Sanctuary for the Abused

Wednesday, April 30, 2008

"Bad Nerves" - What Are They?

By Joseph M. Carver, Ph.D., Clinical Psychologist

As a psychologist, I typically ask patients to describe the emotional state or social situation that brings them to my office. In 34 years of clinical experience, I’ve heard a variety of descriptions. Some individuals have researched their symptoms and may describe themselves as depressed, anxious, phobic, obsessive-compulsive, or anorexic. Others use common words or descriptions such as “I’m sad”, “I worry too much”, or “I’m paranoid!” Some are quite articulate and offer symbolic interpretations such as “My heart’s been eclipsed” or “I’ve lost the wind in my sails”.

Some patients describe family, social, or cultural circumstances as part of their emotional status and condition. I’ve heard “My family put the ‘D’ in dysfunctional” or “We have to use rent-a-cop at the Christmas Dinner”. Some focus on a specific event or situation of concern such as “I’m going through a divorce” or “I’m worried about a surgery”.

It’s also common to encounter a description of their difficulties from a social or competency standpoint. Common interpretations of their condition might be “I’m not running on all cylinders” or “My light’s gone out”.

Bad Nerves
One label is often used to describe all the above – the presence of years of stress, a mental health condition, social problems, and an impairment in their ability to function effectively in the home or community. The description for this condition is often “Bad Nerves”. “Bad Nerves” is patient’s diagnosis - a description of several impairments and/or problems that are generally more complicated than any single clinical issue such as a phobia or depression. The term “Bad Nerves” doesn’t suggest that the physical nerves, neurons, or nervous-system structure of the body is impaired. Shaking and tremors in the hands may be the most visual and observable symptom of “Bad Nerves” but the self-diagnosis suggests more than anxiety or tremors.

The term “Bad Nerves” is almost never used to describe situational depression, grief, or an emotional reaction to a specific stressor. Instead, the term “Bad Nerves” often suggests several different emotional, personal and social problems that have been active for many years. In some cases, it’s difficult to identify when “Bad Nerves” started or what stressful events are involved. In other cases, an incident in the past may be identified as the starting point, suggesting the Bad Nerves began after a divorce, work injury, death of a loved one, or other significant trauma.

Psychologists use the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) to describe mental health conditions. To be given a diagnosis of depression for example, a patient must have a depressed mood, reduction in interest/pleasure, weight loss or gain, sleep disturbance, physical agitation or chronic fatigue, feelings of worthlessness, impaired concentration, and recurrent thoughts of death or suicide. As I thought about what conditions, symptoms, and situations combine to produce “Bad Nerves”, a list of criteria came to mind.

In my experience, the condition of “Bad Nerves” is actually a group of several factors that are present in the same individual. When these “Bad Nerves” factors are combined, they tend to be overwhelming and often make it very difficult for the individual to function effectively in their life. The following diagnostic criteria might be considered for a diagnosis of “Bad Nerves”:
1. An on-going sense of tension and apprehension. The majority of individuals reporting “Bad Nerves” also report a near-constant sense of tension, anxiety, and apprehension. As though waiting for something bad to happen, they report a sense of anxious expectation. There is also a feeling and attitude that they are not safe or secure, both emotionally and socially. There’s a sense of living in a combat zone where a situation that creates sheer terror can occur at any time. This apprehensive expectation is a characteristic of anxiety and becomes part of “Bad Nerves” when it becomes a daily emotional state that is not triggered by the presence of a real threat or danger. When in a safe and protected environment, individuals with “Bad Nerves” remain anxious and upset.

2. The presence of a difficult, traumatic, or stressful upbringing. Patients reporting “Bad Nerves” frequently describe stressful, traumatic or difficult childhoods. They are frequently the product of very stressful family backgrounds where a positive or healthy role model was not available. Many patients with “Bad Nerves” describe how threats, yelling, screaming, and other anxiety-producing situations were part of their daily childhood routine. From descriptions, their families had little in the way of coping or problem-solving skills. Their history may include episodes of abuse or neglect, divorce, or severe family problems. Most individuals who feel they have “Bad Nerves” can also list members of their family who experience the same condition.

