Psychology

The professional world is bombarded with the concept of ethics. Ethics, which in essence, is the battle between what is right and wrong, has been given several interpretations since rightness and wrongness, is far too subjective to be understood in a single context. The conflict in understanding ethics has been addressed by creating models that aims to explain ethical reasoning.

For one, mental health professionals are guided by the need for ethical reasoning models such as that which covers philosophical models of ethical reasoning. This is when readers are supplied with the necessary milieu for discerning bases of ethical obligations and the meta-ethical rationalization principal the ethical code of their profession. Furthermore, another tool provides for the manner for a decision making that exemplifies ethical dilemmas and ethical responses. It cares for the matter of ethical predicament, in which two or more ethical tasks actually clash. Other contents provide topics one at a time, enhanced by case exemplars linking right and wrong answers, leaving professionals unprepared to apply ethical principles to novel state of affairs, predominantly where several ethical duties disagree. An example is the egocentric model where the human tendency to judge the world from a narrow, self-serving perspective is dominant. Humans are usually masterful at self-deception and explanation. People frequently preserve viewpoints that flutter in the face of the confirmation. People regularly connect in acts that deliberately infringe ethical ideologies (Paul and Elder, 2010). This becomes in conflict with other models like the ecocentric model because the former is based on the self and the latter is based on a wider view of the world.

More so, mental health professionals provides for a feature of ethical reasoning in the aspect of the reflection of the complexity of real-life situations. Abundant stimulating case examples facilitate students in applying ethical ideologies to novel qualified circumstances. Thorough coverage of ethical concerns in evaluation, rehabilitation, trademanagerial, instruction, study, and forensic actions is provided, as well as in rising areas such as e-therapy and internet research. Addressing multi-cultural concerns, on the other hand, is another philosophical basis. The effectiveness of each model really essential in solving ethical dilemmas and conflicts because it provides an objective ground to solve clashing interests in the subjective world of professional ethical interpretations.

This paper discusses the case of world renowned musician Clive Wearing. It includes a reflection on the significance of memory to the human person. It also explains the relevance of studying cases such as this to learning about memory.

The Case of Clive Wearing The Importance of Memory
One of the most essential parts of the human brain is the hippocampus. It is located near the temporal lobe and is the one responsible for storage of memory. It is the memory card of the human body. The absence of such mechanism would result to catastrophic consequences.

This paper discusses a case where the hippocampus is completely destroyed because of a disease called Viral Encephalitis. This is the case of world-renowned British musician Clive Wearing.

Memory in humans is no different from memory in computers. Basically, information is relayed from the moment of perception to the different connecting circuits until it reaches the physical memory (in our case, the hippocampus) of the system. Without the physical memory of the system, it would be impossible to save new information, which is essential to future tasks.

However, unlike computers, human beings are not limited to plain information. We are a biological beings composed of behavior, reasoning, and emotion. Perception is essential to human existence because it is our basis for saying that we are here and alive. Our memories are our source of gratification that we are here, we perceive, and we act. In the case of Clive, he would often write to his diary everything that happened to him by the minute only to forget that he even wrote it. His diary is filled with erasures and cross-outs because he completely cannot recall what happened. Even the thought that he is alive is written there.

This case is a revelation of the importance of memory in human existence. It opens up the doors to practitioners of psychology in being familiar with the nature of human memory, how fragile it is and how to prevent it from deteriorating. This also gives the general public awareness as to how such disorders can be possible, whereas preventing them from the chances of getting the same fate as with Clive.

The society that we live in today is composed of people of different ages, nationalities and body sizes, for some reason, the issue of body size is quite sensitive across all nations, majority of people do not like talking about it or even acknowledging that a problem exists, when your body has to be a certain size for you to be considered trendy. The sad fact in this case is that women are more affected by the negative body images as opposed to men who are not faced with pressure from the society to lose weight and maintain a certain body size. Teenagers and young adults, especially the girls, through the media, are influenced think that for them to be successful, they have to be skinny. These girls therefore result to unorthodox methods in order to remain thin and not gain weight.
                   
Evolution of the Female Body
According to an article by The Feminist e-Zine-Health, American women are living in a society that is obsessed with being thin. Magazine pages and television screens are filled with images of ultra-thin women, diet and exercise tips. The society moved from full figured female bodies to the thin bodies and this led to an increase in the eating disorders bringing forth negative body images. Over the years, there has been an evolution of how an ideal female body should look like. In the 1800s a woman who looked voluptuous and had extra weigh on her body was considered to be a rich and wealthy. However, in the early 1900s the women body size shifted from being plump and voluptuous to thinner bodies with less curves.

Although the more curvaceous type of body came back in the 1950s, in the 1960s the ideal body size was of a woman who was really skinny, super model Twiggy who had a tiny body frame was seen as the ideal image of the 1960s.  Karen Carpenter, a singer died of heart failure related to anorexia nervosa in 1983, the public became aware of the dangers of eating disorders  after her tragic death, she had began her battle with the disease in the 1970s (The Feminist eZine-Health).                                                 
In the 1980s there was an increase in the articles on dieting trends and body weight matters, the trend was for women to become thinner, the womens hips and busts were decreasing as their height increased. America began to emphasize on dieting, exercise and weigh loss. Today this trend continues even more not only are ideal women supposed to be ridiculously under weight, but are also supposed to be physically fit and toned without being too muscular. Nonetheless, many women are not able to achieve this unnatural body standard and those that do usually end up with an eating disorder (The Feminist eZine-Health).                                                 

Eating disorders
According to National Institute of Mental Health (NIMH), a person with an eating disorder tends to highly reduce food intake, overeats or has distress over body weight and image. distress or concern about body weight or shape.

A person with an eating disorder may start out by gradually reducing or increasing the amount of food that she consumes daily but with time, she finds out that she can no longer control her food intake, that being the case she may lose weight drastically or gain weight uncontrollably.

Eating disorders are very complex, and despite scientific research to understand them, the biological, behavioral and social underpinnings of these illnesses remain elusive.

There are disorders that result from reduction of food intake anorexia and bulimia are two such eating disorders. A third category is eating disorders not otherwise specified (EDNOS), which includes several variations of eating disorders. Most of these disorders are similar to anorexia or bulimia but with slightly different characteristics. Binge-eating disorder, which has received increasing research and media attention in recent years, is one type of EDNOS.

Eating disorders frequently appear during adolescence or young adulthood, but some reports indicate that they can develop even in small children or later in adulthood. Women and girls are much more likely than males to develop an eating disorder. Men and boys account for an estimated 5 to 15 percent of patients with anorexia or bulimia and an estimated 35 percent of those with binge-eating disorder. Eating disorders are real, treatable diseases with complex underlying causes. They frequently co-exist with other psychiatric disorders such as depression, substance abuse, or anxiety disorders. People with eating disorders also can suffer from numerous other physical health complications, such as heart conditions or kidney failure, which can lead to death.

Eating disorders are treatable diseases
Psychological and medicinal treatments are effective for many eating disorders. However, in more chronic cases, specific treatments have not yet been identified.

In these cases, treatment plans often are tailored to the patients individual needs that may include medical care and monitoring medications nutritional counseling and individual, group andor family psychotherapy. Some patients may also need to be hospitalized to treat malnutrition or to gain weight, or for other reasons.

Anorexia Nervosa
This disease occurs mostly in young girls and the obvious symptoms include emaciation, a relentless pursuit of thinness and trying to lose a lot of weight and the person is not willing to be of normal body weight, a distortion of body image and intense fear of gaining weight, a lack of menstruation among girls and women, and extremely disturbed eating behavior. Some of the girls lose weight by excessive dieting and exercise there are some who try to expel the food through vomiting or misusing laxatives, diuretics or enemas.

Many people with anorexia see themselves as overweight, even when they are starved or are clearly malnourished. Eating, food and weight control become obsessions. A person with anorexia typically weighs herself or himself repeatedly, portions food carefully, and eats only very small quantities of only certain foods. Some who have anorexia recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic form of anorexia, in which over many years as they battle the illness, their bodies can no longer take the pressure and they may even die.

According to some studies, people with anorexia are up to ten times more likely to die as a result of their illness compared to those without the disorder. The most common complications that lead to death are cardiac arrest, and electrolyte and fluid imbalances. Suicide also can result.

Many people with anorexia also have coexisting psychiatric and physical illnesses, including depression, anxiety, obsessive behavior, substance abuse, cardiovascular and neurological complications, and impaired physical development.

Other symptoms may develop over time, including
thinning of the bones (osteopenia or osteoporosis)
brittle hair and nails
dry and yellowish skin
growth of fine hair over body (e.g., lanugo)
mild anemia, and muscle weakness and loss
severe constipation
low blood pressure, slowed breathing and pulse
drop in internal body temperature, causing a person to feel cold all the time
lethargy

TREATING ANOREXIA involves three components
restoring the person to a healthy weight
treating the psychological issues related to the eating disorder and
reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing relapse.
Some research suggests that the use of medications, such as antidepressants, antipsychotics or mood stabilizers, may be modestly effective in treating patients with anorexia by helping to resolve mood and anxiety symptoms that often co-exist with anorexia. Recent studies, however, have suggested that antidepressants may not be effective in preventing some patients with anorexia from relapsing. In addition, no medication has shown to be effective during the critical first phase of restoring a patient to healthy weight. Overall, it is unclear if and how medications can help patients conquer anorexia, but research is ongoing.

Different forms of psychotherapy, including individual, group and family-based, can help address the psychological reasons for the illness. Some studies suggest that family-based therapies in which parents assume responsibility for feeding their afflicted adolescent are the most effective in helping a person with anorexia gain weight and improve eating habits and moods.

