HeartBeats Episode 13: Women and Violence

Host:

Welcome, I'm Cathy Murtagh-Schaffer and I'm your host for this episode of HeartBeats. This podcast is brought to you by Shipley Cardiothoracic Center, an educational series dedicated to providing our patients and the community with information and education about our cardiothoracic surgery program, Lee Health, and matters that affect your health. Today. We're talking with Dr. Paul Simeone, the Vice President and Medical Director of Behavioral and Mental Health, and he's here to talk with us today about women and violence. Dr. Simeone, thank you so much for being here today to discuss this critical issue. But before we begin, would you tell us a little bit about your background and how you became the VP Medical Director of Behavioral Health?

Dr. Simeone:

Well, firstly, thank you so much, Cathy, for inviting me to this. This is really a wonderful opportunity to talk to you and my colleagues. So, yeah, I am a clinical psychologist by training, I began my training in New York, where I was at the Institute for Advanced Psychological Studies at Adelphi University finished my training in Boston, at what is now Beth Israel Deaconess Medical Center, and then spent the entirety of my career in Boston, working for a number of hospital systems in a variety of different roles and responsibilities. You know, I had a very big clinical caseload across a wide variety of clinical settings. I was leader in a number of programs. I was on the faculty at Harvard Medical School and the Department of Psychiatry for almost 30 years and so, my heart is in training as much as it is in anything else. So I came down here roughly two plus years ago having been recruited from Boston to join Lee Health in the center for population health. So I was offered and took the, the role of VP Medical Director for Behavioral Health. And as such, I sort of have two, three different roles. The first is to create a strategic plan for pediatric and adult behavioral health. Two, to create a service line with colleagues like you and others, that inspires that strategic planning process and then three, to both, you know, convene and fund community partnerships, and at the same time, you know, provide advocacy and some social commentary about what ails us as people and as a society. So I sort of tack between those various roles, spent a fair amount of time fundraising for kids minds matter in particular. And, then in addition to that, out in the community, just, you know, training and talking to people about, you know, what, what we're all trying to do.

Host:

And someday you and I will have a long talk about what really ails us.

Dr. Simeone:

Yes, happy to have that comversation. I do have some thoughts about that. Some of what you'll probably hear a little bit today.

Host:

I wanted to have this discussion around violence and women's, so we might help educate our listeners as to what constitutes violence against women. And the reason there seems to be an uptick in that violence. Pandemics, like COVID-19 can exacerbate not only violence within the home, but other forms of violence against women and girls. Violence against female healthcare workers, as well as migrant or domestic workers increases. Xenophobia related violence, which we are witnessing with these increased attacks on Asian Americans, harassment and other forms of violence in public places, and online is more prevalent. And the risk of sexual exploitation and abuse becomes more likely. Some groups of women, including human rights, defenders, women in politics, journalists, bloggers, women, belonging, to ethnic minorities, indigenous women, lesbian, bisexual, and transgender women and women with disabilities are particularly targeted. And I've heard women described as the invisible gender. Do you think that this idea of an invisible gender makes it easier for men to perpetrate violence against women?

Dr. Simeone:

Yeah, it's interesting, I hadn't heard that until, having heard it from you a few, a few days ago. But it makes perfect sense to me, invisibility as a state that is born as a yeah, as a mantle or an identity better put, that's foisted on somebody is the beginning of objectification and dehumanization. I mean, you see this around the world in a number of different, circumstances, particularly in war. I mean, when you, you know, we heard, the way that we treated the Japanese, for example, or the Vietnamese, we called them gooks, it makes it easier to kill people when you reduce them to that, to that status. And so, there's no doubt, but that when people start talking about, people being invisible, that's essentially the negation of self, when you rob people of their humanity, you can do whatever you can with justification. And I think we're seeing more and more of that. I think largely as a function two things, I think that are going on. One is that I think there are many men these days, both in the United States, but, in the East end in the West who are feeling increasingly disenfranchised, you know? And so we have a group of men who are holding on for dear life because they're feeling their life and lifestyle and way of life, is slipping away from them. It's changing, it's changing, and you know, I think what we're looking at today in the United States is, you know, this very pernicious, coming together of two big vectors. One is grotesque income inequality and, the increasing diversification of the culture. And so when you put those two things together, you get a lot of fear, paranoia and scapegoating and women have always been scapegoated. I mean, ever since the dawn of time women, despite the fact that women, you know, women are what makes the world go round. They are the, the mothers to the children, right, of the world. (host) We're the keepers of the generation. The of the generation. And despite that there is this, kind of relentless, ongoing perpetration of violence in various forms against women. I think it's gotten worse recently because, because I think what's, what's happened to men. You know, men have men are slipping it's, it's, it's interesting that there are, I think that the data now is that there are, many more women who are going to college and succeeding than men are. And so there are a lot more, I remember when I was treating patients in Boston, there were a lot of men, young men that I saw that I would describe as failure of launch, you know, failure to launch people. These are guys who were in their early to mid twenties who were couch surfing on people's couches, smoking too much marijuana, working 20 hours a week, and that was a life to them. And yet the women all around them were surpassing them in almost every domain. And it's the first time I had seen this in my professional and personal career. So, men I think, are feeling really threatened. And when men feel threatened, they take it out on women.

