Health

Health
(Grade 12)
Health
Copyright 2013 by 3G Elearning FZ LLC
3G Elearning FZ LLC
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ISBN: 978-93-5115-000-8
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Preface
This is a book for students who want to learn about evidence-based public health because of its importance to local, national, and world health. This book has been the leading teacher resource book
used to prepare future and current school teachers to teach health. Because the broad mission of public
health is to fulfill societys interest in assuring conditions in which people can be healthy, there will be
unavoidable integration of new genetic technologies and information into public health programs to
target intervention strategies that will prevent morbidity, mortality, and disability from a wide array
of conditions.
This book defines and illustrates the application of the effectiveness, efficiency, and equity criteria
for evaluating healthcare system performance. It introduces and integrates the fundamental concepts
and methods of health services research as a field of study and illustrates their application to policy
analysis. Specific examples of the application of health services research in addressing contemporary
health policy problems at the national, state, and local levels are presented.
How to use this Book

This book has been divided into many chapters. Chapter gives the motivation for this book and the use
of templates.
1. Chapter in the book includes a number of pedagogical aids. The text is presented in the
simplest language. Each paragraph has been arranged under a suitable heading for easy
retention of concept. All important formulae, figures and practical steps have been presented with better visibility to grab the attention. Each unit has been uniformly organized.
2.
Objectives in the beginning of the chapter provide a glimpse of related issues which has
been discussed in the chapter.
3.
Key Vocabulary is a technique designed to use the most meaningful words in a childs
world to develop literacy. It is a structured process that can be used with individuals or
classes to expand reading vocabulary. As a student accumulates a bank of key words,
he/she develops confidence as a reader. While they are used primarily for rhetoric, they
are also used in a strictly grammatical sense for structural composition, reasoning, and
comprehension. Indeed, they are an essential part of any language.
4.
Multiple choice questions provide a set of answers from which the respondent must
choose. Multiple choice questions are closed questions. It is a form of assessment in which
respondents are asked to select the best possible answer (or answers) out of the choices
from a list.
5.
Review questions at the end of each chapter ask students to review or explain the concepts.
For an easier navigation and understanding, this book contains the complete 3G curriculum of this
subject and the topics.
Introduction
An introduction is a beginning of
section which states the purpose
and goals of the topics which are
discussed in the chapter. It also
starts the topics in brief.
Objectives
Objectives in the beginning of
the chapter provide a glimpse
of related issues which has been
discussed in the chapter.
Key Vocabulary
Key Vocabulary is a technique
designed to use the most meaningful words in a childs world to
develop literacy. It is a structured
process that can be used with individuals or classes to expand
reading vocabulary.
Multiple Choice questions

Multiple choice questions provide a set of answers from which
the respondent must choose. It is
a form of assessment in which respondents are asked to select the
best possible answer (or answers)
out of the choices from a list.
Review Questions
Review questions at the end of
each chapter ask students to review or explain the concepts.
Table of Contents
1.
Introduction to Health
1.1
1.2
1.3
1.4
Definition of Health
1
1.1.1 Two aspects to health
2
1.1.2 Determinants of Health
2
Importance of Health in our Life 5
1.2.1 Why is Health Important
to Us?
5
in the Workplace?
5
for Children?
6
1.2.4 Personal Life
7
1.2.5 Family Life
7
1.2.6 Social Life
7
Health Risk Factors
7
1.3.1 Alcohol Consumption
8
1.3.2 Smoking
9
1.3.3 Other Drugs and
Substances 10
1.3.4 Nutrition
11
Health Consumer
12
1.4.1 Serving all Californians
12
1.4.2 Helping Individuals with
Medi-Cal Eligibility and
Service Issues
12
1.4.3 Establishing/Maintaining,
and Ensuring Access to
Health Coverage
13
1.4.4 Top Priority: Solving the
Individual Consumers
Problem 13
1.4.5 Providing Significant
Community Education
13
1.4.6 On the Ground Perspective,
Successfully Solving
Problems 14
1.5
1.6
Human Development
14
1.5.1 Disability
15
1.5.2 Maternal Health
15
Family Health
16
1.6.1 Not Enough Family
Exercise 16
1.6.2 Choosing Convenience
Foods 17
1.6.3 Not Spending Time
Together 18
1.6.4 We Should Monitor our
Health Daily
18
1.6.5 A Family Meal Helps
19
2. Violence
2.1
Typology of Violence
22
2.1.1 Self-directed violence
23
2.1.2 Interpersonal violence
24
2.1.3 Collective Violence
25
2.2 Consequences and Costs
25
2.3 Causes of Violence
27
2.3.1 Biological Causes
27
2.3.1 Sociological Causes
27
2.4 Types of Interpersonal Violence 27
2.4.1 Child Maltreatment
27
2.4.2 Youth Violence
28
2.4.3 Domestic Violence/Intimate
Partner Violence
28
2.4.4 Sexual Violence
29
2.4.5 Elder Maltreatment
30
2.4.6 Suicide
30
2.5 Drug
30
2.5.1 Risk Factors for DrugRelated Interpersonal
Violence 31
2.6
2.7
3.
33
34
4.4
Human Development
3.1
3.2
3.3
3.4
3.5
3.6
3.7
4.
War
Violence in the Media
Human rights and Health

37
3.1.1 Public Sector
Accompaniment 40
3.1.2 The Work of WHO on
Health and Human Rights 41
Human Development
41
Challenges to Human
Development 41
Human Development Report
43
3.4.1 Background
43
3.4.2 Human Development: the
Concept 44
Human Development Index
(HDI)
44
Human Poverty Index
46
3.6.1 The Three Indicators of the
Human Poverty Index
(HPI)
47
United Nations Millennium
Development Goals
48
3.7.1 Goal 1: Eradicate Extreme
Poverty and Hunger
48
3.7.2 Goal 2: Achieve Universal
Primary Education
49
3.7.3 Goal 3: Promote Gender
Equality and Empower
Women
50
3.7.4 Goal 4: Reduce Child
Mortality 51
3.7.5 Goal 5: Improve Maternal
Health
52
3.7.6 Goal 6: Combat HIV/AIDS,
Malaria and Other
Diseases 52
3.7.7 Goal 7: Ensure Environmental Sustainability
53
3.7.8 Goal 8: Develop a Global
Partnership for Development 54
4.5
4.6
4.7
4.8
4.9
5.
History
Significance of Mental Health
Perspectives of Mental Health
4.3.1 Mental Wellbeing
4.3.2 Prevention
Emotions and Stress

5.1 Components of Emotion
5.2 Classification of Emotion
5.3 Theories of Emotion
5.4 Disciplinary Approaches
5.5 Emotions and Morality
5.6 Stress
5.7 Effects of Stress on Body
6.
6.2
6.3
6.4
6.5
59
60
61
61
63
6.6
viii
81
83
85
86
88
100
102
Digestion and Excretion

6.1
Mental Health
4.1
4.2
4.3
4.3.3 Cultural and religious

considerations 63
Emotional mental health issues
around the world
65
Emotional mental health
improvement 67
Priority Mental Health Conditions 73
Causes of Mental Disorders
76
Multiple Choice Questions
77
Review Questions
78
Digestive systems
106
6.1.1 What is Digestion?
106
General Structure of the
Digestive System
107
6.2.1 Mouth
107
6.2.2 The Oesophagus
107
6.2.3 The Stomach
108
6.2.4 The Small Intestine
108
6.2.5 The Large Intestine
109
Regions of the Digestive
System 110
6.3.1 Stages in the Digestive
Process 111
6.3.2 Components of the
Digestive System
112
6.3.3 Why is Digestion
Important? 112
Movement of Food Through
the System
113
The Excretory System
114
6.5.1 Excretory System
Functions 115
6.5.2 Invertebrate Excretory
Organs 116
6.5.3 The Human Excretory
System 116
Regulation of Extracellular
Fluids 117
6.7
7.
8.
6.6.1 Changes in Sodium

Balance are Sensed by
Volume-Dependent
Receptors 118
6.6.2 Water and Salt Balance 118
Nitrogen Wastes
119
6.7.1 Ammonia
120
6.7.2 Urea
120
6.7.3 Uric Acid
121
8.1 Depression
What are Mental Disorders?
8.2
8.1.3 Depression in Children

and Teens
147
Clinical Depression
149
8.2.2 Causes of Clinical

Depression 150
128
8.3
7.2.1 How are males/Female

affected? 131
8.2.3 General Treatment for

Clinical Depression
150
Risk Factors for Depression
150
8.3.1 Risk Factors for Clinical

Depression 152
7.2.2 Causes Eating Disorders 131
8.4
7.2.3 Effects of Eating

Disorders 133
7.2.4 Treatment of Eating
Disorders 135
Self Injury
152
8.4.1 Causes a Person to

Engage In Self-Injury
153
8.5 Suicide
155
7.2.5 Types of Eating Disorder

Treatment 137
8.5.1 The Effects of Suicide
156
8.5.2 Causes of Suicide
156
7.2.6 Major Therapies for

Eating Disorder
Treatment 137
8.5.3 Risk Factors and

Protective Factors for
Suicide 156
7.2.7 Co-occurring Disorders

and Dual Diagnosis
with Eating Disorders
8.6
137
Mental Disorder Treatment
139
7.3.1 The initial Assessment
139
8.7
140
9.
7.3.4 Psychological Treatment 141

7.3.6 Other forms of Treatment 142
Multiple Choice Questions
142
7.5
Review Questions
143
8.6.1 Suicide Warning Signs
159
Cluster Suicide
160
9.2
ix
8.7.2 Fact
161
8.7.3 Postvention Guidelines
161
Movement and Coordination

9.1
7.3.5 Treatment with Medication 141

7.4
158
8.7.1 Preventing Cluster

Suicides 161
7.3.2 The role of psychiatrists

and general practitioners 140
7.3.3 Community mental
health services
Suicide Prevention
8.6.2 The Role of the School in

Suicide Prevention
159
7.2.8 Eating Disorder Special

Treatment Considerations 138
7.3
147
8.2.1 Types of Clinical

Depression 149
125
7.1.2 Causes of Mental

Disorders 127
Eating Disorder
8.1.2 Causes of Depression
8.1.4 Treatment of Depression 148
7.1.1 Forms of mental

Disorders 126
7.2
146
8.1.1 Different Forms of Depression

146
Mental Disorder
7.1
Depression and Suicide
Skeletal System
165
9.1.1 Functions of the Skeleton
System 165
Muscular System
169
9.2.1 Necrotizing Fasciitis
171
9.3
Nervous System
173
10.2 Respiratory System

186
10.3 Cardiovascular Risk and
Preventions 189
10.4 Respiratory Risk and
Preventions 193
10. Cardiovascular and Respiratory Health

10.1 Cardiovascular System
181
Chapter 1
1.1 DEFINITION OF HEALTH

The English word health comes from the Old English word hale, meaning wholeness, a being whole, sound or well. Hale comes from the ProtoIndo-European root kailo, meaning whole, uninjured, of good omen. Kailo
comes from the Proto-Germanic root khalbas, meaning something divided.
Medilexicons medical dictionary has three definitions for health, the first being The state of the organism when it functions optimally without evidence
of disease or abnormality.
World Health Organizations (WHOs) definition of health, The most
famous modern definition of health was created during a Preamble to the
Constitution of the WHO as adopted by the International Health Conference, New York, 1922 June, 1946; signed on 22 July 1946 by the representatives of 61 States and entered into force on 7 April 1948.
Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.
Health is the level of functional or metabolic efficiency of a living being.
In humans, it is the general condition of a persons mind and body, usually meaning to be free from illness, injury or pain (as in good health or
healthy). The WHO defined health in its broader sense in 1946 as a state of
complete physical, mental, and social well-being and not merely the absence
of disease or infirmity. Although, this definition has been subject to controversy, in particular as lacking operational value and because of the problem
created by use of the word complete, it remains the most enduring. Classification systems such as the WHO Family of International Classifications, including the International Classification of Functioning, Disability and Health
(ICF) and the International Classification of Diseases (ICD), are commonly
used to define and measure the components of health.
Health is a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity. The state of being hale, sound,
or whole, in body, mind, or soul; especially, the state of being free from physical disease or pain.
Objectives
After studying this

chapter, you will be
able to:
Discuss the
aspects of
health.
Explain the
importance
of health in
our life.
Describe the
health risk
factors.
Explain how
family meal
helps the
children.
Health
1.1.1 Two aspects to health

Physical health
For humans, physical health means a good body health, which is healthy
because of regular physical activity (exercise), good nutrition, and adequate
rest. As a countrys or regions people experience improved nutrition,
health care, standards of living and quality of life, their height and weight
generally increase.
In fact, most people, when asked for a definition of health talk about
Key Vocabulary physical health. Physical health relates to anything concerning our bodies
as physical entities. Physical health has been the basis for active living campaigns and the many nutrition drives that have swept the industrialized
Health: Health is a state
world. People are exposed to so much physical health data these days
of complete physical,
that it is hard to decide what is relevant and what is not.
mental and social wellAnother term for physical health is physical wellbeing. Physical wellbeing and not merely the
being
is defined as something a person can achieve by developing all
absence of disease or inhealth-related components of his/her lifestyle. Fitness reflects a persons
firmity.
cardiorespiratory endurance, muscular strength, flexibility, and body composition. Other contributors to physical wellbeing may include proper nutrition, bodyweight management, abstaining from drug abuse, avoiding
alcohol abuse, responsible sexual behavior (sexual health), hygiene, and
getting the right amount of sleep.
Mental health
Mental health refers to peoples cognitive and emotional well-being. A person who enjoys good mental health does not have a mental disorder. According to WHO, mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of
life, can work productively and fruitfully, and is able to make a contribution to his or her community.
No matter how many definitions people try to come up with regarding
mental health, its assessment is still a subjective one.
People have always found it easier to explain what mental illness is,
rather than mental health. Most people agree that mental health refers to the
absence of mental illness. For some, this definition is not enough. They
argue that if we pick 100 people who do not suffer from any mental disorder or illness that could be diagnosed by a psychiatrist, some people within
those 100 will be mentally healthier than others. Most people also agree that
mental health includes the ability to enjoy life, the ability to bounce back
from adversity, the ability to achieve balance (moderation), the ability to be
flexible and adapt, the ability to feel safe and secure, and self-actualization
(making the best of what we have).
1.1.2 Determinants of Health

The health of individual people and their communities are affected by a
wide range of contributory factors. Peoples good or bad health is determined by their environment and situations - what is happening and what
has happened to them, says WHO. The WHO says that the following fac-
tors probably have a bigger impact on our health than access and use of
health care services:
Where we live
The state of our environment
Genetics
Our income
Our education level
Our relationship with friends and family
The WHO says the main determinants to health are:
Our economy and society (The social and economic environment)
Where we live, what is physically around us (The physical environment)
What we are and what we do (The persons individual characteristics and behaviors)
As our good health depends on the context of our lives, praising or
criticizing people for their good or bad health is wrong. Most of the factors that contribute towards our good or bad health are out of our control.
According to WHO, these factors (determinants), include the following,
among others:
Socioeconomic status
The higher a persons socioeconomic status is, the more likely he/she is
to enjoy good health. The link is a clear one. Socioeconomic status affects
all members of the family, including newborn babies. An Australian study
found that women of lower socioeconomic status are less likely to breastfeed their newborn babies - a factor which will have an impact on the health
of the baby just as he/she enters the world. A South Korean study revealed
a clear link between low socioeconomic status and heart attack and stroke
risk.
Education
People with lower levels of education generally have a higher risk of experiencing poorer health. Their levels of stress will most likely be higher, compared to people with higher academic qualifications. A person with a high
level of education will probably have higher self-esteem. A study carried
out by researchers at Northwestern University Feinberg School of Medicine, Chicago, found that elderly people who had a higher level of health
literacy were more likely to live longer. Another study from San Francisco
VA Medical Center found that Literacy at less than a ninth-grade level almost doubles the five-year risk of mortality among elderly people.
Physical environment
If our water is clean and safe, the air we breathe is pure, our workplace
is healthy, our house is comfortable and safe, we are more likely to enjoy good health compared to somebody whose water supply is not clean
and safe, the air he/she breathes is contaminated, the workplace is unhealthy, etc. A study carried out by researchers at Zuyd University, The
Key Vocabulary
Physical Health: Physical wellbeing is defined
as something a person
can achieve by developing all health-related
components of his/her
lifestyle.
Health
Netherlands, found that just an hour of sniffing car exhaust fumes induces a
stress response in the brains activity. Another study carried out at Indiana
University-Purdue University found that chronic lead poisoning, caused in
part by the ingestion of contaminated dirt, affects hundreds of thousands
more children in the United States than the acute lead poisoning associated
with imported toys or jewelry.
Job prospects and employment conditions

If we have a job, statistics show we are more likely to enjoy better health
than people who are unemployed. If we have some control over our
working conditions our health will benefit too. A study by researchers
at State University of New York at Albany found that workers who lost
Key Vocabulary
their job through no fault of their own were twice as likely as continuMental Health: mental ously employed workers to report over the next 18 months that they
health is a state of well- developed a new illness, such as high blood pressure, diabetes or heart
being in which the indi- disease.
vidual realizes his or her
own abilities, can cope Support from people around us
with the normal stresses
of life, can work produc- If we have family support, as well as support from friends and our comtively and fruitfully, and munity our chances of enjoying good health are far greater than somebody
is able to make a contri- who has none of these things. A study carried out at the University of
bution to his or her com- Washington found that strong family support, not peer support, is protecmunity.
tive in reducing future suicidal behavior among young adults when they
have experienced depression or have attempted suicide.
Culture
The traditions and customs of a society and how a family responds to them
play an important role in peoples health. The impact could be either good
or bad for health. The tradition of genital mutilation of women has an impact on infection rates and the mental health of millions of girls and women
in many countries. A study published in the Journal of Epidemiology and
Community Health found that when young people dress according to the
customs of their own ethnic group, they may be less likely to have mental
health problems later in life.
Genetic inheritance
Peoples longevity, general health, and propensity to certain diseases
are partly determined by their genetic makeup. Researchers from Vrije
Universiteit, Holland, the Medical College of Georgia, USA, and Duke
University, USA showed that peoples genes play a key role in how they
respond both biologically and psychologically to stress in their environment.
What we do and how we manage

What we eat, our physical activity, whether or not we smoke or drink or
take drugs, and how we cope with stress play an important role on our
physical and mental well-being.
Access and use of health services

A society that has access and uses good quality health services is more likely to enjoy better health than one that does not. For example, developed
countries that have universal health care services have longer life expectancies for their people compared to developed countries that do not.
Gender
Men and women are susceptible to some different diseases, conditions and
physical experiences, which play a role in our general health. For example, childbirth, ovarian cancer, and cervical cancer, are experienced only
by women, while prostate cancer, testicular cancer are only experienced
by men. During wars more men than women tend to be called up to fight,
and subsequently become injured or die. Adult women are more likely to
be the physical victims of domestic abuse, compared to adult men. In some
societies women are not given the same access to education as men - education is a factor that influences health. Many studies have revealed gender
disparities in healthcare services, even in developed countries.
1.2 IMPORTANCE OF HEALTH IN OUR

LIFE
When we are talking of health, it is not just about a healthy body but also
about sound mental health. Good health can be described as the condition
where both our body as well as our mind are functioning properly. The
main causes behind poor health conditions are diseases, improper diet, injury, mental stress, lack of hygiene, unhealthy lifestyle, etc. Over the past
few years, our lifestyle has changed and we often tend to ignore the importance of healthy living in one way or the other.
1.2.1 Why is Health Important to Us?

There are several benefits of a healthy life. Our body becomes free from
various forms of disorders and thus, we get a longer life. We can live a life
without suffering from any aches, pain, or discomfort. In every sphere of
our life, we will be able to perform to the best of our ability. Doing excellent
work helps us to be a valuable member of a healthy society. Besides, when
we are physically fit, it gets reflected on our face. So, we look attractive and
start feeling good about ourselves! If we have a fit body, then we can lead a
physically active life even after growing old. This is because, the body can
heal the regular wear and tear associated with aging faster. In short, health
and wellness brings about a drastic improvement in the overall quality of
our life.
1.2.2 Why is Health Important in the Workplace?

We should take good care of our health, both in the workplace as well as
at home. This will make us feel more energetic and we will be able to carry
out both simple as well as strenuous tasks without pushing ourselves too
hard. As mind and body are free from work pressure and mental stress,
Key Vocabulary
Family: The family is a
primary social group. It
is a group of biologically
related individuals.
Health
one can handle the daily chores at workplace with a positive attitude. We
feel motivated to finish off the task at hand and will be interested to work
on more number of things. The mind develops a natural tendency to focus
upon the positives and is not bothered much about the negatives. Most
importantly, at the end of the day, one can sleep well and do not have to
start the next day with a body ache or joint pain or stomach upset.
Good health has a positive effect on the productivity of the employees. Therefore, an organization should also give the prior importance to the
health care of its employees through its policies. When the organization is
showing interests in the well-being of its employees, they in turn will also
feel more responsible and loyal towards the organization. It improves employee retention, reduces absenteeism and cuts down on companys health
care costs.
Key Vocabulary
1.2.3 Why is Health Important for Children?
Culture: The traditions

Staying healthy for kids is vital for proper growth and development of their
and customs of a society.
mind and body. They require enough energy to spend the entire day in
school. They should be able to focus in the classroom and fully participate
in the activities on the field. For this, they need proper nutrition which includes carbohydrates, proteins, calcium, minerals, etc. Today, most parents
have a basic knowledge of food and health related issues. However, they
often fail to understand that regular medical check-up is a must for every
child. This helps them to learn from the experts whether the childs development in terms of height and weight is proper. They should also take the
child for dental check-up and eye check-up on a regular basis. Even child
behavior has to be monitored closely. This way any major health problem
can be prevented in future.
Hope we have understood why health is important for every individual, young or old. It has a huge impact on our overall performance
and efficiency. In other words, we have a better control over our life.
For healthy living, a disciplined life is a must. We have to eat nutritious food and exercise regularly. Stay away from unhealthy habits
like smoking and heavy drinking. It is also essential to keep the mind
healthy by nurturing the right kind of thoughts and proper stress management.
Health is related deeply to life-style. Ideal health will however, always
remains a mirage, because everything in our life is subject to change. Health
may be described as a potentialitythe ability of an individual or a social
group to modify himself or itself continually, in the face of changing conditions of life not only, in order to function better in the present but also to
prepare for the future.
The three most important components put in to general safety, healthy
and in good physical shape are: Self-awareness, a balanced diet and, regular
physical activity. These are truly the main elements of a healthy living head
start. This mainly involves the mental and emotional part of our body as
well as the physical body functions.
1.2.4 Personal Life

The importance of health in personal life cannot be minimized. It has come
to be regarded as a prerequisite for optimum socio-economic development
of man. Health care as a right of every individual has been recognized in

many countries.
In the Universal Declaration of the Human Rights, there are 30 articles. The Right to better living conditions and the Right to Health and Medical service are vital. Though the health is now recognized as a fundamental
right of every human being, it is essentially an individual responsibility. It
is the individual who has to accept certain responsibilities in order to attain
good health, i.e.- responsibility about diet, personal hygiene, cultivation of
healthful habits, carrying out specific disease prevention measures. It is also
desirable that in the personal life every individual should be acquainted
with the essential health skills to stay healthy.
1.2.5 Family Life

The family is a primary social group. It is a group of biologically related
individuals. The family is like a shock absorber to the stress and strains of
life. At the time of emotional upsets, worry, anxiety, economic insecurity,
the family provides an opportunity for release of tension.
The family therefore plays an important part both in health and disease in the prevention and treatment of individual illnesses, in the care of
children and dependent adults, and in the stabilization of the personality of
both adults and children In most societies the family is the fulcrum of health
services Medical schools are developing teaching programmers in family
medicine; because, as Florence Nightingale had said, the secret of national
health lies in the homes of the people.
1.2.6 Social Life

Society is a group of individuals drawn together by a common bond of
nearness and who act together in general for the achievement of certain
common goals. The society plays an important role in the health as well as
in disease; public health is an integral part of the social system. It is influenced by society and society by public health. Many public health problems
are social problems and vice-versa.
1.3 HEALTH RISK FACTORS

Nutrition, alcohol consumption, smoking and use of other drugs and substances, are some of the key health risk factors that contribute to the greater
burden of ill health experienced by Aboriginal and Torres Strait Islander
peoples when compared with non-Indigenous Australians.
Health risk factors impact on the onset, maintenance and prognosis of
a variety of chronic diseases. Understanding risk factors facilitates early intervention and management strategies to prevent or ameliorate disease and
to achieve health gains for individuals and populations. Non-communicable diseases are to a great extent preventable through interventions against
the major risk factors and their environmental, economic, social and behavioral determinants in the population. The health risk factors presented
in this section focus on behavioral risk factors including smoking, alcohol
and other drug use and nutrition, all of which impact on the health and
quality of life of Indigenous Australians. These risk factors are responsible
for a large proportion of the total burden of disease in Australia and are an
Health
important component of the greater burden of ill health experienced by

Aboriginal and Torres Strait Islander peoples when compared with nonIndigenous Australians.
1.3.1 Alcohol Consumption

The hazardous use of alcohol is related to conditions such as alcohol dependence syndrome, alcoholic liver disease, high blood pressure, stroke
and some cancers. Alcohol is frequently a contributing factor to injuries
from traffic accidents, assault and self-harm, and may contribute to social
problems such as family breakdown, domestic violence, and financial and
legal problems.
While several surveys have shown that Indigenous Australians are less
likely than other Australians to drink alcohol, those who do so are more
likely to consume it at hazardous levels. The 20042005 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) showed that 48%
of Indigenous people aged 18 years and over had consumed alcohol in the
week prior to interview; the 20042005 National Health Survey showed
that a higher proportion (62%) of all respondents consumed alcohol in the
week prior to interview.
The 20042005 NATSIHS found that, of the Indigenous Australians

surveyed who had consumed alcohol in the week prior to interview, 16%
had consumed alcohol at a high risk level. Although only 36% of Indigenous people living in remote areas consumed alcohol in the week prior
to interview compared to 54% of Indigenous people living in non-remote
areas, the proportion who drank at high risk levels was similar. Indigenous
males (19%) were more likely to consume alcohol at high risk levels than
Indigenous females (14%). International data indicate that drinking at hazardous levels is more common among the Indigenous populations of New
Zealand and Canada. In the 19961997 New Zealand Health Survey, Maori
adults were twice as likely as non-Maori adults to report that they had not
drunk any alcohol in the previous year but one in three Maori drinkers
were consuming alcohol at hazardous levels compared with one in five
non-Maori drinkers. Canadian data indicate that Aboriginal youths are two
to six times more at risk than non-Aboriginal youths for every alcohol-related problem examined.
1.3.2 Smoking
While the effects of excess alcohol consumption on individuals, families
and communities can be clearly identified, the effects of smoking, a major
cause of preventable ill health and death, may take many years to appear.
As a single risk factor, smoking causes the greatest burden of disease (approximately 10%) for the total Australian population.
Cigarette smoking is associated with the increased incidence of, and
mortality from, various types of cancer, including lung, cervical, bladder
and pancreatic cancers, coronary heart disease, stroke, chronic respiratory
tract diseases, and
pregnancy-related
conditions.
The
effects of passive
smoking are also
associated
with
higher rates of
lung cancer and
heart disease in
adults, asthma and
lower respiratory
tract illness such
as bronchitis and
pneumonia in children, and higher
rates of sudden
infant death syndrome. In addition, smoking is
a risk factor for
low birthweight,
which, as noted
above, is a risk factor for both childhood and longterm diseases.
Surveys have revealed a high prevalence of smoking among Aboriginal and Torres Strait Islander people. The 20042005 NATSIHS found
that 51% of Indigenous males and 49% of Indigenous females were current smokers. After adjusting for differences in age structure, Indigenous
Australians were more than twice as likely to be current daily smokers as
non-Indigenous Australians.
High rates of smoking have also been found among other Indigenous
groups. In New Zealand, the proportion of Maori people who smoke has
decreased over the last 15 years but remains high, with almost half of
all Maori adults aged 15 and over reporting that they were smokers in
the 19961997 National Health Survey, compared with 23% of non-Maori
10
Health
adults. Over 60% of Canadas Aboriginal population over the age of 15

reported that they were smokers in 1997, more than twice the rate of the
general Canadian population.
1.3.3 Other Drugs and Substances

Indigenous Australians are also at risk of ill health through the use of substances such as marijuana, heroin, amphetamines and inhalants (e.g. petrol,
glue, aerosols). The 2001 National Drug Strategy and Household Survey
(NDSHS) indicates that illicit drug use among Aboriginal and Torres Strait
Islander peoples was higher than that for non-Indigenous Australians.
Over half (57%) of Indigenous respondents aged 14 years and over indicated that they had tried an illicit drug compared to 37% of non-Indigenous
respondents.
Data for 20042005 from the Alcohol and Other Drug Treatment Services National Minimum Data Set indicates that Indigenous people made
up about 10% of clients using treatment services, a small increase from
20002001. Indigenous clients were more likely than non-Indigenous clients to be receiving treatment for problems related to alcohol, cannabis or
solvents, but less likely to be receiving treatment for opiates, amphetamines
or benzodiazepines. As this data collection does not cover some Indigenous
specific substance use services, the number of Indigenous clients is underestimated.
Injecting drugs is a risk factor for blood-borne diseases such as hepatitis B and C, and HIV. A study of the prevalence of hepatitis C among injecting drug users using needle exchanges in 19951996 found that about 70%
of Indigenous and non-Indigenous injecting drug users were infected with
the virus. Over the period 19921999, 140 cases of HIV among the Indigenous population were notified to the National HIV Surveillance Centre.
Eight of these cases were reported in conjunction with injecting drug use,
while a further 14 cases were reported in conjunction with exposure to both
injecting drug use and male homosexual contact.
Petrol sniffing continues to be a major problem in some Indigenous
communities, and particularly affects young people. Petrol sniffing can
cause confusion, aggression, lack of coordination, hallucinations, respiratory problems, and chronic disability including mental impairment.
1.3.4 Nutrition
The importance of the roles played by diet and nutrition in health is universally acknowledged. Less well understood are the complex interrelationships between nutrition and health risk factors. For example, diet-related
diseases may be associated with environmental, behavioral, biological and
genetic factors, making it difficult to determine the extent to which diet contributes to disease.
Many Aboriginal and Torres Strait Islander people live in remote areas
of Australia and do not have the same opportunities as other Australians
to obtain affordable, healthy food. For example, the 2000 Healthy Food Access Basket survey in Queensland confirmed that the cost of basic food was
considerably higher in rural and remote communities than in metropolitan
and regional centres, and noted that the food supply and delivery system
is structured to favor metropolitan areas.
Even when healthy food is available, factors such as competing priorities for limited family incomes, restricted access to traditional foods, lack of
knowledge of the nutritional value of certain foods, and lack of culturally
appropriate nutritional information can lead to inadequate or inappropriate nutrition. A healthy living environment is also important and reduces
the chances of gastrointestinal infection and diarrhoeal diseases, which may
cause or exacerbate malnutrition in infants.
The diet of many Aboriginal and Torres Strait Islander people has undergone rapid change, from a fibre-rich, high protein, low saturated fat
traditional diet, to one in which refined carbohydrates and saturated fats
predominate. As has been found in other indigenous populations undergoing a similar change in diet and lifestyle, Australias Indigenous people
are prone to a group of conditions known collectively as Syndrome X, or
the insulin resistance syndrome. This syndrome includes obesity, Type 2
diabetes, cardiovascular disease and renal disease. All these conditions are
more common in Indigenous Australians than in non-Indigenous Australians.
Diet and nutrition during pregnancy and the childs early life may
have life-long effects. Breastfeeding is associated with reduced infant and
child mortality. Maternal under-nutrition is one factor linked to low birthweight, which is about twice as common among babies born to Indigenous
mothers as it is among babies born to non-Indigenous mothers, and is a
risk factor for infant death and ill health in childhood. In addition, Barker
11
12
Health
proposes that under-nourishment of the foetus may predispose the person

to diseases such as heart disease, stroke, high blood pressure and Type 2
diabetes in later life. More research is necessary to confirm these findings.
1.4 HEALTH CONSUMER

TheHealth Consumers Council (HCC) is an independent (not-for-profit)
community based organization, representing the consumers voice in health
policy, planning, research and service delivery. We advocate on behalf of
consumers to doctors, other health professionals, hospitals and the wider
health system. The HCA is a partnership of consumer assistance programs
operated by community-based legal services organizations. Our common
mission is to help Californians obtain essential health care.
Since opening its doors in October 1998, HCA has helped more than
128,000 consumers with health access problems. The HCA receives its core
funding from The California Endowment. The initial Endowment grant included an independent evaluation of HCAs work by the USC Division of
Community Health. The evaluators final report was released February 19,
2003. An independent evaluation in 2011 demonstrates that in tough economic and political climates, collaboratives like HCA play an important
role in raising awareness, offering alternatives, and creating an environment of hope for its clients.
The Health Consumers Council believes that all people are entitled to:
Be treated with respect, dignity and understanding
Be informed about their rights and have those rights protected an
enhanced
Receive safe evidenced based care
Be informed about their condition and any proposed treatment
Have equitable access to health services
Have access to information about themselves held by health professionals and the right to correct anomalies.
In 2012, HCA expanded statewide in a partnership with the Department of Managed Health Care to provide comprehensive, local, one-on-one
assistance to individuals and families struggling to navigate the complex
health care system. The consumer assistance partnership is supported by a
federal Affordable Care Act grant.
1.4.1 Serving all Californians

The HCAs local Health Consumer Centers serve consumers in all 58 California counties. They are supported in this work by the National Health
Law Program, which serves as lead agency, and the Western Center on Law
and Poverty.
1.4.2 Helping Individuals with Medi-Cal Eligibility

and Service Issues
Medi-Cal eligibility and service issues predominate in our work on behalf
of individual clients. Our clients ethnicity is as follows:
Latino 52%
Anglo 27%
Asian-American Pacific-Islander 10%
African-American 7%
American Indian or Other 4%
1.4.3 Establishing/Maintaining and Ensuring

Access to Health Coverage
Our two main priorities are (a) helping consumers establish or maintain
health coverage; and (b) ensuring that low-income consumers with health
coverage get good access to essential services, including through managed
care plans. We are committed to resolving problems in the most efficient
manner possible, without wasting resources in unnecessary formal proceedings. Our closed cases were resolved as follows:
Counsel and advice to consumer 50.2%
Negotiation without formal proceedings 8.6%
Other brief service 25.7%
Administrative appeals decision 2.1%
Negotiated settlement of litigation (primarily collection actions
against indigent consumers) 1.9%
Referral to other agencies 0.4%
Court decision (primarily collection actions against indigent consumers) 0.1
Other outcomes (including client withdrawal, client ineligible for
service, claim meritless) 11.0%
1.4.4 Top Priority: Solving the Individual

Consumers Problem
The top priority is to help solve the individual consumers problem. But
also view the stream of low-income consumers coming to doors as an important opportunity to diagnose systemic health access issues. The diagnosis is aided by a database system that collects uniform, comprehensive
information about the problems consumers bring to us and the results
we achieve. Put simply, we are in a position to provide, not just compelling anecdotes, but also the objective data needed to discern the extent to
which problems are truly systemic. Then work collaboratively with other
stakeholders to seek effective solutions to the problems our consumers
experience.
1.4.5 Providing Significant Community Education

In addition to individual assistance and work on systemic issues, we provide significant community education about such topics as Medi-Cal coverage for working families and immigrants, how to use Medi-Cal HMOs
effectively and the services HCA offers. Each month, more than 6,300 low-
13
14
Health
income consumers and community organization staff attend our education

and outreach events.
1.4.6 On the Ground Perspective, Successfully

Solving Problems
Taken together, these activities give us a unique on the ground perspective about health access and quality issues facing low-income consumers.
As consumers begin to experience new problems, we quickly see them reflected in our caseload. Likewise, as old problems are addressed successfully, we see them fade away among the consumers seeking our help.
1.5 HUMAN DEVELOPMENT

The inequalities are arrayed against two axes: One reflects household
background, such as caste, religion, education, and income, and the other
reflects the characteristics of the area the respondents live in, as characterized by urban or rural residence, level of infrastructure development,
and state of residence. While both sets of inequalities are reflected in
most indicators of human development, their relative importance varies.
As this chapter discusses a variety of health outcomes and health care,
it is striking how regional inequalities dwarf inequalities in the household background. A poor, illiterate labourer is less likely to suffer from
short- and long-term illnesses, and has greater access to medical care
than a college graduate, forward caste, or large landowner in rural areas.
Social inequalities matter, but their importance is overwhelmed by state
and ruralurban differences. Another theme to emerge from the IHDS
data is the dominant position of the private sector in medical care. In
the early years following independence, discourse on health policy was
dominated by three major themes: providing curative and preventive
services delivered by highly trained doctors, integrating Indian systems
of medicine (for example, Ayurvedic, homeopathic, unani) with allopathic medicine, and serving hard to reach populations through grassroots organization and use of community health care workers.
This discourse implicitly and often explicitly envisioned a health
care system dominated by the public sector. Public policies have tried to
live up to these expectations. A vast network of Primary Health Centres
(PHCs) and sub-centres, as well as larger government hospitals has been
put in place, along with medical colleges to train providers. Programs for
malaria, tuberculosis control, and immunization are but a few of the vertically integrated programs initiated by the government. A substantial investment has been made in developing community-based programs, such
as Integrated Child Development Services, and networks of village-level
health workers. In spite of these efforts, growth in government services
has failed to keep pace with the private sector, particularly in the past two
decades. The results presented in this chapter show that Indian families,
even poor families, receive most of their medical care from private practitioners. Maternity care is a partial exception here. For most other forms of
care, however, the public sector is dwarfed by the reliance on the private
sector, even though the quality of private sector providers and services
remains highly variable.
15
1.5.1 Disability
Being blind, deaf, or unable to walk imposes enormous burdens on some
individuals. How widespread are these disabilities? The survey asked if
any household member, eight years old or older, had to cope with any of
seven problems (for example, walking one kilometre) that created difficulty
for daily activity. If there was some difficulty with a particular activity, respondents were asked whether the person was unable to do that activity or
whether the person could do it with some difficulty. Total disabilities were
recorded around 34% for each of the activity of daily living. Activities that
could be done only with some difficulty varied more, so overall disability/
difficulty ranged between 7 persons per 1,000 (for example, speaking) to 15
persons per 1,000 (seeing from far distances)
1.5.2 Maternal Health

Maternal mortality rates have been declining, but complications before and
after birth are common. The IHDS asked about whether recent mothers had
experienced any of the eight medical problems during, or shortly after their
pregnancies as listed in Figure 5.1.
35
30
25
18
10
Fatigue
Anaemia
Convulsions
Excessive Bleeding
(after birth)
12
14
Night
Blindness
12
High Fever
(after birth)
15
Blurred Vision
20
Excessive Bleeding
(in Pregancy)
Per cent Having Problems
40
Figure 1.1. Pregnancy problems for last birth between

the period 20002005.
Fatigue during pregnancy was most common (36%), but more serious medical risks were also apparent. Eighteen percent of recent mothers reported they had been anaemic, and 14% had had convulsions. Excluding fatigue, 40% of recent Indian mothers reported having at least
one of the more serious maternity problems. Poor and illiterate mothers are more likely to have a serious maternal medical problem, but the
important variation is again more geographic than social. Rural womenparticularly those living in the least developed villagesreported a
problem more often (45%) than those in metro cities (30%), and the state
wise differences are enormous. About four out of five women treported
a medical problem surrounding their last pregnancy.
16
Health
In summary, looking across various dimensions of self reported

health status, poor health is a consequence of biology, behavior, and
aging, but those outcomes also appear to be socially structured. While
education and income play some role in the prevalence of illnesses, rural-urban and state differences are particularly important. Although not
all health problems show the same state wise patterns, the south is noticeably healthier along several dimensions, while the poorer heartland
reports more illness and disability. We note similar differences in infant
and child mortality, with infant mortality at nine per 1,000 births (rivaling that of developed countries) and infant mortality at 80 per 1,000.
This suggests that the regional differences in morbidity are not simply
due to differences in reporting.
1.6 FAMILY HEALTH

A healthy family is a happy family, but what exactly is family health? It is
more than just eating right and exercising though these are crucial factors. It also encompasses physical, emotional, and financial issues. Family
health extends beyond kids to spouse, parents and grandparents, and even
family pet. Here, one will get the information need to safeguard loved ones
and keep family unit strong.
Keeping family healthy is a full-time job. Yet just as planned for a
family, one can also plan for familys health. Do we know our familys
health history? Is our health insurance policy up-to-date? Do we have a
strategy in place in case of an unexpected emergency? Taking the time
to organize these details will enable us to monitor hereditary conditions,
handle unforeseen events, and prevent unwanted medical errors. Start
today by putting together a health journal and remember to keep it up
to date.
Our familys health should be of utmost importance to us. Not only
will the well being of our family help to create opportunities for memories
and for future adventures, but the habits we instill now for our family will
help to keep our family active and healthy for a long time. Avoiding the
common family health issues will allow us to maintain our familys health
and it will allow us to become closer as a family too. Our family is not the
only one making these family health mistakes, but we can be the ones to set
a better example for all those around us.
1.6.1 Not Enough Family Exercise

Exercise is an important part of our familys health. Many families are busy
with work, school, and other groups. As a result, it can be difficult to fit in
exercise as well. By taking the time to exercise together, our family health
will improve substantially. We might want to make it a rule that when everyone comes home from school or work that they do some sort of exercise,
if only for a half an hour. Kids who are resistant might be more open to exercise if it is done with a video game system, for example. Make the exercise
fun for everyone and we will find that our family health goals are easier to
reach.
1.6.2 Choosing Convenience Foods

Choose healthy foods. In todays busy world, it seems so much easier to
just pick up fast food when it is time for dinner. But these foods are high
in calories, in fats, and in cholesterol. Instead of turning to convenience
foods, we should work together as a family to create meals which are easy
and which are healthy. Getting together on Sunday morning to prepare
the meals for the week will be helpful in changing the way we eat, while
also making the foods easy to reheat as our lives become busy. Freeze the
meals we make and we will have no excuse to not eat healthy during our
busy schedule.
17
18
Health
1.6.3 Not Spending Time Together

Finally, family health will be greatly improved when one begin to spend
time together. Listening to each others days and talking about stresses
will help everyone feel more supported and healthy. While family might
be moving in a million different directions, just sharing one meal together
a week can help to be healthier, happier, and more connected. Study after
study has shown that gathering with others improves immune systems and
happiness levels.
Family health issues are found in any family and at any time, but when
we are aware of how they might be impacting our life, we might be more
motivated to take action. With these healthy family steps, we can ensure
that our health monitoring tests only show good results.
1.6.4 We Should Monitor our Health Daily

If we get a full assessment of our health, with seven different measurement
points, in just five minutes. By monitoring the state of our health, we can be
the one in charge of our body once more. We do not have to wait around for
a doctor to tell us that we are sick. We can watch our health levels change
with any software program. And if we notice the daily measurements are
heading downward, we can take action by changing our habits. But if those
changes still do not make a difference to our values, it is time to get additional help to get healthy.
According to a survey from the American Psychological Association,
over half of Americans are experiencing stress due to health problems of
family members--53%, which is up 6 percentage points from the numbers
of the past two years.
While sad, this statistic is not surprising. The rising number of older
adults in America has meant that many middle-aged Americans (particularly women) are finding themselves taking care of their parents, many
of whom are experiencing health issues. This comes on top of the regular
health issues that can impact every member of a young family. All of these
issues can contribute heavily to caregiver stress, which is a particularly taxing form of chronic stress for those who experience it. On top of the worry
and concern for a family members health and comfort, as well as the uncertainty of what the future may hold, caring for an ill family member can
mean a hectic schedule and not enough down-time. All of these things can
bring stress.
While there is often little one can do to influence the health of a parent, and many health issues may not be prevented in ways that we know
of, there are still many things we can do to impact our own health and the
health of our family and friends, and increase our own longevity, wellness,
and quality of life. Additionally, because stress and health are connected,
learning effective stress management techniques can contribute to overall
wellness and help relieve the stress of a family members illness at the same
time.
Although todays families face numerous challenges, there is reason
to believe that routines and rituals may ease the stress of daily living. Here
are some suggestions that may increase our familys observation of routines
and rituals:
Plan to have sit-down family meals at least 23 times per week.
Enforce regular bedtimes, especially for young children.
Assign chores so that each family member makes a fair and regular
contribution.
Plan family weekends often, and family vacations at least once a
year.
Emphasize the importance of holidays (including birthdays) in our
family. If our family currently has few holiday observances consider
adopting new ones.
1.6.5 A Family Meal Helps

Overall, researchers found that 63% of children did not consume the
World Health Organization recommended amount of five portions
(400g) a day.
Children who always ate a family meal together at a table consumed
125g (1.5 portions) more fruit and vegetables on average than children who never ate with their families.
19
20
Health
Even those who reported eating together only once or twice a week
consumed 95g (1.2 portions) more than those who never ate together.
Even if it is just one family meal a week, when children eat together
with parents or older siblings they learn about eating. Watching the
way their parents or siblings eat and the different types of food they
eat is pivotal in creating their own food habits and preferences.
1.7 MULTIPLE CHOICE QUESTIONS

1.
2.
The English word health comes from the Old English word ___.
(a) Hael
(b) Hale
(c) Heal
(d) Health
By which organization is the following definition of health is created

Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.?
(a) WHO
(c) Health consumer

3.
4.
(b) Health Organization
(d) ICD
The state of being ___ from physical disease or pain is called healthy.
(a) Close
(b) Near
(c) Free
(d) Friendly
Which are the two main aspects of health?

(a) Our income and management
(b) Physical and Mental health
21
(c) Muscular strength and flexibility

(d) Muscular strength and our income
5.
Only good food or nutrients can help to be healthy.

(a) Yes
(c) Both a and b

6.
7.
8.
9.
(b) No
(d )None of the above.
Poor and illiterate mothers have ___ serious maternal medical problem.
(a) Less
(b) None of this
(c) No
(d) More
Which of the following element is not injurious to health?

(a) Cigarette
(b) Fruits
(c) Soft-drinks
(d) Drugs
Which of the following element affects our mental health?

(a) Food
(a) Nutrients
(c) Stress
(d) Proteins
A Family Meal helps in ______ health problems.

(a) Increasing
(b) Decreasing
(c) None of this
(d) Both a and b
10. Which of the following food can be called as healthy food?

