The End of Mental Illness with Dr. Daniel Amen

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Hey, it's J.J. here. I am really excited to do this interview today. So I've got my son's daughter, Dr. Dr. Daniel Amen, who has been instrumental in helping him recover from his traumatic brain injury. And also I took him to him early on when Grant was first starting to struggle with some different kinds of brain stuff. I'm going to call it that. You'll see why in a minute. Because we're going to be talking today about the end of mental illness and it is a bold statement and absolutely can be backed up. And we have this, the pioneer of all of this, of spec scanning and really just understanding how we can change our brains and change our lives. In fact, that was the name of his first big New York Times bestseller, Change youe Brain, Change youe Life, along with Healing, Add Memory, Rescue, Change youe Brain, Change youe Grades, the Daniel Plan, and now the End of Mental Illness coming out. So let me tell you a little bit about him and I will also link to some of our other podcasts. He's been on that podcast a bunch. He is called by the Washington Post the most popular psychiatrist in America and Discover magazine listed as Brain Imaging Research as the top neuroscience story for 2015. He's a double board certified psychiatrist, 10 time New York Times best selling author and again this new book, the End of Mental Illness. I think this is going to change the conversation dramatically. This is so sorely needed. As you'll hear in this interview, I am like breathing a big sigh of relief and a big one of hope in all of the information we're about to share with You. He's the founder of eight of Amen clinics. There's now eight locations across the US and he has the world's largest database of brain scans related to behavior, totaling more than 160,000 SPECT scans on patients from 121 countries. Mine's in there as well. And he has published with his team more than 70 scientific articles. He's the lead researcher on the world's largest brain imaging and rehabilitation study and professional football players. And he has also hosted 14 national PBS shows, public television shows about the brain, which have aired over 100,000 times across North America. I mean, he is just amazing and then and just continues to innovate and get that information out there. And really, again, he has been a pioneer. He has gone against the grain and gotten this information out that is helping millions of lives. So before I dive in, I want to do a shout out to Linnell, who said, this show is the perfect companion to your eye opening books. Dear jj, I love your podcast. It's the perfect companion to your eye opening, life changing books. I first saw you on PBS discussing the sugar impact diet. Everything you said made so much sense to me. Since then, I've lost £30 and have kept it off for almost two years. Go, Linnell. I no longer need to lose weight. Can't say that about anything else I've done to maintain my weight. And I'm. Can't say that about. Oh, okay, I get it. I was like, what? She says, I can't say that about anything else. I tried before to maintain my weight and I'm 58 years old. I feel like I've found the holy grail. I have cut so many bad habits. Splendid diet. So soda, gluten. All right. Yay, yay, yay for you. And she uses. She says, I bought and used my exciser. Right on. Because you're going to hear today again how important exercise is. Keep up the great work on the show. You and your guests inspire me to be the best I can. Well, I got to tell you, today's guest will totally inspire you. Again, it's Dr. Daniel. Amen. We'll be back in a moment with a mind expanding interview. Stay with me.

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Chicago, IL Dr. Daniel Amen. Welcome back. I'm so excited to talk to you about this subject.

Hello my friend.

Yes, so I mean, this is near and dear to my heart, having a son diagnosed as having a mental illness. And so I am very curious about, first of all, what a provocative book title, the End of Mental Illness. Very bold.

Well, they're not mental. And if we don't understand that we damage people, we hurt them, we shame them, and the end of mental illness begins with a revolution in brain health. And what I'm trying to do with this book with this title is to change the conversation. After looking at 160,000 scans over the last 30 years, it's really clear to me that they're not mental illnesses, they're brain illnesses. And when someone gets their brain right, their mind will follow. And changing the paradigm from mental health to brain health decreases stigma, increases compliance because people want better brains. Nobody wants a mental illness. So if we can get rid of the stigma and shame, it also increases forgiveness and compassion from families and it's just what we see it our eight Amen clinics around the world, get your brain right, your mind will follow.