Host:

They become, they become aggressive.

Host:

I want to cite some statistics from the National Coalition Against Domestic Violence. 137, That's the average number of women killed by a family member worldwide every day, 38% of Florida women experience intimate partner violence, intimate partner sexual violence, or stalking in their lifetimes. In 2019 221 Floridians were killed in domestic violence incidents, 42% were killed with firearms. Yet Florida does not have a law requiring respondents and domestic abuse cases to surrender their firearms. However, I think it's important that we recognize there are other forms of violence besides murder, for instance, intimidation, emotional abuse and isolation. These are ways men use to control women, and I think more difficult for women to recognize as abuse. I've heard women say, oh, really a good provider, and if all he wants is for me to stay home, I think I can live with that. Dr. Simione can you tell us what the psychological effects of these methods are on a woman?

Dr. Simeone:

Yeah. They're, they're extensions of that sense of self negation that I just talked about a minute ago. And I would say the vanguard symptoms of that state would be depression, anxiety, and cumulative trauma. And by which I mean, when I when I talk about cumulative trauma, it's the drip, drip, drip of trauma over a lifetime. You know, we oftentimes think about trauma is happening because we had some bad events, it was a car accident or an avalanche, a terrorist attack. It's been my experience that that's not the worst kind of trauma that visits itself upon people. It's instead it's the drip, drip, drip, and I think, you know, young, having a daughter myself, I can tell you that watching what happens to little girls and women over the course of their development, women are, trained to be negated. They are, unless you grew up in a family where that's, you know, with a culture, doesn't promote that. Women get used to, you know, bending themselves to men's whims, many of them. And also, they're trained to make men their reclamation projects. I see this over and over and over again. And, often it's a fool's error. You can't, bring people, you can't heal people who don't want to be healed. And so oftentimes women in the sorts of intimate relationships are in positions where it's kind of know when, you know. If they give themselves up, they don't feel like themselves anymore. If they fight with their husbands, who have essentially outsourced their emotional lives to them, it's as if they say, here you take it. And then they develop this kind of hostile, dependent relationship with their wives and girlfriends. You know, here, you take it, I don't know what to do with it, but I don't really like what you're doing with right now. And so they're caught in this, this sort of unfortunate back and forth that becomes highly political within the relationship itself.

Host:

And your point is well taken. I can't tell you how many girlfriends, when I was young, they were involved in relationships and, oh, I'm going to marry this guy. I know he's got this problem or that problem, but when we get married, things will change. Things will be better. We just have to get married. And that kind of thinking has never, ever registered with me is like, well, if he's like this now, why do you think he's going to be different later? Yeah. It led to a lot of trouble

Dr. Simeone:

Yeah. It continues to lead to a lot of trouble. You know, I did a lot of marital and otherwise couples therapy when I was in Boston. And one of the things that I, that I learned that I had to quickly figure out was what was the explicit and the implicit contracts that people were making with one another. The explicit contracts got all the attention, but it was the implicit contracts that held sway over the relationship and created all the problems. So while people might agree in a superficial way about this and that, the way to raise kids, religion, where they want to live, that sort of thing, the more difficult, gnarly discussions that were never had, but sort of conditioned with the relationship was going to go with things like, you know, if I'm with you, then, I will support you if you allow me to control you, right. That never got articulated as such, but I became foundational in the relationship and things began to get really bad when somebody changed that contract. And so it was always, for me, it was always very interesting and very important to figure out, you know, where the original contract was drafted, who changed it and for what reason, and oftentimes it was women who changed it because they had to.

