What happens after you or your loved one receives care? Aftercare is the missing link for treatment. Join celebrity pain and mental health expert Dr. James Flowers, his Co-Host Robin French, and VIP guest Arden O’Connor as they discuss support for you or your loved one post-treatment.
Key Takeaway:
00:51 – Why Does Increasing the Odds for Long-Term Clinical Stability Need More Attention?
02:53 – The Importance of Care in Post-Treatment
11:37 – The Success of O’Connor Professional Group
17:31 – The Challenges Wealthy Families Faced in Treating Addiction
27:00 – Eating Disorder
29:11 – The Importance of Companion Services
31:25 – The Power of Support
This podcast uses the following third-party services for analysis: Chartable
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Increasing The Odds For Long Term Clinical Stability
Welcome everyone to the show, joined by my beautiful co-host, Robin French.
Thank you. Dr. Flowers.
How are you?
I’m good, how are you?
I’m super excited to have Arden O’Connor from Boston with us.
Thanks for having me.
You are so welcome. Thanks for being here. The topic in this episode is Increasing The Odds for Long-Term Clinical Stability, which I know you know a lot about. It’s a topic that’s very important to you, Arden. You’re joining us via Zoom as we discuss and support aftercare treatment for you or a loved one.
Thank you for joining us, Arden. We know this topic is personal to you, so we were wondering if you could tell us about your experience and why this topic needs more attention.
O’Connor Professional Group
First, thank you for having me here and letting me talk about something foundational in terms of me starting the O’Connor Professional Group. As many people know, I had a younger brother named Chris, who struggled with addiction for a very long time. I’m sure as you see it. Flowers Institute and others see in the environments that they work in. My brother was the typical story of somebody who cycled in and out of the system.
He would get himself into what AA calls the jackpot, a detox, and go to a facility. Our family would take a breath of fresh air and a breath of relief and then my youngest brother Chris would wind up coming out of the facility looking like things were going to go well and things would fall apart. I think a lot of that had to do with his age and our lack of understanding as a family as to what could be supportive to him and what wasn’t as supportive, but what was more protecting behavior or what people call enabling behavior.
I think he was an impulsive young man and so figuring out what a life in recovery looks like at 26 when it was much easier to say, “I’m going to go hang out with my friends who are at a bar and I’ll have club soda.” Before we know it, we’re back to the races again. Our family spent about $500,000 out of pocket on his care. He cycled in and out of about fifteen different residential treatment stays.
I was studying healthcare at business school and said to my parents, “I’ve never seen an area of healthcare where there’s less transparency around outcomes, less of a focus on what we can do over the long-term and more guessing on behalf of family members as to what’s going to make a difference and more dependence on parents or spouses to be almost like probation officers. Did you go to AA? Did you do this? Would you do that?” That’s what sparked my interest because I felt like my parents were in the worst position to try and monitor my brother’s behaviors. He still needed someone who was both going to hold him accountable and cheer him on.
Arden, you and I share that literally almost exact same story. My oldest sister was your brother. She was in and out of drug treatment. My family spent probably about the same amount of money that your family has. She was nine years older than me. I would watch her in and out of treatment and the frustration that my mom and dad had, the depression that my mom had related to it and she would get out and everybody was in the pink cloud and happy and doing well and then she’d relapse.
It was over and over through 18 different treatment centers from the time I was 10 years old. When I was a senior in college, unfortunately, she had gotten out of treatment. She went to probably the same treatment centers your brother did. She was sober and said, “I want to move to Portland, Oregon.” My grandparents bought her a condo in Portland. She was there for a month and fell off her eight-story balcony and died.
We don’t know how she fell or what happened, but she was having a party and there was lots of cocaine involved. She had cocaine in her system. She had relapsed and we’re not sure what happened. This was from the time I was ten until my senior in college, undergraduate school. My parents didn’t know about the effective navigation of the treatment system. They didn’t know where to go. They didn’t know who to talk to. They didn’t have people like you to visit with.
It was so frustrating to my family and then, of course, devastating when she died, but effective navigation of treatment and aftercare are so essential. I never saw my sister have any type of aftercare program. She was at Betty Ford, CR2Son, all the best wonderful programs back in the ‘70s and ‘80s, but there wasn’t a lot of follow-through. Families struggle with pre and post-treatment and helping their loved ones. Can you speak to us a little bit and tell us and our audience about the importance of that process?
