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General : WEEKLY CASE STUDY BEGINS AGAIN: CAST STUDY: KAREN
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 Message 1 of 13 in Discussion 
From: XtraMSN Nickname·TammyJo·  (Original Message)Sent: 5/01/2004 11:34 p.m.
Hi Everyone,
 
I will be making the posts for "Karen" this week. This is where her correspondance with Dr. Vaknin will take place. We got off to a little bit of a late start, but we are looking forward to getting the ball rolling right away!
 
This is Karen's first post to Dr. Vaknin:
Dr. V.

Thank you for including me in this project.  Background: Currently separated from N/P husband with whom I have a 5 yr old daughter.  N husband meets 100% of the criteria for N; 90% for P and about 90% for BPD.  He has been in and out of therapy/meds etc. for about 7 years.  He is such the liar, I have to check the clock if he tells me the time, cause there's only a small chance its the truth!  He has been violent (only toward me and our pets so far) many times and can rage at and cruely torment me for any perceived slight on my part.  These "slights" can simply be him "thinking" I am "thinking somthing he doesn't like". Bizzzzzarrre!

Toward my question...  None of his docs ever brought up personality disorders in their diagnosis, but instead lead with Bi-polar disorder w/ schizo, Borderline or anti-soc tendancies.  From everything I have read here and elsewhere, it is because they can't use axis II disorders in insurance reimbursements and perhaps they would have to admit there is NO CURE for the same.  They have in fact medicated him with Zyprexa and Depakote for the "Bi-polar" at various times, but he always takes himself off the meds.  Of course he's only in therapy when compelled in some way to benefit him; he insists he has no mental illness. 

My question(s) is why do these meds seem to mitigate some of the personality disorder behaviors?  Is Bi-polar the doorway to the N/P disorder?  And, why when he is medicated (and reacting/behaving somewhat normally) does he feel: "its like being dead, no zest for life, no creativity, life isn't worth living"?  He's barely human without the meds... I don't get it ...


Karen


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Reply
 Message 2 of 13 in Discussion 
From: XtraMSN NicknamesamvakSent: 6/01/2004 6:37 p.m.
Hi, Karen, Happy New Year!
 
In future, let us concentratec on one question per day, rather than three. It will allow me to serve you better within my time constraints.
 
Karen:
 
My question(s) is why do these meds seem to mitigate some of the personality disorder behaviors? 
 
Sam:
 
Well put. Medications can mitigate some behaviors - but not the underlying cause (the personality disorder).
 
Why? That's what medications do. They alter behavior.
 
More here:
 
 
 
Karen:
 
Is Bi-polar the doorway to the N/P disorder? 
 
Sam:

The manic phase of Bipolar I Disorder is often misdiagnosed as Narcissistic Personality Disorder (NPD)

Bipolar patients in the manic phase exhibit many of the signs and symptoms of pathological narcissism - hyperactivity, self-centeredness, lack of empathy, and control freakery. During this recurring chapter of the disease, the patient is euphoric, has grandiose fantasies, spins unrealistic schemes, and has frequent rage attacks (is irritable) if her or his wishes and plans are (inevitably) frustrated.

The manic phases of the Bipolar Disorder, however, are limited in time - NPD is not. Furthermore, the mania is followed by - usually protracted - depressive episodes. The narcissist is also frequently dysphoric. But whereas the Bipolar sinks into deep self-deprecation, self-devaluation, unbounded pessimism, all-pervasive guilt and anhedonia - the narcissist, even when depressed, never forgoes his narcissism: his grandiosity, sense of entitlement, haughtiness, and lack of empathy.

Narcissistic dysphorias are much shorter and reactive - they constitute a response to the grandiosity gap. In plain words, the narcissist is dejected when confronted with the abyss between his inflated self-image and grandiose fantasies - and the drab reality of his life: his failures, lack of accomplishments, disintegrating interpersonal relationships, and low status. Yet, one dose of narcissistic supply is enough to elevate the narcissists from the depth of misery to the heights of manic euphoria.

