What are sadism and masochism?

Introduction

The terms “sadism” and “masochism” have been used to refer to a variety of behaviors by both clinicians and laypersons, resulting in considerable confusion as to what they actually are. Although sadism and masochism can fall within the range of normal variations in sexual behavior, the medical terms “sexual sadism disorder” and “sexual masochism disorder” refer to paraphilic disorders, as defined in the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5).

Sexual sadism disorder, as defined in the manual, consists of recurrent sexual fantasies, urges, or behaviors involving the psychological or physical suffering of another. To meet the clinical diagnostic criteria, these behaviors must be ongoing and have been present for at least a period of six months. Behaviors engaged in may include, but are not limited to, dominating, beating, restraining, whipping, burning, cutting, strangulation, torture, mutilation, and killing. Also, to meet the diagnostic criteria, the fantasies, urges, or behaviors must cause significant distress, interpersonal difficulty, employment disruption, or have been inflicted on a nonconsenting person.

Sexual masochism disorder, as defined in the manual, consists of recurrent sexual fantasies, urges, or behaviors. These must occur over a period of at least six months, and the fantasies, urges, or behaviors must cause significant distress, interpersonal difficulty, or employment disruption. Sexual sadism and sexual masochism are frequently seen in the same individual.

Sexual sadism and sexual masochism disorders are both classified as
paraphilias, which means that the individual is sexually attracted to deviant stimuli. Among other paraphilic disorders are pedophilic (arousal from children), exhibitionistic (arousal from exposing one’s genitals), fetishistic (arousal from objects such as shoes or leather), and frotteuristic (arousal from rubbing up against strangers) disorders. It has been noted in clinical practice that an individual is likely to exhibit not only both sexual sadism and sexual masochism but also other paraphilias as well.

History of the Disorders

The terms “sadism” and “masochism” were first introduced by Richard von Krafft-Ebing in his work Psychopathia Sexualis: Mit besonderer Berücksichtigung der conträren Sexualempfindung—Eine klinisch-forensische Studie (1886; Psychopathia Sexualis: With Especial Reference to Contrary Sexual Instinct—A Medico-legal Study, 1892). He discussed a variety of sexual perversions. According to Krafft-Ebing, a sexual perversion was any action that could not result in procreation. He saw a basic tendency toward sadism in men and masochism in women. Interestingly, both “sadism” and “masochism” were derived from the names of authors (the marquis de Sade and Leopold von Sacher-Masoch) whose writing seems to exemplify the terms. Although the terms are derived from the writing of these individuals, it should be noted that behavior that could be labeled “sadistic” or “masochistic” was known long before this time.

The marquis de Sade was born to a noble family in France. He served in the military but spent much of his life living as a libertine. He enjoyed the company of many prostitutes and apparently physically and psychologically abused a number of them. Although best known for his sexual writings that exemplified his lifestyle, Les 120 journées de Sodome(written 1785, published 1904; The 120 Days of Sodom, 1954) and Justine (1791; English translation, 1889), he also wrote on philosophical topics. Due to his lifestyle and the condemnation of his family, Sade spent much of his life incarcerated.

Leopold von Sacher-Masoch was born in the Austrian Empire. He was a professor and wrote extensively on the history of his homeland; however, he is most known for his stories that dealt with his fetishes of dominant women. Like the marquis de Sade, Sacher-Masoch attempted to live out his fantasies during his life with a number of women. It is believed that Sacher-Masoch spent the end of his life insane.

Sigmund Freud
expanded on masochism and, to a lesser extent, sadism in his psychosexual theory. He postulated that masochism was a perversion that arose out of guilt caused by sexual desire for the opposite-sexed parent. Because the child could not have the parent sexually, he or she desired to be beaten by that parent. This served both as punishment for the inappropriate feelings but also as sexual satisfaction. Freud’s theory held that masochism was a common perversion and indicative of improper sexual development. He viewed women as inherently masochistic.

Philosopher Jean-Paul Sartre
saw both sadism and masochism as being examples of what he termed “bad faith,” which consists of misleading the self about relationships. Both sadism and masochism are part of what he termed “being-for-the-other.” In masochism, the self becomes an object of the other. In sadism, the other becomes an object for the self.

Possible Causes

There is no known definitive cause of sexual sadism and sexual masochism disorders. Researchers have looked to the areas of genetic predisposition, biophysical influences, personality development, learned behavior, and brain studies. Freud believed that masochism and sadism were the result of improper psychosexual development, generally in the anal stage of development. Object-relations theorists maintain that all paraphilias are caused by domineering and frustrating parenting. The child responds to being powerless with a need for power.

Learning and reinforcement may play a significant role in sadistic and masochistic behavior. Children who grow up in an environment with sadistic or masochistic models may themselves repeat such behaviors. Orgasm is a strong reinforcer, and any behavior that accompanies an orgasm is likely to be repeated.

Some brain studies show that individuals may seek to give or receive pain to increase stimulation in a brain that is not receiving enough stimulation. Individuals who are sensation seekers engage in dangerous behaviors to increase their level of stimulation and arousal.

Diagnosing Sexual Sadism and Sexual Masochism

Previously all forms of sadism and masochism were considered mental disorders. Now only sadistic acts practiced on unwilling partners or sadistic and masochistic acts that cause mental anguish to the individual are considered to be pathological. Masochistic behavior generally is brought to clinical attention when it has resulted in patient self-harm, which may result from acts of consent or from self-induced harm to the point wherein the patient can no longer self-regulate the sexual experience.

Sadistic behavior is considered pathological only once it crosses certain legal and medical boundaries of harm with nonconsenting partners, children, or animals. Illegal behaviors include coercing partners through acts of rape and molestation. Sexual sadists may even kill a partner—either accidentally or intentionally.

Individuals who practice sadism and masochism as forms of sexual expression seem to be significantly different from those individuals who are seen clinically for treatment of sexual sadism and sexual masochism disorders. These sadists do not seek to hurt others outside of sexual play and administer only forms of pain that the masochist has agreed on. Masochists enjoy pain only in a sexual setting, but it is not coercive pain—such as rape—and it is generally pain that they maintain control over through agreement with a partner. Sadists and masochists can engage in a wide range of behaviors, which are often referred to as “play.” Very often their fantasies are highly structured and, in fact, very safe. Some individuals may engage in sadomasochistic fantasies only and not act them out. Others may use playful spanking or light bondage; some may engage in whipping and even forms of minor mutilation. Like any other interest, individuals’ involvement levels vary. There are those who only engage in some sadomasochistic activities with their partner, and others who live a master-slave relationship full time. Sadists and masochists can find others who share their interests at clubs in most major cities, on websites and chatrooms, and through magazines.

One potentially very dangerous practice of sadists and masochists is erotic asphyxiation (referred to as "autoerotic asphyxiation" when practiced alone). In erotic asphyxiation, one partner deprives the other of oxygen to increase sexual pleasure during orgasm. However, the inability to judge when to stop oxygen deprivation has resulted in accidental deaths. In some instances, when the evidence is inconclusive, the surviving partner has been charged with murder.

Clinical Issues

A variety of personality disorders have been associated with sexual sadism and sexual masochism disorders. Although not an official diagnosis, self-defeating personality disorder, also referred to as "masochistic personality disorder," has been used by some clinicians and researchers to describe a cluster of extremely self-defeating personality traits. People with this disorder may interpret positive events and actions in a negative light or behave in such a way as to engender a negative response from others and then feel unreasonably hurt when that response is forthcoming. These individuals seem to choose situations or relationships that are disappointing, self-defeating, negative, and even harmful. They are drawn to abusive, hateful individuals. In some cases, they will avoid pleasurable experiences or experiences that are likely to lead to success and even react negatively to individuals who treat them well.

Sadistic personality disorder was classified as a disorder in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) but does not appear in the revised fourth or fifth editions. People with sadistic personality disorder are cruel, manipulative, and aggressive. They can be physically violent and enjoy harming others. Individuals with sadistic personality disorder may enjoy humiliating others and use intimidation and violence to get what they want. The behavior must be directed toward more than one person and is not used for sexual arousal.

Antisocial personality disorder (ASPD)
is found in the DSM-5. People with this disorder are marked by a disregard for the rights and feelings of others. They may break laws and may be deceitful, impulsive, aggressive, and irresponsible. Although they are often superficially charming, they have difficulty maintaining a job or relationship. They tend to lack remorse for their behaviors. These individuals have often been diagnosed with conduct disorder in childhood.

Some clinicians and researchers have created a subcategory of rapists known as "sadistic rapists." Although some might argue that all rapists, because of the act of coerced sex, are sexual sadists, many rapists use little force during their crimes. Sadistic rapists are more deviant than other rapists. They seem to reoffend more rapidly than other rapists. They tend to use much more force than is necessary to control their victims. However, caution should be taken when assigning rapists to this category. Just because force was used during a rape—or even if the victim was killed—it cannot be assumed that the rapist is a sadistic rapist. Also, some rapists who do not use extreme force still engage in sadistic fantasies that would classify them as sadistic rapists.

Treatment Options

Sexual sadists and sexual masochists rarely present themselves for treatment unless their behavior is causing them significant psychological distress or they are mandated into treatment for coercing others into sexual behavior. Although there are treatment options, none has had overwhelming success. Pharmacological treatment options include antiandrogen steroids and gonadotropin-releasing hormone agonists, which use medications that act on testosterone and other androgen hormones. Psychotherapeutic approaches may use operant conditioning or cognitive behavioral therapy. These approaches aim to improve the patient's self-control and self-regulation of behavior; whether paraphilic interests, such as sadism or masochism, can change remains subject to debate. Involving a sexual partner in treatment can increase the chances of success, but overall, these patients are difficult to treat.

Bibliography

Assumpção, Alessandra Almeida, et al. "Pharmacologic Treatment of Paraphilias." Sexual Deviation: Assessment and Treatment. Ed. John M. W. Bradford and A. G. Ahmed. Philadelphia: Elsevier, June 2014. 173–81. Digital file.

