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Unfortunately, they can find lots of encouragement for this belief in media coverage of the claims of prominent psychiatrists and psychologists. My colleagues and I have also questioned exaggerated estimates of the psychiatric disorder associated with cancer — comorbidity with mental health problems is no higher than for other chronic and acute physical illness — and the wisdom of professional guidelines recommending and mandating that all cancer patients receive routine screening for psychological distress and depression, if improvement in patient well-being and quality life is the goal.
The evidence for screening and other aspects of psycho-oncology remains weak. Guidelines and mandates that are being promulgated are consensus-based, not evidence-based. My colleagues and I continue to point to the lack of evidence that mandated routine screening will improve patient well-being, and we continued to warn that implementing screening may even disrupt existing efforts to provide cancer patients with the support and clinical and practical information that they need to cope.
Most patients decline services. Why not let interested patients directly access the support and services they want without this expensive intervening step? These data keep getting citeddemonstrating a persistent reluctance to exclude the fake data from consideration when they are impressively supportive of the view that mind matters in cancer. I cover these topics in my peer-reviewed papers, but also in my Skeptical Sleuth blog, which is designed to disseminate critical skills for interpreting both the scientific journals and media reports and to encourage a general skepticism towards these sources.
For my inaugural post here, I will touch on both of my major themes in discussing how the Journal of Clinical Oncology is not a reliable source for evidence about the relationship between cancer and the mind. JCO has a high journal impact factor of From time to time, I have challenged especially outrageous JCO articles, which are often accompanied by laudatory editorials.
No matter how fundamental the flaw being identified, the author of an article is the final judge of whether the critique will be published. I co-authored the commentary with an eminent expert on posttraumatic stress disorder, Naomi Breslau and I have drawn on it with her permission and enthusiasm for my writing this blog. JCO, Dec 1;29 The authors drew parallels between NHL survivors and victims of disaster and violence. This article displayed some typical flaws found in psycho-oncology studies providing inflated estimates of psychiatric diagnoses from checklists administered to patients without involving a trained interviewer to explain to them what is being asked of them or probe their responses.
Also typical is that diagnosis was made on the basis of complaints that are nonspecific and common across health conditions which give patients good reason to worry about their future. The PTSD checklist used in this study was validated with combat veterans who had been exposed to a war zone, but who had left.
The stressor was securely in the past for these vets, unlike for cancer patients facing a high likelihood of recurrence or actual recurrences.
A third of this sample of cancer patients had a recurrence before completing the questionnaire. These are not specific to PTSD, but are reasonable and expectable responses to actual or anticipated recurrence of cancer. More generally, these complaints become symptoms of PTSD only when they co-occur as part of a syndrome, not just in isolation, and when they can be linked to exposure to a past psychological threat.
The authors did not establish a syndrome or a link. If these cancer patients were actually suffering posttraumatic stress, the most empirically supported cognitive behavioral treatment would be exposure therapy, in which a patient is exposed to the traumatic situation with evidence that danger is no longer present, a luxury that current and former NHL patients do not have.
I am skeptical that this treatment would benefit many NHL patients and that they would take up the offer of therapy until the threat of the disease was assuredly in the past. I am disappointed that JCO let these authors decide that our critique could not be published and I remain quite interested in how they would have responded.
This article claimed that an average of just minutes of psychotherapy produced a year survival benefit among a mixed group of patients with gastrointestinal cancer.
Steve Palmer and I pointed out that preliminary reports of this clinical trial had designated quality of life as the primary outcome, but that no effect on quality of life was ever reported.
The authors conceded that no effect on survival had been hypothesized. There was no manual guiding this therapy, but patients received an eclectic mix of supportive talk therapy, crisis intervention, and a small amount of relaxation training, with considerable time taken up with strategizing and rehearsing interactions with oncology physicians and nurses.
The oncology treatment team was aware of which patients were in the intervention group and the therapists spent as much time meeting with the surgical and nursing teams as with the patients. As a result, the patients assigned to psychotherapy got considerably more medical treatment: Furthermore, our inspection of the survival curves for the two groups indicated that an advantage for the group getting psychotherapy was observed immediately and lasted for a few months with no additional advantage accumulating in years 2 through 6.
Better medical surveillance and treatment for patients getting talk therapy in this study are the most likely source of differences between groups, particularly since the investigators could not identify a possible mechanism by which talk therapy should influence survival.
