Briefly Noted

At last week's annual conference of the National Association for Behavioral Healthcare (NABH), the increase in managed care figured prominently as causing a significant barrier to access to treatment. “The issue that is front and center is access to care, the problems that people are having getting necessary care, and not being able to access the right care at the right time,” NABH President and CEO Mark Covall told ADAW. In addition, the continuum of care has been severely impacted by managed care, he said. “Managed care companies are restricting care to crisis care only,” he said. This means that the longer‐term care needed for recovery when patients emerge from a crisis is not being covered. There are no clear legislative or regulatory fixes yet, said Covall, speaking by phone from the busy meeting. As an organization, NABH “will continue to be proactive and reach out to managed care companies,” he said. “We hope the collaboration that is desperately needed will be a two‐way street.” NABH members have reported that “it has been exceedingly difficult to get patients the care they need, and our members are saying that it's hurting patients, and this is not acceptable.” Last week, NABH launched Access to Care, an initiative “that will send our message to policymakers, regulators, payers and patient advocates that only true access to care can lead to recovery.”     

Danielle Kirby receives Ramstad/Kennedy Award

The 12th annual Ramstad/Kennedy Award for outstanding leadership went to Danielle Kirby , director at the Division of Substance Use Prevention and Recovery at the Illinois Department of Human Services and the state's Single State Authority, for her leadership in recovery support programs across Illinois and nationally. The award was announced last week and was established in honor of Congressmen Jim Ramstad and Patrick J. Kennedy. The two congressmen have been vocal advocates of recovery support services in all forms and championed localized efforts to support prevention, treatment and recovery. Now more than ever, recovery leaders are essential to our ability to address historic rates of overdoses and suicides, said Kennedy, founder of the Kennedy Forum. “People like Danielle Kirby are not only serving the communities in which they work; they are also serving their country. We are extremely grateful for her hard work and dedication,” Kennedy said. Kirby addressed stigma through innovative public awareness campaigns, as well as including persons with lived experience at decision‐making tables, showing others in strategic roles the importance of making recovery visible, according to the award announcement, which came from the National Association for Children of Addiction (NACoA), a Recovery Month planning partner. “Danielle Kirby has been in this position for less than two years, and yet has shown an energetic and inclusive spirit in supporting and promoting recovery community organizations and recovery resources for the present and future benefit of Illinois families and communities,” said Sis Wenger, NACoA president and CEO. “Together, in partnership with the dedicated organizations who comprise the Recovery Month Planning Partners, recovery success stories are becoming commonplace in Illinois, in part because of Danielle's ongoing and exceptional leadership and commitment.”     

AATOD and NAMA praise DEA methadone van proposal

The two big organizations representing opioid treatment programs (OTPs), on the one hand, and methadone patients, on the other, were unified in cheering the long‐awaited proposal by the Drug Enforcement Administration (DEA) to allow clinics to transport the medication to patients via “conveyances,” or vans. These vans would obviate the necessity of traveling, sometimes for hours, to get medication. Both the American Association for the Treatment of Opioid Dependence (AATOD) and NAMA Recovery (NAMA) sent official comments to the DEA, citing three ways the vans can be used.     

A Bionian Reading of the Mother in Anne Enright’s The Green Road

ABSTRACT

Anne Enright’s The Green Road (2015a) centers on the mother, Rosaleen. When she leaves her children and her home in the West of Ireland to walk the Green Road, Rosaleen asks herself, “Where did it begin?,” which is “more a cadence than a question” (p. 259). Her journey echoes that described by Wilfred Bion, with reference to Samuel Taylor Coleridge: “like one that on a lonesome road, doth walk in fear and dread” (Bion, 1970, p. 46). Rosaleen is attempting to escape the feeling that she does not exist. As she travels, reality gives way to fantasy as time and space appear to merge. Eventually, she is frightened to turn back because “she had fallen into the gap” (Enright, 2015a, p. 266). This may be read as the emotional state of transformation in O. Bion (1970, p. 43) exhorts us to forget what we think we know: memory, desire, and understanding. Applying this to a consideration of Rosaleen, whose children know her by so many names (“Mammy,” “Mama,” “Ma,” “Rosaleen,” and “Dark Rosaleen”), provides for an exploration, alongside Rosaleen, not of who she was in the past or who we might wish her to be but beyond preconceived ideas of Irish motherhood to a place where new meaning may emerge.     

