Gabriel Gherasim Due September 10th 2018 Essay, You and Culture: How are ageism, disability, alcoholism, mental health, LGBT viewed in Daco-Romanian culture? The word ‘culture’ meant in its original use: “the cultivation of a piece of land” (tilling, or preparing the earth for crops). It was an agricultural term designating the needed steps to harvesting of the land. It was an arduous, time consuming effort, preparing the land in the spring and collecting its rewards in the autumn. It still is. Daco-Romanian tradition and history expands back in history by millennia: the oldest writing in the world is in Romania, i.e. the Tartaria tablets (6,000 BC, one thousand years older than the Sumerian one); the Dacians (later Daco-Romanians) are the proverbial Aryans who migrated and left a lasting mark to Indian culture (Sanskrit culture and the Veda texts); today’s successors of the Dacians, the Romanians live in the richest country in natural resources in Europe, with the largest population of bears, wolves and forest in the Carpathian Mountains; and they have a traditional agricultural matriarchal culture resplendent with cosmic symbolism through and through. Therefore, before any norms of equality and standardization of law regarding the treatment of minorities were pushed by the US and the European Community to the world, the Daco-Romanians had their own ‘culture’ in these regards. So how does ‘culture’ reflect in our customs, particularly on the topics mentioned above? The following statements are generalizations and do not take into consideration specific efforts at the governmental, NGO’s and family levels. The short answer is that if a condition had functional purposes it was useful and therefore accepted, embraced and honored. If it didn’t have functional purposes, it was frown upon, discarded, or persecuted (depending on the times in history). Ageism: elders are praised for their wisdom. A Romanian proverb states: “the village which doesn’t have elders, should go about buying them.” The families cherish and assist them as primary support. The Orthodox Church provides some nursing homes and private NGOs assist with home-bound elders’ services and living conditions. The government’s assistance is lackadaisical. Disability: Disabled individuals are cared for by the families. They are loved and taken care of, since they are seen explicitly and implicitly to be the charge of their loved ones. While not-functional, they are seen as the center of attention for the family’s sacrifices, since able family members are expected to take care of the disabled and frail family members. The infrastructure, from street ramps and public transportation navigation for the disabled people, to public benefits is lackadaisical. Alcoholism: there is no functional purpose to alcoholism, nor a noble meaning to this infirmity. Alcoholics/drug addicts are seen as capable individuals who choose to derail from a balanced life into a shameful behavior. Therefore, the family members do not enable their compulsion. Similarly, the state doesn’t provide proper rehabilitation to alcoholics and drug addicts. Rather than looking at substance abuse as a disease, it is seen as a shameful self-determined act (along with other compulsions such as gambling and sexual addiction). It is judged and condemned individually and societally. In fact, long before the American prohibition of the 1920-1933, it was a Dacian King called Burebista (82-44BC), who prohibited the cultivation of grapes and use of wine in present day Romania. That is not to say that alcohol consumption is not used for functional purposes. Romania has very harsh winters and it is when alcohol is being used to allow better functioning in this kind of weather, that alcohol is praised and used moderately. Mental Health: Individuals with mental health are frown upon and institutionalized. Some are disposed of in psychiatric institutions and some are hurdled in prison (often are exploding into a violent incident). While the minimal consumption of psychotropic medications (compared to the US and Western Europe) spared the country of individuals suffering from the medications’ harmful side-effects (including suicidal ideation and/or shooting sprees), it also stopped individuals from benefiting from their respective treatments. The usual approach is to address the symptoms of mental health conditions by seeking herbal remedies, counseling in the family (with family elders), then go to the local parish priest for spiritual advice. In the cities, the practice of psychological and/or psychiatric treatment has seen an increase. And in extreme cases, institutionalization remains the action of last resort. When individuals with dual conditions (mental and substance abuse) are becoming disruptive for the society, more often than not they are isolated from society in the family homes, psychiatric wards and/or prisons. LGBT: Unlike the Greek culture where homosexuality has several precedents of being practiced in the open with societal acceptance throughout history, the Daco-Romanian culture sees no reason to accept this behavior. Since this preference is non-functional to the society (it doesn’t lead to procreation), is seen as parasitic and therefore, something to condemn. During Communism, this condition was selectively punished (the excluded homosexuals from arrest were those from the families of the Politburo, Central Committee and Securitate (KGB) apparatchik). After the toppling of the Communist system in 1989, the laws were voted to impose acceptance of the homosexual agenda, including but not limited to adoption being allowed by homosexual couples. Therefore, while the law has been protecting the homosexual couples, the moral judgment of homosexuals is quite harsh and is being fueled by the Orthodox Church and the conservative part of the population still.
Gabriel Gherasim Homework 8/15/2018 Section 2 Class 27 -What are the three levels of prevention? Universal: targeting the general public, or a whole population group. Selective: targeting subgroups of a population, whose risk of developing the disorder is significantly higher than average (imminent risk) Indicated: targeting high-risk individuals indicating a predisposition for the disorder. (US Institute of Medicine) -What are the 6 levels of Substance Abuse Hierarchy? Morality Creativity Spontaneity Problem solving Lack of prejudice Acceptance of facts -Write 4 examples of System of Care A system of care is: a spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life. Examples of system of care could include, but not be limited to: mental health services; social services; educational services; health services; substance abuse services; vocational services; recreational services; and juvenile justice services.
