Philosophical Suicide

Introduction Philosophy can be defined as the desire to acquire wisdom and knowledge on life. It thus deals with a person’s intelligence on aspects of life that an individual has developed an interest in. Camus, for instance, developed an interest in understanding the human nature and how humans respond to the environment. This paper seeks to discuss the argument made by Camus over philosophical suicide. The paper will look into what Camus defined as psychological suicide with the aim of evaluating the decision that was made by Camus.Advertising We will write a custom essay sample on Philosophical Suicide specifically for you for only $16.05 $11/page Learn More Philosophical Suicide The origin of Camus’ argument over philosophical suicide is based on the concept of nature being abstract and thus making it very hard for people to fully and clearly understand it. Camus had the views that it would be difficult, if not impossible to digest and understand the world in a reasonable way thus presenting a conflict in human beings who want to have a rational life. The inability of humans to develop an understanding of the world has also resulted in people’s internal conflict as expectations fall apart to what nature dictates upon people. He explained that absurdity is a result of questions that are asked in life following occurrences that are not understood. Such questions, owing to their lack of answers bring the awareness that nature is abstract. One of the thoughts that Camus laid down for his argument is the idea that once the abstract nature of the world is revealed to an individual, a person develops attitudes that are connected to the urge to die, bringing in elements of suicide among people (Sandres and Skoble 121). Available options The conflict that is created by the existence of absurdity of nature enlists reactions from individuals to try and understand nature for an appropriate response. According to Camus, there are just but a few available options that an individual has in the face of the abstract nature of the world. These options are â€Å"actual suicide, philosophical suicide and revolt† (Sandres and Skoble 122). The option of actual suicide involves the termination of an individual’s life in a bid to eliminate the problem experienced due to absurdity. The other available response to nature’s abstract condition is revolt against it. Revolt, however, has the effect of torturing an individual as well as being quite demanding. In revolt, a person will, for example, have to abandon weaknesses in order to be able to endure the effects that are caused by inability to understand or even react to nature. Philosophical suicide on the other hand involves an assumption of the complexity presented by nature. Under this response, a person isolates self from the existence of nature by suppressing knowledge towards nature. Philosophical suicide takes a safer ground that is not available in revolt under which a person still ends up being alienated in life like in the case of suicide (Sandres and Skoble 123).Advertising Looking for essay on philosophy? Let's see if we can help you! Get your first paper with 15% OFF Learn More Conclusion The abstract nature of the world poses problems that can only be solved through three ways. Suicide and revolt either technically or implicitly eliminates an individual from the world leaving philosophical suicide as the neutral and safer resort. Philosophical suicide is thus the comfort zone among the three options. A fair opinion will therefore concur with Camus that once in it a person cannot easily walk out of philosophical suicide. Work Cited Sandres, Steven and Skoble Aenon. The philosophy of TV noir. Kentucky: University Press of Kentucky, 2008. Print. This essay on Philosophical Suicide was written and submitted by user Amari Perez to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

The megathrust earthquake Essays

The megathrust earthquake Essays The megathrust earthquake Paper The megathrust earthquake Paper Chile is hit by what is called a megathrust temblor. Chile lies on a convergence or destructive home base boundary. This means that to different home bases, in this instance the Nacza home base ( an pelagic home base ) and the South-American home base, travel towards each other. In this boundary, the home bases move with an mean velocity of 80 millimeter every twelvemonth. The Nacza home base is heavier because it s an pelagic home base. Pressure makes it dive or sink beneath the lighter Continental home base in an east-north-east way, in a procedure called subduction. This procedure though, does non continue continuously and on the 27th of February, there was a minute that the Nacza home base skidded. At that point, there is a motion of home bases there and a release of great sums of energy ensuing from the force per unit area. This topographic point where the temblor originates, is called hypocenter. In this instance, the deepness was 35 kilometer. From here, seismal moving ridge s are send out in every way. Depending on the stuff, waves pass rapidly ( harder stuffs ) or lose some of their velocity and energy ( unstable, softer stuffs ) . On the right figure, there is made a cross profile of the left figure. The pointer indicates the subduction zone, in this instance, about the full litoral of Chile. In ruddy, there is explained why home bases move in the same way: convergence and droping convection currents pull plates together. explicate the strength of this temblor This temblor had a strength of 8.8 on the minute magnitude graduated table. This is a logarithmic manner of mensurating the strength of seismal moving ridges. With an ultrasensitive pen attached to a spring they can see how much the maximal amplitude was at a certain point. Great amplitudes were measured during 4 proceedingss. Changes in co-ordinates are registered along a 700 kilometer long section of the mistake zone ( the zone were the Nacza plates subducts ) , with largest supplantings of about 10 metres. Using the GPS co-ordinate system, measurings have shown that it moved for illustration Concepcion about 10 pess due wests. It besides moved other large metropoliss like Santiago and Buenos Aires. It was even so powerful that the period of Earth s rotary motion is shortened, ensuing in a twenty-four hours that is 1.26 microseconds shorter than earlier. The ground is that the heavy pelagic home base moved towards the Earth s karyon, which makes that the mass is more concentrated in the karyon than before, which shifts the centre of gravitation. 