Altruism, Well-Being, and Mental Health in Late Life
Altruism, Well-Being, and Mental Health in Late Life
Abstract and Keywords
This chapter begins with the background of and a theory on altruism. It then focuses on research on older helpers, emphasizing work on Holocaust heroes, who are at the time of writing this book quite elderly. The basic premise of this chapter is that the consequences of altruism, in the form of well-being and mental health, can be viewed through the prism of the altruism paradox.
Giving is more joyous than receiving, not because it is deprivation, but because in the act of giving lies the expression of my aliveness.
Blood donors and community service volunteers are recruited with posters announcing that by giving to others, they will receive even more than they give. Is this true? Will those who help others to benefit themselves obtain the rewards that they expect? In this chapter, we begin with the background of and theory on altruism. We then focus on our own research on older helpers, emphasizing work on Holocaust heroes, who are now quite elderly. A basic premise of this chapter is that the consequences of altruism, in the form of well-being and mental health, can be viewed through the prism of the altruism paradox.
The paradox of altruism is based on the law of effect, wherein human beings pursue pleasure for themselves, and avoid pain. How, then, can we explain “pure” altruism, which is motivated by concern for the well-being of another, despite the costs or risk to the self? Although such pure altruism is considered to be a rare phenomenon (Batson & Powell, 2003; Midlarsky, 1968; Midlarsky & Kahana, 1994) both within and between individuals, it is worthy of investigation for both theoretical and practical reasons. When we genuinely comprehend the behaviors of the most altruistic among us (and altruism in ourselves), then an important facet of humanity can be understood. We will also consider behaviors variously referred to as volunteering, rescuing, prosocial behavior (p.57) generativity; and compassion. What these terms have in common is that none assumes that altruism motivates the behavior.
Background and Theory
Why should altruism have positive consequences for well-being and for mental health? The first conceptions of altruism and its consequences are found in the domains of philosophy and theology, rather than in science. The earliest recorded theories about altruism and its consequences were promulgated by the Chinese philosopher Mencius, in the philosophies of the Greeks (agape) and Romans (philanthropia), in the Torah (tzedaka), and in the New Testament, just to name a few sources (Batson, 1991; Midlarsky & Kahana, 1994). In 1851, Auguste Comte coined the term altruism from altrui, an Italian adjective meaning “of or to others, or someone else,” which he used to characterize unselfish as opposed to egoistic tendencies. In this doctrine, the goal of all conduct, and the source of happiness, is a life lived for others. Comte wrote that the two primary impulses are the egoistic, or self-oriented, and the altruistic, or social. In human life, one of these must be dominant; a balance is impossible. Both individual and social well-being can only be achieved by subordinating self-love to the love of others (Lewes, 1904).
According to Tenzin Gyatso, the Fourteenth Dalai Lama of Tibet, the most certain way to attain happiness, and particularly inner tranquility, is by developing the capacities for love and compassion. Indeed, much human misery results from an egoism in which one pursues one's own self-interest at the expense of others. Conversely, most of our joy and security results from emotions and thoughts suggesting that the well-being of others should be cherished (Piburrn, 1990). The paradox here is that it is only when we develop empathy for all organisms that we can secure our own well-being.
The sociologist Pitirim Sorokin was one of the first to bring altruism into the social sciences, arguing that generosity to others leads to increased mental and physical health (Sorokin, 1954/2002). Among Freudian psychoanalysts, on the other hand, genuine altruism is theoretically impossible, because human beings are viewed as intrinsically hedonistic and self-centered. Any behavior that may appear altruistic is viewed by psychoanalysts as either egoistic or masochistic. For the psychosocial neo-Freudians, the emphasis is on the relationship between social interactions and personality development. For Alfred Adler, social interest was important for the fully functioning adult (Schwartz, Meisenhelder, Ma, & Reed, 2003). According to Erich Fromm, we all crave love, and love is not emotion but behavior. Love for Fromm is based on giving rather than receiving and is conceptualized in a manner similar to conceptions of altruism. Erik Erikson's eight stages were designed to replace Sigmund Freud's stages of psychosexual development. The seventh stage involves a conflict between generativity (p.58) and stagnation. The generative individual, destined to mature into the eighth stage, is an adult who works to give support to the next generation. Thus, in Erikson's theory, maturity is equated with generosity.
