Schizophrenia can come on rather suddenly around age 18 in men and 24 in women or it can have an insidious, meaning gradual onset. It took at least 8 years for schizophrenia to render me incapable of taking care of myself. The progression of symptoms starts with loss of attention, then loss of social skills, then loss of academic skills, then often rather intriguing reality distortion, which finally turns into absolutely terrifying reality distortion. At some point people are usually totally incapable of taking care of themselves. I lost my social skills rather early but I experienced my first major romantic relationship at 17 which proceeded to gradually deteriorate over the next four years as symptoms of my schizophrenia increased. I dropped the male friends I would drink and smoke marijuana with at that age because they started to put me down. I had essentially made a good choice. You can experiment with recreational drugs or you can experiment with romantic relationships. If you choose the latter your life will be much happier, and I was with Elizabeth and her friends for several years. When I was sixteen I scored in the top three percentile in a province wide mathematics contest, and my favorite subjects were math and physics. When I was in love with Liz I took on her interests, English, history, and feminism. By the time I was eighteen I had lost interest in school altogether and only applied to university because my father was so insistent I go. I was quite strange from 16-25 at high school and then university and thought I needed psychological therapy along the lines of Gestalt therapy or Rolfing. With an insidious onset you gradually lose your human relationships as your symptoms increase and you can literally end up homeless and absolutely alone in the world. That is what happened to me. Most people with schizophrenia have few human relationships and it's certainly true for me, although I don't really understand why that is. My mother says now that she noticed a change in me around 18, that I seemed to lose all my ambition to succeed.During the prodrome of schizophrenia you lose your ability to function in competitive environments. That is you lose your abilities to participate in life, whether it be romance, school, jobs, or even drinking in the bar with friends. The primary characteristic of mental illness is disability, and when that happens during the prodrome of schizophrenia, it usually causes a lot of emotional turmoil. So during high school I basically dropped out of society. I wanted to buy some land and become a hippy. Of course you need money to do that, and I didn't have the skills to earn that. I actually didn't have any male friends during the last few years of high school, only female feminist friends. The experimental high school I was in didn't stress competition, didn't have any athletic teams, and there was twice as many girls as boys. If it wasn't for those factors I probably would have failed high school and turned to drugs which I later did in university. Drug use, particularly marijuana use, is very common by the first psychosis. I actually felt much more confident while stoned. But the cause per se of my underachievement at school, my loss of a girlfriend, my inability to get good summer jobs, was primarily a loss of functioning ability. I couldn't function well in anything and dropped out of society and started smoking more and more marijuana.
One significant indication of schizophrenia was my inability to plan my future. I took courses in University that sounded interesting with no real plan. I was notably incapable of developing another long term romantic relationships and in fact was very anxious in any kind of social situation. I doubt that any psychiatrist would have been able to diagnose schizophrenia at that point though. I graduated with an Hon B. Sc. from Trent University with a double major in biology and anthropology. I applied to one graduate school at the last minute as I realized that my degree was not a career and was accepted. I was trying to apply to three graduate schools but was so disorganized I only got all the necessary documents to one in time to be considered for admission.
At graduate school in Nova Scotia in 1978 I kept going to the university clinic about my physical health, afraid that my health was going to fall apart. I thought the town water supply had become contaminated because it tasted metallic to me. I was convinced I was going to die of a heart attack. I thought I had been poisoned by Dioxin like the Vietnam Veterans who handled Agent Orange. The most frightening was that I had contracted a form of syphilis that couldn't be detected by regular lab tests. I thought the heroin addicts who lived downstairs had raped me and this Vietnam strain of syphilis had evolved beyond the ability of standard lab tests to pick it up. I was referred to a psychiatrist and expected to talk about Freud and Carl Jung, maybe Gestalt and how Rolphing works. He prescribed Chlorpromazine which took me by surprise. I had never heard of psychiatrists prescribing medication. Before long I was hospitalized for a couple of weeks. What started as having an analyst like Woody Allen became an involuntary hospitalization. I had some delusions that Jim Jones, who was responsible for 500 people committing suicide en masse, was trying to force me to commit suicide telepathically. I decided to quit graduate school and go home to Toronto but wasn't sure if I would make it home on the plane because I developed diabetes during my telepathic struggle with Jim Jones. I went to the University clinic and two doctors talked to me, and as I stepped outside two men grabbed me by the shoulders and put me in the back of an ambulance and off I went to the local psychiatric ward of the local hospital. I was confused but it cleared up as soon as I entered the hospital. In two weeks I was discharged. Unfortunately no one mentioned schizophrenia or psychosis or why I had been hospitalized to me or my father, who is a physician, and I thought I had just had some sort of nervous breakdown. I saw someone after I was discharged about once a month for a few months. I remember taking Chlorpromazine before I was hospitalized which I didn't like and Stellazine after I was discharged. My father encouraged me to take it but I was scared of it and I only took it for a little while. No one mentioned how long I would need to take the Stellazine. When I look back at those events the word MALPRACTICE is written all over them, but it happened so long ago now.
