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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
The PIE principles were in place for the "not yet diagnosed nervous" (NYDN) cases:
- Proximity – treat the casualties close to the front and within sound of the fighting.
- Immediacy – treat them without delay and not wait until the wounded were all dealt with.
- Expectancy – ensure that everyone had the expectation of their return to the front after a rest and replenishment.
United States medical officer Thomas W. Salmon is often quoted as the originator of these PIE principles. However, his real strength came from going to Europe and learning from the Allies and then instituting the lessons. By the end of the war, Salmon had set up a complete system of units and procedures that was then the "world's best practice". After the war, he maintained his efforts in educating society and the military. He was awarded the Distinguished Service Medal for his contributions.
Effectiveness of the PIE approach has not been confirmed by studies of CSR, and there is some evidence that it is not effective in preventing PTSD.
US services now use the more recently developed BICEPS principles:
- Brevity
- Immediacy
- Centrality or contact
- Expectancy
- Proximity
- Simplicity
Modern front-line combat stress treatment techniques are designed to mimic the historically used PIE techniques with some modification. BICEPS is the current treatment route employed by the U.S. military and stresses differential treatment by the severity of CSR symptoms present in the service member. BICEPS is employed as a means to treat CSR symptoms and return soldiers quickly to combat.
The following BICEPS program is taken from the USMC combat stress handbook:
The Institute of Medicine reviewed the evidence for treatments for symptoms associated with Gulf War syndrome and related conditions. They concluded that selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors and cognitive behavioural therapy were most likely to be beneficial to patients.
This disorder may resolve itself with time or may develop into a more severe disorder such as PTSD. However, results of Creamer, O'Donnell, and Pattison's (2004) study of 363 patients suggests that a diagnosis of acute stress disorder had only limited predictive validity for PTSD. Creamer et al. did find that re-experiences of the traumatic event and arousal were better predictors of PTSD. Early pharmacotherapy may prevent the development of posttraumtic symptoms.
Studies have been conducted to assess the efficacy of counselling and psychotherapy for people with ASD. Cognitive behavioral therapy which included exposure and cognitive restructuring was found to be effective in preventing PTSD in patients diagnosed with ASD with clinically significant results at 6 months follow-up. A combination of relaxation, cognitive restructuring, imaginal exposure, and in vivo exposure was superior to supportive counseling. Mindfulness based stress reduction programs also appear to be effective for stress management.
In a wilderness context where counseling, psychotherapy, and cognitive behavioral therapy is unlikely to be available, the treatment for acute stress reaction is very similar for the treatment of cardiogenic shock, vascular shock, and hypovolemic shock; that is, allowing the patient to lie down, providing reassurance, and removing the stimulus for the occurrence of the reaction. In traditional shock cases, this is generally the relieving of pain from injuries or the stopping of blood loss. In an acute stress reaction, this may be pulling a rescuer away from the emergency to calm down, or blocking the sight of an injured friend from a patient.
Multisymptom illness is more prevalent in Gulf War veterans than veterans of previous conflicts, but the pattern of comorbidities is similar for actively deployed and nondeployed military personnel.
Shell shock is a phrase coined in World War I to describe the type of posttraumatic stress disorder many soldiers were afflicted with during the war (before PTSD itself was a term).
It is reaction to the intensity of the bombardment and fighting that produced a helplessness appearing variously as panic and being scared, or flight, an inability to reason, sleep, walk or talk.
During the War, the concept of shell shock was ill-defined. Cases of 'shell shock' could be interpreted as either a physical or psychological injury, or simply as a lack of moral fibre. The term "shell shock" is still used by the Veterans Administration to describe certain parts of PTSD but mostly it has entered into popular imagination and memory, and is often identified as the signature injury of the War.
In World War II and thereafter, diagnosis of 'shell shock' was replaced by that of combat stress reaction, a similar but not identical response to the trauma of warfare and bombardment.
The treatment of chronic shell shock varied widely according to the details of the symptoms, the views of the doctors involved, and other factors including the rank and class of the patient.
There were so many officers and men suffering from shell shock that 19 British military hospitals were wholly devoted to the treatment of cases. Ten years after the war, 65,000 veterans of the war were still receiving treatment for it in Britain. In France it was possible to visit aged shell shock victims in hospital in 1960.