Briefly Noted

Last week, Safehouse, a Philadelphia nonprofit that will open a supervised injection site in the city (see ADAW, Oct. 15, 2018), has hired an executive director, Jeanette Bowles, Ph.D. According to radio station WHYY, Bowles will help with fundraising and finding a site. “I believe in it so much,” Bowles said. “We see this working in other places, and the evidence supports it so strongly, that we don't have progress in public health without some controversy and scrutiny accompanying it.” Whether the Department of Justice will allow the site to operate remains unclear. “I've joined the team that respectfully disagrees with the Justice Department,” Bowles said. “Sitting in the office and doing the work separate from the community has never been my approach or style,” she said. “Being embedded with the community and developing those relationships and having my feet on the ground has always been most important to me. That's how the best public health work is done, through building bridges with community members.” Bowles earned a bachelor's degree from Temple University; obtained his master's in social work from the University of Pennsylvania; did postdoctoral work at the University of California, San Diego; and for her Drexel dissertation focused on opioid overdoses in the Kensington section of Philadelphia. The city, in giving the go‐ahead for the injection facility, said it would have to be run by a private nongovernmental entity.     

What do we call post-apartheid?

In this paper, the author examines the different uses and meanings of the usual expression “post-apartheid.” It has been used extensively in the social sciences, political discourse and the media since the mid-1980s. But what does it refer to, and has it always meant the same thing over the last 20 years? To answer that question, the author reviews the different ways she has used the notion in her research into workers’ forms of thinking and political subjectivities in South Africa since 1996. She distinguishes between its use as a chronological marker, an academic concept open to various problematics and epistemological decisions and a notion used by interviewees under various acceptations. She concentrates more specifically on the sequential implications of the adverb “post” in her work and argues that there have been political sequences in what she (with others) has named “post-apartheid.” She concludes that she intends to stop using this term in order to concentrate on identifying the current political sequence in South Africa.     

A Single-Case Study of Resiliency After Extreme Incest in an Old Order Amish Family

This exploratory research brief presents a single case study of the resiliency of “Mary B.” She grew up in an Old Order Amish family where isolation, secrecy, and patriarchy masked repeated sexual assaults by her older brothers that began at age 7. By the age of 20, Mary alleged she had been raped on more than 200 separate occasions by members of her Amish family. After years of pleading with her mother and church officials to intervene, she sought therapy outside the Amish community. This led to three of her brothers being incarcerated. Her family disowned her and she was banned from the Amish community, leaving with an 8th grade education and little more than the clothes she was wearing. In less than 2 years, Mary had moved to a new town, completed her GED, obtained a car and driving license, maintained a small home, and worked as a certified nursing assistant. She consented to tape recorded interviews and completed several quantitative diagnostic measures. Scores on the diagnostic measures placed her within the normal range on self-esteem, competency, depression, stress, social support, and life skills. Analysis of interviews revealed Mary rebounded from her past by reframing her experiences. Themes identified within the interviews supported 6 of the 7 types of resiliencies (insight, independence, initiative, relationships, humor, and morality) outlined in the therapeutic Challenge Model.     

New generation of harm‐reduction workers: Helton's concerns

Tracey Helton has been running peer programs for a decade, and involved with harm‐reduction work for two. Her “real” day job is working for San Francisco, a job that includes benefits and enables her to support her children. But it also allows her to run harm‐reduction services “from my closet,” as she puts it. We called her because we wanted to learn more about how she views the field.     

Sign‐on letter requests more flexibility in methadone treatment during COVID‐19

A sign‐on letter spearheaded by the National Alliance for Medication Assisted Recovery (NAMA), and harm reduction groups, including the Urban Survivors Union (USU) and the Drug Policy Alliance (DPA) is calling for reducing restrictions on methadone and opioid treatment programs (OTPs), so that patients don't have to go to the clinics so often. Included in the over 100 signatories are Patty McCarthy Metcalf of Faces & Voices of Recovery, Ben Levenson of the Levenson Foundation (and former founder of Origins) and many addiction physicians, as well as drug user organizations. Many of the signers have said for months that OTPs should be eliminated entirely.     