When empirically oriented psychologists began to investigate altruism and helping, much of the work within psychology was devoted to the question of whether altruism can exist and to the causes of helping behavior (Penner, Dovidio, Piliavin, & Schroeder, 2005). An important goal was to determine factors that could promote the development of altruism in children. It was not until very recently that helping in later life was recognized as valuable for the older adult and for society. Instead, explanations of social behavior in late life focused almost entirely on theoretical models—dependency, autonomy, and exchange—that did not allow for the possibility of altruism (Kahana, Midlarsky, & Kahana, 1987).
In the depedendency model, the elderly are depicted as recipients of aid and, indeed, as a sick and handicapped group, to the extent that aging is viewed as “a terminal illness that uniformly begins in the sixties” (Sankar, 1984, p. 251). The presumption of the dependency model is that when helping behavior occurs in a social interaction involving older adults, helping flows from the younger (including middle-aged) to the older people. The older the individual, the more likely it is that he or she will be a helpless, dependent recipient (Settersten, 1999).
A second model, the autonomy model, reflects the assumption by developmental theorists that independence is a hallmark of adult development. Disengagement theory (Cumming & Henry, 1961), a related perspective, historically was the lens through which late life was viewed. According to Cumming and Henry, people become less amenable to social demands and obligations as they age. This motive to limit involvement with others as either helper or recipient is combined with a desire to fulfill one's own egoistic needs. What is predicted, in turn, is a lesser involvement in helping by older people and fewer benefits, including satisfaction, from helping others.
The exchange orientation, rooted in economic theory and in behaviorism, assumes that all social interaction is governed by the motive to maximize rewards and to minimize costs. Because human behavior is governed by the norm of reciprocity according to the exchange model, older adults would give help only to reciprocate for resources received or expected or to earn resources from others. Helping may occur under these circumstances, but altruism is not a possibility in this model.
To this panoply of theoretical orientations, we added a fourth model, the contributory model of successful aging (Kahana, Midlarsky, & Kahana, 1987). This model presents altruistic or contributory helping, which is prompted by concern for the other and/or by moral or religious motives. In contrast to the dependency and autonomy models, the contributory model depicts older adulthood as a period in which altruistic motivation is probable, rather than improbable. (p.59) In contrast to the exchange model, the contributory model depicts altruistic helping as behavior that is based on moral dispositions, such as empathetic concern and altruistic moral judgment, rather than on reciprocation or on expectations of extrinsic rewards. Although altruistic helping is not motivated by rewards to the helper, and may be very costly, it is expected to yield benefits to the helper. In contrast to models of older adulthood as a period in which people are primarily consumers of social support, older adults can therefore be viewed as an important resource to others. Our model of contributory behavior in late life may also serve as a counterpoint to views in which older adults are depicted as costly and burdensome.
What positive consequences can accrue to older adults when they help others? One possibility is that helping behaviors may ameliorate the impact of the normative stresses of aging (Kahana, Kahana, & Kercher, 2004). If altruism and helping do buffer stress, what mechanisms can account for this effect? One possible explanation is attributable to the importance of the volunteer role, especially for older people who have suffered role losses. In role theory, role accumulation has positive effects on well-being because social roles provide meaning, status, and a sense of purpose (Thoits & Hewitt, 2001). In a similar vein, Pillemer, Wethington, and Glasgow (2000) emphasize the role of volunteering in promoting social integration by older adults, a model supported by findings about the impact of helping in families and in the community (Midlarsky & Kahana, 1994) and about the link between generativity (helping that is designed to maintain the next generation and civic society) and social integration (Keyes & Ryff, 2000). In addition to the enhancement of social integration, helping others has been linked to competence, mastery, and perceived control (Midlarsky, 1984). Others propose that helping results in elevations in mood. For example, social psychologists, such as Cialdini and his associates, have argued that people are socialized to reward themselves when they help others. Helping should therefore lead to decreases in depression and increases in happiness, a proposition that has been supported by research with older helpers (Cialdini & Fultz, 1990; Piliavin & Callero, 1991).
