Comparison of Electroconvulsive Therapy and Antidepressants

Comparison of Electroconvulsive Therapy and Antidepressants Brief 101151 INTRODUCTION Depression is one of the more common forms of mental illness. It has been estimated that approximately 9.5% of the population will suffer with depression at any one time (Robins and Regier 1990) and that 17% of people will suffer with depression at some point in their life (Blazer et al 1994). Defining depression is not a straight forward task. This is due to the fact that it can range from normal unhappiness through persistent and pervasive ways of feeling and thinking to psychosis (Hale 1997). Having said this, a number of different features which can be associated with depression have been identified by Hale (1997): Persistent low mood Loss of interest and enjoyment Reduced energy and diminished activity Poor concentration and attention Low self esteem and low confidence Ideas of guilt and unworthiness Bleak pessimistic views of the future Ideas or acts of self harm or suicide Disturbed sleep Diminished appetite It is also possible to distinguish between three major types of depression. The first form of depression is Dysthymia which involves long-term chronic depressive symptoms which do not necessarily disable the individual. The second form is Bipolar Disorder which involves the patient experiencing periods of mania and depression through cycles of mood change. The third and final category concerns Major Depression. The symptoms involved with this mental illness combine to ensure that it is difficult for the patient to work, study or to enjoy activities as well as them having difficulties regarding eating and sleeping patterns. It is this third and most serious form of depression which will be the focus of the following discussion. TREATMENT OF SEVERE DEPRESSION A number of different approaches to the treatment of depression have been taken which are based on a range of theoretical perspectives. These include approaches such as Cognitive Behavioural Therapy, Psychoanalysis and those based on increasing exercise levels. However, perhaps the most common treatment for depression involves the use of antidepressant drugs (American Psychiatric Association 1993) These include medications such as Tricyclic (which is cheap and effective but does have side effects which limit compliance), Selective Serotonin Up-Take Inhibitors (which has fewer side effects but less effective for disturbed sleep) and Monoamine (which, in rare cases, can be fatal when mixed with certain foods) Although antidepressants can be effective, research has indicated that they may not be the optimal solution. For example, Thomas et al (1982) conducted a study involving 115 participants who were randomly allocated to receive either a combination of antidepressants or a placebo. T he medication was found to have a significant effect but non-compliance was identified as a significant problem. It has been estimated that non-compliance regarding antidepressant drugs is between 20 and 59% (Johnson 1973 and Thomas et al 1982). Further research has also reported that patients who are suffering with depression are still at a significant risk of relapse or recurring symptoms even when they have been adhering to their medication programme for a long period of time (Grunhaus et al 1990). It may also be the case that medication is not suitable for all forms of depression. For example, Hale (1997) suggested that antidepressants may not be effective for psychotic depression. Therefore, as a result of the potential drawbacks of non-compliance, relapse and not being effective for all forms of depression, efforts have been made to identify other approaches for the treatment of severe depression. One of the most controversial treatment approaches is Electroconvulsive Therapy (ECT). It was first used in 1938 by Cerletti and Bini (Linington and Harris 1988). It involves sending an electrical current through the patient’s brain with the aim of stimulating the release of neurotransmitters which will ultimately improve the patient’s mood. ECT has obtained a somewhat negative reputation due to stories of bitten tongues and fractured bones and it is often seen as a form of punishment rather than treatment. However, reviews of its application have demonstrated that ECT does have significant benefits compared to simulated ECT, when all procedures are followed without an electrical current actually being given (The UK ECT Review Group 2003). Whenever one is making decisions regarding the use of any given treatments, one must consider the body of scientific evidence which has assessed the treatment’s efficacy and effectiveness. The following review will aim to consi der the research which has assessed the efficacy and effectiveness of ECT as a treatment for severe depression in order to determine its effectiveness with reference to the use of antidepressants. RESEARCH QUESTION Thus, the following review will aim to answer the question ‘Is ECT an effective treatment compared with antidepressants in cases of severe depression’. The methodology which was employed within this research will now be outlined. LITERATURE SEARCH A systematic review aims to integrate existing information from a comprehensive range of sources, utilising a scientific replicable approach, which gives a balanced view, hence minimising bias. It can also be stated that systematic reviews provide a means of integrating valid information from the research literature to provide a basis for rational decision making concerning the provision of healthcare. 2.1 SOURCES OF DATA The methodology employed within the research involved obtaining data from three key sources: Computerised searches, Manual searches, and the Internet. Each of these data sources will now be considered in more detail. 2.11 COMPUTERISED SEARCHES The methods used in this research will include a detailed computerised literature search. Multiple databases, both online and CD–Rom will be accessed to retrieve literature because they cite the majority of relevant texts. The computerised bibliographic databases are:- MEDLINE EMBASE CINAHL PSYCHINFO Biological Abstracts Cochrane SIGLE However because articles may not be correctly indexed within the computerised databases, other strategies will be applied in order to achieve a comprehensive search. 2.1.2 MANUAL SEARCHES A manual search will be performed to ensure that all relevant literature is accessed. The manual searches will include:- Books relevant to the topics from university libraries and web sites Inverse searching- by locating index terms of relevant journal articles and texts Systematically searching reference lists and bibliographies of relevant journal articles and texts 2.1.3 THE INTERNET The internet will provide a global perspective of the research topic and a searchable database of Internet files collected by a computer. Sites accessed will include:- Department of Health National Institute of Clinical Excellence English National Board of Nursing, Midwifery and Health Visiting Google British Medical Journal 2.2 IDENTIFICATION OF KEY WORDS A set of key words will be used within the literature search. Elements of the research question will be used to provide the search terms. Therefore, the words Electroconvulsive Therapy, Antidepressants, Depression, Effectiveness and Evaluation will all be used. 2.3 INCLUSION AND EXCLUSION CRITERIA To ensure that the more relevant research studies are identified, a set of inclusion and exclusion criteria will be utilised. In order to be included in this research the studies will need to relate to the evaluation of Electroconvulsive Therapy and relate to the treatment of depression. Furthermore, studies will be excluded if they are published before 1975 or if they are not available in English. DISCUSSION This review has identified literature which has focussed on assessing the effectiveness of ECT in comparison to antidepressants regarding the treatment of severe depression. In order to structure the discussion, the research will be analysed with reference to the benefits of ECT regarding relapse, patients who are drug-resistant and those with severe depression in particular. The potential drawbacks of ECT will then be briefly considered before overall conclusions are drawn regarding the research question. 