2 History of temblors What opportunity of temblors in that part ( + clarify with maps ) On the figure, there is indicated in ruddy where the greatest chance for an temblor is calculated. Most of the temblors due to tectonic motion are originated at the so called ring of fire. This is an country in the Pacific Ocean where a batch of temblors occur and where there is a batch of volcanic activity. The northern part of Chile ( centered on Antofagasta ) has experienced the most temblors: 61 strong ( M6.0-6.9 ) , 10 major ( M7.0-M7.9 ) , and one great temblor of magnitude 8.0 since the beginning of 1975. This means 80 heavy temblors in period of 35 old ages, about 2 per twelvemonth. The cardinal part around Santa Cruz has experienced a small less temblors: 52 strong, and 7 major temblors since 1975. 3 Why yes/no a opportunity to tsunamis with the temblor? With a sudden gesture of the sea floor, there can be triggered a tsunami. This tsunami on the 27th of February merely had a tallness of 1.29 metre, but because of its high velocity, it can still hold black effects. There is a possibility of a tsunami because it s an pelagic home base that is subducting the South-American home base. With subducting home bases, there is perpendicular gesture of the home bases, which triggers the tsunami. The opportunity of a tsunami is therefore a batch bigger along a destructive ( meeting ) home base boundary than along a constructive home base boundary.

Intellectual Autobiography Essay Example | Topics and Well Written Essays - 750 words

Intellectual Autobiography - Essay Example From this discussion it is clear that as well, mother taught the reporter that he could develop intellectually through questioning what he never understood, but it sometimes never worked for people who never liked being questioned. The author had to do, experiment, copy, talk, listen, play and experience as a child in the attempt of enhancing his intellectual development. His mother told him as a child that sometimes trial and error could make the author develop intellectually when doing things he was not sure of. He remember mother teaching him to speak Chinese as a little child as way of boosting his communication skills with friends and everybody heI interacted with. She as well taught the reporter on using his mind to organize his thinking in the attempt of understanding the world around him.This essay stresses that the reporter came to realize that mother wanted him to develop in some specific areas that include learning to read, learning to speak, learning to solve problems and making decisions of his own. He had to do several things to order to boost his intellectual development such as identifying a problem by himself, working out a solution and predicting what may happen after the author decided on the solution. In addition, he came to realize that crying sometimes serves as a way of taking bitterness and sadness away from our minds. He can reflect on times he used to cry when he was a child and he could feel the pain go away.  

Role of Stock Market and Banking System in Promoting Economic Growth Assignment

Role of Stock Market and Banking System in Promoting Economic Growth and Ensuring Financial Stability - Assignment Example In the given project different theoretical factors will be discussed to understand how banks and stock exchange influences the economic growth of a nation. After conducting the required literature review, some case studies will be discussed to critically verify the role of banks and stock market. On the basis of this research final conclusion will be drawn. Literature review Walter Bagehot (1873) and Joseph Schumpeter (1912) emphasised on role of banking system in economy growth and productive investment in a nation. However, there are economists like Robert E. Lucas (1988) who stated that â€Å"the economists have badly over-stressed the role of financial system† (Levine & Zervos, 1998, p.1). Similarly Joan Robinson (1952) also critically pointed out that banks respond passively to the economic growth. No doubt these critics were not wrong but one cannot deny the role of banks in economic growth. To have a healthy economic growth, it is quite essential for a nation to maintai n different businesses and industries operating in a harmonised manner. Bank acts as an intermediary that facilities fast and secure flow of capital within the domestic market as well as in international market. A healthy and well developed banking system is one of the core factors which are taken into consideration by foreign investors while making investment in a country. To attract foreign investment in a country, the government provides special changes in the monitory policy. Cameron (1972), pointed out that banks should vigorously search for ideal funds that can be used, mobilised and circulated in the economy. To attract the investors, high interest rate on deposits is a good tool, as that will attract more saving (Badun, 2008, p.122).... This paper outlines the crucial role of banks and stock markets in promoting growth and development in the modern world. After conducting the required literature review, the case study, pertaining to a global financial crisis, is discussed to critically verify the role of banks and stock market. The root cause of financial crisis was the loose monitory policy followed by the financial institutes of developed country like US and UK. The main aim of the banks was to provide easy loans at comparative lower rates. As soon as this strategy was introduced, the flow of capital increased and the liquidity position went high. Though the global economy was performing well but on the side the credit growth in the balance sheet of financial institutions also increased Banks paid less attention towards risk associated with loans at sub-prime rate. They used highly complex hybrid debt instruments without developing a proper method to analyse the risks. The policy of extensive use of sub-prime rates resulted into a bubble that burst in 2007. The poor condition of many banks created a state of liquidity crisis in the international stock market. Till mid of 2007, the stock market of US and UK was too bullish. People had ample capital to invest and thus liquidity was high. The failure of the banking system along with decline in the stock market performance created a state of harsh liquidity crisis in international market. The result was economic crisis in developed countries followed by fall in economic growth in developing nations.

