Author Archives: Bipolar1Blog

Processed Meats Associated with Manic Episodes

An analysis of more than 1,000 people with and without psychiatric disorders has shown that nitrates—chemicals used to cure meats such as beef jerky, salami, hot dogs and other processed meat snacks—may contribute to mania, an abnormal mood state. Mania is characterized by hyperactivity, euphoria and insomnia.

The findings of the Johns Hopkins Medicine study, which was not designed to determine cause and effect, were published July 18 in Molecular Psychiatry. Specifically, it found that people hospitalized for an episode of mania had more than three times the odds of having ever eaten nitrate-cured meats than people without a history of a serious psychiatric disorder.

Experiments in rats by the same researchers showed mania-like hyperactivity after just a few weeks on diets with added nitrates.

While a number of genetic and other risk factors have been linked to the manic episodes that characterize bipolar disorder and may occur in other psychiatric conditions, those factors have been unable to explain the cause of these mental illnesses, and researchers are increasingly looking for environmental factors, such as diet, that may play a role.

The researchers say that their new study adds to evidence that certain diets and potentially the amounts and types of bacteria in the gut may contribute to mania and other disorders that affect the brain.

“Future work on this association could lead to dietary interventions to help reduce the risk of manic episodes in those who have bipolar disorder or who are otherwise vulnerable to mania,” says lead author Robert Yolken, M.D., the Theodore and Vada Stanley Distinguished Professor of Neurovirology in Pediatrics at the Johns Hopkins University School of Medicine.

Mania, a state of elevated mood, arousal and energy that lasts weeks to months, is generally seen in people with bipolar disorder, but can also occur in those with schizoaffective disorder. Manic states can lead to dangerous risk-taking behavior and can include delusional thinking, and most of those affected experience multiple hospitalizations in the course of their psychiatric illness.

Bipolar disorder affects an estimated 1 to 3 percent of the population of the United States and costs an estimated $25 billion a year in direct health care costs, according to a study in the Journal of Affective Disorders.

Yolken, trained as an infectious disease expert, was originally interested in whether exposure to infections such as viruses transmitted through food might be linked to any psychiatric conditions. Between 2007 and 2017, as part of an ongoing study, he and colleagues collected demographic, health and dietary data on 1,101 individuals aged 18 through 65 with and without psychiatric disorders. Approximately 55 percent of the participants were female and 55 percent were Caucasian, with 36 percent identifying as African-American.

Those with psychiatric disorders were recruited from patients receiving care at the Sheppard Pratt Health System in Baltimore. Individuals with no history of psychiatric disorders were recruited from posted announcements at local health care facilities and universities in the region.

A study of their records between 2007 and 2017 showed that, unexpectedly, among people who had been hospitalized for mania, a history of eating cured meat before hospitalization were approximately 3.5 times higher than the group of people without a psychiatric disorder. Cured meats were not associated with a diagnosis of schizoaffective disorder, bipolar disorder in people not hospitalized for mania or in major depressive disorder. No other foods about which participants were queried had a significant association with any of the disorders, or with mania.

“We looked at a number of different dietary exposures and cured meat really stood out,” says Yolken. “It wasn’t just that people with mania have an abnormal diet.”

Nitrates have long been used as preservatives in cured meat products and have been previously linked to some cancers and neurodegenerative diseases, so Yolken suspected they may also explain the link to mood states such as mania.

The dietary survey did not ask about frequency or time frame of cured meat consumption, so the researchers couldn’t draw conclusions about exactly how much cured meat boosts one’s risk of mania, but Yolken hopes future studies will address this.

To get at the roots of the association, Yolken collaborated with researchers studying the impact of nitrates on rats.

Kellie Tamashiro, Ph.D., associate professor of psychiatry and behavioral sciences, and M.D./Ph.D. student Seva Khambadkone, both of Johns Hopkins, and others divided a group of otherwise healthy rats into two groups: one received normal rat chow, and the other received both normal chow and a piece of store-bought, nitrate-prepared beef jerky every other day. Within two weeks, the rats receiving the jerky showed irregular sleeping patterns and hyperactivity.

Next, the team worked with a Baltimore-based beef jerky company to create a special nitrate-free dried beef. They repeated the experiment, this time giving some rats the store-bought, nitrate-prepared jerky and others the nitrate-free formulation. The animals that ate the nitrate-free meat behaved similarly to a control group, while the animals that consumed the nitrates once again showed sleep disturbances and hyperactivity similar to that seen in patients with mania—increased activity during normal sleep times and in new environments.

The results were then replicated with a specially formulated rat chow that had either nitrate added directly to the chow, or no nitrate.

Importantly, the amount of nitrate being consumed on a daily basis by the rats¾when scaled up to the size of a human—was equivalent to the amount a person might eat for a daily snack, such as one beef jerky stick or hot dog.

“We tried to make sure the amount of nitrate used in the experiment was in the range of what people might reasonably be eating,” says Yolken.

When the group analyzed the gut bacteria of the different groups of rats, they found that animals with nitrate in their diet had different patterns of bacteria living in their intestines than the other rats. Moreover, the animals had differences in several molecular pathways in the brain that have been previously implicated in bipolar disorder.

While the team also cautions that it’s too early to take any clinical messages from the results, and occasional cured meat consumption is unlikely to spur a manic episode in most of the population, Yolken says the findings add to evidence of the multiple factors that contribute to mania and bipolar disorder.

“It’s clear that mania is a complex neuropsychiatric state, and that both genetic vulnerabilities and environmental factors are likely involved in the emergence and severity of bipolar disorder and associated manic episodes,” says Khambadkone. “Our results suggest that nitrated cured meat could be one environmental player in mediating mania.”

Yolken’s group recently published results of a separate study showing that when people with bipolar disorder are given probiotics—which can change the composition of gut bacteria—after a manic episode, they are less likely to be rehospitalized in the following six months. “There’s growing evidence that germs in the intestines can influence the brain,” says Yolken. “And this work on nitrates opens the door for future studies on how that may be happening.”

This article has been republished from materials provided by Johns Hopkins Medicine. Note: material may have been edited for length and content. For further information, please contact the cited source.

