By E. Gambal. Lawrence University.

He acknowledges the struggle associated with persevering with illness symptoms in the absence of medication by pointing out that consumers will have to “push through it” but constructs life “without” medication as a better alternative to medication adherence in unspecified circumstances discount 5mg plendil otc hypertension young living, potentially for first episode consumers plendil 10 mg generic blood pressure chart mayo, for example, for whom the likelihood of relapse is uncertain. Despite recognizing the benefits of medication adherence for consumers (“it is a good thing”), Travis implies that the efficacy of antipsychotic medication is somewhat offset by associated side effects (“but it would be lovely for newer tablets to come out with less side effects”). Travis specifically links medication adherence to the side effects of decreased motivation, increased appetite and weight gain, using pre and post-medication adherence comparisons to emphasise the drastic impact of side effects. Travis’s stance in relation to medication adherence despite attributing medication adherence to saving his life highlights the significance of side effects to consumers. Research consistently indicates that the efficacy (or perceived efficacy) of medication in treating illness symptoms exerts a significant influence on adherence (i. The main utility of medication was seen as its ability to act directly on symptoms by stopping them or reducing them to make them more manageable. The degree to which consumers’ past and present medications treated illness symptoms varied. There was also inter-consumer variability in terms of responses to the same medications. The impact of medication on symptoms was emphasised through constructions of adherence as intrinsically linked to “sanity” or “normality”, which were contrasted with constructions of non-adherence as related to “insanity” or “abnormality”. The following extracts, thus, also tend to emphasise how mental illness can detract from consumers’ lives and how medication addresses detractions. It is noteworthy that like the “Reflection on Experiences” code, this code also emphasises that experiences with medications and adherence are interlinked. In the following extracts, direct correlations between adherence and sanity, and non-adherence and insanity, are made: 178 Ryan, 26/09/2008 R: Uh, um yeah, the difference between being sane and not being sane, so that’s how I’d encourage other people. Because like, being, being bad and then being good is two different sides of the fences, ya know? G: Because like, with the medication, it impacts a lot ‘cause we’re dependent, we’re not dependent on it, but… it helps keep us sane sort of thing, ya know, it helps. In the context of being asked how adherence could be encouraged amongst consumers, Ruth emphasises the effectiveness of medication in treating symptoms through her construction of medication adherence as “the difference” between two opposing mental states: “being sane and not being sane”. Gary also constructs medication adherence as the catalyst for a shift between contrasting mental states. He deploys a fence metaphor to illustrate how, by “over-rid[ing] the symptoms”, medication adherence is aligned with 179 “being good” and implies that non-adherence is aligned with “being bad”. Gary elaborates by attributing his maintained adherence, constructed as medication “dependence”, to the capacity of medication to “keep us sane”. Medication adherence is ascribed a significant amount of power in the above extracts, as it is essentially associated with alleviating insanity. In the following extracts, interviewees promote adherence by indicating that through its efficacy in treating symptoms, medication can normalise consumers. I’ve never been on strong medication but if I don’t take my medication it ain’t funny you know? The number one strategy what I’d say to someone with schizophrenia to take their medication is that sometimes, being out of the hospital, say for the first episode, for me, for example, um, it uh, they give you medication in tablet form like I did, but they may give you injections and sure, it may be sedating, a bit tiring and lack of energy taking some of these different medications for schizophrenia but the reality is, uh, then you 180 realise you will turn to normal because it treats that, I guess that chemical imbalance in your mind. In the first extract, George explicitly describes that “bein’ happy and just bein’ normal” influences him to remain adherent, in contrast to being a “bit loopy” and to getting “sick” when he does not take his medication. Furthermore, he describes the effects of not taking medication as being obvious to others (“people know”) and implies that the public element of displaying symptoms partly influences his adherence, possibly reflective of self-consciousness in relation to his illness and awareness of the associated stigma. A clear contrast is worked up, functioning to present medication adherence as linked with being ‘normal’. In addition to George’s construction of being “sick” without medication, in the second extract, Ryan also appeals to the biomedical model of mental illness through his description of medication treating “that chemical imbalance in your mind”. As before, medication is constructed here as alleviating this illness or abnormality: Despite side effects (“sedating, a bit tiring and lack of energy”), through its efficacy in treating the “chemical imbalance”, medication allows an individual to “turn to normal”. Through Ryan’s reference to these side effects, followed by his construction of medication as a normalizing agent, it is suggested that the experience of side effects does not compromise the ‘normal’ status of consumers despite antipsychotic medication side effects being absent from the ‘normal’, mentally healthy human experience.

