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Selected Readings

Lessons from the Lifelines Writing Group

by Alan Dienstag

Few illnesses inspire the kind of dread as that caused by the prospect of Alzheimer's disease, which is understandable. For people in the early stages of the illness who are experiencing impairments but still entirely cognizant of the dissolution that lays ahead, the challenge is to construct a life in the shadow of an advancing darkness: to answer the question, "What is the point?"

Intimations of the Great Unlearning:

by Gisela Webb

What remains after the unraveling of mind, language, and knowledge in Alzheimer's was there in the beginning.

Selected Poems

Oblivio Gate

by Sean Nevin

A poem with seven parts. We excerpted a portion of part IV for the end of the program — and included the poem in it entirety online.

Self-Portraits from the Widow House

by Sean Nevin

A grouping of nine poems based on a backwards progression of painter William Utermohlen's self-portraits chronicling his descent into Alzheimer's.

Pertinent Posts from the On Being Blog

1

A moving visual reflection on memory and relationships, absence and loss, and on the frail, tender love between family members.

1

"I am building my capacity for love now, so it can sustain me later." —Alanna Shaikh, on Alzheimer's lessons and the love of her father.

Krista acknowledges the inspiration for this show.

Ina's Story, a new therapeutic initiative for caregivers of loved ones with Alzheimer's.

"It's a prime time of my life, and I basically gave it away." A film that explores one family's story on the high stakes of caregiving for their parents.

About the Image

The photographer with his 98-year-old father, who lost his short-term memory. As an act of remembering, the son documented his final time with him in "Days with My Father."

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in regards to the topic for this Sunday, my experience with fleeting moments of Alzheimers of the past two decades has been observed and corrected more less with the personal aquired disciplines of healthy living and allowing of moments for breaks (social,quiet space intervals,meditation and more)from stress crunch overload which if not so disciplined will creep up on one from behind and find me hypnotized. Is a quantity-v-quality matter. Not sure if you would be able to use this, but inspired non-the-less to share.

Listening to the show about Alzheimer's and you're speculating about patients ability to remember the Lord's prayer (?) sing a hymn (?).

Instead of being so well learned that it can't be forgotten, maybe it is lodged in a different area of the brain, that isn't impacted by Alzheimer's in the same way, e.g., the role of song in Melody Gardot's recovery http://en.wikipedia.org/wiki/Melody_Gardot

Another example is the way that cycling skills exist in some people with advanced Parkinson's. http://www.nytimes.com/2010/04/01/health/01parkinsons.html

Diseases may affect the brain in ways we can't being to understand.

Interesting show.

The fear of loss, of diminishment, though raised to a higher than usual level for one with dementia, is present throughout our lives to a greater or lesser degree and in varying manifestations. There is, apparently, no way of knowing what one takes with him...fear, joy, peace, anger,frustration... into the mysterious world of Alzheimer's. And I don't presume to suggest that a cause and effect relationship exists between how I handle life today and how my personality may be altered by biology should I slip into dementia. But what I do believe is that I have choice at every intersection in my daily life, and as I make the effort to choose deliberately and courageously, being truly aware of my thoughts and actions, and their motivations,I discover a much more expansive self beneath the ego/fear-driven one that once governed me. Peace, joy, and patience push aside fear, anger, and frustration. I cannot control my future, but each moment wisely lived is an eternity to be celebrated.

I have been listening to your program on Alzheimer's today and I loved it so much. My mother died in 2008 at 94 and she struggled with dementia for many years. She was never really diagnosed with Alzheimer's but she had many difficult years and grew combative at the end. I kept believing in the value of my visits from 3 hours away and hoping that they were worthwhile for her. You verified that in your conversation this morning. Mother said when she was in assisted living that she felt like her head "is filled with chiffon scarves." It is such an amazing image and I, as a writer and artist, am haunted by it. She was always stubborn and we should not have been surprised at her late-in-life rebellion, but we also needed to take it seriously. That is my sorrow: that we could do so little about how she was cared for day-to-day. I have written a little poem about the things I found in her room when she moved to nursing care. They were cheap littl e children's toys which I am sure were a part of her rebellion. You helped articulate the importance of regarding our parents' beauty even in the midst of their drifting away. I believe that, most of the time, I was able to do that. Thank you, Cindy Cronn

