HOW AFRICANS UNDERDEVELOP AFRICA

How African Leaders Under-Develop Africa

 

Accra (Ghanaian Chronicle, May 22, 2000) - The May 13-19 issue of the Economist, the influential London news magazine has Africa on the cover. The magazine also has a sketch of Africa on an inside page.
It depicts Africa lying prostrate while a bloodied black hand drills a knife into her very heart: Africa's problems are self- inflicted! It used to be fashionable to blame the ills of Africa on others: Colonialism; Neo-colonialists; Imperialists; the CIA (never the KGB!), etc.
Political Scientists describe this phenomenon of the blame game as Dependency Theory, a symptom of a symbiotic relationship between the rich and the poor where the poor is dealt the weak hand, deliberately.
The late Walter Rodney, the Guyanan historian wrote a book about that titled, "How Europe Under-Developed Africa." This is no longer absolutely tenable.
The reality of the matter is that the major culprits of the destruction of Africa today, are AFRICANS themselves. To wit: our corrupt leaders and their bands of sycophant, president does-no-wrong minions.
Major corruption in African officialdom continues to cause degenerative under-development on the continent. African countries have become the personal estates of official criminal gangs whose avowed aim is not the development of their countries, but rather the siphoning off of national resources into foreign banks.
Officials in the tiny European principality of Luxembourg have just frozen eight bank accounts totalling 600 million U.S. dollars, belonging to the late super corrupt Sani Abacha of Nigeria. This is one example of how our African leaders contribute to the under-development of Africa!

               CORRUPTION

Official corruption siphons off money intended for the development of Africa. Apart from making a lot of profit on the interest on investments accruing from Africa's stolen money, Europeans turn around and loan such money to Africa at exorbitant rates. Thus, in nearly all African countries today, we spend more money to pay the interest on such loans (not on the debt itself) than we do on Health and Education!
In effect, African countries are played like a football. Whoever has the ball kicks it until it is near deflation! It is then pumped up by some foreign loans, and the process continues. Such has been our lot since independence. Africa suffers from chronic intermittent growth, and perpetual deflation.
Another method whereby our African leaders contribute to the under- development of Africa is the pursuit of wrong-headed policies that result in rampant and continuing wars in Africa. At this very moment, at least sixteen African countries are involved in some form of warfare or another. In this manner, African leaders spend a lot of money buying various types of armaments and ammunition from Europe, America and elsewhere. In this manner, money intended for development projects, are spent on the project of war-making.
Meanwhile, the money we spend on the arms purchases, provides jobs and income for people in other continents.
In the early 1990s, it was hoped that corrupt policies that contributed to the under-development of Africa would stop. In fact, President Thabo Mbeki of South Africa, was so infatuated with this notion of a new wind of leadership blowing across Africa. He described it as the "African Renaissance". There was rebirth in the air. Notably, new leaders in Ethiopia, Eritrea, Rwanda, and Uganda, not to mention President Mbeki, were seen as purveyors of accountability, good governance, and mature decision-making.

AFRICAN LEADERSHIP

When he visited Africa, President Clinton described these men as the "New Breed of African Leadership" who were going to set worthy examples to be followed by leaders yet unborn. Alas, it was a harvest expected too soon!
As you read this column, Uganda and Rwanda are close to war, unless cooler heads prevail. Ethiopia and Eritrea have just resumed their two- year old senseless war after a short cease fire which lasted long enough for the combatants to catch their breath, it now appears. These are four countries whose leaders exuded the appearance of "renaissance."
However, some of us could decipher from the very beginning that they were merely chips off the old block; or as the locals where I grew up would say "the same Kokrokwan". To paraphrase the words of the Ghanaian writer Ayi Kwei Armah, it would seem that the beautiful ones are (still) not yet born!

BEST OF FRIENDS

President Yoweri Museveni of Uganda and President Paul Kagame of Rwanda were the best of friends. In fact, they were Comrades-in Arms. When Museveni was a rebel in the Ugandan bush fighting for the overthrow of Milton Obote, he employed Kagame, a Rwandan Tutsi exile living in Uganda as his Chief of Staff. General Paul Kagame was an integral part of the rebel forces who helped General Yoweri Museveni to attain power in Kampala by defeating the Ugandan Army and causing the flight from power of President Milton Obote.
Once in power, and no longer a rebel, President Museveni turned to assist Paul Kagame who had formed his own rebel group to fight for the overthrow of the Rwanda Hutu Government. They were successful, and today General Paul Kagame is the President of Rwanda. But, Kagame and his Tutsi government in Kigali had a problem. The Hutus whom he overthrew had fled to Zaire and they posed infinite danger to him.
The late President Mobutu Sese Seko of Zaire was supportive of the Hutus. In fact, Mobutu kept the body of the Rwandan Hutu President whom Kagame forces had shot down, in a fridge in one of his estates in Zaire for future burial in Rwanda! If only a rebel would surface in Zaire!! Lo and behold, one did emerge in Zaire, sworn to overthrow Mobutu!
Thus, Kagame and Museveni again united to support Laurent Kabila who eventually caused Mobutu to flee in May 1997, and eventual death in Morocco in November 1997. Once in power, Kabila did not prove amenable to the interests of either Museveni or Kagame.
Meanwhile, Kagame and Museveni clashed over the spoils of the huge Congo natural resources. Hence, the two leaders are now supporting rival rebel groups aimed at overthrowing Laurent Kabila. It is this latter issue that is driving Uganda and Rwanda to war, unless diplomatic efforts succeed.

WE'RE READY

Both countries spend huge amounts of money to beef up their arsenal, thereby diverting funds that ought to be used in the development of their poor countries. A top Ugandan army official, Brig. Gen. James Kazini, remained in a fighting mood, saying Uganda was ready to fight if provoked. He told The Monitor, a Ugandan newspaper, "This time we're ready for them...., We're beginning to realise these people (Rwandans) may be real enemies."
The other two men touted as "renaissance" leaders have actually drifted to war. Ethiopia and Eritrea have been at war since May 1998, when Eritrea occupied Ethiopian "territory". The causes of the war resist rational explication. It is ostensibly a border dispute, with both sides claiming sovereignty over a remote frontier that was never clearly delineated when Eritrea regained its independence from Ethiopia in 1993.

INDEED BROTHERS

President Isaias Afwerki of Eritrea and President Meles Zenawi of Ethiopia are indeed brothers. They belong to the same Tigrean ethnic group. Like Museveni and Kagame, President Isaias and President Meles were also Comrades-in-Arms as rebels fighting for the overthrow of Ethiopia's Marxist dictatorship under Mengistu Haile Mariam. With the overthrow of Mengistu, Isaias Afwerki became the president of an independent Eritrea, and Meles Zenawi assumed power in Addis Ababa.
Relations were cordial until Eritrea started to behave like a real independent country by adopting policies such as introducing its own currency. That, and other policies angered Ethiopia. Eritrea, though a small country, has proven quite belligerent. Since 1993, it has gone to war with Sudan, Yemen, Ethiopia, and has also threatened its smaller neighbour, Djibouti.
Both Ethiopia and Eritrea, also find time to support rival rebel groups in the country that used to be called Somalia. As a result, funds that could be spent on the development of these countries are diverted to arms purchases.
The current war between Ethiopia and Eritrea coincides with acute famine brought on by drought in both countries. Millions of people are thought to be in danger.

