Photo of Pearls of Wisdom Psychiatric Services, Psychiatric Nurse Practitioner in Lorain County, OH
Pearls of Wisdom Psychiatric Services
Psychiatric Nurse Practitioner, MSN , PMHNP, BC
Verified Verified
Lorain, OH 44053
At Pearls of Wisdom Psychiatric Services, a qualified, professional mental health care provider is available to manage prescribed psychiatric medications that treat symptoms of depression, anxiety, bipolar disorder, ADHD or PTSD.
Pearls of Wisdom Psychiatric Services has partnered with SonderMind, a Denver-based digital behavioral health company, to provide quality behavioral health care services to those seeking to improve their mental and emotional health care needs. We are currently accepting new patients for medication management services. Brief, goal oriented and solution focused psychotherapy services provided upon request. Symptoms of ADHD and anxiety treated holistically, without prescribed scheduled medications, (e.g., stimulants/benzos). Make an appointment to discover, recover and live your best life. Give us a call today!
At Pearls of Wisdom Psychiatric Services, a qualified, professional mental health care provider is available to manage prescribed psychiatric medications that treat symptoms of depression, anxiety, bipolar disorder, ADHD or PTSD.
Pearls of Wisdom Psychiatric Services has partnered with SonderMind, a Denver-based digital behavioral health company, to provide quality behavioral health care services to those seeking to improve their mental and emotional health care needs. We are currently accepting new patients for medication management services. Brief, goal oriented and solution focused psychotherapy services provided upon request. Symptoms of ADHD and anxiety treated holistically, without prescribed scheduled medications, (e.g., stimulants/benzos). Make an appointment to discover, recover and live your best life. Give us a call today!
(440) 530-7090 View (440) 530-7090
Photo of Edena Walden, Psychiatric Nurse Practitioner in Lorain County, OH
Edena Walden
Psychiatric Nurse Practitioner, MSN, PMHNP, APN
Verified Verified
Elyria, OH 44035
If you have been suffering with anxiety or depression, unable to get a restful nights sleep, or just feel like you are not reaching your full potential, contact me.
Ideally my patient is as invested in their care as I am. They could have a variety of diagnoses but the thing they have in common is they are willing to give the process time, are open to new ideas, and know there is no magic pill to fix all their problems. My patients want to get to the best version of themselves and are willing to try therapy as well as medications to help them reach that goal. My patient wants an empathetic, listening provider who can guide their care based on the evidence, but tailored to their individual needs.
If you have been suffering with anxiety or depression, unable to get a restful nights sleep, or just feel like you are not reaching your full potential, contact me.
Ideally my patient is as invested in their care as I am. They could have a variety of diagnoses but the thing they have in common is they are willing to give the process time, are open to new ideas, and know there is no magic pill to fix all their problems. My patients want to get to the best version of themselves and are willing to try therapy as well as medications to help them reach that goal. My patient wants an empathetic, listening provider who can guide their care based on the evidence, but tailored to their individual needs.
(937) 909-0557 View (937) 909-0557
Photo of Krista McDonald, Psychiatric Nurse Practitioner in Lorain County, OH
Krista McDonald
Psychiatric Nurse Practitioner, NP
Verified Verified
1 Endorsed
Avon, OH 44011
Her main areas of focus include depression, anxiety, bipolar, schizophrenia, eating disorders, ADHD, panic disorder, PTSD, women's mental health issues, pregnancy and mental health, obsessive compulsive disorder, chronic pain and mental health, and more.
Krista Mousted is a dual certified nurse practitioner in family medicine and psychiatry/mental health, who has been practicing since 2007. She graduated from University of Tampa with a master's degree in nursing, University of Akron with a post-master's certificate in family practice, and Ohio University with a post-master's certificate in psychiatric mental health. Her current focus/specialty is general psychiatry for pediatrics and adults. Prior to being a nurse practitioner Krista worked for 25 years as an LPN/RN with part of that time working as a medic in the United States Air Force.
Her main areas of focus include depression, anxiety, bipolar, schizophrenia, eating disorders, ADHD, panic disorder, PTSD, women's mental health issues, pregnancy and mental health, obsessive compulsive disorder, chronic pain and mental health, and more.
Krista Mousted is a dual certified nurse practitioner in family medicine and psychiatry/mental health, who has been practicing since 2007. She graduated from University of Tampa with a master's degree in nursing, University of Akron with a post-master's certificate in family practice, and Ohio University with a post-master's certificate in psychiatric mental health. Her current focus/specialty is general psychiatry for pediatrics and adults. Prior to being a nurse practitioner Krista worked for 25 years as an LPN/RN with part of that time working as a medic in the United States Air Force.