Not so with the Bipolar. The source of her or his mood swings is assumed to be brain biochemistry - not the availability of narcissistic supply. Whereas the narcissist is in full control of his faculties, even when maximally agitated, the Bipolar often feels that s/he has lost control of his/her brain ("flight of ideas"), his/her speech, his/her attention span (distractibility), and his/her motor functions.

The Bipolar is prone to reckless behaviors and substance abuse only during the manic phase. The narcissist does drugs, drinks, gambles, shops on credit, indulges in unsafe sex or in other compulsive behaviors both when elated and when deflated. 

As a rule, the Bipolar's manic phase interferes with his/her social and occupational functioning. Many narcissists, in contrast, reach the highest rungs of their community, church, firm, or voluntary organization. Most of the time, they function flawlessly - though the inevitable blowups and the grating extortion of narcissistic supply usually put an end to the narcissist's career and social liaisons.

The manic phase of Bipolar sometimes requires hospitalization and - more frequently than admitted - involves psychotic features. Narcissists are never hospitalized as the risk for self-harm is minute. Moreover, psychotic microepisodes in narcissism are decompensatory in nature and appear only under unendurable stress (e.g., in intensive therapy).

The Bipolar's mania provokes discomfort in both strangers and in the patient's nearest and dearest. His/her constant cheer and compulsive insistence on interpersonal, sexual, and occupational, or professional interactions engenders unease and repulsion. Her/his lability of mood - rapid shifts between uncontrollable rage and unnatural good spirits - is downright intimidating. The narcissist's gregariousness, by comparison, is calculated, "cold", controlled, and goal-orientated (the extraction of narcissistic supply). His cycles of mood and affect are far less pronounced and less rapid.

The Bipolar's swollen self-esteem, overstated self-confidence, obvious grandiosity, and delusional fantasies are akin to the narcissist's and are the source of the diagnostic confusion. Both types of patients purport to give advice, carry out an assignment, accomplish a mission, or embark on an enterprise for which they are uniquely unqualified and lack the talents, skills, knowledge, or experience required.

But the Bipolar's bombast is far more delusional than the narcissist's. Ideas of reference and magical thinking are common and, in this sense, the Bipolar is closer to the Schizotypal than to the Narcissistic.

There are other differentiating symptoms:

Sleep disorders - notably acute insomnia - are common in the manic phase of Bipolar and uncommon in narcissism. So is "Manic speech" - pressured, uninterruptible, loud, rapid, dramatic (includes singing and humorous asides), sometimes incomprehensible, incoherent, chaotic, and lasts for hours. It reflects the Bipolar's inner turmoil and his/her inability to control his/her racing and kaleidoscopic thoughts.

As opposed to narcissists, Bipolar in the manic phase are often distracted by the slightest stimuli, are unable to focus on relevant data, or to maintain the thread of conversation. They are "all over the place" - simultaneously initiating numerous business ventures, joining a myriad organization, writing umpteen letters, contacting hundreds of friends and perfect strangers, acting in a domineering, demanding, and intrusive manner, totally disregarding the needs and emotions of the unfortunate recipients of their unwanted attentions. They rarely follow up on their projects.

The transformation is so marked that the Bipolar is often described by his/her closest as "not himself/herself". Indeed, some Bipolars relocate, change name and appearance, and lose contact with their "former life". Antisocial or even criminal behavior is not uncommon and aggression is marked, directed at both others (assault) and oneself (suicide). Some Biploars describe an acuteness of the senses, akin to experiences recounted by drug users: smells, sounds, and sights are accentuated and attain an unearthly quality.

As opposed to narcissists, Bipolars regret their misdeeds following the manic phase and try to atone for their actions. They realize and accept that "something is wrong with them" and seek help. During the depressive phase they are ego-dystonic and their defenses are autoplastic (they blame themselves for their defeats, failures, and mishaps).

Finally, pathological narcissism is already discernible in early adolescence. The full-fledged Bipolar Disorder - including a manic phase - rarely occurs before the age of 20. The narcissist is consistent in his pathology - not so the Bipolar. The onset of the manic episode is fast and furious and results in a conspicuous metamorphosis of the patient.