Baumeister, Roy F. Masochism and the Self. Hillsdale: Lawrence Erlbaum, 1989. Print.

Briken, Peer, Dominique Bourget, and Mathieu Dufour. "Sexual Sadism in Sexual Offenders and Sexually Motivated Homicide." Sexual Deviation: Assessment and Treatment. Ed. John M. W. Bradford and A. G. Ahmed. Philadelphia: Elsevier, June 2014. 215–30. Digital file.

Freud, Sigmund. Three Essays on the Theory of Sexuality. Rpt. Mansfield: Martino, 2011. Print.

Gosselin, Christopher C. "The Sado-Masochistic Contract." Variant Sexuality. Ed. Glenn Wilson. New York: Routledge, 2014. 229–57. Digital file.

The Relevance of Sigmund Freud for the Twenty-First Century. Spec. issue of Psychoanalytic Psychology 23.2 (2006): 215–455. Print.

Stekel, Wilhelm, and Louise Brink. Sadism and Masochism: The Psychology of Hatred and Cruelty. Vol. 2. New York: Liveright, 1953. Print.

Von Krafft-Ebing, Richard. Psychopathia Sexualis: With Especial Reference to Contrary Sexual Instinct—A Clinical-Forensic Study. 1886. Burbank: Bloat, 1999. Print.

What are Chiari malformations? |

Causes and Symptoms

Primary or congential Chiari malformations are a result of structural flaws during fetal development of the brain
of spinal canal. The classification of Chiari malformations into four types is based on the extent of the structural flaws. Chiari malformations may also occur after surgery of the head and neck area or after an injury; they are considered secondary or acquired Chiari malformations.

Some individuals with type I do not have any symptoms and may not even know they have a Chiari malformation. This type is considered the adult form of the disorder because often symptoms first appear in adolescence or adulthood. Headaches, neck pain, balance problems, dizziness, hearing and vision problems, and numbness in the arms and legs are the symptoms that result from the pressure on nerves caused by the herniation of the cerebellum into the foramen magnum; the symptoms may come and go. A secondary condition called a syringomyelia may develop in some cases, and it can cause permanent nerve damage.

Type II, also known as an Arnold-Chiari malformation, is considered the classic Chiari malformation. In this type, both the cerebellum and part of the brain stem are pushed into the foramen magnum. Type II is a pediatric disorder, and it almost always involves a form of spina bifida.

Types III and IV, also pediatric disorders, are the most serious forms of Chiari malformations and involve significant brain and neurologic defect. Children with these types do not usually live past two years of age.

Treatment and Therapy

Treatment is not necessary for those individuals who do not have symptoms. Otherwise, treatment is based on the severity of the disorder. Pain medications or nonsteroidal anti-inflammatory drugs (NSAIDs), or both, are used to reduce the pain.

Surgery, specifically some type of decompression surgery, is used to alleviate the pressure on the spinal cord and nerves. Various surgical procedures may be performed to reduce pressure by making more room. One frequently used procedure is a posterior fossa decompression, in which a small piece of the skull at the back of the head is taken out; sometimes a piece of synthetic tissue, called a dura patch, is used to enlarge the area for the brain. Another surgical procedure that is used to relieve pressure and make more room is a laminectomy, in which some of the bony border of the spinal canal is removed.

Other surgical procedures, such as insertion of a shunt for drainage of a syringomyelia or surgical closure of the spinal column in spina bifida, may be necessary. Some surgeries for treatment of the pediatric forms of the disorder are done before birth.

Surgery does not cure Chiari malformations, and it cannot undo the nerve damage that has already occurred. Nevertheless, the various surgical procedures can reduce the pressure and relieve the symptoms. Surgery is not always effective, however, and it is possible that a more severe Chiari malformation may result after surgery.

Bibliography:

McCoy, Krisha. "Arnold-Chiari Syndrome." "Health Library, Sept. 30, 2012.

National Institute of Neurological Disorders and Stroke. "Chiari Malformation Fact Sheet." NINDS, Apr. 18, 2013.

Novegno, F., M. Calderelli, A. Massa, et al. “The Natural History of Chiari Type I Anomaly.” Journal of Neurosurgery Pediatrics 2, no. 3 (September, 2008): 179–87.

Oakes, W. Jerry, and R. Shane Tubbs. “Management of the Chiari Malformation and Spinal Dysraphism.” In Clinical Neurosurgery, edited by Guy M. McKhann. Denver: Lippincott Williams and Wilkins, 2004.

Parker, James N. The Official Parent’s Sourcebook on Chiari Malformations. San Diego, Calif.: Icon Health, 2003.

Which specific military battles were the Loyalists' most influential during the Revolutionary War? How did they affect the war off the...

Loyalists played a prominent role in a number of military campaigns during the course of the Revolutionary War, especially in the early years, when resistance to rebellion against the British Crown remained strong. As a category of colonialist sympathetic to the British Crown, and determined to remain united with England, Loyalists were present in virtually every region where the Patriots, the revolutionaries, sought to capture territory. No where was this more prevalent than in the...

Loyalists played a prominent role in a number of military campaigns during the course of the Revolutionary War, especially in the early years, when resistance to rebellion against the British Crown remained strong. As a category of colonialist sympathetic to the British Crown, and determined to remain united with England, Loyalists were present in virtually every region where the Patriots, the revolutionaries, sought to capture territory. No where was this more prevalent than in the territories around Quebec, Canada, where "the Battle of Quebec" at the end of 1775 involved large numbers of volunteers loyal to Britain. Loyalist resistance was instrumental, in fact, in Canada remaining Canada rather than becoming part of the United States.

If one wanted to focus on one particular battle in which Loyalists played a major role, albeit, an ultimately unsuccessful, one should examine the failed effort of British General John Burgoyne to defeat the Patriots in New York. The Battles of Oriskany and Saratoga in October 1777, involved British Army regulars augmented by a large contingent of Loyalists along with Iroquois Indians. Initially promising with the successful defeat of Revolutionary Army General Nicholas Herkimer at Oriskany, Burgoyne's luck would change drastically with his subsequent defeat in the Battle of Saratoga. 

Combined forces of Loyalists and Indians played major roles throughout New York and New England in the early years of the Revolutionary War. If one wanted to focus on just one or two campaigns, the Battles of Oriskany and Saratoga are good starting points. There are many additional examples that can be reviewed, including the Battle of King's Mountain in October 1780, which represented one of the most definitive defeats for the Loyalists and that set back very seriously British efforts at retaining the southern colonies. The South, as well know well, was extremely resistant to change, especially in the area of slavery, away from which the North was already beginning its transition. With the growth of abolitionist sentiments, British influence in the southern colonies declined, and with it the availability of Loyalists in that region.

What are adult issues with separation and divorce?

Introduction

Separation and divorce occur when a husband and wife decide to cease living together. In some cases, separation is temporary, allowing a couple to resolve their problems and resume living together. A divorce is a permanent loss and the end of a marriage.

In the United States, divorce is very common, with approximately one divorce for every two marriages in an average year. This is among the highest divorce rates in the world (although rates of marriage and remarriage in the United States are also among the highest). This rate, however, varied considerably over the twentieth century. Factors contributing to these trends include the decreasing significance of religious and social stigma surrounding divorce, the increasing perception that marriage should be based on love and serve personal growth and self-fulfillment, and the attainment by women of economic self-sufficiency.

Demographically, divorce is more common in couples who married young, who experienced a premarital pregnancy, and who are financially downwardly mobile. Divorce is also more prevalent in couples who come from divorced families or have not resolved attachments or conflicts with their families of origin. Divorce is more frequent in subsequent marriages than in first marriages.

Divorce as a Legal and Economic Reality

Divorce, like marriage, is a legal arrangement with significant economic consequences. The major legal issues include division of property, alimony, child support, custody, and visitation. Although these issues are settled by the divorcing couple through negotiation or litigation, the courts of each state now have guidelines that specify certain parameters as generally appropriate. How these are handled will have a large impact on the psychological experience of divorce. The legal process establishes and promotes an adversarial relationship for the couple. Although this arrangement is to be expected of a jurisprudence system built on an adversarial pursuit of justice, an essentially combative relationship is profoundly antithetical to the goal of a psychologically healthy divorce. Rather than working together toward a mutually satisfying result, divorcing couples are trained to compete in a distinctly win-lose arena, often with disastrous consequences for both. As an appreciation of the psychological costs of these consequences has grown, mediation has emerged as an increasingly popular alternative way of resolving the legal issues.

The Psychological Phases of Divorce

When a couple divorces, a great loss is experienced by all family members. This experience is not a momentary event. Its impact continues to unfold over time, as its meaning undergoes various transformations until it is gradually assimilated. There are predictable stages involved in letting go of a marriage and moving on in life. These stages appear in the experience of both members of the couple, regardless of who wanted the separation or divorce. The spouse who decides to live apart usually begins grieving the relationship while the couple is still living together. Although both spouses go through a mourning process, they often go through stages at different times and rates.

Much of the literature in the psychology of divorce has been devoted to mapping these phases. Some recognize that the steps of divorce actually begin in the period before separation. As Constance Ahrons demonstrated in The Good Divorce (1994), divorce is not entered into easily or quickly. Typically, the preseparation phase involves a protracted period of confused tension, and it is during this painfully drawn-out ending that the most serious psychological harm is inflicted on any children. Divorced couples frequently realize, in hindsight, that the marriage should have ended sooner. Sadly, it is this period of painful conflict that often provides the needed momentum for the separation to be enacted as welcome relief.

