403: My Thoughts on Meds & Mocking During Arguments

Hello, friends!

In today’s episode, we tackle two profound listener questions that may resonate with many of you:

  1. How Do You Feel About Antidepressants and Anti-Anxiety Medications? A listener asks about the use of antidepressants and anti-anxiety medications, expressing concerns about addiction and the potential difficulty of getting off these meds. Dr. Duff shares his positive personal experience with Lexapro, explaining the various classes of medications, including SSRIs, SNRIs, and benzodiazepines. He emphasizes the importance of evaluating both the benefits and potential side effects of these medications, as well as considering the cost of not using them. Dr. Duff also addresses misconceptions about feeling disconnected from reality due to medication and discusses the concept of psychological and physiological dependence.

  2. Dealing with a Hurtful Partner: Another listener seeks advice on how to help their partner understand the impact of their hurtful behavior, which includes yelling and mocking. Dr. Duff offers empathetic support, acknowledging the listener’s heartbreak. He outlines the importance of healthy conflict resolution, setting personal boundaries, and recognizing signs of potential abuse. Dr. Duff encourages open communication and suggests resources for improving relationship dynamics, while also addressing the need for safety and support when dealing with ongoing hurtful behavior.

As always, you can send me questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode403

Cycle of Abuse Graphic Mentioned:

What is the Cycle of Abuse? - Hyde County Hotline

Transcript

[00:00:00] All right. Hello, friends of all varieties. Thank you so much for joining me today. We are back with a question and answer episode. Don’t forget if you would like to send me a question for the show, please send me an email to duffthepsych@gmail.com or head over to duffthepsych.Com and use the contact form there.

I’ve gotten some questions recently after I bugged you guys about it, so I really appreciate that. But keep them coming in. Great stuff. The two questions today are both newer ones, so thank you for sending those in. I also wanted to say thank you for the support on the interviews recently. I’ve released, uh, two interviews at this point, I believe, and it’s been a blast to get back into it.

My anxiety that I described about interviewing has decreased each time. So it has been a wonderful exposure exercise. If you listen to my first interview that I put out, I talked about it with the guest about how I was feeling anxious and she was also feeling anxious and how this was an opportunity for us to work through it.

[00:01:00] So it has been a great exposure work exercise. And I found that now I am. I’m already much more comfortable after doing three, four or so of these interviews. Funny thing is I’ve also gotten some really great feedback from guests and none of them have suspected that I was nervous or that I had anything that I was concerned about regarding the interviews.

Typically after I, you know, kind of cut the recording, I talked to the guests for a little bit about how was that for you. And a lot of them have been very complimentary and very kind saying things like, well, how long have you been doing this? You ask really good questions. And if I say something like, well, it’s been quite a while, it’s been years.

I’m just getting back into it. It’s a little nerve wracking. They’ll say, I had no idea you wouldn’t expect it. One funny thing I’ll let you guys in on behind the scenes is on the first interview that I did, , with Jennie Ketchum Crooks, I, I certainly had to edit out a little bit of me hyperventilating at the [00:02:00] beginning.

So you can’t hear it in the recording or on YouTube, but I welcome Jennie to the show. And then in the background, while she’s saying hello and thank you for having me and introducing, you know, herself, you could hear me if I didn’t edit it, just going like into the mic. And that certainly chilled out a little bit, but yes, uh, that was the level that I was at.

And now I’m just kind of cruising with it and enjoying talking to people. So thank you for the support with those. I have more interviews in the pipeline. I’m hoping to be able to alternate back and forth because I know that you guys like both. I’ve gotten great feedback about the interviews, but I also know that you like the Q and A’s.

So I have plenty of them to, fill up the next few weeks or months here. I talked with a psychologist about ketamine and psychedelic assisted therapy, not just the substances themselves, but how you actually integrate those into therapy. I talked to somebody [00:03:00] about the invisible pieces of ourselves that we grieve without even knowing it.

I’m going to be talking to an OCD expert next week. I talked with somebody about black representation and mental health and more requests keep rolling in. So I’m trying to be selective. I get requests for guests to be on the show all the time, pretty much every day, but I want to be selective and find guests that I think you would really like.

