Psychoanalytical Approach to Family Counseling Essay Example for Free

Psychoanalytical Approach to Family Counseling Essay Whether one is conscious of it or not, we all have our respective worldviews. The way we view life in general and our approach to it is the worldview that control and guide us in every decision that we make – in the way we cope pressures, and even as we celebrate and enjoy good days. Since on a particular worldview a person stands or falls, it is very important to constantly check and evaluate one’s philosophy of life. If I will be asked the question: â€Å"Which philosophy is the best philosophy? † The best answer that I can come up with is, â€Å"Of course, the philosophy that encourages intellectual development. † Christianity is a religion that has been compared, every now and then, to many philosophical persuasions; and most of the time, it was either mixed with other worldviews which were totally strange to it, or the proponents of other strange worldviews have attempted to enjoin Christianity to their philosophy, which inevitably have resulted in confusion and clever duplicity in individuals who follow and experiment into this game (Cheung, 2007, p. 34). For generations, people in different civilizations have become witnesses of how their fellows advocated multiple philosophical disciplines. In fact, today, if one would just observe closely, many hold a compound of various beliefs that got rooted and accumulated for years in the family via environmental conditioning. The by-product of this kind of influence is an individual who cope through the varying situations and circumstances of life with the competence of a chameleon. This kind of approach will not properly help in the development and growth of a person as he or she wades his/her way through college. Contrary to the perception of many, the Biblical Worldview is the one philosophy that encourages the pursuit of true knowledge. It, in fact, commands the engagement of the intellect in the pursuit and exploration of true scientific studies. What precipitated the period of Enlightenment? Was it not when people were hungry for the Truth (Shelley, 1982, p. 55)? And these are periods in the history of humankind when the Biblical Worldview was being brought to the fore of society’s endeavors. If there are two philosophies that developed naturally from one to another, they are Judaism and Christianity. The flow of growth from beginning to consummation is recorded in the Old and the New Testament of the Bible (Escalona, 2008, p. 87). B. Literature review The Extent of Usefulness of the Theory A survey in literature reveals that there is little evidence so far in studies that deliberately seek to determine the efficacies of psychodynamic approach in comparison with any of the other approaches in the treatment of abnormal behavior. A few which came out, in particular one research looked into the applicability of treatment in anorexia and bulimia cases which utilized the psychodynamic model and other models such as cognitive orientation treatment. Results of the experiment by Bachar et al (1999, p. 67) showed positive outcomes where this particular approach was used. It must be remembered that mainstream psychology and psychiatry widely use the cognitive model in explaining and treating abnormal behavior. In the controlled, randomized study by Bachar and team members however, the research highlighted the efficacy of psychodynamic approach in the treatment of anorexia and bulimia disorders. Other studies however show that therapists usually employ a combination of cognitive and psychodynamic approaches or an integrative method in the psychological treatments and interventions (Kasl-Godley, 2000, p. 92). Many of the cases today then, support this view rather than a single method in an efficacious treatment of many of these mental and emotional diseases. The disadvantages of the psychodynamic approach in many of the studies done based on a using this as a single method is that of the apparent difficulty of precise measurements on the treatment procedure itself. The approach usually is limited by whether it can be exactly replicated. Specifically, one other limitation or disadvantage is that the cause of phenomena (i. e. , symptom substation) cannot be located. In addition, another setback is that not all individuals can be hypnotized when using hypnosis in the therapy especially (Kaplan, 1994, p. 431). Reference: Bachar, Eytan, Yael Latzer,Shulamit Kreitler, Elliot Berry 1999. Empirical comparison of two psychological therapies: Self Psychology and Cognitive Orientation in the treatment of Anorezia and Bulimia. Journal of Psychotherapy Practice and Research. American Psychiatric Association 8:115-128, Freud, Sigmund. [1901] 1990. The psychopathology of everyday life. New York. W. W. Norton and Company, Inc. Halonen, JS and JW Santrock, 1996. Psychology: Contexts of Behavior, Dubuque, IA: Brown and Benchmark, p. 810. Hilgard, ER, RR Atkinson, and RC Atkinson 1983. Introduction to Psychology. 7th ed. New York: Harcourt Brace Jovanich, Inc. Hurlok, E. B. 1964. Child Development. New York: Mcgraw-Hill Book Company, Inc. Kaplan, HI, BJ Saddock and JA Grebb. 1994. Kaplan and Saddock’s Synopsis of Psychiatry: Behaviroal Sciences clinical psychiatry. Baltimore: Williams and Wilkins. Kasl-Godley, Julia 2000. Psychosocial intervention for individuals with dementia: An integration of theory, therapy, and a clinical understanding of dementia. Clinical Psychological Review. Vol. 20(6). Leahey, B. B. 1995. Psychology: An Introduction. Iowa: WCB Brown and Benchmark. Rathus, S. A. 1990. Psychology 4th ed. Orlando Fl. : Holt, Rinehart and Winston, Inc. Sdorow, L. M. 1995. Psychology, 3rd ed. Dubuque, IA:WCB Brown and Benchmark Publishers Santrock, J. W. 2000. Psychology. New York: McGraw-Hill. ________ Models of abnormality http://intranet1. sutcol. ac. uk:888/NEC/MATERIAL/PDFS/PSYCHO/ASPSYCHO/23U2_T5. PDF Part II. Integration Section A. Introduction Nowhere is counseling more relevant than the conditions and dilemmas faced by man today. The Bible mentions about the the fears that assail humans then during the early days, and which will be experienced also as time draws to a close. Jeremiah 17:8 implies about the kind of fear which some if not many, will succumb â€Å"when heat comes† (RSV). This illustrates as well that the stressful days are but natural to one’s existence; an affliction to being born into a fallen world. Ephesians 2 is even more clear what befalls on a person who is â€Å"dead in trespasses and sins† (KJV); he is subject to the dictates of a world system (v. 2a, KJV), being in the clutches of the evil spirit (v. 2b, KJV), and awaits the anger that God has on them (v. 3, KJV). All these may position any individual to a life of anxiety, depression, wrongful habits ((v. 3, KJV), substance abuse and other addictions that definitely determine the deterioration of overall mental and physical health. The functioning therefore of any person may be compromised and taxed to the limits, producing individuals who are abusive and getting abused. When not operating in optimal condition, man is sure to experience what psychology tends to diagnose and label as malfunctioning and maladjusted; at worst, the evidence of mental institutions’ existence only shows how this truth has long been spoken about in the Bible. Hence, the Bible becoming more relevant, and a theologically and scientifically trained counselor is even more needed these days. In the field of counselling, the primary considerations that those in the field who are practicing directly or indirectly have something to do with the previously held belief system, or the worldview or philosophy behind the notion of human behaviour. This goes to say that one who ventures into the business of healing and curing emotions and psychological problems must get into a thorough understanding of his/her personal approach to the study of human behaviour. The counselor seeks to explain human nature, the issue of sin or prbably emphasizing or reducing the Scriptural mandate and God’s verdict (whichever side he/she is on), and which eventually dictates intervention strategies, if any. It is even bold as to say that counseling in whatever front is basically â€Å"religious† in nature because in the end, what is upheld or emphasized by the counselor expresses deep-rooted philosophy or religious beliefs. The paper thus seeks to present a personal understanding of how practice in counseling is believed to be done considering the personal qualities, depth and realizations of Biblical truths (this is pre-eminent), and many of the nitty-gritty concepts that comprise the practice of counseling in one’s context. Being in contemporary America, with the recent economic meltdown that leave many surprised and shocked of the reduction of most of their economic capabilities to barely the minimum, being relevant as a counselor is not only a necessity, but it is the very important ingredient to helping many survive with their mental faculties intact. Therefore, this paper makes bold assumptions about human nature in general, how this is addressed in various situations that the average man will be meeting, and how growth (which is interpreted as a positive direction the individual will take) in all areas of his existence may take place. B. Psychoanalytic therapy Leading figures Primary importance is given into the development of one of the most influential disciplines in the world today and that is psychology. This is due to the fact that psychology seemed almost foremost in virtually every kind of decision making process that man makes. Because of this serious biblical ministers and/or scholars or theologians have long studied these effects and have come up with their answers and with their verdict. A Brief History of Modern Psychology by Ludy T. Benjamin, Jr. (2006, p. 23) starts to trace the roots of psychology when Wundt, in 1879, initiated what is now recognized as the first psychology laboratory. The author Benjamin satisfies the reader on what made the psychology today a very much pursued subject of interest as well as a career. Tackling on the lives of the people foremost in this discipline, the book made an otherwise boring and usually uninteresting subject matter into an exciting topic any student will be able to handle. The author mentioned details of the pioneers’ lives and the social milieu that characterized their lives and culture during their day which in all realistic evaluation had made its contribution to what their theoretical perspectives had developed. Other important highlights include the development of psychological tests and assessment techniques that Stanford and Binet spearheaded among others. The following narrative on one of psychology’s key players and foremost in what is now known as the â€Å"first force† in the field gives the reader the importance of their contribution to cotemporary psychology (Benjamin, 2006, p. 76). -Freud, Sigmund Viennese neurologist, founder of psychoanalysis (1856-1939) took his medical degree at the University of Vienna in 1881 and planned a specialist’s career in neurology. Lack of means forced him to abandon his research interests for a clinical career. His interest in what was to become psychoanalysis developed during his collaboration with Josef Breuer in 1884, which