28 juin 2008

On peut décréter et ressentir sa mort, sans attenter à sa vie. La mort est un état d'âme.


Ivan Aivazovski, Storm, 1854.


Crépuscule

L'étang mystérieux, suaire aux blanches moires,
Frisonne; au fond du bois la clairière apparaît ;
Les arbres sont profonds et les branches sont noires ;
Avez-vous vu Vénus à travers la forêt ?

Avez-vous vu Vénus au sommet des collines ?
Vous qui passez dans l'ombre, êtes-vous des amants ?
Les sentiers bruns sont pleins de blanches mousselines;
L'herbe s'éveille et parle aux sépulcres dormants.

Que dit-il, le brin d'herbe ? et que répond la tombe ?
Aimez, vous qui vivez ! on a froid sous les ifs.
Lèvre, cherche la bouche ! aimez-vous ! la nuit tombe;
Soyez heureux pendant que nous sommes pensifs.

Dieu veut qu'on ait aimé. Vivez ! faites envie,
O couples qui passez sous le vert coudrier.
Tout ce que dans la tombe, en sortant de la vie,
On emporta d'amour, on l'emploie à prier.

Les mortes d'aujourd'hui furent jadis les belles.
Le ver luisant dans l'ombre erre avec son flambeau.
Le vent fait tressaillir, au milieu des javelles,
Le brin d'herbe, et Dieu fait tressaillir le tombeau.

La forme d'un toit noir dessine une chaumière;
On entend dans les prés le pas lourd du faucheur;
L'étoile aux cieux, ainsi qu'une fleur de lumière,
Ouvre et fait rayonner sa splendide fraîcheur.

Aimez-vous ! c'est le mois où les fraises sont mûres.
L'ange du soir rêveur, qui flotte dans les vents,
Mêle, en les emportant sur ses ailes obscures,
Les prières des morts aux baisers des vivants.




Victor Hugo, 1858, Les contemplations.

La eternidad es una de las raras virtudes de la literatura.


Raffaello Sanzio, Le Tre Grazie, 1505.


Despite the heterogeneity in both the bipolar and unipolar groups, the breadth of reported ipolar–unipolar diVerences is impressive. They include four separate spheres of data-enetic,clinical, biological and pharmacological. Bipolar and recurrent unipolar disorders,nevertheless, appear to be very similar in some important respects (e.g., prophylactic response to lithium). Taken together, the data suggest that they are best considered as two subgroups of manic-depressive illness rather than separate and distinct illnesses.

The available data also support a continuum model, with ‘‘pure’’ bipolar illness at one end and unipolar illness at the other.In the 15 years since the Goodwin and Jamison review, the separation of unipolar and bipolar depression has been increasingly questioned, and the diffculty in separating mood disorder patients into two clusters is exemplified by evidence of frequent misclassification. A review of the records of 48 patients identified as having bipolar disorder and 4 patients considered schizoaVective disorder (bipolar type) found that 40% (19/48) were previously diagnosed with a unipolar major depressive disorder. An average of 7.5 years elapsed before the patients were relabeled as suffering from bipolar disorder. Over the course of illness, depression was the predominant mood disturbance found in a literature review assessing the incidence of depressive phases of patients with bipolar disorder.

The authors concluded that the label of bipolar disorder is more often associated with psychosis, melancholia, psychomotor retardation, ‘‘atypical’’ symptoms, and higher suicide rates, and that the depressed phase is the major contributor to the disability in this illness. This understanding follows the conclusion by Taylor and Abrams (1980; Taylor et al., 1980) that mood disorders should be separated by the presence or absence of melancholia and not by the presence of mania or hypomania.Psychopathologic studies of unipolar and bipolar disorder are rife, with overlaps in psychopathology, course of illness, and family illness. An examination of patients with rapid-cycling mood disorder found major depression in 85% and salient manic features were identified in at least half the patients with recurrent depression.

An assessment of depressive features in 36 patients with bipolar disorder and 37 patients with unipolar major depressive disorder was unable to separate the two groups. The authors concluded that ‘‘bipolar disorder is characterized by some depressive features less likely to be found in unipolar depression,’’ but that otherwise the two conditions are alike. In yet another study, a sample of 313 patients with bipolar I disorder with an index episode of depression, signs of agitated depression were readily identified in 61 (20%) as the only distinction from recurrent depressive illness.

