Depression: a message the mind-body sends 02/06/2012Posted by ALT in Recovery Story.
Tags: chemical imbalance, crisis, depression, mind-body split, survival
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In response to my critique of the newest edition of the biopsychiatric model of depression (as publicized by NPR), a commentor asked me…
“Do you have ideas about why certain people are prone to depression or any other mental condition?”
Yes, I do. Here follows my honest, subjective, and throughly “inexpert” opinion:
DEPRESSION. Have you ever experienced it?
I’ve never had my experience of it validated by a diagnosing professional; nevertheless there have been somewhat lengthy periods of my life where I felt nothing but “corrosive apathy” for everyone and everything around me. I was shocked… shocked and sickened and horrified… by the cult of death that is our society. It was a black hole I fell into and had a lot of trouble digging myself out of again. This mainly occurred when childhood, adolescence, and extended adolescence were over and it was time to face facts outside the bubble I had grown accustomed to.
Was there something wrong? Yes, and no. EVERYTHING was wrong… and so nothing was wrong. If that makes sense. I began to think that something was wrong with me specifically when I saw most everybody else was still carrying on and enjoying the very things that made me so sick, sick, sick.
But there was nothing “wrong” with me in the pathological sense. Really, it’s just that my bubble popped and theirs’ were (and perhaps are) still intact.
The point I’m trying to make is that we’re ALL “pre-disposed” to this kind of depression. It’s sort of a natural reaction to the state of our society, as far as I’m concerned. And to me, this “depression” is a MESSAGE. Something needs to be addressed, and resolved, inside yourself, if you feel this way. Depression is the furthest thing possible from a “biological” problem. It is a SPIRITUAL problem.
Psychiatry actually does recognize this, or it once did – their recognition is buried in the language, the etymology. So what does it say about the profession that they will now do anything to deny this idea?
Dealing with depression as a biological pathology is extremely problematic to me because it is a way to avoid taking responsibility. It’s a way of saying “Shut up, mind-body. I don’t want to hear what you have to say.” That kind of attitude is not sustainable, because in order for the mind-body to carry out its mission (homeostasis), it WILL be heard. And if it has to SHOUT, then so be it.
Crisis is not a necessary part of change. You can address issues before there is no other choice. And then your response can be more measured, gradual, and successful. In times of crisis you do whatever you have to do to survive, and you do it as quickly as possible. This usually doesn’t turn out as well as it could if your intellect were more involved in the process.
This is why the quick fix of [insert chemical imbalance theory/chemical HERE] is so galvanizing: many who are grasping at it are doing so from an animal-in-crisis mentality. And when the crisis moment has passed they are spellbound by the chemical, ushering in a whole new era of problems, crises, and equally unsuccessful quick fixes.
Perhaps you are thinking that I was “depressed” but not “clinically depressed.” Meaning, I suppose, that my experience of depression was not as “bad” as “truly depressed” peoples’. I don’t know. I can’t get inside their heads. I guess I “got better,” so at the very least we can agree that it was not chronic. But it was also not medicated. Are those two facts connected? There is good reason to think they may be.
Regardless, the experience of “depression” (or whatever you want to call it) was, for me, an important part of growing up, finding a more wholesome and healthy path through life. I received the message, and then I made some serious changes in the way I was doing things in response to the message.
If I had instead suppressed the messages that my mind-body was sending me, I believe they would only have gotten stronger and louder, until I was forced to hear.
“He that hath ears to hear, let him hear.” Very good advice, I think. And there is so much to listen to.
Tags: ADHD, akathisia, autism, Cymbalta, Geodon, recovery, Seroquel, sexual abuse, suicide
[Submitted by a reader, in response to the ALT_mentalities "Open Invitation"]
As a child, I was described as “dreamy” by a lot of my teachers. “So bright, so sweet. I wish I could have ten just like her in my classroom. But she doesn’t seem to be paying attention,” they would say to my parents. At the same time, my mother noticed that I did a lot of repetitive movements known as “tics”. I didn’t know I was doing them. As a registered nurse, this concerned her, so she videotaped me one day as I was ticcing and gave the tape to a neurologist, who brought me in to give me a full neurological exam. I thought it was kind of fun. He pulled my arm down and asked me to resist him. He asked me with a smile, could I stand on one leg? Could I show him? How about the other leg? Did I know my ABCs? Could I recite them for him?