Shown to be effective in case studies and clinical trials, this particular approach is discussed in some guidelines and studies for treating eating disorders in younger, non chronic patients.

Others have noted that a combined approach of medical attention and supportive psychotherapy designed specifically for anorexia patients is more effective than just psychotherapy. But the effectiveness of a treatment depends on the person involved and his or her situation. Unfortunately, no specific psychotherapy appears to be consistently effective for treating adults with anorexia. However, research into novel treatment and prevention approaches is showing some promise. One study suggests that an online intervention program may prevent some at-risk women from developing an eating disorder.

Bulimia Nervosa
Bulimia nervosas main symptoms are recurrent and frequent episodes of eating unusually large amounts of food, and the person finds herself not being able to control her food intake. This episode is followed by a type of behavior that compensates for the binge, such as purging (e.g., vomiting, excessive use of laxatives or diuretics), fasting andor excessive exercise.

Unlike anorexia, those suffering from bulimia can fall within the normal range for their age and weight. But like people with anorexia, they often find themselves obsessing over their weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly, because it is often accompanied by feelings of disgust or shame. Similar to anorexia, people with bulimia often have coexisting psychological illnesses, such as depression, anxiety andor substance abuse problems. Many physical conditions result from the purging aspect of the illness, including electrolyte imbalances, gastrointestinal problems, and oral and tooth-related problems.

Other symptoms include
chronically inflamed and sore throat
swollen glands in the neck and below the jaw
worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids
gastro esophageal reflux disorder
intestinal distress and irritation from laxative abuse
kidney problems from diuretic abuse
severe dehydration from purging of fluids
As with anorexia, TREATMENT FOR BULIMIA often involves a combination of options and depends on the needs of the individual.

To reduce or eliminate binge and purge behavior, a person may require nutritional counseling and psychotherapy, especially cognitive behavioral therapy (CBT), or be prescribed medication. Some antidepressants, such as fluoxetine (Prozac), which is the only medication approved by the U.S. Food and Drug Administration for treating bulimia, may help patients who also have depression andor anxiety. It also appears to help reduce binge-eating and purging behavior, reduces the chance of relapse, and improves eating attitudes.

CBT that has been tailored to treat bulimia also has shown to be effective in changing binging and purging behavior, and eating attitudes. Therapy may be individually oriented or group-based.

Binge-Eating Disorder
When a person is suffering from this disorder, she finds herself consuming a lot of food with out being able to control her food intake. However the person does not try to expel the food and therefore she gains a lot of weight and in most cases becomes obese. Obese people with binge-eating disorder often have coexisting psychological illnesses including anxiety, depression, and personality disorders. In addition, links between obesity and cardiovascular disease and hypertension are well documented.
Treatment options for binge-eating disorder are similar to those used to treat bulimia.
               
Blame the Media
There are always images of skinny actresses, artistes and models on the television screens, internet and magazines that are accessible to the teenage girls. Anorexia nervosa and Bulimia nervosa are the conditions that result from the teenage girls wanting to look like the famous thin people that they see. These conditions are almost not found in the developing countries, but in the western, developed countries, they are very common.

Images on the television rarely show us men and women of average body size in their popular shows. The people in these shows and the advertisements are always of smaller body sizes and they have well toned bodies with no visible fat. Fashion models on television and on magazines have become thinner, while modeling agencies pursue anorexic models. Diet advertisements clutter magazines, television and newspapers we are continuously led to believe that by losing weight we will be happy. Pop culture combines with the diet industrys drive to make money and therefore they are always trying to convince people to follow a certain diet in order to lose weight and in the process they make a lot of money from the gullible people.

Magazine reading and television viewing, especially exposure to thinness-depicting and thinness-promoting media, significantly predict symptoms of womens eating disorder. Kristen Harrison, assistant professor of communication studies, conducted a study on how general fitness and fashion magazines and television shows with thin characters also play a key role in influencing irregular eating patterns of young women. Reading fashion magazines in particular is related to a womans drive for thinness and her dissatisfaction with her body. Drive for thinness is a learned behavior that magazines and television explain how to achieve through dieting and exercise. Body dissatisfaction is associated with a set of attitudes. Attitudes about a person individually and her views of  what could keep her happy which in this case she thinks it is having a certain body size (DeGroat,1997).

It seems clear that young womens patterns of disordered eating, including both attitudinal and behavioral tendencies, are related not only to the types of media they expose themselves to, but also to the way they perceive and respond to specific mass s media characters, Harrison says. This relationship may seem obvious to readers who are concerned with this issue and openly acknowledge the possibility that the media operate as transmitters of potentially dangerous socially desirable values and norm s (DeGroat, 1997).
               
Quest for Thinness
In January 2010, Brittany and Samuel Labberton were facing felony charges on grounds of being concerned about their daughters appearance at the expense of her health. Even after the girl had been taken from them and placed in foster care, her adoptive parents noticed that after a visit with the Labbertons,  the then five-months feeding bottle had a suspicious smell, on further investigation, a pediatrician found out that the bottle was likely filled with a laxative, which is used in most cases for weight loss. This meant that her biological parents were still trying to force her to lose weight even after she had been taken from them (Pulkkinen, 2010).

The girl was underweight when she was born, her parents did not feed her as instructed by the doctor and they returned her to the hospital less than two months after her birth. They blamed her poor eating habit for the weight loss, the girl gained weight while in hospital despite her parents earlier claims. When Brittany was told of the progress, she was not happy and when she finally saw the girl, she complained that the girl was fat. The couples other daughter was taken away by social service workers after Brittany said that she felt she would kill her self and the older girl. The girl was quite hungry and she nearly chocked on the food they had offered her at the foster home where she had been taken (Pulkkinen, 2010).

Commenting on the Samuel and Brittany labberton case, Dolgoff who is a pediatrician child obesity specialist, said that she had seen similar cases in her practice, for instance, cases of mothers bringing their normal weight teenage daughters to her office and complaining that the girls were fat. She said that the mothers are never happy when she would refuse to treat their daughters. According to her, parents should accept their children the way they are and not place unrealistic expectation on them, this will make the children feel secure, do well in school and live happy lives (Dolgoff, 2010).

According to an article published on April 14, 2010, a study conducted on women showed that when shown pictures of overweight strangers, women go into self reflection. This is because women are conditioned to be afraid of growing fat they are constantly bombarded with images of being thin being ideal.  The same test done on men revealed that men showed no interest in their weight, that is why women are more prone to eating disorders.

Neuroscientist, Mark Allen said that the women in the study had no history of eating disorders and yet they had fears of getting fat (Telegram.co.uk).

Conclusion
The society in general needs to stop the obsession on body size this obsession has led to many unnecessary deaths from the eating disorders. Individuals should be left out to make decisions on the body size that heshe wants and she should not have to conform to what the media claims to be the ideal body size.

There are beds full of dying men and children in hospitals, most of them dying because of the despondency associated with the way the society view them. Some children are coiled in a corner of a hut, lonely and rejected because they are termed as outcasts, as a result of being orphaned and living with HIVAIDS. Their neighbors believe they are cursed, and therefore subject the poor children to the leper treatment of the biblical days. A HIVAIDS infected woman is wailing, as the children watch helplessly, as all her livestock have been snatched away from her after losing her husband. The society members believe she is not in a position to rear the livestock, as she is cursed. Such cases are representations of the level of rejection that the HIVAIDS people are going through. As a result, they go through a lot of psychological effects from the society, culture and the religion they are affiliated to.

Psychological problems relating to society, culture and religion in the HIVAIDS affected people will be discussed at length, as well as the approaches in dealing with the same.   
 Several researchers have been trying to invent ways of educating and sensitizing the public about the HIVAIDS pandemic. This is a topic which has gotten the attention of most of the people in the world as a result of the impact it has had on human beings. There are several campaigns which have been enacted so as to ensure that all the people are aware of the pandemic and the way to curb it. It is important, however to realize that it is not only physiological effects that are related to the pandemic, but also psychological ones. The people who live with HIVAIDS are usually referred to as the infected, while those who care for them are referred to as the affected (Bezuidenhoudt).

Aids The persistent pandemic
Retrospective research reveals that cases of Aids occurred from the early 1950s. One of the first people who were described as having Aids was a sailor from England, who died at the age of twenty six. He experienced severe gingivitis, a persistent cough, anal and nasal ulcers which became worse each day (Kallings, 2008). The numbers of the infected people are overwhelming. According to the UNAIDS, WHO (2007), there was a total of 32.2 million people who were infected with the disease in the whole world as at 2007. This was however a reduction of the estimates that was present in the previous years. According to research, the reason why there was this reduction of the numbers is because of the several exercises that were present so as to assess the HIV pandemic in India and which resulted to a great change of the estimates of the country. The estimates were also revised in other parts of the world, like the Sub-Saharan Africa. Additionally, as the people become aware of the risks of the disease, they tend to decrease risky behavior.
           
Definition of psychological effects
It is important to understand the effects of the HIVAIDS infected people as far as their psychological well-being is concerned. Psychological effects are defined as those thoughts, feelings, emotions that affect the mental state and well being of the infected and affected persons (Bezuidenhoudt).Therefore, statistics in the pandemic are important, but they are merely used to present the findings that are collected. However, statistics are not keen on discussing the critical matters such as psychological manifestations of the pandemic. The best way to assist the infected, as well as the affected is making them aware of the psychological issues associated with the disease (Bezuidenhoudt).

