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Peter Stastny / Peter Lehmann (Eds.)
Alternatives Beyond Psychiatry
Soft
cover, 432 pages, 3 figures, 14,8 x 21 cm, British ISBN
978-0-9545428-1-8 / American ISBN 978-0-9788399-1-8.
Berlin · Eugene, OR (USA) · Shrewsbury (UK): Peter
Lehmann Publishing 2007. € 24.90 / $ 39.50 / £ 18.99 /
CHF 43.70 / CAD 40.25 / AUD 42.90 / 3900 JPY / British edition:
Order No. 550 / American edition: Order No. 590
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Preface by Robert Whitaker
Publisher's information
The book highlights alternatives beyond psychiatry,
current possibilities of self-help for individuals experiencing
madness, and strategies toward implementing humane treatment.
61 authors(ex-)users and survivors of psychiatry, therapists,
psychiatrists, lawyers, relatives, politicians and social
scientists from all continentsreport about their alternative
work, their objectives and successes, their individual and
collective experiences.
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Reviews
Heinz
Mölders in Deviant (NL), Vol. 14 (2008), nr
56 (Maart), pp. 18-19 (pdf, 121 KB)
Peter Campbell in Open Mind (UK), March/April 2008,
p. 20
Alternatives beyond psychiatry is a welcome breath of fresh
air. In its pages, 61 authors from around the world (mainly Europe
and North America) describe initiatives, projects and personal strategies
that challenge traditional approaches. It will be thought-provoking
and inspirational reading for anyone interested in innovative responses
to madness.
The shortcomings of biomedical psychiatry have been much explored
and this book does not uncover new territory in this respect. Familiar
messages are hammered home around central issues like coercion,
diagnostic systems and over-reliance on psychiatric medication.
There are two passionate personal statements against the psychiatric
enterprise by Kate Millett and Dorothea Buck, whose 70 years experience
of the German psychiatric system includes compulsory sterilisation,
and an interesting short (too short) piece by Pat Bracken about
the need to move away from paradigms and models entirely.
But at the heart of Alternatives beyond psychiatry, and
what makes it such a valuable resource, are the many chapters describing
actual alternatives. A few of these have attracted attention in
recent years and may already be known to some readers, but a large
number have received little coverage and will be hardly known outside
their own countries. The editors have done a great service in drawing
all this information together.
The alternatives included cover a huge range, from crisis provision
and Hearing Voices groups to service user-led research, personal
ombudsmen and advance directives. Perhaps inevitably with so many
contributors, the quality of writing is variable and I found one
or two chapters quite difficult to digest. It is not easy to compress
the description of innovative work into one short chapter and I
sometimes felt I was not being given enough relevant information
to really appreciate a new approach. On the other hand, there are
many excellent summaries. I thought the chapters 'Intervoice: Accepting
and making sense of hearing voices' and on 'Soteria: A treatment
model and A Reform Movement in Psychiatry' were particularly good.
There is so much positive practice and experience captured in this
book that it is impossible not to feel encouraged about the possibilities
for a better way forward. Nevertheless, the editors are quite downbeat
about the overall impact of alternatives, admitting in the final
chapter: 'Since there are currently no widely encompassing alternatives
available that offer humane help, psychiatric ex-users and survivors
must learn to make the best of the existing services.' This is probably
a realistic judgement. On the other hand, Alternatives beyond
psychiatry is an excellent argument and blueprint for a continuing
effort to construct alternatives. If you are making a list of important
mental health titles for 2008, this one should certainly be on it.
'One of the most important books
on mental health to have come out in the last decade'
Shaun Johnson in Mentalhealth today (UK), March 2008, p.
38
If you accept the medical model approach to mental health doesn't
work, you may well have been asked: 'But what would you replace
it with?' Opening and closing with impassioned arguments against
the psychiatric system, this thought-provoking and exhaustive anthology,
featuring 61 different authors from many different countries, looks
at alternatives to psychiatry and its medical model approach. It
describes a whole range of creative approaches to mental health
and recovery that are about the efficacy of empowerment, support
and cultural sensitivity, of inspiring hope and offering choice,
information, self-determination, advocacy, and the possibility that
mental health workers can create trusting relationships with their
clients.
One of its many strengths is that it offers so many ways forward.
