document_title: Ghost Whisperer (season 4)

question_text: when does sam realize he is jim in ghost whisperer

text: Ghost Whisperer (season 4)

text: Plot[edit]

text: In the fourth season, Melinda meets Eli James (Jamie Kennedy) after a fire at Rockland University who, after his own near-death experience, develops the ability to hear ghosts. Melinda says goodbye to her close friend Rick Payne, who leaves Grandview on a research trip for the university. In this season, Jim is shot and killed. He does not "cross over" because he does not want to leave Melinda, and his spirit later enters the body of a man named Sam Lucas, who died in an unrelated accident in Grandview and crossed over. When Jim/Sam regains consciousness, he has no memory of being Jim. Melinda works to get him to remember his past life and her, and succeeds after much difficulty and skepticism on the part of her friends. They soon discover that Melinda is pregnant and that the date of conception was right before Jim died.

text: At the end of the season, Ned and Eli find the Book of Changes, a book written by the Watchers (a benevolent group of ghosts who keep watch over the living). The book tells them of past and future prominent dates, such as Andrea and Jim's deaths. One date is listed as September 25, 2009; Melinda's due date. Melinda learns from a Watcher named Carl that her child is destined to not only inherit her gift, but be far more powerful than her. Melinda and Jim decide to remarry and have a small ceremony on a snowy night, on the street where they first met.

text: Development[edit]

text: Ghost Whisperer is based on the work of "Spirit Communicator" James Van Praagh,[3] who is co-executive producer[4] and regularly updates a blog about the show through LivingTV.[5] The stories are also said to be based in part on the work of "Spirit Communicator" Mary Ann Winkowski.[6] Development of the show dates back to at least two years before its premiere.[7]

text: The show was produced by Sander/Moses Productions in association with CBS Television Studios (originally Paramount Network Television in season one and ABC Studios (originally Touchstone Television in the first two seasons) and CBS Paramount Network Television in seasons two and three).

text: The show was filmed on the Universal Studios back lot in Los Angeles.[8] One area on the lot is Courthouse Square from the Back to the Future trilogy, though it has been drastically modified to depict Grandview. For example, the clock tower in Back to the Future has been completely covered up. Cast and crew members believe that the set gets visits from real spirits.[9]

text: Sound effects were completed at Smart Post Sound.[10] Visual effects for the pilot and some season one episodes were completed at Flash Film Works.[11] Visual effects for nearly the entire series were created at Eden FX.[12]

text: Creator John Gray grew up in Brooklyn, New York, which is not far from Grandview-On-Hudson, west of the Hudson River. Piermont is often referenced in episodes as the neighboring town, which is accurate to real life as Grandview-On-Hudson is actually located just north of Piermont. Professor Rick Payne worked in the fictional "Rockland University," and perhaps not coincidentally, the actual Grandview, New York is a village located in Rockland County, New York.

text: Cast[edit]

text:
Jennifer Love Hewitt as Melinda Gordon (23 episodes)
David Conrad as Jim Clancy/Sam Lucas (23 episodes)
Camryn Manheim as Delia Banks (23 episodes)
Jay Mohr as Rick Payne (1 episode)
Christoph Sanders as Ned Banks (13 episodes)
Jamie Kennedy as Eli James (23 episodes)

text: Episodes[edit]

text:
No. in
Series
No. in
Season
Title
Directed by
Written by
Original air date
U.S. viewers
(millions)

63
1
"Firestarter"
Eric Laneuville
P.K. Simonds
October 3, 2008 (2008-10-03)
9.44[13]

Melinda hears that there has been a fire at the Rockland University Building when Jim is called over there, and hurries over, fearful for Professor Rick Payne, but he is revealed to be alive and well. However, a therapist by the name Eli James dies, and Melinda witnesses his soul being brought back. This 'near-death' experience grants him the ability to hear ghosts. The episode is focused on the ghost of one of Eli's patients,who was possibly more than that, and whether or not she has been starting fires since she was 12. Whilst Melinda is trapped in the archives, she meets a group of seemingly benign ghosts calling themselves the watchers, who warn her that dealing with death may brush off on something she loves.
Note: This was Jay Mohr's last appearance as Professor Payne. First appearance of Jamie Kennedy
Guest Star: Alona Tal as Fiona Raine

64
2
"Big Chills"
Peter Werner
Laurie McCarthy
October 10, 2008 (2008-10-10)
9.69[14]

A woman finds her friend dead and strange things start happening around her. She remembers Melinda's abilities from high school (not that she ever believed it before) and calls on her for help. Mel quickly uncovers the story-Grace, her current boyfriend and the dead friend were in a car accident with a motorcyclist 10 years ago and they left him for dead. The guilt ate away at the dead friend but when he tried to go to the police, the other two stopped him. Melinda must tell the motorcyclists family what happened to him in order for the ghost to move on.

65
3
"Ghost in the Machine"
Steven Robman
Jeannine Renshaw
October 17, 2008 (2008-10-17)
8.97[15]

Melinda watches Ned playing a computer game, and notices one of the Avatars staring right at her, and he appears in her shop, making her realise she has pulled him out of the game. She realises he is a ghost who appears as his Avatar because that is how he remembers himself, he died whilst playing the game. After realising that this Ghost/Avatar-'Phoenix' is usually hanging around with a teenage girl in the game, Mel, Ned and Eli suspect that he is a Predator, and proceed to try and catch him. Melinda sets up an Avatar and enters the game, and eventually discovers that 'Phoenix' is the girls dad, and is actually trying to protect his daughter from the real Predator, who they then have to work together to catch.

66
4
"Save Our Souls"
Gloria Muzio
Mark B. Perry
October 24, 2008 (2008-10-24)
10.14[16]

Melinda and Jim go to a cruise ship that is going to be scrapped soon and meet the newlywed couple staying in the room next to theirs who want to swap because they are having problems with their room and marriage. Mel sees lots of ghosts on the ship and one is very friendly and helpful. Mel realises room M108 is haunted by a ghost who is looking for her fiancé and swaps rooms so she can help her. She figures out the story of how the ghost died and who her fiancé was- he happens to be the owner of the ship, and has to get him to help the ghost cross over.
Guest Star: Solange Knowles as cruise singer.

67
5
"Bloodline"
Ian Sander
Melissa Blake & Joy Blake
October 31, 2008 (2008-10-31)
9.40[17]

A teenager dies while playing tennis with Ned and a friend, and her ghost starts haunting the girl. Mel finds out that the two girls used to be friends until their mothers stopped talking and one family moved away. After the discovery that the blood clot that killed Diana is a genetic condition, it is revealed that the girls were swapped at birth. The ghost tries to stop Melinda revealing the truth.

68
6
"Imaginary Friends and Enemies"
Eric Laneuville
Vivian Lee
November 7, 2008 (2008-11-07)
11.06[18]

Mel and Jim visit an old lodge with an old friend, her daughter and her new fiancé, and Melinda quickly realises that the little girl's imaginary friend is actually a ghost. The ghost seems obsessed with the girl's mother, and wants to play a game with her, but the game ends up hurting the mother. It is later revealed that the mother used to be friends with the ghost (when he was alive and after), and he is trying to warn her about someone, using a clues game they used to play. Melinda has to convince Tricia to play the game and work out the clues. Jim is shot.

69
7
"Threshold"
John Gray
John Gray
November 14, 2008 (2008-11-14)
11.57[19]

Jim meets his brother in the in-between state, but decides that he needs to stay behind to be with Mel, since she's not coping without him. She can't see him even though he's there, because her grief is strengthening the veil, but there is another ghost who wants her help, and she mistakes the signs as being from Jim. Eventually he gets through to her, and she tries to convince him to cross over, but he refuses. The other ghost is revealed to be the recently deceased stepdaughter of the man who shot Jim. At an accident, a man dies and goes into the light, and Jim steps into the body, despite Melinda's warning.

70
8
"Heart & Soul"
Ian Sander
Mark B. Perry & P.K. Simonds
November 21, 2008 (2008-11-21)
11.28[20]

Jim/Sam has no memory of being Jim and very little of being Sam, and Melinda tries to help, wanting the love of her life back. He visits Sam's family but eventually accepts Mel's offer to fix up her garage and live there whilst doing so. Delia doesn't believe Melinda about Jim's spirit stepping into Sam's body.

71
9
"Pieces of You"
Jim Chressanthis
Laurie McCarthy
December 5, 2008 (2008-12-05)
9.71[21]

Jim/Sam is concerned about what might be going on between him and Melinda, thinking they were having an affair, and she assures him she would never cheat on her husband. She starts to tell him about the whole Jim/Sam thing, but his reaction stops her. Delia believes Mel about Jim/Sam after seeing him waiting for Ned at the basketball court, and convinces him to stay. Meanwhile, Mel has to help the ghost of a little girl who is haunting a wishing well.

72
10
"Ball & Chain"
Eric Laneuville
Christina M. Kim & Jeannine Renshaw
December 19, 2008 (2008-12-19)
10.18[22]

Whilst doing work at a house, Jim/Sam hears a car backfire and remembers being shot, which he finds weird, but Mel sees it as a sign of Jim still being in there somewhere. Whilst searching for clues about who he is, he finds an engagement ring Sam was planning on giving his on/off girlfriend, bought a month before his accident. Mel has to unravel the mystery behind a ghost's death, since the ghost is convinced she didn't abandon her family.

73
11
"Life on the Line"
Eric Laneuville
Christina M. Kim & Jeannine Renshaw
January 9, 2009 (2009-01-09)
10.64[23]

Delia is selling a house and she and Mel find it odd that there are still so many family photos and personal effects everywhere. Ned finds the lawnmower and awakens a ghost, who resends an old 911 call made from the house. This leads Melinda to investigate, and she discovers that a 14-year-old boy was killed by the lawnmower there. She must uncover the truth behind the accident and get the family back together for the ghost to move on. Also, Sam remembers medical procedures, indicating that more of Jim's past is coming up. He also tries to find evidence of his fiancé in his personal effects including looking through his sent e-mails.

74
12
"This Joint's Haunted"
Mark Rosman
Mark B. Perry
January 16, 2009 (2009-01-16)
10.58[24]

Delia throws a dinner party for a couple of her high school friends and Eli who quickly hears a ghost about the place. Ned housesits for Mel whilst she goes on a road trip with Sam who is trying to find his fiancé in the hope that she can help with regaining his memory. Mel has to help a few ghosts along the way, all without revealing her abilities to Sam. The ghost in Delia's house is trying to stop her from being so hard on Ned because she blames her own parents for her death. Sam's fiancé comes to see him and finally believes him about the amnesia.

