1040-5488/04/8111-0872/0 VOL. 81, NO. 11, PP.

872879
OPTOMETRY AND VISION SCIENCE
Copyright 2004 American Academy of Optometry

ORIGINAL ARTICLE

Critique of Claims of Improved Visual Acuity

after Hypnotic Suggestion
AMIR RAZ, PhD, DSc, ZOHAR R. ZEPHRANI, BA, HEATHER R. SCHWEIZER, BA,
and GERALD P. MARINOFF, MD
Magnetic Resonance Imaging Unit in the Department of Psychiatry, Columbia University College of Physicians & Surgeons and New York
State Psychiatric Institute, New York, New York (AR), Brain Imaging Division in the Department of Analytical Psychopharmacology, New
York State Psychiatric Institute, New York, New York (ZRZ), Department of Human Development, Cornell University, Ithaca, New York
(HRS), Department of Ophthalmology, Albert Einstein College of Medicine, Bronx, New York (GPM)

ABSTRACT: Psychological approaches to improving vision present an enticing alternative to invasive procedures and
corrective lenses; hypnotic suggestion is one such technique. During the past 60 years, multiple studies have
documented improvements in the vision of myopic individuals after hypnotic interventions. Given the increasing
interest in behavioral and alternative approaches, we have reviewed the pertinent studies to evaluate their validity. We
delineate various shortcomings in these reports, including potential methodological caveats, problems with experimental controls, and controversial data interpretation. Overall, the data do not seem to support hypnosis as a viable
option for significant long-term improvement of myopia. However, hypnosis can increase ones subjective feeling of
enhanced visual acuity by affecting higher cognitive functions, such as attention, memorization, and perceptual
learning, which could influence performance on visual tasks. (Optom Vis Sci 2004;81:872879)
Key Words: myopia, suggestion, hypnosis, attention, visual acuity

yopia is a leading cause of visual impairment, affecting

15 to 20% of the adult population1 and about 25% of
young adolescents in industrialized Western societies.2, 3 Myopic persons have many options for improving their
vision.4 Potential therapies range from corrective lenses and surgery to specialty diets, visual exercises, and behavioral interventions, all the way to complementary medicine. Alternative treatments present the alluring possibility of changing vision through
natural techniques. Such approaches are gaining popularity, as
shown by the proliferation of programs for preventing and treating
poor vision (e.g., http://www.seeclearlymethod.com).5, 6 Practitioners and visual scientists should be aware of the details and
validity of these approaches.
In some cultures, it is common to use alternative techniques
such as acupuncture and eye massages to improve vision.7 The
ophthalmologist William Horatio Bates pioneered the field in the
U.S. with his controversial behavioral approach to help people out
of their glasses.8 Despite considerable scientific refutation,9, 10 the
Bates method still finds adherents. To improve vision, practitioners have used visual training programs,11 optical feedback,12, 13
and behavioral modification.14 Incorporating hypnosis into their
arsenal, some optometrists and hypnotherapists have led efforts

purporting to improve vision using behavioral and relaxation

methods.1517 Evidence supporting the use of hypnosis for enhancing visual acuity often appears in pseudoscientific books and
nonrefereed journals. However, seemingly scientific outlets have
also published accounts of the effects of suggestion on visual acuity.18 Evidence-based scientific reports show significant modulations of visual perception after hypnotic and other forms of suggestion.19 Among lay audiences and some professional circles,
these findings have given credibility to the idea of using hypnosis as
a remedy for myopia.6 This new acceptance warrants examination
of the supporting evidence. In this article, we review the relevant
studies and investigate claims of using hypnosis to improve visual
acuity.20

PSYCHOLOGY AND VISION

Evidence shows that psychological and environmental factors
can affect visual perception, sensitivity, and acuity. Painful stimuli,
vibrational stress, and thermal strain can all decrease visual acuity.21, 22 Additionally, attentional load and task demands can significantly influence visual processing,23 as can moderate fatigue
and drowsiness.24 Studies show that a decrease in visual perfor-

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Visual Acuity with Hypnotic SuggestionRaz et al.

