Case Study: Bruce /Brenda

Case Study Reflection: Bruce/Brenda Gabriel R. Boynton Abnormal Psychology Professor Wolfson September 24, 2012 Diagnostic Overview: Gender Identity Disorder (GID) is defined as: â€Å"strong and persistent cross gender identification† and â€Å"persistent discomfort with his or her sex or sense of inappropriateness in the gender of that sex (DSM-IV)†. Put simply: it is a painful inner conflict between a person’s physical gender, and the gender he or she identifies as. For example, a person who identifies as a boy may actually feel that he is, and act like a girl.In response to those feelings, people with GID may act and/or present themselves as members of the opposite sex. The disorder may affect things such as their choice of sexual partners, mannerisms, behavior, dress, as well as their own self-concept. Males with GID are often characterized by feminine behaviors such as: â€Å"wearing his mother’s clothing, displaying a great interest in girlsâ€℠¢ toys, playing with girls, and showing distress over having male genitalia (Gooran)†. Associated essay: Nature or Nurture: The Case of the Boy Who Became a GirlIn contrast biological females with GID will most likely exhibit typical masculine behaviors such as: â€Å"rough (masculine) games, refusing to wear dresses, becoming very athletic and strong, and identifying more with her father (Gooren)†. â€Å"True cases of GID are fairly rare and occur in only 3 to 5 percent of the U. S. population (Meyer)†. The exact cause of GID is unclear, however â€Å"hormones in the womb, genes, and social and environmental factors (such as parenting) may be involved (NLM)†. Observable symptoms almost always present in early childhood. Case History:David Reimer was born as a twin on August 22, 1969 to Ron and Janet Reimer. His given birth name was Bruce; his twin brother was named Brian. Both babies were born as healthy males. When the twins were about 7 months old, their mother noticed that â€Å"the skin on the tip of her sons’ penises was sealing over, making the act of urination particularly painful and difficult. On the advice of their doctor, Janet took the twins to the local hospital to be circumcised to correct the problem (Meyer)†. On April 27, 1966 a urologist performed the circumcision operation using the unconventional method of cauterization. The procedure did not go as doctors had planned, and Bruce’s penis was burned beyond surgical repair. The doctors chose not to operate on Brian, who’s phimosis soon cleared without surgical intervention (CBS)†. So botched was the surgical procedure that the sex organ resembled a burned piece of flesh, rendering it useless as well as lifeless. â€Å"Eventually Bruce’s penis dried up and flaked away until there was no sign that he had ever had any sort of genital appendage (Meyer)†. The original plan by doctors was to construct an artificial penis for Bruce-a procedure called a â€Å"phallic reconstruction† or â€Å"phalloplasty†. This reconstructed organ would only serve as a urine conductor, and never be capable of sexual function. Concerned about their sons prospects for future happiness and sexual function without with a penis, Ron and Janet agreed to meet with John Money M. D. , at John Hopkins Hospital in Baltimore to discuss any and all options. Dr. Money suggested that Bruce be raised as though he had been born a female. â€Å"Won over by Dr. Money’s reputation, confidence, and charm the Reimers decided to follow his advice and raise their biological son Bruce- as their daughter, Brenda (Meyer)†.At the age of 22 months old, an orchiectomy was performed to remove Bruce’s’ testis. From that point on the main focus of the Reimer’s life was to try to raise Brenda as a girl. â€Å" She was clothed in dresses, given dolls and other feminine toys to play with, grew her hair long, and was encouraged to spend time and bond with her mother and play with other little girls at school (Meyer)†. This situation, however tragic†¦ seemed to make for a perfect case study. â€Å"What does gender mean if one male twin can be raised as a boy, while the other male twin becomes a girl (NOVA)†?However, it quickly became evident to everyone that Brenda was going to fight the forced femininity, desiring instead to â€Å"play with trucks and solders, getting into fights at school, and rejecting the dresses and ladylike attire. She even insisted un urinating in the standing position (Meyer)†. Years later Dr. Money published an article asserting that the experiment carried out with Brenda had been a resounding success. He wrote, â€Å"the child’s behavior is so distinctly feminine like that of a little girl her age, which differs completely from the behavior of her twin brother Brian (Money)†.The case became widely known in medical circles worldwide as: The John/Joan case†. At