75
13
"Body of Water"
Jennifer Love Hewitt
P.K. Simonds & Laurie McCarthy
January 23, 2009 (2009-01-23)
11.18[25]

A girl swims in a lake and is scared away. It is later discovered that there are many dead bodies in the lake and one of them is the girls' father. Mel and Eli have to figure out what happened to the bodies to stop the ghosts from being so angry and helping them move on, and it has something to do with the owner of the funeral home, who now has cancer and won't take his medication. Sam's fiancé Nikki ends up staying with Mel and spending a lot of time with Sam, which worries Delia, who urges Mel to fight for him. The Watchers return and warn Mel again, and she learns that they chose to stay earthbound to help the living. After his past life regression session with Eli, Sam remembers loving Mel, but he thinks he is remembering Nikki.
Note: This episode was Jennifer Love Hewitt's directorial debut.

76
14
"Slow Burn"
Steven Robman
Jeannine Renshaw
February 6, 2009 (2009-02-06)
11.41[26]

Delia asks Sam and Mel to help her chaperone Ned's school dance, and Mel sees a ghost trying to stop a girl leaving with an older boy. She quickly realises the ghost is the girls' mother, and must figure out why she doesn't want the two to be together, with very little help from the ghost herself. Delia and Eli help her. Sam asks her on a date and she accepts, but helping the ghost causes her to miss it, and leads Sam to think she's not ready to date after losing her husband.
Guest Star: Kendall Schmidt as Jeff

77
15
"Greek Tragedy"
Karen Gaviola
Christina M. Kim
February 13, 2009 (2009-02-13)
10.30[27]

A sorority at Rockland University 'hazes' new members with a brutal ritual, and one girl never returns the next day, which is a first. Mel plans a date with Sam and promises Delia no ghost business, but is unable to help herself when she sees a ghost with a bag over her head, immediately thinking it is the missing girl. Eli works with her to figure out how she died, but the ghost is not who they thought she was at all, she died forty years ago after trying to make amends for the horrible things she did as a sorority leader. Mel told Sam she was volunteering at the firehouse, and when he asks about her there he finds that she never signed in, but he sees on her TV at the Rescue mission. He asks her about it and she lies, making him suspicious.

78
16
"Ghost Busted"
John Behring
Mark B. Perry & P.K. Simonds
February 27, 2009 (2009-02-27)
11.54[28]

Melinda's neighbours hire a ghost hunter right when she was about to tell Sam about her gift, and after seeing his sceptical reaction, she holds off on telling him, despite Delia's urging otherwise. Eli hangs out with the ghost hunter and accidentally reveals his own gift, ending up thinking the ghost hunter is legit, and they incorrectly deduce that the ghost is the house's previous owner. Eli lies to Sam when he asks questions about Mel, and Delia tells him to keep an open mind. Mel works out who the ghost really is and helps him move on, finally tells Sam about her gift, and is crushed when he is sceptical.

79
17
"Delusions of Grandview"
Jefery Levy
Laurie McCarthy & Mark B. Perry
March 6, 2009 (2009-03-06)
11.09[29]

Sam wants to see Melinda doing her thing, and follows her to a school where he's been doing work. Mel quickly sees ghosts and works out that they are patients of the mental hospital that the school used to be. One ghost in particular needs her help, she was admitted to the hospital after supposedly drowning her baby. Sam goes into the tunnels with Melinda, and gets freaked out when she has a vision of how the ghost died, which involved electro-shock therapy. Delia and Eli work out that the ghost's doctor was a ghost himself, and she is trying to protect the children in the school from him. Mel finally tells Sam about him being Jim, and he refuses to believe it, instead thinking that Mel needs professional help.

80
18
"Leap of Faith"
Ian Sander
P.K. Simonds & Laurie McCarthy
March 13, 2009 (2009-03-13)
10.58[30]

Sam moved out at Melinda's request, but he forgot something, so tries calling her to ask for it, but she won't answer his calls. Mel is scared by a break-in at her shop, especially when Dr Byrd's ghost shows up again. Eli goes to see the guy who broke in and discovers that he is another step-in (like what Jim did to Sam). Mel deduces that Dr Byrd is behind the step-in's, and works out that he wants another body for himself. Mel realises the other step-in is lost and confused somewhere in the tunnels and goes to find and help him, but the water valve has broken and the place is quickly filling with water. Byrd goes to get Eli and Sam is sceptical of his belief in a ghost he doesn't trust, but follows him down anyway. Since Eli can't swim, Sam goes to rescue Mel, and after his bag gets trapped on something, Jim's life flashes before his eyes.

81
19
"Thrilled to Death"
Gloria Muzio
Laurie McCarthy & Jeannine Renshaw
April 10, 2009 (2009-04-10)
10.08[31]

A young woman in Eli's apartment building is being haunted, but claims she doesn't know anyone who has died. Mel and Eli investigate together and figure out who the ghost is, and when they find out that Morgan was lying about knowing him, they wonder what else she's been lying about, and quickly discover that she is ill herself. Meanwhile, Jim misses his job and friends but realises that can't be his life anymore, and he eventually decides he wants to go to Med School. Mel and Eli realise there is much more to Morgan's story, and have to stop the ghost hurting her out of his anger at being lied to.
Guest Star: Hilary Duff as Morgan.

82
20
"Stage Fright"
Eric Laneuville
Mark B. Perry
April 24, 2009 (2009-04-24)
9.23[32]

A TV show is shooting in Grandview and wants to use Melinda's store. Mel, Delia, Jim and Eli go to a Promotional Event, and Mel and Eli quickly pick up that a ghost is haunting the writer of the show and the lead male actor, and is also involving a seemingly random girl in the audience. They discover that they were all in a play together and the ghost was shot on stage when the blank gun malfunctioned. Mel and Eli think he blames the other three for his death and Eli jumps to the conclusion that the ghost is trying to kill someone on the show. They have to unravel the truth behind what happened in the play all those years ago so the ghost can cross over. After an accident shooting a walk-on part, Jim takes Mel to the hospital and they get some great news.
Guest Star: Amelia Heinle as Brook Dennis.

83
21
"Cursed"
Kim Moses
Laurie McCarthy
May 1, 2009 (2009-05-01)
9.79[33]

A little girl comes into the store, searching for a very specific doll, and when the older girl (a cousin) explains that it is for a replica dollhouse of the house the older girl lived in with her family before they died, and that the dolls 'talk' to the little girl, Melinda suspects that the spirits of Emma's family are trapped in the dollhouse. She investigates until she finds out the truth behind their deaths, leading her to think that the little girls mother (and Emma's Aunt) killed the family for their money and wants to hurt Emma. Mel tells Delia she's pregnant, then discovers that she's lost her wedding bands. Jim proposes again.

84
22
"Endless Love"
Ian Sander
P.K. Simonds
May 8, 2009 (2009-05-08)
9.50[34]

Melinda is at Delia's when she realises that one of the girls in Ned's study group is being haunted. After a sleepwalking incident, Mel and Eli try to work out who the ghost is and what he wants. Eli's friend Zoe (who told him about Voodoo in the previous episode) recognises the hauntings as Vampire Myths, leading Mel to wonder if Serena knew the ghost, and whether she was into Vampires. When she tries to ask her about it, Serena ends up thinking Vampires are real, and is surprised when Mel reveals she was talking about a ghost. The ghost leads Serena to his crypt after she says she wants to see him, and Mel has to race against time to get there and get her out of the sealed crypt before all the oxygen runs out. Also, Mel and Jim plan their second wedding-with Jim as Sam.
Guest Star: Alexa Vega as Serena

85
23
"The Book of Changes"
John Gray
John Gray
May 15, 2009 (2009-05-15)
9.15[35]

Melinda's mother hires a wedding planner who completely ignores what the couple want. Someone breaks into the University Library and then Zoe's house, but is interrupted by Eli. The thief only stole one book- called 'The Book of Changes' by the Watchers. It has important dates in it, such as previous deaths and Melinda's due date, which is why Carl the Watcher tells Eli not to let Melinda see or touch the book. Because the collection it was hidden in is being bought, the Watchers are trying to protect it. Melinda keeps getting visions of a faceless girl holding the book and saying that Mel's future is in 'her' hands and that Mel can't save 'her'. Mel is scared for her unborn baby, especially when she learns that it will be able to do much more than her (with their gift). Jim and Mel have a quiet wedding on the street where they first met, with only Delia and Eli in attendance, and Jim calls it a renewal of everything they already had and have. Mel is told she has lots of white light around her-spirits protecting her, but if the balance slips, that could change. Eli becomes 'The Book of Changes' new caretaker.

tag: table


document_title: Kaiser Permanente

question_text: where did the name kaiser permanente come from

root

text: Kaiser Permanente

text: Structure and governance[edit]

text: Kaiser Permanente provides care throughout eight regions in the United States. Two or three (four, in the case of California) distinct but interdependent legal entities form the Kaiser system within each region. This structure was adopted by Kaiser Permanente physicians and leaders in 1955.

tag: p

text: Governance[edit]

text: Each entity of Kaiser Permanente has its own management and governance structure, although all of the structures are interdependent and cooperative to a great extent. There are multiple affiliated non-profits registered with the U.S. Internal Revenue Service. According to Form 990 governance questions, Kaiser Foundation Hospitals and Kaiser Foundation Health Plan do not have members with the power to appoint or elect board members, meaning that the board itself nominates and appoints new members.[3]

text: Chairman and CEO George Halvorson retired in December 2013, after serving since 2002.[4]

text: On November 5, 2012, the board of directors announced that Bernard J. Tyson, Kaiser's president and chief operating officer for the last two years, would replace Halvorson[5] — the first time an African American was appointed to that position.[6]

text: National structure[edit]

text: The two types of organizations which make up each regional entity are:

text:
Kaiser Foundation Health Plans (KFHP) work with employers, employees, and individual members to offer prepaid health plans and insurance. The health plans are not-for-profit and provide infrastructure for and invest in Kaiser Foundation Hospitals and provide a tax-exempt shelter for the for-profit medical groups.
Permanente Medical Groups are physician-owned organizations, which provide and arrange for medical care for Kaiser Foundation Health Plan members in each respective region. The medical groups are for-profit partnerships or professional corporations and receive nearly all of their funding from Kaiser Foundation Health Plans. The first medical group, The Permanente Medical Group, formed in 1948 in Northern California. Kaiser doctors become Permanente stockholders after three years at the company.[7]

tag: ul

text: In addition, Kaiser Foundation Hospitals operates medical centers in California, Oregon, Washington and Hawaii, and outpatient facilities in the remaining Kaiser Permanente regions. The hospital foundations are not-for-profit and rely on the Kaiser Foundation Health Plans for funding. They also provide infrastructure and facilities that benefit the for-profit medical groups.

text: Regional entities[edit]

text: Kaiser Permanente is administered through eight regions, including one parent and six subordinate health plan entities, one hospital entity, and nine separate, affiliated medical groups:

text:
[show]Various legal entities serve the areas of the US where Kaiser operates: California (the largest two), Colorado, Georgia, Hawaii, mid-Atlantic, Pacific Northwest, and Washington.