So please let me know. Give me feedback through email, through DMs on social media, wherever you could find me because I want to know what you think about these interviews. Last thing, before we get into the questions for this episode, if you’ve not already seen, I’ve been uploading the interviews and podcast episodes to YouTube.

Not just a static image either. I have that kind of automatically importing from my podcast host, but I’ve actually been uploading the video files of me talking with guests or me doing these solo episodes. So if you want to look at it and actually see me and the guests talking, check it out on YouTube, easy to [00:04:00] find just search for duffthepsych, and I would really appreciate your support over there as well.

All right, all that said though, let’s go ahead and jump into the first question. It reads, hello, my question for you is how do you feel about antidepressants and anti anxiety meds? Do you think it’s easy to get addicted to these meds and then have difficulty getting off them and getting in touch with reality again?

Also just want to point out that your podcast has helped me in many ways, so thank you for doing what you do.

Hello. Thank you very much. Great question. I appreciate the praise there and a very good question or questions. I should say there are multiple questions in here. I’ll tackle them one at a time. The first is how do I feel about antidepressants and anti anxiety medications? My overall answer to that is I feel great about them.

I am on an SSRI Lexapro. I take 10 milligrams of it every day and it’s been one of the best decisions that I’ve ever made for my health. It quiets my brain down. So I’m not as exhausted by the incessant chatter that can be present there. [00:05:00] Most of the time throughout the day, if I don’t have it. And I also feel much less activated in situations that would normally cause me some serious problems with physiological anxiety symptoms.

Not that I can’t have them anymore, as I’ve discussed with. You know, relation to the interviews and such, but the intensity is lower and it’s something that I can deal with. So I’m very, very happy with the medications that I’m on. In my opinion, taking a medication for your mental health is just like taking a medication for your blood pressure or thyroid or asthma.

We’re very fortunate to live in a time when we have modern medicine that’s discovered a variety of options that can be used to treat common mental health issues. Now, it is important to point out that there are multiple classes of medications and several medications within each of these classes that can be considered an antidepressant or an anti anxiety medication.

I’m not going to go into excessive detail here, but I will mention a few categories. First off, you have the [00:06:00] kind of medication that you take every day. As I was just talking about with myself, these don’t cause a big, huge physiological change right away when you take them, but instead they take about a month to progressively change your brain’s chemistry so that you get that desired effect.

These would be things like SSRIs or SNRIs. They work by changing the neurotransmitter balance in your brain. You’ve probably seen memes about serotonin before, right? Like my last molecule of serotonin, things of that sort.

That is one of the major neurotransmitters that’s targeted. And these medications basically help your brain have more of it available. In the case of SSRIs, they help to stop your brain from sucking it back up and recycling it, and instead let more of that serotonin linger in your brain so it can be more helpful to you.

Interestingly, though, a lot of these medications, they double dip for both anxiety and depression. So often people don’t realize that somebody getting an antidepressant or somebody getting an anti anxiety medication may actually be [00:07:00] getting the same thing. So those are a few of the medications, SSRIs, SNRIs, and there are others that are similar to that.

Another class of medications are benzodiazepines or benzos. These are medications that are designed to sedate you. These would be things like Xanax, Valium, Klonopin, and there are more. Typically, these ones are not prescribed to be taken every day, although some prescribers will use them in that way, depending on the case.

They might have you take a small amount several times throughout the day. That’s less common, though, and not really what they’re designed for. These medications are faster acting and they actually help to sedate you and calm down your nervous system, similar to the way that alcohol might, although they’re not identical and the effect is not exactly the same, but it’s a good kind of way to understand how they work.

They’re best used for periods of acute symptoms like a panic attack or mania, right? When somebody has bipolar and they are having trouble [00:08:00] controlling the fast pace of their mania, sometimes a benzodiazepine can help bring things down to a manageable level. Same with a panic attack. They can also be prescribed for things like significant anxiety when doing things like flying or undergoing a medical procedure.

