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Problem-Based Behavioral Science and Psychiatry
Daniel Alicata • Negar Jacobs • Anthony Guerrero
Melissa Piasecki
Editors

Problem-Based Behavioral
Science and Psychiatry
Second Edition
Editors
Daniel Alicata Anthony Guerrero
John A. Burns School of Medicine John A. Burns School of Medicine
University of Hawaiʻi University of Hawai‘i
Honolulu Honolulu
Hawai‘i Hawai‘i
USA USA

Negar Jacobs Melissa Piasecki

School of Medicine School of Medicine
University of Nevada University of Nevada
Reno Reno
Nevada Nevada
USA USA

ISBN 978-3-319-23668-1    ISBN 978-3-319-23669-8 (eBook)

DOI 10.1007/978-3-319-23669-8

Library of Congress Control Number: 2015959569

Springer Cham Heidelberg New York Dordrecht London

© Springer International Publishing 2016
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita-
tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or in-
formation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica-
tion does not imply, even in the absence of a specific statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.

Printed on acid-free paper

Springer International Publishing AG Switzerland is part of Springer Science+Business Media

(www.springer.com)
Foreword

Learning behavioral science is a critically important part of becoming a physician.

More and more, professional and accrediting organizations are explicitly endorsing
the necessity of physicians being skilled and well trained in these areas.
Physicians themselves are increasingly aware of the importance of behavioral
health and psychiatric issues in their practices. Whether one intends to practice in
a primary care or subspecialty area, an appreciation of behavioral health issues and
basic principles of psychiatry is critically necessary. In addition to topics that are
more specific to the practice of psychiatry, the authors of this textbook have chosen
to cover a range of topics important to all aspects of clinical medicine, including
culture, violence, physician–patient relationships, adherence and substance abuse.
Almost any practicing physician will admit that effectively addressing these types
of behavioral issues is among the more challenging tasks they face.
Teaching and learning about psychiatry and behavioral sciences can be diffi-
cult. Basic textbooks do not easily connect their lessons with the complexity of
clinical reality. Students cannot easily find the clinical importance from classroom
lectures. Even clinical clerkships in psychiatry have difficulty exposing students to
the breadth of clinical experiences they need to learn about.
This valuable book has realized the promise of becoming a solution to these chal-
lenges. The study of psychiatry and the behavioral sciences is perfectly matched
with the problem-based learning methods utilized in this book. Problem-based
learning (PBL) is a widely utilized approach to learning that involves the detailed
study of patient cases, with a primary goal of identifying topics for self-study rel-
evant to the cases. This approach helps students find meaning in learning a wide
variety of topics, and provides an opportunity to apply new knowledge to clinical
situations. Through understanding the cases, they learn psychiatry.
This second edition of Problem-Based Behavioral Science and Psychiatry has
found a way to improve itself from the first edition. In addition to updating the
material in each of the chapters, the additional attention to the most recent editions
of the content maps of the United States Medical Licensing Examination (USMLE)
Step 1 and Step 2 CK will provide additional value to medical students and those
responsible for organizing medical student curricula.

v
vi Foreword

For those familiar with the PBL process, this book offers a welcome resource in
the area of behavioral sciences and psychiatry. Students are sometimes reluctant to
vigorously pursue a study of behavioral issues. They often cite difficulty in finding
reliable, evidence-based resources for their independent learning. Unlike the bio-
logical and clinical sciences, where there are scores of readily available textbooks,
review articles and web-based resources, students often report frustration with the
relative dearth of medical student-friendly resources in the behavioral sciences.
This book represents a significant addition to student learning resources in behav-
ioral health, and should become a familiar and well-worn companion to students in
PBL environments.
For those new to the PBL process, this book will also serve as a useful guide to
approaching clinical problems. By working through the case studies in this book,
the reader will not only be able to learn important material related to psychiatry and
the behavioral sciences but also develop a systematic approach to lifelong learning
that will serve them well in their clerkships and beyond.
In addition to providing opportunities to work through clinical vignettes in a
problem-based learning format, the authors incorporate other useful and practical
learning tools such as mechanistic case diagramming and the bio-psycho-social-
cultural-spiritual formulation. In the long term, readers will benefit as much from
these exercises as they will from learning the content within the pages of this book.
So, in many ways, this book represents a learning tool as much as a content resource.
I am also particularly encouraged to see that a number of the contributors to this
book are themselves graduates of PBL medical schools. Their experiences should
provide them with a unique and valuable perspective in what they have chosen to
offer on the pages that follow.
Readers will find the methodology and approaches offered in this book to be re-
freshing and educationally rewarding. I hope that this text will prove to be the first
of a number of books that skillfully and thoughtfully blend authoritative content
with effective problem-based learning exercises.

Richard T. Kasuya, MD, MSEd

Associate Dean for Medical Education
Professor of Medicine
John A. Burns School of Medicine
University of Hawai‘i at Mānoa
Contents

1 How to Use This Book��������������������������������������������������������������������������������    1

Anthony P. S. Guerrero and Melissa Piasecki

2 Child Development������������������������������������������������������������������������������������ 15
Andrea Sorensen, Aubrey Klaich and Maya Strange

3 Effects of Early Experience on Brain and Body������������������������������������� 33

Debra J. Hendrickson

4 Learning Principles of Human Behavior������������������������������������������������� 55

David Antonuccio and Amber Hayes

5 Sexuality Throughout the Life Cycle������������������������������������������������������� 79

Steven R. Williams and Anthony P. S. Guerrero

6 Adaptation and Coping in a Medical Setting������������������������������������������ 99

Maria-Christina Stewart and Lance Hartmut Linke

7 Violence and Abuse������������������������������������������������������������������������������������ 113

Jeanelle J. Sugimoto-Matsuda and Anthony P.S. Guerrero

8 The Physician–Patient Relationship��������������������������������������������������������� 135

Negar Nicole Jacobs and Lisa A. Calvo

9 Clinical Ethics and Professionalism��������������������������������������������������������� 159

Kimiko Ishibashi, Shaye Lewis and Timothy Baker

10 Adherence in Medicine������������������������������������������������������������������������������ 187

Jared T. Ritter

11 Stress and Health���������������������������������������������������������������������������������������� 199

Lisa A. Calvo and Alex A. Morrison

vii
viii Contents

12 Health Care 101 and Systems-Based Practice��������������������������������������� 215

Paula Yoshioka and Michael H. Fukuda

13 Stigma and Medicine������������������������������������������������������������������������������� 229

Barbara Kohlenberg

14 Culture, Ethnicity, and Medicine����������������������������������������������������������� 243

Anthony P. S. Guerrero and Asad Ghiasuddin

15 Quantitative Measures in Health Care�������������������������������������������������� 259

M. Anand Samtani, Earl S. Hishinuma and Deborah A. Goebert

16 Death, Dying, and End-of-Life Care������������������������������������������������������ 291

Lori Murayama-Sung and Iqbal Ahmed

17 Basic Principles of Evaluation: Interviewing, Mental Status

Examination, Differential Diagnosis, and Treatment Planning����������� 309
Anthony P. S. Guerrero and Daniel A. Alicata

18 Disorders of Childhood��������������������������������������������������������������������������� 331

Erika Ryst and Jeremy Matuszak

19 Substance-Related and Addictive Disorders����������������������������������������� 353

William F. Haning and Anthony P. S. Guerrero

20 Schizophrenia Spectrum and Other Psychotic Disorders�������������������� 377

Steven J. Zuchowski and Brian Kirkpatrick

21 Mood Disorders and Suicide������������������������������������������������������������������� 403

Frederick Duennebier, Daniel A. Alicata and Anthony P. S. Guerrero

22 Anxiety Disorders, Obsessive-Compulsive and Related

Disorders, Trauma- and Stressor-Related Disorders���������������������������� 441
Gretchen Gavero

23 Somatic Symptom and Related Disorders��������������������������������������������� 463

Catherine McCarthy and Jason Reinhardt

24 Personality Disorders������������������������������������������������������������������������������� 487

M. Nathan Mason, Negar Nicole Jacobs and Latha Pai

25 Neurocognitive Disorders������������������������������������������������������������������������ 511

June C. Lee, Russ S. Muramatsu and Junji Takeshita
Contents ix

26 Sleep–Wake Disorders����������������������������������������������������������������������������� 533

Ole J. Thienhaus and Justin B. Otis

27 Feeding and Eating Disorders���������������������������������������������������������������� 551

Hy Gia Park

28 Sexual Disorders�������������������������������������������������������������������������������������� 571

Brandon Harsch

29 Other Disorders���������������������������������������������������������������������������������������� 597

Anthony P. S. Guerrero

Index���������������������������������������������������������������������������������������������������������������� 609
Contributors

