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The limited infor- mation presented here is based on research by the authors buy 25mg doxepin with visa, and unless other- wise referenced is based on this work proven doxepin 75 mg. A particular effort has been made to give credit directly to the sabedores who have given specific information. The authors have recorded ancestral knowledge of healing pueblos or ethnic groups of the Amazon forest. They do not suggest that the plants and other natural products should by used by anyone in any way. As has been reported the sabedores adhere to restrictions and regulations and have a lifetime of experience of survival in tropical forest conditions. Each of these treatments has been used by the sabedores following the necessary restrictions, dosage and follow-up by the relevant sabedor. Photography Unless otherwise stated, photographs were taken by Ann Mitchell and Blanca de Corredor. Theoretical proposal for an innovative study of the cognitive mechanisms of cultural adaptation. Plantas de los Dioses Orígenes del uso de los alucinógenos (Plants of the Gods – Origins and use of hallucinogens). Ministry of National Education; Amazon Fund Programme; Coordina- tion of Amazon Education; Fundación Caminos de identidad (Foundation of Paths of Identity), 1996: 12–13, 16–18, 29. Cross-cultural adaptation in urban ethnobotany: The Colombian folk pharmacopoeia in London. Sabedores, Sabedoras: Metodos de recuperación, preservación y manejo de la selva y de la várzea. Wisemen, wisewomen: Methods of recuperation, preservation and management of the forest and varzea. Interview with Sabedor Rene Moreno Vaneo, Cocama ethnic group, Leticia, Amazonas Colombia 23/11/08. Interview with Sabedor Oscar Román Enokayai-, Araracuara, Caquetá medio 26/6/91 3. Interview with Sabedor Oscar Román Enokayai-, Sabedora Alicia Sánchez Román, Tomás Román 9/4/89 4. Interview with Sabedor Gabriel Tapuy, ethnic group: Quichua del Napo, Amazon forest, Ecuador 26/11/94. Interview with Sabedor Hilario Rivero Yukuna, Yukuna ethnic group from Mirití, Amazonas, Colombia. Interview with Sabedores: Placido Mendoza Ethnic group Uitoto Muina, Araracuara, Amazonas; Oscar Román Enokayai- Ethnic group Uitoto Muina Araracuara, Amazonas; Cacique Eduardo Paki-, Muinane, del Resguardo Villa Azul, Caquetá medio, heart of the Colombian tropical forest. Interview with Sabedor Joa¯o Costa Rios Filho, Ethnic group Quichua, Leticia, Amazonas, Colombia 22/11/08. Interview with Sabedor Isaias Román Sánchez, Muina, Uitoto ethnic group, who has inherited the career of his father: elder: Oscar Román Enokai- 19/2/98. Interview with Sabedor Oscar Román Enokayai- and his son Tomás Román, Uitoto, Araracuara, Caquetá medio, Colombia 1989. Interview with Sabedora Alicia Román Sánchez, Uitoto, Araracuara, Caquetá medio, Amazonas, Colombia 7/4/92. Interview with Sabedor Oscar Román Enokayai- and his son Tomás Román, Uitoto, Araracuara, Caquetá medio, Colombia 27/6/91. These 46 states lie between 20ºN and 32ºS and support vegetation ranging from lowland rain forest to semi-desert succulent scrubland (Figure 5. Of these, the first seven are also among the ten most common causes of mortality in the region, together with malignant neoplasms, cerebrovascular disease and ischaemic disease. One of the products of colonial occupation was the introduction to Africa of the western allopathic system of medicine. The traditional medical practices of the continent, despite their ancient origins, were largely ignored by colonial authorities. This state of affairs can, in part, be Traditional medical practice in Africa | 83 Figure 5. This is borne out by the fact that only a handful of African indigenous remedies have found their way into western pharma- copoeias (Table 5. Traditional African medicine is also considered to be the sum total of practices, measures, ingredients and procedures of all Traditional medical practice in Africa | 85 Table 5. This is especially true of neighbouring states, between which ethnic ties may be very strong and political boundaries quite artificial. There is evidence to suggest that the different groups lived side by side for several centuries, interacting and intermarrying. After the arrival of European settlers in South Africa in 1652, the inexorable process of cultural disruption continued, to the point where only small isolated groups of San and Khoi-khoi peoples are to be found in southern Africa today. Little remains of their traditional medical practices and there is a real risk that much of their medical knowledge will be lost to modern science. This is regrettable because the San in particular are widely acknowledged as having been exceptional economic botanists. It is likely, however, that, through intermarriage and cultural exchange, much San medicinal plant lore has been subsumed into modern traditional medical practice in southern Africa. This is recognised as an illness, the symptoms of which are caused by ancestral spirits seeking to possess the future healer. Once the call to priesthood is diagnosed, the patient is immediately placed under the care of a traditional healer and enters training as an initiate. Training can last from a minimum of 7 years to 15 years, depending on culture, religion, ethnic group and custom. Favourable healer:patient ratios (an estimated 1:200 in some African states) ensure that traditional healthcare is accessible to most, usually at affordable rates. Indeed, many healers will accept payment (or a gift) only when the patient has been cured. Three factors – affordability, accessibility and cultural acceptability – together account very largely for the fact that some 80% of Africa’s people today utilise traditional systems of medicine.

