Benefits of Cohabitation Essay Example | Topics and Well Written Essays - 1000 words

Benefits of Cohabitation - Essay Example They understand that they want and need to determine if they are right for each other, if they can accept each other’s quirks and habits, and of course, if they can see themselves still being together after the honeymoon stage. As stated by Monika Johnson, â€Å"a wedding will not change your relationship. If you and your partner have difficulties living together, a marriage license will not improve things. In such a case, it may be better to end the relationship, rather than to enter into a marriage that is troubled from the start† (Johnson). What Johnson tries to point out is that marriage is not a solution for a troubled relationship. It is not a way to resolve differences and issues. Marriage should be commitment not a solution. Although the majority of people, those who believe in the traditional religious beliefs, believe that living together is in fact going against the norm by asserting that â€Å"cohabitors are partially rejecting the society's dominant value system. Those people who enter cohabitational relationships tend to perceive social rules in flexible terms† (Cohabitation). Because the dominant value system is strongly associated with traditional religious beliefs, the bulk of which are Christians, cohabitation without the institution of marriage poses great threat to the stability of traditional values. Couples entering into the arrangement of cohabitation without marriage can be seen as people challenging, or even rejecting, the norms, which places great pressure and stigma on the relationship. This may put a strain on the relationship. This may pose a question on the stability of the relationship. But a glimpse on the research on contemporary generation has proven that â€Å"young couples are most accepting of cohabitation,... Benefits of Cohabitation By living together, couples satisfy their personal beliefs and companionship without sacrificing an acknowledged vow that legally binds them through marriage. Couples opt to decide on living together before getting married for diverse reasons including compatibility, fear of the consequences of divorce and economic considerations. Young couples believe that living together before marriage is part of choosing as to how they will go on about their life. It may be seen as a test period, but consequentially this set-up allows the couple to realize whether they want to live their life with each other. For young couples, this set-up is part of expressing themselves. On the other hand, those couples who spent time living together run the risk of falling out of love eventually. Couples eventually develop psychological problems that lead to depression and anxiety due to the possibility that they are really not meant to be together in the long term. Living together before marriage shows that there may be a fear of commitment. The institution of marriage legally binds the couple. This can be viewed as fully committing oneself to the other. Cohabitation without the institution of marriage can be perceived as lack of solid foundation and structure to build a family and future together. Living together before marriage is a controversial topic. I strongly believe that couples should live together before marriage to understand whether they are willing to be bound to their partners without fear of divorce.

A Play emulating Poe in The Raven and QUestions Essay

A Play emulating Poe in The Raven and QUestions - Essay Example The â€Å"tapping† that rhymes with â€Å"napping† also is a great contrast because â€Å"tapping† wakes up the â€Å"napping.† Poe knows how to tell a story that comes alive through the sounds of his rhymes and alliterations. I grew up with my grandmother who treated me like I was the most favorite grandchild. She always cooked my favorite meals and she always listened to me. She is the kind of grandmother whom some might say have spoiled me because she always understood me and took my side when I am arguing with others. After she died, I miss her so much. I remember that when I am sad and I feel lonely, I sometimes feel someone hug me, even if it is just the wind. For me, it is my grandmother’s way of showing me that she is still with me, loving me and taking care of me. Sometimes, I also feel a craving for my favorite food, and when I come home, I smell my grandmother’s cooking even when it is just in my head because I miss how she takes care of me. Other times, when I have problems, I dream of my grandmother. In my dreams, she listens to me and helps me think of solutions to my problems. I remember her sweet apple smell because she loves baking apple pies that I love so much. I also hear her humming old songs when she puts me to sleep. My grandmother is long dead, but her memories are forever alive with me. Restate the question in your response and support your answer with evidence from the story. Explain the use of repetition in the Raven... What does Poe repeat, and why? what is his purpose in repeating...? Support response. For example, when the narrator says â€Å"†¦rapping, rapping at my chamber door†(4), the effect is onomatopoeic melody, as if the reader can hear the rapping at their own doors. The repetition also contributes to the sad tone of the poem because the choice of words. In addition, in this example, the

Fungi as a source of food Essay Example | Topics and Well Written Essays - 750 words

Fungi as a source of food - Essay Example There is vitamin d2 production when ergosterols in mushrooms are exposed to ultraviolet light. Fungi have certain interesting twists especially when one zeros down to the mushrooms. In the ancient Egypt for example, mushrooms were exclusively believed to be foods for the royalties. The unique flavors intrigued the powerful pharaohs to the extent of declaring them illegal for the commoners to consume. In china, Greece, Mexico, Russia and Latin America, the practice of mushroom rituals took place. They believed that mushrooms possessed properties capable of producing super human strengths. They also believed that mushrooms could help recover lost objects, and take the human soul to the presence of the gods (Phillips and Reid 62). Edible fungi like mushroom have been in consumption since the 18th century. France prides early leadership in the farming of mushrooms with certain accounts stating that Louis XIV being the first mushroom grower. Mushrooms were grown near Paris in special caves set aside for this activity. Mushroom farming later spread to England since the farmers there found it very easy to grow. It demanded low investments, less labor and space. Mushroom farming found its way to the United States in the 19th century though the growers there largely depended on the spawn they imported from England (Phillips and Reid 32). A book was published in 1891 shedding a lot of light on mushroom growing. Immediately after, the department of agriculture in the U.S allocated some money in research and produced a pure-culture virgin spawn cutting their dependency on imported spawn. The growth of mushroom production has since then achieved great development in the U.S. Recent research by scientists on hallucinogen psilocybin, which is an active ingredient in mushrooms, shows that one dose causes serious positive personality change in their patients. The changes were

A Play emulating Poe in The Raven and QUestions Essay

