They Had a Mysterious Illness. Someone Finally Told Them It Was Real—and There Was a Cure. They Got Something Very Different.

Audrey was in seventh grade when her bones started breaking: eight in total, over six months. Some of them broke dramatically, like her wrist, which fractured when she fell down a flight of stairs. Others less so: She broke her foot just stepping on it oddly.

The broken bones became part of a strange collection of symptoms: Her tendons and ligaments started tearing. She would faint suddenly. Her joints swelled. She began going about her daily life on crutches. “At one point, I couldn’t wear pants or socks and shoes,” Audrey said. Baffled and frightened, Audrey’s parents took her from hospital to hospital. (Audrey and other patients interviewed for this story requested that we use their first names only, to protect their privacy and help ensure that sharing their experiences does not affect their future medical care.)

Doctors were able to diagnose Audrey’s fainting spells as part of a condition called POTS —postural orthostatic tachycardia syndrome. Your autonomic nervous system regulates heartbeat and blood pressure, but with POTS, the body stops keeping these functions in check, causing symptoms like nausea, dizziness, and extreme fatigue.

But for her frequent injuries, swelling, and pain, doctors didn’t have answers. It was actually even more frustrating than that: “All of the doctors were saying that there was nothing wrong with me,” Audrey said. She was told she was simply experiencing “growing pains.” She dialed back her time with friends and stopped playing soccer.

When Audrey was 15 years old, her family made the trip from their home in Harrisburg, Pennsylvania, to Children’s Hospital of Philadelphia, one of the best in the country. That’s where they met pediatric rheumatologist David Sherry. Sherry had an explanation for Audrey’s symptoms: She didn’t have growing pains. She didn’t have POTS, either. She also wasn’t making up her pain. She had amplified musculoskeletal pain syndrome, or AMPS—and he had a treatment that could cure her.

Sherry began using the term AMPS in the early 2000s while working at a children’s hospital in Seattle. There, he met patients—usually girls—who experienced intense pain with the slightest touch. The nervous system usually creates pain in response to injury, not the brush of a hand. He theorized that in these patients, this system was firing abnormally, causing excruciating pain in the absence of any physical damage or even much physical input at all.

The kind of therapy he developed is perhaps best described as “Spartan,” and is in place at CHOP and other hospitals today. At these boot camps, kids with AMPS undertake a routine of intense physical exercise—up to five hours of running, swimming, and strength drills daily. When they’re not exercising, they go through desensitization therapy, a therapeutic technique in which kids are purposely exposed to sensory inputs that their nervous systems will perceive as excruciating, even though they’re innocuous—like harsh rubbing with towels or having their limbs dunked in ice. The goal here is to desensitize the child’s nervous system to pain by putting them through more of it. (Slate reached out to Sherry multiple times to request an interview for this article but did not receive a response.)

For three or four weeks, patients follow this program, some living in the hospital throughout the month, others staying in hotels and Airbnbs with their families. According to medical literature and former patients, some programs, including CHOP, wean children off medications—including narcotics, antidepressants, steroids, and seizure medications—or encourage them to stop cold turkey. (In an email statement sent to Slate, CHOP said that the AMPS program works with families to make shared decisions on medication use. However, the hospital did not respond to a detailed list of questions for this article.) Kids are also discouraged from exhibiting “pain behaviors,” like limping or complaining—anything that might communicate their pain to another person.

That these programs are excruciating is the entire point. A tongue-in-cheek rule repeated by at least one pain program modeled after the one at CHOP instructs patients that they should never skip any activity unless they’re unconscious, have bones protruding, or have a fever of at least 102.8 degrees. (On their website, CHOP notes that participants should refrain from activities if they have a fever above 101 degrees.) A 2019 episode of NPR’s Invisibilia reported and hosted by Alix Spiegel follows one teen patient at a rehabilitation program at Children’s Mercy Hospital in Missouri as she has an asthma attack, then develops a nosebleed, then has an asthma attack, and finally vomits in a trash can while completing the program’s exercises. In reporting this story for Slate, I spoke to former patients who described an environment where they were surrounded by other teens crying and screaming in pain. It’s perhaps for this reason—the emotional intensity of the program—that phones go in a locked cabinet and parents are forbidden from seeing their kids throughout the day.

