Electrical Bone Growth Stimulator Devices

Electrical Bone Growth Stimulator Devices Nonunion and delayed fractures are prevalent in the United States, accounting for a significant health care cost (Simon Simon, 2008). Bone is able to remodel and adapt to applied loads and electromechanical stimuli (Smeltzer, Bare, Hinkle, Cheever, 2009). One method of repairing these types of fractures is with an electric bone growth stimulator, which has been used for over 25 years. There are three types of electric bone growth stimulators, all of which provide an electric current to the bone that causes the bone cells to grow and proliferate. Treatment with bone growth stimulators shortens the recovery time, however cannot be used for large gaps in the bone (Simon Simon, 2008). Clinical Significance Every year in the United States 7.9 million fractures occur (Goldstein, Sprague, Petrisor, 2010). Approximately 600,000 fractures do not heal properly. Fractures that do not heal properly are usually delayed or nonunion fractures. These fractures require treatment or surgical intervention to heal properly and cost the United States $3 to 6 billion health care dollars each year (Simon Simon, 2008). A delayed union is a fracture that heals very slowly and does not heal within a normal amount of time. Although many factors affect how long it takes for a bone to heal such as which bone is broken and the severity of the fracture, the typical healing time is about three to four months. A delayed union can be caused by several factors including, poor blood supply, not casting the bone properly, and infection (Parker, 2010). Sometimes delayed union fractures can heal on their own without intervention or treatment. A nonunion is a fracture that does not heal within twice the expected healing time, generally six to nine months after the injury. Fibrocartilage also forms between the two pieces of broken bone (Mora, Pedrotti, Galli, 2006). Figure 1 shows a nonunion fracture of the tibia, the fracture is circled in red and you can see some of the fibrocartilage that formed between the two pieces of bone. Several factors that can cause nonunion are poor blood supply, not casting the bone p roperly, infection, and loss of bone or soft tissue (Parker, 2010). A nonunion fracture will not heal on its own and requires some form of intervention. Some of the options for treating nonunion are internal and external fixation devices, bone grafts, bone substitutes, biologics like platelet extracts and bone morphogenic proteins, and biophysical stimulation including ultrasound and electrical stimulation (Simon Simon, 2008). Since the repair of delayed and nonunion fractures requires intervention and treatment, the clinical problem is how to provide an intervention that allows the patient to recover from the injury in the shortest possible amount of time with the fewest complications and the least cost (Simon Simon, 2008). The ideal treatment is to repair the fracture without surgery and hospitalization (Goldstein, Sprague, Petrisor, 2010). Therefore, electrical bone growth stimulators are frequently used to treat delayed and nonunion fractures. Research has shown that electrical stimulation is a prevalent treatment that is utilized to speed up the process of healing in delayed and nonunion fractures. In the United States, electrical bone growth stimulators have treated approximately 400,000 delayed and nonunion fractures (Goldstein, Sprague, Petrisor, 2010). Electrical bone growth stimulators, shown in Figure 2, are therapeutic devices that are used to produce and apply electric fields to bone, similar to the electric fields that occur naturally inside the body but as a result of the injury are either not being produced fast enough or are not being produced at all (Goldstein, Sprague, Petrisor, 2010). Electrical bone growth stimulators have been shown to be 88% effective for treating delayed and nonunion fractures (Nolte, van der Krans, Patka, Janssen, Ryaby, Albers, 2001). The typical treatment time with an electrical bone growth stimulator is between three and six months (Simon Simon, 2008). Biology and Physiology Humans have 206 bones in their body (Smeltzer, Bare, Hinkle, Cheever, 2009). Bone can adapt and remodel as a result of an applied force, an injury or a stimulus. Bone is made up of three types of cells, osteoblasts, osteocytes, and osteoclasts, which are involved in bone formation and remodeling. Osteoblasts are cells that form bone (Smeltzer, Bare, Hinkle, Cheever, 2009). Osteocytes are formed from osteoblasts and are responsible for maintaining bone, whereas, osteoclasts are cells that absorb bone. These cells play an important role in fracture healing (Smeltzer, Bare, Hinkle, Cheever, 2009). The process of healing a fracture, shown in Figure 3, has four major steps. The first step occurs within hours following the injury and lasts for about a week. During this step, the injury causes increased blood flow and bleeding, causing a hematoma to form. This results in inflammation and swelling (Smeltzer, Bare, Hinkle, Cheever, 2009). The next step begins when fibroblasts reach the injury site then release collagen fibers and form a soft fibrocartilaginous callus between and around the two pieces of bone. The third step begins around week 4, when osteoblasts enter the callus, multiply and begin to form bone. This forms a harder bony callus that eventually turns into bone. The final stage is remodeling which starts around week 17 and continues until the bone is completely healed. During the remodeling stage, the callus is completely turned into bone by the osteoblasts, and the osteoclasts absorb the extra bone that was produced and not needed (Chiras, 2008). Market Trends The market for electrical bone growth stimulators has grown to over $500 million dollars in the last 25 years, and by 2012 the market is expected to rise to $690.1 million (Schenberger, 2007). The consumers of electrical bone growth stimulators are hospitals, orthopedic surgeons and patients with a delayed or nonunion bone fracture. Electrical bone growth stimulators have been used to treat 400,000 fractures (Simon Simon, 2008). These devices can be both invasive and noninvasive. The typical cost for a noninvasive electrical bone growth stimulator is between $3000 and $7000 and can increase to $20,000 for an invasive stimulator that requires two surgeries (Morone Feuer, 2003). Insurance will cover the cost of the device as long as the patient meets certain criteria, for example the gap between the bones must be less than 1 centimeter (CIGNA , 2010). This cost is much less than the approximately $27,000 cost for surgery and hospitalization after a procedure such as internal fixation (Hughes Anglen, 2010). Seven companies have received FDA approval (U.S. Food and Drug Administration, 2010) and the five companies that have electric bone growth stimulators on the market are Orthofix, Biomet, DJ Orthopedics (acquired the company Orthologic), Smith and Nephew and DePuy Spine (medcompare, 2010). The only company that has received FDA approval (U.S. Food and Drug Administration, 2010) and that has invasive electric bone growth stimulators on the market is Biomet (medcompare, 2010). Some of the noninvasive stimulators are shown in Figure 4 and two of the invasive stimulators from Biomet are shown in Figure 5. Bioelectric Principles Bone that goes through effective growth or repair holds an electronegative potential