A Play emulating Poe in The Raven and QUestions - Essay Example The â€Å"tapping† that rhymes with â€Å"napping† also is a great contrast because â€Å"tapping† wakes up the â€Å"napping.† Poe knows how to tell a story that comes alive through the sounds of his rhymes and alliterations. I grew up with my grandmother who treated me like I was the most favorite grandchild. She always cooked my favorite meals and she always listened to me. She is the kind of grandmother whom some might say have spoiled me because she always understood me and took my side when I am arguing with others. After she died, I miss her so much. I remember that when I am sad and I feel lonely, I sometimes feel someone hug me, even if it is just the wind. For me, it is my grandmother’s way of showing me that she is still with me, loving me and taking care of me. Sometimes, I also feel a craving for my favorite food, and when I come home, I smell my grandmother’s cooking even when it is just in my head because I miss how she takes care of me. Other times, when I have problems, I dream of my grandmother. In my dreams, she listens to me and helps me think of solutions to my problems. I remember her sweet apple smell because she loves baking apple pies that I love so much. I also hear her humming old songs when she puts me to sleep. My grandmother is long dead, but her memories are forever alive with me. Restate the question in your response and support your answer with evidence from the story. Explain the use of repetition in the Raven... What does Poe repeat, and why? what is his purpose in repeating...? Support response. For example, when the narrator says â€Å"†¦rapping, rapping at my chamber door†(4), the effect is onomatopoeic melody, as if the reader can hear the rapping at their own doors. The repetition also contributes to the sad tone of the poem because the choice of words. In addition, in this example, the

Jazz & Rock in the Soviet Block Essay Example | Topics and Well Written Essays - 1000 words

Jazz & Rock in the Soviet Block - Essay Example They were seen as thugs and hooligans revolting and siding with the capitalist west. For instance, outward appearance was seen to be double oppositionist. This explains why sixties teenagers enjoyed the illusion of seeing themselves as revolutionaries by simply wearing blue jeans keeping long hair. A different paradoxical aspect is that rock movement during its promising phases stood at the heart of dynamic artistic amateur by embracing a wide activity range like acting, puppetry, ballet movement etc. thus integrating a few criticism elements which had been denied expression in other public life spheres (Anna Szemere, Some Institutional Aspects of Pop and Rock in Hungary, Pp 125). Rock and jazz verse structures  are known to influence individual actions within a common activity situation. This kind of musical progression focuses on both community and individuality. For the soviet youth it had no comparison. Rock music gradually evolved into essential freedom and self expression ing redient. It was viewed by its lovers as a political action companion rather than a being just a driver. This was especially because it unfolded from the west. Many rock ‘n’ roll musicians adhered to west anti war movement because of its rebelliousness appeal rather than political goals.  Rock music engendered opposing the authority, specifically when it was tied to rigid political ideologies restricting freedom of expression (Yuri Pelyushonok, Strings For a Beatle Bass, Pp. 8-17). Rock and jazz  played an important role in  subverting the Soviet Union political order. This unique genre of music undermined Soviet authority and humanized the West. It helped to alienate the young generation from oppressive political systems and sparked a revolution. It was achieved through use of... This essay mostly discusses on how the youth lost interest in the Soviet unshakeable ideals of communism. The Soviet youth no longer thought of English-speaking people as enemies. The essay describes how in the process of jazz and rock music development in the USSR the Communists had lost two young generations. The impact and power of music as a revolutionary act is a main focus of this essay, such change was incredible and remarkable in the Soviet Block. Even if some people were no rock or jazz fans due to political reasons, since the political system was against it, by merely having to listen to music was disobedience by itself. Active participation by extension made an individual an active agent working against the soviet regime. The researcher also mentiones that some of the dedicated writers and composers went to greater lengths of concealing their dissent and discusses impacts and effects of it. This was given a code name, ‘Rocking the Wall.’ Either way, the music reached its audience and the message was well received. Some songs would be indirectly talking about the west or the United States or sometimes capitalism. To the music fans this was coded message which was obviously ridiculing and criticizing the soviets and their communist ideologies. To conclude, the researcher sums up that the communist regimes inability curb, replace, eradicate, or assimilate rock music influence probably helped in ensuring that the population would one day turn against totalitarianism.

Solution to the Media’s Effect on Women Essay Example for Free

Solution to the Media’s Effect on Women Essay Recently, the media has come under numerous criticisms due to the manner in which it has been objectifying the female gender. According to Britton, the media has taken advantage of women’s quest for beauty to enrich themselves. This is evident due to the media’s involvement in numerous product advertisements addressing the female gender in terms of beauty and body posture. These advertisements have lately been in plenty not only in televisions but also in billboards as well as the numerous social media platforms. In most of these advertisements, the media is ever stressing on one main factor, which is beauty. According to these advertisements, for a woman to be beautiful, in addition to being slender in posture, she also has to apply cosmetic products. Whereas the media is reaping heavily from these advertisements, little concern has been given to the women, who happen to be the main victims. This has negatively affected the female gender since most of them become discontented with their appearance. It is because of this discontent that most women start skipping meals in addition to spending thousands of dollars in cosmetic surgeries (â€Å"RCPSYCH†). The study looks forward to addressing some of the necessary measures that ought to be taken in a move to curb the media’s role in objectifying women. For instance, apart from the introduction of a new bill targeting the media, the essay also addresses the creation of awareness programs for women in addition to other factors such a s health education as well as changes in media advertisements. Introduction of a New Bill                     Although the Media’s objectification of women is high, men too are victims of these issues. In order to minimize the images being displayed by the media, the government also has a role to play. It is the responsibility of the US government to ensure that its citizens live responsively. It is the government’s responsibility to come up with solutions that address the issue of women objectification. For instance, , the government ought to come up with a new billnew laws. This bill, which can be called â€Å"The Media for Health Bodies Act needs to in a move to curb the manner in which the media is using false images to lure women and women into purchasing beauty product with the objective of acquiring the perfect body as portrayed by the Media. Presence of this billese laws will be beneficial since through it there will beit will result to a steady decline of women objectification by the media. Curbing the Media’s role in women obj ectification will minimize the rate at which women are spending their money on cosmetic products and surgeries. In 2013, women residing in the US spent 12 billion dollars on surgical as well as non-surgical procedures in a move to improve their appearance (ASAPS). Although this is a large amount to be spent on surgeries, it is likely to rise if the media is allowed to continue using false images in conducting promotions. In this bill, the government needs to come up with strict rules targeted to the media, especially in relation to the manner in which they display their advertisement images. According to studies, most of these images are computerized; hence, they are false (Webster). Although these images are of famous celebrities and models, most of them are computerized; hence, they are not