What is trichotillomania?

Causes

The cause of trichotillomania is unclear. It is likely that it is caused by both environmental (learned) and biological factors. One possibility is that hair pulling is a learned response to increasing stress and that the act relieves that stress. Biological explanations are neurological in nature and focus mainly on an imbalance of neurotransmitters.

Risk Factors

Some indication exists that there may be a family history of trichotillomania. The disorder begins most commonly between the ages of six and thirteen years and is four times more likely to affect women than men. It typically appears in persons who are depressed, anxious, or stressed.

Symptoms

Persons with trichotillomania generally show signs of depression, anxiety, or increasing stress. The obvious symptoms of trichotillomania involve pulling hair from the head, eyelashes, eyebrows, beard, or other area of the body.

The disorder is characterized by areas of baldness or by patches of hair just starting to grow. Persons with trichotillomania may play with their pulled hair or even eat it. In cases where enough hair is ingested, an intestinal obstruction may develop.

Screening and Diagnosis

A person with trichotillomania presents with hair loss. Differential diagnosis involves ruling out other causes of hair loss, including both congenital and acquired causes. When hair loss cannot be attributed to any other medical condition in a person who exhibits high levels of stress or anxiety, that person is evaluated to determine if he or she exhibits hair-pulling behavior on a regular basis. Such an individual is likely to be diagnosed with trichotillomania.

Treatment and Therapy

Because the causes of trichotillomania are not clearly understood, treatment can often be complicated. All treatments generally involve attempts at decreasing or managing stress, anxiety, and depression, which can affect trichotillomania. Specific treatments for trichotillomania can be either psychological or pharmacological in nature.

Psychological treatment involving cognitive behavior therapy (CBT) seems to be most effective, although hypnosis and biofeedback have also been used. The most common type of CBT used is habit reversal, in which the person is taught to attend to hair-pulling desires and to engage in a behavior that prevents the hair pulling.

Most of the medications that are used to treat trichotillomania block noradrenalin and serotonin reuptake in the brain. Effexor (venlafaxine) has been found most effective in treatment. Selective serotonin reuptake inhibitors and dopamine-blocking medications also have been investigated as treatment modalities. All of these potential pharmacological treatments deal with the regulation of neurotransmitters.

Prevention

The only real means of prevention involves diagnosing anxiety, stress, or depression prior to the onset of hair-pulling behavior. Treating the underlying condition may prevent this physical manifestation.

Bibliography

Keuthen, Nancy J., Dan J. Stein, and Gary A. Christenson. Help for Hair Pullers: Understanding and Coping with Trichotillomania. Oakland: New Harbinger, 2001. Print.

Penzel, Fred. The Hair-Pulling Problem: A Complete Guide to Trichotillomania. New York: Oxford UP, 2003. Print.

"Trichotillomania." Upd. Timothy Rogge. Rev. David Zieve, Isla Ogilvie, and ADAM editorial team. MedlinePlus. Natl. Lib. of Medicine, 10 Mar. 2014. Web. 6 Nov. 2015.

Walther, Michael R., et al. “Recent Advances in the Understanding and Treatment of Trichotillomania.” Journal of Cognitive Psychotherapy 24.1 (2010): 46–64. Print.

How does Chekhov use farce as a literary device in The Proposal?

"Farce" refers to a dramatic work that utilizes absurdity as a literary device by placing exaggerated characters in improbable situations. Anton Chekhov's The Proposal is an example of farce because the main characters, Lomov and Natalia, are both absurdly sensitive and so prone to arguing over minor details that Lomov can't manage to accomplish his marriage proposal. The two fail to become engaged because they are too distracted by arguments over land disputes between their families and whose family owns the superior dog. Lomov is so offended by Natalia's claims that he even passes out at one point in the play. The Proposal is a farce because the concept of two people being unable to start their engagement because they are too busy bickering is humorous and absurd, and the characters of Lomov and Natalia are so exaggeratedly sensitive and argumentative.

The human population today is approximately seven billion. Many parts of the Earth (like Siberia, Australia, Northern Canada, the Amazon) are still...

I would have to say that the answer to this question is that these areas do not offer relief to the world population growth mentioned in this scenario.  There is a reason that these areas of the world are on populated:  they are not ideal for human habitation.  If they are geographically habitable, they are being used for purposes that support the population, especially agriculture (like the areas in the middle of the United States.)  I have attached a map to your question as a reference for the rest of the answer.

You can tell by the map that humans like to live near water sources.  The majority of the dark areas are near water.  This is because urban areas are located near bodies of water for transportation and all of the economic benefits that water offers.  These areas will most likely need to absorb the additional population in the coming centuries.

The areas that are light on the map are difficult environments to live.  They are dense jungles or harsh deserts.  The areas to the far north and south are cold. While it is possible for people to live in these environments (and some do,) the regions cannot support large population density.  They are not attractive places for people to locate business and industry.  This means that jobs would not be available for large populations.  Additionally, they are so unattractive as a place for people to live that most would choose to live in crowded cities and suburbs than to relocate to these sparsely populated areas.  

Using the conventions of correct sentence structure,explain why the following sentences are grammatically incorrect. Provide correct versions of...

While I cannot complete your homework exercise for you, I hope that I can help you better understand the rules of grammar amiss here. Maybe with a few pointers in the right direction, you can re-write the sentences yourself!

Let's begin with the first statement, "the downslide country of the economy is a on." I see two problems here, the first being that all of the words in this sentence seem to be out of order. The human brain is typically able to make connections between and understand the words of a sentence, even when they are out of order. Even so, it's better to make sure all of the words are in order according to the rules of grammar and what "makes sense." To figure out the proper order of these words, consider the following questions.

• What is the subject of the sentence? 


• What is happening to the subject?

The second problem I noticed is that the sentence does not begin with a capital letter. Please remember to capitalize the first word of your sentence when you have rearranged it.

The second sentence, "The price of cars have escalated," has an inconsistency in plurals and action. When we are referring to the price of cars overall, it is correct to use has as opposed to have. However, if you were to refer to the prices of any number of individual cars, it would be appropriate to use have. To better understand the consistency in plurals and possession or action, consider the difference between the following two statements.

• He has a dog.


• They have a dog.

For the third statement, there is an inconsistency in the conjugation of the acting phrases. "If I had known, I will not have told him." Here, had known and have told imply that the action occurred in the past. However, will implies future action. How would you rephrase this so that the action will matches up with the past-acting and conditional phrase, "If I had known?" Can you think of any past-tense or conditional alternatives for the word will?

Finally, let's have a look at your fourth sentence: "The quantity of drinks for the party are huge." Just like in the second sentence, we see an inconsistency relating to plurals. In this sentence, though, we are dealing with the plural drinks and the state of being verb are. "Are" is a form of the state of being verb, "be." While it would make sense to say, "The drinks are huge," the drinks themselves are not the subject of the sentence. We want to know about the quantity of drinks, and "quantity" is a singular word. So, what is a singular, not plural, form of the word, "be?" Don't forget that we're talking about the present tense! Let's look at another example to compare the difference between plural and singular forms of "to be."

• "They are going to the store." Here, the word they is plural, and the word are communicates their state of being.


• "She is going to the store." Here, the word she tells us that we're talking about a singular person. The word is communicates her state of being.

I hope this has helped you to better understand these tricky rules of grammar! Good luck!

In Anne Frank: The Diary of a Young Girl, what is one example of her sense of humor and her way of responding to life?

Anne Frank certainly approaches life with energy and personality. Not only is Anne sensitive and bold, but she is also not afraid to laugh. She's clever, too. Before going into hiding, and before Jews were not allowed to ride bicycles, she loved to ride her bike. At this point in time, she is interested in boys as well, but she seems to be overwhelmed with the amount of boys who are also interested in her. Apparently, boys ask to ride their bikes next to her on the way home after school. She allows them to ride with her sometimes, but she is always nervous that they will fall in love with her. She gets away from some of the boys by riding away from them. However, if a boy starts to talk about approaching her father about dating her, she takes care of the situation in a humorous way. For example, in the entry dated Saturday, 20 June, 1942, Anne says the following about boys who start to show too much interest in her while riding bicycles home after school:

"I swerve slightly on my bicycle, my satchel falls, the young man is bound to get off and hand it to me, by which time I have introduced a new topic of conversation" (5).

Thus, Anne responds to life and boys by cleverly avoiding the topic of conversation by creating a humorous distraction.

Another way in which Anne responds to life with humor is when her teacher, Mr. Keptor, punishes her for talking too much by assigning her a composition entitled, "Quack, quack, quack, says Mrs. Natterbeak" (7). She refuses to be made the fool by this, and with the help of a friend, a poem is written about three baby ducks whose father bites them to death for talking too much. Mr. Keptor appreciates her joke and takes it with a good sense of humor, just as intended. Anne does become offended sometimes, but for the most part, she is full of enthusiasm for life, which helps her to respond to it with energy.

What perspective is "The Masque of the Red Death" told from?

