Getting work done is not enough.

You will not get gold stars for neat handwriting,
complete paperwork, or Playing Well With Others.

Teamwork means removing yourself from the equation,
not splitting the credit.

You are not here to find yourself,
your soulmate, or for the Master to Appear.

Your job is to own the problem,
solve it better than it's been solved before,
and make sure it stays solved.

If you do a good job,
you'll get harder problems to solve.

Success, recognition, and mastery come from results and luck,
not effort. And from results only sometimes.

You fail only when you give up, and sometimes giving up is necessary.

Rinse & repeat.

I run the risk of offending a number of people that I am close to with the material that I present here - both because of my assessment and opinions of the LGAT organization "Impact Training", and because I may also cite religious materials in the process. Normally I leave personal relationships out of my posts, as well as religion - this is a public forum after all, and the materials I'm likely to discuss here have nothing to do with either (it's a personal geek blog, after all). I am willing to take this risk because the alternative is to say nothing, and I find this far less palatable than being despised for standing by my scruples. I'm saying it in public in the interest of helping and inspiring others.

First up, what is this all about?

LGAT stands for "Large Group Awareness Training." It is a model of presentation whereby groups (usually large ones, hence the name) are exposed to selected materials under circumstances designed to elicit compliance and predictable responses. That "designed to elicit" part is my take on them - most of the definitions of the format include language such as "teaching simple but often overlooked wisdom" etc., which has more to do with content (and their opinion of it) than the delivery mechanism itself. More on this in a moment.

"Impact Training" is an organization operating locally in Utah as a purveyor of content using this format, which has gone on to combine its own origins with pop psych, a warped version of LDS theology, hard sales, and MLM practices in order to operate a for-profit organization for its own enjoyment and aggrandizement. It leverages several key principles of psychological manipulation to deliver its content under the guise of improving confidence, self esteem, relationships, and material success. The remainder of this article will be broken into two sections, "Method" which describes the tools of LGAT, and "Madness" covering the specific philosophies and principles of Impact Training.

Method

To best describe LGAT methods it's appropriate to pull in some primers on its history and evolution, and some principles of modern psychology and their background.

Impact Training specifically comes from an individual by the name of Hans Berger, who has been involved as a founder and controller of both Impact Training and the "Harmony Institute" here in Utah. Hans got his start with "Lifespring", which itself is an offshoot from the "Landmark Forum", which came from "est" (erhard seminars training [capitalized as branded]), which came from "Mind Dynamics", a component of "Scientology" (done with the "quotes" for now). The basic premise remains essentially unchanged from the abreactive therapies on which it was founded and are visible even now in the Dianetics that Scientology still deals in. Abreaction itself is simply a form of catharsis - the release of previously repressed emotion. This release typically takes the form of reliving events, but can be disembodied (which is to say, not linked to a specific trauma or episode) as well. The military looked at a formalized proposal for Abreactive Therapy following WWII, and concluded that though potentially effective it took too long and the results were not on par with other therapeutic techniques available at the time¹.

In more modern psychology, catharsis and abreaction are occasional tools but are some distance from main line practice because of some significant drawbacks. The emotional release, while temporarily pleasing, does not absolve the original sensitizing events or traumas of their sting (repeated desensitization can be used to help, though that has more to do with controlled exposure to traumatic memory in a safe and productive environment than simple expulsion of pent-up emotion), and suffers from re-interpretation (experiencing memory in the light of the present state of mind) and false memory mechanisms (fantasy and invention, even unintentionally). Which is to say that, based on the presentation of the technique it's possible to elicit an abreactive response from an individual solely in response to the environment, without basis in any specific or even real emotional injury.

The Impact Training LGAT utilizes several techniques to produce abreactive responses to its own ends. I'll go into both the techniques in play and the intent with which it does so (which both still fall under the "Method" part of this discussion). First, the techniques.

Visualization, Guided Imagery, and Hypnosis: I myself am a practitioner of hypnosis; it's an excellent working toolset for the application of behavioral psychology at the subconscious level, and if used properly can help to re-wire aberrant or undesired manifestations of motivation (e.g., behaviors) in non-conflicting and gestalt ways very quickly (specifically through the use of the hypnoanalytic techniques developed by Milton Erickson, rather than the more commonly portrayed authoritarian or sensationalized stage versions of hypnosis). I enrolled in certification as a hypnotherapist in 2002 in light of the bad tech economy as a fallback career which was never required (I landed with Overstock and things picked up from there). To date I've only ever used its therapeutical practices on myself, to reasonable effect. In the case of Impact Training, however, the analytical approach is avoided: the specific accounts of the imagery used there indicate standard induction practices (descending darkened staircases, presentation of doors, contextualized environments, etc.) and are then followed by very selective exercises. What and who the subject encounters and the means of their interaction with the same are dictated, and while the content of that interaction is up to the subject it's predictable given the setup. It is meant to be confrontational, potentially provide some resolution, but mostly be empowering to the subject based on the transference of emotional responsibility that is the essence of the Impact Training philosophy.

The results of the repeated visualizations are reframed by the "Trainer" (I say "Trainer" in quotes as a branded(tm) title rather than an earned honorific, as the Impact Training staff are not licensed or certified by any governing body and are in fact students of the program themselves working off the volunteerism required to advance rather than credentialed therapists). Reframing is the practice of interpreting content (usually carefully selected content) according to preferred ideologies, prescribing "this is because of that" and "x is due to y" correlation to imply causation and inculcate those ideologies in the subject or other observers.