the age of 12, Brenda began a strict female hormone regimen. She began to develop breasts, hips, and an overall feminine shape. Eventually, her behavior began to conform to her physical appearance. However, this transformation did not help improve her psychological state. â€Å"Feelings persisted of being trapped in her own body, eventually she becoming socially isolated and depressed (Meyer)†. Brenda began seeing a psychologist named Dr.Mary McKenty who was successful in helping her face her anxiety, depression, and confusion. After seeing Dr. McKenty for a few months- at the age of 14, Brenda made the decision to stop living as a female, even though she was still unaware of the circumstances surrounding her gender identity issues. It was at this point that her parents â€Å"realized that Brenda was never going to embrace her surgically reassigned sexual identity, the finally decided the time had come for a troubling, yet inevitable confession (Meyer)†. After processing this revelation, Brenda’s decision to liv e as a male became concrete. She opted for testosterone treatments to masculinize her figure, and to undergo surgery to construct an artificial penis. She also changed her name from Brenda to David (Meyer)†. In no way did this mean David’s lifelong struggles were over. Multiple surgeries were needed to try and created a functioning penis. Psychological issues continued to plague him as well. During this time period, â€Å"he attempted suicide three times. The third- an overdose of pill- left him in a coma. He recovered and began the long climb towards living a normal life-as a man (CBS)†. David eventually met a woman, and the two fell in love. Due to the success of his surgery, he was able to have sex with her, and for the first time have a fulfilling sexual relationship. He married her in September 1990. Tragically, this happiness was short lived for David. He continued to suffer from severe depression, â€Å"which deepened markedly when his identical twin Bria n, killed himself in the spring of 2002 by an overdose of anti-depressants. David later became unemployed and was conned out of $65,000 by a scam artist. All of this contributed to marital problems, and on May 2, 2004, his wife suggested they separate (Meyer)†.David Reimer committed suicide on May 4, 2004. He was 38 years old. Analysis: The case of Bruce/Brenda is unique among GID cases in that its cause is not a mystery. David Reimer was born a male, in every sense of the word. â€Å"The origin of his disorder was in the environmental efforts to raise him as a female and not his true biological sex (Meyer)†. The damage done to him physically, mentally, and emotionally is almost uncomprehend able. Although his parents seemed to have had his best interest at heart, it is clear that the decisions made in his behalf were at times misguided, and certainly not the right ones for him.Stressors in his later life such as the suicide of his twin, the loss off income and money, a s well as the deterioration of his marriage, likely may have been enough to push many to their breaking point. It is tragic that David proved to be one of those many. From the Biological perspective- behavior, personality, and presumably gender are seen as products of genes and other biological processes. From this theory, a person is not born as a blank slate†¦ready to be molded by their parents, doctors, or surroundings.David Reimer seems to prove the validity to this perspective. The desire to live as a man was so strong, that he came to the conclusion he needed to as early on as age 14. I can only imagine the feelings he experienced when he learned the truth of his past. The validation must have been equal parts: relief and frustrating. Treatments: One might assume the preferred treatment for an â€Å"average† person with GID is psychological treatment. However, many transgender people as well as researchers support the declassification of GID as a mental disorder.Th ere are many reasons for this: â€Å"recent medical research on the brain structures of transgender individuals has shown that some have the physical brain structures that resemble their desired sex even before hormone treatment (Hamzelou)†. â€Å"Therefore, the most widely prescribed treatment option for the disorder is sex reassignment surgery (SRS) (Meyer)†. These are the surgical procedure s used to change a person’s physical appearance ,as well as the function of their existing sexual characteristics to resemble that of the other sex.Once a diagnosis of GID has been made, recommendation for SRS should be based on the following strict criteria: 1. The patient should show evidence of stable transsexual orientation 2. The patient should show insight into his/her condition and should not suffer from any serious psychiatric disorder 3. The patient