Host:

They go back to school, they go to work, they have kids now take their attention away from their husband, and all of a sudden things are not the same thing.

Dr. Simeone:

Things are not the same. And oftentimes they are blamed for not maintaining the status quo. That was very injurious to their sense of self. They could not both be good wives in partnership with their husbands and accept that level of negation. And you just kind of compromise.

Host:

I think one of the things that I have seen over and over again is this concept that kids change everything. And it's really unfortunate that the kids are the impetus for that change and create the havoc in the house because the kids walk away then with the fact, I caused the problem, and I just wish women could see a little more clearly what they're getting into before they start having children that are really going to make things different.

Dr. Simeone:

Well, I think they labor under that misapprehension that they're able to do both, but most, most good mothers that I've seen always take their responsibility to their kids first. Right. And so that puts them in this kind of, essential tension between them and their husbands, and often the kids get triangulated into that. You know, and it's, it's sort of pulling that apart and trying to understand the function and the elements of that triangulation, that really is really important. So totally get that.

Host:

Other forms of violence, include coercion and threats, minimizing and denying blame, and using children, as we just mentioned to make the female partner feel diminished and powerless. However, one of the bigger traps is economic abuse. For example, a male breadwinner withholds, basic financial support for the family. I actually knew a woman who lived with a man who was in the top 1% of wage-earners. He was making a lot of money yet, she had no idea how much money they had in their checking account. She had no idea where he kept money or how to access it, and when she asked him he would get angry and threatened her, he would tell her, I'm the breadwinner I pay the bills you don't have to worry about that. How do women, how do we help women say, this is not okay,

Dr. Simeone:

This is a tough problem, because I think it starts with, you know, kind of, what goes on in the culture of the family. I think if women, I think about my daughter, who's 27 and just finishing her law degree and she's like a force to be reckoned with. And, because of that, she has scared off a lot of men in her life. She happens to be involved with a spectacular guy right now. Who's up to her. I mean, he's not threatened by her. My wife was the role model for this, and, you know, my daughter learned early on that, that's a quid pro quo that she wasn't going to make. She, wasn't going to say, okay, you can support me, and I'll be whatever you need me to be. That was never going to be in the cards, and so I think it starts very early on and in the absence of that kind of modeling mostly by mothers, some by fathers, but I think it's mostly a mother thing, you know, in the absence of that and the absence of a culture that really supports that kind of psychological development, it becomes more and more difficult and the older a child gets where that's not going on in the family, the more difficult it is. And so then, then that person, that young woman has to deal with it, you know, as an adolescent issue or as a young woman, it's very, very difficult. It's very, very difficult because, you know, you want to be like everybody else and you want to go along to get along. And I think that really it's all about, you know, what we create for young girls, and in like manner for young boys, you know, maybe we can talk about that a little bit down the road, but again, same kind of issue is for, you know. I also have a son and I can tell you that raising a son is really quite different than raising a daughter, but I think it really begins with, you know, a cultural change, both in the larger culture and the culture of family

Host:

Talk about, uh, within a particular culture. Have you identified any cultures that are particularly adept at creating women, strong women?

Dr. Simeone:

You know, this takes me back to my ethnic psychiatry days, which I'm not gonna remember, but there are a matriarchal cultures, particularly more so-called primitive cultures. It's really interesting to question like, are they really that primitive? Right? But there, there are ways there are ways that some of these, societies really celebrate women and take care of women and the women essentially run the culture. Right. And they do it in a way that is much more human and compassionate than I think many cultures run by men. You know, it was the Buddhist think of Ken Wilber, who wrote that, he saw testosterone as being the principle problem, and it describes the role of testosterone in a kind of off-color way. He says "Everybody knows that testosterone is responsible for two functions. It makes men want to screw it or kill it". And I often times think that after having read that it was Freud who really understood better than anybody that it's often both. Yeah. It's often both. So it's where you get sexual sadism, you know, all varieties of that sort of thing, which I think are really pretty much the Bailey wick of men, men of men have sexual perversions at about 10 to one ratio to two women. It's changing a little bit. And what also, what we consider to be perversions is changing in the culture, but yeah, men are much more, prone to this sort of thing than women.

Host:

I feel that part of the problem is this pervasive concept that those who live in poverty are de-humanized or marginalized. We know poverty affects mainly women. And in particular women of color, the most recent statistics show 17% of white women, 30% of black women, and 31% of Hispanic, Latino women are living in poverty and food insecurity. Do you think that marginalization opens them up to this violence?

