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Black Bile

Black bile

Melancholia (Greek μελαγχολια) was described as a distinct disease as early as the fifth and fourth centuries BC in the Hippocratic writings. It was characterized by "aversion to food, despondency, sleeplessness, irritability, restlessness," as well as the statement that "Grief and fear, when lingering, provoke melancholia". It is now generally believed that melancholia was the same phenomenon as what is now called clinical depression. clinical depression.]] The name melancholia comes from the old medical theory of the four humours: disease being caused by an imbalance in one or other of the four basic bodily fluids, or humours. Personality types were similarly determined by the dominant humour in a particular person. Melancholia was caused by an excess of black bile; hence the name, which means 'black bile' (Greek μελας, melas, "black", + χολη, kholé, "bile"); a person whose constitution tended to have a preponderance of black bile had a melancholic disposition. See also: sanguine, phlegmatic, choleric During the early 17th century, a curious cultural and literary cult of melancholia arose in England. It was believed that the passing of the dazzling culture of Elizabethan England after the death of Queen Elizabeth I, together with religious uncertainties caused by the English Reformation and a greater attention being paid to issues of sin, damnation, and salvation, led to this cultural mood. In music, the post-Elizabethan cult of melancholia is associated with John Dowland, whose motto was Semper Dowland, semper dolens. ("Always Dowland, always mourning.") The melancholy man, known to contemporaries as a "malcontent," is epitomized by Shakespeare's Prince Hamlet, the "Melancholy Dane." Another literary expression of this cultural mood comes from the death-obsessed later works of John Donne. Other major melancholic authors include Sir Thomas Browne, and Jeremy Taylor, whose Hydriotaphia, Urn Burial and Holy Living and Holy Dying, respectively, contain extensive meditations on death. But the most extended treatment of the cult of melancholia comes from Robert Burton, whose Anatomy of Melancholy treats the subject from both a literary and a medical perspective. A famous allegorical engraving by Albrecht Dürer is entitled Melancholia I; amongst other allegorical symbols, it includes a magic square, and a truncated cube. The image in turn inspired a sonnet by Edward Dowden. A similar phenomenon, though not under the same name, occurred during Romanticism, with such works as The Sorrows of Young Werther by Goethe. In the 20th century, much of the counterculture of modernism was fueled by comparable alienation and a sense of purposelessness called "anomie."

External links


- [http://www2.hammer.ucla.edu/etc/durer/ Grunwald Center website: Durer's Melencolia and clinical depression, iconography and printmaking techniques]
- [http://www.theotherpages.org/poems/2000/d/dowden53.html "Dürer's Melancholia": sonnet by Edward Dowden] Category:Psychology Category:History of medicine

Greek language

Greek (Greek Ελληνικά, IPA – "Hellenic") is an Indo-European language with a documented history of 3,500 years. Today, it is spoken by 15 million people in Greece, Cyprus, the former Yugoslavia, particularly The Former Yugoslav Republic of Macedonia, Bulgaria, Albania and Turkey. There are also many Greek emigrant communities around the world, such as those in Melbourne, Australia which is the third-largest Greek-populated city in the world, after Athens and Thessaloniki. Greek has been written in the Greek alphabet, the first true alphabet, since the 9th century B.C. and before that, in Linear B and the Cypriot syllabaries. Greek literature has a long and rich tradition.

History

This article does not cover the reconstructed history of Greek prior to the use of writing. For more information, see main article on Proto-Greek language. Greek has been spoken in the Balkan Peninsula since the 2nd millennium BC. The earliest evidence of this is found in the Linear B tablets dating from 1500 BC. The later Greek alphabet (q.v.) is unrelated to Linear B, and was derived from the Phoenician alphabet (abjad); with minor modifications, it is still used today. Greek is conventionally divided into the following periods:
- Mycenean Greek: the language of the Mycenean civilisation. It is recorded in the Linear B script on tablets dating from the 16th century BC onwards.
- Classical Greek (also known as Ancient Greek): In its various dialects was the language of the Archaic and Classical periods of Greek civilisation. It was widely known throughout the Roman empire. Classical Greek fell into disuse in western Europe in the Middle Ages, but remained known in the Byzantine world, and was reintroduced to the rest of Europe with the Fall of Constantinople and Greek migration to Italy.
- Hellenistic Greek (also known as Koine Greek): The fusion of various ancient Greek dialects with Attic (the dialect of Athens) resulted in the creation of the first common Greek dialect, which gradually turned into one of the world's first international languages. Koine Greek can be initially traced within the armies and conquered territories of Alexander the Great, but after the Hellenistic colonisation of the known world, it was spoken from Egypt to the fringes of India. After the Roman conquest of Greece, an unofficial diglossy of Greek and Latin was established in the city of Rome and Koine Greek became a first or second language in the Roman Empire. Through Koine Greek it is also traced the origin of Christianity, as the Apostles used it to preach in Greece and the Greek-speaking world. It is also known as the Alexandrian dialect, Post-Classical Greek or even New Testament Greek (after its most famous work of literature).
- Medieval Greek: The continuation of Hellenistic Greek during medieval Greek history as the official and vernacular (if not the literary nor the ecclesiastic) language of the Byzantine Empire, and continued to be used until, and after the fall of that Empire in the 15th century. Also known as Byzantine Greek.
- Modern Greek: Stemming independently from Koine Greek, Modern Greek usages can be traced in the late Byzantine period (as early as 11th century). Two main forms of the language have been in use since the end of the medieval Greek period: Dhimotikí (Δημοτική), the Demotic (vernacular) language, and Katharévousa (Καθαρεύουσα), an imitation of classical Greek, which was used for literary, juridic, and scientific purposes during the 19th and early 20th centuries. Demotic Greek is now the official language of the modern Greek state, and the most widely spoken by Greeks today. It has been claimed that an "educated" speaker of the modern language can understand an ancient text, but this is surely as much a function of education as of the similarity of the languages. Still, Koinē , the version of Greek used to write the New Testament and the Septuagint, is relatively easy to understand for modern speakers. Greek words have been widely borrowed into the European languages: astronomy, democracy, philosophy, thespian, etc. Moreover, Greek words and word elements continue to be productive as a basis for coinages: anthropology, photography, isomer, biomechanics etc. and form, with Latin words, the foundation of international scientific and technical vocabulary. See English words of Greek origin, and List of Greek words with English derivatives.

Classification

Greek is an independent branch of the Indo-European language family. The ancient languages which were probably most closely related to it, Ancient Macedonian language (which may be regarded as a dialect of Greek) and Phrygian, are not well enough documented to permit detailed comparison. Among living languages, Armenian seems to be the most closely related to it.

Geographic distribution

Modern Greek is spoken by about 15 million people mainly in Greece and Cyprus. There are also Greek-speaking populations in Georgia, Ukraine, Egypt, Turkey, Albania, Former Yugoslav Republic of Macedonia and Southern Italy. The language is spoken also in many other countries where Greeks have settled, including Armenia, Australia, Austria, Belgium, Bulgaria, Canada, Denmark, France, Germany, Netherlands, Sweden, United Kingdom, and the United States.

Official status

Greek is the official language of Greece where it is spoken by about 99.5% of the population. It is also, alongside Turkish, the official language of Cyprus. Due to the membership of Greece and Cyprus, Greek is one of the 20 official languages of the European Union.

Phonology

This section generally describes the post-Classic phonology of the Greek language. :All phonetic transcriptions in this section use the International Phonetic Alphabet

Vowel sounds

Greek has 5 vowel sounds, all phonemic:

Disease

A disease is any abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person affected or those in contact with the person. Sometimes the term is used broadly to include injuries, disabilities, syndromes, symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts these may be considered distinguishable categories. Pathology is the study of diseases. The subject of systematic classification of diseases is referred to as nosology. The broader body of knowledge about diseases and their treatments is medicine.

Syndromes, illness and disease

Medical usage sometimes distinguishes a disease, which has a known specific cause or causes (called its etiology), from a syndrome, which is a collection of signs or symptoms that occur together. However, many conditions have been identified, yet continue to be referred to as "syndromes". Furthermore, numerous conditions of unknown etiology are referred to as "diseases" in many contexts. Illness, although often used to mean disease, can also refer to a person's perception of their health, regardless of whether they in fact have a disease. A person without any disease may feel unhealthy and believe he has an illness. Another person may feel healthy and believe he does not have an illness even though he may have a disease such as dangerously high blood pressure which may lead to a fatal heart attack or stroke.

