Hamlets Psychological Aspect Essay Example for Free

Hamlets Psychological Aspect Essay I decided to do this research work because I have enjoyed a lot reading this play: Hamlet. The inner motivations and psyche of this character have captured my attention. Therefore, the aim of this research is to depict Hamlet’s attitudes during the play. I will try to approach to his real feelings on life and death taking into consideration what critics and researchers have said about Hamlet. In order to clarify Hamlet’s personality and behaviour, I will provide some aspects of the historical context in which Shakespeare was inspired to write this play, and a brief summary of it to take into account the plot. Finally, I will make a conclusion in which I will try to summarise the most important impressions of this research. Historical Context of the play Shakespeare wrote Hamlet in the last years of the reign of Queen Elizabeth 1, who had been the queen of England more than forty years. As she had no children the question of who would succeed her was a situation that provoked anxiety at that time. Due to this fact, researchers agree that many of Shakespeare’s plays from this period concern transfers of power from one monarch to the next. Another important issue dealt with in his plays is the general sense of anxiety, fear, uncertainty, betrayal and revenge. For instance, Hamlet displays all the themes mentioned above. Shakespeare was able to sum up the most impotant values of the Renaissance. Cultural phenomenon that began in the fifteenth-century and proclaimed the humanism: a new thought that revalued the social and popular aspect of life. People who belonged to the Renaissance period claimed that human beings lived in a world of appearances, in which they tried to hide their realities, that is to say, their deepest desires and what they actually were. Hamlet had to face one of the most difficult realities: injustice. A task that presents a dilemma to him: â€Å"to be or not to be†. While pointing out questions that cannot be answered, the play as a whole chiefly demonstrates the difficulty of knowing the truth about other people: who are guilty or innocent, which their motivations and feelings are. Brief Summary of the play Shakespeare begins the play with the death of the King of Denmark and the possession of the throne by the King’s brother Claudius, instead of the King’s son, that is to say the prince Hamlet, who was supposed to be the next in line. What is more, the new king Claudius suddenly married Gertrude, the dead king’s widow. Thus, the prince Hamlet got depressed by the unexpected situation. One night, Hamlet’s father appears as a ghost to tell Hamlet that he had been murdered by his own brother Claudius, that is to say, Hamlet ´s uncle. In his anger, Hamlet decides to fulfill his father’s request, which is to avenge his death. In order to confirm what the ghost has said, Hamlet organizes a play in which he represents the assessination scene. While the play is being performed, Claudius stands up and goes out feeling guilty. At the moment, Hamlet confirms the truth and discusses the situation with his mother. As Hamlet notices that someone is spying on them behind the curtains, he stabs his sword without checking who this person is. As a result, he kills Polonius, Claudiuss chief councillor. When Ophelia, Polonius ´s daughter, is informed about her fathers death she reacts with madness and eventually falls in a stream and drowns. After that, Laertes, Ophelia’s brother, is told that Hamlet is involved in Polonius’s death and Ophelia’s madness. Therefore, he wants to avenge his father’s and sister’s death trying to eliminate Hamlet. As Claudius promised Laertes to help him with the revenge, they plan to kill Hamlet as if by accident with a poisoned sword in a fencing match. Claudius also plans to offer Hamlet a poisoned drink during the fight. When the fencing contest begins, Hamlet’s mother Gertrude drinks the poisoned drink before Caludius can stop her and she dies. Hamlet turns away and Laertes wounds him with the poisoned sword, but Hamlet goes on fighting. During the struggle, they exchange swords and Hamlet wounds Laertes, who confesses the plan telling Hamlet that he is also sure to die from the effect of the poison. After hearing the truth, Hamlet stabs Claudius with the poisoned sword and forces him to drink the poison, too. Finally, while Hamlet is dying by the effect of the poison, he orders one of his friends called Horatio to tell the terrible story of the happening to everyone.

