1.c) Undertake a literature search on osteoporosis inorder to update and revise your knowledge of this disease in more depth. 2.d); 3. b); 4. d); 5. a); 6. a) What do you know about ultrasound? Thinkabout how you can find more information about the different types of ultrasoundequipment available. Discuss with your colleagues the value of the differenttypes of equipment in your work area. 7. c); 8. d) Review the healthpromotion work that you do on “healthy living and healthylifestyles”. Do you cover, or take into account osteoporosis in this work?9. b); 10. b) Design a programme or a poster on osteoporosis awarenessfor use in your area of practice. Comments are closed. Related posts:No related photos. Previous Article Next Article Learning for life: OsteoporosisOn 1 Jul 2001 in Personnel Today Life Long Learning and Continuing Professional Development are the processesby which professionals, such as nurses, develop and improve their practice. There are many ways to address CPD: formally, through attending courses,study days and workshops; or informally, through private study and reflection.Reading articles in professional journals is a good way of keeping up-to-datewith what is going on in the field of practice, but reflecting and identifyingwhat you have learnt is not always easy. These questions are designed to helpyou to identify what you have learnt from studying the article. They will alsohelp you to clarify what you can apply to practice, what you did not understandand what you need to explore further. 1. Osteoporosis affects a) All women b) One in three women c) One in three women and one in 12 men d) One in 12 women and one in three men 2. Per year osteoporosis costs the NHS a) £15,000 b) £150,000 c) £1.5m d) £1,500m 3. Half the survivors of a fractured hip a) Are permanently disabled b) Never regain their former level of independence c) Always regain their level of independence d) Make a complete recovery 4. New bone is laid down by cells called a) osteoclasts b) osteobasts c) osteophytes d) osteoblasts 5. The World Health Organisation defines osteoporosis in terms of a) Bone density b) Fracture risk c) Post-menopausal age at time of fracture d) Ratio of healthy bone 6. Ultrasound is ideal in a community setting because it is a) Safe, painless, portable and quick b) Safe, painless, portable and inexpensive c) Safe, painless, inexpensive and quick d) Safe, quick, inexpensive and portable 7. Which of the following is NOT part of an osteoporosis risk assessment?a) It must be carried out by trained personnel b) There must be an auditable set of procedures c) It must use the most easy-to-use equipment d) The full range of risk factors should be investigated 8. Women can take action to reduce bone loss by a) Taking medication b) Seeing their doctor for a prescription c) Doing nothing and resting d) Following a healthy lifestyle 9. Which of the following is NOT an increased risk factor inosteoporosis? a) Early menopause b) Regular exercise c) Previous fracture after a minor accident d) Family history of a broken hip 10. Occupational health nurses can help to a) Take on the work of the GP b) Prevent 200,000 fractures a year in the UK c) Carry out tests as no special training is needed d) Reduce GPs’ budgets Feedback
Previous Article Next Article UK organisations still have a lot of work to do before the Information andConsultation Directive becomes law this time next year, Will Hutton has warned.Speaking exclusively to Personnel Today, the chief executive of The WorkFoundation, said he hoped UK employers would be ahead of the game, but fearsthat the reality will be somewhat different. “The legislation will create more demands on employers and another setof arguments,” he said. “UK companies don’t do enough talking withtheir workforces and there needs to be an increase in dialogue.” Hutton expects employees and unions to demand earlier and more detailedconsultation. “They will say ‘thank you for consulting with us – but why didn’t youdo it earlier and is that all you’ve got to tell us?’,” he said. He said the workforce was shrinking while the economy is in a period ofalmost unprecedented growth. “One of the main problems is that we need every woman to have 2.1babies if the UK population is to remain stable. British women are simply notdelivering the babies we need.” He urged businesses to look to older workers as a potential solution to theproblem. “The good thing about older people is they tend to be more stable, moreloyal and more committed workers,” he said. Related posts:No related photos. UK has long way to go on keeping workers informedOn 16 Mar 2004 in Personnel Today Comments are closed.