What is the Investment case for floating of offshore wind turbines Essay

What is the Investment case for floating of offshore wind turbines - Essay Example Future climate alteration and connected effects will change from place to place all over the world, according to the IPCC report. The impacts of a growth in worldwide temperature comprise of an increase in the levels of sea and a variation in the quantity and pattern of precipitation, as well as a possible growth of subtropical deserts..One among the many proposed policy responses to global warming is the investment of offshore wind power, according to the 2013 Report of the European Wind Energy Association. Compared to the environmental effects of conventional energy sources, the environmental wind power effect is minor, a bit high than the environmental effect of hydro-water on a life-cycle basis. Different from electricity resulting from fossil fuels and nuclear power firms, wind power consumes no fuel and, emits no air pollution in operation. What is the Role of Fukushima Floating Offshore Wind Turbine Generating power? The Fukushima event played a significant role in this techno logy of floating offshore by setting up a sub-station, which was the only one of that type in operation. A development to tap the wind power about 20 kilometer off the coast of Fukushima, the region where the March 2011 nuclear disaster took place, started producing power based on operation, according to the report published on Bloomberg.com(http://www.bloomberg.com/news/print/2013-11-11/fukushima-floating-offshore-wind-turbine-starts-generating-power.html) The project that was funded by the government is a sign of Japans interest to develop the technology which has not yet been proved for floating the wind powers off the coast and its aim to change quake-ravaged Fukushima into an outstanding centre for energy production.†Fukushima is gaining ground in...Offshore wind ability is growing fast, from 4 GW (gigawatts) in 2011 to 175 GW by 2035, its development being underpinned by administration support," according to the International Energy Agency's 2012 World Energy Outlook rep ort (pages 226-227). This leads us to the question; what is the Investment case for floating of offshore wind turbines and for onshore wind turbines? Introduction This paper is meant to investigate the investment case for floating offshore wind turbines and for onshore wind turbines. Throughout the paper I will discuss various modes of offshore and onshore wind technology and how various nations across the globe have adapted that source of energy .Also throughout the paper I will discuss the various companies in the business of production of wind turbines and their rate of investment in the technology. What is driving the development and deployment of the technology? Global warming is the increase rise in the regular temperature of Earth's ambiance and oceans ever since the late 19th century and its predictable continuance. The Bloomberg report helps explain that a traditional floating offshore wind turbine tower that is constructed upward from the seafloor results to be too expensive to install in waters deeper than 50 meters, and this is a big issue for Japan since a continental shelf varying from 50 to 200 meters deep surrounds its coast.

Psychosocial Interventions for Psychosis Evaluation

Psychosocial Interventions for Psychosis Evaluation Introduction This report aims to critically appraise psychosocial interventions (PSI) that are utilised when working with complex cases. In order to do this the term complex is explored with reference to people with psychosis. Different types of complexity are discussed with a more detailed examination of a specific complexity; the relationship between substance misuse and psychosis (dual diagnosis). The effects that substance misuse and psychosis have upon the service user and their care givers are outlined. An overview of the use of psychosocial interventions when working with complex cases is given. This discussion is then focused on particular interventions for dual diagnosis that show promise for enhancing service user and carer experience, namely a integrated treatment approach of cognitive-behavioural therapy, motivational interviewing and family therapy. These interventions are critically appraised with reference to evidence base, policy and guidelines. Examples from clinical practice are given to illustrate potential barriers, and outcomes when implementing such interventions with service users with complex needs and their caregivers. Strategies to overcome such barriers are generated and recommendations are made. Aliases are used within the scenarios of this report in order to maintain anonymity of the service users and carers described to illustrate points and examples. Complexity The term complex case is referred to frequently within mental health literature, policies and guidelines but there are very few definitive explanations of what the term actually means. Griffiths Allan (2007) discuss how the term complex case is ill defined within mental health literature summarising how the term is often used to denote circumstances where people appear to have many interrelated needs that require several, coordinated responses from multiple services. The term complex case is often used to denote needs that services do not fully understand or provide for effectively. This report aims to explore the term complexity in relation to individual cases of those with serious mental illness. Complex: ‘Made of many different things or parts that are connected; difficult to understand (Soanes Stevenson 2005) Interpreting the above definition of complex within the Oxford Dictionary of English one could describe a complex case as a service user with more than one problem or need that are connected making the case more difficult to work with. For example having a diagnosis of schizophrenia and being detained within a medium secure unit. A person fitting this example would potentially present the mental health professional with more challenges than a person with moderate depression living with their supportive family. Wilson, Holt and Greenhalgh (2001) discuss the term complexity in relation to human health and illness. They suggest there are a number