THE HUMAN CAPACITY FOR INTENTIONAL
SELF—HEALING & ENHANCED WELLNESS
A research proposal
John Heron,
British Postgraduate Medical Federation, University of London
Peter Reason,
Centre for the Study of Organizational Change and Development,
University of Bath
March 1985
Aims of project
This project sets out systematically and critically to
explore the human capacity for intentional self-healing and enhancing
wellness. This means exploring, developing, and assessing self-help
techniques for a) transforming illness into wellness for those who are
currently "ill"; and b) for enhancing wellness for those who are
currently "well" (ill and well being in the first instance defined by
conventional standards).
Overview of method
The project will involve exploration in four domains of
inquiry, using co-operative and experiential inquiry methods. The four
domains and the general approach to be taken are outlined briefly in
this section, and further detail of the method is given in the next
section, Thus the inquiry will include:
-
Self-directed techniques involving both internal action (such as
visualisation, meditation, etc), and external action (such as
diet and exercise), and combinations of both.
-
Techniques undertaken alone, and in
interaction with others such as peers and professional
practitioners.
- An important aspect of the project will be the development of
training programmes for patients and practitioners.
- The empirical investigation of the effects and outcomes of these
methods, using collaborative and experiential inquiry methods.
Outline of method
1. Review the literature, consult a wide range of
medical and health practitioners, a wide range of patients of both
conventional and complementary approaches, discuss and reflect, and from
this develop:
- A list of techniques for self-directed healing and enhancement
of wellness that are currently being used; make a provisional
assessment of their feasibility and, if it can be assessed, their
efficacy; speculate about innovative techniques; set all this in a
historical and cultural context.
- Evolve a provisional philosophy of illness and wellness, with
special reference to agency and self-direction; from this evolve
working definitions of illness and wellness that bear witness to but
go beyond prevailing concepts.
- Evolve a provisional conceptual model of the ways through which
these intentional self-help processes work.
2. Recruit groups of people who are currently ill, both
groups of those with the same illness, and groups of those with
different illnesses, and for each group:
- Initiate them into the perspective derived in 1 above; indeed
they would be recruited and self-selected on the basis of the appeal
of these ideas to them.
- Facilitate their development as a co-operative inquiry group
which would:
- Define and record in physical and non-physical terms the
state of illness of each person at the start of the inquiry
process using criteria developed within each group.
- Agree on appropriate self-directed techniques for recovery
from illness and apply these over time, monitoring and recording
their effects, periodically reviewing their efficacy, and if
appropriate revising their design and use.
- From time to time interact with other groups of both ill and
well persons (see below) in order to share and learn from
periodic review findings.
- Define and record in physical and non-physical terms the
state of the illness or wellness of each person at the end of
the inquiry.
- Judge from within the total experience and its internal
findings the weight to be given to the different factors that
have contributed to the return to wellness or the continuation
of illness, Of particular interest, of course, will be the
weight given to the use of self-directed techniques of
self-healing, No control groups would be used for reasons
elaborated in the discussion below.
- The groups would be designed to maximise heterogeneity by having
all the following combinations of: same illness, same technique;
same illness, different techniques; different illness, same
technique; different illness, different techniques.
3. Recruit groups of people who are currently well by
conventional standards, and for each group:
- Initiate them into the perspective derived in 1 above; indeed
they would be recruited and self-selected on the basis of the appeal
of these ideas to them.
- Facilitate their development as a co-operative inquiry group
which would:
- Define and record in physical and non-physical terms the
state of wellness of each person at the start of the inquiry
process, using criteria developed within each group.
- Agree on appropriate self-directed techniques for enhancing
wellness and apply these over time, monitoring and recording
their effects, periodically reviewing their efficacy and if
appropriate revising their design and use.
- From time to time interact with other groups of both ill and
well persons in order to share and learn from periodic review
findings.
- Define and record in physical and non-physical terms the
state of wellness (or loss of it) of each person at the end of
the inquiry.
- Judge from within the total experience and its internal
findings the weight to be given to the different factors that
have contributed to the enhanced wellness or the continuation of
conventional wellness (or loss of it), Of particular interest,
of course, will be the weight given to the use of self-directed
techniques of enhancing wellness, No control groups would be
used for reasons elaborated in the discussion below.