25 juin 2008

An ounce of blood is worth more than a pound of friendship.


Marcantonio Bassetti, Adorazione dei pastori, 1615.



In psychiatric classifications today, mood disorders are divided along the faultline of the presence or absence of manic or hypomanic periods in the patient’s personal history. The 1980 Diagnostic and Statistical Manual (DSM) classification recognized a disorder of depressed mood as a major depression. The presence of mania or hypomania, either in the examination or in the history, categorized the illness as a bipolar disorder. In the seesaw of psychiatric history, the mood disorders were seen either as two disorders or as a single entity. Defining the intimate connection between depression and mania is usually ascribed to the French authors Falret (1854) and Baillerger (1854), who described patients with both disorders at diVerent times in their illness. Karl Kahlbaum (1882) applied the term cyclothymia to a syndrome of circular disorders of excitement and depression that did not end in dementia. The concept was adopted by Kraepelin (1921) when he diVerentiated manic-depressive illness from that of dementia praecox. In Kraepelin’s view, the moods in manic-depressive illness included:

"certain slight and slightest colouring of mood, some of them periodic, some of them continuously morbid, which are to be regarded as the rudiment of more severe disorders . . . [or] pass without sharp boundary into personal predisposition . . . I have become more and more convinced that [manic-depressive] states represent manifestations of a single morbid process."


The groundwork for splitting manic-depressive illness into bipolar and unipolar disorders was laid by Leonhard (1995). In family studies he described patients suffering an endogenous illness with a history of mania who had a higher than expected prevalence of relatives with mania (labeled bipolar illness). These patients were distinguished from patients and their families with depressive illnesses only (monopolar illness).

The binary model was quickly supported by family history studies.It was incorporated in the DSM-III classification. This change in nosology encouraged the elaboration of new subtypes of bipolar disorder. Hospitalized depressed patients were divided into those with a history of mania and those who experienced hypomania into bipolar I and bipolar II groups. Unipolar depressed patients were divided into familial pure depressive disease, sporadic pure depressive disease, and depressive spectrum disease based on the family history of alcoholism and antisocial personality.

Additional variants were proposed in studies of less severely ill patients using criteria of family histories and statistical analyses of rating-scale items. The argument to classify unipolar and bipolar depression separately was challenged by Taylor and Abrams, first in literature reviews and then in a prospective clinical study of hospitalized, acutely ill patients with mood disorders and their first-degree relatives.

The family illness patterns were not clearly dichotomous. The most common mood disorder in the first-degree relatives of patients with bipolar disorder was recurrent depressive illness (unipolar disorder). The morbid risk (age-corrected prevalence) for unipolar disorder in the families of the bipolar patients was greater than the morbid risks for unipolar depression in the families of unipolar patients. The authors reviewed reports of mixed concordance for the two forms of mood disorder in twins, concluding that they could not distinguish the unipolar and bipolar patients by any family, psychopathological, treatment response or laboratory variable as long as depression was defined as melancholia.

They could not justify separating mood disorders by the presence of mania or hypomania, or by the clinical features of depression. In another detailed analysis, Goodwin and Jamison (1990) examined the course, epidemiology, family history, physiological measures, and similar criteria for the unipolar and bipolar forms of depression. These are assessed as either ‘‘less’’ or ‘‘more,’’ ‘‘younger’’ or ‘‘older,’’ ‘‘lower’’ or ‘‘higher’’ and other descriptive, nonquantitative differences.

Similar qualitative factors assess the incidence of the clinical signs of anxiety, anger, psychomotor agitation, mood lability, sleep time, pain sensitivity with the items rated as unipolar > bipolar or unipolar <>

23 juin 2008

Insomnie : maladie des époques au cours desquelles on ordonne aux hommes de fermer les yeux.


Joseph Wright, The Alchemist in Search of the Philosopher's Stone, 1771.

The recent literature has equally compelling descriptions. In a memoir of his illness, the novelist William Styron oVers a poignant description of melancholia. After depending on alcohol ‘‘as a conduit to fantasy and euphoria, and to the enhancement of the imagination’’ for more than 40 years, he was suddenly unable to drink without experiencing nausea, ‘‘wooziness,’’ and epigastric distress. He slowly became melancholic.

