Stigmatization A Mental Health Clinical Case Analysis Nursing Essay

Stigmatization A Mental Health Clinical Case Analysis Nursing Essay During my mental health clinical rotation at Karwan-e-hayat, I encountered a 45 year old female patient with the diagnosis of Obsessive compulsive disorder and depression in her rehabilitative phase. She gave Rs 50/- to the nursing assistant to bring nimco for her which costed Rs 25/-. The nursing assistant returned with the nimco but did not returned the rest Rs 25/- to the patient by saying that no money was left. When the patient reported the incident to the nurse, the nurse did not pay any attention to the patient. In the beginning the nurse said that she dont have time to talk about it followed by the statements such as Unlike you, I have too much work to do and then when the patient went to another nurse, she ignored the patient also by saying that The nursing assistant would not have been lying. Patients like you come and go from here every day saying these kinds of things. Go and do your work. The patient went away quietly looking down. Later she verbalized Nobody takes us se riously as we are mentally ill patients. So we cant do anything. Furthermore she said Does being mentally ill means we are not humans? Stigma is a Greek word meaning mark, and is derived from the verb stizein to tattoo, to prick, to puncture. Stigma is usually a mark of disgrace or infamy, which leads to action: discrimination against the stigmatised person (Arboleda-Fl ´orez Sartorius, 2008, P.69). stigma occurs when leading social group diminishes the qualities of a less influential group. Stigma in health care is a very common entity for many groups of the community. One of which is psychiatric patients. People identified as having mental health problems are one of the most marginalised groups in society (Martin, 2009, p.6) The above mentioned case is an example of such cases whereby a mentally ill patient was stigmatized in the hospital settings by the health care professional. Many patients and surveys have highlighted this sheer reality that health care professionals themselves display stigmatizing behaviors and practices (Hinshaw, 2007). Moreover, they depict dehumanizing behavior and lowered expectation towards mentally ill. In this case scenario, the health care professional directly passed on stigmatizing comments to the client. According to Hinshaw, (2007), the health care providers sometimes use frequent comments which are hurtful jokes for the clients. They often use judgmental terms for the patients with one another in the presence of the patient, as though the patients were not even present there. This behavior from the side of the health care provider makes the patient doubt their own self, leading towards self-stigmatization (Hinshaw, 2007). This self-stigmatization in turn makes the patie nts doubt their own self-esteem, lowering their own self-image (Hinshaw, 2007; Link, Struening, Todd, Asmussen, Phelan, 2001). One of the accounts presented by Hinshaw in 2007 clearly states that a kid has internalized the belief that his grandmother punishes him because of his misbehavior as a child and self-blaming himself for the adult psychiatric episodes which he was having. In this way, public stigma makes the patients think that there is something wrong with them and they dont deserve to exist in this world. Many mentally ill people want to get settled in the society but are unable to do so because the world stigmatizes them, the health care professionals stigmatize them and then they doubt their own credibility ending up in self-stigmatizing their own selves. According to former U.S. surgeon David satchers report on mental illness of 1999, he clearly concluded that stigma leads to low self-esteem, isolation, and hopelessnessà ¢Ã¢â€š ¬Ã‚ ¦, it deprives people of their digni ty and interferes with their full participation in society. (Satcher, 1999) That clearly highlights the effected abilities of the individual on the grounds of mental illness. According to the writer, self-stigma is inevitable. This highlighted effect of self-stigma is clearly evident in the case scenario presented above by the action of the patient herself, which she has looked down and moved away. This lowered self-esteem in turn brings out hopelessness in the clients (Link, Struening, Todd, Asmussen, Phelan, 2001). Like the client in the given case scenario says that nobody takes us seriously. We cant do anything. That clearly identifies the notion of hopelessness that the patient has no hopes from life and has accepted clear defeat because of the stigma associated with mental illness. The next question is how does stigma affects the rehabilitation of the mentally ill patients. How does it affect the coping skills of the mentally ill patients? What are the coping mechanisms of the mentally ill patients which they use in stigma? What are the coping mechanisms of the patients