The Dangers of Diagnosis

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“Nearly 1 in 5 Americans had mental illness in 2009.” This recent CNBC online headline captured my attention.

The brief article that followed was based on a report by the Substance Abuse and Mental Health Services Administration, a federal agency (oas.samhsa.gov). The article repeats highlights from the agency’s report entitled “Results from the 2009 National Survey on Drug Use and Health: Mental Health Findings,” available in PDF form.

The article states that an estimated 45 million US residents had a mental illness, and 11 million had a serious mental illness, and that these numbers reflect increasing depression among the unemployed.

The article’s intention — to create alarm — is loosely veiled. If people do not have access to interventionist and preventive treatment, any number of woes can follow: “disability, substance abuse, suicide, lost productivity and family discord.” Lost employment equals lost health insurance equals a lack of access to treatment equals a crisis. The insinuation is that government should step in to close the treatment gap.

Finding this article was fortuitous. Only days before I had read an article in Skeptic magazine about the “foibles of the Diagnostic and Statistical Manual V” — the diagnostic guide for mental health practitioners. (For details, see “Prognosis Negative” in Skeptic, volume 15, number 3 [2010], by John Sorboro, himself a licensed, practicing psychiatrist.)

The state of the psychiatric arts today, complicated by increased government control over our nation’s healthcare industry, should alarm all citizens, not just libertarians.

According to Dr. Sorboro, the upcoming version of the DSM will have a marked increase in diagnosable psychiatric disorders, which may include “compulsive shopping” and “Post Traumatic Embitterment Disorder.” But the problem with the DSM has to do with the validity of what it says.

To rectify the unscientific nature of prior versions of the work, the third version was intended to “increase reliability by standardizing definitions.” Still, critics maintained that “the rhetoric of science — rather than scientific data — was used by the developers of the DSM-III to promote their goal, and science did not support [their] claims.” In 1994, the DSM-IV was published, listing 297 disorders. The latest revision is set to increase that list. Yet according to Dr. Sorboro, almost “every major psychiatric construct is seen as being of questionable validity by a vocal group within the field itself[,] or outside it.”

Psychiatric disorders are supposed to be pathological constructs, as Parkinson’s disease is a pathological construct. For a construct to be valid, Sorboro states, it must differentiate itself from other pathological constructs and provide a theoretical framework for prediction and specific intervention. He likens psychiatric pathological constructs to the construct for fibromyalgia — “a loose collection of non-specific complaints.” Fibromyalgia lacks an underlying, identifiable pathology. So do psychiatric constructs.

Critiques of the DSM include claims that it’s a collection of “the moral objections of a group within power [who] desire to medically pathologize another group for self serving purposes,” and that it is “a-theoretical and purely descriptive.” Evidence in support of the former critique is that homosexuality was not entirely removed from the DSM’s list of mental disorders until the latter half of the 1980s!

A diagnosis based on the DSM is not a divination of pathology. The DSM is tautological. It describes. It does not explain. Thus, diagnosis is subjective, not objective. Sorboro uses bipolar disorders to illustrate. Bipolar I disorder appeared in the DSM-III in 1980, followed by Bipolar II Disorder, Bipolar Disorder NOS (not otherwise specified — that’s worrisome), and cyclothymia. There has been a correlative rise in the diagnoses of such disorders — one statistic that Sorboro cites is a 4000% increase in bipolar disorder diagnoses in children during the past decade, despite the fact that mental health practitioners know “hardly anything more of real scientific significance about bipolar disorder than we did in 1980.”

Soboro states that medical disease classification evolves in a messy and inconsistent way, “and often has to do with politics and not just compelling scientific fact. It’s just much worse in psychiatry.” For example, contributors to the DSM-V include “health care consumers”; and as Sorboro says, no other branch of medicine would ask consumers for advice in defining pathology. Moreover, the American Psychiatric Association taskforce handling this revision is conspicuously closed and non-transparent — task force members must sign confidentiality agreements and cannot keep written notes of their meetings.

Hmm.