There must be a clear temporal connection between the impact of an exceptional stressor and the onset of symptoms; onset is usually within a few minutes or days but may occur up to one month after the stressor. In addition, the symptoms show a mixed and usually changing picture; in addition to the initial state of "daze," depression, anxiety, anger, despair, overactivity, and withdrawal may all be seen, but no one type of symptom predominates for long; the symptoms usually resolve rapidly in those cases where removal from the stressful environment is possible; in cases where the stress continues or cannot by its nature be reversed, the symptoms usually begin to diminish after 24–48 hours and are usually minimal after about 3 days.
Many veterans of the wars in Iraq and Afghanistan have faced significant physical, emotional, and relational disruptions. In response, the United States Marine Corps has instituted programs to assist them in re-adjusting to civilian life, especially in their relationships with spouses and loved ones, to help them communicate better and understand what the other has gone through. Walter Reed Army Institute of Research (WRAIR) developed the Battlemind program to assist service members avoid or ameliorate PTSD and related problems. Wounded Warrior Project partnered with the US Department of Veterans Affairs to create Warrior Care Network, a national health system of PTSD treatment centers.
There is debate over the rates of PTSD found in populations, but, despite changes in diagnosis and the criteria used to define PTSD between 1997 and 2013, epidemiological rates have not changed significantly. Most of the current reliable data regarding the epidemiology of PTSD is based on DSM-IV criteria, as the DSM-5 was not introduced until 2013.
The United Nations' World Health Organization publishes estimates of PTSD impact for each of its member states; the latest data available are for 2004. Considering only the 25 most populated countries ranked by overall age-standardized Disability-Adjusted Life Year (DALY) rate, the top half of the ranked list is dominated by Asian/Pacific countries, the US, and Egypt. Ranking the countries by the male-only or female-only rates produces much the same result, but with less meaningfulness, as the score range in the single-sex rankings is much-reduced (4 for women, 3 for men, as compared with 14 for the overall score range), suggesting that the differences between female and male rates, within each country, is what drives the distinctions between the countries.
As "trauma" adopted a more widely defined scope, traumatology as a field developed a more interdisciplinary approach. This is in part due to the field's diverse professional representation including: psychologists, medical professionals, and lawyers. As a result, findings in this field are adapted for various applications, from individual psychiatric treatments to sociological large-scale trauma management. However, novel fields require novel methodologies. While the field has adopted a number of diverse methodological approaches, many pose their own limitations in practical application.
The experience and outcomes of psychological trauma can be assessed in a number of ways. Within the context of a clinical interview, the risk for imminent danger to the self or others is important to address but is not the focus of assessment. In most cases, it will not be necessary to involve contacting emergency services (e.g., medical, psychiatric, law enforcement) to ensure the individuals safety; members of the individual's social support network are much more critical.
Understanding and accepting the psychological state an individual is in is paramount. There are many mis-conceptions of what it means for a traumatized individual to be in crisis or 'psychosis'. These are times when an individual is in inordinate amounts of pain and cannot comfort themselves, if treated humanely and respectfully they will not get to a state in which they are a danger. In these situations it is best to provide a supportive, caring environment and communicate to the individual that no matter the circumstance they will be taken seriously and not just as a sick, delusional individual. It is vital for the assessor to understand that what is going on in the traumatized persons head is valid and real. If deemed appropriate, the assessing clinician may proceed by inquiring about both the traumatic event and the outcomes experienced (e.g., posttraumatic symptoms, dissociation, substance abuse, somatic symptoms, psychotic reactions). Such inquiry occurs within the context of established rapport and is completed in an empathic, sensitive, and supportive manner. The clinician may also inquire about possible relational disturbance, such as alertness to interpersonal danger, abandonment issues, and the need for self-protection via interpersonal control. Through discussion of interpersonal relationships, the clinician is better able to assess the individual's ability to enter and sustain a clinical relationship.
During assessment, individuals may exhibit activation responses in which reminders of the traumatic event trigger sudden feelings (e.g., distress, anxiety, anger), memories, or thoughts relating to the event. Because individuals may not yet be capable of managing this distress, it is necessary to determine how the event can be discussed in such a way that will not "retraumatize" the individual. It is also important to take note of such responses, as these responses may aid the clinician in determining the intensity and severity of possible posttraumatic stress as well as the ease with which responses are triggered. Further, it is important to note the presence of possible avoidance responses. Avoidance responses may involve the absence of expected activation or emotional reactivity as well as the use of avoidance mechanisms (e.g., substance use, effortful avoidance of cues associated with the event, dissociation).
