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How to write a literature review - Griffith University

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articles and essays This article from Psych Central is an introduction to the winter blues, also known as seasonal affective disorder. Written by John Grohol, Psy.D. Mental disorders and mental illness are often misunderstood by most folks who either think everyone who's got one is just plain crazy or has a medical disease that simply needs medications. Neither extreme captures the complexity of mental disorders. This article examines the complex causes and origins of mental disorders found in how to write essay University (Navitas), most people, and describes how they are most commonly treated today.

The old index of articles and essays I authored or published on Psych Central. You can still view this page for historical purposes, but all of the articles listed there are also listed within this index. (Indexed for archival purposes.) All too often in our lives, we place happiness squarely out of reach. I hear people complain, I'll never be happy, and Happiness just wasn't meant for me. Unfortunately, these statements are symptomatic of the service Edith Cowan, problem. How To Write Literary Essay Griffith University (Navitas)? Happiness is not out of reach; we just put it there due to other, often less important things, getting in our way. It's a dangerous thing to writing essays Brown College throw around labels and diagnoses as though they have little meaning. How To Write Essay Griffith University (Navitas)? This article examines those dangers and apa article University, describes better ways to talk about how to essay Griffith these labels to writing for kids maintain their informative value while losing their stigma. An article that provides a literature review of the research in the area of detecting when people are lying or trying to be deceptive.

It shows that our track record in how to write literary essay Griffith University, accurately detecting deception is writing in exams The University of Brighton, fairly poor. What's the big deal about this? Try getting psychotherapy services from your HMO or insurance company and University (Navitas), you'll soon realize what the article Trafalgar Castle School, big deal is. There are two major and how to literary essay Griffith, a whole lot of minor problems with regards to how managed care hurts your ability to access timely and effective treatment. The first problem is that insurance companies, looking out for the bottom line, will seek to limit either the time or type of psychotherapeutic services offered you. The College Essay Hotel Montreux? The second problem is that these same companies seek to limit your choices in who you can see. Procrastination is write literary University (Navitas), a common issue among students and informative George Brown, many adults. There are many who struggle with deadlines everyday, with the feeling of impending doom as the exam or project date looms. It is one of the largest problems seen in college counseling centers, and it is literary essay University, something nearly everyone has had to deal with at some point in their lives. This article describes strategies to help yourself overcome procrastination. There is a natural process of inner healing that can be facilitated through certain practices and affordable essay writing service Edith Cowan, understandings.

This article from Psych Central offers a few good ideas to help you build your self-esteem. Procrastination is a common issue amongst students and essay University, many adults. There are many who struggle with deadlines everyday, with the feeling of impending doom as the exam or project date looms. It is one of the largest problems seen in college counseling centers, and affordable essay writing Edith University, it is how to literary Griffith, something nearly everyone has had to deal with at some point in their lives. This article describes the Castle School, roots of procrastination, while the second article describes strategies to help yourself overcome procrastination. Love versus infatuation, important considerations before you take the plunge in a new relationship.

In order to facilitate the dissemination well-established and probably efficacious treatments, the Task Force on Psychological Interventions has now collected a list of manuals detailing the literary essay Griffith University (Navitas), well-established treatments. Article Writing Trafalgar? Weblogs (or blogs) and their brethren, online journals, have infiltrated every crevice of our online society today. You can't shake a URL these days without stumbling upon someone's attempt at self-disclosure or ego-boosting linking. Weblogs have been around since the very first Web site was popularized, even before Yahoo, making them nearly as old as the Web itself. Yet it is only in recent years that they've gained greater attention and notoriety, as though a new phenomenon. If they were new, at least they might be interesting. An article about the different ways that men and women communicate (or fail to communicate effectively) in how to essay, a relationship. An article about how the in exams The University, National Alliance for the Mentally Ill (NAMI) has reinvented mental disorders as medical brain diseases, while the evidence is still coming in. NAMI emphasizes the biology of mental disorders, while virtually ignoring the psychological and social components of disorders.

Dr. Comeau writes a weekly column, Your Mind Matters, which is published in several Southern California newspapers. His site archives a large number of these columns on a wide range of mental health topics. Color psychology is literary University (Navitas), vital within the apa article University, everyday work of people, and in this article furniture maker BT Office describes how color schemes in the workplace can effect the mood, human emotions and even behaviors of employees. An article about the relationship (or lack thereof) between higher rates of violence and people who have a mental illness. This myth continues to be published and reprinted in newspapers and new articles regularly. It's often a vicious circle. Having mental or emotional problems can make it harder to get a job, or to get the job that you want. Being unemployed or settling for a job that is how to literary essay Griffith (Navitas), unsatisfying to you doesn't do your mental health any favors either.

The problem is quite serious and Castle, breaking the cycle can be difficult. Many homeless people have mental health issues, without which perhaps they would have jobs and access to housing, but not having an essay Griffith University, address contributes further, and makes it that much harder to writing George Brown College get a job. Sometimes one thing just seems to build on top of another, making it harder to see solutions to anything. Write Essay Griffith University (Navitas)? Yet there are also people who have mental and emotional struggles, yet they have good jobs. Sometimes they may struggle with work-related issues also, but they can serve as an inspiration and example to others. Five easy-to-digest tips for helping you keep your resolutions in the New Year.

Read it and find the help you need to stick with them this year! Latinas in affordable essay writing service, Pursuit of how to essay Healing: Cultural Implications for Counseling Sexually Abused Latinas Musings about psychotherapy and why it doesn't always work as well as it should. Various articles, from sexual harassment to writing George back pain disability. There have been a number of standards for determining the quality of literary essay Griffith a health or mental health Web site proposed over apa article the years. Few of these standards have been formally implemented and there have been far too many uncoordinated efforts in this area. This article looks at the various standards to try and help consumers figure out what to how to literary (Navitas) look for in a quality health online resource. Writing Essays The University? This article describes a study published in the New England Journal of Medicine (NEJM) in September 1996 that illustrated how close researchers are (and how dependent they are) on the same pharmaceutical companies whose drugs they test. How To Essay Griffith University (Navitas)? An eye opening article for anyone who believes there is no bias in drug research. Step-by-step instructions and University, information about essay Griffith University (Navitas) how to go about creating new support groups on the Internet from scratch.

Surviving and review of Dayton, Thriving: Understanding Asian Americans’ Experiences of Relationship Trauma by how to literary essay Griffith University, Dr. Leena Batra. There are a wealth of studies that are published everyday, some that come with their own press releases and PR campaign. Some you hear about on the evening news, while other just-as-important research collects dust in from thesis to essay writing School, a peer-reviewed journal. What makes good research so good, and how can ordinary folks tell? This article delves into how to literary (Navitas), the differences between good, solid research studies, and poorly constructed, bad studies, and writing essays in exams, lets you know what to write literary Griffith University look for to tell the difference. The Carlat Report is an eight-page monthly newsletter (in both print and online form) that provides clinically relevant, unbiased information on writing psychiatric practice. This newsletter is targeted toward psychiatric and mental health professionals. The newsletter receives no corporate funding, which allows a clear-eyed evaluation of all available treatments. A typical issue provides: A concise review of a current topic of interest An evaluation of treatment options, including prescription medications, OTCs, and psychotherapies An in-depth interview with a national expert on how to write Griffith the issues topic Clinical wisdom culled from front-line clinicians (Anecdotes from the Field) An intriguing snippet from the past (Tales from the History of Psychiatry) Site last updated: 28 Dec 2016.

Psych Central does not provide medical, mental illness, or psychological advice, diagnosis or treatment. Learn more.

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panic attack essay A Comprehensive Overview. This essay summarizes current information about varieties of panic disorder and write literary essay Griffith University their treatment. It is based almost entirely on article writing for kids Castle School, publicly available information gathered during the years 1998 through 2000 from sources (not specifically cited) that include published research papers (most available through MedScape or MedLine), published textbooks and trade books authored by qualified mental health professionals, articles in Griffith University (Navitas), WebMD and the New York Times, the opinions of clinicians specialized or experienced in the treatment of writing, panic disorders, and the experiences of some hundreds of individuals (patients, health care professionals, and write essay University peer counselors) who have shown up in various Internet-based support communities focused on writing Institute Montreux, panic disorders or other anxiety disorders. The intent is to introduce the write literary essay Griffith University (Navitas) reader to the wide body of knowledge that exists today and to integrate and writing the college Institute Montreux disseminate a variety of write literary essay Griffith University (Navitas), emerging insights often omitted from the writing essay narrow classical view of these disorders.

This essay should not take the place of medical and psychological treatment. Individuals who believe they may have panic disorder should be evaluated by a physician familiar with the complexities of panic disorders and the conditions that mimic or accompany them (some of which are discussed herein) and should receive an essay Griffith appropriate combination of pharmaceutical and George psychological treatment from qualified caregivers specialized in how to write literary essay, this family of conditions. For further background and a more detailed disclaimer, please refer to article writing for kids Trafalgar Castle School the end of this document. The online source for this essay resides at write essay Griffith University This essay may be linked to or printed for limited noncommercial distribution by individuals.

Any other form of apa article University of Dayton, dissemination or republication must be authorized in how to University (Navitas), writing. Panic Disorder is a broad-brush label currently applied to a variety of conditions having clearly distinct etiologies, prognoses, and appropriate treatment strategies. Reasonably distinct causes of panic disorder include: Phobic sensitization to writing essays Brown College symptoms of panic or anxiety #150; fear of the fear Prolonged stress Anxious or obsessive patterns of thinking Poor breathing habits, whether rooted in literary essay Griffith University, anxiety or other causes Emotional or existential turmoil (whether conscious or unconscious), often deriving from writing informative essays George Brown College, conflicting expectations, needs, desires, or external requirements and resulting in a subjective perception of helplessnes or paralysis. These first causes are the best known and, together with one or two concepts such as false suffocation alarm and separation anxiety, are considered the classic causes. However, they may in fact explain a minority of cases.

Other causes include: A hereditary defect in literary, the metabolism of thesis to essay, cholecystokinins (CCK), endocrine substances involved with regulating both digestion and stress endorphins. People with this form of Griffith University, panic disorder have likely exhibited escalating gastrointestinal symptomatology, often Gastro-Esophageal Reflux Disease or Irritable Bowel Syndrome, for years or decades before the emergence of panic attacks. Norepinephrine and secondarily epinephrine GABA Serotonin. Each of the causes of panic disorder listed above is supported by a body of published research, except as noted in the last point, where the relevance to panic disorder is more speculative and is not suggested by the researchers but is suggested by from to essay writing School the well-documented statistical association of Griffith (Navitas), panic disorder with schizophrenic families. Ongoing advancement in the scientific understanding of panic disorder may reveal etiological overlap among these factors beyond the overlap already suggested or it may lead to further differentiation. In addition, there are a number of distinct medical conditions, some commonly recognized and others not, that mimic panic disorder or exacerbate sub-acute cases into an acute phase. Writing Essays In Exams The University Of Brighton! Beyond the universally recognized but very rare pheochromocytoma, some of the more commonly encountered conditions are: Hypothyroidism. Screening for TSH levels is widely regarded among first-line clinicians as sufficient screening for thyroid abnormalities; however, such limited screening consistently fails to identify a number of how to write literary essay Griffith (Navitas), hypothyroid conditions that lead to panic attacks and other serious and thesis to essay Millfield sometimes life-threatening pathology. Essay Griffith! Once the condition has advanced to the stage of panic disorder, correcting the underlying imbalance may not be sufficient to bring about remission, as damage to Millfield School the nervous system can already have occurred at how to essay (Navitas) this point. Strictly speaking, it can be argued that panic disorder is a misdiagnosis when it is secondary to any of these conditions. In the real world, however, medicine most often fails to diagnose the underlying condition if the presenting symptoms have an anxious presentation to them.

As a result, the panic disorder population #150; on apa article University, which all research is conducted, from which the understanding of how to write literary, panic disorder derives, on apa article University of Dayton, which treatments are tested, and to which the resulting diagnostic and therapeutic protocols are applied #150; is exactly this mixed bag of patients and causes. A diagnosis of panic disorder carries with it a substantial likelihood that one (or more than one) of these factors is present. Studies over long periods have established that thought patterns once thought to be causative in how to write literary Griffith, panic disorder, such as hypervigilance, catastrophic thinking or catastrophic interpretation of of Dayton, sensations, among others, emerge in many patients as a result of the condition and cannot in fact be considered preexisting causative factors in those patients #150; that, for instance, the tendency toward catastrophic interpretation of how to write literary essay, relatively normal physical sensations typically emerges (if at all) as a gradual consequence of the normal interpretation of catastrophic physical sensations lying outside non-afflicted individuals' realm of experience. It is also critical to understand that individuals with panic disorder do not necessarily worry more, feel more stressed, or internalize or somatize more than non-afflicted individuals. They can certainly develop such traits as a result of the condition (or possess them from birth), but the distinguishing factor is that the neurochemistry of an individual with panic disorder reacts differently from that of a non-afflicted individual even to low or normal levels of stress #150; or to other, idiopathic factors not necessarily related to situational stress or worry.

This difference manifests itself in a variety of ways, some of which are well understood and some of which are not. Absolute elimination of writing in exams, panic attacks should be one goal of treatment, because of their kindling effect. With each panic attack, the nervous system becomes more prone to experience the next one. This is not only a psychological process, but a neurological one as well. Absolute elimination of panic attacks is not a sufficient goal of treatment, much as elimination of sugar from the urine of a diabetic is not a sufficient goal of how to write literary Griffith, treatment for diabetes. Apa Article Review! The insufficiencies, imbalances, and processes leading up to the panic attacks, both neurological and psychological, are far from benign. Because of the variety of causes and processes at work in panic disorder, there are few generalizations one can make that would apply to as much as 75% of the panic population. However, subgroups and regularities do clearly exist, so there are many generalizations one can make that apply to various groups of as much as 30-40% of the population.

The American Psychiatric Association's Diagnostic and Statistical Manual of how to write literary essay (Navitas), Mental Disorders, Fourth Edition (DSM-IV™) describes a panic attack as follows: The essential feature of a Panic Attack is a discrete period of intense fear or discomfort that is accompanied by at least 4 of 13 somatic or cognitive symptoms. The attack has a sudden onset and builds to a peak rapidly (usually in 10 minutes or less) and is often accompanied by a sense of essay, imminent danger or impending doom and an urge to escape. The 13 somatic or cognitive symptoms are palpitations, sweating, trembling or shaking, discomfort, nausea or abdominal distress, dizziness or lightheadedness, derealization or depersonalization, fear of losing control or going crazy, fear of dying, paresthesias, and chills or hot flashes. Attacks that meet all other criteria but that have fewer than 4 somatic or cognitive symptoms are referred to as limited-symptom attacks. This is probably as good a rudimentary operational description as any, although it is literary Griffith (Navitas) only a committee consensus not based on any consideration of essential underlying mechanisms. (The idea of affordable essay writing Edith, peaking within 10 minutes is now generally agreed in (Navitas), the panic disorder community to apply to a minority of cases. Writing Millfield School! Full status panicus can persist for hours or even days. Write! Presence of the 10-minute observation in DSM-IV is probably a legacy from the time when panic disorder was thought to be synonymous with hyperventilation syndrome.) It is Cowan University important to note that anxiety or fear, although typical, is not a requirement.

Intense discomfort, whether existential or physiological, is how to equally a qualifying factor. In fact, the terms panic disorder and panic attack may do as much to obscure the true face of the disorder from clinicians and essays in exams The University patients as they do to make it understandable to the general public. Much additional insight can be gained from write literary essay (Navitas), one of the pioneers in apa article review University of Dayton, treating panic disorder before there was much medical understanding of the condition, Dr. Claire Weekes. She wrote of a panic attack as consisting of how to University (Navitas), a first fear and a second fear. The first fear is some cluster of review University of Dayton, sensations, often untriggered, of literary essay Griffith, which the service Edith Cowan University patient suddenly becomes aware. These would be sensations like those broadly categorized in the DSM-IV definition (and treated in literary Griffith, somewhat more detail under later headings in apa article, this essay). We know today that the term arousal or dysautonomia is more appropriate than fear to many patients and clusters of sensations, but Dr. Weekes' early insight is still remarkable for her time, crucial to understanding the anatomy of a panic attack, and therapeutically useful today.

The second fear is a reaction to how to literary Griffith (Navitas) the appearance and sensations of the first fear. Competing descriptions have emerged for why this second fear comes about #150; premonition of death, fear of essay service Cowan University, suffocation, resonance with primal separation trauma, catastrophic thinking, etc. #150; but basically, Weekes' premise is that the second fear is fear of the how to literary essay University first fear. It is writing School a rapidly escalating, possibly eruptive panic reaction that feeds back into the manifestations of the first fear or triggers new manifestations. It is Weekes' second fear that is addressed by most attempts to write (Navitas) treat panic disorder. Review University! Patients are taught not to fear the University (Navitas) primary sensations of the episode. This is an writing essays George Brown extremely useful concept in Griffith University (Navitas), Cognitive-Behavioral Therapy for from thesis to essay writing Millfield School panic attacks. In the days before any such phenomena were recognized, patients either learned to how to essay Griffith University (Navitas) do this on their own or medicated themselves with alcohol or with medications prescribed for nerves. (Or in the worst cases, they were committed to psychiatric hospitals.) The aim of such CBT is to learn and internalize the idea that the primary manifestations are benign and to learn not to compound them with a panic reaction. Review University Of Dayton! Antidepressant medications also primarily treat this second fear, even as some of write literary Griffith (Navitas), them may exacerbate the primary manifestations of panic disorder. Nonetheless, the fact remains that the primary manifestations of a panic attack, the first fear, can be intensely unpleasant. Even without any second fear, the primary manifestations of a panic attack can have a distinctly paroxysmal quality of their own, akin to vomiting or a slow-motion sneeze or a slow-motion shudder or an orgasm.

They have differing causes in different cases. Various theories compete to provide an explanation. Some neurologists hypothesize neuroelectrical chaos. Some make an analogy to a sort of epilepsy outside the brain, while others dispute the appropriateness or desirability of such an analogy. Others find deficiencies of parasympathethic neurotransmitters.

In some patients, blood oxygen saturation drops by 25% or more, sometimes in response to circulatory disturbances and other times in writing essays The University of Brighton, response to write Griffith (Navitas) underbreathing. It is likely that a relatively large number of transitory endocrinological and neurological manifestations exist but are difficult to observe in progress. And then there are patients in whom the primary manifestations are non-paroxysmal. Such patients may simply shake randomly and uncontrollably, or feel intense generalized abdominal distress, or experience a variety of alien internal sensations. Apa Article Of Dayton! These sensations can be frustratingly difficult to describe, since they often lie outside of shared experience, the language lacks any directly descriptive terms for them, and the non-afflicted can only try to (Navitas) interpret such descriptions in terms of personal experience. A further complication is that even medical doctors versed in panic disorder do not always know what is happening biologically or how to observe or measure it in other than superficial terms. Thesis School! The experience usually looks like fear and it most often, though not always, feels like fear as well, albeit sometimes a strange fear. These manifestations may continue for how to write literary essay University hours or even days in the college application Hotel Institute Montreux, the absence of medical intervention (despite the essay DSM-IV's specification of 10 minutes as a norm), and not all patients experiencing these symptoms experience the escalating or eruptive second fear to essays in exams The University of Brighton which Weekes refers. It is possible to learn not to compound one's reaction when blood oxygen saturation falls substantially, or when a drop in the availability of the how to literary University neurotransmitter acetylcholine below a certain threshold causes muscles to go into random spasms, or when any of writing the college essay Hotel Institute, a host of other manifestations appear, but absence of a compounding second fear by how to essay University (Navitas) no means implies that one is well or feels well. One might well say of some cases #150; and such cases are not rare #150; that over from to essay writing Millfield School, time the panic disappears but the disorder remains. On one level, that is a facetious statement, but on Griffith (Navitas), another level, it captures an important truth.

So while practicing psychologists and psychiatrists largely focus (wittingly or unwittingly) on writing essays The University, treating Weekes' second fear and write literary (Navitas) associated complications (primarily inter-attack anticipatory anxiety, agoraphobia, or phobic avoidance), researchers and neurologists work at expanding our understanding of the first fear, or the writing informative essays George primary manifestations of panic attacks. The belief that most panic disorder patients are simply overreacting to write literary essay University (Navitas) normal sensations that others ignore is rapidly being relegated to informative essays George Brown history. The primary manifestations of panic attacks are often anything other than normal sensations. Researchers in whom such sensations have been induced artificially have described them as harrowing. One described them as comparable in degree of write literary essay University (Navitas), trauma to wartime experiences. Hyperarousal and the Mind-Body Duality. The conditions commonly called anxiety disorders #150; Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder, and other less commonly diagnosed conditions #150; are all essentially disorders of hyperarousal.

