Showing posts with label isolation. Show all posts
Showing posts with label isolation. Show all posts

Sunday, January 15, 2023

Toilet

My toilet continues to be plugged.  Kelvin replaced the seized valve.  He pulled more toilet paper residue out of the pipers. He even found the wash valve and washed out the holding tank and pipes.  There an elbow close to the tank he could’ve reach and it appears to be the source of trouble .  He left after five or so hours and the toilet has been filled with two bottles of tissue digester.  I even added a liquid plumber and a blue digester.  This morning the water is clear but filled to the top. I’ve bailed it with a pan to add more chemicals. His snake and my snake haven’t worked.

My back hurts.  I prayed and meditated and did the morning back exercises.  I just let Madigan out to pee.  His half complete grooming still makes him look like a clown dog,

I have my invertion back machine in the garage.  It needs assembly.  I have a pile of ‘stuff’ to go to the storage locker.

I’m stymied. 

I feel blocked by the toilet and the back pain.  I enjoyed sitting cross legged. I enjoyed prayer and meditation.  

The back pain isn’t waking me like it did in the fall. It’s only with movement.  Hot tubs and swimming are fine.  I limped in sheer pain to the rest station from the car in November when the sciatica was at it’s worse.  Now I can walk for 20 minutes and my back is sore.  The next day I sometimes can’t move without pain.  Massage helps. I’ve not been back to the chiropractor.  My daily back exercises make me flexible but I don’t have relief.  The pain is constant with varying degrees Right now sitting I’m without pain but if I get up to get another cup off coffee I’ll have pain,.  It’s better than the fall and it doesn’t feel like something is unstable and ‘breakable’ like it did last year when I was walking in Scotland. I don’t feel so fragile just sore and fearful of doing damage by overstraining. I suffer the next day or two if I push myself.  

I don’t feel manly,  I haven’t felt manly since I had ED with pain. Then when I hurt myself so severely just mounting and having sex,  I carry resentments and self pity and weary of the constant lifetime complaining of feminists who haven’t bailed hay, done construction or hurt their backs. All the men I know at my age have major physical disabilities from work or sports. Being on constant pain I ‘m finding it hard to listen to the news and all the View girls and Huffington Post girls complaining their life is tough, like a trust fund PM.  

As a psychiatrist I believe pain is anger turned inward, All pain is psychosomatic.  I’m suffering.  I know the X-ray shows a fracture and traumatic arthritis.  It s more important that I continue to have flashbacks of resentment. Intrussive thoughts of the government thugs and low brows backing the criminal liars.  I feel like I’m going to die without seeing any justice.  I used to think of Jesus on the cross disheartened by the government and state laughing and mocking him as the falsely accuse and shame him and kill hill

I’ve listened to 4 years of Trump being falsely accused with the fake Russian Dossiers.  Meanwhile Trudeau is a liar and his hair brain policy are hurting everyone financially and ethically except his little cult following.

I bought another book on forgiveness.  Resentment is taking poison and hoping the other guy will die. I’m thought blocking and praying all day long,  The triggers of ‘false accusations’ are there all the time. I look at a colleagues mansion and know he was a lying shit. I still have difficulty forgiving my ex wife for the lies or her and her friends.  

I once had back bone.  I had courage .  The government licensing bodies have for decades being overstepping their authorities, invasive and demeaning.  Their agenda was to destroy doctors and other professional.  Classic communism.

I felt safer in Arizona than I do here, Her there are so few civil liberties left. Trudeau freezing bank accounts on a lie and Jordan Peterson defending his license from false accusation, It just brings back the government backing the meth addict threatening to kill me and my dog. I cry sometimes as I don’t feel safe and my back hurts.  

I wear a dress and am like Klinger but also feel safer.  Being a man in Canada is so terrifying and being alone and the girls have sided with Trudeau.  It’s the history of Lenin and Hitler.  

I liked reading Kelly Anne Conway and hearing of all the network of mothers fighting the friends of Epstein and Hillary.  Another year has gone by without Epstein or Ghislane ‘s list.  Elon Musks release of the Twitter correspondence of FBI makes the FBI just a less bloody Stazi, same ideation as Trudeau, above the law, elites only interested in power and corruption, 
I’m just weary and afraid and alone,
I was thankful sharing with my group and seeing my old friend who suffered back pain for years till he finally had back surgery when he couldn’t walk and now is walking .

