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Yes. 20 reasons why the paper entitled "Complaints of group-stalking ('gang-stalking'): an exploratory study of their nature and impact on complainants" by Dr. Lorraine Sheridan and Dr. David James (published online in 2015) - concluding that all people alleging organized group harassment are delusional - is, at best, shoddy research.P​reface - My name is Richard Griesinger. During the 50 years I lived in Pinellas County, Florida USA, I was never harassed by local law enforcement until just days after I started dating my ex-girlfriend (Jennifer Brunner) - the divorcing, soon to be ex-wife of the then fourth highest member of the Pinellas County Sheriff’s Office (Major Kirk Brunner, now retired). His best friend, Dan, had been an FBI agent in the nearby Tampa office according to my ex-girlfriend. She and I dated from 2003 until 2011 despite police harassment. The ex-husband blamed me - "the attorney-boyfriend" - for the divorce throughout our relationship per my ex-girlfriend. She initialed a list itemizing some of the harassment, uploaded into my main website - My Five Years of Systematic Police Harassment in Pinellas County Florida (and Organized Group Harassment) (link). The harassment in 2003 (by Sheriff vehicles parked near my house when my ex-girlfriend started coming over to my house) lasted only a few weeks. There was no harassment during the next five years (until 2008). But the new harassment lasted for years and was much more extensive. - The ex-husband was behind it because it occurred just days after a relationship-related event (discussed in my main website). I had to close my law office in 2012 because of the harassment, the hacking of my office’s and personal computers, phones, iphone, and email accounts, and other dirty tricks. (I was in private practice in Pinellas County for over 20 years). Initially, the harassment was traditional police harassment, if you will, by police cruisers. But because I continued dating my ex-girlfriend despite harassment, the ex-husband and/or his cohorts in the Pinellas County Sheriff’s Office tapped into a network of ordinary individuals to harass me. I referred to this harassment as “psychological lynching” in the addendum to my FBI color of law complaint which I filed with the FBI’s Clearwater field office in May 2013. Significantly, I filed it before I researched organized group harassment (gangstalking) online, before the first Snowden documents were published, and before Jeffrey Kantor's lawsuit was discussed by news media online. The type of "psychological lynching" against me which I experienced has been variously referred to as community mobbing, public mobbing, organized mobbing, community stalking, group stalking, vigilante stalking, group adult bullying, organized harassment, organized psychological harassment, organized stalking, cause stalking, street theater, and, most often, as gangstalking. I contend that members of, and/or persons associated with, the U.S. law enforcement/intelligence/private contractor community have illegally harassed me and, no doubt, many other law-abiding Americans.I do not buy into outlandish claims online and elsewhere that gangstalking involves mind reading and other such nonsense. No doubt, truly delusional individuals post online, but Snowden documents revealed that intelligence agencies have tools to flood the internet with false information and have tools to disrupt online polls (like questionnaires) and discussion forums to discredit legitimate topics and individuals. (link to The Intercept article about Edward Snowden revelations). Another example of intentional disinformation - A noted left-leaning Swedish journalist, Martin Frederiksson, who surprisingly wrote anti-WikiLeaks articles, was discovered in 2010 to be on the payroll of Sweden's intelligence agency. Near the bottom of my website at +++, I have discussed three disinformative websites about organized group stalking (gangstalking) and which discussed me - pop~agenda~culture, Research Gang Stalking, and Protected Blog › Log in. The tell-tale signs of a disinformative website regarding organized stalking are some or all of the following - (a) a bizarre website name such as “Your BioAPI and a small experiment in insanity...,” "LunaticOutPost - Conspiracy - Ufo - Fun - Discussion Forum," "http://medawarscornflakes.com," “Kooky Stuff - Gangstalking”, "TalkShoe voice talk shows and discussion groups," "popagandaculture..." (connoting propaganda). No legitimate victim would use such names; (b) lack of a verifiable name and location of the author; (c) lack of specific details about why the author was initially harassed and other facts regarding the author's harassment; (d) goofy graphics; and (e) interspersing the website with outlandlsh references to UFO’s and the like.The psychological (and financial) harassment against me has often involved bizarre activity and has been extensive, therefore, it has plausible deniability. Because very similar harassment still occurs even though I now live in another country (Thailand), I contend that it must be directed and/or financed by members of U.S. agencies. My website is not a commentary about the Thai government or police.Interestingly, before I discussed the Sheridan and James gangstalking study - "Complaints of group-stalking ('gang-stalking'): an exploratory study of their nature and impact on complainants" - in this website, the study was easily accessible online on the publisher's website (Taylor & Francis Online). Now it is not. That is, links to the study now only bring the reader to a short summary (abstract), not to the full study. Now one has to pay $258 just for 30 days access. However I believe that Drs. Sheridan and James "research" study is available on the ResearchGate - Share and discover research website (link) by clicking "Download Full-Text PDF" at its upper right-hand corner (or another possible link). The Sheridan and James study may just be misleading and shoddy research. However, based upon my personal experience, I contend that it was written at the behest of a corrupt person(s) in, or associated with, the U.S. law enforcement/intelligence/private contractor community concerned about the few, but growing number of, legitimate websites and posts online like mine. The Sheridan and James paper reminded me of the tobacco industry's past misuse of "research" to downplay the cancer link. I also contend that the above community is at the heart of organized group harassment (although corporations and other entities have used the same tactics, discussed below. Government agencies and corporations in the United States and other countries have often misused psychologists and psychiatrists to diagnose dissidents, whistleblowers, and other targets as "delusional.” For example, in 2005 an in-house psychologist labeled an NSA intelligence analyst, Russell Tice, “delusional” after he blew the whistle on NSA’s massive illegal surveillance of law-abiding Americans. Another NSA psychologist played the same game against computer specialist, Diane Ring, who was retaliated against due to a personal vendetta. Former NSA contract officer, Thomas Reinbold, said employees called NSA’s “delusional” tactic as “doing a mental." Another example of the “delusional” tactic - the U.S. Department of Labor determined the Pacific Gas and Electric Company used an in-house psychiatrist to diagnose as “delusional” the manager, and whistleblower (Neil J. Aiken), of its Diablo Canyon nuclear power plant (link to New York Times article re labeling whistleblowers as "delusional"). Another example, the East German secret police (Stasi) and the Soviet Union's KGB, under its program called Psikhushkas, used the “delusional” tactic against political dissidents and others. But perhaps the worst example of governmental officials using the “delusional” tactic is the following - In 2009, New York Police Department Police Officer Adrian Schoolcraft accurately revealed to his Internal Affairs department that many cops in his station were engaged in a criminal conspiracy. How did his superiors respond? - He was physically abducted from his residence by N.Y.P.D. members and committed to a psychiatric hospital for six days! His lawsuit recently settled for a total of nearly two million dollars.(1) Dr. Lorraine Sheridan, a forensic psychologist, and Dr. David James, a forensic psychiatrist, have no background, training, or expertise in the U.S. law enforcement/intelligence/private contractor community. They have never substantially investigated, nor have relied upon any substantial investigation, of the above community. Dr. Sheridan works with law enforcement only in the field of traditional stalking, if you will. Drs. Sheridan and James extensively relied upon Dr. Paul Mullen in their study, but he is just a forensic psychiatrist who also has no background, training, or expertise of the above community and never conducted, or relied upon, a substantial investigation of the community.(2) The Sheridan and James study was based solely upon the answers of 128 anonymous and “self-selected” persons to a questionnaire which the co-authors posted online. The questionnaire was placed on an unnamed website which was hosted by an unnamed organization offering advice to group stalking victims. My response - The anonymity of respondents afforded an easy opportunity to post phony disinformation online - a tactic exposed by Snowden documents. In 2014, Snowden documents revealed that the British equivalent of the NSA - the GCHQ - has tools to manipulate results of online polls (e.g., answers to questionnaires), to disrupt online forum discussions, etc. No doubt, in addition to phony respondents to Drs. Sheridan and James' questionnaire, there were also legitimate and truly delusional respondents. (I wonder if the unnamed organization used by Drs. Sheridan and James was FFCHS, a probable disinformation site. For example, its website previously advised victims to detoxify their bodies by ingesting “food grade diatomaceous earth” - in other words, to eat dirt. This advice was removed in May 2014 after it was pictured in a screen shot, taken in January 2014 and discussed in the website Fight "Gang Stalking", discussed below. Three fairly recent mass shooters in the United States - Myron May, Gavin Long, and Aaron Alexis - who reported being victims of group harassment, stated that they were in contact with FFCHS for advice. Yet, I have not read of any substantial investigation conducted by the FBI or other law enforcement agency of FFCHS).(3) Surprisingly, Drs. Sheridan and James failed to discuss the recognized "Martha Mitchell effect" which warns psychologists, psychiatrists, and other mental health professionals not to diagnose a patient as "delusional” just because his or her claims seem far-fetched, particularly if the patient has no history of being delusional or clinically paranoid. Martha Mitchell was the outspoken, alcoholic wife of President Nixon's Attorney General. Her rants to news reporters about illegal conspiracies within the White House were dismissed by everyone (except for White House reporter Helen Thomas). White House officials tried to downplay her claims as "delusional." But the Watergate hearings proved Mrs. Mitchell’s claims to be true. (link to Wikipedia article about the Martha Mitchell effect).(4) Forensic psychologists and psychiatrists often testify in civil and criminal proceedings as to a person’s competency. Yet, Drs. Sheridan and James, who are forensic professionals, did not reference the case of The People of the State of New York vs. D.J.H. (link), New York Supreme Court, Queens County, decided in 2011 - in which the Court relied upon the “Martha Mitchell effect.” (I found the case online simply by searching “Martha Mitchell effect" and “lawsuit”). The Court released a man who had been confined to a psychiatric hospital. The Court wrote that he was formerly a wealthy Iranian who competently testified in the case that (whether or not true) he incurred great financial loss due to illegal activity of government officials in New York, that New York cops planted two weapons in his home, and that evidence went missing in his civil case (all three claims certainly possible). The Court noted that the man knowingly refused a plea bargain in the criminal case against him just so he could testify in open court. The Court rejected the opinion of the state's medical witness, a psychiatrist, that the man was "delusional” merely because his claims seemed far-fetched and he would become upset and angry when discussing them. Importantly, the Court noted that neither the state's witness, nor any other person or entity, ever conducted a substantial investigation of the man's claims.(5) Drs. Sheridan and James relied upon the textbook definition of a “delusion” to be a firmly-held “false” and “bizarre” belief, despite “incontrovertible or obvious evidence” to the contrary, which very few others believe. Religious beliefs are excluded only because many people share similar beliefs. My response - As stated above, the beliefs of Martha Mitchell and pre-Snowden NSA whistleblowers, for example, were not supported by “incontrovertible or obvious evidence" and were, no doubt, considered “bizarre” at the time, but turned out to be true. Also, as stated below, U.S. diplomats wrote of harassment which was certainly bizarre. (The more bizarre or minor the harassment, the less likely it will be believed without documentation).