Unit One Essay Assignment Developmental Psychology: Lifespan
Note: I expect all essays in this class to be at LEAST 1 page long typed, double spaced (12 pt TNR font) or equivalent. For some questions you may need significantly more space.
DO NOT PLAGIARIZE THE REFERENCE MATERIAL; make sure to use your own words.
Your text in chapter two talks about prenatal diagnosis and detection of disorders. If you were having an (or another) child, what kind of tests would you want done (if any)? For each of the following prenatal diagnostic methods first explain what it is, when it is done and what medical benefits and risks it has. Next discuss for each whether you would consider having that type of testing done (and why or why not). Address at least the following methods: Ultrasound, maternal blood analysis, Amniocentesis, Chorionic Villus Sampling. Finally I would like you to discuss the greater societal impact that genetic testing has and could have on our culture. In what ways is genetic testing good or bad for us as humans/Americans/etc? Make sure to read the reference material below.
Read the information below on postpartum depression and psychosis. Then write an essay analyzing Shelley Ash’s & Karen’s cases. For each case, cite the frequency of the disorder in the general population, then describe the symptoms you feel are consistent or inconsistent with a diagnosis of postpartum psychosis or depression, and share your opinion about whether Shelley and Karen did indeed suffer from these disorders. Finally, discuss what steps could have been taken by the medical community, themselves and/or their families in these cases to prevent Ash’s suicide attempt and Karen’s early emotional separation from her child.
New York Times
MIA PETERSON is not a fan of tests. Because she has Down syndrome, she says, she cannot always think as fast as she would like to and tests end up making her feel judged. A recent driving test, for instance, ended in frustration.
Ms. Peterson, 31, the chief of self-advocacy for the National Down Syndrome Society, prefers public speaking and travel. And her test aversion extends to the latest one designed to detect Down in a fetus. "I don't want to think like we're being judged against," Ms. Peterson said. "Not meeting their expectations."
Heralded in the Nov. 10 issue of The New England Journal of Medicine, the new prenatal test provides earlier, more reliable results for all women than the current test, which is routinely offered to only older women who are at higher risk. But for people with Down syndrome and the cluster of other conditions subject to prenatal screening, the new test comes with a certain chill.
Because such tests often lead to abortions, people with conditions from mental disability to cystic fibrosis may find their numbers dwindling. As a result, some fear, their lives may become harder just as they are winning the fight for greater inclusion.
"We're trying to make a place for ourselves in society at a time when science is trying to remove at least some of us," said Andrew Imparato, president of the American Association of People With Disabilities, who suffers from bipolar disorder. "For me, it's very scary."
Some bioethicists envision a dystopia where parents who choose to forgo genetic testing are shunned, or their children are denied insurance. Parents and people with disabilities fear they may simply be more lonely. And less money may be devoted to cures and education.
The Cystic Fibrosis Foundation, for instance, does not endorse prenatal testing, which the American College of Obstetricians and Gynecologists recommends offering during pregnancy.
"If you can terminate pregnancies with a condition, who is going to put research dollars into it?" said Nancy Press, a professor of medical anthropology at Oregon Health and Science University.
Indeed, the $15 million spent on the new test for Down by the National Institute of Child Health and Human Development might have gone instead toward much-needed research on the biochemistry of people living with the condition, said Michael Bérubé, co-director of the disabilities studies program at Pennsylvania State University.
Mr. Bérubé, whose 14-year-old son has Down syndrome, worries that if fewer children are born with the condition, hard-won advances like including them in mainstream schools may lose support. "The more people who think the condition is grounds for termination of a pregnancy, the more likely it will be that you'll wind up with a society that doesn't welcome those people once they're here," he said. "It turns into a vicious cycle."
Anthony Shriver, founder of Best Buddies, a nonprofit organization that helps people with intellectual disabilities form friendships, said smaller numbers will mean even greater social isolation for the people his group serves.
"Loneliness is one of the most significant challenges they face," Mr. Shriver said. "And it would only become more acute as they became a smaller segment of the population."
Beyond the impact on the disabled, disabilities activists say, the implications of prenatal testing for diversity and democracy require more attention than they have so far received.
Lisa Hedley, whose 10-year-old daughter has dwarfism, said the condition is usually not detected prenatally. It is so rare that it has traditionally not been considered worth the expense of the genetic test. Soon, though, pregnant women may be offered a gene-chip technology that can perform hundreds of tests at once for a few hundred dollars.
"It's so complicated," said Ms. Hedley, president of the Children of Difference Foundation. "Would I choose to have my child have a disability? Oh my goodness, no. It's difficult for her. It's difficult for everyone. But difference is what makes the world go round."
