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What a complex and paradoxical cycle need/scarcity is. It seems it's roots are quite consistent and begin with malformed parenting of one sort or another. For example, most often for boys a home without a male role model: 85% of youth in prison are from fatherless homes; 90% of runaway children are from fatherless homes; 71% of high school dropouts are from fatherless homes; 90% of inmates on death row are from fatherless homes. It appears that Daniel Patrick Moynihan quote from the 60s was prescient: "From the wild Irish slums of the 19th century Eastern seaboard to the riot-torn suburbs of Los Angeles, there is one unmistakable lesson in American history: a community that allows a large number of young men to grow up in broken families, dominated by women, never acquiring any stable relationship to male authority, never acquiring any set of rational expectations about the future -- that community asks for and gets chaos." No finger pointing here as the conundrum is complex and multiform. However, tertiary care cannot possibly stop this problem and we remain unwilling/unable as a culture to articulate or institute primary preventive measures to effectively treat such. There is much to repent of and current diagnosis and treatment plans must honestly be seen as a failure on all accounts. Yet the same bromides continue to be applied without honest reflection of causation. The patient is in desperate need and we have failed miserably.