Not quite so simple 5 mg plendil fast delivery heart attack kiss the way we were goodbye, but yet very plain is the second form of direct medication cheap 10 mg plendil amex heart attack reasons, illustrated by the following examples. A heavily loaded tongue at base, with a bad taste in the mouth and fullness in the epigastric region, demanding an emetic. A uniformly yellowish coated tongue from base to tip, relieved by Podophyllin or Leptandrin. A pallid large tongue, with a moist pasty coat, demanding the alkaline sulphites, say sulphite of soda. Quite as plain, but not so easily and directly reached by medicine, is the need of a good condition of the intestinal canal for digestion and blood making, and associated with it the recognition of the need of certain restoratives that may be necessary to normal nutrition and functional activity. In acute cases, it is required first to rid our patient of functional disease before we can fully establish digestion and nutrition, but in chronic disease it will many times stand first, and must always be associated with treatment for local lesions. The complement of this is, treatment to increase the removal of old and worn-out tissues, and thus relieve the solids and fluids of material that must necessarily depress functional activity. Probably we have as little positive knowledge of remedies that increase retrograde metamorphosis, as of any other class, still they are being studied, and in time we will be enabled to use them directly. Remedies that increase excretion are in common use, and form a very important part of our practice. From the earliest periods of medicine, the fact that disease is destructive has been recognized. Destruction of the material of our bodies, necessarily leaves the debris either in solids or fluids, and experience has shown that it can not remain in the body with safety. But there has been a failure to appreciate the true nature of these processes, and from this has flowed a very great deal of bad practice. These processes are strictly vital processes, carried on by delicate organisms under the control of the nervous system. As they are the basis of life, we may well suppose that nature has guarded them on all sides, and that they are the true centre of life. The doctor of the olden time has looked upon them as mechanisms to be powerfully influenced by remedies. He powerfully excites the stomach and intestinal canal as a means of derivation, and works upon the skin and kidneys as if secretion from them were a purely physical process. Any one who will take up Huxley’s Physiology, and read the clear and simple description of this apparatus for digestion and waste, upon which our lives rest, can not but be satisfied that the common practice of medicine is a very great wrong. Take away this power and he will die in a brief time; take it away in part, and you have lessened his power to that extent; take it away for an hour, for a day, or for a week, and his power to live is weakened to that extent. Studying the condition of the stomach and intestinal canal in this light, we will see how a direct stimulant, or tonic, an alkali, an acid, a remedy that will relieve nervous irritation, or one that will give increased innervation, will in different cases be an aid to digestion. Looking farther, we will see the necessity, in one case of histogenetic food, in another of calorifacient, in one of iron, in another of phosphorus, etc. It is just as much specific medication to be able to select the proper food for the sick as it is the proper medicine. The past winter I was called in consultation, in a case of continued fever in the third week. The treatment, so far as medicine was concerned, had been very judicious, but the food had been starchy, and for a week the patient had been able to take very little. The most striking features of the disease to me were: the feebleness of the heart’s action, the want of respiratory power, and the evidences of a general failure of muscular power - in all other respects the patient was in good condition. I advised enemata of beef-essence, and its internal administration in small quantities frequently repeated, and a suspension of all medicine. She was very feeble, and I had been giving her freely of the bitter tonics, stimulants and animal food. The old Quaker remarked, if thee will stop the medicine and stimulants, and give her fatty matter she will recover - and the result justified the old doctor’s skill in diagnosis. I have had to take this advice twice in the past eighteen months, from other parties, when I should have recognized it myself; in both it was the one thing necessary to success.