with neurosis who are well aware of the reality and understand this notion of stigma, as opposed to the psychosis patients. According to literature, many a times, the stigma posed is due to many of the bizarre symptoms caused by psychosis and the patients with neuroses also have to take it as they all fall under the category of mental illness for the laymen regardless of psychosis and neurosis (Hinshaw, 2007). According to the ethical principle E of the American psychiatric association, the patients have the right of dignity and respect regardless of any differences; that implies to both psychosis and neurosis (Lowman, 2005). The psychotic patient as mentioned earlier is away from the reality co ntent but they surely understand that they are being treated wrongly. (Levine Levine, 2009) They are not able to think rationally but surely they are human beings and are witnessing what is going on with them. Many a times we witness that they cry over small things which are going wrong with them. They are witnessing the behavior of the health care provider but are unable to interrelate it to their past experience. Regardless of the psychosis, it is wrong to treat them any bad so how bad can it be for the neurosis client whose reality content is intact and who can rationalize everything that is going on with them and who can interrelate these aspects with their past and then can feel the shame (Hinshaw, 2007). The patient in the above mentioned case scenario would be forced to think if something is wrong with her resulting in feelings of shame and guilt. This guilt in turn takes the patient in the situation of self-stigmatization which leads on to hopelessness which clearly affects the coping mechanism of the individual since if the person would be hopeless towards his illness, the reconstitution would be delayed (Hinshaw, 2007). Stigmatization affects the personal response of the patient which is a vital part of process of coping. The personal responses are individualized and can change over time. Many a times, the strategy which patients use to avoid stigma and to preserve their self-esteem is secrecy, which preserves their self-esteem but isolates the individual from social support (Satcher, 1999; Hinshaw, 2007). stigma has an important part in determining public health consequences by revealing stigmatized individuals to health-harmful conditions, by aggregating stress, declining coping, and by putting a barrior to receiving health care (Link Phelan, 2006). According to Corrigan and Watson (2002) as cited in hinsaw, 2007 there are many new reasons emerging to justify the reason for some individuals to respond with anger whereas some to nerely ignore the stigma and move on with their lives whilst some internalize the negative message while hurting their self-image. If stigma-related threat is believed to be of greater magnitude than ones coping responses, several types of voluntary and involuntary reactions can come about, like lowered self-esteem, reduced achievement, and compromised physical health. (Hinshaw, 2007) Several questions arise Looking upon the behavior of the health care professional such as is the attitude of the nurse justifiable? Would she have had the same stigmatized responsein the case of another pfysically ill patient? If she would have then she is not following the ethical principle E of the American psychological association of respect of peoples right and dignity. This principle clearly states that the regardless of the awareness of the disability, the health care provider has to maintain the respect of the patient. For the violation of this ethical principle, who is responsible? The nurse or the society to see all the mentally ill patients on a single wavelength and stigmatize them. Who is accountable for it? The nurse or the hospital settings or either the society to be accountable for such stigmatization? Would the same behavior have happened in the western settings? If the patient would have sued the in the court, whose statements would be more valued and listened to t he nurses or the mentally ill clients who is savaged and stigmatized in the community by the names of irrational and unthinkable. Many accounts of the depressed patients state the fact that they are not been taken seriously while giving some statements because of the stigma associated whereas if some other person of pathological chronic condition gives the same statement, it is taken seriously (Shaw, 1998). In the settings of the above mentioned case scenario, would anyone have had listened to her that her rights are being violated or would this all be given the name of mental illness and let go of? One more side of stigmatization comes when we tease normal people by the names of the stigmatized people to embarrass them. In everyday life, language patterns indicates an anxiety with mental disorder across all age groups with a host of terms related to mental illness used to scapegoat