Defense, denial, and rationalization addicts use that slow the recovery process, and what family and friends can do to help.

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Denial and rationalization are two common defense mechanisms that addicts can use that can slow or prevent recovery. Denial is common among addicts. Denial happens when a person fails to accept or acknowledge a reality. Sometimes the truth hurts, and emotions can be difficult to deal with. Addicts can also be manipulative, and this comes from the addict’s ability to rationalize their behavior to themselves and to convince others that there is not a problem.

Everyone uses defense mechanisms to protect themselves from anxiety and in social settings to cope with what is happening around them. Defense mechanisms are usually healthy ways that people have to deal with whatever is happening but become pathological when maladaptive behaviors emerge from the unconscious mind to manipulate or deny reality. Addicts use defense mechanisms to rationalize their addiction and to protect their own ego.

Addicts deny that they have a problem. They deny that they are addicted or that an addiction is the cause of any negative consequences. Often times an addict will blame others for problems and therefore shift the focus off of themselves and the addiction so that someone else or something else is to blame. This is also the way that an addict compartmentalizes their addiction because morally the addict most likely does not want to be an addict or behave like an addict. Extreme denial can lead to dissociative disorders where the addict becomes detached from reality all together and can no longer cope.

Rationalization is the addict’s way of justifying their behavior both to themselves and to other people around them. Addicts can use logic manipulatively to avoid the issues of their addiction. They can even convince their friends and family that nothing is wrong and sometimes even have their friends and family rationalize their behavior for them. Projection and acting out are other defense mechanisms, but they also stem from the addicts ability to deny that they have a problem and shift the blame on to others therefore creating the rationalization that nothing is wrong with them and that someone or something else is to blame.

Defense mechanisms become an addict’s reality and recovery becomes further out of reach. Denial is a major roadblock to recovery and the main reason that addicts do not seek help. Nobody wants to admit that they are wrong or that they have a problem and lots of people do not like asking for help even when they know that they have a problem. A person will have a hard time accepting the fact that an addiction has taken control of their life and that can prevent treatment all together.

Family and friends may even deny that someone is addicted and say that the person has a reason for acting the way they do, that something bad is to blame. The sad thing about that is that the addict has to admit that they have a problem and take responsibility for their life. And sometimes, family and friends may know that their loved one is addicted but the more they push the addict to get help, the more the addict becomes further withdrawn from the people that could be positive influences in their life.

Common behaviors may include acting out, accusing loved ones of be judgmental and condemning, playing the victim, or manipulating the situation and blaming others, and minimizing harm caused by the addiction.

Depression and other mood disorders may also surface further complicating things for both the addict and the people around them. The addict may seem like they just don’t care. The addict may truly believe that they are the only one affected by the addiction and not realize the negative effects the addiction is having on their family.

Denial is just the start of complications to treatment. As the addict denies that they have a problem and places the blame on other things or other people, family and friends may also question their own beliefs about the addiction. Everyone starts to rationalize the addict’s behavior and make excuses. Reality becomes distorted and an addict may withdraw themselves from anyone that disagrees with them and become isolated, or they could just decide to hang around with other people that share their addiction. Afterall, those people are more understanding and less judgmental. The best thing that family and friends can do is admit that there is an addiction and to be understanding rather than judgmental.

How we approach intervention is important. It is possible to push a person further away and further into a crowd of people that share their addiction. This can result in death and other horrible outcomes. Strategies that are proven to be effective are motivational techniques that involve both the addict and their family and support group. Showing an addict how their addiction is affecting the people they care about can sometimes motivate them to change their life and their behaviors. Nobody wants to hurt the person they care about. It is also important to show the family how their action may be enabling the addiction or pushing the addict further away from accepting help. Counseling centers have experts that can help guide a family to accept that their loved one is addicted and teach family and friends to listen and understand the addict so that they can help them recover.

