Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for chronic pain?

Chronic pain is not maintained by faulty thoughts or unwillingness to accept experience. It is the result of a nervous system living under ongoing threat, overload, and unmet needs. When pain is chronic, the body is already doing everything it can to protect itself.

Cognitive Behavioral Therapy (CBT )aims to change thoughts and beliefs about pain. That can slide into telling people that their thinking produces their suffering. For someone in chronic pain, that easily turns into self-blame and pressure to “think better” while nothing in their life or body conditions improves. It also keeps attention focused on pain, which often intensifies it rather than settling it.

Acceptance and Commitment Therapy (ACT) reframes this by saying the pain can stay, and the work is to accept it and live anyway. That sounds kinder, but for chronic pain, it often becomes another demand placed on an already overburdened system. 

Accepting pain while the body remains unsafe, exhausted, or unsupported is not regulation. It’s endurance. It teaches people to coexist with suffering rather than asking why the pain persists and what conditions would alleviate it.

Both models individualize the problem. They place the needed change within the person instead of in the environment, relationships, workload, medical neglect, financial stress, or ongoing injury. They ask the person to adapt to pain instead of reducing what drives the pain.

From an Interpersonal Neurobiology (IPNB) lens, pain eases when the nervous system is supported enough to settle. That means safety, rest, predictability, physical support, relational support, and relief from constant demand. Without those, no amount of cognitive reframing or acceptance practice will resolve chronic pain. It may only teach people to override their own signals.

The issue is not resistance or lack of acceptance. The issue is that the body is still under threat. Until that changes, CBT and ACT are at best incomplete and at worst they are harmful.

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Profiteers of Human Misery: the Corporate Greed Behind Unchecked Psychiatric Abuse

In 2016, BuzzFeed published an investigative report that exposed widespread abuse within the psychiatric industry, specifically revealing Universal Health Services (UHS), one of the largest operators of behavioral health facilities in the U.S. The report uncovered disturbing practices, particularly the unnecessary hospitalization of patients for financial gain. UHS, which operates more than 200 behavioral health facilities, was found to have admitted individuals who didn’t need psychiatric care, solely to secure payments from insurance companies and government programs. This practice was part of a larger business model prioritizing profits over patient care.

The Investigation’s Key Findings

The report revealed the following systematic abuses:

Patient Brokering: UHS, along with other facilities, engaged in “patient brokering,” admitting individuals who didn’t require psychiatric hospitalization, due to financial incentives. 

Targeting Vulnerable Individuals: Patients with private insurance or Medicaid were especially targeted, often being kept in the hospital unnecessarily or diagnosed with falsified conditions.

Deceptive Billing Practices: UHS was found to have manipulated diagnoses and billing codes to maximize profits.

Harmful Treatments: Many patients were subjected to psychiatric treatments they didn’t need, resulting in physical and emotional distress.

Legal and Industry Response

Following the BuzzFeed report, the U.S. Department of Justice (DOJ) launched an investigation into UHS. This led to a $122 million settlement in 2017, which addressed fraudulent billing practices but failed to confront the broader issues of overmedication, unnecessary institutionalization, and patient abuse.

Whistleblowers within UHS, many of them members of the Service Employees International Union (SEIU), were instrumental in exposing these practices. While the whistleblowers received $6 million from the settlement, patients harmed by UHS’s misconduct received no direct compensation. Critics argued that the settlement’s focus on financial penalties did not ensure long-term reforms to protect patients.

Lack of Long-Term Patient Protections

Despite the large settlement, UHS was not required to implement meaningful changes to its patient practices. The systemic issues, including the industry’s profit-driven model and over-reliance on medication, remained unresolved. Patient protections and access to holistic, trauma-informed care continued to be inadequate.

While there has been increased scrutiny of the mental health industry, large providers like UHS still operate under a business model prioritizing profits over patient well-being. The psychiatric industry continues to use outdated methods, such as long-term medication, without addressing patients’ neurophysiological needs or offering trauma-informed approaches to healing.

