Topical Blog Due 2/10 10pm

For my topic, I chose the article Al-Anon 12-Step Recovery Program: Love It or Leave It. The basic premises of this article was to take a brief look into the Al-Anon program (which is the AA equivalent for friends and family members of recovering and non-recovering drugs and alcohol users). In the article the gave opinions in support of and against the program.
Being a former member of Al-Anon, I think the program is a crucial component in helping those closest to the addict understand and cope with their loved-one's disease. When you attend a meeting, you are never "told" what you should do unless you directly ask (and even then, you are given several possible options and are told that you need to decide for yourself what is the right choice). Rather, the other members are there to lend a supportive ear to your dilemma. There is also comfort in knowing that you are not alone. Through the stories of others, you gain insight into your own situation and develop methods to regain your sanity in a life filled with chaos.
Many people may assume that Al-Anon is only beneficial when you are still directly associated with the addict. This could be further from the truth. When I joined Al-Anon, I had already left my ex-boyfriend who was suffering from alcoholism and drug addiction. In Al-Anon, I was able to work through my issues that I had still lingering from the relationship and to somewhat make sense of the situation I had found myself in (it was during this time in my life, that I had first been introduced to the term "co-dependency").
Al-Anon operates in the same fashion as an AA meeting. The 12 steps that AA strive to complete are slightly modified (in language anyway) and are used as the 12 steps that members of Al-Anon strive to complete. In case some are unfamiliar with the 12-Steps, they are the following (the Al-Anon addition):
1) We admitted we were powerless over alcohol-that our lives had become unmanageable.
2) came to believe that a Power greater than ourselves could restore us to sanity.
3) Made a decision to turn our will and our lives over to the care of a Higher Power as we understood Him.
4) Made a searching and fearless moral inventory of ourselves.
5) Admitted to our Higher Power, to ourselves and to another human being the exact nature of our wrongs.
6) Were entirely ready to have God remove all these defects of character.
7) Humbly asked our Higher Power to remove our short-comings.
8) Made a list of all persons we had harmed, and became willing to make amends to them all.
9) Made direct amends to such people wherever possible, except when to do so would injure them or others.
10) Continued to take personal inventory and when we were wrong promptly admitted it.
11) Sought through prayer and meditation to improve our conscious contact with our Higher Power as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12) Having had a spiritual awakening as the result of these Steps, we tried to carry this message to others, and to practice these principles in all our affairs.

Now #8 and #9 of the 12 Steps may seem a bit odd. After all, it's the addict who harms themselves and sometimes others right? Wrong. Those closest to the addict do harm others, including the addict. How is this possible? Simply put, when involved with an addict, your life and responsibilities start to revolve around the addict and their addiction. You get caught up in the chaos of the lifestyle and your reasoning and perceptions become altered. In doing so, we may harm others by lying to cover up the truth (or at the very least the full extent of situation), we neglect ourselves of our own needs which in turn may also needs of our children (both emotionally and physically). So how do we harm the addict when it's their very actions that is putting us in this situation? Simply put, we're enablers. We enable the addict to continue their use by covering up for them at their jobs, with other family members, taking care of financial issues, bailing them out of jail or other legal issues, etc. Our harm to them is not direct but indirect in that we care so much for them that we do not let them hit rock bottom (as we may all have heard before, the only way an addict will be willing to go into recovery is if they hit what they perceive as rock bottom)and feel the full effects of the destruction their addiction is causing them and others. So in a way, our actions may essentially be equivocated to holding the bottle up to their mouths for them (a slightly controversial analogy but one I feel does fit).
In Al-Anon, one of the key things you are taught is that you can not in any way shape or form, control the addict, their addictions, or their actions. This is the message that both programs (AA and Al-Anon) hope to get across to their members through repeating the Serenity Prayer at the beginning of each meeting "God grant me the serenity
To accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference."
Once the full extent of this message is clearly understood ("the wisdom to know the difference" line of the Serenity Prayer), the way you handle yourself is completely different. Whether you choose to stay with the addict or move on from the relationship, from that point forward you begin to regain control in your own life.
As we discussed in class, addictions can be viewed as violent in that the destruction and harm they are cause is to themselves. Well the destruction and harm they are causing is not just to themselves. It's also inflicting pain and anguish on those closest around them and that is then transcending on to the people closest to them. So the violence of the addiction is actually perpetuating through close personal social networks to others although the effects tend to be more emotional than physical. So I would have to argue that addiction is violent from the stand-point that it does cause unwanted harm on to others through the psychological torture of watching their loved-ones deteriorate from their own actions.
While doing this assignment, I started referencing my Al-Anon material. The book "One Day At a Time in Al-Anon" is one of the handbooks that is used during meetings. The book is written not to be read from front to back like a novel. Rather it is composed of daily affirmations in which you read a short page for each day. One thing that was often mentioned about the "weird" workings of these affirmation books, is that some days you will come across a post that is so fitting for you on that very day that it is almost scary. Well keeping true to this, the post for the day reads this:
"February 9
Would it help my situation to know why the alcoholic drinks to such excess that everything around him is damaged in some way by his compulsion? If he drinks to drown out the pain of shattering childhood experiences, which he does not even identify or remember, how can such pain be located and removed? Certainly not by us; we are amateurs-- and emotionally-involved amateurs at that! It would take years and thousands of dollars worth of psychiatry--and even then the outcome would be uncertain. But at least the knowledge that he suffers should keep me from condemning him.
Today's Reminder
It is enough for me to know that the unhappy drinker can get help in AA, where so many have found contented sobriety. It is enough for me to know I can overcome my own confusion by using the Al-Anon program.
'Let me conduct myself and my life in such a way that I will have no reason to reproach myself for making a bad situation worse. This, at least, is within my power: to make it better.'"

