Cornwall Counseling


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My Special Education


When my sister was born, she was clearly unusual.  Her appearance, her distinctive facial and physical features were a curious, unexplainable phenomenon.  I remember thinking, “Where did this baby come from?  Whose baby is this?”  

My sister, as an infant, had dark, almost black, upturned eyes, a flat nose, a small mouth and large tongue.  Her ears were curved inward.  She had a single crease across both palms of her tiny hands, short stubby fingers, tiny feet with a larger than normal space between the big toes and the rest of them.  

She was extraordinarily double-jointed – almost as if she had no bones at all.

I didn’t know that the features that gave my sister her unique appearance were the physical elements that made people with Down syndrome recognizable.

Lying in her crib, I often peered in at her; she, staring into space, her dark eyes, like the black buttons that closed my winter coat, fixed on the musical mobile dangling above her head.  I don’t remember her ever crying or laughing or making any sound, really.  She was always silent, lying on her back, occasionally moving her feet and hands. 

For the first three years of her life, my sister couldn’t roll over, sit-up or stand; and she couldn’t talk.  She shifted her position only minimally, often with help.  Around three years, she started to roll over, sit up, maneuver herself onto all fours and sit in a chair without slumping into a bunch.  She experienced some level of independence at around four years, scooting across the floor, propelling herself by thrusting her legs and feet forward and humping herself ever onward.  

She grew and developed in her own way, along her own timeline.

“I hate it,” she told me one day as we prepared to go to her job at McDonald’s. She cleared and wiped down tables at McDonald’s and was overjoyed to do that. She was around twenty-two. “I hate it.”   She looked down at her lap, seemingly talking to herself.

I reached to pull her seatbelt over her ever-expanding waistline. “Why?” I asked. “You like working there.”

“They make fron’ a me.”

“Who?”

“The kids; the kids; make fron’ a me.” Her eyes magnified behind her thick glasses, smudged and always in need of a good cleaning, searched for answers in my face that, even if I could explain, would never really ring true for her. 

Even now, my sister survives on the belief that people are essentially good; and each time she experiences the recklessness of others, her expression is consistently a mix of deep sadness, regret and the hope that she will be forgiven for being so unusual – so much unlike others that the most she could ever expect is to be forgiven.  

All people with Down syndrome have some degree of mental retardation or developmental delay.  They are, however, far from being incapable of learning, especially to the degree that emotional expression, social expectation and the way in which others treat them as normal.  They are very sensitive to being a part of the social group. I know I am well outside the boundaries of making a gross generalization, but it is my best judgment that people with Down syndrome are quite emotionally adept, genius at expressing affection toward others. Their intellectual capacity cannot be reliably predicted in infancy and early childhood, but their ability to express love and caring toward others is evident from a very early age.  (I am well within my comfort zone making this generalization, and I invite my reader to take exception with it.)

My sister entered school at around the same age as other children, only she spent her days in a room where the window in the door was covered with construction paper.   I never saw her at recess, and we never sat together at lunch.  Knowing her as I did, I could only imagine that she was content among her friends and teachers, never questioning the good intentions of those who were responsible for her care and education. 

My sister went from elementary, to junior and on to senior high school seated behind a window covered in construction paper.

When she was twenty, she graduated from high school; and for all her efforts, she was mailed a diploma and a copy of her yearbook.  Inside were an empty oval where her picture should have been and a barren, blank square where her biography might have been printed, if anyone had taken the time to gather the information from her.

Of course, when she got the book in the mail, she leafed through it.  She had no idea that her picture should be there, alongside the other members of her graduating class.  She couldn’t even have imagined such an honor. She was content to look over the familiar faces she remembered from school – the lunch lady, pictures of the abandoned hallways, the quad.

My mother, much less content, contacted the school and demanded that my sister’s picture be duplicated and sent by mail to everyone who had purchased a yearbook.  Not only should there be a picture, but my mother strongly suggested that my sister’s favorite color, her favorite song, her most commonly spoken phrase and her most cherished memory accompany the photo in exactly the same proportions as the oval and blank spaces that were provided to her on page 31 of her yearbook.

My sister was quite proud when she pointed out her own picture in the yearbook, after discovering it one day, glued perfectly within the spaces inside her yearbook – as if it had always been there, proof that she was like everyone else.  She looked up at me, through those damnable glasses, kissed her hand and brought it down on top of her own picture. “S’me,” she said, “S’me.” She laughed, extending her long tongue as she drew in more air to feed her belly laugh.