The infected psychological problems and how to deal with them
The internal or psychological challenges associated with people living with HIVAIDS changes from one person to another. Not all people experience the same psychological problems. All HIVAIDS situations are unique. Some individuals go through very severe catastrophic changes while others experience problems not only in their job and personal relationships but also in their self esteem, self image and physical bodies. Therefore, these factors may lead to a great change on the behavior of the people. Most of these people usually become withdrawn, rude and aggressive to friends and colleagues. The infected may face low self esteem as well as loss of confidence. This is because the societies they live in perceive them as lesser people, and in most cases, they are devalued (Bezuidenhoudt).
 
The infected are in most cases fearful because they are forced to look for ways of adjusting to the new lifestyle. It is very difficult for the people to accept that they are infected. Therefore, there is disbelief and shock which in most case leads to denial. This is one of the initial responses. There are very many emotional responses that are associated with the psychological effects of the infected. In many instances, the infected are usually confronted with the examination of their sexual identity, and all the behavioral choices associated with it. In most societies, religions and cultures, HIVAIDS is associated with immorality. In such a situation, the infected person will look for ways to reaffirm his or her feelings so that he or she may continually feel good about him or herself. The infected are also viewed to be suffering from contagious diseases, which may lead to the people being socially isolated, and their feelings become undisclosed and withdrawn. As a result of suppressing their feelings, there may be an emotional breakdown (Bezuidenhoudt).

There is also another stress factor associated with the infected, which is the feeling of being independent. The infected person relies so much on the supporters and care givers. This is especially so when the infected people apply for care from social services. Some countries have continued to suppress the infected, and have even led to further psychological effects on the affected by ensuring that the infected do not get any form of life insurance policies. Indeed, this is a very sensitive issue as it degrades the people and renders them psychologically affected (Bezuidenhoudt).

In some of the traditional cultures, especially in African countries, some communities are very discriminative once they realize that one of their society members suffers from HIVAIDS. In some African communities, if the head of a certain household passes away because of the pandemic, all the livestock that belongs to the victim are taken away from the family as soon as he dies. As a result, the family is subjected to great hunger, poverty and desperation (Bezuidenhoudt).

Solution to the psychological problems
One of the best approaches in dealing with those that are affected with the pandemic is to ensure that there is a positive mentality which is created on all the people, both affected and infected. There should be constant minimization on the stigma about dying, so that all people can contribute living healthy and productive lives. Campaigning and mass advertising should be encouraged for this to happen.

Therefore, it would be very beneficial as several people will be comfortable in regard to getting tested. The keys to this are education and psychotherapy. In Namibia, there are a lot of ways in which the non-governmental organizations have stated that would be of benefit to the infected. This would be through the offering of subsidies to all the families that have been infected and affected. However, the income level of the family has to be considered (Bezuidenhoudt).

Psychological effects to the affected
In most cases, the infected include the children, as they experience the pain associated with the sickness of their parents. Some of the children might also be infected and therefore may be going through double suffering, as they are both infected and affected (Bezuidenhoudt).

One of the psychological effects of the affected, especially to the children is that since the parents are sick, they may not provide the necessary affection that the child requires from the parents. This is because they have dramatic mood swings as a result of the pressure of the infection. In most cases, the children are unaware of the problems of their mother or father. They do not understand that the mood swings are not intentional. Therefore, the child has a tendency of acting with anxiety and fear, and even blaming themselves in most cases. Ordinarily, most children hate seeing their parents sick. Therefore, the pressure starts in a child when he or she realizes the sickness of the parent. The structure of the family changes as a result, and the child is exposed to very many responsibilities, especially the performance of the household chores (Bezuidenhoudt).

Additional psychological effects come in when the responsibilities at home are too much for the children to bear. This is common especially in the rural areas where the children are required to perform so many activities as compared to those in the urban settlements. Such children are also rejected by their peers as a result of their suffering. The other children tease them, especially if they cannot afford to go to school like their peers. As a result, they feel neglected, and are in constant anger (Bezuidenhoudt).

The psychosocial impacts related to grief, stress, and avoidance also add to additional effects. All these instances of discrimination and social isolation could result to fatalism, emotional disturbances, and increased abuse opportunities. Most of the childrens time is spent as they ponder on whom will take care of them once their parents die. They are always afraid that their infected parents will die once they leave them alone. As a result, most of these children do not go to school. If they do, they are often inattentive or hyperactive in school (Bezuidenhoudt).

The children are also left with much suffering as far as the economic provision is concerned. This is because the parents are the main breadwinners of the family. In most cases, especially when there are no other caring relatives, the responsibility of provision of food and earning money is entirely left to the children. As a result, they are often malnourished, and cannot concentrate in school (Bezuidenhoudt). 
They lack school fees, clothing and all the basic needs. In school, there are constant poor performers, who keep on dropping out from school. There are symptoms which are associated with trauma, lack of bonding and depression for the young children. The children therefore are deprived of all the enjoyment of their childhood. The trauma is so much that in most cases, the children contemplate suicide. For the orphans that have an extended family, they are considered lucky they have caregivers (Bezuidenhoudt).

For an infected child, the stigma is even more as the child always fears death. He or she is rejected in the society because some of the parents in the neighborhood even restrict their children from playing with the affected children (Bezuidenhoudt). If there are other caregivers of the infected, they are also exposed to the same challenges from their society. Some of the care givers are advised to bury the infected alive, especially in some parts of Asia and Africa. This is especially so in societies which believe that the pandemic results from a curse and burying is the only way to wipe out the curse from the community. These types of beliefs are associated with some cultures of the global societies.

Additionally, the care givers also receive pressure from their religious counterparts, who claim that the HIVAIDS is as a result of immorality, and therefore the victim deserves to die. Some of these responses from the society make the care givers a very depressed lot. Failure to respond to the advice of the members of the society leads to a high level of depression. The care givers are often faced with discrimination, and are challenged because they fear death and loss. They are also faced with the fear of being infected as they cater for their loved ones. Other types of fear include helplessness, shame, fear of infection and anticipatory grief (Bezuidenhoudt).

HIV AIDS Psychological effects on children
 In addition to the infections associated with HIV, the children have problems which act as stressors. HIVAIDS is said to be very challenging as it presents several psychosocial issues in relation to the medical condition. Since there is the overlapping of cultural, individual, financial and family factors, the healthcare and communities often have a challenge, and they therefore strive in the provision of comprehensive services to this type of people (Fischer, 1999).

The Hemophilic children and HIVAIDS
There are several studies which have revealed that the HIV infected children and who also suffer from hemophilia have a tendency of suffering from greater psychosocial issues. According to research, these children develop social incompetence, and very high levels of anxiety. Mothers of theses types of children have reported that their children have a lot of psychosocial symptoms compared to their peers. The general populations of the children with HIV and hemophilia differ from those who are HIV infected but do not have the hemophilic condition. Studies have revealed that stigma is most in the children with hemophilia (Fischer, 1999).
 
Studies have revealed that the background of the families that most of these children come from is one of the contributing factors .Several of theses types of children come from families with low incomes and also from urban environments. In most cases, the parents are usually diagnosed with HIV, either both or one of them (Fischer, 1999).
 
The families of children with HIVAIDS have so many issues to cope with apart from the ones related to HIV. There are additional stressors which are associated with inner-city living. This includes violence, drug abuse and violence. Research reveals that most of these children are working hard so as to cope, as most of their parents are drug users. They are usually in wrangles with the law, thereby affecting the children, and adding more effects on them. Therefore, they are required to deal with all the psychosocial ramifications which are associated with this (Fischer, 1999).
 
Families are also faced with a challenge in the addressing all the medical concerns and the medical environment. Therefore, families are faced with a challenge of dealing with insurance and financial difficulties as they try to seek audience with the physicians. Additionally, they have the constant pressure to cope with clinic visits, hospitalizations and vital medical decisions. The people who are responsible for these children are given the task of caring for the medical conditions of their children and that of all family members. The medical regimen can also be a very difficult task to undertake (Fischer, 1999).
 
Most of the children suffering from the pandemic have been orphaned at a very early stage. They are presented with a very difficult task of not only dealing with the loss associated with their grief, but also with constant disruptions in their homes and family life. This is because most of the orphaned children are placed in foster care or in other relatives homes (Fischer, 1999).
 
The other psychological issue associated with infected children is that of isolation. Despite the frantic efforts of encouragement, the children are most of the times faced with stigma and secrecy associated with it. Those infected are in constant fear, prejudice and rejection when diagnosed. Cultural issues may be the contributing factors in the communication of the affected and the others in the society. As a result, they may not be willing to access help from the psychological and social support systems (Fischer, 1999).

The children are also infected with psychosocial difficulties which are associated with behavior. These difficulties include hyperactivity, social withdrawal and attention deficits. It is sometimes difficult to test whether these symptoms and their disorders are neurological and emotional in nature. The academic performance of these children can be affected by the neurological symptoms, which include learning disabilities, developmental delay and cognitive deficits (Fischer, 1999).

Dealing with the effects
In the field of pediatric psychology, there is a very large literature body which aims at addressing the means of disclosing the status of the disease to all the pediatric patients. A very great deal of the literature has been researched in the pediatric oncology. The research has revealed that it is important for all the children to have a good method of helping the children to adjust emotionally. This is not possible unless the children are told about their condition (Fischer, 1999).
 
Additionally, the open discussion of their condition with the medical caregivers and family is important. Research has revealed that this has worked even for the terminally ill children. However, if the parents and caregivers are contemplating revealing the childrens condition to them, they must ensure that the environment will be supportive to the children, and the children must get all the necessary reassurance and information (Fischer, 1999).

It is also necessary to place more emphasis on stories and the lives of people who are infected, and not only relying on statistics. As (Bezuidenhoudt) puts it, .the statistics are people and not just numbers. We must create a paradigm shift in thinking about HIVAIDS (Bezuidenhoudt).