In addition to monitoring activation and avoidance responses, clinicians carefully observe the individual's strengths or difficulties with affect regulation (i.e., affect tolerance and affect modulation). Such difficulties may be evidenced by mood swings, brief yet intense depressive episodes, or self-mutilation. The information gathered through observation of affect regulation will guide the clinician's decisions regarding the individual's readiness to partake in various therapeutic activities.
Though assessment of psychological trauma may be conducted in an unstructured manner, assessment may also involve the use of a structured interview. Such interviews might include the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995), Acute Stress Disorder Interview (ASDI; Bryant, Harvey, Dang, & Sackville, 1998), Structured Interview for Disorders of Extreme Stress (SIDES; Pelcovitz et al., 1997), Structured Clinical Interview for DSM-IV Dissociative Disorders- Revised (SCID-D; Steinberg, 1994), and Brief Interview for Posttraumatic Disorders (BIPD; Briere, 1998).
Lastly, assessment of psychological trauma might include the use of self-administered psychological tests. Individuals' scores on such tests are compared to normative data in order to determine how the individual's level of functioning compares to others in a sample representative of the general population. Psychological testing might include the use of generic tests (e.g., MMPI-2, MCMI-III, SCL-90-R) to assess non-trauma-specific symptoms as well as difficulties related to personality. In addition, psychological testing might include the use of trauma-specific tests to assess posttraumatic outcomes. Such tests might include the Posttraumatic Stress Diagnostic Scale (PDS; Foa, 1995), Davidson Trauma Scale (DTS: Davidson et al., 1997), Detailed Assessment of Posttraumatic Stress (DAPS; Briere, 2001), Trauma Symptom Inventory (TSI: Briere, 1995), Trauma Symptom Checklist for Children (TSCC; Briere, 1996), Traumatic Life Events Questionnaire (TLEQ: Kubany et al., 2000), and Trauma-related Guilt Inventory (TRGI: Kubany et al., 1996).
Children are assessed through activities and therapeutic relationship, some of the activities are play genogram, sand worlds, coloring feelings, Self and Kinetic family drawing, symbol work, dramatic-puppet play, story telling, Briere's TSCC, etc.
Western doctors are more likely to diagnose it as a kind of stress or depression. The "Diagnostic and Statistical Manual of Mental Disorders" currently lists "hwabyeong" among its culture-bound illnesses. Outside of Korea, informally "hwabyeong" may be mistaken as a reference to a psychological profile marked by a short temper, or explosive, generally bellicose behavior. To the contrary, "hwabyeong" is a traditional psychological term used to refer to a condition characterized by passive suffering, is roughly comparable to depression, and is typically associated with older women. It is important that when diagnosing Hwabyeong, the culture of the patient is well understood. Since Hwabyeong can often be misdiagnosed as depression, the symptoms and culture need to be clearly and thoroughly looked into. Once Hwabyeong has been diagnosed, past treatments need to be reviewed. The treatments for the patient can then be a combination of pharmacological, and therapy-based interventions.
The treatment methods used to combat hwabyung include psychotherapy, drug treatment, family therapy, and community approaches. To be more successful psychiatrists might need to incorporate the teachings from traditional and religious healing methods or the use of han-puri, which is the sentiment of resolving, loosening, unraveling and appeasing negative emotions with positive ones. One example of hann-puri would be a mother who has suffered from poverty, less education, a violent husband, or a harsh mother-in-law, can be solved many years later by the success of her son for which she had endured hardships and sacrifices.
A self-inflicted wound (SIW), is the act of harming oneself where there are no underlying psychological problems related to the self-injury, but where the injurer wanted to take advantage of being injured.
A number of psychotherapy approaches have been designed with the treatment of trauma in mind—EMDR, progressive counting (PC), somatic experiencing, biofeedback, Internal Family Systems Therapy, and sensorimotor psychotherapy.
There is a large body of empirical support for the use of cognitive behavioral therapy for the treatment of trauma-related symptoms, including posttraumatic stress disorder. Institute of Medicine guidelines identify cognitive behavioral therapies as the most effective treatments for PTSD. Two of these cognitive behavioral therapies, prolonged exposure and cognitive processing therapy, are being disseminated nationally by the Department of Veterans Affairs for the treatment of PTSD. Recent studies show that a combination of treatments involving dialectical behavior therapy (DBT), often used for borderline personality disorder, and exposure therapy is highly effective in treating psychological trauma. If, however, psychological trauma has caused dissociative disorders or complex PTSD, the trauma model approach (also known as phase-oriented treatment of structural dissociation) has been proven to work better than simple cognitive approach. Studies funded by pharmaceuticals have also shown that medications such as the new anti-depressants are effective when used in combination with other psychological approaches.
