Although it is an essential aspect of one of the most common forms of entertainment, psychologists know almost nothing about how children understand the act of portraying a character in a realistic manner—realistic acting. Do children possess the sort of meta-theory of acting that adults possess? In two studies we find that, unlike adults, children between the ages of 3–5 do not think that a realistic actor is better at portraying a characteristic than a nonrealistic actor, nor do they prefer one to the other. As they develop, they come to understand that realistic acting is different from nonrealistic acting, but unlike adults, children think that a nonrealistic, pretense-like portrayal is more difficult to achieve than a realistic representation of an emotional or physical state. These findings show that children’s metarepresentational understanding of acting is relatively immature at age 5, and that their understanding of this specific domain of pretense lags behind their understanding of pretense in general. Adults enjoy realistic acting. Indeed, watching others act—in television shows, in movies, and in theatre—is one of the main pleasures of modern life –3. AdultOur judgments about the praiseworthiness of acting are based in part on our judgments about how close an actor’s portrayal is to reality, how truthful it seems. Realism in the fictional world of realistic television, movies, and plays has many facets—the language, plot, scenery and costumes all play a role. However, we hypothesize that the most important facet of realism in acting is its behavioral cues. The more behaviorally realistic acting is, the better we judge it to be. Indeed, in good acting, there are no behavioral cues to the fact that what the actor is doing is fictional.In contrast, unrealistic acting is often laughably bad, particularly when it involves over-exaggerated emotional expression or physical movement. The difference between these two types of acting is how close they are to everyday behavior. Behaviorally realistic acting attempts to be as close to everyday behavior as possible, such that if actors were seen engaging in these behaviors on the street, they would not stick out as performative. Emotional expressions are natural, and actors say their lines in a conversational tone with conventional body movement.To put it differently, nonrealistic acting looks as though the actor is obviously “faking it”. This includes both behaviors that professional actors would think of as overacting and what developmental psychologists have found as “cues to pretense” . This tyThis focus on behavioral realism in acting is actually a relatively new development. Before the past 100 years, acting styles were closer to oration or even interpretive dance . Even sois James Bond. Indeed, there is anecdotal evidence that adults sometimes confuse the representational nature of high-quality realistic acting by attributing the properties of a character to the actor. For instance, Hugh Laurie has mentioned in several interviews that he is often asked for medical advice due to playing Dr. Gregory House for nine years on television. Leonard Nimoy, who played the Vulcan Mr. Spock on Star Trek, was subsequently plagued throughout this career with people who believed that Nimoy himself was hyper-rational and emotionless, so much so that he titled his autobiography I Am Not Spock [General Hospital, who said the line “I’m not a doctor, but I play one on TV” to explain to the viewer why they should buy the product.Behavioral realism in acting comes with a cognitive price for the audience: the more realistic acting is, the harder it becomes to separate it from reality. The representational difficulties of separating actor from character are even built into the way we talk about acting. Actors “inhabit” roles, or “take on” parts. This is distinguished from pretense—it would be strange, for instance, to hear Daniel Craig described as “pretending” to be James Bond, but quite natural to say that Daniel Craig ot Spock  . AdvertHow does the capacity to appreciate realistic acting develop? The average American preschool-aged child spends between 90 minutes and two hours watching television and DVDs per day . Much ofThe developing understanding and appreciation of realistic acting in children is interesting for several reasons. For one thing, realistic acting can serve as an unusual and particularly challenging case study of children’s developing meta-representational understanding. A mature understanding of realistic acting engages multiple representations—the person you are watching is both the actor and the character that the actor is representing. The actor has his or her physical, emotional, and personality states and traits, and the character/portrayal has his or her emotional, physical and personality states and traits. Previous research has shown that for emotional states particularly, children typically have problems identifying that a person can feel one way internally but express a different emotion until after five years old –15. Otheactual versus represented properties [Studying the domain of realistic acting is interesting as well in how it contrasts with other representational challenges. For instance, even young children show a relatively mature understanding of representation in pretend play. Just as with realistic acting, children engaging in pretend play must hold multiple representations in mind as they switch from the real world into the pretend one –18. But operties –21. At toperties –23), andoperties . By threoperties  and can operties , althougWhy would pretense be so much easier than realistic acting? This is likely due to the abundant behavioral cues in pretend play that distinguish it from real-world actions: these cues make its representational nature obvious. These cues are necessary in part because pretense is embedded in the everyday activities of children. Children and their caretakers often move from real interactions to pretend ones, and therefore must demarcate the pretend world with behavioral and vocal cues. These cues include: extensive interpersonal eye contact, non-context appropriate smiling, high levels of vocal variation, and over-the-top physical actions , 27–28.Realistic acting, a close representation of the real world, does not contain these cues. If someone were to ask how children distinguish the behavior manifested in realistic acting from actual real world behavior, the answer is that—based on the solely on the behavior—they cannot; the whole point of realistic acting is that, when done well, it is indistinguishable. If someone were unfamiliar with the external cues to acting, such as the framing of television, movie screens, or proscenium arches, or the genre cues that distinguish acting from realistic filming (such as music and camera angles), he or she would not be able to tell the difference between realistic acting and reality. When not given the appropriate framing cues, even adults can confuse realistic acting and reality, a popular example being the famous first broadcast of War of the Worlds, which was only voice acting. Children must learn the conventions of fictional framing—title cards and opening theme songs, laugh tracks and montages—in order to understand that television and film are fiction in the first place .This understanding of realistic acting is intimately connected to the pleasure that we get from it. For adults at least, one possible source of this pleasure is the enjoyment we derive from an appreciation of the dual representation implicit in acting: the actor versus the character. We give awards and large sums of money to those who can create realistic portrayals of emotional and physical states, and do it well. Much as we enjoy watching talented individuals run races, kick soccer balls, and sing arias, we enjoy watching people complete the task of portraying human psychologies on a stage or screen .In this regard, children’s appreciation of realistic acting provides a window into their understanding. That is, while children may not be able to explicitly outline the complex logic of realistic acting, they can tell us what they like. If children agree with adults that realistic acting is better than nonrealistic acting, that means that, among other things, they understand that acting is about generating an impression that is indistinguishable from reality. However, if children believe that nonrealistic acting is better than realistic acting, that means they may instead believe that behavioral cues that makes something as unreal are important for the quality of a performance. They might either be incapable of understanding that one can behave in a realistic way while acting, or they might think that someone who acts realistically is doing it wrong.In two studies, we compare children’s understanding of realistic acting with their understanding of overt and exaggerated nonrealistic acting—behaviorally similar to what they engage in during everyday pretend play , 30–31. In Study 1, to investigate what children think is good acting, we introduced children to an actor who wanted to be on “television and movies like some shows that you watch.” We then showed them two versions of the same actor enacting the same characteristic: once in an overblown manner, closer to pretense, and once in a realistically acted manner, asking children to decide which they thought was the best.Children could respond in one of three ways: 1) If children choose realistic actors as “better”, this would imply that children have an adult-like understanding of the importance of realism in acting. 2) If children choose the nonrealistic actors as “better”, this would imply that children do not appreciate that realism in the representation of an enacted characteristic is important, and/or may instead be choosing based on shows that they themselves watch, or cues they find in their own pretense. 