should be able to pass successfully as a member of the opposite sex, and there should be clear evidence of cross gen der functioning 4. Improvement in personal and social functioning should be predicted for the individual prior to and after surgery (Benjamin, H) Personal Reflection:After reading about this man’s life, I am ashamed that I choose his case study because it, â€Å"sounded interesting†. Tragic- doesn’t begin to describe this poor man’s circumstances. Handled correctly by his doctors and parents, he may have had a fighting chance. I have come to appreciate that this disorder, like many others, should not be taken at face value. Be it because you had a bad urologist, or because you were born with this disorder†¦ more compassion for these people needs to be developed in our, as well as many other cultures. Bibliography 1. Meyer, R.G. , Weaver, C. M. : Case Studies in Abnormal Behavior 9th edition 2. DSM-IV-TR 3. Cohen-Kettenis &Gooran: Transexualism: A review of etiology, diagnosis, and treatment 1999 4. The U. S. Natinal Library of Medicine (NLM) 5. CBS N ews: David Reimer: The boy Who Lived as a Girl July 2002 6. Cohen, A. , Sweigart, S. : Sex Unknown; NOVA, PBS Airdate: October 30, 2001 7. John Money: Man Woman, Boy Girl: 1972 8. Hamzelou, J: Transexual differences caught on brain scan- January 26, 1011 9. The Harry Benjamin Internatinal gender Dysmorphia association- 1985

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Impact of Financial Crisis on the Role of the Labor Union Movement in the US - Essay Example It is generally agreed that due to union partnership, wages are often driven up and those who are members of the labor unions tend to benefit more from the labor unions as compared to the workers who are not the members of the unions. Due to higher wages, the overall costs are increased and countries lose their overall competitiveness and hence jobs relocate to regions like Asia to provide low cost labor services. The current economic situation is also a glaring example of how higher wages and costs associated with the unions can actually increase the cost for the firms and hence make them less competitive as compared to other countries with little or no union activity. The resources of the firms are already under stress and higher costs therefore can further increase the costs. It is pertinent to note that trade union movement, at the global level, has also transcended itself into a much bigger role. During the initial phase of the current economic recession, global leaders of the d ifferent labor unions actively coordinated with G20 countries to bail out the global economy. This active participation into the overall policy making process therefore suggest that with the advent of the current global crisis, trade unions have also evolved the much bigger role for themselves including the element of policy making. (Russell) There is also a growing demand from different other quarters to suggest that labor unions must play an active part in resolving the economic crisis. As such emphasis has been laid on the role of labor unions as the facilitators of the management in overcoming the economic crisis. This new role of the labor unions therefore suggest that at least in US, the overall role of labor unions is... This essay offers comprehensive review of the Labor Union Movement in the United States in the post-crisis years. The paper outlines the diminishing role of labor unions in the modern economy. The current economic recession in US and other developed countries of the world has resulted into sharp decline in employment level. As such firms are cutting jobs in order to become more competitive and save costs. Rising unemployment therefore has also resulted into the lack of new memberships for the labor unions thus effectively reducing their influence within the organizations. Sharp decline in the output and lack of demand is resulting into lower output produced by the firms. Government is also looking for ways to further streamline and rationalize its expenses. Labor union is considered as an organization of workers wherein workers collectively strive to achieve some common goals such as better pay, improved working conditions and other benefits. The collective bargaining agent role of the labor unions therefore outlines that labor unions have the explicit right to enter into negotiations with the management of the firm to make mutual decisions in order to safeguard the interests of the workers. There have been efforts in some States of US, wherein due to high cost paid to unionized public employees that the union activity in public organizations should be banned. This suggests that there is a huge cry over curtailing the union activity in order to avoid further damage to the pubic as well as private institutions.

