Hippocrates

Hippocrates, a Greek physician (479–377bc) who is referred to every bit the "male parent of mod medicine," was aware of the potential of heat to cure or shrink tumors.

From: Handbook of Clinical Neurology , 2018

Foundations

Donald K. Routh , in Comprehensive Clinical Psychology, 1998

ane.01.1 Introduction

The story goes that Hippocrates (460–377 BC), the famous physician, was one time summoned to the Greek city of Abdera by its citizens in guild to investigate the seemingly irrational behavior of the philosopher Democritus. Democritus (460–370 BC) is best known today for his view that everything consists of tiny particles called atoms. On this occasion, Democritus was seated nether a airplane tree surrounded by the carcasses of dogs and cats. He was experiencing an episode of melancholy and was dissecting these animals in order to discover the source of black bile, considered to be responsible for such mental disturbances ( Burton, 1621/1971). The term "melancholy" literally means black bile in Greek, and Hippocrates' theory of melancholy, like that of Democritus, was that it was caused by an imbalance of the "humors" of the body (e.g., Jackson, 1978). Hippocrates thus considered Democritus to be rational, non insane.

Hippocrates was not a psychiatrist, nor was Democritus a clinical psychologist. Information technology would be many centuries before either of these specialized fields was to emerge. Nevertheless, the principal theme of this affiliate is that fifty-fifty from early historic times, mental disorders were the concern not only of physicians but also of philosophers and others who did not practise medicine. This fact can serve as a sort of historic precedent for the existence of clinical psychology and related nonmedical fields concerned with mental disorders. As Democritus once said in a letter of the alphabet to Hippocrates:

Wisdom is the sister of medicine: the one rescues the soul from passions, the other alleviates the disease of the body. The listen benefits from wellness, whereas sick wellness dampens the want for virtue, and disease binds the soul. (Temkin, 1991, p. lxx)

This history of "clinical psychology" is thus at the same fourth dimension a history of aspects of medicine, psychiatry, and other related fields. It is concerned with a broad spectrum of pathophysiology, psychopathology, assessment, and various types of interventions for mental disorders.

The author's earlier inquiries into the history of clinical psychology concerned the organizations of clinical psychologists that adult in the United states starting time in 1917 and some of the practitioner pioneers in the field including Lightner Witmer, J. E. Due west. Wallin, and Leta Hollingworth (Routh, 1994, 1996, 1997). These writings gave relatively little recognition to events before the 1890s, to the contributions of side by side disciplines such as psychiatry, or to the piece of work of colleagues in other countries. The asking from C. Eugene Walker to write the present affiliate was interpreted as an invitation to explore non only the organizational history of clinical psychology but its substance too, not just in contempo times but from its origins. In its first 100   years, clinical psychology has become and then intertwined with psychiatry (peculiarly in the domain of research) that it fabricated more sense to consider them jointly rather than separately. It soon became evident that writing such a history was naught short of a lifetime project. However, the nowadays chapter was prepared over simply a two-year menstruation and thus required the use of many secondary sources and even some third sources in lodge for it to be completed at all. The main justification for trying to carry out such a task is that about clinical psychologists are remarkably ignorant nigh the history of their field.

The affiliate begins with a brief history of ideas concerning mental illness in ancient, medieval, and early on modernistic times. It then discusses the development of the specialty of psychiatry in the eighteenth century and after and of clinical psychology near 100   years later. Finally, information technology describes the further development of the two fields, considered equally aspects of a larger whole, during the twentieth century, with a focus on developments in the areas of psychopathology, cess, and treatment. Many histories of psychiatry and psychology have been written, offset in the early nineteenth century (eastward.g., Marx, 1994). And so far as the writer is enlightened, still, this admittedly pocket-sized effort is the commencement attempt to write a combined history of psychiatry and clinical psychology.

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History of Predictive Analytics in Medicine and Health Care

Linda A. Winters-Miner PhD , ... Gary D. Miner PhD , in Practical Predictive Analytics and Decisioning Systems for Medicine, 2015

Hippocrates and Classical Greece

Hippocrates organized existing medical texts (and wrote some of them) in an try to integrate the previous philosophical concepts of Empedocles (the 4 elements), Philistion (the torso is separate from the soul, and must be treated as such), and Diogenes (the soul, or the pneuma, is the vehicle of life; Wellmann, 1901) (see Effigy 1.three). This group of documents included detailed discussions of brain, lungs, heart, liver, and blood, together with recommended treatments, and became known as the Hippocratic Corpus (about 400   BC). The corpus was composed of nigh 60 documents, and it represented the first widely distributed and integrated repository of medical information in the world that contained guides to diagnoses and treatments of ailments and diseases. A previous example of this sort of repository in the course of the Babylonian Sakikku documents written on clay tablets and stored in a majestic library, was relatively inaccessible to common people.

Figure one.3. Roman coin of the first century Advertizement from the isle of Cos (birthplace of Hippocrates) showing his bust as of about 377   BC. (see why this Roman coin is important in the discussion of Roman medicine below).

 Source - British Museum, Coins and Medals catalogue number: GC18p216.216.