In a model of helping as a useful means for coping with stress, Midlarsky (1991) proposed that several mechanisms combine to account for any positive consequences of helping that may be experienced by the helper. Helping may benefit the helper because helping may (1) increase self-evaluations and perceived competence, (2) distract the helper from focusing on other troubles and stresses, (3) enhance the sense of meaning and value of life by indicating that he or she “matters,” (4) increase positive moods, and (5) facilitate social integration. Snyder, Clary, and Stukas (2000) have been conducting research on six functions that are theoretically served by volunteering behavior, some of which are similar to the mechanisms proposed by Midlarsky (1991) as responsible for the beneficial effects of helping for the helper. These functions are social, knowledge, enhancement, career, value-expressive, and defensive.
(p.60) In sum, then, the theoretical perspectives reviewed here suggest that altruism is a unique form of helping or motive for helping and that both altruism and helping can theoretically yield benefits for the older helper as well as for the recipient. In the following section, we turn to our research findings about altruism and helping and their association with well-being and mental health in later life.
During the past 24 years, we have engaged in a program of research relevant to altruism and helping in late life. Our research has focused on altruism and helping across several studies, employing diverse methodologies. Participants have ranged from older adults residing in age-heterogeneous and age-homogeneous community settings, who are generally engaged in more normative volunteering and helping, to older Gentiles who courageously rescued Jews during the Holocaust. We have also conducted experimental studies to determine the impact of situational influences on patterns of prosocial behavior in late life. In general, the results of our research provide evidence of links between helping, on the one hand, and both well-being and mental health, on the other.
Community-Residing Older Adults
Our program of research was initiated in the 1980s and was designed to address several questions: (1) Do older adults help others? (2) If so, why do they help? What are their motives for helping? (3] Is late-life helping related to psychosocial being? (4) Are there psychosocial benefits for altruism and helping in very late life
Do Older Adults Help Others?
In the mid-1980s, we were planning a series of naturalistic experiments on factors that could increase the rates of donation behavior. We chose shopping centers, malls, and parks as the locations in which to assess the effects of employing a young woman who was or was not visibly pregnant as the solicitor of donations on behalf of children with birth defects. All age groups were exposed to this appeal, but we expected the primary donors to be young through middle-aged adults.
In the pilot study, we waited for the expected younger adults to approach the donation booth. However, it was the older adults who approached, one after the other, while searching for cash and grumbling about not having more to give. (p.61) This was not what we expected, as we were aware of the prevailing view of older adults as people who were more likely to need help than to help others.
We then completed two naturalistic experiments on donation behavior, which were designed to assess donation throughout the lifespan (Midlarsky & Hannah, 1989). In both experiments, the independent variables were the solicitor's condition (pregnant or nonpregnant) and the age of the donor (ages 5–75+). In the first experiment, in which cash donations were requested, there was a linear increase with age in numbers of people donating, with the people aged 65 and over the most frequent and most eager to donate. However, the amounts of money donated by the older, retired adults were lower than the monetary amounts donated by the younger adults. In the second experiment, which served as a replication and extension of the first, the donations consisted of time and effort, rather than money. In this second experiment, the older adults were the most generous on all measures. These findings pointed to the important influences of personal resources and other situational influences in shaping social behavior in late life. We thus concluded that older adults are eager helpers when resources permit them to provide aid to others.
In a cross-sectional survey research study of 400 Detroit area older adults (Midlarsky & Kahana, 1994), about a quarter of the elderly respondents spent a great deal of time helping others, and the helping was more likely to be spontaneous than planned (59% reported that they provided assistance on the spur of the moment). In contrast to the dependency, autonomy, and exchange models of earlier gerontological work (Kahana, Midlarsky, & Kahana, 1987), these older adults described helping as a highly valued activity and said that they greatly preferred to give help over receiving help from others.
In a second set of naturalistic studies, we found that the number of people participating in a fee-based CPR course was significantly related to age, and this relationship accounted for 22% of the variance (Midlarsky & Kahana, 1994). People aged 65 and older had the highest rates of participation. Furthermore, unlike younger participants, there were no significant differences in participation by older adults that were attributable to variations in the course fee ($0, $3, or $10). Several people commented that any amount of money was worth learning ways to help people in life-and-death emergencies.
Why Do Older People Help Others?
