Literature review on depressive disorders

Literature review on depressive disorders Depression is one of the most prevailing medical disorders. Depression has been recognized as a distinct pathological entity from early Egyptian times (Reus, 2000). Depression is the most common psychiatric disorders. Each year, more than 100 million people worldwide develop clinical depression (Bjornlund, 2010). During a lifetime, it is estimated that between 8% and 20% of the general population will experience at least one clinically significant episode of depression (Kessler et al., 1994). Major depression causes the fourth-highest burden of disease among all medical diseases. It is expected to rise to second place, preceded only by cardiovascular disease by 2020 (Thompson, 2007). Depressive disorder has significant potential morbidity and mortality. Suicide is the second leading cause of death in persons aged 20-35 years. Depressive disorder is a major factor in around 50% of these deaths (Semple et al., 2005). A suicide attempt among patients with major depressive disorder is associated with the presence and severity of depressive symptoms. Lack of partner, previous suicide attempts and time spent in depression are risk factors of suicide attempts. Reducing the time of depression is a likely preventive measure of suicide (Sokero et al., 2005). Depression is a medically significant condition that needs to be diagnosed and properly treated. It is a severe disorder, tend to recur, and it costs the individual and society (Stefanis Stefanis, 2002). Epidemiology of Depressive Disorders Prevalence and Incidence Studies show substantial variability in the lifetime rates of depression. Lifetime rates are ranging from under 5 percent to 30 percent, but it is widely accepted that the lifetime prevalence is between 10 percent and 20 percent. The 6-month prevalence rate is considered to be between 2 percent and 5 percent based on surveys in several countries (Young et al., 2010). A cross- sectional WHO world health survey carried out in 60 countries covering all regions of the world showed a 1-year prevalence of depressive episode of 3.2 percent, with a 95 percent confidence interval of 3.0 percent to 3.5 percent (Moussavi et al., 2007). The life time prevalence of depression for adults varied from 3 percent in Japan to 16.9 percent in the US, with most countries in the range between 8 percent and 12 percent (Andrade et al., 2003). The prevalence of major depressive disorder is estimated to be about 2 percent in children (Birmaher et al., 1996). Estimates of the point prevalence of MDD in adolescence is range from 0.4 percent to 8.3 percent. Lifetime prevalence rates across adolescence range is from 15 percent to 20 percent (Roberts Bishop, 2005). In Dubai the prevalence of depressive disorders were 13.7% among women mostly neurotic depression (Ghubash et al., 1992). About 12-20% of persons experiencing an acute episode develop a chronic depressive syndrome, and up to 15% of patients who have depression for more than one month commit suicide (Reus, 2000). Risk Factors Genetics There is now substantial evidence that the genetic factors are of major importance as risk factors for vulnerability to major depression. Traditional estimates have put the heritability about 40 % (Joyce, 2003). Genetic influences are most marked in patients with more severe forms of depressive disorder and biological symptoms. The morbid risk in first-degree relatives is increased in all studies. This elevation is independent of the effects of environment or upbringing. In fewer severe forms of depression, genetic factors are fewer significant and environmental factors relatively more important (Souery et al., 1997). Gender Major depressive disorder is the twofold greater prevalence in women than in men independent of country or culture. The reasons for the difference are hypothesized to involve hormonal differences, the effects of childbirth, and differing on psychosocial stressors for women and for men (Sadock Sadock, 2007). Age Major depressive disorder occurs in all cultures and affects all age groups. Depression is common in Childhood and late adult. The mean age of onset is generally in the 30s (Dunner, 2008). Early-onset depression is associated with a higher female to a male ratio than late-onset depression. The incidence of major depressive disorder in old age is lower in both sexes. However, first incidence and prevalence of minor depressive disorder shows the opposite trend (Rihmer Angst, 2009). Personality In younger people, mild depression tends to affect anxious or dependent personalities with poor tolerance of stress. Severe depressive illness in middle age tends to affect hard-working, conventional people with high standards and obsessional traits. Obsessional personalities can find it, particularly difficult to adapt to stress or life changes, as in work or relationships, and this can come out as depression (Gill, 2007). Childhood experiences Early theorizing suggested that the loss of a parent in childhood increased the later risk for major depression. However, many studies have examined this issue; they have inconsistently found it to be a risk factor for adult depression (Tennant, 1988). Childhood sexual abuse has been established as a risk factor for adult major depression (Joyce, 2003). Marital status Rates of depressive illness is lower in the married man than in the single, widowed, or divorced. The protective effects of marriage are less marked in women. Young married women with children have high rates of depression; single women have low rates (Gill, 2007). However, those in a poor marriage with deficient intimacy are at increased risk of depression (Weissman, 1987). Social classes and occupation People of low socio-economic status (i.e. low levels of income, employment, and education) are at higher risk of depression (Semple et al., 2005). While job satisfaction can enhance mental well-being, the workplace can also be a source