AN EXPLORATORY STUDY OF PSYCHOSOCIAL FACTORS AFFECTING QUALITY OF LIFE FOR CANCER SURVIVORS AND FAMILY CAREGIVERS

July 14, 2008 - 5 Responses

AN EXPLORATORY STUDY OF PSYCHOSOCIAL FACTORS AFFECTING QUALITY OF LIFE FOR CANCER SURVIVORS AND FAMILY CAREGIVERS

Thesis Proposal

By

Abdul Rahman Seuti Magba-Kamara

College of Arts, Humanities and Social Sciences North Dakota State University

Major Department.

Sociology, Anthropology, and Emergency Management

(May 2008)

Fargo, North Dakota

INTRODUCTION

Cancer is the second leading cause of death in the United States, second only to cardiovascular and pulmonary diseases (Anderson, 2001). There are more than 10.5 million Americans today who are cancer survivors, “more than one in three Americans are at a risk of getting cancer, or know someone who has survived cancer” (IOM, 2006, p.1). According to the American Cancer Society (ACS, 2002a) an estimated $56.4 billion is spent from the American health care resources each year in direct medical costs caring for cancer patients in addition to an estimated $100.3 billion associated with lost productivity due to illness or premature cancer deaths.

Although the mortality rates for both men and women across the major cancer sites (lung, breast, prostrate, colorectal, and cervical) has been reduced due to improvement in early detection and treatment, there are certain members of America’s cancer survivorship population and their family caregivers, who suffer a disproportionate burden from the disease. The poor access to health care because of lack of health insurance, or the lack of adequate health insurance, financial issues, a fragmented medical system, absence of any psychosocial oncology, and the lack of social support, all contribute to create a burden that impedes on the quality of life for them and their family caregivers.

To address the psychosocial needs of cancer survivors and family caregivers, it is paramount to establish a meaningful understanding of factors that affects their quality of life. This study will employ a qualitative methodology to explore the perceptions held by cancer survivors and their family caregivers following diagnoses, treatment and post-treatment. It will use focus groups and one-on-one interviews to present cancer survivors and care givers perspectives on the psychosocial impediment to a better quality of life.

Literature Review

A study on cancer survivorship by the Institute of Medicine and National Research Council (IOM 2006) revealed rather gruesome statistics on the number of Americans who are considered cancer survivors. There are more than 10.5 million Americans today who are cancer survivors. What is the quality of life of these individuals who have faced a fatal disease, survived it, but still live under the cloud of its possible reappearance? The IOM cancer survivorship study which was supported by the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), and the American Cancer Institute (ACI), has suggested that for cancer survivors “the transition from active treatment to post-treatment care is critical to long-term health. If care is not planned and coordinated, cancer survivors are left without knowledge of their heightened risks and a follow-up plan of action” (IOM 2006, p.1).

Cancer survivors and family caregivers are experiencing many life challenges in their transition from active treatment to post-treatment care that impedes on their Quality of Life (QOL). A population based study of the quality of life cancer survivors and family caregivers (Mellon, Northouse and Weiss, 2006) have suggested “Although there has been attention to the psychosocial adjustment of cancer survivors and family caregivers after the initial diagnosis and throughout the cancer trajectory, there has been little research directed to the quality of life of cancer survivors and their family caregivers who are living with the illness during an extended time frame after treatment has ended” (Mellon, North, & Weiss, 2006, p.3).

Most of the research conducted on cancer survivors and family caregivers has focused on larger population based samples in an attempt to understand the needs of family members of survivors after the initial diagnosis; after recurrence, or during the long-term survivor phase. Only a few studies have directed their attention to the quality of life of cancer survivors and family caregivers during the long-term survivor phase of the disease. The focus of this study is to identify common needs from the perspectives of individual survivors and family care givers from their survivorship experiences.

Medical Survivorship Issues

The Institute of Medicine and National Research Council (IOM, 2006) study indicates more than 10.5 million Americans are living with a history of cancer. Mortality rates across all 4 major cancer sites for both men and women have declined. This dramatic increase in the numbers and lengths of survival for individuals with cancer has been studied and documented in two studies (Parker et al., 1997; Rowland et al., 2004) as the result of improved early detection and treatment

Over the past several years, epidemiological researchers studying cancer survivors have focused most of their attention on breast cancer survivors and primary care for cancer survivors of breast cancer. Burnstein and Winer (2000) focused their cancer investigations on primary care for survivors of breast cancer. Examination of the side effects of adjuvant treatment (Shapiro and Reicht, 2001) has been their primary research interest. Some other epidemiological researchers (Partridge, Burstein, and Winner, 2001) have focused their investigations on the side effects of chemotherapy and combined chemo hormonal therapy in women with early stages of breast cancer.

Epidemiologists (Emens and Davidson, 2003; Hurria and Hudis, 2003), focused their attention on follow-up care of breast cancer survivors, while Mrozek and Shapiro’s (2005) study focused on survivorship and complications of treatment in breast cancer. The primary focus of these investigations was only on female breast cancer survivors, no mention was made on family caregivers. The results of their findings indicate that the meaning of health and life itself for cancer survivors following their diagnosis of cancer can be altered.

Herold and Roetzhein (1992) studied Cancer survivors, while Muzzine, Anderson, Figuerredo, and Gudelis’s. (1994) studied ‘the experience of cancer’. Results from these cancer survivor studies also suggest an on going experience for cancer survivors to achieve a balance in their lives after diagnosis of their cancer. The struggle for survivors to achieve a balance extends through treatment and post-treatment.

The psychosocial problems of cancer survivors have been investigated by Smith and Lesko (1988), while Quigley (1989) observed the psychosocial consequences of cure in adult cancer survivors. The results from these studies suggested an array of psychosocial problems for cancer survivors such as fear of occurrence of their cancer, the fear of death, worries, and the pervasive uncertainty that is associated with cancer, as their particular concerns.

Gunz’s (2000) ‘Quality of Life across the continuum’ study of breast cancer care indicates dynamic constant changes in their survivorship overtime. Gunz observed such psychological factors as stress and notes, that breast cancer survivors’ moment of stress is transitional from treatment to long-term follow up across the continuum of cancer cure.

The Institute of Medicine and National Research Council (IOM 2006) view the study of cancer diagnosis to its post-treatment phase as a disease phenomenon, which has been lost in transition. The IOM study highlighted some of the lasting psychological and psychosocial impact of cancer and its lasting affects not only on the individual with the disease but on the entire family. It indicated the debilitating and stressful impact cancer has on the entire family. The study called the public’s attention to the psychological and social needs of the children, spouses, partners, and other loved ones of the cancer survivor as part of survivorship.

Needs of Survivors and Caregivers

As Ferrell et al., (2002), suggested in a study on family perspectives of ovarian cancer, and Given et al., (2001) found in a study of family support in advanced cancer, family caregivers and family members should be seen as essential participants in the health care and maintenance of cancer patients. Their role in the treatment and post-treatment phase in the cancer trajectory is important in the cancer survivorship nexus because they are filling the void left by care professionals. Cancer survivors have a unique and varied mix of emotional, physical, and spiritual needs. Significant number of survivors in poor physical health will need ongoing cancer post-treatment homecare.

The absence of a nationwide comprehensive system of referral and services for cancer survivors makes it difficult to identify their psychosocial needs and match them with the appropriate resources and services to enhance their quality of life. It is difficult for cancer survivors and family caregivers with educational and socioeconomic limitations, and inadequate life-management skills, to navigate the current health service network with its complex structure and methods of financing health and medical care. The complexity of the present health and medical care system has a profound effect on the quality of life for cancer survivors and family caregivers.

Amid their various struggles and attempts to navigate the complexity of the medical system, both survivors, and family caregivers, each have their own interpretations of what is happening in their lives. How does a family caregiver reconcile the cancer survivors’ needs, making sure he or she organize meals, make sure the cancer survivor’s vocational and recreational needs are met, with thoughts of he or she earning money to pay the bills for maintaining the household, without compromising both of their quality of life?

More research in psychosocial oncology on how educational and socioeconomic limitations and inadequate life-management skills influence the short-and long-term needs of cancer survivors and family caregivers is needed. As noted in Shifflet et al. study (2002) published literature in this field is largely based on small groups of patients who are treated in “elite university affiliated cancer centers where researchers have the resources, motivation, and expertise to conduct such research” (Shifflet et al, 2002, p.190).

Financial Issues

American Cancer Society (ACS, 2003) study indicates that cancer is the second most expensive disease in the United States, next to heart disease, with estimated annual costs of $171 billion. It also indicates that only about one third of these costs are paid by Medicare or private health insurance programs. The remaining two thirds are paid by non-reimbursed or “out-of-pocket” costs. Direct nonmedical expenses that are related to cancer treatments such as transportation, and children falls under non-reimbursed costs that are out- of- pocket costs.