Iqbal Ahmed Department of Behavioral Health, Tripler Army Medical Center,

Honolulu, HI, USA
Daniel A. Alicata Department of Psychiatry, John A. Burns School of Medicine,
University of Hawaiʻi, Honolulu, HI, USA
David Antonuccio Private Practice, Reno, NV, USA
Timothy Baker School of Medicine, University of Nevada, Reno, NV, USA
Lisa A. Calvo Psychiatry and Behavioral Sciences, University of Nevada School
of Medicine, Reno, NV, USA
University of Nevada School of Medicine, Reno, NV, USA
Frederick Duennebier Department of Psychiatry, John A. Burns School of
Medicine, University of Hawaiʻi, Kaneohe, HI, USA
Michael H. Fukuda Department of Psychiatry, University of Hawaiʻi John A.
Burns School of Medicine, Honolulu, HI, USA
Gretchen Gavero Department of Psychiatry, University of Hawaiʻi John A.
Burns School of Medicine, Honolulu, HI, USA
Asad Ghiasuddin Department of Psychiatry, John A. Burns School of Medicine,
University of Hawaiʻi, Honolulu, HI, USA
Deborah A. Goebert Department of Psychiatry, University of Hawaiʻi John A.
Burns School of Medicine, Honolulu, HI, USA
Anthony P. S. Guerrero Department of Psychiatry, John A. Burns School of
Medicine, University of Hawaiʻi, Honolulu, HI, USA
 epartment of Psychiatry, University of Hawaiʻi John A. Burns School of
D
Medicine, Honolulu, HI, USA
William F. Haning Department of Psychiatry, University of Hawaiʻi John A.
Burns School of Medicine, Honolulu, HI, USA

xi
xii Contributors

Brandon Harsch Department of Psychiatry, University of Nevada School of

Medicine, Reno, NV, USA
Amber Hayes Renown Medical Group, Sparks, NV, USA
Debra J. Hendrickson Northern Nevada Pediatrics, Reno, NV, USA
Earl S. Hishinuma Department of Psychiatry, University of Hawaiʻi John A.
Burns School of Medicine, Honolulu, HI, USA
Kimiko Ishibashi School of Medicine, University of Nevada, Reno, NV, USA
Negar Nicole Jacobs Psychiatry and Behavioral Sciences, University of Nevada
School of Medicine, Reno, NV, USA
Brian Kirkpatrick Department of Psychiatry and Behavioral Sciences,
University of Nevada School of Medicine, Reno, NV, USA
Aubrey Klaich Department of Psychiatry, Tufts-New England Medical Center,
Boston, MA, USA
Barbara Kohlenberg Reno, NV, USA
June C. Lee Department of Psychiatry, University of Hawaiʻi John A. Burns
School of Medicine, Honolulu, HI, USA
Shaye Lewis Boise, ID, USA
Lance Hartmut Linke Saint Louis, MO, USA
M. Nathan Mason Department of Psychiatry, University of Arizona College of
Medicine, Rocklin, CA, USA
Jeremy Matuszak Willow Springs Center, Reno, NV, USA
Catherine McCarthy Department of Family and Community Medicine,
University of Nevada School of Medicine, Reno, NV, USA
Alex A. Morrison University of Nevada School of Medicine, Reno, NV, USA
Russ S. Muramatsu VA Pacific Islands Healthcare System, Honolulu, HI, USA
Lori Murayama-Sung Honolulu, HI, USA
Justin B. Otis University of Arizona College of Medicine at South Campus
Psychiatry, Tucson, AZ, USA
Latha Pai Psychiatry, Mental health services (116), Veterans affairs Sierra
Nevada health care system, Reno, NV, USA
Hy Gia Park Arahant Health Services, LLC, Denver, CO, USA
Melissa Piasecki Department of Psychiatry and Behavioral Sciences, University
of Nevada School of Medicine, Reno, NV, USA
Contributors xiii

Jason Reinhardt Department of Psychiatry, University of Nevada School of

Medicine, Reno, NV, USA
Jared T. Ritter Florida State University College of Medicine, Holly Hill, FL,
USA
Erika Ryst Department of Psychiatry, School of Medicine, University of Nevada,
Reno, NV, USA
M. Anand Samtani Department of Commerce and Consumer Affairs, Public
Utilities Commission, Honolulu, HI, USA
Andrea Sorensen Department of Psychiatry and Behavioral Science, Reno, NV,
USA
Maria-Christina Stewart Berkeley, CA, USA
Maya Strange Reno, NV, USA
Jeanelle J. Sugimoto-Matsuda Department of Psychiatry, Research Division,
University of Hawaiʻi John A. Burns School of Medicine, Honolulu, HI, USA
Junji Takeshita Department of Psychiatry, University of Hawaiʻi John A. Burns
School of Medicine, Honolulu, HI, USA
Ole J. Thienhaus University of Arizona College of Medicine at South Campus
Psychiatry, Tucson, AZ, USA
Steven R. Williams Honolulu, HI, USA
Paula Yoshioka The Queen’s Health Systems, Honolulu, HI, USA
Steven J. Zuchowski Department of Psychiatry, University of Nevada School of
Medicine, Reno, NV, USA
Chapter 1
How to Use This Book

Anthony P. S. Guerrero and Melissa Piasecki

Welcome to the second edition of Problem-Based Behavioral Sciences and Clinical

Psychiatry: A Review for Medical Students! In this chapter, our aim is to illustrate
how the problem-based learning (PBL) process works so that you can apply it to the
other cases in this textbook.
The goals of this chapter are:
1. To provide the readers with a guided experience on “how to use this textbook.”
2. To review basic principles of problem-based learning, and the rationale for why
this approach is used.
3. To illustrate, with a sample case, the processes of:
a. “Progressive disclosure”
b. Identifying facts/problems, hypotheses/differential diagnoses, additional clin-
ical information needed, and learning issues
c. Thinking about underlying neurobiology and other physiological mechanisms
to understand the signs and symptoms of a case
4. To review the more generic process of bio-psycho-social-cultural-spiritual for-
mulation in order to understand the various perspectives offered by patient cases.
Because a textbook is not the same as a patient encounter or face-to-face small
group discussion, we are not claiming to represent PBL in a pure or “authentic”
form (Barrows 2000). However, we hope to integrate many of the principles and
potential benefits of PBL into this textbook.

A. P. S. Guerrero ()
Department of Psychiatry, John A. Burns School of Medicine, University of Hawaiʻi,
1356 Lusitana Street, University Tower 4th Floor, Honolulu, HI 96813, USA
e-mail: [email protected]
M. Piasecki
Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine,
1664 N. Virginia Street, MS 0426, Reno, NV 89557-0426, USA
e-mail: [email protected]
© Springer International Publishing 2016 1
D. Alicata et al. (eds.), Problem-based Behavioral Science and Psychiatry,
DOI 10.1007/978-3-319-23669-8_1
2 A. P. S. Guerrero and M. Piasecki

PBL, as described by Norman and Schmidt (1992), aims to endow learners with
the skills of clinical reasoning, cooperative learning, and patient-based integration
of knowledge. In its ideal form, it begins with a free-inquiry process, in which
learners explicitly discuss hypotheses and additional lines of investigation. This is
followed by a period of self-directed learning and a synthesis and application of in-
formation back to the case. The student then has an opportunity to critically evaluate
the initial clinical reasoning process. Because PBL attempts to integrate information
from multiple disciplines, all phases of the process emphasize attention to the bio-
logical, behavioral, and populational aspects of the case. Several articles (Guerrero
2001; Guerrero et al. 2003) have discussed how certain learning tools can be used
to ensure that beneficial PBL processes actually occur in the course of studying a
case. We will illustrate these tools, including “mechanistic case diagramming” as
part of this sample case.
When compared to traditional learning methods, PBL may enhance the applica-
tion of concepts to clinical situations, long-term retention of knowledge, and life-
long interest in learning (Norman and Schmidt 1992). It has been shown to improve
student and faculty satisfaction and educational outcomes in numerous clinical dis-
ciplines, including family medicine, pediatrics, obstetrics, and psychiatry (Wash-
ington et al. 1999; McGrew et al. 1999; Kaufman and Mann 1999; Curtis et al.
2001; Nalesnik et al. 2004; McParland et al. 2004). Furthermore, we believe that
psychiatry and the behavioral sciences, because of the inherently integrative and ho-
listic approaches of these subject areas, are particularly well suited for the study in a
PBL format (Frick 2005; Zisook 2005; Skokauskas et al. 2011). Peters et al. (2000)
report on the longitudinal outcomes of a randomized controlled trial and conclude
that the New Pathways Program at Harvard Medical School—of which PBL is one
important component—improved students’ interpersonal skills and humanistic ap-
proach to patient care, with no loss in medical knowledge.
We will illustrate the PBL process as applied to a case in this textbook. Typically,
each chapter will begin with the first paragraph introducing a case. For example:

Case Vignette 1.1.1 Presenting Situation: Melanie Crystal

Melanie Crystal is a 39-year-old woman who is the single mother of a 17-year-
old boy. She was referred for psychiatric assessment at the local emergency
room because a police officer on foot patrol found her crying and confused
in a nearby parking lot. She was tearful and hostile. She told the screening
nurse that she would kill herself “at the first opportunity.” On screening for
substance use, she stated that she used “dope.” Needle marks were visible on
both arms.

At this point, the student will see the following sign, which is a prompt to “Proceed
with the PBL process” before moving on to the remainder of the case.
1 How to Use This Book 3

Please proceed with the problem-based

approach using the worksheet located in the
appendix of Chap. 1!