resulted in Studies in Hysteria, The Interpretation of Dreams appeared in 1900, Three Contributions to the Theory of Sex in 1905, and the General Introduction to Psychoanalysis in 1916 – a book which contained the evolving theory of the libido and the unconsciousness, in subsequent years, Freud’s outlook became increasingly broad as revealed by the titles of his later works (Benjamin, 2006, p. 54). C. Psychoanalytic Theory The psychodynamic perspective is based on the work of Sigmund Freud. He created both a theory to explain personality and mental disorders, and the form of therapy known as psychoanalysis. The psychodynamic approach assumes that all behavior and mental processes reflect constant and unconscious struggles within person. These usually involve conflicts between our need to satisfy basic biological instincts, for example, for food, sex or aggression, and the restrictions imposed by society. Not all those who take a Psychodynamic approach accept all of Freud’s original ideas, but most would view normal or problematic behavior as the result of a failure to resolve conflicts adequately. This paper attempts to distinguish itself in trying to not only understand the theory that Freud pioneered and polished by some of his faithful followers but especially determine the extent of its usefulness in explaining and treating abnormal behavior.. It is the aim of the author to present in precis a description and explanation of the psychodynamic approach and its usefulness in the context of abnormal behavior (Kaplan, 1994, p. 657). To interpret the theoretical framework of Freud in the context of the Christian religion or Biblical Christianity is essential in order to discover whether their fundamental teachings can mix well in mainstream Christianity. Freud taught about the personality constructs of id, ego and superego; about free association, instincts (life and death); his very controversial psychosexual stages of oral, anal, phallic, latency and genital; the fixation and cathexis concepts. In general this is a theory of personality dynamics which is aimed at the motivational and emotional components of personality. It sounds good that according to Freud, man inherits the life and death instincts (libido and mortido). In the Biblical perspective, however, all these concepts are traceable to the sinful nature which all human species have inherited from the first couple Adam and Eve. In some portions of the Biblical record (Roman 5:12), Adam is said to be the federal head and from him has proceeded both sinful nature, which is inherent in all men, and death – which is the Fall’s eventual outcome. The Bible highlights sin as the main problem of all of the manifestations of abnormality as reflected or manifested in the psyche or human behavior (Bobgan, 1987, p. 543). This theory discounts religion’s God’s pre-eminence, sovereignty and will, and active role in a person’s life. It also discounts man’s ultimate accountability before an almighty God. Moreover, it discounts many of the fundamentals that the Bible teaches, like sin and repentance, just Freud’s other followers propounded (Bobgan, 1987, p. 544). Fundamentally, environment is not to be blamed. Nothing could be more accurate than stating it in exactly the same manner that the Apostle has echoed the true state of affairs. It is somehow true to say, â€Å"It’s all up in the mind. † People violate neighbors because first they have violated the laws of God. And so, â€Å"In the futility of their mind, having their understanding darkened, being alienated from the life of God, because of the ignorance that is in them, because of the blindness of their heart; who, being past feeling, have given themselves over to lewdness, to work all uncleanness with greediness† (Eph. 4:17-19). As daily news in the headlines air everyday, and practically speaking, people have made it their daily business to work driven by greed, never minding what they leave behind in their wake. Because the fight has long been lost – which is in the level of consciousness – everyone now is at the mercy of chance, relationally, in this world. And it goes both ways. Many of the disorders or mental illnesses recognized today without a doubt have their psychodynamic explanation aside from other viewpoints like that of the behaviourist, or the cognitivists. From simple childhood developmental diseases to Schizophrenia, there is a rationale that from Freud’s camp is able to explain (Kaplan et al, 1994, p. 76, 98, 456). I. The Psychodynamic concepts A. Theory of Instincts Libido, Narcissism, Instincts and Pleasure Reality Principles. Freud employed â€Å"libido† to denote to that â€Å"force by which the sexual instinct is represented in the mind. † This concept is quite â€Å"crude† or raw in its form hence this refers far more than coitus. Narcissism was developed by Freud as his explanation of people who happened to have lost libido and found that in the pre-occupation of the self or the ego, like in the cases of dementia praecox or schizophrenia. Persons afflicted with this mental illness appeared to have been reserved or withdrawing from other people or objects. This led Freud to conclude that a loss of contact with reality is usually common among such patients. The libido that he conceptualized as innate in every person is herein explained as invested somewhere else and that is precisely the role of self-love or narcissism in the life of one afflicted. The occurrence of narcissism is not only among people with psychoses but also with what he calls neurotic persons or in normal people especially when undergoing conditions such as a physical disease or sleep. Freud explains further that narcissism exists already at birth hence, one can expect realistically that newborn babies are wholly narcissistic (Sdorow, 1995, p. 67). Freud classified instincts into different distinguishing dimensions namely: ego instincts, aggression, and life and death instincts. Ego instincts are the self-preservative aspects within the person, while aggression is a separate construct or structure of the mind which is not a part of the self-preservative nature of the human mind. Its source is found in the muscles while its objective is destruction. Life and death instincts called Eros and Thanatos are forces within the person that pulls in opposite directions. Death instinct is a more powerful force than life instinct (Rathus, 1988, p. 55). The pleasure and reality principles are distinct ideas that help understand the other aspects of Freud’s theory. The latter is largely a learned function and important in postponing the need to satisfy the self (Sdorow, 1995, p. 98). B. Topographical theory of the mind Much like real physical mapping or description of a land area, the topographical theory appeared as attempt to designate areas of the mind into regions; the unconscious, the preconscious, and the conscious. The Unconscious mind is shrouded in mystery (Kaplan, 1994). It is the repository of repressed ideas, experiences and/or affects that are primary considerations when the person is in therapy or treatment. It contains biological instincts such as sex and aggression. Some unconscious urges cannot be experienced consciously because mental images and words could not portray them all in their color and fury. Other unconscious urges may be kept below the surface by repression. It is recognized as inaccessible to consciousness but can become conscious by means of the preconscious. Its content is confined to wishes seeking fulfilment and may provide the motive force for the formation of dream and neurotic symptoms. In other words, unconscious forces represent wishes, desires or thoughts, that, because of their disturbing or threatening content, we automatically repress and cannot voluntarily access (Santrock, 2000, p. 43). The Preconscious is a region of the mind which is not inborn but developed only when childhood stage is beginning to emerge. The preconscious mind contains elements of experience that presently out of awareness but are made conscious simply by focusing on them. Freud labelled the region that poked through into the light of awareness as the Conscious part of the mind. Conscious thoughts are wishes, desires, or thoughts that we are aware of, or can recall, at any given moment. It is closely related in understanding as that of the organ of attention operating with the preconscious. With attention the individual is able to perceive external stimuli. However, Freud theorized that our conscious thoughts are only a small part of our total mental activity, much of which involves unconscious thoughts or forces (Leahey, 1995, p. 433). C. Structural Theory of the Mind Freud conceptualized the mind into what is called as three provinces equivalent to its functions: the id, ego and superego. The id is that aspect which only looks forward to gratifying any of its desires and without any delay. The ego is the structure of the mind which begins to develop during the first year of life, largely because a child’s demands for gratification cannot all be met immediately. The ego â€Å"stands for reason and good sense† (Freud, 1901, p. 22), for rational ways of coping with frustrations. It curbs the appetites of the id and makes plans that are compatible with social convention so that a person can find gratification yet avert the censure of others. In contrast to the id’s pleasure, the ego follows the reality principle. The reality principle has a policy of satisfying a wish or desire only if there is a socially acceptable outlet available (Halonen et al, 1996, p. 43). The superego develops throughout early childhood, usually incorporating the moral standards and value of parents and important members of the community through identification. The superego holds forth shining examples of an ideal self and also acts like the conscience, an internal moral guardian. Throughout life, the superego monitors the intentions of the ego and hands out judgment of right and wrong. It floods the ego with feelings of guilt and shame when the verdict is negative (Halonen et al, 1996, p. 43). As children learn that they must follow rules and regulations in satisfying their wishes, they develop a superego. The superego, which is Freud’s third division of the mind, develops from the ego during early childhood (Hurlock, 196, p. 66). Through interactions with the parents or caregivers, a child develops a superego by taking on or incorporating the parents’ or caregivers’ standards, values, and rules. The superego’s power is in making the person feel guilty if the rules are discovered; the pleasure-seeking, id wants to avoid feeling guilty. It is motivated to listen to the superego as a moral guardian or conscience that is trying to control the id’s wishes and impulses (Hilgard, et al, 1979). From the Freudian perspective, a healthy personality has found ways to gratify most of the id’s demands without seriously offending the superego. Most of the id’s remaining demands are contained or repressed. If the ego is not a good problem solver or if the superego is too stern, the ego will have a hard time of it (Halonen et al, 1996, p. 43). D. Therapeutic goals Sigmund Freud offered a psychoanalytic viewpoint on the diagnosis and understanding of a person’s mental health. Other perspectives, the behavioristic paradigm offers to see this in a different light. The psychoanalytic perspective emphasizes childhood experiences and the role of the unconscious mind in determining future behavior and in explaining and understanding current based on past behavior. Basing on his personality constructs of the Id, Ego and the Superego, Freud sees a mentally healthy person as possessing what he calls Ego strength. On the other hand, the behavior therapist sees a person as a â€Å"learner† in his environment, with the brain as his primary organ of survival and vehicle for acquiring his social functioning. With this paradigm, mental health is a result of the environment’s impact on the person; he learns to fear or to be happy and therein lies the important key in understanding a person’s mental state. Considering that the achievement and maintenance of mental health is one of the pursuits of psychology, the following is a brief outline of what psychologists would endorse a healthy lifestyle. The individual must consider each of the following and incorporate these in his/her day to day affairs: 1. The Medical doctor’s viewpoint – well-being emphasis than the illness model 2. The Spiritual viewpoint- a vital spiritual growth must be on check. 