Craig and Sandra Everett in Healthy Divorce (1994) identify three preseparation stages. First, clouds of doubt gather, as one becomes increasingly disillusioned with one’s partner and ambivalent about continuing in the marriage. One may become confused, with questions about what was initially attractive about one’s partner. One becomes increasingly angry and critical and acts out that unhappiness. These early warning signs could lead the couple to make changes to save their marriage, especially with the help of marriage therapy, but the full significance of these signs is usually unrecognized and therapy entered into only later, when it is too late. The second preseparation stage is “the cold shoulder.” Warmth and affection are withdrawn, and there is less talk, disclosure, or support as one becomes emotionally unavailable to one’s partner. This pulling away is also evident in a declining interest or responsiveness in sexual relations and even in physical withdrawal, as more separate and independent activity is undertaken, excluding the partner. In stage three, fantasies of a life beyond the marriage emerge. Usually they are idealized sexual or romantic liaisons or adventurous escapes. Sometimes a spouse may act out these fantasies through extramarital affairs.

Once the actual physical separation takes place, the couple undergoes a grieving process, an experience of letting go of their marriage. As a form of grief work, this process is analogous to the phases people experience when mourning the death of a loved one, or when coming to terms with one’s own impending death (a process first identified by Elisabeth Kübler-Ross in 1969). Not everyone goes through all the stages, and sometimes people’s grieving varies from the usual sequence. Some people get stuck in certain stages of the mourning process and need psychotherapy to help them move on.

Stages of Grieving

In the first phase, denial, people may completely deny the marital problem, or, in a more sophisticated form, they may minimize the import of the problem by a sort of magical thinking, an “if only” fantasy (“It could all be resolved if only . . . ”). Such a fantasy can be held only in the mind (safe from any testing against reality), or it may lead to desperate, even self-destructive efforts to resurrect a dead relationship. In the extreme, this course can become a pathological morbid dependency on the partner. Unable to move on, such people may remain fixated on their former spouse for many years afterward. Even after it becomes evident that the partner has actually left, people can still use wishful thinking to minimize the real impact of this rupture. For example, they may think that the partner will come back once he or she realizes that no one else will be as suitable. The children of divorcing parents are prone to such fantasies of reconciliation as well. They will be very vulnerable to construing parents’ words or actions as hopeful indicators of this possibility.

In the second phase, anger, people tend to blame the breakup on the other partner. Thoughts such as, “If he (or she) were not like this, we could still be married,” are very common. Here, unlike the experience of grieving a death, there is an overwhelming sense of personal rejection by one who was loved dearly. It is this profound hurt that underlies the intense feelings of anger. In such a view, the marital breakdown is seen as completely the fault of the other, and people cannot see their own role in the unsatisfactory state of the marriage. In this phase, people are likely to become outspokenly critical of their partner to friends and children. Richard A. Gardner has described this “campaign of denigration” and the sad consequences that accrue when one parent successfully induces in the children a directive to carry this anger toward the other parent. Gardner identifies the subsequent withdrawing of affection by the child as the parental alienation syndrome: a loss, sometimes for years, of a close bond with that parent. In another extreme form, such anger can become pathologically overgeneralized. It is directed then to all men or women. Such a negative stereotype will preclude or sabotage any subsequent effort toward an intimate relationship with a person of that gender.

In the third phase, bargaining, the reality of the ending is still avoided, now by maneuvers designed to ward it off. Typically, they involve implicit or explicit offers to act differently to better suit the partner. The “bargain” involves a fantasy that change would eliminate the problem and stop the divorce. Like denial, these typically are formulated as “if only . . . .” In the extreme form, people make bargains with themselves, to enact changes designed to alter the situation. While all these bargaining ploys are unrealistic, their function is something deeper than warding off the divorce, for which they are ineffective. They serve to ward off the subjective experience of the reality and finality of the divorce by remaining focused on how to “fix” it.

In the fourth phase, depression, the reality of the divorce breaks through people’s previous efforts to minimize or avoid its emotional impact. People feel the depressive weight of the loss without the cushioning provided by denial, anger, and bargaining. This initial despair is founded on a deep sense of shame for having a failed marriage and so is accompanied by feelings of guilt and low self-esteem. Then the demands of life and fears about the future can become overwhelming. People feel inadequate to handle the roles previously taken care of by their spouse (such as finances or social arrangements). Self-defeating thoughts further undermine functioning. People may cry frequently and experience a variety of somatic problems, including changes in appetite (either eating very little or overeating); changes in sleep (either insomnia or excessive sleeping); a marked decrease in level of energy; a tendency to become isolated from social contact; an increased use of addictive substances (such as alcohol, nicotine, television, computers); and a loss of pleasure in things that used to bring joy. These symptoms are manifestations of the crushing sadness that the reality of the divorce now brings as people begin to experience the true impact of the loss.

Beyond the sense of sheer loss, there is a final phase of this process. In the fifth phase, acceptance, resolution occurs. People accept that the marriage has ended and will not be revived and that they can survive and even thrive. People reorient to a single life, incorporating this reality into a new sense of identity and functioning. When this occurs, there is a renewed interest in life; regular patterns of sleeping, eating, and activity resume; and coping mechanisms (such as excessive drinking or television viewing) abate. As anger and guilt are released, people become able to speak about and relate to their former spouses without bitterness. They do not forget the painful experience of the divorce or the preceding unhappiness in the marriage. Rather, the marital failure is seen as an opportunity for personal growth, an occasion to learn lessons and to gain insights to integrate into subsequent relationships.

As negative overgeneralizations about the other gender and about the possibility of intimate relationships are released, people become available to form new interpersonal connections. Typically, divorced individuals do remarry, often to others who are themselves divorced. The resulting unions can involve a bewildering array of step-relationships with children of new partners. Their success will depend on whether the new couple has been able to work through the issues from their divorces.

Bibliography

Ahrons, Constance. The Good Divorce. Rev. and updated. New York: HarperCollins, 1995. Print.

Clarke-Stewart, Alison, and Cornelia Brentano. Divorce: Causes and Consequences. New York: Yale UP, 2008. Print.

Demo, David H., and Cheryl Buehler. "Theoretical Approaches to Studying Divorce." Handbook of Family Theories: A Content-Based Approach. Ed. Mark A. Fine and Frank D. Fincham. New York: Routledge, 2013. Print.

Everett, Craig, and Sandra Everett. Healthy Divorce. San Francisco: Jossey-Bass, 1998. Print.

Gardner, Richard A. The Parental Alienation Syndrome. 2nd ed. Cresskill: Creative Therapeutics, 2000. Print.

Guttman, Joseph. Divorce in Psychosocial Perspective. Hillsdale: Erlbaum, 1993. Print.

Kaufman, Taube S. The Combined Family. New York: Plenum, 1993. Print.

Kübler-Ross, Elisabeth. On Death and Dying. 1969. Reprint. New York: Routledge, 2009. Print.

Margulies, Sam. Getting Divorced without Ruining Your Life. Rev. and updated. New York: Simon, 2001. Print.

Mercer, Diana, and Katie Jane Wennechuck. Making Divorce Work. New York: Perigee, 2010. Print.

Schaffer, Jill. “A Humanistic Approach to Mediation.” Humanistic Psychologist 27.2 (1999): 213–20. Print.

How could I go about writing four pages about the essay "Mother Tongue" by Amy Tan, citing two or more different authors to support my claims?

Since you did not say what claims your essay needs to make and support, I will assume that is up to you. An interesting approach to "Mother Tongue" by Amy Tan would be to compare it to essays from previous centuries by authors who wrote about writing. You could claim that Tan is maintaining and updating a tradition of authors who analyze their craft and the way they use language. Two sources I recommend are "Silly Novels by Lady Novelists" by George Eliot (Marian Evans), written in 1856, and "Politics and the English Language," by George Orwell (Eric Blair), written in 1946. 

While pointing out first that neither Eliot nor Orwell concerned themselves with writing for an audience whose first language was not English, you can nevertheless assert that both Eliot from the 19th century and Orwell from the mid-20th century—like Tan in the late 20th century—abhor snobbery in writing and embrace honesty.

Eliot, for example, has this to say, speaking of the "woman of true culture":

In conversation she is the least formidable of women, because she understands you, without wanting to make you aware that you can’t understand her. She does not give you information, which is the raw material of culture—she gives you sympathy, which is its subtlest essence. (p. 196 on link below)

This sounds very close to the conclusion Tan eventually arrived at when she realized that understanding, not grammar, was important in reaching her Chinese American readers, including her mother. Eliot also mocks writers who use elevated diction and whose writing is marked by "a careful avoidance of such cheap phraseology as can be heard every day" (187). Tan learned that using everyday speech in her dialogue, even with its grammatical inaccuracies, was much more engaging for her readers.

Although Orwell's essay advocates for improvements in the English language, he doesn't mean a blind adherence to grammar rules. In fact, he states the defense of the English language "has nothing to do with correct grammar and syntax, which are of no importance so long as one makes one's meaning clear." In this he would support Tan's use of "broken" English to communicate with her audience. After spending most of his essay mocking the snobbery of certain ways of speaking and writing in English, a snobbery which Tan admits she practiced in her early days, Orwell states, "If you simplify your English, you are freed from the worst follies of orthodoxy." This is certainly what Tan learned as she embraced the simple beauty of her "Mother tongue."

What is aplastic anemia? |

Related conditions:
Thrombocytopenia (low platelet count), neutropenia (low white count)

Definition:
The bone marrow is responsible for producing all of the blood cells in the body. Aplastic anemia is a life-threatening condition caused when the bone marrow stops producing enough new cells to create new blood cells. The typical life span of red blood cells is 120 days, platelets about six days, and white blood cells about one day. The bone marrow needs to produce cells continuously to replace the dying cells. Aplastic anemia can be acquired or hereditary. The more common acquired aplastic anemia can be a temporary condition caused by exposure to toxic chemicals, pesticides, and benzenes. Common causes for the cancer patient are chemotherapy and radiation. Hereditary aplastic anemia is rare and can be associated with Fanconi anemia, Shwachman-Diamond syndrome, and dyskeratosis congenita.

Etiology and the disease process: Although the cause of most aplastic anemia is unknown, those cases induced by chemotherapy and radiation result from the therapy’s suppression of bone marrow function. The bone marrow is not able to manufacture the cells that are needed to create red blood cells, platelets, and white blood cells.

