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Obesity, Anxiety and The Divided Mind

In past posts, we’ve discussed how to effectively and efficiently lose weight and open the gates of the fat cells.  We’ve talked about the keys to the back doors of the fat cells that must be opened to create effective lipolysis (releasing of fat from the fat cells) and weight reduction.

I want to focus, today, on another key found in the brain.  The brain neuropeptides play a huge role in metabolic balance of the body and have direct relationships to anxiety, stress and post-traumatic stress disorder (PTSD).  In the last few years, research into the hormones of the brain (neuropeptides) and body demonstrates that the “autonomic nervous system” plays a very significant roll in losing weight.

The autonomic nervous system is the part of the nervous system responsible for “fight or flight responses.”  If a bear rises up in front of you while you are strolling in the woods, and begins to chase you, the autonomic nervous system kicks in to speed up the heart rate, shunt blood to the muscles and turn down the processing of food in the gut while you run from or fight the bear.  This autonomic nervous system is also the system that links emotions (like happiness, sadness, stress, anger, depression) between the conscious and subconscious mind and creates the attachments of these emotions to specific memories.

The Divided Mind and Disease

A disconnect or poor communication between our conscious mind and subconscious mind wreaks havoc in the balance between memory, emotion, cognitive function, endocrine glands and immune system.  One example of this is the onset of panic attacks for no reason.  Another example is chronic fatigue and many symptoms found in autoimmune diseases.  This same autonomic nervous system, when malfunctioning, plays a significant roll in our ability to lose weight.   The subconscious mind triggers the autonomic nervous system without the conscious mind’s involvement.

Thanks to the work of John E Sarno, MD, and Candace B. Pert, PhD, the link between our subconscious mind and the autonomic nervous system is much more clear.  This opens the door to our understanding how the subconscious mind can have a profound effect on obesity.

This field of research requires one to understand a concept about the psyche initially outlined by Dr. Sigmund Freud and his colleague Dr. Josef Breuer (the Father of Psychoanalysis) in the 1880’s.  Misconceptions regarding the basic drives of the human psyche aside, they identified through their clinical evaluations that the human psyche is made up of three parts, the subconscious (the id), conscious (the ego), and the super-conscious (the superego).  They identified an essential concept that the subconscious is a more primitive and childish component of the mind functioning much more instinctually,  and that the ego and super-ego house the intelligent, ethical, and moral consciousness.  They also identified that a split or division can arise between these two partitions causing physiological conflict to arise (i.e. – onset of a panic attack for no reason).

Autonomic Nervous System is made up of two parts: Sympathetic and Parasympathetic divisions. These divisions act like a gas pedal or brake for various organs and functions.

It is important to understand, as Freud pointed out, that you cannot divide the mind into neat compartments suggested by these three divisions.  The mind acts as a single unit.  However, understanding the “id” and it’s instinctual functions being tied to the autonomic nervous system is central to understanding how subconscious can derail weight loss.

Freud and Breuer identified in their Studies on Hysteria that a simple subconscious idea or instinct could be strong enough to exert powerful physical responses without  sufficient intensity to become conscious thought recognized by the individual. This means that a physiologic motor response in the body could be stimulated without being conscious of the reason for the stimulus.  They, along with Jean-Martin Caharcot, Alfred Alder, Franz Alexander and Allan Walters, witnessed this multiple times clinically.  They came to the conclusions that pain and other nervous functions could originate and could actually be created by the mind.

The Mind has the Power to Create Disease

Dr. Pert’s research over the last 40 years has been able to clearly identify a communication system between the brain, the endocrine system and the immune system.  Dr. Pert’s research identified that memory and/or subconscious idea is directly tied to emotion through the brain hormones called neuropeptides that, when triggered, reproduce stored memory, emotion physical autonomic responses (like changes in heart rate, dry mouth, dilation or constriction of the pupils, sweating of the palms or trunk, chest pressure, etc) and even auto-immunity.

Memory, Emotion & Storage Controlled by Neuropeptides

Neuropeptides also participate in memory sorting, storage and recall .   In his recent book, Beyond Order, the clinical psychologist and professor Dr. Jordon Peterson explains that the miracle of memory is not that we remember, the miracle of memory is that we forget and that we only remember what is necessary.  The miracle of memory is that we only remember those things that are important and teach us meaning.  Because we can forget, we don’t drag the horrible details of the past along with us.  Our memories allow us to get free of the past.  All you need is three sleepless nights in which you cannot dispense with the past and you would understand that life would be a literal hell if we cannot dispense with the day, the memory and the emotions of each day. We must renew ourselves in this cyclical unconsciousness we call sleep and resetting of the memory.   It is during this time that memory, emotion and neurohormones are tied together.