SEIU’s Role and Criticism

The involvement of the SEIU in the whistleblower case has sparked controversy. Although the union played a crucial role in exposing UHS’s fraudulent practices, the settlement largely benefited the union and the government, not the patients harmed by unnecessary hospitalization. Whistleblowers received $6 million as part of the settlement, while survivors received no compensation. This situation has led to criticism that survivors’ stories were leveraged for financial gain without addressing their trauma or providing justice.

The Current State of the Behavioral Health Industry

Since the BuzzFeed report, only minor improvements have been made in the behavioral health industry:

Long waiting lists for care persist.

Trauma-informed treatment remains inaccessible for many.

Many psychiatric institutions, like UHS, still rely heavily on outdated treatment models, including overmedication and inadequate patient care.

Despite growing awareness of the importance of holistic, trauma-informed care, psychiatric hospitals remain slow to adopt these approaches. Patients continue to fall victim to a system that is not designed to support their long-term recovery.

A Call for Systemic Change

The BuzzFeed investigation brought significant attention to abuses within the behavioral health industry, but the response has been insufficient. Meaningful reform remains elusive, with the industry continuing to prioritize profits over people. 

This systemic failure underscores the importance of understanding Interpersonal Neurobiology. By promoting compassionate, trauma-informed care and challenging harmful hierarchies within psychiatry and the medical system, we can build a path toward genuine healing. True change will come when we prioritize human connection and well-being over corporate profit.

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The 17-Gun Salute That Shattered Me

Five years ago, during a year near death, one of the most intense stressors wasn’t the medical neglect or the endless fight for even minimal care. It was sound. The moment that shattered me was the 17–gun salute at my father’s funeral.

Hyperacusis had already taken over my life. Every sound hit like an intrusion. Even small, harmless noises felt like they were attacking my body. The metallic tick of the HVAC ductwork cooling down felt like explosions up my spine. So, when the rifles fired, it wasn’t “a loud moment.” Each shot tore straight into my system and hit so hard I thought I might crumble to the ground.

This is what people with hyperacusis and audio-somatic synesthesia need to hear: you’re not strange. This is sometimes what the human body does when it has been pushed so far past its limits that the entire auditory pathway remains on high alert. The world stops being “sound” and starts being “impact.” 

At that time, sound didn’t stay in my ears. It crossed over into the somatic system. That’s audio-somatic synesthesia. It began in early childhood, when my ears had to be hypervigilant so I could brace for when my abuser was coming for me. The worse my environment treated me, the worse my condition. Several years ago, it was so disruptive that I wrote to Harvard neuropsychiatrist Dr. Alice Flaherty. She explained that my auditory processing center had become so sensitized under prolonged threat that it was activating the neighboring somatosensory areas. Interpersonal Neurobiology widens the frame: when life has been too loud, too threatening, and too relentless for too long, the boundaries between senses thin.

Those rifles didn’t “startle” me. They slammed through an auditory system already burning from years of overload. They triggered the same survival pathways that had kept me alive when every form of care was withheld. My response wasn’t unusual. It was the exact reaction any human body gives when sound becomes danger.

People with auditory sensitivities need to know this: the world makes this worse by refusing to recognize that hearing is relational. Our auditory system developed within community. Humans settle through voice tone, breath, presence, and rhythm. We were built to hear within circles of safety. When safety collapses, hearing can become a channel for threat.

Hyperacusis isn’t “too sensitive.” It is a natural response when life has demanded more than any human nervous system can hold. Audio-somatic synesthesia isn’t “weird.” It’s the body folding sound into the rest of the system when threat has been chronic and relief has been absent. When people live through cruelty, contempt, medical impunity, and a culture that treats them as disposable, of course, sound can become too much, and the auditory channel can become sensitized.

I survived because I understood what was happening inside me. But I shouldn’t have had to rely solely on knowledge while my body screamed for support that wasn’t available. Community care should have been the buffer. It wasn’t. I’m still rebuilding. Thanks to the application of IPNB principles, my symptoms are a tiny fraction of what they were 5 years ago. I’m rarely startled by sound, and hardly ever feel it in my body.

If you live with hyperacusis or audio-somatic crossovers, understand that your body is doing exactly what human bodies do under prolonged threat without enough co-regulation. This is the predictable outcome of living without safety for too long. Nothing about you is strange.