Transmission of disease

Some diseases, such as influenza, are contagious or infectious, and can be transmitted by any of a variety of mechanisms, including droplets from coughs and sneezes, by bites of insects or other vectors, from contaminated water or food, etc. Other diseases, such as cancer and heart disease are not considered to be due to infection, although micro-organisms may play a role.

Social significance of disease

The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognitions as diseases of post-traumatic stress disorder, also known as "shell shock"; repetitive motion injury or repetitive stress injury (RSI); and Gulf War syndrome has had a number of positive and negative effects on the financial and other responsibilities of governments, corporations and institutions towards individuals, as well as on the individuals themselves. The social implication of viewing aging as a disease could be profound, though this classification is not yet widespread. A condition may be considered to be a disease in some cultures or eras but not in others. Oppositional-defiant disorder, attention-deficit hyperactivity disorder, and, increasingly, obesity are conditions considered to be diseases in the United States and Canada today, but were not so-considered decades ago and are not so-considered in some other countries. Conversely, the number of people in the West who consider homosexuality to be a disease became widespread in the 20th century but has been decreasing in the last two decades. To consider a condition to be a disease can sometimes involve a negative social value judgement. Lepers were a group of afflicted individuals who were historically shunned and the term "leper" still evokes social stigma. Fear of disease can still be a widespread social phenomena, though not all diseases evoke extreme social stigma.

Other uses of the term

In biology, disease refers to any abnormal condition of an organism that impairs function. The term disease is often used metaphorically for disordered, dysfunctional, or distressing conditions of other things, as in disease of society.

See also


- List of childhood diseases
- List of common diseases
- List of diseases for a huge list of 6000+ diseases, many very rare.
- List of genetic disorders
- List of environment topics
- Diagnosis
- Epidemic
- Illness
- Palliative care
- Therapy
- Transmission

External links


- [http://www.nlm.nih.gov/medlineplus/healthtopics.html Health Topics], MedlinePlus descriptions of most diseases, with access to current research articles.
- [http://www.cdc.gov/health/default.htm Center for Disease Control Health Topics A-Z], fact sheets about many common diseases
- [http://rarediseases.about.com/ Rare/Orphan Diseases]
- [http://www.national-health.org/rarediseases/ National Organization for Rare Disorders] Extensive, useful information on rare diseases.
- [http://www.merck.com/pubs/mmanual/sections.htm The Merck Manual], detailed description of most diseases, freely searchable online. Category:Diseases Category:Medical terms als:Krankheit zh-min-nan:Pīⁿ ms:Penyakit ja:病気 simple:Disease th:โรค

5th century BC

(2nd millennium BC - 1st millennium BC - 1st millennium) ----

Overview

The 5th and 6th centuries BC are a period of philosophical brilliance among advanced civilizations. Ancient Greek philosophy develops during the 5th century BC, setting the foundation for Western ideology.

Events


- Demotic becomes the dominant script of ancient Egypt
- Persians invade Greece twice (Persian Wars)
- Battle of Marathon (490)
- 486 BCE First Buddist Council at Rejgaha, under the patronage of King Ajatasattu. Oral tradition established for the first time.

Significant persons


- Pythagoras of Samos, Greek mathematician. See Pythagorean theorem. (582 - 496 BC).
- Gautama Buddha, founding figure of Buddhism (ca. 563 - 483 BC).
- Confucius, founding figure of Confucianism (551 - 479 BC).
- Aeschylus of Athens, playwright (525 - 456 BC).
- Darius I, King of Persia (reigned 521 - 485 BC).
- Sophocles of Athens, playwright (496 - 406 BC).
- Pericles of Athens, politician (ca. 495 - 429 BC).
- Herodotus of Halicarnassus, historian (ca. 485 BC).
- Euripides of Athens, playwright (ca. 480 - 406 BC).
- Socrates of Athens, philosopher (470 - 399 BC).
- Aristophanes of Athens, playwright (ca. 446 - 385 BC).
- Darius II, king of Persia (reigned 423-404 BC)
- Ezra and Nehemiah active in Judea.
- Tollund Man, Human sacrifice victim on the Jutland Peninsula in Denmark, possibly the earliest known evidence for worship of Odin.
- Empedocles

Inventions, discoveries, introductions


- Cast iron is first used in Wu.

Decades and years

Category:5th century BC ko:기원전 5세기 ja:紀元前5世紀

4th century BC

(2nd millennium BC - 1st millennium BC - 1st millennium) ----

Overview

Events


- Invasion of the Celts into Ireland
- Battle of the Allia and subsequent Gaulish sack of Rome
- 383 BCE Second Buddhist Councel at Vesali. 100 years after the Parimirvana.
- 312 BCE Seleucus I Nicator established himself in Babylon. Begins the Seleucid Empire.
- 323 BCE Alexander the Great conqueres the Persian Empire.
- Kingdom of Macedon conquers Persian empire
- The Scythians are beginning to be absorbed into the Sarmatian people.
- The Romans conquer the Abruzzi region, decline of the Etruscan civilization

Significant persons


- Marcus Furius Camillus, Roman dictator (c.446–365 BC).
- Plato, philosopher (c.427–347 BC).
- Tollund Man, Human sacrifice victim on the Jutland Peninsula in Denmark, possibly the earliest known evidence for worship of Odin.
- Aristotle, philosopher and scientist (384–322 BC).
- Philip II of Macedon (born 382, reigned 359–336 BC).
- Darius III of Persia, last King of the Achaemenid dynasty (born 380, reigned 359–330 BC).
- Mencius, Chinese philosopher and sage (371–289 BC).
- Ptolemy I Soter, founder of the Ptolemaic dynasty (c.367–283 BC).
- Shang Yang, Prime Minister of Qin, his reform helped Qin to become the strongest country and later unified China (term 361–338 BC).
- Seleucus I Nicator, founder of the Seleucid Empire (c.358–281 BC).
- Alexander the Great, King of Macedon, invades Asia Minor, Persia and reaches India (born 356, reigned 336–323 BC).
- Brennus, Gaulish chieftain

Inventions, discoveries, introductions


- Oldest Brahmi script dates from this period (Brahmi is the ancestor of Indic scripts)
- Romans build first aqueduct
- Chinese use bellows

Decades and years

Category:4th century BC ko:기원전 4세기 ja:紀元前4世紀

Hippocratic

: Hippocrates

Grief

Grief is a multi-faceted response to loss. Although conventially focused on the emotional response to loss, it also has a physical, cognitive, behavioural, social and philosophical dimensions. Common to human experience is the death of a loved one, be they friend, family, or other. While the terms are often used interchangeably, bereavement often refers to the state of loss, and grief to the reaction to loss. Losses can range from loss of employment, pets, status, a sense of safety, order, possessions, to the loss of the people nearest to us. Our response to loss is varied and researchers have moved away from "cookie cutter" views of grief, that is that people move through an orderly and predictable series of responses to loss to one that considers the wide variety of responses that are influenced by personality, family, culture and spiritual and religious beliefs and practices.

Stage Theories vs Processes

Some researchers such as Dr. Elisabeth Kübler-Ross and others have posited sequential stages including shock and numbness, denial, anger, depression and resolution. As research progressed over the past 40 years, many who worked with the bereaved found stage models too simplistic and instead began to look at processes, dynamics, and experiences common to all. Bowlby, a noted psychologist, outlined the ebb and flow of processes such as Shock and Numbness, Yearning and Searching, Disorganization and Despair, and Reorganization. Bowlby and Parkes both note psychophysiologic components of grief as well. Included in these processes are:

Risks of Grief

Many studies have looked at the bereaved in terms of increased risks for stress-related illnesses. Colin Murray Parkes in the 60s and 70s in England noted increased doctor visits, and real illnesses such as colitis, breathing difficulties, and so forth in the first six months following a death. Others have noted increased mortality rates (Ward, A.W. 1976) and Bunch et al found a five times greater risk of suicide in teens following the death of a parent. Grief puts a great stress on the physical body as well as on the psyche, resulting in wear and tear beyond what is normal. Further, grief is often accompanied by crying, lack of sleep, loss of appetite, and ceasing to care for one's physical and emotional wellbeing. All these can contribute to a predisposition for illness in bereavement, a finding which has been replicated often since the Lindemann studies of the Coconut Grove fire survivors in 1944. Other problems in social relations may arise: there is for example an increase of divorce following the death of a child, and children may exhibit signs of delinquency, rage, introversion or other problems. Further, grief can insidiously work in family relationships as individual members sort or act through their feelings about the death. The risks following a death in the family are as great or greater than for any other traumtic life event.