Trauma therapy allows processing trauma-related memories and allows growth towards more adaptive psychological functioning. It helps to develop positive coping instead of negative coping and allows the individual to integrate upsetting-distressing material (thoughts, feelings and memories) resolve internally. It also aids in growth of personal skills like resilience, ego regulation, empathy...etc.
Process' involved in trauma therapy are:
- Psychoeducation: Information dissemination and educating in vulnerabilities and adoptable coping mechanisms.
- Emotional regulation: Identifying, countering discriminating, grounding thoughts and emotions from internal construction to an external representation.
- Cognitive processing: Transforming negative perceptions and beliefs to positive ones about self, others and environment through cognitive reconsideration or re-framing.
- Trauma processing: Systematic desensitization, response activation and counter-conditioning, titrated extinction of emotional response, deconstructing disparity (emotional vs. reality state), resolution of traumatic material (state in which triggers don't produce the harmful distress and able to express relief.)
- Emotional processing: Reconstructing perceptions, beliefs and erroneous expectations like trauma-related fears are auto-activated and habituated in new life contexts, providing crisis cards with coded emotions and appropriate cognition's. (This stage is only initiated in pre-termination phase from clinical assessment & judgement of the mental health professional.)
- Experiential processing: Visualization of achieved relief state and relaxation methods.
The utility of PTSD derived psychotherapies for assisting children with C-PTSD is uncertain. This area of diagnosis and treatment calls for caution in use of the category C-PTSD. Ford and van der Kolk have suggested that C-PTSD may not be as useful a category for diagnosis and treatment of children as a proposed category of developmental trauma disorder (DTD). For DTD to be diagnosed it requires a
'history of exposure to early life developmentally adverse interpersonal trauma such as sexual abuse, physical abuse, violence, traumatic losses of other significant disruption or betrayal of the child's relationships with primary caregivers, which has been postulated as an etiological basis for complex traumatic stress disorders. Diagnosis, treatment planning and outcome are always relational.'
Since C-PTSD or DTD in children is often caused by chronic maltreatment, neglect or abuse in a care-giving relationship the first element of the biopsychosocial system to address is that relationship. This invariably involves some sort of child protection agency. This both widens the range of support that can be given to the child but also the complexity of the situation, since the agency's statutory legal obligations may then need to be enforced.
A number of practical, therapeutic and ethical principles for assessment and intervention have been developed and explored in the field:
- Identifying and addressing threats to the child's or family's safety and stability are the first priority.
- A relational bridge must be developed to engage, retain and maximize the benefit for the child and caregiver.
- Diagnosis, treatment planning and outcome monitoring are always relational (and) strengths based.
- All phases of treatment should aim to enhance self-regulation competencies.
- Determining with whom, when and how to address traumatic memories.
- Preventing and managing relational discontinuities and psychosocial crises.
Most self-inflicted wounds occur during wartime, for various possible reasons.
Potential draftees may self-injure in order to avoid being drafted for health reasons. This was practiced as Abstinence (conscription) by some Jewish conscripts in the Russian Empire.
The most common reason enlisted soldiers self-wound is to render themselves unable to continue serving in combat, thus resulting in their removal from the combat line to a hospital. Thus, self-injury can be used to avoid a more serious combat injury or a combat death.
In prisons and forced labour camps people sometimes self-injure so that they will not be forced to work and could spend some time in the more comfortable conditions of the barracks.
Survivor guilt (or survivor's guilt; also called survivor syndrome or survivor's syndrome) is a mental condition that occurs when a person believes they have done something wrong by surviving a traumatic event when others did not. It may be found among survivors of murder, terrorism, combat, natural disasters, epidemics, among the friends and family of those who have died by suicide, and in non-mortal situation. The experience and manifestation of survivor's guilt will depend on an individual's psychological profile. When the "Diagnostic and Statistical Manual of Mental Disorders IV" (DSM-IV) was published, survivor guilt was removed as a recognized specific diagnosis, and redefined as a significant symptom of post traumatic stress disorder (PTSD).