National Health Institute (NIH, 2000) study of disease specific estimates suggested that income loss due to cancer-related morbidity and treatment represents opportunity cots. Hayman, Langa, Kabeto, et al., (2001) studied the cost of informal caregiving for elderly patients with cancer. They suggested that as a result of non-reimbursed cancer cots cancer patients and family caregivers often endure financial hardship. A study on the impact of serious illness on patients’ families (Covinsky, Goldman, Cook et al., 1994) found that one third of families lost most or all of their savings following a cancer diagnosis. Their study also found that a family member quit work or made another lifestyle change to provide care in the remaining in the one fifth of the families they studied.

Limited financial resources and poor family support place many cancer survivors at risk for financial hardship. This is more so for women cancer survivors who are household heads. Even if they have comprehensive health insurance policies, the financial impact can be large. The paradox of the medical insurance system is insurance, was designed to reduce illness eventualities, it is the primary reason why many people buy cancer insurance policy. The belief is that cancer insurance policies were designed to reduce the holders’ financial burden in the event cancer, but as Arozullah, Calhoun, Wolf, et al (2001) financial burden of cancer for women with breast cancer study indicated the majority of out-of-pocket costs were for co-payments for hospitalizations and physicians visits.

A study on the Quality of life of husbands of women with breast cancer (Wagner, Bigatti and Storniolo, 2006:109) cited a study on the supportive care needs of spouses of women with breast cancer by Petrie et al (2001) which suggested that the:

Life threatening nature of breast cancer, along with the side effects of treatment, place great strain on patients and their families. Husbands may be especially vulnerable as the main source of support to patients….Throughout this journey, the adverse effects of cancer and its treatment extend beyond the patient to negatively impact the quality of life (QOL) of the family, especially the husbands, who often act as informal caregivers and are most frequent providers to married women with breast cancer.

The effects of cancer are not relegated only to the individual with the disease; it has as the IMO (2006:67) study suggested:

an impact on the entire family, and the needs of children, spouses, partners, and other loved ones all need to be considered…Financial concerns may also arise because family income, insurance status, and employment can all be profoundly affected by cancer. Caregivers and family members often require, but do not receive

the respite, health care, psychosocial, and financial assistance they need in meeting the many needs of cancer survivors in their lives.

Because most personnel decisions are based on economic factors “employers may be motivated to fire an employee with cancer or a history of cancer because of concerns about increased operation costs due to insurance expenses and lost productivity or because of concerns about the psychological impact of a survivor’s cancer history on other employees” (IOM, 2006, p.382).

Inadequate Insurance Coverage

Many cancer survivors, their family caregivers and families, are at risk of loosing both their employment and insurance during their extensive and prolong cancer treatment. Young adult cancer survivors and family caregivers in the lower income brackets who are particularly in dire straits are the most vulnerable segments of our population. These groups of cancer survivors do not have adequate coverage for psychosocial care and follow-up care, since they have inadequate insurance even under the most comprehensive health plans or Medicare.

The National Cancer Institute (NCI, 2005) surveyed working-age cancer survivors’ between the ages of 20 to 64 about their employment opportunities after their cancer post-treatment. The NCI survey results suggested that those with health and medical insurance coverage may have problems maintaining their coverage following a diagnosis with cancer. NCI survey revealed that there are an estimated 3.8 million working age adult Americans with a history of cancer as of 2002. Although most Americans have some form of health insurance that provides coverage for most cancer related care, however, there are over 42 million Americans with no form of health or medical insurance. IOM study suggested that “for those Americans who are without any health or medical insurance there are serious negative consequences and economic costs for both the uninsured and their families, and the communities they live in and the nation as a whole” (IOM, 2006, p.390).

Many cancer survivors, who have attained the age of 60 years or older, who are still able to work, and want, to be gainfully employed are experiencing job loss and some times are deprived of their right to be gainfully employed. Some who are fortunate enough to be working are forced into early retirement due to cancer. The loss of a gainful employment results in a loss of health benefits, but they are not eligible for Medicare due to what the Department of Health and Human Services (DHHS 2005) termed age eligibility criterion. For many of these vulnerable and marginalized groups of cancer survivors, out-of- pocket health care cost creates a significant challenge and economic burden for them and their families. This economic burden from out-of-pocket health cost is especially felt by those survivors on a fixed income.

Cancer survivors, who are living alone, or are living far from members of their family lacks adequate social support network, the absence of such a social support network impedes on their quality of life. Another barrier preventing women with breast cancer from getting appropriate psychosocial intervention and care is the lack or inadequacy of health insurance coverage. Findings from the HOM (2004) study on the psychosocial needs of women have suggested “an estimated 8 percent of women with breast cancer are uninsured, or, if insured, there is coverage of mental health services with lower reimbursement levels or placement of mental health services in behavioral health contracts, separate from health coverage” (HOM, 2004, p.5).

Fragmented Medical System

A Report by the President’s Cancer Panel (PCP, November 4, 2003) indicated that the absence of a national electronic health record system is one of the major impediments to medical continuity and the quality of care for most cancer survivors. It also mentioned the lack of a national policy that could protect cancer survivors and their families employ -ment, insurance and assets. Another impediment to the quality of life for cancer survivors and their family caregiver was mentioned in the IMO (2006:192) study on cancer survivor -ship, “while in treatment, cancer patients often see multiple specialists-surgeons, medical oncologists, and radiation oncologists-in addition to their primary care provider.”

The fragmented medical system not only makes the coordination of medical care difficult but it also adds great stress and difficulty in addressing psychosocial needs. The IOM study (2004) mentioned earlier noted:

The dramatic shift in the delivery of almost all cancer care from inpatient hospital to out patient settings has not included a similar shift in the out patient psychosocial services to the outpatient clinics and private oncology office practices…the increased complexity of care has limited access even further. Women with breast cancer usually see multiple specialists (e.g., surgeons, radiation oncologists, medical oncologists), and care is often not well coordinated (HOM, 2004, p.5).

Because women with breast cancer are experiencing a fragmentation of care, and are not given care by a single, trusted physician, this creates an added psychological burden for them. The IOM study also mentioned that in addition to the fragmented care women with breast cancer are experiencing “the outpatient office and clinics are extremely busy; the length of time doctors can spend with patients is often limited, and the opportunity to bring up psychosocial problems may be lost” (HOM, 2004, p.5).

Psychosocial and Social Support Needs

Another impediment to the quality of life for many cancer survivors, family caregivers, and family members is the absence of much needed psychosocial assistance and support during treatment and post-treatment. With the advances of medical research and the increase in the survival rate one will assume that the patient’s trouble will disappear. But as Roberts (1984: 92) discovered in his study on cancer today “it has become clear that the patients’ troubles don’t disappear along with the physical symptoms. The disease and the treatment may leave emotional scars that hamper the individual’s efforts to resume an active life”

Despite the “encouraging advances in finding a medical cure for this dreadful and debilitating disease coupled with the discovery of new techniques for early detection and diagnoses and the availability of new therapies for treating some of the highly recalcitrant forms of cancer therapies” (Roberts, 1984p.1). She suggested a new direction to deal with some of the challenges of survivorship. Roberts mentioned in her psychological and social effects study on cancer survivors that “as the survival rate has increased, it has become clear that patients’ troubles do not disappear along with the physical symptoms” (Robert, 1984, p.92)

Some epidemiologists (Demark-Wahnefried et al., 2000; Blanchard et al., 2003a; Ganz, 2005), have devoted a great amount of attention in the literature in their investigation of cancer survivorship. Most of their focus has been devoted to life style behavior, such as smoking, and unhealthy diet, less or none of their attention was focused on examining the psychosocial factors that are associated with cancer or the reoccurrence of cancer. Earlier studies on cancer survivorship published in the cancer survivorship literature by Evans (1926) had suggested a linkage between psychosocial and other personality factors to some certain forms of cancer. Evans views psychosocial factors such as the loss of a love object or an important emotional relationship as one of the leading causes of cancer.

Since Evan’s (1926) study linking psychological factors to cancer was published in the literature over half a century ago, the epidemiological literature has been saturated with studies associating stress to the disease. For instance, Selye‘s (1979) study attributed stress and cancer by suggesting that stress plays a primary role in development and reoccurrence of cancer in the cancer patients he was observing. In his study on the psychological factors and cancer on men with lung cancer, Kissen’s (1967) study went further when he suggested psychological factors like life events such as the loss of love object, despair, depression and hopelessness can lead to cancer.