Afterward, he told my mother that there was nothing physically wrong he could find with my nervous system, but that my tics in the video were suggestive of autism. Also based on what my teachers had said, he referred us to a psychiatrist. I don’t really remember the psychiatrist, but he ended up diagnosing me with ADHD (Inattentive Type), and PDD-NOS (a mild form of autism). I was prescribed a stimulant, though which one I’m not sure. I did eventually take both Adderall and Straterra (not at the same time).
As I progressed through the grades, school became less and less fun for me. Being around other children in a crowded classroom was sometimes hard for me, with all of the background noise and disruptions. My social skills were not as developed as some children’s, and this became very noticeable in middle school, when I became somewhat of a target for bullying. I got into a fight with a friend, and she instituted the full “silent treatment,” refusing to speak to me at all.
Freshman year of high school, my parents decided to put me in a small private school. The classes were smaller and quieter, and the teachers knew me well. I got very high grades and joined sports teams, earning the Scholar-Athlete award. But my home life was not as good. My parents were arguing a lot, and separation was discussed. My father and older brother got into loud and intense fights, a few culminating in one calling the police on the other. My brother was abusive to me, hitting me, choking me, smothering me with a pillow. When I was 12, he had sexually abused me. I did not tell anyone this. He had also been diagnosed with autism and ADHD, given stimulant medication, and when he hit one of his teachers at school, diagnosed bipolar and given Depakote. This made him reclusive and gain a lot of weight, which I brutally teased him for as a small way to “get back at him” for hurting me. Looking back, we had almost the same psychiatric/drug history, but we reacted in entirely different ways, which we also used as a way to cope with our intolerable home life. He became abnormally aggressive, I became abnormally anxious.
Toward the end of my freshman year, my only friend drifted away from me and sought the company of others. Depressed over the memories and the family situation I couldn’t tell anyone about and very anxious over schoolwork and lonelieness, I began restricting my food and exercising.
Sophomore year, things continued going downhill. I became extremely perfectionistic about everything, and paradoxically the constant anxiety got so exhausting that to protect myself I pretended I didn’t care about schoolwork, procrastinating yet still agonizing over homework and assignments and berating myself for being “lazy.” I became very depressed, and when I told my mother tearfully that I didn’t want to live anymore, she took me to see my family doctor, who suggested anti-depressants. I had read up on them and asked them about the warning that these drugs increased suicidal thoughts in those under 18. “Don’t worry about that,” my mother and doctor said, and I trusted them, so I took the medicine. I also started seeing a therapist. Sometime after I started taking the meds, I got my first strong urges to cut myself. When I did cut for the first time, I cut far more deeply than I’d intended, and experienced my first dissociative episode, looking at the deep wound on my arm with detached amazement (demonstrated by my first thought after I saw it: “Wow, those movie guys are good. It looks just like makeup on a horror movie.”). When I couldn’t get it to stop bleeding, I got my mom, who immediately figured out what I had done and brought me to the ER. A kind British doctor numbed the area and gave me 12 stitches altogether while a pysch consult was called. It was determined I could go home after I signed a safety contract stating that I would not harm myself again.
Just a little while after my ER visit, I was caught self-harming at school and my parents brought me to a private psychiatric hospital, where I was admitted to their Adolescent Inpatient Unit for violating my safety contract. The psychiatrist I had been seeing to manage my psych meds saw me in the hospital, and I tried to be honest with him and the other hospital staff. I thought they could help me feel better and relieve some of my suffering. In the grand scope of things, they really added to it. I wasn’t allowed to have my textbooks (they could be used as weapons, said the staff), so I got behind in school. I was strip-searched upon admission (very distressing) and had to wear paper clothes (humiliating). I missed my parents. If I was on Unit Restriction (not allowed to leave the locked unit whatsoever), I was trapped in a twenty-foot hallway 24 hours a day and became bored and frustrated. I was kept for about 5 days the first time, discharged, and then re-admitted two weeks later, again for self-harming. The doctors decided I was your run-of-the-mill severely depressed person.