Nitrated meat products are associated with mania in humans and altered behavior and brain gene expression in rats. Seva G. Khambadkone, Zachary A. Cordner, Faith Dickerson, Emily G. Severance, Emese Prandovszky, Mikhail Pletnikov, Jianchun Xiao, Ye Li, Gretha J. Boersma, C. Conover Talbot Jr., Wayne W. Campbell, Christian S. Wright, C. Evan Siple, Timothy H. Moran, Kellie L. Tamashiro & Robert H. Yolken. Molecular Psychiatry (2018),

Bleeding Out by Clint Malarchuk

Clint Malarchuk’s incredible journey, from sickness to health.

I’ve interviewed him twice after his first book came out called: “A Matter of Inches

Here are my blogposts with his interviews:


Bleeding Out by Clint Malarchuk.

I know there might be a bullet in the rifle, but I press it against my chin anyway.

I don’t care.

I’m drunk as hell.

Coors Light. In the cans. Twenty down the hatch, maybe even 25 by this point in the afternoon.

My wife, Joanie, had needed a break from all the chaos that was going on — a quiet evening to gather her own thoughts and get some rest — so she spent the night with friends. But my brain keeps telling me she was with another man. Over and over and over again that thought clangs around in my brain. Each beer is like a pause button for my head. But the pauses don’t last long enough. So I figured I’d try something else. I decided to go out onto our ranch and shoot at some cans — head spinning all the while.

When Joanie gets home I’m just sitting on a bench behind our barn, screaming about who knows what.

I see her, and I look her in the eye, and then I reach for that rifle. With it pushing so hard against my jaw that it tilts my head upward, I yell some more.

“This is what I would love to do! This would solve everything.”

She’s sobbing. I keep going.

“You don’t know what it’s like to live with my brain. Everything would be so much better if I could just turn off my head. It would be so much easier on everyone.”

I’m staring Joanie dead in the eye when I say that, and then I just….

Pull the trigger.

I don’t feel anything after that.

It turns out that there is a bullet in the gun. And now it’s headed right for my brain — the brain that, over the course of 47 years, had proven to be among my worst enemies.

That bullet is directly on course to turn off my head.

For good.

The blood was everywhere.

It was pouring out of my mouth and streaming from my nose.

The bullet traveled up through my jaw, knocked out a couple of teeth, ricocheted through my nasal passages, and then kept on going until it got stuck in my skull.

Somehow I never lost consciousness. I never felt a bit of pain, either. So even in my drunken, blood-soaked state, I was immediately able to shift my focus to what I knew I needed to do next: beg my wife.

I begged and begged and begged. Not for forgiveness, or understanding, but for something simpler.

I begged her not to call the cops.

“I can take care of this. I can fix this. Don’t do this to me, Joanie. You can’t! Don’t do this.”

She wouldn’t listen. She just started dialing the phone.

I walked around to the front of the barn and got a towel for my chin, sitting down for a second and almost passing out. Then I went back behind the barn again, where I sat down on that bench and started begging Joanie for something else.

“Don’t tell them that I shot myself, then. Please! You can’t let them know. Tell them it was an accident. You have to do that for me. You have to tell them it was an accident. This would ruin me.”

At that time, October 7, 2008, I was coaching goalies for the Columbus Blue Jackets, and I’d already been given several second chances by employers over the years. I didn’t want to lose my job, what remained of my connection to the NHL. I couldn’t.

So I begged and I begged, and Joanie took pity on me and did what I asked.

When the police arrived, she was sitting right beside me. She wouldn’t leave because she was afraid that the cops would see the gun and just fire away. Or that I’d do something stupid, and then they’d kill me.

The officers kept telling her to move away. To leave my side.

But Joanie wouldn’t leave.

“He was drinking. It looked like his head was going a mile a minute. He just started rambling. ”

No matter what they said, she wouldn’t leave.

It wasn’t until things had calmed down a bit and the medics asked her about whether I’d been drinking, and if I was taking any medication, that she walked off for a moment to go inside the house.

In an instant, she was hurrying back towards us with a determined look in her eye and a large plastic bag in her hands.

“This is what he’s taking,” she said, holding out the bag filled with prescription bottles.

Everyone looked down at all the different medications in there, and then just kind of remained silent for a second.

“Which one?” someone asked, finally. “Which of these has he taken today.”

And Joanie, she just looked at the guy for a moment, and then she pointed into the bag.

“Everything,” she said. “Everything in here. This whole bag.”

How I ended up as a 47 year-old man with a bullet in his head and bag full of prescription medications may go all the way back to my early childhood for all I know, but it definitely has a lot of its roots in what happened on the night of March 22, 1989.

I was the starting goalie for the Sabres at the time, and we were playing against the Blues at the old Aud in Buffalo. At first it was just like any other game. We were up 1–0 in the opening period, and I wasn’t seeing a ton of action in goal. Then the puck goes down into the corner to my right, and their guy gets to it immediately. I take a look over my shoulder and I can see one of their forwards rushing the net on the opposite side. Steve Tuttle. He’s a little ahead of our defenseman, so I know a pass is coming that way. I also know that I have to push hard off my post and get across to the other post as quickly as I can. Almost as soon as I get over there, though, Steve gets knocked over … and that’s when I see his skate come up.

I felt it hit my mask, but there was no pain, and I didn’t think much of it in that moment.

Then I saw the blood.

When you watch the video, it’s hard to really make out, but those first few squirts from my neck? We’re talking five or six feet in distance. That’s how far the blood flew.

AP Images

I knew it was bad at that point.

But there was still no pain. And I was definitely expecting it to come, believe me, because within seconds the blood was just gurgling out of me.

So this is it, Clint. You are going to die. Tonight. Right here. In Buffalo.

That’s what I was thinking as I watched the blood splatter and stain that goalie crease.

But the weird thing was, as I’m thinking that, my main focus wasn’t on saving my life. Here are the two things that were on my mind….

First, I thought about something I’d been told going all the way back to peewee league: If you get hurt, don’t lay there on the ice like a weakling. Get up and go. Get yourself off that ice. Show that you’re tough.

So that was the first thing. I didn’t want to die on the ice, out there in front of all those people.

But the other thing I thought about was my mom watching the game back home in Calgary on the satellite dish.

I didn’t want my mum to see me die on TV.

Bill Wippert

Terry Gregson was reffing that night. I’ll never forget him skating over to me right after I went down. I saw his face go completely white, and then I just heard him screaming to anyone who could hear his voice.

“Get a stretcher out here now!”

Then a quick beat.