More about this topic here:

Stormberg, D., Roningstam, E., Gunderson, J., & Tohen, M. (1998) Pathological Narcissism in Bipolar Disorder Patients. Journal of Personality Disorders, 12, 179-185

Roningstam, E. (1996), Pathological Narcissism and Narcissistic Personality Disorder in Axis I Disorders. Harvard Review of Psychiatry, 3, 326-340

See also - Narcissism and Asperger's Disorder

Karen:
 
And, why when he is medicated (and reacting/behaving somewhat normally) does he feel: "its like being dead, no zest for life, no creativity, life isn't worth living"?  He's barely human without the meds... I don't get it ...
 
Sam:
 
Partly because he hates to "lose control" and to admit his "inferiority", imperfections, and needs as a patient.
 
Partly because psychoactive medication does have very serious side effects. It really does "kill" certain traits and behavior patterns and reduces vitality.
 
See this:
 
 
Talk to you tomorrow.
 
Sam

Reply
 Message 3 of 13 in Discussion 
From: XtraMSN Nickname·TammyJo·Sent: 6/01/2004 10:08 p.m.
Hey Dr. V! Here is the next response and question from Karen:
 
Here's the next question:


Dr. V.

Thanks for your detailed insight yesterday, very helpful!

My husband id the only NPD'd person I've ever encountered in a close, personal relationship.  Many nights I lay awake wondering "how did I ever get in this mess with such a sick person"...  Through much introspection and some therapy, I am quite convinced I didn't seek out him or the dynamics of this very unhealthy relationship.  Rather, I am totally convinced he targeted me, even abandoned his last wife for "me" (no, I didn't know he was still married when I met him... he was the consumate liar and con artist).  And now, years later I see a pattern to his aquirement of female partners.  He has been engaged 4 or 5 times and married twice.  All of us were well educated, successful careers and would probably be described as kind, nuturing and loyal.  Most startling to me was to realize we were ALL  9-10 years older than him.  He's a fairly attractive, body builder type and could certainly target women his own age or younger.  And no, he didn't pick particularly wealthy women, so no real "profit motive" there.  Even when he has cheated, it has been with increasingly older women.

Though he always has a superior, macho-mysogonist attitude, when he is in conflict, I feel like he emotionally puts me in the position of the evil and controlling mother.  In fact, I have heard myself say "hey, I'm not your Mother, work out your demons with her" more times than I can count.  Some times he gets really bizzarrrre and tells me to slap him or to hate him or to "punish" him, cause he's so bad!  Of course he's the abuser, not me so I just retreat... totally baffled by what I have just wittnessed.

Have you any clues or comments on this "older woman" preferrence as it relates (if it does in fact) to this freaky "mommy" dynamic?  As a note, he recently, (out of the blue, no apparent reason) has cut his mother totally out of his life, says he won't even go to her funeral.  Confusing since you wrote a NPD'd person losing a parent can become psychotic from the loss of "bearings".  Maybe he's just pre-empting the inevitable "injury" as a queer way of controlling that which cannot be controlled ...


Karen

Reply
 Message 4 of 13 in Discussion 
From: XtraMSN NicknamesamvakSent: 7/01/2004 2:50 p.m.
Hi, Karen,
 
Preference for older women is almost always about a "Mommy (Oedipal) Complex" - but it is not uniquely linked to pathological narcissism.
 
And, yes, you are right again:
 
You are a transference figure - you represent his mother and he uses you to achieve closure with her, to reenact erstwhile conflicts.
 
These may shed some light on this predilection:
 
 
 
 
I have reprinted this FAQ below and emphasized some pertinent portions of the text:
 

The narcissist has a complicated relationship with his parents (mainly with his mother, but, at times, with his father). As Primary Objects, the narcissist's parents are often a source of frustration which leads to repressed or to self-directed aggression. They traumatise the narcissist during his infancy and childhood and thwart his healthy development well into his late adolescence. Often, they are narcissists themselves. Always, they behave capriciously, reward and punish the narcissist arbitrarily, abandon him or smother him with ill-regulated emotions. They instil in him a demanding, rigid, idealistic and sadistic Superego. Their voices continue to echo in him as an adult and to adjudicate, convict and punish him in a myriad ways.

