Differences: physical, behavioral, social, definitional

(2-11-03)

“Homo sum: humani nil a me alienum puto”
Terrence

On display: how others define us

Differences may be obvious to others, may have high social impact in our culture, may be difficult/impossible to conceal
- “I notice you don’t have a hand.” – ignoring a difference
- “I get better tips with this hand.” – cosmetic vs. functional prosthesis
- “Your mom is white!” – biracial, multiracial, 5% Northern Irish, who can keep track
- “I’m not interested in being evaluated for ADD.” – clinical symptoms without functional impairment (and clear social, occupational, and possibly legal consequences)
Hypothesis: differences are to a large extent social constructions, carried in the language of the culture and subcultures
- This is not a denial that some differences are rooted in physical realities (Only in The National Enquirer do men bare children), but an assertion that most of the important aspects differences are interpersonal in nature.
- Socially defined differences are tremendously powerful in our lives, regardless of how “reality based” these may be

“Who am I?”
- Self-identity, gender identity, competency (efficacy, Origin, locus of control), role identity (religious, political, occupational–modeling effects in adolescents and adults)
- the onion model–persona, “true self”, etc.
- the situational/enactment model–personality as self delusion
- the multiple self model–we’re all DID (MPD)
Hypothesis: The problem/issue of self is liked to the problem/issue of consciousness

“My father’s here.”
physical, cognitive, social changes
risks
being left behind (technologically, socially)
morbidity (physical, medical, cognitive)
meaninglessness (dread, depression, despair)
“We had to take Papa’s keys away.”
medications
- increased sensitivity, increased side effect profile, possibly increased interactions
- monitoring all medications from all prescribers, OTC, alcohol, illicit, herbals, caffeine, nicotine, etc.
- monitoring medication compliance
- monitoring effects and side effects
- monitoring accuracy of report to physicians
specific psychotropic medications often used with geriatric populations:
- Antiparkinsonian (anticholinergic)
  - benztropine (Cogentin)
  - trihexyphenidyl (Artane)
  - L-dopa, levodopa (Atamet, Larodopa, Dopar, Sinemet)
Anti-Alzheimer (acetylcholinesterase inhibitors: SChE-I)
current focus on enhancing cholinergic function: agents that inhibit acetylcholinesterase–the enzyme that breaks down acetylcholine–are most widely used
- donepezil (Aricept)
- ergoloid (Hydergine)
- glantamine (Reminyl)
- rivastigmine (Exelon)
- tacrine (Cognex)