3.1 RELAPSE Studies were located which highlighted the benefits of ECT regarding the reduction of relapse. For instance, Petrides et al (1994) reviewed the case histories of 33 patients who had been diagnosed with long term depression. A set of 21 patients were included in the study as a one year follow up report was available for analysis. Each of the participating patients had been taking antidepressants for a significant length of time but were still experiencing relapses of depression. After the delivery of ECT it was reported that the number of patients with depression who suffered relapses fell from a normal rate of 50% to 33% at the one year follow up. For the patients with delusional depression in particular, the relapse figure fell from a normal rate of 95% to 42%. Based on this research it would appear that ECT can be more effective than antidepressants in terms of reducing relapse rates. A more recent and relevant study was conducted by Gagne et al (2000) which also involved the retrospective reviewing of patients’ notes. Two groups of 29 matched participants were identified. The first group had only been taking antidepressants were as the second group had antidepressants along with ECT. At the two year follow up stage the relapse rates for those who had ECT was 52% compared to the 93% associated with those who only had medication. At the five year follow up stage, the relapse rate for the drug-only group had fallen slightly to 73% where as the ECT group had fallen dramatically to just 18%. The average survival rate of the ECT group was 6.9 years which was significantly longer than the 2.7 years for the drug-only group. Therefore the research considered in this section would lead one to conclude that ECT can be more effective than antidepressants alone in terms of reducing relapse rates. Having said this, it should be noted that these research projects involve d combining ECT with antidepressants rather than replacing them entirely. 3.2 MEDICATION RESISTANT PATIENTS Although antidepressants are effective for many patients with depression, there are some groups for whom it is less effective. Rabheru and Persad (1997) reviewed the literature which focused on assessing the effectiveness of ECT for patients who were found to be resistant to antidepressant medication. They found that the research evidence indicated that ECT could have significant benefits for medication resistant patients. These benefits were particularly relevant for elderly patients with depression. An important point to make here, however, was demonstrated by research conducted by Prudic et al (1996). They reported that the effectiveness of ECT may decline as the time for which the patient has suffered with severe depression increases. Therefore, the approach of using ECT when the patient has been found to be resistant to antidepressants may not be the optimal approach as the possible benefits of ECT may have been reduced. Therefore, this section has demonstrated that ECT could be beneficial for patients who have severe depression and have not been significantly helped by the use of antidepressants. However, it is important to note that the use of ECT may decline over time. 3.3 PATIENTS WITH SEVERE DEPRESSION Further research has indicated that ECT may well have particular benefits over antidepressants with regards to patients who have severe depression. Sobin et al (1996) conducted research to evaluate the effectiveness of ECT for patients with a range of levels of depression. They reported that 70% of the participants responded significantly as a result of the ECT and that significant improvements were made by those who had severe depression. Other research has also leant support for the assertion that ECT is particularly beneficial for patients with severe depressive symptoms, mood congruent delusions and those who are at prominent risk of committing suicide (Martin 1989, Schatzberg 1992, Persad 1990, Philibert et al 1995 and Fink et al 1996). It appears that the attributes of ECT are particularly suited to the treatment of people with severe depression. It may be that the more severe a person’s depressive symptoms are, the more drastic and severe the treatment approaches need t o be for them to be effective. CONCLUSIONS This review has considered research which has investigated whether ECT is effective in treating severe depression when compared to antidepressant drugs. Based on this research it can be concluded that ECT, when combined with antidepressants, does appear to significantly reduce patients’ relapse rates. It can also be said that the evidence supports the view that ECT can be effective for patients who have been found to be resistant to antidepressants. The third and final conclusion is that ECT appears to be particularly suited to patients with the more severe forms of depression. Having said this, some criticisms need to be acknowledged regarding this body of research. For instance, Rose et al (2003) highlighted three major drawbacks. Firstly 1 in 3 patients who are given ECT report persistent memory loss. Secondly, the research studies conducted by clinicians in this area report more positive results than those conducted by consumer agencies. This may be due to the selection of participants or the focus of the research questions. The third and final drawback outlined by Rose et al (2003) is that the studies which support ECT rarely assess the long term effects or cognitive functioning and the majority of them were conducted many years ago using small samples. The research is also limited because it mainly uses case studies (Thienhaus et al 1990), naturalistic studies (Aronson et al 1987) or retrospective reviews of patient notes (Stiebel 1995). Few randomly controlled trials were highlighted by this literature search. Such criticisms must be kept in mind when considering the effectiveness of ECT in comparison to antidepressants for treating severe depression. 