3. The presence of a period of severe stress or turmoil. In almost every case of “Bad Nerves” there is a period of time in the patient history of severe stress, anxiety, threat, or emotional trauma. Military combat, an abusive marriage/relationship, abuse/assault, environmental trauma (tornado, flood, etc.), a severe injury, or other significant social situation is often identified. The patient with “Bad Nerves” may feel they have never fully recovered from that experience, reporting the sense that the experience still haunts or torments them. They often use the event as a dividing timeline, discussing how their life was different before and after the stressful experience. The changes produced by the event are often extensive and overwhelming, describing the changes with “I haven’t been the same since…”. Patients also describe themselves as having two different social and emotional states – before and after the period of stress. I’ve often heard “Before the accident I was…” as well as “Since that happened I’ve not been able to…”.

4. Presence of an active mental health concern. Every individual with “Bad Nerves” has clinical depression and/or anxiety to some extent. As “Bad Nerves” is used to suggest a condition that has been present for several years, a clinical depression is often found. The depression or anxiety disorder brings multiple physical and body symptoms to the stressful social situation. Individuals with “Bad Nerves” have sleep and appetite problems, low energy levels, excessive worry, fretfulness, and bodily signs of stress and/or agitation such as bowel/bladder problems, chest pain, choking sensations, muscle twitches, hand tremors, and a sense of being on-edge or “wired”. Poor concentration and memory are also present and complicate the recovery process. The physical signs of anxiety and depression add to the feeling that “nerves” are involved in their situation.

5. Low Self-Esteem. While “Bad Nerves” is used to describe their emotional status, “Bad Nerves” is also part of their self-description and personal identity. In the way that medical patients may describe themselves as “diabetic” or “asthmatic”, individuals who report “Bad Nerves” typically view themselves as less competent than their peers, especially in areas of emotional stability and social judgment. The may view their emotional status as a form of disability or hindrance in their life. Even when they find themselves in times of calm or low-stress, their self-perception of having “Bad Nerves” suggests that if a difficult situation arises – they won’t be capable of handling it. This chronic low self-esteem and self-defeating attitude often prompts individuals to apply for disability, listing “Bad Nerves” as their reason for disability. It may also prevent them from engaging in positive activities such as additional schooling, relocations, better jobs, and other changes in their life – feeling their “Bad Nerves” would surface and prevent their success. A self-description of “Bad Nerves” tells us that self-defeating attitudes and opinions are present. The low self-esteem present in Bad Nerves may have originated in childhood, related to upbringing or family dysfunction, or it may be linked to years of depression.

6. A weak or dysfunctional support system. Most individuals seek emotional support, advice, and encouragement from trusted others in their environment. Patients reporting “Bad Nerves” rarely have a good support system where they can obtain positive, useful, and mature information. Often, their support system contains individuals with similar backgrounds or social difficulties. The inappropriate advice from the poor support system often complicates the difficulties of the individual with “Bad Nerves”. Bad advice is typically more damaging than receiving no advice at all. Seeking support from relatives who were also involved in the high-stress childhood and/or upbringing typically adds problems. Confronted with a social issue, for example, advice to “Go out and get drunk” is clearly not effective problem solving. It may be a common family reaction to stress however.

7. Impaired or Dysfunctional Coping Skills and Techniques. Individuals reporting “Bad Nerves” typically have inadequate or weak skills when it comes to coping with problems, reducing stress, evaluating situations, and/or knowing what to do in difficult times. Usually related to the lack of a positive or mature role model in their past, their coping strategies range from ineffective to actually making their situation worse. It’s like playing tennis with a broom – your heart’s in the right place but your technique is terrible. When confronted with stressful or complex situations, those with “Bad Nerves” often attempt to cope by using alcohol or drug use/abuse, physical violence, threats, escape behaviors (“I’ll just quit the job!”), or even bizarre reactions. Confronted with a marital separation, they may use partying and sexual promiscuity in an attempt to improve their mood, only to be disappointed when they notice they feel worse. Due to their poor support system, they may follow inappropriate, immature, or even ridiculous advice or recommendations such as “To get out of this depression, you just need to buy a new car!” Poor problem solving and coping skills always keep the solution to most problems out of reach.