DROUGHT AND CONFLICT

President Meles has defiantly deflected any questions about the propriety of fighting in the midst of a natural disaster that affects millions. He has said this in response, according to a newspaper report: "In Ethiopia, we do not wait to have a full tummy to protect our sovereignty...,We resist the link between the drought and the conflict."
President Isaias on his part, has suggested that the current conflict, has an advantage in showing the reality of the independence struggle to a younger generation growing up without full realisation of past efforts and sacrifices.
Africa, indeed, has enormous resources to attack some of our myriad problems. Sadly, such resources are depleted by official corruption, and genuflected to wrong policies of our leaders. The so-called "new breed" of African leaders are merely like old wines in new bottles. It seems the expectation of an "African Renaissance", to borrow some words of Bob Marley, is a dream to be pursued, but never attained.

Read more »

MOMERIES OF UNDERDEVELOPMENT'''

MEMORIES OF UNDERDEVELOPMENT

  Coined from'' Julia Lesage
The word "subdesarrollo" or underdevelopment plagues everyone who lives in South America. It may mean a colonized economy or insufficient industrial development, or it just may come to mean that foreign is better. The Cuban film MEMORIES OF UNDERDEVELOPMENT directed by Tomás Gutiérrez Alea, deals with this topic of underdevelopment in a number of ways. Primarily the film concerns itself with the life and thoughts of a bourgeois intellectual, Sergio, who has literally stayed behind the revolution. He stays in Cuba when his wife and parents go to the United States because he wants to observe what is going to continue to happen in Cuba. He thinks of himself as Europeanized; to him, underdevelopment means that the Cuban mind is underdeveloped. Sergio criticizes people, especially women, for forgetting and not being consistent, but in his own case, remembering everything just paralyzes him.
The original novel from which the film was made, published in English as INCONSOLABLE MEMORIES, was written by Edmundo Desnoës, a Cuban intellectual who spent many years in the United States, which influenced his writing, returned to Cuba after the revolution to an active position in the publishing house Casa de las Americas, and then went back to the United States to live his later years in New York City. Desnoës seems to have put a lot of himself into INCONSOLABLE MEMORIES' first person narrator, giving that protagonist many insights and sympathetic qualities. But in the novel, he also puts this alter ego up to criticism. Within the formal structure of an autobiography, an unnamed protagonist is writing a diary to maintain his sanity and personal identity, to gain a kind of control over his own life. He also writes a first-person narration of lived experience since he feels himself to be a frustrated author who cannot create. In a circular fashion he sees the world as so complex that he has nothing to say. In Alea's film this intellectual, named Sergio, stands as a "memory of underdevelopment," a bourgeois who immerses himself in his own mental acuity but who cannot break out of angst to enter into commitment.
Both novel and the film are complex. In the novel the protagonist criticizes his friend Eddy (Desnoës) for writing a story with flat characterization about an alienated intellectual who is saved by committing himself to the revolution. That reference indicates the vigor and with which Cuban artists and intellectuals have long battled socialist realism, and this film stands as one of the best indications of Cuban artists' independence and efforts to create whole new forms for political art. Significantly, MEMORIES OF UNDERDEVELOPMENT is thoroughly urban; neither author Desnoës nor director Alea have unearth native or folkloric strains to write about, although this path is an esteemed one for Cuban artists. (An example of the native type of literature is the poetry of Nicholas Guillen, who captures afro-cuban rhythms in his poetry, or the novels of Alejo Carpentier, who celebrates a "primal" Cuba in such works as THE LOST STEPS.) The novel and the film look directly at European and American cultural influences and are not afraid to use mainstream Western contemporary modes of expression--in both novel and film--even while criticizing European and U.S. influences on Cuban life.
The film MEMORIES OF UNDERDEVELOPMENT contains two stories, one explicit and one implicit, which Alea uses to comment on each other. In the background the film presents the story of Cuban society, which moves with the force of the revolution and history. The fact that political history provides the film's framework is established by three principle documentary sequences. First, the film's opening sequence shows a public dance at which a political leader is assassinated. Later, a central documentary sequence, seemingly unrelated to the narrative, depicts and analyzes moments from the trial of the counterrevolutionary officers captured at Playa Giron. And a final series of sequences on the missile crisis combine both documentary shots and narrative material to conclude the film.
In terms of film style, Alea is commenting in two ways on the topic of underdevelopment. He develops a psychological narrative in the style of European films about Sergio's existential alienation. At the same time he holds that alienation up to criticism by means of documentary footage which shows us the revolution which Sergio will not join. For example, in a complex way, the film mixes cinematic styles and modes of spoken discourse, moving back and forth in time, frequently according to Sergio's memories. The shots of the Cuban people on the street during the film and particularly at the dance at the beginning of the film establish a sense of race, against which background we can see that Sergio, a tall fair man who looks like a gringo, is deliberately shown as very white -- something a Latin audience would pick up on since skin color is often an index of class. In the middle of the film Alea repeats the opening sequence of dark-skinned Cubans dancing and the sudden shooting of one of the men there, but this time we see Sergio among the crowd, and his whiteness stands out. It seems that Alea uses such a fair protagonist to emphasize in visual terms this middle class intellectual's alienation from the people.
Alea, the director of the film, commented himself on the transformation from novel to film. In the film as in the novel, Sergio's "perceptions of reality, sometimes deformed, and always subjective," also become the object of our critical attitude:

"... The confrontation between his world with the 'documentary' world that we show (our subjective world) can have some rich overtones... We developed more than what was included in the novel, that line which shows 'objective' reality that surrounds the character and that little by little closes in on him and suffocates him at the end. That line alternates with the protagonist's own and is basically built with documents, that is, with current testimonies."