This is an excellent question and substantially more difficult to answer than it seems!  The narrator does use the first-person pronoun "I" twice in the story, indicating that it is written from a first-person perspective; this would lead us to believe that the narrator is, on some level, a participant.  As the ebony clock strikes midnight for the last time, the narrator says, "And then the music ceased, as I have told; and the evolutions of the waltzers were quieted [...]."  Further, in describing the strange effect that seeing the Red Death has on the courtiers, he says that "In an assembly of phantasms such as I have painted, it may well be supposed that no ordinary appearance could have excited such sensation."  As a result of these two first-person references, we might assume that either the narrator is present at the masquerade (perhaps even the Red Death itself?) or that he is some kind of omniscient figure outside of the story (perhaps the author himself?). 

We know this narrator to be omniscient because he does know the thoughts and feelings of all the characters.  Of the courtiers, he says, "There are some who would have thought [Prince Prospero] mad. His followers felt that he was not."  Moreover, he describes them as eventually having "found leisure to become aware of the presence of a masked figure which had arrested the attention of no single individual before."  In order to describe their thoughts as well as their feelings and the persons of which they are or are not aware, the narrator must be omniscient.  Further, at the end of the story, the narrator describes the way in which the prince, "maddening with rage and the shame of his own momentary cowardice [in the face of the Red Death], rushed hurriedly through the six chambers [...]."  The narrator knows that the prince feels rage and shame and cowardice, knowledge that would not be possible were he not omniscient.

Therefore, we have an odd mixture of the first-person perspective with an attribute much more typical of third-person narrators: omniscience.  The narrator refers to himself as "I" but also has knowledge of all the characters' thoughts and feelings.  Thus, first-person omniscient seems to be the appropriate -- if atypical -- description of this story's perspective.

What are some quotes from Lee's To Kill a Mockingbird that depict Tom's innocent nature when he agrees to help Mayella Ewell?

In Chapter 19, Tom Robinson takes the witness stand and testifies that he did not assault or rape Mayella Ewell. Tom tells Atticus that he was acquainted with Mayella Ewell and even helped her bust up an old chiffarobe. Atticus then asks Tom if he ever went inside her yard again. Tom responds by telling Atticus that he entered the Ewell yard numerous times. Tom comments that every time he walked past the Ewell home, Mayella asked him if he could help her with various small jobs and tasks. When Atticus asks Tom if he was ever paid for his services, Tom says,

"No suh, not after she offered me a nickel the first time. I was glad to do it, Mr. Ewell didn't seem to help her none, and neither did the chillun, and I knowed she didn't have no nickels to spare" (Lee 117).

Later on in the trial, Mr. Gilmer comments that Tom must have been a generous person for helping Mayella with her chores. Gilmer then asks Tom why he did all that work knowing that he wouldn't get paid. Tom says,

"I felt right sorry for her, she seemed to try more'n the rest of 'em---" (Lee 120).

Despite Tom's generosity and willingness to help out Mayella, he is viewed with contempt by the jury because he is a black man who felt sorry for a white woman.

What is a living thing that carries out all life functions?

All living things are capable of carrying out all life processes. Some examples of such organisms are plants, animals, microorganisms (such as bacteria), and human beings. All of these life forms carry out life processes such as growth, metabolism, and reproduction. Depending on the complexity of the life form, such processes may be simple or very complex. In other words, the same process may be carried out by simple cells in simpler life-forms or may be carried out by complex organ systems in more complicated life-forms, such as human beings.

Cells are the smallest life-forms that can carry out all life processes. According to the cell theory, all organisms are made up of cells, which are the smallest unit of life (which means capable of carrying out life processes). Cell theory also states that all the cells come from pre-existing cells.

Hope this helps.

I have an 80 in my sports medicine class, but we took a test. The test is 60% of the grade. Will it affect my grade?

Grade averages are usually calculated as weighted averages. This means that grades on assignments that are worth a higher percentage have more of an effect on the the final grade average. Whether your test grade will impact your current grade average of 80 depends on what grade you made on the test.

To calculate a weighted average grade, each grade is multiplied by the percentage that the grade is worth. The resulting answers are then added together to give the final grade. 

In the case of your sports medicine class, your test is worth 60%. So, your other grades will be worth 40%. You indicated that you have an 80 for your other grades. 

Now, let's look at some different scenarios.

• If you made a 90 on your test, you would calculate your final grade as follows: (80)(.40) + (90)(.60) = 86

• If you made a 70 on your test, you would calculate your final grade as follows: (80)(.40) + (70)(.60) = 74

• If you made a 50 on your test, you would calculate your final grade as follows: (80)(.40) + (50)(.60) = 62

How would you describe Helen's love for nature? How did she come to know that nature could be unkind in The Story of My Life?

Helen loves nature, but she describes a time when she was in a tree during a storm and realized nature could be frightening.

Helen adores nature. Anne Sullivan brings her into the fields to smell flowers and feel the waves of the grass. Helen is mesmerized. Nature seems wonderful, especially after her sheltered existence. It helps her experience the entire world and all life has to offer, despite her disabilities.

Even if you are blind and deaf, you can still enjoy nature.  You can feel the sunlight on your face, smell flowers, and dip your toes in a pond. Helen Keller never really saw nature as dangerous or scary until one time she managed to climb a very tall tree.

Suddenly a change passed over the tree. All the sun's warmth left the air. I knew the sky was black, because all the heat, which meant light to me, had died out of the atmosphere. (Ch. 5)

Helen can tell from the smell of the air that the weather is changing and thunder is imminent. She suddenly feels alone and vulnerable. She is in the tree, and the safe earth seems far away. Fortunately, Anne Sullivan rescues her.

...I clung to her, trembling with joy to feel the earth under my feet once more. I had learned a new lesson—that nature "wages open war against her children, and under softest touch hides treacherous claws" (Ch. 5).

This incident does not end Helen’s love for nature, but it tempers it a little. She realizes that nature can be wonderful, but also dangerous. You have to be careful of snow and water, for example. Even though Helen is missing two senses, being part of nature is important to her. It helps her feel alive.  She just has to learn to interact with nature in a safe way.

Explain the differences in challenges faced by a phytoplankton compared to a fish. Specifically, discuss how their Reynolds number affects their...

Since they are so much more massive, metazoa such as fish have much high Reynolds numbers than microorganisms such as phytoplankton. As a result, fish swim in turbulent flow while phytoplankton swim in laminar flow. The kinds of bodily appendages that are necessary for movement in turbulent versus laminar flow are quite different, and in general it's much harder to control your direction of motion in laminar flow. As a result, phytoplankton had to evolve to acquire nutrients from whatever they happen to flow toward, while fish evolved to seek out and consume the most efficient sources of nutrients (typically other fish).

Almost all organisms face the external challenge of predation (the only exception being apex predators such as sharks, orcas, and humans---and even then sometimes apex predators will attack one another). Phytoplankton have essentially no defense against being eaten, while the primary defense fish have evolved is simply to swim away as fast as possible---though by forming schools, fish can also reduce their individual probability of being eaten in a similar fashion to herds of land animals.

Another external challenge is competition with other organisms for the same ecological niche. Phytoplankton mainly compete with other phytoplankton---e.g. diatoms compete with algae---for sunlight and CO2. Fish compete with a variety of other organisms, ranging from other fish to cetaceans to jellies to molluscs. The ocean is a very crowded place.

As far as internal challenges, one is pressure. By being on a larger scale, fish face the challenge of pressure; pressure is largely meaningless at the scale of phytoplankton, but at the scale of metazoa it is extremely hazardous. Deep-water fish especially have had to evolve various mechanisms for resisting high pressure.

Another is respiration. Water cannot itself be respired by either plants or animals, so both must evolve means of extracting what they do breathe from water (namely, O2 and CO2), and in turn must live in water that contains sufficient amounts of dissolved gases.

Other than Johnny, who else admired Dally in the novel The Outsiders?

In Chapter 2, Ponyboy, Johnny, and Dally sneak into the drive-ins to watch a movie. After they enter, Dally begins to annoy two Soc girls who are watching the movie, and Johnny sticks up for them by telling Dally to stop. Ponyboy and Johnny befriend the two girls, Cherry and Marcia, and Johnny asks Cherry why she wasn't scared of them like she was of Dally. Cherry tells them that they seem sweet, and Johnny mentions that Dally isn't such a bad guy. Ponyboy then comments that Dally would have left them alone if he knew them and Marcia responds by saying that she is glad Dally doesn’t know them. Cherry then comments, "I kind of admire him” (Hinton 24). Later on that night, Cherry and Marcia's boyfriends arrive to pick them up in a blue Mustang. Before leaving, Cherry looks at Ponyboy and says that she could fall in love with Dally and hopes that she never sees him again. Cherry is attracted to Dally's "bad-boy" persona and unique approach to life, but is afraid of loving him. She admires him because he doesn't care what other people have to say about him and does what he wants, when he wants.

In Treasure Island, why don't Jim and his mother grab the money the captain owes them and run from the inn?

"The captain" is Billy Bones, a grizzled and unpleasant sailor who stays at the inn for months, falling far behind on payments for his boarding, and at this point in the story, has just died of alcoholism immediately after being marked for death by his former shipmates. 