Thank you so much for your program on Alzheimer's - my 90-year-old dad has been diagnosed with early dementia, and while I missed most of the program (overslept!), I look forward to listening to it on the website - thank goodness for the Internet and your wonderful, informative website! The comment "I don't know who you are but I love you" was so poignant - thankfully my dad isn't that far gone yet. It is very similar to a statement made by a friend's husband after he no longer "knew" her - "I don't know who [you are], but I know you love me very much." He's been gone now for a few years, but that statement gives me so much comfort for what may lie ahead for my family. I love your program - it airs at 7 a.m. Sundays on my NPR station, and I love to lay in bed and listen to it. It replaces going to church for me... no longer participating in organized religion....

I've been listening to your program on Sunday morning for several months. This morning's program on Alzheimer's was particularly moving. My 83-year old mother herself does not have Alzheimer's but one of her closest friends does. She sees this as tragic both for him and his wife. This helps me understand and prepare for the possibility that she, too, may some day "fade away". It need not be "tragic".

I listened again to the interview with Alan Dienstag whom I knew when I worked at the Alzheimer's Association. His experience was poignant and instructive - despite a diagnosis that scares and often sends people into depression Alan found a way to reach them through writing and offering a place where their thoughts and expression still had value.

I also run support group for caregivers, now in New Jersey and also work at a day program designed to maintain stimulation and socialization for people with cognitive impairment (not all have an Alzheimer's diagnosis).

Where my experience varies somewhat from Alan's is meeting people who do fight against the diagnosis and the changes they see in themselves. Not all go quietly into the night. Some people become very belligerent and continue fighting well beyond their ability to maintain independence.

One man looks to the sky and cries out, "this isn't me, G-d. This is you. This isn't me."

Another woman one time looked at me when it was clear she wasn't able to follow the conversation we were having with her daughter. "Can you believe this? This is a hell of a place to end up."

In the support group I ran in NY a regular member started to fail himself while caring for his wife whose dementia was advanced. He brought her to the Center (a senior center with a special program for people with dementia) a day early. He'd show up for the group at odd days and times. I called his family after having to send him to the hospital after he had TIA's and each time he looked at me with his charming smile. "I'll be ok." By the time his family stepped in, he was exhibiting clear signs of mid-late early stage of the illness but fought until the day he, too, was placed in the same facility as his wife.

And one last, sad account. The woman who was in an assisted living. She and others knew that the building on the other side of the courtyard were for "them." The crazy people. Those with dementia. When she was no longer able to care for herself her daughters did everything possible to make that transition as easy as possible, first telling their mother that her apartment had flooded and she was going to a room there temporarily.

Despite routing around her purse for her underpants; despite calling her daughter to say there was something wrong with her phone and other increasing episodes when she saw where she was to live, this woman had a breakdown. This is not where she belonged, this was for "them" not her.

She stopped eating and taking her medications. Her anger was palpable even while her behaviors continued to deteriorate.

Some people know. Some fade slowly into oblivion. But all watch and react to peoples' attitudes and actions towards them. It's in the eyes. The safer people feel and the more eye contact is made, the feeling of safety continues.

It continues even when there's no language. It's the feeling of the person that professionals from paid caregivers to social workers, family members, physicians remember and need to be cognizant.

Never talk in front of this person who, too, is in the room. Think kindly because when you don't it shows and that person who can no longer talk may feel your words.

One

I just wanted to comment on the Alzheimer's story. My grandmother, around 1960, came down with, what they then called "Hardening of the Arteries", however it was classic Alzheimer's. She would sit, when the disease had progressed, probably 5-6 years after we knew she was sick, and recite the books of the Bible and gospel hymns, although she knew no one. My mother who was her only child had passed away when I was born. This caused my grandmother to experience terrible grief. I have always thought this might have been the "triggering" event, although I was about 9 years old when the family really knew something was wrong. I so appreciate your program. God bless you always. Roberta Young

Krista, I would just like to thank you for your inspiring and caring work. Listening to the Alzheimers program, with tears streaming down my face, I was reminded how similar it is to sinking deeper and deeper into my lifelong struggle with chronic depression. I am now 69 years of age and even with medication, it is a daily nightmare trying to force myself out of bed each morning to face another day. Each day I am less and less the person I was. My last two visits with my daughter and her family, she lamented to me she felt as though she is slowly losing me. So like Alzheimers. Bless you. ~Joyce

I chose to listen to "Alzheimer's, Memory, Being" where Krista interviewed Alan Dienstag, a clinical psychologist, and together they explore early signs of Alzheimer's disease and memory recognition. Alzheimer's effects 1-8 Americans, 65 and older, and by the year 2050, more than 100 million people will be effected by this disease. There is no cure for Alzheimer's disease and this doctor helps patients focus on cognitive memory and to take life for everything it's worth and have the patient share with others things that they are feeling because before too long, that memory is once again gone.