and humiliate those who violate social norms. They are associated with mentally ill and words like psycho and wacho are used to compare people who go against social norms in the western community (Hinshaw, 2007). Whereas, no literature is to be found for the usage of such words due to the lack of researches in this field. Usage of variants of such terms at young ages signals the pervasiveness of the criticism of persons with mental disorders. Indeed, judgmental tags of retard or crazy are among the first terms used by children who havent even started their schoolings yet to relegate socially rejected friends in the west. (Hinshaw, 2007) Media also plays important role in stigmatizing the mentally ill . Media differs in east and west which directly effects pattern of stigmatizing. People with psychotic-level disorders, as well as milder disturbances, were portrayed as ignorant, dangerous, dirty, unkind, and unpredictable. (Hinshaw, 2007, p.118) The model which could best be incorporated in this is Link and Phelans model of stigma. In this model stigma is processed by many different components. First one is on distinguishing and labeling differences(Link Phelan, 2001). Most of the differences are usually ignored but sometimes they are not overlooked at and thus labeled. In my clinical case scenario, the patient was labeled as mentally ill having no work to do. The second component is on associating human differences with negative attributes(Link Phelan, 2001). This occurs when the labeled differences are linked to stereotypes and so my patients mental illness was stereotyped as workless people. The third component is of on separating us from them which brings the notion of stigmatization(Link Phelan, 2001). In the above mentioned case scenario also, the patient was referred to as out group as evidenced by the statement patients like you come and go each day but we have work to do, clearly defining the notion of us versus them. The last component is status loss and discrimination(Link Phelan, 2001). In the status loss, patient is connected to undesirable characteristics that reduce his or her status in the eyes of the stigmatizer. In this case, the undesirable characteristic was that mentally ill patients are laid off and redundant where as we are working people so we are higher than them and in this way stigmatized people are put down at the bottom of the hierarchy. Keeping in view the principles of American psychiatric association, the strategies which I would like to pose in this context is the nurse should look in the matter and confirmed the case with the nursing assistant as well as to the shop from which the nursing assistant got the nimco from. Moreover, nursing assistants should be taught all the rights of the patients so that being a health care provider; they would follow all the ethical principles. On an institutional level, a system should be made in which patients can have some responsible person to take care of these things instead of asking anyone they can get their hands on to. To conclude, not much research has been done on this issue of mental health and proper awareness does not exist in this society. More researches needs to be done to address this issue as stigma in mental health persists all around the world. Strategies needed to be thought about to remove this factor of stigma. More education sessions about this needs to be done on the clinical side to make the nurses and other health care providers aware of what the rights of the patients are and a check and balance system should be there to acknowledge either those rights have been followed and fulfilled or not. (word count: 2201 words) References Arboleda-Fl ´orez, J., Sartorius, N. (Eds.). (2008). Understanding the Stigma of Mental Illness: Theory and Interventions. New Delhi, India: Aptara. Hinshaw, S. P. (2007). The Mark of Shame. New York, USA: Oxford University Press. Husted, J. H., Husted, L. G. (2008). Ethical Decision Making in Nursing and Health Care (4th ed.). New York, USA: springer publishing company. Link, B. G., Struening, E. L., Todd, S. N., Asmussen, S., Phelan, J. C. (2001). Stigma as a barrier to recovery-The consequences of Stigma for the self-esteem of people with mental illnesses. Psychiatric Services, 52(12), 1621-1626. Link, B. G., Phelan, J. C. (2006). Stigma and its public health implications. Lancet, 367, 528-529 Link, B. G., Phelan, J. C. (2001). Conceptualizing Stigma. Annual Reviews, 27, 363-85. Levine, J., Levine, L.S. (2009). Schizophrenia for dummies. Canada: Wiley Publisher. Lowman, R. L. (2005). Respect for Peoples Rights and Dignity. Journal of Aggression, Maltreatment Trauma, 11(1), 71 77. Martin, N. (2009). From Discrimination to Social Inclusion. Australia: Queensland Alliance. Shaw, F. (1998). Mistaken identity. Lancet, 352, 1051. Satcher, D. (1999). Mental Health: A Report of the Surgeon General. Washington, DC: Department of health and human services.