Bones arrived at the inn with a "sea chest", or footlocker, that he seemed to keep well-guarded at all times. Jim and his mother suspect he keeps some kind of treasure in it, at least enough to pay his debts, and they decide to open it before the other pirates arrive, confident the pirates will fail to pay the dead man's debts, let alone spare Jim and his mother. When they open the chest and find Bones's store of gold, Jim is inclined to simply take all of it, but his mother insists on only taking the amount she thinks Bones would have owed them. She does this as a matter of pride and moderation, since no one but she and Jim would know the better. 

The pirates arrive earlier than expected, and Jim, wanting to "even the score," so to speak, takes what turns out to be the map to Treasure Island, since they didn't have enough time to count out the money Bones owed.

Money is not "everything," as it is often a source of much anxiety and trouble. How does this truth relate to the story "One Thousand Dollars" by...

The irony of O. Henry's story "One Thousand Dollars" is that the spendthrift nephew of the now deceased, wealthy Mr. Gillian has never been materialistic, and the greatest anxiety that he feels is how to be rid of money, not how to attain an inheritance from his uncle.

Young Gillian, who has lived in luxury without having to work, undergoes the task of spending $1000.00 that his uncle has stipulated in his will that he spend and report the manner in which it has been dispersed. Unable to think of a way to spend this money, Gillian goes to the men's club and asks the surly Old Bryson how he should dispense with a thousand dollars. Old Bryson sarcastically suggests that Gillian buy Miss Lotta Lauriere a diamond pendant and then go run a sheep ranch in Idaho.

Gillian then goes to the stage actress's dressing room and offers her "a little thing in the pendant line," but the materialistic Miss Lotta is uninterested in such a mere bauble when another actress has received a necklace valued at $22,000.00. Disappointed, Gillian departs; he asks people on the street outside how he can spend one thousand dollars, but receives only unethical answers. He then takes a cab to the law offices of Tolman & Sharp, who are handling his uncle's affairs. There he inquires if Miss Hayden, who has worked for his uncle, was left anything in the will besides the ring and the $10 that all the employees were given. "Nothing," says Mr. Tolman.

Gillian hurries to the mansion, places the one thousand dollars in an envelope and tells Miss Hayden that he has just come from the law offices where a codicil to his uncle's will was discovered and $1000.00 was left for her. "Oh," she exclaims, and Gillian professes his love for her. "I am sorry," replies Miss Hayden as she happily takes the money.

Greatly disappointed by this rejection, Gillian writes a note accounting for his expenditure of the one thousand dollars and places it in an envelope. He returns to the lawyers, informing them that he has completed his assignment of spending the money. However, the lawyers explain that the uncle wished to test Gillian to learn if he deserved any inheritance. If he has dispensed with the $1000.00 in an altruistic manner and not used it in "dissipation" as has been his habit, he can now receive $50,000.00.

Gillian cannot believe how much trouble money is causing him. He now has to be rid of a greater sum. So, as Mr. Tolman reaches for the envelope containing his explanation of his spending, Gillian quickly tears it into strips, saying that he has spent the money on gambling bets. Tolman & Sharp shake their heads "mournfully." 

Indeed, money is not "everything" to Gillian, who loves Miss Hayden. Even when he tries to give her some, it causes him trouble and anxiety. But he finally is rid of it, and he laughs as he departs.

In "Raymond's Run" by Toni Cade Bambara, what do Squeaky's judgments of Cynthia Proctor, Mary Louise, and Rosie tell you about the type of person...

The paragraphs in which Squeaky narrates her feelings about Cynthia, Mary, and Rosie are great because Squeaky doesn't hold anything back from the reader.  She is completely honest about her disdain for those three girls and her reasons.  Those paragraphs tell a reader a lot about Squeaky.  First, it tells you that Squeaky is judgmental, which sounds bad.  But it is important to note that Squeaky is only being judgmental and harsh toward people that she sees as "two faced."  Cynthia acts like she doesn't care or practice things, but Squeaky knows better.  Mary and Rosie are the same way.

. . .and Rosie, who is as fat as I am skinny and has a big mouth where Raymond is concerned and is too stupid to know that there is not a big deal of difference between herself and Raymond and that she can’t afford to throw stones. 

Those two paragraphs also tell me that Squeaky is a very confident young lady.  She obviously isn't great friends with these three girls, and Squeaky doesn't appear to care about it either.  She doesn't need their approval or affection.  That's a big deal at Squeaky's age.  I teach junior high students, and having a friend clique is super important.  But Squeaky has enough self-confidence in herself to be okay with being a bit of an outsider.  She doesn't feel that she has to seek the approval of her peers.  

In the second chapter F. Scott Fitzgerald's The Great Gatsby, what does Tom bribe George Wilson with?

In F. Scott Fitzgerald's novel The Great Gatsby, power between characters and within their relationships is the pivotal aspect of many decisions and choices. In Chapter 2, Nick is introduced to the Wilsons by Tom Buchanan. 

In this particular relationship, Tom has power over George in two separate ways. The first is personal: Tom is sleeping with Myrtle, George's wife. However, the second is societal: Tom belongs to a higher socioeconomic class than the Wilsons. Tom is able to use his money and class to manipulate the Wilsons. 

This is demonstrated in Chapter 2 when Tom bribes George with the promise of selling him his car. Tom has the power to determine whether or not George will in fact be granted opportunity; his car, which he has promised to sell to George but has never followed through with, could be resold to significantly help George's socioeconomic status. It is not simply a car that Tom bribes George with; it is the promise of hope and economic growth. 

Provide four examples from the text of Animal farm which describe Napoleon's character traits. Indicate whether each of the traits influences the...

In order to effectively complete this task, you obviously have to know what a character trait is. The term refers to the characteristics which make up a person's personality - these may be mostly good or bad or the character may be presented as a balanced character who is neither specifically good or bad.

Look for examples in the text which describe what kind of an animal Napoleon is. Chapter two, for example, provides a distinct contrast between Napoleon, Snowball, and Squealer. Focus on Napoleon's character description and how he differs from the other two specifically. You should then be able to closely define which character trait he does or does not have in this regard.

Look at what Napoleon does when he gets rid of Snowball. What does this particular incident suggest about him? Furthermore, look at his actions after Snowball's expulsion. How do these provide further insight into his character? You can also explore Napoleon's instructions to Squealer - what do these suggest about his personality? There are many relevant incidents you can explore in this instance such as the alteration of the commandments, Squealer talking about Napoleon's 'tactics' etc.

A good idea would also be to refer to how Napoleon treats the other animals, specifically his dogs, the sheep, the porkers that protested, the hens, his treatment of Boxer, and so on. The specific texts can be used to gauge which trait or traits Napoleon displays in these instances.

Further insight can be gained from Napoleon's relationship with the solicitor, Mr. Whymper, the fact that he played Frederick off against Pilkington, and , the issue regarding the fraudulent notes. Also, food for thought would be Napoleon's misrepresentation of the quantity of food on the farm. 

You can also describe Napoleon's character by interpreting which traits he displays when he starts walking on his hind legs, carries a whip, starts drinking, has his food tasted, have the dogs constantly surround him and so forth. All of these particular instances provide insight into his character.

Added to all of this, it will be easy to make a connection between the circumstances and conditions in which Napoleon does what he does in order to meet the requirements of the second part of your question. You will be able to determine whether it's the circumstances or setting which makes Napoleon act the way he does or whether his actions determine the circumstances, and the effect it has on the other animals.

I am quite sure that if you follow the guidelines I have mentioned, you will have more than enough material to successfully complete the task.

What are identity crises?

Introduction

The foundation for theories involving identity crises and the importance of these crises in human development is Erik H. Erikson’s eight stages of identity development. The identity development theory, also called the
psychosocial theory, creates a blueprint for how personality is expressed and how a person becomes integrated with others. The theory involves the role of social interaction between the self and others as each individual undergoes the process of socialization. In each stage of identity development, a person encounters a conflict or crisis that needs to be resolved to successfully navigate through the stage. During an identity crisis, a person experiences intensive self-reflection and exploration. Erikson describes a crisis as the process of resolving conflict regarding a person’s colliding desires for both individuality and communal belonging. The approach people take toward resolving a crisis will ultimately develop into a pattern, which Erikson considered the cornerstone of identity development.

Erikson proposed a sequential stage theory to explain identity development. He believed that prior stages of development (specifically identity) or construction influence later stages of development and that the ability to move through the stages is influenced by stages of physical maturation, such as puberty. However, completion of a stage was not necessary to move on to another stage, and development did not come to fruition at the end of adolescence. Erikson felt that identity development and the accompanying crises continued throughout a person’s life span.

The Stages

The first stage of psychosocial development and later identity development is trust versus mistrust. During this stage, which Erikson associated with infants up to one year old, babies learn to trust their caregivers and the support, both emotional and physical, that they provide. At this point in human development, people are at their most vulnerable; to survive, they must rely on others. Children begin to identify with their caregivers’ actions toward them, which creates a model for their own caregiving later in life. According to Erikson, the crisis arises as babies mature and their mothers begin to resume their prior roles, including that of wife. The mothers must begin to alter their responses to their babies’ needs while maintaining their trust. This conflict is evident in the process parents go through to help their babies sleep through the night. Parents may be told not to respond to every cry to help the baby self-regulate and maintain a sleep routine. Babies must learn that fewer responses are not an indication of abandonment. Successful completion of this stage is the formulation of a model of trust and security in future interactions.