compared to that of resting bone (Glazer Glazer, 2001). In bone where a break or fracture has occurred with nonunion or delayed union, it has been found helpful to introduce electric stimuli to the area undergoing complications. The introduction of an electrical current allows the process of bone regeneration to reinitiate. The electrically charged particles within the current act as the missing catalyst for the necessary chemical reactions to stimulate the desired biological response of bone repair at the site of nonunion. Pulsed electrical stimulation can cause changes in the intracellular level of cyclic adenosine monophosphate (cAMP) and thus triggers DNA synthesis within cells (Somjen, Fischler, Binderman, 1984). The electrical current excites the Na+/K+ pump of mesenchymal osteoblasts, which causes them to differentiate into osteoblasts that produce a woven matrix of bone (Shapiro, 2008).The electronegative current (DNA synthesis) applied at the surface of the fracture site or at the surface of the skin initiates endochondral bone formation the synthesis of cartilage, closely followed by bone formation (Shapiro, 2008). Bone naturally generates an electrical field because of Wolffs Law and piezoelectric properties, which is what the electric bone growth stimulators are also based off of. Wolffs law states that bone changes its external shape and internal (cancellous) architecture in response to stresses acting on it (Hunt, 2008). Piezoelectricity (Figure 6) is the stress-generated potentials in bone in which the side of the bone under mechanical compression [becomes] electronegative and the side under tension [becomes] electropositive (Kim, Won-Ki, Sung Jac, 1984). The mineral matrix in bone is piezoelectric because of the applied force to the skeletal system from tension (resting bone), and it changes its charge when the bone is under mechanical compression (bone repair/hematoma). The electric field produces electric potentials that cause the bone cells to grow and proliferate (Kim, Won-Ki, Sung Jac, 1984). Electrical stimulation creates an increased regulation of osteoinductive growth factors as well as enhancing osteoblastic activity, and decreasing osteoclastic activity through electrochemical reactions. This all leads to the desired reactions of increased bone formation and repair. The electrical stimulation increases the transmembrane calcium translocation, which activates calmodulin, a calcium binding protein involved in inflammation (Hematoma). Electric stimuli also brings about the upregulation of BMP-2, BMP-6, BMP-7, and the BMP receptor ALK-2, which are all bone morphogenic proteins needed to promote bone regeneration (Gan, Fredericks, Glazer, 2004). At the cathode of the Electric Bone Growth Stimulator, when the electric impulse is applied, three things happen: 1) the local oxygen concentration decreases, causing an increase in the biological process of bone growth, 2) the pH level increases, resulting in a decrease of osteoclastic function, and 3) the release of hydrogen pe roxide causing macrophages to release VEGF, which stimulates the growth of blood vessels in the area of injury. These growth factors enter the tissue matrix and trigger proliferation and differentiation which causes bone to form, thus increasing the healing rate of delayed union or nonunion (Gan, Fredericks, Glazer, 2004). History Device History The history of Bone Electric Growth Stimulators dates back to the late 1780s when the biologist, Luigi Galvani used electricity on a biological system. Galvani discovered that a frog could generate muscle spasms throughout its body when an electrical charge was applied to its spinal cord. Alessandro Volta, a colleague of Galvanis, was able to reproduce these (SilcoTek, 2010). The first documentation of electrical stimulation being used to heal fractures was in 1841 by Dr. Hartshorne, when he reported that a patient with a tibial nonunion was treated with electricity. In 1850, the scientist R. W. Lente was the first to report successful use of Galvanic currents used to treat patients with nonunion. In 1892, the German scientist Wolff was the first to describe how bone formed in response to stress; this description became known as Wolffs Law (Glazer Glazer, 2001). The significant gains of healing with electrical stimulation in the 17 1800s ends with Wolffs phenomenon description of bone formation. The modern theories that the Electric Bone Growth Stimulators are based off of are from the work that Iwao Yasuda and his colleagues found in the 1950s. In 1938 Yasuda started researching electrical stimulation of square wave to organic substance at Kyoto Prefectural University of Medicine (Crenshaw, 1977). In 1953, Yasuda et al discovered that bone in compression was electronegative, and bone in tension was electropositive (Glazer Glazer, 2001). From 1962 to 1964, the scientists Friedenberg and Brighton furthered Yasudas research and discovered that bone that is growing or repairing itself shows and electronegative potential, while bone that is not has an electropositive potential. This discovery has encouraged others to research electrical stimuli in relation bone regeneration (Glazer Glazer, 2001). In 1975, Dr. McElhannon published a report stating the technology used to treat fractures in humans with electrical stimulation is not yet advanced enough to promote bone regeneration, but shows promise in animals (Meadows, 2008). Two years later, Dr. Paterson et al performed an experimental model on delayed union fractures of the tibia in adult dogs. The model showed an accelerated healing time where Osteogenesis was normal, and no other abnormalities were found (Meadows, 2008). In 1978, the FDA approved the use of external bone growth stimulators (Haverbush, 2005). In 1983, Dr. Hanaoka performed a study observing the effects of pulsed micro-electrical currents on internal remodeling in long tubular bone and bone healing (Meadows, 2008). A group of 14 dogs had electrodes inserted into the femora with pulsed micro-electrical currents applied to the right femora for four weeks. The dogs were split into groups and each group had different electrical currents (Hz) applied. The results s howed that bone healing in all cases was promoted (Meadows, 2008). Dr. Ahl et al, in 1984, used a semi invasive technique for bone healing on 23 patients with nonunion. Ten of those had solid bone regeneration, and the other 13 did not fully unite these were later determined to have been breaks that were too far apart (Meadows, 2008). In 1985, Dr. Kondo performed a study on the femur of dogs. The bones in the experimental group observed proliferation of osteoblasts on the third day, which transitioned into bone remodeling and a shortened healing time by the end of the third week (Meadows, 2008). In 1995, Dr. Zamora-Navas et al performed a study on 22 patients with nonunion, with a gap of 0.5 or more, using capacitively-coupled electrical signal for a treatment time of about 26 weeks. In the end, over 70% of the 22 had solid bone union if the gap was 1 cm or smaller (Meadows, 2008). In 1996, the FDA approved the use of Electrical Bone Growth Stimulators, both invasive and noninvasiv e. Patent History On May 31, 1977, Dr. Levys bone generating device was approved. The stimulator produced electrical pulses applied to the bone, as opposed to direct current potential, to make the bone grow faster and stronger (Levy, 1977). The device is invasive, and