Psychosocial Stage Essay Example for Free

Psychosocial Stage Essay Psychological development is generally accepted as product of the interaction among social and psychological forces which directly affect and shape the personality of every individual (Erikson, 2000). This may also encompass changes in self-control, and prosocial behavior. In relation to this, Erik Erikson established a unifying theory on the social and psychological aspects of human development throughout life span. In his eight developmental stages, each individual should, from infancy to senescence, accomplish psychological tasks in line with his or her social experiences. In addition, his theory, often called as â€Å"the stages of man,† is primarily grounded on the notion that every individual develops self-images through others perceptions and his or her own perceptions (Erikson, 2000). Erikson described the development of personality and the process by which an individual acquires societal role and shapes his or her identity. In contrary to Freuds psychosexual emphasis, Erickson accentuated the development of ones attitudes, skills, and the sense of responsibility. Further, Erikson argued that individuals undergo the different developmental stages, each with crisis or dilemma, and expected to resolve specific conflict in every stage. Unresolved conflicts in the previous stage will pass on the succeeding stages which impart negative traits in ones personality (Erikson, 2000). On the other hand, as an individual successfully confronted every developmental crisis, he or she achieves positive traits or psychological attributes. Generativity versus Stagnation Erikson viewed â€Å"development† as a continuous process of facing the complexities of life (Santrock, 2002). A young professional, for example, to ensure success and intimate relations, he or she must perceive and accomplish the task of creating and caring his or her life role or style. Ericksons 7th stage of psychosocial development, generativity versus stagnation, coincides with the middle adulthood period of humans. As defined by Erikson, generativity is the desire to take an active role in establishing the society and nurturing the youth to ensure the continuity of human generation (Lerner, 2002). In this stage, individuals should develop concern for the next generation in order to prevent personal stagnation (Santrock, 2002). While some individuals accomplish this through active community involvement and participation, some contribute for the welfare of the society through responsible parenthood. In any means, the dynamic that must be attained is the outward shifting from the well-being of one’s self to the consideration and care for the humanity. As such, the strength of care is achieved through creating, parenting, volunteering, and mentoring. For instance, by means of genuine care and concern, the generative religious teachers indoctrinate traditional religious view on development. Generative adults, on the other hand, may take responsibility on the cycle of life by leading and guiding their children in the first five stages of psychosocial development (Santrock, 2002). Meanwhile, a key element of â€Å"generativity versus stagnation† is the continuity of stages and cumulative implications of various experiences in life (Santrock, 2002). The adults sense of generativity is stimulated by encouraging and supporting the future of the next generation. However, individuals who fail to bestow the continuity to the next generation may possibly become engorge with his or her personal needs, disregard the needs of other individuals, and eventually become stagnated. Influences on my Personality The psychosocial development constructs of Erickson encompasses every experience of an individual that processes and shapes his or her personality, generativity, and perceptions. These processes are deemed universal; that is, although individuals experience family, social, and cultural life differently, the variations are minor. The minor variations account for other individual variables such as socioeconomic status, age, race, gender, ethnicity, religion, education, and culture (Lerner, 2002). Hence, the psychosocial processes in the middle adulthood show variations on themes but of similar dynamic of change. Erikson outlined these changes in every developmental stage through specific conflicts or tasks that one needs to attend to or resolve. As such in middle adulthood, generativity versus stagnation is the conflict that needs to be resolved. However, as the resolution of conflicts in the early adulthood influences this stage, the outcome in this stage will directly affect the late adulthood period (Lerner, 2002). As well, as individuals are expected to provide inspiration, care, and guidance for the youth, they are also challenged to acquire productive roles for the societal development and continuity. Generativity then should not only be confined in parenting but should stretch out to community involvements through projects, leadership, and commitment. It must be deemed with respect to the manner by which an individual handle his or her relations with his or her family, societal institutions, friends, relatives, and with other individuals. Whereas every social behavior is determined by myriad of factors, the commitment and concern for the welfare of the next generation must be the primary motivation in all those aforementioned social responsibilities and activities (Lerner, 2002). As I learned the middle adulthood psychosocial stage of Erikson, about 35-40 years of ages, I examined the present state of my personality in terms of generativity and stagnation. That is, I assessed my self if I am productive in my field of endeavor and geared towards