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Remedies are made from plant doxepin 10mg lowest price, to prevent various diseases and allergies engage the animal generic 10 mg doxepin overnight delivery, and mineral sources and are available at Law of Similars by administering trace amounts of health food stores and pharmacies. Recognized as a a disease component, such as a virus, to promote scientific method of medicine, homeopathy was an antibody-producing immune response in the developed in the late 18th century by the German body. He observed that pathos, “suffering,” may be found in ancient med- symptoms of a disease could be induced in a healthy ical practices and now has a history of more than individual by certain substances. In addition to the Law of Similars (like edy cinchona, for example, could produce malaria- cures like), Hahnemann, who was appalled by cer- like symptoms, Hahnemann observed, and he tain conventional methods of the time such as experimented with numerous plant, mineral, and bloodletting, the use of leeches, and purging with animal substances on himself and other volunteers. Hoxsey therapy 57 Described universally as a humane, low-cost, The Definitive Guide, Celestial Arts, Berkeley, Calif. It is said its thousands of remedies, proponents continue to that the ancient Greek physician Hippocrates believe in its efficacy for relief from a multitude of touted a combination of honey, water, and certain illnesses and conditions. Eating sprigs of parsley dis- premise of a remedy’s “energy imprint,” “essence,” pels bad breath, and mint has long been known as or “memory” of symptoms that calls forth the body’s a remedy for indigestion. Home remedies may also “vital forces” to elicit relief of those symptoms, be based on ethnic traditions and beliefs. In New Orleans, homeopaths treated 1945 amarga, and prickly ash bark—in a potassium victims of the 1879 yellow fever epidemic, with a iodide solution, plus a regimen of nutrition, supple- 5. According to interventions and disciplines, homeopathic treat- reports, the cancer medicines were handed down to ments are “of tremendous value in reversing dis- the Illinois-born Hoxsey from his great-grandfather. When all the humors were balanced, an indi- banned the sale of all Hoxsey tonics, and all vidual maintained health, and the body needed to Hoxsey’s alleged requests for scientific investigation expel any excesses in order to keep the humors in of his formulas went unanswered. Hydrotherapy, largely based on the use of reopened as the Bio-Medical Center in Tijuana, water internally and externally, along with a diet Mexico, under the auspices of Hoxsey’s longtime and exercise regimen, became popular in the 19th clinical nurse, Mildred Nelson, R. Yellow bile was considered warm external use (the topical version was a paste that and dry; black bile was thought of as cold and dry. If the level of one of these humors cer remedy among Lake Superior Native Ameri- became excessive or deficient, illness occurred in cans). Since laboratory studies of its effectiveness three stages: first, the humoral change; second, were conducted, the Hoxsey formula has been fever or what was called “boiling”; third, the dis- reported to reduce tumors, inhibit tumor growth, charge of one of the humors in the form of urine, and provide antioxidant and antiestrogen activities feces, phlegm, bleeding, sweating, vomiting, and so that are known to have a deleterious effect on can- on. It has also been shown that laughter have responded particularly favorably to the stimulates the body’s natural production of endor- Hoxsey therapy. Hoxsey believed that his herbal phins, chemicals almost identical to the painkiller preparations balanced the chemical process in the morphine. In mind-body medicine, laughter, opti- body; his idea was that cancer is a systemic disease mism, and other qualities associated with pleasure that “occurs only in the presence of a profound are believed to have a positive impact in the treat- physiological change in the constituents of body ment of disease. Box 727, 615 General Hydrotheraphy and hydrothermal therapy are Ferreira, Colonia Juarez, Tijuana, B. Hydrothermal therapy involves varying tempera- ture of the water according to need, as in hot baths, humectant A substance used as a moisturizer. Therapeutic water treat- ments have been known and used for centuries as humors, the four The ancient theory that human an all-purpose therapy based on the ancient con- temperament and propensity for disease are based cept of the four bodily humors and the need to hydrotherapy 59 diminish or expel excessive humors such as bath to a still bath because whirlpools had a more phlegm and bile. Water is also a significant compo- direct impact on the ravages of stress and anxiety nent in the traditional Chinese and Native Ameri- than a still bath. A major proponent of A number of hydrotherapy techniques are avail- hydrotherapy was Vincenz Priessnitz (1799–1851), able: baths and showers, neutral baths, sitz baths, whose system of administering water therapeuti- contrast sitz baths, foot baths, cold-mitten friction cally in numerous ways along with an appropriate rub, steam inhalation, hot compresses, cold com- nutrition and exercise regimen sparked the estab- presses, alternating hot and cold compresses, heat- lishment of hydropathic institutions in the United ing compresses, body wrap, wet sheet pack, and States and Europe. After douching, dry off excess France, have been a destination for thousands of water, dress, and exercise. This may apy stimulates the body’s reaction to hot and cold, help treat headache, migraine, hypotension, to the protracted application of heat, to pressure insomnia, contusions, and varicose veins and other exerted by the water, and to the sensation of the vascular injury. The nerves of the skin tract infections, irritable bladder, sciatica, or during carry impulses into the body, where they can menstruation. Generally heat soothes treat rheumatism, varicose veins, arthritis, and cer- and relaxes the body, slowing the activity of inter- tain forms of paralysis. For example, muscle tension and but including the lower torso, is used to help treat stress anxiety may warrant a hot bath or shower. Baths, the liver, enlargement of the gallbladder, and stone pools, hot tubs, or any body of water in which one formation. Hydrotherapy