of factors (outlined in Table 1) that we all posses that makes us all complex. They go on to suggest that human illness and behaviour are not predicable and neither can be thought of as a simple cause and effect system. Again, adding to the complexity of individuals that because one individual responds one way to an event does not mean all will. Although this list of human complexities was written with medical practice in mind it applies to all and provides the baseline of those service users we work with in mental health services. Table 1 (Wilson, Holt, Greenhalgh 2001 p685) Factors that add the human complexity The human body is made up of multiple interacting and self regulating physiological systems including biochemical and neuroendocrine feedback loops. An individuals behaviour is determined partly by an internal set of rules based on past experiences and partly by unique and adaptive reaction to external stimuli. The web of relationships in which individuals exist contained varied and powerful determinants of their beliefs expectations and behaviour. Individuals and their immediate social relationships are embedded within wider social political and cultural systems which can influence outcomes in entirely novel and unpredictable ways. All of these interacting systems are dynamic and fluid. A small change in one part of the web of interacting systems may lead to a much larger changes in another part through amplification of effects. If we bear this in mind, that all humans are complex, then maybe the term complexity needs to be described as a continuum (Figure 1). That the more problems a person has or the more difficulties they face the further they move up a complexity continuum. People with a diagnosis of serious mental illness (as with all people) can face a large number of problems and difficulties through the course of their lives for example, positive symptoms, negative symptoms, anxiety, depression, mania. When adding this to the complexity of an individual this produces more challenges for the health care professional, the individual and their carers/families. However, these experiences also produce problems and difficulties for the service user making their case even more complex. For example the impact of experiencing voices does not end here but effects other areas of a persons life (see Table 2). Table 2. Laura Case study Laura first started to hear voices at the age of 9 and at first these did not bother her. As she got a bit older and discovered that this wasnt ‘normal her voices started to become critical of and derogatory towards her. To cope with this Laura started to experiment with Illicit drugs and alcohol as this blocked out the voices for a short time. However, this also made Laura lose her inhibitions and she would participate in sexual acts with men in her local area. This fuelled the voices and they became much more negative. So to cope Laura would take more drugs. Eventually Laura would run out of money and so would shoplift and resorted to prostitution. Her life became very chaotic and at 16 her mother kicked her out. Laura was now sleeping in neighbours gardens, sheds, anywhere she could. Laura lost touch with all her family and friends, her physical health suffered and she ended up very underweight and her voices became worse. Eventually Laura was found by the police sleeping se mi-clothed in a car park under the influence of drugs and alcohol. It was at this point she was admitted to an acute mental health unit. From the case of Laura it can be seen how not even having a diagnosis of schizophrenia, but experiencing positive symptoms can result in stigma, social exclusion and have a huge impact on a persons life. Lauras case was exacerbated by the use of illicit substances and alcohol demonstrating how substance misuse can add greatly to the complexity of an individual. Within the literature it can be seen that there are many factors that add to the complexity of a person with mental health needs including: medication resistant symptoms (Tarrier et al 1993), receiving care within secure forensic units (DOH 2005), psychological reactance (Moore, Sellwood, Stirling 2000), poor social functioning (Cather 2005, Couture et al 2006), , learning disabilities (DOH 2001a), insight (David 1990 and Buckley et al 2001), physical health (Marder et al 2003) homelessness (Randall et al 2006), and dual diagnosis (DOH 2002). These complexities have been recognised by the government and national drivers have been produced to guide mental health professionals and services to enable delivery and provision of the best services. For example ‘The National Service Framework for Mental Health (1999a) outlines a number of interventions for several complex groups including some of those mentioned above. Rankin Regan (2004) discuss how the term complexity means that there is no generic complex needs case. This therefore suggests each individual has a unique interaction between their own health and social care needs, therefore, requiring personalised responses from mental health services. Adopting an approach that incorporates psychosocial interventions could help to achieve a personalised response and provide individualised, tailored care for the service user and their care givers. Psychosocial Interventions The use of psychosocial interventions (PSI) is advocated in national drivers such as ‘Schizophrenia: Core intervention is the treatment and management of schizophrenia in adults in primary and secondary care (NICE 2009). This guidance recommends that all service users and their families are offered psychosocial interventions as a treatment of schizophrenia. Also, documents such as ‘From values to action: The chief nursing officers review of mental health nursing (DOH 2006) recommends the use of psychological therapies to improve outcomes for service users and ‘The mental health policy implementation guide (DOH 2001b) advocates the use of psychosocial interventions through a variety of service delivery modes. Demonstrating the emphasis that is placed upon such interventions in the treatment of serious mental illness. Mairs and Bradshaw (2005 page 28) suggest PSI is â€Å" a range of evidence-based interventions for people with psychosis and their care givers. The term is generally used to include both models of service delivery such as assertive outreach and specific interventions, for example Family Intervention and Cognitive Behavioural Therapy (CBT). PSIs aim is to reduce stress experienced by an individual with psychosis or help him or her to cope with stress more effectively.