inspiring and guiding my children and other youngsters and young adults. I became concern with the achievement of generativity for Erikson argued that it is crucial for a positive outlook during midlife. As such, I formulated my developmental goals of preparing my self for my senescence period and caring for and guiding the youngsters for adulthood. However, life experiences in this stage of life are not identical among individuals; some are still single adult while others are happily married or divorced during this period. Generally, the middle adulthood has developmental discontinuity and continuity. In particular, psychological attributes like cognitive functioning may rapidly change while the others such as intelligence and personality may attain stability during midlife (Lachman, 2001). I realized then that in defining life’s success, experiences in midlife have significant roles. During middle adulthood, every individual compensates for and copes with life’s losses which tend to be apparent as senescence life approaches. As revealed by psychological researches, life satisfaction is at its peak in midlife; this is the period of life where subjective happiness and well-being are rated best as compared to other stages of life (Lachman, 2001). Thus, midlife is known as the prime of one’s life, where most middle adults are at the summit of their family and professional careers, and income generation. In addition, middle adults experience a very satisfactory psychological well-being; they have positive outlook in life, autonomy, and aim for both personal and professional growth (Lachman, 2001). They perceived midlife as the period where one should function best. Thus, my consciousness on my work performance, multiple-role playing, and parenting styles were awakened. Nevertheless, at the other extreme of middle adulthood are the midlife crises. Based on psychological reports, middle adulthood is battered by worries in life such as the feelings of individuals of life losses and failures, non-achievement and underachievement, and trivial and non-essential goals (Lachman, 2001). Yet, amidst these crises and as compared to other stages of life, middle adulthood is the period of less depression and higher well-being. In this period, most individuals attained their professional and personal goals. Those who are susceptible to environmental factors, limited resources, and poverty, are at risk to psychological and physical distress (Lachman, 2001). It was then clarified in my mind that during midlife, individuals may either enjoy the fruition of their respective labors or suffer the cumulative deficits of their life due to unresolved conflicts in previous stages. Therefore, middle adulthood, as generativity versus stagnation implies, is not only a period of fulfillment and accomplishment but also a transition period for the past and present events of life basically influence the later life’s transition. Midlife is the stage of life when individuals, more frequently, have already decided for a lifestyle and other social context like vocation, routine, neighborhood, and support network. Thus, I postulated that personality molds the life of an individual, rather than life experiences shapes the personality of an individual. In particular, only specific aspect of personality is altered by dramatic life events during middle adulthood. For example, career or marriage failure, affliction due to mental or physical disorder, and death of a loved one may alter the behavioral trait of an individual which in turn only causes minor shifts in personality but do not reflect in the holistic personality structure. Moreover, the concept of midlife crisis, perceived as inevitable in middle adulthood, was found to be false (Lerner, 2002). Even though midlife is a stage of reflection, increased anxiety, midcourse correction, and unpredictable transformation, researches revealed that during middle adulthood, individuals still undertake the shifting of life perspective from birth until to their last years to live (Lerner, 2002). The nature of an individual’s response to midlife challenges is largely affected by personality attributes and less by the individual’s present developmental stage or chronological age. As proposed, the enduring nature of midlife crisis is possibly related to the capability of an individual to cope with the tragic life events and in the end still considers his or her self as fairly fortunate. In sum, Erikson suggested the importance of finding oneself in another during midlife developmental stage. By merely serving oneself or own family, an individual becomes engorge with his or her personal needs, disregard the needs of other individuals, and eventually ends as stagnated. Hence, I must not confine my self in looking at and working only for the welfare of my family. Bringing up my children into the best that they can be is inadequate contribution for the welfare of the society. I need to acquire the sense of altruism in order to contribute whatever resources I have, actively involve myself to community projects, and to extend whatever support I can give for the welfare of the next generation. In addition, since midlife crisis is inevitable in middle adulthood, I realized that in order to face every travail, empathy and support to others are crucial so as to establish a network support where I can lean on as I resolve any form of midlife crisis. References Erikson, E. H. (2000). The Erik Erikson Reader. Coles, R. Ed. New York: Norton. Santrock, J. W. (2002). Life-span development. New York: McGraw-Hill. Lachman, M. E. (2001). Handbook of Midlife Development. New York: John Wiley. Lerner, R. M. (2002). Concepts and Theories of Human Development, 3rd ed. Mahwah, NJ: Erlbaum.

