Advair Diskus

By D. Farmon. Gwynedd-Mercy College. 2018.

By developing these methods of ginseng culti- vation cheap 500 mcg advair diskus with amex, a number of tonic formulae could be prepared in both Korea and China order 500 mcg advair diskus visa. This time period also corresponded to the Renaissance in the Occidental world buy discount advair diskus 100 mcg online, a period when the use and devel- opment of modern medical technologies and chemical drugs, which differed from those of the dark Middle Ages, began to blossom. In the Oriental world in the period of the late seventeenth to the early eighteenth century, a new medical theory on infectious diseases evolved and was advocated by a group of medical doctors who were frustrated by the fact that the old, conventional ways of therapeutic doctrine, based on the Shang Han Lun, which had been 260 | Traditional medicine Korean medicine | 261 used for more than 1000 years, were no longer effective. These doctors then began to seek a new view on the causative factors of infectious diseases. Subsequently, they tried to define the newly infectious diseases, and proposed a hypothesis called ‘warm-climate disease’ by which all infectious diseases arise in or are due to a warm climate environment. None the less, it is very interesting that those medical doctors had not known of the exis- tence of microorganisms, and some of these virulent microorganisms were responsible for a variety of infectious diseases that plagued many Oriental societies until the late nineteenth century. During the late Renaissance period, a number of Christian missionaries arrived in China, Japan and Korea; they brought various western diseases, but they also brought various western medicines, and some of the missionaries even performed surgical operations. There was an episode in which a Chinese emperor of the Qing dynasty had a malaria infection, and the royal family doctors tried to cure him, but failed with the traditional formulae. Interestingly, when a missionary father had the chance to give him a drug containing quinine, which was derived from the bark of the Cinchona tree, the emperor completely recovered from the malaria infection. This is an example by which the Oriental world became aware of the realities and efficacies of modern western medicine. However, looking more closely at the story, it becomes a bit more controversial because there had already been a traditional herbal medicine with superior effectiveness in malaria infection, artemisine, the active ingredient isolated from Artemisia annua, and now used for malaria resistant to quinine. However, it is not known why the royal family doctors did not use Artemisia annua for the Emperor at that time. These outcomes were largely a result of the Great King Sejong’s policies on science and technology development in the early Chosun dynasty. In that period, various scientific and technological innovations and advances were made: the development and adoption of a standard calendar, the establishment of a standard metrology system for the units of weight and measurement and, most importantly, the invention of the Han Geul (Korean alphabet). Han Geul is based on phonetic letters, entirely different from the ideographic Chinese alphabet, and basically consists of 14 consonants and 10 vowels. Consequently, several epoch- making contributions for the advancement of traditional Oriental medicines were also achieved. Half of these books were lost, and the remaining half were collected and are preserved at the Kyu Jang Gak Library (formally the Chosun Dynasty Royal Library) at Seoul National University and the Han Dok Museum of Medicine and Pharmacy which was founded by a private collector. Of these medical classics, there were several famous books that significantly influ- enced the progress of traditional medicines in Korea as well as in China and Japan. Eui Bang Yoo Chui (the Classified Assemblage of Medical Prescriptions) This book is a series of compilations of almost all herbal formulae and medical theories available in Korea and China. This last copy is now kept in the Japanese royal library located in the Japanese king’s palace. There is no doubt that this book contributed to the progress of traditional Japanese medicine (kampo). Hyang Yak Chae Chui Wol Ryong (the Harvest and Collection of Indigenous Herbal Plants during the Four Seasons) This book is a kind of guidebook for identifying and collecting indigenous herbal material in each month of the year across the Korean peninsula. The purpose of publishing this book was to supply domestic needs for commonly used herbal materials with indigenous herbal plant sources. Subsequently, this book was the basis for establishing various herbal formulae using Korean herbal materials. It comprises 57 chapters in which 959 disease patterns are well classified, and their pathological characteristics and therapeutic treatments are also described, with a total of 10 706 herbal formulae and 1416 kinds of acupuncture applications. In addition, a special chapter is dedicated to Korean herbal formulae with indigenous herbal materials for the treatment of various diseases. In the annex, various methodologies for processing herbal materials in order to remove the toxic components out of the herbal constituents are described in detail. Such processing methodologies are unique and characteristic pre-treatments of crude herbal materials and for prolonging the preservation of herbal materials. This information is a research source for preparing the standard processing methodology in the herbal medicine industry at the present time. It has 25 volumes in which he discussed and commented on various traditional Korean and Chinese medical theories based on actual clinical experiences, and listed more than 6800 herbal formulae and some acupuncture therapies. This book has been recognised to be a sort of medical bible in the area