and hydrothermal cold hands, nervous disorders, neuralgia and paral- therapy are chiefly used to tone up the body; to ysis, rheumatism of the arms, heart problems, ver- stimulate digestion, blood flow, and the immune tigo, headaches, and catarrh in the nose and throat. This is useful for chronic bronchitis and hydrotherapy quiets the lungs, heart, stomach, and bronchial asthma, and angina pectoris. Caution: endocrine system by stimulating nerve reflexes on Moderate the temperature if there is risk of the spinal cord. It is useful for person study at the University of Minnesota, 85 the treatment of bronchitis, bronchial asthma, dis- percent of the participants preferred a whirlpool ease of the larynx and vocal cords, headaches, ner- 60 hydrotherapy vous excitability, varicose veins of the legs, toning, Baths may be warm and rising-temperature and stimulating cardiac and respiratory activity. Do baths or may employ herbs and other substances not use if there is blood stasis in the pulmonary cir- added to the water. Hot water is then gradually added until the disease, multiple sclerosis, bronchial asthma, and level reaches the navel. This form of bath Neck douches help alleviate headaches, migraines, should last 15 to 30 minutes, not more than three tension in the shoulder and neck, hypersensitivity times per week, and is not recommended for indi- to changes in the weather, mild depression, tinni- viduals who have cardiac or circulation disorders, tus, vertigo, and arthrosis of the hand and finger hemorrhoids, or varicose veins. Warning: It is not to be used by persons with which the feet are placed into calf-high cold water, high blood pressure, enlargement of the thyroid, or may help relieve varicose veins, susceptibility to raised intraocular pressure. How- left over the forehead, and repeatedly from the ever, it is not recommended for individuals who forehead to the chin, then in circles over the face. Sauna heat onset of a common cold or cold feet or for treat- acts more quickly to eliminate toxins through the ment of tension but is not effective for those with skin, though some consider the moist air of a steam varicose veins, edema, or lymphostasis. Other ther- bath to have a more satisfying effect on the respira- apeutic baths include herbal baths (using valerian, tory system. A sauna promotes deep relaxation lavender, linden, chamomile, hops, burdock root, while it stimulates circulation, increases heart rate, sage, lemongrass, and many other herbs), the cold has an immune-modulating effect, promotes hor- arm bath, the rising-temperature arm bath, and the mone production, encourages mucosal secretions in sitz bath. A cold sitz bath may help hemorrhoids or back, chronic rheumatoid arthritis, bronchial inflammation of the anus; a warm or rising-temper- asthma, unstable hypertension (stages I and 11), ature sitz bath may relieve difficulty in voiding the and impaired peripheral blood circulation. How- bladder, an irritable bladder, and inflammation or ever, saunas should not be taken by individuals infection of the prostate or enhance preparation for who have acute rheumatoid arthritis, acute infec- pregnancy. Do not use warm or rising-temperature tion, active tuberculosis, sexually transmitted dis- sitz baths for hemorrhoids. To prevent ill effects of excessive should be in a relaxed position while a linen cloth heat, wipe your face often with a cold cloth and stay moistened with cold water (warm water for respi- in the sauna no longer than 15 to 20 minutes. The moist linen cloth hyperthermia Various types of heat treatment is in turn wrapped with a dry cotton or linen cloth.

Although people think that positive and negative events will make a huge difference in their lives purchase doxepin 25 mg on-line, and although these changes do make at least some difference in life satisfaction 75mg doxepin otc, they tend to be less influential than we think they are going to be. Motivations are often considered in psychology in terms of drives and goals, with the goal of maintaining homeostasis. The desire to be thin can lead to eating disorders including anorexia nervosa and bulimia nervosa. Uncontrolled obesity leads to health problems including cardiovascular disease, diabetes, sleep apnea, arthritis, Alzheimer‘s disease, and some types of cancer. The sex hormone testosterone is particularly important for sex drive, in both men and women. Sexual behavior varies widely, not only between men and women but within each sex. The vast majority of human beings have a heterosexual orientation, but a smaller minority is primarily homosexual or bisexual. The love and sexual lives of homosexuals and bisexual are little different from those of heterosexuals, except where their behaviors are constrained by cultural norms and local laws. Chapter 11 Personality Identical Twins Reunited after 35 Years Paula Bernstein and Elyse Schein were identical twins who were adopted into separate families immediately after their births in 1968. It was only at the age of 35 that the twins were reunited and discovered how similar they were to each other. She loved her adopted parents and older brother and even wrote an article titled ―Why I Don‘t Want to Find My Birth Mother. In 2003, 35 years after she was adopted, Elyse, acting on a whim, inquired about her biological family at the adoption agency. Elyse dialed Paula‘s phone number: ―It‘s almost like I‘m hearing my own voice in a recorder back at me,‖ she said. The two women met for the first time at a café for lunch and talked until the late evening. Looking at this person, you are able to gaze into your own eyes and see yourself from the outside. Elyse and Paula You can learn more about the experiences of Paula Bernstein and Elyse Schein by viewing this video. One of the most fundamental tendencies of human beings is to size up other people. When we make these statements, we mean that we believe that these people have stable individual characteristics— their personalities. Personalityis defined as an individual’s consistent patterns of feeling, [2] thinking, and behaving (John, Robins, & Pervin, 2008). The tendency to perceive personality is a fundamental part of human nature, and a most adaptive one. If we can draw accurate generalizations about what other people are normally like, we can predict how they will behave in the future, and this can help us