62 terms

LCSW

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Terms in this set (...)

Alogia
Greek α-, "without", and λόγος, "speech"[1]), or poverty of speech, is a general lack of additional, unprompted content seen in normal speech. As a symptom, it is commonly seen in patients suffering from schizophrenia, and is considered as a negative symptom. It can complicate psychotherapy severely because of the considerable difficulty in holding a fluent conversation.
Q: Do you have any children?
A: Yes.
Q: How many?
A: Two.
Q: How old are they?
A: Six and sixteen.
Q: Are they boys or girls?
A: One of each.
Q: Who is the sixteen year old?
A: The boy.
Q: What is his name?
A: Edmond.
Q: And the girl's?
A: Alice.
Blunted affect
is the scientific term describing a lack of emotional reactivity on the part of an individual.

Victims of post-traumatic stress syndrome are often said to display blunted affect. Veterans of intense combat have been described as having the thousand-yard stare (or thousand-yard gaze). Some of these veterans suffer from a disorder once referred to as shell shock and may experience a number of symptoms, including recurring nightmares, hypervigilance, and avoidance of situations that may cause distress. Others have developed less emotional reactivity as an arguably natural reaction to stress. Those displaying on this end of the spectrum may self-report dissociation but no psychological distress per se.
Anhedonia
******** is the decrease or cessation of all feelings of pleasure (which thus affects enjoyment, happiness, fun, interest, and satisfaction). Emotions relating to pleasure will not be expressed as much or at all because they are literally not experienced or are decreased. A person with ******* may be unable to laugh or smile, for example. Conversation will not be pleasurably stimulating for a person with extreme ******** , and thus that person may not be as responsive to conversation or its emotional subject matter.

Both blunted affect and anhedonia are considered negative symptoms of schizophrenia, meaning that they are indicative of a lack of something. Other negative symptoms of schizophrenia include: alogia, lack of concentration, social withdrawal (sometimes called social anhedonia), etc.
Frued
In the beginning there was Freud. While mental processes had been tweaked throughout the years in philosophy, it was Freud who really began to systematize and bring together psychological thought into a coherent framework. Regardless of Freud's current status in the psychological and therapeutic community, his work is nonetheless foundational and important (all quotes in this essay are from Gleitman, Psychology (3rd ed.), W.W. Norton and Company, 1991).Freud's psychoanalytic tradition began with an attempt to "understand the forces of human irrationality through reason and science" (p. 426).
free association
Freud's method of therapy included free association which allowed room for "clients" to tell whatever came to mind. This was precipitated by the notion that everything in the mind was connected and that whatever was mentioned would lead to the problems that hindered an individual.
Resistance Repressed Memory: Fruad
Freud found that people opted to resist instead of comply with his requests. Resistance became one of the things Freud and his clients would look for in the stories they told, believing that revealing whatever repressed memory was resisted would help in the healing process.
complementary
A specific ego state sends a message, a specific state responds.
" Start where the Client is"
Basis social work prinicpal of begining relationships and rapport.
Professional code of ethics
most comprehensive/ sidely acceping resource on ethical issues.
SW should always hade direct access to the code of ethics and should consult it before contacting other for interpretations.
Disequailibrum
An emotional state that may be characterized by confusing emotions, somatic complaints, erratic behavior. The severe emotional discomfort experienced by the person in crisis propels reducing him or her tward action that is aimed at reducing the subjective discomfort.
Somatoform Disorder
A history of many physical complianst beginning before age 30 years that occur over a period of several years and sreslut in treatment being sought or significant impoairement in social, occupational, or other important areas of functioning.
Acute
Duration of less then 6 months
Chronic
Druation of 6 months or more
Criteria for Somatization Disorder
Each criteria to be met at anytime during course of the disturbance:
1. Four Pain Symptoms: a history of pain related to at least four different sites or functions (head, abdomin, back, joints, extremities, chest, rectum, during menstration, during sex, during urination)
2. Two Gastrointestingal symptions:
Transactional Analysis
developed by Erin Berne, is based on the premise that people make decisions based on past assumptions that were once appropriate for their needs but may well have become invalid. In this model, cognitive, rational, and behavioral aspects of therapy are emphasized.