(6) Drs. Sheridan and James wrote that the beliefs of the 128 respondents to their questionnaire basically fell into one of three categories - (a) “highly improbable” beliefs - such as regarding an elaborate organization carrying out its activities; (b) “impossible” beliefs - such as witchcraft focused through gold objects and the invasion of a person’s dreams at night; or (c) “impossible and bizarre” beliefs - such as a family dog replaced by an exact double with a bad temper and the remote enlargement of bodily organs. My response - The examples stated in (b) and (c), were either posted as intentional disinformation (per the Snowden documents discussed above) and/or posted by truly delusional persons. The categories (b) and (c) seem to be a distinction without a difference. But a belief based upon bizarre events certainly does not make a belief impossible (e.g., those of the U.S. diplomats discussed below). However, I am not suggesting the examples of (b) or (c) above were possible. Regarding (a) above - I contend that there is not one monolithic, world-wide organization harassing law-abiding American citizens. Rather, it is, most likely, a loose network of (hopefully, just rogue) members of the U.S. law enforcement/intelligence/private contractor community. Laws enacted after 9-11 have facilitated the sharing of information, whether or not accurate, among the 17 U.S. intelligence agencies, law enforcement agencies at all levels, and local fusion centers. Additionally, U.S. private contractors (now nearly a half million with top secret clearances) have access to much of this information. Members of a private organization Law Enforcement Intelligence Unit (LEIU), who include active and retired police officers and private investigators, also have access to much of this information. The LEIU exists to "gather, record, and exchange confidential information, not available through regular police channels." Lastly, U.S. corporations are increasingly hiring part-time "surveillance role players" (discussed below). The networking, unaccountibility, funding, and advanced technology of the above entities facilitate opportunity to illegally harass law-abiding Americans.(7) Drs. Sheridan and James failed to mention that U.S. diplomats complained of bizarre harassment, having plausible deniability, similar to complainants of organized harassment. Fairly recently, WikiLeaks revealed top secret U.S. diplomatic cables that Russian agents, presumably, were breaking into the diplomats’ homes just to move a piece of furniture, to turn on a t.v., etc. (link to Washington Post article re the psychological harassment of U.S. diplomats). I wonder if Drs. Sheridan and James consider the U.S. diplomats to be “delusional”? Another example of bizarre harassment appeared in a Sydney Morning Herald article in 2015. Michael Page, the CEO of a well-established local firm in Sydney called Netventures, said he contacted a lawyer after his firm's address and phone number were listed on the internet as those of Australia's domestic intelligence agency ASIO. During the prior two months, Mr. Page received strange and intimidating emails, text messages, and phone calls, his home's front door lock was broken, his home's power often went out, and he said "I came home and there was a bowl of sugar in the middle of the kitchen floor." He had a falling out with a prior employee who said he trained with ASIO. Mr. Page believed that he might be the victim of gangstalking where a person is relentlessly targeted and harassed. (link to Sydney Morning Herald article about possible gangstalking of CEO Michael Page). A very similar and even more recent example of bizarre psychological harassment is the following - On October 13, 2016, ABC 10 News (KGTV, San Diego, California) interviewed Facika Tafara who was the target of psychological harassment. Although it was not mentioned in the segment, she is a board certified physician specializing in internal medicine and the director of the Family Health Centers of San Diego. The ABC 10 News segment did not discuss the motive for harassing Dr. Tafara, but my guess is that she crossed a powerful member of the San Diego community, perhaps a high ranking law enforcement officer (like I did). The following is a summary of the segment - “A San Diego mother said she was being targeted for weeks by people she doesn’t know coming in her house when she’s not there. Facika Tafara thinks she may be the victim of a bizarre practice called gang stalking or community stalking. ‘It’s like an alternate reality, really,' she said. 'It’s spooky, and it’s my understanding that if this is actually what it is, it can go on for years.' The reporter said that community or gang stalking is an eerie practice that takes aim at your psyche to make you almost feel like you’re going crazy. In Tafara’s case, she said she noticed strange things out of place in her house when she would get home from work such as her windows being opened at the same level, dresser drawers opened at the same distance. She said she even found a camera inside the bedroom of her 11-year-old son. Tafara said she contacted police, and detectives visited her home, but they said 'if it happens again call us, but there’s not much we can do because we don’t know who it is, we don't have a face...' That local law enforcement did not conduct a substantial investigation of Dr. Tafara's harassment is no surprise to me. Neither the FBI’s Clearwater Florida field office, the Pinellas County Florida Sheriff’s Office, nor the Clearwater Florida Police Department investigated my factually specific, written complaints of a criminal conspiracy against me by members of local law enforcement and others on behalf of them. Based upon my personal experience, the psychological harassment described by Dr. Tafara is just one tactic used in organized psychological harassment. Other tactics that I have experienced in Pinellas County, Florida and here in Chiang Mai, Thailand are street theater and mobbing. (I define “street theater” as a pre-arranged display in public, usually by more than one person, to psychologically harass. Although the term "mobbing" is often used as a synonym for organized harassment or gangstalking, I define it more narrowly as one tool of organized harassment - subtle, intentional crowding of an individual in public places, such as a store, usually by one or two people at a time to psychologically harass and/or to attempt to provoke a response.). I emailed the U.S. Consulate's Office here in Chiang Mai on March 19, 2015 just for the record. I briefly discussed the psychological harassment of me by Americans, presumably evangelicals (e.g., a guy at a fitness center quietly repeating that a man was hit by a slow moving vehicle). My email also briefly discussed similar harassment which occurred in Pinellas County, Florida, and I cited my main website - My Five Years of Systematic Police Harassment in Pinellas County Florida (and Organized Group Harassment). Significantly, I sent my email well before I had my Summary translated into Thai and gave it to a few Thai people. Again, my website is not a commentary about the Thai government or police. (link to the ABC10 News, San Diego, t.v. segment regarding the possible gangstalking or community stalking of Dr. Facika Tafara).(8) Drs. Sheridan and James failed to research the history of organized group psychological harassment (or, if they did research it, they did not include it in their study). They wrote - “Little is known about the nature of the phenomenon of group- or gang-stalking.” and “Group-stalking is an unresearched area.” My response - Any research would show that group psychological harassment was extensively used by East Germany’s law enforcement/domestic intelligence agency (Stasi) until 1990 under its Zersetzung program (discussed below in paragraph 11); by the Soviet Union; by the United States’ FBI under its Zertsetzung-like Cointelpro program in which targets were illegally harassed, not just surveiled (including John Lennon, Martin Luther King, actress Jean Seberg, among others); by the Church of Scientology against defecting members; by corporations against whistleblowers such as Stephanie Gibaud (In 2015, a French labor tribunal ruled that Ms. Gibaud, the former marketing director of UBS Bank’s Paris subsidiary, was targeted with psychological harassment by UBS when she refused to destroy records showing that UBS concealed more than 12 billion euros via offshore accounts. Referring to her psychological harassment, Ms. Gibaud said - "That’s what I call ‘organised mobbing, gang stalking.’ It’s meant to make you crack. That’s what they expect". (link to Reuters article about the psychological harassment of Stephanie Gibaud).(9) Drs. Sheridan and James excluded discussion of legislation, enacted by several countries which define and prohibit group psychological harassment in the workplace (known as "mobbing" in Canada and European countries). (link to Wikipedia article about workplace mobbing and other types of mobbing).(10) Drs. Sheridan and James failed to discuss, even to criticize, that an increasing number of academic writings have been published about group psychological harassment outside of the workplace (academically referred to as “public mobbing” or “community mobbing”). For example, Professor Brian Martin (professor of social studies at the University of Wollongong, Australia), and Professor Florencia Peña Saint-Martin (professor of anthropology at the National School of Anthropology and History, Mexico) co-authored a paper published in 2014, an excerpt of which follows - “In mobbing, targets are judged ‘guilty’ .... afterwards, evidence to justify this initial judgment is gathered … Perpetrators manipulate and hide information, lie, … and monitor targets in a continual search for ‘new evidence’ that supposedly proves their allegations … There is a long history of other types of mob behavior, not to be confused with … mobs .., notably the Ku Klux Klan … The concept of mobbing today refers to more subtle forms of aggression … such as … continual derogatory comments, …starting rumors...’” (excerpt translated from Norma González Coordinadora Organización, Prometeo Editores, 2014). (I referred to the mobbing against me in Pinellas County, Florida as "psychological lynching" in the complaint I filed with the local FBI office. It continues even though I am residing in a foreign city. Mobbing is not only psychological harassment, but also an attempt to provoke responses which could be used against a person).(11) Surprisingly, Drs. Sheridan and James failed to discuss the well-documented use of diabolical, subtle psychological harassment by East Germany’s law enforcement/domestic intelligence agency (Stasi). Thousands of law-abiding citizens were targeted until 1990 when Germany reunified. The goal of the harassment, known as “Zersetzung” (decomposition), was stated in Stasi Directive 1/76 - “...systematic degradation of reputation, image, and prestige in a database on one part true, verifiable and degrading, and on the other part false, plausible, irrefutable, and always degrading…” It is important to know that Stasi used its extensive surveillance power, not only to surveil citizens, but also to harass them. I contend that members of the U.S. law enforcement/intelligence/private contractor community are doing the same. The goal of Stasi's surveillance was to know - “everything about everybody.” But even more onerous is the NSA’s present goal as stated in a PowerPoint slide revealed by Edward Snowden - “Collect It All; Process It All; Exploit It All; Partner It All; Sniff It All; and Know It All.” Stasi agents, with the help of civilians, such as neighbors, co-workers, employees of local businesses, health care providers, etc. spread lies and half-truths, entered targets’ residences just to move, add, or remove an object, engaged in mobbing, etc. Similarly, I contend that local FBI agents, perhaps by misusing the FBI's Infragard program, illegally convinced community members, including a few of my neighbors, local businesses, local professionals (e.g., Dr. Michelle Zetoony), and others to harass me. Of course, members of the Pinellas County Sheriff's Office, and persons acting on their behalf, did so as well, including the financial harassment of my law practice. I can only speculate who hacked my law office's internet usage, as well as my personal internet usage - which continues. An exiled East German, Jurgen Fuchs, wrote an article entitled “You’re Going to Crack,” in a West German magazine, Der Spiegel, about his personal account of being targeted under Zersetzung. Of course, the Stasi labelled him “paranoid,” much like the NSA has done to whistleblowers. But like pre-Snowden whistleblowers, Mr. Fuchs was later vindicated when Stasi documents were released to the public. (link to Zersetzung article in Wikipedia). My main website discusses Zersetzung-like tactics used against me. (Possibly relevant, Snowden documents revealed that, via NSA’s “Stateroom” program, the NSA and CIA jointly operate in countries, such as Thailand including in northwest Thailand where Chiang Mai is located. “These sites are small in size and in number of personnel staffing them. They are covert, and their true mission is not known by the majority of the diplomatic staff at the facility [U.S. embassies and consulates] where they are assigned").(12) Drs. Sheridan and James failed to discuss that U.S. private contractors and intelligence agencies are increasingly advertising for part-time - “surveillance role players.” These players are typically persons with security clearances and recruited from the U.S. military and law enforcement. They are hired to work in everyday places in a community and must sign non-disclosure agreements. The potential to misuse “surveillance role players” to harass targets is obvious. This subject is ripe for investigative reporting.