Experienced Stigma in Severe Mental Illness

Experienced Stigma in Severe Mental Illness Exploring experienced stigma in severe mental illness – contributing to validation of a psychometric instrument Luà ­s Pedro Santos de Mendonà §a Table of contents (Jump to) Acknowledgements   Acronyms 1 Introduction 1.1 About stigma 1.1.1 Why to focus on stigma? 1.1.2 Evolution of the concept 1.1.3 Development of stigma 1.1.4 Different concepts of stigma 1.1.5 Correlates and consequences of stigma 1.2 Stigma research 1.2.1 Instruments to measure stigma categories and criteria for psychometric properties 1.2.2 Perceived stigma 1.2.3 Self-Stigma 1.2.4 Experienced stigma 1.2.5 Stigma studies in Portugal 1.3 Consumer experiences of stigma questionnaire (CESQ) 1.3.1 Main research with psychometric data involving CESQ. Acronyms CASS Clinician Assessment of Schizophrenic Syndromes CAT Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment CESQ – Consumer Experiences of Stigma Questionnaire CFA – Confirmatory Factor Analysis CI – Confidence interval CRPD Convention on the Rights of People with Disabilities DISC – Discrimination and Stigma Scale DSSS – Depression Self-stigma Scale EDS – Experiences of Discrimination Scale EFA – Exploratory Factor Analysis FBS Frankfurter Befindlichkeits-Skala GAF Global Assessment of Functioning GAS Global Assessment Scale HIV/AIDS – Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome HSRS Health Sickness Rating Scale HSS – Stigmatisation Scale ICCPR International Covenant on Civil and Political Rights ICD – International Classification of Diseases ISE – The Inventory of Stigmatising Experiences ISMI – Internalised Stigma of Mental Illness KMO – Kaiser-Meyer Olkin statistic M – Mean MIDUS – MacArthur Foundation Midlife Development in the United States MSA – Measures of sampling adequacy MSS – Maristan Stigma Scale NAMI National Aliiance for Mentally Ill PA – Parallel Analysis PAF – Principal Axis Factoring PANSS – Positive and Negative Syndrome Scale PCM – Polychoric correlation matrix PDD – Perceived devaluation and discrimination scale PD-S Paranoid-Depresività ¤ts-Skala QOLI – Quality of Life Interview RES – Rejection Experiences Scale RMSEA Root mean square error of approximation SD – Standard deviation SESQ – Self-esteem and Stigma Questionnaire SFS – Social Functioning Scale SLDS – Satisfaction with Life Domains Scale SRER – Self Reported Experiences of Rejection SS – Stigma Scale SSMIS – Self-stigma of Mental Illness Scale UDHR Universal Declaration of Human Rights WHO – World Health Organization WLSMV Means and Variance adjusted weighted least square 1 Introduction 1.1 About stigma 1.1.1 Why to focus on stigma? Stigma is defined as a sign of disgrace or discredit. Authors agree it is a powerful negative attribute, having its impact on all social relations. Stigma is present everywhere in our society. It affects different characteristics in people, ranging from sexual orientation to HIV/AIDS, several medical disorders, gender, race, unemployment or obesity. However, it is in mental health disorders that stigma has its most devastating impact, although not always obvious. Discrimination, the enactment of stigma, appears closely associated to it. While stigma lies at the base of discrimination, discriminatory practices also promote and reinforce stigma. Discrimination is also about the conditions in which patients live, mental health budgets and the priority which we allow these services to achieve.1 In other words, stigma and discrimination lead to social exclusion – a triad that is a key determinant of mental health. Stigma and discrimination are violations of human rights. Intention and commitment to fight stigma are present in the spirit of legally binding treaties such as the Universal Declaration of Human Rights (UDHR)2 , International Covenant on Civil and Political Rights (ICCPR)3, International Covenant on Economic, Social and Cultural Rights (ICESCR)4 and Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT)5, and are explicitly mentioned on the Convention on the Rights of People with Disabilities (CRPD)6. CRPD actually demands that signatories ‘take all appropriate measures to eliminate discrimination on the basis of disability by any person, organisation or private enterprise’, and to ‘adopt immediate, effective and appropriate measures †¦ to combat stereotypes, prejudices and harmful practices relating to persons with disabilities †¦ in all areas of life’.6 From the part of the World Health Organization, tackling stigma, discrimination and social exclusion is a major concern of the General Assembly, with of the General Assembly, with reflection in the WHO Mental Health Action Plan 2013-20207. At regional level, in European Union, commitment to fighting stigma and discrimination is a consequence of signing treaties like European Convention on Human Rights, European Social Charter, European Convention on the Prevention of Torture and Inhuman or Degrading Treatment or Punishment and, specifically, Recommendation Rec(2004)10, of the Committee of Ministers to member states, concerning the protection of the human rights and dignity of persons with mental disorder. Still at regional level, and in line with WHO Mental Health Action Plan, stigma and discrimination is one of the main action areas of European Mental Health Action Plan.8 At national level, fighting stigma, discrimination and social exclusion is a component of policies, plans and programs worldwide. In a time when quality mechanisms tend to be implemented into healthcare systems, there is also a trend to develop parts of quality standards that have statements on fighting stigma at a local level. NICE quality standards are a good example9. To implement stigma into quality standards is, by itself, a strategy to fight it, by turning each service user in a potential advocate, as Byrne noted1. Therefore, there is the need to foster development of indicators that can be used regarding mental illness stigma. 