real. According to Webster, it is because of these falsified images that women and men are spending a lot of money on cosmetic products and surgeries. This is because the media has made people believe that perfect bodies exist. In order to carry out its mandate effectively, the government needs to introduce a bill that will oversee a reduction on in the types of images being used in advertisements. Since most of these images are false, enactment of this bill will this bill ought to ensure that the media does not use falsified images while promoting products such as clothes, cosmetics and groceries. Apart from women, men too are also objectified by such images. For this to be achieved, the government needs to introduce strict penalties for any media that will be found using false images in conducting its advertisements. In this bill, the government needs to ask all Medias to ensure that all false images are labeled. By ensuring that all false images used by the media are labeled, the government will aid in reducing the rate of depression among women as well as menat which women are spending money on beauty products and surgeries. For instance, the government needs to infor m Medias that they risk losing their business licenses once found to be using unlabeled false images in product adverisements. Apart from the loss of business licenses, hefty fines will also be imposed on these Medias. Apart from coming up with a bill that will oversee a reducing tion in the image falsification, the bill also needs to introduce education programs aimed at creating awareness of false images in addition to the negative effects of excessive usage of cosmetic productsgovernment also needs to introduce laws that will minimize the high rate of cosmetic surgeries in the nation. This will only be achieved if the government increases the cost of beauty products as well as cosmetic surgeries. In addition to increasing the cost of surgeries, the government also needs to offer education on the negative effects of cosmetic surgeries. The bill ought to include education programs that can be can either be televised or be taught in seminars or learning institutions. Women ought to be made aware that some beauty products are toxic; hence, using them is risky for their health. Through education, women will also be informed of diseases such as Bulimia and Anorexia. Most women undergo these surgeries since they are not aware of the pending consequences. It is therefore evident that the number will drop drastically once they are educated on the effects of these products. Awareness Programs to the Female Gender                     In order to curb the high rate of women objectification by the media, women ought to review the manner in which they perceive these images. The numerous advertisements being displayed by the media tends to give women negative impressions concerning their physical appearance. In many advertisements, the media is ever displaying images of women that are slim with lots of makeup. This gives many women the impression that beauty is only achievable if one has a slim body and applies makeup (Goh-Mah). Women need to know that most of these models never exist since they are just computerized images intended to lure women into believing they can achieve the same beauty (Striegel-Moore Franko 186). Since age is rarely considered, awareness ought to incorporate not only adults but also children. This is because just like older women, little girls are also lured into believing that a ‘perfect body’ is the only way to beauty. According to studies, h alf of all girls aged 6-8 have at one time stated that they wish to be slim (Striegel-Moore Franko 183). This is because they too have been made to believe that beauty is achievable only if one attains the perfect body. Since the entire female gender has fallen victim, awareness ought to target the entire female gender. The awareness need to be conducted in different venues in a move to create awareness to many women. For instance, apart from places of work, awareness programs also ought to be introduced in other institutions such as schools and health centers frequently visited by women. These awareness programs need to be initiated by non-governmental organizations not only in the US but also globally. This is because the issue is gradually becoming catastrophic to the female gender not only in the US but also in other nations worldwide. In these programs, women ought to be made aware that there is nothing like a ‘perfect body’. Additionally, they need to be asked not to believe everything they see on media platforms. This is because most of the information is false and the media’s main objective is usually to objectify women in order to receive its monthly income. In order to make them comprehend this information, organizations ought to compare them with their male counterparts in relation to the manner in which they react to such media advertisements. According to Gianatasio, just like women, the media targets men as well when it comes to objectification of their body. However, the only difference between these two genders is that whereas men rarely take these advertisements seriously, the same cannot be said for the female gender. This is because women tend to take these advertisements seriously and this has resulted to a number of negative effects such as low self-esteem, depression in additio n to contraction of disorders such as anorexia as well as bulimia and nervosa (Holmstrom). In men objectification, Medias showcase images of men who are not only handsome but also masculine. In such advertisements, Medias tend to display the fact that men ought to be masculine in order to look attractive and win the hearts of many women. Unlike women, men rarely take such advertisements seriously since most are contented with their physical appearance. In these awareness programs, women ought to know that the main reason why they are the most affected is due to the fact that they are more conscious about their body appearance than any other object. Health education                     In addition to the awareness program, women also need to be educated about their body in addition to how these images are posing great risk to their health. Through efficient health education, women will be in a position to change the manner in which they view most of the media images. According to Holmstrom, women tend to adore media images so much to the extent they forget their own body. In most of these images, the media uses women that are slender with lots of makeup. Since these images are ever popping up in various media platforms, women have become addicted to them that they are willing to go to the extreme in a move to achieve the so-called ‘perfect body’. In a move to become slimmer, most women have opted to go on diet. This is whereby they are eating little food compared to what they are actually supposed to consume on a daily basis. Apart from consuming less food, women are also spending billions of dollars on cosmetic produc ts in addition to undergoing cosmetic surgeries to improve certain features on their bodies (Stewart). Although Medias are busy urging women to buy beauty products in addition to going on diet, little is being said about the consequences that are likely to surface. Since little is being done by the media in relation to finding a solution for women objectification, health organizations need to come up and educate women on some of the risks they are exposing themselves to when they opt to embrace media images. Through health organizations, women ought to know that apart from spending a lot of money on beauty products, influences by the media images are likely to cause other negative effects such as depression and low self-esteem. Additionally, due to these images, most women have developed anorexia and bulimia. According to studies, these are eating disorders whereby a person starts avoiding food due to the fear of increasing weight (â€Å"RCPSYCH†). These disorders tend to affect women more compared to men. Apart from the worry of weight gain in addition to consuming less