mance after prolonged wakefulness and sleep deprivation correlates with a cumulative strain on many muscles, including perhaps
the ciliary body. Visual fatigue induced by continuous engagement
in visual tasks also causes a temporary decrease in visual acuity.25
Given the evidence for psychological effects on vision, investigators have attempted to use a variety of psychological strategies to
improve myopia. Researchers have claimed success using biofeedback (enabling voluntary control by using system monitoring),
fading mechanisms (i.e., a variant of reinforcement), and training.26 31 Other scientists have disputed these findings. For example, some claim that although training may have a positive effect on
psychological conditions and subjective visual acuity, it does not
measurably reduce myopia.26, 3234 After reviewing the literature,
prominent researchers argued that more clinical data were needed
before operant conditioning and biofeedback qualified as effective
treatments of myopia.35
Precedents do exist for using operant conditioning to improve
myopia. However, they are based on unpublished observations36
and sparse data.37, 38 One study reported a significant decrease in
refractive error using operant conditioning.39 Several earlier studies claimed that optometric training could significantly improve
visual acuity without using corrective lenses.40, 41 However, investigators have concluded that these training techniques do not alter
the refractive power of the eye.42 Instead, visual acuity improves
when subjects learn to maximize their use of available perceptual
cues. It is likely that such perceptual changes form the basis of the
effects caused by hypnosis.

HYPNOSIS AND VISION

Hypnosis is a form of focused concentration.43 Although clinicians have used hypnosis for hundreds of years, the American Medical Association only certified the technique as a legitimate treatment tool in 1958. In 1996, a National Institutes of Health panel
approved hypnosis as an effective intervention for pain regulation.
Despite these official recognitions, the scientific community has
been slow to accept hypnosis, partly because of misconceptions and
folk beliefs and largely because its mechanism has not been adequately explained. With the advent of novel neuroimaging techniques that allow a quantitative analysis of hypnotic phenomena,
this bias is changing.44
It is possible to classify individuals as either highly hypnotizable or
less hypnotizable based on their susceptibility to hypnotic suggestion as evidenced by performance on standardized scales.43 Hypnotic procedures change the way highly hypnotizable individuals
experience themselves and the environment.44 Researchers can
study these changes using posthypnotic suggestion, a condition
after termination of the hypnotic experience wherein a subject is
compliant with a suggestion made during the hypnotic episode.
Within vision, hypnotic suggestions can induce tunnel vision,19, 45
color blindness,46 51 visual hallucinations,52 alexia,53 and agnosia.54 Such phenomena can manifest in other modalities as well.55

HYPNOSIS AND MYOPIA

The scientific literature contains multiple scientific abstracts
and reports describing the effects of positive suggestion on the

873

56 61

improvement of visual acuity.

In his doctoral thesis, Kelley
investigated the effects of direct suggestion (e.g., hypnosis) and
indirect suggestion (e.g., reinforcement) on visual acuity.62, 63 Using such techniques as cycloplegia and such tools as a haploscope,
Kelley determined that suggestion improved visual acuity in waking and hypnotized subjects. These changes involved physiologic
correlates relating to the lens or shape of the eyeball rather than
accommodative factors. Accordingly, Kelley hypothesized that
psychological factors might have reduced the refraction of the
eye.62 Although he did not provide direct evidence that psychological conditioning could affect visual acuity or refractive error,
Kelley proposed that behavioral manipulations might have modified visual functions.
In 1971, Graham used a real-time laser technique to investigate
the effects of suggestion on myopic visual acuity.59 He measured
changes in relative accommodation in five individuals after hypnotic suggestion64 and argued that although suggestion could improve acuity, the changes he observed in the refractive power of the
eye were neither significant nor consistent enough to explain the
result. Graham concluded that the underlying mechanism must
have operated at the retinal or higher cerebral level.
Graham and Leibowitz subsequently published a seminal article
presenting three experiments on the effect of suggestion on visual
acuity in nine myopic subjects.60 The studies showed that hypnotic and posthypnotic suggestion rapidly and significantly improved the visual acuity of highly hypnotizable subjects. The enhancement was greatest initially, with the hypnotic procedure
most effective for those with the poorest acuity and higher suggestibility. This improvement did not involve a change in the refractive
power of the eye. Some subjects reportedly maintained their improvement outside of the experimental context.
In the field of hypnosis, other reports support these findings.
Several accounts propose that hypnosis can improve visual acuity
without changing the refractive power of the eye.65 67 Studies
show that hypnotic age regression, to a time before the subject
required corrective lenses, improves myopia and hyperopia.47, 68
Others report spontaneous improvement in visual acuity while
testing hypnotized subjects on unrelated tasks.69, 70 One study
reports transient improvement of visual acuity in nine cases of
suppressive amblyopia.71
These claims remained neither confirmed nor contested for an
entire decade until Sheehan et al.,61 using a better-controlled experimental design, reported similar findings using a signal detection task.a In their study, myopic visual acuity improved after as
little as 15 min of listening to suggestions intended to produce
relaxation and an improvement in vision.61 Their study also controlled for potential sampling differences that may have influenced
the original results of Graham and Leibowitz.60 Overall, these
investigations concluded that suggestion significantly affected the
visual sensitivity of highly hypnotizable subjects. Although the
mechanism underlying postsuggestion visual improvement remained unknown, it was presumably a result of the more efficient
a
In signal detection theory, the detection of a stimulus depends on the observers sensitivity and on higher decisional and motivational factors. The parameters
used are sensitivity (or d', a measure of the average difference perceived by an
observer) and criterion (or , the minimum level of activation an observer needs to
claim detection of a target stimulus).