Philosophy final paper pre-question Essay Example | Topics and Well Written Essays - 1500 words

Philosophy final paper pre-question - Essay Example have a function or activity, the good and the ‘well’ is thought to reside in the function.† Therefore, it is the human good which keeps the function the soul performs in accordance with virtue. The key points in Aristotle’s concept of function include the following arguments in brief: Aristotle argues that everything has a function or activity to perform. Further, based on this argument, he states that everything that has a function has a virtue as well. Therefore, it is the virtue of the thing that enables it to perform its function well. The basic function of the soul, as argued by Aristotle is to take care of things, rule and deliberate, and so on. Because, these are the activities one cannot perform without the soul. Again, the soul can perform well only when it has the virtue associated with its function. In this way, a good soul performs, takes care of things, and in general, lives a good life. This is where the conception of happiness comes into being. Therefore, the conception of happiness is mainly derived from the good functions performed by the soul while performing them all well with the nature of virtue. When the soul performs its function virtuously, then the soul becomes associated with justice. That means the just soul performs well and, therefore, lives well. That is how the soul is blessed with happiness. Whereas a bad soul does just the opposite of what a good soul does. In that sense, the bad or the unjust soul performs as well as lives badly and so is wretched. This is what Aristotle describes as the definition of the notion of happiness. In the process of his argumentation, Aristotle wants to identify happiness with virtuous activities performed by the soul. A happy man will have a pleasant life. However, pleasure is not the only good thing that happens to a happy man. In simple words, a happy man will share both a pleasant as well as virtuous life. When the notion of happiness is introduced, Aristotle proposes his view of

Effecte of hyperoxia in bovine bronchail epithelial tissue Dissertation

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Clinical Examination - Case Study Example History: This is a 56-year-old male who works in a travel agency. He is a smoker for years, and he is still smoking about 10 cigarettes per day. In this presentation, he started feeling breathless with his usual activity about a week back. He stays near his office, and normally he goes to work on foot. Previously he was able to walk to his office in a slower pace without much of discomfort; however, for the last 1 week or so, he is trouble covering this small distance without taking rest midway, and the distance for taking rest is decreasing day by day. Although with rest, the breathlessness seems to wane down, he is worried due to the fact that his feet are swollen, and this time the grade of swelling is much more than earlier ever. EHehHe has noted also that he is coughing a little with expulsion rusty sputum of small quantities. His sleep is disturbed since he can no longer sleep on the bed with usual two pillows that he uses, and of late, he needs to use 4 pillows which makes him reclined on the bed. Over the top of that he can sense his heart is beating faster, and last night he had to wake up from whatever sleep he was having with sudden episodes of acute breathlessness just after midnight. He is feeling fatigued, tired, and exhausted. His appetite is poor, he is having a bloated sensation in the abdomen, and heaviness in the upper part of his abdomen, more on the right hand side. From his previous visit, the doctor asked him to quit smoking, and he did not comply, and now he knows that like previous such episodes, he is going to have another now, and so he decided to visit the clinic. He has past history of congestive heart failure with ischaemic heart disease. He has no evident drug allergies or drug interactions. He is on diuretic and digitalis. He has associated hypertension. On interrogation, there is no suggestive history of weight loss or blood loss; however, he has gained some weight. Clinical Examination: On inspection, he was obviously with discomfort, and respiratory distress was obvious with nasal flaring, retraction of the suprasternal notch, moderate use of accessory muscles of respiration, and intercostal retraction. His vital sign examination revealed him to be puffy, with pallor. There was no cyanosis, jaundice, but he had grade 2 clubbing and +4 pitting edema in both the ankles and pretibial regions. There was no cervical lymphadenopathy, thyroid was not palpable, face was puffy. On examination, he had harsh vesicular breath sounds throughout the lung fields, with features of laboured breathing at a rate of 22 per minute at rest. The lungs were otherwise clear except at the bases, there were fine moist rales. There was no dullness to percussion in any lung area including the bases. His pulse rate was 92, blood pressure 100/92, peripheral pulses were equal volume on both the sides with carotids being palpably normal. The jugular venous pressure was elevat ed in clinical examination with distention up to 12 cm from the suprasternal notch on a 45 degree recline on the examination couch. The apical pulse was located in the seventh intercostal space 1.5 cm lateral to the left midclavicular line, and with close inspection, the apical impulse was visible. There was obviously evidence of cardiomegaly, but it was difficult to discern whether there was any