Thinking about suicide

Do you think about dying? I do, quite often.

In an article published last week in the Sydney Morning Herald, Daniel Mezrani wrote about his father’s suicide. Daniel’s tone was honest and heartfelt. His message was sobering. Daniel’s father was an emergency physician, highly respected, with “three teenage children, dozens of enamoured colleagues and an innumerable network of people he had touched with his generosity, humour and passion for social justice”, yet he ended his life.

Throughout the article, Daniel approaches suicide through a social framework. “I don’t think that suicide should be viewed as a purely psychiatric issue” he writes. “The idea that suicide is always the consequence of a definable mental illness continues to dominate the public consciousness despite a growing consensus among the academic community that there is much more at play.”

“We know that isolation significantly increases suicide risk, as do other social stressors such as unemployment and relationship failure. A new paradigm in suicide prevention emerges – if we begin to see people in context, we become privy to external factors that may be causing them distress and can thus look out for more subtle cues that they may be at risk.”

He’s not incorrect. Social factors are important to a person’s risk of suicide, though mental health is very important too.

“There is no simplicity in this conclusion, but there is promise. It means that anything we do to address stigma, discrimination and hardship at a systemic level has the potential to bring down our national suicide rate. If we really want to stop people dying in this most horrific way, we need to make it easier for them to live.”

True again. More suicides are prevented through decisions at a systems and government level than through direct personal intervention.

He concludes by saying, “They are tangible reminders that things can get better, and that we are never, ever alone.”

It’s a lovely way of rounding out an article on a very difficult topic, I give him credit for that. And for the average person, it seems like a very reasonable thing to say … things do get better, no one is ever truly alone.

Except that’s not how someone who’s suicidal will see it.

Daniel succinctly encapsulated the essence of suicide earlier on in his article: “The final common pathway is not neurochemical disturbance or a discrete socioeconomic stressor, it is an anguish that feels otherwise inescapable; hopelessness manifest.”

I’ve battled with depression for a long time now, the chronic latent adversity of pathological hopelessness. Most of the time it sits on me like an emotional weight vest, making the simplest tasks feel like so much more of an effort, subtly stealing my energy, tempering my sense of joy. But there are times when I feel like I’m being crushed by a tonne of wet sand and I can’t move or breath or see. There are other times where I feel like someone has ripped out my heart and is pouring battery acid into my chest, and all I can feel is pain.

I think about suicide. Depending on where my mood is, there are times when I think about it a lot. The recurrent theme connecting all those times is hopelessness.

Shame brings isolation, inequality brings inertia, but it is hopelessness that finally destroys.

Most people have never felt the depths of despair that true hopelessness brings, and I hope they never do. Unless you’ve been there, it’s impossible to truly understand how overwhelming it is. The only way I think I could describe it would be to imagine that you’re out to sea and your boat sinks, leaving you stranded in the middle of the ocean at night in the middle of a storm – it’s dark, it’s disorientating, numbingly cold, fighting to try and keep your head above the water when the swells and the currents are constantly dragging you down.

Things can get better, and we are never alone, but when overwhelmed by deep existential despair, you can’t see it.

It might sound like I’m against addressing stigma, discrimination and hardship, but I’m not. The purpose of this article isn’t to advocate for one solution or another. I certainly don’t pretend to know all, or maybe any of, the answers. The purpose of speaking out like this is simple … I want to add to the conversation.

At the opening plenary of the conference I attended this weekend, Dr Geoff Toogood, a doctors mental health advocate, spoke about his own personal journey with mental illness as a way of starting the conversation. It’s a hard conversation, but it’s one we have to have, and it needs to be authentic if it’s going to have any real resonance. It would be much easier to simply hide away, masking the pain, pretending it’s not there, but lets face it, we’ve tried that strategy already and it’s killing us.

I can’t offer answers, but I do promise authenticity.

I also wanted to broach the key issue of hope. How do we give people hope? Hope doesn’t come from a pill or a program, but where does it come from? Can we mobilise hope? Can we give hope to the hopeless, and if so, how do we communicate hope to those who struggle the most to hear it?

I know there will be people reading this who have thought about, or might even be thinking about suicide. I know what you’re feeling. I know how hard it is.