Thus, in most important respects, the narcissist's parents never die. They live on to torment him, to persecute and prosecute him. Their criticism, verbal and other forms of abuse and berating live on long after their physical demise. Their objectification of the narcissist lasts longer than any corporeal reality. Naturally, the narcissist has a mixed reaction to the passing away of his parents. It is composed of elation and a sense of overwhelming freedom mixed with grief. The narcissist is attached to his parents in much the same way as a hostage gets "attached" to his captors (the Stockholm syndrome), the tormented to his tormentors, the prisoner to his wardens. When the bondage ceases or crumbles, the narcissist feels both lost and released, saddened and euphoric, empowered and drained.

Additionally, the narcissist's parents are Secondary Narcissistic Supply Sources (SNSSs). They fulfil the triple role of "accumulating" the narcissist's past, evidencing the narcissist's grand moments ("live history") and providing him with Narcissistic Supply on a regular and reliable basis (Regulation of Narcissistic Supply). Their death represents the loss of the best available Narcissistic Supply Source and, therefore, constitutes a devastating blow to the narcissist's mental composure.

But beneath these evident losses lies a more disturbing reality. The narcissist has unfinished business with his parents. All of us do �?but his is more fundamental. Unresolved conflicts, traumas, fears and hurts seethe and the resulting pressure deforms the narcissist's personality. The death of his parents seals inability to come to terms with the very sources of his invalidity, with the very poisonous roots of his disorder. These are grave and disconcerting news, indeed. Moreover, the death of his parents virtually secures a continuation of the debate which rages between the narcissist's Superego and the other structures of his personality. Unable to contrast the ideal parents with the real (less than ideal) ones, unable to communicate with them, unable to defend himself, to accuse, to pity �? the narcissist finds himself trapped in a time capsule, forever reliving his childhood and its injustice and abandonment, denied the closure he so craves and needs.

The narcissist needs his parents alive mostly in order to get back at them, to accuse and punish them for what they have done to him. This attempt at reciprocity ("settling the scores") represents to him justice and order, it introduces sense and logic into an otherwise totally confused landscape. It is a triumph of right over wrong, weak over strong, law and order over chaos and capriciousness. The demise of his parents is perceived by him to be a cosmic joke at his expense. He feels "stuck" for the rest of his life with the consequences of events and behaviour not of his own doing or fault. The villains evade responsibility by leaving the stage, ignoring the script and the director's (=the narcissist's) orders. The narcissist goes through a final big cycle of helpless rage when his parents die. He then feels, once again, ashamed and guilty, worthy of condemnation and punishment (for being angry as well as elated at their death). It is when his parents pass away that the narcissist becomes a child again. And, as it was during the first time round, it is not a pleasant or savoury experience.

Hence your N's defiant - and infantile - statement:

"says he won't even go to her funeral"

Take care.

Sam


Reply
 Message 5 of 13 in Discussion 
From: XtraMSN Nickname·TammyJo·Sent: 8/01/2004 3:07 p.m.
Hi Dr. Sam!
 
Here is Karen's next reply:
 

Dr. V

Thank you for your response on the "mommy" thing!  I'm most interested in your expansion on being a "transference object" for Nh. Is this an inescapable dynamic for such an N in all of his "love" relationships or can he ever maintain a "normal" adult relationship (even though he hasn't yet at almost 40)?  No, I no longer have any delusions of our relationship ever even resembling normal, but I have (as I have seen expressed by some members here) wondered if after 8 years of misery can he just pop off to the next victim and suddenly be happy and healthy.  Sour grapes on my part, but I hope not... after all of these years of him abusing me and blaming me for EVERYTHING... I might start to actually believe him...  His most frequent claim as of late is "I DESERVE a real wife and a healthy relationship" I think if "she" is willing to "shut up", have no thoughts or opinions and essentially be a piece of pretty furniture in his made up world, it could work... did I just answer my own question!?  Anyway, your thoughts?


Karen

Reply
 Message 6 of 13 in Discussion 
From: XtraMSN NicknamesamvakSent: 8/01/2004 5:29 p.m.
Is this an inescapable dynamic for such an N in all of his "love" relationships or can he ever maintain a "normal" adult relationship (even though he hasn't yet at almost 40)? 
 