Speaker 5:

Absolutely. I'm thinking about, I'm thinking about a couple of things. One is when I was up in Boston, I had oversight responsibility for a number of cultural linguistic teams that we had, which is a really wonderful part of that outpatient psychiatry, but we had a Portuguese team and a Latine team, African-American team and a Haitian-Creole team, and a couple of other ones, I'm not thinking about it at the moment. But, it was the Portuguese team that really taught me that you had all of these, often beautiful undocumented, Brazilian women who were, who had come to this country and they were sitting ducks for American men. It reminded me of, there's an old Russian proverb that goes, if you become a sheep, the wolves always come, right. And these men were the wolves and what they had were sort of, economic power over a lot of these women, these women were undocumented, they were cleaning houses. Many of these men would have never been able to get women this attractive, and there was this whole drama that played out that taught me a lot about exactly what you're talking about. I think there are multiple versions of that thing, but that, that's a kind of stark reminder of the role of poverty and how it gets exploited by people who have the goods.

Host:

In an article by the Southern poverty law center published, this year in February, they noted that our far right militia groups are, have become organized groups of misogyny with this absurd ideology, and what we were just talking about actually, that women are devious yet incompetent, genetically inferior, yet the progenitors of the white race and deserving a violent punishment, both for having sex and denying sex to men. The SPLC found that these narratives are the basic beliefs of nearly all extremist groups. This is a quote from a proud boys member, leftist women are more third wave feminists and less feminine than ever, and now you're not even women anymore, either you are women, and if you are please stop fighting men or you're not women, and your face is now punchable, where did these notions come from? Is there some psychological explanation? And not that I want to excuse this behavior, but one wonders if child abuse plays a role in the development of these ideas.

Dr. Simeone:

Yeah. It's complicated. It's a really complicated issue. I think that, just to go back as a starting point to where we were, I don't know, 10 minutes ago when I said that I think many men these days are feeling, you know, under great threat and, that group that you just alluded to,you know, people who are on kind of the right, who feel like their lives are going, you know, their lives, as they've known them are going, is going away. That sort of fear and loathing comes right out of, and paranoia comes right out of a sense of being disenfranchised. And I think, you know, it's interesting when they talk about, you know, third wave feminine women, what I find fascinating about talking about it that way is it, these are women who are actually just advocating for a place alongside our right. That's all they are. I mean, right. Whereas, you know, by implication, these men are obviously have a notion of women as subordinate, right. And if you, if you do not subordinate yourself to my own self-esteem problems, then you have a punchable face. Yeah, exactly. And so the issue of child abuse, just to sort of address your question, I think that's certainly one way to get to it, but I think more than anything we're talking about what psychoanalysis is called narcissistic injury. So the self, whenever the self is threatened, then that produces a set of self-protective mechanisms that we generally think about as narcissistic, grandiosity contempt, you know, a lack of empathy for the other, a need for a constant adoration and support all of these things are ways in which the self , the destabilized self, then lashes out and oftentimes finds scapegoats in order to project onto them when they can't tolerate in themselves.

Host:

I guess my counter to that would be, then these must be relatively weak personalities to be threatened so easily by someone who just wants to walk alongside of them.

Dr. Simeone:

Yeah. I, sadly, I think that that's true. I mean, I think, you know, I'm often asked what is the hallmark of, you know, mental health, you know, and what I say to people is, it's the endless capacity to compromise and adapt, to remain flexible in the face of changing conditions, whether they're internal or external conditions. And what you see are, you know, people who have those qualities don't need to lash out and act out and control in the way that these men do. And it's very difficult because, you know, you know, a part of me feels compassionately towards them because they are, you know, it's like that old Maslow quote that a fall you have is a hammer everything looks like a nail, right? And so now they have as a hammer, right? When they really need a screwdriver or adjustable wrench or a pair of pliers or some vice grips, and they don't have any of those. And so they've got to make it all work using, you know, one concept that they torture into you know, applying to a number of different situations and you can see the tortured logic, you know, you know, like this.

Host:

The Southern Poverty Law Center also mentioned that, it may be time to change the language we use to describe incidents of violence against women. They stay at well, domestic violence and intimate partner violence, accurately, the types of harm that is being enacted. These terms fail to capture the root cause of these incidents. They feel that patriarchal violence better defines what is happening. And this is a quote, "Patriarchal violence is a global power structure. It's rooted in interlocking systems of oppression, which include race, class, religion, and gender". Do you think this change in verbiage will help us better identify and intervene in the root causes of violence against women?