Ferrell’s (2004) study of Quality of Life Issues for cancer patients, suggested that cancer survivors report ongoing struggles to achieve a balance in their lives and a sense of wholeness and life purpose after a life-altering experience. Bacon et al., (2002) scholarship on prostate carcinoma investigated men with prostrate cancer and suggested that men who are prostrate cancer survivors are more concerned about recurrence and the effects of post-treatment symptoms on their quality of life and this may contribute to their psychosocial distress.

For example, Hewitt, Bemundo, Day and Harvey’s (2007:2270-2273) have provided us with some perspectives on post treatment cancer care for cancer survivors. They noted, “Insights into post-treatment follow-up practices and the acceptability and feasibility of providing survivors and referring physicians with cancer survivorship care plan reveal cancer survivors were satisfied with post-treatment follow-up practices but were not satisfied with their psychosocial needs because they were not met”.

Finally, the lack of adequate social support is also felt by some survivors who are cared for by their elderly family members who may themselves have illness, limited mobility, or short-term memory problems. Social support can take many forms ranging from emotional to practical. For example, one support issue for many survivors is the lack of transportation, especially for those who are no longer able to drive. Increased attention should be focused on the psychosocial needs of cancer survivors and family caregivers, not just on cancer survivors. More attention should also be directed to family members and care givers in distress. The psychosocial intervention should also be focused on ways to support family members, and family caregivers, that will help them reduce the stress they are experiencing in taking care of a family member 24 hrs a day 7 days a week.

The Cancer Survivorship Phase

When cancer survivors and doctors describe cancer survivorship phase, they are usually referring to the living with cancer stage, the living through cancer stage, and living beyond cancer stage (Anderson, 2008), three stages which make-up the cancer trajectory phase. Living with cancer stage, refers to the experience of receiving a cancer diagnosis and any treatment that may follow. During this initial stage of the disease, the patient will undergo treatment and may be asked to join a clinical trial to study new cancer therapies. During the living with cancer stage, the cancer patients and their caregivers are sometimes offered services to help them cope with emotional, psychological and financial concerns.

Living through cancer stage is the period following the patient’s treatment in which the risk of cancer is relatively high. It is also during the living through cancer stage when many cancer patients are relieved that their cancer treatments are over. During this stage patients are anxious and at the same time relieved because they will no longer be seeing their cancer doctors on a regular basis. Depending on the patients circumstances visits to their cancer doctors will now be reduced from regular weekly visits to two to four times a year.

Living beyond cancer stage is the post-treatment and long-term survivorship stage. During this post-treatment stage, most survivors will go back to the care of their primary physicians. It is during living beyond cancer stage that two out of three cancer survivors report that their lives are returning to normal. It is also during the living beyond cancer stage that 1 out of 3 survivors will complain about continuing physical, psychosocial or financial consequences of the disease (Andersen, 2008).

Research on the medical and psychological effects of cancer and its treatment on cancer survivors (Herold and Roetzheim, 1992) and cancer survivors (Muzzin et al., 1994) have been recognized for many years but it is only very recently that cancer survivorship is coming to be recognized as a distinct phase in the cancer trajectory. Fobair et al., (1986) studied the psychosocial problems among survivors of Hodgkin’s disease, whilst Long et al., (2000) investigated fatigue and psychiatric morbidity among Hodgkin’s survivors. The findings from both studies suggested that survivors of Hodgkin’s disease often report post-treatment fatigue that can affect their work and leisure activities.

Mullen (1985) articulated the concept of cancer survivorship in an article in the New England Journal of Medicine in which he described his personal experience as a cancer survivor. In his description of the cancer survivorship phase, Mullen referred to them as the “three seasons of concerns”, each according to Mullen, has its unique sets of concerns. Mullen called the first cancer survivorship phase “the first season” or “Acute survival” phase, a period marked by fear and anxiety.

The Acute survival phase begins with the diagnosis of the illness, and is dominated by diagnostic and therapeutic efforts. Extended survival phase, is the next stage in Mullen’s three seasons of concerns, it is a period during which a cancer patient goes into remission or has terminated the rigors of the treatment or has entered a phase of watchful waiting. It is also a period of examination and consolidation or intermittent therapy. Extended survival phase is also, a phase during which the cancer patient is psychologically dominated by a period of fear that the disease might reoccurred. Extended survival is a phase marked by physical limitations because the tumor and treatment would have exacted a corporal price on the cancer patient.

The physical toll experienced by the cancer patient from the tumor treatment are diminished strength, fatigue, a reduced capacity for exercise, amputation of a body part, or hair loss. Because of the financial cost it will take to keep the patient in the hospital for an extended stay, a cost which many health insurers don’t want to incur, an the shortages of medical oncologists, cancer clinicians, the cancer patient will now be sent home to be cared for by the family caregiver. The permanent survival phase is Mullen’s third survival phase, is marked with problems of employment and insurance. This study will highlight some of the lasting psychological and psychosocial impact of cancer survivors, their family, loved ones, physicians, and care givers.

Issues for the present study

The aim of this exploratory study is to examine the range of psychosocial issues experienced by cancer survivors and their family caregivers from diagnoses, treatment to post-treatment from both the survivors and family caregiver’s perspectives. Previous quantitative studies have shown the residual effects of having cancer on survivors, such as fatigue, pain, low energy levels and sleep disturbance long after treatment ends (Kornblith et al., 2003; Brocket et al., 2002; Wenzel et al., 2002).These quantitative studies offered insights into the symptomatic complaints of long-term survivors, but they did not pay attention to the overall cancer perspectives of the cancer survivors and family caregivers. These studies ignored the experiences of the cancer survivors, and their family caregivers.’ The present exploratory study attempts a gestalt interpretation of how cancer survivors and family caregivers define their existence after living through diagnosis, treatment, and beyond treatment. The focus is on their social psychology, and their day-to-day experiences with the disease. This approach is to help us to understand the fundamental psychosocial factors that are impeding on their long-term quality of life.

The present study also aims to fill some of the gaps in the qualitative literature on long-term survivorship by giving opportunity to a diverse group of cancer survivors and caregivers (with different types of cancer) to talk about their survivorship experiences in focus group discussions, and in-depth interviews. It will present survivors own interpretations of their cancer survivorship experience from their own perspectives, and how those interpretations of their experiences affect their quality of life. This qualitative approach will help us obtain a richer understanding of the cancer survivorship experience.

This study of the psychosocial needs impeding on the quality of life of cancer survivors and family caregivers utilizes a naturalistic approach to provide new insights, meanings and descriptions as it seeks to understand, interpret and explain the experiences of survivors from cancer diagnosis through treatment and post treatment from the pers -pectives of cancer survivors and family caregivers themselves. This study hopes to identify issues specific to the life stage at which cancer was diagnosed and also to identify issues that may differ across different diagnoses. Following the tradition of qualitative researchers (Glaser & Straus 1967; Straus and Corbin, 1990), this study utilizes a grounded theory approach as its methodological format to explore cancer survivorship from the psychosocial experiences of survivors themselves.

RESEARCH QUESTIONS

The following research questions will guide this study and help it yield important

insights into the many complex social process underlying some of the psychosocial factors

impeding the quality of life for cancer survivors and family caregivers.

* How do survivors and family caregivers adjust to the trajectory of the disease? And what is the role of family caregivers in cancer care?

* How do survivors perceive their disease?

* What are the factors related to caregiver burden and depression?

* How do family caregivers relate to the challenges in taking on the caregiver role?

METHOD

The present study is a qualitative study aimed at exploring the psychosocial experiences of cancer survivors from diagnoses, treatment and post treatment. Following the tradition of qualitative researches Glaser and Straus (1967), Straus and Corbin (1990), it utilizes the grounded theory approach as a methodology for exploring the psychosocial experiences of cancer survivors from diagnoses, treatment and post treatment. This methodological approach is aimed at identifying issues that may differ across different diagnoses, from diagnoses to treatment and post treatment, and from the survivorship experience of the cancer survivors to their families, nurses, physicians and care takers.

As a methodological approach, the utilization of a grounded theory format will enable this study to collect situational information from participants under observation (cancer survivors, loved ones, care givers, nurses, and physicians). The utilization of grounded theory as an element of the investigation will help in introducing discovery of the investigation by soliciting emic view points of the psychosocial experiences directly from the cancer survivors themselves (subjects of interest) this will assist in determining the meanings and purposes that they ascribe to their health conditions. This aim can be accomplished through the utilization of this qualitative technique.

This study will utilize focus group discussions and in-depth interviews as part of the qualitative research method as was adopted by qualitative researchers (Merton, Fisk & Kendall, 1956; Busch 1987; Murray, Tapson, Turbull, McCallum & Little, 1994; Kitzinger, 1995) to gain an understanding of what is important to cancer survivors and family care givers. The utilization of focus group discussions and interviews (structured and semi-structured) with cancer survivors and family caregivers will help provide insights and understanding of the post-treatment follow-up and practice of cancer survivors.