“And Let the Grove,If Not the Parlour,Stand”: Home,Memory, and Gender in Mary Leapor's “Crumble-Hall”

ABSTRACT

This article focuses on Mary Leapor's “Crumble-Hall” and attempts to shed light on her gendered/class poetics. It argues that the poet uses the house as a metaphor for gendered (male) and social class (gentry) dominance as well as that through memory she assumes (poetic) control over it, demolishes and remakes it, thus forging her female/literary identity. The article also demonstrates that Leapor makes use of both social and psychological space in her poem. By appropriating the country-house convention, she creates a dialectical relationship between external space—the architectural structure; and internal space—the kitchen maid's unconscious; and points out that as the former crumbles, the latter stands because of the significance it acquires. Indeed, her memory of Crumble-Hall not only spawns years of suppression and hardship but also becomes the stepping-stone for her rebellion as well as for the creation of her verse. Her poetic empowerment is projected through the image of the grove surrounding the country house, a multifaceted symbol signifying the interrelation of home, memory, and female literary production. Overall, Leapor re-creates the past glory of the gentry house, depicts her subservient state, conveys her subversion, and finally, establishes her newfound identity as a female poet, all within the framework of fragmented memories. Consequently, she succeeds in promoting the need for gendered and class transgression, in the hope that her sisters can bring about the “crumbling” of their own “house” and remake their “home.”     

The Downfall of Gomułka

Marina Tsvetaeva’s 1934 “Chërt” (The Devil) forms a central part of the cycle of autobiographical prose she wrote in emigration. This article assembles clues to the hidden origins of the Devil she describes in prose about her grandfathers, some of it censored in pre-1990 editions of her works. Tsvetaeva’s Devil is not simply metaphysical: it has the unusual appearance of a Great Dane. Though she goes on to trace its appearances in the literature and culture of her childhood, some of its physical features (eyes, nose, colour and posture) link it with other people in her life. The vivid details of the Devil suggest relationships, though peculiarly mediated ones, to members of her own family, especially her maternal grandfather, Aleksandr Danilovich Mein. The poet describes herself using Pushkin’s poem “Utoplennik” to camouflage her own sense of self from her mother. Much of the rest of “The Devil” describes her recognition of the Devil in varying symbolic or even phonetic guises, tracing how the poet stayed faithful to him even after he ceased to appear visibly, how she found and read his symbols in surrounding reality—e.g., card games, toys, rituals for finding lost objects—and in unexpected, otherwise respectable, parts of society, including her own grandfather. As always, Tsvetaeva creates a story that affirms her identity as a poet and illustrates the work she had to do to achieve that identity.     

Recovery Month will take place: Faces & Voices of Recovery will run it

Last week, we reported that the Substance Abuse and Mental Health Services Administration is walking away from its sponsorship of Recovery Month (see “After 30 years, SAMHSA walks away from Recovery Month,” ADAW, July 8, https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.32770 ). This is correct. However, what needs clarification is this: Recovery Month will still take place, hosted by Faces & Voices of Recovery. Philip Rutherford, director of operations of Faces & Voices of Recovery, told ADAW in an email last week that the organization “is excited to host the Recovery Month website, previously found at recoverymonth.gov .” The new site “will contain a repository for the 2020 Recovery Month digital assets, like graphics and display banners for anyone to download and use, and more. Equally as important, organizations will be able to post information about their events on the Recovery Month calendar.” These materials have “been a staple of the event for years, and Faces & Voices is pleased to be able to keep it going.”     

Philanthropic Soldiers,Practical Orientalism,and the Occupation of Iraq

This article discusses the ways in which white, male, United States soldiers make sense of both themselves and Iraqi others. Drawing from qualitative interviews with twenty-four said soldiers from southern Indiana, most of whom having deployed to Iraq, it is shown how these soldiers perform gendered and racialized Orientalist discourses to rationalize United States empire and in particular the military occupation of Iraq. Specifically, imperialist discourses that imagine a superior “us” and an inferior “them” and understand United States state violence as ultimately a Western humanitarian “rescue” are shown to be powerful cultural logics in the sense-making practices of the interviewed soldiers. This article then is concerned with what others have called “practical Orientalism”—or the ways in which formal and official Orientalist discourses are adopted by everyday actors.     

