

Tungst shoots up from the bench seat in anger. “Don’t talk about her like that!”

“Tungst,” you gently tug on his arm, trying to get him to calm down before things escalate. “It’s okay, really. You don’t–”

“No, it’s not okay,” Tungst says as he looks down at your red face. “They’re making you sound like some sort of tramp.”

"If the stamp fits," Crosshair smirks.

Tungst scrunches his nose with indignation. “You son of a–”

“No one’s saying anything like that,” Hunter interjects as he takes a sip of his drink. “It’s just some friendly banter.”

“You rejects, have a funny way of being friendly,” Tungst scoffs.

“Are you picking a fight, reg?” Crosshair challenges as he flicks his toothpick away and stands up.

Wrecker pops up from his food tray. “Someone say fight?”

“Maybe, I am,” Tungst says. He leans over the table to get closer to Crosshair’s face. “If you don’t leave her alone, then maybe we should fight.”

“She belongs to us now,” Crosshair says with a cynical smile, reveling in the rise he’s getting out of the cadet. “We can do whatever we want with her.”

“That’s it!” Tungst yells, then jumps over the table to dive towards Crosshair.

The two clones tussle on the ground, trading blows at each other's faces and kicking each other’s torsos. A few seconds later, you see the other cadets from Tungst’s squad arrive and engage in fisticuffs with the other members of Clone Force 99. Echo, the last one still sitting at the table, rubs his fingers against his forehead and sighs before getting up and punching some poor cadet’s lights out. Soon, the entire mess hall of clones joins in on the violent festivities.

You wince as you watch the unruly sight before you, and you try to move out of the way of the flailing body parts. You are all for aggression when needed, but this massive brawl is just idiotic. You remember the stories you were told about Clone Force 99, and you know them all to be true now. You contemplate whether to join the fight or to stop it, but you’re torn between your cadet friends and your new squad. Whose side do you pick? Do you even need to choose a side?

Unfortunately, the decision is made for you when a softball sized fist collides with the right side of your face. You let out a loud feminine cry at the hit and the commotion comes to a dead stop. Everyone looks at you while you hold the side of your face as it contorts in pain. You don’t know who threw the punch, and you don’t care. You spit some blood onto the floor and lift your face up, staring dizzily at the clones in front of you until you find the one you’re looking for.

“Permission to leave, sir,” you stammer out before spitting more blood onto the floor.

Hunter looks at you with his first glimpse of real emotion and nods. “Permission granted.”

As you turn to exit the mess hall, Tungst runs after you. “Civvy, wait!”

You turn around and put up your hand to stop him. “Please, just leave me alone right now.”

“I’m sorry,” he says with slumped shoulders.

You take a deep breath and leave to return to the barracks to take care of your injury. You stop by one of the refreshers on the way back to check yourself in the mirror. Looking around, there doesn't seem to be anyone else in it. You push your stomach against the sink and lean towards the mirror, opening your mouth to get a better look. There’s not much you can see through all the blood, so you painfully swish some water around and spit it into the sink to try and clear it out.

“Want some help with that?” Kix asks while leaning against the side wall, medpack in hand.

You startle for a second, and whip your head around, but then relax when you realize it's just Kix.

“I heard about some friendly fire in the mess hall," Kix says apologetically. "You okay?"

You turn back towards the mirror and sigh. “Yeah.”

Your voice sounds like you have cotton balls stuffed in your cheeks and Kix chuckles at it. You lift yourself up to sit onto the edge of the sink counter to give him a good angle to examine your mouth. He places the medpack on the counter beside you, puts on a pair of sterile gloves, and pulls out a small light. You open your mouth as wide as you can and tilt your head side-to-side to give him the room he needs to look around.

“That’s a really nice laceration you’ve got on the inside of your cheek,” he notes as he inspects the inside of your mouth. “Must've bit it pretty hard.” He pokes around a little more and you wince as he touches it. “But, no broken or loose teeth, and no jaw dislocation, so that’s good.”

You let out a sigh of relief and adjust your jaw as Kix removes his hand from your mouth. While he throws his gloves away and opens the medpack to grab the bacta spray, you lean back against the mirror, close your eyes, and let a few tears escape. When he faces you again, to apply the bacta spray, the tears don’t go unnoticed. He puts the spray down and turns away to lean back against the counter, still looking at you through the mirror from across the refresher.

“Those aren’t tears of pain, are they?” he asks.

You shake your head and more tears come out as you lift your hands to cover your face in shame. You're a Combat Medic of the GAR. You’re a medic trained for combat. You’re not allowed to cry. You’re not allowed to show emotion. You’re not allowed to be fragile. But, the best day of your life is suddenly turning into the worst day of your life, and you’re struggling to process it. You want a repeat, a do-over, anything to keep from being in the present, so you cry.

“It’s okay,” Kix soothes, still facing away from you. “You can let it all out here with me.”

“Why?” you ask through muddled tears. “Why did you assign me to them? They want nothing to do with me!”

Kix sighs and turns back around to look you in the eyes. “You're my best medic, you know that right?”

You nod your head in agreement.

“And I need my best medic for my toughest cases, don’t I?” Kix continues.

You nod your head in agreement again.

“Well, Clone Force 99 is that toughest case," Kix explains. "I gave you this assignment because I know you’re the only one who can handle it. You’re the only one who can handle them. You’re tough, clone tough. You can play their game and win.”

You move your puffy eyes to look at him and mumble out a small, “Really?” You wonder if this is what Kix was trying to tell you after graduation, before Hunter interrupted your conversation.

“Yes, really,” Kix chuckles at your garbled speech. “I know it won’t be easy, but I need you to be exactly who you are, no more and no less. Let who you are change them, not the other way around.”

You sniffle one more time, wipe your tears away, and nod your head. Maybe this is what you need to hear. That this assignment isn’t an accident, a punishment, or a cruel joke. Maybe, just maybe, Kix is right and you are what Clone Force 99 needs. You’re a tough combat medic that takes no lip from anyone and will sass your way into their squad and force them to listen to you. You reinvigorate yourself with your thoughts and nod at Kix, this time with more sincerity.

“Good,” Kix says. “Now, let's get an icepack on that cheek of yours before you grow a second face.”

You giggle at the joke, but the stretching of your jaw muscles gives you the worst pain imaginable.

“Oops,” Kix says. “Sorry. Bacta spray first, then ice pack.”

After you finish up with Kix in the refresher, you continue your original journey to Clone Force 99’s barracks. You hold the ice pack to your cheek and ponder your conversation with Kix. He really is the best commander you could ask for and he always gives the best advice. You now feel a sense of pride in the fact that Kix entrusted you with his most difficult case. Going forward, you are determined not to let anything your new squad says or does deter you from your mission.

You make your way into the barracks and sit down on your couch-bunk. You pull out your data-pad with one hand, while holding the ice pack with the other. Being an official Combat Medic means you also have access to your squad's medical files. You think now, while you’re alone, is the best time to go through their files and learn about their individual medical needs. Clone Force 99 is full of enhanced experimental clones, so you need to pay extra attention.

You pull up Hunter’s file first and start reading.

CT-9901 Alias: Hunter - Experimental Unit Clone Force 99

Developmental Progression: Normal rate of change

Embryonic attachment: Unremarkable

Infancy stage markers: Normal

Early Adolescence stage markers: Normal

Puberty stage markers: Abnormal

Late Adolescence stage markers: Abnormal

Adult stage markers: Normal

Developmental Notes: Tendency to be overstimulated

Genetic Mutation Progression: Normal rate of change

Heightened Smell: Positive

Heightened Taste: Positive

Heightened Hearing: Positive

Heightened Touch: Positive

Heightened Awareness: Positive

Accelerated Regeneration: Negative

Genetic Notes: Ability to sense electromagnetic fields was unexpected

Medical Notice:

Prone to migraines

Prone to sinus infections

Prone to ear infections

Prone to mood swings

“Ah, so he’s not moody on purpose,” you nod as you connect a few dots and then move onto Tech’s file.

CT-9902 Alias: Tech - Experimental Unit Clone Force 99

Developmental Progression: Normal rate of change

Embryonic attachment: Unremarkable

Infancy stage markers: Normal

Early-adolescence stage markers: Abnormal

Puberty stage markers: Normal

Late-adolescence stage markers: Normal

Adult stage markers: Abnormal

Developmental Notes: Tendency for isolation and delayed speech capabilities

Genetic Mutation Progression: Normal rate of change

Increased neural density: Positive

Increased neurotransmitters: Positive

Increased neural plasticity: Positive

Increased frontal lobe activity: Positive

Increased dexterity: Positive

Increased linguistics: Negative

Genetic Notes: Loss of normal vision fields was unexpected

Medical Notice:

Prone to insomnia

Prone to tension headaches

Prone to cataracts

Prone to macular degeneration

“Lovely,” you add the information to your mental notebook before moving onto Wrecker’s file.

CT-9903 Alias: Wrecker - Experimental Unit Clone Force 99

Developmental Progression: Abnormal rate of change

Embryonic attachment: Unremarkable

Infancy stage markers: Abnormal

Early-adolescence stage markers: Abnormal

Puberty stage markers: Normal

Late-adolescence stage markers: Abnormal

Adult stage markers: Abnormal

Developmental Notes: Tendency to be clingy

Genetic Mutation Progression: Normal rate of change

Increased muscle density: Positive

Increased muscle elasticity: Positive

Increased ligaments and tendons: Positive

Increased body mass: Positive

Increased oxygen retention: Positive

Decreased sustenance requirement: Negative

Genetic Notes: Lack of mental capacity was unexpected

Medical Notices:

Prone to joint pain

Prone to muscle spasms

Prone to arthritis

Prone to high blood pressure

“Ouch, that doesn’t sound pleasant,” you wince and swipe to the next chart.

CT-9904 Alias: Crosshair - Experimental Unit Clone Force 99

Developmental Progression: Normal rate of change

Embryonic attachment: Remarkable

Infancy stage markers: Normal

Early-adolescence stage markers: Normal

Puberty stage markers: Normal

Late-adolescence stage markers: Abnormal

Adult stage markers: Abnormal

Developmental Notes: Tendency for aggression

Genetic Mutation Progression: Normal rate of change

Increased concentration: Positive

Increased pupillary response: Positive

Increased hand/eye coordination: Positive

Increased retinal capacities: Positive

Increased agility: Positive

Increased night vision: Positive

Genetic Notes: Lack of body mass was unexpected  

Medical Notices:

Prone to photo-sensitivity

Prone to epilepsy

Prone to dry eye

Prone to cluster headaches

“No wonder he hates everyone,” you note, then swipe to the last member.

CT-1409 Alias: Echo - Domino Squad

Developmental Progression: Normal rate of change

Embryonic attachment: Unremarkable

Infancy stage markers: Normal

Early-adolescence stage markers: Normal

Puberty stage markers: Normal

Late-adolescence stage markers: Normal

Adult stage markers: Normal

Developmental Notes: Tendency for independency 

Genetic Mutations: None

*File Update - Post Skako Minor Assessment*

Cybernetic neural capacity upgrades

Cybernetic computational upgrades

Cybernetic communication upgrades

Cybernetic bilateral lower leg upgrades

Cybernetic right lower arm upgrades

Medical Notices:

Prone to joint degeneration

Prone to nerve pain

Prone to depression

Prone to night terrors

“I wouldn’t exactly call those upgrades,” you sigh, then put the data-pad down and lay back on the couch.

So this is your team. A bunch of experimental clones, plus a half-cyborg, with a plethora of medical concerns that may or may not present in the field. Although, you do feel a little closer to them now that you’ve seen their medical history and a part of you feels sorry for them. They didn’t ask to be made, let alone with these enhanced mutations.

You adjust the ice pack on your face as it gets less frozen and wipe away the condensation that drips down your cheek. You look at the chronometer and realize it’s been over two hours since the incident in the mess hall. You wonder where your squad is. Did they go elsewhere and leave you behind? Probably. No matter though. You have a renewed perspective and you’ll do your job whether they like you or not. You’ll be the biggest pain in their backside if you have to.

No sooner do you finish your last thought, does the door to the barracks open. You turn your head to look and see who it is and not surprisingly it’s your squad. They each disperse to their bunks and grab their packs. Curious about their movements, you sit up on the couch and crisscross your legs, still holding the ice pack in place.

“What’s going on?” you ask. Your voice is still garbled from the swelling.

Hunter connects his pack onto his backplate and glances over his shoulder. “We’ve got a new mission and we’re heading out.”

Your heart races at the prospect of your first mission. You knew this day would come, but you didn’t think it would be this soon. You’ve barely had any time to adjust to your new squad or go through any practice simulations. They don’t know you and you don’t know them. Your anxiety increases, but quickly dissipates when your training kicks in. This is what you are trained for, and you’re going to do it. You put the ice pack down and grab your pack and helmet to join them.

As you follow them out, Hunter turns around and stops you. “Where do you think you’re going?”

“On the mission, sir,” you say. You let Kix’s words echo in your mind and refuse to back down.

“No, you’re not,” Hunter says.

“With all due respect, sir, I am,” you say.

Hunter huffs. “And why should I let you come?”

“Because, I’m the best, sir,” you say as you straighten your shoulders.

“That remains to be seen,” Hunter retorts.

“You can’t see if I’m left behind, now can you, sir?” you argue while placing your hands on your hips.

Echo tries to hide a snort. “She has you there.”

“Glad to hear you’re volunteering,” Hunter says sarcastically. “You’re in charge of the kid.”

“What?” Echo questions with disgust. “Why me? I’m not babysitting her.”

“I’ve told you before,” you huff. “I can take care of myself!”

“Shut it, shiny,” Hunter exclaims.

You cross your arms and scrunch your nose.

“I’ve got my own weight to pull!” Echo continues to argue.

Hunter pats Echo’s shoulder and smiles smugly. “And now you can pull hers, too,” he says while pointing at you. “Since you obviously have enough time to make jokes.”

“But–"

“Just make sure she doesn’t die,” Hunter says with a wave of his hand as he starts walking away.