This finding is congruent to expectations that trust promotes better medication adherence (Benkert et al order plendil 2.5 mg otc blood pressure medication grapefruit. Because the sex of participants in the study was not reported discount plendil 2.5 mg overnight delivery heart attack lyrics demi, it is unclear whether Black women were included. Although the findings of the current study support currently held beliefs regarding trust and medication adherence, there is reason to consider an alternative viewpoint for clients who may not trust their health care providers. Clients who are distrustful may recognize that their health needs are not satisfied when they are left with superficial directives that are virtually meaningless and impossible to follow. Over time, the clients 171 become symptomatic and gain the label of being nonadherent to the treatment regimen that they may have had no knowledge. In essence, health care providers may not be providing Black clients with the health care information and services necessary to promote healthy lifestyle changes, thus increasing distrust of the health care provider. According to Cox, Sullivan, and Roghmann (1984), multifaceted interventions to manage health problems are required from health care providers. These interventions include combining the client‘s physiological, psychological, sociodemographic, and environmental characteristics to achieve the desired health outcome, such as adherence to antihypertensive medication. Cox (2010, August 4) contends that clients must be involved as participants in the self-care of their health and initially, ample time must be spent to clear up misperceptions, misunderstandings, and misknowledge. Barksdale (2009) concurs and recommends a client-centered approach to delivering health care. Thus, increasing client knowledge, involvement in the treatment process, and devising interventions pertinent to the client‘s needs may be vital to establishing trust and maintaining medication adherence. Stress on the other hand refers to how the body reacts to internal and external experiences. Black women, unlike other racial/ethnic groups, are confronted with the triple jeopardy of racism, sexism, and classism that may overtax coping mechanisms and contribute to insurmountable 172 psychological and physiological stressors (Beal, 1969; Jones & Shorter-Gooden, 2003). Further, 21% of those below the poverty level reported total medication adherence with a perfect Hill-Bone Compliance score. In contrast, two studies showed that coping was associated with mean arterial changes (R. In a study conducted by Shorter-Gooden (2004) on mechanisms to identify coping strategies in Black women, results indicated that those who were resistant to the damaging effects of stress-related health consequences tended to engage in various coping strategies, such as spirituality, social support, and valuing oneself. The age of participants in the current study may have been an influencing factor on their perceptions of racism/discrimination. Therefore, many participants were not directly exposed to the harsh realities of racism/discrimination and may only have experienced subdued forms of racism/discrimination. However, since the election of the nation‘s first Black President, ―silent racism‖ has evolved (Rossing, 2011, p. The term racism has become distorted and downplayed, especially in the political arena, because it signifies racial disunity. Therefore, any racist attacks on the President or other people of color are virtually ignored in the mainstream public discourse (Rossing, 2011). In the current study, perceived racism/discrimination was not related to medication nonadherence. In contrast, several qualitative studies found that perceived racism/discrimination was identified as a factor in nonadherence to antihypertensive medications (L. Clients who feel they are treated unfairly may respond with anger and hostility and be less likely to follow the health care providers‘ treatment advice. Consequently, the impact of racism/discrimination may reflect mistrust and rejection of health care providers and services offered, contributing to poor medication adherence and subsequent poor health outcomes (Chakraborty, King, Leavey, & McKenzie, 2010). Depression in Black women is not fully understood (Read & Gorman, 2007) and may be difficult to detect (Jones & Shorter-Gooden, 2003). Typically, Black women deny depressive symptoms (Duckwork, 2009) and describe depression differently, such as feeling stressed or tired (Jones & Shorter-Gooden, 2003). Therefore, treatment for depression is either not readily sought by Black women, or depression is oftentimes misdiagnosed (Duckwork, 2009). Therefore, capturing the true clinical picture and prevalence of depression in Black women may be elusive. Hypertension was associated with a greater risk of depression in Canadian men, but not women (Patten, 2001). Despite the association of depression and medication adherence, depression was not in the optimal predictive model. Implications for Nursing Hypertension is rampant among Blacks, especially Black women.