Please fill in the facts, your hypotheses, further information needed, and learning
issues for Learning Issue Table 1.1.1.
Learning Issue Table 1.1.1

FACTS HYPOTHESES INFORMATION LEARNING

NEEDED ISSUES

Learning from these cases will be maximized if the student carefully digests all
components of the case and engages in the clinical reasoning processes that a cli-
nician uses to effectively evaluate and manage the case. For example, in the case
above, it may be worthwhile to:
1. Highlight or underline the facts
2. Specifically identify the clinical signs and symptoms that are present, as these
are likely to be the relative “endpoints” of a mechanism that must be subse-
quently understood. Below we show a graphical way of identifying signs and
symptoms through use of italics
Melanie Crystal is a 39-year-old woman who is the single mother of a 17-year-
old boy. She was referred for psychiatric assessment at the local emergency room
because a police officer on foot patrol found her crying and confused in a nearby
parking lot. She was tearful and hostile. She told the screening nurse that she would
kill herself “at the first opportunity.” On screening for substance use, she stated that
she used “dope.” Needle marks were visible on both arms.
3. Organize these findings in a grid shown below in appendix A (blank samples are
provided for photocopying).
4. Use this grid to guide the clinical reasoning process that will guide further evalu-
ation and management of the case.
4 A. P. S. Guerrero and M. Piasecki

Obviously, there will be variations in the specific items one will choose to put under
each of the columns. The main principles to follow are as follows:
1. To come up with specific hypotheses, ask the question: “What are the possible
mechanisms (biological or otherwise) behind the signs and symptoms present in
the case?” In this text, we emphasize the neurological and physiological mecha-
nisms that are known to be associated with normal and pathological behavior.
2. Additional clinical information (“What do you want to know next?”) reflect your
hypotheses and should follow a logical clinical organization.
In this textbook, the use of the clinical reasoning process will prompt or answer
many of the questions in the right-most column. Each clinical case includes text
coverage of the learning issues likely to be most relevant to medical student learn-
ers. Therefore, if this sample chapter were an actual textbook chapter, it would
contain sections on:
• The mechanisms behind abnormal mood and confusion
• The mechanisms of action of common illicit drugs
• Definitions of child abuse and neglect
Some chapters offer high-density tables and figures to illustrate mechanisms of
action. Examples include the mechanism of psychotic symptoms (see Chap. 20)
and the mechanism of action of common substances of abuse (see Table 19.1 in
Chap. 19).
With an effective clinical reasoning process, the subsequent sections of the case
will address items in the “what do you want to know next” column. A sample con-
tinuation of the case vignette is shown below:

Case Vignette 1.1.2 Continuation

Ms. Crystal was uncooperative with further questioning. Attempts to reach
collateral informants were unsuccessful. On examination, vital signs were as
follows: temperature 100.3°F, pulse 106/min, blood pressure 142/88, respira-
tory rate 22/min. The remainder of the physical examination was unremark-
able except for thin appearance, poor dentition, and needle marks on her
skin. Mental status examination (MSE) was remarkable for poor cooperation
and eye contact, mumbled rapid speech, labile and tearful affect, tangential
thoughts, possible auditory hallucinations, and suicidal ideations.

Please proceed with the problem-based

approach using the worksheet located in the
appendix of Chap. 1!
1 How to Use This Book 5

Please fill in the facts, your hypotheses, further information needed, and learning
issues for Learning Issue Table 1.1.2.
Learning Issue Table 1.1.2

FACTS HYPOTHESES INFORMATION LEARNING

NEEDED ISSUES

Once again, this will be a prompt to analyze the case and complete the table as
shown above.

Case Vignette 1.1.3 Conclusion

After admission to an inpatient unit, Ms. Crystal went to sleep and remained
asleep for almost 14 h. She was ravenously hungry and only marginally
cooperative with measurements of vital signs or attempts at interview. She
remained irritable and was verbally abusive to staff for the next day.
Three days later, Ms. Crystal became conversant with staff. On the fourth
day, she was pleasant and social. She described her history of methamphet-
amine use disorder beginning in her 20s, with 10 years of abstinence. She
stated that she stopped going to meetings and “it only took one guy” who
showed her the drug at his home. She reported that as soon as she saw and
“smelled” methamphetamine, she began to have intense cravings and imme-
diately relapsed. She has used daily for the last month or so and is not sure
where her adolescent son is. She thinks that he will be graduating from high
school “one of these days.”

The case and text discussion cover core curricular material relevant to the general
subject matter. For example, if the goal of the chapter were to review methamphet-
amine use disorder (refer to Chap. 19 on substance-related disorders), the following
learning issues would be covered:
6 A. P. S. Guerrero and M. Piasecki

• Epidemiology (including the recent epidemic, age groups affected, mortality sta-
tistics)
• Differential diagnosis (including mood, psychotic, and other substance disor-
ders)
• Etiology and neurobiological mechanisms
• Clinical findings (including cognitive changes, psychotic symptoms, motor
symptoms, acute and secondary drug effects, and craving)
• Treatment (psychosocial and pharmacological)
• Social, cultural, and legal factors
• Prognosis

1.1 Bio-Psycho-Social-Cultural-Spiritual Model

In all our teaching, we invite students to conceptualize patients’ problems by using a

bio-psycho-social-cultural-spiritual formulation. This model is used throughout the
psychiatric curriculum at the authors’ institutions. The goal of these patient formu-
lations is to consider the complexities of patient presentations and to drive treatment
planning. Formulations help explain, “how did this patient get to this psychiatric
state at this time?”
What follows is a description of the components of the bio-psycho-social-cul-
tural spiritual formulation (adapted from Kohlenberg and Piasecki 2006). We have
added prompts for the students to help them think about and organize clinical mate-
rial. Students are encouraged to include each component in formulations.
This model generally includes the following:

1.1.1 Biological

1.1.1.1 Past

Genetics:
• Consider whether any blood relatives have had psychiatric problems, substance
use problems, or suicide attempts/suicides. Is there a history of close relatives
who have been hospitalized for psychiatric reasons? What kind of treatments did
they get, and how did they respond?
History of Pregnancy and Birth:
• Consider pregnancy variables: Was there in utero exposure to nicotine, alcohol,
medications, or illicit substances? Was there anything unusual about pregnancy?
• Note birth complications, such as prematurity, birth trauma, and extended peri-
ods of hospitalization.
1 How to Use This Book 7

Relevant Previous Illnesses

• Consider any history of head injury, endocrine disorders (e.g., thyroid and adre-
nal), seizures, malignancies, or neurological illnesses.
• Consider potential lasting effects of past substance use on brain functions such
as cognition, affective regulation, etc.

1.1.1.2 Present

Current Illnesses:
• Identify current illnesses and any direct impact they may have on psychiatric
presentation.
Medications:
• Assess current medication regimen. Consider whether these medications have
psychoactive effects. (e.g., steroids, beta blockers, pain medications, benzodi-
azepines, serotonin-selective reuptake inhibitors, and antipsychotics). Consid-
er possible side effects of current medications and pharmacogenomic profiles
that influence how medications are metabolized. Note any noncompliance with
medications.
Substances:
• Consider the influence of nicotine, alcohol, and illicit drugs on current psychiat-
ric symptoms.
• Consider the possible effects of substance withdrawal.
Endocrine/hormonal:
• Consider the impact of onset of adolescence.
• Consider the impact of the menstrual cycle, pregnancy, postpartum period, and
menopause.

1.1.2 Psychological

Past
• Comment on any past history of trauma (child abuse, combat, rape, serious ill-
ness, etc.), as well as resiliency (how the patient coped with trauma, for example,
through friends, family, and religion).
• Consider the sources of positive self-image and positive role models.
• Comment on the patient’s experience with loss.
8 A. P. S. Guerrero and M. Piasecki

• Comment on the patient’s quality of relationships with important figures, such as

grandparents, friends, significant teachers, and significant employers.
• Comment on how past medical problems, substance use, or psychiatric problems
impacted the patient’s development and their relevance to the patient today.
Present
• Describe the recent events and experiences that precipitated the admission or
appointment.
• What are the current stressors? Do they have any symbolic meaning?
• Assess and comment on coping skills, defense mechanisms, and presence or
absence of cognitive distortions.
• Consider current developmental demands on the person, such as marriage, di-
vorce, birth, children leaving home, loss, and aging. At what stage of develop-
ment is the patient now? Is it appropriate to chronological age?
• What is the developmental impact of the patient’s illness?

1.1.3 Social

• How adequate is the patient’s current support system?

• What is the current status of relationships with important figures?
• What are the possible peer influences?
• Consider the patient’s current housing arrangement.
• Comment on vocational/financial status.
• Comment on any relevant legal problems.
• Consider the role of agencies (e.g., Veteran’s Administration, Child Protective
Services, and Criminal Justice System) on the patient.

1.1.4 Cultural

• Comment on cultural influences and acculturative pressures that may impact the
current situation.
• Comment on cultural influences on understanding of illness and/or help-seeking
behavior (including language issues).

1.1.5 Spiritual

• Comment on the role of spirituality in the patient’s life.

• Is the patient affiliated with some sort of spiritual community?
• How does spirituality contribute to the patient’s ability to hope, their position on
suicide if relevant, or their contact with a supportive community?
1 How to Use This Book 9

A sample bio-psycho-social-cultural-spiritual formulation for Ms. Crystal would be

as follows:
This is a 39-year-old woman with acute psychiatric symptoms. Biological fac-
tors that contribute to her presentation include the acute effects of methamphet-
amine on her mood and behavior. Methamphetamine is likely also contributing to
her abnormal vital signs. There is no history of current or previous medical prob-
lems, family history of substance use disorder/mental illness, or current medication
use.
Psychologically, this patient has recently experienced a relapse. Cues for drug
use included the sight and smell of the drug. She apparently lacked coping skills
for resisting relapse. There is no information about recent stressors, past trauma,
or relationship history. Her role as the mother of a 17-year-old has been seriously
compromised, but there is little information about how she perceives this. Her rela-
tionship with a man appears to be superficial and based on mutual drug use.
Socially, we have little information about her employment status, housing, legal
situation, or social supports. She appears to have benefited from meetings in the
past and may have been lacking the social support she needed to remain abstinent
prior to her relapse.
Spiritually, we have little information about her history and current beliefs.
In addition, we believe that both pre-clerkship behavioral science students and
clerkship psychiatry students can benefit from seeing a “big-picture” graphic rep-
resentation of the formulation: which uses arrows to detail how one aspect of the
case leads to another and ultimately results in her presenting concerns; which shows
how the biological, psychological, and social/spiritual/cultural aspects are ultimate-
ly related; and suggests how all knowledge learned (including basic neurobiological
mechanisms) can be used to benefit the patient in the form of specific treatments
(shown as circled items, connected to the rest of the diagram using dotted arrows).
An example is shown below (Fig. 1.1):
While it is up to the readers to decide on the degree to which such an exercise
suits their learning needs, the textbook chapters will attempt to provide such dia-
grams on some of the cases, in order to integrate knowledge learned in the chapter
and to provide closure to the case vignettes, particularly those that cover major
psychiatric illnesses and symptoms (e.g., substance-related and addictive disorders,
bipolar and related disorders, depressive disorders, anxiety disorders, neurocogni-
tive disorders, and feeding and eating disorders) We hope that this feature of the
textbook will enhance the clinical relevance of topics learned in behavioral science
and clinical psychiatry and will stimulate interest in further learning about funda-
mental neurobiological mechanisms behind behavioral symptoms.
It is now time to learn about other specific topics in this textbook. Once again,
welcome aboard and happy learning!
10 A. P. S. Guerrero and M. Piasecki