Homework Assignment for class # 30 Section # 2 Part # 2 Gabriel Gherasim What does the term “Culture” mean to you? Culture is a set of shared norms by a community. Give 2 examples from the material covered of what “Not to do” if you want to be deemed culturally competent. Refrain from generalizing on a community the attitudes and behaviors of an individual from said community (stereotyping) Refrain from projecting one’s own stereotypes of a community to said community (suspended judgment) The definition of “Cultural Competence” is: “A set of behaviors, attitudes and policies that come together in a system, agency or program, or among individuals enabling them to function effectively in diverse cultural interactions and similarities within , among and between groups” (US Department of Health and Human Services) In the material covered, how many stages are contained in the “Stages of Cultural Sensitivity”? 3 stages Please define each “Stage of Cultural Sensitivity” Denial (I don’t recognize cultural differences); defensive (I recognize cultural differences but, as being unimportant or negative); and acceptance (recognize and adapt to said differences). In the material covered, how many steps are on the ladder called “The Continuum of Cultural Competency”? 4 stages Please define each step of “The Continuum of Cultural Competency”? Cultural Incapacity (unintended stereotyping); Cultural Blindness (forcing the melting pot approach –all people are the same-); Cultural Pre-competence (accepting inability to presently be culturally competent; preparing to become culturally competent); Cultural Proficiency (all the concepts of cultural competence are incorporated into the agency’s policy, practice and attitude. Individuals are able to add to the body of knowledge and to teach those concepts to others). Please provide one paragraph answer to the question: “Why is cultural competence relevant to a CASAC in New York State? New York City and by extensions New York state is home to the most diverse population of immigrants in the country. Therefore, cultural competence is a must in terms of approaching the issues of substance abuse from the perspective and through the prism of the patients’ own cultural standards and norms. This would allow for clarity of terms, language, definition of the patients’ substance abuse problems, goals for treatment and evaluation of progress, from the patients’ own cultural understanding of substance abuse. Gabriel Gherasim July 19th 2018 Assignment 22 What are the 3 levels of prevention? -Universal (targeting the general public); Selective (subgroup of the population at risk); Indicated (targeting high risk individuals). What are the 6 levels of substance abuse hierarchy? -Morality, Creativity, Spontaneity, Problem solving, Lack of prejudice and Acceptance of facts. 3) Write 4 examples of Systems of Care: -Family services, child care, employment services, individual services coordination, transportation, supporting substance abuse services, housing support and information and referral
Gabriel Gherasim 7/16/2018 Assignment 21 a Cases 1 and 2 https://www.cnsproductions.com/pdf/casestudies.pdf What preliminary Axis I diagnosis would you give each of your patients and why? Use the DSM IV to look to the Axis I disorder and select one or two that best fit the clinical picture. Patient # 1: Preliminary Opiate withdrawal, or Opiate Dependence. Patient # 2: Preliminary Alcohol withdrawal, or Alcohol withdrawal delirium. What if any medical dangers, do you see or should consider for either patient? Why? The patient with opiate withdrawal is in no imminent danger. However, because of the severity of alcohol withdrawal, the second patient is in imminent danger and warrants immediate medical attention. What transference and countertransference issues would you expect to be present in working with patient A? What transference and countertransference issues might present themselves with patient B? Patient # 1: the patient may be using transference when equating the medical staff to his existing or imagined informal providers. He may be using seductive language to convince the staff to give him his “fix”. When that doesn’t work, he may be using threatening and/or complaining techniques in order to solicit the “fix” (i.e. “if you don’t give me the “fix” you are ‘forcing’ (sic!) me to steal, hurt someone and/or kill myself”). The countertransference concerns may reflect in the staff reacting negatively to the patient’s threats by becoming punitive in tone, words and/or actions. Patient # 2: Transference from the patient may reflect to his comparing his more advanced age to the younger medical and/or counseling team and equating advanced age and youth with experience and lack of experience respectively (including at a professional level). Therefore, he may be more reluctant to disclose his concerns and needs for assistance to younger members of his assisting team. The countertransference concerns may reflect in the staff by affecting positive parental association towards the patient and thus providing extra care and patience. If the associations with the elders are negative in the staff, the opposite countertransference may also be true, where the assisting team may actually provide mediocre if not neglectful quality of care to the patient. Finally, based on all the information, who gets the available bed and why? The bed should be given to patient # 2 due to his alcoholism-based withdrawal, intensity of symptoms and therefore, more intensive if not life-threatening need for immediate medical supervision and care. Case 3-Suzanne S. What drugs does Suzanne seems to be most addicted to? Heroin, alcohol and benzodiazepines (Valium and Klonopin). Of the drugs being used, which ones pose a more danger to withdraw from and why? Alcohol and benzodiazepines because the sudden withdrawal from these drugs can trigger deadly symptoms such as seizures and heart attacks. What dangers do you see as you read this case? What are the dangers for Suzanna? What are the dangers for the baby? Health problems may include contamination with HIV/AIDS, Hepatitis, and putting her health at risk if facing withdrawal symptoms from alcohol and benzodiazepines. What treatment options would you offer Suzanne and why? Be referred to a methadone clinic to address her opiate dependency for both her detoxification treatment and the baby’s (after it is born). What referrals would you give to her and in what order? Referral to methadone clinic (in and outpatient, particularly if Suzanne decides to give birth). Also, referral to an abortion clinic, if Suzanne decides to terminate the pregnancy. Referral to counseling groups