Of course. What we learned as a family during this process is that we got tired of telling the story over and over again. Not only did my brother get tired of repeating symptoms in his history, but my parents, by the end of his treatment stay, we had a lovely woman who works for us named Diana Clark. My brother was at a facility here in the Northeast. I remember I attended her workshop. I said to my parents like, “We should all go. It’s a family workshop.” My father rolled his eyes and said, “What am I going to learn that I haven’t learned today?”
I think a lot of that was because we were guessing things went along. On the pre-treatment side, which you bring up, I think is a big reason we were started. On a financial level, I’d never seen an investment that’s $30,000, $40,000, $50,000 up to $100,000 these days in treatment where parents are taking the advice of a friend of a friend who liked a center or somebody Googled and addiction rehab popped up and the pictures looked pretty good so we’re going to go that way.
That’s my soapbox.
It’s like throwing a dart. You might as well throw a dart on a map.
I said to my parents, “If you looked at the corollary, I understand college has a different implication for somebody’s trajectory, but there’s a whole industry around ed consultants and books.” Now, we do have the treatment consultants, but at the time that my brother was going through it, it wasn’t a fully developed industry for sure. I kept telling my parents that there has to be a way to have better recommendations that are vetted and that give us some sense of comparing apples to apples. This center costs X, this center costs Y, and here’s why.
One passion that we have at OPG is helping parents to think through in the beginning, what’s the investment not for the next 30 or 60 days, but for the lifetime of this person? Some families that we work with are blessed enough that money is not even a consideration. Others are certainly financially stable and they’re doing well, but they’re going to have more limits. That was the case in my family system around how much they can spend.
One passion we have at O’Connor Professional Group is helping parents think through things in the beginning.
It’s important, in my opinion, in that second scenario to think through well how much you pay in the first center and how that determines where you’re going to go after that, both on the center side but also on therapy and psychiatry. If we know anything about COVID, it’s harder now these days to get immediate appointments with in-network therapists.
I think families have to think about aftercare in the broad sense of what types of professionals are going to be needed and what the budget is. I got passionate about that, not even to, and I won’t do a diatribe because we’ll be here for four hours, on some of the challenges with internet marketing as it relates to treatment centers. It seems like that’s starting to change in the way the algorithm has been impacted, but that at the time my brother was going into treatment, that was an issue, too.
It was impossible to figure out. I even to this day say to families, “You’re going to see the term dual diagnosis.” That means very different things. It isn’t necessarily going to be a suggestion that your son, who has bipolar disorder unmedicated with addiction issues, is going to be at a facility where he can be stabilized because the term dual diagnosis is mentioned.
Dual diagnosis and trauma-informed.
Another one of my favorites. I think families, both our clients and then people who call us for advice, who I joke about all the time, O’Connor Professional Group, my last name is O’Connor, I’m Irish Catholic by descent and we could stay in business serving the family, and friend group of the O’Connors for years. We get a lot of calls. A lot of what we’re trying to do is help people figure out how to triage.
We’re not the right solution. Where can they get unbiased information? Where can they get a facility? How do we set expectations appropriately with families? They’re not also putting the burden on a facility to say, You’ve got to fix my son, my spouse, my whomever,” because that also isn’t realistic. I think when we see families investing the majority of their capital in one solution, the expectations go through the roof as to what they’re hoping for.
I think part of what you’re talking about is multiple treatment centers and pre-care, aftercare, pre-placement, all of that, I think that one of the reasons I started J. Flowers Health Institute and the Comprehensive Diagnostic Program is truly because I was laughing a minute ago when you’re like, “We place people in treatment based on what a beautiful center this is, what a beautiful town that is. My son’s always wanted to go to San Juan Capistrano for treatment. Let’s send him there and spend $100,000.” They get there, but it’s not what they expected. They don’t know the patient with whom they’re working who’s sitting in front of them.
It takes a while to get to know. By doing these comprehensive diagnostic evaluations upfront and presenting a clear and concise, what I call living behavioral MRI that produces a set of diagnoses and you can walk in with the help of OPG, O’Connor Professional Group, and then someone like us placing them together in a treatment program, I see the relapse rate going through the floor instead of staying up at 70% or higher.