Stoking, game/racket, and structural analysis belongs to this group orientation
Program Evaluation
The use of social research methods to systematically investigate the effectiveness of social programs in ways that are adapted to their political and organizational environments and are designed to inform social action in ways that improve social conditions.

****** ********* is the use of social research methods to systematically investigate the effectiveness of social intervention programs. It draws on the techniques and concepts of social science disciplines and is intended to be useful for improving programs and informing social action aimed at ameliorating social problems.
Evaluation Sponsor
The person or group, or organization that requests or requires that evaluation and provides the resource to conduct it.
Social Program; Social intervention
An organized, planned, and usually ongoing effort designed to ameliorate a social problem or improve social conditions.
Social Research Methods
Procedures for studying social behavior devised by social scientists that are based on systematic observation and logical rules for drawing inferences from those observations.
Stakeholders
Individuals, groups, or organizations having a significant interest in how well a program functions, for instance, those with decision-making authority over the program, funders, and sponsors, administrators and personnel, and clients or intended beneficiaries.
Utilization of evaluation
The use of the concepts and findings of an evaluation by decision-makers and other stakeholders whether at th day to day management level or at broader funding or policy levels.
modern evaluation research
****** ********* ******* grew from pioneering efforts in the 1930's and burgeoned in the years after World War II as new methodologies were developed that could be applied to the rapidly growing social program arena. The social policy and public administration movements have contributed to the professionalization of the field and to the sophistication of th consumers of e *** ********** ******** grew from pioneering efforts in the 1930's and burgeoned in the years after World War II as new methodologies were developed that could be applied to the rapidly growing social program arena. The social policy and public administration movements have contributed to the professionalization of the field and to the sophistication of th consumers of evaluation research.
Need for program evaluation
The need for ****** ********* is undiminished in the current era and may even be expected to grow. Concern over the allocation of scarce resources makes it more essential to evaluate the effectiveness of social interventions.
evaluation requires:
********* requires an accurate description of the program performance or characteristics at issue and assessment of them against relevant standards or criteria.
Evaluation typically involves one or more of the five program domains:
1. The need for the program.
2. the design of the program.
3. program implementation and service delivery
4. program impact or outcomes
5. program efficiency
(An evaluation must be tailored tot he political and organizational context of the program being evaluated.
challenges program evaluation
Program circumstances and activities may change during the course of an evaluation, an appropriate balance must be found between scientific and pragmatic considerations int he evaluation design, and the wide diversity of perspectives and approach in the evaluation field provide little firm guidance and how best to proceed with an evaluation.
training for evaluators
Moste evaluators are trained either in one of the social sciences or in professional schools that offer applied social research courses. Highly specialized, technical, or complex evaluations may require specialized evaluation staffs. A basic knowledge of the evaluation field, however, is relevant not only to those who will perform evaluation but also to the consumers of evaluation research.
Ego States Eric Berne
1. Parent: part of the personality that is an introject of the parents and parental substitutes. "Shoulds" and "oughts". We each have both a Nurturing Parent and a Critical Parent.
2. Adult: the processor of data. Objective. Not emotional or judgmental; without passionate convictions.
3. Child: consists of feelings, impulses, spontaneous acts.
a. The Natural Child- impulsive, spontaneous expressive infant
b. The Little Professor- unschooled wisdom of a child. Manipulative, egocentric, and creative. Intuitive.
c. The Adapted Child- modifications of the Natural Child's inclinations. Whines, complies, and rebels.
Injunctions
are messages given to the child by the parents' internal Child out of the circumstances of the parents' own anxiety, anger, frustration, and unhappiness. These messages tell children what they have to do and be in order to get recognition. Often inferred from parental actions. We may have invented them or misinterpreted the messages from our parents.
Early decisions
are responses to the injunctions, motivated by the need to be recognized by our parents, to be stroked by them, and by sheer need for physical or psychological survival. These early decisions may have been appropriate in certain situations in childhood, but are inappropriate in adulthood. As adults, we can examine these decisions and determine if we will continue living by them.
Injunctions and Early decisions example
Don't: tells children not to do normal things for fear that they could lead to disaster.
decision- "I can't decide for myself." "I might be wrong, so I won't decide."

Don't be: Often delivered nonverbally. May be implied by brutality or
indifference.
decision- "I'll get you to love me if it kills me." "I'll disappear or kill myself."

