Behavioral Corner
Hi, and welcome. I'm Steve Martorano. And this is the Behavioral Corner; you're invited to hang with us, as we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and wellbeing. So you're on the corner, the Behavioral Corner, please hang around a while.

Steve Martorano 
Hello, everybody, and welcome again to the Behavioral Corner. Here I am again hanging, Steve Martorano. What we do at the Corner, you know, is we are really lucky. People come and go and they walk by they go to the bodega, and they get their sandwiches and they buy a newspaper and they always...and some of them stop by. And they have great stories to share with us and fantastic expertise in areas we hope you're finding interesting. Okay? Behavioral Corner, of course, is underwritten by our great, great partners Retreat Behavioral Health. They provide the funding for this and on occasions, not unlike today, they provide the expert people we can call upon them. We're very, very grateful for that. Tom Longenecker joins us for the first time in almost a year. Tom has been a great help both on this program, and just being able to pick up the phone and call him when I have questions. He is a clinical supervisor for Retreat, Behavioral Health and he has vast experience in both mental health treatment and addiction treatment. He also has a background and an extensive background in theology, which is very interesting. I think those two things might not seem to coincide but...but they do. The next time you try to pray your way out of a problem. That's what you're doing. Anyway, Tom joins us for an opportunity to take a look at something that - listen we all know about there are moods, we're here to find out on the Behavior. Corner today, you know what kind of mood you're in. But for many, many of us, but all of us, we're all creatures of our moods. For most of us managing our moods is fairly simple, sometimes automatic, but for many, many others, our moods become problems, serious problems, sometimes. Problems that can ruin a life, or best I guess made for a horrible existence. I'd like to begin at you're suggesting that it's a great place. When we talk about mood disorders. What exactly are we talking about?

Tom Longenecker 
I think Steve, one of the ways to start with that is actually in the term mood disorder. The mood itself is disordered, and it brings disorder to my life. Just as when we talk about personality disorders, which is a whole other topic, characteristics of personhood, personality, or disordering, to my life, and oftentimes other people's lives as well. But so I think we start off with simply that the mood itself brings disarray to my life, it works against stability, and often against stamina as well. So for instance, depression is perhaps the most common if we're going to talk about what is affecting mood, anxiety, both of them with anxiety, there's a lot of difficulty with focusing, it's difficult to track a thought, My thoughts are running all over the place. We talked about racing thoughts, difficulty sleeping, irritability, there might be some kind of suicidal tendencies and fear. With depression, we have often a difficult focusing difficulty, and focusing my thoughts are all over the place. They are racing thoughts. We have difficulty sleeping, it's often elusive, or it's the only thing I can do. There's often a degree of irritability that goes along with it as well. So I just respond to anything. I just kind of carry around a mood, always just easily, finding it difficult to find joy or to respond to my environment with some kind of gratitude because everything just irritates me. And it's a very real thing. As well as depression, there's a lot of tendency toward suicide, suicidality, and despair. So when we talk about those two things, you recognize that they sound a lot alike, but they're very different. And, you know, in the brain, they probably are functioning at different ends of a specific kind of element of the brain. But one of the ways to kind of distinction between those is anxiety is often associated with agitation and high arousal. And depression is often associated with rumination and low arousal. So with anxiety, I tend to be amped, okay, I tend to have the energy I can't quite know what to do with. And you can kind of see that in terms of, you know, kind of fidgeting and another kind of physical expressions with depression. I tend to ruminate on thoughts. I dwell on them, as opposed to them racing around with me. And the movement itself. My body is depressed, it feels through my whole body. In fact, that's kind of why we talked about feeling okay, I feel these things in my body.

Steve Martorano 
Right. It's interesting you think of something intangible, a feeling, isn't it? It does not matter, right? It's, but...but it is -- but it is something that manifests itself very physically. So okay, so we begin right at the obvious point where you say when we talk about mood disorders, it's not the mood. That's by itself the problem because we all have these books, but it's that they become disordered. You know, you mentioned anxiety, for instance, to a certain extent, anxiety is like an evolutionary result of evolution, isn't it? I mean, they were, you know, in order to survive, we had to recognize, for instance, the threat to our environment, or the condition in our environment. And when it wasn't good, feel bad about it, or feel anxious about it. I mean, the example is, if the lion is chasing you, and you don't feel anxiety about that, you're gonna get eaten by the lion. So when we talk about anxiety as a disorder now, and that aspect is gone. Right? Are we talking about a free-floating kind of a problem? In other words, I'm anxious, but I really don't have any reason to be anxious, is that part of the character?