In the School case of how to write literary essay University (Navitas), panic disorder, particularly of the familial variety, the hyperarousal tends to be essential (having no single, clearly identifiable cause, much like essential high blood pressure) and, at from thesis to essay Millfield School least in the early years, autonomic (expressing itself primarily or initially in physical symptoms not under conscious control). There has been a tendency in the conceptualization of these disorders (at least the first three) to think in terms of hyperarousal specifically of the fear, alarm, and watchfulness circuits of the brain, but in truth the write literary essay Griffith University (Navitas) hyperarousal tends to writing informative essays George Brown be more generalized in nature. It may even lack an intuitively anxious presentation. Because typically anxious arousal is more likely to essay be noticed, clinicians' unawareness of the generalized nature of the hyperarousal involved can lead to underdiagnosis of hyperarousal disorders or to too narrow a focus on treatment of for kids Trafalgar School, specific symptoms. Mental arousal comprises thoughts and feelings, both conscious and how to literary University (Navitas) unconscious. It may express itself in many ways, some of them subjectively negative (such as worry or non-specific agitation), some of them subjectively positive (such as anticipation), some of University of Dayton, them constructive (such as productive focus on how to literary Griffith University, a project), some of them destructive (such as constant worry about improbable what-if scenarios). From Thesis Writing Millfield! Mental arousal resides in the higher levels of the brain, those responsible for conscious and unconscious thoughts and feelings. Autonomic arousal consists of many bodily functions that are not under volitional control, such as heartbeat, sweating, digestion, and others; and write essay Griffith University some bodily functions that are partially under volitional control, such as breathing and writing the college application essay Hotel Institute excretion, so that they self-regulate in normal circumstances but are subject to conscious or unconscious intervention from higher levels of the how to write literary essay (Navitas) brain.

Autonomic arousal resides nearly everywhere in writing essays Brown, the body outside the higher levels of the brain, including the nervous, endocrinological, and essay Griffith (Navitas) immune systems and the most primitive parts of the brain that regulate autonomic function. It is an axiom of psychosomatic medicine that where the mind goes, the body will follow. There is, however, an equally true but often neglected corollary to that maxim, namely that where the body goes, the mind will follow. Each type of essays, arousal disorder and each individual case has its characteristic mixture of mental and autonomic arousal and its own characteristic relationship between the two. It turns out to how to essay Griffith University make little difference in panic disorder whether arousal is subjectively perceived as negative or positive, as anxiety or as pleasurable excitement. It is the fact of arousal in itself that primes the body to experience panic attacks and then triggers the affordable service Edith Cowan attacks. This is how to literary University true whether the arousal stems from external stimulation or from from thesis to essay, internal factors, whether from primarily mental influences or primarily autonomic ones such as reactions to essay Griffith University (Navitas) medication, food, heat, or panicogenic inhalants (including certain common air pollutants). The classical view of anxiety disorders is that mental hyperarousal is the impetus behind autonomic hyperarousal. This is an understandable oversimplification, because it describes what is true much of the time in George Brown, normally functional individuals. It ignores the key point, however, that these are precisely disorders of arousal, and that there are various forms of these disorders. An arousal disorder may be driven by intrinsic hyperarousal of the mind, by intrinsic hyperarousal of the autonomic nervous system, or by an aberration in the way either one influences the other.

And whatever the primary impetus of the how to essay University disorder, secondary effects nearly always emerge to complicate the condition and confuse its characterization #150; effects seen in writing George, the mental and autonomic domains and in the way that the two domains influence each other. Yes, the write University mind can arouse the body and it can calm the body. It can even make the body ill, as one sees in informative essays George College, the traditional view of how to write literary essay Griffith (Navitas), stress and psychosomatic medicine; and it can heal the body, as one sees in the response of such conditions as cancer to review University of Dayton the influence of psychotherapy #150; although thankfully, one does not see anyone advocating treatment of the mind as the primary care for cancer patients. (One hopes that the average treatment of panic disorder will some day be so enlightened…) However, the how to literary University reverse is equally true: the body can arouse the writing the college application essay Hotel mind and it can calm the mind; and it can even make the mind ill or heal the mind. Essay Griffith (Navitas)! One sees one obvious example in the relaxing (or in application Hotel Montreux, some cases invigorating) effects of massage #150; indeed the ability of massage therapy to influence the course of mental and even physical illness. Another example is found in the mental illnesses #150; depression, obsession, anxiety #150; that frequently develop as secondary consequences of write (Navitas), chronic organic illness.

Food reactions distinct to certain genetic groups constitute another example, as do arousal reactions to certain antibiotics and anticholinergic medications that do not act directly on for kids Trafalgar School, higher levels of the brain. The spectrum connecting mental and autonomic arousal could be compared to a pushme-pullyou, the fictional creature from Dr. Dolittle with two front ends and write literary essay University two brains. The beast is particularly unpredictable in individuals with anxiety/arousal disorders. Writing Service Cowan! The mind can be driving the disorder with the body mostly along for the ride. Or the body can be driving the write literary essay University (Navitas) disorder, with the article writing Castle mind doing its best to write Griffith resist. Treatment of the mind can accomplish surprising effects on biology, but this is compensation, and it does have its limits. Service! If this were not so, then psychotherapy would be the primary treatment against for instance epilepsy, a condition with certain similarities to some forms of literary University, panic disorder and The University a condition that is how to literary essay sometimes partially responsive to psychotherapy. So a good understanding of the mind-body connection in panic disorder generally and in any specific patient is essential to intelligent diagnosis and effective treatment. Notwithstanding the mind-body overlap, the essence of each case is usually to be found in some intrinsic factor on one side or the other. The reader should know that the medical community currently applies the term dysautonomia to an abnormality in the self-regulation of writing Trafalgar Castle, autonomic arousal and applies the term anxiety to literary essay Griffith (Navitas) an abnormality in the level of essays George College, mental arousal, including any manifestations of autonomic arousal presumed correctly or incorrectly to derive from conscious or unconscious thoughts or feelings.

This conceptual bias tends to hobble treatment, but it is important for literary University the reader to understand the doctor's likely perspective at the outset of the relationship. Most of the the college Hotel Montreux clinical progress currently taking place in the medical treatment of panic disorder occurs through the process of patients exposing their doctors to literary essay Griffith the body of research relevant to their own variant of panic disorder. Dysautonomia and its Paroxysms. The panic attacks in panic disorders are usually just the tip of the writing essays in exams of Brighton iceberg. Just as significant as panic attacks per se is the chronic dysautonomia present in how to University (Navitas), panic disorder. A number of expressions of dysautonomia are often present for extended periods in panic disorder patients, even in the absence of frank panic attacks. Indeed panic attacks could in essays George Brown College, most cases be called dysautonomic paroxysms, and the disorder could reasonably be called paroxysmal dysautonomia. The following is a reasonably comprehensive but certainly not exhaustive list of mostly dysautonomic symptoms associated with panic disorder. (Not all of how to Griffith University, these are strictly speaking dysautonomic, though most are, but this is from School a convenient place to gather symptoms frequently associated with panic disorder.) Any given person is likely to literary experience only a handful of thesis to essay writing School, these symptoms, though they may be frequent and intense. The point of write literary essay Griffith University (Navitas), such an extensive list is to essays The University of Brighton provide reassurance to how to literary essay Griffith (Navitas) someone diagnosed with panic disorder who is experiencing any of these very diverse symptoms that they can indeed be merely symptomatic of panic disorder and not necessarily a sign that some other medical or biological condition is present.

Heart-and circulation-related: Rapid, irregular, or forceful, loud heartbeat. Affordable Writing Service Cowan! Sensation of skipped heartbeats. Chest pain. Low or high blood pressure, often with remarkably wide swings. Panic disorder patients are sometimes diagnosed with atypical mitral valve prolapse or mitral valve prolapse syndrome.

It is characteristic of panic disorder that symptoms from several of the groups above occur together. Write Literary Essay Griffith! (panic disorder is a polysystemic condition, which is one factor leading to poor recognition, diagnosis, and treatment.) It is also normal for some varying level of writing The University of Brighton, these symptoms to be present much or most of the time for uncontrolled patients, but for the symptoms periodically to escalate to the point of how to literary Griffith University, paroxysm followed by essay relief of varying duration. It is common for panic attacks to occur during sleep, especially in patients with the gene for cholecystokinin-related bile reflux panic disorder. In many respects, these dysautonomic symptoms ought to be of more concern to clinicians than the panic attacks themselves, except that patients experiencing panic attacks are at a strikingly elevated risk of suicide. Normal research subjects who have had panic attacks induced by the administration of GABA antagonists have described the experience as completely unbearable and the worst experience of their lives. (It is how to literary Griffith conceptually interesting that although synthetic panic attacks can be created with some degree of affordable essay writing service Cowan, success under laboratory conditions using serotonin depleters, serotonin reuptake inhibitors, cholecystokinin, sodium lactate, and norepinephrine, no class of substances but perhaps cholecystokinin comes anywhere close to the panicogenic effect of a GABA antagonist. This suggests that the old GABA-based conceptualization of how to write literary essay (Navitas), panic disorder in the wild was more correct than newer serotonin-based conceptualizations.) In a significant number of patients, dysautonomic symptoms and writing informative George Brown panic attacks emerge not during periods of long-term or short-term stress, but after the cessation of such stress or during its period of abatement. This is probably true in how to write (Navitas), particular of the patients with cholecystokinin abnormalities.

In a significant number of patients, mental/emotional anxiety waxes and apa article review University of Dayton wanes, and the dysautonomia waxes and wanes, but there is no identifiable pattern of correlation. It is in these patients that the neurological dimension of the disorder is the Griffith (Navitas) most obvious. There is an interesting minority of patients who experience severe dysautonomia, even to the point of physical incapacitation, without experiencing what they themselves would call a panic attack. This is not too difficult for many sufferers of panic disorder to understand, particularly after therapy or years of thesis to essay writing Millfield, experience with the condition have desensitized (to varying degrees) the how to write University (Navitas) fear response that can be aroused by the dysautonomia. One experiences all of the escalating dysautonomic arousal without the paroxysmal culmination that provides temporary relief. Writing Essays In Exams The University Of Brighton! People who have not experienced a panic attack can perhaps understand this distinction by thinking of sexual arousal and orgasm as an analogy. It is possible to be highly aroused without experiencing orgasm. Similarly, these non-paroxysmal dysautonomic states can be very intense #150; indeed they can be more intense than the states that would induce paroxysmal panic in how to University, other panic disorder patients or in normal individuals. Current thinking distinguishes between Generalized Anxiety Disorder (GAD) and article writing Trafalgar Castle School panic disorder largely (though not entirely) on the basis of absence or presence of how to literary University, panic attacks.

But in some respects, these conditions appear much of the writing the college application Hotel Institute Montreux time to be differing degrees of the same biological disorder, and if it is useful to distinguish at all, it might be more diagnostically and therapeutically useful to literary apply a distinction at right angles to Brown College the current one, recognizing one disorder that is primarily somatic/dysautonomic and how to write literary University another that is primarily cognitive/emotional. Writing The College Application Essay Montreux! Granted there is overlap, but there does appear often to be an etiological distinction in reality. It is common practice to consider panic disorder controlled when panic attacks are eliminated. However, the goals of treatment should actually include elimination of write literary essay, most or all of the associated dysautonomia, as the dysautonomia is symptomatic of uncontrolled underlying pathology and in some cases exacerbates the underlying pathology (just as uncontrolled panic attacks escalate through neurological as well as psychological mechanisms). Panic disorder of biological genesis is chronic and affordable essay service Edith Cowan University mildly progressive. Although some clinicians claim encouraging cure rates, usually in carefully selected groups, studies have shown that when one looks at essay Griffith (Navitas) patients over periods of time four years or longer, a preponderance of writing Edith Cowan University, patients experience relapse in the absence of literary essay Griffith (Navitas), ongoing pharmaceutical treatment. This is not always evident to treating clinicians (who have been known to claim cure rates as high as a thoroughly suspicious 100%), because patients frequently change doctors if they perceive that their treatment was unsympathetic or ineffective; and relapse is readily perceived as a sign that treatment was ineffective if the treating physician has created unrealistic expectations of a permanent cure or has exerted subtle pressure to recover or to tough out minor episodes. It is often stated that panic attacks do not lead to heart attacks. This is writing true as far as it goes; however, sufferers of uncontrolled panic disorder are at literary essay Griffith a quadrupled risk for eventually experiencing a serious cardiac event. For instance, QT prolongation (a type of subtle heart arrhythmia) is present in a disproportionate number of from thesis, undertreated panic disorder patients.

In fact, a variety of arrhythmias are observed with disproportionate frequency in panic disorder patients, though many of them are only observable during an how to write literary Griffith University (Navitas) episode or during the lead-in to an episode. The paroxysm of the attack itself may serve to correct the arrhythmia. One of the essays George Brown greatest health risks for sufferers of panic disorder as they grow older is unrecognized serious illness that would be diagnosed earlier in other patients. If it is how to write true that a certain proportion of panic disorder patients tend toward hypervigilance and hypochondria, particularly in the years just prior to and following correct diagnosis with panic disorder, yet it is also documented that primary care physicians and many specialists tend to dismiss the The University of Brighton complaints of (Navitas), patients bearing a diagnosis of panic disorder (or generalized anxiety disorder) without sufficient foundation for doing so. Panic disorder patients get organic illness just as often as other patients. They just don't get it diagnosed as often. In fact, it has been clearly shown that patients with anxiety disorders go longer before diagnosis of serious conditions than do patients without these stigmatizing diagnoses, and physicians have cause to be more concerned with the potential for medical error and liability. Particularly problematic is the practice in some emergency rooms of shunting panic disorder or GAD patients presenting with chest pain or other possible cardiac symptomatology into psychiatric observation without sufficient examination. There are documented instances of application Institute, fatalities resulting from such systematized negligence. On the other side of the (Navitas) same coin, emergency rooms also represent frequently missed opportunities to identify potential cases of panic disorder.

Many ER doctors are poorly trained to recognize panic disorder, particularly in thesis to essay Millfield, its pre-emergent guise of non-paroxysmal dysautonomia. This is not surprising given the diagnostic criteria in use today. Pre-emergent panic disorder often does not look much like GAD, as it is is likely to how to write literary (Navitas) be primarily somatic until the first string of panic attacks initiates the cycle of affordable essay service Edith University, fear or worry and how to write literary essay cognitive-emotional-behavioral disturbance. Unfortunately, even when ER doctors do recognize panic disorder, they are still as likely as not to dismiss it as neurosis unworthy of serious attention and counseling or referral. Apa Article Review Of Dayton! Patients are still likely to write essay Griffith be told to breathe into essays a paper bag next time, although this is in fact more likely to trigger than to stave off a panic attack for a sufferer of biologically rooted panic disorder. In fact, panic disorder patients are often told (not asked) that they are claustrophobic, or anxious travelers, when in fact their bodies are reacting in predictable and well-understood ways to the elevated levels of literary University (Navitas), CO2 present in poorly ventilated spaces full of breathing bodies. This ties in apa article review of Dayton, with the false suffocation alarm interpretation of panic disorder, although this theory has become less prominent in the field as other mechanisms have become better documented.

This is how to write literary University (Navitas) not to say that the interpretation will prove to be wrong, merely that it is affordable essay writing service Edith University not universal. Write Griffith! And in point of essays College, fact, it has not as yet been proven to be anything; hypotheses and assertions relating to how to University (Navitas) panic disorder must be subjected to the same standard of proof as other, non-psychology-related, statements of medical doctrine. One finds that clinicians who demonstrate admirable scientific rigor in making non-psychiatric diagnoses are given to comically whimsical leaps of faith in attributing patients' symptoms to psychosomatic processes. From Thesis Writing Millfield School! (Hence the derisive terms psycho-so-magic and psycho-so-magical that one sometimes encounters in patient discussions.) Note: There is how to literary essay Griffith (Navitas) ample research around the false suffocation alarm to indicate that elevated CO2 levels do in fact provoke hyperarousal and panic attacks in a subset of the panic disorder population. Writing Essays In Exams The University! At issue is the how to write essay Griffith (Navitas) histrionic labeling of this reaction on the assumption that all individuals ought to experience identical toxic reactions to CO2 at identical concentrations. One might just as easily label hypoglycemic states as false starvation alarm reactions. It is writing not the alarm per se that is false, it is merely its characterization as one of life-threatening suffocation or starvation that is false #150; and that is not the patient's error of interpretation, as the term implies, but the how to essay Griffith University diagnostician's. (And when this model was extended to a population with anxiety from pulmonary disease, the from Millfield School alarm sadly turned out not to write literary Griffith University (Navitas) be so false.) There are a number of essays, conditions frequently associated with panic disorder. Some of how to write literary University, them may be cause or effect of the disorder, while others are merely associated. It is important for physicians to recognize the associations, because sometimes it is difficult to treat the associated condition if the underlying or associated panic disorder is left untreated.

GERD, IBS. Probably the conditions most universally present in panic disorder are Gastro-Esophageal Reflux Disease and Irritable Bowel Syndrome. In approximately 40% of panic disorder patients, both are caused primarily though not entirely by the excessive and irregular secretion of bile so characteristic of hereditary panic disorder. In some patients the effects are mostly upward in the GI tract, resulting in excessive stomach acid secreted to neutralize the bile and leading to GERD #150; sometimes with associated asthma or sinusitis that is not recognized as related to panic disorder or GERD. (Gastric swelling and from thesis to essay writing Millfield School consequent pressure on the diaphragm or a nerve center has been proposed as one possible cause of abnormal breathing in panic disorder; such a suggestion is how to literary essay Griffith University (Navitas) supported by the fact that subjective difficulty in breathing related to panic disorder can be alleviated in some individuals by affordable Edith University pressing fingertips downward into the abdomen not far below the sternum.) Often patients will have had GERD or IBS for years or decades, frequently even since childhood, before the emergence of how to literary University (Navitas), panic disorder diagnosable by affordable Edith current DSM-IV criteria. Even panic disorder patients who do not show overt symptoms of GERD or IBS often exhibit the characteristic abnormalities of bile secretion. How To (Navitas)! The combination of Xanax and Carafate has been found to be remarkably effective in treating these conditions in panic disorder patients; indeed therapeutic response of GERD or IBS to this combination can almost be regarded as a diagnostic criterion. (It is not known why Carafate is often so much more effective in the panic disorder population than newer drugs like acid blockers and writing essays in exams proton pump inhibitors, but the phenomenon is distinct.) As one follows any group of panic disorder patients over a period of years, half or more do apparently keep the diagnosis of essential panic disorder. How To Write Essay University! However, every year a certain percentage are found to have an organic condition the diagnosis and treatment of affordable essay writing service Cowan, which resolves the panic disorder. Obviously the organic condition, or at how to write Griffith least a tendency to it, was present years before it became overt enough to trigger normal diagnostic flags. A panic disorder patient should be prepared to believe and to accept the benign diagnosis of panic disorder for the rest of their life. But clinicians and patients alike should be alert to changes and should recognize that for instance normal ranges on laboratory tests apply to a statistical abstraction and not necessarily to every individual.

Often individuals experience well-being only from thesis Millfield School, within a narrower range of values than the essay stated range (which varies from lab to lab in any case), and on The University, some types of tests, even the optimal center point may be different for how to University different individuals. Panic disorders, the comorbid conditions mentioned above, and the possible reasons for comorbidity offer much fertile and largely unturned ground for research in the coming years. There are quite a few chicken-and-egg questions raised by just the associations discussed above, not to mention associations that will emerge with more research. One thing that is clear even now, though, is writing essays of Brighton that with or without statistical documentation, most of the associations discussed above are widely recognized in the panic disorder community. On Medicine As Biology. Those of write Griffith (Navitas), us without a medical education tend to think of our doctor as a kind of master detective biologist. It's a natural assumption but it reflects an important misunderstanding of apa article review, medicine as art or science. A doctor is write literary University only a master biologist in the loose sense that an architect or a structural engineer would be a master physicist. After a few notoriously rigorous courses in certain traditional elements of human biology, a medical education branches rather quickly into writing informative George Brown the study of established medical protocols for diagnosis and treatment of well-recognized conditions. When a doctor examines and how to Griffith diagnoses us, he is the college essay Hotel Institute not, as we might easily imagine, unraveling the mysteries of our biological individuality. Literary University (Navitas)! Rather he is comparing our presentation to a multitude of checklists that would match us to affordable service Cowan one of the standard diagnoses and treatments he has (in the best case) mastered.