Don't be close ( or trust or love)
decision- "I won't get close and then I won't be hurt."

Don't grow: don't grow up and leave me. Stay a child.
decision- "I'll stay little and helpless." (Anorexia Nervosa)

Don't succeed: From excess parental criticism. Children get stroked for failing.
decision- "I'll show you I can make it even if it kills me." "No matter how good I
am, I'll never be good enough." "I'll always be a loser."
Strokes Eric Berne
- a form of recognition
TA therapy pays attention to how people get their strokes, as well as the kinds of strokes they get and give. We need positive strokes for healthy development, but negative strokes are better than no strokes at all.

1. Positive strokes say, "I like you." (words and gestures)
2. Negative strokes say, "I don't like you." (words and
gestures)
3. Conditional strokes say, "I will like you if or when..."
4. Unconditional strokes say, "I like you for being who you are."
Games Eric Berne
An ongoing series of transactions that ends with a bad feeling for at least one player. Games are designed to prevent intimacy. Games support original decisions and are part of a person's life script (a plan for life, or a conclusion that was reached about how to behave in order to survive in this world). The life script supports early decisions and bring people the kinds of strokes to which they are accustomed. Games are exchanges of strokes that lead to payoffs of bad feelings and advance the script.

TA helps people become aware of the nature of their transactions with others so they can respond to others with directness, wholeness, and intimacy.

Common games: 1. Poor me; 2. Martyr; 3. Yes, but; 4. If it weren't for you;
5. Look what you made me do; 6. Harried; 7. Uproar.

Karpman Drama Triangle: Persecutor, Rescuer; Victim

(What distinguishes a game from a transaction is the fast "switch" from one position in the triangle to another.)
Rackets Eric Berne
Unpleasant feelings that we experience after a game. The chronic feelings we hold on to are often the ones we experienced with our parents. They support early decisions and are part of a life script. (anger racket, guilt racket, depression racket, etc.)
Life scripts Eric Berne
Includes parental injunctions, early decisions that resulted, games played to maintain the early decisions, resulting rackets, and expectations of the way we think our story will end. As children we decide is we are "O.K." or "not O.K."
Redecisions Eric Berne
We can make new decisions to replace early decisions. Go back to early childhood scenes, then from Child ego state client makes a new decision both emotionally and intellectually.
Structural Analysis Therapeutic Technics (TA)
Client becomes aware on content and functioning of his or her Parent, Adult, Child. It allows them to find out which ego state their behavior is based on.

Problems:

Contamination- when contents of one ego state are mixed with those of another. (Parent or Child intrude on Adult.)

Contamination by Parent = prejudiced ideas and attitudes

Contamination by Child = distorted perception of reality

Exclusion- when rigid ego-state boundaries do not allow for free movement between ego states, i.e. the Constant Parent (duty bound; judgmental; moralistic)

Technics:
Empty Chair / Two Chair work: Used for structural analysis.
Role Playing: Another group member becomes the ego state with which the client is having problems.
THERAPEUTIC PROCESS (TA)
1. Therapeutic Goals:
Help client make new decisions regarding their present behavior and the direction of their life. Substitute an autonomous life-style characterized by awareness, spontaneity, and intimacy for a life of game playing and self-defeating life scripts.

2. Therapist's Function and Role:
Teacher, trainer, and resource person with heavy emphasis on involvement. Teach clients how to rely on their own Adult, not the therapist's Adult.

3. Client's Experience in Therapy:
Client is an active agent in the therapeutic process. Must understand and accept a therapeutic contract. Must do assignments. Demonstrate willingness to change by "doing" not just talking.

4. Relationship between Therapist and Client:
Contract is and Adult-to-Adult agreement between therapist and client, describing both the goals and the process of therapy. Must be specific. Therapist and client are partners in the therapeutic process.
Transactional Analysis
A description (in Ego state language) of what people do and say to themselves and to each other.

Complementary- message sent from a specific ego state gets predicted response from a specific ego state of the other person.

Crossed- When message gets response from unexpected ego state.

Ulterior- When overt and covert message sent at same time. (More than two ego states involved.
Transactional analysis or TA
is a branch of psychotherapy developed by Eric Berne. His definition of it is "a theory of personality and a systematic psychotherapy for personal growth and change".