Supporters of abortion are especially wary of wading into a discussion over the ethics of prenatal testing, lest they be seen as playing into the opposing side in the fraught national debate over abortion rights. But advocates for people with disabilities are troubled by how much faster the science of prenatal testing is advancing than the public discussion of how it ought to be used.
If no child is ever born again with the fatal childhood disease Tay-Sachs, many might see that as a medical triumph. But what about other conditions, including deafness, which some do not consider to be a disability, and Huntington's Disease, an adult-onset neurological disorder?
Among the difficult choices facing prospective parents in coming years, genetics researchers say, will be the ability to predict the degree of severity in chromosomal abnormalities like Down syndrome, which can cause mild to moderate retardation.
"Where do you draw the line?" said Mark A. Rothstein, director of the Bioethics Institute at the University of Louisville School of Medicine. "On the one hand we have to view this as a positive in terms of preventing disability and illness. But at what point are we engaging in eugenics and not accepting the normal diversity within a population?"
Abortion, Mr. Rothstein and others fear, could become a kind of "poor man's gene therapy," if cost-conscious health insurance companies see it as less expensive than treating a disabled child. Others argue that prenatal testing will be limited to those who can afford it, leaving the poor to grapple with genetic disability and disease.
Of course, as more conditions are diagnosed in utero, many parents may simply decline testing, or use the information to prepare themselves. But studies have shown that women are considerably more likely to terminate their pregnancies if they know of fetal anomalies.
One study of 53,000 women's choices, published in Obstetrics & Gynecology in 2002, found that the termination rate ranged from about 1 percent for conditions that were classified as having no impact on the quality of life, to 50 percent for those considered to have a serious impact.
Women were far more likely to choose abortions for disabilities that have a high probability of affecting cognitive functioning. For conditions that have little or no impact on the quality of life but might require medical or surgical therapy, the abortion rate was 16 percent, but doubled for those likely to cause mental dysfunction.
As for Down syndrome, doctors estimate that about 80 percent of women who get positive test results choose abortion.
Still, some who work with Down syndrome children don't believe the future is that grim. Allen C. Crocker, director of the Down syndrome program at Children's Hospital Boston, believes that number of women who choose to continue their pregnancies will go up in the coming years.
Even as genetic tests appear to have lowered the number of Down syndrome births, he said, social conditions for people with the conditions have improved markedly.
"We're in the midst of a gentle social revolution," said Dr. Crocker, and, he believes, it may just outpace the scientific one.
REFERENCE MATERIAL FOR ESSAY TWO:
Note: 'baby blues' is NOT the same as postpartum depression.
One Mother's Story
Postpartum Psychosis: Rare, Frightening and Treatable
Feb. 18, 2002 -- Today in Houston, a jury will begin hearing testimony in the murder trial of Andrea Yates. She's accused of drowning her five young children last June. Her lawyers have said she'll plead not guilty by reason of insanity, citing her history of postpartum depression with psychosis. For Morning Edition, NPR's Joanne Silberner reports that the condition is rare, frightening -- and treatable.
When Shelley Ash of San Jose, Calif., was pregnant five years ago, she read all the baby books she could. She never came across the term postpartum psychosis. Then she gave birth to her son. "I knew right away something was wrong," says Ash. She sensed she was watching the delivery from above. She was terrified. Hospital nurses told her the feeling would pass. It didn't, even after she and her baby went home. Ash says was pacing all the time, and caught in a horrible depression. She was constantly crying, couldn't sleep and couldn't eat.
Symptoms of Postpartum Psychosis Postpartum psychosis is a more rare and severe disorder than postpartum depression. It affects about 1 in 500 to 1,000 new mothers. Onset is severe and quick, and should be treated as a medical emergency. Symptoms include:
Delusions, or false beliefs.
Hallucinations -- hearing voices or seeing things that are not real.
Thoughts of harming or killing the baby.
Unwillingness to eat or sleep.
Severe depressive symptoms.
Symptoms of Postpartum Depression About 70 percent of new mothers get the "baby blues" -- feelings of anxiety and irritability that can hit three or four days after delivery, but disappear quickly. Postpartum depression, which can appear even a year after giving birth, is more severe and can last for months, if not treated. About 1 in 10 new mothers experience the disorder. Symptoms include:
Severe sadness or emptiness; emotional numbness or apathy.
Withdrawal from family, friends or pleasurable activities.
Constant fatigue, trouble sleeping, overeating or loss of appetite.
A strong sense of failure or inadequacy.
Intense worry about the baby or a lack of interest in the baby.
Thoughts about suicide; fears of harming the baby.