(a) Burger
(b) Pizza
(c) Spinach
(d) Cold-drinks
1.8 REVIEW QUESTIONS

1. What does good health means?
2. Define physical health.
3. How do a family meal helps in reducing health problems?
4. How is fast-food injurious to health?
5. Explain mental health.
6. What are the main determinants of health?
7. How Education is important in maintaining good health?
8. Why health is important in workplace?
9. How exercise helps to maintain fitness?
10. Why family meal is important for children?
ANSWERS FOR MULTIPLE CHOICE QUESTIONS

1. (b)
2. (a)
3. (c)
4. (b)
5. (b)
6. (d)
7. (b)
8. (c)
9. (a)
10. (c)
Chapter 2
Violence
INTRODUCTION
iolence is an extreme form of aggression, such as assault, rape or murder. Violence has many causes, including frustration, exposure to violent
media, violence in the home or neighborhood and a tendency to see other
peoples actions as hostile even when they are not. Certain situations also increase the risk of aggression, such as drinking, insults and other provocations
and environmental factors like heat and overcrowding.
Violence is defined by the World Health Organization as the intentional use of physical force or power, threatened or actual, against a person, or
against a group or community that either results in or has a high likelihood of
resulting in injury, death, psychological harm, maldevelopment or deprivation. This definition associates intentionality with the committing of the act
itself, irrespective of the outcome it produces.
Violence, however, is preventable. Evidence shows strong relationships
between levels of violence and potentially modifiable factors such as concentrated poverty, income and gender inequality, the harmful use of alcohol, and
the absence of safe, stable, and nurturing relationships between children and
parents. Scientific research shows that strategies addressing the underlying
causes of violence can be effective in preventing violence. Examples of scientifically credible strategies to prevent violence include nurse home-visiting
and parenting education to prevent child maltreatment; life skills training for
children ages 618 years; school-based programmes to address gender norms
and attitudes; reducing alcohol availability and misuse through enactment
and enforcement of liquor licensing laws, taxation and pricing; reducing access to guns and knives; and promoting gender equality by, for instance, supporting the economic empowerment of women.
2.1 TYPOLOGY OF VIOLENCE

The World report on violence and healthalso presents a typology of violence that, while not uniformly accepted, can be a useful way to understand
the contexts in which violence occurs and the interactions between types of
violence. This typology distinguishes four modes in which violence may be
inflicted: physical; sexual; and psychological attack; and deprivation. It further divides the general definition of violence into three sub-types according
to the victim-perpetrator relationship.
Objectives
After studying this

able to:
Explain the
Typology of
violence.
Understand
the consequences and
costs.
Explain the
causes of
violence
Discuss the
types of
interpersonal
Violence
Explain
about drugs
Discuss
about the
Violence in
the media
Violence
23
2.1.1 Self-directed violence

Self-directed violence refers to violence in which the perpetrator and the
victim are the same individual and is subdivided into self-abuse and suicide.
Suicide is one of the leading causes of death worldwide and is an important public health problem. Among those aged 15-44 years, self-inflicted
injuries are the fourth leading cause of death and the sixth leading cause of
ill-health and disability. In much of the world, suicide is stigmatized and
condemned for religious or cultural reasons. In some countries, suicidal behavior is a criminal offence punishable by law. Suicide is therefore often a
secretive act surrounded by taboo, and may be unrecognized, misclassified
or deliberately hidden in official records of death.
Risk Factors for Self-Directed Violence

A variety of stressful events or circumstances can put people at increased
risk of harming themselves including the loss of loved ones, interpersonal
conflicts with family or friends and legal or work related problems. To act
as precipitating factors for suicide, though, they must happen to someone
who is predisposed or otherwise especially vulnerable to self-harm.
Predisposing factors include:
Alcohol and drug abuse
A history of physical or sexual abuse in childhood social isolation
Psychiatric problems such as mood disorders, schizophrenia and a
general sense of hopelessness.
Having access to the means to kill oneself (most typically guns,
medicines and agricultural poisons).
Physical illnesses, especially those that are painful or disabling.
Having made a previous suicide attempt.
Certain social and environmental factors also increase the likelihood
of suicide. Rates of suicide, for instance, are higher during economic recessions and periods of high unemployment. They are also higher during periods of social disintegration, political instability and social collapse.
Remedies to Prevent Self Directed Violence

Treatment of Mental Disorders: The early identification and appropriate treatment of mental disorders is an important prevention
strategy especially given the relevant contribution of depression
and other psychiatric problems to suicidal behavior. Equally important is early identification and treatment for people with alcohol
and substance abuse problems.
Behavioral Approaches: People who are suicidal generally express
difficulty in solving problems. Behavioral therapy approaches are
designed to probe underlying factors and to help patients develop
problem-solving skills. While conclusive answers are not yet known,
there is some evidence to suggest that behavioral therapy approaches
are effective in reducing suicidal thoughts and behavior.
Community-based Efforts: Local communities are important settings for suicide prevention activities. Some of the more common
Key Vocabulary
Collective violence: Collective violence refers
to violence committed
by larger groups of
individuals and can be
subdivided into social,
political and economic
violence.
24
Health
measures include: suicide prevention centers that offer telephone

hotlines, counseling, and outreach, community-based programmes
in youth centers and centers for older people. School-based interventions are important for reaching young people. While school
staff cannot replace mental health professionals, they can be trained
to identify the signs and symptoms of suicidal behavior and refer
those at risk to appropriate mental health services. Educational programmes for students can also be beneficial.
2.1.2 Interpersonal violence

Key Vocabulary
Interpersonal violence:
Interpersonal violence
refers to violence between individuals, and
is subdivided into family
and intimate partner
violence and community
violence.
Interpersonal violence refers to violence between individuals, and is subdivided into family and intimate partner violence and community violence.
The former category includes child maltreatment; intimate partner violence; and elder abuse, while the latter is broken down into acquaintance
and stranger violence and includes youth violence; assault by strangers;
violence related to property crimes; and violence in workplaces and other
institutions.
Interpersonal violence is subdivided into two categories Family and
intimate partner violence is that occurring between family members and intimate partners, usually, though not always, taking place inside the home.
This category includes child abuse and neglect, intimate partner violencet
and elder abuse.
Community violence includes violence between unrelated individuals,
who may or may not know each other, and generally, although not exclusively, occurs outside the home. This includes youth violence, random acts
of violence, rape or sexual assault by strangers, and violence in institutional
settings such as schools, workplaces, prisons and nursing homes.
Preventing Interpersonal Violence

Prevention programs focus on encouraging bystanders and allies to
help their friends before violence occurs and to know how to respond if
and when it does. Instead of alienating students by approaching them as
potential perpetrators or victims, bystander education programs approach
students as allies and potential leaders who can shift social norms that are
traditionally supportive of sexual violence.
Bystander education programs simultaneously educate students about
gender inequality while providing them with knowledge and tools to prevent violence. These programs discourage victim blaming by taking a community approach to prevention and, importantly, they offer the opportunity to change social norms surrounding gender.
Prevention means to stop acts of interpersonal violence from occurring
by intervening to eliminate or reduce the underlying risk factors and shore
up protective factors, or to reduce the recurrence of further violence and its
ill effects. Violence prevention strategies and programmes can be classified
along two dimensions. The first dimension concerns time, and classifies interventions according to where they are located in the chain of risk factors
and situational determinants that stretch from long before the occurrence
of violence to long after the attack has occurred and into the consequences
incurred by victims and perpetrators. The second dimension relates to the
target population, and ranges from prevention strategies that target every-
Violence
25
one (universal) to interventions that address victims and perpetrators only,

or high-risk groups.
2.1.3 Collective Violence

Collective violence refers to violence committed by larger groups of individuals and can be subdivided into social, political and economic violence.
Collective violence, in its multiple forms, receives a high degree of
public attention. Violent conflicts between nations and groups, state and
group terrorism, rape as a weapon of war, the movements of large numbers
of people displaced from their homes, gang warfare and mass hooliganism
all of these occur on a daily basis in many parts of the world. The effects
of these different types of event on health in terms of deaths, physical illnesses, disabilities and mental anguish, are vast.
Key Vocabulary
Self-directed Violence:
Self-directed violence refers to violence in which
the perpetrator and
the victim are the same
individual and is subdiThe impact of conflict on health can be very great in terms of mortality, vided into self-abuse and
morbidity and disability.
suicide.
Various forms of collective violence have been recognized, including:
Wars, terrorism and other violent political conflicts that occur within or
between states, . State-perpetrated violence such as genocide, repression,
disappearances, torture and other abuses of human rights, organized violent crime such as banditry and gang warfare.
2.2 CONSEQUENCES AND COSTS

There are multiple consequences of violence, having immediate and shortterm to inter-generational effects. The consequences and costs of violence
have impacts at the individual level (for survivors, perpetrators and others
affected by violence), as well as within the family, community and wider
society, which translate into costs at the national level.
Costs due to violence against women and girlsbeyond the intangible
suffering and impacts on quality of life and well-being--include costs to the
survivor and her family in terms of health (mental and physical), employment
and finances, and the effects it has on children. Out of ten selected causes and
risk factors for disability and death among women between the ages of 15
and 44, rape and domestic violence rated higher than cancer, motor vehicle
accidents, war and malaria. Some of the consequences and costs include:
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Health
immediate injuries such as fractures and hemorrhaging, and longterm physical conditions (e.g. gastrointestinal, central nervous system disorders, chronic pain);
mental illnesses, such as depression, anxiety, post-traumatic stress
disorder, attempted suicide;
sexual and reproductive health problems, such as sexually transmitted infections (including HIV), and other chronic conditions;
sexual dysfunction; unintended/unwanted pregnancies and unsafe
abortion; risks to maternal and fetal health (especially in cases of
abuse during pregnancy);
Key Vocabulary
Violence: Violence is
defined as the intentional
use of physical force or
power, threatened or
actual, against a person,
or against a group or
community that either
results in or has a high
likelihood of resulting in
injury, death, and psychological harm.
substance abuse (including alcohol);

poor social functioning skills and social isolation and marginalization;
death for both women and their children (from neglect, injury,
pregnancy-related-risks, homicide, suicide and/or HIV and AIDSrelated);
lost workdays, lower productivity and lower income;
overall reduced or lost educational, employment, social, or political
participation opportunities; and,
expenditures (at the level of individual, family and public sector
budgets) on medical, protection, judicial and social services.
Beyond the direct and short-term consequences, child witnesses of violence are more likely to have emotional and behavioral problems, perform
poorly in school and be at risk of perpetrating or experiencing violence in
the future. Businesses and employers can incur financial losses on account
of absences due to the health consequences inhibiting the survivor from
working; incarceration of the perpetrator; and expenses related to additional security measures that might be needed in the workplace
Children who witness domestic violence are at increased risk of anxiety, depression, low-self esteem and poor school performance, among
other problems that harm their well-being and personal development. In
Nicaragua, 63 percent of children of abused women had to repeat a school
year and they left school on average 4 years earlier than other children.
Children, both girls and boys, who have witnessed or suffered from gender-based violence, are more likely to become victims and abusers later
in life. For example, surveys in Costa Rica, Czech Republic, Philippines,
Poland and Switzerland revealed that boys who witnessed their father using violence against their mother were 3 times more likely to use violence
against their partners later in life.
Beyond deaths and injuries, highly prevalent forms of violence (such
as child maltreatment and intimate partner violence) have serious lifelong
non-injury health consequences. Victims may engage in high-risk behaviors such as alcohol and substance misuse, smoking, and unsafe sex, which
in turn can contribute to cardiovascular disorders, cancers, depression, diabetes and HIV/AIDS, resulting in premature death[ In countries with high
levels of violence, economic growth can be slowed down, personal and collective security eroded, and social development impeded. Families edging
out of poverty and investing in schooling their sons and daughters can be
ruined through the violent death or severe disability of the main breadwinner. Communities can be caught in poverty traps where pervasive vio-
Violence
27
lence and deprivation form a vicious circle that stifles economic growth.
For societies, meeting the direct costs of health, criminal justice, and social
welfare responses to violence diverts many billions of dollars from more
constructive societal spending. The much larger indirect costs of violence
due to lost productivity and lost investment in education work together to
slow economic development, increase socioeconomic inequality, and erode
human and social capital.
2.3 CAUSES OF VIOLENCE

The political right believes that the root cause of violent crime is bad genes
or bad morals. Violence surely requires a political ideology, the only way
we can determine what those causes are in the first place is to check our
ideologies at the door and to try to keep our minds open as wide, and for
as long.
2.3.1 Biological Causes

Many biological factors have been nominated as candidates for causes of
violence. Hormones like testosterone, transmitters in the brain like serotonin, and blood abnormalities like hypoglycemia are only a few that have
been mentioned. Biological factors do not have to be hereditary. They could
be caused by a head injury, poor nutrition, or environmental events, such
as exposure to lead paint.
Fortunately, the National Academy of Sciences just reviewed hundreds
of studies on the relationship between biology and violence, and it came to
one clear bottom-line conclusion: No patterns precise enough to be considered reliable biological markers for violent behavior have yet been identified. The National Academy of Sciences found many promising leads that
should be vigorously pursued by researchers, but so far, it could point to
nothing as a proven, or even close to proven, biological risk factor for future
violence.
2.3.1 Sociological Causes

Social factors, such as demography, are relatively easy to measure and because people have been measuring them for a long time
2.4 TYPES OF INTERPERSONAL

VIOLENCE
Interpersonal violence is defined by the World Health Organization as any
behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship. There are many types of
interpersonal violence.
2.4.1 Child Maltreatment

Child maltreatment is the abuse and neglect that occurs to children under
18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploita-
Key Vocabulary
Child maltreatment:
Child maltreatment is
the abuse and neglect
that occurs to children
under 18 years of age.
It includes all types of
physical and/or emotional ill-treatment,
sexual abuse.
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Health
tion, which results in actual or potential harm to the childs health, survival,
development or dignity in the context of a relationship of responsibility,
trust or power. Exposure to intimate partner violence is also sometimes included as a form of child maltreatment.
Child maltreatment is a global problem with serious lifelong consequences, which is, however, complex and difficult to study. There are no
reliable global estimates for the prevalence of child maltreatment. Data for
many countries, especially low- and middle-income countries, are lacking.
Current estimates vary widely depending on the country and the method
of research used. Approximately 20% of women and 510% of men report
being sexually abused as children, while 2550% of all children report being
physically abused.
Consequences of child maltreatment include impaired lifelong physical and mental health, and social and occupational functioning (e.g. school,
job, and relationship difficulties). These can ultimately slow a countrys
economic and social development. Preventing child maltreatment before
it starts is possible and requires a multisectoral approach. Effective prevention programmes support parents and teach positive parenting skills.
Ongoing care of children and families can reduce the risk of maltreatment
reoccurring and can minimize its consequences.
2.4.2 Youth Violence

The Kids off the Block memorial featuring hundreds of simple stone blocks,
one for each child killed by violence in Roseland, Chicago.
Following the World Health Organization, youth are defined as people
between the ages of 10 and 29 years. Youth violence refers to violence occurring between youths, and includes acts that range from bullying and physical fighting, through more severe sexual and physical assault to homicide.
Worldwide some 250 000 homicides occur among youth 1029 years of
age each year, which is 41% of the total number of homicides globally each
year (Global Burden of Disease, World Health Organization, 2008). For each
young person killed, 20-40 more sustain injuries requiring hospital treatment.
Youth violence has a serious, often lifelong, impact on a persons psychological and social functioning. Youth violence greatly increases the costs of
health, welfare and criminal justice services; reduces productivity; decreases
the value of property; and generally undermines the fabric of society.
Prevention programmes shown to be effective or to have promise in
reducing youth violence include life skills and social development programmes designed to help children and adolescents manage anger, resolve
conflict, and develop the necessary social skills to solve problems; schoolsbased anti-bullying prevention programmes; and programmes to reduce
access to alcohol, illegal drugs and guns. Also, given significant neighborhood effects on youth violence, interventions involving relocating families
to less poor environments have shown promising results. Similarly, urban
renewal projects such as business improvement districts have shown a reduction in youth violence.
2.4.3 Domestic Violence/Intimate Partner Violence

Intimate partner violence refers to behavior in an intimate relationship
that causes physical, sexual or psychological harm, including physical
Violence
aggression, sexual coercion, and psychological abuse and controlling

behaviors.
Population-level surveys based on reports from victims provide the
most accurate estimates of the prevalence of intimate partner violence and
sexual violence in non-conflict settings. A study conducted by WHO in
10 mainly developing countries found that, among women aged 15 to 49
years, between 15% (Japan) and 70% (Ethiopia and Peru) of women reported physical and/or sexual violence by an intimate partner.
Intimate partner and sexual violence have serious short- and long-term
physical, mental, sexual and reproductive health problems for victims and
for their children, and lead to high social and economic costs. These include
both fatal and non-fatal injuries, depression and post-traumatic stress disorder, unintended pregnancies, sexually transmitted infections, including
HIV.
Factors associated with the perpetration and experiencing of intimate
partner violence are low levels of education, past history of violence as a
perpetrator, a victim or a witness of parental violence, harmful use of alcohol, attitudes that are accepting of violence as well as marital discord and
dissatisfaction. Factor associated only with perpetration of intimate partner
violence are having multiple partners, and an antisocial personality disorder.
The primary prevention strategy with the best evidence for effectiveness for intimate partner violence is school-based programming for adolescents to prevent violence within dating relationships. Evidence is emerging
for the effectiveness of several other primary prevention strategies those
that: combine microfinance with gender equality training; promote communication and relationship skills within communities; reduce access to,
and the harmful use of alcohol; and change cultural gender norms.
2.4.4 Sexual Violence

Sexual violence is any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed
against a persons sexuality using coercion, by any person regardless of
their relationship to the victim, in any setting. It includes rape, defined as
the physically forced or otherwise coerced penetration of the vulva or anus
with a penis, other body part or object.
Population-level surveys based on reports from victims estimate that
between 0.311.5% of women reported experiencing sexual violence. Sexual violence has serious short- and long-term consequences on physical,
mental, sexual and reproductive health for victims and for their children as
described in the intimate partner violence. If perpetrated during childhood,
sexual violence can lead to increased smoking, drug and alcohol misuse,
and risky sexual behaviors in later life. It is also associated with perpetration of violence and being a victim of violence.
Many of the risk factors for sexual violence are the same as for domestic
violence. Risk factors specific to sexual violence perpetration include beliefs
in family honor and sexual purity, ideologies of male sexual entitlement
and weak legal sanctions for sexual violence. Few interventions to prevent
sexual violence have been demonstrated to be effective. School-based programmes to prevent child sexual abuse by teaching children to recognize
and avoid potentially sexually abusive situations are run in many parts of
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Health
the world and appear promising, but require further research. To achieve
lasting change, it is important to enact legislation and develop policies that
protect women; address discrimination against women and promote gender equality; and help to move the culture away from violence.
2.4.5 Elder Maltreatment

Elder maltreatment is a single or repeated act, or lack of appropriate action,
occurring within any relationship where there is an expectation of trust
which causes harm or distress to an older person. This type of violence
constitutes a violation of human rights and includes physical, sexual, psychological, emotional; financial and material abuse; abandonment; neglect;
and serious loss of dignity and respect.
While there is little information regarding the extent of maltreatment in
elderly populations, especially in developing countries, it is estimated that
4-6% of elderly people in high-income countries have experienced some
form of maltreatment at home. However, older people are often afraid to
report cases of maltreatment to family, friends, or to the authorities. Data on
the extent of the problem in institutions such as hospitals, nursing homes
and other long-term care facilities are scarce. Elder maltreatment can lead
to serious physical injuries and long-term psychological consequences. Elder maltreatment is predicted to increase as many countries are experiencing rapidly ageing populations.
Many strategies have been implemented to prevent elder maltreatment
and to take action against it and mitigate its consequences including public
and professional awareness campaigns, screening (of potential victims and
abusers), caregiver support interventions (e.g. stress management, respite
care), adult protective services and self-help groups. Their effectiveness
has, however, not so far been well-established.
2.4.6 Suicide
Suicide is the act harming ones self to the point of death, usually caused by
severe depression and mental disorders. Cause of suicide can range from
extreme pain, both emotional and physical, to trying to prove a point.
2.5 DRUG
The relationship between drugs, alcohol, and violence has been a recurring theme for social scientists, policymakers, and informed citizens. The
associations between substance use and violence are strong, they have endured over many years, and they are consistent for many different types of
violent acts. Alcohol and drug use are associated with more than half of all
homicides and a disproportionate share of other violent events including
sexual assaults, marital aggression, and serious assaults among strangers.
In many violent incidents both victims and offenders were drinking prior
to the violence. Among heroin users, rates of assault and robbery increase
sharply during periods of their addiction. In U.S. cities both homicide rates
and the proportion of homicides involving drugs have raised sharply since
the appearance of crack cocaine in 1985. These increases are a consequence
of the violence associated with cocaine and crack distribution as well as of
the chaotic circumstances that often surround their use.
Violence
2.5.1 Risk Factors for Drug-Related Interpersonal

Violence
The following points outline a range of risk factors specifically linked to
drug-related interpersonal violence.
Individual level factors

Gender: In general, males are more at risk of experiencing violence
and correspondingly drug-related violence. For example, a study of
heroin users in Scotland found that males were significantly more
likely to have been victims and perpetrators of assault than women.
However, women who have been abused and/or neglected in childhood may be at greater risk than males of subsequently developing
drug use and dependence and being arrested for both violent and
non-violent crimes. In a Norwegian study, female hard drug users
admitted to treatment had experienced more childhood emotional
and sexual abuse and neglect than males.
Age: Age is a risk factor for both violence perpetration and victimization among drug users. Young people are at a higher risk of drugrelated interpersonal violence, particularly intimate partner and
gang-related violence.
Gang membership: Gang membership is a risk factor for both drug
use and violence perpetration. Research shows that the use of drugs
such as cannabis, ecstasy and cocaine is often integrated into the
day-to-day activities of criminal subcultures and gangs. In Latin
America and the Caribbean, youth gangs involved in drug trafficking are involved in higher levels of violence than young people
who do not belong to a gang. Psychiatric factors: There are elevated
levels of psychiatric conditions, particularly Post Traumatic Stress
Disorder (PTSD), in drug users experiencing and perpetrating violence. For example, high rates of intimate partner violence have
been found among women with both drug use and PTSD, while
the presence of both cocaine dependence and PTSD is associated
with increased perpetration of partner violence. Furthermore, psychological distress and PTSD associated with experiencing rape and
physical assault are related to greater severity of drug use.
A history of childhood victimization: A history of abuse and/or witnessing violence in childhood increases the risk of subsequent use
of crack, cocaine, heroin, cannabis and methamphetamine. At the
same time it increases the risk of being a victim of violence, particularly intimate partner violence, in later life.
Social functioning problems: Social functioning problems such as
school, family, work and financial problems have been found to increase an individuals risk of perpetrating drug-related violence.
Drug use and dealing: Young peoples drug use and initiation into
drug dealing increases the risk of weapon carrying, and being a victim or perpetrator of violence. Furthermore, within the illicit drug
market violence is common place, with firearms specifically used by
dealers, runners and users for protection, enforcement and punishment.
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Health
Type of drug: A range of drugs, particularly cocaine and amphetamines (including methamphetamine) are associated with increased
aggressive and violent behavior. Users of cocaine and/or heroin
may be at greater risk of observing, perpetrating and being a victim
of violence than users of cannabis. Individuals under the influence
of benzodiazepines have been found to be more likely to act aggressively than non-intoxicated individuals. However, such findings
may be due to high levels of pre-existing hostility and aggressive
dispositions. The no prescribed use of anabolic-androgenic steroids
(AASs) is also associated with a number of psychiatric and behavioral changes including aggression, which in some cases may lead
to violence. As with other drugs, whether such effects are caused by
AAS use, or whether users are predisposed to such effects, remains
unclear.
Relationship level factors

Parental use of drugs: A connection between parental use of heroin
and cocaine and the risk of child maltreatment, poor parenting and
neglect has been documented. A childs exposure to unsafe environments in which parental drug use occurs may increase their risk of
being a victim of violence. Prenatal drug exposure is also associated
with increased levels of parenting stress and child maltreatment.
Exposure to violence: Young people who have experienced or witnessed violence have been found to be more likely to use cannabis
and hard drugs than those who have not experienced violence. Aggression and violence may be learned and transmitted within violent and illicit drug using families. A North American study found
that children raised in households where crack is sold and used,
routinely learn aggressive and violent behaviors through observation and interaction with their drug using parents and other kin.
Exposure to family deviance and drug use are both risk factors for
violence perpetration and illicit drug use.
Community level factors

Drug availability: A high availability of drugs within communities
contributes to the prevalence of drug-related violence and is a risk
factor for initiation into both drug use and violence. Children exposed to drug trafficking are also at increased risk of delinquency
including drug use and violence. A higher number of arrests for
drug possessions in a neighborhood have been found to be positively related to the rate of child maltreatment.
Neighborhood deprivation: Neighborhood level factors such as a lack
of employment opportunities, vacant housing, and a lack of street
lighting allow illicit drug markets and associated violence to flourish.
Nightlife environments: Widespread drug use and the existence
of drug markets in nightlife environments contribute to violence.
Within nightlife-focused holiday resorts in Spain, use of cocaine
and cannabis was associated with increased risk of being involved
in violence during a holiday. Drug use has also been identified as
a common occurrence amongst door staff working in nightlife set-
Violence
tings. Furthermore, opportunities to control drug sales in nightlife

have resulted in individuals with violent and criminal tendencies
occupying and controlling door staff positions. In such environments door staff may use violence, intimidation and bribery to take
control of illicit drug markets and may also be victims of violence
by criminal gangs who force door staff to allow drug dealing to take
place in night time settings.
Societal level factors

Culture of violence and drug use: A culture of violence, drugs and criminality contributes to risks of individuals using drugs and experiencing
violence. For example, street children are at high risk of violence and illicit drug use as a result of the environment in which they live. Almost
half of street children in Rio de Janeiro report a history of physical abuse
and illicit drug use and one third report belonging to a gang. A study of
Nigerian street children found a quarter operated as drug couriers, 14%
abused drugs and a third had been arrested for street fighting and drug use.
Social and economic inequality: Social inequalities and poverty are also
linked to violence. For example, a lack of money and employment opportunities can lead young people to become involved in drug markets, which
in turn contributes to the risk of violence perpetration and victimization.
2.6 WAR
War is a state of prolonged violent large-scale conflict involving two or
more groups of people, usually under the auspices of government. War is
fought as a means of resolving territorial and other conflicts, as war of aggression to conquer territory or loot resources, in national self-defense, or to
suppress attempts of part of the nation to secede from it.
Since the Industrial Revolution, the lethality of modern warfare has
steadily grown. World War I casualties were over 40 million and World
War II casualties were over 70 million.
Nevertheless, some hold the actual deaths from war have decreased compared to past centuries. In War Before Civilization,
Lawrence H. Keeley, a professor at the University of Illinois, calculates that
87% of tribal societies were at war more than once per year, and some 65%
of them were fighting continuously. The attrition rate of numerous closequarter clashes, which characterize endemic warfare, produces casualty
rates of up to 60%, compared to 1% of the combatants as is typical in modern warfare. Primitive Warfare of these small groups or tribes was driven
by the basic need for sustenance and violent competition. Their environment dictated the size of their groups for the most part, they would only
include as many people as the tribe could provide for. The small group size
also made moving much easier if needed, once resources were becoming
scarce in the area. Stephen Pinker agrees, writing that in tribal violence,
the clashes are more frequent, the percentage of men in the population who
fight is greater, and the rates of death per battle are higher.
Jared Diamond in his award-winning books, Guns, Germs, and Steel and
The Third Chimpanzee provides sociological and anthropological evidence
for the rise of large-scale warfare as a result of advances in technology
and city-states. The rise of agriculture provided a significant increase in
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Health
the number of individuals that a region could sustain over hunter-gatherer

societies, allowing for development of specialized classes such as soldiers,
or weapons manufacturers. On the other hand, tribal conflicts in huntergatherer societies tend to result in wholesale slaughter of the opposition
(other than perhaps females of child-bearing years) instead of territorial
conquest or slavery, presumably as hunter-gatherer numbers could not
sustain empire-building.
2.7 VIOLENCE IN THE MEDIA

While violence is not new to the human race, it is an increasing problem in
modern society. With greater access to firearms and explosives, the scope
and efficiency of violent behavior has had serious consequences. We need
only look at the recent school shootings and the escalating rate of youth
homicides among urban adolescents to appreciate the extent of this ominous trend. While the causes of youth violence are multifactorial and include such variables as poverty, family psychopathology, child abuse, exposure to domestic and community violence, substance abuse and other
psychiatric disorders, the research literature is quite compelling that childrens exposure to media violence plays an important role in the etiology
of violent behavior.
Over the past 30 years there has been extensive research on the relationship between televised violence and violent behavior among youth.
Longitudinal, cross-sectional, and experimental studies have all confirmed this correlation. Televised violence and the presence of television
in American households have increased steadily over the years. In 1950,
only 10% of American homes had a television. Today 99% of homes have
televisions. In fact, more families have televisions than telephones. Over
half of all children have a television set in their bedrooms. This gives a
greater opportunity for children to view programs without parental supervision. Studies reveal that children watch approximately 28 hours
of television a week, more time than they spend in school. The typical
American child will view more than 200,000 acts of violence, including
more than 16,000 murders before age 18. Television programs display 812
violent acts per hour; childrens programming, particularly cartoons, displays up to 20 violent acts hourly.
How does televised violence result in aggressive behavior? Some researchers have demonstrated that very young children will imitate aggressive acts on TV in their play with peers. Before age 4, children are unable to
distinguish between fact and fantasy and may view violence as an ordinary
occurrence. In general, violence on television and in movies often conveys
a model of conflict resolution. It is efficient, frequent, and inconsequential.
Heroes are violent, and, as such, are rewarded for their behavior. They become role models for youth. It is cool to carry an automatic weapon and
use it to knock off the bad guys. The typical scenario of using violence
for a righteous cause may translate in daily life into a justification for using violence to retaliate against perceived victimizers. Hence, vulnerable
youth who have been victimized may be tempted to use violent means to
solve problems. Unfortunately, there are few, if any, models of nonviolent
conflict resolution in the media. Additionally, children who watch televised
violence are desensitized to it. They may come to see violence as a fact of
life and, over time, lose their ability to empathize with both the victim and
the victimizer.
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Violence
There are other, new forms of violence to which children and adolescents are exposed. In one recent study, it was demonstrated that 15% of music videos contain interpersonal violence. Still another new source of violent
exposure is access to the Internet and video games. There is little data on the
incidence of violence on the Internet; however, there is concern about sites
that may advocate violence, provide information on the creation of explosive devices, or reveal how to acquire firearms. There is also little research
on the impact of violent video games. We do know, however, that they are
extensive and have a role-modeling capacity. The fact that the child gets to
act out the violence, rather than to be a passive observer, as when viewing
television or movies, is especially concerning to experts.
Child and adolescent psychiatrists, pediatricians and other physicians
can have a major impact on the effects of media violence. The American
Academy of Pediatrics (AAP) has created a list of recommendations to address television violence. It suggests that physicians talk openly with parents about the nature and extent of viewing patterns in their homes. Parents
should limit television to 1-2 hours daily and watch programs with their
children, enabling them to address any objectionable material seen. Physicians should make parents and schools media literate, meaning they
should understand the risks of exposure to violence and teach children how
to interpret what they see on television and in the movies, including the
intent and content of commercials. In doing so, children may be increasingly able to discern which media messages are suitable. Schools and homes
should teach children conflict resolution. The American Academy of Child
and Adolescent Psychiatry, along with medical organizations, has been
a strong advocate for television ratings and installation of chips to block
certain programs. Physicians, in their role as health promoters, should become more active in educating the media to become more sensitive to the
impact of violence on youth. We should be speaking up to the networks,
cable vendors, local stations, federal agencies, and our political officials to
help insure that programming decisions are made with an eye open to the
potential consequences to the viewing audience, and that when violence
is present, there are adequate warnings provided to the public. The arena
of media violence is a new frontier where physicians can promote health
through public education and advocacy.

1.
.refers to violence between individuals, and is subdivided into family and intimate partner violence and community violence.
(a) Collective violence
(c) Interpersonal violence

2.
(d) None of these
.. such as demography, are relatively easy to measure and because people have been measuring them for a long time
(a) Biological factors
(c) Interpersonal factors

3.
(b) Self-directed violence
(b) Social factors

(d) None of these
.refers to violence committed by larger groups of individuals and can be subdivided into social, political and economic violence.
(a) Collective violence
(b) Self-directed violence

(d) None of these
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Health
4. Child maltreatment is a global problem with serious lifelong consequences.

(a) True
(b) False
5. .is the abuse and neglect that occurs to children under

18 years of age. It includes all types of physical and/or emotional illtreatment, sexual abuse.
(a) Domestic violence

6.
(c) Elder maltreatment
(d) None of these
(b) Child maltreatment

(d) None of these
Suicide is the act harming ones self to the point of death.

(a) True
9.
is predicted to increase as many countries are experiencing rapidly ageing populations.

(a) Domestic violence
8.
(d) None of these
is a risk factor for both drug use and violence perpetration.

(a) Gang membership
7.
(b) False
American child will view more than .acts of violence.

(a) 300,000
(b) 100,000
(c) 50000
(d) 200,000
10. Intimate .refers to behavior in an intimate relationship that

causes physical, sexual or psychological harm.
(a) domestic violence
(c) Elder maltreatment
(b) partner violence

(d) None of these

1. Explain the term violence in brief.
2. Describe typology of violence.
3. What are two main causes of violence?
4. Explain different types interpersonal violence?
5. Describe risk factors for drug-related interpersonal violence.
6. Write in short about violence in the media.
7. Explain how to prevent interpersonal violence.
8. What are consequences and costs of violence?
9. What is child maltreatment?
10. What is domestic violence?
1. (c)
2. (b)
3. (a)
4. (a)
5. (b)
6. (a)
7. (c)
8. (a)
9. (d)
10. (b)
Chapter 3
Human Development
3.1 HUMAN RIGHTS AND HEALTH
romoting and protecting health and respecting, protecting and fulfilling

human rights are inextricably linked, and every country in the world is
now party to at least one human rights treaty that addresses health-related
rights and the conditions necessary for health. The United Nations Universal
Declaration of Human Rights recognizes that Everyone has the right to a
standard of living adequate for the health and well-being of himself and of
his family.
The WHO Constitution: the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being...
The world needs a global health guardian, a custodian of values, a protector and defender of health, including the right to health. Dr. Margaret
Chan, Director-General, WHO.
Every country in the world is now party to at least one human rights
treaty that addresses health-related rights. This includes the right to health as
well as other rights that relate to conditions necessary for health.
The role of the Health and Human Rights Team is to:
Strengthen the capacity of WHO and its Member States to integrate a
human rights-based approach to health.
Advance the right to health in international law and international development processes.
Advocate for health-related human rights.
Article 25 of the Universal Declaration of Human Rights 1948 states that
Everyone has the right to a standard of living adequate for the health, and
well-being of himself and his family.... The Preamble to the World Health
Organizations (WHO) constitution also declares that it is one of the fundamental rights of every human being to enjoy the highest attainable standard
of health. Inherent in the right to health is the right to the underlying conditions of health as well as medical care.
The human right to health means that everyone has the right to the highest attainable standard of physical and mental health, which includes access
to all medical services, sanitation, adequate food, decent housing, healthy
working conditions, and a clean environment.
The human right to health care means that hospitals, clinics, medicines,
and doctors services must be accessible, available, acceptable, and of good
Objectives
After studying this
able to:
Discuss Human rights
and Health
Explain how
WHO works
on Health
and Human
Rights
Describe Human Development.
38
Health
quality for everyone, on an equitable basis, where and when needed. The
design of a health care system must be guided by the following key human
rights standards and principles:
Universal Access: Access to health care must be universal, guaranteed for all on an equitable basis. Health care must be affordable
and comprehensive for everyone, and physically accessible where
and when needed.
Key Vocabulary
Human rights: the enjoyment of the highest
attainable standard of
health is one of the fundamental rights of every
human being
Availability: Adequate health care infrastructure (e.g. hospitals, community health facilities, trained health care professionals), goods
(e.g. drugs, equipment), and services (e.g. primary care, mental
health) must be available in all geographical areas and to all communities.
Acceptability and Dignity: Health care institutions and providers
must respect dignity, provide culturally appropriate care, be responsive to needs based on gender, age, culture, language, and different ways of life and abilities. They must respect medical ethics
and protect confidentiality.
Quality: All health care must be medically appropriate and of good
quality, guided by quality standards and control mechanisms, and
provided in a timely, safe, and patient-centered manner.
The human right to health also entails the following procedural principles, which apply to all human rights:
Non-Discrimination: Health care must be accessible and provided
without discrimination (in intent or effect) based on health status,
race, ethnicity, age, sex, sexuality, disability, language, religion, national origin, income, or social status.
Transparency: Health information must be easily accessible for everyone, enabling people to protect their health and claim quality
health services. Institutions that organize, finance or deliver health
care must operate in a transparent way.
Participation: Individuals and communities must be able to take an
active role in decisions that affect their health, including in the organization and implementation of health care services.
Accountability: Private companies and public agencies must be held
accountable for protecting the right to health care through enforceable standards, regulations, and independent compliance monitoring.
The Human Right to Health is protected in:
Article 25 of the Universal Declaration of Human Rights
Article 12 of the International Covenant on Economic, Social and
Cultural Rights
Article 24 of the Convention on the Rights of the Child
Article 5 of the Convention on the Elimination of All Forms of Racial
Discrimination
Articles 12 and 14 of the Convention on the Elimination of All Forms
of Discrimination Against Women
Human Development
39
Article XI (11) of the American Declaration on Rights and Duties of

Man
Article 25 of the Convention on the Rights of Persons with Disabilities
The human rights approach to public health systems development has
been a central theme to emerge from the unprecedented growth in funding for global health in the last two decades. The notion that health care
systems are public goodsprotecting the essential rights of all citizens, while
not universally embraced, is increasingly invoked in debates about health
care financing, governance, and implementation.In this chapter, challenges
in translating the emerging consensus around health as a human right into
one particular aspect of the right to health are explained: namely, access, for
the most vulnerable, to effective health care systems.
The Universal Declaration of Human Rights was adopted by the United
Nations in 1948, marking the beginning of the modern human rights movement.But to invoke a modern movement is not to suggest either consistency or universal agreement. Perhaps the deepest division was between
the human rights regimes focusing on civil and political rights and another
focusing on social and economic rights. These opposed orientations, established during the Cold War era, prevailed until the early 1990s, when a relative consensus emerged that the different human rights domains should be
integrated.
The global movement to combat HIV/AIDS is one of the broadest,
best-coordinated efforts to date to forge a link between health and human
rights. It is no coincidence that this movement was initiated, expanded, and
sustained by members of communities bearing the highest burdens of HIV
disease. The movement was successful because it was driven and led by
those affected directly by the epidemic. This movement globalized public
health and connected it to the rights agenda.
One major challenge in translating the successes of AIDS activism into
health systems change is to increase the awareness and involvement of
those who stand to benefit the most from such changesoften, the very
people most marginalized.
Herein lies a paradox in health and human rights. At no time in human
history has the notion of health as a human right enjoyed such prominence
in international and national health discourse as it does now. Yet this newfound prominence of the right to health clashes with the ongoing expansion
of the politics of exclusion and the economics of inequality.
This clash stems in large part from a pathology identified by many
names over the years. Whether termed the know-do gap or a need to
focus on thedeliveryof services, its clear from recent experience that, although the funding gap is usually the largest one, there are many other
barriers to effective implementation. Human rights legislation is impotent
without effective delivery systems; effective delivery systems without human rights protections (for example, legislative guarantees) will fail to deliver to the most vulnerable.
Given the know-do gap, what are the implications of the rights-based
view for health systems development? The large-scale forces driving health
disparities are much the same on every continent and although these forces
are differentially weighted, they are similar at every level of GDP. We believe that effective care-delivery systems must include the right to health
for the poor and vulnerable. While this is a sweeping statement, it is impor-
Key Vocabulary
Health: Health is a state
of complete physical,
mental and social wellbeing and not merely the
absence of disease or infirmity.
40
Health
tant to differentiate this rights-based approach from other approaches that

seek merely to maximize cost-effectiveness, or facilitate rational private investment in health. Our stance is a fundamentally moral one, rooted in the
lived experiences of our patients, but it is also deeply pragmatic. To free the
worlds poor from the diseases that continue to stalk them, we must build
better public sector systems.
3.1.1 Public Sector Accompaniment
Key Vocabulary
Maternal Health: Maternal health refers to the
health of women during
pregnancy,
childbirth,
and the postpartum period.
The private sector cannot by itself guarantee the health of the poor,
whose right to care (and cure) is so routinely violated. The private
sector can sometimes deliver dignified care to significant segments
of the worlds population, especially when private corporations are
partners in innovation. One has only to contemplate the development
of novel diagnostics and therapeutics to see the potential of the private sector. But it is not the task of the private sectorwhether notfor-profit or for-profitto guarantee access to health care for the poor
or otherwise marginalized. These tasks, which include basic regulatory obligations and also ensuring access to services, are necessarily
the task of government. Note that we are not discussing here which
types of care delivery systems are needed or recommended. Rather,
we posit that, within any mechanism of care delivery, government
is responsible for ensuring that the poorest get the treatment that is
their right and that the services are of the highest quality. Patients
may receive care, services, and goods from private companies or nongovernmental organizations, but these institutions cannot often provide the basic social protections the poor need to survive. This is why
our work in care delivery is centered increasingly on accompanying
the public sector.
If our goal is to reach the most destitute, we must learn to better accompany governments.Accompaniment, in a rights-based approach to public sector services, has two elements: working with governments to build
their capacity to deliver services while working with communities to hold
governments accountable for the quality, equity, and effectiveness of those
services.
The work has long been located at the intersection of human rights
theory and policy, and health care delivery. By our we mean a collective of physicians, nurses, community health workers, and managers. We mean implementers and academics, teachers and students. Such
complexity can be difficult to explain, but one would argue, and have
before, that complexity is central to sound analysis of health disparities, and how best to respond to them. But complexities can sometimes
be illuminated by personal experience and by historical and geographic
specificity. Since experiences and understanding of such health disparities are also disparat. The focus of these more personal narratives is
South Asia, a region home to 33.9% of global child deaths, 30% of maternal deaths, and 55% of tuberculosis cases.South Asia also continues to
have the highest rates of malnourished children; in India, Bangladesh,
Afghanistan, and Pakistan, prevalence rates of under-nutrition are much
higher (38 to 51%, respectively) even than those in sub-Saharan Africa,
which stand at 26%.
Human Development
41
3.1.2 The Work of WHO on Health and Human

Rights
Every country in the world is now party to at least one human rights treaty that addresses health-related rights, including the right to health and a
number of rights related to conditions necessary for health. The WHO is
actively strengthening its role in providing technical, intellectual and political leadership in the field of health and human rights. Promoting and
protecting health and respecting, protecting and fulfilling human rights are
inextricably linked:
Violations or lack of attention to human rights (e.g. harmful traditional practices, slavery, torture and inhuman and degrading
treatment, violence against women) can have serious health consequences.
Health policies and programs can promote or violate human rights
in their design or implementation (e.g. freedom from discrimination, rights to participation, privacy and information).
Vulnerability to ill health can be reduced by taking steps to respect,
protect and fulfill human rights (e.g. freedom from discrimination
on account of ethnicity, sex and social status and the rights to food
and nutrition, water, education and adequate housing).
3.2 HUMAN DEVELOPMENT

In seeking that something else, human development shares a common vision with human rights. The goal is human freedom. Therefore, human
development is interconnected with human rights and human freedom because in well-managed prisons life expectancy and literacy as measured
by the Human Development Index could be quite high. And in pursuing
capabilities and realizing rights, this freedom is vital. People must be free
to exercise their choices and to participate in decision-making that affects
their lives. Human development and human rights are mutually reinforcing, helping to secure the well-being and dignity of all people, building selfrespect and the respect of others. In the days of fast globalization, human
rights issues surface in relation to multilateral corporations and poverty
issues. The idea of human development stipulates the need for education,
better conditions for work and more choices for individuals. The idea goes
with what human rights. The two concepts is simultaneously promoted
first by well governance, implementation of human rights policy and a formation of participation of community in decision making processes, second by the promotion of civil and political rights and economic and social
rights, which are components of the level of development. For instance, the
right for education relates to intellectual development, and political rights
relates to the level of the political development of that society.
3.3 CHALLENGES TO HUMAN

DEVELOPMENT
With the concern for the growing size of the population (1.21 billion and
still growing at the rate of 1.8% per annum), It should be first find out how
Key Vocabulary
Poverty: Poverty is the
state of one who lacks a
certain amount of material possessions or money.
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Health
worried the government was, and what is it that it is doing about population control. The Economic Survey 20112012 of the Government of India
for an update. And pleasant realization about the change in perception. The
key is to focus on human development; for development is the best contraceptive.
On several things, many of understanding and approaches have
changed in a very positive way, enabling us to approach solutions to the
problem in different ways. For instance, one are no longer using the word
disabled but differently abled people. Similarly, the term population
would perhaps be forgotten altogether someday, and we shall be speaking
of human resources or human capital.
Key Vocabulary
Child mortality: Child
mortality, also known
asunder-5 mortality,
refers to the death of infants and children under
the age of five.
This takes the concern off my mind, and makes me feel reassured that
so far as our 1.21 billion human resources are concerned, as a polity we are
now concerned about development. For a developing economy like ours,
the challenges of human development are enormous. The challenge can be
briefly summarized by this question: How to convert a large-sized resource
into productive and efficient human capital of magnificent scale? This, in
my view, is the challenge facing us in the economy in general and industry in particular. This challenge is neither ordinary nor easy, if we keep
in mind the diversity across regions, languages, castes, cultures, etc. Making the challenge more difficult, the diversity is accompanied with growing
sensitivity, as is natural in a democratic society that is both dynamic and
fluid at the moment.
Going back to Economic Survey we find that there has been unprecedented changes in our demographic pattern, in favor of huge increase in
labor force. This is both a positive and negative development. Positive because India will remain for many more years to come a source of cheaper
workforce which will help in competitiveness of Indian industry. It is negative in the sense that this imposes a tremendous challenge of generating
opportunities for gainful and pro-active employment. This requires that the
economy must have sustained high growth. There are other implications
associated with it.
Proportion of working population between 15 and 59 years is likely to
increase from approximately 58% in 2001 to more than 64% by 2021. According to Economic Survey, in absolute numbers, there will be approximately 63.5 million new entrants to the work age group between 2011 and
2016. What is more, bulk of the increase is likely to take place in the relative younger age group of 2535 years. Such a trend would make India one
of the youngest nations in the world. In 2020 the average Indian will be only
29 years old, compared to Chinas 37 and USAs 45 years. This is what is
flaunted as demographic dividend, and I agree that it provides India great
opportunities for development and fast growth.
At the same time, there is other aspect of our human capital where we
look at things such as quality of human capital, which is often represented
in terms of Human Development Index (HDI). According to Human Development Report of the United Nations Development Program, 2011, Indias
HDI was 0.547 in 2011 with an overall global ranking of 134 out of 187 countries. Some of the parameters that go into calculation of HDI are really poor
in our case. For instance, gross national income per capita, at constant 2005
PPP $, compared to world average of 7.4. This compares poorly with 9.5
years in Malaysia, 9.8 years in Russia, 7.2 years in Brazil, 7.5 years in China
and 8.2 years in Sri Lanka. Even Bangladesh and Pakistan are above India in
Human Development
terms of mean years of schooling. All the more surprising is life expectancy
at birth in Bangladesh is 68.9 and 75.2 in Vietnam.
3.4 HUMAN DEVELOPMENT REPORT

The aim of the Human Development Report is to stimulate global, regional
and national policy discussions on issues that are relevant to human development. To be of relevance, the data in the Report requires the highest standards of data quality, consistency, transparency and accountability.
Several steps are taken each year to ensure that the Report maintains high
quality and reliability. These steps include partnering with many national
and international statistical agencies. In this chapter, we will find an extensive array of information to help understand how the data presented in
the Report indicator tables are compiled and how they should be used and
interpreted.
The first Human Development Report introduced a new way of measuring development by combining indicators of life expectancy, educational
attainment and income into a composite human development index, the
HDI. The breakthrough for the HDI was the creation of a single statistic
which was to serve as a frame of reference for both social and economic development. The HDI sets a minimum and a maximum for each dimension,
called goalposts, and then shows where each country stands in relation to
these goalposts, expressed as a value between 0 and 1.
Pushing the frontiers of measurement has always been a cornerstone of
the human development approach. But it has never been measurement for
the sake of measurement. The HDI has enabled innovative thinking about
progress by capturing the simple yet powerful idea that development is
about much more than income. Over the years the Human Development
Report has introduced new measures to evaluate progress in reducing poverty and empowering women.
3.4.1 Background
The Human Development Report presents analytical tools for policy choice.
These tools are amongst the most significant contributions of the Report.
They provide user friendly methods for the analysis of human development at the international, regional, national and sub-national levels and the
means for assessing trends and gaps in human development.
For policy makers and development practitioners, the analytical
tools introduced in the reports have the advantage of being simple, requiring only basic statistical data and mathematical knowledge. They
are readily understandable by non-specialists and facilitate stark findings that attract support for human development and help decisionmakers determine priorities and formulate human development-related
policies.
In the Reports these tools are generally applied at the international level. Subject to the availability of data, they are also applicable at the national
and sub-national levels. The latter include: regional, urban/rural, male/female, age-group, income level, ethnic group, etc. This note briefly presents
the analytical tools developed in the Human Development Reports and describes their potential uses in national settings.
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Health
3.4.2 Human Development: the Concept

