Tuesday, November 22, 2005

some news articles of child neglect and abuse

Orphaned Babies Show Hormone Disruption Years after Adoption

Orphans have a hard lot in life, particularly in Eastern Europe, where state institutions sometimes provide care that has been reduced to simple feeding and changing with a minimum of physical contact. That neglect--even without any other abuse--can take a profound emotional and physical toll, potentially deeply affecting a child's neurobiology. New research shows that children adopted from such institutions who have spent as many as three years in their new homes still suffer from depressed levels of hormones that have been linked to bonding, caring, communicating and stress regulation, among other things.

Scars That Won't Heal: The Neurobiology of Child Abuse

In 1994 Boston police were shocked to discover a malnourished four-year-old locked away in a filthy Roxbury apartment, where he lived in dreadfully squalid conditions. Worse, the boy's tiny hands were found to have been horrendously burned. It emerged that his drug-abusing mother had held the child's hands under a steaming-hot faucet to punish him for eating her boyfriend's food, despite her instructions not to do so. The ailing youngster had been given no medical care at all. The disturbing story quickly made national headlines. Later placed in foster care, the boy received skin grafts to help his scarred hands regain their function. But even though the victim's physical wounds were treated, recent research findings indicate that any injuries inflicted to his developing mind may never truly heal.

Though an extreme example, the notorious case is unfortunately not all that uncommon. Every year child welfare agencies in the U.S. receive more than three million allegations of childhood abuse and neglect and collect sufficient evidence to substantiate more than a million instances.

You have to pay to read the last article. I'm just linking to it so if I do a paper later on the subject, I know what keywords to use in the scholarly journal databases for the actual studies.

Wednesday, November 16, 2005

Poster for next week's presentation. Posted by Picasa

Factsheet for my oral report next week

Expressing the Inexpressible
Art in Grief Work - Fact Sheet

Art has been an integral part of grief work since the dawn of time.

“(A)rt forms have been a part of funeral ceremonies since Neanderthal times.“ - Malchiodi, C. (1998). The Art Therapy Sourcebook. (p. 142)

During the Black Plague, art took on a more morbid air, reflecting the fear, anger and sorrow which was universally felt. “Marked by crowded, paranoid compositions, ugly, menacing faces, bright colors and increased violence, Black Death art is unbalanced and uneasy.“ - Art and Death (http://death.monstrous.com/art_and_death.htm)

In the 19th century, posthumous mourning portraiture and other art became part of the morning process. - Leming, M. & Dickinson, G. (2002). Understanding Dying, Death, and Bereavement. (p 406).

Private bereavement art can take other forms besides drawing and painting.

Masks - Masks can represent “faces” of ourselves. (Allen, P. [1995]. Art is a Way of Knowing. p 81-82, 113-114) Similar to some primitive cultures, making masks of deceased loved ones helps to deal with the grief. (Allen, 127-140) Masks can also help resolve issues with long deceased relatives. (Allen, p165-167)

Collages - Using images from family photos, magazines and other sources can help a client connect and/or explore their personal history and the connections with family and society. (Allen, p 144-145)

Mandalas - Creating circular drawings helps to symbolize “wholeness” or the intention to be whole. It is often a very calming task. (Allen, p. 192) Releases tension and gives a holistic way to examine inner conflicts using Jungian principles. (Fincher, S. [1991]. Creating Mandalas - For Insight, Healing and Self-Expression. p. 24-32) Also allows the client to focus themselves mentally. (Fincher, p. 175)

Heart-shaped Memory Boxes - Heart-shaped boxes decorated usually decorated in collage-style. Allows the client to represent their public and private relationship with the deceased. (Primetime Live, March 7, 2002. “Tender Hearts - Art Helps Children of 9/11 Heal”.)

Quilts make a good community grief project, as in the AIDS Memorial Quilt. (Malchiodi, p 142-143)

Art Therapy is especially effective in grief work.