(216) 626-7105 View (216) 626-7105
Photo of VirtualPsych™, Psychiatrist in Lorain County, OH
VirtualPsych™
Psychiatrist, MD
Verified Verified
2 Endorsed
Elyria, OH 44035
VirtualPsych allows for telepsych healthcare remotely in an easy to use environment. Our physicians specialize in the treatment of conditions such as anxiety, depression and bipolar disorder and have over 30 years of experience in psychiatry and mental health. We accept a variety of insurance plans from providers including Aetna, CareSource and United Healthcare. We also cover most Medicaid and Medicare plans as well. We have appointments available on a daily basis and the time to see a physician is typically less than a few days. Please call us at (216) 238-3555 if you have any questions or would like to set up an appointment.
VirtualPsych allows for telepsych healthcare remotely in an easy to use environment. Our physicians specialize in the treatment of conditions such as anxiety, depression and bipolar disorder and have over 30 years of experience in psychiatry and mental health. We accept a variety of insurance plans from providers including Aetna, CareSource and United Healthcare. We also cover most Medicaid and Medicare plans as well. We have appointments available on a daily basis and the time to see a physician is typically less than a few days. Please call us at (216) 238-3555 if you have any questions or would like to set up an appointment.
(216) 238-3555 View (216) 238-3555
Photo of Michelle McCarthy, Psychiatric Nurse in Lorain County, OH
Michelle McCarthy
Psychiatric Nurse, APN, MSN, PMHNP
Verified Verified
Elyria, OH 44035
Michelle is passionate about delivering care to individuals suffering from anxiety, substance use, and depression. Client motivation and dedication are key to utilizing the tools provided during our sessions including medication management, implementing lifestyle interventions, and therapy to help develop and implement a successful treatment plan. Relief of the client's suffering in dealing with their mental health issues and striving for an improvement in their quality of life is key to treatment.
Michelle is passionate about delivering care to individuals suffering from anxiety, substance use, and depression. Client motivation and dedication are key to utilizing the tools provided during our sessions including medication management, implementing lifestyle interventions, and therapy to help develop and implement a successful treatment plan. Relief of the client's suffering in dealing with their mental health issues and striving for an improvement in their quality of life is key to treatment.
(937) 909-1330 View (937) 909-1330
Photo of VirtualPsychiatricCare.com, Psychiatric Nurse Practitioner in Lorain County, OH
VirtualPsychiatricCare.com
Psychiatric Nurse Practitioner, MSN, PMHNP, APRN
Verified Verified
Lorain, OH 44052  (Online Only)
Accepting new patients for telehealth visits in Ohio for psych evaluation and medication management. We treat anyone suffering with depression, anxiety, or other mental health issue adversely affecting optimal functioning at work, deterring their best social self, or preventing being fully present for loved ones. Our clients are looking to be properly diagnosed and treated using the safest prescribing principles. Make your appointment on our website. Evening and weekend hours are available. Affordable rates out of pocket rates. Also accepting some insurance plans.
Accepting new patients for telehealth visits in Ohio for psych evaluation and medication management. We treat anyone suffering with depression, anxiety, or other mental health issue adversely affecting optimal functioning at work, deterring their best social self, or preventing being fully present for loved ones. Our clients are looking to be properly diagnosed and treated using the safest prescribing principles. Make your appointment on our website. Evening and weekend hours are available. Affordable rates out of pocket rates. Also accepting some insurance plans.
(513) 434-6732 View (513) 434-6732
Photo of David Kwon, Psychiatric Nurse Practitioner in Lorain County, OH
David Kwon
Psychiatric Nurse Practitioner, PMHNP-B
Verified Verified
Elyria, OH 44039
David Kwon is a board-certified advanced practice psychiatric nurse practitioner. He master's and doctoral degrees in nursing from Case Western Reserve University. His previous experience includes providing psychiatric services to patients in both community and private practice settings. He currently provides medication management to adult patients ages 18 to 64. His treatment areas of specialty include anxiety disorders, depression, bipolar disorder, schizophrenia, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
David Kwon is a board-certified advanced practice psychiatric nurse practitioner. He master's and doctoral degrees in nursing from Case Western Reserve University. His previous experience includes providing psychiatric services to patients in both community and private practice settings. He currently provides medication management to adult patients ages 18 to 64. His treatment areas of specialty include anxiety disorders, depression, bipolar disorder, schizophrenia, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
(440) 750-1162 View (440) 750-1162
Photo of Michele Norman, Psychiatric Nurse Practitioner in Lorain County, OH
Michele Norman
Psychiatric Nurse Practitioner, PMHNP-B