Normal vs Complicated Grief

While the experience of grief is a very individual process depending on many factors, certain commonalities are often reported. Nightmares, appetite problems, dryness of mouth, shortness of breath, sleep disorders and repetitive motions to avoid pain are often reported, and are perfectly normal. Even hallucinatory experiences may be normal early in grief, and our usual definitions will not suffice, necessitating a lot of grace for the bereaved. Complicated grief responses almost always are a function of intensity and timing: a grief that after a year or two begins to worsen, accompanied by unusual behaviors, is a warning sign, but even here, caution must be used; it takes time to say goodbye.

Types of Bereavement

Differing bereavements along the life cycle may have different manifestations and problems which are age related, mostly because of cognitive and emotional skills along the way. Children will exhibit their mourning very differently in reaction to the loss of a parent than a widow would to the loss of a spouse. Reactions in one type of bereavement may be perfectly normal, but in another the same reaction could be problematic. The kind of loss must be taken under consideration when determining how to help.

Childhood Bereavement

The loss of a parent, grandparent or sibling can be very troubling in childhood, but even in childhood there are age differences in relation to the loss. A very young child, under one or two, may be felt to have no reaction if a caretaker dies, but this is far from the truth. At a time when trust and dependency are formed, a break even of no more than separation can cause problems in wellbeing; this is especially true if the loss is around critical periods such as 8-12 months when attachment and separation are at their height in formation and even a brief separation from a parent can cause distress. (Ainsworth 1963) A change in caretakers can have lifelong consequences, which may become so blurred as to be untraceable. As a child grows older, death is still difficult to assimilate and that fact affects the way a child responds. For example, younger children will find the 'fact' of death a changeable thing: one child believed her deceased mother could be restored with 'band-aids', and children often see death as curable or reversible, more as a separation. Reactions here may manifest themselves in 'acting out' behaviors: a return to earlier behaviors such as sucking thumbs, clinging to a toy or angry behavior: they do not have the maturity to mourn as an adult, but the intensity is there. As children enter pre-teen and teen years, there is a more mature understanding. Adolescents may respond by delinquency, or oppositely become 'over-achievers': repetitive actions are not uncommon such as washing a car repeatedly or taking up repetitive tasks such as sewing, computer games etc. It is an effort to stay 'above' the grief. Childhood loss as mentioned before can predispose a child not only to physical illness but to emotional problems and an increased risk for suicide, especially in the adolescent period.
-

Death of a Child

Death of a child can take the form of a loss in infancy such as stillbirth or neonatal death, SIDS, or the death of an older child. In all cases, parents find the grief devastating and while persons may rate the death of a spouse as first in traumatic life events, the death of a child holds greater risk factors. This loss also bears a lifelong process: one does not get 'over' the loss but instead learns to assimilate and live with the death. Intervention and comforting support can make all the difference to the survival of a parent in this type of grief but the risk factors are great and may include family breakup or suicide. Feelings of guilt, almost always unfounded, are pervasive, and the dependent nature of the relationship disposes parents to a variety of problems as they seek to cope with this great loss. This, coupled with normal experiences of grief, can be overwhelming.

Death of a Spouse

The most common loss in our society of a loved one is that of the death of a spouse: it is an expected change, particularly as we age. A spouse, though, often becomes part of the other in a unique way: many widows and widowers describe losing 'half' of themselves, and after a long marriage, at older ages, the elderly may find it a very difficult assimilation to begin anew. Further, most couples have a division of 'tasks' or 'labor', e.g. the husband mows the yard, the wife pays the bills, etc. which in addition to dealing with great grief and life changes means added responsibilities for the bereaved. Social isolation may also become eminent as many groups composed of couples find it difficult adjust to the new identity of the bereaved. When queried about what in life is most troubling, most rate death of a spouse first, although the death of a child presents more risk factors.

Other Losses

Many other losses predispose persons to these same experiences, although often not as severely. Loss reactions may occur after the loss of a romantic relationship (i.e. divorce or break up), a vocation, a pet, a home, children leaving home (empty nest), a friend, a favored appointment or desire, etc. While the reaction may not be as intense, experiences of loss may still show in these forms of bereavement.

Summary

Bereavement, while a normal part of life for us all, carries high risk factors when no support is available. Severe reactions to loss may carry over into familial relations and cause trauma for children and spouses: there is an increased risk of marital breakup following the death of a child, for example. Many forms of what we term 'mental illness' have loss as their root and aetiology, but covered by many years and circumstances this often goes unnoticed. Issues of personal faith and beliefs also come under severe attack as persons reassess personal definitions in the face of great pain. Probably the best resource to avoid problems are early intervention and caring support, and understanding of the experience. Often non-professionals are just as or more effective in this role than professionals.

References


- Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.
- Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation. New York: Basic Books.
- Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. New York: Basic Books.
- Klass, D., Silverman, P. R., & Nickman, S. L. (Eds.). (1996). Continuing bonds: New understandings of grief. Philadelphia, PA.: Taylor and Francis.
- Kübler-Ross, E. (1969). On death and dying. New York: Macmillan.
- Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141-148.
- Neimeyer, R. A. (Ed.). (2001). Meaning reconstruction & the experience of loss. Washington, DC: American Psychological Association.
- Parkes, C. M. (1998). Bereavement: studies of grief in adult life (3rd ed.). London: Penguin.
- Stroebe, M. S., Hansson, R. O., Stroebe, W., & Schut, H. (2001). Handbook of bereavement research : consequences, coping, and care. Washington, DC: American Psychological Association.

External links


- [http://www.grief.org.au Centre for Grief Education]
- [http://www.angelfire.com/journal2/forgottengrief Grief at Perinatal Loss]
- [http://www.griefsjourney.com Grief's Journey (focuses on spousal loss)]
- [http://www.helpguide.org/mental/grief_loss.htm Helpguide: Grief & Loss]
- [http://www.judishouse.org Judi's House: A children's grief support center in Denver, Colorado]

See also


- Thanatology

Fear

:For other uses, see Fear (disambiguation). Fear is an unpleasant feeling of perceived risk or danger, real or not. Fear also can be described as a feeling of extreme dislike to some conditions/objects, such as: fear of darkness, fear of ghosts, etc. It is one of the basic emotions. Fear may underlie some phenomena of behavior modification, although these phenomena can be explained without adducing fear as a factor in them. Furthermore, application of aversive stimuli is also often ineffective in producing change in the behaviour intended to be changed. Fearing objects or contexts can be learned; in animals this is being studied as fear conditioning, which depends on the emotional circuitry of the brain. Fear inside a person has different degrees and varies from one person to another (see also phobia). If not properly handled, fear can lead to social problems. People who experience intense fear have been known to commit irrational and/or dangerous acts. Some philosophers have considered fear to be a useless emotion with uniformly bad consequences; other thinkers note the usefulness of fear as a warning of bad situations.

Degrees of fear

Fear can be described by different terms in accordance with its relative degrees. Fear covers a number of terms - terror, fright, paranoia, horror, persecution complex and dread.

Distrust

A mild stage of fear, more like caution than fear. A lack of trust in an object or person. For example, having mistrust in a rickety old bridge across a 10,000ft drop.

Paranoia

Paranoia is a term used to describe a psychosis of fear, related to perception of being persecuted. This perception often causes one to change their normal behaviour in radical ways, after time their behavior may become extremely compulsive.

Terror

See also: terrorism Terror refers to a pronounced state of fear, where someone becomes overwhelmed with a sense of immediate danger.

Expression

Facial

In fear, ones eyes widen and the upper lip rises. The brows draw together and the lips stretch horizontally.