My sister has never been like anyone else, really. She is my cherished and pure spirit, someone who is never truly unhappy for long or without a friend.  Her life has been a hearty handshake, a warm and sincere hug and a promise for unconditional positive regard toward everyone she meets, no matter who they are or how they may have treated her in the past. I can never imagine comparing myself to my sister’s strength of character and her dedication to the idea that everyone possesses inherent goodness – if we just take the time to see it.

My sister’s medical and cognitive impairments have increased over the years; they unravel the mystery of her human condition more and more each day; but from the day she came home from the hospital, wrapped in a yellow, satin edged blanket, she was the most wonderful gift I could ever have imagined receiving. 

My sister provides me with special education.

From the day she was assimilated into our family and our neighborhood, complete with her own unique personality, her own strengths and her own weaknesses, she has taken every opportunity to become the strong-willed, sensitive and tremendously good-humored woman she is today.

Climbing the Ladder / A Therapist’s Dilemma


Just like anywhere else in business, the phenomenon of climbing the ladder exists in the mental health industry. Yes, even mental health therapists (and those who work alongside us) routinely choose this route to power. 

Climbers are often quite easy to spot; after all, climbing the ladder is a game and most people can spot the often unskillful moves of the players.  If you are going to play, you can never forget this one simple fact: Never throw in your ante unless you’re willing to lose.

Are you playing?

What is your wager?

1. Your wager will usually involve giving up some degree of integrity, replacing it with any number of less flattering traits – traits you would not normally want to model for your parents, your children or your clients; but you do and you are not fooling anyone.

2. The moment you start on your journey up the ladder, it is unlikely that you will ever be able to stop climbing. Neither will you ever truly rest. You will always be afraid of taking your eye off the ball. There is always someone coming up behind you – someone just starting to play. Keep alert!

3. The prize for climbing is never clear; it is unique to each player. To know what your prize is, ask yourself what would it mean if you got to the top? What would be there waiting for you? What are you after? Ultimately, over time, some players realize that the prize has always available to them. It may have been in how they viewed themselves to begin with – before setting their sights on climbing to the top.

If you’re not enough without something; you will never be enough if you get it.

4. The object of the game is to just keep going up. In order to maintain the momentum, you have to grip the rungs that are most likely to propel you forward, faster. That is not as easy as it sounds. Over time, you forget the risks ahead and you become more and more vulnerable to others with the same level of enthusiasm or more ambition than you have.

5. Some climbers believe that luck plays a part in winning the game. This idea might prove harmful, if and when your luck runs  out or someone else gets luckier. There are a lot more snakes nearer the top, as you climb – and a lot further to fall if you do.

6. If you’re playing the game, people can always identify you; and they will describe you in terms of your game: an opportunist, a user, fake, untrustworthy, back-stabber – duplicitous. The impression most people make of those who climb, play and promote their own interests are:

• They forget about everyone except themselves and the key people they believe can help them move up. People notice that.

• They develop a single-mindedness and a whatever-it-takes frame of mind. People notice that.

• They have no limit to their ruthlessness in pursuit of their goal. People notice that.

• They try to take less risk than those above them and those below, leaving everyone motionless and ineffective. People notice that.

• They become more focused on looking active and fast-moving than actually being active and fast-moving. People notice that.

• They start to believe and behave as if they are active and fast-moving. People notice that.

• Their management of others is just another way of pursing their own ambitions. They eventually lose support, because people notice that.

• They make sure all of the successes of their team are attached to them and the failures are attached to others. People notice that.

• The closer they get to the top, the more visible their game playing becomes; because the game gets more demanding as the field of players begins to narrow and people notice that.

•If they play long enough, they will eventually meet someone on the way they never expected to see; and they will recognize you.