Northern California, 3,351,449 members[8]

Kaiser Foundation Health Plan, Inc. (KFHP)
Kaiser Foundation Hospitals (KFH)
The Permanente Medical Group, Inc. (TPMG)

Southern California, 3,499,035 members

Kaiser Foundation Health Plan, Inc. (KFHP)
Kaiser Foundation Hospitals (KFH)
Southern California Permanente Medical Group (SCPMG)

Colorado, 531,908 members

Kaiser Foundation Health Plan of Colorado (KFHPCO)
Colorado Permanente Medical Group, P.C. (CPMG)

Georgia, 222,074 members

Kaiser Foundation Health Plan of Georgia, Inc. (KFHPGA)
The Southeast Permanente Medical Group, Inc. (TSPMG)

Hawaii, 226,900 members

Kaiser Foundation Health Plan, Inc. (KFHP)
Kaiser Foundation Hospitals (KFH)
Hawaii Permanente Medical Group, Inc. (HPMG)

Mid-Atlantic (vicinity of Washington, D.C., including Maryland and Virginia), 581,000 members

Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. (KFHPMA)
Mid-Atlantic Permanente Medical Group, P.C. (MAPMG)

Northwest (Northwest Oregon and Southwest Washington), 480,386 members

Kaiser Foundation Health Plan of the Northwest (KFHPNW)
Kaiser Foundation Hospitals (KFH)
Northwest Permanente, P.C. Physicians and Surgeons (NWP)

Washington (except Southwest Washington), 681,386 members

Kaiser Foundation Health Plan of Washington
Washington Permanente Medical Group

text: In addition to the regional entities, in 1996, the then-twelve Permanente Medical Groups created The Permanente Federation, a separate entity, which focuses on standardizing patient care and performance under one name and system of policies. Around the same time, The Permanente Company was also chartered as a vehicle to provide investment opportunities for the for-profit Permanente Medical Groups.[9] One of the ventures of the Permanente Company is Kaiser Permanente Ventures, a venture capital firm that invests in emerging medical technologies.[10]

text: History[edit]

text: Early years[edit]

text: The history of Kaiser Permanente dates to 1933 and a tiny hospital in the town of Desert Center, California. At that time, Henry J. Kaiser and several other large construction contractors had formed an insurance consortium called Industrial Indemnity to meet their workers' compensation obligations. Dr. Sidney Garfield had just finished his residency at Los Angeles County-USC Medical Center at a time when jobs were scarce; fortunately, he was able to secure a contract with Industrial Indemnity to care for 5,000 construction workers building the Colorado River Aqueduct in the Mojave Desert. Soon enough, Garfield's new hospital was in a precarious financial state (with mounting debt and the staff of three going unpaid), due in part to Garfield's desire to treat all patients regardless of ability to pay, as well as his insistence on equipping the hospital adequately so that critically injured patients could be stabilized for the long journey to full-service hospitals in Los Angeles.[11]:19–26

text: However, Garfield won over two Industrial Indemnity executives, Harold Hatch and Alonzo B. Ordway. It was Hatch who proposed to Garfield the specific solution that would lead to the creation of Kaiser Permanente: Industrial Indemnity would prepay 17.5% of premiums, or $1.50 per worker per month, to cover work-related injuries, while the workers would each contribute five cents per day to cover non-work-related injuries. Later, Garfield also credited Ordway with coming up with the general idea of prepayment for industrial healthcare. Garfield also later explained that he did not know much at the time about other similar health plans except for the Ross-Loos Medical Group.[12]

text: Hatch's solution enabled Garfield to bring his budget back into the positive, and to experiment with providing a broader range of services to the workers besides pure emergency care. By the time work on the aqueduct concluded and the project was wrapped up, Garfield had paid off all his debts, was supervising ten physicians at three hospitals, and controlled a financial reserve of $150,000.[13]

text: Garfield returned to Los Angeles for further study at County-USC with the intent of entering private practice. However, in March 1938, Consolidated Industries (a consortium led by the Kaiser Company) initiated work on a contract for the upper half of the Grand Coulee Dam in Washington state, and took over responsibility for the thousands of workers who had worked for a different construction consortium on the first half of the dam. Edgar Kaiser, Henry's son, was in charge of the project. To smooth over relations with the workers (who had been treated poorly by their earlier employer), Hatch and Ordway persuaded Edgar to meet with Garfield, and in turn Edgar persuaded Garfield to tour the Grand Coulee site. Garfield subsequently agreed to reproduce at Grand Coulee Dam what he had done on the Colorado River Aqueduct project. He immediately spent $100,000 on renovating the decrepit Mason City Hospital and hired seven physicians.[14]

text: Unlike the workers on Garfield's first project, many workers at Grand Coulee Dam had brought dependents with them. The unions soon forced the Kaiser Company to expand its plan to cover dependents, which resulted in a dramatic shift from industrial medicine into family practice and enabled Garfield to formulate some of the basic principles of Kaiser Permanente. It was also during this time that Henry Kaiser personally became acquainted with Garfield and forged a friendship which lasted until Kaiser's death.[15]

text: World War II[edit]

text: In 1939, the Kaiser Company began work on several huge shipbuilding contracts in Oakland, and by the end of 1941 would control four major shipyards on the West Coast. During 1940, the expansion of the American defense-industrial complex in preparation for entrance into World War II resulted in a massive increase in the number of employees at the Richmond shipyard.[16] In January 1941, Henry Kaiser asked Garfield to set up an insurance plan for the Richmond workers (this was merely contract negotiation with insurance companies), and a year later Kaiser asked Garfield to duplicate at Richmond what he had done at Desert Center and Mason City.[17] Unlike the two other projects, the resulting entity lived on after the construction project that gave birth to it, and it is the direct ancestor of today's Kaiser Permanente.[18]

text: On March 1, 1942, Sidney R. Garfield & Associates opened its offices in Oakland to provide care to 20,000 workers, followed by the opening of the Permanente Health Plan on June 1.[19] From the beginning, Kaiser Permanente strongly supported preventive medicine and attempted to educate its members about maintaining their own health.[20]

text: In July, the Permanente Foundation formed to operate Northern California hospitals that would be linked to the outpatient health plans, followed shortly thereafter by the creation of Northern Permanente Foundation for Oregon and Washington and Southern Permanente Foundation for California. The name Permanente came from Permanente Creek, which flowed past Henry Kaiser's first cement plant on Black Mountain in Cupertino, California. Kaiser's first wife, Bess Fosburgh, liked the name. An abandoned Oakland facility was modernized as the 170-bed Permanente Hospital opened on August 1, 1942. Three weeks later, the 71-bed Richmond Field Hospital opened. Six first aid stations were set up in the shipyards to treat industrial accidents and minor illness. Each first aid station had an ambulance ready to rush patients to the surgical field hospital if required. Stabilized patients could be moved to the larger hospital for recuperative care.[21] The Northern Permanente Hospital opened two weeks later to serve workers at the Kaiser shipyard in Vancouver, Washington.[22] Shipyard workers paid seven cents per day for comprehensive health care coverage; and within a year the shipyard health plan employed sixty physicians with salaries between $450 and $1,000 per month. These physicians established California Physicians Service to offer similar health coverage to the families of shipyard workers.[21] In 1944, Kaiser decided to continue the program after the war and to open it up to the general public.[18]

text: Meanwhile, during the war years, the American Medical Association (AMA) (which opposed managed care organizations from their very beginning) tried to defuse demand for managed care by promoting the rapid expansion of the Blue Cross and Blue Shield preferred provider organization networks.[23]

text: Courage to Heal, a novel by KP Historical Society President, Paul Bernstein, MD, is based on the story of Garfield's life, his struggles with the AMA, and the origins of Kaiser Permanente.

text: Postwar growth[edit]

text: In 1948, Kaiser established the Henry J. Kaiser Family Foundation, (also known as Kaiser Family Foundation), a U.S.-based, non-profit, private operating foundation focusing on the major health care issues facing the nation.[24] The Foundation, not associated with Kaiser Permanente or Kaiser Industries, is an independent voice and source of facts and analysis for policymakers, the media, the health care community, and the general public.[24]

text: The end of World War II brought about a huge plunge in Kaiser Permanente membership; for example, 50,000 workers had left the Northern California yards by July 1945. Membership bottomed out at 17,000 for the entire system but then surged back to 26,000 within six months as Garfield aggressively marketed his plan to the public.[25] Sidney Garfield & Associates had been a sole proprietorship, but in 1948, it was reorganized into a partnership, Permanente Medical Group.[26]

text: During this period, a substantial amount of growth came from union members; the unions saw Kaiser Permanente care as more affordable and comprehensive than what was available at the time from private physicians under the fee-for-service system. For example, Fortune magazine had reported in 1944 that 90% of the U.S. population could not afford fee-for-service healthcare. Kaiser Permanente membership soared to 154,000 in 1950, 283,000 in 1952, 470,000 in 1954, 556,000 in 1956, and 618,000 in 1958.[27]

text: From 1944 onward, both Kaiser Permanente and Garfield fought numerous attacks from the AMA and various state and local medical societies. Henry Kaiser came to the defense of both Garfield and the health plans he had created.[28]

text: In 1951, the organization acquired its current name when Henry Kaiser unilaterally directed the trustees of the health plans, hospital foundations, and medical groups to add his name before Permanente.[29] However, the physicians in the Permanente Medical Group deeply resented the implication that they were directly controlled by Kaiser, and successfully forced him to back off with respect to their part of the organization. That same year, Kaiser Permanente also began experiments with large-scale multiphasic screening to identify unknown conditions and to facilitate treatment of known ones.[30] Simultaneously, although no one questioned his medical competence, Garfield's deficiencies as an executive were becoming apparent as the organization expanded far beyond his ability to manage it properly.[31]

text: Henry Kaiser became fascinated with the healthcare system created for him by Garfield and began to directly manage Kaiser Permanente and Garfield. This resulted in a financial disaster when Kaiser splurged on the new Walnut Creek hospital; his constant intermeddling led to significant friction at every level of the organization. The situation was not helped by Kaiser's marriage to Garfield's head administrative nurse (who had helped care for Kaiser's first wife on her deathbed), convincing Garfield to marry the sister of that nurse, and then having Garfield move in next door to him. Clifford Keene (who would eventually serve as president of Kaiser Permanente) later recalled that this arrangement resulted in a rather dysfunctional and combative family in charge of Kaiser Permanente.[32]

text: Keene was an experienced Permanente physician whom Garfield had personally hired in 1946. During 1953 he had been trying to get a job at U.S. Steel, but on the morning of December 5, 1953, with internal tensions worsening day by day, Garfield met with Keene at the Mark Hopkins Hotel in San Francisco and asked him to turn around the organization. It took Keene 15 years to realize that Kaiser had forced Garfield to ask Keene to become his replacement. Due to the chaos on the board, Keene at first took control with the vague title of Executive Associate, but it soon became clear to everyone that he was actually in charge and Garfield was to become a lobbyist and "ambassador" for the HMO concept.[33]

text: However, even with Garfield relieved of day-to-day management duties, the underlying problem of Henry Kaiser's authoritarian management style continued to persist. After several tense confrontations between Kaiser and Permanente Medical Group physicians, the doctors met with Kaiser's top adviser, Eugene Trefethen, at Kaiser's personal estate near Lake Tahoe on July 12, 1955. Trefethen came up with the idea of a contract between the medical groups and the health plans and hospital foundations which would set out roles, responsibilities, and financial distribution.[34] Trefethen, already a successful attorney, went on to a successful career with Kaiser Permanente and in retirement became a famous vintner.