In the naturalistic study in which CPR training was provided, participants were asked why they enrolled. Many of the people aged 18 to 64 (54%) said that they were curious about how CPR and first aid are administered. About one third (36%) wanted to use the class to discover whether they were interested enough to consider careers in the health professions. About 34% said they took the class to learn how to help people in need. Among the older adults, on the other hand, (p.62) the vast majority, 85%, said that their only reason was to learn how to help others during a health-related emergency, and 62% said that their goal was to learn how to save lives in a crisis. These findings suggest that older adults tend to value more intrinsic rather than extrinsic reasons for helping.
In our survey of 400 community-dwelling older adults (Midlarsky & Kahana, 1994), the perceived importance or value of helping and two “moral” motives—the sense of social responsibility and empathy—were significant predictors of helping. The preponderance of respondents, 75%, cited motives that included the desire to give help because it was “the right thing to do,” their “duty,” a religious obligation, or because someone they knew was obviously in need. An additional 10% said that they helped to feel useful or to alleviate their own distress at seeing another person suffer. About 5% indicated that extrinsic motives, including specific forms of reciprocal help, material payments, acknowledgment by others, gratitude, or a good reputation, served as motives. These findings indicate that, for most of the older adults in our study, altruistic motives prevailed. In considering the anticipation of extrinsic rewards that motivated a few respondents, most were given by people who appeared to be more needy and less independent.
Results of the quantitative analyses provided support for the central hypotheses, i.e., that helping would be related to morale, subjective social integration, and self-esteem. A result that was unexpected but interesting is that empathy is negatively related to morale after helping is entered into the equation. A possible explanation of this finding is that empathetic older adults may experience serious distress if exposed to others' pain and suffering, which helping may not alleviate. This suggests that exposure to severe, long-term illnesses and other forms of suffering may result in adverse reactions by caring older adults.
Is Helping Related to Well-Beinge?
In the community survey of 400 older adults, 220 reported that they found helping others to be especially rewarding. Of this number, 182 people (83%) cited rewards that are intrinsic. These included a sense of inner satisfaction (55%); the feeling that they were socially integrated (22%); the perception of usefulness, competence, and “mattering”; increased self-esteem (10%); and a feeling that they had done the right thing (10%). As one 88-year-old respondent said, “Even though there are things I can no longer do, I can still bring a smile to my neighbor's face.” In the words of an 86-year-old respondent, “Helping others confirms one's own existence and integration.” Correlational data indicated that those reporting intrinsic motives for helping (e.g., empathetic concern, social responsibility, and altruistic moral judgment) were most likely to report that altruism was rewarding for them. The finding that the rewards were intrinsic in nature was made intelligible by the theoretical perspectives (p.63) identified above. That is, helping may be rewarding by “enhancing the sense of meaning” (Midlarsky, 1991) and by serving a “value-expressive” function (Snyder, Clary, & Stukas, 2000).
An additional study, an experimental follow-up to the original survey (Midlarsky & Kahana, 1994), was then conducted to investigate the possibility that helping positively affects psychosocial well-being. In our study, 120 of the people who had been interviewed in the survey research project 4 years previously either were (N = 60) or were not (N = 60) exposed to a powerful intervention soliciting their participation in volunteer activities, an intervention that we expected would promote the helping of others.
Results indicated that the intervention did significantly affect the helping of family and neighbors and in volunteer roles. Unexpectedly, the intervention had a direct effect on self-esteem. Many respondents were gratified and reassured about their potential usefulness when “so much trouble” was taken to tell them that their efforts were valuable for their community. The helping of family and neighbors and volunteering all affected well-being. However, only volunteering significantly affected all four indices of well-being: positive affect, morale, self-esteem, and subjective social integration.
Are Altruism and Helping Related to Well -Being in Very Late Life?
In a survey by Kahana, Felldman, Lechner, Midlarsky, and Kahana (2004), 366 old-old people (mean age 85 years), living independently in a Florida retirement community, were asked about their altruism, volunteer behavior, and well-being. Altruism was operationally defined, here, as scores on a measure which included such items as “I place the needs of others ahead of my own, “and” I try to help others, even if they don't help me.“ Helping was defined as the frequency with which people volunteered during the past year, on a 5-point scale ranging from “rarely or never” to “several times a day.” Indices of well-being were life satisfaction, positive affect, and depressive symptomatology. The aim was to determine whether altruistic attitudes predicted psychosocial well-being: altruistic attitudes or volunteer activities. We also assessed the degree to which volunteering mediated the relationship between altruism and well-being.