Again, I don’t pretend to know all the answers. All I can say is that you’re not the only one, and you’re not alone. I know it’s not easy, but find even the faintest glimmer of hope – in your family, in your job, in people around you, in a faith. Hold on to it. The storm will pass and day will break.

Sometimes even the simplest connection to another person can help. If you need to talk to someone, there are always people that can help. In Australia, call Lifeline ~ 13 11 14, BeyondBlue ~ 1300 22 4636 or https://www.beyondblue.org.au/about-us/contact-us or the Suicide Callback Service ~ 1300 659 467 or https://www.suicidecallbackservice.org.au. In the USA, call the National Suicide Prevention Lifeline ~ 1-800-273-TALK (8255). In New Zealand, call Lifeline Aotearoa 24/7 Helpline ~ 0800 543 354. In the UK, call Samaritans ~ 116 123. For other countries, Your Life Counts maintains a list of crisis services across a number of countries: http://www.yourlifecounts.org/need-help/crisis-lines.

Kudos to Daniel Mezrani. It’s shattering to lose someone you love so much, and it takes a special kind of person to turn that tragedy into something that will help other people. I wish him and his family all the best as they continue on their difficult journey.

Stigma, discrimination and hardship do need to be addressed at a systemic level if we are going to help lower our nation’s suicide rate.

We also need to better understand hope, how to foster it in those whose hope is dormant, and how to help those who have lost all hope to find it again.

We need to keep talking too. The conversation is extremely challenging, but without an open and authentic dialogue, many will continue to suffer, silent and alone, instead of getting the help they deserve.

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More love, not less guns?

Wow.

Just … wow.

Dr Caroline Leaf is no stranger to ignorance and controversy – she thinks that our minds can create matter, that our thoughts can control our genetic expression, and that psychiatric medications are a leading cause of death. So it should come as no surprise when she proves the Dunning-Kruger Effect over and over again.

Still, I found her podcast and meme today utterly breathtaking.

Dr Leaf, communication pathologist and self-titled cognitive neuroscientist-cum-life-guru continues to weigh in on the gun debate every time there’s a mass shooting. I wouldn’t if I were her, but fools rush in.

At least Dr Leaf has finally stopped blaming mental illness or psychiatric medication for causing such mass murders. That said, there’s still more twisting and contorting in her statement than at a pretzel convention.

Dr Leaf has relinquished one over-simplistic solution in favour of another. Yes, mass shootings aren’t related to mental illness, but can you really say with a straight face that mass shootings occur because of a lack of love? So we should all hold hands and sing Kumbayah? Have a few more hugs? Dr Leaf’s suggestion is childish and inane.

Since 1996, Australia’s number of mass shootings has been zero. Australia’s gun-related homicide and suicide rate also fell. Why? It’s not because we all started loving each other more down here after 1996. It’s because, amongst other reasons, the Australian government introduced gun law reform, drastically reducing the number of guns available within the general population.

Perhaps living in Texas has rubbed off on her, or perhaps Dr Leaf is an NRA sympathiser. I honestly don’t know why Dr Leaf is so afraid to speak directly to the problem. Most of the US and the entire rest of the world can see the issue for what it is. If it wasn’t so tragic, her dance around the issue would be comical.

Dr Leaf is welcome to her opinion, but she can not claim any level of moral or professional authority on this issue. Her “years of experience in the mental health field” are zero, as is her credibility as an expert. Encouraging more love with the same number of handguns and semi-automatics on the street is not going to prevent more casualties.

Stop mislabelling labels.

The last time I looked through the supermarket, I bought some baked beans. How did I know the can I took off the shelf was full of baked beans and not freshly harvested sheep’s innards? Because the label on the can said so.

Labels aren’t perfect of course. Every now and then, a can of something has the wrong label applied in the factory. Usually it’s nothing too sinister – no accidental swaps of some goat entrails instead of your tinned salmon. Instead, it’s usually something similar – tuna gets labelled as salmon and vice versa, and the worst that happens is that the tuna mornay you’ve just made had an unexpected flavour.  Even these sorts of mild mix ups are rare. Overall, we trust that the labels are guides and the information they provide us helps us make an informed decision about what do to with that particular can and its contents.