Incidence: Aplastic anemia is a rare condition with only about 600 to 900 new cases each year in the United States, according to the Aplastic Anemia & MDS International Foundation. Of patients who are diagnosed with aplastic anemia, 20 percent have an inherited disorder as well.

Symptoms: The signs and symptoms of aplastic anemia may be seen immediately or can be slow to develop and be dependent on the blood counts themselves. Common symptoms include fatigue, dizziness, an irregular heart rate, fevers, frequent infections, frequent nose bleeds, oozing gums, blood in the stool, bruising, difficulty in stopping bleeding from a cut, and petechiae (similar to a red pinpoint rash, located on the arms, legs, and trunk). Patients may also complain of severe shortness of breath even while at rest.

Screening and diagnosis: Aplastic anemia is typically found when patients complain of fatigue to their physicians. The physical assessment includes looking for pale or yellow-tinted skin; listening to the heart, lungs, and breathing patterns; feeling the liver and spleen for enlargement; and checking for signs of bleeding. The physician may also assess the patient’s environment to determine whether exposure to toxic chemicals or other triggers has occurred. Diagnostic testing includes analysis of blood, urine, and stool samples, and bone marrow aspiration and biopsy. The patient may also have images taken (X rays, computed `tomography scans, and ultrasound) to look for enlarged organs. Once testing is complete, the aplastic anemia is staged according to how many cells are seen in the bone marrow. The three stages are moderate, severe, or very severe.

Treatment and therapy: The treatment for aplastic anemia depends on the severity and the patient’s symptoms. The patient’s overall health also determines what type of treatment can be tolerated. Moderate aplastic anemia is not treated, but the physician keeps a close eye on the blood counts and the patient’s symptoms. If the aplastic anemia is caused by chemotherapy or radiation, the patient is treated with transfusions and growth factors.

Transfusions of red blood cells and platelets are the most common. Red blood cell transfusions help raise the hematocrit and hemoglobin, which improves the anemia symptoms. Epoietin alfa, a red blood cell growth factor, can be given to help the bone marrow release immature red blood cells from the bone marrow to mature and become functioning red cells.

Not all forms of aplastic anemia will respond to growth factors. Platelet transfusions will help the patient be able to form clots to stop bleeding. White blood cells are not typically transfused because of their short life span; however, they may be given to patients who have a severe infection. Patients with a low white blood cell count may receive filgrastim, a white blood cell growth factor, to stimulate the release of the immature white blood cells so that they can mature and fight off infections. Like the red cell growth factor, filgrastim may not be applicable for all forms of aplastic anemia.

Patients may receive medications such as antithymocyte globulin (ATG), cyclosporine, and methylprednisolone. Traditional therapy consists of the patient taking all three medications. It may take a few months before an improvement in blood counts is apparent. Patients may say that they are feeling better before their counts actually reflect an improvement. Antibiotics and antivirals may also be given to prevent infection.

Bone marrow transplants are more commonly used with younger patients to replace damaged bone marrow. Research is ongoing to develop additional treatments for aplastic anemia.

Prognosis, prevention, and outcomes: Historically aplastic anemia has had a poor prognosis. However, great strides have been made on the treatments available for aplastic anemia, and modern therapy has cured or managed the disease in many patients. Treatment can be effective but may take months before results are seen. Patients may also need to try different therapies to find one that works for them. Some forms of aplastic anemia can be prevented by avoiding exposure to toxins, radiation, and medication, but other forms cannot be prevented.

DeZern, Amy E., and Eva C. Guinan. "Aplastic Anemia in Adolescents and Young Adults." Act Haematologica 132.3/4 (2014): 331–39. Print.

Hoffman, Ronald, et al. Hematology: Basic Principles and Practice. 6th ed. Philadelphia: Saunders/Elsevier, 2013. Print.

Klag, Michael J, ed. Johns Hopkins Family Health Book. New York: HarperCollins, 1999. Print.

Korthof, E. T., et al. "Management of Acquired Aplastic Anemia in Children." Bone Marrow Transplantation 48.2 (2013): 191–95. Print.

Schrezenmeier, Hubert, and Andrea Bacigalupo, eds. Aplastic Anemia: Pathophysiology and Treatment. New York: Cambridge University Press, 2000. Print.

What is the significance of hands for Lennie in Of Mice and Men?

In "Of Mice and Men," hands take on a symbolic quality, and often reflect the characteristics of the those to whom they are attached. For example, Curley is described as keeping one of his hands in a vaseline-filled glove at all times, to keep it soft for his wife. His other hand is free for cruelty and beatings, as Lennie will soon find out. Thus, Curley's true nature is revealed both by his gloved hand, which is unnaturally, publicly, and deceptively softened, and his un-gloved hand, which is openly sadistic. He is the kind of man who believes that cheap, quick fixes, such as moisturizing one of his hands, will cause his wife to love him more, and trick her into thinking that he is actually a good man. He is superficial and silly, yet cunning and malevolent.

In contrast, Lennie's hands are quite paw-like, and he is described as being shapeless. Lennie's hands, and the rest of his body, reflect his child-like, innocent, and almost animalistic nature. They lack George's characteristic cleverness, or Curley's sadism. Unlike Curley, Lennie has neither the desire nor the ability to hide his true intentions. Ultimately, the brute strength of Lennie's hands, combined with his innocence, leads to his demise. He kills Curley's wife by accident, and, as a result, both his and George's dreams are irrevocably crushed.

Last, Curley's wife is described as having red nails. Her hands, and the rest of her, are soft, delicate, and alluring. In particular, her nails reflect her sense of beauty, pride, and flirtatiousness. She is, in many ways, the polar opposite of Lenny, who is huge, hulking, and oblivious. She is also a dangerous figure on the ranch, as Curley will attack any man who tries to connect with her. However, her nails also reveal a second, and perhaps more critical, aspect of her personality: she has dreams. Indeed, Curley's wife wants to be an actress, but because of her current situation (that is, her marriage to Curley, and her isolation), she cannot achieve it. Thus, her red nails and sausage-like curls represent her hope, and her unwillingness to let go of an impossible dream. Like Lennie and George, she yearns for a brighter future.

What is informed consent? |

Informing the patient: Patients receive information about the proposed medical course of action. It should be as nontechnical as possible to ensure that it is understandable. Explanations can be in the following forms:

• Verbal, via the physician or other health care provider





• Written, via patient information handouts or educational booklets





• Short films on video or DVD





• Computer-provided interactive tutorials

After receiving comprehensive information, patients are to have all their questions answered in language that they are able to understand.

Nonsurgical treatments: For treatments, the American Cancer Society recommends that patients include questions about the diagnosis that has prompted the procedure, including how serious the condition is; the recommended treatment methods and possible benefits and risks of having, or not having, the treatment, including the effect on normal functions and everyday activities and possible immediate, short-term, and long-term side effects; other treatment options, if available, and their possible benefits and risks; any potential discomforts associated with the treatments and the methods used to prevent or relieve those discomforts; the treatment’s duration; and the treatment’s cost.

Surgical procedures: For surgical procedures, the American College of Surgeons recommends that patients pose questions about the factors that indicate an operation is required, and the possible benefits and risks of having, or not having, the operation, including the impact on health or quality of life; the alternatives to the surgery, if available, and their possible benefits and risks; the basic procedures involved in the operation, including expected length of hospitalization, if necessary; and expectations during the recovery period, including length of time before resumption of normal activities.

Giving consent: Once patients have had all questions satisfactorily answered, they are asked to decide whether they want to undergo the proposed medical course of action. An affirmative decision is indicated by signing and dating a written informed consent form, signaling voluntary willingness. This form may then be signed by a witness to confirm that the patient has received an accurate explanation of the information contained both in the form and in any other printed or orally delivered material, has understood the information, and has freely given consent.

Clinical trials: For clinical trials, the informed consent process is more detailed than that for a nonexperimental medical course of action. Clinical trials for investigational drugs, medical procedures, or medical devices are to be conducted using Good Clinical Practices (GCPs), as mandated by the Code of Federal Regulations (CFR) of the U.S. Food and Drug Administration (FDA) and by guidelines of the International Conference on Harmonization (ICH). Before screening for possible participation, the potential study subjects must receive information on and have all their questions answered about the investigational drug or medical device being tested and the probability of being assigned to a treatment group or placebo (nonexperimental drug/device) group; the study procedures to be followed (including identification of any that are experimental) and tests to be administered; and the potential risks and benefits involved in study participation.

Patients must also receive information about the expected length of participation, their responsibilities as study subjects, anticipated compensation for participation (if any), the possible circumstances under which participation may be discontinued (despite subjects’ consent), the possible compensation and treatments available should they have a trial-related injury, and the extent to which records that contain information about their identity will be kept confidential.

Once patients have had all questions satisfactorily answered, they are required to sign an informed consent form that has been approved by an institutional review board (IRB) or independent ethics committee (IEC). By providing written informed consent, patients are indicating that all their questions have been answered, their participation in the study is voluntary, and they understand that they have the right to withdraw this consent to participate at any time during the study.

During the procedure or clinical trial: Although an informed consent form has been signed to indicate voluntary participation in a clinical trial, the study personnel including sponsors, investigators, monitors, clinical research assistants, and anyone else involved with clinical trial procedures are not released from liability for negligence. In addition, patients have the right to have their questions answered throughout the treatment process and to withdraw their consent at any time. In the case of clinical trials, subjects are to be informed if any significant results occur during the study that might affect their willingness to continue to participate in that study.

Berg, J. W., P. S. Appelbaum, C. W. Lidz, and L. S. Parker. Informed Consent: Legal Theory and Clinical Practice. New York: Oxford University Press, 2001.

Faden, R. R., and T. L. Beauchamp. A History and Theory of Informed Consent. New York: Oxford University Press, 1986.