5.0 IMPLICATIONS FOR PRACTICE Guidelines produced by the National Institute of Clinical Excellence, based on a review of Department of Health and Cochrane database research, recommends that ECT be used for rapid and short term improvements for patients with severe depression or who are at significant risk of suicide (Tharyan and Adams 2003). However, as highlighted by the Royal College of Psychiatrists (2003) in their response to these guidelines, the use of ECT may have a wider scope than this approach would suggest and the guidelines may ensure that patients who may benefit from ECT are not given the treatment. Further research in this area will provide a basis upon which to test the appropriateness of these guidelines and the current use of ECT. It would appear that ECT can have significant benefits for patients with severe depression but that more efforts need to be made to tackle the negative impressions which may be associated with this treatment such that it can become a more accepted approach. The main im plication of this review for practice is that ECT appears to have a significant role to play in the treatment of severe depression but that it is likely to be alongside the use of antidepressants rather than instead of them. This strategy will enable the most comprehensive treatment programme to be delivered to the patients and ensure that their chances of a full recovery are maximised. REFERENCES American Psychiatric Association (1993). Practice guidelines for major depressive disorder in adults. American Journal of Psychiatry; 150(suppl): 4. Aronson TA, Shukla S, and Hoff A: (1987) Continuation therapy after ECT for delusional depression: a naturalistic study of prophylactic treatments and relapse. Convulsive Therapy; 3:251–259[Medline] Blazer DG, Kessler RC, McGonagle KA, and (1994) Swartz MS. The prevalence and distribution of major depression in a national community sample: the national comorbidity survey. American Journal of Psychiatry;151:979-6. Gagne, G. G., Furman, M. J., Carpenter, L. L. and Price, L. H. (2000) Efficacy of continuation ECT and antidepressant drugs compared to antidepressants alone in depressed patients. American Journal of Psychiatry, 157, 1960-1963 Grunhaus L, Pande AC, and Haskett RF (1990) Full and abbreviated courses of maintenance electroconvulsive therapy. Convulsive Therapy; 6:130–138 Johnson DAW. (1973) Treatment of depression in general practice. British Medical Journal; ii: 18-20. Linington, A. and Harris, B. (1988) Fifty years of electro-convulsive therapy. British Medical Journal, 297, 1354-1355 Martin BA (1989) Electroconvulsive therapy for depression in general psychiatric practice. Psychiatric Journal of the University of Ottawa; 14:413–417 National Institute for Clinical Excellence (2003). Guidance on the use of electroconvulsive therapy. London: NICE, 2003. www.nice.org.uk/pdf/59ectfullguidance.pdf (accessed 9 Jun 2003). Persad E: (1990) Electroconvulsive therapy in depression. Canadian Journal of Psychiatry; 35:175–182[Medline] Petrides G, Dhossche D, Fink M, and Francis A: (1994) Continuation ECT: relapse prevention in affective disorders. Convulsive Therapy; 10:189–194 Philibert RA, Richards L, Lynch CF, and Winokur G: (1995) Effect of ECT on mortality and clinical outcome in geriatric unipolar depression. Journal of Clinical Psychiatry; 56:390–394[Medline] Prudic J, Haskett RF, Mulsant B, Malone KM, Pettinati HM, Stephens S, et al. (1996) Resistance to antidepressant medication and short-term clinical response to ECT. American Journal of Psychiatry;153:985-92. Rabheru K, and Persad E: (1997) A review of continuation and maintenance electroconvulsive therapy. Canadian Journal of Psychiatry; 42:476–484 Robins LN, Regier DA (Eds) (1990). Psychiatric Disorders in America, The Epidemiologic Catchment Area Study,; New York: The Free Press. Rose D, Wykes T, Leese M, Bindman J, and Fleischmann P. (2003) Patients perspectives on electroconvulsive therapy: systematic review. British Medical Journal;326: 1363-5.[Abstract/Free FullText] Sackeim HA (1994) Continuation therapy following ECT: directions for future research. Psychopharmacology Bulletin; 30:501–521 Schatzberg AF: (1992) Recent developments in the acute somatic treatment of major depression. Journal of Clinical Psychiatry; 53(Mar suppl):20–25 Sobin C, Prudic J, Devanand DP, Nobler MS, and Sackeim HA. (1996) Who responds to electroconvulsive therapy? British Journal of Psychiatry;169:322-8. Stiebel VG: (1995) Maintenance electroconvulsive therapy for chronically mentally ill patients: a case series. Psychiatric Service; 46:265–268 Tharyan P, and Adams` `C`E (2003) Electroconvulsive therapy for schizophrenia. Cochrane Schizophrenia Group. Cochrane Database Systematic Review;(1): CD000076 The UK ECT Review Group (2003) . Electroconvulsive therapy: systematic review and meta-analysis of efficacy and safety in depressive disorders. Lancet;361: 799-808 Thienhaus OJ, Margletta S, and Bennett JA: (1990) A study of the clinical efficacy of maintenance ECT. Journal of Clinical Psychiatry; 51:141–144 Thompson J, Rankin H, Ashcroft GW, Yates CM, McQueen JK, and Cummings SW. (1982) The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline and a combination of L-tryptophan and amitriptyline with placebo. Psychological Medicine; 12: 741-751[Medline].

Media Essays Newspaper Circulation Distribute

Media Essays Newspaper Circulation Distribute Newspaper Circulation Distribute Without doubt, the newspaper is the oldest form of communication. Newspapers are almost as old as the printing press itself. Britains press can trace its history back more than 300 years. A newspaper is a Publication containing news and information and advertising, usually printed on low-cost paper called Newsprint. It may be general or special interest, most often published daily or weekly. A newspaper is one of the most remarkable products of modern society. To gather news from five continents; to print and distribute it so fast that what happens at dawn in India may be read before breakfast in England; to perform the feat afresh every twenty-four hours; and to sell the product for less than the price of a box of matchesthis, were it not so familiar, would be recognised as an astonishing achievement.- From the report of the Royal Commission on the Press ( 1947- 1949). Most nations have at least one newspaper that circulates throughout the whole country: a national newspaper, as contrasted with a local newspaper serving a city or region. National papers are a mixture of national reputation, geographic reach and breadth of content. In the United Kingdom, newspapers can be classified by distribution as local or national and by page size as tabloids and broadsheets. The principal newspapers of England are all nationals edited in London. Wales and Northern Ireland are also dominated by the London-based press; in Scotland, although the London-based press is widely available and widely read, two Scottish newspapers can claim quasi-national status: The Scotsman (based in Edinburgh) and the Glasgow Herald. Because of the small geographical area of the UK, and the good travel infrastructure, there are many national newspapers the main national papers are morning newspapers UK nationals newspapers can be grouped into 10 dailies and 12 Sundays, generally grouped into three, rather historical, groups mass market tabloids, or red-tops (eg The Sun), middle-market tabloids (eg the Daily Mail), and quality broadsheets (eg The Times). Most UK newspapers are now tabloid-sized. The provincial press (regional and local) contains mainly local news. There are 21 provincial newspapers still published which were founded before 1776. Berrows Worcester Journal (around 1690) and the Lincoln, Rutland and Stamford Mercury (around 1695) are the oldest. These pre-date the surviving national papers, the Times (1785) and the Observer(1791). There are about 1500 regional newspapers in the UK By 1945 the national newspapers sold almost twice as many copies as the provincials (regional papers). In 1947 several provincial papers rivalled that of Fleet Street in London. Fleet Street in London had been the centre of the British print industry almost since its origins in the 15th Century; and throughout the 20th Century the street and its newspapers had become dominated by charismatic proprietors and increasingly powerful unions. Sales continued to rise among all types of newspaper until the early 1950’s, despite post-war restrictions on paper; papers could make good profits from the big demand for advertising space. Total sales of all national daily newspapers reaches all-time peak of 17 million copies per day, in 1950. 