Our memories are tied to emotions through neurochemical synapses created in the brain by the neuropeptides.  Forgetting and remembering are very complex and sophisticated cognitive processes.  Our subconscious reduces the memory, emotion and experience to it’s significance.  The significance is then recorded as memory with it’s associated emotion, then our brain lets go of the details.
If you think about it, we boil our lives down to the “jest” of the story and then we remember only the significance of that story with attached emotion.  This process saves us from being crushed by days, years and decades of the gory details of day to day experience.

Anxiety Provoking Memories are Experiences that Still Need Unpacking

If memories from 18 months or older are still bothering you, if they produce negative emotions, that is a sign that that memory has not been correctly or completely unpacked by the complex processes of the brain. It is essential that the brain unpack wisdom from the past that learning can occur and it can be applied to the future.  This process occurs so that you don’t do the same stupid thing over and over again.  Or, it is there so that you can repeat things that worked well.  That is the purpose of memory.  Not recollection, our memory is the extraction of wisdom for the lesson of life from vast experience.
If you have a memory that is still hurting you, making you anxious, causing, fear, guilt or shame, you have not undertaken the complex process of analyzing that memory, pulling out from it the moral, and dispensing with the details.   This is why writing down these specific memories is so very important.
You must write the bad memory out.  You must write out all of the details you remember and the emotions of that experience.  It allows the mind to do the complex processing of identifying wisdom and social moral barriers of uncertainty, anxiety, threat, fear and panic that are bothering you.  This is what therapy does when talking about and discussing the past.
If journaling and writing out the memory is not effective in resolving the anxiety or if you are unable to identify the memory causing the anxiety, you may want to consider hypnotherapy and directed meditation.  This has been very effective with many of my patients having anxiety relating to childhood experiences improperly tied to strong emotions.
W. Dennis Parker does a wonderful job in his book, Spiritual Mind Management, elucidating how our subconscious mind inappropriately ties emotion to simple experiences and memory, and how these can cause anxiety. For those with resistant anxiety to journaling and therapy, hypnotherapy has been very effective.

Other Hormones associated with Anxiety and Obesity

Over the last two decades, I’ve found that two other hormones play a huge role in handling stress, anxiety, brain repair and play a very large role in sleep.  Both of these hormones are derived directly from cholesterol.  Low fat, vegan and vegetarian diets lead to low cholesterol availability and I commonly see low levels of the following hormones in both men and women.
The first of these is Pregnenolone.  Pregnenolone is the precursor sex hormone derived from cholesterol in the blood stream.  When serum pregnenolone level is lower than 50 mg/dL anxiety, insomnia, hair loss, poor recovery from exercise and difficulty with concentration become chronic.  The cognitive cloudiness that occurs with low pregnenolone levels make the unpacking of traumatic experiences and the sorting of wisdom from day to day experience difficult due to poor sleep.  I have been amazed that just the simple supplementation of pregnenolone nightly reverses anxiety, improves sleep, stops chronic migraine headaches, increases cognition and frequently allows people to “feel normal again.”
The second hormone is Progesterone.  Interestingly progesterone is derived directly from pregnenolone.  If large amounts of mental or physical stress are occurring, pregnenolone is used to make DHEA, Cortisol and Cortisone.  Little is left to make progesterone which is necessary for further hair growth, sleep, focus, memory, the healing effects from stress and trauma in the brain.  Progesterone often acts like a “brain steroid” healing both brain and spinal cord from stress and trauma.
Any evaluation for anxiety, insomnia, PTSD or stress must include screening both of these hormones, because without them, I’ve seen patients suffer for years with failure of the standard approaches.
One other molecule that has hormonal activities in the arena of anxiety and weight loss is that of methylated folic acid.  Folic acid is converted into L-Methyl Folate within every cell of the body.  This is accomplished by and enzyme called methytetrahydrofolate reductase (MTHFR).  About 60-65% of the patients I see in my office with insulin resistance, impaired fasting glucose or diabetes have a deficiency in one or both of the MTHFR genes leading to poor conversion of folic acid to the methylated form.   This is detrimental as methylated folic acid is essential in using Vitamin B12 within every cell of the body.
Lack of effective MTHFR enzymes leads to neuropathy, anxiety, depression, obesity and in severe cases elevated homocysteine levels and schizophrenias.  You can learn more about that by reading my blog article on Folic Acid here and a youtube video on it here.