American medicine in particular prides itself in being based on how to literary essay University, statistical models of disease. The European medical tradition recognizes the statistical perspective and and the case-based or anecdotal perspective as complementary halves of a complete picture, halves that are roughly analogous to macroeconomics and microeconomics. But the case-based perspective interests American medicine only insofar as cases reflect what is typical of the statistical perspective on a patient's illness. Doctors are explicitly trained to gloss over and filter out the idiosyncrasies that conflict with the accepted model of the condition. Thus many will persist with a favored class of medication despite a patient's obvious adverse effects or lack of response. It is revealing that the doctor's impatience will be with the patient, not with the medication. They will ignore patients' reports of unusual symptoms as irrelevant when in thesis writing School, fact they could be highly relevant to unraveling the individual mystery and essay University finding a treatment that is effective for the individual patient. In such cases, the doctor is not treating the patient, he is treating the statistical model of the patient's diagnosis (a diagnosis which may or may not be correct) . Nowhere does this approach to medicine fail more spectacularly than in a condition like panic disorder, where it is so difficult to define what is typical. But it fails in other contexts as well.

The author of this document himself was evaluated by 14 doctors over a span of more than 10 years before aldosteronism was finally noticed, proven, and identified as the root cause of all the symptoms that had received such a variety of diagnoses and writing Institute misdiagnoses (including panic disorder) over that time. Mumblings about anxious patient and panic attacks were always somewhere in essay (Navitas), the background. In the end, he himself had to suggest the diagnosis that proved to be correct and argue vigorously for the definitive test that clinched the affordable essay writing service Cowan University diagnosis. Unfortunately, the author's experience is not at all unusual. Such outcomes are commonplace in panic disorder support groups.

They may even be more the rule than the exception. The overlooked diagnoses vary, but the experience is the same. Patients go years and even decades getting hurried, substandard and frequently condescending care from doctors (often at premier practices or medical facilities) who jump to hasty conclusions and rush to try out the latest psychotrophic medication. Often the how to write literary essay (Navitas) final and correct diagnosis is a condition thought to writing informative essays George Brown be rare, such as celiac disease, aldosteronism, or thyroid dysfunction, but which appears to be strikingly common in the panic disorder population. Sometimes these failures of diagnosis occur because a doctor who might recognize a single unmistakable result on a routine test or some other unmistakable clinical indicator is not good at recognizing a constellation of borderline results or suggestive indicators that must be considered in combination before they add up, as in how to write essay, the author's case, to a clear picture. More often such failures of diagnosis reflect a simple failure to be meticulous. So patients suffer years of adverse medication reactions, stigma, and other woes that often include lost jobs, lost mobility, lost careers, lost marriages, and lost financial security.

Then a single meticulous doctor provides a correct diagnosis and essay Edith Cowan correct treatment, and the neurotic symptoms magically evaporate. One truth is how to essay University (Navitas) abundantly clear in all of this: the extent to from thesis to essay writing which our presentation is write University (Navitas) atypical is writing application Hotel almost precisely the extent to which our doctors will fail to correctly diagnose and treat us. They are trained to ignore the atypical, not to seek an explanation or accommodation for it. And there are virtually no typical cases in panic disorder or the conditions that mimic it. There are only typical treatments. There have been studies showing that doctors almost universally overstate their treatment successes and understate their patients' adverse reactions. Some studies have even explored psychological reasons for the disconnect from reality. But it is also easy to explain by natural selection. There are many doctors who treat panic disorder ineffectively and who fail to diagnose medical conditions masquerading as panic disorder.

There are only how to write literary, a few who routinely do well at it. It is well documented that most panic patients see multiple doctors (averaging ten or more) before finally receiving effective treatment or correct diagnosis. Almost every one of those earlier doctors assumes that treatment has been successful, or at the very least fails to receive any feedback on affordable essay writing service University, the negative outcome or misdiagnosis. Thus there will inevitably be a large majority of doctors who think they are doing much better than they actually are. One could well object, in cases of delayed diagnosis, that then it's not panic disorder. But if all the patients who have had this experience or will have it in literary University (Navitas), the future could omnisciently be removed from the population that forms the core of the panic disorder industry, it's not clear that there would be many left. Certainly much that the medical community now thinks it knows about the condition would no longer be valid in such an omnisciently sifted patient population, because most of the current knowledge (such as it is) has been derived from this heterogeneous population.

Unfortunately, all of writing essays George College, this talk about undiagnosed and misdiagnosed conditions feeds into the worst and most common fear in the panic disorder community, namely that some terrible condition has gone unnoticed, one that will kill us before it is discovered. The bad news is how to literary Griffith that undiagnosed medical conditions are very common in the panic disorder population. But the thesis writing Millfield School good news it that they are almost never fatal conditions. The fatal conditions do get diagnosed quickly. In fact, finding things that will kill you is the one thing that modern American medicine does better than anything else. By the time a panic disorder patient has undergone EKGs, MRIs, and all of the other routine technological marvels requiring little initiative or detective work from a doctor, the patient can be confident there is no undetected brain tumor, no undetected adrenal tumor, no potentially fatal heart arrhythmia, and no other killer lurking unseen in the background. The conditions that commonly mimic panic disorder are almost never fatal. But it is inarguably difficult to get adequate testing.

Out of every 30-60 Americans with celiac disease (a common mimic of panic disorder), only one will be diagnosed during his or her lifetime. Countless celiac patients have written in online panic support groups about the long battle for testing that they had to wage before getting the definitive tests and a correct diagnosis. For aldosteronism, the figure would be around one out of about 10-30 who ever receives the correct diagnosis. For autoimmune hypothyroidism, the prospect of diagnosis is presumably brighter, but many people write of waging long battles before the diagnosis was made. Panic disorder or the syndrome of its symptoms, even when caused by how to write literary University some other condition makes it hard for the patient to practice acceptance. Affordable Edith University! Yet it is vital to do so. We should recognize and accept that if we had a fatal condition, it would be noticed. We should recognize and accept that there may very well be some non-fatal condition causing our symptoms that has not yet been noticed #150; and that is not a catastrophe . How To Write Literary Essay Griffith (Navitas)! We should recognize and accept that in the doctor corps, as in every other walk of life, there is a small percentage (maybe 5%?) of people who do their work really well, a somewhat larger minority who are adequate for garden-variety patients (which we are not), and a full 50% who are below average (not to mention inadequate). University! We must be our own detectives and how to literary essay Griffith University advocates, but we should do so methodically, patiently, and without rancor. We should ignore the essay writing service condescension and hostility of doctors threatened by our persistence or our discontent.

People can only be as good as they are, and it is futile to hold anyone's mediocrity against them. We should never remain locked in conflict with an unresponsive doctor, but should undramatically find another. How To University (Navitas)! We should remember that statistically, it will probably be the tenth or eleventh doctor who turns out to the college application essay Institute understand our condition and its treatment. Every new doctor is a step toward the right one. We should not be ashamed of looking for the right doctor, not be intimidated by charges of doctor shopping. If there is a treatable and unnoticed medical condition underlying our case, it will be our own initiative and nobody else's that leads to how to literary essay (Navitas) a doctor who can diagnose it. But in many cases, maybe half or more, no such underlying medical condition will ever be found, and essays College we should accept that probability as well. Griffith University (Navitas)! The fact that panic is so hereditary (and genetically linked to a variety of other conditions) makes it clear that biology is a strong factor, but not every biological problem has found its way into the protocols of informative, medicine. We should accept that as well. It is very possible to live a good life with panic disorder if only we find a doctor who can practice appropriate and essay Griffith individualized treatment. We should seek a therapist as well, one who can teach us to use the mind to compensate for writing essays in exams of Brighton failings of the body.

The first resolution must be to live as well as possible within the parameters of the condition. Often correct medication and competent therapy can lead to virtual normality. The search for explanations should never become more important than making the most of the function and possibilities we have. The search for another explanation is like prospecting for gold: it is a long-term quest, one in which we must pace ourselves wisely and one in which there may never be a payoff. On Treatment Options. The most commonly used treatments for panic disorder, in no particular order, are Cognitive-Behavioral Therapy (or a special variant known as Panic Control Therapy), various meditation or progressive relaxation practices, medication with tricyclic antidepressants, medication with SSRIs (selective serotonin reuptake inhibitors, another class of antidepressant agent), medication with benzodiazepines (a form of how to literary, minor tranquilizer), medication with anti-epileptic agents other than benzodiazepines, and occasionally hypnosis or medication with one or another class of monoamine oxidase inhibitors (MAOIs or RIMAs) or antipsychotic agents. Hypnosis is relatively uncommon because it is seldom effective for non-phobic panic and can easily worsen the situation. Attempts to unearth and article Trafalgar Castle School treat the underlying trauma are usually misguided because if the initial diagnosis of panic disorder has been rigorous, it appears that there is seldom an underlying trauma to unearth. Medication with MAOIs is relatively uncommon because of the dietary restrictions involved and the danger of hypertensive crisis.

Some clinicians are working with reversible monoamine oxidase inhibitors, but so far there appears to be little data on how to write literary essay (Navitas), success. In listening to writing the college essay Hotel patients, it becomes apparent that there are patients who respond well to each of the therapies in common use, either alone or in combination. It appears somewhat common and highly advisable, for example, to supplement medication with CBT or PCT, but one also sees combinations of medications. Reactions to medications appear to be highly variable in panic disorder #150; less consistent, for instance, than reactions to anti-hypertensive medications in the treatment of hypertension. One sees that some patients respond negatively to several medications or classes of how to essay (Navitas), medications, only to respond well to another. Some patients report that SSRI medications foster a return to spontaneity and exuberance, but others report a range of negative outcomes ranging from a dulling out of emotions or even physical sensations (resulting in essays College, serious accidental burns or cuts) at one extreme to unbearable agitation at write Griffith (Navitas) the other. Similarly, some patients report a normalizing effect from benzodiazepines, but others experience negative outcomes ranging from Hotel, stupefaction or emotional dulling at one extreme to awkward or even dangerous disinhibition at the other. It seems quite clear in talking to write literary University (Navitas) patients that reactions are highly individual, and it seems probable that this is due to differences in respective patients' underlying biochemical disturbances. (A number of studies have pointed out that generally speaking, antidepressants seem to work well when the primary manifestations are of a psychological character, while benzodiazepines seem to work better when the primary manifestations are of a somatic character. Here again we see evidence that there are separate etiologies underlying such a systematic difference in efficacy #150; that indeed distinct conditions are probably involved: a sort of GAD plus panic attacks and a dysautonomia with paroxysms and sometimes secondary worry.) It appears that few psychiatrists are aware of the distinct varieties of panic disorder outlined in the beginning of this essay, although the research documenting them is readily available in research journals and correct identification of the variety of panic disorder is critical to thesis School the correct choice of treatment.

Moreover, it appears that few cases of panic disorder are even referred for psychiatric evaluation in the first place. Instead, primary care physicians tend to feel competent to diagnose and treat the condition. A typical PCP is even less aware of the complexities of panic disorder than a psychiatrist, and will almost certainly regard the condition as invariably a serotonin deficiency (which term is how to write essay Griffith itself a considerable oversimplification of one of from thesis writing Millfield School, several serotonin-related pathologies sometimes present in depression, panic disorder, anxiety disorders generally, and some other conditions not relevant to this discussion). So while it is quite apparent that reactions to panic disorder medications and the correct choice of medication vary by individual and by subtype of panic disorder, it also becomes apparent in listening to patients that many if not most physicians prescribe not according to write literary essay University what should or does work for individual patients, but according to what works for the individual doctor. One doctor treats virtually all cases of panic disorder with SSRI medications; another treats virtually all cases with tricyclic antidepressants; another treats virtually all cases with benzodiazepines. Patients who respond poorly to that class of medication typically suffer through several trials of four to six weeks each before changing doctors. It is not uncommon for a panic disorder patient to have gone through a number of informative essays George Brown College, physicians (with considerable personal suffering and sometimes loss of employment) before responding well to treatment. Oddly, it is the patient rather than the physician who is labeled non-responsive when one size does not fit all.

(Patients also tend to be unaware of the large proportion of doctors who have conflicts of interest in the form of subtle and sometimes not-so-subtle financial incentives to write Griffith University prescribe particular medications. In this respect, the ethical canons in medicine appear, at least based on actual practice, to apa article review be remarkably lax in how to literary Griffith University (Navitas), comparison to those of other licensed professions.) It is unfortunate that individual response is essay writing Edith Cowan University typically ignored in prescribing for panic disorder, because the more one examines the evidence, the more it becomes apparent that any given individual is likely to respond really well to a benzodiazepine or to an antidepressant, but not interchangeably. How To Griffith! Response to one of these classes of drugs is writing for kids Trafalgar likely to be optimal, while response to the other will be marginal at best. A small minority of patients seem to need both, but it can also happen that the two types of meds antagonize each other instead of complementing each other. This is contrary to the prevailing treatment practice, but at how to write literary essay Griffith present, practice appears to be based more on agenda (or sometimes on tradition, lore, or peer pressure) than on objective evidence. Indeed most non-specialists appear to be wholly unfamiliar with the actual evidence, which is often at odds with the claims of the salespeople (most of whose education is in sales,marketing, or communication) on whose counsel they rely.

The first rule of treatment in panic disorder should be: If it's currently working, don't even think about changing it! It is utterly appalling to see the numbers of patients who have been controlled and highly functional with one strategy of informative essays George, management over the course of years, only to move to a new state or change employer (and thus change insurance company) or have their doctor retire, and then have complete havoc wrought in their medical condition, their emotional state, their marriage, and even their employment and financial status, all because an inept and overly self-assured doctor sought to adhere to one or another of the literary (Navitas) continually emerging vogues in prescribing. One need only apa article review, search MedLine to see the course of these successive vogues over the last two decades, and it is clear that what is in today will be out a few years from now. There are choices to make in treating any newly emergent case of how to write literary Griffith University, panic disorder, and humane, flexible, patient-responsive experimentation may be necessary. But experimentation with patients who are functional and satisfied is unconscionable, should be regarded as malpractice, and has indeed been grounds for from thesis successful malpractice litigation. How To Write Griffith! Undermedication of chronic anxiety or dysautonomia is just as irresponsible and essay Hotel Institute Montreux just as ripe for judicial redress as undermedication of chronic pain. On Cognitive-Behavioral Therapy.

(and Panic Control Therapy) A large proportion of patients undergoing CBT or PCT report that they have experienced significant benefits from such therapy, particularly in the area of coping with their symptoms, reducing the severity of their panic attacks, and improving their overall well-being. How To Write (Navitas)! However, very few report that CBT or PCT alone is sufficient to eliminate or even necessarily to reduce the for kids School number of their panic attacks. Although there have been reports in essay Griffith (Navitas), the past of very high success rates with CBT alone, a recent study revisited some of the results and came to quite different conclusions. Writing! David Barlow, Ph.D., one of the leading figures in how to literary Griffith (Navitas), psychological treatment of informative George Brown, anxiety, commented on this study with the laudable observation that The one thing that we've learned . now that more data are in, is that we're not really as good as we thought we were. This was refreshing candor and literary Griffith University (Navitas) integrity in a field where professional pride has often taken priority over a dispassionate and in exams monetarily disinterested look at the relative merits of essay (Navitas), various approaches to treatment. One would expect the the college best results of CBT or PCT to be achieved when the condition is rooted in anxious or obsessive patterns of thought. How To Write Literary Essay University (Navitas)! However, it is not always easy to distinguish such cases. Certainly it seems incumbent to treat such thinking whenever it is present, whether it is a preexisting causative factor or merely a result of the disorder. Further investigation is affordable writing Cowan University needed into the effects of CBT and PCT on the dysautonomia associated with panic disorder.

Although a patient is likely to be very grateful (and at a sharply reduced risk for suicide) after learning to write essay (Navitas) experience less severe panic attacks in the face of writing for kids School, prolonged dysautonomia or dysautonomic paroxysm, little has been gained from a medical perspective if the patient nonetheless experiences prolonged and how to literary essay Griffith University frequent dysautonomic episodes. There is a certain value in affordable essay writing service Cowan University, teaching patients to cope with the symptoms of medically uncontrolled essential dysautonomia (especially if such treatment may reduce actual symptoms), just as there is value in teaching patients to cope with the (Navitas) symptoms of other chronic medical conditions. Nonetheless, such therapy should not be substituted in whole for treatment of the medical condition itself. Meditation and progressive relaxation techniques are helpful for some people. Meditation techniques need to be undertaken with the understanding that dissociative states like those it may promote are not always desirable in panic disorder patients #150; that indeed they can trigger panic attacks in themselves or simply be more difficult to terminate for individuals with anxiety disorders. (There is apa article University a fair amount of essay Griffith University, controversy around meditation in apa article review of Dayton, panic disorder, with strong opinions for and against.) And individuals undertaking either meditation or progressive relaxation need to how to write literary essay understand that even when the practices are beneficial, a panic attack is most likely to affordable writing service Cowan occur during the transition from a state of high arousal to one of how to literary essay Griffith (Navitas), lower arousal.

This appears to be true of all or most panic disorder patients, but it is affordable essay service Edith Cowan University especially noticeable among those who have the write essay Griffith (Navitas) aberrant CCK gene. Obviously it is desirable to make the review University of Dayton transition from high to low arousal, but most people would prefer to do so without triggering panic attacks in the process. How To Write Literary Essay Griffith University (Navitas)! Learning effective relaxation may thus be more complicated for the panic disorder patient than for other individuals. On Tricyclic Treatment. A growing number of clinicians now treat panic disorder using tricyclic medications, often after having used SSRI treatment for a number of years and writing service University then reverted to the use of tricyclics based on the number of adverse patient experiences. Tricyclics seem to how to write literary essay Griffith University work well for a minority of panic disorder patients. Statistically, some tricyclics are the affordable essay service Edith most successful type of antidepressant for literary (Navitas) treating panic disorder, and from thesis writing those statistics were compiled in an era of less brazen manipulation of clinical trial data than we see today.

However, due to the parasympathetic insufficiency so frequently present in write essay Griffith University, the disorder, a certain subset of panic disorder patients seem particularly prone to excessive cardiac stimulation from this class of medications, which increase the writing informative George College availability of norepinephrine. Tricyclics are also inherently less safe than most modern antidepressants, with substantially lower margins for dosage error or deliberate misuse. Tricyclic medications also reduce the availability of how to write University, acetylcholine, and reduced availability of acetylcholine is believed to be implicated in the mechanism of essay writing service Edith Cowan, panic disorder. Their overall effect is to increase autonomic arousal, so like the SSRIs, they seem to work best where the panic disorder is of psychological origin or has highly prounounced psychological manifestations. On SSRI Treatment. Among clinicians new to treating panic disorder or new to using SSRI-type medications, these medications are often regarded as the how to write University (Navitas) treatment of choice or even a panacea. This point of view appears to be in retreat among more experienced clinicians, although it is still heavily promoted by pharmaceutical companies, whose representatives still grossly understate the side effect and withdrawal profiles while greatly overstating the success rates of these medications in treating panic disorders. However, the side effect profile for SSRI medications is much worse than initially published studies revealed, the effectiveness is highly unpredictable in writing informative, treating panic disorder, and how to essay (Navitas) there is high risk for precipitating iatrogenic crisis when using this class of medications to treat panic disorder (especially during the beginning of treatment). An alarming percentage of patients in the Internet support communities for panic disorder had never experienced or even heard of a panic attack before they were treated for depression with an SSRI, but experienced panic attacks leading to an ultimate diagnosis of from thesis Millfield School, panic disorder within their first week or even the first day of Griffith University, treatment and have not been able to rid themselves of the disorder after discontinuation of the SSRI.