1957 was the peak year for total national sales, before the competition from ITV (Independent Television) advertising began to have a strong effect. Overall circulation growth, from the 1940s to the 1960s The next 35 years saw a drop of one-third in sales. Total newspaper sales slumped between 1950 and 2000, a trend that was especially marked on Sundays. The 1951 average daily sales were 16.62 million copies for the national morning press, 30.59 million for the national Sunday press, 2.94 million for the provincial morning, and 6.84 million for the provincial evening. The corresponding figures for 1994 were 13.58 million, 15.84 million, 1.88 million, and 4.50 million (Seymore-Ure). Seymore-Ure pointed out that the number of provincial morning papers fell between 1945 and 1995 from 29 to 18, with most closures happening in the 1960s. The number of provincial evening papers, by contrast, remained stable, with 76 titles in 1945 and 72 in 1994. (This apparent stability, however, masks the fact that there were 23 new launches during that period offset by 27 closures.) The following tables show the circulation of national newspapers in 1961, 1966, 1975, 1980 and 1984 The economic framework of the British press changed dramatically between 1980 and 2000. As in many other developed nations, in Britain the most salient qualities of the presss economic framework are concentrated, international, and cross-media ownership patterns and the increased intensity of economic competition that these factors entail. In addition, newspaper finances are organized on what Independent editor Simon Kelner calls an uneconomic basis, largely because of circulation wars. Finally, all newspapers, but particularly the broadsheets, heavily depend on advertising revenues. In 1980, the industry appeared to be in terminal crisis, and many newspapers appeared unlikely to yield profits in the near future. As of the early 2000s, this was no longer true because newspaper economics were transformed during the 1980s. Fleet Street was traditionally the home of the British press up until the 1980s. Over the years, Fleet Street had acquired a reputation for poor labour relations and had a history of industrial disputes. Presses were antiquated, resulting in the loss of many newspaper runs. Between 1983 and 1985, for example, there were 60 plate breaks at The Sun’s headquarters in Bouverie Street, where one press had been in use since 1936. For most of the 20th century, Fleet Street had been a microcosm of all that was worst about British industry: pusillanimous management, pig-headed unions, crazy restrictive practices, endless strikes and industrial disruption, and archaic technology. In 1986 Rupert Murdoch secretly moved his newspaper business overnight to a fortress-like plant in Wapping, east London, sparking a bitter and doomed year-long strike by printers which revolutionised labour relations as well as the newspaper industry. the newspaper industry has been transformed in the last 50 years, most notably since the Wapping revolution in 1986. Nevertheless the phrase Fleet Street is still used to refer to the British national press at large. Even though the last major British news office, Reuters, left in 2005, the name Fleet Street has continued to serve as a shorthand term for the British national press. The growths of advertising and changes in production have enabled papers to expand enormously in size and to publish in colour. Competition has forced closures but new titles have taken their places and there are roughly the same numbers of titles available now as there were in 1945. (Incidentally, there are also roughly the same numbers of owners). Seymore-Ure pointed out that the number of provincial morning papers fell between 1945 and 1995 from 29 to 18, with most closures happening in the 1960s. The number of provincial evening papers, by contrast, remained stable, with 76 titles in 1945 and 72 in 1994. (This apparent stability, however, masks the fact that there were 23 new launches during that period offset by 27 closures.) Trends in national and local newspaper circulation/distribution for the years 1980 to 2002 is shown in Figure 3.1. The long-term trend in the overall volume (circulation and distribution) of newspapers is downwardsTrends in national and local newspaper circulation/distribution over the last 26 years are summarized in Figure 4.1. The total circulation of national newspapers has shown a slow decline and, within the total, the circulation of Sunday newspapers has declined more rapidly than that of daily newspapers. The newspaper industry survived competition from 20th-century technologies, especially radio and television, but 21st-century developments on the Internet are posing major threats. The survival of the nationals is remarkable in view of the greater choice of alternative media, especially television / video / DVD and the Internet. It shows how they have been able to adapt to changing trends and technology to maintain appeal, both form advertisers and the public. Newspapers are now going online as well with their own websites and with the ever increasing pressure to reduce waste in the UK and paper and ink cost rising it will not be far off when all newspapers will become electronic only using the internet and e-paper as ways to publish. This rise in costs made one UK media group to publish the UK first online only recognized local newspaper. It was the Southport Reporter and it went online fully in 2000 as an online only publication from day one. This type of local newspaper could spell the move for all local newspapers in the UK to publish only on the internet. Also in the perceived gap left by local newspapers, many of which have closed district offices in smaller towns, local news websites are emerging in the form of webforums and blog sites Newspapers are big business and many national and local dailies and Sunday titles now have websites to support their paper offering the latest news and headlines online. The internet is a great place to keep up to date with your favourite newspaper whether tabloid or broadsheet and as well as reading the latest news you can also enter competitions, take part in discussions and read the classifieds online. A relatively recent phenomenon in the newspaper industry has been the free morning papers. Free weekly papers are fairly common, supported by advertising. The United Kingdom possesses one of the most universally respected and widely read national presses. The history of newspapers in the UK is a fascinating story and it is impossible to find comparable sizes with the newspaper press in my country, Cyprus. The media in Cyprus functions freely and independently without intervention or control by any state authority. Freedom of the press is enshrined in the Republics constitution. There are no media ownership restrictions in relation to the print media. Currently there is a relatively developed press with dailies, weeklies and periodicals of varying frequency, expressing a broad spectrum of ideologies and covering a wide variety of subjects Since the first newspaper was published in 1878, more than 400 newspapers and periodicals have been published mainly in Greek, but also in Turkish, Armenian and English, for (and by) the respective communities and minorities. The development the Cypriot media has shown great progress, with all newspapers having switched to computerisation, and adopting up-to-date printing techniques. However, the small size of the population defines some of the barriers imposed on all the aspects of organisational structure and outcomes of the press. Since the amendment of the 1989 Press Law makes the accessibility to information on newspaper circulation non–obligatory by the distribution agencies, no official data is available on circulation. Some basic data for press in UK and Cyprus are shown in the table below.