One of the best resources for family and caregivers is the National Alliance of Mental Health (NAMI) and a motivational tool they published several years ago for family members dealing with schizophrenia, “I am not sick, I don’t need help”. Although the booklet is written for people dealing with a family member that suffers schizophrenia, the techniques used to help them want help are also useful to help an addict accept help and it is a useful tool to teach family members and friends how they can help someone they care about who is suffering from addiction or some other disorder.

If someone you know is looking for free resources.

SAMSHA National Helpline 1-800-662-4357

US Substance Abuse and Mental Health Administration

Genetic Enhancements and Brain Machine Interfaces

“Even every one that is called by my name: for I have created him for my glory, I have formed him; yea, I have made him.” Isaiah 43:7

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Unfortunately, not everyone defines morals the same way and not all scientists look at the same moral compass. A few years ago, I looked at Karen Moxom’s Mind Over Matter Project that is moving beyond implanting chips in people who are paralyzed or missing a limb to implanting chips in addict’s brains to change their behaviors (Moxon, K, Ph.D., Ignacio Saez, Ph.D., and Jochen Ditterich, Ph.D., 2019). What I found disturbed me, and leads us back to moral and ethical questions about how technology should be used.

Karen Moxom speaking about her Mind Over Matter project stated that “Technology in neuroscience will soon let us simply think about something we want our computers to do and watch it instantaneously happen” (Moxon, et al., 2019). As the technology, she is working with becomes more available and safer to use there are also ethical questions to ask about when the technology is appropriate to use and how it should be used in the future. The technology can change someone’s life that is missing an arm or a leg by decoding algorithms of recorded neuron activity to carry out the patient’s intention to move. There is also a theory that the device will work with memory patients that suffer from Alzheimer’s or be able to change an addict’s decision-making process so that they make better decisions. Besides deciding how to use the device, there are also cost and inequality concerns because the device will be costly. Another concern is that no one knows what the societal impact of being able to plug thoughts into a computer will be. She did not mention any of those things in her reports though.

Besides the fact that technology has taken off so fast that there are not ethical guidelines in place to refer to when ethical questions arise, the definition of “personhood” may need to be changed to make the experiments legally ethical. Moxon’s study from 2015 intended to establish genuinely causal relationships between neurophysiological activity and behavior shows  brain-behavior causality can be achieved by disrupting neural activity with an external intervention and observing the consequent change in behavior. The study shows in neurorobotic BMI, brain-behavior causality is not between the brain and the body, but between the observed neurophysiological activity within the brain and an external device outside the body. Possibilities are endless and there are numerous studies about how neurol coding in the interface can be used to change behavior. They all show how beneficial the technology can be to someone that is missing a limb or suffering from paralysis or Parkinson’s disease but do not say much about the possible adverse effects of using the device.

“Who makes these judgments and how?” R&D (research and development) is crossing the line in genetic modifications. Science is always going to seek answers. Scientists are inquisitive beings that will always have more questions about how humans and other things are made and how to improve them. Addictions is a field with little scientific data to base any decisions on. Addicts are often misunderstood and are rarely cared for. Most addicts end up in jail and there are experiments there that raise ethical questions also, but the big question that I have about Moxom’s work is who gets to decide how a person is supposed to think and behave? To link that back to genetic modifications, who gets to decide what the perfect human is? Will we ever have eyes blue or brown enough? Will humans ever be the desired look? with the desired personality?

Who’s desire? It cannot be a matter for either science or society alone to decide. We as a culture have to decide what we will and will not accept as morally and ethically acceptable. Will we allow the definition of personhood to be changed so that scientist’s work does not legally violate human rights?