A lot of times you might be prescribed Valium before a dental procedure or something of that sort. Now you also have medications that are not made precisely for anxiety, but they help with anxiety. This would be things like gabapentin, for instance. Gabapentin is an anticonvulsant, meaning it’s for seizures.

It also helps with neuropathic pain, but it can also serve as an anxiety medication or a mood stabilizer in some cases. So it really kind of triple, quadruple dips. I’d say that, uh, propanolol can also fit into this category. It’s a beta blocker, which can help with blood pressure, but it also by nature of reducing blood pressure helps to reduce the physical symptoms of anxiety.

So it’s often prescribed for people with performance [00:09:00] anxiety. There’s a really good clip out there with Robert Downey Jr. where he’s being honest and he’s on a talk show. I forget which, but he says, I’m cool. I took a beta blocker before I came out here, let’s go. And that’s often what it is used for.

There are more than the few categories that I described, but I don’t really want to go any further than that. This is all to say, just be aware that we aren’t talking about one single type of medication. There are different types. And for each of these different types of medications, there are different considerations.

Now I want to get more into the topic of medication and what I think about it, but let’s take a quick sponsor break.

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There are a lot of moves [00:10:00] personally, that I’ve been trying to make for this show in 2024, that I can definitely give myself a little pat on the back for. And I hope that you have some things that you’re proud of for the year so far as well. But if you need help finding those moments of victory to celebrate, therapy can be an awesome tool.

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Now that we’ve talked about some of the different types of medications, I want to say that medication is often just one piece of a larger puzzle. No medication is going to change the circumstances of your life or make you adopt new habits, but it can reduce your symptoms to the point where you can actually succeed in your life.

Or you can approach those different strategies like self help or therapy [00:11:00] or reading or exercise. So, they’re one piece of a larger puzzle for some people. For others, all you need is just a little bit of a boost and that’s totally enough. The awesome thing is medications don’t have to exist in isolation.

You can also engage in these other things. You can do therapy, you can journal, you can read self help books, you can get a hobby, you can invest in your interpersonal relationships. You could exercise all sorts of things like that. As a person, though, you’re allowed to have your own feelings and opinions regarding medication, whether you’re talking about mental health medications or other kinds.

It’s important to be informed and always evaluate the short term and long term side effects of medication that you may start. I’m currently on a low dose of a blood pressure medication following all that medical crap that I talked about a few episodes ago, but I am planning on and in the process of looking more into the longterm impact of these medications so I can be more informed.

Right now they’re working [00:12:00] perfectly. They’re exactly what I need at this moment. And I’m effectively out of the woods for the issue that I was having physically, but I want to know whether I need to try to reduce the medications in the future and just see if exercise and dietary changes are sufficient to keep it down.

I want to know if there’s a rationale to do that, or if I’m good to just keep taking it for now.

At the same time, you need to consider the potential cost of not using medication. I hear people that are very wary of medication because they don’t like putting things into their body. However, when we’re talking about mental health medications, sometimes they’re also so depressed that they’re drinking themselves to death, which is counterproductive for their health.

No variable exists in isolation when it comes to your mental health. Maybe there are some side effects or risk factors associated with medication, but what risk do you run letting your life continue on the same track without it? Depression and anxiety come with a cost. This can be relational, having to do with the people that you associate with, family, romantic relationships, and [00:13:00] otherwise.

It can also be financial. Hospitalizations cost a lot. Lost opportunities related to work or school can cost a lot, both in terms of money and just how you feel about yourself. So I’m not trying to say that everybody should be on medication, but it’s important to really think about the pros and cons before you make a quick decision.

The next question that I’ll address in what you wrote here is whether it takes a long time to get in touch with reality again if you stop taking medication. I think this is showing a bit of a fundamental misunderstanding about medication. Rarely is this how it really works. You can definitely have different and sometimes a little bit blunted emotions from medications.

They’re there for a reason. And if you’re feeling too strong of emotions, they’re going to curb that a little bit, especially when you get to the higher doses. But that stereotypical picture of somebody walking through life like a zombie, totally unable to feel anything is very rarely what it looks like.