I just, I mean, I could jump up and down and cheer. I grew up in a family, I'm adopted and my, my adoptive brother has schizophrenia. And in my family, you were not allowed to talk about it. We were, there was a lot of shame associated with this. And as I was watching all this, I go, I don't really understand the difference between schizophrenia or diabetes. Like, why is one all of a sudden like someone's choice or, you know, has so much shame around it, where you don't have shame around someone's, you know, had a heart attack or someone's got diabetes or someone's got cancer. So, you know, hearing this is like a huge sigh of relief and it just is amazing it's taking this long. But of course it doesn't surprise me that you as such a pioneer in this industry and I, I also remember this, you early on saying, you know, the brain's the one place that we're the doctors that don't look at the brain. So here you've been the person who studied more, more brains out there than anybody. And now you've got this idea out there that I'm just having a big deep breath over. I'm just thrilled. So someone approaching it, now you're approaching it this way. What, you know, what can you say for people who have different types of conditions? You know, my son had traumatic brain injury and got diagnosed with bipolar. You know, someone who's got struggling with a mental illness now, a brain illness. What's the new hope?

Well, you know, Grant's actually a perfect example. Traumatic brain injury is a major cause of psychiatric problems and nobody knows about it because nobody looks at the brain. So you don't know that when you fell out of a tree when you were eight and damaged the left front side of your brain, that could cause depression, suicidal ideation, ADHD symptoms in school. And we, you know, because, and I don't know JJ, if you know this, but 85% of psychiatric drugs are prescribed by non psychiatric physicians in seven minute office visits. And they do standard of care treatment 12% of the time. And so it's insane what's happening. And once you start these drugs, they're really hard to stop because they're insidious. They actually change your brain and to need them and so you can't stop them. And the pharmaceutical companies, and this was purposeful on their part, they don't want to be in the order business, they want to be in the reorder business. And so when I was at Joe Polish's genius event, he had John Paul DiGiorio speak, who's the founder of Paul Mitchell, and he said from a business model, you don't want to be in the business where people order things. You want to be in the business where they reorder things. And then when I heard that's what the pharmaceutical companies is, they're trying to create chronic illness. And I'm not okay with this. Wow, we can protect a child's brain. Well, shouldn't we do that first? Shouldn't that be your number one priority? God gave you parents to protect you, to be your frontal lobes until yours develop, which really are not until 25. If you've not hurt your brain. If you've hurt your brain, it's probably 30 or sometimes 35. So this whole idea of you have to get your brain right is when Grant's brain works better, he works better. And you've probably seen this. When he supplements right, when he eats right, when he sleeps right, things are just better than when his habits are.

Bad, just like they're with everybody. You know, it's amazing. I still think back to two things that, that were why I went and actually stalked you, hunted you down at an event. And the first one was when we started having issues with him. And I remember I got a call from school and they said, he's climbing the walls. And I think he was six at the time. And yeah, he was climbing the walls because a teacher had given him a pound bag of M M's as a reward for selling a bunch of wrapping paper for a Christmas holiday contest. I'm like, I'd be climbing the walls if you gave me that. Like any six year old opens the bag and starts eating them. And then we took him to a local psychiatrist who in five minutes diagnosed him with add, like adhd, OCD, and one other thing. And I'm like, you haven't even, like, where did this come from? You know, so crazy. And wanted to put them on a ton of different medications. No talk about diet, no talk about what was going on at home. Nothing. Zero. Just crazy. And then you hear this about the, you know, and that was a psychiatrist.

And that's the standard of care. And they have called me crazy for a very long time, and I'm not okay with that. It's. Why are we the only medical specialists that never look at the organ we treat? And in the end of mental illness, there's a whole chapter on making invisible illnesses visible, how looking at the brain disrupts an outdated paradigm and charts a new path forward. And I'm a classically trained psychiatrist, I'm board certified and general psychiatry and also child and adolescent psychiatry. I trained at the Walter Reed Army Medical center in Washington D.C. i have really great training and throughout the whole time I'm like, why aren't we looking at the brain? Of course you should look at the brain. The brain is our organ. Why did neurologists look and psychiatrists don't? It's because they had a bad divorce in the 1920s. Neurologists got the brain, psychiatrists got the mind and we lost because these are brain illnesses. If you just think about it, your mind is vague and it's hard to define. And that's why, you know, outdated theories like psychoanalysis became popular because there was nothing to grab onto. So they were basically grabbing on, grabbing straws. You know, your anxiety is because you didn't get to marry and have sex with your mother. I mean that's just looney.

I just didn't know this about neurology and psychiatry getting divorced. That just sounds like the craziest thing ever.