determine how they are likely to respond in different situations. Understanding personality can also help us better understand psychological disorders and the negative behavioral outcomes they may produce. We‘ll consider how and when personality influences our behavior, and how well we perceive the personalities of others. We will also consider how psychologists measure personality, and the extent to which personality is caused by nature versus nurture. The fundamental goal of personality psychologists is to understand what makes people different from each other (the study of individual differences), but they also find that people who share genes (as do Paula Bernstein and Elyse Schein) have a remarkable similarity in personality. Define and review the strengths and limitations of the trait approach to personality. Early theories assumed that personality was expressed in people‘s physical appearance. One early approach, developed by the German physician Franz Joseph Gall (1758–1828) and known as phrenology, was based on the idea that we could measure personality by assessing the patterns of bumps on people‘s skulls (Figure 11. In the Victorian age, phrenology was taken seriously and many people promoted its use as a source of psychological insight and self- knowledge. Machines were even developed for helping people analyze skulls (Simpson, [1] 2005). However, because careful scientific research did not validate the predictions of the theory, phrenology has now been discredited in contemporary psychology. Sheldon (1940) argued that people with more body fat and a rounder physique (“endomorphs‖) were more likely to be assertive and bold, whereas thinner people (“ectomorphs‖) were more likely to be introverted and intellectual. As with phrenology, scientific research did not validate the predictions of the theory, and somatology has now been discredited in contemporary psychology. Another approach to detecting personality is known as physiognomy, or the idea that it is possible to assess personality from facial characteristics. In contrast to phrenology and somatology, for which no research support has been found, contemporary research has found that Attributed to Charles Stangor Saylor. Despite these results, the ability to detect personality from faces is not guaranteed. Olivola and [4] Todorov (2010) recently studied the ability of thousands of people to guess the personality characteristics of hundreds of thousands of faces on the website What‘s My Image? In contrast to the predictions of physiognomy, the researchers found that these people would have made more accurate judgments about the strangers if they had just guessed, using their expectations about what people in general are like, rather than trying to use the particular facial features of individuals to help them. It seems then that the predictions of physiognomy may also, in the end, find little empirical support. Personality as Traits Personalities are characterized in terms of traits, which are relatively enduring characteristics that influence our behavior across many situations. Personality traits such as introversion, friendliness, conscientiousness, honesty, and helpfulness are important because they help explain consistencies in behavior. The most popular way of measuring traits is by administering personality tests on which people self-report about their own characteristics. Psychologists have investigated hundreds of traits using the self-report approach, and this research has found many personality traits that have important implications for behavior. You can see some examples of the personality dimensions that have been studied by psychologists and their implications for behavior in Table 11.

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Disguising threatening impulses by attributing A man with powerful unconscious sexual desires for Projection them to others women claims that women use him as a sex object 25mg doxepin for sale. Generating self-justifying explanations for our A drama student convinces herself that getting the Rationalization negative behaviors part in the play wasn‘t that important after all buy doxepin 10mg free shipping. Reaction Making unacceptable motivations appear as Jane is sexually attracted to friend Jake, but she formation their exact opposite claims in public that she intensely dislikes him. Retreating to an earlier, more childlike, and A college student who is worried about an important Regression safer stage of development test begins to suck on his finger. Repression (or Pushing anxiety-arousing thoughts into the A person who witnesses his parents having sex is denial) unconscious later unable to remember anything about the event. A person participates in sports to sublimate Channeling unacceptable sexual or aggressive aggressive drives. A person creates music or art to Sublimation desires into acceptable activities sublimate sexual drives. The most controversial, and least scientifically valid, part of Freudian theory is its explanations of personality development. Freud argued that personality is developed through a series of psychosexual stages, each focusing on pleasure from a different part of the body (Table 11. Freud believed that sexuality begins in infancy, Attributed to Charles Stangor Saylor. Pleasure comes from the genitals, and the conflict is with sexual desires for the opposite- Phallic 3 years to 6 years sex parent. Genital Puberty and older If prior stages have been properly reached, mature sexual orientation develops. In the first of Freud‘s proposed stages of psychosexual development, which begins at birth and lasts until about 18 months of age, the focus is on the mouth. During this oral stage, the infant obtains sexual pleasure by sucking and drinking. Infants who receive either too little or too much gratification becomefixated or “locked‖ in the oral stage, and are likely to regress to these points of fixation under stress, even as adults. On the other hand, the child who was overfed or overly gratified will resist growing up and try to return to the prior state of dependency by acting helpless, demanding satisfaction from others, and acting in a needy way. During this stage children desire to experience pleasure through bowel movements, but they are also being toilet trained to delay this gratification. Freud believed that if this toilet training was either too