and therapist for former sexual workers and to vocational training centers to allow her to gain skills for gainful employment under the color of law. Is Suzanne’s friend correct in suggesting that she did not stop the heroin use if she is pregnant? If yes, why? Yes, in the sense that stopping heroin use may lead to the fetus dying and spontaneously being aborted, because of the withdrawal symptoms. Also, because of the mother’s use of alcohol, stopping cold turkey may result in Fetal Alcohol Syndrome (FAS) complications such as physical deficiencies and mental retardation. What legal issues may present themselves in this case, if she decides to keep the baby? Legally, Suzanne may incur criminal charges for endangering the safety of her child once it’s born, including but not limited to going to prison and/or having her child being taken away by the Child Protective Services. Do you see and transference or countertransference issues that can cloud your judgment in handling this case? Please explain! The counselor may be seen as an obstacle to Suzanne, by counseling her to make decisions in terms of changing her life-style and mentality (drug use, prostitution, abusive relationship) in order to become a responsible mother and a legitimate constructive member of the society (gain and maintain sobriety, be a doting parent, gain and education and choose a legal profession). Countertransference-wise, the professional may judge Suzanne as being an irresponsible individual, or perhaps as being a victim incapable to advocate for herself. Either way, these perspectives of Suzanne are disempowering for her, since she would need a professional interested to help her find and develop her strengths, not her weaknesses, be they at a mental, emotional and/or at a behavioral level. Case # 4-Reese C. Based on the information, what other information would you need to determine Reese’s level of drug use? Reese needs to provide when, how often, and how much of each drugs he is taking (time, frequency and amount). Where would you place him on the Addiction-Compulsion scale? Tobacco, marijuana and alcohol-wise, recreational to habitual levels. The details above are needed for more specific evaluations. Is there a genetic component in his addictions? More evaluation is needed. Still, based on the present disclosures, Reese may have both environmental and genetic components which influenced his addictions. What factors in his medical history might lead to a conclusion of the patient suffering from dual diagnosis? The patient reported being diagnosed with ADD/ADHD at age 8. Further evaluation is needed for a more definitive answer. What environmental factors might have played a role in his addictions? Yes, from both parents’ negative role-models. No from the brother, who seems to have found refuge in his studies. Case # 5 Laura What would the initial assessment be? Substance abuse dependency as manifested by: cravings; loss of control; tolerance; continued use despite negative consequences. What is Laura’s main drug of choice? Does she need detoxification? Alcohol and Benzodiazepines. Start with out-patient treatment and progress to inpatient rehabilitation if needed. Case # 6-Lloyd What is a “speedball”? An intravenous injection of combined heroin and cocaine. What would your initial assessment be? His primary drug of choice is heroin; his secondary drug of choice is cocaine. What would be your recommendation for medical treatment? Inpatient treatment aiming for abstinence. Also, outpatient methadone treatment. Either way, HIV counseling and treatment. What pharmacology would you recommend for drug use and medical condition? Please see above. A counselor may only provide information to the patient for the latter to make an informed decision. How would you handle a patient using street terms for drugs? What will you do if you don’t recognize these terms? Why does he use street terms? Could be part of the individual’s routine lexicon. Could be a way to test the counselor’s ‘applied’ knowledge of her theoretical skills. If in doubt state “I’ll get beck to you on this one” when it comes to being unsure about slang terms for drugs. Discuss transference and countertransference possible rationales to Lloyd’s street terms. For Lloyd, the slang usage of drug terms may project ‘experience’, ‘empowerment’ and ‘expertise’ on the matter of drugs and being street smart. For the counselor, his verbiage may trigger disdain or admiration, either way providing an unwanted bias from a professional whose sole job is to locate accurately the individual’s, desires, abilities and needs and come up with a treatment plan which could maximize the patient’s strength and prepare him/her for a life of content sobriety. How should the counselor address Lloyd’s statements of contemplated suicide and his reasoning in this regard? By addressing his misperceptions on the society as he minimizes and denies his role in the matter, while blaming society at large for his HIV predicament. These are logical fallacies and by inviting the patient to take an active role in his treatment, the counselor may advise Lloyd on the whys and hows to deal with his medical condition, not to mention to feel empowered and motivated to continue and maximize his life to the best of his abilities (which would lead to a moot point his suicidal ideations). Case # 7-Jane What are Jane’s regular drugs contributing to her mental state? Hallucinogens (LSD, XTC, mescaline and mushrooms). Is it possible for Jane to be addicted to marijuana and hallucinogens? Yes, it is possible for Jane to be addicted to both marijuana and to hallucinogens. What part of her family and social life history seem to influence her drugs consumptions? Boredom, loneliness, inhibitions and peer pressure (concerts) seem to have contributed to her drug use. What mental health condition should be ruled out prior to recommending treatment? Schizophrenia. Does Jane have a mental, drug problem, or both? For sure a drug problem. It is still to be determined if she is a MICA (Mentally Ill Chemically Addicted) patient. How would the ARRRT skills have helped Janet at the concert? Allowing her to think logically on the course of her actions (and not just accepting to partake in a self-harmful behavior due to peer pressure). What hospital would you be more likely to recommend Jane for? Inpatient detoxification center. Gabriel Gherasim 7/16/2018 Case Study Danny B. Assignment 21 b. When meeting with this client, would you have a direct or a non-direct session with him? List reasons why? Initially, I would recommend a direct (as in one on one) session with him, while the style of the counseling session would