As a form of group interview, the sole purpose for utilizing focus groups as a method of investigation is to generate a rich source of data that will help explain the day- -to- day experiences of cancer survivors, their families, relatives and care givers. Focus group discussion and interviews as part of the method in this study is used to encourage research participants to generate and explore their own questions and develop their own analysis of common experiences. As a form of a group interview, the use of focus group discussion as part of a method will enable this study to capitalize on a formal and semi formal communication between study participants in order to generate rich data. The use of focus groups means that instead of asking each person to respond to a question in turn, study participants are encouraged to talk to one another, asking questions, commenting on the experiences and points of views of each other that otherwise, might be left under -developed in a one on-one interview. Thus, the utilization of focus group discussion will encourage study participants to illuminate their perspectives through the debates within the group.

Finally, the utilization of focus group discussion as part of the methodological approach will enable this study to examine not only what survivors think but how they think and why they think that way. The discussions from the focus group and the interviews will be transcribed, thoroughly read and reread for content analysis.

Sample/description and setting of participants

Purposive sampling will be used to identify and recruit study participants who meet the definition of survivorship as defined by the National Coalition for Cancer Survivorship (NCCS) and National Cancer Institute (NCI) Potential participants for this study will be recruited through flyers and brochures distributed to recruitment sites associated with the National Cancer Registry. Within reason and financial restraints, I hope to visit two or more locations for on-site focus groups. In addition, I hope to gain the cooperation of the Cancer Survivors Network which is network that supplies information, resources, chat rooms and discussion opportunities over the internet for cancer survivors. Hopefully I can make arrangements to contact members directly via mail or phone. Letters will be sent to select oncology practices in the Fargo Moorhead areas. Announcements will also be sent to local survivors’ support and advocacy groups.

Prospective participants who are interested in participating in the study will be contacted via telephone and email to set up an informal interview. As the study progresses, theoretical sampling procedures will allow this study to develop an in-depth description that will help us to understand the psychosocial needs that are crucial to the quality of life for survivors and family caregivers by continually making theoretical based comparisons using the emerging data (Straus & Corbin. 1998). The data collection will conclude when theoretical saturation is reached. Eventually 20 male survivors and 20 female survivors and family caregivers who are cancer survivors will be invited to participate in focus group discussions and in-depth face-to-face interviews. A series of semi-structured interviews will be conducted; each interview will last duration of about 45 minutes.

DATA ANALYSIS

The data analysis in this study will involve multiple step process, starting with a thorough examination of the phrases, sentences and paragraphs of the transcribed texts extracted from the focus group discussions and the interviews. Following in the tradition of Denzin and Lincoln ( 1998), Straus (1987), Znanieck (1934), Lofland and Lyn (1995), Spradley (1980), and Katz (1983). I will thoroughly examine the text materials from notes taken during the focus group interviews and one-on-one discussions, field notes from observational visits and discussions in hospitals with oncologists, and will be assigned shorter phrases and coded.

The next step for me is to look for indicators of categories in the phenomena under observation, name them and code them on a separate document. My third step will be to compare codes to find consistencies and differences. My fourth step in analyzing the data is to look for consistencies between the assigned codes and group codes with similar meanings if they relate to the similar basic idea to reveal their categories by categorizing each group of code as it relates to specifics until eventually the categories become saturated then look for their central foci to see how they each relates to one another.

Through the method of analytic induction as adopted by previous qualitative researchers this study will identify regularities from the emergent data to determine their explanations, and find other contexts in the emergent data to determine whether they hold. This process of analytic induction will help this study to search for identifiable universal prepositions and causal laws. The goal is to find the precise and specific boundaries within the categories from the textual notes and link them together to help explain particular experiences by looking for similarities and differences. I will again examine and re-examine my notes and match each code to find their contextual significance to see what themes will emerge. The process of constant comparative method is a strategy that will allow this study to constantly compare and integrate the data that have emerged to help this study get a clear understanding of what the study participants were concern about the most, and will help me to see how the themes relate to each other.

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LOOKING FOR FOCUS GROUP PARTICIPANTS FOR CANCER RESEARCH

July 14, 2008 - One Response

A study to investigate the range of medical, psychological, and psychosocial issues experienced by cancer survivors, their families, physicians, and care providers, from diagnoses, treatment to post treatment. Cancer is not only isolated to the individual with the disease but also has a debilitating psychological impact on the entire family, the children, spouses, partners, relatives, and other loved ones. This qualitative study explores and highlights some of the lasting psychological and psychosocial impact of cancer survivors, their family, loved ones, physicians, and care givers.

Goal of study

The goal of this study is to explore the range of psychosocial issues cancer survivors, their families, physicians and care providers are experiencing from diagnoses and treatment, to post-treatment. This study aims to raise the public’s awareness of the psychological, psychosocial and economic needs of over one million cancer survivors and their families in order to influence a change in our medical insurance policies that will ensure cancer survivors an improved and prolonged Quality of Life. The aim of this study is to provide public health policy makers with a wider array of conceptual and practical tools to ensure the health, well-being and Quality of Life of cancer survivors long after cancer treatment has ended.

IF YOU HAVE BEEN DIAGNOSED WITH CANCER, OR YOU ARE A CANCER SURVIVOR OR A CARE GIVER I WILL LIKE YOU TO PARTICIPATE IN A FOCUS GROUP DISCUSSION SO YOU CAN SHARE YOUR EXPERIENCES WITH OTHER MEMBERS AND HELP DRAW PUBLIC ATTENTION TO THE EVERY DAY LIFE STRUGGLES OF CANCER SURVIVORS AND THEIR FAMILIES, LOVED ONES AND CARE GIVERS. YOUR PRIVACY WILL BE GUARDED UNDER THE ETHICS OF RESEARCH; YOUR PARTICIPATION WILL HELP INFLUENCING PUBLIC POLICIES AND WILL BRING ABOUT CHANGES TO ENSURE THAT THE PSYCHOSOCIAL, MEDICAL, ECONOMIC AND SOCIAL NEEDS OF CANCER SURVIVORS, THEIR SPOUSES, CHILDREN, LOVED ONES, AND CARE GIVERS ARE ADEQUATELY FULFILLED.

IF YOU LIKE TO PARTICIPATE IN THIS STUDY DROP ME AN EMAIL @ MY NORTH DAKOTA STATE UNIVERSITY EMAIL ADDRESS TO SET UP A TELEPHONE INTERVIEW TO SEE IF YOU MEET THE INITIAL CRITERIA TO PARTICIPATE IN THIS STUDY. RESPOND TO ME AT THIS EMAIL ADDRESS : AbdulRahmans.Magba-Kamara@ndsu.edu

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March 16, 2008 by bitterlemonexperience

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THE GREAT AMERICAN HYPOCRACIES

February 1, 2007 - Leave a Response

America is without comparison to any other nation on the face of this earth, when it comes to writing and talking about noble notions such a Equal Rights, Democracy, Human Rights, Freedom, Rule of Law, Gender Equality, Racial Tolerance, multiculturalism, and so on and so forth. Lets take one of the foundation of our democratic idealism that of the Right to vote one of the noblest of democratic excercises given to every citizens in societies that have professed to practice the concept of governing by the consent of the governed as one example. An idealism we in America professed hold as dear to our hearts than any other in a free society, yet there are millions of our American citizens who have been deprived that very right because of technicalities which have nothing to do with the constitution. It might seem subtle to many people, but depriving millions of black people and poor whites in this country their right to vote just because they have a felony is a blatant violation of their civil rights under the 14th Amendment of the United Sates constitutional guarantee each and every citizen Of the United States Equal Rights and Protection. Their rights to vote is being blatantly violated in a country that boast to be the champion of the free world. Those whose rights to vote have been taken away from them even after they have paid their debt to society by serving time in jail, contradicts the belief that we are a society that guarantees Equality of treatment to all, regardless of race, etc….

The noble notion or idealism to democratize the globe contradicts the deprivation of our very own citizenry whose relatives are in the battle fields in nations such as Iraq, Afghanistan, and who knows else where, Somalia etc… putting their lives on the line to bring democracy in those countries, when millions of their own country- men here in the U.S. are not allowed to choose who should represent them in their state House of Representatives, or in the U.S. congress. It is a shame when some of our policy makers in this country are using every possible dubious means to derail and circumvent the law (The Civil Rights Act of 1964)and getting away with it. We have become a nation of men and not of laws, what a shame. It will be an outcry, if what is happening in this country to the rights of people of color and poor whites is allowed to happen to the rich and affluent whites. But because it happens only to people that do not have the means and resources to challenge such injustice, the almighty media is silent about it, yet we profess to be a free and democratic country.

