Parody on the stupidity of Indian Movies---Why Newton Committed Suicide

Why Newton Committed Suicide

Once, Newton came to India and watched a few Tamil movies that had his head spinning. He was convinced that all his logic and
laws in physics were just a huge pile of junk and apologized for everything he had done.

In the movie of Rajanikanth, Newton was confused to such an extent that he went paranoid. Here are a few scenes

1) Rajanikanth has a Brain Tumor which, according to the doctors can't be cured and his death is imminent. In one of the
fights, our great Rajanikanth is shot in the head. To everybody's surprise, the bullet passes through his ears taking away the tumor along
with it and he is cured! Long Live Rajanikanth!

2) In another movie, Rajanikanth is confronted with 3 gangsters. Rajanikanth has a gun but unfortunately only one bullet and a knife.

Guess, what he does?

He throws the knife at the middle gangster? & shoots the bullet towards the knife. The knife cuts the bullet into 2 pieces, which kills both the gangsters on each side of the middle gangster & the knife kills the middle one.

3) Rajanikanth is chased by a gangster. Rajanikanth has a revolver but no bullets in it. Guess, what he does. Nah? not even in your remotest imaginations.

He waits for the gangster to shoot. As soon as the gangster shoots, Rajanikanth opens the bullet compartment of his revolver and catches the bullet. Then, he closes the bullet compartment and fires his gun.
Bang... the gangster dies...

This was too much for our Newton to take! He was completely shaken and decided to go back. But he happened to see another movie for one last time, and thought that at least one movie would follow his theory of physics. The whole movie goes fine and Newton is happy that all in the world hasn't changed. Oops, not so fast!

The 'climax' finally arrives.
Rajanikanth gets to know that the villain is on the other side of a very high wall. So high that Rajanikanth can't jump even if he tries like one of those superman techniques that our heroes
normally use.
Rajanikanth has to desperately kill the villain
because it's the climax.

(Newton is smiling since it is virtually
impossible)

Rajanikanth suddenly pulls two guns from his pockets. He throws one gun in the air and when the gun has reached above the height of the wall, he uses the second gun and shoots at the trigger of the first gun in air.

The first gun fires off and the villain is dead.

Newton commits suicide..

Difference between ADHD and Mania in Children(Source)

The incidence of ADHD in children who are later diagnosed in adulthood with bipolar disorder (BD) is indeed quite high. Compounding this situation is the high rate of co-occurrence of these 2 disorders. In some series, 93% of children with diagnosed BD have comorbid ADHD, whereas 59% of adolescents with adolescent-onset mania have ADHD. The association becomes less pronounced in adults with diagnosed mania, of whom only 10% have comorbid ADHD.

Symptoms common to both, especially in younger children, include hyperactivity, inattention, irritability, and rage, with the severity of these symptoms being more intense in children with BD. Overall impairment is more profound in individuals with both disorders, although environmental accommodations, including the provision of structure, help less to alleviate symptoms in BD than those ascribed to ADHD.

There are several other clinical distinctions that I use in my practice to differentiate ADHD from BD. A strong family history of bipolar disorder is highly supportive of that diagnosis in a particular child. Children with BD are often "mean" and hurtful in their style of social interaction, something not typically seen in ADHD. Children with bipolar disorder can be sexualized to a worrying extent, without any history of sexual abuse. Comments and actions might make adults in their environment feel uncomfortable. Grandiose statements regarding their strengths and abilities might also be a tip-off to BD.

Although in young children the diagnosis relies heavily on clinical impression, supportive mania scales are also available and may be used to guide the diagnosis. These include the Young Mania Rating Scale (YMRS), the parent version of the YMRS, and the Child Behavior Checklist (CBCL).

(Source)

Lewy Body Dementia

Fluctuating cognition with pronounced variation in attention and alertness is essential for a probable diagnosis of LBD

Fluctuating cognition with pronounced variation in attention and alertness is essential for a probable diagnosis of LBD

Spontaneous motor features of parkinsonism are essential for a diagnosis of probable LBD

Features supportive of the diagnosis are:

Repeated falls

Syncope

Transient loss of consciousness

Neuroleptic sensitivity

Systematized delusion

Hallucinations in other modalities

Key points

LBD is characterized by distinct cognitive impairment with fluctuating confusion, disturbance of consciousness, visual hallucinations, delusion, falls and significant parkinsonism

The hallmark feature is the presence of widespread Lewy bodies throughout the neo and archi cortex with the presence of Lewy body and cell loss in the subcortical nuclei

In studies comparing both Diffuse Lewy Body disease and Dementia of Alzheimer’s Type they exhibit impaired performance across the range of tasks designed to assess semantic memory. Whereas patients with DAT showed equivalent comprehension of written words and picture stimuli, patients with DLB demonstrated more severe semantic deficits for pictures than words. As in previous studies, patients with DLB but not those with DAT were found to have impaired visuoperceptual functioning. Letter and category fluency were equally reduced for the patients with DLB whereas performance on letter fluency was significantly better in the DAT group. Recognition memory for faces and words was impaired in both groups.
Semantic impairment is not limited to patients with DAT. Patients with DLB exhibit particular problems when required to access meaning from pictures that is most likely to arise from a combination of semantic and visuoperceptual impairments.

The dementia associated with Lewy body disease affects:

• memory
• language
• the ability to judge distances
• the ability to carry out simple actions
• the ability to reason.

People with this form of dementia suffer hallucinations for example seeing a person or pet on a bed or a chair when nothing is there.

They may suffer from falls for no apparent reason, because their ability to judge distances and make movements and actions accurately is disrupted.

They may develop some Parkinson type symptoms such as slowness of movement, stiffness and tremor. In a few cases heart rate and blood pressure are affected. The abilities of the affected person often fluctuate from hour to hour, and over weeks and months. This sometimes causes carers to think that the person is putting on their confusion.

ORTHOREXIA NERVOSA

Orthorexia Nervosa

People want to eat healthy, but people also have a strong tendency to become obsessive about the things they do. As a consequence, some people who seek healthy diets also become obsessive about those diets - and that means that they take something that should be healthy so far and to such extremes that it becomes very, very unhealthy.

We have all admired the lithograph Waterfall by Maurits C. Escher (1961). His waterfall recycles its water after driving the water wheel. If it could work, this would be the ultimate perpetual motion machine that also delivers power! If we look closely, we see that Mr. Escher has deceived us, and any attempt to build this structure using solid masonry bricks would fail.

The Land Of The Insane

In the land of men, where many abound,

Are some hale and hearty, some mentally unsound

Who among us can hear them call,

From a momentous past , they suddenly fall

Into a chasm that is too hard to gauge

For now they remain in a cage of their own,

bitter, cold and forlorn.

ELEKTRA

Did You Know:

ELEKTRA is Enhanced Learning Experience and Knowledge transfer;ELEKTRA is a Specific Targeted Research or Innovation Project (STREP) funded by the European Commission. In this project nine partners from six European countries are involved.

ELEKTRA will develop an innovative design and development methodology for producing e-learning experiences. This methodology will be derived from combining State of the Art (SoA) research in cognitive science, pedagogical theory and neuroscience with best industrial practice in computer game design and e-learning software design.
As a demonstrator ELEKTRA will produce a 3D virtual reality based virtual learning environment, in which learners can experience learning experiences as rich as gaming experiences. These enhanced learning experiences will improve the knowledge transfer of the learner through innovative knowledge representation and visualisation: The learners will be able to actively interact with and visualise the relationships between concepts and engage in multimodal approach of concepts. The anticipated outcome of ELEKTRA is new approach to design and development of e-learning experiences that is underpinned and supported by research and evaluation findings.

The aim of the ELEKTRA project is the creation of an e-learning game that is apt to overcome the main problems of the existing SoA e-learning games.
• SoA e-learning games use traditional learning methods that are ineffective and do not motivate the learner
• SoA e-learning games do not offer an immersive and coherent learning experience. They lack a holistic approach that combines the actual learning with the gameplay in one immersive and interactive environment (gameworld).
• In general SoA e-learning games can not be used in class room or for classroom related homework.

________________________

BIOLOGICAL BASIS OF EMPATHY

Psychological literature tends to focus on the emotional basis of morality. One of the most important affects in determining moral behavior is empathy, an emotional response triggered by the apprehension of another's emotional state and characterized by having feelings similar to what the other is feeling. This ability to perceive another individual's emotions is crucial to our ability to make moral decisions - that is, to make decisions that positively influence others. The neurobiology underlying empathy relies on both targeted and generalized control. Recognition of another's emotional state, a targeted mechanism in that it activates a specific region of the nervous system, appears to rely heavily on right cortical activity. As might be expected, the visual cortex plays a role in recognizing facial expression of emotion, but researchers have also proposed the involvement of right-hemisphere somatosensory cortices, the region of the brain responsible for interpreting sensory input from one's own body. Adolphs, et al., found that subjects with lesions in this region of the brain were less able to recognize emotions, and hypothesized that to recognize an emotion in another individual, the brain simulates the response it would have if one's own face were exhibiting the features seen on the other person. To the extent that empathy drives moral behavior - or, in very basic terms, to the extent that we choose to act in ways that make others happy because we know how it feels - this somatosensory response may offer a partial neurobiological mechanism for moral behavior.