be non-directive (listen, acknowledge, reflect, paraphrase, discuss his feelings). This is needed due to the individual feeling more prone to discuss confidentially his issues, rather than in group; and feeling listened to (literally and figuratively) by the counselor, when expressing his thoughts and feelings, rather than being dictated what to do under the counselor’s presumption of knowing him and his needs. Later on, the counselor may start directing the client in the right course of action, after gathering sufficient knowledge from the client to assess accurately the client’s needs for treatment. Gabriel Gherasim June 13th 2018 Assignment 14 Alternative therapies may provide a welcome addition and supplementation of treatment to the recovery patient involved in the medical model. As such Nutritional therapy may provide much needed nutrients and supplements to the individuals who, because of extensive drug usage, have ignored much needed replenishment of their bodies’ vitamins, anti-oxidants and minerals. For example, beta-carotene, zinc, vitamins C and E, Selenium and the B-complex spectrum replenish the former alcoholics’ and drug addicts’ bodies with much needed building blocks for the healthy balance of their metabolism, there where, sometimes for decades, the addict was only preoccupied to get his/her fix. Other examples of alternative treatments include: herbal medicine; acupuncture; auriculotherapy; guided imagery; chiropractic therapy; hypnotherapy; mediation; and aromatherapy. At more clinical levels we may mention harm reduction therapy, psychodynamic therapy and brief individual therapy. While the latter three fit the clinical label, they are ‘alternative’ in the sense that they are not widely being used as therapeutic tools. With time, some trends may change, such as with the brief individual therapy model, which seems to become increasingly popular. Gabriel Gherasim 6 /11/ 2018 Assignment Class 13 Section 1 Medicated assisted treatment /Medication supported recovery Medicated Assisted Treatment or Anti-Relapse Medication? The presently used Medicated Assisted Treatment is the terminology I favor, as opposed to the “anti-relapse medication.” This is because for a person in recovery, medication does assist in treatment and it is often part of a more complex understanding of treatment which involves counseling, healthy people, places, things and appropriate time set for healing. Conversely, “anti-relapse medication” is very reductionist in nature, assuming that treatment is solely a matter of bio-chemical exchanges, with no correlation to any other variables. As placebo-based experiments have shown over and over again, the meaning a patient gives to his/her treatment, medications, causes and effects, can actually interfere if not outright cancel out the bio-chemical medications. This is because individuals want to be in control of the being, time and place of their treatments. Therefore, by using exclusively the medical model, the “anti-relapse medication” may be promptly made inefficient by the negative perception the individual in treatment may attribute to it. The medical model states and quite correctly so, from a bio-chemical aspect, that addiction is: “a primarily chronic disease of brain reward, motivation, memory and related circuitry.’ That “motivation,” however, is also quite a psychological tool in the individual’s own quest for recovery, since neuroplasticity clearly shows that: “Recent discoveries about neuroplasticity give a whole new meaning to the phrase ‘mind over matter.’ By encouraging repeated thoughts and repeated motor actions, we can actually re-wire the physical brain to some extent. We can monitor some of these changes with neuroimaging studies.” https://sciencebasedmedicine.org/thoughts-on-neuroplasticity/ In other words, if we change our paradigms from exclusively depressive and/or negative, not to mention aggressive in nature, to positive, loving, caring and gratitude based, in time, the brain will rewire its own neuronets to create a physical system of thinking best suited for an optimist. Some opioid based treatments include: agonists; partial agonists; and antagonists which can provide a bio-chemical relief to the recovery patient. Examples of agonist medication are: morphine; methadone; and oxycodone. Examples of partial agonist medications include: buprenorphine. Examples of antagonist medications include: naltrexone; and naloxone. There are four phases associated with medication assisted treatment for opioid dependence: induction; stabilization; maintenance; and medically assisted withdrawal. While opioids caused withdrawals do not necessarily require supervision, Benzos and Alcohol triggered withdrawals certainly demand supervision during the detoxification process. Alcohol withdrawal has been segmented in: minor withdrawal (6-7 hours after the last drink); major withdrawal symptom (24-72 hours after the last drink); and delirium tremens (72-96 hours after the last drink). Treatments include prescriptions of: Disulfiram; Acamprosate; Naltrexone; and Vivitral. Nicotine replacement therapy, is a set of medications being employed in assisting the patient to kick the smoking habit. It includes among others: the trans-dermal patch; and nicotine gum. The Holistic care approach involves a whole host of auxiliary elements to the medical treatment of the person in recovery, ranging in assistance to: mental health (group and individual therapy); vocational; educational; legal; financial; housing; family; and case management. Additionally, part of this holistic treatment umbrella includes but not limited to: nutrition; massage; acupressure; acupuncture; yoga et al. Therefore, Medication Assisted Treatment/Medication Assisted Recovery (MARS), seems to be the more complete description of medical treatment for the recovering patient, rather than the more simplistic and limiting “anti-relapse medication.” Medication Assisted Treatment may contradict the impetus on total abstinence promulgated by the 12 Steps programs. While this may be truer in the case of harm reduction approaches, it still may create a conflict between the total abstinence proponents and the functional medical treatment proponents. This is not to say that there couldn’t be a conviviality between the medicated recovery patient and the AA/NA attendant. Treatment versus abstinence have to be prioritized on a case by case level, perhaps in various stages, with the safety of the recovery participant being the sine qua non goal of both the medical specialists and the individual’s support group involved in his/her recovery. For abstinence comes in many shapes and forms, including as a patient