Psychology

The main neurotransmitter systems in humans are fully established at differing rates, with its behaviors restricted by the emerging systems as cells become functional.  A failing brain system can cause various illnesses such as schizophrenia which may at times render someone incapacitated, (Goodwin, 2005). Schizophrenia is a severe psychiatric disorder with symptoms of detachment from reality, emotional instability, and withdrawal into the self. It is usually characterized by abnormalities in the sensitivity or expression of reality.

Notably, schizophrenia is not associated with culture or any part of normal development in any way. People with schizophrenia may hear virtually non existent voices, (Kandel, Schwartz, Jessel, 2000). They may deem other people to be controlling their thoughts, reading their minds or scheming to harm them hence they are always terrified and extremely disturbed. These individuals may sit for hours without talking or moving. They also experience multiple difficulties in taking care of themselves hence may completely be dependent on other people.

Classification
Schizophrenia symptoms are broadly classified into three different categories inclusive of positive, negative and cognitive symptoms.  Positive symptoms are the unusual behavior not seen in normal people. They tend to lose touch with reality and are usually on and off depending on the treatment the patient is receiving. The patient may hallucinate by talking to himher self and seeing things which do not exist. The patients thinking is delusional and characterized by illogical thinking. They also generally suffer from unusual way of thinking depicted from the way they organize their thoughts and connecting them logically, (Wickens, 2005).

In extreme cases, the person may become catatonic a state were by a person does not speak or move at all. Negative symptoms are linked with disruptions in ordinary emotions and behaviors furthermore the individual is unable to move hisher face and talks in a repetitive or dull voice. The person seams to have lost hope in daily life and even lacks the capability to start and sustain any planned activity. Cognitive symptoms are faint hence difficult to recognize and are detected only when a potential patient is subjected to clinical testing. A person may be unable to understand and execute a problem in a required way and even has problem paying attention or even focusing, (Goodwin, 2005).

Biological Origin
 Schizophrenia may be caused by malfunctioning of an important brain gene responsible for proper brain functioning. Imbalance in the brain structure and chemistry is also a possible cause of schizophrenia. If one parent suffers from schizophrenia, there exists a 10 chance of children developing it. Use of harmful drugs like amphetamine, cannabis and illicit brew may stimulate neurosis in people who are exposed to developing schizophrenia. The most effective treatment of schizophrenia mainly focuses on eliminating its signs and symptoms by use of various psychosocial treatments and antipsychotic medication.

Therapy and sustaining its impacts on everyday life can also help in cubing schizophrenia. The disorder has also been linked to the onset of significant violence. Kandel, Schwartz, Jessel (2000) affirm that, since majority of patients have an increased perception of threat, they tend to be violent. Conclusively, the prognosis and outcome of the disease remains relatively unknown although considerable developments into gaining a clear understanding of the disease have been within the past century, (Kandel, Schwartz, Jessel, 2000).   

Literature Review
Substance abuse of alcohol is known to affect people to control anxiety that involves fearful apprehension that is mainly out of proportion to external circumstances accompanied by hyperactivity symptoms such as sweating, palpitations, and other indicators.  The notion of people suffering from anxiety have a tendency to consume alcohol in an effort to relieve symptoms is supported by reports showing a high comorbidity rates of alcohol and anxiety problems.  The high co-occurrence of anxiety and substance abuse disorders is an explanatory mechanism of self-medication with the use of alcohol or drugs to attempt to reduce anxiety (Robinson, J., Sareen, J., Cox, B.,  Bolton, J. 2009).  It is hypothesized that alcohol dependence are though to be related to anxiety disorders.  The following five literature reviews attempt to demonstrate and support the hypothesis. 

In a critical review by Schukit and Hesselbrock (1994), the authors evaluated studies regarding the relationship between lifelong DSM-III-R anxiety disorders and alcohol dependence. The review was based on studies made about children of alcoholics, alcohol-dependent individuals, and people with lifelong anxiety disorders.  The selection of the subjects were based on the premise that if alcohol dependence and anxiety disorders are closely tied together, the children of alcohol-dependent parents are at high risk for the future development of alcoholism, that demonstrates a high rate of anxiety disorders.  A sample size of 786 was gathered as subjects who were people who are alcohol dependent and another group were children of alcoholics.  The results showed that the majority of alcoholics do not have major lifelong disorders.  It was further concluded that the relationship between symptoms of anxiety and alcohol use disorders is complex.  It did not prove a close relationship between alcohol dependence and anxiety disorders.  In addition to, the children of alcoholics and individuals from the general population did not indicate a high rate of anxiety disorders before the period of dependence on alcohol.    The critical review found out that the studies had several limitations namely (1) documenting symptoms is not equivalent to establishing a diagnosis, (2) assertive mating wherein alcoholic choose their mates and are more likely to select a partner who also has major behavioral or psychiatric problems, (3) many alcohol-dependent men and woman have comorbid drug use and associated disorders, and (4) combination of other life stressors covers the independent anxiety disorders.  The authors developed a hypothesis that there is an interaction between anxiety disorders and alcohol dependence exists, which wasnt supported when results did not prove a close relationship but a complex interaction between lifelong anxiety disorders and alcohol dependence. 