of traditional Oriental medicine, and many copies were published in China, Japan and Taiwan. This book shows very accurate citations with a total of 83 reference books that were previously published in Korea and China (Figure 9. Sa Am ascetic’s summary of acupuncture–moxibustion therapy Sa Am is the pseudonym of a monk who led an ascetic life during the middle of the Chosun dynasty. He wrote the above book, but it was not accurately known when the book was printed. He established a new methodology of acupuncture therapy on the basis of the five-phase theory of the Oriental cosmology. His method, which had been outside the mainstream for a long period, has been re-discovered in recent years, and further developed. Dong Eui Soo Se Bo Won (the Textbook of Oriental Medicine for Longevity and Life Preservation) The above book consisted of four volumes, and was written by Lee, Je Ma. He proposed a new theory, the so-called four constitutional medicines, based on the physiological and functional differences of the human body according to the external shape, emotional activities, and size of the internal viscera and bowels. Such physiological and functional differences are categorised into four constitutions by which all humans can be classified: the Greater Yang person, the Greater Yin person, the Lesser Yang person and the Lesser Yin person. In his theory, patients with the same disease should be treated differently according to their constitutional characteristics. It is characterised by the following two distinct requisites: • First, the therapy follows the five-phase theory by engendering or restraining the functions of the viscera and bowels, which were rendered defective by certain diseases. As the acupuncture is applied to the proper acupoints, the patient’s emotional conditions are also considered. In addition, relatively small-sized needles are clinically applied to, at most, the eight acupoints located on the arm–hand and knee–foot areas. Therefore, patients feel the acupuncture therapy safe and comfortable and its therapeutic potency appears to be very effective in clinical practice. The Greater Yang person has large lungs and a small liver; the Greater Yin person has small lungs and a large liver; the Lesser Yang person has a large spleen and small kidneys; and the Lesser Yin person has a small spleen and large kidneys. These different sizes of the viscera and subse- quently related physiological functions lead to different clinical treatments. In addition, size difference and physiological function are also directly asso- ciated with the emotional behaviour. When the Greater Yang person gets sick with a high fever, a unique herbal formula is given both to reduce the fever and to soothe the anger during the initial treatment. In his book, there are just a little over 100 herbal formulae available for various illnesses of the four constitutional types. Actually, he did not fully complete his proposed theory in terms of clinical evidence during his life, so various scientific efforts have been continued to objectify its effec- tiveness, e. Along with the questionnaire, routine check-ups including a pulse diagnosis are also given.

purchase advair diskus 500mcg visa

Reports of a Medline search on the term ‘quality of life’ indicate a surge in its use from 40 citations (1966–74) purchase advair diskus 250 mcg, to 1907 citations (1981–85) buy cheap advair diskus 100 mcg on-line, to 5078 citations (1986–90) (Albrecht 1994) purchase advair diskus 100mcg with amex. For example, it has been defined as ‘the value assigned to duration of life as modified by the impairments, functional states, perceptions and social opportunities that are influenced by disease, injury, treatment or policy’ (Patrick and Ericson 1993), ‘a personal statement of the positivity or negativity of attributes that characterise one’s life’ (Grant et al. Further, whilst some researchers treat the concepts of quality of life as interchangeable, others argue that they are separate (Bradley 2001). Such problems with definition have resulted in a range of ways of operationalizing quality of life. For example, following the discussions about an acceptable definition of quality of life, the European Organisation for Research on Treatment of Cancer operationalized quality of life in terms of ‘functional status, cancer and treatment specific symptoms, psychological distress, social interaction, financial/economic impact, perceived health status and overall quality of life’ (Aaronson et al. In line with this, their measure consisted of items that reflected these different dimensions. Furthermore, Fallowfield (1990) defined the four main dimensions of quality of life as psychological (mood, emotional distress, adjustment to illness), social (relationships, social and leisure activities), occupational (paid and unpaid work) and physical (mobility, pain, sleep and appetite). Creating a conceptual framework In response to the problems of defining quality of life, researchers have recently attempted to create a clearer conceptual framework for this construct. In particular, researchers have divided quality of life measures either according to who devises the measure or in terms of whether the measure is considered objective or subjective. The first of these is described as being based on the assumption that ‘a consensus about what constitutes a good or poor quality of life exists or at least can be discovered through investigation’ (Browne et al. In addition, the standard needs approach assumes that needs rather than wants are central to quality of life and that these needs are common to all, including the researchers. In contrast, the psychological processes approach considers quality of life to be ‘constructed from individual evaluations of personally salient aspects of life’ (Browne et al. They argued that quality of life measures should be divided into those that assess