Specific volumes of the Hippocratic Corpus were devoted to the iv humors: blackness bile, yellow bile, phlegm, and claret. In this regard, Hippocrates followed the general arroyo of Empedocles, explaining medical illnesses as an imbalance between the four basic elements, only the elements in medicine were the four humors. Other volumes covered information and treatment regarding fractures, head wounds, gynecology, epidemics, obstetrics, ophthalmology, the heart, the veins, and bones. Hippocrates also used tools. He mentions using a rectal speculum (Figure ane.4) to detect a rectal fistula (Volume iii, p. 331).

Effigy i.4. Rectal specula of the type used past Hippocrates.

 Reproduced with permission from: www.hsl.virginia.edu/historical/artifacts/roman_surgical/

Particularly relevant to the history of predictive analytics is that this repository of knowledge and practices arose largely due to concern for the poor in Greece (equally it did in Mesopotamia). We run across a reflection of this business organisation today in the electric current controversy over access to health data and health care in America. Evidently, our concern today is not purely a mod phenomenon – its roots extend dorsum to ancient Greece and fifty-fifty to the cradle of civilization in Mesopotamia.

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Hippocrates☆

J.R. Lanska , D.J. Lanska , in Reference Module in Neuroscience and Biobehavioral Psychology, 2017

Hippocrates gave a lucid clinical description of a seizure that was not bettered for centuries:

the patient loses his voice communication, and chokes, and foam issues past the oral cavity, the teeth are fixed, the hands are contracted, the eyes distorted, he becomes insensible, and in some cases the bowels are evacuated. And these symptoms occur sometimes on the left side, sometimes on the correct, and sometimes in both … The patient kicks with his anxiety when the air is close up in the lungs and cannot observe an outlet, owing to the phlegm; and rushing by the blood upwards and downwards, it occasions convulsions and hurting, and therefore he kicks with his feet.

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Epilepsy

A. Martins Da Silva , L. James Willmore , in Handbook of Clinical Neurology, 2012

Historical background

Hippocrates identified the brain as the organ causing epilepsy and recognized trauma equally a cause ( Temkin, 1971). Throughout the 16th century, surviving a serious head wound was a claiming, and the part of trauma as such, rather than complicating infection, was not clear (Temkin, 1971). Valescus de Tharanta (1523; quoted past Temkin, 1971) described a man with a head wound that penetrated to the pia mater with resultant six or seven seizures each day until his decease 8   days after the injury. Latency betwixt injury and subsequent epilepsy was observed too, with Berengarius treating a man whose seizures began virtually 60   days later head injury. There was a type of surgical intervention involving the opening of the wound and evacuation of a large quantity of watery substance similar in color to milk that was associated with "the epilepsy ceasing immediately" (Temkin, 1971). Latency between injury and epilepsy was reported by Duretus (1527–1586) with his description of a 17-year-old human being with seizures offset v   years after he had "a os of the skull broken and depressed…" (Martins da Silva et al., 1990). Charcot divided the etiology of epilepsy into directly and indirect, wherein there was immediate, or periconcussive, seizures or seizures occurring later after trauma with the association made by the clinical history (Féré, 1890).

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Radiographic Vasospasm and Clinical (Symptomatic) Vasospasm

Jasmeet Singh , ... Kyle M. Fargen , in Intracranial Aneurysms, 2018

11.two Historical Perspective of Vasospasm

Hippocrates showtime described a condition probable consistent with symptomatic delayed cerebral vasospasm over 2400 years agone: "When persons in expert health are suddenly seized with pains in the caput, and straightway are laid downwards speechless, and breathe with stertor, they die in 7 days" ( Clarke, 1963; Pluta et al., 2009). The first likely case of cerebral vasospasm in the mod medical literature was described by an English language md, Sir William Gull in a young lady with a ruptured aneurysm, but the miracle was not fully recognized then (Baggott & Aagaard-Kienitz, 2014). In 1951, Ecker and Riemenschneider have demonstrated vasospasm of major cerebral arteries associated with ruptured circle of Willis aneurysms in half dozen aneurysm cases (Ecker & Riemenschneider, 1951). They performed angiograms and showed that vasospasm was the about marked in the vicinity of the ruptured aneurysm—correlating to the largest amount of hemorrhage. They also found vasospasm was a self-limited process with no vasospasm seen in angiograms performed 26 days subsequently SAH.

The fourth dimension course of cerebral vasospasm in humans was eventually described by Weir and colleagues in 1978 (Weir, Grace, Hansen, & Rothberg, 1978). They performed serial measurements on angiograms in 293 patients and ended that the onset of vasospasm afterwards SAH occurred on approximately day 3, was maximal on days six–8, and essentially resolved by twenty-four hours 12. Fisher et al. then described the correlation betwixt findings on angiogram and the development of focal neurologic deficits in 1977 (Fisher, Roberson, & Ojemann, 1977).

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Sexual practice Headache, Primary

S. Evers , A. Frese , in Encyclopedia of the Neurological Sciences (Second Edition), 2014

Introduction

Hippocrates described a headache resulting from 'immoderate venery.' More recently, Harold Wolff, in the 1970s, drew attention to a beneficial form of headache that occurs during sexual activity. The term 'beneficial' implies a primary headache disorder that is not caused by dangerous intracranial lesions such every bit ruptured aneurysms or other intracranial disorders.