At first he experienced malaise; the shadows of nightfall seemed more somber, the mornings less buoyant. Insomnia and a host of bodily fears followed and everything ‘‘slowed down.’’ He became suicidal, explaining that: ‘‘The pain of severe depression is quite unimaginable to those who have not suVered it, and it kills in many instances because its anguish can no longer be borne.’’

Frightened of these thoughts, he turned to a hospital for asylum. Its protection and the support of antidepressant medication and of friends allowed him to heal slowly; he avers that the protection served him well.

A physician describes his experience with melancholia:

Depressive illness is probably more unpleasant than any disease except rabies.

There is constant mental pain and often psychogenic physical pain too. If one tries to get such a patient to titrate other pains against the pain of his depression one tends to end up with a description that would raise eyebrows even in a medieval torture chamber.

Naturally, many of these patients commit suicide. They may not hope to get to heaven but they know they are leaving hell. Secondly, the patient is isolated from family and friends, because the depression itself reduces his affection for others and he may well have ideas that he is unworthy of their love or even that his friendship may harm them. Thirdly, he is rejected by others because they cannot stand the sight of his suVering . . . Fourthly, the patient tends to do a great cover-up . . . he does not tell others how bad he feels.

21 juin 2008

Those who danced were thought to be quite insane by those who could not hear the music.



Die Anatomie des Dr. Tulp, Rembrandt van Rijn, 1632

Porphyria's Lover

The rain set early in tonight,
The sullen wind was soon awake,
It tore the elm-tops down for spite,
and did its worst to vex the lake:
I listened with heart fit to break.
When glided in Porphyria; straight
She shut the cold out and the storm,
And kneeled and made the cheerless grate
Blaze up, and all the cottage warm;
Which done, she rose, and from her form
Withdrew the dripping cloak and shawl,
And laid her soiled gloves by, untied
Her hat and let the damp hair fall,
And, last, she sat down by my side
And called me. When no voice replied,
She put my arm about her waist,
And made her smooth white shoulder bare,
And all her yellow hair displaced,
And, stooping, made my cheek lie there,
And spread, o'er all, her yellow hair,
Murmuring how she loved me--she
Too weak, for all her heart's endeavor,
To set its struggling passion free
From pride, and vainer ties dissever,
And give herself to me forever.
But passion sometimes would prevail,
Nor could tonight's gay feast restrain
A sudden thought of one so pale
For love of her, and all in vain:
So, she was come through wind and rain.
Be sure I looked up at her eyes
Happy and proud; at last I knew
Porphyria worshiped me: surprise
Made my heart swell, and still it grew
While I debated what to do.
That moment she was mine, mine, fair,
Perfectly pure and good:
I found A thing to do, and all her hair
In one long yellow string I wound
Three times her little throat around,
And strangled her. No pain felt she;
I am quite sure she felt no pain.
As a shut bud that holds a bee,
I warily oped her lids: again
Laughed the blue eyes without a stain.
And I untightened next the tress
About her neck; her cheek once more
Blushed bright beneath my burning kiss:
I propped her head up as before
Only, this time my shoulder bore
Her head, which droops upon it still:
The smiling rosy little head,
So glad it has its utmost will,
That all it scorned at once is fled,
And I, its love, am gained instead!
Porphyria's love: she guessed not how
Her darling one wish would be heard.
And thus we sit together now,
And all night long we have not stirred,
And yet God has not said a word!

Robert Browning

20 juin 2008

Il genio è la punta estrema del senso pratico.


A Favourite Custom, Lawrence Alma-Tadema, 1909.

The validity of the DSM depression criteria has been questioned. In an examination of comorbidity in twins and the occurrence of future episodes to validate externally the DSM depression criteria, the number of symptoms (the hallmark of the criteria), their duration, and resulting impairment did not predict the presence of depressive illness in a co-twin or future episodes in the proband. Another study found DSM criteria to have poor agreement with core features of melancholia derived from cluster analytic and similar techniques. A consequence of the non-specificity of the diagnostic criteria is seen in prevalence figures for depression which have increased from a population lifetime base rate in the 1960s of about 6–8% to present estimates of over 10% for men and 20% for women. In both periods investigators actively sought and evaluated community samples and used similar methodology, making unlikely the explanations that the increase is based on better identification procedures or a postulated greater willingness of sufferers to seek help. Cohort and period effects (respectively, earlier onset ages for first depression and more new depressions in persons born closer to the present) may account for some of the change, but not to the extent indicated by marked increase in base rates. In another example in a Swedish population cohort study of 2612 persons, the lifetime cumulative probability of suVering from depression was estimated to be almost 27% for men and a staggering 45% for women, but only 8 men and 9 women were identified as having a ‘‘serious’’ depressive illness.