3) If children do not have a preference either way, they may not understand that realistic and nonrealistic portrayals are somehow different. Alternatively, they may not have a preference because they may both understand that behavioral realism is acting is important, and think that nonrealism is important because of what they see on their own television programs, and therefore answer randomly.To ensure the target actors really did show differences between realistic acting and nonrealistic acting, we also had adults rate which acting style they believed was “better” for television and movies.M = 42 months; 11 female), 16 4-year-olds , 13 5-year-olds , and 10 adults . Ethnic information was not collected, but most participants were representative of the predominantly Caucasian population from which they came. Child participants were recruited from a database of families who had agreed to participate in developmental research or were students at a preschool that agreed to participate in psychological research. Adult participants were either working in a psychology laboratory and had no knowledge of the study, or were recruited while walking across campus and participated in exchange for candy.Participants included 17 3-year-olds ”. Acting is when someone plays different characters in movies or plays. In this movie, people are acting. What is your favorite movie? This discussion lasted a few minutes, and the experimenter made sure that the child did not only talk about cartoons, but also live action, enacted characters from TV shows and movies. Then children were shown two exemplar videos of the same actor portraying two different characters, from a television movie aimed at children, a modern retelling of “The Prince and the Pauper” [Do you know who this is? (Experimenter shows picture of actor) This is someone who is acting. See, in this video, he is acting as a character. (Experimenter shows video) And here he is acting as another character. (Experimenter shows second video) So, do you know what acting is? (Child responds).All research reported in this manuscript was approved by the Yale University Institutional Review Board (IRB). Informed consent was obtained in writing from all participants or their parents, and verbal assent was obtained from all children during the course of the study. Two videos  were presented side-by-side on the same screen in a Power Point presentation. Children were told “ Pauper” . They weChildren then watched our target videos. They first watched one video, then the other, and then answered our questions. Type of portrayal was counterbalanced by side across trials, as was the order in which the conditions were presented. There were eight sets of characteristics: happy, sad, scared, surprised, tired, strength, food preference, and hurt. For each set of characteristics, the same actor portrayed a single characteristic , but in two different ways: in one condition, the actor acted realistically and in the other, the same actor acted in an overblown nonrealistic manner. In both conditions, the target walked across the screen, stopped at a desk, had an emotional or physical reaction, and then continued off screen. In the realistically acted condition, the responses were as realistic as possible, while in the nonrealistic acting condition, the targets acted in an overblown and obviously fake manner: they made extensive eye contact with the camera, smiled even when portraying a negative emotion or physical action, and had higher levels of vocal expression and variation than the realistic acting, all signals of pretend as found in previous research , 27–28 ahttps://osf.io/kn56y/.After watching both videos, children were asked “Which one is better? Which one is the best?” While answering, children were looking at a screen shot, frozen, from the same moment of the end of each video while making their choices. For each choice, children were given a score of “0” for choosing “realistic acting” and “1” for choosing “nonrealistic acting”. Therefore, children could score between 0  and 8 . Examples of “realistic acting” and “nonrealistic acting” videos can be found at osf.io/ms9wu. All data for this study are freely available through the Open Science Framework and can be found at To investigate whether there was a developmental trend in choice of “better” acting, we conducted a one-way ANOVA with age as the between subject variable. F  = 15.41, p <.001, d = 2.13. Tukey’s post-hoc tests showed that adults were much more likely to choose the realistic actor as “better” than the 3- 4- or 5-year-olds , but there were no significant differences between the 3- 4- and 5-year-olds. We then reran the ANOVA without the adults and there was no significant effect of age.There was a main effect of age, t-tests to see if participants responded that the realistic actor was “better” differently from chance, understanding that acting should be realistic in its behavioral cues. Adults were significantly more likely to say that the realistic actor was “better”, t (9) = 8.40, p < .001, d = 5.6. Both the 3- and 5-year-olds responded at chance. However, 4-year-olds were more likely to say that the nonrealistic actor was “better”, t (15) = 3.77, p = .002, d = 1.94.We then examined the results at each age by conducting In sum, while adults thought the realistic actor was better, children did not. They either showed no preference (3- and 5-year-old children), or thought the over-the-top, nonrealistic actor was better, more like the acting they saw on movies and TV (4-year-old children).representational nature of both realistic and nonrealistic acting, they may not understand the metarepresentational properties of acting: that a nonrealistic representation is not as good as a realistic representation. However, if this is the reason for the 3- and 5- year olds’ responses, this means that only the four-year-olds can tell the difference between realistic and nonrealistic acting—that only at this intermediate age could children understand the metarepresentational nature of acting . We find this explanation unlikely, given the pattern of age differences found in our study. Clarification of this issue was one motivation for Study 2.There are at least two possible explanations for the developmental difference between children and adults. First, it is possible that the 3- and 5-year-old children cannot tell the difference between nonrealistic and realistic acting. They may think that both are valid representations of an emotional or physical state and not be able to distinguish between the two despite the perceptual differences in the behavior. So, these children may have an understanding of the Blue’s Clues and Yo Gabba Gabba) involves unrealistic and exaggerated behavior. The four-year-olds in our study could have been responding in reference to the type of acting they see on their television shows, although the three- and five-year-olds were not. Although we did not measure children’s exposure to television shows in this study, as mentioned above, preschool children in the United States watch on average 90 minutes to two hours of television and DVDs per day [Secondly, children were introduced to the study by talking about movies and television they watch regularly, and then asked about the movies and television shows they watch regularly. A lot of children’s television . This lack of preference could support the theory that 3- and 5-year-old children did not take acting style into account when deciding their preferences for actors in the same way as adults.We admit, then, that neither explanation fully captures the differences in responding between the 4-year-olds and the 3- and 5-year-olds. It may be that the three- and five-year-olds look as though they responded in the same way, but do so for different reasons. This is an admittedly post-hoc explanation, but it may be that 3-year-olds were confused about the representational nature of the two types of acting and therefore equated them; four-year-olds preferred the nonrealistic acting because this is what they see on television and in their own pretend and do not understand the importance of realism in acting, and five year olds are beginning to understand the importance of realism in acting, but were confused or still have a preference for nonrealism given their pretense and television exposure, and therefore appeared to answer randomly. However, it should also be noted that while the four-year-olds did respond differently from chance, their pattern of responding was not significantly different from the pattern of responding from the 3- and 5- year-olds as found by an ANOVA. As our primary goal is to investigate children’s understanding of the differences between the two types of enactment, we attempted to focus on this question in Study 2.Finally, it is possible that children did not understand the concept of acting as we explained it in the instructions. Children may have conceptualized the video clips as simply real expressions of real emotions, not thinking of them as representational at all.Study 2 attempts to clarify these alternatives, expand our previous findings, and provide children with a clearer way to distinguish between realistic acting and nonrealistic acting. In Study 2, we provided children with an example of what we meant by realistic acting, rather than only talking with them about the movies and television they experience in their daily lives. We showed children the same portrayals of characteristics as in Study 1. In Study 1, it may have been that children also interpreted our target question differently than adults. They may have interpreted our question of “which is better”  to mean “which do you like better”, and therefore answered with their preference rather than with a judgment. We clarify this possibility in Study 2 by giving children a chance to distinguish between what kind of acting they prefer and what kind of acting they think of as more like the realistic acting adults value. We also ask which kind of acting they consider to be more difficult to explore whether children understand that part of an appreciation of acting’s representative nature is an appreciation of the difficulty of creating that representation. In this way, we can clarify the reasons behind the similarities in three- and five-year-old children. These questions help to illuminate the results from Study 1 and see if there are aspects of realistic acting, such as its difficulty, that children between the ages of three and five represent and understand in the same way as adults.In Study 2, we introduced the children to an actor who “played different characters on movies and television” and showed them a sample of realistic acting. We then showed them two versions of other actors either realistically or nonrealistically enacting the same characteristic—and asked children to pick which one was more similar to the sample of realistic acting, which one they liked better, and which one they believed was harder to do.There are again three possibilities. 1) If children have a mature understanding of realistic acting and they understand the centrality of realistic behavioral cues in acting, they should respond that our realistic acting videos are the same as the realistic acting exemplar, prefer realistic acting, and believe realistic acting is more difficult to achieve than nonrealistic acting. 2) If children do not understand the representational goals of acting and instead believe that “bigger is better” when it comes to portrayals, or that realistic behavioral cues are not actually representational, only over-the-top portrayals are, they may respond that our nonrealistic acting videos are the same as the realistic acting exemplar, prefer nonrealistic acting, and believe nonrealistic acting is more difficult to achieve. This response pattern may imply that children think of our target realistic acting as the same thing as real behavior—not representational at all and not difficult to perform—and therefore not the same as the exemplar video, which is introduced as a representation. Children’s preferences for nonrealistic acting and belief in the difficulty of nonrealistic acting would then imply that only nonrealistic acting was considered representational, separate from real behavior from our realistic actors. 