In the first systematic description of the affliction past James Lance, 21 patients were reported. One subgroup of patients had pain that developed slowly during sexual activity possibly related to excessive muscular contraction of the neck and jaw muscles. A second, larger grouping of patients had a sudden onset of severe pain shortly earlier, at the moment of, or before long afterward orgasm. Some other publication described iii patients with a 3rd type of headache that resembled the headache post-obit lumbar puncture. It was suggested that the latter headache resulted from a leakage of the dura mater during sexual intercourse leading to low cerebrospinal fluid (CSF) force per unit area.

In the first edition of the International Headache Order (IHS) classification, primary sex headache was called 'headache associated with sex activity,' three subtypes were differentiated (diagnoses 4.6.1–four.6.3): type 1 equally a slow ache in the caput and neck that intensifies as sexual excitement increases; type 2 as a sudden astringent ('explosive') headache occurring at orgasm; and blazon three as a postural headache resembling the one caused by low CSF force per unit area. It appeared, notwithstanding, that type three must be regarded as a symptomatic headache. In the 2d edition of the IHS classification from 2004, but type 1 and type 2 are divers (Tabular array i).

Tabular array 1. Operational diagnostic criteria of the International Headache Guild (IHS) for headache attributed to sexual action

4.4.1 Preorgasmic headache
1.

Dull anguish in the head and cervix associated with awareness of cervix and/or jaw muscle contraction fulfilling benchmark 2

two.

Occurs during sexual activity and increases with sexual excitement

3.

Not attributed to another disease
4.4.two Orgasmic headache
ane.

Sudden severe ('explosive') headache fulfilling criterion 2

2.

Occurs at orgasm

3.

Not attributed to another illness

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Paranoid Delusions Explained by Manic Grandiosity and the Guilt of Low; There Is No "Schizophrenia"

C. Raymond Lake , in Bipolar, 2021

9.1 Introduction

Hippocrates (400 BCE), Soranus (100 CE), and Aretaeus (150 CE) link paranoia and depression with cases that today would be diagnosed with Bipolar. Agreeing with these classical authors, in 1921, Kraepelin published his volume titled Manic-Depressive Insanity and Paranoia establishing paranoia and insanity or psychosis as parts of Bipolar. However, the influences of Bleuler (1911) and later Schneider (1959) contradict these associations. They reassign paranoia and psychosis and fifty-fifty some types of depression to "Schizophrenia." The paranoid subtype of "Schizophrenia," carried in the DSM until 2013, was the most prominent and common type of "Schizophrenia." Paranoid delusions became synonymous with "Schizophrenia." Farther examples of the influences of Bleuler and Schneider include the diagnosis of "Post-Schizophrenic Depression," classified under "Schizophrenia" in the ICD-10-CM. This condition is a severe depression with overwhelming psychotic symptoms that obscure depression until the psychotic symptoms begin to remit, revealing symptoms of depression. "Post-Schizophrenic Depression" is not a type of "Schizophrenia" equally demonstrated by cases presented in this chapter. Paranoid delusions are instead indicative of a psychotic Mood Disorder (Tables 9.1.1, 9.1.2).

Table 9.1.i. Historical links of paranoia with Mood Disorder not Schizophrenia

Date Name Quote
ca 400 BCE Hippocrates "Described melancholia as a condition associated with … fear or low that when prolonged means melancholia."
ca 100 CE Soranus of Ephesus Idea that mania sometimes involved "an overpowering fearfulness of things which are quite harmless. … sometimes …. suspicion that a plot is beingness hatched confronting him …."
ca 150 CE Aretaeus of Cappadocia "… others [manics] are suspicious and they feel that they are being persecuted …."
1799 Sims, James Sims convincingly linked astringent depression (melancholia) with paranoid delusions (Swartz and Shorter, 2007, pp. 24 to 25).
1905 Specht, G "Chronic Mania and Paranoia" (article title). Specht associated mania with both chronicity and paranoia and believed these combinations were mutual.
1921 Kraepelin, E Kraepelin wrote a book titled, "Manic-Depressive Insanity and Paranoia" (1921). Described "paranoid depression" as a disorder with a loftier rate of suicide, marked depression, auditory hallucinations, paranoia, and agitation.
1967 Beck, A.T. He found that 46% of severely depressed patients suffered delusions of having sinned or committed terrible crimes. They and so suffered paranoid delusions that torture and execution were imminent (Swartz and Shorter, 2007, pp. 137).
1974 Abrams et al. They published a paper titled, "Manic-Depressive Illness and Paranoid Schizophrenia," in which they implied that almost 95% of their sample of patients diagnosed with paranoid Schizophrenia actually suffered from mania because classic Bipolar patients were observed to endure paranoid delusions.
1976 Hamilton, M "Several British investigators … contend that delusions in a depressed individual normally arise from guilt and a depressed mood. Persecutory thoughts, in this context, are a derivative of these guilt feelings and a mood disorder, and non primary in themselves. For example, the patient may say, 'I have committed terrible crimes and I'thousand going to be punished,' or even, 'the police are pursuing me and will hang me for my crimes.' Initially, these thoughts appear persecutory in nature, but they actually stem from the mirage of guilt and the basic mood disorder" (Doran et al., 1986).
2008 Lake, CR He attributes paranoia to either psychotic manic grandiosity or psychotic depressive guilt resulting in delusional persecutory fears for one'south life, thus discounting the validity of paranoid Schizophrenia.