Women Have the Right to Choose Abortion Essay -- Papers Argumentative

Women Have the Right to Choose Abortion An abortion is a woman's option to terminate a pregnancy. It is an induced miscarriage. Abortion has become an extremely controversial topic in the past 3 decades since it has been legalized. There has been extreme violence stemming from this issue that we as a country need to put under control, regardless of our personal stances on the issue. There are many reasons why a woman would choose to have an abortion. She does not feel she is ready to be a parent, she can not afford a baby, and being too young or immature to be responsible for another life are only three of these reasons. If a woman becomes pregnant due to a rape or from incest would be another reason. It has been found that almost fifty per cent of all women will have an abortion by the time they reach 45. Is this number increasing since the legalization of abortion? Probably not, considering the fact that before abortions were legal they were still being preformed. The only difference is now they are safer. Before 1965, abortion was somewhat taboo. No one dared to even discuss the issue. Abortion was frowned upon and considered "evil"; therefore it remained a very private issue. Abortions were performed by doctors, nurses, midwives, even chiropractors. Being that abortions were not performed in a hospital or clinic, anyone who felt like it could become an abortionist. These abortions were referred to as back- alley abortions. They were unsafe and lead to the deaths of many women, but in 1933 it was estimated that nearly 2 million were performed (Grisey). This proves to us that regardless if abortion is legal or not, if a woman feels she needs to have one she is going to. The prices of thes... ... to an increase in child abuse and neglect. I am not encouraging the use of abortion as a method of birth control, but accidents will happen. Some people are responsible enough to deal with these accidents, but some feel that they are not ready to bring a child into this world. If a mother feels she can not properly care for a child, isn't it better for the fetus to be aborted before it is brought into a world where it can not be properly loved, cared for and supported?  Bibliography: Works Cited 1. Grady, John L, Abortion Yes or No. (no printing press). Florida,1972. 2. Grisey, Germain, Abortion: the Myths, the Realities and the Argument.Corpus Books, New York,1970. 3. O'Donnell, Thomas J, Medicine and Christian Morality. Alba House, New York, 1976 4. www.plannedparenthood.org/abortion.html 5. www.religioustolerance.org/abortion.htm

The Meaning Behind Alien Abductions :: essays research papers

www.angelfire.com/mt/montalk Souls can only incarnate inoto bodies with DNA responsive to and compatible with that soul. Because souls are shaped by experiences and thoughts, different soul types will reincarnate into different body types of the same species. As humans, their personality is influenced and restricted by the characteristics of their soul. Spiritual evolution is limited by one's biological, genetic, and physical composition. For instance, a dog cannot grow emotionally as we do because their brains are biologically incapable of perceiving the same range of emotions. Dogs also do not feel equal self sacrifice and devotion to truth that some of us humans enjoy, and we are therefore superior to them. Lastly, since all souls, once out of the physical body and deep into the stages of the afterlife, are essentially the same being, there is no place for evolution in the spiritual realm; all evolution occurs on the physical plane of existence. This is why planet earth is so valued by the powers that be. It is the perfect training, evolving, and learning grounds for positive souls with the privilege of physical presence. In this region of the solar system, without an earth, there is no evolution, and whatever pain a soul is in continues indefinitely until that soul can reincarnate to evolve out of its pain. Because souls evolve by earthly hardships, new types of souls can only develop by modification of the older ones over millions of years of evolution. Thus, if a sudden jump occured in the genetic sophistication of a species, a spiritual void would be left as the older souls would be outdated and incompatible with the newly created species. The new species would be born as still births unless some source of soul were available that is suitable with the DNA of that species. The human race was a result of drastic genetic engineering by a coalition of several alien species/races several hundred thousand years ago, each group putting its own spin on the basic human template. Most of the aliens themselves were products of undisturbed evolution upon their homeworlds. Since human evolution was catalyzed, the souls of our ancient primate ancestors could not reincarnate in the newer advanced bodies. Thus existed a spiritual void which was immediately filled with a new source. Considering it was aliens who created humans, these aliens must have had some reason to profit from the task. In fact, most alien bodies were too primitive to allow further spiritual

