Dissed Ability

At one and the same time I am extremely grateful that I have disability insurance and can be sustained by that safety net as I cope with my Bipolar diagnosis, AND am extremely resentful that I am considered disabled at all.  The most aggravating part of being on disability is to be asked the evaluative questions by my insurance company.  Can you dress yourself?  Can you care for your own personal hygiene.  Can you assist with routine household chores?  (Truth be told, I've never done well with that last one even when I was at my best.  Just ask my wife!)

My experience has been that I have been more disabled since diagnosis and treatment than I was prior to treatment, when I was still maintaining a full work schedule, though admittedly, it was getting more difficult.  But before we proceed, a bit of background on Bipolar II symptoms.  First of all, someone who is Bipolar will experience recurring bouts with depression alternating with periods of "hypo-mania", or an elevated mood, but one that is not a full blown manic episode.  Symptoms of hypo-mania are:

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility (e.g., attention too easily drawn to unimportant or irrelevant external stimuli)
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potentional for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indescretions, or foolish business investments)

As I began to recognize these symptoms in my own life and that they were symptoms of a disease, two things occured:  First, I felt that some of my greatest gifts had been dissed, or devalued, and were now to be considered as liabilities, symptoms of a disease to be managed, not assets to be drawn upon; and secondly, I felt extremely vulnerable, unable to confidently trust in my own abilities.  For example, one of my most recent episodes occured when I decided to resign from my position as pastor of First Lutheran and go back into the woodworking business.  I immediately determined that to be successful I need to cash in some of my pensions and invest in a CNC router, along with upgrading some of the other woodworking equipment in my shop.  I was absolutely unable to hear and appreciate my wife's caution in this regard. In my mind my abilities to make this work and the goals so achievable if I just went "all in", that to even question them was inappropriate.  I, over and against my wife's concerns, bought the equipment, and only time will tell whether it was a wise choice or an "unrestrained buying spree" and "foolish business investment".  The jury is out.

I went on disability because of a deep depression.  Stress at work was also producing within me "partial complex seizures", where my right arm would shake uncontrollably.  This was particularly pronounced in Church, where I could not sit through a worship service, let alone lead one, without experiencing the seizures.  I was also diagnosed with PTSD at that time, which I preferred to call "Post Traumatic Church Disorder".

As I mentioned above, my decision to not return to the ministry, but rather establish a woodworking business, triggered a hypo-manic episode.  That proved to be relatively short lived, however.  Once we had the CNC Router up and running, a simple complaint about the noise by a neighbor (we were operating it with the garage door open) sent me into a tailspin into a deep depression.  My productivity went way down.  And since that time, I have struggled to maintain a full work schedule.

It's this vulnerability to external triggers that keeps me on disability.  My medical team is absolutely convinced that parish ministry is toxic for me, now.  Too many triggers.  And there is no way to predict whether a trigger, such as a simple negative comment from a parishioner, will send me into a deep depression that has previously left me feeling borderline suicidal or ignite the engines for another hypo-manic phase.  

I am fortunate that our Church has a good and generous disability program.  What I have come to appreciate is that there are two distinct advantages to having that in place.  First of all, and most obviously, it provides a safety net for me.  Through the disability program the Church has cared for me and my family and we have not suffered as a consequence of my being Bipolar.  But, I also realize now that the disability program also protects the Church from becoming a victim of my disease.  As I mentioned in a previous post, one of my most pronounced hypo-manic episodes ended up costing the Church millions of dollars.  Yes, that is no exaggeration.  Hopefully, one day, that will be recoverable.  Perhaps the greatest risk associated with a bipolar pastor would be if a hypo-manic episode manifested itself in "sexual indiscretions".  The potential damage of that would be irreversible.

And so, for my sake and for the sake of the Church, I've accepted the safety net.  I just wish I didn't have to answer questions about whether I can dress myself.

Sleep,or Not.

Sleep has been a constant problem, since my adolescence.  The irregularities concerning sleep have varied over time, but the lack of a consistent, healthy sleep pattern has remained constant.  A good night's sleep, illusive as it may be, is the end that has justified many means.