Tom Longenecker 
Sure, we recognize anxiety by itself is just part of life. As you said, you know, evolutionarily, yeah, if I see a lion, I should be anxious. This morning, I was coming in, and suddenly the traffic was congested. And I put up my Waze, and I saw, it's gonna take me an additional 20 some minutes to get here, you know, suddenly, I kind of my chest starts to tighten up a little bit. Things are not going as planned. Okay? You know, if you sit down to take a test, or you step into the batter's box, you probably will feel a lot of the same things that people talk about when they say they talk feel anxious. Okay? This is some of this is simply a matter of what's going on inside, it's like there's a release of adrenaline into your body. This allows us to move quickly, this allows us to function this has in the past allowed us to survive. The difficulty with anxiety, when we talk about this as something that's more pervasive is that, again, it's disordering our life, it makes it difficult for me to remain in relationships, it makes it difficult for me to make decisions, it makes it difficult for me to move ahead. And so so much of the issue is learning how to navigate with anxiety. And some of that is a matter of also recognizing our world as a whole is perhaps not as anxiety-driven, not as just as many natural things drive that anxiety that that allows us to survive. At this point, some of those things are actually detrimental to our lives, because it's not actually a big threat. One of the issues is oftentimes trauma, the experience of trauma, at some point in life, has basically activated that system of releasing adrenaline into the body. But it does not put the brakes on. And so we start to see so many things as red flags as so many things as potential terror or potential danger when they're not. So part of the issue of anxiety is that it has changed our perception. So we're seeing an experience in the world as more fearful, more dangerous than it is. Which means we tend to respond to many things as potentially dangerous.

Steve Martorano 
Yeah, there are things that you should worry about. And there are things that you should not worry about. Obviously, the same conditions prevail with regard to depression. By the way, these disorders that we're talking about, have these moods in general and have been with us forever. They have never been more acutely affected, I believe, in our lifetimes than during this pandemic. I mean, there is nothing but reasons to be anxious. There is nothing but reasons to be depressed about what's been going on. Again, the dividing line is when you fall into a debilitating or counterproductive activity, stopping you from enjoying your life and making things worse. So because it's okay...it's okay to be depressed. I mean, you know, we still can't go to the movies.

Tom Longenecker 
We first started talking about things that we probably would label anxiety, probably in the middle of the 19th century, as part of the industrial revolution. We were building trains, people were concerned that people could not travel that fast. But what also was happening was the pace of life was quickening. So that was new. And so we're experiencing a different kind of world. And that's exactly what's happened in the last year and a half with COVID -- we're suddenly experiencing a very different kind of world. And so it's difficult to distinguish what is potentially dangerous, what is not. But it's also thrown off just our natural pacing. So that's part of that, again, you can recognize that's part of a reaction to the world around us. And some of that is distinguishing between how do I continue to thrive? How do I continue to move through this and navigate through this? And at what point does this now become debilitating?

Steve Martorano 
Well, you're mentioning the industrial revolution is sort of the beginning of taking a look at these problems because they were exacerbated because of the changes of the industrial revolution. Certainly, social media and the internet have accelerated everything in an explosion of information. That has been, I guess, impacted very significantly in these mood disorders, you agree?

Tom Longenecker 
Well, and certainly, you know, if you're really hooked into a lot of media, a lot of what the media runs is the same disaster or catastrophe or incident over and over. So that's basically a way that we're being we're ruminating, without ourselves being particularly motivated to ruminate. But we go through the same kind of scene over and over again, if you're, if you're kind of like in the news loop for the 24-hour news loop, you know, and you can think back to any kind of catastrophe, it gets played over and over and over. And that's one way to deal with trauma is to re-address it. But usually, in that form, it's really just heightening rumination, I just see it again, I see it again, I see it again, with just keeps me keeps my whole self inflated and anxious.

Steve Martorano 
Can you give us just a few of the maybe not so obvious symptoms of this? Because, you know, you run into problems of, "Well, are they just a gloomy person? Or are they depressed?" This affects everything affects. Tell us some of the ways it affects it.