- The groups would be designed to maximise heterogeneity by having
some groups each of which uses the same technique, and some groups
each of which uses a range of techniques.
4. Draw conclusions from the total study. These would
include:
- A philosophical statement concerning illness and wellness with
particular reference to agency based in the experience of the
project as a whole.
- A conceptual map of the self-help process with respect both to
illness and wellness, and maps of particular techniques used.
- A set of practical procedures and exercises for teaching people
how to use and develop their capacities for self-healing and for
enhancing wellness, These might be written, on audio or videotape,
and in the form of workshops for patients and practitioners.
- An assessment of the efficacy of the self-directed techniques
used in both illness and wellness groups in terms of the criteria
internal to those groups; and further an assessment of those
internal criteria.
- A comparison of the use of techniques in the illness and
wellness groups, using the different perspectives in order to
understand better the self-help process.
- Recommendations about the future use of self-directed techniques
in health care; and recommendations with regard to further research.
Background
Healing and wellness
In our view, understanding, using, and enhancing the
human capacity for self-healing is the central issue in the development
of holistic medical and health-care practices, whether viewed from the
perspective of orthodox medicine or the variety of complementary
therapies. While interventions from outside are clearly important, it is
only the patient as person who can develop a capacity for wellness, The
danger in focussing research on different types of interventions is that
we lose sight of the fundamental truth that it is the patient who gets
well and stays well, rather than the therapy that does well or badly.
In our recent inquiry into the theory and practice of
holistic medicine with a group of general medical practitioners we
developed and critically applied a five-part model of holistic medicine.
The five inter-related parts were: treating the patient as a whole being
of mind body and spirit; using a wide range of interventions;
power-sharing between doctor and patient; the doctor as
"self-gardening", by which we meant looking after themselves in a
holistic fashion; and the patient as potentially an agent of intentional
self-healing.
We meant by this last point not just the obvious fact
that the human body is within variable limits a self-healing organism
-for example the healing of wounds and the unaided recovery from viral
infection -- but also the more radical principle that each person as a
mental and spiritual being has the potential capacity consciously and
intentionally to facilitate healing in their bodymind by a variety of
internal and external actions. In our view the range of this potential
is unspecified and unknown, but we assume it to be much greater than
either patient expectation or conventional medicine allow. We did not,
in our holistic medicine inquiry, focus specifically on this dimension
of the model, and so in many ways the current proposal builds on and is
a development of this earlier work.
We are also aware of the enormous amount of work that
has gone into the development and testing of a wide variety of
approaches to self-healing such as biofeedback, autogenic training,
meditation, visualisation, exercise and diet, co-counselling. (for
references see, for example, Pietroni 1984). These have been applied and
explored in a very wide variety of situations and clinical conditions.
We are also aware of the work done in the educational and personal
development fields which is designed to enhance the individual's
physical, mental, and spiritual capacities (for a recent example of this
work see Houston, 1982), And thirdly, we are aware of enormous amount of
experience and practice of healers and mediums. We intend that this
project build on and develop this diverse work.
It is the emphasis on intentional self-healing and the
enhancement of wellness which distinguishes this proposal from the
earlier work. As Dossey argues in his radical approach to medical
thinking, Space, Time, and Medicine (1982), the best health strategies
are those which make the bodymind wiser, Our view is that many
approaches to health and illness, both in orthodox and complementary
practice, overemphasise the intervention and its impact, at the expense
of the patient as a being who has an relatively undeveloped capacity to
re-order their physical, mental, and spiritual processes to maintain,
restore, and enhance their health, We therefore argue that a central
task in the development of complementary and holistic medicine is to
explore and develop our understanding of the intentional self-healing
process, its potentials and its limitations.
We further argue that the issue of self-healing for
those who are seen as ill by conventional standards needs to be explored
in the context of the enhancement of wellness for those who are already
well by those standards. This is because a focus on pathology may limit
our vision of human potential, and thus limit also our view of the
powers that can be used to heal. Similarly, inquiry with conventionally
well people may generate a more imaginative and comprehensive range of
self-help techniques: it may be that techniques that in the first
instance appear only to be relevant to enhancing wellness may be highly
effective in recovering from illness. Also, since illness and wellness
are polar conditions dialogue between the poles may illuminate the
nature of each. Finally, and most important of all, the long term
welfare of society benefits more from the development of techniques that
are prophylactic and life enhancing rather than curative. For all these
reasons, an important aspect of the inquiry will be to compare and
contrast techniques used for healing with techniques used for
enhancement of wellness, to see what they have to contribute to each
other in terms of development and understanding.