3) If children equate any type of human representation  they may answer at chance.We again asked adults, this time using a larger online sample, to rate the videos on the same characteristics as the children as well as on which portrayal type was more typical of what they saw on movies and television.M = 40.8 months; 5 female), 15 4-year-olds , 15 5-year-olds , and 43 adults . Most participants were Caucasian, reflecting the community from which they came. Child participants were recruited from a database of families who had agreed to participate in developmental research or were students at a preschool that agreed to participate in psychological research. Adult participants were either working in a psychology laboratory (10 participants) or were recruited via Amazon’s Mechanical Turk (33 Participants) and had no knowledge of the goals of the study.Participants included 14 3-year-olds . In this clip, a child actor is acting in a realistic manner, having a conversation with a security guard about the possibilities of jobs on a movie set. The style was conversational and realistic, and even though it takes place in a television movie aimed at children, the style is such that it could be part of most realistically acted films or television shows. The character Josh asks a question with some hope, and then expresses mild disappointment upon receiving a negative answer. There is no overlap in the physical or emotional state of Josh with the emotional or physical states shown in our target videos. The children were told “This is Josh. Josh is acting. After you watch this, I am going to show you some more people and ask who you think is acting more like Josh.”In the same manner as Study 1, children were first introduced to the concept of acting and asked to talk about their favorite movies and television shows, with the experimenter explaining that on those shows, people were acting. They were then shown a clip from the same television movie as in Study 1 , introdusad video was not shown due to experimenter error in transfer between computers, and the food preference video was not shown due to wanting to keep the number of physical and emotional videos equal in this study.Once they watched the sample video, children were shown a series of paired videos, similar to Study 1. Two videos were presented side by side, and both videos were presented before children were asked questions. Videos were again counterbalanced by type. Children saw 6 videos. The In each set of videos, two actors again portrayed a single characteristic  in two different ways: in one video, the actor acted realistically and in the other, another actor acted in an overblown nonrealistic manner. After watching both videos, children were asked three questions: “Which one was acting more like Josh?” “Which one did you like better?” and “Which one do you think was harder to do?” We asked the questions in this set order and with this wording to orient children’s responses back to the initial target video of realistic acting, and to ensure that children were thinking about realistic acting in their responses. Children again looked at two frozen screen shots from the same moment of each video while making their choices. Children were scored for how often they chose realistic acting rather than nonrealistic acting.https://osf.io/kn56y/.Adults were told that they were participating in a study of acting. They were also shown the sample video and then the target videos and asked the same questions, but without a lengthy introduction about the definition of acting. The Mechanical Turk sample was also asked one additional control question: “Which type of acting was more like what they typically saw on television and movies?” All data for this study are freely available through the Open Science Framework and can be found at t(32) = 2.60, p = .014.To investigate whether adults believed that our videos of realistic acting were more like the type of acting they saw on movies and television than our nonrealistic acting, we ran a one-sample t-test against chance. Adults from our online sample believed that our realistic acting videos were more like the acting they saw on movies and television, To investigate whether there was a developmental trend in ability to differentiate, preference for, and understood difficulty of realistic compared to nonrealistic acting, we conducted a 4  X 3  mixed-model ANOVA. F  = 12.39, p < .001, d = 1.36 and a main effect of age, F  = 15.32, p < .001, d = 1.68, this was qualified by a significant interaction of question type and age, F  = 4.28, p = .007, d = 0.46. Follow up ANOVAs showed that there were developmental differences for similarity, F  = 22.26, p < .001, d = 2.44, and preference, F  = 5.26, p = .002, d = 0.58, but not for difficulty, F  = 1.43, p = .24. Tukey’s posthoc tests showed that adults answered differently than 3-year-olds on the questions of preference (p = .002), and differently from 3- and 4- year olds (ps < .01), but not 5-year olds, on the question of similarity, but that all four age groups answered similarly on questions of difficulty.There was a main effect of question type, F  = 4.16, p = .004, d = 0.65, and there was a main effect of question type, F  = 6.73, p = .003, d = 1.06, but no main effect of age. Follow-up ANOVAs showed that there was a developmental difference for the question of similarity, F  = 16.56, p < .001, d = 2.58. This occurred because 5-year-olds answered significantly differently than both 3- and 4- year olds, ps < .001. There was no effect of age on questions of preference or difficulty . While the three questions were asked in the same order, to ensure that choice of the video more like the exemplar was the same as the choice of preferred video, we conducted a bivariate correlation on choice of video for each question. For all children, there was only a moderate correlation between responses to the question about preference and responses to the question about similarity, p = .081. Across question type, for the videos “tired” “surprised” “happy” “hurt” and “strength” overall children’s response was not significantly correlated. For the videos “scared”, responses were moderately correlated, p = .057.We then re-ran the ANOVA without the adults. There was a significant interaction of question and age t-tests to determine if children and adults answered differently from chance for each question. Adults believed that the realistically acted videos were more like the example, t(42) = 10.17, p<.001, d = 3.13, and preferred the realistically acted videos, t(42) = 5.75, p = .001, d = 1.77, and but did not think that the realistic acting was more difficult to do than the nonrealistic acting, t(43) = 0.07, p = .94.We then conducted t (13) = 2.51, p = .02, d = 1.39, but did not prefer nor did they think either type of acting was more difficult. Four-year-olds did not differ from chance for which type of acting they preferred or which they thought was more similar to the sample acting. However, four-year-olds answered that the nonrealistic acting was more difficult to do, t(15) = 2.51, p = .025, d = 1.29. Five-year-olds answered that the realistic acting was more like the sample, t (14) = 6.874, p <.001, d = 3.67, and that nonrealistic acting was more difficult than chance, t (14) = 2.16 p = .048, d = 1.15, but did not differ from chance in their preferences.Three-year-olds answered that the nonrealistic acting targets were significantly more like the realistic acting example, F = 5.02, p = .028, d = 1.08. Neither age nor the interaction of age and matching of similarity were significant predictors of preference for realistic acting, ps >.27. It should be noted that no 3-year-old children answered 5 or 6 matching questions correctly, and only 2 four year olds did so, while 11 (out of 15) 5-year-olds did so.It is also possible that those participants who did not match our exemplar realistic acting with our target videos of realistic acting answered the preference question differently than those who were able to match the two realistic acting videos, regardless of age. Therefore, we created a new variable, dividing participants into two groups: those who correctly matched on 5 or 6 of the test videos, and those who correctly matched on 4 or fewer videos regardless of age. We then conducted a univariate ANOVA with age and amount of correct matching as predictor variables and preference as the dependent variables. Participants who matched 5 or 6 videos on similarity significantly preferred realistic over nonrealistic acting, The findings suggest that as children develop, they begin to distinguish more clearly between nonrealistic acting and realistic acting. Five-year-olds have mature ability to match realistic acting style of professionals to realistically acted characteristics created for our laboratory, but 3- and 4-year olds have difficulties differentiating between the two, with 3-year-olds equating nonrealistic acting with realistic acting.not actually representational, but really happening, and therefore not difficult to portray. In contrast, adults understand that both the realistic and the nonrealistic acting are portrayals, and believe, at least in our videos, that both types of acting are equally difficult.One area where there is a difference between children and adults concerns the relative difficulty of realistic acting and nonrealistic acting. As preschool children develop, they think that nonrealistic acting is harder to perform than realistic acting. This is unlike adults, who do not endorse the idea that either type of acting is more difficult. . This belief may signify a problem with children’s understanding of realistic acting as both representational of the real world and false. They may believe that the behavioral cues of the actor are so close to reality that they are Although children’s television is nonrealistic in its acting, and certainly cartoons are not realistic, children do not seem to have a preference for one type of acting over another. It may be that if we had asked children instead which type of acting they found more entertaining, not just which one they liked better, but which was more fun, or more interesting, they would have chosen the nonrealistic acting, reflecting the type of acting they see on children’s television.One additional possibility for these findings is that children believe that “bigger is better and harder to do” across domains, with acting included in their theory. Children may have applied this theory to all questions about acting, thinking that bigger portrayals of emotions or physical states are more difficult to create, and preferable over small, more realistic portrayals. If this is children’s operating theory of not just acting but action in general, it may be that if we presented children with a choice between someone jumping a “big” versus “small” jump, or stringing a set of “big” beads or a set of “small” beads, children would always chose the larger choice.In two studies, we found that young children do not have consistent views as to whether a more or less realistic enacted portrayal is better, and they believe a less realistic enacted portrayal is more difficult to achieve. In