Brookfieldbrookfield asset managementBrookfield Property PartnersRetail Real Estate Share on FacebookShare on TwitterShare on LinkedinShare via Email Share via Shortlink Share via Shortlink Through a sprawling web of associated entities, Brookfield is one of the country’s biggest real estate investors, particularly in office and retail (Illustration by Maciej Frolow)Standing in front of a mostly virtual audience in a fitted dark suit with slicked-back salt-and-pepper hair, Brian Kingston attempted to calm investors’ nerves about the coronavirus’ impact on real estate.“Ultimately, this is temporary,” the CEO of Brookfield Property Partners said at the firm’s investor day in late September. “We will recover, we’ll come out the other side of it.”The numbers were concerning: As of Sept. 18, only about 10 percent of Manhattan workers had returned to the office, according to CBRE. An August survey of hundreds of CEOs by KPMG showed that 69 percent of them planned to downsize their long-term space requirements. Brookfield Property Partners is among New York City’s largest office landlords — it controls about 27 million square feet in the city —and is in the midst of building an office megacomplex known as Manhattan West. The company’s U.S. retail portfolio — a mall-heavy 120 million square feet — was also coming under stress. Just days before the investor conference, the firm told employees it was cutting roughly 20 percent of its retail staff and suggested it would shed some of its assets.While most retail and office landlords have been hit by the coronavirus, Brookfield Property Partners has far more leverage than its American peers. But as a Canadian company, it can value its assets differently. At the heart of these differences is the company’s accounting. Unlike its American rivals, who report under GAAP, Brookfield Property Partners uses IFRS, an accounting standard commonly used by foreign companies. Under IFRS, the company has greater discretion over its real estate asset valuations — it does not have to base its valuations on independent third-party appraisals and can instead devise them based on internal assessments. To put it simply: The listed values of its properties may not reflect current market conditions if Brookfield’s leaders choose not to sufficiently adjust them.In a rising market, those distinctions may not matter. But given that the company collected just about 35 percent of its retail rents in the second quarter and long-term office occupancy is in flux, the question becomes: Does Brookfield’s balance sheet fully reveal the health of its assets?We the NorthBrookfield declined to make executives available for an interview, but provided written responses to The Real Deal’s questions. Brookfield Property Partners is one of the largest commercial landlords in the U.S., but its roots are deeply Canadian. Edper Investments, precursor to Brookfield Property Partners’ parent company Brookfield Asset Management (BAM), was founded by members of the Bronfman family of the Seagram liquor fortune.This Canadian pedigree gives the firm a competitive advantage over local U.S. real estate investors. IFRS allows Brookfield Property Partners to rely on its management’s own judgment. “Even though you have a reasonable amount of discretion in the United States, you even have a hell of a lot more with IFRS,” said James Cox, a securities law expert at Duke University.Under IFRS, Brookfield Property Partners does not need to turn to third parties to assess the value of its real estate assets. Instead, the company can base valuations on its internal assessments. Meanwhile, companies that report under GAAP usually base valuations on historical cost — i.e., how much the assets traded for. Al Rosen, a Toronto-based forensic accountant who predicted the collapse of Canadian telecom giant Nortel Networks, likens IFRS to an 8-year-old preparing their own report card.“The rules themselves allow you to pick the numbers,” said Rosen, speaking generally about IFRS and not specifically about Brookfield. “This bullshit does not get exposed enough in Canada.” Brookfield Property Partners said it uses third-party appraisers to “compare the results of those external appraisals to our internally prepared values.” And those numbers, according to the firm, match up pretty closely. In its most recent quarterly report, the company said it used external appraisals on 14 percent of its office portfolio, and that those appraisals were within 0.5 percent of management’s valuations. But there is no mention in the report of whether Brookfield conducted these appraisals for its retail portfolio. Retail was among the sectors hardest hit by the pandemic, and thus retail properties were at greater risk of losing value. Over the years, BAM and its subsidiaries