That’s not the point of these [00:14:00] medications. I’m on a low dose, a 10 milligram dose of an SSRI, like I mentioned, and I literally can’t tell that I take it. I can tell if I look for the things that would be there otherwise, as I mentioned, but just if I sit here. And scan my body. It’s not like I can tell that I’m on this medication and other people if they meet me aren’t like, something’s up with that guy.

He looks like he’s out of it. If anything, I think that the medication makes me more connected to reality because it calms that rapid fire storm in my head so I can actually be there and be more present. Obviously, there are other medications, though, the more sedating medications like the benzos. These can definitely make you feel out of it and disconnected from reality, but this is a temporary effect that goes away.

You might be out of it for the night, have a little bit of hangover into the morning if you’re sensitive to it, but after that, you’re back to essentially your baseline. Um, there are some more hardcore medications like what you might use if somebody has severe psychosis and that [00:15:00] causes them to be agitated and lash out physically.

And that can look a little bit more like what they depict in the movies where somebody really has to be heavily sedated with those. But I don’t think that’s exactly what you’re referring to here.

Now, the other issue when it comes to addiction, that’s a bit more complicated. For most of the medications that I talked about, like SSRIs, they’re not considered to be addictive in the traditional sense, not in the same way something like nicotine or heroin, for instance, would be. You can certainly become psychologically dependent on them, meaning if you rely on them to cope with the challenges you encounter in life, you might rely on this as your sole coping mechanism, which would be more relevant if you weren’t doing other things like therapy or other forms of self help.

The other thing that happens is your body does adapt to it and develops a degree of tolerance and physiological dependence. Not addiction, but dependence. Essentially your body adjusting to the medication and getting used to it so that if you were [00:16:00] to suddenly discontinue it, you might get some withdrawal symptoms.

However, for many of the medications we’re talking about here, these withdrawal symptoms are not too severe. Like if I were to go for a few days without my medication, I would get brain zaps, which are basically Imagine a heart palpitation, but happening in your brain, which is very disconcerting, but it’s not painful per se and It’s a relatively minor side effect when you look at the grand scheme of what can happen when you withdraw from other types of substances Now, for others, you can have other symptoms like nausea, headaches, resurgence of the psychiatric symptoms that you were treating.

All of those things are possible, but it’s expected, and this is why you taper off medications gradually with your provider rather than just stopping cold turkey. Usually, and this is a blanket statement, it’s not the case for everybody, but usually it’s not too difficult to get off these medications. And again, even before getting off of them, it’s not like you’re walking through life as a [00:17:00] zombie disconnected from the world.

So the statement there that you made about, you know, getting back to reality, that’s not totally exactly what it’s like in most cases. An exception though to that whole, non addictive thing is the benzodiazepines, right? These do have an addictive potential. So these are things like, you know, your Xanax, people will sometimes get addicted to that.

And as well, there is an overdose risk. So people can take medications like Xanax or like Klonopin and overdo it purposely or accidentally. Which might result in an overdose. That’s why they’re not meant to be used every day or multiple times a day in most situations. And they’re also something that we’re very wary of in older adults who don’t metabolize it quite as well.

When someone is really dependent on benzodiazepines, it can sometimes be a rough time getting off of them, similar to what you might see in alcohol detox. And again, it’s very important, not just to go cold Turkey, [00:18:00] because that can have some real physical risks for you. But overall, in addressing your question for most antidepressants or anti anxiety medication you’re going to encounter, they are not going to make you feel like a zombie.

They’re not traditionally addictive like nicotine or something like that. And they can be an essential part of your mental health strategy. So I think it’s really important not to vilify them, but to think of them just like any other healthcare decision. There are pros, cons, there are opportunity costs, and it’s important to be informed about it.

So thank you for the question. I hope that helps.

And before we get into the second question, I want to take a quick break and talk about our other sponsor, who is OneSkin. I am loving summer this year. I am very fortunate to live in an area where I can enjoy the beach. I can spend time by the pool with my family, with my kids, and I’ve definitely been enjoying just being out and about in the sun.