Table ix.1.2. Instance Summaries of paranoid psychotic Mood-Disordered patients misdiagnosed with Schizophrenia

Case #
Initials		 Age/Sexual activity; Job/School Emergency department Presentation Initial Symptoms Initial Dx a Subsequent Symptoms Paranoia Acquired by Actual patient experience ("thread of truth") Concluding Dx a
1. Mr. B. R. 58/M; Ex-Vietnam Army officer; college grad chem major; now unemployed day laborer Handcuffed; paranoid, fearful, agitated, resistant; involuntary Feared emptying by CIA; feared poison PS b Decreased sleep with increased activities, grandiosity; lost 20 pounds due to "no fourth dimension to eat"; made over 300 phone calls to the CIA often betwixt midnight and 4 a.m.; sprayed automated gunfire through cranium in the middle of the night Believed he possessed disquisitional cognition about the Vietnam War that was embarrassing to the U.s.a. government who had sent the CIA to eliminate him Had fought in Vietnam BP-I Manic, Severe with Psychotic Features
two. Mr. One thousand. Five. 46/M; military officer, Colonel; college grad; PhD in engineering Escorted by MP'south; handcuffed; paranoid, fearful, agitated, resistant; involuntary Feared for his life from assassination by KGB and NSA; coded letters from TV PS b Decreased slumber with increased activities; grandiosity; called President Reagan multiple times; moved daily from cabin to cabin to escape assassination Believed he had a design for a "Star Wars" missile interceptor system that the KGB and NSA wanted for themselves Was a PhD rocket engineer BP-I Manic, Astringent with Psychotic Features
3. Mr. A. Z. 28/M; microbiology technician; college grad Delusional paranoia; assaultive; restrained in ED; involuntary Feared his murder by al-Qaeda was imminent; feared poison PS b Decreased sleep with increased activities; worked on his estimator 24/7 for weeks; grandiosity; marked weight loss due to no time and to fright of poisonous substance Believed God had named him as a Christian prophet and that al-Qaeda would electrocute him with anthrax because of his Christianity Was a microbiologist and in New York Metropolis on eleven September, 2001 BP-I Manic, Severe with Psychotic Features
4. Mr. B. Northward. 29/M; musician; college grad Police force escort; handcuffed; delusional paranoia; violent; restrained; involuntary Feared execution by Cuban Mafia; messages from TV and radio PS b Decreased sleep with increased activities; grandiosity; moved from urban center to city to escape harm Believed he had written a vocal worth millions that the Cuban Mafia wanted Was a Cuban musician who supported the anti-Castro effort BP-I Manic, Severe with Psychotic Features
5. Mr. M. S. 24/M; unemployed; college grad, chem major Delusional paranoia; disorganized; voluntary Feared execution past Cali Cartel PS b Decreased sleep with increased activities; fleeing for his life; grandiosity; kept walking and lived on the street to avoid capture Believed he possessed a formula to make constructed narcotics and then the Cali Dare wanted it and him expressionless Was from Colombia, SA, and a chemistry major BP-I Manic, Severe with Psychotic Features
half-dozen. Mr. East. J. 56/M; unemployed business firm painter; loftier school grad Delusional paranoia; disorganized; suicidal; voluntary Feared death at the hands of the devil and God; feared toxicant PS b Mail service-Schiz Dep c Decreased slumber; psychotic, suicidal depression followed by psychotic mania when he ordered 10,000 oysters in the shells dumped on his front yard for a party for the governor of the state of NC Believed he had sinned over 40 years before and deserved torture and death by God and the devil; believed he was friends with the governor Did steal $v from his gas station job at xv years of historic period for a date MisDx as MDD d ; and then BP-I, Manic, Astringent with Psychotic Features
7. Mr. A. N. 28/Grand; fast food restaurant worker; higher grad Delusional paranoia; handcuffed; catatonia; coprophilia; involuntary Feared his execution by "striking men"; poisonous substance PS b Decreased slumber with increased activities; disorganization due to racing thoughts; grandiosity; premeditated coprophilia with a purpose to get transferred to the land hospital to escape "hit men" who had infiltrated the unit Believed he was to gain ownership of his mom's banking concern but "hit men" were sent to impale him to get the bank for themselves; planned on millions in purchases Did brand trips to mom'due south bank on a regular footing for his mom BP-I Manic, Severe with Psychotic Features
8. Ms. Fifty. M. forty/F; unemployed lawyer; police force school grad Delusional paranoia; suicidal; voluntary Auditory hallucinations keeping up a running commentary; feared torture, execution PS b Psychotic, suicidal depression; delusional guilt; persecutory delusions; persistent psychosis with "downwardly drift" to homelessness; history of hypomanic episodes Believed she was such a failure that she deserved torture and death; then feared her torture and expiry Lost several legal positions and then was fired from fifty-fifty menial jobs due to recurrent severe depression BP-Ii, Depressed, Severe with Psychotic Features
9. Ms. G. S. 54/F; artist; Master's Caste in a rt from Tulane Univ Constabulary escort; delusional paranoia; assaultive; involuntary Feared "rogue CIA and Cuban Agents" trying to kill her; messages from TV PS b Decreased sleep with increased activities; had flown from NY to Chicago at last infinitesimal; extensive grandiosity; angry; violent; loud; intrusive Circuitous grandiose delusional system incorporating the jewels of the Queen of Spain, Fidel Castro, and the assassination of President Reagan Had visited Spain and Cuba and had a distant relative with a CIA position BP-I, Manic, Severe with Psychotic Features
10. Ms. D. R. 62/F; unemployed higher grad Law escort; delusional paranoia; involuntary Feared her imminent bump-off by "anti-Jewish foreign agents" PS b Decreased sleep with extensive writing to the The states Dept of Land for 20 to 24   hr a 24-hour interval sustained episodically over decades; fled lodging when TV or radio indicated she had been located; walked all night to escape; slept on the streets Believed she was an cloak-and-dagger "Strange Affairs Counselor" for the US State Dept covertly tasked to protect the Jewish people Had held a depression-level task in the US government in her 20s BP-I, Manic, Severe with Psychotic Features
eleven. Ms. South. C. 36/F; nurse; college grad, advanced RN degree Ambulance; unconscious due to overdose in a serious attempt to die Feared her capture by law enforcement, sentencing her to decease by execution PS b ; Post-Schiz Dep c Psychotic suicidal depression; endorsed full manic episodes in the past with decreased slumber and a marked increase in dangerous activities due to "spur-of-the-moment" impulses and lack of judgment Believed she had "murdered" by neglect a terminal, four-year-former patient under her care in hospice Had lost such a patient nether her hospice care BP-I, Depressed, Severe with Psychotic Features
12. Mr. L. C. 39/G; journalist; college grad Delusional paranoia; voluntary Feared assassination by CIA or FBI; messages from Telly and radio PS b Mixed symptoms of psychotic, suicidal depression along with racing thoughts, decreased sleep with increased activities such as uncharacteristically walking twenty miles to escape damage Complex grandiose delusional organization involving his assassination by the CIA and the FBI, messages from the TV and radio Was a journalist and expanded the subjects of some of his writings; believed he had a very valuable story BP-I, Mixed, Severe with Psychotic Features