objective functioning and those that assess subjective well-being. The first of these reflects those measures that describe an individual’s level of functioning, which they argue must be validated against directly observed behavioural performance, and the second describes the individual’s own appraisal of their well-being. Therefore, some progress has been made to clarify the problems surrounding measures of quality of life. However, until a consensus among researchers and clinicians exists it remains unclear what quality of life is, and whether quality of life is different to subjective health status and health-related quality of life. However, ‘quality of life’, ‘subjective health status’ and ‘health-related quality of life’ continue to be used and their measurement continues to be taken. The range of measures developed will now be considered in terms of (1) unidimensional measures and (2) multidimensional measures. Whilst the short form is mainly used to explore mood in general and provides results as to an individual’s relative mood (i. Therefore, these unidimensional measures assess health in terms of one specific aspect of health and can be used on their own or in conjunction with other measures. Multidimensional measures Multidimensional measures assess health in the broadest sense. For example, researchers often use a single item such as, ‘would you say your health is: excellent/good/fair/poor? Further, some researchers simply ask respondents to make a relative judgement about their health on a scale from ‘best possible’ to ‘worst possible’. Although these simple measures do not provide as much detail as longer measures, they have been shown to correlate highly with other more complex measures and to be useful as an outcome measure (Idler and Kasl 1995). Because of the many ways of defining quality of life, many different measures have been developed. Some focus on particular populations, such as the elderly (Lawton 1972, 1975; McKee et al. In addition, generic measures of quality of life have also been developed, which can be applied to all individuals. All of these measures have been criticized for being too broad and therefore resulting in a definition of quality of life that is all encompassing, vague and unfocused. In particular, it has been suggested that by asking individuals to answer a pre-defined set of questions and to rate statements that have been developed by researchers, the indi- vidual’s own concerns may be missed. Individual quality of life measures Measures of subjective health status ask the individual to rate their own health. This is in great contrast to measures of mortality, morbidity and most measures of functioning, which are completed by carers, researchers or an observer. However, although such measures enable individuals to rate their own health, they do not allow them to select the dimensions along which to rate it. For example, a measure that asks about an individual’s work life assumes that work is important to this person, but they might not want to work. Furthermore, one that asks about family life, might be addressing the question to someone who is glad not to see their family. How can one set of individuals who happen to be researchers know what is important to the quality of life of another set of individuals? In line with this perspective, researchers have developed individual quality of life measures, which not only ask the subjects to rate their own health status but also to define the dimensions along which it should be rated. This is an interesting paper as it illustrates how a measurement tool, developed within a psychological framework, can be used to evaluate the impact of a surgical intervention. In addition, it compared the use of composite scales with an individual quality of life scale. Background There are a multitude of measures of quality of life available, most of which ask patients to rate a set of statements that a group of researchers consider to reflect quality of life. However, whether this approach actually accesses what the patient thinks is unclear. These were matched to control subjects from local general practices in terms of age, sex and class. The study consisted of 20 subjects, who underwent hip replacement operation, and 20 controls. Design The study used a repeated measures design with measures completed before (baseline) and after (six-month follow-up) unilateral total hip replacement surgery. Measures The subjects completed the following measures at baseline and follow-up: s Individual quality of life: this involved the following stages. First, the subjects were asked to list the five areas of life that they considered to be most important to their quality of life. Second, the subjects were then asked to rate each area for their status at the present time ranging from ‘as good as could possibly be’ to ‘as bad as could possibly be’. Finally, in order to weight each area of life, the subjects were presented with 30 randomly generated profiles of hypothetical people labelled with the five chosen areas and were asked to rate the quality of life of each of these people. Results The results were analysed in terms of the areas of life selected as part of the individual quality of life scale and to assess the impact of the hip replacement operation in terms of changes in all measures from baseline to follow-up and differences in these changes between the patients and the controls. Happiness, intellectual function and living conditions were nominated least frequently. Health was nominated more frequently by the control than the patients who rated independence and finance more frequently. Therefore, this study illustrates the usefulness of an individual quality of life measure in evaluating the effectiveness of a surgical procedure. Therefore, health status can be assessed in terms of mortality rates, morbidity, levels of functioning and subjective health measures.