Early one in my life, transitions were the problem.  When awake, I could stay awake late into the night or even for days at a time without a noticeable problem.  But once asleep, I had a hard time waking.  During adolescence, when sleep problems first manifested themselves, I began by staying up late.  I became a Johny Carson fan and never missed an episode.  At the conclusion of the show, I would stack six or seven albums on my record player and attempt to sleep with the music providing the 'white noise' in the background.  By morning, I was finally in a deep sleep and could not wake up without difficulty.  My father rigged  up an alarm bell in the ceiling above my bed that they could activate from upstairs, and leave ringing until I got out of bed and went upstairs to turn it off.

During college and my years in seminary, I dealt with my sleep disorder by studying late into the night.  I found that I was most alert after 10 pm, and completed most of my work between 10 and 2 am.  One semester in college I purposely arranged my schedule with late afternoon classes and evening classes so that I could stay up till 2 or 3 in the morning, and then sleep past noon.  Even then, waking was extremely problematic.  I found myself dependent on roommates, or later, my wife to wake me up as devices such as alarm clocks could easily be ignored or turned off.  The irregular sleep pattern was difficult on relationships, whether a roommate or my wife, simply because some people actually wanted to be undisturbed by my 'alternative' schedule.

After I got married, in an attempt to regulate the sleep pattern I found that an excessive amount of walking late in the evening helped me get to sleep.  I would typically leave the house about 9 pm and walk until I was so exhausted that I could fall asleep.  This might involve 2 or 3 hours of walking, I suppose 8 to 10 miles of pavement pounding.  I became notorious in the communities in which I lived and well known by the police departments, who on many occasions had been called to investigate who this person was walking about the neighborhoods late at night.  There were times when I wondered about my safety as I walked late at night.  Then I realized that I was the one everyone was frightened by.  I wore my knees out in the process.

When I was first diagnosed with depression, I was put on Ativan, and anti-anxiety drug that also helps sleep.  Of all the remedies, Ativan, or lorazapam, was the most effective.  With it I could fall asleep on schedule and sleep for 8 hours or so.  After about four years, I decided that my depression had passed and that I could go off all medications, including the Ativan.  What I didn't realize was that the Ativan was addictive and worked on the same receptors in the brain as alcohol.  Upon quitting the Ativan, I immediately replaced it with alcohol, and found that a couple of "Scotch doubles" (my definition of a "double" varied greatly over time, and I would get really irritated at what a restaurant or bar considered a double).  Alcohol worked for me as well as the Ativan had, though my dependence on it brought a whole lot of other problems that would have to be addressed later.

When I went through chemical dependency treatment for the alcohol, my psychiatrist informed me that both alcohol & Ativan (which I had resumed taking prior to that time) were now off limits.  My "bottom" that had led me into treatment had involved taking Ativan and alcohol simultaneously, which is not to be recommended.  I nearly died that night.

Since then, my anti-depressant medications and the mood stabilizer all have a sedative side effect, though non-addictive.  And I have been prescribed trazodone to specificallly aid the insomnia.  One of the impacts that this has had on me is that now, going to sleep is no longer the problem.  I struggle to stay awake until bedtime, which has moved up from midnight or later to 8:30 pm.  But then I wake.  I begin waking up as early as 10:30 or 11, but more frequently at 1 to 2 am.  I am typically, after a half hour or so awake, able to get back to sleep for an additional hour or so, but then by 3 or 4 am I can no longer sleep.  I have subsequently been diagnosed with sleep apnea, requiring the use of a CPAP, but that has not changed the basic sleep pattern.  During the day I find myself overwhelmed with drowsiness, which is a problem in that my work as a woodworker involves using tools that are dangerous to operate while drowsy.  Occasionally, I can take a nap and actually feel rested afterward, but normally that is not effective.

It seems such a simple thing.  A night's sleep.  But a solution to my insomnia has been the most illusive issue I've dealt with since adolescence.  And to this day, the greatest threat to both my remaining on medications and my sobriety is this simple desire -- to have a full night's sleep.

Mustard Seeds or "You haven't seen nothing yet"

If I had a hero it would be Eric Norelius, a Swedish Lutheran pastor who came to this country in 1856 and began by serving two congregations, in Red Wing and Vasa, MN.  I first became aware of Norelius because the education building at my internship congregation, First Lutheran Church of St. Paul, MN was named after him.  First Lutheran Church was the oldest Lutheran Church in Minnesota, and in the early years, lacking a pastor of their own, Norelius would come up from Red Wing to help them.  On one such trip the congregation approached him about a family that had just arrived from Sweden.  Shortly after arrival, both the father and mother had died, leaving four children alone.  Norelius decided to take them home with him.