I read the addiction article - "Why do some people have addictive personalities" I choose this article because I believe I have addictive personality traits and the article made a lot of sense to me. The article discussed the differences between habit and addiction, factors associated to addiction, the dopamine role/brain chemistry issues and brief insight about ways to treat and overcome addiction. The article first distinguishes the difference between habit and addiction, defining addiction as, "when it (the behavior) takes center stabe and shoves everything else off, destroying relationships, finances and careers." I believe it is very important to understand this distinction when working with and processing addiction. There is a distinct difference between habit and addiction and it should be treated and analyzed distinctly. The article also addresses the factors associated with addiction. I feel that this information is very helpful in understanding the possible causality and ongoing addictive behaviors. This information can be useful in developing prevention programs and treatment of individuals with addiction. The article also discussed the brain chemistry which is effected by addictions and was very helpful in reading and enhanced my understanding overall of addiction. The end of the article emphasizes, "without understanding the reasons for and finding healthy ways to manage them, addicts will often kick a habit only to replace it with another one." I found this notion to be very beneficial and insightful. I believe it encourages individuals working with addicts to gain a better/ more holistic understanding of the individual in order to treat them most effectively.
I believe that addiction is strongly correlated to violence because the primary definition of addiction specifically identifies that the addiction takes center stage and shoves everything else off.... I believe this is related to violence because it identifies that an individuals moral judgements and decision making abilities are compromised when they are struggling with addiction. I feel that this makes the individual very vulnerable to potentially violent behaviors.