Optometry and Vision Science, Vol. 81, No. 11, November 2004

874 Visual Acuity with Hypnotic SuggestionRaz et al.

utilization of available information (e.g., crowding/contour

interaction).
In searching for a mechanism to explain this noted improvement, we revisited Grahams initial study in which he inducted
subjects into hypnosis and then suggested that they perform a
visual vigilance task to the best of their ability.59 After his suggestion, the less-hypnotizable individuals could better detect stimuli
in their flanking visual fields than could the highly hypnotizable
subjects. This may suggest that attentional increase at the center
is achieved at the expense of peripheral attenuation. Such a
process could explain the improved sensory discrimination of
highly suggestible individuals at the focal point. Only recently
have cognitive neuroscientists been able to investigate this attentional explanation.20

ATTENTION AND VISUAL ACUITY

There is general accord that hypnotic phenomena implicate attention.7274 Cognitive scientists draw a distinction between the
role of attention in simple detection vs. its ability to enhance visual
performance.20 Although scientists agree that heightened attention
may improve performance, there has been great controversy over
what orienting attention to a visual stimulus does. However, there
is consensus that the attended stimulus receives priority, which
decreases reaction time. There also is clear evidence of enhancement of electrical activity over extrastriate visual areas by 90 ms
after visual presentation.75 Conversely, it is also clear that attention
to a peripheral stimulus does not compensate for the lack of acuity
that would be present for a foveal stimulus. Although stimuli falling on the fovea always have an advantage in detail, the priority for
processing the input is elsewhere. Whereas visual acuity requires
the resolution of detail, detection thresholds and reaction time can
involve the summation of luminance, which may obscure detail.
Thus, detection and improved visual acuity are not synonymous.
Toward this end, attention can exert its effects as early as the
primary visual cortex76 by either improving discriminability in
visual tasks or by increasing the rate of information processing.77

A CRITIQUE
Hypnotic suggestion and other behavioral techniques may improve visual acuity in myopic individuals. However, the published
reports on the subject have many shortcomings that bring into
question the validity of such claims. These include questionable
background data, experimental problems, and controversial interpretation of results.
Graham and Leibowitzs influential study60 based its claim on
largely anecdotal findings. Not only did it reference preliminary
case studies67, 71 but also it cited data using scenarios devoid of
suggestion.65 67, 70 The references included an unrelated report,69
an unpublished case report using an authors wife as subject,68 and
a reference-free paper based on a brief unpublished thesis66 with an
unclear number of subjects (once reported as 8 and once as 9).
Methodological shortcomings within the experiments also obscure the validity of the results. Memorization effects occur when
the same chart is used between left and right eyes or test-retest
assessments of the same eye.78 Increased tolerance of blur can also
contribute to an apparent improvement in myopia after a period