This same reframing is applied to lots of emotional responses, produced not only via the guided imagery but a host of other exercises and activities. One of the most distressing for me to learn about was the experiential reframing: an exercise where one participant discloses to another an event wherein they felt victimized, specifically a personal and meaningful such episode. After mutual disclosure from the other participant both are instructed to repeat their original story but from the vantage as though they were somehow responsible for the event themselves (this touches somewhat on the "Madness" content that will be explored in greater depth later). Having a person make such an assertion about their own experience, even if they are predisposed to discount such an assertion (and the preparatory exercises to that point do their best to reduce or eliminate such a predisposition), is tragically manipulative.

Why would a person go along with such an exercise? The key psychological tendencies which make LGAT sessions successful are that:

1. People are wired to trust one another. If you are given a written statement, and told in advance that any portion of that statement written in red ink is false, you will still be influenced by it to a degree as though it were true.
2. People are wired to listen to authority figures. As illustrated in the Milgram Experiment, and relied on especially heavily in LGATs via the establishment of the Absolute Authority of the Trainer (usually through overt authoritarianism and over-the-top bullying of non-compliant participants: anyone arriving late or otherwise not adhering to the strict and stressful schedule, for example, is deeply berated as a public example in front of others).
3. We are influenced by the behavior of those around us. Through the use of mirror neurons which inspire observed behaviors and reactions within the observer, and the natural tendency toward conformity, it's possible to expand the effect of an exercise and its reframed response from one to many, and to use the many to reinforce and enhance the intensity of the same so it really sticks. LGAT sessions frequently have plants as well - prior participants and other accomplices placed throughout the audience who already know the anticipated response and play along (either to earn the favor of the Trainer and advance, or in order to help things progress in a controlled fashion).
4. Emotions produce endorphins. Eliciting extremes of emotion causes a cocktail of endorphins to be secreted throughout the brain, as effective as if administering mind or consciousness altering drugs via syringe. The "Love Bombing" stages of LGAT depend on this, specifically the production of endogenous opiates that both block pain and create a social-bonding specific high that reinforces desired attitudes and responses and inspires a need to return to the same (behavioral/chemical addiction).
5. Emotions trump rationale. There are 2 paths of analysis in the human psyche: emotional and rational. The rational is the one that says "it's unlikely that person approaching from the other direction means me harm" and it's the emotional that says, "yeah, but if they do I'm in for a world of hurt" and makes us cross the street anyway. Statistics, oddly enough, seem to act as the antidote for this by grounding the rationale in something concrete.
6. Distraction induces suggestibility. The schedule of the LGAT is structured to be demanding, high-paced, and run extremely late into the night/early morning in order to keep the energy ramped up and reduce the amount of time for digestion, critical analysis, or rejection.

As to the intent of these methods then, and to finish up the line of discourse regarding abreaction, the authority figure produces dramatic and intense (intentionally dramatized and intensified) responses from participants, frames them according the the preferred ideologies, and uses the group setting to amplify the emotional response in an environment designed to make people susceptible to suggestions regarding the same. This falls under the "predictable response" and "compliance" parts of my initial description of LGATs.

Other tools in use are standard propagandist indoctrination (refer to the Institute for Propaganda Analysis, 1938), and some cultic persuasion practices: secrecy, isolation, and specialized dialog.

On the point of secrecy, attendees are counseled that they are not to reveal anything of the proceedings to those who are not also themselves participants in the program, and even then only up to the level of that participant. They are requested to sign "non-disclosure" agreements at the beginning of the sessions to reinforce this fact and provide an authoritative standard on which they can rely, and this point is hammered home with remarkable force.

This secrecy lends itself to a form of isolation - unable to discuss the nature of the experience (which, from the perspective of the participant so affected can be a subjectively remarkable experience they are eager to discuss, or an unsettling one for which they require consolation), with any other than the group or prior attendees associated with their program, sets them apart from the world (and frequently from family and friends). They must rely on the new special-status group of co-participants or the Trainers who are in a position of authority over the same.

New terminology or new definitions for existing concepts are regularly introduced and strongly reinforced, creating a specialized dialog for discussing the experiences that makes little sense to those unfamiliar with the glossary. The loaded words and phrases create an extra layer of distance between participants and the uninitiated, and are used to prop up the philosophies of the training: much the same way that experiential reframing is used to instill a particular perspective in the subject, altered dialog is used as a means of manipulating thought through manipulating language. One of the remarkable attributes of the psyche is its ability to create contiguous reality out of disparate sensation - in many ways the condition in which one finds oneself is based on an almost external level of observation: "Am I smiling? I must be happy then." Language is a part of this - the words we speak reflect attitude and belief, and if the words are altered it changes the regions of the brain in play (exciting some, suppressing others) and by association the expressed attitudes. In Impact Training, for example, "need" becomes "deserve", and all such "needs" are discussed as the things a person "deserves."

The final steps of isolation come from Love Bombing: the literal bombardment of affirmations of acceptance and even physical affection that overload the limbic system (responsible for secreting those endogenous opiates in response to positive social contact) and overwhelm rational barriers and any negative self-assessments. This exaggerated display of endearment creates a sense of belonging within the group that draws a very distinct line with what is now the "outside world" that fails to understand the participant and their budding transformation. It creates a very real chemical high and associates it with that social environment - the same one wherein any misstep concerning the schedule or authority of the Trainer results in massive public beratement. The combination of control and reward have a deep and profound effect, lasting a few weeks to a few years, though other times waning without refreshers (which is where the sales tactics come in to solicit further participation).