Tom Longenecker 
Now, the gloomy person might actually be struggling with some kind of anxiety, or some kind of mood or personality disorder as well. But again, some people are just gloomy. But, you know, again, depression, there's dysthymia, which is, I guess, for lack of a better word, a mild form of depression, but it tends to be longer, it tends to, I believe, the diagnosis usually looks at it to last, maybe two years or more. And this tends to be related to...

Steve Martorano 
Constant...as a constant kind of state of affairs for someone?

Tom Longenecker 
It's always in some way present. It might be lighter at times, but generally, this is the mood. If you kind of look at a mood as a climate and emotions as the weather of the day. Okay, this would be the mood, this would be the climate for a long period of time. You know, I eat food, but it just doesn't taste like what I remember tasting like I don't really get enjoyment from it. I really enjoyed fishing, but now I'm just standing in the water with a pole in my hand. And so a lot of that is related to detachment from life, and particularly the enjoyment and connection of life. I connect to others, but it's just difficult. It takes energy, to be connected. And again, some of this is in the aftermath of a death, in the aftermath of a dissolution of a marriage in the aftermath of fill in the blank, that would be a very normal response. Okay, this has been a body blow to me and my spirit. And so at some level, it is a very normal response. It doesn't mean that it's not debilitating. But it's an understandable response.

Steve Martorano 
Well, what is your default position -- then you've got a problem.

Tom Longenecker 
Well, and because it's it is limiting to live, it is limiting to my personhood at that point. Certainly, you know, there's...

Steve Martorano 
The meteorological metaphor you just used about the weather is interesting, because, and I know we want to talk a little more specifically about bipolar. But in reading up on bipolar, I saw it described once as a storm in your emotions. Is that an accurate characterization of someone who's suffering from bipolar disorder?

Tom Longenecker 
I think that's a good metaphor because it talks about the kind of explosive and the extremes of what can occur across the dynamics of bipolarity. Certainly. Certainly.

Steve Martorano 
Let's take a moment here and talk about bipolar. Again, we'll do what we did at the beginning, when we say bipolar disorder, what are we talking about?

Tom Longenecker 
Okay, so historically, this was referred to as manic depressive. And they're the term is like there are periods of mania, there are periods of depression. We've since moved that over to talk about bipolar, speaking about polarity, that those types of different dimensions. And there's some, there's some, some kind of vagary, some kind of distinctions around making the different kinds of diagnosis there, there's bipolar one, and then there's bipolar two, we can often think about bipolar two as a milder form of bipolar one, but they're probably actually quite distinct. But one of the things we see, particularly in bipolar one is a very elevated mood. Okay, going back to the mood itself, very expansive, that sense of self in a manic period can be very elevated, very grandiose. This is different from narcissism. This has to do with, I think I'm going to create the cure for cancer. I haven't gone to medical school. What do you do? Well, I do everything well, and it can become really detached from reality. Extremely detached from reality. The other piece of that is sleep becomes very limited and decreased so people can get a lot of things done. You hours asleep. Speech tends to be pressured on ending. If you and I were talking, this interview could go for a long time because it'd be very difficult for you to cut me off. Kind of the pacing of life is very erratic. There are often high-risk behaviors that can be related to sex. That can be related to spending, shopping, which can again go back to speech. I say things that are inappropriate, that in another mood of my life would be unthinkable for me to say.

Steve Martorano 
Judgment is impaired? 

Tom Longenecker 
Certainly, judgment is impaired, again, seems to orbit around the sense of myself, that my sense of self is very elevated and messianic grandiose,

Steve Martorano 
during this manic stage, the person experiencing it doesn't feel it as anything abnormal, they, in fact, enjoy it.

Tom Longenecker 
Often, and that's part of the perception is it's very enjoyable. And so people often resist the meds that will level that out, or even the suggestion, there's anything wrong? Can I see that? Certainly, because I'm, and it's difficult sometimes to point it out because I'm actually doing very well. You know, in your field, you might be out-selling everybody else. Or you might be creating all kinds of art or what have you know, you can kind of fill in the blank, it does tend to move at some point where that's no longer really functional, where it's no longer really serving you or yourself or your life anymore. Because it's it's so disconnected from skill, from capacity from reality.

Steve Martorano 
There is obviously another side of bipolar, and that is the inevitable depression, that follows is quite a mania, right?