We were built for circles of safety, steady voices, warm presence, and connection without hierarchy. That’s what helps the auditory system ease again. That’s what allows sound to return to being sound instead of impact.

I want a life ahead where hearing isn’t a battlefield and where my system finally gets to settle. A life of belonging, warmth, steadiness, where sound no longer hurts. A life where I’m surrounded by people who understand that healing isn’t magic, but relational.

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IPNB: Bucking the Culture That Keeps Us in Survival Mode 

Standard treatments do not address ongoing conditions. They try to change thoughts while the body is still organized around threat. From a Relational Neuroscience perspective, that is a mismatch. The system is responding accurately to the conditions under which it must live.

Meanwhile, entire industries are built around managing the outcomes: pharmaceutical companies, the mental illness industry, universities producing practitioners, diagnostic systems, insurance structures, and hospitals. Each makes money off what happens when a child grows up in chronic adversity and becomes an adult shaped by those conditions.

That person is treated like the problem the entire time. Told they are not trying hard enough, need to think differently, be positive, let it go, and find the right medication. Instead of anyone looking directly at the conditions that maintain their survival adaptations.

If those conditions changed, the nervous system would change. If there were consistent attunement, safety, relational repair, and actual support, the system would have what it needs to reorganize. Instead, the environment keeps demanding protection. So the system keeps protecting.

This is why I teach Relational Neuroscience/Interpersonal Neurobiology (IPNB). People can learn to recognize what their bodies actually need, understand how their nervous systems respond to ongoing threats, and find ways to meet those needs in daily life. Learning this gives tools to create safety, attunement, and support outside of the systems that often cause additional harm while claiming to provide care.

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When the Body Sets the Pace: Trauma Integration Through Agency and Relationship

I had a remarkably powerful experience with my craniosacral practitioner after I had realized that my Moro Reflex flashbacks were also connected to the suffocation torture. It was the same posture–prone face up, arms wide, head back–and inability to breathe. I had experienced scores of them as a teenager. I never had the support I needed to integrate them. So, I told my practitioner I wanted to put my arms out and touch into the suffocation torture during the craniosacral treatment. My doctor expressed a little concern about it being okay for me. But he knew from experience the depth of my work and that I had always been okay before.

As soon as I settled in on the table with my doctor’s hands cradling my head, I felt a huge wave of grief roll up my body. I knew it was best to keep my hands at my sides. Stretching my arms out would be too much. This was my system signaling the limit of what I could hold in that moment, and I adjusted in the moment, rather than pushing past it.

In my process, I was in the basement where my abductor had kept me for most of my 15th year. I could safely remember a great deal, including details like the texture of the avocado green blanket on the low bed. I saw the dark wood paneling, bare concrete floor, cheap gun cabinet in the corner, and the stack of 2×4 lumber along one wall. Implicit memory was becoming explicit here, with sensory, positional, and emotional elements linking together while I stayed aware.

I was there, but I was also in the treatment room with my doctor. It was the first time in the 6 years I’ve been seeing him that he spoke during the treatment. Dr. Seth said he had the feeling to tell me that I was safe. I thanked him and told him it was kind of like being in a virtual reality. I was dually aware of being in that dark basement and simultaneously, on my doctor’s table with him there. It was safe enough to be in that basement because I was also present and accompanied by a trusted caregiver. This dual awareness meant the past was active, but it was linked to present-time orientation and a regulating relationship, which changed how the experience unfolded.

As my doctor continued the craniosacral treatment, I found myself at the organic farm where I had happily lived and labored for 9 months. That ended a few weeks before the abduction. Again, like a VR experience, I could see so much: the rolling fields, the creek and pond, the white farmhouse, the big barn, outbuildings, and even the chickens. This shift brought in a different physiological state associated with connection, agency, and ease.

Then I was back in the dark basement of my abduction, and found I could connect with the memories of the torture itself. I could see, hear, and feel what that was like, as if it was happening again. But I knew it wasn’t, and I knew my doctor was there, and that made the difference. I was mostly struck by the recognition of how many times I had experienced that kind of torture, which I learned decades later was in the same field as waterboarding. I remembered I had estimated it had been approximately 175 times, and I felt grief for the 15-year-old who had to endure such unbearable treatment again and again. The memory networks were active, but they were now linked with present safety and relational support, which allowed them to be experienced without taking over completely.