“He’s gonna die!”

After that, everything went quiet for me.

I just kept thinking, Wow, O.K. so I guess this is what it’s like when you pass away. No pain. No noise. Just … nothing.

Our head trainer, Jim Pizzutelli, jumped right out there to help stop the bleeding, and he knew exactly what he was doing. Jim had done a tour of duty over in Vietnam, so he had seen guys suffer gruesome injuries in his day. He pressed some gauze against the wound on my neck as hard as he could, and then he helped me skate over to the door behind the net so that I could get back to the trainers room.

As soon as I was up on that table, they basically just started cutting off all of my equipment with a big ol’ pair of scissors. And even though I thought I was going to die, that still kind of pissed me off a little bit. I specifically remember thinking, like, Hey, that’s my chest protector! I need that. It fits just right. That’s important. What are you doing?

Since the gash was on the right side of my neck, the doctor positioned me looking to my left so I wouldn’t see all the blood and get worked up by it, but I could tell it was everywhere. I wasted no time in asking if the team chaplain could come in and read me my last rites. I also talked to our equipment manager, Rip Simonick, and got him to call my mom back home in Calgary and tell her that I loved her.

Beyond that, I just kept telling myself not to close my eyes or go to sleep: Whatever you do, don’t pass out. Just don’t pass out. I thought it was inevitable, though, knowing how much blood I had lost.

After a few minutes of pressure and controlling the bleeding, one of our team doctors, Dr. Phelan, looked at me and smiled.

“Son, you’re gonna be alright.”

I didn’t believe him.

Bill Wippert (2)

Three hundred stitches. That’s what they say it took to close up my neck.

When I woke up at Buffalo General after the surgery, one of my first thoughts was something along the lines of, Wow, Clint, you’ve got some fortitude to you … to make it out of that alive.

I was actually … proud of myself.

I never gave up, or allowed myself to close my eyes and pass out. Carotid artery cut. Jugular vein partially sliced. And at no point did I start crying or panic. I held it together, and I did what I had to do to survive.

The wound on my neck was covered by bandages at first, but when I was able to remove them and check out the scar, I was kind of blown away by how large it was. I was impressed. It was a big gash, probably six or 6½ inches.

All I could think about that first week was that I was going to bump it the wrong way, or hit it on something and then have blood start gushing out again.

It would be a long time before I stopped noticing or thinking about that scar. It developed this earth-worm-looking thing. I think they call it a keloid, but I always just called it “the worm.” And that’s literally what it looked like.

Imagine having a six-inch earthworm glued to your neck 24/7.

And then imagine having to shave your face without nicking that thing.

It was a total pain in the ass.

Ten days after my throat got slashed by Steve Tuttle’s skate, I was back on the ice.

I should’ve taken more time. But I wanted to prove everyone wrong, you know what I mean?

One of the first things I did when I got back into that Buffalo locker room was chat with Jacques Cloutier, the guy who had to go into the game after me and play in a goal crease stained with the 1.5 liters of blood that gushed out of my body that night. Jacques told me his legs were shaking as he skated out there a few moments after the rink guys had done their best to scrape up the blood from the ice.

Thankfully, by the time I got back out there at the Aud, they’d completely redone that crease and it was all clean. I had some moments that first week back where I flinched a little bit when guys would cut hard to the net, but mostly I was just feeding off all the love and support I was feeling from upstate New York. That really allowed me to get past those moments of fear and push forward and do what I had to do.

I just went with it, and I don’t think everything really sank in for me until that offseason, when the initial adrenaline rush of making an amazing comeback wore off. It was almost like I was still in shock for the rest of that season, and then when I got to the offseason, and had more time to be alone and process things, I fully realized how serious the injury was, and how fortunate I was to still be alive.

I began to struggle with all sorts of anxiety and depression and paranoia, and it just kept getting worse and worse. That’s when I really could’ve used some counseling, for sure.

And there was just….

There just wasn’t any counseling to be had.

You know what, though, I probably would’ve refused it if it had been available back then. I’d become a hero to my family, my friends and thousands of hockey fans around the world. I wasn’t about to jeopardize that by showing any weakness. I was also afraid that if I spoke up some doctor would diagnose me and find that I was crazy. Because, back then, I was really starting to feel like I was crazy. And I was scared to have someone confirm it. I was worried about losing my career.

Day to day, I was getting to a point where I couldn’t even function mentally, or distinguish real life from the things I was seeing in my head, but I still had enough presence to put on this big act to trick everyone into thinking, you know, Clint’s fine. I pressed forward and made jokes and horsed around and pretended everything was O.K. I didn’t talk about what I was going through.

I just clammed up and didn’t say a word to anyone about anything.

The nightmares started happening during that next season after the injury.

At first everything was kind of faint — just moments from that night in Buffalo when the skate came up. But as time passed, those dreams got more and more vivid.

I was afraid to go to sleep. That’s how bad it got.

And when I was able to fall asleep, it would only be an hour or two before I’d shoot straight up in bed because of how realistic the visual would be in my head.

The gash. The blood. The fear of taking my last breath. It would all be there waiting for me in super slow motion. So every night, at one point or another, I’d have to deal with feeling like I was going to die — and it would be the most realistic, terrifying version of that feeling imaginable. I was living that one moment over and over again.

I wasn’t able to get any rest, and so I wasn’t playing worth a damn. I was unable to stay focused and alert during practice. My eyes would burn constantly due to the lack of sleep.

Then I went to this Super Bowl party that year, and going into it I hadn’t slept for 10 straight days. So I left early and decided that I was going to get some sleep … regardless of what it took. I had these painkillers, and the label said not to take them with alcohol because it would make you drowsy.


I took a few extra painkillers and then downed a bottle of scotch.

Instead of dozing off….

My heart stopped.

B Bennett/Getty Images

It wasn’t a suicide attempt, but that’s what everyone thought.

I actually really did just want to sleep. I needed to sleep.

Shortly after the doctors revived me at the hospital, a psychiatrist came to my bedside.

“What’s going on with you, Clint?”

Everything came flooding to the surface at that point.

“I called him up just to see if his flight was on time and he said ‘I don’t know, I’m not at the airport. I can’t leave my room.’”