text: While Keene and Trefethen struggled to fix the damage from Kaiser's micromanagement and Garfield's ineffectual management, Henry Kaiser moved to Oahu in 1956 and insisted on expanding Kaiser Permanente into Hawaii in 1958. He quickly ruined what should have been a simple project, and only a last-minute intervention by Keene and Trefethen in August 1960 prevented the total disintegration of the Hawaii organization.[35] By that year, Kaiser membership had grown to 808,000.[36]

text: Managed care era[edit]

text: Having overseen Kaiser Permanente's successful transformation from Henry Kaiser's healthcare experiment into a large-scale self-sustaining enterprise, Keene retired in 1975.[37] By 1976, membership reached three million. In 1977, all six of Kaiser Permanente's regions had become federally qualified health maintenance organizations. Historians now believe then-President Richard Nixon specifically had Kaiser Permanente in mind when he signed the Health Maintenance Organization Act of 1973, as the organization was mentioned in an Oval Office discussion of the Act, where John Ehrlichman characterized Kaiser's philosophy thus: "All the incentives are toward less medical care, because the less care they give them, the more money they make."[38] In 1980, Kaiser acquired a non-profit group practice to create its Mid-Atlantic region, encompassing the District of Columbia, Maryland, and Virginia. In 1985, Kaiser Permanente expanded to Georgia.

text: Regional evolution[edit]

text: By 1990, Kaiser Permanente provided coverage for about a third of the population of the cities of San Francisco and Oakland; total Northern California membership was over 2.4 million.[39]

text: Elsewhere, Kaiser Permanente did not do as well, and its geographic footprint changed significantly in the 1990s. The organization spun off or closed outposts in Texas, North Carolina, and the Northeast. In 1998, Kaiser Permanente sold its Texas operations, where reported problems had become so severe that the organization directed its lawyers to attempt to block the release of a Texas Department of Insurance report. This prompted the state attorney general to threaten to revoke the organization's license.[40] Kaiser Permanente closed health plans in Charlotte and Raleigh-Durham[41] in North Carolina four years later. The organization also sold its unprofitable Northeast division in 2000. The Ohio division was sold to Catholic Health Partners in 2013.[42]

text: In 1995, Kaiser Permanente celebrated its fiftieth anniversary as a public health plan. Two years later, national membership reached nine million. In 1997, the organization established an agreement with the AFL-CIO to explore a new approach to the relationship between management and labor, known as the Labor Management Partnership. Going into the new millennium, competition in the managed care market increased dramatically, raising new concerns. The Southern California Permanente Medical Group saw declining rates of new members as other managed care groups, notably DaVita HealthCare Partners, flourished.

text: KP HealthConnect[edit]

text: In 2002, Kaiser Permanente abandoned its attempt to build its own clinical information system with IBM, writing-off some $452 million in software assets. This information technology failure led to major changes in the organization's approach to digital records. Under George Halvorson's direction, Kaiser looked closely at two medical software vendors, Cerner and Epic Systems, ultimately selecting Epic as the primary vendor for a new system, branded KP HealthConnect. Although Kaiser's approach shifted to "buy, not build," the project was unprecedented for a civilian system in size and scope. Deployed across all eight regions over six years and at a cost of more than $6 billion,[43] by 2010, it was the largest civilian electronic medical record system, serving more than 8.6 million Kaiser Permanente members, implemented at a cost exceeding a half million dollars per physician.[44]

text: International reputation[edit]

text: Early in the 21st century the NHS and UK Department of Health became impressed with some aspects of the Kaiser operation, and initiated a series of studies involving several healthcare organizations in England.[45][46] Visits occurred and suggestions of adopting some KP policies are currently active. The management of hospital bed-occupancy by KP, by means of integrated management in and out of hospital and monitoring progress against care pathways has given rise to trials of similar techniques in eight areas of the UK.

text: In 2002, a controversial study by California-based academics published in the British Medical Journal compared Kaiser to the British National Health Service, finding Kaiser to be superior in several respects.[45] Subsequently, a group of health policy academics who were experts on the NHS published a competing analysis claiming that Kaiser's costs were actually substantially higher than the NHS and for a younger and healthier population.[47]

text: Quality of care[edit]

text: In the California Healthcare Quality Report Card 2013 Edition, Kaiser Permanente's Northern California and Southern California regions, Kaiser received four out of four possible stars in Meeting National Standards of Care. Kaiser North and South also received three out of four stars in Members Rate Their HMO.[48] KP's performance has been attributed to three practices: First, KP places a strong emphasis on preventive care, reducing costs later on. Second, its doctors are salaried rather than paid per service, which removes the main incentive for doctors to perform unnecessary procedures. Thirdly, KP attempts to minimize the time patients spend in high-cost hospitals by carefully planning their stay and by shifting care to outpatient clinics. This practice results in lower costs per member, cost savings for KP and greater doctor attention to patients. A comparison to the UK's National Health Service found that patients spend 2–5 times as much time in NHS hospitals as compared to KP hospitals.[49][50]

text: In June 2013, the California Department of Managed Health Care (DMHC) levied a $4 million fine, the second largest in the agency's history, against Kaiser for not providing adequate mental health care to its patients. Alleged violations of California's timely access laws included failures to accurately track wait times and track doctor availability amid evidence of inconsistent electronic and paper records. It was also found by the DMHC that patients received written materials circulated by Kaiser dissuading them from seeking care, a violation of state and federal laws. DMHC also issued a cease and desist order for Kaiser to end the practices.[51][52] DMHC conducted a follow up investigation which published in April 2015. The report found Kaiser had put systems in place to better track how patients were being cared for, but still had not addressed problems with actually providing mental health care that complied with state and federal laws.[52] Kaiser's challenges on this front were exacerbated by a long, unresolved labor dispute with the union representing therapists.[52]

text: Kaiser appealed the findings, the order, and the fine, and sought to keep the proceedings closed, but in September 2014, in the face of the administrative judge's order to keep the proceedings open, and facing the beginning of public testimony, Kaiser withdrew the appeal and paid the $4 million. It also issued a statement which denied much of the wrongdoing. Kaiser faces ongoing inspections by DMHC and three class-action lawsuits related to the issues identified by the DMHC.[53]

text: Historical issues[edit]

text: In 2006 Kaiser settled five cases for alleged patient dumping—the delivery of homeless hospitalized patients to other agencies or organizations in order to avoid expensive medical care—between 2002 and 2005. Los Angeles city officials had filed civil and criminal legal action against Kaiser Permanente for patient dumping, which was the first action of its kind that the city had taken.[54] The city's decision to charge Kaiser Permanente reportedly was influenced by security camera footage, allegedly showing a 63-year-old patient, dressed in hospital gown and slippers, wandering toward a mission on Skid Row (this footage was prominently featured in the Michael Moore 2007 documentary Sicko). At the time that the complaint was filed, city officials said that 10 other hospitals were under investigation for similar issues.[54] Kaiser settled the case, paying $5,000 in civil penalties and agreeing to spend $500,000 on services for the homeless.[55] During that same period, the Department of Health and Human Services' Office of the Inspector General settled 102 cases against U.S. hospitals which resulted in a monetary payment to the agency.[56][57]

text: In 2004, Northern California Kaiser Permanente initiated an in-house program for kidney transplantation. Prior to opening the transplant center, Northern California Kaiser patients would generally receive transplants at medical centers associated with the University of California (UC San Francisco and UC Davis). Upon opening the transplant center, Kaiser required that members who are transplant candidates in Northern California obtain services exclusively through its internal KP-owned transplant center.

text: While it was in operation, the Kaiser program had a 100% survival rate, which is better than other transplant centers. However, patients who needed a kidney were less likely to be offered one.[58] Northern California Kaiser performed 56 transplants in 2005, and twice that many patients died while waiting for a kidney. At other California transplant centers, more than twice as many people received kidneys than died during the same period. Unlike other centers, the Kaiser program did not perform riskier transplants or use donated organs from elderly or other higher-risk people, which have worse outcomes. Northern California Kaiser closed the kidney transplant program in May 2006. As before, Northern California Kaiser now pays for pre-transplant care and transplants at other hospitals. This change affected approximately 2,000 patients.[59][60]

text: Research and publishing[edit]

text: Kaiser operates a Division of Research, which annually conducts between 200 and 300 studies, and the Center for Health Research which in 2009 had more than 300 active studies. Kaiser's bias toward prevention is reflected in the areas of interest—vaccine and genetic studies are prominent. The work is funded primarily by federal, state, and other outside (non-Kaiser) institutions.[61]

text: Controversies[edit]

text: Mandatory arbitration[edit]

text: In order to contain costs, Kaiser requires an agreement by planholders to submit patient malpractice claims to arbitration rather than litigating through the court system. This has triggered some opposition.[62]

text: Wilfredo Engalla is a notable case. In 1991, Engalla died of lung cancer nearly five months after submitting a written demand for arbitration. The California Supreme Court found[63] that Kaiser had a financial incentive to wait until after Engalla died; his spouse could recover $500,000 from Kaiser if the case was arbitrated while he was alive, but only $250,000 after he died. The Foundation for Taxpayer and Consumer Rights contends that Kaiser continues to oppose HMO arbitration reform.[64]

text: Watchdogs have accused Kaiser of abusing the power imbalance inherent in the arbitration system. Kaiser engages in many cases whereas a customer will usually engage in just one and Kaiser can reject any arbitrator unilaterally, thus they can select company-friendly arbitrators over those that rule in favor of customers. As a large organization, Kaiser can also afford to spend much more on lawyers and orators than the customer, giving them more advantages. In response to criticisms, Kaiser established an Office of Independent Administrators (OIA) in 1999 to oversee the arbitration process. The degree to which this office is actually independent has been questioned.[65]

text: Patients and consumer interest groups sporadically attempt to bring lawsuits against Kaiser Permanente. Recent lawsuits include Gary Rushford's 1999 attempt to use proof of a physician lie to overturn an arbitration decision.[66]

text: In one case, Kaiser attempted to significantly expand the scope of its arbitration agreements by arguing it should be able to force nonsignatories to its member contracts into arbitration, merely because those third parties had allegedly caused an injury to a Kaiser member which Kaiser had then allegedly exacerbated through its medical malpractice. The California Court of Appeal for the First District did not accept that argument: "Absent a written agreement—or a preexisting relationship or authority to contract for another that might substitute for an arbitration agreement—courts sitting in equity may not compel third party nonsignatories to arbitrate their disputes."[67]

text: Labor unions[edit]

text: While Doctors of Medicine (M.D.) and Doctors of Osteopathic Medicine (D.O.) are partners within the for-profit physician groups, many employees are members of various unions and guilds, depending on their role and service area.