It concentrates on the practicalities, reporting real, live projects
and groups, what they have achieved and the challenges they've faced.
It offers individual stories of how people have coped on their own,
outside of the psychiatric system. It even includes contributions
on using the law to challenge, for example, coercive and forced
treatment and the failure to implement advance directives.
What could easily have been a disjointed collection of articles
is skillfully edited into a narrative for radical change. It works
on several levels, whether as a compendium of imaginative ideas
and first-person stories, a toolbox of alternatives to psychiatry,
or as a summation of the kind of support most service users and
survivors would prefer to receive from the mental health system.
If read by enough people in a position to make a real difference,
it has the potential to radically reform even revolutionise
mental health care in this country. As such, it is one of
the most important books on mental health to have come out in the
last decade.
Paul Cutler (UK) on his blog Public
Action An Activist's Personal Thoughts, Ideas and Journeys
Through the Complexity and Chaos of the Real World (March
13, 2008)
I am finally getting round to writing a short review of this excellent
book that was sent to me last year by a German based publisher called
Peter Lehmann. Peter is a ex-service user and activist who has taken
the publishing route as a way of inspiring change through stories
and writing. He has also been very active in the European Network
of (ex) Users and Survivors of Psychiatry (ENUSP).
The book is a series of chapters written by a mix of mental health
authors. Some are professionals while others are service users.
All share a fundamental perspective that the user voice is essential
to the development and delivery of decent services. The book describes
a series of different approaches that can support mental health
service users towards recovery and challenge discrimination, unemployment
and low income. Standout chapters include those by my friends at
Bradford University on mental health, culture and ethnicity and
a series of chapters on the power and benefits of self-help.
The writing is accessible with a good mix of personal stories and
case studies combined with more academic references. It provides
some inspirational examples and well as vivid descriptions of the
barriers and difficulties people face as they claim their rights.
What I particularly like is that the book addresses a full range
of diversity issues including gender, culture, sexuality and disability
without it feeling like an after thought or tokenism. Given the
range of different authors 61 in total even if there
are certain ones who you do not agree with, there are plenty of
others that will resonante and also there are new authors and mental
health activists to be introduced to for the first time in the pages.
Highly recommended!
Ian
Parker in the Journal of Critical Psychology, Counselling and
Psychotherapy (UK), Vol. 8 (2008), No. 1, pp. 60-61
This marvellous collection brings together innovative alternatives
to psychiatry from different parts of the world. It will stimulate
new connections between those who are struggling to speak about
experiences of abuse at the hands of those who claim to understand
and 'cure' them.
There are some intriguing common themes that emerge as we read
about initiatives like Soteria, Hotel Magnus Stenbock or The Windhorse
Project (to name but three that get an airing here). There is an
assumption that 'psychotherapy' of some kind can be counterposed
to 'psychiatry', and that genuine psychotherapeutic work is in the
good place, beyond bad psychiatry. Each brief scattered mention
of Freud in the book, for example, is positive, and quasi-psychodynamic
notions jostle alongside humanist perspectives. There is a further
assumption that appears in the description of these and other organisations
(ranging from Icarus to the Berlin Runaway House to La Cura), which
is that this therapeutic work should be conducted in a way that
brings people together even perhaps in some kind of therapeutic
community rather than working with each person individually.
There are, of course, tensions between the strategies that are
adopted in different cultures. So, for example, the Open Dialogue
initiative in Finland works on the assumption that contributions
should be tailored to an evolving discussion (and so here the community
ethos is very strong), whereas the Law Project for Psychiatric Rights
in the United States appeals to individuals to assert their power
to seek compensation for wrongs they have suffered at the hands
of the psychiatric system.
One thing that is striking about the collection is how people
faced with psychiatry have often had to reinvent their critique
of the medical model in ways that are suited to particular political-cultural
circumstances but in ways which also enable them to forge a common
cause that is increasingly internationalist. Medical psychiatry
has for sure been one of the forces of globalisation, and its proponents
have been keen to use 'cross-cultural' research to reinforce its
claims to find universal underlying disease entities. This book
shows that radical non-psychiatric approaches to suffering are also
now able to turn diversity of experience from apparent weakness
into strength. Readers can follow the links from the Lehmann website
to access debates in and across the various groups that are represented
in the book (at www.peter-lehmann-publishing.com) and those debates
will no doubt be augmented by the voices of groups that are fighting
on the same ground who are not directly involved in this edition.