Kushner, Sher,  Beitman did another critical review (1990) on the relation between alcohol problems and anxiety disorders.   The authors reviewed relevant epidemiologic surveys, family studies, and field studies.  The study concluded that the relationship between alcohol problems and anxiety appears to be variable among the anxiety disorder similar to the study done by Schukit and Hesselbrock.  Several studies were analyzed having met the criteria that the studies dealt with anxiety disorders including agoraphobia, social phobia, phobic disorder, obsessive-compulsive disorder, generalized anxiety disorder, social phobia, panic disorder, and simple phobia.  The diagnostic methods employed by these several studies were self-reports, psychiatric diagnostic interview, structured clinical interview, lifetime history, and DSM-III.  The review found out that alcohol problems, along with agoraphobia and social phobia, appear more likely to follow attempts to self-medicate of anxiety symptoms while panic disorder and generalized anxiety disorder may be more likely to follow from pathological alcohol consumption.  The analysis of the studies had limitations such as the difficulty to evaluate the basis of the studies reviewed, inability to separately analyze multiple anxiety disorders, and a lack of differentiation of findings based on different reference populations. In the review, the authors found out that the studies combined individuals with different anxiety disorders into one group reported that anxiety problems most often begin before alcohol problems.  In addition to, the review of the studies concluded that the evidence for a simple causal relation between alcohol problems and clinical anxiety was not established.  Thus, the authors found out that increased alcohol consumption motivated by the short-term relief of anxiety may result to increased anxiety thus leading to more alcohol consumption to relieve symptoms.

The next topic of attachment is a cross-sectional study on self-medication of anxiety disorders with alcohol and drugs.  Robinson, Sareen, Cox,  Bolton (2007) investigated on the use of alcohol or drugs in an attempt to lessen anxiety to explain the high co-occurrence of anxiety and substance use disorders.  The results were derived from the National Epidemiologic survey on Alcohol and Related Conditions (NESARC) or a nationwide, household comorbidity survey.  The NESARC administered the survey face-to-face through 1800 experienced lay interviewers who finished 10 days of training prior to data collection. The NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule IV (AUDADIS-IV) were used to come up with the DSM-IV Axis I and II diagnoses.  The diagnoses were composed of mood, anxiety, personality and substance use disorders.  The results indicated that the highest rates of self-medication were found among those diagnosed with generalized anxiety disorder.  Next to GAD, were social phobia, and panic disorder with agoraphobia.  Panic disorder with agoraphobia had the highest rate of self-medication with both drugs and alcohol.  Participants of each anxiety disorder type self medicate with alcohol.  It can be theorized that people diagnosed with GAD are likely to encounter anxiety-provoking stimuli with considerable frequency and will likely self medicate.  Gender differences among self-medication for anxiety disorders were paralleled wherein individuals who did not self-medicate were women.  The majority of people who opted to self-medicate with drugs and alcohol were male.  In regards to this finding, it supported the theory that anxiety increases the likelihood of abuse on alcohol as a coping means.  The cross-sectional study revealed a general pattern of increasing comorbidity starting from anxiety with no self-medication to self-medication with alcohol, and then finally to self-medication using both drugs and alcohol.  Furthermore, the authors found that individuals who use multiple substance (i.e. alcohol and drugs) to control anxiety symptoms as more at risk for psychiatric comorbidity.  The limitation of the study, however, was the lack of assessment on the frequency of self-medication and amount of substances.  It raised the question of whether to include participants who have self-medicated infrequently or in small amount under the same category. 

Hasin, Stinson, Ogburn, and Grant (2007) examined the prevalence, correlates disability and comorbidity of alcohol abuse and dependence in the US.   It also provided an update and evaluation of treatment rates and medical attention for alcoholic use disorders.   The target population was those residing in households and group quarters aged 18 years and older.  A sample size of 43,093 was interviewed face-to-face. The questions were structured using the extensive AUDADIS-IV in the DSM-IV criteria for alcohol abuse and dependence.  The AUDADIS-IV alcohol diagnosis has a high test-pretest reliability ranging from good to excellent. During the 12-month prevalences of DSM-IV alcohol abuse and dependence, men participants had higher odds of alcohol abuse more among whites compared to blacks, Asian, and Hispanics.  For lifetime abuse and dependence, the odds were higher among men and lower among black, Asians and Hispanics compared to whites.  The odds of lifetime alcohol abuse were greater among respondents aged 30 to 64 years old.  The study revealed a disappointing lack of progress of the treatment rates for alcoholic use disorders in 2001-2002 in comparison with 1991-1992.  Medical attention to alcohol problems also has declined given that people with alcohol disorders expressed lack of confidence in alcoholism treatment.  The study posed limitations that may have directly or indirectly affected the findings such as bias and pseudocomorbidity due to age at onset of the comorbid disorders, small sample size for stable 12-month comorbidity estimates. 

Grant, Dawson, Stinson, Chou, Kay and Pickering (2003) spoke to the reliability and findings of the AUDADIS-IV related to alcohol consumption, tobacco use, and family history of depression among others in the general population.  The tests evaluated were the National Institute of Mental Healths Diagnostic Interview Schedule (NIMH-DIS) and the World Health Organizations Composite International Diagnostic Interview.  The sample consisted of 60 respondents in Germany conducted by Grant, Dawson, Stinson, Chou, Kay  Pickering (2003).  Results showed that AUDADIS-IV has a high degree of reliability as a diagnostic tool in clinical and research settings.  The authors recommended AUDADIS IV to treat the general population samples having demonstrated fair to excellent reliabilities, as well as for continued and sustained research to construct and evaluate diagnostic classification in the DSM-IV.  The limitations of the study was the small population size of 60 thus noncases or those who failed to endorse the relevant diagnostic stem questions were excluded from the study.    The instrument was administered in a test interview or face-to-face interviews and retest interview or telephone interviews.  Thus, the mode of administration of test was a form of blinding when respondents were reminded of their responses during the pretest. 