I have been skeptical of the DSM since I first read it. I was a judicial clerk, and my judge kept a copy of the DSM-IV on one of his bookshelves. He used it for reference during sentencing hearings and when he presided over mental health hearings. During lulls in my clerkship tasks, I read several large chunks of the DSM-IV. My initial thoughts were: there certainly are some people with severe mental problems, but this is bullshit. Symptoms of the indicated mental “conditions” were so encompassing that anyone and everyone could be classified as having some type of mental disorder.

My best friend from high school is a psychiatrist, and after reading the DSM-IV, I asked her about it. She said that it gives a practitioner guidelines for diagnoses. But don’t guidelines have to guide? I asked. Isn't a diagnostic process that has no conceptual limits wholly subjective? The flu is marked by symptoms that make it the flu and not a common cold or pneumonia. But even a brief reading of the DSM shows that mental illnesses are not marked by unique symptoms. Why? My friend had a few forgettable justifications, but no answers.

Homosexuality was not entirely removed from the DSM’s list of mental disorders until the latter half of the 1980s!

Many Liberty readers are familiar with libertarian criticisms of the mental health industry. But the state of the psychiatric arts today, complicated by increased government control over our nation’s healthcare industry, should alarm all citizens, not just libertarians. Psychiatric abuse by states against citizens is well documented; psychiatric imprisonment for dissidents in the Soviet Union is just one example.

The dangers are clear. In the legal realm, when a criminal statute is overbroad, behavior otherwise constitutionally protected is criminalized, subjecting more citizens to state control. Overdiagnosis of overinclusive mental disorders will subject more citizens to treatment — which, under Obamacare, means subjection to more government control. This should be enough to give anyone an anxiety disorder. Considering the political nature of mental “disease” classification, I wonder if a disorder marked by “irrational fear” of a “benevolent government” might be among the disorders included in the new DSM.




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Your 401k Is a Sitting Duck

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In Liberty some time back (“Pension Peril,” March 2009), I reflected on President Kirchner of Argentina, who helped fund her country’s failing public pension system by simply stealing money from the private pension savings accounts that many of her countrymen had managed to accumulate. Her government expropriated (“nationalized”) the $24 billion private pension funds industry in order to save the public system, forcing citizens to trade their savings for Argentinean Treasury bills of dubious creditworthiness. I suggested then that such a thing might happen in the US, where Americans have many billions put aside in various retirement vehicles — a tempting target for any cash-starved government.

I think that dark day is growing closer. My feeling is confirmed by some troubling news, recently reported by the Adam Smith Institute’s wonderful website. The author of the report, economist Jan Iwanik, notes that a number of European countries are shoring up their tottering public pension plans by the Peronista tactic of stealing from those who have prudently put aside some extra money for their retirement.

Bulgaria, for example, has put forward a plan to confiscate $300 million from the private savings accounts of its already impoverished citizens and put those funds into the public social security system. Fortunately, organized protest has cut the amount transferred to “only” $60 million — for now, at least. And Poland has crafted a scheme to divert one-third of all future contributions that are made to private retirement savings accounts, so that the money flows instead to the public social security scheme. This will amount to $2.3 billion a year stolen from frugal people to shore up the improvident public system.

The most egregious case is that of Hungary. This state, which has been teetering on the verge of insolvency for years, has taken a drastic punitive step. Under a new law, all citizens who have saved for their retirement face a Hobson’s choice: either they turn over their entire retirement accounts to the government for the funding of the public system, or they lose the right ever to collect a state pension, even though they have paid and must continue paying contributions to the state system. The Hungarian government thus hopes to pocket all of the $14.2 billion that the hapless Hungarians have managed to squirrel away.

As our own national insolvency grows nigh, it is just a matter of time before the feds take a swing at the enormous pot of private retirement savings held by Americans. If you think you’ve heard nothing but class warfare rhetoric from this administration, just wait till it feels the need to take your 401ks, IRAs, and so on. The demonization of the productive and the prudent will be loud and shrill.