It would be pretty silly for some random person to preach out the front of the supermarket, ranting about how all labels for a particular thing are all wrong.

“Uh, just because the occasional can of tuna was accidentally filled with cat food doesn’t mean to say that all labels are wrong. And just because one person had a bad experience with the wrong label, the supermarket shouldn’t stop using them … otherwise how else is anyone supposed to manage their cans effectively without labels? Honestly, stop looking like a fool by preaching about labels and let the rest of us finish our shopping.”

Dr Caroline Leaf, communication pathologist, self-titled cognitive neuroscientist, and a self-elected champion of irrelevant mental health advocacy, has come out all guns ablazin’ over ADHD labels again. She needs to give it a rest – she’s just like the crazy person standing in front of the supermarket.

“Labels for ADHD are bad”, she says. “Look at Avery Jackson, who was labeled ADHD but did not accept the label. He went on to earn multiple degrees and become one of the top neurosurgeons in the U.S!”  The underlying message – labelling a child with ADHD will lock then into a life of pathetic excuses and they won’t ever reach their full potential until they renounce the curse of their ADHD label.

For every scary anecdote about the evils of ADHD and the mental prison that everyone with such a label is supposed to find themselves in, there are ten more where the ADHD label helped them.  There are so many more people where the ADHD label helped them to finally understand their condition and receive the correct treatment, enabling them to reach their potential and improve their life in leaps and bounds.

Take, for example, one of my patients called Little Jimmy (not his real name). When Little Jimmy was in the early primary school grades, he was a bit of a fidgeter and couldn’t concentrate well enough at school or at home to complete his homework tasks. His mother took him to a naturopath who told him he had a disorder of “pyrolles disease”. Thankfully, mum brought him to see me, and after a careful history and a long chat, Little Jimmy went to see a specialist who diagnosed him with ADHD and commenced him on stimulant medications. Before his label, Little Jimmy’s reading levels were languishing at the bottom off his class after two years of stagnation.  He was more than a year behind in reading levels and going nowhere fast.  Two weeks after getting his label and the right medication, he went to the top three reading levels in the class.  His mother told me of the massive gains he made, and the flow-on effect this had to his self-esteem and confidence in other areas of his school work and school life. She cried as she recounted his story, and then I cried too.

So perhaps Avery Jackson became an orthopaedic surgeon because he chose to ignore his label of ADHD and worked hard anyway.  Good for him.  Little Jimmy got a label of ADHD and because of it, he learnt to read. Now he’s got the chance to follow in Avery Jackson’s footsteps, BECAUSE of his label.

Labels are important. Without them, we wouldn’t know how to know who needs which treatment. Labels can help people overcome some of the strongest barriers and connect with others for support.

And let’s face it, if someone really wanted to, they don’t need a label of ADHD to find excuses in life.

So labels are not a hinderance, but rather, they are a guide to help you know what’s going on so informed choices can be made. In Dr Leaf’s mind, those kids with ADHD are just naughty children, with bad parents, who are using the label of ADHD to cover their poor parenting and their bad behaviour. Clearly all they need to do is to stop their toxic thinking and they wouldn’t need their medications, but they would be cured.

Dr Leaf is wrong … she can stand and scream blue murder about labels and ADHD all she wants.  But just like the crazy random person screaming about labels in front of the supermarket, it means very little. It’s not helping her cause, and if anything, it’s sewing distrust in an system that, despite it’s flaws, works very well, and has helped thousands of children and adults alike to achieve their potential.

That’s the power of labels, and Dr Leaf would do herself and all her followers a favour if she stopped mislabelling them.

The lost art of joy – Something to look forward to

Bacon.

With only about eight hours left in 2017, I should be contemplating bigger things … the lessons learnt from the year gone by, what did I achieve, where did I fall down, what can I learn from those experiences.

Instead, I feel like bacon, so I’m cooking bacon.

Bacon is delectable. It’s one of those foods that proves God’s love. On it’s own, it’s special, but you can also add bacon to almost any other food and it will add to the gustatory experience of pleasure. The auditory and olfactory stimulation of bacon frying is distinctly pavlovian – I’m drooling just thinking about the culinary delights that await me.

As I was standing over the frypan, listening to the crackling and popping, smelling the juicy aroma and mopping up my hypersalivation, it also stimulated the rusty gears of my cognition.