of stress and depression. However, the consequences of unemployment probably have far changed on mental health. The economic hardship to the unemployed and their families with depression due to long-term unemployment hindering job seeking and re-employment chances, exacerbated by loss of confidence and perceived loss of skills (Strandh, 2001). Depression is more common in urban than a rural district (Gill, 2007). Physical illness Having a chronic or severe physical illness is associated with an increased risk for depression. This suggests that the stress associated with a serious or chronic physical illness may act by bringing out an individuals lifetime vulnerability to depression (Joyce, 2003). Etiology of Depressive Disorders The etiology of major depressive disorder is unknown (Dunner, 2008). Multiple etiologic factors genetic, biochemical, psychodynamics, and socio-environmental may interact in complex ways to cause major depressive disorder (Loosen Shelton, 2011). GENETIC MODELS OF DEPRESSION There is evidence to suggest a genetic basis for the major depression disorder. Occurrences of major depressive episodes are clearly cluster in families. This degree of increased risk is about three to five times that of the normal population. Twin and adoption study is consistent with a genetic contribution to major depressive disorders. However, studies suggest that other factors also are important (Schiffer, 2008). Actually, it is the tendency to become depressed in response to life events that are inherited (Hirschfield Weissman, 2002). Moreover, family and twin studies show a clear genetic component of life events themselves (Kendler Karkowski, 1997). ENDOCRINE MODELS OF DEPRESSION Neuroendocrine abnormalities that reflect the neurovegetative signs and symptoms of depression include: first, increased cortisol and corticotrophin-releasing hormone (CRH) secretion, second, an increase in adrenal size, third, a decreased inhibitory response of glucocorticoids to dexamethasone, and fourth, a blunted response of thyroid-stimulating hormone (TSH) level to infusion of thyroid-releasing hormone (TRH). Antidepressant treatment leads to normalization of these pituitary-adrenal abnormalities (Reus, 2008). Thyroid hormone may potentiate both the speed and the efficacy of antidepressant medication (Altshuler et al., 2001). Furthermore, there also evidence that patient resistant to other treatments may respond to addition of thyroid hormone (Joffe Marriott, 2000). NEUROCHEMICAL MODELS OF DEPRESSION The most famous hypotheses generated to account for the actual mechanism of the mood disorder focus on regulatory disturbances in the monoamine neurotransmitter systems, particularly that involving norepinephrine and serotonin (5-hydroxytryptamine). It has also been hypothesized that depression is associated with an alteration in the acetylcholine-adrenergic balance and characterized by a relative cholinergic dominance. In addition, there are suggestions that dopamine is functionally decreased in some cases of major depression. Original reports suggesting that patients with endogenous depression experienced either decreased noradrenergic or serotonergic activity now appear to be overly simplistic. All the monoamine neurotransmitter systems are interrelated and subject to compensatory adaptation to perturbation over time (Reus, 2000). CELLULAR MODELS OF DEPRESSION Most current hypotheses of neurotransmitter function in altered mood states have focused on changes in receptor sensitivity and second messenger systems. With a few exceptions long-term antidepressant treatment is associated with reduced postsynaptic ÃŽÂ ²-adrenergic receptor sensitivity and enhanced postsynaptic serotonergic and cyclic adenosine monophosphate activity (Reus, 2000). A number of intracellular changes which involve alterations in cellular second messenger systems and ion channels are postulated to occur in depression. Intracellular changes may involve changes in guanine triphosphate binding proteins, G-proteins on the receptor, cyclic adenosine monophosphate (cAMP) regulation, reduced protein kinase activity and brain derived neurotrophic factor (BDNF). Antidepressants as well as ECT increase BDNF and BDNF have been found to increase functioning of serotonin (Kay Tasman, 2006). NEUROIMAGING MODELS OF DEPRESSION Recent rapid advances in neuroimaging methodology have attempted to relate the phenomenological abnormalities seen in depression to changes in brain structure and function (Fu et al., 2003). There is increasing evidence that depression may be associated with structural brain pathology. Magnetic resonance imaging (MRI) has revealed decreased volume in cortical regions, particularly the frontal cortex, but also in subcortical structures, such as the hippocampus, amygdala, caudate, and putamen (Sheline Minyun, 2002). The most widely replicated Positron emission tomography (PET) scanning (PET) finding in depression is decreased anterior brain metabolism, which is generally more pronounced on the left side. In addition, increased glucose metabolism has been observed in several limbic regions (Thase, 2009). Neuroimaging has also helped in the further investigation of the neurochemical deficits in depression. The largest study to date using PET found a marked global reduction in brain 5-HT2 receptor binding (22-27%) in various regions (Sheline Minyun, 2002). There is an increasing literature using neuroimaging to understand suicidality, particularly in depression. Mann (2005) cites several imaging studies suggesting decreased serotonin function in suicidal individuals and decreased activity in associated areas of the dorsal system involved in emotion regulation, such as the anterior cingulate. A number of regions more speci ¬Ã‚ c to suicidality are also highlighted, particularly those that seem to be involved in impulsivity and aggression, such as the right lateral temporal cortex, right frontopolar cortex, and right ventrolateral prefrontal cortex (Goethals et al., 2005). This literature has as well found structural abnormalities in relevant regions of the dorsal system, particularly the orbitofrontal cortex, which has speci ¬Ã‚ cally been linked to potential decision making de ¬Ã‚ cits that could lead to suicidality. Thus, such data potentially suggest clinically important subtype differentiation in brain function for this sym ptom (Ingram, 2009). PSYCHOSOCIAL FACTORS Stressful life events more often precede first, rather than subsequent, episodes of mood disorders. Some clinicians believe that life events play the primary or principal role in depression; others suggest that life events have only a limited role in the onset and timing of depression. Data indicate that the life event sometimes associated with development of depression is losing a parent before age 11. The loss of a spouse is the environmental stressor most often associated with the onset of an episode of depression. Another risk factor is unemployment; persons out of work are three times more likely to report symptoms of an episode of major depression than those who are employed (Sadock Sadock, 2007). PSYCHOLOGICAL FACTORS PSYCHODYNAMIC THEORIES OF DEPRESSION Psychoanalytic theory as postulated by both Freud and Abraham emphasized the connection between mourning and melancholia. The melancholic patient experiences a loss of self esteem with associated helplessness, prominent guilt and self deprecation. According to the theory, these symptoms result from internally directed anger or aggression turned against the self, leading to a depressive experience (Kay Tasman, 2006). Melanie Klein understood depression as involving the expression of aggression toward loved ones. Edward Bibring regarded depression as a phenomenon that sets in when a person becomes aware of the discrepancy between extraordinarily high ideals and the inability to meet those goals. Edith Jacobson saw the state of depression as similar to a powerless, helpless child victimized by a tormenting parent. Silvano Arieti observed that many depressed people have lived their lives for someone else (a principle, an ideal, or an institution, as well as an individual) rather than for themselves. Heinz Kohuts conceptualization of depression, derived from his self-psychological theory, rests on the assumption that the developing self has specific needs that must be met by parents to give the child a positive sense of self-esteem and self-cohesion. When others do not meet these needs, there is a massive loss of self-esteem that presents as depression. John Bowlby believed that damaged early attachments and traumatic separation in childhood predispose to depression. Adult losses are said to revive the traumatic childhood loss and so precipitate adult depressive episodes (Sadock Sadock, 2007). Interpersonal Theory (IPT) Interpersonal theory focuses on difficulties in current interpersonal functioning. In IPT, depression is held to relate to one or more of four functional areas: grief, interpersonal role disputes, role transitions, and interpersonal deficits. In IPT, the reciprocal relationship between ones mood and interpersonal events is investigated. Stressful life events may overwhelm coping ability and produce a depressed mood, which then contributes to ongoing interpersonal difficulties. Once this relationship is identified, modifying it becomes the focus of treatment (Grunze et al., 2008). THE COGNITIVE MODEL Cognitive theories of depression hypothesize that particular negative ways of thinking increase individuals probability of developing and maintaining depression when they experience stressful life events. According to these theories, individuals that possess specific maladaptive cognitive patterns are vulnerable to depression because they tend to develop negative information processing about themselves and their experiences (Sanderson McGinn, 2001). Behavioral Models Martin Seligman developed the theory of learned helplessness as he was searching for an animal model of depression. In this formulation, individuals in stressful situations in which they are unable to prevent or alter an aversive stimulus (i.e., physical or psychic pain) withdraw and make no further attempts to escape even when opportunities to improve the situation become available (Reus, 2000). Clinical Features of Depressive Disorders Depressed mood is the most characteristic symptom, occurring in over 90% of patients. The patient usually describes himself or herself as feeling sad, low, empty, hopeless, gloomy, or down in the dumps. The physician often observes changes in the patients posture, speech, faces, dress, and grooming consistent with the patients self-report. A small percentage of patients does not report a depressed mood, usually referred to as masked depression. Similarly, some children and adolescents do not exhibit a sad demeanor, presenting instead as irritable or odd (Loose Shelton, 2008). Anhedonia manifests with a lack of interest in formerly pleasurable activities; sports and hobbies, etc. no longer arouse patients, and if they force themselves to partake, they take no pleasure in such activities. Libido is routinely lost and there is no pleasure in sexual activity (Moore, 2008). Depressed individuals frequently report cognitive changes that include impaired attention, concentration, and decision making (Woo Keatinge, 2008). Sleep may be increased or decreased. Insomnia is one of the major manifestations of depressive illness and is characterized more by multiple awakenings, especially in the early hours of the morning than by difficulty falling asleep. Young depressive patients, especially those with bipolar tendencies, typically complain of hypersomnia, sleeping as long as 12 to 15 hours a day. Obviously, such patients will have difficulty getting up in the morning. Although decreased sexual desire occurs in both men and women, women are more likely to complain of infrequent menses or cessation of menses. Decrease or loss of libido