CIA, Central Intelligence Agency; ED, emergency department; FBI, Federal Bureau of Investigation; NSA, National Security Bureau.

a
Dx diagnosis/diagnosed
b
PS Paranoid Schizophrenia.
c
Mail-Schiz Dep Post-Schizophrenic Depression.
d
MDD Major Depressive Disorder.

Psychosis and paranoia are common to severe Bipolar during both mania and depression. Psychotic low causes delusional guilt and paranoia that result from the conventionalities that grave sins take been committed and that punishment is deserved and imminent. Only every bit psychotic depression tin lead to guilt-induced paranoia, manic grandiosity readily gain to paranoia. For both manic and depressed patients with paranoid delusions, the fearfulness of harm and drive for survival overshadow the delusional grandiosity of mania and guilt of depression. Doctor focus on the paranoia misses the delusional guilt or grandiosity that are more conspicuously mood derived, leading to misdiagnoses. Psychotic idea processes are mutual to both severe depression and mania (Malaise et al., 2005). Traditionally considered unique to "Schizophrenia," paranoid psychosis, mild persistent cognitive defects, a ''arrears'' land of restricted bear on, avolition, and ''downward migrate'' are consistent with severe Bipolar, peculiarly during low. This affiliate offers 12 instance reports to support these ideas.

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Sexual response

Ami Rokach PhD , Karishma Patel MSc , in Human Sexuality, 2021

The clitoris: Anatomical and psychological issues

Some people call information technology "the dearest push button" or "the picayune human being in the boat." However, the clitoris, the pivotal organ of female sexual response, is far from being little. Most people assume that the part that is seen, the little button of mankind nestled between the labia and under the hood of its foreskin, is all at that place is to the clitoris (Blechner, 2017). O'Connell, Sanjeevan, and Hutson (2005), using magnetic resonance imaging (MRI), have shown that there is much more to the clitoris than meets the eye. They establish that the clitoris is a wishbone-shaped structure that is near 3.5   in. (nine   cm) in length and two.5   in. (6   cm) in width. The part that protrudes from the top of the vulva and is observable from the outside is the glans. Notwithstanding, the glans extends astern interiorly into the clitoral body. Information technology so splits downwards into two leglike parts, the crura, which are composed of erectile tissue and are located near the vagina and urethra (Mascall, 2006). This discovery, opined Blechner (2017), has several important implications for sexology, gender, and sexuality studies, clinical sex activity therapy, and psychoanalysis. To begin with, this discovery raises serious anatomy-based questions about Freud'due south original distinction between clitoral and vaginal orgasm, which is used by many to this day, and that in the class of "normal" development, the seat of female person sexual responsiveness moves from clitoris to vagina. This finding helps to materially footing the fact that the chief reason that intercourse is heady sexually is probably due to stimulation of the bulbs of the clitoris adjacent to the vaginal walls. In sexual intercourse, a different role of the clitoris may be stimulated from that during masturbation, merely the pleasance is still clitoral (O'Connell, Eizenberg, Rahman, & Cleeve, 2008). Next, O'Connell's description of the clitoral anatomy sheds light on the Grafenberg, or Grand-spot (Gräfenberg, 1950; Whipple, 2000), which is an area of heightened sexual responsiveness that can be felt through the anterior wall of the vagina. His proposition of that area was controversial, and some claimed that it does non exist at all. O'Connell et al.'southward (2008) findings suggest that the One thousand-spot may exist and is an area where the clitoral extensions of the crura are side by side to the vagina and receive special stimulation through the vaginal wall (Komisaruk, Whipple, Nasserzadeh, & Beyer-Flores, 2010; O'Connell et al., 2008). Aside from the theoretical importance of O'Connell et al.'s (2008) findings, their relatively precise clarification of the clitoris may impact surgery in the pelvic area of women, when such surgeries as hysterectomies and urinary surgeries, which can damage the neural connections of the clitoris, are considered (O'Connell et al., 2005; Yucel, de Souza Jr., & Baskin, 2004). Blechner (2017) observed that from ancient times to the present day, the anatomy of the clitoris has been discovered, repressed, forgotten, denied, or shrunk and rediscovered many times. These recent discoveries of clitoral anatomy call for a rethinking of our understanding of the female torso and sexuality from every perspective. We may say that what you see is not always what you become.