We do not argue that self-healing approaches will
supplant current orthodox or complementary therapies; but that an
understanding of the intentional self-healing process is an essential
complement to practitioners' interventions.
Co-operative inquiry
A major problem in the exploration of holistic health
care strategies has been the lack of an appropriate inquiry method.
Orthodox medical research, as a branch of orthodox science, offers
methods which are inappropriate for the study of self-healing potential,
based as they are on a deterministic view of the body as a chemical and
mechanical machine, cut off from the influence of mind and spirit (Heron
and Reason, 1984). Thus for example, the controlled clinical
double-blind cross-over trial is designed to control out extraneous
variables such as the patient's intent to get well or stay ill.
In contrast to orthodox research methods, we have been
developing and using over the past decade an approach to inquiry which
is experiential and collaborative, in which all those involved in the
enterprise contribute both to the thinking that goes into the inquiry
and to the research action which is its object, and in which the primary
instrument of inquiry is informed, critical, and discriminating human
consciousness. This methodology has been set out in earlier books and
papers to which we refer the reader for a more detailed exposition than
can be included in this proposal (Heron, 1971; Reason and Rowan, 1981a;
Heron, 1981; Heron and Reason, 1985.). We include as an appendix to this
proposal a more detailed discussion of co-operative inquiry, and we also
explore further issues of validity in the section below on outcomes.
Our view is that intentional self-healing can best be
explored using co-operative experiential inquiry. Indeed, the research
method and the research topic seem ideally matched, since they both take
as fundamental the person as agent: in inquiry the self-directing
intelligence, critically and creatively exploring experience; in
self-healing the self-directing patient as intentionally managing their
disease condition; and more widely the self-directing person enhancing
their wellness through living a life which is healthy for the
body-mind-spirit.
Indeed, we argue that if we wish to take this human
potential seriously we can only explore and understand it using
cooperative experiential inquiry methods. If illness and health are to
any significant degree constructs of mind and spirit manifest in the
body, we will only understand self-healing and the enhancement of
wellness if we use a method rooted in personal experience; a method in
which people can help each other critically examine their own
experiences of healing and developing themselves.
Illness and wellness are fundamentally experiential
concepts in that they can only be understood in terms of personal
experience; and healing and enhancing wellness are similarly
experientially defined processes. In this sense, illness is to be
differentiated from disease, because the degree of experienced illness
may or may not correlate with the degree of observed disease in the
body. We have to allow for the paradox that experiential recovery from
illness may not be the same as clinical recovery from disease. For
example, a person with a clinically incurable heart condition may
effectively recover from the associated illness by learning through
intentional self-help to compensate for the disease physiologically. And
of course, we would argue that there is often a major psychological and
spiritual component to any experienced illness, as well as the physical
component.
The experiential view of illness and wellness and the
importance of intentional self-help is supported by Dossey:
In the modern view, because of these profound
interrelations between consciousness and the physical world, rather
than attempting to extinguish the subjective element in the healing
process, we tend to maximise it; for we see it as a potent force in
exerting purposeful change. Furthermore, we reason that this change
can be initiated by patients as well as professional healers. In our
new view of health, therefore, each patient has the potential of
being his own healer. Healing becomes democratized in the new view.
(Dossey, 1982).