8. Presence of a high stress lifestyle. Individuals with “Bad Nerves” report stress or emotional turmoil in almost every aspect of their daily life. Problems with finances, jobs, children, spouses and ex-spouses, friends, extended family, medical problems, and life-in-general are reported. One patient added to his list with “Even my dog hates me!” Ineffective problem solving often adds stress to the lifestyle by adding the complications of alcohol/drug use, gambling, illegal behavior, or impulsive actions. When a parent is dealing with Bad Nerves, their ability to parent and guide their children may be impaired, creating behavior problems in the children. This high-stress lifestyle acts to maintain a high level of tension in the individual, making it difficult to address single or specific sources of stress.

9. Unstable Friends. Individuals with Bad Nerves typically have relationships with unstable friends and/or family. These friends may be emotionally unstable, needing support at all hours of the day and night, or they may be socially unstable in the sense of needing money, emergency shelter, and help with various complex situations. Instead of being part of a support system, these friends become an additional stressor in the lifestyle of someone with Bad Nerves. There’s a big difference between a friend-in-need and a friend-in-constant-need. When struggling emotionally, these unstable friends add significantly to the level of stress and obligation.
The individual with Bad Nerves feels overwhelmed. They often summarize their situation with “I don’t know what to do…or where to start!” They also voice a sense of hopelessness and helplessness with “I’ve always been this way” or “Nothing I’ve ever done has helped”.

Treatment for Bad Nerves
Treatment for Bad Nerves involves several approaches that include mental health care, improving social skills, and reorganizing the lifestyle. Here are some guidelines:
* If your background involves a high-stress upbringing that includes abuse, neglect, drug/alcohol problems, domestic violence, or mental instability in one or both parents – recognize that you may have been given a poor or ineffective role and life model. It’s helpful to compare your social and parenting practices with those recommended in self-help or advice books and magazines. As an example, we may have difficulty parenting due to our poor models. We may be using parenting techniques – while they were acceptable in our childhood home – that may increase problems in our children. As an example, high-stress homes often produce parents who slap their children in the face or who throw objects when angry. Not surprisingly, children in these environments use these same behaviors when they become teens and adults, often becoming behavioral problems in the school and community. Like scanning our computer for a virus, it’s helpful to look at our behavior for signs of defective or inappropriate mental and social programming.

* High-stress homes often widen our tolerance for maladaptive/bad situations by teaching us inappropriate “standards” of what is acceptable behavior. As a result of this “high tolerance” we accept bad and abusive situations, often because similar situations were present in our home. For example, if our father or mother were an alcoholic, drinking a beer for breakfast may seem “normal” to us. If we have developed a high tolerance for bad situations, we may begin to think all relationships involve screaming, jealousy, domestic violence, or other abusive behaviors. Possessing a “high tolerance” for bad situations assures us that those bad situations will continue in our life. I’ve worked with some families where domestic violence is a weekly event. To reduce problems created by a high tolerance for dysfunctional situations, it may be helpful to seek out the opinion of someone you consider emotionally and socially healthy. You can also imagine that your decisions are being reviewed by a committee of individuals you feel are good decision makers. This approach allows us to improve our decision-making skills by imagining what a healthy response or decision might be, especially if our poor social or personal judgments are creating more problems. Faced with a situation or decision, we might think to ourselves “What would Uncle Bob or Pastor Jones think of this situation? What would their advice be?” If we think about our previous poor judgments, we know what others would have thought about it. If we want healthy relationships, seek guidance from people who have healthy relationships. If we want a stable, calm life – seek guidance from those who have a stable and calm life. If we have Bad Nerves, we complicate our life by asking advice from the wrong people. It doesn’t make sense to ask a hobo how to become a millionaire.

· When we have a background of personal, family, and social difficulties it’s difficult to decide what is normal and healthy. This is related to that “high tolerance” for bad situations. After a series of abusive or poor relationships – a new normal or healthy partner might actually seem strange to us. If we have a temper tantrum and tell the healthy individual “Get out of my life” – guess what? That’s what they may do. They may not yell and scream, fight back, or try to fix the situation. They may not throw a brick through your window with an “I Love You” note tied to it. Their healthy decision is to avoid a relationship that includes aggressiveness, tantrums, or other forms of high-stress drama. After an abusive relationship, we may feel our healthy partner doesn’t love us because they aren’t aggressively or violently jealous. We use our background and experiences to evaluate and judge our current situations. As we might expect, this sets us up for more of the same. If we feel we are a “jerk magnet” or say “I always end up in the same type of relationship” – we may be unintentionally ignoring healthy partners because they don’t act like our past abusive, controlling or emotionally-detached partners.