3. The Psychologist’s viewpoint- emotional and relationship factors in balance. 4. The Nutritionist’s viewpoint – putting nutrition and health as top priority. 5. The Fitness Expert’s viewpoint- Exercise as part of a daily regimen. The theory I have in mind then is an amalgamation of several approaches, primarily the integration of the Christian worldview and the theories set forth by Cognitive-behaviorists and psychoanalytic models, and biological/physical continuum. There are other good models but a lot of reasons exist why they cannot be â€Å"good enough;† a lot depends on my own personality. Being authentic to who you are, your passion, is effectively communicated across an audience whether it is a negative or positive one. The basic way of doing the â€Å"amalgamation† or integration is that the Christian worldview takes precedence over the rest of the approaches. Although many of the concepts and premises of each theory mentioned are sound and at times efficacious, when it clashes with the faith-based theory, the former must give way to the latter. It is understood then, that I thoroughly examined each of the theory and set them against the backdrop of spirituality. Interpreting a problem that a client suffers for instance, entails that the theoretical viewpoint that I am convinced with, has better chances of properly understanding the maladjustments that the client had been suffering. To come up with the balanced worldview (an integration in other words), the balance between the realms mentioned, including the true frame of human individuals and the true nature of God (or theology) are properly considered. Thoroughly accepting the fact that there is no contest between the natural and the spiritual; only that troubles arise when one realm is overemphasized at the expense of another. This thin line or slight tension between the two levels is best expressed in the personhood of Jesus Christ, who was a perfect man as well as God. If we start to equate ourselves with that notion (which is usually happening) and we start to think that we are balanced, then we surely lack understanding or real self-awareness of the fact that we are deeply and seriously out of balance and this is one reason why we need help. ~ What are your general goals in therapy? Christian counseling admittedly embraces in reality, a basic integration of the biblical precepts on the view of man and psychology’s scientific breakthroughs in addressing the dilemmas that beset human individuals. Depending on the persuasion of the practitioner, especially whether he or she comes from either the purely theological or â€Å"secular† preparation, Christian counseling can either lean to certain degrees of theology or psychology. According to Larry Crabb, â€Å"If psychology offers insights which will sharpen our counseling skills and increase our effectiveness, we want to know them. If all problems are at core spiritual matters we don’t want to neglect the critically necessary resources available through the Lord by a wrong emphasis on psychological theory† (Crabb in Anderson et al, 2000). Dr. Crabb’s position certainly ensures that science in particular, has its place in counseling in as much as theology does. He made sure that all means are addressed as the counselor approaches his profession, especially in the actual conduction of both the diagnostic and therapeutic or intervention phases (Crabb in Anderson et al. , 2000). Trauma inducing and crisis triggering situations have spiraled its occurrence and in its primacy in the US and in many other countries in recent years. Its broad spectrum ranges from the national disaster category such as that of Hurricane Katrina or the 911 terrorist strikes in New York, Spain and England, to private instances such as a loved one’s attempt at suicide, the murder of a spouse or child, the beginning of mental illness, and the worsening situation of domestic violence (Teller et al, 2006). The acute crisis episode is a consequence of people who experience life-threatening events and feel overwhelmed with difficulty resolving the inner conflicts or anxiety that threaten their lives. They seek the help of counselors, paramedics and other health workers in crisis intervention centers to tide them over the acute episodes they are encountering. These are defining moments for people and must be adequately addressed else they lead lives with dysfunctional conduct patterns or disorders (Roberts et al, 2006). In the integrated or eclectic approach the goal of the therapy is not just relief to the patient or client. Although an immediate relief is very helpful, this may not always be the case in most illnesses. The goal as mentioned in the preceding pages is to provide long-term reduction of the symptoms and the occurrence of the disease altogether if possible. The management then is not impossible but neither is this easy. Specifically, the counselee or patient must want to heal or believe that there is going to be curative effects in the process. It presupposes that he/she must learn to trust the therapist in his/her capabilities as well in leading or facilitating the changes or modifications. It is very much essential that (in the perspective of a cognitive-behaviorist) that the client understands ownership to the deeds and choices in thought patterns he/she made are crucial to the recurring or occurring condition that s/he experiences (Rubinstein et al. , 2007; Corey, 2004). Moreover, the identification of specific treatments or interventions according to the diagnosed issue will be accommodated and implemented based on the chosen treatment modalities fit with the therapeutic approach utilized. It may be a single modality based on a single approach (e. g. , learning principles and desensitization for a patient with specific phobias) or it maybe a combination of many modalities (CBT, Rogerian, Phenomenological, or Family systems) (Rubinstein et al. , 2007; Corey, 2004). E. Summary Every theoretical approach has its own assumptions. In the psychodynamic theory, the following three assumptions help guide a student of human behavior or an expert in this field determine the underlying factors that explain the overt manifestations of specific behaviors. These assumptions therefore, help guide the diagnosis of the presence or absence of mental illness. They are the same assumptions that guide the therapist in choosing what treatment that will better help heal, cure or alleviate the symptoms. These assumptions are: â€Å"There are instinctive urges that drive personality formation. † â€Å"Personality growth is driven by conflict and resolving anxieties. † â€Å"Unresolved anxieties produce neurotic symptoms† (Source: â€Å"Models of abnormality†, National Extension College Trust, Ltd). The goals of treatment here include to alleviate patient of the symptoms is to uncover and work through unconscious conflict. The task of psychoanalytic therapy is â€Å"to make the unconscious conscious to the patient† (â€Å"Models of abnormality†, National Extension College Trust, Ltd). Employing the psychodynamic viewpoint, the therapist or social scientist believes that emotional conflicts, or neurosis, and/or disturbances in the mind are caused by unresolved conflicts which originated during childhood years. Reference: Corey, Gerald, 2004. Theory and practice of counseling and psychotherapy. Thomson Learning, USA. Corey, Gerald. 2001. The Art of Integrative Counseling. Article 29: â€Å"Designing an Integrative Approach to Counseling Practice† Retrieved May 9, 2009 in http://counselingoutfitters. com/vistas/vistas04/29. pdf Crabb, Larry, 2000. Found in Anderson et al resource. Christ-centered therapy. http://books. google. com/books? id=Rn-f2zL01ZwCpg=PA11lpg=PA11dq=effective+biblical+counseling+by+larry+crabb+critiquesource=webots=WFVYLIqP1nsig=MqIhqE_XfGzIQODAKV5iMPjqz14#PPA19,M1 Davison, Gerald C. and John M. Neale. 2001. Abnormal Psychology. Eighth ed. John Wiley Sons, Inc. Ellis, Albert 2001. Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy. Prometheus Books Kaplan, HI, BJ Saddock and JA Grebb. 1994. Kaplan and Saddock’s Synopsis of Psychiatry: Behavioral Sciences clinical psychiatry. Baltimore: Williams and Wilkins. Benjamin, Ludy T. Jr. 2006. A brief history of Psychology. Wiley-Blackwell; 1 edition. Bobgan, Martin Deidre. 1987. Psychology: Science or Religion? From Psychoheresy: The psychological seduction of Christianity. Eastgate Publishers. Retrieved May 6, 2009. http://www. rapidnet. com/~jbeard/bdm/Psychology/psych. htm Boring, Edwin G. et. al. 1948. Foundat

Hemoglobin Malaria Haemoglobinopathies