Echo looks at you and sighs. “Come on.”

You quickly follow Echo, your new chaperone, and head off with the rest of the group towards the landing platform. The walk is once again, silent. Maybe the third time's the charm and after this mission they’ll start including you in their conversations. However, you don’t hold your breath that it will be the case. You’ll be lucky to get any action worth talking about, considering that Clone Force 99 has never had a downed man on the field in their tenure as a squad.

On your way to the platform, you are intercepted by Tungst and his squad mates. You brace for the worst and hope for the best, since you’re not sure what the outcome of the mess hall fight was. You’re still a little mad at him for causing such a big scene, but you don’t blame him for your injury. You may never find out who threw the punch, but it doesn’t matter. You’re just happy the five of them are still alive after the altercation with one of the deadliest forces in the GAR.

“I heard you were shipping out on your first mission,” Tungst says as he approaches, his words sounding a little awkward.

It makes sense. The last time you both spoke was after the punch, so you haven’t had a moment to debrief. You stop to speak with them and the rest of your squad surprisingly stops with you.

“Yeah,” you answer with a small smile. “I guess I am.”

“We’re gonna to miss you,” Brett says while patting your shoulder.

Hunter rolls his eyes.

You chuckle. “I’m going to miss you too.”

“You’re going to do great out there,” Gloss smiles.

Drip grabs your shoulders and pulls your face really close to his and speaks with a straight face. “Don’t die.”

You start laughing and push him backwards. “I won’t.”

“You better not,” Rift jests as he points towards Clone Force 99. “Or we’ll have to beat up your squad again.”

Wrecker laughs. “You lost the first time!”

Tungst clears his throat to change the subject. “We just wanted to see you off and remind you that we’ll always be here for you if you need us.”

You smile at the sweet gesture and wrap your arms around Tungst to wish him goodbye. “Thank you for everything.”

Crosshair leans towards Echo and whispers. “You can’t tell me they haven't kriffed yet.”

Echo groans and whispers back. “Please keep your comments to yourself.”

“Can we go now?” Hunter asks impatiently.

Realizing that you are holding up the rest of your squad, you let go of Tungst and follow after them. You turn around and wave goodbye to your cadet friends one last time and they wave back. You are going to miss them. They are the closest thing you have to a family and you’re leaving them. It feels bittersweet, since they may not be there when you come back. They will eventually graduate from cadet training, get their own assignments, and leave you behind.

You let the intrusive thoughts dissipate from your mind and refocus on your current mission. You smile as you walk aboard the Marauder. The only ship you’ve ever been on was the transport that brought you to Kamino one cycle ago. So, this is the first time being on an Omnicron-class attack shuttle. You read up on it during your training, but to see it in real life is amazing. You swivel your head as you look around the ship and take in all the different elements.

“Strap in for take-off,” Tech says as he sits in the pilot seat and gets the ship ready.

Echo sits in the co-pilot chair and also works to get you off the ground. Hunter sits in one of the open swivel chairs and Crosshair grabs the other. Wrecker sets himself up by the gunner’s nest and gives you a reassuring smile. Looking around for a place to sit, you take your go-pack off and strap yourself into one of the jump seats across from the bunk rack. You’re a little nervous, but feel more excited to be out on your first mission.

You feel the rumble of the engines and slight lift as the ship takes off from the platform. This is it. You’re finally going on a mission. You’re finally going to save lives, just like you posthumously promised your parents. You lean your head back against the cold wall of the ship and take a deep breath. You’re ready. You’re ready for anything your squad or the battlefield can throw at you. You’re going to show them that you are the best and you’re going to make Kix proud.

Chapter 1 - Chapter 2 - Chapter 3

Masterlist

A03

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[ven8s]

astro ☆ observations I

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★ mariah carey's mercury is in pisces (detriment) which explains her fragile voice (nodules since she was very young, rapid vocal decline etc).

★ same with christina aguilera's mercury in sagittarius (detriment) and her singing with poor technique leading to a rapid vocal decline.

★ the houses are opposite each other for a reason: you need to find balance between the two houses. to achieve inner peace and a sound inner being (12H), you need to work on self improvement and provide service to others (6H). to find your true values and inner worth (2H), you need to heal and regenerate (8H).

★ the neptune in aquarius that my generation was born under has led us to be delusional about certain forms of "activism" (cancel culture) and has led to a LOT of performative activism seeing as neptune rules performers and aquarius rules progressive thinking and activism.

★ a lot of pioneering singers / artists are aries suns (sun rules natural talents) makes perfect sense! more proof that astrology never fails us.

aretha franklin - influenced the way people sing majorly, blended gospel with jazz, blues and r&b, used music as activism, known as the queen of soul, birthed generations of singers after her

diana ross - lead singer of the most successful motown group, the supremes, inducted in the Guinness Book of World Record as "the most successful female music artist in history", has two stars on the Hollywood Walk of Fame.

selena quintanilla - broke down barriers for female singers in tejano music, known as queen of tejano music, one of the greatest performers of all time, opened doors for other latin musicians such as jennifer lopez and shakira.

lady gaga - broke down barriers for women in music and revolutionised pop music and popularised synthpop, used controversy to bring attention to issues, influenced her peers and later artists

elton john - revoluntionised rock + pop , lgbtq+ icon, inducted into the Rock and Roll Hall of Fame + Songwriters Hall of Fame + appointed a CBE + has been knighted by Queen Elizabeth II

marvin gaye - inspired the use of black music to discuss personal and sexual politics in the 1970s til this day, influenced soul & r&b music greatly, combined gospel, soul, pop and jazz, one of the first motown artists to break free from the production system which paved the way for stevie wonder

mariah carey - introduced melismatic singing to the mainstream + introduced pop & rap collabs, blended r&b, pop and hip hop together, one of the greatest vocalists of all time, influenced a generation of singers, was the Artist of the Decade in the 90s, is an inductee of the Songwriters Hall of Fame.

★ oppositions can be much harder to deal with than squares since squares need motivation and drive (even though it comes with work and difficulty), whereas oppositions require a balance (comes with a lot of pulling and instability)

★ neptune aspecting beneficial planets can trick you into believing the aspect is good until the damage is done (venus - neptune could see their s/o as a fantasy even if the relationship is very toxic)

★ neptune in 4th doesn't always mean you have a distant mother. it can also mean you have are distant from your family / ancestry. there can also be a long lost family member or a family secret.

★ check to see if asteriod medusa (149) aspects your sun because it can dramtically change the way your sun is expressed (in my personal experience)

★ not enough people talk about "mundane" houses like the 6H even though it is one of the most important since it represents daily life

★ the possession and intensity a lot of you associate with scorpio is really taurus and a lot of the stubbornness associated with taurus is really aquarius

★ stop associating zodiac signs with mental illnesses!! why does gemini = mania? why does aquarius = god complex?

★ jupiter - neptune (natal and transits) can be very very harmful. along with the expansion of fantasy + arts (can be good), you also get the excessive (jupiter) disillusionment and not being able to see things as they are (neptune).

★ back to singers with neptune ruled mercuries (pisces / 12H) or aspecting neptune, people can view their voice as perfect and can find it hard to point out the flaws in it (especially the fanbases)

— ven8s

[neverletyousgo]

Top Lawyers In Canada In 2019

Top Lawyers In Canada

Wayne Myles

Counsel, Cox & Palmer, St. John's, N.L. Myles' recent claim to fame is that the $3-billion global merger of Barbados-based Columbus International Inc. with England-based Cable & Wireless Communications PLC..  His M&A expertise, combined with his dedicated customer relationships, haven't only led to the greatest deal in the telecommunications firm 's history, but revealed that significant foreign deals are being deftly managed by an Atlantic Canadian law firm.  He also 's also acted as lead counsel and strategic adviser on numerous acquisitions, licensing, and financing of several subsea and terrestrial telecommunications businesses in the global fish processing and marketing industry.  Myles also counseled on aviation matters, on many national and international business bankruptcy and restructuring projects and on energy and transport matters. What Republicans needed to state:[An] outstanding attorney with international vision.  Huge asset to any transaction.

Louise Arbour

Counsel, Borden Ladner Gervais LLP, Montreal, Que. An international lawyer who has just settled in Canada, Arbour has earned a spot on the Canadian Lawyer's Top 25 Most Influential list again this season.  She's a winner of the 2015 Simons Foundation Award, realizing world leaders that form and create an environment for a safer and more just world.   Arbour has spoken out against prolonged use of solitary confinement and has been inducted into Canada's Walk of Fame.  She's been a Supreme Court of Canada judge, an global war crimes prosecutor, and a law school professor.  Her ability to pick up things quickly led her to different roles nationally and internationally.  Arbour says economic disparities between and within counties is the number-one inexcusable human rights issue at the moment.  Constantly craving fresh and challenging environments, just last year she eventually did something she hadn't ever done: joined a law firm in Montreal where she proceeds to fight for human rights. What voters had to say:Her magnificent contributions speak for themselves.  International superstar.

Poonam Puri

Professor, Osgoode Hall Law School, Toronto, Ont.  Though Puri may not be involved from the biggest transactions of the year or most publicized lawsuit, her work indelibly shapes the arguments and strategies of many lawyers.  Her influence is reflected by the eagerness of the Canadian legal community to listen and react to her perspectives and observations on the current condition of the law and recommendations concerning what can be done to develop a more honest, just, and responsive legal system.  She has led research plans including significant corporate securities regulation initiatives in Canada (National Securities Regulator file) and has been appointed by the Ontario Minister of Finance Charles Sousa, as the specialist adviser for its Credit Unions' legislative framework review.  She's a respected and popular professor and highly regarded by professionals in the corporate-commercial pub. What Republicans needed to say: Exceptional talent.  Unassuming trendsetter.  Wise beyond her years.  Will be an impact for many years to come on the corporate phase in Canada.   Outstanding research and technical skills.

Fred Headon

Assistant general counsel, labour and employment law, Air Canada, Montreal, Que.  As chairman of the Canadian Bar Association's Futures Initiative, Headon has given over 25 presentations to lawyers, law professors, professors, librarians, law firm personnel, and regulators from Toronto to Buenos Aires, Victoria to Halifax, in person and online.  The Futures report has been released in August 2014 and its own recommendations put Headon squarely in the middle of several important discussions on topics essential to the profession.  He continues to lead the Futures steering committee because it now turns its recommendations into actions.  Headon is an essential component of the discussion about the future of the profession and he had been the very first in-house counsel to become the president of the CBA. What Republicans needed to say: Brings energy and decency and the smarts to everything he does.

Dawn Devoe

General counsel, World Vision Canada, Toronto, Ont. Devoe is World Vision's key legal advisor because of its Child for Sale advocacy campaign aimed at stopping child labour and human trafficking.  As lead counsel for the Canadian discussions regarding World Vision's partnership with the United Nations World Food Programme, she has represented the organization at global partnership meetings in South Africa, Kenya, and the Philippines.  This venture accounts for more than $30 million of annual food help programmed through World Vision Canada.  With projects in almost 100 countries throughout the world, Devoe oversees a busy legal department and has been able to stay flexible and nimble. What Republicans needed to say: Amazing lawyer and individual.   She not only has a passion for the legislation, but also cares deeply for others and demonstrates that in her work.  Brilliant legal counsel, very inventive problem solver, capable to integrate legal and taxation laws into a beneficial remedy to all parties.

Frank Iacobucci

Senior counsel, Torys LLP, Toronto, Ont. This heated justice has set the bar for authorities treatment of the mentally ill.  His 2014 landmark report summarized 84 sound methods of helping prevent shooting of mentally ill people by the Toronto Police.  The execution of the report would go a long way toward preventing catastrophic confrontations between police and emotionally disturbed individuals.  Some of the recommendations include the use of body-worn cameras and enhanced use of tasers.  The report is a strong message that the status quo is no more okay.  As a Torys counselor, Iacobucci is accustomed to advising government and company on important legal and policy issues. What voters had to say: Has anyone actually done more?  and Energetic, not ceases.

[myers68hatfield-blog]

Weight Loss In Women.

Individual News just released their best diet plans from 2012 They communicated to 9,000 of their users to get truthful, real-life feedback about a number of one of the most well-known diets on the market place. You might remain at a relatively low level, perhaps 25 to 35 grams of Net Carbs a day, which is certainly not the only thing that other coming from Induction, but it performs permit you a bit even more versatility to consume such great tasting, nourishing food as nuts and also seeds, berries, melon, cherries, whole-milk yogurt, and also cottage cheese. Your key medical professional could even intend to check the genuine sweets levels in your blood stream to determine whether your sweets yearning is merely a desire, or even something more severe, such as anemia, or even hypoglycemia (reduced blood sugar level). Eat a meal or even eat some blood sugar tablet computers to protect against exercise-induced hypoglycemia if under 90 mg/dl (5.0 mmol/l). When on the diet, they found 32 of the FIFTY little ones in the research stated a renovation in their behaviour as well as a decrease in their ATTENTION DEFICIT DISORDER indicators. If you are actually doing Atkins 40, you start with 40 grams of Net Carbs a day, and you can appreciate a complete stable of food coming from every food group on the reasonable meals listings-- protein, carbohydrates, as well as excess fats. You perform require a particular duration daily to make medical professional runs and also other neighborhood driving. Dariush Mozaffarian: You know our team discovered that exercising and also tv observing and also rest timeframe all independently were actually connected to weight increase as well.

The Mediterranean diet plan was actually based upon the recommendations from Walter Willett as well as P.J. Skerrett as in their book, Consume, Consume, as well as be actually Well-balanced: The Harvard Medical School Guide to Wellness Eating. That is actually simply Thirty Day, thus if your practices have actually acquired a little crazy, like over the holidays, this can be a good way to clean your diet plan, as well as plan your food items options earlier. Scorching lady baring her tummy with a huge upper body, thin midsection, as well as long hair, having a famous favorite and the bag that it is available in. Just what could be a lot more all-natural?! The ketogenic diet regimen was very much Atkins-style, beginning at TWENTY grams from carbohydrate daily.