† As a result of adopting a PSI approach an individualised service is offered to the service user to help meet their needs utilising a variety of interventions and services with great emphasis being placed upon collaboration. Psychosocial interventions assume a complex link between biological, environmental, and sociological factors which suggests that ambient stress, together with life events may trigger onset or relapse of, mental health in some people (Gamble Curthoys 2004). A model which displays this link is the Stress Vulnerability Model by Zubin and Spring (1977 cited in Norman, Ryrie 2004). This model helps explain the aetiology, course and outcome of mental illness, demonstrating how stress has different effects on individuals. The Stress Vulnerability Model (See figure 2) suggests that some people are more vulnerable to stress than others and that when an individuals stress threshold is passed they can become unwell i.e. experience positive symptoms. In terms of a complex case it could be proposed that an individuals complexities cause stress in themselves and/or increase a persons vulnerability to stress. An example of how ‘The Stress Vulnerability Model can be illustrated to enable it to be shared with a service user with complex needs, using an easy to understand analogy can be seen in Appendix 1. As previously mentioned the aim of PSI is to reduce stress or to help cope with stress better; therefore, it can be seen how the Stress Vulnerability Model plays a central role in providing psychosocial interventions. Substance Misuse and Psychosis Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels (Cleary et al 2009) and even low levels of substance misuse can have detrimental effects and cause serious complications (Barrowclough et al 2001). The combination of substance misuse and mental health problems (dual diagnosis) is associated with a range of social, behavioural, physical and psychological problems (see table 3) providing challenges for mental health services and adding to the complexity of an individual (Hussein 2002). In addition to this complexity ‘The national service framework of mental health (DOH 1999a) identifies patients whom misuse substances and have a diagnosis of serious mental illness as a population of greater risk of stigmatisation and exclusion from existing service provision. Demonstrating some of the factors that add to an individuals complexity. Table 3 Complications posed by dual diagnosis (Cleary 2009, Drake Mueser 2000, Clark 1996, Dixon, McNarey Lehman 1995, Griffiths Allen 2007 and Gibbins Kipping 2006) Increased risk of Suicide, Self Neglect, Violence, Poor compliance with treatment, More inpatient stays worsening psychiatric symptoms Relapse, Homelessness, HIV and Hepatitis, Contact with criminal justice system Prejudice and Stigma. Negative impacts on Social relationships Financial resources (of individual and/or family/friends) Family Relationships i.e. increased burden, increased expressed emotion Within literature the most commonly reported reason that people with serious mental illness use illicit drugs is to self medicate, for example, to relieve negative symptoms of schizophrenia (Littlejohn 2005). However, as Conley Benishek (2003) report there is the additional complexity of trauma that has lead to the use of substances for various reasons including dissociation, and modelling from parents. They continue recommending that nurses working within the substance misuse field should be trained in picking up such information. If an approach adopting psychosocial interventions was utilised and therapies such a cognitive behavioural therapy were delivered then this historical information may be identified and dealt with appropriately. Therefore, leading to a different delivery of services compared to someone who uses substances to self medicate. However, the mental health professional must also bear in mind that service users also use substances for the same reasons as others (L ittlejohn 2005). Even though the NICE (2007) Guidelines, ‘Drug Misuse: Psychosocial Interventions recommends that CBT be offered to those with anxiety and depression who are stabilised with their drug use, but does not discuss its use with those with psychosis. There is growing literature examining the use of CBT for those with a dual diagnosis (Cleary et al 2009, Barrowclough et al 2001, Baker et al 2006, Weiss et al 2007 and Haddock et al 2003) although, as mentioned earlier the amount of literature in this area is limited. Also the CBT that is delivered to the participants within the studies has been adapted to suit the needs of those with dual diagnosis. This integrated treatment, namely C-BIT (Cognitive-Behavioural Integrated Treatment), has a number of components; Cognitive Behavioural Therapy, Motivational Interviewing and Family Interventions. C-BIT is not only about adapting psychosocial interventions to suit those with dual diagnosis but it is also about service provision and developm ent (Thylstrup Johansen 2009, Graham et al 2006, Graham et al 2003). Such interventions are used as part of an individualised treatment plan that incorporates the key principles of working with dual diagnosis (see table4). Table 4 (Drake et al 1993 cited in Abou-Saleh 2004) Principles of treatment of substance misuse in people with severe mental illness Assertive outreach to facilitate engagement †¢ Close monitoring to provide structure and social reinforcement †¢ Integrated concurrent service †¢ Comprehensive, wide range of interventions †¢ Stable living situation †¢ Flexibility and specialisation (modified approaches) †¢ Stages of treatment: engagement, persuasion, active treatment and relapse prevention †¢ Longitudinal perspective for relapsing and chronic disorder †¢ Optimism instilling hope in patients and carers Motivational Interviewing (MI) The aim of this intervention is to increase a persons ability to recognise and do something about any problems they have (Gamble Curthoys 2004) and that change would be desirable (Kipping 2004 and Miller Rollnick 2002). This approach conveys hope and is non-confrontational in it style (Kemp et al 1996) and is largely used within substance misuse services (DOH 1999b). This intervention is used alongside Prochaska DiClemente (1986 Cited in Kipping 2004) Model of Change (see Figure 3) to provide a framework of which interventions should be used at which stage of change a service user is at. Motivational Interviewing is mainly used as a persuasion tool to move people from precontemplation/ contemplation to decision and active change. Four General principles are followed as outlined by Miller Rollnick (2002); expressing empathy, developing discrepancy, rolling with resistance, and supporting self efficacy in order to facilitate this change. When a service user demonstrates that they have arrived at the decision or action stage of the cycle of change cognitive behavioural interventions are then commenced. Cognitive Behavioural Therapy (CBT) The aim of CBT is to lessen distress caused by negative feelings; it attempts to do this by changing the thoughts (cognitive) and beliefs that underpin them. It can also alter actions (behavioural) and circumstances that are affecting these thoughts and feelings (Nelson 2005). This approach has been written about for many years and has arguably evolved from the work of Aaron Beck, a psychiatrist whose work dates back to the 1950s. There is a vast amount of literature examining the use of CBT with psychosis (Jones et al 2004). Generally the research and literature supporting the use of CBT for Those with serious mental illness often excludes people who misuse illicit drugs and/or alcohol for example Garety et al (2008), and Jackson et al (2008). The topics covered within CBT sessions for those with dual diagnosis differs from that of someone who does not use substances. For example Baker et al (2006) outlines components of CBT sessions used within their trial. They include, presenting the model of problematic substance use and psychotic symptoms (Graham et al 2004), specific techniques for managing substance use, and identification of triggers and beliefs that could lead to substance use and increase psychotic symptoms. Finally a large component of CBT for dual diagnosis is around relapse prevention, identifying unhelpful thinking patterns and managing cravings. Family Interventions (FI) A relative of a person with a diagnosis of schizophrenia may experience negative consequences in many areas including: emotionally, socially, psychologically and economically, as they adjust to their new role as a care giver (Reader 2002). How the care giver attempts to cope with these consequences can have an effect on their relative. Research has shown that expressed emotion within families could lead to relapse in schizophrenia (Brown et al 1962, Kavanagh 1992). Often a person with dual diagnosis is only marginally engaged with services but may have regular contact with their families who provide financial and psychological support (Thylstrup Johansen 2009). Putting them under immense strain; but also in prime position to work with mental health services to promote engagement and treatment adherence. There is a vast evidence base to support FI for promoting recovery from psychosis (Pharoah et al 2006, Pilling et al 2002). The family dynamics of a person with a dual diagnosis is often impacted greatly due to the complexities discussed earlier and there is growing evidence to suggest how family involvement can have positive impacts on outcomes for both the service user and their families (Fischer et al 2008; Dixon, McNarey and Lehman 1995). Within integrated treatment Barrowclough et al (2001) use family interventions as a means of encouraging care givers to adopt motivational interviewing styles to improve motivation, and treatment adherence amongst other interventions. See Table 5 to illustrate how minimal family work in the form of psycho-education enhances the experience of service users and their care givers, even when staff have had no formal training. Unfortunately, family relationships of those with dual diagnosis can often be put under vast amounts of strain that cause the family dynamics to breakdown. Leading to people losing contact with their friends and families. This therefore makes family interventions very difficult as often one or both parties (care giver(s) and service user) do not wish to accept family work. In addition to this there are service users who do not wish their care givers be informed of their illicit drug use as they are worried of the consequences this may bring, for example: negative appraisal due to the stigma surrounding substance misuse. From experience this can be overcome in some cases through normalisation and psycho-education. Providing a good rationale of why care givers should be informed and how doing this can help the situation. Although, this often takes a lot of guidance and motivational interviewing techniques. Table 5 Psycho-education with Laura and her Father. Once Laura was admitted to the rehabilitation unit where she is currently residing her father got in touch. Laura was keen to build on the relationship between her and her father and started to visit him once a week. Staff at the unit (whom are not trained in family interventions) thought it would be a good idea to spend some time with Laura and her father to help them both gain an understanding of each others situation, thoughts, feelings and behaviours. After explaining the benefits of this to Laura she consented and her dad was offered to come and have a few informal sessions with Laura and her named nurse. Lauras dad explained how he had never been given any information about schizophrenia or substance misuse and how he knew very little of how these effected his daughter. This information was shared with both Laura and her dad. The stress vulnerability model was explained to Lauras dad with a view to building on his understanding of why his daughter experiences psychotic symptoms and providing a reason why she uses drugs. Leading on to state how this only causes more problems (all of this was discussed with Laura at an earlier date). Lauras Dad was given the opportunity to voice any