in men often results in erectile failure (Dunner, 2008). Appetite can be decreased or increased with or without weight loss or gain; the most typical pattern is a decrease in appetite with weight loss (Faravelli et al., 2005). Psychomotor disturbances include, on the one hand, agitation and on the other, retardation. Agitation, usually accompanied by anxiety, irritability and restlessness, is a common symptom of depression. In contrast, retardation, manifested as slowing of bodily movements, mask-like facial expression, lengthening of reaction time to stimuli, increased speech paucity. The extreme form of retardation is an inability to move or to be mentally and emotionally activated (stupor) (Stefanis Stefanis, 2002). The attitude and outlook of these patients may become profoundly negative and pessimistic. They have no hope for themselves or for the future. Self-esteem sinks and the workings of conscience become prominent. Patients see themselves as worthless, as having never done anything of value. Rather they see their sins multiply before them (Moore Jefferson, 2004). Suicidal ideation is almost always present. At times this may be merely passive and patients may wish aloud that they might die of some disease or accident. Conversely, it may be active, and patients may consider hanging or shooting themselves, jumping from bridges, or overdosing on their medications. Often the risk of suicide greatest as patients begin to recover. Still seeing themselves worthless and hopeless sinners, these patients, now with some relief from fatigue, may find themselves with enough energy to carry out their suicidal plans. The overall suicide rate in major depressive disorder is about 4 percent; among those with depressive episodes severe enough to prompt hospitalization, however, the rate rises to about 9 percent (Moore, 2008). Up to 15 percent of untreated or unsatisfactorily treated patients give up hope of ever recovering and kill themselves (Akiskal, 2009). Proximal risk factors for suicide include agitation, current suicidal intent or plan, severe depression and/or anhedonia, instability (e.g., alcohol abuse or decline in health), recent loss, and availability of a lethal agent. Distal risk factors include a current suicidal intent with a plan, personal or family history of suicide, aggressive or impulsive behavioral pattern, poor response to treatment for depression, poor treatment alliance, a history of abuse or trauma, and/or substance or alcohol abuse (Hawton Harriss, 2007). Paranoid symptoms can occur among patients with major depression. There are usually exaggerated ideas of reference associated with notions of worthlessness. Characteristic delusions of patients with depression are those of a hypochondriacal or nihilistic type. Hallucinations may also occur in major depression. These commonly involve accusatory voices or visions of deceased relatives associated with feelings of guilt (North Yutzy, 2010). Adolescent-onset depression often takes on a more chronic course associated with dysthymic symptoms. In adolescence, MDD appears to be associated with greater fatigue, worthlessness and more prominent vegetative signs. The sequelae of depression in children and adolescents are sometimes characterized by disruption in school performance, social withdrawal, increased behavioral disruption and substance abuse (Kay Tasman, 2006). Among the elderly, agitation and hypochondriacal concerns are common, and indeed the patient may deny feeling depressed at all. Memory and concentration may be so impaired in demented elderly. In the past, this has been called a pseudodementia, presumably to distinguish it from other kinds of dementia. However, a better, more recent term is dementia syndrome of depression (Moore Jefferson, 2004). Elderly people are more likely than younger adults to have a depressive illness that goes undetected and thus untreated, which may contribute to the high risk of suicide among older patients. The suicide rate of this population is higher than for any other age group, and the attempts are serious: One out of four succeeds, compared with one out of two hundred for young adults (Bjornlund, 2010). Diagnosis and Classification of Depressive Disorders Depression conceives a variety of psychic and somatic syndromes, and the diagnosis is derived from diligent clinical observation (Grunze et al., 2008). Depression as a term in popular use is mostly considered to be synonymous with low mood or grief. Depression mental (and medical) disorder, however, is different, and besides low mood, is characterized by a variety of additional symptoms (Grunze et al., 2008). Depressive disorders are defined by clinically derived standard diagnostic criteria of emotional, behavioral, cognitive, and somatic symptoms, and associated with functional impairment. They are assessed through structured clinical interviews and observation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 2000) and International Classification of Diseases 10 (ICD-10; World Health Organization, 1992) use the same criteria to diagnose depressive disorders in children, adolescents, and adults (Roberts Bishop, 2005). The term affect usually refers to the outward and changeable manifestation of a persons emotional tone, whereas mood is a more enduring emotional orientation that colors the persons psychology (American Psychiatric Association, 1984). Subtypes of Depressive Disorders: Major Depressive Disorder (MDD) According to DSM-IV-TR, a major depressive disorder occurs without a history of a manic, mixed, or hypomanic episode. A major depressive episode must last at least 2 weeks. Typically, a person with a diagnosis of a major depressive episode also experiences at least four symptoms from a list that includes changes in appetite and weight, changes in sleep and activity, lack of energy, feelings of guilt, problems thinking and making decisions, and recurring thoughts of death or suicide (Sadock Sadock, 2007). Table 1.1.1 shows DSM-IV-TR