Now they have depression and panic disorder, or sometimes panic disorder that persists beyond recovery from depression. Primary care physicians on the whole, and a sizable minority of writing the college application essay Hotel Montreux, psychiatrists, are unfamiliar with the true side effect profiles of various SSRI medications, are unaware of the tolerance that develops to these medications when they are used to treat panic disorder, and write essay Griffith University (Navitas) are unaware of the withdrawal syndromes, despite the fact that all of these have been well documented in such sources as the British Medical Journal and the Journal of Clinical Psychiatry, among others. Writing Essays Of Brighton! (And yes, it is called withdrawal and not discontinuation or discontinuation syndrome everywhere except in the United States.) A disturbing number of patients are not informed of the potential long-term risks of their medications, including the significant weight gain and sexual dysfunction, both of which can persist long after discontinuation of how to write (Navitas), SSRI medications. When patients report some of the side effects of usage or discontinuation that are typical in panic disorder, such as visual lag and sensations of random electric shock, their physicians incorrectly state that these are not recognized as attributable to SSRI medications, even though they are well documented in affordable essay service University, the psychiatric literature. Additionally, almost every recent, independent study that has looked at suicidality with SSRIs has concluded that although these medications are indeed safer in overdose than tricyclic antidepressants, a significantly greater proportion of SSRI users than tricyclic users actually attempt suicide. These people are not uninformed, either #150; they know that their SSRI is not lethal, so they tend to use acetaminophen, gunshot, or hanging instead. Both anecdotal reports and systematic surveys of clinical practice reveal that a majority of physicians prescribing SSRIs do not know how to correctly taper the beginning and end of write essay (Navitas), treatment with these medications, nor what reduced dosages to use in treating panic disorder, nor what protocol to follow in switching from one SSRI to another #150; usually a direct switch is advisable, but some physicians prescribe a washout period that is both uncomfortable (if not debilitating) and dangerous to the patient #150; nor how to switch between an SSRI and another class of thesis to essay Millfield, antidepressant. One does see a large minority of panic disorder patients whose condition responds well to SSRI medications, even though these patients are no more exempt from the how to literary University usual side effects than other patients. (Some find that the addition of writing essays, Serzone [now banned], or less often Wellbutrin, can restore sexual function lost to the primary SSRI and/or reverse the perversely treatment-resistant weight gain experienced by a majority of long-term SSRI users; however, neither of how to write literary, these medications appears to be useful alone in the treatment of panic disorder.) Not all of the patients who respond to SSRI treatment are the ones in whom the condition seems attributable to anxious or obsessive thought patterns, so it appears likely that there is some set of patients for whom these medications correctly target some underlying abnormality or imbalance.

However, many physicians seem unaware that a significant number of panic disorder patients react very badly and sometimes very suddenly to the anticholinergic effects of SSRI medications, a reaction that should not be surprising given the parasympathetic insufficiency posited to be so often present or even causative in writing Millfield School, panic disorder. Most long-term panic disorder patients who show up in the Internet support communities have been on a progression of different SSRI medications, often with a progression of write literary essay Griffith (Navitas), different doctors, before being stabilized long-term on a regimen of Xanax, Ativan, or Klonopin. A small number end up on Valium, Tranxene or other benzodiazepines. [Update: A study presented in Atlanta at the 2001 annual conference of the Anxiety Disorders Association of America made a similar observation regarding the panic disorder population as a whole.] A significant number of other panic disorder patients who show up in the Internet support communities began treatment on both an SSRI and a benzodiazepine, but were forced to discontinue the writing essays George SSRI due to essay (Navitas) unacceptable side effects, and then found that they were well controlled on the benzodiazepine alone. One of the disturbing characteristics of SSRI medications is that once a particular SSRI has ceased to be effective in controlling panic disorder, it usually cannot be used effectively again in the future, not even years later #150; the cessation of effect is persistent and article writing for kids Trafalgar School perhaps permanent. Write Essay! This raises some troubling questions about the mechanisms behind the writing in exams of Brighton well-known poop out phenomenon distinctive to SSRIs and other reuptake-inhibiting medications.

Current research hypotheses with some degree of experimental foundation include depletion of dopamine (though it is essay University (Navitas) unclear why that would be so persistent), an excess of the otherwise therapeutic effect of desensitizing serotonin receptors (but why so persistent?), and physiological damage to or destruction of serotonin receptors (in which case it is doubtful but unproven whether they can be regenerated). SSRI medications reduce the availability of nitric oxide, and reduced availability of nitric oxide is suspected as a factor in the mechanism of panic disorder. They also increase production of prolactin, which may be a factor in the high incidence of sexual dysfunction, and alter the function of the thesis to essay Millfield School hypothalamus, which is one of the mechanisms being studied as a possible factor in the strangely treatment-resistant weight gain associated with SSRI usage. (It is a shame that the dramatic differences in reactions to SSRI treatment are so often minimized, trivialized, or dismissed outright instead of being acknowledged and studied more closely. It is a shame because the differences probably provide, in their sheer starkness, some of the how to write literary University (Navitas) best clues currently available to the college application essay Hotel the varieties of biochemical mechanisms underlying panic disorders #150; and to the various mechanisms underlying depression and obsessive-compulsive disorder too, for that matter. Groups of how to literary essay Griffith University (Navitas), people with similar reactions to one class of drugs, particularly drugs as selective and powerful as SSRIs, probably represent de facto classifications of writing service Cowan University, people with similar variants of panic disorder or depression. It is possible that failure to follow up such an obvious line of investigation is due to commercial agendas. But it is also possible that it is simply easier, with current research technology, to plan and study interactions between drugs and neurons in how to write literary Griffith, the laboratory than it is to look inside a living human being and observe the individual's true neurochemical processes or status at a given moment #150; that our ability to create drugs that act at the neuronal level has far outpaced our ability to observe in thorough and objective ways their actual effects on living creatures' neurochemistry. Writing Essays George! And so we rely on a priori speculation, we rely on subjective reporting of sensations and feelings far removed from the biochemical processes that cause them, and we conjecture as to their meaning.

Typically this takes place in trials where the protocol assures minimization or even outright dismissal of how to write Griffith (Navitas), reactions that are not universal or at least common to a large proportion of subjects. So when something goes wrong for a minority of patients, we conjecture around variations on the presumed and intended workings of the drug at the biochemical level; but we do not know, and essay writing we have few tools to uncover, the subtleties that explain the full range of unintended effects.) There is an old saw that antidepressants cure panic disorder, whereas tranquilizers merely control it. Never mind that such a belief erroneously regards panic disorder as a single monolithic disorder. Even overlooking that point, when one looks beyond the short-term perspective of typical clinical trials, it becomes apparent that antidepressants do not cure panic disorder, other than in rare cases #150; the condition is chronic and often mildly progressive.

Follow-up studies show similar relapse rates in the long term, and it is dishonest and irresponsible to write essay University (Navitas) tell patients anything else. With CBT or PCT, one can sometimes reduce the from thesis to essay writing Millfield School incidence of outright attacks by reducing sensitivity to triggers, but the underlying dysautonomia persists #150; and write literary Griffith (Navitas) it is the dysautonomia, not its paroxysms, that represents the writing application essay Hotel Institute most insidious threat to health and longevity. In any case, the cure/control distinction is at best misleading because very few pharmaceutical treatments cure anything. Literary University! Control of symptoms is an admirable ambition and one that is deemed fully sufficient in review of Dayton, many other medical contexts. There is no call to literary essay Griffith University discriminate against the panic disorder population with a specious and condescending distinction between cure and bandaid. The fixation on SSRIs as the one-size-fits-all treatment of choice for panic disorders is largely attributable to a marketing campaign targeting primary care physicians and their patients that was conducted for SmithKline Beecham (as the makers of essay writing service University, Paxil were known at the time) by the Ruder Finn agency.

As Ruder Finn trumpeted until recently on a World-Wide Web site intended for advertising industry insiders, the how to literary essay University (Navitas) Paxil for Panic Disorder program was one of the most spectacular successes of pharmaceutical blitzmarketing in the history of the industry. Writing George Brown! To quote from the Web site: The Paxil for Panic Disorder program leveraged a new indication of an existing antidepressant for a relatively obscure anxiety disorder to how to University generate unprecedented product sales growth. Seven months after the panic disorder launch, The Wall Street Journal referred to panic attacks as the writing service Edith University hot new malady that is quickly replacing depression as the mental illness du jour.. The objectives of the Paxil for Panic Disorder campaign are: Increase sales and overall market noise [sic] about Paxil by generating widespread awareness of FDA clearance of the medication's new indication as a treatment for panic disorder. Urge undiagnosed sufferers to see their physicians for a diagnosis and ask for Paxil.

Take advantage of seasonal and other opportunities. The launch phase of the program was also supported with a Morning Drive-Time Radio Tour in 18 cities across the country. A satellite media tour was considered [but dropped]. Tie in to the stressful nature of the write essay holiday season. Sales growth of Paxil since May, which SmithKline Beecham describes as unprecedented, has been attributed by writing Castle School the company to the sales and public relations launch of the literary University panic disorder indication. Writing The University Of Brighton! SmithKline Beecham saw its share of the total SSRI market share grow by essay Griffith University 8.7% and its share of new prescriptions grow 7.7% between April and November.

Note that by Ruder Finn's published report, SKB itself attributed the success of Paxil not to scientific or medical documentation but to its savvy sales and public relations launch. The clinical trials submitted as the basis of the FDA approval and ensuing media blitz were three, and in them the drug was successful in eliminating or reducing panic attacks in for kids Castle, 25% (misstated as 76%*), in 51%, and in write University, 33% of trial subjects on Paxil, versus 44%, 32%, and 14% of subjects on writing for kids Castle School, placebo. How To Write University (Navitas)! To specialists in the treatment of panic disorder, these numbers are anything but impressive #150; indeed if the writing essays in exams The University drug had been promoted on numbers like these rather than the how to University (Navitas) sweeping generalizations primary care physicians hear from pharmaceutical salespeople, it is unlikely that much enthusiasm would ever have developed in the first place. Additionally, grave questions have since been raised about the integrity of the research itself. * The company did not cite a figure for article Trafalgar Castle all subjects in the first study, but instead counted only the one-third of subjects who responded best #150; and who were on how to essay Griffith, a dosage intolerable to many patients. Thus the writing essays George College 76% for best-responders actually represents 25% for the study as a whole. Write Essay Griffith University! (3/4 x 1/3 = 1/4) This little white lie is among the least of the irregularities that have emerged in court cases involving the clinical trials of writing for kids School, Paxil. The Ruder Finn campaign aimed to broadcast the cleaner side effect profile of Paxil, although the sad truth is write that clinicians are largely in agreement today, about three years later, that of all the commonly prescribed SSRIs, Paxil seems to have the dirtiest long-term side effect profile and the most problematic withdrawal. (The World Health Organization's statistics on complaints about writing the college withdrawal put Paxil in a very clear #1 position.) Based on the difficult-to-ignore evidence of their own clinical experiences, primary care physicians are spontaneously moving away from how to Griffith University (Navitas), Paxil in review University of Dayton, favor of how to write essay (Navitas), milder or supposedly cleaner SSRIs. The plaintiffs in a California class-action lawsuit against the makers of Paxil (seeking changes to labeling, release of embargoed data, and only modest monetary damages) intend to introduce documentary and testimonial evidence: that Paxil performed significantly, indeed markedly, worse than placebo in its early trials, before statistical spin doctors were brought in to fix the problem; that when dozens of trials did not yield positive results, statisticians manipulated the numbers to produce hypothetical trials in which one single patient who endured or thrived on apa article review of Dayton, Paxil for 365 days would completely offset 365 patients who could not endure the medication for more than one day; that the makers changed numerous reports (adding up to tens of percents) complaining explicitly of how to write Griffith University, withdrawal, as distinct from writing for kids, relapse, to instances of literary essay, relapse instead; that the company suppressed evidence of a 0.77% incidence of review, suicidality (considered quite high for such a serious side effect, and how to literary essay Griffith University (Navitas) later demonstrated to be even higher); that a certain identified FDA official illegally coached the makers of Paxil in clandestine conversations on essays in exams of Brighton, how to avoid scrutiny on the suicidality issue; that the company suppressed information on a 20-25% dropout rate in early trials; that the company deliberately claimed on the record in essay Griffith University, an FDA hearing that it had studied withdrawal issues and found none, when in fact it had not studied withdrawal issues but had inadvertently become aware of frequent and severe withdrawal experiences; and that the company has systematically promoted the impression that the only people who become dependent on from, Paxil are multi-drug abusers, even though the company has abundant evidence (which it suppresses) that dependence and a pronounced neurological withdrawal syndrome are common. How To University! As internal company documents have come to light in other civil and criminal trials regarding Paxil in the United States and other countries, it has become clear that the drug's makers possessed far more documentation of the drug's potential for adverse effects than they ever disclosed to the FDA, to the public, or to the scientific community.

There is obviously a place for the discriminating use of SSRI medications in the treatment of writing essays, panic disorder. They are irreplaceable, indeed life-saving for literary University many people. However, they have been prescribed indiscriminately and even recklessly in recent years. The appropriateness of their use has been greatly exaggerated and writing for kids the long-term risks and sometimes severe dependence and withdrawal effects (which bear no resemblance at all to the condition being treated) have been swept under the write literary University (Navitas) carpet for as long as humanly possible. Edith Cowan University! The question is not whether there is write essay Griffith University a place for SSRIs in the treatment of panic disorder. The question is what is the proper role of an advertising agency in shaping medical opinion and practice in the treatment of neuropsychiatric disorders. On Benzodiazepine Treatment. By far the largest group of functional, well-controlled panic disorder patients who show up in the Internet support communities are those on a regimen of long-acting or short-acting benzodiazepines (or both). This parallels the conclusions of George College, recent long-term reports following up on earlier studies and in Griffith, some cases coming to new conclusions.

The most common regimen among such patients is a long-acting benzodiazepine taken on affordable writing Edith University, a regular schedule, with a short-acting benzodiazepine to be taken for breakthrough symptoms. However, significant numbers do well on a regimen of short-acting or long-acting benzodiazepines alone. Literary Griffith University (Navitas)! A substantial proportion of these patients take only article writing for kids Castle School, enough medication to University (Navitas) manage their autonomic arousal, thus breaking the writing autonomic link in the arousal-anxiety-arousal-panic cycle, and normally rely on techniques learned in Cognitive-Behavioral Therapy to manage the cognitive-emotional aspects of the condition. Many clinicians are reluctant to prescribe benzodiazepines long-term for panic disorder, despite abundant evidence that panic disorder patients respond better to this class of medication than any other group of patients and that panic disorder patients are the least likely to abuse these or any other medications. The typical pattern is that panic disorder patients require some adjustment of dosage in the beginning of their treatment #150; either up or down #150; and then remain at how to write Griffith or below that dosage for years. When considering research on benzodiazepines, there is every reason to writing application Institute look at research specifically into their use in panic disorder, because the patterns that emerge are quite different from those that emerge when this class of medication is used to treat GAD or situational conditions. It is common for panic disorder patients spontaneously to how to literary essay University reduce their medication after six months to a year, and to remain satisfactorily controlled at the lower maintenance dosage.

It is to essay writing Millfield School common for panic disorder patients to try to eliminate their medication after a considerable period free of symptoms, only to how to write essay University (Navitas) find that they must go back on their original level of medication. There may be a medication-free period of success lasting months or occasionally years, but the condition eventually returns #150; sometimes with an intensity requiring more medication than before. Panic disorder, at least in its biologically-rooted forms, is apa article a chronic condition. Where normal individuals report a dulling of sensation from write literary Griffith, benzodiazepine treatment, panic disorder patients typically report that they feel normal again for the first time in years. This subjective assessment is often supported by an increased level of performance at work or in school. Such an assessment might even be regarded as a useful diagnostic factor. The baseline levels of autonomic arousal and of parasympathetic nervous system activity tend to be different in panic disorder patients from those found in normal individuals, and writing application essay Hotel Institute that helps explain why benzodiazepine treatment can be not merely therapeutic but normalizing in how to essay, the panic disorder patient, with a lower incidence of side effects than those experienced by the general population and affordable essay service Edith an incidence of abuse so low as to be almost nil. Optimal cognitive and motor function require the nervous sytem to be within a certain functional range of write literary essay Griffith (Navitas), arousal. If you have just woken up from a deep sleep or you have just hopped off a treadmill after ten minutes of running your fastest, your cognitive ability in particular but also your motor ability to deal with demanding tasks are both going to from to essay School be well below adequate.

Your nervous system is write outside its functional range of arousal. States of depression and states of autonomic anxiety like those seen in panic disorder are analogous. Both may fall outside the optimal range of autonomic arousal, or even outside the functional range. This explains why people with panic disorder often demonstrate improved cognitive or motor function when taking benzodiazepines. Learning is a particularly demanding task, and the brain is biochemically inhibited from apa article University, learning well when there are high levels of arousal-inducing hormones or neurotransmitters. How To Write Literary Essay Griffith University! Thus patients with panic disorder or a condition that mimics it may be unable to learn in an academic setting and unable to benefit from writing informative essays George Brown College, Cognitive-Behavioral Therapy (which teaches the how to write literary University brain new patterns of thought and affordable writing Cowan University new reflexive behaviors) until an appropriate dose of write literary essay Griffith University, a benzodiazepine is taken. The dose must be large enough to thesis lower nervous arousal into how to write Griffith University (Navitas) the optimal range without being so large as to push it from thesis to essay Millfield, over-arousal to how to write University a state of under-arousal.

Much of the early research on the use of in exams The University of Brighton, benzodiazepines in anxiety and panic was conducted with dosages that today appear stunningly high. It is strange indeed to (Navitas) read of from to essay writing School, studies using 6-10 mg of Xanax for panic disorder when today we know that the great majority of patients function optimally on 1-4 mg spread across 24 hours. Some patients require as much as 6 mg per day, but that is so rare that even the most benzodiazepine-friendly physician would almost certainly question the diagnosis or consider a different type of medication. Literary Essay University (Navitas)! At present Xanax is the best-known benzodiazepine used against panic disorder (and the one that is FDA-approved for the condition), but perusal of early research into the use of Klonopin and other benzodiazepines against writing for kids Trafalgar, panic disorder shows the same thing: the dosages tested tended to how to write University be far higher #150; 2x, 3x, or even 4x #150; than the dosages commonly used and known to writing Brown College be effective today. It is of course important to taper the cessation of benzodiazepines carefully. Papers on this subject report that a three-month taper is a reasonable standard, but that six months or a year is not unreasonable for high dosages or long-term use.

In the case of panic disorder, there should not be undue pressure to get off of any class of medication, and during cessation it is often difficult to how to literary distinguish withdrawal symptoms from for kids Trafalgar School, symptoms of the underlying panic disorder (except in the case of how to write University, discontinuing SSRIs, where the most dramatic withdrawal symptoms are clearly neurological and bear no resemblance to essays in exams panic disorder or depression). A number of papers report that panic disorder patients are frequently withdrawn successfully from their medication only to have to essay (Navitas) go back on it at the same or a higher level half a year or a year or two later. These papers suggest that it is probably healthier to maintain panic disorder patients at article Trafalgar School a constant level of medication, if no problems emerge, than to how to write literary essay University subject them to this cycle of cessation and recommencement of medication #150; regardless of the class of medication in question. There are occasional patients who taper cessation of College, benzodiazepines over write University, two weeks or less without difficulty. This is definitely the exception, however, and should not represent an expectation. Such a rapid taper can be dangerous and even life-threatening. One sees a small number of panic disorder patients who do not tolerate benzodiazepines well.

It is widely regarded as canonical that benzodiazepines cannot be used in essay service Cowan University, the treatment of patients with a history of alcohol abuse. However, with proper supervision, this is not necessarily true. In fact, it turns out that benzodiazepine treatment for panic disorder can be a key to preventing alcoholic relapse. Abusers of alcohol who experience panic attacks may have been self-medicating for their panic disorder, and some even lose the desire to drink at all once the underlying state of arousal is how to write Griffith University controlled. This seems particularly true in the case of writing College, measured drinkers, those who drink regular amounts at regular times of literary essay Griffith (Navitas), day. Both anecdotal reports and published research emphasize that the definition and manifestations of tolerance, dependence, and from writing addiction are commonly misunderstood among physicians and write Griffith University even among a surprising number of psychiatrists. Experts in for kids Trafalgar Castle, the use of essay Griffith University (Navitas), benzodiazepines report that tolerance normally develops to their sedative, cognitive, emotional, and motor effects, but not to the autonomically anxiolytic effects, i.e. not to their ability to interrupt the neurological panic circuit. Thus a patient may report drowsiness in the early days of treatment, but the drowsiness wears off. Once an apa article effective dosage is found in the first weeks of treatment, this dosage (or, after a while, a lower one) will eliminate panic attacks and most dysautonomia for years and decades. Patients on such a maintenance dosage should be regarded as medically dependent, just as many patients are dependent on glucophage or insulin or anti-hypertensive medications that exhibit a rebound effect on cessation #150; or on Paxil, for write literary essay that matter #150; but should not be regarded as addicted in the absence of all the other criteria that characterize addiction. The matter of dependence is also put into a new light by the appearance of more and more studies (particularly, it would seem, in Britain) stressing the point of view that antidepressants also promote physical dependence in anxiety disorders.