The concept of human development focuses on the ends rather than the
means of development and progress. The real objective of development
should be to create an enabling environment for people to enjoy long,
healthy and creative lives. Though this may appear to be a simple truth, it
is often overlooked as more immediate concerns are given precedence.
Human development denotes both the process of widening peoples
choices and improving their well-being. The most critical dimensions of
human development are: a long and healthy life, knowledge and a decent
standard of living. Additional concerns include social and political freedoms. The concept distinguishes between two sides of human development. One is the formation of human capabilities, such as improved health
or knowledge. The other is the enjoyment of these acquired capabilities, for
work or for leisure. Human development is often being misconstrued and
confused with the following concepts and approaches to development.
Economic growth is a means and not an end of development. Moreover, high GDP growth does not necessarily translate to progress in human
development. Global experience has shown that income and human development are not always perfect companions, where some countries display relatively high levels of human development for their income and vice
versa.
Theories of human capital formation and human resource development view human beings as means to increased income and wealth rather
than as ends. These theories are concerned with human beings as inputs to
increasing production; The human welfare approach looks at human beings as beneficiaries rather than participants in the development process;
The basic needs approach concentrates on the bundle of goods and services
that deprived population groups need - food, shelter, clothing, health care
and water. It focuses on the provision of these goods and services rather
than their implications on human choices. Thus the concept of human development is a holistic one putting people at the centre of all aspects of the
development process.
3.5 Human Development Index (HDI)

The Human Development Index (HDI) measures the average achievements
in a country in three basic dimensions of human development: a long and
healthy life, access to knowledge and a decent standard of living. Data
availability determines HDI country coverage. To enable cross-country
comparisons, the HDI is, to the extent possible, calculated based on data
from leading international data agencies and other credible data sources
available at the time of writing.
The Inequality-adjusted Human Development Index (IHDI) adjusts
the Human Development Index (HDI) for inequality in distribution of each
dimension across the population. The IHDI accounts for inequalities in HDI
dimensions by discounting each dimensions average value according to
its level of inequality. The IHDI equals the HDI when there is no inequality across people but is less than the HDI as inequality rises. In this sense,
the IHDI is the actual level of human development (accounting for this inequality), while the HDI can be viewed as an index of potential human
development (or the maximum level of HDI) that could be achieved if there
Human Development
was no inequality. The loss in potential human development due to inequality is given by the difference between the HDI and the IHDI and can
be expressed as a percentage.
The Gender Inequality Index (GII) reflects womens disadvantage in
three dimensionsreproductive health, empowerment and the labor marketfor as many countries as data of reasonable quality allow. The index
shows the loss in human development due to inequality between female
and male achievements in these dimensions. It ranges from 0, which indicates that women and men fare equally, to 1, which indicates that women
fare as poorly as possible in all measured dimensions.
The Multidimensional Poverty Index (MPI) identifies multiple deprivations at the individual level in health, education and standard of living.
It uses micro data from household surveys, andunlike the Inequality-adjusted Human Development Indexall the indicators needed to construct
the measure must come from the same survey. Each person in a given
household is classified as poor or non-poor depending on the number of
deprivations his or her household experiences. These data are then aggregated into the national measure of poverty.
The Human Development Index (HDI) is a summary measure of human development. It measures the average achievements in a country in
three basic dimensions of human development: a long and healthy life
(health), access to knowledge (education) and a decent standard of living
(income). Data availability determines HDI country coverage. To enable
cross-country comparisons, the HDI is, to the extent possible, calculated
based on data from leading international data agencies and other credible
data sources available at the time of writing.
The education component of the HDI is now measured by mean of
years of schooling for adults aged 25 years and expected years of schooling
for children of school entering age. Mean years of schooling is estimated
based on educational attainment data from censuses and surveys available
in the UNESCO Institute for Statistics database and methodology). Expected years of schooling estimates are based on enrolment by age at all levels
of education and population of official school age for each level of education. Expected years of schooling are capped at 18 years. The indicators are
normalized using a minimum value of zero and maximum values are set
to the actual observed maximum value of mean years of schooling from
the countries in the time series, 19802010, that is 13.1 years estimated for
Czech Republic in 2005. Expected years of schooling are maximized by its
cap at 18 years. The education index is the geometric mean of two indices.
The life expectancy at birth component of the HDI is calculated using
a minimum value of 20 years and maximum value of 83.4 years. This is the
observed maximum value of the indicators from the countries in the time
series, 19802010. Thus, the longevity component for a country where life
expectancy birth is 55 years would be 0.552.
For the wealth component, the goalpost for minimum income is $100
(PPP) and the maximum is $107,721 (PPP), both estimated during the same
period, 19802011.
The decent standard of living component is measured by GNI per
capita (PPP$) instead of GDP per capita (PPP$) The HDI uses the logarithm of income, to reflect the diminishing importance of income with
increasing GNI. The scores for the three HDI dimension indices are then
aggregated into a composite index using geometric mean. The HDI fa-
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cilitates instructive comparisons of the experiences within and between

different countries.
The HDI was created to emphasize that people and their capabilities
should be the ultimate criteria for assessing the development of a country,
not economic growth alone. The HDI can also be used to question national
policy choices, asking how two countries with the same level of GNI per
capita can end up with such different human development outcomes. For
example, the Bahamas and New Zealand have similar levels of income per
person, but life expectancy and expected years of schooling differ greatly
between the two countries, resulting in New Zealand having a much higher
HDI value than the Bahamas. These striking contrasts can stimulate debate
about government policy priorities.
3.6 HUMAN POVERTY INDEX

If human development is about enlarging choices, poverty means that opportunities and choices most basic to human development are denied. Thus
a person is not free to lead a long, healthy, and creative life and is denied
access to a decent standard of living, freedom, dignity, self-respect and the
respect of others. From a human development perspective, poverty means
more than the lack of what is necessary for material well-being.
The Human Poverty Index (HPI) is a composite index of poverty that
focuses on deprivations in human lives, aimed at measuring poverty as a
failure in capabilities in multiple dimensions, in contrast to the conventional headcount measure focused on low incomes. The HPI was introduced in
the United Nations Development Program Human Development Report
1997 and concentrates on deprivations in basic dimensions of life. This
chapter develops an axiomatic characterization of a family of global deprivation indices using an arbitrary number of dimensions of human life.
When we consider only the three basic dimensions, a member of this family
becomes ordinally equivalent to HPI. The general index allows the calculation of percentage contributions of deprivations in different dimensions,
and hence to identify the dimensions whose failures affect the overall deprivation more. This is important from a policy perspective. We also provide
an empirical illustration of the characterized indices using cross-country
data for the three basic dimensions and the anthropometric indicators birth
weight, height for age and nourishment.
For policy-makers, the
poverty of choices and opportunities is often more relevant
than the poverty of income.
The poverty of choices focuses
on the causes of poverty and
leads directly to strategies of
empowerment and other actions to enhance opportunities
for everyone. Recognizing the
poverty of choices and opportunities implies that poverty
must be addressed in all its dimensions, not income alone.
Human Development
The Human Development Report 1997 introduced a human poverty

index (HPI) in an attempt to bring together in a composite index the different features of deprivation in the quality of life to arrive at an aggregate
judgment on the extent of poverty in a community.
3.6.1 The Three Indicators of the Human Poverty

Index (HPI)
Rather than measure poverty by income, the HPI uses indicators of the most
basic dimensions of deprivation: a short life, lack of basic education and
lack of access to public and private resources. The HPI concentrates on the
deprivation in the three essential elements of human life already reflected
in the HDI: longevity, knowledge and a decent standard of living. The HPI
is derived separately for developing countries (HPI-1) and a group of select
high-income OECD countries (HPI-2) to better reflect socio-economic differences and also the widely different measures of deprivation in the two
groups.
The first deprivation relates to survival: the likeliness of death at a
relatively early age and is represented by the probability of not surviving to ages 40 and 60 respectively for the HPI-1 and HPI-2.
The second dimension relates to knowledge: being excluded from
the world of reading and communication and is measured by the
percentage of adults who are illiterate.
The third aspect relates to a decent standard of living, in particular,
overall economic provisioning.
For the HPI-1, it is measured by the unweighted average of the percentage of the population without access to safe water and the percentage
of underweight children for their age. For the HPI-2, the third dimension
is measured by the percentage of the population below the income poverty
line (50% of median household disposable income).
In addition to the three indicators mentioned above, the HPI-2 also includes social exclusion, which is the fourth dimension of the HPI-2. It is
represented by the rate of long term unemployment.
The NHS Plan (2000) states that no injustice is greater than the inequalities in health which scar our nation and proposes a number of developments to combat this situation. One of these is the production of a
Health Poverty Index (HPI). Following the publication of the NHS Plan,
The Department of Health (DoH) commissioned a major consultation and a
series of discussions within the DoH and between the DoH and other bodies charged with tackling the issue of health inequalities.
The HPI tool will allow groups, differentiated by geography, social or
economic position and cultural identity, to be contrasted in terms of their
health poverty. A groups health poverty is a combination of both its present state of health and its future health potential or lack of it. The key justification for the selection of a particular set of groups is the expectation of an
equal distribution of health and its determinants between the groups from
the perspective of social justice.
The indicators collected have been scaled in such a way that high numbers represent a situation of high health poverty. The main groups are Local
Authority Districts (LAD) in England as they existed from April 1st 2001.
Each indicator has been scaled in reference to scores across all the groups
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being compared (i.e. all LADs in England). Thus, for each domain, a score
of zero indicates the best situation in terms of health poverty and a score of
1 the worst situation. The data for each indicator has also been ranked, with
the ranks then converted to a scale from 0 to 1.
3.7 UNITED NATIONS MILLENNIUM

DEVELOPMENT GOALS
The United Nations Foundation is committed to helping the UN achieve
the eight Millennium Development Goals by 2015. The MDGs are a commitment by the UN to establish peace and a healthy global economy by
focusing on major issues like poverty, childrens health, empowerment of
women and girls, sustainable environment, disease, and development.
It reflects the fact that the fates of all people and nations are linked.
Unless we can help the worlds poor create a better life, no ones prosperity
can be secure.
Progress towards reaching the goals has been uneven. Some countries
have achieved many of the goals, while others are not on track to realize
any. A UN conference in September 2010 reviewed progress to date and
concluded with the adoption of a global action plan to achieve the eight
anti-poverty goals by their 2015 target date. There were also new commitments on womens and childrens health, and new initiatives in the worldwide battle against poverty, hunger, and disease.
The United Nations Millennium Development Goals are eight goals
that all 191 UN member states have agreed to try to achieve by the year
2015. The United Nations Millennium Declaration, signed in September
2000 commits world leaders to combat poverty, hunger, disease, illiteracy,
environmental degradation, and discrimination against women. The MDGs
are derived from this Declaration, and all have specific targets and indicators.
Eight Goals for 2015

Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria and other diseases
Ensure environmental sustainability
Develop a global partnership for development
3.7.1 Goal 1: Eradicate Extreme Poverty and

Hunger
The number of hungry people in the world remains unacceptably high despite expected recent gains that have pushed the figure below 1 billion. The
FAO estimates that the number of people who will suffer from chronic hunger in 2010 is 925 million.
Human Development
The FAO focuses on poverty and hunger reduction through: improving agricultural productivity and incomes and promoting better nutritional
practices at all levels and programs that enhance direct and immediate access to food by the neediest. The FAO helps developing countries to improve agriculture, forestry and fisheries practices, to sustainably manage
their forest, fisheries and natural resources and ensure good nutrition for
all. The FAO promotes greater investment in agriculture and rural development and has assisted governments to establish National Programs for
Food Security aimed at smallholder farmers. In emergency response and
rehabilitation efforts, FAOs expertise in farming, livestock, fisheries and
forestry is crucial. The FAO works quickly to restore agricultural production, strengthen the survival strategies of those affected, and enable people
to reduce their dependence on food aid. The FAO also plays a crucial role
in prevention, preparedness and early warning.
3.7.2 Goal 2: Achieve Universal Primary Education
About 72 million primary school age children do not attend school. Over
four out of five of these children live in rural areas. The urban-rural
knowledge and education divide is todays main barrier to achieving universal primary education by 2015. At the same time the learning ability of
rural children is compromised by hunger and malnutrition. Food security
and education need to be tackled simultaneously to develop the capacity
of rural people to feed themselves and overcome poverty, hunger and illiteracy.
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The FAO is the UN lead agency for Education for Rural People (ERP),
a network of about 370 partners including governments, civil society and
the private sector. The ERP fosters rural peoples capacity to be food secure
and to manage natural resources in a sustainable way through increased access to quality education and skills training for all rural children, youth and
adults. The FAO also provides technical assistance to member countries for
implementing school gardens and school-feeding programs, which can encourage school attendance and bring direct nutritional benefits to children.
3.7.3 Goal 3: Promote Gender Equality and

Empower Women
The FAO recognizes the importance of promoting the full and equitable
participation of rural women and men in efforts to improve food security
reduce poverty, and fuel social and economic development. Without rural
womens economic and social empowerment and gender equality, food security will not be achieved. The FAO promotes the equal participation of
rural women in decision making processes, employment opportunities and
access to and control of resources.
The FAO develops tool kits, guidelines and training programs for the
production and analysis of sex disaggregated data that enable targeted intervention on the vital role rural men and women play in ensuring food security, especially at the household level. The FAO builds technical capacity
among member countries to address gender issues in policy and program
Human Development
development; works directly with rural women and men to strengthen their
agricultural and livelihoods skills; assists member countries to identify and
remove obstacles to womens equal participation and decision-making; supports the formulation of gender-sensitive national and regional agricultural
policies; links rural women and men through an information and communication network; and shares good practices that highlight womens roles.
3.7.4 Goal 4: Reduce Child Mortality

Undernutrition is estimated to be an underlying cause in more than onethird of all deaths in children under five. Programs to improve household
food security and nutrition information increase childrens chances of
growing to adulthood. The FAO programs assist poor households and communities to secure access to nutritionally adequate diets and reduce child
undernutrition. Activities include: community-centered initiatives, training
materials, nutrition education programs, training programs for national
and local staff, and promotion of a forum on household food security and
community nutrition.
Improved complementary feeding for young children, i.e. giving foods
in addition to breast milk, is an important way to prevent undernutrition
and reduce child mortality. The FAO helps countries strengthen local capacities to improve complementary feeding for young children, using locally available and affordable foods. Through linking household food security with nutrition education, improved complementary feeding using
family foods is feasible even in resource poor environments. Programs
have been successfully implemented in Afghanistan and Zambia and FAO
is now applying this approach in more countries. The FAO is also part of
the Renewed Efforts against Child Hunger and Undernutrition (REACH) in
partnership with UNICEF, WHO, and WFP.
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3.7.5 Goal 5: Improve Maternal Health

Improving maternal health is key to saving the lives of more than half a
million women who die as a result of complications from pregnancy and
childbirth each year. Almost all these deaths could be prevented if women
in developing countries had access to adequate diets, safe water and sanitation facilities, basic literacy and health services during pregnancy and
childbirth. Hunger and malnutrition have been found to increase both the
incidence and the fatality rate of the conditions that cause up to 80% of
maternal deaths.
The FAO contributes to improving maternal health through efforts to: improve
womens access to productive resources and
income; improve womens nutritional status;
and empower women to obtain better health
care, education and social services. The FAO
also promotes nutrition awareness among
women and girls in rural areas and nutrition
education in schools. Heavy workloads, combined with poor diets and frequent pregnancies, severely weaken womens health. The
FAO provides assistance for the introduction
of labor-saving technologies for womens
tasks in agriculture, food preparation and processing and for more easily accessible water
supplies and fuel for cooking. The FAO also
promotes home gardens as a means to improve household and maternal nutrition.
3.7.6 Goal 6: Combat HIV/AIDS, Malaria and Other

Diseases
The MDG 6 aims to combat HIV/AIDs, malaria and other diseases. HIV,
malaria and other diseases have a direct and indirect impact on rural de-
Human Development
velopment, agricultural productivity and food and nutrition security. At

the same time, food and nutrition insecurity and malnutrition can increase
vulnerability to disease. The FAO supports policy makers and program
planners to incorporate HIV, malaria and other disease considerations into
food, nutrition and agriculture policies and programs.
The FAO promotes awareness among key actors in
the food and agriculture sector on the impacts of HIV
on food security and agriculture, while advocating for
multisectoral responses to the epidemic. The FAOs
programs to enhance the access of people with HIV/
AIDs to adequate and nutritious diets include home
and community gardening projects, nutrition education
and communication, and local training. Field projects
use a mix of interventions including food provisions, labor- and time-saving technologies and microfinance to
help support food production and diversification; and
technical assistance to household gardening projects in
HIV/AIDS affected communities. The FAO also supports projects that encourage more HIV/AIDS orphans
and other vulnerable children to attend school, The FAO
Emergency Centre for Transboundary Animal Disease
(ECTAD) addresses livestock epidemics with major economic, social and public health impacts.
3.7.7 Goal 7: Ensure Environmental Sustainability

The natural resources base and ecosystems must be managed sustainably to
meet peoples food requirements and other environmental, social and economic needs. Climate change, increased water scarcity and conflicts over
access to resources all pose challenges to environmental sustainability and
food security. In addition, hunger and poverty often compel the poor to
over-exploit the resources on which their own livelihoods depend.
The FAO supports sustainable natural
resource management including agricultural water use efficiency; land and soil productivity; sustainable forest management,
aquaculture and inland fisheries; integrated
crop and livestock systems; pesticide management and watershed management. The
FAO also supports the major environmental conventions, including the United Nations Framework Convention on Climate
Change. The FAO provides technical and
policy advice to address the main threats
to the natural resource base, which include
land degradation, water scarcity, deforestation, overgrazing, over exploitation of marine resources, increased green house gas
emissions and loss of genetic resources and
biological diversity. The FAO carries out
significant work on the links between food
security and bioenergy development.
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3.7.8 Goal 8: Develop a Global Partnership for

Development
Goal 8 aims to develop a global partnership for development. The targets
most relevant to the mandate of FAO relate to the special needs of least
developed countries (LCDs), landlocked countries and small island developing states; the trading and financial system; and new information and
communication technology (ICT).
Much of FAOs work of reducing hunger and improving agriculture
and food security is directed to least developed countries, including landlocked countries and small island developing states. In 2009, FAOs field
program delivered US$715 million in technical assistance and emergency
and rehabilitation operations and started 2010 with an available budget of
over US$1.5 billion. The FAO, working with its Members States and the
World Trade Organization (WTO), is an active partner in efforts to create an
open, fair and rules-based multilateral trading system, in particular through
its support for food, agricultural trade and overall trade policies conducive
to food security. The FAO provides advice and technical assistance for governments, institutions and rural communities to strengthen capacities in agricultural information management. The FAO also helps rural communities
to access modern information and communication technology.
Each of the goals has specific stated targets and dates for achieving
those targets. To accelerate progress, the G8 Finance Ministers agreed in
June 2005 to provide enough funds to the World Bank, the International
Monetary Fund (IMF), and the African Development Bank (AfDB) to cancel
an additional $40 to $55 billion in debt owed by members of the Heavily
Indebted Poor Countries (HIPC) to allow impoverished countries to rechannel the resources saved from the forgiven debt to social programs for
improving health and education and for alleviating poverty.
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Human Development

1.
2.
How many indicators are there of the Human Poverty Index?

(a) 5
(b) 6
(c) 3
(d) 4
What is the main goal of Human Development?

(a) Human Freedom
(c) Create health awareness

3.
(c) Both a and b
5.
6.
7.
8.
(d) Reduce poverty
(b) Yes
(d) None of these
How many goals should be achieved by 2015 by United Nations Foundation?

(a) 5
(b) 6
(c) 7
(d) 8
The Gender Inequality Index (GII) reflects womens disadvantage in

___ dimensions.
(a) Many
(b) Less than three
(c) Three
(d) More than four
When did the United Nations adopted the Universal Declaration of

Human Rights?
(a) 1947
(b) 1960
(c) 1950
(d) 1948
Food and nutrition insecurity and malnutrition can _____ vulnerability

to disease.
(a) Increase
(b) Decrease
(c) Maintain
(d) Both b and c
Most of the women die due to.

(a) Diarrhea
(c) Pregnancy and childbirth

9.
(b) Solve health Problems
Human development is interconnected with human rights and health.

(a) No
4.
(b) HIV/AIDS
(d) Leprosy
The NHS Plan (2000) states that

(a) No injustice is greater than the poverty.
(b) No injustice is greater than the inequalities in health which scar our
nation.
(c) No injustice is lesser than the inequalities in health which scar our
nation.
(d) Both a and b
10. What do Goal 8 aims to develop?

(a) A global partnership for development.
(b) Globalization
(c) Poverty
(c) Our Nation
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Health

1. Explain the term human rights.
2. What is the role of the health and human rights?
3. What are the challenges in human development?
4. Which are the eight millennium development goals of United
Nations?
5. What is human development report?
6. What are the principles of Health and Human Rights?
7. Explain Human Development Index.
8. Which are the three indicators of the Human Poverty Index?
9. Describe the goal Ensure environmental sustainability.
10. What is Human Poverty Index?

1. (c)
2. (a)
3. (b)
4. (d)
5. (c)
6. (d)
7. (a)
8. (c)
9. (b)
10. (a)
Chapter 4
Mental Health
INTRODUCTION
The term mental health is commonly used in reference to mental illness.However, knowledge in the field has progressed to a level that appropriately differentiates the two. Although mental health and mental illness are related,
they represent different psychological states.
Mental health isa state of well-being in which the individual realizes
his or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or her
community.It is estimated that only about 17% of U.S adults are considered
to be in a state of optimal mental health. There is emerging evidence that
positive mental health is associated with improved health outcomes.
Mental illness is defined as collectively all diagnosable mental disorders or health conditions that are characterized by alterations in thinking,
mood, or behavior (or some combination thereof) associated with distress
and/or impaired functioning.Depression is the most common type of mental illness, affecting more than 26% of the U.S. adult population.It has been
estimated that by the year 2020, depression will be the second leading cause
of disability throughout the world, trailing only ischemic heart disease.
Evidence has shown that mental disorders, especially depressive disorders, are strongly related to the occurrence, successful treatment, and course
of many chronic diseases including diabetes, cancer, cardiovascular disease,
asthma, and obesity and many risk behaviors for chronic disease; such as,
physical inactivity, smoking, excessive drinking, and insufficient sleep.
Characteristics of mental health

Health is a state of being hale, sound or whole in body, mind or soul. Mental
health today is recognized as an important aspect of ones total health status
is basic factor that contribute to the maintenance of physical health as well as
social effectiveness. In the words of John, Sutton and Webster is a positive but
relative quality of life. It is a condition, which is a characteristic of the average
person who needs the demands of life on the basis of his own capacities and
limitations. By the word relative we imply that the degree of mental health,
which an individual enjoys at a time, is continuously changing. It is not mere
absence of mental illness that constitutes mental health. On the other hand
it is a positive active quality of the individuals daily living. This quality of
living is manifested in the behavior of an individual whose body and mind
Objectives
After studying this

able to:
Describe
Mental
Health
Explain Significance and
Perspective
of Mental
Health.
Describe
causes of
Mental Disorder
Describe
Emotional
mental health
issues and
its Improvements
Explain
prior Mental
Health Conditions
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are working together in the same direction. His thoughts, feelings, actions,
functional harmony is oriented towards the common end.
Key Vocabulary
Mental health isa state
of well-being in which
the individual realizes
his or her own abilities,
can cope with the normal
stresses of life, can work
productively and fruitfully, and is able to make
a contribution to his or
her community.
It means the ability to balance feelings, derives ambition and ideals
in ones daily living. It means the ability to face and accept realities of life.
It connotes such habits of work and attitudes towards people and things
that bring maximum satisfaction and happiness to the individual. But the
individual gets this satisfaction and happiness without any friction with the
social order or group to which he or she belongs.
From these one can conclude that mental health has two important aspects. It is both individual and social. The individual aspect connotes that
the individual is informally adjusted. He is self confident, adequate and
free from internal conflicts and tension or in consistencies. He is skillful
enough to be able to adapt to new situations. But he achieves this internal
adjustment in a social setup.
Society has certain value system, customs and traditions, by which it
governs itself and promote the general welfare if its members. It is in this
the social frame work that the internal adjustment has to be built up only
then the individual becomes a person who is acceptable as a member of
society. It is an understandable fact that social forces are in constant flux.
They are constantly moving and changing. Similarly our internal adjustment is also affecting various stresses. As such mental health is a process
of adjustment, which involves compromise and adaptation, growth and
continuity.
Because of the significance of individual and social aspects some psychologists have defined mental health as the ability of the individual to
make personal and social adjustments.If one can establish a satisfactory
relationship between himself and his environment, between his needs, desires and those of other people or if one can meet the demands of a situation
he has achieved adjustment.Adjustment results in happiness because it im-
Mental Health
59
plies that emotional conflicts and tensions have been resolved and relieved.
Keeping this criterion in mind one can say that a mentally healthy nurse
will be able to make successful adjustments that are needed by the nature
of her job adjustment to her strenuous life to work and study toward duties
to night duty and to a residential life away from her home.
Other definitions of mental health refer to such abilities as of making
decisions, of assuming responsibilities in accordance with ones capacities,
of finding satisfaction, success and happiness in the accomplishment of
everyday tasks of living effectively with others of showing socially considerate behavior.
4.1 HISTORY
Many cultures have viewed mental illness as a form of religious punishment or demonic possession. In ancient Egyptian, Indian, Greek, and Roman writings, mental illness was categorized as a religious or personal
problem. In the 5th century B.C., Hippocrates was a pioneer in treating
mentally ill people with techniques not rooted in religion or superstition;
instead, he focused on changing a mentally ill patients environment or occupation, or administering certain substances as medications. During the
Middle Ages, the mentally ill were believed to be possessed or in need of
religion. Negative attitudes towards mental illness persisted into the 18th
century in the United States, leading to stigmatization of mental illness, and
unhygienic (and often degrading) confinement of mentally ill individuals.
In the 1840s, activist Dorothea Dix lobbied for better living conditions for
the mentally ill after witnessing the dangerous and unhealthy conditions in
which many patients lived. Over a 40-year period, Dix successfully persuaded the U.S. government to fund the building of 32 state psychiatric hospitals.
This institutional inpatient care model, in which many patients lived
in hospitals and were treated by professional staff, was considered the
most effective way to care for the mentally ill. Institutionalization was also
welcomed by families and communities struggling to care for mentally ill
relatives. Although institutionalized care increased patient access to mental health services, the state hospitals were often underfunded and understaffed, and the institutional care system drew harsh criticism following a
number of high-profile reports of poor living conditions and human rights
violations.By the mid-1950s, a push for deinstitutionalization and outpatient treatment began in many countries, facilitated by the development of
a variety of antipsychotic drugs. Deinstitutionalization efforts have reflected a largely international movement to reform the asylum-based mental
health care system and move toward community-oriented care, based on
the belief that psychiatric patients would have a higher quality of life if
treated in their communities rather than in large, undifferentiated, and
isolated mental hospitals.
Although large inpatient psychiatric hospitals are a fixture in certain
countries, particularly in Central and Eastern Europe, the deinstitutionalization movement has been widespread, dramatically changing the nature
of modern psychiatric care.The closure of state psychiatric hospitals in the
United States was codified by the Community Mental Health Centers Act
of 1963, and strict standards were passed so that only individuals who
posed an imminent danger to themselves or someone else could be committed to state psychiatric hospitals.By the mid-1960s in the U.S., many se-
Key Vocabulary
Mental Illness is defined as collectively
all diagnosable mental
disorders or health
conditions that are
characterized by alterations in thinking, mood,
or behavior (or some
combination thereof)
associated with distress
and/or impaired functioning.
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verely mentally ill people had been moved from psychiatric institutions to
local mental health homes or similar facilities. The number of institutionalized mentally ill patients fell from its peak of 560,000 in the 1950s to 130,000
by 1980.By 2000, the number of state psychiatric hospital beds per 100,000
people was 22, down from 339 in 1955. In place of institutionalized care,
community-based mental health care was developed to include a range of
treatment facilities, from community mental health centers and smaller supervised residential homes to community-based psychiatric teams.
Key Vocabulary
Depression: An illness
that involves the body,
mood, and thoughts and
that affects the way a
person eats, sleeps, feels
about himself or herself,
and thinks about things.
Depression: An illness
that involves the body,
mood, and thoughts and
that affects the way a
person eats, sleeps, feels
about himself or herself,
and thinks about things.
Though the goal of deinstitutionalization improving treatment and

quality of life for the mentally ill is not controversial, the reality of deinstitutionalization has made it a highly polarizing issue. While many studies have reported positive outcomes from community-based mental health
care programs, (including improvements in adaptive behaviors, friendships, and patient satisfaction,) other studies have found that individuals
living in family homes or in independent community living settings have
significant deficits in important aspects of health care, including vaccinations, cancer screenings, and routine medical checks.Other studies report
that loneliness, poverty, bad living conditions, and poor physical health
are prevalent among mentally ill patients living in their communities.However, some studies argue that community-based programs that have proper
management and sufficient funding may deliver better patient outcomes
than institutionalized care, and are not inherently more costly than institutions
Though the deinstitutionalization debate continues, many health
professionals, families, and advocates for the mentally ill have called for
a combination of more high-quality community treatment programs (like
intensive case management) and increased availability of intermediate and
long-term psychiatric inpatient care for patients in need of a more structured care environment. Many experts hope that by improving communitybased programs and expanding inpatient care to fulfill the needs of severely mentally ill patients, the United States will achieve improved treatment
outcomes, increased access to mental health care, and better quality of life
for the mentally ill.
4.2 SIGNIFICANCE OF MENTAL HEALTH

Our mental health has a huge impact on every aspect of our life.
Self-image
Good mental health means appreciating our achievements and accepting our shortcomings. A mental illness can cause an inferiority complex, a
negative body image, and intense feelings of self-hate, anger, disgust, and
uselessness, which could mutate into extreme depression, psycho-social
disorders, or eating disorders.
Education
Students with mental problems socially isolate themselves, and develop
anxiety disorders and concentration problems. Good mental health ensures
an all-round educational experience that enhances social and intellectual
skills that lead to self-confidence and better grades.
Mental Health
61
Relationships
Mental health largely contributes to the functioning of human relationships.
Mental illness can hamper even basic interactions with family, friends, and
colleagues. Most people suffering from mental illness find it difficult to
nurture relationships, have problems with commitment or intimacy, and
frequently encounter sexual health issues.
Sleep
An inability to handle stress or anxiety can cause insomnia. Even if we
mange to fall asleep, we may wake up a dozen times during the night with
thoughts of what went wrong the day before or how bad tomorrow is going Key Vocabulary
to be. We may develop severe sleeping disorders which leave we exhausted
Family: The family is a
and less productive.
primary social group. It
is a group of biologically
Eating
related individuals.
People with mental disorders are more prone to indulging in comfort
eating or emotional binges. Finding comfort in food is something we
all do from time to time. But with a mental illness, it becomes difficult
to control ourself. Overeating can lead to obesity, which puts we at a
risk for heart disease and diabetes, in addition to creating an unhealthy
body-image.
Physical Health
Our mental state directly affects our body. For example, stress can lead to
hypertension or stomach ulcers. People who are mentally healthy are at a
lower risk for many health complications.
So make a conscious effort to improve and maintain our mental health.
Good health is not a struggle, nor it is an extraordinary feature. Healthy
living is about understanding what our body needs and what is good for it.
4.3 PERSPECTIVES OF MENTAL HEALTH

Following are three perspectives of mental health:
4.3.1 Mental Wellbeing

Sometimes aspects of our lives can have effects on our thoughts and feelings, leading us to experience difficulties and problems. Wellbeing is not
just about the lack of illness or the absence of sadness or worry. Wellbeing can be thought of as a combination of our physical, mental, emotional,
spiritual and social health. Often, simple things such as accepting a compliment, recognizing our strengths, or coping well with a stressful situation
can help in getting us through the day and feeling mentally well.
It can be easy to turn towards negative coping mechanisms when we
are feeling down, for example: drinking too much alcohol, misusing drugs;
self-harm, acting in a way which is harmful to ourself or others around we
or not dealing with anger appropriately. However, this type of behavior
will probably only make things worse in the long term and so it is impor-
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Health
tant to look after ourself and actively engage in reaching and maintaining
good mental health and wellbeing, using positive techniques.
Five ways to mental wellbeing
Key Vocabulary
Culture: The traditions
and customs of a society.
1. Connect: With the people around we. With family, friends, colleagues and neighbors. At home, work, school or in our local community. Think of these as the cornerstones of our life and invest
time in developing them. Building these connections will support
and enrich we every day.
2. Be active: Go for a walk or run. Step outside. Cycle. Play a game.
Garden. Dance. Exercising makes we feel good. Most importantly,
discover a physical activity we enjoy and that suits our level of mobility and fitness.
3. Take notice: Be curious. Catch sight of the beautiful. Remark on the
unusual. Notice the changing seasons. Savour the moment, whether
we are walking to work, eating lunch or talking to friends. Be aware
of the world around us and what we are feeling. Reflecting on our
experiences will help we appreciate what matters to us.
4. Keep learning: Try something new. Rediscover an old interest. Sign
up for that course. Take on a different responsibility at work. Fix a
bike. Learn to play an instrument or how to cook our favorite food.
Set a challenge we enjoy achieving. Learning new things will make
us more confident as well as being fun.
5. Give: Do something nice for a friend, or a stranger. Thank someone.
Smile. Volunteer our time. Join a community group. Look out, as
well as in. Seeing ourself, and our happiness, as linked to the wider
community can be incredibly rewarding and creates connections
with the people around us.
Mental Health
4.3.2 Prevention
Mental health can also be defined as an absence of amental disorder. Focus
is increasing on preventing mental disorders. Prevention is beginning to
appear in mental health strategies,
Anyone can have a mental illness, regardless of age, gender, race, or
income. Mental illnesses are more common than cancer, diabetes, heart disease, or AIDS. It is believed that one in five adults and children has a diagnosable mental disorder, one in every 10 young people age 9 or older has a
serious emotional disturbance that severely disrupts daily life. and one in
four families will have a member with mental illness. Children who develop depression often have a family history of the illness, many times a parent who had depression at an early age. Untreated mental health problems
can lead to suicide, which is the sixth leading cause of death for 5- to 14year olds. An estimated two-thirds of all young people with mental health
problems are not getting the help they need. It is important to remember
that mental illness can occur at any age, but most people start experiencing symptoms for the first time between the ages of 25 and 44. With proper
treatment, as many as 8 in 10 people suffering from a mental illness can return to normal, productive lives, and almost everyone receives some benefit
from treatment.
The causes of mental illness are complicated. Mental health disorders
in children and adolescents are caused mostly by biology and environment.
Examples of biological causes are genetics, chemical imbalances in the body
caused by genetics, lack of sleep or poor nutrition, or damage to the central
nervous system, such as a head injury or fetal alcohol spectrum disorder.
Many environmental factors also put young people at risk fordeveloping
mental health disorders. Examples including exposure to environmental
toxins, such as high levels of lead; exposure to violence, such as witnessing
or being the victim of physical or sexual abuse, being the child of an addict
or alcoholic, drive-by shootings, muggings, or other disasters; stress related
to chronic poverty, discrimination, or other serious hardships; and the loss
of important people through death, divorce, or broken relationships.
The following preventive services are recommended and can be carried out in a clinic, church, library or local community center:
Prenatal and infancy home visits or support groups.
Targeted cessation education and counseling for smokers, especially those who are pregnant.
Targeted short-term mental health therapy.
Self-care education for adults (i.e. exercise, nutrition, stress management, relationships and finances).
Brief counseling and advice to reduce alcohol use.
Mentoring programs for young children
A variety of adult-supervised after-school and weekend activities
4.3.3 Cultural and religious considerations

Attitudes toward mental illness vary among individuals, families, ethnicities, cultures, and countries. Cultural and religious teachings often influence
beliefs about the origins and nature of mental illness, and shape attitudes
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Health
towards the mentally ill. In addition to influencing whether mentally ill

individuals experience social stigma, beliefs about mental illness can affect
patients readiness and willingness to seek and adhere to treatment.Therefore, understanding individual and cultural beliefs about mental illness is
essential for the implementation of effective approaches to mental health
care. Although each individuals experience with mental illness is unique,
the following studies offer a sample of cultural perspectives on mental illness.
A review of ethno cultural beliefs and mental illness stigma by
Abdullah et al. (2011) highlights the wide range of cultural beliefs surrounding mental health. For instance, while some American Indian tribes do not
stigmatize mental illness, others stigmatize only some mental illnesses, and
other tribes stigmatize all mental illnesses. In Asia, where many cultures
value conformity to norms, emotional self-control, [and] family recognition through achievement, mental illnesses are often stigmatized and seen
as a source of shame.However, the stigmatization of mental illness can be
influenced by other factors, such as the perceived cause of the illness. In a
2003 study, Chinese Americans and European Americans were presented
with a vignette in which an individual was diagnosed with schizophrenia
or a major depressive disorder. Participants were then told that experts had
concluded that the individuals illness was genetic, partly genetic, or
not genetic in origin, and participants were asked to rate how they would
feel if one of their children dated, married, or reproduced with the subject
of the vignette. Genetic attribution of mental illness significantly reduced
unwillingness to marry and reproduce among Chinese Americans, but it
increased the same measures among European Americans, supporting previous findings of cultural variations in patterns of mental illness stigmatization.
Many studies have reported other significant differences in attitudes towards mental illness among ethnic groups in the United States.
The study conducted an intensive 18-month observation-based ethnographic study of 25 severely mentally ill individuals living in inner city
Hartford, Connecticut. The European American participants frequently
sought care from mental health professionals and tended to express beliefs about mental illness that were aligned with biomedical perspectives on
disease. In contrast, African American and Latino participants were more
likely to emphasize non-biomedical interpretations of mental illness
symptoms. Although participants of all three ethnic groups reported experiencing stigma due to their mental health, stigma was a core component
of the African Americans responses but was not highly emphasized by the
European Americans. While European Americans tended to view psychiatric medications as central and necessary aspects of treatment, African
American participants reported frustration over mental health professionals focus on medication. Furthermore, Latino participants often viewed
clinical diagnoses as potentially very socially damaging, preferring to describe their mental health conditions more generally asnervios,which was
perceived to hold less stigma. Because African Americans and Latinos in
the U.S. are significantly less likely to seek and receive mental health care
compared to European Americans, investigating possible cultural contributions to this usage pattern may help efforts to increase uptake of mental
health care services.
There are also report negative attitudes toward health care professionals among many African Americans, noting that stigma, religious beliefs,
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distrust of the medical profession, and communication barriers may contribute to African Americans wariness of mental health services.In a 2007
study, approximately 63% of African Americans viewed depression as a
personal weakness, 30% reported that they would deal with depression
themselves, and only one-third reported that they would accept medication for depression if prescribed by a medical professional.Because African
Americans are less likely to receive proper diagnosis and treatment for depression and are more likely to have depression for longer periods, African
Americans perceptions of mental illness and the medical profession should
be taken into account in efforts to improve mental health care access.
Although the reasons for stigmatization are not consistent across communities or cultures, perceived stigma by individuals living with mental
illness is reported internationally. For instance, the World Mental Health
Surveys showed that stigma was closely associated with anxiety and mood
disorders among adults reporting significant disability. The survey data,
which included responses from 16 countries in the Americas, Europe, the
Middle East, Africa, Asia, and the South Pacific, showed that 22.1% of participants from developing countries and 11.7% of participants from developed countries experienced embarrassment and discrimination due to their
mental illness. However, the authors note that these figures likely underestimate the extent of stigma associated with mental illness since they only
evaluated data on anxiety and mood disorders.
Finally, presenting mental health care services in culturally-sensitive
ways may be essential to increasing access to and usage of mental health
care services, as local beliefs about mental health often differ from the
Western biomedical perspective on mental illness. For example, one study
comparing Indian and American attitudes toward mental illness surveyed
students at a university in the Himalayan region of Northern India and at
a university in the Rocky Mountain region of the United States. The Indian
students were more likely to view depression as arising from personally
controllable causes (e.g. failure to achieve goals) and to endorse social support and spiritual reflection or relaxation as ways to deal with depression. The reports that conceptualizations and treatments for depression
should take into account diverse perspectives on mental illness in order to
maximize the effectiveness of mental health care delivery programs.
4.4 EMOTIONAL MENTAL HEALTH

ISSUES AROUND THE WORLD
People who are emotionally healthy are in control of their emotions and
their behavior. They are able to handle lifes challenges, build strong relationships, and recover from setbacks. But just as it requires effort to build
or maintain physical health, so it is with mental and emotional health. Improving our emotional health can be a rewarding experience, benefiting all
aspects of our life, including boosting our mood, building resilience, and
adding to our overall enjoyment of life.
What is mental health or emotional health?

Mental or emotional health refers to our overall psychological well-being. It
includes the way we feel about ourself, the quality of our relationships, and
our ability to manage our feelings and deal with difficulties.
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Good mental health is not just the absence of mental health problems.
Being mentally or emotionally healthy is much more than being free of depression, anxiety, or other psychological issues. Rather than the absence
of mental illness, mental and emotional health refers to the presence of
positive characteristics.Similarly, not feeling bad isnotthe same as feeling
good. While some people may not have negative feelings, they still need
to do things that make them feel positive in order to achieve mental and
emotional health.
People who are mentally and emotionally healthy have:
A sense of contentment.
A zest for living and the ability to laugh and have fun.
The ability to deal with stress and bounce back from adversity.
A sense of meaning and purpose, in both their activities and their
relationships.
The flexibility to learn new things and adapt to change.
A balance between work and play, rest and activity, etc.
The ability to build and maintain fulfilling relationships.
Self-confidence and high self-esteem.
These positive characteristics of mental and emotional health allow us
to participate in life to the fullest extent possible through productive, meaningful activities and strong relationships. These positive characteristics also
help us to cope when faced with lifes challenges and stresses.
Being emotionally and mentally healthy does not mean never going
through bad times or experiencing emotional problems. We all go through
disappointments, loss, and change. And while these are normal parts of
life, they can still cause sadness, anxiety, and stress. The difference is that
people with good emotional health have an ability to bounce back from
adversity, trauma, and stress. This ability is called resilience. People who are
emotionally and mentally healthy have the tools for coping with difficult
situations and maintaining a positive outlook. They remain focused, flexible, and creative in bad times as well as good.
One of the key factors in resilience is the ability to balance stress and
our emotions. The capacity to recognize our emotions and express them
appropriately helps us avoid getting stuck in depression, anxiety, or other
negative mood states. Another key factor is having a strong support network. Having trusted people we can turn to for encouragement and support will boost our resilience in tough times.
Physical Health is connected to mental and emotional health

Taking care of our body is a powerful first step towards mental and emotional health. The mind and the body are linked. When we improve our
physical health, well automatically experience greater mental and emotional well-being. For example, exercise not only strengthens our heart and
lungs, but also releases endorphins, powerful chemicals that energize us
and lift our mood.
The activities we engage in and the daily choices we make affect the
way we feel physically and emotionally.
Get Enough Rest:To have good mental and emotional health, its
important to take care of our body. That includes getting enough
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sleep. Most people need seven to eight hours of sleep each night in
order to function optimally.
Learn about good nutritionand practice it: The subject of nutrition is complicated and not always easy to put into practice. But the
more we learn about what we eat and how it affects our energy and
mood, the better we can feel.
Exerciseto Relieve Stress and Lift Our Mood. Exercise is a powerful
antidote to stress, anxiety, and depression. Look for small ways to
add activity to our day, like taking the stairs instead of the elevator
or going on a short walk. To get the most mental health benefits, aim
for 30 minutes or more of exercise per day.
Get a dose of Sunlight Every Day: Sunlight lifts our mood, so try to
get at least 10 to 15 minutes of sun per day. This can be done while
exercising, gardening, or socializing.
Limit Alcohol and Avoid Cigarettes and Other Drugs: These are
stimulants that may unnaturally make us feel good in the short
term, but have long-term negative consequences for mood and emotional health.
Risk factors
Certain factors may increase our risk of developing mental health problems, including:
Having a biological (blood) relative, such as a parent or sibling, with
a mental illness
Experiences in the womb for example, having a mother who was
exposed to viruses, toxins, drugs or alcohol during pregnancy
Experiencing stressful life situations, such as financial problems, a
loved ones death or a divorce
Having a chronic medical condition, such as cancer
Experiencing brain damage as a result of a serious injury (traumatic
brain injury), such as a violent blow to the head
Having traumatic experiences, such as military combat or being assaulted
Use of illegal drugs
Being abused or neglected as a child
Having few friends or few healthy relationships
Having a previous mental illness
Mental illness is common. About 1 in 4 adults has a mental illness
in any given year. About half of U.S. adults will develop a mental illness
sometime in their lives. Mental illness can begin at any age, from childhood
through later adult years.
4.5 EMOTIONAL MENTAL HEALTH

IMPROVEMENT
Mental health is essential to a persons health and well-being. Mental health
problems are found in people of all ages, regions, countries and societies.
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This webpage can provide us with information that can help us to look after
our own emotional and mental health as well as how to help others.
There are a wide variety of things which contribute to experiencing
such problems but there are also a range of things which people can do to
help prevent and improve any difficulties.It is important that awareness is
increased about possible contributors to mental health problems, recognizing signs and symptoms and also how to improve these symptoms and
help prevent any problems from becoming worse.
The more of the things we do the more our mental well-being can benefit and the less likely we are to develop a mental health problem. However,
this does not exclude the possibility of experiencing such problems, as it
varies from person to person and depends upon life events.
Social support
Research has shown that people who have good social support from family and friends are better able to deal with stressors and cope with change.
Having support from other people seems to act as a protecting factor against
mental health difficulties. Therefore, it is important to build support and to
keep in contact with people, even when we do not feel so good. It is probably even more important to have contact with those people at the times
when we feel anxious or low in mood.
It is helpful to imagine if it was one of our friends or family who was

feeling low in mood or anxious/stressed. How would we help them? What
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would we say? What would we think of them? This can give a good indication of how others may think in a positive way about us, when we may not
feel positive about ourself.
Express ourself
Communication and expressing how we feel are a key aspect of mental
well-being. When feelings and thoughts are not expressed, they do not usually just go away. This could build up to contribute to feelings of stress,
anger or low mood, which can also affect physical as well as mental wellbeing. Even though there are many reasons why people do not feel they
want to talk about their own feelings, it is important to do so sometimes.
Another positive way of expressing feelings is by writing. Even if we
do not share it with anyone, things often look clearer when on paper, rather
than lots of things whizzing around our head.
Take time for ourself

It is important to keep a balance in life and make time for us. Think of
things that we like doing and ways of relaxing. Sometimes it is good to have
a hobby/interest which is just for us to enjoy. It is helpful to take some time
every day if possible so that we can feel more relaxed and better manage
any stress.
Stress can build up if we are always doing things that we feel need
to be done, including things for other people and we are not doing many
pleasurable activities. There needs to be a balance. Therefore, as stress increases we should try to balance it out by also increasing time for us to
relax. After all, we cannot help others if we do not help ourself first.
Laughing
Research has found that laughing has great health benefits, both physically and mentally. There are lots of health benefits to humor and it is of-
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ten used as a therapy. One of these benefits is that when we laugh certain
hormones are released called endorphins. These endorphins help create a
feeling of happiness, which helps reduce feelings of depression and stress.
Therefore, this reduces potentially harmful chemicals that can be produced
by prolonged feelings of stress. This also makes us feel more relaxed and
therefore, we are in a much better position to deal with the not-so-good
things that happen in day-to-day life.
Exercise
Extensive research has found the great benefits that exercise has, not just
on physical health but also, importantly, on mental health. Regular exercise has been found to significantly reduce depression and anxiety/stress.
Physical activity prompts the brain to produce chemicals such as serotonin
and endorphins, which are found to be lacking in a person who suffers
depression.
After exercising we are likely to feel a sense of achievement, which

helps increase motivation (reduced motivation is often one of the main
symptoms of depression) and improve self-esteem (low self-esteem is a major contributor to mental health difficulties).
Positive thinking
Thinking positively is very important when considering well-being. Negative thinking can blow problems up and is associated with the development
and maintenance of depression/anxiety. Once a person continues to think
in this unhelpful way, they find it difficult to turn their thoughts to be more
positive. Nobody is able to think positively all the time, but when thinking
in a negative way it is important to have the ability to recognize this and to
then challenge this way of thinking, so that this way of thinking does not
become frequent (e.g. consider if there are any alternative explanations or
ways of seeing a situation).
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Positive thinking will eventually improve mood (e.g. frustration, feeling down), physical symptoms (e.g. sweating, increased heart rate/breathing) and also help us to do things (e.g. things we may not enjoy doing).
Negative thoughts cause negative emotions/moods (e.g. sadness, anger,
helplessness, dread etc), which sometimes leading to feelings of anxiety and
low mood
Healthy diet
Having a healthy diet is very important for physical and mental health. Certain foods and drinks can affect mood. For example, caffeine can increase
anxiety and chocolate causes changes in blood sugar levels, which can
sometimes result in periods of low mood. Serotonin helps stabilize mood
and when a person suffers low mood, this chemical is found to be reduced.
Bananas have been found to help promote production of the brain chemical
serotonin.
Eating healthily is also important in maintaining energy levels and energy is needed in order to function effectively both physically and mentally.
Alcohol should be drunk in moderation. Alcohol is a depressant so it can
have negative effects on mood and increase feelings of anxiety. This can
either be during or after drinking alcohol.
Setting goals
Increased activity is associated with positive moods/feelings. Although
when a persons mood is lower they may not feel like doing anything and
everything seems more of an effort, it is actually more important than usual
activity is maintained as much as possible. Lack of activity seems to prolong
negative feelings and motivation can reduce further, resulting in feeling
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stuck in that mood. It is important to set small achievable goals and try
to focus on achieving these no matter how we feel. Achievement helps increase self-esteem and by increasing our self-esteem it helps protect us from
suffering low mood/anxiety.
Activity therapies
Activity therapies, also called expressive therapies promote healing
through active engagement. These therapies include music therapy, art
therapy,dance therapy,drama therapy,writing therapy, andplay therapy.
Alternative therapies
Alternative therapy is a branch ofalternative medicine, which includes a
large number of therapies imported from other cultures. It also includes
a number of new medicines that have not yet passed through the process of scientific review. Alternative therapies include traditional medicine,prayer,yoga,traditional Chinese medicine,Ayurvedic medicine,homeopathy,hypnotherapy, and more.
Meditation
Increased awareness of mental processes can influence emotional behavior and mental health. A 2011 study incorporating three types of meditative practice (concentration meditation, mindfulness meditation and
compassion toward others) revealed that meditation provides an enhanced
ability to recognize emotions in others and their own emotional patterns, so
they could better resolve difficult problems in their relationships.
Biofeedback
Biofeedbackis a process of gaining control of physical processes and brainwaves. It can be used to decrease anxiety, increase well-being, increase relaxation, and other methods of mind-over-body control.
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Group therapy
Group therapy involves any type of therapy that takes place in a setting
involving multiple people. It can include psychodynamic groups, activity
groups forexpressive therapy,support groups(including theTwelve-step
program), problem-solving andpsychoeducation groups.
Pastoral counseling
Pastoral counselingis the merging of psychological and religious therapies
and carried out by religious leaders or others trained in linking the two.
Psychotherapy
Psychotherapyis the general term for scientific based treatment of mental
health issues based on modern medicine. It includes a number of schools,
such asgestalt therapy,psychoanalysis,cognitive behavioral therapyand
dialectical behavioral therapy. However, it is also important that we do not
set too many things for ourself as this is likely to cause feelings of stress/
anxiety. By breaking down bigger tasks and only setting smaller goals,
e.g. going for a short walk, and then slowly building on that. This helps to
build confidence and motivation and therefore this leads to improvement in
mood. Setting higher goals may sometimes result in being unable to achieve
what we set out to which can eventually reduce our confidence and sometimes contribute to a low mood.
Who can I go to for help?