(13) Although Drs. Sheridan and James listed the website - Fight "Gang Stalking" (link) - in its Reference section, they failed to discuss it, even to criticize it. I believe that this website (not the one in Facebook) is one of the few legitimate, well-researched sites online regarding the past and recent history of organized group harassment. Although not relevant to its legitimacy, the website is ranked high in any online search of the subject.(14) Drs. Sheridan and James failed to discuss the concerns of prominent Americans (some listed below) about the lack of accountability, past abuses, and potential for future abuse of the U.S. law enforcement/intelligence/private contractor community, particularly after 9-11 - former CIA operative Valerie Plame; Pulitzer Prize recipient and former Washington Post journalist Diane Priest in her book "Top Secret America"; Senator Frank Church (who, 40 years ago, chaired the Senate Committee which investigated systemic abuses by the FBI, NSA, CIA, and the IRS and accurately predicted the future widespread misuse of secrecy and technology. He warned - "That capability at any time could be turned on the American people..." and added that the community's secrecy and technology "could enable it to impose total tyranny, and there would be no way to fight back."); Edward Snowden; pre-Snowden NSA whistleblowers; former CIA division chief Melvin Goodman (who said, in 2008, the U.S. intelligence and private contractor community lacks accountability and "is essentially out of control. It's outrageous"); and former FBI counterintelligence agent and whistleblower, Michael German. Mr German, like others, is concerned that local fusion centers, created after 9-11, share information throughout the U.S. law enforcement/intelligence community, whether or not facts and assumptions are correct. He is also concerned about the potential for abuse of the FBI’s Infragard program (which I know of firsthand), and the new low threshold to initiate FBI investigations.(15) Drs. Sheridan and James failed to discuss the following persons’ allegations of organized group harassment (gangstalking) - Florida Highway Patrol Trooper Donna Watts (link to her pending federal lawsuit - Donna Jane Watts vs. City of Palm Gardens, et. al.), very similar allegations by another female Florida law enforcement officer Toni Foudy, Mr. and Mrs. Krlich of Hubbard Ohio (link to ABC’s 20/20 interview of Mr. and Mrs. Krlich) who filed a federal lawsuit (Krlich vs. Taafe; link) in February 2017), Jeffrey Kantor (whose federal lawsuit was dismissed for lack of evidence (similar to claims of pre-Snowden whistleblowers who lacked Snowden's documentation) (link to American Bar Association article about Jeffrey Kantor's federal lawsuit), Stephanie Gibaud (discussed above), Roderick Russell, and me. I discussed the above individuals more extensively in my main website - My Five Years of Systematic Police Harassment in Pinellas County Florida (and Organized Group Harassment).(16) Drs. Sheridan and James implied that persons complaining of group stalking suffer from psychiatric problems, such as staying in their residences and fearing to go out. My response - Drs. Sheridan and James apparently did not read, for example, Trooper Watts' pending federal lawsuit stating that she began living like a hermit due to the constant harassment by numerous Miami cops for months. Trooper Watts received intimidating voice messages of her private phones; police vehicles stalked her on and off duty; her private information was illegally accessed in a police database by a hundred cops; her neighbors reported seeing "strange--looking cars" idling and parked in their cul-de-sac (typical of the psychological harassment against me), etc. All this because Trooper Watts stopped a police cruiser travelling over 120 mph through traffic. She didn't know if the cruiser was stolen because its driver ignored her lights and siren for miles. It turned out that the driver was an off-duty Miami cop late for his second job. He was later fired. A law enforcement officer in Sarasota County, Florida (next to the county where I used to live) posted the following anonymous comment online about Trooper Watts. It was one of many posts personally attacking Trooper Watts in Activity Stream - LEO Affairs Forums (“leo” meaning law enforcement officers. - “ Dear Donna: All of us at the Sarasota County Sheriff's Office feel you will be out of a job in the near future. We do not condone stopping or writing other cops citations in this county and have a strong brother/sister hood in this tri-county area. With that being said, we would like to offer you a second chance at the Sarasota County Sheriff's Office Animal Services Unit cleaning our kennels. You being a piece of $hit will fit right in with cleaning up animal $hit. Please consider this position as your days are most likely numbered from the Florida Highway Patrol for your inappropriate/dangerous and malicious actions. We look forward to handing you a bucket and a mop in the near future. (link to an article about Trooper Donna Watts' experience) (link to Trooper Donna Watts' ongoing federal lawsuit, of note are paragraphs 170-182 and 332-339).(17) Drs. Sheridan and James implied that victims of group stalking are not to be believed because they have “no idea” who their stalkers might be. My response - No response is needed.(18) Drs. Sheridan and James wrote - “...We have not been able to find any record in the literature of cases where victims have been subject to two or more separate stalking campaigns by unrelated individuals in one 12-month period.” My response - Drs. Sheridan and James failed to discuss the federal lawsuits filed on behalf of Trooper Watts and Mr. Kantor, failed to discuss the EEOC lawsuit filed on behalf of by NSA intelligence analyst Karen Stewart, failed to discuss Roderick Russell's website (link) regarding the Zertsetzung-like harassment against him, failed to discuss my main website, and other legitimate sites.(19) Drs. Sheridan and James wrote that there are “limited police … resources” on the subject of organized psychological harassment. My response - The reason is obvious.(20) Drs. Sheridan and James wrote that their study of group stalking was the first to use the scientific method and peer review. My response - This is gobbledygook. What is needed instead is a Congressional investigation of organized psychological (and financial) harassment of the unaccountable U.S. law enforcement/intelligence/private contractor community similar to the Senate “Church Committee” of 40 years ago. There also needs to be substantial investigative reporting on the subject.A year after the Sheridan and James paper was published online, and only three weeks after the Washington Post article about the bizarre psychological harassment of U.S. diplomats, a New York Times article entitled "United States of Paranoia: They See Gangs of Stalkers" by Mike McPhate (link) was published (June 2016). Mr. McPhate relied upon the Sheridan and James paper to conclude that all complainants of organized group harassment must be delusional. Like Drs. Sheridan and James, Mr. McPhate has no background, training, or expertise in the U.S. law enforcement/intelligence/private contractor community. (He was the New York Times web page designer and manager). Also, like Drs. Sheridan and James, he failed to substantially investigate, or rely upon any substantial investigation of the community. (Years earlier, another New York Times reporter, Judith Miller, wrote articles based upon misinformation spoon-fed to her by government officials shortly before the U.S. invaded Iraq). Mr. McPhate's poor research and/or biased journalism was demonstrated by what he wrote, or more correctly, by what he failed to write about Karen Stewart in his article - “Karen Stewart of Tallahassee, Florida, believes large numbers of regular people have been brainwashed by the National Security Agency into thinking that she is a traitor or terrorist. Wherever she goes, she says - to church, to the grocery store, to the doctor’s office - they are there, watching. It baffles her, she said. But worse ,’It makes me angry to see how many people in this country are sociopaths. They are absolute group think drones,’ she said ’I don’t even consider them human anymore.’” But, astonishingly, Mr. McPhate failed to write that Karen Stewart was a longtime intelligence analyst for the National Security Agency (NSA) in the Weapons and Space department. She had worked for the NSA for 28 years until she was fired. Because another employee was credited with, and promoted for, Mrs. Stewart’s award-winning intelligence work, Mrs. Stewart filed an EEOC lawsuit against the NSA in 2010. She alleged that the other employee, who also worked in the Weapons and Space department, was a woman who provided sexual favors to NSA managers. NSA officials threatened to label her “delusional” if she did not drop her lawsuit. But she did not drop her lawsuit, was then diagnosed as "delusional” by the NSA - despite prior positive evaluations - and was fired. Another NSA whistleblower, Thomas Reinbold, said that NSA employees call NSA's delusional tactic as “ doing a mental." Because of my experience, I believe Karen Stewart that she was the target of organized group harassment by NSA security and by civilians acting on its behalf.Shortly after Mr. McPhate's article was published, another article, entitled “The Nightmarish Online World of ‘Gang-Stalking,’”(link) by Roisin Kiberd (link), was published online (July 2016). Ms. Kiberd, like Mr. McPhate, also relied upon the Sheridan and James paper to also conclude that all people reporting group harassment must be delusional. Like Drs. Sheridan and James and Mike McPhate, Ms. Kiberd has no background, training, or expertise in the U.S. law enforcement/intelligence/private contractor community, and did not substantially investigate, or rely upon any substantial investigation, of the community.Other articles have relied upon the Sheridan and James' "research" and, unfortunately, future articles will do so as well.​​​​​+++ More than a year after the Sheridan and James gangstalking "research" was posted online (on July 16, 2015), I published my website criticizing the study (on August 18, 2016). The two following articles appeared online just a few days after I published my website - An article entitled “Academic Research on Organized Gang Stalking is Lacking. So are Sheridan and James, and Dietrich” (posted in the website pop~agenda~culture on September 9, 2016) and an article entitled “Gangstalking Study by Dr. Lorraine Sheridan is Fundamentally Flawed” (posted in the website - Research Gang Stalking on September 14, 2016, which is linked to the above website). I am certain that the two phony articles were published as disinformation by a corrupt person(s) in, or associated with, the U.S. law enforcement/intelligence/private contractor community to counter my website. Consider the following - I sent the following email to the supposed author of the first article on October 3, 2016 -“ Mon, Oct 3, 2016<[email protected]> Name: Richard GriesingerContact Form URL: ContactDear volunteer teacher:I have read your criticism of the Drs. Sheridan and James study re group-stalking. I believe the study is shoddy "research," but I have some questions for you - 1. What is your name? 2. What city do you live in? 3. What [my comment - I meant to ask - Why] are you writing articles about group-stalking? That is, are you a victim of group-stalking? If so, what are the specific reason(s)? Your website contains no details of your personal experience (names, dates, etc.) why not?Thank you,Richard Griesinger ”I received the following email reply on October 5, 2016 - which not only failed to answer my questions, but also attempted to intimidate and threatened me. Understand that the author wrote that “she” was a volunteer teacher, but comes across as a private investigator. But more significantly, although the author is a supposed fellow victim of organized harassment - supposedly empathetic with fellow victims - “she" did “her” best to try to intimidate, threaten, and marginalize me -“ Richard-Also, in my sidebar, I have posted some 'free tools that you can use' to document these gang stalkers. As you might imagine, as an investigative journalist, I have developed habits- and one of those habits is checking IP addresses. Yours is x.xx.xxx.xx [my comment - I changed the numbers to x's], in Thailand, as you noted. I have also noticed someone (you) checking my blogs regularly in the last several days via my wordpress 'stats counter.' This sort of information, while in and of itself is not a case or necessarily immediately useful, is evidentiary material in piece and in parcel. In my sidebar, I offer you free tools that you can use as well to document any harassment you might still be enduring. I do not know what you would like from your personal situation, but I am available to investigate should you need a stateside investigator. As you know, these hidden investigations take the form of harassment, and death threats etc. And much of the is online, and leaves trace evidence. And, it is these little pieces of data that create for you, and others, the basic claim that you have been, in fact, targeted by scumbags.Best regards,popi ”A few hours later, I received another email from “popi” - which also did not answer my