discussion post 308

To earn full credit, you need to answer each of the questions correctly and fully with substance making at least 2 reference in addition to the unit material, text, or other academic source, and meet the length requirement of 200-350 words minimum. Your responses should be clearly written and consist of original ideas rather than a recap of what others contribute. Avoid “great post”. If you agree, support your agreement in your own words. Do not repeat the questions!

Background for Question I: A moral question. Should the woman who gives birth to a child with Fetal Alcohol Spectrum Disorder (FASD) be penalized in some manner? The child will require economic and psychosocial support, possibly for the rest of his or her life, an expenditure that might cost many tens of thousands (or hundreds of thousands) of dollars over the child’s lifespan. This will be necessitated because the child has a handicap that was entirely preventable, had the mother abstained from alcohol use during her pregnancy. The mother’s alcohol use behaviors during pregnancy are the sole determinant whether the infant develops FASD.

So, should she be penalized if the child should be born with this disorder? (Answer “yes”, “no,” or “I am not sure” before reading on, please.)

The answer to this question is a bit more complicated than a simple yes or no, however. Many infants who have FASD have a mild form of the disorder that might not even be recognized by a physician with great experience in working with children with FASD. Even the most severe form, the Fetal Alcohol Syndrome, can be difficult to diagnose at times. The more subtle forms of FASD would be exceptionally difficult to definitively diagnose, and the danger would exist that the mother would be penalized for a condition that the infant did not have.

The conundrum is this: FASD can be entirely prevented by the simple expedient of maternal abstinence from alcohol during pregnancy. One solution would be to require that women planning to become pregnant to abstain from alcohol. However, many pregnancies are unplanned, which negates this possible solution. Further, for a number of reasons many women do not know that they are pregnant until the second, or even the third month of pregnancy. If the mother had consumed alcohol at a time when she did not know that she was pregnant, the exposure of the fetus to the alcohol would be accidental.

In addition, is research into prenatal drug exposure sexist? At first this question may seem unrealistic; after all, it is the mother who carries the fetus (hopefully to term), and delivers the infant. Thus, the majority of the research to date has been on the impact of maternal substance use on fetal growth and development. However is the father’s contribution unimportant? Exposure to several industrial chemicals can affect sperm development; possibly with dire consequences for the fetus should conception take place. There is very little in clinical literature addressing the effects of paternal alcohol use, marijuana use, or even therapeutic methylphenidate use on the viability of the sperm produced at that time.

Question 1: Should a mother (or both parents) be penalized for fetal alcohol exposure? What if the exposure is inadvertent? Explain

Background for Question II. Globalization of diagnostic protocols? Language helps to shape the brain’s growth (Kenneally, 2010). Given the variety of different languages spoken on this planet, the potential exists for a wide variety of neural growth patterns based on each individual’s language. Therefore, the diagnostic classification system utilized by the American Psychiatric Association is not without cultural bias. It was conceived of, and shaped by, psychiatrists who speak English. Their brains were designed to speak and understand English, and thus have subtle differences from the brains of those individuals who grew up in an indigenous culture that had its own language. Thus, the American Psychiatric Association’s diagnostic nomenclature system reflects certain cultural (lingual?) biases.

However, if language helps shape the brain, then there could very well be local variations in behavior that within that culture (or linguistic group) might not be seen as abnormal (Watters, 2010). In light of the globalization of diagnostic nomenclature, as the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) gains acceptance in other cultures, are we, as a society, forcing our perspective on mental illness (including the addictions) onto other cultures? For example, imagine that a person within an unspecified culture were to lose his or her spouse, and embark on a six month “binge” of alcohol use. The person’s alcohol or hallucinogenic substance use, which might be entirely normal within that culture, might also meet the criteria for an SUD within the American diagnostic system.

Question 2: Consider the above example. If this drinking is a recognized and accepted reaction to the loss of a spouse within that culture, should our values and diagnoses be use to assess this person? Following this argument further, suppose that the hypothetical culture has a built-in behavioral correction system in which a village elder approaches the person in mourning and says, “You have mourned enough. Stop drinking, or stand before the village council for judgment!” Would that person’s alcohol use be a diagnosable condition, or a behavioral/cultural manifestation of their mourning process?

Background for Question 3: There are many subcultures within this country, each with their own traditions and beliefs. One such example is the Native American Church, which originated in Oklahoma and which is now the largest indigenous religious sect among Native Americans with an estimated 250,000 members.

Prior to the historical accident in which Columbus stumbled upon the continents so inconveniently placed along the path that he wished to follow to the far east, native cultures viewed the peyote cactus as a central element to their religion. The specific role that peyote played differed from one tribe to another, and it has been viewed as a way to commune with the gods, a way to speak to Jesus, and a way to find the path to spiritual enlightenment. The use of the peyote cactus might be carried out in isolation, or with others, depending on how the participant believes the Spirit wishes. It is usually used to allow the user to speak to God, the deceased, for guidance, and for spiritual and emotional healing.

For many years the use of peyote was contentious, and various State and Federal agencies sought to restrict, if not deny, its use in these religious ceremonies. The courts have ultimately ruled, however, that the use of peyote in religious ceremonies by members of the Native American Church is permitted as an acceptable religious practice and thus exempt from the drug classification system established by the Drug Enforcement Administration. However, its use by nonmembers of this religious group remains a violation of the law and peyote remains classified as a Category I compound. In this manner, the practices of a minority population were accommodated by that of the predominant culture.

Question 3: If the traditions and beliefs of a hypothetical tribe living in southern Wyoming were to inhibit the growth of substance use disorders, would those traditions and beliefs be of value to another hypothetical tribe living in southern New England? Should a single form of treatment be established for Native Americans, or should treatment centers in each region develop region-specific treatment modalities to accommodate the needs of the Native Americans who live in that area? Who would make these decisions? If a person who grew up in a specific tribe in New England should move to Washington State, should that person be forced to adapt to the treatment program developed for Native Americans indigenous to Washington State?

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