It's the craziest thing and it was a bad divorce. We lost the brain. When clearly I've seen the brain is our organ. I did the big NFL study when the NFL was lying. They had a problem. And what we found high levels of damage but in our football players. You, you know, some world class athletes, they have a 400% increased risk of depression. Their level of obesity is insane because they have damaged frontal lobes. And if you damage in a society where bad food is everywhere, you're going to make bad decisions. And did you know half of them get divorced or file bankruptcy within three years of retiring.

Oh wow. I have to share this one with you because I had a friend, I'm not going to name her name, but she, we went out to dinner and she came in and I thought she was bringing her ex football player, ex NFL football player husband with her. And she walked in with a new guy, her new boyfriend. She's now separated, living separate from her ex husband because he's so angry, violent, depressed. And I go, well, wow, sounds like, you know, brain injury issues. Oh no, he didn't hit his head. I go, he's a football player. Like what are you talking about? You know, you know, he never passed out. He never, you know, and gosh, now really being, you know, so close to a very severe traumatic brain injury. I remember you saying, like, you hit your head, you hurt your brain. It doesn't take, you know, being on the football field time after time after time, or, you know, being an athlete to hurt your brain. And I think that you brought that one up right away. And I'd love to talk about some of the different things that can hurt your brain and what, what you're seeing from this, because, you know, I think about that all the time. As I looked at here's Grant. With a traumatic brain injury, they say there's something like 5 million people at any time in the US who are struggling from the symptoms. I actually think it probably is a lot higher because most people don't even realize they hurt their brain.

Yeah, no, it's way higher. Every year, 2 million new people have a brain injury in the United States, and most of them live. So that means over the last 40 years, there's 80 million people probably still walking around with the effects of traumatic brain injury. And 91% of the time, according to our study, it affects their frontal lobes. So why should you care about your frontal lobes? Sort of the guardian angel of your brain watches you. It helps you make good decisions. It's involved with things like forethought and judgment, impulse control, organization, planning, empathy, learning from the mistakes you make. And when you damage it, you damage your decision making, which means your money's not as good, your honey's not as good, your relationships are not as good, your work is not as good, you don't do as well in school, and undiagnosed brain injuries. Brand new study account for about 50% of the homeless problem that we're dealing with. And nobody's thinking about it. It's like, oh, they're bad people or they have personality disorders or they have mental illness. And it's just so unhelpful because as soon as you go, oh, it's a mental illness. You remember when Sandy Hook happened, the massacre from, you know, Adam Lanza, who had autism, who collected guns and was obsessed and killed all those small children. I mean, still, it's horrifying. President Obama came out and said, we need more money for mental health. Well, quite frankly, virtually all of the school shooters had seen mental health providers. And more money for what we're doing means we're going to get more of what we have. And no, we need a new paradigm that if Adam Lanza, somebody would have looked at his brain. And how do we know if he didn't have toxic exposure to mercury or lead or he lived in Connecticut. That's Where Lyme, Connecticut is. And in the book the end of mental illness, you know, after I sort of highlight the problem, I'm like, okay, how do you fix it? If you want to keep your brain healthy or rescue it if it's headed for the dark place, you have to prevent or treat the 11 major risk factors that steal your mind. And I created a mnemonic called Bright minds. And this is how people get sick, and it's how they get well, is identify which of these 11 you have and go after each one of them. So for.

Can we run through these 11? Sure.