Behaviorial Based Interviewing :: Human Resources

Behavioral interviewing is a technique employers use to determine if you are a good fit for the job. This is accomplished by asking questions that pertain to your past behavior. The information gained through this technique is used as an indicator of your future success. In other words, the answers you give about your past experiences will be used to predict your future performance (Quintessential) Employers use often use behavioral interviews to evaluate the candidates past behavior and experiences to determine their potential for success within the company. Organizations need to be prepared in searching for the right employee. There may be a wealth of talent looking for a job, but it's important to find right person who "fits" the company. Dr. Paul Green of Behavioral Technology, Inc. developed and trademarked the behavioral interviewing system. In behavioral interviewing, employers expect candidates to succinctly reveal specific stories about relevant work situations they encountered. If the interviewer does not receive an sufficient answer, the interviewer usually probes the candidate to receive more concrete examples. Although some consider this task time consuming, it is a valuable method in narrowing a large pool of applicants. In this technique, employers learn how people actually behaved in certain situations in prior jobs. Many human resources professionals believe this is a very effective predictor of behavior in future positions (Green). The employer identifies job-related experiences, knowledge, behaviors, skills, and abilities that the company desires for the particular position. Behaviorial Based Interviewing :: Human Resources Behavioral interviewing is a technique employers use to determine if you are a good fit for the job. This is accomplished by asking questions that pertain to your past behavior. The information gained through this technique is used as an indicator of your future success. In other words, the answers you give about your past experiences will be used to predict your future performance (Quintessential) Employers use often use behavioral interviews to evaluate the candidates past behavior and experiences to determine their potential for success within the company. Organizations need to be prepared in searching for the right employee. There may be a wealth of talent looking for a job, but it's important to find right person who "fits" the company. Dr. Paul Green of Behavioral Technology, Inc. developed and trademarked the behavioral interviewing system. In behavioral interviewing, employers expect candidates to succinctly reveal specific stories about relevant work situations they encountered. If the interviewer does not receive an sufficient answer, the interviewer usually probes the candidate to receive more concrete examples. Although some consider this task time consuming, it is a valuable method in narrowing a large pool of applicants. In this technique, employers learn how people actually behaved in certain situations in prior jobs. Many human resources professionals believe this is a very effective predictor of behavior in future positions (Green). The employer identifies job-related experiences, knowledge, behaviors, skills, and abilities that the company desires for the particular position.