questions and was another attempt to intimidate and threaten me --“ Hi Chiang Mai ( Richard?).You can call me popi, like the flower. Well, for all of your questions, I would have to defer to my attorneys, located in my sidebar, where you can also read a bit about me in my bio ( but not too much). I am primarily, a writer, and a journalist. My case began many years ago, when I wrote a story about a purported terrorist in a college newspaper. Yes, I have been gang staked multiple times, in multiple places over time. And, my website DOES contain details, but they are laced within the narrative itself. Unlike yourself, I cannot afford to leave this country in order to write my story [my comment - "popi"'s community knows full well that I moved to Chiang Mai because I could no longer afford to live in Pinellas County due to my loss of income [my comment - "Popi''s community knows full well that I moved to Chiang Mai because I could no longer afford to live in Pinellas County due to my loss of income], and as you well know, people get hurt and even killed over talking about these things [my comment - intimidation and threats]. If I recall correctly- you are the guy who got stalked in Florida? Your narrative is a wonderful, clear, and concise telling of your tale.Very helpful, and insightful, and unlike the nutty blogs out there, is nearly court room worthy. And, this that you endured is called "pedofication," this situation that you described in your online work. A man named John Lang, an ex-marine, and a police corruption activist, from Fresno California was found dead in his burning house, as firefighters sat blocks away [my comment - more intimidation and threats], after he described essentially the same thing you described. They accused you of being a pedophile and so on. This fits a pattern, and part of my goal is to reveal those that do these things to others. I am offering a reward of up to 15k for anyone who can successfully bring a group of these cowardly POS to trial, and conviction. I honestly don't care if the people who are accused by these gang stalkers are indeed guilty of these purported crimes [my comment - I care] - what matters to me is how these hidden harassment campaigns, misuse of inappropriately gained personal data, and slander based in hearsay are affecting my country. I mean- if these things are true about you, and others, as the stalkers claim- then why not get it into a courtroom? [my comment - I tried to hire a law firm to file a police misconduct lawsuit, but soon learned that firms only wanted to handle cases that involve one or two incidents and, therefore, easier to litigate]. The answer to that is that they are avoiding, in plain legal terms- they are avoiding cases where clear legal standing would invoke the very hidden processes that they employ in these domestic terror campaigns waged against American citizens. I am interested in interviewing people who this has happened to, and also, possibly building towards a class action lawsuit, or in the very least, bringing this practice to light in a legitimate narrative structure that 'ordinary' people can understand, and begin to dismantle as a social ill. My case, like yours, involves dirty cops who misused data, and access to my personal life. It also included Jewish organizations [my comment - My harassment has not included Jewish organizations, but has included many evangelicals], community groups and more. And, regardless of their basis, it was illegal and needs to be brought to light. I am sure you have heard that phrase more than once from these religious nutjobs? They are fond of the phrase " what happens in darkness...." and so on. So, yes, my goal is to shine a light on these POS. If you are interested in telling me more, it would be on condition of anonymity- I am a journalist doing deep cover journalism, and my word is my bond. I would sit in jail for a source that provides accurate, factual information, and I would even put that into a confidentiality agreement if necessary. Well, if you would like to coresspond, I will be available.Best regards,popi “1st Update re"popi" --I regularly Google search my name "Richard Griesinger" with the word “harass” or "gangstalking" to see what websites have discussed me. In mid October 2016, my search revealed an article entitled "Former Clearwater Florida City Attorney criticizes Dr. Lorraine ..." posted in the website pop~agenda~culture. Although I previously opened that website (as "popi" mentioned in "her" first email above), I tried to open it after it mentioned me, but I could not. It is now marked “private." (The “popi,” who sent me the two above emails claims “her” real name is “popi gander.” The phrase “pop-agenda-culture” is listed near the top of the website; “popagandi” is the name of the author of the sister website - whatisorganizedstalking.wordpress. com). As a bad pun, the above names bring to mind "propaganda" defined as misleading information designed to promote a cause. The website - pop~agenda~culture - preposterously begins with a quote by a science fiction writer (Kurt Vonnegut), contains outrageous posts (either written as disinformation or posted by delusional individuals), discusses chewing gum on the bottom of a shoe, its sidebar contains an item "this is not a conspiracy theory blog," and, of course, contains no specific and verifiable facts about the author.2nd Update re "popi" --On November 13, 2016, “popi” - the anonymous corrupt person or persons in, or associated with, the U.S. law enforcement/intelligence/private contractor community - published the below article online about me entitled “In re: Richard Griesinger, Esq, and online defamation and libel." The article was published soon after I discussed “her” above two threatening emails to me in this website. The article was published in several of "her" disinformative websites,e.g., Protected Blog › Log in, Research Gang Stalking. and pop~agenda~culture. There are perhaps five reasons why "popi"'s community is concerned about my two websites - (1) My factual statements about the organized financial and psychological harassment against me since 2008 are true, many are detailed, and some are documented; (2) I am a credible person (established attorney forced to close my law office in 2012 due to hacking and harassment); (3) The motive for my harassment - revenge by the ex-husband (a high ranking law enforcement officer whose divorcing/ex-wife I dated from 2003 to 2011 - is obvious and documented; (4) I am verifiable (i.e., my identity and location is clear, unlike “popi”); and (5) The above community’s use of gangstalking and other harassing tactics is slowly losing the cover of plausible deniability due to increasing exposure in legitimate media (e.g., a Sydney Morning Herald article about CEO Michael Page in Australia, an ABC TV segment about Dr. Facika Tafara in California, Miami Herald articles about Florida Highway Patrol Trooper Donna Watts, an ABC TV 20/20 segment about Mr. and Mrs. Krlich in Ohio, etc.), and due to an increasing number of legitimate websites by credible individuals (for example, Roderick Russell in Canada, longtime NSA intelligence analyst Karen Stewart, and me). The following is “popi”’s article about me, portions of which I have bolded and underlined, followed by my comments in brackets -- “In re: Richard Griesinger, Esq, and online defamation and libel. The researcher of organized stalking will note various information/disinformation on the web about organized gang stalking [my comment - I agree, and the websites and articles by “popi”’s community are prime examples of disinformation. Snowden documents revealed that Western intelligence agencies post phony websites and articles online to discredit legitimate individuals and topics]. What should become clear after some amount of time is that this is by design of the hidden cultural practice that it is. This researcher has several blogs, and I do not use my personal identity in any of them [my comment - “popi” wouldn’t even disclose “her” name or city of residence to me by email] because in this ‘phenomena’ what then happens is that blogs are stalked, hacked, and online comes offline, as gang stalkers seek to silence those of us who research, or raise awareness of this topic. In other words, criminal activity under color of law begins when this topic is discussed openly [my comment - subtle intimidation and threats against me]. I wrote about a case that has all the trappings of authenticity - the case of one Richard Griesinger, Esq. [my comment - authentic because all of my factual statements are true, many are specific, and some are documented - a concern to “popi”’s community] - on one of my blogs, and the very next day received a phone call from a state where he formerly resided. That could indicate that he is not who he says he is; it could indicate that his blog is just another psyop; it could indicate many other things. But to me, the researcher, what it revealed- again- is how well connected these people are, as I never give that phone number to anyone-ever. That seems significant. Then, the blog became increasingly interesting to some in the community of gang stalking, and for various reasons, I closed the blog to any but registered and verified users. In short order, Israeli’s, MEPCON, and a few un-named persons requested access. Put another way- my blog got mobbed by people interested in that story and others. I have been mobbed by the fanatical Zionists, LEIU pedophiles, Israeli’s from Squad 8200, and law enforcement as well as pimple faced military trolls​ [my comment - What??], and often, these mobbing’s come offline, into the real world, where these people do other things that endanger life and safety [my comment - again, more intimidation and threats]. What this indicates to the researcher, is an inference that this topic gets certain folks riled up in the least, and drives some into furious counter-narrative. That seems important, because most legitimate research agrees that those who practice in the occult of gang stalking, are in fact from within the LEO and security industry, which at this time, has effectively replaced the Ku Klux Klan, the JDO, and the so-called ‘white identity’ movement that preceded the current Christian Zionists [my comment - Harassment against me in Pinellas County, Florida and here in Chiang Mai has included, among others, American evangelicals (e.g., by Pinellas County Circuit Judge George Greer, former client Cathy Bulger, my ex-girlfriend’s ex-husband, basically a Catholic evangelical, probably a large number of law enforcement officers in Pinellas County, etc.), no doubt, because I viewed some gay porn online. I never would have a gay or bisexual encounter, but that should be nobody’s business] as fanatical bombers and so on, as a domestic terrorists. In fact, the cross cultural membership, criminal, and institutional corruption of theses LEIU, security contractor, Scientologist/Mormon/Christian/Jewish gangs [my comment - My harassment has not involved Jewish gangs, but has involved evangelicals], LEO’s, community policing initiatives nearly vindicate the modern Klan as a mere political action group that practices free speech, and their version of history. According to OSINT easily found online, Richard Griesinger, Esq., was formerly a City Attorney in Pinellas County Florida, in an era when Scientologists were seeking influence in that area. I saved a copy of the original webpage (here is what he- or someone- calls his original webpage), and all communications I have had with him, as often these near legitimate stories are in fact psychological operations designed to intimidate me, the researcher, or the people like him, a purported victim of gang stalking. In other words, I protect both of us, from whoever would corrupt or challenge the narrative. I use WordPress because it auto saves posts with a time stamp, as does Gmail, and so, I can prove beyond any and all reasonable doubt that Richard Griesinger has libeled and defamed this author [my comment - Truth is a complete defense, and anonymous persons, like “popi,” cannot be the subject of defamation], and attempted to discredit the narrative I have documented. I will make this available to any credentialed researcher of organized gang stalking, should you be verifiable as an authentic researcher. I reached out to this Griesinger fellow, because I believe that much of what he wrote is an authentic story, and based upon his recent post, I believe that, like many of these victims, his narrative is mixed with features of a possibly un-diagnosed personality disorder [my comment - First, remember that "popi" is supposedly a fellow victim of organized group harassment, but is doing "her" best to marginalize me! Also, as I discussed in both of my websites - governmental agencies, corporations, and other entities in the United States and other countries have used the “delusional” tactic against whistleblowers, dissidents, and targets (e.g., the NSA against whistleblowers Russell Tice and Thomas Reinbold, the Pacific Gas & Electric Company against a manager and whistleblower Neil J. Aiken, etc. all of whom were later vindicated], but I find his story credible on cursory research ( I am not a mental health professional [my comment - There "she" goes again], this is just my opinion about a person who made their business public online; nor do I seek to make life harder for this fellow, but I will not discuss it further than that.) I attempted a dialogue with this person/entity, and in return, was rewarded with libelous, slanderous comments about my work. A sad fact of those of us who actually seek to bring light to this dark practice are often pitted against each other, perhaps by our own biases or mental illness [my comment - There “she” goes again]; and often by agents and agencies whose exact goal is this form of exploitation. I have a background with social workers and psychologists, and so, I am aware that mental illness can be of the paranoid variety. Griesinger’s current version of “his” story exhibits this trait [my comment - There “she” goes again. And, as I wrote above, "popi" is supposedly a fellow victim of organized group harassment]. These days, and since I closed that blog, this blog gets hits every two days or so from Thailand. I can prove that to any legitimate researcher of organized gang stalking. So, Mr/Miss Griesinger, [email protected], former City Prosecutor, etc, or whoever, whatever agency has co-opted your/his name and identity, I once again, here in plain sight of the whole world, extend you the opportunity to retract your slander/libel, or whatever it is. Then, in lieu of that, I will take other measures [my comment - more subtle intimidation and threats]. Now, to the researcher of organized stalking, note that Thailand is a beneficiary of tens of millions of American dollars per year [my comment - no doubt, “popi” is letting me know that “her” community has financial clout in Thailand] for initiatives that ‘combat sex trafficking and child sexual exploitation.’ [my comment - I will not be smeared as a pedophile, child molester, a potential one, a sex trafficker, or potential one. My ex-girlfriend’s ex-husband - a high ranking local law enforcement officer whose best friend was a retired FBI agent - had me smeared for revenge (detailed in my main website). The smear has always been secret (that is, always behind my back or anonymous) and was denied by law enforcement in Pinellas County. My attempts to hire professionals to disprove it were always interfered with. The FBI denied my written request to investigate. (I notified the U.S. Consulate’s Office here in Chiang Mai in 2015 of the smear and threats against me, my main website, etc. just for record). It is a cross-roads nexus state where sex trafficking takes place as children and women, and Thai lady-boys are shuffled across borders by actual rings of sex traffickers. This is one reason why talking about this topic can be dangerous [my comment - more intimidation and threats], both to the researcher, and to individuals who are targeted by gang stalking. Organized rings of pedophiles, and literal and actual gangs of sex traffickers operate from Thailand to America and beyond, often in the disguise of these social justice movements, and anti-sex trafficking NGO’s, cults and actual gangs, many of which are funded by USAID and other military’ intelligence agency black budgets. Do you see a connection? I do. It is this researchers opinion that organized gang stalking, pornography, prostitution, and sex trafficking are related, and part of my hypotheses is that both sides of the trafficking narrative derive billions per year, one way or the other, and often work together, as was the case of Yugoslavia/Bosnia in the 1993 era. It is no different today, and many who research gang stalking will find this to be the case as well- there is a provable link between those who create a moral panic, and those who police the narratives of moral panic. In fact, they are one and the same, like Laurel and Hardy, Pinky and the Brain-or a cat and a mouse [my comment - What??] : those who claim to be ‘combating’ a moral scourge, are the exact same people and groups deriving profit from all sides of the issue. But in the case of the ‘targeted individual,’they are the scratching post the cats sharpen claws on; a form of bullying so severe and debilitating, that many take their own lives, are forced into false confessions, or worse, with some committing crimes in attempts to get a case into a court room, because the involvement of police and other institutional and community occult factors into often unwinnable dilemmas, and legal basis or legal standing issues. So, Mr. Griesinger, I do not wish to add to your trauma- regardless of whatever you were accused of, the hidden practice of gang stalking needs to be brought into the light- I applaud your attempt to do that. And as you know, I extended my empathy to you, and you returned it by posting alleged private data. Regardless of your choice, once again- I ask that you retract your deliberate lies, and other statements about my writing, and my hypotheses. Any correspondence I have had with you will be revealed in a court room if necessary [my comment - I have nothing to hide except embarrassment, but your community certainly has a lot to hide. Also, I have been consistently denied the opportunity to place the secret smear and harassment against me into public view.]. And, in lieu of that, I will take further active measures [my comment - more intimidation and threats].“ (posted on November 13, 2016). [My final comment - Compare the content of my two websites with that of “popi”’s emails, 'her' article about me, and 'her' disinformative websites. Unlike “popi,” I am verifiable and have provided specific details regarding the motive and nature of the hacking and organized financial and psychological harassment against me].3rd Update re "popi"'s community --I recently (December 6, 2016) noticed text at the top of one of my documents ("CM - Diary") in my Google Docs app on my iphone. I did not write it. (A linguistic expert isn't needed to show this). The text was hacked and placed into my “CM - Diary,” no doubt, as a psychological ploy by a corrupt person(s) in, or associated with, the U.S. law enforcement/intelligence/private contractor community. "CM" stands for Chiang Mai, the Thai city where I live. I do not write lengthy, general text in my CM-Diary, but rather only write short comments about specific events which occur in Chiang Mai, except for an occasional, short general comment. Although much of the content is true and although I wrote somewhat similar text in other Google Docs, some of it is not, and some of it is exaggerated. Interestingly, the hacked text does contains some methods which are used to harass me (in Chiang Mai and previously in Pinellas County, Florida). I have bolded and underlined portions of the text followed by my comments in brackets. -- “The number of people despising me here in Chiang Mai is astounding [my comment - First, consider the diabolical effort in writing and hacking the below text. Second, consider the diabolical and extensive effort to smear me in Chiang Mai as a pedophile. Also, although the fact of the smear is true (initially secretly spread as revenge by my ex-girlfriend’s ex-husband in Pinellas County. There has always been an evangelical undercurrent, if you will, involved in the smear both in Pinellas County and in Chiang Mai), I would not use the words "despising" and "astounding" in this context.] When viewed in one perspective, it’s almost fascinating. Again, I cope well because I naturally consider myself a reader, not a participant of my novel-like harassing experiences. What outfits [my comment - I do not use the word "outfit" or "outfits"] will some harassers be wearing, what newspaper or book will they be reading and want me to peek at [my comment - I do not use the word "peek," although Jeffrey Kantor's lawsuit, which I discussed, refers to "sneak and peek" surveillance]. What vehicles wlil be backing up near me this time. Will giggles [my comment - I do not use the word "giggle" or "giggles," but psychological harassment against me has included, for example, cars backing up as I pass, people coughing as I pass, a customer next to me in a restaurant doing his best to get my attention to an opened newspaper he was holding out which had the word “delusional” prominently displayed on a page, etc.] be used or a menacing look, or maybe get a passing cough. It all is curiously and loosely organized [my comment - The phrase "loosely organized" was parroted from what I wrote in this website (reason 6 above) - that I believe that there is a loose network worldwide of, hopefully just rogue, members of the U.S. law enforcement/intelligence/private contractor community. However, the harassment here in Chiang Mai, as in Pinellas County, Florida, is very organized]. I get it, but it really and truly has no lasting effect on me, except for the dramatic entry of an oddball-looking guy [my comment - I would not use the phrase "dramatic entry of an oddball-looking guy"] etc. It all seems a big waste of time and money (assuming some of the sheep are paid. No doubt, the vangies work free of change. They hate gays, I know, I get it. But the funny thing, folks [my comment - I would not use the word "folks" which I consider is disingenuous, particularly when used by politicians], I’m not gay, I know that’s a tough one for you. And for you vangies and others, I have never fantasized about my Little Brother and any other child, ever. You can believe that or not - it won’t change the truth. I admire the clean lifestyle and many values you vangies hold to, but I feel sorry for you as well, really (not pity), that your minds and emotions are trapped and limited by setting life and religion in black and white concrete. You folks have tried to set who I am in concrete terms as well, but most people defy such classifications. I’m not a religious person - I don’t like organized religions, particularly dogmatic ones like yours, any orthodox, maybe if I were black and the rousing and soulful gospel music and all, but I was a robotic acolyte for three or four years and the form over substance turned me off. Vange churches are even worse. Vanges are too Old Testament, not enough New Testament - lighten up and live longer."4th Update re “popi”’s community --That “popi”’s community - those corrupt individuals in, or associated with, the U.S. law enforcement/intelligence/private contractor community - is concerned about my website was demonstrated by five, no doubt related, websites which recently (in mid December 2016) posted “popi”’s phony criticism of my website - WordPress.com: Create a website or blog, WordPress.com: Create a website or blog, WordPress.com: Create a website or blog, WordPress.com: Create a website or blog, and WordPress.com: Create a website or blog. A minor update - In January 2016, I discovered two more, no doubt related, websites which also posted "popi"'s phony criticism of my website - http://en.wordpress.com and http://li.wordpress.com. A second minor update - In February 2017, I discovered yet another, no doubt, related website which posted "popi"'s phony critcism of my website - http://yi.wordpress.com. As I wrote above, Snowden documents revealed that intelligence agencies flood the internet with disinformation to discredit legitimate individuals and topics.

Impact of Social Media on Mental HealthThe methodology chapter is fundamentally aimed at understanding the aspect that lies behind data collection, processing, and analysis concerning the impacts of social media on mental health. Through this chapter, the used research methodologies will be presented and the way they were employed in answering the research questions as posed in the first chapter of the study. Hence, this chapter focuses on the research design which entails aspects of epistemology, ontology, and methodology, used data collection methods, processing of the collected data, and the used approach to gain ethical approval. Besides that, chapter three also elaborates on the instruments of research that were used during the data collection. The chapter is elaborative on all aspects revolving around the methodology used and how it was used.Epistemology, ontology, and methodologyEpistemology is defined as the philosophy of knowledge. Before the research process was started, it was necessary to search through literature material and observe what problems people would be encountering but do not notice. Literature materials also enabled us to gain enough knowledge of how social media platforms work and who are the most affected people in society and the actions that can be taken to save the situation. This was the essence of epistemology. On the other hand, ontology is defined as the study of beings. Though this study was able to understand how people react to the environment and act in response to what affects them. This was the basis of the research trying to understand the relationship between people, social media platforms, and the environment around them. Lastly, research methodologies are what are used in selecting, identifying, processing, and analyzing information on specific topics. The methodology was then decided and clear paths to be used outlined. This directed the research enabling us to collect valuable data for analysis.Methods of Data CollectionMethods of data collection are determiners to the quality of data and its usefulness in research. In this study, several methods that were used in collecting data will be exploited.Questionnaires.By definition, questionnaires are a set of written or printed questions that are presented to specifically targeted people to get their response regarding a particular subject. Questionnaires can either be designed in such a way that they have choices are left as open-ended questions given the targeted sample of people the freedom to give their views. This method of data collection was effective in the study since from it we were able to gauge what people feel about the internet (social media) and the impacts it has had on them. The