Hi, Karen,
 
Narcissists cannot love or maintain adult, mature relationships.
 
To start with, they are misogynists:
 
 
All their interactions with others are geared towards securing maximum narcissistic supply:
 

Narcissists "love" their spouses or other significant others �?/SPAN> as long as they continue to reliably provide them with Narcissistic Supply (in one word, with attention). Inevitably, they regard others as mere "sources", objects, or functions. Lacking empathy and emotional maturity, the narcissist's love is pathological. But the precise locus of the pathology depends on the narcissist's stability or instability in different parts of his life.

From "The Unstable Narcissist"

(I have omitted below large sections. For a more elaborate treatment, please read the FAQ itself).

"Narcissists belong to two broad categories: the "compensatory stability" and the "enhancing instability" types.

I. Compensatory Stability ("Classic") Narcissists

These narcissists isolate one or more (but never most) aspects of their lives and "make these aspect/s stable". They do not really invest themselves in it. The stability is maintained by artificial means: money, celebrity, power, fear. A typical example is a narcissist who changes numerous workplaces, a few careers, a myriad of hobbies, value systems or faiths. At the same time, he maintains (preserves) a relationship with a single woman (and even remains faithful to her). She is his "island of stability". To fulfil this role, she just needs to be there physically.

The narcissist is dependent upon "his" woman to maintain the stability lacking in all other areas of his life (=to compensate for his instability). Yet, emotional closeness is bound to threaten the narcissist. Thus, he is likely to distance himself from her and to remain detached and indifferent to most of her needs. Despite this cruel emotional treatment, the narcissist considers her to be a point of exit, a form of sustenance, a fountain of empowerment. This mismatch between what he wishes to receive and what he is able to give, the narcissist prefers to deny, repress and bury deep in his unconscious. This is why he is always shocked and devastated to learn of his wife's estrangement, infidelity, or divorce intentions. Possessed of no emotional depth, being completely one track minded �?he cannot fathom the needs of others. In other words, he cannot empathise.

II. Enhancing Instability ("Borderline") Narcissist

The other kind of narcissist enhances instability in one aspect or dimension of his life �?by introducing instability in others. Thus, if such a narcissist resigns (or, more likely, is made redundant) �?he also relocates to another city or country. If he divorces, he is also likely to resign his job. This added instability gives these narcissists the feeling that all the dimensions of their life are changing simultaneously, that they are being "unshackled", that a transformation is in progress. This, of course, is an illusion. Those who know the narcissist, no longer trust his frequent "conversions", "decisions", "crises", "transformations", "developments" and "periods". They see through his pretensions and declarations into the core of his instability. They know that he is not to be relied upon. They know that with narcissists, temporariness is the only permanence."

We are, therefore, faced with two pathological forms of narcissistic "love".

One type of narcissist "loves" others as one would attach to objects. He "loves" his spouse, for instance, simply because she exists and is available to provide him with Narcissistic Supply. He "loves" his children because they are part of his self-image as a successful husband and father. He "loves" his "friends" because �?/SPAN> and only as long as �?/SPAN> he can exploit them.

Such a narcissist reacts with alarm and rage to any sign of independence and autonomy in his "charges". He tries to "freeze" everyone around him in their "allocated" positions and "assigned roles". His world is rigid and immovable, predictable and static, fully under his control. He punishes for "transgressions" against this ordained order. He thus stifles life as a dynamic process of compromising and growing �?/SPAN> rendering it instead a mere theatre, a tableau vivant.

The other type of narcissist abhors monotony and constancy, equating them, in his mind, with death. He seeks upheaval, drama, and change �?/SPAN> but only when they conform to his plans, designs, and views of the world and of himself. Thus, he does not encourage growth in his nearest and dearest. By monopolizing their lives, he, like the other kind of narcissist, also reduces them to mere objects, props in the exciting drama of his life.

This narcissist likewise rages at any sign of rebellion and disagreement. But, as opposed to the first sub-species, he seeks to animate others with his demented energy, grandiose plans, and megalomaniacal self-perception. An adrenaline junkie, his world is a whirlwind of comings and goings, reunions and separations, loves and hates, vocations adopted and discarded, schemes erected and dismantled, enemies turned friends and vice versa. His Universe is equally a theatre, but a more ferocious and chaotic one.