Race and notions of intellectual inferiority in America Essay

Introduction In public schools, it could not be denied that the administrations prioritize the needs of the White American students. Aside from the reason that the place of the institution is the so-called White’s territory, the administration, being diverse consider the White American students to be more superior among the other students. In this regard, they are able to provide the needs of the White students amply compared to how they are able to provide for those others who belong to minor races. Not to mention that these minor students belong to the ‘poor sector’ of the society, they are less taken care of by their administrative officers. Of course, knowing that the public schools cater to such type of students, the government of the United States sees to it that the said educational institutions are able to get the possible funds that could be used in utilizing some psychological applications and therapeutic health remedies that could be made available for the students. However, as clearly stated earlier, the administration of the schools, as the ‘trustees’ of the fund are given the responsibility to provide for their students directly. Due to the discriminative attitude of several administrative officers, these services are not equally distributed and accessed by the students. Usually, the ones who are able to have full benefits of the said provisions are only the White students and their family. Psychologists claim that such neglect of student need does not only display a clear picture of racial inequality but also aggravates the situation of the students who are less serviced well. Hence, instead of being progressively taught by concerned educators, minorities are left behind to learn things on their own, which they could not obviously do because of their difficulties in learning. It may not be as obvious as it stated in this study, but actual situations suggest the fact that discriminative measures that institutional administrations of the public schools usually overlook this need. As a result, their role in assisting the children enrolled in their institution is not completely realized. Worse case scenario suggests that the aggravation of such situations leads to deeper social depression that may not be obvious, but is felt by the students under the condition of having a learning disability and belonging to a minor race in the society. As these young learners grow up they begin to see the actual results of social divide. During most periods of history, civil rights granted by governments were often altered or withdrawn at will, which led to continued struggles for freedom of speech. Starting in the middle ages, some of the people demanded a written statement spelling out their rights, with limitations placed on government control of those rights. As a result, significant bills of rights began to be formulated. Among these was the Magna Carta, a landmark in the field of human rights. Dealing with human rights issues have always been the main core of debate among social enthusiasts within the American region. The respect for life and the right for living that every individual is entitled to has long been a withholding topic that almost everyone is highly concerned about. Within the American history, human rights issues have also been the reason why there existed several civil movements against the state during the early decades of development within the said society. To be able to examine how these issues primarily affects the present American society and its relationship with American-African minorities, relating the situation with history of the relationship that existed between the two races is essential for discussion.

How to Score A1 Grade in English Subject of Ssc

English – Study Plan Planning your study helps in making it extensive and thorough. Given below are some guidelines that may help you to score high in each section of SSC English papers. Answering questions based on the lessons in the main reader: Start by studying the questions for comprehension asked after each lesson at least a few times, which helps in grasping the important topics that can be asked in each lesson. Then take up a more detailed approach for a deeper understanding of each lesson-to understand questions better and know the necessary points to be written for each question.Make a note of the important topics-whichever can be asked as questions. Don’t depend entirely on the questions given after each lesson. Meanings: Keep a dictionary beside you while reading lessons to look up the meanings of words you are not so sure of the meaning. Also a dictionary/thesaurus gives a list of similar meaning words. Meaning of the underlined word: Knowing the different ways a word can be used and the meaning it conveys in each context helps you score marks in the ‘meaning of the underlined word’ section.Ask the teacher for the subtle differences in meanings and usages of those words. Pronunciation: Listen carefully when the teacher pronounces unfamiliar words. Listening is the way to recognize sounds in a language. This will help in recognizing similarly pronounced words and rhyming words. Spellings: While reading a lesson, observe the spellings and make note of words which may be mis-spelt. E. g. : enmity, pilgrimage, austere etc. This helps in recognizing the wrongly spelt words and correcting them. Read the exercises after each lesson also with a critical eye.Practice solving old question papers, bit banks etc and keep evaluating yourself-your strengths and areas that need more work. Rewriting sentences as directed: Practice the different sentence structures (Direct- Indirect speech, Active-passive voice, conditional clauses, parti cipial clauses, relative clauses etc). Structures taught in 8th and 9th classes also need to be revised. Passages for comprehension: Practice the passages for comprehension-the unseen passages of Paper I and the passages from the supplementary readers in Paper-II. The questions following these passages are for one mark each.So they have to be answered briefly, in a sentence or two. After reading the passage, read all the questions, before attempting to answer them. Two or more questions might seem similar. You need to understand how each question is different from another, to answer them well. Read the relevant part of the passage repeatedly to arrive at a concise, precise answer. Answering questions based on the lessons in the supplementary readers: This is the only section in English question paper that allows the students to choose the questions which they can answer the best.The questions may not be the ones that are given after each lesson in the supplementary readers. So a tho rough reading of the lessons is absolutely necessary. Scrambled sentences: The sentences in a passage are jumbled up. The order of the sentences doesn’t convey the meaning correctly. It is necessary to re-arrange the sentences logically, so that they become coherent and connect to each other. Only the letters corresponding to the sentences are to be written in the right order.Writing an argumentative passage based on the given dialogue: Understand the topic being discussed and express your views on the topic. Depending on the topic under discussion, you may argue on one or both sides. It is advisable to divide the argument into a few paragraphs-at least three. State briefly your opinion in the first paragraph. Then go on to express your views, and finally give your conclusion in another paragraph. Letter-writing: Go through the letters given in the previous SSC exams. Practice writing different letters.Understand the difference in style of writing different kinds of formal le tters. Business letters: A business letter-answering an advertisement, is different from a letter written to the Editor of a newspaper to be read by the general public. In a business letter we focus on the purpose of writing the letter-applying for a job or educational course. When you are applying for some educational course you need to tell them what attracted you to the course and why you think that course would be helpful to you.When you are applying for a job, you have to mention that your qualifications suit those required for the job. Lay emphasis on the qualities in you that you think would make you a suitable candidate for the job. Express your eagerness to impress the employer with your sincerity. Â ¤ Understand each new word introduced-the subtle differences in similar meaning words-and how they are used. Â ¤ Pay attention to the textual exercises given after each lesson. They are valuable guidelines to develop a good understanding of the language. Link every new word, to words of similar meaning you learnt earlier. Â ¤ The SSC exam tests the knowledge of the student-it includes words and usages introduced in the earlier classes as well. Â ¤ Listen and read extensively-to develop a better vocabulary. Â ¤ Use the words you have newly learnt at every opportunity-in writing letters and in writing your argument based on a dialogue. Â ¤ Understand the difference between formal and informal expressions. Know the vocabulary to be used in each context. Â ¤ Last but not the least-WRITE IN A NEAT, LEGIBLE HANDWRITING. Avoid striking off or overwriting.