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Snow White and Mayor Dork

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On Sunday December 26, 2010, the blizzard of 2010 hit the northeastern United States. I, for one, enjoyed watching the snow fall. If we can’t have a white Christmas, a white day-after-Christmas is the next best thing.

But in New York City things were not so merry. Upwards of two feet of snow fell in New York. Clearing the roads after a snowstorm seems a relatively simple challenge, one for which Mayor Michael Bloomberg should have had ample time to prepare. The mayor’s absolute failure reveals him as an absolute incompetent.

For years Bloomberg has opposed libertarian freedoms in New York City, from gun rights to the right to smoke cigarettes in bars. (This was a pet peeve of mine, back when I used to smoke and drink.) But at the very least, he has tended to handle emergencies well — at least, one always saw him on the evening news at the scene of the disaster, once the mess had been cleared up. But not this time.

I spoke with my father two days after the blizzard. He lives in eastern Queens, and he was still snowed in, with the roads outside his house unplowed, the piles of snow too high to get past, and bus and subway lines in his area not running. His fate was shared by most people in Queens and Brooklyn.

I am spending my winter vacation at my mother’s home in southwestern Connecticut, and here I get New York TV news channels, which showed that the city was in a state of devastation. It was reported that the day after the snowstorm it took eight hours for ambulances to respond to 911 calls because of the condition of the roads. The next day, the news said that the mayor blamed his inability to plow the roads on drivers who had irresponsibly abandoned their cars in the middle of the street. TV reporters are consistent in saying that New Yorkers are outraged. The City Council plans to respond to this emergency by… holding a hearing.

What New York City needs is men of action, not windbag politicians. If the city is too incompetent to clear the roads after a snowstorm, it is only because politicians and bureaucrats have no accountability and suffer no monetary loss from the failure of state-owned infrastructure. Needless to say, two feet of snow is not the worst crisis that the city may face in the future. The only way to prevent a future disaster is to stick our hand into our magical bag of libertarian wisdom and pull out an idea whose time has come: privatize the roads.

If the streets of New York City were under private ownership, the owners would make certain that snow removal happened efficiently; if they failed then they would go bankrupt and someone else would buy the roads and operate them to the satisfaction of consumers. One TV news story showed a Brooklyn family with a newborn baby. With an oil truck trapped in piles of snow just a few streets away, their heat had gone out for lack of oil, and ambulances had trouble reaching them. Their baby’s death should weigh on the conscience of every statist who fights against allowing free market competition to improve upon the nightmare of state-owned infrastructure.




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Your Recovery Dollars at Work

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About three months ago, a curious sign appeared at one end of my street. It reads, “Putting America to Work. Project Funded by the American Recovery and Reinvestment Act.” It depicts a hard-hat-wearing stick figure digging into a pile of dirt — as if this jaunty cartoon of a “shovel-ready” project would soothe my anger at the wealth confiscation that funds such ridiculous endeavors.

Not much goes on in my small, East Coast rural enclave. The acquisition of “city” sewage by the nearest two towns was a big deal around here. So the government sign was the talk of our street. There was no explanation of why the sign appeared, no explanation of what project was in the offing. This was strange.

Then, roughly two weeks after the sign was erected, road crews appeared on both ends of our street and started tearing up the asphalt. The re-paving project was completed two weeks later.

Some neighbors speculated that the project was inflicted on us to predispose us to vote Democratic in the upcoming local election. But elections here are the smallest of small potatoes. It wasn't logical that federal funds would be spent to influence local voting. One neighbor speculated that the road was being prepared for a utility development set to occur in the next few years; but another road is slated to be built specifically for that purpose, at the opposite end of the nearest big town. None of us could come up with a reasonable answer. I suppose I could have attended a township meeting to divine the reasons behind this project, but I don’t have the time to waste and it’s highly unlikely that the simple folk, and by that I mean simpletons, who make up the township committee would have a credible answer.