Another contradiction has to do with the right of every American citizenry to be able to work and provide for their families, that right is also one of our most cherished fundamental capitalist idealism, the pursuit of happiness. But as it now stands, millions of people of color and poor whites who have been convicted of drug charges and have done their time in prison are deprived of a right to seek and gain employment in jobs for which they are qualified. But people who have been convicted of drunk driving or alcohol related charges have no problem gaining employment in their respective professions. Since alcohol is a drug, just as marijuana or cocaine, why should there be different a treatment for one type of drug in terms of gaining employment when the two offenses have the same result, that of a public health issue. If that is not contradiction, then i don’t know what is. The only difference is this one is a people of color and poor white crime, the other is white affluent crime. A similar scenario and double standard applies to the so called war on drugs. When the crack cocaine epidemic was rampant in urban America, congress and the state legislatures wasted no time in instituting a mandatory minimum sentencing guidelines and a three strikes you are out policy. Now, that we have a “Meths” epidemic in suburbia there is no call for mandatory minimum sentencing guidelines for its offenders. Just because offenders of meths or meths addict are white and affluent suburbanites and people in rural America, the call is for drug sentencing courts, probation,and drug treatment. If that is not a double standard and unequal treatment then i wonder what is.

America is still the greatest nation in the world, but we still have a long way to go before we can actually claim the moral authority to start telling other nations to guarantee human rights to their citizens, when we ourselves are not practicing what we are preaching. How can people of color take care of their families and live a contributing and progressive life in their communities when more than 25% of their husbands,spouses,sons,and daughters under the ages between 18yrs to 35yrs are being incarcerated in state and federal prisons for victim less crimes that was caused by a disease called drug addiction, when their white affluent counterparts with similar drug addictive problems are spending time in drug rehabilitation clinics, of which many of those cases are paid for by the American tax payers, why not accord the same treatment to people of color and poor whites, instead of sending them to state and federal prisons and jails, to be away from their communities and their families were they could have taken up their responsibilities of providing for their children. It costs more to send one person to state or federal prison a year than it costs to attend a private university. Incarceration then becomes a cash cow to milk the tax payers by state governments all in the name of combating crimes, a crime that has no victim. The great American contradiction goes on.

TIME FOR A NEW DIRECTION IN OUR FOREIGN POLICY APPROACH

January 31, 2007 - Leave a Response

What is most troubling to me is how our political commentators and those talking heads who think they know it all, can’t even think of one workable approach to solve the madness that is going on in the Middle East and the Gulf Region. I am talking about the brutal and senseless  sectarian violence in Iraq; the terrorist attacks on our troops who have gone to that God forsaken region of the world to help them get rid of one of the most brutal dictators in modern times; the new form of mass  killing device the insurgents are using (the human bomb) to inflict sensesless destruction of innocent civilian lives in the name of a twisted idelogical belief or better still a misunderstood world view. These talking heads and so called experts should be discussing how best can we use our greatest assets at our disposal (American ingenuity) to bring order and stability in Iraq before it spread across to other nation states in Gulf region, or nation states in the Arab penisula. America  has always been successful diplomaticly when we have employed a practical approach grounded on pragmatism to design and implement a workable policy to solve problems in other parts of the world without resorting to military means as a first resort. Why not discuss a pragmatic approach to bring an end to the madness that is Iraq instead of a a military surge which will only escalate the problem.  There is no argument the situation in Iraq is part of a broader war on terror, but why not find a pragmatic solution to resolve the mitigating condition that was brought about as a result of almost forty years of political oppression, ethnic hatreds and religious disharmony. By defining what is going on in Iraq as simply Islamic terrorism or sectarian violence we are  blurring the fight of those who are using the situation to demand forcefully  by any means necessary (including violence) for an equal and just society; economic self determination for all Iraqi’s; for a mutual ethnic and cultural respect between Islam and western religions in the present world of globalization. It appears that there are some remnant of fundamental religious leaders in the Middle East and the Islamic world who are suspicious of western hegemony especially Americas uni-polarism, and are trying everything within their powers to make sure that Islam as a way of life is not threatened by western cultural beliefs and value system.

How can we be certain for sure which is which? if we just dismiss those concerns and labelled them terrorirism, because of our failure to see things as they really are, are approach in solving the actual problem will be guided by our misapprehension of the real causes for the madness in Iraq. How can you combat an idea which has no value for human life with another violent idea like war? We tried that formula in the past and we were virtually in a stalemate with the former USSR for over 50 years. What was the outcome of all that mutual prepared armament build up to protest us from communist aggression? The USSR and their satellite countries in Eastern Europe and the USA together with its western alliance in western and central Europe spent trillions of dollars trying to mutually destroy each other in the Cold War days. All the money that were spent preparing for a war that never happened could have been spent by both the communist block nations and the western alliances  for the good and well-being of humanity. Now we are faced with similar situation, but now only differently. It is different because the enemy we are preparing to fight is an invisible enemy, just think about it for a minute.

We in the good US of A have spent billions of dollars to liberate people two countries from regimes that were very oppressive to their own citizens and posess immense threats to the world community. We found those regimes unacceptable to be an integral part of the civilized community of nations. We had no choice but to use military measures for humanitarian reasons to correct the unacceptable dehumanizing conditions the leaders in those two regimes put their own people through. Many of our young brave men and women have sacrificed their lives to make human conditions better for the people in those two countries (Afghanistan and Iraq). Now see how they are repaying us for our good deeds. What does that tell us? It means that this is one battle we can’t win on the battlefield. It means that we have to win this battle the same way we won the stalemate that lasted for 50 plus years with the USSR without firing a shot. We won that stalemate with a counter idea that was most acceptable to people in Eastern Europe. We provided them with an alternative they can’t refuse, that was the end of the stalemate. Economic opportunity a-la- a member of the global free market econic club. Don’t you for a minute think, that if we adopt similar policies to the youths in the Arab world , with a promise for a better world they won’t take us on that. History tells us what a little token such as the Maeshall Plan did after WWII, to keep the peace amongst the billegerant Europeans. That Plan went a long way to keep wars at bay in Europe. Don’t you agree that the Marshall Plan was very cost effective comapared to the spending that is required to fight a war? We had our own war on Terror back her in the 1960s, don’t anybody remember? The Blacck Panther, Black Power and all the other radical elements who were fighting to make sure that they also get Social Justice. What did we do? We tried waterhose, mass arrests and all other cohesive and inhuman tactics, but it never worked. Haven’t we learnt that Ideology is not geared for solving practical problems. Pragmatism, my fellow Americans, calls for solution to a practical problem. In the USA we adopted a pragmatic solution to combat our own war on terror. We created programmes such as Affirmative Action, to enable those who felt they were left out of the great American dream to become a part of it. We created a War on Poverty and the Great Society, to help those who could not make it through the rat race to at least get on by. Before long, no one is talking about BUrn Baby Burn, or Black Power, or all that social Justice stuff. I am not at least arguing that that solved all the problems, but at least, it was the beginning of something practical. Not before long people of color and women were graduating from some of the most prestigious universities and colleges. As part of the “Artificaial Middle-Class” they were no more interested in Burning down their neighborhood, for now they are the neighborhood. That is what pragmatism will give you, solid solution. Why not try a pragmatic approach in the Middle East for a change? Le us literally force the state of Israel to make peace with its neighbors, let us force the Arab countries that we have influence with to recognize the state of Israel, and let us force the wealthy Arab states to invest in the Palestinian refugee camps to help create a better living conditions for those young men and women. Then let us wait and see, if they are going to continue strapping bombs around their waste line and kill innocent people together with their own lives as young as age 15.