both regards, children are different from adults. In our studies, adults show a clear understanding of the dissociation between nonrealistic and realistic acting—they believe realistic acting is better and prefer realistic acting. In contrast, our data suggest that preschool children are confused by realistic acting, though they do not prefer nonrealistic, exaggerated acting.It may be that children are confused by the representational task of acting, that of understanding the difference between realistic behavior and fictional enactment. This is more difficult, we believe, than understanding the obvious behavioral representation of pretense, which preschool children do with ease , 22–23. Alternatively, children, unlike adults, may be thinking of all human representation of traits in the same way regardless of the type of perceptual cues that are given. Three-year-olds, in particular seem unable to separate the realistic from the nonrealistic acting, and may in fact think of less realistic acting as being more obviously a “representation” and therefore more closely matched to the sample of acting that we showed them at the beginning of Study 2. In the same way that at three and four years old children are still confused by appearance-reality tasks  and taskIn the same way we are asking children to distinguish “good” acting it may be interesting to see whether and how children distinguish “good” pretense, which is behaviorally cued to its representational nature. As far as we know, no research has investigated whether children believe someone who is pretending in an announced, exaggerated way is a “better” pretender than someone who is pretending in an understated way. Children may believe that the more exaggerated the behaviors and less representational the actions and props of the pretense, the “better” children consider it to be. Future work will distinguish between the framing of a behavior  and the behavioral cues themselves  to determine children’s preferences given contrasts between the labels and cues.Finally, how do children then come to understand the realistic representations of acting? We see three non-exclusive possibilities.One possibility is while children are first exposed to the nonrealistic enacted world of children’s television, as they grow, the type of television and therefore the type of acting they are exposed to changes as well. This predicts that as children begin to watch more realistically acted television programs, their understanding of realistic acting will also develop. In particular, it may be that children’s understanding of acting (in our studies) is moderated by their understanding television as unreal but representational. Beginning at age 3, children begin to learn that objects on television are not actual objects existing within the square box of the screen, and by age four, children realize that the objects seen on the screen are representations . At fourA second related possibility is that given the complex layering of representations in acting , as representational abilities increase with age, so does understanding of acting and judgments of what makes an actor good at the task of acting. As children become better able to distinguish the appearance of realistic behavioral cues from the reality of a fictional portrayal, they will be more adult-like in their judgments of acting. Children will then understand, as adults do, the activity of realistically portraying the personality, emotions and physical states of a fictional being onstage or onscreen.Correspondingly, although no work that we know of has explicitly investigated the acting abilities of children, previous research has shown that while children can engage in pretense easily, with the associated cues to its falsity, preschool aged children have difficulties convincingly lying—that is, they cannot perceptually act as though the lie is reality while the truth of the situation is something different . Child aA third possibility is that as children’s other social cognitive abilities, such as the ability to separate fiction from reality, appearance from reality, and have a complex theory of mind continue to develop, so does their ability to understand the fictional but realistic nature of characteristic portrayals in acting. If this is true, understanding acting may be linked to understanding the social world and mental and emotional states in general. Future work in our laboratory will explore these possibilities.Although realistic acting is pervasive in modern culture, children do not understand how it works. Even with the obvious quarantining of a television set, children have problems understanding acting. This lack of understanding lags behind how well children reason about the fiction/ reality barrier and pretense in general. We propose that acting’s multiple layers make it a unique case study into children’s developing metarepresentational understanding and deserving of further exploration.


Albeit the existence of ‘free radicals’ having been known for a considerable time within the sphere of chemistry, these interesting kinds of oxidizing molecules attracted the attention of medical scientists and physicians during the early 1950s when Denham Harman started to publish a number of reports on the “free radical theory of aging” , 3. Desp•), a gaseous radical molecule, another term, namely ‘reactive nitrogen species’ was included to the nomenclature of this particular field of science.Starting with the 1970s, overwhelming research began to appear in the medical literature elucidating the relationship between free radicals with this or that pathophysiological condition which resulted in the formulation of the definition of “free radical diseases” . Through2•−) or the hydroxyl radical (•OH) and another group of ‘non-radical reactive molecules’ such as hydrogen peroxide (H2O2) and peroxynitrite (ONOO−) were defined and various deleterious effects of these molecules have been described through the past decades [viz., Alzheimer’s [e.g. scavenging enzymes such as superoxide dismutase, catalase, glutathione peroxidase, etc., or chemicals inhibiting the activities of oxidant generating enzymes such as xanthine oxidase, e.g. polyphenols. These molecules can be either natural or synthetic, either hydrophilic such as ascorbic acid or hydrophobic such as α-tocopherol. By these actions, antioxidants can either prevent the generation of oxidizing species or reduce the effects of dangerous metabolic or xenobiotic oxidants and hence prevent the body from acute or chronic diseases and/or repair the cellular/tissue damage already sustained. Therefore, it is not surprising that a large number of studies have been concentrated on molecules with antioxidant activity for therapeutic purposes to counteract the harmful effects of reactive species and oxidative stress. It should be noted, however, that a considerable number of antioxidant molecules were instead proved to have pro-oxidant potential and to promote oxidative reactions [A significant number of radicals such as the superoxide free radical anion (O decades , 8. Ulti decades , 10. The decades –14, RNA  decades , mitochoheimer’s  and Parkheimer’s , variousheimer’s , and agiheimer’s , amoungseactions . Thus, teactions , 22 and On the other hand, it also became obvious that free radicals are not only involved in pathological processes, but their existence is also necessary for many physiological functions of living organisms , 24, incTaken together, the current concensus is that a controlled and sustained production of both radical and non-radical reactive molecules is essential for normal physiological and cellular functions; however, their uncontrolled or excessive production can cause ‘oxidative/nitrosative stress’ resulting in the destruction of structural biomolecules consequently leading cellular dysfunction and death and ultimately to tissue and organ injury or failure. The scientific world is encouraging engaged in investigating whether oxidants or antioxidants are friends or foes for each other and/or for living organisms; more and more research is being performed in order to clarify the mechanisms of action of endogenously produced oxidizing molecules, their relation to physiological processes and interactions with other biomolecules.Oxidants and Antioxidants in Medical Science”, we announce a new periodical resource for research professionals in this attractive area in order to find chance to share their experiences and knowledge with medical professionals through the medical literature. We are starting with a 10-article issue from authors and research groups all over the world including the United States, Cuba, Belgium, Estonia, India and Malaysia. The first issue includes both review articles authorized by senior academicians and research papers of the field of redox science. Our main aim is to provide relevant and reliable knowledge for scientists of this field and, by this way, to open a new door to the world and secrets of oxidants and antioxidants in medical science.With this first issue of “


Immunization of health care workers (HCWs) against influenza has been associated with improvements in patient safety. The aim of this study is to assess the beliefs, attitudes, and knowledge of HCWs and health profession students regarding influenza. An anonymous questionnaire was distributed to HCWs in three local Florentine healthcare units, at Careggi University Teaching Hospital, and to students in health profession degree programs. A total of 2576 questionnaires were fully completed. A total of 12.3% of subjects responded that they were “always vaccinated” in all three of the seasonal vaccination campaigns studied (2007–2008 to 2009–2010), 13.1% had been vaccinated once or twice, and 74.6% had not received vaccinations. Although the enrolled subjects tended to respond that they were “never vaccinated,” they considered influenza to be a serious illness and believed that the influenza vaccine is effective. The subjects who refused vaccination more frequently believed that the vaccine could cause influenza and that it could have serious side effects. More than 60% of the “always vaccinated” group completely agreed that HCWs should be vaccinated. Self-protection and protecting family members or other people close to the respondent from being infected and representing potential sources of influenza infection can be considered motivating factors for vaccination. The results highlight the importance of improving vaccination rates among all HCWs through multi-component interventions. Knowledge of influenza should be reinforced. Influenza is a major public health challenge. The most effective way to prevent infection with the influenza virus and its potentially severe complications is immunization. Vaccination is safe and well-tolerated and can prevent up to 70%–90% of influenza cases in healthy adults ,2.Health care workers (HCWs) and medical students not only are at risk of exposure to influenza viruses because of their contact with patients but are also considered a potential source of transmission. The World Health Organization and the United States