Not just details about the nightmares and insomnia, but other stuff I hadn’t told anyone about either. I just spilled my guts. Everything. The fact that I would clean things over and over again for no apparent reason, and that I was terrified to leave the house. And that when I did leave the house, I’d convinced myself that unless I left it in a certain way I was going to have a bad game. That I’d watch movies that dealt with infidelity and be sure that what I was seeing on the screen was happening to me in real life. That I’d have panic attacks about my wife cheating on me … and I didn’t know how to make them stop.

Those panic attacks had become so serious, in fact, that my chest would tighten up. A lot of people think they’re having a heart attack when a serious panic episode sets in, and I can totally relate to that. When you think things are happening around you and they’re not, and you know they’re not, but your mind can’t accept that they’re not … that’s when you start to panic. There were times when I thought the FBI was after me, or the CIA. I thought so many far-out things. Somewhere, deep down, you know they’re not true. But your mind isn’t convinced. Your emotions aren’t convinced. And that was the life I had been living.

In a flash, I was diagnosed with OCD and depression and anxiety.

I’d been afraid in the past to hear those words said to me, but at the time I actually felt … relieved.

When Richard Zednik had his throat slashed by a skate during a regular season game up in Buffalo in 2008 — same city, a full 19 years after my accident — I didn’t think it would have much of an impact on me.

Boy was I ever wrong.

By that time, I’d been dealing with my mental health issues for several years. There had been good days and bad days … and some really bad days, but I was surviving. And doing the best that I could. I’d even done some work I was very proud of as an NHL goalie coach.

But I had come to rely on medication to get me through, and by that point the pills I was taking weren’t working like they had in the past.

So Zednik happens, and immediately I’m getting bombarded with interview requests and reliving my accident all over again, and….

It didn’t go well for me.

All of a sudden I’m being asked to watch Richard’s injury again and again, and then my own. The whole time, I thought I was O.K., but it affected me on the inside, you know?

Something got triggered for me after that Zednik injury.

I started drinking heavily again. And self-medicating.

Before long, I found myself being checked into hospitals and mental health facilities. Not ever staying long enough to get any help or get my feet under me.

I was at this one treatment center in Sausalito, California, for a while in 2008 and 2009 and I probably broke out of there, I don’t know, two, three times.

But I didn’t have a car, so I’d be trying to escape on foot. I didn’t even have a wallet, all I had was some pocket change. I’d be looking for a payphone, because I didn’t have a cellphone or a credit card. I wanted to reach my wife to get me a plane ticket out of there. But, you know, by the time I’d reach her, the people from the treatment center would’ve already spoken with her.

She’d just say, “No I’m not sending you money. You’ve got to stay. You have to go back.”

So I would.

And then I’d try to break out again a day or two later.

via the Malarchuk Family

A few weeks before I shot myself out by the barn at our ranch, I was in a really bad way and a friend of mine took me up to this hospital in Carson City. But I had visions of that place trying to lock me up forever, so I just left. I’d talked to a security guard beforehand, and he saw me walk out, so he called the cops on me.

And things just went downhill from there.

Next thing I know I’m crawling on my hands and knees through some bushes to escape. A helicopter passes overhead, and I think that’s someone looking for me. It was total paranoia.

I was losing grip on reality.

Within a matter of days, I’d down 25 beers and fire a rifle into my own chin.

I never passed out or lost consciousness after I shot myself in the face. In fact, they had to knock me out to get me onto the helicopter for life-flight.

After that….

“The doctors told me he was highly intoxicated, so they were going keep him unconscious so he didn’t go through withdrawal during recovery.”

Things go blank for me.

Aside from the details I mentioned above, I don’t really remember a ton more from that day. You’d have to ask my wife if you want to know more.

The doctors kept me in a medically induced coma for a full week after that. When I woke up, Joanie was the first person I saw.

She told me that she loved me. And I knew that I loved her. That I couldn’t have been happier to see here there, along with my mom, in that hospital room. All of us alive, and breathing, and together. But there was some bittersweetness there too, that’s for sure.

Months later, Joanie reminded me of something I said to her right after I pulled the trigger. I guess I had blocked it out of my mind back then.

“See what you made me do!”

I actually said that to her.

I blamed Joanie. For everything. The person who had stood by me through the worst times imaginable, and never left, and always remained supportive … I blamed.

So back there by the barn, after I fired the gun, I looked her in the eye, and said those words.

I realize now, when I think back on doing that … just how sick I was.

I was ill. I was very ill.

And I was lashing out at the one person closest to me. That much couldn’t be more clear to me now.

The scar from where the .22 short-caliber bullet entered my chin is only about two inches from the base of the scar left over from that night on the ice in Buffalo. They’re reminders of how I’ve been hurt over the years, and how I’ve struggled to make it through. But they also serve as reminders of those I’ve hurt along the way.

via the Malarchuk Family (2)

And get this, after all of the stuff I’ve just told you — the nightmares, the panic attacks, the running away from evil helicopters, the gunshot — it wasn’t until I got out of the hospital after the shooting and checked into a long-term rehabilitation facility that someone put two and two together and began assessing me for post traumatic stress disorder.

At first, I wasn’t having it. I didn’t want to hear it.

This psychologist just wouldn’t quit talking about that night in Buffalo, and how it must’ve caused some trauma. I remember she kept using that word again and again: trauma. I was, I don’t know … insulted. I kept going on about how I was the man in Buffalo, and how they love players with real toughness and grit up there. It was like, What do you know, lady? I’m a hero in Buffalo. They love me up there. Do you understand the amazing comeback I made in that town? Back on the ice after 10 days? Come on!  

I fought it like you wouldn’t believe. But she wouldn’t quit.

Eventually she gave me a book to read about how animals respond negatively to traumatic situations, and that’s how she got through to me. I’m a rancher. I love animals. I’ve got horses and goats and dogs. And so, for whatever reason, that made everything click for me.

I thought back to those first two years after the accident, and how that’s when everything started to get really bad for me. The OCD became over the top, and the panic attacks set in, and the nightmares escalated. And….

It all made sense.

Once I accepted that the PTSD combined with my alcoholism was probably what led to everything else, I could finally process things and move forward.

I could also, I realized, help lots and lots of people at the same time.

These days I speak to groups all over the country about mental health issues. I tell them that there is no shame in needing help, or in asking for that help in whatever way you are able. I get emails and Facebook messages every day from people who have heard me speak, or have read my book, and when I’m speaking about these issues or responding to those messages, I feel like I’m on top of the world. Just knowing that I might be able to help someone in their journey through life is enough to make me so happy.

