Essay // Philosophy Review: “The World as Will and Idea”, by Arthur Schopenhauer (1818)

Schopenhauer et Nietzsche

Arthur Schopenhauer (1788 – 1860) & Friedrich Nietzsche (1844 – 1900)

Schopenhauer, a pessimistic philosopher, focused on the dark side of life and mental evils and cruelty, which he considered inevitable and that we as psychologists, intellectuals and masters of the mind view as mental disorders that have a negative effect on both the character of the affected and the human environment at large exposed to the vile side of human nature.

This negative view of man’s behaviour and role in life was a sharp contrast to the other more euphoric philosophers who marked the spirits of the generation before him, and who embraced a more idealistic and perhaps a slightly exaggerated euphoric side of man’s mind and character. Though Schopenhauer’s work originally gained little attention at the time it was published [perhaps being too avant-garde for the atavistic institutions of his time], he expressed an interpretation of the world that was dragging and opposed the great ideal of who went before him, such as Victor Schelling and Hegel on some very important points but did not deny expressions of art such as the romantic movement in its various forms.

Schopenhauer who never refrained from publicly criticising people and ideas he disliked was very vocal in his complete contempt for these men, and regarded himself as their great opponent in the ring of the leaders delivering the “Real truth” to mankind and civilisation. Schopenhauer’s work in many ways could be viewed as an extension of another famous German philosopher, namely Immanuel Kant, who preceded him by one generation, delivering his major philosophical work, “a critique of pure reason”. Schopenhauer worked out a system in which reality is known inwardly by a kind of feeling where intellect is only an instrument of the will: the biological will to live and where process rather than result is ultimate.

Schopenhauer’s pessimism lies in his very strong rejection of life. In fact, this rejection is so strong that he even had to address the question of suicide as a solution to life. He fortunately also rejected this “solution” to life, this rejection to life reflected influences with roots in Eastern philosophy, particularly Buddhism, and it is one of the most significant aspects of his work that he was the first Western philosopher to integrate Buddhist thought into Western philosophy. His preoccupation with the evil of the world and the tragedy of life was also somewhat reminiscent of ancient Hindu philosophies. His writings helped to stimulate in Germany an interest in Oriental thought and religion, which can also be seen in the work of many later German philosophers.

In “The World as Will and Idea”, Schopenhauer also considered the important question of the function of art. The value of arts to human life in far more depth than any of his predecessors, and even graded each of the arts, such as music, poetry, architecture [etc], from most important to least important. For that reason, his book had not only a profound effect on future philosophers, but also artists, particularly poets and composers, such as the enigmatic Wagner, who felt indebted to him and sent him a letter of gratitude when he was first introduced to Schopenhauer’s work.

Tristan und Isolde (John Duncan 1912 Symbolism)

Image: Tristan and Isolde (1912) by John Duncan

It is believed that Wagner’s popular opera “Tristan und Isolde” in particular, shows Schopenhauer’s influence as a philosopher who believed that music was the highest form of art, an idea that of course, Wagner found pleasing and so the composer began to think of himself as a prime example of Schopenhauer concept of a genius. People in other fields of the arts were also influenced by Schopenhauer, including the novelist Thomas Mann. Schopenhauer’s ideas had the unique ability to influence not only philosophy but many other fields of human endeavour and expression. Within philosophy itself, Schopenhauer never founded a school of thought “per se”, but his influence instead was in stimulating other philosophers towards a particular line of thought, which varied with the individual and his or her response to Schopenhauer’s writing. His writing had a major impact on the German philosopher Nietzsche, who was also a friend of Schopenhauer’s admirer, Richard Wagner. Nietzsche shared the idea that life is tragic and terrible but can sometimes be transformed through art. Nietzsche was also the man famous,for his concept of the Ubermensch “Superman”, which later helped to inspire the German National Socialist movement and eventually the founding pillars of the Third Reich of Adolf Hitler.

The Apollo Belvedere (Ancient Sculpture) - Vatican Museum - Roma

Image: Apollo Belvedere (Sculpture Ancienne), Musée du Vatican, Rome

So, these three names Schopenhauer, Wagner and Nietzsche are often linked and are also associated at times, through no fault of the men themselves with a dark period of human history.

“The world is Will and Idea” begins with the famous line, “The world is my idea” when Schopenhauer says the world is his idea, he is referring to the relationship between an “object” and “the subject” [i.e. The person who sees or senses the object]. As an example, he did not mean that an apple is identical with your abstract concept of an Apple, he means that the apple as perceived by you exist only in relation to you as a person or “the subject” who perceives it. Its reality is only in what you perceive, it is what you perceive it to be so.

So, the world is my idea means that a whole visible world and its sum of total experience is “object” for a “subject”, its reality consists in appearing to be perceived by a subject. This theory of the world of idea was taken and developed from Kant’s philosophy, but the second part of Schopenhauer’s philosophy “The World as Will” is completely his own and expresses his very unique interpretation of human life. Briefly, this interpretation says that the will, « the will to survive and live » is the strongest force in man and everything else is subordinate to it. His conception of the supreme wisdom of life is one of resignation to the power this “will” has and the tragic results of it.

Arthur Schopenhauer was born on February 22nd of 1788 in Danzig, Germany. His father was a wealthy merchant and banker who hoped his son would follow in his steps. He was also an independent minded man who moved his family from the city of Danzig when it was taken over by Prussia in 1793. The new family home was in Hamburg. Schopenhauer left to visit England and other countries, on the understanding that when he completed his tour, he would begin work in a business. Schopenhauer, then 16 years old, kept his promise but he had no attraction to business and when his father died, he got consent from his mother to continue his studies. In 1809, he entered the University of Göttingen to study medicine, but he changed to philosophy in his second year, as he put it “life is a problem and he decided to spend his life contemplating it”. He also studied at Weimar where he lived with his mother until he became estranged from her.

Schopenhauer had a moody, irritable temperament and could be violent in his passion. At the university, Schopenhauer developed an affection for Plato and visited Berlin to hear the lectures of contemporary philosophers Johann Gottlieb Fichte (1762 – 1814) and Friedrich Schleiermacher (1768 – 1834). Fichte was the first transcendentalist idealist and Schleiermacher was a founder of modern Protestant theology. Schopenhauer found Fichte’s comment, “No one could be a true philosopher without being religious” absurd and retorted that no man who was religious turns to philosophy since they have no need for it [a questionable statement when religion (e.g. Christianity) does not cover all the aspects of the experience of life in detail, or study God’s works methodically through the lens of science and rationality, to understand the further implications in the betterment of the human world].

Rodin - Hands (Musee Rodin, Paris)

Image: « Les Mains » par Auguste Rodin

Schopenhauer left Berlin when Prussia rebelled against Napoleon. He never developed strong German patriotic values and sentiments [perhaps never given a chance or a reason or support to do so at the time], and always regarded himself more as a cosmopolitan without any strong national affiliation. He went into retirement to write his first dissertation called “On the fourfold route of the principle of sufficient reason”, which was published in 1813 and earned him a doctorate at Vienna. The poet Goethe congratulated Schopenhauer, and in return he wrote an essay called « On Vision and Colours » which supported Goethe in his stand against Isaac Newton. But the dissertation, although it won the admiration of Goethe, went practically unnoticed. The author however always considered it the groundwork and essential introduction to his philosophy. Shortly after he published his dissertation, Schopenhauer met an Oriental scholar, Friedrich Majer (1771 – 1818), who introduced him to Indian philosophy and literature. He maintained an interest in Indian philosophy throughout his life, and as an old man, he meditated on the Upanishad, part of the Vedas [the sacred script of the Hindus]. He would later associate his theory of the world of ideas with the Indian doctrine of Maya [to the Indians, Maya is illusion or the world as an illusion]. To Schopenhauer, this meant that the individual subject and object he wrote were “Maya”, all at the end.

For 4 years between 1814 and 1818, Schopenhauer lived in Dresden, which is where he wrote his masterpiece “The World as Will and Idea”. He sent the manuscript to his publishers and left for an art tour of Italy. The book was published the following year in 1819, and although it received attention from some philosophers, it sold very few copies. This was a disappointment to the author who felt sure it contains the secret of the universe.

This failure did not kill his eagerness however, so he returned to Berlin and started lecturing. By now he was 32 years old. He deliberately scheduled his lectures for the hour at which the philosopher Hegel was also accustomed to lecture – planning to compete with the master. But his lecturing career was a failure and Schopenhauer gave it up after only one semester. His ideas seemed at odds with the dominant spirit of the time.

Dolly_the_Sheep

Schopenhauer roamed around a bit and then settled in Frankfurt in 1833, he read European literature and scientific books and journals looking for illustrations or confirmations of his theories. He frequented the theatre and also continued writing, publishing on the Will of nature and winning a Norwegian prize for an essay on freedom. He failed to win a similar prize from the Royal Danish Academy of the Sciences for a separate essay on ethics. The Academy disapproved of his disparaging remarks about other philosophers. These two essays were later published together in 1841, under the title “The two fundamental problems of Ethics”.

In 1844, Schopenhauer published a second edition of “The world as Will and Idea”, which contained 50 new chapters. In the Preface, he took the opportunity to make a strong statement of his views about university professors of philosophy, which were of course not admiring. In 1848 there was an unsuccessful revolution in Germany. A revolution from which Schopenhauer had no sympathy whatsoever. But after the failure of this revolt, people were more willing to consider a philosophy which emphasised the evil in the world in which preached the rejection of life for the route of contemplation. Schopenhauer’s popularity was on the rise. In 1851, he published a collection of essays that dealt with a wide variety of topics, and finally in 1859, he published third edition of the “World as Will and Idea” with more supplements. In the last decade of his life, the author finally became a famous man, all kinds of visitors with all kinds of philosophies came to see him and to enjoy his brilliant conversations. Lectures were given on his system at the University, the very university he has attacked, a sure indication that he had finally achieved success. Schopenhauer has spent a long, lonely life of reflection and only after his works were ignored for many years that he attained fame and reputation. He died in September 1860, at the age of 72.

Schopenhauer by Mitch Francis

Image: Arthur Schopenhauer (1788 – 1860) by Mitch Francis

As a man, Schopenhauer was cultured, broadly educated, eloquent and articulate, witty and conversational, and a very talented writer, but he was also opinionated, egotistical, and often quarrelsome. His remarks about other philosophers were assaulted and his remarks about women in general were so scathing that they had to be deleted from his book by his editor. He was obsessed with the suffering of humanity, but did nothing to alleviate it. He himself made the comment that it is no more necessary for a philosopher to be a saint than it is for a saint to be a philosopher, and he never tried to prove otherwise. But, in the final analysis he was exactly the man he needed to be to write what he wrote. His pessimistic and grim interpretation of life are not very likely to have come from a man of infallible kindness or tolerance, and that interpretation of life played a significant role in the development of human thought and philosophy by inspiring both similar and opposing viewpoints which forced humanity to re-examine itself yet again.

 

Now is a summary of the text of “The World as Will and Idea

The world is my idea. This truth applies to everything that lives and knows, but only man can reflect on it and bring his abstract consciousness to it. It becomes clear to him when he looks at the sun that what he knows is not a sun, but an eye that sees the sun, not a nurse but a hand that feels the earth. This truth is by no means new, it was a fundamental text of the Vedanta philosophy of the Hindus, it was also part of the reflections of the French philosopher René Descartes and finally it was also clarified by the philosopher George Berkeley – although neglected by Kant. But this view of the world as idea is one-sided and must be balanced by another one which is the impressive and awful truth that the world is my “Will”. The world has necessary hands, the subject and object. The object and the subject that perceives it operate together. If one were to disappear, then the whole world would cease to exist. All objects have universal forms and either space, time and causality or the relation of cause and effect as Kant has demonstrated, they may be discovered and known apart from the objects in which they appear, as an expression of reason or the principle of sufficient reason. But what if our whole life is but a dream, or how do we distinguish between dream and reality? Kant tried to answer this question by stating that the connection of ideas, according to the law of causality, constitute the difference between them. But the long life dream in distinction from our short dreams has always had complete connection, according to the principle of sufficient reason. We are such stuff as dreams are made on and our little life is rounded with a sleep.

Life and dreams are leaves of the same book, the book we read through and the one whose leaves we turn idly to read a page here and there. Any system of philosophy that starts with the object has to deal with the whole world of perception, the most consistent form of these philosophies is simple materialism. It regards time and space and matter as existing absolutely. It ignores the relationship to the subject in whom these ideas exist, then it takes a law of causality as its guiding principle: causality exists by understanding alone. Materialism seeks the most simple states of matter and then tries to develop all other states from it. It ascends from mere mechanism and chemistry: the chemical properties and attractions of objects. It ascends to vegetable and animal life, to sensibility and thought. But, the thoughts and knowledge reached through materialism in a long, laborious process, assumed from its starting point that there was a subject or perceived matter: eyes that side, hands that felt it and understanding that knew it.

This system of philosophy which opposes this materialism is idealism, which instead starts with the subject and then tries to derive or reach the object from the subject, but it overlooked the fact that there can be no subject without an object, like materialism this idealism begins by assuming what it is supposed to prove later. The method of Schopenhauer’s system is different from both of these, for it starts from neither object nor subject, it starts from the idea. The idea is the first form of consciousness and its essential form is the antithesis or opposite of subject and object. For each one of us it is our own body that is the starting point in our perception of the world and we consider it like all other real object simply as an idea, the understanding which develops ideas could never come into being if there were no simple bodily sensations from which to start. If the thinker were no more than a pure knowing subject without a body like a winged cherub that is all spirit, he would not be able to know the nature of the world. He would be like a man going around a castle getting to its façade and trying in vain to enter it, all reality would be a riddle, but because the subject of knowledge is also an individual with a body and a bodily nature, the world becomes revealed, it is revealed in the will. Every true act of the will is a movement of the body for the action of the body is nothing but will express through an object. The body is the object, my body and my will are one. The double knowledge which each one has of his body out of idea and inner will becomes the key to the nature of the world. Phenomenal existence, the existence we perceive with our senses, is an idea and nothing more. Real existence or the thing in itself is will.

die welt als wille und vorstellung

Will is a term that applies to both the highest and lowest in man’s nature, it is that which drives us to pursue the light of knowledge and it’s also that which in nature strives blindly and dumbly to survive. Both come under the common name of will, just as the first dim light of dawn in the rays of the full midday are both called sunlight. If we consider the impulse with which waters hurries to the ocean, or the way in which a magnet turns to the North Pole, or the eagerness with which electric poles seek to be united or the way a Crystal takes form, we can recognise our own nature, for the name will describes the inner nature of everything that is in the world. The world as will is one, it knows nothing of the multiplicity of things in the outer world: the world of perception, the world of time and space. Notions like more or less, don’t exist to it, it knows nothing of quantities or qualities. For this reason, it cannot be said that there is a small part of the will in a stone or a large part of the will in a man. Relations like this between part and whole belong to the idea of space which does not apply to the will. In reality, the will is present in its entirety and undivided in every object of nature and in every living thing. Yet in terms of its objectification, that is, its external expression, it has different grades in inorganic matter, in vegetation, in animals and in man. The lowest of these appear in the most universal forces of nature, in the form of gravity, rigidity, elasticity, electricity and the like, which are in themselves manifestations of the will, just as much as human actions are. The higher grades are seen in man where the will takes the form of individuality and consciousness. It is here that the will shows its second side. For in the human brain lies the potential of comprehending the will, so that as it is kindled by a spark it brings the whole world as idea into existence. In this manner, knowledge proceeds from the will, knowledge that is either from the senses or is rational and is destined to serve the will in its aim of expressing itself. In all beasts and in most men, knowledge remains in subjugation to the will, yet in certain individual men, knowledge can free itself from this bondage so the subject of knowledge exists for itself as a pure mirror of the world. As a rule, knowledge remains subordinate to the will and grows on the will [so to speak] as a head on the body. In the case of the beast, the head is directed towards the Earth where the objects of its will are. But in the case of man, the head is elevated and set freely upon the body as in the Apollo Belvedere where the head of the guard stands so freely on his shoulders that it seems delivered of the body and no longer subject to it.

The transition from the individual’s knowledge of particular things to the knowledge of the idea takes place suddenly. It happens when the knowledge of the will changes someone into a pure will-less subject of knowledge, contemplating things as they are in themselves. If raised by the power of the mind, a man leaves the common way of looking at things behind and forgets both his individuality and his will, then he becomes a pure “without will” timeless and painless subject of knowledge – this appears in the genius. For when Genius appears in a man a far larger amount of the power of knowledge comes to him than is necessary for the service of his will. This extra knowledge is free and purified from will: a clear mirror of the inner nature of the world. All willing arises from want. The satisfaction of a desire ends it, but for one wish that is satisfied, there remain 10 which are denied. No attained object of desire can give lasting satisfaction, for it is likely alms thrown to a beggar that keep him alive today that misery may be prolonged tomorrow.

Attending to the demands of the will, continually occupies and influences our consciousness. But when we are lifted out of the endless stream of willing, we can comprehend things free from their relation to our will without any personal interest or subjective opinions, and then the peace we have been seeking comes of our own accord. For we are, at least for the moment, set free from the miserable striving of the will – the wheel stands still. There is no more slavery to the will. It is the function of the fine arts to express this freedom from will or the different grades along the way. Matter as such cannot be an expression of the idea but when it is express through an art like architecture, its characteristics of gravity, cohesion and hardness, the universal qualities of stone appear as a direct but low grade of the objectified or expressed will. In the building nature reveals itself a conflict between the gravity of the building and the rigidity of the structure of the support, as in the simplest form of a column. The problem of architecture, apart from practical utility, is to make this conflict appear in a distinct way so that the building material instead of a mere heap of matter bound to the earth is raised above it, so that the roof example is realised only by the means of the columns or arches which support it. The pleasure that comes from looking at a beautiful building lies in the fact that the viewer is set free from the knowledge which serves the will and is raised to the kind of knowledge which comes from contemplation that has no will.

Woman and Man Roman Sculpture

The highest grade of the expression of the will is found in anything that reflects human beauty in a way which reveals the idea of man. No object transports us so quickly into will-less contemplation as the most beautiful human form. We know human beauty when we see it, but true artists can express it so clearly that it surpasses even what we have seen. In the genius of a sculptor, we find a representation of what nature intended to express, so that if you were to present his statue to nature, he would say “This is what you wanted to say!”

danaide-le-baiser-par-auguste-rodin

Image: « Danaide » & « Le Baiser » par Auguste Rodin

Painting as an art has character as well as beauty and grace for its object, for it attempts to represent the will of the highest grade in the idea of humanity. This, however, can be an abstract form of the concept known as the picture attempt [as it does at times an allegorical painting] to represent something other than what is perceived. In poetry the relationship is reversed, for here what is given directly in words is the concept that leads readers away to the object of perception, this is done through metaphors, similes, parables, allegories and the like. The aim of all poetry is the representation of man. When it is a representation of the poet himself, we have the lyric. The lyric poet reveals himself in joy or more often grief as the subject of his own will, but along with this as the sight of nature impresses him, there is the awareness of himself as the subject of pure will-less knowing, and his joy now appears as a contrast to the stress of desire: desire imposed on him by his will. Epic poetry portrays man in a more historical context in connection with significant situations in human life. Drama in the form of tragedy is not only the best of poetic art, but the most significant in terms of this system of philosophy because it is the strife of the will represented at its highest grade of objectivity, it becomes visible in human suffering that is brought about by fate or error or wickedness, in which the will lives on while people fight against and destroy one another. The tragic effect in poetry may be produced by means of a character of extraordinary evil such as Iago in Othello or Creon in Antigone or by blind fate is in the Oedipus Rex of Sophocles or by circumstance and the situation in which the character finds himself such as Hamlet. In the tragic character we can observe how the noblest of men – after a long personal conflict and inward suffering – come at last to renounce the pleasures of life and the particular goals once so keenly fought for, instead the character joyfully surrenders to life itself. It is in this sense that Hamlet renounces life for himself but askes Horatio to remain a while and to – in this harsh world – draw his breath in pain to tell Hamlet’s story and clear his name.

Shakespeare's Hamlet Tragedy

Beginning with architecture in which gravity and rigidity reveal the lowest grade of the conflict of the will with itself and ending with tragedy where this conflict reaches its highest grade, we have considered the arts and how they represent the will and the idea, but music stands quite alone, cut off from all the other arts, since it’s not a mere copy of any idea of existence in the world. Music is as direct an expression of the whole will as the world itself is. Nature and music are two different expressions of the same thing, and so music speaks a universal language. In the deepest tones of harmony in the bass we recognise the lowest grades of the will, for bass is in harmony with the crudest matter on which all things rest and from which they originate. The higher complimental parts of music are parallel with animal life and in the melody of high voice singing we recognise the high grade of the will in the effort and intellectual life of man. The pleasure we received from beauty, the consolation we get from art and the enthusiasm of the artist, rest on the fact that whereas existence in the world is something sorrowful and terrible, the contemplation of the world as idea is both soothing and significant. But in the case of the artist, the contemplation of beauty doesn’t quiet the will and it doesn’t provide a pathway out of life as does the resignation of the saint. The deliverance from the will only occurs when – tired of the game – one renounces life and gets a grasp on what is real. When the will – this blind and incessant impulse of nature – becomes conscious in man, it is recognised as the will to live. Man may affirm or deny it. He affirms the will to live when – having seen it as that which has produced nature and his own life – he then adds his own desires to it. The denial of the will to live occurs when the awareness or consciousness of it means the end of desire. The phenomena of the world – that what we see and perceive – no longer motivates the will, for the comprehension of the world as idea has freed the will and allowed it to be silent. It the essential nature of the will – nowhere free and everywhere powerful – to strive endlessly towards satisfaction that it is incapable of getting. Just as in nature, gravitation is the ceaseless striving towards a mathematical centre and this striving will not stop even if the whole universe were rolled into a single ball. In the same way the solid will become a fluid, the fluid will become a gas, and the plant – restless and unsatisfied – will strive through ascending forms until it goes to seed where it finds a new starting point.

All nature is a struggle in which war is waged that is deadly to both sides. All striving is in vain, and yet it cannot be abandoned and all this is identical to what appears in us. In us, the blind striving of nature becomes the will to live, but it is self-conscious will: we are aware of it! The fate of this will is in keeping with its striving nature in the face of constant obstacles and hindrances, and anyone who will consider the character and destiny of the will to live, will be convinced that suffering is essential to all life.

Ad Augusta Per Angusta

Translation (EN): « Has grandiose results by narrow lanes » / Source: Le Petit Larousse 2018 / Les locutions étrangères gravées dans nos mémoires ont la magie des formules oubliées dont le charme va croissant lorsque l’alchimie des mots nous est plus mystérieuses. Elles ont l’autorité de la chose écrite. / Mot de passe des conjurés au quatrième acte d’Hernani, de Victor Hugo. On n’arrive au triomphe qu’en surmontant maintes épreuves.

From where then did Dante take the materials for his hell? From the world! And when it came to describing the delights of heaven he had an insurmountable task, for the world could offer him no proper material. The fatal assertion of the will to live has produced man’s body and the desire to preserve and perpetuate it. So the assertion of the will is really the assertion of the body. In such assertion, we find the source of all egoism and all wrongdoing, but such selfhood is really an illusion due to a false philosophy in which the individual imagines he lives to himself alone. He is really only a product of the one will to live. Just as a sailor sitting in a boat trusting to his frail barque in a stormy sea, so it is that in the world of sorrows man sits quietly, trusting to the principle of individualisation and separateness, in which he only knows things superficially or as they appear to him, but when he comes to understand that the one will to live exists in all men alike, he realises that the difference between those that inflict suffering and those that bare it is only a perceived difference that is not real. In truth, the evil man is like a wild beast, who frenzied and excited, unintentionally buries its teeth in its own flesh, injuring itself as it tries to injure another. But no matter how veiled and evil man is by illusion, he still feels the sting of conscience, which creates a sense that the gulf which seems to separate him from others isn’t real. As all hatred and wickedness rely upon egoism and as egoism rest on the assertion of the will to live, so do all goodness and virtue spring from the denial of the will to live. The will turns around and no longer asserts itself but denies its own nature instead. Man then denies his own nature as expressed in his body and no longer desires sensual gratification under any condition. Voluntary and complete chastity is the first step in the denial of the will to live. But then the human race would die out, and with it the mind in which the world is reflected, and without a subject of knowledge, there would be no object, there would be no world. To those in whom the will to live has turned and denied itself, this world of ours with all its sun and milky ways is nothing [dead inside].

 

These are some of the ideas and the basic themes presented in Schopenhauer’s “The world as Will and Idea”, a very lengthy work that of course includes many other ideas and elaborations of the ones we have mentioned. But the essence of Schopenhauer’s philosophy can be found in a few basic point.

 

To begin with, he sees the will of man, and specifically the will to survive as the dominant force in the universe and slavery to this will is the root of all evil. Man and all other creatures are subservient to their will to live. In exercising his will, man inflicts all kinds of cruelties and evil. Schopenhauer first examined these cruelties in the world of nature, spending a lot of time on the way in which animals of one species prey on those of another. Then he moved onto man and says, “the chief source of the most serious evils which afflict man is man himself”. Whoever keeps this last fact clearly in view sees the world as a hell which surpasses that of Dante, through the fact that one man must be the devil of another. Schopenhauer uses war and various other cruelties such as industrial exploitation, bravery and social abuses to back up his claim. Schopenhauer had no sympathy for the revolution of his time because he felt the state was justified, exactly because of the cruelty of man. It existed to make the world a little more bearable than it would otherwise be. He did not consider the state government divine, but he considered it necessary [a view he may have been willing to revise had he been alive in 2018 with democracy falling apart and not being properly applied, leading to evil, unethical, unscrupulous and unskilled street politicians getting into positions above their understanding].

Schopenhauer believed we can do something to alleviate suffering but it is pointless to think that we can change the fundamental character of the world or of human life. If war was abolished for instance and if all of men’s material needs were met, they would eventually still resort to conflict – “it is their nature”. He is quick to condemn the optimism or idealism of other philosophers who disregard the dark side of human existence, or who try to justify it as rational. To Schopenhauer these dark aspects of life were not secondary feature, they were the most significant aspects of human life in history. On this basis, he created his theory of The Blind and Striving Impulse, he called the Will. Then, he looked around and found support for his theory in the inorganic, organic and human phenomena of life.

Unquestionably, Schopenhauer held a one-sided vision of the world, but because of its one-sidedness and exaggeration it served as a counterbalance to philosophers like Hagel who focused attention on the glorious triumph of reason throughout history and he tended to dismiss evil and suffering with elaborate, evasive, phrasing. Schopenhauer did offer 2 ways of escape from the slavery to the will. One was the path of contemplation, which is the way of art and the other was the path of asceticism, of renouncing the world in one’s personal desires or will. He did believe that the human mind could develop beyond what was required just to satisfy his physical and material needs, it could develop a surplus of energy over and above what was needed to fulfil its biological function. When that happened, man can use the extra energy to escape the life of desire and striving, of assertion of the ego, of conflict, none of which brings him satisfaction anyway. In transcending the Will through art [expressing it with insight], Schopenhauer was very specific about which art forms served what purpose, and in defining which were superior to others. Not surprisingly, the the supreme poetic art is tragedy, for tragedy reveals the real character of human life expressed in dramatic form or as he said the unspeakable pain: the wail of humanity, the triumph of evil, the mocking mastery of chance and the irretrievable fall of the just and innocent. But art and contemplation, besides reflecting on the evil of life, can also open a door that becomes perhaps the only hopeful point in Schopenhauer’s entire book. This door is opened when man can see through the veil of Maya. Maya, being the Hindu concept for the illusionary nature of the world and life. It is Maya that causes to see separateness and division where there is none, but Schopenhauer also believed that man had the intellectual capacity to develop gradually a site that penetrated Maya, and raised some questions that made even a glimmer of hope seem a little bright. What is the purpose of achieving such virtue? What happens afterward?

To start with, the man who denies the Will treats the world as nothing, for the world is just the appearance of the will, which he denied. So it is true that when the will denies itself, our world with all its sun and Milky ways is nothing as Schopenhauer said, then what happens at death? Schopenhauer is convinced of the finality of death. “Before us”, he says “there is indeed only nothingness”. Death or the withdrawal from the world means the extinction of consciousness, In life, he reduces existence to thin thread, and at death, it is finally destroyed. The man who denies his will to live reaches the final goal, which is to not live. Schopenhauer does leave one last hope beyond the grim disappearance of consciousness and of the world, admitting that it is possible that ultimate reality, which he called the thing in itself may possess attributes that we do not know about and that we cannot know. This reality would not be a state of knowledge since there would not be a subject and an object, that phenomenal and illusionary relationship that is required for knowledge, but it might resemble some experience that cannot be communicated and to which mystics refer to, but only in obscure vague ways. So, in the end like all great philosophers must, Arthur Schopenhauer admitted that he did not have all the answers but he thought he had some, and ultimately it is the questions his answers posed to others that became his most significant contribution, for the role of the philosopher and of philosophy itself is not only to solve our problems, but also to express points of views that stimulate us to further thought and consideration on human nature and the meaning of life, in that, he was incredibly successful.

Schopenhauer sur Le Style

« Style is the physiognomy of the mind. It is a more reliable key to character than the physiognomy of the body. » – Arthur Schopenhauer

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24.08.2018 | Danny J. D’Purb | DPURB.com

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Essay // Developmental Psychology: The 3 Major Theories of Childhood Development

TheoriesOfDevelopment

Source: An Introduction to Developmental Psychology by Slater & Bremner (Blackwell:Oxford, 2nd Edn, 2011)

THE 3 MAJOR THEORIES OF DEVELOPMENT

In 1984, Nicholas Humphrey described us as “nature’s psychologists’” or homo psychologicus. What he meant was that as intelligent social beings, we tend to use our knowledge of our own thoughts and feelings – “introspection” – as a guide for understanding how others are likely to think, feel and hence, behave. He also argued that we are conscious [i.e. we have self-awareness] precisely because such an attribute is useful in the process of understanding others and having a successful social existence – consciousness is a biological adaptation that enables us to perform introspective psychology. Today, we are confident in the knowledge that the process of understanding others’ thoughts, feelings and behaviour is an ability that develops through childhood and most likely throughout our lives; and according to the greatest child psychologist of all time, Jean Piaget, a crucial phase of this process occurs in middle childhood.

Developmental psychology can be characterised as the field that attempts to understand and explain the changes that happen over time in the thought, behaviour, reasoning and functioning of a person due to biological, individual and environmental influences. Developmental psychologists study children’s development, and the development of human behaviour across the organism’s lifetime from a variety of different perspectives. Hence, if we are studying different areas of development, different theoretical perspectives will be fundamental and may influence the ways psychologists and scholars think about and study development.

Through the systematic collection of knowledge and experiments, we can develop a greater understanding and awareness of ourselves than would otherwise be possible.

 

Focussing on changes with time

The new born infant is a helpless creature, with communications skills that are limited along with few abilities. By 18 – 24 months, the end of the period of infancy – this scenario changes. The child has now formed relationships with others, has gained knowledge about the aspects of the physical world, and is about to undergo a vocabulary explosion as language development leaps ahead. At the time of adolescence, the child has turned into a mature, thinking individual actively striving to come to terms with a fast changing and complex society.

The important contribution to development, is maturation and the changes resulting from experience that intervene between the different ages and stages of childhood: the term maturation refers to those aspects of development that are primarily under genetic control, and which are relatively uninfluenced by the environment. An example would be puberty, and although its onset can be affected by environmental factors such as diet, the changes that occur are genetically determined.

 

Development Observed

The biologist, Charles Darwin, notable for his theory of evolution, made one of the earliest contributions to our understanding of child psychology in his article “A biographical sketch of an infant” (1877), which was based on observations of his own son’s development. By the early 20th century, most of our understanding of psychological development was not based on scientific methodology as much was still based on anecdotes and opinions of qualitative analysis, a method that strict empiricists have never managed to grasp or like. Nevertheless, knowledge was still being organised through both observation and experiment and during the 1920s and 1930s the study of child development started to grow as a movement, particularly in the USA with the founding of Institutes of Child Study or Child Welfare in university centres such as Iowa and Minnesota. Minute observations were made of young children in their developmental phase along with normal and abnormal behaviour and adjustment. In the 1920s Jean Piaget [refer to essay] started his long and passionate career in child psychology, blending observation and experiment in his studies of children’s thinking.

The observations carried out in naturalistic settings was soon criticised by the empiricists of the behavioural movement in the 1940s and 1950s [although it continued to be the method of choice in the study of animal behaviour by zoologists]. This led to many psychologist carrying their experiments under laboratory conditions with statistical methods, and such experiments although come with some advantages from the perspective of empirical statistics, they do have limitations and drawbacks [e.g. on measuring qualitative aspects of personality such as emotions, values, etc]. It should be noted that much of the laboratory work on child development from the 1950s and 1960s has been described by Urie Bronfenbrenner (1979) as “the science of the behaviour of children in strange situations with strange adults”.

Schaffer (1996, pp. xiv – xvii) notes other changes in the methods in which psychologists now approach child development, such as the importance in understanding the processes of how children grow and develop rather than simply outcomes, and to integrate findings from a range of sources at different levels of analysis – for example meaningful others, community [geography, socio-linguistics, arts, etc] and culture [religion, nationality(ies), education, class, etc).

In the course of this essay, we will be integrating perspectives to make the most of the findings in distinguishing differences in personality, by reflecting on the links to be made by psychologists between the concept of the child’s “internal working model of relationships” and discoveries about the “theory of mind”.

It is fundamental to acknowledge that psychology itself is mostly based on accurate approximations due to the statistical methods used and the problematic nature of the qualitative variables measured, and not precision. And with this in mind, we should accept the complementary virtues of various different methods of investigation and gain a sense that the child’s process of development and the socio-behavioural context in which they exist are closely intertwined, each having an influence on the other.

 

Defining development according to world views

Intellectuals and researchers who study development also have different views on the topic, that is, the way in which development is defined, and the areas of development that are of interest to individual researchers generally orients them towards specific methodologies and philosophy when studying development.

We are now going to look at the 2 main views in the study of development given by psychologists who hold different views or sometimes combine elements of both, like ourselves, being firmly on the organic perspective of development and construction.

A world view [also known as paradigm, model, or world hypothesis] can be characterised as “a philosophical system of thinking, perceiving and feeling [ideas and more] that serves to organise a set or family of scientific theories and associated scientific methods” (1986, p. 42).

They are beliefs we adopt because it aligns with our values, and these are qualitative and often not open to common reductive empirical tests – that is precisely why we believe them!

Lerner and others note that many developmental theories appear to fall under one or two world views: organismic and mechanistic.

 

Organismic World View

The organismic world view which is the main view that we adopted to be the foundation of the Organic Theory, is one that sees a human being on earth as a biological organism that is inherently active and continually interacting with the environment [all aspects and dimensions], and therefore helping to shape its own development. The organismic worldview emphasises the interaction between maturation and experience that leads to the development of new internal, psychological structures for processing environmental input (e.g. Getsdottir & Lerner, 2008).

As Lerner states: “The Organismic model stresses the integrated structural features of the organism. If the parts making up the whole become reorganised as a consequence of the organism’s active construction of its own functioning, the structure of the organism may take on a new meaning; thus qualitatively distinct principles may be involved in human functioning at different points in life. These distinct, or new, levels of organisation are termed stages…” (p.57). A good analogy would be qualitative changes that take place when the molecules of two gasses hydrogen and oxygen, combine to form a liquid, water. Many other qualitative changes happen to water when it changes from frozen (ice) to liquid (water) to steam (vapour). Depending on the temperature, these qualitative changes in the state of water are easily reversed, BUT in human development the qualitative changes that take place are very rarely, if ever, reversible – that is, each new stage represents an advance on the previous stage, and the organism [human being] does not regress to former stages.

Irreversible

The main argument is that the new stage is not simply reducible to components of the previous stage; it represents new characteristics that were not present in the previous stage.

For example, the organism appears to pass through structural changes during foetal development [See Picture A].

PA Development of the human foetal brain_A

PICTURE A. Development of the human foetal brain / Source: Adapted from J.H.Martin (2003), Neuroanatomy Text and Atlas (3rd ed., p.51). Stamford, CT:Appleton & Lange.

In the initial stage [Period of the Ovum – first few weeks after conception] cells multiply and form clusters; in the second stage [Period of the Embryo – 2 – 8 weeks] the major body parts are formed by cell multiplication, specialisation and migration as well as cell death; in the last stage [Period of the Foetus} the body parts mature and begin to operate as an integrated system [e.g. head orientation towards and away from stimulation, arm extensions and grasping, thumb sucking, startles to loud noises, and so on (Fifer, 2010; Hepper, 2007)]. It is important to understand that similar stages of psychological development are postulated to happen after birth also, and the individual from one stage to another is different with new abilities that cannot be reversed.

Jean Piaget is perhaps the greatest and best example of a successful organismic theorist. Piaget suggested that cognitive development occurs in stages and that the reasoning of the child at one stage is qualitatively different from that of the earlier or later stages. The main job of the developmental psychologist who believes in the organismic worldview [like ourselves] is to determine when [i.e., at what age?] different psychological stages operate and what variables and processes represent the different between stages and determine the transition between them.

 

Mechanistic World View

From the mechanistic world view, it is assumed that a person can broken down into components and can be represented as being like a machine [such as a computer], which is inherently passive until stimulated by the environment [this view seems to be more in line with the early British thinkers about the brain]. Human behaviour is reducible to the operation of fundamental behavioural units [e.g. habits] that are acquired in a progressive, cumulative manner. The mechanistic view assumes that the frequency of behaviours can increase with age due to various learning processes and they can decrease with age when they no longer have any functional consequence, or lead to negative consequences [such as punishment]. The developmental psychologists job here is to study environmental factors, or principles of learning, which determine the way organisms respond to stimulation, and which results in increases, decreases, and changes in behaviour.

Quite unlike the organismic world view, the mechanistic world view sees development as reflected by a more continuous growth function, rather than occurring in qualitatively different stages, and the child is believed to be passive rather than active in shaping its own development and its environment. This mechanistic view is generally embraced by behaviourists and cognitive-behaviourists who function on a reductionist philosophy based on the limitations of the scientific method when faced with understanding psychology and the mechanism of mind; instead they tend to focus on measurable behaviour and treat the brain as an information processing centre with a highly similar logic to a computer. The mechanistic view while being fairly grotesque due to its reductionist values, has revealed to be very practical in the study of human-machine interaction and along with new cognitive methods, it has helped to enhance the design of technological equipment to improve human experience in a wide range of areas.

As for us, we are mostly on the perspective of the organismic school of thought but refuse to completely dismiss all the mechanistic world view’s elements, because some of it can be embedded as secondary cognitive processes carried out by the conscious or preconscious areas of the mind when appraising stimuli from an organism’s environment. Hence, some elements can be embedded in understanding interaction with basic objects and elements of an organism’s “external” [not internal] environment, but to fully base our thoughts and behaviour on a mechanistic world view would arguably be irrationally reductionist.

 

Theories of Development

 

“Es gibt nichts Praktischeres al seine gute Theorie.”

–Emmanuel Kant (1724 – 1804)

 

“There is nothing so practical as a good theory.”

-Kurt Lewin (1944, p. 195)

 

Human development is complex and it would be irrational to expect a single universal theory of development that could do justice to this complexity, and indeed no theory of development attempts to do so. Each theory attempts to account for only a limited range of development and it is often the case that within each area of development there are competing theoretical views, each attempting to account for the same aspects of development. We shall see below some of this complexity and conflict in our account of different theoretical views.