The documentary elements in the narrative sections of the film also generally work very well, as in the depiction of a round table discussion which Sergio attends. The forum's topic is Literature and Underdevelopment, and the panelists include the real Edmundo Desnoës and Jack Gelber, the North American playwright who wrote the introduction to the English translation of INCONSOLABLE MEMORIES. In this filmed panel Desnoës speaks about his long stay in the United States, where he says he was just another "spic," and he especially criticizes the U.S. "great white dream." Another speaker says that underdevelopment and development are sick words, a linguistic and ideological alibi, and that Cuba needs instead the words capitalism and socialism. Jack Gelber then demands humorously, "Why use an impotent form like a round table discussion after the revolution?" But the fact that he uses English to assert this just protest against academic bullshit in English reveals cultural imperialism one more time.
In political terms I see one major problem in the effect some of the details in the film are supposed to have on a Cuban audience. Alea shows Sergio living untroubled and alone in luxury, well after the revolution, in an apartment that could have housed a family or two. The audience is supposed to criticize and not envy this way of life. In particular, the kitchen and plumbing are shown in splendid working order, as is Sergio's tape recorder, in spite of the fact that imported fixtures have long since stopped coming in. The film itself raises the point that automobile parts and motor oil are scarce. For many Cubans, when Havana's big department store El Encanto burned down, that signaled the end of imported luxuries. Buildings have deteriorated in Havana since the government has emphasized rural development, but Alea shows Sergio's Havana apartment as being kept up perfectly.
In one sequence in the film, block captains come to inventory the apartment. During this time we learn that Sergio's income comes from monthly state payments for a building of his which had been confiscated, payments he will receive for another thirteen years. All of these details in the film paint a picture of Cuba as being fair to those bourgeois who have stayed, letting them, like Sergio, just fade away of their own accord and not stripping comforts from them. Yet what "message" does this apartment in the movie have for a Cuban audience? It seems to say, "You are superior for you are working for the revolution, while a character such as Sergio has all these fine possessions but is empty inside." But maybe the audience looks on that nice plumbing with envy or thinks it should go to someone more deserving. Specifically, the film does not analyze the relation between Sergio's living in material comfort and the theme of underdevelopment as a whole.
SERGIO AND SEXUAL POLITICS
The character Sergio, acted in Mastroianni style by Sergio Corrieri, elicits a certain sympathy. Yet the film presents this character in a static emotional and social state. If the audience approves of the direction the Cuban revolutionary "background" is going, Sergio's paralysis stands as a critique of those who cannot join the revolution.
Sergio prides himself on his urbanity, on his being Europeanized. He is both obsessed with and condescending about Cuba and the Cubans' underdevelopment. In particular, he thinks of Cuban women as intellectually and culturally underdeveloped, although he uses sex to escape from his alienation from Cuban society and his paralysis as a writer. In the course of the film we see Sergio's egotism in his sexual relations. He has an affair with a young woman, Elena, whom he picks up on the street and whom he tries to educate by taking to bookstores and museums. At one point he reflects, "I discovered Elena didn't think as much as I did. I try to live as a European and she makes me feel the underdevelopment at every step."
Sergio has an acute intellect. He sees much that is true about Cuba and especially is very aware about himself. To criticize Sergio as bourgeois is easy. Yet he himself rejects most of the Cubans of his class, his wife Laura and his friend Pablo especially, as superficial, greedy, and self-deceiving. But he will also not use his intellect to serve the revolution. The film shows that Sergio's refusal to join with others to build a new Cuban society depends both on his class position and on his temperament. The film depicts the cost to him personally of staying apart as an observer. Sergio is not one who flees to the United States, and his reasons for staying in Cuba go beyond the fact that his marriage has gone stale. As he says, he has a great curiosity to see what will happen in Cuba next. A key prop in the film is a high powered telescope installed on the porch of his apartment. Early in the film Sergio looks through it at a couple making love. At the end of the film he looks down on the mobilization for the missile crisis, in which the whole of Havana is unified in the face of impending destruction. Looking through the telescope means more than idle curiosity. It also symbolizes passivity and internalized hopelessness. At the end of the film, Sergio looking through the telescope is a Sergio trapped in his own introspection.
The film details the relation between the personal and the political, which comes out in the critique of Sergio as a male. In the film Sergio's attitude toward women, his machismo, is clearly related to an outmoded pre-revolutionary ( or anti-revolutionary) way of life. Sergio tries to mold women to fit his idea of what they should be. The women in the film include Naomi, the Protestant maid, about whose baptism Sergio has erotic fantasies; Laura, the wife, older than he, accustomed to a material standard of luxury with him, yet presumably eager to make new emotional and material ties in the United States; Elena, the young Cuban woman looking for adventure yet ultimately trapped inside an oppressive family situation; and Hanna, the German girl Sergio courted away from high school and whose expectations for him to develop intellectually he could not live up to. Each one of the woman characters reveals something different about Sergio, and each one also offers an opportunity to elaborate on what Sergio means by "underdevelopment" and what we the viewers are to think about that concept as well.
The woman he says he really loved, Hanna, moved to New York wanted him to stay with her because she considered Cuba a stultifying environment for him.  She wanted him to become a writer, but he went back to Cuba and went into the furniture business (This latter part of Sergio's life is humorously presented in family photo album style). Significantly, Hanna, the unattainable, ideal European woman, is very fair with fine, pale blonde hair. His wife Laura has coarse hair streaked with blonde. And the working class Elena is darker than he, presumably a comment on how class differences often match color differences in Cuba. Sergio's relations with women indicate his efforts to escape into sex and are an index of his class privilege and his refusal to act in a political way. In this regard, Elena, whom Sergio regards as a primitive, understands him more than he understands her. "You're not a revolutionary or a counterrevolutionary, " she says. When he asks her what he is then, she answers, "Nada, tu eres nada--nothing, you're nothing. " As does Humberto Solas' film LUCIA, MEMORIES OF UNDERDEVELOPMENT goes beyond the official Cuban line that problems of sexual politics are solved when women join the work force. As delineated in the narrative, the problem of sexual politics is seen to lie in Sergio's exploitative, condescending and elitist attitude toward women. Laura, the wife, is presented in furs at the airport as she is going to live in the United States. She leaves her wrist watch and wedding ring behind at Cuban customs. As she and her family pass through to the waiting area for their plane, Sergio watches them through the plate glass window, and the moment is like an epiphany as we see through Sergio's eyes what a strange breed these emigrants are and understand everything that is shallow about the Cuban bourgeoisie. We learn more about Laura as Sergio goes back to the apartment and rummages through her clothes, trying on some of them. (I found this visual presentation of Sergio's erotic life sensitive, witty and visually interesting, but could not help wondering if a Cuban audience was supposed to interpret a man putting on a woman's things as a sign of "decadent sexuality.") Sergio plays an old tape recording of a fight he once had with Laura. Her clothes, her voice on the recorder, have no more permanence in Sergio's life than she does, but they reveal how Sergio tried to shape her. His voice on the recording accuses, "I see you struggle between elegance and vulgarity. All these products keep you from being a slovenly Cuban girl." The same sound track is used again when Alea shows us the original fight, a sequence shown in the film after Sergio has seduced Elena, at which point the physical appearance and the class status of the two women stand clearly in contrast.
Alea exploits the character of Elena to present concepts of underdevelopment. She is standing on the street, presumably waiting for someone connected to the cinema industry, when Sergio persuades her to eat with him. He both gets her a screen test and criticizes her desire to be an actress. (The whole screen test sequence is quite funny, with cinematic tricks used to emphasize the artificiality and the foolishness of screen romance.) Sergio then offers Elena some of Laura's clothes, makes love to her, and has an extended affair with her. After he has grown tired of her, there is a series of sequences in which Elena's brother comes to demand Sergio marry her. Sergio was then willing to do so but backs down after being bullied. Finally the family fights with him and takes him to court, where they say he has taken advantage of a woman who is "mentally retarded." At this point one does not know what to make of Elena.
As in the rest of the film Alea's examination of false consciousness here is relentless. He does not hold Elena and her family up as idealized examples of the Cuban people, dignified or even right. Whereas Sergio is wrong to think of Elena as underdeveloped in the way he does, taking her to museums to improve her mind, Alea does not show Elena as having revolutionary goals. Indeed the whole wit of the sequences with Elena's family comes from the inappropriateness of their actions in a presumably revolutionary society. As they blackmail a man because their daughter is pregnant (and she may have been promiscuous), this family is acting out what would have been their best defense in that situation under capitalism, but they are doing so in a post-revolutionary milieu. The film satirizes the family's treating a female child as property, showing this as a reactionary way to behave. Elena is depicted as victimized both by Sergio and by her family, to which victimization she acquiesces.
Interestingly, in the novel from which the film was made, we have a more complex picture of Elena. We learn that she was the daughter of a laundress on a coffee plantation in El Oriente, then, after the revolution, a teacher in the big campaign against illiteracy, then arrested for casual prostitution. Why Alea left these details out of the film I do not know but can only hazard the guess that to show a literacy teacher going into prostitution is taboo.
Another sequence involving Elena that differs significantly from novel to film is the sequence in Hemingway's Cuban home, now a museum. In this sequence, which is a mixture of documentary and narrative, Sergio takes Elena to Hemingway's old estate, which is still tended by the man who was Hemingway's servant, a Cuban who has completely absorbed his white master's ideals. As a further example of false consciousness, in the novel Desnoës has Russian tourists in the place photographing everything in sight and encouraging Elena to pose sexily by the animal trophies. Sergio becomes angry with the way the Russian tourists encourage Elena to act out the wild passionate Cuban woman role and at the way they take Cuba home as a trophy in the form of photographs without understanding Cuban cultural life at all. We can understand why these Russian tourists were not included in the film, especially since night clubs still operate in Havana with traditional style "sexy" shows for the sake of the Russian technicians based there.
In 1967, Desnoës said that he was planning a novel about a girl growing up in the years between the revolution and the missile crisis. Although he never completed such a work, certainly we can see that a character such as Elena was of interest to both Desnoës and Alea. She is a young woman of the people, not underdeveloped in the way Sergio thought, yet with not much interesting to do or be.