After a few minutes there, I was back at the farm, looking up at apple blossoms against the blue New England sky. I realized that my nervous system was naturally pendulating between the threat experiences and the safe ones. Pendulation creates rhythm between distress and ease. It helps the body process stress without becoming flooded or shut down. From a Relational Neuroscience perspective, this kind of movement reflects flexibility across states, allowing integration by linking differentiated experiences without losing stability. It was powerful and a lot, but it was bearable.

I expect this was the first of a series of sessions to resolve the suffocation torture era of my life. I sense it won’t be particularly long, though. So far, my pattern has been to need just a few short sessions, and each one becomes easier. I’m curious about how it might be the next time. As these experiences repeat with the same conditions in place, the system tends to require less effort to move between states and hold more at once.

I felt different after this significant integration of a year of lived experience that had a major influence on my nervous system and my life. The process was so effective because I had all the agency. It was my idea, direction, centered on my experience, at my speed, and by my route. Dr. Seth helped create the space for that by being safely present and by trusting me and my process. I could tolerate being in that horrible old environment. I could walk around in it and even re-experience the torture without being overwhelmed because I intentionally made the contact on my terms. With no external direction, it was agency, pacing, and relational presence that organized the process.

That’s also the difference between the work I need and the work a therapist would have me do. In my experience, therapists rarely trust the client or their process. They direct according to their training. But I don’t need somebody giving me worksheets or telling me to learn new techniques and practice different ways of thinking. I need someone who can be with me while I encounter the traumatic material and do what I need to integrate it. Thankfully, I have one well-qualified practitioner. Due to his exceptional care, I can now own a piece of my life that was too overwhelming. I know that each exploration of this kind can help me own it more until I own it all. This process changed my relationship with the lived experience; it’s no longer overpowering. And when I’m done, it will finally be in the past where it belongs, at rest.

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Why the Treatment Doesn’t Hold: The Truth About SGB for Complex PTSD

I’ve had 28 Stellate Ganglion Blocks (SGBs) for Complex PTSD, hypervigilance, quadrilateral Complex Regional Pain Syndrome, and other sympathetically driven conditions. These are symptoms of extreme central sensitization from a lifetime of environments adverse to my well-being, especially repeated sexualized violence by caregivers, followed by consistent institutional betrayal when there is no justice or accountability.

There is a version of this treatment promoted as a one-and-done fix for PTSD. That has not matched my experience, and it doesn’t match the conditions under which many of us live. It cannot fix the environment. It does not remove the ongoing threat. It does not create the relational and material conditions required for homeostasis.

What it can do, in my experience, is give the system a break. That is important, because when the system does not have to allocate everything toward threat detection and protection–even temporarily–it has more resources for other things. It can more easily think, plan, connect, and make changes that are otherwise out of reach.

From a Relational Neuroscience perspective, such a break does not hold if the conditions stay the same. The system will reorganize again around what the environment requires. So the question becomes “What can be done with that window?”

For me, the SGB has been a tool, not a fix. It has bought time and energy. And over the years, especially during the periods when I experience the benefits, I have used that time and energy to focus on building conditions that support my system.

I’m doing it in a culture that is very much against supporting human nervous systems. Which means the work is slower, more deliberate, and requires ongoing attention to where energy goes and what demands can be reduced. But even a temporary reduction in hypervigilance provides an opportunity to redirect resources. To move something, even slightly, in a different direction.

By understanding what my nervous system needs, I’ve been able to slowly and carefully build better conditions. This includes improved physical environment, but especially the relational environment. My focus is on building and strengthening safe connections with the people around me.

Understanding a few basic concepts about how this works at the neurobiological level changes how that time is used. It gives us language for what is already happening in the body and in lived experience. It makes the pattern visible. And that creates options that were invisible before. When you can see the pattern, you can change it.

The SGB does not resolve the conditions that created the need for it. It does not replace attunement, safety, or consistent support. But it can create a window where those things become more possible to pursue. That has improved my quality of life because of what I have been able to do with the time and energy it gave me.