The second stage, autonomy versus shame or doubt, covers children aged two to three. As children gain the physical ability to move on their own, they begin to want more control; however, they simultaneously doubt their capabilities and fear that their parents will retain too much control over them. These conflicting fears create doubt in children. This conflict can be seen in children who want to touch and explore their surroundings but hesitate to leave the side of their caregivers. If the conflict between a desire for self-control and parental control is not resolved, low self-esteem may develop.

Erikson suggested that in the third stage, initiative versus guilt (ages three to six), children begin to explore who they are and the ways they identify with their parents. Specifically, Erikson speculated that during this stage, children develop the foundation for understanding gender roles. For example, during this stage, children may find themselves favoring one parent over the other. Although the favoring may be a way for children to start to understand gender roles (such as what each parent does), children may also feel guilt for not evenly distributing their attention and affection.

In Erikson’s fourth stage, the industry versus inferiority stage of development (ages six to twelve), he considered the role of the environment. The stage begins when children enter elementary school, where learning is focused on concrete tasks such as classifying objects and recognition of patterns and orders. Children rely on concrete evidence, such as performance in an academic, artistic, or athletic domain, to define who they are. Erikson suggested that children begin to believe that what they produce is used to determine and evaluate them. However, during this time, children also become aware of the social inequalities (such as race, ethnicity, and socioeconomic background) that influence who they will be. The developing of this awareness coincides with the onset of puberty, which also contributes to children’s progression into the next stage of development.

Adolescence and Beyond

The fifth of Erikson’s stages, the identity versus role confusion (about thirteen to eighteen years of age), is one of the most studied. For Erikson, this period marks the transition from childhood to adulthood and is characterized by the adolescents’ continual need to explore the roles they may want to assume. This stage also marks a shift from relying solely on parents for identification cues; youths begin to identify more with their peer groups and any activities, religion, and social-political movements with which they may be involved. However, Erikson proposed that to ward off role confusion, adolescents may be overzealous in their identification with and endorsement of social group leaders, which can lead to total self-conformity. Therefore, the goal of identity development during adolescence is to integrate various identities into a unified whole. This need for integration and the fear of permanent identity diffusion are the result of puberty changes and growing social pressure from peers and the larger community. Integration is considered the successful outcome of identity crisis resolution in adolescence.

Stages six through eight were structured around Erikson’s belief that people emerge from adolescence into young adulthood with an intact identity. In these stages, therefore, the focus shifts from finding the self to becoming intimate with other people. Erikson refers to stage six as intimacy and solidarity versus isolation. During this stage, the conflict or crisis is about learning to coexist in a partnership. However, if individuals do not have intact identities, they will be unable to experience intimacy or commit for fear that they might lose themselves.

During middle adulthood, people enter into the seventh stage, characterized by generativity versus self-absorption or stagnation. Erikson assumed that people would be raising children and would therefore develop a need to impart knowledge to their offspring. People may suffer from self-absorption or lack of psychological growth if not given the opportunity to share their knowledge with others. The generative crisis is the foundation for research regarding the midlife crisis. This stage contains a bias toward having children, which reflects the time in which the theory was developed.

The eighth stage, during late adulthood, is called integrity versus despair. This period is when people reflect on their lives; if people are happy and at peace with their pathways through development, they will have integrity and will therefore not fear death.

Expansions on Identity Development

Using Erikson’s identity development theory as a frame, in 1966, Canadian developmental psychologist JamesMarcia developed anidentity status model based on the use of exploration and commitment in developing an identity. This model deconstructs identity acquisition into four critical statuses. Although the statuses appear hierarchical in organization, they should not be considered stages because no clear sequence exists. The four statuses are identity foreclosure, identity diffusion, identity moratorium, and identity achievement. During each status, people may encounter an identity crisis or confusion, which will prompt them to reconcile the conflict and possibly result in the transition to another status.

Foreclosed statuses are characterized by high levels of commitment and low levels of exploration or agency. In a foreclosed status, identity is ascribed or given to the person. Identity is made up of the ready-made goals and values of an authority figure or society that are accepted by the person. During this status, the people are highly susceptible to peer-group pressure. Erikson described people in this status when he talked about the need for adolescents to quickly conform to the characteristics of a group.

Diffusion refers to a status in which people have no complexity or purpose and high levels of apathy. Prior research suggests that prolonged diffusion past adolescence can result in maladaptive outcomes, such as drug abuse and sexual risk taking. It is during this status that people are incredibly vulnerable to persuasion and have the least amount of agency. This status is often considered a starting point for identity searching.

Marcia’s moratorium status is considered very brief yet functional; it is both intensely stressful and overwhelming. In this status, people are in full-blown identity crisis and cannot commit to any single identity. However, the noncommittal person in moratorium status can become a very open-minded individual. Researcher Harold Grotevant suggests that the moratorium status describes most identity development in adolescence, the period in which alternatives to a current identity and the values and beliefs that are attached are explored. Adolescents seek out alternatives in an effort to resolve the pressures they may be encountering. The moratorium status also marks a shift away from acceptance of ascribed (given) identities and identifications.

Identity achievement is thought to be the endpoint for adolescence and identity crisis or confusion. During this status, the core identity has emerged as a result of successful integrations; adolescents are able to commit to values and goals they have chosen. Researchers suggest identity achievement is the most beneficial status for self-esteem, which is another aspect of identity. Adolescents with higher reported self-esteem are more likely to have reported an identity achievement status.

Although Marcia’s typology is one of the most influential post-Erikson expansions, critics fear this narrowed focus negates the important role of context in identity development and the ensuing crisis. Critics such as E. P. Schachter suggest that there is underlying universality to Erikson’s identity development theory, in that the process to resolve a crisis will remain the same regardless of the sociocultural and sociohistorical frames. For example, achievement identity may be considered the ultimate status for functioning in one society, but foreclosure may be the desired identity status in another society. Renewed interest in the resolution of identity crises has spurred more in-depth examinations of developmental stages beyond adolescence.

Beyond the Adolescent Identity Crisis

Research by American psychologist Jeffery J. Arnett has uncovered a distinct period of exploration and understanding that separates adolescence from adulthood. Emerging adulthood has also been viewed as a prolonged period of high identity exploration and low identity commitment—in other words, a state of persistent moratorium. The normative expectations of this distinct period revolve around identity exploration and the resolution of conflict. However, emerging adulthood and the conflicts encountered are not universal concepts but rather the by-products of cultural construction in Western late-modern societies such as the United States. Arnett defines this period as a time for constant transition and change, and because one-third of emerging adults in the United States are attending college, development during this time often begins to take place during a time of semiautonomy. Semiautonomy implies that although the majority of college students do not live with their families, they still rely on some forms of family financial and social support. An example of semiautonomy is a student who rents an apartment and may have a part-time job but whose parents still pay for his or her medical insurance and health care.

Research on how people conceptualize this period has found that a majority of individuals aged eighteen to twenty-five do not identify themselves as adolescents but do not see themselves as full-fledged adults either. Closer examination as to why individuals have this subjective sense of emerging adulthood has revealed that the criteria that these individuals use to infer a transition to adulthood are financial independence and accepting responsibility for the self. The adherence to these criteria can be a source of conflict resulting in crisis. By enrolling in college, these students are granted the ability to exist in a paradoxical universe, where an emerging adult with a previously stable identity configuration is given permission to revert back into a state of exploration. During this period, personal expectations and social-role expectations collide, allowing a stronger integrated and achieved identity to emerge before adulthood. However, again the assumption is that the achieved identity status is the desired goal.

One of the most commonly cited types of crisis after adolescence and emerging adulthood is the midlife crisis, which usually occurs between the ages of forty and sixty. Experts believe that rapid role changes and expectations, such as facing new limitations because of physical deterioration or reflecting on one's disappointing professional status, bring on psychological distress. A person suffering from a midlife crisis may exhibit personality and behavioral changes, such as a low mood, self-absorption, or depression. The underlying assumption behind midlife crises is that aging is an intensely stressful event that spurs an overwhelming period of self-reflection and possible regret. It has also been suggested that middle age is a time during which people must contend with their own mortality, which echoes the original conflicts of identity posited by Erikson. However, as other major life events such as marriage, parenthood, and career establishment have been taking place later and later, the expectation of having a midlife crisis wanes.

Conclusion

Although an identity crisis is often thought of as typically occurring in either adolescence or middle adulthood, it is actually a normative process experienced throughout a person’s life. The belief in normative crises is a major contribution of Erikson’s original identity development theory. An identity crisis or process of conflict resolution is a necessary aspect of psychosocial development. It is not always stressful and cannot be assumed to lead to the person’s engaging in maladaptive behaviors. Future research should focus on how society and or culture may influence the onset and type of crisis experienced, the factors that assist people during their crises and how these factors may be a function of the culture and society to which the person belongs, and whether identity crises are universal.