Emotional responses also rely on generalized mechanisms, those that have a broad-based effect on the nervous system. Empathy, as well as the negative motivators of guilt and shame, derive most directly from the balance of neurotransmitters. Empathy has been associated with increased levels of serotonin, an effect that can be seen in response to antidepressant medication and, even more dramatically, to the illicit drug Ecstasy. Similarly, guilt and shame are often accentuated in subjects found to have low levels of serotonin - those suffering from depression, for example. Both provide possible biological explanations of moral behavior.

Beyond the emotional aspect of morality, however, is a decision-making ability crucial to prosocial behavior. This points to a frontal lobe involvement. Indeed, the most famous case of antisocial behavior is that of Phineas Gage, a 19th-century railroad foreman who suffered severe frontal lobe damage as a result of physical trauma. An explosion caused a 3.5-foot iron rod to pass through the left ventromedial region of Gage's frontal lobe. As a result, the once social and placid Gage became impatient, unrestrained, and inconsiderate. He began exhibiting behavior that was, if not immoral, certainly not acceptable. The interesting implication of Gage's experience is that, rather than being actively promoted, moral behavior may be the result of cortical inhibition of certain behaviors. That's an attractive proposition because it makes morality seem just like a lot of other nervous system functions; much of the job of the motor cortex is to inhibit action, for example. This makes morality seem almost routine in terms of neurological function.

To the extent that morality describes behavior towards others, a sense of self - and a sense of others' selves - is also necessary. Without an understanding of our individuality and the effect that our behaviors have on other individuals, moral judgement would be impossible. With this in mind, we may propose an additional purpose for the so-called I-function, that ability of the neocortex to create awareness, experience, and self. The I-function may allow us to make moral decisions by creating awareness of emotion and enabling us to predict and project emotions. This may well be a secondary evolutionary benefit of the I-function, but in a social species such as humans, it can well be imagined that this could have conferred a survival advantage; ostracism for immoral behavior could well have meant death for early humans.

This may work well to explain social morality, but what of behaviors that affect only the individual? As an example, why do some people consider sexual fantasies immoral? As long as no action is taken, thoughts can have no impact on others, yet in the Western cultural tradition, impure thoughts are a significant moral issue. This is probably best described by a cognitive approach. A few schools of thought exist to explain the development of morals. Among cognitive psychologists, Lawrence Kohlberg's model, developed in the 1950s, is still the basis for understanding. In this scheme, moral development is described as a progression through three levels, each with two stages. Justification of moral behavior is seen to move from self-interest (punishment and reward) through social approval (being liked by others and following a prescribed social order) to abstract ideals (obligation of proper behavior and universal rights). This model, though, has been criticized for failing to predict people's actual behavior, despite its usefulness in assessing intellectual development.

Of course, even if it were entirely successful in predicting behavior, there is nothing magical about this cognitive theory of morality. In fact, this fits well with our current understanding of the function of the nervous system and brings morality further into the realm of behavior explicable from a biological standpoint. What Kohlberg describes as moral development is distinct from moral behavior itself. The explanation that an individual provides for why he won't perform some immoral act surely does change with time and maturity, but these reasons are self-reported. That is, it is the I-function - the conscious part of the nervous system - that offers the explanation. If, as has been proposed, the principal role of the I-function is to build models to understand the rest of the nervous system, then it stands to reason, and common experience confirms, that the model may change with new experiences. This does not, however, imply that the actual reason for moral behavior changes, only that our understanding of it does. This may very well mean that, if the understanding changes to incorporate abstract ideals, certain entirely private behaviors will be considered immoral. The underlying cause of moral behavior, though, may still be innate and unconsciously biological at its core.

It has also been proposed that morality is a learned behavior. Children, this model suggests, gain an understanding of right and wrong through "observation, imitation, and reward". Moral behavior, in this case, depends on external instruction and the presence of a reward. It is without a doubt true that specific elements of a moral code are learned; it has never been the contention that all of morality is innate, only that the basic aspects of it are. That morality may be the result of a simple external-stimulus learning process raises some intriguing implications, though. In general, it means that moral behavior may not be as special as we think it is. It has been demonstrated that a simple algorithm can cause a computer to learn to distinguish between two categories. It is a small jump indeed, then, to say that a computer could be taught to distinguish between immoral and moral, given sufficient feedback. At best, this means moral behavior is merely a result of conditioning; at worst, it means free will should not be an issue in assessing whether an act is moral: if a computer, which does not have free will, can be taught to behave "morally," why should we make free will a condition for determining morality?

Behavior, though, is almost always a combination of innate properties and conditioning. If morality, then, is more than conditioning, what evidence do we have that it is innate? First, infants appear to exhibit empathic abilities, responding with tears when someone close is upset and with sounds of pleasure when someone close is happy. Again, empathy's role in moral behavior may be a secondary evolutionary development; the ability to perceive another's emotions is a useful survival tool, since the other individual may be aware of some threat that you aren't. This is primarily speculation, but it does offer a plausible justification for having empathy - and the moral awareness that stems from empathy - inborn. The other emotions associated with morality - shame, guilt, and indignation - also appear early in a child's development.

Indignation is of particular interest in considering a biological basis of morality. William Damon, in his article on childhood moral development, writes, "...young children can be outraged by the violation of social expectations, such as a breach in the rules of a favorite game...." He goes on to note that this sort of response appears in every culture. This points to two salient features of moral behavior. First, it demonstrates that morality is again consistent with our understanding of the function of the nervous system. The nervous system is constantly evaluating input and comparing it to expectations; generally, most input is ignored by the I-function, but when input doesn't match expectations, the nervous system alerts the conscious and some sort of response is triggered. It has been theorized that this is the root of discomfort and pain, and even of phantom-limb syndrome. Here, now, we see that moral indignation falls conveniently into that pattern.

This, in turn, suggests the second salient feature of moral behavior: that morality is a method of ordering the world outside the nervous system. One of the major functions of the nervous system in general and the I-function in particular is to build useful predictive models of the world and our response to it. Being able to predict events is clearly advantageous, in a social context as well as in a natural context - again, evidence and justification that a sense of moral order is innate.

Even evolutionary biology weighs in on the issue. Animals can display what we might call moral behavior, although the term in biology is "animal altruism." The fish that swim toward a predator, the birds that sound a warning call, the whales that help an injured member of the pod, all display behavior that is apparently beneficial to others but costly to themselves. Biologists explain this either in terms of game theory, in which it can be shown that cooperation leads to a higher total payoff in the long run than selfishness, or kin selection, in which the majority of the recipients are related to the altruist and thus pass along some part of the altruist's genome. Most humans would probably like to draw a distinction between the altruistic behavior displayed by animals and moral behavior displayed by humans, and certainly, the same sort of decision-making does not go into animal behavior as goes into human behavior. Ultimately, though, we are subject to the same evolutionary pressures, and it seems reasonable that human moral behavior is closely related to animal altruism. We may not think that we make moral decisions so as to receive a favor in kind, but the impulse to behave morally may well have evolved as a result of that type of pressure. After all, daily human behavior is rife with motivations that we don't actually understand.

The observation that infants, animals, and computers can all display what looks like moral behavior forces us to revisit the question of whether free will is a necessary condition of moral judgement. This argument is not that free will does not exist; for a demonstration that we can choose behaviors, see Grobstein. Rather, it's that free will is not a sufficient criterion to distinguish between moral/immoral and amoral behaviors. Furthermore, it is impossible to determine by observation whether free will is being exercised - or in other terms, whether the I-function is being involved - even in other humans. It seems, then, that all behavior must be categorized either as moral/immoral or as amoral, outside the bounds of morality. This conclusion has profound implications for, as an example, the punishment of apparently immoral behavior by actors who cannot be determined to be capable of moral "decisions" - that is, the youthful or the criminally insane.

That humans, and possibly non-human animals, have an innate sense of morality seems clear. At the very least, the rudiments of the emotions and social understanding that underlie morality are inborn, being displayed from an early age and across cultural divisions. Moreover, morality is easily understood in terms that the rest of neurobiology is understood: the attempt by the I-function to form useful models of the external world, the comparison of expectations to input, even the evolutionary advantage (both directly and indirectly through social interaction) that morality confers. This says nothing about whether morality is absolute, however. The distinction between the propensity for moral behavior and a codified morality must be well understood here. Specific behaviors are ultimately judged to be moral or immoral as a result of personal and cultural conditioning. Using this approach, then, it cannot be said that morality is absolute. Even more generally, it cannot be said that there exists a universal moral code, for that implies a morality inherent in nature. Even if we were to accept as absolute the propensity for altruistic morality, this cannot be extended to natural law. Indeed, it seems even less likely that morality exists throughout nature than that it exists throughout humanity. Life, as we all know, just is not fair.

(Source)

The New View.

The preeminent model of men's sexual problems that has developed over the past 30 years (especially after the 1992 National Institutes of Health (NIH) Consensus Conference on Impotence emphasizes organic causes of erectile and other sexual function problems and has paved the way for the legendary success of sildenafil (Viagra, Pfizer) and subsequent sexuopharmaceuticals.
However evidence has emerged to challenge the salience of this model. The challenges come from a methodologically diverse array of medical and social science studies that emphasize the central role of psychological, relational, and cultural factors in men's sexual expectations and satisfactions and downplay the importance of a universal model of sexual function and satisfaction. The challenges also come from critics concerned about the pharmaceutical industry's overweening role in the medicalization of sexual problems through its influence on sex research, guidelines development, professional education, journal publication practices, and possible "disease-mongering."Clinicians interested in a more independent and inclusive approach to understanding, assessing, and treating men's sexual problems can turn to one first developed in 2000 for women by a group of clinicians, sex therapists, and social scientists, called "The New View."