Verified Verified
Elyria, OH 44039
Michele Norman earned her Master's in Nursing and Masters of Science in Nursing degrees from Case Western Reserve University. Upon graduation, she was board certified as a psychiatric mental health nurse practitioner. She has been a psychiatric nurse practitioner for 3 years at this point and her clinical practice has been based primarily in outpatient community settings, where she sees patients ranging in age from 6 to 90. Those skills are incorporated in her treatment plans and appointments. Her specializations include PTSD and other trauma related illness, ADHD, depression, anxiety and adjustment/transition issues.
Michele Norman earned her Master's in Nursing and Masters of Science in Nursing degrees from Case Western Reserve University. Upon graduation, she was board certified as a psychiatric mental health nurse practitioner. She has been a psychiatric nurse practitioner for 3 years at this point and her clinical practice has been based primarily in outpatient community settings, where she sees patients ranging in age from 6 to 90. Those skills are incorporated in her treatment plans and appointments. Her specializations include PTSD and other trauma related illness, ADHD, depression, anxiety and adjustment/transition issues.
(440) 581-1220 View (440) 581-1220
Photo of Brandy Hill, Psychiatric Nurse Practitioner in Lorain County, OH
Brandy Hill
Psychiatric Nurse Practitioner, PMHCNS-
Verified Verified
Elyria, OH 44039
Brandy S. Hill is a Psychiatric Mental Health Nurse Practitioner in Ohio who has been practicing since 2022. Living in today's world can be difficult. Are you struggling with anxiety, depression, bipolar disorder, schizophrenia, or ADHD? Cognitive behavior therapy and medication management are techniques that can be used to treat your symptoms. Brandy specializes in treating mental health needs and addiction. She is available for after-hour appointments to meet the needs of clients who work and attend school during the day. Brandy became a mental health provider to decrease the negative stigma associated with mental illness.
Brandy S. Hill is a Psychiatric Mental Health Nurse Practitioner in Ohio who has been practicing since 2022. Living in today's world can be difficult. Are you struggling with anxiety, depression, bipolar disorder, schizophrenia, or ADHD? Cognitive behavior therapy and medication management are techniques that can be used to treat your symptoms. Brandy specializes in treating mental health needs and addiction. She is available for after-hour appointments to meet the needs of clients who work and attend school during the day. Brandy became a mental health provider to decrease the negative stigma associated with mental illness.
(440) 641-2151 View (440) 641-2151
Photo of Ascension Counseling and Therapy Services, Psychiatric Nurse Practitioner in Lorain County, OH
Ascension Counseling and Therapy Services
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
Lorain, OH 44052
Do anxiety, stress, depression, anger or even mood swings interrupt you realizing your best self? Is talk therapy by itself just not enough? If you experience sleep difficulties, disturbing traumatic memories or even panic attacks, you may need some additional support. Medication management is one option, however, sometimes people may see this as the only option. Many people are better served when treated by a specialist who is trained to carefully consider a person’s unique personality, life stressors and even family history before issuing a prescription. I also offer genetic testing to help inform best treatment options.
Do anxiety, stress, depression, anger or even mood swings interrupt you realizing your best self? Is talk therapy by itself just not enough? If you experience sleep difficulties, disturbing traumatic memories or even panic attacks, you may need some additional support. Medication management is one option, however, sometimes people may see this as the only option. Many people are better served when treated by a specialist who is trained to carefully consider a person’s unique personality, life stressors and even family history before issuing a prescription. I also offer genetic testing to help inform best treatment options.
(216) 930-6350 View (216) 930-6350
Photo of Christopher Smith, Psychiatric Nurse Practitioner in Lorain County, OH
Christopher Smith
Psychiatric Nurse Practitioner, PMHNP, FNP, MSN
Verified Verified
Lorain, OH 44053
I am a dual licensed and board certified Nurse Practitioner in both Psychiatric Mental Health (PMHNP) and Family Medicine (FNP). Prior to my work in psychiatry, I spent over 10 years working in a mix of emergency medicine, trauma care, urgent care and covering for primary care providers.
I am a dual licensed and board certified Nurse Practitioner in both Psychiatric Mental Health (PMHNP) and Family Medicine (FNP). Prior to my work in psychiatry, I spent over 10 years working in a mix of emergency medicine, trauma care, urgent care and covering for primary care providers.
(440) 597-5690 View (440) 597-5690
Photo of Danny Miller, Psychiatric Nurse Practitioner in Lorain County, OH
Danny Miller
Psychiatric Nurse Practitioner, APRN, PMHNP
Verified Verified
2 Endorsed
Elyria, OH 44035  (Online Only)
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
(330) 862-9858 View (330) 862-9858
Photo of Dr. Andrea Papa-Molter, Psychiatrist in Lorain County, OH