without refractive correction.79 Researchers have noted the effect

of blur80 or exposure to unfocused images81 on visual acuity. Because the ability to detect blur may be altered in adult and child
myopia,82 84 additional research in this area would have to account for the effects of chart memorization and blur adaptation.
Selection of subjects could also influence experimental results.
Sheehan et al.61 point out that Graham and Leibowitz60 did not
use suggestibility-matched controls for the highly hypnotizable
experimental group. The controls were almost certainly of lower
suggestibility, which alone brings the results into question. Graham and Leibowitz also assessed visual acuity with a single chart of
Landolt C characters that subjects viewed multiple times. The
subjects may have had sufficient opportunity to view the chart
while wearing glasses between measurements. This lax protocol
may have introduced an appreciable bias.
Grouping of subjects could also have influenced Graham and
Leibowitzs findings. The study contained three subject groups
based on degree of refractive error: those with no myopia, those
with slight myopia (0.75, 0.50, and 0.25), and a highly
myopic group (4, 2.25, and 1.75). Most eye care practitioners would probably label the highly myopic group as moderate
myopes and reserve the designation high myopes for those with
refractive errors 4 D or even 6 D.
Under suggestion, the patients with no refractive error showed
no increased visual acuity; the patients with slight myopia showed
slight improvement; and the patients with the higher myopic errors showed the greatest improvement.60 This result suggests a
statistical regression to the mean effect, in which extreme values
tend to improve the most. However, the authors concluded that
the hypnosis significantly improved visual acuity and that there
was marked improvement over sessions for the highly myopic
subjects.
Choice of experimental technique can also affect a studys results. Graham used the count fingers method to determine visual
acuity when the limits exceeded the size of the letters on the chart.b
This technique is not a standardized quantifiable method because
differences in hand and finger size, spacing between fingers, and
movement during testing can affect the outcome. Slight variations
in distances and lighting conditions could also alter the data. To
analyze these results, we estimated the conversion from count fingers into Snellen letters. Once we express the numbers in Snellen
acuity, the results for improvement of myopia after hypnosis are
less impressive. Two subjects in the highly myopic group showed
slight improvement in one eye only, and the third probably fared
worse under suggestion. In the slightly myopic group, only one of
three showed a potential improvement in vision under hypnosis.
The data simply do not support the claim that the highly myopic
subjects significantly improve.
In general, these investigations of the relationship between suggestion and vision reached conclusions that might not have been
supported by the data. For example, Graham and Leibowitz ruled
out the possibility of relaxation, accommodation, or other causes of
a change in refractive power as the mechanism for the alleged
improvement caused by suggestion. However, variations in the
optical aperture, either by action of the eyelids or changes in the
b
Count fingers can be useful to assess the degree of visual difficulty a subject is
experiencing but should not be used when refractive error is the cause.

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Visual Acuity with Hypnotic SuggestionRaz et al.

pupil, could explain these changes in visual acuity after suggestion.

Myopic individuals are adept at manipulating their eyelids to increase their depth of field. Slight light differences during testing
can also introduce substantial variation in performance for those
with severe myopia. Last, psychological factors could also have
confounded Graham and Leibowitzs original results. For example,
the hold back effect occurs when one expects to be hypnotized and
therefore restricts their prehypnotic performance to allow room for
subsequent improvement under hypnosis.85
Different methods of statistical analysis can also alter the outcome of these studies. In 1983, Wagstaff challenged the statistics in
Sheehans paper and coherently argued that Sheehans results
might have been premature.86 Wagstaff claimed that although the
experimental group did outperform the control group, the control
group might have been marginally better initially. Moreover, he
observed that if suggestions did improve visual acuity, then the
comparison between the experimental groups before and after
treatment should have been significantly different. These differences were not observed.
Wagstaff applied what he believed was a more appropriate statistical model to the data. In doing so, he demonstrated the possibility of concluding that suggestions for improving visual acuity
had little to no effect, whereas listening to music (the control
condition used by Sheehan et al.) appeared to reduce visual sensitivity. In a courtesy reply, the original authors reapplied the conventional analysis of variance to the original data. This re-evaluation illuminated the inadequacy of their initial conclusions on the
effects of suggestion on visual acuity.87
Hypnotic, or even monetary, incentives for changing visual
threshold may be relatively ineffective when participants operate
initially near optimal levels.88 Studies also suggest that although
visual training in myopes does not improve objective measures of
visual acuity, training does promote a greater sense of well-being.
This feeling can then cause a subjective improvement in vision,28
although it does not translate into a measurable change in visual
acuity. Collectively, it seems that a wealth of unambiguous data
dating back 60 years shows no evidence for increased sensitivity
in visual acuity under hypnotic suggestion.89 We compiled a list of
the studies typically cited to support the effects of hypnosis and
suggestion on visual acuity. Table 1 summarizes the results of our
efforts and outlines the shortcomings for each study.
Even if the evidence did support a role for hypnosis in improving vision, the clinical relevance of these techniques would still be
questionable. Behavioral training is typically minimal and short
lived. Few substantive follow-up data show long-term efficacy with
these techniques. It is also unclear whether we can generalize such
data across the heterogeneous myopic population. Clinical ophthalmologists, optometrists, and physiologic optics experts have
thoroughly reviewed the psychological and behavioral factors in
the modification of myopia.39 Most of these eye care specialists
agree that little evidence supports effective behavioral intervention
of myopic vision.90, 91