I still struggle with mental health issues, I fully admit that. I sometimes even still get those nightmares where I see Steve Tuttle’s skate come up in super slow motion and slash my throat. (My last one was about six months ago, if you’re wondering.) And when I’m not out speaking to groups, or things just kind of slow down, I can get sad. But it’s not the deep, deep depression like what I used to experience. And, in fact, maybe I’m just a normal person who struggles with a down day, or with distractions, or the everyday upsetting things in life. You know, like the sun sets at 4:45 or something in the middle of winter, and then I kind of get a bit depressed….

Just like everybody else in the world.

And when challenging times do crop up, Joanie is there — by my side … still, after all that has happened.

We take it day by day, and I think we’re doing pretty good, all things considered.

via the Malarchuk Family

For the longest time, I really thought my sole purpose in life was to be an NHL hockey player. It’s all I ever wanted to be. My path through life couldn’t have been more clear: NHL player, and then NHL coach. That was pretty much it.

Now, as a 56-year-old guy who has been through a ton, I realize that my life in hockey was really mainly all about gaining a platform for what I’m doing now.

For helping people get through tough times.

And the same goes for my struggles with mental health issues. I know what my purpose is now. I really do.

In the past, I used to question God.

Why have you given me this disorder?

Why the nightmares?

Why do you allow me to become so depressed, so anxiety-ridden? 

Well, now I know why.

And, sure, maybe it wasn’t always pretty, or easy to deal with everything I’ve dealt with over the years. Maybe I wouldn’t have chosen to face those challenges if given the choice.

But now, thanks to how I’ve been able to help people, I can truly say that I’m O.K. with what I’ve been through. All of it. I really am.

I’m not glad about it, necessarily. But I’m O.K. with it.

And, through everything … I’m still here.

How To Train Your Brain To Go Positive Instead Of Negative.

Love, love, love this. Just one minute a day, three times a day. I’m going to do this religiously from now on. Sick of looking bing in my awfully negative world.

Love and light my fellow humans. 💖💥❤💥

Negativity will engulf you unless you build yourself a positivity circuit. To do that, spend one minute looking for positives, three times a day for forty five days.

Our brain is not designed to create happiness, as much as we wish it were so. Our brain evolved to promote survival. It saves the happy chemicals (dopamine, serotonin and oxytocin) for opportunities to meet a survival need, and only releases them in short spurts which are quickly metabolized. This motivates us to keep taking steps that stimulate our happy chemicals.

You can end up with a lot of unhappy chemicals in your quest to stimulate the happy ones, especially near the end of a stressful workday. There are a number of reasons why your brain goes negative. The bad feeling of cortisol has its own survival purpose. It alerts you to an obstacle on the path to meeting your needs so you can navigate your way to good feelings. But once you do that, your brain finds the next obstacle. You will feel bad a lot if you follow your survival brain wherever it leads. Fortunately, there’s a simple way to rewire this natural negativity.

Let’s start with an example I call the Dog Poop Paradox. Pet mess was everywhere when I was young because picking up after your pooch was not the norm. Then customs changed and the streets were gloriously cleaner. Did that make anyone happy? NO. People barely noticed. They do notice an oops, however, and they get plenty mad about it.

Our brain evolved to scan for problems and it is skilled at finding problems when it looks. For example, reporters predicted the downfall of civilized society when the bicycle was invented. They warned that people would flit from here to there instead of having long conversations, and that we’d retire early from exhaustion instead of conversing in the evening. We have inherited the brain that helped our ancestors notice threats in time to act. We are skilled at finding threats, even as we seek rewards.

Build Yourself A Positivity Circuit

Negativity will engulf you unless you build yourself a positivity circuit. To do that, spend one minute looking for positives, three times a day for forty five days. This trains your brain to look for positives the way it is already trained to look for negatives. You may think there aren’t enough positives in the awful world around you. But you don’t have to perform in Carnegie Hall and rescue orphans from burning buildings to create positivity. Any positives, no matter how small, will build the pathway that seeks and expects positives. Just appreciate the absence of dog poop on the path in front of you and neural connections will develop. It may seem false to seek out positives when negatives are so apparent. But as explained in my prior post (7 Reasons Why Your Brain Goes Negative), your present lens is false and in need of correction.

It’s hard to go positive when everyone around you is going negative. Your mammal brain wants to run when the rest of the herd runs. In the state of nature, you’d end up in the jaws of a predator if you ignored your group-mates’ threat signals and waited to see the threat for yourself. Mammals bond around shared threats, and fighting the common enemy raises a mammal’s status within its group. If you ignore the perceived threats that animate your group mates, you will probably pay the price in social rewards. Positivity has a cost, but the benefit is greater.

PARE Your Negativity

When you build your positivity circuit, you will PARE your negativity with Personal Agency and Realistic Expectations.

Personal Agency is the pleasure of choosing your next step. You can never predict the results of your efforts but you always get to choose the next step toward meeting your needs.

Realistic Expectations are the alternatives you generate when your cortisol surges. Though it’s natural to have a survival-threat feeling when your efforts fail to bring immediate visible rewards, you can remind yourself that your survival is not actually threatened. Most human achievement came from efforts that did not bring immediate visible rewards. When your results are disappointing, you can adjust your expectations and take another step.

PARE and you will REAP, because Realistic Expectations lead to Acting Personally. You will stimulate your own happy chemicals instead of just hoping the world stimulates them for you.

Loretta Breuning, PhD, is Founder of the Inner Mammal

“What It Really Means to Have a Mental Illness, and What It Never Means”

Thoughtful article about what is mental illness and what isn’t.

It is true it’s suffering, it’s true it’s manageable but not curable. Pretty insightful.

What It Really Means to Have a Mental Illness, and What It Never Means

The MightyJune 14, 2018

It happens again and again. Every time I see or hear it, a small piece of my hope for humanity shrivels up and withers away into nothingness. A politician tweets about the correlation between mental illness and school shootings. A frustrated relative fumes, “You can’t have it both ways. You either have a mental illness and can’t function, or you have to be responsible all the time.” Another celebrity opens up about a recent mental health struggle and receives a tremendous outpouring of public support. Or an acquaintance consoles me with the words, “Everyone struggles with their mental health sometime in their lives. It’s tough, but everyone goes through something.”