taking medications for addiction, who is simply seeking independence from the drugs and a more complete control of and involvement in his/her life. June 11th 2018 Gabriel Gherasim Assignment for Section 1/Class # 12 part II: The 12 Step & Other Types of Mutual Aid Groups Please write about the Role of Mutual Help groups in Extending the Framework of Treatment I was aware of the 12 Step Programs before studying the class’ materials. For 4 ½ years I have been working as a Specialty Counselor with re-entry populations suffering from Mental Illnesses and Chemical Abuses (MICA) in their lives. The subject of the 12 step AA/NA mutual help programs invariably came up during group and individual counseling sessions. This is because many patients had tried abstinence via self-help/mutual aid groups, in an effort to regain sobriety and regain full control of their lives. The reports from them in terms of success rate from this kind of approach to abstinence, was a mixed bag: some reported extensive periods of sobriety; some reported intermitted success; and some reported none. My observation of these accounts would tend to credit self-help and mutual aid approaches to sobriety, for those individuals who are genuinely committed to sobriety AND who have a different, consistent and ongoing passion to replace the one which had been used to chase drugs, sometimes for decades, in their lives. Genuine spirituality is one such passion, which happens to be promoted by the AA/NA 12 Steps standards. Traditional treatment could interact successfully with self-help/mutual aid approaches, when seen from the perspective of the holistic approach. As such, the traditional treatment may address the medical needs of the persons in recovery (chemical-biological-physiological), while the self-help/mutual aid assistance, may address the patients’ more cognitive and existentialist based aspects (such as assisting them to change perception from a drug-focused existence to one related to self-realization, intra-personal, inter-personal, intra-group and inter-group meaningful thoughts, emotions, activities and behaviors). In effect, the self-help/mutual aid assistance provides the skills for the involved participants to improve their physical, emotional, intellectual and behavioral contribution to themselves and to the world. Much like the deconstruction of a uniformed population, followed by the reconstruction of the same individuals according to new standards, seen often from the military cadets, to prison inmates and government, or politically and/or religion indoctrinated youths, the 12 Steps programs empower the participants after first having them admit…powerlessness. The goals of the 12 Steps programs come in three stages: give control to God (deconstruction); build/clean house (reconstruction); and spread the word. So, there is a sense of empowerment after admitting and taking part in one’s own deconstruction. Once the new paradigm of the belief system creates a foundation based on humbleness, spirituality and honesty, the 12 Steps participant moves back into the control of his/her life, only to take ownership of and repair his/her wrong doings, as well as, modeling and propagating positive role-models to one’s self and to others. Rational Recovery, as a counterpoint to the spirituality-based recovery, bypasses the deconstruction aspect of one’s foundation of beliefs, which eventually had led them to abuse drugs, as well as, the collaboration between the individual spirit and the universal spirit (God). Rather, it focuses on one’s strengths entirely, within the individual’s perceptional and behavioral control. The SMART Recovery aspect of it teaches: -Enhancing and maintaining motivation to abstain -Coping with urges skills -Problem solving (managing thoughts, feelings and behaviors) -And Life-style balance (balance momentary and enduring satisfactions). While these may be excellent skills to acquire and master at the intra-personal level, they are isolationist in nature and may lead to lack of gentleness in accepting one’s own failures (i.e. self-forgiveness), as well as, in terms of engaging external support from other individuals, not to mention from the universal strength of the electro-magnetic field pervading our very existence macroscopically and microscopically, which has been traditionally called God. In fact, the very term “sorcerer” is an abbreviation for individuals who can tap into the so[u]rce of God. If we deny the very existence of this Creative all-pervading electro-magnetic source, such as the Rational Recovery school does, it certainly impedes for the persons in recovery to phantom, let alone connect to it and be helped by it, in their healing process. 6/6/2018 Assignment # 11 Gabriel Gherasim Pick a personality disorder and write about it. Dissociative Personality Disorders and Wrongful Convictions. Dissociative Personality Disorders can negatively affect factual testimony, when the “facts” are being loosely interpreted by a jury, where ‘she says/he says’ is enough to warrant a conviction of an innocent person, by his/her peers and allow the actual guilty party (if existent) to go free in the process. DSM IV squarely defines a personality disorder as: personality traits which are inflexible, maladaptive, and cause either significant impairment in social or occupational functioning or subjective (slanted, biased etc) distress.” (our emphasis). In the subjective/objective tandem evaluation of our reality, a certain degree of bias is expected at the subjective level. When judgments and convictions are being dispensed based on subjective perceptions…under the guise of objective findings, it’s just a matter of time when a person affected by a dissociative personality disorder may display dissociative amnesia, and quite confidently emit accusations from the witness stand which are factually false, let alone “proven beyond reasonable doubt.” The new Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has a number of changes to dissociative disorders, including dissociative identity disorder. According to the American Psychiatric Association (APA), the publisher of the DSM-5, the diagnostic criteria for dissociative identity disorder have been updated: Symptoms of disruption of identity may now be reported, as well as observed Gaps in the recall of events may occur for everyday events — not just traumatic events (our emphasis). So, if dissociative amnesia, a possible byproduct of the dissociative identity disorder is creating “gaps in the recall of events which may occur for everyday events-not just traumatic events,” how much more plausible is it then that this form of disorder may render an