Though minor by comparison, there's also the very human tendency to throw good money after bad - these "courses" cost several hundred to a few thousand dollars, and people are likely to see them through in the interest that their money not be wasted, rather than cut their losses early (or ask for a refund, which results in more hard-sales tactics and stiff opposition).

These components follow the basis for all "coercive persuasion" that is the foundation of cultic indoctrination: breaking down resistance and existing psychological structures, introducing new "preferred" ideologies and doctrines, and reinforcing those into the new structures on which the subject is meant to rely (as well as working to limit threats to the same so they remain in effect). These methods produce predictable psychological and emotional responses in the vast majority of the populace - not any specific sub-group of gullible nitwits looking to sign over their concept of reality to the first authority to offer them one, but in fact just about anyone subjected to the battery. They (the methods) are specifically geared to overcome barriers and alter one's general conceptual orientation of the world, and in that goal they tend to be distressingly effective.

Madness

The specific philosophies (especially at the introductory levels of the program) of Impact Training follow the standard Mind Dynamics and other new-age empowerment paradigms. They assert not only that the unclouded mind has immeasurable potential to affect the reality around it (the literal world, not just conceptualized experience of the same), but that ultimate responsibility for the condition of one's existence is entirely up to the participant, and in fact always has been.

This assertion is both positive and negative: one can purportedly "manifest" the reality they "deserve" with the right kind of "spiritual action" (yes, the "quotes" are back), and there are special tools and abilities open only to the initiated to assist them in so doing. It also means that everything that has ever happened to an individual has somehow, consciously or otherwise, been a similar controlled "manifestation" of their own intent, even those involving external entities. All the way up to the weather they've experienced or the drunk driver who killed their family, whatever you've got: the more personal and dramatic the better. Through the indoctrination received, one supposedly inherits the ability to "choose" or "choose out" of first the influence of these events upon them, and then the events themselves as a component of the physical universe.

Beyond the simple laws of physics and conservation of energy revealing such a thing to be impossible (or so comically improbable as to not be worthy of consideration), this philosophy taken to its final conclusion would pit every individual in the world against every other individual, as well as all forces of nature both terrestrial and cosmic. Were this philosophy and its influences to be real, what would be the final arbiter of conflicting manifestations, and how could suffering exist in any form but to be the responsibility of the sufferer? It belies the compassionate humanitarianism (which is nothing at all like the humanized version of vegetarianism) that I believe is the responsibility of every member of organized society and encourages a self-centered orientation of the universe.

Impact Training, as is the standard for LGAT, uses hard sales tactics to persuade, beg, and bully participants into enrollment for successive and increasingly expensive courses. No excuse is accepted, as the tools already imparted to them will supposedly enable them to overcome any obstacles to procuring necessary funds. Any questionable fiscal wisdom or responsibility of the participant to continue is irrelevant - if they have truly accepted the doctrines as presented and are capable of genuinely committing themselves they "deserve" the continuation and can't afford to not continue. Shared pressures from the rest of the group are asserted, and those opting not to continue are either praised for their pledge to continue as resources and timing coalesce to their favor or belittled for not choosing to adhere to the path of enlightenment (though in their defense I've heard that recently the personal attacks for non-continuation have been toned down somewhat).

The Trainer at this point is usually a volunteer of the program, someone demonstrating their dedication to its efficacy by the number of recruits and continuing participants they can manifest. Any inability to effectively do so means the Trainer is simply failing in the execution of the reality-altering concepts, and needs additional training and reinforcement themselves, and any success belongs to the methods and system. This kind of self-fulfilling assertion begins in early levels of the program as participants are strongly urged to recruit family or friends to first attend closing ceremonies and then go on to enroll, with credit and advancement awarded to those successful recruiters (and in some cases "advancement" being conditional on exactly those circumstances).

The hard sales and Multi-Level Marketing style of recruitment as requirements for continuation in the pseudo-cultic program are in my opinion a horribly destructive combination: either one manages a continual stream of inductees and is heralded as a success to the program, or failures become their personal responsibility and grounds for mental and verbal abuse. Accounts of burned-out Trainers putting on the best face for the crowd as their lives fall apart (both within and without the organization) are repeatedly available online, and the responses and rebuttals from Impact Training adherents frequently resonate with double-speak and "blame the victim" tactics that quite honestly creep me out.

At advancing levels of training the overt LGAT tools are no longer necessary due to the depth of the indoctrination and reliance on the group it has created. It is here that the warped LDS theologies are introduced and used to play on LDS members' (of which there are of course a great many in Utah) beliefs as a means of turning spiritual and religious devotion into yet another mechanism of attachment to the organization. I will not repeat any of those specific assertions in public, because I do not feel they warrant repetition of any kind - I'm willing to discuss it privately with anyone (no secrecy here), I just don't ever want to be associated with the words in a public and searchable place. It is also in these levels that the highest amount of volunteer commitment to enrolling others in the program is required until one breaks into the inner circle or burns out and departs.