I miss my friend John He was such a great manner and survived his accident and decades in a wheel chair in constant pain until he was falsely accused and the government lawyers and college attacked him backing the lies and utter cowshit that he was a ‘risk’ .  A man in a wheel chair and a girl getting paid to lie and false ly acuse .  The last days of his life attackers by scum of lawyers.  He’s in heaven and his accusers are rotting in hell watching their organs and intestines torn out day after day for their lies, their faces eaten away by acid over and over again as many days as they persecuted my friend.

Now I’m feeling vulnerable, No one cared when I was raped.  No one cared when I was held hostage, No one cared the many tines my life was threatened on the time the female patient sucker punched me in the emergency. The women cheered her, Violent terrorist women are celebrated by women   I see no justice,  Someone says my parents, grant parents or great grand parents were persecuted so I can persecute. No one rememembers Culloden or Irish and Sligo.  I stood at Sligo and cried. 

Now it’s all nonsense, cancel culture, and woke and all the climate change lies and racism attacks.  Whose going to pay for the Neanderthal all you holier than thous’s

I’m among friends like men are who just laugh and say ‘get off the cross , we can use the wood,’. The offended just get more offended and gaslight and terrorize.  

I have so much to be grateful for and write gratitude lists and am thankful but it’s like there’s still this abscess .  The holding tank full of shit. The chronic back pain. The depression and ptsd.  Identity disorder and gender issues.  Anxiety. 

Last night I watched Hawaii 5-0.  I finished. Kelly Anne Conway’s Memoir.  I thought of high school and the business and social life of that an college,  

I’m fairly isolated.  Aging does that I supposed.  There was a time when I had dinner parties monthly.  Another time when I lived with others.  Decades of my life in community.  Now I’m mostly alone.

Laura just texted me to say that they’d like to come over so the dogs could meet and John could look at toilet.  John’s a marine diesel engineer in charge of maintenance on a fleet of tug boats.  Molly is John and Caroline, Laura’s sister’s, dog.  I’m uplifted by the thought of company.  

At least that’d motivated the next step, getting dressed. I’m suddenly ashamed of the clutter and chaos but I don’t want the cleaning ladies here till the toilet is solved. I wondered last night if they put anything in the toilet not knowing RV or marine toilets.  The toilet on my sailing vessel was invariably plugged by a child’s toy or tampon and I took that toilet a part a dozen times because visitors had put things other than toilet paper in my toilet.  I never gave them the talk , the don’t put anything but toilet paper in toilet. I hád a compost toilet up north.  In my country home I installed a new septic systems.  Living on boats I knew this but here I don’t have signs up and I didn’t give the talk. 

It’s sufficient explanation that the valve was seized and water cojuldn’t be contained so silt built up.  The valves seemed off in the fall and I was a way for a month. I don’t have to look for culprits or conspiracies. There’s obviously a design flaw. If I’m faced with any catastrophe it inevitably has happened to others.  

I can hope. But at least now I have reason to get dressed.


New valve
Kelvin of Travco doing the dirty



I was happy to get new mocassins.

Thursday, July 16, 2020

Checking In, Covid 19

When I was at sea alone in the North Pacific in the midst of hurricanes and storms, high seas and unbearable anxiety, I’d listen on the Hamm Radio for our daily contact.  The Hamm Radio operators liked making contact with us. Odd men in little rooms surrounded by electronics reaching out to solo sailors bouncing about in the middle of oceans thousands of miles from shore. The Hamm operators who managed these nets motivation primarily seemed was to be to check out their equipment’s capability and to play the Hamm Radio Game. Solo sailors like me were playing the Solo Sailor Game with a whole lot of moving parts and games in the Bluewater Solo Sailor Game. I was so thankful these Hamm Radio kindly Asperger sorts were out their on land.
There was always uncertainty. I was wedged in the aft berth with the boat rolling and tossing about. My dog and cat were crouched in beside me, their only comfort, the suspect security of my body.  I’d hear the crackly call and pressing the button on my receiver respond.  Across a thousand miles of empty sea the voice of a person I’d met in SAN Francisco or Vancouver would reach me. I’d pass on my Latitude and Longitude, give him my course, say that all was well when often it wasn’t but it was ‘well enough’.  The contacts were brief. We were strangers, relatively.  Casual friends brought together by mutual interests.  
I was one of a very lose network of adventurers. I was solo sailing across the North Pacific in winter, desperately staying alive, sometimes at all odds. By contrast he was enjoying the warmth of his home trying with arcane and modern equipment to reach out and touch someone bouncing signals off various waves of atmosphere.  I lived each day for the contact, some days more.  When I came more into tropical waters I was handed off to another person, this one a total stranger.I’d give him my lat and long and course. Someone would then record that on a map somewhere and family who followed such things would sigh. I’d once even made a radio telephone contact so that I’d be able to speak with family.  I wanted to reassure them, to let them know I was alive. They were glad and I was so thankful I had someone who cared. I’d doubted that I’d survive that hurricane and it was very uncertain. Surely they had their doubts.  The dog and cat and I continued on.  