food, other symptom associated with these disorders include the wearing of baggy clothes to conceal one’s body, irregular menstrual periods in addition to a regular feeling of guilt and tiredness (â€Å"RCPSYCH†). Health organizations need to provide this information to all women in a move to reduce the rate at which women are embracing the images they view on media platforms. Similarly, health organizations ought to come up with programs on the health effects that come alongside excessive use of cosmetics. According to studies, the cosmetic industry is one of rapidly expanding industry not only in the US but globally. This is because most women have been made to believe that it is only through cosmetic products that they can achieve the perfect body. Although the media has played a major role in terms of advertising these beauty products, little awareness is being said on the health effects of these products. Women need to know that although these products tend to improve one’s physical appearance, they also expose them to a number of health risks. According to studies, some of the ingredients used in the manufacture of beauty products are usually toxic (â€Å"American Cancer Society†). This has resulted to numerous cases of skin and eye irritations. Similarly, some of these products result to allergic reactions, which could easily cause neg ative outcomes for its users. Additionally, although there is still no solid evidence, there are also high probabilities that these products expose women to the risk of contracting skin cancer (â€Å"American Cancer Society†). Apart from cosmetic products, women are also being lured into undergoing cosmetic surgeries in a move to improve their physical appearances. According to research conducted in the US, the number of women undergoing cosmetic surgeries is ever rising on an annual basis (â€Å"ASAPS†). Health organizations need to educate women on the dangers they expose themselves to once they undergo cosmetic surgeries with the objective of acquiring the perfect body. According to Goudreau, tampering with the body balance normally causes new health problems. For instance, when one suctions fats from the lower abdomen, other fat cells are also damaged in the process. Hence, one is likely to spend to spend more funds in search of medication. Changes in Media Advertisements                     Most of the images used in promotion advertisements are usually false. In order to reduce the rate in which women are embracing these images, a number of aspects ought to be considered. For instance, the media needs to change tactic in the manner in which it makes product advertisements. The media needs to minimize the usage of celebrities and other famous models while making product advertisements. Instead, they can make use of animated advertisements. This is because whereas the use of celebrities makes women change the manner in which they view their bodies, the same cannot be said for animated advertisements and images. Since the main objective of media advertisements is usually to create awareness in addition to increasing the target market, animated advertisements can also relay the same information just like models. Apart from embracing animated advertisements, the media needs to be dynamic, that is, instead of choosing only models with a cert ain body posture, the media needs to be all-rounded. For a long time, the media has been using images of slender women; this has driven many women into believing that this is the perfect body. It is due to this perception that has driven many women into skipping meals in addition to spending a lot of money on cosmetic products and surgeries. Instead of using a single type of body posture, the media needs to use women of all sizes, race and color. When the media uses all types of women, this will improve the manner in which women perceive themselves. For instance, by using overweight ladies on images, this improve the manner in which over weight ladies perceive themselves, that is, instead of feeling depressed, they will begin loving adoring their bodies. This will be quite beneficial since it will reduce the high cases of low self-esteem and depression among women. Similarly, this will also result to a steady decline in eating disorders such as bulimia and anorexia. Counter Argument                     Although the media is being accused of being the major contributor of women objectification, it also needs to receive some credits due to the role of improving the nation’s economy through product advertisement as well as marketing. According to studies, it is evident that the cosmetic industry is one of the main contributors of the nation’s high economy. This would not have been made possible without media advertisements. It is through the media that product awareness is created, which is usually directly proportional to more sales, hence, profitability. In my opinion, enacting new laws targeting the media will end up doing more harm than good to the nation. For instance, there will be a reduction in product advertisements and this will result to a decline in the nation’s economy. Conclusion                     Recently, the media has been accused of lowering women’s self-esteem in addition to making them feel have numerous depressed. This hasion that have also resulted to disorders such as bulimia and anorexia. This is because it has been objectifying women by coming up with false images. The media has been using models that are slender, hence, making many women feel ugly. In a move to achieve the perfect body being used by the media, women have skipped meals in addition to going to the extent of undergoing cosmetic surgeries. In order to curb women objectification by the media, a number of factors need to be considered. For instance, organizations need to come up with awareness programs. These programs need to make it clear that there is nothing like a ‘perfect body’, this is because most of these images have been falsified with the aid of computers. Similarly, organizations need to introduce health programs. Through these programs, wo men need to be educated on the health risks associated with excessive usage of cosmetic products as well as the dangers of cosmetic surgeries. The government also needs to make sure that Medias do not use falsified images while conducting product promotions. For this to be achieved, the government needs to introduce new laws such as strict measures on Medias caught using falsified images. Finally, the media needs to change the manner in which they advertise products targeted for women. For instance, apart from using animated advertisements, they also need to incorporate all sizes of women in their advertisements. References American Cancer Society. Cosmetics. 2014. Web. 19 November 2014. http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/cosmetics ASAPS. News Releases. Web. 06 Nov. 2014. http://www.surgery.org/media/news-releases/the-american-society-for-aesthetic-plastic-surgery-reports-americans-spent-largest-amount-on-cosmetic-surger. Britton, Marie. â€Å"The Beauty Industrys Influence on Women in Society.† University of New Hampshire. 2012. Web. 19 November 2014. http://www.google.com/url?sa=trct=jq=esrc=ssource=webcd=23cad=rjauact=8ved=0CCsQFjACOBQurl=http%3A%2F%2Fscholars.unh.edu%2Fcgi%2Fviewcontent.cgi%3Farticle%3D1085%26context%3Dhonorsei=7GxrVMimJeOhyAOw2YHwBQusg=AFQjCNFSyiwFuLgAiCg_YlBJTnBZGN5imQsig2=7GsuFp9KHox47uEXq_s0OAbvm=bv.79908130,d.bGQ Gianatasio, David. â€Å"Hunkvertising: The Objectification of Men in Advertising some wish theyd just keep their assets covered.† ADWEEK. 2013. Web. 19 November 2014. http://www.adweek.com/news/advertising-branding/hunkvertising-objectification-men-advertising-152925 Goh-Mah, Joy. â€Å"The Objectification of Women It Goes Much Further Than Sexy Pictures.† The Huffington Post. 2013. Web. 19 November 2014. http://www.huffingtonpost.co.uk/joy-goh-mah/objectification-women-sexy-pictures_b_3403251.html Goudreau, Jenna. â€Å"The Hidden Dangers Of Cosmetic  Surgery.† Forbes. 2011. Web. 19 November 2014. http://www.forbes.com/sites/jennagoudreau/2011/06/16/hidden-dangers-of-cosmetic-surgery/ Holmstrom, Amanda. â€Å"The Effects of the Media on Body Image: A Meta-Analysis† Journal of Broadcasting and Electronic Media Volume 48 (2004): 1. RCPSYCH. Anorexia and Bulimia. 2014. Web. 19 November 2014. http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/anorexiaandbulimia.aspx Stewart, Dodai. â€Å"Americans Spend Billions on Beauty Products But Are Not Very Happy.†Jezebel. 2012. Web. 19 November 2014. http://jezebel.com/5931654/americans-spend-billions-on-beauty-products-and-are-still-pretty-unhappy/ Striegel-Moore, R., Franko, D. Body Image Issues among Girls and Women. In T. F. Cash T. Pruzinsky (Eds.), Body Image: A handbook of theory, research, and clinical practice (p. 183-191). New York: Guilford Press. Webster, Dr Irina. Eating Disorders And Media. Selfgrowth. 19 June 2008. Web. 7 Nov. 2014. http://www.selfgrowth.com/articles/Eating_disorders_and_media.html Source document