This wasn't the "baby blues," a temporary anxiety and depression that hits about three-quarters of mothers. Nor was it the postpartum depression that afflicts one in 10 new mothers. As Ash eventually learned, she was suffering from postpartum psychosis, which hits about one in 500 to one in a 1,000 mothers within three months of birth.
"Postpartum psychosis is condition in which the person loses touch with reality," says Dr. Ralph Wittenberg, who runs a postpartum screening project in Washington, D.C. Mothers hear voices, see things and feel an irrational guilt that they've somehow done something wrong, he says. Without treatment, women may try to hurt themselves or those around them.
What was happening to Ash was beyond her control. Postpartum psychosis sometimes develops out of postpartum depression, or hits women who've had previous psychiatric problems. Sometimes, as in Ash's case, it shows up out of the blue. Psychiatrists aren't sure what causes such a sudden and powerful break with reality, but they believe the changing hormones and stress of childbirth are somehow involved.
Ash knew she was getting worse. The midwife in her obstetrician's office told her to call a psychiatrist. But that was the last thing Ash wanted to do. "I was terrified," says Ash. She was having delusions and was afraid that if she told anyone about what she was thinking or seeing in her mind, they would take her son away. But after one episode, she became desperate.
She remembers watching David Letterman drop watermelons from high places on his television show. "But that turned into my son," she says. "I kept imagining how it would be to drop him out of his bedroom window and he would go splat on the pavement below and shatter into a million pieces." The image was too much for her. Ash went to her bathroom cabinet and took an overdose of painkillers she had been prescribed for a previous back injury.
Her husband came home from a run to find her on the floor in the front hall, babbling, and he rushed her to the hospital. That pattern isn't unusual, says Dr. Nada Stotland, who specializes in women's health. Stotland says women with postpartum psychosis tend to know that something's wrong, but like Ash, they're often terrified to let anyone else know. Health professionals and family members need to recognize that delusions and really erratic behavior are sure signs of trouble, and that hospitalization and medication are needed, says Stotland.
Ash was hospitalized for a few days. She then spent 18 months on anti-psychotic, anti-depressant and anti-anxiety medications. Her son is now 5 years old and healthy. Ash got a graduate degree in public health so she could educate people about postpartum psychosis. She couldn't be happier now about her own health, or the health of her son. But she's not having any more children.
It's not worth the risk of getting sick again, she says. There's a 10 to 20 percent chance that without treatment, she would, according to British research. But Stotland and others say that with treatment at the first sign of a problem, women with a history of postpartum psychosis can safely have more babies. And while neither psychiatrist would comment on Andrea Yates -- the woman who killed her five children -- both say that the tragedy whenever a case of postpartum psychosis ends badly is that most likely it could have been prevented.
Karen's Story of Postpartum Depression http://www.bcrmh.com/womens_voices/karen.htm
My story is not as dramatic as many of the others; nevertheless, it was a difficult road to travel without support of informed doctors and therapists. My PPD started soon after giving birth to my second child. However, it didn’t become debilitating until my daughter was almost 7 weeks old. I became anxious and fearful to leave the house, even to just go to the grocery store. I became incapable of driving because I envisioned other cars hitting mine. My home life suffered too. I would lie awake for hours at night; thinking of ways I wanted to hurt my husband. My 2-year-old son watched hours of TV because it took all of my energy just to get out of bed in the morning and feed my daughter. Panic attacks and severe depression followed and soon I wanted to simply disappear from life. When I spoke to my obstetrician about how horribly I was feeling, she put me on birth control pills and told me to see how I felt in a few months. She obviously did not understand that I could barely make it through a day, let alone several months. After spiraling downward that following month to the point where I could barely function, I was started on Prozac. A month later I began feeling somewhat better and started therapy. Medication and therapy have probably saved my life, my marriage and the quality of life my children were experiencing.
I am upset that I lost over four months of my daughter’s life and that I was not able to care for her the way a mother should. I was not prepared in any way for the possibility of PPD and not once did anyone (i.e. obstetrician or pediatrician) ask me how I was coping. Then when I approached them, I was told that baby blues are very common and my mood should improve rapidly. What I was experiencing was very different and more intense than "baby blues." When I first started therapy, the psychologist asked me questions regarding my past relationships with family and friends, substance use habits, learning disabilities of my husband’s. Then I was told I didn’t have PPD! I obviously am not seeing him any longer. I feel that because of the lack of understanding of PPD, I was treated in a way that was detrimental to my recovery. I would like to see the medical community more aware of PPD symptoms and how they manifest themselves differently among women. I would like to see better prenatal education so women can recognize the onset of this disorder and receive qualified help, quickly. No one should lose the time with his or her children that I did, just waiting to feel normal again.