These are just a few examples of the many misconceptions and disparities I encounter daily in my struggle with mental illness. Depending on who I ask, “mentally ill” may be a fitting way to describe the latest school shooter, or someone’s quirky friend who is “so OCD” because her desk always must be kept a certain way. Indeed, talking about mental health or mental illness might be a taboo concept for one person, but it can feel like an overused cliché to another. So, the question is: what really is mental illness, and how can it be defined? What does it truly mean to be “mentally ill?”

Related: The Hard Lesson I Learned About Reaching Out to Others Struggling With Mental Health

The formal definition of a mental disorder has evolved somewhat over the years, due to ongoing developments in our knowledge of psychological and pathological processes. However, the current academic consensus, as stated in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), defines mental illness as “a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.” Note that the precise pathology of the illness is not specified; this is because mental disorders are of uncertain origin and classified based on symptoms. The definition continues with three other important criteria: a mental disorder causes significant distress or disability, it is not merely a socially or culturally acceptable response to a stressor or loss and it is not synonymous with socially deviant behavior unless it results from a dysfunction in the individual.

Related: Do You Want a Psychologist or a Therapist?

In other words, mental illnesses deserve to be taken seriously. Not every mental health struggle or stressor is comparable to a severe or chronic mental illness. When I hear young people say things like “I have so much anxiety” or, “I’m literally having a panic attack right now” because they procrastinated or forgot to study for a test, or post on social media “I’m so depressed” because they broke up with their fourth girlfriend this year, it is striking to me how unaware they are of the true gravity of the subjects they are discussing. Likewise, when people tell me to “suck it up like everyone else” or to “just get over it,” it is clear they have never experienced the level of torture and hopelessness I feel day in and day out.

It is just as important to understand that mental illness does not equal socially deviant behavior. Yet this is exactly the stereotype we see presented repeatedly in the media. Where did the serial killer in that movie escape from before he went on a killing spree? It was an “insane asylum.” What do they say could have prevented that high school shooting? The police should have caught the shooter early and institutionalized him. After all, he was a loner with depression. Do you know that erratic, narcissistic leader everyone’s afraid of? He must be mentally ill. What other explanation could there possibly be for such despicable behavior?

Related: 8 Types of Therapy We Don’t Talk About

In reality, violent or hateful intentions are not symptoms of any diagnosable mental illness. We have another, more fitting word to describe such people: evil. More importantly, most of the millions of people living with mental illness, and certainly all I have met, are loving, intrinsically valuable and often exceptionally bright and talented members of society.

Sometimes I even read claims that people who hold certain beliefs, especially unprovable religious beliefs or a sexual orientation that differs from the norm, are afflicted with delusions or other mental illness. Does this mean that everybody who believes strongly in something or feels a certain way is mentally ill? Of course not. We live in an uncertain world in which it is impossible to definitively prove or disprove anything that is not blatantly obvious to be absolute truth based on our limited human logic. Moreover, these feelings and beliefs do not satisfy what in my opinion is the most important criterion for something to be considered a mental disorder: it must cause some form of distress or disability in the afflicted person.

A person’s mental illness was never asked for and never desired; it just happened. Recovery is possible, treatment is available, symptoms are abatable, but mental illness never fully goes away. Many people claim that people who are suffering are just not trying hard enough, faking or exaggerating their symptoms, looking for attention or otherwise at fault for their condition. When the illness affects their functional ability, others view the person as equivalent in social relevance to a child. I have experienced some of this prejudice firsthand. Sometimes it seems as if people are only willing to accept the fact that mental illness will always have some impact on my functioning if I remain completely disabled, permanently dependent and eternally hopeless for the rest of my life. If I say I believe things will get better, then not even my most tenacious efforts to achieve recovery are considered enough. Yet nothing could be further from the truth.

There are many things that mental illness is not, but really only one thing it is. Mental illness is not a death sentence; it does get better. Mental illness does not make someone obsessed with shooting people with guns or prone to violent, erratic behavior. The only lives it ruins are those of the people with a mental illness themselves, and the lives of those who truly care about them. Mental illness is not a joke, not a meme, not a trend and not a quirk. Mental illness is neither a figment of one’s imagination nor a product of their own doing. Mental illness does not equal everyday stress, common fears, different beliefs or uncommon feelings. Mental illness does not mean a temporary mental health struggle, but it certainly does not translate to “crazy psychopath” either. Mental illness does not always mean delusional or psychotic, but when it does, it rarely means dangerous and never means despicable.

Mental illness is unimaginable pain and incomprehensible suffering. Mental illness is a name given to a unique set of symptoms afflicting a human being. Mental illness is serious, and if left untreated, mental illness can be deadly. Mental illness is uncontrollable, but mental illness is always manageable. Mental illness is worth respecting, and mental illness is worth defining.

Anthony Bourdain dies at 61 in apparent suicide

I don’t know what to say, I’m stunned and devastated.–abc-news-topstories.html

Award-winning chef, writer and television personality Anthony Bourdain has died in an apparent suicide. He was 61.

Bourdain was found dead on Friday morning in his room at a luxury hotel in the tiny village of Kaysersberg in the Alsace region of northeast France. He appeared to have hanged himself, according to Christian de Rocquigny du Fayel, the prosecutor of Colmar in Alsace region, southeast of Kaysersberg.

The exact cause of death is under investigation. The hotel where Bourdain was staying declined to comment Friday.

Bourdain was the host of “Anthony Bourdain: Parts Unknown,” which has aired on CNN since its premiere in 2013. The travel and food series, which features cuisines and stories from around the world, has won several Emmy Awards as well as a 2013 Peabody Award, according to CNN.

He leaves behind an 11-year-old daughter, Ariane Bourdain.

‘One of the great storytellers of our time’

CNN confirmed Bourdain’s death in a statement Friday.

“It is with extraordinary sadness we can confirm the death of our friend and colleague, Anthony Bourdain,” the network said. “His love of great adventure, new friends, fine food and drink and the remarkable stories of the world made him a unique storyteller. His talents never ceased to amaze us and we will miss him very much. Our thoughts and prayers are with his daughter and family at this incredibly difficult time.”

CNN reported that Bourdain was in France working on an upcoming episode for his hit series when close friend and French chef Eric Ripert found him unresponsive in his hotel room Friday morning.

