Research Topics: Morbidity And Mortality

Dominance, Subordination and Mortality: Reflections from the epic of Gilgamesh

DOMINANCE, SUBORDINATION AND MORTALITY: REFLECTIONS FROM THE EPIC OF GILGAMESH   Introduction             Dominance and subordination is synonymous to leader-follower scheme wherein the relationship is ideal to obtain the performance of one another’s societal functions in an effective and efficient manner.  The dominant imparts its decision-making and problem solving capabilities to uphold the welfare of people.  In return, subordinates serve the former and follow its conquest that precipitate to loyalty and respect.  The president who is widely respected by the citizenry, a husband who is loved and cared by his wife, and professors who are idolized by students are few of some dominance-subordination design in the society.             To determine such relationship is one thing, to verify the cause and extent of its existence is another.  On top of these is its purpose and implications to social order.  By analyzing the characters, their actions and their aspirations from “The Epic of Gilgamesh”, resolutions to the phenomenon can be settled and questions will be answered.   Pillars of Social Order                   Because Gilgamesh has a “one-third man, two-third God” identity that resulted to super-natural strength, courage and “beauty” (2), he was basically known as a hero, and ultimately a king of  For his part, he should maintain his dominance and show his capability to rule on a regular basis to retain the status quo.  This is exemplified through his stand against (14), challenge to demon-like (40) and brawl against (50) that was all proclaimed victory across his name.  Every triumph was regarded a signal of competence and enduring dominance.  However, being a king who possess of powers, ill-effects of abusing it (xix) was inevitable.  But the extent of the abuse did not outweigh the extent of dominance, and so, continuing the order.  Distant from the tendencies to abuse power, Gilgamesh has a number of virtues like self-discipline () (50) and camaraderie (developed to a former enemy) (14) which strengthened his right to rule.             The features of the main character in the epic are compatible to run a city which was regulated by deities.  The people are at peace that their kingdom will not be easily penetrated by warfare or profoundly cursed by gods.  They can rely to Gilgamesh to do the fighting to outsiders or negotiating to gods as the need arise.  They can focus more on household requirements like livelihood, raising children and develop the local economy.  With this, social order was met.  Thinking of the reverse, when people are equal in power and homogenous in status without the guide of a ruler and an established kingdom, they are highly vulnerable to threats from the outside and the gods would curse without mercy.  Civilization could be slowly attained because people are limited in their aspirations of development knowing that instability and lack of direction could annihilate their efforts in an instant.             This drive to subordination as determinant of social order, however, was partially shaken by who hated the abusive side of Gilgamesh that ignited a collision (14).  Even was lost in the confrontation, the conflict emphasized that dominance should be directed strictly to good purpose alone.  This showed that even a human from the wild is bounded to guard the acts of the ruler to assure that a certain social order does not result to ill-effects like the abusive tendencies of the dominant.  It also exemplified that the dominant-subordinate system would tend to adjust when roles of one another go beyond the rationale behind the creation of the system and deprived the other of substantial power or freedom.  Being the goddess of love, Ishtar retaliated against the refused marriage (50) she initiated partly because it is a deviation from the norm opposite her known status.  Also, the wife of demonstrated this friction when she urged her husband and succeeded to reward the hardship of Gilgamesh (96) — apart from the inherent subordination of women.                  The extent and implications of subordination was also enormous in the story.  The decision of the Council of Gods to impose a death verdict to (58), who had less initiative and participation to the conquest relative to Gilgamesh, illustrated that subordination can justify sacrifice on the part of a subordinate, even its life, to sustain the relative crucial role of the king in the society.  