Centers for Disease Control and Prevention recommend influenza vaccination for health care personnel, health profession students, and trainees ,3 to proImmunization of HCWs has been associated with improvements in patient safety and decreased severe morbidity and mortality in hospitals and other health care facilities ,6,7,8,9.Assessing the beliefs, attitudes, and knowledge of HCWs and health profession students regarding influenza and the influenza vaccine can be useful for planning tailored influenza vaccination campaigns and improving vaccination rates ,13.As described in other publications ,15, the We recruited the study sample from the employees of the Local Health Units (LHUs) of Empoli and Pistoia, at Careggi University Teaching Hospital, and among students in the final two years of degree programs in Medicine, Nursing, Health Care Assistance, and Techniques of Prevention in the Environment and in the Workplace in Florence.In the LHUs of Empoli and Pistoia, and in the Careggi University Teaching Hospital, the total number of employees, including medical, paramedical, and non-medical workers, was 11,369, overall, while the students of the final two years of degree programs included in the survey totaled approximately 920.The study was conducted according to the Helsinki Declaration of 1975.The tool used for the survey was an anonymous self-administered questionnaire with closed questions. The questionnaire was formulated and shared in a peer group, then validated in a survey of 95 HCWs.The questionnaire was composed of three sections. In the first section, the study participants recorded their agreement or disagreement  with factual statements regarding influenza and the influenza vaccine.In the second section, the participants indicated their previous influenza vaccination status  and their reasons for having been vaccinated or not vaccinated. The participants were also asked about their role in administering the influenza vaccine, their preferred type of influenza vaccine, and which categories of patients they would recommend receive vaccinations.The third section included questions on the participants’ socio-demographic characteristics, their degree qualifications, home department, whether they lived with people at risk to transmit influenza (children under 9 years) or to get flu (people over 65 years and/or with chronic illness), and their history of chronic cardiovascular disease, chronic respiratory disease, chronic renal failure, diabetes, autoimmune diseases, and respiratory infections in the previous years. Finally, the questionnaire included an assessment of self-perceived health status (from 1 for “bad” to 10 for “excellent”) that was subsequently grouped into two categories (“not good” from 1 to 5 and “good” from 6 to 10).The sampling criteria are explained in previous publications ,15. The Recruitment was performed according to different approaches: the study team asked HCWs to complete the questionnaire and to return it to a locked box located within the department, or directly administered the questionnaire during mandatory training events. The students were recruited during their classes.The total number of questionnaires distributed was 3597, of which 2627 (73%) were returned.In this paper, we analyze the first and the third sections of the questionnaire, focusing on perceptions of the risk of contracting and transmitting influenza, attitudes regarding being vaccinated, and knowledge of vaccine effectiveness and safety. The other sections have been discussed in other papers, as well as predictors of vaccination against pandemic influenza ,15.ad hoc database. The statistical analysis was performed using IBM SPSS Statistics 20 .The collected data were entered into an Data regarding previous vaccination against seasonal influenza were re-coded into three categories: “always vaccinated” ; “sometimes vaccinated” (once or twice from 2007 to 2009); and “never vaccinated” .2 test. An alpha level of 0.05 was considered significant.A descriptive analysis was performed, including an evaluation of associations using the ChiOf a total of 2627 questionnaires, 2576 were fully completed. Three hundred seventeen subjects answered “always vaccinated,” which indicated they had been vaccinated in all three seasonal vaccination campaigns under consideration (2007–2008 to 2009–2010), and 338 reported receiving vaccinations once or twice. In contrast, 1921 subjects had never been vaccinated during the campaigns under consideration. The data are displayed in vs. 9.8%).The analysis of the results by gender indicates that vaccination continuity  was more common in males than in females , followed by non-healthcare workers (administrative staff and cleaning company employees).Nurses, healthcare assistants, and other HCWS have a high percentage of “never vaccinated” (71.9%–81.4%). This is also the case for students (79.7%). The highest proportion of “always vaccinated” (35.3%) is found among physicians, followed by non-healthcare workers.The subjects living with elderly people or with people affected by chronic illnesses had a greater tendency to receive vaccinations in all three seasons than to receive them once or twice in the three seasonal vaccination campaigns studied. This is also observed in the subjects affected by chronic illnesses such as cardiovascular, respiratory, and autoimmune diseases, kidney-related diseases, and diabetes.Living with children younger than nine years of age or having had a respiratory infection in recent years does not influence vaccination continuity.Those who believe that their own health is “not good” are observed in greater numbers in the “always vaccinated” subgroup than the “vaccinated once or twice” subgroup.Furthermore, the “always vaccinated” subjects have a higher mean age than the other subgroups.The three categories were significantly associated with each statement, with the exception of “fear of needles” and “my Local Health Unit promotes vaccination.”Compared to those who responded that they were “never vaccinated” or “sometimes vaccinated,” those who responded “always vaccinated” were more likely to believe that influenza is a serious illness.Moreover, 54.7% of those “always vaccinated,” 52.3% of those “sometimes vaccinated,” and 40.9% of those “never vaccinated” totally agree with the statement “it is likely that I can transmit influenza.”Among the “never vaccinated” subjects, 10.4% totally disagree that it is better to contract influenza than to get vaccinated; the percentage of disagreement increases in the “sometimes vaccinated” and “always vaccinated” subgroups.Regarding the effectiveness of the influenza vaccine, the percentage of agreement  is high for each category (greater than 71.7%).The subjects who refused vaccination have a greater tendency to believe that the vaccine could cause influenza and that it could have serious side effects than those in the other two subgroups.Agreement regarding adjuvant effectiveness increases from those who were never vaccinated to those who were always vaccinated; in contrast, there is no significant difference between the three categories in beliefs regarding possible side effects caused by adjuvants.Most of the respondents know where the vaccine is offered and are aware that the Local Health Unit promotes vaccination.The percentage of subjects opposed to vaccination  is 57.7% in the “never vaccinated” group, 37.3% in the “sometimes vaccinated” group, and 14.2% in the “always vaccinated” group.More than 60% of the subjects in the “always vaccinated” group totally agreed that HCWs should be vaccinated, but only 17.5% of the “never vaccinated” group shared that opinion.Self-protection and protecting family members and other people close to the HCWs from being infected and representing potential sources of influenza can be considered one of the motivating factors for subjects to receive the vaccine.The percentage of subjects who were “always vaccinated” is higher than those who were “sometimes vaccinated” or “never vaccinated”  among the respondents who believed that the flu vaccine is important to their family members or other people close to them.The results of the survey show that the enrolled subjects tend to be in the “never vaccinated” category despite considering influenza to be a serious illness and believing that the influenza vaccine is effective.Because a person’s history of influenza vaccination is considered a positive predictor of future vaccination ,15,16, wWe paid attention to attitudes and motivators driving vaccine acceptance. These include protection of oneself and family members or other close people, and the belief that influenza is a serious illness and that the vaccine against it is effective. Past research supports our findings ,19,20,21Awareness that influenza is a serious illness with an effective vaccine and understanding that one may transmit influenza are all lower in the “never vaccinated” group than in the “always vaccinated” and “sometimes vaccinated” groups. For this reason, it is important to increase the level of knowledge regarding the risk of acquiring and transmitting influenza in the workplace and to improve the adoption of preventive measures, namely, immunization in this group. For the “always vaccinated” and “sometimes vaccinated” groups, the purpose of public health interventions could be to maintain and support their level of influenza awareness and knowledge through informational campaigns in workplaces.As has been previously demonstrated ,23, physThe survey also investigated possible barriers to vaccination. Contrary to findings in other publications ,25, in tIn Italy, other studies have been conducted to investigate the attitudes and knowledge of HCWs and medical students regarding influenza and seasonal , pandemiThe strengths and limitations of this study are mainly related to its design, as previously described ,15.Adapting strategies for the distribution of questionnaires to the specific needs of the HCWs allowed us to obtain information on as many professionals and students as possible. However, this strategy also had the potential to limit the generalizability of the collected data, introducing a confounder. The ability to administer the questionnaire during training courses led to high response rates. In contrast, the use of locked boxes to collect the questionnaires in some departments resulted in lower levels of compliance.Another limit of the study is represented by the fact that we do not have any information regarding those who did not return the questionnaire; this aspect may further limit the generalizability of the results.In conclusion, the results highlight the importance of improving vaccination among HCWs through multi-component interventions. Targets should include both HCWs who do not usually get vaccinated or who sometimes get vaccinated and HCWs who have been vaccinated in previous years.This study also underlines the importance of improving knowledge of influenza transmission and vaccination among HCWs. Moreover, the findings of this study indicate a need to strengthen knowledge of the risks of influenza through university coursework.