1.1.2 Evolution of the concept Stigma is a word that has its reminiscences in the Greek civilization. Stigma were body marks that were intentionally applied to individuals- the stigmatized that carried unacceptable moral or individual traits, as compared to standards in that society. Christians absorbed the concept, adding two other meanings to those body marks – to indicate a holy grace or to indicate a sign of deformity/physical disease. Anyway, even in early days of Christianity, stigma implied, from the social point of view, firstly, â€Å"imputing a meaning into something† even if it did not have that meaning, and, secondly, dealing with deviations to a social norm. Goffmann10 was the first author to theorize stigma. To Goffmann, stigma is the result of a gap between perceived attributes and stereotypes. It is a matter of perspective, not reality. it is â€Å"in the eye of the beholder†. Stereotypes are selective perceptions that categorize people, and that exaggerate differences between groups (‘them and us’) in order to obscure differences within groups.11 He defines three types of attributes: Body(physical) – e.g. visible deformities in the body, deformity caused by physical disease Character (personal) – e.g. mental illness, criminal conviction Tribal (Social) – e.g. stigma of one group against another. Goffmann also distinguishes between â€Å"discredited† and discreditable†. Those concepts were further developed by Jones et al.12 , who proposed six dimensions of stigma: Concealability indicates how obvious or detectable the characteristic is to others. Course indicates whether the stigmatizing condition is reversible over time. Irreversible conditions provoke more negative attitudes than others. Disruptiveness indicates the extent to which a mark blocks or diminishes interpersonal interactions. Aesthetics reflects what is attractive or pleasing to ones perceptions. When applied to stigma, it means whether a mark provokes a reaction of disgust. Origin refers to how the condition came into being. Perceived responsibility on the conditions will carry more negative attitude. Peril, refers to feelings of danger or threat induced in others. This can mean physical threat (as in â€Å"contamination†) or simply uneaseness. According to Byrne, stigma is connoted with a few negative attributes. Shame is its first expression, resulting from perception as indulgence or as a weakness, despite centuries of knowledge, media campaigns and â€Å"the decade of the brain†. Blame is also an attitude that appears associated to shame.1 Maintaining secrecy is the maladaptive way some people find to cope with shame, but it can lead to deleterious consequences. 1.1.3 Development of stigma Negative attitudes towards people with mental illness, according to Byrne 1, exist since playschool and extend into early adulthood. This is suggested by several studies: Weiss13 examined a cohort of children of elementary school age and confirmed the prejudices eight years after; Green14 compared attitudes between several studies using the same measures, that ranged over 22 years, and found consistent results indicating community had the same negative attitudes. This objects the common belief that with increased scientific knowledge about mental illness, stigma would tend to disappear. 1.1.4 Different concepts of stigma Stigma concept has evolved in the last fifteen years. Link and Phelan have added discrimination to Jones’ original dimensions.15 Still, in 2001 the same authors present two major challenges for the concept of stigma. The first challenge is that researchers who research stigma do so from their own vantage point, giving priority to their scientific theories and research techniques rather than words and perceptions about people they study, which lead to misunderstanding of the experience of people being stigmatized and to perpetuation of assumptions that are unsubstantiated. The second challenge is about individualization of stigma and the fact that in research it tends to be considered as an attribute or a mark of the individual rather than a designation or tag that others affix to a person. Thus, Link and Phelan propose a definition of stigma based on a convergence a few components: Distinguishing and labelling human differences – oversimplification of salient differences between human beings occurs, with further labelling of individuals. Associating human differences to negative attributes – Labels previously mentioned are associated to negative sterotypes, as previously described by Goffmann. Categories and stereotypes are often â€Å"automatic† and facilitate â€Å"cognitive efficiency†. Separating â€Å"us from them† – Social labels connote a separation between the group that stigmatizes (â€Å"us†) and the group that is being stigmatized (â€Å"them†). For example, some people talk about people who have schizophrenia as being â€Å"schizophrenics†. Status loss and discrimination – stigma leads to loss of status in social hierarchy, and to discrimination, both at individual and at structural levels. Link and Phelan also emphasize that stigma is a matter of power – certain groups in the society have the power to stigmatize. Stigma is also a matter of degree – there is a continuum between its existence and its absence. Corrigan16, has an opposing view, focused on cognitive and behaviour features of mental illness. He proposed a model in which stigma was categorized either as public or self stigma. Public stigma is defined as the reaction that the general population has to people with mental illness. Self stigma is the prejudice which people with mental illness turn against themselves. In each of the categories, stigma is broken down into three elements: stereotypes (cognitive knowledge structures) prejudice (cognitive and emotional consequence of stereotypes) and discrimination (behavioural consequence of prejudice)17 . Thornicroft et al.18, elaborate on this framework, stating that stigma is composed of problems at three levels: Knowledge, Attitudes and Behaviour. Mental health knowledge is also known in the literature as mental health literacy. A study by Jorm et al. in Australia has shown better knowledge was correlated with better recognition of the features of depression, and better compliance with help seeking or medication and/or psychotherapy compliance.19 Nevertheless, by citing contradicting evidence, Thornicroft18 states that â€Å"an increase in knowledge about mental illness does not necessarily improve either attitudes or behaviour towards people with mental illness.† Negative attitudes, also known as prejudice, is the most studied component. According to Thornicroft, it can predict more strongly actual discrimination than do stereotypes. Attitudes have been widely researched. There are studies regarding both public, healthcare practitioners (and medical students) and caregivers. Thornicroft emphasizes the importance of studying actual behaviour, stressing that most of the studies have focused on attitudes towards hypothetical situations, rather than actual stigmatizing and discriminative behaviour. Thornicroft proposes a shift from research focused on stigma to research focused on discrimination.18 1.1.5 Correlates and consequences of stigma Stigma can have profound impact both at individuals with mental illness and their relatives. Rà ¼sch et al.17 list four negative consequences of public stigma: Everyday life discriminations encountered in interpersonal relations and depictions in media Structural discrimination – inequity in the access to opportunities in private and public institutions. Self-stigma (versus empowerment) Fear of stigma as a barrier to use health services. About self-stigma and empowerment, Rà ¼sch et al. comment, firstly, that self-stigma and empowerment are on the same continuum of self-esteem. They also remark that people may have different reactions to public stigma – while some people react with low self-esteem (self-stigmatized), some people might react with anger or indifference. They point out a possible explanation for this resides both within group identification with public stigma and perceived legitimacy of it. They also point the issue of self-disclosure – a person who considers mental illness is a part of his/her identity will more likely reveal his/her condition to others. Secondly, Rà ¼sch et al. comment on the relationship between stigma and service use. People decrease usage of psychiatric services in order to overcome public stigma. This is supported by evidence showing associations of this lack of usage with negative reactions from family members and poorer social status. Lack of usage of psychiatric services is intrinsically linked to decreased treatment compliance and, therefore, poorer prognosis.20,21 Personal stigma has shown to be associated with variables at different domains, in a systematic review and meta-analysis conducted by Livingston and Boyd. In the psychosocial domain, stigma has been negatively associated with hope, self-esteem, empowerment/mastery, self-efficacy, quality of life and social support/integration, both at group and individual levels.22–24 In the psychiatric domain, stigma has been positively associated with symptom severity and negatively with treatment adherence22. There are mixed results regarding association of stigma to diagnosis, illness duration, hospitalizations, insight, treatment setting, functioning and medication side effects, with most of the studies failing to show any statistically significant association. Regarding socio-demographic variables, both gender, age, education, employment, marital status, income and ethnicity have failed to show any consistent results.22 We should note, however, that some studies have shown significant associations, both positive and negative, regarding each of the variables, with stigma. 1.2 Stigma research Wahl et al., in 1999, mention four types of stigma research: Research that involves self-reports from general public. Research using vignettes or profiles of individuals and study participants’ ratings of people described. Analogue behaviour studies,(â€Å"experimental studies†) in which people are led to believe they are dealing with a person with mental illness. They note, however, there was, at the time, few research focused on mental health consumer, and his personal experiences of mental stigma.25 The paradigm changed and nowadays there is a relatively large number of instruments to measure personal experiences of mental stigma. 1.2.1 Instruments to measure stigma categories and criteria for psychometric properties In 2010, Brohan et al. 26, reviewed systematically 75 studies with instruments to measure personal experiences of mental stigma. Quality criteria for health status questionnaires have been thoroughly reviewed by Terwee et al,27 and are briefly described in Table 1. Table 1 Criteria for quality of psychometric instruments26,27 Brohan et al.26 considered instruments to measure personal experiences of stigma in three categories: Perceived stigma Self-Stigma Experienced stigma The found fourteen measures, used in the studies, which are listed in Table 2, and that were, thus, grouped in each of those categories. Instruments used were also assessed as to their psychometric properties, according to criteria by Terwee et al.27 Table 2 Scales assessing stigma experienced by people with experience of mental illness (Adapted from Brohan et al.26) 1.2.2 Perceived stigma Perceived or felt stigma, according to Scambler et al46 original definition, refers principally to the fear of enacted stigma, but also encompasses a feeling of shame associated with the illness. Van Brakel et al47, however, remove the feeling of shame from that definition, considering research about perceived stigma as research in which â€Å"people with a (potentially) stigmatized health condition are interviewed about stigma and discrimination they fear or perceive to be present in the community or society†. Perceived stigma can refer both to what an individual thinks most people would believe towards a certain group of the society or what that individual thinks about him personally as a member of a stigmatized group.48 Components of perceived stigma reported in the literature as measurable variables include stereotype awareness (perception by the individual of how individuals with mental illness are viewed by â€Å"most other people† in the society)16 and personal expectations or fears of encountering stigma. Perceived stigma is addressed in the vast majority (79%) of the studies reported by Brohan et al. Seven measures were used in the literature to measure it: PDD, SSMIS, ISE, HSS, SESQ, DSSS and DISC. PDD26,28 is the most commonly used scale. It totals 12 items its two subscales measure perceived discrimination and perceived devaluation – a way of measuring stereotype awareness. Perceived stigma is also measured in 10 item stereotype awareness subscale in SSMIS30. HSS investigates perceptions of how the person feels they have been personally viewed or treated by the society. In 2 of its items, DISC addresses the expectation of being stigmatized in various aspects of life – a concept called anticipated discrimination. Although in a specific setting and about a specific group, MSS44,45 â€Å"health professionals† subscale measures in our opinion perceived stigma regarding healthcare professionals, so it would fit in perceived stigma category. Regarding psychometric properties, all of the measures above mentioned reported on content validity. PDD, SESQ and DSS did not report whether target population was involved in selecting items in the scale. DSSS and SESQ reported results on internal consistency. However, PDD; SSMIS, ISE and HSS, although have calculations for Cronbach’s alpha, do not have factor analysis. SSMIS and SESQ have measured test retest reliability. MSS has been multiculturally tested, and its content validity was assessed. Cronbach alpha, internal consistency and test-retest reliability have been reported and meet criterion level. 1.2.3 Self-Stigma Self-stigma is considered, by Corrigan, the internalization of the public stigma. For Corrigan et al, there are three components in self stigma: negative belief about the self (e.g., character weakness, incompetence) – cognitive response, agreement with beliefs expressed by the public or the society and negative emotional reaction (e.g., low self-esteem, low self-efficacy) – affective response and behaviour response to prejudice (e.g., failing to pursue work and housing opportunities)16,49 Self-stigma is assessed by ISMI, SSMIS, DSSS, SS and ISE. Alienation, stereotype endorsement and social withdrawal subscales in ISMI, measure self-stigma, which correspond to its affective, cognitive and behavioural dimensions50. SSMIS measures self-stigma through three sub-scales: stereotype agreement; stereotype self-concurrence and self-esteem decrement26,30. SS has a â€Å"disclosure† subscale, which focus on the three dimensions already mentioned26,35. ISE contains one item on social withdrwal36. DSSS addresses self-stigma through two subscales – general self-stigma and secrecy: general self-stigma measures personal stereotype awareness. Secrecy subscale can be comparable to social withdrawal subscale in ISMI and disclosure scale in SS33. MSS44,45 has a 4 item subscale on self-stigma. According to Brohan, all the measures reported on content validity. DSSS did not report on target population involvement in item selection. SSMIS and ISE reported on partial criteria for internal consistency, reporting Cronbach’s alpha calculation but not factor analysis. ISMI; DSSS and SS have full internal consistency analysis. ISMI, SSMIS and SS have been reported to have measured test-retest reliability. 