inaccurate narrative from the plaintiff, when the setting was in traumatic environments (people, places, things and -added by me- time)? A good filter to distinguish accurate versus misperceived testimonies would be to condition the narratives to corroboration from scientific resources (such as a positive or negative rape-kit results, DNA match or lack thereof and of other incriminating or exonerating forensic data. The problem is that jurors are not being properly schooled (they are only informed) on the applied responsibilities they have as “considering a person innocent, until proven…” Therefore, with immunity insured, they may turn in a large number of wrongful convictions based only on the plaintiff’s testimony and (often) self-contradicting at that (especially when affected by dissociative disorder related recollections of facts). Even when defense attorneys request permission from judges to bring as expert witness, a psychiatrist who may explain the above, the judge may at his/her discretion refuse such testimony, and explaining all the possible incongruities in the plaintiff’s testimony as “naturally occurring following a traumatic event.” With the added presence of substance abuse in the individual prior, during and/or following a traumatic event, the accuracy of the evocation of the facts is even more clouded by the bio-chemical, genetic, social, and perceptional variables of the plaintiff. The checks and balances of the justice system become only symbolic, when they are being shoved aside when inconvenient, by the jurors, the judge and the Police/courts in general. It takes years, sometimes decades, for a wrongfully convicted individual, solely based on the often self-contradicting statements of a plaintiff affected by dissociative amnesia, to redress this injustice; many don’t. And unlike exoneration given by the irrefutable proof of DNA clearance, convictions based on accusations alone, have no factual remedy to seek, since they are perception based accusations. Unless the defendant is able to prove a negative, which is close to impossible at times, convictions based on false charges from plaintiffs affected by a personality dissociative disorder (including dissociative amnesia), are going to continue leaving a steady trail of wrongful convictions in the American Courts. 5/21/2018 Essay: Why are we addicted?
The bio-psycho-social model addresses both the comprehensive healing effects of addiction treatment, as well as, the possible causes for addiction. Biological, genetic and/or chemical causes of addiction may indeed trigger and/or exacerbate the intensity of one’s addiction, even while sociological and/or psychological causes stay the same. Similarly, a family and environmental exposure to drugs and violence, may be a precipitating factor in one’s addiction, which are summarized as people, places and things (with my adding the time factor) triggers by the AA/NA participants. The psychological factors of one’s internal perception and interpretation of her world is paramount to resiliency. It is at this dimension where the individual may change and in so doing may change her world. Dr. Constantin Dulcan, a famous neurologist from Romania described this connection between the kind of thoughts we entertain and how it affects us, by stating: Let us be aware of our THOUGHTS, for they will become our EMOTIONS. Let us be aware of our EMOTIONS, for they will become our WORDS. Let us be aware of our WORDS, for they will become our ACTIONS. Let us be aware of our ACTIONS, for they will become our HABITS. Let us be aware of our HABITS, for they will become our PERSONALITY. Let us be aware of our PERSONALITY, for it will become our DESTINY. (Dr. Constantin Dulcan, Reteta Fericirii, Gandul, Bucharest, Romania, 2016). One example of perceiving our worlds, as Dan Puric, an internationally acclaimed Romanian actor, dancer and commentator discussed, is our paradigm on our connection to the society in which we live (Puric, Dan, Omul Frumos, Editura Libris, Bucharest, Romania, 2009). He postulates that if a person sees herself as part of a population, her interest is very minimal in regards to society. Her approach to the rest of the people is very individualistic, a ‘winner takes it all,’ ‘me, myself and I’ attitude. However, if the same person sees herself as being part of a people, then her sense of identity is fused with the society in which she lives (in terms of preset, past and future values of that culture). A sense of quasi automatic empathy is generated and the person thinks, feels and acts in terms of ‘we.’ A sense of community brings an implicit and explicit responsibility and expectation that one’s actions benefited both her interests AND the interests of her ‘people.’ We can surmise that man versus population will think, feel and act only for his benefit, regardless of the cost to others, whereas man and his people, will permeate his existence, in some cases leading to his supreme sacrifice for his community. People, ideologies, politics and religions, have thus acquired supporters who will transcend individuals, places, things and time, in order to experience that addictive feeling of ‘belonging’ so dear to human beings, since the beginning of time. They would thus become true believers (Eric Hoffer, The True Believer, Barnes & Noble, New York, 1951). In order for people to feel that they have fully meaningful lives, they seek and try to find validation on four dimensions: intra-personal; inter-personal; intra-group; inter-group. The intra-personal dimension is introversive in nature and covers areas of our identity which we find within; essentially, our thoughts (beliefs, perceptions), feelings and physiology. The inter-personal dimension is extroversive and it involves our one-on-one communication with other individuals. The intra-group communication is extroversive and it involves our functioning within our communities. The inter-group communication, also extroversive, deals with our functioning in new or otherwise unfamiliar groups. An American expression often equaled to defeatism states: “it is what it is.” While the journalists will be quick to list this as a circular argument logical fallacy, the truth of the matter is that even if this statement is taken at face value, it is not true. In fact, what’s more realistic is to state: it is how we PERCEIVE it to be. Therefore, particularly in a circumstance where we cannot change a fact, we can change the perception of it from negative into a positive one and therefore, we can think, feel, talk and act differently in regard to that situation. Let’s take a pen and poke our finger with it. Let’s call that a sensation. How we