Why do I drool when bacon is cooking? For all I know, the bacon could be rancid, or I could have cooked it wrong, or it could be too salty, or it could be pigeon meat in disguise.

But I have hope.

I can’t say, rationally and with certainty, that “the bacon will be good” because there are lots of reasons why it might be bad, but I have hope that the bacon will be delicious.

Hope. It is “the quintessential human delusion, simultaneously the source of your greatest strength, and your greatest weakness.
Hope is “being able to see that there is light, despite all of the darkness”. (Desmond Tutu)
Hope “smiles from the threshold of the year to come, whispering, ‘It will be happier.’” (Alfred Lord Tennyson)

Like we discussed yesterday, happiness is someone to love and something to do. Happiness is also something to look forward to.

Hope is like joy’s air. In order for joy to breathe, it has to be surrounded by hope. Without hope, joy can not survive.

Research bears this out. Numerous studies over the years have shown that those with higher levels of hope had higher academic and sports achievements. Lower levels of hope correlate to general maladjustment and thoughts of suicide. Hope is a crucial factor in dealing with major life stressors and traumas, such as cancer and old age. The impact of hope on depression and adjustment was studied in people with traumatic spinal cord injuries, and it was found that those with higher levels of hope had less depression and greater overall mental and social adjustment irrespective of how long it had been after the injury. In another study, lower levels of hope was related to higher levels of depressive symptoms in general.

Hope is applied optimism. Optimism is the general expectancy that good rather than bad will happen. Hope is “the belief that the future will be better than the present, along with the belief that you have the power to make it so.”  Hope is the ultimate fusion of acceptance, values and committed action – knowing which direction you want to go in, having a path leading in that direction and then going, not knowing what will happen but accepting that not everything will be perfect but believing that it will be better.

So what about 2018? I can’t say, rationally and with certainty, that “2018 will be a great year” because there are lots of reasons why it might be bad.

Still, I have hope that 2018 will be a great year.

Do you have hope? Do you believe 2018 will be a better year? Do you believe that you have the power to make it so? Over the last month, we’ve explored the lost art of joy; the ingredients of joy and how these can shape our lives; the things that can suffocate joy and the things that can help joy flourish. Do you believe that you can apply these principles to experience a life of greater joy, a richer life of deeper meaning and fulfilment? In all sincerity, I hope you can.

Thank you for coming on my journey with me. On the 1st of December when I had the bright idea of writing a blog post a day for a whole month, I thought it would be easy. When I got to the 5th of December, I thought I was going to run out of ideas and I should have thought twice before committing to such a huge project. Now, on the 31st of December, I’m glad I made that ill-considered commitment. It has challenged me for sure. It’s helped me to clarify concepts, to grow in knowledge and make me that little bit more proficient as a writer.

My hope is that my 31-day challenge will not just help me, but help others who are struggling to see the light and to experience the warmth of joy in their souls. “These things have I spoken unto you, that my joy might remain in you, and that your joy might be full.

Happy New Year! May you all have a safe, prosperous, and joyous 2018.

Oh, and by the way, the bacon was delicious.

The lost art of joy – Something to do

“So, what do you do?”

I don’t like that question. We all ask it as a relatively benign conversation starter, but it still makes me cringe a little. It’s not that I’m not proud of what I do, but so often the moment I tell people that I’m a doctor, they assume that I’m rich or pretentious, or that they suddenly have a segue to some free medical advice.
“Oh, you’re a doctor hey? Pleased to meet you … so, uh, can you have a quick look at this mole on my neck?”

It’s interesting that we treat someone’s occupation as the second most important thing to know about them after their name, and it shows how subliminally important our occupations are to us.

And I think that’s largely to do with the personal and social value of purpose.

It’s starts from childhood doesn’t it? “When I grow up, I want to be …”

“I want to do nothing with my life” said no kindergarten child ever. Our subject choices in through high school, and out decisions after high school, to go to University or join the military, or taking a job in a trade, come down to what we want to do, to what we want to be. We all want to be someone, to do something. We all aspire to a life of meaning through purpose, because deep down, having a life which makes a difference is much more rewarding to us than having a life than means nothing.