I have seen a few people go through the program, and I've been genuinely scared by the amount of unrighteous influence I saw exerted upon them and to which they seemingly wholeheartedly subscribed. On the LDS side of things this very much smacks of priestcraft (doctrine for sale), the "philosophies of men, mingled with scripture," and the flattery and telling of pleasing things in order to lure people away from the truth (or their beliefs, such as the case may be). Abandonment of principles and morals associated with those beliefs followed, including a complete falling away from the organization of the Church itself (which has also issued an open letter to its membership specifically targeting these kinds of organizations, but does so in the light of day).

I count myself among the rational participants of the world, and have specifically chosen my religious affiliations (and am willing to discuss this with others, including how I can use the word "rational" and "religious affiliations" in the same sentence). I claim the privilege of worshiping according to the dictates of my own conscience, and afford others the same freedom. What saddens me here is not so much that others do not share my own beliefs as it is to see a core cultural and personal/spiritual conviction undermined by con artists and hucksters for the purpose of turning a buck without regard to the potentially destructive consequences. If they believe their own schtick, I pity them. On the other hand, if they perpetrate these acts knowingly, then Gentlemen: I drop my left glove at your feet and await your response to the challenge.

Any of those of you affected by the teachings of this or other such organizations, I continue to regard you as I always have - I may be saddened by the current state of affairs and the distance it has created between us, but only because I continue to love and cherish you. Loving from across a chasm I cannot bridge yields sadness is all.

For more information I highly recommend searching around for "Impact Trainings" and "LGAT". Take the materials on both sides with a grain (or fistful) of salt and draw your own conclusions. For those open to considering direct challenges to LGAT practitioners (as opposed to those who would rather hear no such thing) I have a thoroughly bookmarked and dog-eared copy of Cults In Our Midst by Dr. Margaret Thaler Singer I'm willing to loan out (though I would like it back after it makes the rounds).

1. Abreaction in the Military Setting: Harold Rosen and Henry J. Mayers. Arch. of Neurology and Psychiatry, LVII, 1947, pp. 161–172.

The biggest gains came from discovering sleep apnea, candidiasis, and suspicions of mitochondrial myopathy. None of these are naturally indicative of McArdle's Disease (the eventual diagnosis) though, nor are they typically concomitant. They didn't fall into their place in the puzzle until the picture was already becoming clear, when it all suddenly came together.

I should start by explaining a little about the condition. Glucose is the primary source of energy for nearly everything in the human body, the whole process referred to as "glycolysis." Most cells, especially muscle cells, have an internal reserve of it in a compact polymer-like form called glycogen. When demand for energy increases, molecules are trimmed off the end of the chain and made available to the mitochondria to do their business of converting it into active energy (adenosine triphosphate, for those taking notes).

This store of energy is pretty high - enough for 12-20 hours worth of activity before needing to be replenished. That replenishment happens on a regular, ongoing basis, to keep stores topped off whenever spare glucose is available, and any surplus is either excreted or converted into starches and stashed elsewhere. Normally this is enough to keep the body readily burning glucose between meals without running low - an exception would be fasting (more than a day), starvation, or extremely high demand: marathon runners, for example, can completely deplete glycogen stores after about 20 miles of continuous running, a phenomenon they refer to as "hitting the wall." At that point continued activity requires use of the stored fats as an alternative fuel, and risks damage to those tissues unable to do so.

McArdle's refers to a defect in or absence of myophosphorylase, which is a fancy name for "the enzyme that breaks glucose off the glycogen chain." This deficiency means that the primary source of stored energy is either completely off limits or so impaired as to be unable to meet the body's demand. This results in dramatic exercise intolerance, and in some cases cramping or seizing of muscle fibers (which require energy both to contract and relax) in a disparate and uncoordinated state so severe that they can actually rupture (rhabdomyolysis - this will be on the test), spilling their proteins into the blood and straining renal functions. Alternatively, the secondary fuel source based on fatty acids can be engaged (lipolysis).

An interesting side note here is that this is the primary intent of low-carb diets: by lowering the intake of glucose (and things easily synthesized into it by the metabolism), glycogen stores are exhausted and the body has no choice but to turn to lipids in order to remain functional. It's a hack, but a potentially effective one - your mileage may vary though, and not every system can handle the kind of stress this creates.

To point, too heavy a reliance on lipolysis floods the body with its waste products and increases the acidity of the blood (ketoacidosis). Healthy folks don't normally get to this point - diabetics can be affected in pretty nasty ways though. Those with McArdle's suffer a similar fate since the reliance on it is more absolute, and constant: this happens on regular diets without regard for carbohydrate intake. I had hit on a form of metabolic acidosis in my investigation earlier but had come to it from the wrong side, thinking that it was an inhibition of the mitochondria in making use of available oxygen, when in fact the mitochondria work wonderfully and are simply making-do with limited materials on hand. The effect is the same though: fatigue, memory disruption, stupor, and eventual unconsciousness.

I hit on McArdle's as a possibility in my own studies just before I was recruited by Amazon, though there were a couple of things that didn't quite add up for me. The subjective descriptions of other sufferers sounded really really close, a better overlap for my experiences than anything else I'd encountered to that point. However, I didn't have the severe cramping, nor the myoglobinuria - the voiding of protein from the damaged muscle in such a way as to turn urine red or "rust colored." I grew up in the Pacific Northwest: rust, in that high-humidity environment, is a bright orange or red. I'd experienced darkened urine before (sorry to get visceral here), but it was more brown than anything else, was very infrequent, and not repeatable under controlled conditions. During a physical before relocating to Seattle I asked them to run a CPK, which looks for serum creatine kinase (the chemical marker of that damaged muscle) which is elevated in 90% of McArdle's sufferers: results came back normal and I scratched this one off the list.