think, feel and act about it depends entirely on whether we perceive that sensation as ticklish, painful, annoying, amusing, or pleasant. Even in an extreme case such as having one’s body being whipped with vengeance, the sensations from it usually perceived as being painful are sometimes perceived by some people as a pleasurable experience. A flourishing industry of dominatrix people, getting paid a good penny by such individuals to hurt them, stands testimony to this fact. We can visualize a fact/sensation as the content in a bottle and the perception, as the bottle itself (context, container). The saying cautioning us: “not to judge a book by its cover,” is telling on how manipulation of the context by the advertisement industries can induce us to buy inferior products (content), often at an inflated price, based on their glorious, external presentation (context/container). Similarly, we can try to ‘manipulate’ the context/perception of our paradigms, related to this or that situation, which we may be facing mandatorily, by reframing how we look at them, that is to say, from a negative into a positive perspective. Our context/perception is in our control, provided that we are reasonably sane in mind and calm. In today’s Western societies we are often encouraged, if not tempted to seek and find instant gratification for our desires. In counseling terms, this is called the P.I.G. (the Problem of Instant/Immediate Gratification). This is a problem because instant gratification can and does address the symptoms of our desires but hardly ever the core or the cause of them. Let’s take the example of a head-ache. If I want instant relief, I go to a doctor who gives me medication. I take the pill which numbs my head-ache. Problem solved. But is it solved? Not really. For as soon as the effects of the medications go away, the head-ache reappears. This means that I have to take another pill to numb the symptom (the head-ache). The headache is there and I simply manage it by taking pills in perpetuity. However, if I want to come to a resolution rather than management of the head-ache, I seek the cause of the head-ache and I try to eliminate it. Without a cause for the head-ache, there is no head-ache. For example, if I eat salty foods which give me high blood-pressure, which in turn constrict the blood vessels in the head and which give me head-aches, I go on a low-salt diet. Following the diet, the blood pressure normalizes, the blood vessels don’t get constricted anymore, which means that there is no more head-ache. By eliminating the cause of the head-ache there is no more head-ache. Whether this approach is taken to address physiological problems or in regards to psychological problems, it is just as successful and permanent in its results. It should be said that a resolution approach takes usually longer than the management approach in showing results. Sometimes, both techniques are being used in addressing a problem but very often, today’s society and individuals opt for the immediate gratification/relief approach only, with its hopelessly temporary and insufficient effects and results. With this distinction in mind, we can reframe our approach to our problems from management to resolution, in a wide array of areas, from stress and pain management, to their respective resolutions, which lead to long-term if not permanent beneficial effects. 5/17/2018 Assignment 2 Faith Based Approaches Gabriel Gherasim
Criticisms to Faith based Approaches: how such framework will compete with, be linked to, or be integrated with the mainstream system of addiction treatment? Before discussing faith based addiction treatment, I shall like to discuss faith based use of psychedelic, stimulant and/or sedative substances. From the use of hallucinogenic mushrooms, to the Indian Soma, to tobacco, cannabis, opium, coffee, chocolate, alcohol and ayahuasca, religions have been actively involved in the employment of mood altering substances to produce ecstatic experiences and therefore communicate with and become closer to the divine. The difference between religious faith-based use of mood-altering substances and the abuse of the addict of the very same substances consists in the setting, frequency, and purpose of them. For the religious use, mood-altering drugs are used in a guided and limited fashion (i.e. controlled). For the addict, with his chaotic, compulsive and “recreational” use, control of use is unthinkable or unreachable. It is therefore quite telling that faith based rehabilitation centers, from AA/NA to church based programs dictate “0” tolerance of use for the recovering addict, since he would not and could not understand using the mood altering substance in a “guided and limited” fashion. This is because the addict could not keep his word of using the mood-altering substance while being in control of the substance; rather, it is the other way around. The word addict means just that in Latin: A-Dictus (not keeping his word). The dis-ease (not being at ease) theory treats drug addiction as a morality free condition, in strict biological, chemical and chemical terms. While this paradigm protects the recovering addict from any judgments from lay and professionals alike, it also protects him from taking ownership of his drug use. This may create a “learned helplessness” mentality in the individual, with disempowering effects on his reasons as to why he’s using, since… it’s his illness. While there is no question that the medical and genetic theories may explain the physical and physiological aspects which may indeed affect upwards of 50% of the reasons for his addiction, the 50% remaining social and personal accountability (perception) aspects respectively, remain unanswered and unused in a person’s recovery and sobriety. Behavioral and socio-cultural theories may explain the sociological aspects of one’s addiction, which may engage upwards of 10% of his rationale for addiction and answer the “people, places, tings and time” aspects of his compulsive use. Yet the remaining 40%, i.e. one’s perception, which incidentally is in most cases 100% in the individual’s control, is where most benefic effects to recovery may be seen through personal efforts: In fact, the 50-10-40% Formula Happiness states that: it’s not just your geneshttp://www.forastateofhappiness.com/tag/50-10-40-formula/