When considering genetic data healthcare professionals have to consider what data needs to be collected and how it should be analyzed and used. We also have to be careful with labels because words count and they can hurt. Patient’s lives can easily spiral out of control if they receive the wrong treatment or no treatment at all. Someone may become depressed or financially stressed, and that can lead to more problems with a person’s health. Low self-esteem about a known genetic characteristic might lead someone to think that they cannot be a good parent or that they can only have children that are physically and mentally disabled. Do we as a society believe that if someone does not look like or think like us that they should not be born? Adoption and fostering is an alternative that many people with physical disabilities choose to take out of fear that giving birth to a biological child will create a person who’s life will not be successful and appreciated. While many children do need homes and people that they can trust, do the genetically challenged people that want children think that by chosing to adopt and foster believe that they are receiving the “perfect child” because of the way that the child looks? That person will end up being disappointed because most orphan children have already suffered unthinkable trauma that looks cannot cover up. Jiankui’s work creating genetically enhanced babies was condemned because he deceived vulnerable patients into using a risky, untested procedure with no medical justification (Sample, 2019).

Society needs to be more aware of how our thoughts and actions affect others. Genetic enhancement can be life-saving such as with treating memory problems before a patient develops Alzheimer’s, or to cure blood disorders, cancer, blindness, AIDS, cystic fibrosis, and other diseases. Genetic screening can be used by doctors to detects pre-existing genetic characteristics.  The goal for most medical scientists is to create a healthier society. Gene editing can be done to prevent diseases, cure diseases, and to change or improve physical appearance, metabolism, and physical capabilities. Mental faculties such as memory and intelligence can also be genetically enhanced. Food can be genetically modified and created.

Beneficence is a foundational moral principle that means that doctors have a moral obligation to make decisions based on what is best for the client and to set their own needs aside to focus on the needs of the clients throughout the relationship. Fidelity is a moral principle that pertains to the importance of building relationships based on trusts. On agreeing to participate in a research project, participants are entrusting themselves to the researcher who has an obligation to protect each participant as much as possible from any harm as a result of participating in their research. Most genetic enhancements probably are for the good of the patient, but then there are other processes and procedures that may cause more harm. The entire mind, body, and spirit of each patient would have to be evaluated to assess how appropriate a genetic enhancement will be. In doing so I hope that doctors will remember that we are all made by God and in his image.

References

Moxon, Karen,  Guglielmo Foffani, (Brain-Machine Interfaces beyond Neuroprosthetics, School of Biomedical Engineering, Science and Health Systems, Retrieved From,), http://dx.doi.org/10.1016/j.neuron.2015.03.036

Moxon, K, Ph.D., Ignacio Saez, Ph.D., and Jochen Ditterich, Ph.D., (2019), Mind Over Matter: Cognitive Neuroengineering, The Dana Foundation, Retrieved From, http://dana.org/Cerebrum/2019/Mind_Over_Matter_Cognitive_Neuroengineering/

Sample, Ian, (2019), Chinese scientist who edited babies’ genes jailed for three years, The Guardian, Retrieved from, https://www.theguardian.com/world/2019/dec/30/gene-editing-chinese-scientist-he-jiankui-jailed-three-years

The Biological Basis of PTSD

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that occurs after a person experiences a traumatic event. PTSD can be the result of combat, abuse, assault, a natural disaster, an accident, or a terrorizing event (DSM-5). Symptoms can include a person reliving the event so much so that they live their life on guard as if they expect the event to reoccur. They may even isolate themselves socially so that they avoid reminders of the event. Sometimes people with PTSD develop anxiety, become depressed, or turn to drugs to escape.

Psychological distress following exposure to a traumatic or stressful event with or without fear-based symptoms can vary. A combination of symptoms has been recognized in the DSM to include adjustment disorders marked by reactive attachment disorder and social engagement disorder that can develop into PTSD. The DSM includes diagnostic criterion for trauma and stress related disorders such as reactive attachment disorder, disinhibited social engagement disorder, post-traumatic stress disorder, acute stress disorder, and adjustment disorders. Clinical characteristics of anhedonic and dysphoric symptoms resulting from demanding situations or the inability to feel pleasure because of circumstances are shown in the DSM-5 for both children and adults. The DSM considers direct and witnessed exposure to actual or threatened death, serious injury, or sexual violence leading to reoccurring involuntary, and intrusive distressing memories of the trauma. Flashbacks and other disassociative reactions are also listed to make the diagnosis.