视界

26岁的黄诗琦为87岁的外婆拍摄了两组照片，上传到网上后感动了众多网友。一组是外婆去年初的样子：活泼可爱，健步如飞；另外一组是她外婆去年8月突发脑溢血后，现在的样子：神情恍惚，几乎站不起来。“还是那个地方，但外婆已经不是当初的外婆……你答应过要等我结婚生子，所以你要好好活着，健康活着……2014年，我们一起努力，孝不能迟。”黄诗琦为这些图片配上“最珍贵时刻”的标题。     

A Barrenness or Body and Theory: An Analysis or Infertility

This essay tracks the vicissitudes of woman's analysis during her three year attempt to become pregnant, and in her own words, “to become a real mother”. As a lesbian daughter of heterosexual parents, she attempted to “cure” her infertility, and redress her self- perceived sexual sins through compliance with a fantasy of heterosexual completion. This fantasy came to be seen as a diversion from the more difficult task of re-engaging with a symbolic oedipal dilemma and bearing parricide guilt.     

Margaret Atwood’s Straddling Environmentalism

Abstract

“Margaret Atwood’s Straddling Environmentalism” asks why Atwood crosses the Canada-US border in her dystopian fiction. It takes Atwood’s 2004 comments that The Handmaid’s Tale (1985) partly grew out of her ‘irritation when people say “it can’t happen here”’ and her claim that she decided to set the novel in Cambridge, Massachusetts as being related to that irritation—’”It can’t happen here,” she explained, “should be placed in the most extreme ‘here”’—as a prompt. Focusing on Oryx and Crake (2003), this article argues that one of Atwood’s motivations for crossing the Canada-US border in this novel is to provoke us to develop what Giovanna Di Chiro has termed ‘a scale-crossing environmental consciousness.’ Oryx and Crake challenges us to think about environmentalism in relation to local, embodied experiences as well as on a global, transnational scale.     

Treatment center sues Tennessee town over zoning ordinance

Last week, ReVIDA Recovery Centers, which provides medication‐assisted treatment for opioid use disorder, announced that it would sue to keep its treatment program in Morristown, Tennessee, where the city has denied the company based on zoning. “Our patients are our first priority,” said CEO Lee Dilworth on September 25.     

Briefly Noted

It's not every day that a nationally known “rehab” offers methadone. Recovery Centers of America (RCA) has opened its second medication‐assisted treatment (MAT) clinic — Bravo Medical — that does just this. “MAT is a vital tool in the battle against opioid addictions,” said Melissa Bishop, RCA national director of MAT, last week. “But many people are still afraid to learn more about it because of the stigma attached to this form of treatment.” The public is invited to tour the clinic on Oct. 16 from 12–2 p.m. At this event, families of loved ones from the southern New Jersey and Philadelphia area can tour the Somerdale, New Jersey, facility; see how medication is administered; and learn about the effectiveness of MAT. RCA offers MAT at its inpatient treatment centers and at stand‐alone MAT facilities such as Bravo Medical and the Trenton Healthcare Clinic. RCA offers methadone and buprenorphine. New Jersey State Medicaid is accepted at Bravo Medical and the Trenton Healthcare Clinic.     

Developing programs for older adults in a faith community

I have worked in all areas of nursing, from staff and head nurse positions to faculty and administrative positions, but my work as a parish nurse, particularly with our community of older adults, is one of the most challenging and rewarding areas of nursing practice I have ever experienced. Recently, one of our independent older adult parishioners, Marge, suddenly had a marked decrease in her ability to function, which was precipitated by two trips to the hospital and surgery. She went from living independently to living in a skilled care unit, no longer able to walk or perform activities of daily living without assistance. I had known Marge for only 2 years. When she became ill, I visited her weekly during the last 4 months of her life, as she had no family in the area. During my visit one evening as I helped Marge get ready for bed, she left me with a very poignant memory. After sharing some hair-raising stories about her care at this facility, she said, "Georgine, you're my best friend. You're the only one I can tell these things to and I know you understand."     

Towards Balancing Power in Domestic Violence Relationships Rejoinder

Based on four years of extensive work on domestic violence issues with both survivors and perpetrators within their Family Safety Program, the authors argue that Wileman and Wileman's suggestion that women could learn skills to “effect positive change” in their relationships is both inappropriate and potentially dangerous. We further argue that to label such “skills” as “empowering” merely endorses a stance that is “more of the same” for the woman. That is, the woman may only learn more about taking responsibility for change, which is a position in which she is already well entrenched, often to her ultimate disadvantage.