concerns he had about regaining contact with Laura i.e. financial drain, crime, and ‘picking up the peices. These problems were discussed and brainstormed with both Laura and her dad to identify ways to prevent these happening, and produce a contingency plan if either person felt they needed support. Lauras Dad reported that these sessions made it easier for him to build on lost relationships with his daughter and reduced his fears that he would have to ‘deal with it all if things went wrong. Laura also felt much more positive as now she was starting to rebuild relationships providing more motiviation to change and sustain change. Her mood improved slightly and she had more hope for the future. Arguably the benefits Laura experienced may have inevitably occurred with out staff intervention. Literature Review A small number of studies examining interventions for use with people with dual diagnosis will now be appraised.Two of the Studies are Randomised Controlled Trials (RCTs) and are considered the gold standard method for evaluating treatment efficiency (Greenhalgh 2006). They are said to produce the least biased results as random samples are used to minimise the possibility of error in design and conduct (Roberts, 1999). Barrowclough et al (2001) and Haddock et al (2003) Barrowclough et al (2001) produced one of the first robust RCTs to examine the impact an integrated intervention programme consisting of CBT,MI and FI had upon service users. The design of the trail was robust in that it was a RCT, ensured as far as possible good treatment fidelity (making certain that the treatment being delivered is the one intended (Leeuw 2009)) and the assessors in the trial were blind to group allocation (reducing the risk of bias). However there were some limitations of this study such as small numbers of participants, short follow up period, and treatment was delivered by cognitive behavioural therapists. In reality it is not possible for all service users with dual diagnosis to receive interventions from a cognitive behavioural therapist. All of these limitations question the generalisibility of the results. Although care givers were in receipt of interventions their outcomes were not reported in this study. It would have been interesting to see these results; even those whom were in the control group received more interventions than the majority of families of substance misusers get (based on experience). One could hypothesise that the results of the two groups were not too dissimilar due to the fact that both sets of care givers were being supported. The Haddock et al (2003) study is a follow on from the Barrowclough et al (2001) study reporting further service user outcomes, cost effectiveness and carer outcomes over an 18month period. The robustness of the study was discussed above. This study found quite significant positive outcomes of those whom received the integrated intervention programme. Results demonstrated improved outcomes for the service users general and social functioning, and reduced number of negative symptoms to a significant degree. When examining this result with experience from practice it could be hypothesised that when a service users level of functioning increases they rely less upon their care givers. Thereupon improved functioning has a positive indirect effect upon carers. There was also a small difference in the percentage of days of abstinence between the two groups with the treatment group proving more favourable. However, the clinical significance of this is questionable. Although carer outcomes we re reported within the Haddock et al (2001) paper they are only briefly examined with more of an emphasis based on cost effectiveness. However, the results do show promise for care givers within the treatment programme, showing some trends towards better personal outcomes. At the 12 month follow up the treatment group demonstrated a reduction in needs and objective and subjective burden. However, these results were not statistically clinically significant. Haddock et al (2003) suggest more intensive work should be done with families due to the high rates of expressed emotion. Baker et al (2006) Baker et al (2006) also produced a RCT to examine the impact a series of sessions of CBT and MI has upon service users with a dual diagnosis. This study was not as robust as the Barrowclough et al (2001) study in relation to randomisation and assessor blindness. Within this study participants were paid for their expenses and time attending assessments. Although the authors suggest this was not enough to influence responses, this procedure was not carried out in similar studies such as the one by Barrowclough and colleagues (Barrowclough et al 2001 and Haddock et al 2003) which should be considered when comparing results. Another negative to this study as with that of Barrowclough et al(2001) was that the interventions were carried out by highly trained psychologists; Echoing the argument of generalisability. On a positive note this study did have a larger number of participants almost double that of Barrowclough et al (2001). Baker et al (2006) suggest both this trial and the one car ried out by Barrowclough and colleagues suggest improvements in substance misuse. However from the results these improvements appear minimal. Baker et al (2006) also report that there was no significant difference in improvement of functioning or positive symptoms; providing opposite and contrast results of the Barrowclough et al (2001) study. Baker et al (2006) conclude that this study demonstrates that this challenging case group (service users with dual diagnosis) is able to engage in CBT and demonstrate positive results. Although this ‘excellent therapy-attendance could be questioned due to the use of payment for time and travel. Graham et al 2006 This study carried out by Graham et al (2006) differs from those discussed above in that it is not a RCT, it is a preliminary evaluation of the impact of C-BIT training on 3 assertive outreach teams and service user outcomes and is not an RCT. Care co-ordinators from 5 assertive outreach teams were allocated to two groups. One of which received immediate C-BIT training and the other groups training was delayed. Results of the training demonstrated