DOCUMENTARY SECTIONS

In terms of the plot line, the film traces Sergio's life after his wife and parents leave for the United States in 1961 through the missile crisis in 1962. The film moves back and forth through time, since Sergio turns frequently to his memories to try to understand what is happening to him. Because of the documentary footage, the revolution is always in the background. History intrudes into the narrative even though Sergio is shown as paralyzed and unable to act in history. The narrative ends at the time of the missile crisis, which reveals Sergio's paralysis even in the face of mobilization. Included in this part of the film is Fidel's own speech at that time in which he emphasized the historicity of each person's life and the importance of living out one's own historical role as well. Not only does Alea present Sergio's alienation but also a picture of an island country facing annihilation as a whole.
A long documentary section which comes in the middle of the film seems unrelated to Sergio's story but serves two important purposes. Footage shot at the trial of the counterrevolutionary officers captured at Playa Giron presents within the film MEMORIES OF UNDERDEVELOPMENT that which the protagonist has excluded from his life -- the revolution and a revolutionary mentality. In terms of cinematic style, this footage also reminds us that one of Cuba's greatest artistic achievements has been the development of a new documentary film style, which combines hand-held camera, location shooting--often in obscure country locations, and political analysis. Alea uses documentary footage to comment on the narrative film style in a way that is reminiscent of early Godard. In MEMORIES OF UNDERDEVELOPMENT the contrast between the long documentary insert, seemingly unrelated to the narrative, and the narrative part of the film serves to reinforce the theme of Sergio's divorce from the political, yet the documentary footage also asserts the inescapable reality of that sphere.
 
In this middle documentary section, the various counterrevolutionary leaders who are being tried do not define themselves as murderers. They define themselves as types with one specific function in society -- the priest, the philosopher, the believer in free enterprise -- all with their niches thought out for themselves. What comes out during the trial of Calviño, the sadistic army officer known as the "butcher," is that by letting Calviño do all the torturing and by not thinking too much about it, the others could maintain their cohesively moral identity. The commentary states, "The truth of the group is in the murderer." Alea uses this sequence in the film to emphasize the consequences of a false consciousness among the bourgeoisie, especially as related to Sergio, who thinks he is truly separate from political action. As the commentary states, all bourgeois society has a division of moral labor and places an emphasis on individuality so that nobody has to assume total consciousness/conscience. The counterrevolutionaries do not recognize themselves as members of a system that entangles them in their own act. In this section, the film also significantly offers the image of the role of a revolutionary woman. We see a strong and angry woman denouncing Calviño at the trial, which is an image of woman which Sergio cannot conceive of.

CUBA AND THE INTELLECTUALS

Both the novel and the film were finished before 1971 and the First National Congress on Education and Culture when Castro waged an all out war on "'cultural imperialism." At that time Castro said that artists and writers must reject "all manifestations of a decadent culture, the fruit of a society or societies that are rent by contradictions." (GRANMA, Engl. edn., 5/9/71) Early in the revolution, Castro had called for the development of a New Person to meet the exigencies of the new society. For ten years then the motto for intellectuals was, "Within the revolution, everything. Outside the revolution, nothing." But by 1968, after the film was made, newspapers published many open critiques of "decadent" art. Although MEMORIES OF UNDERDEVELOPMENT has not lost its place in Cuba as a peak of artistic achievement, both as a novel and as a film, neither Desnoës nor Alea have done any more works like this since then, that is, works which show an obvious European influence. After working with Alea on the screenplay, Desnoës proceeded to write the English translation of the novel, incorporating incidents from the film, and the translation was released in the United States in 1967. Latin intellectuals cannot, even after the revolution, declare themselves untouched by European and North American thought, for the very concept of underdevelopment, which exerts as powerful an influence in post-revolutionary Cuba as ever, means that the intellectual has been strongly shaped by foreign conceptual models. In both its theme and its style, the film MEMORIES OF UNDERDEVELOPMENT takes up the subject of underdevelopment and foreign influences and shows both the need to put and the possibility of putting what has been gained from abroad at the service of the revolution. 
However, the film does not show what should happen to an intellectual class after the revolution, and this is the film's weakest point politically. The New York critics saw in it the depiction of a sensitive intellectual and admired the way the film treated the intellectual's alienation within a changing, proletarian society.  We see Sergio committed to himself, but the film does not say how an intellectual sympathetic and committed to revolution would implement that commitment in action. Desnoës, who goes back to Cuba and then returns to the United States, and Alea, who is sympathetic to the revolution but never joins the Communist Party, and even the actor Corrieri, who leaves acting to lead El Teatro Escambray in rural areas, all made momentous personal decisions in this regard. But the film never depicts these kinds of decision-making processes for intellectuals. Should the intellectual be retrained after the revolution, sent into the provinces to regain contact with the people (Mao's dictum) or sent to cut sugarcane? Or should intellectuals teach to pass on their skills? To whom? To the poor or to university students, who now consider themselves the teachers' peers. If intellectuals join the party, what does party discipline mean to them? Surely Desnoës and Alea have come to terms personally with the issue of party membership and discipline. Cubans do have models of revolutionary intellectuals for obviously Fidel and Che have come from the intellectual class.
If intellectuals in the United States find they can identify with this film, the question still remains. What should intellectuals do if they are sympathetic to socialism? How do they "join" the working class? According to some New York reviewers, that the film does not answer this question is one of its main strengths, saving the film from dogmatism. If as in Cuba, the audience already has a revolutionary mentality, the film stands as a critique of outmoded ways of thought. However, if in the United States we ask whom this film serves and how, we see from its critical reception that MEMORIES OF UNDERDEVELOPMENT has generally been appreciated as a picture of a sensitive person's existential alienation in contemporary Cuba. Within the context of a society accomplishing a revolution, the film serves a political end. In the United States, it can be coopted.

Read more »