19 juin 2008

There is a luxury in self-dispraise, and inward self-disparagement affords, to meditative spleen a grateful feast.

Melancholia syndromes as commonly labeled in present classifications :

Manic-depressive illness
Melancholic ‘‘major’’ depression (unipolar depression)
Manic-depressive depression (bipolar depression)
Psychotic depression
Catatonic and stuporous depression
Puerperal depression
Abnormal bereavement

To reflect is to disturb one's thoughts.


John William Waterhouse, Gather ye rosebuds while ye may, 1909.


Pathological mood is expressed as pervasive and unremitting apprehension and gloom that colors all cognitive processes, resulting in a loss of interest, decreased concentration, poor memory, slowed thinking, feelings of failure and low self-worth, and thoughts of suicide. Regardless of antecedent events, whether a personal loss or a general medical illness, a persistent and unrelieved feeling of gloom is essential to the diagnosis.

Psychomotor disturbance, either as retardation or agitation, is the second characteristic. Retardation varies from a reluctance and hesitation to participate in daily activities, to prolonged inactivity that is so severe as to be labeled a stupor simulating death.

Agitation appears as restlessness, hand-wringing, and inability to remain still. It may be expressed as pacing and continuous movement progressing to purposeless activity so severe that it has been described as furor or frenzy. Vegetative functions are severely aVected.

Sleep is disrupted, appetite and weight lost, sex no longer arouses interest, and the response to stress and chronobiologic functioning are disturbed. Patients describe these changes as beyond their understanding or control, or the signs of illness are obvious in a loss of weight, unkempt appearance, body odor, and haggard look. Neuroendocrine dysfunctions are identified in laboratory studies.

Psychosis is recognized when the disorder is severe and occurs in over 30% of melancholic patients. Like psychomotor dysfunction, it is an integral part of melancholia. Melancholic patients are preoccupied with thoughts of guilt, worthlessness, and helplessness, often so severely distorted and exaggerated as to dominate daily living.

Melancholia is a well-defined clinical picture that can be honed by laboratory tests, course of illness, and treatment response. Understanding the many putative mood disorders in the present classification as they relate to melancholia oVers an opportunity to define a common biology and to simplify and improve therapeutics.

A revival of the concept of a single manic-depressive illness with the depressed phase recognized as ‘‘melancholia’’ is also parsimonious and best fits the evidence. From this perspective, many of the disorders of mood that are described in psychiatric classifications can be considered melancholic illness.

Descriptions of individual patients with a depressive mood disorder offer rich imagery of the patients who meet the criteria for melancholia. The vignettes from Hopewell-Ash’s Melancholia in Everyday Practice (1934) oVer pictures before the present psychiatric classifications and modern therapies evolved.

16 juin 2008

Quelle obscure folie d'avoir laissé mourir ce que m'offrait la vie.



Giovanni Bellini, Pietà, 1505.


Melancholia (n.) - c.1303, ‘‘condition characterized by sullenness, gloom, irritability,’’ from O.Fr. melancholie, from L. L. melancholia, from Gk. melankholia ‘‘sadness,’’ lit. ‘‘black bile,’’ from melas (gen. melanos) ‘‘black’’ (see melanin) þ khole ‘‘bile.’’ Medieval physiology attributed depression to excess of ‘‘black bile,’’ a secretion of the spleen and one of the body’s four ‘‘humors.’’ Adj. sense of ‘‘sullen, gloomy’’ is from 1526; sense of ‘‘deplorable’’ (of a fact or state of things) is from 1710.