The Search for Individual Meaning is The Deepest of Human Instincts

The human psyche is stabilized by the search for and the experience of individual meaning within life. The subconscious instinct for understanding our individual meaning is the deepest thing about us as humans.  It is innate and is part of our survival instinct.  What if the instinct understanding or experiencing meaning meaning goes wrong?  Pathologizing or lying about that individual meaning causes one to become “lost.”  Understanding that the instinct for meaning can be distorted or lied about is the most frightening thing upon this planet.  If you pathologize that individual meaning with deceit, you will be in the hands of things you do not want to contemplate.  If you have no theory of good and evil, if you’ve never been exposed to malevolence and someone malevolent touches you, you’re done for.
Being true to one’s self or truthful with your understanding of individual meaning helps to properly orient a person in the world, and find middle ground between complete chaos on one side of life and rigid totalitarianism on the other.   Finding and living in that middle ground requires one to rely upon individual instincts founded in truth.   If you want to live in harmony with yourself and your instincts, and live in a middle ground between a life of chaos and one of totalitarianism, don’t feed yourself or surround yourself with indigestible lies, half-truths and deceit.  You certainly shouldn’t try to warp the world around you by intentionally sharing deceitful meaning.

Anxiety Arises from Naivete

The sheltered soul or naive person is raised with the mindset that “all people are innately good.”  The thought or concept that people are “fundamentally good” is a complete misconception.  Being “good” is very difficult.  It is by no means the default position of the natural man and the subconscious mind. Entropy, catastrophe, tragedy, malevolence and death is the default position of human nature and the subconscious mind.  Good struggles up against this continually.
The people who are most prone to post-traumatic stress disorder (PTSD) are usually naïve people who have been sheltered from malevolence – sheltered from those who are truly spiteful, hostile, vicious, malicious, malignant, vindictive, pernicious, vengeful, hateful, rancorous, and evil-minded.  This is a well known clinical fact and can be found throughout the psychology literature.  There is nothing about this fact that is questionable.  The naïve world view is that you believe the world is fundamentally good – you believe that good behavior is rewarded with good in return – and you don’t really believe that there is any such thing as evil, and you encounter someone who is malevolent (and often you encounter this in yourself).  That sheltering is general throughout our society.  Death no longer occurs at home, it usually occurs in a hospital.  People live in cities and are rarely exposed to the death of animals and the cycle of life seen 100 years ago in farm and ranch life.
Often in those with PTSD, people who have been sheltered from these things, do something, or are required to do something, so morally reprehensible that it damages them psycho-physiologically. Until their psychological framework of good and evil changes, it is very difficult to recover.   These people have no framework in which to conceptualize violent death, evil or the reprehensible act.  They are unable to balance the conscious and subconscious memories and emotions attached to reprehensible emotional guilt, and it destroys them.  This is very common among soldiers.  It’s not always what they saw, it’s what they did or what they were a part of.
Telling and teaching people that humans are innately good (which has been part of our school system teaching for decades) and that evil doesn’t really exist makes them ripe picking for the malevolent and there is nothing about that which is positive.  It leaves tremendous anxiety and psycho-physiological scars in the wake.  This sheltered outlook is cowardice masquerading as virtue.  We see it more and more in our society.
This is why a teenage boy or girl in a traditional Christian or Jewish school is wiser and happier than the 50 year old professor of philosophy in a secular college.  The person who innately understand that good and evil exist within the world have a much easier time coping with and handling stress and trauma that will cross all of our paths.

What does anxiety, chronic stress and PTSD have to do with obesity and weight gain?

Signals in our environment from very stressful life experiences on a daily basis, chronic underlying stress, chronic anxiety, radiation exposure, infectious organisms (such as bacteria and viruses), xenobiotic chemicals, allergens, intestinal bacterial metabolites and food-derived bioactive substances (including phytochemicals), all have influence on messages received by our genes that then influences their expression. Gene expression can turn on and off neuropeptides.  This can effect the autonomic nervous system turning the metabolism up or down.  The expression of our genes in turn controls our health and disease outcomes.  This is one of the reasons COVID-19 seems to effect some people more dramatically than others.