VARIABLES OF INFLATION

	SOME  VARIABLES OF INFLATION
	Significance Percentage increase in price level. When most prices grow, there is inflation, provided the other prices don't drop too heavily. If inflation is not compensated by nominal increases of income, people become poorer. High and variable inflation makes economic price forecasting more difficult and decision-making processes may be negatively affected. Extremely high inflation attracts too much daily attention from households and decision-makers, distracting them from more important tasks. Computation Economists attempted to distinguish the inflation rate as a continuous systematic process of general price increase from two other situations: 1. an abrupt once-and-for-all overall price increase; 2. a price increase of a narrow group of goods or services to be rather considered as a change in relative prices between that group and the rest of the prices (the former get more expensive, the latter relatively cheaper). From an empirical point of view, this distinction is unpractical and not used: central statistical offices measure inflation in reference to some average of prices growth, irrespective of the abovementioned distinction. Incomes, wages and asset prices (like share quotations) are not included in the averaged "prices", thus inflation has important real effects (i.e. on quantities), to the extent it is not perfectly matched by soaring income and asset prices. Basic types of inflation Different types of inflations can have widely different determinants, effects and remedies. There is no strictly binding definition of ranges of intensity in price increase. Still, some indications can be given as it follows. Hyperinflation is the most extreme inflation phenomenon, with yearly price increases of three-digits percentage points and an explosive acceleration. Extremely high inflation could range anywhere between 50% and 100%. High inflation is a situation of price increase of, say, 30%-50% a year. Both kinds can be stable or dangerously accelerate to enter in an hyperinflation condition. Moderate inflation can be differently defined around the world, given the different inflation histories. As an indication only, one could consider an inflation as moderate when it ranges from 5% to 25-30%. For some countries, the higher part of this range is already "high inflation". Low inflation can be characterized from 1-2% to 5%. Around zero there is no inflation (price stability). Below zero, a country faces deflation. A transversal classification distiguish inflations, basing on their broadly-defined origins: 1. domestic demand; 2. domestic costs, as wages; 3. external sources, as oil price increases or currency relative devaluation. A systematic institutional difference is between countries having or not having (partial or total) indexation of wages (and other income sources). Indexation makes inflation much less painful, but normally keeps it at a higher level and increases the risk of a continous acceleration. Determinants A widely dispersed price increase as it is, inflation is the immediate result of firms' decisions. These decisions may result from coordination and monopoly/oligopoly dynamics, as well as from the attempt to increase margins and profits. But there is no need for formal coordination: a favourable demand situation, with higher income and booming propensity to consumption, makes price increase easier. A generalized cost increase, as with wages, energy prices (especially oil prices), devaluation, and certain taxes, is clearly conducive to inflation. A mediation is given by productivity improvements, which reduce unitary costs of production. Conversely, extensive liberalizations in sectors where prices were rising can lead to a lower inflation rate, thanks to the new entrants and the tougher competition. Large increases in money quantity, especially if clearly exceeding nominal GDP growth, risk to accelerate the current inflation rate. In other words, if present inflation plus real GDP growth is (much) less than money-quantity rate of growth, there is a consistent risk of acceleration, unless other factors push in the opposite direction. A pro-inflation pressure may come also from fiscal deficit, with different dynamics depending on ways of financing it (bonds sold to the market or to the central bank, i.e. with a sharp increase of money quantity). An important determinant of inflation is given by expectations on future rate of inflation, to the extent they are widely accepted and exert influence on decision-making processes, as with long and medium-term wage contracts. Oil price fluctuations exert a distictive important influence on inflation throughout the world. The increase abroad of prices for products that our country purchase, if not counteracted by a re-valuation of the currency, exerts a pressure on the price level, possibly inducing "imported inflation". Inflation in the country's trade partners then spread out and can feedback there. Another sector where there are wide fluctuation is agriculture: food prices are volatile, especially when a number of real world events are amplified by speculation. A relatively similar phenomenon relates to raw materials and industry inputs such as minerals. The attempt by statistical offices to ignore price movements in volatile sectors generates the computation of "core inflation". By contrast "headline" inflation is what the media report more often (being easier to communicate) and tend to influence the perception of inflation by the (media-exposed) population. Impact on other variables Uncompensated inflation reduces incomes, thus consumption and savings, both in aggregate and with particular reference to certain social groups (e.g. the elderly, as surveyed here). Through a Keynesian multiplier, income and consumption will cumulatively fall further. Inflation hits the poor harder than the rich because: 1. for the poor, the share of consumption in total income is larger, so the increase of (goods' and services') prices generates a steeper reduction in savings (if any) and of real income; 2. the composition of the purchases' basket can be skewed towards goods whose price rises more than average, as it happened in UK in 2011; 3. in the industries where the price structure is approximately log-normal, e.g. a large number of goods have a price lower than the average, the poor, who has a certain relatively low reserve price that he can afford to pay, will see many more goods going beyond that threshold (becoming unaffordable) than the rich, who has a much higher riserve price (in a region where few goods are); In this graphical example, the poor has a (black) reserve price of 50 and before inflation can afford almost the majority of goods on that market. The rich has a (purple) reserve price and can afford almost all the goods. With inflation, the number of goods at the different prices (the Y axis) shifts (from the red to the blue curve), with the goods costing less than 50 becoming a small minority but with only a tiny shrinking of the affordable goods for the rich. 4. while, in response to higher prices, the rich can reduce the level of quality of purchased goods, the poor is already purchasing low-priced low-quality goods - the only reaction, if anything, is to stop purchasing, leaving a deeper dissatisfaction of needs; 5. the poor has a much narrower cumulative bundle of durable goods at home, so that with purchases shrinking due to uncompensated inflation, its standard of living and the share of need satisfaction falls more than the rich (which is "buffered" by the goods purchased earlier); 6. the needs that will be less satisfied because of reduction in purchases are more basic - thus important - to the effect that the reduction is more painful and with far reaching negative consequences (e.g. by postponing or abandoning maintenance expenditures, the poor will have higher probabilities of low-performing or even broken goods; by renouncing to satisfaction of very basic goods - such as hygene or shelter in a house - the poor loses social acceptability, increases the likelyhood of diseases, etc.); 7. the working poor is poor because has a weak negotiating command on the resources generated thanks to his work (productivity); conversely, the rich can often react to inflation by asking (and obtaining) higher wages; 8. the rich is more likely to get revenue from commercial and non-working activities (such as dividends and interests from previous investments, resulting from savings and rents), which can raise more than the general level of prices (inflation-leaders). If inflation is mainy demand-pulled, it vanishes the increases in nominal effective demand and it frustrates consumption expectations. By contrast, if inflation is mainly due to efforts of increasing margins and profits, it is possible a rise in consumption in high-income groups. Investment should be discouraged by uncertainty about future engendered by inflation and its wide fluctuation. Still, to the extent that benefits of inflation are mainly reaped by domestic firms, the real interest rate for investment fall inversely with mounting inflation. Thus, a low or moderate inflation may help investments, at least to the extent they are actually influenced by real interest rates and until a central bank intervention. In fact, central banks can try to control the inflation rate through a sharp increase in real interest rates, more than proportionally reflected in nominal interest rates. This move usually provokes a fall in investment and a revaluation of currency. The first effect brakes domestic demand, the second the foreign one. Summarizing some of these arguments, higher inflation leads to higher nominal interest rates. In a first phase, the latter may not keep pace with inflation, thus real interest rates may fall. But afterwards, if the central bank does not accomodate inflation, the real interest rates are kept much higher than before. Still, too many elements are intertwinned, so that these relationships should be treated with great caution. In absence of central bank reaction, it is for example common that inflation tends to provoke currency devaluation, opening a vicious circle. This is certainly the case with hyperinflation. In fact, in this case, central banks often choose to fix a certain exchange rate target as a nominal anchor in the battle against inflation: with fixed exchange rates, inflation makes import cheaper in comparison to domestic products, so that domestic firms face more intense competition, which should brake inflation. Until the fall in inflation does not takes place, domestic goods become more expensive in a international comparison, typically with a fall in exports and a rise of imports, heavily deteriorationg the trade balance. At the same time, if indexed, local wages and incomes will improve their international purchasing power, thanks to fixed nominal exchange rate. On financial markets of fixed-interest bonds, an increase of inflation will reduce the burden of debt and interest payments. In the case of large public debt, inflation is an important relief for the State (also through larger tax revenues and lower personnel costs), menacing to engender a political tolerance toward inflation. Long-term trends World-wide inflation has peaked in the '70s, because of two oil crises. Afterwards, inflation has become a major target of public powers and it has been decelerating in most countries. Nonetheless, significant episodes of hyperinflation are still common and many stagnating economies can't take off both because of inflation and anti-inflationary policies. Business cycle behaviour Domestic-based inflation is pro-cyclical, arousing from positive demand conditions and higher wages as it is. External inflationary impulse can begin virtually at any point of domestic business cycle. Imported inflation, if strong enough, is heavily anti-cyclical, since it engenders a fall in output growth. In fact, not only it reduces consumption as every generalized uncompensated price increase, but also it usually prompts requests for compensating higher wages, giving rise to self-propelling cost inflation. These requests are usually only partially accomodated, leaving real incomes lower. Central bank restrictive policies do the rest. Data Inflation rates for 170 countries (1970-1996) Inflation rates for 192 countries (1969-2011) Oil world prices (1861-1999) Comparable wages for 162 jobs in 132 countries Exchange rates for 200 currencies, spanning across more than 20 years EU data for all the variables in IS-LM model (Germany, France, Italy, Spain, UK, Switzerland and other 13 European countries) Formal models An interactive map of how the economy works according to a basic macroeconomic scheme: the IS-LM model A simulation model of an exporter firm - to play and understand how inflation depends on international trade An experiment showing that people follow heuristics to forecast inflation.....