STATE OF DENIAL OR JUST PLAIN BLAME SHIFTING

January 31, 2007 - Leave a Response

welcome to my corner of the world a place i prefer to call my universa for social and political shock therapy. I am glad you could stop bye and visit with me for moment or two. I am writing this blog piece to wake up your inner consciousness and to let you think for a moment or two about what is really going on. You see my blog land friends i am still trying to understand why President Bush should take all the blame for what is going on in Iraq, after all as far as I can recollect it was with the blessings of the majority of our representatives in congress and the overwhelming support of the American people that the president ordered a preemptive strike on Saddam Hussein’s army. To my recollection it was with the blessing and overwhelming support of both Houses of congress (Senate and the House of Representatives) that Mr. Bush sent our young brave men and women to Iraq to put down a dictator and a tyrant who was threatening the stability of the Arab world and the Persian Gulf Region under the pretentious search for weapons of mass destruction that our American and British intelligence communities claim Saddam Hussein had stockpiled, or in the process of stockpiling. That in my view was a justifiable though a pretentious reason to topple a dangerous dictator and tyrant like Saddam whose massive army had waged a senseless, brutal, unprovocative war on one of neighbors and had moved his massive army said to be the 4th largest army in the world at that time to invade and occupy another neighbor. A man who was head of a regime many people believed and factually so, was one of the most brutal regimes of the twentieth and twenty-first century. Call it false pretense or what you will, it was with the overwhelming support of the American people and the representatives of all the people in congress that the president as commander in-chief of all the armed forces ordered a preemptive military strike against Saddam’s military. What then is the finger pointing and the blaming the president for the war is all about? Why should the president alone take all the blame for the miscalculations and the outcome of what is now becoming a quagmire? I don’t think we should be finger pointing and shifting the blame of a war gone bad solely on the President, now that things are out of control in Iraq? Talking about a State of Denial, it is not Mr. Bush alone who should be blamed for the unforeseeable in Iraq, it is us the American people who gave our overwhelming support to the president to wage a war against Saddam’s Iraq, that are in a State of Denial. After all, we are a democratic society with a republican form of government, and congress has the purse of the string to withhold funds for a war if they so wishes. Don’t forget the War Powers Act, has given that option to congress, and if the people of this great country were not in favor of a war against Saddam’s Iraq, they should have sent a petition to their representatives in congress to withhold funds needed to fight the war at the very beginning. Did congress withheld funds needed to fight the war five years ago? Did any of our leading media outlets call for congress to withhold funds? to my recollection nothing of that sort happened….. What then is the hypocrisy of blaming the president now all about, especially from members of his own party?

The Use of Radioactive Materials in Military Weapons

January 30, 2007 - Leave a Response

The use of radioactive metal uranium-238, depleted uranium in military weapons systems such as armor-piercing bullets, bombing casings, tank shielding, counterweights, and penetrators on missiles, and in cluster bombs, anti-personnel mines, and other anti-
personnel weapons (dirt bomb) has been identified as definitive contaminant to the environment and as tremendous health risks to human health. Its etiological role in the genesis of what has been dubbed as a Gulf War disease has been the subject of sustained controversy since the end of the first Gulf war. Numerous scientific and epidemiological studies have shown evidence of both chemical and radiological toxic properties of uranium isotopes in the environment in the Balkans, the Persian Gulf, and the Middle East, and also in the bodies of the veterans who were deployed to those areas.

Scientific and medical research findings has confirmed what has been clearly determined throughout two decades of research that exposure to radioactive waste of the isotopic enrichment of natural uranium is hazardous to human health and the environment. Furthermore, medical findings from the quantitative analysis of depleted uranium isotopes in British, Canadian and U.S. Gulf War veterans by Horan, Dietz and Durakovic (2002) showed depleted uranium isotopes detection in British, Canadian, and American veterans as long as nine years after inhalation exposure to radioactive dusts.

Durakovic, Dietz and Zimmerman’s (2003)environmental exposure analysis study in Afghanistan districts that were heavily bombarded during the war documented the discovery of more than 350 metric tons of depleted uranium deposited in the environment, and 3-6 million grams of depleted uranium aerosol released into the atmosphere. Durakovic and his team of medical nuclear physicists also conducted an experimental analysis to determine depleted uranium health exposure factors in civilian populations in area that were heavily bombarded by the United States and North Atlantic Treaty Organization (NATO) forces during the Afghanistan war. They wanted to determine whether the symptoms they discovered in veterans in the Gulf War Syndrome were the same as the symptoms present in those populations.

Durakovic and his team collected urine samples from 24 symptomatic subjects.The team divided the study population into two groups: control and experimental subjects. The control subjects were selected among the symptom-free residents in the non-targeted areas and the experimental groups were selected from districts that were heavily bombarded during the war. All the samples collected from the 24 experimental subjects were analyzed for the concentration and ratio of four uranium isotopes using multi-collector, inductively coupled plasma ionization mass spectrometry. The analysis of the findings from the team’s study revealed uranium concentration up to 200 times higher in the experimental groups who were bombardment free.

Various documentary materials in newspaper and magazine articles, together with internet reports of testimonials presented in Congressional hearings by ill Gulf War veterans and their family members have indicated that exposure to depleted uranium and other potentially toxic substances pose a risk to human health. There is convincing epidemiological and scientific evidence to indicate a causal relationship between depleted uranium exposure and many of the strange and undiagnosed illnesses Gulf War veterans and civilian populations in the Gulf are experiencing many years after the end of the Gulf war.

My book entitled “DEPLETED URANIUM ON HUMAN HEALTH AND THE ENVIRONMENT” utilizes a naturalistic approach to provide new insights, meaning and description as it seeks to illustrate, understand and interpret or explain about the day-to-day life experiences and structures from the perspectives of the Gulf War veterans.

Globalization and National Autonomy

January 30, 2007 - Leave a Response

Political Scientist Robert Gilpin (1987: 389) defines globalization as the increasing interdependence of national economies in trade, finance and macroeconomic policies. Globalization is a process fueled by, and resulting in, increasing cross – border flows of goods, services, money, people, information, and culture. It, offers extensive opportunities for truly worldwide development but it is not progressing evenly. Some countries are becoming integrated into the global economy more quickly than others. Countries that have been able to integrate are seeing faster growth and reduced poverty. Outward oriented policies have brought dynamism and greater prosperity to much of East Asia, transforming it from one of the poorest areas of the world 40 years ago, into one of the most vibrant economies.

By contrast, when many countries in Latin America and Africa pursued inward oriented -policies in the 1970s and 1980s, their economies stagnated or declined, poverty increased and high inflation became the norm. In many cases, especially in Africa, adverse external developments made the problems even worse. The Fragmented, discontinuous, contradictory and contingent nature of globalization invites skeptics to make argument that it is not proceeding as fast as generally believed, that it is not spreading uniformly across the globe, or that it is not strong enough to erase cross-national differences. One of the key issues surrounding globalization is whether this process has outgrown the governance structures of the international system of states; and whether the process of globalization is undermining the authority of the nation state.

Economist Raymond Vernon (198: 249, 256-270) for example, has long argued that the spread of multinational corporations creates “destructive political tensions” and there is need to reestablish balance between political and economic institutions. Historian Paul Kennedy (1993: 53-64, 122-134) asserts that governments are losing control, and that globalization erodes the position of labor in developing countries, and degrades the environment. “Today’s global society” he writes, “confronts the task of reconciling technological change and economic integration with traditional political structures, national consciousness, social needs, institutional arrangements, and habitual ways of doing things” (Kennedy 1993: 330).
In a similar vein, Kobrin (1997: 157, 159) argues that globalization challenges both autonomy and independent decision-making of the state and “raises questions about the meaning of sovereignty in its external sense of a system ordered in terms of mutually exclusive territoriality.” Political Scientists Yoshikazu Sakamoto (1994) and Robert Cox (1996: 26-27) concur in arguing that globalization generates problems of international governance and reduce the regulatory power of the states. Rodrik (1997) argues that globalization creates social and political tensions within and across nation-state. Political theorists Michael Mosher (1999:35)asks, “Is there a successful way of reconciling the boundary transgressing character of markets with the boundary maintaining activities of nation-states?” He further notes that globalization has placed two liberal practices the Liberalism of the market and the Liberalism of democratic citizenship on a collision, raising the dilemma of whether “moral concerns stop at the national border” (Mosher 1999: 25).

The analysis by British political economist Susan Strange is perhaps the most sophisticated articulation of the position that the international system of nation -states and the nation-state itself are coming under fire in a global world. She writes about the “declining authority of states,” and preempts several possible criticisms. First, she argues that the state interventionism is on the rise, but it mostly has to do with increasingly marginal matters. Second, she argues that there are more states in the world, especially after 1989, but that most of the new ones are weak and lack control. Third, she points out that the effectiveness of the East Asian State in orchestrating economic growth was only possible in post World War II order in which protectionism of the domestic market was acceptable and mature technologies were available ( Strange 1994: 4-6) She further observes three power shifts in the global world, namely, from weak to strong states, from states to markets, and from labor markets to financial markets, and argues that some power has evaporated or dispersed (Strange1996:189) Some Scholars have argued that globalization is a feeble process.

They maintain that it can be easily handled by nation-states. For example, Hirst and Thompson (1996: 143-149, 179-194) assert that states can cope with globalization, although they have lost some freedom of action, especially concerning financial flows. Feeble proponents, however, are not the only ones against the claim that globalization undermines the nation-state. Neorealist International Relations Scholar Robert Gilpin (1987:389-406) points out that globalization has reinforced the importance of domestic policies, as countries engaged in regionalization, sectoral protectionism, and mercantilistic competition during the 1980s in response to changes in the international location of activities, resulting in a “mixed system,” increasingly globalized and at the same time fragmented.