One day I sailed into Radio Bay and anchored. The world stopped moving.  The rich scent of land and foliage and flowers enlivened my senses.  For 24 days on that passage I’d checked in.  I enjoyed checking in.

Now I’ve a group of medical colleagues and psychiatric colleagues. We’ve met together annually for a conference in different places in the world.  After we keep contact with a increasingly sophistical email list called ‘cyberdocs’.  Sometimes weeks go by when I don’t check in. Then I do.  I’ve a different dog today. The cat died to and another came and went.  I’m in the warmth of my home and the world isn’t on the lean and I”m not afraid of sinking.  I still check in though.  I feel good knowing I have friends, people who care for me , as I care for them.  It’s like the place where everyone knows my name. I’ve never known a bar like that though the community pub I visited when first I lived in South Putney had that flavour.  

I’ve heard they put bells on toilets in Putney now so the neighbours of elderly know that the old are still living. I’ m aging but years I hope before I get bells on my toilet. I’m still hoping to wear bells on my toes..  In our group we laugh a lot.  We cry too but mostly we laugh. We expresss resentments and gratitudes, share platitudes and stories and even a bit of wisdom. One of us who has now died wrote the book, “Spirituality of Imperfection’.  Some of us are famous like that but most of us, like me live in the mixed blessing of relative mediocrity. Walking talking accessorized worms with varying degrees of sentience.  

Locally we have now another cybergroup of like minded doctors who pride ourselves on our caring.  We value humility whether we have it or not. We share this common collection of character traits and values that we hold as true. We have mutual admiration as well. We know what it means to become a doctor. We don’t denigrate each other’s achievements. In our own lives we are too often encountering those who make themselves look taller by chopping their heads off.  Steal from the rich the mob cries thinking that things of value can be taken like objects.  The thieves and animals keen in the streets now looting and stealing. Our group doesn’t do that. We are workers and achievers. We appreciate things aged and pure. We believe in meritocracy.  We celebrate individual effort, thank our teachers, love the guild and apprenticeship, and respect the years that go to making that which is rare.   We understand we are not alone even if we forget it.   Checking in is a reminder.  

They asked me to be the organizer of the next checking in meeting.  We’ve sat around the province at our various computers looking like the opening of the Brady Bunch tv show, our our little squares of faces with varying backgrounds. So many of us are greying.  It surprises me when I see us. I’ve coloured dyed hair with vanity.  We’ve known each other,  many, 20 years or more.  I am reassured.  I  tell the really mensch organization folk among them that I can’t organize.  I’m right now very disorganized.  I’m thankful for the call. I want to rise to the occasion but it’s like when I was in my boat at sea.  I’d be asked for something like the wind speed and required going up  on deck. At that moment  I was afraid to go on deck, because it was so bad outside, I didn’t know I’d make it back, even tethered as I always was to the ship.

Now the word ‘organizer’ shocked me.  I reflected on the disorganization and uncertainty of my life today. In my garage I have two lap top computers, a flat screen monitor, a printer and a filing cabinet on wheels.  I’ve a cell phone and sometimes also use an iPad.  I’ve some books . The space is messy with flotsam, papers,  pens and debris. I’ve thrown this office and control centre together on a folding table. I didn’t know it would go on this long. I’d started it as a temporary solution to the announcement of a plague. We have all entered again into Camus, Plague.  Kafka is still struggling to get into the Castle. And I just want to make love in the time of Cholera while practicing social distancing. 