Once in Seattle, apart from the family, I decided to give myself a break in some respects. Since I didn't have anything better to do (no family, trying to save money since I was living separately, and not particularly interesting) all I really did was work and sleep. I allowed myself to sleep whenever I wanted to, extended naps after work, sleeping-in on the weekends with a nap or two on Saturday and Sunday (each!), until eventually waking up from a nap didn't hurt - I didn't shudder or feel sick within a few seconds after starting to move, and then something even more surprising happened: I stopped needing the CPAP at night. The sleep apnea completely vanished for a time, as long as I was napping with such high frequency.

The results were amazing. I slept better, dreamt more frequently, and was even able to take longer walks. I lost about 10 pounds in a couple of months without changing my diet (I mean come on, I was eating like a bachelor - a bachelor who can cook, granted, but not especially health conscious and with a penchant toward mint ice cream in the evenings). After those couple of months the work schedule started to pick up and my resting decreased, the CPAP came back on, and exercise tolerance reined back in to the "inhibited" range. The stress was a lot higher too - being apart from my family for several months had sucked all the fun out of exploring a novel place. I felt a need to demonstrate to the powers that be that I was not taking any of it for granted, and dove into the work with all the vigor I possessed to make the most of the fortune bestowed upon me: man, did I ever work hard, even during the once-monthly weekend visit back to see my wife and daughters. We did everything we could to help sell the house make judicious use of our resources.

After three months my corporate housing benefit expired and I was forced to find a new apartment on my own dime. I narrowed it to a pair of places relatively close to work and made the move. Interestingly enough, one of the two could never correctly coordinate a showing: three different attempts always saw the super pulled away on some other issue or ill, and I was forced to take the other without ever earnestly evaluating the competition. The reason this is an interesting fact is because the one I got was up the steeper hill, a crucial contribution to the eventual diagnosis.

I ramped up my work even more. During the holidays things are busy in the retail world, and Amazon doubly so (on account of being good at what they do). My areas of responsibility overlapped with physical operations, so everything was closely monitored and actively engaged. I would work 9-10 hours at the office, walk the 1.1 miles back up the hill to the apartment (or in a real pinch take a shuttle bus - I was living across the street from one of Amazon's facilities, just not the one I was supposed to work at, and they have shuttle service between them), have my video chat with the family before the girls went to bed, and work another 6-8 hours on average. Saturdays I would put in only 4-5 hours, and try to rest on Sunday (except for the emergency processing which had to be attended to at 10 pm daily, no exceptions, and any pages I received). It shut me down: I suffered through it because I had to, but the limited treatment I had for the sleep apnea became ineffective and the afternoon meeting narcolepsy started creeping back up on me.

Clearly, this was unacceptable. I was trying to completely own the job and attendant performance expectations out of a desperate display of over-compensation for any perception of my own failings, and still demonstrate to the cosmos that the blessing of opportunity had not been misplaced. I would magnify what I'd been given, and failure was not an option: I re-opened an investigation into my health, starting over with new physicians and determination to finally see it through and regain some dignity. I was also armed with the recommendation from my last consultation in Utah that I follow-up with a neuromuscular specialist to see if they could find anything.

I got myself a referral and an appointment a month in the future. Tired of repeating myself and feeling like I was leaving out anything of relevance, I typed up my medical history and current state of symptoms and controlled conditions under which they were manifest and went into the consult armed with a fairly exhaustive twelve page document. Having previously personally ruled out McArdle's, I essentially wrote around it: made no mention of mitochondrial disorders, glycogen storage issues, anything of the like. I actually gave it a bent slightly toward some kind of transient ischemic event: the intense walk back to the apartment after a series of grueling days eventually resulted in some pretty nasty aches, but not until I took a break and rested. It was only well after the exertion that muscles seized up, and then after a power nap turned into a deep and exhausting pain that easily brought me to tears. On a scale of 1-10, with 1 being pain free and 10 being unconscious, this rates a 7; for comparison, a root canal tops out at 4 and deep lacerations a 6 at most (it'll send me in to shock, but tears are a distant thought). I took this to be a potential sign of ischemia (inhibition of blood flow, usually localized) due to the fact that deep tissue damage from suppressed blood supply doesn't happen in full force until that flow is restored (re-perfusion injury and apoptosis). The resulting darkened excretion following 12-24 hours later confirmed some kind of muscle wasting, but again given its brown color I associated it more with necrotic tissue than a possibility of the more traditionally red myoglobin.

At the appointment, after a very brief evaluation to make sure there was nothing glaringly pathological, the specialist looked over the history and immediately recommended McArdle's as though it was already on the tip of his tongue. I told him why I'd ruled it out, specifically noting the negative CPK test, but by then he'd closed the folder and was wearing that medical professional look of, "I'll listen to you, but I'm pretty sure I already know what's up and am not likely to take it under real consideration." He made no additional notes, and simply stated that he'd like to see me again after my consult with the neurologist (to see if it really all was in my head - though legitimately based on neurological function, rather than psychosis per se).

The neuropsychiatric evaluation was set for the middle of May. Only, I could swear the receptionist told me a corresponding date in March. I showed up on that date with all my paperwork filled out, ready to go, and was a little chagrined to learn I'd rearranged my schedule for something not due to happen for another four weeks. They offered to add me to the waiting list in case something earlier came up, which I accepted, and went back to work dejected.