1.2.4 Experienced stigma According to Brohan and van Brakel, experienced stigma is the â€Å"experience of actual discrimination and/or participation restrictions on the part of the person affected†26,47. For the purpose of this definition, measuring experienced stigma can refer to measuring experiencing stigma in general or a report of experiences of stigma in specific situations or areas of life.26 By measuring experienced stigma, one can, thus, assess direct effects of public stigma on the stigmatized individual. Measures of experienced stigma include ISMI, CESQ, SRES, DSSS, SRE, SS, ISE, MIDUS, DISC and EDS. CESQ will b

Animal abuse Essay

Animal abuse is when someone inflicts pain or harm upon an animal such as not giving them their basic needs (food and water) to beating them. In between 5 and 7 million animal companions enter an animal shelter nationwide, every year (www.aspca.org), and within 50 miles of Hayward, CA, there are 170 animal cruelty cases reported (www.pet-abuse.com). Imagine what these innocent beings that cannot speak out to let the human know they are in pain feel. Animals need us to speak out and help reduce their suffering instead of making their lives worse. Animal safety needs to be improved by creating more laws to protect animals from harm. Animal cruelty is shaped by two forms of abuse, different types of animal abuse, opinions on how animal cruelty happens, organizations that help fight for animal rights, and ways to report it. see more:animal abuse essay Everyday animals are being taken advantage of and being brutally abused. They are beaten, kept in cages, and enslaved just for a person’s own amusement (www.peta.org). Humans like to have freedom but yet they have no problem locking animals away because they don’t feel like dealing with them. The law sees passive and active abuse as illegal but they don’t have strict consequences that follow. Passive abuse is when the crime is less intentional and active is doing it intentionally to cause pain upon an animal (www.pet-abuse.com). Why should animals have to endure this cruel torture? What did they do to deserve this? I believe animals should be more protected under the law and not just thrown around like garbage. Furthermore, there are many three main categories of animal abuse which are slaughter houses, animal testing, and finally in-house abuse. When slaughter house workers cut the heads off of a chicken their hearts are still beating, so they are forced to suffer for to benefit humans and are not protected under the law to be slaughtered humanely. Two hundred and eighty-seven chickens, three point sixty-eight pigs, and one point two cow are  slaughtered per second (www.annimalsuffering.com). Should so many animals be put through this cruel and unusual torture? There should be a maximum number under the law that prevents them from slaughtering so many in a small amount of time. There are many forms of animal testing, but the two main animal tests are, the Eye Irritancy and Acute Toxicity. The Eye Irritancy test is also known as the Draize eye test which is performed on rabbits by inserting a fluid with a needle in one eye to see how it reacts to this fluid. The rabbits are put in a contraption that locks their heads and endure a lot of suffering such as ulcers, blindness, and usually death. Next, Acute Toxicity is a method where they determine how much of a chemical can be exposed to the mouth, skin, and inhaled with rats and mice. These rodents are poisoned and the experiment ends when at least half of the testing animals die from the trial. They suffer from excruciating pain, convulsions, loss of motor function and seizures (www.aavs.org). No laws state that animal testing cannot be performed; therefore, they can inflict pain upon the animals at any time without worry of being prosecuted. They are able to inject them with lethal chemicals but when it comes to humans everyone is against injecting humans such as in the death penalty because it is inhumane and unusual torture. Finally, in-house abuse, is abuse from human to pet. According to the U.S. Animal Abuse Classifications chart neglect/abandonment ranks 1st with 5, 365 cases, animal hoarding ranks 2nd with 2,061 cases, and shooting comes in 3rd with 1,888 cases. I believe there should be laws that require background checks on violence and brutality in order to own pets because there are connection between violence and abusing animals. Overall, the United States has a high rate of people mistreating innocent animals and it must be prevented in order to protect these voiceless beings. Since the law is not doing much to protect these animals from cruel humans, the people believe they can get away with this crime. They have insecurities and since animals are smaller than them and can’t speak out they take all their frustrations out on them. Animals are helpless creatures whom are assumed to have no feelings. Animals are put through pain and torture due to people’s anger and ignorance. When a human is murdered, the law gives consequences to the murderer, but when animals are end up dead because of being tortured, the law does not provide consequences for the crime. These  people need to take responsibility for their actions and get the same punishment that they would get if these inflictions were toward a human. Animals deserve to have the same rights and be protected under the law. Despite of all the ignorant people, there are those who believe in equality between animals and humans and choose to be up standers. If laws were created that protected animals, these organizations would have a better support system for their fight. Laws would make these groups easier to support, therefore they could make more of a difference. For example, animal shelters provide the basic necessities such as food, shelter, and water and a safe environment for them to recover from the harsh acts. Without these shelters, animals will lose hope, so in order to keep them running, donations need to be given. Besides animal shelter, there are specific organizations that help fight for animal rights and help prevent animal cruelty. Some examples of organizations are the ASPCA (American Society for the Prevention of Cruelty to Animals) and PETA (People for the Ethical Treatment of Animals). These groups believe that animals are just as equal as humans and should not be treated the way they are. People need to take responsibility for their actions, take care of their pets properly, and encourage others to do the same. In order to provide sufficient ways of life for animals, the law must support these organizations. Although there are organizations that fight to make a difference, individuals can stop animal cruelty. The Karma Dog organization stated, â€Å"What come around goes around.