Why was the clitoris treated the style information technology was?

Hippocrates, the Greek doctor (460  BC), called the clitoris "columella," the fiddling pillar. About 500   years later, Galen, an Italian physician, denied the existence of the clitoris. "For Galen, the female genitalia is the contrary copy of the male genitalia. The male's penis corresponds, according to him, to the uterus…. No identify is fabricated for the clitoris, then that progress made by Aristotle and the physicians of Ephesus as regards the anatomy of the female sex is truly forgotten" (Di Marino & Lepidi, 2014, p. iii). In 1559, a Paduan surgeon named Renaldo Columbo claimed to have discovered the clitoris. He aptly described it as "the seat of women's delight…. If yous touch it, you will find it rendered a little harder and longer to such a degree that information technology shows itself as a sort of male person member" (Laqueur, 1990). Fallopia (who also discovered the fallopian tubes) also described the clitoris at about the same time. Yet not all contemporaries accepted the clitoris. Vesalius, the famous surgeon of Padua, disagreed forcefully. He insisted that the clitoris did non exist in healthy women and could only be plant in hermaphrodites (Blechner, 2017). Although O'Connell's discoveries were hailed by the media, she herself indicated that they were non new at all (Mascall, 2006; Williamson & Nowak, 1998). Past 1844, Georg Ludwig Kobelt, a German anatomist, had provided a comprehensive and authentic description of clitoral anatomy in his book The Male and Female person Sex activity Organs in Humans and Some Mammals, in the Anatomic Physiological Relation (Kobelt, 1844; Kobelt, 1978). Kobelt accurately reported that the clitoris is much larger than what we can find from the outside, that (every bit O'Connell discovered) it has a wishbone-shaped structure, and extends internally then that its total length can be up to 10   cm. Erectile tissue composes the parts of the wishbone that are not visible in the woman'due south external genitalia. Due to this extended internal structure, the clitoris tin can answer to stimulation of the external vaginal labia, the vagina itself, and the anus. Blechner (2017) concluded that Kobelt was precise and thorough in his description of the vagina.

One might expect that a scientific discipline like beefcake would be physical plenty so that the facts that it explores are researched and antiseptic, merely that does non seem to be the case. The cycle of suppression and rediscovery of the clitoris connected into modern times. For example, in the 1901 edition of Grey's Anatomy (Greyness, 1901) in that location is a cartoon of the female pelvis in cross section, and it shows a small protrusion with the label "clitoris." There are only scant details in this illustration of the clitoris, but at to the lowest degree it is there. In the next edition of Grayness'due south Beefcake published 47   years later (Goss, 1948), we can find an coordinating illustration of female genital beefcake but with the protrusion and the characterization "clitoris" gone. The clitoris has been entirely erased (Moore & Clarke, 1995). That pattern is not new. The clitoris disappears, and then, from time to time, some pioneers revive it, adopting a new worldview or a new technology. And while in the 1970s feminists took mirrors and viewed their genitals and and then described them, and thus influenced what textbooks published (Boston Women'south Health Book Collective, 1971), the old habits returned and the clitoris started to disappear again, non from female person bodies but from the anatomy texts that portray them. One suggested explanation is the gender of the anatomists that described the clitoris. Most anatomists are men. It is probably much more certain that had women been in charge of an anatomy textbook, they would not go out out the clitoris. Perhaps, suggested Blechner (2017), the problem is fearfulness of sexuality itself that the anatomists and gild have. The clitoris is the just human organ whose sole function seems to be sexual pleasure. The penis has the tasks of urination and fertilization of the ovum aside from contributing to sexual pleasure. Thus clitoris envy was suggested amid the reasons for the clitoris having been ignored for and then many centuries (see Marmor, 2004; Person, 1983).

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Nutrition and Breast Cancer

CHERYL L. Rock , WENDY Bind-WAHNEFRIED , in Nutrition in the Prevention and Treatment of Disease, 2001

b. Associations with Adiposity.