We’ve got the alumni program, too. When they leave our care, we wrap our arms around them and follow up with them after two weeks, after a month, and then every other month after that. I thought it would bother them, these telephone calls, but they love it. They love that we still care. They love that we still keep in touch. There have even been some instances where they had their card lying around and there was a family member, or one was a property manager, that actually they had some questions, or they had some concerns about that particular individual, where they actually followed up with us as well to let us know.
It’s so important. Arden, what sets you guys apart? You and I both know in the treatment world and the consulting world, we’re all over the place. There are thousands of us everywhere in the country and you have such an amazing reputation and you have such an amazing practice. We look up to you guys and love working with you. Let our audience know what sets you guys apart in this world, in this industry.
The Contributing Factors To O’Connor Professional Group’s Success
It’s very kind of you to say. I like to think we live up to that aspiration on certain days, not every day for sure. I would say a few things. I think for us, one of the things that was important to me when I thought about it for a hot minute, the idea of opening a treatment center on the East Coast. I remembered that I used to run a home for foster care boys, and I remembered the 24/7 urgent nature of that and said that I’d like to sleep more than five hours a night again. I ultimately didn’t do that and wound up with this more unique practice that doesn’t have a home base, so to speak, in terms of a facility.
The Complexities In Treating Addiction
I think one of the things that I noticed when I was doing some research into practices like mine is that a lot of them were fragmented. People were either geographically restricted, so they would do case management in a certain city, or they would do interventions, and they could do phone case management, but they couldn’t necessarily do in-person case management.
They would do some people did placements, but they didn’t do interventions. We deliberately tried to create a one-stop shop to get to that fundamental issue of a family wanting to come to one place, tell their story, and not have to repeat it. We’ve had many clients in our practice for long periods of time who are very active in our case management services. We get them into some type of residential program. They do well. They may even stop services for a period of time and then they go back in.
I think that the capacity to be able to take families and deal with families separately from the individuals offers varying levels of support, whether it’s a few hours a week or full live-in support. An array of services, I think, is one piece that sets us apart. The second part, and I know this is a little cliched because everybody would hopefully say this, but I feel like we’ve done a very good job in building a team and a culture. We’ve learned the hard way and we have not retained everybody who’s joined our company.
Similar to any startup, we’ve had our own bumps in the road in terms of determining who’s going to be a good fit. I almost say it’s a weird fascination with crisis. We had one employee who was an EMT in an earlier life and I knew he was going to fit in well, and he did because he had that background and understood the importance of jumping right in. We have a very clinically informed team. We have a lot more full-time licensed clinicians than we did at the start of our practice, even though we’re not offering therapy.
We have a broad array of ethnicities, training types, backgrounds, and folks from the LGBTQ+ communities. We are trying to be much more savvy about matching according to our client needs rather than hiring the same version of the same person over and over again. It’s the ability to grow and have a team that’s collaborative. We have our days where we’re certainly if you took a poll, people are cranky. COVID was good to us in many ways. In a weird way, we were able to keep a team culture going and I’m proud of that.
I think that by putting together a team like your EMT, some of us in this field know how to manage crises and work in crises within boundaries and in good health. I like to say we thrive on stress or crises, but we do it in a professional way, and we also do our own self-care. How do you do your own self-care? What do you do to take care of yourself?
I’ve always been an aggressive self-care person. I love going to spas. It’s like my Canyon Ranch here in the Berkshires or the one in Arizona are my favorites. We have a company membership, which I guess is a discounted rate because we’ve used it for company, like one-day retreat-type things. I’m a big fan of that. I abide by the daily roles that I think most people who take care of themselves. I try to exercise, if not every day, most days of the week.
I’m moving towards a plant-based diet. I try to get enough sleep. Meditation I’m on and off with. I’m trying to do even guided for a few minutes a day because I found, and this is the truth, it sounds again very cliché, but I think when I’m kind to myself, I’m kinder to my team. I have more patience to deal with that fifteenth phone call that comes in. I’m sure you feel this. We never have a steady stream of client referrals.
I think the only way that I know for me to be able to handle clients like that, and even handle staff when they’re stressed clients is if I’m taking care of myself first. I also have three dogs who have stayed mercifully pretty quiet during this interview but spending time with them has been helpful.
I was completely with you going, “Yes, I agree with all of that,” until you got to the plant-based diet. I was like, “No.”