Dr. Andrea Papa-Molter
Psychiatrist, MD
Verified Verified
Elyria, OH 44035
I am double board-certified in Psychiatry and Addiction Medicine. I believe in using both medication when indicated as well as therapy. I was trained in CBT and was given the Excellence in Cognitive Behavioral Therapy during my residency program. I use supportive therapy with each client I see. During my residency I served as Chief Resident and was awarded the Overall Excellence in Psychiatry Award as well as the Clinical Excellence Award.
I am double board-certified in Psychiatry and Addiction Medicine. I believe in using both medication when indicated as well as therapy. I was trained in CBT and was given the Excellence in Cognitive Behavioral Therapy during my residency program. I use supportive therapy with each client I see. During my residency I served as Chief Resident and was awarded the Overall Excellence in Psychiatry Award as well as the Clinical Excellence Award.
(937) 795-8896 View (937) 795-8896
Photo of Dr. Allen Masry, Psychiatrist in Lorain County, OH
Dr. Allen Masry
Psychiatrist, MD
Verified Verified
Elyria, OH 44035
I am Board Certified in Adult Psychiatry and have been practicing since 2005. I completed my residency from Tufts University in Boston, Massachusetts and my Fellowship in Addictions from the Robert Johnson Wood Foundation. In 2014, I was featured in SJ Magazine as one of New Jersey’s top psychiatrists. I have experience working with adults as well as adolescents suffering from both psychiatric diagnosis and substance use disorders and have extensive experience working in both out-patient and in-patient settings.
I am Board Certified in Adult Psychiatry and have been practicing since 2005. I completed my residency from Tufts University in Boston, Massachusetts and my Fellowship in Addictions from the Robert Johnson Wood Foundation. In 2014, I was featured in SJ Magazine as one of New Jersey’s top psychiatrists. I have experience working with adults as well as adolescents suffering from both psychiatric diagnosis and substance use disorders and have extensive experience working in both out-patient and in-patient settings.
(937) 862-0573 View (937) 862-0573
Photo of Danny Miller, Psychiatric Nurse Practitioner in Lorain County, OH
Danny Miller
Psychiatric Nurse Practitioner, APRN, PMHNP
Verified Verified
1 Endorsed
Avon Lake, OH 44012  (Online Only)
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
(614) 963-3864 View (614) 963-3864
Photo of Emily Coyle, Psychiatric Nurse Practitioner in Lorain County, OH
Emily Coyle
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
Elyria, OH 44035
An ideal client would be someone who is open, honest, and willing to ask for help. This person wants to get better and is open to suggestions and treatment options. They are willing to put in the effort to help themselves and work as a team with their provider in order to move toward mental wellness.
An ideal client would be someone who is open, honest, and willing to ask for help. This person wants to get better and is open to suggestions and treatment options. They are willing to put in the effort to help themselves and work as a team with their provider in order to move toward mental wellness.
(937) 907-1465 View (937) 907-1465
Photo of Danny Miller, Psychiatric Nurse Practitioner in Lorain County, OH
Danny Miller
Psychiatric Nurse Practitioner, APRN, PMHNP
Verified Verified
1 Endorsed
Lorain, OH 44053  (Online Only)
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
(216) 777-7699 View (216) 777-7699
Photo of Danny Miller, Psychiatric Nurse Practitioner in Lorain County, OH
Danny Miller
Psychiatric Nurse Practitioner, APRN, PMHNP
Verified Verified
1 Endorsed
Lorain, OH 44052  (Online Only)
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
(440) 739-6099 View (440) 739-6099
Photo of Danny Miller, Psychiatric Nurse Practitioner in Lorain County, OH
Danny Miller
Psychiatric Nurse Practitioner, APRN, PMHNP
Verified Verified
1 Endorsed
North Ridgeville, OH 44039  (Online Only)
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but you are not the rain (Matt Haig). Danny is, above all, fully engaged in optimizing your well-being. He believes it is crucial to be totally engaged in patient interactions to really connect with you and provide the best care possible. When you see Danny for medication management, you have his undivided attention. As a patient-centered prescriber, he emphasizes practical, positive medical outcomes.
(234) 265-9757 View (234) 265-9757
Photo of Mark Tuvelle, Psychiatric Nurse Practitioner in Lorain County, OH
Mark Tuvelle
Psychiatric Nurse Practitioner, MSN, APRN, PMHNP
Verified Verified
Elyria, OH 44035  (Online Only)
I strive to provide a safe and welcoming environment and want to always ensure that my clients feel they are “being listened to”. I believe a provider must truly listen to understand their client’s concerns, thus ensuring that the patient's priorities are being addressed. I prioritize health promotion, patient education, and psychotherapy.
I strive to provide a safe and welcoming environment and want to always ensure that my clients feel they are “being listened to”. I believe a provider must truly listen to understand their client’s concerns, thus ensuring that the patient's priorities are being addressed. I prioritize health promotion, patient education, and psychotherapy.
(380) 207-1922 View (380) 207-1922