criteria for major depressive episode. Unipolar and Bipolar Depression When a person develops an episode of mania they are conventionally identified as suffering from bipolar disorder. Patients with depressive episodes only are diagnosed as having unipolar depression (Baldwin Birtwistle, 2002). Melancholic Depression Individuals with melancholic depression experience a loss of pleasure in all or almost all activities or are nonreactive to usually pleasurable activities (American Psychiatric Association, 2000). In addition, according to the DSM-IV-TR, the individual must display three or more symptoms from a list of six, such as worsening depression in the morning, early morning awakening, significant weight loss or anorexia, and the perception that ones mood is qualitatively different from that experienced in other contexts. Melancholic depression is considered a severe form of affective illness (Woo Keatinge, 2008). Self-belittlement, an exaggerated sense of guilt, a feeling that life is pointless and that one has failed in everything are very often accompanied by severe recurrent suicidal thoughts and thoughts about death. However, the risk of suicide usually first becomes prominent when the patient is in the process of improvement and the psychomotor inhibition decreases while, at the same time, expectations about the capacity to cope with the psychosocial situation are still very negative (Wasserman, 2001). Table 1.1.1 DSM-IV-TR criteria for major depressive episode Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. insomnia or hypersomnia nearly every day psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) fatigue or loss of energy nearly every day feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide The symptoms do not meet criteria for a mixed episode. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one. The symptoms persist for longer than two months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. Source. Reprinted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000. Masked Depression About 50% of major depressive episodes are unrecognized because depressed mood is less obvious than other symptoms of the disorder. Alexithymia, or inability to express emotions in words, can focus a patients attention on physical symptoms of depression, such as insomnia, low energy, and difficulty concentrating, without any awareness of feeling depressed. Common masked presentations of major depression include marital and family conflicts, absenteeism from work, poor school performance, social withdrawal, loss of a sense of humor, and lack of motivation (Joska Stein, 2008). Seasonal depression Seasonal depression is a condition in which depressed mood accompanied by lethargy, excessive sleep, increased appetite, and irritability recurs each winter. It was believed to respond exclusively to light treatment. However, recent studies indicate it can be just as effectively managed with standard methods of treatment, such as medication (Gill, 2007). Psychotic Depression The term psychotic depression (or delusional depression) refers to a major depressive episode accompanied by psychotic features (i.e., delusions and/or hallucinations). Most studies report that 16%-54% of depressed patients have psychotic symptoms. Delusions occur without hallucinations in one-half to two-thirds of the adults with psychotic depression, whereas hallucinations are unaccompanied by delusions in 3%-25% of patients. Half of all psychotically depressed patients experience more than one kind of delusion (Dubovsky Thomas, 1992). Dysthymic Disorder Dysthymia refers to symptoms of mild depression, which have persisted for at least two years. Symptoms fluctuate more than in major depression, and they are typical including insomnia, lack of appetite, or poor concentration (Bech, 2003). Double Depression Double depression characterized by the development of MDD superimposed upon a mild, chronic dysthymic disorder (DD). Individuals with double depression often demonstrate poor interepisode recovery. Furthermore, 25% of the depressed individuals manifest double depression (First Tasman, 2006). Table 1.1.2 shows DSM-IV-TR criteria for dysthymic disorder. Table 1.1.2 DSM-IV-TR diagnostic criteria for dysthymic disorder Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. Presence, while depressed, of two (or more) of the following: poor appetite or overeating insomnia or hypersomnia low energy or fatigue low self-esteem poor concentration or difficulty making decisions feelings of hopelessness

Gulliver’s Travels Essay

Swift wrote ‘Gulliver’s Travels’ to be read by the literate higher classes of the British society, he did this because he hoped that the higher class people would have the higher ranked jobs in the government and could change Britain. In chapter 6 Gulliver gave a long detailed, description of Britain’s History and the way in which it had been ruled in Swift’s time, the king was ‘perfectly astonished with the historical account’ Gulliver gave him. The king tried to protest that the affairs of Britain during the last century were ‘only a heap of conspiracies, rebellions, murders, massacres, banishments, faction, cruelty, rage, madness, hatred or ambition could produce. ‘ All of these are negative points about England which clearly shows Swift’s dislike of the country. Swift uses the King’s response to make his point even clearer; this allows Swift to show his disgust of British society without stating that he himself said it; this offended many people. Another aspect of British society which Swift was very interested in was the physical human body and its functions. The public in the 18th century found the human body embarrassing, including things such as sanitation, which is perhaps why swift satirised it to show his unusual, for his time, interest in such things. Swift however was disgusted by bodily functions and he showed his disgust by using the differences for Gulliver in Lilliput and Brobdingnag. In