The next Sunday the congregation in Red Wing decided to hire a woman to care for the children, and the congregation in Vasa opened its basement as a home for them.  Shortly after founding this orphanage, Norelius, together with other Swedish Lutherans started a home for the elderly in Chisago City.  In time these two simple acts of charity ended up becoming Lutheran Social Services of Minnesota and Ecumen (one of the countries largest providers of senior housing).

There was also a need for pastoral leadership as more and more Swedes kept arriving in Minnesota, and Norelius began taking young men into his home to train them for ordained ministry.  Thus, Gustavus Adolphus College of St. Peter was born.  Norelius was instrumental in the organization of the Augustana Synod and became its first president.

Now I would guess that when Norelius brought those four children home that night he was not thinking about establishing one of the largest social ministry organizations in the country.  Probably he was most concerned about what his wife would say.

But if he were Bipolar, it would have been all part of the plan. . .

Shortly after my arrival in Sandpoint, a member of my former congregation in Plevna, MT, who was attending seminary, was assigned an internship as a missionary in Russia, and began serving St. Nikolai Lutheran Church in Novgorod.  That connection led me to get our congregation in Sandpoint to become mission partners and support his work there.  I was able to visit Russia twice.  On the second visit we had the opportunity to meet with the Bishop of the Evangelical Lutheran Church of Russia and Other States, and also the Bishop of European Russia.  During that visit they shared that they were dependent on a 2 million dollar gift from the German Lutheran Church to fund all the salaries of the pastors in Russia, and that the money was running out.  The bells went off in my head.  Hypo-mania kicked in.  We had 4 acres of undeveloped land next to First Lutheran in Sandpoint that was worth about two million dollars.  We could sell the land, and use the endowment fund created to support all the pastors serving in Russia.  Wouldn't it be great for a modest size congregation to take over the responsibility currently being funded by the Lutheran Church in Germany.

But when I got home, I thought, lets have our cake and eat it too.  Instead of selling our land, lets develop a ministry here (senior housing) that would generate more income than an endowment, and use the income to support the pastors in Russia.  Luther Park at Sandpoint was born.

But that wasn't enough.  If we could do this in Sandpoint, why not get the Synod to do a similar project as a means, not only of providing a needed senior housing ministry, but also as a way to fund other mission work, e.g. Hispanic ministries, new congregational starts, etc..  Plans were developed for the Beacon at Southridge in Boise, which would have been about 225 units of senior housing, and was projected to generate over a million dollars a year in revenue.  A 25 acre parcel of land was purchased for 3 1/2 million dollars and we were seeking financing for the project when the economic collapse of 2008 shut it all down.  The Church still holds the land in Boise.  Which, to my way of thinking, could be sold and an endowment could be established to fund the pastors in Russia. . .

Now, the folks at the Mission Investment Fund of the ELCA probably have no clue how a simple desire to offer mission partnership support to an ELCA intern serving in Russia resulted in their owning a 3 1/2 million dollar parcel of land in Boise.  But it all was part of the plan.  There is part of me that would like, more than anything else, to follow through on that.  After all, if Norelius' bringing four kids home could result in the founding of two of the nation's largest social ministry organizations, what could come from a more robust plan with the backing of the Church?  Just give me a modest salary (not a big deal, cause I'm already on the Church's disability plan, why not pay me to do something?).  Just let go of the reins and let me run with it.  I'll get it done.  But first I'll have to go off my medications.

Wounded Eagle

Imagine, if you will, an eagle with one broken leg.  While in flight the eagle can soar with the best of them.  The problem is landing.  Left with only one good leg, every time the eagle comes in to land the result is not pretty.  And then, to avoid the rough landing, it is determined that the only reasonable choice is to keep the eagle from flying.  And so, rather than being able to soar (and crash land), the eagle now is restricted to limping along on the ground.

That pretty much describes how I feel today about being treated for Bipolar II.  