My father convinced me to try and finish my year even though I wanted to drop out. It was a very miserable year for me. Some courses went unfinished and I was kicked out of graduate school. I worked for a summer in Toronto, the fall in London, and feeling a little better I headed out west to Vancouver Island leaving the Stellazine behind. I also left Debbie who I wish now I had married. I had a friend working in a small pulp mill town called Crofton but soon after I got there he moved up island and I rented an apartment in the striptease tavern, alone with my delusions and hallucinations once again.
As I relapsed I had mostly delusions and paranoia. I thought the CIA was after me for awhile after I wrote a letter to the editor of Science magazine about how the US military was using dioxin as a weapon in Vietnam. My delusions had faded for the previous summer but they had never completely disappeared. That is to say I believed some pretty strange things. In Halifax I thought I had discovered the cause of World War Two. The influenza epidemic of 1918 changed peoples' nervous systems and led to the rise of fascism everywhere, so the cause of the war was a neurovirus. I thought my law professor in Halifax was very well connected with influential people in world politics and was telling people about my theory. Various important people were coming from Europe to meet the man who discovered the cause of World War 2. For example, someone might come up to me in Crofton and talk about mopeds and I would believe this man was the president of Motobecane, the world's largest manufacturer of mopeds. People seemed to know me before I introduced myself, and the local townspeople seemed to be laughing at me. I remember once the political cartoon in the local paper seemed to be about me and people who picked me up hitchhiking seemed to know who I was.
In the spring of 1980 I left Crofton forced out by the townspeople who demanded I get a job. I took the bus with no destination in mind until I ran out of money. From then on I usually hitchhiked, mostly through Alberta and B.C. quitting a job with my first pay check because I found working with people so difficult. They were playing games with me and making fun of me. I would then hitchhike somewhere else. I thought I was being followed by a WW2 veteran everywhere I went who wanted me to shape up by working in construction like he did after the war. He was grateful to me for discovering the cause of WW2 in which he fought with distinction, but he had no idea why til he heard about my theory. I kept trying to escape him because I didn't want to work in construction but he had friends everywhere. I slept in city parks, by the side of the road and in single men's hostels. I was homeless and often penniless.
I remember once in Calgary staying at the single men's hostel and not getting to eat very much for several weeks, becoming quite weak. I believed I couldn't work because I had dioxin poisoning and this was affecting my cortical hormone balance making work too stressful. Tibetan buddhist lamas were reading my mind everywhere I went in Calgary, respectful and curious, because I had caused the Mt. St. Helen's eruption for them earlier that year through tantric meditation. In doing so I had taken pressure off the continental plates so that San Francisco didn't drop off into the ocean. The Tibetans told me telepathically I might become the first Western Buddhist saint, comparable to Milarepa who is Tibet's favorite saint.
I don't think I quite understood or believed what was happening to me, but I was determined not to admit defeat and return to my parents house. It seemed like I had powerful friends who wanted me to pull myself up by my bootstraps. Only two years earlier I had been in graduate school, with a new friend, David Rae, discussing world politics while watching the CBC news at a local bar. David's brother, Bob Rae, later became the Premier of Ontario.