Now, that’s been a real adjustment. I have a concierge physician that I switched to who’s lovely, who’s a cardiologist. She’s brilliant, but she started talking to me about it and I kept looking over my shoulder like, “Is there someone else here that you’re selling to?” I am a card-carrying member of Smith and Walensky. There’s all these things. I’ve been trying to commit and reading plant-based diet books and all this. I’m not totally plant-based. I do the cultured meat, but I’m trying to do as much vegetarian as possible.
Arden, can you discuss the unique issues and challenges that wealthy families and firms often face when dealing with addiction?
I think one of the things I notice and we hear this phrase all the time in self-help meetings and AA. The simple answer is wealthy families. There is no rock bottom, unless the parents create one. I think their first fear when families call us is we’re going to say, “Cut them off. Nothing.” We don’t ever recommend that or I should say very rarely, because in most instances, especially if there is a mental health issue that’s active, it’s a pretty dangerous proposition.
If there is a mental health issue that’s activated, it’s a pretty dangerous proposition.
That said, “I think there’s a big gray area that most families are not always ready to explore between the status quo and allowing this person to live. The classic scenario for us is they have an Upper East Side apartment, they’ve lived on their own, and they don’t need to work. The family sees them at gatherings. They look either a little more erratic, so maybe there’s an eating disorder, or maybe they’re drinking a little too much, but nobody knows what the diagnosis is.
In those cases, a lot of times, the parents are like, “We don’t run under any financial imperative to change the scenario. We know my daughter, my son, my whoever is going to be angry if we suggest doing something different.” I think that’s one challenge. I think the issue of finding care, on the one hand, you can afford the best care in the world if you have resources and you’re willing to spend them. The other challenge is you often can be suggested to do things that don’t make sense.
We are starting to work with a celebrity client who’s got a provider out of state prescribing inappropriately and they’re very high profile. A very difficult scenario to navigate. We see that with families that aren’t necessarily celebrities, but they have a big name in their town, they’re on the building of the hospital, so you get people who get intimidated or tell them what they want to hear and say you should see me they’re seeing the same provider for three times a week for ten years and the progress is what the family’s hoping for.
I think those are some of the issues that we see. The last thing I’ll say is a lot of high-network families we work with are part of family businesses and whenever you have a young person reporting to a family member, the chances that they’re going to be held to objective standards are slim and or at least in most family businesses are.
That is problematic because you have other family members who are working hard to uphold the family’s legacy and to help the business to become profitable and that’s somebody in the business who doesn’t belong there clinically. The family is struggling with issues that are not on top of the clinical issues and all the complicated dynamics that every family deals with. Now you’ve got an asset on top of it, which makes it more challenging.
The other thing I can imagine that continues to be challenging for you and me because of the families that you and I both work with is the stress that you personally have in making sure that you are doing everything perfectly because these families demand perfection. The family is trying to meet the goal of the patient and does not always agree with the family or agree with the patient when navigating that family office or that family system. How do you navigate working in a family business or wealthy family, trying to be as perfect as possible and making sure that you manage the stress of placing them in the right program?
I have a big question now. Did you call my company and talk to some of my team members? I’m smiling.
No, he’s telling he knew about the flood. That’s what he’s doing.
I always say we cannot control the outcomes. As much as families put that on us, that’s not possible. We have to be candid about that. We can control somebody’s experience with our firm, within reason. We can be proactive. I have very high standards, and sometimes my team thinks I’m ridiculous when it comes to what I expect in terms of communication. I can appreciate this question.
That’s why I was laughing. I’m talking about myself here.
He always says over-communicate.
If they are asking you a question, we’ve lost the game. If you are proactive, let them say, “We’ve had enough. Thank you. No more updates.” One piece I can say is that we by no means have it perfect. I’m not a huge Salesforce administrator type, but I think the more this can be automated, the better. I’ve come around to this and we’re investing in that.
I don’t mean it in any disrespectful way, but folks on our team are humans, and they’ve got a lot of things they’re balancing, so to expect them to remember every little thing and every little nuance is challenging. The more automated, the better. I’m reluctant to say it here because I feel like everyone’s going to poach her, but we hired an excellent intake director and she has a great colleague who works with her. For me, as a small company, it seemed like a ridiculous.
I’m sorry, what was her name again?