† Furthermore, there are many strategies you can use to report any signs of abuse or neglect. They can call 911 if the animal is being forced to fight other animals, starved, tortured, and has heavy chains around the neck, open wounds, and mutilation. Another number you can call is 311. When calling 311 the conditions are deprivation of food, water, improper vet care and shelter, untreated skin conditions, has extreme flea infestation, and extremely long nails and matted hair. When seeing animal abuse posted through the internet you must immediately contact the Internet Crime Complaint Center (IC3) which is partnered with the FBI (http://www.belladogmagaizine.com). Finally, you can go onto change.org and sign petitions to stop animal testing and cruelty. You may not think one signature will make a difference but it does because once enough signatures  are collaborated, the government will realize something needs to be done. Never give up and keep fighting for these innocent animals. Even though animal abuse is wrong and hurtful to animals, some owners don’t purposely inflict harm upon them. For example, if the owner is having a really busy day and doesn’t have the time to walk their dog or they forget to feed them. Why should the owner be penalized for an accident? If the owner tries his best and treats the dog well any other time shouldn’t he be let off with a warning? A person should not be penalized for an accident because many things happen in life that causes distractions. Pet owners don’t intentionally neglect their pets and they deserve the chance to prove the courts otherwise. Some believe that animals are here to serve us so if so then we should not have to pamper them as we would for ourselves. In conclusion, animals and humans are no different and they should not be treated differently under the law. However, people in the United States mistreat innocent begins and laws need to be enforced to prevent it. Some think that animals cannot speak, that what happens to them will not affect them mentally, but every living animals have feeling whether they can talk or not. Treat an animal the way you would want to be treated. When using products, people should think to look if it has been tested on animals. Registering or volunteering at organizations that help prevent and heal abused animals will set a good example to others to fight for what you believe in. The bible states, â€Å"Do unto others.† This phrase is for all being not just humans so why should animals have to continue suffering. Be your own person and fight against animal abuse because this is cruel and unusual torture. Works Cited â€Å"Pet Statistics.† ASPCA. N.p., 2012. Web. 22 Nov. 2012. . â€Å"Reporting Internet Animal Abuse | BellaDOG Magazine.† Reporting Internet Animal Abuse | BellaDOG Magazine. N.p., 2011. Web. 22 Nov. 2012. . â€Å"The Issues.† PETA. N.p., 2012. Web. 22 Nov. 2012. . â€Å"Types of Animal Testing.† -The American Anti-Vivisection Society (AAVS). N.p., 2012. Web. 22 Nov. 2012. . Corp., Petabuse. â€Å"Animal Cruelty.† Animal Cruelty | Pet-Abuse.Com Animal Cruelty Database. N.p., 2001-2012. Web. 22 Nov. 2012. . Corp., Petabuse. â€Å"Local Animal Cruelty Case Search | Pet-Abuse.Com Animal Cruelty Database.† Local Animal Cruelty Case Search | Pet-Abuse.Com Animal Cruelty Database. N.p., 2001-2012. Web. 22 Nov. 2012. . Hugo, Victor. â€Å"Animal Slaughter, Abuse and Cruelty. Behind the Screens.† AnimalSuffering. Animals Rights Concerns, 2003,2009. Web. 22 Nov. 2012. .

Finny The Great

Throughout the novel A Separate Peace by John Knowles, there were two dominant characters. Gene who is the narrator and Finny who is Gene’s best friend have a great relationship shown in A Separate Peace. Finny whose real name is Phineas has three qualities, manipulation, athleticism, and is a strong leader. Manipulation is shown all through the novel by Finny and is one of his best assets that he has. We see his manipulation skills from getting out of trouble when they skipped dinner to the time he made Gene first jump out of the tree. The reason sir is that we just had to jump out of that tree. You know that tree†¦because we’re all getting ready for the war†¦Mr. Prud’homme released his breath with a sort of amazed laugh, stared at Finny for awhile, and that was all there was to it’† (15,16). Finny, in this quote, gets Gene and himself out of trouble after they skipped dinner the night before and every time they get in trouble. In the Super Suicide Society of the Summer Session he persuades Gene to go on the jump every night even though Gene does not want to and would rather study. Finny is an incredible athlete, modest, and is very brave, this is shown through his breaking of the long-standing school swimming record and not wanting to show off his talent. Another athletic move Finny makes is inventing a new game called blitzball during the summer classes, which they play all the time. When Finny breaks his leg and is never able to play sports again it devastates him. â€Å"‘Listen, pal, if I cant play sports, you’re going to play them for me’† (77). When Finny says this his anger is so high since he cannot play sports that he ant someone else to play for him to have that security of sports still around him. Throughout the novel Finny shows great leadership. Everything done by Finny and his friends he is leading. When they made up Blitzball he was the one who made up the rules and tells Gene and their friends how to play the game. â€Å"‘Now Leper has just brought out a really important fine point of the game. The receiver can refuse a pass if he happens to choose to. Sine we’re all enemies, we can and will turn on each other all the time. We call that the Lepellier Refusal’† 30). Finny has a knack for leading people and does this when they first start the Super Suicide Society of the Summer Session. Without Phineas using his charismatic attitude, athleticism and his leadership skills the novel would be very boring. Finny `s charismatic attitude shown all throughout the novel helps him get the things he wants and has excitement in the novel. His athleticism makes him competitive and makes up the game of the summer blitzball. Finny has great leadership skills so he can manipulate people and get what he wants from his friends.