Hippocrates was the first to report an clan between obesity and breast cancer. The classic studies by Tannenbaum in the 1940s confirmed this premise, and in 1975 deWaard put forth the hypothesis that body nutriture affects risk—an effect mediated by hormonal levels. Despite these observations, it should be noted that a clear discrepancy exists with regard to adiposity and its ability to portend risk for premenopausal versus postmenopausal disease, with relative body leanness serving every bit a risk factor for disease occurring before menopause and obesity serving as a risk factor for postmenopausal breast cancer [ 69, 77, 78]. Many have speculated about the reasons for these differences, with some theorizing that trunk leanness may heighten early detection amidst younger women, whereas others adhere to the belief that premenopausal breast cancer is distinctly different from postmenopausal affliction, being governed more past genetic predisposition and growth factors rather than by long-term exposure to the interacting effects of ovarian steroid hormones and lifestyle factors [seventy, 79].

In addition to obesity, torso fatty distribution also appears to play a part in predicting risk for obesity. A majority of studies back up primal or visceral obesity (primarily assessed via waist:hip ratio) as an boosted take chances factor [69, 73, lxxx]. Results from a large cohort report by Sonnenschein et al. [81] (Due north = 8157) suggest that waist:hip ratio serves as an contained risk factor for premenopausal chest cancer, in which the increased presence of abdominal fat may exist linked to increased levels of insulin and related growth factors, whereas amidst postmenopausal women, waist:hip ratio may serve every bit another indicator of obesity. Studies by Sellers et al. [82] and London et al. [83] suggest that risk conferred by either obesity or waist:hip ratio may exist farther increased past a positive family unit history.

Given that weight is not a static mensurate and fluctuates throughout life, it is conceivable that risk may exist modified by the presence of obesity or torso weight status at differing ages. Although at that place is a dearth of information, some researchers accept speculated that the in utero experience, the hormonal milieu of the host mother and her weight gain during pregnancy, may plant a "gonadostat"—a hormonal thermostat that governs the hormonal levels of progeny after birth and thereby influences adventure for hormonally linked cancers [78]. Further research is necessary to either support or refute the presence of hormonal setpoints and the importance of maternal host factors. Indeed, one of the more astringent limitations to such inquiry, likewise as whatsoever studies that appraise lifelong exposure, is the reliance on instance-control studies and data that for the almost function are collected retrospectively.

Studies that take assessed weight prior to or during early adulthood suggest that obesity may actually exist protective [84, 85]. This relationship appears logical for premenopausal chest cancer, in which relative obesity is already an acknowledged protective factor. Nevertheless, given the human relationship between increased weight and early menarche, it is difficult to reason why early obesity would be protective for postmenopausal chest cancer. Recent studies, however, indicate that although increased torso weight during childhood is predictive of early menarche (among both alpine and obese girls), obese girls have significantly fewer ovulatory cycles and thereby have lower circulating levels of both estrogen and progesterone—hormones that are known to stimulate breast cancer growth [86, 87].

On attainment of adulthood, especially during afterwards machismo, at that place appears to be a consistent finding of weight gain and increased body weight being highly associated with increased take chances for postmenopausal cancer [69, 71, 77, 88, 89]. The reader is referred to reviews past Ballard-Barbash [69] and Ziegler [71], who provide detailed data and estimation of body weight and other anthropometric markers in relation to breast cancer take a chance. In the case of adventure associated with adult weight proceeds, this increased risk has been largely explained by the fact that as women age, their circulating levels of estrogen go more influenced by estrogens produced by adipose tissue rather than those produced by the ovary [79, 89]. Weight gain later age forty years is besides is more likely to be deposited in an android versus gynoid pattern and hence may foretell insulin resistance and the increased production of insulin and insulin-like growth factors that may act synergistically with estrogen to confer chance [69, 77, 88].

Additionally, increased body weight at diagnosis has been recognized as a poor prognostic cistron for breast cancer for more than 25 years [90–92]. While obese women are more than likely to exhibit advanced stage disease at the time of diagnosis, more than than 13 large accomplice and case-command studies suggest increased body weight equally a adventure factor for recurrent disease even after controlling for menopausal status, age, stage, tumor size, and nodal involvement [71, 91–94]. Furthermore, weight gain after diagnosis also increase hazard for recurrent disease and mortality (discussed below).

Because body weight is a modifiable risk factor, diet and concrete action may be beneficial for the prevention and management of chest cancer. Few information, however, currently be regarding weight loss relative to take a chance. Results are conflicting and confounded by the inability of studies to discern whether reported weight loss was the event of voluntary or involuntary efforts [69].