Happiness is someone to love like we discussed yesterday, but happiness is also something to do.

It’s well known that long-term unemployment is associated with poorer physical and mental health outcomes including increased stress and isolation, depression and anxiety, heart disease and a myriad of other illnesses.

By contrast, according to research done at Deakin University, engaging in activities that provided a sense of purpose was strongly associated with wellbeing. It could be paid employment although in order to increase wellbeing, the employment had to provide more than just financial security. However, any activity that provided purpose tended to increase wellbeing, such as volunteering or being a part of a club like Rotary.

Knowing what we know about joy, it’s easy to see why engaging in activities which give purpose to life also increases our joy. Like having someone to love, having something to do that provides purpose usually involves committed action to our values, incorporating psychological flexibility, kindness, giving, moving, learning laughing … the list goes on.

There are several keys to ensuring that what we do is truly purposeful, and thus provides the greatest opportunity for joy to flourish

First, “It’s not about you.” This was the first sentence in Rick Warren’s phenomenally successful book, “Forty Days of Purpose”. True purpose in life goes beyond our needs and aims to fulfil the needs of others. This is a reflection of the true interdependency of the human race. We’re social creatures by design. We can survive independently, but we thrive collectively. We’re at our most successful when we’re dependent on each other and we work together. If we focus only on ourselves and our own needs, we fail to connect with others, and we miss out on the benefits of living in community.

Second, your purpose is inseparable from your values. As we’ve talked about several times in the last month, our values are integral to living a life rich in meaning and joy. Values reflect what is most important in the deepest part of ourselves that we can access. Our values provide us with direction. If our true purpose is going to enrich our lives and enhance our joy, then it will always be built on and synchronised with our deepest values. If your purpose and your values don’t align, then you need to reconsider either or both.

There are lots of other interesting and insightful explorations of purpose in the blogosphere but I don’t want to be over-prescriptive about it. Our own individual purpose in life is as unique to use as our fingerprints. So long as we commit the best of ourselves to being part of something bigger than ourselves.

Or as George Bernard Shaw wrote, “This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy.”

The lost art of joy – Someone to love

In 1939, a doctor at Harvard University initiated a research study into long term health and happiness. He recruited 268 physically and mentally healthy young men who were all in their second year of study at Harvard University, including one John F. Kennedy, who went on to become US President. As the story goes, as part of the recruitment process, “the men who were chosen for the study had what the team considered a ‘masculine body build’: significant muscle mass, narrow hips and broad shoulders. The study participants were asked about masturbation and their thoughts on premarital sex. They were also measured for brow ridge, moles, penis function and the hanging length of their scrotum.”

As it turns out, the hanging length of one’s scrotum isn’t a significant factor in one’s long term health and happiness.

What is important is love.

Over the last eight decades, the study has grown to include a number of control groups, wives and children. The longer the trial has gone on, the stronger the conclusions, that “Close relationships, more than money or fame, are what keep people happy throughout their lives, the study revealed. Those ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes.”

The short and intense forms of love are very strongly associated with happiness. Remember the study we discussed in earlier posts from George MacKerron, who mapped the correlation of happiness to activity and location of the users of his specifically designed mobile phone app? With hundreds of thousands of data points, he was able to show that people were happy when they were exercising, when they were at the theatre, ballet, or a concert; when they were at a museum or an art exhibit; and while doing an artistic activity (like painting etc.). Though at the top of his list, the greatest number of people were at their greatest level of happiness during “sexually intimate moments” (on a date, kissing, or having sex).

Of course, love is more than just a good snog, but it demonstrates that intimate connection with another person you love, and who loves you, is an intense and intoxicating source of joy.

Other research into the relationship between love and joy shows the same thing as the Harvard Study of Adult Development. The “Very Happy People” study showed that there was a 0.7 correlation between social support and happiness, which is higher than the connection between smoking and cancer. People with one or more close friendships are more likely to be happier, and those with few social connections are more likely to be depressed than those who have more social connections. People with strong and healthy relationships are less likely to feel stressed by challenging situations. Supportive marriage is a cause of happiness.

We always need to be careful in interpreting these sorts of conclusions, remembering that correlation does not equal causation – people don’t get depressed because they have no friends. Often times there are underlying factors contributing to both a persons depression and difficulty in forming solid friendships.