Her name is Sammy. She goes by Sammy. You won’t find her anywhere on our website. She’s excellent. I love it. I will say I do think the customer service experience starts with when you enter the firm. How do you answer the phone, what does your contract process look like, how are your releases done, and how held do families feel? I will be the first to admit that we’re a small company. When my CFO and COO said, “We need two intake people,” I looked at them like, “Are there referrals that are coming in that I’m not aware of? Are you crazy?”
Having a bigger team approach and having the right people in those positions kick off cases well. That made a huge difference because I know the details are being handled. We have a ways to go, I will say. This is one area I’m very critical of. I’m critical, in general, of myself, unfortunately, as most of my company team members get it. This area, partially because of what I know we experienced as parents, you couldn’t get calls back, you’d put money down, and you had no idea where it went. Some of it is yes, HIPAA, but I sometimes think we hide behind that in our industry. “I don’t know if I have a release.” You can find that out pretty quickly. There are ways to manage that process in the beginning.
I’m very into customer service and I think a lot of it is over-communicating and being transparent when there is an issue. I always say I’d rather us go forward and say, “We made a mistake here. Here’s how we plan to rectify it.” What else can we do than try to hide behind the dog ate my homework or this happened because, in my experience, families calm down. Some families get angry and that’s the pain of working in this business that we have to endure. Other times, I would say the vast majority of families are kind and understanding.
You and I both also have other family members in recovery. For our audience who want a family member to go into recovery, what’s the one piece of advice you want them to take away? Someone seeking, like, “What do I do with my brother, my sister, my husband, my wife?”
I’m going to give a very cheesy one, which was my philosophy, and my brother passed away. I’m so sorry about your sister, by the way. My brother passed away in 2018. I’m going to say never give up. For me, that’s the philosophy I lived by. Even having the worst thing imaginable happened. We actually created a memorial video about him as a family, which I’ve been watching. You remember what a wonderful human he was.
Part of the story around his addiction and his recovery, which he was in recovery for 4.5 years when he died, but part of it is about who he was. I say never give up because even though the worst thing happened to our family, to this day, I’m very proud of the fact that we all stood by him. As we suspected his last relapse, we said, “We love you and if you need something, we are here. We will send you back to treatment.”
I’m very glad those were the last words he heard. Not to malign families. Lots of things can happen, and somebody may pass away unexpectedly. For me, I always believed that he could get better. I still believe that, or I believe anybody can get better. Some families roll their eyes and I say, “I know.” If I didn’t believe that though, I don’t think I should be running this company, honestly, because it wouldn’t be fulfilling.
I share that with you so much. It’s amazing that sometimes we’ll get a new referral and read the case notes. I’m like, “Absolutely we can help this.” My team is looking at me going, “Are you kidding? Do you want this?” I’m like, “Absolutely. Yes, we can do this.” We do it. It’s not giving up. It’s time, it’s commitment, it’s passion. It’s caring.
One of our guests called it chronic hope. Remember that? It’s true.
I like that phrase, chronic hope.
Arden, you help a lot of families with eating disorders, too. Can you maybe tell us a little bit about the challenges and working with eating disorder patients and families?
Eating Disorder
I’m going to own that I’m not a clinician so I always have to say it because I feel like I always have to have the qualifier. My layman’s interpretation of the difference between eating disorders, there are a lot of similarities with other behavioral health diagnoses. I would say, on a practical level, what’s challenging is so many of our eating disorder clients are very high-functioning. I’m thinking particularly of clients with anorexia and even bulimia. There are folks who are in great high schools, they’re going to great colleges.
By all counts in our world, where you can never be too rich or too thin, they look like they’re accomplishing all these wonderful things. I think particularly high net-worth families are sometimes very reluctant to pull them off the track that they’re already on where they’re looking successful. The other piece I would say is I personally, again, and this is my own view. I do think avoiding people, places, and things with addiction, I don’t think it’s easy, but I think it’s possible.
You can’t avoid eating. It’s a whole psychological mind shift that has to happen. I think it’s a very challenging one. I think there are more nuances to the way the care is delivered. I think it’s harder for families to tackle. As with any behavioral health issue, a predisposition in a family system, but you can also often have a food philosophy within a family.