The precision of medical diagnostic terms is essential to establish the reliability and validity of proposed disease states. While the term ‘‘depression’’ is widely used in society, its meaning varies with the user, an attitude best expressed by Alice in Wonderland’s Humpty-Dumpty, ‘‘When I use a word, it means just what I choose it to mean – neither more nor less.’’In psychology, depression represents a decrease in psychomotor activity or intellectual agility. Within neurophysiology, depression refers to a decrease in the brain’s functioning, measured in electrical activity or cerebral blood flow. For the pharmacologist, depression means the decrease in body functions induced by sedatives, soporifics, and anesthetics. In clinical practice, depression describes a normal human emotion, a pathologic state if it is retained too long or too deeply, or a psychopathologic syndrome that may be mild or severe.


A clinical depressive episode may be defined by its associated adverse life events or it may strike a subject without cause.Accepting ‘‘depression’’ as a medical diagnosis is equivalent to accepting ‘‘infection’’ as a definitive diagnostic term in clinical medicine.

‘‘Melancholia’’ has a more precise meaning. As a central organizing model of mood disorder, melancholia is a recurrent, debilitating, pervasive brain disorder that alters mood, motor functions, thinking, cognition, perception and many basic physiologic processes.

11 juin 2008

Si le paradis est un avant-goût d'éternité dans l'instant présent, alors l'enfer est une éternité de chagrin dans l'instant présent.


Pierre-Narcisse Guérin, Aurore enlevant Céphale, 1813.
Instead of looking to an unsure future classification based on models and studies yet to be reported, there is merit in a simplified classification of the mood disorders based on the classical principles of clinically defined signs and symptoms and course of illness, as oVered by nineteenth-century psychopathologists. The psychodynamic and psychopharmacologic interruptions are false trails, misjudgments in the development of a psychiatric science that were attractive for a time. In addition to clinical criteria, biological treatments are remarkably eVective and they may be used to define diagnostic criteria. Some laboratory tests hold promise for supplementing treatment response. To redress the present false trail on which psychiatric classification is embarked, a single image of depressive mood disorders is parsimonious. Melancholia, recognized as a central theme of depressive illness throughout much of medical history, provides the standard on which to judge mood disorder.

09 juin 2008

Añorar el pasado es correr tras el viento.


Joan Miró, El puerto, 1945.

Lo meo servente core

Lo meo servente core
vi raccomandi Amor, che vi l'ha dato,
e Merzé d'altro lato
di me vi rechi alcuna rimembranza;
ché, del vostro valore
avanti ch'io mi sia guari allungato,
mi tien già confortato
di ritornar la mia dolce speranza.
Deo, quanto fie poca addimoranza,
secondo il mio parvente:
ché mi volge sovente
la mente per mirar vostra sembianza;
per che ne lo meo gire e addimorando,
gentil mia donna, a voi mi raccomando.

Dante Alighieri

La vie est une tragédie pour celui qui sent et une comédie pour celui qui pense.


Dante Gabriel Rossetti, The day dream, 1872.



Bipolar disorder was distinguished as a separate class by the occurrence of excitement, distractibility, agitation, and talkativeness in the patient’s life history. Parallel to the subtyping in the DSM category of major depression, the bipolar disorders weredivided into bipolar I with a single manic episode (with more recent episode mixedor depressed or unspecified), bipolar II (with hypomanic but not manic episodes), andcyclothymic disorder. The list of specifiers is similar to those in the major depressive category, with the addition of rapid cycling.

The new classification and specific criteria were quickly challenged by clinicians who could not fit their patients within the defined categories. In response, new diagnostic classes were included in the 1987 revision (DSM-IIIR) and again in the 1994 iteration (DSM-IV). The number of recognized diagnostic entities dramatically increased. The episodic nature of emotional illnesses was recognized in the definition of major depressive, manic, mixed, and hypomanic episodes that were combined into major depressive disorder (either single or recurrent), and further divided by the specifiers of chronic and severity/psychotic/remission and by the features of catatonia, melancholia, atypical, or postpartum onset. To the recurrent disorders, two additional specifiers of course and seasonal pattern were offered. This extended list of diagnoses was still considered insuYcient. Clinicians labeled variations in the duration of the illness, its seasonal features, diVerential response to medication, and mixtures of psychopathology as seasonal aVective disorder, atypical depression, double depression, brief recurrent depression, and endogenomorphic depression.

Mood disorders were separated by assumed precipitants and labeled major depression following childbirth (postpartum depression), in menopause (invonal depression), with aging (geriatric depression), and after the loss of a loved one (abnormal bereavement).