But first, a few notes on the diagnosis and treatment that I've experienced.  First of all, diagnosis of mental health issues is not an exact science.  There are no brain chemistry tests to determine what exactly is going on in there.  In my case, I was first diagnosed with dysthymia (long term, low grade depression) with major depressive episodes.  Later on, a lovely word was added to the diagnosis -- "unresponsive", meaning that in spite of treatment with many different medicines and a substantial amount of therapy the depression continued.  It was like having a viral infection as opposed to a bacterial infection.  It simply had to run its course.

After unsuccessfully trying to treat the depression with anti-depressants the decision was made to change my diagnosis to Bipolar II and use a mood stabilizer as the major therapeutic drug.  This has been more successful. There is a type of backwards diagnosis going on here.  If the depression responds to a mood stabilizer, but not to an anti-depressant, then the likelihood is that one is dealing with Bipolar depression, not 'normal' depression.

I wish that I could say that having the correct diagnosis, and treating my Bipolar II condition, has now restored me to health and everything is just fine.  What has happened for me is that the ups and downs that I was experiencing have been replaced with a consistent low grade depression.  I once told my doctor that if we were going to stabilize my mood, could we wait and stabilize it during a hypo-manic phase.  A persistent state of 'soaring with the eagles' sounds a lot better than hobbling along on the ground.

This is my experience.  During the ten years or so that I was self-medicating with alcohol I was functioning at a very high level.  I had one of my most substantial and sustained period of hypo-mania and was accomplishing much.  If that could have been sustained I would never sought treatment in the first place.  And quite frankly, if I could return to that state I would do so in a heart beat.  There were two  problems.  They both have to do with the progression, the trajectory, that I was on.  With respect to the bipolar symptoms, the highs kept getting higher, and the lows lower, and the transition between the two more pronounced and in my words, violent.  The second problem is that alcoholism is likewise progressive.  It was taking more and more alcohol to have the same effect, and with the increased consumption came an increase in the negative consequences.  Alcohol works until it doesn't and then it never will again.  What happened was that I had a rock bottom, a major crash and burn, and not treating my condition, both the alcoholism and the Bipolar disorder was simply not an option.

The disturbing thing for me is that prior to treatment I was functioning at a high level.  Though I have to acknowledge that in the year prior to treatment I was on a downward spiral.  On October 14th, 2012, I crashed and burned and entered into treatment.  But I was not in anyway prepared for what happened.  The first thing we addressed was the alcohol, and I have been clean and sober since October 15th, 2012.  Then the effort was made to treat the depression.  However, rather than it getting better, it got progressively worse.  And new conditions developed.  I started having partial complex seizures. I was diagnosed with PTSD.  The depression intensified until I was no longer able to function and went on disability.  I began to notice that I was "rapid cycling", that is, I would awake between 1 and 3 am, and have an elevated mood, be able to accomplish a lot, etc..  But then by 3 or 4 in the afternoon it was like the San Francisco fog rolled in and I would bottom out, unable to function at a most basic level.  (In the years that have passed, the violent swings in mood have been moderated, but I continue to experience a low grade depression and struggle greatly to maintain even a modest work schedule.)

Now this is the way I'm tempted to think.  Life was better, as a whole, prior to beginning treatment.  I would like to erase from my memory the last six months, or so, prior to entering treatment so that I could maintain the illusion of how good life was.  It is tempting to think that it is the treatment itself that now shackles me, leaving me disabled.  If the medication is the problem, then the solution is easy and straight forward.  Stop taking the damn pills.  I know fully well why so many people with a bipolar diagnosis decide to stop taking their meds.  They want to soar with the eagles once again.  Life on the ground doesn't feel that good.

That's the temptation.  However, ceasing meds is a cardinal sin for someone who is bipolar.  In my case I am well aware that if I were to cease meds, my periods of hypo-mania would likely progress rapidly into a full blown manic state, probably requiring further hospitalization.  Also, the depressive states would progress to dangerously intense levels.  And so I continue to remain in treatment and religiously take my meds.

But it is like that eagle being told that the dangers of landing with only one good leg are too great, and the only solution is to never fly again.  I would suppose that an eagle would not be thrilled about that.  And quite frankly, neither am I.