Rhetorical Analysis The Tesla Wasnt God And Thomas...

Tesla Article Rhetorical Analysis Humanity lives in the electronic age, where everything is powered by electricity, but whom is responsible for these marvels of modern engineering and science? Many millennials tout that Nikola Tesla is responsible for the electronic age and that those credited by the history books for ground breaking inventions were thieving from Tesla, however, Alex Knapp of Forbes has a different perspective. He wrote an article titled â€Å"Nikola Tesla Wasn’t God and Thomas Edison Wasn’t the Devil†. Through several strategies and rhetorical appeals the author of â€Å"Nikola Tesla Wasn’t God and Thomas Edison Wasn’t the Devil† makes an excellent case for his argument. In the article the author explains how the comic created†¦show more content†¦It is an excellent literary tactic that affects the reader subconsciously, swaying their opinion even without complete evidence. The author continues to claim that Tesla was not indispensable in the pursu it of making alternating current the means of powering the world by calling The Oatmeal’s comic â€Å"fallacious†, meaning false or misinformed. His use of connotation and literary techniques help drive home his point. Knapp continues, making stellar use of his tone. While it may come off to some as condescending, with the addition of his word choice it comes off as educated and precise. It also has a sense of personal interaction with each individual reader due to his choice of point of view. It creates a connection between the reader and the author that gives weight to their words. There are also portions of the article where he adopts an understanding tone, giving validity to people’s notions about Edison, just not to the degree of fervor with which he is persecuted. His use of tone genuinely allowed him to connect with the audience and worked well in his attempt to sway the reader’s opinion about the battle of Nikola Tesla and Thomas Edison. Knapp als o makes adept use of Rhetorical strategies, particularly Aristotle’s Logos and Ethos. Throughout the article, he appeals to the reader’s sense of logic using historical facts and presentation of irony. He writes in reference

The Application Of Competitive Strategy Dynamics Essay

THE APPLICATION OF COMPETITIVE STRATEGY DYNAMICS: A CASE STUDY OF STARBUCKS CORPORATION Abstract Firms that earn persistently higher levels of profit than competitors have a competitive advantage (Grant, 2008; Porter 1985). Michael Porters famous five forces of competitive position model provide a simple perspective for assessing and analyzing the competitive strength of a corporation or business organization. The competitive advantage (CA) model of Porter learns that competitive strategy is all about taking offensive or defensive action to create a defensive action to create a defendable position in an industry in order to cope successfully with competitive forces and generate a superior return on investment. Starbucks is a notable company that can be useful to researchers and industry observers who want to understand the underlying factors for a company to achieve a sustainable competitive strategic position in an ever-saturating industry. 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Marketing Orientation - 6794 Words

Marketing is an organizational function and a set of processes for creating, communicating, and delivering value to customers and for managing customer relationships in ways that benefit tChapter 1: An Overview of Marketing Learning Objectives 1 Define the term marketing Marketing is an organizational function and a set of processes for creating, communicating, and delivering value to customers and for managing customer relationships in ways that benefit the organization and its stakeholders. 2 Describe four marketing management philosophies Four competing philosophies strongly influence the role of marketing and marketing activities within an organization. These philosophies are commonly referred to as production,†¦show more content†¦C. The Concept of Exchange The concept of exchange means that people give up something in order to receive something that they would rather have. 1. The usual medium of exchange is money. 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Aboriginal People and Alcoholism

Question: Write an essay on "Aboriginal People and Alcoholism". Answer: Introduction: Alcohol is considered as a psychoactive drug, which is widely used in Australia. According to the survey of NDSHS in 2007, 82.9% of Australian people aged over 14 years old consumed alcohol within last 12 months. According to the 2001 Australian Alcohol Guidelines, NDSHS showed that 20.4% of the Australians consumed alcohol at high risk. According to Saitz (2010), 80% of the total number of the alcohol consumption is contributed by the Aboriginal people in Australia. The indigenous Australians contribute only 2.6% of total Australian population. However, it is found that the health and social problems due to alcohol consumption faced by them are not negligible. According to Salmon (2011), the burden of alcohol-related disease, as well as antisocial incidences experienced by the Aboriginal people, is almost double than that of the common Australian people. Despite all of these facts it is also important to mention that reporting of health issues experienced by the Aboriginal people especially alcohol related is overwhelming. Today, it is fair to admit that with the evolution of technologies the role of media has also evolved and now become a part of entertainment (Ward et al., 2013). Therefore, in most of the cases, it is found that the facts or evidence are often masked by the media, who presents news in a new "package." However, the role played by media to reach the ears of common people and dig the truth is convenient as well as beneficial for the society. In this paper, it is aimed to analyse minimum five articles, which covers health related issues of the Aboriginal people due to alcohol consumption and evaluate how these articles can contribute to cultural competence in health care. Article1: Six-month grog ban won't work: Carpenter, June 25, 2007 Key Issues This article was published in The Sydney Morning Herald, June 25, 2007. According to West Australian Premier Alan Carpenter, banning of alcohol consumption in the Northern Territory Aboriginal Communities is no helpful to reduce child sexual abuse. Last week, Prime Minister John Howard declared a list of several steps in order to stop the abuse of children in the Aboriginal communities, which includes mandatory health checks for the children and alcohol ban. Although most of the initiatives were