Perceived as less threatening than many traditional interventions. (Kahn, B. [1999]. “Art therapy with adolescents: Making it work for school counselors.“ ¶ 2)

It's flexible enough to be used with more than one approach and can be very client-centered, giving a safe outlet for disturbing themes. (Kahn, ¶ 5)

“(A)rt seems to appear spontaneously when confronted with a significant loss...“ (Malchiodi, p 144)

Art can be particularly helpful to those whose trauma is so severe that they can't find words for it. (Malchiodi, p 149)

“Color unlocks emotion...” (Fincher, p 172)

Damaging a piece of one's own artwork is an act of damaging the self, without actually harming the artist physically. It is a better release for self-directed anger. (Fincher, p 174)

A puzzling piece of art

Elonka's Kryptos Page

Kryptos is a sculpture located on the grounds of CIA Headquarters in Langley, Virginia. Installed in 1990, its thousands of characters contain encrypted messages, of which three have been solved (so far). There is still a fourth section at the bottom consisting of 97 or 98 characters which remains uncracked. This webpage contains some information about the sculpture, including some photos collected from around the web, some rubbings of the sculpture taken by your intrepid webmistress, links to other articles and Kryptos discussion groups here and there, and information about other encrypted sculptures which have been created by the sculptor, James Sanborn.

Monday, November 14, 2005

Chapter Eleven Short Essay - The Business of Dying

Before the Victorian age, funerals were times of public mourning and long sermons in most of the United States. Most people were buried wherever it was convenient. The Puritans eschewed the displays of grief and buried the dead near churches, but still gave elegies and long sermons on the fate of the living, because in their minds the dead had already had their fate sealed.

With the introduction of industrialization, the need for a third party to handle funerals and burial became great enough that people began to make a living taking care of dead. But while industrialization created a livelihood, the funeral industry made sure they shaped public expectations to make work easier for them, by convincing people to focus more on comforting the survivors than facing the death and loss. Funeral directors talked the clergy into giving shorter and more uplifting sermons. They began removing the morbid and scary images from monuments and memorials. They beautified and preserved the corpse to give them a more peaceful look. They substituted the ominous coffin for the stately casket and decorated the interior to look like a bed. In short, they worked to make it more pleasant to have a “professional” do the funeral, than to adhere to older traditions.

Even in the twentieth century, funeral homes and cemeteries influenced burial traditions. The introduction of “lawn cemeteries” appeared. While they may argue that this is a far more peaceful atmosphere for grieving people, the ease of caring for a lawn cemetery is obviously a savings for whomever maintains them. As is the push to standardize grave markers and minimalize the amount of personalization of them. While the industry calls it aesthetics and making it more economical for the consumer, there is no doubt the main beneficiary is the industry itself.

Sunday, November 13, 2005

Chapter Ten Short Essay - Death Rituals

As varied as death rituals are around the world, like other rites of passage, they all consist of three parts. The first is the separation of the bereaved from the non-bereaved. In most cultures, this is not actually a physical separation as it is identifying the affected people through marking them as mourners. This can be accomplished through a change of clothing and adornment and/or actions that are not commonly used during normal life. Sometimes the bereaved do separate themselves physically from others to be alone with their grief. They withdraw themselves from work and other social activities. Depending on the culture, the mourners can be extremely quiet and stoic about their loss or everyone may take the opportunity to wail and release their sorrow in a physically intense manner. In general, women are expected to take longer at this than men. Many cultures allow men to remarry sooner than women after the death of a spouse without social reprisals.

The second part is the transition from being a part of the society to being accepted as dead. With some cultures this is a relatively short part, taking only as long as it does to bury the body (or send it to professionals to do it) and getting the paperwork done to take care of the estate and notify the government. In other cultures, it can take up to three years and even a few reburials.

Once the deceased has been ritualistically declared no longer a living part of society, the reintegration of the mourners into society occurs. This is done usually through a large meal or party, where people can begin to shed their more visible mourning behavior and return to a normal daily routine.

Chapter Nine Short Essay - Suicide

In general, suicides occur in the context of social connectivity. The people most likely to commit suicide either have too few social ties (troubled adolescents) or too many (high stressed occupations). Changes in social ties like deaths, divorces, unemployment, retirement and relocation, also increases the likelihood of suicide.

Child suicides are more prevalent in homes where family ties are disrupted and/or other members have committed suicide. Adolescent suicides have the same risk factors as child ones, with the extra dimension of poor peer relations. Adolescents are also more likely to commit copycat suicides. Adult suicides are more influenced by personal losses, though parents are less likely to commit suicide than non-parents.

Elderly suicide is most likely to be a rational suicide where the older person decides to end their life in an effort to make life easier for those around them. Another cause of elderly suicide is an inability to adjust to retirement or widowhood. While other age groups are prone to suicide gestures, the elderly are far more likely to be successful with their suicides. They approach suicide with a great deal of forethought and planning. In most cases, they give no warning to their friends and family. However, they usually make sure that their other affairs are in order and try to leave a minimal amount of mess to clean up.