Where is love in all this? Where is the commitment to the loved one's welfare, the discipline, the extension of oneself to incorporate the beloved, the mutual growth?

Nowhere to be seen. The narcissist's "love" is hate and fear disguised �?/SPAN> fear of losing control and hatred of the very people his precariously balanced personality so depends on. The narcissist is egotistically committed only to his own well-being. To him, the objects of his "love" are interchangeable and inferior.

He idealizes his nearest and dearest not because he is smitten by emotion �?/SPAN> but because he needs to captivate them and to convince himself that they are worthy Sources of Supply, despite their flaws and mediocrity. Once he deems them useless, he discards and devalues them similarly cold-bloodedly. A predator, always on the lookout, he debases the coin of "love" as he corrupts everything else in himself and around him.

(MUCH) more about these dynamics in this nine-part essay:

http://www.narcissistic-abuse.com/msla.html

http://www.narcissistic-abuse.com/3.html

Take care.

Sam


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Reply
 Message 8 of 13 in Discussion 
From: XtraMSN Nickname·TammyJo·Sent: 8/01/2004 11:32 p.m.
Hi Dr. Sam,
 
Here's Karen's next question!
 
Dr. V

Thanks once again for your insight.  Some recent posts with CN today, concerning the Nh and our children had me thinking about a new subject.  We all know living with a N partner is hell on us, sanity, esteem etc.  But what about the kids we have with them...  I have a 5 year old daughter with my Nh and she is his only child.  I have a 12 year son from my first marriage.  He's fine, a very loving, emotionally stable kid with a wonderful and loving Dad.  It's my daughter's plight which is worrysome to me.  It is very apparent to me that he sees her as a "mini-me" of himself.  She is a beloved possession to him.  But, he cannot see her as a separate and distinct human being of her own.  He always refers to her as HIS daughter, HIS beautiful girl, HIS flesh and blood, but never by her name.  Though he is very effusive with her, affectionate etc., he has the depth of a parking lot puddle.  He can pontificate, preach and teach but never have a real heartfelt conversation with her.

Toward my question... I have put up with his s__t for several years with the thought that she needed to bond with him, get through that electra thing and then she would be on even footing.  I believe little girls need a daddy in their lives.  Now she is 5 and I'm more concerned she will be damaged in some way by her continued exposure to him.  At times, it seems they have their own little admiration society going.  He relates to her in an almost "romantic", though I have no suspicions of sexual abuse.  Its actually very hard to explain.  He never disciplines her and contradicts me when I do.  He has no boundaries with her at all.  My question: at her age now, what do I do to mitigate his affect on her and her perception of who she is... I married a N I don't want to raise one too...


Karen

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 Message 9 of 13 in Discussion 
From: XtraMSN Nickname·TammyJo·Sent: 8/01/2004 11:33 p.m.
Hi Adair Texas,
 
Please email me at [email protected]
 
Thanks!
Tammy

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The number of members that recommended this message. 0 recommendations  Message 10 of 13 in Discussion 
Sent: 10/01/2004 2:59 a.m.
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 Message 11 of 13 in Discussion 
From: XtraMSN NicknamefemfreeSent: 10/01/2004 3:18 a.m.

Hi Dr. DarkEros. Please email me

thank you

femfree

[email protected]

 


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 Message 12 of 13 in Discussion 
From: XtraMSN Nicknamelibertybell6986Sent: 10/01/2004 8:07 p.m.
Dear All,
 
I found this case study helpful to read.  I wanted to know if
I could possibly get some help and ask Dr. V. some questions
before I have to appear in court soon by l/2l/04. 

Could someone e-mail me back as I am in need of help.
 
I would appreciate it.  Thanks Mary w.

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 Message 13 of 13 in Discussion 
From: XtraMSN Nickname·TammyJo·Sent: 10/01/2004 10:04 p.m.
LB,
 
I am the manager in charge of the case studies, email me at [email protected] and we'll talk...
 
Hugs,
Tammy

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