questionnaires were based on the claims obtained from the journal and other online articles relating to social media's negative impacts. The targeted group's composed of adolescents and middle ages adults who were said to make up the highest number of social media platform users (Berryman, Ferguson, and Negy 2018). The obtained responses from people are what will then be used to guide the research to a conclusion to the study is obtained.Semi-structured interview.Through direct talks with teenagers and adults around the population of research were used to exploit ideas. Information was obtained and the general feel of the people determined. Through the direct interactions that involved talks and questioning, data was recorded on what people think social media has impacted their mental health. The semi-structured interview was designed to find out how people interact with social media and what they feel its negative impacts are (Kaur and Bashir 2015).Examples of questions used in both the questionnaires and the structured interviews were:1. To what extent do young people attribute their self-esteem to the impact of social media?2. How do young people differentiate between the impact of visual and non-visual social media on their mental health?3. In what ways do young people recognize both positive and negative impacts on their mental health that might attribute to social media?Process of Data CollectionBy definition, data collection represents a method of communicating questions to a specific targeted group of people and obtaining responses. The chosen samples were used to represent the situation in the whole lot/group of people. From the questionnaires, quantitative data was collected. The collected data was then kept in a safe place as confidential responses to bar others from accessing it and later giving responses that are either similar or close to those that had been given initially. The collected data was then imported into the database software to offset the analysis process.Through the semi-structured interviews and focus groups, qualitative data was collected. The collected qualitative research is what enabled the research to have an elaborative state of the impacts of social media explained. In some cases, interviewers came across people who seemed to be mentally disturbed. Their linking and coordination with the things that happened around them seemed to have been interfered with. The people who were involved in this study included middle-aged workers and partly university students who were readily available and seemed to have been the most affected lot according to research. Previous literature by different authors indicated that the loneliest people were university students who also seemed to be too much into social media (Bashir and Bhat 2017). It was noted that they stayed on social media to interact with other people they considered not a bother to them. Making new friends, as the results indicated was the main reason why most people spent their time on social media despite its negative impacts which they know.On the other hand, the collection of quantitative data was divided into two distinct stages. The first stage was the sampling of the specific target populations from which needed data would be obtained. After sampling, the questionnaires were set forth, and records were obtained from the people's responses. The second stage was determining whether the people/users of social media platforms, such as TikTok understood that such media had the power of impacting negatively on them. Identifying this was relevant because it would mean the responses are substantial from people who know what they responded to. Both stages involved the populations that were said to be heavy users of social media platforms.Approach to Gaining Ethical ApprovalEthical approvals are necessary for ensuring that whatever data it is that is obtained from people is safely and confidentially kept. The approach used to gain ethical approval was first setting up a pilot study. Through the feasibility study/small version studies, we proved to the regulatory bodies that we were ready to collect, handle, and analyze the data effectively without causing upheavals. Through the pilot study, the university verified that all was in order and that the research had no ill intends but a positive step that would help save the world. The code of practice was also ascertained before the beginning of the research to ensure no kind of breach would be evidenced on either side. Defaming specific social media platforms would go against the codes of practice. It was thus ensured that the research maintained the highest levels of neutrality regarding the various social media platforms that exist such as Facebook, Twitter, TikTok, and Instagram. We proved to the university that we would uphold the code of practice by staying on our lanes and only obtaining the data we needed and nothing more. It was through this that we got ethical approval from the university.ReferencesBashir, H., and Bhat, S.A., 2017. Effects of social media on mental health: A review. International Journal of Indian Psychology, 4(3), pp.125-131.Berryman, C., Ferguson, C.J., and Negy, C., 2018. Social media use and mental health among young adults. Psychiatric quarterly, 89(2), pp.307-314.Kaur, R., and Bashir, H., 2015. Impact of Social Media on Mental Health of Adolescents. International Journal of Education, 5, pp.22-29.

taken from Taking a Second LookSome opinions on the second opinionTwenty-eight physicians, ethicists and sociologists responded to a questionnaire on the role of the second opinion in medicine today. Their comments provide the basis for further discussion on this practice, the issues involved, and the ethical complexities in a changing health-care scenario.When a physician agrees to attend to a patient, there is an unwritten contract between the two. The patient entrusts himself to the physician and the physician agrees to do his best, at all times, for the patient. This contract disallows the patient from seeing another medical expert for opinion or advice without a referral note from his physician. It also enjoins the physician to respect the autonomy of the patient so that if the patient so desires, he will refer the patient to another physician for a second opinion.Traditionally, the concept of a second opinion is based on certain assumptions. First, that the physician has studied the patient's medical history and clinical findings; if he is the patient's family doctor, he has also over time acquired a fund of medical and socio-economic information on the patient and his family. Second, that the physician is knowledgeable about the various specialists in the town or city and their respective strengths and capabilities, and is thus qualified to advise on whom to consult for a second opinion, and provide that consultant relevant and often crucial medical infomation on the patient. Were the patient to consult another physician on his own, these benefits would be lost.However, second opinions are often not sought on these principles. Some patients move from doctor to doctor without the primary physician's knowledge. They obtain a variety of opinions, often conflicting. Without any one doctor in overall charge of their therapy, they may follow whatever advice they choose to accept. If a complication ensues, no particular doctor can be held responsible.Patients who do ask their primary physicians for a note of referral to another doctor are no better off. Such requests are often taken as a personal insult and evidence of lack of faith or trust in the doctor. Some doctors react by withholding key information, such as detailed notes on surgical operations. The result is often a general breakdown in the harmonious relationship necessary for good patient care.The problem is compounded by the absence of clear-cut guidelines on the use of the second opinion. In India, our medical councils have failed to contribute to the discussion, or to regulate the use of the second opinion in any way.It is in this context that colleagues were asked their opinions on the need for, and use of, the second opinion. By recording the views of respected academicians and medical professionals, one hopes to lay the ground for further discussion on the question. The following essay is an attempt to extract, from the responses received, considered thoughts on some aspects of this issue. Excerpts from the responses have been included to illustrate various perspectives.Is the doctor-patient relationship a contract or fiduciary relation?While several medical colleagues agree that the doctor-patient relation ship today is some sort of unwritten contract, there were many qualifying notes. Ruth Macklin raises a fundamental question: what kind of contract is it, anyway, if it is both unwritten and unstated? "A contract in which the provisions are not clearly spelled out is not really a contract at all. In a legal sense, it would be considered invalid. From an ethical point of view, how can all partiesphysicians or patients be fully aware of their obligations or, for that matter, their rights? Contracts in the strict sense of the term are (usually) written documents that spell out the provisions clearly, say what all parties are obligated to do, and also specify penalties or remedies for breach of contract. That sounds very different from the physician-patient relationship, which is perhaps better described as a fiduciary relationship".Clearly, this question needs further discussion for any systematic understanding of the issue.And in fact Thomas George holds that it makes little sense to talk of contracts and obligations in our health care system. He would support enforcing the doctor-patient contract, and expecting referral notes from every patient, if we had a structured health care system, "as, for example, in the National Health Service (NHS) in the UK. Borrowing only one part of the system leads to a lot of problems for the patient. At present there is no system at all in India and the patients are completely at sea as to whom they should consult".Homi Dastur argues that patients would not accept the enforcement of such regulations. "Very few patients would be willing to observe, accept or even understand (the concept of an unwritten contract), as is evident from the frequency with which those who can afford (to pay the different consultants) will seek multiple opinions. Many patients will reveal that they are under the care of another doctor only after the consultation is over. Sometimes one becomes aware (of the earlier consultant) only after reviewing reports which mention the name of the referring doctor".Likewise, Bela Blasszauer suggests that such a contract would work only in theory, for doctor-patient relationships rarely develop in the prescribed manner. "Physician-patient encounters may take many forms. I may bump into the physician. I may have no other choice. I may be shopping for a suitable one. And so on." 'Many doctors oppose enforcing contracts because they perceive the doctor-patient relationship as unequal, and liable to be misused by unethical doctors. "I would like to spare the patient the trauma (of having to face a doctor unwilling to refer his patient for a second opinion)," writes George. Blasszauer suggests that such contracts can generally not be made binding on the patient, since the conditions under which he sought advice or treatment were heavily weighted against him.Others perceive the relationship differently. Eugene Robin and Robert McCauley suggest that the physician-patient relationship is a partnership and not a contract. "Either (patient or doctor) is free to 'terminate the relationship without cause', with the doctor having the additional burden of informing the patient when this occurs, and remaining available for such time as is reasonable for the patient to find another doctor who will assume responsibility for delivering medical care". This is generally true in the urban US, they state.Sociologist Rohit Barot suggests that the Indian situation resembles private sector health services in Britain. He has been a patient in the UK National Health Service, as also with private practitioners there, and comments that the doctor-patient contract and the rules of referral seem to apply only in the NHS.The American Medical AssociationAccording to the American Medical Association's code of medical ethics, physicians should recommend a second opinion whenever they believe it would be helpful in the patient's care. When doing so, they should explain the reasons for their recommendation and inform their patients that they are free to choose a physician on their own or with their assistance. Patients are also free to seek second opinions on their own with or without their physician's knowledge.With the patient's consent, the referring physician should provide any information that the second-opinion physician may need. The second-opinion physician should maintain the confidentiality of the evaluation and report to the first physician, if the patient has given consent. Second-opinion physicians should provide their patients with a clear understanding of the opinion, whether or not it agrees with the recommendations of the first physician.Where a patient initiates a second opinion, it is inappropriate for the primary physician to terminate the patient-physician relationship solely because of the patient's decision to obtain a second opinion.In general, second-opinion physicians are free to assume responsibility for the care of the patient. . . . By accepting second-opinion patients for treatment, physicians affirm the right of patients to free choice in the selection of their physicians.There are situations in which physicians may choose not to treat patients for whom they provide second opinions. Physicians may decide not to treat the patient in order to avoid any perceived conflict of interest or loss of objectivity in rendering the requested second opinion.Physicians must decide independently of their colleagues whether to treat second-opinion patients. Physicians may not establish an agreement or understanding among themselves that they will refuse to treat each other's patients when asked to provide a second.opinion. Such agreements compromise the ability of patients to receive care from the physicians of their choice and are therefore not only unethical but also unlawful.Council on Ethical and Judicial Affairs: Code of medical ethics. _ Chicago: American Meditial Association 1997. 