increased confidence of care co-ordinators in working with substance misuse and mental illness. Graham et al (2006) suggest these findings illustrate the effectiveness of such training and highlights the extent to which implementation actually occurs. They suggest their findings add evidence to the recommendations made for implementation of interventions for this client group presented in Mental Health Implementation Guide: Dual Diagnosis Good Practice (DOH 2002). Graham et al (2006) also discuss the impact of such training upon service user outcomes. The results highlighted an improvement in engagement, reduction in alcohol use and a reduction in positive alcohol related beliefs. Demonstrating that this team approach to C-BIT shows promise. This report does not measure impact on care giver outcomes. All of the reports mentioned here suggest further research is needed to establish a firm evidence base for integrated treatment programmes that use interventions such as CBT, MI and FI. Nonetheless, they do provide a good grounding for recommending that such interventions show promise for enhancing service user and carer experience. In order to do this there may need to be a change in service provision. For example for a change within treatment philosophy of a team may mean that all staff must be trained preferably at the same time (Graham 2004). This causes barriers on numerous levels such as cost implications of all staff receiving training, back fill of their hours, cost of trainer and venue etc.. Potential barriers may occur when implementing these newly acquired skills and knowledge due to feelings of diminished confidence as part of the learning process (Atherton 2008). Discussion Substance misuse services separated for mental health services some time ago (Conley Benishek 2003) and as a result mental health professionals have limited training and experience in working with people who misuse substances. In addition, many drug and alcohol workers have only had minimal education in mental health issues (Frankel 1996). This could result in mental health professionals and substance misuse workers feeling unequipped in working with people with a dual diagnosis; resulting in them receiving inadequate care. A way to overcome this is for more health professionals to acknowledge their deficits in knowledge and attend training. Perhaps as a result of having minimal education in the field of substance misuse, negative attitudes towards those who misuse substances is still present (Howard Chung 2000 and Richmond Foster 2003). This can take the form of moralistic and stereotypical attitudes leading to mistrust, suspicion and avoidance on both sides. Evidence indicates that when such attitudes are held problems of substance misuse are often overlooked and not dealt with or referred on (Howard Chung 2000). Table 6: Luke Case Study Luke was brought up in a deprived area of a large city and often experimented with illicit substances with his friends. He had a very poor relationship with his mother and siblings (although he did reside with them) and never saw his father. Luke started to hear voices at the age of 18 and was soon admitted to an acute unit where he commenced anti-psychotic medication. Luke was discharged from hospital back to his home. Lukes motivation was draining and he was experiencing little enjoyment in life. it wasnt long before he stopped taking his anti-psychotic medication because it was making him put on weight and causing side effects. L

The role of judgement in The Outsider :: English Literature

The role of judgement in The Outsider The actions of Meursault, the protagonist in The Outsider by Albert Camus, are characterized by irrationality. For example, there is no clear logical reason for his decision to marry Marie or to kill the Arab. â€Å"That evening, Marie came round for me and asked me if I wanted to marry her. I said I didn’t mind and we could do if she wanted to† (Camus 44). However, the idea that things sometimes happen for no reason is disturbing and threatening to society, because, as a logical conclusion from that, individual existence could have happened for no reason and would therefore be purposeless. Hence, society always attempts to find logical reasons for everything. In this novel, society superimposes its rational nature upon Meursault’s irrational character, which has the consequence of society making judgements upon Meursault that are false, because the judgements do not agree with his irrational personality. The prosecutor’s speech and the meetings between the magistrate and Meursault will be used as examples to show this. Before getting into them, it must be explained that the prosecutor and the magistrate both symbolize society, since they are part of the court, which stands for society as a whole. The idea of a court already represents very much society, since the law functions as the will of the people, and the jury sits in judgement on behalf of the entire community. But Camus clearly emphasizes upon this image of â€Å"court-as-society† in this novel by making almost all of the characters from the first half reappear to witness in the trial: The warden and the caretaker from the home, Thomas Pà ©rez, Raymond, Masson, Salamano, Marie and Cà ©leste. First of all, the fact that the prosecutor interprets Meursault’s irrational action of killing the Arab in a rational way shows that society imposes its rational character upon Meursault’s irrational personality. â€Å"[Meursault retelling the prosecutor’s argument] I’d asked him for his gun. I’d gone back with the intention of using it. I’d shot the Arab as I’d planned. I’d waited. And ‘to make sure I’d done the job properly’, I’d fired four more shots, deliberately and at point-blank range and with some kind of forethought† (96). The prosecutor provides here a rational explanation for Meursault’s murder of the Arab, that is, he explains how every step that lead to the murder was planned by Meursault. However, nothing in Meursault’s narrative explains why he shot the Arab (let alone that there would be evidence in his narrative that he planned the murder), which suggests that there is no rational explanation for his action. Thus, the fact that the prosecutor, who represents society, interprets here Meursault’s