Tom Longenecker 
That is another side of the cycle. Now people can cycle rapidly, we do have rapid cycling bipolarity, which can be moving through a day between mania and depression. But it's probably more common to see periods of mania that are extended, and periods of depression that followed that are also extended

Steve Martorano 
in the depressive state that follows the heightened mania of the mania rather, there are different dangers, or they're not. I mean, yes, everything you described the heightened stage. Sounds pretty, pretty lousy. But there are other dangers in the depressive area, correct? 

Tom Longenecker 
Certainly, because at that point, there is often still a degree of energy, and the sense of self is still disconnected. And so despair, people in a depressed state are at high risk for suicide...

Steve Martorano 
Yeah.

Tom Longenecker 
...because again, my sense of self, my relationship to kind of hope, is really disconnected. I think for people who don't experience bipolarity kind of some sense of vertigo is kind of a kind of existential vertigo, is probably a way to maybe understand a little bit of that, because it's exhausting to go through these moods. It's exhausting. It's exhausting at some point, after that heightened period, it's exhausting to be in depression,

Steve Martorano 
Are people who have bipolar disorder, able in the depressed stage to reflect upon how their behavior in the manic stage was so problematic, or are they just regretful that it's over?

Tom Longenecker 
I suspect that ranges from person to person, but I believe that I would suspect that I've seen a good number of people in that stage are able to have, some understanding of what was going on in the period. You know, again, it's certainly understandable, I would prefer to be in a heightened stage as opposed to a depressed stage. But yeah, there's some degree of that, but still, the issue isn't depression. And this would be depression across the board, is there is a disconnection from self. And so my vision for myself, my vision for my future, is really skewed and often limited.

Steve Martorano 
Do we know what causes mood disorders in general and bipolarity? In particular, what's going on? It's not like they were caught in disease, or actually, they have a disease...

Tom Longenecker 
They have a disease. They didn't catch a cold.

Steve Martorano 
It's not airborne. Do we know what some of the causes of mood disorders are?

Tom Longenecker 
Um, you know, there's, we have hypotheses, and again, without being too elaborate, you know, the question always is environment and nature and nurture. And yes, the answer is always yes,. The answer is yes to both. Okay. There might be some family tendencies that we can trace across generations. However, if you're raised in a pretty erratic environment, that's probably going to breed more tendencies to be to respond to radically as your as well. So that's difficult to really kind of say, well, this really point to genealogy and say, well, there it is that you see it here. We see it here. We see it here. So there's most likely some kind of genetic predisposition in some ways. However, again, we tend to come back to some kind of trauma or something that was very disassociating that something that was very erratic in one's life, which has developed this kind of off-kilter way of being something has thrown me off kilter at some point in life, whether that might be just the fire myth that I grew up in as a child, whether it's specific several incidences. So when we're talking about bipolarity, there tends (to be) some kind of events or just environment that my erratic behavior developed in

Steve Martorano 
What role is stress play as a trigger? 

Tom Longenecker 
Well, again, stress like anxiety is, you know, it's a piece of life with people who struggle with bipolarity stressors often can kind of set the stage for an episode. So one of the ways of working through that is trying to develop stability. And that's stability with meds, that's stability, with therapy, that stability, just also with routine, diet, everything. And you know, what that also can do is, you know, sometimes people don't care for stability, they don't care that it's the same, the routine gets old and I want something different.

Steve Martorano 
So I'm going to Tom Longenecker. He is a clinical supervisor with Retreat Behavioral Health and he's taking us through the ABCs of mood disorders. And take a moment and pick it up with how do you treat this? How do you treat mood disorders? Behavioral Corner -- don't go away.

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Steve Martorano 
Tom Longenecker is our guest. (We) Always call upon Tom when we've got questions that we don't know anything about. And certainly, mood disorders are so broadly a problem in our culture in our lives. And we wanted to take a look at some of them and their causes and symptoms. Now we're going to take a look at how you treat this. Let me begin with as you know, I get paid this the "dumb guy question," so is the "dumb guy question." Okay, if our behavior and our moods are a function of the way our brains work, and I think that's true. And there's something going on in our brain, that's making us either depressed, anxious, or bipolar. What techniques or methods are there to treat the thing that can correct it -- the problem -- when that's what's not working properly? Does that make any sense to you? 

Tom Longenecker 
Certainly, yeah. 

Steve Martorano 
So what are some of the ways we treat mood disorders and bipolarity, in particular?