Biological substance abuse program Psychological Social/Cultural/Spiritual

?residential

Relapse Exposure to drug Drug-using peer

Intense craving

Continued Oversensitivity of Poor coping skills

methamphetamine use brain reward systems

Inappropriate mesolimbic Norepinephrine release Stressor? Compromised family role

Dopamine release (intoxication)

Appropriate group and

Increased dopamine tone Limbic system Hypothalamus Autonomic nervous system individual psychotherapy

Poor cortical filtering Appetite suppression

Hyperthermia Tachycardia
Delusions Mood lability
Thin Hypertension
Tangentiality
Hallucinations

dopamine blockade Address family concerns

e.g., child welfare

atypical antipsychotic

Fig. 1.1 Sample diagram to integrate knowledge and provide closure to case vignettes

Self-Study Questions
For reflection:
1. Problem-based learning is gaining popularity in medical schools. What are
three of the documented outcomes that contribute to this popularity?
1 How to Use This Book 11

Appendix A: PBL Worksheet to Guide Case Studies

What are the What are your hypotheses? What do you What specific
facts? want to know information
next? would you like
to learn about?

HPI:

PMH:

FH:

SH:

Exam:

Labs:
12 A. P. S. Guerrero and M. Piasecki

Appendix B: Tables with Possible Answers to the Vignettes

Case Vignette 1.1: Presenting Situation Melanie Crystal

Learning Issue Table 1.1

What are the What are your hypotheses? What do you What specific
facts? want to know information
next? would you like
to learn?
39-year old Drugs: HPI: What are the
woman ? Cocaine or What exactly mechanisms
Single mother methamphetamine does she mean by behind
of a 17-year ? Heroin (IV) “dope?” confusion and
old boy Was she having abnormal
Referred for Other psychiatric any symptoms mood?
psychiatric disorders even before using
assessment at drugs? Which drugs
her local ER Abnormal brain activity: Does she have can be used
Found by Limbic system any other intravenously?
police officer Other places? symptoms –
at a nearby disturbed sleep, What defines
parking lot disturbed neglect or
Sadness appetite, abuse of a 17-
Crying/tearful hallucinations year old
PMH: minor?
Confused Other medical
illnesses
Hostile HIV test?
FH:
Stated she Other psychiatric
would kill illnesses
herself SH:
Can anyone else
Used “dope” care for the 17-
year old son?
Needle marks Exam:
Vital signs
(tachycardic?
Possible neglect of the 17- Hypertensive?)
year old minor Heart murmur?
Mental status:
Delirium 1. Speech
2. Thought
Endocarditis process
3. Perceptions
4. Is she
homicidal?
Lab: urine tox
1 How to Use This Book 13

Appendix C: Online resource for additional PBL worksheets

http://www.laney.edu/wp/environmental_control_tech/ect-nsf-initiative/ect-nsf-labs/pbl/
worksheets/#overview

References

Barrows, H. S. (1986). A taxonomy of problem-based learning methods. Medical Education, 20,

481–486.
Barrows, H. S. (2000). Authentic problem-based learning. In L. H. Distlehorst, G. L. Dunning-
ton, & J. R. Folse (Eds.), Teaching and Learning in medical and surgical education: Lessons
learned for the 21st Century. Mahwah: Erlbaum.
Curtis, J. A., Indyk, D., & Taylor, B. (2001). Successful use of problem-based learning in a third-
year pediatric clerkship. Ambulatory Pediatrics, 1, 132–135.
Frick, E. (2005). Teaching somatoform disorders in a “nervous system and behaviour” course:
The opportunities and limitations of problem-based learning. Education for Health (Abingdon,
England), 18, 246–255.
Guerrero, A. P. (2001). Mechanistic case diagramming: A tool for problem-based learning. Aca-
demic Medicine: Journal of the Association of American Medical Colleges, 76, 385–389.
Guerrero, A. P., Hishinuma, E. S., Serrano, A. C., & Ahmed, I. (2003). Use of the mechanistic case
diagramming technique to teach the biopsychosocial-cultural formulation to psychiatric clerks.
Academic Psychiatry: The Journal of the American Association of Directors of Psychiatric
Residency Training and the Association for Academic Psychiatry, 27, 88–92.
Kaufman, D. M., & Mann, K. V. (1999). Achievement of students in a conventional and Problem-
Based Learning (PBL) curriculum. Advances in Health Sciences Education: Theory and Prac-
tice, 4, 245–260.
Kohlenberg, B., & Piasecki, M. (2006). Bio Psycho Social Spiritual Model, personal communica-
tion.
McGrew, M. C., Skipper, B., Palley, T., & Kaufman, A. (1999). Student and faculty perceptions of
problem-based learning on a family medicine clerkship. Family Medicine, 31, 171–176.
McParland, M., Noble, L. M., & Livingston, G. (2004). The effectiveness of problem-based learn-
ing compared to traditional teaching in undergraduate psychiatry. Medical Education, 38,
859–867.
Nalesnik, S. W., Heaton, J. O., Olsen, C. H., Haffner, W. H., & Zahn, C. M. (2004). Incorporating
problem-based learning into an obstetrics/gynecology clerkship impact on student satisfaction
and grades. American Journal of Obstetrics and Gynecology, 190, 1375–1381.
Norman, G. R., & Schmidt, H. G. (1992). The psychological basis of problem-based learning: A
review of the evidence. Academic Medicine: Journal of the Association of American Medical
Colleges, 67, 557–565.
Peters, A. S., Greenberger-Rosovsky, R., Crowder, C., Block, S. D., & Moore, G. T. (2000). Long-
term outcomes of the New Pathway Program at Harvard Medical School: A randomized con-
trolled trial. Academic Medicine: Journal of the Association of American Medical Colleges,
75, 470–479.
Skokauskas, N., Guerrero, A. P., Hanson, M. D., Coll, X., Paul, M., Szatmari, P., Tan, S. M., Bell,
C. K., & Hunt, J. (2011). Implementation of problem-based learning in child and adolescent
psychiatry: Shared experiences of a special-interest study group. Academic Psychiatry: The
Journal of the American Association of Directors of Psychiatric Residency Training and the
Association for Academic Psychiatry, 35, 249–251.
Washington, E. T., Tysinger, J. W., Snell, L. M., & Palmer, L. R. (1999). Implementing problem-
based learning in a family medicine clerkship. Family Medicine, 31, 306–307.
14 A. P. S. Guerrero and M. Piasecki

Zisook, S., Benjamin, S., Balon, R., Glick, I., Louie, A., Moutier, C., Moyer, T., Santos, C., &
Servis, M. (2005). Alternate methods of teaching psychopharmacology. Academic Psychiatry:
The Journal of the American Association of Directors of Psychiatric Residency Training and
the Association for Academic Psychiatry, 29, 141–154.
Chapter 2
Child Development

Andrea Sorensen, Aubrey Klaich and Maya Strange

Changes in the developing child make normal behavior a moving target. It is impor-
tant for clinicians to understand normal developmental stages in order to appreciate
the bounds of normal behavior. The clinical vignettes in this chapter illustrate a
few of these developmental stages that may present as a challenge to parents and
professionals.
At the end of the chapter, the readers will be able to:
1. Describe normal cognitive, social, emotional, and adaptive functioning of a pre-
school age child, latency age child, and adolescent youth.
2. Describe protective and parental factors that can help foster normal development.
3. Identify ways in which development, personality, family, culture, and society
influence development, adaptation, and coping.
4. List risk factors that may contribute to developing psychopathology at various
stages.
5. Relate to how a child’s developmental stage influences the physician–patient
interview.

A. Sorensen ()
Department of Psychiatry and Behavioral Science, 401 W. Second Street, Suite 216,
Reno, NV 89503, USA
e-mail: [email protected]
A. Klaich
Department of Psychiatry, Tufts-New England Medical Center, 800 Washington Street,
Box #1007, Boston, MA 02110, USA
e-mail: [email protected]
M. Strange
4820 Turning Leaf Way, Reno, NV 89519, USA
e-mail: [email protected]
© Springer International Publishing 2016 15
D. Alicata et al. (eds.), Problem-based Behavioral Science and Psychiatry,
DOI 10.1007/978-3-319-23669-8_2
16 A. Sorensen et al.

Vignette 2.1.1 Presentation Situation: Caleb

You are a resident in a pediatric clinic where 34-month-old Caleb is brought in
by his parents with the concern of distressing tantrums. The parents describe
that the child can “rage.” He may lie on the floor and flail around for what
seems like an hour. He may also run away from his parents in the home and
slam doors, then yell at them. He sometimes stands with stiff arms and legs
and cries inconsolably. With further discussion, Caleb’s mother shares that
her sister has been diagnosed with Bipolar Disorder and that she is concerned
that he may have attention deficit hyperactivity disorder “like his cousins.”