Hemoglobin Malaria Haemoglobinopathies Despite major advances in the understanding of the molecular pathophysiology and control and management of the inherited disorders of hemoglobin (haemoglobinopathies), thousands of infants and children with this disease are dying. As a result in heterozygote advantage against malaria the inherited hemoglobin disorders are the commonest monogenic disease. Population migrations have ensured that haemoglobinopathies are now encountered in most countries including the UK. Haemoglobinopathies have spread from areas in the Mediterranean, Africa and Asia and are now endemic throughout Europe, the Americas and Australia. This review examines the available literature to find out more about the prevalence of haemoglobinopathies in the UK. The data on the demographics and prevalence of the gene variants of haemoglobinopathies was extracted from books, journals, reference sources, online databases and published review articles from the WHO. Introduction It has been estimated that approximately 7% of the world population are carriers of such disorders and that 3000 000 4000 000 babies with severe forms of haemoglobinopathies. Haemoglobinopathy disorders occur at their highest frequency in tropical regions and population migrations have ensured that they are now encountered in most countries. Because of this, haemoglobinopathies have become a global endemic, so the World Health Organization published journals and reviews with recommendations on screening programmes and management of haemoglobinopathies. The programmes are tailored to specific socioeconomic and cultural contexts and aimed at reducing the incidence, morbidity and mortality associated with these diseases. www.who.int/en/ The WHO Executive Board wrote a review on haemoglobinopathies. In this article, the WHO Executive Board recognized that the prevalence of haemoglobinopathies varies between communities, and that insufficiency of relevant epidemiological data may hamper effective and equitable management of haemoglobinopathies. On this note England implemented the LIVE programmes. The Executive Board also recognizes that haemoglobinopathies are not yet officially recognized as priorities in Public Health Sector. This raised an issue about awareness of haemoglobinopathies. The WHO Executive Boards advice for prevention and management of haemoglobinopathies was to design, implement and reinforce in a systematic equitable and effective manner, comprehensive national, integrated programs for prevention and management of haemoglobinopathies, including surveillance, dissemination, such programs being tailored to specific socioeconomic and cultural contexts and aimed at reducing the incidence, morbidity and mortality associated with these diseases. www.who.int/en/ With immigration in the UK on its highest, the prevalence of haemoglobinopathies is expected to increase. The NHS has implemented programmes for individuals with haemoglobinopathies by implementation of LIVE program (NHS Plan, 2000). LIVE program is set-up to implement variant screening in the whole of UK by the year 2007. LIVE program started as early as January 2004 in high prevalence. The NHS Trusts involved are to offer variant screening by end of 2004/5 (NHS Plan, 2000). Low prevalence Trust are expected to have implemented the screening program by January 2008 and so far 86 out of 90 Trusts have successfully implemented the program. Antenatal and Newborn Screening programs have compiled a training pack to assist Low Prevalence Trusts with the implementation of haemoglobinopathies screening programmes. The NHS Plan (2000) made a commitment to implement effective and appropriate screening programs for women and children including a new national linked Antenatal and Newborn screen ing programs for haemoglobinopathies. The NHS Plan (2000) recommends that all pregnant women living in high prevalence areas are offered screening for haemoglobinopathies. All pregnant women living in low prevalence areas are offered screening for haemoglobinopathies. If a woman is identified as being at increased risk using the family origin questionnaire, she will then be offered screening for haemoglobinopathies (NHS Plan, 2000). The Low Prevalence Trust is where the fetal prevalence of sickle cell disease is less than 1.5 per 10 000 pregnancies. Low prevalence trusts are to offer screening for variants based on an assessment of risk determine by a question to women about their babys fathers family origin by the end of 2005/6 (NHS Plan, 2000). Background on Haemoglobinopathies Haemoglobin: is the oxygen carrying capacity of the blood and it is also a protein. Haem is iron containing pigment, while globin is made up of chains which are a globular tetrameric protein which accounts for 97.4% of the mass of the haemoglobin molecule (Tortora et.al., 2006) . The globin tetramer consists of four polypeptides which are two alpha (ÃŽ ±) chains and two non-alpha chains. The synthesis of ÃŽ ¶ and ÃŽ µ chains is done during the first 10 to 12 weeks of fetal life. Within the fourth to the fifth week of intrauterine life ÃŽ ± and ÃŽ ² chains are synthesized. The non-alpha is beta (ÃŽ ²), gamma (ÃŽ ³), delta (ÃŽ ´), epsilon (ÃŽ µ) zeta (ÃŽ ¶) chains. Haemoglobin transports oxygen from the lungs to all parts of the body and it gives blood its red colour (Fleming, 1982) Haemoglobin synthesis Haem and globin synthesis occur separately but in a carefully coordinated fashion. Globin synthesis is under the genetic control of eight functional genes arranged in two clusters, the ÃŽ ± globin gene cluster on chromosome 16 and the ÃŽ ² globin gene cluster on chromosome 11. The major haemoglobin in the foetus is HbF (ÃŽ ±ÃŽ ²) 2 and in adults HbA (ÃŽ ±ÃŽ ²) 2 (Fleming, 1982). Haemoglobin Structure The primary structure of haemoglobin is made-up of amino acid sequence of globin. And the secondary structure comprise of nine non-helical sections joined by eight helices; tertiary structure describes globin chain folding to form a sphere and the quaternary structure of haemoglobin describes the tetrahedral arrangements of the four globin subunits ( Fleming, 1982). The external surface of each folded globin is hydrophilic and the inner surface is hydrophobic, this protects the haem from oxidation, which is also why each haem chain sits in a protective hydrophobic pocket. In haemoglobin A, ÃŽ ± ÃŽ ² dimmers are held together strongly at the ÃŽ ±1 ÃŽ ²1 or ÃŽ ±2ÃŽ ²2 junction. The tetramer is held together much less tightly at the ÃŽ ±1 ÃŽ ²2 and ÃŽ ±2 ÃŽ ²1 contact areas (Fleming, 1982). Haemoglobin function Each haemoglobin molecule can carry four oxygen molecules. Oxygenation and deoxygenation are accompanied by molecular expansion and contraction via haem haem interaction (Bienz, 2007). Under physiological conditions, blood in the aorta carries about 19.5ml of oxygen per 100ml of blood. Upon entering the tissues about 4.5ml of oxygen are donated per 100ml of blood. 2,3-DPG is an important modulator of haemoglobin A oxygen affinity in red cells (Fleming, 1982). Haemoglobin disorder (haemoglobinopathies) Haemoglobinopathies is a hematological disorder due to alteration of a genetically defect, that results in abnormal structure of one of the globin chains of the haemoglobin molecule (Bienz, 2007). Haemoglobinopathies are any of a group of diseases characterized by abnormalities, both quantitative and qualitative in the synthesis of haemoglobin (Hb) (Bienz, 2007). Qualitative affecting the quality of haemoglobin e.g. Sickle cell disorder and quantitative affecting the amount of haemoglobin produced e.g. Thalassaemias. Most of them are genetically inherited but occasionally they can be caused by a spontaneous mutation. Haemoglobinopathies are the worlds most common monogenic autonomic and recessive disease in humans (Anionwu et.al., 2001). 2.1Haemoglobinopathies fall into two main types; There are two categories of haemoglobinopathies. The two categories are: qualitative and quantitative; Qualitative affecting the quality of the haemoglobin e.g. Sickle cell disorder. In this disease the globin structure is abnormal. Quantitative the haemoglobin structure is normal but the amount of haemoglobin produced is affected. e.g. alpha and beta thalassaemias (Bienz, 2007). History of haemoglobinopathies In 1910 Herrick wrote an article in it he used the term â€Å"sickle† to describe the shape of the red blood cells of a 20 year old medical student from Grenada. This student had consulted Dr Herrick in 1994 complaining of a cough, fever and Feeling weak and dizzy. He constantly had anaemia episodes, jaundice, chest complications as well as recurring leg ulcers on both ankles. When his blood was examined, his red blood cells showed a large number of thin, elongated, sickle shaped and crescent- shaped forms (Herrick, 1990). The name thalassaemia was coined by the eminent haematologist George Whipple in 1936 as an alternative to the eponymous ‘Cooleys anaemia. He wanted a name that would convey the sense of an anaemia which is prevalent in the region of the Mediterranean Sea, since most of the early cases originated there. Thalassaemia is derived by contraction of thalassic anaemia (from the Greek thalassa -sea, an none and anemia blood) (Fleming,1982). Origins and Geographic distribution of haemoglobinopathies Carriers are found in all parts of the world: people from the North Mediterranean (South Europe) coast are 1-19% carriers. People of Arab origin are over 3% carriers. In Central Asia 4-10% and in South East Asia, the Indian subcontinent and China 1-40% carriers (the very high rates in this part of the world are due to HbE). In the Americas, North Europe, Australia and South Africa the local population has very low carrier rates but thalassaemia is still present because of the significant immigration from high prevalence area (Anionwu et.al.; 2001). Sickle cell and thalassaemia disorder mainly affect individual who are descended from families where one or more members originated from parts of the world where falciparum malaria was, or is still endemic. Population with such ancestry include those from many parts of Africa, the Caribbean the Mediterranean (including southern Italy, Northern Greece and Southern Turkey), Southeast Asia and thalassaemia gene is much wider now due to the hi storical movements of at-risk populations to North and South America, the Caribbean and Western Europe (Livingstone 1985). The geographic distribution of the thalassaemias overlaps with that of sickles cell disease. This is because carriage of these abnormal genes affords some protection against malaria. Thus, being heterozygous for one of these conditions offers a selective survival advantage and increases the opportunity for these genes to be passed on (Campbell et.al.,2004) 4Types and terminology of sickle cell and thalassaemia There are various types of sickle cell and thalassaemia disorders. The thalassaemia syndromes include alpha and beta thalassaemia major as well as beta thalassaemia intermedia. Sickle cell disorders (or Fickle cell disease include sickle cell anaemia (Hb SS), Sickle haemoglobin C disease (Hb SC) ÃŽ ² disease and E beta thalassaemia (www.sickle-thalassaemia.org/sickle.cel.htm) 4.1Sickle Cell Disorder: affects the normal oxygen carrying capacity of the red blood cells. The red blood cell forms a crescent or a sickled shape when it is deoxygenated. The ‘sickled cells are unable to pass freely through capillaries; the sickle cells also get stuck in blood vessels forming clusters which block the blood vessels and the blood flow. They dont last as long as normal, round red blood cells, which leads to anemia. This results in a lack of oxygen to the tissues in the affected area, resulting in hypoxia and pain (sickle cell crisis). Other symptoms include severe anaemia, damage to major organs and infection (NHS Antenatal and Newborn; 2006). There are several types of Sickle cell disease. The most common are: sickle cell anemia (SS), sickle hemoglobin C disease (SC), sickle beta plus thalassaemia and sickle beta zero thalassaemia. Each of these can cause pain episodes and complications. HbSS sickle is due to two sickle cell genes (â€Å"S†), one from each parent. This is commonly called sickle cell anemia. An individual with sickles cell anemia have a variation in the ÃŽ ²-chain gene, which then causes a change in the properties of hemoglobin which results in sickling of red blood cells (www.sickle-thalassaemia.org/sickle.cel.htm) HbSc inherited one sickle cell gene and one gene from an abnormal type of haemoglobin called â€Å"C†. It is due to the variation in the ÃŽ ²-chain gene. An individual with this variant suffers from mild chronic haemolytic anaemia. (NHS Antenatal and Newborn; 2006). HbS beta thalassaeamia: This form of sickle is due to inherited one sickle cell gene and one gene for beta. 4.2Thalassaemias: is a term used for the description of a globin gene