harsh or too lenient, children would become fixated in the anal stage and become likely to regress to this stage under stress as adults. On the other hand, if the parents had been too lenient, the anal expulsive personality results, characterized by a lack of self-control and a tendency toward messiness and carelessness. The phallic stage, which lasts from age 3 to age 6 is when the penis (for boys) and clitoris (for girls) become the primary erogenous zone for sexual pleasure. During this stage, Freud believed that children develop a powerful but unconscious attraction for the opposite-sex parent, as well as a desire to eliminate the same-sex parent as a rival. Freud based his theory of sexual development in boys (the “Oedipus complex‖) on the Greek mythological character Oedipus, who unknowingly killed his father and married his mother, and then put his own eyes out when he learned what he had done. Freud argued that boys will normally eventually abandon their love of the mother, and instead identify with the father, also taking on the father‘s personality characteristics, but that boys who do not successfully resolve the Oedipus complex will experience psychological problems later in life. Although it was not as important in Freud‘s theorizing, in girls the phallic stage is often termed the “Electra complex,‖ after the Greek character who avenged her father‘s murder by killing her mother. Freud believed that girls frequently experienced penis envy, the sense of deprivation supposedly experienced by girls because they do not have a penis. The latency stage is a period of relative calm that lasts from about 6 years to 12 years. During this time, Freud believed that sexual impulses were repressed, leading boys and girls to have little or no interest in members of the opposite sex. According to Freud, sexual impulses return during this time frame, and if development has proceeded normally to this point, the child is able to move into the development of mature romantic relationships. But if earlier problems have not been appropriately resolved, difficulties with establishing intimate love attachments are likely. Freud‘s Followers: The Neo-Freudians Freudian theory was so popular that it led to a number of followers, including many of Freud‘s own students, who developed, modified, and expanded his theories. The neo-Freudian theories are theories based on Freudian principles that emphasize the role of the unconscious and early experience in shaping personality but place less evidence on sexuality as the primary motivating force in personality and are more optimistic concerning the prospects for personality growth and change in personality in adults. Alfred Adler (1870–1937) was a follower of Freud who developed his own interpretation of Freudian theory. Adler proposed that the primary motivation in human personality was not sex or aggression, but rather the striving for superiority. According to Adler, we desire to be better than others and we accomplish this goal by creating a unique and valuable life. We may attempt to satisfy our need for superiority through our school or professional accomplishments, or by our enjoyment of music, athletics, or other activities that seem important to us. He argued that children who are either overly nurtured or overly neglected by their parents are later likely to develop an inferiority complex—a psychological state in which people feel that they are not living up to expectations, leading them to have low self-esteem, with a tendency to try to overcompensate for the negative feelings. People with an inferiority complex often attempt to demonstrate their superiority to others at all costs, even if it means humiliating, dominating, or alienating them. Carl Jung (1875–1961) was another student of Freud who developed his own theories about personality. Jung agreed with Freud about the power of the unconscious but felt that Freud overemphasized the importance of sexuality. Jung argued that in addition to the personal unconscious, there was also acollective unconscious, or a collection of shared ancestral memories. Jung believed that the collective unconscious contains a variety of archetypes, or cross-culturally universal symbols, which explain the similarities among people in their emotional reactions to many stimuli. Important archetypes include the mother, the goddess, the hero, and the mandala or circle, which Jung believed symbolized a desire for wholeness or unity. For Jung, the underlying motivation that guides successful personality is self-realization, or learning about and developing the self to the fullest possible extent. Karen Horney (the last syllable of her last name rhymes with “eye‖; 1855–1952), was a German physician who applied Freudian theories to create a personality theory that she thought was more balanced between men and women. Horney believed that parts of Freudian theory, and particularly the ideas of the Oedipus complex and penis envy, were biased against women.

However cheap doxepin 10mg fast delivery, when substitution therapy is initiated in custody or when symptomatic treatment alone is provided buy doxepin 25 mg, the doctor may well need to assess the effect of the treatment before an interview occurs. The Impact of Psychiatric Illnesses There has been a considerable amount of research on the manner in which certain functional psychiatric illnesses can affect the reliability of testimony (78,79). Thus, anxiety increases a suspect’s suggestibility and depression can lead to feelings of guilt and poor self-esteem that render a suspect vulnerable to providing a false confession (52). Psychiatric illness may also render a per- son unfit for interview by virtue of its effect on cognitive processes or because of associated thought disorder (80,81). However, careful questioning that avoids the use of leading questions and coercive pressures can often elicit reliable testimony. That a suspect suffers from an illness, such as schizophrenia, does not necessarily mean that he or she is unfit for interview (82); such an opinion would depend on the likely demand characteristics of the interview and the functional assessment by the doctor. Learning Difficulties The police rarely have difficulty recognizing moderate or severe learn- ing difficulties, but borderline or low-to-normal intelligence may not be obvi- ous even to trained observers (83–85). It is important to identify people with learning difficulties—questions regarding reading and writing ability and the need for special help with education can be useful—because they will be par- ticularly vulnerable in police custody. Such individuals may have difficulties in understanding their legal rights and in communicating with police officers. The Effect of Physical Illnesses on Fitness for Interview The presence of any physical illness renders an individual more vulner- able when faced with a stressful situation, such as a custodial interrogation. Features, such as anxiety or depression, affect a person’s ability to function during the police interview, and physical illness—especially if severe—is as likely to cause anxiety and depression as any other form of stress (87). The severity of the emotional response will depend on the nature of the illness itself, the personality of the individual, and social circumstances. Suspects who are already coping with physical illness are more likely to focus on the short-term consequences of their behavior than the long-term outcomes, thus increasing the risk that they might provide a false confession (52). Because the effect of physical illness on a person’s coping strategy is not disease-specific, depending more on the actual or perceived severity of the ill- ness rather than the nature of the illness itself, the actual diagnosis is unimpor- tant. By contrast, there are many physical illnesses in which characteristic disturbances in cognitive functioning have been recognized (88). With these illnesses, the nature and degree of the mental disturbance produced depends entirely on the diagnosis of the underlying condition. The more common of the conditions encountered in custody are discussed in the following subheadings. Epilepsy It is now clear, after long historical dispute, that a predisposition to epileptic fits does not mean per se that there will be associated intellectual impairment, personality disorder, or mental illness. Most patients with epi- lepsy remain mentally normal, although this does depend on the presence, site, and extent of any brain damage underlying the epilepsy (89). However, those patients with epilepsy without significant brain damage do, nonetheless, remain prone to cognitive impairment, particularly memory impairment, as a result of their epilepsy and its treatment. The potential impact of this cognitive impairment must be considered when assessing a patient with epilepsy’s fitness for interview. For example, problems with concentration, memory, and intellectual func- tioning can be seen when anticonvulsant drugs are administered in toxic doses or unsuitable combinations (90). Suspicion should be raised when a suspect complains of mental lethargy or appears to be performing below expected levels, symptoms particularly associated with toxicity. Further problems with the reliability of testimony from epileptics may be related to their personality. Patients with epilepsy are often overprotected in childhood by concerned parents and, later in life, can be exposed to pro- 226 Norfolk and Stark found social and occupational discrimination (91). All these factors can lead to personality problems, which include feelings of insecurity, low self-esteem, and dependency. Individuals with these personality traits are likely to be highly suggestible and may strive to please interviewing officers by giving answers that seem plausible and consistent with the external cues provided, even though the responses are known to be untrue. The neurophysiological consequences of an epileptic seizure can seri- ously distort an individual’s perception of events occurring around the time of the seizure, thus rendering any subsequent account of that event potentially unreliable. Complex disturbances of thinking, memory, or awareness may fea- ture as part of an aura preceding the actual seizure. These may include distor- tion sense of time, mental confusion, or feelings of depersonalization or déjà vu. The seizure may also be ushered in by distorted perceptions or actual hal- lucinations of sight, hearing, taste, or smell. When the ensuing fit is mild or abortive, the connection between these reported experiences and their epilep- tic causation may be missed (91). Typical absences, or petit mal epilepsy, is a disorder that usually starts in childhood, but the attacks can continue into adult life. Absence attacks are brief, with an abrupt onset and termination; several such absences may occur in quick succession, producing significant gaps in memory. Further cognitive disturbances can follow in the wake of seizures, with clouding of consciousness and disorientation lasting for a few minutes or up to an hour or more, so that recollection for events occurring during the postic- tal period may also be unreliable (89). Head Injury Head injuries may occur in several circumstances involving possible criminal offenses, such as road traffic accidents and assaults; therefore, it is not uncommon to encounter detainees with head injuries in police custody. The potential for the head injury to affect the person’s ability to recall the details of the accident or assault can assume considerable importance. Memory loss for events occurring around the time of the injury is likely to occur whenever there has been diffuse brain damage of a degree sufficient to cause concussion. In most cases, loss of consciousness will accompany the head injury, but this is not invariable, and it is possible for patients to display both retrograde and posttraumatic amnesia without losing consciousness (88). Retrograde amnesia refers to the loss of memory for events that immedi- ately precede the head injury. Individuals can often indicate with fair preci- sion the last event that they can clearly recollect. In road traffic accidents, the journey may be recalled up to a specific point, which allows an estimate of the Care of Detainees 227 extent of the pretraumatic gap to be made. Such amnesia is usually short in duration and can usually be counted in minutes or hours rather than days or weeks. Indeed, when the retrograde amnesia lasts for a long time the explana- tion often results from hysteria. Retrograde amnesia may render a suspect unfit for interview immedi- ately after the head injury, but the doctor should be aware that the extent of the amnesia can change with time.