Lilliput, where Gulliver was the large person, the empress was disgusted when she looked up at Gulliver walking over her but in Brobdingnag Gulliver was in horror with the maids breastfeeding the child, ‘I must confess no ever object ever disgusted me so much as the sight of her monstrous breast’ and ‘It stood six feet, and could not be less than sixteen in circumference. The nipple was about the half the bigness of my head. ‘ These are both examples of Swift’s hatred for human body parts because both of the descriptions for them are all negative. A second example of Swift’s interest in bodily functions is in Lilliput when Gulliver urinates on the Empress’ palace to save her from the fire, the ironic thing about this is that although Gulliver saved the Empress’ life from the fire he was later banished from the country for displaying such an act in front of the Empress. This is perhaps another satirical point from Swift mocking the English culture, maybe Swift feels like it’s unfair that even if you do something heroic, such as saving a royal family member, you can be convicted because of the method you used. Swift also satirises women and how vain they were, such as Chapter 5 in Brobdingnag ‘They would often strip me naked and lay me at full length in their bosoms; wherewith I was much disgusted; because, to say the truth, a very offensive smell came from their skins’ This is an example of Swift suggesting that women of his time were an illusion of physical beauty and that they weren’t as beautiful as was thought. Swift suggests that people often smelt hence why they used perfumes to cover the smell. Swift later states ‘I found their natural smell was much more supportable than when they used perfumes’, Swift was disgusted with how vain women were by using perfumes to try to impress the males, He could also be satirising how men wanted women to act like this. 18th century England was very different compared with modern day fashions, in the 18th century women tended to cover skin more compared to now where the fashion is to show as much skin as possible. So when Swift wrote in chapter 5 about the maids ‘stripping to the skin’ while Gulliver was in their presence, this would have been a preposterous thought for people of the 18th century even more than it would be now. Swift loved to satirise this because it was something that fascinated, it also makes us laugh in a childish way and would therefore keep us reading. From reading â€Å"Gulliver’s Travels† it is clear that Swift had a very strong dislike of the culture and government of Britain and showed his disgust by satirising them using literature. Satire is a rude way of getting your point across often ridiculing something and will offend many people. When Swift wrote ‘Gulliver’s Travels’ he said ‘he wanted to vex the world and intended to make people angry by holding a mirror up to English society’. Swift wrote ‘Gulliver’s Travels’ as a satirical book but wasn’t sure how the British public would take it, so he first published it under the name Lemuel Gulliver, which makes it sound even more like a travelogue. Swift using Lilliput and Brobdingnag ridiculed Britain and offended the majority of the population, so when the public found out that Swift was the author of ‘Gulliver’s Travels’, he felt he could no longer work in Britain, so he left the country and went to live in Ireland. Bibliography – ‘Gulliver’s Travels’ by Jonathan Swift Word Count: 2,247 Ben Dewsnip 19th May 08 10co Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our  GCSE Jonathan Swift  section.

Assess the View That Cults and Sects Are Only Fringe Organisations That Are Inevitably Short Lived and of Little Influence in Contemporary Society Essay

It can be argued that cults and sects are only fringe organisations that are inevitably short lived and of little influence in contemporary society, however some may have views to contrast this idea. A sect is an organization, which usually breaks off from an established religion, which finds itself in disagreement with beliefs and values of wider society and refuses to tolerate the beliefs of others. Although the desire to be a member is voluntary, as oppose to being born into, like religion, sects are rejected by society and claim strong obligation and commitment by its members. A sect is an extremely narrow-minded organisation, which is often led by a charismatic leader. Whereas, in contrast, a cult does not progress from a mainstream religion and does not reject or challenge societal norms. However, as tolerant of other beliefs as they are, they still attract a great deal of negative press, for example brainwashing. Members in a cult are usually more like customers than followers. An example of a cult is Heavens gate, which is a destructive doomsday cult, centered in California. There is a mass of supporting evidence that cults and sects are short lived and insignificant to wider society. Nevertheless, it must be maintained that the matter is complex as there are many sects and cults, which identify themselves differently. There is evidence to support this view of a short-lived nature of sects. This is due to many reasons. World rejecting sects, due to their nature and succeeding societal rejection and stigma of bad press, must be able to compromise with society and becoming a denomination and therefore cease to be a sect, if this is not done then the sect will die out. There is also an argument that sects cannot have a great deal of affect upon society over a long term period as they cannot survive past the charismatic leader’s lifetime and therefore sustain themselves over more than one generation. The American theologian Niebuhr theorises that another reason for transience of sects is that they rarely live past the 1st generation because the 2nd generation usually lacks the belief of the 1st. In this way, their membership dwindles as the 2nd generation chooses to leave the sect and hold other views in wider society. However Wilson disagrees