disorders that results from a diminished rate of synthesis of one or more globin chains and a consequently reduced rate of synthesis of the haemoglobin or haemoglobins of which that chain constitutes a part ; ÃŽ ± thalassaemia indicates a reduced rate of synthesis of the ÃŽ ± globin chain, similarly, ÃŽ ², ÃŽ ´, ÃŽ ´ ÃŽ ² and ÃŽ µ ÃŽ ³ ÃŽ ´ ÃŽ ² thalassaemia indicate a reduced rate of synthesis of the h, ÃŽ ´, ÃŽ ´, +ÃŽ ² and ÃŽ µ + ÃŽ ³ + ÃŽ ´ + ÃŽ ² chains, respectively (Modell et.al, 2001). Thalassaemia is the most common single gene disorder known. It is autosomal recessive syndromes, which is divided into ÃŽ ±- and ÃŽ ² thalassaemia. Types of thalassaemia There are two types of thalassaemia: (i)Thalassaemia minor (thalassaemia trait) (ii)Thalassaemia major Thalassaemia minor is when a person inherits one thalassaemia gene, while thalassaemia major is a severe form of anaemia if a person inherits two thalassaemia genes, one from each parent (Bienz, 2007). Subtypes of thalassaemia Alpha (ÃŽ ±) thalassaemia results from inadequate production of ÃŽ ± chains, which are normally controlled by two pairs of chromosomes. If one or two are malfunctioning, then there is a healthy carrier state. If three are non- functional then anaemia results, known as HbH Disease, which can be quite severe but usually does not need blood transfusions and is compatible with a normal life span (Anionwu et al, 2001). If all four genes are non functional then the result is severe anaemia of the unborn child, leading to heart failure and death (miscarriage). This condition is known as hydrops felalis (Fleming, 1982). Beta (ÃŽ ²) Thalassaemia is caused by the bodys inability to produce normal haemoglobin, leading to a life threatening anaemia (Bienz, 2007). The severity of illness depends on whether one or both genes are affected and the nature of the abnormality. If both genes are affected, anemia can range from moderate to severe. Beta thalassaemia results from inadequate or lack of production of ÃŽ ² chains (Anionwu et.a.l, 2001). Homozygous, ÃŽ ² thalassaemia has two forms: major, in which the patient can survive only with regular transfusions of blood and intermedia in which the patient can survive with occasional or even with no transfusions at all. The condition requires frequent blood transfusions and treatment to prevent complications from iron overload, such as diabetes and other endocrine disorders (Anionwu et.a.l, 2001). Both of these conditions can restrict a child or adults ability to conduct their normal daily activities and can have profound psychological affects on individuals a nd their families This form of thalassaemia is the most important and constitutes a major public health problem in many parts of the world, because of the high frequency of carriers and the demanding treatment that must be followed (Fleming, 1985). Association of Haemoglobinopathies with Malaria Malariais a vector borne infectious disease caused by protozoan parasites. It is widespread in tropical and subtropical regions, including parts of the Americans, Mediterranean, Asia and Africa. It causes diseases in approximately 515 million people and kills between one and three million people, the majority of whom are young children. Malaria parasites are transmitted by female Anopheles mosquitoes. The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia (Campbell et al, 2004). Sickle cell developed as a by product of human defense mechanisms against malaria. The most severe form of malaria, falciparum malaria, leads to very high death rate in young infants. This is particularly a problem between the time immediately after birth, when they are protected by immunity from the mother, and the time when they are old enough to acquire their own immunity. Malaria is a parasite which lives within the red blood cells and feeds off the protein that is contained within those red cells, haemoglobin (Campbell et al, 2004). When the malarial parasite enters the blood stream through a mosquito bite, it penetrates the red blood cells by attaching to the outside membrane or envelope of the red blood cell and gaining entry (Franklin, 1990). Once in the red blood cell, the malarial parasites use the haemoglobin as a source of energy, so that they multiply within the red cells. The parasites multiple filling-up the red blood cells and once they are filled-up the red cells bur st, thereby releasing the multiple parasites in the blood. Each new young parasite enters a single cell again and multiplies again, thereby causing a disease or infection. Whenever the parasites burst out of the cells they cause illness and fever in patients. Malaria can be severe by causing death; death is believed to be caused by red cells not being able to pass through the narrow gaps in the smallest blood vessels and by blockage of tissues when so many parasites are in the red blood cell (Campbell et al, 2004). Over the years human genes developed ways to prevent malaria becoming serious and potentially lethal, the developments were to prevent malarial parasites from spreading and multiplying (Tortora et.al,2006). The most changes were changes (mutation) in the type of haemoglobin (haemoglobin S) within the red blood cell which would in turn slow down the multiplying of the parasite (Campbell et al, 2004). The individuals with haemoglobin S are known to have a sickle cell trait or being carriers of sickle cell haemoglobin. When sickle-cell haemoglobin has given up its oxygen in the cells, the red cells stick together to form crystalline groupings of haemoglobin known as polymers. The red blood cells become deformed into sickle shapes and the presence of these crystalline polymers within the red cells inhibits the growth of the malarial parasite (Beinz, 2007). Even though individuals with haemoglobin S stills suffer from malaria, they are protected from the most severe effects of malaria (Li vingstone, 1985). Diagnosis Diagnosis for sickle cell disease The most used diagnose test for sickle cell is the haemoglobin electrophoresis. HbS and HbC amino acid substitutions change the electrical charge of the protein, the migration pattern of the haemoglobin with electrophoresis or isoelectric focusing results in diagnostic patterns with each of the different haemoglobin variants. HbSBeta-thal requires careful evaluation of red blood cell count and mean corpuscular red cell volume (MCV) and specifically quantifying HbA, S, A2 and F. In emergency setting, the presence of HbS is detected using a five minute solubility test called sickledex. Sickledex test does not differentiate sickle syndromes from the benign carrier state (HbAS or a sickle trait (NHS Antenatal and Newborn; 2006). Diagnosis for thalassaemias When testing for thalassaemias, a blood test is the simplest and most effective test for diagnosis and also the use of a test called Haemoglobin Electrophoresis. The blood of individuals with thalassaemias tend to be microcytic (smaller in size) and hypochromic (paler in colour) (NHS Antenatal and Newborn; 2006). 7 Pathophysiology 7.1Sickle-cell Sickle-cell anemia is caused by changes (mutation) in the structure of the ÃŽ ² -globin chain of the haemoglobin replacing the amino acid glutamic acid with the less polar amino acid valine at the sixth position of the ÃŽ ² chain. When two wild type ÃŽ ±-globin subunits associate with two mutant ÃŽ ²-globin subunits forms hemoglobin S. Haemoglobin S polymerizes under low oxygen conditions, which causes distortion of red blood cells and also causes red blood cells to lose their elasticity, resulting in red blood cells forming an irreversible sickle shape (Fleming,1982). Very often a cycle occurs, as the cells sickle they cause a region of low oxygen concentration which causes more red blood cells to sickle. Repeated occurrence of sickling causes cells to not return to normal even when oxygen levels are normal. The deformation of cells makes it difficult for the cells to pass through capillaries resulting in vessel occlusion, severe anemia, ischemia and other problems (Beinz, 2007). 7.2Thalassaemias The pathophysiologic effects of the thalassaemias range from mild microcytosis to death in uterus. The anaemia manifestation of thalassaemia is microcytic hypochromic haemolytic anaemia (Belcher, 1993). The haemoglobin abnormality is caused by substitution of a single amino acid for another; or substitution of two amino acids, also amino acid deletion or fusion (point of mutation) and the synthesis of elongated chains. In alpha trait, one of the genes that form the alpha chain is defective (Beinz, 2007). In alpha-thalassaemia minor, two genes are defective and in haemoglobin H disorder, three genes are defective. Alpha-thalassaemia major is most fatal thalassaemia disorder; this is because four of the chains forming genes are defective. Without alpha chains, oxygen cannot be released to the tissues (Belcher, 1993). In beta-thalassaemia haemoglobin abnormality is due to the uncoupling of alpha and beta-chain synthesis. This causes a depression in beta-chain synthesis, resulting in er ythrocytes with a reduced amount of haemoglobin and accumulation of free alpha chains, which are unstable and easily precipitate the in cell (Bienz, 2007). 8.Causes Genetic control of haemoglobin synthesis The synthesis of structurally normal haemoglobin chains is determined by allelic genes situated on the autosomal chromosome (Beniz, 2007). Haemoglobinopathies occur due to an inheritance of one or more faulty copy of gene(s) that contain the information for the cells to make the globin chains. The gene may result in abnormality in the production or structure of the haemoglobin protein causing haemoglobinopathies (Franklin, 1990). Thalassaemia is an inherited autosomal recessive blood disorder. Genetic defects in Thalassaemia results in reduced synthesis of one of the globin chains which make up haemoglobin. Reduced synthesis of one of the globin chains causes the formation of abnormal haemoglobin molecules, which in turn causes anaemia. Anaemia is a symptom of the Thalassaemias. It is caused by under production of globin proteins, often through mutations in regulatory genes (Franklin, 1990). Inheritance of Haemoglobin Disorder Due to haemoglobin mutation, individuals who had haemoglobin trait had a resistance to dying from malaria, therefore passed on their haemoglobin trait gene to their children (Campbell et.al,2004). As time went on more individuals with the trait were born and eventually individuals who had haemoglobin trait had children together (Franklin, 1990). In that satiation (partnership), if both parents carry the trait gene, there is a one in four chance that any one child will receive the haemoglobin trait gene from one parent and also from the other, thereby having a haemoglobin disorder(Franklin, 1990) . Clinical Manifestations 9.1Thalassaemias clinical manifestations Individuals who inherited the alpha trait are usually asymptomatic, with possible mild microctyosis. Alpha- thalassaemia minor has signs and symptoms almost identical to those of beta-thalassaemia; mild microcytic hypochronic anemia, enlargement of the liver and spleen, and bone marrow hyperplasia (Belcher, 1993). Alpha- thalassaemia major cause hydrops fetalis and fulminana intrauterine congestive heart and liver, edema and massive ascites. The disorder usually is diagnosed post mortem (Bienz, 2007). Beta-thalassaemia minor causes mild to moderate microcytic-hypochronic anemia, mild splenomegaly, bronze coloring of the skin, and hyperplasia of the bone marrow. Skeletal changes depend on the degree of reticulocytosis, which in turn depends on the severity of the anaemia (Bienz, 2007). People who have beta-thalassaemia minor usually are asymptomatic, whereas those with beta- thalassaemia major the anemia is severe, resulting in a great cardiovascular burden, with high output congestive heart failure (Belcher, 1993). Blood transfusions can increase the persons life span by a decade or two. Individuals with beta-thalassaemia major have an enlarged liver and spleen, and growth and maturation are retarded (Belcher, 1993). A characteristic deformity develops on the face as the bones expand to accommodate hyperplastic marrow (Belcher, 1993). Both and beta thalassaemias major are life threatening. Children with thalassaemia major usually are week, fail to thrive, how poor development and experience cardiovascular compromise with high-output failure; if the condition goes untreated, these children die by 6 years of age (Modell et.al., 2001) Blood transfusions can return haemoglobin and hematocrit to normal levels, alleviating the anaemia induced cardiac failure. Iron overload and hemochromatosis, which are complications of transfusion therapy, are treated with chelating agents (Bienz, 2007). . 