Herman believes recovery from C-PTSD occurs in three stages:
1. establishing safety,
2. remembrance and mourning for what was lost,
3. reconnecting with community and more broadly, society.
Herman believes recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship. This healing relationship need not be romantic or sexual in the colloquial sense of "relationship", however, and can also include relationships with friends, co-workers, one's relatives or children, and the therapeutic relationship.
Complex trauma means complex reactions and this leads to complex treatments. Hence, treatment for C-PTSD requires a multi-modal approach. It has been suggested that treatment for C-PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems. Six suggested core components of complex trauma treatment include:
1. Safety
2. Self-regulation
3. Self-reflective information processing
4. Traumatic experiences integration
5. Relational engagement
6. Positive affect enhancement
Multiple treatments have been suggested for C-PTSD. Among these treatments are experiential and emotionally focused therapy, internal family systems therapy, sensorimotor psychotherapy, eye movement desensitization and reprocessing therapy (EMDR), dialectical behavior therapy (DBT), cognitive behavioral therapy, psychodynamic therapy, family systems therapy and group therapy.
Underlying causes may include:
- Han (a Korean culture-related depressive sentiment related to hard life and social unfairness resulting not only from a tragic collective national history, but also from personal traumas)
- prior instances of major depressive disorder
- prior instances of anxiety disorder
- prior instances of adjustment disorder
- prior instances of other somatoform disorders
- repression of feelings of anger/resentment arising from past events
Triggering causes are typically external events, including:
- familial stressors, e.g. spousal infidelity or conflict with in-laws
- witnessing acts/actions/phenomena that conflict with one's own moral and/or ethical principles
The syndrome itself is believed to be the result of the continued repression of feelings of anger without addressing their source. In holistic medicine the containment of anger in hwabyung disturbs the balance of the five bodily elements, resulting in the development of psychosomatic symptoms such as panic, insomnia, and depression after a long period of repressed feelings.
It is possible that hormonal imbalances such as those around the time of menopause may also be an underlying cause of hwabyung in middle-aged women, the most often-diagnosed demographic.
Paruresis ( ) is a type of phobia in which the sufferer is unable to urinate in the real or imaginary presence of others, such as in a public restroom. The analogous condition that affects bowel movement is called parcopresis.
Video game playing may be associated with vision problems. Extensive viewing of the screen can cause eye strain, as the cornea, pupil, and iris are not intended for mass viewing sessions of electronic devices. Using video games for too long may also cause headaches, dizziness, and chances of vomiting from focusing on a screen.
However, certain studies have shown that video games can be used to improve various eye conditions. An investigation into the effect of action gaming on spatial distribution of attention was conducted and revealed that gamers exhibited an enhancement with attention resources compared to non-gamers, not only in the periphery but also in central vision. Further studies in 2011, concluded that a combination of video game therapy alongside occlusion therapy, would greatly improve the recovery of visual acuity in those experiencing amblyopia.
There can be serious difficulties with workplace drug testing where observed urine samples are insisted upon, if the testing regime does not recognise and cater for the condition. In the UK, employees have a general right not to be unfairly dismissed, and so have an arguable defence if this arises, but this is not the case everywhere.
There is growing evidence to suggest that some drug testing authorities find paruresis a nuisance, and some implement "shy bladder procedures" which pay no more than lip service to the condition, and where there is no evidence that they have conducted any real research into the matter. In the U.S. Bureau of Prisons, the Code of Federal Regulations provides that "An inmate is presumed to be unwilling if the inmate fails to provide a urine sample within the allotted time period. An inmate may rebut this presumption during the disciplinary process." Although U.S. courts have ruled that failure to treat properly diagnosed paruresis might violate prisoner's constitutional rights, the courts have also "routinely rejected suspicious or unsubstantiated attempts to invoke it in defense of failure to complete drug testing," particularly when there were no medical record or physician testimony to back up the claim of paruresis. The International Paruresis Association stresses the importance of medical documentation of one's condition since "[t]he person who is unable to produce a urine sample is presumed guilty in the absence of any evidence." Some prisons have offered the use of a "dry cell"—i.e., a cell with no toilet facilities, but only a container for the prisoner's waste—as an accommodation to inmates who are hindered by paruresis from providing an observed urine sample.