When taken together into one, the related research articles showed that the theories on how anxiety, specifically generalized anxiety disorder, can be a precursor to a dependence on alcohol as a form of self-medication of alcohol and drugs.  The relationship between anxiety and alcoholism were found to be complex and variable.   Researchers in the past research articles also found correlations on the findings but lack of differentiation between types of anxiety and how these disorders causes or do not cause dependence on alcohol.    Some of the limitations that should be avoided are small sample size, multiple anxiety diagnosis of the sample size, less longitudinal studies, and the blindness where participants are aware of the study and their role in the study.  It is important to note the findings done on the area similar to the current research. The current research examines the relationship between the levels of anxiety symptoms to long-term sobriety as well as to evaluate symptoms of anxiety that may impact sobriety.  It has a significant potential to create a positive impact on how to better manage anxiety and fear of a person without the need for alcohol.

Rape is a common yet seemingly undulated crime.  When I typed in the word RAPE into the Google Search Engine, there are very few specific articles that focus on the definitive word, per se.  What I saw instead are news articles about a certain Filipina named Nicole and her unfortunate fate of being raped by an American soldier by the name of Daniel Smith in Subic, Philippines.  According to the articles, the case dubbed as the Subic Rape case went out for a long period of time, but it has ceased to exist because of rather confusing outcomes Nicole withdrew her case against Daniel for reasons unknown, and the soldier was set free (Rodis, 2009). Rape cases as such are prevalent not only in the Philippines with 3,177 reported rape cases in 1999 (Costo, Almarines, Encarnacion, 2003).  This is a widespread problem that unfortunately is without proper acknowledgment among the authorities. 
There are notions and stereotypes in the incidence of rape.  There are several myths in the incidence of rape, and for this paper, we are going to discuss only two.

Just Myths
We are going to focus on the most common myths for the victim and the rapist.  We go with the victim first.

Rape myths say that victims get raped because they provoke the rapists (Meyer, 2000).  The way they dress, their behaviors, and generally their lifestyle are the main factor why rapists get attracted to them to the point of committing the sexual act.  In a sense, this myth says that if you wear tight-fitting clothes and act flirtatious, you are declaring yourself open for public consumption.  This is not true.
Rapists select their victims without regard to physical appearance or lifestyle unless of course he is a deranged serial rapist that follows a certain physical or behavioral pattern in their victims, as in the case of the Green River Killer (The Seattle Times, 2003).  That is beside the point, however.  The point to be instilled here is that rape is not spontaneous not because you are not wearing provocative clothes doesnt mean someone may not be thinking perverted thoughts about you.  Rape is a partially-planned act of violence that utilizes sex to degrade the victim and satisfy the rapists desire for control and power, or a show in strength and masculinity (Carroll, 2009).  No girl in her right mind would ever want to be emotionally and physically dishonored.  Rape is unsolicited and it targets no specific group, age, or class, of people.

Rapists, on the other hand, are generally regarded as an evil and perverted person whose sexual urges cannot be contained.  Most myths say that they are lonely men who had nothing better to do but fantasize about their neighbors.  They belong to the lower socio-economic classes and to the black community.  They are psychotic men who rapes not only women but men, too these men-rapists are common in prisons.

Rapists, like their victims, do not belong to a single specified classification of the population.  Yes, they are evil, but most rapists know their victims very well they may be relatives, caretakers, even close friends of the victim (Hamlin, 2005).  Id say that the stereotyping of the rapists came from the societys innate racist beliefs.  Most rapists are sane they know what they are doing and why they are doing it.  They do it because they want to gain power every rape victim is like a conquest to them.  They belong to various walks of life, and their educational level or intellectual capacity is not really a factor to their capability to carry out a crime such as rape.

Why Myths Exist and Persist
So why do these misconceptions still persist  Well, we have to partly blame the media for that.  We have television shows and movies showing these stereotypes on the rapists and their victims.  Novels and books, too, unravel a familiar story with the characters showing what the readers wanted to see an old balding man living by himself, a beautiful young girl whos reeking of sexual appeal.

Take the novel-turned-movie The Lovely Bones (2009).  We see the character George Harvey fitting the above description.  However, the movie disrupts another myth regarding the victims Harvey has raped several women of different ages and races, literary and film evidence that no girl is safe from rape.  Not even males, as portrayed in the comedy movie, Big Stan (2007), where Stan was sent to prison, all the while fearing being raped by the inmates.

The media has offered a clear-cut description of what maniacs should look like.  Apparently, no one would believe if the handsome college boy from an Ivy University is a rapist and not his tattooed friend who studies at some loser college in the state.  They have to add an effect that will convince the audience that this man is not to be trusted, that he is devising plans inside his black bald head for his attack on his next prospective victim, combing his mustache and hanging out in his basement.  All these personification, however, cannot be avoided as it is already a part of the industry.

Beliefs and Behavior
The beliefs that we hold are like indelible ink in our minds.  What we saw while we are growing up watching TV or reading books are manifestations of stereotypingcruel, but its true.  We often hear our parents tell their daughters not to wear short skirts and shirts with a deep neckline because it may attract inappropriate behavior from the opposite sex.  More so, girls are advised not to wander alone in the dark for they might encounter someone, nor are they allowed to go on trips that consist mainly of her male friends.  The public, especially these poor girls, are brought up to be afraid of these myths people seem to find a link to rape in one way or another.  But as they say, there is no harm in prevention, as no one is safe from being sexually assaulted (Hamilton, 2004). 