It is at this point where faith based recovery can do marvels. A belief in purpose, positive purpose and healing out of love (which includes [self] forgiveness of wrongs perceived by fact or imagination), allows a catharsis of negativity (from regret, to fear, to anger) and for the scarred individual to replenish the void left by those emotions with the emotions of love, joy, humor and peace. As long as the faith based movements and the clinical based programs emphasize therefore recovery out of love, as opposed to out of duty, fear and/or guilt, then the healing is done for the right reasons. It then becomes more durable, pleasant and transfigurative in nature, where addiction is replaced by diction (speaking out and being able to keep one’s word), obsession is replaced by compassion and avoidance of life and purpose by embracing both life and purpose. Forgiveness, which is tantamount to healing for addicts, without faith/spirituality, may be possible for rational reasons as well. Some clinical benefits of forgiveness include, but are not limited to: 1. Forgiving, looked upon as strength, rather than a weak act. 2. Use forgiveness as a practical or psychological tool rather than just as an abstract or spiritual dogma. 3. Understanding the value of forgiveness in reshaping the perception of past, present and future experiences. 4. Understanding the benefits of forgiveness both internally and externally. 5. Concentrating on the good side rather than on the evil side of human beings. 6. Understanding that survivors are outsiders no more, being active participants in restorative justice measures. 7. Have a desire to heal broken relationships. 8. Use past suffering memories as cathartic rather than an immutable reliving of painful experiences. 9. Understanding the scapegoating mechanism and that the victim was not at fault for going through such suffering. 10. Offering self-acceptance and praise for enduring unwarranted suffering. 11. Separate actions from the perpetrators (forgive the perpetrator but not the crime). 12. Use personal ordeals to work for justice. 13. Create justice first and then expect reconciliation. 14. Be an active participant in restorative justice measures. 15. Receive reparations commensurate with the crimes and seek conviviality but not necessarily communion between victims/perpetrators (Gherasim, G. Theodor and Us, Ginta Latina, Romania Pp. 33-34). The person centered approach will dictate ultimately the best suited approach for the recovering addict. 5/16/2018 Assignment 1 History of AOD Gabriel Gherasim
1) What is Fetal Alcohol Syndrome Disorder? The short description of Fetal Alcohol Syndrome Disorder is incurring damaging effects on the infant, generated by the mother drinking alcohol during pregnancy. The most severe form of the condition is known as fetal alcohol syndrome (FAS). Other types include partial fetal alcohol syndrome (pFAS), alcohol-related neuro-developmental disorder (ARND) and alcohol-related birth defects (ARBD). The effects include but are not limited to, physical malformation, mental retardation, skeletal and major organ inhibited growth and dysfunctions, nervous system and poor motor skills problems, difficulties with learning, poor social interaction and premature death. Because of the disclaimer by alcoholic companies on their products’ labels in this regard, the consumers (including pregnant women) are considered as having an informed consent on these risks and therefore, the alcohol producers claim immunity from prosecution. The same applies with tobacco and big pharmaceutical producers. Therefore, ultimately, it is the responsibility of the adult (in this case the pregnant mothers) in choosing to abstain from consuming the product. The argument has been made that because the consumer is addicted a priori to her pregnancy, she may react (get the fix) rather than respond (use logical decisions) to the alcoholic product, thus not being responsible for intoxicating the fetus with alcohol. Unfortunately, ever since the Nuremberg Trials, once the company provided disclaimer on the risks awaiting the consumer following the consumption of its product, the company usually becomes legally immune from prosecution.
2) How does Nicotine affect one’s health? Nicotine is the chief active constituent of tobacco. It acts as a stimulant in small doses, but in larger amounts blocks the action of autonomic nerve and skeletal muscle cells. Nicotine is also used in insecticides. Nicotine was considered by the natives of the Americas to be a sacred plant and was considered by the Catholic Church as early as 1588 to be incompatible with the priestly duties and was therefore forbidden to the priests before the celebration of the Mass. The differences between its religious use by the natives and the inveterate smokers are quantity and frequency. For the natives’ shamans, nicotine (as well as other “sacred” plants), this was supposed to be used in a guided and controlled (limited) manner (the religious and official ceremonies); for the compulsive smoker it is obsessive and therefore, unlimited. A New York Times 1883 article linked the decaying of Spain (and soon to be of the United States) to the very compulsive custom of smoking. In today’s American lore, smoking is allowed from prisons to rehabilitation centers, including by individuals affected with incurable diseases. The issue of responsibility for the devastating damages of nicotine effects on the consumers’ lives was revisited in 1988, when a family of a smoker and lung cancer victim received by jury decision $ 400,000.00 in compensation from tobacco industry magnates. The argument remains as with the alcohol and pharmaceutical producers, that if the companies put labels with appropriate disclaimers of possible side-effects along the products which they are selling, the consumers are ultimately responsible for the devastating effects of consuming their products. This argument may not be sustained however, if individuals get hurt by second-hand smoking, since the latter had no choice in the consumption (by proxy) of these noxious products. Forcing versus seducing (advertisements, based on informed consent) consumption of intoxicating substances, may ultimately be the dividing line between routine successful versus routine unsuccessful law suits against addictive and toxic substance producers. Lastly, there may be the need of a more clear distinction to be made of the government encouraging drug use in some cases and for some populations, usually in combat zones (Civil War soldiers and their opium kits; WWI and WWII soldiers and sailors using rum and cigarettes; Vietnam War soldiers using opium; Afghan and Iraq Wars soldiers using psychotropic medications) and discouraging the very same use of addictive substances, such as with the civilian population. This dichotomy of policies is confusing and discrediting to the citizens, especially when these substances are addictive and therefore very hard to interrupt usage of on command.