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All right. [00:20:00] And onto question number two. It reads, Dr. Duff, I love your podcast and never miss an episode. Thank you. My question, how do I help my partner understand and care about doing hurtful things to me? He can get really angry and yells and mocks me. We get along most of the time, but he’s unwilling to be accountable and it blames me for almost everything.

When he’s upset, the relationship may not last. If we can’t work this out, maybe we can’t, and then a little sad face. Hey there. Um, thank you for writing in. I’m super sorry to hear what’s going on. You sound really heartbroken, and I wish I could just give you a nice, solid hug. Um, from your question, I can hear how torn you are about this.

This is somebody that you’ve grown to love and care about, but you’re also not okay with what has been going on, and that is a tough position to be in. First things first, I want to say that having conflicts in relationships is normal. They can look different depending on the people involved in the relationship, but for some conflicts, they might be rational discussions.[00:21:00]

For others, things can become a little bit more intense, and for others, maybe it’s more on the passive aggression side. There’s a spectrum, and for each of these, there’s a range in terms of what would be considered acceptable and healthy versus what would problematic. If you raise your voice in a moment of frustration and then apologize and bring things back down to acceptable level.

And this was, you know, one of a handful of times this has happened. That’s okay. That’s totally fine. You can move past that. Constant yelling is probably problematic. Of course, there are cultural variables here. Some cultures have more intense interactions, and that would be considered normal for that culture.

But my perspective is informed by the culture that I live in here in the United States. So just take that for what it is. However, saying things to be intentionally hurtful, outright screaming, mocking your partner, this is not okay. This is unacceptable behavior in a relationship that’s going to transcend most cultures, maybe not all, but [00:22:00] most.

And certainly for your situation, it sounds like it’s an issue. Of course, we can accidentally slip into individual instances of this behavior every once in a while, but usually that’s followed by a recognition that it was a mistake. Maybe you feel foolish or guilty and you move forward from it, but demeaning your partner is not a normal part of a healthy relationship.

And if this is a standard in your relationship, I would consider that to be a problem. The thing that concerns me here is not just the intensity of the interactions. Look, You might have things that are not good in a relationship that you roll with because of the context. Maybe there’s a partner who has legitimate PTSD symptoms or maybe borderline personality disorder, and they can get triggered into a state of elevated behavior, maybe being a little bit irrational, emotional, things of that sort.

But. While that still wouldn’t be healthy for the relationship, there’s not that personal element to it. It’s something that you can have some grace with because you understand your partner’s [00:23:00] challenges. But for you, I hear this personal element to it. Mocking you is not just blowing up. That’s meant to be hurtful and mean.

I don’t know how severe your situation is, but I would encourage you to look up the cycle of abuse. I’m sure I’ve talked about it on the show before, but it’s a very easily Googleable image that I’ll include in the show notes as well. If you just go depth of the site. com slash episode four or three, I’ll include a picture there.

Essentially though, it’s a four stage pattern where you have attention building phase where things are building up and you feel kind of that. Well, tension, and you feel that sense of walking on eggshells and something might happen. You might set something off and Then there’s an incident. There’s a blow up verbal abuse sometimes physical abuse After that you have what’s called the reconciliation phase and there you might have apologies.

Although typically they’re not very Sincere apologies. You can have excuses or gaslighting where you’re being told that it’s your fault or being made [00:24:00] to feel crazy. And after that you have the calm phase. And sometimes in the calm phase, things seem to be better, even maybe better than they were before.

But then the cycle repeats itself. You go from that calm phase into that tension building and then boom, another incident. You said that he is unwilling to be accountable for things and blames you for everything. That sounds very much like that third stage where you’re being gaslit. Maybe you’ve even been told like you need to stop taking things so personally or you know how he gets and you have to stop making him get like this.

I don’t know for sure. I’m not trying to tell you what’s happening in your situation, but these would be things to have a good look at and try to rule out. Make sure that this isn’t happening because those could be signs of abuse happening. This would also be a good prompt for you to get some outside perspective.