Come late fall I was in Victoria, driven south by the approaching winter. I had been homeless for six months or so. There I was somehow able to pay rent and I stayed there for four years. I started studying Tibetan buddhism and took refuge in the lama who lived there. I was given a Tibetan name Tashi Sampo, and ever since I've wondered what it meant. Tashi means good wisdom. I have no idea what Sampo means though. I thought this man was capable of all kinds of supernatural powers of the mind like telepathy and telekinesis. It is a tremendous invasion of privacy to have someone reading your mind all the time uninvited. I believed he was controlling my dreams while I slept as well. He said to me in his broken English, "you special" and I thought that meant I had a lot of natural ability to become a very powerful tantric like him. Somehow I knew he was the equivalent of a graduate teacher in the Tibetan monastic system. He was also very antisexual, having been celibate all his life and it seemed like he was interfering every time I started talking with a girl. The Tibetan Buddhists practice a celibate tantric tradition which is really a contradiction. Tibetan buddhists used to take wives, but the Red Hats as they were called, were persecuted and driven out of Tibet hundreds of years ago, mostly to Nepal, where a few still survive.
I had gone to several family physicians about my physical problems of which dioxin poisoning seemed to be the cause and I thought it was also causing my adjustment problems but the family doctors never realized what was happening to me and I stopped going to them and instead thought this Tibetan buddhist lama would be able to help me. I was aware that something was really wrong. I just had no idea what.
I was losing contact with reality gradually and stayed in abject poverty and I was really miserable. I remember I bought a WW2 rifle to please the WW2 veteran and I would sit in my basement room with the barrel in my mouth and wonder if I should pull the trigger. I started to think that Tibetan lama was very evil because he was celibate and very antisexual. I also started finding messages in Beatle songs, which I thought were from the Marharishi Mahesh Yogi to get out of there, and that's what I did. One day without telling anyone, I just packed up my run down car and drove to Ottawa to see the girl I should never have left, Debbie. It is the deepest regret I have actually, leaving her and Ontario to find my fortune out west. Even my father advised against it. I was convinced there was a secret war going on between two groups, both with supernatural powers, that would decide the fate of humanity after a number of years in Victoria. I called one group the Sexuals and the other the Antisexuals, because these tantric powers came from a kind of sexual state of conciousness and the Tibtean buddhists were so antisexual. If the antisexuals won the secret war, humanity would destroy itself in a nuclear war that would break up the continental plates. The oceans would evaporate with the fire and brimstone, and all life on the planet would be destroyed.
Driving away from Victoria was a miracle in a its own right. I was tortured so severely for my bad karma I could no longer run away from that religious teacher, and I even plotted his murder with the rifle I owned. I was being tortured but I had no proof that I could take to the police. Because he could read my mind I could never be successful attempting to assassinate him because he would always know when the bullet was being fired. And I couldn't leave. I ended up convincing some of his favourite students that human societies were either sexual or violent with copies of an article that appeared in the Bulletin of Atomic Scientists comparing human cultures around the world. Where babies were touched a lot, and where adolescents were allowed to enjoy their sexual pleasure, societies were non violent and pacifist. In societies where sexuality was prevented and repressed, the cultures were fierce and in constant war. It's a truth that Western socieities would be wise to acknowledge, and the main reason I have always wanted to emigrate to Scandinavia. The fact that his students read the article and agreed with the conclusions angered that lama so much it gave me the self esteem I needed to run away. I probably would have died in Victoria otherwise. I attempted suicide in Toronto a few years later, I think partly because of the torture I thought I experienced out west.
I forget some of my life out west. I do remember being very miserable and very alone, identifying strongly with Milarepa, the Tibetan saint who lived most of his life in a cave surviving on the vegetation that grew there. He had bad karma and suffered greatly for several years under his teacher Marpa, and then for many years on his own. He never lost faith in the Dharma, the teachings of Buddhism. I wonder if he wouldn't have committed suicide if he had lost faith. The original Tantric tradition on the other hand, sometimes called the left hand path, is absolutely fascinating. I would love to learn more about the left hand path. I'd just like to document their history in India. These powers of the human mind appear in every culture in recorded history, but they really flourished in India. In the ninth century these supernormal powers appear to have been relatively common. Tibetan buddhism incorporates a residual celibate tantricism in its teachings and I think it has survived because they are extremely religious. Tantric powers are a type of technology, neutral by nature, but very threatening in the wrong hands. In my innocence I was entranced by the erotic temples in India like Konarak and determined to become a tantric and help the world rediscover the supernormal powers of the mind harnessed through sexual states of consciousness. I wonder even now, why they became extinct. The left Hand path that I am so fascinated by, is now considered the path of darkness and evil, much like our Christian witchcraft, when in fact they were both probably quite neutral, residual religious practice and belief that was displaced by another religion, like Christianity or Buddhism, and then literally persecuted to extinction. Watching the Star Wars movies now the struggle between the Jedi warriors and the Sith is remarkably similar, although I wonder if the dark side which would translate to being the left hand path is being misrepresented.