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The present study examined these items in terms of (i) active coping (made up of all the problem focused strategies discount doxepin 75 mg visa, such as planning doxepin 10mg with visa, suppression of competing activities, restraint coping, seeking instrumental support, active coping, and three of the emotion-focused scales, such as seeking emotional support, positive reinterpretation, acceptance); (ii) disengagement/ denial (which is made up of behavioural and mental disengagement items and denial); (iii) focus on and venting emotions; and (iv) turning to religion (see Chapter 3 for a discussion of coping). The present study computed a composite ‘emotional distress score’ composed of items relating to anxiety, depression, fatigue and confusion. Subjects completed measures of diet (using a food frequency questionnaire), alcohol and substance use (e. These were included in order to determine whether any differences in immune status were due to the psychosocial or behavioural factors. In addition, immune functioning was also related to diet (vitamin A) and alcohol use. This supports the prediction that psychosocial variables may influence health and illness. However, the results indicate that the link between psychological variables and health status is probably via both a behavioural pathway (i. Cancer is defined as an uncontrolled growth of abnormal cells, which produces tumours called neoplasms. There are two types of tumours: benign tumours, which do not spread throughout the body, and malignant tumours, which show metastasis (the process of cells breaking off from the tumour and moving elsewhere). There are three types of cancer cells: carcinomas, which constitute 90 per cent of all cancer cells and which originate in tissue cells; sarcomas, which originate in connective tissue; and leukaemias, which originate in the blood. The main causes of cancer mortality among men in England and Wales are lung cancer (36 per cent), colorectal cancer (11 per cent), prostate cancer (9 per cent); and among women are breast cancer (20 per cent), lung cancer (15 per cent), colorectal cancer (14 per cent), ovarian cancer (6 per cent), cervical cancer (3 per cent). While the overall number of cancer deaths do not appear to be rising, the incidence of lung cancer deaths in women has risen over the past few years. The role of psychology in cancer A role for psychology in cancer was first suggested by Galen in  200–300, who argued for an association between melancholia and cancer, and also by Gedman in 1701, who suggested that cancer might be related to life disasters. Psychology therefore plays a role in terms, attitudes and beliefs about cancer and predicting behaviours, such as smoking, diet and screening which are implicated in its initiation (details of these behaviours can be found in Chapters 2, 5, 6, 7, 8 and 9). In addition, sufferers of cancer report psychological consequences, which have implications for their quality of life. The role of psychology in cancer is also illustrated by the following observations: s Cancer cells are present in most people but not everybody gets cancer; in addition although research suggests a link between smoking and lung cancer, not all heavy smokers get lung cancer. The role of psychology in cancer will now be examined in terms of (1) the initiation and promotion of cancer; (2) the psychological consequences of cancer; (3) dealing with the symptoms of cancer; and (4) longevity and promoting a disease-free interval. The psychosocial factors in the initiation and promotion of cancer 1 Behavioural factors. Behavioural factors have been shown to play a role in the initiation and promotion of cancer. These behaviours can be predicted by examining individual health beliefs (see Chapters 2, 5, 6 and 9). They found that if this stressor could be controlled there was a decrease in the rate of tumour development. However, if the stressor was perceived as uncontrollable this resulted in an increase in the development. However, Sklar and Anisman (1981) argued that an increase in stress increased the promotion of cancer not its initiation (see Chapter 11 for a discussion of the relationship between stress and illness). It has also been suggested that life events play a role in cancer (see Chapter 10 for a discussion of life events). A study by Jacobs and Charles (1980) examined the differences in life events between families who had a cancer victim and families who did not. They reported that in families who had a cancer victim there were higher numbers who had moved house, higher numbers who had changed some form of their behaviour, higher numbers who had had a change in health status other than the cancer person, and higher numbers of divorces indicating that life events may well be a factor contributing to the onset of cancer. They identified 29 studies, from 1966 to 1997, which met their inclusion criteria (adult women with breast cancer, group of cancer-free controls, measure of stressful life events) and concluded that although several individual studies report a relationship between life events and breast cancer, when methodological problems are taken into account and when the data across the different studies is merged ‘the research shows no good evidence of a relationship between stressful life events and breast cancer’. Control also seems to play a role in the initiation and promotion of cancer and it has been argued that control over stressors and control over environmental factors may be related to an increase in the onset of cancer (see Chapter 11 for a discussion of control and the stress–illness link). If an individual is subjected to stress, then the methods they use to cope with this stress may well be related to the onset of cancer. For example, maladaptive, disengagement coping strategies, such as smoking and alcohol, may have a relationship with an increase in cancer (see Chapters 3 and 11 for a discussion of coping). Bieliauskas (1980) highlighted a relationship between depression and cancer and suggests that chronic mild depression, but not clinical depression may be related to cancer. Over the past few years there has been some interest in the relationship between personality and cancer. Temoshok and Fox (1984) argued that individuals who develop cancer have a ‘type C personality’. A type C personality is described as passive, appeasing, helpless, other focused and unexpressive of emotion. Eysenck (1990) described ‘a cancer-prone personality’, and suggests that this is characteristic of individuals who react to stress with helplessness and hopelessness, and individuals who repress emotional reactions to life events. An early study by Kissen (1966) sup- ported this relationship between personality and cancer and reported that heavy smokers who develop lung cancer have a poorly developed outlet for their emotions, perhaps suggesting type C personality. At follow-up they described the type of individual who was more likely to develop cancer as having impaired self-awareness, being self-sacrificing, self-blaming and not being emotionally expressive. The results from this study suggest that those individuals who had this type of personality were 16 times more likely to develop cancer than those individuals who did not. However, the relationship between cancer and personality is not a straightforward one. It has been argued that the different personality types predicted to relate to illness are not distinct from each other and also that people with cancer do not consistently differ from either healthy people or people with heart disease in the predicted direction (Amelang and Schmidt-Rathjens 1996). Low control suggests a tendency to show feelings of helplessness in the face of stress. Commitment is defined as the opposite of alienation: individuals high in commitment find meaning in their work, values and personal relationships. Individuals high in challenge regard potentially stressful events as a challenge to be met with expected success. The emotional state of breast cancer sufferers appears to be unrelated to the type of surgery they have (Kiebert et al. However, persistent deterioration in mood does seem to be related to previous psychiatric history (Dean 1987), lack of social support (Bloom 1983), age, and lack of an intimate relationship (Pinder et al. Women with breast cancer often report changes in their sense of femininity, attractiveness and body image. This has been shown to be greater in women who have radical mastectomies rather than lumpectomies (e.