text: KP's California operations were the target of four labor strikes in 2011 and 2012 — two (September 2011, January 2012) involved more than 20,000 nurses, mental health providers, and other professionals.[68] The National Union of Healthcare Workers (NUHW) has accused Kaiser of deliberately stalling negotiations while profiting $2.1 billion in 2011 and paying its CEO George Halvorson $9 million annually. The workers were dissatisfied with proposed changes to pensions and other benefits.[69]

text: On November 11, 2014, up to 18,000 nurses went on strike at KP hospitals in Northern California over Ebola safeguards and patient-care standards during union contract talks. 21 hospitals and 35 clinics in the San Francisco Bay Area were affected.[70]

text: Cash reserves[edit]

text: Jamie Court, president of the Foundation for Taxpayer and Consumer Rights has said that Kaiser's retained profits are evidence that Kaiser policies are overpriced and that health insurance regulation is needed.[71]

text: State insurance regulations require that insurers maintain certain minimum amounts of cash reserves to ensure that they are able to meet their obligations; the amount varies by insurer, based on its risk factors, such as its investments, how many people it insures, and other factors; a few states also have caps on how large the reserves can be.[72]

text: Kaiser has been criticized by activists and state regulators for the size of its cash reserves. As of 2015, it had $21.7 billion in cash reserves, which was about 1,600% the amount required by California state regulations.[73] Its reserves had been a target of advertising by Consumer Watchdog supporting Proposition 45 in California's 2014 elections.[73] At the end of 2010 Kaiser held $666 million in reserves, which was about 1,300% of the minimum required under Colorado state law.[72] Those funds were in Kaiser's risk-based capital account, held to pay for disasters or major projects.[72] In 2008, the Colorado regulator required Kaiser to spend down its reserves; after negotiations Kaiser agreed to spend $155 million of its reserves giving credits to its clients and building clinics in underserved parts of the state.[72]


document_title: List of Gavin & Stacey characters

question_text: who plays stacey's mum in gavin and stacey

question_tokens: who plays stacey 's mum in gavin and stacey

text: List of Gavin & Stacey characters

text: Characters[edit]

text:
Actor/Actress

Character

First Appearance

Last Appearance

Duration

Total

Mathew Horne

Gavin Shipman

13 May 2007

1 January 2010

2007–2010

20

Joanna Page

Stacey Shipman

13 May 2007

1 January 2010

2007–2010

20

James Corden

Neil "Smithy" Smith

13 May 2007

1 January 2010

2007–2010

20

Ruth Jones

Nessa Jenkins

13 May 2007

1 January 2010

2007–2010

20

Rob Brydon

Bryn West

13 May 2007

1 January 2010

2007–2010

20

Larry Lamb

Mick Shipman

13 May 2007

1 January 2010

2007–2010

20

Alison Steadman

Pam Shipman

13 May 2007

1 January 2010

2007–2010

20

Melanie Walters

Gwen West

13 May 2007

1 January 2010

2007–2010

20

Steffan Rhodri

Dave Coaches

13 May 2007

1 January 2010

2007–2010

11

Margaret John

Doris O'Neill

13 May 2007

1 January 2010

2007–2010

8

Adrian Scarborough

Pete Sutcliffe

13 May 2007

17 December 2009

2007–2009

7

Julia Davis

Dawn Sutcliffe

13 May 2007

17 December 2009

2007–2009

7

Sheridan Smith

Ruth "Rudi" Smith

16 March 2008

1 January 2010

2008–2010

7

Robert Wilfort

Jason West

3 June 2007

1 January 2010

2007–2010

6

Mathew Baynton

Deano

11 November 2008

10 December 2009

2008–2009

4

Russell Tovey

Budgie

3 June 2007

10 December 2009

2007–2009

4

Andrew Knott

Dirtbox

3 June 2007

10 December 2009

2007–2009

4

Samuel Anderson

Fingers

3 June 2007

10 December 2009

2007–2009

3

Ifan Huw Dafydd

Neil Jenkins

26 November 2009

1 January 2010

2009–2010

3

Pam Ferris

Cath Smith

26 November 2009

17 December 2009

2009

2

text: Main characters[edit]