In Toronto in 1985 I was homeless for a few months, living in my car, then thrown out of a number of rental rooms in shared houses because I kept stealing food, and eventually managed to get a job changing light bulbs at a large department store. I hated it, and ran away twice, to England and Jamaica expecting to be welcomed personally by the Maharishi. When a terrorist bomb blew up a plane over Lockerbie Scotland I knew it was an attempt on my life by the Buddhists/Antisexuals, which prompted me to fly immediately to the Maharishi's university, (which it wasn't), in England but he wasn't there and I came back the same weekend. I saw a movie called "Oedipus Rex" directed by Passolini and immediately flew to Jamaica expecting to be welcomed by the Maharishi. I was looking for Strawberry Fields mentioned in the Beatles song and there are two in Jamaica. It was a memorable trip. I ran out of money after one week, and went to the wrong Strawberry Fields, but I did learn the true value of money, which is considerable.
I didn't have any friends, any lovers, and very little contact with my family between 1980 and 1990. My parents had moved to the States while I was in Victoria and I never told anyone what was happening. The rooming house where I lived was invaded by cockroaches and I just lived with them, never even realizing that Diazinon will eliminate cockroaches very quickly. I had a strong sense of mission to help humanity instead of myself and in my poverty I believed the cause of suffering in the world was overpopulation. My solution was to hybridize the AIDS virus with the common cold and eliminate 3 - 4 billion people.
I got a lot of messages from favorite Rock and Roll songs, from movies, cartoons and library books. The library was my special friend who could show me what I needed to know by having me open and read exactly the information I was looking for. Someone was leading me to the books I needed like I was a puppet on strings. More than that someone was familiar with every book in every library I went to. It was more than any human could be capable of. When I saw an image of St John the Baptist pointing to the sky, I knew we were both getting messages from the same people. I started to believe I was in contact with aliens from outer space. At first there were two kinds. The nuclear holocaust that would break up the continental plates and evaporate the oceans couldn't be avoided. The aliens had built a box in outer space that would be the next Noah's ark. I read about it in Revelations. I was going to live in a box out in space with a woman the aliens had been breeding, like me, since life started on this planet. She had dark blue skin like the Hindu god Krishna and we were going to have children who would be turquoise in colour. We were going to be the only survivors of Armageddon and we would propagate the species. Only girls would be born as identical twins and they would be able to impregnate each other from a single drop on their funny long noses. I would be the last surviving male although I would only live a thousand years.
I believed that to be my destiny completely and got a lot of messages everywhere I went. I heard voices several times but mostly I experienced telepathy. I had what are called "ideas of reference" where things are thought to have a particular meaning just for you. For example, a license plate on the street could be an important and appropriate message for me from the aliens.
Then a disaster occurred. Revenue Canada wanted me to pay $5,000 in back taxes, and I was becoming alcoholic drinking John Courage beer, which had been created just for me. I needed all my money to buy my beer, and in the "discussions" I had with Revenue Canada, I was assigned a police type of some sort, whom I named David. By the end of that disaster, David realized he was going to have this destiny in the box in outer space with an ocean in it, and I was going to be transformed into an alien and have eternal life. I would be capable of time travel like the aliens and my companion was going to be a part time anthropology professor at the University of Toronto. Sexuality was as important as intelligence to the aliens and they had evolved beyond the use of machinery to doing everything with their mind. I thought they were turning on my nervous system with experiences of pain so that every neuron was active, so that I would be able to experience greater pleasure as an alien. I asked them once if a machine might not make the process less painful and I remember them laughing, saying "Machines... Ian, we don't have any machines."
My delusions changed as the aliens instructed me on the real nature of reality. I saw a book title "3791" that jumped out at me in a bookstore, written by none other than Nostradamus, and I understood the message. I turn 37 in 1991 and that is when I will become an alien. I suspect that Nostradamus actually meant for the title to be read backwards, 1973, which is a practice of esoteric culture.