The disclaimers at the beginning of the book about the liability
of contributors for harm that might arise from readers coming off
medication highlights an issue that is hinted at in different chapters
but is not tackled head-on; the conditions in which we try to go
'beyond psychiatry' today are now circled by legal procedures which
mostly favour medical psychiatry. But, this book shows that there
are ways out. At 431 pages, this sprawling compendium will be an
invaluable resource for all those building alliances for a world
without psychiatry.
Beyond
psychiatry: Catherine Jackson talks to German survivor
activist and writer Peter Lehmann about his new book (pdf, 171
KB), in: mentalhealth
today (UK), February 2008, p. 20
Psychiatry's Real Experts
It seems, as if countries that have adopted the modern drug-based
paradigm of psychiatric care have, in the past 50 years, experienced
a great surge in the number of people disabled by mental disorders.
Accordingly, it would appear that we desperately need to reflect
on alternatives to this failed paradigm of care. Although in its
present form issues dealing with values, meanings, relationships
and power are not ignored, these always seem to be secondary to
the more important technical aspects of mental health. Indeed, it
only tends to underscore the centrality of "experts."
In spite of the fact that service (ex-) users and survivors might
be consulted and invited to comment on the interventions and the
research connected with the reigning paradigm of care, they are
nonetheless always recipients of expertise generated elsewhere.
In contrast, the recovery agenda, as Pat Bracken puts it in a paper
in this book, presents a radical challenge, since it reorients our
thinking about mental health completely. It foregrounds issues that
have to do with power and relationships, contexts and meanings,
values and priorities, which now become primary. Although such an
agenda does not reject or deny the reigning role of therapy, services,
research and, in some instances, even drugs, it does work to render
them all secondary. Indeed, its most radical implication is the
fact that when it comes to issues having to do with values, meanings
and relationships, it is the (ex-) users or survivors themselves,
who are the most knowledgeable and informed. In other words, when
it comes to the recovery agenda, they are the real experts.
This then is the basic theme of this fascinating new book.
After a very short first part on why psychiatry hurts more than
it helps containing a personal report by the 91 year old
activist Dorothea Buck-Zerchin, who describes her experience of
what she calls 70 years of coercion in psychiatric institutions,
as well as a paper by Kate Millett, which focuses on the question
of legal rights and the mental health system the long second
part takes up approximately half the book in its discussion of present-day
actual alternatives to psychiatry.
Its first section describes the concrete strategies of individual
(ex-) users and survivors, with or without professional support,
and demonstrates that the individual paths taken in order to manage
mental crises without ending up in a psychiatrist's office are extremely
varied. All fourteen personal reports presented here are deliberately
positive, since it is meant to show that it is possible at
least for some to recover their mental equilibrium using
the personal resources at hand and uniquely tackling their problems
with at times rather simple and reasonable methods.
The second section, which deals with concrete examples of organized
(ex-) user and survivor self-help, leads off with Wilma Boevink's
paper on the TREE program in the Netherlands, whose underlying principle
is that an important element in recovery from long-term mental distress
is to develop and pass on narratives. In other words, developing
one's own narrative and comparing it with the narratives of other
(ex-) users and survivors of psychiatry is the beginning of building
experiential knowledge.
Of most interest to this reader in this section, however, were
the reports on the Hearing Voices movement. Hannelore Klafki's paper
on how voices accompanied her throughout her life and how she managed
to cope with them to lead a normal life was quite moving. Following
up, Romme and Escher describe INTERVOICE, the international network,
the basic assumption of which is that accepting and making sense
of voices is a much more helpful alternative for recovering from
the distress associated with voice hearing.
Hearing voices in itself, they point out, is not a sign of mental
illness, but it is quite possible to become ill and a psychiatric
patient, when one cannot cope with them and the problems laying
at their roots. Persons who hear voices and have become ill tend
to show a different relationship with their voices than do persons
who hear voices and do not become psychiatric patients. Accepting
the voices means realizing that the experience of voice hearing
is real, and making sense of them suggests that the voices are not
something crazy, but have a purpose in helping to learn to cope
with life's problems.