Dr. Simeone:

Another interesting hard question. I think it, it can both help and get in the way. So I sort of think about language as a roadmap to thinking, and because of that, it both reflects what is in the heart and also in franchises it, meaning that it describes what people are feeling and thinking. And it also codifies it, it says, this is, you know, if you think about meaning as socially constructed, whichI do, I think it's very hard to think about things being meaningful outside of what we all agree is meaningful, right? So that's a, that's an old social cognitive idea, which I think still most people subscribe to, and I do. I think that beginning to change language is, and because language is connected to cognition to thinking it's very important to begin to do that. But as we've seen with like the black lives matter movement and the me too movement, this also stirs the pot, right? You get people who get very angry, who will not say, you know, black lives matter. They have to say blue lives matter, all lives matter, right? And those are defensive reactions to language because people get what that means. They get that there are a set of implications that are tied to that. It means things are going to change. It means that that's very well put Cathy. That means that things are going to change and are changing. And again, I think if you look at the level of social unrest in our country, which from my point of view is as bad as it's been since reconstruction and reconstruction started in the 1860s, right after the civil war, some would argue that we're still in the process of reconstruction. And I think that that's a reasonable historical argument as well. So, you know, with this level of social unrest, you know, it's, you know, the thing that you have to keep in mind is that diversity long-term, diversifying a culture in the way that our culture is being diversified is long-term a very good thing. Short term, it's very, very difficult set of rapids to negotiate, you know, and you can tell people are, people are holding on for dear life. A lot of people who aren't very flexible in the way that they see things. And again, since we're talking about violence and women, I think women are in the vanguard of that. You know, women have always been in the vanguard of, you know, kind of social justice movements. I think women have more of that in their personalities than men do. And that puts them on the front lines of all of this cultural change.

Host:

Movements such as me too, and enough are now demanding that men take responsibility for their unwanted sexual advances and inappropriate behaviors in the workplace. And let's not make any mistake about how we define this unwanted sexual advances are just another form of violence towards women, but it makes it difficult to hold them accountable when rape still goes mostly unpunished and reports of domestic violence are still under-reported by police agencies. Do you think these new movements will have any effect on the current state of violence against women? Or do you think, as we were just talking that this might exacerbate things?

Dr. Simeone:

I think it's, you know, I think that you have to think about cultural changes, glacial. It takes an awfully long time and the, you know, the most effective cultural changes is kind of relentless. You have to practice a kind of relentless incrementalism, you know, you just one step at a time. So again, short term, I think, there's a lot of dust that gets kicked up over this sort of thing, just because people don't want to, you know, any kind of change is difficult, but this kind of, you know, very, very, you know, overheated types of change,are gonna make people a little bit uncomfortable and unsettled. That said, I think we go back to the point I made a while ago, having to do with the need to change culture, as an old son of Massachusetts Tippo, O'Neil used to say, "all politics is local, right?" So, you know, you can, you can pretty much change what's in your wingspan, right. You know, you can't change much outside of that, but the good news is that that's, that's effective change. And so I do think that, that we have to do it in that way, but we have to be patient because look at, look at how long the civil rights movement has taken.Right.

Host:

Well, I was just going to refer back to that. You were talking about, we've been doing this since reconstruction, but one of the things that I remember as a teenager is the violence and the riots that occurred in LA and elsewhere because of racial inequality and poverty and marginalization, and again, African-Americans being treated as less than, and I for being just a naive country girl, I guess, thought that those, those riots and those activities had changed things. I thought we were moving forward, but I feel personally like we're right back where we we started from.

Dr. Simeone:

I don't think so. I think we have moved forward. I really do. I feel more optimistic about that than, than maybe you do. And I understand why you don't, but I think that, I think we're in a particularly difficult period now because of those two vectors that I talked about, income and equality, you know, if we had a bigger middle class, if you know, the way, the way the middle class was when I was a kid, we had a middle-class that was vibrant where people could live, they could buy a house, they could buy a car, they could go on a vacation, modest, but they could go on a vacation. Then I think the diversifying of the culture, the browning of America would not feel so threating, but, you know, we have these so-called diseases of despair, right? Alcoholism, opiod, overdose, deaths, and suicide. If you look at those so-called diseases of the spirit, they're all in the rust belt states, they're all in communities that you know, where the economy has left people behind.