The hormonal counterbalance of blood sugar is regulated, in part, by the autonomic nervous system.  Changes to this system increase or decrease cortisol & glucose production, thereby affecting production of insulin and other weight mediating hormones.  Changes in neuropeptides from stress or anxiety can act just like eating a meal.

As blood sugar falls, the autonomic nervous system responds to balance the blood sugar.  If this system is dysfunctional or under chronic stress, cortisol and adrenalin will cause higher blood sugars due to the stress response and can trigger increased hunger inappropriately.

This is why chronic stress, poor sleep, or even getting cut off while driving in traffic is the equivalent of eating a donut to your hormone responses.  If you’re not exercising, theses hormones will cause weight gain without any change in your diet, and even with caloric restriction.

How Do You Combat Chronic Stress or Anxiety?

  1. Exercise – Because these hormones are released subconsciously, the only way to help control them is regular and consistent physical activity or exercise.  Exercise, 20-40 minutes 3-6 days per week, is often the only way my patients have been able to combat the weight gain from chronic stress, anxiety and PTSD.
  2. Adequate Protein – Recent studies have demonstrated that hitting protein thresholds in men ( > 150 grams per day) and women ( > 90 grams per day) increased growth hormone and decrease insulin, helping to offset the negative effect of stress and anxiety.  This is a key component of a ketogenic or carnivorous lifestyle.
  3. Sleep -Lack of sleep has been implicated in difficulty with weight loss and weight gain.  Lack of sleep places the body into a state of chronic stress. This elevates cortisol, lowers testosterone, increases insulin (there’s that insulin problem, again) and increases the other inflammatory hormones. This perfect storm of stress, driven by lack of restful sleep, plays a big role in fat loss. My average patient needs at a minimum of 6-7 hours of restful sleep to maintain and lose weight. This is where untreated sleep disorders like sleep apnea play a big role. If you have sleep apnea, get it treated. What else can you do to help improve sleep?
    • Remove the computer, iPad and cell phones from the room.
    • Lower the room temperature. Men sleep better around 68-70 degrees F and women sleep better when the temperature is <70 degrees F.
    • Close the blinds or shades to add or darken the room.
    • Don’t study or watch TV in the same room you sleep in. Your body gets used to doing certain activities in certain rooms of the house. The bedroom should be reserved for sleep.
    • Go to bed at the same time
    • Get up at the same time. 
  4. Journaling – Daily journaling of experiences is one of the most powerful keys to helping the brain sort powerful emotions related to anxiety and memory.
  5. Meditation – I’ve created a 23 minute relaxation/meditation audio file that you can listen to for 30 days to help change your subconscious script on weight loss.  You can find it here.
  6. Some people need additional help through hypnosis.  Talk to your doctor about a certified hypnotherapist near you.  If you are a patient of Dr. Nally’s, he offers these services. Set an appointment today.
  7. Additional Resources – If this information is helpful, you may find additional interest in the following books:
  • “Loving What Is ” by Byron Katie
  • “Overcoming Worry and Fear” by Paul A Hauck
  • “The Joys of Living” by Orison Swett Marden

What to Expect

It may take your body and body’s biorhythm 3-4 weeks to adjust to changes you make around exercise, journaling, protein & sleep habits. Be patient with yourself.

Knowing that these challenges plague people on and off throughout the year, and, seeing people get hung up on these issues, I’ve created the Ketogenic Lifestyle 101 Course.  This program gets you jump-started into ketosis and gives you the tools to overcome the individual hurtles you will experience on your health journey.

 

Coronavirus, the Cancel Culture and Tiny Betrayals of Purpose

In the last two decades, it has become more and more clear that the average American has trouble facing reality.  The average American has trouble facing truth.  It affects each of us, and it is affecting physicians, nurses and health professionals individually.

At least once a week, one of my patient’s refuses to get on the scale.  Why would you visit the doctor to improve your health, and yet refuse to look at a measure of health?  Yet, that is the accepted culture of today.