191 pages.A one-way obligation?Does the patient have responsibilities as well as rights in this relationship? "The doctor's duties, ethics, standards are well-known in theory and lapses from accepted norms are recognised in practice", writes Farokh Udwadia. "It is equally important (to emphasise) the patient's duties, responsibilities and obligations... It is time for this aspect to be discussed and the discussion circulated, for it must never be forgotten that the doctor-patient relationship is not a one-way street".Again, this view is a matter of debate. Jagdish Chinappa and Lawrence White argue that the two groups are very different. "The patient is the consumer who has needs based on certain beliefs and attitudes. The doctor is a service provider. Patients, under the stress of their illnesses, should be expected to behave irrationally and inconsistently". Therefore, Chinappa goes so far as to say, "honest and ethical action is therefore dependent only on the doctor and has to be decided upon the merits of every case. Certainly, the emphasis on autonomy guarantees a patient the right to ignore a doctor's advice, and to seek whatever opinions are wished. (I believe that this, even though considered a nuisance and counter-productive regarding patient care, is nonetheless a good thing.)"Likewise, White notes, "Just as it is not an equal relationship in terms of power distribution, vulnerability, etc, so it is unequal with respect to promises on either side... it is generally accepted that patients have the right to do whatever they wish, including shopping for alternative opinions, etc". This does not mean that many physicians like or accept (the practice). "However, to demand otherwise will reinforce the physician's position of power and elitist attitude, which I believe would be a regressive step".Why doctors should want a second opinionThere are a number of reasons why a second opinion may be sought. Traditionally, general physicians and patients seek specialist opinion and advice with benefit, especially when the disease is uncommon or the patient's condition serious. The patient with a hole in the heart, a brain tumour or failing kidneys will do better in the hands of specialists.In certain situations a second opinion is almost a 'must'. "Take for example a 'shadow' in the lung of undetermined aetiology", writes Farokh Udwadia. "Is it tubercle, pneumonia, cancer or a rare disease, for example, Wegener's granulomatosis? What is the patient to do about it? In fact, it would be advisable to take more than one opinion..".Christopher de Souza adds that young consultants would welcome second opinions from respected seniors — provided they were sure the patient would return to them for definitive therapy — in order to validate the line of treatment they propose. The senior consultant's concurrence would protect the younger colleague against unjust accusations and boost the patient's confidence in him.B N Colabawalla feels that a second opinion may benefit the primary physician in yet another way. "Patients are now increasingly conscious of their rights and it would be improper for any physician to deny the patient his autonomy and right to seek a second opinion. It would be in the interest of the primary physician to make the necessary reference for a second opinion."Unfortunately, requests for a second opinion from other consultants are uncommon. "The practice of referral from primary to secondary to tertiary, or from general physician to specialist remains an ideal not realised," according to M S Valiathan, who has rarely had a primary consultant seeking a second opinion from a senior consultant, or referring a patient to him. In cardio-thoracic surgery, at any rate... a senior consultant usually enters the picture only when the primary consultant fears medico-legal trouble in a given situation.That is not to say that patients aren't asking for them. One reason why seond opinons are relatively uncommon is the absence of any publicly available medical audit. "Patients approach several consultants simply because, at present, they have no way to get authentic information on the quality of services provided by a given consultant or institution", says Valiathan.Outpatients come to Anil Desai because they are dissatisfied with the information their primary physician gave them, or with the treatment's progress. "I always request a referral from the family physician, but (find that) many families do not not have a family physician".However, the hospitalised patient is unable to obtain a second opinion without permission from the admitting physician — and even discussing such permission can be a source of stress for the patient and his relatives.Is the second opinion a right?All doctors surveyed felt so, though they did not agree on whether there were any limiting condiions. Some, like BIasszauer held that patient autonomy required that it be unlimited: "The patient has a freedom of choice, and even the responsibility... to go to as many doctors as he wishes. It is his life or that of his loved one that is at stake!" This right becomes particularly important with the deteriorating physicianpatient relations."Since trust in the medical profession has been greatly eroded, it is small wonder that patients (and I, myself, too) try to find the person who is up to date in his profession and displays humane features as well. In an open market system, this is no real problem. Even where there is a national health care system it may be cheaper for the system as well, if I can find the solution".Others would limit that right, mostly to when the physician ignores the patient's wishes. Udwadia feels that the patient's right to consult another doctor (independently) is absolute when the treating physician refuses to allow another opinion in spite of the patient's request; is clearly disinclined or procrastinates unduly in granting permission to seek a second or third opinion, more so when the patient's condition is not improving or is, in fact, deteriorating; when he reacts with anger or displeasure to a request for another opinion, and the patient feels that he now no longer receives the care he expects and needs."Also, when the problem ... is of serious, unsolved diagnostic import (the patient) has an absolute right to seek as many opinions as he wishes. However, the physician should caution the patient that... too many opinions would only confuse and harm the patient".But there are limits to this right, according to Udwadia. "It would be unjustified, in bad taste and bad manners if he seeks fresh medical advice of his own accord when already under treatment for an ailment for a considerable length of time by his primary physician. He should not seek a consultation with a new practitioner without permission and a referring letter from the primary physician. If the patient is dissatisfied, for whatever reason, with the primary physician, he should have the gumption to tell him so and inform him that henceforth he proposes to get treated elsewhere. This... absolves the primary physician from further care of the patient. It is not uncommon for many patients to surreptitiously see many doctors (as if to test the primary physician's management), and then quietly go back to the primary physician without the latter even being aware of this duplicity."The General Medical Council, UKThe General Medical Council (GMC) recommends that patients should continue to see specialists only on referral from a general practitioner. The GMC has strongly defended the referral system as a proven feature of medicine in the UK. Specialists should not usually accept a patient without referral from a general practitioner. The referral system is seen as the best way of ensuring that patients see the right specialist.General Medical Council News, Spring 1997, pages 1-2.Why don't patients tell doctors that they're 'double checking'?Why do patients behave 'duplicitously'? P. K. Sethi and Colabawalla see the reason in the behaviour of most doctors. "In practice this (request by a patient for a second opinion) seldom happens because the public has an apprehension that I may be annoyed. It is we, as a profession, who should work towards dispelling this impression. We have not done so," writes Sethi. He holds that patients are justified in breaking their contracts if physicians are rude at the mention of a second opinion. And it is "morally, ethically and possibly even legally unjustifiable" for medical professionals to withhold information and case history details, either from the patient or the second opinion physician.How should it be done?Under the UK's National Health Service, only the primary physician can refer a patient for a second opinion, writes Blasszauer. The physician must make the request in writing and provide all relevant medical details. In return, he obtains in writing the diagnosis made by the consultant and his advice on treatment.But this is rarely done in India, writes Thomas George, pointing out that patients rarely go up the primary, seondary and tertiary levels of care. Samiran Nundy notes thatmost patients in India do not have a doctor they can call their primary physician.V. R. Joshi points out that even the most punctilious of consultants would find it hard to enforce such a protocol. "Patients often travel long distances from other cities or states to reach you. It is only when they reach your office that they are made aware that a referral note is required.""Having come after seeking an appointment, I cannot refuse to see them just because they have no referral note," writes P. K. Sethi. "If, however, I discover that the patient is admitted to a local hospital and has come to me without informing the treating doctor, I ask him to go back and bring a referral note I feel this is in the interest of the patient and also conforms to the code of medical ethics... The advice is often no implemented."But it is not always possible to get a letter from the first doctor, feels Arunachalam, giving the patient's side of the story. He may be unavailable, or the patient hesitates to inform him, afraid the request would spoil relations. In fact the second opinion is often most needed when the patient is in the hospital — and least able to take an opinion without the admitting doctor's co-operation. Desai has always helped patients under his care obtain a second opinion without his physical presence, giving them full access to his case notes and the help of his house physician. On the other hand, if they seek a joint consultation — something Desai may also sometimes find necessary — he reserves the option on which consultant should be called in. There are also times when he recommends a joint consultation with the patient and relatives.This is not always the practice. "We do not permit second opinions from outsiders under any condition", writes Prakash N. Tandon, arguing that the second opinion can only be used ethically within a structured format. Patients wanting such opinions must first get themselves discharged from the hospital. "Every patient discharged from our ward, either by us or at his request, is given a discharge summary with full information on the various investigations carried out, a copy of the operation note, our final diagnosis and condition on discharge. The patient is at liberty to use this information for whatever purpose he wishes." Tandon's hospital does not provide the patient copies of X-ray films and other imaging tests, but sends them directly to the consultant if asked.Tandon argues that the patient's interests are met through multiple internal opinions. "Every patient admitted to our wards has the benefit of the collective opinion of the whole team which includes several senior consultants. By tradition, every patient is jointly discussed on more than one occasion."Permitting a second opinion from outside would create administrative problems on the one hand and a difficult clinical situation." For example, he asks, what if the second opinion was at variance from the first opinion? Who would implement it?"As a corollary, we refuse to provide a second opinion on patients admitted to other hospitals unless it is formally sought by the person treating the patient and with the permission of his administration. For purely administrative reasons, this is limited to public hospitals. The opinion is given to the treating surgeon and not to the patient or the family. At times, a joint meeting held with the family is addressed by the treating surgeon and ourselves."White disagrees with such a practice. "If a doctor does this, it strikes me that there is a component of spite and petulance arising out of the doctor's own needs. Patients, particularly if seriously