Table 2.1.1
FACTS HYPOTHESES INFORMATION LEARNING
NEEDED ISSUES

Vignette 2.1.2: Continuation

The parents note that Caleb can generally rage up to 10 min, but they can give
an example when it lasted over 30 min. They both agree that triggers for the
episodes may be when he does not get what he wants, when they may not be
understanding what he says, and when he is tired or hungry. The father states
that he speaks clearly to Caleb and sits him in a chair for a couple of minutes.
Caleb usually is able to calm down when this happens. The mother admits
that she becomes frustrated with him and usually ends up yelling at him. She
gives an example from that morning: She gave Caleb some crayons and paper
but he only colored for a few minutes and then wanted to play with blocks.
She redirected him to the coloring and he sat on the floor and “raged” for at
least 5 min. She yelled “stop it” and then felt guilty; so, she gave him the
blocks and walked away.
You ask for more history. The parents state that Caleb was the product of a
full-term first pregnancy. There were no in utero exposures or complications.
He was of easy temperament. He has fed well, slept well, and has always
loved to be held. He responded to social games such as peek-a-boo. He shared
references with his parents as a toddler as he would point at objects and look
at them to share experiences frequently. He spoke his first words by age one
and three-word sentences by age 30 months. He walked at 13 months, rode
a tricycle at 30 months, can color a circle, and potty trained just recently,
though he does wear a pull-up at night. Generally, Caleb is a “happy kid”
when he is not having an episode.
You ask to see Caleb alone, and he agrees to let the parents leave the room
to meet with you. He is shy initially, but after looking at toys he picks out a
2 Child Development 17

toy truck and starts to push it around the room. He looks at you and smiles,
then he tells you about his big green and red trucks that he has at home. You
prompt him to draw and he colors lines and circles. He asks for his mother a
few times during the exam, but he is reassured that she is in the waiting room
and then continues to play. He denies that anyone has ever hurt him. He does
state that he can get mad and he imitates standing up with a stiff posture,
clenching his fists and holding his breath. He then laughs and returns to play-
ing with the truck.

Table 2.1.2
FACTS HYPOTHESES INFORMATION LEARNING
NEEDED ISSUES

Vignette 2.1.3: Continuation

Caleb has attended day care 3 days a week for the past 6 months. The teacher
told Caleb’s mother that he did have difficulty sharing with other kids and
following rules initially. He would throw a tantrum and even hit a couple of
kids during these episodes. The teacher initiated time-outs. The teacher then
used counting to three to give him time to make a choice. Initially, he required
several time-outs per day and had difficulty making the right choice. The past
month they have not noted any concerns.

2.1 Learning Issues

Reviewing the Denver Developmental Screening Test-II in the pediatric clinic, you
note that Caleb has normal development for a boy of his age (Frankenburg et al.
1992). Nearly 3 years of age, he is able to perform social, motor, and adaptive skills
for his age. He communicates socially, appreciates personal boundaries, and shares
affect (Smidt 2006). His play and conversations remain self-centered, but this is ex-
pected of toddlers and preschoolers. This self-centered perspective of the young child
can be frustrating for many adults. For example, Caleb is only focused on his interests
and does not ask the examiner of her opinion. His attention span during activities may
only be 5 min; so he tends to change activities frequently. It is clear, however, that the
examiner’s presence is important to Caleb. The adult provides a reference for the child
and can serve to share experiences and encourage appropriate exploration, communi-
cation, and expansion of the child’s own self-awareness and learning during his play.
Discovering Diverse Content Through
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*** START OF THE PROJECT GUTENBERG EBOOK THE HISTORY OF

LAPLAND ***
In the html version of this eBook, images with double borders are linked to higher-
resolution versions of the illustrations.
The Table of Contents is located at the end of the text.
 The History of
LAPLAND
Wherein are shewed the Original, Manners, Habits, Marriages,
Conjurations, &c. of that People. Written by Iohn Shefferus Professor of
Law & Rhetorrick at Upsal in Sweden.
At the Theater in Oxon 1674.
 THE
HISTORY
OF
LAPLAND
WHEREIN
Are shewed the Original, Manners, Habits, Marriages,
Conjurations, &c. of that People.

WRITTEN

By J O H N S C H E F F E R, Professor of Law and Rhetoric

at Upsal in Sweden.
At the T H E A T E R in O X F O R D.
M. DC. LXXIV.
 Imprimatur
R. A. BATHURST,
Vice-Canc.
July 8. 1674.
 THE
PREFACE.
The Reader may please to take notice, that the diligent and learned
Author of this History, (to the writing of which he was commanded,
and therein assisted by the Chancellor of Sweden) hath in the whole
work taken care to justify what he relates, from the faith of
authentic records, the testimony of Historians, and the Discourses of
Laplanders themselves, with whom he had ready opportunities of
converse. And this he hath don so precisely, that having in the
contexture of his work, given a full account of what he thought
observable in the writings, or narratives to which he refers, he
afterwards constantly puts down at length the very words of his
Authors, a great part of which are in the Swedish Tongue. Now in
this Edition we have spared our selves the labor of such repetition;
which we hope will not be regretted by the Reader, who we suppose
would not have bin much edified by them. As to the subject here
discours’d of, twill not be needfull to give a character of it. Military
Action, and those public murders in which other Histories triumph,
have no share here. Hunger, cold and solitude are enemies that
engage all the fortitude of this People: and where so much passive
valor is necessary, we may dispense with the want of Active. Amidst
the barbarity and darkness which reign in Lapland, there appear
strictures of light, which will entertain the eie of the most knowing
observer; as the Stars are no less remarkable then is the Sun it self.
However the Reader will not fail to meet here with what may gratify
his curiosity. Warmer Climates having all the comforts and
necessaries of life plentifully bestowed upon them, are but a more
distant home; where we have little else talk’d of, then what we daily
see among oar selves: but here it is indeed, where, rather then in
America, we have a new World discovered: and those extravagant
falsehoods, which have commonly past in the narratives of these
Northern Countries, are not so inexcusable for their being lies, as
that they were told without temtation; the real truth being equally
entertaining, and incredible.
 THE HISTORY
OF
LAPLAND

CHAP. I.
Of the Name of Lapland.

This Country doth not every where pass by the same name. By some
’tis called Lappia, as Johann. Magnus in the Preface of his history,
and Saxo Grammat. in his 5th book; by others Lapponia, as Olaus
Magnus in the explication of his Map of Scandinavia, and Ziegler in
his description of the Northern Countries, and before these Ericus
Versaliensis, and after them Andr. Buræus. The Swedes usually call
the Country Lapmarkia, in whose language Mark signifies Land; the
Danes and Norwegians, Laplandia, and also Findmarkia, as appears
from Petr. Claudus description of Norway: for no one can gather any
thing else but an account of this Country, from his whole 38th Chapt.
which himself too seems to intimate, when he promises more about
Findmarkia in his description of Lapland. Of i’ts being call’d
Findmark, I shall speak in another place; Now we will see why ’tis
call’d Lapponia and Lappia, the Etymology of which words is not yet
agreed upon by the Learned. Ziegler thinks they were named so by
the Germans, from the dulness and stupidity of the people, which
the word Lappi signifies amongst them; but this seems improbable,
since this Country is but of late known to the Germans, and none of
their antient Writers make any mention of Lappia. Moreover, the
Finlanders, Swedes and Russians, who differ much in their language
from one another, as well as from the Germans, call it all by the
same name; and the Germans, who are so remote from Lapland,
could not transmit this name to these more Northern Countries,
especially when they had little or no commerce with them. Neither
are the people so very dull and stupid; as Ziegler himself afterwards
acknowledges, when he confesses they are good at the needle, and
make delicate embroidered clothes. Neither can I assent to
Wexionius’s opinion, that the Swedes gave them this name from
their wearing of Skins; for Lapper and Skinlapper do not signify
skins, but the same as the Greeks ῥάκοι (in English Rags) from
whence Ol. Petr. Nieuren, who writ of Lapland in Gustavus
Adolphus’s time, derives their name from their coming into Swedland
every year with rags lapt about them, which is the signification of
Lapp in that language. But they do not deserve that name, meerly
for this reason, any more than the Finlanders and others, for they
are generally cloth’d in good woollen garments, as we shall shew
hereafter. Grotius thinks they are call’d Lapps from running or
leaping, but Lœpa, which in the Swedish language signifies to run, is
writ with a single P, and the name of this Country with a double
one; and these People naturally are no great runners, tho by an art
they have of sliding over the frozen snow, they are very swift in their
motions. Some think that the Inhabitants do not denominate the
Country, but the Country the Inhabitants, as in the name of
Norwegians and others, which seems to be strengthned by this,
because Ol. Magnus calls them Lappomanni, after the manner of
Nordmanni, Westmanni, and Sudermanni, in which words Manni
signifying Men, they were call’d Lappomanni, i. e. Men of Lappia.[1]
Others fancy that the name of the Country is deriv’d from Lappu,
which in the Finnonick language is furthermost, because it lies in the
farthest part of Scandinavia. There is yet another opinion which may
seem no less plausible then any of the former, which agrees as well
with the signification of the word Lapp among the Laplanders
themselves, as the credit given to what has been matter of fact, viz.
that ’twas call’d Lappia, not from its situation, or other such like
accident, but from the Lappi that inhabited it. So that I take Lappi to
signify no other than banish’t persons, which is the genuine
signification of Lapp in the Lapland language; for the Laplanders
were originally Finlanders, and from leaving their Country may be
presum’d to have took their name; and that not of their own
choosing, but the Finlanders[2] imposition, with whom to Lapp
signifies to run away: whence the compellation seeming something
scandalous, no person of quality to this day will endure to be call’d
by it, tho from the Finlanders others Nations, as the Germans,
Swedes and Moscovites, have learnt to call them so. But they of
Lappia Umensis stile themselves Sabmienladti, and those of Lappia
Tornensis, Sameednan, from the word Sabmi or Same; the
signification of which, and whence they had it, we shall see
hereafter.
At what time this Country and it’s inhabitants were first
distinguish’t by these names Lappia and Lappi, ’tis hard to prove: ’tis
certain ’twas but of late, for the words are not found in any antient
writer, neither in Tacitus, who mentions their neighbours and
forefathers the Finlanders, nor in Ptolomy, Solinus, Anton. Augustus,
Rutilius, or others, neither in Authors nearer home (not to name
Jornandes, Paul Warnefrid, &c.) nor in those who have writ the
actions of Heraud and Bosa, or Gætricus and Rolfus, or King Olafus
in the Islandick, Norwegian or Gothick language: we find nothing of
them in Adam Bremensis, whose diligence in writing of the Northern
Countries, his Scandinavia sufficiently testifies; or in Sturlisonius,
who writ very accuratly of these parts in his own language.
Therefore I cannot be so easily persuaded with Grotius to believe
Cluverius, who says they were mention’d in the Peutingerian Tables,
the Author of which is thought to have liv’d at least before
Theodosius’s time, i. e. 600 years before Adam Bremensis: how then
could he, that was none of the best Geographers, if we may beleive
Welserus, and very far distant from these parts, give us any account
of them, since Adam Bremensis, who was so near a neighbour, and
had commerce with those that lived there, could give us none?
Besides, in that Table the Sarmatians are called Lupiones, with
whom the Lappi were nothing concerned, neither doth any antient
Author say they were seated so far Northward: wherefore the
Lupiones there described are any People rather then the Laplanders,
for at that time, when the Author writ, they were not so much as
known to any of their neighbours, the Gothick Norwegian or Danish
writers. The first that mentions Lapland is Saxo Gramat. Hist. Dan. l.
5. who lived and wrote about Ann. 1190, and therefore was after
Adam Bremensis (who lived about 1077) near 130 years, in which
interval this name must needs come first in use. For Saxo making
mention of such a Country a great while before, in the time of
Frotho the third contemporary to Alricus King of Swedland (who they
say lived before Christ) doth not prove that ’twas called so then, but
that that Country might afterwards have had this appellation; and I
am fully perswaded, that Adam Bremensis would not have omitted
this name if he had had any knowledge of it. Afterward Er.
Upsaliensis speaks of it about 1470 i. e. almost 300 years after Saxo,
and 200 before this present time. After them Jac. Ziegler made a
large and learned description of it, by which it came to be known all
over Europe. For however we may meet with the name Lappia in
Saxo, none but the Swedes and Finlanders, before Zieglers time,
knew any thing of it. And so much for the names of Lapland.
 CHAP. II.
Of the Situation of Lapland.