Knight (or night) of the Woeful Countenance

If the hypo-manic state associated with Bipolar II was sustainable I'd never seek treatment.  Never. If somehow a bridge could be constructed to pass from one peak to another without having to descend into the valley in between, life would be good.  Especially, if one knew for certain that the hypo-manic state would never progress into a full blown manic episode.  It's the crash into depression that is the occasion for many, including myself to seek treatment.  And because its during the depressive cycle that people seek treatment they are often misdiagnosed.

A word on that from my experience.  It was in 1998 that I first sought help.  My initial diagnosis was dysthymia with major depressive episodes.  It took my psychologist a year to convince me that I was depressed, in part because I was functioning at an incredible high level, able to work 16 hours or more a day, sometimes, even, round the clock.  Looking back, I believe that I was diagnosed with depression during the tail end of a hypo-manic period, when I was experiencing frustration with some of the stumbling blocks that were getting in the way.  Eventually I did crash and burn, which tended to confirm the original diagnosis.  However, in the years that followed the depression kept recurring, until finally, beginning about three years ago two different psychiatrists suggested that perhaps, as with many, I was not experience recurring bouts with major depression, but rather was Bipolar II.  Part of the problem diagnosing Bipolar II, is that instead of a full-blown manic episode, a person with Bipolar II experiences a hypo-manic episode that may appear to be nothing more than a period of extremely productive, creative, goal oriented activity.  I am convinced today that the Bipolar II diagnosis is correct primarily because of my experience of the continual cycling from periods of high functioning 'euphoria' to debilitating depression.

And its not that I experience a clear, absolute, distinction between the phases of my cycles.  Its more convoluted than that.  With respect to depression/hypo-manic cycle I experience three different cycles.  I've described this like the waves on the ocean.  First you have the ocean swells, that are very long in between the peaks and valleys.  And then, on top of the swells, there are the more distinguishable waves, or the 'chop', that are much shorter in length.  And finally, on top of the waves or chop, there are the ripples cause by the wind.  In my experience, the swells are cycles that may be a number of years between the peaks and the valleys.  I'll have extended periods of time that are high functioning, during which I am highly ambitious, self driven, etc..  Then, sometimes slowly, sometimes suddenly, I descend into a long period of depression.  Within those long term cycles I experience ups and downs in my moods that last, not years, but months.  I feel somewhat better, or somewhat worse.  And then I  have in recent years noticed a rapid cycle that occurs daily.  I awake, often way too early, but feel great and can be quite productive.  But then about 3 or 4 in the afternoon it is like the San Francisco fog roles in.  And a deep darkness descends.  I find myself anxiously waiting for bedtime, just so that it will be over.   It should be noted that the highest highs, and the lowest lows, occur when these three cycles come into alignment.

I have also become aware of the manner in which a few words, or a simple event, can trigger a rapid and powerful cycling.  I realized just the other day that my most powerful hypo-manic episode and my most powerful depression were each triggered by similar comments/actions by the same woman!  (No, this was not my wife.)  I can be riding a high, pursuing grand plans with an overwhelming sense of purpose and calling-and then someone, or some circumstance gets in the way and becomes a roadblock.  And without warning, violently, I descend into a dark depression.  Likewise, a few words or a perceived opportunity to pursue a major goal or objective can flip a switch, and just like that, it's game on, get out of the way, because here we go.

One final note, and for me this is the most frightening aspect of this disease.  As I look back over my life, it progresses.  The highs get higher, the lows get lower.  And the shifts in between the two have become more sudden and pronounced.  And dangerous.

The Dream

I've been thinking about ways to help "normal" people get into the mind of one who is bipolar.  Tonight, rather than write about another episode of hypo-mania or depression, I thought I'd just share the words to a song that has resonated with me for over 40 years.  I think it could be considered the "Manic Anthem".  From Man of La Mancha, "To Dream the Impossible Dream"