These reactions to fear can cause problems in relationships and at work so what is happening? Neurobiological and physiological changes happen after a traumatic experience in the central and autonomic nervous systems. The brain rewires itself to cope with the experience by decreasing the volume of the hippocampus and activating the amygdala. The brain begins to act differently in an abnormal way so that processing memories is affected that can result in physical behavior that cause the body to act as if it is reliving the experience. These behaviors may cause other physical damage, but more research has to be done to find out what the physical and medical effects of PTSD actually are.

If symptoms are persistent and last for more than a month, a doctor can diagnose PTSD by gathering medical history and completing a physical exam on the patient. The physical exam rules out any physical causes of the symptoms.  After ruling out any physical or medical reasons someone shows symptoms of PTSD, the doctor can then refer the patient to a psychiatrist, psychologist, or other mental health professional that is specially trained to assess and use tools to evaluate a patient for PTSD.

Treatment for PTSD can involve both medication and counseling with the goal of reducing symptoms to help the patient cope and make daily life manageable. Psychotherapy can be used with both the patient and the family to teach new coping skills and to help work through the symptoms of PTSD. Patients that attend individual, group, and family therapies have better outcomes than patients that attend individual therapy or do not seek treatment at all. Medications may include serotonin inhibitors (SSRIs) such as Paxil, Celexa, Luvox, Prozac, and Zoloft; and tricyclic antidepressants such as Elavil and Doxepin, mood stabilizers such as Depakote and Lamictal, and atypical antipsychotics such as Seroquel and Abilify are sometimes used to control feelings of anxiety. Blood pressure medicines such as prazosin or propranolol are also sometimes used to control nightmares.

Related Articles: Parents Mental Health, Foster care, Addictions, and Prisons, Our Words Matter., BioEthics of using Stem Cells, Cloning, Genetic Enhancements, Brain Machine Interfaces, and rapidly growing technological advances in science, Think it won’t happen to you? Mom, who got $9.6M in same case, daughter sued Orange County. A look at the Right To Lie Case., Divorcing millennial parents choosing to keep their children in their homes by Birdnesting.

Ethics regarding cloning

Are clones property, or human beings? What rights do clones have? And what rights do others have over clones?

Cloning is something that I think we need to discuss more. I agree with you that healthcare professionals are constantly challenged. Saving lives and making lives better are not easy tasks. The idea of cloning humans raises so many questions in my mind. Why should humans be cloned? What purpose does cloning humans serve? Why would someone want to produce individuals, entities or populations, identical to the parent or original organism from which they were obtained or derived (Iqbal et al., 2020)?

I agree that the idea of saving stem cells from umbilical cords can be useful and ethical, but how many people can afford to store the stem cells once they are harvested? Cloning organs this way is probably the most ethical way to clone organs, and it is certainly better for the patient receiving identical body parts. Are scientist considering cloning people for their organs? That is scary! I would hate to know that the only reason for me being on earth is so that someone could harvest my organs.

Cloning can be useful and improve some people’s lives, but there are still so many unanswered questions about it that I hope the experiments would be limited to plants although I have read about experiments using animals. Legal and ethical issues arising from the human genome project at the Indiana University School of Law-Bloomington in 2001 included discussions about the methods used to clone, whether or not cloning is feasible, and property rights issues (Hilmert, 2001).

There are two methods used in cloning; blastomere separation which involves splitting an embryo soon after fertilization and the somatic nuclear technique (SNTC) that was used to clone Dolly (Collins, 2006) which is a technique that removes the egg cell and replaces it with the nucleus from a somatic cell (Hilmert, 2001). Both methods are capable of creating clones.