An Overview Of Teenage Pregnancy Sociology Essay

An Overview Of Teenage Pregnancy Sociology Essay In the U.S, about one million teenage girls get pregnant every year and this greatly affects the lives of the teenagers, the children they bare and the society at large. The social behavior and attitude towards sex has greatly contributed to the increase of teenage pregnancy since sex is publicly glorified and is even used as a marketing tool. Teenagers are engaging in sexual activities at an early age since they are exposed to it even before they are mature. It is the role of parents to try and bring up their children in a morally upright manner and advice them on the effects of early pregnancies in their lives. The causes and effects of teenage pregnancy are more of the same. They include poverty, unemployment, and lack of education, low self esteem and in some cases, abuse. Factors leading to teenage pregnancy The causes of teenage pregnancy are both social an also economical. The lack of knowledge on the consequences of teenage pregnancy among the teenagers is the primary factor that leads to teenagers to engage in irresponsible sexual practices. Another contributing factor is the up bringing of the children. The way parents bring up their children as well as the kind of environment they are brought up in contributes realty to the sexual behavior of a child. Parents who do not communicate openly to with their children on social issues such as sex are putting their children at the risk of being teenage parents. The lack of open communication between the children and the parents encourages the children to find other sources of information and in most cases, they go to their fellow students or older friends who may end giving them the wrong or misleading information. On the other hand, children who are brought in an environment that consists of many cases of teenage pregnancies or even in situations where the parents are single mothers or were victims of teenage pregnancy are more likely to follow the same course since it is something normal in their ‘world. The way a child is brought up defines who they are in terms of emotional maturity as well as their communication skills. When children are not taught how to communicate and air their views openly and boldly, they end up suffering from low self esteem and this makes them easy targets and increases their chances of being vulnerable to peer pressure which is also responsible for teenage pregnancy. This lack of communication and guidance from parents also contributes to the childs irresponsible behavior. Poverty is another major factor that contributes to teenage pregnancy. In most low income earning areas, the are no facilities that are used to educate children on the effects of engaging in sexual activities at an early age. In some cases, the children are forced to engage in sexual activities as a way of getting money to support themselves and their families. The wealthier people in these areas take advantage of the young children and promise them a better life in exchange for sex. Ignorance is also another aspect that is come in these areas and is usually brought about by the lack of education. When parents are not well educated, they do not see the importance of educating or discussing sex and other issues that affect the teenagers and the children end up messing up since they were not advised. The kind of messages that are sent to teenagers about sex are also contributing factors to the early engagement in sex which leads to teenage pregnancy. Todays culture glorifies sex and does not put into consideration nor is it accountable for its consequences. The social attitudes on the other hand do not provide a conducive environment for open discussions on sex and resources are not also available for the same. From studies, there are some factors such as poor performance in school that force the children to drop out and when they do, the chances o them engaging in sexual activities are very high and they end up getting pregnant. There are many children who are victims of sexual abuse and this completely messes up with their views and attitude towards sex. These children end up perceiving themselves as sexual objects from an early age and this increases the cases of teenage pregnancy. Effects of teenage pregnancy The effects of teenage pregnancy are felt by the individual victims and also the society. When school going teenagers get pregnant, most of them opt to drop out of school due to shame and also so that they can prepare themselves for the coming baby and motherhood in general. On the other hand, teenage fathers are not in a position to support their families financially so they also end up dropping out of school so that they can work and provide for their family. Since getting a job without education is hard, the students find themselves engaging in criminal activities and