7. Working hard, setting more reasonable goals and determining your own list of priorities for success in your life may well prove, over time, to be a more peaceful, self-enhancing ambition. I like to use this guide for my life:

• Take into account the ethical and moral dimension in all of your decisions;

• Take a minority position if you believe it the right thing to do;

• Take responsibility for the mistakes you make;

• Try to forgive – everyone; even if it’s the same person, every day;

• Do a good job without focusing too much on getting attention and praise. Focus more on your own achievement, your own commitment and your own appraisal of your own work;

Try to be happy with what you are asked to do – or have determined to do;

Live a balanced life. Fill your life to the brim with work, fun, friends, hobbies and your private passions.  Top it all off with a never-ending quest for knowledge, empathy and understanding;

• Say ‘no’ when you have different priorities, a different position, a confident opinion – even when everyone else is saying yes; and,

• Commit to your family, your friends, your profession, your community and your colleagues. If you don’t, who will commit to you?

Whether you begin your climb or not is really is up to you. Before you start, however, ask yourself, What am I wagering? What prize am I pursuing? Is it worth dedicating my whole life to achieving it? When I get to the top (wherever that might be), will that be enough for me? When will I know I’ve gotten there? If I get what I want using trickery and self-promotion, will I ever feel secure in my achievements, no matter what I achieve?

Life with equal parts of fun and responsibility, for me, is far more rewarding than a life of climbing the ladder.

If your mind is set on climbing the ladder, ante up! You might, however, want to live your life, instead, by your own standards, reaching your own goals, using established ethics and more person-focused and less self-focused principles. Never allow pretense or appearance to replace true achievement. You will never know when you have achieved your goals if you do.

Integrity and honest should never be what you sacrifice to reach any goal.

To truly succeed in your life, to get to where you want to go, you might stop feeding your demons and drink in inner peace, insight and honesty, instead. After all, you will ultimately leave this world resting in your own skin.

A Boy From Honduras


Several years ago I worked with a seven-year-old boy who didn’t speak English.  He was from Honduras and he spoke about fifty or sixty words familiar to me – mostly nouns and verbs.

The rest of the time, he spoke fluent Spanish.

The boy from Honduras was quite timid, his dark, black bangs covered his eyebrows and flicked whenever he blinked. He rested his chin on his chest, the neck of his striped t-shirt pulled up over his mouth, muffling the English he could speak, making it even harder to understand.

At the time I met the boy from Honduras, I spoke English – and a good amount of French; I didn’t speak any other languages.

The boy had been adopted by an American, English-speaking couple who lived on Cape Cod.  Not long after moving to his new home, the boy’s new parents identified something unusual in their new son’s behavior.  The boy wouldn’t come out of his room.  He sat on the floor beside his bed all day.  The concerned parents sought help for what appeared to them to be depression.  “We thought it would be easier for him to adjust,” they said, almost in unison.  “He has his own room, a new bike, his own TV.  We just thought he would be happy and that we would all just eventually learn to communicate.”

“Does he speak English?”

“Not a lot,” the adoptive mother said.  “He can understand a lot, though.”

Upon our first visit, I found we were having trouble understanding one another, me and this boy from Honduras. I relied on my hands, facial contortions and the tone of my voice to make up for what I couldn’t communicate in words.  “Are you sad today,” I would say, lowering the vocal range of my voice to its lowest low, “Saaaaaaad?” I contorted my mouth into an exaggerated frown with the help of my fingers on either side of my mouth. He nodded in agreement that he understood and, realizing that even though he was sad, there was very little he could do to explain why; he looked at his shoes, swinging them back and forth under the little chair he was sitting in.

The following week, I found that I was quite adept at identifying the obvious.  Are you sad?  Are you happy?  Are you thirsty?  Are you cold? I couldn’t, however, ask him, When you think of leaving Honduras and coming to this strange place, what do you tell yourself?  This little brown boy from Tegus, sitting in an office in Boston, wearing a Red Sox baseball cap, was isolated by language.

The boy’s parents and I discussed the use of a Spanish-speaking therapist or an interpreter.  They said they had tried to find a Spanish-speaking therapist, but one was not available who accepted their insurance or at the price they could afford. The boy’s parents agreed that he may benefit from having an interpreter.

Over the course of the first two weeks of our twice-weekly meetings, while we waited for the interpreter to make room on her schedule for the boy from Honduras, his English vocabulary increased by a few words.  We were both thankful for that; but, alas, my Spanish vocabulary didn’t increase at all and we were soon stuck, again.

“Can you tell me about your trip to Boston?” I asked, “Do you remember that?”

“Trip?” he asked.

“When you came to live here?”

“Cametoleaveear?”