Comparing Characters in the Coen Brothers Miller’s Crossing and Willia

Comparing Characters in the Coen Brothers' Miller’s Crossing and William Kennedy's Legs The movie Miller’s Crossing and the novel Legs by William Kennedy have two characters that have a special quality, which adds dramatically to their characterization. The main character of Miller’s Crossing, Tom Reagan, and the main character from Legs; Jack Diamond shares many similar traits and symbolic equivalence. In particular they had an item that they wore or carried, and this item had the ability to show what is going on inside the character’s mind. Not only did the items have the ability to tell what was on their mind; it also has the ability to foreshadow. At times in the novel where their mind/conscience was tested, the use of their items determined the outcome. The body can not live without the mind, so it is important for the characters to remain close to these items that symbolize their mind or they will surly die. Tom Reagan had a dream in which his hat fell off his head and the wind blew it away. He did not run after the hat in the dream. However in reality he kept the hat close to him at all costs. The dream is the opening to the movie and is explained during a conversation with Verna. During the movie he is seen with the hat and without. The trend his hat wearing follows with when engaging in sex it is off, and actually gets its own scene of being thrown on to a chair or something of that nature. For the most part, it is also seen without his hat when somethin...

Blake Coleridge Swift :: essays papers

The Symbolism of Christ William Blake, Samuel Taylor Coleridge, and Jonathan Swift were very different writes but are bound by basic Christian beliefs. In their writings there are strong references to Christ and symbolic images of Him. Blake writes "The Lamb" as a symbolic representative of Christ. Coleridge uses many form of religious symbolism in his poem "The Rhime of the Ancient Mariner", but the thing that stands out the most is how the albatross represents Christ. Swift writes in "Gulliver's Travels", of a man named Pedro de Mendez who is a savior to Gulliver. These three authors show us how Christian views and Jesus are a part of life not just in the Bible but also in current society. Blake uses our questions about faith to emphasize the importance of Christ in our lives. Blake emphasizes the connection of which the child is naturally aware, when he writes, "I, a child, and thou a lamb, We are called by his name"(p.1289). The tone, however, is the genuine simplicity of a child's speech. The first verse is a series of questions addressed to the lamb, which represents Jesus. The second stanza begins with the child being able to answer those questions. Blake writes, "Little Lamb, I'll tell thee"(p.1289). Meaning that the child understands Christ being the savior. These questions are asked purely for the satisfaction that it gives the child in answering and to show the child's understanding of God. Blake shows Christ in a way that is innocent like the child. Blake writes this poem using the example of the lamb found in nature to represent Christ and uses the child to represent man trying to understand God. Blake uses the lamb to represent Christ in nature in the same way that Coleridge uses the albatross to represent Christ in nature. Coleridge uses religious and natural symbolism, which correspond with one another and play the most important roles in this poem. Although there are many different interpretations of this poem, one idea that has remained common throughout the poem is that of the religious symbolism present. Especially that of Christ and his ability to save, which was present throughout this poem. The symbolism is that of the albatross. The albatross saves the Mariner for bad weather and keeps the sailors in

Heroism Redifined: Lord of the Rings

Heroism redefined Lord of the Rings J. R. R. Tolkien Tolkien’s Lord of the Rings trilogy, offers the reader a truly compelling picture of the world of Middle-earth. The author, in great detail, depicts a complex reality which abounds in a whole variety of creatures, cultures, languages and histories. If we take a closer look on Tolkien’s masterpiece we will easily notice a complexity of themes, motifs, symbols which add to the semantic richness of the text. It is necessary to mention that Tolkien was considerably influenced by the literary tradition.Fascinated by literary genres such as a heroic epic, a chivalric romance or a fairy tale Tolkien skillfully weaved many characteristic conventions of these genres in Lord of the Rings. Among many other features drawn from the literary tradition the theme of heroism occupies a prominent position in Tolkien’s trilogy. On the one hand Tolkien follows a well known model of a courageous epic hero, but on the other hand he operates with the theme in an innovative way.Apart from a careful depiction of a well known image of noble heroism typical of great figures of historical significance such as Aragorn, the novel surprisingly offers a completely new image of heroism which is represented by small hobbits. Providing at the same time two parallel faces of the concept, Tolkien significantly changes and challenges the traditional meaning of heroism and, as a consequence, significantly enriches the literary tradition. A significant part of the trilogy is devoted to the deeds of great Men such as Aragorn.Drawing extensively on the tradition of heroic epic and chivalric romance Tolkien presents a powerful image of a knightly hero full of noble virtues. Aragorn is a â€Å"born hero† – a true heir to the throne of Gondor, â€Å"born to achieve great deeds in his time† (Zimmer Bradley 83). He is a courageous man of action, endowed with physical strength, who combats evil, brings order and re stores peace. Respected and admired by other characters, Aragorn is a hero of indomitable spirit who never commits mistakes and always serves as an epitome of bravery and virtue.Although Aragorn is one of the most prominent characters in the trilogy, the most important mission, to destroy the malevolent Ring, falls upon a completely different figure. The future of the whole Middle-earth does not depend on noble Elves or brave Men or even strong Dwarves but lies in the hands of the seemingly weak and insignificant hobbits (Gulisano 131). Tolkien’s surprising choice falls upon small and rather funny creatures which, in fact, do not really have any particular achievements. Though small and weak, it is Frodo and his faithful servant Sam who are burdened with an extremely difficult task.Contrary to all expectations Frodo is chosen to carry the ring: â€Å"You may be nobody in particular in yourself, yet for some inexplicable reasons, through no choice of your own, the Ring has co me into your keeping, so that it is on you and not on Gandalf or Aragorn that the task falls of destroying it† (LotR, I, 284) At first the small hobbit is full of doubts. He is neither a great wizard like Gandalf to plan the strategy of war against Sauron, nor Aragorn, an outstanding warrior who is destined to be the leader of the army of Gondor. Yet, the Ring has clearly chosen the hobbit.Unlike other significant figures of the trilogy Frodo has â€Å"heroism thrust upon