After controlling for age, gender, marital status, and chronic illness, people with high levels of altruism were higher in life satisfaction, were happier, and had fewer symptoms of depression. On the other hand, formal volunteering did not serve as a mediator between altruism and well-being. It should be noted, though, that among these very old adults, only about one third were involved in volunteer activities during the past year. These findings suggest that among the very old, altruistic attitudes are significantly related to well-being even when increasing frailty prevents them from engaging in volunteer activities. Expanded (p.64) opportunities for prosocial engagement requiring less physical exertion may benefit the growing population of old-old adults who seek to express altruistic attitudes in acts of helping.
Elderly Holocaust-Era Rescuers
In our studies of helping in community-residing elderly, we explored altruistic helping on the basis of self-reported helping and on discrete helping behaviors in field experiments. A second approach consisted of investigating correlates and consequences of helping by people identified as genuine altruists by others. Therefore, as part of our research program on altruism and aging, we conducted empirical research on the late-life helping and well-being of rescuers during the Holocaust in comparison with a group of bystanders (Midlarsky, Fagin Jones, & Nemeroff, in press; M. Midlarsky, 2005).
The sample for our study consisted of 153 people who had lived in Europe during World War II. In contrast to other studies of Holocaust era rescuers (Fogelman, 1994; Oliner & Oliner, 1988), the sample was not selected from people currently residing in Europe. Instead, it included 80 rescuers and 73 bystanders who migrated to the United States or Canada between 1945 and 1950. Studying people who are long-term residents of the United States and Canada and who are reasonably acculturated English speakers allowed us to employ measures that had been used in other studies of altruism (Midlarsky & Kahana, 1994).
These 80 rescuers were people who had intentionally helped one or more Jews despite great risk, and with no extrinsic reward for themselves. They were discovered and verified by the research team for the first time and had never been previously interviewed or honored for their wartime activities. The 73 bystanders consisted of people who lived in Nazi-occupied Europe during the war, were not perpetrators, and did not participate in the rescue of Jews. The bystanders were randomly selected from lists of people who lived in the same geographic areas as the rescuers during the war—indeed, they were typically the rescuers' next-door neighbors in Europe. Following the war, they migrated and were now living in the same communities as the rescuers, once again quite often as next-door neighbors. The bystanders interviewed here were people who reported that they offered no help even when asked for help.
Who Were the Rescuers?
We first asked whether the personality and motivational variables identified in the experimental literature on altruism, which investigates determinants of relatively low-cost, short-term helping behavior, would also characterize Holocaust (p.65) rescuers (cf. Midlarsky, Fagin Jones, & Corley, 2005). A hierarchical discriminant function analysis (HDFA) identified one function that correctly categorized 93.2% of the participants. The rescuers were higher than the bystanders on altruistic moral reasoning, social responsibility, empathetic concern, risk taking, and autonomy. When asked why they helped, they typically answered that there was no choice—“It was the only decent thing to do”—or there was no other way to respond to the fear and pain all around them. Thus, the results of this analysis suggest that the rescuers were indeed extraordinary in the degree to which they manifested prosocial personality dispositions in comparison with the other study participants, even a half century after their wartime rescue activities.
Current Helping Behavior
When asked about their helping of others in the past 6 months, the rescuers said that they gave greater amounts of help and spent more time and effort helping others than did the bystanders. Asked how important helping others is to them, 97.4% of the rescuers versus 45.2% of the bystanders said that helping others is an “important” or “very important” activity. At the other extreme of agreement, none of the rescuers said that helping others is “unimportant,” compared to 19% of the bystanders. All differences were significant at p <.0001.
When asked about their current helping, rescuers dismissed their postwar helping as “minor” and of little consequence in comparison with their activities during the Holocaust when people really needed help. In fact, though, they were found to be more generous than the bystanders with time, money, and effort and in all domains—with neighbors, friends, and family and in volunteer activity. Even in regard to helping behaviors that are infrequent in older adults—such as blood donation—these people often generously participated. One rescuer, for example, mentioned that since she was too old for her own blood to be valuable, she donated money and encouraged others to donate their blood during blood donation drives. It is also noteworthy that significantly more rescuers (44%) than bystanders (12.4%) had signed an organ donor card to have their organs donated after their deaths.