is made of materials that will not poison or react with the surrounding tissue or bone (Levy, 1977). On November 15, 1983, Hirshorn et al had their patent approved on their implantable bone growth stimulator that uses a direct current output, and constantly transmits pulsed electromagnetic energy to the injury site. The output of energy(rate) is directly proportional to the set current. To make sure that the device is not affected by the pulsing of the transmission, a coil was placed inside the device to deliver a constant current. The device is enclosed in a titanium case, and has a longer shelf life due to an electrical switch that was placed inside the device (Hirshorn, Swift, Evans, 1983). On My 19, 1987, Dr. Campbells patent was approved. His stimulator was circuit adapted, and relied on the tissue (bone) to act as the load to make the circuit work. The storage device controlled the oscillator circuit, which in turn controlled the charge of the current that was issued from the battery and applied directly to the bone at the fracture site (Campbell, 1987). On May 9, 1995, Kronbergs stimulator was approved. This device was a non-invasive device that used low alternating currents applied to the patients skin. This particular device is battery powered and was found to generate the electrical characteristics found in bones naturally that generate normal bone growth (Kronberg, 1995). On June 16, 1998, Dr. Ericksons electric bone stimulator was approved. His stimulator came with a hand-held device which transmitted, and received, signals to the implanted stimulator (Erickson, Tepper, Thacker, Varrichio, Pilla, 1995). On August 2, 2007, Dr. Nyezs invasive stimulator was approved. The device is controlled by an external remote that sends a wireless signal to the stimulator. The current is circuitry controlled. It was made to be coupled with a hip prosthesis to help with healing and proper function, but can be used to stimulate healthy bone growth in areas of injury (Nyez, 2007). Device Theory In 1953, surgeon Iwao Yasuda first demonstrated that callus could be created by applying electric fields to bone (Figure 8). His experiment consisted of wrapping wire around a rabbitt femur and sending a small (1 uA) current to the anode, away from the bone. After three weeks of continuous current, Yasuda observed that a callus-typically generated during fracture repair- was beginning to form in the direction of the current (Liboff, 2006). There are three types of electric bone growth stimulators. They are categorized based on invasiveness and type of current. Table 1 gives a brief description of the different devices. Note that there are only two types listed, invasive and noninvasive (Liboff, 2006). Semi-Invasive Treatment Semi-invasive systems are semi-implantable: partially internal and partially external. The device provides a constant direct current supplied by an external power supply. The electrodes, on the other hand, are percutaneous and pass through the skin (Electrical Bone Growth Stimulators). These systems, however, are not currently in production, and consequently are not refered to by other scholars and have no relevant data (Clinical Policy Bulletin: Bone Growth Stimulators, 2010). Invasive Treatment The invasive treatment option, also known as direct current (DC) stimulation, is fully implanted and utilizes constant direct current. The device requires two surgies: one to implant the device, and one to remove the device. The anode is placed in the soft tissue, and the cathodes are connected to a power supply (typically a lithium battery) [cain] and placed at the fusion site. At the fracture site, the electrodes can be arranged in two ways (Figure 9). They can be placed on each side of the fracture as to bridge the defect; or, the electrode can be placed directly in the defect (Liboff, 2006). The although the current setting depends upon the fracture, it is typically set at 20 uA for up to six months (Lyle E. Cain, 2002). Noninvasive Treatments There are both electric and electromagnetic noninvasive EBGS devices. They are completely external and do not require surgery. Electric Option The electric noninvasive EBGS device works through capacitive coupling (CC). The CC device uses a 60 kHz alternating sinusoidal signal to produce a current. Two electrodes are placed on the skin, one on each side of the fracture (Figure 10) (Gan, Fredericks, Glazer, 2004). The power supply (typically a 9-V battery) is worn on the hip, and operated twenty four hours a day. Treatment generally applies 5-10 mA at the skin, and 15-20 uA at the fracture site. Device maintainence relies on the patient and includes changing the battery daily. Electromagnetic Options Pulsed Magnetic Field The pulsed magnetic field device (PMF or PEMF) follows Faradays law that Any change in the magnetic environment of a coil of wire will cause a voltage (emf) to be induced in the coil (Faradays Law). It applies a sawtooth (nonsinusoidal) voltage to two parallel external coils, one above the fusion site, and one below (see figure #). The applied voltage creates a current through the coils that generates a single, magnetic field through the defect. Because the field is constantly changing, an induced voltage is created, which appears as pulses (Liboff, 2006). The coils can be worn on the skin, or over a cast (if applicable) (Lyle E. Cain, 2002). The device includes an external battery pack and may be operated up to ten hours a day (Lyle E. Cain, 2002), but treatment is typically only three hours daily (Liboff, 2006). Ion Cyclotron Resonance The ion cyclotron resonance (ICR) device is similar to the PFM device in that it also uses an external coil system. ICR devices, however, apply a different theory than PMF devices. It was shown in 1985 that the results embodied in the so-called calcium efflux effect were in close agreement with the predictions based on the resonance characteristics of certain biological ions subject to the Lorentz force (Liboff, 2006). The device combines both dc and ac magnetic fields to achieve resonant condition. The theory is that ions in resonance are more likely to stimulate the gating mechanism for ion channel transport, and tuning to these ions can increase growth (Liboff, 2006). The device (Figure 11) also uses an external battery pack, and the unit should only be operated thirty minutes per day (Lyle E. Cain, 2002). Regulatory Standards The FDA recognizes the noninvasive bone growth stimulator and the invasive bone growth stimulator under the Title 21-Food and Drugs, of the Code of Federal Regulations (CFR) (Product Classification, 2010). Both are Class III devices, so they must abide by general controls and receive premarket approval. Class III devices support or sustain human life, that are of substantial importance in preventing impairment of human health, or that present a potential, unreasonable risk of illness or injury. Premarket approval (PMA) is the FDA process of scientific and regulatory review to evaluate the safety and effectiveness of Class III medical devices. A PMA application must be submitted and reviewed before marketing the products because they are considered high-risk medical devices (Device Classification, 2010). Device Review Advantages Previous treatments for nonunions included rigid fixation, bone grafts, and amputation. The electric bone growth stimulator has several advantages over these more tradition treatments. The