9.2.Sickle-cell clinical manifestations The severity of sickle cell disorder depends on the amount of haemoglobin S and the clinical manifestations, which are signs and symptoms of the individuals with sickle-cell (Belcher, 1993) . Manifestations of the sickling are those of hemolytic anemia; pallor, jaundice, fatigue and irritability. Extensive sickling can precipitate four types of crises: vaso-occlusive or thrombotic crises and a plastic crisis (Belcher, 1993). A vaso-occlusive crises begins with red blood cells sickling in the microcirculation. Vasospasm brings a log-jam effect causing blood flow to stop flowing in the vessels and this will lead to thrombosis (blood clot formation) and infarction of local tissue occur, resulting in ischemia, pain and organ damage (Modell et.al.,2001). Vaso-occlusive crisis is believed to be extremely painful and lasts an average of 4 to 6 days. This crisis may develop spontaneously or may be precipitated by localized hypoxemia (low PO2) exposure to cold, dehydration, acidosis (low pH), or infection. In infancy, sickle-cells first manifestation is the symmetric painful swelling of the hands (see Fig 3) and feet, but in older children and adults, the large joints and surrounding tissues become swollen and painful. Individuals with the sickle-cell disorder suffer from severe abdominal pain caused by infarction in abdominal structures (Belcher, 1993). Any cerebral vascular accidents may cause paralysis or othe r central nervous system deficits, and if penile veins are obstructed priapism may occur. Studies have shown that bone, especially weight- bearing bones, are also a common target of vaso-occlusive damage, this is due to bone ischemia (Bienz, 2007). The spleen of individuals with sickle-cell disorder is frequently affected due to its narrow vessels, functions in clearing defective red blood cells and this results in a sequestration crisis (Belcher,1993). A sequestration crises, is occurrence of large amounts of blood pool in the liver and spleen. It only occurs in young children and death results from cardiovascular collapse (NHS Antenatal and Newborn,2006). An aplastic crisis develops when a compensatory increase in erythropoiesis is compromised; this then results in profound anemia (Belcher,1993). A hyperhemolytic crisis is rare but may occur with certain drugs or infections. G-6-PD deficiency, when also present, contributes to this type of crisis (Belcher,1993). Clinical manifestations of sickle cell disease do not usually appear until an infant is at least 6 months old. The most cause of death in individuals with sickle-cell anemia is infections, but it is major problem at all ages. Infections are due to splenic dysfunction from sickle damage (Belcher,1993). This occurs from a few months of age especially with certain bacteria e.g. pneumococcal sepsis. Infection tends to rapidly overwhelm the immune system (NHS Antenatal and Newborn,2006) . Sickle-cell haemoglobin C is known to be milder, with symptoms related to vaso-occlusive crises resulting from higher hematocrit and blood viscosity. Obstructive crises cause sickle cell retinopathy is most common in older children, and this include renal necrosis, and aseptic necrosis of the femoral head (Belcher, 1993). The mildest of sickle-cell is the sickle-cell thalassaemia the individuals with this form of sickle-cell tend to be microcytic and hypochromic, which makes the cells less likely to clog the microcirculation even when sickling (Belcher, 1993). Severe hypoxia can be seen in individuals with the sickle cell trait and may cause vaso-occlusive episodes. The cells in these people form an ivy shape (Belcher, 1993). Recent studies have shown that stroke is co-exiting with Sickle cell disease. At least 1% of patients with sickle cell disorder suffer from stroke and those individuals result in physical disability, IQ reduction, Learning difficulties, TIAs and seizures (Beinz, 2007). Treatment of haemoglobinopathies. 10.1Treatment in Sickle-cell anemia. Febrile illness: Children with fever are screened (a full blood count, reticulocyte count and blood culture taken) for bacteremia. In young children the fever is treated with intravenous antibiotics, the children would be admitted at the hospital so that they can be monitored (Belcher, 1993).. But older children with reassuring white blood cell counts are managed at home with oral antibiotics, but if the older children have a history of bacteremia episodes, they get a hospital admission. (Modell et al, 2001) Zn administration: is when zinc is given to stabilize the cell membrane (Beinz, 2007). Painful (vaso-occlusive) crises: individuals with sickle cell disorder experiences painful episodes called vaso-occlusive crises. Vaso-occlusive crises is often treated symptomatically with analgesics (Beinz,2007). Pain management requires opioid administration at regular intervals until the crises has gone. The frequency, severity and duration of these crises episodes vary tremendously form episodes to episode or from person to person (Belcher,1993). Individuals who suffer from milder vaso-occlusive crises manage their pain on NSAIDs e.g. diclofenac or naproxen. And if the crises is severe, individuals require inpatient management, where intravenous opioids. Diphenhydramine is used to stop the itchiness associated with the opioids (Modell et al, 2001). Acute chest crises management is similar to vaso-occlusive crises treatment with the addition of antibiotics, oxygen supplementation for hypoxia, and close observation. If the pulmonary infiltrate worsen or the oxygen requirements increase,

Causes Of The Punic Wars History Essay

Causes Of The Punic Wars History Essay The Punic Wars were a sequence of three battles that were fought in the period 264 to 146 BC between Rome and Carthage. They were the largest battles of the time. The main reason for the occurrence of the battles was the conflict in the vested interests of the Carthagian Empire and the rapidly expanding Roman Empire. The Romans saw the need to expand their vast empire through Sicily, which was then an important hub, and was partly under Carthagian control. Carthage, being the dominant power in the West of the Mediterranean and strong in its naval power, resisted all advances by the Roman Empire, which was an extensive maritime empire. This resulted in the first of three major wars that were characterized by a number of battles. At the end of wars fought for over a century, Rome emerged victorious in the Roman-Syrian War with the defeat of Seleucid King Antiochus III the Great and went on to be one of the most powerful empires of the time till the fifth century A.D Carthage was a powerful thalassocratic city in modern day Tunisia. It had the largest navy and fought its wars through mercenaries, especially Numidian, rather than a permanent, standing army as was the case with the Roman Empire. In 264 BC, the Roman Empire conquered the Italian peninsula to the south of River Po bringing the conflict between the two rivals to a boiling point. This triggered the First Punic War that lasted between 264-241 BC. The First Punic War was mainly a naval war which was also partly fought on land in Sicily between Hiero II of Syracuse and Mamertines of Messina. The Mamertines first enlisted the help of the Carthagians but went on to betray them and sign a treaty with the Roman Senate. This led to the Carthagians to directly support Hiero bringing them at loggerheads with the Roman Empire for the control of Sicily. In 261 BC, after a defeat at the Battle of Agrigentum, the Carthagians resolved to fight their battles at sea rather than on land. They consequently successfully fought the Romans at the Battle of the Lipari Islands in 260 BC. Rome decided to expand its existing fleets to over 100 warships in two months so as to counter the all-powerful Carthagians in the sea. They were specifically designed to incorporate a Corvus so as to facilitate sinking and ramming of Carthagian ships. This guaranteed a stream of successes for the Roman infantries except for the Battle of Tunis. In 241 BC, the Cart hagians signed a peace treaty with the Romans in which they were forced to evacuate Sicily In addition to paying an enormous war indemnity. Further, in 238 BC, the Carthagians lost the islands of Sardinia and Corsica to Rome during the Mercenary War. This ensured that Rome was the superpower and could comfortably control any sea-borne or land invasion of Italy, all sea trade routes in the Mediterranean and further invade foreign shores so as to expand the Empire. Rome further fought and conquered colonies through the Illyrian Wars. Carthage was however forced to retreat and build its finances and expand its empire in Hispania. In the ensuing period between 238 BC and 219 BC, several trade agreements and mutual alliances between Carthage and Rome took place. These treaties were mainly about the release of all 8,000 Roman prisoners without ransom and the handing over of all deserters serving in the Carthage army. This latter section of the agreement was not adhered to leading to a reject of the treaty by the Roman senate and an increase in the indemnity fines. This therefore resulted in a liquidity problem in Carthage leading to the Mercenary war in which the mercenaries that had previously fought for Carthage to revolt due to loss of power over the sea-ways. With a comfortable win, Carthage and Rome enjoyed relative peace till 219 BC when Hannibal, having silver riches conquered by his predecessor Hamilcar Barca and a large native army from the subdued native tribes such as the Celts of the Po River, attacked Saguntum which was by then under special protection by Rome under conquest termed as the Iberian Co nquest. The Second Punic War occurred between 218-201 BC. Hannibal, leading the Barcid Empire, and allied to the Carthagians, crossed the Alps and invaded Italy in a series of highly successful battles. Hannibal, however, never