· Mental health treatment is very helpful and often takes several forms. If we have symptoms of a clinical depression or anxiety disorder, medications may help. We’d look for sleep and appetite problems, crying spells, panic attacks, and other indicators. Our low self-esteem and mental health conditions can also be treated through individual or group counseling/therapy. Modern psychotherapy may focus on improving decision-making and improving our attitudes. Mental health professionals can also guide us toward those who may treat specific social situations such as children of alcoholics, victims of abuse, etc.

· In seeking mental health treatment, it’s important to spell-out our symptoms. For example, the majority of psychiatric medications are actually prescribed by non-psychiatrists. This is often dangerous. For example, a self-diagnosis of “Bad Nerves” may be incorrectly interpreted as an anxiety disorder rather than depression. Medications that reduce anxiety may have little or no effect on our depression. In a rather strange emotional state, we find ourselves “calmly depressed”. Inform physicians of the exact symptoms such as crying spells, sleep problems, etc. to improve your treatment.

· Actively seek to improve your emotional skills and your judgment. People become good at anything they study and practice. For example, a good golfer knows the number of dimples on his or her golf ball – 336 for an American golf ball and 330 for a British golf ball. Start reading, researching different views and recommendations, and looking at the advice of professionals. Reading allows us to learn about anything we want and the Internet is the world’s largest home library. As another example…I’ve never hit a golf ball, but I know how to read and find answers to questions as they arise in my life. I found the number of dimples in a few minutes searching the Internet. Learn as much as possible about the conditions or difficulties you are facing on a daily basis.

· Emotionally and/or socially unstable individuals often surround people with Bad Nerves. These unstable people are often family or friends. To stabilize our life, we must often work to gradually move these people to a safe emotional, social, or financial distance. When those with Bad Nerves do an inventory of their relationships, they often find a collection of people who take advantage of them for time, money, work, responsibility, etc. We must become assertive and develop a stand with these individuals. Rules can be developed such as 1) I’ll only baby-sit one night per week, 2) I’m good for twenty dollars a week and no more, or 3) I’ll be glad to listen to your stories but only when you call during the daytime. People who take advantage of us are being selfish and have little regard for how they create stress in our lives. They will seldom put controls on their behavior for your protection. When we take a firm position they may protest or try to punish us or make us feel guilty. If these money-friends protest - “If all I can have is twenty dollars a week, you’ll not see me anymore” – use the extra twenty dollars to take a new but healthy friend to lunch.

· Develop a long-term plan for improving your life. Many individuals develop a one, two, or three-year plan. There may be things we stop doing…and things we start doing. We may begin referring unstable friends to the mental health center rather than attempt to solve their problems alone. We may enroll in mental health treatment. We might research opportunities to improve our social of job situation. We can begin programs to improve our self-esteem (exercise, weight-loss, schooling, etc.). When we’re anxious, the idea of a two-year plan seems overwhelming. In truth, everyone with a college degree had a two or four year plan to improve his or her life. Long-term plans can be very successful.

· Make an effort to control, reduce or eliminate those aspects of our life that add to our stress. This may include such things as cigarettes, alcohol, gambling, etc. Try to improve financial and social decisions. Make a mental inventory of what we worry about, decide what can be done to reduce stress in that situation, and develop a plan. Place some control on your vices. If we want to build our social skills, drinking beer at the local bar isn’t an effective plan.

· Recognize that patience and persistence pays off. The “40” in WD-40 spray lubricant tells us the first 39 formulas at the laboratory didn’t work! Effort, discipline and control pay off. Coleman Cox said “I’m a great believer in luck. The harder I work the more I seem to have.” With hard work and persistence, almost any change is possible.

· Understand that “Bad Nerves” is our current situation, not a permanent condition or a curse. The many factors associated with Bad Nerves can be identified, changed, controlled, and improved. By becoming active rather than reactive in life’s activities, we can improve our life and remove “Bad Nerves” from one of the many terms we use to describe ourselves. Rather than describe yourself with “I’ve got Bad Nerves” – you can use “I’ve got a great marriage” or “I’ve got a great career”.
This article is presented as a public service and is not intended as a substitute for professional mental health care. Some of these recommendations may not apply to your individual situation.