treatment is less severe than bone grafting and the hospital stay after the invasive treatment is typically only three to four days, as opposed to ten days of recovery after grafts. Also, the average completion time for a successful union is only four months, compared to six to eight for bone grafts (Anbuselvan, Krishnamurthy, Madhumathi, Manonmani, Aravindan, Babu, 1995). Moreover, the EBGS is less traumatic than amputation and allows for the retention of limbs. In regards to the devices, the invasive option is advantageous because it provides constant uniform current and does not require an active patient role. After surgery, the device is self operated and maintained. Also, the invasive option bypasses tissue resulting in less resistance and better treatment results. The CC device is small, light, and easy to use (Lyle E. Cain, 2002). Disadvantages The main disadvantage of the EBGS is that union may be unsuccessful if the fracture gap is too large, typically over one centimeter. Also, before an EBGS is used, it must be determined that the bone is not healing properly on its own. Lastly, these devices have not yet been proven successful for treatment of nonunions in locations other than long bones or spine (Clinical Policy Bulletin: Bone Growth Stimulators, 2010). In regards to the devices, the invasive option has a higher hospital cost and patient morbidity due to the surgeries necessary for device implantation and removal. The CC device requires patient compliance. The patient must monitor, operate, and maintain the device, which includes changing the battery daily. Also, there may be skin irritation from the electrodes. Also, the PEMF and ICR devices are often larger and heavy than other external devices, which may create difficulties for patients (Clinical Policy Bulletin: Bone Growth Stimulators, 2010). Product Comparison Biomet is the only company that produces invasive electric bone growth stimulators. Their products include the OsteoGen Bone Growth Stimulator, the OsteoGen Dual Lead Bone Growth Stimulator for use with bone graft surgery, and the OsteoGen-M Bone Growth Stimulator, which utilizes a mesh cathode. Biomet also produces the following external, noninvasive EBGS devices: EBI Bone Healing System and the OrthoPak 2 Bone Growth Stimulator. The EBI Bone Healing System is more convenient because the actual device is worn like a sports band or brace that wraps around the limb, where as the OrthoPak 2 is a larger device with dermal electrodes that must be carried along with the battery pack. On the plus side, the OrthoPak 2 allows for easier placement of hard-to-reach fracture sites (Biomet, 2010). DJO sells the CMF OL1000 Bone Growth Stimulator. It follows a similar concept as the EBI Bone Healing System, except this device is not fully closed, giving it the ability of being worn over a cast if necessary (Products, 2009). Literature Review We assigned the designated sections of the report to each team member to research individually. We attended a research session with librarian Christine Drew to better understand WPIs academic databases and resources. Key terms used in our research included the following: electric bone growth stimulator, bone growth stimulator, bone growth devices, fracture healing, delayed union fracture, non union fracture, Faradays Law, Wolffs Law, piezoelectricity, bone repair, bone cells, electric bone growth device regulations, cost of bone growth stimulation, FDA class III devices, premarket approval, bone growth device history, Luigi Galvani, electric bone growth studies, companies that sell electric bone growth stimulators, Biomet, Exogen, modern electric growth theory, and bone growth stimulator patent. We searched several databases and reliable search engines including the following: Google Books, Google Scholar, Gale PowerSearch, EBSCOhost, ScienceDirect, PubMed, and Wiley Interscience.

“by the Waters of Babylon” vs Epic of Gilgamesh.

â€Å"By the waters of Babylon† Vs Epic of Gilgamesh. A lot of stories concerning religions and cultures have lot of similarities and differences, despite the fact that they are not from the same era of time. Humans used these stories and writings to express their culture and religious views. â€Å"By the Waters of Babylon† is very similar to the writings of the Mesopotamian writings in The Epic of Gilgamesh more specificlay â€Å"The story of the flood† and â€Å"The Return†.These similarities include many gods in both, a unique quality in the characters of both than can include â€Å"born to greatness†, people of both writings lead to their death themselves, John and Gilgamesh Come home with lessons. etc In most of all ancient influences, there are characters in the stories, who are born to some kind of greatness, or we can say, a special type of person.In â€Å"By the Waters of Babylon† when John and his father goes to the dead places, Joh n, explains that only priest can touch metal and are believed to have special powers that no other normal human being would have , â€Å"and then he who touches the metal must be a priest or the son of a priest† (Benet 75). This shows how is John born to greatness, being the son of a priest and can touch metal wherever he wants. The priests are believed to have special powers that no other normal human being would have.This compares to the Epic of Gilgamesh, when Author of Epic of Gilgamesh said â€Å"Two thirds they made him god and one third man† (Prologue). This shows how Gilgamesh was born to greatness by having 1/3 characteristics of man and 2/3 of god and this compares the born to greatness in both the writings . Some religions and cultures believe in one god; monotheistic religions, and others believe in many gods; polytheistic religions.In â€Å"By the Waters of Babylon† Benet’s main character, John, speaks of The Place of the Gods, â€Å"It is f orbidden to cross the great river and look upon the place that was the Place of the Gods –this is most strictly forbidden† (75). When speaking of gods house means multiple gods, this shows that the religion in which John follows is polytheistic and worships many gods. In The Epic of Gilgamesh, Gilgamesh speaks of the names of the gods, means a lot of gods ,â€Å"There was Anu, lord of the firmament, their father, and warrior Enlil their counselor, Ninurta the helper, and Ennugi watcher over canals† (N.K. Sandars 25). This shows that the Mesopotamians and people from â€Å"By the Waters of Babylon† were both polytheistic and believed in multiple gods. Almost in all writings there are lessons or message that characters learns in the end ,the same thing happened in our story, where ,Gilgamesh and John both learned lessons in the end of their voyage or journey . In â€Å"By the waters of Babylon† when john returns from the Place of Gods ,â€Å"But they are men who build the city, not dos or demons. †John says â€Å"They are men . I remember a dead man’s face† (Benet 85).This shows how John came home with a message, about the ,City of the Gods, that it is really New York City, and the gods were actually humans, so they have nothing to fear. And on the other side, Gilgamesh also comes home with a lesson which is that immortality is not obtained by some flower or going on a journey but you can be in hearts of the tourists and explorers but making your name fame , which Gilgamesh does but making Uruk’s walls and being in the hearts of people forever. And so, with that it proves a lesson learned in both writings.