First of all, it would be helpful to understand what is implied by a “Theory” in the field of developmental psychology. A theory of development is a scheme or system of ideas that is generally based on evidence and attempts to explain, describe and predict behaviour and development. So, from this account, it is quite clear that a theory aims to bring order to what might otherwise be a chaotic mass of information – and hence why there may indeed not be anything more practical than a good theory.

We usually deal with at least 2 kinds of theory in every area of development, we have the minor theories [that are generally concerned with very specific and narrow areas of development such as eye movements, the origins of pointing and so on], and we have the major theories which are the ones we are primarily interested in as they attempt to explain large areas of development.

They have been divided in 3 groups for the purpose of this essay, with cognition, emotion and motivation in focus:

(I) The Theory of Cognitive Development of Jean Piaget


(II) The Theory of Attachment in Emotional Development by John Bowlby


(III) The Genetic/Psychosexual Model of Development by Sigmund Freud

 

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(I) The Theory of Cognitive Development (Jean Piaget)

The theory of cognitive development we are interested in is that of Jean Piaget who saw children as active agents in shaping their own development,  and not simply blank slates who passively and unthinkingly responds to whatever the environment throws at them or treats them to [an assumption that is insulting to human intelligence, hence why we do not subscribe blindly to the passive school of thought but only consider some elements related to very basic cognitive processes].

This suggests that children’s behaviour and development is motivated largely intrinsically (internally) rather than extrinsically (externally).

For Piaget and intellectuals with a firm belief in the mind as an active entity, children learn to adapt to their environment and as a result of their cognitive adaptations they are now better able to understand their world. Adaptation is an act that all living organisms have evolved to do and as children adapt, they also gradually construct more advanced understanding [internal working models] of their worlds.

These more advanced understanding of the world reflect themselves in the appearance of new stages of development. Piaget’s theory is the best and most accomplished example of the organismic world view, and it portrays children as inherently active, continually interacting with various dimensions of their environments, in such a way as to shape their own development.

With this assumption in mind, Piaget’s theory is also often referred to the Constructivist Theory.

[IMPORTANT NOTE: For a detailed account of Jean Piaget’s Theory of Cognitive Development, please read the essay…]

 

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(II) The Theory of Attachment in Emotional Development (John Bowlby)

If we pick up a new born baby , he/she will respond without any difference to us or to any other person. However, after 9 months, the same baby will have developed one or more selective attachments and will discriminate familiar faces to unfamiliar ones. So, if we were to pick up the baby again, we may face scenarios where he/she displays anxiety or cries, but if the mother or father picks her/him up, the baby will be reassured and pacified.

This section will explore and give an account of the development of attachment relationships between infants, parents, and other close primary caregivers. The significance of such attachments for development in adult life will also be considered, with its implication for the philosophy of education in sculpting the minds of tomorrow, along with some research on parenting styles analysing some of the factors affecting successful and less successful parenting.

 

The Development of Attachment Relationships: Attachment as an innate drive

The infant’s expression of emotions and the caregiver’s response to these emotions is the fundamental foundation of John Bowlby’s Theory of Attachment. Bowlby’s (1958, 1969 / 1982, 1973, 1980) theory was inspired and influenced by an exciting and creative range of disciplines including psychoanalysis, ethology and the biological sciences. Before Bowlby, the main assumption and view of the infant-mother attachment was that it was a “secondary drive” or a side-product of the infant associating the mother with the provision of physiological needs, such as hunger [Picture B – breast feeding image].

Breastfeeding Mother

PICTURE B. Early theories of infant-mother attachment suggested that it was a secondary drive resulting from the mother satisfying the infant’s primary drives, such as hunger. / Photography:  Jo Frances

Bowlby defied this logic, and argued convincingly that attachment was an innate primary drive in all infants, and while his theory went through many revisions over the years, this argument remained fundamental.

In Bowlby’s first version of his theory of attachment (Bowlby, 1958), the emphasis was on the role of behaviours resulting from our instincts [on how behaviours such as crying, clinging and smiling served the purpose of eliciting a reciprocal attachment response from the caregiver]:

There matures in the early months of life of the human infant a complex and nicely balanced equipment of instinctual responses, the function of which is to ensure that he obtains parental care sufficient for his survival. To this end the equipment includes responses which promote his close proximity to a parent and… evoke parental activity.

(Bowlby, 1958, p. 346)

However, in the 1969 version of his theory (1st volume of his trilogy, Attachment and Loss),  Bowlby focussed on highlighting the dynamics of attachment behaviour, and switched to explaining the infant-mother tie in terms of a goal-corrected system which was triggered by environmental cues rather than innate instinctual behaviours. Whether attachment is instinctual or goal-corrected, we know that it eventually leads to the infant maintaining proximity to the primary caregiver.

Bowlby acknowledged that the development of an attachment relationship was not dependent purely upon the social and emotional interplay between infant and caregiver. Since we can only observe attachment behaviour primarily when the infant is separated from the caregiver, it is logically dependent upon the infant’s level cognitive development in the ability for object permanence [i.e. the ability to represent an object (living or non-living) that is not physically present within the child’s proximity].

This seems to synchronise partly with Piaget’s outlook and theory of cognitive development, and indeed Bowlby was inspired by Jean Piaget, and based his argument on Piaget’s (1955) contention that this level of object permanence is not attained until the infant is approximately 8 months old. Furthermore, while children would be able to recognise familiar people before such age, they would still not miss the attachment figure and thus display attachment behaviour until they have reached the level of cognitive sophistication that comes with the ability to represent absent objects [and people, who are in the same class].

 

The Phases of Attachment: Development of Attachment Relationships

Let us imagine a classic example of a mother and child [about 1 – 2 year-old] in a park. What we might observe is that the mother is seated on a bench while the infant runs off to explore the area. Periodically, the child may be seen to stop and look back at the mother, and every once in a while may even return close to her, or make physical contact, staying close for a while before venturing off again. In most cases, the infant rarely goes beyond about 60 metres from the mother or primary caregiver, who may however have to go and retrieve the child if the distance gets too great or if the need to leave is imminent.

The scenario here from a developmental psychologist’s perspective is fairly simple; the infant is exploring the environment it is being exposed to inquisitively, and is using the mother as a “secure base” to which to return periodically for reassurance. This is one of the hallmarks of an “attachment relationship”. These observations of children in parks were made by a student of John Bowlby, Anderson (1972) in London, and the development of attachment has been described in detail by John Bowlby (1969).

Bowlby (1969, p. 79) described 4 phases in the development of attachment and subsequently extended it to a 5th.

The phases are:

I. The pre-attachment phase (0 – 2 months) is characterised by the infant showing hardly any differentiation in their responses to familiar or unfamiliar faces.

II. During the second phase (2 – 7 months), the foundations of attachment are being laid. Here infants start to recognise their caregivers, even if they still do not possess the ability to show attachment behaviours upon separation. The infant is also more likely to smile at the mother or important caregivers and to be comforted by them if distressed.

III. Clear cut attachment behaviours only start to appear after 7 months. At this phase, infants start to protest at being separated from their caregivers and become very wary of strangers [so called stranger anxiety] – this is often taken as a definition of attachment to caregiver and this onset of attachment happens from 7 – 9 months.

IV. When the attachment relationship has evolved into a goal-corrected partnership (from around 24 months / 2 years of age), [i.e. when the child also begins to accommodate to the mother’s needs, e.g. being prepared to wait alone if requested until the mother returns]. This is an important change because before this phase, the infant only saw the mother as a resource that had to be available when needed. Bowlby saw this as characterising the child at 3 years of age, although as mentioned from 2 years old babies can partly accommodate to verbal requests by mothers to await for her return (Weinraub and Lewis, 1977). From this phase onwards, the child relies on representation or internal working models of attachment relationships to guide their future social interactions.

V. The lessening of attachment is noticed as measured by the child maintaining proximity. The characteristics of a school-age child, and older, is the idea of a relationship based more on abstract considerations such as affection, trust, loyalty and approval, exemplified by an internal working model of the relationship.

Bowlby viewed attachment as a canalized developmental process where both the mainly instinctive repertoire of the new born and certain forms of learning are important in early social interactions. Certain aspects of cognitive sensori-motor development [as supported by Jean Piaget] are also fundamental for attachment. Until the developing infant can master the concept of cause-effect relations, and of the continued existence of objects [incl. persons] when out of sight, he or she cannot protest at separation and attempt to maintain proximity [note the importance of object permanence in emotional development and internal working models]. Hence, sensori-motor development is also a canalised process, and it should not be in opposition to an ethological and a cognitive-learning approach to attachment development.

 

Attachments: Between whom?

Many articles and textbooks have characterised the attachment relationship as mainly focussed on the mother (e.g. Sylvia and Lunt, 1981), and this may not be completely true, since many studies have suggested that early attachments are usually multiple, and although the strongest attachment is often to the mother, this need not always be so.

In a study conducted in Scotland, mothers were interviewed and asked to whom their toddlers showed separation protest (Schaffer and Emerson, 1964), the proportion of babies with more than 1 attachment figure increased from 29% when separation protest first appeared [about 7 – 9 months] to 87% at 18 months [1 and half year old]. It was also found that for about one third of babies, the strongest attachment seemed to be to someone other than the mother, such as father, or other trusted primary caregivers. In most cases, attachment were formed to responsive persons who interacted and played a lot with the infant; basic caregiving such as nappy changing was clearly not in itself such an important factor; and similar results were obtained by Cohen and Campos (1974).

UglyLeeches

Peinture: Sandrine Arbon

Studies in other cultures also support this conclusion, for example in the Israeli kibbutzim, young children spend the majority of their waking hours in small communal nurseries, in the charge of a nurse or metapelet. In a study of 1- and 2- year-olds reared in this way, it was found that the infants were very strongly attached to both the mother, and the metapelet; either could serve as a base for exploration, and provide reassurance when the infant felt insecure (Fox, 1977). In many agricultural societies, mothers tend to work in the fields, and often leave infants in the village, in the care of grandparents, or older siblings, returning periodically to breastfeed. In a survey of 186 non-industrial societies, it was found that the mother was rated as the “almost exclusive” caretaker in infancy in only 5 of them; hence other persons had important caregiving roles in 40% of societies during the infancy period, and in 80% of societies during early childhood (Weisner and Gallimore, 1977).

 

The Security of Attachment

Early infant-caregiver attachment relationships and the internal working models are the main aspects of Bowlby’s theory of attachment and have been given the greatest attention, with researchers developing 2 of the most widely used measuring instruments in developmental psychology to investigate Bowlby’s theoretical claims: the strange situation procedure to assess the goal-corrected system that evolved from the early attachment relationship, and the Adult Attachment Interview to assess internal working models.

Bowlby’s theory was focussed and interested with the making and breaking of attachment ties, probably because his experiences of working as a child psychologist exposed him to the negative consequences for emotional development of severe maternal deprivation [such as long term separation or being orphaned].

Nowadays, researchers and intellectuals are generally less concerned with whether a child has formed an attachment [since any child who experiences any degree of continuous care will become attached to the caregiver], but are rather more interested in the quality or security of the attachment relationship. This important shift in emphasis was due to the empirical work of Mary Ainsworth.

Ainsworth interest in the concept of attachment grew after working with Bowlby in London during the 1950s. Later, she moved to Uganda to live with the Ganda people where she made systematic observations of infant-mother interactions in order to investigate Bowlby’s goal-corrected attachment systems in action.

One factor that struck Mary Ainsworth (1963; 1967), was the lack of uniformity in infant’s attachment behaviour, in terms of its frequency, strength, and degree of organisation. Furthermore, these differences were not specific to Gandan infants, since she replicated these findings in a sample of children in the USA when she moved to Baltimore. These variations in attachment type had not been accounted for by John Bowlby’s Theory and hence, this led Ainsworth to investigate the question of individual differences in attachment.

Mary Ainsworth experience of working with Bowlby, along with her rich collection of data harvested over a period of many years, put her in a unique position in the development of attachment as an empirical field of research. Her contribution led to attachment issues becoming part of mainstream developmental psychology, rather than being simply confined to child psychiatry, and behind this achievement was an investigation of the development of attachment under normal family conditions and by developing a quick and effective way of assessing attachment patterns in the developmental laboratory.

Although the strange situation procedure (Ainsworth & Wittig, 1969) circumvented [found a way around] the need for researchers to conduct lengthy observations in the home, it was not developed simply for research convenience, but because there are problems in trying to evaluate attachment type in the child’s own home environment. For example, if a child becomes extremely distressed upon the mother moving to another room in their own home environment, this may be an indication of a less than optimal attachment achieved, because if a child feels secure then such a separation should not trigger any distress. The extensive experience of Ainsworth in observing infant-mother interactions enabled her to identify the situations that we most crucial in attachment terms, and therefore formed the basis of the strange situation procedure.

 

The Strange Situation Procedure

Ainsworth and her colleagues then developed a method for assessing the attachment strength of an individual infant towards her mother or caregiver (Ainsworth et al., 1978). The method is known as the Strange Situation, and has been widely used with 12 – 24 months old infants in many countries worldwide. To sum up, it is a method for checking in a standardised way, how well the infant uses the caregiver as a secure base for exploration, and is comforted by the caregiver after a lightly stressful experience.

The strange situation assesses infants’ responses to separations from and subsequent reunions with, the caregiver [mother here], and their reactions to an unfamiliar woman [the so-called “stranger”]. In the testing room, there are only 2 chairs [one for the mother and one for the stranger] and a range of toys with which the infant can play.

TA - The Strange Situation Procedure

Table A. The Strange Situation Procedure

As Table A shows, the episodes are ordered so that the infant’s attention should shift from the exploration of the environment to attachment behaviour towards the caregiver as the Strange Situation proceeds. The most crucial points are the infant’s responses to the 2 reunion episodes, and form the basis for assessing an infant’s security of attachment. The coding scheme for security attachment was developed by Ainsworth et al. (1978) and describes infant behaviour according to 4 indices:

1) Proximity-seeking
2) Contact-maintenance
3) Resistance
4) Avoidance

Referring to Table A, in a well-functioning attachment relationship, it would generally assumed that the infant would use the mother as a base to explore [Episodes 2, 3 and the end of Episode 5], but be stressed by the mother’s absence (Episodes 4, 6 and 7;  these episodes are cancelled if the infant is overly distressed or the mother wants to return sooner]. Special attention is also given to the infant’s behaviour in the reunion episodes (5 and 8), to see if her or she is effectively comforted by the mother. Based on those measures, Ainsworth and others distinguished a number of different attachment types.

The 4 primary ones are:

Type A – Insecure Avoidant Attachment

Insecure-Avoidant (Type A) infants display high levels of environment-directed behaviour to the detriment of attachment behaviour towards the caregiver [i.e. Avoidant (A) – avoids caregiver and explores environment]. The Insecure Avoidant Types display little if any proximity-seeking behaviour, and even tend to avoid the caregiver, by averting gaze or turning or moving away, if the caregiver attempts to make contact. Throughout the whole process of the Strange Situation, Insecure Avoidant infants appear completely indifferent toward the caregiver, and treat both the latter and the stranger is very similar ways; hence, these infants may show less avoidance of the stranger than of the caregiver.

Note that conversely, the (Type C) Insecure Resistant / Ambivalent Attached infants show high levels of environmental-directed behaviour to the detriment of the caregiver [the complete opposite to Type A].

Type B – Secure Attachment

When the dynamics of the attachment relationship is a balance between environmental exploration and attachment behaviour directed towards the caregiver [See PICTURE C], then the securely attached infants are considered as having the right balance.

PC Attachment as a balance of behaviour TA

PICTURE C. Attachment as a balance of behaviour directed toward mother and the environment. Source: Adapted from Meins (1997).

 

The presence of the caregiver in the pre-separation episodes affords them the security to turn their attention to exploration and play, with the confident knowledge that the caregiver will be available for comfort or support should it be required. However, attachment behaviour is triggered in securely-attached infants during the separation episodes, leading to seek contact, comfort, proximity or interaction with the caregiver when they return. Securely attached infants may or may not become distressed upon separation from caregivers, and this makes the infants’ response to separation a relatively unreliable and poor indicator of attachment security. However, regardless of their response to separation, securely attached children are marked by their positive and quick response to the caregiver’s return, displayed generally by their readiness to approach, greet and interact with the caregiver.

It important to note that Type B [Secure] Attachment is the only “secure” attachment in the group, all the rest are insecure attachment types, and in contrast to Type B, they have their balance of infant attachment tipped to either extreme [i.e. Avoidant (A) – avoids caregiver and explores environment / Resistant (C) – avoids environment and exhausts caregiver]

Type C- Insecure Resistance / Ambivalent

Insecure-resistant infants are over-involved with [to the point of exhausting] the caregiver, showing attachment behaviour even during the pre-separation episodes, with little or no interest in exploring the environment. The Insecure Resistant (Type C) infants tend to become extremely distressed upon separation, however, the over-activation of their attachment system hampers their ability to be comforted by the caregiver upon reunion – this leads to angry or petulant behaviour, with the infant resisting contact with and from the caregiver [in extreme cases this manifests itself as tantrum behaviour where the caregiver may sometimes be hit or kicked by the infant].

Type D – Insecure Disorganised

Besides the original 3 categories mentioned above distinguished by Ainsworth et al. (1978), Main and Solomon (1986, 1990) established a fourth category, Type D [Insecure Disorganised Attachment] for infants whose behaviours appeared not to match any of the A [Avoidant], B [Secure] and C [Resistant/Ambivalent] categories. These insecure-disorganised infants look disoriented during the strange situation procedure, and display no clear strategy for coping with separations from and reunion with their caregivers. Infants classified as insecure-disorganised may simultaneously display contradictory behaviour during the reunion episodes, such as seeking proximity while also displaying obvious avoidance [e.g. backing to which the caregiver or approaching with head sharply averted]. Insecure-disorganised infants (Type D) may also react to reunion with fearful, stereotypical or odd behaviours [e.g. rocking themselves, ear pulling, or freezing]. Main and Hesse (1990) argued that, although the classification criteria for insecure-disorganised attachment are diverse, the characteristic disorganised behaviours all include a lack of coherence in the infant’s response to attachment distress and betray the “contradiction or inhibition of action as it is being undertaken” (p.173).

Main and her colleagues (1985) believe the Type D [Insecure-disorganised ] is a useful extension of the original Ainsworth classification.

There are many subtypes of these main types, however most studies do not refer to them, and in older studies, type D babies [who are often difficult to classify as they do not show a clear pattern] were ‘forced’ into 3-way and 4-way classifications.

In most cases, type B babies (secure – considered as most desired, i.e. “normal” / although debated] are compared with types A and C [inscure-avoidant and insecure-resistant/ambivalent], and the type B [secure-attachment] tends to be seen as developmentally normal, or advantageous. Many criticisms have been made of the attachment typing resulting from the Strange Situation procedure (Lamb et al., 1984), particularly of the earlier work that was based on small samples, and of the normative assumption that “B is best”. They also pointed out the procedure only measures the relationship between mother and infant, and not the characteristics of the infant. Since attachment security is the dyadic measure, infant-mother attachment type is not necessarily the same as infant-father attachment type. In fact, many studies have found that the attachment type to father is not related to that with the mother; meta-analyses (Fox et al., 1991; van Ijzendoorn and De Wolff, 1997) found a very modest association between the two.

However, the strange situation procedure is today a commonly and internationally used technique. One of the most important test of utility of attachment types is that it should allow us to predict other aspects of development, and we now have considerable evidence for this (see Bretherton and Waters, 1985 and Waters et al., 1995, for reviews).

Kochanska (2001) followed infants longitudinally from 9 to 33 months and observe their emotions in standard laboratory episodes designed to elicit fear, anger or joy. Over time, type A (Avoidant – towards caregiver) infants became more fearful, type C (Resistant/Ambivalent – exhausts caregiver) infants became less joyful, type D (Disorganised – does not fit in A, B or C behavioural categories) infants became more angry; whereas type B (Secure) infants showed less fear, anger or distress. Using the strange situation procedure, secure attachment to mother at 12 months has been found to predict curiosity and problem solving at age 2, social confidence at nursery school at age 3, and empathy and independence at age 5 (Oppenheim et al., 1988), and a lack of behaviour problems (in boys) at age 6 (Lewis et al., 1984).

Is the Strange Situation valid across populations worldwide?

Van Ijzendoorn and Kroonenberg (1988) provided a cross-cultural comparison of strange situation studies in a variety of different countries. In American studies, some 70% of infants were classified as securely attached to their mothers (type B), some 20% as Type A, and some 10% as Type C. However, German investigators found that some 40-50% of infants were of Type A (Grossman et al., 1981), while a Japanese study found 35% to be of Type C (Miyake et al., 1985). These percentages do raise the question about the nature of “insecure attachment”: is it a less satisfactory mode of development or are these just different styles of interaction?

Takahashi (1990) argued that the Strange Situation must be interpreted carefully when it is applied across cultures. He found that Japanese were excessively distressed by infant alone episode (episode 6 – Table A), because generally in Japanese culture babies are never left alone at 12 months. This is the reason why fewer Japanese babies scored B (Secure). It is also important to note, that there was no chance for them to show avoidance (and score A – insecure avoidant), since the mother seeing the level of distress went straight on without hesitation to pick up the baby. This may also be possible explanation as to why many Japanese babies were C (Insecure Resistant/Ambivalent) at 12 months [still they are not at 24 months, nor are adverse consequences apparent]. This distortion can be avoided by virtually omitting episode 6 (see Table A) for such babies. Rothbaum et al. (2000) do take a more radical stance, in comparing the assessment security in the USA and Japan. They argue that these two cultures put different cultural values on constructs such as independence, autonomy, social competence and sensitivity; such that some fundamental tenets of attachment theory are called into question as cross-cultural universals.

Cole (1998) suggested that we need information of the geographical trends in socio-behavioural patterns [culture, heritage, language, arts, etc] under study if we are to understand the nature of the everyday interactions that shape the development of young children in relation to their caregivers. The strange situation may be a valid indicator but it is just the we at least need to redefine the meaning of the categories “avoidant, secure and resistant / ambivalent” according to the geographical socio-behavioural patterns [culture]. He also argued that although it is a standardised test, strange situation is really a different situation in different environmental circumstances. However for successful use of the strange situation in a non-western culture [one that is not of Western European heritage], we can take a look at the Dogon people of Mali.

Infant-mother attachment among the Dogon of Mali

The study we are about to discuss is a very rare one among its kind which took place among the Dogon people of Eastern Mali, a primarily agrarian people living by subsistence farming of millet and other crops, as well as cash economy in towns [see PICTURE D].

PD - Dogon mother spinning cotton with child on her lap

PICTURE D. Dogon mother spinning cotton with child on her lap

The study was carried out in 2 villages with a total population of about 400, and one town population of 9000, with the researchers attempting to get a complete coverage of infants born between mid-July and mid-September 1989. Not all infants could take part, due to relocation or refusal, and the researchers excluded 2 infants who had birth defects, and 8 suffering from severe malnutrition. In addition, after recruitment two infants die before or during the two-month testing period. Finally, 42 mother-infant pairs took part and provide a good quality data. The infants were 10 to 12 months old at the time of testing.

The Dogon are a polyamorous society, and mothers typically live in a compound with an open courtyard, often shared with co-wives. There was some degree of shared care of infants, about one half were cared for primarily or exclusively by the mother, about one third primarily by the maternal grandmother with a mother however being responsible for breastfeeding (see PICTURE E).

PE - Dogon mother breastfeeding her child

PICTURE E. Dogon mother breastfeeding her child.

Breastfeeding is a normative response by the mother to signs of distress in in the Dogon infants. Three related features of infant care in the Dogon – frequent breastfeeding on demand, quick response to infant distress, and constant proximity to the mother or caregiver – are seen as adaptive and there is high infant mortality [as in some other traditional African cultures].

The researchers have several objectives in mind, they wish to see if the strange situation could be used successfully in Dogon culture; one distribution of attachment types was obtained; whether infant security correlated with maternal sensitivity – a test of the Maternal Sensitivity Hypothesis; whether infant attachment type related to patterns of attachment-related communications in mother-infant interaction – the test of what the authors call the Communication Hypothesis; and to see if frightened or frightening behaviour by the mother predicted disorganised infant attachment.

Three situations were used to obtain relevant data, the behaviour being recorded on videotape in each case. One was rather new – the Weigh-In, part of the regular well-infant examination, in which the mother handed over the infant to be weighed on a scale – and mildly stressful separation for the in, especially in Dogon culture. The other two were more standard – the strange situation, carried out in an area of courtyard separated off by hanging mats; and two 15 minute observations in the infant’s home, and the mother was cooking, bathing/caring for the infant.

The following data were obtained:

  • Infant attachment classification (from the strange situation)
  • A rating of infant security on a 9-point scale (from the strange situation)
  • Mother and infant communication related to attachment, coded by 5-point Communications Violations Rating scales (from the Weigh-in)
  • Maternal sensitivity, rated in terms of promptness, appropriateness and completeness of response to infant signals (from the home observations)
  • Frightened or frightening behaviours by the mother, such as aggressive approach, disorientation, trance state, rough handling as if baby is an object, on a 5-point scale (from the home observations and the Weigh-In).

[REMEMBER!!!! [although we are quite sure you know this already] : “r” is known as the correlation coefficient and tells us 2 things: (i) Direction of Relationship + or – & (ii) Strength of Relationship : +or- .1 is a small effect / +or- .3 is a medium effect / +or- .5 is a large effect | and p-value is the critical decider of whether to reject Null Hypothesis( i.e. the scenario we rightly thought would be opposite to our predictions) if p small enough (if p < .05 we say results were statistically significant, if p < .01 we say it is HIGHLY statistically significant) we reject the Null Hypothesis [both cases].

The strange situation was found to be feasible, following quite standard procedures. The distribution of attachment types was 67% B (Secure), 0% A (Avoidant), 8% C (Resistant/Ambivalent), and 25% D (or on a forced 3-way classification, 87% B, 0% A and 13% C). This is quite unusual in having no avoidant (A) classifications; D is high but not significantly greater than Western norms.

The Maternal Sensitivity Hypothesis only received weak support. The correlation between infant security and maternal sensitivity was r = 0.28, and with p < .10; the difference in means between attachment classifications was not statistically significant (B=5.26, C=5.00, D=4.20).

The Communications Hypothesis did get support. Infant security correlated -.54 with Communications Violations (p < .001), and the attachment classifications differed significantly (B=2.66, C = 3.50, D = 3.89; p < .01).

Finally, frightened or frightening behaviour by the mother correlated r = -.40 (p < .01) with infant security, and was particularly high in children with disorganised attachment (B= 1.23, C = 1.33, D = 2.35; p < .01).

Besides demonstrating the general application of the strange situation procedure in a nonwestern group with socio-behavioural patterns very different to our own, the findings provides support for the Communication Hypothesis. The case here would have been stronger if the different kinds of communication patterns for each attachment classification had been described in more detail. For example, that insecure resistant / ambivalent (C) attachment type infants would be inconsistent and often unable to convey their intent, or to terminate their own or another’s arousal, whereas insecure disorganised (D) attachment type infants would “manifest contextually irrational behaviours and dysfluent communication” (p. 1451). As it is, the main findings show that insecure infants show more communications violations, do not describe the detailed typology. Indeed, since some of the Communications Violations rating scales were of “avoidance, resistance and disorganisation” (p. 1456), there is a possible danger of conceptual overlap between this scale and the attachment classifications.

Although support for the Maternal Sensitivity Hypothesis was we, the correlation of r = .28 is in line with the average of r = .24 found in the meta-analysis by De Wolff and Van Ijzendoorn (1997) on mainly Western samples. The researchers used a multiple regression analysis to examine the contributions of both maternal sensitivity and mothers frightened/frightening behaviour, to attachment security. They found that the contribution of maternal sensitivity remain modest, whereas the contribution of mothers frightened/frightening behaviour was substantial and significant; ratings of maternal sensitivity do not normally take account of mothers frightened/frightening behaviour, and the researchers suggest that this might explain the modest effects found for maternal sensitivity to date.

The absence of avoidant (A – avoids caregiver and favours exploration) type infants is interesting and the researchers argue that, given the close contact mothers maintained with the Dogon infants, and the normal use of breastfeeding as a comforting activity, it would be very difficult for it Dogon infant to develop an avoidant strategy [this may have some similarity with the low proportion of A-type in Japanese infants). If avoidant (A) attachment is a rare or absent when infants nursed on demand (which probably characterises much of human evolution), this might suggest that A type attachment was and is a rare except in Western samples in which infants tend to be fed on schedule, and often by bottle rather than breast, so that the attachment and feeding systems are effectively separated.

Most Dogon infants showed secure (B) attachment, but 25% scored as disorganised (D) [though mostly with secure as the forced 3-way classification]. The researchers comment that the frightened or frightening behaviours were mild to moderate, and did not constitute physical abuse. But why should mothers show these sorts of behaviour at all? An intriguing possibility is that it is related to the high level of infant mortality prevalent in the Dogon. About one third of infants died before five years of age, and most mothers will have experience in early bereavement. Unresolved loss experienced by a mother is hypothesised to disorganised (D) attachment; perhaps, frightened behaviours are more rational or expected, when the risk for infants are so much higher.

This study to great efforts to be sensitive to the geographically specific socio-behavioural patterns (culture) of the venue, when using procedures and instruments derive mainly from Western samples. A Malian researcher assisted in developing the maternal sensitivity coding, and Dogon women acted as strangers in the strange situation procedure. The Weigh-In and home observations were natural settings. The authors comment, however, that future work might make more effort to tap the perceptions of mothering and attachment held by the Dogon people themselves, in addition to the constructs coming from Western psychology.

(True, M. M., et al, 2001)

Back Home in the West: Why do infants develop certain attachment types?

Individual differences in the caregiver’s sensitivity to infant’s cues were the earliest reported predictors of attachment security. Ainsworth and colleagues (Ainsworth, Bell & Stayton, 1971, 1974; Ainsworth et al., 1978) found that mothers who responded most sensitively to their infants’ cues during the first year of life tended subsequently to have securely attached infants. The insecure-avoidant (Type A) pattern of attachment was associated with mothers who tended to reject or ignore their infants’ cues, and inconsistent patterns of mothering were related insecure-resistant/ambivalent (Type C) pattern of attachment. Although further research is largely supported this link between early caregiver sensitivity and later attachment security, the strength of the relation between these factors has not been replicated. For example, De Wolff and van Ijzendoorn (1997) conducted a meta-analysis to explore the parental antecedents of attachment security using data from 21 studies involving over 1000 infant-mother says, and reported a moderate effect size for the relation between sensitivity and attachment security (r = 0.24), compared with the large effect (r = 0.85) in Ainsworth et al.’s (1978) study. This led De Wolff and van Ijzendoorn to come to the conclusion that “sensitivity cannot be considered to be the exclusive and most important factor in the development of attachment” (p. 585).

It seemed that the construct of sensitivity might have been responsible for the result, so we return to Ainsworth et al.’s (1971, 1974) original definitions in order to have a better understanding of predictors of attachment security. In this research, we were particularly influenced by Ainsworth’s focus on the caregiver’s ability not merely to respond to the infant, but to respond in a way that was consistent with the infants cue. For example, Ainsworth et al., (1971) describe how mothers of securely attached infants appeared “capable of perceiving things from the child’s point of view” (p. 43), whereas maternal insensitivity involve the mother attempting to “socialise with the baby when he is hungry, play with him when he is tired, and feed him when he is trying to initiate social interaction” (Ainsworth et al., 1974, p. 129). Meins et al. (2001) verse argued that the critical aspect of sensitivity was the caregiver’s ability to “read” the infant’s signals accurately so that the response could be matched to this passive cue from the child. In order to test this proposal, Meins et al. (2001) obtain measures of mothers’ ability to read their 6-month-olds’ signals appropriately (so called mind-mindedness), and investigated the comparative strength of mind-mindedness versus general maternal sensitivity in predicting subsequent infant-mother attachment security. Meins et al. reported that maternal mind-mindedness was a better predictor of attachment security 6 months later than was maternal sensitivity, with mind-mindedness accounting for almost twice the variance in attachment security than that accounted for by sensitivity.

This seems like a strong conclusion, since the genetic factors have been accounted for and do not contribute to attachment type as van Ijzendoorn et al. (2000) argued that it has a modest if any influence on attachment type. This can be confirmed from a twin study conducted by O’Connor and Croft (2001) when they assessed 110 twin pairs in the strange situation and found concordance of 70% in monozygotic twins and 64% in dizygotic twins – not significantly different. The model suggested estimates of only 14% of variance in attachment type due to genetics, 32% to shared environment, and 53% in non-shared environment.

A study of attachments formed by babies to foster mothers (Dozier et al., 2001) found as good a concordance between mothers’ attachment state of mind (from the Adult Attachment Interview, see below) and infant attachment type from the strange situation, as for biological mother-infant pairs, once again suggesting little genetic influence on attachment type.

So, it is fairly accepted today that mothers’ mind-mindedness is an important construct and it is defined as the mother treating her infant as an individual with a mind, instead of just an organism or small creature with needs to be satisfied. The emphasis should be on responding to the infant’s inferred state of mind, rather than simply their behaviour. In a longitudinal study of 71 mother-infant pairs, they found that maternal sensitivity (responding to infant cues) and some aspects of mind-mindedness, especially appropriate mind-related comments by the mother, measured at six months, both independently predicted security of attachment at 12 months. True et al., (2001) also found evidence that mothers’ frightened or frightening behaviour may also contribute independently to attachment security (Refer to Dogon Study above – Picture D and Picture E).

We should also take note that a huge amount of variance in attachment type appears to be related non-shared environment, and this cannot be explained by generalised maternal sensitivity. It is highly probable that, mothers are more sensitive and behave differently to some infants than others, depending on birth order, gender and infant characteristics, suggesting the need for family systems on these issues (van Ijzendoorn et al., 2000).

 

Attachment Beyond Infancy & The Internal Working Model

The attachment theory proposes that children use their early experiences with their caregivers to form internal working models (Bowlby, 1969 /1982, 1980) which incorporate representations of themselves, their caregivers, and their relationships with others. These internal working models will then be used by the child as templates for interacting with others. Consequently, because of the sensitive, loving support that securely attached children’s caregivers have supplied, these children are self-confident and have a model of themselves as being worthy; they therefore expect others to behave in a sensitive and supportive fashion. Conversely, given the patterns of interaction typically experienced by avoidant and resistant infants, insecurely attached children expect people to be rejecting, or inconsistent and ambivalent when interacting with them.

The strange situation measures security of attachment in terms of behaviours; especially how the infant behaves at a reunion of the separation. The strange situation procedure is generally used with infants between the ages of 12-24 months old. For 3 – 6 year-olds, variants of the strange situation, such as a reunion episodes after separation, have been used with some success (Main and Cassidy, 1988).

Research during the last 10 years has seen attachment become a life-span construct with corresponding attempts to measure it at different developmental stages (see Melhuish, 1993, for a review). It has been revealed that as infants grow older, in Bowlby’s 4th and 5th stages, attachment relationships become less dependent on physical proximity and overt behaviour, and more dependent on abstract qualities of the relationship such as affection, trust, approval, internalised in the child and also in the adult.

Research has revealed that it is useful to think of internal representations of the relationship in the child’s mind; the child is thought of as having an internal working model of his or her relationship with the mother, and with other attachment figures (Bowlby, 1988; Main et al., 1985). These are characterised as cognitive structures embodying the memories of day-to-day interactions with the attachment figure. They may be ‘schemas’ or ‘event scripts’ that guide the child’s action with the attachment figure, based on their previous interactions and the expectations and affective experiences associated with them.

Different attachment type would be expected to have differing working models of the relationship. Secure (Type B) attachment would be based on models of trust and affection [and a Type B infant would be able to communicate openly and directly about attachment-related circumstances, such as how they felt if left alone for a while]. By contrast, a boy or girl with an Insecure (Type A) Avoidant attachment may have an internal model of his/her mother that leaves the child without any expectancy of secure comforting from the latter when he/she is distressed [the mother may in fact reject his/her approaches]. The child’s action rules then become focused on avoiding her, thus inhibiting approaches to her that could be ineffective and instead lead to further distress; and this can be problematic, as there is less open communication between mother and son, and their respective internal working models of each other are not being accurately updated.

Insecure Resistant / Ambivalent (Type C) infants might not know what to expect from their mother, and they in turn would be inconsistent in their communication with the latter and often unable to convey their intent.

PF - Boy by Land Rover - from Separation Anxiety Test

PICTURE F. Boy by Land Rover: A picture from the Separation Anxiety Test

Over the last 15 years, researchers have attempted to measure attachment quality in older children [as much as the empirical methods allowed them to do in terms of construct validity and internal consistency], by trying to tap in to their internal working models (Stevenson-Hinde and Verschueren, 2002). One of the methods used involved narrative tasks, often using doll-play; children use a doll family and some props and complete a set of standardised attachment related story beginnings. Another method used has been the Separation Anxiety Test, in which children or adolescents respond to photographs showing separation experiences [see Picture G for an example]. The child is questioned about how the child in the photograph would “feel and act”, and then how he/she [the participating child] would feel and act if in that situation (Main et al., 1985). This test was found to have a good rater reliability and consistency 8 to 12-year-olds. Large differences in responses between children having clinical treatment for behaviour disturbance and a normal control group was found (See Table B)

TB - Two Protocols from the Separation Anxiety Test

TABLE B. Two protocols from the Separation Anxiety Test

Securely attached children generally acknowledge the anxiety due to the separation but come up with feasible coping responses; insecurely attached children generally deny the anxiety, or give inappropriate or bizarre coping responses.

 

The Adult Attachment Interview

The internal working models of relationships can normally be updated or modified as new interactions develop. It is likely possibility that for younger children, these changes must be based on actual physical encounters. However, the Main et al. (1985) suggested that in adolescents or adults who have achieved formal operational thinking [Jean Piaget’s 4th and final stage at around the age of 12 as explained in our essay], it is possible to change / modify their internal working models without the need for such direct interaction. In order to measure attachment in older adolescents and adults, they developed the Adult Attachment Interview. This is a semi-structured interview that proves memories of one’s own early childhood experiences. The transcripts are coded, not on the basis of experiences themselves, so much as on how the person reflects on and evaluate them, and how coherent total account is [Adults’ attachment classifications are not based on the nature of their actual childhood experiences, but on the way they represent these experiences, be they good or bad]. They are also generally asked to describe their childhood relationships with mother and father, and to recall times when they were separated from their parents or felt upset or rejected. There are specific questions that also deal with experiences of loss and abuse. According to their responses during the AAI, Allsopp placed into one of the 4 attachment categories: (i) Autononous, (ii) Dismissing, (iii) Preoccupied [Or Enmeshed] and (iv) Unresolved

 

(i) Autonomous Attachment

Autonomous adults are able to give coherent, well-balanced accounts of their attachment experiences, showing clear valuing of close personal and meaningful relationships [note meaningful subjectively to the individual]. These adults classified as autonomous may have experience problems in childhood, or even had a very difficult or abusive upbringings, but they can generally have an open conversation and talk openly about the negative experiences and most seem to have managed to resolve any early difficulties and conflicts. In contrast to the open and balanced way in which autonomous adults talk about childhood experiences, adults in the remaining three categories have incredible difficulties in talking about attachment relationships.