But the promise of the program is extraordinary, too: In exchange for this intensity, desperate families are told that their children will get their health back and be able to return to normal life. On its website, CHOP states that in a published cohort study of 103 patients, they found that all patients went home “fully functional,” and 92 percent were pain-free. Other programs report similar outcomes.

Sherry recommended that Audrey participate in CHOP’s program. It would be grueling, but he was confident Audrey would recover if she worked hard enough.

Audrey was scared to leave home and miss so much school, but her parents encouraged her to take the opportunity. “They were like, ‘This is good! They have great statistics!’ ” Audrey said. Gradually, she started to feel excited as well. “I was hopeful that it was finally going to give me some relief.”

Instead, she found herself leaving the program early—ashamed, and in more pain than when she began. The program would have a lasting detrimental effect on her mental health as well as her relationship with her family.

I interviewed 10 former patients of these programs, all of whom repeated similar stories: They had been sold, essentially, on a cure. The work would be hard, but worth it.

Yet, despite the promising numbers in the reports, the reality many of these patients experienced was much different. “I believed the fairy tale they told me,” said Isabel, a former patient of the AMPS program at CHOP. “Looking back, I know I just went through hell for nothing.”

The broad concepts underlying an AMPS diagnosis aren’t controversial at all. As we move through the world, our nerves send signals to our brain about the sensations in our body; it’s the brain’s job to interpret those signals. In response to danger or physical injury, the brain generates pain. This is necessary for survival—otherwise you might put your hand on a stove and not move it until your skin was visibly burning.

But different factors, from our emotions to our beliefs, can influence that pain response, turning the volume up or down. This adjustability can be a good thing—imagine a marathoner repeating mantras to themself as they push through the final miles of a race—or a very bad thing. Because pain itself is generated in the brain, not the body’s tissues, it can be wildly out of proportion to any physical damage, an amplifier that transforms a whisper into a distorted shriek. There are lots of names for this process. Before Sherry came up with the AMPS diagnosis, some doctors were already calling it “central sensitization,” a phrase that’s still in use. Others use the term “neuroplastic pain.” And when people get stuck in this excruciating loop for three months or longer, we call it chronic pain.

For some people experiencing chronic pain, a combination of physical exercise and cognitive behavioral therapy—both cornerstones of Sherry’s programs—can be life-changing. I’m one of those people. In my mid-20s, after a decade-long struggle with debilitating, widespread pain, I followed a treatment plan that involved pain neuroscience education, where I learned about the biology of pain, paired with a gradual return to my regular activities. I completed the treatment under the supervision of a doctor, but while living at home, and at my own pace. At first, every step I took hurt. But with the reassurance of a pain doctor that I was “perfectly healthy,” I started jogging and working full time, despite pain. Five years later, free of chronic pain, I ride bikes and run endurance races, activities that I could not have imagined doing back when I was laid up in bed with neck spasms, or having trouble so much as typing on a computer. Learning that the pain actually could be all in my head—while still being real—freed me.

Many of Sherry’s former patients report similarly dramatic recoveries. A 2015 study of children with the chronic pain condition fibromyalgia found that 18 of the 54 kids who answered the survey were completely pain-free a year after leaving the AMPS program at CHOP. That teen girl on Invisibilia, the one who threw up and had an asthma attack during physical therapy, was unable to tolerate the breeze of a fan when she first began treatment. One month after the program ended, she was able to dance. The model program that Sherry designed “has helped a lot of patients,” said Jeffrey Boris, a private-practice pediatric cardiologist who specializes in POTS and other autonomic disorders. “It really has.” He’s a former colleague of Sherry’s at CHOP, and has seen the benefits—and the issues—with the program up close.

Here’s the thing that programs tend to gloss over: In this study and others, most kids don’t improve completely. A year after receiving treatment, half of patients in that 2015 study still reported pain scores between 20 and 66 out of 100.

That study and other anecdotes, some patients and experts say, are difficult to square with the promising figure on CHOP’s website, that 92 percent of patients in one cohort returned home pain-free. It makes sense that a survey conducted by the program itself could paint a rosy picture. The studies—like most research on pain—are based not on objective measurements but on self-reported data. And in this case, the data comes from teenage participants who, for weeks, have been repeatedly coached that they need to stay positive and not talk about their symptoms. Patients I spoke to told me how they had downplayed their symptoms in these questionnaires. Former CHOP patient Isabel remembers telling Sherry that she was 100 percent better at her six-month follow-up appointment, when her symptoms were truly worsening. “I wanted to please him,” she told me.