drug abuse as they try to find solutions to their state. Most teenage mothers do not have any support from their families so they and up becoming a part of the lower society whereby they are not able to access basic needs such as health care and well balanced diets. This affects their health and the health of their children and sometimes may lead to complications during child birth. Teenage parents pose a great economic and social risk to the society since they are not financially stable. Dropping out of school, doing drug and also engaging in criminal activities by teenage fathers affect the community in terms of the level of security. Dropping out of school means that one is not well educated and therefore, they cannot secure good jobs and this increases the cases of joblessness and this pull down the economic status of the society. When one is not educated, their level of productivity socially and economically goes down and this affects the community at large. Ways of preventing teenage pregnancy. Teenagers should be encouraged not to engage in sexual activities at an early age and they should also be well informed on early pregnancy and its effects. The students should be well educated on the topic of sex as a whole should be discussed in schools and this will help in the reduction of cases of teenage pregnancy. The teenagers should also be educated on the ways of preventing pregnancy and also ways of ensuring safe sex. They should be allowed to access contraceptives as well as family planning services without age being an issue and confidentiality should be assured. Parents on the other hand have a great role to play in ensuring that their children are brought up morally upright and that they should instill confidence and a sense of responsibility in their children so that they can be able to make wise choices and not be pulled away by peer pressure. Motivating children on positive life options and also enhancing the skills of the children I other ways apart from education is also very important since children know that they have a future despite their performance in school and this reduces the cases of school drop outs who would have otherwise ended up getting pregnant.

The Turn of the Screw Essay -- Literary Analysis, Henry James

Superficially, Henry James’s The Turn of the Screw seems to reinforce the status quo of American literature as male, whereby men are viewed as having power over women leaving women to become mere objects. James creates a nameless female protagonist whose story is told through the guise of a male narrator. She becomes an object viewed by Douglas’s audience and is used simply as means for the master on Harley Street to avoid being bothered by his charges. She is then set up as naà ¯ve and love-struck, willing to do just about anything, including risking her own sanity, for the sake of keeping the master undisturbed. However, on closer examination, James actually creates a novella that subverts the traditional idea of men having power over women as it is the governess who has the final word in her story, not the male Douglas, and it is the male heir Miles who becomes the scapegoat leaving the governess free, â€Å"awfully clever and nice† (James 24). James’s unfinished frame tale creates frustration and confusion but his experiment with form also draws attention to what has largely been left unconscious. Through Douglas’s initial telling of the governess’s story she is reduced to a nameless object that they all raptly listen about rather than listen to. While at the start, Douglas does have power over the governess’s story, in the end it is the governess who has the final word and Douglas, who disappears after only the first seven pages, is never to be heard from again. James relinquishes power to the governess and allows her to participate as there is no need to return to the male voice once she takes over. Furthermore, as the governess does remain nameless throughout her own narrative this hardly is a power issues as both the master on... ...til finally â€Å"the air was clear† (116-117). In this way the governess is able to reverse the roles of passive/female and active/male as she denies Quint the power of his gaze and instead forces him to be the object of her gaze. Through his distortion of traditional male dominated structures and ideas, James is able to not only draw attention to the inequality of men’s power over women but he also uses the same devices to subvert this binary opposition. Through a distortion of the assumed patriarchal order the governess is able to adopt male characteristics in order to wrest back some of the power initially taken from her. Whether consciously or unconsciously James’s unfinished frame, disturbing death of Miles, and the disappearance of Quint’s ghost all point to a hidden power within the governess allowing her to survive long after her weaker male counterparts.