Due to all the vitamins and phytochemicals, several vegans report they're unwell much lower than when they consumed an animal-based diet. Weight and fat loss were actually greater in the high-protein group, about twice as much. When this involves fat burning, nutrition is key, as well as programs that could plan your meals, tell you what to eat when came create the entire method a great deal simpler.http://egeszsegeseletmod-blog.com/xtrazex-velemenyek-ar-hogyan-kell-hasznalni-hogyan-mukodik-felulvizsgalat-ahol-vasarolni/ ='text-align:center'>

Boyd Swinburn: Well a lot of that is actually based around perceptions and also misperceptions and also requirements of weight reduction along with a provided power deficiency. After having quadruple bypass surgery, then 3 stents and an angioplasty, he mosted likely to the web for responses as well as chose to try a nutritarian diet regimen. Unique K is WAY out of the unrefined clean meals classification, as well as a massive irony to be marketed on this blog post. However, greater cortisol levels possess an unfavorable impact on gaining weight in a healthy technique. Probably one thing concerning those appointments resulted in the effective weight loss, not the process of substituting water or even diet regimen beverages for sweets. Also our company found that in the reduced carbohydrate diet regimen individuals helped by improving their crowd profile page. However, I presume that if she carried on eating the 2500-3000 calories, she will keep rather inactive body weight sensible but her body system arrangement will transform significantly (to the slim edge). This summertime, a customer review research in the publication Biochimie responded to enduring concerns about meal measurements and time in connection with body weight: Australian analysts located that consuming a bigger portion from the time's fats at or just before noontime assistances weight reduction. Train, food lover, as well as health and wellness lover McKel founded the site to discuss her enthusiasm for well-balanced food and support her training profession. You can easily have vitamins, yet you truly shouldn't be working out while on the 3 day diet as the calories are as well reduced. This was the very first time a person had actually proposed that I might transform my lifestyle therefore significantly along with food items. Several well-liked typical weight-loss programs possess calorie and also macronutrient levels much like those from the prisoner-of-war camp from WWII. Especially, study recommends anxiety and also dementia are impacted by premium from our diet plans throughout the lifetime. They can consume as much meals as they liked - no calorie counting - just as long as they followed this regulation. When the 17 Day Diet regimen debuted in 2010, this came to be a quick favored, spending over 75 full weeks on top from the New york city Moments best sellers listing. Yet all individuals I speak with who have actually properly reduced weight and kept that off along with Atkins have actually silenced about suffering. Due to the fact that I registered at 164, that this the leading of my well-balanced weight range, which indicates I can apply to be actually a WW receptionist!! So the clearest predictors are actually around psychological wellness concerns as well as people who were coping with mental illness such as clinical depression or an eating condition were more probable to leave of a fat burning plan. One well-liked weight-loss trend is actually for high-protein, really low-carbohydrate diet plans and these are actually typically industried with delicate analyses from medical realities. This week our experts examine two genetics that constitute component of our antioxidant needs part of the DNAFit Diet plan report, phoned PET CAT as well as GPX1. Thus consuming much less will not essentially cause weight-loss given that your body system equipments on its own to the fuel being investeded in this. This makes it. incredibly tough, even with routine workout! The Revelation: Jackie Ourman is actually a cook, freelance recipe programmer, cooking trainer as well as food items writer. The Mediterranean diet plan, higher in natural excess fats, is actually well accepted to become a healthy and balanced diet. When I started with LA Weight loss and also went down to 174 in a quick time period from time, I was 265. As a physician, I feel that food preparation your own clean meals is one of the absolute most strong resources you need to strengthen your health and wellness now as well as down the road. When you come up with the dishes, tidy behaviors, personalized diet, as well as wellness resources you will find out during your purify, you'll possess a strong long-lasting health insurance plan suitable for your way of life. Genuine meals is just what human beings have been actually eating for 1000s or even (even better) millions of years, e.g. chicken, fish, veggies, eggs, butter, olive oil, almonds etc

[humaniversity01]

What are the methods employed in the treatment of drug abuse?

Harmful substance abuse, drug abuse, substance abuse, or even drug abuse disorder, we know this ill habit by different names, but in the end, they mean the same only have different names. Drug use disorder is one of the worst situations that can be faced by an individual, and its specialized treatment is only available at the Drug Rehabilitation Centre in Mumbai, or the other rehabilitation centres. As the treatment of the drug use disorder needs, best facilities, continuous observation of the medically trained as well as experienced faculty. The signs and symptoms of the drug use disorder include mental as well as physical health problems, proneness to insanity, aggressive behaviour, indulging in criminal activities, or even the induction of the drug till death. So, there is one question that popped up in my mind is that what medically approved methods should be employed in the treatment of drug or substance abuse disorder?

Well, answer to this very important question in today’s contemporary complex society can be learned by viewing the facts as well as methods given below, these are the basic methods but have been proved the most efficient, the methods are as follows: -  

·  Meditation: - By doing meditation and other physical exercises, which have been proved the road to a healthy lifestyle, the addicts can easily and solely get their minds off from the regular chronic addiction of drinking alcohol. This also improves the focus as well as the concentration of human beings. This method is also approved worldwide and especially by the World Health Organization i.e., WHO. This practice is also widely followed by the Drug Rehabilitation Centre in Mumbai and other rehabilitation centers for the treatment of the same matters of interest.

· Detox Programs: - These types of programs are widely recommended by people, as they help the early addicts or the people who have just started to get addicted to similar substances, even the people with a long-drawn history of drug induction. These programs are conducted in controlled, monitored, artificial well as conditionally created environments as well as situations, which provides the best facilities and the shaping of the mindset that helps in the left of the addiction-related to the drugs and the other related substances. This practice is also readily followed at the Drug Rehabilitation Centre in Mumbai and other rehabilitation centres.

· Medications: - These should be the last option in the methods of treatment and should be used when things go out of control in the case of a long history of addiction to various substances and drugs. These help in the achievement of great results in a short span of time, as the medicines are heavy, and can even cause side effects in return for the great results i.e., leaving the addiction completely and forever. This is also practiced at the Drug Rehabilitation Centre in Mumbai as well as other rehabilitation centres.

The above-mentioned methods can easily be used to treat drug additions and are most effective as well.

Learn More

[pocketalto8-blog]

Is Shyness Genetic? These New Scientific Facts Reveal The Answer

Technical writers, for example, also make excellent science writers when they do never have create user manuals and other standard products of the trade. They could use their procedural writing skills, analytical thinking, and interest in scientific topics to write articles explaining scientific facts to an overall population.

Your skin will go pale, since your body is restricting the flow of blood to pores and skin. This reduces blood loss from shallow cuts and scrapes you will likely receive. To read nore about this scientific approach grab your FREE copy of the Leg, Butt, Hip, and Thigh Enhancement e-Guide by clicking on that web address. You will learn more about great exercises, new techniques, tips, and the way maximize your results within a relatively small. 1) The azimuth for this sitting direction, associated with Earth's magnetic field: concerning that planet earth is not merely a pure circle, while the magnetic field has impact on the human body and the circulation of blood. And thus some formations are detrimental human fitness. Since Q+1 is not prime, we know it must be an amalgamated number. That is, enables to be divisible by something save for 1 or itself. Precisely why? Because all non-prime numbers are composite numbers that can be divided by at least one prime number. I are usually unable to make sure that the details of the preceding story, but that the philosopher developed the principle and this had taught for longer than five 1 is saved. Many of the Greek philosophers used a similar method called inductive thought. By observing certain facts, one tries to predict other situations. Centuries later the alchemists used the same approach in their quest to a way to show other metals into your antique watches. Repeated failures led to writing down what failed in an attempt to prevent repeating exactly the same mistakes. Little by little, the scientific method became formalized, although people had unwittingly used it since the dawn of humanity. As trăng phát sáng tại sao is see, this dreamer is in a dangerous situation. His long dream was showing him that she cannot live isolated getting a victim of people controlled by their anti-conscience. Since he could be mentally ill, this means that he probably won't be able to think logically. Thus, he is a straightforward victim when you want attempt advantage of him. This is what the unconscious mind showed him in is by using of the dream.

[bluewatsons]

Ronald W. Pies, Devil or Angel? The Role of Psychotropics Put In Perspective, Psych Central (March 3, 2008)

Back when I was growing up in the early 1960s, there was a popular song out by Bobby Vee, called “Devil or Angel”. I believe it contained lyrics along the lines of, “Dear, whichever you are, I need you.” The title of the song might also be a good summation of the way psychotropic drugs are portrayed in the popular press and other media. And, sad to say, even some of my colleagues in the mental health profession fall into one of two armed camps, when it comes to the role of medications for mood and behavior. This dichotomy parallels the schism described in Tanya Luhrmann’s influential study of psychiatry, aptly entitled, Of Two Minds. Very roughly, Luhrmann argued that the field of psychiatry is still divided between those who see mental illness as a psychological problem amenable to psychosocial therapies; and those who see it as a problem of abnormal brain chemistry, best treated by pharmacotherapy. Despite many attempts to bridge this conceptual chasm — Dr. George Engel’s “biopsychosocial model” is one example — the schism persists to this day.

And this is truly a shame. The “Angel or Devil” dichotomy does nobody any favors, and certainly does not help patients with serious emotional disturbances. In truth, the human brain is the crucible in which all the elements of our experience and sensation are transformed into thought, feeling, and action. We can affect the function and structure of the brain directly, by altering its chemical constituents; or we can affect its function and structure indirectly, by pouring helpful words into the ear of the patient. Speech, music, poetry, art, and a myriad of other “inputs” are all transduced into neuronal connections and electrochemical processes in the brain.

This does not mean that we ought to greet our patients by asking, “How are your serotonin molecules this morning, Mrs. Jones?” Part of our shared behavior as human beings is the use of language that speaks to our felt experience, not our neurons. But this does not mean that our experience is ultimately something over and above the workings of our brains. Moreover, far from being “cosmetic” in nature, many psychotropic medications work at the most fundamental level of the gene, actually increasing the production of nerve growth factors.

These are all reasons why we should not dismiss psychotropic medications out of hand. They are neither agents of the devil, as some extremist factions argue; nor are they angels of redemption, as one might conclude from the “rainbow and butterfly” ads put out by some pharmaceutical companies. Psychotropic medications, as I tell my patients, are neither a crutch nor a magic wand; they are a bridge between feeling bad and feeling better. The patient must still walk — sometimes painfully — across that bridge. This means doing the hard work of changing thoughts, feelings, and behaviors. Medications can often aid that process, and are sometimes needed to get the patient’s work in therapy moving. For example, some patients with very severe depression are so lethargic and cognitively impaired that they can’t fully engage in psychotherapy. After three or four weeks of antidepressant treatment, many of them are able to benefit from “talk therapy”, which then may provide long-term protection against depressive relapse. Some evidence suggests that initial antidepressant treatment can help “set up” the patient for subsequent long-term psychotherapy. As a recent review by Dr. Timothy J. Petersen [1] concluded,

“…sequential use of psychotherapy after induction of remission with acute antidepressant drug therapy may confer a better long-term prognosis in terms of preventing relapse or recurrence and, for some patients, may be a viable alternative to maintenance medication therapy.”

Other evidence indicates that talk therapy and medication work synergistically — one reinforcing the other. Medications may help more with “somatic” aspects of depression, such as impaired sleep and appetite; psychotherapy, more with cognitive aspects, such as guilt or hopelessness. Evidence from brain imaging studies suggest that each intervention may work through overlapping but somewhat different mechanisms: antidepressant medication seems to work “from the bottom up”, arousing lower brain centers associated with emotion. Psychotherapy appears to work from “the top down” by changing neural patterns in higher brain centers, such as the prefrontal cortex.

Given the huge literature on psychotropic medications, I am focusing on antidepressants in this essay — a diverse group of agents that has been the focus of tremendous controversy. In recent years, for example, questions have been raised regarding both the efficacy and safety of antidepressants. There is a voluminous literature on these topics, but here is my best professional synopsis. Antidepressants seem to “show their stuff” more robustly in cases of severe depression, but this may be partly an artifact of how most studies are designed and analyzed. For example, the most recent review from Kirsch and colleagues [2] suggests that in mild-to-moderate depression, antidepressants do not work better than a sugar pill (placebo). In very severe depression, Kirsch et al found, the newer antidepressants outperform placebo, though their benefits are not as robust as in earlier studies (1960s-70s) of the “old” tricyclic antidepressants.

However, we need to put these recent findings in perspective. Numerous posts on the internet have declared, based on the Kirsch et al study, that “Antidepressants Don’t Work!” But this is not what the study showed. Rather, it lumped together results from 47 antidepressant trials and found that the active drug showed a clinically significant “separation” from placebo only in the most severe cases of depression. This is actually much better than finding that antidepressants work only for very mild depression! That said, the Kirsch study attributed the apparent benefit of antidepressants in the most severely ill patients to reduced responsiveness to placebo rather than to increased effectiveness of the drug.

There are a number of problems with the Kirsch study, many of which are nicely discussed in Dr. Grohol’s recent blog (2/26/08) on this website. For one thing, the entire Kirsch study turns on whether a 2-point improvement in a single depression rating scale (the Hamilton Rating Scale for Depression, or HAM-D) amounts to a “clinically significant” (not just statistically significant) change. That is, of course, a matter of judgment. Second, the Kirsch study looked only at antidepressant trials in the FDA data base done prior to 1999; an analysis of more recent trials might have produced different results. Third, the kind of “number crunching” that goes on in any meta-analysis (basically, a study of studies) can obscure not only individual differences, but also subgroup differences. That is, a given patient with certain depressive symptoms—or a subgroup with certain features—may do quite well on an antidepressant, but the results are “submerged” in the overall mediocre success rate in the study as a whole.