U.S. Food and Drug Administration. Guidance for Institutional Review Boards and Clinical Investigators: A Guide to Informed Consent. Rockville, Md.: Author, 1998.

What is hydrocodone? |

History of Use

Hydrocodone was first synthesized in Germany in 1920 by Carl Mannich and Helene Löwenheim. The first report of euphoria and habituation was published in 1923, and the first report of dependence and addiction was published in 1961. Hydrocodone was approved by the US Food and Drug Administration in 1943 for sale in the United States.

Hydrocodone relieves pain by changing the way the brain and nervous system respond to pain, that is, by binding to the opioid receptor sites in the brain and spinal cord.

Hydrocodone is not usually produced illegally; diverted pharmaceuticals are the primary source for misuse. Misuse comes in the form of fraudulent call-in prescriptions, altered prescriptions, theft, and illicit purchases online. Diversion and abuse have been increasing. In 2008, hydrocodone was the most frequently encountered opioid in drug evidence submitted to state and local forensics laboratories, as reported by the National Forensic Laboratory Information System.

Effects and Potential Risks

Short-term effects are improvement of mood, reduction of pain, euphoria, sedation, light-headedness, and changes in focus and attention. Side effects include nausea, vomiting, constipation, anxiety, dry throat, rash, difficulty urinating, irregular breathing, and chest tightness. When inhaled, burning in nose and sinuses usually occurs. A newborn of a woman who was taking the medication during pregnancy may exhibit breathing problems or withdrawal symptoms.

Symptoms of overdose include cold and clammy skin, circulatory collapse, stupor, coma, depression, respiratory depression, cardiac arrest, and death. Mixing hydrocodone with other substances, including alcohol, can cause severe physical problems or death.

Abuse of hydrocodone is associated with tolerance, dependence, and addiction. There is no ceiling dose for hydrocodone in users tolerant to its effects. Acetaminophen carries the risk of liver toxicity with high, acute doses (of around 4,000 mg per day).

Bibliography

Amer. Soc. of Health-System Pharmacists. "Hydrocodone." MedlinePlus. US Natl. Lib. of Medicine, 15 May 2015. Web. 27 Oct. 2015.

Girion, Lisa. "DEA Tightens Controls on Hydrocodone Painkiller Drugs." Los Angeles Times. LA Times, 21 Aug. 2014. Web. 27 Oct. 2015.

Parker, Phillip M., and James N. Parker. Hydrocodone: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego: Icon Health, 2003. Print.

McCoy, Krisha. "Opioid Addiction." Ed. Michael Woods. Health Library. EBSCO, Jan. 2014. Web. 27 Oct. 2015.

Seppala, Marvin. Prescription Painkillers: History, Pharmacology, and Treatment. Center City: Hazelden, 2010. Print.

What is yellow fever? |

Causes and Symptoms

Yellow fever is a viral disease of humans spread by infected mosquitoes. The infectious agent is a flavivirus. Yellow fever is primarily a disease of tropical and pantropical areas of South America and sub-Saharan Africa. The absence of yellow fever from Asia is curious but may be explained by the lack of suitable reservoirs. Three types of yellow fever are recognized, sylvan yellow fever, intermediate yellow fever, and urban yellow fever.

All three types are highly communicable, but none are directly transmitted via personal contact between humans. The method of transmission was reported by physician Walter Reed in 1901 after extensive studies. A human contracts the disease through the bite of an infected mosquito that, in turn, has taken a blood meal from an infected monkey or other human. The viral incubation period within the mosquito is nine to twelve days. The virus then appears in the saliva and can be transmitted during the mosquito’s next blood meal. Thereafter, the mosquito carries the virus throughout its life.

Sylvan yellow fever is also known as jungle yellow fever. Forest monkeys are its primary reservoir, but marmosets and marsupials may also harbor the disease. Sylvan yellow fever is spread from monkey to monkey by the bite of infected Sabethes or Haemagogus mosquitoes, which breed in water-filled tree holes.

People who visit or work in rain forest environs, such as miners, engineers, wildlife biologists, and foresters, are at risk of contracting the disease. Sylvan yellow fever is rare or nonexistent outside tropical rain forests, but cases are reported every year in areas where it is endemic. The intermediate, or savannah, cycle of yellow fever is transmitted from an infected mosquito to a human living or working near an area that borders the rain forest. This cycle of the virus can also be transmitted from monkey to human, or from human to human, via the infected mosquito.

Urban yellow fever is spread by the Aedes aegypti mosquito, which is the main reservoir of the disease, along with humans. Aedes commonly lives and breeds in trash dumps and waste places around human habitations. Urban yellow fever often results in thousands of cases and high fatality rates.

In humans, the first symptoms of yellow fever typically appear from three to six days following the bite of an infected mosquito. Symptoms vary widely; the mildest cases may pass unnoticed, but in more severe cases the patient shows a number of flulike symptoms, such as muscle aches, backaches, headache, high fever, chills, nausea, and vomiting. Liver damage may occur as early as the fourth or fifth day of the illness, leading to progressive and extensive jaundice. In the most severe cases, periods of nausea, vomiting, renal failure, and extensive bleeding (hemorrhage) may prove fatal. The fatality rate may range from as low as 5 percent in indigenous populations to 50 percent or more when untreated or during severe epidemics. Higher fatality rates are typically seen in nonindigenous people.

Clinical diagnosis of yellow fever is aided by isolation of the virus in mice, by microscopic examination of liver tissue for necrotic lesions that characterize this disease, by detection of the yellow fever viral antigen in blood or liver tissue fluid of the infected patient, or by detection of the viral genome in liver tissue. Diagnosis can also be determined serologically through the detection of specific antibodies.

Treatment and Therapy

There is no specific antiviral drug for yellow fever, so treatment goals include providing symptom relief, such as oxygen support, medications to reduce fever and pain, and the administration of vitamin K and replacement fluids. Dialysis may be required for patients suffering from kidney failure. Complete recovery may take several weeks, after which the individual has a lifelong immunity to yellow fever. The yellow fever vaccine is used to prevent infection among those likely to be exposed to the virus.

Perspective and Prospects

Yellow fever has long been a dreaded tropical and subtropical disease of humans. Throughout the centuries of exploration, yellow fever epidemics occurred with alarming regularity, and high fatality rates were seen among nonindigenous visitors and settlers in regions where the disease is endemic. The presence of yellow fever on a ship was indicated by flying the fever flag or yellow jack. Before the transmission of yellow fever was understood, the disease was one of the deadliest infections known, with outbreaks such as the Great Yellow Fever Epidemic of 1878 in the Mississippi valley causing great losses of life. Physician Walter Reed was the first to describe the epidemiology of yellow fever and to recognize the importance of the mosquito vector in its spread. His research elucidated control and eradication measures that provide containment during epidemics, including the successful total suppression of yellow fever in the United States. In 1937 microbiologist Max Thieler developed a treatment for yellow fever, with research leading to the 17D vaccine. These breakthroughs led to the widespread eradication of the disease from urban areas.

Despite modern medical advances, yellow fever remains a problem in many areas—the disease is endemic to forty-four countries in Africa and South America. The Centers for Disease Control (CDC) reports five other African nations as at low risk for exposure. Many of these countries require proof of vaccination for visitors. Small numbers of cases of sylvan yellow fever occur every year in certain areas of Amazonia and northern South American countries, including Peru and Bolivia. In central Africa, the yellow fever belt extends from Ethiopia westward through Senegal, Sudan, and Ghana. Both occasional cases and epidemics occur irregularly. Between 1986 and 1988, for example, thirty thousand cases of yellow fever were reported in Nigeria, and ten thousand people died. The World Health Organization (WHO) estimates that there are 200,000 cases of yellow fever worldwide each year, which cause approximately 30,000 deaths. 90 percent of those cases are found in Africa. The CDC estimates that the risk of infection among travelers is 50 per 100,000 in West Africa and 5 per 100,000 in South America, while the risk of death from yellow fever is 10 per 100,000 in West Africa and 1 per 100,000 in South America. Since the 1990s the incidence of the disease has increased due to factors including climate change, deforestation and population movement in endemic areas, and decreasing levels of immunity among human populations.

The traditional and still most effective method of preventing urban yellow fever is the eradication of the Aedes aegypti mosquito vector. Control measures involve a combination of insecticide spraying and the cleanup or removal of potential breeding sites. The prevention of yellow fever can also be achieved through the vaccination of all people within the endemic regions. A single vaccination with an attenuated strain of virus grown in chick embryos has been shown to be effective for thirty or more years, but revaccination is recommended every ten years.

The elimination of sylvan yellow fever is probably impossible because of the difficulty of eradicating jungle populations of Sabethes and Haemagogus mosquitoes. Prevention must therefore be achieved through defensive measures for people who work in or visit jungle areas, including immunization and the use of protective clothing, netting, and mosquito repellents.

Bibliography

Delaporte, François. The History of Yellow Fever: An Essay on the Birth of Tropical Medicine. Translated by Arthur Goldhammer. Cambridge: MIT P, 1991.

"Hemorrhagic Fevers." MedlinePlus. Natl. Lib. of Medicine, Natl. Institutes of Health, 10 Feb 2015. Web. 3 Mar. 2015.

Heymann, David L., ed. Control of Communicable Diseases Manual. 19th ed. Washington, DC: American Public Health Assn., 2008. Print.

Kettle, D. S., ed. Medical and Veterinary Entomology. 2d ed. Wallingford: CAB Intl., 1995. Print.

Murphy, Jim. An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793. New York: Clarion, 2003. Print.

Wills, Christopher. Yellow Fever, Black Goddess: The Coevolution of People and Plagues. Reading: Addison-Wesley, 1996. Print.

"Yellow Fever." Centers for Disease Control and Prevention. CDC, 3 Feb. 2015. Web. 3 Mar. 2015.

"Yellow Fever." Mayo Clinic. Mayo Foundation for Medical Education and Research, 20 Aug. 2014. Web. 3 Mar. 2015.