Bipolar disorder lies in the category of manic depressive disorders. The disorder affects the brain and causes strange mood shifts, change in activity levels as well as causing inability of the afflicted individuals to perform daily tasks (National Institute of Mental Health). The affected individuals have unusually elevated energy levels and other symptoms, which make the individuals to have a damaged relationship, poor school and workplace performance and in severe case, suicide (National Institute of Mental Health). This shows that the symptoms are different from the usual ups and downs that normal individuals undergo in everyday lives. Although the symptoms are often severe, bipolar disorder is easily treated and afflicted individuals can lead normal lives. Symptoms Individuals with bipolar disorder express very unusual and intense emotional stress that normally occurs in specific periods known as mood episodes (Basco 81). They may be in overexcited state (manic episode) or in extremely sad state (depressive episode) (Basco 81). In some situations, mood episodes may show symptoms of both depression and mania. Mood changes for manic episode include agitation, extreme irritability, overly happy and outgoing mood while the mood changes for depressive episodes include long periods of worry or feeling of emptiness (Mayo Clinic Staff). Sometimes there is loss of interest in some activities that the individuals once enjoyed such as sex. Behavioral changes in manic episodes talking at a fast pace, jumping from one concept to another and having what can be termed as racing mood. The individuals are easily distracted, are restless and do not sleep enough (Mayo Clinic Staff). They have unrealistic ideologies about ones abilities and behave in an impulsive manner usually taking plenty of pleasurable behaviors with high risks such as impulsive sex, spending spree and impulsive investments in business (Mayo Clinic Staff). Behavioral changes in depressive episodes include problems of concentration, making decisions and remembering, feeling of tiredness growing irritable or being restless. The individuals with depressive episodes may have problems with sleeping and eating (Medline Plus). In severe cases, depressive episode individuals may develop suicide thinking or having attempted suicide.Diagnostic Criteria The disorder often develops in individuals during early adult years or late teen stages with half of the total bipolar cases diagnosed before individuals attain the age of 25 (Medline Plus). However, in some individuals, the symptoms start appearing in early childhood while others start showing bipolar symptoms in late years of adult stage. It is not easy to identify bipolar disorder as it begins since the symptoms may almost appear like other complications that may not be recognized as a major problem (Medline Plus). It may take long before the problem is properly identified and proper medication provided. Bipolar disorder is generally a long term complication just like heart disease or diabetes and has to be managed throughout the entire life of the afflicted individual.

In order to have a proper diagnosis, it is necessary to talk to a physician who should then carry out a physical examination, oral interviews and various laboratory tests. Although bipolar disorder may not concurrently be diagnosed through brain scans and blood tests, the tests are imperative in ruling out other contributing causes such as brain tumors and stroke ((National Institute of Mental Health). The doctor may be required to carry out an evaluation of mental health in case the problems of stroke and brain tumors are not as a result of other illnesses. In most cases, patients are referred to a mental health expert such as a psychiatrist who is specialized in the diagnosis and treatment of the disorder (National Institute of Mental Health). Criteria for diagnosing bipolar disorder are given in the current fourth version of Diagnostic and Statistical Manual of Mental Disorder (DSM-IV-TR) and the current World Health Organizations International Statistical Classification of Diseases and Related Problems (ICD-10) (National Institute of Mental Health).

Psychiatrists or doctors should carry out a complete diagnostic examination. It is important for the physician or psychiatrist to discuss and identify family history of the disorder or other allied illnesses in order to establish the complete history of the symptoms expressed by the patient (Medline Plus). Because the patient may not explain the exact ways he or she expresses the symptoms of bipolar disorders, it is necessary for the psychiatrist to discuss the family medical history and symptoms with a close relative of the patient. If the afflicted individual is married and stays together with the partner, the spouse can be of great importance in explaining the symptoms.

The common sign among individuals with bipolar disorder is that they readily tend to seek assistance when they have depression than when they are manic or experiencing hypomania (Rheieck, and Steikuller 12). This shows why it is important to carry out a careful evaluation of medical history in order to ensure that the problem is not misdiagnosed as a major disorder of depression known as unipolar depression. With unipolar disorders, individuals do not experience manic depression that is often expressed in individuals with bipolar disorder. It is also important to include previous inputs and records about the patient from the family members and friends in medical histories.Possible Causes and Probable Effect

There are various causes of bipolar disorders which may include genetic causes, childhood precursors, life experiences and events, neural processes, melatonin activity and psychological causes (Basco 122). Chromosomal regions as well as individual genes have been identified and linked to the cause of bipolar disorders. The base pair changes for DNA sequence of TPH1 and P2RX7 genes have been blamed on the cause of the condition. Genes related to dopamine (SLC6A3 and DRD4), serotonin (TPH2 and SLC6A4) and dopamine (DTNBP1 and DAOA) have been identified to contribute to the condition although to a small extent (Rheieck, and Steikuller 14). Melatonin activity has been indicated for bipolar disorder. For instance in the eye, the hypersensitive melatonin receptors causes a rapid drop in melatonin levels during sleep time (National Institute of Mental Health). Valproic acid, used for stabilizing mood, increases melatonin receptor transcription and reduces the sensitivity to light in healthy subjects. However, the extent to which alteration of melatonin may lead to bipolar disorder has not been fully deciphered.Treatment There is no known cure for bipolar disorder although proper care given to the bipolar patients can greatly improve the lifestyle of patients (Medline Plus). With proper treatment of bipolar disorder cases, the individuals will gain an improved control of their mood swings as well as other related symptoms. There is need for a long-term treatment plan for bipolar disorder patients since the condition is a recurrent and lifelong illness. Long-term treatment such as psychotherapy and medications will offer a better control over the symptoms as the symptoms severity will be reduced and prevented from reoccurring (Basco 147).