Pythian Ode Attributed    ·     Sir Harry Platt – There is alas no law against incompetency; no Professor of Orthopaedics buy 2.5mg plendil with mastercard arrhythmia loading, Manchester discount 2.5 mg plendil free shipping blood pressure medication for pilots, and President striking example is made. They learn by our bodily Royal College of Surgeons of England jeopardy and make experiments until the death of the patients, and the doctor is the only person not A physician should not be a servant of any punished for murder. Journal of Medicine  January () Historia Naturalis ‘Greek Physicians’ If you cannot make a diagnosis at least make a There is nothing encourageth a woman sooner to decision. Attributed Historia Naturalis ‘Greek Physicians’ Amid the sufferings of life on earth, suicide is God’s best gift to man. It is being explored by psychiatry but is in danger of being neglected by Plutarch C. Greek essayist Republic Medicine, to produce health, has to examine Future generations, paying tribute to the disease. Moralia ‘Advice about Keeping Well’ ’Tis a portentous sign When a man sweats, Of all drinks, wine is the most profitable of and at the time shivers. Historia Naturalis ‘Greek Physicians’ Attributed ()    ·    Michael Polanyi – Sir Percivall Pott – Hungarian chemist and social philosopher Surgeon, St. Bartholomews Hospital, London Genius seems to consist in the power of applying Surgery has undergone many great the originality of youth to the experience of transformations during the past fifty years, and maturity. Polish proverbs Chirurgical Observations () A beggar does not hate another beggar as much as one doctor hates another. When the mischief seems to be of such nature as that gangrene and mortification are most likely to Every Czech is a musician; every Italian a doctor; ensue, no time can be spared... Johnson, London () The doctor demands his fees whether he has killed the illness or the patient. As fine and as fast as he can; Austrian-born British philosopher Though I am no judge of such matters, I’m sure he’s a talented man. It is not his possession of knowledge of irrefutable Poems of Life and Manners ‘The Talented Man’ truth that makes the man of science, but his persistent and recklessly critical quest for truth. Of which you need not read one letter; The worse the scrawl, the dose the better, Drunkenness turns a man out of himself, and For if you knew but what you take, leaves a beast in his room. By professional patriotism amongst medical men I mean that sort of regard for the honour of the He that is uneasy at every little pain is never profession and that sense of responsibility for its without some ache. Introduction to Abraham Flexner’s Medical Education in the Meddlesome midwifery is bad. Happiness is beneficial for the body, but it is grief that develops the powers of the mind. Scratching is bad because it begins with pleasure They err habitually on the side of optimism as to and ends with pain. If it is capable of deceiving the doctor, The best smell is bread, the savour salt, the best how should it fail to deceive the patient? Le Côté de Guermantes Pt  The best surgeon is he that has been well hacked Everything great in the world comes from himself. The choleric drinks, the melancholic eats, the Le Côté de Guermantes Pt  phlegmatic sleeps. Illness is the doctor to whom we pay most heed; to The eye is bigger than the belly. We are usually the best men when in the worst All would live long but none would be old. A man has often more trouble to digest food than We are born crying, live complaining, and die to get it. Putnam – As long as our brain is a mystery, the universe, the reflection of the structure of the brain, will also be No argument is needed to show what a mystery. Charlas de Cafe Boston Medical and Surgical Journal :  () It is best to attenuate the virulence of our ‘The man’ is above all else, the mind of the man, adversaries with the chloroform of courtesy and and not only the mind as an organ of conscious flattery, much as bacteriologists disarm a thought but the mind as an organ of bodily pathogen by converting it into a vaccine. Like an earthquake, true senility announces itself Boston Medical and Surgical Journal :  () by trembling and stammering. Charlas de Cafe Françis Quarles – That which enters the mind through reason can English poet be corrected. Statistical evidence shows that the greater the François Rabelais – intellectual freedom, and the higher the general average of intelligence in a community, the French physician and satirist greater is also the number of suicides. Jacques Le Clercq) Louis-Antoine Ranvier – Without health life is not life; it is unlivable. French professor of histology Without health, life spells but languor and an It is necessary in a word to make histology image of death.