A World Health Organization report goes so far as to affordable essay writing Edith Cowan state plainly that SSRI withdrawal is a more difficult problem today than Valium withdrawal was in its time. Reports such as these call into question whether it is well-advised after all to promote antidepressants over benzodiazepines in write literary essay Griffith University (Navitas), the belief that ADs do not cause dependence. It is article for kids after all widely recognized that benzodiazepines are often more effective and work more quickly. It is the literary University (Navitas) consensus within the panic disorder community that every medication that is actually effective in review, treating panic disorder has the potential to create dependence. Dr. Robert DuPont, a former director of the [United States] National Institute On Drug Abuse, has stated that the concept of using the lowest possible dose of a benzodiazepine for the shortest period of time is inconsistent with sound clinical practice. This concept needs to include the how to essay University important qualification that our goal is to maximize the patient's ability to function well and to enjoy life. Benzodiazepines are among the from thesis School safest and most effective treatments in all of medicine , including their role in the treatment of panic disorder. He is joined in his opinion by many experts of comparable stature and by a World Health Organization report entitled Rational Use of Benzodiazepines , WHO/PSA/96.11. (This consensus document from the WHO is distinct from the 1994 document Guidelines For The Rational Use Of Benzodiazepines authored by Dr.

Heather Ashton.) These medications are not a panacea and they are not without their potential drawbacks. However, they have been the how to write University subject of such a fierce backlash from their extravagant misuse and overprescription in the 1970s (similar to writing essays but exceeded by the SSRI bonanza of today), and essay Griffith (Navitas) have been the target of such unscrupulous propaganda from the promoters of other drugs which still, unlike most benzodiazepines, enjoy the profitability of patent protection, that most doctors are unfamiliar with the actual evidence that should govern their prescribing. Application Essay Hotel! The evidence clearly shows that at present there is no other class of medication that works nearly as well, in nearly as large a proportion of the panic disorder population, as benzodiazepines; it shows that dependence is real but is not unique to benzodiazepines and thus not a major differentiating factor; and it shows that there is no other population less prone to addiction or abuse of how to literary essay Griffith University (Navitas), benzodiazepines prescribed as part of a comprehensive management strategy. No discussion of benzodiazepine treatment would be complete without a brief mention of at least two quasi-cult-like self-help networks of individuals who claim that use of even very low doses of benzodiazepines for writing George Brown College brief periods caused them permanent neurological damage and literary essay years or decades of anxiety and panic attacks a thousand times worse than anything they experienced before. (One wonders what they were experiencing before that could stand 1000-fold amplification.) With a vehemence and personally directed vitriol strongly suggestive of fanaticism, they reject any suggestion that they might instead be suffering from untreated anxiety or panic disorders, since the symptoms they describe when one pins them down to specifics sound very much like the writing for kids symptoms of uncontrolled, advanced panic disorder. If this were all there were to the story, it would not be worth dignifying with mention here. Write! However, this group cruises the from School Internet panic disorder support communities looking for newcomers and then bombards them with email offering self-help cures for prices that begin in the thousands of how to essay University, dollars and gradually decline, and terrorizing these vulnerable individuals with dreadful anecdotes that sound perfectly outlandish to pharmacologists and review University of Dayton clinicians alike. Identifiable individuals who speak up against this group are deluged with organized hate mail, some of it threatening in nature. In this age when many patients research their conditions using the Internet (as well they should), physicians should know something about this bizarre phenomenon so that they can offer knowledgeable and convincing support to patients who fall prey to these groups' terroristic tactics. On Treatment With Other Classes of Drugs.

Other classes of drugs are sometimes used in treatment of panic disorder but do not represent first-line choices. Other drugs used clinically or in research include anti-psychotics, beta blockers, CCK antagonists, alpha2-adrenergic agonists, and anti-epileptics. Although the author lacks statistical data, there are a notable number of how to write essay, reports from patients experiencing good results with Effexor XR (which seems for unknown reasons to behave very differently from apa article review University of Dayton, its non-extended-release version Effexor), often after having bad results with SSRIs or simply having run the gamut of the write Griffith (Navitas) major SSRIs, only to writing have each one in turn poop out (if the reader will excuse the scientific jargon) after a period that typically begins at a number of years but tends to how to Griffith University shorten with each successive replacement drug. Some patients are also reporting good results with the RIMA moclobemide, and a few are reporting doing well with beta blockers. Reports of success with alpha2-adrenergic agonists are not common but do occur. This class of apa article, medication can be helpful in conjunction with other treatments. The same observations apply to beta blockers.

There is a small but growing trend to treat panic disorder with anti-epileptic medications. Literary Griffith! Success is mixed, but these medications are successful for an indeterminate proportion of panic disorder patients. There has been a puzzling surge of reports over the last year of from to essay Millfield School, doctors resorting to antipsychotic medications in the treatment of panic disorder, often before even trying all of the mainstay classes of medications, and often with unfortunate consequences. However, there are a few patients who do respond better to these medications and how to literary University (Navitas) need to use them despite their extensive side effects. A small number of from writing School, patients have reported success with the opiate blocker naltrexone, which at least theoretically could be of help to people whose symptoms are caused by stimulation from the opioid peptides in gluten or casein.. By patient accounts, the least effective drugs commonly misprescribed for how to write literary University the treatment of panic disorder (although there are always exceptions), are BuSpar, Wellbutrin, and Serzone. Serzone has the particular complication, of which an alarming number of prescribing physicians seem unaware, of for kids School, substantially inhibiting the metabolism of other psychotropic drugs, thus making it difficult to calibrate effective dosages. This is not to say that there are no panic disorder patients who benefit from these drugs, but they are a small percentage. There is a trend toward polypharmacy in the treatment of panic disorder, with drugs added to how to write University (Navitas) treat the writing essays in exams The University of Brighton side effects of how to Griffith, drugs added to essays treat other side effects. Literary University! Often drugs are piled on in an the college application Hotel attempt to avoid or make acceptable the write essay Griffith University (Navitas) obvious but in some circles politically incorrect choice of benzodiazepines, or in blind adherence to the doctrine that SSRI medications simply must work for essays George all.

The author has not encountered much anecdotal or published evidence that a polypharmaceutical approach works better than (or even as well as) the mainstay treatments, except for rare complex cases; and complex cases should absolutely be referred to a specialist in panic disorder. Complications of panic disorder can occasionally be severe and how to literary Griffith (Navitas) even life-threatening. Pharmaceutical industry insiders report that the next big push in anxiolytics will be the CCK antagonists. Already marketed successfully outside the United States for writing in exams The University this purpose (as well as for treatment of GERD and IBS), these are reportedly intended for an aggressive push into how to literary essay Griffith University the American market when a favorable point is reached in the product life cycle of the essay Edith University SSRI medications. (It is possible that this CCK-antagonist generation of anti-anxiety medications may yet be leapfrogged by a newer class of medications under development to how to write essay target GABA receptors even more finely than existing drugs do, but new patent filings for CCK antagonists quietly continue to accumulate.) For the time being, the SSRIs are still among the most profitable of affordable Edith University, pharmaceutical products in the United States and are among the least vulnerable to competition. Their makers aggressively seek new areas of application for these flagship profit-makers.

But factors already at work to shift the market equilibrium include recently published major studies identifying the how to write literary essay University (Navitas) chromosomal locus and the importance in panic disorder, GERD, and IBS of defects in CCK metabolism, increasingly general awareness of SSRI complications, and the proliferation of lawsuits alleging improprieties in the conduct of clinical trials for SSRIs and the withholding of unfavorable research data. It is simply a matter of time before we see the for kids Trafalgar Castle next shift in focus. On Reported Effectiveness and Side Effects. It is how to literary University evident to the author that at least in the case of newer psychotropic drugs, one should trust postmarketing research and review University the reports of experienced clinicians over the published results of Food and Drug Administration -supervised clinical trials for approval of new drugs. For instance, in the case of one popular medication, approval trials reported an incidence of sexual dysfunction well under 5%. How To Write Literary Essay Griffith (Navitas)! Yet today experienced clinicians are in agreement that over the same length of time covered by the original trials, the true incidence of sexual dysfunction is at application essay Institute least 60%. Some claim up to an 85% incidence in their practices. And such numbers have been substantiated in postmarketing research. How does one explain such discrepancies in the light of FDA oversight? Looking at clinical trials generally, without examining specifics of this particular medication, sources of such misrepresentation can lie along a spectrum ranging from poor research protocol to outright fraud.

In the area of protocol, test subjects for how to write essay Griffith the medication above were not asked about sexual dysfunction and felt reluctant to bring it up, especially given the relatively short duration of the trial. Writing In Exams! And while randomization may have been scrupulous within the trial, it has come to light that all candidates for the study, whether they ended up on placebo or the experimental drug, were carefully hand-picked for previously demonstrated tolerance of that drug's side effects. (As an aside, it is interesting to note that physicians participating in clinical trials state that the concept of double-blind placebo control is little more than a convenient fiction in the testing of psychotropic medications, and a somewhat ridiculous fiction at that. They say that in most cases, the high incidence of how to literary essay Griffith University (Navitas), dramatic side effects with psychotropics makes it perfectly obvious to the health care personnel, if not indeed to the patients, who is taking the medication and who is taking the placebo. For this reason, drug-against-drug trials are often more useful.)

Looking again at the general case, there is writing for kids Trafalgar Castle School also the question of Griffith, fraud. Can this actually be a significant factor in American pharmaceutical testing? Doesn't the FDA ensure the writing The University validity and integrity of such testing? The General Accounting Office seems to think otherwise. The New York Times, in a 1999 series of articles on fraud in drug approval trials, cited a GAO report criticizing the FDA for repeatedly failing to investigate whistle-blower reports of fraud and for colluding in some cases to cover up evidence of its commission. How To Write University! According to the NYT, this GAO report concluded that the FDA was oriented toward overseeing methodological correctness and toward screening for scientific error, but was essentially helpless and disinclined to take action in the face of deliberate deception. As the NYT series documented, there are clinics that make a cottage industry out of manufacturing patients, complete with interview results and bogus specimens to go along. Whistle-blowers have faced disbelief, systematic discrediting, and retribution comparable to any found in defense industries.

Far from ferreting out and essays in exams The University of Brighton assuring prosecution of such fraud, certain FDA employees and how to literary Griffith (Navitas) their supervisors seem to have facilitated its commission and cover-up, according to the GAO. This may be one reason that American pharmaceutical testing is viewed with skepticism in for essays instance Germany and how to write University Finland, two of the thirty-odd countries consistently recognized by the World Health Organization (and other international observers) as practicing higher standards of health care and governmental oversight than the United States. The FDA is the college application essay Hotel just another government agency. While it is held in peculiar veneration by the medical community, there is no reason to expect it to be any more competent or any more scrupulous in its regulatory and inspection/examination activities than other agencies such as the Internal Revenue Service, the Department of how to write literary essay Griffith University, Energy, or the writing George College Department of how to write literary Griffith University (Navitas), Agriculture. (Nor is there reason to expect it to be worse, although that is faint reassurance.) All of these agencies have many competent, dedicated, high-minded people trying to accomplish good things, but there is only so much that individuals can do in the face of entrenched bureaucratic culture. All of thesis to essay writing School, these agencies, including the FDA, experience periodic scandals around competence and integrity.

The FDA comes under blistering criticism from European medical authorities (not to mention domestic sources) for its pattern of approving medications for which pre-approval research demonstrated serious problems, only to end up withdrawing approval under pressure from consumer organizations after unacceptable levels of fatality or injury appear. It is how to write literary essay naive to exaggerate the writing essays College competence or integrity of the United States' drug approval and oversight compared to taxpayer service, oversight of the nuclear energy and weapons industries, or inspection of how to write literary essay, meat and agricultural products. Many who work in subordinate roles in pharmaceutical testing claim that data and conclusions are routinely and unethically manipulated under the very noses of the FDA. Diet and writing Brown College Supplementation. The mainstream view in the panic disorder community is that neither diet nor dietary supplementation is sufficient for the management of panic disorder, but that both can make substantial contributions.

There is write Griffith (Navitas) a sizable minority, though, who find that it is possible to manage their own panic disorder primarily or entirely with diet and supplementation. The four most dramatic examples of dietary management are elimination of caffeine-like stimulants, adoption of a gluten-free/casein-free diet, supplementation with the amino acid taurine, and adoption of informative College, a ketogenic diet. Each of these measures is helpful only to a subset of the panic-disorder population, a subset consisting of people with unusual sensitivities. Elimination of caffeine-like stimulants. Some people are exceptionally sensitive to the stimulants known collectively as xanthines, principally caffeine, theophylline, and theobromine, found in various combinations in coffee, most colas, tea (even green tea), and essay University (Navitas) chocolate. The panic disorder population appears to include a greater proportion of these people than the general population. People who are not caffeine-sensitive have a hard time appreciating the affordable writing University extent to how to essay Griffith University (Navitas) which the substance affects sensitive individuals. Application Hotel Institute! For some people, a single 12-ounce diet cola per day, the equivalent of about half a cup of American-brewed coffee, is enough to keep symptoms of panic disorder active. Quite a few people have reported that a single cup of how to write essay, decaffeinated green tea daily was the difference between experiencing heart palpitations and not experiencing them. Caffeine must be discontinued carefully. Article Trafalgar Castle! People seem to write Griffith have the best success by tapering gradually #150; ounce by writing Trafalgar Castle ounce at the end, if necessary #150; before completely quitting.

Many people take an University (Navitas) NSAID like ibuprofen or aspirin for a few days starting the writing Brown day before complete elimination in order to avoid the ferocious caffeine-withdrawal headaches that can otherwise result. It takes 3-8 weeks for a caffeine-sensitive individual to return to true baseline functionality and sensation after completely quitting caffeine-like stimulants. Prominent symptoms during the withdrawal phase are likely to how to write essay (Navitas) include headache, depression, loss of energy and initiative, muscular stiffness, constipation, temporary changes in vision, reduction in coordination, minor edema, sleeping several hours longer than usual, and markedly reduced athletic, physical, and mental performance. Because of the writing the college application essay Hotel Institute Montreux way caffeine affects biochemical production of energy to power muscle cells and brain cells, one is write Griffith (Navitas) quite literally not as strong and College not as smart during caffeine withdrawal, but full function does return after withdrawal is complete. At some point there may be a day or two of unaccustomed heart palpitations as the body moves minerals around, establishing a new balance of electrolytes. But when the withdrawal phase is over, there is normally improvement over pre-withdrawal function in how to literary essay University, most of these areas. Many caffeine-sensitive people who complete withdrawal find that they are able to reduce or in some cases even eliminate their psychotropic medication. Writing Hotel Institute! But this should not be an how to write literary University expectation; the reason to try caffeine-elimination and persist until withdrawal symptoms disappear is simply to feel better, function better, and quite likely lessen some of the dysautonomia. Gluten-free casein-free (GF-CF) diet. It has been known for years that some patients' panic disorder (or GAD) improves with elimination of gluten sources and milk products. Only recently has a strong theoretical foundation for The University such observations emerged from write University (Navitas), research abroad and at a few major American medical centers.

It also turns out that truly aggressive dietary restriction, using the same vigilance a celiac patient must practice in avoiding even minimal, hidden amounts of from to essay writing Millfield School, gluten, benefits more people than was previously apparent with avoidance of only obvious, major sources. Unfortunately there is no quantification available yet, but it is an inviting area for research. Patients who suspect gluten intolerance should have an write essay University (Navitas) inexpensive screening for School IgG anti-gliadin antibodies before commencing the how to write literary essay University (Navitas) GF diet. With strict avoidance, the antibodies disappear in 3-12 months. However, one is still intolerant to gluten. It may be important to know one's status in to essay writing, that respect, since gluten intolerance is how to essay Griffith University such a strong predictor or risk factor for other serious conditions including various forms of gastrointestinal cancer and a variety of from thesis to essay writing Millfield, autoimmune conditions. If celiac disease (one particular autoimmune consequence of gluten intolerance) is suspected, additional screening should be undertaken before commencing the GF-CF diet. A large proportion of people with very high levels of anti-gliadin antibodies also have very high levels of antibodies to casein. Even without such high antibody levels, the gluten-intolerant patient is likely to experience psychotropic effects from casein, although the how to literary Griffith University top American experts in celiac disease note that some patients recover the ability to tolerate milk products as their digestive tract regenerates itself. The amino acid glutamine is particularly helpful to patients with celiac disease, non-celiac gluten intolerance, or other GI problems that respond favorably to dietary elimination. The digestive tract is writing the college application Institute Montreux one of the fastest-rebuilding parts of the human body and one of its principal building blocks is glutamine.

Even though glutamine sounds a little like gluten, it does not contain gluten. When pure it is a safe nutrient and actually an write essay University (Navitas) important nutrient for gluten-intolerant individuals. Taurine supplementation. Taurine was first tried in the treatment of panic disorder because it was known to be effective in the treatment of epilepsy. There are patients who control their panic disorder with nothing more than aggressive taurine supplementation. A number of other panic disorder patients find that they can reduce their medication with the help of taurine supplementation. Ketogenic diet. The overall healthfulness of writing for kids Castle School, a ketogenic diet is certainly debatable. However, it is clear that some panic disorder patients are able to control their panic disorder without medication by following a ketogenic diet, or more often a diet that is borderline ketogenic.

The reasons for the benefit of this diet are not known, although it is well established that a ketogenic diet can also reduce or eliminate the incidence of seizure in epileptic patients. Many panic disorder patients report doing better on reduced-carbohydrate diets that do not, however, go as far in this regard as many of the currently popular low-carbohydrate or high-protein weight-loss diets. There is considerable research to suggest that this might be due to the fact that the insulin-glucagon axis influences a host of other hormonal and enzymatic systems. Essay Griffith University! However, there has been little direct study of carbohydrate restriction in apa article, the treatment of panic disorder, and the only connection that seems obvious and likely to how to essay University (Navitas) be uncontroversial is the review University of Dayton adrenaline response that can be provoked by falling blood sugar levels. Further study will probably show this to be a highly simplistic interpretation. Magnesium supplementation. Write Essay Griffith! Some people find that supplementation with a small amount of magnesium reduces their symptoms, particular symptoms like heart sensations, muscle tics, and annoying nerve sensations. Affordable Essay Writing Edith Cowan University! Too much magnesium will cause diarrhea and exacerbate the body's imbalance of minerals, but just enough can noticeably improve nervous function in how to essay Griffith University, people who have a deficiency of magnesium in review University, nerve cells. (The relationship between magnesium in blood serum and how to literary magnesium in nerve cells is a bit complicated and should be interpreted by a physician who can consider the writing School full picture, including medications that may influence where your body stores the magnesium it has available.) Fat restriction, supplementation with essential fatty acids.

In cases of defective cholecystokinin metabolism, fat restriction is an important but insufficient measure for the prevention of Griffith University (Navitas), panic attacks. Essay Service Edith Cowan! On the other hand, in cases of panic disorder in families where schizophrenia is present, it seems prudent to follow a diet that is sufficient in fat. There are anecdotal reports of panic disorder apparently being precipitated in such families, even relatively late in life, by adherence to the ultra-low-fat diets so recently popular, and there is solid evidence that schizophrenics do better on how to write University, high-fat diets than on fat-restricted diets. Apa Article! While the author has uncovered no proof that a diet relevant to the care of schizophrenia is also relevant to the care of panic disorder in families where schizophrenia is present, it seems prudent, at this point in the understanding of how to write literary essay University (Navitas), such panic disorder and of schizophrenia, for from writing Millfield panic disorder patients from schizophrenic families to how to write essay Griffith University follow the article for kids Castle dietary measures that should be followed in schizophrenia. These include strict avoidance of casein (a milk protein) and gluten and gliadin (a family of proteins found in wheat, oats, barley, rye, and some exotic grains), and write (Navitas) the inclusion of sufficient amounts of fat, perhaps above-average amounts of George, fat. This has obvious implications for weight control but is how to literary University documented as beneficial to schizophrenics. Some mainstream medical sources also warn against writing the college application essay Institute Montreux, supplementation of the how to essay University schizophrenic diet with sources rich in the fatty acid GLA (gamma linolenic acid), principally evening primrose oil and writing essays in exams of Brighton borage oil. However, where the author has observed such warnings, they have occurred in contexts attempting to debunk the essay purported benefits of these supplements, and therefore the standard of proof was probably lower than if the authorities in question had been asserting a benefit rather than a danger. Thesis Writing Millfield School! (In other words, there is in how to literary essay, medicine, as opposed to the college essay Hotel the body of how to write literary essay Griffith, science proper, one standard of proof applied to a claim like substance X may cause hair to grow back on writing essays The University, your balding scalp, but quite a lower standard of how to write literary essay Griffith, proof applied to a scare-claim like not only will substance X not cause hair to grow back on a balding scalp, but furthermore, substance X may cause the hair you still have to fall out, and maybe your teeth, too .) Nonetheless, prudence should prevail. There is solid evidence that GLA is essay Hotel Institute Montreux contraindicated in how to essay (Navitas), patients with seizure disorders, and writing service it may be wise for the panic disorder patient from a schizophrenic family (or an epileptic one) to avoid GLA-rich supplements. Other dietary measures.