Since the 1970s, an emerging interdisciplinary field of knowledge known as "men's studies" has urged scholars in all fields to understand issues concerning men within the context of "what it means to be a man in a particular historical or cultural social setting." This quote, from a 2-volume encyclopedia on Men and Masculinities, scarcely does justice to the importance of understanding men's sexual problems within their social context. As Tepper, a leading expert on sexuality and disability writes, "What boys learn about sex and manhood becomes a critical treatment concern when they reach adulthood and are faced with sexual dysfunction."

Many authors have described that what boys around the world learn about sex and manhood constitutes some variation on a penis-centered mythical performance model that privileges erectile and orgasmic function and downplays issues of pleasure and intimacy. "We can hardly talk about sex without referring to it as a performance," says Apfelbaum. As Zilbergeld and Connell have discussed, impairment in erectile or orgasmic function profoundly threatens a man's gender identity because

[men] learn from an early age that manhood is conditional rather than absolute... Not making the team, not being willing to fight, not performing in bed, losing a job -- that's all it takes and our man no longer believes that he's a man.

And:

[the] constitution of masculinity through bodily performance means that gender is vulnerable when the performance cannot be sustained.

The loss or diminution of erectile or orgasmic abilities can easily constitute a serious identity crisis; although that is not to say that a crisis cannot also be an opportunity. Several recent studies have shown that some, but not all, men react to the threat to sexual function posed by illness by maintaining their masculinity. That is, they cope "like a man" and deal with the situation by adapting, experimenting, and changing practices. The way sexuality, sexual norms, and sexual satisfaction are defined and dealt with by health professionals plays a large role in either helping men cope with problems or, often unwittingly, in converting social norms into clinical standards and thereby exacerbating suffering. "Negative attitudes and misguided beliefs about sexual potential take their toll on sexual self-esteem [and may] make sexual relationships seem pointless."

Understanding and helping men with sexual problems is best achieved through appreciating how specific and contextualized men's sexual lives really are.

The expectations that create the standard script have been narrowly construed as the foreplay mental set and a preoccupation with erections and orgasm... which makes it appear to be the task of therapy to modify [pathogenic interferences] rather than [to modify] the... sex itself.

Treatment Prior to 1998

Until the 20th century, men's sexual problems were dealt with by herbs, ceremonies, incantations, exorcisms, physiotherapy (eg, ointments, baths, exercises), prayer, pilgrimage, external prostheses, and dramatic surgeries, the list id almost unemdimg. Interventions combined psychic and somatic elements that involved complex and culturally specific sexual meanings. Group witness and support were often involved. The outcomes, however, are largely unknown.

Throughout the first two thirds of the 20th century, a range of talk-therapies Psychoanalysis,Psychotherapy were developed to deal with human problems, including problems with sexual relations.

Table 1. Talk Therapies for Sexual Problems

Individual Therapies

• Psychoanalysis

• Psychotherapy

• Behavior therapy

• Cognitive behavior therapy

Group psychotherapies

• Insight-oriented group psychotherapy

• Couples group therapy

• Support groups

• Humanistic group psychotherapy (eg, sensitivity training, encounter groups, gestalt therapy)

• Structured psycho-education groups

Family therapies

Couples therapies (Conjoint approaches)

• Sex therapy

• Marital and relationship therapy

Individual, group, family, and couples talk-therapy approaches emerged from research on trauma, conflict, psychosexual development, conditioning and learning, behavioral change, and interpersonal processes. These approaches directed sexual treatment away from aggressive physical interventions, such as genital surgeries and massive hormones, towards self-understanding, interpersonal skills, empathy, and personal change. Many popular books stressed the importance of resolving neurotic conflicts and educational gaps in order to solve erectile and ejaculatory problems.

In some individual therapies the primary vehicles of insight and behavior change came from the healing potential of the therapist-patient relationship; in others, the benefits came from carefully chosen and thoroughly discussed psycho-educational homework assignments. Schools of psychotherapy competed throughout the century, sometimes criticizing each other's fundamental assumptions and sometimes looking for common ground.

Group therapies emerged in the 1920s to deal with sexual issues such as body image and interpersonal trust.^[24] Postwar, group approaches to sexual problems diversified as a result of the human potential movement in the 1960s and involved modalities such as sensitivity training, encounter groups, gestalt therapy, and bodywork.^[25]

Couples and family therapies were developed in the 1950s and 1960s. They identified the family/couple system, rather than the individual, as "the patient" and the locus of intervention. The crucial but counterintuitive notion that symptoms often maintain the homeostasis of the relationship is at the heart of both understanding and intervention on the systemic level (eg, see LoPiccolo and Friedman^[26]). The thoughtlessness of medical efforts at "simply" removing such symptoms, as with a surgical strike, is reiterated in systems texts.

Masters and Johnson^[27] formalized some of the individual behavioral and educational interventions into a widely publicized couple treatment format and inaugurated a wave of psychiatry-department-based sex therapy clinics that embraced group, couple, and individual formats, but their approach ignored the systems theory approaches developing in family therapy and family medicine.^[28,29] Sex therapy clinics thrived in the 1970s and 1980s but were in decline by 1990 as a result of the growth of biological psychiatry and the medicalization of sexual problems.

Somatic therapies for men's sexual problems remained in the shadows prior to the 1980s, as they had little to offer but experimental surgeries and penile prostheses for impotence.^[30-32] In 1978, a group of physicians convened in New York to discuss new research in the physiology of erection.^[33] They instituted regular meetings that evolved into the International Society for Impotence Research (ISIR) in 1982.* In the 1980s, urologists claimed authority over the new area of sexual medicine, noting "the emergence of the urologist as the primary coordinator of care for the patient with sexual dysfunction, whether the cause of that dysfunction is an organic, a psychogenic, or as sometimes occurs, a combination one."^[34]

In 1983, at the American Urological Association convention, Giles Brindley, a British physiologist and physician, injected his penis with phenoxybenzamine just before his lecture and displayed his erection to the astonished audience.^[35] This legendary event inaugurated an active era of intracavernosal injection treatments, although the first drug was not actually approved by the US FDA until 1997.^[33,36] Also in 1983 came the patenting of a widely advertised vacuum device for erections. (Earlier models had been patented, but either not distributed or sold in sex stores.^[37])

The biological buzz fit with the general molecular Zeitgeist. By 1988, the main health reporters in The New York Times^[38,39] and Time^[40] magazine were promoting the new physiology and treatments for impotence. And, in 1989, a major New England Journal of Medicine review of the field was authored by urologists, with only 2 paragraphs in 11 pages devoted to nonsomatic issues.^[41]

Lifestyle Changes Improve Cognitive Function

Two Weeks of Lifestyle Changes Improve Cognitive Function

Simple lifestyle changes, including memory exercises, daily exercise, relaxation techniques, and a healthy diet, significantly improve cognitive function and brain efficiency in as little as 2 weeks, a small pilot study suggests.
The study is published in the June issue of the American Journal of Geriatric Psychiatry.

For the study, 17 healthy volunteers aged 35 to 69 years with mild age-related memory complaints were recruited. Subjects were then randomly assigned to the intervention group, which combined a healthy diet plan, relaxation exercises, cardiovascular conditioning, and mental exercise that included brainteasers and verbal memory training techniques. The control group was simply instructed to maintain their normal routine.

Mental Calisthenics

Subjects in the intervention group were told to take brisk daily walks and incorporate daily brief relaxation exercises into their routine. They were also given shopping lists and a menu guide to facilitate a healthy diet plan, which included 5 meals per day high in fruits and vegetables, omega-3 fats, and low-glycemic-index carbohydrates.

Intervention subjects were also instructed to incorporate brainteasers and mental puzzles into their daily routine as well as specific memory training techniques to help focus attention and improve visualization and association skills to improve retention and recall.

Baseline and follow-up assessments in all study subjects included a multitrial verbal learning and memory test and a word-generation test. In addition, individuals also completed the Memory Functioning Questionnaire 64-item instrument that measures frequency of forgetting, seriousness of forgetting, changes in current memory compared with past memory, and mnemonics use. In addition, all subjects underwent PET imaging.

Brain Function

Mean baseline subjective and objective cognitive measures did not differ significantly between the 2 groups. However, at follow-up, the intervention group's verbal fluency improved significantly, whereas the control group's did not.

In addition, subjects in the intervention group showed a 5% decrease in left dorsolateral prefrontal activity compared with baseline, whereas the control group showed no significant change in brain metabolism.

"The decrease in brain metabolism in participants who followed the healthy longevity program suggests the brain functioned more efficiently and didn’t require as much glucose to perform effectively,” said Dr. Small.

Based on these results, Dr. Small and his team are planning a much larger study of approximately 150 patients age 60 to 80 years that will assess the effects of each lifestyle strategy.