There must be provisions for money, love and time given to the care givers, especially if they are children. The children who are orphaned as a result of the pandemic are in most cases traumatized, as the child is dealing with the loss of the parent, as well as the ridicule from peers. There are several support groups in the world which are meant to deal with those infected and affected by the pandemic, especially on matters related to their psychological health. However, there is need to establish more information structures. There should also be other means of support provided to these children. The immediate family of all the affected should receive the correct information on the best ways that they can provide psychological and emotional support to their peers (Bezuidenhoudt).

Conclusion
There has been a much talking regarding HIVAIDS in the world today. Most people are only interested in dealing with the statistics, and are not involved in dealing with the psychosocial effects of the infected and affected. Therefore, most people who are infected die because of the stigma that their religion, culture and society associates them to. They receive high class rejection, and the neighbors do not want any association with them. Some of the government authorities in the world are also not concerned with their welfare, as they even deny the infected the necessary help that is required from them. The perception of the world to the HIVAIDS infected and affected ought to change, so that the stigma associated with the diseases can be reduced.

This article deals with the effects of loss on children of both a primary and
secondary nature. Events such as the death of a parent or friend and the resulting
consequences can be difficult for a child to deal with, depending on what stage they are
at developmentally. Other losses such as personal possessions, those resulting from
abuse or a sudden change in a childs life can also be difficult (Goldman, 2004).

The author also discusses, according to Piagets developmental theory, how
children deal with loss. Younger children can often have trouble understanding why a
loved one died may connect an event to the death that is not even related. Older children
are curious as to the events and reasons for the loss, tending to seek answers as to why
the death occurred. It is recommended that when speaking to children about death, an
age-appropriate explanation should be used. Children need to have information that
clearly defines specific type of death that has occurred, such as a murderer or an accident
(Goldman, 2004).

To help children effectively cope with a sudden loss, Goldman proffers several
options that can be productive. Having a team that focuses on supporting the child can
be very beneficial to bereavement counseling. This team has members from the family,
school and includes the counselor. The team assesses exactly what losses have occurred
to the child and what developmental stage the child is at. Based on this information, the
team can set up a plan for supporting the child (2004).

Other methods that can be used to help the child include helping the family
communicate about the death, support groups, play therapy and focusing on early
intervention. The author stresses the importance of having an all-around knowledge of
the circumstances and that considering the consequences that the loss will have on a
childs whole life experience (Goldman, 2004).

The real etiology of schizophrenia is still a dream despite massive studies on the involvement of the brain. Studies of the brain through neuroimaging have revealed that frontal cortex, temporal lobe, and sub cortical structures are involved. Some of abnormalities in the brain of schizophrenic patients include enlarged ventricles, reduced volume of frontal cortex, temporal lobe cortex, and sub cortical structures like hippocampus and amygdala. These abnormalities have been persistently reported in schizophrenic patients and this shows that they are not functioning inadequately. Some of these abnormalities are present at the start and some even before the onset of psychosis and this is in support of neurodevelopment of theory of schizophrenia. The key neurotransmitter in schizophrenia is dopamine however, there are others such as serotonin and glutamate which are also thought to play a role. Schizophrenia is an inherited condition, although genetic research has not come up with a clear conclusion on this matter may be because of the complexity of genetic involvement. Despite the fact that brain abnormalities are still not very clear in schizophrenia, the evidence is continuously pilling and this is driving towards a complicated disease of the brain network that is affected by genetically mediated developmental abnormality.

Introduction
Neuropathologists have been involved in research on schizophrenia for about hundred years. Despite the length of the research, the neuropathogy of the disorder is still not clear. Although they have made some steps in their quest since the beginning when they believed that it was a functional psychosis without structural basis, the main cause of the chronic disorder is still illusive. With the technological advancement in science, researchers have come to a common finding in patients diagnosed with schizophrenia and the common finding is brain abnormalities. These discoveries have made the researchers to wonder if the cause of schizophrenia is brain abnormalities and how the abnormalities arise.

Despite recovery of some brain abnormalities in patients suffering from schizophrenia, most scientists maintained that some of the abnormalities realized are quite slight and some of them are not common in all schizophrenic patients and to occur exclusively in people with schizophrenia. Although these patients have structural pathologies in their brains, the developed abnormalities do not coincide with the disease duration. Some of the abnormalities realized remain the same throughout the development of the disease (Bhogal, 2002).

Understanding of the abnormalities of the brain in schizophrenia is among the challenges currently facing the medical community. The numerous symptoms associated with schizophrenia points at the involvement of various regions of the brain or even a widespread of network or system. Conventional approaches of neurological disorders such as lesion studies or post mortem examinations have defied efforts to understand the brain pathology in schizophrenia. Just like other fields of medicine, luck and destiny have help make major steps in discoveries like dopamine theory and anti psychotics which are used in the management of the disorder. Modern research in neuroscience such as neuroimaging has aided in improving the foundation knowledge of the disorder and has sustained the hope that complete understanding of the disorder will be realized in the future. In this paper, I am going to summarize the major brain abnormalities found in schizophrenia through neuroimaging (Haren, 2004).

Just like other complicated diseases, there are numerous theories on schizophrenia as compared to facts. The initially neurodevelopment theory points at abnormalities in fetal brain development as the cause of the failure of brain functions in early adulthood. A series of information such as increased rate of obstetric complications, minor physical abnormalities, neurologic mild signs, and slight behavioral abnormalities in children who later suffer from schizophrenia. This model is quite relevant to the development of schizophrenia in particular but also for other neuropsychiatric disorders (Bhogal, 2002). The major drawback of this model is that the prevalence of these signs in the non affected population is quite substantial therefore the positive predictive value in the development of schizophrenia is not convincing. The disease usually begins at adolescent or early childhood and early adulthood and this indicates brain maturational problem during that time or before the appearance of psychosis. Excessive synaptic or dendritic pruning during the time of onset of the disorder has been suggested as one of the potential mechanism explaining the onset of psychosis in adolescent or in early childhood, although the biology underlying this stage is still not very clear (Lawrie  Abukmeil, 1998).

Neurodegenerative model is based on active biologic processes that may be going on during the prodromal period or the usually prolonged period of untreated psychosis. Development of the disorder is also linked to environmental factors such as illicit drug use and psychosocial stress which are considered as potential secondary triggers which may be accompanying the beginning and the start of schizophrenia.

The initial researchers believed that schizophrenia is associated with brain pathology. Emergence of imaging techniques such as magnetic resonance imaging (MRI) and computed tomography scanning (CTS) have seriously contributed to the detailed study of the brain. Through computed tomography brain abnormalities such as enlarged ventricles and reduced total brain volume have been reported in schizophrenic individuals and these findings were later confirmed by magnetic resonance imaging (Bhogal, 2002).

Studies of the brain structures have also been made easy through improvement in segmentation techniques coupled with the use of MRI. These techniques can be used to identify grey from white matter and measuring of their volume. These also contributed to a more focused investigations of specific regions of the brain such as temporal, frontal lobes, and subcortical structures. Some of the consistent findings in these regions include alteration in structures such as hippocampus, amygdala, superior temporal gyrus, and platinum temporale (Lawrie  Abukmeil, 1998). Lateral temporal neocortical areas where primary auditory and auditory associations are located are the places of interest in schizophrenia since they are involved in thought processes. Most of the studies in the superior temporal gyrus in schizophrenic patients have always discovered reduced volumes of grey matter in the initial stages of the disorder together with those individuals who are genetically at risk of developing schizophrenia such as offspring of schizophrenic patients.

Other structures of the brain which have also been reported to be abnormally small in schizophrenic patients include medial temporal structures such as hippocampus, amygdala, and parahippocampus gyri. These structures are also reported to be altered in other psychiatric disorders like mood disorders and post traumatic stress disorder (Lawrie  Abukmeil, 1998). Injuries sustained at the time of birth such as anoxia may be associated to hippocampus reduction and this is possibly due to neurodevelopmental abnormality. The finding is also common among concordant twins who had birth injuries. Medial temporal volume reductions have been discovered in people who are genetically at risk of developing schizophrenia. Reductions in the grey matter in the temporal regions of the brain have also been observed in people who are classified as having prodromal features of schizophrenia who have later on developed psychotic symptoms during the follow up (Haren, 2004).

The highly developed region of the brain in man is the frontal lobe. It is involved in the modulations of higher brain functions such as planning, attention, and working memory. Behavioral and cognitive deficits like lack of motivation, defects in executive functions, Wisconsin card score sorting test and spatial working memory points at frontal lobe functional abnormalities in schizophrenic patients (Lawrie, 1999). Decreased blood flow to the frontal lobe is a common finding in schizophrenia. Despite the fact that this finding is not consisted, it can also be attributed to the complex nature of the region, it has been observed though quite slight.

Basal ganglia which contain caudate, putamen, and globus pallidus are involved in information processing in the cortical and subcortical networks involved in integration of cognition, emotion, and motor function. These structures have been reported to be enlarged in patients using the conventional antipsychotics and this can lead to a conclusion that dopamine blockades causes an increase in volume of the above structures. Psychosis patients who have not used any antipsychotics are reported to have a smaller caudate volume which implies that caudate may be involved in the development of psychoses.