My parents didn’t see any significant change in me from the hospitalizations and decided that wasn’t the best route. I became more secretive about my self-harming, hoarding sharp objects in a hiding place in my room and cutting in places easily covered by a t-shirt and jeans. Meanwhile, I saw my psych regularly for med changes/increases, going through Zoloft and Lexapro (which gave me a severe allergic reaction involving a painful red rash), before settling on Cymbalta, which apparently “worked”. All of these medications made my suicidal thoughts worse, but it’s hard to tell if they increased my anxiety or gave me akathisia, as I was already so anxious and restless before taking them. I had strange dreams and intense nightmares. I told my best friend’s father about her pot smoking one night as I was afraid she would drive while intoxicated, and this lost me basically all of my friends. They gave me the group-wide silent treatment and spread rumors that I was a lesbian. A group of boys picked on me, twisting my words and laughing at me at lunch. I began having violent fantasies about bringing a gun to school and making all of those who had hurt me “pay.” I was horrified at what I was thinking, and thought I was an awful, unforgiveable person for wanting that, so I became more intensely suicidal. I didn’t tell anyone, least of all my parents or doctors, because I knew that would mean going straight back to the hospital.
Near the end of sophomore year, I was admitted to the hospital’s evening outpatient program for one last try, since I had failed to complete it twice (once for being admitted inpatient, once for a reason I can’t remember). I became frustrated for a reason that is lost to me now, so I got up and walked out of the outpatient building and ended up wandering along the highway, looking to get hit by a car to self-injure. I was stopped by the group counselor who drove after me and brought me back. My mom was called and told by the counselor that there was really no choice, that I had to go back inpatient. Now forced into the hospital against my will rather than nervously going in to please my parents and doctors, I took advantage of my knowledge of the unit’s inner workings to rebel any way I could. I hid my plastic fork from meals in my pants pocket and self-harmed with it, so staff modified all of my meals and took away my silverware so I had to eat with my hands. I took advantage of the fact that I didn’t have to do anything all day and stopped eating. Staff figured out I had an eating disorder and put me on bathroom restriction; I could not leave the dayroom for two hours after meals despite not eating anything. I grew progressively weaker and lost more weight, by the end of my stay they were threatening to strap me down and tube-feed me. I attempted to escape as a staff member unlocked the door to pass through, so staff decided to solve this problem by keeping me there all day long while the other patients left for art therapy. It was a game of tug-of-war where one side is much stronger than the other, so I eventually gave in. The only good thing about this stay was finally confessing to my mother about my brother’s abuse. This was the last straw for her so she decided to move out of our house and take me with her. After I was discharged, she rented her own apartment and I went to live with her.
I started my junior year at a public highschool. This year was pretty uneventful, in that nothing happened that hadn’t already been happening: Grades were bad and getting worse, suicidal thoughts, urges to do things like throw myself off the side of escalators at the mall, self-harming, eating issues, intense anxiety, seeing my psychiatrist, therapy, and generally lying about how I was. The jarring dissonance between how I pretended I was in my life and how I actually felt and thought caused my self to split into two parts, Black and White. They constantly argued about what do to: Eat or not eat? Tell what I’m thinking or not? Cut or not? Again, I told no-one, afraid they would think I was psychotic. I withdrew from basically all social interaction besides my parents. I had friends at school, but any attempts to contact me outside of school usually fell through; I was just too anxious and exhausted to go out with them. Eventually, they stopped asking. I got a job at the end of that year at my parents’ insistence and worked part-time.
My first semester of senior year I was still officially classified as a junior; I hadn’t passed enough classes to advance a grade, so I re-took a lot of courses and a freshman history class so I could graduate. I reflected bitterly on this a lot (If I was as smart as every teacher I’d had insisted, why had I ended up being held back?). I resented my Cymbalta and saw it as a “stupid crutch” and stopped it cold-turkey a few times. This gave me fun things like electric-shock sensations in my brain so I would always go back on it. I showed symptoms of post-traumatic stress: Flashbacks, more nightmares, and being easily startled. My mom would touch my arm to wake me in the morning and I would bolt awake with a gasp. I dated a very kind boy throughout the year, and grew to genuinely love him, but I was distant to him because of my problems and he didn’t understand why. I realized I had zero energy for anything besides barely getting through the day and broke it off with him. At the end of the year I was told I had to either finish a large amount of work or I couldn’t graduate. I looked at what I had to do, went to my counselor and said, “I’m done. I’ve had enough.” My counselor protested, but I convinced him and my parents and they let me drop out of high school.