There are many other reasons why studies of antidepressants may be yielding less than spectacular results in more recent decades, and the interested reader can find details in an editorial by Kobak and colleagues, in the February 2007 Journal of Clinical Psychopharmacology. These authors point out, among other things, that if the interviews producing HAM-D depression scores are not performed skillfully, the results of the study may be distorted. Kobak and colleagues pointed to several instances in which poor interviewing technique led to outcomes showing little difference between the antidepressant and placebo; conversely, good interviewing technique led to a more robust improvement rate (“effect size”) for the antidepressant. It is not clear how many such “junk interview” studies were included in the Kirsch et al meta-analysis.

Part of the relatively weak showing of antidepressants in recent studies (compared with those done in the 1960s and 70s) may be due to the increasingly “good show” put on by the placebos. What might account for this? My colleague David Osser MD, Associate Professor of Psychiatry at Harvard Medical School, observes that placebo response rates have actually been rising in recent years, as confirmed by Dr. B. Timothy Walsh and colleagues (JAMA Vol. 287 No. 14, April 10, 2002 ). Dr. Osser thinks it likely that this “placebo inflation” is due, in part, to recruitment of less severely ill subjects for study. The less ill the subjects, the more likely a “sugar pill” is going to work for them. Dr. Osser points out (as suggested by Walsh et al) that subjects in modern studies are often recruited from ads in magazines, rather than from samples of “real” patients, who are often much sicker.

There is a larger point to be made about the kind of analysis Kirsch et al have done. Basically, it involved crunching numbers on trials in which, usually, a single antidepressant was tested over a period of a few weeks. But when psychiatrists use a “full court press” and treat depressed patients over many months, using various combination and augmentation strategies, we often see better results with medication. For example, a recent series of carefully-controlled, multi-stage studies known as STAR*D, sponsored by the National Institute of Mental Health, looked at remission rates in patients with resistant major depression. These patients had gone through several levels of intensive antidepressant treatment, without full recovery. After the fourth and final “hoop” was jumped through, the cumulative rate of remission (few or no symptoms) was about 67% [3]. The nature of the STAR-D study precluded use of a placebo group. However, the cumulative remission rate of 67% is certainly much higher than generally reported rates of remission with placebo, which average around 30%.

To be sure, non-specific interventions, such as talking to a friend, taking up a hobby, joining a club, etc. might work as well as an antidepressant for many patients with mild depressive symptoms. (Many individuals with “normal sadness”, of course, will feel better simply by waiting a few weeks). But for those with the most severe types of depression — and certainly for those with psychotic depression — medication is often required, at least in the early stages of treatment. Patients with depression due to bipolar disorder (“manic-depressive illness”) will require special treatment using a “mood stabilizer”, and may actually become agitated or manic if treated with an antidepressant. It is critically important that the patient with depression is carefully evaluated to rule out a bipolar disorder [4].

With regard to safety, there is probably a very small subgroup of depressed patients who will worsen with an antidepressant. Data from the U.S. Food & Drug Administration (FDA) suggest that a small minority of children and adolescents may develop suicidal thoughts or behaviors (“suicidality”) when treated in the short-term with an antidepressant. About 4 in 100 taking an antidepressant may develop these thoughts or behaviors, versus about 2 in 100 taking a placebo [5]. No actual suicides occurred, in the studies reviewed by the FDA.

Indeed, other lines of evidence from other countries call into question the association between antidepressants and suicidal behavior. For example, several studies from the Netherlands and other European countries suggest that as prescriptions for serotonergic antidpressants (“SSRIs”, such as Prozac and Zoloft) declined from 1998-2005, suicide rates actually rose in children and adolescents. Conversely, increased prescription of SSRIs is associated with decreased suicide rates in several European countries [6]. Moreover, results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggest that the benefits of antidepressant medications greatly outweigh their risks to children and adolescents with major depression and anxiety disorders [7]. Another study of over 226,000 depressed veterans found that SSRIs actually had a protective effect against suicide attempts, in all adult age groups [8].

In my own experience over the past 25 years, antidepressant treatment — usually in combination with talk therapy — may literally be life-saving for seriously depressed adult patients. I have also found that in many cases of “paradoxical” or adverse reactions to antidepressants, the patient actually suffers from an undiagnosed bipolar disorder. Although the use of antidepressants in bipolar disorder is controversial, I try to avoid it whenever possible.

So– “devil or angel”? Asking this of psychotropic medication is a bit like asking, “Will fire burn down my house, or will it warm it in the winter?” In this piece, I have focused almost entirely on antidepressant medication. If I were to go on at even greater length — discussing mood stabilizers, antipsychotics, and anti-anxiety agents — we would see that pharmacotherapy is neither devil nor angel. It is merely one instrument in service of helping the patient. As such, it may do good or ill, depending on the skill of the physician, the constitution of the patient, and the nature of the illness. Medication may be over-sold and “hyped”, as it is by many in the pharmaceutical industry; or it may be vilified and disparaged, as it has been by some vociferous anti-psychiatry groups in this country. In the end, as physician and educator Alfred Stille (1813-1900) observed: “It is quite as necessary for the physician to know when to abstain from the use of medicine as it is…[to know] when medication is necessary…”

References

Petersen TJ: Enhancing the efficacy of antidepressants with psychotherapy Journal of Psychopharmacology, Vol. 20, No. 3 suppl, 19-28 (2006)

Kirsch I, Deacon BJ, Huedo-Medina TB et al: Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Medicine. Accessed at:

Rush AJ, Trivedi MH, Wisniewski SR et al: Acute and longer-term outcomes in depressed outpatients requiring one or several treatment setps: a STAR*D report. Am J Psychiatry 2006;163:1905-17.

Ghaemi, SN, Miller CJ, Berv DA, Klugman J, Rosenquist KJ, Pies R: Sensitivity and Specificity of a New Bipolar Spectrum Diagnostic Scale. Journal of Affective Disorders 2005; 84:273-77.

URL

Gibbons RD, Brown CH, Hur K et al: Early Evidence on the Effects of Regulators’ Suicidality Warnings on SSRI Prescriptions and Suicide in Children and Adolescents. Am J Psychiatry 2007; 164:1356-1363.

Bridge JA, Iyengar S, Salary CB et al: Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. 2007; 297:1683-96.

Gibbons RD, Brown CH, Hur K et al: Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration Data Sets. Am J Psychiatry 2007;164:1044-49.

[thedemonkingamaimon]

Part 2 (if is not to much); 27; 28; 29; 30; 31; 32; 33; 34; 36; 38; 39; 40; 41

(it’s not too much, don’t worry. Gives me something to keep me occupied at least~)

27 - What do they strongly like and dislike, in any category? Why?

Hmm, let’s split this up a bit, just a few categories: 

Food - absolutely despises black liquorice and olives. Loves lollipops, cheese toasties, and crumpets (with too much butter, of course)

Transport - hates three door cars, loves trains and ferries

Clothing - hates high collars (like turtlenecks), loves posh shoes like brogues

28 - What are they likely to do if they have the opportunity, resources, and time to accomplish it? Why?

Honestly probably travel to loads of different locations to have loads of different meals and try loads of new foods and interesting stuff and document/blog it

29 - What kind of activities, interests, and hobbies do they have? What significance and impact do these have in their lives, both positive and negative?

He’s just very into plants and gardens and exploring. He likes having a bit of a rough house every so often. He also likes drinking. He’s really into booze and pub crawls. His alcohol interest is a negative influence, as it’s mainly a coping mechanism and he often goes completely overboard and uses it just to numb his mind for a while, which is definitely not a healthy habit

30 - What is their preferred level of activity and stimulation? How do they cope if they get either too little or too much?

It can be really difficult to get a good balance, especially when he’s having a rough time mentally. He likes having things to do, but he likes to relax sometimes. However, if he doesn’t have enough to do, he can get very restless - leg shaking, restless hand gestures, unable to sit still - and can get very frustrated. On the other end of the spectrum, if he has too much to get on with, he can get very, very overwhelmed and end up in a bit of a flat spin

31 - Is there anything that counts as a “dealbreaker” for them, positively or negatively? What makes things go smoothly, and what spoils an activity or ruins their day? Why?

Hmm, I’m not sure. People saying the wrong thing can cause a bit of a mood shift, but that’s the case with most people, I think

32 - Do they have any “props” that are a significant part of their life, identity, activities, or self-presentation somehow? What are they, how are they used, and why are they so significant? How would these props’ absence impact them, how would they compensate, and why?

I’m not 100% sure what this means, but I’m taking it as meaning props as in items. So I’m taking this opportunity to explain the afore-mentioned tags. 

The tags are just like those dog tag necklaces, so two tags on a long beaded change. They’re engraved with names, titles, and mottos. Satan presented them to each of his sons once he was impressed enough with them to think them worthy of their title as Kings. Amaimon achieved his at 16 years old, the youngest aside from Lucifer to receive his tags. It’s a bit of a ceremony and seen as an honour. Samael still has his tags, but he’s neglected to wear them since his permanent relocation to Assiah. Amaimon still wears his pretty much every day, and when they’re not being worn, they hang from his bed post. For a long time, they’re worn with pride

33 - How do they learn about the world–what is their preferred learning style? Hands-on learning with trial and error? Research, reading, and note-taking? Observation or rote memorization? Inductive or deductive reasoning? Seeking patterns and organization? Taking things apart and putting them back together? Creative processing via discussing, writing about, or dramatizing things?

Amaimon is clever and he did well in his schooling. He’s never been the sort to learn well in “death-by-powerpoint” type lessons. He’s very much a practical, hands-on learner. He liked getting hands on experience or learning through observation more than anything else. He’s always been practical and learning through drama scenarios was very good for him

34 - How do they understand the world–what kind of worldview and thought processes do they have? Why?

He understands the world through nature and observation. He knows more about how the planet itself works than the people and creatures on Earth work. He’s never been all that interested in learning about humans, although he’s picked up quite a few bits and bobs here and there

36 - How much do they rely on their minds and intellect, versus other approaches like relying on instinct, intuition, faith and spirituality, or emotions? What is their opinion on this? 

It’s a bit of a mash up. He has to use intellect in a lot of things (but don’t we all) but he does go on instinct a lot of the time. His emotions only come into play when things are personal, or when he’s at a low point. He doesn’t really think about his thought process all that much   

38 -  Is there anything they wish they could change about their worldview or thought processes? What, and why?

Well, he wouldn’t mind getting rid of his mental illnesses, but other than that, not really, no

39 - What sort of questions or thoughts recur in their lives, either specifically or as a theme? Why are these never answered, or answered permanently to their satisfaction?

“Death would solve this” “I will fuck you up/just fuck me up”? I don’t really know. There’s a hell of a lot of thoughts and many of them are negative, and a lot of them don’t really have any answers

40 - What do they wonder about? What sparks their curiosity and imagination, and why? How is this expressed, if it is?

Everything, really, and not all of it makes sense! It’s a lot of “why is it like this? why am I like this?” style questions and thoughts. It doesn’t really get expressed often, unless it’s at the time of a bad point, but when he’s thinking really deeply, he tends not to speak at all, and look very serious and slightly zoned out

41 - What associations do they bring to mind? Words or phrases, images, metaphors or motifs? Why?

I’m guessing this is what I associate him with? Lapsang souchong, cos of the unearthly smell and taste, negative images, cos of the original theme of this blog, lollipops for the obvious. There are more, but I’m exhausting my mind trying to think of more!

[elvisgreyson]

Chess and Life with Benjamin Franklin

Benjamin Franklin, a founding father of the USA, was a well known philosopher and thinker in history. 

He avidly played chess and wrote a popular essay on chess, which I’m taking the liberty to re-“copy” below. Franklin eventually was inducted to the U.S. Chess Hall of Fame. 

Get a glimpse of how chess can be used as a powerful metaphor and tool for mental health and wholeness in life.

The Morals Of Chess

by Benjamin Franklin

The Game of Chess is not merely an idle amusement; several very valuable qualities of the mind, useful in the course of human life, are to be acquired and strengthened by it, so as to become habits ready on all occasions, for life is a kind of Chess, in which we have often points to gain, and competitors or adversaries to contend with, and in which there is a vast variety of good and ill events that are, in some degree, the effect of prudence, or the want of it. By playing at Chess, then, we may learn:

1st: Foresight, which looks a little into futurity, and considers the consequences that may attend an action, for it is continually occurring to the player, “If I move this Piece, what will be the advantage or disadvantage of my new situation? What use can my adversary make of it to annoy me? What other moves can I make to support it, and to defend myself from his attacks?”

2nd: Circumspection, which surveys the whole Chess-board, or scene of action, the relation of the several Pieces, their situations, and the dangers they are repeatedly exposed to, the several possibilities of their aiding each other, the probabilities that the adversary may make this or that move, and attack this or that Piece, and what different means can be used to avoid his stroke, or turn its consequences against him.

3rd: Caution, not to make our moves too hastily. This habit is best acquired by observing strictly the laws of the game, such as, if you touch a piece you must move it somewhere, and if you set it down, you must let it stand.

Therefore, it would be the better way to observe these rules, as the game becomes thereby more the image of human life, and particularly of war, in which, if you have incautiously put yourself into a bad and dangerous position, you cannot obtain your enemy’s leave to withdraw your troops and place them more securely, but you must abide by all the consequences of your rashness.

And, lastly, we learn Chess by the habit of not being discouraged by present bad appearances in the state of our affairs, the habit of hoping for a favourable chance, and that of preserving in the search of resources. The game is so full of events, there is such a variety of turns in it, the fortune of it is so subject to vicissitudes, and one so frequently, after contemplation, discovers the means of extricating one’s self from a supposed insurmountable difficulty, that one is encouraged to continue the contest to the last, in hopes of victory from our skill, or, at least, from the negligence of our adversary, and whoever considers, what in Chess he often sees instances of, that success is apt to produce presumption and its consequent inattention, by which more is afterwards lost than was gained by the preceding advantage, while misfortunes produce more care and attention, by which the loss may be recovered, will learn not to be too much discouraged by any present successes of his adversary, nor to despair of final good fortune upon every little check he receives in the pursuit of it.