Am J Geriatr Psychiatry. 2006;14:538-545.

top selling books of alltime across all ages

The Top Bestselling Books of All Time
1. 'The Holy Bible: King James Version'
2. 'Quotations From Chairman Mao Tse-Tung'
3. 'American Spelling Book'
4. 'Guinness Book of World Records, 2004'
5. 'McGuffey's Eclectic Readers/Boxed'
6. 'A Message to Garcia'
7. 'Dr. Spock's Baby and Child Care Seventh Edition'
8. 'The World Almanac and Book of Facts 2004 (World Almanac and Book of Facts (Paper))'
9. 'Valley of the Dolls: A Novel'
10. 'In His Steps'

Bestselling Fiction
1. 'Jonathan Livingston Seagull'
2. 'The Exorcist'
3. 'Jaws'
4. 'God's Little Acre'
5. 'Catch 22'
6. 'To Kill a Mockingbird'
7. 'The Thorn Birds (Modern Classics)'
8. 'Peyton Place'
9. 'Gone with the Wind'
10. '1984'
11. 'Animal Farm'
12. 'The Godfather (Signet)'
13. 'The Carpetbaggers'
14. 'The Catcher in the Rye'

Bestselling Children's Authors
1. René Goscinny and Albert Uderzo--Creators of Asterix
'Asterix the Gaul (Asterix)'
'Asterix and the Golden Sickle (Asterix)'
'Asterix and Obelix All at Sea (Uderzo. Asterix Adventure, 30.)'

2. Hergé, Creator of Tintin
'Cigars of the Pharoah (The Adventures of Tintin)'
'The Black Island (The Adventures of Tintin)'
'The Crab with the Golden Claws (The Adventures of Tintin)'

3. Enid Blyton
'Noddy Goes to the Fair'
'Noddy Meets Father Christmas'
'Noddy and the Bumpy Dog'
'Noddy and His Car'

4. Dr. Seuss
'Green Eggs and Ham (I Can Read It All by Myself Beginner Books)'
'The Cat in the Hat'
'One Fish Two Fish Red Fish Blue Fish (I Can Read It All by Myself Beginner Books)'

5. Beatrix Potter
'The Complete Tales of Beatrix Potter'

6. Lewis Carroll
'Alice's Adventures in Wonderland and Through the Looking Glass'

recent released good books

Some Good Mind and other books worth reading
The Five People You Meet In Heaven by MITCH ALBOM
The Present by SPENCER JOHNSON
Blood Brothers: A Family Saga by M.J.AKBAR
Shah Rukh Khan: Still Reading Khan

Suicide in Children

Suicide

Epidemiology

Figures published in 2005 by the World Health Organization (WHO) estimated that approximately 877,000 suicides occur annually worldwide. Of these 200,000 of these occur among individuals 15 to 24 years of age. Rates vary from culture to culture and among ethnic groups. In the United States it is estimated that per 100,000 individuals, there are 10 to 15 deaths from suicide annually.
This equates to approximately 31,655 deaths from suicide in 2002 , with about 2000 deaths occurring in individuals 15 to 19 years of age, and another 2000 occurring in those 20 to 24 years of age. Among the adolescents and young adults committing suicide each year in the United States, approximately 90% have some sort of mental illness, with depression constituting the majority of diagnoses.

Sex Differences: Although females make more attempts at suicide, males are much more successful in completing suicide. This is partly because males typically choose more lethal methods such as firearms, hanging, and motor vehicles.
Females tend to choose medication or drug overdosing and cutting, overall less lethal methods. Data published in 2004 showed firearms were involved in 49% of completed suicides among individuals aged 10 to 19 years; hanging in 38%, and poisoning in 7%. Most research reviewing suicide attempts vs completions has demonstrated that there are between 40 and 60 attempts for every completion.

It is important to note that the childhood suicide rate -- the rate among those 5 to 14 years of age -- has also increased over the past 30 years. In fact, this rate doubled between 1979 and 1992. During the 1990s, there were approximately 300 suicides per year in this age group.

Perception variation in different age groups: It has been demonstrated that children and adolescents typically do not perceive suicide in the same way as adults. Mishara and colleagues found that preschool children viewed death as sleeping, raising the question of whether children this age are actually capable of committing suicide. The researchers surmised that children in this age group who kill themselves very likely do not understand the finality of death.

By 6 to 7 years of age, 67% of the children in the study understood that everyone will eventually die. However, during their prepubertal years, many of the children still did not really understand the concept of permanent death. By age 12, 80% of the children still did not think about death occurring in healthy people.

Various Causes of Suicide: Among prepubertal children, depression is not usually a contributor to suicide. Suicide in young children is more likely to be related to family dysfunction, physical abuse, substance abuse, or schizophrenia. The combination of suicidal ideation and disruptive behavior in this age group has also been associated with a marked increase in suicide risk. Additionally, suicidal behavior during childhood significantly increases the risk that suicide will be completed in adolescence.

Multiple data provide a strong evidence base for the link between depression in childhood and/or adolescence and suicide. A study by Olfson and colleagues estimated that
9% of all teenagers make a suicide attempt,
19% express suicidal ideation.
In a cohort of depressed adolescents,
35% to 50% made a suicide attempt
5% to 10%, diagnosed with a major depressive disorder, completed suicide within 15 years. Among those surviving a suicide attempt, 71% had major depression or dysthymia;
64.5% were female.

Characteristics Associated With Suicide Risk

Several factors were associated with increased risk of suicide, including
mood disorders,
familial history of psychiatric illness,
history of abuse,
past suicide attempts, and
presence of a lethal means of suicide.
Gay and lesbian youth, perhaps because they have higher rates of depression than heterosexual adolescents, have also been shown to be at higher risk for suicidal ideation and suicide.

Risk Factors for completed suicide among adolescent boys:
A previous suicide attempt, followed by
a major depressive disorder and
substance abuse.

For girls, major depressive disorder and substance abuse were the 2 leading factors. Family history of suicide also increased the risk 3 to 5 times that an individual would complete suicide. Additional risk factors identified include hopelessness, hostility, and negative self-concept.

Self-injurious Behavior/Deliberate Self Harm

Self-injurious behavior (SIB)/Deliberate Self Harm(DSH) can be defined as a purposeful intent to inflict harm on one's body without an obvious intention of committing suicide.
Prevalence: Estimates indicate that SIB occurs in 20% to 60% of inpatient psychiatric populations and that with increasing levels of psychopathology, increasingly severe behavior can be found.
Risk factors for DSH/SIB:B
Borderline personality disorder,
depression,
posttraumatic stress disorder,
eating disorders, and
abuse or trauma.

Diagnostic features of SIB include:

• An intentional desire to hurt oneself;
  
  
• An inability to resist the impulse to injure oneself; and
  
  
• Injury, not death, is the desired end result.

In a study of 6000 UK adolescents 15 to 16 years of age, 6.9% had experienced SIB within the past 12 months.
The rate was much higher in girls; 11.2% vs 3.2% in boys. Twelve percent of adolescents with SIB episodes had to seek medical care for the injury sustained.

Within this cohort, it was demonstrated that SIB could occur as a result of an irresistible urge. Completing the urge allowed release of whatever tension pushed the individual to self-injury, providing temporary respite. However, in many, tensions inevitably built again. If initial SIB provided relief for the person, he or she was at increased risk for repeating the behavior. Therefore, SIB is considered addictive in nature. Within this framework, some medication or drug overdoses could also be considered SIB.

The UK study also identified some risk factors and predictors for SIB. For both boys and girls, a family history of SIB, drug abuse, and low self-esteem were contributing factors. A history of sexual trauma or abuse also markedly increased SIB risk. For girls, recent SIB by friends, anxiety, and impulsivity were linked to SIB; an additional factor for boys was suicidal behavior in friends.

In a study of pediatric psychiatric inpatients, 63% of children with SIB also reported frequently experiencing suicidal ideation; 73% had made a suicide attempt in the previous 6 months. However, 74% with SIB stated that they inflicted self-harm to release unbearable tension, not to commit suicide.

Another potential explanation is that the pain caused by SIB could decrease or help to overcome feelings of dissociation, thus bringing a person back to reality and serving as a connection to the present. It is also possible that the attention an individual may receive due to SIB may be a way to influence others and gain control over one's environment.

Biologic theories suggest that SIB may be caused by a low level of serotonin -- providing an overlap with depression. Another interesting biological theory is that individuals with SIB may have an attenuated endogenous opioid system. It is postulated that perhaps it takes extreme situations, such as SIB, to trigger the opioid system of such individuals.

Intervention Strategies for SIB

The low level of disclosure of SIB to healthcare professionals, parents, and other adults represents a challenge to effectively identifying SIB, with identification being the first step in any intervention. It was suggested that clinicians be particularly aware of patients who wear clothing that hides much of their body, and that a thorough skin examination be included as part of the adolescent health maintenance visit. The practitioner should always inquire about any scars noted.

Behavioral therapies seem to show the most promise. In particular, dialectical behavior therapy is a promising option. This approach focuses on ineffective problem-solving skills and provides adaptive skills that are less injurious.
Steps to preventing SIB include promoting emotional health, preventing childhood trauma or treating trauma if this has already occurred, and helping to improve coping strategies through cognitive therapy.

Identification and Approach to Suicidal Ideation and Behavior

It has been shown that among youth, 1 suicide attempt raises the risk of suicide completion by 15-fold. Therefore, the initial evaluation following a suicide attempt should be focused on clearly determining intent. On the basis of an extensive review of literature concerning the management of adolescents with suicidal ideation or attempt, Kennedy and colleagues recommended that the following information be obtained:

• The frequency of suicidal thoughts and how long these have been present;
  
  
• The plan for the suicide, with particular emphasis on the details of the plan and the lethality of method selected;
  
  
• Past history of suicide attempts;
  
  
• The patient's access to lethal means of suicide;
  
  
• The history or presence of psychiatric illness, with particular attention to diagnosis and medications;
  
  
• Whether drug or alcohol use is present;
  
  
• Family history of psychiatric illness, substance abuse, and suicide;
  
  
• The relationships between the patient and parents or guardians;
  
  
• Whether physical or sexual abuse occurred in the past; and
  
  
• The sexual orientation of the patient.