I read 3 different articles: 7 Signs of Addiction; Is Cheating an Addiction?; and Do You Have an Addictive Personality?. In 7 Signs of Addiction, they list the signs that addicts can use to determine if they have an addiction. I thought this was a good list of easy to determine symptoms. I agree with Kenlyn that this may not help many addicts realize they have an addiction, but it might help those that realize there's a problem and want to change. I do firmly believe that realizing there's a problem is the 1st step to recovery. Most addicts will deny, deny, deny until they realize that they are hurting themselves and others, often violently, since addiction to substances can and does result in declining health for the addicted person and makes them more prone to violent outbursts with family, friends, and even strangers. It's still a long road after that, but you can't fix a problem you refuse to acknowledge.
The 2nd article I read, Is Cheating an Addiction?, talked about how many people are linking cheating spouses/partners to sex addicts. The article talked about how this may be, to some extent, an excuse to blame the behavior on something "outside" of someone's control. I buy into that argument. Just because you want to do something doesn't mean that you should or that you do. Some people may seriously have a problem controlling their urges, but there is help for that. To say that you don't have willpower to stop cheating is not the same as saying that you don't have willpower to stop smoking or drinking. These people typically are getting sex from their spouse or partner, so it's not like they're sex-starved. While sex is quite pleasurable and activiates the same neurotransmitters that smoking and drinking does, cheating doesn't replace the neurotransmitters like smoking/drinking do. Quitting cheating doesn't stop the neurotransmitters and doesn't give people withdrawals... at least, not physically. Like I said earlier, I do recognize that some people have a very difficult time controlling urges, but I don't think that we should make everything an addiction and "excuse" bad behavior that way. It makes a mockery of both our free will as humans and the restrait that a majority of people show. I see problems such as cheating as violent, although not in the physical sense. I believe that it can be very emotionally violent, for both the victims (who has to deal with shame, anger, sadness, and often, lowered self-esteem) and the perpertator (who also usually has feelings of guilt and remorse).
The last article, Do You Have an Addictive Personality?, had a quote I really liked, "A healthy person plans excerise around their life. An addict plans their life around excerise." This obviously is just one example of an addiction. Overall, though, I was really disappointed in this article. I thought it would list some traits or brain functions that most addicts seem to have in common. Instead, it talked about different kinds of addiction and that to cure it, you must address root issues. This is certainly very important advice, but not the advice I thought I was getting. Again, I think there's a component of violence in all addiction behaviors, whether it's physical violence such as being violently aggressive to another person or persuing a drug that you know is harming you but you can't stop, or emotional violence such as putting people and yourself through emotions that are usually very intense and very violent in nature.

I read the addiction article “Creating a false self: Learning to live a lie.” Dr. Dayton discusses how people, usually beginning in childhood, create these false selves. She explains that all of us, to some extent, create these false beings as a form of protection. We all act differently in different situations, depending on who is there, where we are, and what is expected of us. Some people unconsciously take that to the extreme and create this complete false self as a compulsion to help hide one’s true self and fight things such as deep emotions, anxiety, problems, etc. She calls this false self the “idealized self” because this is the self we feel we should be because we feel our true self is too weak or inadequate. We may be in a situation constantly that we feel we need to gain approval, so we put on this mask and don’t take it off. This ideal version lets us be strong and cope better. She says that we may even idealize the false self, giving different terms to things such as bullying (strength) and manipulation and controlling (cleverness or compassion). This is a form of unconscious defense that we put in place with these false selves. If we do this so much that it becomes compulsive and an addiction, we can harm the growth of our true selves. While our false self may become stronger and better, our true self becomes weaker and goes deeper into hiding.

Dr. Dayton says that the creation of this false self often begins in childhood in a family setting. Family is the one place that we should be able to express our true selves, but if we have family that has problems, such as alcoholism, or has extreme standards, such as religion and wealth, we may feel we have to “be” that false person to survive and to fit in to what we were born into. Many times these family types overlap, such as alcoholism and wealth. The kids start to grow up where they are taught not to express their true feelings or they will be belittled or attacked. Their families are so invested in this “status quo” and if you do not act like you are expected, it could turn violent. People that are in these positions feel that they cannot be truthful or they may lose the one institution which is supposed to be there for them 100% of the time, no matter what. This becomes such an important aspect of their existence that the false self begins to overpower the true self. They can no longer differentiate between the two in other settings and it may go into adulthood. Dr. Dayton says that “the false self in an adaptive (though actually maladaptive) reaction to a dysfunctional situation.” The people who have lived as this false self do not usually know it consciously. Problems can arise if you try to confront them on it or challenge their sense of self. This is where violence can be a major factor. False selves do not want to admit they have had a problem. They try to fight off or cope with unfelt, unacknowledged pain, so when you confront them, you challenge it and they can become very defensive and often times angry. Hurt is such an important and deep feeling that if you confront it, you trigger other deep and intense feelings such as anger or retaliation. They begin to feel vulnerable and can be very scared, so they immediately “protect” themselves, or at least the selves they believe they are. They become so engrossed in this self that they actually believe this to be their true self. How would you feel if someone told you that your “true self” wasn’t really who you were?