The diagnosis and prescription of treatments for bipolar disorder is mainly done by medical doctors, psychiatrists or in some states, psychiatrist nurse practitioners, clinical psychologists and advanced psychiatrist nurses (Mayo Clinic Staff). However, not every individual responds to bipolar disorder medications. It is therefore important to keep a daily chart that shows the symptoms, treatments used, sleep patterns and various life events. These recordings will help the doctor track the details and give effective treatment. This also enables the doctor to make decisions on the change or switch of medications incase the ones used do not work with the patient. Medication options for treating bipolar disorders include mood stabilizing medications, atypical antipsychotic medications and antidepressants (National Institute of Mental Health). Apart from medication and psychotherapy, other treatments include sleep medications and electroconvulsive therapy (ECT).

Mood stabilizing medications form the treatment of choice to help individuals suffering from bipolar disorder. The individuals with bipolar disorder may continue with the mood stabilizers for a number of years. Majority of mood stabilizing medications are anticonvulsants with the exception of lithium (National Institute of Mental Health). Anticonvulsants are usually used in the treatment of seizures although they can also be used in the treatment of moods particularly in bipolar disorders. Lithium is effective in the control of mood symptoms although the levels of thyroid hormone should closely be checked as lithium causes hypothyroidism which is often associated with bipolar disorder particularly in women (National Institute of Mental Health). An alternative to lithium is valproic acid which is equally effective in the prevention of manic recurrence or depressive episodes. Atypical antipsychotic medications have sometimes been used in the treatment of bipolar disorder symptoms although they are often taken together with other medications (National Institute of Mental Health).

They are referred to as atypical since they are different from other first generation or conventional antipsychotics. Olanzapine is an example of atypical antipsychotic medication which when administered with antidepressants, can greatly relive severe symptoms of psychosis and mania. Other atypical medications used include Aripiprazole, Quetiapine and Risperidone (National Institute of Mental Health).

Other forms of medications used in treating bipolar disorders belong to the class of antidepressants. Antidepressants are usually used in the treatment of depression symptoms in bipolar disorder cases (National Institute of Mental Health). Bipolar disorder patients are advised to take mood stabilizers in addition to antidepressants.  This is recommended because relying on antidepressants alone may increase chances of patients switching   from mania or hypomania or even developing symptoms of rapid cycling (National Institute of Mental Health). It is therefore important for doctors who prescribe antidepressants agents for the treatment of bipolar disorder to include mood stabilizing agents. Fluoroxetin, sold as Prozac and Paroxetine marketed as Paxil are some of the antidepressant medications that are widely prescribed by physicians for the treatment of bipolar depression symptoms (National Institute of Mental Health). Psychotherapy is another form of treatment given to individuals with bipolar disorder apart from the medications (Mayo Clinic Staff). It is also referred to as talk therapy which can provide education, support and guidance to individuals with the condition together with other family members. Psychotherapy methods include family-focused therapy, cognitive behavioral therapy (CBT), psychoeducation and interpersonal and social rhythm therapy (National Institute of Mental Health).Prognosis

It always comes out that good prognosis is only feasible when good treatment is provided and a good treatment is possible if doctors make accurate diagnosis of the condition. In most cases, bipolar disorders are often misdiagnosed or under-diagnosed and as a result, it becomes difficult for individuals with bipolar disorder to be given competent and timely treatments. Although bipolar disorders can be a very severe medical condition, which can disable individuals, bipolar individuals can comfortably live satisfying and full lives with the use of medications (Rheieck, and Steikuller19). Even when no medications are used, bipolar disorder patients can experience from normal to near normal lifestyles between episodes.

It was widely assumed that there were no gender differences in mental disorders and any evidences that suggested that women experienced more psychological distress than men.  The assumption lies on the fact that women are being more willing to admit to psychological distress, being more willing to seek treatment andor sex bias on the part of clinicians (Gove 2002). Furthermore, although it was widely recognized that on most indicators of physical illness women appeared to have higher rates of morbidity, it was generally assumed that the apparent higher rates of women did not reflect real differences in morbidity, but gender differences in mental disorder. A survey of the recent literature, however, shows that women experience more psychological distress than men mainly because of the aspects of their societal roles.   
    
Additionally, in the last few years the cumulative evidence indicates that women do in fact have higher rates of morbidity than men and that this probably is also largely a consequence of their social roles. The current paper concentrates on the roles normally assumed by men and women.  The roles of men are inclined to be more structured than the roles of women.  Women, on the other hand, are more likely to occupy nurturing roles than men. It is argued that highly structured roles, in the case of men, tend to be causally related to good mental health and low rates of morbidity. On the contrary, nurturing roles of women tend to enforce a strain that possibly can impair ones ability to effectively adopt a sick role.   As consequences, the nurturing roles are linked to poor mental health and the higher rates of morbidity. In short, the hypothesis of the structured role versus nurturing role complement each other and can be combined to explain their effects on higher rates of psychological distress and mental disorder among women.