I’ve gone to my room and stayed for weeks, now months.  At first I was very afraid. I’d been sick early in the year and had been unable to breathe, coughing and panicking and believing that I was far from God. I’d been scared then. I’d thought how effective water boarding would be on me.  I am terribly addicted to breathe. I take it for granted too much though I love to breathe. I couldn’t then. Repeatedly I was humbled. This virus was announced weeks later and we were told we all could get it and that it would be best if we went inside for a while.  I was very relieved.  It was my fourth epidemic.  I’d already survived the Aids epidemic working in the main hospital emergency bled on, spat on and assaulted but I’d acquired tuberculosis serving up north.  A year of medications cured me after I still wheezed climbing mountains. Now I’m old and wheeze making love.  

We  know now the virus likes the old and sick.   Others are safe,.

Each day I phone or connect online on the computer with a dozen or so folk who so often sound or look like I must have looked to the Hamm operator. I have felt such love knowing that the mere connection has sustained them that day and that week.  I’ve repeatedly heard the tell tale tone of ‘cabin fever’ I’d first heard working in the Arctic. I’ve known too that just talking and checking in I’ve helped another human remain grounded. There’s such relief and gratitude in their voices.  I now know the Hamm Net Operators loved that connection as much as hearing from me the loudness and clarity of their transmission.   I’m glad to have reached my patients too.  I have so many to see and talk to. There are several staff in several clinics asking me to talk to more and more.  I’m feeling nails on a chalk board and the terror or just anxiety and irritability transfers to me even at a distance through communication lines and atmosphere. I have a satellite dish outside my home. I sometime talk to people around the world though mostly I’m just talking to people in this city.  It’s all about distance and time still.  I feel of service and that sustains me. I’m a part of this greater whole. I”m a contributing member of the community and I’ve touched another human and reminded them ‘we are not alone.’  I talk to pharmacists too and write letters to government,  employers and schools and send all these missives signed with my name and all the long line of letters aftert my name that once meant so much to me.  Now I don’t know.  Being alone myself in what the Rolling Stones aptly called ‘living in a ghost town’ I’m finding a lot is being stripped away that hadn’t already fallen away.  

Adventures do that.  Challenges do that. Expose the essentials.  Each day when I’m not working, I’m walking the dog and breathing in the rich scents and joy of nature. We have a trail through the woods by the river. I’ve taken my dog, my camera and love to catch pictures of wood ducks and herons and song sparrows. The blossoms I shot months back have given forth fruits now. My dog has a heart murmur, congestive heart failure, coughs like a 2 pack a day smokers,  is blind and injured his back . We don’t walk fast. My back is sore most days as well.  My heart weary but  still good. I don’t know.  It’s what my patient called the ‘season of uncertainty’. Friends are ill and sometimes I learn someone has died. Our hospitals are full or nearly full. They never empty.  People with covid fall and recover but I’m sure it’s sheer terror. I’m still afraid of being sick. I avoid people ,especially young people and strangers. I see a friend or two. We’ve begun meeting again on weekends.  She is loving and comforts my dog.  We laugh. I love to hung. 

There’s war and rumours of war.  The lies and misinformation are ubiquitous. Mobs in terror roam the streets.  The media has failed everyone, clanging bells of partisan bias and propaganda.  The leadership has so often lost it’s direction. There’s untold deaths of old caused by lizard brains and heartless leaders. I’m protected here. The local government is showing surprising wisdom. The insanity is at a distance.  Some guy is dementing while another talks about his socks.  I think of times of George III and know that I’m in the middle of the likes of the Charge of the Light Brigade.  Chamberlain insists the communists are friends. Still there are equally beautiful and profound hero’s.  A little boy saved his sister from a dog attack. I saw the picture and read the story on Facebook.  I liked the mother elephant rescuing the baby elephant on Utube.  The donkey sanctuary always makes me smile.  I harken back to the times I was a child and my mom and dad and older brother were there to save me, mostly from myself.

Now I pray. My God, My God, why.......I begin.....then change to,  gratitude.  Jesus commanded ‘Do Not Be Afraid’.  I told my sailing friend ‘worrying is wicked’ . He laughs whenever we are in desperate times and asks, “are we wicked yet, Billy.” 