 

 (ii) Dismissing Attachment

Dismissing adults deny the importance of attachment experiences and insist they cannot recall childhood events and emotions, or provide idealised representations of the attachment relationship that they are unable to corroborate the real-life events. [i.e. dismiss attachment relationship as of little importance, concern or influence

 

(iii) Preoccupied [or Enmeshed] Attachment

Preoccupied adults lack the ability to move on from the childhood experiences, and are still overinvolved with issues relating to the early attachment relationship [generally preoccupied with dependency on their own parents and still struggle to please them].

 

(iv) Unresolved Attachment

The final category is reserved for adults who are unable to resolve feelings relating to the death of a loved one or to abuse they may have suffered [people who have not come to terms with a traumatic experience, or work through the mourning process]

It is to be noted that, people from lower socio-economic groups are slightly more likely to score as Dismissing. However the large difference is in people receiving clinical treat, the great majority of whom do not score as Autonomous on the AAI.

 

Are attachments stable over time? From Infancy to Adult Attachment Type

The main question should be asking ourselves is does the security of attachment change the life, or does infant-parent attachment set the pattern not only for later attachment in childhood, but even for one’s own future parenting? As attachment has become lifespan construct, these questions have generated considerable research and debate.

Many studies have now spanned a period of some 20 years to examine whether strange situation classification in infancy predicts Adult Attachment Interview (AAI) classification as young adults (Lewis et al., 2000; Waters et al., 2000). The outcome is varied, but some of these studies have found significant continuity of the 3 main attachment types; that is, from Secure to Autonomous; Avoidant to Dismissive, and Resistant (Ambivalent) to Enmeshed. Several studies have also found relationships between discontinuities in attachment classification, and negative life events such as the experience of parent divorce.

 

Relationship between Adult Attachment Interview (AAI) and Infant-Parent Attachments

Adult Attachment Interview (AAI) and classifications have been found to relate systematically to the security of the infant-parent attachment relationship. Autonomous parents are more likely to have securely attached infants, and parents in the 3 non-autonomous group. Dismissing, Preoccupied and Unresolved are much more likely to form insecure attachment relationships with their infants. This relationship has been identified for both patterns of infant-mother (e.g. Fonagy et al., 1991; Levine et al., 1991) and infant-father (Steele et al., 1996) attachment. Furthermore, unresolved maternal AAI classification has been identified as a predictor of insecure-disorganised attachment (Main & Hesse, 1990; van Ijzendoorn, 1995). Thus, the way in which a parent represents their own childhood attachment experiences is related to the types of relationship formed with their children.

 

Are attachment stable over generations?

On top of the degree of continuity over time for an individual’s attachment typing, there is also evidence for the transmission of attachment type across generations; specially from the parent’s AAI (Adult Attachment Interview) Coding and their infant’s strange situation coding. Main et al. (1985) had reported some evidence for such a link, and indeed the AAI coding system is based on it; it was argued that Autonomous adults would end up with Secure infants; Dismissing adults with Avoidant infants, Enmeshed adults with Resistant (Ambivalent) infants; and Unresolved adults would have Disorganised infants. [See Table C].

TC - Hypothesized relationships between maternal stage of mind (AAI), maternal behaviour, and child attachment type

TABLE C. Hypothesised relationships between maternal stage of mind (from the AAI – Adult Attachment Interview), maternal behaviour, and child attachment type

Van Ijzendoorn (1995) looked at a large number of available studies in the decade since Main’s work and found considerable linkage between adult AAI (Adult Attachment Interview) and infant Strange Situation coding; Van Ijzendoorn argued that this “intergenerational transmission” of attachment may be via parent responsiveness and sensitivity. We discussed above how this is only a partial explanation, and other aspects of maternal behaviour and of the home environment may also be involved.

We have considerable evidence for some degree of continuity of attachment security through life, and onto the next generation; but considerable evidence that this can be affected by life events. An adult’s attachment security can also be influenced by counselling, clinical treatment, or simply by reflection [self mind-mindedness].

Some insight into this matter comes from a study by Fonagy et al. (1994). In a longitudinal study with 100 mothers and 100 fathers in London, who are given the AAI and other measures shortly before their child was born. The strange situation was used subsequently to measure security of attachment, to mother at 12 months and the father at 18 months. As many other studies have discovered, the parent’s AAI scores predicted the Strange Situation scores of the infants. The researchers also calculated the estimates of the amount of disrupted parenting and deprivation which the parents had experienced themselves, and use the measures to find out if these influenced infant attachment, which they did. However, the amount of disrupted parenting and deprivation the parents had experienced interacted strongly with the way in which the parents had dealt with their own representations of their experiences of being parented. Coding the AAI (Adult Attachment Interview), the researchers developed a Reflective Self-function scale to assess the ability parents had to reflect on conscious and unconscious psychological states, and conflicting beliefs and desires. Of 17 mothers with deprived parenting and low reflecting self-function scores, 16 had insecurely attached infants, as might have been expected. Completely opposite to this scenario 10 mothers who had experienced deprived but had high reflective self-function scores, all had securely infants. It was argued that reflective self-function could have the saliency to change the internal working models of people, and also demonstrate resilience to adversity and a way of breaking the inter-generational transmission of insecure attachment.

Adults who experienced difficult childhoods but have overcome early adversity and insecure attachment by a process of reflection, counselling or clinical help, are known as “earned secures”, and could be distinguished from “continuous secures”, who had a positive upbringing and what most might quality as “normal” childhood. Phelps et al. (1998) made home observations of mothers and their 27-month-old children, and found that earned-secures, like continuous secures, showed positive parenting; under conditions of stress, both these groups showed more positive parenting than insecure mothers.

Another fascinating perspective on this issue of inter-generational transmission of insecure attachments would be the Holocaust study (Bar-On et al., 1998; van Ijzendoorn et al., 1999). The Holocaust refers to the experiences of Jews and other persecuted unwanted & unassimilated minorities [who did not want to be Germans] in the concentration camps of World War II to be securely offloaded/deported when Adolf Hitler’s Germany became the Third Reich and when the policies changed to focus on National Socialism and Imperial Intentions of Expansion and Conquest (1939-45).

LittleJewsToBeSentBack

Jew Children: Here we see Jew school children in 1942. They look like younger children who are just beginning school. Notice that at least 2 teachers are with them. By this time the Jewish children had been forced out of public schools. For a short time however, they we allowed to attend schools set up by the Jewish community. At the time this photograph was taken, the transports to the deportation camps had already begun. Often children under 10-years of age were not required to wear the badges, but some of these children look much younger.

Although many revisionist such as the English historian, David Irving, of this dark part of human history are finding out lies regarding the true people responsible for those massacres [if they did really happen under Adolf Hitler’s Third Reich] along with other atrocities as evil if not worse [than some deaths in a concentration camp for a section of a population that was causing instability to the proper functioning of a nation during a huge global conflict involving economic treaties, Jewish propaganda and alien-invasion agendas fused with unethical policies based on business & banking motives] committed by many of the “supposed good guys” from the Allies that involved the rape and murder of innocent children and women, fuelled by pure hate, Bolshevism and Jewish Communism against the native aryans of Germany [i.e. the German Volk/People].


Documentaire: L’Allemagne selon Joseph Goebbels (2004) / A documentary from the diary of Dr. Joseph Goebbels who decided to take a firm stance against the national destruction of Germany (and Western Europe), Christianity, and whom many consider to be among the bravest and most courageous of the last great Christian Aryan men to have walked the earth. [See Aryan Race et aussi Race Aryenne / Also to be noted perhaps quite surprisingly that there were strong ancient Aryan religious & mythological warrior values embedded in the mind of Heinrich Himmler (the Reichsführer of the SS), the person believed to have implemented the « Final Solution », or the Holocaust (remember the term itself originated from human sacrifices by Jews to their god, Baal), as he told his personal masseur & physician Felix Kersten that he always carried with him a copy of the ancient Aryan scripture, the Bhagavad Gita because it relieved him of guilt about what he was doing – he felt that like the sacred warrior Arjuna, who was simply doing his duty for his people and their future without attachment to his actions]


The National Anthem of the Third Reich (1933-1945) « Deutschlandlied » & « Horst Wessel Lied » (Instrumentals) / To note a silent, yet growing movement of conscious Aryans are beginning to re-evaluate the ideologies of the Fuhrer with a recent exposition at Montpellier showcasing 200 photographs from his photographer Heinrich Hoffman

But, since the majority on this planet have been made to believe one version where all the Jews and the alien army of the allies are the good guys, and all the Germans [including Adolf Hitler] were the blood-sucking vampires who also turned into cannibals on the week ends, we are going to base our comments on the politically correct [or should we say atavistic and savage?] version that the history books and mainstream publishers prefer. Politics too nowadays is in serious need of revision; are people really divided into 3 main categories? Left, Centre and Right? I tend to believe that we are above all this and have elements of all 3 embedded in us as modern human beings of the 21st century.

But getting back to the Bedouin cultured civilisation’s distinguished members, i.e. Jews as an example of victims in those concentration camps [that many people created myths of gas chambers when most were only found on the territory occupied by Stalin, while Hitler’s camps were found to have swimming pools, orchestras and kitchens], it is believed by most people of the 21st century who have no other options but to take in their news from mainstream Jewish-owned media, that besides being treated like a despicable rat, degraded and tortured, many of those to be deported kept in those camps were killed [some shot like parasitic animals as they tried to escape], leaving behind them orphaned children in traumatic circumstances.

Our question here however in regards to the focal point of this section, i.e. “attachment”, is whether such traumatic experiences could have an impact on attachment, and could this also have been transmitted inter-generationally to the Jewish children scattered around the globe today like modern gypsies?

The study we are looking at encompasses 3 generations of Jews, now grandparents, who went through the Holocaust [note that the name Holocaust itself comes from an event involving human sacrifices to the Jewish god, Baal], typically as children themselves who had lost their parents; their children, now parents; and their grandchildren. These generations are compared here with comparable 3-generation families who had not experienced the Holocaust.

It was found that the effects of the Holocaust were evident in the grandparent generations, who showed distinctive patterns on the AAI (Adult Attachment Interview), scoring high on Unresolved, as would have been predicted, and high on unusual beliefs – another predicted effect of trauma and unresolved attachment issues. They also displayed avoidance of the Holocaust topic; a very common finding was that the experiences had been so horrific and disgusting that they were unable to talk about their experiences with their own offspring.

However, inter-generational transmission of attachment type was quite low for this group of Jews. The Holocaust parents (‘children of the Holocaust’) showed rather small differences from controls, scoring just slightly higher on Unresolved on the AAI. This normalization process continued to the next generation (‘grandchildren of the Holocaust’), for whom no significant differences in attachment were found from controls. This seems to suggest a trend of  “Unresolved” as a normal trend of attachment among these Jews [note that this is linked to Disorganised attachment in infants and today some question whether Type-B Securely attached infants are really the “Best” way to be, and whether other personality characteristics also help shape the individual’s uniqueness throughout life, such as their reflective abilities and internal working models (reshaped by other meaningful events/relationships) – however it is also important to note that attachment types are known to remain and be transmitted over generations for the majority of people with low self-reflective skills and intelligence].

 

Disorganised Attachment and Unresolved Attachment Representation

The pattern of infant attachment classed as “Disorganised” from the Strange Situation procedure, was only acknowledged much later than the other well known attachment types [Secure, Inscure Avoidant & Insecure Resistant/Ambivalent], and appears to have rather distinctive correlates.

It has been noted that Disorganised infants may show stereotypic behaviours such as freezing, or hair-pulling; contradictory behaviour such as avoiding the caregiver [e.g. mother] despite experiencing severe distress on separation; and also misdirected behaviour such as seeking proximity to the stranger instead of the caregiver. These characteristic behaviours are known as signs of Unresolved stress and anxiety, and for these types of infants the caregiver is a source of fright rather than a symbol of safety (See Table C) – (see Vondra and Barnett, 1999, for a collection of recent research).

Van Ijzendoorn, Schuengel and Bakermans-Kranenburg (1999) reviewed a series of studies on Disorganized attachment, and argued that it was mainly caused by environmental factors [i.e. exposure]; although there is also some evidence for genetic factors in Disorganised infant attachment, and it is known to be higher in infants with severe neurological abnormalities [e.g. cerebral palsy, autism, Down’s syndrome] – around 35%, compared with around 15% in normal samples. However, Type-D (Disorganised Attachment) is also especially for mothers with alcohol or drug abuse problems (43%) or who have maltreated or abused their infants (48%). Type-D attachment is not higher in infants with physical disabilities; and it is not strongly related to maternal sensitivity as such, however there is evidence relating it to maternal unresolved loss or trauma [like the Jews of the Holocaust generation as mentioned above].

While the Maternal Sensitivity Hypothesis suggests that maternal (in)sensitivity predicts secure (B) or insecure (A,C) attachment, a different hypothesis has been proposed to explain Disorganised Type-D attachment (See Table C), which is that it is would be the result from frightened or frightening behaviour by the caregiver (generally the mother) to the infant, resulting from the mother’s own unresolved mental state related to attachment issues [e.g. abuse by her own parent; violent death of a parent/or close one; sudden loss of a child].

A study in London by Hughes et al. (2001) compared the Unresolved scores on the AAI (Adult Attachment Interview) for 53 mothers who had infants born next after still birth, with 53 controls [normal mothers], and found out that among the mothers who had previously stillborn infants, 58% scored as Unresolved, compared to 8% of Controls; furthermore, 36% had Disorganised (Type D) infants, compared with 13% of controls. A statistical path analysis [looking at the relationships among all the variables showed that the stillbirth experience predicted Unresolved maternal state of mind, and that it was this variable [i.e. Unresolved state of mind] then predicted infant disorganisation.

The hypothesised behavioural aspects of maternal unresolved state of mind [and Disorganisation in infants] were supported by the study in Mali reported above. A study in Germany by Jacobsen et al. (2000) provided further support in which 33 children were examined along with their mothers at 6 years of age. Disorganised attachment (assessed from a reunion episode) was significantly related to high levels of maternal expressed emotion, defined as speech to the child that was severely critical of them or over-involved with them.

Van Ijzendoorn et al., (1999), in a review, also found that insecure Disorganised (Type D) attachment in infants predicted later aggressive behaviour, and child psychopathology. Carlson (1998) found significant prediction from attachment disorganisation at 24 and 42 months, to child behaviour problems in preschool, elementary school and high school. Taking into consideration the prior links to parental maltreatment and abuse, it is highly likely that the Disorganised (Type D) attachment type will be found to be the most relevant aspect of attachment in understanding severely maladaptative or antisocial behaviour in later life.

 

Origins of the Insecure Disorganised State of Mind

The origins of insecure-disorganised (Type D) attachment is becoming an increasingly researched topic, and this may be due to the fact that early disorganisation (Type D) has been identified as a risk factor for later psychopathology (Fearon et al., 2010; van Ijzendoorn et al., 1999), with studies identifying a link between insecure-disorganised attachment in infancy and behavioural problems in later childhood (Lyons-Ruth et al., 1993; Munson et al., 2001; Shaw et al., 1996).

In Main and Hesse’s (1990; Hesse & Main, 2000) their seminal work led to the argument that these insecure-disorganised (Type D) infants have not been able to establish an organised pattern of attachment because they have been frightened by the caregivers or have experienced their caregivers themselves showing fearful behaviour. This is supported by findings that have linked insecure-disorganised attachment to infant maltreatment or hostile caregiving (Carlson, Cicchetti, Brnett & Braunwald, 1989; Lyons-Ruth et al., 1991), maternal depression (Radke-Yarrow et al., 1995), and maternal histories of loss through separation, divorce and death (Lyons-Ruth et al., 1991).

In a meta-analytic review however, van Ijzendoorn et al. (1999) reported that 15% of infants in non-clinical middle class American samples are classified as insecure-disorganised (Type D), suggesting that pathological parenting practices cannot fully account for disorganised attachment in infants. As highlighted by Bernier and Mains (2008), the origins of attachment disorganisation are very complex, involving factors ranging from infants’ genetic make up to parents’ experiences of loss or abuse, and much remains to be learned about why some infants are unable to form and organised attachment relationship with the caregiver.

 

Links between Attachment & Emotional Development

It is fundamental to understand and grasp the importance of the early stages of life, as the brain’s cognitive patterns are shaped by these early experiences that tend to have a lasting effect on personality. The infant’s earliest mode of exploring and engaging with the world revolves around conveying emotions: fear, discomfort, pain, contentment, happiness.

As we have already explained above in the section exploring the reasons why infants develop particular attachment types, the caregiver’s responses [not sensitivity, but mind-mindedness, i.e. the ability to respond “appropriately” to the cues] to such emotional cues and their representations of their own childhood emotional experiences [generally measured with the AAI for Autonomous, Dismissing, Preoccupied or Unresolved] are accepted as strong predictors of attachment security [i.e. Autonomous – Secure, Dismissing –Avoidant, Preoccupied- Resistant and Unresolved – Disorganised].

With this in mind, it is quite surprising that so little research has been conducted on the relation between security and children’s emotional development.

There are 2 main ways in which links between attachment and emotional development have been addressed:

(i) The research has investigated whether infants’ early emotional experiences predict attachment security

(ii) The researchers have explored whether the security of the infant-caregiver attachment relationship predicts children’s subsequent emotional development.

 

Emotional Regulation and Attachment Security

This section is focussed mainly on how caregivers’ ways of responding to the infants’ emotional cues predict later attachment security.

Mothers of insecure-avoidant infants have been found to withdraw when their infants express negative emotions (Escher-Graeub & Grossmann, 1983). Conversely, mothers of insecure-resistant infants typically find it difficult to comfort their infants effectively, meaning that their responses result in prolonging their infants’ feelings of distress (Ainsworth et al., 1978).

Cassidy (1994) argued that caregivers may enable their children to develop good emotional coping and regulation strategies through their willingness to acknowledge and respond to their children’s emotions. She also argued that secure attachment is characterised by the openness with which the caregiver [mother, father, etc] recognises and discusses the full spectrum of emotions [which leads to the child’s understanding that emotions should not be supressed and can be dealt with effectively]. Insecure-avoidant attachment is generally associated with caregivers failing to respond to their infants’ negative emotions because of their tendency to bias interactions in favour of positive emotional expressions. On the opposite, insecure-resistant attachment is associated with the caregiver amplifying the infant’s negative affect. Cassidy maintained that mothers of insecure-resistant children fail to emphasise the importance of attachment relationships, and therefore adopt strategies that fail to help the child regulate negative emotion, hence, prolonging the need for contact with the mother [or caregiver].

 

Affect Attunement

Cassidy’s views are in synchronisation with other theoretical positions, such as Stern’s (1985) characterisation of sensitive parenting in terms of effect attunement, with the sensitive mother being the type of human being who is attuned to all of her infant’s emotions, is also accepting and sharing in their affective content.

Insensitive mothers on the other hand, undermatch or overmatch their infants’ emotional signals because of their own perceptual biases.

In support of these approaches, Pauli-Pott and Mertesacker’s (2009) investigation revealed that mismatches between maternal and infant affect at 4 months [e.g. mother shows positive affect while her infant demonstrates neutral or negative affect] predicted insecure mother-infant attachment at 18 months. Mind-mindedness is also operationalised in terms of the caregiver’s tendency to accurately interpret the infant’s cognitions and emotions, and has been found to predict later attachment security (Meins er al., 2001). Thus, observations by a mother of her infant displaying surprise in response to a jack-in-the-box, followed by enigmatic comments such as “my infant is surprised” are associated with subsequent secure attachment. In contrast, insecure attachment is related to mothers misreading their infants’ internal stress by, for example, commenting that the infant is scared when no cue to suggest such an emotion is present in the infant’s overt behaviour. In more recent work it has been found that these inappropriate mind-related comments are particularly common in mothers of insecure-resistant infants, with mothers in this group being more likely to comment inappropriately on their infants’ thoughts and feelings than their counterparts in the secure, insecure-avoidant and insecure-disorganised groups.

Evidence suggests that mothers in the insecure-avoidant and insecure-resistant groups are aware of over-controlling and under controlling strategies respectively in coping with their children’s negative emotions. Berlin and Cassidy (2003) followed up a sample of infants who had been assessed in the strange situation in infancy, and questioned the mothers when the children were aged 3 about how they dealt with their child’s emotional expressive, and found that insecure-Avoidant (Type A) group mothers reported the greatest control of their 3-year-olds’ negative emotional expressiveness [e.g. expression anger or fear], whereas mothers in the insecure-Resistant(Ambivalent – Type C) reported the least control of children of their children’s expressing negative emotions.

These findings suggest that maternal behaviours associated with avoidant and resistant attachment that have been observed in infancy are stable and persist into the preschool years.

Security-related differences in the way in which children regulate their emotions are also in line with Cassidy’s (1994) approach. Spangler and Grossman (1993) took physiological measures of infant distress during the strange situation procedure and compared these measures with infants’ outward shows of upset and negative affect. The physiological measures showed that insecure-Avoidant (Type A) group infants were as distressed or more distressed than their secured group conterparts (Type B), despite the absence of overt behavioural distress observed in the insecure-avoidant (Type A) groups infants. It was therefore concluded by Spangler and Grossman that insecure-Avoidant infants mask or dampen their expression of negative emotions as a way of coping with the facts that caregivers are likely to ignore or reject their bids for contact and comfort when they are distressed.

Belsky, Spritz, and Crnic (1996) reported that 3-year-olds who had been securely attached in infancy were more likely to recall and memorise the positive emotional events that had witnessed on a puppet show, whereas insecurely attached children tended to attend and remember only the negative events. On the same note, Kirsch and Cassidy (1997) found that both secure and insecure-resistant attachment in infancy were associated at 3 years of age with better remembering and recall for a story in which a mother responded sensitively to her child than to a story where the child was rejected.

In contrast to the scenario above, insecure-Avoidant infants showed no difference in their recall of the responsive versus rejecting stories. Kirsch and Cassidy also found that 3-year-olds classified as insecure in infancy were more likely than those in secure groups to look away from drawings depicting “mother” – child engagement.

These findings suggest that the positive experiences of secure infants with their caregivers may result in these children attending more to positive emotional events because they are consistent with their attachment security.

 

__________

 

(III) The Genetic/Psychosexual Model of Development (Sigmund Freud)

“For generations almost every branch of human knowledge will be enriched and illuminated by the imagination of Freud” (Jane Harrison, 1850- 1928)

The Genetic Model of Psychosexual Stages

The genetic model that we are now going to explore may not have much to do with genes, and relates more to the “development” of the child. Sigmund Freud proposed that childhood development proceeds through a series of distinct stages to adulthood, each of them with their own themes and preoccupations.

The stages are based on the life-drive present in all organisms, as Freud proposed, and it seems logical from a physician who carried empirical work on the sexual organs of eels, to assume that all organisms have the embedded urge for “life” [i.e the life drive to keep itself and its species alive, which involves sexual selection and the fertilisation achieved through sex] that is primarily sexual but some also argued that it can be interpreted (unconsciously or consciously) in other forms [as flamboyant French psychoanalyst, Jacques Lacan proposed in his Theory with the Symbolic, the Imaginary and the Real] to suit a sophisticated society [e.g. France] with all its dimensions. Freud proposed that the psychosexual stages are understood to be organised around the child’s emerging sexuality.

It is important however to not exaggerate or misinterpret Freud’s assumption and also to remember the logic and vital purpose behind the sexual (life) drive in organisms in its own existence and continuity [breeding]. This is also a very good discussion point for the 21st century as it seems to imply that all healthy organisms should have healthy sexual drives, but whether these should « always » find expression through genital sexual acts with another organism is debatable and questionable from an ethical and moral perspective [especially for those not in a healthy and stable relationship]; hence many psychologists recommend « masturbation » as a healthy and safe alternative in managing excessive sexual desires in both young people and adults.

In the process of the child’s emerging “sexuality”, the term « sexual drive » itself meant more than simply adult genital sexuality, and from a psychological perspective, was broadly referring to a physiological/biological sense of “pleasure in the body” and more to “sensuality”. As many psychologists who based their foundations on some aspects of Freudian perspectives, it is assumed that adult sexuality is nothing more than the simple culmination of an orderly set of steps in which the child’s “psychosexual” focus shifted from one part of the body to another, with these body parts or “erotogenic zones” all having something in common with the generation of pleasure; which are orifices lined with sensitive mucous membranes.

Hence, Sigmund Freud may have adequately proposed in a statement regarding mental health that, “the only unnatural sexual behaviour is none at all.”, taking note once again that the term “sexual” from a psychologist exploring the developmental stages of a child generally tends to refer more to “sensuality”. The erotogenic body parts with orifices and sensitive mucous membranes leads to the infant sensuality being initially centred on the mouth (oral cavity), followed by the anus and then the genitals in early childhood. After some characteristic drama at about the age of 5, the child’s sexuality goes nearly completely dormant for a few years, before re-emerging with a vengeance [a rush of hardly managed sexual feelings] when puberty hits.

As the tradition on the debate of the development of the mind itself as an entity [that reflects in linguistic form the desires, both conscious and unconscious of the human organism] goes on among psychologists in the quest for these answers, we are also familiar with critics [mostly from the reductionist schools of thoughts (e.g. Pavlovian) such as the cognitive-behavioural enthusiasts and the medical department with its accolade, the pharmaceutical industry] who have not been entirely positive about Freud’s contribution to knowledge and are still unconvinced [perhaps due to their philosophy on a kind of methodological epistemology that is lacking to cope with matters of the mind] about the unconscious part of the mind that plays a huge role in our conscious behaviour. This may not be completely negative to intellectuals who subscribe to a version of reality that is embedded in language since critics in many cases have led to systematic investigations [scientific methodology] and until now there is an increasing body of evidence that points to the existence of an unconscious drift/urge/motive that exists in all organisms [e.g. as we noted in the essay about Biological Constraints in Learning by Operant Conditioning and also other studies carried out on priming along with observations of the symptomatic manifestations of certain mental disorders such as OCD and Panic Attacks].

The psychoanalytic theory has been modified by some of the best minds of the psychoanalytic tradition [e.g. Jung, Lacan, and some components adopted by ourselves in the conception of the model of mental life within the Organic Theory] since Freud left the questions open with the freedom of dialogue over the concepts and their expansions and applications throughout various dimensions [e.g. analysing qualitative subjective experiences of the expression of love and passion, or the obsoleteness of politics in modern society, or the impact of animal studies in designing a human world]. However, between all the versions of Freud’s theories, there are 3 components that have never been denied by any great psychoanalyst, which are the 3 structures first mentioned in the early Topographic Model, that is, the Unconscious, the Subconscious and the Conscious. These were later replaced with the Structural Model, which is the popular version that remapped and renamed the concepts, and which includes the (unconscious) id [present in all new born infants which consists of impulses, emotions & desires – id demands instant gratification of all wishes and needs], the (conscious, me) ego [which acts a mediator between reality and the desires of the id] and the (subconscious) superego [the conscience: the sense of duty & responsibility], that adepts such as Jacques Lacan and Carl Jung rejected over the earlier Topographic model [being one that is more flexible for the development of further refined models that also have the option to define the life force in other ways than the questionable specificity of the Structural Model’s id, ego & superego.

 

The 5 Psychosexual Stages

Stage I: The Oral Stage (from birth to 1 year old approximately)

From Freudian assumptions, it is believed that the voracious sucking of infants is not pure nutritional, although the infant clearly has a basic need to feed, it also takes a “pleasure” in the act of feeding, a feeling that Freud did not hesitate to quality as sexual and perhaps more “sensual” at this stage as babies appear to enjoy the stimulation of the lips [in play] and the oral cavity, and will often happily engage in “non-nutritive sucking” when they are no longer hungry and the milk supply is withdrawn. Beyond being an intense source of bodily pleasure – an early expression of later sexuality – sucking also represents the infant’s way of expressing love for and dependency on its feeder [normally it is the mother, but it can also be a primary caregiver that the child is attached to, hence Lacan proposed that the Oedipal & Electra complexes may not only not be true for ALL cases, but the child’s early sexual feelings may be projected on other primary caregivers and not necessarily the direct parents]. The sucking behaviour also serves to a general stance that the infant takes towards the world, one of “incorporation” or the taking in of new experiences.

 

Stage II: The Anal Stage (1 to 3 years old approximately)

At the second stage, the Anal stage, the focus shifts from one end of the digestive tract to the other at it happens at around the age of 2, when the child is developing an increasing degree of autonomous control over its muscles, including the sphincters that control excretion. After the incorporative passivity and dependency of the oral stage, the child begins to take a more active approach to life [note the term active also in line with Jean Piaget’s views on the development of the human child]. Sigmund Freud proposed that these themes of activity, autonomy and control, play out most crucially around the anus as the child learns to control defecation, and learns that it can control its direct external environment, in particular its caregivers attention, by expelling or withholding faeces. Moreover, the child takes a sort of sadistic pleasure in this control, a form of pleasure described as “Anal erotism”. An important conflict for the child during this stage involves toilet training, with struggles/disapproval taking place over the parents/caregivers demand that the child control its defecation according to particular rules. However, the anal stage represents a set of themes, struggles, pleasures, and preoccupations that cannot be reduced in any simple way to toilet-training, as many common psychology students from the wrong linguistic vein are in caricatures of Freud maybe in a defensive act for their lack of linguistic subtlety to understand the mental life and the models that govern it.

 

Stage III: The Phallic Stage (3 to 6 years old approximately)

Gradually, although still in the early childhood years, the primary location of sexual pleasure and interest shifts from the anus to the genitals, where the little boy starts to become fascinated with his penis and his counterpart on other side of the gender register, the little girl with her clitoris. However, this stage is known as “phallic” and not “genital” because Freud maintained that both sexes were focused on the male organ; “phallus” referring not to the actual physical organ, the anatomical penis, but to its “symbolic value”. Briefly explained, the phallic stage is set as the little boy understanding that he has the penis [which has a symbolic value] which the little girl lacks, and develops the belief that he could possibly lose it. In contrast, the little girl does not have a penis and wishes to have one.

This is the very first time that the difference between the sexes comes into play in childhood development, and the contrast between masculinity and feminity, really becomes an issue for the child. It is also the 1st stage at which Freud’s psychosexual theory recognises sexual differences, and marks the crucial point at which, children become gendered beings [between the ages of 3 – 6].

The little boy’s and the girl’s differing relation to the phallus [remember: the “symbolic value” of it not the actual organ] plays a vital role in unfolding drama that takes place within the family during this stage, somewhere around the age of 3 to 5. It has been dubbed the “Oedipus complex”, after the Greek legend in which Oedipus unwittingly murders his father and marries his mother, his original love-object [remember the attachment period in Bowlby’s along with breastfeeding] after all, as is consequently envious of his father, who seems to have his mother to himself. The boy’s fearful recognition that he could lose his penis [symbolically: “masculinity”] – “castration anxiety” – becomes focussed on the idea that the competing male for the love of the mother[the father], could inflict this punishment on him if the boy’s sexual feelings and desire for the female figure of the caregiving mother is recognised. So, faced with fear, he renounces and represses the sexual feelings and desire, to instead identity with the father, becoming his imitator rather than his rival. In this process, the boy learns about masculinity and internalises the societal rules and norms [e.g. about relationships] that the father represents [the development of the Super-Ego, a sense of duty and responsibility, i.e. “conscience” takes place as the Structural Model suggests].

In the case of the little girl, matters are slightly different, and the developing child soon feels her lack of a penis keenly (“penis envy”) and blames the mother for leaving her so grievously unequipped, and then the father soon turns into her primary love-object [the “Electra Complex” appears as the opposite of the “Oedipus” Complex], and the mother her rival.

A similar process to the little boy now takes place in the little girl’s realm, resulting in the repression of her sexual feeling, desires and love, to shift to an identification with her mother, and hence with feminity. However, given that the girl is not under any “castration” threat, this process occurs under much less emotional pressure than in the little boy’s case. Consequently, perhaps due to this difference in emotional pressure, Freud proposed that the Electra complex was resolved less conclusively and with much less complete repression in girls than in boys, but also that girls tend to internalise a conscience [preconscious, or superego] that is in some ways weaker and less prohibitive and punitive than boys. It is not surprising that such a controversial claim about girls has been highly criticised specially with no scientific evidence to back it up; and is perhaps also one reason why Freud’s account of Oedipal [Electra complex] conflict in women has been the subject of much revision [e.g. by Jacques Lacan].

 

Stage IV: Latency (6 years old to puberty)

After the upheavals of the Oedipus and Electra complexes, the sexual drives go into a prolonged “semi-hibernation”. During the pre-pubertal school years, children engage in much less sexual activity and their relationships with others are also desexualised. Instead of desiring the primary caregivers and original love-objects, their parents, children now begin to identify with them – having structured their understanding of the world. However, this sudden interruption of childhood sexuality is largely a result of the massive repression of sexual feelings that concluded the phallic stage. One of the main consequence of this repression is that children come to completely forget their earlier sexual feelings, a major source [Freud claimed] of our general amnesia for early childhood experiences. Other institutional settings with their own social models such as formal schooling, reinforce the repression of sexuality during latency, leading children to focus their energies instead on mastering “culturally valued” knowledge and skills. Freud observed that the desexualisation of latency-age children was less complete among so-called “primitive” peoples.

 

Stage V: The Genital Stage (from the onset of puberty to death)

The latency period of forced or socially imposed sexual repression ends with the biologically-driven surge of sexual energy that accompanies puberty. This marks the final stage of psychosexual development where it all the previous stages were successfully completed, leaves the person with the ability for mature love with sexual feelings. It is important to note that the focus on sexual pleasure is once more shifted to the genitals as it was before the stage of latency [during the phallic stage (3 – 6 years old)] however, now it is fused with the ability for sensible and true affection for the object of desire [and not simply immature sexual feelings trying to find expression from an inadequately developed brain being projected at the easiest accessible caregiver].

In addition, both sexes are now invested in their own genitals rather than sharing a focus on the “symbolic value” of the penis as it occurred during the “Phallic stage”. The Genital Stage therefore marks the end of the “polymorphous perversity” of childhood sexuality. However, these erotic moments have not completely vanished but are instead subordinated to genital sexuality, often finding expression in other subtle ways [e.g. sexual foreplay].

According to the genetic model of psychosexual stages, we pass through each of the psychosexual stages on the way to maturity. However, we do not pass through them unscathed, and there are many ways in which people have problematic difficulties in particular stages [unable to progress successfully] and when such incidents happen a “fixation” develops. A fixation is simply an unresolved difficulty involving the characteristic issues of the particular stage, and leads to a fault-line in our personality, according to Freudian developmental perspectives.

If the individual failed to receive proper and reliable nurturance and gratification during the oral stage – or alternatively if they were over-indulged – a fixation on that stage may develop. It is believed that when a person is confronted with some forms of stresses, they may revert to the typical immature ways of dealing with the world of that period [at the particular point in time of that stage], this process was referred to as “regression” by Freud.

In some cases, fixations may lead to full-fledged mental disorders: Oral fixations are linked to depression and addictions, anal fixations to obsessive-compulsive disorder, and phallic fixations to hysteria [in severe cases]. Fixations [generally later countered by Reaction Formation] do not simply represent forms of behaviour and thinking that people regress to when faced with difficulties but the whole personality [thought structure] or “character” – the term Freud preferred – may be organised around the themes of the stage at which the person is most strongly fixated. As a result, Freud proposed a set of distinct stage-based character types:

(i) Oral Characters

This category of characters tend to be marked by passivity and dependency [think of the sheep metaphor], and are liable to use relatively immature ego defences such as denial.

(ii) Anal Characters

Anal people tend to be inflexible, stingy, obstinate and orderly, with a preference for defence mechanisms such as the isolation of affect [hide their feelings] and reaction formation.

(iii) Phallic Characters

Phallic characters are generally impulsive, vain and headstrong [think alpha-male prototype] with a preference for a defensive style that favours repression.

It is important to note that this 3-part typology is the closest that the psychoanalytic theory of personality comes to bringing forward an explanation for individual differences in personality from early childhood experiences. A phase of development pivotal to the other 2 mentioned theories which also attribute the foundations of fundamental structures to the period of infancy and childhood, although they all also acknowledge the individual’s ability to shape their own minds and correct their own problematic traits through reflection, and indeed as mentioned in the section on John Bowlby’s theory of attachment mothers with high reflective abilities were able to reshape the internal working models of their children’s attachment style and subsequent emotional development. It is to also be noted how all these 3 theorists although different in their perspectives, have been inspired by each other’s works, the idea of attachment itself was inspired by Freud’s pre-oedipal claims, and Jean Piaget like Sigmund Freud came from the school of thought that viewed the mind as an “active” entity in its development and creation, and not a “passive” entity generated by a ball of soft matter acting like a junction box with scripts for stimuli.

 

Psychoanalysis, then and now

One of the main claims of Freudian theory is that much of what motivates us to move forward in life is determined by the unconscious, and since by the reductionist mind state of the common researcher who sadly only had empiricism to dream of a better life for himself, these unconscious processes cannot be measured [such as moles, weight, fingers, teeth, sheep, cattle, etc], and hence it is often claimed [without much understanding or linguistic abilities or skills in discourse and philosophy] that belief in Freudian ideas is precisely that – beliefs rather than mechanical models based on empirical evidence [e.g. medicine, physics, surgery, chemistry, biology, etc – all the disciplines of the hard sciences].

However, while Freud’s views are almost impossible to test with reductionist quantitative methods, his theories and claims have influenced many psychologists who work with different methodologies and the unconscious processes of the brain are also being backed up by emerging fields that focus on the physiology of the brain [e.g. cognitive-neuroscience].

To illustrate one of those views that are hard to test empirically, consider the Freudian notion of “Reaction Formation”. It is assumed for example that if an individual is harshly [by strict parents] toilet trained as a child then the Freudian prediction would be that the person becomes “anally retentive” [i.e. excessively neat and tidy]. However, if in some ways we do recognise such tendencies in ourselves [once again prompting to the existence of a well developed with reflective and perspective taking abilities fully developed by Piaget’s standards], maybe even unconsciously, then we may react against it [Reaction Formation occurs] and we actively become very untidy.

This suggests that we are in control of ourselves and we have the ability to reverse the effects of our upbringing and early childhood experiences, which means in turn that it is impossible to predict a child’s development despite the fact that the first 6 years from birth are supposedly critical in determining later personality formation [self-reflective people save themselves from the mediocrity of the masses].

Freudian Theory has been of immense importance in pointing out 2 possibilities. One is that early childhood can be immensely important in affecting and determining later development [a position also adopted by other major theorists as we have seen such as Bowlby], and the other is that we can be driven by unconscious needs and desires which we are not aware of [until exposed to the right environmental stimuli that release them from their hidden depths]. Thus, it is assumed that if we not complete one of the childhood psychosexual stages very well, it could reflect itself later in adult disorders such as neurotic symptoms, but we would not be aware of the source or cause of the problem. The only way to come to terms with these deeply embedded problems in the depth of the individual’s psyche that has more saliency than the minor cognitive schemas for basic environmental interactions [e.g. making a cup of tea or a sandwich], is through close intensive sessions of psychoanalysis (see Picture G) in which the analyst peers into the unconscious to try and unravel [discover] the problems that occurred during the patient’s childhood development that is causing the current problems.

PG Psychoanalyst tries to discover what went wrong in your childhood that is causing your current problems

PICTURE G. The psychoanalyst tries to uncover the childhood unresolved issues to find the causes of the current problems.