So B is for blood flow. Low blood flow is the number one brain imaging predictor of Alzheimer's disease, But it's also associated with schizophrenia, depression, and adhd. This is why exercise is so important. And it's also why getting your heart right is critical to having your brain right. Did you know that people who have a heart attack will develop May 60% of people have a heart attack will develop major depression within the next 18 months. And I have one young star that we're about ready to embark on a documentary about his recovery from depression. And what he told me was, oh, my brain can have problems, like my heart can have problems, and so I'm okay to get that treated. That's so different from going to take psychiatric medicine because I don't have a mental illness. The R in Bright minds is retirement and aging. When you stop learning, your brain starts dying. So new learning needs to be part of everything we do just to keep the brain young. And there I talk about the hippocampus, seahorse shaped structure deep in your brain that's involved in memory and mood. And every day your brain makes 700 new baby seahorses. So stem cell production happens there, and you're either growing them or you're murdering them through your behavior. I is for inflammation, and I talk a lot about omega 3 fatty acids and gut health and how critical it is because, you know, if you have a course of antibiotics, it actually can disrupt your gut for a year. If you are not really thoughtful in how you replenish the hundred trillion gut bugs that serve your health. They make neurotransmitters. They're involved in detoxifying and digesting digestion. They help with hormones. And when your gut bugs are bad, you're anxious, you have brain fog, you're depressed. The G is genetics, but we have genetics all wrong. People think, oh, I'm fat because of my genes. It's like, no, you're fat because of your habits. Genetics, you should know your vulnerabilities, and they should be a wake up call rather than a death sentence. So in my family, I actually tried to get my brother to you. I have bad genes. You know, I have a brother and a sister that are 150 pounds overweight, but I'm not. Why? Because I don't give in to the behaviors making it likely to be so. H is head trauma, as we talked about. T is toxins. So, yes, drugs and alcohol. And I'm horrified. Many people think alcohol is a health food. It's directly toxic to your brain. Marijuana is not innocuous. I mean, I'm a fan of legalizing it, but, you know, the CBD craze sort of makes me crazy because everybody thinks it's innocuous. And that's just not my experience with it. It's like, oh, it's a plant. And, you know, well, heroin comes from that doesn't.

The fact it's a plant does not make something innocuous. Oh, my gosh.

But, you know, it's not just drugs and alcohol. It's mold. Mold is a major cause of psychiatric problems. So, you know, Dave Asprey is a friend of both of ours. And, you know, he got a SPECT scan 14 years ago, and his brain looked good. Devastated. And turned out he was living in a mold film home. And 13 years later, his brain was dramatically better. M stands for mindstorms. It's abnormal electrical activity in the brain. It's like, why do psychiatrists use anticonvulsants to help with things like bipolar disorder or anger problems? It's because it stabilizes over firing or erratic firing in the brain.

How would someone know if they were having over firing or erratic firing?

So mood swings, anxiety. That just comes out of the blue. Irritability, aggressiveness. Every patient I've ever seen who has this thing called intermittent explosive disorder. It's just like, nothing sets them off. And they start screaming, yelling, hitting every single one of them. They've had abnormal temporal lobe activity that we have seen. I is immunity and infection. So we talked about Lyme. You said your brother had schizophrenia. If I showed you a map of the highest incidence of schizophrenia in the United States. So it's the northeast, the upper Midwest, the west coast. The highest incidence of schizophrenia. And then you overlay the highest incidence of Lyme disease. They're identical.

Wow.

If somebody lives in those areas and they go psychotic, they should at least get screened for Lyme. So I have this great story. I mean, we have so many great Lyme stories but one Adriana was a 16 year old girl. Her family went to Yosemite on vacation and when they got to their cabin, they were surrounded by six deer and they thought it was a magical moment. Well, 10 days later, Adriana starts hallucinating and she's delusional, becomes aggressive. They put her in the hospital at Kaiser, put her on an antipsychotic, diagnose her with schizophrenia and that doesn't work. They then take her to Stanford and the Stanford doctor was such an egomaniac, he told the mother, she has schizophrenia and it's your job to convince her to take this medication for the rest of her life, even though the medication wasn't helpful. And if you knew Adriana's mother, she's like having none of it. And she brought her to our clinic and her brain's on fire. Like, why is her brain on fire? And thank God for the doctor who said she has inflammation, found she had Lyme and an antibiotic. Over the next year she got sane and got her life back. Now, is that a mental illness or is that a brain illness? It's a brain illness. And Adriana just graduated with a master's degree from the University of London in resource management. I'm so proud. And every day about this time, I get a text from Deb, her mom, how can I pray for you today? And that's happened for the last six, seven years. Infections can steal your mind. Just as the Susan Cahalan talked about in the best selling book Brain on Fire. N stands for neurohormone issues rampant in mental health. If your progesterone level goes low, you're more likely to be anxious, you're more likely to have problems with sleep, you're more likely to drink or use Xanax is a way to calm yourself down. And 100 milligrams of progesterone is just such a smarter thing than starting you on a benzo D is diabesity. And it's like, well, what does that have to do with the brain? Everything. As your weight goes up, the size and function of your brain goes down and it's associated with depression, with anxiety disorders, with low self esteem. And now we know it's a major risk factor for Alzheimer's disease. I published two studies that showed as your weight goes up, the size and function of your brain goes down, which should scare the fat off anybody. And getting your blood sugar right. And it's hard, right? I mean, all of these high glycemic, low fiber food like substances, they're put in our face all the time. And, you know, I. Somebody just gave me this big gift basket of bagels from this famous oh, boy in New York. And I'm like, why do these people.