Thalamus acts as the regulatory board for sensory signals and has reciprocal connections to the frontal lobe. It has been suggested that the connections between these two structures are associated with schizophrenia. Thalamus is a bit difficult to measure using MRI, although the findings are inconsistent, smaller thalamus have always been reported in schizophrenic patients. Other anatomic abnormalities in schizophrenia include corpus callosum which is altered both in shape and structure therefore disruption in the integration between the hemispheres. In most humans, brain functions are lateralized with the left cerebrum being dominantly involved in language. There are proposals that developmental abnormalities of language, peculiar functions of the human beings, and its lateralization which is genetically mediated may be one of the causes of schizophrenia (Bhogal, 2002).Temporal lobe findings of smaller superior temporal gyrus and hippocampus have been reported to be in the left cerebrum and loss of normal asymmetry of the left superior temporal gyrus being a bit larger that the right has been reported in patients suffering from schizophrenia (Staal et. al, 2000). In the meta analysis study of laterality in schizophrenia, the researchers who were involved in this study concluded that there is a strong proof for decreased cerebral lateralization in schizophrenia more so in the language cortex. 

We can therefore summarize that structural imaging studies have discovered evidence of extensive anatomic alterations in the brain regions of schizophrenic patients. The regions highly altered in these patients include those mediating higher mental functions like thought, cognition, effect, and language both early in the illness and those at risks of developing the disorder like children born to schizophrenic patients (Haren, 2004).

Synapses and susceptibility genes
Neuroimaging studies are in support of the possibility of neurodevelopmental abnormality in schizophrenia, neuronal, molecular, and neurochemical mechanisms underlying these brain abnormalities are not conclusive. High profile neuropathologic studies have revealed losses in synapse density and relatively normal or elevated neuronal numbers in schizophrenia, which indicates that the main defect may be synapse integrity. This discovery has elicited search for genes that may be associated with synapse integrity by the use of DNA microarray techniques. Post mortem findings on the patients with schizophrenia revealed under expression of a family of synapse related genes (Bhogal, 2002).

Genetic factors are the main factors listed as being associated with schizophrenia, however the exact genes involved in susceptibility is still a puzzle. Although the initial studies on finding these genes was not successful, current studies have implicated several genes in the development of schizophrenia and some of the genes include dysbindin-1, neuregulin-1, d-amino acid oxidase, its activator DAOA, and the regulator of G protein signaling 4. Recent proposals indicated that synapses, especially glutamatergic ones might be the site of initial abnormalities in schizophrenia with downstream disruption of neural circuitry and subsequent effect on other neurotransmitters (Lawrie, 1999).

Conclusions
It has become clear that the early scientists were right in their suspicion that the brain is involved in schizophrenia. This evidence cannot be disputed despite the fact that there is no comprehensive information on the etiology and pathophysiology of the disorder. The brain abnormalities in schizophrenia appear to be distributed in extensive areas supporting the fact that schizophrenia is a disorder associated with brain connections. We are still very far from understanding some of the major neuropsychiatric disorders such as Alzheimers disease. The molecular, physiologic, and neurochemical mechanisms underlying schizophrenia continues to evade our findings. Recent research on the disorder acts as the foundations for future fundamental discoveries on the nature of schizophrenia.

Women in their lifetime pass through many phases. Menopause is a transition phase that represents the end of a womans reproductive age and the onset of an age that is not reproductive. It generally represents the end of the menstruation.  However, this period does not happen abruptly since before the menstruation periods stops completely, irregularity of the same is first observed. The period before menopause is referred to as perimenopause and can be defined as a period when ovaries still work, but fail to produce the required balance of hormones that can stimulate the womb lining to shed regularly. It is a period that is characterized by a lot of changes in the body of a woman due to changes in the level of progesterone and estrogen hormone (Currie 2006).

The perimenopause period paves way to the menopausal period which is closely followed by post menopause period. Post menopause is usually defined as more than twelve months or more without periods, in someone with intact normal ovaries or immediately following surgery, if ovaries have been removed as Currie (2006) records. Since it is a period that is usually characterized by a lot of changes, most women dread it and there are a lot of misconceptions about the same.  In view of the fact that it is a key phase in the development cycle of a woman, it is important to study it more comprehensively.  This essay shall discuss the issue of menopause in all aspects, biological, psychological, sociological, cultural and in any other perspective that can help in understanding the issue better.

The reproductive system of a woman is usually controlled by hormone estrogen which in turn controls ovulation.  High levels of hormone estrogen stimulate the releasing of the luteinising hormone by the pituitary glands, which in turn enhances the release of the egg, a process known as ovulation. The numbers of eggs released continue to decrease as age progresses.  There is a gradual decrease of release of eggs during puberty  and continues to decrease up to the age forty, after which the  decreased level of estrogen leads to as rapid decrease of the same. During this period, there are occasional menstrual periods which characterize peri menopause phase. The irregular periods which are experienced during the perimenopause result from irregular shedding of the womb.  During the initial stages, the ovaries are not usually very stable such that the cycle may be normal for some months and abnormal in others.  Slowly, the number of irregular menstrual cycles increases up to a time when no follicles develop, the level of estrogen and progesterone become very low and the lining of the womb is actually not stimulated at all. At this point the periods stop and the level of the follicle stimulating hormone remain high (Currie 2006).

The three stages are characterized by different symptoms which are usually experienced by about 70-80 of women (Currie 2006). Despite the fact that these symptoms are also influenced by diet, lifestyle and exercise, majority are believed to result from change in hormonal levels. Women experience these symptoms differently depending with their different styles. Women, who do not smoke, eat a healthy diet, exercise regularly, and dont take alcohol experience less severe menopause symptoms. Therefore, this affirms that there are other factors that influence these symptoms apart from low levels of estrogen and progesterone.

The very early symptom that most of the women experience is the change in the menstrual periods. They become irregular such that they can be shorter or even last longer. The flow may also increase or it can be reduced. However, the change of the periods is usually a normal change but incase the abnormal changes are noticed, medical assistance ought to be sought.  The change in periods usually paves way for other physical and psychological changes. It would be important to look at some of these changes more extensively so as to understand better all issues related to menopause.

Physical symptoms are inclusive but not limited to night sweats, hot flushes, insomnia, headaches, breast tenderness, joint aches and palpitations. Of all these, hot flushes which are also known as vasomotor symptoms affect quite a considerable number of women.  Since they occur occasionally, they do not cause much distress expect to some few women. However, to some women, the same symptom can lead to distress which affects their work and sleep. On average, some women are affected by hot flushes for about two years but in some abnormal circumstances they have been known to last for about fifteen years.  While experiencing the flush, the upper part of the body feels hot, the skin turns red and sweating may occur.  It is quite disturbing but it does not last for long, for it takes about two to three minutes (Currie 2006).

Most women do not actually understand much about the hot flushes and it can be quite disturbing at that particular time. For instance, National Institute of Aging (2008), reports that in one cool day, Ellen and Sue were watching their teenage boys playing soccer when one of them by the name Ellen, experienced a hot flush and started to sweat. When Sue became concerned, Ellen explained that it was a hot flush and she was accustomed to it for she was already experiencing it more often, during the day and at night.  She went on to explain to her friend that initially she did not know what it was, until her doctor explained that it was a menopause symptom. Sue only laughed and said that she remembers such although she does not experience them any more. The story of Ellen and Sue clearly illustrate that hot flushes affect women during the perimenopause stage and do not actually last forever. Sue told her friend that though she used to experience them, she had already stopped experiencing such. Yet another story derived from Hamiliton (2004) explains a womans experience during menopause.

After Christine turned fifty she started to feel emotional such that she would cry at very small things and also lose temper very easily. Despite the fact that she knew she was at menopausal age, she was expecting hot flushes, night sweats and change in periods.  Since she was still passing through some problems like difficult court cases, she thought the emotional problems were as a result of stress. Her beloved Husband Neil also thought stress was as all that was making her to be emotional. She often felt guilty of how she was treating her husband but she could not have helped it. She started to put on weight but she still thought it was due to stress. Her symptoms continued for a whole year, and for that time she was still in ignorance. Even though at times she thought it was menopause she was too busy to think about it and still felt embarrassed to speak about it since in her community, menopause was considered to be a taboo.
 
Fortunately or unfortunately, she developed some health problems that forced her to go to hospital to have a blood test. It was after the test that the doctor noticed that her estrogen levels were down and diagnosed menopause. She felt relieved, after knowing that her problems resulted from hormonal changes.  To relieve the symptoms, she used to exercise daily, take a healthy diet as well as calcium tablets to reduce chances of developing osteoporosis. Having gone through that period successfully she felt that she would not opt to go for hormonal replacement therapy.

Although in most cases the symptoms are synonymous some of the symptoms discussed below may not affect all women as highlighted in the Christines story.  Insomnia is yet another symptom that affects most women and can be worsened by the hot flushes. Nearly all women usually complain of lack of sleep such that they stay for too long without getting sleep or they wake up too early. The situation worsens when they are woken up by the hot flashes and getting back to sleep again becomes a problem.  There are still other symptoms like the joint aches which can be taken to be symptoms of other diseases but they are still perimenopause symptoms. Most of the women in this stage usually complain of joint aches around the neck, wrist and the shoulders.  Weight gain is also a common symptom of menopause because most women in this stage have recorded an increase in weight.

Although most of these physical symptoms result from decreased level of estrogen, breast tenderness is usually caused by high levels of estrogen which occur when the level of the same fluctuates.  The same problem is also caused by weight gain and fluid retention. Whichever the case, there are many physical symptoms which can be associated with perimenopause but the problem in categorizing the symptoms usually arises because adequate research has not been conducted in this area .

The hormonal symptoms also result to psychological changes whether directly or indirectly. Currie (2006) records that most women experience mood swings, anxiety, forgetfulness and irritability. Some of these symptoms may be closely related to the sleep disturbances and other life events that are more prevalent at this particular stage, like worries about children, relatives, lack of enough finances to cater for the family problems among others.  Since women usually have a lot of cares, the symptoms some times become unbearable, though with enough family and medical support they are usually able to cope with all the symptoms.