“Anthony was a dear friend,” Ripert told ABC News in a statement Friday. “He was an exceptional human being, so inspiring and generous. One of the great storytellers of our time who connected with so many. I wish him peace. My love and prayers are with his family, friends and loved ones.” From running restaurants to hosting a hit series

Born in New York City and raised in Leonia, New Jersey, Bourdain went on to graduate from the Culinary Institute of America in 1978 and pursue a career in cooking.

In an interview with ABC News’ Rebecca Jarvis last year, Bourdain said that, when he was younger, he had a kind of “live hard, die young” attitude.

“It came as sort of a rude surprise to me when I turned 30 and I was still alive,” he said. “I didn’t really have a plan after that.” Bourdain ran a number of restaurant kitchens in New York City. But he gained fame with his acclaimed nonfiction book in 2000, “Kitchen Confidential: Adventures in the Culinary Underbelly.”

“Mine was not a particularly distinguished cooking career,” Bourdain told ABC News in the interview last year. “When ‘Kitchen Confidential’ was published, [it] was to my great surprise a success … I was determined not to screw this up.”

Bourdain authored several other nonfiction books on the culinary industry as well as accounts of his world-travel and food adventures. In 2011, he founded his own publishing line, Anthony Bourdain Books, at Ecco Press, a New York-based publishing imprint of HarperCollins.

“I’ve known Tony as an author and friend for many years,” Ecco president and publisher Daniel Halpern said in a statement Friday. “He not only revolutionized the memoir genre with his groundbreaking and iconic work, ‘Kitchen Confidential,’ he supported emerging voices and chefs with his imprint, Anthony Bourdain Books. His death is a great personal tragedy. Our thoughts are with his daughter and family at this difficult time.”

On CNN’s “Parts Unknown,” Bourdain delved into different cultures across the globe by talking and sharing meals with locals. U.S. President Barack Obama famously appeared on an episode in Vietnam in 2016, during his final months in office. Obama and Bourdain discussed Vietnamese-American relations, among other things, while dining on grilled pork, noodles and beer at a small family-run restaurant in Hanoi.

Previously, Bourdain had hosted a TV show called “A Cook’s Tour” on Food Network and then “Anthony Bourdain: No Reservations” as well as “The Layover” on the Travel Channel.

<img alt=”PHOTO: Anthony Bourdain poses with Italian actor and director Asia Argento for the Women In The World Summit in New York, April 12, 2018. (Brendan McDermid/Reuters, FILE)” src=”–/YXBwaWQ9aGlnaGxhbmRlcjt3PTY0MDtoPTM2MA–/; class=”caas-img”>

PHOTO: Anthony Bourdain poses with Italian actor and director Asia Argento for the Women In The World Summit in New York, April 12, 2018. (Brendan McDermid/Reuters, FILE)


‘Anthony gave all of himself in everything that he did’

In recent months, Bourdain garnered attention as an outspoken advocate of the #MeToo movement, with his vocal support of dozens of women — including his own girlfriend, Italian actress and director Asia Argento — who accused disgraced movie mogul Harvey Weinstein of sexual assault or misconduct.

“I’ve been seeing up close — due to a personal relationship — the difficulty of speaking out about these things, and the kind of vilification and humiliation and risk and pain and terror that come with speaking out about this kind of thing,” Bourdain told Slate magazine last October. “That certainly brought it home in a personal way that, to my discredit, it might not have before.”

Argento posted a statement on her official Twitter account, saying she’s “beyond devastated” to lose her “love,” “rock” and “protector.”

“Anthony gave all of himself in everything that he did. His brilliant, fearless spirit touched and inspired so many, and his generosity knew no bounds,” she said in the statement Friday. “He was my love, my rock, my protector. I am beyond devastated. My thoughts are with his family. I would ask that you respect their privacy and mine.”

During a 2015 interview with Wine Spectator, Bourdain was asked how he would like to be remembered.

“Maybe that I grew up a little,” he told the magazine. “That I’m a dad, that I’m not a half-bad cook, that I can make a good coq au vin. That would be nice. And not such a bad bastard after all.”

In a now-eerie interview with People magazine that was published last month, Bourdain said he’d rather “die in the saddle” than retire.

“I gave up on that. I’ve tried. I just think I’m just too nervous, neurotic, driven,” he told the magazine. “I would have had a different answer a few years ago. I might have deluded myself into thinking that I’d be happy in a hammock or gardening. But no, I’m quite sure I can’t. I’m going to pretty much die in the saddle.”

ABC News’ Kate Hodgson, Aaron Katersky and Paul Pradier contributed to this report.

Anyone in crisis, or who knows someone in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741-741.

Kate Spade, American Designer, Is Dead at 55

Mental illness wins this one. Kate Spade, a super successful designer, billionaires, with a husband and young daughter. Oh god, how bad things must have been for her to take this action?

Mental illness, insidious, heinous, deadly, masked, terrifying.

The American designer Kate Spade was found dead on Tuesday, according to police officials.

The police said that Ms. Spade, 55, was discovered unresponsive at a Park Avenue apartment, where she had hanged herself. She had left a note, but the official did not comment on what it said. She was pronounced dead at the scene at 10:26 a.m.

A housekeeper found Ms. Spade in her bedroom hanging from a red scarf tied to a doorknob, the police said. She was unconscious and the housekeeper called 911.

Ms. Spade’s husband was at the scene. A police spokesman did not know the whereabouts of Ms. Spade’s daughter.

Born Kate Brosnahan in Kansas City, Mo., in December 1962, Ms. Spade was one of the first of a powerful wave of female American contemporary designers in the 1990s.

She built a brand on the appeal of clothes and accessories that made women smile, her cheerful lack of restraint and bright prints striking a chord with consumers. She herself was the embodiment of her aesthetic, with her proto-1960s bouffant, nerd glasses and kooky grin, which masked a business mind that saw the opportunities in becoming a lifestyle brand, almost before the term officially existed.

Ms. Spade, who had been the accessories editor of Mademoiselle magazine, founded Kate Spade with her husband-to-be, Andy and a friend, Elyce Arons, in 1993. Frustrated with the handbags of the era, which she found to be over-accessorized, she had wanted “a functional bag that was sophisticated and had some style,” she told The New York Times in 1999.