See more therapy options for Lorain County

Depression Psychiatrists

What is the goal of therapy for depression?

Therapy for depression has several major goals. One is to relieve the mental pain of depression, which distorts feeling and thinking so that sufferers cannot see beyond their current state of mind or envision feeling better. Another is to give people the mental tools to recognize and correct the kinds of distorted thinking that turn a problem into a catastrophe and lead to despair. Therapy also teaches people how to process negative emotions in constructive ways, so they have more control over their own emotional reactivity. And it helps people regain the ability to see themselves positively, the motivation to do things, and the capacity for pleasure.

What happens in therapy for depression?

Perhaps most important, no matter the type of therapy, patients form an alliance with the therapist; that connection is therapeutic in itself, plus it becomes an instrument of change. Patients learn to identify and to challenge their own erroneous beliefs and thoughts that amplify the effects of negative experiences. They learn to identify situations in which they are especially vulnerable. And they learn new patterns of thinking and behaving. They may be given “homework” assignments in which they practice their developing skills. In addition, good therapists regularly monitor patients to assess whether and how much the condition is improving.

What therapy types help with depression?

Several types of short-term therapy have been found effective, each targeting one or more areas of dysfunction. Cognitive behavioral therapy (CBT) helps clients challenge their negative thoughts and beliefs, learn new behavioral strategies, and curb reactivity to distressing situations. Behavioral activation (BA) is a form of therapy often used in conjunction with CBT; it focuses on engagement in rewarding activity as a pathway to changing negative feelings and disturbed mood. Another widely used approach is interpersonal therapy (IPT), which targets the social difficulties that both give rise to and get exacerbated by depression. Therapists may combine approaches as needed.

Can therapy for depression be done online?

Studies have found that online therapy can be highly effective for treating depression, although it may be more challenging to build a good therapist-patient alliance on screen than in person—at least at first. However, online therapy can offer considerable advantages. Accessibility and convenience are tops among them. Some people actually find it easier to talk about problems online than in person. While online therapy typically limits visibility of facial expression and body gestures that give important nonverbal cues to a patient’s state of mind, it can give therapists a glimpse into a patient’s world and life, providing information that can be highly useful in guiding therapy.

How effective is therapy for depression?

Many studies show that therapy is highly effective provided that patients complete the prescribed course of therapy, commonly 16 to 20 sessions. Over the long term, it is more effective than medication and the effects are more enduring. As a result, psychotherapy has the power not just to relieve current suffering but to prevent future episodes of the disorder. Therapy reverses the dysfunction in neural circuitry that disposes individuals to a negative view of themselves, the world, and their future and they acquire coping techniques, problem-solving skills, and understanding of their own vulnerabilities that are useful over the course of a lifetime.