Bibliography

Andersson, Matthew A. "Identity Crises in Love and at Work: Dispositional Optimism as a Durable Personal Resource." Social Psychology Quarterly 75.4 (2012): 290–309. Print.

Arnett, Jeffery J. Emerging Adulthood: The Winding Road from Late Teens through the Twenties. New York: Oxford UP, 2004. Print.

Dunlop, William L., and Lawrence J. Walker. "The Life Story: Its Development and Relation to Narration and Personal Identity." International Journal of Behavioral Development 37.3 (2013): 235–47. Print.

Erikson, Erik H. Identity: Youth and Crisis. New York: Norton, 1994. Print.

Grotevant, Harold D. “Toward a Process Model of Identity Formation.” Journal of Adolescent Research 2.3 (1987): 203–22. Print.

Hirschi, Andreas. "Vocational Identity Trajectories: Differences in Personality and Development of Well-Being." European Journal of Personality 26.1 (2012): 2–12. Print.

Kroger, Jane. Identity Development: Adolescence through Adulthood. 2nd ed. Thousand Oaks: Sage, 2007. Print.

Research Network on Successful Midlife Development (MIDMAC). http://midmac.med.harvard.edu/

Schachter, E. P. “Identity Constraints: The Perceived Structural Requirements of a 'Good' Identity.” Human Development 45.6 (2002): 416–33. Print.

Wethington, Elaine. “Expecting Stress: Americans and the 'Midlife Crisis.'” Motivation and Emotion 24.2 (2000): 85–103. Print.

What are examples of hyperbole and alliteration in the poem "The Solitary Reaper"?

In the first stanza, the speaker describes the reaper's song. Alliteration is certainly effective in communicating a musical quality, so the speaker's words sound more musical here, and this is meant to mirror the reaper's singing. Note the repetition of "S" and "L" sounds in the first line. The repetition of "s" and "w" in the final line gives the song a flowing quality:

And sings a melancholy strain; 

O listen! for the Vale profound 

Is overflowing with the sound. 

The speaker gets hyperbolic in the second stanza. Here, Wordsworth takes an ordinary experience and, using his imagination, interprets it as something extraordinary. The speaker welcomes the reaper's song and supposes that he is more grateful to hear it than weary travelers who hear a bird's song signaling that they are close to their destination.

Since the speaker does not understand the girl's dialect, he can only imagine what she must be singing about. In the third stanza, he supposes it might be about some dramatic battle, long ago. But then he comes down from that hyperbolic notion and adds that it might be a more "humble lay." In the last stanza, he adds that she sang "as if her song could have no ending." In a sense, for him, her song indeed has no ending because it stays with him "Long after it was heard no more."

What are legal models of abnormality?

Introduction

In the United States, three broadly based legal principles and their elaboration by judicial interpretation (case law) and by legislatures (statutory law) reflect the law’s core assumptions about normal and abnormal behavior. These principles are rationality, the protection of the incompetent, and protection of the public from the dangerous.

The first of these principles is rationality. The normal person is, the law assumes, sufficiently rational that the individual can base his or her choices and actions on a consideration of possible consequences, of benefits and costs. In the civil law, two people making a contract or agreement are expected to be competent to understand its terms. In the criminal law, a destructive act is deemed much worse and punishable if it is intentional and deliberate. Concern about motivation extends through the normal range of illegal acts, and offenses resulting from malice (that is, intentional offenses) are generally dealt with more harshly than those that result from mere negligence. Under the civil law, those incapable of understanding simple business transactions with ordinary prudence may be deemed incompetent. Under the criminal law, in a principle that dates to Roman times, persons who are deprived of understanding are considered incapable of intent and the corresponding guilty mind (mens rea). According to the 1843 M’Naghten rule
(named for Daniel M’Naghten, also spelled McNaughton), if the accused is laboring under such a defect of reason from a disease of the mind as not to know the nature and quality of the act he or she was doing, or if he or she did understand the act’s nature and quality but did not know that the act was wrong, then this accused person is “insane” and cannot be found guilty.

The second principle deals with the state’s duty to protect those who cannot protect themselves, in this case the mentally incompetent. The doctrine of parens patriae
as early as 1324 authorized King Edward II of England to protect the lands and profits of “idiots” and “lunatics.” Under this doctrine, the state may appoint a guardian for the harmless but helpless mentally ill—that is, those incapable of managing their ordinary business affairs. Because mentally incompetent people cannot make an informed decision about their need for treatment, the protection of the state allows the commitment of such people to hospitals, regardless of their own wishes.

The third principle that has been applied to the abnormal is the police power of the state. Inherent in the very concept of a state is a duty to protect its citizens from danger to their personal safety or property. This includes the right to remove from society those abnormal people who are dangerous and to segregate them in institutions. In the United States, the laws of all fifty states authorize the restraint and custody of persons displaying aberrant behaviors that may be dangerous to themselves or others.

These principles of law, all based on logically derived exemptions from assumptions concerning rational intent and understanding, have changed slowly in response to influences from the public and from the mental health professions. In institutionalization decisions, the parens patriae power of the state became more widely used beginning in the mid-nineteenth century as judges and the public became more accepting of the mental health enterprise. Hospitals were considered protective, nonstressful environments where the harmless insane would be safe.

The insanity exemption from legal responsibility also has been adjusted and modified. The central concern of the professionals was that insanity under the strict M’Naghten rule included only the small minority of offenders who had no understanding whatsoever that their offense was unlawful, the sort of offender who shot the victim thinking he was a tree. An offender could be mentally ill by psychiatric standards but still be considered sane. As a response to these criticisms, new legal tests that expanded the meaning of insanity were somewhat experimentally adopted by a few courts. The irresistible impulse rule, stating that a person would not be considered responsible if driven by an impulse so strong it would have occurred had there been “a policeman at his elbow,” supplemented the M’Naghten rule in some states.

In United States v. Durham (1954), the U.S. Court of Appeals for the District of Columbia created through its decision an even simpler rule: Insanity involves simply the illegal act being “the product of mental disease or defect.” This Durham rule was quickly attacked for turning over a legal decision better left to juries to mental health professionals, some of whom seemed to consider virtually all deviancy a disease. The same court rejected the Durham rule in
United States v. Brawner (1972). The federal courts, along with twenty-six states, adopted a rule proposed by the American Law Institute (the ALI rule) that seemed to incorporate aspects of each of the preceding rules:
A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity to appreciate the wrongfulness of his conduct or to conform his conduct to the requirements of the law.

In endorsing an illness-caused inability to conform to the requirements of law as a standard for insanity, the ALI rule encouraged a definition that extended the parameters of insanity beyond those used to describe obviously disoriented people and not incidentally continued a major diagnostic role for the mental health professional.

Psychiatric Science and Legal Tradition

The legal model assumed that most people are rational in that they can foresee the immediate consequences of their decisions. Those incompetent to comprehend a legal proceeding, those unable to care for themselves, or those unable to understand the wrongfulness of a criminal act must be treated differently. Abnormality in the legal sense was any condition that involved the incapacity to make rational decisions with an awareness of the consequences. There was a sharp dividing line between “normality” and the rare condition of abnormality.

As research into psychology and psychiatry progressed, more discriminating, accurate, and sensitive appraisals of abnormal individuals became possible. In practice, the concept of mental illness proved to be an elastic one, with boundaries that could easily be expanded to include new conditions. Mental health experts looked for the causes behind the behavior of the mentally ill, such as childhood emotional trauma or chemical imbalances within the body. In contrast to the legal model, which interpreted such unwanted or inadequate human behavior as bad decisions willfully undertaken, the mental illness model implied that this behavior was caused by events in the past and beyond the individual’s control.

Criticism and Doubts

The least restricted use of psychiatric standards by the legal profession occurred in the 1950s and 1960s, when faith in the potential of the science of psychiatry appeared unbounded. The ALI rule, which by the 1960s was used in federal courts throughout the United States, premised an underlying condition of mental illness manifested by a lack of control as insanity, a phrase that could easily encompass a wide range of conditions. However, the expansion of conditions that were viewed as insanity caused a backlash of sorts. In the latter part of the twentieth century, the role of psychiatric decision making in the law diminished, with the adoption of procedural safeguards and a return to more restricted legal definitions of insanity.

In the 1960s and 1970s, psychiatrist Thomas Szasz argued that mental illnesses were little more than metaphors for problems in living, myths that were used harmfully to deprive individuals of their feelings of responsibility. Erving Goffman
charged that institutionalization was not a health-restoring, protective sanctuary but rather a degrading, dependency-producing process. John Monahan reviewed research that suggested that the prediction of dangerousness, a primary reason for commitment to institutions, even under the best conditions involved more failures than successes.

Public criticism of psychiatric influence on the law heightened after the use of the insanity defense in some prominent cases. Especially influential was the acquittal by reason of insanity of presidential assailant John Hinckley in 1982. Hinckley’s act had many of the characteristics of one resulting from mental illness. An aimless wanderer who had been diagnosed as schizophrenic, he shot and wounded President Ronald Reagan under the fantastic assumption that this would win admiration from and a date with an actor he had never met. He was committed to a mental hospital after his trial. Nevertheless, his crime seemed premeditated and particularly heinous. The possibility that he might someday be “cured” and released struck many as outrageous. In other well-publicized cases, it was argued, often unsuccessfully, that otherwise criminal behavior resulted from such events as contamination by excessive television viewing, premenstrual syndrome (PMS), or hyperglycemia from eating sugary snack cakes. It appeared to many ordinary citizens that apparent mental illness could be used to excuse practically any type of crime or, alternatively, to have almost anyone involuntarily committed to a mental institution.