On the other hand, loyal () and valuable (Gilgamesh) subordinates in relation to its dominant ruler (Gods) would reward the former by sparing its life and renewing its glory (like intervention (40) in favor of Gilgamesh against) or even bestow eternal life (96) (like and his wife).                        Further, the subordination of women to sexual needs of men in the epic evidenced that such could be also used to achieve an end aside from the peripheral goal of obtaining the system, as in the case of the trapper’s use of harlot (2) to expel from the endowments of the wild.  In the stance of ferry-based servant, , subordination meant less security in terms of tenure particularly means of living (96). The epic is largely immersed to the dominance of partly-god stature of Gilgamesh.  However, his crown was regulated by the full-blooded gods specifically the Council of Gods.  He had lost bargaining capacity and tamed as a subordinate when his first-ever close friend, , was on the verge of death (68) and he had nothing to do to prevent it.    His dominance was eclipsed by the gods who provided guidance and protection to him to continue his reign, and ultimately, the order in the kingdom. In every chapter of the epic, the dominance of gods over men and non-pure gods seemed to be the greatest impediment for Gilgamesh to optimally celebrate the fruits of his dominance over people.  However, the revealing fact of mortality and death seemed to be an overlapping factor behind his vulnerability.  He took much pain and sacrifice to seek the key to immortality.  In the process, he submitted himself to some extent of subordination to eternal life (82, 96).  Although he utilized his status and dominance through self-proclamation to and (82), the motive was aimed to immortality and his submission to it.  Due to the blazing desire to end personal subordination of a mortal to death, he underwent the test of (96) without doubting of possible deception.  Frustrated, the failed quest confined him back to dominating stance again.  However, this move took away the consolation prize of achieving youth rejuvenation.  The suspicion in the effectiveness of the consolation ended him going home empty-handed.  Chapter 11 of the epic implied that such was an unwise thinking coming from an experienced warrior, celebrated hero and notable king.                                                .  Conclusion               The social order in the epic was achieved through establishing levels of hierarchy in the society.  Subordination, in the likes of and his kind including the rest of the people, resulted to ordinary people’s submission of some of their practices under the rule, decision and scrutiny of Gilgamesh because of his domineering attributes.  On the other hand, his rule is neither absolute nor universal as deities are on top of the social system.  This dominance was enforced and permitted to happen, albeit of his partly god status, primarily because of immortality demarcation.  It limits the scope of dominance not only of Gilgamesh but also all mortals when speaking of their subordination.  Dominant and subordinate individuals alike have similar bottom-line, which is death.  This provides disincentive to the ruler to abuse his power aside from good cause and remind him that such wrong doing would not last for a long time because of limitation in life.  On the other hand, people would tend to respect the ruler’s decision and abide the kingdom’s development projects to maximize their existence in the world and help improve the status of civilization keeping in mind that time ticks away from every crime or rebellion they would ensue against a fair dominant and elite.  Social order is thus seen thorough the mutual understanding and accepted vulnerability of the actors in the society giving rise to peace, and ultimately, prosperity.                    Before ending, it is fitting to quote a character in the Asian movie “Hero” which stated, “All under heaven.”  According to the story, these three words transformed the then vicious imperial army to exercise non-violent and non-fatal way of conquering lands, and eventually, meeting the kingdom’s endeavor and achieving its ends.  Finally, being dominant, subordinate and mortal keeps everyone in social order and live each lives to fullest enjoyment.  However, to install abusive and rebellious acts to power or solicited inferiority will lead to disorder and doom of a society.                    Credit:ivythesis.typepad.com