She did not know what to call the company at first and decided to make it a combination of the names of the co-founders. After the first show, she realized that the bags needed a little something extra to catch people’s eyes. She took the label, which originally had been on the inside of the bag, and sewed it to the outside. With that gesture, she created a brand identity and her empire.

Within a few years, she had opened a SoHo shop and was collecting industry awards, her name a shorthand for the cute, clever bags that were an instant hit with career women and, later, young girls, status symbols of a more attainable, all-American sort than a Fendi clutch or Chanel bag. Ms. Spade became the very visible face of her brand.

In 1999, the Spades sold the business to Neiman Marcus Group, and the company changed hands several times after that — in 2006, Neiman Marcus Group sold it to Liz Claiborne, Inc., which eventually shed its other holdings to become the publicly-traded Kate Spade & Company, itself acquired in 2017 by Coach, Inc. (After the Kate Spade acquisition, Coach, Inc. became the holding company Tapestry, which also owns Coach and Stuart Weitzman.)

By then, the Spades had been gone a decade, having left in 2007 to devote themselves to other projects. Ms. Spade dedicated herself to her family and to philanthropy, and in 2016, together with her husband, Ms. Arons, and Paola Venturi, a Kate Spade alum, launched a new venture, an accessories label called Frances Valentine. Ms. Spade was so committed to the project that she told interviews she had changed her surname from Spade to Valentine.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to for a list of additional resources.


The placebo effect is real, sugar pills can have as much of an effect as medication. But how? This video attempts to explain how.  According to the video, it’s energetic. The answers are within us. Of course a wonderful thing to believe and attempt to do! Please comment on any experience you’ve had with the placebo effect or positive thinking. Thank you 😍😍😍

My homage to Georgia O Keeffe

These are from my trip to New York City, we visited the New York Botanical Gardens, such gorgeous flowers! They currently have a Georgia O Keefe exhibition of her time in Hawaii. Here is my photographic homage to her!

Scientists Have Identified The Physical Source of Anxiety in The Brain

Scientists have discovered “anxiety neurons” in the hippocampus of mice. They fire when mice are in anxiety provoking environments. And they can be silenced with light, at which time mice don’t exhibit anxious behavior any longer, but explore environments that would normally have been very anxiety provoking. Also these same cells can be activated with another setting of light and when that happens the mice exhibit very anxious behavior even in safe environments. And as of mice, so of men! So, hopefully this will lead to better treatments for anxiety for us humans. I’d be totally willing to be their guinea pig for new therapies for anxiety! I’ve been dealing with sometimes debilitating anxiety for at least two years now. Waiting for new treatments, as are a lot of others, I’m sure. Godspeed researchers!

And they can control it with light.


13 MAY 2018

We’re not wired to feel safe all the time, but maybe one day we could be.

A recent study investigating the neurological basis of anxiety in the brain has identified ‘anxiety cells’ located in the hippocampus – which not only regulate anxious behaviour but can be controlled by a beam of light.

The findings, so far demonstrated in experiments with lab mice, could offer a ray of hope for the millions of people worldwide who experience anxiety disorders (including almost one in five adults in the US), by leading to new drugs that silence these anxiety-controlling neurons.

“We wanted to understand where the emotional information that goes into the feeling of anxiety is encoded within the brain,” says one of the researchers, neuroscientist Mazen Kheirbek from the University of California, San Francisco.

To find out, the team used a technique called calcium imaging, inserting miniature microscopes into the brains of lab mice to record the activity of cells in the hippocampus as the animals made their way around their enclosures.

Anxiety cells (Hen Lab/Columbia University)

These weren’t just any ordinary cages, either.

The team built special mazes where some paths led to open spaces and elevated platforms – exposed environments known to induce anxiety in mice, due to increased vulnerability to predators.

Away from the safety of walls, something went off in the mice’s heads – with the researchers observing cells in a part of the hippocampus called ventral CA1 (vCA1) firing up, and the more anxious the mice behaved, the greater the neuron activity became.

“We call these anxiety cells because they only fire when the animals are in places that are innately frightening to them,” explains senior researcher Rene Hen from Columbia University.

The output of these cells was traced to the hypothalamus, a region of the brain that – among other things – regulates the hormones that controls emotions.

Because this same regulation process operates in people, too – not just lab mice exposed to anxiety-inducing labyrinths – the researchers hypothesise that the anxiety neurons themselves could be a part of human biology, too.

“Now that we’ve found these cells in the hippocampus, it opens up new areas for exploring treatment ideas that we didn’t know existed before,” says one of the team, Jessica Jimenez from Columbia University’s Vagelos College of Physicians & Surgeons.

Even more exciting is that we’ve already figured out a way of controlling these anxiety cells – in mice at least – to the extent it actually changes the animals’ observable behaviour.

Using a technique called optogenetics to shine a beam of light onto the cells in the vCA1 region, the researchers were able to effectively silence the anxiety cells and prompt confident, anxiety-free activity in the mice.

“If we turn down this activity, will the animals become less anxious?” Kheirbek told NPR.

“What we found was that they did become less anxious. They actually tended to want to explore the open arms of the maze even more.”

This control switch didn’t just work one way.

By changing the light settings, the researchers were also able to enhance the activity of the anxiety cells, making the animals quiver even when safely ensconced in enclosed, walled surroundings – not that the team necessarily thinks vCA1 is the only brain region involved here.

“These cells are probably just one part of an extended circuit by which the animal learns about anxiety-related information,” Kheirbek told NPR, highlighting other neural cells justify additional study too.

In any case, the next steps will be to find out whether the same control switch is what regulates human anxiety – and based on what we know about the brain similarities with mice, it seems plausible.

If that pans out, these results could open a big new research lead into ways to treat various anxiety conditions.

And that’s something we should all be grateful for.

“We have a target,” Kheirbek explained to The Mercury News. “A very early way to think about new drugs.”

The findings were reported in Neuron.

It Can Be Done!


It Can Be Done!

What’s done is done.
What’s past is past.
Nothing to be done about it but learn from it.
And let it go.
Banish fear.
Live confidently, fearlessly, positively.
Be sure of your success in everything you do.
Live with positive thoughts and gratitude.
With confidence, make the present the best it can be.
Enjoy the moment and savor and relish it
Have confidence that you can do it.
Look to the future with hope.
With confidence that you will make it good.
And know you will handle what comes your way with love and grace.

With love and grace for my friends and family,