Her plan was to start on the parasite killing program cheap plendil 2.5mg otc pulse pressure fluid responsiveness, clean her kidneys buy discount plendil 2.5 mg on-line pulse pressure young, remove toxic elements, kill bacteria and clean her liver. Long before she accomplished this, in one month, she was feeling better and had return of her strength on some days. Universal Allergies If minor allergies are due to a disabled liver, then extreme allergies must be due to an extremely disabled liver. A few flukes might not be noticed but a liver full of flukes that spill over into the intestine can give the worst case of allergy imaginable. Sometimes the body manages to kill them with its own re- sources (maybe you ate something even too toxic for them! In the water of the toilet bowel they explode, spewing their infectious eggs all over in little black threads. Because these look like hairs, you may believe you passed “things with black hairy legs. Amongst sheep, only certain sheep will be severely affected, being called “liver-rot. Come to the aid of the liver by avoiding food molds, removing dental metals, stopping chronic Salmonella infection and finally cleaning the kidneys and liver. When more than a few flukes are present in the liver, they keep the liver from doing its major job: detoxifying all the food and chemicals that are taken into your body. One part detoxifies plastics and solvents, another part detoxifies perfumes and another newsprint ink, and so on. By changing our food constantly we avoid overburdening any one of our detoxifying mechanisms. Less extreme forms of allergy can be due to other flukes in the liver, such as human liver fluke (Clonorchis), or just plain clogging with numerous cholesterol crystals. Beryllium, from “coal oil,” kerosene and gasoline attaches itself to the brain easily. The extreme form of allergies simply requires killing the sheep liver fluke and other flukes inhabiting the liver. In this case, you might actually see some in the bowel movement after killing them. They have two attachments to hold onto you, yet, they are not difficult to kill, even with herbs. Sheep liver flukes might actually be breeding, that is, multi- plying in the liver of the hyperallergic person. When the baby stages are also found in our bodies, (instead of in minnows or snails) there is undoubtedly a specific solvent involved. Environmentally ill persons have quite a few solvents accumulated in their organ tissues. Which one enables the sheep liver fluke to go through all of its development in the human is not known yet. Obviously, the extremely allergic person, should remove all solvents from their diet and environment. Often, but not always, persons with sheep liver fluke, have a specific allergy to lanolin, a sheep product. Since lanolin is widely used in other products, this becomes a very broad range allergy. Such persons “can get no fat” at mealtimes or wear no wool without a considerable reaction. But cleaning the liver with several liver cleanses (page 552) after killing parasites will start the recovery process. Perhaps something else poisoned the liver so both solvents and flukes are given a home in your liver! The diet must be quite limited at first, to allow the liver time to “regain” its detoxifying capability. Of course, it is assumed that environmentally ill persons have had their dental metal replaced by metal free composite. Read the section on healing the jaw and Bone Strengthening (page 87) to ensure this move brings you success. If it has been a month or more since you killed para- sites, then go on a high dose parasite herb treatment the week before, or zap.

Remember Laplace’s law: the larger the aneurysm cheap 2.5mg plendil arrhythmia practice tests, the greater the likelihood of rupture and the resultant catastrophic consequences (Tables 23 purchase plendil 10mg visa pulse pressure and kidney disease. Such analysis has been done, and, while there is evidence to support operative intervention of “small” aneurysms (those between 4 and 5cm in size) in selected cases, most surgeons feel that 5cm is the size for which the risk of rupture is high enough to accept the operative risk of intervention. This surgical threshold may change with the evo- lution of endovascular stent grafting. There is very little evidence, however, that aggressive preoperative cardiac risk assessment significantly has lowered operative mortality. The primary improvements in surgical outcome more likely can be attributed to improved surgical and anesthetic techniques. Standard open surgical repair remains a significant operative intervention, with an operative mortality rate of between 3% and 5% at the best surgical centers. The majority of these complications can be avoided with proper preopera- tive planning, proper intraoperative technique, and superb postopera- tive care. Abdominal Masses: Vascular 431 resulted in promising short- and medium-term results. The obvious appeal of an endovascular approach is that it is minimally invasive and obviates the significant incisional discomfort and recovery of the standard operation. The overall cost-effectiveness and utility of this procedure await further testing and development. Case Discussion With regard to the case presented at the beginning of this chapter, several important points can be made. Obviously, if the patient were having severe abdominal pain after the procedure, then a more urgent radiologic exam, if not emer- gent surgery, would be indicated. This allows the vascular surgeon to evaluate optimally the extent of an aneurysm and to make an accurate assessment as to the best and safest way to repair the aneurysm. If the aneurysm is greater than 5cm in transverse diameter, it should be repaired electively, assuming that the patient is a reasonable operative risk. Summary The diagnosis, workup, and treatment of vascular abdominal masses have been presented in this chapter. A basic understanding of ab- dominal anatomy and physiology greatly assists in the evaluation of a patient with a vascular abdominal mass. Classifying the mass anatom- ically, based on etiology and clinical course, greatly helps in the under- standing of the problem and type of intervention necessary to facilitate proper therapy. The diagnosis and treatment of vascular abdominal masses frequently requires input from several medical and surgical specialists. In addition to primary care specialists, gastroenterologists, oncologists, general surgeons, surgical oncologists, gynecologists, radiologists, infectious disease specialists, urologists, and vascular sur- geons often contribute in the management of a patient with a vascular abdominal mass. Ciocca abdominal mass depends on the nature of the mass, the timing of the diagnosis, and the overall condition of the patient. Elective interven- tion, whether medical or surgical, generally is better than delayed or emergent intervention. Collagenase activity of the human aorta: a comparison of patients with and without abdominal aneurysms. Selective evaluation and management of coronary artery disease in patients undergoing repair of abdominal aortic aneurysms: a 16-year experience. To understand bilirubin metabolism and classify jaundice as nonobstructive or obstructive. To describe the usefulness and limitations of blood tests and hepatobiliary imaging in the eval- uation of a jaundiced patient. Cases Case 1 A 43-year-old woman has had intermittent episodes of right upper quadrant pain, usually associated with eating fatty foods. That pain radiates to her right shoulder, but it spontaneously resolves after several hours. She now presents to the emergency room with a deeper, more persistent pain in the right upper quadrant. She noticed yellow- ing of her eyes and darkening of her urine for the past 36 hours. Case 2 A 63-year-old man complains to his physician about yellow dis- coloration of his eyes.