What we can safely say is that happiness and love are intimately connected. The deeper the social bond, the more likely there is to be happiness.

It’s also important to remember that it’s not quantity of the social connections that’s important, but the quality of the social connections. A hundred loose associates, or deep but unequal, unreciprocated relationships are not associated with happiness. Joy comes from sincere, committed love that gives as much as it receives.

Do those themes sound familiar? They are the same sort of themes that we have discussed on other blogs in this series, the same sort of things that are common to our personal search for joy – kindness, giving, honesty and acceptance, committed action to a deeper value. When you apply the same things that bring individual joy to a relationship, they also bring joy, but to more than just yourself.

And what else better sums up love, but sharing the best things in life with another person.

If you want to foster happiness, invest in quality connections with other people by sharing those same things that bring individual joy. Be thankful, be kind, be generous and be committed and there will be more than enough joy to go around.

The lost art of joy – Resolve

When it comes to New Year’s resolutions, we’re pretty abysmal.

Not that making New Year’s resolutions is abysmal, but our ability to actually keep them is particularly poxy. It’s said that about half of us make New Year’s resolutions, but only about eight percent of us actually keep them. Eight percent … that’s a solid F minus.

New Year’s Eve inevitably brings out the mantras, affirmations and aspirations, millions upon millions of people taking to social media to express how they’re making new goals or stepping into their destiny, moving to the next level or claiming their inheritance from the universe … something like that. It’s like someone coded a random phrase generator using the twitter feeds of Tony Robbins and Deepak Chopra and pumped out a random string of meaningless drivel.

Hey, we’ve all been there. This post certainly isn’t about judging the spirit of all these mantras, affirmations and aspirations. People genuinely want to change, to improve, to have a better life … to live a life of joy and meaning.

Wishing to have a life of joy and meaning isn’t enough though. We don’t get a life of joy by just wanting one. How do we go from etherial to tangible?

One day, I would like to visit England. I want to trace my family’s roots. I want to see the world famous landmarks like Buckingham Palace, Big Ben, St Paul’s Cathedral. I want to watch the first day of an Ashes test match at Lords. I would like to attend a lecture at Cambridge. I want to see sites of wonder like Stone Henge. I want to experience the local delicacies like black pudding. I would even love to go to Ireland and drink a pint of Guinness, or to the highlands of Scotland, put on a kilt, and have a haggis.

That’s all well and good, but I’m not going to get there unless I get a passport, buy plane tickets, book hotels, book transport, get some maps, and ensure that I’m in the right place at the right time to be at Lords for the opening session of the Ashes test.

Then I actually have to get on the plane and go, and do all those things I want to do.

We all want joy – no one ever seriously says that they want a life of misery. We all have values that we aspire to fulfil. We need those values. As I’ve written about before, they provide direction to our lives. Values reflect what is most important in the deepest part of ourselves that we can access.

In order to live by those values, and to experience the richness and meaning that our values add to our lives, we have to act on them.

We have to get on the plane. We have to take effective action.

In the framework of ACT, this sort of effective action is called “Committed Action”. Committed action means connecting with individual styles of effective action, driven and guided by core values. As we talked about yesterday, things in life inevitably change, so committed action also needs to be flexible – being able to adapt to the invariable changes of life but still being driven by your underlying values.

Committed action doesn’t mean perfect execution. We are human beings and we are bound to fail, to drift off course or to run into obstacles. No matter how many times we drift away from our values, when we are committed to our values, we can always reassess where we’re at and get back to them.

The word “resolution” comes from the word “resolve”. If we want a life of joy and meaning, we need to do more than make up some New Year’s aspirations. If we’re going to have New Year’s “resolutions”, we need “resolve”, “settle or find a solution to a problem or contentious matter, decide firmly on a course of action”.

Take the next step. What’s one specific, concrete thing you can do in the next day that’s in line with your values? It doesn’t have to be complex. It can be as simple as hugging your kids every day, or calling a friend to arrange a time to catch up over lunch, or getting up ten minutes earlier to go for a short walk in the morning sunlight. Whatever it is, take that step.

If we resolve ourselves to committed action in line with our values, we will be able to translate our desire for a life of joy and meaning into actually experiencing it.