As healing becomes democratized, so does the inquiry
process. The human capacity for self-healing is the central issue for
the development of holistic approaches to health care, and the
appropriate way to study this is through co-operative inquiry. We have
outlined above the method of such an inquiry; we need to discuss further
the implications of its four main parts, philosophy, models of practice,
experiential method, and outcomes, since what we are up to is the
development of a whole new approach to wellness,
Discussion
Philosophy
The philosophical aspects of the inquiry must address
the issues of our beliefs about the human being and about human
potential. We must begin to build a philosophical system in which the
intent to be well or ill can be seen as a central aspect of health, not
just a rather awkward appendage on an essentially deterministic world
view. In doing this it is likely that we will draw on modern approaches
to systems theory and ecology, and the suggestions about the nature of
reality coming from high energy physics and from consciousness research;
as well as on modern humanistic psychology and those ancient disciplines
and worldviews which are re-emerging. We will need to build a philosophy
which includes the material world and the body, society and culture, the
conscious and non-conscious mind, the transpersonal realities of symbol,
myth, and archetype, powers and presences in other dimensions, and the
power of Being itself. This philosophical inquiry is essential, and it
is essentially integrated with the whole inquiry process: the
self-healing person and the person involved in the intentional
enhancement of their wellness is likely to have a radically different
world view from that accepted normally in our culture today.
We would emphasise that this project affirms the values
of heterogeneity, diversity, and creativity. The validity of the
findings will be enhanced not only by the consistency and convergence of
findings as in conventional inquiry, but also by the ways in which
diverse perspectives overlap and illumine a common area of inquiry.
These philosophical investigations will start with
visits and discussions with those persons and groups worldwide who are
making fundamental contributions to thinking on these issues; it will
involve reading widely and creatively, writing working papers and
circulating them for comment; organising seminars and maybe a conference
at which these emerging ideas can be critically discussed. And the
philosophical investigations will also involve grounding the inevitably
abstract ideas in seminars and discussions with those involved in our
inquiry groups and other interested persons.
Phenomenology and conceptual models
A second and closely related aspect of the inquiry will
be to build a phenomenology of the processes of self-healing and
enhancement of wellness drawing on many different healing and
developmental disciplines, the experience of practitioners in this
field, as well as on our own experiential inquiries as they develop.
This phenomenology will offer a conceptual map of self-healing work,
encompassing a wide range of key variables such as consciousness and
different states of consciousness; relationships with others such as
family, peers, practitioners; specific self-directed interventions such
as meditation, visualisation, diet, catharsis, ceremony, exercise,
prayer etc; pressure and support from social and cultural influences;
relationships with the natural world and other realities. And in
addition to this the phenomenology will need to describe the dependence,
independence and systems effects of these variables.
As with the philosophical framework, this phenomenology
will be derived through discussions, papers, and wide-ranging personal
contacts. It will be clarified, refined, revised, and grounded through
the experiential knowledge arising from the co-operative inquiry groups
on the project.
Experiential methods of intentional self-help
The third aspect of the inquiry will be critically to
explore and describe practical methods of intentional self-healing. This
will involve introducing self-healing techniques to groups of patients.
These patients, working as co-researchers, will practice these methods,
periodically taking time to reflect together on this practice and its
outcomes in order to refine both the methods and the concepts on which
they are based. They will then
take these refined methods into further cycles of
action and reflection. This research
cycling between practice and reflection is a central part of the
experiential inquiry method and of its validity procedures. Similarly
groups of persons who are well by conventional standards would engage in
co-operative inquiries on techniques for enhancing their wellness.
This aspect of the inquiry is the empirical core of the
whole project: our aim is to set up 30 co-operative inquiry groups, each
one including 10 - 15 persons, each group looking critically at
self-directed methods of healing and enhancing wellness. Thus there will
be a network of interacting co-operative inquiry groups, a kind of
federation of inquiring self-healers and self-developers all fed by and
reporting back to the central core of the inquiry process.
We envisage a range of different groups: one whose
members have the same illness, and all use the same self-healing
technique; another whose members have the same illness, and use
different self-healing techniques; there may be a group whose members
each have a different illnesses, but who will all use the same
self-healing technique; and a group whose members have different
illnesses, in which a range of different techniques are used.
Complementing this could be two kinds of wellness groups, one kind whose
members use the same techniques and another whose members use a range of
different techniques. Of course these are guiding ideas only; in
practice strategic decisions in the philosophical and conceptual stages
of the inquiry may change this, and group members may decide for good
reason to run their groups in ways that do not accord with this logical
plan.
Such a set of groups would also be able to interact,
exchanging views and discoveries, thus increasing the richness of the
inquiry process. As a result, our empirical findings will be based not
in controlled experiments, but in the critical interaction of different
perspectives, building into a concatenated or pattern theory grounded in
experience. The validity of this kind of research lies in the
development of patterns of knowledge based on direct experience
(Deising, 1972; Reason, 1985).