Dominance, Subordination and Mortality: Reflections from the epic of Gilgamesh

DOMINANCE, SUBORDINATION AND MORTALITY: REFLECTIONS FROM THE EPIC OF GILGAMESH Introduction Dominance and subordination ...

CO-MORBIDITY

CO-MORBIDITY           Introduction                 Co-morbidity is defined in medicine and psychiatry as the co-existence of one or more diseases in connection to a primary disease or illness diagnosed in a client.  There are three reasons as reported by  (2003) why co-morbidity occurs.  These are: (1) that there is a direct causal relationship between the two, with the presence of one disorder making another more likely to develop; (2) that there is an indirect causal relationship between the two, with one disorder affecting a third variable in a way that increases the likelihood of the second disorder; and (3) that there are common factors that increase the risk of both disorders (p. 15).             Co-morbidity of mental disorders and substance or alcohol use disorders is common (2003, p.1).   (2004) stated that problems associated with alcohol and other substance abuse affect individuals and their families. They also have a wider economic impact on society, in terms of lost work days and increased burden on health systems, as well as the social impact of injuries, violence and crime.  Alcohol use contributes to a range of acute and chronic health consequences, from injuries resulting from traffic crashes to cancer and cardiovascular disease (2003).  In like manner, substance abuse has been a major source of health and social problems in developing societies as elsewhere ( 2004).     Co-morbidity of Psychiatric Disorders with Alcohol and Substance Misuse      (2000) declared that approximately 50% of individuals with psychiatric disorders will meet the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria for drug or alcohol abuse or dependence at some point during their lives.  Clinicians in mental health and addiction treatment services are frequently confronted with co-morbid substance abuse and psychiatric problems, often in seriously mentally ill persons. Co-morbidity involving psycho-active drug misuse can often be present at the point of psychiatric clinical assessment, bringing with it a perceived enhanced risk of suicide or self harm.  By their very nature, all psychoactive drugs can affect mood and possibly be responsible for presenting psychiatric symptoms, such as delusions and/or hallucinations. Other presenting features may also be present such as anxiety irritability and restlessness                                                     ( 2001, p. 3). Traditional treatment approaches have emphasized substance abuse in psychiatric patients as a secondary disorder i.e. self-medication in a primary psychiatric disorder (2000).   A central assumption of this “self-medication” hypothesis according to  (1985) is that substances are used to alleviate symptoms and that specific substances will be selected for their specific effects upon mood and cognition (cited in  2003, p. 15).  Furthermore, the common co-occurrence of alcohol use and anxiety disorders has suggested the “tension reduction” hypothesis.  (1987) said that this hypothesis proposes that persons with anxiety disorders use alcohol to relieve anxiety or distress, and that problematic use becomes more likely because alcohol becomes the means to control these negative mood states (cited in 2003, p. 15). A recent multi-centre collaborative study of co-morbidity of substance misuse and mental illness found that: 75% of users of drugs services and 85% of users of alcohol services experienced mental health problems; approximately 30% of the drug treatment population and over 50% of those in treatment for alcohol problems experienced the co-occurrence of a number of psychiatric disorders in addition to substance misuse; and  44% of CMHT patients reported drug use and/or harmful alcohol use in the preceding 12 months                               (2005, p. 2).   Approaches in Treatment                 Co-morbidity             presents substantial treatment problems – standard interventions are complicated or even excluded in individuals with co-morbid disorders.  On the one hand co-morbid substance use disorders can pose difficulties for treatments that are narrowly defined for specific symptoms, or those treatments may have been developed on pure diagnostic groups and therefore of unknown benefit for co-morbid individuals (2003, p. 7).  Co-occurring mental health and substance use disorders will, most often, in any individual experiencing them, influence each other in their development, severity, response to treatment and relapse circumstances.  Because the disorders are so intimately intertwined failure to recognize and respond to either of the disorders will compromise the effectiveness of the response to the disorder being focused upon ( 2005).  According to (2005) there are six guiding principles in treating clients with co-occurring disorders.  These principles are: employment of a recovery perspective; adoption of a multi-problem viewpoint; development of a phased approach to treatment; addressing specific real-life problems early in treatment; planning for the client’s cognitive and functional impairments; and use of support systems to maintain and extend treatment effectiveness (p. 38).  Conversely, anxiety and depression can complicate the treatment of substance use disorder ( 2003, p. 7).  People with co-occurring disorders have a range of medical and social problems – multidimensional problems that require comprehensive services.  In addition to treatment for their substance use and mental disorders, these clients often require a variety of other services to address other social problems and stabilize their living conditions.  Treatment providers should be prepared to help clients access a broad array of services, including life skills development, English as a second language, parenting, nutrition, and employment assistance                        (2005, p. 46).    The Role of Client Engagement in Treatment                (2000) wrote that in the treatment of co-morbid patients, engagement is the first step in developing a trusting alliance between the client and a service provider.  Successful engagement is critical to effective intervention or treatment and is dependent on a number of factors including a clear delineation of the interventions that can be offered and their potential value (p.8).             However, engagement of individuals with co-morbid disorders may be difficult.  These clients are often in denial and difficult to enlist in treatment.  Other factors impacting on engagement include possible cognitive deficits within the client, amotivation and resistance.  Further, some authors suggest that the complications of both illnesses mean that the dually diagnosed individual is often unable to comply with treatment or to benefit from standard interventions             ( 2003, p. 15).                   References     Credit:ivythesis.typepad.com

CO-MORBIDITY

CO-MORBIDITY Introduction Co-morbidity is defined in medicine and psychiatry as the co-existence of one...