ALTERNATIVE ACCOUNTS
Although psychological approaches may not improve myopia at
the level of the eye, differences in visual information processing in

875

the brain can affect vision. When we train the brain to interpret
retinal blotches, the cognitive phase of seeing becomes more responsive, causing an improvement in vision. An illustration of this
phenomenon is a smudge on an X-ray chart that may be a blur to
a novice but highlights a serious medical indication to an experienced radiologist. The retinal images in the eyes of the two observers may be identical in clarity, size, and shape, but the cognitive
interpretation and mental contribution of this retinal image are
vastly different. In another example, individuals who failed military entrance tests because of color blindness managed to pass the
required test after visual training. There was consensus within
medical circles that the visual exercises did not cure their color
blindness but instead educated the individuals in how to better
discern colors. Regardless of whether these individuals were cured
or educated, they could distinguish the colored patterns of the
test92, 93 after completing the training exercises. Despite current
knowledge of the substrates of color vision, some practitioners still
mistakenly interpret these data to mean that those persons had
acquired a greater degree of color perception and color discrimination than they had before doing the exercises.
We do not wish to disparage perceptual training to develop a
keener ability to interpret blurred images. The improvement of
some aspects of visual performance through perceptual learning
has been verified.42 Instead, we stress that there is admissible evidence of improvement in visual acuity not explained by refractive
changes.
Graham and Leibowitz60 showed a slight increase in visual acuity for some subjects under suggestion. The effect was the same for
low to moderate myopes and was not related to relaxation of accommodation as would be present in pseudomyopia. Eye practitioners acknowledge that ones vision fares differently on different
examination days, either within multiple tests with the same examiner or among independent examiners. The degree to which an
examiner pushes the patient to discern the visual objects, colloquially called whipping the patient, can affect the testing, producing
an increase on the order of magnitude equal to that seen in some of
the experimental subjects studied under hypnosis. This outcome
probably results from increased attentional effort, concentration,
motivation, or a willingness to use visual (e.g., contrast) and cognitive (e.g., elimination) clues other than enhanced resolution. To
implicate suggestion or hypnosis as the cause of this slight increase
in visual acuity may be overreaching.
Negative accommodation could also possibly explain this occasional improvement in visual acuity in uncorrected myopes.94
Sparsely documented in rare individuals, the baffling phenomenon
of negative accommodation involves evanescent increases in vision
(i.e., flashes of clear vision) accompanied by a decrease in the overall
plus power of the eye. It is thought that there is a base tonus for the
accommodative mechanism9597 that, combined with the dioptric
power of the lens/cornea and the axial length of the eye, produces
the total refractive state. Actively reducing the base accommodative
tonus would reduce the plus power of the eye, enabling myopes to
see better.98 However, negative accommodation, if it does exist, is
extremely rare. In our search, we have found only a few personal
communications from prominent clinicians who report having
assessed negative accommodation objectively (e.g., by retinoscopy).94 However, these accounts are not consistent with the descrip-

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876 Visual Acuity with Hypnotic SuggestionRaz et al.