Statement of the Problem
Gender affects various aspects of life including methods of coping with stress, social interaction, self-evaluation, spirituality, access to resources, and expectations of others.  These factors influences mental health of both men and women in a negative or positive way.  The current paper seek to develop understanding between the relationship between gender and mental health so as to lessen risk factors predisposing men and women to develop mental disorders, as well as to improve treatment methods.

Research Questions
The study aims to answer the research question of whether there is a relationship between gender specific stressors and the development of mental disorders.

Research Hypothesis
The research hypothesis is that there is a relationship between gender specific stressors and the development of mental disorders.

Relevance to social work
The current study can be utilized as a guide on planning therapies to individuals, both men and women.  The focus of therapy differs based on issues of role stressors of patients and their gender.  Thus, the social workers can recognize causative factors that led to the development of mental disorders and plan interventions that best fit the client along with his or her past experiences. 

Furthermore, social workers can reduce the incidence of anxiety among toddlers and young children by first identifying high-risk conditions that produce greater than average number of children having unmet needs not given by their caregivers.  Social workers can intervene to reduce the number of risk conditions among young children.  Before interventions are instituted, the need for a strong association in the connection between risk factors and their effects on young children.  Frequently, evidences of childhood issues such as unmet needs are limited, thus it seriously weakens the rationale for intervention efforts. 

III. Background and significance

Womens typical stressors
During the time of post-independence, it has been realized that women were granted an active participation and cooperation to the progress of a nation.  They were provided with equal opportunities whether in the field of education or occupation.  These efforts increasingly resulted to a great change in life of women that influences their attitudes, values and roles.  While women participates in the labor workforce, much of their feminine or nurturing roles remains unchanged.  Research on womens roles has revolved around two competing theories.  The role of enhancement theory argues that employment provides psychological and social benefits to women due to increased contact, social interaction and increased sense of esteem.  In contrast, the role overload theory implies that the pressures and demands of juggling multiple roles including career, parenting, spouse roles, may exhaust womens personal resources and impair womens physical and mental health (Singh  Shyam 2007).  Rosenfield (1999) reported that women perform 66 percent more of the domestic work compared to men.  The study showed that women sleep one half hour less per night and perform an extra month of work each year.  Some of the obstacles to womens psychological health are the emerging demands and challenges linked to work and non-work responsibilities of women.  Thus, it is assumed that most patients in psychiatric facilities experienced stress from multiple roles at home and work. 

Besides the multiple roles of women, personality variables could also affect reactivity to the demands of multiple role-playing.  In relation to, Type-A individuals are more motivated to control stressful situations compared to Type-B individuals (Glass 1977).    Houston and Kelly (1987) studied Type-A behavior among housewives when it comes to work, marital adjustment, stress, tension, health, fear of failure and self-esteem.  Ninety-five housewives were administered the Framingham Type-A Scale and the Jenkins Activity Survey.  The data gathered were from personal interview and questionnaire concerning different aspects of their daily lives, various psychological and psychosocial variables.  Type-A was found out to be in contrast from Type-B concerning more stressful, work-related experiences.  Type-A reported lower covert self-esteem and report more fear of failure than Type-B. 

Mens typical stressors
The traditional role of men is marked with expectations for superior physical strength, intellect, or sexual performance.  Some situations typically produces stress for men that challenges their self-identity hence makes them feel inadequate.  Research indicates that men who strictly adhere to extreme gender roles are at higher risk for mental disorders.

Traditional male gender roles are adhered in particular cultures. An exaggerated form of masculinity is characterized by qualities such as concerns for personal honor, virility, physical strength, heavy drinking, toughness, aggression, risk-taking, authoritarianism, and self-centeredness.  In a study by Jose Abreu and colleagues, an exaggerated form of masculinity is adopted by Latino men, coming close are European Americans, and then African Americans.

Mental Health
Well-being is defined as a subjective, positive emotional state with general life satisfaction (Diener 1984).  The most common and comprehensive indicator of the sense of well-being including life satisfaction which refers to a persons global judgment of his or her quality of life, feeling of contentment and happiness. 

Mental health is best achieved by maintaining a balance between masculine and feminine qualities. When either set of qualities is taken to the extreme and to the exclusion of the other is detrimental to health and self-esteem. A non-traditional gender role orientation would combine the best of both genders a social focus (reciprocally supportive relationships and a balance between interests of self and others) and active coping strategies.

It is also necessary to know the educational attainment, family environments, emotional health and marital status of patients.  Educational attainment influence socio-economic status or level of prosperity and welfare of people consequently contribute to wellbeing.  Higher educational attainment are typically associated with higher income, higher standards of living and above average health (Federal Interagency Forum on Aging Related Statistics 2004).
 
Vulnerability to depression presumably began in early family environments in which the childrens needs for security, comfort, and acceptance are not met.  In fact, a study found out that two-year-old children with secure attachments to his or her primary care givers were more cooperative, persistent, and enthusiastic, show more positive affect, and function and better overall than those with insecure attachments (Matas, Arend,  Sroufe 1978).  Moreover, adolescents undergoing stressful life events are more likely to become depressed if they had insecure attachments to their parents than adolescents with more secure attachments (Kobak, Cole, Ferenz-Gillies, Fleming  Gamble 1993).   A persons emotional and economic wellbeing can be greatly affected by marital status.   The marital status can influence living arrangements and life satisfaction.  Cross sectional studies have shown that married people have significantly higher levels of subjective well-being than people in de facto relationships, newer married people, or divorced people (Singh  Shyam 2007). 