It is how to write Griffith University (Navitas) beyond the scope of this document to treat the Hotel Montreux full complement of dietary supplements being used in the treatment of how to literary Griffith University (Navitas), panic disorder or investigated for such use. There are simply too many to discuss, and the results are too individual to each patient. Writing Essays In Exams Of Brighton! It is clear, however, that while different individuals respond to different supplements, there are beneficial effects that go beyond what can responsibly or scientifically be attributed to a placebo effect. The supplements that prove effective are not the obvious choices #150; for instance, only a very small number of how to write literary essay (Navitas), people report significant benefits from the well-known anti-anxiety supplements like Kava kava or Passionflower. Of those supplements, patients typically report no effect whatsoever or a reduction in anxiety without a corresponding reduction in dysautonomia. This poses an interesting conundrum for researchers who consider the dysautonomia of panic disorder to be caused by anxiety, and supports those patients (and some clinicians) who claim that it seems the anxiety is actually caused by the dysautonomia. Nor does the antidepressant supplement St. John's Wort have very wide support among those who favor dietary supplementation.

One more often hears complaints of thesis Millfield, exacerbation of anxiety and dysautonomia, or complaints of sleep disturbance with no effect on literary essay, anxiety or dysautonomia. These are similar to, but much milder than, the complaints one hears from many (by no means all) panic disorder patients treated with antidepressants. Valerian fares somewhat better, but when used in doses sufficient to exert a beneficial effect, it is reported to cause more drowsiness than its pharmacological cousins the benzodiazepines. The currently popular 5-HTP has been variously described as either useful in the control of panic disorder or directly panicogenic. (Of course the the college application Hotel Institute Montreux same observation applies to 5-HTP's very distant cousins, the SSRI medications.) 5-HTP administered without restriction of vitamin B6 has been linked to (Navitas) heart fibrosis. Very recent double-blind, placebo-controlled research suggests that Gotu Kola is somewhat effective against the variant of panic disorder arising from the genetic aberration in cholecystokinin metabolism. This fits theoretical predictions, because Gotu Kola and from thesis writing Millfield a small number of other far eastern herbs have been demonstrated to compete with cholecystokinin at CCK receptors in the body.

So far there is little experience or consensus in the panic disorder community. Supplements more commonly reported to be mildly beneficial are those that support parasympathetic nervous system function (B-vitamins, alpha-lipoic acid, precursors or cofactors for the synthesis of acetylcholine and nitric oxide), supplements promoting cardiac stability (Q10, carnitine), supplements soothing the digestive tract (chamomile, bismuth, glutamine, MSM, occasionally peppermint - although the last can also be counterproductive)… It is how to Griffith (Navitas) simply not possible to do more than scratch the writing essays George Brown surface lightly in this discussion. There is write literary essay no clear consensus and there are almost no formal studies of the essay effects of special diets or supplementation on panic disorder. How To Write Literary Essay Griffith (Navitas)! However, clinicians and patients alike report that certain measures have an obvious effect for certain individuals. One might suppose that panic disorder patients would be more susceptible than most to a placebo effect; but in fact, panic disorder is The University of Brighton so difficult to control without medication, and panic disorder patients are so reluctant to resign themselves to a lifetime of medication, that they often try many dietary supplements in a systematic fashion, generally rejecting the preponderance of them as ineffective.

For a panic disorder patient to report that a supplement is beneficial, even if it is how to write literary (Navitas) not sufficient to fully control the condition, is an in exams exceptional event that should usually be taken seriously #150; especially if it makes possible a lighter use of medication. How To Literary Essay University! One cannot easily feign control of panic disorder or delude oneself about essay service Edith University doing so, and there is little incentive to try. Panic disorders are a family of how to literary Griffith University, disorders the understanding of which is still in its infancy. Much of what we thought we knew only a few years ago has been proven false. (In some cases the earlier understanding directly confused cause and thesis effect.) There is far more that is not known about panic disorder than there is that is how to known; however, a nascent body of Castle School, research in literary Griffith University, several new directions is in exams The University revealing some of the write University (Navitas) secrets. Panic disorder is not a monolithic condition. Few generalities apply to a majority of the panic population, but many generalities apply to sizable minorities within the population. Some cases of panic disorder fit the classical (since 1981, that is) psychiatric interpretation. Article For Kids! Another set, quite possibly larger, does not, although this set has distinct subtypes for which it would be possible to develop a widely applicable diagnostic protocol. Nonetheless, by the time these disorders are diagnosed, they have almost invariably progressed to how to literary essay Griffith psychiatric dimensions. The disorders are polysystemic and usually require multi-modal diagnosis and treatment. Parasympathetic insufficiency, often hereditary, is emerging as a new and promising direction of investigation and treatment.

Problems in CCK metabolism have been linked to panic disorder by multiple independent researchers for some time now, but 1999 saw publication of a major study that claims to have identified the genetic defect in informative Brown, question. The biological basis of panic disorder and the long prelude of University, non-paroxysmal dysautonomia that typically precedes it are only beginning to receive the attention they require. College! It will be a tremendous step forward when there is general recognition that treatment of how to literary essay, panic disorder must aim not only at total elimination of to essay, panic attacks (or dysautonomic paroxysms) but at elimination of the associated chronic dysautonomia as well. Beyond this, the goal should be much earlier recognition of chronic dysautonomia so that it can be treated well before it reaches a paroxysmal stage and the psychiatric complications that ensue. Write! It is possible that focusing on the condition as chronic dysautonomia and its advanced stages as paroxysmal dysautonomia might facilitate such recognition and a shift in perception and attitude. It seems inevitable that subtypes of panic disorder will eventually receive individual recognition, naming, and treatment protocols.

Primarily for commercial reasons, funding for panic disorder research has lately been focused far too narrowly on the role and the promise of SSRI medications in treating panic disorder. This shift in focus to follow the availability of research funding interrupted a number of other fruitful areas of writing application essay Hotel Montreux, earlier research. Nonetheless, the biological understanding of this set of disorders has reached a stage where researchers have claimed for some time now that this reigning emperor in how to literary essay Griffith, the pharmaceutical realm is at best scantily clad. Apparently the from emperor's successor, in the form of CCK antagonists, has already been designated and is awaiting coronation, but only time and experience will tell whether the next panacea is more universally effective than the write literary University current one. The author is extremely doubtful that any panacea will ever be found for what we know today as panic disorder #150; it is too clear that distinct and distinguishable disorders are being carelessly lumped together as one. There is a wide open field of from thesis to essay Millfield School, research investigating panic disorder and how to write literary Griffith University (Navitas) its comorbid conditions.

There is much yet to essays The University of Brighton be discovered, and some of how to write essay Griffith University (Navitas), it will revolutionize our understanding of psychosomatic medicine and somatic anxiety in particular. Panic disorder of biological origin (which probably includes all or nearly all hereditary forms of the condition) is lifelong in nature. It does not begin when panic attacks begin, but most probably began years or decades before reaching that point. Remissions may occur, but relapse should be expected. This is true regardless of the method used in treating the condition #150; it is a myth that antidepressants provide a cure, except in a limited subset of cases where panic disorder is secondary to another condition. Untreated or under-treated panic disorder should be considered a serious and sometimes degenerative condition. Of Dayton! It puts significant strain on a number of body systems, and the goal of treatment should be not merely the elimination of panic attacks but the elimination of the underlying or associated autonomic hyperarousal as well. Cognitive-Behavioral Therapy or Panic Control Therapy is an essay Griffith University (Navitas) important component of the treatment plan, even for panic disorder of apa article, biological origin. However, it should be recognized that such therapy is sufficient in itself only in those cases that are primarily cognitive-behavioral in nature.

Now that biological bases for panic disorder have been identified and tools are emerging for their quantification, more research is needed to determine what proportion of panic disorder cases are in fact of biological vs. psychological origin. It may prove to be difficult to how to literary (Navitas) draw a clear distinction, since each type spills over into the other, but it is already evident that such a distinction is real and meaningful. It is high time to reopen the non-specialist community's mind about essays panic disorders and to move them from the exclusive province of psychiatry and psychology into the domains of neurology, endocrinology, genetic analysis, and probably other disciplines that will become apparent with further research. This is how to essay exactly what growing numbers of researchers and practitioners are doing. This document summarizes observations about panic disorders and apa article University of Dayton their treatment gathered during the years 1998 through 2000 from research papers, recent textbooks, mental health clinicians, patients, and support groups. It is not intended to how to write (Navitas) provide medical advice. Writing The College Essay Hotel Montreux! Nor is it intended to advocate original points of view in the scientific or medical arenas. Rather it is intended to integrate and write literary essay disseminate a variety of emerging insights often omitted from the narrow classical view of these disorders. As the 2000's roll in, the affordable essay writing service Cowan University understanding and treatment of this family of disorders (and they are multiple) is in clear and dramatic transition. Ongoing research about modalities of diagnosis and treatment is beginning to how to write literary University (Navitas) bear fruit that will profoundly influence both the medical and affordable service Cowan psychological perspectives on these conditions.

The viewpoints advanced in this paper are for the most part not of the author's own invention #150; they represent viewpoints that have arisen and show growing support in the researcher, clinician, and patient communities. In one sense, they represent a consensus; but in another sense, the term consensus is misleading because the field is still in turmoil, with different schools of thought pursuing different avenues of research and how to write literary essay University (Navitas) fighting to advance different agendas. This paper represents the author's good-faith efforts to gather the points of view that appear, in article for kids Trafalgar, his lay judgment as a hardheaded observer and a patient himself, to write University (Navitas) have the best foundation and most correspondence to the reality that he and countless other patients live every day. Sources, which are not cited, include published research papers (most available through MedScape or MedLine), published textbooks and trade books, articles in WebMD and the New York Times, the opinions of clinicians specialized or experienced in the treatment of panic disorders, and the experiences of some hundreds of individuals who have shown up in various Internet-based support communities focused on panic disorders or other anxiety disorders. Citing of writing essays in exams of Brighton, sources, which were not recorded during the author's odyssey through what was then unfamiliar territory, and literary Griffith (Navitas) many of which were reviewed long before the writing essays The University idea of writing this document was conceived, would have multiplied the complexity of compiling the document, greatly lengthening and delaying it as well. Write Literary! Such a format might also have given the appearance of advocacy in essays George College, the scientific arena when the how to write Griffith University (Navitas) author's intent is from thesis Millfield School instead to provide a coherent overview of the points of view advocated by professional scientists and clinicians specialized in panic disorders. Readers wishing to look up further information on write essay, one angle or another should not find it too difficult to do so through the resources above and through discriminating use of review of Dayton, Internet search engines. Somewhat contrary to established practice, the literary Griffith University (Navitas) author has chosen to give considerable weight and exposure to consensus within the patient community. It is this community that lives the day-to-day reality of panic disorders, this community that feels the effects and the side effects of medications and writing for kids Trafalgar Castle School therapies every day and knows the reality and write essay Griffith University nuance of our experience. Our doctors and therapists can (and certainly do!) try to writing essays George tell us what we are and are not experiencing based on the most interesting presentation they attended at a recent conference, or on the glowing reports of a new medication (this one miraculously free of all the side effects that have come to be associated with each of its predecessors), or on the doctrines that have brought recognition and prestige to their alma maters; but we as patients have only one agenda, which is a return to well-being and normality; and we have only one truth, which is the experience within our own bodies that most of literary essay, our doctors and therapists will never (to their great good fortune) be able to do more than imagine.

(Note: It is true that individuals showing up in informative George Brown, Internet support communities represent in some sense a self-selecting sample. However, the write Griffith same observation could be made with equal or greater validity about the individuals who choose to remain in treatment with a particular clinician or about those who choose not to drop out of controlled clinical trials. Article Writing For Kids Trafalgar School! Indeed even a telephone book represents a self-selecting sample. Internet support communities in the aggregate do represent one of the broadest and write (Navitas) most diverse sources of essays The University, real-world information available and how to (Navitas) include a wide variety of experiences. In the case of the college essay Hotel Montreux, panic disorder, these groups include individuals who are well-controlled and those who are not; those who claim to be cured or in remission without ongoing treatment and those who do not; those who favor one class of how to write Griffith, treatment and those who favor another; those who agree with their doctors' assessment of successful or unsuccessful treatment and those who make a different assessment.

Absent evidence of systematic bias, the author considers Internet support communities to be a valuable source of perspective among others.) Understanding of writing in exams, panic disorders is still in its infancy. The whole family of disorders was more or less stumbled upon because of their severe manifestations in the psychiatric domain. But the more researchers investigate panic disorders, the more it becomes apparent that the psychiatric dimensions are merely the tip of a very complex iceberg. There is much disagreement within the researcher, clinician, and patient communities. The two or three orthodoxies that exist seem on closer examination to be illusory and shifting, and, unfortunately, are sometimes based on narrow samples or populations and are sometimes colored by commercial interests or professional vesting in certain doctrines.

Ultimately the how to (Navitas) viewpoints and conclusions presented here, which are meant to represent some diversity of opinion, are of the author's own selection and are not necessarily endorsed by article for kids Castle any other individuals or institutions except where specifically attributed. So in literary essay Griffith, one sense this essay is merely one person's collection of opinions. But this collection has been reviewed by researchers, clinicians, and patients alike; and while no essay could please all readers, and most especially not those who are vested in affordable writing Cowan University, one particular point of view to the exclusion of others, the author feels reasonably justified in write Griffith University (Navitas), stating that in another sense, this document is not only built largely on published research and writing essays George College teaching materials, but also does meet with general approval and endorsement from at least a substantial segment of the how to literary (Navitas) researcher, clinician, and patient communities. The online source for this document resides at essay This document may be linked to how to write literary essay University or printed for limited noncommercial distribution by individuals.

Any other form of dissemination or republication must be authorized in affordable essay writing service Edith University, writing.

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95 theses full text The indulgence being marketed by Tetzel distressed Luther because he saw it as misinforming lay people (i.e., non-clerics) about crucial aspects of how to write literary (Navitas), God's plan for The University, redeeming fallen humanity ­- about, in other words, the whole purpose of history, and about the nature (specifically, the write literary essay University, Will) of God. To be misinformed in essentials about the nature of God means that what one ends up obeying is a false image of informative George College, God. This constitutes a mortal sin (see the note to Thesis 2), and leads (if not corrected) to damnation. Literary! Specifically, Albert's indulgence (as represented by Tetzel) encroached on the sacrament of penance. The numbers to the left (in red) refer to essay Cowan University the respective theses that comprise the document as a whole. In the note to Thesis 6, you will find some suggestions about literary (Navitas) how to think of the organizational strategy Luther follows in listing his first 52 theses.

[References to WH are to Matthews and Platt, editors, The Western Humanities , 3rd Ed. Mountain View, California: Mayfield Publishing Co., 1993. These need updating, since this text is for kids School now in at least its 5th edition.] 1. Poenitentiam agite: Do penance. Penitence here means sincerely repenting (detesting, deploring) one's sins, and resolving not to return to them in the future. 2. This word: refers to the Christ's word in the saying quoted in the previous thesis, and in particular to the term penitence ( poenitintia ). Sacramental penance : the sacrament of penance consisted of four elements: confession of one's sins before a priest, sincere contrition (regret) for them, satisfaction imposed by the priest, and absolution (remission of the sins in question, or pardon). Luther confines himself to citing here the two elements of action (confession and satisfaction) that were to be carried out by the penitent (the person undergoing or receiving the sacrament). How To Essay University (Navitas)! The term satisfaction refers to penalties imposed by the priest to discharge the debt of punishment owed for the sins in question. (When carried out, these satisfy or fulfill the justice of God. [Compare the language of the honor code regulating duels among the European aristocracy: an insult to writing service Edith University one's honor requires satisfaction, and the insultee acquires the right to choose what that shall be, within the limits of the prevailing code.]) See WH 217­218 for a capsule description of the how to literary Griffith University (Navitas), medieval sacrament of apa article review of Dayton, penance. (For a far more detailed discussion, covering medieval doctrines as well as the teaching of the Roman Catholic Church in the wake of its response [in the Council of Trent] to the Protestant Reformation, consult the article on write essay University, The Sacrament of Penance in The Catholic Encyclopedia .) Two categories of sin are recognized. Mortal sins involve turning away from the eternal good, or God. (The breach of writing The University of Brighton, Faith committed by Adam and Eve in the Garden constituted mortal sin. So did what Cain did to Abel.) The punishment due for turning away from the eternal good is eternal punishment, or damnation.

Venial sins occur when a person turns inordinately to a mutable good ­ a good subject to change, because, being created, it exists in time. (Such goods are thus also called temporal or earthly goods.) Orthodox teaching holds that every created being as such is good, inasmuch as it is the creature of God. But aside from the fact that some created beings (angels and human beings) can sin, any created being, not being God Himself, requires to be loved just in the way ­ i.e., in the degree and circumstances ­ that God ordains. A love of any temporal being that goes beyond the literary Griffith (Navitas), intensity or occasions willed by God is thus said to be inordinate. Castle! Such sin incurs a debt of temporal punishment (a term that you will see often in the theses to follow). The priest (via his ordination by how to literary Griffith (Navitas), a bishop appointed in turn by the pope) is a designated representative of the pope. (We meet here the general concept of affordable service, vicars and vicarage, which will become a focus of even more fundamental dispute when Luther a few years later comes to attack the even more fundamental notion that the pope is Christ's own designated vicar.) Hence when a priest administering the write literary essay University (Navitas), sacrament of writing informative essays George College, penance imposes satisfaction on the penitent, he is acting on behalf of the pope. This explains why Luther speaks interchangeably of penalties. Write Essay University! imposed by [the pope's] own authority (Thesis 5), or of essay service, those imposed by how to write essay University (Navitas), himself (Thesis 20), or of penalties of sacramental satisfaction, which are of human appointment (Thesis 34). 3. Can you see the connection with asceticism here, and in Thesis 4? (Of course there are ascetics and ascetics! Remember, Pelagius was an ascetic, too. In what points of essay writing service Cowan, doctrine would Luther and Pelagius part company?) 5. Remittance ­- like satisfaction ­- is a term that comes from the world of the balance sheet, of debits and credits.

Both guilt and how to literary essay Griffith (Navitas) punishment due are conceived as debts that must be paid. When a debt is either paid off (by the debtor or someone who does surety for him) or forgiven, it is no longer due. When the creditor or injured party signifies (directly or through his authorized agent) that the debt is no longer due, he is writing College said to write (Navitas) remit the sin. (The term remit comes from the the college application Institute, Latin word meaning to send back. The custom persists in banking today: when you pay off your house mortgage, the bank will give back to you the loan certificate, now marked paid, along with the how to literary Griffith University, deed to the property, both of which it kept in its physical possession until you paid off your debt.) The canons here (and in Thesis 23) are rules established in Canon Law (the law governing the administration of Church affairs) for guiding priests in assigning satisfaction in administering penance. They amount to a schedule of affordable essay writing Edith Cowan, penalties for different offenses, according to the seriousness of the sin, as determined by various factors they specify. (As such, they are somewhat analogous to write literary the sentencing guidelines for judges, under criminal law in the US today.) 6. Orthodox teaching makes a distinction not only between sins of various degree (mortal and in exams of Brighton venial) but between the guilt attaching to how to Griffith (Navitas) a sin (sometimes referred to simply as the sin itself) and from thesis to essay writing School the penalties attaching to it (the punishments due because of it). The damned, it is held (for example), repent the punishment they suffer for their sins but, being confirmed in sin, are not displeased by their sin itself (since their wills eternally now reaffirm and assert it). Debts consisting of punishment due for sin are understood as payable by the sinner who incurred them. The debt of guilt (the debt of how to literary University, sin per se ) is not. It can be discharged only when one of of Brighton, two things occurs: either it is either forgiven (by God the Father) or it is how to University taken on and paid off by another (the Son) whose wealth is sufficiently great to do so. (Can you see the connection to what is referred to in Thesis 33). Theses 5 and 6 together turn on this distinction. (So does Thesis 76, later on.) When the pope (represented in the priest) dispenses absolution -- remission of sin (more precisely, of the guilt attaching to sin) -- as part of the sacrament of penance, he does not (according to Theses 6 76) actually effect it himself. Rather he discloses to the penitent what God has done (remitting of writing informative essays George, guilt).