Everyone has bad days, which could be for no apparent reason or when
negative life events such as bereavement, accidents etc occur. However, if
we notice that negative feelings/emotions are occurring more frequently
for no apparent reason e.g. over a few weeks and we are finding them difficult to manage and would like support; it is a good idea to visit our GP.
The GP should be able to offer advice and options about services that
can provide us with support. If we prefer, there are a range of self-help
booklets available in bookshops and libraries. There is also a range of information on the internet.
4.6 PRIORITY MENTAL HEALTH

CONDITIONS
The World Health Organization (WHO) identified several priority mental
health conditions that represented a high burden (in terms of mortality,
morbidity, and disability); caused large economic costs; or were associated
with violations of human rights. The priority conditions are depression,
schizophrenia and other psychotic disorders, suicide, epilepsy, dementia,
substance use disorders, and mental disorders in children.
Depression
Major depression is one of the most common mental illnesses, with a worldwide lifetime prevalence of approximately 12%. Symptoms of depression
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include sad mood, loss of interest in activities that used to be pleasurable, weight gain or loss , fatigue, inappropriate feelings of guilt, difficulty
concentrating, and thoughts of suicide.Depression can cause problems at
work, in personal relationships, and can lead to suicide. Depression rates
are twice as high in women as in men.
Depression has also been correlated with adverse health behaviors including smoking, alcohol abuse, physical inactivity, and sleep disturbances. Antidepressants are typically used to treat depression, as are psychotherapy
and lifestyle changes. In treatment-resistant cases, some people turn to electroconvulsive therapy (ECT), in which the brain is electrically stimulated to
reduce depressive symptoms. Psychotherapy or psychological counseling
is often an important part of treatment, and includes improving problemsolving capabilities, setting goals, and changing depressive cycles of thinking.Lifestyle changes like regular exercise, avoidance of alcohol and drugs,
and adequate sleep may lessen the effects of depression.
Schizophrenia
Although the lifetime risk for schizophrenia is only 0.08-0.44 %, the symptoms that characterize the disorder can severely impair daily functioning.
Schizophrenia is a psychotic disorder categorized by a variety of symptoms. Positive symptoms (behaviors that are induced by the illness) include
hallucinations (perceiving stimuli that are not there), delusions (strongly
held false beliefs), thought disorders), and movement disorders. Negative symptoms (the feelings or behaviors that are reduced or not present
in those with the illness) include flat affect, loss of pleasure in daily life,
and not speaking. Cognitive symptoms include a decreased ability to use
information and make decisions, and problems with attention, focus, and
working memory. Although schizophrenia is rarely cured, it can often be
managed with antipsychotic medications and psychosocial interventions
such as cognitive behavioral therapy. However, the nature of the disease,
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as well as the unpleasant side effects of the medications, often decrease patient adherence to treatment regimens.
Epilepsy
Epilepsy is characterized by repeated seizures caused by abnormal electrical signaling in the brain. Epilepsy is estimated to affect approximately 50
million people worldwide, or approximately 5-8 people per 1,000, of whom
80% live in developing countries. Epilepsy can be caused by stroke, dementia, congenital brain defects, brain injuries, some metabolism disorders, and
tumors. Seizures can present differently depending on which areas of the
brain are affected . Doctors in developed nations often diagnose epilepsy by
monitoring the brains electrical activity using use EEGs (electroencephalograms) . Epilepsy treatment typically includes anticonvulsant medications
or surgery, depending on the cause and severity of the seizures.
Dementia
Dementia is characterized by a loss of brain function that impairs memory,
language, thoughts, judgment, and behavior. Dementia can be caused by
stroke, brain tumors and other brain injuries, chronic alcohol abuse, and
diseases such as multiple sclerosis, Parkinsons disease, and Alzheimers
disease (the most common type of dementia). Treatments for some forms of
dementia include antipsychotics, mood stabilizers, and stimulants, though
degenerative forms of dementia (such as Alzheimers disease) do not yet
have a cure. As life expectancies increase worldwide, dementia is becoming
an increasingly important global health issue. Currently, an estimated 24.3
million people worldwide have dementia, 60% of whom live in developing countries.By 2040, it is estimated that 71% of the projected 81.1 million
dementia cases will be in the developing world.
Alcohol and Drug Abuse
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The World Health Organization reports that 4.4% of the worldwide disease
burden is attributable to alcohol consumption, and an estimated 200 million people worldwide used illicit drugs between 2005 and 2006. Studies
suggest that alcohol and drug abuse in developing countries is rising due
to urbanization, poverty, migration, changes in technology, lack of education, and the high profit potential associated with drug sales. Alcohol and
tobacco each contribute 0.5 to 16% of the disease burden (DALYs) in developing counties. Excessive alcohol consumption can lead to injury, disease, and birth defects, while tobacco use increases the risk of a variety of
cancers, and intravenous drug use contributes to the spread of HIV/AIDS.
Substance abuse disorders are often addressed via prevention programs,
psychological counseling, medication, and support groups.
Mental Disorders in Children

Common childhood mental disorders include autism, Down syndrome,
fetal alcohol syndrome, and attention deficit disorder. Although the specific symptom set depends on the disorder, many developmental disorders
are characterized by delayed achievement of (or failure to achieve) developmental milestones, limited cognitive functioning, impaired language
or motor abilities, and behavioral problems. Childhood mental disorders
are particularly challenging to address in low-income countries due to a
lack of nutritional foods that aid in mental development, lower levels of
parental education, and limited or no social services for developmentallychallenged children.
4.7 CAUSES OF MENTAL DISORDERS

Mental disorders usually are caused by a combination of genetic and biological factors (nature) and environmental factors (nurture). Substance use
and other medical conditions also can play a role in mental health problems. Although it is difficult to separate the role of factors in an individual
presentation of mental illness, it is important to understand how these factors independently affect mental functioning so prevention and interventions can be implemented.
Genetic / Biological Causes

Many mental disorders have a genetic component, meaning a predisposition or vulnerability to a particular illness can be passed down through
family. According to the 2000 Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR), individuals with first-degree relatives suffering
from schizophrenia are at 10 times greater risk for getting the illness themselves compared to the general population. Major depressive episodes are
between one and a half and three times more common in individuals with
first-degree relatives who also suffer from major depression.
In addition, alcohol dependence, anxiety disorders and attention deficit/hyperactivity disorder (ADHD) have been found at increased incidences among those with first-degree biological family members with major
depression. Bipolar disorders have a strong genetic factor; increased incidence of either bipolar I or bipolar II disorders have been found to be between 4 and 24 percent in those with a first-degree biological relative with
the disorder. These individuals also show an increased likelihood (between
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1 and 5 percent) of developing major depressive disorder. Panic disorder

also carries a strong genetic link. According to the DSM-IV-TR, those with
first-degree biological relatives with panic disorder are 8 to 20 percent more
likely to get the disorder themselves.
Environmental Causes
Environmental conditions also play a large role in the development of, or resilience to, mental illness. Many parents struggle to provide consistent, patient and
nurturing environments for their children. Inconsistency, neglect and abuse
on the part of the parent (lack of appropriate food, vitamins or doctor visits,
for example) can affect the childs development as well as affect his ability to
construct a healthy model of interpersonal relationships and social behavior.
Other environmental factors outside the family also can affect mental health.
For example, toxins such as lead in paint have been linked to a number of
developmental and cognitive deficits, and certain foods have been linked
to hyperactivity and ADHD symptoms. Environmental disasters such as
hurricanes or earthquakes, or other dangerous situations such as a school
shooting or being mugged, can lead to symptoms of anxiety, post traumatic
stress disorder (PTSD) and depression.
General Medical Conditions

Sometimes, symptoms of mental illness arise due to a physical change or
medical condition. Traumatic brain injury can result in personality changes,
although these changes are not always negative. Other medical conditions,
such as diabetes also can affect mental health. If uncontrolled, blood sugar
fluctuations in diabetics can cause significant fluctuations in mood, temper,
impulse control and cognitive acuity.
Substance use and abuse is often co morbid with mental illness. It is
often difficult to determine if substance use triggers underlying vulnerabilities for mental illness or if individuals are self-medicating a pre-existing
mental illness, but the substances themselves can cause symptoms of mental
illness. For example, individuals who use crack, cocaine or amphetamines
can become paranoid and delusional secondary to their drug use or drug
withdraw. Alcohol and barbiturates are downers and can cause symptoms of depression or anxiety. Certain prescription medications include
side effects with potential mental illness symptoms such as hallucinations,
thoughts of suicide, sleep disorders and anxiety.

1.
2.
is a state of well-being in which the individual realizes his

or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or
her community.
(a) Physical Health
(b) Mental Health
(c) Mental Wellbeing
(d)None of These
Which of the following does not help to improve mental health?
(a) Laughing
(b) Healthy Diet
(c) Drugs, Alcohol
(d)Mediation
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3.
..is the general term for scientific based treatment of mental

health issues based on modern medicine
(a) Mediation
4.
(b) Depression
(c) Schizophrenia
(d) Psychotherapy
Which of the following is prior mental condition?

(a) Depression
(b) Positive thinking
(c) Social support (d) None of These

5. What can be thought of as a combination of our physical, mental, emotional, spiritual and social health?
(a) Mental Wellbeing
(b) Mental Illness
(c) Mental Disorder
(d) Emotional Health
6.
Mental health can also be defined as an absence of a..
(b) Mental Illness
(c) Mental Disorder
(d) Emotional Health
7.
.is characterized by repeated seizures caused by abnormal electrical signaling in the brain.
(a) Epilepsy
(c) Mental Disorder

8.
9.
(b) Mental Health
(d) Depression
The World Health Organization reports that .% of the worldwide

disease burden is attributable to alcohol consumption
(a) 10
(b) 5.5
(c) 4.4
(d) 12.4
In the 5th century B.C., ..was a pioneer in treating mentally ill

people with techniques not rooted in religion or superstition; instead,
he focused on changing a mentally ill patients environment or occupation.
(a) Hippocrates
(b) Dix
(c) Dorothea
(d) None of These
10. An inability to handle stress or anxiety can cause .

(b) Insomnia
(c) Depression
(d) None of these

1. What is Mental Health? Explain in brief.
2. Explain Significance of Mental Health.
3. Describe Perspectives of Mental Health.
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4. Write five ways to mental wellbeing.

5. What is cultural and religious considerations?
6. Explain emotional mental health issues around the world in brief?
7. Describe emotional mental health improvement.
8. Write priority mental health conditions.
9. Explain causes of mental disorders.
10. Write characteristics of mental health.

1. (b)
2. (c)
3. (d)
4. (a)
5. (a)
6. (c)
7. (a)
8. (c)
9. (a)
10. (b)
Chapter 5
Emotions and Stress
Objectives
After studying this
able to:
Describe
Emotions
and Components of
Emotion
Explain
Theories of
Emotion.
Describe
Classification
of Emotion.
Describe
Stress and its
Effect.
INTRODUCTION
The etymology of emotion is the Latin word to move something. Until the
mid 18th century the word emotion in English meant movement. Later it
came to mean political agitation or disturbance. It was only in the late 18th
century that the sense of strong feeling came to the fore. Powerful visceral
feelings are noteworthy to us because they contrast with the norm of controlled, rational, calculating thought. Emotions and thinking seem so different that we classify them as different kinds of phenomena. Emotions appear
to be natural phenomena governed by biological mechanisms that are beyond our control (autonomic). In contrast, thinking appears to be voluntary,
learned, controlled, and dependent upon cultural symbols and concepts.
Emotions are associated with art, beauty, poetry, and music. Thinking is associated with logic, science, calculation. Emotions appear so antithetical to
thinking that they are said to interfere with it. Clear thinking supposedly
requires eliminating emotions.
Despite the apparent plausibility of this viewpoint, it actually rests upon
a number of misconceptions. The most fundamental error is dichotomizing
emotions and thinking and attributing them to different processes. A little
reflection reveals that all thinking entails feelings -- e.g., thinking about going to work entails feelings of displeasure while thinking about going home
entails pleasurable feelings; thinking about a problem entails feelings of frustration, despair, or excitement. Similarly, all feelings entail thinking. Artistic
work which is regarded as emotion-laden and emotion-driven is not purely
emotional; it requires serious cognitive planning and reflection. Conversely, scientists are not devoid of emotions in their work. They are passionate
about their work; they feel a sense of intrigue, frustration, satisfaction, and
even elation and aesthetic appreciation at discovering a new phenomenon
or formulating an elegant theory. Emotions do not cause thinking to be nonobjective; they can motivate a passionate concern for objectivity -- as anger
at falsehood or injustice often does. Objective thinking entails feelings, and
non-objective thinking entails cognition. Objective thinking is more precise,
comprehensive, and insightful than non-objective thinking. However, it is
just as emotional.
Emotions are feelings that accompany thinking. They are the feeling side
of thoughts; thought-filled feelings; thoughtful feelings. Emotions never exist alone, apart from thoughts. The thoughts that are felt may be implicit and
difficult to fathom, however they are ultimately knowable. We may be fascinated by intense feelings however we should not be deluded into thinking
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that they have an independent existence apart from cognition. They are as
dependent on cognition as weak feelings are.
If feelings and thinking are two sides of the same coin, different aspects
of one thing, then the term emotion must be reconceptualized. It must
denote feeling sides of thoughts, or thoughtful feelings, rather than feelings
as a distinctive phenomenon.
Articulating the cultural nature of emotions requires a comprehensive, coherent concept of culture. Without such a concept, we would have
no framework for understanding what was cultural about emotions. We
would have no parameters for deciding what cultural includes. The most
specific and comprehensive conception of culture as it encompasses psychological phenomena is Vygotskys work on activity theory. Vygotskys
conception is more specific and comprehensive than the standard general
definition of culture as the totality of socially constructed behaviors, beliefs,
and objects. Vygotsky accepted this definition as far as recognizing that
cultural phenomena are humanly constructed artifacts rather than natural
products, and that cultural phenomena are social facts in Durkheims sense
of being emergent products of social interactions rather than individual
creations. However, this general definition provides no guidelines for identifying specific aspects of culture that are vital to emotions. Consequently,
Vygotsky developed a more concrete definition of culture that bears on
emotions. While Vygotskys work requires refinement, it is an important
step in delineating the cultural nature, origins, characteristics, functions,
and formation of emotions.
Emotions exert and incredibly powerful force on human behavior.
Strong emotions can cause us to take actions that might not normally performed, or avoid situations that we generally enjoy. So what exactly are
emotions? What causes these feelings? Learn more about some of the major
theories of emotion that have been proposed by researchers, philosophers
and psychologists.
What Is Emotion?
In psychology, emotion is often defined as a complex state of feeling that
results in physical and psychological changes that influence thought and
behavior. Emotionality is associated with a range of psychological phenomena including temperament, personality, mood and motivation. According to author David G. Meyers, human emotion involves ...physiological
arousal, expressive behaviors, and conscious experience.
5.1 COMPONENTS OF EMOTION

In Scherers components processing model of emotion, five crucial elements
of emotion are said to exist. From the component processing perspective,
emotion experience is said to require that all of these processes become coordinated and synchronized for a short period of time, driven by appraisal
processes. Although the inclusion of cognitive appraisal as one of the elements is slightly controversial, since some theorists make the assumption
that emotion and cognition are separate but interacting systems, the component processing model provides a sequence of events that effectively describes the coordination involved during an emotional.
Key Vocabulary
Emotion:A psychological
state that arises spontaneously rather than
through conscious effort
and is sometimes accompanied by physiological
changes; a feeling.
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Cognitive appraisal: provides an evaluation of events and objects

Bodily symptoms: the physiological component of emotional experience
Action tendencies: a motivational component for the preparation
and direction of motor responses.
Expression: facial and vocal expression almost always accompanies
an emotional state to communicate reaction and intention of actions
Feelings: the subjective experience of emotional state once it has occurred
Key Vocabulary
Stress:Stress is the
bodys reaction to a
change that requires
a physical, mental or
emotional adjustment or
response.
The component that seems to be the core of common sense approaches

to emotion, the one that most people have in mind when talking about human emotions, is the feeling component, i.e., the passion or sensation of
emotion. For example, people generally agree that the state of mind during
anger is different from that when one is happy. This component is also one
of the most contentious in scientific discussions of emotion, raising many
questions such as:
To what extent are such feelings, especially the claimed differences
in quality, based on real physical differences?
Is the feeling quality of a particular emotion shared among people?
What is the nature of the differences in quality among emotions?
What underlies or produces these feelings?
What importance or function do such feelings have?
Another obvious descriptive component of emotion is the set of behaviors that may be performed and observed in conjunction with an emotion. These behaviors are produced by the striated muscular system and
are of two general types: gross behaviors of the body effected by the skeletal muscles and the so-called emotion expressions. These categories shade
into each other because any behavior can be interpreted as expressing emotion. The gross body behaviors may have no apparent adaptive value, e.g.,
wringing and rubbing the hands or tapping a foot, or they may be directed
towards a goal, e.g., striking something or running away. In the field of
animal behavior, discovering the adaptive function and organization of
behaviors in situations analogous to human emotion, and speculating on
the evolutionary patterns of these behaviors is an established endeavor.
This emphasis has not typically been given to the study of human emotions
by psychologists. The facial and bodily behaviors called emotion expressions are indicators of emotion, as opposed to effecting some action or
achieving some goal. These expressions can differentiate one emotion from
another. The most widely discussed and investigated emotion expressions
are the emotion faces.
A less obvious component of emotion is the set of internal bodily
changes caused by the smooth muscles and glands. Chemicals secreted
by the bodys various glands are activated during emotion and spread to
other parts of the body, usually by the blood, to act in diverse ways on the
nervous system and other organs. Smooth muscles of the digestive system,
circulatory system, and other bodily components can shift from their typical level or type of operation during emotion under the effects of chemical
and neural action. This component includes some behaviors that can be
observed, such as the constriction or dilation of the iris of the eye, possibly
piloerection, and sweating, blanching, and flushing of the skin, and other
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responses that are relatively hidden, such as heart rate, stomach activity,
and saliva production.
Another less observable component in emotion consists of the ideation,
imagery, and thoughts that occur during emotion. These aspects of emotion
are also cognitive activities, and can both give rise to an emotional event
and be affected by it, e.g., thinking about a lost pet may evoke feelings of
sadness, which may in turn evoke memories of a romance now finished.
Since thoughts and other cognitions, like feelings, cannot be directly observed and are hard to measure, there is less understanding of how they fit
into the emotion picture than other components.
The circumstances that give rise to emotions comprise another component, called the elicitors of emotion. These elicitors might be internal or
external to the organism, e.g., a frightening pain in ones chest or a frightening dog at ones heels. Some events seem to activate similar emotion in
people of all cultures, for example, the death of ones own child typically
elicits sadness. Other things, such as what foods are relished or rejected
with disgust, vary widely according to acculturation.
Finally, the neural processes that underlie much of the preceding activities can be considered a component of the emotion process, especially
how the neurons and their emotional concomitants are organized centrally
in the brain. Many contemporary research studies, and thus a lot of the
research money, is focussed on anatomical and functional aspects of brain
activity in regard to emotion.
5.2 CLASSIFICATION OF EMOTION

Psychologists have yet to fully tackle the question How many emotions
do we have?
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Part of the difficulty is because our experiences are so complex and

involve so many different factors, so distinguishing one emotion from another is a lot like drawing lines of sand in the desert. It can be hard to determine where one emotions ends or another begins. Even when we analyze a commonsense emotion like happiness or anger, we know from
everyday experience that these emotions come in many different degrees,
qualities, and intensities. In addition, our experiences are often comprised
of multiple emotions at once, which adds another dimension of complexity
to our emotional experience.
Despite how difficult these distinctions may be, plenty of psychologists
have attempted to classify our emotions into different categories. Early philosophy of mind posited that all emotions could be categorized as either
pleasure or pain, but since then more in depth theories have been put
forth. Here we want to go over some of the main theories that have been
researched over the past half century.
Ekmans List of Basic Emotions (1972)

Ekman devised his list of basic emotions after doing research on many
different cultures. He would describe a situation and ask individuals
to choose a facial expression that best fit. He would also show photographs of different facial expressions and ask individuals to identify
the emotion. Across all cultures studied, Ekman found 6 basic emotions:
Anger
Disgust
Fear
Happiness
Sadness
Surprise
Ekman added to this list in the 1990s, but stated that not all of these can
be encoded via facial expressions:
Amusement
Contempt
Contentment
Embarrassment
Excitement
Guilt
Pride in achievement
Relief
Satisfaction
Sensory pleasure
Shame
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Plutchiks Wheel of Emotions (1980)

Robert Plutchik created a new conception of emotions in 1980. He called it
the wheel of emotions because it demonstrated how different emotions
can blend into one another and create new emotions. Plutchik first suggested 8 primary bipolar emotions: joy versus sadness; anger versus fear;
trust versus disgust; and surprise versus anticipation. From there Plutchik
identified more advanced emotions based on their differences in intensities.
If we look at the diagram below we can see how each emotion relates to the
other:
Parrots Classification of Emotions (2001)

The most nuanced classification of emotions so far is probably Parrots 2001
theory. Parrot identified over 100+ emotions and conceptualized them as a
tree structured list:
Research of Emotions In The Future

As we can tell, there is a lot of disparity on how researchers choose to group
different emotions. It is amazing to me how despite all the technology and
scientific advancements we have made, we still do not have a clear-cut answer on how many emotions the human mind is capable of experiencing.
We assume that future research is going to build on the above theories and
start identifying the neural correlates between each emotion (measured
through MRI brain scans). Neuroscience is probably the only way to determine an objective measure of what emotions we have and how they
related to one another. Unfortunately, there is still a lot of research to be
done, so we are probably going to have to sit and wait until we can learn
more about the emotional aspects of the human mind.
5.3 THEORIES OF EMOTION

The major theories of Emotion can be grouped into three main categories:
physiological, neurological and cognitive. Physiological theories suggest
that responses within the body are responsible for emotions. Neurological
theories propose that activity within the brain leads to emotional responses.
Finally, cognitive theories argue that thoughts and other mental activity
play an essential role in the formation of emotions.
The James-Lange Theory of Emotion

The James-Lange theory is one of the best-known examples of a physiological theory of emotion. Independently proposed by psychologist William
James and physiologist Carl Lange, the James-Lange theory of emotion suggests that emotions occur as a result of physiological reactions to events.
According to this theory, we see an external stimulus that leads to a
physiological reaction. Our emotional reaction is dependent upon how we
interpret those physical reactions. For example, suppose we are walking
in the woods and we see a grizzly bear. We begin to tremble and our heart
begins to race. The James-Lange theory proposes that we will interpret our
physical reactions and conclude that we are frightened
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The Cannon-Bard Theory of Emotion

Another well-know physiological theory is the Cannon-Bard theory of emotion. This theory states that we feel emotions and experience physiological
reactions such as sweating, trembling and muscle tension simultaneously.
More specifically, it is suggested that emotions result when the thalamus
sends a message to the brain in response to a stimulus, resulting in a physiological reaction.
Schachter-Singer Theory
Also known as the two-factor theory of emotion, the Schachter-Singer Theory is an example of a cognitive theory of emotion. This theory suggests that
the physiological arousal occurs first, and then the individual must identify
the reason behind this arousal in order to experience and label it as an emotion.
5.4 DISCIPLINARY APPROACHES

Many different disciplines have produced work on the emotions. Human
sciences study the role of emotions in mental processes, disorders, and
neural mechanisms. In psychiatry, emotions are examined as part of the
disciplines study and treatment of mental disorders in humans. Nursing
studies emotions as part of its approach to the provision of holistic health
care to humans. Psychology examines emotions from a scientific perspective by treating them as mental processes and behavior and they explore
the underlying physiological and neurological processes. In neuroscience
sub-fields such as social neuroscience and affective neuroscience, scientists
study the neural mechanisms of emotion by combining neuroscience with
the psychological study of personality, emotion, and mood. In linguistics,
the expression of emotion may change to the meaning of sounds. In education, the role of emotions in relation to learning is examined.
Social sciences often examine emotion for the role that it plays in human culture and social interactions. In sociology, emotions are examined
for the role they play in human society, social patterns and interactions, and
culture. In anthropology, the study of humanity, scholars use ethnography
to undertake contextual analyses and cross-cultural comparisons of a range
of human activities. Some anthropology studies examine the role of emotions in human activities. In the field of communication sciences, critical
organizational scholars have examined the role of emotions in organizations, from the perspectives of managers, employees, and even customers.
A focus on emotions in organizations can be credited to Arlie Russell Hochschilds concept of emotional labor. The University of Queensland hosts
EmoNet, an e-mail distribution list representing a network of academics
that facilitates scholarly discussion of all matters relating to the study of
emotion in organizational settings. The list was established in January 1997
and has over 700 members from across the globe.
In economics, the social science that studies the production, distribution, and consumption of goods and services, emotions are analyzed in
some sub-fields of microeconomics, in order to assess the role of emotions
on purchase decision-making and risk perception. In criminology, a social
science approach to the study of crime, scholars often draw on behavioral
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sciences, sociology, and psychology; emotions are examined in criminology

issues such as anomie theory and studies of toughness, aggressive behavior, and hooliganism. In law, which underpins civil obedience, politics,
economics and society, evidence about peoples emotions is often raised in
tort law claims for compensation and in criminal law prosecutions against
alleged lawbreakers (as evidence of the defendants state of mind during
trials, sentencing, and parole hearings). In political science, emotions are
examined in a number of sub-fields, such as the analysis of voter decisionmaking.
In philosophy, emotions are studied in sub-fields such as ethics, the
philosophy of art (for example, sensoryemotional values, and matters of
taste and sentimentality), and the philosophy of music (see also Music and
emotion). In history, scholars examine documents and other sources to interpret and analyze past activities; speculation on the emotional state of
the authors of historical documents is one of the tools of interpretation. In
literature and film-making, the expression of emotion is the cornerstone of
genres such as drama, melodrama, and romance. In communication studies, scholars study the role that emotion plays in the dissemination of ideas
and messages. Emotion is also studied in non-human animals in ethology, a
branch of zoology which focuses on the scientific study of animal behavior.
Ethology is a combination of laboratory and field science, with strong ties
to ecology and evolution. Ethologists often study one type of behavior (for
example, aggression) in a number of unrelated animals.
Sociology
We try to regulate our emotions to fit in with the norms of the situation,
based on many (sometimes conflicting) demands and expectations which
originate from various entities. The emotion of anger is in many cultures
discouraged in girls and women, while fear is discouraged in boys and
men. Expectations attached to social roles, such as acting as man and
not as a woman, and the accompanying feeling rules contribute to the
differences in expression of certain emotions. Some cultures encourage or
discourage happiness, sadness, or jealousy, and the free expression of the
emotion of disgust is considered socially unacceptable in most cultures.
Some social institutions are seen as based on certain emotion, such as love
in the case of contemporary institution of marriage. In advertising, such as
health campaigns and political messages, emotional appeals are commonly
found. Recent examples include no-smoking health campaigns and political campaign advertising emphasizing the fear of terrorism.
Psychotherapy and Regulation of Emotion

Emotion regulation refers to the cognitive and behavioral strategies
people use to influence their own emotional experience. For example, a
behavioral strategy in which one avoids a situation to avoid unwanted
emotions (e.g., trying not to think about the situation, doing distracting
activities, etc.). Depending on the particular schools general emphasis on
either cognitive components of emotion, physical energy discharging, or
on symbolic movement and facial expression components of emotion, different schools of psychotherapy approach the regulation of emotion differently. Cognitively oriented schools approach them via their cognitive components, such as rational emotive behavior therapy. Yet others approach
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emotions via symbolic movement and facial expression components (like

in contemporary Gestalt therapy).
Computer Science
In the 2000s, research in computer science, engineering, psychology and
neuroscience has been aimed at developing devices that recognize human
affect display and model emotions. In computer science, affective computing is a branch of the study and development of artificial intelligence that
deals with the design of systems and devices that can recognize, interpret,
and process human emotions. It is an interdisciplinary field spanning computer sciences, psychology, and cognitive science. While the origins of
the field may be traced as far back as to early philosophical enquiries into
emotion, the more modern branch of computer science originated with Rosalind Picards 1995 paper on affective computing. Detecting emotional information begins with passive sensors which capture data about the users
physical state or behavior without interpreting the input. The data gathered is analogous to the cues humans use to perceive emotions in others.
Another area within affective computing is the design of computational
devices proposed to exhibit either innate emotional capabilities or that are
capable of convincingly simulating emotions. Emotional speech processing recognizes the users emotional state by analyzing speech patterns. The
detection and processing of facial expression or body gestures is achieved
through detectors and sensors.
5.5 EMOTIONS AND MORALITY

The role of emotions in the moral domain is controversial two central features of emotions are particularly problematic for the integration of emotions into the moral domain: (1) the nondeliberate nature of emotions,
and (2) the partial nature of emotions. The nondeliberate nature has been
claimed to contradict the possibility of moral responsibility, and the partial
nature of emotions has been perceived to be incompatible with.the impartial nature of morality Although admitting the presence of these features,
emotions are very important in morality. We argue that we have some responsibility over our emotions and that emotions have both instrumental
and intrinsic moral value.
1. The nondeliberate and partial nature of emotions

Deliberate evaluations involve conscious rational processes, whereas nondeliberate evaluations are more elementary spontaneous responses. The
two types of evaluations may clash. Thus, we sometimes persist in being
afraid when our conscious and deliberate judgment reveals that we are in
no peril. We may explain such cases by assuming that certain nondeliberate evaluations become habitual to a degree where no deliberation can
change them. This corresponds to situations in which deliberate thinking,
or knowledge acquired by such thinking, fails to influence illusory perceptual contents. Spontaneous evaluations are similar to perceptual discriminations in being immediate, meaningful responses. They entail no deliberate mediating processes, merely appearing as if they were products of such
processes. Spontaneous evaluations are either the result of evolution or of
personal development. In both cases they reflect certain structures of our
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personality. They are ready-made mechanisms of appraisal. Since the evaluative patterns are part of our psychological constitution, we do not need
time to create them; we just need the right circumstances to activate them.
Complex deliberate evaluations are more recent on the evolutionary
tree: they entail conscious deliberation, characteristic mostly of human beings. The presence of emotions in some higher animals and the existence of
conflicts between emotional evaluations and deliberate thinking indicate
that at least some emotions involve spontaneous rather than deliberate
evaluations The question is whether typical emotions are not deliberate.
A key consideration in this respect is that emotions are usually generated
when the agent confronts a sudden and significant change in light of the
sudden generation of emotions, it is reasonable to suppose that they involve
spontaneous evaluations which do not require much time. If emotions are
typically immediate responses to changing situations, they probably result
from the activation of evaluative patterns or schemes which do not require
a lengthy process of deliberation. This, however, does not imply that deliberate thinking has no role in the generation of emotions. We may think
about death and become frightened, or think about our mates and become
jealous. Similarly, we may decide not to curb our anger but rather to intensify it. In such cases, deliberate thinking brings us closer to the conditions
under which evaluative patterns are spontaneously activated. Deliberate
thinking may be the immediate Cause for the activation of an evaluative
pattern, hut the emotional evaluation itself is typically nondeliberate.
Emotions are partial in two basic senses: they are focused on a narrow
area, as on one or very few objects, they, as well, express personal and interested perspectives. Emotions involve evaluations made by an interested
agent from a specific and partial perspective. Emotions direct and color our
attention: they limit what can attract and hold our attention; they make
us preoccupied with some things and oblivious to others. Emotions draw
on a personal and interested perspective. They are not detached theoretical states; they address a practical concem, often personal, associated with
readiness to act. Not everyone and not everything is of emotional significance to us. We usually cannot assume an emotional state toward someone
utterly unrelated to us. Emotions require resources of time and attention.
Since these resources are finite, emotions must bc partial and discnminative.
The partiality of emotions is clearly demonstrated by their intentional
com-ponents, namely, cognition, evaluation, and motivation. The cognitive field of emotions does not engage vaned and broad perspectives of our
surroundings but a narrow and fragmentary perspective focused upon an
emotional object and a subject-object relation. Thus, love limits a subjects
range of interest, focusing almost exclusively on a beloved and his or her relationship with the subject. As the popular song has it, Millions of people
go by, but they all disappear from view because I only have eyes for us.
Similarly, the cognitive field of an envious person is limited to some, often
petty aspects of an envied person and to the subjects own inferionty. Because of the partiality of the cognitive field in emotions, it is often distorted.
Aristotle compares emotions such as anger to hasty servants who run out
before they have heard the whole of what one says, and then muddle the
order and to dogs who bark if there is but a knock at the door, before
looking to see if it is a friend. The evaluative field of emotions is narrow
owing to its highly polarized nature. In comparlson with other people, an
emotional object is often characterized as either highly positive or highly
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negative. The motivational field is narrow in the sense that the desired
activity is often clearly preferred to any altemative. In intense emotional
states we are somewhat similar to children. Like children, our perspectives are highly partial and involved. Our immediate situations are all
that interest us; no rational explanations concerning broader perspectives are relevant. Partiality is an important, not an incidental feature of
emotions.
The spontaneous nature of emotions has been perceived to contradict
the very nature of moral responsibility. And the discriminative, partial nature of emotions has been perceivedto be incompatible with the more egalitanan and impartial nature of moral principles.
2. Emotions and moral responsibilitv

The major problem concerning the relationship between emotions and
moral responsibility concerns the allegedly necessary presence of a broad
perspective involving intellectual deliberations in moral behavior for which
we are responsible, The problem may be formulated as follows.
1. Responsibility entails free choice; if we are forced to behave in a
certain manner, we are not responsible for this behavior.
2. Free choice entails an intellectual deliberation in which alternatives
are considered and the best one is chosen. Without such consideration we cannot clearly understand the possible altennatives and are
not responsible for preferTing one of them.
3. Since intellectual deliberations are absent fiTom emotions, we cannot be responsible for our emotions.
Before facing this difficulty, it should be clear that we do impute responsibility to persons for their emotions. We praise and criticize people
for their emotions . We speak of appropriate reasons for being afraid, or
inappropnate grounds for hating someone. We often advise others to desist
from some emotions as when wc say: We have no reason to be angry.
We may also urge them to adopt emotions with the injunction: Love our
neighbor - but not our neighbors wife. The problem we face then is not
whether wc impute responsibility to persons for their emotions, but how
such imputation is possible and what kind of responsibility is imputed. Remarks such as I couldnt help it, I was madly in love with hint. or Ignore
his action, he was overcome with anger, indicate that we often do not attribute full responsibility to agents having certain emotions or acting out of
emotions. The major flaw of the argument denying our responsibility over
our emotions is that it presupposes a too simplistic picture of responsibility
and emotions.
Personal responsibility is also assigned when these three factors are
clearly absent at the time we pertbmm the particular deed, but were present
at some time in the past. Ilere we assign indirect responsibility. A drunken
driver who causes a fatal accident and a drug-addicted person who steals
in order to have money for drugs are examples of such cases. Indirect responsibility is assigned when we are responsible for cultivating the circumstances which give nse to the blameworthy deed or attitude.
In addition to indirect responsibility, legal and moral systems recognize partial responsibility. For example, provocation is understood as a
partial defense of murder, since it reduces the agents responsibility: a successful provocation plea involves a concession of partial responsibility but
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a denial of full responsibility. The personal responsibility we bear for our

emotions is mainly indirect and partial.
The view denying our responsibility for emotions often encompasses
not just a narrow notion of responsibility, but also a narrow picture of emotions. Emotions are reduced to fleeting, unreliable feelings over which we
have little control and no responsibility. In the same way that we do not
choose to have a toothache, and accordingly are not responsible for having
it, it is assumed that we do not choose our emotions and are not responsible
for them.
However, emotions are obviously more complex than fleeting feelings. The presence of intentional components such as cognition, evaluation,
and motivation enable us to impute responsibility for emotions and consequently to criticize or praise them. Indeed. emotions may be criticized or
praised with regard to their three intentional components: the cognition
ofthe situation may be flawed, false, or partial; the evaluation of the situation may be flawed or inappropnate, as when based on unfounded, vague,
or immoral grounds; and the motivational components of desires and conduct may be self-defeating, socially destructive, only of short-temm value,
or excessive. The whole emotional attitude may also be regarded as appropriate or inappropriate in the given circumstances. Thus, we may cnticize
ourselves for grieving too much or too little. Emotions may also be experienced as unsuitable with regard to their timing. It is disputable whether all
emotions. in particular love and grief, can be criticized in light ofthe above
considerations, but it is clear that we do War criticize or applaud people for
having certain emotions.
Typically, we cannot immediately induce ourselves or others to assume
a certain emotion. We do not invoke emotions by a deliberate, purposive
decision. We cannot expenence, or stop exTtenencing, an emotion by simply deciding to do so. This, however, does not imply that there are no voluntary elements in experiencing emotions, or that we are incapable of regulating our emotions. Any regulation is, however, indirect. It can be done by
changing ourselves or our environment. We can cultivate or habituate emotions by attaching more or less value to certain things. For example, attaching much importance to the bosss opinion may bring with it vulnerability
to fear and disappointment. Since emotions express our profound values,
cultivating values may also be the cultivation of emotions. We can also create or avoid the circumstances generating emotions. We may indirectly, but
intentionally, make ourselves angry, sad, or envious by imagining that the
circumstances typical of such emotions are indeed present. How we feel is
less a matter of choice at the moment than a product of choice over time in
which we habituate certain dispositions.
The view of emotional responsibility suggested here is basically Aristotelian. For Aristotle, virtuous people have the kind of character that leads
them to experience emotion in a proper way, as well as leading them to
act in a proper way. Similarly, to display vice is to depart from the proper
response; it is to show either excess or deficiency in our emotional and behavioral responses. To shape our character properly is partially our responsibility, but is neither entirely nor directly under our control. As we are
responsible for our character traits, so we are responsible for our emotions;
the responsibility for our emotions may even be greater, since it is easier
to manage them. Emotions and character traits are not raw impulses but
socialized modes of response.
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Like other types of habituation, emotional habituation can be more

successful if started at an early age. Accordingly, we have responsibility
in educating our offspring to generate the proper emotions in the proper
circumstances. We teach our children not just to avoid fire but to fear it,
not just to consort with others but love them, not just to repair wrongdoing
but to suffer remorse and shame for its execution. Habituating emotional
dispositions is also possible with adults, but it is more difficult and limited.
Our responsibility for our emotions is different from our responsibility
for our rational, calculated actions. Whereas a fully explicit reason for a rational action entails a positive evaluation of the action itself, a reason for an
emotion does not entail a positive evaluation of the emotion itself By virtue
of its causal structure alone, we can expect rational actions to be judged as
good or bad. This does not hold for emotions, insofar as they are not generated by rational processes. Accordingly, whereas we are answerable for
nomms concerning our rational actions, we are not answerable in a similar
manner for norms constituting our emotions.
We are not punished for our emotions as we are punished for our rational actions. There are hardly any legal sanctions against having certain
emotions. Nonlegal punishment for having emotions are more common.
Thus, we may not want to live with someone who is jealous or angers easily. This sort of punishment is indirect in the sense that it is not a localized response to a particular emotion, but one factor in the negative assessment of a whole person. It is then often the case that although people are
perceived to be somehow responsible for their emotions, they are hardly
punished for having them. A major reason for this is the mere indirect and
partial control over emotions. Our responsibility for our emotions is not
expressed in the particular activation of our emotional response, but in the
creation of the mechanism underlying the response, and in not preventing
the circumstances responsible for the generation of the emotional response.
The view defended here, which imputes a certain type and degree of responsibility for our emotions, avoids two extreme positions held by several
philosophers: emotions are always manifestations of freedom, and people
can never be responsible for their emotions.
After indicating the possibility of moral responsibility in the emotional
domain, we are in a position to examine the second problem concerning the
relevancy of emotions to the moral domain: the apparent incompatibility of
the partial nature of emotions with the impartial nature of moral principles.
3. The role of emotions in the moral domain

In order to show that emotions are morally valuable we must first indicate how the discriminatory, partial nature of emotions can be compatible
with the more egalitarian and impartial nature of moral principles. Those
who consider this difficulty to be unresolvable believe that emotions impede moral behavior. The functional value of emotions does not necessarily
imply moral value as well. it can be argued that although emotions have
practical value in terms of leading a more comfortable life, they have nothing to do with leading a more moral life. The difference between practical
and moral values is clearly expressed in uses of the phrase the prosperity
of the wicked and the suffering of the righteous.
The moral value of emotions may be established by showing that partial emotional Concern is not so egoistic, as it often addresses the well-being
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of others too, and that it is extremely valuable in some moral circumstances.