SGB is a tool. It buys space. What happens in that space depends on the conditions and on what can be built despite them.

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What Happened to Empathy in Medicine?

Empathy in healthcare is strongly shaped by the conditions practitioners work under and the training culture that forms their habits of attention.

Most medical education emphasizes hierarchy, speed, and diagnostic authority. Students learn early that their role is to control uncertainty and deliver answers. That focus can narrow their attention toward symptoms and protocols rather than the lived experience of the person in front of them.

Work environments add further pressure. Short appointment times, productivity quotas, administrative surveillance, and constant exposure to suffering place practitioners under chronic strain. Under those conditions, people tend to narrow their field of awareness to keep functioning. Emotional distance becomes a practical strategy for getting through the day.

The result is not necessarily indifference but a contraction of the capacity to stay present with another person’s experience.

Institutional culture also plays a role. Many systems reward efficiency and compliance while discouraging reflection about relational impact. When patients question decisions or describe experiences that do not fit the clinical framework, the response can shift toward defensiveness.

The practitioner’s professional identity and the institution’s reputation become priorities that override curiosity about the patient’s perspective.

Another factor is training that privileges abstract knowledge over embodied understanding. Practitioners are taught to observe and categorize, but often receive little support in recognizing how their own stress, fear of error, or discomfort affects the interaction. Without that awareness, empathy can be replaced by technical problem-solving alone.

The loss of empathy in these settings reflects a set of social and organizational conditions that repeatedly pull attention away from relationship and toward control, speed, and institutional protection.

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Seeing the Pattern Changes Your Options: Contempt, Power, and the Environment

Contempt is not just a tone or a facial expression. It is a way of organizing a relationship around power. It places one person above and the other below, and it does it in a way that shuts down curiosity, mutual influence, and repair.

I have seen this up close in my own family. A relative showed contempt toward me during a first introduction to someone important to them. That moment was not random. It set a hierarchy in real time. It defined how I was to be seen and how I was expected to participate, without my agreement and without space to correct it.

From an IPNB perspective, that kind of moment is shaped long before it happens. People learn how to position others through repeated exposure. If contempt is present in their environment over time, it becomes a familiar way to manage relationships. It simplifies things. One person is right or aligned, the other is reduced. That pattern stabilizes certain relationships while distorting others.

The environment matters here. If someone is consistently around narratives that diminish another person, and there is no meaningful counterbalance through direct, respectful contact, those narratives start to organize perception. Over time, they can feel like fact. When there is little or no ongoing interaction to update the relationship, the system fills in the gaps with what it has been given.

Contempt also has a strong effect on the person receiving it. The body shifts quickly into protection. Attention narrows. Energy moves toward managing exposure rather than engaging. If this happens repeatedly, it shapes expectations. Future interactions are approached with more monitoring and less openness because the pattern has already been established.

It is often overlooked that these are not isolated “attitudes.” They are patterns maintained by context. Family dynamics, long gaps in contact, unequal access to influence, and unchallenged narratives all reinforce them. Without a change in those conditions, the pattern tends to hold.

Reducing the impact of contempt does not come from convincing the other person to change in the moment. It is recognizing the structure you are being placed into and deciding what level of participation you are willing to have. It is also investing in relationships where there is reciprocity, where your presence is not used to establish someone else’s status, and where there is room for repair when something goes wrong.

Understanding the pattern gives you more choice. You can see when you are being pulled into a hierarchy that diminishes you. You can track how your body responds and what it needs in that moment. And you can decide where your time and energy go, based on what actually supports stability and respect in your daily life.

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Complex PTSD as Sensitization to Cues of Danger

People sometimes wonder why I react so easily. Why a tone shift, pause, or subtle power move can instantly affect my body. They want to know why I notice things others miss and why my system seems to live so close to the edge. Complex PTSD makes sense when understood as sensitization to cues of danger.

I did not become this way because I am weak or fail to “let go.” My nervous system learned hypervigilance from environments where harm was real, repeated, and often wrapped in authority, expertise, or supposed care. It learned that danger did not always look dramatic. Sometimes it seemed polite, wore a white coat, or arrived as dismissal, control, silence, or being overridden while being told it was for my own good.