Mental Health and Well-Being
The rescuers emerged as a highly empathetic group, with the sensitivity accompanying that personality trait. Probably as a consequence of their extreme sensitivity, the rescuers (but not the bystanders) told the interviewers that they participated in the interview with a combination of positive feelings and trepidation; some later reported that they had flashbacks and trouble sleeping after (p.66) the interviews. They shared memories of the good times: the hours spent delivering a hidden Jew's baby, the jokes and tender moments that they shared, the feeling of being engaged together in a critically important enterprise, the feelings of love and warmth. On the other hand, they spoke of the constant vigilance and fear, often over a period stretching for years, not hours or days. Some had been found out and seriously punished. One person, who had sheltered and saved the lives of 12 people, still cried about one Jewish child who had wandered out of the cellar and been shot almost instantly. No feelings or memories of this kind were shared by the bystanders.
When asked about mental health problems that they had experienced during their lives since the war, approximately 20% of the rescuers and none of the bystanders reported that they had experienced anxiety—especially during the period in which they left their home countries and migrated to the United States or Canada. Close to 60% of the bystanders and none of the rescuers reported that they had serious problems with alcoholism and/or depression, which continued to the present. The differences in mental health were significant at p‼.001.
In regard to well-being, the rescuers reported that they were generally more satisfied with life than did the bystanders. They also reported greater satisfaction when they reminisced about their lives. These differences were obtained although the rescuers were, on the average, 4 years older than the bystanders and had more health problems. They also reported far higher levels of contentment with their family lives and with the friendships that they had made.
The rescuers did not report higher levels of overall happiness, health, or wealth than the bystanders. On the average, they were far less affluent. However, they differed significantly in the aspect of life satisfaction that is termed value congruence, which is defined as a sense of deep inner contentment derived from the sense that one's life has been lived in accord with one's own values. The people who were higher in congruence than any other group were rescuers who were high in both altruistic attitudes and altruistic moral judgment (Midlarsky & Kahana, 1994).
Discussion and Conclusion
Theoretical approaches to altruism have a very long history, evolving as they have from philosophy and theory. Research on altruism and helping is relatively recent, and the study of altruism in late life and its consequences is even more recent. In reporting the findings of our program of research, based on diverse samples and methods, some coherent patterns emerge. Older adults, as a group, are apparently committed to the values of helping, but they are sometimes deterred by barriers based on limited resources or opportunities for helping. When barriers are removed and opportunities for helping arise, older adults not only rise to the occasion but may outperform younger persons in prosocial activities. (p.67) These findings call attention to the value of placing prosocial behaviors in late life in an ecological context (Lawton, Windley, & Byerts, 1982). They also suggest that it is not age per se, but age-associated limitations that may contribute to perceptions of older adults as being less prone to helping than their younger counterparts (Kahana & Kahana, 1983).
Our findings relevant to the question “Do the aged help?” have resulted in affirmative conclusions. In addressing questions about the motivational antecedents and the well-being sequelae of helping, our studies posit the value of simultaneously considering the motivational context and the well-being outcomes of helping in late life. Our data across diverse studies of older adults support expectations concerning the mental health and psychological well-being benefits of helping, which have also been reported in the gerontological literature (Brown et al., 2005). Of special interest, however, are our findings about the unique positive sequelae of altruistic helping.
For those older adults who report altruistic orientations in our studies of the old-old, as well as for older adults who actually engaged in altruistic helping as rescuers earlier in their lives, benefits accrue beyond traditional mental health indicators. Altruistic helpers derive existential benefits related to mattering and experience meaning in their lives without needing to involve secondary gains from engagement in helping, such as keeping busy, making friends, or obtaining reciprocal help from others. Altruism appears to be its own reward even when actual helping acts are no longer possible. Indeed, altruistic motives may continue to result in a sense of meaning and value congruence, regardless of levels of volunteering or other helping acts.
We can also gain insights into late-life altruism by assuming a life course perspective (Settersten, 1999) and recognizing that altruism early in life can serve as both prelude to and rehearsal for late-life altruistic behaviors. Such early and enduring altruism may actually result in modesty and an underestimation of one's helping acts. Older adults who do not give in order to get may experience lives rich in meaning and contentment, based on their empathy and love for others.
Support for the research reported in this chapter was provided by grants awarded by the National Institutes of Health and by the AARP Andrus Foundation.
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