And then there’s the fact that this boot-camp approach isn’t just being used to treat pediatric chronic pain, the condition it was originally developed for. Some pain rehabilitation programs also admit patients with a variety of other chronic conditions, from POTS to “nonepileptic spells,” which look like seizures but don’t have the same underlying cause as epilepsy. The best argument for sending such patients to these programs might be that, similar to chronic pain, these conditions don’t always have an underlying physical cause. Instead, just as with pain, the brain can generate other symptoms when it starts perceiving danger where there is none, said Alan Gordon, the director of the Pain Psychology Center in Los Angeles. But critics and former patients are dubious that the hopeful statistics presented in clinical trials apply to the broad swath of conditions that some programs claim to treat.

Take Taylor H., who was referred to Mayo Clinic’s Pain Rehabilitation Center after she suddenly began having seizures for no discernable reason. While she was hopeful that the program might help her, she was also confused. “I was like, I don’t have chronic pain,” Taylor said. Taylor attended a three-day-long trial version of the boot camp, offered for patients who aren’t ready to commit to the full three weeks, and decided to go home afterward. “They’re saying they’re going to treat everything from migraines to gastroparesis,” Taylor said. “It’s such a wide range. My question is how do they magically pick what they can treat? Is it just what has the least research?” (While Mayo Clinic initially responded to Slate, they did not respond to detailed questions by time of publication.)

Some patients with functional symptoms do benefit from programs that are designed to rewire the brain’s pain system. In practice, however, that can be dicey: A symptom might not appear to have a physical cause, but could end up having one after all. And just because a psychological approach works for some patients, not all will benefit from the intensive boot-camp approach.

Whether admitted primarily for pain or something else, patients are told that if they only apply themselves at the program, they can get their lives back. When the promise doesn’t pan out, they are left grappling with the consequences: worsened physical health, guilt, shame, and, in some cases, persistent mental health issues. Focusing too hard on the success stories glosses over these patients’ experiences—and oversimplifies the complex nature of treating chronic pain for teens who come to these programs hoping for a cure.

The first sign that CHOP’s program wasn’t going to be a good fit for Audrey came when doctors took her off of her blood pressure medication. Audrey used her blood pressure medication to control her POTS; even though Sherry had told her she didn’t have POTS, the medication had been helpful and Audrey didn’t want to stop taking it. Without it, her heart rate was all over the place, she recalls: “I was dizzy all the time. I was nauseous all the time. I was constantly on the verge of fainting.”

But Audrey had been told that she would feel worse before she felt better, so she continued to tough things out. One week in the program passed, then two. In addition to the dizziness, her pain wasn’t lessening. Instead, it was becoming unbearable. “It was 10 times worse than it ever was at home,” Audrey said. “My legs were so swollen that I couldn’t wear shoes.” When Audrey sat on the floor, close to fainting, she was told that she was engaging in a “pain behavior,” and that she needed to get back up. When she started to slow down while running stair repeats, she was ordered to do more.

Audrey was able to complete the amount of time prescribed to her—four weeks—but program doctors urged her to stay longer. Another week or two of hard effort, and she’d start to see the benefits, they told her. But Audrey couldn’t take any more. She left the program feeling crushed, and disappointed in herself for failing to push through the pain. “I felt like it was my fault,” Audrey said. “Like I didn’t do enough.”

Back at home, Audrey fell into a deep depression. Before the AMPS program, despite her chronic pain and the limitations it posed, she had been a social, high-achieving kid. When she got home, she started attending high school online and stopped seeing her friends. She didn’t tell her parents what was going on in her head, afraid that they wouldn’t believe her. “I was scared to talk about how I felt,” Audrey said. “I internalized this idea that I had to ignore my physical pain, and tried to ignore every negative emotion I had.” By high school graduation, she became so withdrawn, her parents enrolled her in an all-day psychiatric program.

The shame Audrey felt over failing to get better is common among patients who attend pain programs with the boot-camp approach. Teens and their families internalize the message that if they only try hard enough, adopt the right mindset, they’ll get their health back—a message that implies it’s their fault if they don’t.