Language of Euphemism

Another evidence of this can be seen in the changes to our language. Our language has become flowered with euphemism and politically correct phrases.  It is why we have a whole generation hyper-focused on “cancel culture.”  People have set aside their faith to live by their feelings.  People no longer accept another’s right to share their perspective or express themselves, especially if it hurts another’s feelings.  We’ve created soft language that has taken the life out of life and medicine.

Shell Shock to PTSD

An example of this change is the softening of language describing what happens to a persons nervous system when in combat.  During World War I from 1914 to 1918, if a soldier’s nervous system became overwhelmed due to the fatigue, stress and horror of battle it was called “shell shock.”  The term describes the power and struggle that occurs with this overwhelming stress. The word almost echos the rattle of a cannon on one’s soul.  Men would return home with hysteria, muscle contractions, heart palpitations, dizziness, depression, blindness, paralysis, insomnia, loss of appetite, flashbacks, nightmares or unable to speak without any physical damage to explain the symptoms.  Because little was understood about the cause, it was seen as a sign of emotional weakness.  Many were even branded as deserters or cowards because of the condition shell shock would cause.  At the end of the war, 80,000 men were diagnosed with shell shock in the British Army medical facilities.

But instead of addressing the pain and addressing the trauma, we buried it under the jargon and euphemisms.  After the second world war in 1945, we toned the term down because we didn’t want to hurt anyone’s feelings describing them as “shell shocked.” So, we called it “Battle Fatigue.”  It is the same problem, overwhelming a person’s emotional coping mechanisms and nervous system with stress to the point of failure, but “battle fatigue” just sounded better, and softer.

Enter the Korean War of 1950-1951.  Actually, we softened that too.  It wasn’t really a war, we were told, and our leaders turned it from war into a softer more acceptable “Korean Conflict.”  Men and women who encountered the same overpowering effects on the nervous system from witnessing the horror of battle, death and destruction were told they had “operational exhaustion.”  This was an even softer term that allowed for a further avoidance of the truth.

Five years later, the U.S. entered a 19 year “conflict” with Vietnam.  The politicians of the time didn’t want to call it war either.  The same trauma causing shell shock in World War I was experienced by men and women in Vietnam.  Seeing the horrors of battle on a daily basis and only being allowed to police those attacking you with guerrilla warfare in a foreign country led to severe trauma in many of our soldiers.  Fighting was intense and millions of people were killed including 60,000 U.S. soldiers.  Yet, we further softened the term “operational exhaustion” with the same symptoms of shell shock to “Post-traumatic Stress Syndrome (PTSD).”  (Hey, at least they added a hyphen, right?)

Waking The Tiger – Working Through Trauma

Trauma is trauma, no matter how or where you experience it.  Because of it’s complexities, the treatment of trauma can’t be addressed here, but according to Peter Levine in his book Waking the Tiger, trauma, no matter what the cause, must be worked through.  Peter Levine does a wonderful job in explaining this in his second follow up book In An Unspoken Voice.  There are additional treatments for burnout.  The brain has a consistent pattern that it follows to resolve trauma and burnout.  If that pattern is disrupted, shell shock, battle fatigue, operational exhaustion or PTSD ensues.

Elizabeth Metraux describes this in her 2018 article this way:
“I was on my honeymoon in Colombia when I first became aware of the true extent of my post-traumatic stress disorder. My husband and I were walking across a smooth, granite platform to take a closer look at a fountain in downtown Cartagena. As we neared the structure, mist from the fountain’s jets dampened the ground at my feet.

“I froze, paralyzed with fear by a flashback — my first — triggered by something as ordinary as wet pavement on a warm day.

“Two years earlier, I was working in civic engagement efforts in Baghdad. One morning, as I walked across a smooth, granite platform toward my apartment, gunfire erupted. I tried to run, but my flip-flops bested me on the pavement, still damp from an early mopping. I slipped and fell backward, hitting my head hard enough to knock me out. When I opened my eyes minutes later, the platform was covered with my blood.

“That happened 15 years ago this week, those Ides of March when American forces invaded Iraq.

“Back home in the U.S., it was clear to those around me that I had PTSD. It wasn’t until six months after my honeymoon, however, that I had the courage to acknowledge that I needed help. It’s not easy seeing your own weaknesses, much less conceding them. But when my habitual glass of wine with dinner became a bottle, and fireworks left me sore and sleepless for days, it was hard to fight the signs.