Whatever its weaknesses are, the psychoanalytic theory remains the most complete theory in terms of depth and detail in capturing the essence of the human mind [soul as metaphor, or psyche], and today there are still many who believe that psychoanalytic theories are fundamental in understanding human development with many theoreticians who have brought forward variations and alternatives to Freud’s proposals on some controversial issues [e.g. Jacques Lacan, John Bowlby and Carl Jung] while many of his proposals have also lead to the scientific discovery of unconscious mental processes.

_____________________________________

 

*****

 

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Essay // Clinical Psychology: Learning Disabilities, Anxiety, Depression & Schizophrenia and the Effectiveness of Psychotherapy

Part 1 of 5 | Children and Adolescents’ Mental Health Services (CAMHS) & Learning and Intellectual Disabilities

ClinP_Descr_Header_01

CAMHS deal with the psychological issues of people under the age of 18. They are a non-specialist service and often refer to other more specialised departments following the initial assessment of patients. The most common cases tend to be adolescents with depression and anxiety whose manifestations are not different to those of adults and so are treated fairly similarly.

Inclusivism in Learning Disabilities

In 1969, Bengt Nirje adopted and developed the concept of normalisation in Sweden and beautifully described it as…

“making available to all mentally retarded people patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways of life of society.”

– Nirje, 1980

Learning Disability is not just an impairment in Cognition

The social impairment of Learning Disabilities – US Statute 111 – 256: Rosa’s Law defines the factual impairment, the imposed or acquired disability and the awareness of being different.

The Normalisation Theory

This theory focuses on the mainstream trends of social devaluation or deviancy making. Some categories of people tend to be valued negatively due to their behaviours, appearances and characteristics, and this places them at the risk of being devalued [according to the Normalisation Theory of Nirje on the societal processes he assumed] – people fulfil various social roles and stereotypes. As part of the deviancy making or social devaluation, the unsophisticated minds of the masses generally do not mean to stereotype, however they seem to do it unconsciously [the unconscious is a concept Sigmund Freud and Jacques Lacan acknowledged in their psychoanalytic theories of mental/psychological activity and mental health problems linked to psychopathic tendencies in people towards others], i.e. deviant groups with social symbols or images that are at a higher risk of being devalued are the focus of the normalisation theory, which is believed to be done with the aim of providing them with the skills they need and eventually change the status of these deviant groups to functional members of society.

Society tends to distance itself from deviant groups without any purpose or belonging, however psychologists provide support for the social integration and valued social participation of people with learning disabilities through exercises that involve learning through imitation. This challenges stereotypes within wider society through direct experiences of spending time with people who are affected by learning disabilities.

While psychology evolves and sophisticated and modern theories about intelligence and communication such as our « Organic Theory » take shape, we hope that observations such as this one may be digested and understood by the masses, that is:

« While the communicative patterns [language] in human primates vary with socio-behavioural and geographical patterns; creativity and IQ remain constant and do not change. Intelligence and creativity cannot be stopped because of linguistic differences, since talented and gifted humans do not choose the location of their birth nor their linguistic heritage but still contribute to the enhancement of our civilisation. »

 

Which concludes that that the intelligence of an invidual when assessed on a range of variables [e.g. perception, fluid intelligence, artistic creativity, reasoning, emotional intelligence, courage, values, etc] cannot be deduced by simply assessing their academic abilities, since human life has various sides to itself. Hence, the true worth and value of an individual may always remain a problem and a mystery to fully assess [since most only assess people on the variables they are interested in, for e.g. a company looking for a secretary will assess the applicant on her ability to handle office politics, and not other abilities essential to exist as a human within civilisation], and this seems to go in line with Jean Piaget’s deduction about the uniqueness of the human organism and mind.

Michel-Ange-Toujours-A-Apprendre-Always-Learning

« I am still learning » – Michael-Angelo at the age of 87 / Image: La Création d’Adam (1508 – 1512)

Neurodevelopmental Disorders & Intellectual Disabilities

Neurodevelopmental disorders are disorders occurring due to the biological dysfunction of the brain that in turn lead to developmental deficits that come in a range that can be very specific to global impairment. These groups however often co-occur together, i.e. one could be affected with Intellectual Disability (ID) and also Autistic Spectrum Disorders. Psychologists are expected to show great care when assessing this group of disorder as they vary in severity. Severity has 4 Specifiers and 3 Domains [Intellectual].

Specifiers: [1] Mild – [2] Moderate – [3] Severe – [4] Profound

Domains [Intellectual]: [1] Conceptual – [2] Social – [3] Practical


Intellectual Domains

The first domain, which is the Conceptual Domain refers to all things learnt at school and required for employment and adequate independent functioning within the community. Secondly, the Social Domain refers to social, developmental and emotional factors associated to age. This manifests in them as being victims of manipulation and abuse by others. Finally, the Practical Domain refers to all skills required to live healthily [also this is subject to interpretation depending on contexts, socio-linguistic and cultural settings].

Intellectual Disability

For one to be qualified as intellectually disabled, we would have to meet all the 3 criteria below:

  • Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgement, learning [also from experience].
  • Deficits in adaptive functioning that means failure to meet developmental milestones within the socio-cultural standards. Limited function in daily life, participation, communication, independence in multiple environments (i.e. Global).
  • Onset is during developmental period [childhood – another link to the Psychoanalytic theory of Sigmund Freud & Jacques Lacan]


Assessment and Judgement

Careful distinction must be made when assessing patients suspected of suffering from Intellectual Disabilities (ID) between the low end of normal function and ID itself. The most widely used method clinically are IQ assessments and typically suggest any score that is 2 Standard Deviations below the mean [IQ scores of 75 +/-5] and whether the patient has had any clinical experience. Assessment based on the patient’s reasoning in real-life situations are also made. Global Developmental Delay is a term reserved for children under 5 who cannot adequately be assessed, but have missed all their developmental milestones.


Associated Features with Intellectual Disabilities (ID) to look for when diagnosing patients are:

  • Social judgment
  • Assessment of risk
  • Self-management of behaviour – interpersonal relationships and emotions
  • Motivation in school, university or work
  • Lack of communication skills and functional problem behaviours
  • Gullibility [Diagnosis is based on how people and society mistreat them – quite shocking or controversial?]
  • People with Intellectual Disabilities (ID) are also at high risk of suicide


Prevalence of Intellectual Disabilities

In the UK, 1% of people suffer from intellectual disabilities and 0.006% of the population have severe disabilities requiring supported living [that is about 360, 000 people in the UK] – a slight bias with a ratio of 1.6:1 towards males; this is due to the vulnerability of the male brain.


Autism Spectrum Disorders

As psychology evolves more consideration are being given to a dimensional aspect of abnormal behaviour rather than the usual dimensional [i.e. inflexible and sometimes exaggerated in terms of descriptive precisions disregarding individual fluctuations in symptomatic manifestations] constructs of mental disorders. Autistic Spectrum Disorders (ASD) was the first mental disorder to initiate such a shift from categories to dimensions.

  • Autistic Spectrum Disorders (ASD) with Intellectual Disability (ID) = Autism
  • Autistic Spectrum Disorders (ASD) without Intellectual Disability (ID) = Asperger’s Syndrome


Characteristics of Autism Spectrum Disorders

ASD is characterised mainly by deficits in social communication and restricted patterns of behaviour. For a diagnosis of ASD the deficits must appear early in the developmental period [however they cannot be diagnosed until the demands of a particular task exceeds the child’s capabilities] – so more severe it is the earlier it is diagnosed [e.g. Rett syndrome].


[A] Communication in ASD

In ASD, it is common to find persistent deficits in social communication and social interaction across multiple contexts illustrated by:

  • Deficits in social-emotional reciprocity, ranging from abnormal social approach. Failure to initiate or respond to social communications. Reduction in sharing interests, affect and emotions.
  • Deficits in non-verbal communicative behaviours used in normal social interactions. Abnormal or no eye contact, body language or deficits in reading [understanding] gestures. A total lack of facial expression and non-verbal communication.
  • Deficits in developing, maintaining and understanding relationships [e.g. from difficulties in adjusting behaviour to suit context]. Difficulties in sharing imaginative play or in making positive social acquaintances or friends. Hardly any interest in any form or peers.


[B] Behaviour in ASD

It is also fairly normal to notice restricted, repetitive patterns of behaviour, interests, or activities manifested by at least two of the following:

  • Stereotyped or repetitive motor movements, use of objects, or speech
  • Insistence on sameness, inflexible adherence to routines, or ritualised patterns of behaviour. Shows extreme distress at small changes, difficulty in transition, rigidity, insistence on same route taken or foods
  • Hyper or hypo-reactive to sensory inputs or unusual interest in sensory aspects of the environment (indifference or hyper-responsive to pain, temperature, sound, textures, excessive smelling to touching of objects, visual fascination with movements or lights.

ASD may also manifest itself with or without intellectual disability, with a similar scenario for language impairment, and can be associated with medical or genetic conditions or environmental factors [exposure]. ASD can also be associated with another neurodevelopmental, mental or behavioural disorder and can also comprise catatonia.
Features to look out for

  • People with ASD often have uneven profiles or abilities – even the high functioning variants, and this can lead to substantive stress for them
  • They also often have odd motor idiosyncrasies – such as an odd gait, clumsiness and abnormal ambulatory movements.
  • Disruptive, challenging behaviour and injuries are also very common
  • As sufferers of ASD age, they are also more prone to developing anxiety and depression and are likely to end up in a catatonic state


Prevalence

Autistic Spectrum Disorders (ASD) seem to be a genetic disorder, however it involves a variety of genes. 15% of ASD is due to a known mutation in over 90% of concordance studies with twins. Most researchers nowadays suggest that it is inherited and polygenic [lots of genes from genetic ancestry with each adding their weight to the likelihood of the disorder manifesting]. Males are 4 times more likely to suffer from ASD than females, and even high functioning adults with ASD have poor functioning, such as low rates of independent living and employment – older adults tend to become isolated and do not engage in help-seeking behaviours [note that this is different to individuals who may have a solitary personality by conscious choice or a highly selective social circle in personal relationships based on values, in ASD the patients are generally not conscious of the causes of their debilitating condition]

Specific Learning Disorders

Specific Learning Disorders are characterised by the following:

[A] Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that has persisted for longer than 6 months:

(1) Inaccurate or slow reading
(2) Difficulty understanding meaning in what was read
(3) Difficulties with spelling
(4) Difficulties with written expression
(5) Difficulties mastering number sense, number facts and calculation
(6) Difficulties in mathematical reasoning

[B] The affected academic skills are substantially and quantifiably below the expected level for the chronological age causing interference with academic, occupational or daily living

[C] Learning difficulties begin during school-age years, but will only manifest itself and be diagnosed when the affected person’s capabilities are stretched by demands

[D] It is also independent and not caused by another health or psychological disorder


Specifications of Specific Learning Disorder

SLD generally involves impairment in reading, writing and mathematics. If it is mild in intensity, the person can generally compensate. Moderately affected people however cannot compensate, but will respond to specialist teaching. Finally, severe conditions require specialist teaching in a specialist school as learning will not occur without such arrangements.


Features to look out for in confirming SLD

  • SLD can occur in any individual, even those classed as gifted (IQ 130+)
  • It is usually diagnosed in the early years, but in higher ability individuals it may manifest in odd ways especially when their compensatory methods are undermined
  • Patient generally have difficulties with motor co-ordination
  • It is a life-long condition and does not improve with therapy, but has to be compensated for
  • Patients also tend to have working memory deficits and keep messy environments
  • Early signs include mispronouncing words, struggling to break down words into syllables


Prevalence of Specific Learning Disorders (SLD)

SLD tend to occur in premature children or among societies with a very low birth rate. It is also more common in children with parents that smoke cigarettes [nicotine?] and is 8 to 10 times higher in families with a heritability index of 0.6 and 3 times higher in males [the vulnerability of the male brain once again]. The problems it causes with attention are likely to predict problems with the mathematical and reading components of the brain. SLD usually ends with unemployment, under-employment depression, poorer mental health and suicidal behaviour – support of any kind alters all of these outcomes.

 

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Part 2 of 5 | Anxiety Disorders

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Anxiety disorders are linked to the development of irrational fears of situations that are not life-threatening (Antony & Stein, 2009a). The avoidance of feared situations or experiences also lead to non-adaptive behavioural patterns. People suffering from anxiety disorders generally have fears accompanied by intense physiological arousal displayed by some or all of the following features: accelerated heartbeat, sweating, trembling, sensations of shortness of breath or smothering feelings of choking, chest pain, nausea, numbness or tingling, and chills or hot flushes. Other experiences of dizziness, derealisation (feelings of unreality) or depersonalization (feelings of being detached from the self) are also present in some cases.

In contemporary psychology there are a number of distinctions made between a variety of anxiety disorders based on the developmental timing of their emergence, the classes of stimuli that elicit the anxiety, the pervasiveness and topography of the anxiety response, and the role of clearly identifiable factors in the aetiology [the cause, set of causes, or manner of causation] of the anxiety.

The six main anxiety disorders are described below.


[1] Separation Anxiety

This condition most occurs in children and is generally manifested by a recurrent and persistent fear that is aroused when separation from the parents or caregivers is anticipated or imminent (American Psychiatric Association, 2000; Furr et al., 2009; Pine & Klein, 2008; World Health Organization, 1992). The persistent, excessive worry about losing, or about possible harm befalling a parent is the main characteristic of Separation Anxiety Disorder with nightmares on the similar themes also present in some cases along with recurrent head-aches, stomach-aches, nausea and vomiting. Separation anxiety is also one of the most common causes of school refusal, and sufferers may also display a refusal to sleep without being in close proximity with the parents.


[2] Phobias

Phobic anxiety is the irrational and intense fear aroused when one is faced with an object, event or situation from a clearly defined class of stimuli which is exaggerated in terms of danger posed (American Psychiatric Association, 2000; Blackmore et al., 2009; Hofmann et al., 2009; World Health Organization, 1992). When the person affected is exposed to the phobic stimulus, or anticipates its exposure, panic attacks may arise in adults whereas is children this may lead to excessive crying, tantrums, freezing or clinging. The persistent avoidance of phobic stimuli in phobias is endured with intense distress and this affects an individual’s personal functioning.

In the DSM, specific phobias are subdivided into those associated with animals, injury (including injections), features of the natural environment (such as heights or thunder), in particular situations (such as elevators or flying). These specific phobias are different from social phobias and agoraphobia.

In those affected with social phobias, anxiety is generally mainly aroused by social situations [e.g. public speaking, eating in public where there is the possibility of scrutiny by others and humiliation or embarrassment as a result of acting inappropriately]. In those with agoraphobia, the condition is known to manifest itself with panic attacks in public places, such as being in a queue, or on public transport – hence, these situations tend to be compulsively avoided to prevent the reoccurrence of the panic attacks.


[3] Generalized Anxiety Disorder

One of the main characteristics in general anxiety disorder is the constant feeling that misfortunes of various sorts will occur (American Psychiatric Association, 2000; Bitran et al., 2009; Hazlett-Stevens et al., 2009; World Health Organization, 1992) and the anxiety is not focused on one particular object or situation along with difficulties controlling the worrying process and a belief that worrying is uncontrollable.

General anxiety disorder is mainly composed of nervousness, restlessness, difficulty relaxing, feeling on edge, being easily fatigued, difficulties in concentration, irritability, tearfulness, sleep disturbance and signs of autonomic over-reactivity such as trembling, sweating, dehydrated mouth, light-headedness, palpitations, dizziness and stomach discomfort. [DSM requires some or more of those symptoms to be present]

Case Example of Generalised Anxiety Disorder

Margie, a 10 year old girl was referred to the psychologist after displaying excessive tearfulness in school, the condition which had been gradually amplifying over a number of months and the bouts were unpredictable. Margie would often end up in tears while playing with her friends during break time or when spoken to by the teacher. In the family doctor’s referral letter she was described as a worrier like her mother.

Presentation

in the assessment interview Margie explained that her worries were mainly about a routine daily activities and responsibilities, she would also worry about doing poorly at school and that she had made mistakes which would later be discovered, that her school friend would not like her, that she would disappoint her parents with the way she did her household chores, that she would either be too late or too early for the school bus, that there would not be any space for on the bus and that she would forget her school books. Her worries also extended to health with frequent stomach aches.

The safety of a family also troubled her, she would worry that her house would be struck by lightning, that the river would break its banks and flood the low-lying fens where she lived, washing away her whole house. The future was also a major concern of hers as she worried about failing her exams and being unable to find a satisfactory job, and being unable to find a marital partner or marrying an inadequate person. A continuous feeling of restlessness with the inability to relax was also reported by her.

Family History

The family was very close and Margie was the eldest of four children and the only girl. It was observed during the intake interview that the mother and the father displayed symptoms of anxiety, while the former had been treated with benzodiazepines for anxiety over a number of years. The family also admitted to regularly discuss their problems about their own health and safety and their own worries about the uncertainty of the future.

The father, Oliver was employed by the insurance company and regularly have conversations at the dinner table about the accidents and the burglaries that had befallen his client, and Margie regularly participated in these conversation, being the eldest among her siblings. However the main concern of the parents was about Margie’s tearfulness which they believed was unusual along with her worries and fears which they thought as legitimate. Margie spent a lot of time with her parents’ company but also had a couple of close friends with whom she played at the weekends.

Formulation

Margie was diagnosed with generalised anxiety disorder. The precipitating factor for the condition was not apparent as it had gradually evolved over the course of Margie’s development. The referral however, was precipitated by episodes of tearfulness at school. The predisposing factors in her case comprised of a highly likely possibility of genetic vulnerability to anxiety and exposure to family culture characterised by an excessive concern with safety and oversensitivity to dangerous situations. The ongoing parental conversations about potential threats to the family’s well-being likely maintained the condition along with inadvertent reinforcement of Margie’s tearfulness at school, where her tears were responded to with considerable concern.

The protective factors in the case included good premorbid adjustment, the parents’ and the school’s commitment to solving the problem and the availability of peer group support. [This formulation is diagrammed below]

General Anxiety Disorder Formulation

Treatment

In this particular case, treatment involved family work focused on helping Margie parents reduce the amount of time they spent discussing themes related to danger and threats to their health and safety, and increase the amount engaged in activities and discussions focused on Margie’s strengths and capabilities. The parents were also assisted in coaching Margie into learning relaxation skills and mastery oriented coping self- statements. Eventually Margie showed improvement in her adjustment in school with some reduction in anxiety and tearfulness.

[4] Panic Disorder

In panic disorders, there are recurrent unexpected panic attacks; an ongoing primary fear of further attacks; secondary fear of losing control, going insane, having a heart attack or dying (American Psychiatric Association, 2000; Ballenger, 2009; Hofmann et al., 2009; World Health Organization, 1992). Acute episodes of intense anxiety our experienced in panic attacks, and these reach a peak within 10 minutes. They are characterised by autonomy hyper arousal shown by some of the following symptoms:

– Palpitations

– Sweating

– Trembling or shaking

– Shortness of breath

– Feelings of choking or smothering

– Chest pain or discomfort

– Nausea or abdominal distress

– Dizziness

– Chills or hot flushes

– Parasthesias (Numbness or tingling sensations)

– Derealisation (Feelings of unreality)

– Depersonalisation (Feelings of being detached from oneself)

In panic disorder, patients tend perceive normal fluctuations in autonomic arousal as a stimulus that provokes anxiety, with the belief that these may signal the onset of a panic attack. During a panic attack, patients typically tend to report an irresistible urge to escape the location where the attack occurred and to avoid such situations in the future. Public settings are usually the most common location where panic attacks take place [e.g. queues, public transport, shopping mall, etc] and acute autonomic arousal is only alleviated upon escape from these places or situations – hence secondary agoraphobia often develops when the patient fears leaving the safety of their homes in case of panic attacks occurring in public settings.

[5] Posttraumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) tends to occur after a catastrophic trauma such as a terrorist attack, an armed combat/robbery, a natural or man-made disaster, a serious accident that was perceived to be potentially life-threatening for oneself or others, torture, child abuse or rape.

PTSD is mainly composed of:

– Recurrent intrusive traumatic memories

– Intense anxiety in response to these memories and ongoing hyper arousal in anticipation of their recurrence

– attempts to regulate anxiety and hyper arousal by avoiding cues that trigger traumatic memories and attempts to suppress these memories when they intrude into consciousness (American Psychiatric Association, 2000; Ehlers, 2009; Friedman, 2009; World Health Organization, 1992).

Recurrent, traumatic memories include flashbacks, nightmares, or repetitive trauma themed play in the case of children, and these occur in response to internal (psychological) or external (environmental) cues that symbolise the traumatic event or aspects of it. Since patients with PTSD tend to anticipate the recurrence of traumatic memories, they experience chronic hyper-arousal which may in turn lead to difficulties in concentration, sleep difficulties, hyper-vigilance and irritability. In PTSD, the attempts to suppress traumatic memories and the avoidance of trauma-related situations may turn out to be unsuccessful, when such a scenario occurs, the PTSD person generally experiences an increase in the frequency and intensity of past traumatic memories. Emotional numbing is also quite common in chronic cases due to the frequent attempts to keep the trauma-related memory out of consciousness – this eventually leads to the inability to recall the traumatic memories. To some this may seem like a solution but the cost is excessive since emotional numbing does not only result in the exclusion of trauma-related emotions such as anxiety and anger out of consciousness, but also tender feelings such as love and joy – which cease to be experienced by the patient.

PTSD may also lead to a subjective sense of foreshortened future to the patient and this may also be accompanied by limited involvement in his/her usual activities.

[6] Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is generally characterised by distressing obsessions and compulsive rituals that reduce the anxiety associated with those obsessions [like 2 opposing forces] (American Psychiatric Association, 2000; Matthews, 2009; World Health Organization, 1992; Zohar et al., 2009). Obsessions are stereotyped thoughts, impulses or images that are recurrent and persistent. These cause serious anxiety to the patient since they are experience as senseless, uncontrollable and involuntary, and are linked to issues such as obscenity [this does not mean that healthy people with normal sexual feelings in healthy relationships have OCD], violence and danger [for e.g. some people suffer from irrational fears of the possibility of a catastrophe occurring unless symmetry or order is maintained, or there may be fears of losing control and violently raping or assaulting others, or fears of contamination [hygienic].

These compulsions are ritualistic and repetitive accompanied by stereotyped behaviours such as hand washing, ordering and checking or mental acts such as repeating words silently [which some patients feel compelled to do to regulate the anxiety caused by the obsessions], counting or praying [this should not lead to the belief that all people with faith in God suffer from OCD]. Compulsions are generally excessive attempts or unrealistic ways to avert imagined dangers entailed by these recurrent obsessions that are debilitating and are usually recognized as pointless while repeated attempts are made to resist them [once again this seems to be linked to the unconscious yet active component of mental activity and yet again leads us to Sigmund Freud and Jacques Lacan].


Clinical Features of Anxiety Disorders

The 6 anxiety disorders listed above are classified into the domains of Perception, Cognition, Affect, Arousal, Behaviour and Interpersonal Adjustment. In regards to perception, the disorders vary in the classes of stimuli that elicit the anxiety in the patient.

i)Perception

In cases of Separation Anxiety, the separation itself is the stimulus. Where phobias are the condition present, it is specific creatures [e.g. animals], events [e.g. injury], or situations [e.g. meeting new people] that trigger the anxiety. With Generalized Anxiety Disorder [GAD], the interpretation of multiple aspects of the environment end up being interpreted as potentially threatening. Panic disorder is characterised by somatic sensations of arousal such as tachycardia being perceived as threatening since they are treated as the signals that lead to full-blown panic attacks. In people with PTSD external and internal cues that bring back memories of the trauma that led to the condition elicit anxiety. In Obsessive Compulsive Disorders (OCD) stimuli that evoke obsessional thoughts elicit anxiety [e.g. potentially dirty environments or situations may give rise to obsessional ideas about hygiene and cleanliness, and anxiety about contamination.

ii)Cognition

It is important to note that in all 6 of those listed anxiety disorders, that the central organizing theme around cognition is “detection and/or avoidance of danger”. In children with Separation Anxiety there is the irrational belief that the caregivers or parents will be harmed if the separation occurs. In people affected by Phobias there is a constant fear of being harmed by either the feared object or creature, or being in the feared situation [e.g. being bitten by a god – in the case of Dog Phobia OR being negatively judged by meaningless strangers that have no connection or impact on the life of the patient in the case of Social Phobia]. As for Generalized Anxiety Disorder (GAD), patients tend to catastrophize about any features of their environment [e.g. fears of their house being burnt down, or that they will be the victim of a car crash, or punishment for some wrongdoing, they will be forsaken by those they consider as friends, and so forth – they also believe that their worries are uncontrollable. In Panic Disorder, there is the belief that more panic attacks are imminent and that they might be fatal to the patient. In many cases secondary agoraphobia also develops as they individual develops the belief that remaining in the safety of their homes might lower the probabilities of suffering from a panic attack. As for PTSD, there is the belief that as long as the intrusive memories of the trauma are forced out of consciousness, the danger of re-experiencing the intense fear, distress and horror associated with the traumatic event that led to the condition of PTSD can be avoided. Obsessive Compulsive Disorder (OCD) generally leads to obsessions mainly concerned with dirt and contamination; catastrophes such as fires, illness or death; symmetry, exactness and order; religious scrupulosity; disgust with secretions and bodily wastes [e.g. urine, saliva or stools]; lucky or unlucky numbers and extreme, wild, violent and even dangerous sexual thoughts [risk-taking] – the neutralisation of the threat posed by specific obsession-related stimuli is believed to be achieved through being engaged in specific rituals.

iii)Affect

In all 6 of the mentioned anxiety disorders affective states generally follow the beliefs about threat and danger, and these are characterized by feelings of uneasiness, restlessness and tension. In the case of OCD, outbursts of anger may occur if the patient is restricted from executing his/her compulsive rituals or if compelled to approach the feared stimuli; and in children with Separation Anxiety Disorder (SAD) may display aggressive tantrums if compelled to stay in school without their caregivers or parents. In Post-Traumatic Stress Disorder (PTSD), on top of the affective experiences of tension and uneasiness, emotional numbing arises from repeated attempts to exclude all affective material from consciousness.

iv)Arousal

The pattern of physiological arousal varies depending on the frequency of contact with the feared stimuli. In Separation Anxiety Disorders (SAD), hyper-arousal only occurs when separation is anticipated or imminent. In the case of Specific Phobias hyper-arousal only manifests in the present of the feared object or animal. In General Anxiety Disorder (GAD), a pattern of ongoing hyper-arousal can be observed, while in Panic Disorder and PTSD it is moderate followed by brief episodes of extreme hyper-arousal – these occur during attacks in Panic Disorder and when memories of the traumatic event intrude into consciousness in PTSD. In the case of OCD, specific cues related to the obsessions evoke acute and intense episodes of arousal.

In somatic symptoms the extent to which physiological arousal finds expression varies, for e.g. recurrent abdominal pain and headaches are quite common in Separation Anxiety. Sleep problems also occur in most Anxiety Disorders. In Panic Attacks it is also common to notice full blown attacks with sweating, feelings of choking or smothering, shortness of breath, trembling, nausea, dizziness, chest pains, hot flushes or chills, parasthesias, depersonalization or derealisation.

v)Behaviour

All Anxiety Disorders are characterized by avoidance behaviours, and in Specific Phobia, avoidance may even lead to a constriction in lifestyle [using an Injury Phobia as example, the patient may refuse to take part in any form of physical activity [e.g. sports] or ride a bicycle]. In other cases, the patient sometimes become house bound due to his compulsive avoidance, and this generally occurs in Separation Anxiety Disorder, Generalized Anxiety Disorder, Panic Disorder and PTSD. In those with PTSD, the use of alcohol or drugs to alleviate negative affect and suppress traumatic memories is quite common; and in OCD the patients generally engage in compulsive rituals in a desperate effort to regulate their anxiety associated with obsessional thoughts [it may be fair to note the relation between the Anxiety [as the Signifier] and the Obsessional Thoughts [as the Signified] in a Lacanian perspective here to point out the logic behind the flamboyant Frenchman’s model of Mental Activity based on Freud’s initial Topological Model – the Unconscious, the Preconscious and the Conscious]. These compulsions in OCD genereally include washing, repeating a particular action, checking, removing contaminants, touching, ordering and collecting.

vi)Interpersonal Adjustment

All 6 Anxiety Disorders affect interpersonal adjustment in a precise manner. In cases of Simple Phobia, interpersonal difficulties arise only in those situations where the individual does not conform or co-operate with normal activities [deemed social] so as to avoid the feared stimuli [e.g. a brief episode of marital conflict may occur if a husband refuses to enter an elevator at a shopping mall because of his claustrophobia]. Separation Anxiety Disorder (SAD), Panic Disorder (PD), Generalized Anxiety Disorder (GAD) and Post-Traumatic Stress Disorder (PTSD) sometimes prevent young people from attending school or adults from attending work, and in all those situations friends or family relationships may be seriously compromised. In the case of OCD peers or relatives may sometimes attempt to reduce the sufferer’s anxiety in participative actions in the compulsive rituals or in other cases, they may also exacerbate the anxiety by punishing the patient for his or her compulsive behaviour. In extreme cases, these compulsions can become so extreme that the affected person becomes constricted.


Epidemiology, Risk Factors and Course of Anxiety Disorders

Anxiety Disorders are the most common types of psychological disorders, and the lifetime prevalence rate in adults in the US National Comorbidity Survey Replication was 28.8% (Kessler et al., 2005). There is a consensus that Phobias are the most prevalent anxiety disorders and OCD is the least prevalent across a wide range of epidemiological studies (Kessler et al., 2009; Furr et al., 2009). For Phobias, lifetime prevalence estimates range from 6% to 12%, whereas those with OCD fall below 3%. Generalized Anxiety Disorder (GAD) has a lifetime prevalence of 1% to 6 %, whereas Panic Disorder in adults and Separation Anxiety in children range from 2% to 5%. In National representative samples, the prevalence of PTSD ranges from less than 1% or 2% in Western Europe to almost 8% in the US. The great variability is believed to be due to the fact that PTSD rates depend on the prevalence and traumatic exposure within specific locations geographically and the vulnerability of the populations within these countries to developing PTSD – in populations exposed to terrorism the prevalence is 12% – 16% (DiMaggio & Galea, 2006).

In people suffering from Anxiety Disorders, there is also a high risk of comorbidity [i.e. other anxiety disorders may also be present], and up to 1/3 of those suffering from Anxiety Disorders also suffer from another (Kessler et al., 2009) – they may also occur comorbidly with mood disorders in adults as well as children, substance use disorder in adults and adolescents and disruptive behaviour in young people/children (Furr et al., 2009; Huppert, 2009; Zahradnik & Stewart, 2009).  In cases where substance misuse is also present, the use of drugs or alcohol is quite common in managing anxiety.

OCD is also present in a significant proportion of people with eating disorders such as anorexia nervosa. (Halmi, 2010).

We can observe a clear age and gender difference in the prevalence of Anxiety Disorders (Antony & Stein, 2009a; Furr et al., 2009; Kessler et al., 2009) and across most studies that are available, the modal age of the onset in Separation Anxiety Disorder and Specific Phobias is during the developmental phase in childhood [a stage pointed out by both great Western psychotherapists, Freud and Lacan, and also John Bowlby in his observational research on the development of attachment types in children at this critical stage of development], whereas that of anxiety disorders generally happens during adolescence or adulthood. In both adults and children, there is a tendency for more females to suffer from Anxiety Disorders than males, with the exception to this balance being for OCD which has a similar number men and women suffering from the condition although it is the rarest of anxiety disorders.

Anxiety Disorders tend to show a recurring episodic course with a gradual reduction in prevalence over the course of the life cycle (Kessler et al., 2009). It is also worthy to note that most children with anxiety disorders do not grow up to be adults with anxiety disorders or depression, however most anxious adults do have a history of childhood anxiety disorders. There are a number of risk factors associated with Anxiety Disorders and these include anxiety disorders or psychological disorders in the direct genetic network, an inhibited temperament of behaviour, neuroticism as a trait of personality, a personal experience of psychological problems, a history of over-controlling or critical parents, a history of conflict and violence and a history of stressful life events (Antony & Stein, 2009b; Pine & Klein, 2008). In the scenario of Anxiety Disorders, a behaviourally inhibited temperament is generally the tendency from birth – to become nervous and withdrawn from unfamiliar situations and stimuli. Neuroticism is a trait of personality that gradually develops over the life-span, and it is characterized by the tendency to escape negative affect and includes hostility, anxiety and depression in its manifestations.

In those suffering from Post-Traumatic Stress Disorder (PTSD) the additional factors that increases the risk for development include the severity of the trauma, high-life stress following the trauma, low socio-economic status, low support [from friends or those considered as friends], low intelligence and low educational level (Ehlers, 2009; Ozer et al., 2003). In PTSD, dissociative experiences tends to refer to abnormalities of perception, memory or identity such as derealisation [seeing the world as dream-like], depersonalization [seeing oneself from an external perspective or inability to recall important information]. In the case of parents with PTSD, their children are also at a higher risk of developing the disorder (Pine & Klein, 2008).

 

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Part 3 of 5 | Depression

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The states of being happy or sad are adaptive feelings, and many behaviours that lead to happiness among human beings, such as socializing [with the people that matter to the subject], becoming completely absorbed in productive work and developing longstanding friendships that are meaningful around values and loyalty, are important not only for the emancipation of the individual but also for a harmonious and functional society that embraces the qualities of mankind in all its creative aspects.

Sadness on the other hand is a psychological state commonly preceded by loss [of various kinds, which may range from material objects to valued relationships or abilities/skills and status related to them through accident or disease or other situations], and it is a negative feeling which may also be adaptive, in a sense that it is a reminder to most people [at least for those who are NOT philosophically oriented / cultured or have an understanding of values and loyalty in interpersonal relationships], that valued things or people need to be taken care of if they do not want to lose them in the future, especially the common volatile brain [i.e. the basic Darwinian instinct-guided average brain that lacks reflective abilities, reasoning skills, intuition and insight, while also failing to realises or understand the motivation behind its behaviour until matters have taken a disastrous course]. Sadness is also a way of signalling to others that we as human beings also need care and elicits [to most psychologically healthy human beings with a theory of mind] support that soothes our emotional pain – this is what makes us a superior breed of primates, i.e. our ability to reason and evolve with emotions as a propulsive form of energy for both individual and group, like Alexandre Dumas put it, “Un pour tous et tous pour un!” [French for “One for all and all for one!”].

Some extreme states of mood such as depression and mania are less adaptive than happiness and sadness; and it is now commonly known that during periods of hypomania or mania some patients suffering from Bipolar Disorder [which is characterized by episodes of mania and depression] produce highly creative artistic work (Silvia & Kaufman, 2010). This should not lead us to the conclusion that ALL creative people with extreme ways of exploring and expression their emotions through art suffer from Bipolar Disorder. But for those who do suffer from Bipolar Disorder and produce creative work, this highly valued asset comes at a price, since these individuals generally involve themselves in high-risk behaviours that come with the possibility of severe dehydration and exhaustion during manic episodes.

Seasonal Affective Disorder [or Winter Depression, its colloquial name] is a condition that is believed to be linked genetically to our cave-dwelling ancestors from the prehistoric era, who may have hibernated – an adaptive behaviour for the ancestors. However, in the world of today, depression does not seem to serve any adaptive function, and despite this it remains a highly prevalent condition that affects up to 25% of the population (Kessler & Wang, 2009); because of this prevalence the main focus of this section will be on Major Depressive Disorder. It is quite fundamental to grasp that depression is not simply “feeling sad”, as Major Depressive Disorder is an ongoing condition characterized by episodes of low mood and loss of interest in pleasurable activities along with other symptoms such as poor concentration, fatigue, pessimism, suicidal thoughts, and sleep and appetite disturbance. Depression is a serious public health concern because it radically decreases the quality of life of those affected, is a huge economic burden in terms of reduced productivity [and lack of creativity] among the national work force, and it also has adverse effects on the mental health and adjustment of the children of the depressed people (Garber, 2010; Kessler & Wang, 2009). This section will focus on the clinical features, epidemiology, risk factors and course of depression [suicidal risks will also be discussed].


Clinical Features of Depression

Severity

Depression can be classified as mild, moderate to severe, depending on the degree of impairment

Melancholia

In regards to somatic or melancholic features, in severe depression where there is a loss of pleasure in all activities [known as anhedonia] and a lack of reactivity to pleasant stimuli along with diurnal variation in mood and sleep and appetite disturbance, we tend to qualify such episodes as having melancholic features. Historically [please take note that this is not the case anymore], there was an ongoing view that these symptoms reflected “endogenous”, a genetically determined and biologically based form of depression, as different to a “reactive” depression arising from exposure to stressful life events and environmental adversity (Monroe et al., 2009).

However, the difference between these 2 forms of depression was not supported by empirical research, which instead shows that ALL episodes of depression are preceded by stressful life events, and that in any given scenario, we tend to have a combination of genetic vulnerability and environmental adversity that contribute to the development of depression (Parker, 2009).

Psychotic Depression

When mood disrupting delusions and hallucinations are present, depressive episodes are described as having psychotic features. Mood-congruent delusions are generally firmly held beliefs that are extremely pessimistic in nature and that have no basis in reality [illogical and cannot be explained and justified; for e.g. that a completely innocent individual is guilty of many wrongdoings and deserve to die. Mood-disrupting hallucinations in depression are generally auditory and sometimes involve the hearing of voices in a complete absence of any form of external stimuli [uncontrolled and unimagined and ongoing for months], which has negative advices to the sufferer [e.g. You are a failure, you are guilty of wrongdoing, or evil].

Among children, adolescents and adults, there has been a range of clinical features identified through both clinical observation and empirical research (e.g. Bech, 2009; Brent & Weersing, 2008; Gotlib & Hammen, 2009; Nolen-Hoeksema & Hilt, 2009a). Common clinical features of depression tend to affect the domains of cognition, perception, mood, somatic state, behaviour and relationships. Loss is once again a main thematic feature in depression as pointed out by Psychoanalytic Theories [loss of any kind, e.g. material, emotional, relationship, valued attribute due to sickness/accident, health, etc], and clinical features may be linked to those different domains of mental life.

Perception

In regards to perception, depressed individuals who have suffered some form of loss [internal or external] tend to perceive reality and the world as one where further losses are possible, and individuals who suffer from depression also selectively attend to negative stimuli and features in the environment. This leads them to engage in further depressive cognitive patterns in their thoughts processes and unrewarding behavioural patterns which amplify their depression’s severity – in cases of severe depression, mood-congruent auditory hallucinations are often reported. Psychologists tend to go with the assumption that such severe perceptual abnormality is present only when patients report hearing harsh critical voices or containing depressive contents [as mentioned above]. These auditory hallucinations are also present in schizophrenia, however they are not always mood-congruent like in depression.

Cognition

Depressed patients tend to describe the world and the fabric of reality of their subjective experience in negative terms, this also include descriptions of themselves and their abilities [e.g. occupational and social accomplishments] – this negative evaluation is often portrayed as guilt for not living up to the standards [they set themselves based on their ‘perceived’ abilities] or for letting others down. They perceive their direct environments [peers, network, family, work colleagues or school/university] as hostile, apathetic, critical and unrewarding. The future is also described in very bleak terms by those suffering from depression, and they also report little if any hope that matters will improve. When extreme hopelessness is reported is it usually accompanied with excessive guilt for which the patients believe they should be punished – suicidal ideas and intentions may also be declared. In depressive delusional systems, extremely negative thoughts about the self are generally reported with the world and their future entangled in them.