him† (Zimmer Bradley 84). In contrast with Aragorn, Frodo is not born to gain glory, yet through experience and ability to endure hardships he finally rises to heroism. Though hesitantly, Frodo humbly accepts the task: â€Å"’I will take the Ring,’ he said, ‘though I do not know the way. †(LotR, I, 284) Even though Frodo would rather â€Å"stay at home than risk my life on the very slight chance of winning glory† (LotR, I, 284) eventually he resigns from his own comfor t and safety and full of hope takes up a dangerous journey to save the world of Middle-earth.During the journey he often trembles, regrets his lot and wonders why he was burdened with such an enormous load, still he manages to remain faithful to the mission till the very end. Deciding to carry the Ring Frodo starts to follow a path full of sacrifices and pain. As the Ring bearer he is forced to put up a constant resistance to his own ambitions and desire for power (Bramlett 70). Frodo undeniably becomes a hero of the story. Though he actually fails at the very last moment of his mission – he yields to the temptation and wants to posses the Ring for his own- the quest is still completed and Frodo returns covered in glory.However, as Frodo rather reluctantly accepts the heavy burden of the unusual quest there is another character who follows the same path on his own free will and without complain. Sam, Frodo’s devoted servant, becomes an unrecognized hero of the story, w ho bravely accompanies and supports Frodo till the very last stage of their journey. He is the one who cares even less for glory and heroic deeds. His only wish is to protect his master and follow Frodo even if it means death. (Zimmer Bradley 84) Throughout the story Sam undergoes perhaps the most significant development.He starts out as a minor character. Even Sam describes himself as a â€Å"luggage in a boat†. He is a rather comic and childish character hardly adequate for such a grand enterprise (Purtill 89). Although at first he displays a sort of a limited perception, which is not unusual for a hobbit – he can be very practical at times – â€Å"his mind was slow but shrewd† (LotR, II, 625). In the course of the novel Sam gradually takes more and more responsibility and acquires such importance that without him the quest would be unfulfilled.Sam seems to be a typical hobbit servant, yet Tolkien endows him with certain features which differentiate him from the traditional literary servants. This peculiar hobbit is endowed with a sort of curiosity which is quite unique for a hobbit. He is fascinated with Elves and dreams about an opportunity to meet them one day. He is much more open to the new ideas and experiences than a typical hobbit (Purtill 90-91). What is more, Sam is also aware of his own limitations. He usually depends on the opinion of others, as he is not able to decide on grand matters: â€Å" I hope that the master will think it out carefully.He’s as wise as any, but he’s soft-hearted, that’s what he is. It’s beyond any Gamgee to guess what he’ll do next† (LotR, II, 625). Moreover, Sam is also endowed with a significantly greater independence than a typical servant (Purtill 90-91). When Frodo decides to abandon Shire alone, without any support of his friends, Sam reveals Frodo’s plan to Pippin and Merry in order to protect his master. On another occasion he disobeys Ar agorn and secretly follows Frodo on the further journey without informing the rest of the fellowship. When his master comes at stakeSam is able to do absolutely anything. Above all else, Sam characterizes an enormous devotion, selflessness and love for Frodo. His care for his master is truly incomparable: â€Å"It is hardly possible to separate you form him [Frodo], even when he is summoned to a secret council and you are not† (LotR, I, 284). Throughout the story signs of Sam’s love for Frodo can be frequently encountered: â€Å"Sam came in. He ran to Frodo and took his left hand, awkwardly and shyly. He stroked it gently and then he blushed and turned hastily away. † (LotR, I, 237) His love for Frodo is immense.He is totally selfless and ready for sacrifices for his master. His devotion is best portrayed in the last stage of the quest, when the fellowship is broken and the two hobbits continue their dark journey to Mordor all by themselves. As Frodo, due to the malevolent power of the Ring, gradually becomes both physically and mentally weaker, Sam becomes an actual guide and protector. He deals with the practical aspects of the journey and combats various obstacles throughout the way. Gradually Sam becomes less comic and much more doughty.Along with their approaching the gates of Mordor Sam is significantly gaining importance and becoming a truly mature character. When the two hobbits are just one step form completing their mission of destroying the Ring everything is almost ruined due to Gollum’s betrayal. Sam and Frodo are attacked by a giant spider Shelob. Frodo is wounded in the combat and Sam is convinced that his beloved master is dead. Though terrified and totally miserable he does not turn back. He feels an obligation to continue the quest. As soon as he realizes that his master is still alive he rushes to rescue Frodo.As for the time being he carries the Ring, and just like Frodo and others he is subject to the great temp tation. On this stage of the journey ominous power of the Ring is the most dangerous and the temptation is respectively stronger. The Ring plants in Sam visions of himself as a great warrior: Samwise the Strong. Hero of the Age, striding with flaming sword across the darkened land, and armies flocking to his call as he marched to overthrow of Barad-dur. And then all the clouds rolled away and the white sun shone, and at his command the vale of Gorgoroth became a garden of tress and brought forth fruit.He had only to put on the Ring and claim it for his own and all this could be. In that hour of trial it was the love of his master that helped most to hold him firm; but also deep down in him lived still unconquered plain hobbit-sense: he knew in the core of his heart he was not large enough to bear such a burden, even if such visions were not a mere cheat to betray him. The one small garden of a free gardener was all his need and due, not a garden swollen to a realm; his own lands to use, not the lands of others to command. And anyway, all those notions are only a trick,† he said to himself. (LotR, III, 880-881) Sam is saved by his great love for his master and his extraordinary common sense combined with modesty and humility. Deep down he realizes that the vision of himself as a great warrior is ridiculous. The illusion, in fact, does not even constitute a dream that he aspires to. Sam is aware that he is not meant to be a grand hero. He knows perfectly well that his true vocation is to be a humble servant and this is exactly what makes him happy.The great trial Sam is subject to requires from the little hobbit a great deal of common wisdom and strength. Sam who at first seems to be a rather weak and at times an irritating character demonstrates strength which can be compared to the one of Galadriel or Gandalf. He is not only able to resist the temptation, but also to return the Ring to Frodo without hesitation. Sam displays enormous grandeur. At this poi