Lily attended the Mayo Clinic’s Pain Rehabilitation Center, but says she was asked to leave early for failing to adopt the right mindset. (According to Lily’s mom, the program had called Lily’s attitude “uncooperative and disrespectful.”) Lily said she had repeatedly questioned the concept of a “pain behavior.” She recalls being crushed by the look on her mom’s face. “I wish you had just tried,” she recalls her mom saying.

Laura attended a pain boot camp at a different hospital when she was 14 years old, to receive treatment for complex regional pain syndrome and POTS. She managed to complete the program, but it had a lasting impact on the way she viewed her chronic illnesses—which she says got worse in the aftermath of the treatment. “I still struggle today; it’s so engraved in me that I’m causing myself this pain, I’m causing myself this misery,” said Laura.

For many people with chronic pain, the metaphors that scientists use—like the amplifier, making a whisper sound like a scream—don’t tell the whole story. There are people who experience what I endured—ongoing pain independent of any physical damage. There are also people who have some type of physical damage—like arthritis or an old injury that healed poorly—that still benefit from a cognitive retraining approach. Then there are people like Audrey who are experiencing pain as well as illnesses that can cause very real damage to the body if left untreated. Many of those chronic illnesses that can live alongside chronic pain are poorly understood, with researchers still working to understand their causes and how best to treat them. Dropping chronically ill kids into programs with intense schedules—and little room to voice concerns—has the potential for physical harm and, at minimum, psychological damage. Yet, patients like Audrey are frequently referred to intensive pain rehabilitation programs, according to what Boris, the private-practice cardiologist, has observed. Before beginning his practice, Boris worked at CHOP for almost 12 years. There he saw many patients who had POTS, often alongside other chronic conditions like Ehlers-Danlos syndrome, or EDS, a genetic condition that causes the body to produce weak connective tissue, such as ligaments, cartilage, and even blood vessels. Sherry, also at CHOP, was seeing some of the same patients as he was. He and Boris didn’t exactly see eye to eye. “He and I very much differed in the way I approached the care of these patients,” Boris said. Patients would come to see Boris after attending the AMPS program with worse symptoms than when they began.

Boris eventually left CHOP due to what he calls “fundamental philosophical differences” in how he felt POTS patients should be cared for. But even in his private practice, he often encounters patients who have attended, or plan to attend, intensive pain rehabilitation programs like the one at CHOP. Last year, a survey of 1,130 people with POTS found that 13 percent of respondents had attended one of these intensive hospital-based boot-camp programs.

Today, the website for CHOP’s AMPS program is careful to state that they only accept patients with POTS and EDS if chronic pain is their “primary complaint.” However, other programs, including Mayo Clinic’s Pediatric Pain Rehabilitation Center and Children’s Specialized Hospital’s Pediatric Chronic Pain Management Program, explicitly state on their websites that they treat POTS—not just pain associated with it. (These programs don’t explicitly mention EDS.)

Kids are entering the programs with other chronic conditions as well—conditions that scientists don’t fully understand, and which are difficult to treat with a blanket approach. The 2024 survey of patients with POTS, the results of which were published in the International Journal of Management and Applied Science, found that most respondents who attended one of these programs had more than one chronic illness diagnosis, 2.5, on average. Among the most common co-occurring illnesses were chronic fatigue syndrome and mast cell activation syndrome, or MCAS, a condition where patients experience intense episodes of diarrhea, hives, vomiting, and, in many cases, life-threatening anaphylaxis attacks. These conditions can both be aggravated by excessive exercise and stress. The study found that more than a third of patients left the programs feeling just as bad as when they entered—and 24 percent felt even worse.

“Often the people that are going into these programs are the sickest of the sick,” said Cathy Pederson, a neurobiologist at Wittenberg University in Ohio and the lead author of the study. Pederson’s daughter has POTS, and 12 years ago, it was recommended that she attend a boot camp–style pain rehabilitation program. Ultimately, Pederson and her family decided against it; they felt their daughter, who was 12 at the time, was too young to spend that time away from home. It’s impossible to know how things might have turned out for her daughter had the family made a different choice, Pederson said, acknowledging that the programs do bring relief to some patients. She’s even encountered people with chronic illnesses for whom intensive rehabilitation programs, like the one at CHOP, were life-changing, enabling them to return to school, sports, and their friends.