“Celexa for guilt. Ambien for sleep. Therapy for months. My psychologist and primary care physician spoke regularly to coordinate my care. Most importantly, family and friends became members of my care team. Isolation is a trauma victim’s ill-advised drug of choice, one my loved ones and clinicians wouldn’t let me take.”

Most Physicians Suffer from Moral Trauma combined with PTSD

What concerns me is that many of today’s heath-care workers, physicians and nurses, suffer from PTSD and moral trauma.  Dr. Metraux goes on to describe a conversation she has that is reminiscent of many recent conversations I’ve had with my colleagues:

“A few weeks ago, I was talking with a physician who served our country in Iraq. We chatted nostalgically about the taste of sand and shawarma before he said something that gave me pause: ‘You know, I’d go back to the field any day. Beats practicing in my clinic.’
“‘Why’s that?’ I asked.
“’I didn’t become a doc to put up with billing codes and power struggles. I thought that PTSD would hit when I came home from Fallujah. It’s so much worse when I come home from the office. Truth is, I’ve lost my sense of purpose.’”

Physician burnout is easily chalked up to the 4-8 minute hurried visit with 30-40 patients per day, and the additional 6-8 hours spent each day entering patient information into an electronic medical record, combined with the life-and-death decisions this profession requires routinely every day.  Add to it a time when a physicians and nurses are called upon to be the only people in the clinics and hospitals taking care of a viral infection still unknown in its full spectrum.  But, that doesn’t even scratch the surface.

Thousands of Tiny Betrayals of Purpose

The real cause of injury is the fear created by a society that doesn’t really want to hear or face the truth, and the hundreds and thousands of tiny betrayals of purpose that occur every day in the clinic or the hospital.  Most physicians find themselves expressing horror and disgust at how far they’ve been steered away from their primary purpose of taking care of people.  Clinicians and nurses, much like combat veterans, are forced to take actions every day that contradict their core purpose – sometimes compulsory, sometimes voluntary.  It causes a slow imperceptible unwinding of character.

The 4-8 minute visit means the physician can’t take time to build a real relationship with you or take care of the whole person whose real diagnosis can’t be logged into a computer.  The 8 hours of daily charting requires the clinicians eyes to be taken off their patients, missing the humanity that brought us to the work in the first place.  The government mandated “quality metrics” imposed on every patient encounter by Medicare, Medicaid and intrusive insurance plans that crowds out the deeper connection with patients to help them manage triggers, feel truly cared for and navigate treatments.  Each of these are a “tiny betrayals of purpose,” 30-40 times a day over the course of weeks and months and years.  When you subconsciously betray yourself with every interaction you have throughout the day, it adds up.

Medicine now requires clinicians to practice in a manner inconsistent with their values, because it saves costs, increases access and improves quality, . . . maybe.  Then, add a new virus with an unknown morbidity, mortality and infectivity to the spectrum without a clear treatment protocol. Then add to that layers of bureaucratic regulation and mandates around treatment and insurance.

In 20 years of medical practice, including battlefield medicine, I’ve never seen physicians express public fear, angst and fatigue in the course of their duty.  I’ve seen it every day in the last year.

We Lose a Physician Every Day

Since 2018, over 400 physicians committed suicide per year.  Every day, at least one physician commits suicide (Tanwar D, Amer Psych Asso 2018 Annual Meeting).  That is the highest rate of suicide in any profession.  40 suicides per 100,000  is twice that of the general population.   This rate is higher than the military.  The claim is that doctors are under-treated or untreated for their depression.  It is more than that.  Doctors and nurses alike are experiencing “shell shock,” or in today’s vernacular, “post-traumatic stress disorder” and being force to live, work and function all while suffering with subconscious moral injury.   It goes untreated and unrecognized.

It’s why your doctor is curt with you.  It’s why he or she can only spend five minutes with you in the exam room.  It’s why you get the sense of fear from them when dealing with COVID-19.  It’s why there is confusion about wearing masks and why so many physicians struggle to keep up with the ever changing science.  It’s why 30% of them are divorced.  It’s why 73% of the physicians and 50% of nurses you meet are effected by burnout, trauma and PTSD.

The challenge, is it’s only going to get worse before it gets better.  Some will leave medicine, some will leave life.  Others will suffer until it kills them.  Unless, you and I change it.  Until then, society will be offended.