nt he presents more heroism than for instance one of Tolkien’s classic heroes Bromir for whom temptation turned out too great to resist.As one of the critics rightly suggests: â€Å"He [Sam] exhibits concrete wisdom rather than abstract reasoning, finds relationship more important than objects, is supportive, nurturing, and self-sacrificing. † (Purtill 95) Tolkien seems to suggest that these are the features that account for true heroism. Thanks to Sam the quest can be completed. He supports Frodo emotionally till the very end and even literally carries him to the Mount Doom when the latter is physically unable to reach the destination.At the last stage of their journey Frodo is so debilitated by the power of the Ring that he is practically unable to think clearly. All his powers are focused on resisting the temptation of putting the Ring on the finger. Form now on the success of the mission depends on Sam. At this point, the development of Sam is clearly visible. He r ealizes that the mission has to be completed, that they must do everything in their power to end the task. He knows that they have reached a point from which there is no return.Though, he is convinced that there is no hope for them and they are doomed to death, he still manages to follow once entrusted mission. Sam becomes an undeniable hero of the story. Though he does not acquire a sort of glory that Pippin and Merry achieve on a battlefield, still he does acquire the necessary virtue and wisdom to eventually become the leader and the ruler of the hobbits – the Mayor of the Shire. Lord of the Rings, among many other beautiful and complex images, provides one of the most extraordinary and memorable depictions of heroism.Greatly influenced by the literary tradition, Tolkien both follows and modifies the concept of heroism and consequently provides the reader with two faces of this traditional notion. Tolkien emphasizes a number of features characteristic for a heroic epic and a chivalric romance. Features such as courage, fortitude, nobleness and honour can be found in several prominent figures in the novel. One of the most distinct examples, personifying all these virtues, is to be found in Aragorn. He is a classic hero, descendant of the line of kings, great warrior, the one who restores peace and brings back justice.Aragorn is the rightful heir to the throne who bravely struggles with the forces of evil and at the end triumphantly comes back to his kingdom and marries Arwena – Elf princess. Aragorn embodies all features typical of a truly heroic character in the traditional sense of the concept. However, the author does not only provide the reader with a well known model of heroism based on strength and courage. The novel presents a new surprising aspect of this concept and at the same time establishes a modern, innovative definition of the notion.In the course of the novel the reader is exposed to a very peculiar juxtaposition of characters. Next to such heroic figures as Aragorn Tolkien places queer, little, funny hobbits. It is Frodo and his devoted servant Sam who become true heroes of the story. If it had not been for their simplicity, ordinariness, lack of violence and ability to self-sacrifice the whole Middle-earth would be seized by the forces of evil. Frodo and Sam represent ordinary, insignificant figures who through their selflessness, loyalty and love for friends are brought to the heroic glory.Realization of their own limitations, common sense and modesty prevents them form mistakes that other characters are prone to commit. Hobbits represent the kind of courage exhibited by an ordinary person, who rises to heroism in the face of challenge (Purtill 77). Their courage is moral as well as physical. On their quest they have to face both mental torments, such as resisting the power of the ring and fear of enemies, and physical hardships, like lack of food and water, exhaustion due to the strenuous journey and w ounds they receive during combats.Tolkien presents the reader a new definition of heroism which is based on love and humility and can be achieved not exclusively by the chosen, great figures but by everybody. Heroism that Tolkien offers in Lord of the Rings is within everybody’s reach, no matter how small and weak and ordinary they would be (Gulisano 132). Juxtaposing the two kinds of heroism Tolkien stresses the fact that both can harmoniously coexist and are complementary: â€Å"without the high and noble the simple and vulgar is utterly mean; and without the simple and ordinary the noble and heroic is meaningless† (Tolkien in: Purtill 60).

America Needs It Nerds Essay

People around the world need to open there eyes to what intellectual individuals can do for the world rather than only idolizing the celebrity’s and athletics. â€Å"America Needs Its Nerds† by Leonid Fridman talks about how in our society that we idolize celebrity’s and athletics more than intellectual people. Friedman effectively persuades an audience of intellectuals to value their academic prowess with a logical definition of â€Å"Geek,† comparisons that highlight the extent of the issue, and rhetorical questions that encourage actions. In the beginning of his essay, Friedman defines â€Å"geek† to catch the reader’s attention and offend them, so that they will take action. He cites the Webster’s New World Dictionary defining â€Å"geek† as a street performer who shocks the public by biting off the heads of live chickens.† The archaic term was used derogatorily about geeks. Today, intellectuals would be offended by th is definition, and it would ultimately catch their attention. He intends that intellectuals, when learning this fact, will become offended, read the article, and then take action to resolve the injustice. Halfway through his essay, he compares the United States with East Asia and the intellectuals at Harvard to athletes in order to show the dire need to take a stand. He compares to the intellectuals that live in the United States and the intellectuals that live Asia. who ironically do not feel comfortable expressing their own intellectual self’s to the world because the chance of embarrassment. In the last sentence in the third paragraph â€Å"Nerds are ostracized while athletes are idolized.† this quote is explicitly trying to inform the reader that intellectual individuals should be more idolize as well as any other athlete or celebrity. At the end of his essays, he uses a rhetorical question to get the reader to think about how intellectualism should be valued and what they are going to do to change society’s fault. To prove his point, Fridman asked, â€Å"How long can America remain a world- class power if we constantly emphasize social  skills and physical prowess over academic achievement and intellectual ability?† He asked us this show the necessity of knowledge we need to strive and stay a main power in the world. Present day, we emphasize the need for social skills an America rather than intelligence, and it will definitely catch the citizens of America who still want to be a striving country. Fridman asked this question to the intellectuals of the United States to evaluate the current situation we are in and ultimately speak up, take a stance and make knowledge the main focus of our nation rather than social skills.