I, to some extent, can relate to this article. My boyfriend grew up in a home where he had to always protect himself and not show any emotion. He had to somewhat create this “false self” of someone who is always so strong and is not bothered by anything. It has often caused problems, because I, myself, am a very upfront, honest person. I call him out on his stuff. I like to talk about things, and if he feels even the slightest bit like he is being “attacked” or criticized, his anger is triggered and he goes into defense mode. He will often say that he really doesn’t feel how I am suggesting and that it just isn’t how it is. This false self has created someone who lies to protect themselves, even about stupid little things. He doesn’t know how to act differently because he spent so much time protecting himself when he was younger. We have been together for 3 years and I have only seen him show other emotion, besides anger, and cry, maybe 2 times. That is why I chose this article. I think that realizing why people may act this way when you confront them is vital. I know it’s not him just trying to be a jerk sometimes or lie to me; he has just made himself be this person who immediately wants to protect whatever he is really feeling. He doesn’t want to be vulnerable. I think an important thing for violence to realize is that it doesn’t always have to be physical. In some ways, I think that verbal and mental violence is worse than physical. It creates mental scars that don’t go away as easily as physical ones. There have been times when his false sense of self has been so “threatened” that his only way to ward off that pain is to lash out with words to get that attention away from the “problem”. That is one recurring problem with addicts of false selves. If confronted, even if they are not typically a violent person, they will do about anything to get the focus off of themselves and this self that is threatened. He has never been physically violent with me, and that is wonderful, but I can definitely see how this creation of a false self can be a violent problem. I always knew that lying could be an addiction, but I never really thought that this behavior in him was something that he didn’t realize he was doing. I have, for a long time, discussed with him the fact that he may not be able to help it because he has had to do it for so long, from such an early age, but realizing that he may unconsciously be doing this makes me think about how I have reacted to these times myself. It is a cycle of violence, not necessarily physical, but violence nonetheless. Maybe if you know someone who seems to have this sense of false self, they should be approached a different way to try to help them overcome it and be who they really are. You cannot just confront this type of person, but get them help, because professional help will allow their true selves to become just as strong as the false self. That is what I believe anyway.

Here is the article; I think it is definitely worth the read: http://www.huffingtonpost.com/dr-tian-dayton/creating-a-false-self-lea_b_269096.html

I read three articles concerning the effects of eating disorders: One covering a new “trend” in college called Drunkorexia, another discussing the effects of the social network, and the last one also covers more about disordered eating in college. I tried to pick articles I thought would relate well with the college generation. Due to the pressures of society placed upon people to be thin (more often women, but not excluding men), it is not surprising how often one hears of another engaging in unhealthy eating habits. Weight-loss is almost always seen as positive in our society now, and oftentimes it does not seem important how said weight is lost, either. This sort of negative thinking ingrained into our everyday lives can have harmful consequences overall, physically and mentally.

The first article I read was over eating disorders in college. Eating disorders are often known as the “silent scourge” of college campuses, according to the article. This statement actually is quite resonating. Unhealthy eating habits are quite common all over any campus, but it often seems to be swept under the rug (so to speak) when it should be considered more than just a hectic life. I know personally when in discussion with other college students, we do not always eat three meals a day (or even two!) and sometimes our “meals” are nothing more than a beverage or something to tide a person over. I do think, however, once the disordered eating (which is not considered as severe as an eating disorder, but still has many harmful bodily consequences) becomes intentional is when a college students’ eating habits should be taken notice. As also mentioned within the article is pressure, which I had mentioned earlier. Entering college can be an extremely stressful time for either male or female, and controlling what one eats can often be a way of relieving anxiety.

The second article I read, also in conjunction with the first article, had to do with the topic of drunkorexia. This is apparently a new trend in which alcohol is often swapped for food calories. I believe society’s acceptance with college binge-drinking could be helping to further propagate this idea of alcohol replacing food as not such a big deal. This is harmful to the body, which ties in to violence due to willful intent to starve the body along with risking potential death with alcohol poisoning (which could be even more potentially fatal with those struggling with weight problems). “Anorexia nervosa has the highest death rate of any psychiatric illness,” says Dr. Kenneth Weiner, medical director at Eating Recovery Center in Denver. When death is involved, especially at such a high rate, it definitely seems to be related to violence. This sort of problem seems to becoming more popular within binge-drinking too. And while students might not be as drastic as full-blown drunkorexia, they still might engage in instances of drinking on empty stomachs (to “get your money’s worth”), or to stave off extra weight one might just think it is okay to skip a meal sporadically because they are drinking those calories. Also, as mentioned above, many students perceive this sort of unhealthy engagement can assuage their social anxiety. Drunkorexia seems to be gaining more popularity due to the fact those who struggle with eating problems can keep it hidden more easily by hiding the problem behind binge-drinking.