Strategic decisions about the inquiry process - what
techniques to explore, what different sorts of illness to look at, what
groups to set up etc - will be made by the Directors of the project in
consultation with others involved as appropriate. At this stage it is an
open question as to the kind of illnesses we explore, and how we choose
from chronic and acute, functional and organic, curable and "incurable"
conditions etc.
Outcomes
The final aspect of the inquiry is research into
outcomes. In other words, what impact does the involvement with these
self-directed methods, both specifically and in general, have on
people's health and on their lives? It is important to emphasise
that the kind of holistic and experiential inquiry process we
are proposing here will not produce the kind of positivist answers
produced by the controlled clinical trial; nor do we believe this to be
desirable. Any inquiry into an intervention, whether that intervention
originates externally or through human agency, must view the whole
person within their context, and take into account the many variables
and their interaction. Thus we reject the use of matched control groups
in this study, since these can only reduce comparisons to crude unitary
dimensions, and do not help specify what factors internal or external
are having what effect.
Rather than resort to experimental methods, we argue
that it is possible for persons to discriminate within their experience
as to whether changes from illness to wellness, or from wellness to
enhanced wellness, are the result of intentional processes, external
factors, or some of both (and if so to what degree). In the final
analysis such an experiential discrimination is the only way in which
such a weighting of factors can be achieved. As we have argued before,
the primary instrument of inquiry is the individual inquirer in relation
to her or his co-inquirers, and the primary issues for validity are to
do with their perceptual discrimination, their emotional competence, and
their critical acumen, both as individuals and as a group (Heron and
Reason, 1984). We have developed a range of procedures which will assist
an inquiry group develop these three qualities (Reason and Rowan, 1981b;
Heron, 1982).
Also, this richly complex and heterogenous study, which
offers many diverse perspectives, will enable us to build an assessment
of outcomes based on contextual validity in which:
The validity of a piece of evidence can be assessed
by comparing it with other kinds of evidence on the same point, Each
kind has its own characteristic ambiguities and shortcomings and
distortions, which are unlikely to coincide with those of another
kind, (Deising, 1972, p 147-8).
In this kind of inquiry we are building a pattern and
systems model of explanation in contrast to the linear causal model as
with experimental method.
For the pattern model, objectivity consists
essentially of this, that the pattern can be filled in and extended:
as we obtain more and more knowledge it continues to fall into place
in this pattern, and the pattern itself has a place in a larger
whole, (Kaplan, 1964).
Programme and timetable
Our proposal is for a inquiry project over five years,
the first year being a time of preparation leading to a block of three
years in which the empirical work of the co-operative inquiries would
take place, and the fifth year being one of pulling findings together
and communicating through writing and direct teaching.
Year One
Overall objectives: Philosophical and phenomenological
preparation and groundwork for co-operative inquiries.
As we have argued above, this project needs to
interweave the philosophical with the practical. In this first year we
plan to build on our current knowledge and experience through reading
and visiting leading thinkers in the field of health and health
development, talking with them, attending their workshops, and from all
this developing an overall philosophy and starting perspective on the
self-healing process. Through these visits and discussions we will also
build up a network of critical and supportive colleagues who can comment
on the project as it unfolds, and develop working relationships with
those who we wish to invite as visiting contributors, for example as
teachers of a particular approach to self-healing.
This leads to the
second objective of the first year, which is to prepare the ground for
the series of co-operative inquiries which will take up the middle
period of the project. As suggested above, we plan to complete 30 such
projects over the three years, for which purpose we will require about
10 competent inquiry facilitators on a part-time basis. While there are
plenty of people competent to facilitate self-directed educational
ventures, few of these will also have had experience of co-operative
inquiry. Thus we intend toward the second half of the first year to
mount a pilot co-operative inquiry into self-healing and/or enhancement
of wellness, with ourselves as initiating facilitators and a group of
potential inquiry facilitators as members of the project. Thus this
group will have experience of the co-operative inquiry process at first
hand, and we will be able jointly to select those who have the skills
and interests to continue in the second phase of the project,
Thus during this first year the following activities
will take place:
- Visits to other researchers and attendance at their workshops
etc.