Cause of fear

See also: mass hysteria The causes of fear can vary to a surprising degree; fear is to a certain extent a "cultural artefact" (Clifford Geertz). In 19th century Britain, one of the biggest fears was of dying poor, unmourned, unremembered, and possibly ending up on an anatomist's dissection table. By the early twentieth century, this had given way to a fear of being buried alive, to the extent that those who could afford it would make all sorts of arrangements to ensure this would be avoided (eg glass lids, for observation, and breathing pipes, for survival until rescued). During the Second World War, fear of death by bombing was much less than during World War I, even though many more bombs fell; air wardens would complain of civilians continuing to gossip on street corners instead of taking shelter. Similarly, when cars were new, fear of them was such that for a time the law required a man with a red flag to walk in front of it to warn the public; today, tens of thousands die in road accidents each year yet governments struggle to instill a real fear of drunk driving or speeding. In 2005, University of Toronto researchers traced the origin of memories to the prefrontal cortex of the brain.[http://www.news.utoronto.ca/bin6/050915-1631.asp]

Further reading


- Joanna Bourke (2005), Fear: a cultural history, Virago
- Corey Robin (2004), Fear: the history of a political idea, Oxford University Press
- Duenwald, Mary. "The Psychology of ...Facial Expressions" Discovery Magazine Vol. 26 NO. 1

See also


- Angst
- Phobia
- Appeal to fear
- Culture of fear
- Shame
- Guilt
- Freud

External links


- [http://www.thefamousquotations.com/subjects/fear-quotations.htm Quotations on Fear]
- [http://buddhism.kalachakranet.org/fear.html A Buddhist View on Fear] Category:Emotion Category:Propaganda

Clinical depression

Clinical depression is a health condition of depression with mental and physical components reaching criteria generally accepted by clinicians. Although nearly any mood with some element of sadness may colloquially be termed a depression, clinical depression is more than just a temporary state of sadness. Symptoms lasting two weeks or longer in duration, and of a severity that they begin to interfere with daily living, can generally be said to constitute clinical depression. Using DSM-IV-TR terminology, someone with a major depressive disorder can, by definition, be said to be suffering from clinical depression. Clinical depression affects about 16% of the population on at least one occasion in their lives. The mean age of onset, from a number of studies, is in the late 20s. About 2 times as many females as males report or receive treatment for clinical depression, though this imbalance is shrinking over the course of recent history; this difference seems to completely disappear after the age of 50 - 55, when most females have passed the end of menopause. Clinical depression is currently the leading cause of disability in the US as well as other countries, and is expected to become the second leading cause of disability worldwide (after heart disease) by the year 2020, according to the World Health Organization.

Signs and symptoms

According to the [http://www.behavenet.com/capsules/disorders/mjrdepd.htm DSM-IV-TR criteria for diagnosing a major depressive disorder] (see also: DSM cautionary statement) one or both of the following two required elements need to be present:
- Depressed mood, or
- Loss of interest or pleasure. It is sufficient to have either of these symptoms in conjunction with four of a list of other symptoms. These include:
- Feelings of overwhelming sadness or fear, or the seeming inability to feel emotion.
- A decrease in the amount of pleasure derived from what were previously pleasurable activities.
- Changing appetite and marked weight gain or weight loss.
- Disturbed sleep patterns, such as insomnia or excessive sleep.
- Changes in activity levels, such as restlessness or a slowing of movement.
- Fatigue, both mental and physical.
- Feelings of guilt, helplessness, anxiety, and/or fear.
- A decrease in self-esteem.
- Trouble concentrating or making decisions.
- Self-harm or ruminating on self-harm.
- Ruminating on death and/or suicide. Depression in children is not as obvious as it is in adults. Here are some Symptoms that children might display:
- Loss of appetite.
- Sleep problems, such as recurrent nightmares.
- Learning or memory problems where none existed before.
- Significant behavioural changes; such as withdrawal, social isolation and aggression. In older children and adolescents, an additional indicator could be the excessive use of drugs or alcohol. Depressed adolescents are at particular risk of further destructive behaviours, such as eating disorders and self-harm. One of the most widely used instruments for measuring depression severity is the Beck Depression Inventory, a 21 question multiple choice survey. It is hard for people who have not experienced clinical depression, either personally or by regular exposure to people suffering it, to understand its emotional impact and severity, interpreting it instead as being similar to "having the blues" or "feeling down". As the list of symptoms above indicates, clinical depression is a syndrome of interlocking symptoms which goes far beyond sad or painful feelings. A variety of biological indicators, including measurement of neurotransmitter levels, have shown that there are significant changes in brain chemistry and an overall reduction in brain activity. One consequence of a lack of understanding of clinical depression is that the depressed individual will often feel extreme guilt over their inability to recover; and that guilt can be aggravated by those close to them. Because of this profound and often overwhelmingly negative outlook, the depressed individual is unlikely to recover on their own without some sort of treatment. Untreated depression is typically characterized by progressively worsening episodes separated by plateaus of temporary stability or remission. If left untreated it will generally resolve within six months to two years although occasionally depression becomes chronic and lasts for many years or indefinitely. In many cases (but not all) treatment can shorten the period of distress to a matter of weeks. While depressed, the person may damage themselves socially (e.g. break up relationships), occupationally (e.g. lose his job), financially, and physically. Treatment of depression can significantly reduce the incidence of this damage, including reducing the likelihood of suicide which is otherwise a common outcome. For all of these reasons, treatment of clinical depression is seen by many as very useful and at times life-saving. Some people can experience anhedonia for long periods of time before they discover it is a mental illness. The inability to feel pleasure can advance negativity already present in a depressed person's mental state.

Historical perspective

The modern idea of depression seems to be the same as the much older concept of melancholia. The name melancholia derives from 'black bile', one of the 'four humours' postulated by Galen. The Ebers papyrus (ca 1550 BC) contains a short description of clinical depression. Though full of incantations and foul applications meant to turn away disease-causing demons and other superstition, it also evidences a long tradition of empirical practice and observation.

Types of depression

# Major depression. Also referred to as 'major depressive disorder' or biochemical, clinical, endogenous, unipolar, or biological depression. It is characterized by a severely depressed mood that persists for at least two weeks. Episodes of depression may start suddenly or slowly and can occur several times through a person's life. Major depressive disorder may be categorized as "single episode" or "recurrent" depending on whether previous episodes have been experienced before. Major depression may also be referred to as unipolar affective disorder, a term which emphasizes its relatedness to bipolar disorder.

Clinicians recognise several subtypes of Major Depression: #
- Melancholic depression (what used to be referred to as endogenous depression) is characterized by insomnia, poor appetite and weight loss, less responsive mood, and morning worsening. #
- Atypical depression is characterized by "reversed vegetative symptoms" which include oversleeping, overeating, leaden paralysis, rejection sensitivity and temporary brightening of mood in response to positive events. It may overlap with anxiety and panic attacks. It is often more chronic than melancholic depression. #
- Psychotic depression is accompanied by hallucinations or delusions. # Dysthymia is a long-term, mild depression that lasts for at least two years. By definition the symptoms are not as severe as in major depression, although those with dysthymia are highly likely to have superimposed major depressive episodes (known as "double depression"). It often begins in adolescence and spans several decades. #Bipolar disorder is a cyclical illness in which moods fluctuate between mania (extreme happiness or giddiness and frantic activity) and clinical depression. Bipolar disorder has also been commonly called "manic depression", although this usage is now unpopular with psychiatrists, who have standardised on Kraepelin's usage of the term "manic depression" to describe the whole bipolar spectrum that includes both bipolar disorder and unipolar depression; they now usually use the term bipolar disorder. This then leaves the term unipolar depression which is used to differentiate it from bipolar disorder. #Unipolar Bipolar disorder is a depression similar to bipolar disorder with the exception of very weak or completely absent mania periods. This is often a long-term severe depression with no or at most very few good periods. #Depressive pseudodementia is a syndrome in which the patient shows symptoms of dementia that are actually caused by depression.