The inadequacy of identifying emotional, personal Concern with immoral, egoistic concern is evident from the fact that helping other people
may be as emotionally exciting as if we were gaining something for ourselves; similarly, hurting others may be as emotionally distressing as if we
were being hurt ourselves. Positive emotional states usually increase inclinations toward helping. The reverse direction is also common: helping other people may increase our happiness, and perceiving injustice can provoke
negative emotions which may lead to the elimination of the injustice. We
may enjoy greater happiness from the good fbrtune we have procured for
others than from our own. If benevolence is as essential to our constitution
as personal gratification, then helping others may be an important constituent of our happiness.
Even if we grant that emotional, personal concenn should not be identified with immoral, egoistic concern, it can be still argued that benevolent
emotional concern, whenever it appears, is quite limited in nature and
mainly refers to those who are close to us. indicating the importance of
emotions in morality should show that the partial, discriminative perspective so typical of emotions is valuable in many moral circumstances. These
circumstances can be divided into those in which the partial perspective
has instrumental moral value as a means for achieving positive moral consequences, and those in which the partial perspective has Intrinsic value as
something valuable in itself.
Emotions which in themselves can be regarded as morally negative,
may have instrumental moral value in the sense that they may lead to positive moral consequences. Jealousy is morally valuable in protecting unique
relationships; envy may encourage improvement of our situation and that
of other people; and anger may be useful in maintaining our values and selfrespect. it is often the case that pursuing our own egoistic happiness may
increase the happiness of other people as well. Adam Smiths view of economic benefits is similar: by pursuing our own private economic benefits,
we contribute to the well-being of other people. Only excessive intensity
of negative emotions is morally harmful; moderate forms of negative emotions are typically morally beneficial since they prevent indifferent attitudes
toward others. Society v. u id be less humane if we were not immediately
irritated by the presence of evil, or ashamed of our misdeeds.
Another instrumental advantage of negative moral emotions is their
necessary coupling with positive moral emotions. Emotions express our
sensitivity to what is going on around us. Elimination of negative moral
emotions would require eliminating our sensitivity, and hence, also eliminating positive moral emotions. Elimination of the capacity of jealousy and
pleasure-in-the-misfortune-of others would require elimination of love and
happiness-for-the-fortune- of-others. The elimination of the capacity of anger and shame would require the elimination of gratitude and pride.
The coupling of negative and positive emotions in the moral domain
or elsewhere is compatible with the view which assumes that an emotional
state tends to generate another emotional state with the opposite sign. Thus,
interruption of a pleasurable sexual expenence tends to create acute disappointment and irritation before a return to a neutral state. This coupling is
also compatible with the common sense idea that we cannot have emotional
highs without exposing ourselves to emotional lows. It also fits in with the
Buddhist notion that the proper object of character planning is to get rid of
all emotions, not just the unpleasant ones, since that is not feasible.
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Generally, when we describe someone as emotional we refer, among

other things, to the great sensitivity of the person: emotional reactions are
easily invoked in the person. Indeed, for many emotions too great sensitivity leads to more extreme stands in multiple directions.
The great personal involvement of an emotional relationship has not
merely advantages, but nsks as well. Those who are close to us can easily
hurt us, as the popular song puts it: We always hurt the one we love.
Telling our secrets to someone may establish a friendship relationship, but
it also exposes our vulnerability. Some people actually avoid having fnellships for this reason. I once lived in an apartment building of low-income
families. Being acquainted with my new neighbors was mostly a sad experience, as most of them had very difficult economic and social situations. I
noticed that members of one family on my floor avoided making social contacts; later on l realized that they did that in order to avoid being exposed to
the sad emotional experiences associated with these families.
The choice we face is not that of having positive emotions or a mix of
positive and negative emotions, but rather that of having close emotional
tics, or living in an isolated environment. Whereas having close emotional
ties includes many emotional benefits and risks, living in isolation has few.
Nancy Sherman rightly argues that by letting emotions play an important
role in our lives, we assent to being passive in a certain sense; we give up
control in order to be able to live emotionally. Yet, this is precisely what our
friends may value in our relationships with them that we show willingness
to be emotionally drawn, to be vulnerable to emotional losses and gains
resulting from our close relationships with them.
So far we have indicated the instrumental moral value of emotions:
they are a valuable means for leading a sensitive and moral life. I turn now
to the more crucial moral value of emotions: their intrinsic value.
The intrinsic value of emotions is expressed in the fact that from a moral
viewpoint, we care not only about how people act, but also about how they
feel. This is so since emotions are genuine expressions of our basic attitudes
and enduring values. When we really value something, our evaluation is
often accompanied by a certain emotion. Holding a certain value emotionally is necessary for adopting that value as central to us. Accordingly, an
important advantage of incorporating emotions into the moral domain is
the greater role of sincerity in our behavior. A system based on intellectual calculations can more successfully hide our real attitudes. Children,
whose behavior is based more on spontaneous emotional evaluations, are
more sincere than adults. Knowing how to hide our emotions is a personal
discovery. Teaching children good manners is teaching them, among other
things, to hide their real emotions. At least in this sense politicians are well
educated.
Although emotions express our most profound values, it is easy to
evoke them. We do not need a profound argument to generate emotions;
on the contrary, very superfficial matters easily induce emotional reactions.
Because of their depth, emotional values are comprehensive and relate to
many events in our life.
Due to the profound and sincere nature of emotional behavior, its value is particularly important in our relationships with those who are close
to us. our behavior toward our friends and family is less restrained and
more sincere; for instance, we can fall asleep while watching TV together,
expressing more freely our opinion, and be less careful in our effort not to
Emotions and Stress
insult other people. Unlike emotions, good manners often express superficial attitudes which are more typical of our behavior toward strangers.
Take, for example, the following response of Miss Manners to a question by
a professional woman in business who is wondering about the proper way
for a man to shake a womans hand: Gentlemen were taught to shake ladies hands lightly because ladies, but not gentlemen, often wear diamond
rings on their right hands.... Other reasons for light shaking include arthritis, sweaty palms, and a hand frozen onto a cocktail glass. In light of their
superficial nature, good manners can be deceptive in so far as they do not
necessarily express our genuine profound attitude .
The profound nature of emotions and their natural emergence toward
those who are close to us is related to their central moral characterization
With regard to our intimates, partial emotional treatment is morally required and justified. We ought to treat our intimates with special emotional
preference. Stephen Toulmin argues that in dealing with our families, intimates, and immediate neighbors or associates. we both expect to - and are
expected to make allowances for their individual personalities and tastes,
and we do our best to time our actions according to our perception of their
current moods and plans.
General moral rules cannot colt or the whole range of activities and attitudes required for the close and special relationships. As Anatole France
remarks, the law, in its majestic equality, forbids all men to sleep under
bridges, to beg in the streets, and to steal bread the rich as well as the poor
General moral rules are especially valuable in our behavior toward strangers.
Along similar lines, Henry Sidgwick justifies special care toward
friends insofar as we are psychologically so constituted that we are capable
of affection for only a few other persons; furthermore, most of us are not
in a position to do much good to more than a very small number of persons. Calculated, impartial behavior is often taken to indicate the lack of an
intimate, close relationship. As Grunebaum suggests, once friends begin
to keep a credit-debit accounting of their relationship (making sure that
they are not giving more than they receive or that they have not incurred
too great a debt of gratitude), the beginning of the end of the fnendship is
close at hand.Being moral is not necessarily being alienated; abiding by
morality need not alienate us from the particular commitments that make
life worthwhile. The personal emotional perspective addresses, among other things, the concern for the well-being of others. The personal element
should not be excluded from morality; it should, however, be molded in
such a way that considerations about the well-being of others are not excluded. Similarly, happiness cannot be achieved by merely comparing ourselves to others. Our personal constitution should be taken into account.
However, happiness cannot be achieved by ignoring others. Morality and
happiness combines personal and social concems.
The morality of canng suggested by some feminists attempts to incorporate personal concerns typical of the emotional domain into the general
moral domain. In this approach, the particularized self is of no lesser moral
significance than the abstract general self assumed by some impartialist
approaches to morality; sensitivity to particular differences, care and concern for individual persons are as central to morality as general principles.
The feminist struggle carries some of its supporters to the extreme position
denying any real gender differences. Such a denial undermines the very
foundations upon which a morality of canug is based: the emotional and
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moral significance of individual differences. Radical egalitarianism cannot

be integrated into the emotional domain, as it neglects individual differences which are so essential in emotions. Such differences should not harm
certain individuals. but they will give nse to different emotions toward different individuals. Legislation and contracts may reduce the nsk of harmful
discrimination in our behavior toward various individuals. but they cannot
replace care and individualistic emotional attitudes. Whereas in personal
relationships care is the essential feature, more distant relationships are
based on contract. We should avoid the tendency, prevailing in mode m
society. to base all relationships on formal contracts.
The distinction between intimates and strangers is obviously not clearcut. In addition to personal relationships toward our intimates, and nonpersonal relationships toward strangers, there are other types of relationships
in between. Thus, although my relationship with my personal physician
for the last ten years is not as personal as my relationship with my children, it is not as remote as a relationship to a complete stranger. Such a
relationship may be temmed quasi-personal relationship. Moreover, there
are circumstances in which partial emotional attitudes should be applied to
strangers, and impartial attitudes to our intimates. Some situations, such as
those in which a stranger suffers a great mistbrtune, call for our compassion. Because of the huge resources demanded by compassion, such an attitude cannot be applied to more than a few strangers. In the same way that
a partial emotional attitude is sometimes required in our attitude toward
strangers, the attitude toward our intimates should sometimes be impartial
and non-emotional. The circumstances are present when partial behavior
toward our intimates may hurt bas ic rights of strangers. Thus, when serving as judges, referees, or teachers, we should not favor our children over
strangers. Since doing that is hard, it is preferable to try to avoid such circumstances in the first place.
The personal, special care typical of emotional attitudes is by nature
limited; it cannot be directed toward everyone. The moral ideal may be
that of enlarging the circle of people enjoying our personal emotional care.
Martha Nussbaum describes the following Stoic metaphor of moral development. Imagine that each of us lives in a set of concentric circles, the
nearest being our own body, the furthest being the entire universe of human beings. The task of moral development is to move the circles progressively closer to the center, so that our parents become like ourselves, our
other relatives like our parents, and strangers like relatives. This metaphor
is apt for describing our ideal moral development, as long as it is remembered that the process of drawing the circles closer to the center can never
be completed and should not result in their elimination They express the
very foundations of ouremotional structure Our emotions will always be
more intense toward people included in the closest circle. Another task for
moral development is realizing the inevitable presence of such circles and,
accordingly, our partial emotional perspectives. One way to deal with the
shortcomings of this partiality is to be acquainted with many such perspectives. Leaming to appreciate the diversity of partial human perspectives is
crucial for giving our own perspective its proportionate weight.
Another reason for the intrinsic moral value of emotions is that
they serve as a kind of moral compass. In Death In the Afternoon,
Emest Hcmingway argues: What is moral is what we feel good after and
what is immoral is what we feel bad after. Emotions are often moral barriers for many types of immoral behavior. Some of the most horrible cn-
Emotions and Stress
mes have been committed on the basis of cool intellectual calculation. What
sometimes prevents a person from committing a cnme is emotional resistance. In one trial of white-collar workers in the United States, forty-five
individuals were convicted of secretly fixing consumer prices for electricity.
One senior executive conceded in the trial that in retrospect, he seemed to
intellectually believe that what he was doing was wrong, but he avoided
emotional recognition and heartfelt conviction about his wrongdoing.
Sometimes we must violate one moral duty in order to fulfill another,
as in cases of dirty hands, in which an agent must ham in order to help in
these situations, our moral character is expressed in the negative emotional
experiences, like sadness and regret, that are associated with them. Our
moral strength is often measured by the types of emotional resistance we
have against wrongdoing. A person who exclusively behaves in accordance
with the intellectual system may easily become indifferent to other people, since emotions express sensitivity toward other people. Moral behavior
comes harder for people who lack feelings and emotions. Such people cannot have any feeling toward their children or others; they have to convince
themselves or remind themselves to behave morally as they cannot do so
out of compassion or friendship.
We believe that emotions have three basic evolutionary functions:
an initial indication of the proper direction in which to respond; a
quick mobilization of resources, and a means of social communication.
Emotions function within individuals to indicate and regulate prionties, and between individuals to communicate intentions Since emotions are generated when we perceive a significant change in our situation, their purposes must be related to our ability to function in the
circumstances. This is clearly expressed in the first two functions. The
indicative function is required for giving us an initial direction in the
uncertain novel circumstances we are facing. The mobilizing function
of emotions is to regulate the locus of investment in the sense of allocating resources away from situations where they would be wasted,
and toward those urgent circumstances where investment will yield a
significant payoff. The communicative function is that of revealing our
evaluative stand and accordingly eliciting aid from others while insisting upon social positions. All functions are particularly important
when urgency is in evidence.
In light of these general functions, we may describe three moral functions of emotions:
1. Emotions have an epistemic role of initially indicating moral salience and hence the general moral response. Emotional sensitivity
helps us to distinguish the moral features of a given situation, and
as such serves as an initial moral guide.
2. Emotions have a motivating role of supporting moral behavior and
opposing immoral behavior. In accordance with their general mobilizing role, emotions help us to mobilize the resources needed for
moral behavior, which is often not the most convenient course of
action.
3. Emotions have a communicative role of revealing our moral values to others and to ourselves. Since emotions express our profound
values, emotional experiences can reveal these values. Taking care
of another person with sympathy and compassion can reveal our
evaluation of the person to ourselves and to the person himself
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Sometimes we do not know how much we care for someone until

emotions such as jealousy, fear, or compassion are generated.
4. Combining the emotional and intellectual perspectives

Emotional and moral attitudes are not contradictory. We can have close
emotional ties with our intimates and still exhibit moral behave ior toward
strangers. There may be cases in which the two attitudes clash, but the
conflict is not inherently unresolvable. Take, for example, loyalty whose
diverse types to our family, friends, community, and nation, usually involve some conflict between a partial emotional state and a more general
and impartial moral attitude. Thus, patriotism involves a partial preference
for the well-being of our country, which may be in conflict with a more
universal concern for the well-being of all humanity. A morally acceptable
form of patriotism, similar to the morally acceptable form of love or family
loyalty, is feasibic. We really should care more about those near and dear to
us than we care about strangers, but this should not be an exclusive concern
that violates the rights of strangers. Our love should not be a submersion
in someone else to the exclusion of worldly responsibilities. Likewise, our
partial attitude toward our nation is morally recommended, so long as it is
curbed by other moral principles.
Since particularistic emotional commitments readily lend themselves
to excesses, they should be combined with a more general and impartial
perspective for strengthening their moral value. Partial emotional attitudes
and impartial moral attitudes represent complementary perspectives for
the evaluation of human beings and their activities. A healthy human society needs all these perspectives. Utilizing such different perspectives is not
only natural but morally recommendable.
A spontaneous emotional system and a deliberate intellectual system
are both important for conducting moral life. The presence of several systems in the moral domain is as valuable as the presence of several powers in
the political domain. For example, it is important to have legislative, executive, and judicial systems, as well as national and local powers, to balance
each other in a modern democracy. The different systems oRen express
opposing tendencies and competing interests. Yet, each system retains a
somewhat independent voice and influence. It is as important for an individual as it is for a state to have potential sources of dissent from within.
The possibility of internal conflict is sometimes a wellspring of vitality and
sensitivity, and a check against one-sidedness and fanaticism. if our moral
decisions were reached only through intellectual deliberations, then our
decisions would be morally distorted insofar as they would be one-sided,
neglecting important aspects of our lives . The presence of conflict between
the intellectual and emotional systems is frequently useful from a moral
viewpoint, since it indicates a moral predicament to which we should pay
attention.
Neglecting the role of intellectual deliberations in morality is as dangerous as neglecting the role of emotions. Although emotions serve as
our moral compass, the compass may in some cases provide inadequate
directions. In oppressive societies, such as Nazi Germany, or many malechauvinist societies, inappropriate emotions have been cultivated. There,
the emotional compass becomes largely immoral, generating inappropriate emotions and requiring intellectual deliberations to reveal its deficiencies. An important task of intellectual deliberations in such societies is that
Emotions and Stress
of correcting the emotional compass. Otherwise, the intellectual objections

will hardly be expressed in actual behavior, as they will not be absorbed
into the basic evaluative system.
In addition to the emotional capacity shared by both animals and people, people also possess an intellectual capacity. It is implausible to suppose
that it is not involved in determining our moral behavior If it were not, we
would be like non-human animals. But, it would be morally dangerous to
determine our moral behavior by refemng to the intellectual capacity alone.
Some scholars argue that God acts in this way: in a cold and calculated
manner, unfeelingly, and only as reason directs. Contrary to animals and
God, the moral behavior of people is detemmined by emotions and reason.
Vir uous people should not attempt to imitate the behavior of animals or
God by basing their actions on mere emotions or reason. They should behave in a way typical of human circumstances which combines emotions
and reason. Combining emotions and reason is complex and difficult, and
only virtuous people can accomplish it smoothly. Virtuous people are not
angels; their advantage over most of us is that in their case, the combination
of emotions and reason is not a source of conflict, but instead a valuable
means to a moral and happy end.
While emotions should not be overlooked, their v eight should often
bc limited. Virtuous people are not calm and unfeeling, but they are also
not people led by passion. Their behavior is in accordance with the dictates
of reason, but it is not generated by intellectual deliberations; it is nule-described behavior rather than nule-following behavior. The role of emotions
in such behavior is crucial. As Plato suggests, a sound education consists of
training people to find pleasure and pain in the nght objects. Similarly, for
Aristotle the virtuous person is not only the one who acts virtuously, but the
person who has the appropriate emotional dispositions and character traits
while doing so. Not having the proper emotion is as significant as not acting
in accord with it. The virtuous, good-tempered person is not only someone
who acts angrily against the right person, to the nght degree, at the right
time, for the nght purpose, and in the right way, but someone who also feels
anger in these circumstances.32 in this sense, the actor Dustin Hoffman may
be considered to be a virtuous person, since he claimed that after meeting
his wife he felt no passion toward other women. There is no infidelity in the
behavior and heart of such a true lover, since the emotions and values are
not in conflict. Most other people are less fortunate, and overcoming such
a conflict is a major step toward achieving happiness. This is obviously the
case of Amencan presidents, such as John Kennedy, Bill Clinton, and even
Jimmy Carter, who once admitted that although he was very religious, he
had lusted in his heart.
An essential moral difference between virtuous people and ordinary
people is in their sensitivity. Virtuous people are less sensitive to hnmoral temptations and are more sensitive to moral wrongdoing. They cannot
be characterized merely by their insensitivity to sinful temptations; they
should also be charactenzed by their sensitivity to the suffering of other
people. In order to be a really virtuous person, it is not enough that Dustin
Hoffman desires no woman other than his wife; he should also care for
other women and men. On the opposite side, we may describe Bill Clinton
as a kind person, since he has a very positive attitude toward every woman.
Even if some womanizers are indeed kind in nature, I would not describe
them as vir uous people, since they are not insensitive to certain temptations
Dustin and Bill may be taken to represent partial and general sensitivity.
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Dustin is closer to the ideal of a virtuous person than Bill, since in close relationships, the partial perspective should be more dominant. Finding the right
proportion between the partial and general types of sensitivity is not easy, as
greater emotional sensitivity to one person may naturally lead to insensitivity
toward other people. No wonder there are so few virtuous people these days.
The emotional sensitivity of virtuous people is accompanied by a more
acute moral perception. Virtuous people can better perceive the moral features of vanous situations that they encounter in the same vein, people who
are sensitive to tea can better perceive vanous features of tea. Similarly, it
was found that anti-Semitic people can identify Jews better than other people. Moral perception in itself does not necessarily lead to moral behavior
NVe can imagine a person who clearly perceives other peoples suffering
but is totally unmoved by itthe person simply does not care. Virtuous
people do not only possess better moral perception, but also have the appropriate emotional sensitivity.
There are major difficulties in assigning emotions a major role in morality: their nondeliberate nature seems to contradict moral responsibility
and their partial nature seems to contradict the more general and egalitarian nature of morality. Conceming the first difficulty, one have argued that
we do have some kind of responsibility over our emotions. Our responsibility stems from our indirect control over the circumstances generating
emotions. The partial nature of emotions has been described as giving us a
moral perspective in addition to an intellectualist perspective. In this sense,
emotions enlarge our global perspective, thereby enabling us to conduct a
more meaningful and moral life. Emotions are especially important in our
relationships with those near and dear to us. In such circumstances, which
constitute the bulk of our everyday behavior, partial emotional attitudes are
not only possible but morally commendable. Sincerity and particular attention to specific needs, both typical of emotional behavior, are of cnucial importance Emotional attitudes are also a moral barrier against many comes.
Emotional evaluations have emerged from a long process of evolutionary
and personal moral development. Accordingly, they are morally significant
in expressing some of our deepest value commitments and in providing
basic guidelines for moral behavior. However, the crucial role of emotions
in moral life does not imply their exclusivity; the intellectual capacity is
important as well.
5.6 STRESS
Modern life is full of hassles, deadlines, frustrations, and demands. For
many people, stress is so commonplace that it has become a way of life.
Stress isnt always bad. In small doses, it can help us to perform under pressure and motivate us to do our best. But when were constantly running in
emergency mode, our mind and body pay the price. We can protect ourself
by recognizing the signs and symptoms of stress and taking steps to reduce
its harmful effects.
What is Stress?
Stress is a normal physical response to events that make we feel threatened
or upset our balance in some way. When we sense danger whether its real
or imagined the bodys defenses kick into high gear in a rapid, automatic
process known as the fight-or-flight reaction, or thestress response.
Emotions and Stress
The stress response is the bodys way of protecting us. When working
properly, it helps us to stay focused, energetic, and alert. In emergency situations, stress can save our life giving us extra strength to defend ourself,
for example, or spurring us to slam on the brakes to avoid an accident.
The stress response also helps us rise to meet challenges. Stress is what
keeps us on our toes during a presentation at work, sharpens our concentration when were attempting the game-winning free throw, or drives us to
study for an exam when we rather be watching TV.
But beyond a certain point, stress stops being helpful and starts causing major damage to our health, our mood, our productivity, our relationships, and our quality of life.
Causes of Stress
The situations and pressures that cause stress are known as stressors. We
usually think of stressors as being negative, such as an exhausting work
schedule or a rocky relationship. However, anything that puts high demands on us or forces us to adjust can be stressful. This includes positive
events such as getting married, buying a house, going to college, or receiving a promotion. What causes stress depends, at least in part, on our perception of it. Something thats stressful to us may not faze someone else;
they may even enjoy it. For example, our morning commute may make us
anxious and tense because we worry that traffic will make us late. Others,
however, may find the trip relaxing because they allow more than enough
time and enjoy listening to music while they drive.
Common External causes of Stress

Major life changes
Work
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Relationship difficulties
Financial problems
Being too busy
Children and family
5.7 EFFECTS OF STRESS ON BODY

Stress often is accompanied by an array of physical reactions. These symptoms can be characteristic of other physical or mental disorders. A health
care professional can rule out other causes after we have undergone a physical examination. Signs of stress can include the following:
sleepdisturbance (insomnia, sleeping fitfully)
clenched jaw
grinding teeth
digestive upsets
lump in throat
difficulty swallowing
agitated behavior, like twiddling fingers
playing with hair
increased heart rate
general restlessness
sense of muscle tension in body, or actual muscle twitching
noncardiac chest pains
dizziness, lightheartedness
hyperventilating
sweaty palms
nervousness
stumbling over words
high blood pressure
lack of energy
fatigue
Cognitive signs of stress include:
mental slowness
confusion
general negative attitudes or thoughts
constant worry
mind races at times
difficulty concentrating
forgetfulness
difficulty thinking in a logical sequence
the sense that life is overwhelming; cannot problem-solve
Emotional signs of stress include:
Emotions and Stress
irritation
no sense of humor
frustration
jumpiness, overexcitability
feeling overworked
feeling overwhelmed
sense of helplessness
apathy
Behavioral signs of stress include:
decreased contact with family and friends
poor work relations
sense of loneliness
decreased sex drive
avoiding others and others avoid us because were cranky
failing to set aside times for relaxation through activities such as
hobbies, music, art or reading
Recently, much has been reported about stress and its relationship to
other health problems, such as heart disease, blood pressure and depression. While research has not confirmed that having a hostile or aggressive
personality (so-called Type A) directly causes cardiovascular disease, it
may place us at greater risk, especially if our heart rate or blood pressure
rises dramatically in response to everyday stress.
Stress also has been linked to suppression of the immune system, increasing our chances of becoming ill or altering the course of an illness if
we already have one. In particular, it has been implicated as playing a role
in cancer and gastrointestinal, skin, neurologic and emotional disorders,
and even the common cold. Some studies have shown that relaxing while
listening to soothing music can improve immune system functioning and,
we can assume, help with our long-term health.
Elevated blood pressure is another response to stress. Too much stress
with little or no coping skills keeps the body revved up. Learning to relax
can help lower our blood pressure. Elevated blood pressure always should
be discussed with our family physician, who can help us sort out whether
our elevated blood pressure is due to a medical or genetic condition or a
reaction to uncontrolled stressors.
If we do not end up identifying a method to handle our stress then it
eventually can lead to a heightened sense of dysfunction. This may result
in increasedanxietyor a sense of depression because were not mastering
our world. Feeling depressed (for example, sad, pessimistic, hopeless or
helpless) is a common reaction to stress. When these symptoms are temporary, they may simply be a reflection of lifes normal ups and downs.
But if they persist for long periods of time, especially after the stressful
situation has passed, we may have a problem that could benefit from professional help.
When stress and anxiety escalate without a means to cope with the
stress, they often are linked to many troublesome psychological and physiological conditions. Oftentimes, psychological distress accompanies and/
or produces these conditions, which include:
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amnesia
sleepwalking
multiple personality
obsessive-compulsivedisorders
phobias
generalized anxiety disorder
hypochondriasis (fear and excessive complaints of bodily disease)
high blood pressure

1.
2.
3.
4.
5.
6.
7.
8.
According to author .., human emotion involves ...physiological arousal, expressive behaviors, and conscious experience.
(a) Scherer
(b) David G. Meyers
(c) Ekman
(d) Plutchik
The circumstances that give rise to emotions comprise another component, called the
(a) elicitors
(b) piloerection
(c) Expression
(d) Feelings
Robert Plutchik created a new conception of emotions which was

called as..
(a) wheel of emotions
(b) Biopolar Emotions
(c) Neuroscience
(d) None of these
.. is a normal physical response to events that make us feel threatened or upset our balance in some way
(a) Emotions
(b) Feelings
(c) Sadness
(d) Stress
In which year Robert Plutchik created a new conception of emotions?

(a) 1945
(b) 1980
(c) 1975
(d) 1990
The situations and pressures that cause stress are known as ..

(a) Nervousness
(b) Confusion
(c) Stressors
(d) Frustration
Which of the following is the emotional sign of stress?

(a) insomnia
(b) high blood pressure
(c) dizziness
(d) apathy
.. is not egoistic, as it often addresses the well-being of others

(a) Concern
(b) fatigue
(c) Jealousy
(d) irritation
9. According to Ekmans List of Basic Emotions there are .Basic

emotions.
(a) 4
(b) 5
(c) 6
(d) 10
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10. theories propose that activity within the brain leads to emotional responses.
(a) physiological
(b) Neurological
(c) cognitive
(d) None of these

1. Explain emotion in brief
2. Describe emotion and componets of emotion.
3. Write classification of emotion.
4. Explain any two theories of emotions.
5. What are disciplinary approaches.
6. Explain in short two central features of emotions
7. What is stress?
8. Explain different types of stress.
9. Write causes of stress.
10. Write difference between stress and emotions.

1. (b)
2. (a)
3. (a)
4. (d)
5. (b)
6. (c)
7. (d)
8. (a)
9. (c)
10. (b)
Chapter 6

6.1 DIGESTIVE SYSTEMS
he human digestive system is a complex series of organs and glands that

processes food. In order to use the food we eat, our body has to break the
food down into smaller molecules that it can process; it also has to excrete
waste.
Most of the digestive organs (like the stomach and intestines) are tubelike and contain the food as it makes its way through the body. The digestive
system is essentially a long, twisting tube that runs from the mouth to the
anus, plus a few other organs (like the liver and pancreas) that produce or
store digestive chemicals. Our digestive system is uniquely designed to turn
the food we eat into energy our body needs to survive. Here is how it works.
6.1.1 What is Digestion?

Digestion is the process of breaking down food so that its small enough to
be absorbed and used by the body for energy or in other bodily functions.
Food and drink must be changed into smaller molecules of nutrients to be
absorbed into the blood and carried to cells throughout the body. Digestion
is the process by which food and liquid are broken down into smaller parts so
that the body can use them to build and nourish cells, and to provide energy.
Digestion involves a number of different stages. The first phase is
known as the cephalic (head) phase. It starts before food has even entered
our mouth. The sight, smell, taste or even the thought of food will activate saliva in the mouth as well as digestive juices, which contain enzymes to break
down food. Digestion involves the mixing of food, its movement through
the digestive tract, and chemical breakdown of the large molecules of food
into smaller molecules. Digestion begins in the mouth, when we chew and
swallow, and is completed in the small intestine. The chemical process varies
somewhat for different kinds of food.
The large, hollow organs of the digestive system contain muscle that enables their walls to move. The movement of organ walls can propel food and
liquid and also can mix the contents within each organ. Typical movement
of the esophagus, stomach, and intestine is called peristalsis. The action of
peristalsis looks like an ocean wave moving through the muscle. The muscle
of the organ produces a narrowing and then propels the narrowed portion
slowly down the length of the organ. These waves of narrowing push the
food and fluid in front of them through each hollow organ.
Objectives
After studying this

able to:
Explain the
digestive
system.
Discuss the
General
Structure of
the Digestive
System.
Describe the
Regions of
the Digestive
System.
Explain The
Excretory
System.
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6.2 GENERAL STRUCTURE OF THE

DIGESTIVE SYSTEM
The first major muscle movement occurs when food or liquid is swallowed. Although we are able to start swallowing by choice, once the swallow begins, it becomes involuntary and proceeds under the control of the
nerves.
The esophagus is the organ into which the swallowed food is pushed.
It connects the throat above with the stomach below. At the junction of the
esophagus and stomach, there is a ringlike valve closing the passage between the two organs. However, as the food approaches the closed ring, the
surrounding muscles relax and allow the food to pass.
Key Vocabulary
The food then enters the stomach, which has three mechanical tasks
to do. First, the stomach must store the swallowed food and liquid. This
requires the muscle of the upper part of the stomach to relax and accept
large volumes of swallowed material. The second job is to mix up the
food, liquid, and digestive juice produced by the stomach. The lower
part of the stomach mixes these materials by its muscle action. The third
task of the stomach is to empty its contents slowly into the small intestine.
Digestion: Digestion is
the process of breaking down food so that
its small enough to be
absorbed and used by
the body for energy or in
other bodily functions.
Several factors affect emptying of the stomach, including the nature

of the food (mainly its fat and protein content) and the degree of muscle
action of the emptying stomach and the next organ to receive the stomach
contents (the small intestine). As the food is digested in the small intestine
and dissolved into the juices from the pancreas, liver, and intestine, the
contents of the intestine are mixed and pushed forward to allow further
digestion.
Finally, all of the digested nutrients are absorbed through the intestinal
walls. The waste products of this process include undigested parts of the
food, known as fiber, and older cells that have been shed from the mucosa.
These materials are propelled into the colon, where they remain, usually for
a day or two, until the feces are expelled by a bowel movement.
6.2.1 Mouth
Once food is in the mouth, the tastebuds begin determining the chemicals
within the food via their nerve endings, in order to give us the taste sensations of salt, sweet, sour or bitter. As our teeth chew and grind the food,
breaking it down, its mixed with saliva. This comprises many enzymes
including salivary amylase, which begins to break down the long chains of
starch found in foods such as bread, cereals, potatoes and pasta. Saliva also
contains mucin, which moistens the food so it can pass easily through the
digestive (gastrointestinal) tract.
6.2.2 The Oesophagus

After the food has been swallowed, it is carried down the oesophagus
(a muscular tube) towards the stomach. The oesophagus can contract and
relax in order to propel the food onwards, and each mouthful of food takes
about 6 s to reach the stomach once swallowed.
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6.2.3 The Stomach

The stomach is a sack made of muscle and, when it is empty, it has a volume of only 50 ml but this can expand to hold up to 1.5 litres or more after a meal. The walls of the stomach are made of three different layers of
muscle that allow it to churn food around and make sure it is mixed with
the stomachs acidic digestive juices. The presence of hydrochloric acid in
the stomach prevents the action of salivary amylase and helps to kill bacteria that might be present. The stomach also produces the enzyme pepsin,
which breaks down proteins (mostly found in meat, fish, eggs and dairy
products).
Key Vocabulary
Digestive system: The
digestive system is a
complex series of organs
and glands that processes food.
The hormone ghrelin is produced by cells lining the stomach. Ghrelin

stimulates hunger and tends to increase before a meal and decrease after
eating. This hormone forms part of the communication system between the
gut and the part of the brain that controls hunger and satiety (how full we
feel).
Food can stay in the stomach for a few minutes or several hours in
the gastric phase where numerous acids and enzymes are released, including the hormone gastrin. When the food has been churned into a creamy
mixture known as chyme, the pyloric sphincter (an opening controlled by
muscle) opens and chyme passes gradually into the small intestine.
6.2.4 The Small Intestine

Prebiotics are mainly indigestible carbohydrates called oligosaccharides.
On reaching the large intestine, they selectively stimulate the growth and/
or activity of beneficial microorganisms already in the colon, such as bifidobacteria and lactobacilli.
About 3ml of chyme is squirted into the small intestine at short intervals as the pyloric sphincter opens. This is known as the intestinal phase
and causes the secretion of many hormones, which all aid the digestive
process. The sphincter is designed to open partially so that large particles
are kept in the stomach for further mixing and breaking down.
Digestion and absorption of fats, protein and carbohydrates occurs in
the small intestine. Three important organs are involved:
The gall bladder provides bile salts that help to make fats easier to
absorb.
The pancreas provides bicarbonate to neutralize the acidic chyme
from the stomach, and also produces further digestive enzymes.
The intestinal wall contains cells that make up the wall of the small
intestine. These cells help to neutralize the acid and also produce
enzymes to digest food.
The inner surface of the small intestine is folded into finger-like structures called villi, which greatly increase the surface area available for absorption - in fact the surface area of the villi is equivalent to that of a tennis
court! Blood vessels receive the digested food from the villi where its then
transported through the blood stream to the liver via the hepatic portal
vein.
Probiotics are live bacteria similar to the bacterial micro-organisms
that live in the large intestine. They are often referred to as friendly bacteria, and come from food sources or dietary supplements. The mix of these
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friendly bacteria and other gut microorganisms is important for good

health, and many factors can alter this delicate balance, such as infection
or use of antibiotics. Friendly bacteria are vital for proper development of
the immune system, to protect against micro-organisms that could cause
disease, and to aid the digestion and absorption of food and nutrients.
Fat can take much longer to be broken down, with the process of fat digestion and absorption taking between 3 and 5 hr. The unabsorbed residue
of this process finally reaches the end of the small intestine and enters the
large intestine.
6.2.5 The Large Intestine

This is one of the most metabolically active organs in the body. It measures
about 1.5 m and contains over 400 different species of bacteria that break
down and utilize the undigested residues of our food, mostly dietary fibers.
As the watery contents move along the large intestine, water is absorbed
and the final product - faeces - is formed, which is stored in the rectum before excretion from the body.
Key Vocabulary
Excretion: Excretion is
the process of removing
cellular metabolic wastes
from the body.
Single-celled organisms can directly take in nutrients from their outside environment. Multicellular animals, with most of their cells removed
from contact directly with the outside environment, have developed specialized structures for obtaining and breaking down their food. Animals
depend on two processes: feeding and digestion.
Animals are heterotrophs, they must absorb nutrients or ingest food
sources. Ingestive eaters, the majority of animals, use a mouth to ingest
food. Absorptive feeders, such as tapeworms, live in a digestive system
of another animal and absorb nutrients from that animal directly through
their body wall. Filter feeders, such as oysters and mussels, collect small organisms and particles from the surrounding water. Substrate feeders, such
as earthworms and termites, eat the material (dirt or wood) they burrow
through. Fluid feeders, such as aphids, pierce the body of a plant or animal
and withdraw fluids.
Figure 6.1. The digestive systems of representative animals.
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6.3 REGIONS OF THE DIGESTIVE

SYSTEM
The digestive system uses mechanical and chemical methods to break food
down into nutrient molecules that can be absorbed into the blood. Once in
the blood, the food molecules are routed to every cell in the animals body.
Key Vocabulary
Large Intestine: This is
one of the most metabolically active organs in the
body.
There are two types of animal body plans as well as two locations for
digestion to occur. Sac-like plans are found in many invertebrates, who
have a single opening for food intake and the discharge of wastes. Vertebrates, the animal group humans belong to, use the more efficient tubewithin-a-tube plan with food entering through one opening (the mouth)
and wastes leaving through another (the anus).
Where the digestion of the food happens is also variable. Some animals
use intracellular digestion, where food is taken into cells by phagocytosis
with digestive enzymes being secreted into the phagocytic vesicles. This
type of digestion occurs in sponges, coelenterates (corals, hydras and their
relatives) and most protozoans. Extracellular digestion occurs in the lumen
(or opening) of a digestive system, with the nutrient molecules being transferred to the blood or some other body fluid. This more advanced type of
digestion occurs in chordates, annelids, and crustaceans.
The digestive tract is composed of the mouth, esophagus, stomach,
small and large intestines, and anus. Various other structures and organs,
such as the salivary glands and liver, also aid in digestion. A few of the key
structures are described below:
Salivary glands: There are three sets of glands that drain saliva into
the mouth. The saliva mixes with the feed that is being chewed and
is swallowed with the feed. Saliva, which has a high pH, is very
important in maintaining the correct pH balance in the rumen and
is a key component of rumen fluid. Therefore, the salivary glands in
ruminants are extremely productive. An adult sheep, for example,
may secrete over 25 litres of saliva per day.
Esophagus: The esophagus is a long muscular tube that runs to the
stomach. When feed is swallowed, muscles in the esophagus move
the food to the rest of the system
Stomach: The stomach of ruminants greatly differs in structure and
function compared to monogastrics (dogs, pigs, horses, humans
etc.). Monogastrics have a relatively simple, single-chambered
stomach. Sheep, like other ruminants, have three additional chambers (reticulum, rumen, and omasum) that feed passes through before reaching the true stomach (abomasum).
a. Reticulum: The reticulum is a blind pouch of the rumen that acts
as a holding area for feed after it passes down the esophagus.
The reticulum receives material coming into the digestive system and will trap large inedible objects. As there is no distinct
division between the rumen and the reticulum, they are often
referred to together (reticulo-rumen).
b. Rumen: The rumen is a very large muscular pouch, which extends within the left side of the body cavity from the diaphragm
to the pelvis. The rumen is a critical site for feed digestion in
ruminants. The rumen has a complex environment composed
of microbes, feed at various stages of digestion, gases, and ru-
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men fluid. The microbes (bacteria, protozoa and fungi) number

in the billions and are the basis of the fermentation (digestion)
process. The rumen contents separate into three zones based on
their density and particle size: gas (fermentation by-product)
rises to the top; small, dense particles sink to the bottom (grain,
well digested forage), and lighter, longer particles form a middle layer on top of the rumen fluid (recently eaten forage). Feed
remains in the rumen until the particles are small enough to pass
into the omasum.
c. Omasum: The omasum is much smaller than the rumen. It
grinds feed particles (digesta) coming from the rumen/reticulum to reduce the particle size and to absorb excess moisture.
As fermentation requires large amounts of fluid, it is important
to recapture water to avoid dehydration. From the omasum, digesta proceeds into the abomasum.
d. Abomasum: The abomasum is called the true stomach. It functions in a similar manner as the stomach of a monogastric, including the production of acids to aid in digestion of certain feed
components. Protein that is insoluble in the rumen fluid, a small
percentage of starch, and any fats in the diet are passed from the
rumen into the abomasum relatively intact. As large numbers
of microbes are also flushed from the rumen, the abomasum is
specialized to break down the microbes. These microbes are an
important source of nutrients for the ruminant.
Small intestine: The small intestine is the main site of absorption
of nutrients that have by-passed the rumen. The small intestine is
approximately 85 feet long in adult sheep. Bile and pancreatic juice
drain into the small intestine to aid in digestion of certain feed components, such as dietary fat.
Liver: The liver is a large organ, about 1.5% of an animals live
weight. It is located towards the front of the animals body cavity,
just behind the diaphragm. Newly digested and absorbed nutrients
are transported from the absorption sites to the liver for storage
and/or further processing. The liver also produces bile that drains
into the intestine to aid in the digestion of fats.
Large intestine: The mammalian large intestine consists of the caecum and the colon. The caecum is a blind pouch that opens into the
digestive tract. In ruminants, approximately 10-15% of the animals
energy requirement is supplied through microbes in the caecum.
6.3.1 Stages in the Digestive Process

Food for the most part consists of various organic macromolecules such as
starch, proteins, and fats. These molecules are polymers made of individual
monomer units. Breaking these large molecules into smaller components
involves:
Movement: propels food through the digestive system
Secretion: release of digestive juices in response to a specific stimulus
Digestion: breakdown of food into molecular components small
enough to cross the plasma membrane
Key Vocabulary
Nitrogen wastes: Nitrogen wastes are by
product of protein metabolism.
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Absorption: passage of the molecules into the bodys interior and

their passage throughout the body
Elimination: removal of undigested food and wastes
Three processes occur during what we loosely refer to as digestion.
Digestion proper, which is the mechanical and chemical breakdown of food
into particles/molecules small enough to pass into the blood. Absorption
is the passage of food monomers into the blood stream. Assimilation is the
passage of the food molecules into body cells.
6.3.2 Components of the Digestive System

The human digestive system, as shown in Figure 6.2, is a coiled, muscular
tube (69 m long when fully extended) stretching from the mouth to the
anus. Several specialized compartments occur along this length: mouth,
pharynx, esophagus, stomach, small intestine, large intestine, and anus.
Accessory digestive organs are connected to the main system by a series of
ducts: salivary glands, parts of the pancreas, and the liver and gall bladder
(bilary system).
Figure 6.2. The human digestive system.
6.3.3 Why is Digestion Important?

When we eat such things as bread, meat, and vegetables, they are not in a
form that the body can use as nourishment. Our food and drink must be
changed into smaller molecules of nutrients before they can be absorbed
into the blood and carried to cells throughout the body. Digestion is the
process by which food and drink are broken down into their smallest parts
so that the body can use them to build and nourish cells and to provide
energy. The long continuous tube that is the digestive tract is about 9 m in
length. It opens to the outside at both ends, through the mouth at one end
and through the anus at the other. Although there are variations in each
region, the basic structure of the wall is the same throughout the entire
length of the tube.
The wall of the digestive tract has four layers or tunics:
1. Mucosa
2. Submucosa
3. Muscular layer
4. Serous layer or serosa
The mucosa, or mucous membrane layer, is the innermost tunic of the
wall. It lines the lumen of the digestive tract. The mucosa consists of epithelium, an underlying loose connective tissue layer called lamina propria,
and a thin layer of smooth muscle called the muscularis mucosa. In certain
regions, the mucosa develops folds that increase the surface area. Certain
cells in the mucosa secrete mucus, digestive enzymes, and hormones. Ducts
from other glands pass through the mucosa to the lumen. In the mouth and
anus, where thickness for protection against abrasion is needed, the epithelium is stratified squamous tissue. The stomach and intestines have a thin
simple columnar epithelial layer for secretion and absorption.
The submucosa is a thick layer of loose connective tissue that surrounds
the mucosa. This layer also contains blood vessels, lymphatic vessels, and
nerves. Glands may be embedded in this layer. The smooth muscle responsible for movements of the digestive tract is arranged in two layers, an inner circular layer and an outer longitudinal layer. The myenteric plexus is
between the two muscle layers.
6.4 MOVEMENT OF FOOD THROUGH

THE SYSTEM
Water and food particles are drawn in through one siphon to the gills where
tiny, hair-like cilia move the water, and the food is caught in mucus on the
gills. From there, the food-mucus mixture is transported along a groove to
the palps which push it into the clams mouth. The second siphon carries
away the water. The gills also draw oxygen from the water flow.
In a wave-like movement, called peristalsis, muscles propel food and
liquid along the digestive tract. In general, there are six steps in the process
of moving food and liquid through the digestive system:
The first major muscle movement is swallowing food or liquid. The
start of swallowing is voluntary, but once it begins, the process becomes involuntary and continues under the control of the nerves.
The esophagus, which connects the throat above with the stomach
below, is the first organ into which the swallowed food goes.
Where the esophagus and stomach join, there is a ring-like valve
that closes the passage between the two organs. When food nears
the closed ring, the surrounding muscles relax and allow the food
to pass into the stomach, and then it closes again.
The food then enters the stomach, which completes three mechanical tasks: stores, mixes, and empties:
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a. First, the stomach stores the swallowed food and liquid, which
requires the muscle of the upper part of the stomach to relax and
accept large volumes of swallowed material.
b. Second, the lower part of the stomach mixes up the food, liquid,
and digestive juices produced by the stomach by muscle action.
c. Third, the stomach empties the contents into the small intestine.
The food is digested in the small intestine and dissolved by the juices from the pancreas, liver, and intestine, and the contents of the
intestine are mixed and pushed forward to allow further digestion.
Last, the digested nutrients are absorbed through the intestinal
walls. The waste products, including undigested parts of the food,
known as fiber, and older cells that have been shed from the mucosa, move into the colon. Waste products usually in the colon remain
for a day or two until the feces are expelled by a bowel movement.
6.5 THE EXCRETORY SYSTEM

If we knew there was poison hidden in our house, we would surely do everything possible to find and remove that poison. If we didnt, we and our
family would slowly die. How would we find it? How would we remove
it? We would probably figure out a system of searching and removing. That
would be an excretory system.
Our body does the same thing every day. Hidden throughout our body
are dangerous poisons that must be removed in order for it to survive. The
process of excretion involves finding and removing waste materials produced by the body.
The primary organs of excretion are the lungs, kidneys, and skin.
Waste gases are carried by blood traveling through the veins to the lungs
where respiration takes place. Dead cells and sweat are removed from the
body through the skin which is part of the integumentary system.
Liquid waste is removed from the body through the kidneys. Located beside the spine in our back within our ribcage, the kidneys are small
(about 10 cm long) reddish-brown organs that are shaped like beans.
Excretion is the process of removing cellular metabolic wastes from the
body. These wastes include chemicals from cellular metabolic activity and
foreign substances like drugs. During circulation, blood passes through
the kidneys in order to deposit used and unwanted water, minerals, and
a nitrogen-rich molecule called urea. The kidneys filter the wastes from
the blood, forming a liquid called urine. The kidneys funnel the urine into
the bladder along two separate tubes called ureters. The bladder stores the
urine until muscular contractions force the urine out of the body through
the urethra. Each day, our kidneys produce about 1.5 l of urine. All of it
needs to be removed from our system. This occurs through urination.
If our kidneys are diseased and not working properly, the buildup of
waste in our system will eventually lead to death. Some kidney diseases
can be treated with medication. Severe kidney diseases require more intense treatment. One treatment is called dialysis. The patients blood is
pumped through a dialysis machine which filters the waste from the blood
and returns the clean blood. A dialysis patient has to spend nearly 60 hr
each week attached to the machine.
The most radical treatment for kidney disease is a kidney transplant.