Benjamin Levine, a sports cardiologist at UT Southwestern, developed an exercise protocol for patients with POTS used at hospitals around the country. It’s important for these patients to begin exercise gradually, Levine said. “I would be skeptical of any program that lasted all day and is a blast into a maximal effort,” Levine said.

What’s more, Pederson’s survey found that 37.7 percent of the POTS patients who attended boot camp–style pain programs also had EDS—and the percentage was even higher among the category of patients who didn’t get better. Intense exercise can put patients with this syndrome at risk for joint dislocations, tendon tears, and even broken bones, Boris said.

Some pain programs do take a tailored approach that accommodates chronic conditions like POTS and EDS. At the Cleveland Clinic Pediatric Pain Management Program, for example, physical therapists help POTS patients pace activity in a way that doesn’t exacerbate their symptoms, said the program’s clinical director, Ethan Benore. Meanwhile, EDS patients receive coaching on how to move their joints in a way that minimizes risk of injury. Doctors at the program allow patients to remain on any medications, other than narcotics, that are helping them.

“It’s very important that we don’t paint these programs as good or bad. More often, it’s gradations,” Svetlana Blitshsteyn, a neurologist and the director of the Dysautonomia Clinic, a private practice offering medical consultation to patients with POTS and Ehlers-Danlos syndrome, among other chronic illnesses. “My problem is when the program is marketed for everyone.”

In the context of all that we don’t know about chronic illness, the “boot camp” model can present a simple, alluring solution that, in some cases, doesn’t end up being a solution at all.

For three years, Laura had been living with POTS and pain that radiated up her legs, preventing her from participating in the activities she loved: hockey and track. When a rheumatologist recommended that she come in for inpatient pain rehab, her parents didn’t hesitate to spend thousands of dollars out of pocket. (After a long battle with their insurance, they were able to get reimbursed.) “They were like, If this is going to fix my child, of course that’s what I’m going to do,” Laura, now 20, said.

The program’s boot-camp activities were excruciating. Each night, she would lie awake dreading the next day. “I was so anxious that I couldn’t eat, I couldn’t sleep,” Laura said. Four weeks passed. Laura finished the program. When she was discharged, she tried to put on a brave face for her medical care providers. In an essay, and in emails to her therapist, she wrote how much she benefited from the program—how she was back to attending band practice and spending time with her friends again. She didn’t want them to know that she was actually feeling much worse than when she’d begun the program. Her pain had intensified and was spreading to her arms. Other symptoms were appearing as well: nausea, and a rib that continually dislocated. (Later, Laura was diagnosed with EDS and MCAS—conditions she believes were exacerbated by the stress of the program. According to Boris, it’s plausible that the stress of the program could worsen symptoms, but it’s unlikely to have triggered them if they weren’t already present.)

But the worst impacts were psychological. When she returned home, her love for running was gone; sprinting exercises she’d done in the program had ruined physical activity for her. She would have flashbacks where she’d vividly hear other kids screaming. And when she tried to tell her parents what she was going through, she got blank stares. They had been coached that responding in any other way would enable Laura’s pain behaviors and cause her symptoms to worsen.

“Leaving that program, that tore my family apart,” Laura said. “The program impacted my life in so many other ways besides just pain.”

There’s a tendency among doctors who recognize and treat AMPS to start seeing all chronic symptoms through that lens, said Lauren Stiles, the founder and president of Dysautonomia International, an organization which, among other things, funds research on POTS. Looking at these disorders through a purely psychosocial lens is often well-intentioned, but can be harmful when patients have multiple diagnoses or underlying medical issues.

“The people who run these programs are true believers in the psych-exercise approach,” Stiles said. That can result in them missing the bigger picture, she added. “They can’t see that sometimes people with these problems have other medical issues that need to be addressed.”

In her work, Stiles frequently meets families struggling with the long-term impacts of these programs. She recalls one patient who, after initially sending their child to an AMPS program, found out that their child’s supposedly psychogenic seizures were actually caused by long QT syndrome, a heart rhythm disorder that was causing a loss of blood flow to his brain. There was also the young woman who found out that she had Sjögren’s syndrome, an autoimmune disease that is simply very hard to treat, after being told by doctors at a pain program that she wasn’t getting better because she wanted to remain sick.