- Joseph M. Carver, Ph.D., Clinical Psychologist

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Thursday, April 03, 2008

4/3/08 - Blogs Against Sexual Violence

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The social phenomenon of female juvenile prostitution is a serious problem that is difficult to understand and troublesome to acknowledge. The fact that young girls are finding their way into the complex system of prostitution is often met with disbelief. Many myths and stereotypes exist about prostitution. Without an understanding of these, one cannot fully appreciate the exploitation factors that exist for the juvenile. (Many abusers & sex addicts use prostitutes. 92% of prostitutes clients are MARRIED men.)

MYTH 1 - Prostitution is a natural expression of sexuality and a necessity for inadequate sexual relationships.

This view supports a sexual myth that men have uncontrollable sexual urges that must be fulfilled. Herein lies a justification for prostitution. The juvenile prostitute is dehumanized by the implication that prostitutes serve a useful purpose as an object for sexual gratification. The reality, as described by our sample of former juvenile prostitutes, is that juvenile prostitutes are often appalled at and damaged by the acts demanded of them. Their participation is often a threat to their physical well-being. The act of prostitution is structured by the desires and fantasies of the customer, which are incongruent with the desires and sensitivities expressed by the young women in this sample.

MYTH 2 - Prostitution is a victimless crime.

Prostitution creates a setting whereby crimes against men, women, and children become a commercial enterprise. When a customer uses a juvenile prostitute for his/her own sexual gratification, he/she is committing the crime of child sexual abuse. It is an assault when he/she forces a prostitute to engage in sadomasochistic sex scenes. When a pimp compels a prostitute to submit to sexual demands as a condition of employment, it is exploitation, sexual harassment, or rape--acts that are based on the prostitute’s compliance rather than her consent. The fact that a pimp or customer gives money to a prostitute for submitting to these acts does not alter the fact that child sexual abuse, rape, and/or battery occurs; it merely redefines these crimes as prostitution.

MYTH 3 - Juveniles freely choose prostitution.

The following self-reported data on the impact of child abuse shows that victims of violence can lose their sense of psychological and physical well-being. Case histories suggest that a number of juveniles engaged in prostitution grew up in abusive and/or neglectful homes. A fragile self-esteem and limited resources lead some young girls to believe that they have no other choice but to enter the world of prostitution.

MYTH 4 - Prostitution can be an exciting and glamorous life.

Cultural mythology about prostitution is built on misinformation and fantasies of sexuality that are promulgated through movies, television, videotapes, and printed material including pornography. These may entice naive young women into prostitution with false promises of glamour and riches. In reality juvenile prostitutes suffer pain, humiliation, and degradation at the hands of their pimps and customers. They are susceptible to sexually transmitted diseases and unwanted pregnancies.

MYTH 5 - The system of prostitution offers wealth to the participant.

The economics of prostitution are complex. If a juvenile is controlled by a pimp or madam most, if not all, of his/her earnings are turned over to the pimp or madam. If working independently for a house of prostitution a large percentage of his/her earnings are turned back to the house. Their lives are strictly controlled, and their ability to set up independent funds is carefully guarded. Part of the strategy for control over their activities is for pimps and madams to keep them economically dependent upon the system of prostitution itself. Any profit is often spent as rapidly as it is obtained, reinforcing the efforts that go into prostitution. A rapid turnover of "feel good or look good" money into immediately expendable, positively reinforcing products perpetuates the need for continued participation in prostitution.

MYTH 6 - Prostitutes have power and control within the system.