It is also crucial to evaluate stressors and to assess whether the patient can state a reason or reasons for living.

Outpatient Management of Suicide Attempt

Kennedy and colleagues also formulated criteria for outpatient management of a patient who has made a suicide attempt. It is strongly suggested that if any of the criteria are not met, the patient should be hospitalized. The criteria include:

• No inpatient medical treatment needed for conditions such as delirium;
  
  
• No previous history of suicide attempt or a psychiatric disorder;
  
  
• The patient should not be actively suicidal;
  
  
• There should be an adult in the home where the adolescent will be cared for who has a good relationship with the adolescent, and this adult agrees to monitor the patient;
  
  
• The monitoring adult agrees to remove all lethal suicide methods from the home;
  
  
• Both the patient and the monitoring adult have a clear understanding of emergency contact procedures and when to return for additional care;
  
  
• Further outpatient care has been arranged; and
  
  
• Both the patient and monitoring adult agree with the plan and state they will comply with all recommendations.

It was stressed that even though a suicide contract (getting the patient to promise not to commit suicide until the clinician sees him or her again) has limited value, a treatment contract can serve to decrease the short-term risk of suicide. A treatment contract should include frequent and quantifiable goals for follow-up and should incorporate steps aimed at improving the patient's mental and emotional state.

Treatment of Suicidal Behavior

The mental status of the patient should be assessed, and stressors identified. If depression is present, a combination of cognitive and medication therapy is recommended.

There have been recent concerns about increased suicide risk in association with use of selective serotonin reuptake inhibitors (SSRIs) for treatment of depression. In 2005, the United States Food and Drug Administration (FDA) placed a black box warning on SSRI medications, citing an increased risk of suicide among children and adolescents taking this type of antidepressant. However, some experts are not sure the concern is justified. They point out that patients being treated for depression are the individuals most often prescribed SSRIs. Therefore, the multitude of data supporting the strong link between depression and increased risk of suicide cannot be easily discounted.

Additionally, other data show the overall suicide rate has not increased over the past decade, though use of SSRIs has increased significantly during the same time period.

Although there is continued debate about risk associated with SSRI use in treatment of depressed children and adolescents, the acknowledged benefits of treatment are substantial.However untreated depression is clearly associated with a very high risk of suicide which is much higher than among patients being treated with antidepressants.

The use of SSRIs in children and adolescents remains a difficult decision point for many clinicians. If use is being considered, frank discussions need to occur between clinician and parents/patient. It is incumbent upon the provider to fully inform those involved in treatment decisions about the potential risks and benefits. Currently, fluoxetine is the only antidepressant medication FDA approved for treatment of major depressive disorder in children.

MOTIVATIONAL INTERVIEW

Motivational Interview is a style of patient-practitioner communication that is specifically designed to resolve ambivalence about, and build motivation for, behavior change.
Focus: Motivational Interview focuses on creating a comfortable atmosphere without pressure or coercion to change.
Aim: To help patients better understand their reasons for and against change
Thus to help them make informed decisions about whether or not to change and to feel more intrinsically invested in the decisions.
Hence first it helps make patients take the crucial decision to change and only then does it provide patients with solutions or problem solving.
Process: Motivational Interviewing involves careful listening and strategic questioning, rather than teaching, in order to help patients resolve their ambivalence about change.
Requisite skills: Questions aim to help their subjects think more deeply about issues, use reflective listening to clarify and understand the subject, and approach the subject in a nonjudgmental manner so that information is shared in a truthful and unbiased manner. Focus: MI is patient-centered, in that it focuses on the concerns and the perspectives of the patient, rather than those of the practitioner. This simply means that listening first to the patient can provide invaluable information that would otherwise not be known.
In short: OARS [open-ended questions; affirmations; reflective listening; summaries]

Among thesse the process of reflective listening has been elaborated.
Reflective listening involves taking a guess at what the patient means and reflecting it back in a short statement. The purpose of reflective listening is to keep the patient thinking and talking about change. Several types of reflections are useful, all of these should be crafted as statements rather than as questions, which allows the patient to elaborate on their ideas.
Repeating. This is the simplest form of reflection, often used to diffuse resistance.
Rephrasing. Slightly alter what the patient says in order to provide the patient with a different point of view. This can help move the patient forward.
Empathic reflection. Provide understanding for the patient's situation.
Reframing. Much as a painting can look completely different depending upon the frame put around it, reframing helps patients think about their situation differently.
Feeling reflection. Reflect the emotional undertones of the conversation.
Amplified reflection. Reflect what the client has said in an exaggerated way. This encourages the client to argue less, and can elicit the other side of the client's ambivalence.However it is important to have a genuine, not sarcastic, tone of voice).
Double-sided reflection. Acknowledge both sides of the patient's ambivalence.

As practitioners we must remember that medical nonadherence is more the norm than the exception. Two critical steps must occur before educating the patient and problem-solving any barriers to change:
(1) building the patient's motivation for changing the behavior (eg, smoking, medication adherence); and
(2) building the patient's motivation for treatment .
The practitioner cannot begin to educate the patient and help remove barriers to treatment adherence unless he or she first addresses motivation. Commonly encountered problems are premature problem-solving which leads to patient resistance; for example, "I've tried that and it doesn't work" or "Your'e right, but... I really need the cigarettes to calm me down." Thus, education and problem solving may be effective for those who are ready and willing to change, but is less so for those who are not ready or are unwilling to change.


Providing education to those who are not yet ready/ not thinking about change constitutes an interventional "mismatch" in that the patient feels pressure to do something about which they are ambivalent. Education can have a paradoxical effect on motivation, actually reducing, rather than increasing, motivation to change.
People who are ambivalent about change have a natural tendency to present arguments from the opposing side of their ambivalence. Therefore, if the practitioner states the reasons for initiating change, the natural tendency of the patient is to state the reasons for not initiating change. The ambivalent person is genarally moved to the opposite side of the ambivalence by the very act of defending it.
MI capitalizes on the idea that if people can talk themselves out of change, they can also talk themselves into change.
THus the primary aim of MI is to elicit from patients their own "change talk" (positive statements about change) and their own reasons and arguments for change.Thus it is the act of verbally defending change (and hearing oneself do so) in the absence of coercion that causes the person to change in attitude and behavior. Research indicates that the more patients hear themselves argue for change, the more committed they become to that change.


Ambivalence
The concept of resolving ambivalence is central to MI. This follows Approach Avoidance Conflict Theory.
Wrong Approach-Typically, when practitioners encounter a person who is ambivalent about change, they persuade and lecture the patient to change his or her mind. This approach only entrenches the ambivalent patient further into his or her position of not changing, because the patient begins to argue the opposite side .
However ambivalence is a central part of the natural process of change, a phase that people must go through before fully committing to a decision. Accepting change without a full consideration of the pros and cons of changing could lead to "buyers' remorse" and early relapse. The role of the practitioner is to help patients resolve their ambivalence and empathize with their ambivalence, not argue for change.
Table 1. Contrasting Communication Styles
Standard Approach Motivational Interviewing Approach
• Focused on fixing the problem Focused on patient's concerns and perspectives
• Paternalistic relationship Egalitarian partnership
• Assumes patient is motivated Match intervention to patient level
• Advise, warn, persuade Emphasizes personal choice
• Ambivalence means that Ambivalence: normal part of the change process
the patient is in denial.
• Goals are prescribed Goals are collaboratively set; patient is given a menu
of options.
• Resistance is met with Resistance: interpersonal pattern influenced by provider
argumentation and correction behavior

Change as a Continuum Rather Than a Discrete Event
Prochaska and DiClemente's stages of change model, which theorizes that people go through a series of stages before taking action for change.
These stages are:
1)Precontemplation: the person is not thinking about change;
2)Contemplation: the person is thinking about change and perhaps is starting to weigh the pros and cons of change;
3)Preparation, during which the person is actually taking steps to change;
4)Action, during which the person initiates the change;
5)Maintenance, during which the person adheres to the change for at least 6 months.
Those who are in earlier stages need to build their motivation and confidence for change; those in later stages need more education about how to change and how to prevent relapse.
Practitioners can assess the stage of change as a measure of patient motivation, or simply use a 1-10 scale (like a pain scale), in which "1" is not at all motivated to change and "10" is very motivated to change. This allows the practitioner to calibrate the counseling approach to the patient's level.


