Sense Of Entrapment Research Articles

Factors associated with family caregivers' burden and depression in Korea.

This study determines the relative effects of functional impairment, cognitive impairment, and duration of care of the elderly on caregivers' depression, and identifies the factors that influence this relationship. The variables were entered individually, based on a logical order in the path modeling. For mediators, the order of three types of social support was assumed to be financial support, instrumental support, and emotional support. The order of five dimensions of caregiver burden was assumed to be impact on finances, feelings of abandonment, impact on schedule, impact on health, and sense of entrapment. Findings indicate that functional impairment had both direct and indirect effects on caregiver depression, and direct effects on impact on schedule, impact on health, and sense of entrapment. The effect of cognitive impairment on caregiver depression was primarily indirect but had direct impact on sense of entrapment. Duration of care had no direct effect on caregiver depression and burden, but did have indirect effects on impact on finances, feelings of abandonment, and impact on health through emotional support. Caregivers of elders with functional impairment were more likely to give care for longer periods, and those who give care for longer periods were likely to receive less emotional support and experience more burden in the dimensions of impact on finances, feelings of abandonment, and impact on health. Caregivers who experience greater impact on finances and impact on health ultimately were at higher risk of depression. The results have important implications for intervention models aimed to increase emotional support for the caregiver.

Doc in a Box [Commentary

Doc in a Box, a novel by San Francisco Bay neurologist Robert A. Burton, is a redemptive tale of a physician, Dr. Webb Smith, who loses his way mightily, both personally and professionally, only to discover what matters most about life and doctoring. The title, in addition to summoning up dreadful images of Jack in the Box managed care models, also alludes to the good doctor's sense of entrapment, of being “boxed in” so to speak, by his interpersonal relationships, money worries, and work. In this excerpt, Dr. Smith has hit bottom. His medical license suspended for an act of compassion toward a patient, Dr. Smith is employed illegally at a clinic where few questions are asked so long as the bills are paid. Craving expiation in the form of someone he can “fix,” Dr. Smith instead encounters a completely uncommunicative patient with headache and his demanding wife. For exhausted, overburdened residents, the excerpt provides an easy entry point into the frustrations of a relationship with a perceived “difficult” patient. Told exclusively from the physician's perspective, what we first encounter is a sympathetic (albeit confused and lost) physician, trying to do a good job with his patients, only to be faced with the patient and family member from hell. Residents quickly smile in recognition at the monumental passivity of the patient and the entitled, confrontational attitude of the spouse. It is easy to feel sympathy for the beleaguered, boxed-in Dr. Smith. But is Dr. Smith the only character trapped in this web of substandard, McDonaldized medicine? Point of view is indeed a marvelous thing. Usually without prompting, learners quickly start to be curious about the other characters in the story, the almost pathologically taciturn patient and his “hawk-like” wife, with whom they initially feel less affinity. What could have happened to make a man so hopeless and helpless? Are there other ways to understand the aggressive tenacity of his wife? As learners imaginatively explore the landscape of these so-called problem patients, they begin to surmise that husband and wife may be as trapped and desperate as Dr. Smith. The patient has been imprisoned by headache for twenty years, almost a life sentence. As for his wife, who might not display a bit of temper after having been relegated in perpetuity to the thankless role of ineffectual but solely responsible caregiver? Together, husband and wife are trapped in a co-dependent relationship organized around the patient's suffering. Other dimensions of the boxed-in metaphor also become illuminated. Once a resident commented, “I can really relate to that man.” When asked why, she responded, “I've been captured by headaches too.” This evocative language gave rise to an innovative alternative story about how wife and doctor might join together to emancipate the walled-off captive. We may also wonder how prevailing social ideas about gender affect the interactions of doctor—patient—spouse.* Trapped in a traditional female role of caregiver with no reward and great frustrations, the wife struggles to expand its parameters by manifesting certain characteristics traditionally associated with men (aggressiveness, protectiveness, confrontation). For this violation of the wife's own gender-based box, the two males in the story join in fantasizing about her being bludgeoned to death by the reflex hammer! At this point, having identified the experience of entrapment shared by doctor, patient, and family member alike, residents can profitably revisit the story. They have not lost their compassion for and identification with Dr. Smith. They still acknowledge that his inclination toward kindness and his awareness (albeit fleeting) of peering into his patient's soul are efforts to free both himself and his patient from the confines of their highly constricted and unsatisfying options. But through reflection and imagination, the story has become more complex, richer, and multi-layered. By recognizing the suffering of all participants in this doctor—patient—family member encounter, learners can conjecture different endings built upon their common predicament. They explore alternative strategies of limit setting with the wife, restructuring the encounter, and expressing empathy and compassion toward both patient and spouse. They speculate about how to extend the system through referral to a counselor or an alternative practitioner. In a bold vision, they can even imagine Dr. Smith disclosing his sense of failure before his patients leave the room, the wife experiencing for a moment the relief of surprised silence, and the first halting words of the patient. Out of enslavement, shared possibilities of liberation emerge.