The low estrogen levels lead to dryness of the vaginal which causes a lot of discomfort during sexual intercourse.  As a result, most of the women lose interest in sex. Some of the menopause symptoms like insomnia and hot flushes can also contribute greatly to sex problems as well as other problems that women may be going through at this stage. All these early symptoms may last for a period of few months and in some instances, they may last for a period of between two to five years. As discussed earlier, there is deficiency in research necessary to confirm how these symptoms are related to hormonal changes.

After menopause, there are still other symptoms that follow almost immediately and are usually referred to as post menopausal symptoms. These symptoms are usually due to effects of a reduced level of estrogen on the vagina and the bladder. They include leakage of urine, vaginal discomfort, burning and itching, discomfort usually experienced during intercourse and while passing urine, and vaginal discharge. Most of such symptoms are the same in almost all women, although the severity may vary from one woman to another due to different lifestyles. Other symptoms that may be as a result of menopause include hair thinning or extra hair, depression, memory loss and skin problems.

Most of these menopause problems are quite disturbing and some women usually seek medical attention so as to reduce the severity of the same. Some doctors prescribe birth control pills to women with heavy and irregular periods and it actually helps to alleviate the problem. In addition, birth pills help to reduce the severity of the hot flushes. There are a lot of other interventions that can help control the severity of the menopausal problem but since the main cause is hormonal imbalances most women go for the hormone replacement therapy (National Institute on Aging, 2008).

Hormone replacement therapy is a treatment that involves use of hormones so as to treat certain medical conditions and more so menopausal problems that affect women.  Hormones that are used in this mode of treatment are usually synthetic for they are manufactured in a laboratory.  However, once inside the body these hormones act alike natural hormones and that is the reason as to why they have been used to treat problems that emanate from hormonal imbalances. The therapy which was developed in 1960s requires women to take small doses of hormone estrogen and progesterone. Since then, the therapy has been very popular especially in the United States until recently, when some concerns were raised that the therapy may actually pose some health risks to the users (Callahan 1993). 

In view of the fact that the hormones act just like the natural hormones once in the body as highlighted earlier, women are very much fond of this therapy since it helps them to continue functioning normally even though the levels of estrogen and progesterone are usually low at this stage. The therapy has also been known to protect women from other diseases like osteoporosis since their cause is closely related to low levels of estrogen in the body. Nonetheless, every medicine has got some side effects. After the continued use of the hormonal replacement therapy, Women Health Initiative was set up so as to study the most probable side effects of the hormone replacement therapy. Although this study was stopped after it was realized that the HRT risks are more than the benefits that can be realized from the same, it was set up to study the health of women who had gone though the therapy as measure to prevent the onset of the menopausal symptoms. The same study found out that continued use of the HRT led to the increased risk of breast cancer heart attack, blood clots and some strokes. Compared to women who did not use the therapy, the risk of these conditions was found to be 8 more in women who had used the hormone replacement therapy for a period that exceeded five months (American Academy of Family Physicians 2008).

Menopause is a natural phenomenon and women can go through it without much trouble if they can only learn to be positive about it and be ready to cope with all the eventualities of the same. If only they can become more relaxed during this period and have supportive family members the period can easily pass without much havoc. Some problems like insomnia can be addressed by ensuring that the conditions necessary to enhance sleep are put in place so as to avoid the sleep disturbances. Some studies have revealed that reduced use of drugs like alcohol and beverages that contain nicotine and caffeine can contribute greatly in reliving the problems associated with menopause (Currie 2006).

Different cultures regard the issue of menopause differently and that affects the women who are in that particular stage. For instance the medical culture portrays women in menopause as people who are hormone deficiency and in need of medication (Fecteau 2002). Further studies illustrate that the same contribute to the negative view of menopause as people view these women as people in need of hormones so as to treat their ailments. As a result of this, women usually go for the hormonal replacement therapy so as to treat menopause symptoms. However, other cultures view the issue of menopause differently, in a more positive way like some modern western societies.  In some cultures like in the African American societies, the issue of menopause is viewed to as a relief, more so economically, as it marks the end of the pregnancies.  Since the African American women have more exposure to the family counselors and family groups where they learn more about the realities of menopause, they view the issue in a more positive and neutral way compared to women in other cultures. Menopause symptoms still vary from one culture to another such that in some instances, some symptoms are not mentioned like in Japan, sweats are never mentioned though it is difficult to know whether they actually have them or it is only that they do not talk about them.

Although there are a lot of negative aspects of menopause some positive aspects about the same have also been reported. Most people view it as a phase that leads to increased   sense of freedom from fear of pregnancy, childcare responsibilities, menstruation and freedom for a woman to concentrate on personal needs and goals. However, the positive aspect of increased sense of freedom is only reported in those cultures where women independence is highly recognized. The increased sense of freedom especially from pregnancy and menstruation improves women sexual life.  Therefore, even though menopause symptoms affect the sexual life of women negatively, sexual confidence can still improve with age but this is usually dependent on the attitude attached to the menopause.

Apart from cultural, biological, and social factors that affect menopause, psychological factors also affect the menopause either negatively or positively. Women having problems in their relationships are bound to experience more problems in menopause than those who are in healthy and less problematic relationships.  Similarly, women with a high self esteem have also been reported to experience less problematic symptoms compared to women with a low self esteem. On the other hand, menopause also affects women psychologically because it is a phase that involves change of a woman perceived role in life as a child bearer and the same lead to a low self esteem.

Menopause, though a stage that signifies the cessation of menstruation in women has a lot of issues related to it.  A lot of changes take place during, before and after menopause. During the perimenopause a lot is experienced like the changes in periods. After menopause, more changes still take place especially because low levels of estrogen have some effects on the bladder and vagina. However, even though majority of these changes are synonymous in most women, the severity is not the same due to different attitudes and perceptions. Different cultures have different views about the same and therefore have got different intervention methods. Some go to an extent of using herbal medicine so as to relive the severity of the symptoms. In the medical culture, the hormonal replacement therapy is used and it is effective although some risks are involved. Psychological factors also affect the issue of menopause such that women suffering from psychological disturbances are more affected compared to others with no such disturbances. The various interviews that have been conducted show that since there are a lot of misconceptions about the issue of menopause, women need to be taught concerning the reality of the same and through that, they can be empowered to wait and face menopause in a more positive manner.

A Check List for Menopause Symptoms
Menopause symptoms
Peri Menopause
Hot flashes, night sweats and cold flashes
Bone loss
Weight gain
Insomnia
Dry skin and hair loss
Mood changes, Irritability
Vaginal dryness
Heart palpitations
Inability to hold urine
Sudden bouts and bloats
Difficulty in concentrating and confusion
Loss or decreased sexual desire
Respiratory problems
Allergies and Sinus problems
Internal Shaking and tremors
Menopause
Stopping of menstrual period
Post menopause symptoms
Facial hair growth
Osteoporosis and reduced bone density
Vaginal discharge
Hot flashes
Vaginal bleeding
Slowing down of mental processes
Skin wrinkles
High blood pressure
Stress incontinence
Vaginal dryness
Gum problems and increased bleeding

This paper is going to look at lobotomies and most of its aspects, what the procedure is and what it entails, why the procedure is carried out and to which persons is the procedure carried out, the level of safety of the procedure and its origins as well as if the procedure is still in practice. These are some of the aspects of lobotomies that the paper is going to look at. The main aim of the paper is to discuss lobotomies and if they were actually good or they just did more harm than good. The paper will also look into the history of the procedure and if the procedure is still being done in the modern world today.

Lobotomies are forms of psychosurgery which are neurosurgical treatment of mental diseases or psychiatric diseases. It has a history that dates back to antiquity and it involves all the clinical processes that are involved in the neurosciences (Acharya, 2004).

Introduction
Before looking into the intricacies of lobotomy, it is important to understand that the main aim of this procedure is to cure mental disorders and thus it is important to try and understand what mental disorders are all about. The nature of mental disorder is such that they are so dynamic and thus their management is no walk in the park. A dynamic problem requires an integrated approach and so has the approach to mental disorders management been. The exact cause of mental disorder cannot be easily ascertained as it depends on a number of issues and may also be as a result of a complex interplay of a number of factors (Meleis, 2006). The evaluation of the patient in such a case is therefore difficult and thus an integrated approach which is people and time intensive becomes necessary in carrying out the evaluation. Evaluation is not only required at the diagnosis stage, since continuous evaluation is required to asses any development that have been made with regards to the patients health (Meleis, 2006). An integrated approach to medical delivery employs the use of biological, psychological, socio-cultural, environmental and pharmacological approaches in delivery of medical services to a patient (Meleis, 2006). Health being the total well being of an individual, the integrated approach is seen as the best approach in ensuring the provision of better healthcare (Meleis, 2006). In a mental healthcare system the nurse is charged with the following responsibilities Biological There role of the doctors has for a long time been considered as the evaluation of the patient (Meleis, 2006). In an integrated approach the system is such that the role of the nurse in evaluation of the patient is on the increase as they play an important role in the evaluation of the patients.

A lobotomy is a surgical procedure that is carried on the brain of a patient, and it is thus psychosurgery since it involves neurology, and it is also known as leucotomy or even leucotomy. The procedure involves the cutting off of the connections that run all the way to the prefrontal cortex to the anterior parts of the brain especially on the frontal lobes (El-Hai, 2004). The procedure has always been controversial ever since it was introduced in the year 1935, despite that fact that it has been the main form of prescribed treatment for more than two decades and even some times being prescribed occasionally for some other conditions (El-Hai, 2004). This has been done despite the fact that there have been claims and even evidence that the procedure is known to produce frequent and in most cases very serious side effects. The time that its usage was most prominent was between the years 1940 and 1950 and it was also during this time that modern antipsychotic drugs were introduced. By the end of the year 1951, more than 20,000 lobotomies had been performed with America (Acharya, 2004).