A study indicated that, overall, neither women nor men are at greater risk to develop mental disorders.  Certain types of disorders, however, may indicate susceptibility to males or females.  Gender identification possesses advantages and disadvantages.  Findings of the study showed that women are protective against antisocial behaviors and substance abuse, but is linked to develop increased levels of avoidant coping strategies and low levels of achievement.  On the other hand, men are protected against depression, but have a high tendency in antisocial behavior and substance abuse (Rosenfield 1999).

The current study attempts to determine whether men and women who has and had mental disorders experienced stress from assuming gender roles.  Women participants will be assessed based on their age, emotional health, personality type, and the nature of their lifestyle including their roles at home andor work prior to admission and discharge from psychiatric care. 

Participants who are men will be also assessed based on their age, emotional health, employment, marital status, and nature of lifestyle upon assuming roles at work and home. 

IV.  Research Methodology
Research Design
The current study utilizes an approach of retrospective and explanatory to demonstrate the hypothesized relationship between gender specific role stressors and the development of mental disorders.
 
Sampling Plan
The study uses stratified sampling method, as it is advantageous to sample each group of participants namely men and women who have a history of mental disorders and has been treated in a psychiatric facility.  Each group is divided into two based on the

C.  Procedures
The sampling frame included every eligible patient who had completed psychiatric rehabilitation as a treatment for mental disorders.  Psychiatric nursing staff based on the given criteria initially recruited potential participants.  The potential participants are those who have successfully completed psychiatric therapy and adhere on his or her medication management.  As the recruitment of patients progresses gradually, the researcher seeks participants through weekly discussions with staff nurses to identify patients meeting study-screening criteria.  After initial screening administered by RN staff, the researcher explains the study to the potential participants and obtained patient consent.  The staff nurses are not asked to secure patient consent since patients might be compelled to participate in order to please their caregivers.  The researcher is not the direct patient caregiver thus it is less likely that patients would be compelled to participate in the study when they are not initially willing to do so.  Patients are asked to sign an authorization to use protected health information before the conduct of the study, as medical records will be utilized.  Initial data are collected through open-ended questions asking about the participants history on family and relationship to parents, marital or single status, educational attainment, occupation, experiences and understanding on current medical condition. 

D.  Operationalization of Concepts and Measurement

Variables
The current study investigates the hypothesized relationship between gender specific role stressors and the development of mental disorders.  The two concepts of gender specific role stressors, as the independent variable, and the development of mental disorders, as dependent variable, are involved in the study.  The main concept that needs to be operationalized and measured is mental disorders. 
Gender specific role stressors will be measured through retrospective means via structured questionnaire and interviews.  A correlation of other variables such as gender, age, emotional health, marital status, educational attainment, occupation history, type of personality (Type A or Type B) will be taken into consideration upon administering the structured questionnaire and interviews towards determining the hypothesis.

Mental disorders can be measured through past and current information of the patient including family history and relationship, DSM-IV results, and medical history relating to length and frequency of psychiatric admission and current and past medications given. 


Level of Measurement
The independent variable of gender specific role stressors such as gender, age, emotional health, marital status, educational attainment, occupation history, type of personality is measured at a nominal level and ordinal level or referred to as categorical variables.  The attribute of the categorical variables will have a central tendency measured as mode and chi square.  The same level of measurement will be applied to the dependent variable.

Instrumentation
The structured questionnaire will ask participants both basic information and other pertinent information including but not limited to age, gender, family background, family relationships, occupation, marital status, Several psychiatric tests will be employed to determine gender specific role stressors and its relationship to mental disorders.  DSM-IV-TR will also be utilized to know the history of the client but not necessarily to know the underlying cause of the mental disorder.  Personality tests in mental health will be determined with the use of the Minnesota Multiphasic Personality Inventory (MMPI) 2.  Trained professionals to assist in identifying personality structure and psychopathology use the MMPI 2 test.  It is appropriate for use with adults 18 and over.  The current MMPI-2 has 567 items, all true or false formats, and typically lasts between 1 and 2 hours to complete depending on reading level.  The raw scores on the different scales of the MMPI-2 are transformed into a standardized metric known as T-scores that renders an easier interpretation.  Clinical scales will measure different descriptions of personalities, shown below

NumberAbbreviationDescriptionWhat is measuredNo. of items1HsHypochondriasisConcern with bodily symptoms322DDepressionDepressive Symptoms573HyHysteriaAwareness of problems and vulnerabilities604PdPsychopathic DeviateConflict, struggle, anger, respect for societys rules505MFMasculinityFeminityStereotypical masculine or feminine interestsbehaviors566PaParanoiaLevel of trust, suspiciousness, sensitivity407PtPsychastheniaWorry, Anxiety, tension, doubts, obsessiveness488ScSchizphreniaOdd thinking and social alienation789MaHypomaniaLevel of Excitability460SiSocial IntroversionPeople orientation69ValidityReliability

The validity of the study signifies the strength of the inferences and hypothesis made.  The conclusion validity of the study inquires if there is a relationship between gender role stressors and development of mental disorders.  The external validity is the study can be strengthen when future researchers attempt to investigate the effect of other variables such as occupational history, marital status, emotional health and their respective effects to the development of particular mental disorders.  A mortality threat exists when subjects decided to drop out of the study due to confidentiality concerns. 