Yeah, why hate things?

I mean, when you really understand it, it's a weapon of mass destruction. And so getting your blood sugar right, getting your weight right, and S is sleep. Children who sleep just an hour less on average than their peers have a higher incidence of depression and suicide. So I don't want to call these things mental illnesses anymore. I hate the term. I've hated it for 40 years. I think it is shaming. And shame on us for doing that to people when clearly their brain things. But if you're wed to making diagnoses based on symptoms in five minutes, like, what happened to your son, we should just be embarrassed by that. And I'm embarrassed for my colleagues, and I'm like, no, we're going to do things differently.

I'm just betting, though, like, when you look at. Look at your colleagues, you. It would be so frustrating to be trained in that paradigm and feel so helpless. Like, what you just outlined here is absolutely genius. And it just shows you that you can't pull the brain apart and say, you know, here's mental illness over here. If something's going on with your gi. If something's going on with your blood sugar and your hormones, all those things will impact your brain. As we, you know, we know this. It just. No one's been putting it all together, which is crazy in itself. And I would imagine as you review this, I mean, no, this, this should be foundation. Like, this is foundational medicine. And the cool thing is you fix these things as you go through, like, go through this whole list and figure out which of these things are issues. And when you fix these, it doesn't just fix your brain, right? I mean, it's like it's fixing everything. So if you had a higher risk for diabetes or cancer or heart disease or all these things are going to improve together. You don't just pull the brain out. Who doesn't want that? Everybody wants that. It's just, you know, the crazy paradoxical thing is you go in with a mental illness, you're given a medication that if it can stabilize that issue, it doesn't fix it. And it wasn't deficiency in that in the first place. It's going to create all sorts of problems. I mean, when I first started studying pharmacology, it was just like, how do I offset all this terrible stuff that these Medications that aren't really fixing anything are doing.

Another book I think you'll really like is I have this writing device that says, if I was an evil ruler and I wanted to create mental illness because if we know how they're created, we can prevent them. If I was an evil ruler and I wanted to create mental illness, what would I do? And I'd basically create American society. I would have world class athletes go to the White House and have the White House serve them fast food. That's an evil ruler strategy and it's not a political statement because I'm sort of an equal opportunity hater. If I was an evil ruler, I'd create a culture that causes people to need caffeine in the morning to wake up and alcohol at night to go to sleep. I would pass out video game consults and online free online streaming services to all the subjects, stealing their time and their attention so they wouldn't exercise. If I was an evil ruler, I would recommend everyone retire early. I'd start school early in the day, depriving children of sleep. Anyways, I have 62 evil strategies that I just think if you look at society and I know you know this, if you look at society, it's killing us if we're not armed, prepared and aware to really win the fight for our health.

I think just this shift, I love this shift so much. I mean, for me personally to be able to talk about having a brain illness and you know, it's interesting with Grant having a brain injury, it's a much easier thing to explain to someone than saying, you know, he's got a, you know, mental health problem where everyone looks at you like you're a bad mom, you know. So this whole idea of just shifting it to having a brain, a brain illness and talking about brain health is so, so fantastic. I think this alone can change everything. So I just love it. And I love this Bright Minds whole list. This is fantastic. I'm super excited about this. Now you've got the book the End of Mental Illness. What's also exciting is you're going to be able to start today with the first chapter of that book. We're going to link straight to it. I'm going to put everything@jjvirgin.com end of mental illness. Daniel, tell them what they'll get in that first chapter to get them started. Obviously you're going to want the whole book and there's a bunch of great bonuses that go along with that. But that first chapter, what will they learn?