Knowing about TA can be very useful for improving our communication skills. TA is about how people are structured psychologically and is both a theory of communication and a theory of child development.
ego state
"A consistent pattern of feeling and experience directly related to a corresponding consistent pattern of behaviour".

Berne's model is a three part ego-state model
There are three ego states in Berne's model:
• Parent,
• Adult,
• Child.

Ego states are irrespective of age and are capitalised to differentiate from the normal use of the words parent, adult and child.

The Parent and Child ego states are echoes of the past. The Adult ego state is a response to the here and now when a person is grown up and using grown up responses.

Ego states are 'things' not names. They are a set and related; thoughts, feelings and behaviors.
Communication and Ego States
Communication between people can be from one ego state to a different one or from one ego state to the same ego state.

Normally communication will be from one ego state either to the same ego state or a different one. The person who first communicates will expect a reply to be from a certain ego state. If communication is from a different ego state to the expected one, then the communication may be ineffective and the message may be lost, not received or disregarded by the person receiving it.

If communication is from Adult to Adult then it is likely to be the most effective communication for most of our communications.
The '3 Rules of Communication' in TA
1st Rule of Communication
•So long as transactions remain complementary, communication can continue indefinitely.

2nd Rule of Communication
•When a transaction is crossed, a break in communication results, and one or both individuals will need to shift ego states in order for the communication to be re-established

3rd Rule of Communication
•The behavioural outcome of an ulterior transaction (one where two messages are sent at the same time; one overt social and one covert psychological) is determined at the psychological level and not at the social level.
Example of Complementary Communication
P -> P, P <- P
A -> A, A <- A
C -> A, A -> C
Example of non complementary communication
Diagram shows Parent ego state - expected reply would have been something like &quot;I&#039;m sorry it won&#039;t happen again&quot; from Adapted Child

P ----------------------&gt; C
A &lt;---------------------- C
&quot;You took your time &quot;So what, I was busy&quot;
to reply to my call&quot;
Sub-division of Ego States
Parent ego state is divided into:
• Parent into Critical Parent CP - which is negative, unsupportive, critical.
• Nurturing Parent NP - which is supportive, helpful, nurturing, comforting.

Child ego state is divided into:
• Free Child FC (sometimes referred to as Natural Child NC) which is spontaneous, free-wheeling, playful, self-indulgent, curious, rebellious.

• Adapted Child AC - which is toned down behaviour that has been learnt in response to the reactions from other people to us and our behaviour. The learned or adapted responses are more likely to generate a given result from the receiver.
Transactions
is a communication from A to B and the response from B to A. The 3 ego states can be used as a way of analysing transactions (communications) between people.
Examples of Complementary Transactions
Where the message is sent from one ego state and the reply is from the expected ego state. The transaction is complementary.
Example of Critical Parent to Critical Parent:
P-----------------------------> P
P<---------------------------- P
"The government "They are
is making us all it's really annoying"
criminals by putting
speed cameras everywhere"

Example of Adult to Adult:
A------------------------->A
A<------------------------ A
"what time is "It's due at
the train due?" one fifteen"

Example of Adapted Child to Nurturing Parent:
AC-------------------> NP
AC <------------------ NP
"Oh, I'm really "Don't worry, I'll
struggling with give you a hand
all this painting" right now"

Example of Free Child to Free Child:
FC -----------------> FC
"Oh what the "yeah, great idea
hell, let's have make that 2 drinks
another drink and a pudding, and some
pudding" gateaux"
TA for effective communication
For effective communication you need to keep the transaction complementary i.e. focus on sender to receiver and receiver to sender where the message is sent to the ego state from which you expect a reply. Using ego states we can look at how others communicate and how we communicate with others. It's possible to identify which ego state we are in and which ego state we are expecting a reply from.

We can also use TA to help us plan transactions. For example we can identify which ego state would be most valuable for us to send the message from and which ego state it would be better for it to be received by. If we receive a reply from the wrong (non expected) ego state then we can either try to shift the other person's ego state; or if we cannot do this it may be better to stop the communication and try again another time when the person may be in a different ego state.

We can listen to people's communication to identify if they are habitually in one ego state and then decide if communication to that ego state would be appropriate or not.

TA therefore can be used to elicit the reactions you want from other people (and this will happen consciously or unconsciously).