Back in the early 2000s when lawmakers were making legislation to ban cloning, a former ethicist for the NIH, John Fletcher, commented, “the reasons for opposing this are not easy to argue.” (Hilmert, 2001). We are now twenty years down the road and scientists are cloning organs. Therapeutic cloning, which is also known as organ cloning, is the process of creating new human organs and tissues, never newborn babies, from the cultivation of stem cells. As such, the resultant organ has an identical gene structure as the recipient such that there are theoretically little chances for rejection (Surfcrs, 2011).

We have a moral obligation to cure diseases when we can, and to save lives when we can, but it is still unclear what rights a clone has and who owns the rights to a tissue. Could a clone ever be developed for the well being of the clone?  Cloning plays an important role in the development of stem cell research for embryonic stem cells transplantation into patients because the stem cells would be a genetic match for the donor patient. There would be no risk of rejection and for xenotransplantation which is the cloning of organs using animals that has a higher rejection rate.

Who owns the clones? Courts already recognize a property interest in living material.” Several different parties may potentially claim cloned organs or tissues: the DNA/tissue donor, the clone, and the scientist who developed the cloned tissue/organ or transgenic animal (Hilmert, 2001). Property law governing renewable and nonrenewable body parts addresses ethical and moral questions. The DNA donor to has an interest in his or her own DNA and any claim over the organs of the clone. In the cloning case, Moore v. Regents of the University of California, the court determined Moore had a cause of action for breach of fiduciary duty, but the court declined to find a cause of action for conversion.’ To bring an action

for conversion, Moore had to “establish an actual interference with his ownership or right of possession” (Hilmert, 2001). In other words, he had to have retained ownership of his cells after they had been removed. The court in Cornelio v. Stamford Hospital” followed a similar line of reasoning. However, other cases indicate that there may be property interest in cryopreserved pre-zygote and the Hecht v. Superior Court that involved property rights concerning sperm(Hilmert, 2001).

Patentability of living things is addressed in the Diamond v. Chakrabarty case where the respondent filed a patent application for a genetically engineered bacterium capable of degrading oil, something which no naturally occurring bacteria is known to do. The patent examiner rejected the claim on the grounds that “micro-organisms are ‘products of nature,’ and… as living things they are not patentable subject matter.” But the Court of Customs and Patent Appeals, Supreme Court found the bacterium is  patentable subject matter under § 101 of the Patent Act and reversed the decision (Hilmert, 2001).

Patent US 6,211,429, granted to the University of Missouri on April 3, 2001 by the United States Patent and Trademark Office (PTO) was written so broadly that it appears to include human cloning and products of cloning in its protection (Cunningham, 2002). Cunningham’s vision of public policy concerning humans either conceived or created through science entails; a right to autonomy, i.e., that his or her bodily integrity must not be invaded or compromised by others; No person or entity has the right to enslave, own, or control any human being, regardless of stage of biological development; Any organism that is genetically human is a human being; A cloned embryo is distinct and separate from the person donating the genetic material, and therefore is a unique being protected in law; No person or institution has the right to control or profit from any process designed to clone a human being.

Related Articles: BioEthics of using Stem Cells, Cloning, Genetic Enhancements, Brain Machine Interfaces, and rapidly growing technological advances in science.

References

Collins, F. S. (2006). The language of God: A scientist presents evidence for belief. New York,          NY: Free Press. ISBN: 9781416542742.

Cunningham, Comstock, (2002), The Right to Patent a Human Being: Fact, Fiction, or Future Possibility?, The Center for Bioethics and Human Dignity, https://cbhd.org/content/right-patent-human-being-fact-fiction-or-future-possibility

Hilmert, Laura, J., (2001), Cloning Human Organs: Potential Sources and Property Implications, J.D., Indiana University School of Law-Bloomington 2001; B.S. Biology, Indiana, University, 1998, Retrieved from, http://ilj.law.indiana.edu/articles/77/77_2_Hilmert.pdf

Pozgar, G. D. (2019). NVPMD: Legal aspects of healthcare administration. 13E-Liberty Custom. Burlington, MA: Jones & Bartlett. ISBN: 9781284170931.