- A pilot/training inquiry project with potential inquiry
facilitators.
- Conceptual development -- reading, writing and exchange of
working papers, theoretical discussions and seminars.
Years two, three, and four
Overall objectives: the conduct of 30 co-operative
inquiry projects, and the continuous integration of their findings into
an overall theoretical and practical statement.
During this middle period of the project the great
majority of the actual co-operative inquiries will take place. The
strategic decisions about the direction of these inquiries will be taken
by the Directors of the project in collaboration with those others who
by this time are significantly involved, while detailed decisions will
be decided co-operatively within the inquiry groups in consultation with
the Directors as appropriate.
Thus we expect that during this period:
- Different co-operative groups will be set up and will continue
their work.
- Such groups will meet with other groups to compare experiences.
- As a result of these experiences, new groups will be set up to
inquire into interesting directions.
- All this empirical work will feed into continued conceptual
development: working papers, seminars, conference papers, etc.
Year five
Overall Objectives: developing concluding statements.
This final year of the project will be used to pull
together all the different findings into a final report. We would expect
that this report would be partly written in book form, partly more
specialist papers in journals, and partly in the form of practical
exercises and workshops as a way of teaching others directly about our
findings.
Organization
We propose that this project be jointly established at
the British Postgraduate Medical Federation, University of London, and
the Centre for the Study of Organisational Change and Development,
University of Bath.
Directors
The project will be co-directed by John Heron and Peter
Reason. Their responsibilities will be for the overall direction of the
project, for recruitment, training and supervision of additional staff,
and for much of the conceptual development and writing.
Advisors
We intend to recruit a group of honorary luminaries from
both orthodox and complementary medical practice to advise and support.
In addition to this, we expect the project to form close working links
with doctors, complementary practitioners, and other interested
individuals, as well as with institutions such as the BHMA, BHHA, RCCM
etc.
Senior Inquiry Facilitator
As outlined above, this project will require the support
of a number of part time co-operative inquiry facilitators. One of these
will be more active in the project, working probably on a half-time
basis throughout the five years, and on a full time basis during the
middle three years. Her or his responsibilities would include helping
the directors with the selection, training, and management of the
inquiry facilitators, as well as conducting several herself, and
assisting with the development of the ideas and practice of the project.
Part-time Inquiry Facilitators
Approximately ten such persons, skilled group
facilitators, would join the project on a free lance basis to lead and
conduct about three inquiries each.
Administrator
This is a complex project, involving possibly 500
people, money, premises, phone calls, papers and letters, and a mass of
written and taped information. For efficiency, it will require at least
a part-time administrator with typing skills.
Budget
The following proposed figures are very approximate.
Director's fees £10,000 pa
Senior Inquiry Facilitator Year 1 £5,000 Year 2-4
£10,000 pa Year 5 £5,000
Inquiry Facilitators: 30 inquiries, 15 contact days each
at £150.00 = £67,500
Administrator/secretary £7,000 pa
Travel £2,000 pa
Rent £3,000 pa
Equipment £3,000 pa
Administration £1,000 pa
Total £237,500 over five years
References
Diesing, P. (1972) Patterns of Discovery in the
Social Sciences, London: Routledge and Kegan Paul.
Dossey, L. (1982) Space, Time, and Medicine,
Boulder: Shambhala.
Heron, J.(1971) Experience and Method, Human
Potential Research Project, University of Surrey,
Heron, J,(1981) Philosophical basis for a new paradigm,
In P Reason and J Rowan (eds), Human Inquiry, a sourcebook of new
paradigm research, Chichester: Wiley.
Heron, J.(1982) Empirical Validity in Experiential
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Heron, J and Reason, P, (1984) New Paradigm Research and
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Heron, J and Reason, P. (eds),(1985) Whole Person
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London.
Houston, J, (1982) The Possible Human, Los
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Pietroni, P. (1984) Holistic Medicine. New Map, Old
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on Research Methodology and Complementary Medicine. To be published in
Complementary Medical Research, Vol 1.
Reason, P and Heron, J. (1985). Research with
people: the paradigm of co-operative experiential inquiry. Working
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