Tag: stigmatization

Bioethics Blogs

Orkideh Behrouzan’s Prozak Diaries: Psychiatry and Generational Memory in Iran by Dina Omar

Prozak Diaries: Psychiatry and Generational Memory in Iran

Orkideh Behrouzan

Stanford University Press, 2016, 328 pages

 

Orkideh Behrouzan’s first ethnographic endeavor, Prozak Diaries (2016), explores a question that has provoked much interest in the Middle East in recent years: what’s with all the talk about depression nowadays? The influence of Western clinical psychiatry seems to traverse language: the Farsi word afsordegi, for example, is often substituted by ‘depreshen.’ Prozak Dairies is a multifaceted exploration of the pervasiveness of depreshen talk, or the use of psychiatric language more generally, in Iranian society. The main thrust of Prozak Diaries considers the extent to which modern clinical psychiatric language has become vernacular—gradually normalized within Iranian popular culture and public discourse and co-constitutive with trends in psychiatric treatments and scholarly debates. Behrouzan identifies depreshen, as well as other psychopathologies such as attention deficit hyperactivity disorder (ADHD) and post traumatic stress disorder (PTSD), as diagnoses that have grown in popularity over the past three decades. She then follows the many elusive manifestations of psychiatric discourses and therapeutic practices amongst Iranians. Behrouzan asks questions that are not only relevant to Iranians but which also reflect global trends pertaining to increased rates of prescribing and consuming psycho-pharmaceuticals, an adoption of American clinical language, and an acceptance of an agenda standardized by American pharmaceutical companies. How, she asks, has the normalization of the psychiatric vernacular engendered new ways “of knowing, interpreting, and perceiving oneself in the world?” How might the contemporary psychiatric vernacular open up new ways of expressing mental or emotional conditions in Iran?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Opioid Epidemic is an Epidemic of Stigma

Kristie Serota and Daniel Z. Buchman argue that eradicating the stigma associated with opioid use is an ethical necessity and is critical for population health.

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The Government of Canada reports that over 2458 Canadians died of apparent opioid-related deaths in 2016 (excluding Quebec). Last November, an average of 4 people died from overdoses every day in British Columbia. Recent U.S. estimates project opioid-related deaths at over half-a-million people over the next decade. Interventions have been implemented in many jurisdictions to minimize opioid-related mortality, but each year the death toll continues to rise and shows no signs of relenting.

While people dying from opioids in large numbers is not new, the present epidemic arose due to several complex factors. For example, OxyContin was aggressively marketed and prescribed for chronic non-cancer pain. Doctors and the public were misled about OxyContin’s addiction risks. In addition, health professionals receive limited training on pain and addiction. There are also inequities due to the social determinants of health and the harmful effects of substance use-related stigmas.

Stigma, operating at individual, institutional, and social levels, has led to punitive legal, policy, and clinical responses toward people who use drugs. Stigma has also led to chronic underfunding of addiction research and treatment services relative to the burden of disease. Although the current epidemic does not discriminate across the social gradient, stigma disproportionately burdens people from less privileged social groups more frequently and harmfully than others. People with no history of a substance use disorder risk the pejorative label of ‘addicts’ when they are prescribed opioids for pain management.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – July 2017 by Danya Glabau

American Quarterly

Regina Kunzel

Among the central themes of the eclectic field of mad studies is a critique of psychiatric authority. Activists and academics, from a range of positions and perspectives, have questioned psychiatry’s normalizing impulses and have privileged mad-identified knowledges over expert ones. One of the most successful assaults on psychiatric authority was launched by gay activists in the 1960s and early 1970s, resulting in the removal of homosexuality from the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973. But if that event marked an inspirational victory against psychiatric power, it was also, as Robert McRuer notes, “a distancing from disability.”1Revisiting this history through analytic lenses offered by disability and mad studies defamiliarizes familiar historical narratives and unsettles the critique of psychiatric authority, especially when countered by claims to health.

 

Conflicts over the value, meaning, and efficacy of vaccination as a preventive practice suggest that vaccination resistance stages disagreement within modern biological citizenship. This paper explores how immunity circulates in both vaccination controversy and biopolitical philosophies. Two positions—one characterized by somatic individualism, flexible bodies, reflexive approaches to knowledge, and the idea of the immune system as “the essential relation the body has with its vulnerability,” and another characterized by the immunitary paradigm, biosecurity, trust in expert systems, and vaccination—emerge. Understanding that oppositional relation can reframe public understanding of vaccine skepticism and public health responses to it.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Revising the Ethical Framework for Deep Brain Stimulation for Treatment-Resistant Depression

By Somnath Das

Somnath Das recently graduated from Emory University where he majored in Neuroscience and Chemistry. He will be attending medical school at Thomas Jefferson University starting in the Fall of 2017. Studying Neuroethics has allowed him to combine his love for neuroscience, his interest in medicine, and his wish to help others into a multidisciplinary, rewarding practice of scholarship which to this day enriches how he views both developing neurotechnologies and the world around him. 