Prompted by the prior meeting and hint toward McArdle's from the neuromuscular specialist I did some more research, and found the available materials evolved somewhat since my prior glance in this direction. Someone equated "rust" with "brown," a real forehead slapping moment of course - not only was the event predictable enough that I should have seen it and been able to disregard the minor deviation, but I've seen brown rust long enough I should have adapted to a broader definition anyway. Secondly, an explanation that the cramping was not necessarily present in all conditions, and frequently occurs after the exertion or even during rest. Following as many threads as I could I tied the alternate lipolysis metabolism to non-diabetic ketoacidosis, which rounded out the remainder of my symptoms. I had a fit for everything, there was no part of my condition not explained by the disorder, and nothing in the disorder at odds with my presentation. I didn't know what to do about it yet, but after 15 years of intensely searching I received a concrete corroboration and vindication: life really was hard, and I wasn't simply incapable of handling otherwise normal levels of stress.

One week after that appointment, as I was preparing for my monthly trip down to see the family, I had my regular meeting with the boss to sync up. This time, however, rather than the one-on-one format, our friendly neighborhood HR representative was there. As nice as they usually are there are times you don't want to see them; this was, in fact, one of those times. Business concluded, boxes were packed, and with an hour to go before I was already scheduled to head out to the airport I found myself an unemployed victim of a tightening financial reality. The timing could have been better, certainly - relaying the news to my family under those circumstances was bittersweet. I was due to see them, and to return to be with them more permanently, but with an uncertain future. Not only that, but the steps I was taking toward possible management and resolution of my health were going to have to be put on hold once again: even with a continuation of health coverage through the next month and opportunity for COBRA it would simply cost too much, and without new work lined up I couldn't risk the family finances.

While I was down visiting the family and celebrating my daughter's birthday, I received a phone call: it was the neuromuscular department letting me know they'd had a cancellation and would I be interested in moving my appointment up from May 12th to the coming Monday? Talk about providence! My return flight was on Sunday night, and I was planning on immediately breaking down the apartment and closing off accounts so I could have my belongings packed up and be back on my way to Utah as an officially binding move (cats and all) by Thursday. If I were to be able to get this evaluation at all, that would be the only way and the only day to do it - I very gratefully accepted the rescheduling and continued to enjoy my time at home.

I returned to Washington and went in for the six hour battery of tests designed to exercise and measure the functional capacity of the brain. During a break in the tests I had the opportunity to speak with the prior specialist, from the earlier consult - I let him know my findings, and we chatted at some length about possible avenues for management (and how to begin exercising in a legitimately beneficial way despite the condition, rather than as a grueling ordeal of determination). The tests concluded with favorable results, I finished packing the apartment, and made the long haul drive (14 hours straight) to be home genuinely and officially: for the first time in seven months I didn't have a looming clock ticking away until my next departure.

Further study and experimentation has led me to the following series of conclusions and strategies:

1. Most of the really nasty bits of McArdle's (the rhabdomyolysis, resulting myoglobinuria and possible renal failure) are only distantly present in my condition, which is certainly in my favor and gives me hope for decades to come.
2. The majority of my symptoms are the result of persistent lipolysis and metabolic ketoacidosis, so things are working pretty well and happen to have unpleasant side effects.
3. Minor snacking under ketoacidosis can in fact lead to a "sucrose induced second wind," but the body's already primed to store the excess since it's reacting as though starving (or otherwise resource impaired) and has slowly but constantly contributed to my weight gain over the years.
4. A carbohydrate (especially sucrose) rich environment contributed to the candida albicans overgrowth of yore, long since controlled.
5. Metabolic acidosis has a disproportionate effect on the diaphragm, even capable of inducing sleep apnea due to paralytic hypopnea (found some nice research papers on this).
6. Acidic (low pH) blood is filtered by the kidneys, which neutralize it using bicarbonate.
7. Most of the bicarbonate in the body is secreted by the acid pumps in the stomach, and an extra need for it does increase total pump output (acid reflux anyone?).
8. THEREFORE: adequate rest, which prevents the accumulation of metabolic toxins and/or provides opportunities for their filtration, OR a heightened filtration schedule, should be able to restore a more normal functional baseline. In practice, this means I either have to take it really easy (intense aerobic activities of my youth are all off the radar) or find some way of flushing out the kidneys, which I can do by massively upping my intake of water.

The recommended daily hydration regimen is 8 cups (1/2 gallon, or 64 ounces). Most people don't quite get this (and to be fair, it is a pretty arbitrary standard), and feel a little water-logged if they go for it. I've found experimentally that my ideal water throughput for symptomatic management ranges from 1.2 to 2 gallons per day, or two to four times the standard recommendation. Putting upwards of ten pounds of water through my body a day is not without its inconveniences, but the results are astounding: I have been able to consistently function, retain focus throughout the day, and consistently move without a broad distribution of muscles slowly constricting and seizing (I ignored a lot of this before, it had settled in so gradually). In those cases where the toxicity increases beyond my ability to handle it with water I can supplement with bicarbonate (sodium-bicarbonate in this case, or common baking soda - unfortunately you can't get bicarb without it being bound to another agent, and sodium in the related concentrations is the least threatening) to give my kidneys a boost. If that's still not enough it's time to take it easy and sleep it off.