Healthy people can live comfortably with only one kidney. Therefore,
their other kidney can be donated to a person with kidney disease. The
donor and patient must have very similar genetic structures in order for
the patient to accept the new kidney without complications. The patient
also receives anti-rejection drugs. During a kidney transplant operation, the
healthy kidney is placed in the abdomen of the patient and attached to the
blood vessels and bladder. The patients original kidneys are not removed.
Cells produce water and carbon dioxide as by-products of metabolic
breakdown of sugars, fats, and proteins. Chemical groups such as nitrogen, sulfur, and phosphorous must be stripped, from the large molecules
to which they were formerly attached, as part of preparing them for energy
conversion. The continuous production of metabolic wastes establishes a
steep concentration gradient across the plasma membrane, causing wastes
to diffuse out of cells and into the extracellular fluid.
Single-celled organisms have most of their wastes diffuse out into the
outside environment. Multicellular organisms, and animals in particular,
must have a specialized organ system to concentrate and remove wastes
from the interstitial fluid into the blood capillaries and eventually deposit
that material at a collection point for removal entirely from the body.
The excretory system plays a major role in homeostasis. Because onecelled organisms are in constant contact with their environment, they do
not need excretory organs. However, multicellular organisms need a mechanism to carry waste products from cells to the external environment. Flatworms, such as planaria, have a series of excretory cells, called flame cells.
Flame cells contain cilia that direct water and metabolic wastes to enter the
cells and to pass into excretory canals. The excretory canals join with other
canals to form excretory tubules. Fluid from the excretory tubules leaves
the body through pores.
In earthworms, members of the phylum Annelida, the excretory system consists of structural units called nephridia. Each nephridium contains
a ciliated tunnel that leads to a long, coiled tubule, which leads to a bladderlike sac (a primitive bladder). Fluid moves from the internal environment
into the funnel. As fluid passes through the tubule, cells in the tubular lining absorb useful compounds such as glucose, amino acids, and salts. The
remaining materials constitute metabolic waste, and they are passed into
the bladderlike sac. The sac later opens through a pore in the earthworms
skin where the waste products are discharged.
Insects have a series of tubules for excretion called Malpighian tubules.
Fluid enters at the upper end of the tubules and passes down their entire
length. The cells in the tubular walls reabsorb precise amounts of water,
salts, and other materials to maintain delicate balance within the insect tissues. The tubules eventually lead to an insects intestine where waste products are removed.
6.5.1 Excretory System Functions

Collect water and filter body fluids.
Remove and concentrate waste products from body fluids and return other substances to body fluids as necessary for homeostasis.
Eliminate excretory products from the body.
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6.5.2 Invertebrate Excretory Organs

Many invertebrates such as flatworms use a nephridium as their excretory
organ. At the end of each blind tubule of the nephridium is a ciliated flame
cell. As fluid passes down the tubule, solutes are reabsorbed and returned
to the body fluids.
6.5.3 The Human Excretory System

The human excretory system functions to remove waste from the human
body. This system consists of specialized structures and capillary networks
that assist in the excretory process. The human excretory system includes
the kidney and its functional unit, the nephron. The excretory activity of the
kidney is modulated by specialized hormones that regulate the amount of
absorption within the nephron.
The urinary system is made-up of the kidneys, ureters, bladder, and
urethra. The nephron, an evolutionary modification of the nephridium, is
the kidneys functional unit. Waste is filtered from the blood and collected
as urine in each kidney. Urine leaves the kidneys by ureters, and collects in
the bladder. The bladder can distend to store urine that eventually leaves
through the urethra.
Kidneys
The human kidneys are the major organs of bodily excretion. They are beanshaped organs located on either side of the backbone at about the level of
the stomach and liver. Blood enters the kidneys through renal arteries and
leaves through renal veins. Tubes called ureters carry waste products from
the kidneys to the urinary bladder for storage or for release.
The product of the kidneys is urine, a watery solution of waste products, salts, organic compounds, and two important nitrogen compounds:
uric acid and urea. Uric acid results from nucleic acid decomposition, and
urea results from amino acid breakdown in the liver. Both of these nitrogen
products can be poisonous to the body and must be removed in the urine.
Nephron
The functional and structural unit of the kidney is the nephron. The nephron
produces urine and is the primary unit of homeostasis in the body. It is essentially a long tubule with a series of associated blood vessels. The upper
end of the tubule is an enlarged cuplike structure called the Bowmans capsule. Below the Bowmans capsule, the tubule coils to form the proximal
tubule, and then it follows a hairpin turn called the loop of Henle. After the
loop of Henle, the tubule coils once more as the distal tubule. It then enters
a collecting duct, which also receives urine from other distal tubules.
Within the Bowmans capsule is a coiled ball of capillaries known as a
glomerulus. Blood from the renal artery enters the glomerulus. The force
of the blood pressure induces plasma to pass through the walls of the glomerulus, pass through the walls of the Bowmans capsule, and flow into the
proximal tubule. Red blood cells and large proteins remain in the blood.
After plasma enters the proximal tubule, it passes through the coils,
where usable materials and water are reclaimed. Salts, glucose, amino ac-
ids, and other useful compounds flow back through tubular cells into the
blood by active transport. Osmosis and the activity of hormones assist the
movement. The blood fluid then flows through the loop of Henle into the
distal tubule. Once more, salts, water, and other useful materials flow back
into the bloodstream. Homeostasis is achieved by this process: A selected
amount of hydrogen, ammonium, sodium, chloride, and other ions maintain the delicate salt balance in the body.
The fluid moving from the distal tubules into the collecting duct contains materials not needed by the body. This fluid is referred to as urine.
Urea, uric acid, salts, and other metabolic waste products are the main components of urine. The urine flows through the ureters toward the urinary
bladder. When the bladder is full, the urine flows through the urethra to
the exterior.
Control of kidney function

The activity of the nephron in the kidney is controlled by a persons choices
and environment as well as hormones. For example, if a person consumes
large amounts of protein, much urea will be in the blood from the digestion
of the protein. Also, on a hot day, a body will retain water for sweating and
cooling, so the amount of urine is reduced.
Humans produce a hormone called antidiuretic hormone (ADH), also
known as vasopressin, which is secreted by the posterior lobe of the pituitary gland. It regulates the amount of urine by controlling the rate of water
absorption in the nephron tubules.
Some individuals suffer from a condition in which they secrete very
low levels of ADH. The result is excessive urination and a disease called
diabetes insipidus. Another unrelated form of diabetes, diabetes mellitus,
is more widespread. Persons with this disease produce insufficient levels
of insulin. Insulin normally transports glucose molecules into the cells. But
when insulin is not available, the glucose remains in the bloodstream. The
glucose is removed from the bloodstream in the nephron; to dilute the glucose, the nephron removes large amounts of water from the blood. Thus,
the urine tends to be plentiful.
Hormones from the cortex of the adrenal glands also control the content of urine. These hormones promote reabsorption of sodium and chloride ions in the tubules. Thus, they affect the water balance in the body,
because water flows in the direction of high sodium and chloride content.
6.6 REGULATION OF EXTRACELLULAR

FLUIDS
Excretory systems regulate the chemical composition of body fluids by removing metabolic wastes and retaining the proper amounts of water, salts,
and nutrients. Components of this system in vertebrates include the kidneys, liver, lungs, and skin.
Not all animals use the same routes or excrete their wastes the same
way humans do. Excretion applies to metabolic waste products that cross a
plasma membrane. Elimination is the removal of feces.
The ability of the kidneys to regulate extracellular fluid volume by
altering sodium excretion is important for maintaining adequate volume
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within the vascular system. This ensures that appropriate tissue perfusion
occurs under various physiological conditions. Provided that the antidiuretic and thirst systems are functional, changes in the balance between sodium intake and sodium output determined the total quantity of sodium
in the body and the volume of the extracellular compartment. For example, when sodium intake exceeds sodium output by the kidneys, total body
sodium (not Na1 concentration) and extracellular fluid volume increases.
Conversely, when renal excretion of sodium exceeds sodium intake, total
body sodium and extracellular fluid volume decrease. Thus the maintenance of a constant extracellular fluid volume depends on the bodys ability to regulate the amount of NaCl in the compartment. The body achieves
this important regulatory function by varying sodium excretion to match
the level of sodium intake. Volume
6.6.1 Changes in Sodium Balance are Sensed by

Volume-Dependent Receptors
To maintain a constant extracellular fluid volume, the body monitors the
volume of this compartment by sensors or receptors in different regions
of the body. In response to the sensory output, effector mechanisms are
activated to make appropriate adjustments in the renal output of sodium.
The portion of the extracellular fluid compartment that is sensed by these
receptors is plasma volume. Plasma volume determines the magnitude of
various hemodynamic variables that are sensed by volume and/or pressure receptors. For example, changes in plasma volume can cause changes
in the distending pressures in certain regions of the cardiovascular system.
Volume receptors are located in the low- and high-pressure portions of the
cardiovascular system. The low-pressure receptors are found in the pulmonary vasculature and in the atria. An increase in atrial pressure in response
to an increase in plasma volume activates two effector mechanisms that
enhance sodium excretion. An increase in atrial pressure decreases renal
sympathetic nerve activity via a neural reflex mechanism and increases
the release of atrial natriuretic peptide (ANP) from atrial myocytes. Conversely, a decrease in plasma volume reduces atrial pressure, which leads
to enhanced renal sympathetic nerve activity and decreased ANP secretion.
6.6.2 Water and Salt Balance

The excretory system is responsible for regulating water balance in various
body fluids. Osmoregulation refers to the state aquatic animals are in: they
are surrounded by freshwater and must constantly deal with the influx of
water. Animals, such as crabs, have an internal salt concentration very similar to that of the surrounding ocean. Such animals are known as osmoconformers, as there is little water transport between the inside of the animal
and the isotonic outside environment.
Marine vertebrates, however, have internal concentrations of salt that
are about one-third of the surrounding seawater. They are said to be osmoregulators. Osmoregulators face two problems: prevention of water loss
from the body and prevention of salts diffusing into the body. Fish deal
with this by passing water out of their tissues through their gills by osmosis and salt through their gills by active transport. Cartilaginous fish have
a greater salt concentration than seawater, causing water to move into the
shark by osmosis; this water is used for excretion. Freshwater fish must pre-
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vent water gain and salt loss. They do not drink water, and have their skin
covered by a thin mucus. Water enters and leaves through the gills and the
fish excretory system produces large amounts of dilute urine.
Terrestrial animals use a variety of methods to reduce water loss: living
in moist environments, developing impermeable body coverings, production of more concentrated urine. Water loss can be considerable: a person in
a 100 degree F temperature loses 1 l of water per hour.
6.7 NITROGEN WASTES

Metabolism produces toxic by-products. Perhaps the most troublesome is
the nitrogen-containing waste from the metabolism of proteins and nucleic acids. Nitrogen is removed from these nutrients when they are broken
down for energy or when they are converted to carbohydrates or fats. The
nitrogenous waste product is ammonia, a small and very toxic molecule.
Some animals excrete their ammonia directly; others first convert it to less
toxic wastes such as urea or uric acid (Figure 6.3). We shall see that the form
of nitrogenous waste an animal excretes depends on both the animals evolutionary history and its habitat. Ammonia Most aquatic animals excrete
nitrogenous wastes as ammonia. Ammonia molecules are small and very
nitrogenous wastes.
Figure 6.3. Urea or uric acid.

Ammonia is a toxic by-product of the metabolic removal of nitrogen
from proteins and nucleic acids. Most aquatic animals get rid of ammonia
by excreting it in very dilute solutions. Most terrestrial animals convert the
ammonia to urea or uric acid, which conserves water because these less toxic wastes can be transported in the body in more concentrated form. soluble
in water, so they easily permeate membranes. In soft-bodied invertebrates,
ammonia diffuses across the whole body surface into the surrounding water. In freshwater fishes, most of the ammonia is lost as ammonium ions
(NH4+) across the epithelium of the gills, with kidneys playing only a minor
role in excretion of nitrogenous waste. The epithelium of the gills takes up
Na + from the water in exchange for NH4 +, which helps freshwater fishes
maintain Na + concentrations much higher than that in the surrounding
water.
Nitrogen wastes are by product of protein metabolism. Amino groups
are removed from amino acids prior to energy conversion. The NH2 (amino
group) combines with a hydrogen ion (proton) to form ammonia (NH3).
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Ammonia is very toxic and usually is excreted directly by marine animals. Terrestrial animals usually need to conserve water. Ammonia is converted to urea, a compound the body can tolerate at higher concentrations
than ammonia. Birds and insects secrete uric acid that they make through
large energy expenditure but little water loss. Amphibians and mammals
secrete urea that they form in their liver. Amino groups are turned into
ammonia, which in turn is converted to urea, dumped into the blood and
concentrated by the kidneys.
Cells use amino acids to construct proteins and other nitrogencontaining molecules. Amino acids can also be oxidized for energy or
converted to fats or carbohydrates. When amino acids are oxidized or
converted to other kinds of molecules, the amino (NH2) group must be
removed. The nitrogen-containing compounds produced as a result of
protein breakdown are toxic and must be removed by the excretory system. Nitrogenous wastes of animals are excreted in form of ammonia,
urea, or uric acid.
6.7.1 Ammonia
Ammonia is formed immediately after the amino group is removed from
an amino acid. This process requires very little energy. Ammonia is highly
soluble in water but very toxic. Aquatic animals such as bony fishes, aquatic
invertebrates, and amphibians excrete ammonia because it is easily eliminated in the water.
Ammonia is a toxic by-product of the metabolic removal of nitrogen
from proteins and nucleic acids. Most aquatic animals get rid of ammonia
by excreting it in very dilute solutions. Most terrestrial animals convert the
ammonia to urea or uric acid, which conserves water because these less toxic wastes can be transported in the body in more concentrated form. soluble
in water, so they easily permeate membranes. In soft-bodied invertebrates,
ammonia diffuses across the whole body surface into the surrounding water. In freshwater fishes, most of the ammonia is lost as ammonium ions
(NH4+) across the epithelium of the gills, with kidneys playing only a minor
role in excretion of nitrogenous waste. The epithelium of the gills takes up
Na+ from the water in exchange for NH4+, which helps freshwater fishes
maintain Na+ concentrations much higher than that in the surrounding water.
6.7.2 Urea
Terrestrial amphibians and mammals excrete nitrogenous wastes in the
form of urea because it is less toxic than ammonia and can be moderately
concentrated to conserve water. Urea is produced in the liver by a process
that requires more energy to produce than ammonia does.
Ammonia excretion, though it works in water, is unsuitable for disposing of nitrogenous waste on land. A terrestrial animal would have to urinate
copiously to get rid of ammonia, because a compound so toxic could only
be transported in the animal and excreted in a very dilute solution. Instead,
mammals and most 1 amphibians excrete urea. (Many marine fishes land
turtles, which have the problem of conserving water in their hyperosmotic
environment, also excrete ) This substance can be handled in much more
concentrated form because it is about 1,00,000 times less toxic than ammo-
nia. Urea excretion enables the animal to sacrifice less water to discard its
nitrogenous waste, an important adaptation for living on land.
Urea is produced in the liver by a metabolic cycle that combines ammonia with carbon dioxide. The cir-culatory system carries the urea to the
kidneys. As mentioned earlier, not all urea is excreted immediately by mammalian kidneys; some of it is retained in the kidneys, where it contributes to
osmoregulation by helping to maintain the osmolarity gradient that functions in water reabsorption. Sharks, remember, also produce urea, which is
retained at a relatively high concentration in the blood, which helps balance
the osmolarity of body fluids with the surrounding seawater.
Amphibians that undergo metamorphosis generally switch from
excreting ammonia to excreting urea during the transformation from an
aquatic larva, the tadpole, to the terrestrial adult. This biochemical modification, however, is not inexorably coupled to metamorphosis. Frogs that
remain aquatic, such as the South African clawed toad (Xenopus), continue
excreting ammonia after metamorphosis. But if these animals are forced to
stay out of water for several weeks, they begin to produce urea. Similarly,
African lungfish switch from ammonia to urea excretion if their habitat
dries up and they are forced to burrow in the mud and become inactive.
6.7.3 Uric Acid

Insects, reptiles, birds, and some dogs (Dalmatians) excrete uric acid. Reptiles and birds eliminate uric acid with their feces. The white material seen
in bird droppings is uric acid.
It is not very toxic and is not very soluble in water. Excretion of wastes
in the form of uric acid conserves water because it can be produced in a
concentrated form due to its low toxicity. Because it is relatively insoluble
and nontoxic, it can accumulate in eggs without damaging the embryos.
The synthesis of uric acid requires more energy than urea synthesis.
Uric acid and urea represent two different adaptations that enable terrestrial animals to excrete nitrogenous wastes with a minimal loss of water. One factor that seems to have been important in determining which of
these alternatives evolved in a particular group of animals is the mode of
reproduction. Soluble wastes can diffuse out of a shell-less amphibian egg
or be carried away by the mothers blood in the case of a mammalian embryo. The vertebrates that excrete uric acid, however, produce shelled eggs,
which are permeable to gases but not to liquids. If an embryo released ammonia or urea within a she]Jed egg, the soluble waste would accumulate to
toxic concentrations. Uric acid precipitates out of solution and can be stored
within the egg as a solid that is left behind when the animal hatches.
In grouping the various vertebrates according to the nitrogenous
wastes they excrete, the boundaries are not drawn strictly along phylogenetic lines but depend also on habitat. Among reptiles, for instance, lizards,
snakes, and terrestrial turtles excrete mainly uric acid; crocodiles excrete
ammonia in addition to uric acid; and aquatic turtles excrete both urea and
ammonia. In fact, individual turtles modify their nitrogenous wastes when
their environment changes. A tortoise that usually produces urea can shift
to uric acid production when the temperature increases and water becomes
less available.
This is another example of how response to the environment occurs on
two levels: Evolution determines the limits of physiological responses for
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a species, but individual organisms make adjustments within that range as

the r environment changes. This principle also applies to the regulation of
body temperature.

1.
Digestion begins in____.

(a) Eyes
2.
3.
4.
(b) Mouth
(c) Stomach
(d) Hand
Which of these processes cannot be included in digestion?

(a) Swallow
(b) Chew
(c) Cook
(d) Drink
Which of the following organs is one of the most metabolically active

organs in the body?
(a) Small intestine
(b) Mouth
(c) Large intestine
(d) The Oesophagus
After the food has been swallowed, its carried down the oesophagus
(a muscular tube) towards the ____.
(a) Stomach
5.
6.
7.
(b) Mouth
(c) Large intestine
(d) Small intestine
What does the gall bladder provides that help to make fats easier to
absorb?
(a) Proteins
(b) Bile salts
(c) Salt
(d) None of these
What do ingestive eaters use to ingest food?

(a) Stomach
(b) Fingers
(c) Hand
(d) A mouth
How many layers the wall of the digestive tract has?

(a) Four
8.
9.
(b) Less than four
(c) Three
(c) More than three
The omasum is much ___ ___ the rumen.

(a) Bigger than
(b) Smaller than
(c) Longer than
(d) Greater than
Where is liver located of the animals body cavity.

(a) None of these
(b) Towards the back
(c) In middle
(d) Towards the front
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10. Uric acid is not very soluble in water.

(a) False
(b) None of these
(c) True
(d) Both a and c

1. Define digestive system.
2. What is the role of mouth in digestion process?
3. What is involuntary movement of food?
4. What regulates food movement in the small intestine?
5. What are the three main types of nitrogen wastes excreted by living
beings?
6. What are nitrogen wastes?
7. Explain uric acid?
8. Which are the stages in the digestion process?
9. What are the functions of excretory system?
10. Why is digestion important?

1. (b)
2. (c)
3. (c)
6. (d)
7. (a)
8. (b)
4. (a)
9. (d)
5. (b)
10. (c)
Chapter 7
Mental Disorder
INTRODUCTION
ental disorders are common in medical practice and may present either
as a primary disorder or as a comorbid state. The occurrence of mental
or substance use disorders in the United States is 18.5%, resulting in an annual cost of $148 billion dollars, only slightly less than the costs of cardiovascular diseases. Only 15% of these individuals are currently receiving treatment.
A Mental Disorder is a health condition characterized by significant dysfunction in an individuals cognitions, emotions, or behaviors that reflects a disturbance in the psychological, biological, or developmental processes underlying mental functioning. Some disorders may not be diagnosable until they
have caused clinically significant distress or impairment of performance.
The current system of classification is multiracial and includes the presence or absence of a major mental disorder (axis I), any underlying personality disorder (axis II), general medical condition (axis III), psychosocial and
environmental evils (axis IV), and overall rating of general psychosocial
functioning (axis V).
Changes in health care delivery underscore the need for primary care
physicians to assume responsibility for the initial diagnosis and treatment of
the most common mental disorders. Prompt diagnosis is essential to make
sure that patients have access to suitable medical services and to maximize
the clinical outcome.
Validated patient-based questionnaires have been developed that systematically probe for signs and symptoms associated with the most prevalent
psychiatric diagnoses and guide the clinician into targeted assessment. Prime
MD (and a self-report form, the PHQ) and the Symptom-Driven Diagnostic
System for Primary Care (SDDS-PC) are inventories that require only 10 min
to complete and link patient responses to the formal diagnostic criteria of
anxiety, mood, somatoform, and eating disorders and to alcohol abuse or
dependence.
A physician who refers patients to a psychiatrist should know not only
when doing so is appropriate but also how to refer, since societal misconceptions and the stigma of mental Disorder impede the process. Primary
care physicians should base referrals to a psychiatrist on the presence of
signs and symptoms of a mental disorder and not simply on the absence
of a physical explanation for a patients complaint. The physician should
discuss with the patient the reasons for requesting the referral or consultation and provide reassurance that he or she will continue to provide medi-
Objectives
After studying this
able to:
Explain the
mental disorder
Define the
eating disorder
Describe the
mental disorder treatment
Mental Disorder
125
cal care and work collaboratively with the mental health professional.
Consultation with a psychiatrist or transfer of care is appropriate when
physicians encounter evidence of psychotic symptoms, mania, severe depression, or anxiety; symptoms of posttraumatic stress disorder (PTSD);
suicidal or homicidal preoccupation; or a failure to respond to first-order
treatment.
7.1 WHAT ARE MENTAL DISORDERS?

A mental disorder is a mental health condition assessed as abnormal or
maladaptive and involving significant distress or disability. Mental disorder could be of various types. Some of the major mental disorders are phobias, mood disorders, cognitive disorders, personality disorders, Schizophrenia and substance related disorders like alcohol dependence.
Behavioral health care

professionals call disorders,
disorders or diseases that
have prominent emotional,
behavioral, and psychological symptoms mental disorders. These include substance
use disorders and disorders
associated with physical
changes or disorders, many
of which directly affect the
brain. For most of these disorders, however, physical
causes have not been demonstrated or are poorly understood, even though biological treatments (e.g. drugs) may be effective in
treating them. They may be distinguished from and classified separately
from the personality disorders, or the term may be used in such a way as to
include personality disorders.
Experts say we all have the potential for suffering from mental
health problems, no matter how old we are, whether we are male or
female, rich or poor, or ethnic group we belong to. In the UK over one
quarter of a million people are admitted into psychiatric hospitals each
year, and more than 4,000 people kill themselves. They come from all
walks of life.
According to the NIMH (National Institute of Mental Health, USA)
mental disorders are common in the USA and internationally. Approximately 57.7 million Americans suffer from a mental disorder in a given
year that is approximately 26.2% of adults. However, the main burden of
Disorder is concentrated in about 1 in 17 people (6%) who suffer from a serious mental Disorder. Approximately half of all people who suffer from a
mental disorder probably suffer from another mental disorder at the same
time, experts say.
In the UK, Canada, the USA and much of the developed world, mental
disorders are the leading cause of disability among people aged 15 to 44.
Key Vocabulary
Anxiety Disorders: It is
exaggerations of our normal and adaptive reaction to fearful or stressful
events.
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7.1.1 Forms of mental Disorders

The most common forms of mental Disorders are:
Anxiety Disorders: Anxiety disorders are exaggerations of our normal and adaptive reaction to fearful or stressful events. The most
common group of mental disorders. The sufferer has a severe fear
or anxiety which is linked to certain objects or situations. Most people with an anxiety disorder will try to avoid exposure to whatever
triggers their anxiety. Examples of anxiety disorders include:
Key Vocabulary
Eating Disorder: It is any
of several psychological
disorders (as anorexia
nervosa or bulimia) characterized by serious disturbances of eating behavior.
a. Panic Disorder - the person experiences sudden paralyzing terror

or imminent disaster.
b. Phobias - these may include simple phobias - disproportionate
fear of objects, social phobias - fear of being subject to the judgment of others, and agoraphobia - dread of situations where
getting away or breaking free may be difficult. We really do
not know how many phobias people may experience globally there could be hundreds and hundreds of them.
c. Obsessive-compulsive Disorder (OCD) - the person has obsessions
and compulsions. In other words, constant stressful thoughts
(obsessions), and a powerful urge to perform repetitive acts,
such as hand washing (compulsion).
d. PSTD (Post-traumatic Stress Disorder) - this can occur after somebody has been through a traumatic event - something horrible
and scary that the person sees or that happens to them. During
this type of event the person thinks that his/her life or other
peoples lives are in danger. The sufferer may feel afraid or feel
that he/she has no control over what is happening.
Mood Disorders: these are also known as affective disorders or de-
pressive disorders. Patients with these Disorders share disturbances or mood changes, generally involving either mania (elation) or
depression. Experts say that approximately 80% of patients with depressive disorder improve significantly with treatment. Examples
of mood disorders include:
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127
a. Major Depression: The sufferer is not longer interested in and

does not enjoy activities and events that he/she previously got
pleasure from. There are extreme or prolonged periods of sadness.
b. Bipolar disorder: Also known as manic-depressive Disorder, or
manic depression. The sufferer oscillates from episodes of euphoria (mania) and depression (despair).
c. Dysthymia: Mild chronic depression. Chronic in medicine means
continuous and long-term. The patient has a chronic feeling of
ill being and/or lack of interest in activities he/she once enjoyed
- but to a lesser extent than in major depression.
d. SAD (seasonal affective disorder): A type of major depression. Key Vocabulary
However, this one is triggered by lack of daylight. People get
it in countries far from the equator during late autumn, winter,
Heart Failure: It is a cliniand early spring.
cal syndrome character Schizophrenia Disorders: Whether or not schizophrenia is a single dis- ized by systemic perfuorder or a group of related Disorders has yet to be fully determined. sion inadequate to meet
It is a highly complex Disorder, with some generalizations which the bodys metabolic
exist in virtually all patients diagnosed with schizophrenia disor- demands as a result of
ders. Most sufferers experience onset of schizophrenia between 15 impaired cardiac pump
and 25 years of age. The sufferer has thoughts that appear fragment- function.
ed; he/she also finds it hard to process information. Schizophrenia can have negative or positive symptoms. Positive symptoms
include delusions, thought disorders and hallucinations. Negative
symptoms include withdrawal, lack of motivation and a flat or inappropriate mood.
7.1.2 Causes of Mental Disorders

Mental disorders usually are caused by a grouping of genetic and biological factors (nature) and environmental factors (nurture). Substance use and
other medical situation also can play a role in mental health problems. Although it is difficult to separate the role of factors in an individual presentation of mental Disorder, it is important to understand how these factors
independently affect mental functioning so prevention and interventions
can be implemented.
Genetic/Biological causes
Many mental disorders have a genetic part, meaning a tendency or vulnerability to a particular Disorder can be passed down through family. According to the 2000 Diagnostic and Statistical Manual of Mental Disorders (DSMIV-TR), individuals with first-degree relatives distress from schizophrenia
are at 10 times greater risk for getting the Disorder themselves compared
to the general population. Major depressive episodes are between one and
a half and three times more common in individuals with first-degree relatives who also suffer from major depression.
In addition, alcohol dependence, anxiety disorders and attention deficit/hyperactivity disorder (ADHD) have been found at increased incidences among those with first-degree biological family members with major depression. Bipolar disorders have a strong genetic factor; increased incidence
of either bipolar I or bipolar II disorders have been found to be between 4
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Health
and 24% in those with a first-degree biological relative with the disorder.
These individuals also show an increased likelihood (between 1 and 5%) of
developing major depressive disorder. Panic disorder also carries a strong
genetic link. According to the DSM-IV-TR, those with first-degree biological relatives with panic disorder are 8 to 20% more likely to get the disorder
themselves.
Environmental Causes
Key Vocabulary
Mental Disorder: A behavioral or psychological
syndrome or pattern that
occurs in an individual
Environmental conditions also play a large role in the development of, or

resilience to, mental Disorder. Many parents struggle to provide consistent,
patient and nurturing environments for their children. Inconsistency, neglect and abuse on the part of the parent (lack of appropriate food, vitamins
or doctor visits, for example) can affect the childs development as well as
affect his ability to construct a healthy model of interpersonal relationships
and social behavior.
Other environmental factors outside the family also can affect mental
health. For example, toxins such as lead in paint have been linked to a number of developmental and cognitive deficits, and certain foods have been
linked to hyperactivity and ADHD symptoms. Environmental disasters
such as hurricanes or earthquakes, or other dangerous situations such as
a school shooting or being mugged, can lead to symptoms of anxiety, post
traumatic stress disorder (PTSD) and depression.
General Medical Conditions

Sometimes, symptoms of mental disorder arise due to a physical change or
medical condition. Traumatic brain injury can result in personality changes,
although these changes are not always negative. Other medical conditions,
such as diabetes also can affect mental health. If uncontrolled, blood sugar
fluctuations in diabetics can cause significant fluctuations in mood, temper,
impulse control and cognitive acuity.
Substance Use
Substance use and abuse is often comorbid with mental disorder. It is
often difficult to determine if substance use triggers underlying vulnerabilities for mental disorder or if individuals are self-medicating a
pre-existing mental disorder, but the substances themselves can cause
symptoms of mental disorder. For example, individuals who use crack,
cocaine or amphetamines can become paranoid and delusional secondary to their drug use or drug withdraw. Alcohol and barbiturates are
downers and can cause symptoms of depression or anxiety. Certain
prescription medications include side effects with potential mental disorder symptoms such as hallucinations, thoughts of suicide, sleep disorders and anxiety.
7.2 EATING DISORDER

An eating disorder is a disorder that causes serious disturbances to your
everyday diet, such as eating extremely small amounts of food or severely
overeating. A person with an eating disorder may have started out just eat-
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129
ing smaller or larger amounts of food, but at some point, the urge to eat
less or more spiraled out of control. Severe distress or concern about body
weight or shape may also characterize an eating disorder.
Eating disorders frequently appear during the teen years or young
adulthood but may also develop during childhood or later in life. Common
eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.
It is unknown how many adults and children suffer with other serious, significant eating disorders, including one category of eating disorders
called eating disorders not otherwise specified (EDNOS). EDNOS includes
eating disorders that do not meet the criteria for anorexia or bulimia nervosa. Binge-eating disorder is a type of eating disorder called EDNOS.3
EDNOS is the most common diagnosis among people who seek treatment.
Eating disorders are real, treatable medical disorders. They frequently
coexist with other disorders such as depression, substance abuse, or anxiety disorders. People with anorexia nervosa are 18 times more likely to die
early compared with people of similar age in the general population. Eating
disorders are so common in America that 1 or 2 out of every 100 students
will struggle with one. Each year, thousands of teens develop eating disorders, or problems with weight, eating, or body image.
Eating disorders are more than just going on a diet to lose weight or
trying to exercise every day. They are extremes in eating behavior the
diet that never ends and gradually gets more restrictive, for example. Or the
person who cannot go out with friends because he or she thinks it is more
important to go running to work off a snack eaten earlier.
The most common eating disorders are anorexia nervosa and bulimia
nervosa (usually called simply anorexia and bulimia). But other
food-related disorders, like binge eating, body image disorders, and food
phobias, are becoming more and more common.
Anorexia
People with anorexia have a real fear of weight gain and a distorted view of
their body size and shape. As a result, they cannot maintain a normal body
weight. Many teens with anorexia restrict their food intake by dieting, fasting, or excessive exercise. They hardly eat at all and the small amount of
food they do eat becomes an obsession.
Others with anorexia may start binge eating and purging eating a
lot of food and then trying to get rid of the calories by forcing themselves
to vomit, using laxatives, or exercising excessively, or some combination of
these.
Bulimia
Bulimia is similar to anorexia. With bulimia, someone might binge eat (eat
to excess) and then try to compensate in extreme ways, such as forced vomiting or excessive exercise, to prevent weight gain. Over time, these steps
can be dangerous both physically and emotionally. They can also lead to
compulsive behaviors (ones that are hard to stop).
To be diagnosed with bulimia, a person must be binging and purging
regularly, at least twice a week for a couple of months. Binge eating is dif-
Key Vocabulary
Mood Disorder: A mood
disorder, also referred to
as an affective disorder,
is a condition impacting
mood and related functions. In a mood disorder,
moods range from extremely low (depressed)
to extremely high or irritable (manic).
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ferent from going to a party and pigging out on pizza, then deciding to
go to the gym the next day and eat more healthfully.
People with bulimia eat a large amount of food (often junk food) at
once, usually in secret. Sometimes they eat food that is not cooked or might
be still frozen, or retrieve food from the trash. They typically feel powerless
to stop the eating and can only stop once they are too full to eat any more.
Most people with bulimia then purge by vomiting, but may also use laxatives or excessive exercise.
Although anorexia and bulimia are very similar, people with anorexia
are usually very thin and underweight but those with bulimia may be a
normal weight or can be overweight.
Binge Eating Disorder

This eating disorder is similar to anorexia and bulimia because a person
binges regularly on food (more than three times a week). But, unlike the
other eating disorders, a person with binge eating disorder does not try to
compensate by purging the food.Anorexia, bulimia, and binge eating disorder all involve unhealthy eating patterns that begin gradually and build
to the point where a person feels unable to control them.
Signs of Anorexia and Bulimia

Sometimes a person with anorexia or bulimia starts out just trying to lose
some weight or hoping to get in shape. But the urge to eat less or to purge
or over-exercise gets addictive and becomes too hard to stop.
Teens with anorexia or bulimia often feel intense fear of being fat or
think that they are fat when they are not. Those with anorexia may weigh
food before eating it or compulsively count the calories of everything. People to whom this seems normal or cool or who wish that others would
leave them alone so they can just diet and be thin might have a serious
problem.
How do you know for sure that someone is struggling with anorexia or
bulimia? You cannot tell just by looking a person who loses a lot of weight
might have another health condition or could be losing weight through
healthy eating and exercise.
But there are some signs to watch for that might indicate a person has
anorexia or bulimia.
Someone with anorexia might:
Become very thin, frail, or emaciated
Be obsessed with eating, food, and weight control
Weigh herself or himself repeatedly
Deliberately water load when going to see a health professional to
get weighed
Count or portion food carefully
Only eat certain foods, avoiding foods like dairy, meat, wheat, etc.
(of course, lots of people who are allergic to a particular food or are
vegetarians avoid certain foods)
Mental Disorder
Exercise excessively feel fat

Withdraw from social activities, especially meals and celebrations
involving food
Be depressed, lethargic (lacking in energy), and feel cold a lot
Someone with bulimia might:
Fear weight gain
Be intensely unhappy with body size, shape, and weight
Make excuses to go to the bathroom immediately after meals
Only eat diet or low-fat foods (except during binges)
Regularly buy laxatives, diuretics, or enemas
Spend most of his or her time working out or trying to work off
calories
Withdraw from social activities, especially meals and celebrations
involving food
7.2.1 How are males/Female affected?

Like females who have eating disorders, males also have a distorted sense
of body image. For some, their symptoms are similar to those seen in females. Others may have muscle dysmorphia, a type of disorder that is
characterized by an extreme concern with becoming more muscular. Unlike girls with eating disorders, who mostly want to lose weight, some boys
with muscle dysmorphia see themselves as smaller than they really are and
want to gain weight or bulk up.
7.2.2 Causes Eating Disorders

Eating disorders are complex conditions that arise from a combination of
long-standing behavioral, biological, emotional, psychological, interpersonal, and social factors. Scientists and researchers are still learning about
the underlying causes of these emotionally and physically damaging conditions.
We do know, however, about some of the general issues that can contribute to the development of eating disorders. While eating disorders may
begin with preoccupations with food and weight, they are most often about
much more than food. People with eating disorders often use food and
the control of food in an attempt to compensate for feelings and emotions
that may otherwise seem over-whelming. For some, dieting, bingeing, and
purging may begin as a way to cope with painful emotions and to feel in
control of ones life, but ultimately, these behaviors will damage a persons
physical and emotional health, self-esteem, and sense of competence and
control.
Genetic
Many researchers believe that there is an inherited predisposition to having an eating disorder. Studies have shown that the co-occurrence of eating
disorders such as anorexia and Bulimia among identical twins is greater
than the co-occurrence among fraternal twins. Since identical twins are genetically more similar than fraternal twins, this would support an inherited
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component. Other research on the genetic component of eating disorders

has focused on neurochemistry. Researchers have found that the neurotransmitters serotonin and neuroepinephrine are significantly decreased
in acutely ill patients suffering from anorexia and bulimia nervosa. These
neurotransmitters also function abnormally in individuals afflicted with
depression. This leads some researchers to believe there may be a link between these two disorders. Besides creating a sense of physical and emotional satisfaction, the neurotransmitter serotonin also produces the effect
of feeling full and having had enough food.
Other brain chemicals have also been explored for their possible role
in eating disorders. Individuals with eating disorders like anorexia nervosa or bulimia Nervosa have been shown to have a higher than normal
level of the hormones vasopressin and cortisol. Both these hormones are
normally released in response to physical and possible emotional stress,
and may contribute to some of the dysfunction seen in eating disordered
individuals. Other research has found high levels of the neuropeptide-Y
and peptide-YY to be elevated in individuals suffering from anorexia and
bulimia. These chemicals have been shown to stimulate eating behavior in
laboratory animals. The hormone cholecystokinin (CCK) has been found to
be low in women with Bulimia and has caused laboratory animals to feel
full and stop eating.
Personality Traits
There is various childhood personality traits associated with the development of eating disorders. During adolescence these traits may become intensified due to a variety of physiological and cultural influences such as the
hormonal changes associated with puberty, stress related to the approaching demands of maturity and socio-cultural influences and perceived expectations, especially in areas that concern body image. Many personality
traits have a genetic component and are highly heritable.
Biological Factors
Eating disorders often run in families. Risk of developing an eating disorder is 50-80% determined by genetics. Women with a mother or sister
who has/has had Anorexia Nervosa are 12 times more likely than others to
develop it themselves. They are four times more likely to develop Bulimia.
Also, once individuals begin to starve themselves, binge eats, or purge,
those behaviors in and of themselves can alter brain chemistry and exacerbate the eating disorder.
Psychological
The practice of an eating disorder can be viewed as a survival mechanism.
Just as an alcoholic uses alcohol to cope, a person with an eating disorder
can use eating, purging or restricting to deal with feelings and emotions
that may otherwise seem overwhelming. Through the practice of the eating
disorder, the individual may feel a sense of partial control over their seemingly uncontrollable life. Some of the underlying issues that are associated
with an eating disorder include low self esteem, depression, feelings of loss
of control, feelings of worthless, identity concerns, family communication
problems and an inability to cope with emotions. The practice of an eating
Mental Disorder
disorder may be an expression of something that the eating disordered individual has found no other way of expressing.
7.2.3 Effects of Eating Disorders

One of the many downfalls of eating disorders in young people
is that adolescents often think they are invincible. This is partially
due to the very real physiological fact that a teenagers brain is not
fully developed yet. In particular, the part of the brain that links
actions with consequences is still gathering information to support the fact that there are consequences.
Teens and young adults do not know or believe that there could be any
real long-term effects of eating disorder on their bodies. That could not be
further from the truth. The plain fact is that individuals with Eating Disorders will ignore or minimize the significance of physical problems, even
when their trips to their doctor or to emergency rooms become frequent.
The following section summarizes some of the physical changes that occur
with eating disorders, ranging from frequent to life threatening
Effects of Anorexia Nervosa

Starvation: Starvation can have very serious effects on all major body
systems and organs. The basic metabolic response to starvation is to
conserve body tissues and energy. However, the body will also start
to use its own tissue, including muscle and organs, for energy since
the body has no food to use instead, the liver and intestines typically lose the highest percentage of their own weight during starvation, followed by the heart and kidneys which both lose a moderate
amount of weight. This often causes permanent damage to the organs in the process. Because someones heart size may be reduced,
they will experience low blood pressure and a slowed pulse. It cans
also lead to cardiac arrest or kidney failure. Total starvation is usually fatal in 8 to 12 weeks.
Dehydration: the healthy functioning of cells and tissues is dependent upon a certain level of water content in the body. Also, salt and
other minerals need to be kept within a narrow range. In a person
who has become dehydrated, it is possible they are suffering from
depletion in salt as well as water. Long-term dehydration can ultimately lead to kidney failure.
Muscle and Cartilage: Over-exercise can put a huge strain on muscles
and cartilage, particularly if the exercise is concentrated on one area
for long periods of time.
Bones: Osteoporosis is a loss of protein matrix tissue (density) from
bones, leaving them brittle and susceptible to fracture. Although it
is a natural part of the aging process, the chances of developing osteoporosis later in life are significantly increased for anorectics, due
to hormone changes. Bones may also stop growing, which causes
stunted growth in younger anorectics.
Irregular or Abnormally Slow Heart Rate: An irregular or slow heart
rate can mean that the heart muscle is undergoing changes. This is
likely to lead to low blood pressure and, the lower blood pressure
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and heart rate goes, the greater the risk of heart failure.
Heart Failure: The heart muscle is extremely sensitive and can become thin and flabby from nutritional deficiency. A lack of calories
and protein can have a negative effect on the heart, and body chemical may become so imbalanced that heart failure occurs.
Sexual Function: the body does not have enough fat to produce oestrogen in females, which will cause amenorrhea (cessation of periods), and infertility, and testosterone in men, resulting in low sex
drive.
Lanugo Growth: Lanugo (fine hair) grows all over the body to keep it
warm, compensating for the lack of insulating fat in the body.
Hyperactivity: The body relies on adrenaline (a hormone that is normally released during times of stress and fear) instead of food for energy.
This causes excitability
Effects of Bulimia Nervosa

The frequent purging that occurs with bulimia does serious damage to the
body.
Self-induced vomiting:
Damages the Digestive System: it can cause a peptic ulcer which is
an area of the stomach or duodenal lining which becomes eroded
by stomach acid. These are known as peptic ulcers. The symptoms
can vary, with some people not noticing anything out of the ordinary but others may vomit blood and experience abdomen or chest
pains. The pain is usually increased when the individual eats or
drinks. Peptic ulcers can be serious and need immediate attention if
one are vomiting blood or passing digested blood in stools.
Damages the oesophagus (throat), since stomach acid irritates the
oesophagus, which can cause inflammation and raw areas, sometimes making swallowing painful. Of greater concern is a rupture of
the oesophagus, because this can be fatal in some cases. A MalloryWeiss tear is the technical term for the rupture or tearing of the mucous membrane of the oesophagus at its junction with the stomach.
It is caused by repeated vomiting and the person will have bright
red blood in their vomit. One should always consult doctor if one
are vomiting blood.
Brings stomach acids into the mouth, causing the tooth enamel to
wear away, and tooth decay to occur, giving the teeth a ragged appearance and cavities. Eventually all teeth may need extraction. If
one are bulimic, it is recommended that one do NOT brush teeth
straight after vomiting. Instead should drink water, as this will be
gentler on teeth and help replenish lost fluids.
Swollen salivary glands
Stomach cramps and difficulty in swallowing
Dehydration: The healthy functioning of cells and tissues is dependent upon a certain level of water content in the body. Also, salt and
other minerals need to be kept within a narrow range. In a person
who has become dehydrated, it is possible they are suffering from
depletion in salt as well as water. Long term dehydration can ulti-
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mately lead to kidney failure. Amongst bulimics, dehydration usually occurs because the stomach is being emptied of its gastric fluids.
Abuse of laxatives and diuretics:
Causes constipation, since the body can no longer produce a bowel
movement on its own
Bloating, water retention, and oedema (swelling) of the stomach.
Because the body is constantly being denied the nutrients and fluids
it needs to survive, the kidneys and heart will also suffer. Specifically, a lack of potassium will result in cardiac abnormalities and
possible kidney failure, which can also result in death.
Effects of Binge-eating
The physical effects of binge eating are not as severe as with anorexia and
bulimia, since the body is not denied food or put through purges. However
this is not to say that there are not still serious consequences.
The obesity suffered by many binge eaters can cause complications
such as diabetes type II, or heart problems.
High Blood Pressure: overweight people between the ages of 20-45
have a six times higher incidence of hypertension than do peers
who are normal weight. The risk appears to be even greater for older obese people.
Diabetes: even moderate obesity, especially when the extra fat is carried in the stomach and abdomen (instead of hips and thighs), increases the risk of non-insulin dependent diabetes mellitus.
Osteoarthritis: arthritis can occur in obese individuals because of the
extra strain being placed on the joints by the weight of the person.
Heart Attack: high blood pressure and cholesterol dramatically increase the chances of having a stroke or heart attack.
Yo-yo dieting can cause hypertension, and long-term damage to major
organs, such as the kidney, liver, heart, and muscles.
7.2.4 Treatment of Eating Disorders

Eating disorders are very complex diseases that can have severe physical and emotional consequences if left untreated. For this reason, it
is imperative that men or women dealing with eating disorders seek
professional help, especially with more clinically severe eating disorders. Utilizing a professional treatment team who specialize in eating
disorders can be one of the most powerful and influential resources for
enhancing recovery. Though the journey of recovery if often long and
arduous and includes many highs and lows, the rewards reaped are invaluable and life-saving.
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Eating Disorder Recovery

The road to eating disorder recovery starts with admitting one have a difficulty. This admission can be tough, especially if you are still clinging to
the beliefeven in the back of mindthat weight loss is the key to happiness,
confidence, and success. Even when one finally understand this is not true,
old habits are still hard to break.
The good news is that the eating disorder behaviors one have learned
can be unlearned if you are motivated to change and willing to ask for help.
However, overcoming an eating disorder is about more than giving up unhealthy eating behaviors. It is also about rediscovering who one are beyond
eating habits, weight, and body image.
Getting Help for an Eating Disorder

Confronting the eating disorder is the first step of eating disorder recovery.
If one suffering with an eating disorder, it is imperative to admit that one
need help. Though this can be the most painful and difficult part of the
process, it is essential in order for recovery to begin. By reaching out for
help and confiding in others one love and trust about struggles, one taking
the biggest step towards victory over eating disorder. If one have a loved
one who is suffering from an eating disorder and are worried about their
eating behaviors or attitudes, it is crucial to communicate your concerns in
a loving and supportive way. Confronting the person one care about is a
necessary step towards getting them the help and treatment they deserve.
This should occur in a private and comfortable setting and expressed in a
non-confrontational tone. Talk with family and friends Asking for help
is usually the hardest aspect about initiating recovery and a treatment plan
for eating disorders. If at all possible, start by opening up and speaking in
confidence to family and friends.
Find an Eating Disorders Treatment Specialist

A key step in starting recovery is to find a capable eating disorders professional; someone who specializes in eating disorders and who will help in
coordinating and overseeing care and treatment. This may typically begin
on the outpatient level, as many people with eating disorders often respond
successfully to this level of treatment. The eating disorder specialist will be
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vital in developing a treatment plan that is tailored to the man or womans

individual problems and needs. A treatment team may also be formed and
coordinated with your eating disorder specialist to address the various
complications associated with the disorder, such as therapy and nutrition.
If outpatient treatment is not enough, these professionals will help you seek
higher levels of care.
7.2.5 Types of Eating Disorder Treatment

The severity of the eating disorder and any co-occurring disorders will determine the preliminary treatment level you or your loved one should pursue, though it is typical to begin with the outpatient level. Health professionals seen in the outpatient level of care can determine if a higher level of
care is needed and refer as necessary. The following are the common levels
and types of eating disorder treatment, in order of acuity:
Outpatient Treatment [Seeing a Therapist / Counselor]
Intensive Outpatient Treatment [IOP]
Residential Treatment
Inpatient / Hospital Treatment
7.2.6 Major Therapies for Eating Disorder Treatment

As part of eating disorder treatment are several types of therapy options
that address a variety of aspects of the disease. These therapies can be
a part of a comprehensive treatment plan for recovery from an eating
disorder.
Some specific examples of these helpful therapies are:
Art Therapy
Dance/Movement Therapy
Dialectical Behavioral Therapy
Family Therapy
Medical Nutrition Therapy
When considering which therapies to include as part of a treatment plan
for an eating disorder, it is important to work with a health professional to
determine what problems or underlying issues are priority in addressing, the
desires and strengths of the individual participating in the treatment, and
the level of eating disorder treatment needed. Understanding these various
aspects can be helpful in establishing which therapies can be included in the
treatment plan. It is also useful to include the guidance and input of a health
professional to help in deciding what therapies should be chosen.
7.2.7 Co-occurring Disorders and Dual Diagnosis

with Eating Disorders
Because of the multifaceted nature of eating disorders, they may often coexist with or be a side effect of other diseases/disorders, such as depression,
trauma, or anxiety disorders. It is common that eating disorders may not
be the primary disease suffered, thus intensifying the need for treatment to
address all co-occurring disorders.
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7.2.8 Eating Disorder Special Treatment

Considerations
In addition to co-occurring disorders, there are a number of general topics
and circumstances that affect or are affected by whether a person suffering
with an eating disorder is:
Male or Female
Teen or Senior Citizen
Pregnant
An Athlete
Heavy Dieter or Weight Loss Surgery Recipient
A Diabetic
Medical Complications Associated with Eating Disorders
Though the road to recovery from an eating disorder is often a hard
and challenging experience, there is hope in finding freedom from these
Disorders. While the eating disorder treatment process may be extended
and on-going, the recovery journey is priceless in that it will help you or
your loved one regain your life back. Nothing is more precious or valuable
than your own life and well-being and worth every step of the way through
the process of recovery.
What are Special Treatment Issues?