As I said, this is a rural area. Roads need only be passable  — pickup trucks and tractors do just fine. Given that my street is only one section of a decently long through road, this paving project does not qualify as a “road to nowhere”; but it is very strange that the project was limited to one section of the road. Even stranger, there was nothing wrong with this part of the road in the first place. Nary a pothole! There is no meaningful difference between the street in its pre-recovery- dollars condition and the street in its post-recovery-dollars state. The road is now black. It used to be to gray.

In short, the project was a colossal waste of money. The dollars devoted to it should not have been printed, let alone spent. The workers involved in it did not achieve sustainable employment; they simply received unemployment subsidies by another name. No one was “put to work” in the sense that the designers of the Recovery Act intended the populace to believe.

Increased employment results from increased demand for goods and services. Allowing taxpayers to keep the majority of our dollars is the best option for “Recovery and Reinvestment” in all areas. Greater disposable income spurs demand as well as mitigating the risk of investment in small ventures. A person can spend his or her own dollars on any number of goods or endeavors that would contribute to sustained economic activity. More dollars in the hands of the citizenry will “put more people to work” than dollars in the hands of government ever will.

The first step to an actual recovery is limiting government spending. How do we achieve this?

We can apply my friend’s sound advice on dealing with young children: give them only very limited options. For example, instead of asking, “Where would you like to go for your birthday dinner?” ask, “For your birthday dinner, would you like to go to Friendly’s or McDonald’s?” Young children are ill-equipped to handle unlimited discretion. Governments are too.

With the country in its present mood, severely limiting government’s spending discretion is an attractive and realizable goal. We already have the set of tools necessary to do this. It’s called the Constitution.




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The Simple Life

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Remember calculators? How simple. Even my three score and ten year-old brain could use a calculator without the benefit of a 12-year-old associate offering advice on the sidelines. Naturally, this was B.C. (Before Computers). Then the computer came along and with much difficulty — much cursing — much advice from mocking 12-year-olds who found an activity they loved, besides obnoxiousness and noisemaking — my stressed brain learned to operate the device. So I thought.

Then “they,” the strange pointy-headed people who lived in the woods and emerged to design software, somehow discovered that even I could use 30% of the functions on the computer. No good. They changed it.

Why, oh why, are they obsessed with change? No sooner do I learn X than they change it to Y.

Highly intelligent but aged minds hate change. “Leave it alone,” says the home page of my 15-year-old Mac, to those people who live in the woods.

It all reminds me of the mania to modify a product just to make it different — to stimulate sales, not efficiency. “Hey look, I’ve got the new whatchamacallit - newest model, makes popcorn, too. Bet your iPad or Raspberry can't make popcorn.”

Thank goodness, for the moment, we still live in a capitalist society. Companies like profits, and change is often the engine of profit. That’s OK, just give me a choice. If I don’t need to track the

number of passengers with green shirts flying out of Kennedy, don’t build it into the “M” key on my keyboard. And don’t ring bells and flash green naked women on my screen so I remember to upgrade to this bizarre requirement.

Because of those technical wood nymphs, change becomes religious. It doesn’t always bring improvement, but it does always bring complication. There ought to be two streams of development. The first would be like your car. You bought a 2010 Ford; it remains a 2010 Ford. The accelerator never moves from its floorboard position. The instrument panel still indicates miles per hour, not feet per second. My kind of device. The second would be a test of your mental flexibility. Here, everything changes. The accelerator is now the brake. This is for users who like puzzles and are intrigued by how the device operates, not by what it does.

But in the computer world, even if you stick with the same computer, it’s always bugging you to update this or that. And it has clever little tricks. While you’re playing tennis, it swaps out your operating system so you have to call that smart aleck 12-year-old just to send an email. This is a world that worships change — for better or worse.

My pet remembrance of the “fix it even if it ain’t broke” philosophy is the battery-powered watch. Yep, I’m convinced that’s when it all started — a pivotal date in the history of uselessness. Now, I’m not a watchmaker, but batteries cost money and add an item to your “to do” list. And I swear they’re dying sooner and sooner. How long will it be before it’s a daily ritual? And few stores will change a battery.