And that's it - I can do 2 miles on the treadmill in the morning and become warm and flush in the face, with a good steady and heavy sweat instead of my previous experience of becoming pale, pupils dilating, and pulse threatening to become erratic as I felt increasingly weak and physically disconnected. I'm invigorated and capable, and with any luck will be able to set a good precedent for weight management. I've been doing this for a month now and am still amazed at the clarity of thought, presence of mind, and restored function of an engaged subconscious (especially for automatic mental reminders and short-term background processing). There are things I'll clearly never be able to do again, but I'm more OK with that now than ever before - the burden is easier to carry, and I'm relieved of the expectation of rising to a super-human standard.

None of this would have been possible except for:

1. Mental faculties adequate enough to both use as a means of trade in providing for self and family (and thus avoiding reliance on otherwise impossible physical performance), and sufficient to withstand the stupefying effects long enough to be effective in that employ.
2. An opportunity to both rest and subsequently push myself in opposite extremes: without the intensity of work and schedule I never would have been able to consistently reproduce the final few symptoms of the puzzle. The new job, attempted relocation, and first and second apartments created the perfect environments.
3. The urgency of investigation based on family need: I owed it to them not to screw things up, admitted I had a problem I couldn't solve on my own, and persisted in seeking out the care and advice I needed.
4. The inability of our beautiful home to sell despite our efforts to undercut the market.
5. That final appointment perfectly rescheduled (and only because I made a mistake that landed me on a waiting list) to coincide with my dramatically foreshortened stay in Washington. In fact, the foreshortening came on the heels of our most recent and drastic attempt to sell the house - almost as though we forced the hand of the cosmos, since we weren't really supposed to move but the evaluations still needed to happen.
6. All the little steps over the years that gave me hope.

In the end it seems as though the whole experience with Amazon was perfectly designed for the investigation into and subsequent resolution of health that was continuing its frustrating decline (every minor gain was eventually curtailed). It was very costly: the time apart from family is not something I would otherwise have chosen. That's being quickly made up for though - before the severance ran out I managed to land a good gig locally, with a favorable commute, frequent opportunities to work remotely (time with the family and care for my health), a nice level of influence and corresponding title, and chances for some stability. Certainly more humble in many ways than the work at Amazon, but arguably far better suited for both me and the family.

I'm being taken care of; it feels like stepping from shadow into warm sunshine. Health is finitely understood and controlled for the first time in my life. I have a much better idea of relative costs now and know what I will and will not do at the expense of closeness to my family, and most of it falls into the "will not" category. I learned a tremendous amount (the kind of education you really can't pay for) and am better prepared for the advancement of my career than ever before; and I can start living again.

Thank you.

Fear and trauma are a prime combination, snapping the mind into ultra-constricted awareness and attention to specific aspects of the given situation. Personal testimony provided by survivors of terrible events often include comments about how some small feature, perhaps even counter-intuitively and difficult to consciously reconcile after-the-fact, takes on increased significance disproportionate to other factors (try searching the web for "I just remember," quotes included). Beneath this conscious awareness, the sub-conscious performs similar singular attachment. The results of this extreme focus creates new triggers for the remembered trauma, and seemingly ordinary settings or items can reproduce the original emotional state and responses (one of the most disruptive conditions of flashbacks and Post-Traumatic Stress Disorder). The victim/subject of this experience will be unable to "let go" or become selectively unaware of the triggers, and the gut-wrenching realism of the recall causes enough distress as to interfere with daily living, as well as essentially reinforcing the response to the original stimuli in a self-perpetuating pattern.

Interestingly enough, the sub-conscious mind thinks it's doing a favor by initiating and exercising these connections.

One of the primary duties of the sub-conscious is protection of mental, physical, and emotional wellbeing. Its perceptions of what constitutes a threat do not necessarily agree with conscious opinion of the same, hence the seeming irrationality of many phobias and some behavioral disorders. Methods used for protection from the evaluated threat can similarly be at odds, capable of producing responses which one would not otherwise agree with. My old hypnotherapy mentor's materials included a case study of a woman in broadcasting who found herself suddenly unable to control her weight as she became more successful. All reasonable attempts at healthy diet and activity failed repeatedly, and the decline in her appearance began to interfere with that success (such is the business). Through therapy it came to light that years prior, during her communications schooling, she was informed by someone that she would "never get anywhere [in broadcasting] without sleeping with the right people." It was meant as a word of caution based on genuine concern and poor information, but stuck in her mind all the same. As she garnered attention for her efforts years later, her sub-conscious equated the impending success with the potential exploitation of her closely-guarded sexuality and formed a barrier to that negative expectation by lowering her appeal; all without conscious involvement or awareness.

Traumatic conditioning is much the same: a minor queue such as smell, the time of day or impressions of light and shadow, certain sounds, in addition to any overt similarities, can queue the sub-conscious to begin a protective response. Focus becomes selective once again and emotions and hormones run high, informing the conscious mind and primal instinct that fight or flight may be immediately necessary for self preservation. The similarity in physical and emotional reaction is so dramatically familiar as to force the recall of the original sensitizing event, bringing on the rehearsal of a deeply ingrained episode literally programmed into the mind.

Case in point, I recently had a minor weather-related accident in my car. The path of least destruction to others and property led me to a trajectory which damaged my driver's side C.V. axle and control arm, rendering the car undrivable and requiring extensive repair. I was not frightened or upset by the incident, though I did feel a little embarrassed for not judging the changing road conditions well enough and for the resulting financial setback. Once back behind the wheel, I found myself having moments of impending fear when decelerating for residential right turns: a startling, unbidden reflex out of sync with my (admittedly more cautious) thorough evaluation of the circumstances. It's taken me the better part of two months to unwire that reflex, and if not paying close enough attention or relaxing my efforts can still feel the sub-conscious intent.