Tobacco Industry: Its Significance in US Economy

The United States is the world†s second largest tobacco grower. Thus, tobacco is an important cash crop and the cigarette manufacturers play a very important role in the U. S economy.(7:2) Approximately 500,000 Americans die every year as a direct result of smoking (1:66). As the U. S. population becomes more health conscious, the number of smokers is decreasing every year. However, the tobacco industry has remained prosperous due to the continuing demand of millions of smokers still present in the U.S.A and other places like Asia, Russia and Eastern Europe.(7:2) The tobacco industry has never before publicly admitted to a direct connection between smoking and lung or heart diseases (7:2). Since 1954, 825 cases have been filed against cigarette companies demanding compensatim. Out of this only 22 have gone for trial, three of which resulted in partial victory.(1:66) Marketing can be defined as the process by which goods and services are sold and purchased. It also includes functions like, advertising, mail-order business, public relations and the like. The main goal of marketing is to acquire, retain and satisfy customers.(2:1) Cigarette companies seem to understand the above mentioned definition perfectly. They carefully follow management's wishes about promotion of cigarettes. Like any other firm, cigarette manufacturers try to supply, design and produce products that will satisfy consumer needs.(4:4) However, critics complain of the effects of marketing tobacco on society. Advertisement of brand names like Marlboro, Lucky Strike etc. are harmful for children since they generally glorifies smoking. Cigarette firms have been criticized for designing and promoting brands that target the special tastes of working persons, African -Americans etc. (4:4). Thus, critics feel that for tobacco no marketing tool that increases profit or marketing share should be used.(4:11) No matter how unhealthy cigarettes are, they still are legal. Therefore, tobacco companies have a right to market their products. After all, we could categorize tobacco marketing as â€Å"Misplaced Marketing†.(4:4) The major tobacco companies of U.S.A were headed for trouble this year. In early 1997, the smallest tobacco company. Liggett Group agreed to a wide-ranging settlement of health-related lawsuit and admitted publicly that tobacco causes cancer, is addictive and is â€Å"marketed† to teens. This admission ended up being a big problem for other's tobacco companies.(6:3) On 27 June 1997, the companies: Philip Morris RJR Nabisco Holdings, B.A.T Industries, Brown & Williamson and Loews Corp. reached an agreement with the attorneys -general of nearly 40 American states. This settlement resulted in the tobacco industry changing its own marketing rules.(5:23) 1.Financial implications of the settlement The above mentioned settlement calls for the tobacco industry to start an annual payment of $10 billion (eventually rising to $15 billion) to compensate states for smoking-related health costs and to pay people who successfully file for damages. The five tobacco companies must also finance anti-smoking medical and educational research, in order to prevent youths from smoking.(5:23) The cigarette companies also have to pay $60 billion in damages as a form of punishment. Besides all this, the industry will face additional penalties if the number of teenage smokers does not decrease by 50% in seven years.(5:25) This settlement, is set to drastically change the marketing program of the tobacco companies. From now on, human or cartoon figures will not appear in cigarette advertisements. That is, the advertisements will have to consist of words only (5:23). Tobacco advertisements are also banned from billboards, stadiums and the Internet. They are also prohibited from advertising in films or in theaters. The settlement also ends the use of all cigarette vending machines (5:24). Tobacco companies cannot use their brand marks on T-shirts, caps and other promotional free gifts (5:25). The agreement would give the Food and Drug Administration (FDA) authority to regulate tobacco products. In addition, cigarettes would come with tough new warnings such as ‘smoking causes cancer† and ‘smoking can kill you†.(5:24) The above mentioned changes will alter the marketing techniques of tobacco as never before and thus, the tobacco companies have to adapt to a new way of doing business. The tobacco industry has been hit hard by the settlement it signed. But it does not mean the end of this multi-billion dollar business. Let us have a look at some new and upcoming ways in which tobacco is sold. Even if the tobacco industry faces a gloomy business future in U.S.A it can earn a lot by selling more cigarettes in developing countries from the Middle East to South East Asia INTERFERENCE With practically no government interference and millions of smokers, tobacco companies could even earn profits from brands that are dead in USA. They can also expect bigger profits by trying to change local customs. For example: In Japan, the number of women's smokers is on the rise, after tobacco promotions persuaded society not to prohibit women smoking.(3:34) As the numbers of public outlets for cigarettes decrease in the future a mail-order tobacco business could be created and this could be even more profitable. Being good database marketers, the databases of the tobacco industry will act as a communication and distribution channel. RJ Reynolds has already taken a lead in this type of marketing.(3:34) From now on, tobacco companies will have to do most of their advertising in adult magazines. They might even end up opening cigarette only retail stores, as another way to supply smokers. As marketing of tobacco has become more challenging than ever before, it will remain a powerful part of management for the tobacco companies.(5:27) Tobacco firms have always shown enthusiasm in marketing their products. However, they have to face constant criticism of their marketing techniques. Critics feel that tobacco marketing is an example of misplaced marketing. The recently signed agreement between leading cigarette companies and nearly forty American states, will lead to radical change in the marketing field. Besides financial penalties, cigarette companies have also agreed to restrict and reshape their promotional strategies. In the future, tobacco firms will have to come up with new ideas to market cigarettes and probably will have to increase their foreign sales. Basically, cigarette manufacturers have to right to promote and advertise their products so long as they are legal. Thus, clearly tobacco will be marketed, in some form or the other, for years to come.