Besides the content and thoughts being incredibly negative and bleak, depressed patients also tend to display concentration problems and logical errors in their thinking. These mistakes in reasoning are also characterized by a tendency to maximise the significance of negative events and minimize the significance of positive ones. Depressed patients also suffer from memory problems and struggle to remember happy events but instead have global over-general autobiographical memories about both positive and negative events. In addition to these, this category of patients also suffer from concentration, attention and decision-making problems that in turn give rise to difficulties managing leisure activities requiring sustained attention and academic or occupational responsibilities.

Affect

The impact on the patient’s affect tends to lead to low mood, and diurnal variations in mood and anhedonia. The depressed mood is usually reported as a feeling of sadness, loneliness, emptiness and despair. Diurnal variations in mood is usually quite common in severe cases of depression, with the patient’s mood generally being worse in the morning or after waking up. In cases of major depression, as a person moves from mild to moderate to severe depression, the increasing number of symptoms along with the intensity can also lead to intense anxiety. Generally, fears are experienced in the form of “Will this get worse? Am I stuck in this living hell forever? Will I ever be myself again? Will I be able to prevent myself from committing suicide to escape? Irritability is also a characteristics of depression, with the patient sometimes expressing their anger at the source of their loss [e.g. anger at a deceased one for abandoning the grieving person or sometimes at the health professional for not being able to alleviate their depressive symptoms].

Somatic State

The changes in the patient’s somatic state associated with depression include the disturbances of sleep and appetite, the loss of energy, failure to make age-appropriate physiological growth, weight loss, pain symptoms and a loss of interest in sexual activities. Commonly, depressed people struggle to find sleep and eat insufficiently due to their poor appetite; these symptoms are known as vegetative features. The sleep disturbances in depressed people generally involve problems trying to sleep, wakefulness at night or early-morning sleep disruption. Other symptoms such as racing thoughts and engaging in depressive rumination while unable to sleep is also quite common. In atypical cases of depression, patients may sometimes oversleep due to a constant feeling of exhaustion and consume excessive food due to an increased appetite or due to the feeling that eating may temporarily reduce their distress.

Medically unexplained chest, abdominal and back pain along with headaches are some of the additional features of depression. In some cases the pain symptoms are some of the first signs that would be reported to the doctor and it is only when the medical investigations of these symptoms turn out to be negative that depression is suspected to be the cause. All the somatic symptoms mentioned are consistent with research: dysregulation of neurobiological, endocrine and immune functions is associated with depression and the sleep is also affected.

Behaviour

Depressed patients are characterized behaviourally by the reduced and slow activity levels [psychomotor retardation] that they display, and are often helpless [without any control over their abilities] about their inability in getting involved in activities that could have helped their condition by bringing a sense of achievement or connectedness to meaningful [those chosen by the individual as a person with significance to him/her – note that it is a choice] people in their life. In rare cases some individual become house bound and immobile; such a condition is known as depressive stupor.

One of the major risks of depression is self-harm [a clear distinction is made between non-suicidal deliberate self-harm and suicidal behaviour]. In non-suicidal tendencies, patients may cut or burn themselves to distract themselves from the depressive feelings. In some cases, some have taken non-lethal overdoses to elicit attention and care from their close ones or to simply gain admission to hospital and remove them from the stressful situations that may have been amplifying their depressive symptoms.

Relationships

Depressed patients generally report a deterioration in their relationships with a range of significant figures in their lives from a wide range of environments [from professional to personal], and describe themselves as lonely, et unable or unworthy to take steps to try and engage in some form of contact with others. Surprisingly, when the depressed attempt to overcome their loneliness by talking to others, they tend to come across as repulsive, unpleasant and draining through their depressive behaviour, pessimistic belief and sometimes arrogant narcissistic talks, this drives away those they interact with.


Epidemiology, Risk Factors and Course of Depression

The most common mood disorder is Major Depression, and it has a lifetime prevalence rate of 6 – 25% in international community studies (Kessler & Wang, 2009). In the US National Co-morbidity Survey Replication the lifetime prevalence of DSM-IV Major Depression was 16.6% (Kessler et al., 2005). It is good to note that Depression is less common among pre-pubertal children than adolescents and adults (Brent & Weersing, 2008). Among children the number of boys to girl with depression is equal, however this changes in adolescence and by adulthood; compared with men, about twice as many women have depression (Nolen-Hoeksema & Hilt, 2009b).

In most cases of depression, there are many comorbid disorders also present. In the US, National Comorbidity Replication Survey, 59% of depressed patients suffered from comorbid anxiety disorders and 24% had comorbid substance use disorders (Kessler & Wang, 2009). Depression also tends to follow a chronic relapsing course, with up to 80% of people suffering from recurrent episodes, and it has been found that the median duration of episodes in community samples typically lasts for about 5-6 weeks. In clinical samples depressive episodes tend to last for about 5 to 6 months; the majority of cases however recover within 1 year and about half of patients continue to suffer from fluctuating residual symptoms between those depressive episodes; and for less than 10% of patients, recovery does not occur and chronic depressive symptoms persist and most cases relapse within 5 years (Angst, 2009; Boland & Keller, 2009).

During treatment, as more depressive episodes occur, we tend to notice a decrease in inter-episode intervals and a reduction in the amount of stress required to trigger the onset of further depressive episodes, an issue related to Stress Theories (Boland & Keller, 2009).

NOTE: Stress theories propose that individuals develop depression following exposure to stress. The diathesis- stress theories propose that depression only follows after exposure to stress in people who have specific biological or psychological attributes that render them more vulnerable to stressful life events, and the most vulnerable require the least stress to trigger depression (e,g., Joiner & Timmons, 2009: Joormann, 2009; Levinson, 2009). On the other hand, Stress-generation theory proposes that people with certain personal attributes inadvertently generate excessive stress, which in turn leads to depression (Liu & Alloy, 2010)

The risk factors for depression include a family history of mood disorders, female gender, low socio-economic status involving educational and economic disadvantage, and adverse early family or institutional environment, the depressive temperament, a negative cognitive style, deficits and self-regulation, high levels of life stress, and low levels of support from meaningful others (Garber, 2010; Hammen et al., 2010).

Risk factors for recurrent major depressive episodes identified in the US collaborative depression study of 500 patients, include a history of three or more prior episodes, comorbid dysthymia (often known as Double Depression), comorbid anxiety and substance use disorders, long duration of individual episodes, poor control of symptoms by antidepressant medication, onset after 60 years of age, the family history of mood disorder, and being a single female (Boland & Keller, 2009).

Four small category of people who suffer from depression, deficits the visual processing of light and the season of the year are risk factors for depression (Rosenthal, 2009). These people, who experience regularly recurring depressive episodes in the autumn and winter, with remission in the spring and summer, are generally considered as suffering from Seasonal Affective Disorder. These patients develop symptoms in the absence of adequate light and respond positively to enhanced environmental lighting, often referred to as “Light Therapy or Treatment” (Golden et al., 2005).

In community samples about 3.4% of people with major depressive disorder commit suicide; the rate in clinical samples about 15%; about 60% of completed suicides (studied by psychological autopsy) had suffered from depression (Berman, 2009).

 

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Part 4 of 5 | Schizophrenia

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Before covering the topic of schizophrenia, it is important to take note that the condition is commonly confused to refer to another condition that involves split-personalities, and this is mostly a trend that lives in the world of pop culture and Hollywood. About 40% in the UK equated split or multiple-personality with schizophrenia in a National Survey (Luty et al., 2006). However, after covering this section, we hope that the confusion will be cleared since schizophrenia does not refer to conditions that involve split-personalities [the closest scientific equivalent to this state of being, is a condition known as Multiple Personality Disorder or Dissociative Identity Disorder and are both not as debilitating as schizophrenia with treatment being much more effective].

Schizophrenia refers to a collection of seriously debilitating conditions characterised by positive and negative symptoms in this organisation (Mueser & Jeste, 2008).

Delusions and hallucinations are the principal positive symptoms of schizophrenia. Delusions are strongly held, unfounded, culturally alien beliefs. For example with persecutory delusions, individuals may believe that a group of people conspiring to harm them [this should not lead us to believe that a healthy person with a suspicion caused by the critical analysis of a person or group of people is deluded and is schizophrenic – remember that human beings have individual personalities too]. Hallucinations on the other hand involve experiencing sensations in the absence of external stimuli [e.g. with auditory hallucinations – which are the most common type in schizophrenia – people reported hearing voices that others cannot hear].

The negative symptoms of schizophrenia include flattened affect, alogia and avolition. In the case of flattened affect, the emotional expression of the patient is limited, and with alogia there is an impoverished thought that is inferred from the patient’s speech. Short brief and concrete replies are given to question [this is referred to as poverty of speech], or in some cases speech production is normal but it conveys little meaning and information due to repetition, or being overly abstract [referred to as poverty of content], or being too concrete. When patients suffer from avolition, a lack of goal directed behaviour can be observed. The negative symptoms generally give rise to a restricted lifestyle involving little activity, little social interaction with others and little emotional expression – disorganisation may also affect both speech and behaviour [disorganised, illogical, incoherent, speak are the signs of an underlying formal thought disorder]. Disorganised catatonic behaviour is usually characterised by the complete absence of spontaneous activity or excessive purposeless activity.

Schizophrenia is a debilitating and re-occurring condition that comprises the capacity to carry out normal activities, and also consists of incomplete remission between episodes.  (Hafner & der Heiden, 2008). Symptoms of schizophrenia typically appear in late adolescence or early adulthood, wax and wane over the life course, and have a profound long-term effect on patients and sometimes their families.

Schizophrenia is considered to be the most debilitating of all psychological disorders, since it affects the patient’s capacity to live independently, make and maintain satisfying and enduring relationships, engage in family life, parent children effectively, work productively and enjoy leisure activities. Rates of unemployment, homelessness and imprisonment are very high among people with schizophrenia, although just under 1% of people suffer from schizophrenia, the World Health Organization has rented as second only to cardiovascular disease in terms of overall disease burden internationally (Murray & Lopez, 1996).

Despite these unattractive facts, the scientific advances in our understanding of schizophrenia, along with advances in both psychological and pharmacological approaches to treatment, making it increasingly realistic for people who suffer from schizophrenia to live far more productive lives than were previously possible (Mueser & Jeste, 2008).


Case Example of Schizophrenia

A young man, named Julian was referred for assessment and advice by his doctor. Since returning to his rural home after studying in London for one year, his parents started to worry about his state because of his strange behaviour. After failing as exams, the patient said that he had to ”sort his head out”. Since his return, the parents had noticed a lack of concentration along with incoherent speech during his conversations which happen most of the time – his behaviour was also erratic and unpredictable.

The parents concern grew when Julian suddenly went missing a few weeks prior to the referral. After hours of searching, he was found about 55 Km from their home, dehydrated, exhausted and dressed only in sport shorts, singlet and running shoe. After enquiry, the latter developed the belief that a secret mission in the East had to be undertaken by him; and as he started jogging in the morning, he headed eastwards towards the rising Sun. He even planned to jump onto the car ferry when he reached the coast, across the sea over to Holland, and continue east towards India in his secret mission [reminiscent of a James Bond episode].

Since the episode, Julian has spent much of the time in his room muttering to himself, often becoming quite distressed, and when his parents spoke to him they found it hard to make any sense out of his words.


Family History

Julian was the 19-year-old son of a prominent farmer in a rural English village where the whole family lived in a large amount on an extensive estate. The farm was managed by the patient’s father; who had a traditional authoritarian manner and a positive, if distant, relationship with Julian. While he was incredibly worried about Julian and to the search for him, once the latter was found, the father returned to work unless the care of his son to his wife.

The mother was an artist who dressed flamboyantly, behaved in a theatrical manner and held century, unconventional beliefs [e.g. Conspiracy theories about many issues, was interested in eastern mysticism and believe that faith healing and alternative medicine were preferable to traditional Western medicine]. These characteristics of a personality along with her beliefs affected her treatment of Julian after the ”Running East” episode, where she engaged the latter in intense conversations about mystical meaning of the psychotic experiences that led to him trying to make his way to India on foot. Rather than taking Julian to the accident and emergency department of the local hospital for assessment, she brought him to a feeler and then than homeopathist. It was only of these interventions failed to our view the distress that she took Julian to the doctor, who made the referral to the community mental health team. In the preliminary assessment that was conducted with Julian and both of his parents, the mother responded to the son with intense emotional over involvement (an index of high expressed emotion associated with a relapse in schizophrenia; Hooley, 2007).

With regard to the extended family, according to parents there has never been a family history of psychological disorder. However some members of the mother’s well-to-do family were fairly eccentric and odd, especially her brother, Sedric, and her uncle, William Jr. Williams eccentricities led him into serious conflict with his father, and Sedrick’s odd behaviour underpin his highly conflictual, childless marriage.


Developmental history

Julian on a family farm and went to the local school, his development was what most people would call normal. His Academy former school was above average and he had many friends in his local village, and was a popular child and adolescent who also excelled at cricket. At 18 years old before going to university London, he had no psychological problems.

His first term at college was successful academically and socially, however, the occasional experimental cannabis use that had begun the summer before going to college turn to a regular use once Julian moved to London. During his time at university, the patient also experimented with LSD on a few occasions. In the final term of his first year at college, Julian developed intense fear of exam failure. Other symptoms quickly followed such as difficulty studying effectively and sleeping problems. Julian stopped attending classes regularly and spend more time alone, and was relieved to return home after sitting as exams. Once home he was described as quiet and thought during most of the time prior to the “running East” episode.


Presentation

Julian presented with symptoms such as delusions, hallucinations, disorganised speech and anxiety. At the very start the patient was very reluctant to be interviewed because he believed he had urgent business to attend to in Holland and further afield in India. He also showed signs of being anxiously distressed throughout the interview, explaining that his path was to the east and believed he was being called there by an unknown source. He firmly believes this because of a sign he had seen while out jogging on the morning of the enigmatic “running East” episode. The way in our God will record the sunlight and cast a shadow on the red barn against which it was leaned made a distinctive pattern, which to him meant a special sign indicating that he should go East, first to Holland and then all the way to India. Upon questioning this idea, a clear authoritative voice said that he should leave at once.

At this point in his narrative, stopped mid-sentence and displayed thought blocking, and will strive the topic he was talking about. Upon being asked to continue his story, he began to giggle, and when questioned about the reason behind his amusement, Julian declared to have heard someone say something funny. Julian then spoke about a number of unrelated topics in an incoherent way before experiencing thought blocking again.

Later he expressed the desire to leave soon because people will try to prevent him, as he had heard them plotting about this the day before, and also declare that they had tried to put bad ideas into his head [which he described as frightening]. He was also frightened by periodic sensations that everything was too loud or too bright and coming at him, declaring “it was like doing acid [LSD] all the time… a really bad trip.”


Formulation

In Julian’s case he presented with auditory hallucinations, delusions, thought disorder, anxiety and a significant deterioration in social and occupational functioning which had been present for more than 1 month [symptoms consistent at the time of this essay with a diagnosis of Schizophrenia]. The patient also showed a complete lack of insight and was unable to understand that the voices being heard were hallucinations and that the delusional beliefs were unfounded. Among the major precipitating factors were the experience of recent exam pressure and his transition from living at home to living in London at attending college. The principal predisposing factors were possible genetic vulnerability to psychosis and a history of hallucinogenic drug use.

His psychological condition was maintained by what was likely to be an excessive level of maternal expressed emotion characterised mainly by emotional over-involvement. His delusions were also reinforced by the mother since the latter engaged Julian in long and draining conversations about them. The protective factors in this case were godo premorbid adjustment and a strong family support for the boy.


Treatment

The treatment plan included antipsychotic medication and family will to reduce parental expressed emotion, with an initial brief period of hospitalisation. Julian did recover from his first psychotic episode, and his hallucinations and delusions decrease considerably with medication. Through family Psycho-education, parents develop understanding of this condition and of the requirement of a “low-key” approach to interacting with the boy as he recovered.

However some obstacles were encountered in Julian’s recovery, since he disliked the side effects of the medication, especially the weight gain and reduced sexual drive/function, and so had poor medication adherence – depression also manifested during the remission, when Julian came to realise about the many losses that followed his condition. He was unable to pursue his university studies and thus, could not continue the law career he had dreamed of. He also experienced difficulties in maintaining friendships or to commit to engaging on a regular basis in physical exercises or sports. When his mood was low, Julian would smoke some cannabis to lift his spirits.

The mother found it very difficult to accept the diagnosis of Schizophrenia and continued to hold the belief that his psychotic symptoms were linked to some spiritual or mystical explanation. She even sometimes declared that she thought of her son not as an ill young man, but a gifted seer or a “chosen one” [based on no rational explanation or series of events], and often engaged Julian in intense, distressing conversations about these issues. In the years that followed his initial assessment, poor medication adherence, ongoing cannabis use [which the patient could not tolerate unlike some other users] and exposure to high levels of intrusive parental emotions led Julian to relapse more often than might otherwise have been the case.


Clinical Features of Schizophrenia

A range of clinical features have been identified and associated with Schizophrenia though research and clinical observations (Mueser & Jeste, 2008). The generally concern the domains of perception, cognition, emotion, behaviour, social adjustment and somatic state.


Perception

At the perceptual level, patients suffering with schizophrenia generally describe a breakdown in perceptual selectivity, with difficulties focusing on essential information or stimuli to the exclusion of accidental details or background noise. Most aspects of the environment seem to be salient, however, the inability to distinguish between figure and ground is a serious problem to the sufferer. During an acute psychotic state, internal stimuli such as verbal thoughts are experienced as auditory hallucinations that have the same sensory quality of the spoken word.

Auditory hallucinations can sometimes be experience as extremely loud thoughts, or as thoughts being repeated by another person aloud (thought echo), as voices speaking inside the head or as voices coming from somewhere in the outer environment. The auditory hallucination may occur as third person making comments on the patient’s action, as a voice speaking in the second person directly to the person, or as two or more people talking or arguing – the effect did may also perceive voices to vary along the number of dementia [may be construed as benign or malevolent, controlling or impotent, or knowing or knowing little about the patient, who may sometimes feel compelled to the demands of the voice or not.

When hallucinations are perceived to be malevolent, controlling, all-knowing, where the individual affected feels compelled to obey the demands of the voice, the situation is deemed to be far more distressing than those who do not have these attributes. While auditory hallucinations are the most common features in schizophrenia, hallucinations may okay other sensory modalities too. Somatic hallucinations also often occur in schizophrenia, with many cases including reports of electricity in the body or the feeling of something crawling underneath the skin [these may be qualified as delusional interpretations. For example, a patient reported that the television was activating a transmitter in her pelvis and she could feel the electricity from this closing insects to grow and move around under the skin. Visual hallucinations [seeing visions] are relatively rare in schizophrenia very common in temporal lobe epilepsy.


Cognition

At the cognitive level, delusions are the most common cognitive clinical feature of schizophrenia, and are false, idiosyncratic, illogical and stubbornly maintained erroneous inferences drawn to explain unusual experiences, such as hallucination. [e.g. patient with auditory hallucinations where an authoritative voice commanding the latter to gather the children, was interpreted by the patient that she had been chosen by God to prepare all the children for the second coming of Christ]

Delusions may also arise from unusual feelings associated with psychosis. Persecutory delusions may develop from feelings of being watched. Delusions of thought insertion or thought withdrawal may develop as explanations for feelings that thoughts are not one’s own, or that one’s thoughts have suddenly disappeared. Factor analyses show that delusions fall into 3 broad categories:

Delusions of influence [including thought withdrawal or insertion, and beliefs about being controlled]; delusions of self-significance [including delusions of grandeur or guilt]; and delusions of persecution (Vahia & Cohen, 2008). Delusions may vary in the degree of conviction with which they are held [great certainty to little servant, the degree to which the person is preoccupied with them [the amount of time spent thinking about the belief], the amount of distress they cause.

Particular sets of the may comprise of a confused sense of self, particularly paranoid delusions with the patient holds the belief that they are being persecuted or punished for misdeeds, or delusions of control where there is a belief that their actions controlled by others [e.g. an unknown source or entity].

A lack of insight along with an impaired judgement is quite common during a psychotic episode. This happens when the patient believes that the contents of their hallucinations and delusions are real, and are incapable of coming to terms with the fact that their experiences and beliefs arise from a clinical condition. However in between psychotic episodes, the patient’s insight may improve and in some cases they may acknowledge that their hallucinations and delusions are symptoms of schizophrenia.

Speech in schizophrenic patients is also fairly hard to understand due to the abnormalities in the underlying thought pattern. This formal thought disorder is characterised by

  1. Tangentiality [answers given to questions are off the point]
  2. Derailment [sentences makes sense but hardly any meaning is conveyed by the sequences of sentences because there is a constant jumping from one topic to another, with very loose association between topics and little logic to what is said]
  3. Incoherence [sentences are incorrectly formed so little sense can be made out of them]
  4. Thought blocking [the patient abruptly stop’s in mid-sentence and is unable to complete the train of thought]
  5. Loss of goal [the difficulty in following a logical train of thought from A to B]
  6. Neologisms [inexistent new words are made up that only have idiosyncratic meaning for the patient]

Cognitive impairment or deterioration occurs in schizophrenia and this may either be general or specific. In cases with general cognitive deterioration, we can observe a reduction in overall IQ with many cognitive function also negatively affected. With specific cognitive impairment one or more of the following functions may be impaired: attention, memory, cognitive flexibility, social cognition and executive function, and most commonly the ability and dedication to follow through on a planned course of action. Cognitive impairment remains a better predictor of disability and vocational functioning than positive symptoms.


Emotions

At the emotional level, especially during the prodromal phase, before an acute psychotic episode, anxiety or depression may occur in response to changes in perceptual selectivity and cognitive inefficiency. One of the main functions of relapse prevention is for patients to learn [and eventually master] the ability to identify and manage prodromal changes in affect.

During psychotic episodes that are intense, anxiety or depression may occur in response to hallucinations, delusions, formal thought disorder and other debilitating symptoms. Inappropriate affect may also be present in hebephrenic schizophrenia, where the patient responds to the internal stimuli such as auditory hallucinations [e.g. laughing wildly] and not the external social context. In chronic cases, blunted or flattened affect can also be observed, and in remission [following an episode of psychosis], the sense of loss [e.g. of valued personal relationships, material, career, etc] that comes with increased insight into the reality of the condition may give rise to post-psychotic depression in some cases.

Behaviour

In terms of behaviour, prodromal excitation may occur prior to an acute psychotic episode, characterised by sleep disturbance, impulsive behaviour, and over-reactivity [may include compulsive behaviour]. Avolition also occurs during psychotic episodes with an observable impairment in goal-directed behaviour.

In some chronic cases, it is common to also find catatonic behaviour along with an impairment in the ability to initiate and organise voluntary movement and posture. Catatonia may be either retarded or excited. Excessive purposeless motor activity is the hallmark of excited catatonia and may include stereotypies [repetitive actions], echolalia [repeating the words said by others] or echopraxia [imitating the actions of others] – these tend to occur without the patient being consciously aware of it [not a conscious choice]. In cases where retarded catatonic behaviour is present there is an observable reduction in purposeful activity; patients may display signs of immobility, mutism, adopt odd postures for extended amounts of time, and display waxy flexibility or negativism.

Social Adjustment

A marked deterioration in social adjustment is also common in schizophrenia, and the ability for self-care, appropriate dressing, grooming and personal hygiene deteriorates – patients with schizophrenia often look dishevelled and unkempt. A decline in also commonly present in the domains of education and work with a withdrawal from regular patterns of socialisation and difficulty making and maintaining significant relationships. A deterioration with others also occurs and schizophrenia tends to have a negative impact on parent-child, marital and sibling relationships.

Somatic State

Approximately 50% of people with Schizophrenia also have comorbid substance use disorders and almost 75% have significant health problems, with the most common one being Chronic Obstructive Pulmonary Disease (COPD) [usually due to heavy smoking]; heart disease and diabetes due to obesity; HIV/AIDS and hepatitis B and C caused by unsafe sex and intravenous drug use [e.g. heroin]. These drug and medical problems in schizophrenia are lifestyle problems. However, one the positive side, schizophrenia is associated with reduced rates of cancer and rheumatoid arthritis (Tandon et al., 2008a).

 

Epidemiology, Course, Outcome and Risk Factors of Schizophrenia

International epidemiological studies that have been reviewed have allowed for a number of conclusions to be deduced regarding schizophrenia. We know that [luckily] under 1% of the population suffer from schizophrenia, and the lifetime risk of the condition is about 0.7% (Saha et al., 2005). More men than women suffer from schizophrenia: the male-female ratio is about 1.4:1 (McGrath et al., 2004). Schizophrenia has an earlier onset in males (20-28 years) than in females (28-32 years) (Murray & Van Os, 1998). The rates for schizophrenia have also been found to be similar across countries and cultures when diagnostic criteria are used (Mueser & Duva, 2011).

Schizophrenia tends to follow a distinctive course although a considerable variability exists across cases (Jablensky, 2009; Jobe & Harrow, 2010; Mueser & Duva, 2011, Tandon et al., 2009). The onset of schizophrenia generally occurs in late adolescence or early adulthood and may be acute or insidious [onset generally takes place over 5 years, starting with negative and depressive symptoms, followed by cognitive and social impairment and finally positive symptoms]. Longitudinal studies suggest that there is an early deterioration phase that extends over 5-10 years, a stabilisation phase and a final gradual improvement phase. In over 50 – 70% of cases, the condition follows a chronic relapsing course, typically with incomplete remission between episodes. However, up to 40% of patients show one or more periods of complete recovery with good adjustment for at least 1 year, and  4 – 20% of cases show complete remission.

Psychotic episodes may last from 1 – 6 months, although some cases extend up to 1 year. They are usually preceded by a prodromal period of a number of weeks. Psychotic episodes may be lessened and the severity of the symptoms ameliorated through early detection and the use of pharmacological and psychological treatment. Inter-episode functioning may differ greatly and better inter-episode functioning is associated with a better prognosis. The duration of remission between episodes may be lengthened through the use of maintenance medication and psychosocial interventions to reduce stress and improve coping and illness management.

With treatment, usually positive symptoms (hallucinations and delusions) abate between episodes but negative symptoms (blunted affect, alogia and avolition) can be enduring and are more likely to persist during remission. In the stabilisation phase of schizophrenia, positive symptoms become less prominent, while negative symptoms and cognitive deficits become more prominent. The lifespan of people with schizophrenia is also 9 years less than that of the general population, and this is partly accounted for by the high rate of suicide during the first 10 years of the disorder and the high rate of comorbid medical disorders that also tend to occur along with schizophrenia. About 50% of schizophrenics attempt suicide or self-harm, and about 10% commit suicide (Heisel, 2008; Schennach-Wolff et al., 2011).

One of the greatest risk factors for schizophrenia is a family history of psychosis. Other risk factors make a small contribution to the overall risk within the context of associated with genetic vulnerability. However until now, it is important to note that we still do not have any clear consensus or evidence on how these risk factors operate and whether environmental factors remain a stronger prediction of the onset of schizophrenia than genetic factors that only set a predisposition [risk] of possibly developing the condition. Prenatal and perinatal risk factors, such as maternal flu infection and obstetric complications, are likely to have a negative effect or indirect effect on the development of the nervous system in line with the neurodevelopmental hypothesis that states how those affected by such issues while also being genetically predisposed to schizophrenia are even more neurologically vulnerable to psychosis (Murray & Lewis, 1987). Trauma exposure and most demographic risk factors (being unmarried, low-SES urban migrant) are associated with higher levels of stress and lower levels of social support [which increases the risk of psychosis in the genetically vulnerable] according to the Diathesis-Stress Conceptualisation of Schizophrenia (Zubin & Spring, 1977).

In the short term, relapse is more likely in cases where these is heavy cannabis use [along with poor personal/subjective tolerance of the effects on consciousness], poor treatment adherence, frequent contact with insignificant extended family members who may display excessive negative emotional expressions towards the patient [e.g. criticism, hostility and emotional over-involvement] and exposure to acute stress life events (Jablensky, 2009).

A poor outcome is associated with substance use and a longer period of untreated psychosis in people who have poor premorbid adjustment and an early insidious onset with no clear stressful life event preceding their first treated episode. One of the main traits associated with a poor outcome is “Anxiety”, and people with this stress profile are generally more sensitive to and reactive to life’s stressful events, along with populations living in a developing economy, and family-based stress associated with excessive negative expressions of emotion. The symptom profile predictive of a poor outcome is also marked by severe negative symptoms, cognitive impairment and lack of depressive symptoms.

A favourable outcome in schizophrenia is associated with a range of factors (Bota et al., 2011). These include good premorbid adjustment, and a brief duration of untreated psychosis characterised by an acute onset in response to precipitating stressful life events. A family history of affective problems/disorders [rather than schizophrenia] or little psychopathology and a personal symptom profile in which there are affective as well as psychotic features are also predictive of a good prognosis. A better outcome tends to follow those who have a favourable life situation to return to following discharge from hospital.

 

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Part 5 of 5 | The Effectiveness of Psychotherapy

 

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The main help that a psychotherapist provides is psychotherapy, a contractual process where professionals with expert knowledge interact with clients to guide and help them in the resolution of their psychological conflicts, emotional imbalance, psychological problems and address mental health and behavioural difficulties [if any]. Psychotherapy can be offered to both adults and children on an individual, couple, family or group basis.

Often psychotherapists offer therapy as one element of a multimodal programme provided by a multidisciplinary team [e.g. a multidisciplinary adult mental health team may routinely offer a multimodal programme of psychotherapy combined with some mild anti-depressant for depression]. This final section will focus on the evidence base for the overall effectiveness of psychotherapy.


Evidence-based Practice

In today’s trend of mainstream clinical psychology where the mechanical model of early behaviourists has been combined with cognitive psychology to become Cognitive-Behavioural Psychology, there has been a gradual shift from practice guided by descriptions of clinical cases [qualitative, detailed and individual] to “evidence-based” practice guided by the results of empirical studies using the statistical methods of science to make inferences about behaviour [that can be measured at least] on the effectiveness of psychological interventions. This movement has started in part due to the influence of policies derived from the medical field which bases itself on evidence-based medicine [i.e. tested with laboratory-rigour and statistical methodology] (Sackett et al., 1996, 2000).

Evidence practice in medicine as it has been applied to psychology [or should we say behavioural science] involves the judicious and compassionate use of the best available evidence to make decisions about patient or client care. In clinical psychology, this involves considering available scientific evidence about “what works” on one side, and the client’s unique problems, needs, rights and preferences on the other; while also making balanced, compassionate judgements (APA Presidential Task Force on Evidence Based Practice, 2006; Norcross et al., 2006).


Meta-analyses

The most persuasive form of evidence as far as the effectiveness of psychotherapy and other psychological interventions are concerned in regards to empirical measurements and statistical methodology, comes from meta-analyses on controlled trials.

Meta-analysis is a systematic, quantitative approach to reviewing evidence from multiple trials while also reducing the impact of reviewer bias since the data from many trials are synthesised using statistical methods.

In a meta-analysis, effect sizes are calculated for each trial and then averaged across all trials to provide a quantitative index of the effectiveness of a particular form of treatment with a specified population. The effect sizes calculated in meta-analyses express quantitatively the degree to which treated groups improve over untreated control groups [A graphic explanation of the calculation of an effect size in given in FIGURE A.

FIGURE A - EFFECT SIZES

FIGURE A. A Graphic Representation of an Effect Size of 1

 

Table A shows a system for interpreting effect sizes, and using it, it may be seen that .9 is a large effect size, and if such an effect size was obtained in a meta-analysis it would mean that the average treated case fared better than 82% of the cases in the control group. It would also indicate that 71% of cases in the treatment group had a successful outcome compared with 29% of control group cases. Finally, a large effect of .9 would indicate that 17% of the variance in outcome would validly be attributed to the effects of the treatment rather than other factors.

Table A - Interpretation of Effect Size

TABLE A / Note: Adapted from Wampold (2001, p. 53). 1. From Cohen (1988), 2. From Glass (1976). 3. From Rosenthal and Rubin (1982). Binomial effect size display, assuming overall success rate of .5, success rate for treated cases is .5+ correlation with outcome/2, and success rate for untreated cases is .5-correlation with outcome/2. 4. From Rosenthal (1994, p. 239), percentage of variance = d²/(d² +4).

Is Psychotherapy effective? If so, how effective?

Mary Smith and Gene Glass published the first major meta-analysis of psychotherapy result studies in American Psychologist in 1977. They included 375 controlled trials of psychotherapy in their analysis and found an average effect size of .68. They concluded that a typical therapy client was better off that 75% of untreated individuals.

Since that seminal study many meta-analyses have been conducted, and in a synthesis of 68 separate meta-analyses of psychotherapy with children, adolescents and adults with a wide range of different psychological problems, Grissom (1996) found an aggregate effect of .75, indicating that the average treated case fared better than 77% of untreated controls.


Effects of Psychotherapy with Adults

The mentioned meta-analysis conducted by Smith and Glass (1977) also included many studies of therapy with children and young people. In the quest to determining the effects of psychotherapy for adults with psychological problems, Shapiro and Shapiro (1982) conducted a meta-analysis of 143 studies of psychotherapy exclusively involving adult populations. This revealed an effect size of 1.03, meaning that after treatment the average adult who participated in psychotherapy fared better than 84% of untreated control group cases.


Effectiveness of Psychotherapy with Children and Adolescents

The results of 4 broad meta-analyses of studies involving children and adolescents under 18 years with a diverse range of psychological problems receiving a variety of forms of psychotherapy provide evidence for the overall effectiveness of psychotherapy with children (Casey & Berman, 1985; Kazdin et al., 1990; Weisz et al., 1987, 1995). These meta-analyses included more than 350 treatment outcome studies. Effect sizes ranged from .71 to .88, with a mean effect size of .77. This indicates that the average treated case fared better than 78% of control group cases.


Psychodynamic Psychotherapy

Within the psychodynamic tradition, a distinction is made between short-term psychodynamic psychotherapy and intensive long-term psychoanalysis. Short-term psychodynamic psychotherapy involve weekly sessions for periods of 6 – 12 months, while Long-term psychoanalysis involves two or more sessions per week, usually lasting for periods longer than 1 year [Jacques Lacan, one of the main psychoanalytic figures in France, broke from other associations to create his own school where he advocated short psychoanalytic sessions that varied ranging from 10 minutes to more, as he argued that the point of therapy is to shape the patient’s consciousness and depending on the person, this can be achieved by a range of ways, e.g. metaphors or word plays that allows the patient to peer into his own psyche and understand himself]

Two important broad meta-analyses have been conducted to evaluate the effectiveness of psychodynamic psychotherapy with adult mental health problems (Leichsenring et al., 2004; Leichsenring & Rabung, 2011). In a meta-analysis of 17 studies, Leichsenring et al. (2004) found that short-term psychodynamic psychotherapy yielded an effect size of .7 for psychiatric symptoms in patients mainly diagnosed with anxiety and mood disorders when therapy was compared with waiting list or minimal intervention control groups. This indicates that after treatment the average treated case fared better than 76% of controls. In this meta-analysis, the outcome for psychodynamic psychotherapy did not differ from that of other forms of psychotherapy in the 14 studies where such comparisons were made.

In a further meta-analysis of 10 studies, Leichsenring and Rabung (2011) found that Long-term psychodynamic psychotherapy involving more than 50 sessions over periods longer than a year yielded an effect size of .54 for overall effectiveness for complex cases with severe symptomatology, comorbid diagnoses, or personality disorders, when long-term psychodynamic psychotherapy was compared with a range of other therapies including Cognitive-Behavioural Therapy (CBT), dialectical behaviour therapy, family therapy and short-term psychodynamic psychotherapy. This indicates that after treatment the average case fared better than 70% of cases treated with other therapies. The gains made during treatment were sustained at 1 to 8 years after follow up.

The results of these two meta-analyses show that short-term psychodynamic psychotherapy is an effective as other widely used forms of psychotherapy, including Cognitive-Behavioural Therapy (CBT), for common psychological problems such as anxiety and depression in adults; and that long-term psychodynamic psychotherapy is more effective that some other forms of therapy for adults with complex mental health difficulties.


Client-centred Humanistic Psychotherapy

Elliot et al., (2004) conducted a meta-analysis of trials of psychotherapy that fall broadly within the client-centred humanistic psychotherapy tradition [over 90 trials of client-centred, experiential, gestalt and emotionally-focussed therapy were included in the analysis]. Clients in these studies had a wide variety of psychological problems including anxiety, mood, eating and relationship distress. The average duration of treatment was 22 sessions, reflecting about 6 months of therapy. An effect size of .78 was obtained, indicating that the average treated case fared better than 78% of cases in control groups. These results indicate that client-centred humanistic psychotherapy is an effective form of treatment for a range of common psychological problems in adulthood.


Overall Effects of Psychotherapy

FIGURE B summarises the results of meta-analyses, described above, of the effectiveness of psychotherapy from a range of different traditions with adults and children. In this figure, where appropriate, effect sizes from multiple meta-analyses have been averaged, and graphed as success rates based on the system given in TABLE A.

From FIGURE B it can be deduced that meta-analyses of psychotherapy trials yield moderate to large effect sizes that range from .65 to 1.02. When expressed as success rates, the results of meta-analyses indicate that 65 – 72% of people with psychological problems benefit from psychotherapy. Thus approximately two-thirds to three-quarters of people who engage in psychotherapy find that it leads to improvements in their mental health.

FIGURE B - SUCESS RATES WITH ADULTS &amp; CHILDREN

FIGURE B. Success Rates of Psychotherapy with adults and children, and Therapy from other schools of thought [traditions] based on Effect Sizes from Meta-analyses

Comparison of the effects of Psychotherapy and Medical Procedures

In order to make sense of the overall effectiveness of psychotherapy, it may be useful to ask ourselves: Are the moderate to large effect sizes associated with psychotherapy very different from those associated with the medical and surgical treatment of physical illnesses, diseases and medical symptoms?

In a synthesis of 91 meta-analyses of various medical and surgical treatments for a range of medical conditions, Caspi (2004) found an average effect size of .5. This falls in the moderate range of effect sizes (.5 – .8) and not very dissimilar to the effect size of .75 from Grissom’s (1996) synthesis of 68 meta-analyses of psychotherapy trials mentioned at the beginning of this section. Hence, it may be concluded with some certainty that the moderate effect sizes associated with psychotherapy are similar to those associated with the treatment of medical conditions.


Deterioration and Drop-Out

A consistent finding within psychotherapy research literature is that up to 10% of clients deteriorate following treatment (Lambert and Ogles, 2004; Lilienfeld, 2007). In a review of 46 studies on negative outcome in adult psychotherapy, Mohr (1995) found that deterioration was associated with particular client and therapist characteristics and particular features of psychotherapy. Deterioration was much more common among clients with obsessive compulsive disorder or severe interpersonal difficulties. Lack of motivation and the expectation of benefiting from psychotherapy without personal effort were also associated with deterioration. Deterioration was more common when unskilled therapists lacked the empathy and did not collaborate with clients in pursuing their agreed goals. Failure to manage counter transference appropriately and frequent transference interpretations were also associated with deterioration.