The true and exact situation of this Country the Antients seem not to
have sufficiently discovered. Saxo makes it bordering upon Jamtia,
extending its self as far, or rather lying as it were between Helsingia
and Finland, when in these words he says the Provinces of the
Helsingi, Iarnberi, Iemti, with both the Lappia’s, as likewise Finnia
and Estia paid annual tribute to one Domarus. Ericus Upsaliensis
seems to make it a part of Finland, mistaking it for a certain part of
that Kingdome so called, on the one side adjoining to Swedland, on
the other to Russia, giving it a place between Carelia and Nylandia.
Ol. Mag. in his Table, and so his brother Johan. Magnus in the
Preface of his History, place it higher then the western Bothnia,
making neighbours to it Scrikfinnia furthest towards the North, and
Biarmia towards the East; though some[3] think there is no such
place as Scrikfinnia, as it is certain there is none in those parts at
this day called by that name. But yet we must not slightly pass over
the unanimous opinion of so many learned men, especially Saxo, not
a little knowing in the Northern affairs, who have all not barely
named it, but have described the humours of the Inhabitants, their
manners, habits and fashion of their governments, with other
matters belonging to them. Instead of the Scrickfinni or Scricfinni of
Johan. and Ol. Magn. I would rather read it Scritofinni; and as for
Skidfinni as Adr. Buræ would have it, all the Antients, what ever else
they differ in, will agree in this, that there must be an R in the word.
Jornandez calls them Scretfennæ, Paul. Warnefrid. and Diacon.
Scritobini changing f in b (of which and some other things of the like
nature I will treat in due time and place) Adam Bremensis
Scritefiani: and the Greeks agree in this writing, so that we ought
not to doubt of the Latines. Procopius will have them sometimes
Σκριθιφίκους, other times Σκριθιφίνους. Besides ’tis manifest since
the Scritefinni are the same with the Finni, whose Etymology in their
own language is from leaping,[4] by an art they have, by which with
crooked pieces of wood under their feet like a bow they hunt wild
beasts; they could not therefore take their name from Skidh,
signifying the wooden shoes themselves, but from their leaping, i. e.
swift running with them, which doubtless antiently was meant by
Skriida, and which the Author cited by Warnius in the 46 page of his
Lexicon confirms, where he relates the form of an oath made by
Hafur, that he would preserve the peace Quamdiu Finnur skriidar,
i. e. as long as the Finlanders continued their manner of leaping. As
for the Etymology that is there given, that it signifies their wandring
up and down, ’tis altogether false, for Skridsko at this day denotes
those wooden shoes which they run upon the ice with; neither doth
Skirida signify any thing else among the Antients but to glide along
the ground, for they do not take up one foot after the other, as in
common running, but carrying themselves steady upon the frozen
snow, they move forward stooping a little, as shall be shewn
hereafter. And perhaps this is the onely cause that they are called
Himantopodes,[5] People creeping upon their knees; which agrees
exactly with these Scritofinni: for they hearing that Skriida was to
creep along, what could they fancy the Scritofinni to be, but People
not going like other men, but crawling forward like creeping
animalls, but of this I shall speak more at large when I come to the
Laplanders gliding upon the ice. That which I would chiefly evince
here, is, that there are such a people rightly called Scritofinni, and
the Country which they inhabit is Scritofinnia or Scritfinnia, and that
there is no reason we should think there was no such place, since
there are those who are called Scritfinni, i. e. Finlanders, who run
upon the ice with wooden shoes, whose Country from thence may
well be called Scritofinnia. And the same may be urged for Biarmia
against those that will not allow there is any such place. For first the
antient Writers making frequent mention of it, as that Author of the
History thereof, calls it often Biarmaland in the old Gothick or
Islandick language, who also calls the King of it Hereker in Ch. 7.
and his two Sons, the one Rœrik the other Siggeir. Saxo likewise in
his 9th book, speaks of a certain King of this place, who reigned in
the time of Regner King of the Danes, making it border upon
Finland, when he says the King of Biarmia fled for refuge to
Matullus, who then reigned in Finland. But now granting there were
antiently such names as Biarmia and Scritfinnia, it remains doubtfull
still whether they were distinct Countries or no. All Authors except
Johan. and Ol. Magn. seem to make them the same, Procop.
Jornand. Paul. Warnfrid. and Adam Bremensis speak of Scritfinnia,
but none of Biarmia, and the Northern writers do just contrary. Saxo
indeed mentions them both, but not at the same time: once in his
Preface he names Scritfinnia, leaving out Biarmia, in other places he
names Biarmia omitting the other; from whence I am almost of
opinion that ’tis the same Country called by native Writers Biarmia,
by forreign Scritfinnia. We may add further that as Adam Bremensis
makes Scritfinnia next to Helsingia, the Author of the History of
Heraud and Bosa sets Biarmia in the same place, speaking of some
Woods in it, and Rivers that emty themselves into the Sinus
Bothnicus or bay of Ganduia next to Helsingia. And moreover as the
Scritfinni are a People of Finland, which not onely their name, but an
old Chorographick Table commended by Grotius doth intimate,
distinguishing the Fenni into the Scritfenni and Redefenni, so ’tis
probable of the Biarmians as well for their neighbourhood to
Helsingia, of which before, as for their worshipping a God by the
name of Jomala, which is a Finland word, denoting God amongst
them to this day. Moreover the Biarmians have many other things
like the Finlanders, as the Art of darting, of Magic, &c. So that
Biarmia may be a Colony of Finland, whose People were called by
Strangers, from their skirring along, or gliding upon the snow,
Scritofinni. But now supposing all this true, and that the Biarmia of
the Ancients, and Scritfinnia were the same, ’tis a question still
whether Lapland be distinct from them or not. Joh. and Ol. Magnus
in their Geographic Tables and descriptions, make them distinct
Countries. But that cannot be; for if Scritfinnia and Biarmia reach
one way to Helsingia and Jamtia, on the other to Finland; if they lye
so near these Provinces, and extend to the Bay of Bothnia (both
which have bin demonstrated before) I do not see where Lapland
can have any place at all. And the same Authors are also mistaken in
putting it South of Biarmia and Scritfinnia, whereas the Antients
placed these beyond it. For that they mean’t only by Biarmia that
which the Swedes now call Trennes, appears to be false from what
has bin said before: for where are any Rivers in Trennes that run
into the Bay of Bothnia? and how is it bordering upon Finland?
Wherefore contrary to Joh. and Ol. Magnus, I think rather that
Lapland is the same that was first by the Inhabitants called Biarmia,
by Strangers Scritfinnia, then changing the name for some of the
reasons here produced, it came to be Lappia or Lapponia; which
beginning from Jamtia and Angermannia, goes all about each
Bothnia, and at length ends in the extremities of Carelia and Finland,
so as to comprehend all the whole tract from the North even to the
main Ocean, the white Sea, and the Lake Ladek, which are the very
bounds of old Biarmia and Scritfinnia. But that it went as far as the
Ocean, the Antients seem not to have so well understood; nor
indeed Johan. and Ol. Magnus, who in those parts, have made
Scritfinnia and Biarmia different Countries from Lapland. So also
Damianus Goes, who, whatever he knew of Lapland, had it from
them, says it extends it self to unknown Regions, because he knew
not who lived further towards the North Sea. But the Antients have
placed there, besides the Scritfinni, the Cynocephali, Busii,
Troglodytes, Pygmies, Cyclops’s,: and some others, passing by the
Himantopodes, of whom we have spoken before: tho in this age
none doubts but the Laplanders inhabit it all, and those who have
sailed along those Coasts have met with none others but Laplanders.
In fine Charles the 9th King of Swedland in the year 1600, being
desirous to know the truth of that Country, sent two famous
Mathematicians, M. Aron. Forsius a Swedish Professour, and
Hieronymus Birkholten a German, with instruments, and all
necessaries to make what discoveries they could of Lapland; who at
their return, did certify, and make it out, that beyond the Elevation
of the Pole 73 degrees there was no Continent towards the North
but the great frozen Sea, and that the farthest point was Norcum or
Norcap, not far from the Castle of Wardhouse. But of this distant
Lapland those that are curious may enquire at their leisure, we
purpose to treat here only of that which is subject to the
Government of the Swedes; and this is a vast Country, thought by
Paulinus in his history of the North, of equall extent almost with all
Swedland properly so called. Andr. Buræus says it contains in length
above 100 German miles, and in breadth 90. All this Country comes
now under the name of Lapland, in which all agree that ever
described it; and if we would take an account of the Climate of it by
this vast compass of Earth, we must begin from the 64th degree of
latitude, and so to the 71; but in longitude it must extend at least to
the 27th Meridian, or more. Moreover if we will compute the
longitude from journies that have bin made thither, all hitherto have
unanimously put the beginning of it about the 38th degree, and the
end in the 65th. And this may suffice partly for an account of the
situation of Lapland in general; and partly of that which is subject to
the Swedes. Dam. à Goes, a Knight of Portugall, sets its bounds thus
in his description of Spain: Lapland is divided into the Eastern and
Western part, the Bothnick Sea coming between. The extremity of it
is Tornia. Eastward it reaches to the white Lake, towards the North
comprehending diverse Provinces, and extends it self beyond all
knowledge. On the West towards Island it joins to part of Norway,
and on the other side of Norway ’tis bounded with Swedland,
Finland, and both the Bothnia’s. But Ol. Petr. Nieuren confutes this of
the Bothnic Sea lying between; for so part of Lapland would lie in
Finland or Ostrobothnia, part in Westrobothnia, which every one
knows is false: and the very vulgar can tell so much, that the
Bothnic Sea comes not any where within 18 or 20 miles of Lapland:
tho this ought not to pass beyond Damianus’s time, since Nieurenius
himself confesses in another place, that the Laplanders had their
seat about the Bothnic Sea, but that afterwards they were driven
out, of which I shall speak hereafter. I will only add here a Table of
the latitudes and longitudes of the chiefest Places, as they were
taken by M. Aronis Forsius and Hieronymus Birckholten Ann. 1600.
Longit.Latit.
Uma 38, 0. 65, 11.
Pitha 40, 0. 66, 14.
Lula 40, 30. 66, 30.
Tœrna 42, 27. 67, 0.
Kimi 42, 20. 67, 1.
Lappijærf 42, 33. 70, 9.
Antoware 44, 4. 70, 26.
Tenokijle 46, 0. 70, 50.
Porsanger 44, 2. 71, 42.
Porsanger 43, 35. 71, 35.
Lingen 37, 30. 70, 30.
Trænees 32, 30. 70, 25.
Euvenes 33, 35. 70, 0.
Titisare 37, 55. 69, 40.
Piala 41, 40. 60, 15.
Siguar 38, 35. 68, 59.
Tingwar 38, 0. 69, 40.
Rounula 39, 30. 69, 47.
Koutokrine 42, 0. 69, 17.
Waranger 45, 0. 71, 35.
Lanzord 45, 35. 71, 26.
Hwalsund 42, 40. 71, 12.
Skrisæ 38, 50. 71, 18.
Trumsæ 35, 52. 70, 55.
Andaces 32, 0. 70, 30.
Serghen 32, 20. 69, 3.
Wardhus 52, 0. 71, 55.
Norkaap. 45, 30. 72, 30.
 I proceed next to the disposition and nature of the Country,
having first given you a Map of it.
 CHAP. III.
Of the temperature of the Air, and soil of
Lapland.