The loss of memory, one of the early signs of Alzheimer's diseases, has to be such a horrific feeling, not only for the patient, but also for the family and loved ones of that patient. They physically see the person they've always known, but over time this person becomes a stranger because they have no recollection of the past. It's horrifying to think that there is no cure for this devastating disease, but Dr. Dienstag tries to help his patients by continuously writing things down. By writing things down, the patients are turning over their memories to the doctors, therefore the memory does not become lost. Verbal memory is much different than a tangible memory, verbal memory can easily be lost and forgotten about, where a tangible memory, such as writing something down, will last forever.

I have been so fortunate and blessed to not have Alzheimer's in my family, however, millions of people do have to live through this debilitating disease. There are support groups available and doctors to help through this tough time and Dr. Dienstag does such wonderful things in trying to help patients and loved ones through this rough journey. I don't think that anyone could understand the pain and suffering that Alzheimer's brings to a family until they've have to deal with it.

I think that we must cherish each moment in our lives with our loved ones and try to have everlasting memories, through photos, or film, or even through artwork. This way the memories we share can never be forgotten. Memory and health is something that many of us take for granted because it's so common, it's like breathing, we just atomatically do it, but to not have our memory, or health, would be truly devestating. I think it's so important to love in the moment because we never know when our time is up.

There is Alzheimer's disease on my mother's side of the family. My favorite aunt started with the disease at the age of 59. She lived with this terrible disease until she was 73. Two of my mother's other sister's had the disease also. Fortunately my mother does not have the disease as of yet. She will be 74 this June. For about the last year of my aunts life she did not know who anyone of us were. We would talk to her but she showed no response to us. We tried to spark some recognition from her through memories we had of her.

I found what Alan Dienstag is doing great. I think that for a person with the beginning stages of Alzheimer's disease to be able to write down memories or some special words for a loved one before they forget is a great idea. By having these memories written by your loved one would almost help with the grieving for the lost memory. I believe when you lose someone like this it is almost like grieving a lost soul.

I think that the personality of people with Alzheimer changes a lot. I remember how my aunt never said a swear word while I was growing up. When she was in the advanced stages of the disease she would swear all of the time. If she would have known that she was swearing she would have been embarrassed.

I find this disease one of the most terrible diseases that the victim as well as the family has to go through. It is not an easy thing to watch an aunt go through this as I have. It is heartbreaking to see a loved one go through this.

Right off the bat, I liked how they stated that in the brain, memory is not in just one place, it is throughout the entire brain in many different areas. Which is why it is so hard to know why, such things as Alzheimer's, happens and how it can effect many different parts of the brain.

Memory and identity, two things that are closely linked to one another. Through some memories that you hold, it begins to form you identity. Memories are something that separate you, from someone else. They are something that only you can hold on to. "People lose the ability to present themselves" was a quote that was said in the show. That held very true to me. Because Alzheimers comes at such a late age, many people are very used to how they have lived for the past many years, and to one day depend on someone more than you can depend on yourself has to be something of much difficulty.

Overall I very much liked this broadcast. It had opened my eyes in areas of the disease that I had not thought of before. Especially when thinking about how close memory and identity run together within a person. And how much I personally, take for granted my ability to not depend on someone else for as many things as others do. This broadcast made me very thankful to have the memories I do have, good and bad. Because overall my memories are what make me who I am, and make me different from everyone else.

I found this topic was one I could really relate to. It was interesting to me that many older American’s are afraid of getting Alzheimer’s disease more than heart disease and stroke. I would be frightened as well. I would never want to lose my memory. I think that Allen Dienstag’s idea of “giving memories away” in the form of writing things down is a great way for them to have some control over a disease that they ultimately have no control over.