attained the goal of creating a major division between Rome and its allies. These wars were fought on three frontiers. First, in Italy, Hannibal fought the Romans; secondly, in Hispania, Hasdrubal, a brother to Hannibal, constantly defended the colonies conquered and finally in Sicily, Rome fought for control which was further troubled by the continuing First Macedonian War. After a successful attack on Saguntum, Hannibal went further on to surprise the Romans by attacking Italy. Although he managed to win that particular battle, and also the Battle of Trebia, The Battle of Trasimene and the Battle of Cannae; he lost his only siege engines and most of the elephants and men to the icy mountains thereby strategically losing the battle in Rome which would have ensured a win of the entire war. His war strategy, which was to turn the allies of Rome against it since he could not take Rome on due to insufficient men, failed. Except for a few southern states, the rest remained loyal. Rome further drafted army after army after the defeats which ensured Hannibal was cut off from aid. Hannibal also never received any substantial reinforcements from Carthage which prevented him from decisively conquering Rome and ending the war at a win. The war raged for fifteen years during which the Roman Empire was unable to conclusively end the battle since Hannibal was a master general coupled with the fact that they were already engaged in the Macedonian Wars. Hannibal, realizing he was eventually running out of supplies, decided to retreat to his home base in Africa in aid to an attack waged by Rome but was thoroughly defeated in The Battle of Zama. In Hispania, Hasdrubal was soundly defeated by a young Roman commander, Publius Cornelius Scorpio. He therefore decide d to abandon Hispania so as to reinforce his brother Hannibal. This alliance was later trampled upon ending the Second Punic War in 201 BC. The Third Punic War, which lasted between 149-146 BC, was invoked by the extended Siege by Rome on Carthage and its consequent complete destruction. There was growing resurgence by Hispania and Greece against Rome coupled with the tangible increase in Carthagian wealth and martial power. The Roman Treaty incorporated a clause in which Carthage was to have no military thereby suffering attacks from the neighboring Numidia, a favorite of the Roman Empire. All arbitrations were done by the Roman Senate which was heavily in favor of Numidia. After 50 years since the end of the Second Punic War, The Carthagians decided they were no longer bound by the treaty and mustered an army to combat the Numidian attacks. This Punic Militarism was heavily objected to by Rome especially by Cato the Elder who declared that Carthage must be destroyed. In 149 BC, Rome issued demands that could not be met such as the proposal to demolish Carthage and build it further from the coast into the interiors of A frica. This drew Carthage into an open fight with the Romans. Over a short period, Carthagians innovatively made a myriad of weapons and were able to resist initial Roman attacks on their city. However, a three year siege on the city ended the war in which the walls of the city were breached by the Romans under the command of Scipio Aemilianus, who burnt the city to the ground and aggrandized other Carthagian settlements. The Carthagians who were not killed were sold into slavery. This brought the Carthagian Empire to an end.

Where Abortion Goes Wrong Essay -- Pregnancy Birth Papers

Where Abortion Goes Wrong Abortion is wrong. This is a bold statement for a twenty-one-year-old, white male raised in a middle class home, and one that I am not at all comfortable making. It is not just that the debate over abortion is so heated, or that I fear being labeled a Bible-beating fanatic. I am uncomfortable because the issue of abortion is mired in uncertainty. We all know that child abuse and rape are wrong. Under no condition can rape be justified. This is simply a fact that we all accept. The problem of abortion, on the other hand, is not nearly as straightforward. As pointed out by Frederick Turner in Abortion Can be a Moral Sacrifice, pro-life people can be sure that late-term abortions are murder. However, the same surety is not there when they consider two-day old embryos. A similar confusion can be seen by those in the pro-choice camp (Turner, 1992). Here lies the central question: With so much uncertainty surrounding abortion, can and should it ever be legislated? To answer this question, we must first understand the basis for both sides' positions. Misunderstandings have long been the major block to meaningful discussions. The pro-life camp's position is often thought to stem from a hidden agenda to suppress women, whereas the pro-choice position is often linked to loose morals and little emphasis on responsibility. These ideals or traits may be held by a limited number in each group, but they are not indicative of the majority. Most pro-life and pro-choice advocates sincerely believe in their convictions and have legitimate arguments to back up their beliefs. Actually, the arguments of both sides are rooted in the same key principles. The first is an understanding of the worth of the fetus, and, based... ...orn. New York: Delacorte Press/Seymour Lawrence. Thomson, J.J. (1971). A defense of abortion. In R.M. Baird & S.E. Rosenbaum (Eds.), The ethics of abortion: pro-life vs. pro-choice (pp. 29-44). New York: Prometheus Books. Tooley, M. (1972). Abortion and infanticide. In R.M. Baird & S.E. Rosenbaum (Eds.), The ethics of abortion: pro-life vs. pro-choice (pp. 45-59). New York: Prometheus Books. Turner, F. (1992). Abortion can be a moral sacrifice. In L. Bruno (Ed.), The abortion controversy. (pp. 55-58). Warren, M.A. (1973). On the moral and legal status of abortion. In R.M. Baird & S.E. Rosenbaum (Eds.), The ethics of abortion: pro-life vs. pro-choice (pp. 75- 82). New York: Prometheus Books. Zindler, F.R. (1985). Human life does not begin at conception. In C.P. Cozic (Ed.), Abortion: opposing viewpoints (pp. 17-22). San Diego: Greenhaven Press, Inc.

Act 2 Scenes 8-10 Essay -- Aboriginals Moore River Australia Essays

Act 2 Scenes 8-10 The scene starts at superintendent’s office at Moore river Native settlement, the date set 10 April 1933. It represents an institution of white power-a place of forced confinement and conformity. The importance of the construction of this place is to give a medium for the Aboriginals to resist such conformity, as demonstrated by Joe and Mary escaping from white control. It reinforces the theme of the play –‘the refusal of aboriginal people to submit to the ways of European invaders’ The 1930’s represented two major political turning points of Western Australia. Firstly, the loss of the James Mitchell’s seat as the premier of Northam to the labor government epitomises changing white attitudes by electing a fairer government system. In previous scenes, Mitchell’s desperate attempt to win the election by sending the Aboriginals to Moore River as an act of racial segregation reflects his inequality and exploitation of his political hegemony. The second political concern at this historical point was the success of the secession referendum vote. This secession of the 1930’s was led by the organisation Dominion League of Western Australia and in success of secession, Western Australia would break away from federation and the rule of the Commonwealth of Australia, therefore having dominion status similar to that of New Zealand. Despite the favoured votes for the secession referendum, by 1935 the proposition to Parliament was denied and WA still remained pa...

Men Makes Better Teachers Than Women

Men Make Better Teachers than women (Just for comment)The simple answer is women should teach by men teacher and boy should teach by women teacher so both are study interestingly and paying attention on their subject so students get a good marks I will discuss in general view about men make better teachers than women and in my point of view both are good and bad. There are many characteristics, techniques and other factors that make a successful and exemplary teacher. These may be varied as the teachers themselves.However, there are certain time-tested attributes, characteristics, practices and environmental actors which contribute immensely to teacher success. The main topic of today is to be categorized as Teacher-Personality and Attitude, Teacher-Student Psychology and Teacher-Institute Relationship and who can be teach better men and women? If teacher doesn’t have knowledge and clear concept of his teaching he shouldn’t teach. There are some cases that, a teacher ma y be a good student in his class but he cannot be a good teacher. Good teacher requires communication skills and Teacher-Student Psychology between students and teachers.A teacher also a good friend of you. He understand the nature of students either they are in mood of study or not and how should I convey my knowledge to students in a fun or serious, in story or in joke. That’s make the teacher best that he/she understand the student on their level and if some students asks any question he/she try to understand that what students want to say and try to clear this concept on his mind. One thing also play a big role in class, â€Å"Teacher-Personality and Attitude with students†. There are certain personality characteristics and attitude issues which will help a teacher excel at his/her work.It is widely believed that if a teacher is presentable, he/she will give a good impression to the students especially in the first few days of the class. This indicates that the tea cher is taking his/her job seriously and acting professionally and the students eventually will appreciate that. In addition to looking presentable, the teacher’s personality in class plays a big role in how efficiently the class will be conducted. It is essential that the teacher send the right signals to the students so they will understand the basic rules in the class. A teacher also should active and energetic, some teachers are good in nowledge but they don’t have much communication skills with student in the result, the students are sleeping in the class and they don’t much concentrate on that subject. According to my point of view I generally categorized the teacher in different situation that are: An average teacher just tells the students that what did they do? But, A good teacher explain the students that how did they do? And also, A very good teacher demonstrate the students that like this way they can do? And a great and best teacher inspires you, he gives motion to student to achieve the target for not be a good student but also a very good person in community.That teachers are very rare today that they sincere with their students and wish they always done a best in every field of life. A famous quote â€Å"In every successful student behind a teacher, and in failure a strict teacher† So that’s reason our villages people don’t study more because teacher treat them strictly and they prefer work instead of study. The teacher who follow these things it is a good teacher either it is women or men. But in my personnel point of view a man teacher is more best then women teacher because he behaves sometime strict and he doesn’t compromise with their students as women teacher.