text:
Gavin Shipman (Mathew Horne) - Gavin is 28 when the series starts. He is an only child, and when the series starts he still lives with his loving mother and father in Billericay, Essex. He gets on well with his parents. He works for a company called ICB and spends his spare time with his best friend Smithy (James Corden) along with his other friends Gary & Simon, Dirtbox, Fingers, Budgie, Swede, Chinese Alan and Jesus. He is a big fan of Tottenham Hotspur (as is Mathew Horne) and is often seen wearing his Spurs shirt. In the course of his job, he had to deal with a company called Bedmores, based in Barry. The Bedmores representative he had to correspond with was a woman called Stacey West (Joanna Page). Gavin and Stacey had to speak regularly because of their jobs, and they found they got on very well. After months and months of talking and flirting, they agreed to meet up in London. They agreed that Gavin would bring his best friend Smithy with him, and Stacey would bring her best friend Nessa (Ruth Jones) with her. They met up and went clubbing. They had a great time, and got on very well. They went back to Stacey's hotel room and had sex. The next day, Stacey had to go back to Barry, but she and Gavin promised to keep ringing each other and that this would not be the end of their relationship. While Stacey and Nessa boarded the coach back to Barry, Gavin and Smithy got a cab back to Billericay. Without waiting for Smithy, Gavin jumped in his car and drove all the way to Barry, and met Stacey when her coach pulled into the station, to her surprise. He and Stacey told each other they loved each other for the first time. Within 9 weeks, they had got engaged and married. Despite a few initial problems regarding Stacey being homesick, their relationship was successful, and Stacey became eventually pregnant. Gavin, and his father Mick (Larry Lamb), often play the "straight men" in the series. Much of the comedy comes from the actions of those around them (especially his mother Pam (Alison Steadman) and Smithy). It is clear that Gavin loves his friends and family very much. Despite the fact that his mother Pam often overreacts and acts without thinking, Gavin still loves her, despite being occasionally exasperated by her. His best friend Smithy is also prone to overreact, but Gavin sticks with him and loves him like a little brother. Gavin's main personality flaw is that he is slightly spoiled, possibly due to being an only child, and reacts with irritation when he doesn't get his way. He is also not particularly sensitive - he sometimes fails to understand the much more emotional Smithy and Stacey, and this occasionally puts strain on his relationship with both of them - when Stacey, who is very attached to her hometown of Barry, gets depressed and homesick upon moving to Billericay after she and Gavin marry, Gavin is more confused than concerned about this, and his responses are lacking in sensitivity about the matter. This can also be seen in the fact that Gavin is less talkative and expressive than Stacey is - while at dinner with their families after their honeymoon, Stacey is excited and full of conversation, while Gavin simply sits and listens to her. Despite all of this, Gavin loves Stacey enormously, and is very affectionate towards her, and his greatest display of love for her is when he decides to move to Barry with her despite having expressed a dislike of it previously, and he manages to get himself a new job in Wales so he can reside there. There, his boss Huw Davies and colleague Owain Hughes (Steven Meo) act very similar to Stacey's uncle, Bryn (Rob Brydon), talking incessantly and being over-friendly, personality traits that bewilder Gavin. Gavin is more reserved and less willing to discuss his private life than his wife. He finds it odd that Stacey is so eager and ready to spill information about their private life to Nessa, Bryn, her mother Gwen (Melanie Walters) and her brother Jason (Robert Wilfort). When Gavin is applying for a job in Cardiff, the only people who know are Stacey and Mick. When he and Stacey announce it to the rest of the characters, Gwen announces that she knew as well, because Stacey told her. Gavin is annoyed that Stacey told Gwen, and by the fact that Stacey did not tell him she had told Gwen. He doesn't understand why Stacey always has to be so close to her family. It isn't that he is distant from his family, he just doesn't depend on his as much as Stacey does hers. In Series 3, he agrees with Stacey to try to have a baby, only to discover she stopped taking the pill a year ago. Although he is very angry about Stacey not telling him the truth, he becomes much more depressed when he learns that he has fertility problems. However, he eventually comes round, and has a serious discussion with Stacey about the problem, deciding they will carry on trying to conceive for a few months, and if that doesn't work, they should start looking at alternatives. However, in the final episode, Stacey discovers she pregnant, and Gavin is completely as overjoyed.
Stacey Shipman (née West) (Joanna Page) - Stacey is 26 and is from Barry, near Cardiff. Her father, Trevor, died three years ago, and she lived at home with her mother in Barry until her marriage. Her gay brother, Jason (Robert Wilfort), lives in Spain. She had been engaged five times before meeting Gavin Shipman (Mathew Horne), something she preferred to forget and kept from him. She is very bubbly, excitable and full of conversation but also slightly fragile and prone to overreacting. An example is her misreading Gavin's sudden businesslike tone during a call from work, when his boss appears over him, as him being distant and breaking up with her and he has to drive all the way to Barry to reassure her in person. She confides frequently in her best friend, Nessa (Ruth Jones). Stacey has never been away from Barry Island before she visits Gavin, and becomes very homesick when she marries him and moves to Essex. After a few months of finding no work, she tells Gavin she can no longer live in Essex and will be moving back home. During the course of their separation, Stacey decides their selfishness about where they'll live means they aren't meant to be together and she gives Gavin his wedding ring back. They are able to work things out and Gavin decides to get a job in Cardiff so he can move to Barry Island to keep Stacey happy. Stacey discovers she is pregnant in the final episode of Series 3, after desperately taking a large number of pregnancy tests.
Neil "Smithy" Smith (James Corden) - Smithy is 28 and Gavin's (Mathew Horne) best friend, and they've known each other since primary school. He is a self-employed builder and decorator. He is very protective of Gavin - he is disappointed when Gavin gets engaged to Stacey (Joanna Page) and when Gavin and Stacey go on a honeymoon, he calls Gavin every day for the 3 weeks they are there, and gets angry at Gavin for leaving his phone off. He loves Gavin's parents more than his own, and has an unseen girlfriend called Lucy, who, according to Smithy, is seventeen years and three quarters old. He loves unusual beer, paintball and West Ham United. When Nessa (Ruth Jones) gives birth to their son, they name him Neil after himself and Nessa's father. In the series finale, Smithy stops Nessa's wedding declaring his feelings for her, thus causing Nessa and Dave (Steffan Rhodri) not to get married. He is shown to have obvious similarities to Nessa, such as: refusing to share food, being very upfront, protective of their best friends, and they like most of the same food and drink, such as KFC, corn on the cob, and Irn-Bru. Smithy wears his heart on his sleeve and is given to intense public displays of emotion, and will cry or sulk with little provocation. Smithy eats, drinks and smokes to excess and is overweight.
Vanessa Shanessa "Nessa" Jenkins (Ruth Jones) - Nessa is Stacey's (Joanna Page) best friend, also from Barry. She discovers she is pregnant in the fourth episode of Series 1 and it is later revealed that Smithy (James Corden) became the father the second time they were intimate at Pam (Alison Steadman) and Mick's (Larry Lamb) house. She speaks fluent Italian and Welsh, has several tattoos, most notably a large red dragon on her right upper arm. She is a chain smoker (except during her pregnancy) and was one of the original members of All Saints (but didn't get along with Shaznay). She works at the Barry Island Amusement Arcades or "The Slots". Nessa regularly recalls strange and often lewd experiences with celebrities. She gives birth to baby Neil in the series finale of Series 2 and becomes engaged to Dave Coaches (Steffan Rhodri) in the 2008 Christmas special. In the series finale, Smithy declares his feelings for Nessa at her wedding, and Dave accepts that the feelings he and Nessa share are not as strong as hers and Smithy's. Nessa's age is unknown throughout the show even to Stacey. To date she has slept with Gavin's (Mathew Horne) best friend Smithy four times. Her catchphrases include "Ohhhh", "Tidy", "Genuine",  "Truth be told", "Immense", "I'm not going to lie to you" and "What's occurring?". In the third series, it was discovered that she is an Aston Villa fan. She has a jet black bob-style hair and wears Gothic style make up. She is serious, ongoing and surprisingly intelligent at times. She has had a number of interesting occupations including being a BBC radio producer, a roadie for a major band, and driving trucks for Eddie Stobart (who gave her two trucks to keep when she left,) and a running feature of the programme is her wide range of impressive occupations, abilities (apart from speaking fluent Italian she is an excellent ten pin bowler) and acquaintance or relationships with various famous people. The reaction of those around her to mention of these invariably suggests that they are factual rather than a fantasy, despite the rather incongruous fact that she now works as a cashier at an amusement arcade in Barry.
Michael "Mick" Shipman (Larry Lamb) - Mick is Gavin's (Mathew Horne) father. He is often mistaken to be 53 and is a down-to-earth bloke, like his son. He's happy with his life — running his own company, playing golf and going to the pub quiz every Tuesday. He is something of a calming influence on his wife, Pam (Alison Steadman).
Pamela Andrea "Pam" Shipman (née Griggell-Eschefska) (Alison Steadman) — Pam is Gavin's (Mathew Horne) proud and doting mother. She is in her fifties, though her exact age is unknown as, according to her husband, she has claimed to be 51 on her past five birthdays. She is a stereotypical Essex wife and is very house-proud. She is also very caring of Smithy (James Corden), Gavin's best friend, and treats him as if he were her own son. Pam adores Camilla, Duchess of Cornwall (referring to Princess Diana as a "hussy") and acts out sexual fantasies of Charles and Camilla with her husband, Mick (Larry Lamb). She dotes on Gavin, who she calls her "Little Prince". She is very welcoming of Stacey (Joanna Page) into the family - the first time Stacey meets her, she helps her with a pimple on her face, in a motherly fashion, which allows the two to bond. Although she is initially angry at Stacey when Gavin announces they're moving back to Barry, accusing Stacey of 'stealing' her son, she apologises the next morning for overreacting. Pam is prone to malapropisms, such as saying "ours is not to question while" (instead of "why") or "Barry's Island" instead of "Barry Island".  She is often nervous and excitable and this leads her into awkward social situations, such as forcing Mick to go food shopping in response to an attack of paranoia about her guests' dietary requirements, and then falsely claiming to be newly vegetarian (a pretence she is forced to maintain, much to her frustration because she craves meat) in order to explain why he has arrived with several bags of vegetarian food.  Her catchphrases include "Oh My Christ", "I panicked (name)" and "Mick! Michael!"
Brynfor "Bryn" West (Rob Brydon) - Bryn is Stacey (Joanna Page) and Jason's (Robert Wilfort) uncle. He is the brother of Stacey's deceased father, Trevor and is a single man in his late forties. He lives across the road from Stacey and his sister-in-law, Gwen (Melanie Walters) and is very protective of them. In Series 1 and 2, he had a strained relationship with his nephew Jason due to an unspecified but clearly disturbing incident on a fishing trip. He leads a very simple life and often gets excited about trivial things such as his Sat Nav or the Internet. He also enjoys typically female-oriented TV shows such as Desperate Housewives and Sex and the City. He is a keen singer and sings with Stacey's best friend, Nessa (Ruth Jones). In Series 2, he puts a home gym in his house that is "the talk of the street". Bryn also displays latent homosexual tendencies but is seemingly too innocent and childlike to address them. For instance, Bryn converted one of the bedrooms in his home into a gym and invites Smithy (James Corden) over where they strip shirtless and have a close workout followed by a "warm down" that involves rubbing each other. Smithy does not see this as a sexual thing at all, even though it makes Gavin (Mathew Horne) uncomfortable. It has been implied a number of times that Bryn was abused by his brother Trevor as a child, such as Trevor leaving him terrified on a ghost train or hanging him by his ankles and swinging him against rocks, resulting in two broken arms. He claims he "rather enjoyed the experience" as it was only "tomfoolery" but it shocks everyone and horrifies Pam (Alison Steadman).
Gwen West (Melanie Walters) - Gwen is Stacey (Joanna Page) and Jason's (Robert Wilfort) mother. She is a widow in her late forties and has two children, Jason and Stacey. She is a housewife and regularly offers to cook omelettes. She's a caring, kind woman who lets herself be taken advantage of by Stacey's best friend, Nessa (Ruth Jones). She's very close to Stacey as they spent many years living together. In Series 3, she lives with Stacey and her husband Gavin (Mathew Horne). On the day of Nessa's wedding, Nessa told Gwen that she was like a mother to her before kissing her on the lips, which gobsmacks Gwen but does not affect Nessa.

text: Other characters[edit]

text:
David "Dave Coaches" Lloyd Gooch (Steffan Rhodri) - Coach driver in Barry and Nessa's (Ruth Jones) fiancé, after they got engaged in the Christmas special. Aspersions are cast regarding his sexual health in Series 1, although it is revealed in Series 2 that he has been to "the clinic". He is the only person, other than Bryn (Rob Brydon) and Jason (Robert Wilfort), who knows what happened on the fishing trip, after Bryn told him to get the matter off his chest. His relationship with Nessa results in both Bryn and Jason being incredibly nervous about him telling their friends what happened, although he makes it very clear to Bryn he wouldn't tell anyone about it. He also has his own company named Dave Coaches. He often shows jealousy towards Smithy (James Corden) for being the father of Nessa's child. Smithy gets jealous of him for always spending time with his son and treating him like his own, and in the final episode leaves Nessa at the altar as he doesn't believe she loves him. Nessa's father mentions him having "blood on his hands", but says he was joking, knowing that "nothing was proven". Dave often has a strained relationship with the other characters, and has publicly had angry exchanges with Bryn, Smithy and Pete (Adrian Scarborough), who punched him in the face after he made an uncharitable remark about his wife, Dawn (Julia Davis).
Jason West (Robert Wilfort) - Stacey's (Joanna Page) elder brother, son of Gwen (Melanie Walters) and her late husband, Trevor. Lives in Spain with his boyfriend, José. He and Bryn (Rob Brydon) share a rather awkward relationship due to some mysterious goings-on on the fateful fishing trip. Although the events of the fishing trip are never explicitly revealed, it is strongly implied that there was a close and intimate encounter between Jason and Bryn. When they attempt to explain to Dave the reason for what they did that night, Bryn says "It was freezing cold...and when you're that cold you-" before being cut off by Gavin entering the room. He is disappointed in the first series when Gavin (Mathew Horne) and Stacey get married and he is not chosen to take Stacey down the aisle. He and Bryn eventually become friends again, something they are both glad about.
Peter "Pete" Sutcliffe (Adrian Scarborough) and Dawn Sutcliffe (Julia Davis) - Friends of Pam (Alison Steadman) and Mick's (Larry Lamb). They have a very strained marriage and regularly insult each other in public. Also part of the ongoing joke that characters share their surnames with serial killers — in this case Peter Sutcliffe, the Yorkshire Ripper. He punches Dave in the Christmas special. He also attempts a threesome in the beginning of Series 2 with his wife Dawn and a man named Seth. It didn't work out as Seth said the photo was not representative of them as a couple. The couple renewed their vows in Series 3. They have two children, Fiona and Alex. In the series finale of Series 1, their surname is revealed to be Whitely, but in the 2008 Christmas Special, it is revealed to be Sutcliffe.
Catherina "Cath" Smith (Pam Ferris) - Smithy (James Corden) and Rudi's (Sheridan Smith) mother who first appears in the first episode of Series 3. She is rumoured to have had a lesbian relationship with the headteacher of Gavin (Mathew Horne) and Smithy's primary school. She claims to suffer from narcolepsy, though Pam (Alison Steadman) attributes this to her excessive drinking. She attends single mother support groups and has been known to perform lewd acts on webcam, having once accidentally exposed herself to Nessa (Ruth Jones) thinking she was a man named John.
Doris "Dor" O'Neill (Margaret John) - Gwen's (Melanie Walters) elderly next door neighbour. She looks like a stereotypical "little old lady", in sharp contrast to her behaviour and blunt, profanity-littered conversational style. Doris regularly dates younger men, even offering herself up to Gavin (Mathew Horne) for "discreet" extramarital relations, and is described by Bryn (Rob Brydon) as "a player". She has a daughter named Moira, whom she loathes and would like to "smother" if she saw her again. Gwen even goes so far as to say "she was a nasty piece of work". It is Doris who spots the unfortunate coincidence of Gavin and Stacey (Joanna Page) sharing the West and Shipman surnames with serial murderers Fred and Rose West and Harold Shipman.
Ruth "Rudi" Smith (Sheridan Smith) - Smithy's (James Corden) sister, also likes to be called "Smithy" in an attempt to imitate her brother, with whom she often fights.
Neil Noel Edmund Smith aka Neil, the Baby - The son of Smithy (James Corden) and Nessa (Ruth Jones), named after both Smithy and Nessa's father. His middle names come from Smithy's uncle Edmund and Nessa's friend Noel from Hear'Say.
Neil Jenkins (Ifan Huw Dafydd)[1][2]- Nessa's (Ruth Jones) father; appears at the Christening but is obviously uncomfortable at being back in Barry due to unknown previous events. He is a part-time actor who has appeared as an extra in Lark Rise to Candleford and as a man in a coma in Holby City.
Dick Powell (Gwynfor Roberts) The only exclusively Welsh-speaking inhabitant of Barry. Sells items on the black market such as satellite navigation systems and meat that his brother steals from the slaughterhouse where he works. He enjoys chicken and Glamorgan sausage sandwiches.
Deano (Mathew Baynton) is a friend of Gavin (Mathew Horne) and Smithy's (James Corden). He works with Smithy and is known for being gormless and somewhat naïve. He learnt Welsh prior to coming over to Wales with the "Essex Lads".  He wasn't at Gavin's stag, but got a T-shirt made afterwards when they went to the foam party.  Among his idiosyncrasies is a fondness for drinking a mixture of equal parts tea and coffee, which he calls a "toffee" or a "cea" (pronounced "key").
Owain Hughes (Steven Meo) - one of Gavin's (Mathew Horne) co-workers at his new job in Cardiff in Series 3. Constantly the subject of an unclear joke - "My name is Owain Hughes and before you ask, no I don't!".