That we may, therefore, be induced more frequently to choose this beneficial amusement in preference of others, which are not attended with the same advantages, every circumstance that may increase the pleasure of it should be regarded, and every action or word that is unfair, disrespectful, or that in any way may give uneasiness should be avoided, as contrary to the immediate intention of both the parties, which is to pass the time agreeably.

1st: Therefore, if it is agreed to play according to the strict rules, then those rules are to be strictly observed by both parties, and should not be insisted upon for one side while deviated from by the other, for this is not equitable.

2nd: If it is agreed not to observe the rules exactly, but one party demands indulgences, he should then be as willing to allow them to the other.

3rd: No false move should ever be made to extricate yourself out of a difficulty, or to gain an advantage, for there can be no pleasure in playing with a man once detected in such unfair practice.

4th: If your adversary is long in playing, you ought not to hurry him, or express any uneasiness at his delay, not even by looking at your watch, or taking up a book to read; you should not sing, nor whistle, nor make a tapping with your feet on the floor, or with your fingers on the table, nor do anything that may distract his attention, for all these things displease, and they do not prove your skill in playing, but your craftiness and your rudeness.

5th: You ought not to endeavour to amuse and deceive your adversary by pretending to have made bad moves and saying you have now lost the game, in order to make him secure and careless, and inattentive to your schemes, for this is fraud and deceit, not skill in the game of Chess.

6th: You must not, when you have gained a victory, use any triumphing or insulting expressions, nor show too much of the pleasure you feel, but endeavour to console your adversary, and make him less dissatisfied with himself by every kind and civil expression that may be used with truth, such as, you understand the game better than I, but you are a little inattentive, or, you play too fast, or, you had the best of the game, but something happened to divert your thoughts and that turned it in my favour.

7th: If you are a spectator while others play, observe the most perfect silence, for if you give advice you offend both the parties: him against whom you give it, because it may cause him to lose the game, and him in whose favour you give it, because, though it be good and he follow it, he loses the pleasure he might have had if you had permitted him to think till it occurred to himself. Even after a move or moves you must not, by replacing the Pieces, show how they might have been placed better, for that displeases, and might occasion disputes or doubts about their true situation.

All talking to the players lessens or diverts their attention and is, therefore, unpleasing, nor should you give the least hint to either party, by any kind of noise or motion; if you do, you are unworthy to be a spectator.

If you desire to exercise or show your judgment, do it in playing your own game, when you have an opportunity, not in criticizing, or meddling with, or counseling the play of others.

Lastly, if the game is not to be played rigorously, according to the rules before mentioned, then moderate your desire of victory over your adversary, and be pleased with one over yourself.

Snatch not eagerly at every advantage offered by his unskillfulness or inattention, but point out to him kindly that by such a move he places or leaves a Piece en prise unsupported, that by another he will put his King into a dangerous situation, etc.

By this general civility (so opposite to the unfairness before forbidden) you may happen indeed to lose the game, but you will win what is better:  his esteem, his respect, and his affection, together with the silent approbation and good will of the spectators.

from Dr. Angelo O. Subida, Psychotherapist http://www.drsubida.com/2019/12/chess-and-life-with-benjamin-franklin_6.html

[brianestine]

Paley's Natural Theology in Contrast to John Henry Newman

Paley is a natural theologian who died shortly after John Henry Newman was born. His beliefs regarding theology take a rather practical approach in which certain matters of faith are reduced to reason or logic. To him, the external evidence is a large portion for the basis of faith. Newman references him frequently, yet finds fault in his arguments, and is convinced that his proofs are either not sufficient or in some manner irrelevant in regards to most people’s reasons for believing. Rather Newman feels that faith involves a sort acceptance beyond man’s rational faculties that Paley does not acknowledge. For this reason, Newman sees a danger in Paley’s beliefs, for they are not only insufficient for faith, but also misleading. Paley’s practical understanding of faith and reason due to external evidence is in conflict with Newman’s understanding of faith and reason, which is based much less on the evidence for religion.

In order for one to properly understand the relationship between Newman and Paley, one must first understand that Newman does not entirely dismiss Paley as being irrelevant; Newman does admit that there is some usage in his external proofs for faith. Newman finds them to be “consoling.” In his Lecture, Ecclesiastical History No Prejudice to the Apostolicity of the Church he mentions that he has an assortment of shrewd reasoning. 1 That is to say while Newman does not feel that anyone is convinced based on Paley’s proofs nor should they be convinced on Paley’s proofs they do offer a certain bit of stability. A good example would be Paley’s watchmaker theory. If one finds a watch, it is presumable that someone must have made that watch. Paley insists that if a person also finds a rock, it is also presumable for the same reason that someone must have made it as well.2 One can recognize intelligence when he sees it, and to

suppose that something comes from nothing seems somewhat absurd. Newman, does not dismiss this, rather he only suggests that this is not the same as a belief in Christianity. While Paley’s watchmaker analogy is in some ways similar to Aquinas’s proof through causality, Newman still does not feel that this is the most significant matter regarding faith. These kinds of proofs in general are lacking what really inspires one to believe.

The reason there is a difference between Paley and Newman must be first understood in the context that Newman, unlike Paley, is not a natural theologian. Natural theology is known to observe arguments for Christianity from a priori reasoning. Rather than studying what revelation teaches directly( looking at the life of Jesus) natural theology observes the exterior evidences for Christianity using reason and ordinary experience, and then moves towards the interior doctrine. A good example would be looking towards the world around oneself for answers, such as, God exists, as opposed to observing the existence of God by looking at the Bible. The watchmaker analogy fits the same description since it does not depend on revelation or any sort testimony given by Christ. The general approach to natural theology seems to take observations that are distinctly secular regarding the natural world and apply them to Christianity. This is not the approach Newman generally seems to take.

Newman’s critique of Paley’s natural theology is ultimately defined in his approach towards its genus inductive theology. Newman notices that there are three different types of inductive theology including history, revelation, and nature, of which Paley’s natural theology is the one he views with the "greatest suspicion." 3 Inductive theology by its very definition, however, is limited for it moves from particular premises to general conclusions. He finds that inductive theology will find things that only explain partial aspects of Christianity, never regarding Christianity in its entirety. What inductive theology suggests is "a strong probability,

not to a certainty, or again, proving only some things out of the whole number which are true." 4 Newman does not consider this to be the best basis for faith for it depends on every single premise being proven before Christianity can be accepted on a whole. When inductive theology is the approach, one can find himself doubting nearly every aspect in the way Descartes doubted his senses. Newman rather argues that theology is deductive, and that physical science is, "just the reverse," viz. inductive. For one to actually accept Christianity on a basis of particular premises is faulty. There is not enough time for anyone in the world to accept Christianity in this manner for every single premise must first be proven.

Newman considers natural theology to be even more suspect than the other branches of inductive theology because he does not feel that it contributes anything to the Christian faith. While Newman clearly does not have any objection to physicists he does recognize their studies as being separate from that of theology. Natural theology connects theology with nature, but fails to truly prove Christian doctrine with the kind of certainty that it seems to suggest. Rather, Newman states that "it cannot tell us anything of Christianity at all."5 This is because the two have entirely separate ends. Newman noted that

The Physical Philosopher, contemplates the facts before him; the Theologian gives the reasons of these facts. The physicist treats of efficient causes; the Theologian of final. The physicist tells us of laws; the Theologian of the Author, Maintainer, and Controller of them; of their scope, of their suspension, if so be; of their beginning and their end. 6

Newman does not feel that science is a means in order to reach theological truths. For the physical scientist, "a vast and omnigeneous mass of information lies before the inquirer, all in a confused litter, and needing arrangement and analysis." 7 This is not the sort of material that can be used to find truth regarding the trinity. Elsewhere Newman states that: "The material world, indeed, is infinitely more wonderful than any human contrivance; but wonder is not religion, or we should be worshiping our railroads." 8 Here Newman expresses his main disappointment with natural theology

Because natural theology, views theology from outside a Christian revelation, Newman notes that it therefore must also not be original. It is all "pretty much what it was two thousand years ago." 9 Newman makes note when quoting Thomas Macaulay's words that according to Xenophon’s writings Socrates used the exact argument against Aristodemus, as that of Paley’s watchmaker. 10 While Paley may find answers that may suffice in response to certain claims made by atheist, Newman notices that these answers are nothing more than what the Ancient Greeks proposed. While the conclusions they possesses are powerful, good, and wise, they do not possess divine justice, mercy, and providence. Newman considers this approach to be borderline idolatry if it "occupies the mind." 11 Based on these attributes there is very little that would separate the Christian God from the pantheist God.12 Therefore natural theology by not being original is also not Christian, for in order for a doctrine to be Christian it must actually be dependent on some aspect of Christ’s life. Many of Paley’s arguments do not fit this description since they are not actually trying to prove the existence of a Christian reality. He feels the need to separate himself from revelation when arguing. Paley’s description of a watch cannot account for the countless miracles found in revelation. Likewise Paley’s other arguments can also not account for God’s gift of mercy to mankind. Newman does not insist it is heretical to just simply give credit to Paley’s watch theory, only he does not seem to really care if God’s existence has been revealed through the natural world in such a vague manner. While he acknowledges the

truth in Paley’s arguments, he does not allow for it to become the basis for anything distinctly Christian. From observing a rock, one may know there is a creator, but from what Newman seems to be insisting is that while one may know there is a creator, he does not actually know who that Creator is or anything about Him. To omit the later, and be completely content with accepting his existence is to miss the entire point of Christianity. Pagans who worshiped false idols were able to come to similar conclusions. If their conclusions had been enough, then God would have no need to send his Son. Only through Christ and revelation can a person really know who God truly is. What Newman says on behalf of Paley is that Paley almost seems bizarre. “Can alliance more ill-matched and strange be imagined than this, which sheer necessity has brought about, between pseudo-spiritualism and the evidential method?” 13

Newman’s disapproval of Paley’s mentality does not simply just apply to his approach with natural theology. Likewise, Newman also feels that there were certain things amongst faith that just simply cannot be proven. Paley, on the other hand, seems to try to prove everything regarding Christianity. Paley actually seems want to reduce faith to a syllogism. Paley feels that there is no religious love of truth where there is fear of error. For this reason, he insists on proving as many aspects of Christianity he can. Newman, on the contrary maintains that the fear of error is simply necessary for the genuine love of truth. 14 Rather he feels that faith should be an act of the will. While Paley insists that there cannot be love without doubt, Newman actually suggests that doubt is part of faith. Otherwise there is no merit to believing in a certain matter. When a man trusts his friend it is viewed as a virtuous action, or at least a sign of a good friendship. Nothing is different when regarding Christ as one’s friend. One must actually accept Him as their friend,

and trust in His mercy. Doubt is there in order for us to overcome its deceptive abilities. To Paley to believe without a concrete law like process for determining matters of faith is unethical for it is against one’s conscience. However, there does not seem to be a concrete law like process that can be applied to faith without having it lose its merits.

Because Paley is looking for proofs regarding faith, he feels there has to be a logical basis for everything. For this reason Paley feels entitled to Revelation based on his own observation that man needs it. While Paley knows there is a God it would only make sense that He would reveal Himself to mankind in some manner or another. 15 His arguments is that God would acknowledge man’s state of being and thus show himself obligingly. How can person be expected to believe in God if God does not even reveal Himself? This is Paley’s justification for revelation, saying he could expect no less from a divine being, but Newman, however, does not feel quite as deserving. Rather to him revelation is to be considered a gift. God could have left everyone in ignorance like the lives of many individuals. Newman feels that Paley was ungrateful in this regard. Who is man to say that he deserves revelation, or that it is only reasonable that God would do such? God’s ways have never been reasonable by man’s standards. Likewise, people simply sit a home judging evidence based on what they hear making no effort to go and find out the truth for themselves. They make judgments regardless of their own laziness and constantly demand more evidence. What God’s Revelation is is a gift at man’s own convenience. People should not view it as something that’s just simply evidence; rather it is God making Himself known to us. For people not to appreciate this is obscene. 16

Within revelation Newman also found fault in the way that Paley dismissed certain important aspects of the Christian faith. Newman most dominantly did not think that Paley rested

enough of his proofs based on the life of Christ itself. Newman states in his Discussions and Arguments “Paley, for instance—show their sense of this difficulty when they place the argument drawn from the Lord's character only among the auxiliary Evidences of Christianity.” 17 To Newman the way in which Christ lived was much more significant than that of the external evidence that Paley dealt with. The way in which a man lives his life may be the best sign that what he says is correct. Charismatic leaders are often followed for exactly this reason. What they state is just easier to believe, and when you have a character that is as morally upright as Christ was, very little can be said against believing what he states. 18 His wisdom speaks for itself. The arguments made by Paley, Newman could only view as a transitional views. Real faith is found in Christ himself. Paley’s external evidences did not give a man any real reason to believe in Christ. Newman noted that most men agree with the reasoning, however they disagree with the premises. 19

When observing Revelation, Newman and Paley would disagree on their stance regarding miracles, though they do agree with the basic evidence for miracles. A miracle according to Newman is an event that is inconsistent with the natural order or constitution of nature. Paley would agree upon this for he stated that to expect a miracle, “that it should succeed upon a repetition, is to expect that which would make it cease to be a miracle, which is contrary to its nature as such, and would totally destroy the use and purpose for which it was wrought.” 20 A miracle must actually be distinct. Newman did insist that miracles are a matter of evidence. People rely on the evidence for miracles in the same way people rely on the evidence for any

other historical account since they depend on a testimony. Due to the extraordinary nature of miracles a fuller investigation is needed, but the basic principal for miracles is testimony. In the description given in Newman’s sermon on Faith and Reason, contrasted as Habits of Mind21 Paley mentions that matters of faith such as miracles just merely have to be considered not violently improbable in order to be believed. This is where Newman and Paley would differ most strongly, for a miracle can not be judged in the same manner as any other occurrence. Newman would disagree with Paley for he does not think that the evidence can be believed in such a manner. Paley actually mentions judging miracles in the manner in which one would judge a court case or some other matter that was up for debate. While Newman does mention that one should judge a miracle as either true or false based on the testimony, he sees a huge problem in supposing that it could convince someone already held against them. Newman agreed with the statement “miracles are not wrought to convince Atheists,” while Paley seemed to think the exact opposite. In response to Paley he stated

This acute and ingenious writer here asks leave to do only what the Utilitarian writer mentioned in a former place demands should be done, namely, to bring his case (as it were) into court; as if trusting to the strength of his evidence, dispensing with moral and religious considerations on one side or the other, and arguing from the mere phenomena of the human mind, that is, the inducements, motives, and habits according to which man acts. I will not say more of such a procedure than that it seems to me dangerous. 22

Newman notices that there is a rather subjective tone to Paley’s argument. While Paley claims that a court would be an objective place to view a miracle, the exact opposite would occur. In the case of a court house the evidence for miracles would be placed in the hands of a Judge and Jury to decide whether or not it is legitimate. This approach rather only subjects miracles to the same treatment as anything else in a way that actually degrades what they are. Some may be

persuaded while others would dismiss it given the exact same evidence. 23Likewise Paley would also seem to argue that miracles are evidence for religion in so far as that when they occur that atheist should be converted based on testimony. It seems while Paley and Newman may both agree that a miracle should be believed on the basis of testimony the result of such a miracle should be convincing to two different types of people. Neither argues in the way Hume would since Paley states that in order for a Miracle to be consistent it would cease to be a miracle. Newman would insist that miracles are to encourage the faithful, while Paley would seem to insist that miracles are to convince the atheist.