The broadcast said that it is expected that one in every eight people age 65 and older are going to get the disease. As they age the risk of developing the disease rises. That is scary to think about. I work in a nursing home where I see all stages of the disease. There are people who have the early stages and then there are people who have lost the ability to speak. It is hard for me to see the progression, but it is also harder for the families because they remember what Grandma or Grandpa used to be like.

I think that writing their thoughts, feelings and memories down is a really great way to make sure that what they have to offer their family is not lost. I would think the family would love to have those memories written down, so that when their loved one is gone they can remember how they used to be.

There are no words to describe the pain, sadness,helplessness when you have a loved one with Alzheimers disease.My father was ill for seven long years.He was a devoted,great man.A fabulous dad,his grandchildren just loved him.All his friends and neighbours new him as a helpfull good citizen. When he began to forget, my sister and I decided that we will keep him at home. Well, the doctors told us then you better quit your job. We could not do that and had to place him in a locked facility. I must say however,we found a great place and I used to visit the owner just to say: THANK YOU SO MUCH for taking such good care of Papa.We had a schedule, every single day one of us went to the home to see him and check him out. That made us feel so good, I could not sit down and eat my dinner without knowing how father was doing. That is the memory we have about Father,because we took part in his sickness, my sister and I were there ALL THE TIME rain or shine, we never missed one day without seeing and checking on him.I recall that many patients did not get visitors as they should, many patients are put in homes and yes, maybe twice a year, once for Birthday and once for Christmas they would visit them NOT US. It was not easy but we gave him all the love and care he needed and that we want to pass on,maybe help a neighbour, friend or relative. EH

This show lead me on a journey of thinking about what makes me “Me”. If all my memories left me, what would stay behind? What is the core of a person? It is hard to know what the patient sees as the core; we don’t know what they’re thinking about. Care givers try hard to dig inside the shell that was once a loved one of theirs. They recognize the exterior, but have no idea what is going on in the interior. They hope for that look of recognition, anything, that would tell them that the memories they had with the patient didn’t vanish.

I can only imagine the loneliness an Alzheimer’s patient lives in. It must be hard for them to not recognize the world around them, who they are, what they are, and what their life is all about. It is a scary disease that nobody wants to suffer from. It is the scariest disease for people, because it’s the one disease when you know that you would be alone in. People move about around you, but you don’t have the emotional connection that would assure you that things will be OK. The memories are gone. They used to bring us closer to the ones around us; knowing what we went through together, how things affected us, and where they lead us are what made us build relationships. It would definitely be scary for me to live in a blank world; just me and my blank mind.

Alzheimer’s disease is a progressive degenerative disease of the brain that ultimately results in dementia which is a mental deterioration. Victims exhibit memory loss, particularly for recent events, disorientation, shortened attention, and eventual language loss. This is such a familiar case in my country but we usually blame it on aging. My grandfather at age of seventy could still remember all his grandchildren birthdays but after a while he had cataract refuse surgery as he think he will die soon anyways but he could still recognize his children and grandchildren voices. This blindness leads to a shortness of memories so severe that he could not remember our names nor who could he identify us.. We were not familiar with such a disease so we thought the memory loss was caused by the blindness. It was so sad to watch our strong grandfather becoming a stranger to us, there was not much conversation when we visit him., he get very frustrated and tear bed sheet, wet the bed… I learn about the disease when I came to America and took psychology and anatomy and then I begun to understand what my grandfather went trough. I wish we wrote down his last thoughts like the psychologist Allen Dienstag is suggesting.

Alzheimer's is a sobering disease since it it the gradual dissolution of identity, and it's terrifying to watch someone you love, slip away in this way. My mother in law suffered from Alzheimer's and it was shortly after receiving her law degree at age sixty-five, after a long and productive life as teacher, that this happened. We knew and she knew, that something was terribly wrong.

There are sadly, many people dealing with the pain of this kind of loss in those they love. I have run groups called The Stories We Tell and have had people in the early stages of Alzheimer's in these groups. I think they have found it rewarding to share their stories, on paper, as best they could, and yes, it seems like a concrete way to capture that which is so deeply a part of another's being, their stories.

I wonder when I contemplate what happens to people suffering this loss, about the nature of identity itself. Who are we, if not the stories we tell, that rich interlocking web of connections that so informed us and our lives? It seems to lose this, is to lose the world, and to lose what anchors us, what keeps us deeply rooted.