No wonder then that severe, genuine trauma is capable of providing such long-lasting ill effects on the life and mental health of the sufferer. In an attempt to shelter a person from an anticipated real or imagined horror, it is possible for them to be adversely subjected to the same ill-affects they're trying to avoid. Due to the unintentional receptivity of the mind during the formation of the reflex, it's able to take root at surprising depth: easily enacted, difficult to remove. Common therapies attempting to soften the reaction through dissociative objective analysis (re-experiencing some elements in a safer environment, removing the reality of danger whilst maintaining triggers) can help, but may not ever be able to truly eradicate it. Could therapeutic hypnoanalytical techniques provide a better solution by addressing the triggers themselves?

I have not used hypnosis to remove my slight aversion to right turns, yet - I didn't think it disruptive enough to require such direct management. I also have not had opportunity to apply this to those suffering from any form of PTSD, though I'm intrigued by the potential. I'll have to give it a try on myself and report back.

I'd say up until about age 14 or 15, the average American youth doesn't have any secrets worth keeping. The whole point of the magical "dear diary" is to pour out the superficial embarrassments and heartaches of adolescence, oblivious to the utterly transcendental nature of the competing pressures and fear of failure, and the difficulty of attempting to reconcile the need to affirm an identity distinct from others yet compatible with the limited society of one's exposure. The incompatible drives summed up well as "You can't understand how I feel!" and "Isn't there anyone who understands me?" Hormones don't help a whole lot.

Before tipping over into the juvenile portion of adolescence, however, the "tweens" and younger, life is a much simpler power struggle within the sibling pecking order. I can easily recall the formidable vehemence with which secrets were guarded, and the deviousness with which they were created solely for that purpose. I cannot bring to mind, however, the contents of those secrets. I'm sure they were naively inflammatory, along the lines of "so-and-so is mean" or "smells", or otherwise possesses objectionable qualities or exhibits diminutive aptitudes. These pithy epithets would then be lovingly translated into an immature cypher and safeguarded after some grand parade or announcement of their existence was put on.

The only reason the pseudo-clandestine article held any draw for the target subjects is well illustrated by a quote from The Simpson's:

Lisa: Dad, this isn't about glue.  It's about territoriality.    He only wants the glue because I'm using it.Bart: Oh yeah?  Prove it.Lisa: [hands him the glue]  Here.Bart: Hey man, I don't want your stupid glue.Bart tosses the glue away-- Bart vs. Thanksgiving (7F07)

Assertion of control over the artificial restriction reaffirms one's importance and viability in the competition for... whatever it is we were competing for.

The method of obscuring the text was invariably a form of substitution of letters for other letters, numbers, or symbols in a one-to-one relationship. Elaborate maps of the enigmatic keys would be refined and hidden, and the correspondingly enciphered material could then be allowed to fall into enemy hands in the knowledge that the sibling(s) would encounter prolonged frustration in attempting to comprehend the contents, and if eventually successfully would only be annoyed at the revelation.

The most amusing one I ever encountered was concocted by my sisters: the holy grail, the impenetrable Double Cypher. This involved substituting the letter for a number - and then that number for another number. The mathematical relationship of A = B = C being identical to A = C not only escaped attention, it resisted enlightenment when confronted.

With enough practice at the game and adequate source material, any simple substitution puzzle can be solved (forming the basis for the Sherlock Holmes' novella The Adventure of the Dancing Men) on its own. Once my brother and I entered determinedly into this altitude of the arms race it was time to move on to new forms of subterfuge.

Later, my older sister sought to confound the process further by introducing phonetic constructs. But by then it was outside of this petty rivalry and instead used to foster the darker side of Borderline Personality Disorder, allowing a descent into paranoid dysphoria in the loudest silent way possible - writing on walls of her room and all over notebooks in an intentional display of manipulative privacy: you weren't supposed to know what she was thinking, but you were supposed to know that she was thinking and it was bothering her (thus allowing for a projection of her emotional caretaking needs onto others without their explicit consent or even involvement, and without the insight required to fulfill the heinous responsibility). Heaven help he who dared trod on the meanings of said script, too.

I eventually inherited the room for an office (having moved into my Father's house by then) after she moved out and on with her life, and I took the time to decipher the scrawl before returning the walls to neutral colors. The thoughts were angry and hurtful, frequently dictating the dire consequences to issues outside of her control were they to resolve in a light unfavorable to herself (things that would "happen" or that she would do if she were not allowed to X, for example). Things that no one should have to suffer alone, real or imagined.

Not that there's much point to my anecdotal ramblings - childhood was carefree even in most of its assaults, people should care about and help one another, and it's pretty pointless to hide those things which give us cause and identity (as by doing so the possibility of caring connection is mitigated).

Today I suppose I've carried that into a general philosophy: aside from necessarily hiding the financially sensitive and authoritatively identifying bits and numbers assigned to me as a modern citizen, there's nothing in my life I choose to hide away from the world. Though some of this is probably the cynicism that the world wouldn't care to do anything about those things I so freely share anyway, being unimportant and uninteresting on any grand scale. Randomly useful perhaps, but not actually interesting.