Read more »

Mental status examination

Mental status examination
Intervention

The mental status examination in the USA or mental state examination in the rest of the world, abbreviated MSE, is an important part of the clinical assessment process in psychiatric practice. It is a structured way of observing and describing a patient's current state of mind, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight and judgment.^[1] There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.
The purpose of the MSE is to obtain a comprehensive cross-sectional description of the patient's mental state, which, when combined with the biographical and historical information of the psychiatric history, allows the clinician to make an accurate diagnosis and formulation, which are required for coherent treatment planning.
The data are collected through a combination of direct and indirect means: unstructured observation while obtaining the biographical and social information, focused questions about current symptoms, and formalised psychological tests.^[2]
The MSE is not to be confused with the mini-mental state examination (MMSE), which is a brief neuro-psychological screening test for dementia. The mini-mental state examination (MMSE) is a popular screening tool used to determine cognitive functioning. The MMSE is a reliable measurement containing thirty questions that are used to test basic cognitive functions such as attention, language production, orientation, language comprehension, and immediate memory. The average time it takes to complete the MMSE is five to ten minutes. People with normal cognitive functioning usually score high on the measurement, ranging from 27 to 30. The instrument is accurate in determining Alzheimer's disease and other forms of dementia in elderly populations.^[3]

The Scream by Edvard Munch has been described as a representation of anxiety^[4]

Theoretical foundations

The MSE derives from an approach to psychiatry known as descriptive psychopathology^[5] or descriptive phenomenology^[6] which developed from the work of the philosopher and psychiatrist Karl Jaspers.^[7] From Jaspers' perspective it was assumed that the only way to comprehend a patient's experience is through his or her own description (through an approach of empathic and non-theoretical enquiry), as distinct from an interpretive or psychoanalytic approach which assumes the analyst might understand experiences or processes of which the patient is unaware, such as defense mechanisms or unconscious drives.
In practice, the MSE is a blend of empathic descriptive phenomenology and empirical clinical observation. It has been argued that the term phenomenology has become corrupted in clinical psychiatry: current usage, as a set of supposedly objective descriptions of a psychiatric patient (a synonym for signs and symptoms), is incompatible with the original meaning which was concerned with comprehending a patient's subjective experience.^[8][9]

Application

The mental status examination is a core skill of psychiatrists, psychologists,Occupational therapist, physician assistants, nurse practitioners and other qualified mental health personnel. It is a key part of the initial psychiatric assessment in an out-patient or psychiatric hospital setting. It is a systematic collection of data based on observation of the patient's behavior while the patient is in the clinician's view during the interview. The purpose is to obtain evidence of symptoms and signs of mental disorders, including danger to self and others, that are present at the time of the interview. Further, information on the patient's insight, judgment, and capacity for abstract reasoning is used to inform decisions about treatment strategy and the choice of an appropriate treatment setting.^[10] It is carried out in the manner of an informal enquiry, using a combination of open and closed questions, supplemented by structured tests to assess cognition.^[11] The MSE can also be considered part of the comprehensive physical examination performed by physicians and nurses although it may be performed in a cursory and abbreviated way in non-mental-health settings.^[12] Information is usually recorded as free-form text using the standard headings,^[13] but brief MSE checklists are available for use in emergency situations, for example by paramedics or emergency department staff.^[14][15] The information obtained in the MSE is used, together with the biographical and social information of the psychiatric history, to generate a diagnosis, a psychiatric formulation and a treatment plan.

Domains

Appearance

Clinicians assess the physical aspects such as the appearance of a patient, including apparent age, height, weight, and manner of dress and grooming. Colorful or bizarre clothing might suggest mania, while unkempt, dirty clothes might suggest schizophrenia or depression. If the patient appears much older than his or her chronological age this can suggest chronic poor self-care or ill-health. Clothing and accessories of a particular subculture, body modifications, or clothing not typical of the patient's gender, might give clues to personality. Observations of physical appearance might include the physical features of alcoholism or drug abuse, such as signs of malnutrition, nicotine stains, dental erosion, a rash around the mouth from inhalant abuse, or needle track marks from intravenous drug abuse. Observations can also include any odor which might suggest poor personal hygiene due to extreme self-neglect, or alcohol intoxication.^[16]Gelder, Mayou & Geddes (2005) tells us to look out for weight loss. This could signify a depressive disorder, physical illness, anorexia nervosa or chronic anxiety.

Attitude

Attitude, also known as rapport,^[17] refers to the patient's approach to the interview process and the interaction with the examiner. The patient's attitude may be described for example as cooperative, uncooperative, hostile, guarded, suspicious or regressed. The most subjective element of the mental status examination, attitude depends on the interview situation, the skill and behaviour of the clinician, and the pre-existing relationship between the clinician and the patient. However, attitude is important for the clinician's evaluation of the quality of information obtained during the assessment.^[18]

Behavior

Abnormalities of behavior, also called abnormalities of activity,^[19] include observations of specific abnormal movements, as well as more general observations of the patient's level of activity and arousal, and observations of the patient's eye contact and gait. Abnormal movements, for example choreiform, athetoid or choreoathetoid movements may indicate a neurological disorder. A tremor or dystonia may indicate a neurological condition or the side effects of antipsychotic medication. The patient may have tics (involuntary but quasi-purposeful movements or vocalizations) which may be a symptom of Tourette's syndrome. There are a range of abnormalities of movement which are typical of catatonia, such as echopraxia, catalepsy, waxy flexibility and paratonia (or gegenhalten^[20]). Stereotypies (repetitive purposeless movements such a rocking or head banging) or mannerisms (repetitive quasi-purposeful abnormal movements such as a gesture or abnormal gait) may be a feature of chronic schizophrenia or autism. More global behavioural abnormalities may be noted, such as an increase in arousal and movement (described as psychomotor agitation or hyperactivity) which might reflect mania or delirium. An inability to sit still might represent akathisia, a side effect of antipsychotic medication. Similarly a global decrease in arousal and movement (described as psychomotor retardation, akinesia or stupor) might indicate depression or a medical condition such as Parkinson's disease, dementia or delirium. The examiner would also comment on eye movements (repeatedly glancing to one side can suggest that the patient is experiencing hallucinations), and the quality of eye contact (which can provide clues to the patient's emotional state). Lack of eye contact may suggest autism.^[21][22][23]

Mood and affect

The distinction between mood and affect in the MSE is subject to some disagreement. For example Trzepacz and Baker (1993)^[24] describe affect as "the external and dynamic manifestations of a person's internal emotional state" and mood as "a person's predominant internal state at any one time", whereas Sims (1995)^[25] refers to affect as "differentiated specific feelings" and mood as "a more prolonged state or disposition". This article will use the Trzepacz and Baker (1993) definitions, with mood regarded as a current subjective state as described by the patient, and affect as the examiner's inferences of the quality of the patient's emotional state based on objective observation.^[26]
Mood is described using the patient's own words, and can also be described in summary terms such as neutral, euthymic, dysphoric, euphoric, angry, anxious or apathetic. Alexithymic individuals may be unable to describe their subjective mood state. An individual who is unable to experience any pleasure may be suffering from anhedonia.