Zār is the term used to describe a form of spirit possession common in northern African, eastern African, and some Middle-Eastern societies. Although these regions share some cultural similarities arising from their history of slavery, in these places, zār varies in prevalence, clinical characteristics, and social context. Based on a selective review of the literature, this paper looks at the place of zār spirit possession in both DSM-IV and DSM-V; it also examines how zār is manifested in Iran and in African countries including Sudan, Ethiopia, and Egypt; and it aims to provide practical information to mental health clinicians so that they can better understand how this cultural concept is practiced by Iranians and Middle Eastern and African immigrants living near the Persian Gulf coast.Zār refers to a type of spirit, to the illness caused by those spirits who possess humans, and to the rituals needed to pacify those spirits . The zārIn the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), zār is addressed as a culture-bound syndrome. DSM-IV contains symptomatic descriptions of 25 culture-bound syndromes. According to the Glossary of Culture-Bound Syndromes in appendix I of DSM-IV (p. 844), “[T]he term culture-bound syndrome denotes recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be ‘illnesses’ or at least afflictions and most [of them] have local names. . . . [C]ulture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.” Although zār is not considered pathological in local cultures, depending on its severity, it can be perceived outside of the cults in which it develops as a symptom of more serious mental health problems , such asSimilar to DSM-IV, in DSM-V, there are comments on specific culturally shaped syndromes—those few disorders around the world that are truly “bound” to one culture—but there are also discussions about the cultural concepts of illness and a deconstructed notion of culture-bound syndromes, which many believe were a legacy of colonial psychiatry. Based on the most recent change in DSM-V, culture-bound syndromes are actually better understood as some forms of Cultural Concepts of Distress such as cultural syndromes, cultural idioms of distress, and/or cultural explanations. According to DSM-V, “Cultural Concepts of Distress refers to ways that cultural groups experience, understand and communicate suffering, behavioral problems, or troubling thoughts and emotions” . This isAlthough in DSM-V the zār is not listed among the examples of the cultural concept of distress, it is still crucial to be aware that in the places where the zār ritual is practiced, the patients’ clinical presentations may be influenced by the cultural concepts and modes of expression explained in DSM-V. People in the cults where zār is believed and practiced use it when they face difficult circumstances such as marital conflicts, gender and social inequalities or in response to social and cultural changes , 15. BelSimilarity in the names of this spirit possession suggests that many of the cults are historically related although evidence has not directly addressed this claim. For example, in Chad, there is the liban sheitan , 28; amoConsidering the globalization and the migration of a large number of people from rural areas and small cities to larger cities, as well as immigration from low- and middle-income countries to high-income countries, it is important that mental health clinicians familiarize themselves with zār, this formerly-called culture-bound syndrome, and its historical roots in different contexts. Based on a selective review of cultural psychiatry and medical anthropology literature, this paper aims to provide clinicians and researchers with a sociocultural and historical understanding of zār spirit possession that will help them identify this condition in clinical settings in order to avoid misinterpreting it as a psychosis and/or dissociative identity disorder and to increase intervention efficiency.Forms and Variations of Zārs in African CountriesEthiopia:According to a well-known Ethiopian story, Adam and Eve had thirty children and to protect the most beautiful ones from the Divine envy, Eve tried to hide fifteen of them in the Garden of Eden, out of God’s sight. God, who was all-seeing, got angry with Eve and declared that those children would remain invisible for eternity. The fifteen invisible children became the ancestors of resentful and unpredictable spirits like zārs, and the other fifteen became the ancestors of humanity. In Ethiopia, if a zār chooses a person, then that person would be a member of the zār cult. The zār’s intention almost always would be identified by the physiological symptoms that have not effectively responded to the existing medical options. The most common symptoms include headaches, lethargy, or infertility, which different types of healers, including biomedical doctors, could not treat , 16. ResAlthough spirit-possession-related illnesses are treated as an ancillary concern by most cult members, in the Amhara, zār-related illnesses are considered important in terms of the relations between cult spirits and cult members both during and after initiation. In fact, participating in illness episodes provides members with the adaptive strategies that the cult offers .Egypt: In a study on the spirit possession cult in Nubia, Egypt, Kennedy 1967) provided a clear picture of the Nubian zār cult mentioning several methods that the Nubians use to deal with their health disturbances. Among those methods, zār is known as the most powerful therapeutic practice; it is effective for several types of illnesses and is specialized for alleviating states of hysteria and anxiety. According to the Nubian disease theory, illnesses are caused by the evil eyes of envy, the breaking of taboos, and sorcery, which all are associated with spirits; mental illnesses are mainly caused by spirits or jinn. Nubians believe that the spirits or jinn occupy rooms and houses when no one is at home. They will then enter the person’s body—specifically angry or aggressive persons, who are more attractive to the jinn. However, the spirits or jinn, rather than the possessed person, would be blamed for the erratic behaviour 7 provide. The NubAccording to Kennedy, the zār ritual in Nubia, which is mainly an adult female activity, reflects Nubian social conditions in terms of sex segregation, gender inequality, low female status, the restriction of women from religious participation, relative isolation, and marital insecurity. By observing the non-sick participants, he also supports his hypothesis that zār and other ritual activities allow not only the sick persons (possessed ones) but also the normal persons to be relieved of persistent and regular anxieties and tensions arising from Nubian life conditions. The common symptoms of the zār-possessed person include apathy, withdrawal from human company, minimal communication, refusal to work, strong desire to die, anorexia, and insomnia. Anxiety reactions or hysteria reactions like paralysis are also seen among the majority of the zār patients, and dissociative states are an outstanding characteristic of the zār ceremony. Although the zār ritual is specialized for healing these cases, a few psychotic patients are reported to have been healed as well. It is also assumed that the ceremony is like an acting-out of wish-fulfillment fantasies on the part of the women participating; the spirit who possessed the person demands material favours such as jewellery, new clothes, or expensive food, which the husband is expected to provide. The audience’s responses provide social support and temporarily indulge the possessed person’s wish fulfillment. Although ethnographers suggest that most patients are prone to hysteria or anxiety, the cult members feel that wass wassa (a depressive condition) is healed by zār , 36.Sudan:In Sudan, possession is usually associated with an illness that can be caused or intensified by spirits. However, it is not the case of every sickness. Doing ethnography on zār possession in the Hofriyati community of northern Sudan, Boddy states that the villagers attributed the illnesses to the variety of factors resulting from natural causes and that only the stubborn symptoms such as persistent headaches, nausea, anorexia, lassitude, apathy and depression, sleeplessness, anxiety, unspecified aches and pains, being easily saddened, and fertility problems may be ascribed to zayran (different kinds of zār). Similar to Kennedy’s observations in Nubia, some hysterical conversion disorders (as defined in the West) are reported in Hofriyati . These conditions are mainly associated with the zār possession. However, Hofriyati people might also link them to other supernatural causes, like sorcery  or the evil eye (ayn harra), that make people more susceptible to spirit possession. In the Hofriyati, someone who is considered to be zār-affected is called either inda zār or inda dastur, which means “she has a spirit,” or is said to be mazur or madastir, which means “with a spirit,” possessed. Zār possession is known as an affliction and is expressed as an illness. Moreover, it is believed that zayran never abandon their hosts’ body, which means a person who is possessed will be always possessed and will be affected by her spirit(s) at any time. Villagers say if zayran infiltrate their hosts’ body, it will coincide with the latter's