Tom Longenecker 
I just want to just refer back to some of the distinctions between bipolar one and bipolar two is that bipolar two, while seeming milder, tends to have increased in longer periods of depression. So it is also very, very debilitating as well. You know, so there are several ways of working with any of these mood disorders. Some of that is psychotropics medication. Okay, because as you pointed out, at some level, whether my neurons made me do it or not, at some level, this is what's going on in the neurology in the brain chemistry. Okay? And so there's a range of psychotropic meds that are utilized. This is one of the reasons and I can't speak very specifically about this, because I'm not a psychiatrist. But it's one of the reasons to get a very good diagnosis. Because if you're being treated for depression, that's probably most likely not the way to treat somebody who has bipolar. So getting a really good diagnosis and a clear sense of clarity around what is going on. Because they are not the same thing neurologically.

Steve Martorano 
Yeah. Well, let me stop you right there. When we talk about meds, the class of drugs we're talking about, are they are the benzodiazepine drugs, they are?

Tom Longenecker 
Oftentimes benzodiazepines -- again, psychiatrists, this is not my field. But psychiatrists will use often a combination of sometimes beta-blockers, anti-SSRIs, antidepressants, and benzodiazepines, in particular.

Steve Martorano 
The reason a psychiatrist does that and not a psychologist is that that is a medical decision that has to be made. And again, I know this isn't your field and if you don't feel like it's your place to have an opinion about this, my sense is on some level, and maybe this is true about all diagnoses. And then treatments is that it's less science -- it's...it's certainly science, but there's some art to this correct?

Tom Longenecker 
I would say there's an awful lot of art to this.

Steve Martorano 
Because as I understand it, when you begin treating somebody with a mood disorder, the first drugs introduced, may not be the right drugs. 

Tom Longenecker 
And this is my plug for a good psychiatrist. Because a good psychiatrist is going to some understanding of being able to track this across time, recognize how the meds also interact with one another. And to recognize when something is working, and when something is no longer working. And again, a psychiatrist will often kind of look at that sometimes in terms of this is my initial goal, and then we're going to transition to other things. That's my plug for good psychiatry.

Steve Martorano 
It's also important for the sufferer of the mood disorder and his family to understand this and not grow frustrated, or angry. that they're not seeing results, in addition to the meds not being very effective, they also can have a negative impact on the patient by making it easy for them to say, well, it's not working, I'm not talking anymore, and I don't like the way it makes me feel. That process of finding the right medicine, does take a long time or longer for some people? Or how does that work?

Tom Longenecker 
Well, partly because meds don't necessarily do their work, you know, in the first dose. That will take oftentimes weeks, sometimes months to be able to see the implications in terms of how that's interacting with somebody's own neurology. So certainly, if you're looking for a quick response, quick fix, meds probably will not actually be able to provide what we're expecting or hoping for. That's oftentimes, you know, at least several weeks, usually to be able to see how that's affecting people, person to person, and med to med. You know, the benzodiazepines primarily, are slowing down the central nervous system. That's primarily what they're doing. So we're not experiencing some of the symptoms, so the physical symptoms, and some of the other issues that go along with that heightened mood.

Steve Martorano 
So let me move now to the more standard stuff, the stuff that we're more familiar with through media and reading and stuff at let's talk therapy, or, you know, the couch and the psychiatrist at the other end. What's the role there? Since as we just got done explaining these problems occur -- with regard to brain chemistry -- I mean, how can you talk somebody into having better brain chemistry,

Tom Longenecker 
We can talk people into working with their lives and using different skills and resources. And the other piece is, we do have this kind of very active dynamic between our brains and our behaviors and our attitudes and our thoughts and our emotions. So it can feed both ways. We're not simply and this might be what my theology background comes in. Because the challenge is that our neurons make me do it, or is there a greater interaction between my thoughts, what I'm doing, and how that actually affects my neurological pathways, which we suspect it does. So there's a couple of different kinds of methodologies that have been developed, that we tend to utilize with people working with polarity. One is Dialectical Behavioral Therapy, DBT, and it's basically in the short description is basically in the name, that it's an evaluation of, of your behaviors. It's often very work-intensive in terms of people keeping cards, where they're monitoring their actions, their behaviors, how they're understanding the world. Cognitive-behavioral therapy, again, is really looking at a lot of how I perceive things, how I'm thinking about things. And so it tries to raise that up as to evaluate it. Its granddaughter is ACT, acceptance commitment therapy, which tends to focus primarily on how do I live out of some of my deepest values. Now, by themselves, these might not necessarily derail, you know, an episode. But they are ways to maintain stability through the times and to build strength and greater resources through the time outside of an episode.