Dropping out of psychotherapy is a relatively common event. In a meta-analysis of 125 studies, Wierzbicki and Pekarik (1993) found a mean dropout rate of 47%. Dropout rates were higher for minority ethnic groups, less educated clients, and those with lower incomes. Thus, we can conclude that about 1 in 10 clients deteriorate following therapy and that marginalised clients with particularly troublesome disorders and negative attitudes to psychotherapy are vulnerable to dropping out of psychotherapy and deterioration.


Medical Cost Offset

So, all the evidence that has been reviewed shows that psychotherapy is effective for a range of problems and populations. However, an important factor regarding the delivery of psychological treatment is the financial implication of it [i.e. the cost to the economy and health services]: How much does it cost to provide such a psychotherapy service? From this financial perspective, two questions would be of interest:

First: Do clients who received psychotherapy use fewer medical services and so incur reduced medical costs? This saving would be referred to as the Medical Cost Offset.

Second: Is the Medical Cost Offset associated with psychotherapy greater than the cost of providing psychotherapy? If so, we would be able to conclude that psychotherapy has a total cost offset.

Findings from meta-analyses and narrative reviews of the cost-offset literature provide explanations on these questions. In a meta-analysis of 91 studies conducted between 1967 and 1997, Chiles et al. (1999) found that psychotherapy and psychological interventions led to significant medical cost offsets. Participants in reviewed studies included surgery inpatients, high health-service users, and people with psychological and substance use disorders who received psychotherapy or psychological interventions alone or as part of a multimodal programme. Chiles and his team found that medical cost offsets occurred in 90% of studies and ranged from 20% to 30%. In 93% of studies where data were provided, cost offsets exceeded the cost of providing psychotherapy. Greater costs offsets occurred for older inpatient who required surgery, oncology, and cardiac rehabilitation than for outpatients who required care for minor injuries and illnesses. Structured psychological interventions, tailored to patient needs associated with their medical conditions, led to greater medical cost offsets than traditional psychotherapy.

In a set of meta-analyses from earlier studies involving Blue Cross and Blue Shield US Federal Employees Plan claim files and 58 controlled studies, Mumford et al. (1984) found that 85% of studies medical cost offset for psychotherapy occurred, and this was due to shorter periods of hospitalisation for surgery, cancer, heart disease and diabetes – particularly in patients over the age of 55. In a review of psychological interventions for people with a variety of health-related difficulties, Groth-Marnat and Edkins (1996) found that medical cost offsets occurred when such interventions targeted patients preparing for surgery and patients with difficulty adhering to medical regimens. Medical offset also occurred for smoking cessation programmes, rehabilitation programmes, and programmes for patients with chronic pain disorders, cardiovascular disorders and psychosomatic complaints.

Three other important reviews of medical cost-offset literature, which focussed largely on mental health problems in adults rather than adjustment to physical illness, deserve mention. In a review of 30 studies of psychotherapy for psychological disorders and drug and alcohol abuse, Jones and Vischi (1979) found that medical cost offsets occurred in most cases. In a review of eight cost-effective studies for substance abuse, Morgan and Crane (2010) concluded that family-based treatments can be cost-effective. In a review of 18 studies of psychotherapy for psychological disorders, Gabbard et al. (1997) found that in more than in 80% of studies, medical cost offsets exceeded the cost of providing psychological therapies. Significant cost-offsets occurred for complex problems and in studies of psychoeducational family therapy for schizophrenia and dialectical behaviour therapy for personality disorders this was achieved by reducing the need for inpatient care and improving occupational adjustment.

Therefore, to conclude with all the evidence reviewed here, it is widely accepted today that psychotherapeutic interventions have a significant medical cost offset. Those who participate in psychotherapy use fewer extra medical services at primary, secondary and tertiary levels and are hospitalised less than those who do not receive psychotherapy.

 

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2nd of July 2018 | Danny J. D’Purb | DPURB.com

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Essay // Clinical Psychology: Controversies that surround modern day mental health practice

mentalhealth

Modern day mental health practice could be defined as the application of the four main schools of thoughts that dominate the field of psychology in the clinical setting, by abiding to strict criteria set out by packaged behavioural sets, diagnostically defined by names and categorised depending on the core nature of their specific characteristics in terms of behaviour, aetiology and epidemiology. While these four [biological, psychodynamic, cognitive-behavioural & systemic] main schools of thought have contributed to the development and ongoing evolution of the field of psychology, they also have downsides when applied to different types of psychological cases, with some being more efficient in treating particular disorders while others being hardly efficient and questionable. Applying and integrating these four schools of thoughts with new intuitive fact-based theories to explain psychological constructs and disorders are leading to major innovations in psychology; however with each field’s limitations controversies over the validity of their interpretations and the efficiency of their applied doctrines remain a constant topic of debate among scholars and clinicians.

One of the main controversies that surround modern day mental health practice is the medicalisation of psychological disorders, a tradition influenced by the field of medicine which contradicts an important founding philosophy of psychology, which was originally initiated to study the “mind”, not the physical characteristics of the brain as an organ. Furthermore, evidence suggests that psychological problems are not caused exclusively by organic factors. In anxiety, depression and/or schizophrenia, people with genetic vulnerability to the development of those psychological disorders only do so when exposed to particular stresses in their environment (Hankin & Abele, 2005). However, on the other side of the argument, evidence has also shown that deficiencies in genetics and neurobiological anatomy are linked to psychological difficulties and disorders, and hence nowadays, integrated approaches are used in a variety of assessments when treating patients affected by psychological disorders.

On the theme of medicalization, the debate over eating disorders has led to one of the major controversies within the field between advocates of the biomedical conceptualisation of eating disorders and the feminist position (Maine & Bunnell, 2010). The former sees an individual woman as a patient with a debilitating disease, in need of a cure to her illness; while the feminist position views eating disorders as a condition that is gender specific with the woman as a victim of socio-cultural pressures generated by a male-dominated society governed by a hedonistic economic reality focused on the pursuit of the thin ideal. There is an important distinction that should be made here for the benefit of patients since the feminist view may not fully comprehend that in the case of obesity and emaciation related to eating-disorders, the patients are at severe risk of medical complications such as growth retardation, osteoporosis, gastrointestinal bleeding, dehydration, electrolyte abnormalities and cardiac arrest [in chronic cases]. The social feminist constructivist perspective may be interpreting eating disorder as an image debate of “Fat” versus “Thin”. This may lead to the normalisation of obesity and destructive eating habits which in turn may result in further medical complications that involve surgical interventions. As for the feminists, it may be ethical to acknowledge that obesity & emaciation associated with eating disorders are major health issues that precede further complications such as diabetes, cancer and high blood pressure; and should not be confused with social stigma regarding image, but seen as a sign of poor-health and lifestyle that require attention and effort in providing patients with the medical and psychological help they need to adjust their patterns of life to a healthy one by adopting a culture synchronised with dietary & nutritional education.

Secondly, the medicalization of anxiety disorders as distinct medical & psychological conditions may seem less favourable to the biological model previously mentioned. A mass market of pharmacological products used in treatment has been favoured for being more convenient and less time consuming. This may lead to patients feeling disempowered and hopeless when being treated as victims of an uncontrollable illnesses requiring pharmacological treatment, while already being in a state of distress, shock, disbelief and/or confusion. Diazepam (Valium) or other benzodiazepines that are highly addictive have also been prescribed for years to treat anxiety disorders. The long term side effects have been trivialised along with the arrogant act of medicalizing fear and courage (Breggin, 1991). Critics of the medicalization of experiences argue that if patients are helped in understanding that panic attacks develop from the misrepresentation of bodily sensations and hyperventilation, this knowledge along with their own courage may strengthen them to take control of their fear. Research has also shown how patients who are educated in cognitive-behaviour techniques learn to use problem-solving and develop other skills (e.g. social – help them build meaningful lasting relationships while letting go of psychosocial burdens) that they lack to reappraise situations that may formerly have brought distress.
TheDownfallOfTheWildAnimals.jpgThe tragic death of one of the most talented vocalists on the planet, Chris Cornell, has sent a shock throughout the arts world and reports have revealed that the gifted artist was on Lorazepam [a benzodiazepine medication sold under the name Ativan used in the treatment of anxiety disorders], the substance is known to heighten the risk of suicide in those suffering from depression, while a recent investigation (Bushnell et al., 2017) has also shown no meaningful clinical benefit from the addition of benzodiazepines during treatment initiation. To prevent such tragedies from affecting the human race, more emphasis could be placed on « the mind » with clear guidance on the « thinking styles » (cognitive scripts) to adopt in the protection of the individual organism’s own psyche (mind). Simple foundations based on psychological logic should be propagated educationally to help people understand their uniqueness as organisms while protecting their psyche [mind] from the influence/control of external environmental factors that are beyond their control [e.g. biased negativity, uninformed prejudicial comments of meaningless acquaintances, etc]; acknowledging the fact that as long as an individual organism is within the boundaries of the law, he is allowed to live the life of his choice, and external factors would only affect one’s psyche if attention is given to them; and selectively ignoring parts of the environment  is also an acquired skill vital in maintaining sanity, along with the ability to select experiences that are positive & progressive to the organism [while discarding negative ones] in the context and theme of their chosen individual lifestyles.

ChrisCornell

An artist many might consider to be the Fréderic Chopin & the Edouard Manet of Rock, composing with his heart and painting with his voice, enigmatic vocalist Chris Cornell, known for timeless titles such as « What You Are« , « Like A Stone« , « The Last Remaining Light« , « Exploder« , « Be Yourself« , « Getaway Car » & « Dandelion » left a hole in the hearts of millions touched by his work. His tragic death is a reminder that further research is required in understanding the thought structure of artistic individuals whose psychological subjective reality would likely be deeper and more complex compared to the average person – an approach focusing on the « mind » rather than the « behaviour or brain » in the tradition of Sigmund Freud would likely reveal and explain the granularity of their psyche; and whether their suicidal decisions are rooted in full awareness and motivated by a reality they consider to be inadequate for their state of consciousness and IQ; and whether appropriate interventions involving the restructuration of their psychosocial patterns/exposure [to prevent the burden of stress] may be more individualistic & appropriate.

This would also shift the focus to the individual’s mind, courage & abilities to handle the world while maintaining a stable sense of self and resilience; and not turn them into biological organisms that are having their neurochemistry savagely altered by powerful chemical substances that are known to affect individuals differently with dangerous & sometimes fatal outcomes.

PrinciplesOfPsychology

The same would apply to sufferers of post-traumatic stress disorder who would benefit of a non-pharmacological and empowering intervention to manage and take control of recurrent intrusive and distressing memories – it may be useful to study fear, distress and courage as normal psychological processes happening on a dimensional scale on a normal continuum from one individual to another where those on the extreme ends of the scales may be considered for psychological interventions.

Similarly, antidepressant medication used to treat depression remains controversial due to its questionable efficacy and side-effects. The high level of effectiveness of SSRIs reported in academic journals was greatly due to only trials with positive results of antidepressants being published while those where antidepressants were found to be no more effective than placebos being rejected. The effects of TCAs and SSRIs have also been found to be negligible in mild to moderate depression but effective in severe depression in meta-analyses (Fournier et al., 2010). The negative side-effects of antidepressants are known to be risky and dangerous where symptoms such as loss of sexual desire and impotence, weight gain, nausea, sedation or activation, and dizziness are known to be some of the more disturbing ones, with effects varying with types of antidepressants – for depressed pregnant women, health risks may affect their offspring. Dangerous antidepressants such as MAOIs are only prescribed to patients who can follow strict dietary patterns that exclude foods with thyramine (e.g. cheese) to prevent risks of high blood pressure and hypertensive crises. Although meta-analyses suggest benefits may outweigh the risks, an increased risk of suicide has also been noted among patients under 25 (Bridge et al., 2007).

Edouard Manet - Le Suicide

Edouard Manet (1832 – 1883), « Le Suicidé« 

Electroconvulsive therapy has also sparked a major controversy as a primitive, dangerous and non-scientific practice for the brevity of its effect and negative side-effects on memory (Read & Bentall, 2010). A thorough review of studies on the effectiveness of ECT and its side-effects [retrograde and anterograde amnesia] revealed it to be effective for a brief duration in treating severe depression [in cases that are unresponsive to psychological treatment] and questionably only supported by psychiatrists with a vested interest in proving ECT’s effectiveness. ECT has also been associated with a slight but significant risk of death, and a qualitative study of patients’ negative experiences concluded that for some ECT leads to fear, shame and humiliation, and reinforces experiences of worthlessness and helplessness associated with depression.

brainbuilding

Medicalization has also led to controversy over the diagnosis of schizophrenia, a condition classified as a disease by the World Health Organization and ranked second only to cardiovascular diseases in terms of overall disease burden internationally (Murray & Lopez, 1996). Diagnosis is believed to be part of best practice in the patient’s “best” interest, however a strongly presented viewpoint by Thomas Szasz (2010) qualified diagnosis as an act of oppression as it may pave way for involuntary hospitalisation; where a deviant, maladjusted or poorly educated person may be subjected to « control » processes that they are not fully aware of – this has been proposed as a « possible » explanation for the greater rates of schizophrenia among ethnic minorities (particularly Africans in the US & those of low-SES groups). This view has also been supported by many who argue that schizophrenia as a distinct category may not be a fully valid diagnostic, but a fabrication constructed that may stigmatise disadvantaged or poorly educated people – while this may be positive in shaping « unacceptable behaviour » and protect citizens & society, some people with moderate symptoms may also be forcefully hospitalised. Thus, nowadays, schizophrenia is not a single definite disorder anymore, but one among others, as it has been revised and turned into a spectrum, known as the schizoid spectrum [with other related disorders]. In the treatment of schizophrenia, medicalisation has also led to the evaluation of psychotherapy as a possibly ineffective treatment (Lehman & Steinwachs, 1998). Freud & others in his discipline acknowledged the treatment of psychosis as problematic with psychotherapy as psychotic individuals tend not to develop transference [interpretation of their hidden feelings, defences & anxiety] to the analyst – unlike neurotic patients. For personality disorders, addictions and other severe mental health problems medicalisation has led to the development of alternative methods of treatment that unlike the traditional authoritarian & hierarchically organised inpatient mental health settings, are run in a more democratic line where service users are encouraged to take an active role in their rehabilitation rather than simply being passive recipients of treatment.

clinicalpsychology

Therapeutic communities have turned out to be effective in the long-term treatment of difficult patients with severe personality disorders with the outcome being more positive with longer treatments. These therapeutic communities are believed to lead to improvements in mental health and interpersonal functioning. For drug misuse issues, the assumption that clinicians make over users attempt to quit being due to conscious guidance & coherent plans should be revised as no evidence suggests so, and more evidence argue that unconscious processes, classical and operant conditioning, erratic impulses, and highly specific environmental cues affect the development and cessation of drug use (West, 2006). According to West, interventions should not stimulate adolescents to think of what ‘stage’ they are in or be matched to a stage, but maximum tolerable pressure should be put on the young person to cease drug use – which contradicts the stages of change model (DiClemente, 2003; Prochaska et al., 1992) where 30 days are allocated to stages [pre-contemplation, contemplation, action & maintenance] based on no evidence. While concepts such as harm reduction programmes with needle exchange, safe injection sites, and the provisions of free tests of quality of MDMA sold at raves remain controversial, some believe they prevent mortality and morbidity (Marlatt & Witkiewitz, 2010), while others argue they send the message that hard drug use [such as heroin] may be acceptable.

The second major controversy in modern day mental health practice remains the “Person or Context” debate where many in the field still question the validity of focusing on context as it shifts attention from the individualistic characteristics of the patient, and whether the focus should shift depending on the disorder and the patient’s age. For example in the treatment of childhood disorders, if difficulties are assumed to be individual ‘psychiatric’ illnesses the risk of focus being solely on the child and not on broader social environment may lead to medical treatments and individual therapy without addressing important risk factors for those of such young age who are influenced by their social environment, e.g. teacher, school and wider social context. This may not be the case for some adults who value a sense of autonomy more than being influenced by wider social contexts that they have no connection to, interest in or affinity for. In contrast, to the autonomic adult, treatment cases of other childhood behaviour disorders such as oppositional defiant disorder and conduct disorders may be particularly problematic, since the major risk factors that should be addressed are social: through interventions such as parent training, family therapy, multisystemic therapy and treatment foster care. For ADHD, the bold emphasis on medication is dangerous as the effects are limited to only 3 years (Swanson & Volkow, 2009), while growth and cardiovascular functioning may be affected that may lead to somatic complaints such as loss of appetite, headaches, insomnia and tics, which are present in 5-12% of cases (Breggin, 2001; Paykina et al., 2007; Rapport & Moffitt, 2002).

Another interesting argument comes from the Scottish psychiatrist and psychoanalyst R. D. Laing (2009) in the 1960s and 1970s who opposed the view that schizophrenia was a genetically based medical condition requiring treatment with antipsychotic medication. His dimensional approach led him to view schizophrenia as a ‘sane reaction to an insane situation’ where the contents of psychotic symptoms were simply viewed as psychological responses to complex, confusing, conflicting and powerful parental injunctions that left no scope for more rational and adaptive modes of expression. Thus, Laing proposed that the treatment involved creating a context where insight into the complex family process [e.g. poor housing, low SES, deviant parents with drug problems, over-involved family members who maintain the patient’s stress, alcohol problems, sexual deviance, incest, lack of financial stability, poor educational motivation, poor emotional education, lack of problem solving skills, lack of sophistication, poor nutrition, restricted finances, etc] of patients with schizophrenia and psychotic response to these could be facilitated. The context here seems partially important in the case where the patient’s delusions and hallucinations are linked, where their interpretation would be the client’s response to conflicting parental injunctions. The experience of psychosis and recovery was a process where the individual could emerge stronger with new and valuable insights regarding the solutions to their problems. However, this has not been supported by any evidence or subsequent research. In contrast, strong scientific evidence points to the importance of a more client-centred individual approach focussed solely on the patient with defective inherited neurobiological factors as major focus for the role they play in schizophrenia, and antipsychotic medication for the reduction of symptoms in two-thirds of psychotic patients affected (Ritsner & Gottesman, 2011; Tandon et al., 2010). Research has supported the hypothesis that suggests the family does affect the psychotic process and that psychotherapy has a place in the management of psychosis, for example personal trauma, including child abuse increases the risk of psychosis, and stressful life events including those within the family can precipitate an episode of psychosis, and high levels of family criticism, hostility and emotional over-involvement increase the risk of relapse (Bebbington & Kuipers, 2008; Hooley, 2007; Shelvin et al., 2008). So for those with a strong sense of family, and heavily involved peers, family therapy delays relapse in troubled families characterized by « extreme » levels of expressed emotion; and cognitive behaviour therapy which stresses the idea that psychotic symptoms are understandable and on a continuum with normal experience can help patients control these psychotic symptoms (Tandon et al., 2010), with solutions to rebuild their lives, their own identity and manage their social circle intelligently by differentiating types of relationship and expectations.

personality

The third and last controversy to be addressed is the ongoing debate in clinical psychology over the categorisation of psychological disorders where many have been arguing over a dimensional outlook on psychological conditions that offers more precision in diagnosis along with a more scientific approach. In the case of childhood behaviour disorders with regard to scientific approaches, there is an ongoing debate over whether they should be viewed and classified in categorical or dimensional terms. While DSM are based on rigid categories, most empirical studies support the view of a dimensional outlook. Furthermore, factor analytic studies consistently show that common childhood difficulties belong to two dimensions of internalizing and externalizing behaviour, which are normally distributed within the population (Achenbach, 2009). Young children diagnosed with oppositional defiant disorder (ODD), conduct disorder and ADHD are part of a subgroup of cases with extreme externalizing behavioural problems, while those with anxiety or depressive disorders have extreme internalizing behaviour problems (Carr, 2006a). By the same dimensional approach, children diagnosed with intellectual disability fall at the lower end of the continuum of intelligence, a trait also normally distributed within the population (Carr et al., 2007). The dimensional approach is not only more scientific, but also has a less stigmatizing and rational approach to human uniqueness. The dimensional approach has also enhanced the movement critical of qualifying psychological deficiencies as ‘real psychiatric illnesses’, conditions such as ADHD, conduct disorder and other DSM diagnoses. Questions have been raised over whether they are invalid fabrications or spurious social constructions (Kutchins & Kirk, 1999). Those who trust the evidence of the dimensionality of childhood disorders argue that they may simply be traits distributed normally among the population where some cases fall on the extreme ends of certain traits, while those who point to the interests of pharmaceutical industries’ financial motives argue that they are spurious social constructions. The latter seems unethical but is a part of the decadent and immoral economic reality that we have allowed to exist. As parents, health and educational professionals, it is clear that the pharmaceutical industry and governments may all gain from conceptualising children’s psychological difficulties as ‘real psychiatric illnesses’. Some schools or uncaring parents may prefer children to receive a diagnosis of ADHD with stimulant therapy as they may have difficulty meeting their needs for intellectual stimulation, nurturance and clear limit-setting; thus these children in their care become more aggressive and disruptive.

In the case of schizophrenia, a dimensional approach has also led to the schizotypy construct as a dimensional alternative to the prevailing categorical conceptualization of schizophrenia (Lenzenweger, 2010). In contrast to the categorical view based on Kraepelin’s (1899) work and used in the DSM which sees schizophrenia as a discrete diagnostic category, this one proposes that anomalous sensory experiences, odd beliefs and disorganized thinking exist in extreme forms of schizophrenia as hallucinations, delusions and thought disorder, but these are simply on continuum with normal experience [i.e. it is present in all ‘normal’ people but peaks in abnormal ones] – a position originally advocated by Bleuler (1911). Research measures have provided support for the dimensional construct of schizotypy (Lenzenweger, 2010) where the continuum may be composed of sub-dimensions; from normal to psychotic experiences. Schizotypy is heritable; and patients with high schizotypy scores but who are not psychotic show attentional, eye-movement and other neuropsychological abnormalities associated with schizophrenia. Further, the dimensional approach has also led to the distinction between schizophrenia and split personality where 40% in the UK equated split or multiple personality with schizophrenia – as popular culture often does. It is clear that schizophrenia does not refer to such characteristics.

dr_jekyll_and_mr_hyde

The closest equivalent to split personality is a condition known as dissociative identity disorder (DID), where the central feature is the apparent existence of two or more distinct personalities within the same individual, with only one being evident at a time. Each personality (or alter) is distinct with its own memories, behaviour and interpersonal style. In most cases, the host personality is unaware of the existence of alters and these vary in knowledge of each other. Evidence suggests that the capacity to dissociate is normally distributed within the population and an attribute many use to manage their own lives and network. Those with high degree of this trait may cope by dissociating their consciousness from the experience of trauma (such as child abuse, extreme graphic violence, etc) in early childhood by entering a trance-like state. This dissociative habit is negatively reinforced (strengthened) as an effective distress-reducing coping strategy over repeated traumas in early childhood as it brings relief from distress during trauma exposure. Eventually a sufficient number of experiences become dissociated to constitute a separate personality that may be activated in later life at times of stress or trauma through suggestion in hypnotic psychotherapeutic situations. Treatment often simply involves helping clients integrate the multiple personalities into a single personality and develop non-dissociative strategies for dealing with stress [e.g. argument with work colleagues, new manager, divorce, adolescents leaving home for studies, partner with alcohol problems, over-involved family members, etc] – this helps them deal with tough situations by facing them with problem-solving abilities and skills to come out with a firm resolution and have their views understood. Core symptoms of multiple personality disorder are not treated with psychotropic medication unlike schizophrenia but involves psychological education for patients to learn the skill of mentalizing [understand their own state of mind and that of others].

whoareyou

Finally, with personality disorders, the dimensional approach has led to the trait theory in conceptualizing important aspects of behaviour and experience from a limited number of dimensions. Any given trait is believed to be normally distributed in the population, for example, introversion – extraversion, most people show a moderate level of the trait, however those who exhibit extremely low or high levels [extremes] would have the sort of difficulties attributed in the DSM. So, normal people only differ from the abnormal in the degree to which they show particular traits. The trait theory has become dominated by the five-factor theory (McCrae & Costa, 2008) in recent years. This model includes the dimensions: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. There is evidence for the heritability of all of factors within the Five Factor Model except agreeableness which seems to be predominantly determined by one’s environment (Costa & Widiger, 1994). Thomas Widiger has proposed that the five-factor model may be used as an alternative system for describing personality disorders (Widiger & Mullins-Sweatt, 2010). Widiger also argues that trait theory offers a more scientifically useful approach to assessment with good psychometric properties embraced by its questionnaires (De Raad & Perugini, 2002) – they are reliable and valid, and have population norms. Compared to categorical classification systems, trait models offer a more parsimonious way of describing patients with rigid dysfunctional behaviour patterns which in turn offers a more parsimonious way to conceptualize the development of effective treatments.

LondonCity

Photo: The Promise of Dawn (J.Hawkes)

The major controversies in modern day mental health practice seem to revolve around the precision and the validity of constructs as psychological illnesses, and since they may stigmatise those who suffer from them, the constant research into better and more modern interpretations and explanations of their characteristics and treatment seem bound to revolutionise the field of psychology, as the movement takes a more dimensional approach; with a new generation of psychologists applying the rules with an open mind and a creative outlook on new perspectives and methods – the field of psychology looks set on a positively progressive course.

UneNation

« A great aggregation of men sane in mind & warm in the heart, creates a moral conscience that is known as a nation » – Ernest Renan / Source: Université Paris 1 Panthéon-Sorbonne

Arthur Hughes - A Music Party 1864

Arthur Hughes (1832 – 1915), « A Music Party« 

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References

  1. Achenbach, T. M. (2009). ASEBA: Development, findings, theory, and applications. Burlington, VT: University of Vermont Research Centre for Children, Youth and Families.
  2. Bleuler, E. (1911). Dementia praecox or the group of schizophrenias. New York: International University Press.
  3. Breggin (1991). Toxic psychiatry. London: Harper Collins.
  4. Breggin, P. (2001). Talking back to Ritalin: What doctors aren’t telling you about stimulants and ADHD. New York: Da Capo Press.
  5. Bridge, J. A., Iyengar, S., & Salary, C. B. (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in paediatric antidepressant treatment: A meta-analysis of randomized controlled trials. Journal of the American Medical Association, 297, 1683-1696.
  6. Bushnell, G., Stürmer, T., Gaynes, B., Pate, V. and Miller, M. (2017). Simultaneous Antidepressant and Benzodiazepine New Use and Subsequent Long-term Benzodiazepine Use in Adults With Depression, United States, 2001-2014. JAMA Psychiatry, 74(7), p.747.
  7. Carr, A. (2006a). Handbook of child and adolescent clinical psychology: A contextual approach (second edition). London: Routledge.
  8. Carr, A. (2012). Clinical psychology. 1st ed. New York: Routledge.
  9. Carr, A., O’Reilly, G., Walsh, P., & McEvoy, J. (2007). Handbook of intellectual disability and clinical psychology practice. London: Brunner-Routledge.
  10. Costa, P. & Widiger, T. (1994). Personality disorders and the five factor model of personality. Washington, DC: APA.
  11. De Raad, B., & Perugini, M. (2002). Big five assessment. Bern, Switzerland: Hogrete & Huber.
  12. DiClemente, C. (2003). Addiction and change. New York: Guilford.
  13. Fournier, J., DeRubeis, R., Hollon, S., Dimidjian, S., Amsterdam, J., & Shelton, R. (2010). Antidepressant drug effects and depression severity. Journal of the American Medical Association, 303, 7-53.
  14. Hankin, B., & Abele, J. (2005). Developmental psychopathology: A vulnerability-stress perspective. Thousand Oakes, CA: Sage.
  15. Kraepelin, E. (1899). Psychiatrie (sixth edition). Leipzig, Germany: Barth.
  16. Kutchins, H. & Kirk, S. (1999). Making us crazy: DSM – The psychiatric bible and the creation of mental disorders. New York: Constable.
  17. Laing, R. D. (2009). Selected works of R. D. Laing, Volumes 1-7. (Vol. 1. The divided self. Vol 2. Self and others. Vol. 3. Reason and violence. Vol. 4. Sanity and madness in the family. Vol. 5. The politics of the family. Vol. 6. Interpersonal Perception. Vol. 7. Knots.) London: Routledge.
  18. Lehman, A., & Steinwachs, D. (1998). At issue: Translating research into practice: The Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophrenia Bulletin, 2, 1-10.
  19. Lenzenweger, M. (2010). Schizotypy and schizophrenia. New York: Guilford.
  20. Maine, M. & Bunnell, D. (2010). A perfect biopsychosocial storm: Gender, culture, and eating disorders. In M. Maine, B. McGilley, & D. Bunnell (Eds.), Treatment of eating disorders: Bridging the research-practice gap (pp. 3-16). San Diego, CA: Elsevier.
  21. Marlatt, G. A., & Witkiewitz, K. (2010). Update on harm-reduction policy and intervention research. Annual Review of Clinical Psychology, 6, 591-606.
  22. McCrae, R. R., & Costa, P. T., Jr. (2008). The five-factor theory of personality. In O. P. John, R. W. Robins, & L. A. Pervin (Eds.), Handbook of personality: Theory and research (third edition, pp. 159-181). New York: Guildford Press.
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  25. Prochaska, J., DiClemente, C., & Norcross, J. (1992). In search of how people change: Applications to addictive behaviours. American Psychologist, 47, 1102-1114.
  26. Rapport, M. & Moffitt, C. (2002). Attention deficit/hyperactivity disorder and methylphenidate: A review of height/weight, cardiovascular, and somatic complaint side effects. Clinical Psychology Review, 22, 1107-1131.
  27. Read, J., & Bentall, R. (2010). The effectiveness of electroconvulsive therapy: A literature review. Epidemiologia e Psichiatria Sociale, 19, 333-347.
  28. Ritsner, M., & Gottesman, I. (2011). The schizophrenia construct after 100 years of challenges. In M. Ritsner (Ed.), Handbook of schizophrenia spectrum disorders, Volume I: Conceptual issues and neurobiological advances (pp. 1-44). New York: Springer.
  29. Swanson, J. M., & Volkow, N. D. (2009). Psychopharmacology: Concepts and opinions about the use of stimulant medications. Journal of Child Psychology and Psychiatry, 50 (1-2), 180-193.
  30. Szasz, T. (2010). Psychiatry, anti-psychiatry, critical psychiatry: What do these terms mean? Philosophy, Psychiatry, & Psychology, 17, 229-232.
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  33. Widiger, T.A., & Mullins-Sweatt, S. N. (2010). Clinical utility of a dimensional model of personality disorder. Professional Psychology: Research and Practice, 41, 488-494.

Updated 8th of August 2017 | Danny J. D’Purb | DPURB.com

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Essay // History on Western Philosophy, Religious cultures, Science, Medicine & Secularisation

essayhistory2016

Part I: Western Philosophy

The fact that philosophy’s focus has never remained static over time makes its history very complex with the added possibility that most of the early writers may have even been philosophers before historians. The world’s main philosophical trends and traditions can however be traced with a decent amount of precision while considering that the ruling philosophy of any period is determined by the socio-cultural climate and economic context [when it was written and published].

The first Western philosophers, starting with Thales of Miletus (c.620-c.555BC), were cosmologists who made inquiries about the nature and origin of all things; what defined them particularly as a new type of thinkers was that their speculations unlike those before them were purely naturalistic and not based on or guided by myth or legend. The traditions of Western philosophy originates around the Aegean Sea and southern Italy in the 6c BC in the Greek-speaking region which saw its philosophical traditions and teachings blossom with Plato (c.428-c.348BC) and Aristotle (384-322BC), who have remained highly influential in Western thought, and who probed virtually all areas of knowledge; no distinction separated theology, philosophy and science then.

As the centuries came, Christianity grew as a major religious and socio-cultural force in Europe (2-5c), and apologists such as Augustine de Hippo (354-430) started to synthesise the Christian world-view with ancient philosophy, a tradition that continued with St Thomas Aquinas (1225-1274) and throughout the Middle Ages.

As the 16c and the 17c were the years that experienced the Scientific Revolution, the physical sciences started to assert their authority as a field of their own and grow separate from theology and philosophy. A new age of Rationalist philosophers, notably Descartes (1596-1650) started their works based on the minute analysis and interpretation of the philosophical implications of the ground-breaking new scientific discoveries and knowledge of the time. The 18c produced the empiricist school of thought of John Locke and David Hume (1711-1776) in the search for the foundations of knowledge, to conclude the turn of the century with Immanuel Kant (1724-1804) who developed a strong synthesis of rationalism and empiricism as a school of philosophy. Further, the development of positivist philosophy in the 19c was inspired and based solely on the scientific method and American pragmatism [with the competing philosophy of Utilitarianism and Marxism]. Later, the individual experienced the philosophy of existentialism based on the works of Soren Kierkegaard (1813-1855) and in the 20c the discipline of psychology had firmly invented itself as a field separate from philosophy [including many branches such as neuroscience, psychiatry, psycho-analysis, etc].

 

The 20c and Western Philosophy’s influence across civilisation

Perhaps due to its wide use in maintaining reason among intellectuals and society, philosophy had fragmented into different precise and specific branches by the 20c [philosophy of mind, philosophy of science, philosophy of religion, philosophy of medicine…]. However at its core, the emphasis of philosophy remained on the analytics and linguistic philosophy due to the huge influence of Ludwig Wittgenstein (1889-1951).

Indian philosophy for example shares similarities with some aspects of Western philosophy in its foundations based on the development of logic from the Nyaya School, founded by Gautama (fl. 1c). The tenet of most schools were codified into short aphorisms (sutras) commented upon by later philosophers in the Southern parts of Asia, and India. More specifically the emphasis on linguistic expression and the nature of language which is believed to be similarly important as in the West, but different in theme as India’s language was greatly enhanced by the early development of linguistics or Sanskrit grammar, and the nature of knowledge and its acquisition. In modern times, Indian philosophy has seen an increasing Western influence especially from the social philosophies of utilitarian schools which inspired a number of religious and socio-cultural movements, such as the Brahmo Samaj. The 20c saw the Anglo-American linguistic philosophy form the basis of research, with added influence from European phenomenology present in the works of scholars such as KC Bhattacharya. The trend of Western philosophy as inspiration continued to be disseminated by intellectuals in the East, and Chinese philosophy too which first made its appearance during the Zhou Dynasty (1122-256BC) later experienced Western influence in the 20c, most notably in the introduction of the leftist branch of Marxism which became China’s official political philosophy. Around the same period, a New Confucian movement rose, attempting to synthesise the traditions of the West and the East [traditional Confucian values with Western democracy and science].

As for the African continent, starting from the Middle-East and North-Africa, it may be unsurprising that Western values or philosophy had no major influence in the Islamic territories and Muslim world who had been subjugating non-Muslin civilisations with violent wars [jihad] in the name of their God. The major European incursions and hence influence in the Arab world comes from the time of Napoleon I’s invasion of Egypt (1798) which led to the promotion of Western philosophy in the area for a short time before a backlash from Islamic circles called for a religious and politically-oriented philosophy to counter foreign domination.

Regarding African philosophy, it is to this day a subject of intense debates among intellectuals and cultured circles whether such a thing exists, along with the definition that ‘African philosophy’ may include: for example, many scholars associate the term to communal values, beliefs and world-views of traditional Black African oral cultures, highlighting the rich, long and sometimes violent tradition of indigenous African philosophy [stretching back in time] with tales of supernaturalism and communally-derived ethics by tribes. What seems to be a certitude is that African philosophy is unlike Western, Indian, Chinese and Arabic traditions as there is very little in terms of African philosophical traditions before the modern period. However, the logical question remains, and that is: if African philosophy are works that were created within the geographical area that constitutes Africa, then perhaps all of the writings of ancient Egyptians may quality as African, and also Christian apologists of the 4-5c period like St Augustine de Hippo. Indeed, to further the argument of logic, the whole world’s culture and societies could all be qualified as African, since it has recently been proven scientifically that all humans evolved after leaving Africa.

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Part II: Religious Cultures

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Image: The Atlantic

SigmundFreudOnReligion

The main driving power behind the psychological movement focused on the « Human Mind », Sigmund Freud, was an atheist unlike Isaac Newton who was a devout Christian with complex and heterodox private beliefs

The world’s cultures are generally classified into the five major religious traditions:

  • Buddhism
  • Islam
  • Hinduism
  • Judaism
  • Christianity

 

Buddhism

The tradition of Buddhism which is made up of thought and practice originates in India around 2500 years ago, it was inspired by the teaching of Buddha (Siddhartha Gautama). The concept of Buddha is explained in the ‘Four Noble Truths’, which concludes by the claim of a path leading to deliverance from the universal human experience of suffering. One of its main tenet is the law of karma, which states that good and evil deeds result in the appropriate reward or punishment in life or in a succession of rebirths. 

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Dharma day commemorates the day when Buddha made his first sermon or religious teaching after his enlightenment

Division

Dating from its earliest history, Buddhism is divided into two main traditions.

  • Theravada Buddhism adheres to the strict and narrow of early Buddhist writings, where salvation is possible only for the few who accept the severe discipline and effort necessary to achieve it.
  • Mahayana Buddhism is the more ‘liberal form’ and makes concession to popular piety by seemingly diluting the degree of discipline required for salvation, claiming that it is achievable for everyone instead. It introduces the doctrine of bodhisattva (or personal saviour). The spread of Buddhism lead to other schools to expand, namely Chan or Zen, Tendai, Nichiren, Pure Land and Soka Gakkai.

 

Theravada Buddhism in South and South-East Asia

While being nearly eradicated in its original birthplace, the practice of Theravada Buddhism has turned into a significant religious force in the states of Burma, Cambodia, Laos, Sri Lanka and Thailand. Traditionally, it is believed that missions in the area by the emperor of India, Ashoka in the 3c BC introduced Buddhism. While the evidence lacks the consistency to be conclusive, it is assumed and believed by most that many different variations of Hindu and Buddhist traditional movements were present, scattered across South-East Asia up to the 10c. Theravada Buddhism eventually acquired more influence from the 11c to 15c as it experienced growing contacts with Sri Lanka where the movement was outward looking. In Burma (now Myanmar), Buddhist states arose and soon others followed, namely Cambodia, Laos, Java and Thailand, including the Angkor state in Cambodia and the Pagan state in Burma. During the modern period [at the exception of Thailand which was never colonised], the imperial occupation, Christian missionaries and the Western world-view challenged Theravada Buddhism [the strict version of Buddhist philosophy] in South=East Asia.

 

Mahayana Buddhism in North and Central Asia

The Mahayana which is the form of Buddhism commonly practised in China, Tibet, Mongolia, Nepal, Korea and Japan dates from about the 1c when it arose as a more liberal movement within the Buddhist movement in northern India, focussing on various forms of popular devotion.

Tibetan Buddhism

Orthodox Mahayana Buddhism and Vajrayana Buddhism (a Tantric form of Mahayana Buddhism) had been transmitted through missionaries invited from India during the 8c in Tibet. Today’s popular Tibetan Buddhism places an emphasis on the appeasement of malevolent deities, pilgrimages and the accumulation of merit. Since the Chinese invasion in 1959 and the Dalai Lama’s exile from India however, Buddhism has been repressed drastically.

Chinese Buddhism

China’s introduction to Buddhism from India happened in the 1c AD via the central Asian oases along the Silk Route. It had surprisingly established itself as a reasonable presence in China by the end of the Han Dynasty (AD 220). Buddhism had become so successful by the 9c that the Tang Dynasty saw it as ‘an empire within the empire’ and persecuted it in 845 after which the Chan and Pure Land Schools only remained strong, drew closer and found harmony with each other. Buddhism and other religions however was nearly subjugated by the attempts of the Marxist government of Mao Zedong (1949 onwards) when the lands of China were nationalised and Buddhist monks forced into secular employments. Since 1978, the Buddhist movement and other religions have seen a revival in China.