entrancement. The spirit's forceful entry into the body, which Hofriyatis called ghaybiya or ghaybuba (possession trance), displaces the person’s self to another perceptual stage. A trance is only one of many manifestations of possession as zayran affect their hosts in various ways see also , 28. TheIn Sudan, the possession ritual is not considered exclusive to women. However, spirits are attracted to married women, mostly between the ages of thirty-five and fifty-five, and rarely affect unwed women, whose fertility has not been activated yet. Spirits are also known to covet those women who use henna, perfumes, soaps, and scented oils, and wear gold jewelry and diaphanous wraps. As Boddy observed 1989), “[T]he proclivities of zayran are symmetrical to those of Hofriyati women: both are regarded as consumers of goods provided by men (p.141) , which is equal to zār in the south . AccordiThe origin of Iran’s Zār: The word “zār” in Farsi means desolate, feeble, languid, and weak; and it is derived from Persian rather Arabic  or more These similarities suggest a common origin for this belief and practice . In the Slavery and Persian Zārs: Africans were enslaved, transported, and sold through the slave trade network in the African interior. Most enslaved Africans were shipped through the sea trade route of the Indian Ocean, which ran from the Swahili coast to Muscat, the Ottoman Empire, the Arab States, and Iran. Thus, most of the Africans sent to Iran through the slave trade came from northern and eastern Africa through the Persian Gulf. Moreover, Iranian pilgrims brought another group of slaves from the Arabian cities of Baghdad, Karbala, Mecca and Medina to western and southwestern Iran. The landed slaves were taken to the customs houses at the Iranian ports and were sent from there to various cities of Iran, which had specialized slave markets in the 19th century. Local people in southern cities bought most of the enslaved Africans. A small number of slaves were also sent from southern ports to other parts of the country and were absorbed in different socioeconomic sectors. Most of the slaves who settled along the Persian Gulf coast worked as pearl fishers, laborers, or domestics. Some of them settled in the capital city and other big cities and were engaged in specific tasks in the harems of the Shah and princes. In harems, African male slaves served as lala  and female slaves as daya (nanny) and dada  and their children were called khanazad (house-born) .The prophet Mohammad rejected the idea of slavery. The Quran established rules related to the treatment, sources, marriage, and emancipation of slaves. In Islam’s view, slaves have to be considered as a part of the household and had to be absorbed into the society after they converted to Islam. As converting non-Muslims to Islam and freeing the slaves are advocated and valued by Mohammad, Iranians had the religious justification to employ slaves, convert them to Islam, and then treat them as equals with the Iranian employees. This religious belief helped Persians to consciously justify enslavement; however, they might have treated the slaves as a part of their household. The trade of African slaves to Iran shaped the diaphonic communities of Afro-Iranians along the coast of the Persian Gulf in the southern parts of the country. However, because the slaves were integrated into a society dominated by non-blacks, they were invisible in certain areas of Iran. Nevertheless, the African heritage has been kept alive by the survival of the Afro-Iranian community in a few regions in southern Iran. Slavery and the diasporas of Africans from eastern and northern Africa allowed the slaves to introduce their cultural beliefs and practices to wherever they settled. These cultural features and traditions helped them preserve their heritage , 44. In Zār Ritual in Iran: The zār ceremony has changed over time and from place to place; however, two common phases are recognized in most of the zār rituals along the Persian Gulf coastline: separation and incorporation. Sabaye Moghaddam in the Encyclopædia Iranica explains these phases . AccordiWhen the zār is identified, Bābā or Māmā zār starts to communicate with the zār in a language that is ordinarily unfamiliar to themselves and the patient. This language is a combination of Persian, Arabic, Swahili, and Indian. Through this communication with the zār, the healer tries to find out the reasons behind the affliction and what the spirit wants in exchange for leaving the patient alone. Through the afflicted, the zār names its demands, which vary from simple things, such as a few prayers or a piece of bamboo (ḵeyzārān), to something more considerable, such as a sacrifice. Bābā/Māmā zār assures the zār that its demands will be met by tying a piece of cloth around the patient’s arm. It is believed that if the zār’s wishes are not granted, the zār will return and make more trouble for the patient. Depending on how easily the demand of the zār can be fulfilled, it will be quickly provided during the ceremony or will be met in a similar ritual later. For example, if the zār requests a sacrifice and that sacrifice can be provided quickly, then the cult members slaughter the animal; and after that, the patient, healer, and Ahl-e-Hava drink the blood. If the animal cannot be provided, then in another zār ceremony, this patient will ride in on an animal, which later will be sacrificed. The patient is then considered a cult member (Ahl-e-Hava) and must participate in all future ceremonies. These ceremonies can last for a week after the separation phase. There are also certain rules for the cult members: their clothing must be always clean and white and they must not touch the animal or human corpses, drink alcohol, or have sex outside their marriages. Also, they cannot sell or give away the object the zār has asked for, and if it is portable , the patient must bring it to all future ceremonies. Otherwise, the zār will possess the patient again and the ceremony has to be repeated  refers to the spirit possession that causes illness. Believing in the zār illness and the practice of the zār ritual as a therapy originated in Northern and Eastern Africa and was transported to other countries in the Middle East (such as Kuwait and Iran) through slavery. In most African countries, zār is mainly an adult female activity—involving married women mostly between the ages of thirty-five and fifty-five—which reflects the condition of sex-separation, low female social status, marital insecurity and relative isolation. Young states that the woman seeks remission from a sickness caused by the zār . She remNevertheless, in southern Iran, women are not the only ones who are affected by zār. In the regions where the zār cults still exist, everyone is subject to the action of the zār, but the poor and the deprived, such as fishermen, seem to be the zārs’ most common targets , 39. AltZār was considered as a culture-bound syndrome in DSM-IV; however, due to some innovations in DSM-V that led to a change in the notion of culture-bound syndromes and the appearance of cultural concepts of distress, the zār lost its place on the list of relevant examples. Several generations of anthropologists and cultural psychiatrists have tried to understand whether the languages that people use to explain their suffering can be brought into the psychiatric realm as conceptual tools. In the latest version of DSM, few disorders that are truly “bound” to one culture have been identified. Luis-Fernandez points out that these disorders are seen in different cultural contexts with the similar presentations, and though rarely, there are different cases across very diverse societies. He also emphasizes that all disorders, regardless of the context, are influenced by the cultural concept of the patient .Balhara (2011), in his study on dhat syndrome—another formerly-called culture-bound syndrome and newly-called a cultural concept of distress—adds that even though these psychiatric disorders are classified under the same diagnostic category, various local cultural beliefs, attitudes, and knowledge generate different manifestations and illness models of these disorders in different cultures . AccordiFinally, due to the rapid increase in globalization and cultural diversity, particularly in Western societies, cases with any or all of the three new terms listed within the cultural concepts of distress—including culturally shaped or influenced symptom clusters; cultural idioms of distress; and explicit causal models, attributions, or explanations—are more likely to seek mental health care in different cultural contexts. Moreover, as it is mentioned in DSM-V’s cultural formulation chapter, cultural concepts provide clinicians with a framework that can help them to avoid misjudging the severity of a problem or assigning the wrong diagnosis because of its cultural variation in symptoms and/or in explanatory models . Given that clinical presentation of a patient can be influenced by cultural concepts and modes of expression, it is crucial for clinicians to be able to understand the sociocultural and historical contexts of where the illness is developed and how people in those contexts perceive their own mental health suffering.Mianji Fahimeh: Doctoral Award; Global Health Research-Capacity Strengthening Program (GHR-CAPS) – Trainee Award; McGill Institute for Health and Social Policy.