As for a larger literature demonstrating that psychotherapy improves survival, the studies claiming an effect do not withstand scrutiny. JCO is a prestigious journal that frequently provides results of clinical trials of biomedical interventions.DIY Phone Case Life Hacks! 20 Phone DIY Projects & Popsocket Crafts!
I seriously doubt that the biomedical trials enjoy such relaxed standards for reporting or interpreting results or that a biomedical trial with such co-treatment confounds or increased surveillance given to the intervention group would go unchallenged. Talk Therapy as Pro-Biotic Yogurt: Depression, immunity, and survival in patients with hepatobiliary carcinoma.
The editorial called for research evaluating of interventions to reduce depressive symptoms that incorporated designs by which the effects on cancer progression and survival could be examined. This editorial refers to post hoc claims by Fawzy that his stress reduction intervention increased NK cell activity and improved survival in malignant melanoma patients to which. My colleagues and I previously dispensed with this claim in a detailed critical analysis.
At the same time, dark eyelashes indicated--in a man at least--"a soul which is solid and constant"; black or blue eyes, neither too large nor too small, "an excellent constitution… demonstrating good judgement [and] faithfulness"; while a tall forehead "demonstrates good sense. Alberto Arecchi, Milan Laughran 6 The small mouth and thin eyebrows were however considered by Della Porta to be quintessentially feminine characteristics indicating, according to him, effeminacy when present in a manas did a small nose which demonstrated, he said, a "servile mentality, thieving and unfaithful… I would liken it to that of women".
Last but not least, the broadness of the forehead compensated for its height, indicating a tendency to change one's mind and suggesting stupidity. For that, she would need the complementary presence and guidance of the ideally moderate male complexion. In addition, Firenzuola continued, there should also be "somewhere fair and vermillion, as in the cheeks… [and] somewhere red, as in the lips…" "dove candido e vermiglio come le guance… dove rosso come le labbra…" 15 Red too had gained popularity among humanists, not least because Plato had called it a spirit color, "holding the world together.
Caroline Beamish, New Havenp. The contemporary talismanic wearing of coral was a perfect example of these attempts to use red to ward off male, both spiritual and physical. Laughran 7 At the same time, while cosmetics had long been particularly associated with women, men were not averse to using cosmetics themselves. With the advent of courtly baroque aesthetics, in fact, men would openly use cosmetics to the same degree as their female counterparts: Thus, a man must not embellish himself like a woman, for his adornments will then contradict his person, as I see some men do, who put curls in their hair and beards with a curling iron, and who apply so much make-up to their faces, neck, and hands that it would be unsuitable for any young wench, even for a harlot who is more anxious to hawk her wares and sell them at a price.
Whereas men's and women's dress had previously tended to reflect and complement each other, clothing items were themselves steadily gendered during this period as in the case of skirts and gowns, for example, which would be increasingly identified as "female" costume. Paolo Rovesti, Venicep. Konrad Eisenbichler and Kenneth R. Bartlett, Torontop. Giancarlo Rati, Romep.
Laughran 8 The issue seems to have stemmed from one of "virtue," derived from the Latin "virtus," meaning "manly excellence.
We can see that your appearance is very agreeable and pleasing to all, even if your features are not very delicate, though then again you manage to appear both manly and graceful… And I would like our courtier to have the same aspect. I don't want him to appear soft and feminine as many try to do, when they not only curl their hair and pluck their eyebrows but also preen themselves like the most wanton and dissolute creatures imaginable… Since Nature has not in fact made them the ladies they want to seem and be, they should be driven out from all gentlemanly society, let alone the Courts of great lords.
pseudoscience – DOPPIOCIECO
Difficut to define in English, sprezzatura was a cultivated nonchalance that aimed at maintaining constantly a natural and effortless appearance. Indeed, when Castiglione would introduce the concept of sprezzatura in his Book of the Courtier, he extended Ovid's saying of "the art is to conceal the art" beyond its original reference to cosmetics in order to apply it to the recommended presentation of the courtier's persona as a whole.
Nevertheless, one of the few ways that Castiglione himself was very comfortable with his courtly lady demonstrating the courtier's sprezzatura was precisely through her use of cosmetics: Laughran 9 clearly wearing no make-up on her face, which is neither too pallid nor too red, and whose own colouring is natural and somewhat pale but who occasionally blushes openly from embarrassment or some other reason … betraying no effort or anxiety to be beautiful.