"Yellow Fever." World Health Organization. WHO, March 2014. Web. 3 March 2015.

What is woman-centered care? |

Woman-centered care is an approach to medicine that empowers women to make decisions and manage their own care, ensuring consideration of their values, cultural traditions, and personal choices in health care. Woman-centered care provides ample information on available options and respects the woman's choices. For example, in maternal health care, the mother who wishes to give birth naturally could choose among a home birth with a midwife; a birth center staffed by midwives and nurses, with a doctor on call; or a hospital birth room, where medical care and intervention are readily available. Even in the hospital setting, the woman would make the final decision after receiving complete information regarding any interventions.

Woman-centered care does not necessarily come naturally to health care providers, however. Because they are highly educated and used to being in a position of authority, many doctors find it difficult to allow patients to make decisions regarding care. Hospital routines do not bend easily to patient preferences, either.

Woman-Centered Childbirth

In woman-centered childbirth, the patient has options related to her care. These choices involve not only medical treatment but also values, hopes, and fears. For example, a woman planning the birth of a child might wish to choose who will be with her, whether she will eat or drink during labor, and whether she will stay in bed or walk about. Her decisions on intervention or medical procedures are final, based on complete information regarding the benefits and risks of each choice. For example, the couple considering a home birth meets with the doctor and midwife to discuss possible scenarios, including an exceptionally long labor, a medical emergency, or other complications. They opt for the home birth, but they are prepared to make decisions based on the situation.

Poorly informed patients in medical facilities may feel isolated and forced to accept treatment that does not meet their expectations or needs. A possible outcome of such a scenario is that the patient will not comply with treatment or follow-up care. In many cases, the patient will not return to the medical facility, and in cultures where women have been disrespected or mistreated by medical personnel, they may avoid all medical care in the future.

Barriers to Woman-Centered Care

Historically, pregnancy and childbirth were part of the women's sphere, with midwives attending during labor and deliveries. While midwives still thrive in many places around the world, most first world countries have adopted hospital-based, physician-directed obstetrical care. Doctors generally believe that their knowledge and experience give them the authority to make decisions for their patients. When a malpractice suit is a potential result of a poor outcome, it is in the physician's interest to choose a radical intervention such as a Cesarean section, if it reduces risk. Under woman-centered care, the physician's role is to provide accurate information and an assessment of the conditions, while the final decision is always that of the patient.

Technology also impacts woman-centered care. A variety of monitors, scanning devices, and medications have made the medical staff comfortable with readouts and a constant supply of information, even if it restricts the laboring mother's comfort and ability to fully participate in the birth. Such technology potentially moves the focus to the machines and to the baby, rather than on the mother or the combined needs of both mother and child.

Hospital routines also affect the incentive to provide woman-centered care. In some cases, babies may be routinely removed from the mother's care for bathing, medical evaluations, or treatment with little regard for the mother's wishes. However, offering individual timetables is difficult and expensive in a large hospital.

Rights-Based Care

In many developing countries, access to quality, affordable women's health care is severely limited. Where it is available, medical care is rarely centered on the woman. In some places, the status of women is so low that they are disrespected or even abused by clinical workers. Women accordingly refuse to return to a clinic after they have been mistreated or stigmatized. In most cases, that is the end to the woman's relationship with not only the clinic but also the entire health care system. Women in Nigeria and Ethiopia, for example, often prefer traditional medicine and home care during pregnancy. Even when health services are free, women choose not to use them after being ignored, left alone during labor, or slapped for crying out during childbirth. While ideally they would receive follow-up care, women who have been mistreated simply do not return for health services.

Beyond Maternal Health Services

Woman-centered care often concentrates on family planning, pregnancy, and childbirth. However, all women need access to appropriate care throughout every stage of their lives. For example, girls and young women need good nutrition to ensure a healthy body, and they benefit from educational materials that help them understand their bodies' processes and changes. They also need information on sexually transmitted diseases and contraception.

Specialized care should also address the needs of women in prison, victims of domestic abuse, and sex workers. Mental health issues also must be addressed to provide comprehensive care.

Women also need care beyond the childbearing years. Rather than seeing separate doctors at various life stages, it is in the patient's best interest to stay with a primary doctor to meet her basic health care needs. There her history and preferences are understood and respected.

Bibliography

Dekker, Rebecca. "What Is Patient-Centered Maternity Care?" Evidence Based Birth. Evidence Based Birth, LLC. 24 July 2012. Web. 31 Mar. 2015. http://evidencebasedbirth.com/what-is-patient-centered-maternity-care/

Glass, Jacob. "Woman-Centered Maternity Care, Family Planning, and HIV: Principles for Rights-Based Integration." Wilson Center. Woodrow Wilson International Center for Scholars. 11 June 2013. Web. 30 Mar. 2015. http://www.wilsoncenter.org/event/woman-centered-maternity-care-family-planning-and-hiv-principles-for-rights-based-integration

Gleckman, Howard. "What Is Person-Centered Care, and Does It Work?" Forbes. Forbes.com LLC. 17 Oct. 2012. Web. 31 Mar. 2015. http://www.forbes.com/sites/howardgleckman/2012/10/17/what-is-person-centered-care-and-does-it-work/

Kulick, Rachael B. "Women's Health Movements." Encyclopedia of Gender and Society. Vol. 2. Ed. Jodi O'Brien. Thousand Oaks: SAGE Publications, 2009. 900–903. Print.

Shields, Sara, and Lucy Candib, eds. "Part Four: Finding Common Ground in the Care of Pregnant, Laboring, and Postpartum Women." Woman-Centered Care in Pregnancy and Childbirth. London: Radcliffe Publishing, 2010. 265–285. Print.

"A Woman-Centered Approach to the U.S. Global Health Initiative." Center for Health and Gender Equity. Center for Health and Gender Equity. Feb. 2010. Web. 31 Mar. 2015. http://www.genderhealth.org/files/uploads/change/publications/womancenteredapproach.pdf

"Women at the Center." Center for Health and Gender Equity. Center for Health and Gender Equity. Web. 31 Mar. 2015. http://www.genderhealth.org/files/uploads/YMM.CHANGE.Info.MaternityCare._FINAL.pdf

What are warts? |

Definition

Warts are usually painless, harmless growths on the skin caused by a virus that can be disfiguring, embarrassing, and occasionally itchy and uncomfortable. Different types of warts include common warts, which usually appear on hands but can appear anywhere; flat warts, which usually appear on the face and forehead and are common in children and teenagers but rarely seen in adults; genital warts, which are usually found on the genitals, in the pubic area, and in the area between the thighs, but can also appear inside the vagina and anal canal; plantar warts, found on the soles of the feet; and subungual and periungual warts, which appear under and around the fingernails or toenails.

Causes

The typical wart is a raised round or oval growth on the skin with a rough
surface caused by a virus. This virus includes dozens of types of the
human
papilloma virus (HPV).

Risk Factors

Most warts are harmless and are more of a nuisance than a threat, but
genital
warts are the main cause of cervical
cancer. Although not a danger, warts around and under nails
are much more difficult to cure than warts elsewhere.

Symptoms

Warts are named by their clinical appearance and location; different forms are
linked to different HPV types. Common warts (verrucae vulgaris) are caused by HPV
1, 2, 4, 27, and 29. They are usually asymptomatic but sometimes cause mild pain,
especially when they are located on a weight-bearing surface. Flat warts, caused
by HPV 3, 10, 28, and 49, are smooth, flat-topped, yellow-brown papules, most
often located on the face and along scratch marks. Genital warts manifest as
discrete flat to broad-based smooth to velvety papules on the perineal,
perirectal, labial, and penile areas. Infection with high-risk HPV types (most
notably 16 and 18) is the main cause of cervical cancer.

Screening and Diagnosis

Diagnosis of warts is based on clinical appearance; biopsy is
rarely needed. A primary sign of warts is the absence of skin lines crossing their
surface and the presence of pinpoint black dots (thrombosed capillaries) or
bleeding when warts are shaved. Differential diagnosis includes corns (clavi),
lichen planus, seborrheic keratosis, skin tags, and squamous cell carcinomas. DNA
(deoxyribonucleic acid) typing is available in some medical centers but is
generally not needed.

Some warts will disappear without treatment, although they can sometimes remain
for a couple of years. Treated or not, warts that go away often reappear. Genital
warts are contagious, while common, flat, and plantar warts are much less likely
to spread from person to person. All warts can spread from one part of the body to
another. Treatment is often sought because people generally consider warts
unsightly and because the appearance of warts is often stigmatized.

Treatment and Therapy

Standard treatment for warts includes freezing (cryotherapy,
or liquid nitrogen therapy), treatment with cantharidin (a substance extracted
from the blister beetle), and minor surgery that may involve cutting away the wart
tissue or destroying it by using an electric needle in a process called
electrodessication and curettage.

Other possible treatments include self-care approaches such as salicylic acid and patches available at drugstores. Another approach is the use of duct tape to cover warts for six days, followed by their soaking in warm water and rubbing them with an emery board or pumice stone. Other therapies include injection with bleomycin or the use of retinoids.

Prevention and Outcomes

Avoiding the following behaviors will help to reduce the risk of getting or spreading warts: brushing, clipping, combing, or shaving areas that have warts; using on healthy nails the same file or nail clipper used on warts; biting fingernails near warts; and picking at warts. One should also keep hands as dry as possible, wash hands carefully after touching warts, and use footwear in public showers or locker rooms.

Bibliography

American Academy of Dermatology. “Warts.” Available at http://www.aad.org/public/publications/pamphlets/common_warts.html.

Androphy, E. J., et al. “Warts.” In Fitzpatrick’s Dermatology in General Medicine, edited by K. Wolff et al. 7th ed. New York: McGraw-Hill Medical, 2008.

Berger, T. G. “Dermatologic Disorders.” In Current Medical Diagnosis and Treatment 2011, edited by Stephen J. McPhee and Maxine A. Papadakis. New York: McGraw-Hill, 2011.