with Neibuhrs view and says that he overates his case and chooses to not pay attention to groups who did preserve a ‘ distinct sectarian stance’. Similarly, evidence proves to discredit the belief that a sect fails to live on past their leader’s death. For example, The Mormons have continued for many generations and also the Amish- however this could be attributed to the protective ‘isolation-like’ in which they live. There is also a possibility that the Moonies surviving is due to the leader preparing for his son to take over his position as the charismatic leader after his death, however this is yet to be seen. Cults have seen a large incline in their number recently and because they are more accepting of wider society and despite receiving bad press, offer a practical solution to peoples’ issues and wishes, seem less likely to die out due to refusal and disapproval. They are also financially rather stable, the Church of Scientology for example has an estimated income of over  £200m per year. This is down to the consumer attitude of cults. There is also a mass of evidence for their importance in society in a sense that audience cults have a mass market of ‘self help therapy’ there are many books available for example, tarot reading, crystals and reflexology regularly appear on the best seller list and often more room is devoted to these books rather than Christianity books themselves. The view that cults are fringe movements is less supported than that for sects. Sects very infrequently continue on as sects but cults such as scientology are not only prosperous but also have a huge celebrity following trend; admired by the public for example Tom Cruise. There is also evidence that sects and cults can be of great influence to society – though it is debatable as to whether or not that is possible today in a society as apparently secular as ours. Weber suggests in his Theodicy of Disprivilege that because they offer a solution to problems: justification and explanation for life and its problems, to marginalised groups such as dropouts or ethnic minorities, world rejecting sects that offer status appeal to people. An example of this is Liberation Theology which was for the poorer people which had great influence upon the priorities of the Catholic Church in Latin America (though it has become more conservative, it continues to represent human rights and democracy). Bruce argues that it is not a religion and is instead a shallow, meaningless thing. Due to the elements of choice it offers, the choice about which bits to believe and whether to take its readings into account, it does not require commitment. This he argues prevents it having religious status. Post Modernists see it as being spiritual shopping: it is part of a consumerist culture. Despite not necessarily being a religion, there is lots of evidence to show that it has influenced society as a whole and, some sociologists would claim, aided secularisation. There is also evidence to show that it is unlikely to be particularly short lived as it fits in so well with our Capitalist, consumerist society and our individualistic values and is so profitable. Therefore, though there is strong evidence to show that sects and cults are ‘fringe organisations’, there is sufficient evidence to suggest that neither are short lived in themselves either through the Sectarian cycle or demand and supply (though sects tend to become denominations) and also to suggest that the influence of sects and cults on society is greater than expected; though the influence of sects and cults is exemplified by older examples and so one cannot be sure as to how successful they will be in today’s society, except in regards to specific sects and cults. In conclusion, the view that cults, sects are fringe organisations that are inevitably short-lived and of little influence in modern-day society, is on the whole not wholly correct but has some strength in that the permanency of all is arguable as is their status as fringe organisations.

Primary Source Analysis on The Feminine Mystique

Potter 1 Rebecca Potter Gray Section 4975 12 May 2015 Primary Source Analysis on The Feminine Mystique The Feminine Mystique is the title of a book written by Betty Friedan who has also founded The National Organization for Women (NOW) to help US women gain equal rights. She describes the Feminine Mystique as the heightened awareness of the expectations of women and how each woman has to fit a certain role as a little girl, an uneducated and unemployed teenager, and finally as a wife and mother who is happy to clean the house and cook things all day. After World War II, a lot of womens organizations began to appear with the goal of bringing the issues of equal rights into the limelight. The Feminine Mystique also seems to come†¦show more content†¦Friedan also notes that this is helped along by the fact that many of the women who work during the war filling jobs previously filled by men faced dismissal, discrimination, or hostility when the men returned, and that educators blame over-educated, career-focused mothers for the m aladjustment of soldiers in World War II. Yet as Friedan shows, later studies find that overbearing mothers, not careerists, are the ones who raised maladjusted children. It is interesting to apply the notion of the feminine mystique to modern culture and see that it often still exists. Though there are many women who are getting jobs, there are still a lot of families that fit the mold of the traditional family with the breadwinner and the bread baker with bunch of kids running around. Some counterarguments that could be made against The Feminine Mystique are that it focuses on what was not a universal female problem but rather a problem endured only by white, upper- and middle-class mothers and wives. Friedans phrase, the problem that has no name,†(15) could actually refer to the plight of a select group of college-educated, middle- and upper-class, married white women or housewives bored with leisure, with the home, with children, with buying products, who want more out of life. Friedan concludes her first chapter by stating: We can no longer ignore that voice within women that says: I want something more than my husband and my children and my house.’