“Airplane,” I said, making wings with my arms and the sound of an airplane with my teeth and lips.

In our third week, I greeted the boy in much the same way I had when we met a few weeks prior, “How are you?”

“I-ng fy-ng.”

“How’s it going?”

“Fy-ng.”

You talk today?” I said, pointing my finger at his chest and then at my own mouth.

The boy sat looking around the room and then down at his shoes.

I waited.

Each time, just before speaking, the boy looked up, expressed some excitement, started to speak but gradually returned to thinking.  In fact, he tried several times to say something, but returned to thinking, his eyes roaming from left to right, as if trying to transform his Spanish thoughts in the right side of his brain into the English words on the left.  He did this several times until finally he said, “I not give good English.”

“I know,” I said, slumping my shoulders and frowning. “Just tell best you can.”  I emphasized the words, as if I were chatting with someone who was hard of hearing.  “I-try-good-understand.”

“O.K.,” he said, “I-yam . . . estoy nostálgico,” and gripped his fists together, “Nostálgico?”

“No,” I said, sadly, “again . . . try again.”

The boy looked at me, transforming the space between us into a brick wall with his expression.  He returned his chin to his chest.

“I have an idea! Tell me in Spanish,” I heard myself suddenly say.  “Just talk to me in Spanish.  Use your own language to explain to me. You understand?”

“Non,” he said, but obviously interested, energized by my facial expression. He leaned forward.

“You-talk-Spanish,” I said.  “You-say-Spanish.”

He appeared uncomfortable, embarrassed by the idea of speaking Spanish to me, knowing full well I wouldn’t understand a word of it.  “Non,” he said, covering his mouth, smiling broadly.

“You try!” I said.  “We try! You, me.”

He waited. Cautious not to speak outside the conventions of discourse he had learned over the course of his lifetime.  He appeared outwardly self-conscious of the sound of his own voice; as if talking to himself was wrong – outside the boundaries we allow ourselves to express our thoughts. He leaned forward and began whispering in a somewhat animated, articulated fashion.  He said something that only he and other Spanish-speaking people could understand.  He waited for my response.  Was he testing me?  He smiled broadly, giggled and said the same thing again. I raised my shoulders and put my hands in the air, expressing my inability to understand.

He laughed and seemed content.

“How you to-day?” I asked. “Talk Español.” I moved my hands, expressing some universally understood sign language I imagined would help translate each word.   “How (raise and lower shoulders and show palm of hands) you (point finger at his chest) today (move hands in a circular motion; finish by showing the palms of my hands)?” “Talk (point at mouth with finger and point at his mouth) Español (put finger in front of my own mouth and turn it in circles).

The boy sat back in his chair, placed his hands between his thighs and looked down at his chest.  He spoke softly at first, but then gradually, as he grew accustomed to the sound of his own voice, raised his eyes and spoke with more volume, determination and intention.

The boy from Honduras spent the next thirty minutes telling me a story that occasionally brought a smile to his face but, just as quickly, filled his eyes with tears.  He wiped his eyes with his t-shirt.

Of course I couldn’t understand his words, but his eyes, his face, the color of his ears, the way he moved told me something about his story that could be clearly understand – something not really available to language.  After a few minutes, however, I was in pace with him. I allowed my own face to mirror his face, and, checking for understanding now and then, he clearly recognized something in the way I was responding, something deeper than words; something that fueled his story by promoting a sense that I was truly hearing him.

Mental health experts believe that facial expressions are primarily communicative in nature.  They can serve as a prelude to our intentions, an indication of our internal state. In fact, facial expressions are often recognizable across cultures.  Facial expressions, even among some animals, could possibly be a primitive way of expressing thought – thought that this is not readily available in spoken language.  (Even those who share a common language have been known to use facial expressions to communicate an internal state, quite accurately.) Facial expressions may even predate spoken language and may have been, at one time, long ago, our primary source for communicating with others. Anger, suspicion, happiness, sadness, disgust and surprise are regularly expressed using universally accepted facial expressions. Now, in instances where language is a barrier between people, facial expressions seem to be Nature’s enduring gift, bridging the median that often exists between understanding and indifference.

A great deal of emphasis is often placed on the use of spoken language in the provision of mental health services.

What do I say to my client?

What if my patient says this?

What do I say then?