Introduction To Dual Diagnosis Health And Social Care Essay

Introduction To Dual Diagnosis Health And Social Care Essay Over the last ten years in mental health, there has been a significant change and considerable debate about the definition of dual diagnosis, this terminology refers to a mental health disorder combined with substance misuse (Department of Health, 2002). This can cover a broad range of disorders from learning disabilities and substance abuse of legal or illegal drugs to severe mental illness such as schizophrenia and substance misuse of cannabis or alcohol (Department of Health, 2002). However in medicine dual diagnosis is an umbrella term, for a primary and secondary disorder for example diabetes and hypertension (Sowers Epstein, 1995) This research proposal will focus on the client group duality of psychosis and substance misuse of cannabis or alcohol. Psychosis can be defined as a severe mental health disorder in which thought and emotions are significantly impaired, whereby people can lose contact with reality. However the symptoms can vary between negative and positive, the negative symptoms can cause apathy, a reduction or absence of social skills, resulting in confused thoughts which impair their ability to concentrate or complete instructions. The positive symptoms can be defined as either visual or auditory hallucinations or delusional thoughts, where a person may have an undeniable belief in something false (National Institute for Clinical Excellence (NICE), 2011). However substance abuse can aggravate psychosis leading to further hallucinations, which is associated with a wide range of negative outcomes, such as higher rates of relapse, increased hospitalisation (revolving door clients), suicide, housing issues and poorer levels of social functioning, such as poverty, violence, criminality and social exclusion, less compliance with treatment, greater service costs to National Health Service (NHS) or the criminal justice system and government services (Department of Health, 2007). More significantly The World Health Organization (WHO) reported 51,353 admissions of drug-related mental health disorders in 2010/11. These admissions have increased year on year and are now nearly twice as high as they were ten years ago, therefore families are at greater risk of having a family member diagnosed with dual diagnosis (The World Health Organization , 2012). Significantly the impact of the dually diagnosed within families is drastic, family dynamics are altered by challenging and difficult situations within the home, by displaying disruptive and aggressive behaviours (Biegel et al, 2007). Clearly people with dual disorders have strained interactions with their families. However when relationships are strained families might be less willing to help, the relative with dual diagnosis which could contribute to higher rates of homelessness and social problems (Clarke, R E; Drake, R E, 1994). Yet family members may have differing amounts of contact and distancing, because of the negative impacts of their behaviour. However someone in the family takes the role of main caregiver, being the person most directly linked to the caring of the dually diagnosed whilst care giving not only affects their QOL, it also impacts on possible depressive symptoms and research has indicated that care giving burden has a risk factor for early mortality (Biegel et al, 2007), (Marcon et al, 2012) (Walton-Moss et al, 2005) Yet a lack of social support, and informal and formal care, has been found to be the most important source that predicts the burden of family caregivers (Biegel et al, 2007) although informal caring occurs naturally within family relationships, which is typically unpaid, this goes beyond the caring expected of these relationships in contrast to a paid formal carer (Chaffey Fossey, 2004) additionally being a carer can raise difficult personal issues about duty, responsibility, adequacy and guilt (Shah et al, 2010). Research into the impact of care giving shows that carers suffer significant psychological distress and experience higher rates of mental ill health than the general population, the triggers for distress are as follows; worry, anger, guilt, and shame; financial and emotional strain; marital dissatisfaction, physical effects of the stress of living with a substance abuser (Biegel, et al 2007). However without the contribution of the UKs 6.4 million unpaid carers health and social care services would collapse. In 2037 its anticipated that the number of carers will increase to 9 million (Carers UK, 2012). Worldwide several authors have argued for service systems to acknowledge and address family members need to ensure their own well-being, as well as to ensure effective community support for people living with mental illness (Chaffey Fossey, 2004) (Igberase et al 2012) (Carey Leggatt, 1987). The last ten years have seen major reform of the law as it relates to carers; consequently families have been forced to give up work to care for their relatives. Family carers need assistance to prevent becoming unwell themselves (Carers UK, 2012). Therefore supporting carers must be a central part of government reform, which acknowledges the family as associated clients who desperately need support. This is paramount because relatives often know little about how the interactions between mental illness and substance misuse are interchangeable. Therefore families need practical information about dual disorders, to help recognise the signs of substance abuse, and strategies for its management for example medication adherence and recognising relapse triggers. Addressing these factors would enable the improvement in the dually diagnosed directly related to greater outcomes in the well-being of the family (Mueser Fox, 2002). Overview, context and background information relevant to topic It costs the UK Â £1.3 billion a year in carers benefits and lost taxes whereby family members are becoming increasingly responsible for providing support, although in 2012 the British government submitted the Care and Support Bill which will guide future services for caregivers. Families will no longer be treated as an extension of the person they are caring for, they will have a right to an assessment, this will give carers much better access to support them balance their caring roles and responsibilities (Carers UK, 2012). Yet informal carers may experience less choice about the discontinuation of care in comparison to volunteer or paid carers, possibly due to love of the family member and a sense of duty, it is essential that the family understand the facts about dual diagnosis, to have every hope for recovery of the family (Department of Health, 2007) Additionally health services should acknowledge the families by assessing them as associated clients so that carers can learn to recognise the triggers of caregiver burden and moreover be given general education and health promotion (Rethink, 2007). However in 2006, the College of Occupational Therapists (COT) announced a 10 year vision for occupational therapy in mental health which included by 2013 for practitioners to have extended