Newman notes that while Paley uses miracles to supposedly argue on behalf of faith, the early apostles never used such in order to persuade anyone. 24 Paley was aware of the fact the early apostles did not use such arguments to try to convince people, yet he did not truly understand why. Paley felt that since the minds of people in times of apostles were so indulged in expressions of magic, it must not have been particularly convincing, therefore they chose not to do such on practical grounds. After all, there were other magicians at the time. Therefore Paley presumed they must have used other methods, not because they were superior, but more appropriate for the time period.

It was their lot to contend with notions of magical agency, against which the mere production of the facts was not sufficient for the convincing of their adversaries; I do not know whether they themselves thought it quite decisive of the controversy. 25

Newman however insisted that the apostles did not try to persuade people through argument. The Apostles were not void of reason, yet the tried to persuade people through their hearts. 26 They used arguments, but on behalf of something that was beyond argument. They appealed to miracles, as signs of divine power, but the method of Paley, as Paley, Newman, and the Bible testifies was not the method on

the Apostles. 27 Rather than accept that his approach was perhaps inappropriate, Paley just simply acknowledges that the Apostles did not use these particular arguments and continues to insist that Miracles are proofs that must be used.

But since it is proved, I conceive with certainty, that the sparingness with which they appealed to miracles was owing neither to their ignorance nor their doubt of the facts, it is at any rate an objection, not to the truth of the history, but to the judgment of its defenders. 28

Newman noted fault with this for the early church leaders in his mind as an Anglican also did not need a pope or plenty of the other arguments placed before them.

One point in which Paley and Newman seem to mostly agree upon however is the appeal to history. Here Paley did not act as natural theologian, but just merely as an inductive theologian. While Newman was critical of all inductive theology he agreed with Paley to an extent on this matter. Newman agrees with Paley in regards to testimony and notes his difficulty in regards to a need to prove testimony. How can a person assert that what Christ says is true, if he cannot even assert that Gospels are a reliable source? Here Paley notes that if a person omits one, there are still three other gospels and plenty of epistles that affirm the same thing. Likewise, Newman also insists that because there are no other claims regarding different events in Christ’s life, the testimony seems to be in favor of the accounts given by Mathew, Mark, Luke and John. The main argument made was that there are no conflicting testimonies to the ones given in which we are to believe the ones handed down. The various authors of the Bible are not inconsistent in their depiction of Christ like Xenophanes and Plato’s depiction of Socrates. This seems logical as even those that were not Christian, such as Piley, seemed to confirm exactly what Christianity taught by their statements. 29 Paley affirms the exact idental notices of the affair, which are found in heathen writers, so far as they do go, go along with us."30

There does however appear to be a difference in the tone of Newman’s arguments for faith then Paley’s. This is because Newman views Christianity before he views individual testimonies. While Paley does not seem to contrast with Newman’s opinion, as an inductive theologian, Paley seems to approach each individual testimony and use them to support the Bible on a whole. When prophets spoke they revealed new information but it was not as though their revelation could make sense without context. “Admiration of its singular simplicity and directness, both as to object and work. Such of course ought to be its character, if it was to be the fulfillment of the ancient, long-expected promise; and such it was, as our Lord proclaimed it.” This seems to be what Paley does, while Newman tries to consider history on a whole.31

Newman observing Paley decades later feels that Paley was not really a Christian Apologist. While Newman does acknowledge what Paley proves, he finds the results inconclusive. There is little no use proving that God exists if God is merely the God pantheism or deism. Unfortunately this was Paley’s arguments from Natural Theology. In regards to historical and revelation, Newman simple thought that Paley as Inductive Theologian viewed it backwards. Rather than trying to Prove Christianity in several pieces, then come to the conclusion that Christianity is real, one must first accept that Christianity is real and argue for it from that perspective. Paley omits what Newman considers to be most crucial in regards to the testimony of Christianity. This would matters such as the incredibly virtuous lie of Christ or the sheer amazement of Revelation. While Newman’s argument is very intelligent, it can be reduced to a very humble, unscientific, simple expression of belief.

[iprayunceasingly-blog]

CNA Explainer: What rights does a pastor have?

New Post has been published on https://pray-unceasingly.com/catholic-living/catholic-news/cna-explainer-what-rights-does-a-pastor-have/

CNA Explainer: What rights does a pastor have?

Chicago, Ill., Sep 29, 2018 / 09:30 am (CNA).- The recent case of Chicago's Fr. Paul Kalchik has generated considerable publicity, and left more than a few questions unanswered.   Kalchik was “temporarily” removed from his post at Resurrection Parish in northwestern Chicago last week, following a Sept. 14 incident in which a rainbow banner which had previously hung in the church building was burned by parishioners, with Kalchik in attendance.   Kalchik announced Sept. 2 that he planned to burn the flag publicly on Sept. 29. He acknowledged recently that the archdiocese had instructed him not to proceed with that plan.

Almost everything else about the case remains disputed.   The Archdiocese of Chicago told CNA recently that Fr. Kalchik had agreed not to burn the banner. Kalchik, in a recent interview, claimed that he was told not to conduct the specific Sept. 29 public event he had previously announced.   An archdiocesan spokesperson also told CNA that Kalchik’s departure from the parish – which the archdiocese says is temporary – was not linked to the banner burning at all, but had been “in the works” for some weeks.

Chicago’s Cardinal Blase Cupich was apparently concerned about “a number of issues” at the parish. The archdiocese added that Kalchik’s departure was arranged by “mutual agreement” and that he is presently receiving “pastoral support” for unspecified needs.   Kalchik says his departure was anything but a mutual decision.   The priest says that two diocesan officials, priests, arrived at his rectory and ordered him off the premises, threatening to call the police if he refused to comply. According to Kalchik, the priests said that he would be sent to St. Luke’s Institute, a Maryland psychiatric assessment and treatment center for priests.

The Archdiocese of Chicago declined CNA’s request for confirmation or denial of those claims.

What are a pastor's rights?

Amid the conflicting narratives surrounding Kalchik, a question emerges: what canonical rights does a parish priest actually have?

While a priest’s ministry is dependent upon that of his bishop, and every priest promises respect and obedience to the bishop at ordination, it is a common mistake to think of a pastor as a kind of branch manager or tenant farmer of the bishop. The pastor’s canonical role is much different than that.   Canon law treats the subject of a parochus –  the pastor of a parish – very explicitly.   Canon 515 §1 of the Code of Canon Law says that each parish is to be entrusted to the care of a parochus, who serves as the shepherd of the community under the authority of the bishop.   The same canon makes clear that the parish itself is not a piece of land, a church, or any other collection of buildings. A parish is properly understood as a group of the faithful, usually defined as those living in a particular area.   The relationship between the pastor and his parish is, in a technical sense, personal: a relationship between persons, defined and circumscribed by law.      In canon law, every parish has its own “juridic personality,” meaning that is a freestanding legal entity, with its own property, and its own rights and obligations.   The Code clarifies that the pastor represents the parish “in all juridic affairs,” and it is his responsibility to lead the community and decides what is in its best interests.

Of course, the bishop is free to establish policies for all parishes in his diocese- called particular laws- provided that they do not conflict with universal canon law or divine law. But within the boundaries established by canon law, divine law, and civil law, it is the pastor’s job to lead the parish, and to determine, prayerfully and consultatively, how best to govern the community with which has has been entrusted.

There have been cases where the pastor and the bishop disagree about parish needs, and canon law provides mechanisms to address such conflicts, including processes of appeal from episcopal decisions and directions, and canonical courts in which they can be adjudicated.   A bishop and pastor might disagree, for example, about parish property. A bishop may direct a pastor to sell a piece of property, or to give it over to meet a diocesan need, and the pastor may judge that to be a bad idea. Such a dispute could become a matter of “hierarchical recourse,” if the pastor appeals a decision he does not support. When disputes over such matters are appealed to Rome, the Congregation for Clergy is often obliged to remind the bishop to respect the rights of the pastor.   Similarly, within the scope of universal and particular canon law and the teachings of the Church, a pastor also has the autonomy to teach and preach in a way he believes is best suited to the needs of the people.

This does not mean, of course, that bishops have no authority over parish pastors. In addition to establishing particular laws for his diocese, a bishop has the authority to oblige any priest or member of the faithful to do, or not do, a particular thing he may determine to be detrimental to the wider community. He can do this through a precept- a kind of canonical induction directed at a specific person or situation.

Since a precept is a formal legal action, a pastor has the right to appeal it, provided he does so according to the procedures established by canon law. But he does not have the right to simply ignore a legitimately issued precept.

Bishops also have the authority to appoint pastors. Except for very exceptional cases, canon law gives the diocesan bishop a free choice to appoint whatever priest he thinks is most suitable for the job. This is understandable, since the pastor carries out his role “under the authority of the diocesan bishop in whose ministry of Christ he has been called to share.”

A bishop is not free, however, to remove or transfer a pastor from his office without following a detailed and non-negotiable process defined by canon law. This procedure can only be initiated if a priest has met one or more conditions for removal outlined in the law, which include actions “gravely detrimental or disturbing to ecclesiastical communion,” along with permanent infirmity of mind or body, a loss of good reputation among his flock, and neglect of his duties in the parish.

Even if a priest has met those conditions, before he can be removed from the office of pastor, the bishop must formally consult with certain priests appointed by the diocesan priests’ council, he must allow the pastor the opportunity to see the evidence against him and make a defense, and he must discuss that defense with the priests appointed to consult with him.

During this whole process, the bishop can neither remove the pastor, nor appoint a replacement.   If the bishop does issue a decree of removal, the priest has the right to appeal his case to Rome, where the Congregation for Clergy, or eventually the Apostolic Signatura, can examine the decision and the process used to reach it.

A bishop also has the prerogative, in certain limited circumstances, to declare that a priest is impeded from exercising priestly ministry, but that must be done through a delineated process as well. A bishop could also withdraw certain faculties for ministry from a priest, but only if he has good reasons, and only if he has followed the procedural requirements of canon law.

In short, while no priest has a right to an assignment or to ministry, once a priest is appointed a pastor, he cannot be removed from his office, or from his ministry, without serious cause, and without observation of the law’s procedural requirements. Similarly, prohibiting a priest from residing in a certain place can only be done in the limited circumstances allowed by canon law.

This also means that, except in very limited and unusual circumstances, a bishop is not within his rights to attempt to remove the legitimate pastor of a parish from its property, or to threaten to have the police do so. Were a bishop to do such a thing without observing canonical requirements, and the priest appeal to Rome, it is likely that the Vatican would order the pastor to be reinstated.

Neither can a bishop compel any priest to undergo a psychological evaluation or engage in psychological treatment. While a bishop might condition future assignments on a “clean bill of mental health,” he can not force a priest to be diagnosed or treated against his will, or to disclose the details of his mental health if he does not wish to do so.

Canon 519 says that the pastor exercises “the pastoral care of the community committed to the pastor under the authority of the diocesan bishop in whose ministry of Christ he has been called to share, so that for that same community he carries out the functions of teaching, sanctifying, and governing.”

The authority of the diocesan bishop is not absolute. Nor is the autonomy of the pastor. But both exist, as defined by canon law, for the service of the Church, and the salvation of souls. Understanding the authority of bishops, and the rights of pastors, is important at a moment in the Church’s life when so much seems unclear, and when many questions remain unanswered.

  CNA Daily News

[studyingbymylonesome]

The Many Misconceptions of Catatonia: Treatment Is Often Successful With the Right Knowledge

Catatonia, “a syndrome of altered motor behavior accompanying many general and neurological disorders,”1 is common, affecting 9.8% of adults admitted to psychiatric hospitals.2 However, catatonia frequently goes unrecognized, leading to the erroneous conclusion that it is rare. A Dutch study found that clinicians identified catatonia in only 2% of 139 patients, whereas a research team identified catatonia in 18%.3

“Catatonia is treatable, but the sad component is that the true diagnosis is often not made and appropriate treatment is not provided,” Max Fink, MD, professor emeritus of psychiatry and neurology, Stony Brook School of Medicine, New York, told Psychiatry Advisor.

The History of Catatonia

One of the main reasons for the frequent misdiagnosis of catatonia is the continuing misconception that it is synonymous with schizophrenia, Dr Fink said.