Analysis of Erik, Phantom of the Opera Using Two Contrasting Personality Theories

The tremendously popular and well-known Andrew Lloyd Webber’s 1986 musical production of The Phantom of the Opera was based on the French novel Le Fantome de l'Opera written by Gaston Leroux in1910 (Leroux, 1910/1990). The original novel gave little direct details with respect to Erik’s past; what was abundant however were hints and implications about the character’s life history throughout the book (Leroux, 1910/1990).Erik was actually not his birth name but rather a name given to him by accident, and Leroux had simply called him â€Å"the man’s voice† in the novel; Erik, however, had referred himself as â€Å"the opera ghost† and â€Å"the angel of music† throughout the texts (Leroux, 1910/1990). The history of Erik was revealed in the novel mostly by the character Persia (also known as the Persian or the daroga), a local police chief in Persia that followed Erik to Paris.The character Erik will be described below based on the transl ated work of Leroux (1910/1990), followed by an analysis of his personality using concepts derived from (1) the Freudian theory of psychoanalysis, and (2) the Skinnerian radical behaviorism concept. These two theorists were chosen because they represent polar opposites on how personality is viewed. While Freud maintained that the unconscious is the underlying driving force from which personality develops, Skinner rejected all non-observable parameters such as thoughts, feelings, emotions, and the unconscious in his scientific analysis of human behavior.Freud’s emphasis on personality development was on the continuous struggle between the id and the superego, and how successfully the ego can manage a healthy balance between them. Freud also determined 5 psychosexual stages that must be negotiated and satisfied during childhood development, failure on doing so will result in aberrant personality traits. Skinner, however, believed that all behavior, and hence personality, are le arned as a function of environmental factors.A behavior that is reinforced will likely to be repeated, one that is punished will most likely not. He maintained that genetic predispositions allow humans to react to stimuli within a certain range, and where within that range our behavior falls is determined by how we are shaped by the influence of the environment we find ourselves. In this paper, the major differences in how those two theorists might interpret Erik’s personality will be discussed. The Character Erik Erik was born in a small town on the outskirts of Rouen, France.Hideously deformed at birth, his mother was horrified by his appearance and his father refused to even look at him. Tortured by ridicules and spite from his own mother, he ran away as a young boy and was adopted by a band of travelling Gypsies. He earned his living by performing in freak shows, where he was labeled as the living death. Despite his monstrous appearance, Erik was an extremely talented ind ividual. In addition to possessing a most eerie and supernatural singing voice, he gained great skills as an illusionist, magician, and ventriloquist.A fur trader recognized Erik’s gifted abilities and mentioned it to the Shah of Persia, who then ordered to have him brought to his palace. Erik soon proved to the Shah his knowledge in architecture, and the Shah commissioned him to design and build Mazenderan, an elaborate palace full of trap doors, hidden passages, and secret rooms such that no one could be certain of his/her privacy: someone would be listening or spying at anytime and anywhere. The Shah could practically vanish from a room in an instant and reappear elsewhere in utter secrecy.During Erik’s tenure with the Shah, he was also employed as a political assassin, carrying out the Shah’s orders by strangling his victims using an unique noose known as the Punjab Lasso. Pleased with his work but determined that no other such palaces should be built and ow ned by anyone else (not to mention Erik and his workers were the only ones that had intimate knowledge of the palace’s layout), the Shah first ordered Erik and his workers be blinded but then realized he could build another one even without his eyesight, ordered their executions.By the intervention of the local police chief (the Persian), Erik escaped to Constantinople and was employed by its’ ruling Sultan to build his grand palace of a similar design. Alas, he was later forced to escape Constantinople for the same reason he fled Persia. Erik’s next destination was most likely to be somewhere in Southeast Asia, where he decided that he was tired of his nomadic lifestyle. Eventually, he returned to Paris and successfully bided on a contract to help build the Paris Opera. Using his extensive experiences from the past, the theater was built withtrap doors and secret passageways throughout. In addition, Erik built himself a palace, or a playhouse, of a sort deep wi thin the cellar of the opera house so that he did not have to live amongst the cruelty of humankind. He spent the next 20 years or so in his â€Å"home† writing and composing music of various sorts. At about the same time, a beautiful and technically talented chorus girl by the name of Christine Daae, who had lost all passion to sing and perform due to her father’s passing, somehow heard Erik’s singing and music in her dressing room at late nights.Thinking that must have been an â€Å"angel† sent by her father, Christine took singing lessons from the â€Å"Angel of Music† during the nights and later emerged as a virtuoso singer better than she ever was. By now, Erik was secretly in love with Christine, and one night he revealed himself to her from behind a mirror in her dressing room, wearing a mask, and led her through the mazes and labyrinths into his domain in the cellar of the theater.It turned out that Erik had been composing his masterpiece f or the last 20 years, and realizing his genius, Christine asked if he would play a part from the masterpiece for her, and Erik refused as the piece was yet incomplete. Erik’s original plan upon the completion of his masterpiece was to go to his bed, which was in fact a coffin, and fall into an eternal sleep. Feeling the obvious pain from Erik and yearning to see his face, Christine ripped the mask off, and saw the horrible disfigurement. Another person vying for Christine’s affection was the Vicomte Raoul de Chagney.A childhood friend of Christine, he was captivated by her new-found voice, so unearthly passionate that led Raoul to fall madly in love with her. In the final chapters of Leroux’s novel, Erik kidnapped Christine straight from the stage during one of the performances, showed her the completed masterpiece, and asked her to marry him instead of the Vicomte so that the two of them can live a happy life, rather than him simply slip way into his â€Å"bed † and dies. If she were to refuse, however, Erik would detonate the massive amount of gun powder he had secretly accumulated under the opera house over the years.Christine submitted to his request in order to save herself, unknowing Raoul had fallen accidentally into Erik’s torture chamber while searching the opera house for her with the help of the Persian and the opera house staffs. Acknowledging her acceptance, Erik gave Christine a gold ring and kissed her cheek. He was so overwhelmed with joy that he fell to his knees and cried uncontrollably. Seeing the genius with a tortured soul finding happiness at last, Christine cried with Erik. Erik then surprised Christine by saying that he is now willing to let her go, and she was free to marry Raoul.Erik freed Raoul and let them both leave the dungeon, but not before making Christine promise to come back and bury him upon his death. Christine kissed Erik on his forehead, and disappeared into the night with Raoul. Carrying his most cherished possession, the diary kept by Christine detailing