Reliability measures the consistency of the measurement of the instrument used when used under the same conditions with the same subjects.  The current study does not involve test and retest given that the nature of data collection is of retrospective in nature.  It means that the researcher will link the current mental disorder of participants with their history on various variables. 

Preliminary Data Analysis Plan
The descriptive and retrospective study utilizes history of the participants including their age, gender, occupation history, marital status, family history, family relationships, and emotional health.  The dependent variable of mental disorders will be correlated to the independent variables mentioned above.  The quantitative data collected will be measured as categorized variables as nominal and ordinal forms of data.  The researchers will link the independent variables on whether they contributed to the development of the mental disorders of both men ad women participants.


Human Subjects Protocol
The current study anticipates a sample size of 150 subjects, divided into two groups of male and female, or 75 men and 75 women.  Participants of the study are further divided into unemployed and employed group given that stressors can vary based on employment and unemployment.  The age range of the sample population is 30-65 years of age.  There is no specific race chosen for the study provided that the participants have a history or current medical condition of mental disorder.  Participants should be alert and not under any sedative effect of medications that might render him or her unable to communicate her answers.  Furthermore, participants are expected to converse in English and have completed the rehabilitation program of a particular psychiatric facility.
The mental disorders included in the scope of the study are mood and anxiety disorders (depression, phobias, obsessive-compulsive disorders, bipolar-affective disorder, PTSD, panic disorders), personality disorder (paranoid personality, schizoid personality, antisocial personality, borderline personality, histrionic personality, narcissistic personality, avoidant personality, dependent personality) and psychotic disorders (schizophrenia, schizophreniform, schizoaffective disorder, substance-abuse psychotic disorder).  The study mainly investigates the relationship of gender specific stressors to mental disorders thus the criteria for inclusion of participants should be clients who have history of mental disorders based on admission records of psychiatric facilities.

The research data will be derived from participants from second hand data from records as well first-hand data from structure questionnaire and interviews.  The variables such as occupation, emotional health, marital status, gender, age, and family relationships and structure will be based on second data from records of the participants and their DSM-IV TR results from Axis I t o Axis IV including their Global Assessment Functioning (GAF) deemed vital to rate the social, occupational and psychological functioning of adults. 

Several local psychiatric facilities will be contacted and proposed to participate on the study.  The nature and background of the study will be discussed to these facilities as well as an affirmation of the confidentiality of the data and names of participants will be stated under false names or aliases to protect their identity.  A written consent will be secured from participants following full disclosure of all details of the current study. 

Several steps will be undertaken to further protect the identity and sensitive information of the participants information.  No real first or last names, addresses and name of psychiatric facilities will be mentioned in the complete 

A consent form will be handed out to participants to ensure their willingness to be involved in the study.  In addition to, the consent form signifies their full understanding on the background of the study as well as their role as subjects.

Information and Consent for Participants (sample)
The purpose of this form is to provide information regarding the purpose of the study on the hypothesized relationship of gender specific role stressors and the development of mental disorders.  Please read the information carefully, discuss your concerns with the researcher or clinical psychiatric staff.  Indicate your choice, and sign this form in the area indicated below.

I have read and have had read to me the above information and I understand it.  I have discussed the potential risks and confidentiality issues with the researcher team or clinical psychiatric staff.  I have received all the information I need to know.

____ I want to be a participant ____ I dont want to be a participant

______________________ _______________________
Patients signature Print Patients name

________________ ____________________
Date Witnessed by

Administration and Timetable
The administration of the structured questionnaires and interviews will be conducted when participants are able to communicate and think well without any sedative or cognitive affecting side effects of medication.

There are three phases of the administration of the current study pre-working phase, working phase, and termination phase.  The pre-working phase involves orientation of the study and allows the staff nurse to narrow down the potential participants.  The working phase involves building trust and rapport with participants.  The researcher entails consistency and clarity on the details of the study.  The researcher will se a contract on the duration of the study as well as the necessary steps involved such as the background of the tests and enabling participants to have a sense of trust in relation to privacy and confidentiality of data.  When participants commit on the study, the administration of the structured questionnaires and face-to-face interviews will be conducted.   It allows the researcher to further confirm whether participants decided to be subjects of the study.  The termination phase involves the researcher and participant to terminate their working relationship as researcher-subject.

Limitations of the Study
Recruitment issues
During the course of the study, some issues were known in patient recruitment that may have resulted in selection bias.  The participants selected were based on an outpatient arrangement and not those patients who are currently experiencing cognitive dysfunctions.  Future studies can explore selection of participants such as those who finished the psychiatric rehabilitation program and are employed versus participants who were admitted in psychiatric rehabilitation program but unemployed.  Thus, future researchers can determine whether the aspect of employment and the nature of the job contribute to a depressive state of emotional health.

Variables concerned
Future researchers should consider breaking down the variables stated to be under investigation in the current study.  Studies on the effect of occupational history towards the development of mental disorders should be looked into.  The link between marital status as a stressors to the development of mental disorders should also be investigated.

Precise and accurate history of participants
Another limitation of the study is the question whether the history and records of the participants documented are accurate and truthful.  Patients who have cognitive disorders such as delusions, hallucinations, and illusions among others may have contributed to inaccurate statement of facts.  Even if the researcher was able to gather all pertinent data and was secured from official medical records, some important facts relating to the current mental disorder of the patient may be lacking or were presented in different implications.  Thus, researchers should gather data from the family, community of the participants.   

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.