In another paper, Rufus May, after describing his own struggle
with mental crises, discusses the unusual beliefs movement. For
example, he reports on the Beyond Belief Network, which aims to
help people to cope with unusual beliefs that might be termed delusions
by mental health professionals. There are many people, he says,
who have beliefs that meet the criteria for delusions, yet who are
living successful lives with no contact with psychiatry. The difference
between them and those who receive mental health services is whether
the individuals involved can cope with their beliefs, and whether
they are distressed or preoccupied by them. This way of thinking
about unusual beliefs, then, follows from the main concept of the
Hearing Voices movement, which states that each person should be
able to choose how best to understand his or her own reality and
that acceptance, as already mentioned, is an important stage in
gaining back the power to manage one's experiences.
The third section then goes on to report on alternative models
of professional support. In it, the editors Stastny and Lehmann's
long paper on Soteria the treatment model introduced by Loren
Mosher in the early 1970s was to me one of the most informative
in the book. After describing Mosher's original model in detail,
they discuss the dissemination and replicability of the Soteria
approach, list the catalogue of crucial elements that must be in
place before a program can call itself Soteria, and soberly give
a current assessment and outlook with respect to the model's future,
stating there is a risk that Soteria development might come to a
complete halt, or even gradually recede.
In this section there are also papers on a user-controlled house,
the Hotel Magnus Stenbock in Sweden; the Windhorse Project in Boulder,
Colorado, Nova Scotia and Vienna, based on Podvoll's working model
of psychosis; the Crisis Hostel Project in Ithaca, New York; the
Berlin Runaway House; the Second Opinion Society in the Yukon; Trauma-informed
Peer Run Crisis Alternatives; La Cura in Sicily; and the Open Dialogue
in Finland
The third part focuses on general and specific beneficiaries of
alternative approaches, that is, on certain subgroups of people
with mental health problems. For example, Philip Thomas and Salma
Yasmeen's paper presents a conceptual critique of mental health
theory and practice to help understand the problems that Western
psychiatry poses for people from non-Western cultures or for those
in the black and minority ethnic communities. Bruce Levine's paper
on managing troubled children and teens without using psychiatric
drugs analyses the ten most common sense causes and solutions and
is most interesting. In another article, Erich Schützendorf
considers the development of a person with dementia not as a pathological
alteration, but rather as an expression of individualistic behavior,
which makes a respectful encounter possible, offering many concrete
examples to prove his point.
Psychiatric (ex-) users and survivors, as is known, have been highly
skeptical of family involvement in the recovery movement, and have
often felt both the controlling and paternalistic experience of
not only their own families, but also those of large family advocacy
organizations. Dealing with this issue, Karyn Baker contributes
a paper on the Family Outreach and Response Program (FOR) in Toronto,
which is based on the belief that families can be exceedingly helpful
in their relative's recovery when given proper education, support
and skills based on a critical recovery perspective. Finally, this
section also contains a paper by Guy Holmes and Geoff Hardy on the
means of breaking what the authors call the shame cycle, especially
in homosexual men.
Part four, which this reviewer particularly enjoyed, examines the
problem of realizing the alternatives and the humane forms of treatment
discussed earlier. It centers on the potential strategies for promoting
and disseminating such alternatives and for achieving human rights
for mental patients. It is stressed, however, that implementation
remains a most difficult undertaking, because the pharmaceutical
industry, the health insurance companies, the hospitals and other
institutions of authority banded together with the psychiatric
profession have more or less succeeded in keeping effective
alternative projects deprived of funding opportunities.
Three articles in this part (as well as one earlier by Miriam Krücke)
treat of the manner in which psychiatric patients can legally protect
themselves and/or fight for their rights. Two of these focus on
the issue of the advance directive, which can be used to assert
and sustain self-determination in situations, where people are no
longer able to express their will, or are deemed to be lacking the
capacity to express their free will. This, then, is a legal instrument
designed to preserve the rights of competent individuals to choose
or refuse health care. One of these papers, from the American perspective,
by Laura Ziegler, is of great interest, especially since she concretely
and extensively reports on six cases of varied legal complexity
from the USA, showing how patients had to fight to have their psychiatric
advance directives accepted by the courts.