their scope of practice across a range of agencies to meet the occupational needs of mental health services (COT, 2006) Statement of the problem proposed to be investigated The proposed research intends to investigate, what are the experiences of people who are carers for people with dual diagnosis? General aim(s) of the proposed research To find out how families cope living with someone with dual diagnosis? What are their biggest challenges? To identify the current experiences from the perspective of the carer regarding the impact of dual diagnosis, the burden; grief and the loss of their relative. Relevance, significance or need for the study The relevance to occupational therapy and the health service; carers are associated clients and therefore need to be taken into consideration when assessing this client group. Furthermore the lacking of occupational therapy literature in this area makes a clear case for the proposed research. Chapter 2: Literature Review Introduction to the chapter Literatures in dual diagnosis are largely separate, mainly based in substance abuse or mental health fields. However over the past decade, family work in dual diagnosis has been mainly focused on client outcomes and not the families well-being or quality of life QOL. However occupational therapy literature is also limited, lacking investigation of occupational needs identified from the families perspective. However a considerable amount of literature has been published on descriptions of occupational therapists roles by defining and establishing what an occupational therapist does within the multi-disciplinary team in mental health services, but not specifically to dual diagnosis (Brown, 2011) (Hyde, 2001)(Lloyd et al, 2008). Therefore it is beneficial for occupational therapists to have a better understanding of the families perspectives, as associated clients to enable additional support for the caregiver thus improving outcomes for the whole family. There is a plethora of literatures, on outcomes associated with family support for the dually diagnosed, the majority of studies examined the relationship between family involvement and client outcomes such as reduction in mental health symptoms, engagement in treatment services, lower hospitalisation rates, improved decrease in substance abuse, sustained remission (Clark, 2001) (Mueser Fox, 2002) (Biegel et al, 2007). Although the high service costs of treating the substance abuser and the frequent involvement of relatives in the lives of dually diagnosed clients, there are few resources to help clinicians engage and collaborate with families (Mueser Fox, 2002). This implies that families or informal carers can easily become the main source of care when treatment fails, the family being the last resort (Clark 2001). On the other hand, some research has shown that individuals with dual diagnosis are less satisfied with their family relationships than those with a severe mental illn ess alone (Kashner et al. 1991) and that receiving family support may exacerbate difficulties by increasing conflict (e.g. supply of additional money may be used for drugs, existing poor family dynamics worsen carer-client relationship). Conversely research is lacking in the support of families caring for the dually diagnosed (Biegel, et al, 2007) (Townsend, et al, 2006). In contrast families are often the most significant people in the dually diagnosed life, this unique relationship puts families in the central position of being able to encourage the dually diagnosed to take the necessary steps towards recovery by providing direct care such as practical help, personal care, emotional support as well as financial support (Clarke, R E; Drake, R E, 1994) (Shah et al, 2010) (Mueser Fox, 2002). The impact of mental illness on families is usually conceived in terms of caregiver burden, this experience may help determine the quality of life QOL for family members, the most significant being, isolation, coping with behavioural problems, and relationship problems between family members (Clark, 2001). Mueser et al, (2009) study of 108 families conducted a randomised control trial utilising Lehmans QOL interview instrument with satisfactory reliability and validity (Lehman, 1998) for the diagnosed, the caregiver was assessed using the family experiences interview schedule (FEIS) with established reliability and validity which did not incorporate the QOL for the family this was not addressed. The findings from this study found that motivating relatives, to participate in family intervention can address the disruptive effects. These stressors that affect quality of life include; worry, anger, guilt, and shame; financial and emotional strain; marital dissatisfaction, physical effects of stress of living with a substance abuser (Biegel et al, 2007). Additionally Biegel et al (2007) exploratory, non-experimental cross-sectional survey design conducted interviews / surveys with 82 females with dual diagnosis and 82 family members and considered the caregivers experience as moderate, and found that behavioural problems contribute to the burden affecting their quality of life, the strength of this study is acknowledging how substance abuse impacts on the role of care giving which was also tested by applying FEIS. Many studies of family carers of persons with mental health and or substance abuse issues consider how families quality of life is affected, the main themes highlighted that emerges throughout the reviewed literatures are caregiver burden which is documented as worry, anger, guilt, isolation, stress which results in a diminishment of QOL of family members (Biegel et al, 2007) (Chaffey Fossey, 2004) (Shah, Wadoo, Latoo, 2010) (Chan, 2010). Behavioural problems have been found to be the strongest predictor of caregiver burden across chronic illnesses (Biegel et al, 2007). In contrast Jokinen Brown, (2005) conducted a focus group study which included 15 subjects would argue that there are positive aspects of lifelong care giving and quality of family life, the study acknowledged the concerns for the health of all family members (Jokinen Brown, 2005). Research in the QOL of care giving highlights that carers suffer significant psychological, distress and experience higher rates of mental ill health than the general population. Therefore by improving the QOL of carers will likely to reduce caregiver burden that requires further research to explore the lived experiences of families living with the dually diagnosed (Shah et al, 2010). However, literatures addressing the family as a collective unit and the impact of care giving on each family members role is lacking therefore this literature reviews the research. The majority of family caregivers, mostly women report experiencing moderate to high levels of depression as well as stress, this type of informal care giving is taken on in addition to existing roles and responsibilities (Chaffey Fossey, 2004) (Biegel et al, 2007) (St-Onge Lavoie, 1997). Traditionally, informal care was supplied by women but nowadays women are not only more likely to work, but also likely to be significant contributors to family finances. For women, this implies that earnings will be lost due to informal care increasing. However women play a central role in care-giving which may impact on their well-being more than other members of the family (St-Onge Lavoie, 1997). Although according to shah et al (2010) women have higher rates of depression than men in the care-giving role (Shah et al, 2010). However male carers tend to have more of a managerial style that allows them to distance themselves from the stressful situation to some degree by delegating tasks (Shah et al, 2010). Significantly (Mays Holden Lund, 1999) Interviewed 10 male caregivers and the findings, men expressed their means of coping by being realistic and action-oriented in response to their feelings. However the effect of care giving on children can be considered by the physical changes to normal growth, for example migraines, inflammation of the lining of the colon, and ulcers (Biegel et al, 2007) (Townsend et