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Allah

Islam

Islam is simply Arabic for ‘submission to the will of God (Allah)’ and the name of the religion which was founded in Arabia during the 7c throughout a controversial prophet known as Muhammad. Islam relies on prophets to establish its doctrines which it believes have existed since the beginning of time, sent by God like Moses and Jesus, to provide the necessary guidance for the achievement of eternal reward; and the culmination of this succession is assumed by Muslims to be the revelation to Muhammad of the Quran, the ‘perfect Word of God’.

Beliefs and traditions

There are five religious duties that make up the founding pillar of Islam:

  • The shahadah (profession of faith) is the honest recitation of the two-fold creed: ‘There is no god but God’ and ‘Muhammad is the Messenger of God’.
  • The salat (formal prayer) must be said at fixed hours five times a day while facing towards the city of Mecca
  • The payment of zakat (‘purification’) [a form of religious tax by the Muslim community] which is regarded as an act of worship and considered as the duty of sharing one’s wealth out of gratitude for God’s favour, according to the uses laid down in the Quran [such as subjugation of all non-Muslims, the imposition of violent and controversial Sharia law (a section of Islam as a political ideology which dictates all aspects of Muslim life with severe repercussions if transgressed), learning to adapt behaviour to protect Islam at all cost even if it means deceiving (‘Taqqiya’), etc]
  • There is an imposition regarding fasting (saum) which has to be done during the month of Ramadan.
  • The pilgrimage to the Mecca, known as the Haji is part of the sacred law of Islam which applies to all aspects of Muslim life, not simply religious practices. The Haji is described as the Islamic way of life and prescribes the way for a Muslim to fulfil the commands of God and reach heaven, and must be performed at least once during one’s lifetime. The cycle of festivals such as Hijra (Hegira), the start of the Islamic year, and Ramadan, the month where Muslims fast during daytime are two of the most known practices still misunderstood by mainstream media.

Divisions

Although all Muslims believe in the ideology of Islam and its teachings from Muhammad, two basic and distinct groups exist within Islam. The Sunnis are the majority and acknowledge the first four caliphs as Muhammad’s legitimate successors. The other group, known as the Shiites make up the largest minority movement in the Muslim world, and view the imam as the principal religious authority. A number of subsects and derivatives also exist, such as the Ismailis (one group, the Nizaris, regard the Aga Khan as their imam), while the Wahhabis, a movement focussed on reforming Islam begun in the 18c.

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Islam remains a priority in matters of identity for most Muslims, unlike Westerners who tend to have more nationalistic feelings

Today Islam remains one of the fastest growing religions – probably due to the high birth rate of third world North Africa where it originates along with the strong impositions it inculcates in its adepts such as the subjugation of all non-Muslims into slaves, sexual slavery, forced conversation, childhood indoctrination, honour killings and jihad (a war in the name of Islam that guarantees salvation along with mass migration to promote Islam) – and today about 700 million Muslims exist throughout the World. The constant clash with enlightened movements of the Christian West, with intellectuals such as Dr Bill Warner who initiated the movement for the study of political Islam to help break down and propagate important facts about the ideology of Islam’s political techniques in subjugating global non-Muslim societies, have started to gain major attention from the intellectual crowd [who are active on media platforms such as Twitter, a controversial platform that uses its administrative rights dictatorially, known to restrict freedom of speech, research & factual information that oppose liberal opinions, and many researchers from accessing their archived ‘tweets’ and ‘retweets’, affecting their work and research – a direct breach of Human Rights as specified by Article 10 of the Human Rights Act 1998 – and many have questioned the practice over possibilities of World War III being caused by the USA’s unethical technological monopoly over other Western nations data. Saddam Hussein was assaulted militarily by the UN after breaching human rights]

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Status of Women in the Hadith [purely based on the life, habits & actions of Muhammad]

Islam remains a controversial religions tradition while also being the only religion with a “manual to run a civilisation” as Dr. Bill Warner phrased it, in the Sharia [an Islamic set of doctrines in managing a civilisation – politics, culture, philosophy and economy] which at its deeper core includes the war on other civilisations through jihad, the subjugation of all non-Muslims, the destruction of all non-Islamic historical heritage, forced circumcision of both sexes and a whole set of violent and radical forms of Islamic lifestyle requirements that include violent and sometimes fatal repercussions [for ‘transgressing‘]. Repeatedly France has profoundly rejected Islam as a dangerous religious practice and culture that is incompatible with the values of French society & culture; however the obsolete system of management that is politics remains an atavistic barrier to banning Islam due to the concept of ‘political correctness’ – an invalid ideology created by the most corrupt & untrustworthy adepts of the obsolete practice of ‘politics’ [for reasons that are now being scrutinised in the name of change]. The late Christopher Hitchens was also a prominent speaker on secularisation and particularly focused on countering the atavistic Islamisation of the West which threatens personal liberty, freedom of expression, education, innovation, development, cohesion and socio-cultural creativity due to its rigid doctrines.

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Hinduism

Hinduism does not trace its origin to a particular founder, does not have any prophets, no set creed, and no institutional structure, but instead focuses on the ‘right way of living’ (dharma) rather than a set of doctrines. It embraces a variety of religious beliefs and practices. Variations exist across different parts of India where it was founded, differences in practice can be found even from village to village in the deities worshipped, the scriptures used, and the festivals observed. Those of the Hindu faith may be either theists or non-theists, and revere one or more gods or goddesses, or none, and instead represent the ultimate in personal (e.g. Brahma) or impersonal (e.g. Brahman) terms. Over 500 million Hindus exist today.

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Beliefs

Most forms of Hinduism assume and promote the idea of reincarnation or transmigration. The process of birth and rebirth continuing for life after life is a process referred to and termed ‘samsara. The state of rebirth (pleasant or unpleasant) is believed to be the results of karma, the law by which the consequences (good or bad) of actions reflect when life is transmigrating from one form to another which influences its character. Hindus’ ultimate spiritual goal is maksha – release from the cycle of samara.

 

Literature

No specific text is regarded as specifically authoritative unlike any other religion, Hinduism is based on a rich and varied literature with the earliest dating from Vedic period (c.1500-c500BC), known collectively as the Veda. Later (c.500BC-AD500) the religious law books (dharma sutras and dharma shastras) surfaced; they codified the classes of society (varna) and the four stages of life (ashrama), and formed the basis of the Indian caste system. The great epics were added to these, notably the Ramayana and the Mahabharata which includes one of the most influential Hindu scriptures, the Bhagavad Gita.

Caste

The concept of Hinduism is founded centrally on the caste system which is believed to have been structured since the first Aryans came to India and brought a three-tiered social structure of priests (brahmanas), warriors (Kshatriyas), and commoners (vaishyas), to which they added the serfs (shudras), the indigenous population of India which may have been hierarchically structured. The Rig Veda (10.90) gives sanction to the class system (varna), describing each class as coming from the body of the sacrificed primal person (purusha). Orthodox Hindus regard the class system which is derived from the caste system as a sacred structure in harmony with natural or cosmic law (dharma). The system of class developed into the caste (jati) system which exists today and there are thousands of castes within India based on inherited profession and concepts of purity and pollution. The upper castes are generally regarded as ritually and philosophically purer than the lower ones. While this practice was outlawed in 1951, a number of castes are still considered so ‘polluting’ that their members are known as ‘untouchables’ [too ‘polluting’ to be touched or meddled with], thus marriage between castes is forbidden and transgressors have been known to be harshly punished.

Gods

Shiva, Vishnu and Brahma are the main chief gods in Hinduism, and together form the triad (the Trimurti). Many lesser deities also exist, such as the goddesses Maya and Lakshmi. It is common to most Hindus to go on pilgrimages to local and regional worship sites with an annual cycle of local, regional and all-Indian festivals.

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Like Christianity & the other major religions, Hinduism too gradually spread in influence across the globe. However, 94% of people who practice Hinduism  are the native Hindi-speaking population of India

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judaism

Judaism

Judaism is the religion of the Jews where the central belief in one God is the foundation. The primary source of Judaism is the Hebrew Bible, with the next important document being the Talmud, which consists of the Mishnah (the codification of the oral Torah) along with a series of rabbinical commentary. Jewish practice and thought however would be shaped by later documents, commentaries & the standard code of Jewish law and ritual (Halakhah) produced in the late Middle Ages.

Communal Life

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Peinture: Sandrine Arbon

Most Jews see themselves as members of a group whose origins lie in the patriarchal period – however varied the Jewish community may be. There is a marked preference for expressing beliefs and attitudes more through rituals that through abstract doctrine. In Jewish rituals, the family is the basic unit although the synagogue too has developed to play an important role in being a centre for community study and worship. The Sabbath, a period starting from sunset on Friday and ending at sunset on Saturday is a central part of religious observance in Judaism with a cycle every year comprising of festivals and days of fasting, the first of these being Rosh Hashanah, New Year’s Day; in the Jewish year, the holiest day is Yom Kippur, the Day of Atonement – others include Hanukkah and Pesach, the family festival of Passover.

 

Divisions

Rabbinic Judaism is the root of modern Judaism with a diverse historical development. Most Jews today are the descendants of either Ashkenazim or Sephardim, while many other branches of Judaism also exist. The preservation of ‘traditional’ Judaism is generally linked to the Orthodox Judaism movement of the 19c. Other branches, such as Reform Judaism attempt to interpret Judaism in the light of modern scholarship and knowledge, a process pushed further by Liberal Judaism – unlike Conservative Judaism which attempts to emphasise on the positives of ancient Jewish traditions in attempts to modify orthodoxy.

Modern Controversies

Waves of anti-Semitic prejudice and persecution during World War II have been regular features of Western media outlets’ [mostly Jewish owned] focus, who throughout history have clashed with the Christian influenced heritage of European civilisations, and this ongoing tension between Semitic traditions/philosophies/beliefs and Western Christian-influenced cultures was to take a turn when the rise of a form of « patriotic socialism » [neither left or right, but all encompassing] nationalism across Europe was marked by the spectacular election of the talented Adolf Hitler, who had been the leader of the National Socialist party [Nationalsozialismus later tarnished as « NAZI » by a jew known as Konrad Heiden from the Social Democratic Party of Germany (Sozialdemokratische Partei Deutschlands)] in Germany, and implemented the core ideologies of National Socialism [a focus on self-sustainability and socio-cultural and economic independence while creating a healthier – psychologically & physically – nation] with Darwinian influence on health policies, and the arts and a scientific culture of research as an integral part of its core.

The lies surrounding the event known as « the holocaust » based on Communist propaganda, Global Zionist interests, along with the credulity of mediocre politicians across the globe, has today been unfairly implanted in the minds of the ignorant mass media consumer as being the « dark legacy » of a talents such as Adolf Hitler. This exaggerated picture that the media had already been circulating to the disapproval of some leading world figures such as John Kennedy and Gandhi [Article: Quand Gandhi écrivait à son « cher ami »… Adolf Hitler], is still being reviewed by a wave of daring, talented and modern historians of whom many have denied accusations of gas chambers that were not present or inadequate to be used as gas chambers on all of German soil. More testimonies of camp survivors gave notes of swimming pool, orchestras, shower rooms and even a canteen, without ever mentioning gas chambers. Others explained how the media propaganda videos of mass deaths with emaciated bodies were due to the outbreak of Typhus carried by lice which was caused by low hygiene due to the Allied bombing of train tracks which restricted many cities from supplies of food, medicines & sanitation; causing the starvation and death of not only camp detainees but many German men, women and children who were scavenging the streets for food. The shower rooms in the camps on German soil were also documented as working shower rooms that were vital for hygiene and the delousing process.

English historian David Irving was jailed for his revision of events linked to Adolf Hitler while other ground breaking documentaries such as ‘The greatest story never told’ by Dennis Wise keep spreading the real facts that are never part of mainstream media to the new generation of the internet era who seek factual analysis over historical controversies, such as the 150 000 Jews who gave up their heritage and had firmly assimilated German society in Adolf Hitler’s Third Reich and served loyally against Bolshevism & Communism until the very end.

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The 1290 Edict of Expulsion from England, the expulsion from France in 1306 to name a few & the Chart showing all the times throughout human history that the Jews have been expelled from the locations they had migrated to. Many books over some despicable practices regarding human sacrifices have been written by a range of  non-Jewish intellectuals and thinkers who opposed such vile ancient traditions.

However, the mainstream mind set remains stuck on the theory of the ‘gassing of the Jews by the Germans’ for most, with urgency being given to the Zionist movement, established by the World Zionist Organisation for the creation of a Jewish homeland, which is still pivotal in most relations between Jews and non-Jews to this day, with over 14 million Jews scattered around the world.

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christianity

Christianity

Christianity is a religion that developed out of Judaism, centred on the life of Jesus of Nazareth in Israel. Jesus is believed to be the Messiah or Christ promised by the prophets in the Old Testament, and in a unique relation to God, whose Son or ‘Word’ (Logos) he was proclaimed to be. He selected 12 men as his disciples during his life, who after his death by crucifixion and his resurrection, formed the very nucleus of the Church as a society of believers. Christians gathered together to worship God through the risen Jesus Christ, in the belief of his return to earth and to establish the ‘kingdom of God’.

Despite sporadic persecution, the Christian faith saw a quick progression and spread throughout the Greek and Roman world through the witness of the 12 earliest leaders (Apostles) and their successors. In 315 Christianity was declared by Emperor Constantine as the official religion of the Roman Empire. The religion survived the Empire’s split and the ‘Dark Ages’ through the witness of groups of monks in monasteries, and made up the basis of civilisation in Europe in the Middle Ages.

The Bible

Christian scriptures are divided into two testaments:

  • The Old Testament (or Hebrew Bible) is a collection of writings originally composed in Hebrew, except for sections of Daniel and Ezra which are in Aramaic. The contents depict Israelite religion from its roots to about the 2c.
  • The New Testament, composed in Greek, is called so in Christian circles because it is believed to represent a new ‘testament’ or ‘covenant’ in the long history of God’s interactions with his people, focussing on Jesus’s ministries and the early development of the apostolic churches.

Denominations

Differences in doctrines and practices however have led to major divisions in the Christian Church, these are the Eastern or Othodox Churches, the Roman Catholic Church, which recognises the Bishop of Rome (the pope) as head, and the Protestant Churches stemming from the break-up with the Roman Catholic Chuch in the Reformation. The desire to convert the non-Christian world and spread Christianity through missionary movements led to the establishment of numerically strong Churches in developing economies such as Asia, Africa and South America.

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Image: Jim Caviezel as « the Lord Jesus Christ » in Mel Gibson’s « Passion of the Christ (2004) » [An extract from the incredible depiction of Jesus Christ’s journey can be viewed here]

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Part III: Science

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‘Science’ derives from the Latin Scientia, ‘knowledge’, from the verb scire, ‘to know’. For many centuries ‘science’ meant knowledge and what is now termed science was formerly known as ‘natural philosophy’, similar to Newton’s work of 1687, Naturalis Philosophiae Principia Mathematica (‘The Mathematical Principles of Natural Philosophy’). In can be argued that the word ‘science’ itself was not widely used in its general modern meaning until the 19c, and that usage came with the prestige that the scientific method and scientific observation, experimentation and development had by then acquired.

Early Civilisations

The first exact science to emerge from ancient civilisations is astronomy. Astronomical purposes were the guiding force that led to studying the heavens – so that the ‘will of the gods’ may be foreknown – and in order to make a calendar [which would predict events], which had both practical and religious uses. The seven-day week for example is derived from the ancient Egyptians who although not known as excellent mathematicians, had wanted to predict the annual flooding of the Nile. Chinese records and observations provide valuable references in modern times for eclipses, comets and the positions of stars. In India and even more so in Mesopotamia, mathematics was applied in creating a more descriptive form of astronomy. The ancient Mesopotamian number system was based on 60, thus from it the system of degrees, minutes and seconds was developed.

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The Ancient Greeks

It is to be noted that in all these civilisations, the emphasis had been on observation and description, as the tendency was to explain phenomena as being ‘the nature of things’ or the ‘will of the gods’. The Greeks, who had been looking for more immediate explanations, instead relentlessly examined phenomena and the theories propounded by other earlier thinkers critically. Thales of Miletus initiated the study of geometry in the 6c BC.

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Thales de Miletus (c.620-c.555BC)

At the similar period, Pythagoras had been discovering the mathematical relationship of the chief musical intervals, crucially relating number relationships to physically observed phenomena. Early Greek natural philosophers (today known as ‘scientists) passed on two major concepts to their successors: the universe was an ordered structure, and the ordering of it was organic not mechanical; all things had a purpose and were imbued with the propensity to develop in accordance with the purpose they were fated to serve.

The main voice for such ideas to later ages was Aristotle (384-322BC), who provided a cosmology with the earth at its centre in which everything above the moon was subject to circular motion, and everything beneath it [on earth] was composed of one of the four elements: earth, air, fire or water. The whole system was believed to be set in motion by a ‘prime mover’, usually identified with God.

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This concept was later given a Mathematical basis by Ptolemy (c.90-168AD), an astronomer and geographer working in Alexandria, whose main work [a solar system with the earth at its centre], the Amagest, was revered until the 17c. Aristotle also taught that living creatures were divided into species organised hierarchically throughout creation and reproducing unchangingly after their own kind – an idea that remained unchallenged until the great debate on evolution in the 19c. For Aristotle, scientific investigation was a matter of observation. Experimentation, by altering natural conditions, falsified the ‘truth of things’.

Archimedes (c.287-212BC) was Ancient Greek’s most famous and influential mathematician, who founded the science of hydrostatics, discovered formulae for areas and volume of spheres, cylinders and other plane and solid figures, anticipated calculus, and defined the principle of the lever. His principal contribution to scientific advancement lies perhaps in demonstrating how physical properties can be rendered in terms of mathematics and how formulae thus produced can be subjected to mathematical manipulation and the results translated back into physical terms.

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Archimedes Thoughtful by Domenico Fetti (1620)

The Middle Ages

The pursuit of mathematical theory and pure science was not of great importance to the Romans, who preferred practical knowledge and concentrated on technology. After the fall of the Roman Empire, ancient Greek texts were preserved in monasteries. There the number system, derived from ancient Hindu sources, had given more flexibility to mathematics than was possible using Roman numerals. It was combined with an interest in astronomy and astrology, and in medicine.

Aristotelian thought made an emergence in Christian West in large measure through the work of St Thomas Aquinas in the 13c. Christianity assimilated what it could from Aristotle, as Islam had done some centuries before. Scientific knowledge was still regarded as part of a total system embracing philosophy and theology: a manifestation of God’s power, which could be observed and marvelled at, but not altered. Eventually, Aristotle was proclaimed as the ultimate authority and last word in natural philosophy. His enormous prestige combined with the conservatism of academics and of the Church laid something on the progress of science for several centuries. In the later medieval era and the Renaissance period however, ancient Greek scientific thought was refined, and advances were made both in the Christian Mediterranean and in the Islamic Ottoman Empire. The European voyages of exploration and discovery stimulated much precise astronomical work, done with the intention of assisting navigation. Jewish scholars who could move between the Christian and Muslim worlds were often prominent in this work.

The Scientific Revolution

The Scientific Revolution of the 16c and 17c remain up until this day the most defining era in science, and it happened just after the renaissance, where the conduct of scientific enquiry in the West underwent an incredible change. Nicolaus Copernicus (1473-1543) refuted many aspects of the already established Ptolemaic model of the solar system where the earth is at the centre of everything in astronomy – where he redefined the system with sun instead at the centre.

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A German mathematician, Johannes Kepler (1571-1630), who was also influenced by his work concluded that the movements of planets’ orbits around the sun are elliptical rather than circular. Galileo Galilei who is now championed by many intellectuals as the father of modern science was an Italian philosopher, mathematician and scientist in those days who improved on the telescope that had been invented in Holland, and used it to make observations that included the Milky Way and Jupiter’s satellites. Later, his further research convinced him of the truth in the new Copernican system [with the sun at the centre], but under threat from the Inquisition he recanted.

In England, William Gilbert (1544-1603) established the magnetic nature of the earth and was the first to describe electricity; William Harvey (1544-1603) explained the circulation of blood; and Robert Boyle (1627-91) studied the behaviour of gases under pressure – all in the early 17c.

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Isaac Newton (1642-1727)

Isaac Newton (1642-1727), who was to replace Aristotle as the leading authority in natural philosophy for the next two centuries also came from England. He established the universal law of gravitation as the key to the secrets of the universe. In 1687, he published his ground breaking work entitled Principia, which stated his three laws of motion. Alongside Gottfried Leibniz (1646-1716) he invented calculus, and he also did incredibly influential work on optics and the nature of light.

Cooperation and discourse among scientists and intellectuals had been fostered by the creation of societies where meeting and discussions about their work could take place: for example, the Royal Society in London established in 1662, and the Académie des Sciences in Paris, founded in 1666. Discoveries made by various scientists were used by others in science to advance faster to new theories, leading to science obtaining more status and prestige as a driving force in society.

The 18-19c

The 18c Enlightenment saw its writers play a major part in bringing the scientific advances of the previous century to the wider public and further enhancing the prestige of science as a reliable driving force of civilisation. The scientific method – observation, research, even experimentation and the use of reason, unfettered by preconceptions or dogma to analyse the findings – was applied to almost all aspects of human life.

Chemistry saw significant advances in the latter part of the century – notably the discovery of oxygen by Lavoisier in France, Priestley in Britain and Scheele in Sweden. The Industrial Revolution was a substantial contribution of scientific knowledge’s impact on society and a variety of minds from various fields with various intentions. The discovery of the dye, aniline led to a ‘revolution’ in the textile industry – an example of science’s usefulness to the ‘eyes of the public’, which gradually led to more public support and hence government funding. The École Polytechnique was founded in France in 1794 to propagate the benefits of scientific discovery throughout society. Elsewhere, technical institutions followed that were funded for scientific work – the new era of the professional in science had begun.

Throughout the 18c, botany also advanced when Linnaeus invented his system of binomial nomenclature (1735), while ever growing interest was aroused by the great variety of new species of plants and animals being discovered by explorers, particularly by Captain Cook.

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The French naturalist Jean-Baptiste Lamarck’s (1749-1829) work foreshadowed Charles Darwin’s theories of evolution and made the first break with the notion of immutable species proposed by Aristotle. That particular moment in time also saw geology develop into a science: William Smith (1769-1839), ‘the father of English geology’, was drawn to investigate strata while working as an engineer on the Sommerset coal canal to eventually become the first to identify strata by the different fossils found in them. The epoch-making conclusions of Darwin’s (1809-1882) work on his theory of evolution was accepted by almost all biologists upon its publication as The Origin of Species in 1859, which however did clash with the ideologies promoted by the church. The laws of heredity that had been the work of Gregor Mendel (1822-84) was unfortunately not appreciated in his lifetime – to only later become the founding stone for genetic research. The germ theory of disease was also formulated by the French chemist Louis Pasteur (1822-1895) who moved into biology.

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Physics also evolved from tremendous advances in the 19c, as the Italian, Alessandro Volta (1745-1827) developed the current theory of electricity, and invented the electric battery and electrolysis [a study which he formulated in French and sent as a letter to the Royal Society later]. Michael Faraday (1791-1867) carried out experiments with magnetism and electricity, and enabled the building of generators and motors. James Clerk Maxwell (1831-79) proposed the field theory of electromagnetism which mathematically related the phenomena of electricity, magnetism and light. The existence of radio waves was also predicted by him, which was eventually demonstrated by Heinrich Hertz (1857-1894).

Although science itself had not been of major importance in the very early stages of the Industrial Revolution in 18c Britain, technology by the end of the 19c – influenced by the works of scientists – had led to the development of most of the machines and tools that were to transform life for most of humankind in the developed world in the following century. Germany as a single nation excelled and innovated for the time between 1870 and 1914, where scientific education and applied science became major parts of the educational system, all the way up to the tertiary level. A research culture, with the ability to generate change became instilled and institutionalised to become part of German education, culture & philosophy.

 

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The Reichsadler or Emblem of the Deutsches Reich (1933–1945) with the Swastika symbol

Atomic physics and relativity

The theory that all matter is made up of minute and indivisible particles known as atoms was proposed by the ancient Greeks, and various early 19c scientists such as Newton, John Dalton (1766-1844), Amedeo Avogadro (1776-1856) and William Prout (1785-1850) made significant contributions in refining the concept of the atom and the molecule, and in 1869 Dmitri Mendeleyev (1834-1907) conceived the periodic table classifying the chemical properties of each known element to their atomic weight.

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An Atom

Albert Einstein’s (1879-1955) theoretical work gave way to the development of the quantum theory in the early 20c. Einstein’s theory of relativity would incorporate Maxwell’s electromagnetic theory and Newton’s mechanics, while also predicting departures from the classical behaviour of materials at velocities approaching the speed of light. The century’s most famous formula was also provided by Einstein – E = mc 2 – to define the mass equivalence of energy. The postulation of the existence of subatomic particles, the building blocks of atoms and their nuclei, was also made after a series of experiments with ionising radiations. The large energy release created by the splitting of the atomic nucleus predicted by Einstein was demonstrated by Ernest Rutherford (1871-1937) in 1919. Force fields and their subatomic particles were studied further in the second half of the 20c through the use of large particle accelerators [up to 27km/17mi in length] with a view to forming a unified theory that would describe all forces including gravity.

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What the laboratory could not provide in terms of information was gained through astronomical observations which would lead to complementary information in understanding the universe on a microscopic and cosmic scale.

The understanding of the atom in terms of a heavy nucleus surrounded by light electrons has led to a deeper knowledge of the chemical and electronic properties of materials and ways of modelling them. Near the end of the 20c, such advancement enabled the ‘tailor-making’ of materials, substances and devices exploited in chemical, pharmaceutical and electronic products.

Genetics and beyond

The study of the basic building blocks of organic life was largely influenced by the study of the atom of the 20c. Research into understanding the nature of the chemical bond and molecular structure applied in biology led to the work on DNA. Investigation by Francis Crick (1916-2004), James Watson (1928- ) and Maurice Wilkins (1916-2004) in the early 1950s revealed the famous helical structure, which has a particular structural feature in that it is composed of four types of proteins, which proved the existence of a genetic code.

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A surge in genetic science was the reality of the latter second half of the century, suddenly unlocking the possibility of cloning and even more controversially, ‘tailor-making’ or ‘engineering’ living beings.

The pace of scientific development has definitely been progressing since the Renaissance and the ongoing Scientific Revolution started in the 16c and 17c. In the 20c, the revolution was exponential, and new information gained from research and experiment is still being used in the applied sciences and technology in the search for newer and more efficient modes of power, tools, and to meet the ever increasing demand for useful and smarter environmentally friendly materials to meet the demands of civilisation while maintaining the fragile balance of our environmental ecosystem due to excessive exploitation and fossil fuel use. The public perception of science is unfortunately only based on its practical applications in everyday life and not on the more life changing matters such as atomic physics or genetics – which are as remote from the average citizen as they have ever been.

Similarly to religion, science arose out of the desire to explain the world around us. The fierce clashes between both institutions have been hard fought, although by the 20c science was crowned as the dominant orthodoxy in guiding civilisation. Yet, with the existence of uncertainty factors and the development of chaos theory, science may be less dogmatic since the Renaissance.

The Scientific Revolution of the 16c & 17c: where science was established as a driving force

scientific-revolution

The Scientific Revolution could be qualified by many scientists, intellectuals and historians as an era born of a thirst of development and knowledge since it started just after the Renaissance, near the end of the 15c to give birth to science as it is known today. Perhaps its lasting appeal to the world is that it helped refine intellectual thoughts and establish the basis for the founding methods of investigation still used by all fields of science today. In fact, the Scientific Revolution is the name given to change in the nature of intellectual inquiry – the way in which civilisation thought about and investigated the natural world. This wave of scientific revolution began near the end of 15c Europe, and until it was accomplished or at least under way, it could be easily argued whether any of the thinkers, intellectuals and scholars of Christian Europe could properly qualify themselves as ‘scientists’.

The medieval mind set

Although the middle ages lacked the sophistication of today’s society, original thinkers did exist. It may be true however to say that scholasticism – the term given to theological and philosophical thought of the period operated within a tightly structured and closed system: the universe was God’s creation where the primary truths revealing its nature and workings were only found in the Bible. As knowledge, the Bible was also supported by the writings of selected authors of immemorial and unimpeachable authority, namely Galen, Aristotle and the Church Fathers. If one wanted to establish the truth in any matter, one would first seek support from such an authority, and if support was found, the case would be closed. The desires to critically challenge while pushing the boundaries was clearly not present as many may have believed. Most attempted rather to move closer to the supposedly ‘true meanings’ of the already authoritatively established or formulated. When Bishop James Ussher as late as the 1650s tried to investigate the age of the world, his attention went no further than the Holy Scripture, and by voraciously studying Biblical chronology, concluded at a precise date for the Creation – 4004BC.

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The Creation of Adam by Michelangelo (part of the Sistine Chapel painted in 1508-1512)

Moreover, it was also axiomatic for the times and the credibility of such a powerful voice as the church for no loose ends to be present in God’s original ‘perfect Creation.’ Although the Fall of Man had created feelings of uncertainty into the cosmos, evidence of the intended order was still arguable – there was an underling order, pattern and correspondence everywhere. Things could – in most cases – best be understood or described by analogy with another. Assuming that the one who governs the universe is God, the Sun would therefore be most powerful of all the planets circling the earth, so the king is chief ruler among men, so reason should rule over the inner life of humankind, and even more so the lion must be the king of beasts. Nowadays, it would simply not be revealing much about the lion to claim that its position on the scale of nature in the animal kingdom is equivalent to that of a king among men or the sun among the planets; in medieval times the conversation would be closed here without any space for questioning or clarifying.

The Renaissance and the Reformation

The process of modernising and opening up the workings of the closed system began with the Renaissance, the Reformation, and the voyages of exploration and discovery. Those living during the Renaissance had then possessed new knowledge or had new access to old sources. Many thinkers and intellectuals of the time believed themselves to be part of a movement that was making a significant break with the past to pave the way for a new era of modern knowledge. A process of secularising knowledge was started, prising it away from its basis in theology, and making the study of subjects such as science and mathematics a thing of value in its own right. In northern Europe the Reformers rejected the authority of the Church and instilled in believers the confidence to study the Word of God – and, by extension, His works – for themselves. Voyages of discovery finally made known the existence of new worlds entirely unsuspected by the ancients on earth, leading to the questioning of not only the value of geographical authorities but of other authorities as well.

Copernicus, Kepler and Galileo

The Polish astronomer Nicolaus Copernicus (1473-1543) completed his work De Revolutionibus Orbium Coelestium (‘On the Revolutions of the Heavenly Spheres’). It represented the mature expression of an idea expressed earlier in a brief commentary, namely, that the sun was the centre of the universe and the earth and the other planets revolved around it. The work was published as a book in Frankfurt in 1543 by a Lutheran printer, shortly after Copernicus’s death.

Copernicus’s theory, if accepted, not only destroyed the old earth-centred system devised by Ptolemy, but also made obsolete all the analogies based on that cosmology. The new model however was accepted by few, not even by the popular Tycho Brahe (1546-1601), who himself contributed hugely to astronomy during the 16c through his observations of the stars and their movements. De Revolutionibus was banned by the Roman Catholic Church and remained so until 1835 [292 years].

The Copernican theory was however accepted by Johannes Kepler (1571-1630), a German mathematician and astronomer who was Tycho Brahe’s assistant and on his death succeeded him as the imperial mathematician and court astronomer in Prague. Intensive works on planetary orbits done by Kepler helped develop the theory further and provided it with a mathematical foundation. Kepler’s findings on the laws of planetary motion, published in Astronomia Nova (‘New Astronomy’) in 1609 and Harmonice Mundi (‘The Harmony of the World’) in 1619, formed an essential foundation for the later discoveries of Isaac Newton (1642-1727). Further significant discoveries in optics, general physics and geometry was also made by Kepler. It may also be noted while considering the still fragile and transitional status of science in the 17c, that he was appointed as astrologer to Albrecht Wallenstein, the Catholic general who commanded the Thirty Years’ War. Newton too was a student of alchemy.

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Galileo Galilei (1564-1642)

The Copernican theory was also accepted by Johannes Kepler’s (1571-1630) older Italian contemporary, Galileo, who first took issue with Aristotle while studying in Pisa. When he was made Professor of Mathematics there in 1589, he disproved Aristotle’s theory regarding the assumption that the speed of an object’s descent is proportional to its weight – a presentation he made to his students to demonstrate the phenomenon, by releasing objects varying in weight from the Leaning Tower of Pisa. After his Aristotelian colleagues pressured him into giving up his professional chair, Galileo would make his way to Florence, by the same time he had also inferred the value of a pendulum for the exact measurement of time, created a hydrostatic balance, and written a treatise on specific gravity. From 1592 to 1610 when he was a Professor of Mathematics in Padua, Galileo modified and perfected the refracting telescope after learning of its invention in Holland in 1608 and used – a powerful tool denied to Copernicus and Tycho Brahe – to make remarkable discoveries, notably the four moons of Jupiter and the sunspots, which further confirmed his acknowledgement of the Copernican system which stated that the earth moved around the sun in an elliptical orbit, a system first formed in 1595. However Galileo’s daring conclusions at the time lead to conflicts not only with traditionalist academics, but also more seriously with the Church due to his writings when he was employed as the court mathematician in Florence in 1613. A warning from Cardinal Bellarmine in 1616 instructed the mathematician that his support of the Copernican system should be dropped as the belief in a moving Earth contradicted the Bible. After several years of excruciating silence, in 1632 he published Dialogo sopra I due massimi sistemi del mondo (‘Dialogue on the Two Chief World Systems’) in which, in the context of a discussion of the cycles of tides, he concluded with supporting Copernicus’s system of the solar system. The savage religious laws of the times saw Galileo compelled to abjure his position and sentenced to indefinite imprisonment – a sentence commuted immediately to house arrest. After abjuring he is believed to have murmured ‘eppur si muove’ (‘it does move nonetheless’).

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More Progress

The 16c saw major strides in all branches of science, the Belgian Andreas Vesalius (1514-1564) became one of the first scientists to dissect human cadavers. Based on his professional observations, he published De Humani Corporis Fabrica (1543, ‘On the Structure of the Human Body’), the very same year that Copernicus’s De Revolutionibus appeared. The anatomical principles of Galen were repudiated, and paved way for William Harvey’s discovery of the circulation of the blood, explained in a book in 1628. The works of Galileo however had not only had an impact on knowledge itself but on many other intellectuals such as Evangelista Torricelli (1608-47), the inventor of the barometer [a vital equipment for experimentation], and the Dutch physicist Christiaan Huygens (1629-1693), the inventor of the pendulum clock, the discoverer of the polarisation of light and the first to put forward the idea of its wave nature

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De Humani Corporis Fabrica by Andreas Vesalius (1543)

At the similar period, the Irish experimental philosopher and chemist, Robert Boyle (1627-1691), the formulator of ‘Boyle’s Law’, was studying the characteristics of air and vacuum by means of an air pump, created in partnership with his assistant Robert Hooke (1635-1703). The anti-scholastic ‘invisible college’ meetings of Oxford intellectuals, a precursor of the Royal Society, saw Boyle play an active part – his air pump became a powerful symbol of the ‘experimental philosophy’ promoted by the Royal Society since its founding in 1660. In 1662, Robert Hooke became the Royal Society’s first curator of experiments.

The Royal Society gradually provided a forum and focus for scientific discussions and a means of discussing scientific knowledge – its Philosophical Transactions became the first professional scientific journal. Together with other comparable institutions in other countries, such as the Académie des Sciences of Paris, founded in 1666, the systematisation of the scientific method and the way in which experiments and discoveries were reported were promoted. The importance of plain language in the detailed & systematic description of experiments for reproducibility was emphasised. The creation of prominent scientific associations also marked a cornerstone for the socio-cultural acceptance of science.

Newton

The Scientific Revolution’s culmination is believed to lie in the work of Isaac Newton, where his early mathematical studies led to the invention – simultaneously with Gottfried Leibniz (1646-1716) – of differential calculus. While focussing on the behaviour of light and prisms, he created the first reflecting telescope, a pivotal tool to the astrologers who followed. In 1684, Newton published his theory of gravitation, and in 1687 his famous Philosophiae Naturalis Principia Mathematica (‘Mathematical Principles of Natural Philosophy’), which stated his three laws of motion, would become the founding stone of modern physics – unchallenged until the arrival of Einstein in the early 20c.

Most importantly, Newton’s universal law of gravitation not only explained the movements of the planets within the Copernican system but it even gave an explanation to such humble events as the fall of an apple from a tree. But more surprisingly, it never excluded God from the universe since all of Newton’s work was undertaken within the framework of a devout Christian, though his private beliefs were complex and heterodox.

By the time of his death in 1727, the scientific method was firmly established, and the thinkers, intellectual and writers of the Enlightenment acknowledged that an era had dawned where observation, experiment and the free application of human reason were the foundation of knowledge. In fusing science with culture and spreading knowledge through various themes and outlet of the discoveries made from previous centuries, the writers of the Enlightenment helped to firmly establish the prestige that science and its affiliates and practitioners have inherited and enjoyed down to the present day.

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Part IV: Medicine

medicine

From the earliest times of human civilisation, all societies seem to have had a certain amount of knowledge of herbal remedies and to have practised some folk medicine. Most patients in the earliest days were treated with the objective of regaining the favour of the gods or to ‘release’ the evil from the body, therefore the cause of illness was believed to be rooted in supernatural causes. In early civilisations such as in Egypt and Mesopotamia, for example, salves were used as part of medical practice which included divination to obtain a prognosis and incantation to help the sufferer. In the East, many commonly occurring diseases were documented by doctors in India and where they used some drugs still exploited by modern medicine; they also performed surgery that included skin graft. In some parts of the world, some societies banned the cutting of dead bodies due to religious beliefs and policies fused with the law. Unsurprisingly however, knowledge of physical anatomy was incredibly basic. Early Chinese society also banned the desecration of the dead and this resulted in Chinese concepts of physiology not being based on observational analysis. A developed medical tradition flourished in China however from the earliest times to the present day, with special focus placed on the pulse as means of diagnosis.

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In Chinese medical philosophy, the objective is to balance the yin (the negative, dark, feminine, cold, passive element) and the yang (the positive, light, masculine, warm, active element), and the pharmacopoeia for achieving this: vegetable, animal and mineral. Similarly important is the practice of acupuncture, where needles are used to alter the flow of ch’i (energy) that is believed to travel along invisible channels in the body (meridians). Anaesthesia puts the efficacy of acupuncture to the test – being its most widespread use.

The sophistication of modernity in the West started to set a new course to medicine when it was partially rationalised by the Greek philosophers, since before this it was mainly an aspect of religion.

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Asclepius, the Greek god of medicine

In ancient Greece for example, people suffering from illness would go to the god Asclepius’s temple for incubation – a sleep during which the god would visit in a dream which would then be interpreted by the priests to reveal the diagnosis or advice for the cure. Empedocles later came up with the idea that four elements exist – fire, air, earth and water, which when applied to the human body turned into blood, phlegm, yellow bile and black bile – which must obey certain rules to be maintained in harmonious balance. That concept was further reinforced when it was adopted by Aristotle (384-322BC) and remained a founding pillar of Western medicine until the new discoveries of the 18c. From the viewpoint of a biologist, Aristotle observed the world, performing dissections of animals and learning more of anatomy and embryology.