Of the two other articles that deal with the issue of the legal
rights of patients in this part, the one by James Gottstein is a
must read. It highlights the work of PsychRights in the USA, which
aims at mounting a coordinated litigation campaign in order to substantially
reduce forced psychiatric treatment and to create non-coercive,
non-medical model alternatives. After some interesting theoretical
considerations, Gottstein presents extensive concrete detail on
just how a PsychRights campaign works, drawing upon a legal action
in Alaska as his primary example. The other paper by Peter Rippmann
describes the work of PSYCHEX in Switzerland, which also has taken
up the legal fight to free patients incarcerated against their will.
David Oaks's paper on MindFreedom International is another high
point of the book, in which he calls for a non-violent revolution
of freedom, equality, truth and human rights throughout the entire
mental health system, the unfair influence of the psychiatric drug
industry adding to these human rights violations. He points out
that drug corporations use fraud, force and fear to violate the
human rights of clients, that they have manipulated the media, advertising
and research to convince the public and mental health professionals
that those with mental health problems have a chemical imbalance,
and that they also use fraud by routinely covering up any information
that their products might be harmful and can even kill.
Forced drugging is growing, Oaks insists, and psychiatric drug
companies fund organizations that lobby the government to make it
easier to force the products they manufacture into customers. Moreover,
fear is used to show that there is no alternative to force and drugs.
In light of this, there ought to be a full range of voluntary, humane,
safe options and alternatives offered to all who choose to use them.
This Western style mental health system, he says, is often called
a "medical model," but more accurately ought to be called
the "domination model", since its main effect is to squeeze
out all other options from mental health care.
Another paper in this section by Ahern et al reports on INTAR,
the International Network Toward Alternatives and Recovery, founded
in 2003, which is dedicated to advancing the knowledge and availability
of alternative approaches for individuals experiencing severe mental
distress. Quite characteristic of many alternatives, they point
out, is that they often remain the sole example of their generally
quite successful approach, but with INTAR there is the possibility
that such individual efforts will cross-fertilize and these positive
results will become disseminated to a wider audience.
In their paper Peter Lehmann and Maths Jesperson describe how (ex-)
users and survivors of psychiatry are presently organized and how
they cooperate internationally, with a particular emphasis on the
role that the internet plays in reaching their goals. Rounding out
this part of the book, there are articles on the system of the personal
ombudsman in Skåne, Sweden; on user-led research, which emphasizes
the value of personal experience in knowledge creation in order
to develop an evidence base for alternative approaches; and on the
Distress Awareness Training Agency (DATA), which prepares people
for (ex-) user or survivor involvement work in England.
Part five, the last in the book, takes up the issue of why alternatives
to psychiatry are needed. It starts off with Marc Rufer's long article
on various aspects of present-day psychiatry's "reductionist
vision of humanity", a hard-hitting critique aimed at its diagnostic
methods, its therapies and the power that it thereby wields. And
then there is Pat Bracken's short, but incisive, analysis of the
radical interpretation of recovery, alluded to at the outset. In
the last paper, the editors Stastny and Lehmann sum up their position.
They believe that a non-medical alternative to psychiatry is possible
either within the psychiatric system or outside. Basically, however,
they harbor no hope that the psychosocial system will change of
its own accord, since it does not support in any substantial manner
the organizations of (ex-) users and survivors of psychiatry, the
cooperation with other human rights or self-help groups, or promote
forms of living with mental problems outside of institutional settings.
Psychiatry, they feel, still tends to turn a cold shoulder to the
movement of (ex-) users and survivors of psychiatry and its supporters,
and to scorn its proposals for reform along with all the important
knowledge it has generated.
Hopefully this book will help the (ex-) user and survivor movement,
not only by introducing a wider public in and out of psychiatry
to its very many real accomplishments, its vital importance and
its future goals, but also by strengthening the international ties
of those directly involved in the movement itself. I can only wish
that this book be read by all psychiatrists, especially younger
psychiatrists in training, since I am quite certain that they will
find much food for thought in its pages.
Karl Koehler, M.D.
Professor Emeritus of Psychiatry, Bonn (Germany)
Mary Maddock of Cork, Ireland, on www.mindfreedom.org
on October 27, 2007. Mary is co-founder of MindFreedom Ireland,
and also co-author of the book Soul Survivor.