I got on full-time at my job and started seeing a new therapist, Dr. S, who I liked very much. The first thing she said to me was: “I’m here to suggest things that might help you. If you think it won’t help, if you have any doubts about what I say, tell me right away and we’ll go in a different direction.” This was completely unlike what I had been told over the years. She listened to what I had to say. I eventually trusted her enough to give her a list of all the abuse that I remembered happening (it was too hard to talk about out loud), and I told her about Black and White. She did not call me psychotic, she confirmed what I had suspected all along: they were split parts caused by trauma and keeping the secret of that trauma.
What happens next is where things get simultaneously weird, terrifying, and awful. I debated not including this part, because most people would think I had completely snapped (the professionals certainly thought so), but the narrative wouldn’t make sense if I didn’t include this next paragraph.
Other people in my head (it’s the best way I can describe it) started coming forward. They weren’t split off of me, they were completely separate. The trouble was, we shared the same brain and to an extent, they felt what I felt, so when I felt anxious, suicidal, and so on, they did too. I fed off of them in a never-ending cycle until none of us were sure exactly whose was supposed to be feeling what. More people appeared–men, women, teenagers, adults, children, with a complex network of politics and ways of interacting with each other. I thought I had Dissociative Identity Disorder (formerly Multiple Personality Disorder), as this was the only possible explanation for what was going on.
In any case, the chaos from this latest development finally pushed me over the edge. I was suicidal as usual, decided to go to sleep and see how I felt in the morning, felt no better the next day, and overdosed on my Cymbalta in a daze. Once I had swallowed everything it hit me what I had done and I reluctantly (I thought I was “bothering them”) called 911. Paramedics came and brought me to the ER. My upset parents were called and I was given charcoal to drink. My parents called my boss and said I would need an emergency week off. Once I was stable, my psychiatrist ordered me to be transferred by ambulance to the same psych hospital I’d gone to years ago. Only once the paramedics had escorted me inside were intake papers presented to me and I was told I had to sign myself into their Adult Inpatient Unit now that I was 18 (a clever tactic indeed–I was already there, they could easily force me in if I refused). I signed in voluntarily so that I could theoretically sign out again whenever I wanted. I learned that this wasn’t really true–technically I could leave whenever I wanted, but the doctor could either change me to involuntary or if he let me go, insurance wouldn’t pay for my stay and I would be stuck with tens of thousands of dollars of medical expenses.
So I went onto their Adult Acute Unit and got admitted. A tech and one who was being trained took me back to a room for my strip-search. The trainee took notes while the other tech said, “You have to look for stuff they hide in places like…,” and she approached me and basically put her gloved hands down my pants and up my shirt, groping and feeling me all over. They had never done this on the Ads Unit (they mostly just had you pull up your shirt and pull down your pants), so I struggled, but she just moved with me and I gave up. Then the trainee pulled out the familiar paper scrubs one wore on suicide watch and I changed into them in full view of the two techs. The Acute Unit was full of people who were career mental patients, but even though we were considered the sickest, we were still allowed to go outside for “outdoor breaks.” Patients primarily used them to smoke, and though I didn’t smoke, I went out for the fresh air and something to do. I confessed to the professionals about the other people in my head and diagnosed “Bipolar w/ Psychotic Features.” Despite my suicide attempt, it was hoped that this was my first and last “psychotic break” so I was just given a “mood stabilizer” (Zyprexa) and sent home.
I spent the next month utterly without hope. I worked a low-level, dead-end job, I had dropped out of high school, I had dropped out of college (I had been going to take classes at the community college, but forced to cancel before I started), and now all of my managers at work knew I was crazy. So a little more than a month after my discharge, while I was at work I grabbed the large bottle of Tylenol kept in the first aid kit and downed the entire thing in between helping customers. I knew that even one Tylenol went through the liver several times, so the amount I forced down my throat would result in liver failure and a painful death. I continued to work through my mounting nausea and went on break with a co-worker a few hours later. We got to talking and again I had second thoughts and I confessed what I had done. She was shocked, but wanted to know what she could do. “Do you want me to call 911 for you?” she asked. After a little convincing, I agreed, and she led me out of our work building (telling our boss that I was very sick and needed to go to the hospital) and across the street to a gas station where she dialed 911. Again paramedics came and got me. Again I went to the ER and was given charcoal, but I couldn’t keep it down and kept vomiting and vomiting every five minutes. The doctor on call drew some blood and my Tylenol level came back triple the maximum level. I was given an IV of the antidote to the Tylenol. My mom and dad came, but eventually my dad went home to get some sleep as I stayed in the ER for hours upon hours, still vomiting. The nurses explained that they weren’t going to supress the vomiting for now so that I could get as much Tylenol out of my system as possible, but they hung some IV fluids so I wouldn’t get dangerously dehydrated. Finally the ER doctor came in and said he was admitting me to the ICU for observation and to get several rounds of the Tylenol antidote. The nurses gave me Zofran to stop the vomiting (a true miracle drug, if you ask me) and sent me upstairs.