Journal Entries for the play, “Of the Fields, Lately” by David French. Essay

The play Of the Fields, Lately portrays an average working class family living in the cold, isolated area of Newfoundland. Written by David French, The Mercer Family struggles with themselves in their close-knit traditions and encounter difficulties in getting along with each other. The Mercer Family is not a picture-perfect family as the Brady Bunch. They have values and behaviour which predominantly affects their lifestyles. The relationship between Jacob and Ben is very bizarre considering that they are father and son. Their relationship is revealed to be bitter and dysfunctioning, as proven through the conversation between Ben and his mother, Mary (pg. 7). This implies that Ben does not wish to interact with his father in any way. He doesn’t even take notice of his father’s presence in the household. He is immediately insulted when Mary questions him regarding his father. Ben states to Mary that he does not wish to establish any type of new relationship with Jacob. Mary acts as a peacekeeper in order to establish a â€Å"sense of belonging† between the two but both Ben and Jacob simply avoid each other. The last line from this selection (pg.7) is the most effective part of the dialogue since it is interesting to notice that Ben suspects his mother wants him to leave the house, when she only wishes for him to acknowledge the presence of Jacob. Another piece of dialogue which defines the relationship between Ben and Jacob is when Ben is asked about his flight coming home (pgs 9-10). Both Ben and Jacob stare at each other painfully, waiting for the other person to respond. This reveals that this family is so dysfunctional that they cannot even speak to one another in a sincere manner for a few seconds. Usually, people are very emotional and especially excited to speak to a family member  after a distant period of time. People tend to resolve past disputes by apologizing for whatever barrier had caused them to not speak to each other. However, in this particular case, it certainly seems that the â€Å"brick wall† is simply a barrier too wide for them to resolve their differences. The â€Å"brick wall† illustrates the tension in the father-son relationship. The wall symbolizes the force that keeps the two from expressing themselves with each other. In addition, the third moment that sheds light on Ben and Jacob’s relationship takes place when Ben asks Jacob if he can stay at home for a short while (pgs 65-66) Once again, Jacob shows his stubbornness by unwilling to open up to Ben when he offers to move back in. Ben feels that deep down inside, Jacob wants him to stay at home, but Jacob shows his unreasonableness by stating that Ben can stay home on his mother’s share of the house. The significance of the title, Of the Fields, Lately relates and holds great significance to many aspects of David French’s play. It ties into the themes of isolation and faà §ade. The title sheds light on the major events that shape the relationships of the play. The characters in the play resemble the ideal characteristics of the Newfoundland land and cultural customs. Newfoundland is a distant province in the Eastern Coast of Canada, off the mainland. This resembles Ben being a distant place away from Jacob. The elements of stagecraft also play an important role in the play. The music establishes the mood of the scene. The lighting and set design also play a role in setting the atmosphere of the play. The room with the radio shows the audience how distant away Ben and Jacob’s relationship really is. The stagecraft also helps express things that simply wouldn’t surface. There is a lot of conflict stirred up on Of the Fields, Lately which raises the question as to who is to blame for the family’s situation. Jacob blames  Ben for not being there when he suffered a heart attack. Ben blames Jacob for beating him as a child and embarrassing him amongst his childhood. Mary feels distressed since her sister has recently passed away. Mary is stuck in the middle of things as she tries to act as a peacekeeper in the ongoing dispute between Ben and Jacob. I feel that if there is someone to blame for the family’s situation, it must be Ben. I feel that Ben is the character responsible for the pain experienced in the Mercer Family. Ben has to realize that as children, we make mistakes many times in our lives and our parents are there for us everyday to assist us whenever we’re in trouble. Perhaps even if it were Jacob’s fault, Ben has to realize to forgive and forget. Instead, he remains passive and becomes frightened by his father, rather than accepting his father for who he is. Ben has to learn that we all make mistakes as human beings. Despite this, Ben is still bitter as he doesn’t hold much back. He was not willing to listen to his father for any reason and now he will regret having the opportunity to clear things up when Jacob was still alive. The character who I feel is not responsible for the pain experienced in the family is Mary. This is certainly because she acts as a peacekeeper in trying to resolve the ongoing quarrel between Ben and Jacob. She is reminiscent of the good times where her life was less problematic. She wants him to come to terms and resolve their pity issues but they are both unwilling to do so, showing their stubbornness. Mary feels very awful since she not only has to cope with her sister’s death, but experience this quarrel that she feels must be prevented in order to resolve peace in the family. Also, she has to cope with Jacob’s heart condition. Perhaps his heart attack was a result of his drinking and smoking problem. Wiff is also getting on Mary’s nerves. Mary tries to discuss with both Ben and Jacob individually but it seems as if they are too distant away from each other and can never break the â€Å"brick wall† standing between them. The main interest in Of the Fields, Lately was the relationship between Ben and Jacob. They have a very dysfunctional relationship for a father and son. As the play progresses, their relationship grows further apart. The audience  becomes aware about the past and present situation as it is revealed. Ben and Jacob are in constant arguments and can only hope to obtain a beneficial relationship in the future. Despite neither Ben nor Jacob reaching a compromise with each other, the future of their relationship is foretold through Wiff’s stories of himself and Dot. Wiff is portrayed to be a sensitive, misunderstood man whose monologues foretell the audience that the relationship between Wiff and Dot was quite similar to Ben and Jacob’s relationship. It seems that Wiff and Dot undergo difficult times. They are portrayed to be very loving and intimate with each other in the beginning of the play. Perhaps Ben and Jacob were like this when Ben was young too. Dot sees Wiff as an ignorant, self absorbed person. Likewise, Ben sees Jacob in the same light. Despite this, Dot still deeply cared for Wiff. Ben does not care for his father, while it seems that deep down inside, Jacob actually cared for Ben. Jacob made his sacrifice for Ben by moving the family to Newfoundland in pursuit of finding better education. Ben ignored him and did not acknowledge nor take advantage of his father’s sacrifice. Jacob was a hardworking man who brought home the dough after a long day’s work. Towards the end, Jacob shows an interest in Ben’s personal life. This suggests that the â€Å"brick wall† is slowing being taken down; they are able to communicate in a compatible way. When Wiff refers to moments when he was having affairs with other women, I feel that this resembles the moments when Ben hated Jacob. Jacob was so proud of Ben at the baseball game, even though it didn’t seem this way. This can be related to the love that Dot shared with Wiff. Both of these relationships took an intense downfall after this given moment. When Jacob dies, Ben regrets having the opportunity to apologize and make up with his father. Likewise, when Dot dies, Wiff regrets neglecting her by engaging in affairs with other women. Overall, Ben’s relationship with Jacob strongly relates to Wiff’s relationship with Dot. It foreshadows that Ben would have made the decision to resolve the issue with his father before it became too late. Unfortunately, this did not occur. Jacob is the character who I relate most to in Of the Fields, Lately. Although, I am not exactly a stubborn, abusive, old bully who has no admiration for his family, I never conclude fights! I am the type of person that openly starts them to obtain reaction from the other person(s). I find myself also to be an aggressive person at times. I feel that my perspective must be heard and understood for someone. I dislike resolving conflicts from the past and tend to hang onto situations that appeal to me for a long period of time. I also feel that I should let things go and establish relationships with those from my distant past who I haven’t kept in touch with. Similarly, Jacob should have given Ben another chance for their relationship to be reconstructed. It is arguable to state whether or not Of the Fields, Lately is a very realistic play. Each person has their own views based upon how they interpret and analyze the play. The realism can be determined by the characters, the dialogue, situations, and the mood going through the air during each scene. I believe that this is a realistic piece of work because it includes many disturbed characters who have a very struggling life. For instance, Jacob is an old, strict father who always picks on Ben. He also acts rudely, especially to his family members. His family loves him and wishes that he stops working and rest due to his poor heart condition. The doctor also sees Jacob as a stubborn, old man who won’t listen to the doctor’s orders or what’s best for him. He doesn’t want to see Jacob get hurt so then Mary holds responsibility for the family. Jacob should respect their wishes and spend time with his family before he ends up dying, rather than trying to burn out in his own glory by working in his last few days. Ben is the son who feels that his father treats him unfairly. Wiff is an alcoholic who has marriage problems and who suffers from severe depression at times. Mary is trying to cope with the death of her sister and her husband who is in poor health and also trying to keep the family’s structure together. Sam, Jacob’s friend from the past brought about different aspects of Jacob’s early life that was not established earlier. He portrayed innocence and curious behaviour that Jacob likely occupied when he was younger. Also, Billy (Ben’s older brother) is angry with Ben and agreed with  Jacob’s way. Sarah portrays a different perspective as she tells her story by siding with Jacob, showing Ben to be ignorant and the source of the family’s problems. I agree totally with Sarah’s interpretation. Ike Squires is jealous and bitter towards Jacob. He is portrayed as a success man who is doing well for himself. Ike feels bitter about Jacob obtaining all the attention! It seems that many of the characters in French’s play do not get along. Although these problems do not take place in most families, it still seems possible. In our world, there is always a family member who has a kind of problem like the ones displayed in Of the Fields, Lately. There are often people who are alcoholics, siblings who are fighting, family members not speaking to each other due to some reason. The Mercers remind me of â€Å"The Simpsons† with their constant family disputes. I feel that the situations in Of the Fields, Lately seem unrealistic since most Canadian families do not have excessive problems like the Mercers taking place. Every family has their times of grief and there is no skepticism that there are families who possess a lot of stress on their backs, like the Mercers. Ben and Jacob need to come to terms; Mary needs to resolve her issues with Wiff and most importantly, everyone needs to â€Å"forgive and forget† in order to sustain a happy life! *NOTE: This is my collection of journals that I have compiled into this creative writing piece; it is not a formal essay and this is why I use personal pronouns such as â€Å"I†*