have faced scrutiny for how they value assets. Roddy Boyd at the Foundation of Financial Journalism first highlighted these issues in 2013. A September report by Dalrymple Finance, an investment firm run by short seller Keith Dalrymple, also flags some of these concerns.Given the pandemic, some of Brookfield’s peers wrote down their asset values substantially. A look at Brookfield Property Partners’ second-quarter financial statements, however, reveals that the company did not follow suit. (The company says its valuations are “compared to market data, third-party reports, research material and broker opinions” for Brookfield to review. )Brookfield Property Partners’ joint venture in the Ala Moana Center, a 2.2 million-square-foot retail center in Honolulu, saw its carrying value decline just 3.75 percent to $1.87 billion in June from December. Hawaii’s tourism has fallen off dramatically since the state ordered mandatory quarantines for out-of-state travelers in March. Neiman Marcus, one of the center’s anchor tenants, filed a WARN notice Sept. 21 announcing plans for mass layoffs at the store and stated that “there is no realistic prospect for store revenues to recover to a sustainable level in the foreseeable future.” Mahattan WestSome of Brookfield Property Partners’ valuations even went up during the height of the pandemic.In Las Vegas — where the unemployment rate is above 15 percent and the Strip shut down for the first time since the JFK assassination in 1963 — the company reported increases in its carrying values of its retail properties. In the six-month period ending in June, its valuation of its stake in the Grand Canal Shoppes rose to $423 million from $414 million, while its stake in the Fashion Show Las Vegas shopping center also increased in value, to $846 million from $832 million.A Brookfield spokesperson said the change in the Las Vegas valuations “was a result of several recently signed leases at above expected rents.”Overall, Brookfield Property Partners claims that its “proportionate fair value” of its core retail properties declined by just 3.35 percent to $34 billion over the first half of 2020, according to the company’s second-quarter supplemental report.Compare that to U.K. real estate REIT British Land, which also reports under IFRS and marked down its U.K.-centric retail portfolio by about 26 percent to 3.9 billion pounds. Unibail-Rodamco-Westfield, a Paris-based mall conglomerate that uses IFRS, wrote down the valuations of its U.S. mall portfolio by about 5 percent.“We have made substantial progress in reaching agreements with tenants in regards to their rental arrears, and current collection rates are materially higher,” a Brookfield spokesperson said of the health of its retail portfolio since its most recent filing. In September, Kingston told financial news publication PERE that the dire prognostications about retail mirrored what was being said in 2010, when BAM invested in retailer General Growth Properties (GGP) to pull it out of bankruptcy. That bet, Kingston said, turned out to be lucrative.“We’re looking at this period of time the same way,” he said. “There is clearly disruption happening in the market. But ultimately we take a long-term view that high-quality real estate assets will hold their value and recover when the economy recovers.”Flatt out investingToronto-based BAM is a closely held conglomerate with interests in everything from railroads to hydroelectric dams to office buildings. With about $550 billion in assets under management, there are few companies with such resources, reach and power. The SoNo CollectionFrom the 1970s to the 1990s, the company, then known as Edper, was led by Jack Cockwell, a tough South African-born accountant. Edper almost collapsed under its debt, but survived and expanded its real estate holdings by acquiring the assets of the failed Canadian conglomerate Olympia & York in the mid-1990s. Those properties included the World Financial Center in Lower Manhattan, later rebranded as Brookfield Place.In 2002, Cockwell handed over the reins to Bruce Flatt, a fellow accountant from the Canadian province of Manitoba. That leadership transition marked the beginning of one of the world’s most aggressive investment sprees. A 2017 Forbes cover story described Flatt as the “Billionaire Toll Collector of the 21st Century.” BAM and its subsidiaries are now among the world’s largest property owners. The investment giant has a major stake, along with the Qatar Investment Authority, in the Canary Wharf megadevelopment in London. (QIA is a substantial investor in Brookfield Property Partners, owning roughly 7 percent of the company as of the end of 2019, filings show. It is also a significant investor in the firm’s Manhattan West development, owning 44 