The labels were offered as if the psychopathology, course, outcome, or treatment of the condition was differentiable from other depressive disorders. In clinical practice, however, these situational precipitants do not define the presentation of the illness, the response to treatments, or the endocrine markers. The limitations of the present DSM classification are well recognized. The DSM-V iteration planned for the years 2007–2010 seeks a basis in experimental studies of genetic, neuroanatomic, neuroimaging, developmental science, and family criteria. Whether the neurosciences will oVer suYcient data to define a more useful classification is unpredictable.

06 juin 2008

L'émotion nous égare : c'est son principal mérite.


Dante Gabriel Rossetti, The Holy Grail, 1860.
By the late 1960s it was no longer acceptable to treat all depressed patients as if they were suVering from a single condition because some treatments were eVective for some patients and not for others. One group, for example, examined 33 studies that had assessed medication treatments of depression and could not find a diagnostic formulation that had predictive strength. The DSM-II and ICD-8 classifications had poor reliability, best demonstrated in international studies.

An operationally defined diagnostic scheme was oVered in the Research Diagnostic Criteria (RDC).44 Its usefulness encouraged the American Psychiatric Association to update the oYcial classification in DSM-III of 1980.45 Lacking a defined theory of psychiatric illness, however, the classes represented a consensus among observers who used diVerent texts, idiosyncratic personal clinical experiences, and diVerent psychological and pharmacologic theories as guidelines. For some disorders, a Kraepelinian template can be recognized (e.g., the schizophrenia criteria); for others, a psychological template is apparent (e.g., dissociative disorders). The committees represented diverse constituencies and the final formulations were designed to be accepted by the average psychiatrist who would vote it up or down in an American Psychiatric Association election.46Within a few years, dissatisfaction with the classification called for revisions (DSM-IIIR) in 1987 and in 1994 (DSM-IV).

Melancholia was ignored as each revision added new categories in response to the needs of diVerent practitioner groups. In the first DSM classification, four different depressive reactions were identified, with four subtypes for ‘‘aVective reactions.’’ In the 1968 version, two additional subtypes were added. By 1980, four major mood disorders were identified, with 10 subtypes. For major depression, an additional three subtypes were listed. ‘‘Melancholia’’ could still be specified as either present or absent for major depression but was not recognized as a specific disorder. As the core disorder of mood, the DSM-III commission oVered a single concept of ‘‘major depression’’ (with descriptors of single episode or recurrent) and with the variant
bipolar depression (with mixed, manic, and depressed variants).

Depressive disorder not otherwise specified and abnormal bereavement were two additional entities. Psychosis became a specifier of mood disorders. A syndrome of ‘‘dysthymia’’ was revived. The concepts of melancholia, melancholic depression, and involutional depression were discarded.

01 juin 2008

Laissons les jolies femmes aux hommes sans imagination !


Salvador Felipe Jacinto Dalí Domènech, Buste de Voltaire, 1940.


"No soy yo quien grita"

¡Cuidado! ¡Cuidado! ¡El diablo ha enloquecido!
Escóndete en el fondo limpio de los manantiales,
fúndete al cristal de la ventana,
ocúltate tras los fuegos de los diamantes,
bajo las piedras, entre los insectos,
escóndete en el pan recién salido del horno.
Oh, Tú, pobre, mi pobre.
Con el fresco aguacero fíltrate en la tierra.
En vano hundes tu rostro en ti mismo,
sólo podrás lavarlo en otro rostro.



Attila József

Siempre son los demás los que se mueren.


Death Crowning Innocence, George Frederick Watts, 1896


Maman

Huit jours déjà que je ne pense qu’à maman,
tout le temps, en m’arrêtant,
son panier grinçant dans les bras,
elle montait au grenier,
montait de vifs pas, décidés.

A l’époque, l’homme sincère qui j’étais,
je hurlais, je tapais du pied
qu’elle laisse le linge lavé à d’autres,
qu’elle me prenne moi dans ses bras et,
au grenier, qu’elle me monte.

Impassible, en silence, elle allait tendre,
sans me gronder ni m’adresser un regard
et le linge éclatant, en fendant l’air,
voltigeait, s’en volait vers le ciel.

Je ne pleurnicherais plus mais c’est trop tard,
désormais, je vois comme elle est grande –
ses cheveux gris frôlent le ciel haut,
ainsi diluent-ils du bleu dans son eau.


Attila József