Motivational advice must include 5 components, which can be remembered with the mnemonic, "RAISE":
Relationship with the patient;
Advice to change;
"I" statements ("I am not going to pressure you to change");
Support for patient autonomy when making the decision; and
Empathy.
(Source)

depression theories

THEORIES ABOUT THE CAUSES OF DEPRESSION Guilt Depression-prone people are super aware of their wrong doings--and feel especially guilty. Mowrer, et al (1975) does not believe this guilt necessarily involves some highly immoral behavior, such as intense hostility or vile impulses, but rather could be the accumulation of many ordinary "sins." We all do inconsiderate things: selfish acts, hurtful comments, just not thinking of others, etc. Our society encourages us to look out for #1 first or "do your own thing." As Mowrer observes, since the Protestants protested confessing to a priest 500 years ago, the Protestant religions provide no authorized way to confess our sins and atone. And, because we hold inside "real guilt" for what we have done, we become depressed and may have other neurotic reactions. (Other theorists say it isn't guilt as much as being ashamed of not trying harder.) Mowrer's solution was to form "integrity groups" (modeled after the small early Christian congregations) in which understanding, permanent friends listened to our shortcomings (our "sins"), forgave us, and then helped us make up for the harm we have done. Regret for things we did can be tempered by time; it is regret for the things we did not do that is inconsolable.-Sydney J. Harris Guilt isn't always the result of doing something inconsiderate or immoral. Often it is just not doing what you think you should--"I should never have let my son go out with that crowd," "I should have known they weren't telling me the truth," "I should have kept better records for taxes." In this case, you may be assuming too much responsibility for whatever happened, setting impossible (perfectionistic) standards, and/or engaging in irrational thinking (see #6 and #7 above). Your mistaken views of the world and your unreasonable expectations of yourself may cause guilt. Guilt may cause depression. Or there is another possibility: whoever makes us feel guilty is resented. In the case of guilt or regrets, you make yourself feel badly; thus, you become angry at yourself, and that anger is assumed by analysts to be the cause of depression. Handling guilt and regrets is dealt with in the next section. Unmet dependency Some psychoanalysts and interpersonal therapists have looked into the history of depressives and found over-protective, indulging, overly involved or over-controlling, restrictive parents. The child grows up with an "oral character:" dependent, low frustration tolerance, and so desperate to have people like them that they are submissive, manipulative, demanding and so on. Before becoming depressed they are described by therapists as "love addicts in a perpetual state of greediness...sending out a despairing cry for love" (Chodoff, 1974). Their self-esteem depends on the approval of others. When their dependency needs are not met, they become depressed and cry, just as they did as infants. Moreover, it usually makes us mad when we feel weak and dependent. So, an over-dependent depressed person may resist help ("You can't make me be productive and happy") and become hostile ("I will pay you back for not loving me"). Thus, the loss of love is a triple threat to a dependent person prone to depression: (a) sadness and panic occur because our vital, life-long struggle for security has been lost, (b) low self-esteem and hopelessness occur because "I have lost everything" or "I do not deserve anything" and (c) anger and resentment occur because "they have deserted me, a helpless child" (Zaiden, 1982). So, it isn't surprising that research confirms, especially for very needy people, the old saying, "you can't live with them; you can't live without them." Relationships (marital problems and stress with children) are the most common stresses associated with depression in women. And, relationships (good, caring, intimate ones) are the best protection against depression (Brown & Harris, 1978; Klerman & Weissman, 1982). See sections below on loss of a relationship and loneliness. These interpersonal, psychodynamic, and psychoanalytic therapists would say that explaining depression as a result of negative thoughts or a lack of social skills is superficial and foolishly ignores the life-long, internal struggle for love for survival. Likewise, this theory sounds very similar to the currently popular feminists' description of social pressures put on traditional women to give up their individuality ("be nice," serve and accommodate others, put your needs last) in order to be "loved." Evidence is accumulating for this kind of theory (Barnett & Gotlib, 1988), including relying on others for one's self-esteem (see chapter 8). Impossible goals or no goals Overly demanding parents who are critical, perfectionistic, and harshly punitive tend to have anxious, withdrawn, and sometimes hostile children who have an "I'm not OK" attitude (like Sooty Sarah). Perhaps they adopted the parents' impossible goals. On the other hand, Coopersmith's (1967) work suggests that uninvolved parents, who do not discipline consistently and/or do not provide moral guidelines for living, tend to have children with low self-esteem (and higher risk of depression). Losing one's goal or values may lead to depression too. Hirsch and Keniston (1970) studied 31 drop outs from Yale during the late 1960's--during the time of the drug counter-culture, hippies, flower people, anti-war demonstrations, etc. They did not flunk out; they just weren't interested. Indeed, nothing interested them very much. They seemed mildly depressed. But there had been no losses, no big stresses. Yet, one experience was common: loss of respect for their fathers. They had once idolized their fathers, but now could not accept their fathers' values. Middle-class materialism, money, and the country club weren't for them. They felt lost, unsure of what they wanted, and a little bored with it all. Thousands dropped out of school and traditional society during the 1960's and early 70's. This condition has been called "existential neurosis." Existential therapy aims to restore the person's sense of freedom and responsibility for his/her choices now and in the future. To do this, life must have meaning and purpose. (Note: the dropping out stopped in 1973-74 when we had a recession causing people to start worrying about making a living. The drop outs would be 45 to 50 years old now and have 20-year-old children.) Shame: feeling ashamed of yourself has to be depressing. A critical problem with several previous theories is that the origin of the depression is not clear, i.e. where exactly does the helplessness, the negative views, the irrational ideas, the faulty thinking, the self-criticism, the low self-esteem, etc., come from? The shame theory can not be faulted in this way; it identifies the origin as early childhood experiences. Shame is feeling you are inadequate, inferior, lacking, not good enough, "ashamed of myself." In contrast with fear which involves external threats, shame is when we feel disappointed about something inside us, our basic nature. Shame is an inner torment: feeling cowardice, stupid, unloved, worthless, "a bad person." We hide in shame, i.e. we "hang," turn, or cover our heads, we lower our eyes, we isolate ourselves. (There is a related dimension--shyness or bashfulness--but here we are dealing with self-loathing or feeling ashamed of oneself.) The great concern with addictions in the last 15-20 years has resulted in a new body of literature about the dysfunctional family, toxic parents, the inner child, codependency, adult children of alcoholics, support groups, etc. There are 100's of relevant books: Kaufman (1989, 1992), Bradshaw (1988, 1989), and Beattie (1989). The origin of shame is usually assumed to be in our infancy or childhood. Shaming is used for control by parents, by friends, by society. Some of the most hurtful discipline consists of shaming comments: "shame on you," "you embarrass me," "you really disappoint me when...." We say insulting things to children that we would never say to an adult: "stupid," "clumsy," "selfish," "sissy," "fatty," "it's all your fault," "you're terrible," "you're hateful," "stuck up," etc. Many adults vividly remember the sting of these comments. Siblings and peers are cruel: mocking, laughing at, teasing, calling names, etc. Children are slapped and whipped, overpowered and humiliated, their "will" broken. All of this may make a child feel ashamed (depressed) of him/herself. Even in adolescence we feel watched and judged (mistrusted); we are "shamed into" giving up crying and touching; we are looked down upon if we aren't successful, attractive, independent, and popular. We feel ashamed if we are poor and dress poorly, if we are over or under weight, if we can't express ourselves well or use poor grammar, if our grades are low, if we have few friends, etc. Some shame and anxiety may serve useful purposes, but it can be devastating. There is some data to support the shame-based theories. Andrews (1995) found that "deep shame," not just dissatisfaction, in women about their bodies (usually breasts, buttocks, stomach or legs) was powerfully related to suffering severe depression. If a female is physically or sexually abused as a child or as an adult, it increases the likelihood of depression four or five times! Only childhood abuse caused shame about the body in women, however. See Lisak (1995) for an impactful discussion of the effects of childhood abuse on males. The memories of our past--our childhood and adolescence--form our identity or our basic sense of self. Because we have shame-based families and cultures, shame gets connected with many things, such as our basic drives, interpersonal needs, feelings, and life purposes. Examples: much shame is attached to sexual drives (witness the uneasiness we feel about masturbation, not to mention homosexuality) and to hunger drives (witness the feeding problems of infants, the fights over food with children, and the eating disorders of young people). We are deeply hurt and made ashamed of our needs for closeness and security whenever a basic bond is broken by rejection, abuse, neglect, divorce, or smothering overprotection and overcontrol. Sometimes shame is connected with our bodies, our lack of competence, our life goals (witness others' reaction to someone wanting to be a popular singer or a girl wanting to be a mechanic or a boy wanting to be a nurse). Also, emotion-shame connections ("Don't cry!" or "Don't feel that way!" or "Stop sniffling or I'll spank you") are made and we become ashamed of crying, anger, fear, self-centeredness, even joy sometimes. And, in extreme cases, you can become ashamed of everything you are--of your entire self--"I am worthless." Shame is a powerful force but we can understand and overcome some of its sources. There seem to be several natural defenses used against self-attacking shame: · Striking out at others. Attacking others by being critical, sarcastic, or abusive are ways to repair a wounded ego and to protect our vulnerable weak parts from exposure. Acting superior and having contempt for others are other ways to sooth a hurting self. · Striving for power and being perfect. The wish of a child would be to make up for our weaknesses by becoming powerful and being perfect. · Blaming others. What better way to deny our weaknesses than to blame others for our problems or for the world's problems? · Being an overly nice people-pleaser or rescuer or self-sacrificing martyr. If you feel unworthy, your hope might be to compensate for it by being "real good." Being super nice often means pretending or lying about our feelings and true opinions, presumably because we are ashamed of our real selves. · The self can withdraw so deeply or shut off the outside world so completely (denial) that shameful actions or events just don't upset our self, in this way the self can't be hurt. Obviously, a person feeling shame but using these defenses would inflict shame on others; that is, wounds of shame are passed from parent to child. This is done by parents in a variety of ways: (a) verbal, sexual and physical abuse, (b) physical and emotional abandonment (the child may even be expected to take care of the parent's emotional needs), (c) thinking of children as insignificant inferiors to be dominated and blamed or as persons to be controlled by threats of rage, disapproval, and withdrawal of love or as persons to be taken care of excessively, and not told the truth because they are needy, fragile, and "can't understand" or as persons to stay emotionally enmeshed with because they are perfect, wonderful, can meet your needs, and may be the only ones that care for us. So, shame begets shame. What are the consequences of a shame-oriented family? Self-blame and criticism (like Sooty Sarah). Constantly comparing yourself with others and coming up short. Depression--we may dislike and disown parts of our self and even feel disdain for our self as a whole. The shamed person may engage in compulsive disorders--physical and sexual abuse, drug and alcohol addiction, anorexia-bulimia and obesity, workaholism, sex addictions, addictions to certain feelings (rage, being shamed and rejected), intellectualization, anti-social acting out, and other personality problems, including multiple personality. The list is long. Some of these "sick" behaviors, like addictions, help us hide our shame; some, like workaholism, try to make up for our weaknesses; some, like abuse, adopt the harmful behavior that was imposed on us; some, like criminal acts, reflect fear and hatred of the shaming techniques used against us. Shame operates inside all of us...it is a voice inside our head. The voice usually sounds like our parent. Sometimes the voice of shame is healthy and helpful; sometimes it is unhealthy and self-defeating. Nathanson (1995) should help you understand this complex emotion. Shame-based families often have unspoken but well understood "rules," such as: Don't have feelings or, at least, don't talk about them. Don't try to make things better--leave the family problems alone. Don't be who you really are; don't be frank and explicit; always manipulate others and pretend to be something different, such as something good, unselfish, and in control. Always take care of others, don't be selfish and upset others, and don't have fun. Don't get close to people, they won't like you if they know the truth. Rules such as this keep you weak, hopeless, immature, hurting, and unhealthy--depressed and maybe addicted as well. Discouragement is simply the despair of wounded self-love.-Francois De Fenelon Treatment, according to this theory, involves uncovering the sources of shame and recognizing the oppressing controls placed on you by internal voices of shame, family rules, and cultural-gender restrictions. Getting free may mean taking care of the hurt, scared little boy/girl inside, and building your self-esteem (see the later section on shame in this chapter and method #1 in chapter 14). Lacking self-control causes depression This explains why single women with little education and low income are the most likely to be depressed; they lack support and control over their lives. Also, dominated women report feeling they have "lost themselves." They are in a relationship in which they have lost the option of expressing their feelings openly, lost faith in their own ideas, lost reliance on their abilities and skills, lost their self-respect, and even lost their right to express anguish and despair (Jack, 1991). One can see why they must suppress their very being to keep their last shred of "love." Somehow these suppressed parts of our inner self must regain some control and learn to express themselves again. Rehm (1977) said the lack of self-help skills, i.e. not knowing how to get better, caused depressed people to over-emphasize the negative, set too high standards, and give too little self-reinforcement. Pyszczynski & Greenberg (1987) contended that depression is the inability to avoid focusing on one's self. D'Zurilla & Nezu (1982) claimed that poor interpersonal problem-solving skills cause depression; the skills depressed people often lack are (a) the ability to see alternative solutions, (b) the ability to develop detailed plans for reaching a final goal, and (c) the ability to make decisions. A sense of self-control is basic to these three skills. This way of viewing depression expands beyond the helplessness theory, which focuses on a pessimistic attitude; it emphasizes the importance of skills and cognitive techniques, which increase our ways and means of self-control as well as our optimism. This "explanation" of depression says much more than "take responsibility and heal thyself." To all of us, whether we are now depressed or not, it says that more research must be done. Miserable people can't learn what they need to know if wise people and science haven't uncovered the knowledge yet. It is a scientific necessity to laboriously test the effectiveness of each promising anti-depressive self-help method. There is already considerable evidence that some self-control methods work, but there are thousands of ordinary, everyday methods still to be tested with many different kinds of depressed people (maybe 100 years of research--let's get going!). Consider these complexities which need to be clarified: married people have more support, thus, less depression. Okay, but if women have more support than men, why are they more depressed? (See discussion of gender differences above and in chapter 9.) Moreover, we ordinarily think support is gotten by talking to someone, but Ross & Mirowsky (1989) reported that talking increased depression. How could this be? Perhaps talking (without problem-solving) drives others away and/or involves self-handicapping more than garnering support. For instance, research has shown that depressed people more than nondepressed people will actually fail a task (then talk about how awful they feel) in order to avoid doing more of a simple task (Weary and Williams, 1990). Like the motivated underachiever in chapter 4, some depressed people seem motivated to do poorly, have little self-control, and be depressed; depression may sometimes provide convenient excuses to ourselves and to others. This last explanation of depression emphasizes how uninformed the depressed person is about self-control and how much more science needs to learn about what helps and what harms depression. Summary of the Causes of Depression and How to Use Them These 14 theories give you ideas about how depression develops. Each theorist tends to assume that his/her explanation is the major cause. But, as you know, I don't think life is simple. I suspect that any one person's depression may have many causes. For instance, you might have a genetic propensity for depression. Then, you grew up in a shaming family who had a critical, pessimistic attitude. Feeling rejected anyway, you sensed and resented the hostility within the family, which lead to your gaining a lot of weight at puberty. All these factors together resulted in your having serious social problems and low self-esteem; you not only disliked yourself, you felt your family had caused a lot of your emotional problems--and told them so. The family had never been emotionally supportive anyway and honestly thought "if you are fat, stop eating" and "if you are unhappy, get happy--and drop all this psychology crap about parents being responsible." Being unable to deal with these personal problems, when your lover of two years, who you depended on greatly, decided to dump you, the depression was more than you could handle. You become lonely and sad all day, nothing seems fun any more, you gain more weight, feel tired and listless, become more self-critical and guilt-ridden, are unable to see anything good in your life now or in the future, and even have some thoughts of ending it all if your lover doesn't come back. The history is complex. You have serious depression and need professional help; it is too late to depend on will power alone. Yet, you must also learn about and help yourself. That's real life. You need to understand and consider how true each theory is of you--perhaps you need to read more or talk it through with a relative, friend, or counselor. Clearly, understanding the possible causes (in your case) helps you work out a possible solution. Consider the five parts or levels of any problem--behavior, emotions, skills, cognition, and unconscious factors--and then plan your attack, based on the rest of this chapter and chapters 11-15. Keep trying to climb out of the darkness until you feel better. Even if the depression is mild to moderate, get help if your self-help efforts don't work within a month or two. There are medications that relieve many people's depression; don't be foolish and reject drugs if psychological approaches don't work. Keep your hopes up. (source)