The last article had less to do with college dysfunctions, but it still discussed something that affects everyone’s lives in every way possible: social networks. This article showed the differences between those who own a television versus those who do not. It appears that body image is affected negatively for exposure to the media (with the article even going as far as to say second hand exposure still has a negative influence on body image). It seems this sort of emotional negativity cannot be avoided, even by those not within the actual range of social networking. Mentioned within this article is also the fact that social networks spread eating disorders, which are obviously harmful psychologically to teenagers, which the articles were more focused on.

I chose to read the article “Why Do Some People Have Addictive Personalities?” I chose this article because this question has been an important area of study for quite a long time and I find it very interesting. The article included information regarding personality traits that have tendencies to be more addictive, brain chemistry of addictive individuals, and differences between addictions. The interesting distinction made in the article was identifying the difference between habit and addiction. We all have habits that may be healthy or unhealthy. The difference is when we are addicted it causes significant problems in our lives, personal or professional. When the “habit” becomes problematic and disrupts a healthy lifestyle, it becomes an addiction. The article discusses differences in our brains that have been found to distinguish addicts from non-addicts. Addicts utilize their addiction as a way to increase dopamine in their brain. Whether shopping, gambling, sex, or drug usage gives a person the satisfaction they need, it is that “high” they get from the rush of dopamine entering the brain that they rely on.
The article also points out that women are more likely to become addicted to shopping and eating issues, while men are more likely to abuse drugs as their addiction. It is discussed that because women may have more pressure from society to fit a particular physical image that these issues are seen more in women.
While addiction may not directly relate to violence on the surface, there has been large amounts of research done on addicts and violence. As the explanation of addiction in this article states, individuals become so obsessed with the object of their addiction that everything else in their life comes after it. So while violence may not have a direct link to addiction, it is possible that those dealing with addiction issues may become violent if something stands between them and the object of their addiction. I have worked with clients who have gotten into legal trouble due to their addiction because they became violent because they were under the influence or were attempting to gain access to the drugs. While this does not mean that all addicts will be violent, it is important to address the issue and further research is needed in order to provide the best possible treatment to those with addictive personality traits.

I chose to read an article on addiction: “Should Alcoholics Really Be Anonymous?” This article was really insightful, and gives a new approach to help groups for alcoholism. Her view on the subject has a very valid point, and I think that more help groups should pay attention to this type of view point; as it could really help generate more people into their clinics and support groups.
http://www.huffingtonpost.com/maggie-lamond-simone/alcoholics-anonymous_b_810802.html
The author is a recovered alcoholic herself, which seems to lend more credibility to her theory. She discusses how the anonymity of AA groups instills a more severe aspect of shame into the recovery process. At first, my response was that being an alcoholic is somewhat of a shameful addiction, why should we eliminate negative feelings from something that is looked down upon? I found myself sort of thinking that alcoholics should feel shame for what they are doing to their bodies and to society- they deserve it. But as I continued to read the article, it occurred to me that she was making a point to say that the recovery process should be a source of pride, rather than shame. Shame is going out and getting wasted every night, waking up hung over, and going out and getting wasted again. Pride, on the other hand, is having the courage to make a change and get help from programs like AA.
This article brings up a variety of ways that this approach could change the recovery process for addictions. While having an unhealthy addiction can definitely be a shameful occurrence, I think it’s a great idea to encourage people to get help by making the support groups more open. Making rehab a source of satisfaction could increase the success rates, making others take notice that people really can make a change in their lives. In addition, taking away the anonymity of the group could present people with a sense of accountability. When going through a rehabilitation process, it can be difficult to stick to their intended recovery plan. If the patients feel as though they are accountable by society to complete their recovery plan, maybe they will be more successful in the improvement process. If there is a sense of dependability; that is, society is depending on you to get better and recover from your addiction, success rates are likely to increase.
When I took Motivation and Emotion, I read the book A Million Little Pieces by James Frey. The book gives great detail in one man’s road to recovery. It expresses his deep shame and almost a hatred for himself, something that I think many addicts experience. That sense of depression can increase the chances of relapse, as it did with the character in A Million Little Pieces. His recovery plan was very intense, and caused him to really concentrate and put all of his energy towards getting better, even though he felt depressed enough that he often thought of suicide. While he is in his rehab center, he meets a few friends. These friends were a key point in his recovery process; as they made for a sense of accountability. They made sure that he was sticking to his recovery plan-and made sure that he knew that they were counting on him to make a full recovery. I think that this feeling could be increased if we applied the thoughts from the article to all recovery centers.
As far as the violence aspect goes, James Frey gives a great example as to how much harm addicts are really doing to their bodies. When he arrived in his facility for his physical check up, the doctors told him that he was so close to death that they were astounded he was functioning by himself, let alone alive. His many years of alcohol and drug abuse had destroyed his body to such an extent that he was close to his death bed. I think that addictions could go along the same lines as suicide and self harm, as there is only one person that acts as both the victim and the persecutor. The violent acts that are inflicted on the body as a result of drug and alcohol abuse could definitely be seen as violent, as these things can often lead to illness and many times can cause death.