Procedural and Definitional Adjustments

As a result of such criticisms, civil commitment decisions were subject to increasing procedural safeguards. According to the illness model, such decisions should be left to the doctors, the experts who could diagnose the patient as “sick” and pronounce the patient “cured.” However, civil commitment was less oriented toward treatment and more like incarceration in prison, depriving the mental patient of many freedoms. Increasingly, the legal system began to focus on commitment to a mental hospital in terms of the freedoms denied rather than health benefits conferred. Reasons for such enforced hospitalization were narrowed. Laws and judges demanded that the disability had to be grave and the inability to care for the self life-threatening before the parens patriae powers of the state could be invoked. “Dangerousness” increasingly meant dangers that were imminent, such as suicide or physical violence against others. Emergency detention, a loose procedure invoked during an emotional crisis, became limited in time to a few days.

In
Wyatt v. Stickney (1971), the Supreme Court held that institutionalized mental patients must be actively treated. Also, in the landmark decision of
Addington v. Texas (1979), the Supreme Court decreed that civil commitment required a formal hearing, adversarial in nature. In such a hearing, the prospective patient should be permitted counsel and the cross-examination of witnesses. The state must demonstrate clear and convincing evidence of the need for such commitment.

The legislatures of most states enacted legislation requiring that inpatient hospitalization be employed only as a last resort. Such “least restrictive alternative” laws compelled judges to consider placement of the mentally ill outside hospitals whenever possible. Increasingly, patients who continued to take their medication were permitted to live under supervision in the community.

In a similar vein, the rules concerning the determination of legal incompetency were tightened in the last decades of the twentieth century. Ordinary citizens are required to make many important decisions in matters such as handling everyday purchases, willing property to heirs, selecting and consenting to medical treatments, and standing trial for an alleged offense. Each situation requires a certain level of comprehension and an ability to appraise the benefits and risks. The mere diagnosis of schizophrenia or mental retardation came to be regarded as insufficient evidence of incompetence in any legal situation. Instead, legal tests for incompetence focused on the presence or absence of decision-making skills demanded in specific situations.

Procedural and definitional changes in evaluating a defendant’s competence to stand trial, or adjudicative competence, offers a case in point. Such competence demands that defendants in criminal trials possess the ability to understand the charges against them, the nature of a court, the role of the participants (judge, prosecutor, defense lawyer, and jury), and the consequences of being found guilty or innocent. Throughout the earlier part of the twentieth century, defendants who had been diagnosed as psychotic might be automatically considered to lack such understanding and be institutionalized for an indefinite period. By the 1980s and 1990s, the specific required understandings were being investigated, often by psychologists. Tests were developed that quantitatively measured defendants’ capacity to understand courtroom procedures. Procedural safeguards were developed against using such incompetence as a pretext for indefinite hospitalization. The Supreme Court ruled in
Jackson v. Indiana (1972) that confinement of defendants incompetent to stand trial could last only for the limited period necessary to determine whether competence could be restored. If competence was restored, defendants should stand trial; if not, they must be formally committed or released.

Similar trends occurred in criminal law, where definitions of insanity narrowed and the conditions under which an insanity defense could be employed were restricted. The insanity defense is employed in only about 1 percent of criminal cases, and most contested attempts to employ this defense fail. Many cases involve defendants so clearly impaired that they are uncontested by the prosecution, and most defendants decreed insane spend many years in mental hospitals. However, because of a very few, highly publicized cases such as that of Hinckley, public opinion moved sharply to a concern that the insanity defense was a convenient loophole permitting wealthy defendants to escape punishment by having themselves declared “mentally ill.” Closing this loophole became of public concern.

In 1984, Congress enacted the Insanity Defense Reform Act, which removed the “inability to conform to the requirements of law” phrase from the definition of insanity and returned to the narrower “inability to appreciate the wrongfulness of one’s acts” of the M’Naghten rule. This act further specified that an insanity defense could be considered only in cases of a severe mental illness. The Insanity Defense Reform Act applied to the federal courts. The scope of the insanity defense was reduced by at least twelve states in another way. These states added a “guilty but mentally ill” alternative to strict M’Naghten rule insanity. Under this alternative, mentally ill but not “insane” defendants might serve part of their sentence in a hospital rather than a prison. Only institutional placement, not the length of the sentence, would be affected by the presence of mental illness or its cure. The presumption was that juries, with an alternative way to treat a defendant with an obvious mental illness, would reserve insanity verdicts for only the most extreme cases.

Psychology in the Service of Law

The era of the law’s enchantment with the science of abnormal psychology has ended. Forensic psychologists and psychiatrists remain important to the law’s functioning, but their psychological concepts and perspectives have receded in importance as legal safeguards have reduced their discretion in determining who is legally insane. The law’s allegiance to its assumption of a rational citizen who makes rational decisions endures. Necessary exceptions to this rule also endure. Citizens incompetent to make legal decisions or unable to determine the difference between right and wrong continue to be treated as special cases. In 2002, the U.S. Supreme Court ruled that it was unconstitutional to execute intellectually disabled murderers. Forensic scientists are essential in examining these conditions and in applying the legal rules to individual cases, but they function within the legal framework as servants of the law.

Bibliography

Bartol, Curt R., and Anne M. Bartol. Psychology and Law: Theory, Research, and Application. 3d ed. Belmont, CA: Thomson/Wadsworth, 2004. Print.

Borum, R. “Improving the Clinical Practice of Violence Risk Assessment.” American Psychologist 51 (1996): 945–56. Print.

Davison, Gerald C., and John M. Neale. Abnormal Psychology. 10th ed. New York: Wiley, 2006. Print.

Elliot, Carl. The Rules of Insanity: Moral Responsibility and the Mentally Ill Offender. Albany: State U of New York P, 2000. Print.

Frederick, Richard I., Richart L. DeMier, Martha S. Smith, and Karin Towers. Examinations of Competency to Stand Trial: Foundations in Mental Health Case Law. Sarasota, FL: Professional Resource, 2014. Print.

Gaylin, Willard. The Killing of Bonnie Garland. New York: Penguin, 1995. Print.

Greene, Edie, et al. Wrightsman’s Psychology and the Legal System. 7th ed. Belmont, CA: Thomson/Wadsworth, 2011. Print.

Kapardis, Andreas. Psychology and Law: A Critical Introduction. New York: Cambridge UP, 2014. Print.

Melton, Gary B., et al. Psychological Evaluations for the Courts: A Handbook for Mental Health Professionals and Lawyers. 3d ed. New York: Guilford, 2007. Print.

Stredny, Rebecca V., Amber L. S. Parker, and Ashley Engels Dibble. "Evaluator Agreement in Placement Recommendations for Insanity Acquittees." Behavioral Sciences and the Law 30.3 (2012): 297–307. Academic Search Premier. Web. 10 Feb. 2014.

What are nausea and vomiting?

Causes and Symptoms

Nausea is defined as a subjectively unpleasant sensation associated with awareness of the urge to vomit. It is usually felt in the back of the throat and epigastrium and is accompanied by the loss of gastric tone, duodenal contractions, and reflux of the intestinal contents into the stomach. Retching is defined as labored, spasmodic, rhythmic contractions of the respiratory muscles (including the diaphragm, chest wall, and abdominal wall muscles) without the expulsion of gastric contents. Vomiting, or emesis, is the forceful expulsion of gastric contents from the mouth and is brought about by the powerful sustained contraction of the abdominal muscles, the descent of the diaphragm, and the opening of the gastric cardia (the cardiac orifice of the stomach).

Nausea and vomiting are important defense mechanisms against the ingestion of toxins. The act of emesis involves a sequence of events that can be divided into three phases: preejection, ejection, and postejection. The preejection phase includes the symptoms of nausea, along with salivation, swallowing, pallor, and tachycardia (an abnormally fast heartbeat). The ejection phase comprises retching and vomiting. Retching is characterized by rhythmic, synchronous, inspiratory movements of the diaphragm and the abdominal and external intercostal muscles, while the mouth and the glottis are kept closed. As the antral (cavity) portion of the stomach contracts, the proximal (nearest the center) portion relaxes, and the gastric contents oscillate between the stomach and the esophagus. During retching, the hiatal portion of the diaphragm does not relax, and intra-abdominal pressure increases are associated with a decrease in intrathoracic pressure.

In contrast, relaxation of the hiatal portion of the diaphragm (near the esophagus) permits a transfer of intra-abdominal pressure to the thorax during the act of vomiting. Contraction of the muscles of the anterior abdominal wall, relaxation of the esophageal sphincter, an increase in intrathoracic and intragastric pressure, reverse peristalsis (movement of the contents of the alimentary canal), and an open glottis and mouth result in the expulsion of gastric contents. The postejection phase consists of autonomic and visceral responses that return the body to a quiescent phase, with or without residual nausea.