FBOP Program Statement 6060.08 states, "Ordinarily, an inmate is expected to provide a urine sample within two hours of the request, but the Captain (or Lieutenant) may extend the time if warranted by specific situations (for example, the inmate has a documented medical or psychological problem, is dehydrated, etc.). Staff may consider supervising indirectly an inmate who claims to be willing but unable to provide a urine sample under direct visual supervision. For example, this might be accomplished by allowing the inmate to provide the sample in a secure, dry room after a thorough search has been made of both the inmate and the room." At least six state prison systems — Florida, Massachusetts, Maryland, Michigan, New York and Tennessee — have modified their drug testing regulations to provide accommodations for prisoners with paruresis.
Per the "Handbook of Correctional Mental Health", "No definitive or objective test is available to confirm or refute the presence of paruresis. The absence of prior treatment or the ability to void in some social situations but not in others does not rule it out. Although modalities associated with the treatment of social phobias help some individuals, no universally effective medication or other treatment exists. Coercive interventions, such as forcing fluids while observing a person with paruresis, are ineffective and can cause serious medical complications. Alternatives to observed urine specimen collection for individuals who self-report paruresis include unobserved collections in a dry room, testing of hair specimens, sweat testing with a patch, and blood testing ('Test for Drugs of Abuse' 2002). These alternatives preclude the need for futile attempts to differentiate inmates with true paruresis from those who fabricate complaints."
Video game play has been constantly associated with obesity. Many studies have been conducted on the link between television & video games and increased BMI (Body Mass Index). Due to video games replacing physical activities, there appears to be a clear association between time spent playing video games and increased BMI in young children. One such study produced data that indicated that boys who spend less than 1.5 hours on the television and playing video games, were 75.4% less likely to be overweight than those who spend more than 1.5 hours.
A study conducted in 2011 formalized the association of video game play and an increase in food intake in teens. A single session of video game play resulted in an increase in food intake, regardless of appetite. The recent trend of "active video games" revolving around the Wii and Xbox Kinect might be a way to help combat the aforementioned problem however this finding still needs confirmation from other studies. Furthermore, a study conducted in Baylor College of Medicine revolving around children claims that there is no evidence which supports the belief that acquiring an active video game under naturalistic circumstance would result in a beneficial outcome toward children. The study produced no results showing an increased amount of physical activity within the children receiving the active video games. It has been estimated that children in the United States are spending 25 percent of their waking hours watching television and playing video games. Statistically the children who watch the most hours of television or play video games have the highest incidence of obesity we can see.
Exposure therapy has been proven as an effective treatment for people who have a fear of bees. It is recommended that people place themselves in a comfortable open environment, such as a park or garden, and gradually over a prolonged period of time move closer to the bees. This process should not be rushed, it may take many months spent watching bees before people feel comfortable in their presence.
Apiphobia is one of the zoophobias prevalent in young children and may prevent them from taking part in any outdoor activities. Older people control the natural fear of bees more easily. However, some adults face hardships of controlling the fear of bees.
A recommended way of overcoming child's fear of bees is training to face fears (a common approach for treating specific phobias). Programs vary.
Media, marketers, politicians, youth workers and researchers have been implicated in perpetuating the fear of youth. Since young people in developed countries are expected to stay out of the workforce, any role for them outside that of consumer is potentially threatening to adults. Selling safety to parents and teachers has also been a driving force, as home security systems, cellphones, and computer surveillance usage is marketed to parents; and x-ray machines, metal detectors and closed-circuit television are increasingly sold to schools on the premise that young people are not to be trusted. These steps are in spite of the fact that experience consistently shows that monitoring youth does little to prevent violence or tragedy: the Columbine High School massacre occurred in a building with video surveillance and in-building police.
The very creation of the terms youth, adolescence and teenager have all been attributed to the fear of youth. As the western world became more industrialized, young people were increasingly driven from the workforce, including involuntary and voluntary positions, and into increasingly total institutions where they lost personal autonomy in favor of social control. Government policies outside of schools have been implicated as well, as over the last forty years curfews, anti-loitering and anti-cruising laws, and other legislation apparently targeted at teenagers have taken hold across the country. Courts have increasingly ruled against youth rights, as well. Before the 1940s "teenagers" were not listed in newspaper headlines, because as a group they did not exist. The impact of youth since World War II on western society has been immense, largely driven by marketing that proponents them as the "Other". In turn, youth are caused to behave in ways that appear different from adults. This has led to the phenomenon of youth, and in turn has created a perpetuated fear of them.