Related/Risk Factors (“related to”) [Substance intoxication] [Substance withdrawal] [Disorientation] [Seizures] [Hallucinations] [Psychomotor agitation] [Unstable vital signs] [Delirium] [Flashbacks] [Panic level of anxiety] Goals/Objectives Short-term Goal Client’s condition will stabilize within 72 hours discount advair diskus 100mcg line. Assess client’s level of disorientation to determine specific requirements for safety cheap advair diskus 500mcg on-line. Knowledge of client’s level of func- tioning is necessary to formulate appropriate plan of care discount advair diskus 100mcg without a prescription. Knowledge regarding substance ingestion is important for accurate as- sessment of client condition. Observe client behaviors frequently; assign staff on one- to-one basis if condition is warranted; accompany and assist client when ambulating; use wheelchair for trans- porting long distances. Pad headboard and side rails of bed with thick towels to protect client in case of seizure. Use mechanical restraints as necessary to protect client if excessive hyperactivity accompanies the disorientation. Ensure that smoking materials and other potentially harmful objects are stored away from client’s access. Disori- entation may endanger client safety if he or she unknow- ingly wanders away from safe environment. Monitor client’s vital signs every 15 minutes initially and less frequently as acute symptoms subside. Vital signs provide the most reliable information about client condition and need for medication during acute detoxification period. Com- mon medical intervention for detoxification from the follow- ing substances includes: a. Benzodiazepines are the most widely used group of drugs for substitution therapy in alcohol with- drawal. Commonly used agents include chlordiazepoxide (Librium), oxazepam (Serax), diazepam (Valium), and alprazolam (Xanax). In clients with liver disease, accumulation of the longer-acting agents, such as chlordiazepoxide (Librium), may be problematic, and the Substance-Related Disorders ● 91 use of shorter-acting benzodiazepines, such as oxazepam (Serax), is more appropriate. Some physicians may order anticonvulsant medication to be used prophylactically; however, this is not a universal intervention. Multivitamin therapy, in combination with daily thiamine (either orally or by injection), is common protocol. Narcotic antagonists, such as naloxone (Narcan), naltrexone (ReVia), or nalmefene (Revex), are administered intravenously for narcotic overdose. Substitution therapy may be instituted to decrease withdrawal symptoms using propoxyphene (Darvon), methadone (Dolophine), or buprenorphine (Subutex). Substitution therapy may be instituted to decrease withdrawal symptoms using a long-acting barbiturate, such as phenobarbital (Luminal). When stabilization has been achieved, the dose is gradu- ally decreased by 30 mg/day until withdrawal is complete. Treatment of stimulant intoxication usually begins with minor tranquilizers such as chlordiazepoxide (Librium) and progresses to major tranquilizers such as haloperidol (Haldol). Antipsychotics should be adminis- tered with caution because of their propensity to lower seizure threshold. Withdrawal treatment is usually aimed at reducing drug craving and managing severe depression. The client is placed in a quiet atmosphere and allowed to sleep and eat as much as is needed or desired. Desipramine has been especially successful with symptoms of cocaine withdrawal and abstinence (Mack, Franklin, & Frances, 2003). Client is no longer exhibiting any signs or symptoms of sub- stance intoxication or withdrawal. Client shows no evidence of physical injury obtained during substance intoxication or withdrawal. Possible Etiologies (“related to”) [Weak, underdeveloped ego] [Underlying fears and anxieties] [Low self-esteem] [Fixation in early level of development] Defining Characteristics (“evidenced by”) [Denies substance abuse or dependence] [Denies that substance use creates problems in his or her life] [Continues to use substance, knowing it contributes to impair- ment in functioning or exacerbation of physical symptoms] [Uses substance(s) in physically hazardous situations] [Use of rationalization and projection to explain maladaptive behaviors] Unable to admit impact of disease on life pattern Goals/Objectives Short-term Goal Client will divert attention away from external issues and focus on behavioral outcomes associated with substance use. Long-term Goal Client will verbalize acceptance of responsibility for own behavior and acknowledge association between substance use and personal problems. Ensure that he or she understands, “It is not you but your behavior that is unacceptable. Client may rationalize his or her behavior with Substance-Related Disorders ● 93 statements such as, “I’m not an alcoholic. Factual information presented in a matter-of-fact, nonjudgmental way explaining what behaviors constitute substance-related disorders may help client focus on his or her own behaviors as an illness that requires help. Identify recent maladaptive behaviors or situations that have occurred in client’s life, and discuss how use of substances may have been a contributing factor. The first step in decreas- ing use of denial is for client to see the relationship between substance use and personal problems. Confrontation interferes with client’s