everything that had happened between them, Erik went to the Persian and told him the whole story, with the hand-written diary as proof. Erik died three weeks afterwards. Christine kept her promise and returned to the opera house, but before the burial, she slipped the gold ring Erik had given to her three weeks earlier onto his finger.Sigmund Freud’s Psychoanalytic Approach to Erik’s Personality The core concept of psychoanalysis developed by Sigmund Freud (1856 – 1939) is the significant influence the unconscious mind has on the conscious (Burkitt, 2010; Freud, 1923/1990). The unconscious is a vast reservoir of latent thoughts and memories (real, repressed, or false) that are not associated with the activities of the conscious mind, but those activities consciously executed are in fact directed and driven by the unconscious (Burkitt, 2010; Freud, 1923/1990).In the novel, Erik was able to util ize this power of the unconscious to strategically place himself in the mind of Christine, letting her to believe that he was sent by her deceased father and thus masquerading as the â€Å"Angel of Music†. According to Freud, the oral stage is the first stage of psychosexual development (Freud, 1923/1990; van Beekum, 2009). In addition to providing nourishment, the mother’s breasts provide a source of love, pleasure, and security to the infant (Freud, 1923/1990; Wagg & Pridmore, 2004).Weaning would therefore create a stressful situation for the infant: giving up the comfort feelings the mother’s breasts have provided. Some infants are easier than others to succeed in negotiating and resolving this conflict between the id and the ego (Freud, 1923/1990; van Beekum, 2009) by redirecting their psychosexual energy (libido) toward other challenges. For those infants that do not, the psychosexual development theory affirms they will develop into orally fixated adults ( Freud, 1923/1990; van Beekum, 2009; Wagg & Pridmore, 2004).Although it was not detailed in the novel, Erik most likely was never breast-fed as his mother loathed his appearance and his father refused to even look at him. It is therefore reasonable to assume that as an adult, Erik would have an extreme case of oral fixation, constantly seeking for the pleasure and comfort that would have been derived from oral stimulations denied during infancy. In theory, adult manifestations of oral-stage fixation include nail-biting, eating, chewing, smoking, and alcoholism (Wagg & Pridmore, 2004).Similarly, they may derive psychological pleasure from talking and constantly seeking knowledge (Wagg & Pridmore, 2004). Although Leroux did not detail Erik’s personal habits, we can certainly see that he was constantly looking for and acquiring knowledge and skills, being an accomplished magician and ventriloquist, a brilliant architect and master builder, a royal assassin, a music genius with a most haunting, unearthly, yet passionate voice (Leroux, 1910/1990).Instead of talking, Erik’s obsession with oral stimulation was manifested as singing: singing to himself, hoping to seek solace throughout his life; and later to Christine as well as giving her vocal lessons. It therefore appears to me that the desirable, pleasurable substance he chose to keep in his mouth was music in the form of his own voice. The first, and most psychoanalysts would argue to also be the most important, ego defense mechanism identified by Freud was what he called repression: threatening thoughts and ideas are repressed, or pushed back into the unconscious (Freud, 1923/1990; Rosenzweig, 1943; Wagg & Pridmore, 2004).Repression can therefore be viewed as a barrier used by the conscious mind to block out specific (usually painful, unpleasant, or inappropriate) thoughts arising from the unconscious. In the phallic stage (around age 4 years) during which a child’s sexual energy is focused o n the genitals, the aggressive thoughts in the Oedipus complex about the same sex parents are learned to be repressed (but must be resolved later) by the developing boy (Adler, 2010; Rosenzweig, 1943; Wagg & Pridmore, 2004). One of those feelings the boy represses is the fear of castration, which will be discussed below.Base on a Greek legend in which Oedipus, the Thebes king who unknowingly killed his father and married his mother, the term â€Å"Oedipus complex† was used by Freud to describe a boy’s sexual desires toward his mother and rivalries toward his father (Adler, 2010; van Beekum, 2009). Freud theorized that such thoughts and feelings and the psychological defenses against such thoughts and feelings are of critical importance in personality development as they will become the fundamental reaction pattern the individual relies on throughout life (Adler, 2010; van Beekum, 2009).Freud noted that during this phallic stage when children begin to explore their geni tals – boys with their penises, at the same time they are also concerned with their fathers’ penises and girls who do not have them. Freud theorized that while the boy is struggling with his intense sexual desire toward his mother, he must have also realized that he does not have the physical strength to overpower his father; he fears the father may castrate him as an act of revenge, leaving him without a penis and therefore resembling a girl – Freud termed this unconscious fear â€Å"castration anxiety† (Adler, 2010; van Beekum, 2009).In order to resolve this conflict successfully, the developing boy pledges allegiance to his father. He tries to become a person like his father, and by assuming his characteristics, the boy replaces his father to become the authoritative, father-of-the-household figure and so, by extension, achieves sexual relations with his mother while diminishing the fear of being castrated (Adler, 2010; van Beekum, 2009).In Erikâ€℠¢s case, I believe his total alienation from his family as well as the society at-large led to a totally unresolved Oedipus complex: he felt no love for his mother, he did not know his father at all, and therefore no parent to identify with. Failing to identify himself with one parent, Erik therefore was incapable of moral internalization. He did whatever made him feel good at the time; he neither feared nor knew punishment because it did not matter what he does or does not do, the results were inevitably the same.In other words, his repressive defense mechanism, neither learned nor developed in childhood, was practically non-existent. Having no basic repressive skills and thus letting the thanatos force of the id to freely and repeatedly surface to the conscious and gratified, it is no wonder why Erik experienced frequent negative emotional outbursts, lack of remorse as an assassin, and an irrational, maniacal fixation on whatever he wished for, specifically, Christine. In addition , his obsession with Christine may be a way Erik dealt with impulses that he knew was unacceptable even to himself.I believe he unconsciously identified himself with Christine, both talented and tormented but with the exception of her being accepted publically and he loathed. Because he could never be accepted by the public regardless of how talented he was, teaching Christine all he knew and thus controlling her may be a way Erik thought he could live his imaginary â€Å"good life† through her success. By allowing Erik to kiss her on her cheek, a pivotal moment in the novel was created as Christine appeared to have melted his cold heart.Although Maslow’s self-actualization theory may view Erik’s reaction as a peak experience, I do not believe that to be the case. Maslow’s hierarchy of needs placed self-actualization on the very top of the ladder and can only be achieved after all other needs, physiological, safety, belongingness and love, and esteem, are satisfied (Hanley & Abell, 2002). Clearly, none of Erik’s life needs were even close to being satisfied, and therefore the innate process of self-actualization (Hanley & Abell, 2002) must