A related, though distinct, argument against the presumed loss of state power in the wake of globalization comes from Political Scientist Leo Panitch (1996: 84-86). He argues that “today’s globalization is authored by states and is primarily about reorganizing rather than bypassing them.” Another influential Political Scientist, Saskia Sassen (1996: 25-30), maintains that the state does not lose significance. Rather, there is a redefinition of modern features of sovereignty and territoriality, a denationalizing of national territory.” According to most political scientists, therefore, the nation-state is alive and well, and the Westphalian order is unlikely to be replaced by a fragmented medieval one.

Finally, the world-society view also rejects the claim that globalization undermines nation-states. Noting the expansion of state bureaucracies since World War II, Meyer (1997: 157) writes that “globalization certainly poses new problems for states, but it also strengthens the world-cultural principle, that nation-state are the primary actors charged with identifying and managing those problems on behalf of their societies.” This argument is strikingly similar to the one offered by Panitch (1996: 84-86). The modern nation-state, world-society scholars conclude, “may have less autonomy than earlier but it clearly has more to do.” The analysis and critique presented in this reaction paper indicates that globalization, far from being a feeble phenomenon, is changing the nature of the world. However, it is neither an invariably civilizing force nor a destructive one. Political Scientist Ngaire Woods (2003) cautioned that “Governments need delicately to balance sovereignty and reaping the benefits of globalization.”

In his earlier publication of the Political Economy of Globalization (2000) Woods had asserted that “Globalization does not prohibit strong governments from maintaining welfare and good working conditions and how governments can cooperate to manage the flow of goods, people and problems across the borders.” He also asserted that surrendering some sovereignty and submitting to global rules will unshackle global commerce from messy national interventions; the result he claimed will “benefit all countries.” In Globalization and National Autonomy’ Woods (2003) seemed to be reversing his position on the issue of Globalization and National Autonomy’ study he had published in The Political Economy of Globalization” of the benefits of nation-states giving up national autonomy in a globalize economy. In his (London 2003) Review, he does not seem to be the optimist he once was in his earlier publication. He asserted that “the evidence of the impact of liberalization in countries across the world economy gives pause for thought to governments considering giving up national autonomy to integrate further into the world economy.” Woods concluded this time with less enthusiasm “evidence has been adduced to show that liberalization and globalization have been bad for developing countries.”

In conclusion globalization is neither a monolithic nor an inevitable phenomenon.
Its impact varies across countries, societal sectors and time. It is fragmented, contradictory, discontinuous, and even haphazard. It is centered on cross border flows and global communication and has affected two distinct features of the modern state: sovereignty and exclusive territoriality. In many nation-states, globalization has been accompanied by the creation of new legal regimes and practices. To many observers that process has been U.S. driven. In many countries, international or transnational has become a form of Americanization. Global capital has made claims on national states, which have responded through the production of new forms of legality. Globalization has undercut the social bargain that many nation-states in the developing countries have adopted since they became a nation-state after colonialism.

References

Cox, Robert W. 1996. “A Perspective on Globalization.” In Globalization: Critical
Reflections, edited by James H. Mittelman. Boulder: Lynne Rienner Publishers.
Gilpin, Robert. 1987. The Political Economy of International Relations.
Princeton, NJ: University Press.
Kennedy, Paul. 1993. Preparing for the Twenty-First Century.
New York: Random House.
Kobrin, Stephen J. 1997 “The Architecture of Globalization: State Sovereignty in a
Networked Global Economy,” Government, Globalization, and International
Business. New York: Oxford University Press.
Panitch, Leo. 1996. “Rethinking the Role of the State in Globalization Critical
Reflections.Boulder: Lynne Rienner Publishers.
Rodrik, Dani. 1997. Has Globalization Gone too Far?
Washington DC: Institute of International Economics.
Sakamoto, Yoshikazu. 1994. Global Transformation: Challenges to the State System.
New York: United Nations University Press.
Strange, Susan. 1996. The Retreat of the State: The Diffusion of Power in World
Economy. New York: Cambridge University Press.
Sassen, Saskia. 1996. Losing Control? Sovereignty in an Age of Globalization.
New York: Columbia University Press

Black Feminist Thought in the Matrix of Domination

January 30, 2007 - One Response

 The advent of the contemporary women’s movement became strong and widespread after the 1960s. Although few period of mobilization for the feminist cause existed prior to the 1960s, those causes were primarily around issues of suffrage and employment. Contemporary feminist writers like Patricia Hill Collins and Lemert hall drew their ideas from the works of early sociological theorists, most particularly Marx, Engels, and Freud. Collins (1990) for instance, reworks their ideas of these writers by analyzing gender differences, inequality and oppression. For example, Collins Matrix of Domination gave us path-breaking and deep theoretical understanding of African-American women and portrays them self-reliant individuals confronting race, gender and class oppression. Collins (1990:536) suggests that “Black feminist thought fosters a fundamental paradigmatic shift that rejects additive approaches to oppression.”

Black feminist thought’s in the matrix of domination emphasis the ongoing interplay between Black women’s oppression and Black women’s activism and presents the matrix of domination as responsive to human agency. Such a radical feminist thought as presented by Patricia Hill Collins views the world as a dynamic place where the goal is not merely to survive or to fit in or to cope; rather, as a place where black women will feel ownership and accountability. This existence of Afro centric feminist thought suggests that there is always choice, and power to act, no matter how bleak the situation may appear to be. Viewing the world as one in the making raises the issue of individual responsibility for bringing about change. It also shows that while individual empowerment is the key, only collective action can effectively generate lasting social transformation of political and economic institutions.

Collins reconceptualize race, class and gender as three interlocking systems of oppression. She argues that black feminist thoughts see those three distinctive systems as part of one overarching structures of oppression and domination. She views “any given sociohistorical content as being structured via a system of interlocking race, class, and gender oppression” (Collins, 1990:537). She argues that black woman’s experiences and the Afro centric feminist thoughts challenges prevailing definitions of community which stress community as arbitrary and fragile, structured fundamentally by competition and domination. Instead, Collins suggests that afro centric models of community which stress connections, caring, and personal accountability” (Collins, 1990:537).

Collins argues that the black female spheres of influence constitute potential sanctuaries where individual Black women and men are nurtured in order to confront oppressive social institutions. She argues that “Addictive models of oppression are firmly rooted in either/or dichotomous thinking of Eurocentric, masculinist thoughts” (Collins, 1990:538). She argues that in addition to being structured along race, gender, and social class, black feminist thought emphasizes three levels as sites of domination and as potential sites of resistance. Collins believes that the matrix of domination is structured on several levels. Collins suggests three levels by which people experience and resist oppression, “the level of personal biography; the group or community level of the cultural context created by race, class, and gender; and the systemic level of social institutions” (Collins, 1990:540).

Collins believes that domination operates by seducing, pressuring, or forcing African American women and members of subordinated groups to replace individual and cultural ways of knowing with dominant group’s specialized thought. She argues against traditional accounts which “assume that power as domination operates from the top down by forcing and controlling unwilling victims to bend to the will of more powerful superiors. But these accounts fail to account for questions concerning why, for example, women stay with abusive men even with ample opportunity to leave or why slaves did not kill their owners more often; the willingness of the victim to collude in her or his own victimization becomes lost” (Collins, 1990:540).

Collins argues that these assumptions also fail to account for sustained resistance by victims, even when chances for victory appear remote. She indicates that by emphasizing the power of self-definition and the necessity of a free mind, Black feminist thoughts now speaks of the importance and place of African-American women thinkers and their own consciousness as a sphere of freedom. Collins argues that black women intellectuals are now beginning to realize that domination operates not only by structuring power from the top down but by simultaneously annexing the power as energy of those on the bottom for its own ends. “In their efforts to rearticulate the standpoint of African-American women as a group, Black feminist thinkers offer individual African-American women the conceptual tools to resist oppression”(Collins, 1990:540).

Collins believes that, that each individual biography is rooted in several overlapping cultural contexts–for example, “groups defined by race, social class, age, gender, religion, and sexual orientation and that the cultural component contributes, among other things, the concepts used in thinking and acting, group validation of an individual’s interpretation of concepts, the “thought models” used in the acquisition of knowledge, and standards used to evaluate individual thought and behavior” (Collins, 1990:540). Viewing domination from a black women’s standpoint and those of other oppressed groups she suggests that because “black women’s ideas have been suppressed; this suppression has stimulated black women to create knowledge that empowers people to resist domination” (Collins, 1990:541).

Collins (1990:544) suggests that “Afro centric feminist thought represents a subjugated knowledge and that a Black women’s standpoint may provide a preferred stance from which to view the matrix of domination because, in principle, Black feminist thought as specialized thought is less likely than the specialized knowledge produced by dominant groups to deny the connection between ideas and the vested interests of their creators. In conclusion Collins argues that “portraying Black women solely as passive, unfortunate recipients of racial and sexual abuse stifles notions that Black women can actively work to change their own circumstances and bring about changes in their own lives. She argues that by presenting African-American women solely as heroic figures who easily engage in resisting oppression on all fronts minimizes the very real costs of oppression and can foster the perception that Black women need no help because we can “take it.”