appreciated by other, Mr. Carpenter argued and stated that a six-month alcohol ban is not enough to control child abuse. It is evident that a large number of Aboriginal communities in Western Australia are dry, but the rate of child abuse is not negligible. However, Mr. Carpenter agreed that the presence of police in the community was helpful to address the matter. Links to models and approaches According to Hopkins et al., (2012), people who belong to the minority group (Aboriginal community) are less educated and follow their distinct cultures. Therefore, controlling the lifestyle of the minority group is not an easy task for the government of Australia. Although it is noticed that the successful implementation of several laws helped to control the lifestyle of the Aboriginal people, it is not possible to modify them according to the civilizing rule of Australia. Reducing child abuse among the Aboriginal people is, therefore, a critical task but not an impossible one. How the material affects current debate Although this article was published in 2007, the matter of this news article is still valuable and related to the current situation. With the evaluation of the current situation of the Aboriginal communities, it can be said that the incidences of child abuse are not rare. The current situation also emphasizes that the steps or initiatives taken by John Howard were not successful to meet their aim. On the other hand, according to a recent survey, the rate of sexual abuse among the children has increased from the last couple of years. Therefore, it can be said that the government needs to take firm steps to control the situation and save the life of Aboriginal children. Article2: Alcohol bans without support 'inhumane', Penelope Debelle, 2008 Key Issues This article was published in The Age. Banning alcohol in Aboriginal communities is one of the most critical tasks. Although the government took several initiatives to ban alcohol consumption in the Aboriginal community, it is found that the mission was never fully successful. Banning alcohol in a community without providing supportive services such as suicide prevention or counselling is inhuman. Professor Stanley indicated that this was the main reason behind the failure of the program "close the gap." The project was fully successfully only in the West Australian Kimberley town only after the death of 22 people due to drug or alcohol consumption. Professor Stanley stated that Australia is still a racist country, and the Aboriginal people are the victim of the situation. Links to models and approaches According to Perreault (2011), consumption of alcohol is the root of disaster and all of the antisocial activities among the people in Aboriginal people. The rehabilitation program arranged by the government, in most of the cases tastes failure due to the lack of proper infrastructure (Calabria et al, 2010). When the government is thinking to ban alcohol consumption, they need to follow a proper procedure and offer proper rehabilitation program. However, it is recognized that the initiative taken by the government is not only illogical but also inhuman. How the material affects current debate With the current political focus, it is recognized that the number of Aboriginal people who seeks rehabilitation and cure from alcohol addiction is very few. In this situation, when media reflects more about the wrong procedures are taken by the Australian government, it generates miscommunication and unrest among the Aboriginal people. The miscommunication conducted by the media by the overwhelming focus on this topic influence the Aboriginal people to believe that they are not much of importance their government. Article3: Indigenous health: No alcohol debit card backed by Noel Pearson divides Kununurra, Daisy Dumas, 2015 Key Issues In Kununurra and northern West Australian region alcoholism and drug abuse is a very common incident. The attendance of school is lowest in this part of the country. The Kimberleys Empowered Communities Group took initiatives and met with Tony Abbott (former Prime Minister) and came up with a radical and blunt economic instrument in order to control the crisis among the Aboriginal communities. According to the plan, eligible personals in this area will receive debit cards, where 80% money will be secured and cannot be used to buy any illegal drug or alcohol. Although this is a trial program, most of the Aboriginal people are against this initiative. Links to models and approaches According to the research study of Niccols et al. (2010), the reason behind the lack of development and crisis among the indigenous people is their addiction towards alcohol and drugs. In order to control their expenditure on alcohol and drugs, the government needs to take several steps. According to Razack (2011), controlling the expenditure and saving money is the only way to help the Aboriginal people to lead a better life. Therefore, restrain the personal expenditure by the government could be proved as fruitful to help the new generations in Aboriginal community to lead a better life. How the material affects current debate Although the steps taken by the former Prime Minister Tony Abbott was still in trial, it can be said the initiatives taken by him and the community is highly controversial. The media played an interesting role to elaborate the good and bad side of this project. However, media also emphasized the feelings of the Aboriginal people and focused extravagantly on the poor condition of the Aboriginal people and their almost cashless condition. This step encouraged the debate of highlighting their cashless condition and restricting the use of their health. Article 4: A burden too heavy to carry?, Russell Skelton, 2012 Key Issues This article was published in The Age in 2012. From this article, it is found that the Northern Territory government is relaxing the drinking laws of the states. According to Mrs. Campbell in the article, it is found that she is a mother of four children and strictly against the relaxation in laws. The moves taken by the government in those regions were not only acceptable but inhuman. The government in those regions also demolished the rules of banning drinkers and necessity of showing ID documents while purchasing the alcohol from shops. The relaxation in liquor laws in the Aboriginal communities is a political move, which is rejected by most of the common people. Links to models and approaches According to Conigrave et al. (2012), the government only have the power to take initiatives in order to inhibit alcohol consumption among the Aboriginal people. When the government takes initiatives to relax the laws, which