And so I think the human touch is so important. Routine is so important. Anything that can help ground a person who is losing so much, to tether them, as best we can, to love itself. There is for me, a deep connection in words, and the word routes, and roots is aurally synonymous. I do believe, when we lose our routes, namely the paths we have taken, that which is also roots, being identity, we need each other like never before, to provide whatever anchors can be provided. Sometimes it is a case of trial and error, I do deeply feel that routine, something predictable, is important, because one needs to build in somehow, the "known". Structure becomes important. It just might be helpful.

I would hope that all Alzheimer's "patients" get loving care, because I cannot imagine how it might be to totally lose that sense of myself in the context of friends and family, and I think compassion is the only answer. I do know that often people with Alzheimer's deeply respond to music and also to animals. Something to hold on to, if just for a short time.

Alzheimer's has been the topic I've heard about but was never knowledgeable about. After seeing the topic online I decided to listen to the show.

In his conversation with Krista Tippett psychologist Alan Dienstag shares his experiences with Alzheimer's patients. Detecting the diagnosis early is very important, even though people naturally try to deny the desease. Apparently, a person with Alzheimer's loses memory, one of the vital functions of the brain. Moreover, a person can see how their mental abilities deteriorate.

One particular item of interest for me was the experience of Alan Dienstag with the group writing therapy. It turns out that memory while writing can be different from memory while speaking. The way of thinking while writing works differently. I think I can relate to that: it is easier for me to structure my thoughts in written than in the oral form. Sometimes, during writing you can come up with things you didn't realize you remebered. Importantly, Dienstag's patients didn't mind the therapy and it seemed to provide comfort to them.

I began having a personal interest in Alzheimers after my grandmother was diagonised with the disease. When she began to have some memory loss we all thought she was just getting old. We saw my grandmother disappear right before our very eyes and this was one of the hardest thing we as a family had to deal with. It was not until we attended a support group for families that we began to realise that what she needed was acceptance and love.

We began taking her to support group and it was there that you could see her come back to life as she had the old spark in her eyes. I never quite understood it until I listened to this interveiw, especially the part where Alan Diestang had stated that, group does provide a sense of commonality which is more powerful than what the family can give them. I would recommend this interview to anyone who wants to learn more about memory.

My grandmother died a little over a year ago from Alzheimer's. Even though it's been that long, it's still hard for me to think about it without feeling like I want to cry. When my grandmother died, she had been in the nursing home for only three years. Before that, she lived with my parents and I. Now, usually when someone has Alzheimer's, their personality does a complete 180; that wasn't the case with my grandmother, though. She had the same sweet personality she had always had. The only thing that seemed to change was that she became more childish as it progressed. While she was living with us, it kinda annoyed me. I felt like I was having to help take care of a child. It was only after her death did I realize that some of the stuff she did was funny. One thing I'll never forget was something she said when she was in the hospital once. She said that she planted her house and also planted a hot chicken in the backyard. Another time when she was in the hospital, our preacher came to visit her. After a little while our preacher decided to pray and asked my grandmother if she could quiet for a minute. Well what did she tell him? "I reckon I can." When my mom told me about it, I just couldn't help but laugh at it.

Now that my grandmother has died, I'm glad to know that she is no longe suffering. Even though I still miss her a lot, I feel better knowing that some day I will get to see her someday. Granny, I love you and can't wait to see you again!

I work in a nursing home-direct care and I am in the department of alzymers. This discussion was really important to me in understanding and answering my questions. Worship of deity I believe involves your mind, cognitive part of your memory and I have been worrying what happens to their spirituality, they have forgotten everything, their families and their loved ones also God, there is nothing that makes sense to them not even the reason of their existence. This discussion, hosted by chista tipit, guest psychologist Allan Lindbergh. Alzymer or dementia is a disease that affects the mind, from the programmed this, giving memories away than receiving them this is affecting 1/8of Americans and 100million people will be affects by 2050. And most people are scared of this than any other disease, there is generally no linier development during this period and they live in denial. They are not conscious of their presence, only that what is only left is their core left, but not always. Sometimes it ends up with full of despair and pain. Place of knowing and not knowing. From those who have experienced this maybe from close friends relatives and love ones they say they are totally different. Their feelings, intuition and cognitive abilities are no more. This programme helped me realize that they still have memory only that they cannot convey, I realized there are different kinds of memory. They can write it down; it expanded my thinking that we sometimes do things without thinking, or write something down without thinking. If you give something away you don't loose it. And in the memory bank they are well learned, they internally know and acknowledge and love God if they did if they were young. This was really challenging to me because at work they can sing the songs they used to sing when they were young and to me this is really important. As a Christian ill rather encourage people to be serious with God and his service such that if they loose anything later in life they will still have Jesus.