I agree with these seven steps 100%. When we know we truly don't have any addictions, we tend to not think about what the signs of an addiction can be. I had an uncle who had a gambling addiction, but he was able to admit he had one. He just never looked for help to stop. It took his boss figuring out he had a gambling addiction and forcing him to sign papers that said if he was reported at any Casino he would be arrested. Before this my uncle had spurts where he would do good not going and then would relapse.
What I admired most about this article was how it mentioned that addictions don't discriminate against gender, race, financial status, or anything else for that matter. I don't have and never have personally had any addictions, but I can only imagine how tough it has to be to admit to yourself that you have an addiction. But even after you find the courage to admit to yourself, it has to be even tougher to admit to someone close to you that you have one.
These seven signs are great ways for people with addictions or people who feel they may know someone with an addiction to help them. Sometimes it takes close friends or family to seek help for them. This may be a better option rather than waiting for them to admit to you that they have an addiction.
After reading this article, I thought back on my life to see if I could relate to any of the seven signs. Fortunately I can't, but this definitely gave me some insight to be able to detect if anyone close to me may have an addiction that I could possibly help with. It also wakes us up that when the word "addiction" is mentioned, the first thing we tend to think of is drugs, alcohol, or gambling; things like that. But it informs us that an addiction can be something as simple as shopping or letting clothes clutter up.
There are so many different types of addictions to list that it's not safe for anyone to just say "I KNOW I don't have an addiction!" without actually taking time to think back to "habits" they may have and making certain that they have not turned into addictions.

For this assignment i took a look at addiction. I actually read one article, then got drawn in by a second. the first was on twelve step programs and how they may not be the best way for addicts to ovecome thier addictions. research shows that the faith based programs, such as AA, which ask you to put faith in a higher power during recovery don't work as well as other forms of therapy, such as cognitive behavioral therapy. There are higher rates of depression and relapse in the faith based program participants when compared to other types of therapy groups at four months. I would have to assume that the patients who put thier stock in a higher power may feel like God has failed them, bringing on some depression, if the cravings and urges are still nagging at them months after starting treatment. Those who do behavioral training and cognitive restructuring may find that they have more tangible resourses at their disposal, thus keeping urges and cravings at bay and thwarting the depression that accompanies a relapse.
The second article I read was on addictive personalities. I felt this fit in good wiht the GAM we discussed earlier in the class because it is looking at more biology and personality traits that would contribute to someone being more suceptible to addictions than others. One branch of research looks at low seretonin levels in people making them more likely to have an addictive personality. I think it's interesting that brain chemistry can effect our lives in such a drastic way. those suffering with addiction find themselves basing their entire lives on "getting a fix" and will forgo all relationships, thier jobs, their health, they will break laws and do things that were unthinkable before becoming addicted.
Addiction may not be one of those things we think of as violent in a traditional way, but if we look at the self harm behaviors that an addict may exhibit we see how violent they behave to themselves. Years ago I watched the movie "Requiem for a Dream". I think this is a great example of how addiction can completely destroy a person beyond recognition. If you haven't seen it, you should. Addictions of all types can be terrible forms of self injurious behaviors. It's interesting to see how addiction fits in to the general aggression model and the different ways research is finding to attempt to help those suffering form addiction, because for many they are truly suffering.