Farrell's Ethnic Neighborhood and Wright's Urban Ghetto: Two Visions of Chicago's South Side

Although often described as naturalistic urban writers, James T. Farrell and Richard Wright portray the with strikingly non-naturalistic styles, rejecting the documentary methods of naturalism in favor of more expressive techniques. Wright, in order to suggest the extremity of his hero's radically alienated consciousness, describes the in Native Son as gothic mindscape reflecting the fear and horror that dominate his protagonist's life. Surrealistic techniques are extensively used to dramatize the fundamental lack of connection between Bigger Thomas and the world in which he is placed. Because his external life offers him so little, Bigger perceives the as process of fragmentation and dislocation, strange nether world that threatens to destroy him. Farrell's South Side in Studs Lonigan, although geographically few blocks away from Wright's city, is in fact different universe, and Farrell uses very different literary techniques to describe it. Whereas Bigger Thomas's Chicago is racial ghetto, massive trap that dehumanizes the people who are forced to live in it, Studs Lonigan's South Side is an ethnic neighborhood presented in complexly ambivalent way. While it can indeed be dead end to those who succumb to what Farrell in The League of Frightened Philistines called spiritual poverty (86), it can also be the setting for human fiberation for those like Danny O'Neill who use it as foundation for human development. To suggest the powerful duality of the urban setting, Farrell subtly combines standard realistic techniques that present the as densely reified environment with wide range of poetic techniques that lyrically suggest the surprisingly rich human possibilities contained in such world. The first principal difference that strikes readers of the two novels is the fact that Native Son describes so little of the actual urban environment that Studs Lonigan details so fully. Because Wright was intent on filtering external experience through Bigger's radically alienated consciousness, he describes Chicago with very few coordinates in time and place.(1) We are never given precise idea of the year in which the novel takes place and we do not see much of the actual physical characteristics of the in which Bigger lives. Washington Park is used for important scene but is never clearly described. Full, coherent descriptions of streets, houses, stores, schools and other important landmarks are never given. The novel's second scene, which describes Bigger leaving his family's apartment and walking the street, provides vivid example of Wright's highly selective method of depicting life. The few details mentioned are designed more to suggest what Bigger is thinking and feeling than to establish the setting in any minetic way. Frustrated that his environment does not present him with a wider course of action, Bigger's attention is drawn to streetcar rattling over steel track (16). This sense of confinement is intensified when he looks up at an election poster for District Attorney, which reminds blacks that If you break the law you can't win (16). When Gus and Bigger meet on street comer, their sense of entrapment is further underscored by the wall (21) they lean up against. Observing the high-flying planes and fast-moving automobiles, which painfully remind them of the mobility and possibility extended to whites in American society, they realize that black people have been placed in one comer of the city that amounts to little more than jail (32). Studs Lonigan, however, provides densely rendered, fully reified urban world. Throughout the trilogy Farrell stresses the temporal setting in precise way, usually connecting the seasons, months and years to the development of his central character.(2) More importantly, though, Farrell physically describes the urban setting in copious detail, providing complete sense of external reality and of how it naturally interacts with the consciousness of the central character. …

Motherhood, Employment and the Development of Depression

A prospective inquiry of a largely working-class sample of women with children considers the effect of employment on risk of developing clinical depression. The hypothesis was that there would be a direct protective effect arising from employment once quality of other support was taken into account. In fact full-time working mothers were at high risk. This appeared to be explained by either prior work strain or a severe event involving 'deviant' behaviour on the part of husband/boyfriend or child. Neither factor was relevant for part-time workers. The severe events appeared to be particularly depressogenic for full-time workers because they represented either failure in the motherhood role or a sense of entrapment in an unrewarding work/domestic situation. However, those in part-time work had a low rate of onset compared with non-workers, and the difference appears to be related to non-working women feeling less secure about their marriages.

The Revolt of the Urban Ghettos, 1964-1967

The revolt of the urban ghettos in the mid-1960's was in large part the consequence of a dichotomy in the think ing of Caucasians regarding the city. Accepting the city as a source of work but rejecting it as a desirable place to live, whites moved out to the suburbs and left the inner city to the underclasses. The minority groups, on the other hand, ini tially sought socioeconomic salvation within the city; it was, in the words of biographer Claude Brown, the "Promised Land." Instead, the ethnic groups suffered confinement to the ghettos and restricted opportunities within the city. The ghetto enclave produced a consciousness of experience among its residents, of which a sense of entrapment was an integral aspect. The more than one hundred major riots which ensued between 1964 and 1967 were spontaneous outbursts of hostility toward ghetto conditions and toward those who perpetuated the environment. A high level of support, demonstrated in both attitude and action, prevailed during the revolts. Significantly, the two institutions which represented the white establishment, the police and businesses, were singled out for attack. Largely ignored were libraries, schools, and civic buildings. The riots were thus the result of an ecological malaise in American soci ety which had prevailed for decades prior to the assaults of the ghettos in the 1960's.