percent.)In 2018, Brookfield Property Partners acquired the rest of GGP for $9.25 billion in cash, making it one of the largest mall owners in the U.S. This August, Flatt disclosed that BAM had raised a record $23 billion in the second quarter, with over half of that earmarked for distressed-debt investing. In New York, Brookfield is a commercial behemoth with a penchant for rescuing high-profile players from struggling projects: In April 2018, Brookfield Property Partners paid Somerset Partners and the Chetrit Group $165 million for a sprawling waterfront site in the South Bronx, a project for which the developers had struggled to land financing. A month later, BAM was in advanced talks to take over the ground lease at Kushner Companies’ albatross, a 41-story office and retail skyscraper at 666 Fifth Avenue; it closed on that transaction over the summer. “We like them, we like their culture, it’s very similar to our company culture,” Charlie Kushner, founder of the firm, said of Brookfield in a 2018 interview with TRD. All in the familyThe Brookfield name is ubiquitous in U.S. real estate, but it can be difficult to discern which arm of the organization owns which property. That’s because Brookfield Property Partners often makes deals with other Brookfield entities.(Click to enlarge)These transactions — known as related-party deals — are sparsely disclosed in quarterly filings with securities regulators. Take, for instance, Brookfield Property Partners’ 2018 sale of a 27.5 percent stake in a New York office portfolio for $1.4 billion to BAM.“The only reason we did that,” Flatt told the Financial Times, speaking of the sale in a profile of the company in 2019, was that “it [BPY] needed some extra capital. And this was an easy way to do it.” While Brookfield Property Partners disclosed the sale in its quarterly filings, it did not disclose a comprehensive list of the properties included at the time. In response, a Brookfield spokesperson said, “the specific assets within that portfolio are well known to our investors and industry participants and easily accessible on our website and in other public-facing materials.”In August 2019, Brookfield Property Partners sold an 81 percent stake in its 700,000-square-foot SoNo Collection mall in Norwalk, Connecticut, in a deal it said was worth $419 million.“This is a fully stabilized mall in one of the highest-income demographics in the United States. We made a lot of development profit on this one,” Kingston said during the company’s third-quarter earnings call.The deal was, in fact, between two related parties: Brookfield Property Partners and a BAM-controlled investment fund. Kingston briefly mentioned this on the call, and Brookfield Property Partners did disclose a related-party transaction for a retail asset, but did not specifically identify the asset in its third-quarter report. The deal was disclosed as a related-party transaction and the asset was named, however, in Brookfield Property REIT’s annual filing.“We have a robust process in place for managing all related-party transactions to ensure that any potential conflicts of interest are handled appropriately,” a Brookfield spokesperson said.Such moves have attracted government attention in the past. In the summer of 2017, the SEC asked Brookfield Property Partners for clarification on a series of transactions the firm had first disclosed in its 2015 annual report.Sixteen Brookfield senior officers invested $2 million in an entity called 9165789 Canada Inc., which held an indirect minority interest in a Downtown Los Angeles office portfolio, the company’s disclosures show. The transaction appeared to give Brookfield senior officers total control over the entity. “The arrangement,” Brookfield said in the report, was to “align executives’ interests with those of the partnership.” Brookfield did not disclose who these officers were or how much money they would make from the deal. Bills, bills, billsAsset valuation disclosures are important because they help illustrate a company’s financial health.And understanding Brookfield Property Partners’ current health is important for its investors, because the firm has a hefty debt burden, with $9 billion of its nearly $48.9 billion in debt obligations coming due this year and in 2021, its second-quarter supplemental filing shows. (The second-quarter filings show $13.6 billion of secured debt coming due; the company said the discrepancy is because the supplemental filing only reflects the debt associated with the company’s specific interests in properties.)The firm may be poised to take on more debt in the near future, as it and Simon Property Group are finalizing a $1.75 billion deal to buy J.C. Penney — a key anchor tenant at both operators’ malls — out of bankruptcy. In May, BAM