Steve Martorano 
It also sounds like you're, this would fit with your theology background, it keeps the person in a place where they're able to make a leap of faith. So they can say, if I keep thinking and talking about these things, maybe I can get to a better understanding of what's wrong.

Tom Longenecker 
And it also provides a discipline at the practice of slowing down and developing reflection and introspection.

Steve Martorano 
They have to work on it, work on it. The final thing, and we're gonna let you run because, you know, we know you're very busy. There has been a lot written lately, and broadcast about a field that is not even new - it's pretty new. But it has to do with treating some mood disorders with psychedelics -- from LSD, which is created in a lab to psilocybin, which is grown out of the ground, its mushrooms. That field is they're trying to open that field up, get some of these drugs reclassified so that you can study them. And just recently, 60 Minutes did a piece on work being done with post-traumatic stress disorder, and MDMA, which is known by its club drug name as ecstasy. Do you see that field growing in the next couple of years?

Tom Longenecker 
Certainly. And I think it's important to remember that neither of these is the new, the middle part of the 20th century. I particularly believe in some hospitals in the plains of Canada, that we'll see were being experimented with and used in experimental treatment of people with schizophrenia. It's been used and also terms of treating substance use and nicotine dependency as well. And that suddenly fell out of favor in the mid-1960s. People turned on tuned in dropped out guru. 

Steve Martorano 
Thank you, Dr. Leary.

Tom Longenecker 
So yeah, so the response was very reactive in terms of ability to fund and do that research that recently, and I'm not quite sure the timeline, it's in the last decade or maybe two, where there's been more research. So the use of LSD might be a potential kind of medical intervention in the future. One of the difficulties with it is the difficulty to control it. It's much more difficult to manage than any other kind of minute. MDMA, also known as the club drug ecstasy, was used by therapists in the Bay Area, particularly around working with people with trauma, because it created an environment of safety where they were able to go deeper and deeper. And then that again became used in the club scene and exploded across the country. Both of these are really returned to earlier research. In terms of what their potential is, it's difficult for me to really say because I'm not really aware of all of the new research on them. Like anything, it's, it's unlikely to provide everything that people would hope it provides. But that doesn't mean that it doesn't have some potential likelihood of being something of a way to try to treat some of this.

Steve Martorano 
The real danger is I have seen and read is that these drugs while illegal, are available. You can get them. There are people who claim they can microdose you and help you with some of these things. People got to be very careful about doing this with the right people under the right circumstances, or it can just make everything much, much worse. But yeah, I think there's there's, it's going to be interesting in the next 20 years or so, Tom Longenecker, thanks so much. I don't know whether there's an answer to this, but I'll give it a shot. If people are feeling some particular way -- and they know it's not right -- who should they turn to? Family? Professionals? What does somebody out there now depressed and they know they're depressed? Who do they turn to?

Tom Longenecker 
So one of the key parts of this is to turn to somebody who can understand. Your first step might be your PCP, primary care physician. If you're working with somebody in therapy, it's imperative, to be honest, people often come to therapy and build slowly to really reveal everything that's going on with them. Clergy, rabbi -- some people, you might have somebody in your family who you feel that you can reach out to who can be able to provide the least support and trying to find some ways to address this. But I would say, everybody. But it is key, however, oftentimes in recognizing who is going to be understanding and supportive. It's oftentimes, the family will already recognize this, but not every family is inclined to understand the depths and the complexities of any of these new disorders. Many times families are just frustrated. It's important to be able to bring in your crew bring in the people who can understand and be asking the questions. Where can I get help?

Steve Martorano 
Yeah, never forget that what we're looking at is a disease. 

Tom Longenecker 
Certainly.

Steve Martorano 
And not somebody misbehaving for the sake of misbehavior. Tom Longenecker, thanks so much. It's always a pleasure to talk to you.

Tom Longenecker 
It's always a pleasure to talk to you, Steve. 

Steve Martorano 
I know you're incredibly busy, so I appreciate your time. Your time as well, you guys that are hanging with us don't forget to follow us on Facebook and you know, like us where you like us. We'd love to hear from you, plenty of opportunity to feedback, their topics you want to hear on the corner. We want to hear from you. We'll catch you next time on the Behavioral Corner. Take care, everybody, bye-bye.

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