text: Gavin and Smithy's Friends[edit]

text:
Budgie (Russell Tovey) - A friend of Gavin (Mathew Horne) and Smithy's (James Corden). He is nicknamed as such because he has big ears. He has a brother called Magpie, who works as a DJ.
Chinese Alan (Dominic Gaskell) - A friend of Gavin (Mathew Horne) and Smithy's (James Corden). His catchphrase is "Did someone order a Chinese?"
Fingers (Samuel Anderson) - A friend of Gavin (Mathew Horne) and Smithy's (James Corden). He is so named because of his womanizing attitude. He has an on-off relationship with Stacey's (Joanna Page) friend, Louise.
Dirtbox (Andrew Knott) - A friend of Gavin (Mathew Horne) and Smithy's (James Corden). He seems to be somewhat short tempered and snappy.
Jesus (Daniel Curtis) - A friend of Gavin (Mathew Horne) and Smithy's (James Corden). He only appears in the stag episode; most likely owing to the fact that no one in the group really seems to like him.
Swede - (John Grisley) A friend of Gavin (Mathew Horne) and Smithy's (James Corden). He rarely says anything.
Gary (Jason Gregg) - A friend of Gavin (Mathew Horne) and Smithy's (James Corden). He has been friends with them since primary school. He is never seen without his best friend Simon; except for in Series 3, where it appears they have had an argument.
'N' Simon - A friend of Gavin (Mathew Horne) and Smithy's (James Corden). He has been friends with them since primary school. He is never seen without his best friend Gary (Jason Gregg); but he does not appear in Series 3, as it appears he has had an argument with Gary.
Luggy - A friend of Gavin (Mathew Horne) and Smithy's (James Corden). He has glasses and is quite tall. He is relatively quiet when compared to the rest of Gavin's friends as he is often seen in the background of the conversation and has no dialogue. He is not seen in Series 3 for unknown reasons.

text: Minor and unseen characters[edit]

text:
Japanese Margaret - A friend of Pam (Alison Steadman) and Dawn's (Julia Davis) whose name came up during the protest over the telephone mast.
No Man Jan - A friend of Pam's (Alison Steadman) who told her about the rumour of Cath's (Pam Ferris) lesbian relationship with Smithy (James Corden) and Gavin's (Mathew Horne) headmistress. Mick (Larry Lamb) claims she can't be trusted - "that's why she's been divorced three times".
Big Fat Sue - Pam's (Alison Steadman) overweight friend. Pam calls her "Susan" to her face; however, other characters such as Dawn (Julia Davis) directly address her as "Big Fat Sue".
Fat No More Pat - Pam's (Alison Steadman) friend from her Fencing class. She was mentioned when Pam asked Stacey (Joanna Page) if she would like to come along in Pat's absence.
Seth - Swinger who responded to Dawn (Julia Davis) and Pete's (Adrian Scarborough) request for a threesome partner, he denied because the picture of Dawn and Pete was 15 years old.
Nigel Havers - Actor, Nessa's (Ruth Jones) ex-boyfriend
Tom Jones - Singer, Nessa's (Ruth Jones) ex-boyfriend
John Prescott - Politician, Nessa's (Ruth Jones) ex-boyfriend
Noel Sullivan - Singer, Nessa's (Ruth Jones) close friend. Nessa's son, Neil's middle name is after him.
Griff (Alan David) - Bryn (Rob Brydon) and Doris' (Margaret John) friend. He attended Gavin (Mathew Horne) and Stacey's (Joanna Page) wedding with Doris in Series 1.
Father Chris (William Thomas) - A vicar in Barry.
José - Jason's (Robert Wilfort) boyfriend, who attends Gavin (Mathew Horne) and Stacey's (Joanna Page) wedding.
Edna Sutcliffe (Edna Doré) - Pete's (Adrian Scarborough) mother, only seen once in the Christmas Special, where Pete forgot her and she stayed behind the bar over night
Betty (Hazel Douglas) - A neighbour of Pam (Alison Steadman) and Mick's (Larry Lamb). She is only seen talking to Pam about Mick's short stint on a news broadcast.
Scott - One of Doris' (Margaret John) much younger boyfriends, whom she casually describes as "a bit of a pothead".
Natalie Lewis - Sales assistant whose brother and father once had a fight with Nessa (Ruth Jones)
Lucy - Smithy's (James Corden) much younger girlfriend, who is still in secondary school. She is never seen on-screen, and dumps Smithy in Series 2 when he discovers that she has been seeing somebody else. In a running joke meant to illustrate the age gap between her and Smithy, she is often mentioned to be doing activities that would normally be associated with younger people (such as Brownies or trampolining).
Jean - A character who Bryn (Rob Brydon) invites to Gwen's birthday party, due to guests he'd already invited saying they can't attend. Jean is hated to Gwen however for reasons that weren't really mentioned. Doris warns Bryn not to invite her and does not like her. Jean is not seen on screen, however Gwen sees her and it is unknown what happened next.
Glenda - In series 3 episode 4, Glenda gets in contact with Bryn (Rob Brydon), Doris (Margaret John) and Gwen (Melanie Walters) almost immediately after Pam (Alison Steadman) and Mick (Larry Lamb) arrive outside Gwen's house all via different forms of contact. It is not mentioned where Glenda lives, though she is within hearing range as she heard that Pam and Mick were going to the beach, nor is she ever mentioned again.


document_title: Amnesia: The Dark Descent

question_text: when did amnesia the dark descent come out

text: Amnesia: The Dark Descent

text: Gameplay[edit]

text: In a similar vein to the developer Frictional Games' previous games, Amnesia is an adventure game played from a first-person perspective. The game retains the physical object interaction used in the Penumbra series, allowing for physics-based puzzles and interactions such as opening doors and fixing machinery.[3] Few in-game objects are operated by toggle; to open a door, for instance, the player must hold down a mouse button and then push (or pull) the mouse. This gives the player stealth, allowing them to peek out a barely-opened door or open it slowly to sneak away, but also adds to the player's sense of helplessness, as it is now entirely possible to attempt to push open a "pull" door whilst danger approaches from behind.

text: In addition to a health indicator, Daniel's sanity must be managed. Being in darkness too long, witnessing unsettling events, or staring at monsters will reduce Daniel's sanity, causing visual and auditory hallucinations and drawing the attention of monsters. Light sources help restore sanity, and if none are available Daniel may use tinderboxes to ignite candles in wall sconces and candelabra, or deploy an oil-burning lantern found near the beginning of the game. However, the number of tinderboxes and the amount of oil available are both limited, and standing in a light source also makes the player more noticeable to monsters. The player must balance the amount of time Daniel spends in light and shadow. Sanity is fully restored once Daniel completes an objective or progresses the game's story. It may also be restored by staying in the shadows until Daniel passes out, but this leaves him extremely vulnerable to any nearby monsters.

text: If a monster spots Daniel, it will chase him until he's out of sight. If spotted, Daniel must flee, as Amnesia does not give the player access to weapons. Daniel must find hiding places or barricade doors with rocks, chairs and other obstacles; however, monsters are capable of tearing down doors in their path and kicking obstacles out of the way, and move extremely fast once they have spotted their prey. Players can also choose to hide Daniel in the shadows, at cost to sanity. Monsters who lose sight of Daniel will search for him for a time, but will eventually leave and vanish. They can also choose, preferably while being chased, to pick up an object and throw it to the monster, temporarily stunning the monster for about two seconds and giving Daniel some extra distance.

text: Plot[edit]

text: In late August 1839, Daniel, a young man from London, awakens in the dark and empty halls of the Prussian Brennenburg Castle with little to no memory about himself or his past.[2] All he can remember is his name, that he lives in Mayfair and that something is hunting him.[10][11] He has a note written to himself, which informs him that he has deliberately erased his own memory and is being hunted by a "shadow", and instructs him to descend into the Inner Sanctum of the castle in order to find and kill its baron, Alexander. As he makes his way through the castle, Daniel gradually learns both about its mysteries and about his own past, through notes and diaries he finds as well as through sudden flashbacks and visions. He also finds himself followed by an unearthly presence – the Shadow – manifesting itself through fleshy, acidic growths spreading through the castle, and encounters terrifying humans-turned-monsters known as "gatherers" from whom he must hide or flee.

text: Throughout the game, Daniel collects his own diaries which reveal that in May, he had gone on an archaeological expedition with a professor Herbert, who sought to excavate the tomb of Tin Hinan, buried in the Algerian desert. Separated from his men in the tomb, Daniel discovered a mystical orb and felt it calling to him, entering into a trance when he held it. Afterwards, Herbert sent him back to London to recover and he brought the orb with him. Engrossed in its other-worldly quality, he consulted books and educated men about the orb's nature, finding that others have been known to exist, and wrote letters to people from Herbert's address book. He began to be plagued by nightmares, and found that Herbert's expedition has disappeared and the men he had recently consulted have suffered horrible deaths. Feeling desperate and hunted, he decided to accept the invitation of Alexander, who had replied to his letter by offering him protection at Brennenburg. After his arrival, the baron told him that he is being followed by the orb's "shadow" or "guardian", which will kill anything in its path to reclaim the orb, and that he should use the orb's power to fight back. Deep in the castle, he instructed Daniel in rituals supposedly serving to at least temporarily banish the Shadow, which included the killing and torture of imprisoned people, supposedly criminals. When they kidnapped the children of a farmer for what Alexander said would be the final banishment ritual, and Daniel killed one of the girls as she attempted to flee, he lost faith in Alexander, who left him for dead and descended into the Inner Sanctum alone with the orb. Broken, he decided to kill Alexander in revenge for making him a monster. He wiped his memory with an "amnesia" potion, thus setting up the events of the start of the game.