announced a “retail revitalization program,” which would recapitalize struggling retailers in markets where Brookfield is active. The company said it was targeting seed funds of $5 billion for the initiative. In July, Moody’s downgraded its rating of Brookfield Property REIT (not to be confused with Brookfield Property Partners), which owns 122 retail properties across the U.S. The agency cited the REIT’s “elevated leverage entering the pandemic and the high likelihood of weakening operating income” as reasons for the downgrade, but said the high quality of its assets and the backing of its parent companies were credit positives.As it stands, Brookfield Property Partners is far more leveraged than other major U.S. mall owners. Its debt-to-EBITDA ratio — a common measure of leverage — was 16 in the second quarter, according to Yahoo Finance. That’s compared to 7.1 for Simon Property Group and 12.2 for Taubman Centers in the same period. Brookfield Property Partners’ access to BAM, of course, gives it firepower those rivals cannot count on. For that privilege, Brookfield Property Partners pays BAM a minimum annual fee of $50 million, plus an “equity enhancement fee,” according to its annual report. At the September investor day, many of these issues surrounding its leverage didn’t come up. Instead, executives pitched their stock as a value opportunity. Like real estate, they argued, buying at the bottom of a cycle allows more upside than buying at the top.“Today, our shares trade at a significant discount to the underlying value of our real estate,” Kingston said. The value of that underlying real estate? That’s up to Brookfield. Tags
This study provides the summary of the reports of the geographical distribution in the Maritime Antarctic and sub-Antarctic regions of Parochlus steinenii (Gercke, 1889) (Diptera, Chironomidae), the only flying insect occurring naturally in the Antarctic continent. The distribution encompasses the South Shetland Islands (Maritime Antarctic), South Georgia (sub-Antarctic), and parts of the Cape Horn Biosphere Reserve (CHBR, southern Chile). In total 78 occurrence records were identified, 53 from our own records, 19 from the literature, and six from other data present in GBIF. Of the 78 records, 66 are from the South Shetland Islands, eight are from South Georgia, and four from the CHBR. This database was developed as one of the main objectives of two Chilean-funded research projects addressing understanding the effects of climate change on sub-Antarctic and Antarctic insects. It provides dataset documenting the distribution of Parochlus steinenii in the Maritime Antarctic, the sub-Antarctic, and the CHBR in southern South America (Chile). The complete dataset is available in Darwin Core Archive format via the Global Biodiversity Information Facility (GBIF).
Written by FacebookTwitterLinkedInEmailiStock(NEW YORK) — Here are the scores from Thursday’s sports events: MAJOR LEAGUE BASEBALLNATIONAL LEAGUE PLAYOFFSSt. Louis 7, Atlanta 6LA Dodgers 6, Washington 0NATIONAL FOOTBALL LEAGUESeattle 30, LA Rams 29 NATIONAL HOCKEY LEAGUECarolina 4, Montreal 3Buffalo 3, Pittsburgh 1Nashville 5, Minnesota 2Boston 2, Dallas 1Colorado 5, Calgary 3Anaheim 2, Arizona 1Copyright © 2019, ABC Audio. All rights reserved. Beau Lund October 4, 2019 /Sports News – National Scoreboard roundup — 10/3/19
Home » News » Housing Market » 500,000 homeowners aged 55+ want to move but don’t previous nextHousing Market500,000 homeowners aged 55+ want to move but don’tThe Negotiator25th October 20160737 Views One in five (19per cent) homeowners aged 55 or over considered moving in the past two years but have not done so; equating to more than 2 million homeowners.23per cent of them say lack of suitable housing was the main reason they did not do so, which equates to 500,000 homeowners.According to the annual Homeowner survey conducted by YouGov for HomeOwners Alliance and BLP Insurance, 6per cent of homeowners aged 55 or older say they have moved in the two past years and a further 19per cent have considered moving but not done so – the equivalent of more than 2 million homeowners.The survey revealed that it is emotional ties more than financial concerns that are a significant barrier to moving home in later life. The stress of moving is more likely to be among the reasons not to move for homeowners age 55+ who considered a move (30per cent vs 21per cent homeowners overall), as well as, not wanting to move away from friends, neighbours and their community (23per cent v 17per cent homeowners overall).Paula Higgins, CEO of HomeOwners Alliance, said, “The recent Brexit decision means we are now in the midst of uncertain times and new housing is likely to be a victim. Government needs to focus efforts on negotiating a European