How hard was it in the old days to give that little stem a few twists? Free twists, I might add. Think about it.

Gotta go now — my computer is groaning, which means that if I don’t install the popcorn app, it’ll erase my files of all stories that contain the word “popcorn."




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Good News, for a Change

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Little noticed in all the year-end political hysteria has been the good news about fossil-fuel energy production in the US and Canada. Unfortunately, the good news could have been better, if only we had better leaders.

The Globe and Mail (Dec. 8) reports that in 2010 the U.S. will end up having produced 140,000 barrels of oil a day more than it did in 2009. That’s incredible, when you consider Obama’s jihad against deepwater drilling. October, a banner month, saw 5.5 million barrels a day produced from American wells. Indeed, the US Energy Information Agency (the EIA) reports that our proven reserves of petroleum are now 22.3 billion barrels, up by 9% last year, in part because of the newly explored Green River shale oil field straddling Colorado and Utah.

America has even more bracing news about natural gas. The US now leads Russia in natural gas production. Again, this is in great measure because of expanding reliance on our extensive shale fields. We have the four largest natural gas fields in the world, and the EIA now puts our proven natural gas reserves at 284 trillion cubic feet, up 11% last year alone, and now at the highest level since 1971.

No doubt this is why China’s state-owned energy company CNOOC has cut a deal with Chesapeake Energy, according to which CHOOC will cover three-fourths of development costs and pay Chesapeake an up-front $1.08 billion for a one-third interest in its Texas natural gas project, a project that will produce the natural gas equivalent of half a million barrels of oil a day.

Our ally to the north, Canada, has also been doing well in fossil fuel energy production. Canadian oil sands production has increased dramatically; it now delivers more oil to North America than does Saudi Arabia. And while the Canadians may not love us, they don’t hate our guts. Young Canadian men don’t strap bombs around themselves and blow Americans apart. This is clearly preferable to the example of other countries.

Also exciting is the prospect of exploiting methane hydrates — essentially frozen water containing gas, found in stupefying abundance beneath ocean floors and the northern permafrost. This is something that the US and Canada can exploit when the time comes. How much of that stuff is there? The US Geological Survey estimates that even with a miserable 1% recovery rate, America could cover all of its present natural gas needs for the next century. And the UN Environmental Program hails methane hydrates as “the most abundant form of organic carbon on Earth.” Canada has been the leader in field-testing this form of gas extraction, and plans to exploit it commercially within a decade or so.

So we are doing fine in terms of resources. What is hurting us is our environmentalist-controlled leadership. We have at the federal level an administration that is hostile to fossil fuels in general and petroleum in particular, and has done its best to push us toward grotesquely costly and inefficient alternatives, such as solar and wind power.

Even at the state level, success in domestic fossil fuel production often happens in spite of, rather than because of, government help. Consider a Wall Street Journal piece (Dec. 16) about New York Governor David Paterson’s decision to issue an executive order imposing a virtual ban on drilling for natural gas within the state.

We don’t normally think of New York as a place like Texas, a petroleum-rich state. But the huge Marcellus shale formation, all 65 million acres of it, stretches from Ohio and West Virginia to Pennsylvania and upstate New York; it’s a repository of vast amounts of natural gas.

Natural gas can be readily extracted from this shale by hydraulic fracturing (“fracking”) — injecting a mixture of water and sand, together with miniscule amounts of various chemicals. Fracking, used now for over 60 years, is used in about a third of our oil and natural gas extraction. Even the EPA has published studies concluding that it’s safe.

But New York environmentalists — among the most devout in the nation — naturally oppose fracking, and the legislature there recently banned it. Paterson vetoed the bill, but put a moratorium on horizontal fracking until the New York Department of Environmental Conservation issues new regulations. This will take at least six months, and will likely manage to keep the ban in effect.

Pennsylvania — hardly a bastion of redneck petroleum lovers — saw $4.5 billion in investment in the massive shale field, creating about 44,000 jobs and $400 million in state and local taxes last year alone. Between July 2009 and June 2010, the 632 Pennsylvanian Marcellus wells produced 180 billion cubic feet of gas, doubling the state’s production.