Vincent van Gogh's 1889 Self Portrait suggests the artist's mood and affect in the time leading up to his suicide.^{[citation needed]}

Affect is described by labelling the apparent emotion conveyed by the person's nonverbal behavior (anxious, sad etc.), and also by using the parameters of appropriateness, intensity, range, reactivity and mobility. Affect may be described as appropriate or inappropriate to the current situation, and as congruent or incongruent with their thought content. For example, someone who shows a bland affect when describing a very distressing experience would be described as showing incongruent affect, which might suggest schizophrenia. The intensity of the affect may be described as normal, blunted, exaggerated, flat, heightened or overly dramatic. A flat or blunted affect is associated with schizophrenia, depression or post-traumatic stress disorder; heightened affect might suggest mania, and an overly dramatic or exaggerated affect might suggest certain personality disorders. Mobility refers to the extent to which affect changes during the interview: the affect may be described as mobile, constricted, fixed, immobile or labile. The person may show a full range of affect, in other words a wide range of emotional expression during the assessment, or may be described as having restricted affect. The affect may also be described as reactive, in other words changing flexibly and appropriately with the flow of conversation, or as unreactive. A bland lack of concern for one's disability may be described as showing belle indifférence,^[27] a feature of conversion disorder, which is historically termed "hysteria" in older texts.^[28][29][30]

Speech

The patient's speech is assessed by observing the patient's spontaneous speech, and also by using structured tests of specific language functions. This heading is concerned with the production of speech rather than the content of speech, which is addressed under thought form and thought content (see below). When observing the patient's spontaneous speech, the interviewer will note and comment on paralinguistic features such as the loudness, rhythm, prosody, intonation, pitch, phonation, articulation, quantity, rate, spontaneity and latency of speech. A structured assessment of speech includes an assessment of expressive language by asking the patient to name objects, repeat short sentences, or produce as many words as possible from a certain category in a set time. Simple language tests form part of the mini-mental state examination. In practice, the structured assessment of receptive and expressive language is often reported under Cognition (see below).^[31]
Language assessment will allow the recognition of medical conditions presenting with aphonia or dysarthria, neurological conditions such as stroke or dementia presenting with aphasia, and specific language disorders such as stuttering, cluttering or mutism. People with autism or Asperger syndrome may have abnormalities in paralinguistic and pragmatic aspects of their speech. Echolalia (repetition of another person's words) and palilalia (repetition of the subject's own words) can be heard with patients with autism, schizophrenia or Alzheimer's disease. A person with schizophrenia might use neologisms, which are made-up words which have a specific meaning to the person using them. Speech assessment also contributes to assessment of mood, for example people with mania or anxiety may have rapid, loud and pressured speech; on the other hand depressed patients will typically have a prolonged speech latency and speak in a slow, quiet and hesitant manner.^[32][33][34]

Thought process

The paintings of the outsider artist Adolf Wölfli could be seen as a visual representation of formal thought disorder.^{[citation needed]}

Thought process in the MSE refers to the quantity, tempo (rate of flow) and form (or logical coherence) of thought. Thought process cannot be directly observed but can only be described by the patient, or inferred from a patient's speech. Regarding the tempo of thought, some people may experience flight of ideas, when their thoughts are so rapid that their speech seems incoherent, although a careful observer can discern a chain of poetic associations in the patient's speech. Alternatively an individual may be described as having retarded or inhibited thinking, in which thoughts seem to progress slowly with few associations. Poverty of thought is a global reduction in the quantity of thought and thought perseveration refers to a pattern where a person keeps returning to the same limited set of ideas. A pattern of interruption or disorganization of thought processes is broadly referred to as formal thought disorder, and might be described more specifically as thought blocking, fusion, loosening of associations, tangential thinking, derailment of thought, or knight's move thinking. Thought may be described as circumstantial when a patient includes a great deal of irrelevant detail and makes frequent diversions, but remains focused on the broad topic. Flight of ideas is typical of mania. Conversely, patients with depression may have retarded or inhibited thinking. Poverty of thought is one of the negative symptoms of schizophrenia, and might also be a feature of severe depression or dementia. A patient with dementia might also experience thought perseveration. Formal thought disorder is a common feature of schizophrenia. Circumstantial thinking might be observed in anxiety disorders or certain kinds of personality disorders.^[35][36][37]

Thought content

A description of thought content would describe a patient's delusions, overvalued ideas, obsessions, phobias and preoccupations. Abnormalities of thought content are established by exploring individual's thoughts in an open-ended conversational manner with regard to their intensity, salience, the emotions associated with the thoughts, the extent to which the thoughts are experienced as one's own and under one's control, and the degree of belief or conviction associated with the thoughts.^[38][39][40]
A delusion can be defined as "a false, unshakeable idea or belief which is out of keeping with the patient's educational, cultural and social background ... held with extraordinary conviction and subjective certainty",^[41] and is a core feature of psychotic disorders. The patient's delusions may be described as persecutory or paranoid delusions, delusions of reference, grandiose delusions, erotomanic delusions, delusional jealousy or delusional misidentification. Delusions may be described as mood-congruent (the delusional content in keeping with the mood), typical of manic or depressive psychoses, or mood-incongruent (delusional content not in keeping with the mood) which are more typical of schizophrenia. Delusions of control, or passivity experiences (in which the individual has the experience of the mind or body being under the influence or control of some kind of external force or agency), are typical of schizophrenia. Examples of this include experiences of thought withdrawal, thought insertion, thought broadcasting, and somatic passivity. Schneiderian first rank symptoms are a set of delusions and hallucinations which have been said to be highly suggestive of a diagnosis of schizophrenia. Delusions of guilt, delusions of poverty, and nihilistic delusions (belief that one has no mind or is already dead) are typical of depressive psychoses.
An overvalued idea is a false belief that is held with conviction but not with delusional intensity. Hypochondriasis is an overvalued idea that one is suffering from an illness, dysmorphophobia is an overvalued idea that a part of one's body is abnormal, and people with anorexia nervosa may have an overvalued idea of being overweight.
An obsession is an "undesired, unpleasant, intrusive thought that cannot be suppressed through the patient's volition",^[42] but unlike passivity experiences described above, they are not experienced as imposed from outside the patient's mind. Obsessions are typically intrusive thoughts of violence, injury, dirt or sex, or obsessive ruminations on intellectual themes. A person can also describe obsessional doubt, with intrusive worries about whether they have made the wrong decision, or forgotten to do something, for example turn off the gas or lock the house. In obsessive-compulsive disorder, the individual experiences obsessions with or without compulsions (a sense of having to carry out certain ritualized and senseless actions against their wishes).
A phobia is "a dread of an object or situation that does not in reality pose any threat",^[43] and is distinct from a delusion in that the patient is aware that the fear is irrational. A phobia is usually highly specific to certain situations and will usually be reported by the patient rather than being observed by the clinician in the assessment interview.
Preoccupations are thoughts which are not fixed, false or intrusive, but have an undue prominence in the person's mind. Clinically significant preoccupations would include thoughts of suicide, homicidal thoughts, suspicious or fearful beliefs associated with certain personality disorders, depressive beliefs (for example that one is unloved or a failure), or the cognitive distortions of anxiety and depression. The MSE contributes to clinical risk assessment by including a thorough exploration of any suicidal or hostile thought content. Assessment of suicide risk includes detailed questioning about the nature of the person's suicidal thoughts, belief about death, reasons for living, and whether the person has made any specific plans to end his or her life.^[44]