al, 2006). Tracy Martin, (2006) examined the effects of dual diagnosis via cross-sectional survey design which examined the types of support provided by minor children and the differences in support perceived by the child versus the support perceived by the adult. The findings that the role of children is often ignored or neglected, the effects are referred to as a role reversal parental child or parentification thus resulting in negative developmental outcomes for the child, although a weakness with this study is the support perceived by the child is not the views of the children but by the mothers reporting on both, these findings represent a design bias (Tracy Martin, 2006). Significantly Rupert et al (2012) aim to identify the issues when engaging children whose parents have a dual diagnosis explored the perspectives of 12 children via semi-structured interviews. A strength with this study is that the authors were able to elicit the sensitive data ethically by gathering information about secrecy issues around their parents substance abuse and remaining loyal to their parents, children experience negative times spent with their parents, with family arguments and the knowledge of when the parent abuses substances these findings represent the need to acknowledge childrens perspectives as associated clients (Reuper et al, 2012). The authors acknowledge that the study does not recognise the other family members within the household that could provide an exploratory view of their perspective. Although the effect of care giving on siblings is lacking, Sin et al (2012) studied the phenomena of understanding the experiences of siblings of individuals with first episode psychosis. Qualitative semi-structured interviews with 31 sibling participants researched that they had somehow lost their brother or sister as his or her character had changed since the onset of their diagnosis (Sin et al, 2012) Younger siblings were much more likely to cope by withdrawing and not getting involved, they often reported that they were not made aware of information and resources available to help with the situation and were also less likely to want to know about the illness (Sin et al, 2012). Strength of this study is the qualitative exploratory semi-structured interviews, and the themes that emerged although this study does not address the issues of substance abuse or the quality of life of the other family members. The gap in the literature is that quality of life does not consider the affects of mental health and substance abuse on the family. This paper has not been able to locate any studies that consider the qualitative exploratory lived perspectives of all family members living with the dually diagnosed, and the impact on their quality of life, therefore due to the lack of research on families living with the dually diagnosed this research seeks to explore their perspectives. To conclude Health professionals should focus on the familys environmental context, and their perceptions of their relative with mental illness, thus by assuming that each family is different, clinicians should evaluate how family dynamics can affect the families quality of life and how theses interactions impact in their plan of care (Walton-Moss et al, 2005). However, numerous studies have looked at the effects of family involvement on the outcomes of the dually diagnosed, current literatures are lacking on the quality of life of family members, and does not consider the effects of mental health and substance abuse on the family, this provided the focus for the present research. The relevance to occupational therapy The relevance to occupational therapy services is to lessen the burden on the carers so that they can continue in their caring role, being fully informed of diagnosis, relapse triggers, substance abuse, and the available services so that they can continue their caring role. Statement of aims To explore the perspectives of carers of clients with dual diagnosis To explore the perspectives of the carers regarding substance misuse To find out how carers cope, living with someone with dual diagnosis, what are their biggest challenges? Research question proposed to be investigated To explore the lived experiences of a family that lives with the dually diagnosed client. Chapter 3: Methodology Description and justification of research Design A qualitative semi-structured interview which utilises open ended questions, has been chosen because these methods lend themselves to exploring the familys perspective and meanings of living with the dually diagnosed, this will permit individual members of the family narrative to be acknowledged. Moreover the researcher will ask questions in similar ways to all participants, which will attempt to maximise the confidence in the research reliability and validity (Hicks, 2009). This method will attempt to understand a complex novel phenomenon, whereby the researcher needs to understand that the concepts and variables that emerge may be different from the aims, sought by the study (Pope Mays, 2006). In contrast focus groups were not chosen due to the consensus of a group of people rather than the individual perspectives from the family (Pope Mays, 2006). The research will be conducted in the participants home, due to purposive sampling methods in which sites are selected on the basis that they are typical of the phenomenon being investigated (Pope Mays, 2006: 115). This will attempt to justify the rationale for the research taking place in the home in environment (Pope Mays, 2006). Moreover purposeful sampling techniques will be used to obtain participants whereby the researcher identifies specific people to take part (Hicks, 2004). However an aspect which illustrates rigour can be identified through member checking, whereby cross-checking findings with participants, can help to refine explanations, and aims to reduce subjectivity in processing of data analysis (Pope Mays, 2006). Therefore Living with dual diagnosis through the families eyes, can be addressed by using semi-structured interviews whereby rigor can be associated with this type of approach, due to data collected from as many appropriate sources to provide in-depth information (Pope Mays, 2006). Indication and justification of required number of Participants The participants will be family members of the dually diagnosed client, that attend a community mental health daycentre. However this study acknowledges the stigma attached to mental health services, as recent studies have shown that public education campaigns on mental illness and the integration have done little to alter the stigma associated with mental health (Schulze Angermeyer, 2003). Conversely the recruitment of participants may rely upon their visit to the day centre or if not appropriate for them then the dually diagnosed participation at the centre and the passing on of the flyer or information about the study, requiring no attendance at the day centre is necessary, due to the research being conducted in the participants family home. However It is argued by Crouch McKenzie (2006) that for in-depth qualitative studies small numbers of cases facilitates the researchers association with the participants, and enhances the validity therefore a maximum of 20 participants in total will be recruited to allow sufficient time to analyse the collected data (Crouch McKenzie, 2006). However snowballing sampling, was not the chosen method of recruitment because recruited participants in the study, would refer and reccommend future participants (Patton, 2002). Organisation of access to and recruitment of possible participants Participants for this study will be obtained through voluntary participation advertised via flyers and posters at a community mental health daycentre (Appendix 7), the flyers will provide instructions for participants to contact the researcher, the purpose of the study; requirements to be a volunteer, and the time commitment of the volunteers will be listed on the flyer, once families (maximum total of 20 people) are recruited for the study, the researcher will remove