It is, then, only penalties attaching to sin that the pope himself (whether directly or through his representatives, i.e., priests) can remit. Any indulgences purporting to remit the guilt attaching to write literary Griffith University sin (the sin itself, so-called) are simply fraudulent. Moreover, within the category of penalties, it is only those that have been prescribed by writing Hotel Institute, canon law or that he had the authority to impose in the first place and how to write Griffith University (Navitas) did indeed go on to impose (again, whether directly or through the priesthood) that he can remit. All other penalties are remittable only by God. And among these other penalties are those referred to by Christ in the quotation in Thesis 1, and described again in Thesis 4. Since this true inward repentance that consists in hatred of self for having committed the sin continues until our entrance into the kingdom of heaven, it continues to be suffered by souls in purgatory. Conclusion: these penalties of sin -- the remorse suffered by souls in purgatory on their way to heaven -- are outside the power of the pope to remit. Any indulgences purporting to essays in exams of Brighton remit the suffering of souls in purgatory (penalties for how to Griffith University (Navitas), sin being experienced by them, namely, their remorse for having committed them) are likewise fraudulent. But even among the living, this sort of penalty for sin cannot be remitted by the pope -- for Christ has commanded us to undergo it as long as we live (Thesis 1). Any indulgence that purports to relieve us of being heartily sorrow for our wrongs is likewise fraudulent. Worse, it encourages us to violate Christ's express command. (And, since the pope, as the Vicar of Christ on earth, enjoins us to obey Christ's commands, remission of these penalties for sin is outside his power as pope.) What remains are those penalties imposed by the pope or the canon law, in the context of the the college application essay, sacrament of penance, as administered by priests. [This is the language of Theses 5 and 20.

Thesis 34 uses the formula appointed by man (since the pope and the priests are not God) to describe sacramental satisfaction -- i.e., penalties of the sort the priest declares the write, penitant to owe).] Coming at review this category from still another point of view, authorities described them as temporal punishment. (See the note to Thesis 2.) Referentially, these terms are all synonyms: that is, they identify the same class of individual things. Their difference lies only in the fact that they pick up these things by different handles, approaching them from different angles, i.e., via different relationships they have with other things. How To Write Literary University! Theses 7-8 focus on Tetzel's claim that the article for kids Castle School, indulgence he was selling was issued by the pope and how to literary Griffith University (Navitas) had the power to remit guilt for sins. Luther circles back to this theme later on, in Theses 75-76. Theses 8-29 focus on Tetzel's claim that that indulgence was issued by the pope and had the power to remit the essay service Cowan, penalties owed by how to write essay Griffith (Navitas), souls in University purgatory.

Theses 30-52 focus on the risks, in Tetzel's behavior, for literary essay Griffith University (Navitas), the people who are induced to buy his indulgences -- i.e., the misunderstandings about justification that are perpetrated among the living. (In passing -- Theses 35-37 -- his remarks touch again on the absurdity of writing School, Tetzel's claims about the how to literary Griffith, purgatory.) The emphasis is upon the peril these misunderstandings pose for the soul of the naive clientele. Article Castle School! In Theses 30-40, the chief emphasis here is the necessity, for sinners, of a proper understanding of the requirement for genuine contrition , and the way in which indiscriminate peddling of indulgences implicitly preaches the contrary. Literary Essay (Navitas)! In Theses 41-46, the informative essays Brown College, emphasis shifts the write University, risks that lie in presenting purchase of pardons as instances of Edith Cowan University, good works, when, in their effect on the soul, or what they signify about the condition of the soul, is far inferior to write essay University what is accomplished by works of charity. Thesis 52 sums up this line of writing essays of Brighton, attack. [??Thesis 47: does it fit in this organizational scheme? Or does it belong with Theses 48-51??] From this point on, Luther's organizational strategy loosens even further. For one thing, it is clear that he likes to return to certain themes within new contexts. Moreover, as we have already seen, he sometimes takes the opportunity to tuck in theses (for example, Theses 50-51) that are marginal to the logical categorization that defines the main line of development at the moment (Theses 30-49 + 52). Sometime the stimulus for doing this seems to be that Luther has entered upon how to, a certain rhetorical device (e.g., the repetition of an opening formula, like Christians are to be taught that . ) which carries its own power of suggestion for what could be usefully included at a given moment. After Thesis 52 , there does not seem to be a definite overall pattern of organization at work, although there are clearly stretches within which Luther is focusing on a particular theme (e.g., what are the Trafalgar, true Treasures of the Church? [ Theses 56-68 ]) or a rhetorical turn (e.g., Theses 81-91 , where the how to write essay University (Navitas), move is to point out how the pardons being sold by Tetzel bring the thesis School, pope into disrepute with the how to write literary University (Navitas), laity by stimulating them to sarcastic impieties that nevertheless seem plausible on the false assumption that the pope supports the sale of such pardons). 7. The priest is God's vicar insofar as the pope is the Vicar of Christ and the priest is a vicar of the pope. See note 5 above.

Thesis 7 says, then, that remission of guilt, though it is done only by God, is something God has for his own reasons chosen to do only for those who submit themselves to the Church, and, as part of doing this, participate in the sacraments (here, specifically, the sacrament of penance, though communion is also a part of what is comprehended here). In other words, there is no salvation outside the Church. (Cf. Thesis 38.) Later, Luther doesn't abolish the priesthood. Rather, he declares the doctrine of the priesthood of all believers. (He will, however, declare that penance is not, properly considered, a sacrament.) 20. Plenary remission means full remission. (In Thesis 23 the synonymous formula entire remission is used.) Luther concedes the power of the Pope to remit all penalties of only the restricted class of temporal penalties imposed in the sacrament of penance or due under the canons of governing the assignment of satisfactions in penance (in the case of sins committed but not yet dealt with by receiving the sacrament of University of Dayton, penance). 22. Neither other penalties (for example, those actually due for University, souls in purgatory) nor guilt attaching to sins (even venial sins ­ Thesis 76) are within the power of the Pope to remit. But all indulgences are issued by the Pope. Therefore indulgences can be effective in remitting either the service Cowan University, suffering of how to (Navitas), souls in purgatory or the guilt itself attaching to sin. Hence the claims Tetzel is making for the indulgence he is peddling in the Pope's name is fraudulent (Thesis 24).

People are being induced to apa article review University of Dayton believe these claims at literary essay Griffith University (Navitas) the peril of informative essays George Brown College, their soul (Thesis 32). For the doctrine of purgatory , and how to essay Griffith University (Navitas) its connection with the medieval system of penance, see WH 218 (paragraph 3). Purgatory is the place (or state) in which souls who die in God's grace may expiate venial sins or satisfy divine justice for the temporal punishment still due for remitted mortal sin. The term comes from the past participle of the Latin verb purgare , which means to purge (to purify by getting rid of defilement). How does Luther stand with respect to the bull Salvator Noster (1476)?

Note that Luther's tactic in the Ninety-five Theses is to assume that the Pope is unaware of the doctrinal errors being preached in his name by a mad servant, who is betraying his master. The Pope is being offered the writing, opportunity to repudiate Tetzel's behavior. How To Write Literary Griffith University (Navitas)! Compare the implicit characterization given of the Pope's personal dispositions in Thesis 50. 23. Note that Luther concedes here that it is possible for writing of Brighton, some rare individuals to pass directly to heaven. But he does not go so far here as to claim what the Church had long insisted on, namely, that the saints die in a state of excess of merit, which then passes into how to write essay Griffith University the Treasury of Merit, out of which merits can be drawn to substitute for writing informative essays College, the temporal penalties that would otherwise be due for sin. How does this re-definition of the concept of saint square with the particular theory of the Treasury of Merit set forth in Pope Clement VI's bull Unigenitus (1343)? On the write literary essay Griffith (Navitas), other hand, are we really authorized to attribute to Luther at this moment such a re-definition of the concept of saint as just described?

Consider Thesis 58. 27. One of the jingles attributed to Tetzel went like this. Review! (The rhymes, incidentally, are basically the same in how to write literary essay German and essay service Cowan English.) As soon as the coin in write literary essay Griffith University the coffer rings, The soul from Purgatory springs. 32. In Exams! Letters of pardon are the how to write literary essay Griffith, documents certifying the granting of an indulgence. (See also Thesis 52.) In this Thesis, is Luther accusing Tetzel and his customers of committing venial, or mortal, sins? 33. Review Of Dayton! The inestimable gift of God by which man is reconciled to God is the divine grace conveyed in the blood of Christ shed in the Crucifixion. 35. By now you should be imagining for yourself what kind of sales pitch Tetzel relied on in convincing people to pay good money to get souls out of purgatory. Whose souls would he be pointing to? How would he paint them?

A confessional license would exempt the holder from the necessity for confession. Why would Luther insist that confession is an essential element in the process by which one achieves justification? 36. How To Write! Compunction is of Dayton a synonym for contrition, regret, repentance. (See note on penitence at Thesis 1.) Why does Luther insist that this is an essential element in the process of how to literary essay, justification? 42.

Along what lines could a case be made that contributing to the Church (and receiving an apa article review University indulgence) is in itself a work of mercy? (What, supposedly, would the Church be using the contribution to support? [What is the divinely ordained purpose of the Church in the first place, according to write literary Griffith (Navitas) traditional doctrine? What is writing Trafalgar School its role in history ?]) 43. Does it strike you here that Luther (writing on this particular occasion, at how to Griffith University this particular phase in his thinking) seems to be according a positive value to in exams at least some items in the category of works ? What do you understand to Griffith (Navitas) be Luther's ultimate position on the value and effect of works in the salvational scheme? Is this Thesis inconsistent with that position, or can it be construed in a fashion that can be made to writing Edith square with that position? 50. Here we find a claim that must have resonated strongly with those who resented the flow of capital from the German North to Italy. 52-56. Here Luther lays out a theory of what constitutes the Treasury of the Church.

How does it compare with the theory elaborated by Clement VI in the bull Unigenitus (1343)? 62. Notice that it is not clear in write essay the Ninety-five Theses themselves what a crucial role Thesis 62 will play in future Lutheran theology: Luther does not explicitly spell out the implications. But, retrospectively, can you see how this claim was destined to become the from to essay writing, central bombshell in the breach between Luther and the Church of Rome? 65. How To Write Essay University (Navitas)! What does Luther mean here by the phrase men of riches? Is he referring to the college application Hotel Montreux people with lots of money and property? How would you explain your answer ­ in the context, for example, of the thesis that follows this one, #66? 83. What does Luther consider mistaken about the practice of performing funeral masses and anniversary masses for the deceased (masses for the dead celebrated on the anniversaries of the death of the person in question)?

What is the purpose of these ceremonies? (What is prayed for how to write Griffith, in them?) In what sense is it a confidence game to accept money for performing such services? (Is the issue of simony also at stake here, i.e., separately and essays The University of Brighton distinctly?) 86. Does the tone here strike you as completely consistent with that in Thesis 50? 93. If we read this thesis carefully in the context of #92, which immediately precedes it, and how to essay Griffith University which is writing informative essays couched in grammatically parallel form, what are we to understand as the sense of the included claim that there is no cross? 94.-95.

Can you see how Luther has crafted his conclusion to collaborate with Theses 1-4 at the very beginning, to form a frame for the rest? Does Luther think it is correct and spiritually healthy for how to Griffith University (Navitas), a person to writing essays College seek to escape just punishment? (What evidence can you give for literary essay, your answer?) What is the proper attitude to take towards the suffering that results from writing essays The University Original Sin? What elements of literary Griffith University, it are we under an obligation to resist? What elements of it are we under an obligation to accept ­ even to affirm? The force of your answer will come home to you to the degree that you explicitly recall for yourself what the effects of Original Sin are, according to apa article University of Dayton the theology we constructed in the spirit of Augustine upon the Genesis account of the Fall of Mankind. How To Literary (Navitas)! Go to the Home Page for English 233 (Introduction to Western Humanities: Baroque Enlightenment). Suggestions are welcome.

Please send your comments to writing for kids School . Contents copyright © 1997 by Lyman A. Baker. Permission is granted for non-commercial educational use; all other rights reserved.

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cold war essay Memorandum by the Counselor of the Department (Kennan) to the Secretary of State. Explore U.S. views of Latin America in the 1950s through George Kennan's memorandum to Secretary of how to write essay (Navitas) State Dean Acheson. Interpret history through the analysis of a photograph . Experience the emotions of the Cuban Revolution through song. When studying the Cold War Era, students often focus on article for kids Trafalgar Castle School the struggle between the United States and the U.S.S.R. However, as these two powers competed for literary essay University (Navitas), political, military, and ideological supremacy, the conflict transcended borders to encompass countries and peoples around the application essay Montreux, world. Indeed, as the how to essay Griffith (Navitas), Iron Curtain descended in Europe, Latin American countries such as Cuba, Guatemala, Nicaragua, and El Salvador became very real and fertile battlegrounds for the struggle between communism and capitalism. The primary source materials presented here use the example of Cuba to underscore the for kids Trafalgar School, deep-rooted mistrust and essay University resentment on George both sides of the Latin America--U.S. conflict and demonstrate how both the U.S. and U.S.S.R. took advantage of long-standing rivalries and frustrations in the region to advance their own agendas. While the Kennan Memorandum unveils American prejudice and patronization towards Latin America and its peoples generally, the how to literary Griffith University, revolutionary fervor found in apa article review of Dayton, the words of Carlos Puebla's En Eso Llego Fidel and Alberto Korda's iconic image of write literary essay University (Navitas) Che Guevara convey the dissatisfaction and anger many Cubans felt towards America and the status quo. When considered together, these resources reveal the dynamic and turbulent relationship between the U.S. and an influential Latin American nation during this time, and demonstrate the emotions and ideologies that almost turned the Cold War hot. Several key events from 1959-1962 framed the U.S.-Cuba relationship during the for kids Castle School, Cold War.

These primary source videos highlight three of those key events. Castro and Rebel Forces in literary University (Navitas), Havana. October 22, 1962. The Cold War (1947-1989) altered Latin America's relationship to the United States profoundly, as the region became a battleground between two competing ideological systemscapitalism and for kids Trafalgar communism. Prior to the Cold War, both economic and how to write literary Griffith (Navitas) geopolitical concerns had motivated U.S. policy toward Latin America. But, after the lowering of the Iron Curtain in Eastern Europe, George Kennan, the chief architect of American foreign policy towards the Soviet Union, advocated containment to halt the spread of communism, not just in Europe, but globally. The result was a bipolar world featuring proxy wars fought throughout the Third World by Castle, surrogates and clients of the how to write essay Griffith University (Navitas), two superpowers. Latin American nations, historically considered to be part of our backyard, were not permitted to remain neutral as Washington expected Latin America to ally with the United States while the Soviet Union sought to gain access to what had been an American sphere of influence.

The U.S. sought to secure its backyard by signing a mutual defense treaty, the Rio Pact, in 1947, and by establishing the Organization of American States a year later. In one sense these regional agreements were an extension of the Monroe Doctrine (1823) that had warned Europeans against retaking their former colonies, but in the Cold War context, these partnerships gave the U.S. the opportunity to strengthen Latin American states militarily against communist penetration. How did Latin Americans respond to the Cold War? With democratic reform stymied, thirty separate guerrilla movements, all proclaiming some Marxist ideologies, employed armed struggle to achieve their ends. These insurgencies received arms, funds, and moral support from Cuba (and indirectly the Soviet Union). Initially, a number of these insurgencies adopted a model promoted by informative essays George Brown College, Cuba where a small, committed group would create revolutionary cells in the countryside to how to write literary Griffith University, win the hearts and minds of Latin America’s peasantries. Che Guevara's influential manual, Guerrilla Warfare , became a handbook for would-be comandantes as middle class activists left the cities to stir up rebellion. By the end of the Cold War, Cuba was the lone holdout in the backyard, although it remained economically and diplomatically isolated, and now without material support from Moscow. Latin America, which had been such a flashpoint during the University of Dayton, Cold War, fell off the geopolitical map.

No longer of write Griffith strategic value, Latin America was left to rebuild its shattered countries with little or no assistance from either of the two superpowers. Allen Wells is the Roger Howell, Jr. Professor of History at Bowdoin College in Brunswick, Maine. His scholarship has focused on modern Mexican history, especially Yucatán and he offers a range of courses in colonial and modern Latin American history. Originally from New York, he received his M.A (1974) and Ph.D. (1979) in History at the State University of writing The University New York at Stony Brook and his B.A. (1973) in literary essay (Navitas), History and Latin American Studies from the State University of New York at apa article of Dayton Binghamton. Recent publications include Tropical Zion: General Trujillo, FDR and the Jews of how to write literary (Navitas) Sosúa (Durham, NC: Duke University Press, 2009) and Reports of its Demise are not Exaggerated: The Life and review University of Dayton Times of Yucatecan Henequen, in From Silver to Cocaine: Latin American Commodity Chains and how to literary essay Griffith the Building of the World Economy, 1500-2000 , eds. Writing Essays The University Of Brighton. Carlos Marichal, Zephyr Frank and Steven Topik. (Durham, NC: Duke University Press, 2006.) Memorandum by the Counselor of the Department (Kennan) to how to essay Griffith University, the Secretary of State.

Memorandum by the Counselor of the Department (Kennan) to the Secretary of State, March 29, 1950. This is the first paragraph of the 27-page document. For the full document, see the Document section below. Suggested for grades 9 to 12. 1. How did the United States view Latin America during the early years of the essay, Cold War? 2. What factors led to the growth of nationalism and guerilla movements in Latin America during the Cold War? 3. Which did Kennan feel was the more important political value for the U.S.: democracy or security? Do you agree with his position?

Try using this activity when teaching about. The Cold War Cuba National security Democracy or democratic rights U.S.-Latin America relations Nationalism and guerrilla movements. Determine central ideas or themes of a text and analyze their development; summarize the key supporting details and ideas. Analyze how and literary why individuals, events, or ideas develop and interact over the course of a text. Interpret words and phrases as they are used in a text, including determining technical, connotative, and figurative meanings, and analyze how specific word choices shape meaning or tone. Analyze how two or more texts address similar themes or topics in order to from thesis School, build knowledge or to compare the approaches the authors take. George F. How To Write Literary Essay Griffith University (Navitas). Kennan was the U.S.

State Department's premier expert on writing informative essays Brown College the Soviet Union and the author of the containment theory. His staunch view that the United States should fight communism at all costs was used to rationalize support for dictators throughout the world. How To Griffith University (Navitas). Memorandum by the Counselor of the Department (Kennan) to the Secretary of State is a report that Kennan sent to Secretary of State Dean G. Acheson after a whirlwind tour of Latin America in 1950. Acheson had been accused of being too soft in confronting the spread of Communism, and in this document, Kennan sought to article Castle School, use his firsthand experiences in Latin America to convince Acheson that the United States needed to be tougher on literary essay Griffith regions with communist connections and writing informative Brown sympathies. Large pieces of construction paper Signs reading Strongly Agree, Strongly Disagree, and Unsure Part I: Defining Democracy and Security. 2. Have each group create short definitions of democracy and how to write literary essay University security and write the definitions on large pieces of writing Edith construction paper. 3. Have a spokesperson from how to essay University (Navitas), each group tape the paper up, read the writing the college Institute, group's definitions, and literary essay briefly explain how the group settled on the definitions.

4. Writing Trafalgar. After each group has shared its definitions, share dictionary/textbook definitions of each word (see Terms section above). 5. Work as a class to create consensus-based definitions for democracy and security. Write the definitions on chart paper or the University (Navitas), board for later reference. From Millfield. Discuss and list some of the signs, or evidence, of a functioning democracy. Discuss and list some of the rights citizens in a democracy have. Part II: Debating Democracy v. Security. 2. On the other end of the write essay, wall, hang a sign that says, Strongly Disagree. 3. Writing Service. In the middle of the how to write literary, wall, hang a sign that says, Unsure. 4. Essays College. Explain to students that you have created an opinion spectrum. Discuss opinions and how to University (Navitas) different intensities of opinion that might exist between the signs to ensure that students understand the spectrum. 5. Make a statement such as, Though both are important, when national security and democracy are at writing Cowan odds, protecting national security is more important than protecting people's democratic rights.

Ask students to stand in write, the place on the opinion spectrum that best represents their opinion on this statement. Ask a few students to defend where they are standing. Allow students to move around on the spectrum as they listen to from thesis writing Millfield School, their classmates' opinions and arguments. Ask students who move why they moved. 6. Follow up with other questions about democracy/democratic rights v. security. Consider themes of: Torturing prisoners to gain information. Wire-tapping, personal information, and how to write essay (Navitas) the Patriot Act Support of and alliance with non-democratic regimes (i.e., Saudi Arabia) for security/resources.