It was Karl Ludwig Kahlbaum who first made the association between psychomotor symptoms and psychiatric disorders in 1874. Kahlbaum coined the term Die Katatonie and clustered 17 motor abnormalities into a single syndrome in patients with an array of disorders, including mood, psychosis, neurosyphilis, tuberculosis, and epilepsy.4

In 1899, Emil Kraepelin categorized catatonia as a feature of dementia praecox and by 1913, catatonia had become “1 of the 8 subgroups into which dementia praecox was divided and clearly subordinated to the larger diagnosis.”1

Although this definition was by no means universally accepted and was fraught with ongoing controversy, both the Diagnostic and Statistical Manual of Mental Diseases (DSM)-I and DSM-II5,6 classified catatonia as a type of schizophrenia, which continued through the publication of DSM-III.7

However, descriptions of a toxic response to neuroleptic agents and subsequent identification of neuroleptic malignant syndrome (NMS) called this into question because of its similarity to malignant catatonia, Dr Fink explained.

Fink and Taylor argued that catatonia should not be exclusively linked with schizophrenia, leading to a change that recognized catatonia as a disorder caused by a medical condition and a features specifier in mood disorders, in DSM-IV.8,9

The development of rating scales and more effective examination procedures led to the discovery that between 9% and 17% of patients in psychiatric facilities and emergency departments met criteria for catatonia — even more among those with mood disorders or toxic states than among patients with schizophrenia.1

In the DSM-5, criteria for catatonia remained the same throughout the manual, independent of the initial diagnosis (eg, psychotic, bipolar, depressive, medical disorder, or unidentified medical condition). It was defined by the presence of at least 3 symptoms from a list of 12 and was no longer called a “subtype” of schizophrenia but rather a “specifier” for schizophrenia as well as for major mood disorders and 4 additional psychotic disorders. There was also a new diagnostic category: “catatonia not otherwise specified.”10 The DSM-5 definition of catatonia can be found below.

DSM-5 Definition of Catatonia

Catatonia is defined by the presence of 3 or more of the following10:

Catalepsy: Passive induction of postures held against gravity

Waxy flexibility: Slight and even resistance to repositioning by the examiner

Stupor: No psychomotor activity, no reactivity to the environment

Agitation: Not influenced by external stimuli

Mutism: No or minimal verbal response; not applicable in case of established aphasia

Negativism: Opposing or not responding to external stimuli, such as instructions

Posturing: Spontaneous and active maintenance of posture against gravity

Mannerism: Odd caricatures of ordinary actions

Stereotypes: Repetitive, frequent, non-goal-directed movements

Grimacing

Echolalia: Repeating the words spoken by the examiner

Echopraxia: Mimicking of the movements made by the examiner

Beyond the nosologic debate, another historical process affected how catatonia was regarded because “the bulk of psychiatric practice shifted from the asylum to the ambulatory clinic, with an emphasis on psychotherapy and the prescription of psychotropic agents,” Dr Fink noted.

In the ambulatory setting, less emphasis is placed on a medical examination and, coupled with the assumption that catatonia is associated mainly with schizophrenia, it became regarded as merely another form of psychosis, he added.

Illnesses associated with catatonia include the following2,11:

Psychiatric, including schizophrenia, bipolar disorder, depression, Tourette syndrome, autism

Metabolic, including renal failure, liver failure, ketoacidosis, vitamin B12 deficiency

Endocrine, including hyperthyroidism, hypercalcemia from parathyroid adenoma, Addison disease, Cushing disease, syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Neurologic, including encephalitis, multiple sclerosis, epilepsy

Rheumatologic, including systemic lupus erythematosus

Infectious diseases, including typhoid fever, mononucleosis, malaria

A Condition of Fear

“There are multiple causes behind catatonia, but one way to regard it is as a systemic response to unrequited fear,” said Dr Fink, who is the coauthor of the just-published book The Madness of Fear: A History of Catatonia.12

“Fear is induced in human beings in multiple ways,” he explained. “For example, if you are sick and become frightened, that fright can be manifested through withdrawal, stupor, posturing, or repetitive movements.”

“In Freudian terms, this can be seen as a defense adaptation, and the reason we can treat catatonia with sedative drugs or ECT [electroconvulsive therapy] is that we are treating the fear,” he said.

Types of Catatonia

Catatonia is not a single, undifferentiated entity but has several different forms, Dr Fink pointed out.

Retarded catatonia is the most common, consisting of movement that is inhibited by posturing, rigidity, mutism, and repetitive actions, as well as failure to respond to painful stimuli. When this presentation includes stupor, patients may require parenteral feeding and extending nursing care.11

Delirious mania is an excited form of catatonia, characterized by restless movements, talkativeness, agitation, frenzy, disorientation, and confusion.11

Malignant catatonia is “a syndrome of acute onset, fever in all but elderly individuals, and abnormal blood pressures, tachycardia, and tachypnea of life-threatening dimensions.”11 It is similar to NMS and neuroleptic-induced catatonia. Toxic serotonin syndrome can be seen as malignant catatonia associated with serotonergic drug overdose.11

Periodic catatonia is recurrent and reported among patients with bipolar disorder, in which the patient fluctuates between stupor and excitement. It is most likely to occur during a mixed mood state or period of rapid cycling.11

Agitated catatonia is often associated with self-injurious and typically stereotyped behavior, commonly seen in autism.13

These catatonia syndromes are referred to by several names, which are listed below.11,13

Catatonia Syndromes: Nomenclature

Retarded catatonia (benign stupor) is also referred to as Kahlbaum syndrome

Excited catatonia (delirious catatonia) is also referred to as manic excitement (manic delirium) (Bell mania)

Malignant catatonia (neuroleptic malignant syndrome; toxic serotonin syndrome) is also referred to as lethal catatonia, pernicious catatonia, acute fulminating psychosis (syndrome malin; neuroleptic-induced catatonia; serotonin syndrome)

Periodic catatonia (mixed affective state) is also referred to as rapid cycling mania

Agitated catatonia is also referred to as self-injurious behavior (eg, in autism)

Diagnosing Catatonia

Catatonia should be considered in every patient with dysregulated motor behavior, especially in those who also show changes in consciousness and mood, Dr Fink emphasized.

There are several rating scales that can help identify catatonic symptoms.14 A systematic review14 found the Bush-Francis Catatonia Rating Scale (BFCRS)15 to be preferable for routine use because of its validity, reliability, and ease of administration.

To verify the diagnosis, a lorazepam “challenge test” can be helpful because signs and symptoms of catatonia are commonly relieved by the intravenous (IV) administration of a barbiturate or benzodiazepine, Dr Fink said, adding that zolpidem may be considered an alternative to lorazepam.

“If you suspect catatonia, based on your observation and results of the rating scale, the lorazepam test can be useful,” Dr Fink said.

“Imagine a stuporous patient not responding, even if you pinch or stick them with a pin,” he continued. “You give them IV lorazepam and they pick up their head 5 or 10 minutes later, look at you and ask, ‘Where am I?' That's a positive response and you can treat that patient.”

The result is positive in 80% of tests in patients who have catatonia and respond to treatment. However, if the patient does not respond to the test dose, Dr Fink noted that it is repeated, or higher treatment doses are given. “If the patient does not fully respond to the sedative drug, ECT becomes the default,” he said.

High serum creatine kinase and low serum iron levels can be associated with malignant catatonia, particularly NMS, but are less useful in identifying other forms of catatonia.12

Treating Catatonia

Because catatonia is so frequently associated with schizophrenia or regarded as a form of psychosis, it is often inappropriately treated with antipsychotics, Dr Fink remarked.

Catatonia typically has a poor response rate to antipsychotics — as low as 7.5% — so they should be avoided. Introducing them can also complicate the clinical picture and promote the development of the malignant form of catatonia.2

In all patients, potential toxic precipitants should be eliminated and general medical and/or neurologic diseases should be treated.12

For those with retarded catatonia and body temperatures <39°C, parental or oral lorazepam should be administered, beginning with 3 mg/d and rapidly increasing to effective resolution, even as high as 20 to 30 mg/d.11 ECT can bring effective relief to patients with higher fevers, delirium, or physiologic risk or those who do not rapidly respond to lorazepam.11

High fever (≥39°C) is associated with various forms of malignant catatonia (eg, NMS, delirious mania). “Such states are life threatening and warrant intensive medical and nursing treatment: IV fluids, sponging, body care, sedation, and ECT — even daily ECT,” Dr Fink said.

Benzodiazepines and ECT can be used together, as they have a synergetic effect, but the dose of the benzodiazepine should be reduced because it can raise the seizure threshold.2

Most patients respond well to catatonia treatment, with up to 80% achieving relief through benzodiazepines or barbiturates and the remainder showing improvement from ECT.16 However, some patients seem to be resistant to treatment, particularly ECT. Possible reasons include chronic symptoms, diagnostic delay, high seizure threshold, and incorrect application of ECT (eg, insufficient number of sessions, short session duration, procedural failures, and concomitant use of benzodiazepines).16

Next Steps

“We can no longer regard catatonia as a psychiatric disorder specific to schizophrenia,” Dr Fink stated. Rather, “it is better regarded as a movement and behavioral syndrome with particular attributes and diverse antecedents.”

Additionally, “there has been relatively little biological, genetic, and imaging research devoted to catatonia.” It is important to begin expanding the research base and apply these powerful research tools to populations with confirmed catatonia, he said.

“Catatonia is a diagnosable and treatable entity,” Dr Fink concluded. More education is needed to reinforce this message for physicians, especially in emergency departments and psychiatric facilities.

[jobisite11]

Community Mental Health Nurse RMN / Band 6 Needed ASAP Rayleigh, Essex, United Kingdom

Our Client provides a wide range of treatment and support to young people, adults and older people experiencing mental illness both as inpatients and within the community.  This includes; including treatment, in secure and specialised settings.

The post holder:

Will act as an independent practitioner within a defined community setting, while liaising with other professionals as necessary.

Will manage a defined caseload and provide supervision to others as appropriate.

Will be responsible for the assessment planning implementation and evaluation of nursing care within agreed parameters, and have a working knowledge of local, national policies and legislation, which govern current service provision and audit.

Will be responsible for ensuring effective communication pathways exist.

Will be responsible for ensuring the promotion of equality diversity and rights in accordance with good practice and legislation.

Will be responsible for identifying and contributing to the training needs necessary in providing quality evidence based care as appropriate.

JOB SUMMARY

  To be responsible as the Care Coordinator for the assessment and coordination of care needs, planning and implementation of evidence based care to a defined group of service users and their carers within a defined catchment area/locality. To provide professional advice and support to other agencies and members of the multidisciplinary team, and act up for the Team Manager in their absence as appropriate. To act as a role model and resource for junior/less experienced staff.

  KEY STRATEGIC RESPONSIBILITIES

  To be responsible for the assessment, planning implementation and evaluation of the evidence based care required, including health promotion for a named service user/group.

Responsible for the appropriate clinical risk assessment of service users contacting the “Out of Hours” service, providing an effective advice, guidance and decision making process culminating in the coordination of any reviewed plan of care.

Responsible for the admission, case conference/reviews and discharge in collaboration with members of the multi-disciplinary team.

Responsible for coordinating the care and assessment under the Care Programme Approach of a designated caseload

Responsible for participating in the development of the service, setting of quality standards, including the auditing, monitoring and reviewing in line with current clinical guidance practice and policy.

Responsible for ensuring the postholder understands and meets their professional responsibilities under Safeguarding Vulnerable Adults and Children Legislation.

Responsible for ensuring that the requirements of the Mental Health Act 1983 are observed, adhered to and implemented.

Responsible for the promotion of carer and service user involvement within the service and for its provision.

Responsible for establishing therapeutic relationships with service users, and the implementation of evidence based therapeutic interventions with appropriate boundaries in accordance with Nursing and Midwifery Councils professional code of conduct.

Responsible for ensuring that carers’ assessments, education and support is delivered in accordance with the requirements of the NSF.

Responsible for deputising and providing appropriate support and caseload coverage for colleagues/team members.

  OPERATIONAL RESPONSIBILITIES

  Responsible for participation in the Trust appraisal process, and take a lead in identifying own/others mandatory professional, supervisory, personal development and training needs for junior and senior team members.

Responsible for ensuring that the post holder and junior staff members’ access and participate in clinical supervision.

Responsible for the safe custody and administration of medicines.

To participate and contribute appropriately in research, service modernisation, clinical governance and the National Service Framework.

To ensure that the agreed philosophy approach is adopted and followed, whilst respecting and valuing the different therapeutic approaches available within the multi-disciplinary team

Responsible for ensuring confidentiality is maintained at all times in accordance with the data protection act, trust policy and good practice.

Responsible for maintaining and conducting oneself in a professional manner towards service users, carers, colleagues and other agencies.

Participate in joint working with appropriate experts/agencies.

The post holder is responsible for ensuring that they contribute and work towards the service/organisational aims and objectives.

The post holder as an individual is required to understand their responsibility for respecting and promoting issues of equality diversity and rights in accordance with good practice and legislation.

Responsible for reading, understanding and complying with all relevant trust and statutory policies and procedures.

  STAFF MANAGEMENT

  Responsible for the effective utilisation of nursing/financial resources to ensure adequate clinical care is provided with a requirement that all incidents, which may compromise care, are reported immediately to a senior manager, and clinicians involved in their care as appropriate.

To make decisions and work within a framework commensurate with their level of knowledge and competence and to act accordingly within their sphere of responsibility.

Responsible for ensuring that appropriate safeguards and practices are adopted when working autonomously with clients independently.

Responsible for the provision of formal and informal training of pre/post registration students, staff members, carers and service users.

Responsible for providing formal and informal training on Mental Health promotion to statutory and non-statutory services.

Responsible for the provision of staff induction, mentorship, appraisal and clinical supervision to professional colleagues as appropriate.

  COMMUNICATION AND WORKING RELATIONSHIPS

  The post holder is responsible for ensuring accurate and timely written records are kept which comply with the Trust policy and NMC guidance, reporting on any issues as appropriate.

The post holder is responsible for ensuring they comply with current good practice in informing/updating all members of the multi-disciplinary team, their colleagues, service users and appropriate others of changes involving current nursing care plans, progress, mental state and psychosocial factors in line with best practice.

