Pete is a married 50-year-old man with two adolescent sons recently who was recently diagnosed with syphilis. He has been advised to discuss this with his wife in order that she approach her GP, but he is reluctant to for various reasons. Pete is in a vulnerable situation. Coming from a devotedly catholic family, Pete himself is not religious although he receives strength from his religion and accepts syphilis as divine punishment. Married when 20, Pete's marital sex life has been poor, although Kathleen, his wife, has accepted the situation since she generally has a happy marriage. Pete, however, in his 30s discovered sexual fulfillment from other men and, reckless with protecting himself, rarely, if at all, used condoms. His homosexual encounters become increasingly more uninhibited, and plagued with guilt, he soon started drink heavily. Kathleen, concerned at Pete's drinking, insomnia, and depression, urged him to confide in her or her father; Pete declined. He has also refused his doctor's recommendation to see a counselor, since that would entail discussing his sexuality. The situation that we have here is of a seriously ill man, who plagued by guilt caused by disloyalty to wife and religion, has fallen into depression. On top of it all, he is putting his wife and other partners at risk. His wife might be seriously ill too and her husband is afraid to tell her. Perspective There is the bio-medical model that is particularly pertinent in this case to homosexuality. Bio medical reduces the patient to a machine, and seeing biology as explanatory, uses medicine as intervention. Depression, here, for instance, would be seen as reducible to genetic and biological mechanisms. Studies have found, for instance, that carriers of the genetic short allele of a polymorphism of the serontonin transporter gene have been found to have increased anxiety related temperamental traits including enhanced amaygdala activity and, accordingly, an elevated risk of depression (Pezzawas, et al., 2005). Using this model, depression would be treated with anti-depressants.
Homosexuality, likewise, is reported to have a hereditary basis. This has been reinforced by recent twin studies with larger and more representative samples, whilst some research suggests that hormonal secretion during prenatal development may shape sexual development, and have lasting neural influence (Weiten, 2007).
As regards the social model of health and illness, this, too, has relevance to Pete's condition, since, as mentioned, religion and upbringing have indoctrinated him to perceive his homosexuality as sinful and wrong. Research shows that social support can ameliorate negative sequalea of gene and environmental factors. Risk for negative outcomes may be modified by varying gene and environmental factors, but availability of social support may be amongst the most important controls for limiting risk to depression (Kaufman et al. 2004). Given Pete's society, however, his family and friends would likely be non-supportive of Pete's condition, and Pete's case history mentioned that he had no close friends. Added to that, is the question of how his wife and children would react. His depression, consequently, is a consequence of social, psychological, cultural and environmental factors, although posited environmental support for homosexuality has long been thoroughly refuted (Weiten, 2007)
Finally, one can perceive Pete's condition in a holistic way. In other words, there are many factors that have resulted in the disease - physical, mental, spiritual, economic, political, social, environmental, and so forth. As empathized by WHO, health in our society is influenced by living conditions as much as it is by lifestyle changes (Jensen, 1997), and, therefore, solutions to health problems must be sought at both the structural / social level of living as well as at a personal/lifestyle level. The whole of Pete has been impacted and has caused this situation; therefore, the whole of Pete must be addressed for improvement to occur.
The Biomedical orientation is valid since sufficient evidence shows both homosexuality and depression to be associated with physiological, neural mechanisms and to be impacted by physical treatment. The environmental model, likewise, is significant since Pete's depression and drinking is undoubtedly stimulated and exacerbated by environmental, social, and cultural characteristics. But seeing Pete as a whole and acknowledging that there is so much more to the case - that even if the physical components and social components were addressed, Pete would still suffer from mental anguish and spiritual vacuum as well as a sense of meaninglessness - is to consider the holistic perspective as being of arch importance; and, accordingly, given the complexity of Pete's case, I consider a holistic approach to be most applicable in this situation.
To elaborate: Pete's spirituality has been impacted: he feels that he sinned against his religion and his god. His illness makes him feel a broken person, as well as having failed with his marriage as retards his wife. In this sense, it is not only Pete's physical body that is at stake and suffering -- and therefore reductionism to body qua machine is inadequate; Pete is in a far worse state. He feels failed as a human being, as a husband, as a father, as a 'good' man altogether. He feels that he has ruined his life, and, possibly, that of his family, too, and deems himself to be utterly worthless. Until, all these different components are acknowledged and addressed, Pete's depression will worsen, and depression, far more than syphilis or the drinking, is the killer element. It will prevent Pete from being cured, since Pete has no interest in seeking a cure. Subconsciously, he may no longer wish to live, and therefore, Pete's solution, as far as the holistic model goes, would be to seek practitioners who can help him cure each part of this paradigm.
Theory and practice
Since multiple elements of the person that comprises Pete have been negatively impacted, reversal or solution would entail all affected aspects to be positively affected or at least addressed and treated, and, in this way, Pete would need a compassionate medical model that would see him in terms of a whole.
Pete certainly needs continued and ongoing medical treatment. At the same time, Pete needs to come to grips with his homosexuality and with his homosexuality via-a-vis his church. Options might be reading material on this, finding a chaplain whom he could talk to, anlayzing relevant material on death, finding some perspective within the catholic church that he can confide to about his homosexuality, attending support groups such as AA, and so forth. This might mean attending confession or taking the sacrament if that would be helpful to him. Counseling would be helpful in this situation. Pete declines to seek therapy, but there might be some counselor whom Pete might be less reluctant to see. Relaxation and means of diffusing stress would be also helpful as well as ways to alleviate Pete's remorse. Pete has always been a good husband. If focus could be placed on that, and Pete could be helped to refocus on being the husband and father that he attempted to be, guilt might be assuaged allowing the depression to be alleviated.
The disadvantages are that it is difficult, if not almost impossible, to impose treatment on a reluctant individual. For treatment to stand a chance, the person has to be determined to seek a cure and follow through regardless of physical and psychological pain and discomfort. The person has to be determined to help himself. Pete is reluctant to seek therapy. Added to that are the years of Pete's acculturation. The strength of indoctrination cannot be overcome that easily via counseling. Pete's guilt and self-hatred, induced by religion and upbringing, is strong and far-reaching. Alteration in perspective may be attempted, but it is rare that therapy can reverse years of indoctrination. Pete has to also overcome a lot: his friends, family, environment may reject him altogether. He may have to make dramatic changes to win himself the approval and support that he needs. He may lose his job. His financial situation may nosedive. His medical bills may be beyond his resources. Past acquaintances and his wife may acquire syphilis due to him. What Pete strongly needs in this situation, more than anything else, and particularly right now is support. Given his religious environment and past, it is seemingly unlikely that he will receive this. If his wife (and/or others) were to be diagnosed with syphilis, too, this would be the penultimate stroke for Pete.
Compounded to this is Pete's depression. The whole is intertwined. His situation has ushered his depression, but it is his depression that anchors him to his situation and aggravates it. For Pete to be helped, he has to help himself, but for him to be willing to help himself, a way must be found to fracture his depression so that he can see his situation as it is and take the first tottering steps as way out for resolution to help himself and his family.
Each of these different three…
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