†(32) That moreShow MoreRelatedRape Culture And Its Effect On Society2129 Words   |  9 Pagesthe origin of rape culture in 1970 and relate the stimulation of rape culture to how the societal definitions of rape required adherence to traditionally defined feminine roles and attitudes. The implicit advisement to women was to behave according to the stringent gender roles or suffer the consequence of rape. Secondary sources: Sources: Noreen Connell, Rape: The First Sourcebook for Women By New York Radical Feminists, 1974 (New York : New American Library) This book is the first time in literatureRead MoreThe Good Mother, The Wise Mother1717 Words   |  7 Pagespurpose of this report is to analyze the history of woman’s liberation and the effect this had on the perception of homemakers, understand the benefits of staying home to raise children, and provide solutions to staying relevant in the workforce. Sources and Methods Information regarding the history of woman’s rights will be pulled from several peer reviewed journals. I will use other research organizations to explain the benefits and disadvantages of making the choice to stay home. I will use dataRead MoreFemale Serial Killers: Statistics and Research864 Words   |  3 Pagessentenced to death for planning the death of her husband Julian and stepson Charles in 2002. She confessed to arranging the killings, which she planned in order to obtain financial gains from her husbands life insurance policy. As evident in the analysis of major cases involving female serial killers, the court rulings on this issue has mainly involved death sentences. The main advantage in the case is that rulings on female serial killers will be carried out professionally, which will contributeRead MoreFeminine Mystique12173 Words   |  49 Pagesthemselves and their contributions? What did society as a whole think? 3) What role did mass media play during the 1950s and 1960s in regard to supporting or undermining the â€Å"feminine mystique†? 4) Which television heroine -- Alice, Lucy, or Miss Brooks -- came the closest to TRULY overcoming the feminine mystique, and elaborate on that heroine’s situation and relationship to the men in her life. It was 1957. Betty Friedan was not just complaining; she was angry for herself and uncounted otherRead MoreLetter From Gloria Naylor s Mama Day2479 Words   |  10 Pagescentre having its impact on every course of action. Though women like Sapphira Wade, Bascombe Wade, Miranda or Mama Day, Cocoa or Ophelia and Ruby have been acquainted as the centre of action, Naylor has both positively and negatively depicted their mystiques. Keywords: Gynocentrism, Gynocriticism, androcentrism ---------------------------------------------------------------------------------------------------------- The term ‘Gynocentrism’ has been construed from the Greek words namely, ‘Gyno’Read MoreMale Reception And Resistance Of Feminism3444 Words   |  14 PagesQ – Analysis of male reception and resistance to feminism (1960’s to present day) Introduction There are many ideas behind the actual theory of feminism and this therefore divides feminists into three main schools of thought regarding the subject these include; Radical, Marxist and Liberal Feminism, all of which agree on one thing which is the advocacy of women s rights in economic, social and domestic settings. The idea is therefore to place women at the same position that men have allegedlyRead MoreWomen, Hair, And Cancer10628 Words   |  43 Pagesmedium, which means middle: â€Å"The communication media are the different technological processes that facilitate communication between (and are in the middle of) the sender of a message and the receiver of a message† (7). Indeed, advertising is the key source of revenue for television, newspaper, and more recently the Internet. As a consequence, an enormous amount of messages sent from the sender to the receiver are contained in advertisings. Because women are considered as the main consumers, commercialsRead MoreEssa y Womens Employment in the 1940s6029 Words   |  25 Pagesthe end of the war gladly returned to fulltime domestic work. The ideas in the second theory did not appear until after reconversion to a peace time economy had ended and people began to analyze women’s employment during the 1940s. In the Feminine Mystique, Betty Friedan pioneered the idea that discrimination enacted against women, played a significant role in their departure from the workforce at the end of World War II. This second theory argues that women were forced out of their war jobs.Read More Abortion in the United States Essay3509 Words   |  15 Pagesalleges that a woman is entitled to â€Å"the right to physical integrity, the right to decide freely and responsibly the number and spacing of ones children, and the right to privacy.† (â€Å"Safe and Legal†) Whether or not a fetus is a â€Å"person† is another source of controversy involving fetus’ rights. Anti-abortionists firmly believe in the full-fledged personhood of the unborn fetus. â€Å"They argue that life begins at conception and that the right of the fetus to be born outweighs any other consideration.†Read MoreAmerican Revolution and Study Guide Essay example5377 Words   |  22 PagesAmerica? (6points) 3. Compare and contrast the advantages and disadvantages of the British and the colonists, respectively, as the American Revolutionary War began? (20 points) 4. To what extent did â€Å"No taxation without representation† become a major source of controversy between the colonists and Parliament? (Hint: refer to the Stamp Act riots-1765, â€Å"virtual representation) 10 points Vocabulary: John Hancock Marquis de Lafayette Abigail Adams Royal Veto Declaratory Act Quartering Act Boston