Thank you for this day, Lord. Thank you for the joy that comes with checking in. Thank you for my family and friends and colleagues. Thank you for the example of my courageous little dog.  Thank you that I can still be of service. Thank you for the good leadership. Thank you for technology and networks that allow me to reach out and still the fear in others. Thank you for nature. Thank you for breath.  Thank you God of Gods, Creator, Sustainer, Lover and Friend  Help me to be less afraid. May my faith grow stronger. May I know you more dearly.  Thank you for checking in.







  

Tuesday, April 28, 2020

April 28, 2020 Covid 19 Quarantine

I reviewed the genetic information and was still not convinced that it wasn’t engineered. Truly it could be a natural virus but again, the lady protestest too much. It’s the same kind of ‘science’ that we were bludgeoned with by the UN IPCC.  Another agenda more alligned with money and power than with truth seemed to fuel the denial.  On FB the geneticists whose work I uploaded has been removed.  The explanation was simply ‘our fact checker disagrees’.
It’s frustrating. I’m a curious person and yet when there is such a massive expensive cover up which persists I am frightened.  The question raised today was ‘why was Beijing immune?”
How dare you question!
I’m reminded of my times as a child at home and at school where I corrected parents and teachers and was severely punished.  It’s not a matter of what is right as to who is saying it. Do not question the king!  Bill Gates and Justin Trudeau are Gods. Heil Comrade Xin Jinping.  The Balkanization of the world trade and corporations with politics making strange bedfellows.  The media graphs are even grossly biased.  The Goebbels propaganda techniques by CBC say 1984.
Now the virus is mutating. 30 strains.  The nervous system is being attacked.  First lungs then heart and blood and now nervous system. Children sick with new mysterious diseases.  We told them not to tamper with nature.  We will survive of course. Most of us. I once tried to eliminate rats in a chicken coup and became impressed with reproductive resilience and the adaptation of survival.
I’m happy here. Locked in my room. I’m seeing patients in a virtual reality. I’m walking the dog. I’m again testing the limits of no skin to skin contact with another human 30 plus days.  I’m assailed by erotic thoughts of all kinds and don’t believe it’s Satan talking.  The image of God and Adam from the Sistine chapel comes to mind.
Already I notice people normalizing the experience. Lovers in the time of cholera.  The reopening of normalcy is beginning.  The social distancing and masks remain but the false belief I’ve survived this long without sickness, perhaps I’m immune. Perhaps I’m immortal.  Even in WWI the soldiers talked about the sense of ‘normalcy’ in the midst of hell.
I loved the “We’re Living in a Ghost Town ‘. song by Rolling Stones.
I miss naked bodies entwined, soft summer nights.  I miss my youth.  Yet I am safe here.  The obituary will read, he was a quiet person and he lived a safe life till the end. I know so many women living lives of quiet desperation ‘safe’ in their luxurious apartments, alone.  The men are more rangy. A bit like alley cats. The families are faring well. When I was married I needed no one but my lover and wanting nothing but children to expand this contentment. I was upwardly mobile , a bright light, outshining my cohort, but never quite right with my partners who struggled for dominance and we eventually parted because I preferred my own company. We all create myths to survive.Sometimes it was their families and friends. Once we were just going in two different ways. What we want could not be found in the same town. Perhaps my continued suspiciousNess of government stems from then.  The burocratic nonsense that separated love and made it near impossible for us to remain and work in the same city.  So many people have their jobs separating them. 
I ‘m reading and hearing now of old married couples being separated by institutions. Yesterday I learned of a 75 year old who visited his wife of 60 years not being allowed even to see her.  They talk through alien technology now.  So much tragedy and the Chinese communists are flush with the cash they are making and rub their hands with glee because they simply lack heart. It’s a developmental stage that requires freedom.  Collectively they are barbarians.  Ant hills of greed and fear.
I would be no different.  I’ve been blessed to be raised Christian in a god loving home to be surrounded by people who loved freedom.  I am a dying breed.  I’ve ridden horses and sailed oceans. My grandfather taught me about ranching and my father about machines. My mother and brother taught me to cook. There are apartments now without kitchens and few men know their way around a garage. They don’t even know what they don’t know.
I wonder how much longer I have to live and expect it’s decades. The very question of the future seems to extend it.
It’s all in God’s hands. Rejoice.  Gilbert and I had a great barbecued steak dinner last night. I loved watching his joy in chewing on the bone the rest of the evening. There are cherry tree blossoms and the gay mallards have returned with the wood duck family. Some new birds are making a nest in the tree outside my window. I must find the bird book.  In a prison somewhere a man sits watching a spider trying to remember taxonomy and phylogeny. 