Well, and they also get the introduction. And it really lays out why we need a completely new paradigm. And there's a great story of Chase, who was diagnosed with bipolar disorder and ADHD and a personality disorder. And his parents owned the Pocono Speedway. And it turned out he had been in two crashes and he'd been around gasoline fumes for a long time. He had a terribly toxic, damaged brain. And on his medication, he gained 80 pounds, his face broke out, he hated himself. I mean, he became a recluse. And when we took him off all of his medicines, got his diet right, he lost 80 pounds, put him in a hyperbaric chamber, really helped his brain overall. I mean, it's just a great inspiring story. In chapter one, I take another kid who'd been diagnosed with add, failed five stimulant medications. They were going to put him on an antipsychotic. And that's when he came to see me, and I talk about, well, how would we have treated him throughout history? So you really get sort of the history of mental health treatment and why it's not the way to go and the beginning of a completely new model. So with the introduction and chapter one, you're going to learn to fall in love with your brain and why you need a new model to look at things like anxiety, depression, adhd, schizophrenia, and so on. And so my hope is it will inspire you to really start taking care of the most important organ in your.

Body and give you a framework to be able to do so, which is so amazing. So thank you so much for that and for all of your work and for being such a savior for me and my son. I mean, my like, you came to the hospital for Grant. We've done multiple spec scans with him. It's. You've been a huge, huge part of his recovery. Back to that 110%. So I super appreciate that and always will. And just reminding everyone, go to jjvirgin.com end of mental illness. And again, thank you so much for your time today, Daniel. I super appreciate you and all your work.

Thank you, my friend.

All right, now after the break, I'm going to give you some easy action steps to take from this interview. So stay with me.

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Welcome back. All right, this is when I give you your action steps. So when I finished recording with Daniel, I said, okay, I need that chart. I need that chart, that Bright Minds chart. And so here's what I'm going to do. Not only are you going to get the intro in that first chapter, that will get you started right away, you are also going to get the Bright Minds chart. Here's the deal. If you want a better brain, you want to go through this because you really want to look and go, all right, how am I doing on blood flow? That's something where exercise is super important. What's going on with new learning, with retirement and aging and inflammation? Am I doing everything to control that with genetics? Am I making sure that I'm doing the things that keep me from turning on the genes that I shouldn't? What about any kind of head trauma, toxins? My mindstorms, immunity, neuro hormones, diabetes and sleep allow you to go through all of that and with a checklist, evaluate and see which areas you need to work on. I was like, you got, like, you got to get me that. So we're getting a poster that you'll have access to so that you'll be able to go through all of that super important. So that is really my big takeaway is I want you to review that chart because, you know, the more we go through discussions with all the different expert guests who are amazing, aren't they, on this show, I think the more you're probably realizing, oh, my gosh, it's all connected. And this reframe from mental illness to a brain illness and understanding how the brain is connected to blood sugar, to gut microbiome, to all the things we talk about here, so key and critical. And I hope the biggest thing that does is give you hope. As a mom with a son and a brother who had diagnosed mental illnesses, I know what it feels like to feel kind of hopeless with a lot of this stuff until you start to change the way you look at and go, how do I. How do I change this? How do I improve this? And you realize there's so many things that you can do that can make a big, big shift. So I am so excited to be able to share that information with you. And of course, a big ask, if you've loved this as much as I have, will you please jump on and rate and review? It helps a lot and share this. It's so important for this to get out to everyone. This is such a major topic. I know it's near and dear to my heart, but I'm pretty sure that if you know anybody, you know, if you've got friends and family, if you're living on this earth, you know people who are struggling and suffering. And my goal is to help a billion people get and stay healthy and end the suffering. So let's get it on out there. Alrighty, I'll see you next time. Bye.

Hello listeners. This is Anne Bogle, author, blogger, and creator of the podcast what Should I Read next? Since 2016, I've been helping readers bring more joy and delight into their reading lives. Every week I tag all things books and reading with a guest and guide them in discovering their next read. They share three books they love, one book they don't, and what they've been reading lately, and I recommend three titles they may enjoy reading Next. Guests have said our conversations are like therapy, troubleshooting issues that have plagued their reading lives for years and possibly the rest of their lives as well. And of course, recommending books that meet the moment. Whether they are looking for deep introspection to spur or encourage a life change or a frothy page turner to help them escape the stresses of work, school, everything, you'll learn something about yourself as a reader and you'll definitely walk away confident to choose your next read, with a whole list of new books and authors to try. So join us each Tuesday for what Should I Read Next? Subscribe now wherever you're listening to this podcast and visit our website what Should I read next podcast.com to find out more.