In addition buy cheap doxepin 10 mg, the mood measurements reflect an attempt to examine the less rational aspects of sex doxepin 25 mg online. Methodology Subjects A total of 219 Australian gay men completed a questionnaire containing questions about two sexual encounters in the preceding year. Questionnaire The subjects were asked to think about two sexual encounters in the preceding year, one involving safe sex and one involving unsafe sex. They were asked to complete the following ratings/questions about each of these encounters: 1 Details of the encounters. The encounter was then divided into four temporal stages: (i) start of the ‘evening’; (ii) time of meeting the potential partner; (iii) start of sex; and (iv) during sex. The subjects were then asked to answer questions about each stage of the encounter for both the safe and unsafe encounter. The subjects were asked to rate (i) the type of desires that had been in their mind (e. The subjects were asked (i) how much time there was between meeting the partner and the start of sex; (ii) details of the sex (e. The subject was asked (i) how intoxicated he was; and (ii) whether he/his partner communicated about safe sex. They related to (i) ways in which the subjects may have engaged in unsafe sex without really wanting to (e. Here we are on cloud nine: how can we suddenly interrupt everything just to get a bit of rubber out and roll it on’, ‘Other guys fuck without a condom much more often than I do. Results The results were analysed to examine the characteristics of both the safe and unsafe encounter and to evaluate any differences. The results showed that type of partner, desires, sexual attraction, mood, knowledge of condom availability and communication about safe sex differentiated between the two encounters. However, level of intoxication was not related to the type of resulting encounter. The results were also analysed to examine the frequency of self-justifications used. The most common justification was a belief that they could have sex without ejaculation (‘It’ll be safe to fuck without a condom, so long as we don’t cum up the arse. Conclusion This study is interesting because it integrates cognitions with situational factors. The authors discuss the results in terms of developing educational interventions to promote safe sex. In addition, the authors emphasize that it is the thoughts and beliefs that occur during sexual encounters which are perhaps more relevant than those described in the cold light of day. To further the understanding of the process of interaction, some research has used qualitative methods and has focused on negotiation between people. They suggested that although the process of negotiation may be hindered by embar- rassment as suggested by some of the health promotion campaigns, this ‘embarrassment over using condoms is not simply a question of bad timing but indicates a very complex process of negotiation’. Therefore, they place condom use within the context of the relationship and rather than see the interaction between individuals as only one component of the process of condom use, they place this interaction centrally. Some of the interviewees reported no difficulties in demanding safe sex, with one woman saying ‘if they don’t want to wear a condom, then tough, you know, go and find someone else’. Another woman said ‘he really hates using them, so I used to say to him, look, right, look, I have no intention of getting pregnant again and you have no intention to become a father so you put one of these on’. However, other women described how difficult it was to suggest safe sex to their partner with reasons for this relating to not wanting to hurt their boyfriend’s feelings, not wanting to ‘ruin the whole thing’, and not being able to approach the subject. One woman said ‘When I got pregnant I thought to myself, “I’m not using a condom here, I’m not using anything” but I just couldn’t say, just couldn’t force myself to say, “look you know”. In addition, it provides a relationship context for individual beliefs and cognitions. They conceptualized negotiation in terms of six strategies: withholding sex, direct request, education, relationship conceptualizing, risk information and deception and indicate that these factors account to variance in a range of safer sex variable such as behavioural intentions and actual condom use. Therefore qualitative and quantitative research has emphasized the importance of negotiation which seems to have been taken on board by Health Education Campaigns with advertisements highlighting the problem of raising the issue of safer sex (e. Are interviews simply another method of finding out about people’s cognitions and beliefs? Debates about methodology (quantitative versus qualitative) and the problem of behaviour as an interaction are relevant to all forms of behaviour but are particularly apparent when discussing sex. This social context takes many forms such as the form and influence of sex education, the social meanings, expectations and social norms developed and presented through the multiple forms of media, and created and perpetuated by individual communities and the wider world of gender and inequality. However, it is important to have some acknowledgment and understanding of this broader world. They interviewed a group of young people in the south of England to examine how they interpreted ‘knowing their partners’. The results suggest that 27 per cent of the interviewees had had sex within 24 hours of becoming a couple, that 10 per cent of the sample reported having sex on the first ever occasion on which they met their partner, and that over 50 per cent reported having sex within two weeks of beginning a relationship. In terms of ‘knowing their partner’, 31 per cent of males and 35 per cent of females reported knowing nothing of their partner’s sexual history, and knowing was often explained in terms of ‘she came from a nice family and stuff’, and having ‘seen them around’. The results from this study indicate that promoting ‘knowing your partner’ may not be the best way to promote safe sex as knowledge can be interpreted in a multitude of different ways. This presentation is epitomized by govern- ment health advertisement slogans such as ‘You know the risks: the decision is yours’. School sex education programmes Information about sex also comes from sex education programmes at school. It wasn’t really personal’ and ‘Nobody ever talks to you about the problems and the entanglements, and what it means to a relationship when you start having sex’. It has been argued that this impersonal and objective approach to sex education is counter- productive (Aggleton 1989) and several alternatives have been suggested. This approach would attempt to shift the emphasis from didactic teachings of facts and knowledge to a discussion of sex within a context of relationships and the broader social context. An additional solution to the problem of sex education is a skills training approach recommended by Abraham and Sheeran (1993). They argued that individuals could be taught a variety of skills, including buying condoms, negotiation of condom use and using condoms. These skills could be taught using tuition, role-play, feedback, modelling and practice. They are aimed at changing cognitions, preparing individuals for action and encouraging people to practise different aspects of the sequences involved in translating beliefs into behaviour.

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