Odocoileus virginianus). Captures occur on winter yards where deer migrate in response to changing environmental conditions. Yet, not all deer migrate in all years, and captures during mild years are more likely to target deer that migrate every year . Characterizing deer as conditional or obligate migrators is also challenging unless deer are observed for many years and under a variety of winter conditions. We developed a hidden Markov model where the probability of capture depends on each individual's migration strategy , a partially latent variable that depends on winter severity in the year of capture. In a 15-year study, involving 168 white-tailed deer, the estimated probability of migrating for conditional migrators increased nonlinearly with an index of winter severity. We estimated a higher proportion of obligates in the study cohort than in the population, except during a span of 3 years surrounding back-to-back severe winters. These results support the hypothesis that selection biases occur as a result of capturing deer on winter yards, with the magnitude of bias depending on the severity of winter weather. Hidden Markov models offer an attractive framework for addressing selection biases due to their ability to incorporate latent variables and model direct and indirect links between state variables and capture probabilities.An important assumption in observational studies is that sampled individuals are representative of some larger study population. Yet, this assumption is often unrealistic. Notable examples include online public-opinion polls, publication biases associated with statistically significant results, and in ecology, telemetry studies with significant habitat-induced probabilities of missed locations. This problem can be overcome by modeling selection probabilities simultaneously with other predictor–response relationships or by weighting observations by inverse selection probabilities. We illustrate the problem and a solution when modeling mixed migration strategies of northern white-tailed deer ( An important assumption in observational studies is that sampled individuals are representative of some larger study population. Yet, this assumption is often unrealistic. When selection probabilities of observational units depend on the response of interest, sample and population summaries can be vastly different. Selection biases can also distort observed relationships between variables when selection probabilities depend on unmeasured characteristics related to both predictor and response variables. These problems are common when data are collected using voluntary surveys as individuals are more likely to respond if they hold strong opinions, often referred to as self-selection bias  processes. As an example, Nielson et al.  developeOdocoileus virginianus).Our primary purpose of this study is to raise awareness of the potential for selection bias in ecological studies, but also to illustrate another interesting example where a model-based solution is possible. Specifically, we illustrate the problem of selection bias and a solution in the context of modeling mixed migration strategies of northern white-tailed deer  have typically been concentrated on wintering areas, called "deer yards" . Using this model, we reanalyze the data from Fieberg et al. . Our spe2 study area in northern Minnesota, USA. Inclusion of summer grounds expanded the study area to 1,865 km2  and one point for each day when snow depth was ≥38 cm (snow-day) during 1 November–31 April. Maximum winter severity indices (hereafter WSI) in each winter ranged from 42 to 195 during the course of the study.Minimum and maximum ambient temperatures and snow depths were recorded daily at designated nonforested  locations in the study area during January–March 1991–2005  probability an animal is captured given that it is a member of group s, ps,t. Using Bayes rule, the probability that a randomly captured deer in year t will have migration strategy (S = s) is given by:Fundamentally, the initial probability of capturing and radiocollaring animals subscribing to different migration strategies is composed of two components: the proportion of animals (without collars) in the population belonging to each migratory group ps,t; for instance, we might want to model ps,t as the product of the probability that an animal is available for capture , θs,t, and the probability of capture , pt. The subscripts in this case indicate that migration strategies influence the probability that an animal is available for capture, but not the probability of capture (once available). Under this formulation, Eq. where the summation is taken over all possible migratory strategies. In some cases, we might wish to further expand the model for pt, canceling out. Our strategy will be to employ Eq. with the probability of detection, t for conditional migrators as a linear function of the WSI in year t, xt. Specifically, let yi,t = 1 if the ith deer migrates in year t and 0 otherwise, and zi = 1 if the ith deer is an obligate migrator and 0 otherwise . Then:While obligates migrate every year, conditional migrators are more likely to migrate during severe winters. To capture this dynamic, we modeled the logit probability of migration in year Or, unconditionally:2) denotes a normal (Gaussian) distribution with mean μ and variance σ2. The migration strategy indicators, zi, are only partially observed. Deer that do not migrate from their summer grounds in ≥1 year are known to be conditional migrators , but the converse is not necessarily true. Thus, zi is treated as a latent (unknown) parameter for deer that migrated in all years that they were observed.Here, To account for the selection bias that occurs from capturing deer on winter yards, we applied Eq. ti indicates the sampling occasion on which individual i was initially captured and collared. In our special case of only two migratory classes , the expression for ωt1, .Thus, the probability that a captured deer will be an obligate migrator will be higher in mild years  expansion and contraction of the relative abundance of each migratory sector; and (2) selection bias in the marking  process drawing down the number of unmarked animals in each sector at different rates. Although we did not consider the latter to be important in our deer example because of the relatively small proportion of the population that is caught and radiocollared each year  using natural cubic regression splines with 2 degrees of freedom:Population-level state distributions, owing to  expansioB1 and B2) using the "ns" function in the splines library of Program R , we used Markov chain Monte Carlo (MCMC) to numerically integrate over the latent variables using a Bayesian formulation of the problem. We specified β0 and α0 because reverse transformation results in an approximately uniform distribution on . We specified β1, α1, α2. Lastly, we specified a uniform prior for σε. We used the R2jags package in Program R to facilitate estimation with jags , nt is the number of radiocollared individuals in year t, n is the total number of migratory animals followed throughout the survey, and Ii is an indicator taking on a value of 1 if individual i is in the study in year t and 0 otherwise. Lastly, we calculated the expected value of zi for each deer in the study, as the average of the zi's across all MCMC iterations.where The mean annual cohort size was 24 and ranged from a low of 11 in the first year of the study to a high of 35 during the winter of 1996–1997  were captured in all years, those deer identified as most likely being obligate migrators  close to 1) were most often captured and collared during mild winters  as a function of an individual's follow-up time and the minimum WSI experienced while under observation.Our approach built on hidden Markov models, which allowed us to separate underlying migration states  from observation type (migrate/did not migrate). However, unlike most hidden Markov models for mark–recapture–recovery data, our model provides a framework for estimating the proportion of obligate migrators in the unmarked population, 1,t Fig. A are in 1,t Fig. . The latωt1,] = γ0+γ1xi,c, where xi,c is the WSI during the year individual i was captured, and γ0 and γ1 are additional regression parameters to be estimated. Although this modification would allow one to model and adjust for selection biases, the advantage of the current formulation is that it provides a direct estimate of πs,t.In developing our model, we assumed conditional migrators could not be captured unless they migrated to winter grounds. This assumption was reasonable for these data, as all of the capture efforts were concentrated on winter yards and capture efforts did not begin until late in the winter after deer had migrated. Nonetheless, this assumption may not be realistic if a wider distribution of capture effort  is employed. This key assumption could be relaxed by using a more general model for the selection bias. For example, one could assume: logit=β0+β1xt+zi. Selection biases could once again be accounted for by allowing zi to depend on the winter severity during the year of capture.In our application, we made the simplifying assumption that the population was composed of a mixture of two types of animals: those that always migrate (obligates) and others that migrate in response to winter weather . Nonetheless, it would be easy to extend the approach to populations exhibiting a variety of partial migration strategies (Mueller and Fagan Our primary focus in this study was on estimating migration-related parameters, as opposed to other life-history parameters like survival. As such, we were able to greatly simplify model construction by conditioning our model on animals that were known to be alive. As with hidden Markov models for mark–recapture–recovery data (cf. Pradel Selection biases are likely to be prevalent in many ecological studies, and in such cases, researchers should make attempts to study and correct for these biases. One area that has received much attention, particularly lately, is the potential bias that can result from missed locations in animal telemetry studies (e.g., Frair et al.


I was set to condemn yet another narcissistic autobiographical account that would be pro-anorexia fodder – but the author herself cleverly forestalls that objection. She acknowledges that we can't stop ‘wannarexics’ from devouring this as a motivational manual. Thus from the start, the book evokes that familiar sense of intellectual duelling between patient and clinician, with anorexia always at least one step ahead. This is one reason why I would recommend this book to any colleague with the stomach to read it, and to anyone who dares trivialise the challenge of working with people with eating disorders.I found the spitefulness, the scorn, the superiority of anorexia quite chilling. It dehumanised Nancy, and made it hard to feel for her, although she suffered dreadfully. I laughed uncomfortably. I wondered with horror which of the three caricatured clinicians is me – Kind-face, Mean-face or Hangover face. Or, hopefully, ‘Sharp Psychiatrist’, even ‘The Right Therapist’. Patients have made me all of these at times. I cringed at the thought of her parents reading about their ‘marital(ish) bed’ – a quip which outlasts the apologies and appreciations at the end.What did I learn? Well, that out-patient weights mean next to nothing. Nancy isn't unique in ‘faking’ as much as 10 kg – so why do we base clinical decisions on BMI alone? I knew that anorexia is like possession by devils but I saw it afresh. I learned from the black humour of Tucker's ‘questionnaires’ that there are no right answers. Whatever your responses to anorexia's dilemmas, you have got it wrong. That is the dynamic.Anorexia: The Musical. As Tucker's style matures, her archness may be used more sparingly, she may edit out such distractions as colour titles and metaphors, and attend to the overall balance of the narrative, rather than merely acknowledge its imbalance. In fact, 300 pages give us the gory details of her anorexic career, while only the final 50 are devoted to the real meat of the story, the ‘time in between’ which the title evokes.It's a chilling read, and both gratifying and irritating in turns. Tucker is a razor-sharp thinker and writer. The satirical dramatisations and caricatures evoke a stage adaptation – perhaps But I would not change the title. The last pages are the real genius of this book. The author poignantly describes her loss of anorexic power, descent into bulimia and weight gain. She re-enters real life, makes genuine relationships (including one with ‘the Right Therapist’) and experiences self-compassion for the first time. The spiteful start is transformed into lyrical, youthful, purple passages about her rites of passage. I was won over.