Surfcrs, (2011), Organ Cloning Ethics, http://www.cloneorgans.com/organ-cloning-ethics/18/

BioEthics of using Stem Cells, Cloning, Genetic Enhancements, Brain Machine Interfaces, and rapidly growing technological advances in science.

Discussing bioethics and rapidly growing technological advances in science.

I was a little confused this week when I started looking at the different ways that scientists can use technology to enhance patient’s lives. Actually, I think I still am a little fuzzy on the subject and the differences between techniques. The discussion surrounding genetic enhancements is similar to the discussion about the use of stem cells. Cell therapy can be defined as a technique that infuses or transplants stem cells into patients to treat diseases or repair tissues. The key difference between gene therapy and stem cell therapy is that in gene therapy, genetic material is injected to patients while, in stem cell therapy, whole cells are injected to patients to treat diseases (Samanthi, 2017). Both bring up varying ethical issues about how this knowledge should be used and when it should be used.

The somatic cell nuclear transfer (SCNT) that scientists used to clone Dolly the sheep stirred the entire world (Collins, 2006). People wondered how long it would be before scientists cloned people and when and if so, if those people would be spiritual human beings. The good that came from the experiment is that life-saving human organs can be cloned. Would it be ethical to clone a human for organs? It is scary to think of where this science is capable of going.

Technology is advancing faster than the ethical guidelines for it are. Karen Moxom created a mind-over-matter project decades ago to help patients regain use of their limbs (Moxon, et al., 2019). It sounded like sci-fi fiction back then and it still does to some people today. As with neurotechnology, stem cell technology is also a rapidly advancing science that can greatly improve patient’s lives. One of the most useful and least questioned techniques to harvest stem cells is from the umbilical cord. The cost of getting the stem cells and then storing them until they are needed is more than most people can afford though. Deciding right and wrong, costs, and equality concerns, and the overall benefit to humanity will help us put guidelines in place for future experiments.

Stem cell research and cloning raise the issue of clones having a living soul. I looked up the definition for personhood at dictionary.com and found it defined as; the state or fact of being a person, the state or fact of being an individual or having human characteristics and feelings. Genetics makes up our physical bodies, and environmental factors form our developed feelings. Maybe our DNA holds more than we think it does. Bioethics addresses complex issues about how vulnerable people should be treated (Pozgar, 2019). Clones would most definitely be a vulnerable population that people would want to know the answers to many questions about.

Related Articles: Ethics regarding clones

References

Collins, F. S. (2006). The language of God: A scientist presents evidence for belief. New York,  NY: Free Press. ISBN: 9781416542742.

Moxon, Karen,  Guglielmo Foffani, (Brain-Machine Interfaces beyond Neuroprosthetics, School of Biomedical Engineering, Science and Health Systems, Retrieved From, http://dx.doi.org/10.1016/j.neuron.2015.03.036

Moxon, K, Ph.D., Ignacio Saez, Ph.D., and Jochen Ditterich, Ph.D., (2019), Mind Over Matter: Cognitive Neuroengineering, The Dana Foundation, Retrieved From, http://dana.org/Cerebrum/2019/Mind_Over_Matter_Cognitive_Neuroengineering/

Pozgar, G. D. (2019). NVPMD: Legal aspects of healthcare administration. 13E-Liberty  Custom. Burlington, MA: Jones & Bartlett. ISBN: 9781284170931.

Samanthi , (2017), Difference Between Gene Therapy and Stem Cell Therapy, Key Difference – Gene Therapy vs Stem Cell Therapy, https://www.differencebetween.com/difference-between-gene-therapy-and-vs-stem-cell-therapy/