The complex act of vomiting, involving coordination of the respiratory, gastrointestinal, and abdominal musculature, is controlled by what researchers label the emetic center. This center in the brain stem has access to the motor pathways responsible for the visceral and somatic output involved in vomiting, and stimuli from several areas within the central nervous system can affect this center. These include afferent (inward-directed) nerves from the pharynx and gastrointestinal tract, as well as afferents from the higher cortical centers (including the visual center) and the chemoreceptor trigger zone (CTZ) in the area postrema (a highly vascularized area of the brain stem). The CTZ can be activated by chemical stimuli received through the blood or the cerebrospinal fluid. Direct electrical stimulation of the CTZ, however, does not result in emesis.

Clinical assessment of nausea and vomiting usually focuses on the occurrence of vomiting, namely the frequency and number of episodes. Nausea, however, is a subjective phenomenon unobservable by another. Few data-collection instruments that measure separately the patient’s experience of nausea and vomiting and his or her symptom of distress have been reported in the literature. In fact, the Rhodes Index of Nausea and Vomiting (INV) Form 2 is the only available tool that measures the individual components of nausea, vomiting, and retching. This index measures the patient’s perception of the duration, frequency, and distress from nausea; the frequency, amount, and distress from vomiting; and the frequency, amount, and distress from retching (dry heaves). The INV score provides a measurement of the total symptom experience of the patient.

While the causes of nausea and vomiting are numerous, including gastrointestinal diseases, infections, intracranial disease, toxins, radiation sickness, psychological trauma, migraines, and circulatory syncope, three of the most common causes are motion sickness (air, sea, land, or space), pregnancy, and anesthesia administered during operative procedures.

The sequence of symptoms and signs that constitute motion sickness is fairly characteristic. Premonitory symptoms often include yawning or sighing, lethargy, somnolence, and a loss of enthusiasm and concern for the task at hand. Increasing malaise is directed toward the epigastrium, a sensation best described as “stomach awareness,” which progresses to nausea. Diversion of the blood flow from the skin toward the muscles results in pallor. A feeling of warmth and a desire for cool air is often accompanied by sweating. Frontal headache and a sensation of disorientation, dizziness, or light-headedness may also occur. Vomiting occurs early in the sequence of symptoms for some; in others, malaise is severe and prolonged, and vomiting is delayed. After vomiting, there is often a temporary improvement in well-being; however, with continued provocative motion, symptoms build again and vomiting recurs. The symptoms may last for minutes, hours, or even days.

The most coherent explanation for the development of motion sickness is provided by sensory conflict theory. Motion sickness is generally thought to occur as the result of a “sensory conflict” between information arising from the semicircular canals and organs of the vestibular system, visual and other sensory input, and the input that is expected on the basis of past experience or exposure history. It is argued that conflicts between current sensory inputs are by themselves insufficient to produce motion sickness, since adaptation occurs even though the conflicting inputs continue to be present. Visual input alone, however, can produce symptoms of motion sickness, such as watching motion pictures shot from a moving vehicle or looking out of the side window (as opposed to the front window) of a moving vehicle.

Nausea and vomiting in the early morning during pregnancy, so-called morning sickness, is so common that it is accepted as a symptom of normal pregnancy. Occurring soon after waking, it more often takes the form of retching rather than actual vomiting and usually does not disturb the woman’s health or her pregnancy. The symptoms nearly always cease before the fourteenth week of pregnancy. In a very small number of cases—approximately 0.3 percent to 2 percent of pregnancies—the vomiting becomes more serious and persistent, occurring throughout the day and even during the night. The term “hyperemesis gravidarum” is given to this serious form of vomiting. Theories on the etiology of morning sickness have tended to be grouped under four main areas: endocrine (caused by estrogen and progesterone levels), psychosomatic (a conscious or unconscious wish not to be pregnant), allergic (a histamine reaction), and metabolic (a lack of potassium).

Nausea and vomiting occur frequently as unpleasant side effects of the administration of anesthesia in many clinical procedures. Most postoperative vomiting is mild, and only in a few cases will the problem persist so as to cause electrolyte disturbances and dehydration. The factors affecting postoperative nausea and vomiting (PONV) may be divided into two categories: the type of patient and surgery, and the anesthetic and preoperative and postoperative medications used. Patients with a history of motion sickness have a predisposition to PONV. An article published in OR Nurse 2012 reported that approximately 30 percent of surgical patients experience PONV within the first twenty-four hours after surgery, while patients with a history of either PONV or motion sickness are two to three times more likely to experience PONV in the future. The length of the surgical procedure is also a factor; a procedure lasting 30 minutes or less carries a 28 percent risk of PONV, while a procedure lasting between 151 and 180 minutes carries a 46.2 percent risk.

No direct association between vomiting and age has been found. That vomiting may be hormonally related, however, is suggested by the higher incidence of nausea and vomiting in women, particularly women in the latter half of their menstrual cycles. Other factors that may affect nausea and vomiting associated with anesthesia include patient weight (female obese patients being particularly more vulnerable), degree of hydration, metabolic status, and psychological state. With regard to the type of surgery performed, the highest incidences of nausea and vomiting appear to be associated with abdominal surgery and ear, nose, and throat surgery, with middle-ear surgery being the major category.

Most of the causes of vomiting associated with general anesthesia are expected to be eliminated with regional or spinal anesthesia. The type of anesthesia used also has an effect on nausea and vomiting. Research indicates that cyclopropane, ether, and nitrous oxide are potent emetics.

Treatment and Therapy

Since the generation of sensory conflict underlies all motion environments that give rise to motion sickness, practical measures that reduce conflict are likely to reduce the incidence. Motion sickness can be minimized if the subject has the widest possible view of a visual reference in which the earth is stable. Passengers aboard ships are less likely to be seasick if they remain on deck at midship, where vertical motion is minimized, and view the horizon. In a car or bus, individuals should be in a position to see the road directly ahead, since the movement of this visual scene will correlate with the changes in the direction of the vehicle. While head movements in a rotating environment are known to precipitate motion sickness, there is no clear experimental evidence that they elicit nausea in mild linear oscillation. Thus, some nonpharmacologic remedies for motion sickness include restricting head movements, lying in a supine position, and closing one's eyes. In addition, the use of acupressure wrist bands has proven effective in combating motion sickness.

Pharmacologically, the drug hyoscine hydrobromide (also called hyoscine or scopolamine) emerged as a valuable prophylactic drug following extensive research during World War II into the problems of motion sickness in troops transported in aircraft, ships, and landing craft. It remains one of the most effective drugs for short-duration exposures to provocative motion. Doses in excess of 0.6 milligram, however, are very likely to lead to drowsiness, and there is much experimental evidence that the drug impairs short-term memory. Hyoscine can be absorbed transdermally, and in order to extend the duration of action, a controlled-release patch was developed to deliver 1.2 milligrams on application and 0.01 milligram hourly thereafter. There is substantial evidence of its sustained effectiveness, but, perhaps as a result of variable absorption rates, there is an increased risk of blurred vision after more than twenty-four hours of use.

Amphetamines, ephedrine, and a number of antihistamines (such as dimenhydrinate) have been found to be clinically useful in motion sickness. Following oral administration, these drugs are generally slower than hyoscine in reaching their peak efficacy, but they have a longer duration of action.

For most susceptible subjects whose exposure to motion-sickness-inducing stimuli is infrequent, prophylactic drugs offer the only useful treatment. When exposure to provocative stimuli is more frequent, as in the case of professional aircraft pilots, spontaneous adaption typically occurs during training, and an initially high incidence of motion sickness decreases with time.

In medical conditions in which the cause is relatively unknown, it is usual to find a wide variety of suggested therapies, and morning sickness and hyperemesis gravidarum are no exception. Suggested therapy is mainly drugs of the antiemetic variety; however, since the thalidomide tragedy, in which severe deformities occurred in the children of women who took thalidomide while pregnant, there has been a reluctance to use drugs of any kind during early pregnancy. Probably the only value of drug therapy is at the stage of morning sickness, when antiemetics or mild sedatives may counter the feeling of nausea and prevent women from experiencing excessive vomiting and entering the vicious cycle of dehydration, starvation, and electrolyte imbalance. Once the patient has reached the stage of hyperemesis gravidarum, much more basic therapy is required, including correction of dehydration, carbohydrate deficiency, and ionic deficiencies. This program is best managed by intravenous therapy, with or without the addition of vitamin supplements and sedative agents.

Nonpharmacologic self-care actions for morning sickness fall into the three broad categories: manipulating diet, adjusting behavior, and seeking emotional support. Some of the most effective self-care actions are getting rest, eating several small meals rather than three large ones, avoiding bad smells, avoiding greasy or fried foods, avoiding cooking, and receiving extra attention and support.