ability to use denial; a caring attitude preserves self- esteem and avoids putting client on the defensive. Do not accept the use of rationalization or projection as client attempts to make excuses for or blame his or her be- havior on other people or situations. Rationalization and projection prolong the stage of denial that problems exist in client’s life because of substance use. Peer pressure can be a strong factor as well as the association with individuals who are experiencing or who have experi- enced similar problems. Offer immediate positive recognition of client’s expres- sions of insight gained regarding illness and acceptance of responsibility for own behavior. Positive reinforcement en- hances self-esteem and encourages repetition of desirable behaviors. Client verbalizes understanding of the relationship between personal problems and the use of substances. Client verbalizes understanding of substance dependence and abuse as an illness requiring ongoing support and treatment. Possible Etiologies (“related to”) [Inadequate support systems] [Inadequate coping skills] [Underdeveloped ego] [Possible hereditary factor] [Dysfunctional family system] [Negative role modeling] [Personal vulnerability] Defining Characteristics (“evidenced by”) [Low self-esteem] [Chronic anxiety] [Chronic depression] Inability to meet role expectations [Alteration in societal participation] Inability to meet basic needs [Inappropriate use of defense mechanisms] Abuse of chemical agents [Low frustration tolerance] [Need for immediate gratification] [Manipulative behavior] Goals/Objectives Short-term Goal Client will express true feelings associated with use of substances as a method of coping with stress. Long-term Goal Client will be able to verbalize adaptive coping mechanisms to use, instead of substance abuse, in response to stress. Establish trusting relationship with client (be honest; keep appointments; be available to spend time). Be sure that client knows what is acceptable, what is not, and the consequenc- es for violating the limits set. Client is unable to Substance-Related Disorders ● 95 establish own limits, so limits must be set for him or her. Unless administration of consequences for violation of limits is consistent, manipulative behavior will not be eliminated. Verbalization of feelings in a nonthreaten- ing environment may help client come to terms with long- unresolved issues.

If a hospital admits to “testing” for history of significant traumas such as emotional and bonding generic advair diskus 250mcg free shipping, parents may ask if they may decline the test purchase advair diskus 250mcg fast delivery, or physical abuse buy 250mcg advair diskus with amex, neglect, or the loss of a parent in child- if they can have access to the test results. Feelings of inadequacy and self-loathing that arise the birth and the period immediately after should be han- from these situations may be key in developing the bor- dled according to the parents’ wishes. It has also been theorized that these patients are trying to compensate for the care they were A. Woodward denied in childhood through the idealized demands they now make on themselves and on others as an adult. Borderline individuals have a history of unstable in- •Recurrent suicidal behavior, gestures, or threats, or re- terpersonal relationships. However, their fear of abandonment, and of ending the • Inappropriate and intense anger, or difficulty control- therapy relationship, may actually cause them to discon- ling anger displayed through temper outbursts, physical tinue treatment as soon as progress is made. Psychotherapy,typically in the form of cognitive be- •Transient, stress-related paranoia and/or severe disso- havioral therapy, is usually the treatment of choice for bor- ciative symptoms (a separation from the subconscious, derline personalities. The treatment focuses on giving the bor- derline patient self-confidence and coping tools for life Diagnosis outside of treatment through a combination of social skill Borderline personality disorder typically first appears training, mood awareness and meditative exercises, and in early adulthood. Group therapy is also an op- adolescence, it may be difficult to diagnose, as “border- tion for some borderline patients, although some may feel line symptoms” such as impulsive and experimental be- threatened by the idea of “sharing” a therapist with others. These should be ruled out as causes before have indicated that naltrexone, an opiate antagonist, may making the diagnosis of borderline personality disorder. It has also been suggested by some re- The disorder usually peaks in young adulthood and searchers that borderline personality disorder is not a frequently stabilizes after age 30. Approximately 75- true pathological condition in and of itself, but rather a 80% of borderline patients attempt or threaten suicide, number of overlapping personality disorders; however, it and between 8-10% are successful. If the borderline pa- is commonly recognized as a separate and distinct disor- tient suffers from depressive disorder, the risk of suicide der by the American Psychological Association and by is much higher. See also Dissociation/Dissociative disorders Treatment Paula Ford-Martin Individuals with borderline personality disorder seek psychiatric help and hospitalization at a much high- er rate than people