What the DSM Leaves Out

The DSM-IV-TR is largely unchanged since the DSM-III of 1980. Although much has been learned about depression and the brain since then, it is unlikely that future editions will reflect this knowledge, as the DSM by nature is a very conservative document. There is a case to be made for anxiety-driven depression, and there may be changes to the next DSM to reflect this reality. Anxiety is a frequent co-traveler with depression, either as a co-occurring illness or with any number of anxiety symptoms manifesting in depressive episodes. Researchers such as Robert Sapolsky PhD of Stanford and others argue that stress biologically underpins both anxiety and depression. Pharmaceutical companies are seeking to ward off depression and anxiety by targeting stress hormones such as corticotropin releasing factor (CRF). (See [http://www.mcmanweb.com/anxiety.htm Anxiety in Depression and Bipolar Disorder].) It can be argued that the DSM fails to account for destructive behaviour identified with males such as aggression and substance use while overemphasising “female” failings such as excessive guilt, feelings of sadness, and overeating or not eating enough. As a result, according to this argument, twice as many women as men are diagnosed with depression. Therapists Terrence Real and Jed Diamond and others are seeking to have psychiatry redress this imbalance. (see [http://www.mcmanweb.com/article-227.htm Depression in Men].) Another major behavior the DSM fails to account for is apathy, or the lack of motivation. Motivation is tied mainly to the dopamine system in the brain, rather than the serotonin system that is the target of most antidepressant medications. Apathy is typically discussed in the context of neuropsychiatric illnesses such as Alzheimer’s or Parkinson’s, but remains for the present moment terra incognita to psychiatry. (See [http://www.mcmanweb.com/apathy.htm Apathy Matters].) Finally, the DSM fails to account for manic or hypomanic features in depression. This is the gray area of the mood spectrum, where clinical (unipolar) depression and bipolar disorder appear to overlap. Some researchers such as Hagop Akiskal MD are in favour of widening the criteria for bipolar disorder to include what they see are “softer forms” of this illness. By the same token, depressed patients with some hypomanic or manic features could be regarded as having a “harder” form of depression. (See [http://www.mcmanweb.com/article-137.htm Multipolar Depression].)

Causes of depression

No specific cause for depression has been identified, but there are a number of factors believed to be involved.
- Heredity The tendency to develop depression may be inherited; there is some evidence that this disorder may run in families. Heredity
- Physiology There may be changes or imbalances in chemicals which transmit information in the brain, called neurotransmitters. Many modern antidepressant drugs attempt to increase levels of certain neurotransmitters, like serotonin. While the causal relationship is unclear, it is known that antidepressant medications do relieve certain symptoms of depression- although [http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020392 critics point out that the relationship between serotonin, SSRIs, and depression is usually greatly oversimplified when presented to the public]. Seasonal affective disorder (SAD) is a type of depressive disorder that occurs in the winter when daylight hours are short. It is believed that the body's production of melatonin, which is produced at increased levels in the dark, plays a major part in the onset of SAD, and that many sufferers respond well to bright light therapy, also known as phototherapy. High levels of Omega-6 fatty acids in the brain have also been linked to depression.
- Psychological factors Low self-esteem and self-defeating or distorted thinking are connected with depression. While it is not clear which is the cause and which is the effect, it is known that sufferers who are able to make corrections to their thinking patterns can show improved mood and self-esteem. Psychological factors include the complex development of one's personality and how one has learned to cope with external environmental factors, such as stress.
- Early experiences Events such as the death of a parent, abandonment or rejection, neglect, chronic illness, and severe physical, psychological, or sexual abuse can also increase the likelihood of depression later in life. Post-traumatic stress disorder (PTSD) includes depression as one of its major symptoms.
- Life experiences Job loss, financial difficulties, long periods of unemployment, the loss of a spouse or other family member, divorce or the end of a committed relationship, or other traumatic events may trigger depression. Long-term stress, at home, work or school, can also be involved.
- Medical conditions Certain illnesses including cardiovascular pathologies[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15581413&query_hl=7], hepatitis, mononucleosis, and hypothyroidism may contribute to depression, as may certain prescription drugs such as birth control pills and steroids.
- Alcohol and other drugs Alcohol can have a negative effect on mood, and misuse or abuse of alcohol, benzodiazepine-based tranquillizers and sleeping medications, or narcotics can all play a major role in the length and severity of depression. The link between frequent cannabis use and depression is also widely documented, although the direction of causality remains in question.
- Postpartum depression About ten percent of new mothers experience some form of depression after childbirth. When it occurs, the onset is typically within three months after delivery, and it may last for several months. About two new mothers out of a thousand have depression so severe it includes hallucinations or delusions.
- Living with a depressed person Those living with someone suffering from depression experience increased anxiety, and life disruption, increasing the possibility of also becoming depressed.
- Social Environment Evolutionary theory suggests that depression is a protective mechanism: if an individual is involved in a lengthy fight for dominance of a social group and is clearly losing, depression causes the individual to back down and accept the submissive role. In doing so, the individual is protected from unnecessary harm. In this way, depression maintains the social hierarchy.
- Other Evolutionary Theories Another evolutionary theory is that the cognitive response that produces modern day depression evolved as a mechanism that allows people to assess whether they are in pursuit of an unreachable goal. Still others claim that depression can be linked to perfectionism. People that accept satisfactory outcomes in lieu of "the best" outcome tend to lead happier lives.

Treatment

Treatment of depression varies broadly, and is different for each individual. Various types and combinations of treatments may have to be tried. There are two primary modes of treatment, typically employed in conjunction with one another: medication and psychotherapy. A third treatment, electroconvulsive therapy (ECT) also known as electroshock, may be used where chemical treatment fails. Other alternative treatments used for depression include exercise and the use of vitamins, herbs, or other nutritional supplements. The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control s/he has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others. While treatment is generally effective, there are some cases where the condition fails to respond. Treatment-resistant depression requires a full assessment which may lead to the addition of psychotherapy, higher medication doses, changes of medication or combination therapy, a trial of ECT/electroshock, or even a change in the diagnosis with subsequent treatment changes. Although this process helps many, some people's symptoms continue unabated. In emergency situations with suicidal persons, psychiatric hospitalization is used simply to keep suicidal people safe until they cease to be dangers to themselves. Another treatment program is partial hospitalization, in which the patient sleeps at home but spends the day, either five or seven days a week, in a psychiatric hospital setting in intense treatment. This treatment usually involves group therapy, individual therapy, psychopharmacology, and academics (in child and adolescent programs).

Medication

Medication which relieves the symptoms of depression has been available for several decades. These drugs are listed in order of historical development. Typical first line therapy for depression is the use of an SSRI type drug, such as sertraline (Zoloft). Monoamine oxidase inhibitors (MAOIs) such as Nardil may be used if other antidepressant medications are ineffective. Because there are potenially fatal interactions between this class of medication and certain foods and drugs, they are rarely prescribed anymore. A new MAOI has recently been introduced. Moclobemide (Manerix), known as a reversible inhibitor of monoamine oxidase A (RIMA), follows a very specific chemical pathway and does not require a special diet. Tricyclic antidepressants are the oldest, and include such medications as amitriptyline and desipramine. They are used less commonly now, due to side-effects which may include increased heart rate, drowsiness, dry mouth, and memory impairment. Most importantly, they have a high potential to be lethal in moderate overdose. The reason why tricyclic antidepressants are still used is their high potency, especially in severe cases of clinical depression. Selective serotonin reuptake inhibitors (SSRIs) comprise the current standard family of antidepressants. It is thought that one cause of depression is that an inadequate amount of serotonin, a chemical which the brain uses to transmit signals between nerve cells, is produced. These drugs are said to work by preventing the reabsorption of serotonin by the nerve cell, thus maintaining the levels the brain needs to function effectively, although two researchers recently demonstrated that this is a marketing technique rather than a scientific portrayal of how the drugs actually work. [http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020392]. Recent research indicates that these drugs may interact with transcription factors known as "clock genes"[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15994025&query_hl=24] that may be important for the addictive properties of drugs of abuse and possibly in obesity[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16094306&query_hl=27][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16288309&query_hl=24]. This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro), and sertraline (Zoloft). These antidepressants typically have fewer adverse side effects than the tricyclics or the MAOIs, though such effects as drowsiness, dry mouth, and decreased ability to function sexually may occur. Noradrenaline reuptake inhibitors (NARIs) such as reboxetine (Edronax) act via noradrenaline. NARIs are thought to have a positive effect on concentration and motivation in particular. Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) and duloxetine (Cymbalta) are a newer form of anti-depressant which work both on noradrenaline and on serotonin. They typically have similar side-effects to the SSRIs although there may be a withdrawal syndrome on discontinuation which may require a tapering of the dose.

Dietary supplements

S-adenosyl methionine (SAM-e) is a derivative of the amino acid methionine that is found throughout the human body, where it acts as a methyl donor and participates in other biochemical reactions. It is available as a prescription antidepressant in Europe, and an over-the-counter dietary supplement in the United States. Clinical trials have shown SAM-e to be as effective as standard antidepressant medication, with many fewer side effects., Its mode of action is unknown. Omega-3 fatty acids (found naturally in oily fish, vitamin D, flax seeds, hemp seeds, walnuts, canola oil etc.) have also been found to be effective while used as a dietary supplement.