ill, often feel the need to validate their doctors' opinion; after all, it is their life in the balance. Further, there are often enormous pressures from friends and relatives to get 'another opinion'." In other words, the second opinion can be taken for many 'ethical' reasons.Robin and McCauley add, "If the primary physician learns that the patient is following advice not consistent with his principles of treatment, the doctor should advise the patient of the difficulty/danger as best the doctor sees it... It is the patient's choice how to proceed. The doctor can be held responsible only for his own errors, not those of others.""If the patient is already admitted to hospital under another consultant, I would under no condition see the patient unless specifically asked to do so by the treating consultant," writes Udwadia. "This would apply even if the patient concerned has been previously under my care for several years. ""In the initial stages, before starting on a course of treatment, a patient may seek multiple advice," says Mr Harsh Sethi. "But once treatment has started, then a new doctor should not accept a patient without a note of referral from the first doctor (provided he knows that the patient has been under treatment). At the last, he should speak to the first doctor, and seek concurrence."The unreferred approachWhat does one do when a patient seeks a second opinion without obtaining a note of referral from his primary physician? Macklin does not see this as a dilemma. "If a patient approaches you, seeking a medical opinion (whether it is a first or a second opin-ion), the patient is in need of diagnostic or therapeutic attention. You can decline to form a relationship ... or accept the patient in your care and thereby establish a new doctor-patient relationship."Most respondents feel that it is the duty of the second physician to see the patient even without a note of referral from the primary physician, though such a note is desirable.S. H. Advani adopts a firm stand. "I am absolutely clear in my mind regarding the patient and doctor relationship. In this relationship, the patient has the major say. It is the patient who is going to receive the treatment and he has to make sure that he receives the best treatment. I give my frank opinion to the patient (whether or not he comes with a letter from the primary physician) because I strongly believe that the patient has the right to take a second opinion..! don't want the letter from the primary physician to participate in the second opinion."Ashok Bhanage emphasises that the doctor must work at all times with the patient's interests at heart. "If I realise that I am the second consultant, I write my notes in more detail and elaborate the reasons for my decision. The patient is at liberty to show this note to the first or a third consultant."Aniruddha Malpani emphasises that the autonomy of the patient demands that a second opinion, should be provided. A letter from his primary physician is not necessary. "My relationship is with the patient and I am answerable to him, not to his primary doctor."Taking over the patientWould you take over treatment of a patient already under the care of another consultant? This is one fear physicians have when referring their patients to their colleagues.Some might argue that this is the patient's prerogative. Arunachalam notes, "If I have changed doctors, I will certainly expect the second doctor to take full responsibility in treating me. If I consult more than one doctor (for getting opinions), I will retain the right to decide by whom I should ultimately be treated."Others are unequivocal: "If I find out that the patient is under the care of another consultant, I advise him to go back to that consultant," writes Gajendra Sinh. "I do not take over treatment of these patients."On the principle that a patient has a right to autonomy over his decisions, most respondents see no difficulty in taking over the patient's management at his express request — provided such a step is in his interests.However, Homi Dastur adds, "The suggestion to take over medical care would, at no time, come from me. It would have to be broached by the patient's general practitioner, if present, and the patient himself. Acceptance would follow only when persuasion to return to the primary physician fails."Advani differs. "The patient has the absolute right to be treated by the physician of his choice. If the patient decides to be treated by me, I would not normally hesitate to accept. I may inform the primary physician, though I don't consider this obligatory".Blasszauer argues that the doctor must was incompetent, mistaken, negligent, or in some other way not acting in the best interest of the patient. Patients need physicians who seek to act in their best interest. Physicians owe more to the patient before them than they owe to other members of their profession. Even if 'physician etiquette' dictates that one doctor should not treat another doctor's patient, medical ethics demands that patients receive the best medical care. Notes of referral and reluctance to treat patients under the care of another doctor are elements of physician etiquette, not medical ethics as understood today."Barot feels that the second consultant is duty-bound to approach the primary physician for all relevant medical information on the patient.Colabawalla outlines his approach: "If I am aware that the patient has been under the care of another colleague, I will offer my opinion and leave the choice to the patient. I would not 'take over' the case by ascribing to myself the arrogance that I know better! I would then try and persuade the patient to allow me to discuss the case with the primary physician.""The difficulty arises when the patient unequivocally informs you that he does not wish to be treated by the primary physician, and requests you to take over the management. I would try to resolve that dilemma — not that any dilemma can ever be resolved — by accepting that the patient's autonomy and right to choose must be respected"."If the patient is being looked after correctly I would persuade the patient to return to his consultant". writes Udwadia. "If the patient's problem has been wrongly diagnosed and if it is critical or life-threatening (e.g. a dissecting aneurysm of the aorta or an impending myocardial infarction), I would admit him to hospital under my care, inform the primary consultant and request him to see the patient in hospital as and when he wishes, so that we can jointly look after him".The dangers of mixed therapySome patients will see several physicians to obtain a clutch of prescriptions, selectively following that advice which suits them. How can we help such patients avoid the complications that may follow?Udwadia has seen patients who have gone through half a dozen or more physicians. "This is not uncommonly revealed to me at the end of the consultation! I ask that the treatment advised be carried out under the supervision of any one doctor of the patient's choice, as I would be unable to follow-up on his problem as often as I would like to. I then write a letter to that doctor , outlining what I feel about the patient's problem and how, in my opinion, it should best be tackled. (Finally,) I tell the patient that if he wishes to see me again he will now have to get a letter from this doctor".White agrees that selectively following advice offered by several physicians is courting trouble. "These are difficult situations, and in my opinion there is no one right answer. If I have a patient who is 'mixing and matching', I gently tell him he is receiving fragmented care, and that this is dangerous. Usually I tell the patient that I wouldn't continue management without a clear mandate. I feel strongly that patients have the right to several opinions, but that one doctor must quarterback the actual care. If he should suffer a complication, which of his medical attendants would be held responsible?"And the state of the bypassed..Many feel that the primary physician is justified in terminating his relationship with the patient. Valiathan sums up this sentiment: "The primary physician is not obliged to treat a patient who consults another physician or follows another line of treatment without his knowledge. When a doctor undertakes to take care of a patient he accepts a sacred contract with obligations on both sides. I do not agree that the doctor must take care of a patient 'under any circumstance'. Even Charaka, who imposed many strict conditions on the physician, recognised situations when a physician can terminate his sacred contract."At times, the bypassed physician feels rejected and acts accordingly. Sometimes a seriously ill patient is told, "You have decided to consult X without informing me. I do not wish to have anything further to do with your medical care. Please go back to X".All our experts frowned upon such behaviour. White writes: "Under these circumstances, the doctor's behaviour would be considered patient-abandonment. I would consider it a breach of ethical standards on grounds of beneficence, non-maleficence, fidelity to patient, and respect for patient's autonomy. What would be the physician's reasons for wanting to do this? The relationship starts out unequally, with the doctor having more power. This is counterbalanced, in my opinion, by the greater responsibility of the doctor, who needs to put his needs and wants aside and honour what is both a contract and a covenant. This is a critical issue - the physician's failure to put the patient's needs ahead of his own".Colabawalla writes that the physician should "gracefully end the 'contract... in his own interest" if he feels that he has lost the patient's confidence"for whatever reason".Barot strongly feels that the primary physician must pass information about the patient to the consultant or whoever else the patient may have chosen to deal with on health matters. The underlying ethic is that the primary physician should provide all necessary information as it concerns the patient's health (potentially a question of life and death).Blasszauer agrees. "The primary physician should not shed his responsibility to the patient without clarifying his patient's motives", he writes."The physician should ... understand: he may have failed the patient; the patient may be out looking for hope, or proof that his doctor's diagnosis is right or that the recommended therapy is the only solution. If he cannot find the answer for his patient's motives, than he should sit down with the patient and have a frank discussion. If he sees that the patient had no ground whatsoever to abandon him, he may advise the patient to look for another physician, since without trust no such relationship could be beneficial. But until that moment, I believe, he does have some responsibility. The patient should not fall between two stools. The primary physician should be available till he — on acceptable grounds — terminates the relationship 'officially' . An insult to my vanity is not an acceptable ground."Gajendra Sinh concurs with the need for reform within the profession. "Unless we put our own house in order it is difficult to see how we can restore the doctor-patient relationship".Will a second opinion clinic work in India?In Australia, a group of consultants from different disciplines offer counsel on the clear understanding that they will not take over the patient's medical management. Would such a clinic work in India?"It is fairly common in the U.S., in this connection, for a patient to be referred to a second physician for a decision about, say, the desirability of hysterectomy", write Robin and McCauley." The ground rules here are that the consultant will not be involved in the surgery; is not affiliated with (preferably doesn't even know) the treating doctor; and is paid the same, whatever his opinion. As you may imagine, this system has its own flaws and a long essay could be written about the good and bad aspects of this practice".Several respondents fell that such a clinic has little chance of success. Chinappa holds that it could not work in "an unorganised health care facility like that in India. You need a high level of education in the patient and a high level of ethical and moral integrity in the medical profession for this system to work".Colabawalla adds that the idea is good, but "I doubt if it will ever be welcomed by most professional colleagues. There will always be the doubt that patients would be misappropriated". Also, most medical professionals in India think they are too good to be challenged thus.Udwadia agrees. "You require a general improvement in ethical standards for this to come about. When this does happen, specialist clinics for second opinions would be redundant."Bhanage expresses some hesitation: "It is virtually impossible to get a genuine second opinion in private practice where even the most senior doctors are very insecure and distrustful of their colleagues. A second opinion clinic will have to be manned by a senior doctor with a reputation for integrity."White sees a similar problem in the US. "Medicine here has rapidly become a market commodity (unfornately, in my opinion). A physicial income often depends on 'capturing market share' from other physicians. Thus physicians and hospitals engage in extensive marketing and advertising to 'steal' patients from others.""Can a member of the clinic reject the patient's request for treatment after he has attended the clinic?"Hemraj Chandalia feels that if a patient insists he be followed up by the new consultant, "I will not deny the patient such an option