Essay --

The Differences Sunni and Shia Ideology Thesis: The Sunni and Shia ideology in terms of the concept of imamate, their believe on al-Quran and Hadith and the successor of the leadership after the death of the prophet Muhammad i. Sunni and Shia ideology in terms of the concept imamate. A. The appointment of shall be the duty of human priest or God? 1. Sunni a) They stated that the selection of imam is the responsibility among Muslim and it is not duty of God. b) The Sunni say believe in imams excluding priests rule of faith. c) The importance of Salat (prayer) than Imamate by Sunni. 2. Shia a) They stated that the appointment of the imam is the duty and responsibility of God b) Of the fabricated views and beliefs of the shia is that they hold their imams something of divine origin, much above the human beings, and even above Prophets and Messenger. (Tarjman Al-Hadith, The Shi’ites And The Sunna, Idara Tarjuman Al-Sunnah, 1984, p.90) c) The Shia say, believe in twelve imams, including the pillars of faith. (www.wiki.answers.com.) d) The importance of Imamate in Shia is more importance of salat (prayer). ii. Sunni and Shia ideology in terms of al-Quran and Hadith. A. Al-Quran and Hadith 1. Sunni a) Sunni agreed on the truth of the al-Quran and protected from any deviation. b) Sunni Muslims accept this Hadith as Sahih (authentic). The Hadith of al-Quran and Sunnah is used by the Sunnis to stress importance of following the Sunnah. (Yaykh Muhammad Hisham Kabbani, Islamic Beliefs & Doctorine According to Ahl al-Sunna, As-Sunna Foundation of America, 1996, p.242) c) Accept all the hadith narrated by Bukhari and Muslims and other hadith books. 2. Shia a) They had argument on the truth of the al-Quran and accused that al-Quran have devia... ...ussion concluded whereas faith practiced by the Shia obviously been in conflict with the faith that underpinned by Sunni. It is not only against the consensus of â€Å"the scholars, even worse, it has been inverting the texts that have been handed down by God as understood by the majority of scholars to mankind. Based on this differences, there is no way to achieve unity and strengthen them to adopt beliefs or withholding resources unless one of the parties to leave their positions and recognized source of resources. Although there is a meeting point between the two parties, but much dispute on the ground that creates a gap in the far east and far west. In the case, there is no better shield strong in facing the challenges of this movement effectively unless Muslims should return adheres to the belief that authentic knowledge legacy of the Prophet and his companions R.A.

The Deceitful George in John Steinbecks Of Mice and Men :: Steinbeck Of Mice and Men Essays

The Deceitful George in Of Mice and Men Steinbeck gives a lot of reasons for George to stay with Lennie, but his critics also have some merit in their criticism that the story isn't believable. Steinbeck's critics suggest that Steinbeck is "simply sentimental in this regard." There are some very compelling reasons George would like to stay with Lennie... but being "sentimental," towards Lennie has nothing to do with it. George and Lennie's ultimate goal is to "get the jack together," buy a few acres of land they can call their own, "an' live off the fatta the lan' (pg. 14)." George talks in great depth about how their dream house is going to have individual rooms, a kitchen with a fat iron stove, and an orchard. But, George only recites this yarn when he wants to get Lennie calmed down. Lennie has the mentality of an 8 year old, the memory of a senile 80 year old, and only desires to tend rabbits. George fully understands that Lennie can easily be manipulated. Even though the dream to have a piece of land is shared, George knows that by himself he cannot amass a large enough "stake," to buy it himself (pg. 33)." Just as the boss thought, George was "takin' his pay away from him (pg. 22)." Throughout the story George recites a description of how easy his life could be if he didn't have to keep up with Lennie. "God a'mighty," he could "get a job, an' work, an' no trouble (pg. 11)." At the end of the month, he could take his 50 bucks and go into town and buy whatever he wanted. George says these things like he's only teasing, but in actuality he's dead serious. George started building his alibi when he first arrived at the farm. He wanted to seem like he deeply cared for Lennie, and that Lennie was an overall good person. George then strengthened his alibi, and gave a glimpse of his true motives when he talked to George about why he stopped making fun of Lennie. George said that he told Lennie to "jump in," and that Lennie did it and "he damn near drowned (pg.