We have seen how Lapland is situate; let us next proceed to other

particularities of it. That ’tis very near the Pole appears from its
latitude, insomuch that for some months in the Summer the Sun
here never sets, and on the contrary in the Winter it never rises;
which Herbersten says is but forty days, and tho three hours in the
night the body of it is something darkned, so that his raies appear
not, yet there is so much light, that they continue their work all the
while. Indeed the same account is not to be taken of the whole
Country, since part of it lies nearer, and part further distant from the
Pole; and of these too some parts are more East, and some more to
the West, from whence ’tis that with some of them the Sun is scarce
above the Horizon for so many daies as he pretends. And altho in
the Summer it never sets and goes below the Earth, yet neither does
it rise much above it, but as it were kisses and gently glides along
the Horizon for the most part; as likewise in the Winter when lowest
it is not much beneath it: which is the reason that tho they have one
continued night for some months, yet every day the Sun comes so
near, that it makes a kind of twilight. Joh. Magnus saies that in the
absence of the Sun there are two twilights, one in the morning, the
other in the evening, in which those poor remainders of day provide
that the night should not be utterly destructive. And by how much
the Sun is farther absent, the light of the Moon is clearer. Hence
Petr. Claud. saies that when the Moon shines they go a fishing, and
dispatch all other necessaries that are to be done without doors; and
when it does not, if the air be clear, even the light of the Stars so
much abates the darkness, that the horrour of the night is much
lessened, and there is light enough for the dispatch of severall
businesses, which is farther assisted by the whiteness of the Snow.
The Air of Lapland is cold, but fresh and clear, and consequently very
wholesome, being much purified by the winds which are here very
frequent and violent. It has bin attested to me by eye-witnesses,
that there rises a certain wind out of the Sea, which beginning to
blow raises presently such thick and dark clouds even in the midst of
Summer, that they utterly hinder the sight, and in the Winter drives
the snow with such force and quantity, that if any person be
surprised abroad, he hath no other remedy but to throw himself on
the ground with some garment over him, suffering himself to be
quite buried in snow till the storm is past, which don, he rises up,
and betakes himself to the next Cottage he can meet, all paths and
roads being hid in the snow. But the strongest and most irresistible
winds are upon the Mountains, where they throw down all things
they meet with, and carry them away by their violence into far
distant places, where they are never seen or heard of afterwards.
Their only help against these is to convey themselves into dens and
caves. Here is rain as in other places, sometimes more, and
sometimes less, but in the midst of Summer, this as likewise the
neighbouring Countries have very seldom any at all. Snow they have
more often, and so much that in the Winter it covers all the Country,
of which they make this advantage, that they can travel the more
securely in the night; for the light of the Moon reflected from the
snow, enlightens all the fields, that they can discern and avoid any
pits, precipices and wild Beasts, that would otherwise annoy them:
so convenient are the wayes for any journy, that two rein deer will
draw a greater load over the trodden snow, then a Cart and ten
Horses can in the fields at other times. These snows in some places,
as on the tops of their highest hills, remain perpetually, and are
never melted by the strongest heat of the Sun. In the upper part of
Lapland there are Mountains rising to such a vast hight, that the
snow continues upon them Summer and Winter, and is never
dissolved, but in other places the Land is every year over-flown with
floods of melted snow. They have also very great frosts and mists,
and good store of them, which sometimes so thicken the air, that the
sight is quite obstructed, and Passengers cann’t distinguish one man
from another to salute or avoid him, tho he be come close up to
them. It is so extreme cold here in the Winter, that ’tis not to be
endured but by those who have bin bred up in it. The swiftest Rivers
are sometimes frozen so hard, that the ice is more than three or four
cubits thick; and their greatest Lakes and deepest Seas bear any
burdens whatever. Nor is the Summer, which to some may seem
incredible, more moderately hot. For tho the Sun be very low, and
his raies oblique, yet lying upon them so long together, their force is
strangely increast; the only allay being from the vapors rising out of
the neighbouring Sea, and from the snows, which as well in Summer
as Winter continue undissolv’d in hollow places between the hills. As
for Spring and Autumn they know neither, there being so very little
space between the extremity of cold in the Winter, and heat in
Summer, that by Strangers ’tis look’t upon as a miracle to see every
thing springing fresh and green, when but a week before all things
were overwhelm’d with frost and snow. Ol. Petr. Nieuren. has
observed it as a memorable thing, and which he would not have
believ’d from any one had he not seen it himself, that in the year
1616, June 24, going to the Church of Thor, he saw the trees
budding, and the grass coming up green out of the ground, and
within a fortnight after he saw the Plants full blown, and the leaves
of the trees at their perfection, as if they had known how short the
Summer was to be, and therefore made such hast to enjoy it. Their
soil is generally neither very fertile nor barren, but between both, full
of flints, stones and rocks, every where appearing high, by whose
unevenness and roughness the rest of the ground about is useless.
The ground is generally very soft and flabby, by reason of the many
Lakes and Rivers overflowing, yet would it be fit either for tillage or
pasture if any would be at the pains and charge of draining it. Ol.
Petrus saies of the Southern part, lying under the same climate and
influence of the Heavens with Bothnia, that ’tis as apt to bear any
grain as the Western Bothnia it self, but this is not without a
concurrence and aptitude likewise of the soil: and he himself
confesses in Chap. 12th, that the Land is stony, sandy, uneven,
overrun in some places with briars and thornes, and in others
nothing but hills, moores, fennes and standing waters, which are not
the qualities that usually commend Land for agriculture. Then as to
his urging its verdant and rich pastures, it doth not follow that all
Land which yields much grass should be equally capable of bearing
good corn. Yet doth the Land afford plenty of grass, and that so
good that their Cattel are fatned much cheaper and sooner with it
than any other thing, as also divers hearbs, but particularly ’tis
happy in all kind of pot-hearbs. There are many large Woods and
Forests, especially towards Norway, but not very thick; likewise
steep rocks and high mountaines called Doffrini; upon whose naked
tops, by reason of the violence of the winds to which they are
exposed, never yet grew tree. Below these hills lie most pleasant
Vallies, in which are clear fountaines and rivulets innumerable, which
emtying themselves into the rivers, at length are carried into the
Bothnic Sea. Their water is clear, sweet and wholesome, only their
Forests abound with stinking and standing Pools. This Country
Winter and Summer hath an incredible number of all kinds of wild
beasts, especially the lesser sorts, which suffice not only for their
own use, but to drive a great trade with their neighbours. They have
Birds also of all sorts very many, but Fish in such abundance that a
great part of the Natives are entirely fed by them. But of all these
we shall speak in their proper places, I will add no more here but
this, that the Description of old Finland or Scritofinnia by the
Ancients is the same which hath bin given here of Lapland; to
confirm what I said before that these Countries differ only in name,
and not in nature and situation. We come now to its Division.
 CHAP. IV.
Of the Division of Lapland.