Even therapist who have been in practice for many, many years sometimes focus their encounters with others on language, banter, crafty psychological philosophy and theory, magical talking cures that, when practiced just right will result in a miraculous cure for their patient.

It is our responsibility as therapists to help each of the people we encounter to be what s/he can be.  This goal is better achieved by ensuring that our talking cures are focused not on our own language but on the language our clients use to articulate their ideas, interests, hopes and dreams.  We cannot limit understanding to the words and meanings we understand. We must also strive to truly see and hear the people with whom we come in contact.

Nothing could have trained me better to appreciate any eventuality in language, every nuance of sound and movement, than the boy from Honduras.  I never did learn what he said to me that day.  His parents took him by the hand and they went home.  The interpreter never called back, and everyone blended back into the world.

The boy from Honduras, however, is ever-present in how I have encountered everyone – everyone I have ever met since hearing him.

Children with Character


When I was a child, in the early days of the growing phenomenon that eventually became known as attention deficit hyperactivity disorder (ADHD) – before the harsh, punitive medications we now use to control children with character, my caregivers accommodated, as best they could, my curious nature.  In response to what I believe to be the disastrous burden placed on unsuspecting children by their misinformed caregivers, and drawing from my own experiences as an energetic, intelligent and misunderstood child, I will offer an intervention strategy for helping to improve the futures of children who, instead of having a disease called ADHD, have, instead, a misread and underappreciated gift.

For eating chalk, I sat behind the piano.  For pulling a worm from my nose, I sat in a chair outside the classroom; For general misbehavior, I was sentenced to sit in Murderers’ Row – a special line of seats and desks set aside especially for inquisitive, energetic and distractible children like me – mostly boys.  I was often the sole inhabitant of Murderers’ Row, so, sitting at the first desk in the row, I imagined I was at the head of a series of empty rail cars, chugging across the Pacific Northwest, The Little Engine That Could.

Learning to read, identify colors and do simple mathematics was often achieved from hearing, alone.  I traced my finger on the shiny, painted cinder block wall, making letters, numbers and symbols that I imagined accompanied the lessons that were being taught. A leaf was green.  A fire truck was red.  The sky was . . . blue – and so was the wall in front of me.

I didn’t need to actually see to learn.

I was Helen Keller! Only I could hear.

I adapted.

As punishment for living in my imaginary world, where so much more was possible than in the world in which my classroom merely existed, I would have to write lines –

I will not yell out. 

I will raise my hand and give others a chance to answer. 

I will not aim for the face when playing dodge ball. 

I will take my own bus. 

I will eat my own lunch.

After a while, I simply expected to break the rules and, as a condition of parole, write lines.  I was so confident that I would be found deficient in nearly anything I tried each day in school, I wrote out part of the sentence in advance – the part of the sentence I knew would be there no matter what I had to write – I will not.

I filled my desk to the bursting point with reams of paper; hundreds, thousands, millions, trillions of partial sentences that would only take a few more words to complete – freeing me to do as I pleased.

I will not – turn my eyelids inside out.

I will not – cut in line.

I will not – take powdered soap from the boys’ room.

The crinkled paper with the partially completed sentences written hurriedly across each page spilled out on the floor beside my desk and was the first thing to greet me every morning when I came back to school.

The number of school-age children (ages 3-17 years) who have been diagnosed and treated for ADHD is estimated at 5.2 million.  Following diagnosis, and when placed under psychiatric management, the treatment of ADHD is expected to involve some combination of medications, behavior modifications, lifestyle changes and counseling.  Often, however, the treatment of ADHD is limited to psychotropic medications, alone; leaving children drugged and with less potential than they had previous to the diagnosis.

The symptoms of ADHD can be difficult to differentiate from normal childhood development, increasing the likelihood that the ADHD label will be misapplied.  Impulsivity, emotional fluidity, lack of concentration and variability in mood and behavior are all observations suggestive of ADHD.  In addition, due to the constraints of time and opportunity, the diagnostician will often rely on caregivers, teachers and other adult historians for the longitudinal (biased) data necessary to formulate the diagnosis.  Rather than estimating the potential contribution to the child’s conduct made by the caregiver’s own level frustration tolerance, environmental conditions or early and current parenting style, the child’s behavior becomes, instead, a treatable disease, cured, ostensibly, with drugs.  A kind of no-fault provision in the implied contract between caregiver and child – a provision where the caregivers is absolved of responsibility for the child’s behavior and the child is found blameless for h/er poor choices.