Psychiatry Notes - Stalking

"Stalking" is defined as repeated and persistent unwanted communications and/or approaches that produce fear in the victim. The stalker may use such means as telephone calls, letters, e-mail, graffiti and placing notices in the media.

Dr. J. Reid Meloy, author of Violent Attachments and editor of The Psychology of Stalking, is an expert on stalking behavior. Pathological attachments, he says, most often occur in males and generally start in the fourth decade of their lives. It follows a fairly predictable progression:

1. After initial contact, the stalker develops feelings like infatuation, and therefore places the love object on a pedestal.
2. The stalker then begins to approach the object. It might take a while, but once contact is made, the stalker's behavior sets him up for rejection.
3. Rejection triggers the delusion through which the stalker projects his own feelings onto the object: She loves me, too.
4. The stalker also develops intense anger to mask his shame, which fuels the obsessive pursuit of the object. He now wants to control through harassment or injury.
5. The stalker must restore his narcissistic fantasy.
6. Violence is most likely to occur when the love object is devalued, as through an imagined betrayal.

Several stalker typologies have been developed:

Mullen et al. (1999) proposed a multiaxial classification. The first axis was a typology derived primarily from the stalker's motivation, the second from the prior relationship to the victim, and the third a division into nonpsychotic and psychotic subjects. This attempted to capture the stalker's behavior in terms of both motivation and the needs and desires the stalking itself satisfies. They described five subtypes:
1.The Rejected respond to an unwelcome end to a close relationship by actions intended to lead to reconciliation, an extraction of reparation from the victim or both. For the stalker, the behavior maintains some semblance of continued contact and relationship with the victim. This is thought to be the largest group of stalkers. It is comprised mainly of ex-partners. These stalkers respond to the unwelcome end of a close relationship by actions that are initially intended to achieve reconciliation or retribution. Often, the stalker fluctuates between these goals.The Rejected are more prone to violence than other stalkers but can usually be persuaded to abandon their quest, with the aid of legal sanctions and counselling.