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After his death, the main learning centre in Greece became Alexandria, where principles expounded by Hippocrates (c.460-c.377BC) were upheld and obsolete ideas such as illnesses caused by the gods were rejected, instead he made and raised a new school of thought where his diagnosis and prognosis were made after careful observation and consideration. Today, Hippocrates is regarded as the ‘father of medicine’, and sections of the oath attributed to him are still used in medical schools to this present day.

Galen (c.130-c201), a Greek doctor, was the next major and defining influence on Western medicine who studied at Alexandria and later went to Rome. Galen gathered up all the existing writings of Greek doctors, and emphasised on the importance of anatomy to medicine. He used apes to find out about the ways the body worked since dissection of human bodies were then illegal. Although his daring efforts were justified for medicine, his reports contained many mistakes on anatomical points which included the circulation of blood around the body, which he described instead to have ‘ebbed and flowed’.

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Surprisingly, the point worth noting is that although the people then were living in the early times of human history, Rome had already developed an excellent culture with high regards for public health; more strikingly perhaps is also the fact that they even had clean drinking water, hospitals and sewage disposal – which was never developed or adopted by any civilisation until the 20c.

After the Roman Empire fell, the practice of medicine resided in the infirmaries of the monasteries. In the 12c century, medicine was developing as an important necessity in society from the lower to the upper end, and the first medical school was established at Salerno. Many other medical schools in Europe followed, namely: Bologna, Padua, Montpellier and Paris. Mondino dei Liucci (c.1270-1326) published the very first manual of anatomy after carrying out his own dissections in Bologna. The most major advancement in medicine however came from the Belgian Andreas Vesalius (1514-1564) who contributed through incredibly detailed sketches, descriptions and drawings published in 1543, correcting the errors of Galen. The Inquisition sentenced him to death for performing human dissections [once again an occasion where religious traditions came in the way of reason and research], however a new wave of inquisitive intellectuals had already surfaced abroad who could not be stopped.

A better and more precise knowledge of anatomy led to an improvement in techniques used in surgery, and surgeons, the long considered as inferior practitioners by physicians, began to be recognised as a major part in medicine and its procedures. The huge increase in the armies of Europe in the 16c and 17c created greater demands for effective surgery in the military departments. Ambroise Paré (1510-1590) reformed surgical practice in France, sealing and stopping the cauterising of wounds, while in the United Kingdom, more collectives of medicine intellectuals were formed which later became the College of Surgeons.

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French nobleman and chemist Antoine Lavoisier (1743-1794) and his chemist wife Marie-Anne (1758-1826)

In 1628, the theory of the circulation of blood was formulated by William Harvey’s experiments in the 17c, which was reinforced by Marcello Malpighi’s work. However, it took more than a hundred years for medicine to fully understand the purpose of circulating blood up until Antoine Lavoisier (1743-1794), a French chemist discovered oxygen which has to be transported to various parts of the human body through blood. A new approach to obstetrics was also invented at that time, along with the growth of microscopal studies, and by the end of the 18c Europe was introduced to vaccines which helped to eradicate previously deadly diseases such as smallpox in the 20c.

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Biologist and physician, Marcello Malpighi (1628-1694)

In the 19c scientific research generated new knowledge about physiology and medicine saw refinements to aid diagnosis, such as the invention and introduction of the stethoscope and chest percussions. The field of bacteriology was also born out of the work of Louis Pasteur (1822-1895) after the latter established the germ theory of disease transmission. This had a major impact and transformed safety for all patients, for example in the field of obstetrics where women had been dying regularly from puerperal fever before it was investigated to find out that doctors were transmitting bacteria from diseased patients to healthy ones. The first use of ether as a drug in the USA in 1846 and of chloroform in Scotland in 1847 made way for another major advance in surgery when their use as anaesthetic gases opened new doors to minute, longer and more complicated surgical sessions to be initiated.

The wave of cutting edge and precise research continued into the 19c with the recognition and detailed description of many conditions now available to medical education for the first time. Precautions were taken to halt the propagation of malaria and yellow fever after it was revealed that insect bites could transmit them. At around the end of the 19c, the birth of psychology as the study of the ‘mind’ was taking place with Sigmund Freud’s work, and Rontgen’s discovery of X-rays along with Pierre and Marie Curie’s radium provided new diagnostic tools to medicine.

The 20c continued to flourish with progress when the haphazard discovery of bacteria-killing organism were made, most famously Alexander Fleming, the scottish Bacteriologist and Nobel prize winner who discovered Penicillin in 1928 and also served during the First World War in the Army Medical Corps. After qualifying with distinction in 1906, Fleming went straight into research at the University of London. One of the most important discoveries in medicine would eventually be made by a him in 1928 over a simple observation. Fleming observed that the mould that had accidentally developed on a set of culture dishes used to grow the staphylococci germ had also created a bacteria free circle around itself. After careful observation and research, the substance that repelled bacteria from the mould was named Penicillin. The drug would later only be developed further by two other scientists, Australian Howard Florey and Ernst Chain, a refugee from Nazi Germany [all three shared the Nobel Prize in medicine]. Although the first supplies of Penicillin were limited, by the 1940s the pharmaceutical industry had made it a top priority and it was mass produced by the American drugs industry.

The era also spectated the growth of advanced technology and the further development of various forms of drug treatments, such as sulfonamides when they were discovered, followed by streptomycin, the first effective antibiotic against tuberculosis which was fatal until then similarly to diabetes which was also explored and treated with the discovery of insulin, thus halting its former reputation as deadly into a controllable condition – a new breed of surgeons are claiming to have found surgical methods to completely reverse the Type-2 Diabetes that affects most.

Typhoid, tetanus, diphtheria, tuberculosis, measles, whooping cough and polio were mostly eradicated in the West as the 20c was marked by improved public health services, living condition and nutrition along with well devised campaigns with the sound backing of science to promote immunisation campaigns for children. The West was also freed of diseases such as rickets and scurvy as new discoveries were made on the role and importance of vitamins which also led to the mitigation of beriberi in Africa and Asia early in the century.

Malaria, yellow fever and leprosy were also found to curable, and now that with all the advancement in medicine most people live longer in developed economies [at the exception of some that have mediocre policies due to their mediocre management system, e.g. politics], the chief causes of death nowadays have so far been cancer and heart disease.

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Life Expectancy in the United Kingdom / Source: OurWorldinData.org

 

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Life Expectancy Global / Source: OurWorldinData.org

Unleashing the power of genetics against cancer

Source: Cambridge University

In the field of cancer research, advancement in new therapies involving various techniques are now available and continuously being developed; with the most recent being the promising CRISPR, which involves using a patient’s own immune system to fight cancer, using a particular type of immune cell known as the T cell. The logic behind it explores the usual purpose of those T cells in the human body which involves surveying the body to seek out and destroy abnormal cells that have to potential to turn cancerous- detected by T cells due to the presence of strange proteins on their surface [signs that the T cell knows as ‘dangerous’]. Surprisingly cancer has evolved a cat-and-mouse game to evade T cells by developing the ability to ‘switch off’ any T cell that gets in their way, effectively blocking their healing attack. The most effective cancer therapies try to counteract this response by abnormal and cancerous cells by boosting the immune system.

CRISPR: the promising new cancer treatment

In 2015, a study used an older, less efficient gene engineering technique known as the ‘zinc finger’ which led to nucleases that give T cells better fighting ability against HIV – the therapy was well tolerated in a 12-person test group. A further study used reprogrammed T cells from multiple myeloma patients in the specific recognition of cancer cells which shrank the tumours initially while the T cells gradually withered and lost their ability to regenerate themselves – a common issue that new trials hope to solve in the near future. Perhaps one of the most unfortunate part of the story with CRISPR despite being a promising cell therapy is that it is often offered and used on patients with relapsing diseases. Other genes can also be ‘tweaked’ for the particular protein PD-1 with the CRISPR method that counter the problem of T cells losing their ‘intensive ability’ as these new tweaked genes help prolong the lifespan of the modified T cells while simultaneously enhancing their cancer fighting ability since the PD-1 protein sits on the surface of T-cells and helps dampen the activity of the cancer cells after an immune response [tumours found ways to hide by flipping the PD-1 switch themselves, thus drugs that block PD-1 from this immune suppression have been proven to be a promising immunotherapy cancer treatment].  Researchers are currently carrying intensive research to understand the deeper mechanics of CRISPR by removing T cells from patients of cancers that have stopped responding to normal treatments, and using a harmless virus, deliver the CRISPR machinery into the cells, and perform three gene edits on them. The first gene edit will insert a gene protein called the NY-ESO-1 receptor, a protein that equips T cells with an enhanced ability in locating, recognising and destroying cancerous cells [the NY-ESO-1 displaying tumour]. The T cells have a native trait that is unfortunately unsupportive in this process as it interferes with this process of added protein, so the second edit will be to remove these inhibitors so that the engineered protein will have more efficiency against cancer. The final and third edit gives the T cell longevity by removing the gene that allows recognition as a cancer suppressor by cancer cells that disable the PD-1 protein, thus countering its attack while remaining active due to the added guide RNAs which would tell the CRISPR’s DNA-snipping enzyme, Cas9, where exactly to cut the genome. However, since CRISPR is not always effective, not all cells will receive the genetic modification, thus making the engineered cells in the end, a mixture with various combinations of proposed changes to balance the reaction into the desired one. Only 3-4% may contain all three genetic edits. After the edits, the researchers would generally infuse all the edited cells back into patients and monitor for issues closely. One of the main concerns with CRISPR is that it may inadvertently snip other genes potentially creating new cancer genes or trigger existing ones, and these side effects are planned for monitoring by a team expected to measure the growth rate of engineered T cells and carry test for genomic abnormalities. However, the concluding outlook on CRISPR is very bright, in a pilot run carried out by using T cells from healthy donors, the researchers checked for 148 genes that could be snipped by mistake, and the only faulty cut that was detected was deemed as harmless. Another major concern is the fear of activating the body’s immune system against the engineered T cells since the enzyme Cas9 originates from bacteria and is essential for the cancer cutting process CRISPR relies on – although ways exist to prevent the immune system from destroying engineered Cas9 T cells, the possibility remains.

Gene therapy trials have suffered a recent setback with the death of the young patient Jessie Gelsinger during a trial. Further investigation revealed that some of the researchers failed to disclose the side effects observed in animals and some of the investigators had financial incentive for the trial to be a success. Extra precaution is being taken by UPenn who pioneered the treatment to ensure the smooth progression of medicine in genetics. As Stanford bioethicist Dr. Mildred Cho said, “Often we have to take a leap of faith.”

Cancer research and treatment on the whole has seen innovations in surgery, chemotherapy, radiation therapy, a combination of the mentioned and the new promising method involving gene editing Cas9 based T cells with the CRISPR technique. All these together have and are increasing the prognosis for some sufferers, and in cardiology too, new treatments stunned the world, notably angiograms, open-heart surgery and heart transplants. The process of organ transplant has gradually been extended to lungs, livers and kidneys, and artificial joints for the hips and knees have also been improved.

Further education on family planning has been available and constantly updated since the 1960s where methods of contraception had first been marketed to the wider public [such as the oral contraceptive pill for women]. The controversial act of abortion too with the scientific legitimacy was made safer and legalised in many developing economies and at the other end of the scale couples unable to conceive benefited of fertility drugs and in vitro fertilisation provided many with the choice of starting a family.

With the growing discoveries and nearly godly feats of medicine, public perception of the field also changed and many soon started to entertain the belief that a cure exists for every ill. Unfortunately this is not true, as many complicated diseases such as cancer continue to defy knowledge and scientific research and new diseases and complications continue to emerge such as Ebola, HIV and antibiotic resistance. The constant struggle for 3rd world economies to keep up with medical cost has also led to major culturally destructive waves of migration that have very quickly turned out to be unsustainable for most major Western economies along with the religious and socio-cultural clashes being a constant topic of debate in most educated circles and the connected alternate media alike across Europe [to counter some of the extreme liberal & atavistic views promoted by the mainstream media fuelled by ruthless & scrupulous globalists].

The economic grip of pharmaceutical companies on the world’s economy has been a central issue for many concerned scientists and intellectuals of the times constantly questioning the responsibility of funding and providing cutting edge and hygienic health services for the people; while on the other hand other controversial but vital access to organs for transplantation have caused major social debates regarding the future cultural behaviour regarding the organs of the dead and the provision of a constant supply of fresh organs for the Western economies’ major health requirements.

While the Western model of medicine is the most effective, researched, respected and taught on earth, other sub disciplines of medicine that many medical empiricists consider to be complete lies continue to prosper at a medium scale for a surprisingly constant demand for folk and herbal medicines. In the urban areas of non-Western societies the trend is at a larger scale since Western medicine has still not made a significant impact to the adepts of traditional practices. Medically unproven and scientifically void practices such as chiropractic, aromatherapy, auto-suggestion, homoeopathy, osteopathy and hydrotherapy still exist in the West under the classification of ‘complementary medicine’ where many of the practitioners do not require any degree or certificate to ‘practice’ [a documentary by Dr. Richard Dawkins was aired on the BBC on this topic]. Most of those treatments that have no scientific grounding somehow all have long histories, and a chosen few such as acupuncture, have been fused into Western orthodox medical practice in countries such as the UK.

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Part V: Secularisation

Secularisation may be defined as the process of change where authority passes from a religious source to a secular one. This may turn into an issue or a need only where religion and the religious have gained considerable power or a dominant position in society and penetrate all aspects of life, including the government. For instance, in ancient Greece and Rome, religion does not seem to have ever dominated the state. The main religious officers was shared by the same men who held political office [religion may have been seen as simply a part of national culture]. While virtue consisted of piety and observance to the gods were expected, religion was rarely a primary focus for society. Furthermore, polytheism provided flexibility to the system as new gods and goddesses would be added to the pantheon to accommodate local cults, and an individual would have the freedom to choose a deity as his or her special patron. However, prudence demanded that other divinities not be neglected, and none of this was of major concern to the state.

Yet, as the petty logic of majority in many cases comes into conflict with strategy, the great monotheistic proselytising religions of Christianity and Islam saw a great rise and the situation and relationship with the state started to change. Now, as a matter of righteousness and justification as a moral authority, the state had to go with the religious beliefs that ruled most of the West. This led to the state having to ensure salvation, which became the founding pillar of ‘right religion’. Consequently, this acceptance and spread led to the increased power and influence of Christian kings who with them emerged a body of clerical men who claimed to exercise the spiritual ministry of the most almighty of beings, God, on earth. This led to large amounts of money, land and property being donated by individuals, organisations and Christian rulers to the Church in the hope of maintaining a good relationship and being protected. This also increased the overall influence of the power of the Church which however owed so much to the Crown in terms of donations and freedom that they gradually tended to act as its propagandists and servants. The term and principle of ‘Caesaropapism’ was accepted by the Church in the Eastern Roman (Byzantine) Empire, which simply proved their acceptance of subordination to an Emperor who was thought of as an ambassador of divine authority on earth. However, this claim of a supreme imperial being at the top of the religious scale soon led to conflicts with the popes of the West who were unhappy with such imposition in regards to their contribution to the works of God and soon, conflicts began between the sovereigns and the papacy over the limits and jurisdiction of royal and papal power – both, of course claiming to be guided by the divine mandate.

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Perhaps one of the most famous of these clashes happened between Henry II of England and his Archbishop of Canterbury, Thomas Becket. At that time the Church’s power may have been at its peak, during the pontificate of Innocent III, who claimed that the Holy Roman Emperor was subordinate to him. Later, Innocent III pushed for Emperor Otto IV to be deposed, forced Philip II of France into reinstating his divorced second wife, Ingeborg of Denmark. He also placed England under an interdict, and had King John (Lackland) excommunicated to be able to secure the office of Archbishop of Canterbury for his candidate, Stephen Langton. Those clashes of power and interest saw a decrease however, when in the following years the papacy was in dire need of royal help to defeat the Conciliar Movement – a movement in Western Europe in the 14c and 15c of the Roman Catholic Church which believed that final authority in spiritual matters resided with the Church as a company of Christians, embodied by a general church council, not solely with the Pope [a movement started by Pope Innocent III and is still used today in France].

In other civilisations in the Middle-East, such as in Islamic territory that obeyed the laws of Islam’s sharia, conflicts between the professional religious classes and the rulers tended to be avoided since Islam has no priesthood. Religion and state were unified in the pursuit of what the Quran and the life of Muhammad qualified as the ‘pursuit of Islamic righteousness’. This however includes violent subjugation of all non-Muslims, oppression of women, obsolete traditions in direct conflict with modern human rights in all modern Western nations in relation to restrictions to women and indoctrination of violent political ideologies that are connected to the political teachings of Muhammad, mostly found in the sharia. Thus, the constant links between extremist groups promoting violence and major governments in the Middle-East with Islam as the main religious faith are a constant topic among cultured circles. Most Muslims however are similar in many ways, even on the borders of Europe, in Turkey similar to Saudi Arabia, most adhere and believe in the same ideology that Islam and the Sharia promotes and teaches, unsurprisingly many Islamic scholars too have turned out to have very dangerous views on Islam’s war on non-Islamic civilisations and non-Muslims. The Caliph claim was made in Istanbul by the Ottoman Sultan, or supreme head of all Sunni Muslims (Sunnis). The Shia form of Islam (Shiites) was ultimately associated and identified with the Safavid Sultans in Iran.

In Tibet, where Buddhism had been flourishing, monastic donations and a huge increase in the number of dedicated monks subsequently gave monastic cultural leaders who were regarded as the incarnations of the Buddha, such as the Dalai Lama and the Panchen Lama, ruling powers in their country. In China and Japan situations differed, as instead, religious beliefs tended to reinforce loyalty to the ruler; in China for example, Buddhism, and more particularly, Confucianism, taught civic virtues which were also taught by Buddhism and Shinto in Japan.

The Reformation

When the payments of annates to Rome was abolished by Henry VIII of England as he denied the authority of the pope upon proclaiming himself supreme head of the Church of England (1534) to further supress the monasteries, the new King was simply carrying to extremes the true traditions of his predecessors across Europe. Divine Right Kingship, that was what Henry’s Reformation was essentially, an assertion of complete power and trust in his legitimacy as an extension of God’s ministry. It is worthy to note that Henry VIII would deal as harshly as advocates of Lutheranism as with those who supported the pope as he had no doctrinal differences with Rome, he simply believed in the King as the only vice-regent of God on earth. The Reformation and Counter-Reformation revived the influence and power of religion in the domestic and international socio-cultural debates of the Western world, and for the time, turning the concept of a purely ‘secular’ power completely unconceivable and unthinkable. Yet, as the years went by the intended and expected clashes reached unprecedented heights as a result of competition between religious factions.

The wars that religion brought to humankind

In the Western Christian world, the wars of religion quickly turned into a common phenomenon or justification to shed blood and die for, and they were all based on the firm religious belief that the opposing religious civilisation had no claim to existence and even more importantly should not have any jurisdiction let alone religious or cultural control over some very specific geographical points, as these were believed to have specific powers that could be manipulated for socio-cultural advantages, for example, the ‘crusade’ against the Albigenses in Southern France was simply justified as the French crown simply trying to extend its power. The movements known to most historians as ‘The Crusades’ were in fact directed against the Islamic Middle East who had been subjugating Western Europe & Christians for hundreds of years through deadly wars where many Christian women were raped, tortured and turned into sexual slaves while many Christian leaders were beheaded others forced into Islam. Religious motives in 16c and 17c even led to violence against fellow Western Christians, and as the years went wars were endless, reaching lethal genocidal levels where whole civilisations were wiped out – the remaining joining, converting to or being enslaved by the dominant [a seemingly ruthless spectacle where the cycle of evolution may have simply been the driving force among societies who were less sophisticated and more primal – or in touch with their aggressive instincts in matters of survival and conquest].

Even with all the death in the name of religion, societal events did not persuade the current societies to perceive a possible atheistic lifestyle or system; and this endured even late in the 17c. However, private and secret groups such as ‘The Family of Love’ (of whose members many were close to Philip II of Spain, a leading figure of the Counter-Reformation) had started to spread the seeds of doubts over the particular motive and purpose of having to identity state power and dogmatic religious beliefs and traditions.

An Enlightened, educated and revolutionary civilisation

The only faith with intellectuals who stood with reason without showing any preference for any other school of thought, particularly religious ones, were Christians of the Western world in Europe and it began in the 18c where the term secularisation could only be discussed in European-derived state systems. The practice of secularisation started by individuals who originally came from different schools of thought and were seeking to be guided by a more stable doctrine than religion or traditions. Others like Holy Roman Emperor Joseph II, were dedicated Christians who disagreed with the state being the authority for moral policing or to conscience regulation [quite a perceptive stance judging the questionable reputation and credibility – in terms of morals and ethics – of practitioners of the obsolete discipline that is today still termed ‘politics’]. Even more curiously, the reasoning and avant-garde [at the time] clergy of the Church of Scotland agreed, and set their focus on the barbaric violence of the 17c religious wars as a blasphemous parody of Christianity. Furthermore, the growing movement fuelled and guided by the scientific and intellectual developments of the late 17c and the spirit of the Enlightenment remained sceptical about religion and its revelations, even Voltaire was a deist.

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Religious Scale by GDP per capita

The Cult of Reason was further sponsored as a replacement for Christianity when the Jacobins under Robespierre came to power in France, suggesting that the Gregorian calendar be replaced by a revolutionary and republican one where the year 1783 would be the Year 1. As the era developed, the first ‘secular’ state in the Christian West became the federal government of the USA after 1783, a reason somehow that may have been more due to the lack of options as the foundation of the society in the states was mainly composed of immigrants deeply divided by religion where many were persecuted and faced death in the countries they were escaping from who back in those times had no peace keeping military conventions to protect or sanction the State on the grounds of human rights.

Corruption at the top was also very much present as it still is today in politics in most non-Western societies, especially in Islamic territory where many States are strictly combined with the doctrines of Islam and its violent religious law, sharia, leading to many cases of State connections to extremist terrorists operating under the guise of Islam to protect and propagate the Islamic way of life and eventually subjugate all non-Muslims[with techniques used to abuse diplomacy and the dangerous concept of ‘political correctness’ to slowly infiltrate the law and system of other Western economies to prepare and push for Islamic doctrines to be applied on Western soil]. A situation getting worse today, as obsolete politicians lack the knowledge and education to understand and cope with the techniques of Political Islam which has long been the topic of Dr. Bill Warner’s work – to protect and prevent the atavistic and dangerous Islamisation of the West.

Logically, it seems obvious to most that 3rd world traditions would clash with First World values and individualism and today, many intellectuals and growing movements are beginning to support the complete separation of religious traditions and cultures through geographical relocation and diplomatic arrangement between States of various nations to work on solutions at the source and on location and completely stop the unsustainable and clearly abused systems of refugee relocation as Western societies are at their limits with major socio-cultural clashes and disruptions to First world national communities sparking major concerns over the security of women, children and the vulnerable older people faced with 3rd world migrants with a completely different school of thought, crowding many Western cities and locations where the never-ending clash of values, education, philosophy, language and culture seem to leave authorities contemplating at the only solution that may come with radical policies to preserve the socio-cultural make up and identity of their nations in the face of a destabilizing overgrowth of population from African and the 3rd world Islamic territories and the failure of Western States to adopt appropriate and if necessary tough measures to alleviate and balance the situation while securing their own systems and providing security for their people against socio-economic and cultural degradation.

The 19c

After the final defeat of Napoleon I at the end of the 18c, the conservative climate that followed led to the Catholic Church regaining a lot of credibility that it had lost and the identification and association of Church and State was seen by many intellectuals and movements of the Enlightenment as a bulwark against freedom and revolution. This resulted to the developing climate where bourgeois liberalism rose due to its tendency towards anticlericalism and its strong belief in a new system with a secular state with no sectarian affiliations, based on the US federal model.

France saw the growing clashes over education between Church and State similar to most major Christian Western nations throughout the 19c. In 1829, the Test Act of 1673 was repealed, now not requiring holders of public office [including military officers and elected regional representatives in Parliament] to be active members of the Church of England. Eventually, reason also won in France where education became ‘compulsory, free and secular’ under the Third Republic after a series of acts passed between 1878 and 1886 with Jules Ferry as the main agitator to spearhead the change. Other economies in South America such as Mexico, with an established and influential colonial Church saw that post-independence liberal views tended to demand secularisation of the State.

As the 19c century was ending, secularism and anticlericalism grew in strength and supporters in many nations of the modern world spectated a rise of different branches of « Socialist » influenced movements.

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For example, the late American George L. Rockwell initiated a National Socialist movement in the US, and even gave some brave speeches about Jews and Negroes at Brown University & embraced the derogatory term « NAZI » for its shock value. Although the American agitator clearly drifted far from the refined version of Adolf Hitler’s National Socialism, which initially emphasised strong moral/ethical philosophies, shared communal values at every level of society & synchronised psychosocial unity, Rockwell’s version of National Socialism seemed more appropriately adjusted to the industrialised society of America, focusing on the identity of the average hardworking American citizen and his/her relationship to the unscrupulous economic model that is at the foundation of the « Wild West », i.e. the USA.

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Photo: American Workers

Rockwell remains one of the only US public figures to have proposed a straightforward, practical & ethical direction in finding a harmonious solution to the Negro population problems affecting the US (which is now along with other foreign populations growing faster than the original white US population). George Lincoln Rockwell‘s vision matched that of the prominent visionary & avant-garde Black nationalist, Marcus M. Garvey, who founded the Pan-Africanism movement, the Universal Negro Improvement Association (UNIA) and the African Communities League (ACL).

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Marcus M. Garvey, Jr. (1887 – 1940)

Garvey also founded the Black Star Line, a shipping and passenger line which promoted the return of the African people to their ancestral lands. « Garveyism » wanted all people of Black African ancestry to « redeem » the nations of Africa and for the European colonial powers to leave the African continent. Marcus Garvey’s essential ideas about Africa were stated in an editorial in « Negro World » entitled « African Fundamentalism« , where he wrote: « Our [negroes] union must know no clime, boundary, or nationality… »

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Unknown Painting of a Negro man

Darwinism and National Socialism  gave society an explanation of human rights and human history, and a model for progress where religion was not vital [but optional] and thus not a major concern. In France, the Dreyfus Affair united all the radical progressive elements and the leftist movements in French society against the then major section of the Right: the Catholic Right. The separation of Church and State finally happened in 1905.

The 20c

During the USSR right after the Russian Revolution, the development of socialist-inspired secularism could be seen in their secular state; however, the lack of vision, philosophy and fine management eventually led to its downfall.

One of the most innovative and stunning secular changes in the Muslim world came from Turkey’s founder who believed in secular western systematisation, Mustafa Kemal Ataturk, who in a revolutionary wave abolished the Sultanate and in 1924 abolished the office of the Caliph, the former spiritual head of the Ottoman Empire. Ataturk continued this avant-garde wave of secular changes by closing down all religious schools in Istanbul, and removed the Minister for Religion from the cabinet. Even more confidently, among the changes the modern and westernising founder made was the repealing of the provision in Turkish constitution that made Islam the state religion. From then, deputies would cease to take oaths in the name of Allah, but instead made a secular affirmation. However today with Turkish national representatives such as Recep Erdogan, the forward-thinking, productive and modernising changes of Ataturk have all been reversed and ruined by Erdogan’s atavistic policies that are oriented towards the Islamisation of the whole system and has even been linked and found to be unresponsive towards major anti-Western Islamic Jihadists who spread terror and violence across Western societies without any disregard for children. The retrograde and deluded Chancellor of Germany, Angela Merkel has also played a major part in the Islamisation of Western Europe by successfully being manipulated by Islamic territories’ humanitarian departments to take in excessive numbers of Muslim refugees [by the millions] for resettlement which have mainly been healthy Muslim males with no other objectives but to find support on the welfare systems of the West while also contributing in the Islamic doctrines that promote migration [hijra] in the name of Allah for the process of Jihad [which is a process that involves multiple techniques to subjugate all non-Muslim societies to gradually allow Islam’s doctrines to take over], in the ongoing war for the Islamisation of the West. This continued clash of values makes the secularisation of Turkey by Ataturk particularly striking since Islam’s ideologies continue to control most indoctrinated minds in the vast Islamic territory that continues to promote 3rd world ideologies and show firm stance against secularisation in Muslim countries and perhaps even more shockingly, in some parts of the West where urban and uncultured low-skilled Muslim communities have amassed – a known recruiting field for many extremist Middle-East groups such as ISIS [Daech, Islamic State] and a known breeding place for rapists who in many cases justify their heinous acts as religiously valid, being the teachings of Muhammad on the treatment of non-Muslims, who are deemed spiritually ‘inferior’ beings similarly to the teachings of Judaism where all non-Jews are believed to be inferior, destined to serve the Jewry and are completely disposable, perhaps more shockingly: non-Jews should even be killed. These two 3rd world religions have doctrines of behaviour towards other groups that are rooted in hate and violence. Hence, the early expulsion of the Jewish communities globally much before the Nazi regime or any of its founders were even born. A practice known as holocaust done in the name of the Jewish god Baal, involved sacrificing young male babies was hated by many non-Jewish intellectuals and societies throughout Western history. However, today the atavistic process that should have been inexistent or even annihilated, is ironically happening to modern societies at the verge of being completely secularised after their independence such as in the West: the process of Islamisation. Islamisation of the West which was founded and evolved on Christian values, and famous deist intellectuals such as Voltaire who placed reason before irrational claims of God [although not denying the existence of powers that may be Godly], are being forced into accepting millions of Muslim refugees known to be part of the process of Islamisation linked to major extremist and pro-Muslim association such as the Muslim Brotherhood [a group heavily linked with Barack Obama] who have links to the extreme left leaning seats in the United Nations. These dangerous extreme-left [not socialist] movements with religious affiliations have been finding ways to loosen the security of the West’s defence to infiltrate the ideologies of Islam through the process of cultural Jihad, which involves using techniques such as diplomacy, and twisting arms with the unscrupulous use of ‘political correctness’ to further the purpose of Islam, aided by the act of Taqqiya, which is promoted by Islamic ideology to deceive, lie and act in whatever way it may be required to promote Islam and eventually subjugate non-Islamic societies.

One of the most recent example of complete Islamisation is Iran in 1979 where the overthrow of Shad Muhammad Reza Pahlavi ushered in an Islamic republic. This seemingly Islamic ‘success’ in the Iranian Revolution led to Islamic Fundamentalists in other undeveloped economies such as Pakistan, Egypt and Algeria to believe in their possible future, already being part of economies where governments make concessions to religious militants as they both are supporters of the ideology of Islam.

In some countries, many Islamic terrorists have justified their acts as populist alternatives to what they perceive as corrupt, dictatorial regimes that lack compassion and righteousness. Others have questioned righteousness from the perspective of Islamic ideologies that involve beheading, mass terror and other inhuman practices on non-Muslims in the name of Allah as the teachings of Muhammad, a controversial prophet who consummated a marriage to a 6-year old when the latter was nine [even the practice and promotion of what most Western minds would perceive as paedophilia has seen a near complete silence from most authorities in the west for fear of repercussions such as accusations of racism, lack of political correctness or xenophobia, all forms of speech suppression that have started to raise more voices among many people who believe that Islamisation is incompatible, dangerous and unsustainable – massive causes of systematic socio-cultural and economic degradation].

Lhomme Papillon (1858)Caricature of Jules Didier by Claude Monet (1840 - 1926)

L’homme Papillon (Butterfly Man) / Caricature of Jules Didier by Claude Monet (1840 – 1926)

In order to move towards a system of management that includes government to replace the obsolete concept of politics and reinstate credibility in decision making based on reason and science, balanced with the right philosophy to fit the appropriate expectations at a given time, the mainstream mind set will have to accept reason as a more fitting compass to guide a civilised society instead of religion.

Although most [mentally sound individuals] should have the freedom to choose where to place their faith [religion, science, philosophy, etc], secularisation would at least ensure that the state balances its priorities appropriately without discriminating those who should be prioritised.

The State may initiate a workable but firm control over the appropriate influx of immigrants by specific religious groups to maintain and not discriminate the national cultural identity of the foundation [religion would simply be a part of culture and not a reigning authority synthesised with most departments of the state] while adapting to changes that socio-cultural economic developments and research lead to [however careful consideration over the purpose and benefits must remain of vital importance and focus].

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As the system of democracy still gives voices to the masses, it is also fair noting that majority votes do not decide or confirm the degree of righteousness in a particular thought or decision. In fact, majority debates in choice simply conclude the general ‘views on a specific topic’ of a particular group of human organisms from a particular geographical location on earth. In cases such as medicine, physics, chemistry and other science based studies majority votes lead to and mean nothing, in those disciplines only reason wins, with the conclusion based on logic. Certainly what a perfect secular state may include could be a decision making department that bases every decision based on the required concept that applies to it, i.e. for e.g. matters of professional disciplines could be approved by the required boards of professionals (by their field), and decisions on socio-cultural matters would benefit from public opinion, further matters of economy would be supervised by the board of economy, etc, and this may eventually lead to a system that relies on only democratic values and management, and hardly any politics [if regional representatives by area could have a better description].

The USA’s secular government has so far demonstrated to be far from perfect with major differences in opinion on a range of issues regarding military ethics during World War 2 where Eisenhower sadistically allowed thousands of Germans to die in starvation in his very own ‘death camps’, and other claims of secrecy with Churchill & Stalin in a German boycott along with the ongoing national socio-cultural conflicts with the Islamisation of the USA by the Obama regime – open promoters of Muslims and Islam in the West. The deistic Founding Fathers of the USA’s secular government would definitely be surprised at the influence of orthodox, evangelical Christianity of various kinds in the modern but over-liberal republic. Although it may if appropriate to consider the fact that secular states will somehow forever have religious roots, and while some may not be practising Christians, most of Western literature are full of biblical references. Major festivities such as Christmas have turned into a symbol of celebration and gifts for Western societies more than a religious observance, and it unites and benefits more than only Christians in many major societies of the West – especially economically for most businesses.

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Secularisation in everyday life in an increasingly post-Christian Europe

Nowadays most educated societies in the developed nations of the West are partially entrapped in the global economy and a great section of the people have looked for alternative context for their life, alternative ways to make rites of passage and more importantly other doctrines to be cultured and guided by, and the importance of religious dimensions in public and private life today has decreased considerably.

Munich.jpg

Munich by Harry Schiffer

Major changes in Britain saw the 1836 Marriage Act which for the first time allowed marriages to be solemnised in Britain by other practices besides a religious ceremony. On 1 July 1837, six hundred district offices opened as the act came into force along with an ongoing set of necessary changes. By 1857, divorce was obtainable in the UK by other means than the Act of Parliament – although not easily and only when requested by husbands. These changes along with the liberalised attitude on legislations such as abortion has long been opposed by the Church however, especially in Catholic countries. Nowadays, the growing number of people relying less on religion as guide is ever increasing, notably in developed economies with decent education systems supported by the newly developed Internet of Tim Berners-Lee since the early 1990s. Thus, the knowledge of science has become more widespread, along with its application to modern culture – leading to a new orthodoxy.

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The triumphs of technology have also made life for the secular minds fairly comfortable and safe in the developed world [although a lot of work remains to be done at the systematic level regarding economic policies, socio-cultural and philosophical beliefs and directions in some atavistic States of the West to counter the now dangerously increasing waves of Islamisation].

Perhaps a painful reality to most of those raised in a sophisticated science-oriented philosophical circle, or tutored with a conservative education but a liberal outlook from the West or Western derived systems, or in the ever more secular societies of the UK, France and Western Europe, is that so far we are the ‘minority’ and are seen as an ‘exception’ when compared with the majority in terms of humans living on earth globally.

That may send visions of the inundation of migrants from poorly managed nations of the 3rd world Middle-East and Africa who also play a major part on the low socio-economic birth rate explosion and consequent socio-cultural burden on global humanitarian budgets expected to cause major economic and socio-cultural unrest for the West in the coming future if situations do not change. Sadly for the secular intellectuals today is the fact that in most lesser developed societies of the world, the great religions, the smaller ones, and a series of traditional beliefs [some as illogical and ridiculous to reason or intelligence] continue to give a reason to live and subsequently meaning to the lives of many communities who are born and live in a completely different psycho-social reality fused with religious beliefs of ancient cultures [specially in the 3rd world and/or Islamic territories].

The progressive & ethical solution to deal with the alarming situation

Since, engineering environmentally also applies to the human organism, maximising the potential of humans according to their best environmental (socio-cultural) fit would seem like the most globally progressive philosophy. However, engineering our planet in terms of human abilities would also side with relocating populations to alleviate their own stress caused by incompatibility in terms of culture, language, identity and skills – a process that goes in line with evolutionary logic, but also fosters a harmonious human ecosystem with less tension, thus less stress [mental health & health].

RichardDawkinsEvolution

Cooperation on matters beneficial for both states would be achieved from synchronised work from respective locations [e.g. nature, environment, climate change, business, etc]. This would alleviate systems that lack stability due to massive population imbalance and socio-cultural conflicts caused majorly by uncontrolled geographical shifts and the birth rates that follow, leading to ‘organisms’ [from an objective perspective] that do not ‘identify’ with the system that they were born into, but see themselves as part of an ‘external system and its school of thought’, who mostly earn and live to promote the latter system and flood the current one with further external and incompatible organisms.

This continuous unregulated & unsustainable process of mass-migration & mass low-SES births add to the ongoing burden of socio-cultural conflict and economic degradation due to the sole motivating factor being foreign interest [mostly 3rd world & developing economies] in economic resources from Western systems while remaining ‘foreign’ and indifferent to public/civic expectations socio-culturally [due to a lack of linguistic proficiency and other low-SES complications such as quality education, linguistic acculturation, etc]. Such issues in uncontrollable amounts that reflect in most aspects of a society have shown to lead to systemic instability, fragmentation and low social-cohesion mostly linked to differences in belief systems created by heritage or indoctrination of beliefs from incompatible systems through exposure.

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Top Minority Languages by Country

mostusefulforeignlanguageforpersonaldevelopment

Foreign Language people consider the most useful for Personal Development

Once more, from an objective perspective and through the humble logic of observation, any system from any part of the world would face degradation with excessive sections of their population not focused in contributing in its protection, promotion, strength and stability – a simple matter of factual reasoning, an e.g. of such a statement would be « If an egg is released from a metre on hard floor, it will fall and break. ».  With geographical engineering, it seems to simply be a matter of re-assessing and replacing  ‘organic units’ with ones that are reliable in terms of stability, compatibility and long term development [experience] – a clear example of progressive innovation. A simple case of synthesising the knowledge gained from science and applying its philosophy to prevent further catastrophes while correcting the dangerous path of the present.

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regionalpopulationchangeforecast

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Exposition Victor Hugo - une exposition sur Victor-Hugo

« History has for sewers times like ours. » -Victor Hugo

PublicTrustInGovernmentUK

A New Era for Management may be near: UK & France rank low for trust in government

Updated: 24th of September, 2018 | Danny J. D’Purb | DPURB.com

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Reference

Lenman, B. and Marsden, H. (2005). Chambers dictionary of world history. Edinburgh: Chambers.

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