Work Cited

Collins, Patricia H. 1990. Black Feminist Thought in the Matrix of Domination.

Social theory: the Multicultural and Classic Readings. Charles Lemert (Eds.)

Third Edition.

 

 

 

WAR AS THE SUPREME PRINCIPLE OF HUMAN IRRATIONALITY

January 30, 2007 - Leave a Response

The question that has been raised in many discussion recently relates to the question of whether war is a moral or immoral act against huamnity. The are those who have argued that war is a necessary evil to right inhumane treatment of helpless people from the cruel whims of dictators like Sadam Hussien. In “Grond Work of the Metaphysics of Morals” Kant attempts to search for a practical doctrine of morals and moral laws that is derived from the universal concepts of rational beings that will hold for every rational being regardless of religion. In his search for a principle of mral concepts Kant sets out to present a complete unity of a practical with speculative reason by establishing a supreme principle of morality as the single key to every moral decision. Kant’s postulate that all moral concepts have their seat and origin completely a priori in reason. Kant suggests that just as in reason that is speculative in the highest degree, morals cannot be abstracted from any empirical or mere contingent cognition. When arguments of war are reduced to the concept of moral rights it becomes prblematic, especially when there is nothing moral about killing or maiming another human being to save him or her from him or her self. The argument made by some neoconservatives in the U.S. and in Britain to go to war against Sadam Hussein’s Iraq was that of restoring a new world order as president Bush senior once declared after he took the oath of office as president of the United States. In their designed of a new world order their conservatives in the Bush senior and Bush junior White House failed to realize the rapid social transformation nations in the Balkans, the Persian Gulf regions have been going through since the end of the Cold War. The vision of those neoconservatives who were calling for America the only remaining Super power to asserts its hegemony in a bipolar globalized world were blurred and dsitorted by their insensitivities  to recognize the social and economic injustice  brought about by more than half a century of corrupt regimes put inplace by previous American Administrations during the Cold War to combat Soviet communist expansionism. The neoconservatives who were in the advising George Bush I., and George Bush II,  failed to recognize the spirit of nationalism and religious disharmony which had been brewing for a long time in that part of the world but had been  kept in check by repressive dictators and tyrants kept in power and supported by the U.S. and Britain. They failed to recognize the significance religion plays in the mind set of the people in that region for had they recognize those dangers they would not have driven us to two senseless wars in less thana decade. Had they paid enough attention to what was happening in that region after the Cold War had ended they could have called for economic and educational development in that region to undermine Sadam’s regime instead of calling for a premtive war that has eventually caused more evil than good. What then is the rational or moral principle that has been accomplished by using our miltary to overthrow a dictator that we could control to a sectarian war that will ventually end in creating another Islamic Revolutionary state.I have no remorse for the way sadam and his children met their ends, but I questined the rationale of replacing a power drunk and evil dictaor we can control to that of bunch of  Mulahs we cannot control because they are using the most powerful means at their disposal that of religion to create hatred for America and its allies to foster their ambition of the creation of an Islamic Revolutionary state.

A DISCUSSION OF KANT’S PRINCIPLE OF MORAL CONCEPTS

January 30, 2007 - One Response

 In “Grond Work of the Metaphysics of Morals” Kant attempts to search for a practical doctrine of morals and moral laws that is derived from the universal concepts of rational beings that will hold for every rational being regardless of religion. In his search for a principle of mral concepts Kant sets out to present a complete unity of a practical with speculative reason by establishing a supreme principle of morality as the single key to every moral decision. Kant’s postulate that all moral concepts have their seat and origin completely a priori in reason. Kant suggests  just as in reason that is speculative in the highest degree, morals cannot be abstracted from any empirical or mere contingent cognition. He argued that the purity of their origin lies in their dignity, so that they can serve us as supreme practical principles. Kant’s assertion is that in adding anything empirical to them we are liable to subtract just as much from their genuine influence and from their unlimited worth of actions that is not only a requirement of the greates necessity for theoretical purposes, when it is a matter merely of speculation, but also of the greatest practical importance, that which is to draw its concepts and laws from pure reason.

Kant too the position that everything in nature works in accordance with laws and only a rational being has the capacity to act in accordance with the representation of laws that is in accordance with moral principles or has a will. Kant’s assertion is that since reason is required for the determination of actions from laws, the will is nothing other than practical reason, and since reasons infallibly determines the will, the actions of such a being that are cognized as objectively necessary are also subjectively necesssary. This mean the will has a capacity to choose only that which reason independently of inclinations cognizes as practically necessary that is good. Kant’s claim that all moral concepts  have their seat and origin completely a priori in reason, in the most common reason that is speculative in the highest degree. That which cannot be abstracted empirically and therefore merely contingent cognitions. Kant suggest it is in this purity of their origin lies their dignity, so that they can serve us as supreme practical principles and by adding anything empirical to them we run the risk of subtracting just from their genuine influence and from the unlimited worth of its actions. He suggests that it is not only a requirement of the greates necessity for theoretical purposes, or a matter merely of speculation, but it is of the greatest practical importance to draw its concepts and laws from pure reason, that which is set them pure and unmixed, in order to determine the extent of this entire practical or pure rational cognition, as that which determine the entire faculty of pure  rational cognition, as that which determine the entire faculty of pure practical reason. For Kant the only thing which can be quantifiable is a good will, and he ponders whether anyone can even conceive of anything at all in this world, or even out of it, without qualification except a good will. Kant added, some qualities are ven conducive to this good will itself, however.  He suggests however, they have no inner unconditional worth but always presupposes a good will, which limits the esteem one otherwise rightly has for them and does not permit their being taken absolutely as good. Kant thus contrasted a good will with good fortune, which we call happiness. Kant made an important qualification that although good will (morality) is wholly distinct from good fortune (happiness) and we naturally expect that the two will go together. Kant concludes a good will appears to constitute the indispensable condition even of being worthy of happiness. A good will for Kant is not good because of what it effects or accomplishes, or because of its fitness to attain some proposed end, but only because of its volition, that is, it is good in itself and regarded for itself, is to be valued incomparably highr than all that could merely be brought by it in favor of some inclination.

Kant attested that since reason is not sufficiently competent to guide the will surely with regard to its object and the satisfaction of all our needs, and since reason is nevertheless given to us as a practical faculty, that is one that is to influence the will. He suggests were nature has every where else gone to work purposively in distributing its capacities. The true vocation of reason according to Kant must be to produce a will that is good, not as a means to other purposes, but good in itself, for which reason was absolutely necessary. As Kant puts it, this will must be the highest good and the condition of every other, evenfor all demands of happiness.  This concept of a good will for  Kant is that which is to be esteemed in itself and that is good apart from any further purpose, constitutes a concept of duty. Duty  for Kant contains that of good will though under subjective limitations and hindrances, which, however, far from concealing it making it unrecognizable, rather bring it out by contrast and make it out shine forth all the more brightly. Kant makes an all important distinction between acting in conformity with duty versus acting for the sake of duty. He suggests contrasted with reason are inclinations which are strictly empirical, and so of no moral value. In Kant’s moral philosophy when he says an act has no moral worth, he he is not saying that it is a bad act but rather an amoral one. Therefore for Kant duty either coincide with inclinations or be opposed to them. He suggests that when duty is chosen over inclinations, the act is moral, but in the case of coincidence, the act that follows is amoral. For an action to have a moral worth for Kant that action must be for the sake of duty. In Kant’s proposition he is making a distinction between the purpose and the maxim of an action, meaning the aim of an action, that is what that action is trying to achieve. According to Kant neither the purpose nor the actual consequences themselves are a part of moral considerations. For Kant the aim, like the the results of an action, is posteriori which is a direct contrast to priori. The grocer for example,  who might have his aim  to satisfying his customers and making a profit on the sale,  in other for his action to be considered moral, he should act with honesty. It is this intention to act according to what duty demands, and not by any repercussion of the act, which becomes the essential moral aspect of an action. According to Kant’s moral principle, an action done from duty has moral worth, not in the purpose that is to be attained by it, but in the maxim according which action is determined. For Kant, the moral worth of an action depends, not on the realization of the object of the action, but merely on the principle of volition according to which, without regard to any objects of the faculty of desire, the action has been done. From this, it is clear that Kant meant the purposes which we may have in our actions, as well as their effects reagarded as ends and incentives of the will, cannot give to actions any unconditioned and moral worth. Kant rhetorically asked where then can this worth lie if it is not to be found in the will’s relations to the expected effect? Nowhere, Kant replied but in the principle of the will, no regards to the ends that can be brought about through such action.