It is said that 1 in 8 people over 65+ years old develop Alzheimer's and diagnosing it early on can help the patients prioritize their time and say what they want to loved ones, while they can still convey it. This disease steals away memory, speech, some cognition, and ability to do day to day tasks, but emotion and the spiritual aspect of people are always left. People can still convey humor, happiness, sorrow, and feelings; though they may not be able to form sentences.

In the group settings Dr. Dienstag conducted, he was able to have the patients write down memories and give him the papers as a form of "passing on the memories" rather than losing these memories forever. If you give something away, you don't really "lose" it. Writing accesses a different part of memory in the brain than speaking or just general thinking does, so it helps the patients because they think differently when they are trying to write memories down. Dr. Dienstag spoke of two particuarly interesting female Alzheimer's patients. Both were from his writing group. One of them wrote down just two lines for her memory exercise, and struggled to do so. Some of the letters were backwards, she had crossed out some things, but in the end she was able to write about a lover of hers and a fig tree in Athens. These two sentences conveyed a memory and emotion from her that others may have overlooked her ever having, due to her disease. Another patient named Anne, had progressed too far in the disease that the writing exercises were seemingly not a good use of her time so she started having individual visits. During one of these visits, he told her that he was going on vacation to the beach. Anne smiled and he asked her what she loved about the beach. She paused, looked blankly away, and then said "There's some kind of music that lives there." Dr. Dienstag said this flash of wisdom is something he believes to be of a spiritual component that still lingers with the sufferers of Alzheimer's. This story has changed my entire line of thinking about Alzheimer's. To me, this shows that there is some hope for those of us left behind, so to speak, by those who are suffering from Alzheimer's. They are not entirely gone, and they can still love and are still a part of all of humanity. This is substantially beautiful; that when all is seemingly taken away from the mind of someone, they still remain.

It is said that 1 in 8 people over 65+ years old develop Alzheimer's and diagnosing it early on can help the patients prioritize their time and say what they want to loved ones, while they can still convey it. This disease steals away memory, speech, some cognition, and ability to do day to day tasks, but emotion and the spiritual aspect of people are always left. People can still convey humor, happiness, sorrow, and feelings; though they may not be able to form sentences.
Clinical psycologist Dr. Alan Dienstag was interviewed for this podcast. He works in group settings of people with early to late stage Alzheimer's. In these group settings he was able to have the patients write down memories and give him the papers as a form of "passing on the memories" rather than losing these memories forever. If you give something away, you don't really "lose" it. Writing accesses a different part of memory in the brain than speaking or just general thinking does, so it helps the patients because they think differently when they are trying to write memories down. Dr. Dienstag spoke of two particuarly interesting female Alzheimer's patients. Both were from his writing group. One of them wrote down just two lines for her memory exercise, and struggled to do so. Some of the letters were backwards, she had crossed out some things, but in the end she was able to write about a lover of hers and a fig tree in Athens. These two sentences conveyed a memory and emotion from her that others may have overlooked her ever having, due to her disease. Another patient named Anne, had progressed too far in the disease that the writing exercises were seemingly not a good use of her time so she started having individual visits with Dr. Dienstag. During one of these visits, he told her that he was going on vacation to the beach. Anne smiled and he asked her what she loved about the beach. She paused, looked blankly away, and then said "There's some kind of music that lives there." Dr. Dienstag said this flash of wisdom is something he believes to be of a spiritual component that still lingers with the sufferers of Alzheimer's. These two stories completely changed my outlook on Alzheimer’s. I feel as if this gives hope to the ones left behind, so to speak, by those suffering from this disease. Even though the disease attacks the mind and it seems like all is lost, the person still remains. Love is not gone, the humanity is intact, and the human emotion is stronger than any disease that may ravage the mind.

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is a Clinical Psychologist in private practice in New York City and Westchester County

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