Despite the prevalence of therapeutics for treating depression, approximately 20% of patients fail to respond to multiple treatments such as antidepressants, cognitive-behavioral therapy, and electroconvulsive therapy (Fava, 2003). Zeroing on an effective treatment of “Treatment-Resistant Depression” (TRD) has been the focus of physicians and scientists. Dr. Helen Mayberg’s groundbreaking paper on Deep Brain Stimulation (DBS) demonstrates that electrical modulation an area of the brain called subgenual cingulate resulted in a “sustained remission of depression in four of six (TRD) patients” These patients experienced feelings that were described as “lifting a void,” or “a sudden calmness.” (Mayberg et al. 2005). The importance of this treatment lies in the fact participants who received DBS for TRD (DBS-TRD) often have no other treatment avenues, and thus Mayberg’s findings paved the way for DBS to have great treatment potential for severely disabling depression. 

Image courtesy of Wikimedia Commons
Because DBS involves the implantation of electrodes into the brain, Dr. Mayberg and other DBS researchers faced intense scrutiny following publication of their initial findings regarding the ethics of using what to some seems like a dramatic intervention for TRD.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Ethics of In Vitro Gametogenesis

Françoise Baylis comments on the ethics of using gametes derived from human induced pluripotent stem cells for future human reproduction.

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A recent New York Times article, provocatively titled “Babies from Skin Cells? Prospect is Unsettling to Some Experts,” has once again drawn attention to controversial research by scientists at Kyushu University in Japan who succeeded in making fertile mouse pups using eggs created through in vitro gametogenesis (IVG). This is a reproductive technology that involves creating functional gametes (sperm and eggs) from induced pluripotent stem cells. Induced pluripotent stem cells are cells derived from adult body cells (such as skin cells) that have the ability to become other body cells including reproductive cells (sperm and eggs).

Supporters of this reproductive technology eagerly anticipate similar research in humans. Indeed, enthusiasts are quick to trumpet the potential benefits of in vitro gametogenesis. These benefits fall into three general categories.

First, we are told that research to derive human gametes from induced pluripotent stem cells is important for basic science. It will advance our understanding of gamete formation, human development, and genetic disease. In turn, this increased understanding will create new options for regenerative medicine.

Second, we are told that this research will allow clinicians to improve fertility services. For example, with in vitro fertilization (IVF), women typically have to undergo hormonal stimulation and egg retrieval. This can be onerous in terms of the time required for interviews, counseling, and medical procedures. It can also be harmful. Potential psychological harms include significant stress and its sequelae.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

De-stigmatization of the disgraceful mark of stigma in the opioid crisis

After attending Albany Government Law Review’s symposium, Script to Street: Opioids and the Law in the Capital District this past Thursday, there was several issues addressed but the one overarching concern was about the role of stigma in this opioid crisis. Many different types of stigma were identified and the different ways our negative judgments have impacted society. As one speaker during the first panel discussion stated, addiction is not a new problem. He described one historic painting that showed different reactions of society to addiction: disgust, numbness, shock, or simply ignoring the problem. All of these reactions illustrate stigma and shows how despite all our social advancements, we still have not eliminated (or destigmatized) stigma of the addiction problem. 

Some definitions of stigma include a mark of disgrace, society disapproval of something, or a negative set of beliefs society has about something.  All definitions include this perceived negativity and describe stigma as bad. Stigma is not something one like to face and usually, a judgment one tends to try avoiding. 

The issue with stigma our current opioid crisis is that it is not just one type of stigma, it is layers of stigma on top of one another. There is the stigma of being a drug user and the stereotypes of who is a drug user (the poor, African American, Hispanic). Drug-users are perceived to be “bad” people who only care about drugs.  This perception becomes a barrier to treatment as individuals do not want to seek treatment in fears they will be labeled as a drug user, even if these individuals are suffering from chronic pain.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

De-stigmatization of the disgraceful mark of stigma in the opioid crisis

After attending Albany Government Law Review’s symposium, Script to Street: Opioids and the Law in the Capital District this past Thursday, there was several issues addressed but the one overarching concern was about the role of stigma in this opioid crisis. Many different types of stigma were identified and the different ways our negative judgments have impacted society. As one speaker during the first panel discussion stated, addiction is not a new problem. He described one historic painting that showed different reactions of society to addiction: disgust, numbness, shock, or simply ignoring the problem. All of these reactions illustrate stigma and shows how despite all our social advancements, we still have not eliminated (or destigmatized) stigma of the addiction problem. 