After all, it’s a disease.

As early as the 1970s, when the ADHD diagnosis was first starting to gain momentum, it was, even then, considered a controversial, exploited and mismanaged psychiatric disease of childhood.  (Only recently has the disease become diagnosable in adulthood.)

At a time when the developing brain is highly susceptible to damage by intruding chemicals and other caustic substances, the use of stimulant medications for management and treatment of ADHD in children has become standard, rudimentary practice among healthcare providers.

I find the whole process repugnant.

IMPROVED WILLPOWER AND FRUSTRATION TOLERANCE

As a boy with more energy than I had support for my ambitions, I spent a great deal of time, instead, trying to be like other children.  I remember watching the best-behaved students in my class – mimicking their movements, believing that if I shadowed them, talked like they did, I would be good too.  If one student moved her hand a certain way, I would move my hand just like she did.  If another student sat quietly, his hands folded on his desktop, so did I.  But my plan didn’t work. Nothing could save me from my teachers’ suspicious gazes. They simply didn’t trust me.  They were skeptical of me, even when I was behaving like one of the good kids.

One day, toward the beginning of summer and the opening of spring – a miserable time for a child with character who is stuck inside all day, separated from frogs and swamps and tree limbs, my teacher, the originator of Murderers’ Row, said, “Michael, let’s try something NEW!”

“Sure!” I said, taking my shoes out of my desk and slipping them on.

While the rest of the class was reading silently, my teacher took me to a small foyer in the back of the classroom.  He carried a chair in one hand and a TV tray in the other.  He clung to a bag of marshmallows under his left elbow.  He set the chair down, “Sit,” he said, pointing his chubby finger at the wooden seat, and unfolded the TV tray, clipping the legs into the plastic slots.  He broke open the bag of marshmallows and placed one on the table in front of me.  “I want you to sit there for twenty minutes and, if you can control yourself and not eat the marshmallow, I will give you two.  You can eat it any time you want; but if you can control yourself for twenty minutes and not eat it, I will give you two.”

“Really?”

“Really.”

I remember sitting in the chair for what seemed like hours, waiting for twenty minutes to elapse and I could eat the marshmallow in one bite AND have another one to boot.  Every now and then a student would turn around and give me a knowing glance – to which I stuck out my tongue and returned my gaze to the lone marshmallow sitting on the tray in front of me.

I ate it.

Nineteen minutes later, my teacher returned.  “Hmmmmm,” he said, hands on his hips.  “You couldn’t resist?”

I smiled, looking up at him, my red hair hanging just above my eyebrows.  “Nope,” I said.  “I almost did, though.”

“We can try it again tomorrow.”

Over the course of that spring, my teacher did the same experiment with me every day (sometimes two or three – maybe four times), until I was capable of not only making it through twenty minutes to achieve my second marshmallow, but I had strengthened my resolve and built my frustration tolerance to a point where I could sit for over an hour with little or no reward at all.

My willpower, my self-discipline, had increased dramatically. I had trained myself and built the neurological connections necessary to not only improve my frustration tolerance, but to make it a habit!

I still recall this memory of my teacher’s systematic instruction – his dedicated effort to teach me to focus my attention on a goal – to commit the proper amount of devotion to the task ahead of me.  Toward the summer, when school was letting out and I was free to roam the woods, quarries and sand pits in my neighborhood, that lesson helped strengthen me by creating an atmosphere of achievement and success that I could use to grow and improve.  Over time, my willpower, self-discipline and loyalty to my goals improved – leaving that place in my brain, the one that defined who I was as an individual, intact – where I could be myself and something more.

I am still the child I have always been, unimpeded, spontaneous and impulsive – instinctive and unrehearsed.  I am myself, unadulterated and un-medicated.  I enjoy myself and my unique perspective, and I have learned to live with all of my strengths and weaknesses, even when these traits are not as well received as I would like them to be by others.

Instead of thinking we will all be better off after taking pills, conceding to others and how they think we should be, deadening our intuitive nature to explore and challenge our understanding of the world, we may remember that our brains have immense possibilities that pills will never improve, but only creativity, inventiveness and ingenuity can achieve.