I wanted a fonder memory of my life on earth than a cockroach infested rooming house, and I had three years or so of aging before I would be transformed into an alien. One night the aliens agreed to transfer my mind to the body of a wealthy man living on the French Riviera, my idea of paradise. I bought a bottle of champagne to celebrate and passed out on the living room floor expecting to wake up in the south of France. I got furious at the aliens when I woke up in my body instead, in the cockroach infested rooming house, and I started breaking windows and pulling doors off their hinges and throwing them through windows. The police came very quickly, subdued me and I spent a couple of nights in jail. The judge realized I was a psychiatric case because I carried a pocketknife to defend myself against homosexuals. The world's most powerful man was a homosexual and he was going to try and make me a homosexual by having me raped by a gang of homosexuals. By then the Maharishi was my second worst enemy. I believed they both knew about the end of the world and my destiny with the aliens and they wanted to take my place. I learned a lot about them through the films I was seeing in the evening, like "Alien", although in this case the alien is actually human, the world's most powerful man. It's about as paranoid as you can get I guess. I didn't mention any of that in court though. The charges were mischief under $1,000, and carrying a concealed weapon.
Nobody asked why I did what I did. I got three years probation with the condition that I see a psychiatrist for those three years. Psychiatrists are only human though, while I was almost alien and they wouldn't have understood what was happening so I never told them anything. I went to my appointments to stay out of jail.
Jail was such a shock to me. I was so mad at the aliens after that experience I tried to force them to give me a new body by killing the body I was in. I bought several bottles of vodka and guzzled them like water until I passed out knowing that people overdose and die from alcohol poisoning. I got pneumonia but lived and decided that the aliens wouldn't let me die, only experience pain until it was time for me to go.
Although I didn't drink anything for awhile I eventually started to drink and heavily because I could afford it. You basically need a lot of money for any addiction but for alcohol $11 an hour is enough, provided you don't have any other interests. Originally I drank for the hops which I thought were medication for celibacy. My behaviour became more and more bizarre and I was fired from my job. I went from unemployment insurance to Welfare, brewing my own beer in plastic pails and eating in soup kitchens.
I experienced many extreme emotions when I was psychotic with positive symptoms. In fact its a wonder I didn't come into contact with the police before I did. I can say that I never harmed anyone but I realize I came very close, although I experienced extreme fear more than anything else. I am by nature a gentle person who has never started a fight with anyone. Family members I have met in Guelph have usually had some experience of verbal abuse or physical assault from their ill relative before they were treated. I remember I thought I was dying from celibacy and I hated women for a couple years even though I went through adolescence with only feminist friends and was convinced women were the superior sex. Schizophrenia can force you to feel and do things that are not in character for you. Dr. E Fuller Torrey says violence in schizophrenia is predicted by three factors,
I would destroy my own possessions first like my guitar without having much choice. I shied away from people. I remember sitting on the ledge of a window on the sixth floor wanting to jump but knowing that the aliens would have an open truck loaded with mattresses come by just as I jumped and when I actually saw such a truck weeks later, it only confirmed my conclusions. I expected to win the lottery after losing my job but didn't, and didn't understand why not. Out of work I was drinking my homemade beer all day. The people in my rooming house started mainlining heroin in the living room. I was desperately poor by that point expecting to become homeless and sleep on a hot air vent and I couldn't believe that was a necessary experience in becoming an alien. I was experiencing quite a few blackouts from the drinking I was doing and getting scared of alcohol. I kept waking up in strange places. One fellow in the rooming house had attacked me with a chain such that I needed stitches above my eye. I was too disorganized and too poor to find another place to live. My mind seemed to be falling apart into the left brain, me, and a right brain I hardly knew who was in tremendous pain and very demanding, and a dinosaur or core brain, that was very powerful and angry at me. It took a long time to unlearn that, and even now 16 years later I think my left and right hemisphere are very disconnected from each other. I know it's foolish. I just can't help believing it to be true. I agreed to go to a psychiatric hospital to be treated for alcoholism. Going into hospital was the easy way to get out of a situation that was very frightening. That was at the end of my three year probationary period.