2.The Intimacy Seekers pursue someone they have little, if any, relationship with in the mistaken belief that they are loved, or inevitably will be loved, by the victim. The stalking satisfies needs for contact and closeness while feeding fantasies of an eventual loving relationship.
3.The Incompetent are would-be suitors seeking a partner. Given their ignorance or indifference to the usual courting rituals, they use methods that are, at best, counterproductive and, at worst, terrifying. The stalking provides an approximation of finding a partner.
4.The Resentful respond to a perceived insult or injury by actions aimed not just at revenge but at vindication. The stalking is the act of vengeance.
5.The Predatory pursue their desires for sexual gratification and control. These constitute only a small fraction of stalkers. Their motive is a sexual one, the stalking activities usually being the prelude to a sexual attack. Occasionally, the stalking behaviour is itself the predominant source of sexual gratification The stalking is a rehearsal for the stalker's violent sexual fantasies and a partial satisfaction of voyeuristic and sadistic desires.
6.When the typology, relationship to the victim and psychotic/nonpsychotic dichotomy were combined, the result predicted the duration and nature of the stalking, the risks of threatening and violent behavior, and, to some extent, the response to management strategies (Mullen et al., 1999; Mullen et al., 2000). The rejected used the widest range of behaviors, such as following, repeatedly approaching, telephoning, letter-writing and leaving notes. In contrast, the predatory stalkers concentrated almost exclusively on furtively following and maintaining surveillance. Intimacy seekers were the most prolific letter-writers, and they also sent the most unsolicited gifts and other materials. Duration was longest in the rejected and intimacy seekers and shortest in the predatory. The psychotic subjects were most likely to send unsolicited materials, and the nonpsychotic to follow and maintain surveillance.

The psychotic and nonpsychotic were equally likely to threaten, but the nonpsychotic were twice as likely to proceed to assault. The rejected were the most likely type to assault and the resentful, although often issuing threats, were the least likely to resort to overt violence.

The best predictor of stalking duration was typology. Also best predicted by typology were assaults. When assaults were combined with substance abuse and a history of prior convictions, they accounted for most of the explained variance.

Intimacy seekers were largely impervious to judicial sanctions, and often regarded court appearances and imprisonment as the price to be paid in the pursuit of true love. They often had a treatable psychiatric disorder, however, that when effectively managed, ended the stalking.

In contrast, the rejected, who could usually calculate their own advantage, often responded to the threat or imposition of judicial sanctions by curbing their behavior. The rejected type, however, do have significant levels of psychopathology, particularly connected to personality disorder, and therapeutic interventions can play a role in preventing a relapse.

The incompetent type could usually be persuaded to abandon the pursuit of their current victim with relative ease. The challenge is to prevent them from harassing the next victim who catches their fancy. The predatory were generally paraphilics. Management of their sexual deviance is central to the prevention of stalking recidivism.

The resentful, who all too often were both self-righteous and self-pitying, can be very difficult to engage therapeutically. Unless they have an overt paranoid illness, they rarely benefit from mandated treatment. They will, however, usually abandon their harassment if the cost to them, in terms of judicial sanctions, becomes too high. Contrary to myths perpetrated by the mass media, studies show that most stalkers are men, have high IQ's, advanced degrees, and are middle aged (Meloy and Gothard, 1995; and Morrison, 2001).

CLINICAL STUDY OF 100 STALKING VICTIMS

• 83% were female
• Stalking duration ranged from one month to 20 years
• Prior relationship with stalker:
• ex-partner 29%
• professional 25%
• work-related 9%
• casual acquaintances 21%
• strangers 16%
• Impact of stalking:
• major lifestyle changes 94%
• social activities curtailed 70%
• changed or ceased employment 53%
• moved home 39%
• change in daily routine, avoidance of reminders of the stalker
• Emotional responses to stalking:
• increased anxiety levels 83%
• increased alcohol, tobacco consumption 25%
• suicidal rumination 24%
• post-traumatic stress disorder 37%

source: Drs. Pathe and Mullens

According to Dr. Michael Zona and his colleagues from the University of Southern California School of Medicine, stalkers appear to come in three basic varieties, with a perverse twist on stalking that adds a fourth important category:

1. Simple obsessional
   The most common form is male with a female with whom he was once sexually intimate.
2. Love obsessional
   A love-obsessed stalker tends to idealize a celebrity or someone he has seen from afar and he develops an unrealistic belief that the target person will agree to a relationship.
3. Erotomania
   Someone suffering from this more extreme obsession believes that the victim loves him or her.
4. False victimization
   Claiming harassment and stalking when none exists, this behavior is usually carried on by people with histrionic personality disorders.

Another method of categorizing stalkers comes from the team who wrote the FBI's Crime Classification Manual:

1. Non-domestic stalker, who has no personal relationship with the victim
2. Organized (based in a calculated, controlled aggression)
3. Delusional (based in a fixation like erotomania)
4. Domestic stalker, who has had a prior relationship with the victim and feels motivated to continue the relationship; this constitutes around 60 percent of stalkers and the aggression often culminates in violence.

Stalkers tend to be unemployed or underemployed, but are smarter than other criminals. They often have a history of failed intimate relationships. They tend to devalue their victims and to sexualize them. They also idealize certain people, minimize what they are doing to resist, project onto people motives and actions that have no basis in truth, and rationalize that the target person deserves to be harassed and violated.

While many stalkers view their actions within a delusional framework and therefore see no need to get help, a few do actually approach professionals. One case resulted in a landmark decision that shifted certain responsibilities onto the shoulders of therapiWhile many stalkers only threaten harm, a small percentage carry out their threats, damaging property or harming pets. With the rise in popularity of the Internet, cyber-stalking has become yet another avenue of danger. Many stalkers have a prior criminal record and show evidence of substance abuse, a mood disorder, a personality disorder, or psychosis. At least half of all stalkers threaten their victims, which increases the possibility of violence. Frequency of violence averages 25 to 35 percent, with most violence occurring between people who have been romantically involved in the past.

CYBER STALKING with the advent of the Internet, a new type of anonymous stalking is creating many new dangers that are difficult, if not impossible, to prevent.

The most perilous areas are chat groups, message boards, and personal e-mail boxes, and the most common form of harassment online is done through threatening e-mail and live chats. Cyber-stalkers can spread rumors, post information about you, send a virus, or even draw you out for an offline (f2f) encounter.

Stalking takes a psychological toll no matter who the target is, Saunders says. And even when jailed, the stalkers find ways to continue to threaten and frighten. Since they eventually get out, the victim must always worry about the stalker showing up again. According to what she learned about the disorder, the typical person suffering from this delusion:

• is single
• is immature
• is unable to sustain close relationships
• has a history of obsessive attachments
• gets attached to unattainable objects
• attains these objects through fantasy
• needs the fantasy in order to survive
• mistakes feelings in the self for feelings in the other
• has delusions that can last for years
• will go to great lengths to rationalize why the object ignores them
• may become predatory
• seeks any acknowledgment, even negative, that makes them feel connected
• has delusions that often develop after the loss of a meaningful connection
• is devious about collecting information
• usually requires forced separation from the object

Not all stalkers are erotomaniacs—only about 10 percent---but most erotomaniacs participate in some form of stalking.

The impact on the victim's psychological and social well-being is considerable. Pathé and Mullen (1997) studied 100 victims of persistent stalking. The majority had to severely restrict their lives by changing or abandoning work, curtailing all social activities, and becoming virtual recluses. Over 80% developed significant anxiety symptoms. Sleep disturbance was common, and many resorted to substance abuse. Over half had symptoms of posttraumatic stress disorder. Feelings of powerlessness and depression were common, and nearly a quarter of the victims were actively considering suicide as a means of escape. Similar levels of distress and disturbance were reported in Hall's study (1998).

California passed the first anti-stalking statute in 1990, followed shortly by the rest of the United States as well as Canada, Australia, the United Kingdom and now some European countries. It was only after stalking became a specific form of offensive behavior that behavioral scientists and health care professionals began to systematically study stalkers and, equally important, the impact of their conduct on the victims.

In the late 1960s, Prosenjit Poddar, a native of India, attended the University of California at Berkeley and met Tatiana Tarasoff at a dance. He developed a strong romantic interest in her. When they shared a quick New Year's Eve kiss, he believed it was a sign that they were engaged. Yet Tatiana's disinterest confused Poddar, so he persisted in believing that she in fact had feelings for him.

He went to Tatiana's house, armed with a knife and a pellet gun. She ran from him and he shot her and then stabbed her 14 times, killing her. Then he turned himself in. He was convicted of second-degree murder and was released after serving five years.

Yet this case had an impact on the relationship of psychiatry to stalking and violent obsessions. Where once what was said between doctor and patient was privileged, that was about to change.

The Tarasoffs instigated a civil case of negligence against the Regents of the University of California. In 1974, the California Supreme Court found that, despite confidentiality, a duty to warn exists when the therapist determines that a warning is essential to avert a danger rising from the patient's condition.

Most jurisdictions now recognize a Tarasoff-type duty, but some limit it to situations in which the patient communicates a serious threat of physical violence against an identifiable victim. Standards vary from state to state. However, there is no automatic duty to warn a potential victim, and in fact, issuing a warning has proven ineffective, because more violence has been shown to result after a warning than if no warning is issued. In any event, there are alternatives.

Among the signals to beware of when a potential stalker approaches, according to de Becker are:

1. Forced teaming: He will try to get you to be a "we" with him in some predicament.
2. Charm, which usually has motive driving it. Be aware of the possibilities.
3. Too many details in some narratives indicate possible deception.
4. Loan sharking, or doing something to make you feel you owe him.
5. Unsolicited promises
6. Ignoring the word "no," through things like proposing alternatives}

· Community surveys suggest that each year between 1% and 2% of women and 0.25% to 0.5% of men are stalked

Women report to the police only 50% of all stalkings perpetrated. Almost 5% of women and 0.6% of men in the survey indicated that an intimate had stalked them, with an annual rate of 0.5% of surveyed women and 0.2% of surveyed men. Extrapolation from these data indicates that 503,485 women and 185,496 men were stalked by an intimate partner within the previous 12 months.

(Source)