Lobotomy was just one of a huge number of series of therapies that were developed in Europe within the first century (El-Hai, 2004). This presented a form of a break from the tradition of relegating patients with mental disorders to asylums, which was the norm considering that most of the forms of mental illness were considered to be hereditary disorders and thus they were regarded as unlikely to be mended by treatment. Most of the lobotomies were performed with America with an approximate number of 40,000 patients having been lobotomized (Acharya, 2004).

Despite these changes, the protocols and mechanisms used in handing the mental situation have been rather constant. In many cases the cause of mental problems which include personality, development and psychotic disorders can never be pointed to one particular factor. Many theories that have been proposed to explain the nature of mental disorders One of the theories that is predominant in the Middle East and Africa explains psychiatric disorders as a mixture of divine and magical considerations, some even belief that it is a result of witch hunt (Meleis, 2006). Industrialization and population growth are the two main factors that have been cited as being behind the increase in number of madhouses. The twentieth century saw the recognition of psychiatric disorders as a medical problem when World Health Organization in its definition of health included mental disorders as a medical condition that is considered a disease. American Psychologists Association (APA) and World Health Organization (WHO) have come out as two organizations that are very instrumental in dealing with the management of psychiatrists problems (Meleis, 2006). The two bodies have even merged their policies so as to come up with a more robust document that discusses all aspects of the management of psychiatric disorders. State of fear and anxiety are the main cause of psychiatric problems and include phobias and anxiety disorders. Furthermore, abnormal mood state referred to as mania are also very common though may people fail to recognize them as psychiatric problems (Acharya, 2004).

Rosemary Kennedy
Rosemary Kennedy who was born on September 13th 1918 was the first daughter to Rose Fitzgerald Kennedy and Joseph Patrick Kennedy, Sr. and also their third child. She was born just a year after her brother who later became the United States president President John F. Kennedy was born. At the age of 23, a lobotomy was performed on Rosemary Kennedy and it left her incapacitated permanently (Kotowicz, 2005).

In her early childhood years, she was described as being a very shy child and Intelligence Quotient tests indicated that she had a slight case of mental retardation, though this notion has been a question which has been put under much controversy (Kotowicz, 2005). At the age of 23, Rosemarys father was informed of a new procedure that the doctors thought was capable of assisting in calming her mood swings. This procedure was known as lobotomy and this was the year 1941. At that particular time, the number of lobotomies that had already been performed was relatively few (Kotowicz, 2005).

The result that was hoped for did not occur and instead, Rosemary was left with a condition of incontinence in the urinary functions and a mentality that is infantile. She could be found staring at walls blankly for hours and her speech was unintelligible and incoherent. This devastated Rose even more and it was termed as a tragedy in the Kennedy family (Kotowicz, 2005).

It was later in the year 1949 that Rosemary was taken to the St. Colettas Institute for Backward Children (Kotowicz, 2005). The severity of her condition caused her to be further detached from her family, though one her sisters managed to be able to visit her on a regular basis. Her condition was declared publicly as being mentally handicapped, with only a few doctors knowing the truth behind her condition (Acharya, 2004).

It has been argued by various researchers that Rosemary was probably the first person in America to receive this procedure  prefrontal lobotomy. Watts was of the opinion that Rosemary was not mentally retarded, but was in fact depressed and talked in a manner that made her voice shaky and sounded agitated, and this tended to confuse her family into thinking that she was mentally retarded (Kotowicz, 2005). The procedure was carried out on Rosemary despite that fact that the procedure was meant to be carried out in cases of psychiatric illness only. During the days of Dr. Watts, performing a prefrontal lobotomy on a patient even if the patient was mentally retarded was considered to be a case of medical malpractice (Acharya, 2004).

Mental disorders and drugs that act as lobotomies
One of the most common modes of management is the prescription of mood stabilizers and ensuring the individuals are less exposed to situations that may catalyze high moods. Schizophrenia is a mental disorder that is characterized by an abnormal perception of reality. It is commonly manifested in hallucinations, paranoia and disillusion (Meleis, 2006). Poor speech and disorganized thinking also characterize the condition and it normally kicks in with the beginning of adulthood (Meleis, 2006).

Diagnosis like in most psychiatric cases is based on individual experiences and third party observations (Meleis, 2006). Genetics, environment, social issues and psychological conditions have been cited as the probable causes of the condition. A major problem in the diagnosis of the condition is that no one sign can be keyed on as being deterministic of schizophrenia and therefore diagnosis is quite tiresome. The method used in diagnosis is largely reliant on the presence, duration and degree of certain symptoms and signs. The evaluation of individuals suspected to be suffering from the condition involves a general medical examination and a thorough neurological examination (Meleis, 2006). The tests are rarely repeated except in cases where there is evidence of adverse effects of antipsychotic drugs. The cure for the diseases remains highly controversial, although some have suggested the use of remission as an approach to dealing with the problem (Meleis, 2006). The general trend in the treatment and management of the condition is the minimization of the rate of occurrence and degree of the symptoms. In severe conditions, the patient may be hospitalized for easier management of the symptoms though the treatment often takes on the outpatient approach. The patients are administered with antipsychotic medication and which help in the management of the symptoms. Therapy, especially electroconvulsive therapy, is also used with the drugs in handling the mental conditions (Meleis, 2006).

Dementia is the decline in cognitive abilities due to progressive brain damage for reasons beyond the normal aging process (Meleis, 2006). It can occur at any stage of a human life though it is more common in the elderly people. The condition has no specific set of symptoms and it affects the normal brain activities and may thus lead to loss of memory, attention, verbal activity and comprehension (Meleis, 2006). The disease is characterized by the loss of higher brain functions at its onset. Its symptoms are classified as either reversible or irreversible depending on the nature of its manifestation. The diagnosis of the condition requires specialized practitioners for it is complex, though there are some short tests that can be conducted effectively to determine if an individual suffers from reduced brain activity. The laboratory tests are aimed at determination of the absence of preventable cause and involve the determination of vitamin levels. Chronic use of substance has also been identified as a cause. Development in technology has made it possible for one to come up with images of the brain and help in identification of physical damage though such equipments do not in any way help in discovering the metabolic changes associated with the disease (Meleis, 2006). The disease manifest itself in several forms some treatable and other whose cure is yet to be developed. One management strategy employed in handling the condition is administration of drugs that help in slowing down the progression of the disease (Meleis, 2006). Therapy is widely used in managing the psychological torture that the patients undergo due to the inability to perform basic human activities.

 Depression or unipolar depression is a mental condition whereby the patient is characterized by unusually low mood levels and a loss of interest in daily activities. The diagnosis is made when one has suffered a number of such depressive spells (Meleis, 2006). A majority of the reported cases have their onset at thirties and peak in the fifties (Meleis, 2006). The diagnosis is based on self reporting and observations made by third parties. The official test for this condition is non-existent and labs have resorted to testing for physical conditions that may cause similar symptoms (Meleis, 2006). The causative factors of the condition are classified as either biological or psychological and treatment include the use of medicine, therapy or a combination of both (Meleis, 2006). Psychopharmacological Principles Psychopharmacology is the study of various aspects that relate to drug induced behavior change (Meleis, 2006). The changes that are as a result of the administration of certain drugs could affect thinking, sensation and behavior (Meleis, 2006). The management of people under the influence of psychoactive drugs is a key area of psychopharmacology and plays an important part in the determination of the success of any approach to medical health. Though drugs are administered for a specific reason, their effects are never specific. Moreover, the effect a drug will have on an individual is so dynamic and cannot be predicted with ease. Therefore, any good health management system should also focus on the implementation of psychopharmacological principles of critical thinking, patient education skills and caring in a clinical setting to help in the management of drug induced behavior.

Critical thinking must be developed by all mental health care practitioners if they are to actively help in shaping up the area of mental health (Meleis, 2006). Mental processes, especially analysis and evaluation, are important in dealing with the rather complex nature of mental illness. The unpredictability of the patients is a major concern in management of their health problems thus a health system should provide avenues for the nurses to develop skills and abilities based on professional knowledge and experience that help in identification of behavior patterns and thus determination of what is expected of the patient (Meleis, 2006).

Antipsychotic drugs are some of the drugs that are in use that act in the same manner that lobotomies act, and they are used in the management of psychosis, including hallucinations and delusions (Stone, 2001). The first of this drugs was clozapine which was discovered somewhere in the year 1950s and was put into use clinically in the years 1970s. They also tend to block the receptors that are present in the dopamine pathways in the brain, just as lobotomy involves the cutting off of the connectors that serve the same purpose (Stone, 2001). There are numerous side effects that are associated with these drugs notably weight gain and the lowering of the life expectancy of the patients who tend to use it (Stone, 2001). Thus it is evident that in the present day, lobotomy is still in use, it is just that it is not surgical, as there are drugs that serve the same purpose that the surgical procedure does.

Conclusion
This shows that mental health has always been treated seriously and one of the main methods that have been used to treat mental disorders is the administration of drugs that aid in relieving the psychological discomfort and torture that the patients have been experiencing. But is this so There have been questions over the procedures that surgical psychology and clinical psychologists have been using, and if they uphold the ethical morals. Some of these methods have been viewed to be barbaric such as the lobotomies that are being discussed in this paper. There have also been drugs that have been prescribed to patients that have the same effect on the patients that these lobotomies would have on them, such as making them to be incoherent and damaging their brains even further leaving them in an infantile state.