In terms of PONV caused by anesthesia, it has been found that routine antiemetic prophylaxis of patients undergoing elective surgical procedures is not indicated. Of those who develop these symptoms, many have transient nausea or only one or two bouts of emesis and do not require antiemetic therapy. In addition, commonly used antiemetic drugs can produce significant side effects, such as sedation. Nevertheless, antiemetic prophylaxis may be justified in those patients who are at greater risk for developing PONV. Such therapy is often given to patients with a history of motion sickness, as well as those undergoing gynecologic procedures, inner-ear procedures, oral surgery (in which the jaws are occluded by wires, causing a high risk of breathing in vomitus), operations on the ear or eye, and plastic surgery (in order to avoid disruption of delicate surgical work).

Many different antiemetic drugs are available for the treatment of PONV. Researchers have found it difficult to interpret the results of antiemetic drug studies because the severity of PONV and the response to therapeutic agents can be influenced by many other variables. Even when the same drugs are used in a homogeneous population undergoing the same procedure, the severity of emesis varies from individual to individual.

Because antiemetic drugs have differing sites of action, better results can be obtained by using a multidrug approach. If a combination of drugs with similar sites of action is used, however, the incidence of side effects may be increased. There is little data regarding combination antiemetic prophylaxis or therapy for PONV. Drug combinations have been avoided in postsurgical patients because of concerns about additive central nervous system toxicity. One exception is the combination of low-dose droperidol and metoclopramide, which appears to be more effective than droperidol alone for outpatient gynecologic procedures.

Although a full stomach is best avoided before any operative procedure, in certain situations, such as emergencies, where danger from vomiting is acute, a rapid sequence of administering anesthesia (induction) and clearing the air passage (intubation) remains the method of choice to avoid nausea and vomiting in patients with a full stomach. After the procedure, it is recommended that the patient minimize movement in order to avoid nausea and vomiting. It has been found that avoiding solid food for at least eight hours after a surgical procedure is helpful in preventing postoperative nausea and vomiting.

Perspective and Prospects

Though it has existed for as long as there have been human beings, the symptom of nausea has never received much attention in health care practice or research. In fact, until the early 1970s, the sensation was frequently dismissed as merely a passing phenomenon. The rationale for this dismissal was most likely the knowledge that nausea is self-limiting (it always passes with time); is never life-threatening in itself; is probably psychogenic in nature, at least to some degree; and, being subjective, is very difficult to measure. In addition, in the past, the most predictable nausea was related to pregnancy, which may also explain the lack of attention.

Until the late 1980s, there was still little research being conducted on nausea associated with pregnancy, although it is a common symptom. The historical lack of interest in nausea and vomiting during pregnancy may be traced to the fact that because the symptoms generally persist only through the first trimester, health-care professionals have viewed the problem as relatively insignificant. As more pregnant women work outside the home in demanding positions, however, they have exhibited less tolerance for illness. Demands on the health-care industry and on personal physicians for more research and effective treatment have become more widespread.

While it is surprising that nausea has received scant attention in the history of clinical research, it is even more astonishing that vomiting, an observable behavior, has received so little attention as well. Although vomiting is a primitive neurologic process that has remained almost unchanged in the evolution of animals, the mechanisms that regulate the behavior remain virtually unknown.

One reason for the paucity of information on the subject of nausea in particular stems from the lack of a reliable animal model. This fact has hampered research aimed at establishing the etiological basis for nausea and its relationship to vomiting. While some species of lower animals, such as rats, cannot vomit, it is not known whether they experience the phenomenon of nausea. Thus, no effective means of measuring nausea in lower animals has been devised.

Since the early 1970s, there has been a noticeable increase in research on nausea as a drug side effect because it is so frequently seen in chemotherapy treatment for cancer. As more powerful chemotherapy agents and aggressive combinations were clinically investigated, patients began to experience severe, potentially life-threatening nausea and vomiting. Older drugs such as antihistamines, phenothiazines, and benzodiazepines are still used for their antiemetic characteristics, but they are augmented by newer agents such as benzamides, neurokinin-1-receptor antagonists, and serotonin antagonists.

Another interesting branch of scientific investigation has begun exploring alternative ways of managing these symptoms. Behavioral interventions, such as progressive muscle relaxation, biofeedback, imagery, and music therapy, have been used to alleviate postchemotherapy anxiety. These methods may also be used to treat other patients suffering from the symptoms of nausea and vomiting, such as pregnant women.

Another noninvasive, nonpharmacologic measure that has been considered in the relief of nausea and vomiting is transcutaneous electrical nerve stimulation (TENS). Several research studies indicate that TENS may be useful in alleviating chemotherapy-related nausea and vomiting, including delayed nausea and vomiting. Side effects from using TENS units are negligible, and with further study they may prove to be an acceptable, helpful relief measure.

Bibliography

Blum, Richard H., and W. LeRoy Heinrichs. Nausea and Vomiting: Overview, Challenges, Practical Treatments, and New Perspectives. Philadelphia: Whurr, 2000. Print.

Casey, Georgina. "Treating Nausea and Vomiting." Kai Tiaki Nursing New Zealand 18.11 (2012): 20–24. Print.

Edmundowicz, Steven A., ed. Twenty Common Problems in Gastroenterology. New York: McGraw, 2002. Print.

Funk, Sandra G., et al., eds. Key Aspects of Comfort: Management of Pain, Fatigue, and Nausea. New York: Springer, 1989. Print.

Hesketh, Paul J., ed. Management of Nausea and Vomiting in Cancer and Cancer Treatment. Sudbury: Jones, 2005. Print.

Kucharczyk, John, David J. Stewart, and Alan D. Miller, eds. Nausea and Vomiting: Recent Research and Clinical Advances. Boca Raton: CRC, 1991. Print.

Litin, Scott C., ed. Mayo Clinic Family Health Book. 4th ed. New York: Harper, 2009. Print.

Palatty, Princy Lous, et al. "Ginger in the Prevention of Nausea and Vomiting." Critical Reviews in Food Science and Nutrition 53.7 (2013): 659–69. Print.

Rao, Kamakshi V., and Aimee Faso. "Chemotherapy-Induced Nausea and Vomiting: Optimizing Prevention and Management." American Health & Drug Benefits 5.4 (2012): 232–40. Print.

Sleisenger, Marvin H., ed. The Handbook of Nausea and Vomiting. New York: Caduceus, 1993. Print.

Tinsley, Mary H., and Claudia P. Barone. "Preventing Postoperative Nausea and Vomiting." OR Nurse 2012 6.3 (2012): 18–25. Print.

What gossip about Gatsby does Nick learn at the party?

In Chapter 3, Nick attends one of Gatsby's parties for the first time. He notes that he is probably one of only a handful of people who have been invited to the party.

The rest of the guests seem to have just shown up, without formal invitations of any sort. Nick observes that these guests often "came and went without having met Gatsby at all..." In other words, many people attend Gatsby's parties to enjoy themselves at his expense.

During the party, Nick converses with Jordan Baker and two other young women. The topic of the conversation is Gatsby, of course. One of the young ladies, Lucille, contends that Gatsby is generous for a reason. She relates how she had accidentally torn her gown on a chair at one of Gatsby's parties and how Gatsby had reportedly sent her a very expensive gown to replace the one she had ruined. As a response, the other young lady quipped:

"There’s something funny about a fellow that’ll do a thing like that," said the other girl eagerly. "He doesn’t want any trouble with ANYbody."

The rumor is that Gatsby had once killed a man and doesn't want anyone to turn him in for it; this is supposedly why he is overly generous with everyone. With few facts to back her case, Lucille then pipes up that Gatsby was rumored to have been a German spy during the war. Later, Jordan tells Nick that he once confessed he had attended Oxford University; however, Jordan tells Nick that she doesn't believe Gatsby told her the truth. So, at this point in the novel, we get the idea that Gatsby is an enigmatic man who invites scrutiny. He is rumored to have been a German spy, a murderer, as well as a past Oxford University student.

What rights did free African Americans in the 1860's have?

In theory, though not always in practice, and certainly not in the South, free African Americans after 1865 were granted the full rights of citizenship under the 14th Amendment, and the right to vote under the 15th Amendment. The 14th Amendment extended to all people born in the United States the full rights of citizenship, including the right to own property. Under Reconstruction, the Union Army used its military occupation of the southern states to enforce this new rule of law, and as a result, for the first time, African Americans became members of the House of Representatives, members of municipal governments, and began to exercise their franchise.African Americans in the northerns states had these same rights, and continued to benefit from them.

Unfortunately, once Reconstruction in the South ended, southern state governments passed the Black Codes, which introduced the poll tax, literacy test and other laws that made it practically impossible for African Americans to vote or hold office. Furthermore, the Black Codes gave municipal governments the right to issue or deny work permits for all manner of professions and skilled trades, and because these governments again came under the authority of racist whites, they shut African Americans in the South out of virtually all good paying jobs. This development forced most African Americans to either flee to the North, or take up sharecropping, a watered down form of servitude. 

So, for a short period of time after the Civil War ended and up until the U.S. military ended its occupation of the southern states in The Compromise of 1877, freed African Americans enjoyed economic and political freedoms that they would not again enjoy until after the Civil Rights movement in the 1960s. This period of history demonstrates that even when a government grants rights to its citizens, if that government is not willing to protect the rights of those citizens, then those so-called rights do not really exist.