I spent two days in the ICU completely off my meds, and I genuinely felt better. I wasn’t allowed out of bed, but my nurses were kind women who popped in every once in a while to say, “You alright? Anything I can get you?” Actually, come to think of it, despite my undeniable medical status as a psych patient, the kindest professionals I met were those not in mental health–police officers, paramedics, ER doctors, and nurses. They, who were supposed to only attend to my physical problems, did a lot more to improve my soul than a lot of so-called “soul healers.”
Anyway, as I was being discharged, my ICU doctor called my psych and wanted to know his input on what to do. Predictably, he said, “Bring her over to us.” By this time my parents (divorcing but still amicable to each other) were sick of me going to this hospital and protested, but they were stuck too. They didn’t have medical authority over me anymore, and I certainly couldn’t refuse (see above with my first “voluntary” admission). So it was back to the regular Adult Unit, where the unit psych lectured me on my suicide attempt: “What you did was a crapshoot. Your liver could have failed,” with a disgusted look on her face. Yup, knew that already. She gave me a brief break from all meds to let my liver recover more, then broached the subject of anti-psychotics. Since I had confessed that the other people in my head had been part of the reason I had tried to kill myself, I should take them. “No,” I said. “Why not?” she said. “Because they are heavy-duty drugs and they cause weight gain and tardive dyskinesia.” Just like with the anti-depressants so many years ago, these concerns were brushed aside and I was given Geodon.
Soon after I started Geodon, I was in my room and I gradually became more and more anxious. About what I couldn’t say, but I just felt so restless I got up and started pacing back and forth in my room. At the same time I had the strangest urge to look up at the ceiling. Over and over this happened. To deal with my intense anxiety, I did what I always had: Found something to cut myself with. I grabbed a fork and did it, then was overcome with guilt and confessed what I had done to a tech that I liked, who sat me down and went to get some ointment and a band-aid. Meanwhile, this maddening thing with my eyes got worse and worse. It got so that they were literally stuck there, looking up at the ceiling. If I focused all of my willpower I could bring them back to looking forward for a few seconds, but they always drifted back up. It was scary and incredibly frustrating. I found that if I held my eyes closed with my hands, it helped some, but the tech sitting with me thought I was trying to push my eyes into my skull (which might have helped by severing some of the malfunctioning muscles and nerves, come to think of it. Kidding!) and made me stop. Sitting for so long with my agitation and frustration led me to get up and start banging my head on the wall, so I was restrained with a bear hug by the tech sitting with me and put in the Quiet Room. For hurting myself I had to be transferred to the Acute Unit, and the saw the psychiatrist again just before going. “Why…am I…doing this?” I asked him about my weird eye tic, suddenly having trouble speaking at a normal rate. What he told me I will never forget, because it was classic psychiatrist bullshit:
“This is your response to stress.” No, it wasn’t. I had never banged my head from frustration before, never felt so restless, never had difficulty speaking, and never had this fucking eye thing!
On the Acute Unit, I sat in front of the nurse’s station and continued with the eye thing. Then yet another thing cropped up: My neck was twisting to the side, farther, farther, farther…I contorted in my chair, crying from the pain. A tech passed by and put some tissues next to me before walking on.
