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By R. Ronar. Lancaster Theological Seminary.

Then the telephone rings buy 50mg imitrex with amex, and one of my friends asks me to join her on an outing—a movie effective 50 mg imitrex, an exhibit, a meeting, a shopping mall, a friend’s home, or just a drive. Once I’m involved in something that is interesting, challeng- ing, or just fun, I observe that I can go much longer without med- ication and still feel good. I don’t fully understand it, but I know that I feel better and like myself more when I have a positive attitude. Of course, my state of mind affects my family and friends— and everyone around me. How many times have I heard Blaine say that he didn’t know what he would do if I had a poor attitude about Parkinson’s. Of course, we all have bad spells, but learning how to deal with them is the most important thing. For example, after I have done a certain amount of housework and feel wound down and achy all over, I know it is time to sit down and relax with a maga- zine or a cup of decaffeinated coffee. When I’m depressed, I try to spend an hour visiting someone whose company I enjoy. I’ve noticed that even patients who are confined to wheel- chairs can have positive attitudes. An eighty-six-year-old lady came to our support group meetings faithfully for five years, and the last two of those years she was in a wheelchair. She always said such nice things about her daughter and other caregivers, and they always said such nice things about her. Mark Flapan, a psychologist in New York City, has writ- ten with great insight about the role that attitude plays in Parkin- son’s disease. His article, "Living with Parkinson’s: What You Can Do for Yourself," in the Autumn 1989 issue of the PDF Newsletter, speaks to each one of us: Your Mental Outlook Makes a Difference Even if you or your doctor can’t do any more for your disease than you are doing, you can still do more for your life. You can always learn to live better with Parkinson’s since how you live with your illness comes from your mental outlook—and your mental outlook is something you can do something about. What’s most important in your mental outlook is how you view and judge yourself as a person with Parkinson’s. As it hap- pens, how you view and judge yourself can undermine your life as much as your illness can—maybe even more. Possibly you believe you got Parkinson’s because you didn’t take proper care of yourself over the years, or you did something harmful to your body. If that’s attitude makes all the difference 59 the case, you know something the doctors don’t know, since medical research has yet to find the cause of Parkinson’s. Maybe you believe Parkinson’s is God’s punishment for bad behavior—although you don’t know what you did that was bad enough for you to deserve this. I realize that religions have taught that disease is punish- ment for sinful behavior. If you’re troubled by this thought, I suggest you talk to a pastoral counselor of your religion or read Rabbi Kushner’s book When Bad Things Happen to Good People. You undermine your life if you feel guilty because you think you are a burden on your family. Even though Parkinson’s has affected your family, it isn’t as though you’re deliberately doing something by being sick. When it comes to an illness, there is a big difference between doing something and being something. Furthermore, it’s only by chance that Parkinson’s is in your body rather than in the body of some other family member. After all, it could have been your marital partner who got the disease instead of you. But no matter which member in a family happens to get a chronic illness, the whole family is affected, and each family member has to cope with the illness in some way. Just as you didn’t do anything to get Parkinson’s, you can’t do anything to make it go away. Therefore, you’re not responsi- ble for the physical effects of your illness on your family. But you are responsible for the effects of your mental outlook on your family, because this is something you can change. You undermine your life if you de- value yourself as a person because you have Parkinson’s—if you view Parkinson’s as a weakness, a stigma, something to be ashamed of, rather than as a biological happening. You’re a Person—Not Just a Body There is no question, your body is not what it used to be.

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The medical profession has allowed the public to believe that there is only one way to do anything; that all actions are classifiable in categories generic 50mg imitrex otc, and that the labels of such categories dictate the best actions purchase imitrex 50 mg on line. A public which believes in a simplistic Holy Writ of good practice is a public ready to misunderstand subtleties. We can pretend to have abdicated judgments even though we know we make them all of the time, or we can showcase the value and importance of judgment and ask the public to help us make it better. If caregivers were to drop the pretense that they always adhere to a single gold standard; if they were to stop dictating boilerplate notes which were window dressing only, and which misdescribe actual encounters; if they stopped pretending that they had secret knowledge on which they had a patent; if they made it plain to all that they shared common human foibles; and if they realized that other callings and ways of life were equally as special and important as their own; then they could elicit trust and support from an intelligent society. CONCLUSION Means and ends deliberation is properly broad, not narrow; dynamic, and not static. The categories it uses are not classical, but are radial, generated by various imaginative modes of extension from prototypical core examples. It conceptualizes problems and situations metaphorically, taking advantage of basic embodied image schemas and applying them imaginatively to domains which lend themselves to this type of understanding and no other. Among such conceptions are multiple metaphors 168 CHAPTER 6 for and levels of causation which fail to be analogous to logical entailment. Anglo- American medical care exemplifies such reasoning with its complex, multiply metaphorical conceptualization of disease and the causation of disease. If anything typifies full-spectrum means/ends reasoning it is reciprocity, as opposed to rigid compartmentalization. John Dewey discussed the interrelation of means and ends extensively, as well as the dynamic and not static process involved in developing and attaining ends. Yet, they relate one to another and affect one another in the processes and outcomes of means/ends activity. Balance or harmony, much as Aristotle understood it, has much to do with this relation of qualities. Narratives are arrangements over time which allow qualities in experience to form an array in which they are mutually enhancing. Values are realized in narratives that relate process and product without compart- mentalizing them. These narratives realize old values only as they rejuvenate them in the creation of the new. Because values support each other and are neither isolated nor fungible, expected utility theory is not suited for application to most aspects of an endeavor like medical care. Qualitative, dynamic and interacting values just cannot be modeled on the number system. If we think that it leads us often astray, there are ways other than cutting ourselves off from it, to correct many of its errors. Despite the usefulness in certain instances of conceptualizing mind as a machine, the mind is not a machine. Let us temper distrust of our own capacities for means/ends deliberation with an appreciation of how, why and when they do work well. When rules are felt to be self-sufficient and superior to judgment, then the cultivation of good judgment, as well as the intellectual and moral virtues underlying it, languishes. The healing professions need to recruit, entrain and respect the virtues that make us worthy of trust. This is not to say that the particular emotional attach- ments which drive and motivate individual practitioners should be the paramount virtues of public policymakers. Indeed, objectivity, justice and fairness are essential in formulating policies which must apply to all, such as government regulations and the financing of health care. However, the impartial policymaker must be aware of the limits beyond which impartiality will not carry him. Unless uniqueness of caring and care is allowed its proper place overall, the general enterprise of medicine will fail. Although the health professions use and still exemplify the use of informal means/ends reasoning, many caregivers have been in denial of that fact, and others fail to appreciate it. A profession is not an industry and cannot function or be assessed like an industry.

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