For each question, ask students to writing essays, defend their positions and allow classmates to move if they are persuaded to do so. George Kennan's Memorandum by write literary essay University (Navitas), the Counselor of the Department (Kennan) to the Secretary of State (highlighted text--see document in left column) Signs from Pre-Learning Activity. 2. After students have read the memo, ask one student to pose as Kennan and stand in the middle of the opinion spectrum used during the thesis writing Millfield, Pre-Learning Activity. 3. Ask the other students to take turns reading the portions of the memo they underlined. 4. After each statement, the class should decide which way on the opinion spectrum Kennan should move. 5. After the final statement and corresponding move on the spectrum, lead students in a think/pair/share discussion of: Where Kennan is standing: based on this memo, what is his opinion of democracy versus security as the how to write, higher value? Kennan's tone: what does the tone of the article for kids School, memo show us about Kennan's attitude toward Latin America and Latin Americans? Are there any particular phrases that stand out to us today as not politically correct?

Why Kennan has the opinion he does: is it based on fact? If not, on what else might his opinion be based? What evidence from the document supports this? Kennan's role in write literary Griffith (Navitas), the government: how might his opinion affect American policy? What role should government workers' opinions play in how they do their job?

Consider different jobs: President, Supreme Court Judge, Cabinet member, legislator, military member, etc. Unlike Kennan, Fidel Castro did not see Latin Americans as inherently helpless; he saw them as victims of The University of Brighton both individual and international corruption. Nor did Castro see Cuba's future as hopeless; instead, through revolution, he envisioned a path to rebuilding Cuba and creating a strong, educated, and wealthy nation. Thus, on July 26, 1953, Fidel Castro led a small group of revolutionaries in an attack on Cuba's Moncada Barracks, which was to write literary essay Griffith University, be used as a launching-pad for the guerilla's struggle against the Batista government. Although the attack failed, it was seen as the beginning of the Cuban Revolution. In October, Castro was brought to trial for his role in the attack.

During the trial, Castro spoke on his own behalf, defending his actions and outlining his vision for the future of Cuba and Latin America. In a speech that lasted four hours, Castro condemned Fulgencio Batista as a tyrant, blasted his corrupt government for causing much of the nation's problems, and spoke on writing for kids the behalf of Cuba's poor and Griffith University (Navitas) unemployed. 2. Lead a discussion contrasting Kennan's view of American involvement in writing essays The University of Brighton, Cuba with Castro's view. Create a T-Chart to write literary University, visually represent these contrasting views. Create an imaginary dialogue between Kennan and Castro in which they debate America's involvement in Cuba and/or the importance of apa article University of Dayton democracy and/or security. Using Castro's ideas and criticisms of the United States, create a political cartoon that might have appeared in a Cuban newspaper if Kennan's memo had been leaked. Hold a press conference in which two students act out the parts of how to essay Griffith (Navitas) Kennan and article writing for kids Castle Castro and the rest of the literary essay Griffith University (Navitas), class acts as reporters.

The class should ask questions to determine how the leaders see each other and each other's countries, as well as how each feels about the writing, question of democracy versus security. Marc Antone teaches World History and write literary University Humanities for the Boston Public Schools at Media Communications Technology High. Marc has facilitated Primary Source workshops on Nicaragua, El Salvador, Cuba, and the Cold War. He also has international experience in human rights and electoral observation in writing of Brighton, Guatemala, Mexico, and how to write literary University (Navitas) Honduras. Guerrillero Heróico , Alberto Korda, March 5, 1960.

Source: Museo Che Guevara, Havana, Cuba. Suggested for grades 7-12. 1. What messages did the photographer Alberto Korda hope to essays George Brown College, send in creating his image of Ernesto Che Guevara? 2. Write Literary Griffith. What political and historical significance did the photograph hold for writing for kids Trafalgar Castle, Latin Americans during the Cold War? 3. What can a photograph teach us about how to write literary essay Griffith University (Navitas) history? How does a historian approach or interpret a photograph? Try using this activity when teaching about.

Modern world history Latin American studies Spanish language and culture Art/art history/history of photography Media studies The Cold War Revolution and revolutionaries Political science (political art and activism) Analyze how two or more texts address similar themes or topics in order to build knowledge or to compare the approaches the authors take. Determine central ideas or themes of a text and analyze their development; summarize the key supporting details and ideas. Integrate and evaluate content presented in diverse media and formats, including visually and quantitatively, as well as in words. Guerrillero Heróico , the iconic image of Ernesto Che Guevara, has been printed on so many t-shirts, beach towels, propaganda posters and pocketbooks that for many people today, especially younger viewers, the image has grown disconnected from its historical context. Yet Guerrillero Heróico is an artifact with a significant and revealing history. Its origins in Havana, Cuba, in writing Cowan, 1960 are an important chapter in write literary Griffith University (Navitas), the early history of the Cold War in Latin America. The Cuban photographer who created the image, Alberto Korda (1928-2001), was an exact contemporary of his subject, Che, born in the same year in Argentina. Korda began his career doing fashion photography, but like so many people of his generation, Korda was swept up in Cuba's revolutionary cause. Early in University, 1959 he joined the staff of Revolución , a new publication in literary essay University (Navitas), Havana.

Korda snapped his now famous photograph during a public funeral and political protest in Havana on the 5th of March 1960, one of numerous photographs he took that day. The protest marked the explosion in Havana harbor of a Belgian freight ship, La Coubre , bearing arms purchased by informative, the Cuban government. Fidel Castro denounced the blast as a CIA plot (though the cause of the explosion has never been determined). Korda's photograph of Guevara was first published in how to write essay Griffith (Navitas), 1960 following the U.S.-sponsored Bay of Pigs invasion. Several years later, Korda gave his photograph to a wealthy Italian publisher and writing the college application Hotel Institute leftist, who popularized the image internationally (without crediting Korda). The image reached iconic status in Latin America and elsewhere when it was embraced by the world-wide youth movement of the late 1960s. It took on further significance and poignancy following Guevara's capture and execution by the Bolivian government in October 1967.

Since that time, a giant portrait based on Guerrillero Heróico has overlooked the Plaza de la Revolución in Havana, a symbol of the how to write essay Griffith, image's continuing importance in Cuban historical memory. From To Essay Millfield. (For more detail about the how to literary, photographer, the event and the wider historical context, see the five Historical Context Sheets included in the teaching activity). Laptop computers or computer lab Internet access to a large database of images (eg. Google Images) If you do not have access to such databases, print out ahead of time from the thesis to essay writing Millfield, web several dozen versions of write Griffith University (Navitas) Korda's image as it has appeared in posters, advertisements, outdoor murals, etc. Image Observation Sheet (see Documents section in left column) 1. Divide students into groups of 3-4. 2. Give each group access to a computer with internet connection (this can also be assigned as a homework task for individual students the night before). 3. Ask the groups to do an image search using the thesis writing, term Che image. Encourage students to write Griffith University, look at results beyond the first page. Tell them to pay attention to how many hits they find and what kinds of objects they see. Thesis Writing Millfield School. (More advanced students might choose their own search terms, or compare searches based on several variants such as Che picture and Che photographs.) 4. Distribute the image observation handout and review it with students. 5. Direct the groups to choose 2-3 images that they like and analyze each one using the image observation sheet. [NOTE: if students are familiar with VoiceThread technology, you might instead have them capture their observations in that format, using their chosen image as the centerpiece.]

6. Bring the full class together; ask for volunteers to talk about one image and their group's interpretation of how to essay (Navitas) it. 7. Discuss the multiple meanings that have been applied to Che's photograph. Writing The College Application Essay Hotel Institute. Help students to literary Griffith University (Navitas), note that the meanings are varied, not stable or consistent. 8. Introduce the concept of an icon or an the college application essay Institute iconic image. If your students are familiar with Shepard Fairey's image of Barack Obama, you can use that as an example. Discussdoes the literary essay Griffith (Navitas), image of Che fit this definition? Why do they think certain images become iconic? Why has Che's image been so popular and widely used over such a long period of time? If you or your students have a special interest in the college application essay Hotel Montreux, the media studies angle, consider reading this brief CNN report about Korda's photograph, Examining an Iconic Image. This highlights the work of journalist Michael Casey, author of how to write literary essay (Navitas) Che's Afterlife: The Legacy of an Image (2009).

Casey describes U.S.Cuban relations as a battle of the brandsUncle Sam vs. Che. Apa Article University Of Dayton. The report references Shepard Fairey's image of then-candidate Barack Obama and shows numerous examples of Che in pop and material culture. Casey raises the question, has the Korda image of Che become a hip brand, denoting rebellion and youth and little else? Or does it still bear a revolutionary message?

Ask students to reflect on this question after watching the CNN report. Projection of two Che images: the cropped and write literary essay University uncropped versions of writing Korda's photograph ( via LCD projector or SmartBoard technology) Individual copies of the uncropped photo, one for each student, with room to write literary, write on the margins (See Documents section in left column) Historical Context Sheets for jigsaw activity (See Documents section in left column) Spider web graphic organizer, one copy for each group (See Documents section in left column) 1. This primary source activity takes students through a process of informative re-envisioninglooking again at Korda's too-familiar photograph using the analytical tools of a historianan understanding of place, time, the role of historical actors and the context of historical events. Explain that they are going to be looking again at the famous photo of how to literary (Navitas) Che with fresh eyesthis time viewing it as a historical source, and apa article review of Dayton analyzing it with a historian's set of tools and write literary (Navitas) questions. 2. Give each student a copy of the thesis to essay writing, uncropped version of Korda's photo. 3. How To Write Literary Essay (Navitas). Ask students to look closely at the uncropped photo for article writing Castle, a few moments, paying close attention to its details. Then ask them to use the margins of the photo to make a quick list of how to literary Griffith words or phrases that describe the thoughts and writing essays in exams emotions they see in write Griffith University (Navitas), Che's face or expression. 4. Bring the class together and ask each student to share one word or phrase from their list. From To Essay Millfield School. Summarize their responses, noting patterns or differences.

Tell the how to write literary essay Griffith, class that we also know how the photographer, Alberto Korda, answered the same question: when asked by for kids Trafalgar School, an interviewer, he described Che's facial expression as encabronado y dolienteangry and sorrowful. Write Literary Essay Griffith University. How does this match their responses? What questions does Korda's comment raise for them, if any? (They might wonder, for example, what he could be sad about or what made him angry.) 5. Next, project the cropped and uncropped photos side by side and writing for kids Castle School ask students to compare. Write Literary Griffith University. Take comments from the class using these prompts: How do they think the two images are different? Why did Korda want the tight frame around Che's face, removing the other objects/people? (They might notice that isolating Che places extra importance on himall our attention is drawn to him. Some may note that the shot from below builds him up, or that isolating him makes him look like a super-hero or emphasizes his gaze out into review of Dayton, the future, etc.) Then share the how to write University, title that Korda gave the final, cropped photo: Guerrillero Heróico . What does the title reveal about Korda's view of his subject and his purpose in producing the image?

6. Next, brainstorm with the class: if they were to treat this photo as a historical document, telling us something about essays George College a moment in history and the individuals who were involved in that moment, what information would they want and need to know? List their ideas on blackboard or SmartBoard. How To Write. (They might wonder where Che was at the time, what he was doing, if the photographer knew him, whether the photographer had a political perspective, where he was born, etc.) Tell them the next activity will provide information they can use to find answers to these questions. When they are done compiling answers they will be prepared to create a historical interpretation of the apa article University, photograph. 7. Set up a jigsaw discussion. First, divide students into groups numbered 1-5 and ask them to sit in a small circle (4-6 people per group will work but make the groups as close to five as possible).

Students need to remember the original number of their group. Pass out to each group the stack of Historical Context Sheets that corresponds to their group number (ex: Group 1 gets Historical Context Sheet #1, the essay University, La Coubre incident). Direct the students to read the information on the card silently. When finished, the group should discuss what they read using this task to guide them: what details, facts or items of information from this passage help answer one of the questions the class has about the Korda photograph? Which facts are most important and relevant? Finally, each student should list these facts from most relevant/important to least relevant/important, using their individual judgment. 8. Jigsaw the students. Writing Application Essay Hotel Institute Montreux. Create new groups that now include representation from write literary essay Griffith University (Navitas), each of the writing for kids School, original Historical Context teams, or from as many as possible. How To Literary Griffith University. Each member of the new group will take a turn reporting out the findings of their historical context exploration.

9. Essays Of Brighton. Instruct each group to fill out the Griffith University, spider-web graphic, using the apa article review University, expertise of every group member to fill in the labeled blocks. Write Griffith University. Finally, the group should collaborate to fill in George Brown College, the large block labeled with this question: Your conclusion: what is the how to write, historical meaning or significance of the photograph? Susan Zeiger is service Edith Cowan University, a program director at Primary Source. How To University. Prior to joining Primary Source, she was the chair of the History Department at Regis College for ten years. She is the essays in exams The University of Brighton, author of books and articles on topics that include immigration and race, international relations, and gender, war and peace movements. How To Essay. Her most recent book, Entangling Alliances: Foreign War Brides and writing Trafalgar Castle American Soldiers in the Twentieth Century , examines race and gender in foreign and domestic relationships. Zeiger holds a Ph.D. in U.S.

History from New York University. Audio version of En Eso Llego Fidel Suggested for grades 9 to 12. 1. How To Write Literary (Navitas). How did the spirit and pride of the revolution relate to the reality of Cuban experience? 2. How can poetry and writing essay Hotel Montreux music harness people's emotions to serve a cause? Try using this activity when teaching about. The Cold War Revolution and revolutionaries Latin America Cuba Spanish language and how to write Griffith (Navitas) culture Political art and artistic expression Popular movements Communism v. Democracy.

Read closely to determine what the text says explicitly and to make logical inferences from it; cite specific textual evidence when writing or speaking to support conclusions drawn from the text. Determine central ideas or themes of a text and analyze their development; summarize the key supporting details and ideas. Interpret words and writing the college essay Institute Montreux phrases as they are used in a text, including determining technical, connotative, and figurative meanings, and analyze how specific word choices shape meaning or tone. Analyze the structure of write essay Griffith (Navitas) texts, including how specific sentences, paragraphs, and larger portions of the text (e.g., a section, chapter, scene, or stanza) relate to each other and the whole. When the Cuban Revolution began, Castro and his 26th of July Movement enjoyed broad support as they agitated against Fulgencio Batista, the writing informative essays George College, corrupt American-backed dictator of Cuba.

Cuban artists of the day captured the enthusiasm and optimism of the early days of the revolution through song, painting, and poetry, which allowed them to convey the how to literary essay Griffith University, emotion of the revolutionary spirit in ways that simple prose could not. Song that is engaging for students and University tells a story. It's early in the morning. A tri-colored flag hangs from a pole. Write University (Navitas). Last night, there was a battle nearby. Even though there were rockets and bombs, the flag wasn't destroyed. It still waves in the wind over our home, where free and brave people live.

2. Ask students how this paragraph made them feel. Do they feel excited by these words? What type of imagery do the words convey? 3. Then play the song for the students; provide them with a transcript to read as the song plays in case they aren't familiar with all of the words. 4. Ask the students if they felt more involved with the story upon Brown College listening to the song. Could they better identify with the how to literary essay Griffith University, author's emotions? How did listening to the song help them better understand the event? How did listening to the song make them feel contrasted with how reading the words made them feel? What images did the affordable essay writing University, song convey that they words did not?

5. Lead the students in how to literary essay Griffith University, a discussion of writing essays of Brighton how listening to historical songs or reading historical poetry might help them better understand the context and emotions surrounding historical events. Before asking students to respond emotionally to the song, it is essential that they understand the text, its historical context, and its implications. 1. Ask students to read the Background Essay by Allen Wells. 2. Assign En Eso Llegó Fidel for the students to read individually. 3. After they have read the background and the song, have students work in pairs or small groups to answer the following questions: First Stanza: Who are they? Where is here?

Who are the how to write literary essay Griffith University (Navitas), people? Who is Fidel, and what sentiment does his arrival convey? Second Stanza: What does the phrase up in to essay Millfield, the mountains the future was lighting up mean? Third Stanza: What is infamy, and how could it be used as a shield? Who are the bearded ones, and how might they have been defamed? Fourth Stanza: What does playing democracy mean? 4. Lead the class in a group discussion of the song to ensure comprehension.

Part B: Quaker Read. This student-centered activity is how to Griffith (Navitas), styled after Quaker meetings, during which participants speak when the spirit moves them. The activity focuses on quiet reflection and emotional response. Writing Millfield. The activity also helps to settle classes that have trouble focusing on texts or discussions. The Quaker Read also provides more thoughtful groups with the opportunity to reflect on the ideas of their classmates. Explain that they might choose segments because of their vividness, because they contain interesting points, or because they agree or disagree with the author’s statement. 2. Ask students to listen to the audio version of the song, and to note any differences in emotional response upon listening. They can underline additional phrases or segments based on their reactions to the audio version.

3. Ask students to sit in a circle and, with no explanation, rationale, or prompting, read aloud a part of the how to essay Griffith (Navitas), song that is particularly interesting to them. 4. The College Institute. Ask students to consider each passage read, and to think about what it tells the reader/listener about the sentiment in Cuba when Castro came to power. 5. After the students have finished sharing their passages, lead the class in a discussion that addresses the following questions: What does the Griffith, song tells us about the person who wrote it, as well as the people (they, the essay service Edith University, people, Fidel, etc.) described in how to write literary Griffith University, it? Is reading historical poetry/verse a meaningful way to study historical events?

Why or why not? Whichthe background reading or the songmade you more aware of the revolutionaries' plight? Why? Whicha song or a factual accountwould have served as better revolutionary propaganda? Why? What (emotion, passion, individual experience, etc.) can a primary source like a poem or song offer that a textbook does not or cannot?

Why? Which do you prefer? What other artists have tried to use poetry/song to address political events? Were they effective? Why or why not? Beatles Green Day Dixie Chicks (Kids will be able to apa article, think of how to write literary Griffith University (Navitas) many, many more) 6. Work as a class to list the complaints found in the song against the U.S.-backed Batista government. Ask students to explain if they think each complaint was or wasn't justified, with supporting evidence based on the background narrative and their own understanding of article Castle Cuban and U.S. history. Ask students to choose one of the following options: Write your own song about a political event (past or present) and present to the class for discussion. Bring in a song that addresses a political event for discussion.

Marc Antone teaches World History and essay Griffith University Humanities for the Boston Public Schools at Media Communications Technology High. Marc has facilitated Primary Source workshops on from thesis to essay Millfield School Nicaragua, El Salvador, Cuba, and the Cold War. He also has international experience in human rights and electoral observation in Guatemala, Mexico, and Honduras. Brenner, Philip, et al, eds. University. A Contemporary Cuba Reader: Reinventing the Revolution . Lanham: Rowman and Littlefield, 2008. Chomsky, Aviva, Barry Carr, and Pamela Smorkaloff , eds.

The Cuba Reader: History, Culture, Politics . Durham: Duke University Press, 2003. Perez, Louis A. Cuba: Between Reform and apa article review University Revolution . New York: Oxford University Press, 1988. Smith, Peter H. Talons of the Eagle: Latin America, the United States, and the World . How To University (Navitas). New York: Oxford University Press, 1996. Anderson, Jon Lee. Writing Essays In Exams. Che Guevara: A Revolutionary Life . New York: Grove Press, 1997.

Casey, Michael. Che's Afterlife: The Legacy of an Image . Literary. New York: Vintage Books, 2009. Contesting Cuba's Past and Future . Writing Essays George College. Providence: Watson Institute for International Studies (CHOICES), Brown University, c2008. A curriculum guide published by Choices at Brown University. Korda, Alberto. Cuba by Korda . Christophe Loviny, ed. New York: Ocean Press, 2006. Photographs and commentary by how to write essay, the photographer. Ziff, Trisha.

Che Guevara: Revolutionary and writing College Icon . New York: Abrams Image, 2006. This beautifully-illustrated book of essays and images was created in conjunction with an exhibit organized by how to write Griffith (Navitas), the Museum of Photography, University of California Riverside. The history of the photograph is laid out article for kids Castle, here. A CNN report highlighting the work of journalist Michael Casey. Alberto Korda: The Photographer Behind the Face of Ernesto Che Guevara. Art History Archive: Photography . 2007 November. Accessed 30 March 2010. A documentary about Alberto Korda by Hector Cruz Sandoval.

Carlson, Lori M. and Óscar Hijuelos, eds. Burnt Sugar/Cana Quemada: Contemporary Cuban Poetry in literary essay University, English and Spanish . New York: Free Press, 2006. Smorkaloff, Pamela Maria. Readers and Writers in Cuba: A Social History of Print Culture, l830s-l990s . New York: Garland Pub., 1997.