Dehghani, F., et al. “Healing Effect of Garlic Extract on Warts and Corns.” International Journal of Dermatology 44 (2005): 612.

Egawa, K., et al. “Topical Vitamin D3 Derivatives for Recalcitrant Warts in Three Immunocompromised Patients.” British Journal of Dermatology 150 (2004): 367.

What is the MMR vaccine?

Benefits of Vaccination

The combined MMR vaccine protects children and adults against measles, mumps, and rubella all together. Before the vaccine was developed, these highly contagious diseases were prevalent, and virtually all children became infected at some point. In the 1960s vaccines were developed for each disease individually, and in 1971 the separate vaccines were combined into the MMR vaccine. In 1993 doctors began recommending a booster shot to increase children's protection against the diseases. In 2005 a version known as MMRV was made available that combined the standard MMR vaccine with the vaccine for chickenpox, or varicella.

The vaccination program was highly successful at reducing cases of all three diseases in the United States. Outbreaks of measles, mumps, and rubella only typically continue to occur in areas with clusters of nonimmunized children, such as in religious communities that avoid immunization or in families in which a parent or parents fear that the MMR vaccine has harmful side effects and has a link to autism.

MMR vaccine and autism. A controversial study published in 1998 by the journal The Lancet suggested a link between the MMR vaccine and rising rates of autism. The article soon led to widespread fear among parents of the safety of the vaccine, and some parents refused the vaccine for their children. Pockets of nonimmunized children contributed to renewed outbreaks of measles, mumps, and rubella in the United States and in the United Kingdom and other European countries. The original study, however, was flawed, and The Lancet officially retracted the report in February 2010. The article, authored by the discredited British researcher Andrew Wakefield and coauthors, had erroneous conclusions. Additional research attempting to replicate Wakefield’s findings did not support his results. Rather, further study found no evidence of a link between the MMR vaccine and autism, supporting the safety of vaccination. Still, the negative publicity generated by the report helped sustain a vocal minority of antivaccination advocates despite widespread scientific consensus that failing to vaccinate children has a negative effect on public health.

Side effects. The MMR vaccine is associated with mild side effects that include fever, mild rash, and swollen glands. Less common side effects include seizure and temporary joint pain. Rarely, allergic reactions or serious side effects such as deafness, long-term seizures, and brain damage may occur.

Impact

The MMR vaccine has reduced the incidence of measles, mumps, and rubella by more than 99 percent according to the Centers for Disease Control and Prevention. The success of the vaccine in dramatically reducing the spread of these diseases has enabled the U.S. government’s Childhood Immunization Initiative to set a goal of eradicating native measles, mumps, and rubella in the United States. This goal acknowledges that the viruses may be brought to the United States by people who were infected in other countries.

The vaccine leads to lifelong immunity. Children receive the dose between twelve and fifteen months of age and get a booster shot between four and six years of age. After two doses, the vaccine protects 99 percent of the children immunized. In some cases adults may be recommended to receive the vaccine as well.

Bibliography

Centers for Disease Control and Prevention. “Vaccine Safety: Measles, Mumps, and Rubella (MMR) Vaccine.” Available at http://www.cdc.gov/vaccinesafety.

Editors of The Lancet. “Retraction: Ileal-Lymphoid-Nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children.” The Lancet 375 (2010): 445.

Griffin, Diane E., and Michael B. A. Oldstone, eds. Measles: History and Basic Biology. New York: Springer, 2009.

Hawkins, Trisha. Everything You Need to Know About Measles and Rubella. New York: Rosen, 2001.

Institute of Medicine. Immunization Safety Review: Vaccines and Autism. Washington, D.C.: National Academies Press, 2004.

"Measles: Questions and Answers." Immunization Action Coalition. Immunization Action Coalition, n.d. Web. 23 Dec. 2015.

"MMR Vaccine Does Not Cause Autism." Immunization Action Coalition. Immunization Action Coalition, n.d. Web. 23 Dec. 2015.

What is the independent variable and the dependent variable of a experiment called germinating bean seeds?

When we conduct an experiment, there are independent, dependent and controlled variables. An independent variable is the parameter that is changed by the experimenter, while the dependent variable is the parameter that changes as a result and is measured by the experimenter. The controlled variable is the parameter that is controlled by the experimenter.

In the germinating bean experiment, one can vary different parameters to study the effect of variations in them (one at a...

When we conduct an experiment, there are independent, dependent and controlled variables. An independent variable is the parameter that is changed by the experimenter, while the dependent variable is the parameter that changes as a result and is measured by the experimenter. The controlled variable is the parameter that is controlled by the experimenter.

In the germinating bean experiment, one can vary different parameters to study the effect of variations in them (one at a time) on the germination of the seeds. The independent variables in this experiment can be soil (type and quantity), water (amount and interval of watering), or sunlight (absence or presence), among others. For each of these independent variables, the dependent variable is the germination of seeds. Thus, for the experiment, we can vary one variable at a time, say one pot (containing the bean seeds in the soil) is kept out in the sun, while the other is kept in the dark. Each day, we can observe if the seeds have germinated or not, and if they have, how many.

One can also study the length that the bean plants grow as the dependent variable for each of these independent variables.

Hope this helps.

What is psychoanalysis? |

The Theoretical Basis of Psychoanalysis

Psychoanalysis is a method that is used to understand the workings of the human mind. Adherents to psychoanalysis believe that many forces operate to influence and shape the mind, including some that exist beneath the level of conscious awareness and control. Psychoanalysis permits scientists to observe and collect information about the mind, to develop and test scientific hypotheses about mental processes, and to use the scientific wisdom gained to diagnose and treat mental illnesses. Psychoanalytic theory helps psychiatrists and other mental health practitioners understand more about human emotions and psychological development. Though many psychoanalytic concepts were first developed only in the late nineteenth century, psychoanalysis has made significant and lasting contributions to modern psychiatry and continues to enhance its development.

The precepts of psychoanalysis have been subjected to much scientific scrutiny and criticism. As befits any scientific discipline, psychoanalytic theory has been revised periodically to account for new information, observations, and insights. Psychoanalytic theory also is seen as contributing to other scientific disciplines, such as neurology, the social sciences, and psychology. Psychoanalysis has also broadened understanding in the humanities, the arts, philosophy, ethics, and religion. Psychoanalysis clearly has had a profound and lasting impact upon a broad span of human interests and activities.

Psychoanalytic theory is largely a product of the efforts of
Sigmund Freud (1856–1939) to link the physical processes of the human brain with the psychological manifestations of the human mind. While Freud was frustrated in his ultimate goal of demonstrating clearly the relationship between the two, his work informs the same search today. Therefore, an understanding of early and evolving psychoanalytic theory remains important to psychiatry and psychotherapy.

To begin developing an understanding of the complexities of psychoanalysis, one needs to be familiar with basic information about psychoanalytic theory. The discussion that follows will touch on instinctual drives, the architecture of the mind, psychological development, mental defense mechanisms, and the psychoanalytic classification of mental illness.

Human behavior is driven from early infancy on by the operation of basic instincts. Freud believed that the primitive and evolving physical needs of humans stimulate instinctual drives. He said instincts possess four essential characteristics: source, impetus, aim, and object. Instincts arise from a particular bodily area, generate varying amounts of energy, aim for gratification, and are directed at particular objects, such as other people. Libido, one of these instincts, drives humans to seek pleasure and provides gratification during all the several stages of human development, beginning with the infant sucking at the mother’s breast. Later in his work, Freud expressed his belief that humans possess an aggressive instinct, which appears to be aimed at the destruction of the self and others. His formulation of dual and dueling instincts, as with much of his work, continues to evoke controversy in psychoanalytic circles.

Freud believed that the libido instinct is expressed early in life and continues to be expressed during several stages as a prelude to mature psychosexual development. Infants first experience the oral stage, which centers on feeding. Libido is gratified during the act of nursing, and success experienced at this stage helps the infant develop a sense of trust and self-reliance. Older infants proceed to the anal stage, centering on the retention and expulsion of feces and urine. Successful experience during the anal stage equips children with what they need to develop personal autonomy, independence, guiltless initiative, self-assurance, and willingness to cooperate. Children then move to the phallic stage, finding a new interest in genitalia. Freud’s theories about this stage are controversial, and many have been repudiated. He said that the penis holds the interest of both sexes, but girls form an early sense of inadequacy when they see that they do not have one (penis envy). Early sexual feelings are directed, according to Freud, toward the parent of the opposite sex (Oedipus complex). Parents regard these feelings as unacceptable and send signals to the children, who must repress their sexual urges. Boys act
out of fear of castration, while girls act out of fear of loss of parental love and of envy of the boy’s penis. Children who successfully negotiate this stage are said to have developed a firm basis for sexual identity, uninhibited curiosity, a sense of mastery, and the formation of conscience. Next comes the latency period, from ages five to thirteen, during which previous attainments are integrated and consolidated. Key elements of adaptive behavior develop during this stage. The teenage years are said to be spent in the genital stage, during which the child separates gradually from dependence on parents and begins to attach to new love objects and more mature interests. This stage culminates successfully in a sense of personal identity and acceptance.

Through Freud’s study of and work with hysteria, a condition in which emotional conflicts are transformed into bodily maladies, he became convinced that the human mind contains dynamic forces that often oppose one another. For example, a person who experiences significant trauma in early childhood, and the painful emotions that attend it, can mentally oppose or repress memories of the trauma and the traumatic emotions. The repressed memories and emotions remain embedded in the unconscious regions of the mind until they are revived and re-experienced when stimulated by a later event. Thus, the force of emotional material that was repressed but never forgotten can exceed the force used by the conscious mind to hold the memories at bay. The concepts of repression and the needful recognition of repressed material continue to be important principles guiding psychoanalysis.