- a previous history of violence,
- substance abuse,
- not on medication
I don't know how common this is but when you entrust your life to outside forces that are very powerful, for whom you are vrey special, you will endure a lot more suffering than any sensible person would. I entrusted my life with Tibetan buddhism, until I couldn't stand the pain any longer, then the tantrics and the Maharishi Mahesh Yogi, who is actually also celibate, and I suffered, and then the aliens, who convinced me the expereince of pain was necessary to becoming an alien. So now I'm pretty antirelgious, and I know that only real people ever care for one another.
As I sobered up my delusions faded a lot and I realized I had no concrete proof of aliens or my imaginary wife. I also realized I couldn't put my faith in aliens to take care of me. The hospital was like a resort, with three meals a day, and sports and socializing, and I refused to be discharged. I moved into a basement room in Guelph and started a maintenance dose of anti psychotics. The year was 1990. It took several years to completely believe and understand that I had schizophrenia though. I was sure I had been mis diagnosed, and I would much rather have had bipolar disorder so I could compare myself to various famous people. I repeatedly wanted to go off medication but the psychiatrists were very firm about that. Medication didn't seem to have any effect so there was no reason not to take it. I had run out of options and it kept my psychiatrist happy.
I was very depressed for several years and very lethargic. I didn't accomplish very much and was very anxious. I lived in basement rooms, had no friends and very little contact with anyone. At that time I was seeing a psychiatrist at a Outpatient clinic once a month or so. I don't think my period of depression could have been avoided. Antidepressants didn't help which suggests I didn't have an actual depression. I was very anxious having nothing to do and no one to do it with and had extremely low self esteem. My mood eventually improved a bit and I made a couple of friends and became more active. I started to do a little volunteer work and I eventually met Rosemary and courted her. I started to work for some extra cash, delivering flyers and then the local newspaper. Rosemary and I moved into the apartment building where I delivered newspapers. We shared a two bedroom apartment for 16 months until the Provincial government changed the rules on cohabitation and it became too expensive.
The quality of my life has been improving a little each year for the last fourteen years and I can't complain too much but every once in awhile I really feel the losses I am enduring. Life is a series of opportunities as you grow older, and I missed every one. It is only in the past couple of years that I can say that I have been able to accomplish anything productive. Before that I was pretty unhappy and didn't feel very good about myself.
My friend Susan says there are two kinds of people. You get on a plane that is supposed to go to Hawaii and instead the plane lands in Siberia. Susan prefers to use Arizona as the alternate destination. You can either learn to enjoy Siberia or forever feel bitter that you didn't land in Hawaii. Lately Siberia has been fairly pleasant. My life does seem a bit "empty" compared to ordinary peoples lives. I also have a lot of extremely unpleasant memories in which I've done things I now regret. Its difficult to know how much I'm responsible for and how much schizophrenia is responsible for. I think its important for me to focus on enjoying life as much as I can and not dwell on the past. I know I am a good man and I'm beginning to feel proud of my accomplishments and my individuality. No one has a history exactly like mine, and that is precious in itself.
I went to an international conference on Schizophrenia in 1996, sponsored by Eli Lilly. I was mistakenly booked at the hotel as Dr. Chovil and the next day at the conference in my sports coat and dress shirt I was just another psychiatrist in the crowd and it felt pretty neat. This was the life I should have had. But the first keynote address by Dr. Weinberger, world re known researcher in schizophrenia, compared finding the cause of schizophrenia to finding the cause of the TWA flight explosion that was in the news at that time. There was no evidence that it was a bomb. Finding out what happened when all you have are the twisted pieces of metal scattered along the ocean floor was problematic. Over the three day conference I became so depressed realizing how appropriate that image was for me, that I didn't go the third day. It was just a little too much reality all at once.
That was an important conference for me. I learned a lot. A background of biology and anthropology is very appropriate for understanding the biology and sociology of a disease process like schizophrenia. It's really quite a fascinating illness, very complex, very subtle, very enigmatic, and unfortunately often very destructive. My life has steadily improved each year on medication. I'm pleased with my recovery, such as it is. I feel quite unique, and I've become more social and more successful than I ever would have imagined. I'm beginning to have faith in myself, something I lost when I realized how delusional I had been all those years.
If you're interested in reading about the last 14 years of my life I recommend the pages, - Meaningful activity (which I've updated) and Recovery (which is my take on recovery) The page on Medication is quite thorough but I am only familiar with what's available in Canada. I am particularly interested in the Prodrome now and Early Intervention but both are intricately interrelated with Relapse prevention
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