Co–Morbidity

What is co-morbidity? Introduction:             In particular, the paper will tackle on co – morbidity issues by giving an overview of the topic. The researcher will relate alcohol and substance misuse with co – morbidity by citing research studies that proves significant relationship such as the research study on co – morbidity of substance misuse and mental illness collaborative study (COSMIC). The paper will discuss why there is difficulty with treatment with co – morbidity disorders that result to poor engagement from client groups with co – morbidity issues.   Discussion:             Co – morbidity as defined by the Borderline Personality Disorder Resource Center (no date), is the presence of coexisting or additional diseases with reference to an initial diagnosis. Co – morbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.  In addition, a research study on co – morbidity of substance misuse and mental illness collaborative study (COSMIC) headed by  (2002) summarized their findings to the following data: (1) some 74.5% of users of drug services and 85.5% of users of alcohol services experienced mental health problems. Most have affective disorders (depression) and anxiety disorders. A relatively high rate of psychosis observed. (2) Almost 30% of the drug treatment population and over 50% of those treatment for alcohol problems experienced ‘multiple’ morbidity (co – occurrences of a number of psychiatric disorders or substance misuse. (3) Some 44% of mental health service users reported drug use and / or were assessed to have use alcohol at hazardous or harmful levels in the past year. Evidence from the United States suggests that half of all patients with schizophrenia also have a substance misuse disorder ( 1990).This co – morbidity is associated with poor prognosis and heavy useof expensive inpatient care through recurrent “revolving door”admissions (1995). This high prevalence, the problems of clinical management (1995);and a continued rise in the general rate of drug misuse make co – morbiditya major public health issue              (2002) mentioned the characteristics of co – morbid service users; are the following: (1) significantly poorer social functioning and a greater need care interventions, (2) perceived to be more chaotic and more aggressive by key workers, while co – morbid users of alcohol services were perceived as being more difficult to manage, and (3) drug users with personality disorders were rated as having relatively poor engagement with services. The first characteristics could support the brief intervention on the treatment on alcohol dependence in the clinical review of   (2002) that there should be daily supervision in order to allow early detection of complications such as delirium tremens, continuous vomiting, or deteriorationin mental state. This will not only result to time constraints but including financial constraints especially to individuals who does not have enough money unless there are agencies who would offer free services. Also, as stated by  (2005) to reduce or stop substance misuse requirespatience, an open minded and non-judgmental approach, and anunderstanding of the stages of change in human behavior. Doctorscan help facilitate change, but only the individual can change his or her behavior. Positivereinforcement through comments on any change in substance misusebehavior, however small, can be valuable in continuing to motivatethe individual.This is particularly important in the context of relapses. Substance misuse usually follows a chronic relapsing course, yet relapsesare rarely anticipated. Meaning to say, health care providers must thoroughly explain that occurrences of relapses are normal and an expected course; in reassuring those of chronic relapses will reduce their sense of guilt or failure, thinking that they have not achieve anything which might lead to discontinue treatment. Services for drug misusers and mental health services have tended to develop in ways determined more by public anxiety andpolitical ideology than by research evidence (1998). Despite of higher levels of provision offered, higher levels of unmet need among co – morbid patients (2002). The few trials of assertive community treatment specifically targetedat co – morbidity have shown little benefit ( 1991). Hence a growingbody of opinion now argues that integrated treatment specificallyfor co – morbidity must underpin an approach based on assertive communitytreatment and that clinical teams must be able to implement motivationaltherapy and treatment for both types of disorder without crossreferral to other agencies (1995).             A study was conducted by (1997) at Durham prison, a typical male remandand short sentence prison. Before their reception into Durham prison over 70% of unconvicted remand prisoners reported the use of illicit drugs, regular consumption of excessive amounts of alcohol, or both. Amountsof drugs and alcohol consumed were often substantial, reflectedby 56% of the population having one or more current diagnosesof substance abuse or dependency. Multiple substance use wasalso common. Further, provision of detoxification programmes for prisoners identified by reception screening as having serious drug and alcohol related problems is inadequate; and  prisoners who need help but think that asking for this is more likely to result in punishment than treatment are not likely be truthful about their substance use. The researchers concluded that few receive a detoxification programme,so that many are left with the option of continuing to use drugsin prison or facing untreated withdrawal. Conclusion:             The paper concludes that there is no sufficient evidence that supports the efficiency of interventions with co – morbid individuals that there is a need to call to develop and tested for new mode of delivery services or enhancements of present health care services; since research based knowledge which can be applied to practice can limit errors thus, efficiency can be attained. In addition, there must be adequate supply of skilled health care professionals who are capable of dealing wholistically co – morbid patients which are tends to be aggressive and anxious especially in co – morbid prisoners who would prefer to misuse and abuse drugs rather seek treatment which is likely to face punishments. Credit:ivythesis.typepad.com

Co–Morbidity

What is co-morbidity? Introduction: In particular, the paper will tackle on co – morbidity issues by giving an overview of ...

