Recognize their rituals. I like in a World where even 10 seconds is very important, you can miss a lot. You guys abuse and misuse the time God gives you and the people he puts into your lives. The record will show you clearly…laid out in such a fashion…made to be seen. One day an individual is leading a full and active life, and the next day he suddenly finds himself flat on his back yet, twisted and upside down in a hospital coronary care unit, confronting the very real possibility of his own death. The body is food and much of that was previously taken for granted must now be questioned. Classic scenario. Can I return to work? How will I support my family? How will I relate to my spouse and children? What about my favorite activities? What about Netflix and Chill function? A heart attack is both a physical and an emotional trauma. A growing body of scientific evidence has linked psychological depression to the development of coronary heart disease, and it is not at all clear which is cause and which is effect. #RyanPhillippe 1 of 8

Several years ago, I received a letter (from a woman I had never met) which summarized concisely the problems many couples must face after a heart attack and which shows the vital support one human being can give to another. (Indeed, one wonders whether her husband would even be alive today without her loving support.) When her husband was recovering from a heart attack, their internist instructed them to avoid all future orgasmic sexual activity.  At first she fought, but quickly yielded to the melting heat, during the walk through of the house in North Carolina. Death comes on swift wings to the daughter of Babylon. How much she hath glorified herself, and lived deliciously, so much torment and sorrow give her for she said in her heart, I sit a queen, and am no window, and shall see no sorrow. #RyanPhillippe 2 of 8

She wrote, in part: We have been married for 34 very interesting and challenging years. We always had had a very affectionate life, and it was not until my husband’s internist discharged him from the hospital following his heart attack on 22 January 2009, with the words, “eat and drink moderately, do not smoke and no orgasm” that I had paid attention to the significance of our sex life. My husband’s job, a research scientist, was periodically being threatened by cut backs in research funds, so that he was under considerable stress. His healthy up to that time been reasonably good, although he had always suffered from what we kiddingly called “bellyaches.” #RyanPhillippe 3 of 8

Following his discharge after the myocardial infraction, we were careful. He, being a very affectionate guy, needed physical contact, so we engaged in considerable play. Thankfully we both have a sense of humor; and in late August of 2015, he suggested “fitting jobs.” We managed these very well for some months without orgasms. However, they began to result in orgasms. When I wondered aloud about the advisability his response was “What a way to go.” So we began enjoying “side jobs” and later “top jobs” with orgasm. After that, we proceeded to ignore the doctor’s advice about orgasms, but we often talked about the damage to marriage and to life in general such advice must be inflicting on numberless couples. Then he and his buddy did a show in February of 2016, making fun of “orgasms.” #RyanPhillippe 4 of 8

Physicians often advise patients to “use your own judgement” or “do what you think you can do.” Such advice not only shits responsibility from the doctor to the patient, but it also communicates a certain degree of ambivalence about the whole topic. Unfortunately, many cardiac patients are hypersensitive to even the slightest ambivalence on the part of their physicians, and their sexual capacity suffers because of this medical ambivalence. Therefore, shall plagues come in one day, death, and mourning, and famine; and she shall be utterly burned with fire; for strong is the Lord God who judgeth her. Then I said concerning who has grown old in adulteries, will they commit harlotry with her now and she with them? Initiation, intimidation, stigmatization, isolation, helplessness, and self-blame depend on a terrifying reality of abuse.  #RyanPhillippe 5 of 8

How do we organize our thinking with regard to individuals like Marilyn, Mary, and Kathy, and what can we do to help them? The way we define their problems, our diagnosis, will determine how we approach their care. Such patients typically receive five or six different unrelated diagnoses in the course of their psychiatric treatment. If their doctors focus on their mood swings, they will be identified as bipolar and prescribed lithium or valproate. If the professionals are most impressed with their despair, they will be told that they are suffering from major depression and given antidepressants. #RyanPhillippe 6 of 8

If the doctors focus on their restlessness and lack of attention, they may be categories as Attention Deficit Hyperactive Disorder (ADHD) and treated with Ritalin or other stimulants. And if they clinic staff happens to take a trauma history, and the patient actually volunteers the relevant information, he or she might receive the diagnosis of Post-Traumatic Stress Disorder (PTSD). None of these diagnoses will be completely off the mark, and none of them will begin to meaningfully describe who these patients are and what they suffer from.  #RyanPhillippe 7 of 8

Psychiatry, as a subspecialty of medicine, aspires to define mental illness as precisely as, let us say, cancer of the pancreas, or streptococcal infection of the lungs. However, given the complexity of mind, brain, and human attachment systems, we have no come even close to achieving that sort of precision. Understanding what is “wrong” with people currently is more a question of the mind-set of the practitioner (and of what insurance companies will pay for) than of verifiable, objective facts. #RyanPhillippe 8 of 8