Alternatives Beyond Psychiatry is written by many authors,
ex-users and survivors of psychiatry, therapists, psychiatrists,
social scientists, lawyers and relatives and they are all in agreement,
as the title suggests, that we need to go beyond psychiatry. Many
of them explain very well that the concept of 'mental illness'
is a stumbling block.
Human suffering, interpreted and packaged as a disease, only
makes matters worse for those who suffer while it lucratively
rewards some of those who work in the field, especially the pharmaceutical
companies. Kate Millett writes an amazing account on this point
in the chapter The illusion of mental illness.
The alternatives that work are based on human values and help
to develop that which enhances and improves our humanity. There
are many effective ways described in this wonderful book. I would
like to mention a few. Rufus May from the U.K. writes about reclaiming
madness and establishing unusual beliefs. Rufus, who was diagnosed
with 'mental illness' could see that his own madness had meaning.
His search for a spying mission was a metaphoric search for a
meaningful quest in his life.
Hannelore Klafki from Germany could see that her voices had meaning
and Dutch psychiatrist Marius Romme found that when he listened
to his clients, recovery could be achieved by many people labeled
with 'schizophrenia' when the meaning of their voices were understood
and valued.
The Icarus project was one I was particularly interested in because
I was diagnosed a 'manic depressive'. What a different perspective
to be described as someone with dangerous gifts! Now you could
see something that was very negative being more positive straight
away and helping to empower and strengthen you.
People labeled with 'mental illness' need to be encouraged and
find their strengths. With their emphasis on creativity, inspiration,
alternative healing, modalities, radical egalitarianism and a
commitment to self-determination, they attract many who have been
alienated by other approaches.
Many alternative ways of healing have been very successful for
people who have trouble with altered consciousness and they are
described in this book, Soteria: A Reform Movement in Psychiatry,
Hotel Magnus Stenbock: A User-controlled House in Helsingborg,
Sweden, The Windhorse Project from Colorado, The Crisis Hostel
in New York while it managed to survive, The Berlin Runaway House,
The Second Opinion Society in the Yukon, Trauma-informed Peer
Run Crisis Alternatives, A Sicilian Way to Anti-psychiatry: La
Cura, Open Dialogues and Psychotherapy Instead of Psychiatry?
In the section Alternatives and Humane Treatment, David
Oaks, a tireless worker for over thirty years and Director of
MindFreedom International, writes about the non violent revolution
in the 'mental health' system and his passion and charisma bounce
off the pages. He thinks we are fighting more that the medical
model. It is the domination model and is linked to all forms of
domination in the world.
Here we find another remarkable author's contribution, survivor
and lawyer James B. Gottstein. Jim, as he is commonly known, has
set up www.psychrights.org
and has given his wealth, fine expertise, dedication and time
to reducing forced treatments, such as forced drugs and electro
shock and creating non coercive non medical model alternatives.
He has taken on Big Pharma especially Eli Lilly at great personal
and financial cost.
In this section too Peter Lehmann, the co-editor from Berlin and
Maths Jesperson, an extraordinary psychiatric survivor from Sweden,
describe the work of ENUSP (European Network of [ex-] Users and
Survivors of Psychiatry) and WNUSP (World Network of ex- Users
and Survivors of Psychiatry) and the International Network Towards
Alternatives and Recovery is covered by Laurie Ahern, Chris Stevenson
and Peter Stastny, who is the co-editor of the book.
I was delighted to see that my compatriot, psychiatrist Pat Bracken,
made an important contribution in the last section Why We Need
Alternatives to Psychiatry in his chapter Beyond Models,
Beyond Paradigms: The Radical Interpretation of Recovery.
He has the vision to see, as a psychiatrist, that when it comes
to recovery, the real experts are the former users/survivors.
Thanks for that, Pat and thanks to everyone who took the time
and energy to put this important, informative book together.
This book will be helpful for anyone who has been labeled and
diagnosed with a 'mental illness' to find self determination,
recovery and transformation. It will dismiss the ignorance around
the myth of 'mental illness' for those who read this book and
it should be required reading for ministers for health, workers
in the field, family members and all who are interested in the
subject.
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