We can help communication if we need to by trying to shift the other person's ego state by inviting people to move into a different ego state (they may not always move into it though, particularly if someone is habitually in one ego state). Do this by acknowledging their current ego state (by the appropriate message or response) and then invite them into another ego state by the words (and body language) which you use.
Strokes
- units of recognition

Can be: verbal or non-verbal
Positive or negative
Conditional or unconditional

A stroke is a unit of recognition. E.g. you walk down the street and see your neighbour. As you pass you smile and say &quot;hello&quot;. They smile and say &quot;yes, great day?&quot; That&#039;s a positive stroke you&#039;ve given and received.

If your neighbour ignored you then you felt left out or deprived or wonder what you have done to offend them.

Any transaction is an exchange of strokes. This may be entirely non-verbal.

Positive strokes - the receiver experiences it as being pleasant.

Negative strokes - the receiver experiences it as being painful.

For example if your neighbour replied &quot;It was a nice day until I saw you!&quot; then that&#039;s an example of a negative stroke. But any kind of stroke is better than no stroke at all.

Stewart and Jones identify that this is supported by work on rats where one group were given electric shocks and the other group were not. The rats given the shocks developed better - as they were receiving some stimulation.

Conditional strokes relate to what you do.
Unconditional strokes relate to what you are.

E.g. Conditional: &quot;That was a good piece of work&quot;
&quot;That painting you&#039;ve done is a real mess&quot;

Unconditional: &quot;Your humour always brightens things up&quot;
&quot;I hate you and all which you represent&quot;

As infants we test out behaviours to find out which give us the strokes we need. If we receive strokes from a certain behaviour then we are likely to repeat it (and that can be where many of our learnt behaviours come from - albeit unconsciously learnt)
Invite them to move into Adult by:
• Asking a question
• Stating a few facts
• Asking for their opinion
• Asking for their preference
• Asking for their view
Invite them to move into Nurturing Parent by:
• Asking for their help
• Asking for their advice
• Asking for their expert opinion
• Communicating your fears/worries
Invite them to move into Natural Child (Free Child) by:
• Being one yourself
• Showing the funny side of the situation
• Going to nurturing parent
• Being enthusiastic
• Showing an unconventional way of looking at things.
Racket feeling
- a familiar emotion, learned and encouraged in childhood, experienced in many different stress situations, and useless as a means of problem solving but frequently carried out E.g. my computer screen freezes, I get stressed and hit it.
Playing Games
In &#039;Games People Play&#039; Berne identified that people habitually adopt certain ego states (not necessarily consciously) and &quot;play games&quot; in the way they communicate with others. E.g. a person might say &quot;I&#039;m fat&quot; or &quot;Nobody Loves Me&quot;, they are in Adapted child. They expect a nurturing parent response of &quot;no you are not&quot; or &quot;yes they do&quot;. If they received a response of &quot;I know you are&quot; or &quot;You&#039;re right, everybody hates you&quot; then they have received a reply that they didn&#039;t want. Some people go through life playing a game and people can be in a relationship where one person is the Adapted child and the other the Nurturing parent.

Some people habitually play games and go through life playing games such as:
&#039;Isn&#039;t life unfair&#039;,
&#039;Everyone is against me&#039;
&#039;I am poorly&#039;,
&#039;I am always right and you are always wrong&#039;
&#039;It is your fault that I ...&#039;

Games typically:
• Are repetitive
• Are played without Adult awareness
• Always end up with players experiencing racket feeling.
• Games entail an exchange of ulterior transactions between the players
• Games always include an element of surprise or confusion.

Racket feeling - a familiar emotion, learned and encouraged in childhood, experienced in many different stress situations, and useless as a means of problem solving but frequently carried out E.g. my computer screen freezes, I get stressed and hit it.

Common games include: &quot;oh how I suffer&quot; &quot;Isn&#039;t it awful&quot; &quot;victim, persecutor, rescuer&quot; and &quot;If it weren&#039;t for you&quot;
Examples of Crossed Transactions
When a message is sent from one ego state and the sender expects it to be sent back from the expected ego state: but it's sent back from a different one. The transaction is crossed; communication is non effective.

A crossed transaction could lead to argument and loss of effective communication. The message is 'lost'.