The post holder is responsible for ensuring that they clearly communicate with clients and carers, actively listen to establish an understanding of the needs of the service user and their carers.

CommunityMentalHealthNurse(RMN)Band6(NeededASAP)(Rayleigh,Essex,UnitedKingdom) from Job Portal http://www.jobisite.com/extrJobView.htm?id=109622

[jobisitejobs]

Community Mental Health Nurse RMN / Band 6 Needed ASAP Rayleigh, Essex, United Kingdom

Our Client provides a wide range of treatment and support to young people, adults and older people experiencing mental illness both as inpatients and within the community.  This includes; including treatment, in secure and specialised settings.

The post holder:

Will act as an independent practitioner within a defined community setting, while liaising with other professionals as necessary.

Will manage a defined caseload and provide supervision to others as appropriate.

Will be responsible for the assessment planning implementation and evaluation of nursing care within agreed parameters, and have a working knowledge of local, national policies and legislation, which govern current service provision and audit.

Will be responsible for ensuring effective communication pathways exist.

Will be responsible for ensuring the promotion of equality diversity and rights in accordance with good practice and legislation.

Will be responsible for identifying and contributing to the training needs necessary in providing quality evidence based care as appropriate.

JOB SUMMARY

  To be responsible as the Care Coordinator for the assessment and coordination of care needs, planning and implementation of evidence based care to a defined group of service users and their carers within a defined catchment area/locality. To provide professional advice and support to other agencies and members of the multidisciplinary team, and act up for the Team Manager in their absence as appropriate. To act as a role model and resource for junior/less experienced staff.

  KEY STRATEGIC RESPONSIBILITIES

  To be responsible for the assessment, planning implementation and evaluation of the evidence based care required, including health promotion for a named service user/group.

Responsible for the appropriate clinical risk assessment of service users contacting the “Out of Hours” service, providing an effective advice, guidance and decision making process culminating in the coordination of any reviewed plan of care.

Responsible for the admission, case conference/reviews and discharge in collaboration with members of the multi-disciplinary team.

Responsible for coordinating the care and assessment under the Care Programme Approach of a designated caseload

Responsible for participating in the development of the service, setting of quality standards, including the auditing, monitoring and reviewing in line with current clinical guidance practice and policy.

Responsible for ensuring the postholder understands and meets their professional responsibilities under Safeguarding Vulnerable Adults and Children Legislation.

Responsible for ensuring that the requirements of the Mental Health Act 1983 are observed, adhered to and implemented.

Responsible for the promotion of carer and service user involvement within the service and for its provision.

Responsible for establishing therapeutic relationships with service users, and the implementation of evidence based therapeutic interventions with appropriate boundaries in accordance with Nursing and Midwifery Councils professional code of conduct.

Responsible for ensuring that carers’ assessments, education and support is delivered in accordance with the requirements of the NSF.

Responsible for deputising and providing appropriate support and caseload coverage for colleagues/team members.

  OPERATIONAL RESPONSIBILITIES

  Responsible for participation in the Trust appraisal process, and take a lead in identifying own/others mandatory professional, supervisory, personal development and training needs for junior and senior team members.

Responsible for ensuring that the post holder and junior staff members’ access and participate in clinical supervision.

Responsible for the safe custody and administration of medicines.

To participate and contribute appropriately in research, service modernisation, clinical governance and the National Service Framework.

To ensure that the agreed philosophy approach is adopted and followed, whilst respecting and valuing the different therapeutic approaches available within the multi-disciplinary team

Responsible for ensuring confidentiality is maintained at all times in accordance with the data protection act, trust policy and good practice.

Responsible for maintaining and conducting oneself in a professional manner towards service users, carers, colleagues and other agencies.

Participate in joint working with appropriate experts/agencies.

The post holder is responsible for ensuring that they contribute and work towards the service/organisational aims and objectives.

The post holder as an individual is required to understand their responsibility for respecting and promoting issues of equality diversity and rights in accordance with good practice and legislation.

Responsible for reading, understanding and complying with all relevant trust and statutory policies and procedures.

  STAFF MANAGEMENT

  Responsible for the effective utilisation of nursing/financial resources to ensure adequate clinical care is provided with a requirement that all incidents, which may compromise care, are reported immediately to a senior manager, and clinicians involved in their care as appropriate.

To make decisions and work within a framework commensurate with their level of knowledge and competence and to act accordingly within their sphere of responsibility.

Responsible for ensuring that appropriate safeguards and practices are adopted when working autonomously with clients independently.

Responsible for the provision of formal and informal training of pre/post registration students, staff members, carers and service users.

Responsible for providing formal and informal training on Mental Health promotion to statutory and non-statutory services.

Responsible for the provision of staff induction, mentorship, appraisal and clinical supervision to professional colleagues as appropriate.

  COMMUNICATION AND WORKING RELATIONSHIPS

  The post holder is responsible for ensuring accurate and timely written records are kept which comply with the Trust policy and NMC guidance, reporting on any issues as appropriate.

The post holder is responsible for ensuring they comply with current good practice in informing/updating all members of the multi-disciplinary team, their colleagues, service users and appropriate others of changes involving current nursing care plans, progress, mental state and psychosocial factors in line with best practice.

The post holder is responsible for ensuring that they clearly communicate with clients and carers, actively listen to establish an understanding of the needs of the service user and their carers.

CommunityMentalHealthNurse(RMN)Band6(NeededASAP)(Rayleigh,Essex,UnitedKingdom) from Job Portal http://www.jobisite.com/extrJobView.htm?id=109622

[usajobsite]

Community Mental Health Nurse RMN / Band 6 Needed ASAP Rayleigh, Essex, United Kingdom

Our Client provides a wide range of treatment and support to young people, adults and older people experiencing mental illness both as inpatients and within the community.  This includes; including treatment, in secure and specialised settings.

The post holder:

Will act as an independent practitioner within a defined community setting, while liaising with other professionals as necessary.

Will manage a defined caseload and provide supervision to others as appropriate.

Will be responsible for the assessment planning implementation and evaluation of nursing care within agreed parameters, and have a working knowledge of local, national policies and legislation, which govern current service provision and audit.

Will be responsible for ensuring effective communication pathways exist.

Will be responsible for ensuring the promotion of equality diversity and rights in accordance with good practice and legislation.

Will be responsible for identifying and contributing to the training needs necessary in providing quality evidence based care as appropriate.

JOB SUMMARY

  To be responsible as the Care Coordinator for the assessment and coordination of care needs, planning and implementation of evidence based care to a defined group of service users and their carers within a defined catchment area/locality. To provide professional advice and support to other agencies and members of the multidisciplinary team, and act up for the Team Manager in their absence as appropriate. To act as a role model and resource for junior/less experienced staff.

  KEY STRATEGIC RESPONSIBILITIES

  To be responsible for the assessment, planning implementation and evaluation of the evidence based care required, including health promotion for a named service user/group.

Responsible for the appropriate clinical risk assessment of service users contacting the “Out of Hours” service, providing an effective advice, guidance and decision making process culminating in the coordination of any reviewed plan of care.

Responsible for the admission, case conference/reviews and discharge in collaboration with members of the multi-disciplinary team.

Responsible for coordinating the care and assessment under the Care Programme Approach of a designated caseload

Responsible for participating in the development of the service, setting of quality standards, including the auditing, monitoring and reviewing in line with current clinical guidance practice and policy.

Responsible for ensuring the postholder understands and meets their professional responsibilities under Safeguarding Vulnerable Adults and Children Legislation.

Responsible for ensuring that the requirements of the Mental Health Act 1983 are observed, adhered to and implemented.

Responsible for the promotion of carer and service user involvement within the service and for its provision.

Responsible for establishing therapeutic relationships with service users, and the implementation of evidence based therapeutic interventions with appropriate boundaries in accordance with Nursing and Midwifery Councils professional code of conduct.

Responsible for ensuring that carers’ assessments, education and support is delivered in accordance with the requirements of the NSF.

Responsible for deputising and providing appropriate support and caseload coverage for colleagues/team members.

  OPERATIONAL RESPONSIBILITIES

  Responsible for participation in the Trust appraisal process, and take a lead in identifying own/others mandatory professional, supervisory, personal development and training needs for junior and senior team members.

Responsible for ensuring that the post holder and junior staff members’ access and participate in clinical supervision.

Responsible for the safe custody and administration of medicines.

To participate and contribute appropriately in research, service modernisation, clinical governance and the National Service Framework.

To ensure that the agreed philosophy approach is adopted and followed, whilst respecting and valuing the different therapeutic approaches available within the multi-disciplinary team

Responsible for ensuring confidentiality is maintained at all times in accordance with the data protection act, trust policy and good practice.

Responsible for maintaining and conducting oneself in a professional manner towards service users, carers, colleagues and other agencies.

Participate in joint working with appropriate experts/agencies.

The post holder is responsible for ensuring that they contribute and work towards the service/organisational aims and objectives.

The post holder as an individual is required to understand their responsibility for respecting and promoting issues of equality diversity and rights in accordance with good practice and legislation.

Responsible for reading, understanding and complying with all relevant trust and statutory policies and procedures.

  STAFF MANAGEMENT

  Responsible for the effective utilisation of nursing/financial resources to ensure adequate clinical care is provided with a requirement that all incidents, which may compromise care, are reported immediately to a senior manager, and clinicians involved in their care as appropriate.

To make decisions and work within a framework commensurate with their level of knowledge and competence and to act accordingly within their sphere of responsibility.

Responsible for ensuring that appropriate safeguards and practices are adopted when working autonomously with clients independently.

Responsible for the provision of formal and informal training of pre/post registration students, staff members, carers and service users.

Responsible for providing formal and informal training on Mental Health promotion to statutory and non-statutory services.

Responsible for the provision of staff induction, mentorship, appraisal and clinical supervision to professional colleagues as appropriate.

  COMMUNICATION AND WORKING RELATIONSHIPS

  The post holder is responsible for ensuring accurate and timely written records are kept which comply with the Trust policy and NMC guidance, reporting on any issues as appropriate.

The post holder is responsible for ensuring they comply with current good practice in informing/updating all members of the multi-disciplinary team, their colleagues, service users and appropriate others of changes involving current nursing care plans, progress, mental state and psychosocial factors in line with best practice.

The post holder is responsible for ensuring that they clearly communicate with clients and carers, actively listen to establish an understanding of the needs of the service user and their carers.

CommunityMentalHealthNurse(RMN)Band6(NeededASAP)(Rayleigh,Essex,UnitedKingdom) from Job Portal http://www.jobisite.com/extrJobView.htm?id=109622

[jackmanning]

The six-eyed frog was folding clothes with sweaty hands and being nonchalantly scrutinised by a circling undercover employee evaluator named Brian. Brian was wearing a severely casual €25 shirt and €18 beige chinos and blended in with the flitting swathes of customers to the extent that the frog paid him literally zero mind. It was the frog’s fourth day on the job which when asked by his frog friends he described as simultaneously relaxing and stressful, mostly because he hadn’t yet made up his mind. The room had no discernible temperature. 

Brian wasn’t satisfied. The frog wasn’t folding clothes like he had been shown at induction like just so. By God, when the frog had finished folding for one table, he’d crawl around his given department looking for more to fold and - if everywhere was tidy (and believe it or not, on occasion it would be) - he’d pick up any random garment and refold it. “Waste of resources” was the line running through Brian’s mind as he circled the green six-eyed frog who currently was creepily handling the department’s  woolen sweaters, Brian himself pretending to browse and fumbling with coats.

Few customers approached the frog with queries what with the fact that he was a frog - and had six eyes at that. But just now a doe-eyed soft-lipped probably Mexican woman asked the frog where the fitting room was located. Brian watched intently from the next aisle, his head tilted towards a long-line muscle-fit t-shirt. 

“For women?” The frog rasped, six eyebrows raised, trying his best to seem friendly. 

"Of course!” she laughed, flicking her hair.

“That’s downstairs!” The frog practically shouted at her, green hands pointing to the floor. 

The woman turned, face concerned, and headed for the escalators. Brian shook his head and took a mental note that the frog’s customer interaction skills - the very foundation of what the Company prides itself on - were not up to snuff.

The undercover employee evaluator evaluator named Dave who was wearing a €259 teal slim-fit suit and currently circling Brian took note that he had shaken his head - breaking character. He’d let Angela know later on. 

Dave was faffing about in the sportswear aisle while keeping a cold and piercing green eye upon Brian. He felt the inexplicable urge to sneeze and hence did so. This was duly noted by the ever-wider circling Andréa, the nineteen year old Colombian intern hired Saturday last who wore a spike through her ear and a loose €35 checkered shirt. Dave had not so much as even attempted to cover his mouth - Angela would not be pleased. Andréa herself rarely if ever fell ill, knowing all too well the importance of health to an undercover employee evaluator evaluator evaluator.

The six-eyed frog glanced around as he approached his folding table and, feeling awash in a curious queasy dizziness, knocked one of his poor little green feet harshly against its wheel. As he bent to rub out the pain his keen ears pricked at the sound of somebody tutting - he turned. Some customer had just mocked him. This wasn’t the frog’s day.

Brian was scolding himself and hastily retreating to the Christmas jumper section having just made eye contact with the frog. Assuring himself that the frog didn’t suspect a thing, he once again began to circle. Dave couldn’t help but smile to himself at Brian’s immense fuck up - he had always resented Brian. Always had that air of superiority that employee evaluators seem to be plagued by. Oh how he’d love to burst his pathetic bubble, inform him that he too was observed - he too was being always watched, reviewed, analysed.

Dave’s goofy grin was being added to the list of Andréa’s mental quibbles when something strange happened. The frog was unable to dispel his growing sense that he was the pivot of some paralysing hypnotic spiral. The dizziness became immeasurable and the little green six-eyed frog collapsed in the centre of the store, blocking numerous customers’ access to the shop’s new line of €14 knitwear - much to their chagrin.