Mindfulness is the practice of just being present to what arises from a place of compassion purchase plendil 5mg with amex heart attack grill quadruple bypass burger, acceptance and wisdom purchase 10mg plendil with visa blood pressure medication making blood pressure too low. However, awareness and being present with what arises are not enough to free you from the stressful thoughts that can take over your mind. You believe what you experience, not realizing that it’s really an illusion, an interpretation created in the moment by your inner child. Freedom from stress comes from practicing mindfulness, in order to be aware of your own thought processes, and then combining this mindfulness with inner-child dialogues to discover how your mind creates its sense of reality. When you understand the whole process and have insight into the belief system and needs of your inner child, you can begin to reframe, or change, those beliefs. You can calm your inner child, change how you see the world and how you react to it, and in the process, begin to live life with less stress on your plate. Mindfulness of your thought processes allows you to connect the dots and see the stories that are created from the original sensation or event. Inner-child dialogue reveals that you, along with everyone else in the world, are a wounded child operating from a need to feel loved and worthy. The mind creates stories and there’s no one doing this but your conditioned belief system. When you realize that you’re operating from a four-year-old’s perspective, you’ll start to feel that initial sense of freedom. Understanding this invaluable truth takes time and practice as outlined in this book. It’s a progressive practice that starts with mindfulness of experience, which is just an awareness of what’s happening. Next, there’s mindfulness of process, which allows you to see the mind’s stories and how you relate to them. Inner-child dialogue then lets you discover the origins of your belief system and finally empathy gives you a chance to reframe and reconstruct the experiences, emotions and expressions that imprinted themselves on your childhood. Ultimately, wisdom and freedom come from knowing that the mind’s sense of reality is a fabrication, empty of truth. So to put all that you’ve learned together, let’s use the letters A, B, C, D and E once again. You first used these letters to remind you how to be mindful of your breath, but now you’ll use them as a final overview of your stress-reduction strategy. Here is the essence of your daily practice: • A is for Awareness – What’s happening? Anytime something pops into your mind, you believe that this is who you are and you react automatically and unconsciously according to the conditioned belief system of the inner child. You’re like a puppet controlled by the invisible strings of your belief system, as voiced and acted upon by your inner child. You’re just noticing what’s going on from the position of the observer rather than from the vantage point of the star of the show. In response to this question, in traditional mindfulness, you’d label the experience objectively using the form, “now anger,” “now sadness,” “now worry” etc. It’s important not to personalize what’s happening by using “I” as in, “I am…” or “I feel…”. When you use “I” to describe your experiences, your stories will get more and more complex and you’ll feel more stressed. It’s counterproductive to clamp down and tightly hold on to the sensation that you’re experiencing. In mindfulness, you’re receiving everything with a vast and open mind and then letting it go. Relate to 222 • Mindfulness Medication any experience from a place of acceptance and ‘knowing’. How you anchor yourself, or how you relate to any experience, is simply by being conscious of it with this spacious awareness. Just give yourself the freedom to experience a sensation, accept it and let it go. If you have already had some inner-child dialogues, you may have discovered the underlying core feeling behind many of your emotional reactions.