Example of Critical Parent expecting reply from Adapted Child but receiving reply from Critical Parent.
P----------------------------->C
C <--------------------------- P
"You messed that "Rubbish, it's your fault.
up, it's full of errors It's you that can't understand
and typos" or use correct English"

Example of Adult expecting reply from Adult but receiving reply from Critical Parent.
A ---------------------------->A
C <----------------------------P
"The deadline "What do you mean 'we'. If
is tomorrow. you didn't always leave
We'll need to things to the last minute"
stay on a final
half hour to give it
another check"

Example of Adapted Child expecting reply from Nurturing Parent but receiving reply from Adapted Child.
C--------------------------->P
C<------------------------- C
"Oh, I'm really "Oh, I know what
struggling with you mean, it's really
all this painting" difficult isn't it"

Example Adapted Child expecting reply from Nurturing Parent but receiving reply from Critical Parent
AC------------------------>NP
C<-------------------------CP
" Oh, I'm really "So bl***y what.
struggling with I've got enough to
this painting" do without you
moaning all the time"
Schizophrenia
Must have 2 or more of the characteristic symptoms for a significant portion of time during a 1-month period (or less if successfully treated) for a diagnosis of Schizophrenia.

Characteristic symptoms:

Positive Symptoms:
-Delusions
-Hallucinations
-Disorganized Speech
-Grossly disorganized behavior

Negative Symptoms:
-Affective flattening- reduction in range and intensity of emotional expression
-poverty of speech
-Avolition or the reduction, difficulty , or inability to initiate and persist in goal-directed activity.

Other Symptoms: commonly associated by not identifed as diagnostic criteria:
-Inappropreat affect
-unusual motor behavior (pacing, rocking, etc.)
-Depersonalization
-Derealiztion
-Disorganized thoughts, disorientation, confusion, memory problems.
-Sleep and appetite disturbance.
-Dysphoric mood (anxious, irritable, agitated, depressed).
-Difficulty concentrating and focusing
-Anhedonia
Major Depression
Must have five or more of the symptoms for a 2-week period and they must represent a change in functioning. One to the symptoms must be (1) depressed mood or (2) loss of interest or pleasure (Anhedonia).

-Depressed Mood
-Markedly diminished interest or pleasure in all activities most of the day
-Weight loss or weight gain
-insomnia or hypersomnia
-Psychomotor agitation or retardation
- fatigue or loss of energy
-Feeling of worthlessness or guilt
-Diminished ability to think or concentrate: indecisiveness
-Recurrent thoughts of death, with or without plan.
NOS Category= Not Otherwise Specified
This category means that the patient presents with a symptom pattern that conforms to the general guidelines for a mental disorder but the symptoms do not meet all the criteria for any of the specified disorders. For instance Psychotic Disorder, NOS or Dementia, NOS.
Bipolar Disorder
Bipolar I Disorder: Presence of only one Manic Episode and no past Major Depressive Episodes.

Bipolar II Disorder: Presence or history of one or more Major Depressive Episodes and presences or history of at least one Hypomanic Episode. There has never been a manic episode.

Manic Symtoms:
-Distinct period of abnormally and persistently elevated, expensive, or irritable mood, lasting at least 1 week.
-Three or more of the following symptoms have persisted during period of mood disturbance.
--Inflated self-esteem or grandiosity
--Decreased need for sleep
--Pressured speech
--Flight of ideas or racing thoughts.
--Distractibility
--Increased goal-directed activity or psychomotor agitation.
--Excessive involvement in pleasurable activities that have a high risk for painful consequences.
Partialization
The patient's objectives and goals are first prioritized so that they can be worked on separately and in sequence. This is a way to avoid the patient's becoming overwhelmed by the work he/she must do to attain his/her goals. It is a way of making progress in steps that match the needs and concerns of the patient.
Psychosocial Crisis Theory Eric Erickson
The personality of an individual forms as the ego progresses through a series of interrelated states. Personality development occurs as one successfully resolves a series of turning points, or psychosocial crises. These crises are as follows:
Trust vs Mistrust (Birth to one year)
Autonomy vs Shame/Doubt (2-3 years)
Initiative vs Guilt (4-5 years)
Industry vs Inferiority (6-11 years)
Identity vs Role Confusion (12-18 years)
Intimacy vs Isolation (young adulthood)
Generativity vs Stagnation (Middle Age)
Integrity vs Despair (old age)
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