Many men and women who are suffering with an eating disorder have
unique needs and concerns. These can vary according to age, environmental and social factors, and other medical concerns.
Examples of Special Treatment Issues that may be involved with anorexia, bulimia, or other eating disorders include the following topics around
which Eating Disorder
Adolescent/ teen/ Childhood Eating Disorders: As an adolescent,
teen or child, treatment prognosis may be improved dramatically if
the disorder is caught early. Many factors can also be helpful during
the recovery process, such as a comprehensive treatment team and
family involvement.
Families and Eating Disorders: If a loved one in family has recently been diagnosed with an eating disorder, the implications of
this can be overwhelming for family. There are several ways family can learn to support loved one and be a positive aspect of their
recovery.
Effects of Eating Disorders during Pregnancy: In a time that is often
associated with a widespread of emotions, pregnancy can be a difficult time for a woman who is struggling with an eating disorder.
There are many ways to help establish a healthy pregnancy and outcome for both mother and baby.
Weight Loss Surgery and Eating Disorders: Often viewed as a fix
for many problems associated with obesity, there is more involved
with these procedures than just a simple surgery. Taking appropriate steps helps deal with the root cause of obesity or an eating disorder.
Mental Disorder
Diabetes and Eating Disorders: Having diabetes means needing

to follow a strict regimen to reduce health risks. If insulin is being
manipulated in conjunction with an eating disorder, severe consequences can ensue.
Athletes and Eating Disorders: Athletes can present with various
characteristics that overlap eating disorder behavior. Coaches, parents, and trainers can all benefit from understanding early warning
signs for eating disorder prevention.
Middle-aged Women and Men with Eating Disorders: Because of
the unique challenges that men and women face in middle-age, it is
common that an eating disorder can develop. Learning risk factors
can be an important aspect of treatment and prevention.
Compulsive Spending and Eating Disorders: Having similar traits
to eating disordered behavior, compulsive spending is often correlated with eating disorders. It is crucial to understand how these
addictions can be co-occurring.
Medical Complications from Eating Disorders: Because of the severity of eating disorders, physical consequences often result. It is important to understand what these signs may be, especially if you are
concerned for a loved one who is suffering with an eating disorder.
Males and Eating Disorders: Eating Disorders are not unique to females. Males also struggle with eating disorders and face unique
needs and challenges.
Paying for Treatment: While treatment may be warranted and desired, it can be difficult to understand how to fund it. Learning options will be helpful in being able to pay for treatment.
Choosing a Treatment Center: With the overwhelming amount
of treatment options available, it is key to know what to look
for and questions to ask when making decision about treatment
choice.
7.3 MENTAL DISORDER TREATMENT

Mental disorder can be treated. When someone first starts to develop symptoms of mental disorder, it is important to contact a doctor or a community
mental health service for help.
The correct treatment can help a persons condition to improve or, in
some cases, recover completely. Treatment in the community, rather than
in a hospital, is considered better for a persons mental health. Psychological treatments are often the most helpful for people affected by anxiety disorders or depression, while medications are mainly helpful for people more
seriously affected by mental disorder.
Sometimes the symptoms can be so confusing for the person that they
do not realize they are ill. In this case, family or friends can visit the doctor
to discuss what can be done.
7.3.1 The initial Assessment

A doctor will make a diagnosis based on the particular pattern of symptoms the person has.
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For instance, the following symptoms may indicate that the person has
depression:
Feeling down for a prolonged period
Not sleeping
Being unable to concentrate.
The doctor will then decide on the best treatment for the symptoms
and their underlying causes. Sometimes the diagnosis changes as symptoms change or as other information about the person and their disorder
becomes known. The most important thing is for the doctor to understand
the symptoms so that the most helpful treatment can be selected.
7.3.2 The role of psychiatrists and general

practitioners
People affected by mental disorder may benefit from a range of treatments.
Medical treatment (and/or referral to other health services) can be provided by:
A General Practitioner (GP) doctor can make an assessment and
prepare a Mental Health Plan to help the person get treatment and
support. This may include referral for psychological therapy from
an appropriately qualified health professional, which may be largely covered by Medicare. GPs can also provide ongoing treatment for
many people. Some undertake further training to specialize in this
area. GPs also play a vital role in ensuring that the physical health
of a person with a mental disorder is not neglected.
A Psychiatrist this is a medical doctor who specializes in the study
and treatment of mental disorder. Most people affected by mental
disorder will have contact with a psychiatrist at some stage of their
disorder. Those more seriously affected will have more regular contact.
As well as seeing a GP, services are available in both the private and
the public health sectors:
Public Health Care this includes treatment in public hospitals and
community mental health services. The advantages of this system
are that it provides a range of services in the community and there
is no direct charge.
Private Health Care it is possible to see a psychiatrist or psychologist who works in private practice. This usually involves paying a
fee and then claiming a Medicare rebate, if the person is eligible.
It is also possible to be an inpatient at a private clinic or hospital.
However, unless the person has private health insurance, this will
be expensive.
7.3.3 Community mental health services

It is thought to be better for a persons mental health to treat them in the
community rather than in hospital. Mental health services are increasingly
provided in the community by:
A Case Manager: who will monitor the persons progress and make
sure they have access to all the services they need (for example,
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housing and employment support). They will also help educate the
person and their family or other careers about the disorder and how
to deal with it.
Crisis Teams: groups of mental health professionals who provide
assessment and support for people who are seriously affected by
mental Disorder. They can visit the person in their home and arrange for admission to hospital if needed.
Support Teams: that provides long-term support to the person in
their home. Support teams try to reduce the number of admissions
to hospital a person may need and help them to maintain a treatment plan and a reasonable quality of life.
7.3.4 Psychological Treatment

Psychological treatments are based on the idea that some problems connecting to mental disorder. It occurs because of the way people react to,
think about and perceive things. They are particularly relevant to many
people with anxiety disorders and depression. Psychological treatments
can reduce the distress associated with symptoms and can even help reduce the symptoms themselves. These therapies may take several weeks or
months to show benefits.
Different psychological therapies used in the treatment of mental
disorder include:
Cognitive behavior Therapy (CBT): Examines how a persons
thoughts, feelings and behavior can get stuck in unhelpful patterns.
The person and therapist work together to develop new ways of
thinking and acting. Therapy usually includes tasks to perform outside the therapy sessions. CBT may be useful in the treatment of depression, anxiety disorders and psychotic disorders such as bipolar
and schizophrenia.
Interpersonal Psychotherapy: examines how a persons relationships and interactions with others affect their own thoughts and behaviors. difficult relationships may cause stress for a person with a
mental disorder and improving these relationships may improve a
persons quality of life. This therapy may be useful in the treatment
of depression.
Dialectical Behavior Therapy: It is a treatment for people with borderline personality disorder (BPD). A key problem for people with
BPD is handling emotions. This therapy helps people to better manage their emotions and responses.
7.3.5 Treatment with Medication

Medications are mainly helpful for people who are more seriously affected
by mental disorder. Different types of medication treat different types of
mental disorder.
Antidepressant medications about 60 to 70% of people with depression respond to initial antidepressant treatment. These medications
are now also used (in combination with psychological therapies) to
treat phobias, panic disorder, obsessive compulsive disorder and
eating disorders.
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Antipsychotic medications are used to treat psychotic Disorders, for

example schizophrenia and bipolar disorder. Newer antipsychotic
medications may have some side effects, but tend to have fewer of
the effects that were associated with the older medications, for example stiffening and weakening of the muscles and muscle spasms.
Mood stabilizing medications are helpful for people who have bipolar disorder (previously known as manic depression). These medications, such as lithium carbonate, can help reduce the recurrence of
major depression and can help reduce the manic or high episodes.
7.3.6 Other forms of Treatment

Effective treatment involves more than medications. Treatment may also
involve:
Community Support: Including information, somewhere to live,
help with finding suitable work, training and education, psychosocial rehabilitation and mutual support groups. Understanding and
acceptance by the community is very important.
Electroconvulsive Therapy (ECT): This treatment can be a highly
effective treatment for severe depression and, sometimes, for other
diagnoses when other treatments have not been effective. After the
person is given a general anesthetic and muscle relaxant, an electrical current is passed through their brain.
Hospitalization: This only occurs when a person is intensely ill and
needs intensive conduct for a short time. It is measured better for
a persons mental health to treat them in the community, in their
familiar surroundings.
Involuntary Treatment: This can occur when the psychiatrist recommends someone needs treatment but the person does not agree.
In general, people receive involuntary treatment to ensure their
own safety or that of others.

1.
Organization publishes the Diagnostic and Statistical Manual of Mental Disorders?

(a) American Psychological Association
(b) American Psychiatric Association
(c) American Medical Association
(d) National Alliance for the Mentally Ill
2.
3.
Mental disorders usually are caused by a grouping of genetic and biological factors (nature) and .......
(a) Environmental factors
(b) chemical factors
(c) biological factors
(d) None of these
Environmental conditions play a large role in the development of, or

resilience to, .. disorder.
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4.
(a) eating
(b) food
(c) mental
(d) All of these
Eating disorders are real, treatable disorders.

(a) biological
5.
6.
(b) zoology
(c) Both (a) & (b)
(d) medical
Risk of developing an eating disorder is .. determined by genetics.

(a) 40-70%
(b) 50-80%
(c) 40-80%
(d) 20-70%
Psychological .. are based on the idea that some problems relating to mental disorder.
(a) treatments
7.
8.
(b) mental
(c) both (a) & (b)
(d) none of these
Medications are mainly helpful for people who are more seriously affected by disorder.
(a) disorder
(b) mental
(c) more
(d) none of these
When someone first starts to develop .. of mental disorder

(a) symptoms
9.
(b) develop
(c) Both (a) & (b)
(d) None of these
Which of the following were historical explanations of psychopathology?

(a) Witchcraft.
(b) Social class
(c) General paresis.
(d) The plague.
10. Starvation can have very serious effects on all major body systems and
...
(a) organs
(b) component
(c) body
(d) part and parcel

1. What are mental disorders?
2. Explain bulimia nervosa.
3. What are the causes of mental disorders?
4. Define the eating disorder.
5. How are males/female affected of eating disorder?
6. Describe the causes of eating disorders.
7. What do you mean by anorexia nervosa?
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8. What does treatment really mean?

9. Explain psychological therapies.
10. What are community mental health services.
1. (b)
5. (b)
9. (c)
2. (a)
6. (a)
10. (a)
3. (c)
7. (b)
4. (d)
8. (a)
Chapter 8
INTRODUCTION
Objectives
epression and suicide are major public health issues for older adults.
Depression is one of the most general mental disorders skilled by elders, but luckily is treatable by a variety of means. Current associates of
older adults in the United States confirmation lower rates of major depression than younger cohorts, but experience minor depression or important
subsnydromal depressive symptoms at rates equivalent to or better than
younger groups. Adults soon to enter later maturity, most especially the
so-called Baby Boom cohort, seem to be evidencing depressive disorders at
considerably higher rates than preceding groups; this trend towards greater incidence of depression in subsequent cohorts seems steady. The reasons
for these changes are the subject of much debate and not clearly understood. Because depression tends to be a recurrent disorder, this means that
many older adults will have experienced previous bouts of depression and
will be at increased risk.
Depression is not only an
extensive disorder but is also a
pervasive problem. Depressed
older adults, like younger persons, tend to use health services
at high rates, connect in poorer
health behaviors, and confirmation what is known as excess
disability. Depression is also
associated with suicide. Older
adults have the highest rates
of suicide of any age group,
and this is mainly pronounced
among men.
A number of efficacious treatments are available for geriatric depression
but seem to be underused. Pharmacotherapy and several versions of psychotherapy, including interpersonal, brief psychodynamic, problem-solving,
and cognitive-behavioral, significantly reduce depressive symptoms. Interestingly, when given thorough descriptions of these treatments, older adults
state a preference for receiving psychologically based treatments rather than
medication.
After studying this

able to:
Explain the
mental disorder
Define the
eating disorder
Describe the
mental disorder treatment
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Geriatric depression will continue to be a topic commendable of much

scientific and applied interest in the years to come. This resource guide provides some existing information we hope will be useful as you learn more
about this important health issue.
8.1 DEPRESSION
Key Vocabulary
Clinical Depression: Clinical
depression,
also
known as major depression and unipolar depression, is a serious mental
disorder that affects 121
million people worldwide in a given year,
according to the World
Health Organization.
Depression is a common but serious illness. Most that experience

depression need treatment to get better. Each person infrequently
feels blue or depressing. But these feelings are typically shortlived and pass within a couple of days. When one have depression, it interferes with daily life and causes pain for both one and
those who care about one.
Many people with a depressive illness never seek treatment.

But the majority, even those with
the most severe depression, can
get better with treatment. Medications, psychotherapies, and
other methods can effectively
treat people with depression.
8.1.1 Different Forms of Depression

There are several forms of depressive disorders:
Major Depressive Disorder or Major Depression: It is characterized
by a grouping of symptoms that interfere with a persons ability to

work, sleep, study, eat, and enjoy once-pleasurable behavior. Key
depression is disabling and prevents a person from functioning
normally. Some people may experience only a single incident within their life, but more often a person may have multiple episodes.
Dysthymic Disorder, or Dysthymia: It is characterized by longstanding (2 years or longer) symptoms that may not be severe
enough to disable a person but can prevent normal functioning or
feeling well. People with dysthymia may also skill one or more episodes of major depression during their lifetimes.
Minor Depression: It is characterized by having symptoms for 2
weeks or longer that do not meet full criteria for major depression.
Without conduct, people with minor depression are at high risk for
increasing major depressive disorder.
Bipolar Disorder: It is also called manic-depressive illness, is not
as common as major depression or dysthymia. Bipolar disorder is
characterized by cycling mood changes from extreme highs (e.g.,
mania) to extreme lows (e.g., depression). More information about
bipolar disorder is available.
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8.1.2 Causes of Depression

Most likely, depression is caused by a grouping of genetic, biological, environmental, and psychological factors. Depressive illnesses are disorders of
the brain. Longstanding theories about depression suggest that important
neurotransmitters chemicals that brain cells use to communicate are out of
balance in depression. But it has been difficult to prove this.
Brain-imaging technologies, such as magnetic resonance imaging
(MRI), have shown that the brains of people who have depression look
different than those of people without depression. The parts of the brain
involved in mood, thinking, sleep, appetite, and behavior appear different.
But these images do not reveal why the depression has occurred. They also
cannot be used to diagnose depression.
Some types of depression tend to run in families. However, depression
can occur in people without family histories of depression too. Scientists
are studying certain genes that may make some people more prone to depression. Some genetics research indicates that risk for depression results
from the influence of several genes acting together with environmental or
other factors.10 In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger.
8.1.3 Depression in Children and Teens

Children who develop depression often continue to have episodes as they
enter adulthood. Children who have depression also are more likely to
have other more severe illnesses in adulthood.
A child with depression may pretend to be sick, refuse to go to school,
cling to a parent, or worry that a parent may die. Older children may sulk,
get into trouble at school, be negative and irritable, and feel misunderstood.
Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to
accurately diagnose a young person with depression. Before puberty, boys
and girls are equally likely to develop depression. By age 15, however, girls
are twice as likely as boys to have had a major depressive episode.
Depression during the teen years comes
at a time of great personal change when boys
and girls are forming an identity apart from
their parents, grappling with gender issues and
emerging sexuality, and making independent
decisions for the first time in their lives. Depression in adolescence frequently co-occurs with
other disorders such as anxiety, eating disorders, or substance abuse. It can also lead to increased risk for suicide.
An NIMH-funded clinical trial of 439 adolescents with major depression found that a
combination of medication and psychotherapy
was the most effective treatment option. Other
NIMH-funded researchers are developing and
testing ways to prevent suicide in children and
adolescents.
Key Vocabulary
Cluster Suicides, or mass
suicide, is basically when
a group of people, oftentimes influenced by
a common belief, decide
to all commit suicide together.
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Childhood depression often persists, recurs, and continues into adulthood, especially if left untreated.
8.1.4 Treatment of Depression
Key Vocabulary
Risk Factor: A risk factor is something that increases your chances of
getting a disease.
The first step to getting suitable treatment is to visit a doctor or mental health specialist. Certain medications, and some medical conditions
such as viruses or a thyroid disorder, can cause the same symptoms as
depression. A doctor can rule out these possibilities by doing a physical
exam, interview, and lab tests. If the doctor can find no medical condition that may be causing the depression, the next step is a psychological
evaluation
Once diagnosed, a person with depression can be treated in several
ways. The most common treatments are medication and psychotherapy.
Medication: Antidepressants primarily work on brain chemicals

called neurotransmitters, especially serotonin and norepinephrine.
Other antidepressants work on the neurotransmitter dopamine. Scientists have found that these particular chemicals are involved in
regulating mood, but they are unsure of the exact ways that they
work.
Popular Newer Antidepressants: Some of the newest and most pop-
ular antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (Prozac), sertraline (Zoloft), escitalopram
(Lexapro), paroxetine (Paxil), and citalopram (Celexa) are some
of the most commonly prescribed SSRIs for depression. Most are
available in generic versions. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine
(Effexor) and duloxetine (Cymbalta).
SSRIs and SNRIs tend to have fewer side effects than older antide-
pressants, but they sometimes produce headaches, nausea, jitters,

or insomnia when people first start to take them. These symptoms
tend to fade with time. Some people also experience sexual problems with SSRIs or SNRIs, which may be helped by adjusting the
dosage or switching to another medication.
Monoamine Oxidase Inhibitors (MAOIs): It is the oldest class of an-
tidepressant medications. They can be especially effective in cases of

atypical depression, such as when a person experiences increased
appetite and the need for more sleep rather than decreased appetite
and sleep. They also may help with anxious feelings or panic and
other specific symptoms.
Tricyclics: Tricyclics are older antidepressants. Tricyclics are pow-
erful, but they are not used as much today because their potential
side effects are more serious. They may affect the heart in people
with heart conditions. They sometimes cause dizziness, especially
in older adults. They also may cause drowsiness, dry mouth, and
weight gain. These side effects can usually be corrected by changing
the dosage or switching to another medication. However, tricyclics
may be especially dangerous if taken in overdose. Tricyclics include
imipramine and nortriptyline
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8.2 CLINICAL DEPRESSION

Clinical depression is a medical illness which affects millions of people each year. Though people often get the blues, clinical depression causes persistent changes in some persons mood, behavior, and
feelings. The illness interferes with and disrupts persons education,
job and family life. No amount of cheering up can make it go away,
and neither can keep a stiff upper lip nor toughing it out. No
amount of exercise, vitamins, or vacation can make clinical depression disappear. People with clinical depression need to get proper
treatment which usually includes medication, psychotherapy, or a
combination of both.
Clinical depression symptoms may include:
Depressed mood most of the day, nearly every day
Loss of interest or pleasure in most activities
Significant weight loss or gain
Sleeping too much or not being able to sleep nearly every day
Slowed thinking or movement that others can see
Fatigue or low energy nearly every day
Feelings of worthlessness or inappropriate guilt
Loss of concentration or indecisiveness
Recurring thoughts of death or suicide
Clinical depression causes noticeable disruptions in daily life, such as
work, school or social activities. It can affect people of any age or sex, including children. It is not the same as depression caused by a loss (such as
the death of a loved one), substance abuse or a medical condition such as a
thyroid disorder
8.2.1 Types of Clinical Depression

Clinical depression differs greatly among people, both in its severity and
how long it lasts. Some people suffer only one episode of clinical depression during their lifetime, while others experience recurring episodes. Also,
people suffer from two basic types of clinical depression:
Major Depression--also called unipolar depression, this illness is
identified by many of the symptoms cited above.
Manic Depression--also called bipolar depression, this illness causes
alternate cycles of depression or manic elation. During a manic phase, some
or all of the following symptoms often appear:
Increased energy and decreased need for sleep
Inappropriate excitement or irritability
Increased talking or moving
Promiscuous sexual behavior
Disconnection and racing thoughts
Impulsive behavior and poor judgment, such as spending
sprees.
Key Vocabulary
Suicide Prevention: Diminishing the risk of suicide. It may not be possible to eliminate entirely
the risk of suicide but it
is possible to reduce this
risk.
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8.2.2 Causes of Clinical Depression

Current theory suggests those clinical depression results from complex interactions between brain chemicals and hormones that influence a persons
energy level, feelings, sleeping and eating habits. These chemical interactions are linked to many complex causes--a persons family history of illness, biochemical and psychological make-up, prolonged stress, and traumatic life. Sometimes no identifiable cause triggers an episode of clinical
depression; usually one or more stresses are involved. Medical research
has found that people who suffer from clinical depression have changes
in important brain chemicals, such as serotonin and norepinephrine. New
medications are available that restore these brain chemicals to their proper
balance and relieve symptoms of clinical depression.
Key Vocabulary
8.2.3 General Treatment for Clinical Depression
Suicide: Suicide is deThere are people who would like to end their life due to clinical depression.
fined as the intentional
However, they have to realize that depression is a mental illness that can be
taking of ones own life.
cured so that they can again enjoy and be happy with their life.
If you feel one have no more desire to live because of feelings that haunt
one every moment each day, those moments when one feel the loneliness,
the hopelessness and even the anxiety that grips one every waking moments of life, hold on. Yes, hold on to dear life. The depression that makes
one think of ending life can be cured.
It is curable and it has to be cured at the earliest before it becomes what
is known as clinical depression. The treatment actually is at hand again,
hold on to that dear life, and read about this wonderful news that can surely
make one feel better, appreciate music, and laugh at jokes, to include dirty
ones.
8.3 RISK FACTORS FOR DEPRESSION

Many factors can increase a persons risk of developing depression. For some
types of depression, family history appears to play a role. Certain medications can also increase the risk. There are also some medical conditions that
increase the risk of depression, including diabetes. In addition, stress and
hormonal factors can also increase a persons risk of having depression.
According to major surveys, major depressive disorder affects nearly
15 million Americans (nearly 7% of the adult population) in a given year.
While depression is an illness that can afflict anyone at any time in their
life, the average age of onset is 32 (although adults age 49 - 54 years are the
age group with the highest rates of depression.). Other major risk factors
for depression include being female, being African-American, and living in
poverty.
Depression in women
The causes of such higher rates of depression may be due in part to hormonal factors:
Puberty: While both boys and girls have similar rates of depression before puberty, girls have twice the risk for depression once they reach
puberty. In addition to hormonal factors, sociocultural factors may

also affect the development of depression in girls in this age group.
Menstruation: While many women experience mood changes around
the time of menstruation, a small percentage of women suffer from a
condition called premenstrual dysphoric disorder (PMDD). PMDD
is a specific psychiatric syndrome that includes severe depression,
irritability, and tension before menstruation.
Pregnancy and Childbirth: Hormonal fluctuations that occur during
and after pregnancy, especially when combined with relationship
stresses and anxiety, can contribute to depression. Post-partum depression is a severe depression (sometimes accompanied by psychosis) that occurs within the first year after giving birth. The rapid
decline of reproductive hormones that accompany childbirth may
play the major role in postpartum depression in susceptible women,
particularly first-time mothers. Studies suggest that women who
are more sensitive to hormone fluctuations are at greater risk for
postpartum depression if they have a personal or family history of
depression. Miscarriage also poses a risk for depression.
Perimenopause and Menopause: Hormonal fluctuations that can trigger depression also occur when a women is transitioning to menopause (perimenopause). Sleep disruptions are also common during perimenopause and may contribute to depression. Once women pass into
menopause, depressive symptoms generally tend to wane.
Depression in Men
Some research suggests that depression in men is associated with the following indicators:
Low tolerance to stress
Behaviors such as acting out and being
impulsive
A history of alcohol or substance abuse
A family history of depression, alcohol
abuse, or suicide
Depression in Children and Adolescents

Depression can occur in children of all ages, although adolescents have the
highest risk. Risk factors for depression in young people include having
parents with depression, particularly if it is the mother who is depressed.
Early negative experiences and exposure to stress, neglect, or abuse also
pose a risk for depression.
Adolescents who have depression are at significantly higher risk for
substance abuse, recurring depression, and other emotional and mental
health problems in adulthood.
Studies suggest that 3 - 5% of children and adolescents suffer from clinical depression, and 10 - 15% have some depressive symptoms.
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Depression in the Elderly

About 1 - 5% of elderly people suffer from depression. The rate increases
significantly for those who have other chronic health problems, especially
medical conditions such as Alzheimers, Parkinsons disease, heart disease,
and cancer that interfere with functional abilities. Depression also occurs
in some elderly people who require home healthcare or hospitalization. In
addition, older people often have to contend with significant stressful life
changes such as the loss of a spouse. Suicide in the elderly is the third-leading cause of death related to injury. Men account for the majority of these
suicides, with divorced or widowed men at highest risk
8.3.1 Risk Factors for Clinical Depression

Like heart disease and alcoholism, clinical depression often runs in families. More than twice as many women than men suffer from clinical depression and 25% of women and 10% of men will suffer one or more episodes
of clinical depression in their lifetimes. Though clinical depression strikes
people of all ages, it strikes most often among those aged 24-44.
Certain other age groups are also at risk as high school and college-age
populations. Often the illness is not recognizable because its symptoms resemble normal teenage problems--changes in mood, irritability, risk-taking
behavior, and troubles with friends or school work. If undiagnosed and
untreated, some young people with severe clinical depression may become
vulnerable to suicide now the second leading cause of death among people
between the ages of 15-24.
The elderly also frequently suffer from clinical depression. Their sad
moods, fatigue and withdraw from life are often mistaken as a normal part
of the aging process. For many older people, clinical depressions linked to
the death of a spouse, admission to a nursing home, prolonged illness, or
a major operation, such as heart surgery. The elderly depressed are much
higher risks for suicide than younger depressed
8.4 SELF INJURY

Self-injury is a way of dealing with very difficult feelings that build up inside. Many people with eating disorders also engage in the act of self-injury. Just like the eating disorders are used to help the individual cope, the
act of injuring oneself is also used to help cope with, block out, and release
built up feelings and emotions. Self-injury is probably the most widely misunderstood forms of self harm and there are many myths associated with
it, which can make it difficult for people to reach out and ask for help Selfinjury (self-harm, self-mutilation) can be defined as the attempt to deliberately cause harm to ones own body and the injury is usually severe enough
to cause tissue damage. This is not a conscious attempt at suicide, though
some people may see it that way.
There are three types of self-injury. The rarest and most extreme form is
Major self-mutilation. This form usually results in permanent disfigurement,
i.e. castration or limb amputation. Another form is Stereo typic self-mutilation which usually consists of head banging, eyeball pressing and biting. The
third and most common form is Superficial self-mutilation which usually
involves cutting, burning, hair-pulling, bone breaking, hitting, interference

with wound healing and basically any method used to harm oneself.
Cutting or burning them, bruising them, taking an overdose of tablets,
pulling hair, or picking skin. Some people think that the seriousness of the
problem can be measured by how bad the injury is. This is not the case a
person who hurts themselves a bit can be feeling just as bad as someone
who hurts themselves a lot. Self-injury can affect anyone. It is a lot more
common than people think. Many people hurt themselves secretly for a
long time before finding the courage to tell someone.
8.4.1 Causes a Person to Engage In Self-Injury

Self-injury can occur in either sex and in any race of people. The behavior
is not limited by education, age, sexual orientation, socioeconomic status,
or religion. However, there are some common factors among people who
engage in self-injury.
Self-injury occurs more often among:
Adolescent females.
People who have a history of physical, emotional, or sexual abuse.
People who have co-existing problems of substance abuse, obsessive-compulsive disorder, or eating disorders.
Individuals who were raised in families that discouraged expression of anger.
Individuals who lack skills to express their emotions and lack a
good social support network.
Even though there is the possibility that a self-inflicted injury might
result in life-threatening damage, self-injury is not considered to be suicidal behavior. Self-injury usually occurs when people face what seems like
overwhelming or distressing feelings. Self-injurers might feel that self-injury is a way of:
Temporarily relieving intense feelings, pressure, or anxiety
Being real, being alive, or feeling something
Being able to feel pain on the outside instead of the inside
Being a means to control and manage pain unlike the pain experienced through physical or sexual abuse
Providing a way to break emotional numbness (the self-anesthesia
that allows someone to cut without feeling pain)
Asking for help in an indirect way or drawing attention to the need
for help
Attempting to affect others by manipulating them, trying to make
them care, trying to make them feel guilty, or trying to make them
go away
Self-injury also might be a reflection of a persons self-hatred. Some
self-injurers are punishing themselves for having strong feelings that they
were usually not allowed to express as children. They also might be punishing themselves for somehow being bad and undeserving. These feelings are
an outgrowth of abuse and a belief that the abuse was deserved.
Self-injurers often become desperate about their lack of self control and
the addictive-like nature of their acts, which may lead them to true suicide
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attempts. The self-injury behaviors may also cause more harm than intended, which could result in medical complications or death. Eating disorders
and alcohol or substance abuse intensify the threats to the individuals
overall health and quality of life
Thinking about stopping

One may want to stop injuring your-self but have worries about it, such as
feeling: Embarrassed...
Depressed...about anything ever getting better
Afraid...that one might end up dead
Helpless...one do not know what to do for the best.
Guilty...because one cannot stop harming yourself, even if one want
to
Isolated...one do not know who to talk to.
Hating one...for not being what people want.
Upset...cannot keep feelings in or maybe one cannot let them out.
Worried...in case people think one are just attention-seeking.
Out of control...one might not know why one hurt your-self and
wonder if one are going mad.
Scared...because one do not know why one do it...its getting worse
When self-injury becomes a way of coping with stress it is a sign that
there are problems that need sorting out. Help or support t may be needed
from family, friends, or others.
Diagnosed of Self-injury
If an individual shows signs of self-injury, a mental health professional with
self-injury expertise should be consulted. The mental health professional
will be able to make an evaluation and recommend a course of treatment.
Self-injury can be a symptom of psychiatric illness including:
Personality disorders (particularly borderline personality disorder)
Bipolar disorder
Major depression
Anxiety disorders (particularly obsessive-compulsive disorder)
Schizophrenia
Treatment of self-injury
Self-injury treatment options include outpatient therapy, partial (6-12
hours a day) and inpatient hospitalization. When the behaviors interfere
with daily living, such as employment and relationships, and are health or
life threatening, a specialized self-injury hospital program with an experienced staff is recommended. The effective treatment of self-injury is most
often a combination of medication, cognitive/behavioral therapy, and interpersonal therapy, supplemented by other treatment services as needed.
Medication is often useful in the management of depression, anxiety, obsessive-compulsive behaviors, and the racing thoughts that may accompany
self-injury. Cognitive-behavioral therapy helps individuals understand

and manage their destructive thoughts and behaviors. Contracts, journals,
and behavior logs are useful tools for regaining self-control. Interpersonal
therapy assists individuals in gaining insight and skills for the development
and maintenance of relationships. Services for eating disorders, alcohol/
substance abuse, trauma abuse, and family therapy should be readily available and integrated into treatment, depending on individual needs
Therapy can be used to help a person stop engaging in self-injury.
Cognitive-behavioral therapy might be used to help an individual learn to
recognize and address triggering feelings in healthier ways. Post-traumatic stress therapies might be helpful for self-injurers who have a history of
abuse or incest. Group therapy might be helpful in decreasing the shame associated with self-harm, and in supporting healthy expression of emotions.
Family therapy can help to address any history of family stress related to
the behavior and can help family members learn to communicate more directly and non-judgmentally with each other. In addition, hypnosis or other
self-relaxation techniques are helpful in reducing the stress and tension that
often precede incidents of self-injury. Medicines such as antidepressants
or anti-anxiety medicine might be used to reduce the initial impulsive response to stress.
8.5 SUICIDE
Suicide is the act of one who causes his own death, either by positively destroying his own life, as by inflicting on himself a mortal wound or injury,
or by omitting to do what is necessary to escape death, as by refusing to
leave a burning house. From a moral standpoint we must treat therefore not
only the prohibition of positive suicide, but also the obligation incumbent
on man to preserve his life.
Suicide is direct when a man has the intention of causing his own death,
whether as an end to be attained, or as a means to another end, as when a
man kills himself to escape condemnation, disgrace, ruin etc. It is indirect,
and not usually called by this name when a man
does not desire it, either as an end or as a means,
but when he nevertheless commits an act which in
effect involves death, as when he devotes himself to
the care of the plague-stricken knowing that he will
succumb under the task.
Suicide is the third leading cause of death for
people 10-24 years of age. Teen suicide statistics for
youths 15-19 years of age indicate that from 19501990, the frequency of suicides increased by 300%
and from 1990-2003, that rate decreased by 35%.
However, from 2000-2006, the rate of suicide has
gradually increased, both in the 10-24 years and the
25-64 years old age groups. While the rate of murder-suicide remains low at 0.0001%, the devastation
it creates makes it a concerning public-health issue.
The rate of suicide can vary with the time of
year, as wells as with the time of day. For example,
the number of suicides by train tends to peak soon after sunset and about
10 hours earlier each day. Although professionals like police officers and
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dentists are thought to be more vulnerable to suicide than others, important

flaws have been found in the research upon which those claims are based.
8.5.1 The Effects of Suicide

The effects of suicidal behavior or completed suicide on friends and family
members are often devastating. Individuals who lose a loved one to suicide
(suicide survivors) are more at risk for becoming preoccupied with the reason for the suicide while wanting to deny or hide the cause of death, wondering if they could have prevented it, feeling blamed for the problems that
preceded the suicide, feeling rejected by their loved one, and stigmatized
by others. Survivors may experience a great range of conflicting emotions
about the deceased, feeling everything from intense emotional pain and
sadness about the loss, helpless to prevent it, longing for the person they
lost, and anger at the deceased for taking their own life to relief if the suicide took place after years of physical or mental illness in their loved one.
This is quite understandable given that the person they are grieving is at the
same time the victim and the perpetrator of the fatal act.
8.5.2 Causes of Suicide

Although the reasons why people commit suicide are multifaceted and
complex, life circumstances that may immediately precede someone committing suicide include the time period of at least a week after discharge
from a psychiatric hospital or a sudden change in how the person appears
to feel (for example, much worse or much better). Examples of possible triggers (precipitants) for suicide are real or imagined losses, like the breakup
of a romantic relationship, moving, loss (especially if by suicide) of a friend,
loss of freedom, or loss of other privileges.
Firearms are by far the most common methods by which people take
their life, accounting for nearly 60% of suicide deaths per year. Older
people are more likely to kill themselves using a firearm compared to
younger people. Another suicide method used by some individuals is by
threatening police officers, sometimes even with an unloaded gun or a
fake weapon. That is commonly referred to as suicide by cop. Although
firearms are the most common way people complete suicide, trying to
overdose on medication is the most common means by which people attempt to kill themselves.
8.5.3 Risk Factors and Protective Factors for

Suicide
Risk factors are characteristics that make it more likely that individuals will
consider, attempt, or die by suicide. Protective factors are characteristics
that make it less likely that individuals will consider, attempt, or die by
suicide. Risk and protective factors are found at various levels: individual
(e.g., genetic predispositions, mental disorders, personality traits), family
(e.g., cohesion, dysfunction), and community (e.g., availability of mental
health services). They may be fixed (those things that cannot be changed,
such as a family history of suicide) or modifiable (those things that can be
changed, such as depression). Researchers identify risk and protective factors by comparing groups of individuals who have died by (or attempted
or contemplated) suicide with a group of similar individuals who have not

died by (or attempted or contemplated) suicide. If a specific characteristic
is found more often in those who died by suicide than in the comparison
group, then a risk factor for suicide may have been discovered. Likewise, if
a specific characteristic is found more often in members of the comparison
group, but not in the suicide group, then a protective factor may have been
discovered.
Some Risk Factors for Suicide

There is no single cause of suicidal behavior and each persons situation is
unique. However, research has revealed a number of common risk factors
that may increase the likelihood of someone taking their life:
Individual Factors: such as being male, being Aboriginal or Torres
Strait Islander, experiencing physical health problems and stressful
life events such as bereavement or relationship breakdown. Young
gay or lesbian people may also have an increased risk of suicidal
behavior;
Mental Illness: such as depression, substance abuse, psychotic disorders and a history of previous suicide attempts;
Family-related Factors: such as family breakdown, family conflict,
abuse or family history of suicide;
Social Factors: such as socio-economic disadvantage, unemployment, school disengagement, incarceration, cultural differences and social and geographical isolation (especially remote
communities);
Environmental Factors: such as access to methods of suicide and exposure to suicide methods via the media or peers.
Protective Factors for Suicide

Similar to risk factors, there are no clear universal protective factors that
may decrease the likelihood of a person taking their life. Some known factors include:
Being connected or belonging to a family, school or other community, such as a sporting or recreation group;
Having at least one significant person to relate to and bond with
(whether that is a family member, a friend or other person);
Having personal skills and resilience to deal with difficult situations;
Spirituality and beliefs;
Economic security;
Good physical as well as mental health;
Receiving effective treatment for mental illness and emotional problems.
Suicide in Teens
Teenage suicide is a serious and growing problem. The teenage years can
be emotionally turbulent and stressful. Teenagers face pressures to succeed
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and fit in. They may struggle with self-esteem issues, self-doubt, and feelings of alienation. For some, this leads to suicide. Depression is also a major
risk factor for teen suicide.
Other risk factors for teenage suicide include:
Childhood abuse
Availability of a gun
Recent traumatic event
Hostile social or school environment
Lack of a support network
Exposure to other teen suicides
8.6 SUICIDE PREVENTION

Suicide is a serious public health problem that can have lasting harmful
effects on individuals, families, and communities. While its causes are complex and determined by multiple factors, the goal of suicide prevention
is simple: Reduce factors that increase risk (i.e. risk factors) and increase
factors that promote resilience (i.e. protective factors). Ideally, prevention
addresses all levels of influence: individual, relationship, community, and
societal. Effective prevention strategies are needed to promote awareness of
suicide and encourage a commitment to social change.
A suicidal person may not ask for help, but that does not mean that
help is not wanted. Most people who commit suicide do not want to die
they just want to stop hurting. Suicide prevention starts with recognizing
the warning signs and taking them seriously. If you think a friend or family
member is considering suicide, you might be afraid to bring up the subject.
But talking openly about suicidal thoughts and feelings can save a life.
The World Health Organization estimates that approximately 1 million
people die each year from suicide. What drives so many individuals to take
their own lives? To those not in the grips of suicidal depression and despair,
it is difficult to understand what drives so many individuals to take their
own lives. But a suicidal person is in so much pain that he or she can see no
other option.
Suicide is a desperate attempt to escape suffering that has become unbearable. Blinded by feelings of self-loathing, hopelessness, and isolation, a
suicidal person cannot see any way of finding relief except through death.
But despite their desire for the pain to stop, most suicidal people are deeply
conflicted about ending their own lives. They wish there was an alternative
to committing suicide, but they just cannot see one.
What is the Treatment for Suicidal thoughts and Behaviors?

Those who treat people who attempt suicide tend to adapt immediate treatment to the persons individual needs. Those who have a responsive and
intact family, good friendships, generally good social supports, and who
have a history of being hopeful and have a desire to resolve conflicts may
need only a brief crisis-oriented intervention. However, those who have
made previous suicide attempts, have shown a high degree of intent to kill
themselves, seem to be suffering from either severe depression or other
mental illness, are abusing alcohol or other drugs, have trouble controlling
their impulses, or have families who are unwilling to commit to counseling
are at higher risk and may need psychiatric hospitalization and long-term
outpatient mental-health services.
Suicide-prevention measures that are put in place following a psychiatric hospitalization usually involve mental-health professionals trying to implement a comprehensive outpatient treatment plan prior to the individual
being discharged. This is all the more important since many people fail to
comply with outpatient therapy after leaving the hospital. It is often recommended that all firearms and other weapons be removed from the home,
because the individual may still find access to guns and other dangerous
objects stored in their home, even if locked. It is further often recommended
that sharp objects and potentially lethal medications be locked up as a result
of the attempt.
8.6.1 Suicide Warning Signs

Major warning signs for suicide include talking about killing or
harming oneself, talking or writing a lot about death or dying, and
seeking out things that could be used in a suicide attempt, such as
weapons and drugs. These signals are even more dangerous if the
person has a mood disorder such as depression or bipolar disorder, suffers from alcohol dependence, has previously attempted
suicide, or has a family history of suicide. Many suicidal youth
demonstrate observable behaviors that signal their suicidal thinking.
These include:
Suicidal threats in the form of direct and indirect statements.
Suicide notes and plans.
Prior suicidal behavior.
Making final arrangements (e.g., making funeral arrangements,
writing a will, giving away prized possessions).
Preoccupation with death.
Changes in behavior, appearance, thoughts and/or feelings.
8.6.2 The Role of the School in Suicide Prevention

Children and adolescents spend a substantial part of their day in school under the supervision of school personnel. Effective suicide and violence
prevention is integrated with supportive mental health services, engages the entire school community, and is imbedded in a positive school
climate through student behavioral expectations and a trustful student/
adult relationship. Therefore, it is crucial for all school staff to be familiar with and watchful for risk factors and warning signs of suicidal
behavior. The entire school staff should work to create an environment
where students feel safe sharing such information. School psychologists
and other crisis team personnel, including the school counselor and
school administrator, are trained to intervene when a student is identified at risk for suicide. These individuals conduct suicide risk assessment, warn/inform parents, provide recommendations and referrals to
community services, and often provide follow up counseling and support at school.
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Parental Notification and Participation

Parent notification is a vital part of suicide prevention. Parents need to be
informed and actively involved in decisions regarding their childs welfare.
Even if a child is judged to be at low risk for suicidal behavior, schools will
ask parents to sign a Notification of Emergency Conference form to indicate
that relevant information has been provided. These notifications must be
documented. Additionally, parents are crucial members of a suicide risk
assessment as they often have information critical to making an appropriate assessment of risk, including mental health history, family dynamics,
recent traumatic events, and previous suicidal behaviors.
After a school notifies a parent of their childs risk for suicide and provides referral information, the responsibility falls upon the parent to seek
mental health assistance for their child.
Parents must:
Continue to take Threats Seriously: Follow through is important even
after the child calms down or informs the parent they did not mean
it. Avoid assuming behavior is attention seeking.
Access School Supports: If parents are uncomfortable with following
through on referrals, they can give the school psychologist permission to contact the referral agency, provide referral information, and
follow up on the visit. The school can also assist in providing transportation to get the parent and child to the referral agency.
Maintain Communication with the School. After such an intervention,
the school will also provide follow-up supports. The communication will be crucial to ensuring that the school is the safest, most
comfortable place for child.
8.7 CLUSTER SUICIDE

A group of suicides, grouped by time (all proximal to each other but not
typically simultaneous) and grouped by association in a typically small,
interactive quasi-community such as a high school.
The dynamics of this are not entirely clear to anyone at this time, but it
is thought that one suicide in a closely knit group may serve as the trigger
to a cluster of suicides within that quasi-community.
8.7.1 Preventing Cluster Suicides

Taking the right actions can prevent one suicide from leading to others.
A suburban school system was saddened when its third student in several months died by suicide. The superintendent shared the most recent
tragedy at a meeting with other local superintendents and was startled to
learn that across four neighboring districts, nine teenagers had died by suicide in the last 18 months. Were they in the midst of a suicide cluster? If
so, how could they stop it? Did these teens all know each other? How will
further deaths be prevented? Who is most at risk?
Teenagers are the age group most susceptible to imitating suicidal behavior, and a plethora of significant research has shed light on the very real
problem of contagion often not recognized by communities due to lack of
awareness or desire to face the problem. How to identify those who may
be most vulnerable in the aftermath of a suicide and how to address their
needs are key. Postvention, or intervention done after a suicide to provide
support to friends and family, when conducted properly leads to prevention. Administrators should review the extensive postvention literature prior to a tragedy and remember that no single entity or agency working alone
is likely to stop a suicide cluster.
8.7.2 Fact
Suicide clusters account for 100-200 deaths annually, according to the Centers for Disease Control and Prevention (CDC). A suicide cluster is defined
as multiple deaths by suicide that occurs within a defined geographical
area and fall within an accelerated time. These clusters consist of more than
three victims, typically ranging from 13 to 24 years old, and occur within
approximately a one-to-two-year period. Contagion is the process in which
the death by suicide of an individual influences an increase in the suicides
of others. Exposure to another individuals suicideassuming temporal,
geographic and interpersonal proximity are involved can precipitate imitative suicidal behavior.
8.7.3 Postvention Guidelines

1. Develop a comprehensive plan to address suicides, one that involves various sectors of the community, including educational facilities, mental and public health agencies, crisis intervention centers, local government, police, clergy, media, survivor groups and
local academic resources.
2. Select a crisis team that identifies high-risk individuals, provides
specific recommendations for schools, and conducts its work without sensationalism.
3. Understand the circles of vulnerability in order to identify those
most at risk after a suicide has occurred in the community.

1.
Which of the following is a characteristic of major depression with

atypical features?
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(a) weight loss

2.
3.
(b) insomnia
(c) psychomotor agitation
(d) None of these
Which of the following is a behavioral explanation for depression?

(a) depressogenic schemas
(b) Lack of reinforcement
(c) stress intolerance
(d) None of these
..characterized by having symptoms for 2 weeks or longer that do not meet full criteria for major depression
(a) Bipolar disorder:
(b) Minor depression
(c) Dysthymic disorder
(d) None of these
4. Clinical depression is a ..which affects millions of people

each year
5.
(a) medical illness
(b) major Depression
(c) Self Injury
(d) None of these
Depression in men is associated with the following indicators

(a) behaviors such as acting out and being impulsive
(b) low tolerance to stress
(c) only a
(d) all of above
6.
7.
8.
9.
The term postvention originally applied only to:

(a) suicides
(b) homicides
(c) abuse
(d) None of these
Which one are not risk factors for suicide?