Augmentor drugs

Some antidepressants have been found to work more effectively in some patients when used in combination with another drug. Such "augmentor" drugs include tryptophan (Tryptan) and buspirone (Buspar). Tranquillizers and sedatives, typically the benzodiazepines, may be prescribed to ease anxiety and promote sleep. Because of their high potential for fostering dependence, these medications are intended only for short-term or occasional use. Medications are often employed not for their primary function, but to exploit what are normally side effects. Quetiapine fumarate (Seroquel) is designed primarily to treat schizophrenia and bipolar disorder, but a frequently-reported side-effect is somnolence. Hence, this non-addictive drug can be used in place of an addictive anti-anxiety agent such as clonazepam (Klonopin, Rivotril). Antipsychotics such as risperidone (Risperdal) and olanzapine (Zyprexa), and Quetiapine (Seroquel) are prescribed as mood stabilizers and are also effective in treating anxiety. Antipsychotics (typical or atypical) may be also prescribed in an attempt to augment an antidepressant, to make antidepressant blood concentration higher, or to relieve psychotic or paranoid symptoms often accompanying clinical depression. However, they may have serious side effects, particularly at high doses, which may include blurred vision, muscle spasms, restlessness, tardive dyskinesia, and weight gain. Antidepressants by their nature are stimulants. Anti-anxiety medications by their nature are depressants. Close medical supervision is critical to proper treatment if a subject is presenting both illnesses as the medications tend to work against each other. Lithium and Depakote remain the standard treatments for bipolar disorder, but may also be effective for people with depression, particularly in preventing relapse. Lithium's potential side effects include thirst, tremors, light-headedness, and nausea or diarrhea. Some of the anticonvulsants such as carbamazepine (Tegretol), sodium valproate (Epilim), and lamotrigine (Lamictal) are also used as mood stabilisers, particularly in bipolar disorder. Failure to take medication, or failure to take it as prescribed, is one of the major causes of relapse. Should one feel a change or discontinuation of medication is necessary, it is critical that this be done in consultation with a doctor.

Psychotherapy

In psychotherapy, or counselling, one receives assistance in understanding and resolving problems which may be contributing to depression. This may be done individually or with a group, and is conducted by health professionals such as psychiatrists, psychologists, social workers, or psychiatric nurses. It is important to enquire about both the therapist's training and approach; a very close bond often forms between practitioner and client, and it is important that the client feel understood by the clinician. Counsellors can help a person make changes in thinking patterns, deal with relationship issues, detect and deal with relapses, and understand the factors that contribute to depression. There are many therapeutic approaches, but all are aimed at improving an individual's personal and interpersonal functioning. Cognitive therapy, also known as Cognitive Behaviour Therapy, focuses on how people think about themselves and their relationships to the world. It works to counteract negative thought patterns and enhance self-esteem. Therapy can be used to help a person develop or improve interpersonal skills in order to allow them to communicate more effectively and reduce stress. Behavioral therapy is based on the assumption that behaviors are learned. This type of therapy attempts to teach individuals new and healthier types of behaviours. Supportive therapy encourages people to discuss their problems and provides them with emotional support. The focus is on sharing information, ideas, and strategies for coping with daily life. Family systems therapy helps people live together more harmoniously and undo patterns of destructive behaviour.

Transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation (rTMS) is currently under study as a possible treatment for depression. Initially designed as a tool for physiological studies of the brain, this technique shows promise as a means of alleviating depression. In this therapy, a powerful magnetic field is used to stimulate the left prefrontal cortex, an area of the brain which typically shows abnormal activity in depressed individuals. rTMS has been proposed as an alternative to ECT that would have fewer side effects. No sedation is required, and the only reported side effects are a slight headache in some patients, and facial muscle contraction during treatment. However clear evidence that it is an effective treatment is still awaited. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15307288&dopt=Citation Recent work] in Poland has suggested that weak, variable magnetic fields may offer relief from depression in those that have been unresponsive to medication. However, some of the existing work has been [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11985347&dopt=Abstract questioned] with claims that the effect is not as significant once environmental conditions are controlled for.

Vagus nerve stimulation

Vagus nerve stimulation therapy is a treatment used since 1997 to control seizures in epileptic patients and has recently been approved for treating resistant cases of clinical depression. The VNS device is implanted in a patient's chest with wires that connect it to the vagus nerve, which it stimulates to reach a region of the brain associated with moods. The device delivers controlled electrical doses to the vagus nerve at regular intervals.

Electroconvulsive therapy

Electroconvulsive therapy (ECT), also known as electroshock or electroshock therapy employs short bursts of a controlled current of electricity (this is typically fixed at 0.9 ampere) into the brain to induce a brief, artificial seizure while the patient is under general anaesthesia. ECT has acquired a fearsome reputation, in part, from its use as a tool of repression in the former USSR, and its fictional depiction in films such as One Flew Over the Cuckoo's Nest, but remains a common treatment where other means of treatment have failed, or where the use of drugs is unacceptable (such as in pregnancy). Also, in contrast to "direct" electroshock of years ago, most countries now only allow ECT to be administered under anaesthesia. In a typical regimen of treatment, a patient receives three treatments per week over three or four weeks. Repeat sessions may be required. Short-term memory loss, disorientation and headache are very common side effects. In some cases, permanent memory loss has occurred, but detailed neuropsychological testing in clinical studies have not been able to prove permanent effects on memory. ECT offers the benefit of a very fast response, however, this response has been shown not to last unless either maintenance electroshock or maintenance medications are used. While antidepressants usually take around a month to take effect, the results of ECT have been shown to be much faster. For this reason, it is the treatment of choice in emergency circumstances (for example in catatonic depression where the patient has ceased oral intake of fluid or nutrients). There remains much controversy over electroshock. Advocacy groups and scientific critics, such as Dr Peter Breggin[http://www.breggin.com/Electroshockscientific.pbreggin.1998.pdf], call for restrictions on its use or complete abolishment. Like all forms of psychiatric treatment, electroshock can be given without a patient's consent, but this is subject to legal conditions dependent on the jurisdiction.

Other methods of treatment

Light therapy

Bright light (both sunlight and artificial light) is shown to be effective in seasonal (winter) depression, and sometimes may be effective in other types of depression, especially atypical depression or depression with "seasonal phenotype" (overeating, oversleeping, weight gain, apathy). It is wise to recommend to any depressive patient to take as much sunlight as possible by walking at daytime, even if the patient suffers from depression which does not have seasonal pattern or "seasonal symptoms". Important note: an antidepressant effect is caused by visible light stimulation of retina, not by ultra-violet, so it is not necessary (and may be even dangerous in some cases) to sunburn. It is enough just to walk at daytime or to take light therapy in a light cabin with a special powerful lamp.

Exercise

It is widely believed that physical activity and exercise helps depressive patients and promotes quicker and better relief from depression. It is also thought to help antidepressants and psychotherapy to work better and faster. It can be difficult to find the motivation to exercise if the depression is severe, but sufferers should be encouraged to take part in some form of regularly-scheduled physical activity if possible. A workout need not be strenuous; many find walking, for example, to be of great help. Exercise produces higher levels of chemicals in the brain, notably dopamine, serotonin, and norepinephrine. In general this leads to improvements in mood, which is effective in countering depression. Note that prior to beginning an exercise regime, it is wise to consult a doctor. He or she can establish whether a person possesses any health problems that could rule out some types of exercise.

Enemas and colon hydrotherapy

Severe clinical depression is often accompanied by constipation. Tricyclic antidepressants themselves also tend to produce constipation as a side effect. Laxatives reduce the absorption of an antidepressant in the small intestine, thereby reducing its bioavailability and clinical efficacy. Warm water enemas, on the other hand, do not interfere with antidepressant absorption, and may have a slight antidepressive effect by increasing serotonin production in thick bowel wall and temporarily raising serotonin level in the bloodstream.