Some definitions of stigma include a mark of disgrace, society disapproval of something, or a negative set of beliefs society has about something.  All definitions include this perceived negativity and describe stigma as bad. Stigma is not something one like to face and usually, a judgment one tends to try avoiding. 

The issue with stigma our current opioid crisis is that it is not just one type of stigma, it is layers of stigma on top of one another. There is the stigma of being a drug user and the stereotypes of who is a drug user (the poor, African American, Hispanic). Drug-users are perceived to be “bad” people who only care about drugs.  This perception becomes a barrier to treatment as individuals do not want to seek treatment in fears they will be labeled as a drug user, even if these individuals are suffering from chronic pain.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Ethics at CIHR: Moving Forward

Vardit Ravitsky and Judy Illes provide a summary overview of progress being made at CIHR with respect to its ethics mandate.

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In 2014, the Canadian Institutes of Health Research (CIHR) revamped its Standing Committee on Ethics and tasked it with providing high-level strategic advice on the ethical, legal, and sociocultural dimensions of health research. Per the Committee’s Terms of Reference, there are 14 voting members. Among them are three Canadian ethics experts and two senior international ethics experts, two CIHR Scientific Directors, two members of the public, and various other stakeholders (including a member from industry and a health journal editor).  At the present time, not all of these positions are filled.

Taking into consideration the history of ethics at CIHR and the future needs of the health research community, the Standing Committee on Ethics immediately embarked on the creation of an Ethics Action Plan to set clear, rigorous and impactful objectives.

The Plan was endorsed by CIHR’s Governing Council and then finalized and approved by the Standing Committee on Ethics in January 2015. The Plan sets out to strengthen Canada’s leadership in ethics and to systematically embed consideration of ethical issues into CIHR’s operations. It emphasizes the importance of nurturing and monitoring ethics research capacity, capturing and assessing the impact of ethics activities within CIHR-funded research, and ensuring that ethics considerations inform CIHR decisions regarding priority-setting, policies, partnerships, and peer review.

Photo Credit: Angel Petropanagos

To achieve these goals, the Standing Committee on Ethics recognized the need for baseline data. To this end, with CIHR’s support, the Committee developed a Logic Model to guide the process of selecting, defining and refining performance indicators.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Limits on Medical Marijuana for Veterans

Chelsea Cox questions the federal government’s recent decision to limit reimbursement for the cost of medical marijuana used by veterans to three grams a day.

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Post-Traumatic Stress Disorder (PTSD) affects thousands of Canadians every year and represents a major healthcare challenge in terms of appropriate treatment. At this time, over 3,500 Canadian veterans use medical marijuana for Post-Traumatic Stress Disorder, chronic pain, and other health issues that stem from line of duty experiences. Funding for this drug is provided by the federal government as it is responsible for the delivery of primary care to eligible veterans.

In November 2016, Veterans Affairs Minister Kent Hehr announced a significant change in federal funding for medical marijuana for Canadian veterans. In future, reimbursement for this drug would be limited to three grams a day, instead of 10 grams a day.  Prior to this announcement, there was no national policy on reimbursement for the drug, and the prescribing of 10 grams a day was based on unclear dosing guidelines for physicians due to a lack of clinical data. So why the change in funding guidelines?

Base of National War Memorial, Ottawa, Ontario, Canada (Photo Credit: D. Gordon E. Robertson)

It has been suggested that Health Canada was strong-armed into allowing the use of medical marijuana by the Supreme Court decision in 2000 (R v Parker), and that it has since tolerated an environment of considerable uncertainty. In the intervening years, anecdotal evidence has accrued suggesting that medical marijuana may become a first choice treatment for Canadian veterans.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Ethics & Society Newsfeed: World AIDS Day 2016

World AIDS Day, December 1, 2016

“World AIDS Day is held on the 1st December each year and is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. World AIDS Day was the first ever global health day, held for the first time in 1988.”

Please visit the World AIDS Day website for more information about the history of the day and how to get involved, support and show solidarity with the millions of people living with HIV.

AIDS in the News

Search for HIV Vaccine Resumes With Test in South Africa
In the ongoing search for an HIV vaccine scientists have begun testing a more powerful version of the only shot that has ever shown promise in a new study being conducted in South Africa.

World AIDS Day: ‘Nobody is satisfied with the state of healthcare’, says Tim Cook
Tim Cook, CEO of Apple, comments on the company’s biggest-ever World Aids Day event, and why saving lives is part of the tech giant’s business model.

World AIDS Day: When Will There Be A Cure For HIV? 2016 Brings Vaccine Trials, Medical Breakthroughs
The first AIDS cases were reported over 35 years ago.  Now the world asks: When will there be a cure for HIV?

HIV Tests, Vaccine Spotlighted as World AIDS Day Approaches
What’s the best way to prevent the spread of HIV?  The World Health Organization is calling for more self-testing as a new vaccine trial gets underway in South Africa.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.