Perceptions

A perception in this context is any sensory experience, and the three broad types of perceptual disturbance are hallucinations, pseudohallucinations and illusions. A hallucination is defined as a sensory perception in the absence of any external stimulus, and is experienced in external or objective space (i.e. experienced by the subject as real). An illusion is defined as a false sensory perception in the presence of an external stimulus, in other words a distortion of a sensory experience, and may be recognized as such by the subject. A pseudohallucination is experienced in internal or subjective space (for example as "voices in my head") and is regarded as akin to fantasy. Other sensory abnormalities include a distortion of the patient's sense of time, for example déjà vu, or a distortion of the sense of self (depersonalization) or sense of reality (derealization).
Hallucinations can occur in any of the five senses, although auditory and visual hallucinations are encountered more frequently than tactile (touch), olfactory (smell) or gustatory (taste) hallucinations. Auditory hallucinations are typical of psychoses: third-person hallucinations (i.e. voices talking about the patient) and hearing one's thoughts spoken aloud (gedankenlautwerden or écho de la pensée) are among the Schneiderian first rank symptoms indicative of schizophrenia, whereas second-person hallucinations (voices talking to the patient) threatening or insulting or telling them to commit suicide, may be a feature of psychotic depression or schizophrenia. Visual hallucinations are generally suggestive of organic conditions such as epilepsy, drug intoxication or drug withdrawal. Many of the visual effects of hallucinogenic drugs are more correctly described as visual illusions or visual pseudohallucinations, as they are distortions of sensory experiences, and are not experienced as existing in objective reality. Auditory pseudohallucinations are suggestive of dissociative disorders. Déjà vu, derealization and depersonalization are associated with temporal lobe epilepsy and dissociative disorders.^[45][46]

Cognition

Further information: Cognitive test

This section of the MSE covers the patient's level of alertness, orientation, attention, memory, visuospatial functioning, language functions and executive functions. Unlike other sections of the MSE, use is made of structured tests in addition to unstructured observation. Alertness is a global observation of level of consciousness i.e. awareness of, and responsiveness to the environment, and this might be described as alert, clouded, drowsy, or stuporose. Orientation is assessed by asking the patient where he or she is (for example what building, town and state) and what time it is (time, day, date). Attention and concentration are assessed by the serial sevens test (or alternatively by spelling a five-letter word backwards), and by testing digit span. Memory is assessed in terms of immediate registration (repeating a set of words), short-term memory (recalling the set of words after an interval, or recalling a short paragraph), and long-term memory (recollection of well known historical or geographical facts). Visuospatial functioning can be assessed by the ability to copy a diagram, draw a clock face, or draw a map of the consulting room. Language is assessed through the ability to name objects, repeat phrases, and by observing the individual's spontaneous speech and response to instructions. Executive functioning can be screened for by asking the "similarities" questions ("what do x and y have in common?") and by means of a verbal fluency task (e.g. "list as many words as you can starting with the letter F, in one minute"). The mini-mental state examination is a simple structured cognitive assessment which is in widespread use as a component of the MSE.
Mild impairment of attention and concentration may occur in any mental illness where people are anxious and distractible (including psychotic states), but more extensive cognitive abnormalities are likely to indicate a gross disturbance of brain functioning such as delirium, dementia or intoxication. Specific language abnormalities may be associated with pathology in Wernicke's area or Broca's area of the brain. In Korsakoff's syndrome there is dramatic memory impairment with relative preservation of other cognitive functions. Visuospatial or constructional abnormalities here may be associated with parietal lobe pathology, and abnormalities in executive functioning tests may indicate frontal lobe pathology. This kind of brief cognitive testing is regarded as a screening process only, and any abnormalities are more carefully assessed using formal neuropsychological testing.^[47]
The MSE may include a brief neuropsychiatric examination in some situations. Frontal lobe pathology is suggested if the person cannot repetitively execute a motor sequence (e.g. "paper-scissors-stone"). The posterior columns are assessed by the person's ability to feel the vibrations of a tuning fork on the wrists and ankles. The parietal lobe can be assessed by the person's ability to identify objects by touch alone and with eyes closed. A cerebellar disorder may be present if the person cannot stand with arms extended, feet touching and eyes closed without swaying (Romberg's sign); if there is a tremor when the person reaches for an object; or if he or she is unable to touch a fixed point, close the eyes and touch the same point again. Pathology in the basal ganglia may be indicated by rigidity and resistance to movement of the limbs, and by the presence of characteristic involuntary movements. A lesion in the posterior fossa can be detected by asking the patient to roll his or her eyes upwards (Perinaud's sign). Focal neurological signs such as these might reflect the effects of some prescribed psychiatric medications, chronic drug or alcohol use, head injuries, tumors or other brain disorders.^{[48][49][50][51][52]}

Insight

The person's understanding of his or her mental illness is evaluated by exploring his or her explanatory account of the problem, and understanding of the treatment options. In this context, insight can be said to have three components: recognition that one has a mental illness, compliance with treatment, and the ability to re-label unusual mental events (such as delusions and hallucinations) as pathological.^[53] As insight is on a continuum, the clinician should not describe it as simply present or absent, but should report the patient's explanatory account descriptively.^[54]
Impaired insight is characteristic of psychosis and dementia, and is an important consideration in treatment planning and in assessing the capacity to consent to treatment.^[55]

Judgment

Judgment refers to the patient's capacity to make sound, reasoned and responsible decisions. Traditionally, the MSE included the use of standard hypothetical questions such as "what would you do if you found a stamped, addressed envelope lying in the street?"; however contemporary practice is to inquire about how the patient has responded or would respond to real-life challenges and contingencies. Assessment would take into account the individual's executive system capacity in terms of impulsiveness, social cognition, self-awareness and planning ability.
Impaired judgment is not specific to any diagnosis but may be a prominent feature of disorders affecting the frontal lobe of the brain. If a person's judgment is impaired due to mental illness, there might be implications for the person's safety or the safety of others.^[56]

Cultural considerations

There are potential problems when the MSE is applied in a cross-cultural context, when the clinician and patient are from different cultural backgrounds. For example, the patient's culture might have different norms for appearance, behavior and display of emotions. Culturally normative spiritual and religious beliefs need to be distinguished from delusions and hallucinations - without understanding may seem similar though they have different roots. Cognitive assessment must also take the patient's language and educational background into account. Clinician's racial bias is another potential confounder.^[57][58]

Children

There are particular challenges in carrying out an MSE with young children and others with limited language such as people with intellectual impairment. The examiner would explore and clarify the individual's use of words to describe mood, thought content or perceptions, as words may be used idiosyncratically with a different meaning from that assumed by the examiner. In this group, tools such as play materials, puppets, art materials or diagrams (for instance with multiple choices of facial expressions depicting emotions) may be used to facilitate recall and explanation of experiences.

Read more »