Host:

Where all agriculture is no longer important. Mining has been eliminated, industry factories are gone.

Dr. Simeone:

And so these are places that I think leaped on, you know, a lot of the rhetoric from the right, because they saw in that something that offered them some hope, right? It gave them a bully pulpit to talk about what was bothering them. And we're not through that by a long shot. So that's what I think is going on, but I think civil rights have advanced quite a lot. We still have a long way to go. We still have a long way to go. And we're at a particularly bad time now, because there are so many people feeling threatened.

Host:

Some say the key to resolving this problem of violence in women is eradication of harmful constructions of masculinity in boys and young men. And to help them move away from violence as a substitute for emotional literacy, we have called out the sexualized and objectifying messages that girls get through marketing, advertising, media and entertainment, but we have yet to call out the same issues with regards to boys and the harmful constructs they're fed through these mediums. How do we teach boys emotional intelligence that will supersede the patriarchal indoctrination that most of them receive in an often subliminal fashion?

Speaker 5:

Yeah. Another hard question. Well, I think I'm gonna, I'm going to repeat some of what I said before. I think that it often happens in the family the way that a lot of moral goes on. qI mean, I think the schools have done a really good job with a lot of this with social emotional learning curriculum and that sort of thing. But you know, having raised a son myself, I mean, he watched his father respect his mother and his sister over and over and over again, that doesn't make, by the way, that doesn't make me a virtuous person. I don't mean to present myself the way I've made up. It made a lot of mistakes in my life as a parent and as a person. But I think modeling is a very, very powerful learning tool, right. And I think fathers are very, very important to sons,because they need to teach them how to be men and they need to teach them how to be men who respect women. And when that's not the case, then boys fall prey a much more to the cultural kind of stereotypes and constructs, misogynous constructs that they hear about in the locker room or from other boys who aren't as fortunate to have those kinds of developmental family experiences. So it's, it's all about that. And, it's a very, very important piece of raising boys.

Host:

It's interesting, Florida is the first date that I've ever seen billboards with the concept of, dads you need to teach your your sons how to respect women. I've seen them a couple of times and was actually quite surprised by that, but it also, I think, is an indicator of the amount of violence and domestic violence that Florida suffers with.

Dr. Simeone:

I agree with that. And you know, the truth is, is that there are a lot of, lot of boys that grow up without men around. Whether there's their fathers or, and you know, or other men, you know, that are in their lives. I mean, if they get lucky, they can find a mentor, a teacher, a priest, a, you know, a boy scout leader or something like that. But it's, you know, after the fact that your father's not around it's catches catch can. Right? Correct.

Host:

Yeah. Dr. Simeone thank you for being here today to discuss this incredibly important topic. It's a tough subject to cover, and I know we just scratched the surface, but bet within our system, we have women who are suffering. And one of the things we can do as healthcare providers is to educate, listen to our patients and offer assistance by connecting them to help and reporting to appropriate agencies. And for anyone experiencing abuse, this is a 24 hour hotline, (239) 939-3112. It connects you to the Abuse Counseling and Treatment Center. If you're experiencing domestic violence, please reach out for help. Again, that number is (239) 939-3112. Is there anything else you want to add?

Dr. Simeone:

Well, first let me thank you, Cathy, for inviting me, this conversation has been really a lot of fun in talking about, you know, a very difficult set of issues, but in a, in a really pleasurable way. Though, the one thing that I would add to what you just said would be to offer an invitation to those women out there who might be listening to this, that, you know, take the risk and you know, find somebody that you can talk to. When I, when I was doing a lot of psychotherapy and just do a little bit of it these days, but I had a very big practice in Boston. And one of the invitations I would routinely offer my patients would be just to come in and talk with me about things without any imperative to do anything. All they needed to do is to come in and talk. And if then, if at the end of that session or the end of their treatment, they wanted to go back to where they wanted to go. That would be okay with me. It's just, but they should not, you know, kind of shut down the possibility of having that conversation because it's in that process of self discovery that you become yourself. And so that's, that's what I hope for people who are struggling with this sort of thing. So thanks again for having me.

Speaker 3:

Thank you. That's great. Till next time, I'm Cathy Murtagh-Schaffer, and this has been HeartBeats Shipley, Cardiothoracic Centers podcast, dedicated to bringing research innovation and education to our patients and the community.