Thank you Jesus for this day. May I be of service and fulfill my duties to the best of my ability.  Thank you. 









Tuesday, September 29, 2009

Psychiatric Defence Mechanisms

The term "defence" was coined by the early psychoanalysts. Freud perceived the ego as negotiating between the demands of the id, (sometimes referred to as the wild one, or child) and the superego (sometimes referred to as society or the "parent"). Eric Berne, the psychoanalytic founder of Transactional Analysis described Freud's Superego, Ego, and Id as Parent, Adult and Child looking at the transactions ocurring between these modes of thinking and relating in the more conscious and interpersonal world whereas Freud's work had been predominantly uncovering what occurred unconsciously. The early analysts decribed the ego 'defending' against the demands and later therapists would describe these as 'coping' mechanisms.

In Sadock's Comprehensive Textbook of Psychiatry 7th ed, there's a excellent Classification of Defence Mechanisms in Table 6.1-2. In this table the defences are grouped in 4 major categories, Narcissistic, Immature, Neurotic and Mature.
Narcissistic defences are listed as , Denial, Distortion and Projection.
Immature defences are Acting out, Blocking, Hypochondriasis, Introjection, Passive Aggressive behaviour, Regression. Schizoid Fantasy, and Somatization.
Neurotic Defences are seen as Controlling, Displacement, Externalization, Inhibition, Intellectualization, Isolation, Rationalization, Dissociation, Reaction formation, Repression and Sexualization.
Mature Defences are Altruism, Anticipation, Asceticism, Humor, Sublimation, and Suppression.
http://drsanity.blogspot.com/2004/08/psychiatry-101-defense-mechanisms.html

Knowing the origins of these words and how the understanding of each developed over a hundred years of psychoanalytic studies is most illuminating.
Today while some of these words continue to hold true to their original meaning others have been quite distorted in pop psychology. They are also used too often in a denigrating way and not ironically the so called "mature defences" of humor, asceticism and altruism once wonderfully agreed on by society and it's leading therapists are now not infrequently maligned.

The world of advertising and popularity consensus political machinations indeed appeals to the majority who not uncommonly live little in the rarified world of "mature defences".

"Don't worry, be happy," is a marvellous theme song for Denial though in a different light it becomes the Suppression of maturity.
Distortion is what politics and the media live on.
Projection is the defence where I say you are doing what I'm thinking and feeling and thereby deny my own part in the subsequent interaction. The paranoid bully forever asks "what are you looking at!"
Beaurocrats live on 'passive aggression'. Confrontation is a 'dirty' word in a world where 'deniability' is the end all and be all of success and survival.
Schizoid fantasy is the promise of drugs and alcohol. Why experience "reality on reality's terms when a little something will allow you to alter reality. Increasingly the game world allows you to be the hero of your existence as well.
"Acting out" is the television favourite. Every TV hero from " Bueler" to "Godfather" celebrates the adolescent solution to all problems. "Don't think, do it!
"Controlling" is what the accountants and tax department tell you is the solution to life's anxieties while all of them and their leadership have spent the tax payers money and lives with impunity, denial, distortion and supreme acting out.
"Rationalization" is what makes the legal profession go round while intellectualization is the basis of academia. But the humor about these is the major stuff of comedians when the 'disconnects' are so readily apparent on an almost daily basis.
"Reaction formation", turning an unnacceptable impulse into it's opposite, is the bread and butter of censors and the judgemental. The televangelists condemn human behaviour while being caught themselves in animalistic orgies.
"Sexualization" is the essence of marketting. All life's anxieties are reduced with underarm deodorants and musk scented Depends.
But where is Altruism, anticipation, asceticism, sublimation in our society. "I want it all and I want it now" goes against any of these ideas. Yet the original analysts collectively understood that these were the most enduring and mature coping strategies which came into play as individuals gained wisdom and maturity.
We all use all of the defences mechanisms some of the time. It's only human. What we rely on reflects what historically was seen as emotional maturity. The defences or coping strategies have stood the test of time and are still recognised for their contribution to understanding why so often even our best intentions go awry.