exit but they must not drop the ball in delivering new housing that meets the needs of last time buyers. House builders can’t be allowed to sit on their hands and land bank. The government needs to keep them building and building houses that meet the needs of last time buyers as well as first time buyers.”homeowners aged 55+ movers housing market senior homeowners October 25, 2016The NegotiatorWhat’s your opinion? Cancel replyYou must be logged in to post a comment.Please note: This is a site for professional discussion. Comments will carry your full name and company.This site uses Akismet to reduce spam. Learn how your comment data is processed.Related articles Letting agent fined £11,500 over unlicenced rent-to-rent HMO3rd May 2021 BREAKING: Evictions paperwork must now include ‘breathing space’ scheme details30th April 2021 City dwellers most satisfied with where they live30th April 2021
View post tag: Defense Military administration agencies of Black Sea Fleet (BSF) are passing comprehensive tests in accordance with working plan of Russian Defense Ministry Inspection.In particular, inspection group headed by Principal Military Inspector Gen Lt Gennady Borisov held ceremonial review of the fleet’s top-ranking officers. Admirals, generals and officers passed exams in campaign tactics, military codes, and special subjects. Inspectors checked conditions of operational and combat training of BSF military administration agencies, and held physical drills.It is also planned to check professional skills of the fleet’s staff officers.[mappress]Source: rusnavy, October 10, 2011 View post tag: BSF View post tag: Russia Authorities Share this article View post tag: Ministry View post tag: Inspects View post tag: News by topic View post tag: Naval View post tag: Navy Russia: Defense Ministry Inspects BSF October 10, 2011 Back to overview,Home naval-today Russia: Defense Ministry Inspects BSF
The University of Florida College of Medicine, Department ofPsychiatry is currently recruiting for a Child Psychiatrist to filla faculty position in the Child and Adolescent Division. This is afull-time, (1.0 FTE), multi-mission, non-tenure track facultyposition. This position will have a critical role on the PediatricPsychiatry Consult Service, providing consultation to UF ShandsChildren’s Hospital on a half-time basis. This position will alsoinvolve coverage of child/ adolescent inpatient services andprovision of outpatient services and community-based for childpatients in the Department of Psychiatry. This position will play akey role in teaching students, residents, and scholarship inpromoting the missions of the Division of Child and AdolescentPsychiatry at the University of Florida. Rank will be commensuratewith qualifications.The University of Florida is located in Gainesville, a city ofapproximately 125,000 residents in North- Central Florida: visitthe city of Gainesville website http://cityofgainesville.org/community/aboutGainesville.aspx Applicant must have completed a Child and Adolescent PsychiatryFellowship. Applicant must be Board Certified and/or Board EligibleM.D. and must have or able to obtain a State of Florida MedicalLicense.Interested applicants are required to apply through Careers at UFwebsite http://jobs.ufl.eduApplicants must attach their Curriculum Vitae and Letter ofInterest. Applicants must email three letters of recommendations toSearch Chair: Andres Pumariega, M.D., Chief and Clinical Professoremail address [email protected] of applications will begin immediately and will continueuntil a sufficient applicant pool has been established.Selected candidate will be required to provide an officialtranscript to the hiring department upon hire. A transcript willnot be considered “official” if a designation of “Issued toStudent” is visible. Degrees earned from an education institutionoutside of the United States are required to be evaluated by aprofessional credentialing service provider approval by NationalAssociation of Credential Evaluation Services (NACES), which can befound at http://naces.org/ .If an accommodation due to a disability is needed to apply for thisposition, please call 352-392-2477 or the Florida Relay System at800-955-8771 (TDD). Hiring is contingent upon eligibility to workin the US. Searches are conducted in accordance with Florida’sSunshine Law.#category=35The University of Florida is committed to non-discrimination withrespect to race, creed, color, religion, age, disability, sex,sexual orientation, gender identity and expression, marital status,national origin, political opinions or affiliations, geneticinformation and veteran status in all aspects of employmentincluding recruitment, hiring, promotions, transfers, discipline,terminations, wage and salary administration, benefits, andtraining.