Such is the uncontrived simplicity which is most attractive to the eyes and minds of man, who are always afraid of being tricked by art. Prominent among secrets divulged in these manuals were thus hair colorings, including red, black, but--most popularly--the "arte biondeggiante," the dye formula which would give women the golden tresses which had been so lauded by humanists. By the Renaissance, in fact, "washing one's hair" had actually become synonymous with hair coloring.
Sani, "Il 'ricettario di bellezza' di Catherina Sforza," in Minerva farmaceutica 4 , pp. Isabella d'Este, on the other hand, was apparently famed as an expert in perfumery who used her creations in the ritualized exchanges of courtly gifts. In return, she seems to have possessed the "secret" for toothwashes, the recipe for which was sent apparently to her by the Queen of Naples. She also developed other cosmetics, like nail buffers and hair dyes, the latter of which actually functioned more as a kind of "remedy" by--she thought--simply "returning" her hair to its original color COGNASO, p.
Laughran 10 Venetians were the most famed for their technique: Cesare Vecellio, in his Habiti antichi e moderni di tutto il mondo, captured the process in his famous engraving of "Women of Venice, While They Bleach Their Hair" "Donne di Venetia, mentre si fanno biondi i capelli" fig.
Needless to say, such attempts to manipulate impressions--especially when coupled with the advent of the Reformation--led some elites to increasing preoccupations about mental reservation and dissimulation over the course of the sixteenth century. Part of the popularity of physiognomy treatises had in fact been due to the hope that dissimulation would have been rendered highly difficult through their application. L'arte della cosmesi, Milanp. Laughran 11 even invent not only emotional expressions but also particularly significant somatic characteristics of the subject,36 so too could cosmetics alter perceptions by adding, emphasizing or eliminating the representation of these "stimmate sociali" as desired.
In the early years of the epidemic, syphilis was both highly virulent and unmistakably obvious: The response for at least some sufferers was to attempt to alter their appearance through one of the earliest examples of cosmetic surgery.
As physician Gaspare Tagliacozzi explained in his De curtorum chirugia, he would utilize skin grafts from the arm to rebuild the missing feature fig.
Laughran 12 restringendum vulva,"41 how much more did mere topical cosmetics threaten to act as a "mask" of personality? Boccaccio had not minced his words when he warned of this prospect in his Corbaccio by recounting stories of essentially unhealthy women who concocted tremendous amounts of their own cosmetics to project a falsely beautiful complexion, acting as if, he said, "[they] were a prize damsel about to be married, who had to bolster up a small dowry with beauty" "come se una giovinetta di pregio fosse, alla quale, essendo per maritarsi, convenisse colla bellezza supplire la poca dota": So well did her skills avail her that this dazzled and deceived not only you but also many others less smitten than you: If you had seen her, as I saw her most mornings… sitting on her haunches in her lined mantle, brooding over the fire, with livid rings under her eyes, coughing and spitting great gobs of phlegm… you would have thought that you had met up with a load of dung, or a mountain of manure, from which you would have fled, as you do from something disgusting…42 As a result, some, like Boccaccio, clearly feared the prospect of cosmetics being used as a mask to dissimulate complexion.
As a result of these attempts to manipulate the Renaissance fashion system through the use of cosmetics, one could no longer be certain with whom he or she was dealing, particularly when that person could be engaged in "self-fashioning" right down to one's own physiognomy. Indeed, in addition to explaining how to create cosmetics which could aid in painting certain features, the sixteenth-century "books of secrets" were filled with recipes for removing or masking natural ones--like birthmarks, freckles, wrinkles and any other potential 41ROSETTI, p.
Surely you realize how much more graceful a woman is who, if indeed she wishes to do so, paints herself so sparingly and so little that whoever looks at her is unsure whether she is made-up or not, in comparison with one whose face is so encrusted that she seems to be wearing a mask and who dare not laugh for fear of causing it to crack, and who changes colour only when she dresses in the morning… How much more attractive than all the others is a pretty woman who is quite clearly wearing no make-up on her face, which is neither too pallid nor too red, and whose own colouring is natural and somewhat pale but who occasionally blushes openly from embarrassment or some other reason … betraying no effort or anxiety to be beautiful.
Luigi Pescasio, Veronap. She also developed other Laughran 14 Naturally, most of the early extant evidence regarding cosmetics' use--and indeed fashion as a whole--reflects the viewpoint of the elite, and therefore tends to create the impression of a fashion system which was directed almost entirely at embodying and communicating these subtle distinctions in social position and status.