MATERNAL MORTALITY RATE IN SOUTH AFRICA

MATERNAL MORTALITY RATE IN SOUTH AFRICA       According to Maternal Health Study (MNPI) conducted in Glastonbury USA there are about five hundred thousand (500,000) women and girls who died in maternal complicated disease related to pregnancy and childbirth each year.  At least about 90% or more of the occurrence came from developing countries such as South Africa.  And according to them the following causes are the reasons of their death. Abstetic fistula, ruptured uterus and pelvic inflammatory diseases are among the reasons that may occur up to 42 days following childbirth.  Other causes may include hemorrhage, hypertensive disorder and obstructed labor. Unsafe conditions of women like diabetes, high blood, malaria and Sexually Transmitted Diseases may also affect some of women’s maternal mortality issues. Women’s low status in society, limited education, poor nutrition and decision making power may also contribute significantly to adverse pregnancy helplessness.       The maternal mortality rate in South Africa is consequently high and unacceptable. While the number continues to increase and are highly controversial figure of at least five thousand (5000) girls and women each year more or less still due to pregnancy related complications.  Additionally Some 32,000 to 111,000 South African women and girls will suffer from pregnancy. Although we can easily say that this tragic story can be prevented with proper guidelines and nutrition if given by the government health care system in South Africa.  The government should help to assess and implement these health benefits to its people not just to reduce the maternal mortality rate but to help the people of South Africa in general.   Health care programs should be implemented in all municipalities to the full range of services. Some efforts to undertake this problems have been taken effects but still the continual death rate increases still spread all over South Africa. According to African Government the lack of resources may somehow hinder their programs.         The traditions and culture like early marriage marrying before 20 years old and female genital cutting which includes all or some parts of the external genitalia and or stitching the vaginal opening of girls  who’s body is still in developing process have put girls and baby on their womb at risk. These types of practices are common in all South East Asian nations especially in Africa to maintain social and cultural belief.  These women who indulge themselves in such practice are definitely putting themselves to risk of death.  Abortion is permitted on a broad socio-economic ground or without restrictions as to reasons of gestational limits.        In 1970 there are about 750 health experts’ surrounds entirely the region to investigate and assess the 49 developing countries using tested technology to promote health and activities.  Family planning is now being implemented throughout South Africa.  Health Education and safe sex is also being taught in schools. Since education and training brings utmost importance to resolve the following issues that will prevent maternal death and disability to protect girls and women. As of 2001 the maternal mortality ratio (MMR) remains poor in South Africa it was 542 per 100,000 live births. This level is much higher. The following intervention has been considered to strengthen South Africa’s maternal and neonatal health policies and programs.  These are called the Priority Access Areas. 1.    Increase the access to reproductive health – Due to lack of access in reproductive health maternal death increases in rural areas than in urban areas. 2.    Strengthen health and family planning program – Barriers to strengthen implementation and full financing of reproductive health and family planning policies must be removed.   3.    Increase access to high quality antenatal care – They should give all women information about diet and other healthy practices and where to seek help in for pregnancy complications 4.    Increase access to skilled delivery care- Skilled professionals should be available in the community so that women can easily seek advice when especial attention is needed. Health care establishment should also be available. 5.    Provide postpartum care, counseling – To efficiently manage the problems that may occur after giving birth.  Counseling includes breastfeeding and immunization.   6.    Improve post abortion care – Women needs proper attention due to injuries of infection and cervix uterus hemorrhage cause by abortion. 7.    Strengthen health promotion activities – Educate the public in maternal care through the help of specialists and other forms of media. Source (Population reference Bureau 2002 Women of our world).  The following statistics/figure is joint program estimation under UNICEF- United Nation International Children’s Emergency Funds, WHO- World Health Organization, and World Bank.    Credit:ivythesis.typepad.com

MATERNAL MORTALITY RATE IN SOUTH AFRICA

MATERNAL MORTALITY RATE IN SOUTH AFRICA According to Maternal Health Study (MNPI) conducted in Glastonbury USA there are about five ...

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