Those who have writ of Lapland, mention different divisions of it.

Saxo in his 5th Book, and elswhere, speaks of two Laplands, and
after him Johannes Magnus tells us, that both the Laplands are
joined together Southward. I suppose in that division they had
respect to their situation, and meant the Eastern and the Western
Lapland: for so Damianus Goes, who seems to borrow from Joh.
Magnus, expresses it. Lapland, saith he, is divided into the Eastern
and the Western, separated from each other by the Bothnic Sea.
From whence we may gather that that part of the Country which lies
on one side of the Bothnia, was called the Eastern Lapland, and that
which lies on the other, the Western.
Besides this division of Lapland, there is another taken from the
places most frequented by the Inhabitants. For one part thereof,
lying along the Coasts of the Ocean, is from thence called
Siœfindmarken, that is the maritime Lapland; the other lying higher
on the Continent, Fiœldmarken, that is, inland Lapland: tho by some
they are called simply Findmarken and Lappmarken. This last
division Pet. Claud. gives us in his 27th Chapter. All the Sea Coasts,
saith he, Northward and Eastward as far as Findmarkia reaches, are
possest by the Siæfinni, or maritime Finlanders, but the
mountainous and champaign Country, by the Lapfinni, from thence
named Lapmarkia or Wildfindlandia, that is wild or savage Findland.
Where he calls one part of the Country Lapmarckia, the other
Findmarckia, the one lying along the shore, and bordering on the
Sea, the other mountainous, woody, and savage, upon the Terra
firma. And this too may be worth our notice, that Wildfinland with
him is that which others call Lappmarkia: I suppose, because the
Natives live by hunting, as those of the other do by fishing. For he
presently adds, There are many thousands in that place that feed on
nothing but the flesh of wild Beasts. And indeed some there are with
whom those only pass for the true Laplanders: as Samuel Rheen,
who in his 2d Chapter of his forementioned Book, tells us, that
besides the Scrickfinni (so he calls them that with Pet. Claud. are
Siœfinnes) there are other true Laplanders, that live on nothing but
rain deer. And so from the Natives feeding on wild Beasts, Lapland
properly so called, is also stiled Wildfindland, in opposition to
Findmarkia, whose Inhabitants live both on Fish and Cattel. And yet
there may be given another reason for the imposition of this name,
from the many woods of that Country. Olaus Magnus in more places
then one calls the natives, men that dwell in woods, or Savages: as
in the title of his 3d Chapt. of his 4th Book, which is, Concerning the
fierceness of the Savages, or those that dwell in woods, in which
Chapter he describes the Laplanders. And in the following Chapter
he says, that the wild Laplanders are clothed with rich skins of
several Beasts. The Baron Herberstenius also in his History of
Moscovy, calls them Savage Laplanders, who tho they dwell, says
he, on the Sea Coast in little Cottages, and lead a brutish kind of life,
are yet more civilized then the Savages of Lapland: whence ’tis plain,
that by the Findlanders living near the Sea, he means those that
others call Siœfinnes, and by the Savage Laplanders those that
possess the inland Country, who he thinks were so called from their
wildness and barbarity. And by and by he adds, that by converse
with Strangers, who come thither to trade, they begin to lay aside
their Savage nature, and become a little more civilized. Afterwards
he calls them Diki Loppi, which name the Moscovites give them at
this time, as hath been shewed elswhere.
There is also a 3d Division of Lapland, that respects the several
Princes to whom the Country is in subjection. And this Andr. Buræus
intends, when he tells us, The greatest part of Lapland, viz. the
Southern and inland Country, belongs all to the Kingdom of Sweden:
The maritime tract, that lies on the Ocean, and is called Findmark
(whose Inhabitants the Siœfinni, or maritime Findlanders, are so
named from their living by fishing) to Norway: The rest of them that
dwell from the Castle of Warhuus to the mouth of the white Sea, are
subject to the Russians, which part the Swedes call Trennes, the
Natives Pyhinienni, and the Russians Tarchana voloch. Of their
subjection to these severall Princes, we shall speak when we come
to treat of their Government; and also of those parts that belong to
Norway or Denmark, and Russia. At present we shall only mention
the division of that part which is under the Swedes, and is named by
Buræus, the Southern and inland Lapland, and by Petr. Claud.
Lappmarkia properly so called. This is divided into six lesser parts
called marker, or lands, tho Buræus chuses to render them
Territories or Provinces. Each of these have their distinct names, and
are called Aongermandlandslapmark, Umalappmark, Pithalappmark,
Lulalapmark, Tornalapmark, Kiemilapmark. So Samuel Rheen in his
first Chapter, That part of Lapland which belongs to Sweden is
divided into the Kiemensian, Tornensian, Lulensian, Pithensian,
Umensian, and Angermanlandensian Lapmark. Buræus mentions but
five of these Provinces, viz. Umalappmark, Pithalappmark,
Lulalapmark, Tornelapmark, and Kimilapmark, comprehending
Angermandlandslapmark under Umalapmark, not that they are one
and the same Province, but because they are both governed by one
Lieutenant. Each of these Provinces take their name from Rivers that
run thro the midst of them, as Wexionius in his description of
Swedland assures us. As for their situation, Angermanlandslapmark
borders upon Andermannia and Jemtia, to this joins Umalapmark,
next to that is Pithalapmark, and then Lulelapmark, all of them lying
Westward, reaching on one side to that ridg of Hills that divides
Swedland from Norway, and on the other side to the Western
Bothnia. Northward of them lies Tornelapmark, and extends it self
from the fartheh corner of the Bay of Bothnia all along the North
Sea, called by Seamen Cape Noort. Next to this lies Kimilapmark,
winding from the North toward the East, and bounded on one side
by the Eastern Bothnia, on another side by that part of Lapland that
belongs to Russia, and on a third side by Cajania and Carelia.
 Moreover these Provinces we are speaking of, are subdivided
into lesser parts, called by the Swedes Byar, as Samuel Rheen tells
us, and are equivalent to our Shires, and the Pagi of the Ancients. So
in Cæsar we meet with Pagus Tigurinus, and Pagi Suevorum, which
were not Villages or Country Towns, but large parts of a Country,
such as the Greeks called νόμοι, used in ancient times in the division
of Ægypt. Hence the Glossary renders the ancient Toparchiæ, Pagus,
τοπαρχία, χώρα, νόμος. There are several of these Pagi or Shires in
each Province, except Angermanlandslapmark, which makes but one
Pagus, vulgarly called Aosahla. Umalapmark hath four, Uma, Lais or
Raanby, Granby, and Vapsteen. Pithalapmark seven, Graotreskby,
Arfwejerfsby, Lochteby, Arrieplogsby, Wisierfby, Norrvesterby,
Westerby. Lulalapmark five, Jochmoch, Sochjoch, Torpinjaur,
Zerkislocht, and Rautomjaur. Tornelapmark eight, Tingawaara,
Siggewaara, Sondewara, Ronolaby, Pellejerf, Kiedkajerf, Mansialka,
Saodankyla, Kithilaby. So that all the Territories or Provinces are
divided into 33 Byars. In each of these there are several Clans or
Families, which the Swedes call rakar, each of which have a certain
allotment of ground assign’d them for the maintenance of
themselves and their Cattel; not in the nature of a Country Farm
with us, but of a very great length and bredth, so as to include
Rivers, Lakes, Woods, and the like, which all belong to one Clan or
family. In every Biar there are as many allotments as there are
families that can live of themselves, and are not forced by poverty to
serve others. In the Byar called Aosahla there are about 30 of these
Clans, or families, in others more or less according as they are in
bigness, which all have their several names, tho ’tis not worth while
to repeat them. And thus much shall suffice of the third division of
Lapland, not lately made (except that under Charles IX some Clans
had certain allotments assign’d them) but derived from very ancient
time; as appears from hence that neither the Laplanders have
known, nor the Swedes given them any other, since the Country
hath bin under their subjection. Nor are the words modern, or taken
from any thing that may give any cause to suspect them of novelty:
which I the rather observe, that from hence the native simplicity,
agreable to the antiquity of the Nation, may appear.
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