Social driven suicides, or honorable suicides, only occur in cultures where they are accepted. Even in some cultures that abhor suicides, certain reasons for killing one's self are considered acceptable if they are done to support a higher moral principle. Some cultures will change their acceptance of suicides when it begins to impact society.

Tuesday, November 08, 2005

My Funeral Home Field Trip Summary

Visit to Mercer-Adams Funeral Home
November 7, 2005

I was very impressed with our tour of the Mercer-Adams Funeral Home. The atmosphere there was warm and soothing. Funeral Director Amy Brown was extremely knowledgeable and easy to talk to. I appreciated her ability to give details, such as how a body is handled if the medical examiner finds something suspicious and what legalities are involved when transporting a body over state lines.

It was very interesting to hear how the funeral home accommodated different types of funeral services. Especially the Taiwanese funerals that take about three days to do. I found her observation of how the Taiwanese are more attached to the body interesting, since I did not expect that from the Westerner interpretation of Buddism I have been exposed to. I was always given the impression that the body was merely an impediment to spiritual perfection. However, this is probably an example of how traditions and ideas do not always translate fully into other cultures. It also is probably more of a reflection of how many Eastern cultures are more death-accepting than Western ones.

Ms. Brown also explained how the industry is regulated for quality. The state commission does surprised inspections and not only checks the facilities, but also how the paperwork is handled. She did not mention anything about needing to have their procedures written down, but if so, then the industry is practically ISO compliant. The funeral home also was careful when choosing a crematorium to work with, selecting one that kept track of the remains through a fire-proof tagging system. Mercer-Adams dedication to their deceased clients is obvious in the fact that they still hold on to unclaimed ashes even after several years, just in case someone of the family decides to retrieve them.

Funeral directors must interact with the family while the grief is still numbing. As Ms. Brown said, the shock is a bit of the blessing, since it helps the family to deal with the many arrangements that must be taken care of right after the death. Within two and a half hours, Ms. Brown leads the family through a whole lists of decisions and helps them by not only taking care of things like contacting the cemetery and florist, but also giving them a list of things the family had to take care of, like deciding on pall bearers and the type of funeral.

It is interesting that many features of caskets are more reflective of the fears of the living than the needs of the dead. For instance, unless someone is sending a body to another country, which must be hermetically sealed, there really is not a reason to have a sealed casket except for the fear of being eaten by insects and mold. Because of their beliefs, Orthodox Jews are buried in special wooden caskets that do not have any metal in their construction. After seeing the elaborate adult caskets, it was a bit disturbing to find that child caskets are often consist of a plastic shell and closed with a sealant. I can only assume it is because parents of young children often do not have the money for more elaborate caskets.

I found the embalming room very clean and strongly smelled of bleach. It was interesting to know just how non-intrusive most embalmings are. Just one cut into the skin and then opening a vein and injecting the fluid into a major artery. The fluid is custom mixed for each body and the pump does all the work. When there is problems with circulation, other small incisions are made, but since it is the circulatory system that does the delivery, it is to the embalmer's benefit to keep it as intact as possible. It is after the blood has been replace and the body has set a while that the abdominal fluid is replaced with a thicker solution to kill off the internal bacteria.

It was good to know that Ms. Brown took the time and effort to keep herself from burning out. From exercise to missionary trips to Honduras, it is obvious that she does her best to balance her life. I suspect that the care she takes for her own well-being helps a great deal when she is working with grieving families.

Death and Dying discussion questions

Chapter Five Questions

2. Would you prefer to live with a person who is terminally ill or a person who is chemically dependent? Discuss the advantages and disadvantages of each.

It would depend on the specifics of the disease and the dependency, but in general I would prefer to live with a terminally ill person. With a terminally ill person, I would be more likely to have meaningful communications with them and succeed in some way in making the end of their life better by making sure that they don't die alone. True, there would be a lot of physical caretaking and little sleep, but at least there would be an end, even if it didn't feel that way sometimes. A chemically dependent person on the other hand, would be more mobile and possibly more destructive. I would also have to stay one step ahead of them for their sake and my own sanity, especially since I would be trying to help them to get over their addiction. A chemically dependent person usually loses more of their ability to temper their emotional outbursts than a terminally ill person.

7. Discuss Glasser and Strauss's four awareness contexts. Which do you think more often exists in a medical setting with a dying patient?

Closed Awareness - Patient is not told the truth about their condition or was “told” and refused to hear it. This is an unstable context of awareness since most patients are able to pick up on death-related situational and spatial clues. According to one study, nurses prefer to work in this context more often.