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Social Anxiety in Children and Adolescents: Biological, Developmental, and Social Considerations

Michael F. Detweiler , ... Anne Marie Albano , in Social Anxiety (Third Edition), 2014

Temperament

Hippocrates, the father of modernistic medicine, proposed a theory in the quaternary century BC that emotions had a predominantly physiological basis and differences were due specifically to fluctuations in body fluids chosen "humors." In the 2d century Advertising, the Roman dr. Galen congenital upon Hippocratic sense of humour theory and proposed four classic "temperamental" grapheme styles—melancholic, phlegmatic, sanguine, and quick-tempered. Today, the idea of an innate, constitutionally based grapheme style persists, although considerable controversy exists ( Buss & Plomin, 1984; Rothbart & Derryberry, 1981; Rothbart & Posner, 1985; Seifer & Sameroff, 1986; Strelau, 1983; Thomas & Chess, 1977). Although presumed to have a physiological basis, specific biological processes associated with temperament have been difficult to identify and study (Kagan, 2001). Further, there is disagreement regarding the classification and number of distinct temperamental styles (cf., Goldsmith & Campos, 1982; Kagan, Reznick, & Snidman 1988; Rothbart, 2004; Thomas, Chess, & Birch, 1968). Temperament is generally defined as unlearned, constitutionally based individual differences in both presentation manner and ability to regulate emotion, attention, and behavior (Rothbart & Bates, 2006; Rothbart, Ellis, & Posner, 2004). Simply put, developmental clinicians view temperament as a predisposing dispositional gene that can either aid or hinder a child's adaptation to their environmental setting (Clark & Watson, 1999; Rothbart & Bates, 2006). A considerable inquiry base has been devoted to the degree to which temperament serves as a risk factor for hereafter psychopathology, either directly or indirectly through elicited changes to parental caregiving (Barron & Earls, 1984; Betts, Gullone, & Allen, 2009; Cutrona & Troutman, 1986; Essex, Klein, Slattery, Goldsmith, & Kalin, 2010; Kagan, Reznick, & Snidman 1988; Lerner, Castellino, Patterson, Villaruel, & McKinney, 1995; Putnam, Sanson, & Rothbart, 2002). For example, Thompson, Connell, and Bridges (1988) found a fearful temperamental style had both a direct and indirect influence on children's social interaction. Eisenberg and colleagues (2001; 2005) examined a temperamental manner termed negative emotionality (Rothbart & Bates, 2006) and found its components contribute differently to internalizing versus externalizing problems, with internalizers more prone to fear and shyness (encounter also Bates, Pettit, Dodge, & Ridge, 1998; Leve, Kim, & Pears, 2005). A temperamental style marked by high negative emotionality plus physiological over-arousal has been linked to anxiety bug later in life (Dark-brown, Chorpita, & Barlow, 1998; Chorpita & Daleiden, 2002; Lonigan, Carey, & Finch, 1994; Watson, Clark, & Carey, 1988).

A considerable amount of attending has been applied to the study of behavioral inhibition, an anxious temperamental style marked past exaggerated physiological responding (Schmidt & Fox 1998; Schmidt, Fob, Schulkin, & Golden, 1999; Schmidt, Fox, Sternberg et al., 1999), attentional hypervigilance (Perez-Edgar & Fox, 2005) and an avoidant behavioral way in unfamiliar situations (Kagan et al., 1988). Several studies have identified an association between behavioral inhibition with an increased risk for social phobia later in life (Biederman et al., 2001; Caspi, Moffitt, Newman, & Silva, 1996; Chronis-Tuscano et al., 2009; Hayward, Killen, Kraemer, & Taylor, 1998; Hirshfeld et al., 1992; Muris, Merckelbach, Wessele, & Van de Ven, 1999; Muris, Merckelbach, Schmidt, Gadet, & Bogie, 2001; Reznick, Hegeman, Kaufman, Woods, & Jacobs, 1992; Schwartz, Snidman, & Kagan, 1999). In one study, 61% of children identified as being behaviorally inhibited at age 2 had social feet when evaluated at age xiii (compared with but 27% of those identified equally beingness uninhibited), and this relationship was specific for generalized social anxiety just not other forms of anxiety (Kagan, 1989; Schwartz et al., 1999). Similarly, Hirshfeld-Becker and colleagues (2007) conducted a five-year follow-upward of children assessed for temperament and also found behavioral inhibition significantly predicting new onset of social phobia in middle childhood, without observing an association with this temperamental style and any other anxiety disorders.

In addition to behavioral inhibition in early childhood, research has identified several other temperamental and behavioral styles that may influence the evolution of social anxiety, including the expression of dysregulated fear. Toddlers with a dysregulated fright contour respond to low-threat situations with disproportionately loftier levels of fear, declining to calibrate fright levels to actual danger, and prove social wariness during preschool and early kindergarten (Buss, 2011). In a follow-upwardly study conducted by Buss and colleagues (2013), dysregulated fright at age two predicted anxious behavior during laboratory interactions with both unfamiliar peers and adults at age five. This profile also emerged equally a strong predictor of future damage, as children with greater dysregulated fear at age two were four times more than likely to bear witness high levels of social feet symptoms in kindergarten.

Anxious-lone behaviors incorporate yet some other temperamental construct that may relate to social anxiety. Compared to controls, Gazelle, Workman, and Allan (2010) constitute that tertiary and fourth graders identified past peers as anxious-lonely were at greater risk for developing social anxiety disorder over fourth dimension, besides as other anxiety disorders. Children fitting this description are verbally and behaviorally inhibited, even among familiar peers, are hesitant to socialize, and often engage in "solitary on-looking beliefs." For more discussion of temperament and social anxiety, please refer to the affiliate by Kagan (Chapter 12) for a more than detailed review.

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