Freud conceived of the human mind, or psyche, as having three parts: id, ego, and superego. The basic instincts and repressed Oedipal urges of human beings reside in the id. Freud saw the id as a totally undifferentiated mass of energy, constantly seeking gratification without the constraints of reality or morality. In contrast, he saw the ego as being well organized, governed by an accurate perception of the external environment, and honoring certain principles of socially acceptable behavior. The ego seeks to form gratifying relationships with other people. At the same time, the ego must defend itself against the primitive urges of the id. The superego is the last division of the mind to form, which it does through successful resolution of the Oedipus conflict. It forms what is called the conscience and imposes control through guilt. The superego often operates during dreams, Freud said, sending warnings when the ego fails to defend properly against id impulses. Most work of the id and the superego is carried out unconsciously, while much of the ego’s work operates at the conscious level.

After Freud had seen his theories confirmed in his clinical and personal experience, he felt comfortable in setting out his thoughts on psychopathology. Among the disorders that he identified were various types of neuroses, phobias, perversions, character disorders, personality disorders, psychoses, hypochondriasis, depressive states, and schizophrenia. He believed that mental illness is caused mainly by intrapsychic conflicts that are poorly managed by the mind or by abnormal mental processes and structures.

Indications and Procedures

In relation to medical science and, more specifically, to psychiatry, psychoanalysis is used to diagnose and treat emotional illness.

In diagnosis, psychoanalysts have purposes that differ considerably from those of general psychiatry. The analyst uses diagnosis to determine the patient’s potential for analysis, the usefulness of analysis in treating the particular emotional problem experienced by the patient, the patient’s level of incapacity, the likelihood that the patient will improve, and the likelihood that the analyst will be able to understand and help the patient. Other mental health specialists typically compare the signs and symptoms demonstrated or described by the patient to those cataloged in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (5th ed., 2013) and assign a diagnosis that best fits the patient. The psychoanalytic approach to diagnosis, conversely, is based on what the analyst can learn about the patient’s inner experiences, especially unconscious conflicts and fantasies.

Psychoanalysis is considered to be the treatment of choice for younger adults suffering from chronic emotional illness not helped by less intensive therapies. People who suffer from hysteria, obsessive-compulsive neuroses, sexual perversions, and certain personality disorders are seen as the best candidates for psychoanalysis. To be considered for psychoanalysis, patients must demonstrate an ability to develop a reasonably good relationship with an analyst and must be willing and able to withstand a long, intensive course of treatment. Psychoanalysis is also expensive, and patients must be able to pay for treatment. Some, but not all, third-party payers will bear part of the cost of psychoanalysis; unfortunately, third-party review of the case compromises analyst-patient confidentiality. Patients who are psychotic or who are alcoholics or drug addicts are considered poor candidates for psychoanalysis. Older adults may have personalities too rigid to tolerate analysis, and others have an illness too minor to justify such treatment. Patients who are chronically and deeply depressed may be unsuitable candidates for analysis, as are those who have failed to establish appropriate relationships with both parents. Patients must be deemed able not only to enter analysis but also to tolerate termination of therapy. Patients who need urgent intervention to preserve health and life are not good candidates for analysis; neither are those who have little opportunity to make changes in their lives. Because many factors enter into consideration, analysts give some patients a trial period of analysis before accepting them for treatment.

When a patient enters into psychoanalysis, the patient and analyst must resolve certain practical issues, such as setting up appointment times, payment schedules, and other policy matters. The patient must be willing to spend an hour a day, four or five days a week, for as long as five years to complete analysis.

The analyst and patient must be able to form a therapeutic relationship secure enough to withstand the test of time and the stress of treatment. Early on, the patient and analyst must endure as the patient anxiously defends the ego and resists plunging into deeper emotional material. Eventually, so-called transference
neurosis emerges. Patients re-experience and often project onto the analyst infantile desires and conflicts. The process of returning to more primitive emotional states is called regression, and analysts must be skillful in helping the patient to avoid its inherent dangers.

Free association is used to deepen the regression. The analyst instructs the patient to talk freely about issues of current concern and to continue talking about whatever associations come into the patient’s awareness, making no effort to censor or restrain the monologue. Despite a patient’s apparent willingness to follow the analyst’s direction, the patient’s resistance to uncovering certain material begins to be demonstrated with silences, pauses, stammers, corrections, slips of the tongue, and so on. The analyst remains alert to these signals of resistance, as the shape of the resistance shows the nature of the neurosis. The analyst gives interpretations of the resistance and related unconscious material; for progress to be made, the interpretation must be accurate, and the patient must accept and make use of it. The patient must work through painful emotional conflicts and find ways to resolve them more satisfactorily. “Working through” consumes much of the time spent in analysis.

The analyst often employs several psychological maneuvers to help patients during analysis. The analyst might offer suggestions, in an effort to induce a mental state that opposes the patient’s experiences, expectations, or concept of reality. For example, the analyst may assure the patient that working through repressed emotions will enable the patient to enjoy a more productive life. The analyst may manipulate the patient to facilitate recovery of or to neutralize early unconscious material. The analyst can help the patient by clarifying material that the patient may know only in a semiconscious, disorganized way. The term “countertransference” describes the variety of responses felt by the analyst toward the patient; the analyst must resolve such feelings satisfactorily in order to continue the analytic process.

Dreams are said to be the “royal road to the unconscious,” and the analyst will often encourage the patient to recall dreams experienced the preceding night. Dreams not only process waking experiences but often offer clues as to unconscious reactions, wishes, and conflicts as well. The analyst offers interpretations of the dreams in order to bring unconscious material and patterns to the conscious awareness of the patient.

The couch on which the patient reclines during sessions is a trademark of psychoanalysis; it is used rarely in any other form of psychotherapy. The analyst typically is positioned outside the visual range of the patient. This arrangement is considered to be essential in encouraging regression and projection.

As the patient and analyst struggle together to help the patient bring repressed material into awareness, the patient may achieve greater self-understanding and increased ability to find more satisfactory resolutions to emotional conflicts.

The analyst begins to prepare the patient for termination as the active phase of the analysis comes to a close. Patients must be weaned well from dependence on the analyst and the analytic situation. While the patient may have relived and worked through many primitive wishes and conflicts, the continuing work of resolving conflicts as they arise rests primarily with the patient’s ability to work through them independently.

The outcome of psychoanalysis can be difficult to evaluate, but success has been defined as having helped a patient improve adjustment to life, realize a certain amount of contentment, give happiness to others, deal more confidently with inevitable stresses, and maintain mutually satisfying relationships with others. In addition, the patient should experience a reduction in neurotic suffering and inhibitions, have fewer dependency needs, have increased potential for success in all significant areas of life, and function at a more mature level.

Perspective and Prospects

Psychoanalysis was born in the wake of evidence that hysteria can be caused by repressed memories or unconscious wishes. People who suffer from hysteria, now known as conversion disorder (functional neurological symptom disorder), develop physical symptoms such as paralysis or blindness in an otherwise healthy body. Sigmund Freud was influenced by the work of French neurologist Jean-Martin Charcot (1825–1893) and fellow Viennese physician Josef Breuer (1842–1925), both of whom were trying to find effective treatments for hysteria. Charcot relied on the use of hypnosis, while Breuer allowed patients to empty their minds, in an early version of free association. In 1895, Breuer and Freud published accounts of their theories and successful cures of patients suffering from hysteria. Freud also was influenced by the work of others on the hierarchy of the nervous system, philosophical concepts of the unconscious mind, posthypnotic suggestion, and the organization of the brain. He was a prolific author and teacher who fostered the careers of several followers.

Many of those who learned from and were influenced by Freud later developed their own variations or new areas of emphasis within Freudian psychoanalysis. Closer study of the role of the ego in emotional disorders led to the development of ego psychology, which enhanced the understanding of the defense, coping, and adaptive mechanisms of the ego. Others chose to emphasize the role of parents and other significant early childhood caregivers in the subsequent development of emotional health and illness. Still others developed what is known as self-psychology, a variant which emphasizes the importance of a person’s cohesive sense of self and emotional well-being; the sense of self is either fostered or hindered by interpersonal relationships formed throughout life. Other variants that draw on the psychoanalytical principle include psychodynamic, insight-oriented, relationship, and supportive psychotherapies. Marital, group, and family therapy also depend heavily on an understanding and application of psychoanalytical theory. Generally speaking, most psychotherapeutic interventions used today are grounded in the psychoanalytic precepts developed by Freud and refined by students of his work.

Classical psychoanalysis is still practiced in the United States, but its use is limited by the relatively few properly trained analysts, the time and expense involved in the treatment process, the lack of widely accepted proof of its superiority as a treatment method, and the demand for brief intervention by patients of psychotherapy and those who pay for it. Modern practitioners of psychoanalysis are concerned by several trends: the ascendence of biological approaches to understanding and treating mental illness, the unwillingness of insurers to pay for psychoanalysis, the growing number of nonphysician analysts, the growing skepticism about its effectiveness, and the establishment of a universal system of psychiatric diagnosis that largely ignores the psychoanalytic perspective.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, Va.: Author, 2013.

American Psychiatric Association Commission on Psychiatric Therapies. The Psychiatric Therapies. Washington, D.C.: Author, 1984.

American Psychoanalytic Association. "About Psychoanalysis." American Psychoanalytic Association, 2009–2013.

Clark, Ronald. Freud: the Man and the Cause. London: Paladin Grafton Books, 1987.

Gay, Peter. Freud: A Life for Our Time. London: Little, 2006.

Milton, Jane., Caroline Polmear, and Julia Fabricius. A Short Introduction to Psychoanalysis. Los Angeles: SAGE, 2011.

Mishne, Judith Marks. The Evolution and Application of Clinical Theory: Perspective from Four Psychologies. New York: Free Press, 1993.

Sadock, Benjamin J., and Virginia A. Sadock, eds. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.

Stern, Daniel N. Interpersonal World of the Infant: A View from Psychoanalysis and Development Psychology. London; New York: American Psychoanalytic Association, 2008.