text: It is revealed that Alexander is not human, but rather a being from another dimension who arrived on Earth several centuries ago, establishing himself in Brennenburg under the guise of a baron and constantly prolonging his life with "vitae", a substance harvested from tortured humans, whom he has been hunting for this purpose. He has been seeking a way to use an orb to return to his dimension, and now needs to do this as soon as possible since he fears that other nobles no longer trust him. As Daniel nears the Inner Sanctum, he encounters Heinrich Cornelius Agrippa, a man who had once studied the orbs with his student Johann Weyer and has since been kept alive and imprisoned by Alexander. He tells Daniel that Weyer has been able to harness the power of the orbs to travel between dimensions, which Alexander is preparing to do right now, and instructs him in finding the pieces of what used to be his own orb, which is needed to breach the Inner Sanctum. Agrippa also asks Daniel to take with him his head, which can be severed alive using a tonic invented by Weyer, and throw it into the inter-dimensional portal after Alexander opens it. Once Daniel enters the Inner Sanctum, there are three possible endings: he can let Alexander succeed, then be killed by the Shadow and descend into darkness, while Alexander tells him his sacrifice will be forever celebrated; he can prevent the portal from opening, then leave the castle content with his redemption after the Shadow kills only Alexander; or he can throw Agrippa's head into the portal, which leaves the Shadow to kill both Alexander and Daniel, though Agrippa promises to save Daniel from descending into darkness, calling upon Weyer to help him.

text: Amnesia: Justine downloadable content[edit]

text: The player takes control of an unnamed female character, who awakens with amnesia in a dungeon cell, accompanied only by a phonograph. This phonograph contains a recording by a woman named Justine, who tells the player character that she is the subject of a psychological test. The player character is then allowed to escape, or die trying.

text: The player character is presented with several puzzles to solve. In each, she has the option of simply abandoning the puzzle and walking away, but doing so will cause an innocent victim contained within (a doctor, a priest and a policeman) to die. She is also stalked by the Suitors, three monstrous characters whom Justine (through additional phonographs) reveals to be her own former paramours, now twisted by physical and psychological torture. The player character may also collect notes scattered throughout the testing environs, which give additional background information on the Suitors and Justine herself.

text: The game's exact ending depends on how many puzzles the player has chosen to solve, and thus how many victims survived. However, all of them proceed along roughly the same lines: after surviving the puzzle sections, the nameless female discovers a phonograph dangling from the ceiling, which causes the walls of the chamber to begin moving inward as though to squash the protagonist. She passes out, but awakens unharmed and begins to congratulate herself. The protagonist is Justine, who staged the entire experiment to see if she still had any compassion for humanity within herself. Armed with her new-found knowledge, she moves forward into the ending sequence, in which any surviving victims thank her (not realizing she does not intend to free them now that her memory is restored) and, if none were saved, the Suitors, trapped, shout threats upon her; it is also possible to change Justine's final lines if a hidden document is found in the Library. Then she goes upstairs back to her house to prepare herself to attend her guests for an imminent party.

text: Development[edit]

text: Work began on the game while Penumbra: Requiem was still being developed, with the company working on both projects at the same time.[12] The game was first known under two working titles: Unknown and Lux Tenebras. It was not until 13 November 2009 that it was announced as its current title, Amnesia, with the release of the game's website and a game trailer.[13][14] Initial designs of the game varied considerably from the final game, with the developers interested in reintroducing more combat elements similar to those utilized in their first commercial title Penumbra: Overture. The developers soon discovered that they encountered many of the same problems and difficulties that plagued the combat in that game however, and the design was further changed to be more similar to the style set out by Overture's sequel Penumbra: Black Plague.[15]

text: On 5 February 2010 it was announced that the game had reached the alpha stage of development on all platforms.[16][17][18] Two weeks later the developers released a new teaser trailer that showed actual game-play footage, and the developers began accepting pre-orders for the game through their website. Also revealed was that the game was at that point being tested on all three intended platforms. It was also announced that the game would be released simultaneously for all of them in August 2010.[19][20] This was later rescheduled, and the game was then expected to have a 8 September 2010 release.[21] It was then later announced on 27 August 2010 that the game had officially gone Gold and would soon be ready to sold.[22] On 3 September, the games demo was released containing selected parts of the gameplay and story. It was then successfully released on 8 September 2010.[23]

text: If the game reached 2000 pre-orders by 31 May 2010, Frictional promised it would release extra content for the game. The goal was finally met in early May, after the pre-orders were offered at a discount made available until 31 May. This was done due to the success of Penumbra: Overture as a part of the first Humble Indie Bundle.[24] The extra content was revealed to be commentary,[25] and they explained in the comments section of the same page that its intended function was similar to that of Valve Corporation's commentary system that began in the Half-Life 2 series.[26] The authors cite "Soul Made Flesh" by Carl Zimmer and older horror movies such as The Haunting as being inspirations for the mood and style of the game.[27]

text: Thomas Grip, one of the games main developers, would later write up a post-mortem of the game titled "The Terrifying Tale of Amnesia" for The Escapist, where he outlined in detail the process of the game's development, mostly focusing on its ever-changing design and the financial problems that plagued the developers for most of the game's development.[28]

text: A PlayStation 4 version – Amnesia Collection – was released on 22 November 2016 via PlayStation Network; this title includes The Dark Descent, its expansion Amnesia: Justine, and the sequel Amnesia: A Machine for Pigs.[29]

text: Just two days after its release on PS4 Frictional Games posted a tweet stating that the port managed to recoup all costs and "more".[30]

text: Audio[edit]

text:
Amnesia: The Dark Descent (Original Soundtrack)

Soundtrack album by Mikko Tarmia

Released
17 May 2011 (2011-05-17)

Genre
Video game soundtrack

Length
34:41

Label
The Sound of Fiction

text: The game's music was composed by Mikko Tarmia and released for download on 17 May 2011.

text:
[show]Amnesia The Dark Descent Soundtrack track list

No.
Title
Length

1.
"Menu Theme"
1:16

2.
"Darkness"
1:16

3.
"Lux Tenebras"
3:22

4.
"Grand Hall"
1:27

5.
"Ending: Alexander"
1:53

6.
"Next To The Guardian"
1:49

7.
"Theme For Unknown"
3:04

8.
"Dark Water"
1:17

9.
"Daniel's Room"
1:08

10.
"Grunt's Appearance"
1:14

11.
"Back Hall"
1:22

12.
"Ending: Agrippa"
1:56

13.
"Suitor Attacks"
1:15

14.
"Basement Storage"
2:12

15.
"Brennenburg Theme"
3:13

16.
"Hub"
1:33

17.
"Ending: Alexander" (alternative version)
2:13

18.
"Bridges"
1:06

19.
"The End"
2:05

Total length:
34:41

text: Downloadable content[edit]

text: On 12 April 2011 Frictional Games released an extra free level for owners of the Steam version of Amnesia. This additional campaign is set apart from Brennenburg Castle. Justine was released on Steam as a way to promote the upcoming release of Portal 2, as getting 100% on the campaign (all of the collectables, all of the analysis and making correct choices) unlocks a message from fictional company Aperture Science. The content was made available for all of the games supported platforms and versions as part of the Amnesia v1.2 update on 17 May 2011.[8]

text: Custom stories[edit]

text: It is possible to create custom stories for Amnesia that can then be loaded in the game.[31] Various tools for the HPL2 Engine have been released that allow the creation of own levels, models, particle effects and materials, using an interface similar to Valve's Hammer Editing Software.[32] Game logic can be implemented using the AngelScript scripting language.[33][34][35] A prominent example of a custom story is Penumbra: Necrologue, a fan-made sequel to Frictional's earlier Penumbra series.

text: Reception[edit]

text:
Reception

Aggregate scores

Aggregator
Score

GameRankings
86.10%[36]

Metacritic
85/100[37]

Review scores

Publication
Score

Adventure Gamers
[38]

Eurogamer
8/10[39]

Game Informer
9.25/10[40]

IGN
8.5/10[41]

PC Gamer (UK)
88%[42]

Igromania
8/10[43]

text: Amnesia: The Dark Descent has received critical acclaim with consistent praise given for the ominous atmosphere and horror elements. John Walker of Rock, Paper, Shotgun even went as far as to say that "I think it is safe to say that Amnesia is the most successfully frightening game to have been made."[44] X-Play added Amnesia to its top ten PC games saying "There are a lot of so-called "horror" games out there, this one is no joke. You'll be rocking back and forth and crying in no time".

text: Frictional Games did show some trepidation over the game's initial sales after the first week,[45] but were encouraged by continued sales throughout the first month after the game's release, with Frictional recouping all the expenses from creating Amnesia by early October 2010.[46] By the beginning of January 2011 the developer reported that nearly 200,000 units had been sold, declaring in response that "With these figures at hand, we must confess that it gives us new confidence for the PC."[47] The game kept gaining sales and in July 2011 it had sold almost 350,000 units.[48] At the 2011 Independent Games Festival Amnesia won awards for both "Excellence in Audio" and "Technical Excellence" along with the "Direct2Drive Vision Award" which included a $10,000 prize.[4]

text: A year after the original release of Amnesia, the developers revealed that they had sold around 391,102 units and were continuing to sell about 6000 units per month. They also released details about how much money each platform generated for them by analyzing the sales from their online store, with 70% of sales coming from Windows users and 15% coming from users of Linux and another 15% coming from users of Mac OS X. Frictional did however note that their store was the only place anyone could purchase the Linux version of the game, whereas the Mac OS X and Windows versions could be purchased from other sources, meaning that the total percentage of Linux sales is actually considerably smaller compared to other platforms taken collectively. Observing that their own Mac OS X sales did not go down from their own store even as services like Steam picked up the game for that platform, meaning that it did not steal customers from their store but instead opened up a new market, they decided this makes a good incentive for other stores to support Linux as well.[49] As of September 2012, the game sits at an estimated 1.4 million sales.[50]

text: As of 2018, GamesRadar ranks Amnesia: The Dark Descent as the 13th best horror game of all time out of 20.[51]

text: Sequel[edit]

text: An indirect sequel called Amnesia: A Machine for Pigs was released on 10 September 2013,[52] developed by The Chinese Room and published by Frictional Games. The Chinese Room is known for its Source mod Dear Esther, which was later released as a standalone game to mostly positive reviews. Dan Pinchbeck, writer for The Chinese Room, has stated of the new Amnesia game: "It's not a direct sequel, in terms of it doesn't follow on from the story of Amnesia. It doesn't involve the same characters. The game will be set in an alternate history in the same universe."[53]