with other personality disorders, Further Reading probably due to their fear of abandonment and need to American Psychiatric Association. Trained as a physician, Boss received his medical degree from the University of A state of weariness with, and disinterest in, life. Before that, however, he had spent time in Vienna, where he had met (and been analyzed by) Sig- Everyone, at one time or another, feels bored. Binswanger (1881-1966) has Infants spend large blocks of time asleep and much of been called the first existential psychologist. Toddlers have a nearly unlim- Boss met Heidigger, and it was then that he was able to ited curiosity to explore a world that is still new to them. The child may be engrossed in an activ- Essentially, Boss believed that Dasein was a means ity one minute and, seconds later, lose interest and com- of opening the mind—of bringing light to a situation. The symbolism of light played an important role in Boss’s work: the idea of “coming out of the darkness,” of Adults who complain of boredom may be express- “illuminating an idea,” and ultimately, of “enlighten- ing their frustration at being unchallenged by their pre- ment. People who complain about being bored tant part in how people reacted to their environment. An at work, for example, may feel that they are not being angry person, for example, would be attuned primarily to used to their potential. In rare instances, dreams were important—more so than other existential people who repeatedly complain of boredom might be thinkers. What made his interpretation of dreams differ- suffering from a clinical condition such as depression. Boss’s books include Existential Foundations of Medicine and Psychology, Psychoanalysis and Dasein- Further Reading analysis, and The Analysis of Dreams. Milite Medard Boss 1903-1990 Murray Bowen Swiss psychotherapist who helped build the con- cept of existential psychology. The idea of combining psychology and philosophy may seem to run counter to the idea of psychology as a Murray Bowen grew up in a small town that he be- science. But psychology is a science of the mind, and the lieved gave him the foundation for his theories on family releationship between the mind and ideas is critically im- therapy. Medard Boss, trained as a although it was made up of individuals who had their physician, used his knowledge of philosophy to help hu- own thoughts and needs, much of how they behaved was manize psychology. He spent his career developing the the result of how they functioned as part of the family. His parents were ment of the philosophy of Martin Heidigger (who be- Jesse and Maggie Bowen; their families had lived in came a friend of Boss). Gallen, Switzerland on Octo- Jesse Bowen was mayor of Waverly, and he also ran sev- ber 4, 1903 and raised in Zurich. Zurich during the early eral small businesses there, including the funeral parlor. He then went to meant, and what happened when it did not or could not the University of Tennessee Medical School, where he exist—formed the basis for groundbreaking work that received his M. He completed internships in culminated in his “attachment theory” about maternal New York and in 1941 enlisted in the Army. More important, he made practical as well as military experience he had planned to become a cardiac theoretical use of his research, working directly with pa- surgeon. His observation of soldiers in the midst of war, tients and taking young and talented researchers under however, convinced him that mental illness was a more his wing. Upon leaving the Army in Born in London on February 26, 1907, Edward John 1946, he accepted a fellowship at the Menninger Foun- Mostyn Bowlby was the son of Major Sir Anthony Bowl- dation in Topeka, Kansas, where he studied psycho- by and the former May Mostyn. When John, that, despite Freud’s success, his methods fell short in one of six children, was born, his father was 52 and his one important regard: recognizing the family as a unit mother was 40. His childhood was typical of many mid- with its own emotional needs and behaviors. Whereas dle- and upper-class children in Britain; early years spent Freud focused on the self, Bowen saw the family as a with a nanny or governess, then boarding school. As one of five siblings, and as a husband Bowlby attended the Royal Naval College and Cam- and father of four children, he no doubt observed much bridge, where he prepared for medical school. Two Bowen moved to the National Institute of Mental children in particular intrigued Bowlby: an adolescent Health in 1954, and then to Georgetown University Med- loner who had been expelled from school for stealing, ical Center in 1959, where he remained for the rest of his and a nervous seven-year-old who was called Bowlby’s career. In the late 1950s he further developed what he shadow because he followed him around. At the Institute he was supervised by the innovative cal Practice, in 1978, and he was a founder and first child psychoanalyst Melanie Klein. Although Bowlby president of the American Family Therapy Association did not agree with many of Klein’s theories, her guid- from 1978 to 1982. His first empirical study, in fact, tracked 44 children whose be- havior patterns included anxiety and petty crime. He dis- covered a common thread among these children: they had been deprived of their mothers at some point during their childhood.