have been foreign to him.I believe Erik’s reaction was another manifestation of the uncontrolled id surfacing to the conscious. This time, however, it was the eros force of the id that surfaced. This tremendous emotional release of positive energy, or catharsis, was so foreign yet comforting to him that he b roke down and cried uncontrollably. This was most likely the very first time the eros and not the thanatos force of his id was gratified as he was so accustomed to in his life up to that very moment; he finally felt the positive aspect of what it is to be human.The sensation of having the eros drive satisfied was so much more pleasurable than having the thanatos drive satisfied, his ego decide to choose to release Raoul and free Christine, allowing them to be married. B. F. Skinn er’s Radical Behaviorism Approach to Erik’s Personality In stark contrast to personality theorist such as Freud and Jung, Burrhus Frederick Skinner (1904 – 1990) viewed personality as a result of previous history of reinforcement (such as rewards and punishments) and that personality is determined and controlled by environmental factors (Moore, 2011).Therefore, in order to understand the behavior of a person, we must first uncover the set of environmental conditions where the behavior is exhibited. Skinner reasoned that in the presence of a discriminative stimulus, a characteristic response is elicited (Moore, 2011). Depending on how the response is reinforced, the behavior of the individual toward that discriminative stimulus is gradually shaped (Moore, 2011). In his principles of operant conditioning, Skinner emphasized how behavior can be changed by manipulating the reinforcing consequence (Moore, 2011).Skinner strongly rejected mentalism; terms such as perso nality, psychical structures (Freud’s id, ego, and superego), needs, and instinct were of no meanings to Skinner and instead, he favored the directly observable behaviors and emphasized on the function of the behavior in his research (Moore, 2011). According to Skinner, there is no free will (Moore, 2011). In Skinner’s view, what we see as personality is basically a group of responses to the environment, and if the responses are rewarded, then they are more likely to be repeated.Freud viewed the id as the instinctual driving force from the undifferentiated core of personality while Skinner asserted that what we see as a driving force is really humans’ innate susceptibility to reinforcement (Moore, 2011). Rather than seeing the ego as how humans respond to the world according to the reality principle, Skinner reasoned that all responses are learned, and different behavior will be exhibited by an individual under different circumstances.Refuting the Freudian conce pt of the superego as a set of internalized social rules and values that guide the ego in the continual struggle and negotiation with the id, Skinner believed that behavior is learned from how the society punishes such behavior: we simply control those behaviors that are not allowed by the society – exhibiting such behaviors will lead to unpleasant consequences. Therefore, Skinner interpreted the Freudian ego defense mechanism as avoidance to conditioned aversive stimulations, or punishments (Moore, 2011).In terms of genetic predispositions, Skinner suggests that genes (biological factors) provide an individual a range of response capabilities, but it is the environment that selects for the type of response that best suits the individual’s survival. Skinner also did not deny the existence of internal processes such as emotions and thoughts; he viewed them as individual characteristics caused by the environment and as such they are irrelevant in the explanation and the understanding of behavior (Moore, 2011).Erik appeared to have been genetically gifted with an extremely wide range of response capabilities as well as a talent in knowledge acquisition. Born grotesquely deformed, the environmental factor that selected him came in the form of a band of wondering Gypsies. Exploiting his deformity for monetary gain, they actually provided Eric a chance to survive into adulthood. Because he was gifted as a learner, he mastered the Gypsies’ many different performing skills and incorporated them into his own routines, further securing his acceptance within the band – the members could reliably depend on him as a money maker.His childhood experience thus far conditioned him to be independent: He could not depend on his family because he was a disgrace to them, he had no friends, and the band of Gypsies took pity on him for the sole reason of being able to make money off him. The more he enriched himself, the more valuable he was to the compan y. The reinforcing consequence was shelter and food, and his learned response to the environment was therefore to learn as much skill as he could and to become as selfish as he could.To Erik, it was every man on his own and for his own. Erik would not have any problem in being an assassin. Within the Shah’s realm, killing as directed by the Shah was rewarded. In addition, I believe that it is more than likely that Erik viewed â€Å"punishment† as normal, and hence his interpretation of â€Å"punishment† was not as an aversive stimulation, but rather normalcy. He therefore had no fear of being â€Å"punished† for being a killer and at the same time, successful killings were repeatedly reinforced with wealth and status.This changed, however, when Christine entered the picture. Erik developed an obsession toward the beautiful, talented, but emotionally devastated (due to the death of her father) chorus girl. Behaviorist view obsession as random acts that are by chance reinforced (Moore, 2011). Christine was fascinated with his genius, and thought that he was an angel sent by her father. Having not seen his disfigurement, I believe Christine did love Erik before that revelation. She respected Erik for his talent, and curiousenough to learn more about this â€Å"Angel of Music†. Erik no doubt was first captivated by her beauty, and when they actually spoke, Erik must have been pleasantly surprised that, for the first time in his life, he was treated as a person with no ill side-effects. These encounters-in-the-shadow made Erik feel good about himself, and together with a lack of negative consequences, he became obsessed with her – having a â€Å"relationship† with Christine made him happy, easing the anxiety within.Under Skinner’s concept of operant conditioning (operant because, in Erik’s case, he did not expect to be reinforced with kindness), I would think that by changing the environment from greed, hate, treachery, and death to that of kindness and warmth provided by the presence of Christine, Erik was able to radically change his behavior from total selfishness, oblivious to the needs of others to one that was more or less compassionate. This radical change, however, did not come overnight.It was through multiple encounters with Christine, each time they learn more about each other, each time his action was reinforced by the increasing level of kindness and respect returned to him, that his behavior was shaped. Erik did not know love, compassion, kindness, or any other behavior that we associate as positive, and clearly those behaviors were not instinctual to him. With Christine, he was being rewarded for â€Å"being good† – a teacher, a nurturing figure, or even, a lover.The need to possess Christine solely for himself, however, proved to be overwhelming. Brief liaisons in the shadows, no matter how frequent, were no longer satisfying. He needed the environmen t created by the presence of Christine all the time. Simply put, Erik had learned to become an addict; he was addicted to Christine. Behaviorists view love as a stimulus that elicits a range of responses (Moore, 2011; Tolman, 1923). Upon experiencing the love stimulus, infants and toddlers may respond by stop crying, smiling, cooing, etc.and