(a) Individual factors
(b) Mental illness
(c) Social factors
(d) None of these
The World Health Organization estimates that approximately

people die each year from suicide
(a) 10,000
(b) 1000
(c) 1 million
(d) None of these
Suicide clusters account for 100-200 deaths annually, according to the
(a) CDC
(b) WHO
(d) UNICEF
(d) None of these
10. Depression can sometimes be difficult to detect because it may present

in many different ways, such as:
(a) Loss of pleasure/interest
(b) Irritability/hostility
(c) Somatization.
(d) All of the above

1. What do you mean by depression?
2. What are the different forms of depression?

3. Explain the depression in children and teens.
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4. What is clinical depression? Explain the general treatment for clinical depression.
5. What are the risk factors for depression?
6. What is self injury? Explain causes a person to engage in self-injury?
7. Explain that what are suicide and the effects of suicide.
8. What are the risk factors and protective factors for suicide?
9. What is cluster suicide? Explain also suicide prevention.
10. What is the role of the school in suicide prevention?
ANSWER FOR MULTIPLE CHOICE QUESTIONS
1. (a)
2. (b)
3. (b)
4. (a)
5 (d)
6. (a)
7. (d)
8. (c)
9. (a)
10. (d)
Chapter 9
Objectives
After studying this
able to:
Discuss the
skeletal system
Explain the
muscular
system
Describe
the nervous
system
INTRODUCTION
nurturing environment for young dancers ages 3-7, the Childrens Program gives the best introduction to movement, music, coordination, and
classical dance structured discipline. We immediately start to teach ballet vocabulary and understanding while encouraging their creativity and performing confidence.
Free movement of patients or patient mobility, as it is commonly referred to implies people accessing health care services outside their home
state. Although health care normally is delivered close to where people live,
in some instances the need for medical care arises while away from home or
patients decide to seek care elsewhere. Patients readiness to travel for care,
especially across borders, is determined by a mix of factors linked to the specific situation of the patient, to the specific medical needs and to availability
of care at home and abroad. Motivations for travelling abroad for care vary
from the search for more timely, better quality or more affordable health care
to treatment responding better to the patients wants or needs including
when care is inexistent or even prohibited at home. While citizens in the EU,
in principle, are free to seek health care wherever they want and from whatever provider available, in practice this freedom is limited by their ability
to pay for it or by the conditions set out by public and private funding systems for health care. Traditionally, countries have confined statutory cover
for health care delivered to their population to providers established in their
territory.
Which organizational solution is appropriate for the international coordination of multiple networks of associations, NGOs, trade unions, think
tanks, social movements, etc. known as the ant globalization or global
justice movement? What kind of governance can a network of networks
set up to support collective action while preserving the diversity of its components? The global justice movement has answered these questions with an
original organizational innovation, the process of World Social Forums, initiated in January 2001. Every year, in Porto Alegre (Brazil), Mumbai, Nairobi
and then Belm (Brazil), the WSF brings together thousands of participants
in order to discuss and share different agendas of mobilization. Social forums
are spaces open to hundreds of debates, seminars and workshops; they are
theatres of meetings, confrontations and convergences between actors, incubators of international campaigns and mobilizations; and they are spaces
of socialization, training and identity production. we discuss the history of
the changing organization of the WSF since its first incarnation in January
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2001. We examine the organizational rules that have been created and the
tools that were used in order to govern this heterogeneous coalition. The
aim of this case study is thus to examine one of the many possible governance processes for international civil society. Even if there are many differences, the WSF process gives a few insights into possible organizational
structures and decision-making-processes for the governance of information society. First, World Social Forums and internet governance institutions are two typical advanced examples of large and international network
structures. Second, the resources offered by new technologies are not only
tools of communication for the coordination of activists all over the world;
they are also conceived as an organizational solution to design new ways
of decision-making.
9.1 SKELETAL SYSTEM

Your skeletal system is all of the bones in the body and the tissues such
as tendons, ligaments and cartilage that connect them. Your teeth are also
careful part of your skeletal system but they are not counted as bones. Your
teeth are made of enamel and dentin. Enamel is the strongest substance in
your body.
The main job of the skeleton is to provide support for our body. Without your skeleton your body would fall down into a heap. Your skeleton is
strong but light. Without bones youd be just a lake of hide and guts on the
ground.
9.1.1 Functions of the Skeleton System

The skeletal system in the body provides the form, supports and protects
organs and the soft areas of the body. Its others functions are bodily movement, producing blood for the body, and storing minerals that the physical
structure needs.
Key Vocabulary
Movement and Coordination: a nursing outcome from the Nursing
Outcomes Classification
(NOC) defined as the
ability of muscles to work
together voluntarily for
purposeful movement.
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Key Vocabulary
Muscular System: The
bodily system that is composed of skeletal, smooth,
and cardiac muscle tissue
and functions in movement of the body or of materials through the body,
maintenance of posture,
and heat production.
Protection
One of the main functions of skeletal system involves protection to the soft
and fragile internal organs of the body. The brain is protected by the skull,
the nerves are protected by the spinal column, the rib cage provides protection to the heart and lungs. The fibrous disks between each vertebra act as
shock absorber.
The skeleton protects vital organs from injure by encasing them within
hard bones. The cranium encases the brain, while the vertebral, or spinal,
article protects the delicate spinal nerves, which control all bodily functions
by allowing all body parts to converse with the brain. The bony thorax,
comprised of the ribs and sternum, provides defense to the heart and lungs.
Movement
The skeletal bones attach to each other by
ligaments and further attach to muscles by
tendons. According to MNSU, the muscular
and skeletal system work together to carry out
bodily movement, and thus are jointly called
the musculoskeletal system. When strength
contract, bones are pulled along to produce
a movement allowing people to walk or run.
The shape of the skeletal system also has a role
in movement.
Support
The skeleton is the framework of the body; it supports the softer tissues and
provides points of attachment for most skeletal muscles.
Storage of Chemical Energy

With increasing age some bone marrow changes from red bone marrow
to yellow bone marrow. Yellow bone marrow consists mainly of adipose
cells, and a few blood cells. It is an important chemical energy reserve.
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Blood Cell Production

Inside of the long bones there is a cavity that is filled with a substance called
Bone Marrow that produces blood cells and repairs damaged blood cells.
Bones and Joints

Bones provide support for our bodies and help form our shape. The skull
protects the brain and forms the shape of our face. The spinal cord, a pathway for messages between the brain and the body, is protected by the backbone, or spinal column.
The human skeleton has 206 bones, which begin to develop before
birth. When the skeleton first forms, it is made of flexible cartilage, but
within a few weeks it begins the process of ossification. Ossification is when
the cartilage is replaced by hard deposits of calcium phosphate and stretchy
collagen, the two main components of bone. It takes about 20 years for this
process to be completed.
Key Vocabulary
Nervous System: The system of cells, tissues, and

organs that regulates the
bodys responses to internal and external stimuli.
Development of boons
In vertebrates it consists
of the brain, spinal cord,
The development of our bones is a complex process. Bone formation starts nerves, ganglia, and parts
in the fetus 6 months before birth and is not generally complete until ado- of the receptor and effeclescence (between ages 13 and 18).
tors organs.
Bones grow in length at the epiphyseal plate by a procedure that is similar to endochondral ossification. The carti-lage in the area of the epiphyseal
plate next to the epiphysis continues to grow by mitosis. The chondr-ocytes,
in the region next to the diaphysis, age and deteriorate. Osteoblasts move
in and ossify the matrix to form bone. This process continues throughout
early days and the adolescent years until the cartilage growth slows and
lastly stops. When cartilage growth ceases, usually in the early twenties,
the epiphyseal plate completely ossifies so that only a thin epiphyseal line
remains and the bones can no longer grow in length. Bone growth is under
the power of growth hormone from the anterior pituitary gland and sex
hormones from the ovaries and testes.
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Key Vocabulary
Skeletal System: The bodily system that consists of
the bones, their associated
cartilages, and the joints.
It supports and protects
the body, produces blood
cells, and stores minerals.
Health
Even though bones stop growing in length in early maturity, they can
continue to increase in thickness or diameter throughout life in response
to stress from greater than before muscle activity or to weight. The add to
in diameter is called appositional growth. Osteoblasts in the periosteum
form compact bone around the external bone surface. At the same time,
osteoclasts in the endosteum break down bone on the internal bone surface, around the medullary cavity. These two processes together increase
the width of the bone and, at the same time, keep the bone from becoming
excessively heavy and bulky.
Structure of bones
Bone help us to move. They provide support when we are standing or sitting. They even protect organs of the body such as the brain, heart and
lungs. They also produce red and white blood cells and store minerals. That
means bones are very important, so we must take very go care of them.
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The two structural types of

bones are the spongy bone and
the compact bone. The anatomy of
the human body is very complex.
Although a lay person could not
tell a difference in one look, these
two are very different from one
another. Here is a comparison for
a lay person to know how these
two are not the same in one bone
structure.
Joints
The human skeleton consists of more than 200 bones. The individual bones
are attached in such a way that a large variety of co-ordinate movements
are made possible in different parts of the body. These movements are
made possible by skeletal muscles, the fact that the bones act as levers, cartilage which reduces fricton and ligaments which prevent dislocation and
the presence of movable joints. The site or place where 2 or more bones of
the skeleton are attached to each other is called a joint.
9.2 MUSCULAR SYSTEM

The muscular system includes over 700 skeletal muscles that are directly or
indirectly attached to the skeleton by tendons or aponeuroses. The muscular system produces movement, as the contractions of skeletal muscles pull
on the attached bones. Muscular activity does not always result in movement, however; it can also be important in stabilizing skeletal elements and
preventing movement.
Skeletal muscles are also important in guarding entrances or exits of
internal passageways, such as those of the digestive, respiratory, urinary, or
reproductive systems, and in generating heat to maintain our stable body
temperatures.
Skeletal muscles contract only under the command of the nervous system. For this reason, clinical observation of muscular activity may provide
direct information about the muscular system, andindirect information
about the nervous system. The assessment of facial expressions, posture,
speech, and gait can be an important part of the physical examination.
Classical signs of muscle disorders include the following:
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Health
Gowers sign is a distinctive method of standing from a sitting or

lying position on the floor.
This method is used by children with muscular dystrophy. They move
from a sitting position to a standing position by pushing the trunk off the
floor with the hands and then moving the hands to the knees. The hands are
then used as braces to force the body into the standing position. This extra
support is necessary because the pelvic muscles are too weak to swing the
weight of the trunk over the legs.
Ptosis is a drooping of the upper eyelid. It may be seen in myasthenia
gravis , botulism , myotonic dystrophy , or following damage to the cranial nerve (N III) innervating the levator palpabrae superioris muscle of
the eyelid.
A muscle mass, an abnormal dense region within a muscle, is sometimes seen or felt in a skeletal muscle. A muscle mass may result
from torn muscle or tendon tissue, a hematoma, or the deposition of
bone around a skeletal muscle, as in myositis ossificans.
Abnormal contractions may indicate problems with the muscle tissue
or its innervation. Muscle spasticity exists when a muscle has excessive muscle tone. A muscle spasm is a sudden, strong, and painful
involuntary contraction.
Muscle flaccidity exists when the relaxed skeletal muscle appears soft
and relaxed and its contractions are very weak or absent.
Muscle atrophy is skeletal muscle deterioration, or wasting, due to
disuse, immobility, or interference with the normal muscle innervation.
Abnormal patterns of muscle movement, such as tics, choreiform
movements, or tremors, and muscular paralysis are usually caused
by nervous system disorders. These movements will be described
further in sections dealing with abnormal nervous system function.
Signs and Symptoms of Muscular System Disorders

Two common symptoms of muscular disorders are pain and weakness in
the affected skeletal muscles. The potential causes of muscle pain include
1. Muscle trauma: Examples of traumatic injuries to a skeletal muscle
would include a laceration, a deep bruise or crushing injury, a mus-
cle tear, or a damaged tendon.

2. Muscle infection: Skeletal muscles may be infected by viruses, as in
some forms of myositis, or colonized by parasitic worms, such as
those responsible for trichinosis: These infections usually produce
pain that is restricted to the involved muscles. Diffuse muscle pain
may develop in the course of other infectious diseases, such as influenza or measles.
3. Related problems with the skeletal system: Muscle pain may result from
skeletal problems, such as arthritis or a sprained ligament near the
point of muscle origin or insertion.
4. Problems with the nervous system: Muscle pain may be experienced
due to inflammation of sensory neurons or stimulation of pain pathways in the CNS.
Muscle strength can be evaluated by applying an opposite force against
a specific action. For example, the examiner might exert a gentle extending
force while asking the patient to flex the arm.
Because the muscular and nervous systems are so closely interrelated,
a single symptom, such as muscle weakness, can have a variety of different
causes Muscle weakness may also develop as a consequence of a condition
that affects the entire body, such as anemia or acute starvation.
9.2.1 Necrotizing Fasciitis

Several bacteria produce enzymes such as hyaluronidase or cysteine protease. Hyaluronidase breaks down hyaluronic acid and the proteoglycans
(large polysaccharide molecules linked by polypeptide chains) that make
up the intercellular cement between adjacent cells. Cysteine protease breaks
down conective tissue proteins. These bacteria are dangerous because they
can spread rapidly by liquifying the matrix and dissolving the intercellular
cement that holds epithelial cells together. The streptococci are one group
of bacteria that secrete both of these enzymes. Streptococcus A bacteria are
involved in many human diseases, most notably strep throat, a pharyngeal infection. In most cases the immune response is sufficient to contain
and ultimately defeat these bacteria before extensive tissue damage has occurred. However, in 1994 tabloid newspapers had a field day recounting
stories of killer bugs and flesh-eating bacteria that terrorized residents
of the city of Gloucester, England. The details were horrific minor cuts
become major open wounds, with interior connective tissues dissolving.
There were only 7 reported cases, but 5 of the victims died. The pathogen
responsible was a strain of Streptococcus A that overpowered immune defenses and swiftly invaded and destroyed soft tissues.
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The Body Systems: Clinical and Applied Topics
In some cases the muscle tissue was also destroyed, a condition called
myositis. The problem is not restricted to the United Kingdom. Some form
of very aggressive infectious soft tissue invasion occurs roughly 75150
times annually in the U.S. At present it is uncertain whether the recent
surge in myositis and necrotizing fasciitis reflects increased awareness of
the condition or the appearance of a new strain of strep bacteria
9.3 NERVOUS SYSTEM

The nervous system is a complex network of nerves and cells that carry
messages to and from the brain and spinal cord to various parts of the body.
The nervous system includes both the Central nervous system and Peripheral nervous system. The Central nervous system is made up of the
brain and spinal cord and The Peripheral nervous system is made up of the
Somatic and the Autonomic nervous systems.
Central Nervous system

The central nervous system is divided into two major parts: the brain and
the spinal cord.
The brain
The brain lies within the skull and is shaped like a mushroom.The brain
consists of four principal parts:
the brain stem
the cerebrum
the cerebellum
the diencephalon
The brain weighs approximately 1.3 to 1.4 kg. It has nerve cells called
the neurons and supporting cells called the glia.
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Health
There are two types of matter in the brain: grey matter and white matter. Grey matter receives and stores impulses. Cell bodies of neurons and
neuroglia are in the grey matter. White matter in the brain carries impulses
to and from grey matter. It consists of the nerve fibers (axons).
The Brain Stem

The brain stem is also known as the Medulla oblongata. It is located between the pons and the spinal cord and is only about one inch long.
The Cerebrum
The cerebrum forms the bulk of the brain and is supported on the brain
stem. The cerebrum is divided into two hemispheres. Each hemisphere controls the activities of the side of the body opposite that hemisphere.
The hemispheres are further divided into four lobes:
1. Frontal lobe
2. Temporal lobes
3. Parietal lobe
4. Occipital lobe
The cerebellum
This is located behind and below the cerebrum
The diencephalon
The diencephalon is also known as the fore brain stem. It includes the thalamus and hypothalamus. The thalamus is where sensory and other impulses
go and coalesce.
The hypothalamus is a smaller part of the diencephalon
Other Parts of the Brain

Other parts of the brain include the midbrain and the pons:
The midbrain provides conduction pathways to and from higher
and lower centers
The pons acts as a pathway to higher structures; it contains conduction pathways between the medulla and higher brain centers
The Spinal Cord

The spinal cord is along tube like structure which extends from the brain.
The spinal cord is composed of a series of 31 segments. A pair of spinal
nerves comes out of each segment. The region of the spinal cord from which
a pair of spinal nerves originates is called the spinal segment.Both motor
and sensory nerves are located in the spinal cord.
The spinal cord is about 43 cm long in adult women and 45 cm long in
adult men and weighs about 35-40 grams. It lies within the vertebral column, the collection of bones (back bone)..
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Other Parts of the Central Nervous System

The meninges are three
layers or membranes
that cover the brain and
the spinal cord.The outermost layer is the dura
mater. The middle layer
is the arachnoid, and the
innermost layer is the pia
mater. The meninges offer protection to the brain
and the spinal cord by
acting as a barrier against
bacteria and other microorganisms.
The Cerebrospinal
Fluid (CSF) circulates
around the brain and spinal cord. It protects and
nourishes the brain and
spinal cord.
Neurons
The neuron is the basic
unit in the nervous system. It is a specialized conductor cell that receives
and transmits electrochemical nerve impulses.
A typical neuron has a cell
body and long arms that
conduct impulses from
one body part to another
body part.
There are three different parts of the neuron:

the cell body
dendrites
axon
Cell Body of a Neuron

The cell body is like any other cell with a nucleus or control center.
Dendrites
The cell body has several highly branched, thick extensions that appear like
cables and are called dendrites. The exception is a sensory neuron that has a
single, long dendrite instead of many dendrites. Motor neurons have multi-
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ple thick dendrites. The dendrites function is to carry a nerve impulse into
the cell body.
Axon
An axon is a long, thin process that carries impulses away from the cell
body to another neuron or tissue. There is usually only one axon per neuron.
Myelin Sheath
The neuron is covered with the Myelin Sheath or Schwann Cells. These are
white segmented covering around axons and dendrites of many peripheral
neurons. The covering is continuous along the axons or dendrites except at
the point of termination and at the nodes of Ranvier.
The neurilemma is the layer of Schwann cells with a nucleus. Its function is to allow damaged nerves to regenerate. Nerves in the brain and spinal cord do not have a neurilemma and, therefore cannot recover when
damaged.
Types of Neuron
Neurons in the body can be classified according to structure and function.
According to structure neurons may be multipolar neurons, bipolar neurons, and unipolar neurons:
Multipolar neurons have one axon and several dendrites. These are
common in the brain and spinal cord
Bipolar neurons have one axon and one dendrite. These are seen in
the retina of the eye, the inner ear, and the olfactory (smell) area.
Unipolar neurons have one process extending from the cell body.
The one process divides with one part acting as an axon and the
other part functioning as dendrite. These are seen in the spinal cord.
The Peripheral nervous system

The Peripheral nervous system is made up of two parts:
1. Somatic nervous system
2. Autonomic nervous system
Somatic Nervous System

The somatic nervous system consists of peripheral nerve fibers that pick
up sensory information or sensations from the peripheral or distant organs
(those away from the brain like limbs) and carry them to the central nervous system.
These also consist of motor nerve fibers that come out of the brain and
take the messages for movement and necessary action to the skeletal muscles. For example, on touching a hot object the sensory nerves carry information about the heat to the brain, which in turn, via the motor nerves, tells
the muscles of the hand to withdraw it immediately.
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The whole process takes less than a second to happen. The cell body of
the neuron that carries the information often lies within the brain or spinal
cord and projects directly to a skeletal muscle.
Autonomic Nervous System

Another part of the nervous system is the Autonomic Nervous System. It
has three parts:
1. The sympathetic nervous system
2. The parasympathetic nervous system
3. The enteric nervous system
This nervous system controls the nerves of the inner organs of the body
on which humans have no conscious control. This includes the heartbeat,
digestion, breathing (except conscious breathing) etc.
The nerves of the autonomic nervous system enervate the smooth involuntary muscles of the (internal organs) and glands and cause them to
function and secrete their enzymes etc.
The Enteric nervous system is the third part of the autonomic nervous
system. The enteric nervous system is a complex network of nerve fibers
that innervate the organs within the abdomen like the gastrointestinal tract,
pancreas, gall bladder etc. It contains nearly 100 million nerves.
Neurons in the Peripheral Nervous System

The smallest worker in the nervous system is the neuron. For each of the
chain of impulses there is one preganglionic neuron, or one before the cell
body or ganglion, that is like a central controlling body for numerous neurons going out peripherally.
The preganglionic neuron is located in either the brain or the spinal
cord. In the autonomic nervous system this preganglionic neuron projects
to an autonomic ganglion. The postganglionic neuron then projects to the
target organ.
In the somatic nervous system there is only one neuron between the
central nervous system and the target organ while the autonomic nervous
system uses two neurons.

1.
2.
3.
An axon is a long, thin process that carries impulses away from the cell
body to another ...
(a) neuron
(b) brain
(c) nervous
(d) None of these
.neurons have one process extending from the cell body.

(a) Bipolar
(b) Unipolar
(c) Polar
(d) None of these
Neurons in the body can be classified according to and

function
(a) figure
(b) cord
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(c) structure
(d) None of these
4. . neurons have one axon and several dendrites.
5.
6.
7.
8.
9.
(a) Multipolar
(b) Bipolar
(c) Unipolar
(d) None of these
The human skeleton consists of more than . bones

(a) 100
(b) 200
(c) 50
(d) None of these
The Cerebrospinal Fluid (CSF) circulates around the .. and spinal cord
(a) brain
(b) neck
(c) leg
(d) None of these
The cerebrum is divided into two

(a) semispheres
(b) hemisperes
(c) spheres
(d) None of these
The nervous system includes both the Central nervous system and
...
(a) Somatic nervous system
(b) Autonomic nervous system
(c) Peripheral nervous system
(d) None of these
The Enteric nervous system is the third part of the . nervous

system.
(a) peripheral
(b) autonomic
(c) somatic
(d) None of these
10. Bones provide support for our bodies and help form our
(a) shape
(b) structure
(c) polar
(d) None of these

1. What is movement and coordination?
2. What is the purpose of the skeletal system?
3. What is the purpose of the skeletal muscular system?
4. How does the skeletal system interact with other systems?
5. How does the skeletal system work with the cardiovascular system?
6. How does the skeletal system work with the circulatory system?
7. How does the skeletal system work with the nervous system?
8. What is the function of the nervous system?
9. What is the nervous system and how does it work?
10. What is the central nervous system?
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ANSWERS OF MULTIPLE CHOICE QUESTIONS
1.(a)
2.(b)
3.(c)
4.(a)
5.(b)
6.(a)
7.(b)
8.(c)
9.(b)
10.(a)
Chapter 10
Cardiovascular and
Respiratory Health
Objectives
After studying this
able to:
Understand
cardiovascular system
Explain
respiratory
system
Describe
cardiovascular risk and
preventions
Discuss respiratory risk
and preventions
INTRODUCTION
he cardiovascular system is, in the simplest form, a system that consists

of a pump, pipes, and a fluid system. The system is a closed circuit, which
is elastic, thereby allowing movement and stresses to occur without damaging it. The pump in this system, or the heart, simply allows the blood to flow
in. It does not pull the fluid in; therefore the only function of the heart is as
a pump. As a consequence of the passive filling of the heart, the network
of arteries, capillaries, and veins throughout the body regulates the rate of
circulation of the blood. While this flow to the heart is constant, the actually
pumping of the blood is intermittent allowing a small fraction of time for the
heart to stop and rest between pumps.
Cardiac Output
Cardiac output is the amount of blood ejected per minute by the heart. This
is closely related to the maximum VO2, which we measured in the previous lab. In general, the higher the maximum cardiac output, the higher the
persons VO2. Maximum cardiac output for a physically fit male is about 30
L/min. Consequently, men who are not physically fit tend to have a maximum cardiac output of about 20-25 L/min. In women the maximum cardiac
output is similar, but tends to be higher when performing work at the same
level of oxygen consumption. This is speculated to be due the lower levels of
hemoglobin that exist in women, therefore reducing the amount of oxygen
that a womans blood can carry.
Heart
The heart is a pump, a four-chambered duplex pump. Functionally the heart
can be considered as two separate pumps.
Cardiovascular and Respiratory Health
181
Key Vocabulary
Cardiovascular System:
The organs and tissues
Right side: Smaller half of the heart receives returning blood from involved in circulatall parts of the body, pumps blood to the lungs for aeration by way ing blood and lymph
through the body.
of the pulmonary circulation.
Left Side: Larger half of the heart receives oxygenated blood from
the lungs, responsible for pumping blood to the rest of the body.
Valves: The artioventricular valves in the heart provide for a oneway passage of blood from the right atrium to the right ventricle
and from the left atrium to the left ventricle.
Semilunar valves just outside the heart prevent blood from flowing
back into the heart between contractions.
Pulse Rate and Heart Rate

A surge of blood enters the aorta with each contraction of the left ventricle.
The peripheral vessels do not permit blood to exit the arterial system as rapidly as it is ejected from the heart; a portion of the blood pumped from the
heart is stored in the aorta. This creates pressure within the entire arterial
system and causes a pressure wave to travel down the aorta to the remote
branches of the arterial tree. This stretch and subsequent recoil of the arterial wall during cardiac cycle can be felt readily as the characteristic pulse
in any superficial artery of the body. In healthy individuals, the pulse rate
and heart rate are identical.
10.1 CARDIOVASCULAR SYSTEM

The cardiovascular system includes the heart and two networks of blood
vessels: pulmonary circulation, which moves deoxygenated blood from the
heart to the lungs, and returns oxygenated blood back to the heart; and
systemic circulation, which carries oxygenated blood from the heart to the
bodys tissues and returns oxygen-depleted blood back to the heart. Blood
is that sticky, red fluid which circulates throughout the body in a complex
network of veins and arteries, transporting nutrients and oxygen to the
bodys tissues and removing waste products for disposal. The hearts con-
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tractions work to move oxygen into the blood; it also gathers carbon dioxide from the blood so it can be expelled through the lungs. While the lungs
play an important role in this process, each of the bodys cells is involved.
The cardiovascular system includes organs which take up space throughout the body, including the heart and all of the bodys veins, arteries and
capillaries. The cardiovascular system is basic to life and the beat of ones
heart is an automatic function which is controlled by the brain.
Figure: Cardiovascular System

(Male View) Description
Key Vocabulary
Respiratory System: The
respiratory system functions by taking in oxygen
to the body and giving
off carbon dioxide to the
outside
environment.
This gas exchange happens in the alveolar region of the lungs. When
the blood is oxygenated
the blood then delivers
the oxygen to other parts
of the body.
The cardiovascular system includes

the heart and two networks of blood vessels: pulmonary circulation, which moves
deoxygenated blood from the heart to the
lungs, and returns oxygenated blood back
to the heart; and systemic circulation, which
carries oxygenated blood from the heart to
the bodys tissues and returns oxygen-depleted blood back to the heart. Blood is that
sticky, red fluid which circulates throughout the body in a complex network of veins
and arteries, transporting nutrients and
oxygen to the bodys tissues and removing waste products for disposal.
The hearts contractions work to move oxygen into the blood; it also gathers carbon dioxide from the blood so it can be expelled through the lungs.
While the lungs play an important role in this process, each of the bodys
cells is involved. The cardiovascular system includes organs which take up
space throughout the body, including the heart and all of the bodys veins,
arteries and capillaries. The cardiovascular system is basic to life and the
beat of ones heart is an automatic function which is controlled by the brain.
Figure: Cardiovascular System
(Female View) Description
The cardiovascular system of the
upper extremities ensures adequate
flow of oxygenated blood to - and the
removal of deoxygenated blood from the shoulders, arms, hands and fingers.
Adequate blood flow to these tissues is
critical to the health of these extremities,
helps regulate body temperature, and
reduces the risk of frostbite of the fingers
in extreme weather conditions.
Providing the upper extremities
with oxygenated blood are several large
blood vessels, including the brachial
artery at the top of the arm and the radial and ulnar arteries in the lower arm.
183
These arteries branch into even smaller ones in the hands, including the
palmar arteries. The corresponding veins (they carry the same names as
the arteries - for example, the radial vein) take deoxygenated blood away
from these sites in paths parallel to the arteries and move it to the heart and
lungs, where oxygen stores are then replenished.
Figure: Cardiovascular System of the Arm

and Hand Description
The cardiovascular system of the head
and neck includes the arteries which supply oxygenated blood to the brain (and
to the other organs of the head, including
the mouth and eyes), and the veins which
return deoxygenated blood from these organs to the heart. There are a number of
very important blood vessels within the
head and the neck. These include the brachiocephalic artery/vein, the external and
internal carotid arteries, the jugular vein,
and the retromandibular vein.
Figure: Cardiovascular System of

the Head and Neck Description
The cardiovascular system of
the lower extremities is the system
which provides oxygenated blood
to - and removes deoxygenated
blood from - a persons legs, feet,
and toes.
Deoxygenated blood is moved
from the digital vein (in the toes),
up through the dorsal metatarsal
vein in the foot, to the posterior
tibial vein and the small saphenous vein (both are located in the
calf). The blood is then transported
through the thigh via the great saphenous vein to the femoral vein;
from there, it moves through the
body to the heart and lungs, where
the carbon dioxide in the blood is replaced with oxygen; the freshly oxygenated blood then returns through the legs via the corresponding arteries,
which move in paths parallel to the veins.
Key Vocabulary
Nasal Cavities: Two nasal cavities are separated
from each other by a thin,
cartilaginous median vertical partition called nasal
septum.
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Health
Figure: Cardiovascular System of the

Leg and Foot Description
The cardiovascular system of the lower abdomen and pelvis is made up of the liver and
a large number of blood vessels which come
from networks in the stomach, intestines, pancreas and spleen. The veins of the lower abdomens cardiovascular system carry blood from
these organs through a portal vein to the liver.
There, the blood enters capillary like hepatic
sinusoids; all together, these are called the hepatic portal system. After passing through the
portal veins of the liver, the blood is carried
through a series of merging vessels into the hepatic veins. These empty into the inferior vena
cava
and
return
the
blood
into
circulation. The corresponding arteries of
Key Vocabulary
the same names are taking oxygenated blood to these sites in paths parallel
Pharynx: As it has al- to those of the veins.
ready been described in
the digestive system, it
comprises nasopharynx,
Figure: Cardiovascular System of the
oropharynx and larynLower Torso Description
gopharynx. The pharynx
provides passage to both
The cardiovascular system of the
air and food.
upper abdomen and chest includes a
number of major cardiovascular organs and blood vessels. These structures are critical to the process of
moving deoxygenated blood to the
lungs where carbon dioxide is removed from the blood and replaced
with oxygen, and then circulating
the oxygenated blood throughout the
bodys tissues and organs.
The primary structures of the cardiovascular system of the upper abdomen and chest are the heart, which pumps blood throughout the body;
and the hearts primary structures and blood vessels, including the aorta
and the superior and inferior vena cava. There are also a large number of
important blood vessels which serve the major organs of the upper abdomen, including the splenic vein, the abdominal aorta, and the hepatic veins.
Your heart and circulatory system make up your cardiovascular system. Your heart works as a pump that pushes blood to the organs, tissues,
and cells of your body. Blood delivers oxygen and nutrients to every cell
and removes the carbon dioxide and waste products made by those cells.
Blood is carried from your heart to the rest of your body through a complex
network of arteries, arterioles, and capillaries. Blood is returned to your
heart through venules and veins.
185
Figure: Heart and Cardiovascular System of the Upper Torso Description

If all the vessels of this network in
your body were laid end to end, they
would extend for about 60,000 miles
(more than 96,500 kilometers), which
is far enough to circle the planet Earth
more than twice! The one-way circulatory system carries blood to all parts of your body. This process of blood
flow within your body is called circulation. Arteries carry oxygen-rich
blood away from your heart, and veins carry oxygen-poor blood back to
your heart. In pulmonary circulation, though, the roles are switched. It is
the pulmonary artery that brings oxygen-poor blood into your lungs and
the pulmonary vein that brings oxygen-rich blood back to your heart.
Key Vocabulary
Nostrils (External Nares).

In the diagram, the vessels Holes of the nose are
that carry oxygen-rich blood are called nostrils (external
colored red, and the vessels that nares).
carry oxygen-poor blood are
colored blue. Twenty major arteries make a path through your
tissues, where they branch into
smaller vessels called arterioles.
Arterioles further branch into
capillaries, the true deliverers
of oxygen and nutrients to your
cells. Most capillaries are thinner
than a hair. In fact, many are so
tiny, only one blood cell can move
through them at a time. Once the
capillaries deliver oxygen and nutrients and pick up carbon dioxide
and other waste, they move the
blood back through wider vessels
called venules. Venules eventually join to form veins, which deliver the blood back to your heart
to pick up oxygen.
The heart weighs between 7
and 15 ounces (200 to 425 grams)
and is a little larger than the size
of your fist. By the end of a long
life, a persons heart may have
beat (expanded and contracted) more than 3.5 billion times. In fact, each
day, the average heart beats 100,000 times, pumping about 2,000 gallons
(7,571 liters) of blood.
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Health
Your heart is
located between
your lungs in the
middle of your
chest, behind and
slightly to the left
of your breastbone
(sternum). A double-layered membrane called the
pericardium surrounds your heart
like a sac. The
outer layer of the
pericardium surrounds the roots of
your hearts major
blood vessels and
is attached by ligaments to your spinal column, diaphragm, and other
parts of your body. The inner layer of the pericardium is attached to the
heart muscle. A coating of fluid separates the two layers of membrane, letting the heart move as it beats, yet still be attached to your body. Your heart
has 4 chambers. The upper chambers are called the left and right atria, and
the lower chambers are called the left and right ventricles. A wall of muscle
called the septum separates the left and right atria and the left and right
ventricles. The left ventricle is the largest and strongest chamber in your
heart. The left ventricles chamber walls are only about a half-inch thick,
but they have enough force to push blood through the aortic valve and into
your body.
10.2 RESPIRATORY SYSTEM

1. Nostrils (External Nares). Holes of the nose are called nostrils (external
nares).
2. Nasal Cavities. Two nasal cavities are separated from each other by
a thin, cartilaginous median vertical partition called nasal septum.
Three bony ridges, the superior, middle and inferior nasal conchae
arise from the wall of each nasal cavity. The nasal conchae increase
the surface area of the nasal cavities
3. Internal Nares. These are the posterior openings of the nasal cavities
that the lead into the nasopharynx.
4. Pharynx. As it has already been described in the digestive system, it
comprises nasopharynx, oropharynx and laryngopharynx. The pharynx provides passage to both air and food.
5. Larynx (= Voice Box). Until puberty there is little difference in the
size of the larynx in man and woman. Thereafter, it grows larger
and becomes prominent in man; therefore, it is called Adams apple
in man. Human larynx consists of the following structures.
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i) Glottis. The pharynx opens into the lar.ynx by a slit-like aperture, the glottis.
ii) Cartilages of the Larynx. There are nine pieces of cartilages.
Three are single and three are paired.
Figure: Human Respiratory System
Nasal Cavity
Nasal Cavity and nose is in charge of breathing in respiratory system. When air is inhaled, the nasal cavity is divided into right and
left passageway. The tissue covers the wall of nasal cavity that
contains blood vessels and help warm the air inhaled. It makes
moisture in the nose and air to not get nosebleeds.
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Trachea (windpipe)
The Trachea is a tube that connects to the larynx, lungs as well as the bronchus and bronchiole. It carries air towards parts of the respiratory system
that it works with. It has C-shaped rings of cartilage to prevent the trachea
from collapsing during inhalation.
Nostril
Nostril stands for either of two external openings of the nose. This is where
the air is inhaled from your nose.
Pharynx
Part of digestive system that comes down to larynx and continues with esophagus. Common channel for swallowing and respiration, the food and
air pathways cross each other.
Larynx
Larynx is an organ that connects the lower part of the pharynx with the
trachea.
Lung
The lung is an organ that functions for us to live. It takes oxygen from
breath taken, and removes carbon dioxide. The oxygen enters the lungs
main pipe, the trachea which supplies to right and left lung. When the lung
expands, the air pressure inside the lung drops, thus inhaling air from the
outside. This is because the air must go to the low pressure zone which is in
the lungs. The lung also functions as a defense against infection. The nose is
first thing against inhaling harmful particles, then the lungs.
Pleura
Pleura is a thin membrane that surrounds the lung. The parietal pleura
conceal the chest cavity and the visceral pleura covers up the lungs. The
visceral pleura are when the parietal pleura folds back at the root of the
lung. They protect the lungs from surrounding areas of the body and harmful particles. Pleura are made out of 2 layers, and fluid that takes up space
between 2 layers. The two pleurae are always in contact. But, when air and
liquid between the two pleurae are collected, the pleural cavity will become
apparent. So, both in left and right, there are two pleural cavities. Pleural effusion happens when the blood cannot pump the fluid away from the lungs
which can cause shortness of breaths.
10.3 CARDIOVASCULAR RISK AND

PREVENTIONS
The INTERHEART study assessed the importance of risk factors for coronary artery disease worldwide. Nine measured and potentially modifiable risk factors, accounted for more than 90% of the proportion of the risk
for acute myocardial infarction. Smoking, history of hypertension or diabetes, waist hip ratio, dietary pattern, physical activity, alcohol consumption, blood apolipoproteins and psychosocial factors were identified as the
key risk factors. The effect of these risk factors was consistent in men and
women across different geographic regions and by ethnic group. The British Regional Heart Study also found that smoking, blood pressure and cholesterol accounted for 90% of attributable risk of CHD. Worldwide, the two
most important modifiable cardiovascular risk factors are smoking and abnormal lipids. Hypertension, diabetes, psychosocial factors and abdominal
obesity are the next most important but their relative effects vary in different regions of the world.
Most cardiovascular deaths will occur in individuals at moderate risk
as they constitute the largest group. High risk individuals will have the
most to gain from risk factor modification and historically are given the
highest priority in clinical practice. When estimating risk, total CVD mortality, rather than CHD endpoints should be used to encompass stroke
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Health
prevention as well as CHD prevention. Stroke deaths are underestimated

using traditional CHD endpoints. Current risk prediction systems do not
predict accurately the different risk profiles that exist in different ethnic
groupings and cultures. A risk score derived from Caucasian cohorts may
substantially overpredict the risk in a Chinese population.CVD risk prediction based on absolute risk is now advocated for treatment decisions for
aspirin, statins, antihypertensives and in people with atrial fibrillation, for
warfarin.
Intervention studies have shown that while relative risk reduction may
remain broadly constant, absolute risk reduction varies considerably because it is a function of the initial level of baseline risk. Consider the example in Table 1 of a man with a baseline risk of a cardiovascular event of
10% over ten years who takes effective preventative treatment and lifestyle
measures. His relative risk falls by a third, while his absolute risk is reduced
to 6.7%, an absolute risk reduction of 3.3%. If another man with a higher
baseline risk of 30% takes the same effective treatments his relative risk also
falls by about a third to 20%. However, his absolute risk reduction is 10%.
Relative risk reductions in CHD events in the statin trials appear
similar regardless of baseline risk and baseline cholesterol (except where
baseline cholesterol is<5 mmol/l when relative risk reduction is less. This
would support the concept that the best way to target patients are to calculate absolute risk.
Example illustrating absolute and relative risk reductions
Baseline ten year
CVD risk
Relative risk reduc- Post-treatment

tion
ten year cvd
risk
Absolute risk reduction
10%
33%
6.7%
3.3%
30%
33%
20%
10%
Over prediction of CVD risk means that people with little to gain potentially become patients and are exposed to the questionable benefits and
risks of lifelong treatment. Under prediction means that people with much
to gain may not be offered preventative treatment. The best way to target
patients for risk reducing interventions is to calculate absolute risk.
A large number of risk scoring systems for CHD and CVD have been
devised for use in clinical practice, the majority of which are based on the
American Framingham study.24,25 The Framingham equations are the
most widely accepted method for projecting cardiovascular disease/coronary disease risks, and are used in the British, European and New Zealand
guidelines.
These risk scoring systems are reliable in ranking individual CHD and
CVD risks within populations, based on conventional risk factors, but have
been shown to give a variable performance when predicting actual events
within populations. Framingham risk equations are based on event rates
which occurred in a predominately white, United States population during
the 1970s. CHD rates have been declining in the US and many other countries, resulting in a tendency for the event rates predicted by Framingham
based scores to be higher than actual event rates in populations.
Framingham-based scoring systems tend to overestimate risk in low
and medium risk groups and underestimate risk for certain subgroups including British Asians; people with Type 1 diabetes; people with Type 2 di-
abetes with nephropathy; those with familial hypercholesterolemia; those

with a strong family history of premature CHD; those with left ventricular
hypertrophy on electrocardiography; and those with chronic renal disease.
Framingham significantly under predicted CHD risk in a Scottish male general population cohort (Renfrew and Paisley) which is explained partly by
the high CHD mortality rates in this population. A Framingham based risk
score also underestimated the true level of CVD and CHD risk in men with
lower socioeconomic status whether this was assessed using social class or
a postcode-based deprivation score.
These results were tested in an analysis commissioned by SIGN based
on the Scottish Heart
Health Extended Cohort (SHHEC), involving 6,419 men and 6,618
women aged 30-74 years from 25 local government districts in Scotland, for
whom baseline data were collected between
1984 and 1995.17 While the Framingham score overestimated the actual observed CHD risk in the cohort as a whole, it seriously underestimated
the large gradient in risk by socioeconomic status, particularly in women.
Application of the score as a basis for preventive treatment would result in
relative under treatment of the most socially deprived, compared with the
least deprived, potentially exacerbating social disparities in disease rates.
While risk scores are superior to clinical assessment alone, they can be
misleading when used to guide treatment decisions among people at different levels of social deprivation or of different ethnic backgrounds. Without correction, such scores may foster the relative under treatment of the
socially deprived.18
In order to reduce the deprivation-related difference in the numbers
eligible for preventive treatment, risk scoring systems need to adjust for
deprivation, as the ASSIGN (Assessing cardiovascular risk using SIGN
guidelines to ASSIGN preventive treatment) score has been developed to
do,
Prevention of cardiovascular disease: cardiovascular disease also
known as heart diseases, are a group of diseases that involve the
heart or blood vessels, namely arteries and veins. Cardiovascular
diseases are a name commonly used to refer to arteriosclerosis, a
condition in which artery wall thickens because of a build-up of
fatty materials such as cholesterol. Cardiovascular diseases are on
the rise, because of the inappropriate lifestyle and diet. This group
of illnesses annually kills more US citizens than cancer. It is especially frequent in women and kills more women than breast cancer.
However, cardiovascular diseases are fully preventable. According
to the studies, the vascular injury starts from adolescence, which
means that the early prevention, even from the childhood, is very
important.
Diet: Following a healthy diet can make a huge difference in ones
life and prevent many dangerous diseases, including cardiovascular ones. One scientific study found that vitamins are not effective
in preventing cardiovascular diseases. However, a special dietary
plan, such as Mediterranean diet, remains effective as means of prevention. Good dietary habits are something that a person should
learn from the early childhood. A healthy, heart-friendly and healthbeneficial diet plan should include eating a lot of foods rich in fibers,
and low saturated fats and cholesterol. A diet should be abundant
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Health
in plant foods, fresh fruit and should include olive oil as the principal source of fat. Dairy products, fish and poultry are consumed
in low to moderate amounts, a couple of times per week. It is also
advised to take alcohol, preferably red wine, in moderate amounts
and daily.
Habits: To avoid cardiovascular diseases, one should not smoke or
use tobacco. This is one of the most significant risk factors for developing heart disease. Chemicals in tobacco will damage the heart
and blood vessels.
One should also avoid drinking too much alcohol, but moderate use
of alcohol is found to be beneficial for heart health. The dietary guidelines
propose that people should have up to one drink a day for women or two
drinks a day for men.
On 10 September, the Euro Heart mapping project, co-financed through
the EUs Public Health Program, presented the results of their three-year
study of heart health promotion and cardiovascular disease (CVD) prevention measures in several European countries. The study revealed significant
inequalities in both national prevention policies and levels of cardiovascular mortality. CVD is the main cause of death and disability in Europe. But
according to the World Health Organization (WHO), a modest reduction
in blood pressure, obesity and tobacco use across the population would
cut CVD incidence in half. The EuroHeart mapping project (Mapping and
analysis of national plans, policies and measures impacting on cardiovascular health promotion and CVD prevention across Europe) was launched
in 2007 by the European Heart Network and the European Society of Cardiology to determine specific areas of intervention that would most help
prevent avoidable deaths and disability. In the projects latest study, EuroHeart researchers collected comprehensive information on policies, plans
and measures that impact both the promotion of cardiovascular health
and the prevention of CVD in 16 European countries. The data were collected via structured questionnaires, and helped the partners to identify
differences and gaps in policies and actions as well as to determine the
essential elements of national strategies. One of the main findings was that
while heart disease remains the leading cause of death in Europe, mortality
rates are falling in most countries. However, the researchers also uncovered huge differences between countries in both the rate of cardiovascular
mortality and in national prevention programs. Hungary, Estonia, Slovakia
and Greece had the highest rates of mortality from coronary heart disease
(CHD) in men and women under 65. The lowest rates for men under 65
were seen in France, the Netherlands, Italy and Norway, while for women
in the same age group, the lowest rates were in Iceland, France, Slovenia
and Italy. Risk-factor prevalence such as smoking was also calculated, and
the countries with the highest risk profiles also had a high rate of CHD. For
example, the highest rates of smoking were found in Greece (46%), Estonia
(42%), Slovakia (41%), Germany (37%) and Hungary (37%). The incidence
of premature deaths from CHD was noticeably different between countries.
For instance, rates in Finland declined by 76% between 1972 and 2005, while
in the same period in Greece, mortality rates increased by 11%.All participating countries have some type of legislation in place addressing public
health, tobacco control and food. However, while Belgium, Estonia, Finland, France, Iceland, Italy and Slovenia have several policies in place that
promote cardiovascular health and address CHD, hypertension, stroke and
hyperlipidaemia, Greece has just one. Denmark and Greece both reported
having no national guidelines within the broad context of CVD; all other
countries had national guidelines for the management of hyperlipidaemia,
diabetes and stroke prevention. Most of the countries (with the exception of
Denmark, Greece and Slovenia) had obesity guidelines. France, Germany
and Ireland were the only countries that reported having recommendations
for emergency first-aid. The broader WHOs Europe [region] presents even
greater gaps between its 53 countries, which have been increasing over the
past 20 years, stated Nata Menabde, WHO Deputy Regional Director for
Europe. We are observing a difference up to 10 times in death rates from
ischaemic hearth diseases in men below 65 years of age. On the other side of
the coin, we see that some countries have been able to put in place successful policies to reduce this burden.WHO/Europe and the European Commission are working together with all Member States to strengthen health
systems in Europe and tackle the root causes of CVD, such as smoking, obesity, alcohol use and lack of physical activity. Susanne Logstrup, Director of
the European Heart Network, noted that the new findings show that most
countries have taken legislative action and have policy measures in place
addressing public health, specifically coronary heart disease, tobacco use,
food consumption and physical activity. She added that only in about half
the participating countries could we identify budgets allocated to policy
and programme implementation. The study revealed that smoking bans
significantly impacted the incidence of acute coronary events. For example,
in February last year the French authorities announced a 15% decrease in
emergency admissions for heart attack just 1 year after the public ban on
smoking came into effect. Researchers in Italy and Ireland have observed
a reduction of acute coronary events of approximately 11% since implementing smoking bans a few years ago. Interestingly, the number of people
admitted to hospital for heart attacks fell by 17% in the year after Scotlands
smoking ban took effect in
March 2006. The EuroHeart
project runs until March
2010. In addition to the
above mapping and analysis, its objectives include mobilizing support for cardiovascular health promotion
and cardiovascular disease
prevention,
investigating
issues concerning CVD in
women, improving prevention practices at primary care
level and implementing and
adapting European guidelines on CVD prevention to
national settings.
10.4 RESPIRATORY RISK AND

PREVENTIONS
Chronic cough and chronic bronchitis (cough with phlegm) is a significant
risk factor for COPD (chronic obstructive pulmonary disease) in later life,
she said. Meanwhile, further research is needed to test whether secondhand
smoke as a child die in middle age than those who smoke.
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When we talk
about diseases of the
respiratory tract, we
are talking from the
common cold until the
pneumonia. The infections (such as influenza for example) are
caused some by viruses
and other by bacteria
that are generally in
the environment and
are infected with ease.
In all cases, the measures preventing more
common in against diseases of the airways are
generally the same.
Prevention of the respiratory diseases:

Prevent colds and sudden changes in temperature.
Consume fruits of the season and food supplements containing vitamin C.
Avoid walking barefoot in cold surfaces, since the colds of back,
chest and feet increases the likelihood of develop a cough, cold or
respiratory diseases more complex.
Take hygiene habits constant as the cleanliness of your environment,
washing constant and awareness of your hands: before eating, then
go to the bathroom, after use objects in common use and shared as
telephones, pens, and etcetera; before and after salute of hand, kiss
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or hug; never touch your face with the dirty hands, especially eyes,
nose and mouth.
Never cover your mouth with hands and if you do, wash immediately.
Do not smoke and avoids being close to people who do.
Jabbox Health info recommendations:
Regularly Visits the doctor and tell them for what you felling in
these days..
Let a doctor determined the type of illness and treatment, as the
diseases of the airways can have severe complications reaching
even, if not treated properly.

1.
2.
3.
4.
5.
6.
7.
8.
Drinking Sodas risk of respiratory diseases.

(a) decreases
(b) increases
(c) removes
(d) None of these
Cardiac output is the amount of blood ejected per .. by

the heart.
(a) menute
(b) second
(c) hour
(d) None of these
Nostril stands for either of two external openings of the ...

(a) Pleura
(b) nose
(c) Larynx
(d) None of these
Part of digestive system that comes down to .. and continues

with esophagus
(a) Nostril
(b) Diet
(c) Larynx
(d) none of these
The INTERHEART study assessed the importance of risk factors for

coronary artery worldwide.
(a) Trachea
(b) disease
(c) asthma
(d) None of these
The Trachea is a tube that connects to the larynx, lungs as well as the
bronchus and bronchiole.
(a) Bronchus
(b) Larynx
(c) Health,
(d) None of these
Nasal . and nose is in charge of breathing in respiratory

system.
(a) blood
(b) Cavity
(c) Chronic
(d) none of these
The artioventricular valves in the .. provide for a one-way

passage of blood from the right atrium to the right ventricle and from
the left atrium to the left ventricle.
(a) prop
(b) heart
(c)nose
(d) None of these
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Health
9.
Pleura is a thin membrane that surrounds the .

(a) heart
(b) pump
(c) lung
(d) None of thes
10. Pleural effusion happens when the blood cannot pump the fluid away
from the lungs which can cause shortness of ...
(a) breaths
(b) pneumonia
(c) Larynx
d) None of these

1. What is cardiovascular system and what does it do?
2. What is respiratory system in humans?
3. What is a respiratory system disease?i
4. How does the cardiovascular system work together with the respiratory system?
5. How does the lung work with the respiratory system and the cardiac system?
6. What is the relationship between respiratory system and cardiovascular system?
7. Who is at risk for respiratory distress syndrome?
8. What are the risk factors of respiratory system?
9. What is the prevention of cardiovascular disease?
10. What is difference between Respiratory system and cardiovascular
system?
ANSWERS OF MULTIPLE CHOICE QUESTIONS

1. (b)
2. (a)
3.(b)
4.(c)
5.(b)
6. (a)
7.(b)
8.(b)
9.(c)
10.(a)

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How to use this Book

Multiple Choice questions

Human rights and Health

Emotions and Stress

Digestion and Excretion

4.3.3 Cultural and religious

6.6.1 Changes in Sodium

What are Mental Disorders?

8.1.3 Depression in Children

8.2.2 Causes of Clinical

7.2.1 How are males/Female

8.2.3 General Treatment for

Risk Factors for Depression

8.3.1 Risk Factors for Clinical

7.2.2 Causes Eating Disorders 131

7.2.3 Effects of Eating

8.4.1 Causes a Person to

7.2.5 Types of Eating Disorder

8.5.1 The Effects of Suicide

8.5.2 Causes of Suicide

7.2.6 Major Therapies for

8.5.3 Risk Factors and

7.2.7 Co-occurring Disorders

Mental Disorder Treatment

7.3.1 The initial Assessment

7.3.4 Psychological Treatment 141

8.6.1 Suicide Warning Signs

8.7.3 Postvention Guidelines

Movement and Coordination

7.3.5 Treatment with Medication 141

8.7.1 Preventing Cluster

7.3.2 The role of psychiatrists

8.6.2 The Role of the School in

7.2.8 Eating Disorder Special

8.2.1 Types of Clinical

7.1.2 Causes of Mental

8.1.2 Causes of Depression

8.1.4 Treatment of Depression 148

7.1.1 Forms of mental

8.1.1 Different Forms of Depression

Depression and Suicide

10.2 Respiratory System

10. Cardiovascular and Respiratory Health

1.1 DEFINITION OF HEALTH

After studying this

1.1.1 Two aspects to health

1.1.2 Determinants of Health

Job prospects and employment conditions

What we do and how we manage

Access and use of health services

1.2 IMPORTANCE OF HEALTH IN OUR

1.2.1 Why is Health Important to Us?

1.2.2 Why is Health Important in the Workplace?

1.2.3 Why is Health Important for Children?

Culture: The traditions

1.2.4 Personal Life

of man. Health care as a right of every individual has been recognized in

1.2.5 Family Life

1.2.6 Social Life

1.3 HEALTH RISK FACTORS

important component of the greater burden of ill health experienced by

1.3.1 Alcohol Consumption

The 20042005 NATSIHS found that, of the Indigenous Australians