Psoriasis

Yes, psoriasis can be treated This six-part KULIT article series by the Persatuan Dermatologi Malaysia aims to raise awareness of psoriasis. In this final article, PDM President Dr Allan K C Yee highlights an important message for people with psoriasis – there is no cure yet for psoriasis, but its symptoms can be effectively treated and managed. Be open-minded and willing to work with your doctor to find a treatment that will work for you. The object of treatment is to reduce the extent and severity of psoriasis – the red scaly stigmata, the tell-tale scaling on one’s clothes, the rough cracked palms that make handshakes awkward, painful joints that limit one’s activities. In short, the goal is to improve the quality of life which has been shown in studies to be as affected as much as other major diseases such as cancer, heart disease and depression. The good news is that with today’s medical armamentarium, much can be done to allow the sufferer a greatly improved quality of life. Treatments must be individualized Fortunately, only 20% of psoriatics suffer from severe psoriasis, and the site involved is so variable that the treatments must be individualized. Limited disease can be treated with topical agents but more extensive skin involvement will require oral systemic treatments, phototherapy with artificial UV light, or even injectable agents (biologics). Furthermore psoriasis can affect any part of the body, each meriting special measures. Site-specific treatments For instance, thick scalp psoriasis is often mistakenly treated with endless anti-dandruff shampoos with little results. Scalp psoriasis invariably responds dramatically to tar pomades under occlusion for one to two weeks, a tip that an experienced dermatologist would gladly share with sufferers. Similarly, thick and cracked scaly palms and soles that prevent working with the hands or sometimes even walking, can be significantly improved with special steroid-salicylic acid ointments used under occlusion. These soften and shed the thickened dead skin making the skin pliable and usable once more. Psoriasis affecting the face, body creases – groins, armpits and private areas can be improved with the udicious use of weaker topical steroids and the newer and safer nonsteroidal calcineurin-inhibitors. The problem is that these thinned skinned areas are often treated with strong steroid creams that are not meant to be used in these sensitive areas. The end-result is irreversible side-effects such as ugly pink stretch marks, easy bruising and skin infections. We see a lot of these unfortunate cases who are sold these strong steroids from errant pharmacies without a prescription, or are introduced to them by well-meaning friends and relatives. The Dermatological Society of Malaysia is working with the Ministry of Health to ensure that potent steroids are only available with a prescription. The treatment should not be worse than the disease! Hopefully with warnings such as in this article, the lay public will be better informed about the dangers of self-medicating with potent topical steroids. Topical Treatments Generally, when the extent of psoriasis is limited to less than 5 – 10% of the body surface area (BSA), it is best to use topical treatments in the form of creams, ointments, lotions. As a guide, 1% of the BSA is the area covered by one’s palm. The red, thickened skin in psoriasis is due to the increased multiplication of the skin, allowing the collection of the dead skin layer to be manifested as thick scales. Most effective treatments whether topical or systemic work by reducing the cell multiplication, and by removing the dead skin layers. Time tested agents are coal tar, and anthranols which are messy and brown-staining thus adding further to the stigmatization sufferers feel. More cosmetically acceptable topical agents are steroid creams, vitamin D analogues and calcineurin inhibitors. The latter two are more expensive than the ubiquitous steroid creams but with a superior safety profile. Most psoriatic lesions also tend to be dry and glycerin, urea-based or other humectant moisturizers help relieve soreness and improve recovery especially when used in conjunction with keratolytics – agents that soften and shed the abnormal dead skin layers. Systemic treatments When more than 10% of BSA is involved it becomes impractical to rely on topical measures alone. It may take more than half an hour just to apply creams on large areas of affected skin. Hence, oral or injectable medications are required. Many of these drugs are able to reduce the skin’s cell multiplication or maturation rate eg methotrexate, hydroxyurea, retinoids. However many others