This paper gives a reflection on the theory of associationism. According to this theory all mental activity is based on the relationship between basic mental events, for instance, sensations and feelings. The phenomenon of association had been looked into by many philosophers and psychologists before Hume. However, they did not regard the issue of association as virtually important. Hume, therefore, set out to analyze the phenomenon and even developed the laws of association. John Locke talked of tabura rasa which means that the mind is like an empty surface until it acquires data from sense experience. According to Hartley, sensation derives from a vibration of the minute particles of the medullary substance of the nerves. These vibrations create in the brain fainter vibrations or vibratiuncles which thereafter symbolize ideas of sensation. Mill applies empiricist principles to the ontology of concrete things and his associationist principles to their perception.

Introduction
Over the years many scholars have tried to explain the epistemological nature of the mental content and the underlying principles in it. Experience has been regarded widely as the major source of data presented in the mind. This is an indisputable fact. This study seeks to explore the doctrine of the theory of associationism. In particular, the views of David Hume and his doctrine of resemblance, contiguity in time or place, and cause or effect the positivism of John Locke David Hartley and his law of contiguity and Mill on ontology of concrete things will be considered.

Associationism
Associationism is a theory in psychology which states that association is the basic principle of all mental activity (American Heritage, 2009). It purports that all mental activity is based on the relationship between basic mental events, for instance, sensations and feelings (Collins English Dictionary, 2003). It is the theory that all consciousness derives from the combination, in accordance with the law of association, of specific simple and definitive elements got from sense experiences (Columbia (Encyclopedia 2010).

Epistemologically the aspect of intentionality is greatly considered. Intentionality states that the knowledge that a person possesses is always about something (Lonergan, 2007). There is no mental consciousness that is not founded on reality. In other words, everything in the mind is also in the concrete experience. For instance, if X has an idea of a chair, the idea as it exists in Xs mind is of a chair, probably, in his own house, or in his office or in his college. Contrary to what idealism holds that everything is ideas, associationism will believe that everything is but a representation of concrete objects in the experience.

Intentionality and associationism have one and the same connotation in that the mental representations are always about something that is not illusory or hallucinated. In fact, for an associationist, illusions or hallucinations are not possible. Consider the following X begins to shout aloud that she is seeing walking trees coming towards himher. X is convinced that he is faced with such a reality and is really frightened. Now, this is an illusion because it is a factious mental representation founded on reality. On the other hand, Y screams in his room because he can see flying loaves of bread. He is frightened that the loaves of bread want to bite him, this is funny Now, this is a hallucination because it is not based on real experience. It can be said that Y is seeing his own things. See now Both X and Y mental status lacks sound combination of concrete experience in that there are no walking trees and there are no flying loaves of bread. Remember once again that associationism purports that consciousness is always about some object in the concrete experience.

Law of Association
It is important to note that the phenomenon of association had been looked into by many philosophers and psychologists before Hume. However, they did not regard the issue of association as virtually important. Hume, therefore, set out to analyze the phenomenon and even developed the laws of association. He notes that, the laws of association in regard to the understanding of the mind are similar to what the Newtons laws are to the understanding of the physical world (Bricke, 2010). 

It is noted that despite his zeal in developing his associationist ambitions, his works have not had a warm reception from a number of historians of psychology. Hume develops five laws of association where the first three govern the association of ideas. They can be formulated as follows one idea leads to another idea if the two ideas are connected by resemblance one idea leads to another idea if the two ideas are connected by spatial or temporal contiguity and one idea leads to another idea if both ideas are related by causation (Bricke, 2010).

Hume argues that there is a principle of connection between the different thoughts or ideas of the mind their presentation to the memory or imagination is characterized by a certain degree of method and regularity. He further argues that there are three principles of connexion among ideas. They are as follows Resemblance, Contiguity in time or place, and Cause or Effect (Hume, 1914). Consider the following example

X picks her album and begins to go through it. Among the photos she is going through are of those that belong to her family. She is in her room together with her friends. Immediately she comes across the photo of her mother, and begins to tell others about how her mother has grown big and that she looks beautiful. This by itself is an indication that the picture takes X to the original stature of her mother. It can be seen that whenever one looks at a picture it leads to the original. This also applies to a person who encounters a poster bearing President Obama what will go on in the mind of this person is the real President Obama.

Again X starts talking about her brothers and sisters after seeing the photo of her mother. The mention of her mother leads to the mention of other persons related to her. This also happens when one begins talking about World Trade House and how it was bombed, the next thing that follows is the mention of Pentagon and other buildings adjacent to it. In other words, the mentioning of World Trade Center necessarily invokes other enquiries concerning the others.

Still X comes across a picture that reminded her of her fractured hand. In this context, she immediately talks of the pain that accompanied it. She starts sharing with her friends about how her mother took her to the hospital so that she could get some pain killers to ease the situation. See now In normal circumstances, when one remembers of a wound, the next thing that follows are phrases like oops, it was really painful or ouch..the pain was too much

John Locke (2010) purports that ideas are linked in the mind in such a way that having one idea immediately points to another idea, though the two ideas are not as such connected with each other. He argues further that they are linked through their having been experienced together on a number of occasions in the past. He attaches a great value to the psychological tendency to correlate ideas through experience in that it helps in the education of children.

David Hartley was an English Philosopher and an initiator of the Associationist school of psychologists. John Locke talked of tabura rasa which means that the mind is like an empty surface until it acquires data from sense experience. Hartley on the other hand, considers the law of contiguity, synchronous and successive. He aims to explain not only the phenomenon of memory, but also the phenomena of emotion, of reasoning, and of voluntary and involuntary action. According to Hartley sensation derives from a vibration of the minute particles of the medullary substance of the nerves. These vibrations create in the brain fainter vibrations or vibratiuncles which thereafter symbolize ideas of sensation.

These vibrations in the brains are determined by the kind of past experience the person has had in the past, and also the circumstances present to the person. Those sensations that are largely associated together become each associated with the ideas corresponding to the others. In addition, the ideas relating to the associated sensations become associated together (Barbara, 1976) He argues further that voluntary action proceeds from the firm connection between a motion and a sensation or idea on the other hand and from a physical point of view, voluntary action is explained between and ideal and a motory vibration. This brings about the idea of determinism in the mans Free will.

Notably, Mill applies empiricist principles to the ontology of concrete things and his associationist principles to their perception. Mill gives an example of an orange in that when one cuts it, she is represented with particular sensory impressions, shapes, and colors and textures those which one had not had a prior perception. He further argues that the impressions one get from the cut orange did exist prior regardless of the fact that they had been perceived. According to him, experience forms the persons habit of expectation such that she not only forms the conception of the perceived things as existing prior to their conception but also enable the person to believe in their existence. The elements of the orange are believed to have existed prior to their perception hence they are possible sensations, which expectations become conditional certainties. These possibilities which are conditional certainties become permanent possibilities hence differentiating them from unclear and blurred possibilities which experience gives no warrant for reckoning upon.

A critical Reflection on Associationist Theory
It can be argued and justifiably so that proponents of associationism refer to one and the same thing. Indeed, they all have different approaches in their doctrines but it is evident that they are all empiricists. In fact, the doctrine of empiricism and the doctrine of associationism have the same object of study. They all purport that the mind is a dormant enterprise and is determined by experience through perception.

One would accept the doctrine of association in the dictum that nothing is in the intellect that was not there in the senses or nothing is in the mental content that was not there in the concrete experience. In deed, every person owes a lot of hisher thought-content through the everyday sensations. X will talk of a tree or a chair or a table or an ice cream by referring to a tree in Washington or a chair in hisher room or a table in hisher school or an ice cream in Vegas and so on and so forth. She cannot talk of the aforementioned items just in the blues she must refer or call to mind certain real experiences encountered. To this extent associationism makes a lot of sense.

The doctrine of Hartley has got some unclear elements. Consider the following case A child goes in a very dusty place. As she is walking a long the path, a car drives by leaving a lot of dust particles behind. Suddenly, the child begins to wipe her eyes and somehow, complains that her eyes are itchy. See the point The child as such feels the impact of the dust in her eyes. Why then cant one feel the same in the case when particles get into the brain andor mind It is clear that Hartley refers to measurable and quantifiable particles getting into the brain system but he does not consider the fact that anything physical and tangible that gets into the body has high chances of been felt or detected.

Inasmuch as association is the basic principle of all mental activity, it is worth noting that the mind is not a dormant entity. It has got its structures that function in different ways in the generation of knowledge. The mind is able to develop its knowledge and judgments and by the way, it is the mind that gives meaning to what it experiences. This is very important. The theory of association does not take into account that the mind is endowed with certain faculties that enable it perform complex functions that experience cannot offer. For instance, when Y sees two oranges and another two more oranges she makes the concept of four. Therefore, is the concept of four a percept or a concept Which experience can one obtain that two oranges added to another two oranges, one gets four Or better still, when one sees a donkey grazing in the playground, she will think of it as an animal, belonging to the class of mammals, and so on and so forth. Now, to this extent the person thinks of the donkey from a higher perspective which cannot be acquired from experience.

In general, the mind is structured such that it works on the data it receives from experience to formulate concepts. In fact conceptualization is purely a mental activity that is completely independent of experience.

Conclusion
We have seen the principle tenets of associationism. I believe that this doctrine is well thought, but it has several defects that need to be addressed. A little bit of rationalism is needed to shape it. They should not regard experience as everything in respect to our mental activity. It is not proper to look at the human mind just as a dormant thing since it has got faculties that have certain functions. The likes of Hume, Mill and others should refer to Lonergan who better explains the acts of mind namely experience, understanding and judgment. Again, the associationist cannot deny that we are rational and not mechanical This fact makes it possible that we do not wholly rely on experience in the formulation of our knowledge. We are the subjects of knowledge and were it not for rationality, nothing could make sense in the world.