Meditation

Meditation is increasingly seen as a useful treatment for depression. The current professional opinion of meditation is that it represents at least a complementary method of treating depression. Since the late 1990s, much research has been carried out to determine how meditation affects the brain (for more information see the main article on meditation). While the effects on the mind are somewhat complex, they are often quite positive, encouraging a calm, reflective and rational state of mind which can be of great help against depression. It's notable that while many religions actively encourage/use meditative practice, it is not necessary to be a member of any faith to partake in meditation.

Old methods

Insulin shock treatment is an old and currently mostly abandoned treatment of severe depressions, psychoses, catatonic states and other mental disorders. It consists of induction of hypoglycemic coma by intravenous infusion of insulin. The treatment is potentially unsafe and can be lethal in some cases (about 1% of patients undergoing insulin coma), even with proper monitoring. That was the main reason why it was abandoned from current medical practice. In contrast, ECT is considered to be very safe. Nevertheless, insulin shock therapy is still officially used in Russia and some other countries, and can be administered to a very treatment-resistant patient under his written consent in many Western countries. Atropinic shock therapy, also known as atropinic coma therapy, is an old and currently rarely-used method. It consists of induction of atropinic coma by rapid intravenous infusion of atropine. The atropinic shock treatment is considered relatively safe but the problem with its administration is that it requires prolonged coma (4-5 hours), careful monitoring and preparation, and it has many unpleasant side effects, like blurred vision due to atropine. Thus it is rarely used now. But it can be used under written consent in Western countries in some very treatment-resistant cases, and is still officially used in Russia and some other countries.

Relapse

Relapse is more likely if treatment has not resulted in the full remission of symptoms.4 In fact, current guidelines for antidepressant use recommend 4 to 6 months of continuing treatment following symptom resolution to prevent relapse of depression. Combined evidence from many randomized controlled trials indicates that continuing antidepressant medications after recovery substantially reduces (halves) the chances of relapse. This preventative effect probably lasts for at least the first 36 months of use. Some anecdotal evidence exists to suggest that chronic disease is accompanied by relapses after prolonged treatment with antidepressants (Tachyphylaxis). Psychiatric texts suggest that physicians respond to this by increasing dosage, complementing the medication with a different class, or changing the medication class entirely. The reason for relapse in these cases is as poorly understood as the change in brain physiology induced by the medications themselves. Possible reasons may include ageing of the brain or worsening of the condition. Most SSRI psychiatric medications were developed for short term use (a year or less), but are widely prescribed for indefinite periods.[http://cms.psychologytoday.com/articles/pto-19990301-000032.html]

See also


- Beck Depression Inventory
- Hamilton Depression Rating Scale
- Cyclothymia
- Dysthymia
- Mania
- Bipolar disorder
- Seasonal affective disorder (SAD)
- List of people who have suffered from depression
- Stress
- Hypoadrenia (also covers 'adrenal exhaustion', sometimes called 'adrenal fatigue')
- Learned helplessness
- Wikibooks - Demystifying Depression

Books

Books by psychologists/psychiatrists


- Beck, A. T., Rush, A. J., Shaw, B. F., Emery, G. (1987). Cognitive therapy of depression. New York: Guilford.
- Burns, David D. (1999). Feeling Good : The New Mood Therapy. Avon.
- Klein, D. F., & Wender, P. H. (1993). Understanding depression: A complete guide to its diagnosis and treatment. New York: Oxford University Press.
- Kramer, Peter D (2005). Against Depression. New York: Viking Adult
- Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books.
- Sarbadhikari S. N. (2005).Ed, Depression and Dementia:Progress in Brain Research, Clinical Applications and Future Trends. Hauppauge, Nova Science Publishers. [http://novapublishers.com/catalog/product_info.php?products_id=232] ISBN 1-59454-114-0

Books by persons suffering or having suffered from depression


- Wurtzel, E. (1997) Prozac Nation: Young and Depressed in America: A Memoir. Riverhead Books. ISBN 1573225126
- Lewinsohn, P. M., Munoz, R. F, Youngren, M. A., Zeiss, A. M. (1992). Control your depression. New York: Fireside/Simon&Schuster.
- Nesaule, Agate (1995). A Woman in Amber: Healing the Trauma of War and Exile New York: Penguin Books.
- : ISBN 1-56947-046-4 (hc.); 0 14 02.6190 7 (pbk.)
- Rowe, Dorothy (2003). Depression: The way out of your prison. London: Brunner-Routledge.
- Sealey, Robert (2002). Finding Care for Depression, Mental Episodes & Brain Disorders, Toronto: Sear Publications www.searpubl.ca
- Shields, Brooke (2005). Down Came the Rain: My Journey Through Postpartum Depression. Hyperion. ISBN: 1401301894.
- Smith, Jeffery (2001). Where the roots reach for water: A personal and natural history of melancholia. New York: North Point Press.
- Solomon, Andrew (2001). The noonday demon: An atlas of depression. New York: Scribner.
- Styron, William (1992). Darkness visible: A memoir of madness. New York: Vintage Books/Random House.
- Wolpert, Lewis (2001). Malignant sadness: The anatomy of depression. London: Faber and Faber.

References

# [http://www.cpa-apc.org/Publications/Archives/PDF/1997/May/BLAND.pdf Bland, R.C. (1997)] Epidemiology of Affective Disorders: A Review. Can J Psychiatry, 42:367?377. # Murray, C.J.L., Lopez, A.D. 1997. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 349, 1498-1504 # Roberto Delle Chiaie, Paolo Pancheri and Pierluigi Scapicchio. (2002). Efficacy and tolerability of oral and intramuscular S-adenosyl- L-methionine 1,4-butanedisulfonate (SAMe) in the treatment of major depression: comparison with imipramine in 2 multicenter studies. Am J Clin Nutr, 76 (5): 1172S-1176S # Mischoulon D, Fava M. (2002). Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr, 76 (5): 1158S-61S. # [http://jama.ama-assn.org/cgi/content/full/289/23/3152 Keller, M.B. (2003)] Past, Present, and Future Directions for Defining Optimal Treatment Outcome in Depression. JAMA, 289:3152-3160. # Martin JL, Barbanoj MJ, Schlaepfer TE, Thompson E, Perez V, Kulisevsky J. Repetitive transcranial magnetic stimulation for the treatment of depression. Systematic review and meta-analysis. British Journal of Psychiatry. 2003 Jun;182:480-91. PMID 12777338 # Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, Goodwin GM. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003 Feb 22;361(9358):653-61. PMID 12606176

