Pete's syphilis diagnosis and depression: biomedical and social models

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.

Contribution of theories

Each approach, in its own right, is significant and has something of importance to say. 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.

Conclusions

Each of these different three medical models are helpful in alternate ways, and all approach the human from an alternate perspective. However, the holistic approach deals with the whole person, and with Pete's case, being as complex as it is, the bio-medical as well as the social model are insufficient here. All the components of Pete's situation and persona need to be addressed, so that Pete's disease can be addressed.

In this way, Pete needs psychological as well as physical and spiritual help. The problems, however, lie in the fact that Pete accepts his situation and disease as Divine punishment, is reluctant to seek counseling nor to confide in his wife. For Pete to be helped, he needs to help himself and the first step, therefore, would be to find means to help him overcome his depression so that he can see his situation as is, accept the proffered help and assemble a network of support and social workers as well as medical service that can help him put his life together.

Recommendations

The biomedical model can be used to deal with the physical causes and results of depression. Conventional medicine can be applied here. Conventional healing can be supplemented by the social model that provides the client with social support (e.g. referring Pete to an AA group and counseling as well as social work services).

Once these have fractured the depression and, accordingly, the drinking problem, the other components of Pete's personality and situation (as, for instance, dealing with the marital issue - how to tell his wife; the parental issue; how to tell his children; financial components, making a move in business and living locations if need be and dealing with revelations and possible consequent changes in his workplace etc.), a.k.a the holistic model, can be addressed. This may involve religious guidance (a chaplain for instance), as well as finding as means to resolve his situation with family, and possibly, although not necessarily with friends. Most important, Pete has to be at ease with himself. It is not just Pete but his family, friends, workplace, other partners who need similar assistance. With the holistic model as guidance, we can hope to help Pete, his family, and others deal with this agonizing and challenging situation.