If you have a daughter with an eating disorder and a mom who’s had a restrictive diet, maybe she’s not full-blown anorexia, but you suddenly have a system that is maybe not even recognizing how much they’re condoning these poor patterns of eating behaviors. It has the highest mortality rate of any behavioral health issue. I think it’s insidious. I think families don’t take it seriously. Not always, but many families don’t realize how serious it is until they’re in a dire situation.
Arden, we have two more questions before we run out of time. I want to ask a quick question about companion services and then I know you wanted to hear a story. Tell us about your companion services because I think that they are so important in the process as well.
Companion Services
We’ve always done companion work. I think we started maybe a year into the business. I feel like they’ve been popular, but there’s been a surge in the last couple of years. We see them as a bridge to folks going into treatment if there’s a waiting list for a bed, it could be something simple like a transport. We see them for some folks, and obviously, they’re expensive services. It’s one of the areas in which we’ve increased our pricing, I’ll be very candid, because we know what it takes to offer a high level of service to have companions who feel like they’re supported.
We have a full-time companion coordinator who supervises the supervisors of the companions. There’s an infrastructure behind it, I think, to do it well. I think during COVID, we saw a high increase because many people were thinking about it as an alternative to long-term residential stays for fear of the virus. I think there are families who also have lifestyles that are different. They’re traveling to multiple homes. They’re not going to necessarily stay in a facility over the long-term.
What we’ve learned is good communication with the family, with the companion, having clinical oversight over the services, and being very clear about what we can and cannot tolerate in terms of behaviors on the front end. I like to see rotations. It’s not always possible, but I believe that companions do better work when they have a scheduled break.
Companions do better work when they have a scheduled break.
I would say I think being careful as to which providers you work with. If they’re coming in with a therapist, a psychiatrist, very early on establishing a close relationship, because they’re very high-risk cases. We don’t want to be out there delivering services in a vacuum. We want to be in touch with their therapist and psychiatrist. If they need one, we’ll vet one on their behalf.
I want to give a quick shout-out to a companion who actually texted me right before the show started. He said, “You have Arden O’Connor. How do I listen?” It’s Shawn Dugan down in New York. Shawn, hello.
Shawn, thank you.
Tell us a success story, something that you can leave the audience with.
The Power Of Support
This is actually timely. One of our first cases years ago was a young man who came out of a treatment center on the East Coast. We offered companion services with a schedule of companions. I was heavily involved in dictating the terms for a long time. I’ll be honest, the case went well for a period of time. It had some bumps in the road. It wasn’t totally clear when he left our services that it was going to be this trajectory that went up.
I’m happy to report he’s sober and he doesn’t work for our company, but he works in the field. He got in many years later, and his father came back to our company for separate services for another family member but I love those stories where you see somebody who has outlined goals and has started to get that part-time job, started to go back to school, and started to build a life. His a particularly great trajectory.
That happens a lot. In this industry, people who have had success want to pay it forward, and they get into the industry themselves. Very common.
I am so thankful that you were able to do this. I know how incredibly busy you are. You guys are one of our favorite services out there. I know you’re so well respected. Thank you for what you do every single day.
Thank you. We appreciate you.
Thank you so much. It was great to be with both of you. Have a wonderful rest of your day.
Thank you. Take good care.
If they want to reach you, how do they reach you, Arden?
Our website is www.OConnorPG.com and our intake line is 617-910-3940.
If they want to reach you, Dr. Flowers, how do they reach you?
I always say because I cannot remember the phone number, I’m like JFlowersHealth.com.
That’s a very easy way to do it.
Thank you, everyone, for spending time with us. Thank you again, Arden. You’re spectacular. I love your passion and your excitement and you’re so beautiful.
I want to get up there and see you very soon.
I want to remind everyone that you can find us on a bunch of different platforms. Also YouTube, Apple Podcasts, SoundCloud, Spotify, Stitcher, iHeartRadio. Please share this episode on social media with someone or like it, subscribe, and help us out.
We want to remind you that a clear diagnosis is also the key to the most effective treatment possible. Good to see you, Arden.
Arden, thank you so much.
Thank you.
Important Links:
- Arden O’Connor
- YouTube – Understanding The Human Condition
- Apple Podcasts -Understanding The Human Condition
- SoundCloud – Understanding The Human Condition
- Spotify -Understanding The Human Condition
- iHeart Radio -Understanding The Human Condition