External links


- General Information
  - [http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm Depression Information from the US Institute of Mental Health]
  - [http://www.nelmh.org/home_affective_depression.asp?c=3&fc=001&fid=51 Information and links from the UK National Electronic Library for Mental Health]
  - [http://goldbamboo.com/topic-t2758-depression.html Depression: Clinical and Alternative Treatments]
  - [http://www.psycom.net/depression.central.html Dr. Ivan's depression central] - Links to a plethora of information about depression and related disorders by biopsychiatrist Ivan Goldberg, MD.
  - [http://psychcentral.com/disorders/depression/ Psych Central: Depression Information and Treatments]
  - [http://web4health.info/en/answers/bipolar-menu.htm 100 FAQs about depression]
  - [http://www.kraepelin.org/ Detailed information] - Concerning Emil Kraepelin, who identified Manic Depression
  - [http://buddhism.kalachakranet.org/depression.html A Buddhist View on Depression]
  - [http://www.mental-health-matters.com/disorders/dis_details.php?disID=33 Mental Health Matters: Depression]
  - [http://www.apna-hyderabad.com/health/depression.asp Learn why Depression Happens?]
  - [http://www.depression-doctor.com/antidepressants.htm Antidepressants]
  - [http://counsellingresource.com/distress/mood-disorders/depression-symptoms.html Symptoms of Clinical Depression (Major Depressive Disorder)]
  - [http://www.mentalhealth.com/dis/p20-md01.html Internet Mental Health: Major Depressive Disorder]
  - [http://www.trappedminds.org/ TrappedMinds.org] - Depression and Mood Disorder Resources
  - [http://www.mcmanweb.com McMan's Depression and Bipolar Web]
  - [http://www.wingofmadness.com/ Wing of Madness]
  - [http://www.depressionadvisor.com/ DepressionAdvisor.com: Depression Information]
  - [http://www.clinical-depression.co.uk/ clinical-depression.co.uk] - A free online course that aims to equip people with all the knowledge required to understand, treat and ultimately overcome depression
  - [http://www.ahrp.org/risks/usSSRIuse0604.pdf An Analysis of Use of Prozac, Paxil and Zoloft in USA 1988--2002 (pdf file)]
  - [http://www.philosophicalsociety.com/Archives/Philosophy%20And%20Depression.htm "Philosophy And Depression," Philosophical Society.com] An article which asks whether the depressed state really is a disease that needs to be palliated by drugs.
  - [http://www.spine-health.com/topics/cd/depression/depression01.html Depression and Chronic Back Pain]
  - [http://talentdevelop.com/depresscreativ.html Depression and Creativity]
  - [http://www.depressiontreatment.com Depression Treatment] Information, Resources, and Support Forum
- Online Support Groups
  - [http://secretworld.homeip.net/ Secretworld] - Mood Disorders and Depression Support
  - [http://moodgym.anu.edu.au/ Moodgym] - Training CBT for preventing depression (ANU)
  - [http://bluepages.anu.edu.au/ BluePages] - evidence-based information about depression (ANU)
  - [http://www.crazymeds.org/] - Descriptions of effects of psychiatric drugs by people who take them, links to more information on drugs and discussion groups.
- Books and Publications
  - [http://www.thewaveriders.com/ The Wave Riders] - A book and newsletter with an alternative approach to Bipolar disorder and depression.
  - [http://healthnet.umassmed.edu/mhealth/HAMD.pdf The Hamilton test] - The Hamilton test for evalutating the degree of depression (pdf)
  - [http://www1.va.gov/visn5mirecc/research/teleforms/cacr_madrs.pdf The MADRs test] - The MADRs test for evaluating the degree of depression (pdf).
  - [http://www.penguinputnam.com/nf/Book/BookDisplay/0,,0_0670034053,00.html Against Depression] Peter Kramer's exploration of cultural stereotypes of depression and artistic expression.
  - [http://www.depressionmindbody.com/ Depression: Mind and Body] - A peer-reviewed journal describing advances in the understanding and treatment of depression and its physical symptoms.
  - [http://www.coping-with-bipolar.com/bipolar-disorder.php Bipolar Disorder] Proven techniques to help co-manage and cope with bipolar disorder in a loved one. Compiled by a NAMI faculty member from thousands of bipolar victims and co-victims.
- Organizations
  - [http://www.depressionalliance.org/ Depression Alliance website (UK charity)]
  - [http://www.philosophicalsociety.com/Archives/Philosophy%20And%20Depression.htm "Philosophy And Depression," Philosophical Society.com]
- Discussions
  - [http://www.psychforums.com/forums/viewforum.php?f=136 Psych Forums: Depression Forum]
  - [http://www.depressionet.com.au DepressioNet: board for depression sufferers.]
  - [http://www.auroramd.com/ AuroraMD provides Primary Care screening services]
  - [http://www.wingofmadness.com/forums/ Wing of Madness Message Board] - Message board and chat for people with mood disorders.
- News
  - [http://www.healthdiaries.com/news/mentalhealth/archives/depression/ Depression News]
  - [http://www.isracast.com/tech_news/101005_tech.htm Researchers from the Hebrew university developed a blood test for Anxiety - now working on depression] - A web Article
- Evolution and Depression
  - [http://www-personal.umich.edu/~nesse/ Randolph Nesse's homepage]
  - [http://www.authentichappiness.org Martin Seligman] Seligman was the discoverer of learned helplessness in laboratory mice. He is also the developer of Positive Psychology. Category:Mood disorders Category:Medical emergencies ja:鬱病 simple:Depression (illness)

The four humours

In traditional medicine practiced before the advent of modern technology, the four humours were four fluids that were thought to permeate the body and influence its health. An imbalance in the distribution of these fluids was thought to affect each individual's personality. The concept was developed by ancient Greek thinkers around 400 BC and was directly linked with another popular theory of the four elements (Empedocles). Paired qualities were associated with each humour and its season. The four humours, their corresponding elements, seasons and sites of formation, and resulting temperaments alongside their modern equivalents are: It is believed that Hippocrates was the one who applied this idea to medicine. "Humoralism" or the doctrine of the Four Temperaments as a medical theory retained its popularity for centuries largely through the influence of the writings of Galen (131-201 AD) and was decisively displaced only in 1858 by Rudolf Virchow's newly-published theories of cellular pathology. While Galen thought that humours were formed in the body, rather than ingested, he believed that different foods had varying potential to be acted upon by the body to produce different humours. Warm foods, for example, tended to produce yellow bile, while cold foods tended to produce phlegm. Seasons of the year, periods of life, geographic regions and occupations also influenced the nature of the humours formed. The imbalance of humours, or "dyscrasia", was thought to be the direct cause of all diseases. Health was associated with a balance of humours, or eucrasia. The qualities of the humours, in turn, influenced the nature of the diseases they caused. Yellow bile caused warm diseases and phlegm caused cold diseases. eucrasia In On the Temperaments Galen further emphasized the importance of the qualities. An ideal temperament involved a balanced mixture of the four qualities. Galen identified four temperaments in which one of the qualities, warm, cold, moist and dry, predominated and four more in which a combination of two, warm and moist, warm and dry, cold and dry and cold and moist, dominated. These last four, named for the humours with which they were associated—that is, sanguine, choleric, melancholic and phlegmatic, eventually became better known than the others. While the term "temperament" came to refer just to psychological dispositions, Galen used it to refer to bodily dispositions, which determined a person's susceptibility to particular diseases as well as behavioural and emotional inclinations. Methods of treatment like blood letting, emetics and purges were aimed at expelling a harmful surplus of a humour. They were still in the mainstream of American medicine after the Civil War. Other methods used herbs and foods associated with a particular humour to counter symptoms of disease, for instance: people who had a fever and were sweating were considered hot and wet and therefore given substances associated with cold and dry. There are still remnants of the theory of the four humours in the current medical language. For example, we refer to humoral immunity or humoral regulation to mean substances like hormones and antibodies that are circulated throughout the body, or use the term blood dyscrasia to refer to any blood disease or abnormality. The theory was a modest advance over the previous views on human health that tried to explain in terms of the divine. Since then practitioners have started to look for natural causes of disease and to provide natural treatments. The Unani school of Indian medicine, still apparently practiced in India, is very similar to Galenic medicine in its emphasis on the four humours, and in treatments based on controlling intake, general environment, and the use of purging as a way of relieving humoral imbalances.

See also


- Disposition
- Humor theory
- Medieval medicine Category:History of medicine Category:Psychology Category:Obsolete scientific theories ko:사체액설

Greek language

Greek (Greek Ελληνικά, IPA – "Hellenic") is an Indo-European language with a documented history of 3,500 years. Today, it is spoken by 15 million people in Greece, Cyprus, the former Yugoslavia, particularly The Former Yugoslav Republic of Macedonia, Bulgaria, Albania and Turkey. There are also many Greek emigrant communities around the world, such as those in Melbourne, Australia which is the third-largest Greek-populated city in the world, after Athens and Thessaloniki. Greek has been written in the Greek alphabet, the first true alphabet, since the 9th century B.C. and before that, in Linear B and the Cypriot syllabaries. Greek literature has a long and rich tradition.

History

This article does not cover the reconstructed history of Greek prior to the use of writing. For more information, see main article on Proto-Greek language. Greek has been spoken in the Balkan Peninsula since the 2nd millennium BC. The earliest evidence of this is found in the Linear B tablets dating from 1500 BC. The later Greek alphabet (q.v.) is unrelated to Linear B, and was derived from the Phoenician alphabet (abjad); with minor modifications, it is still used today. Greek is conventionally divided into the following periods:
- Mycenean Greek: the language of the Mycenean civilisation. It is recorded in the Linear B script on tablets dating from the 16th century BC onwards.
- Classical Greek (also known as Ancient Greek): In its various dialects was the language of the Archaic and Classical periods of Greek civilisation. It was widely known throughout the Roman empire. Classical Greek fell into disuse in western Europe in the Middle Ages, but remained known in the Byzantine world, and was reintroduced to the rest of Europe with the Fall of Constantinople and Greek migration to Italy.
- Hellenistic Greek (also known as Koine Greek): The fusion of various ancient Greek dialects with Attic (the dialect of Athens) resulted in the creation of the first common Greek dialect, which gradually turned into one of the world's first international languages. Koine Greek can be initially traced within the armies and conquered territories of Alexander the Great