To dream the impossible dream

To fight the unbeatable foe

To bear with unbearable sorrow

To run where the brave dare not go

To right the unrightable wrong

To love pure and chaste from afar

To try when your arms are too weary

To reach the unreachable star

This is my quest

To follow that star

No matter how hopeless

No matter how far

To fight for the right

Without question or pause

To be willing to march into Hell

For a heavenly cause

And I know if I'll only be true 

To this glorious quest

That my heart will lie peaceful and calm

When I'm laid to my rest

And the world will be better for this

That one man, scorned and covered with scars

Still strove with his last ounce of courage

To reach the unreachable star

Bipolar-Not Crazy

One of my greatest fears about my diagnosis, and being open about that diagnosis, is that every idea and action that I envision is judged as simply a manifestation of my disease and should be suspect.  In my case, I have been diagnosed with Bipolar II, which is differentiated from Bipolar I in that instead of full blown manic episodes, there are hypo-manic episodes, which are not (as) psychotic or delusional.  In my experience, my most creative, productive, and successful times have been during my hypo-manic episodes.  In fact, many of the ideas and activities that I engaged in while in a hypo-manic episode were damn good ideas with excellent results.  My experience of being bipolar is of cycling over and over again from a euphoric high where there seemed to be no limits to what I could do, and a debilitating depression, in which normal everyday activities became nearly impossible to complete without great effort.  Actually, it was during my depressed times that I was probably subject to attitudes and feelings that were the most out of touch with reality.

For example, in my first post I talked about the hypo-manic episode that resulted in the development of Luther Park at Sandpoint.  I'm proud of Luther Park.  It will likely be the crowning achievement of my ministry.  Nothing can diminish that, or the positive impact Luther Park is having on our community and in the lives of those it serves.  Some of the things to note about Luther Park:

• We dared to "dream the impossible dream" (and make it a reality).  Luther Park was the largest endeavor financed by the Mission Investment Fund of the ELCA, and one of the largest building projects ever completed by an individual congregation in our Church.
• In creating Luther Park, the appropriate partners were enlisted that had the expertise to guide its development and operation.  As a consequence we were able to create a state of the art facility that is "transforming aging"  in our community.  
• The sixty units of assisted living and twenty seven units of memory care have filled to capacity.  The quality of care being offered at Luther Park is second to none.  

So far so good.  But what are some of the aspects of my mental state at the time that were more clearly a manifestation of my hypo-manic state.  Well, without trying to be exhaustive, here are a few:

• Caution was thrown to the wind.  I must confess that my sense that this was my special calling from God was so powerful that it prevented any reasonable evaluation of the risk involved.  I saw no reason to be cautious.  OK, so our congregation had an annual revenue of $200,000.  Most people might think twice about taking on a 15 million dollar mortgage with annual payments of over a million dollars.  I must confess, the potential implications of that never truly registered.  

• There was an "Inflated self-esteem or grandiosity" present.  For me this was not just a project that might have a positive impact in Sandpoint, but I envisioned it being duplicated throughout the country (there are thousands of other congregations that could do this, I thought) and that I had the unique gifts to transform the Church by such an endeavor.
    
• "A hypo-manic episode is characterized by a distinct period of persistently elevated, expansive, or irratable mood. . ."  You probably didn't want to get in my way.  My sense of being called by God to this endeavor was so powerful that anyone who objected was seen not only as an irritation, but their concerns were dismissed by me as being invalid (and un-Godly).  I was riding a high and no one was going to burst my bubble.  Besides, in the grand scheme of things, this was but a first step and had to be successfully completed in order for the whole plan to unfold.
• Part of my "plan" was the revenues generated through the development of Luther Park could be used to fully fund the salaries of the salaries of most/all of the pastors serving in the Evangelical Lutheran Church in Russia and Other States.  A long story here that  I'll not go into now, but let it suffice to say that during other hypo-manic episodes other grand schemes were envisioned, and to greater or lessor extents, realized.  Also, in my mind, they were all related.

In the end there are two bottom lines to all this.  The first and most important is that if you or your loved one has dementia, or otherwise needs assisted living in Sandpoint, you will be pleased to know that Luther Park is there.  The second, and this I really wrestle with, is that there was a significant cost associated with my efforts to expand this vision beyond Sandpoint, a cost that others bear.  You win some, you loose some.

Perhaps it is just one more aspect of my bipolar disorder, but I do believe that the "gifts" associated with my disease were able to be used, by God, to advance the mission of the Church.  Again, the fact is that as I write, a hundred residents are being cared for at Luther Park.  That is not a delusion.  That is not the result of psychotic behaviors.  I'm bipolar, not crazy.