The American Petroleum Institute reckoned that if New York allowed its shale gas to be tapped, it would provide $15 billion in economic output and $2 billion in state taxes. But New York apparently couldn’t care less about great-paying blue-collar jobs that add to the nation’s energy supplies and lessen our dependence on foreign tyrannies bent on our annihilation.




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The Case Against the Corporate Tax

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As the new Congress gets set to liberate America from the stranglehold of the freshly defeated Red Congress, hopes for change are arising. One is the hope for a lowering of the US corporate tax rate.

This rate is a hefty 35%, second highest among the developed economies of the world. It seems obvious, just considering basic psychology, that lowering the corporate tax will be economically beneficial. It is a truism of behaviorist psychology that if you punish (negatively reinforce) a behavior you get less of it, and if you reward (positively reinforce) a behavior you get more of it. Corporate taxes punish business activity, resulting in less business — great if you are a leftist, but lousy if you are anyone else.

The Heritage Foundation has released the results of a study by economists Karen Campbell and John Ligon that spells out the case for lowering corporate taxes, called The Economic Impact of a 25 Percent Corporate Income Tax Rate. Campbell and Ligon ran a simulation of the economic impact of lowering the corporate tax from 35% to 25%. The results are eye-opening.

Their simulation (which covers the period 2011 to 2020) estimates that under the lower taxes, GDP would grow by an extra $132 billion annually, creating over 530,000 new private-sector jobs per year. The average family of four would see its after-tax yearly income go up by nearly $2,500. Gross private investment would rise by over $57 billion annually, and foreign assets in the US would rise by 4% annually. American capital stock would grow by $240 billion more a year, and real after-tax corporate profits would increase by an average of $124 billion a year over the current projected levels.

Notwithstanding all this, it is questionable whether Obama will ever allow a drop in corporate tax rates. He is instinctively anti-business, and although the economic case is compelling, he is the most economically ignorant president in recent history.




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What's in a Brand?

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People often complain that the tea partiers confuse socialism, fascism, and communism.  These people argue that the three have distinct definitions and different ideologies.

Well, Chevrolet, Buick, and Cadillac are not the same car. They are, however, different nameplates on similar products, with many parts manufactured by the same people.  They'll all take you to the same place, though some will do it faster.




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The Mother of All Unintended Consequences

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A number of unanticipated consequences of Obamacare have appeared, even before the major provisions take effect.

Thousands of elderly people have lost their Medicare Advantage plans, insurance companies have been forced to jack up their rates to cover the myriad of new mandates, many insurance companies have eliminated child-only policies, and over a hundred companies and unions — many of them supporters of the Obama administration — have been given waivers from the disastrous bill by the selfsame administration that inflicted it upon the nation.

But the mother of all unintended consequences of Obamacare may be coming down the pike in 2014. That is the year when the healthcare plan dumps 16 million people (and even more, if illegal aliens aren’t excluded) on Medicaid. Medicaid is the program that already covers at least 62 million poorer Americans.

Medicaid is partly funded by the federal government, but almost half the costs are paid by the states. It is a heavy burden on them even in the best of times, and some of them now border on insolvency.

Rick Perry of Texas was the first governor to talk about withdrawing from Medicaid and substituting a less expensive alternative devised by Texans, following the tastes of Texans. But now similar ideas are being discussed by officials in Nevada, South Carolina, Washington, and Wyoming.

Will this group of free thinkers regarding Medicaid swell as we get closer to 2014, the Year of the Great Dump? In the immortal words of Sarah Palin, “You betcha!”




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Wait ’Til Next Year

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John Maynard Keynes is the Chicago Cubs of economics. In both cases, repeated failure has been rewarded with undying fanatical devotion.

Meanwhile, I am weary of watching our "brilliant” president blame his predecessor for the economic woes the nation still suffers. True genius confronts adversity. Thomas Edison never once blamed the darkness.




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