were meant to protect the humanity and reduce the health-related problems due to alcohol consumption, it will evidently lead towards chaos. Relaxation to laws about alcohol consumption is not desirable as it can lead to the deterioration of the lifestyle of the common people of the Aboriginal community. How the material affects current debate Considering the current political condition, it can be said that the Australian government is trying their best to abolish alcoholism. However, publications of media, which emphasizes the relaxation in laws that prohibits alcohol and drug consumption, can lead towards chaos (Calabria et al, 2013). May be this news has some evidence, but it is not true that the law relaxation is taking place in all of the Aboriginal religions. Therefore, releasing the news of the relaxation in laws related to alcoholism is not beneficial to maintain peace in all over the country and help the Aboriginal people to lead a better life. Article 5: ACT budget to provide millions for drug rehab and treatment, Christopher Knaus, 2016 Key Issues This article was published in The Age, 2016. The ongoing drug rehabilitation program in Australia is going to have additional $6 million in the budgets of ACT in next month (June). However, the oppositions are concerned about the funding, as they consider that this funding announcement is just the re-announcement. According to the oppositions, it is may be disingenuous to allot $6 million as fresh money. In recent years, the drug support programs are increasingly stretched and becoming more demanding. Last year the government announced $800,000 in order to boost the program. The program includes combat against drug addiction, alcoholism as well as ice addiction among the Aboriginal people. Links to models and approaches According to the study of Carter (2011), it is the government, who can take best steps to control alcohol consumptions and drug addictions among the aboriginal people. However, it is also important to consider the budget of the program. In most of the cases, it is recognized that the allowance of the government for the rehabilitation program cost the government most (Wilson et al., 2010). Declaration of the huge amount of money to encourage the Aboriginal people to lead a better life is very generous but may not be fruitful. The government needs to distribute money among the Aboriginal communities and different programs equally so that it covers all aspects and help the indigenous people to lead a better people. How the material affects current debate This piece of news material is very recently published in The Age and currently considered as a hot topic. The allowance of $6 million on the project is grabbing the attention of oppositions as well as the common people. It is found that the unrest is growing among the common people since this program is costing the government more than $17.2 million in a year (Zubrick et al., 2010). However, the result of the program is not satisfactory as the alcohol-related issues in the Aboriginal region are overwhelming. Personal Reflection: The author of this article reflected how the government is fighting alcoholism and trying to help the indigenous people. The initiatives taken by the Australian government to help the Aboriginal people is no doubt admiring, but there are several shreds of evidence found in the media that emphasizes that not all of the steps taken by the government are right. Although most of the cases it is found that the media articles masks the truth and presents the facts in an entertaining package, in this case, it is recognized that the selected articles in this topic are helpful to cover all aspects of this issue. The declaration of $6 million for the welfare of the Aboriginal people is not only helpful but also admiring. However, the relaxations in the laws related to alcoholism are not desirable. Relaxation of laws is not helpful to improve the present condition of the Aboriginal people. Conclusion: After reviewing the media publications on the topic, it can be concluded that all of the steps taken by the government are not admirable. The Aboriginal people in Australia are dealing with more than one problem. Alcoholism is one of the most concerning issue faced by the Aboriginal people. The negative impact of alcoholism is reflected in their society, culture and behaviour. The increasing rate of child abuse and crisis for food is the result of alcoholism and extensive drug abuse. The presence of police patrol car in the community is helpful to control the situation and save the life of the children. However, health security still needs to be considered with highest priority. On the other hand, the relaxation of laws related to alcohol consumption and dealing is not only unwanted in the society but also against the humanity. The Australian government needs to think about the alcohol-related issued that experienced by the indigenous people with highest priority. The role played by the media to enlighten the truth is very helpful to identify the issues of the society that needs to be taken care of. Reference 'inhumane', A. (2008).Alcohol bans without support 'inhumane'.The Age. Calabria, B., Clifford, A., Shakeshaft, A., Allan, J., Bliss, D., Doran, C. (2013). The acceptability to Aboriginal Australians of a familyà ¢Ã¢â€š ¬Ã‚ based intervention to reduce alcoholà ¢Ã¢â€š ¬Ã‚ related harms.Drug and alcohol review,32(3), 328-332. Calabria, B., Doran, C. M., Vos, T., Shakeshaft, A. P., Hall, W. (2010). Epidemiology of alcoholà ¢Ã¢â€š ¬Ã‚ related burden of disease among Indigenous Australians.Australian and New Zealand journal of public health,34(s1), S47-S51. Carpenter, S. (2007).Six-month grog ban won't work: Carpenter. Carter, T. (2011). Literature review on issues and needs of Aboriginal people. Conigrave, K., Freeman, B., Caroll, T., Simpson, L., Lee, K. K., Wade, V., ... Freeburn, B. (2012). The Alcohol Awareness project: community education and brief intervention in an urban Aboriginal setting.Health Promotion Journal of Australia,23(3), 219-225. Dumas, D. (2015).Indigenous health: No alcohol debit card backed by Noel Pearson divides Kununurra.The Age. Hopkins, K. D., Taylor, C. L., DAntoine, H., Zubrick, S. R. (2012). Predictors of resilient psychosocial functioning in Western Australian Aboriginal young people exposed to high family-level risk. InThe Social Ecology of Resilience(pp. 425-440). Knaus, C. (2016).ACT budget to provide millions for drug rehab and treatment.The Age. Niccols, A., Dell, C. A., Clarke, S. (2010). Treatment issues for Aboriginal mothers with substance use problems and their children.International journal of mental health and addiction,8(2), 320-335.