the flyers and posters. When volunteers respond, a telephone screening interview, approximately 5 minutes per person, will be conducted to determine if the individual family members meet the inclusion criteria. Families that respond and meet the inclusion criteria will be consented and assented (if appropriate) and recruited to participate in the study. The researcher will speak with the families, and communicate with each family member to set up a meeting time and place that is convenient for all members (Pope Mays, 2006). Inclusion/exclusion criteria of participants The validation for the inclusion and exclusion criteria relies on the family homogeneity that they are composed of being related and living together, therefore similar participants may enable a more in-depth enquiry into their shared and distinctive experiences (Hicks, 2004) The inclusion criteria eligibility: a) Family member is living with the person diagnosed with dual diagnosis. b) Family member is capable of engaging in verbal communication pertaining to semi-structured interviews. c) Family member is above 16 d) A family consisting of two or more members (max 4) not including the dually diagnosed client. e) English speaking and capacity to reflect participate. The exclusion criteria: a) Family member is below the age of 16. b) The diagnosed family member with dual diagnosis. c) No mental disorders or substance misuse disorders. d) Non-English speaking or with a cognitive deficit disorder. The semi-structured interviews may discuss topics or issues which are sensitive to the participants, these difficulties can be averted by a procedure of gaining on-going consent and assent for the 16-18 year olds (appendix 2) (Wiles et al, 2007). If distress occurs then the researcher can either stop the activity or will move on to the next area. It will be made clear to participants that they can decline to answer any particular questions or discuss topics that they feel uncomfortable with and can leave the research at any time, additional support and information will be available (Wiles et al, 2007). Indication of Ethical issue relevant to the proposal The researcher should at all times respect the autonomy of the individual by allowing the participant the freedom from control or influence of the study. Additionally the researcher has a duty to uphold beneficence which is the obligation to maximise benefits and minimise harm (Domholdt, 2000). Justice should be maintained throughout which is the obligation to treat each person in accordance with what is morally right and proper, therefore informed consent and ascent will be obtained via the Participant Information Sheet (approximately 30 min) (Appendix 1). Once the inclusion criteria has been met and each of the participants agree to join the study, a meeting time and place for informed consent, form review and data collection can be scheduled. The researcher will review (1) the purpose of the study, (2) an explanation of the procedures including the interviews, and the interview process, (3) an explanation of possible benefits and/or risks or discomforts (4) Consent to audiotape semi-structured interview (amended consent form), and an explanation of the subjects rights and confidentiality, the subjects will be asked to repeat their understanding of the study and procedures in their own words. Once full understanding has been demonstrated of the purpose and procedures of the study, the researcher will ask the participants to sign the consent form. Research approval General approval to be sought from Brunel University Research Ethics committees. Ethical approval for the research study is to be obtained from Brunel University, additional permission to be sought from the community mental health day centre (gatekeepers) to recruit participants via flyers and posters (Brunel University West London, 2010). Discussion of ethical considerations related to participation and consent Due to possibility of participants being aged from 16-18 assent will be required which is a term for participants too young to give informed consent but who are old enough to understand the proposed research, including the expected risks and possible benefits, and the activities expected of them as subjects. Assent by itself is not adequate, however. If assent is given, informed consent must still be obtained from the subjects parents or guardian (Domholdt, 2000). Ethical issues will arise throughout the research process, from initial planning to writing up and data analysis, due to interviews concerning private experience (Kvale, 2007). The researchers will respect the privacy of the participants by making it clear to them that they are free to decide what information they wish to share with the researcher and that they should feel under no pressure or obligation to discuss matters that they do not wish too. Data regarding the patient, family or the community, which will have the potential to identify them, will be omitted, Indication of any risks and benefits to participants and/or researcher The possible risk to the participant is the discussion of sensitive issues, due to the nature of the research and the psychological aspect of discussing experiences. If distress occurs then the researcher can either stop the activity or will move on to the next area. It will be made clear to participants that they can decline to answer particular questions or discuss particular topics (Wiles et al, 2007). Moreover the non-therapeutic approach, whilst designed to advance knowledge and therefore be of collective benefit, it is not expected to give a direct benefit to the research subject (Wiles, Crow, Charles, Heath, 2007). The risk to the researcher is conducting the study in the participants home, the researcher will have to abide by the Suzy Lamplugh Trust lone worker policy (Suzy Lamplugh Trust, 2012) (appendix 4 ) therefore a full risk assessment will need to be completed. Additionally the researcher will indemnifying against risk, to either the researcher or to participants, by taking out insurance for a period of time limited to the research process. Consideration of issues of confidentiality and data security In order to protect confidentiality, the researcher will identify the subjects for this study by the role that the participants fulfil in the family for example mother, son or daughter. Once all data is collected and analysed the interviews will be transcribed, and the audio tapes will be stored in a locked, secure location until the study is completed, after completion, the primary data will be destroyed and all other data will be destroyed and discarded according to data protocol up to two years (Brunel University West London, 2010). Materials or equipment The interviewer is the instrument in this type of evaluation; the instrument can be affected by factors like fatigue, personality, and knowledge, as well as levels of skill, training, and experience. According to (McNamara, 2009), the strength of the general interview guide approach is the ability of the researcher to ensure that the same general areas of information are collected from each interviewee. The equipment required to analyse the data is software for qualitative data analysis which is ATLAS.ti 7, as a tool for enhancing rigour this software is available at Brunel University (Atlas.ti Qualitative Data Analysis, 2012). The training implications required is a one hour training session. Additionally an audio tape recorder is required for the semi-structured interview; a limitation is that the interviewees may be unable to put their thoughts into words and difficulties of analysing data from semi-structured interviews (Atlas.ti Qualitative Data Analysis, 2012). Comprehensive description of Procedures The study will consist of 45 weeks part-time work (appendix 9) the research will be advertised through flyers and posters at the mental health day centre after seeking approval from the day centre (gatekeepers), The recruitment drive will be for two months via dually diagnosed participation at mental health day centre which the researchers have no affiliation too