The Judicial Council announced two tickets for the upcoming elections for the offices of student body president and vice president.Juniors Becca Blais and Sibonay Shewit along with juniors Rohit Fonseca and Daniela Narimatsu Felippe both received the requisite 700 signatures to be eligible for the electoral process.A debate is scheduled for Feb. 6, and the candidates have also been invited to a forum with the student group We Stand For on Feb. 2. The election will take place Feb. 8.If neither ticket receives a majority of the vote, a run-off will take place between the two. Should that be the case, a second debate is set for Feb. 12, and the final election will take place Feb. 14., according to the Judicial Council’s website. The winning ticket will take office for the 2017-2018 term April 1, succeeding current student body president Corey Robinson and Blais, who is also the current student body vice president.The Blais-Shewit ticket emphasizes “innovation, transparency and consistent outreach” according to official campaign materials. Blais and Shewit include offering better follow-up resources and support for victims of sexual assault, hiring a Diversity and Inclusion officer to oversee student training and pushing the University to offer free STD testing in St. Liam’s.The Fonesca-Narimatsu campaign is focused on “serving the community and guiding with a purpose,” according to their platform.Fonesca and Narimatsu include moderated roundtable debates amongst groups of students, publishing a quarterly report on reported sexual assaults, Monday morning prayers with the student body president and broadening the Grab and Go options.Tags: elections, president, Student government, Vice President
April 15, 2002 Regular News The inner world of depression The inner world of depression Garth W. Amundson and Heidi D. SchwartzDepression is the single most common emotional problem with which people struggle. Its symptoms include feelings of listlessness or sadness, sleep and appetite disturbances, and a lack of joy in life.Underlying these symptoms are often pervasive and profoundly painful feelings of worthlessness. The depressed person often feels burdened, at times even tormented, by thoughts of his or her real or perceived failures.For some people, feelings of worthlessness are so intense and/or unremitting that they lose hope in their ability to manage their lives. They may resort to abuse of drugs and alcohol to numb their emotions. However, these attempts at self-medication ultimately fuel feelings of helplessness, and render the individual progressively less able to meet the demands of daily life. As the individual becomes less able to manage his or her daily affairs due to substance abuse, feelings of failure and following this, self-blame increase further.Other people attempt to soothe feelings of self-recrimination by withdrawing from contact with others. Attempts at isolating from others are sometimes driven by the belief that truly responsible and “strong” people should be able to manage these feelings on their own. Isolation may also follow from shame, rooted in the individual’s belief that he or she is a burden on others. However, withdrawal may ultimately leave the individual feeling more helpless and desperate than ever. This is because the individual who isolates him or herself socially is eventually left without the interpersonal support needed to solve concrete problems of living. Causes of Depression There are various causes of depression. For example, there is research now underway that will hopefully clarify the extent to which biochemical or genetic factors play a role in the genesis of this disorder. This research may pave the way for promising new medical treatments. From a psychological perspective, we know that adults who, as children, were placed in a caretaker role in their family of origin are more prone to depression because they were usually only rewarded for taking care of others. As adults, these individuals find it hard or, in some cases, impossible to identify effective ways to take care of themselves. They may even feel that they have no right to have their own, separate wishes or needs, and may feel profoundly guilty or ashamed for asserting themselves in ways that most other people deem appropriate. Help Through Psychotherapy How does psychotherapy help the depressed person? The answer comes in two parts. First, therapists who are successful in treating depression are aware of, and sensitive to, the depressed person’s anticipation of rejection for sharing feelings, since expressing emotional needs is a form of self-care running counter to the messages they received in childhood (i.e., to be “strong,” to keep personal and family affairs private, etc.).Second, putting feelings into words can be the prelude to beginning to understand some of the historical roots of current dilemmas.Talking with a therapist is different from talking with a friend or family member. First, the therapist brings experience to bear on understanding how to help someone struggling with depression. Second, unlike friends or family, the therapist is more likely to be optimally objective about the client’s difficulties. Related to this is the fact that the client benefits from the private, protected nature of his or her relationship to the therapist, by the knowledge that the therapist does not feel influenced by the opinions of friends and family. Garth W. Amundson, PsyD., is a licensed clinical psychologist. Heidi D. Schwartz, is a Licensed Clinical Professional Counselor. Both practice in Chicago, telephone (708) 930-1833. This column is published under the sponsorship of the Quality of Life and Career Committee. The committee’s website is at www.fla-lap.org/qlsm . The Quality of Life and Career Committee, in cooperation with the Florida State University College of Law, also has an interactive listserv titled “The Healthy Lawyer.” Details and subscription information regarding the listserv can be accessed through the committee’s website or by going directly to www.fla-lap.org/qlsm