As with Laura’s case, many of these patients and their families deal with long-term psychological damage. Stiles described one family she met whose daughter died by suicide after returning home from a boot camp–style pain program. Of course, many different factors may have led to her suicide. But the girl’s parents later told Stiles that they thought the stress of the program might have played a role. “They set up unrealistic expectations and took a patient-blaming approach,” Stiles said. “She couldn’t bear the burden of thinking this was all her fault.”

I spoke to two other former patients who said they developed suicidal ideations after attending boot-camp pain programs at Mayo Clinic and Seattle Children’s Hospital. Odessa was a dutiful patient at Seattle Children’s Hospital—she remembers her physical therapists calling her a “trooper” to her parents. Privately, though, she was absorbing the message that her illnesses made her unlovable. (In an email, Seattle Children’s Hospital said psychologists meet with patients multiple times per week to monitor their mental well-being and offer ongoing support.)

Meanwhile, at Mayo Clinic, Lily was caving under the pressure she felt to get better. “You’re a kid and you have no authority over anyone,” said Lily, who has POTS, EDS, chronic fatigue syndrome, and chronic pain. Lily says that she began self-harming after attending the Mayo program because of the guilt she felt when she didn’t improve. (Mayo Clinic didn’t respond to multiple requests for comment on Lily’s story.) “When you’re in that position, you feel absolutely powerless,” Lily said. “All you can do is implode.”

If Audrey’s admission to inpatient psychiatric care four years after attending the AMPS program was an implosion, it was also a kind of rebirth. For two weeks, she participated in dialectical behavior therapy, a form of talk therapy in which patients learn and practice skills, such as mindfulness, to manage intense feelings. The program taught Audrey that she could acknowledge and talk about her emotions and still keep moving forward. “It’s about not letting your behavior be run by your thoughts. Even if you don’t feel like getting out of bed, you still can,” Audrey said. The statement is an echo of the AMPS approach—keep moving despite pain. The major difference is that Audrey was no longer shutting out the discomfort or pretending she could make it go away. She was finding ways to live with it, at a pace and intensity that worked for her.

Once Audrey got home, she started getting out of bed again. She went back to work. She started spending time with friends. And she took steps to treat her illnesses. Soon after leaving that program in 2022, Audrey, who is now 21, was diagnosed with a second chronic illness: EDS, which she’d likely been living with since she was a preteen. That helped explain her repeat injuries and pain. “Getting diagnosed was huge for me,” Audrey said. Her new doctor, who specialized in EDS, started her right away in physical therapy. This time, however, the therapy was tailored to her abilities: a mixture of strength training, yoga, and Pilates all geared toward helping protect her joints. In addition to physical therapy, Audrey underwent gallbladder surgery to help her nausea. At CHOP, she’d been told that her stomach issues were most likely AMPS, pain that she could make go away by muscling through it. Since her gallbladder removal, her appetite has grown, and she loves to bake.

Part of what helped her put her experience at CHOP behind her was an online community she discovered. Young adults and teens were sharing their experiences at pain boot-camp programs. Finding these other patients with similar experiences has helped her see that her experience—namely the fact that she did not improve under the harsh conditions—wasn’t her fault. “It was comforting, almost,” she said. “Others noticed this wasn’t right.”

Other former patients I spoke to have found ways of living with their pain. Some—like Taylor H., who attended Mayo Clinic’s pain rehabilitation program for nonepileptic seizures—have found therapists who specialize in their specific disorder. Others, like Taylor K., who attended Mayo Clinic’s program for POTS, Sjögren’s syndrome, and gastroparesis, have found treatments that help them live more independently. Since leaving Mayo Clinic’s pain rehabilitation program, she started immunotherapy, which is keeping her symptoms under control.

In the end, most patients I spoke with don’t completely reject what they learned at the programs: One’s attitude toward pain and their symptoms does generally matter. You can learn to manage pain while participating in life. It was the execution, however, that failed. “They attempted to teach us the mind-body connection, about pain signals, but it’s all with the underlying theme that it’s your fault,” Laura said.

Today, Audrey’s not better—but then again, she never expected her current treatment regimen to cure her. She’s a junior in college. She still has pain, dizziness, and fatigue. She still struggles with anxiety and depression. But she loves to go to parties. She paints. She just went on a cruise in the Caribbean. “I have a ton of friends now,” Audrey said. “I’m in a really good place.”