the outstretching and flaying of their arms may be interpreted as wanting more of the stimulus (Moore, 2011; Tolman, 1923). Erik never experienced love and yet he felt pleasure from the stimulus. Unlike unpleasant stimuli such as fear and anger that one reacts by removing oneself away from the hostile environment, Erik needed to remain in the environment that gave him pleasure. In order to do so, he must have Christine in order to create an environment that continuously provides him with that stimulus, love.Most likely triggered by seeing her perform on stage that night, Erik resorted to the familiar solution in obtaining reward quickly and easi ly: he kidnapped her, threatened her with her very life if his addiction was not satiated. However, the environment where Christine is present may prove to be the key in his ultimate decision to free her. Skinner viewed that all behaviors are controlled by the environment, and I believe we are seeing this concept consolidate in Erik’s decision. In the presence of Christine, Erik was compassionate, accommodating, and aware of the turmoil within himself and Christine.I believe that in the environment created by her presence, he saw the impracticality and impossibility in the hope of spending the rest of his life with her. Letting her free was the choice he made in order to make Christine happy, for giving her this happiness would be his own greatest reward. Summary In this essay, the personality characteristics of Erik, Phantom of the Opera, were discussed using the Freudian psychoanalytic approach and the opposing Skinnerian radical behaviorism as references.The Freudian appro ach would suggest that Erik’s personality was a manifestation of his unconscious, orally fixated psychosexual development and an unresolved Oedipus complex with no repressive ego defense mechanism. Erik’s life had been devoted to the satisfaction of the thanatos, the id driving force that leads toward aggression, destruction, and death. Without any internalized social rules and values (superego) as a guide to his actions, his ego had very little to resolve between the id and the superego.As such, the id, driven by the thanatos force, repeatedly surface to the conscious and thus repeatedly gratified. The Skinnerian approach would view Erik’s personality as shaped by previous history of reinforcement in his given environment, steadily and progressively as he developed from a severely deformed, ridiculed child to a highly talented but tormented adult with little conscience. Everything that made up the person Erik was learned, and he had no free will to choose other wise. Through operant conditioning, Erik learned to be ruthless, selfish, and hateful.A behaviorist may interpret Erik’s need to possess Christine as a conditioned need for a stimulus, an addiction, and the respect and kindness returned to him by Christine functioned as reinfocers. In total disparity to his personality, the pivotal moment of the story came when Erik chose to let Christine and Raoul free. A Freudian psychoanalyst may interpret this as his unconscious need to re-experience the pleasure he felt when he first unleashed the id eros force when Christine allowed him to kiss her on the cheek, a pleasure far surpassing what a gratified id thanatos force was able to offer him up to that point.Radical behaviorism may view Erik’s decision in releasing Christine and Raoul was environmentally influenced. First in the presence of Christine’s voice alone and later with her physical presence repeatedly created an environment that was pleasurable to Erik – he was rewarded and reinforced with respect and human kindness. In that environment, he behaved compassionately – making Christine happy gave him pleasure in return. It would make her happiest with Raoul, and so the decision to free them was made. These two opposing theories provided very different explanations to Erik’s personality.However, I believe elements from both theories may be combined for a more comprehensive analysis on his behavior. It is very likely that Erik’s behaviors were learned and shaped by the hostile environment he constantly found himself since birth. Those behaviors, however inappropriate from a â€Å"normal† person’s point of view, were none-the-less necessary in ensuring his survival. The other aspect of his personality was his unconscious need for love and human kindness, something that he knew not existed until he encountered Christine.This is the turning point for Erik’s personality development and likely to be the first battle between the thanatos drive that he was so accustomed to and the newly surfaced eros drive that his ego now must resolve. At the end, it was the eros force that predominated. Behaviorists would interpret that his act of compassion was defined by the environment with the presence of Christine; in her presence, Erik was able to explore the positive aspects of human behavior, ultimately realizing that he too possessed those qualities all along, just that they were, as Freud would put it, hidden in the unconscious.

Puberty in Alice and Wonderland - 2171 Words

One of the most prominent themes in children’s literature is maturation and grasping with adulthood. In keeping with this tradition, Lewis Carroll’s Alice’s Adventures in Wonderland presents a girl who transforms immensely from the bored little girl who can’t imagine reading a book without pictures to the mature adult described at the end of the novel. Throughout much of the novel, the reader witnesses Alice struggling with frequent, rapid changes in her body. While the repeated size changes in the book serve to illustrate the difficulties of children in grasping the changes of puberty, the changes in Alice’s personality and state of mind that come with each fluctuation in size hint at the greater rewards of knowledge and certainty that†¦show more content†¦So flustered by these constant changes, Alice’s memory and knowledge have suffered, as she is unable to recall basic facts. This, accompanied by the realization that her voice has become hoarse and strange, once again moves â€Å"poor Alice† to tears. Finding both her body and mind to be completely altered, Alice hints towards not liking who she has become, resolving to stay in Wonderland and only come out if she is somebody else. Just as soon as this stream of thoughts leaves her, though, Alice realizes that she has shrunk once again, and rather than being comforted, Alice is â€Å"frightened at the sudden change† (29), saying that she is now â€Å"worse than ever† and that she â€Å"never was so small as this before.† She finds herself confronted by a pool of tears that had once seemed so inconsequential, frustrated once again by her uncontrollable emotions: â€Å"I wish I hadn’t cried so much!† (30). Once again, she realizes somewhat bitterly that â€Å"everything is queer to-day.† Alice’s size continues to come into play through her interactions with the mouse. Not used to seeing things from small eyes, Alice’s etiquette is brought into question as she offends the mouse with her talk of cats (31). Despite being the same size as the normally-small animals she now interacts with, Alice is viewed as foolish for not utilizing the same logic as her counterparts. In essence, while she is physically small, her mind has not adapted to this new size and she does not fit in amongShow MoreRelatedLewis Carroll s Hidden Presence Of Puberty1540 Words   |  7 PagesLewis Carroll’s Hidden Presence of Puberty The transformations that Alice experiences throughout Lewis Carroll’s, Alice’s Adventures in Wonderland, display the metaphorical change the protagonist goes through from the stage of childhood to adulthood and the continued struggle to understand her identity. These changes are experienced after Alice follows a white rabbit down his hole and into an incredible world known as Wonderland. 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