Reports from these female prostitutes concerning their exchange of sex for money illustrates the reality that they are controlled by their customers. The demands for money placed upon them by their pimps with the instructions to charge accordingly for what the customer wants illustrates a continuum in which the more involved or more deviant the sex act the more that can be charged. These juveniles report being raped and beaten. Sometimes they have been kidnapped or held against their will, taken to deserted areas and abandoned, and robbed or not paid. In some cases they are murdered. The majority of victims in the "Green River" murders are known to be female prostitutes under age 21. (The murder of 48 females has been attributed to the "Green River Murderer." These cases are referred to as the Green River murders because all the victims were discovered in or near the Green River in the state of Washington. In addition, between 1978 and 1986, there have been more than 140 unsolved female homicides in King, Pierce, and Snohomish counties in that state that may also be related to the "Green River Murderer." ) Once involved with a pimp, the prostitute loses autonomy. The more involved one becomes, the more difficult it is to leave. The ability of the prostitutes to find recourse for violations committed against them is limited. Assaults are rarely reported to law enforcement officers. The unwritten "code of conduct" discourages contact with law enforcement in regards to reporting abuse. Also these women often function under the belief that they are responsible for the consequences of their own involvement in prostitution. The pimps who claim to protect may, in reality, "discipline" the prostitute for any perceived shortages of money.

MYTH 7 - Prostitution is a deterrent to sexual crimes.

This myth provides faulty justification to prostitution and pornography. There is no evidence that prostitution deters sex crimes. In fact the opposite may be true. Prostitutes can be victims of violent acts including rape and murder. Young prostitutes can be easy victims for perpetrators. Pornography can feed their fantasies about women and prostitution. Rather than these phenomena being a deterrent, they may reinforce sexual violence.

MYTH 8 - Prostitutes are from specific socioeconomic groups.

Teenage prostitutes come from all socioeconomic groups. While other common denominators exist (drugs, alcohol, child abuse), there is no causative relationship with socioeconomic status.

MYTH 9 - Juveniles make an educated decision to become prostitutes.

Entry into prostitution may begin in the teens or earlier. The majority have been sexually abused as children--usually by fathers, stepfathers, or other trusted adults. Many also suffered physical abuse and neglect. For most of these young women the only way to stop the violence was to run away from home. Young, frightened, with limited skills, and unable to find shelter, teenagers are easy prey for pimps who promise them friendship, romance, and riches. Once involved in prostitution both pimps and customers replicate the abuse these teenagers endured in their families.

MYTH 10 - There are laws to control prostitution.

Historically there has been an unequal application of laws prohibiting prostitution. Until recently only a few customers and even fewer pimps were arrested or convicted.

MYTH 11 - There is a difference between being a high-class prostitute and a street walker.

The most prevalent fantasy is that of the high-class call girl who is typically envisioned as an independent, sophisticated businesswoman whose rendezvous' with well-heeled executives in luxury suites are intellectually stimulating, sensual interludes for which she is handsomely compensated. The following account by one such prostitute dispels that myth:
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I was a New York City call girl with my own book. My johns had careers in the fashion industry, finance, law, and the media. I visited them in their homes, offices, and at well-known hotels like the Plaza. I also worked for madams in well-established brothels around the city. However, this is where any resemblance between my experience and the mythical call girl ends.

I was a young teenage girl, not a sophisticated woman (I lied about my age). I wasn’t an independent agent, but controlled by a brutal pimp who had a stable of women. People believe only streetwalkers are drug addicts, but I abused drugs until well into my twenties. It was the only way I could cope with the physical, sexual, and emotional abuse that defined my job.

As for my well-heeled clientele and their fancy suites, all I can say is, whether you turn tricks in a car by the Holland Tunnel or in the Plaza Hotel, you still have to take your clothes off, get on your knees or lie on your back, and let this stranger use you in any way he pleases. Then you have to get up, get dressed, and do it again with the next trick, and the next.

In the movies, call girls make lots of money which they invest in legitimate businesses when they retire from the life. It’s taken me close to twenty years to undo the damage that was done to me in prostitution. Not only did I leave prostitution impoverished, I was totally isolated from mainstream society.

The only people I’d had contact with for almost a decade were pimps, tricks, and other prostitutes. I was deprived of a basic education. I had no job skills. My health was severely compromised. I required surgery and repeated medical treatment for reproductive damage and remain infertile. In addition to these tangible issues, I’ve coped with the trauma resulting from years of emotional, physical, and sexual abuse that is common in the lives of prostitutes.
Like women escaping abuse men, women in prostitution must totally rebuild their lives.
This material is reprinted from "Female Juvenile Prostitution: Problem and Response" by the National Center for Missing and Exploited Children (NCMEC), Arlington, Virginia, USA, and reprinted with permission. All rights reserved.


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