Eventually, these symptoms went away enough that I could sleep that night. But it just got worse over the next few days. I felt so restless I just started pacing up and down the unit hallway, my mind restlessly fixed on touching the door every single time I finished a lap. If I didn’t touch the door, the lap wasn’t finished, and if I didn’t finish a lap…well…something bad would happen. Let’s just keep pacing. My muscles became stiff, so that I kept my arms in a unnatural position in front of my body. Another patient who I had befriended told me, “You look like a robot,” but they looked concerned. Just before my parents came to visit I launched into full-body muscle spasms. The staff hurried me into a small room with my parents while they finally called the doctor. I lay on an exam table at the mercy of my chemically malfunctioning brain sending out random continuous signals to my muscles. My back and neck twisted, my toes pointed, my fingers curled and stretched until I thought my joints would dislocate from the pressure. My parents were horrified and tried to comfort me by massaging the rigid areas and holding me. A nurse came in with yet another pill: Inderal, a beta-blocker to relax my muscles. This actually worked, and I was again able to get some sleep.
The doctor got the hint that Geodon was not a good idea, and I got off of that, replaced with Seroquel. He prescribed low doses of Inderal also to combat possible muscle issues I might have with this med. Yet another day on the Acute Unit I sat staring off into space, my mind still racing with anxious thoughts. I got up and banged my head against the wall, prompting two nurses to grab me firmly by the arms and offer me a pill, probably another anti-psychotic. I shook my head; I did not want to take any more of that shit. They half-dragged me to the Quiet Room because I wouldn’t take the meds. I paced in the room, anxiously trying to find a way to hurt myself to relieve this feeling of anxiety. I banged my head against the little window. Security was called. The psychiatrist poked his head in and said, “What’s going on here?” I hissed at him, “Go away!” He was the last person I wanted to see. He went away, but now security was there: Two large men. I became afraid and cowered in a corner. This is the last thing I remember; I have a tendency to black out just before something traumatic happens and wake up in time to experience (and thus remember) the actual traumatic event. I woke up on the mattress in the middle of the room, held down by four staff members (including the men from security). It was at that point I lost all connection with reality. I think them holding me down like that brought on an intense flashback, but usually when I have a flashback no one is touching me and I am otherwise safe. Thus, my brain, already confused by the flashback, interpreted their touch as them being about to rape me. I completely forgot who they were, where I was, who I was. I was utterly consumed by primal fear. Thus when they pulled down my pants and stuck the syringe of Haldol into my thigh, I thought this was the moment of penetration and a horrible, ripping scream tore out of me.
They got the Haldol in me and finally let me alone. I can’t remember if they pulled my pants up again or not. The last thing I saw was a nurse watching me with her arms crossed before I went under.
When I was discharged from the hospital again, my new diagnosis was Borderline Personality Disorder and I was sent home with four meds taken three times a day to combat my new Borderline-ness: Cymbalta, Tegretol, Seroquel, and Inderal. It was as if the psychiatrists were saying, “Welcome to the big leagues, kid. Now you’re clearly in it for life, so here’s your new merit badge: Poly-pharmacy.” My mom was concerned about how many meds I was on, and asked a colleague at her work who had worked in mental health. He told her that for somebody with two suicide attempts in a month, that was the norm. So like any good nurse, my mother dispensed the drugs to me.
I didn’t feel better. I’d had to quit my job, so now I just sat at home, getting fat from the meds and being miserable. I gained 40 pounds. Stretch marks streaked my thighs. This was the last straw. I decided to get off of the meds. All of them. At first my mother fought me. You need these meds, honey, you’re sick. No, these meds are making me sick, I countered.
So over a few months, I got off of them. I saw Dr. S., who gave me EMDR to deal with my trauma. Without meds, I didn’t have intense suicidal thoughts! I didn’t self-harm! I lost the weight! I could actually be anxious, get over it, and move on! With the therapy, I managed to bring my PTSD symptoms down to almost nothing. I sleep peacefully and have no flashbacks. I integrated Black and White back into my core self. As for the other people in my head, well, without all of my negative issues, they are happier too. We cooperate and now we are even friends. Only one of my many “diagnoses” do I agree with my doctors on: I am definitely high-functioning autistic, and proud of it.
So there it is. My whole, entire story. Writing it out is hard. I can’t believe I actually lived all of it, especially since I cut some things out for length in the writing. I’m sorry it’s so long. But it did help to get it here, to see the pattern that I’ve read about in so many articles and your blog.
P.S.–My brother is now on no meds and doing well. He lost the weight, calmed down, and married the girl of his dreams. He now serves in the military, and we get along well. I have forgiven him for what he did.