TABLE 1.
Chronological summary of the primary evidence (since 1950) typically cited in favor of the effects of hypnosis and
suggestion on visual acuity
Author(s)

Sample Size

Method

Weitzenhoffer69

N6

LeCron68

N1

Hypnotic suggestions for

improved differential
recognition
Hypnotic age-regression; no
suggestion

Kline70

N1

Browning and
Crasilneck71

N9

Kelley62,63

N 414

Kliman and
Goldberg100

N 10

Copeland65,66

N 8 or 9

Davison and
Singleton67

N1

Graham59

N5

Graham and
Leibowitz60

N9

Sheehan et al.61

N 16

Kay101

N 75

A test of visual
discrimination in both the
waking and hypnotic states
Exploring the effects of
positive hypnotic
suggestion on visual acuity
in patients with
suppression amblyopia
(amblyopia ex anopsia)
Hypnotic suggestion
accompanied by
optometric assessments
using such manipulations
as cycloplegia and a
haploscope.
Studying visual recognition
thresholds of words seen
in hypnotic and control
waking states, compared
with a baseline waking
state.
Hypnosis without suggestion
A glasses-wearing subject
induced to have positive
and negative
hallucinations under
hypnosis with and without
cycloplegia
Hypnotic suggestion to
improve vision.
Three experiments to explore
whether hypnotic
suggestion could improve
vision in myopes while
refraction and acuity were
measured simultaneously.
Signal detection method to
assess monocular spatial
discrimination while
listening to either taped
hypnotic suggestion or
taped music.
Compares hypnosis with
suggestion for improved
vision, neutral hypnosis,
progressive relaxation, and
control conditions across
myopes

Effect Reported

Comments

Superior performance level Visual acuity was not formally

tested.
compared to the waking
state
Improved vision in a
Based on unpublished data
myopic patient
collected from a cited authors
wife.
Hypnotic transcendence of Controversial and preliminary case
waking visual capacities
report.
Visual improvement in
some cases

Inconclusive results; preliminary

report; pilot study.

Significant improved vision Unpublished data or published in

nonpeer-reviewed journal; strong
in myopes following
bias towards the Bates method;
both direct and indirect
failure to measure refractive
suggestions proposing
changes during the actual training
reduced refractive error.
sessions; doctoral dissertation.
Visual recognition at lower Does not address visual acuity.
illumination under
hypnosis.

Improved visual acuity

following hypnosis
Improved visual acuity
with and without
cycloplegia.

Unpublished data; doctoral

dissertation.
Preliminary report; accidental
finding.

Improved vision with some Inconclusive results.

myopes.
Improved vision following The gist of the present paper.
hypnotic suggestion both
within and between
sessions.

Visual acuity can be

improved by suggestion.

Critiqued85 and rebutted86;

questionable conclusions.

Improved vision with some Methodological issues; unpublished

myopes under hypnotic
data; doctoral dissertation.
suggestion.

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Visual Acuity with Hypnotic SuggestionRaz et al.

tion of increased visual acuity that allegedly occurs as a result of

suggestion.

CONCLUSION
We have presented thorough evidence challenging the original
premise that hypnotic suggestion improves visual acuity in
myopes. Early studies supporting this use of hypnosis have many
shortcomings, including small sample sizes, weak procedures, and
disputable interpretation of results. Based on results from these
studies, the effect of suggestion on myopes visual acuity is not
likely to be significant or long lived.
Reports of temporary changes in subjective acuity and refractive
error as a function of behavioral interventions seem to support a
psychological component to vision. Psychological factors may play
a progressively more important role in our understanding of myopia. Whereas the correlation between suggestion and myopic visual
improvement remains uncertain, evidence relating hypnotic suggestion to attentional mechanisms is mounting.53 Hypnotic suggestion can affect visual attention, which in turn could influence
performance on visual tasks. These findings, together with data
illuminating visual attention and acuity,99 provide the likely mechanism of how suggestion can influence visual acuity.

ACKNOWLEDGMENTS
We thank Mindy Tanzola and Karla Zadnik for meticulous editing and
comments on an early version of this manuscript, respectively.
Received March 2, 2003; accepted August 11, 2004.

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Amir Raz
Magnetic Resonance Imaging Unit in the Department of Psychiatry
Division of Child and Adolescent Psychiatry
Columbia University College of Physicians & Surgeons
New York State Psychiatric Institute
1051 Riverside Drive, Unit 74
New York, NY 10032
e-mail: [email protected]

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