I’m obviously answering this from your perspective because I got the information from you. I don’t know what the full situation is, but perhaps there are others that do. I don’t just mean [00:25:00] gossiping about your partner or anything like that, but if you have some close family or friends that understand you and witness your relationship from the outside, they might be extremely helpful to give you a more detached point of view.

If you don’t have people that you can talk to you because he tries to control you either overtly or covertly, more secretly by limiting the people that you have access to, that would be a huge red flag for abuse. So be aware of that. And if you’re worried about just talking bad about your partner and saying that with air quotes, talking bad, I would encourage you to simply repeat back exactly what happened.

In what was said in a recent episode, don’t add a lot of color and commentary, just say what happened. And if you don’t feel comfortable with that, if you don’t feel comfortable saying the actual verbatim words that he said to you, that might be a sign that there’s something serious going on, right? If you can’t actually say those words because you don’t want someone else to hear it, you got to think about that for a sec.

Let’s say the situation isn’t as severe as I’m kind of [00:26:00] discussing here. We’re not seeing full on abuse. It’s more that you guys just have some serious stuff to work out between you. I would want to know first, is it safe for you to talk about this with him? Have you been able to communicate how hurt you are by his actions?

For this, I would definitely suggest having a conversation, not during an argument because that’s not going to be productive and it’s probably going to be something that doesn’t really stick. Even if you come to some sort of agreement. But after the fact after, you know, the argument has passed and things are calmer, you could say something like, Hey, I wanted to address something from the other night.

I understand that we get into these patterns of blowing up and little things turn into big fights. But I have to be honest that I feel very belittled by the way that you talk to me when you’re angry. Hopefully at this point he’s curious and asks what you mean. If he gets mad and blows up on you again about you bringing up your concern, that would be another red flag.

But let’s say that he asks you, what do you mean? You could [00:27:00] say, Last night when you were upset, you were yelling and you started making fun of me. You were making fun of the way that I started crying and that’s really hurtful. And this isn’t the only time that you’ve done that. I often feel like you’re mocking me when you’re angry.

So being very blunt about it and very honest about it would be potentially a very good step because you’re not really leaving room for interpretation. You’re saying what he does that hurts you. He may say you need to be less sensitive or something like that, or he may be apologetic and recognize what you’re talking about.

Who knows, but you are allowed to have personal boundaries. They’re very, very important within a relationship, especially when it comes to conflict. You can make it clear that you’re going to be implementing a boundary here, right? You want to have a firm boundary that you’re not going to engage with him when you feel like he’s mocking you.

That’s not the kind of conversation you’re willing to have. So when that happens, maybe you drop the rope and you walk away because you don’t want to feel bullied or made fun of when you’re trying to work on something in your [00:28:00] relationship. But again, please make sure that these are things that are actually safe to do if you’re worried about retaliation or some sort of physical violence Please take things one step at a time and make sure you have a safety plan There are resources out there for that if it comes to it If you think though on the other hand that he’s willing to work on things There are many different resources out there at your disposal You can go online and look for a couple’s communication workbooks.

There are tons of them. You could co listen to a podcast episode that explains say nonviolent communication and conflict resolution. You can enlist the help of a couple’s therapist or a coach of some kind. If you guys are religious, maybe there’s somebody within your church that could be helpful. Of course, with that, you need to be aware of what the sort of power dynamics are and what their perspective on relationships is before you engage with that, but there are a lot of different types of resources out there.

In the end, though, if you ask for boundaries and they’re continuously violated, if he’s unwilling to work on these behaviors that you’re concerned [00:29:00] about, if you’re feeling like you constantly have to walk on eggshells and you’re on edge, worried about setting him off, that’s a real issue. That would be when you need to consider if this is time to move on from the relationship.

So I really appreciate the question. I truly hope that things ease up for you soon. I can tell your heart is in this. You deserve to be treated with respect and dignity though, even when you have conflicts. So thank you for that. And that is the end of the episode, everybody. Uh, I really appreciate you sticking with me.

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