Determinants of Morality Essay

The determinants are essential features of morality that point to the rightness or wrongness of an action. It enables us to perceive the specificity of morality. Only human person act for a reason, a purpose, and for an intention or goal because it is only the human persons who are created with the intelligence and the freedom to choose from good and evil. The three determinants of morality are the Object of the Act (Finis Operis), End of the Agent (Finis Operantis), and Circumstances B1. What are Circumstances Circumstances are the situational factors surrounding the concurrent of the act. These circumstances may either increase or diminish our responsibility in doing the act. There are seven types of circumstances affecting the act that human people do. These are what, who, where, by what means, why, how, and when. â€Å"What† refers to the nature of the act (Quid). â€Å"Who† refers to the person/doer/agent and the recipient of the act (Quis). â€Å"Where† refers to the locus of the act or the place where the action took place (Ubi). â€Å"By What Means† refers to the instruments used in the performance of the act (Quidis Auxiliis). â€Å"Why† refers to the reason in doing the act (Cur). â€Å"How† refers to the manner or the process of performing the act (Quomodo). And lastly, â€Å"When† refers to the time element in the commission of the act (Quando). There are also three kinds of circumstances. First is aggravating, which intensifies the gravity of the act. Second is mitigating, this lessens the culpability of the act. Third is exempting, it has culpability but is no applicable for the given time. Lastly justifying, which means no more culpability is involved. B2. Principles to Remember The principles to remember in circumstances are it is positive because it can make better an act good or even indifferent in its object and it is negative because it can make worse an act evil or indifferent in its object. It can also make less good or less evil an act good in itself. The act may be morally good, all three determinants must be without a flaw. B3. Examples Examples of circumstances is when one is poor. It is an example of circumstance because it is a situational factor which could increase one’s responsibility to work harder and earn so that he/she could have a living. Another example of circumstance is when one is sick. It is also an example of circumstances because when one is sick, the person will be more responsible in taking care of him/herself.