suppress the disease process at a more fundamental level by suppressing the activity of abnormal white cells (T-cells) or by neutralizing the T-cells inflammatory chemicals (eg TNF a) eg cyclosporine and the newer biologic agents licensed for use in Malaysia. With the proper use of these systemic agents singly or in combination, it is often possible to control even the most severe cases of psoriasis. However, these systemic agents should only be used by experienced physicians as many of them can have significant side effects. For example, persons with liver disease or gastric ulcers should not be treated with methotrexate; women of child-bearing age should not use retinoids as it can cause fetal abnormalities; persons with high blood pressure or kidney problems cannot use cyclosporine. If a person with severe psoriasis has liver disease, is a woman of childbearing age, or has kidney problems what options then are available for him/her? There are 3 options – oral salazopyrine which only works in 50% of Asians, the injectable biologic agents, or phototherapy (see below). Biologic agents are the new kids on the block. They have a much better safety profile than the above mentioned oral drugs and can be used in persons with liver, kidney disease and women but unfortunately their high cost means relatively few can afford them. Even in the west, where such expensive treatments are reimbursable, the psoriasis must be shown to be non-responsive to conventional oral drugs, or organ toxicities with these drugs are present. Some of them are very helpful in controlling psoriasis as well as the disabling arthritis that affects 10-30% of psoriatics. Phototherapy (PUVA, UVB, nUVB) This is an excellent form of treatment with artificial UV light which is relatively free from serious side effects apart from a small risk of developing non-melanoma skin cancers with prolonged use. This risk is probably not significant in the setting of Asian skin types especially with the newer types of phototherapy equipment such as narrow band UVB (nUVB), and the excimer laser or excimer light. Another advantage of phototherapy is that it is a clean form of treatment, nonmessy and can give a long remission period of up to one year. The main drawback is that it does require visits to the phototherapy centre 3 times a week for 2-3 months. The good news is that most states in Malaysia now have phototherapy units to treat not only psoriasis, but also vitiligo and severe atopic eczema. Alternative therapies In this day and age where the emphasis is on evidence-based medicine (EBM), alternative therapies must prove its worth with hard core scientific evidence from well-conducted clinical studies. Many people with psoriasis who have suffered from the condition for years are, not surprisingly, hopeful for answers, breakthroughs, and even a â€Å"cure† perhaps. Unfortunately, there is no shortage of charlatans offering â€Å"cures† for psoriasis, often in network marketing schemes. One has to acknowledge the fact that psoriasis has a genetic basis, and unless gene therapy becomes a reality, there cannot be a cure, even with accepted treatments such as climatotherapy in the Dead Sea. Diets for psoriasis are as yet unproven, although an FDA-approved healthy diet with at least 5-9 servings of fresh preferably organic produce may be of help in improving one’s general health. Stress reduction strategies may help insofar as stress precipitates and aggravates psoriasis. Prayer has been shown useful in several medical conditions, and a strong faith life can only help, if only to give one the equanimity to deal with the turbulence of modern life. The future of psoriasis treatments There is considerable optimism in the search for better and safer treatments for psoriasis in the near future. We now have a much better understanding of the genetics and underlying immune derangements in psoriasis. It is only a matter of time before the tremendous amount of ongoing research bears better fruit that is sweeter and without the bitter aftertaste of side-effects. Indeed here are promising smaller molecules in the offing that are cheaper to synthesize. Watch out for this space. Psoriasis affects 2-3 percent of Malaysians. This is the final article of a six-part series from PDM’s â€Å"KULIT – Living with Psoriasis† Campaign 2007. For more on psoriasis, treatment options and KULIT, visit www. dermatology. org. my or email [email  protected] com. This article is a guide to help you better understand psoriasis and psoriatic arthritis. Consult a suitably qualified medical practitioner before acting on any information contained above. KULIT is a community programme sponsored by Wyeth Malaysia.