Suspicion Awareness - Patient suspects the truth, but receives no verification from the medical staff. This requires the medical staff to be united on not telling the patient. It is possible that it is an unspoken agreement, justified by excuses as in they just haven't found the right time to tell the patient yet. Legislation has reduced context over the years as patients are given more of a right to know the truth about their health.

Mutual Pretense - Everyone, including the patient, knows that the patient's condition is terminal, but all are pretending that the patient is going to beat the odds and live anyway. Considering the weight American doctors and others place on surviving as a measure of success and competency of a medical professional, this is probably the most frequent occurring context in a medical setting in the United States.

Open Awareness - Everyone knows the patient is going to die and are working towards a “proper” death for the patient. A study in England showed that most of the doctors there preferred this context. Unfortunately, the dying patient usually has no clue what a “proper” death is supposed to be like and often receives less care when they don't act as the medical staff expects them to.

Chapter Six Questions

1) What is hospice care? How does it differ from the treatment given by most acute-care hospitals? Identify the major functions of a hospice program.

Hospice is a form a palliative care, where the main goal is to “care” for the patient and family,while most acute-care hospitals focus almost exclusively on “curing” the patient. Not only are the physical needs considered, but also the psychological, social, financial and spiritual needs. The three primary concerns of hospice care are symptom and pain control, the apprehension caused by having others in control of one's life, and the anxiety about being alone at the time of death.

4) Pain control is not a goal of all dying patients. Discuss the cultural ramifications of controlling pain.

While there really isn't any reason for most dying patients to be in pain with the pain-killing medicines we have available, there are many reasons why some patients would rather deal with the pain than the drugs. One is the worry that the medicine will dull their mental capacity and the patient won't be able to interact with other on a meaningful level because of being sedated. Cultural reasons include beliefs about avoiding drugs, showing strength in the face of the final adversity, and the idea in some cultures that dying in pain means an honorable death. Enduring pain may be considered more natural and acceptable by some patients.

Chapter Seven Questions

2) How does “labeling theory” tend to make one a “deviant“?

It creates a set of accepted “norms” through labeling what is expected and what is not. Anything that cannot be given a normal label, becomes deviant and an area of insecurity for those indoctrinated with the labels.

5) Why do you think the medical schools have traditionally offered very little death education?

Because it runs counter to the overwhelming cultural belief of doctors being able to cure everything and therefore a very uncomfortable subject for many to deal with. After all, doctors help people live. If a doctor helped people die, it might be considered murder. The concept of care versus cure does not exist in most medical schools, so the idea of caring for someone who is dying creates confusion when compared to the rest of the medical education.

Chapter Eight Questions

1) Compare and contrast passive and active euthanasia. What difficulties does implementing each of these approaches have for current social policy dealing with health care for the terminally ill?

Passive euthanasia is allowing someone to die by not implementing measures that could prolong their life. It is legal in most of the technological countries of the world. While many people consider it acceptable and even preferable, there are some who see it as immoral not to do everything possible to sustain life, especially people who place the sanctity of life over the quality of life.

Active euthanasia is when the patient and/or doctor does something to accelerate the dying process. This is illegal in most countries and comparable to suicide or murder. Many fear that taking this path will lead to the slippery slope of a society choosing to euthanize non-terminal people who are not considered useful to that society.

Interestingly, quality of life is more of a concern for those in well-to-do segments of society. People who have had experienced more suffering and discomfort due to living in lower social economic levels tend to care more for the sanctity of life, since for them pain and misery is a common part of life and not a reason to end it.

6) Discuss your reaction to Dr. Timothy Quill's assisting his patient with leukemia, “Diane,” with her death.
Though I probably wouldn't have told her of the Hemlock Society, I'm not exactly appalled at him for giving her medication to do what she did. First off, he gave her directions for how to use the medicine in a non-life threatening way, before telling her the toxic doses. That gave her the chance to use the medicine in another, more acceptable, way. With that education, she could make her own decision. It was also obvious that he would have prefer she tried to stay alive and I believe that was obvious to her too, since she waited several months before finally doing it. And by making her tell him before she did, he made her more accountable for her actions because she couldn't just sneak in her suicide, she had to actually face the reality that she was ending her life.

Though I am a religious person and believe that suicide is wrong, I also believe that how accountable a person is for taking there own life depends on their knowledge and understanding of what they are doing. I also believe that I cannot know for sure how accountable they are and it's not my place to make that decision anyway. I don't condemn the doctor because while he did give her the means, he also gave her a clear knowledge of what she was considering. The was a very good chance that had he not educated her, she would have found another way to overdose herself.