When danger is ongoing and relational, the nervous system adapts. It detects tone changes, shifts in hierarchy, that autonomy is about to be taken, or needs will be ignored. This is not fearfulness, but accuracy shaped by experience.

From an Interpersonal Neurobiology (IPNB) perspective, Complex PTSD is not a disorder of thinking or a failure to be rational. It happens when a human nervous system has spent too long in conditions that demand constant vigilance. The system becomes sensitized. It starts to respond to cues that resemble past threat because, historically, missing those cues came at a serious cost.

This is why telling someone with complex PTSD that they are safe does not help. Safety is not a concept or decision. It is a lived, repeated experience. My body does not respond to reassurance, but conditions. Does this environment reduce hierarchy or reinforce it? Do I have choice, or am I being managed? Is repair possible, or will harm be denied? Are signals consistent or unpredictable?

Healthcare professionals and family blamed me for my responses. They said I was anxious, thinking the wrong thoughts, focused on the wrong things, needed to forgive, or just needed to take up yoga. They ignored and bypassed the real issue. My nervous system was doing exactly what it had been trained to do: scan, prepare, protect, and react. The problem was not my sensitivity, but that my environment demanded that I take the hits and act like nothing was wrong.

Complex PTSD arises when a sensitized system does not receive enough sustained relief to recalibrate. Healing does not emerge from desensitizing people through exposure or teaching them to tolerate more. It requires reducing the load: fewer threats, less coercion, reduced hierarchy, and more predictability, dignity, and support.

As those conditions change, the nervous system changes. Not because it is convinced, but because it learns through experience that vigilance is no longer required at the same intensity.

This is why I focus on Interpersonal Neurobiology (IPNB). It supports the truth of what happened to us. It explains our responses without shaming. It makes clear that recovery is not an individual failure or success story. It emerges when sufficient safety and connection exist for the nervous system to recognize that the environment no longer requires hypervigilance.

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Why I Quit Therapy

Over 6.5 years, I was traumatized by 13 therapists. Even the intake, first session, and attempt to explain my history put my nervous system back into the same defensive state. In session, I frequently encountered misattunement that prompted their disbelief, dismissal, minimization, and attempts to pathologize and gaslight me. The hospital’s psychologist twice blew off my concerns about intensifying suicidal ideations from Lexapro. I ended up in the hospital. A different psychologist tried to convince me I shouldn’t be upset that medical abuse destroyed everything I had worked to build because, “at least, you had it for a while.” His colleague insisted that I needed to take on starting a food co-op, though I was flattened and barely functioning. An intern at a rape crisis center asked if I had a will to live, right after I told her how I had been fighting for my life for years. A Somatic Experiencing psychologist broke down crying and admitted she didn’t “have the bandwidth” for my somatic experience. The more I tried to find a therapist who would help and not harm, the higher my stress levels rose.
 
I stepped back and looked at it through a Relational Neuroscience lens. The basic principle is simple. Human regulation depends heavily on the relational environment. When the people around you repeatedly misattune, dismiss, or overpower your autonomy, the body learns that those environments are unsafe. Continuing to expose yourself to the same type of environment keeps the nervous system in protection mode.
 
When an environment repeatedly triggers threat responses, distance can be one of the most stabilizing steps a person can take while they rebuild safety elsewhere. I decided to stop going to therapy because even the stress of searching for a therapist was causing harm. Instead, I focused on applying Relational Neuroscience principles in my daily life. A big part of that was choosing to avoid relationships that were likely to destabilize me. In my experience, therapists were very likely to do that.
 
I focused on building regulation through safer relationships, predictable routines, and people who could meet me with basic respect and attunement. Initially, these had to be with healthcare practitioners because they had become my primary social contact. The trauma of repeated medical abuse and neglect had severed my numerous prior connections and destroyed my sense of safety. I needed authentic care, so I worked to build a team of practitioners who intentionally participate in my recovery. With their support, my body began to settle. By shaping my relational environment more carefully, I was able to regain enough sense of safety to start building new relationships outside of medicine.
 
Life is much better now.
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