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There is no reason to assume that natural sexual acts are in general more safe than unnatural sexual acts; for example symptoms 4 dpo buy nitroglycerin 2.5 mg otc, unprotected (sans condom) heterosexual intercourse is more dangerous medications 44 175 cheap 2.5 mg nitroglycerin visa, in several ways, than mutual homosexual masturbation. Since there are no necessary connections between the naturalness or unnaturalness of a particular sexual act or a specific type of sexual activity and its moral and nonmoral quality, why would we wonder whether a particular sexual act or a type of sexual activity was natural or perverted? With such deliberations, the human self-reflection about humanity and the human condition that is the heart of philosophy becomes more complete. A second reason is that an account of the difference between the natural and the unnatural in human sexuality might be useful for the discipline of psychology, if we assume that a desire or tendency to engage (exclusively) in unnatural or perverted sexual activities is a sign or symptom of an underlying mental pathology. Just as whether a sexual act is nonmorally good, that is, produces pleasure for the participants, may be a factor, sometimes an important one, in our evaluating the act morally, whether a sexual act or type of sexual expression is natural or xxx Alan Soble unnatural may also play a role, sometimes a large one, sometimes not, in deciding whether the act is morally good or bad. Both Aquinas and Nagel make the relatively innocuous assumptions that what is unnatural in human sexual behavior is perverted, and that what is unnatural (or perverted) in human sexuality is simply that which does not conform with or is inconsistent with natural human sexuality. But beyond these trivial areas of general agreement, there are deep differences between the views of Aquinas and Nagel. Based on a comparison of the sexuality of humans and the sexuality of lower animals (birds, dogs, etc. Heterosexual coitus is the mechanism designed by the Christian God to ensure the preservation of animal species, including the human species, and hence engaging in this activity is the primary natural expression of human sexual nature. Although Aquinas does not say so explicitly, but only hints in this direction, it follows from his philosophy of sexuality that fellatio, even when engaged in by heterosexuals, is also unnatural and morally wrong. At least in those cases in which orgasm occurs by means of this act, the sperm is not being placed where it should be placed and procreation is therefore not possible. Applying this formula, Aquinas concludes that the purpose of sexual activity and the sexual organs in humans is procreation, as it is in the lower animals. Nagel, by contrast, argues that to discover what is distinctive about natural human sexuality, and hence, derivatively, what is unnatural or perverted for humans, we should focus, instead, on what humans and lower animals do not have in common. We should emphasize the ways in which humans are different from animals, the ways in which humans and their sexuality are special. For it is human psychology that makes us different from other animals, and hence an account of natural human sexuality must acknowledge the uniqueness of human psychology and its role in sexuality. Nagel proposes that sexual interactions in which each person responds with sexual arousal to noticing the sexual arousal of the other person exhibit the psychology that is natural to human sexuality. In such an encounter, each person becomes aware of himself or herself and the other person as both the subject and the object of their joint sexual experiences. I am sexually aroused not only by your physical attractiveness or your touch, but also by the fact that you are aroused by me and my touches; we become sexually aroused by recognizing that we are aroused. Sexual perversion, then, is a departure from or a truncation of a psychologically "complete" pattern of arousal and consciousness. That is, for a sexual encounter to be natural, it need not be procreative in form, as long as the requisite psy- xxxii Alan Soble chology of mutual recognition is present. Aquinas and Nagel agree that such activities are unnatural, but they disagree about the grounds of that evaluation. The arousal of the fetishist is, from the perspective of natural human psychology, defective. Note, in this example, one more difference between Aquinas and Nagel: Aquinas would judge the sexual activity of the fetishist to be immoral precisely because it is unnatural (it violates a natural pattern established by God), while Nagel would not conclude that it must be morally wrong-after all, a fetishistic sexual act might be carried out quite harmlessly and be quite pleasurable. Gudorf concludes that the existence of the clitoris in the female body suggests that God intended that the purpose of sexual activity was as much for sexual pleasure for its own sake as it was for procreation. That the clitoris, through its ability to provide pleasure, can play a crucial role in sexuality that is eventually procreative, is not obviously false. Debates in Sexual Ethics the ethics of sexual behavior, as a branch of applied ethics, is no more and no less contentious than the ethics of anything else that is usually included within the area of applied ethics. Think, for example, of the notorious debates over euthanasia, welfare entitlements, capital punishment, abortion, environmental pollution, and our treatment of lower animals for food, clothing, entertainment, and in medical research. So it should come as no surprise that even though a discussion of sexual ethics might well result in the removal of some confusions and a clarification of the issues, very few final or absolute answers to questions about the morality of sexual activity are likely to be forthcoming from the philosophy of sexuality. And most ethical systems conclude that adultery is morally wrong or at least morally suspect. We have already encountered one of these debates: the dispute between a Natural Law approach to sexual morality and a more liberal or secular outlook that denies that there is a tight connection between what is unnatural in human sexuality and what is immoral.

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A trauma-informed approach adjusts services to meet the needs of women who have a history of trauma symptoms gluten intolerance buy cheap nitroglycerin 2.5 mg line. In 6- and 12-month outcome studies evaluating program and person-level effects among women with co-occurring disorders and trauma (Morrissey et al symptoms adhd safe 2.5mg nitroglycerin. Programs can use Appendix F, Integration SelfAssessment for Providers, to determine the extent to which their agency integrates treatment for substance abuse, mental illness, and trauma. To be trauma-informed means to know of past and current abuse in the life of a woman. But more importantly, it means to understand the roles that violence and victimization play in the lives of women seeking substance abuse and mental health services, to design integrated service systems that accommodate the vulnerabilities of a trauma survivor, and to deliver services that facilitate participation 164 Substance Abuse Treatment for Women in treatment (Harris and Fallott 2001b). Being trauma-informed does not mean that the program forces clients to reveal their trauma unwillingly. Nor does it mean that substance abuse treatment counselors need the level of expertise that is required to help women resolve all their problems related to trauma. However, knowledge about violence against women and the effects of trauma helps counselors to: נConsider trauma when making assessments and treatment plans. The project used relational strategies to facilitate systems change across three systems levels: local treatment providers, community or regional agencies, and the State government. Substance abuse treatment clinicians in the study reported they tended to be insensitive to trauma/violence issues because they were unaware of the overlap between these two issues (there were notable exceptions among staff at programs that were gender-specific and evidence-based). Clinicians who were cross-trained or attempted to provide a broader range of services to clients often encountered restrictions embedded in existing procedures, forms, and documentation requirements that made integrated care more difficult. Clients in the study recounted their frustration at having to slant their histories depending on the agency or practitioner they were addressing, and at having to conceal part of their histories to receive certain services. Rather than promoting wholeness and recovery, the experience in the treatment program recreated the secrecy of abuse and fed the stigma associated with their illnesses. Project activities included cross-training for clinicians, convening a consumer advisory group to provide guidance, submission of recommendations from the local leadership councils to the State level, and visits by consultants to each agency to assist clinicians in putting their training into practice. These activities resulted in greater understanding of trauma-related issues by clinicians, stronger linkages to community services for women with histories of trauma, and more referrals to these services. Substance Abuse Treatment for Women 165 Note to Clinicians and Administrators Preliminary data support that integrated trauma-focused interventions for women in substance abuse treatment programs appear to be safe, thus presenting no differences in adverse psychiatric and substance abuse symptoms or events in comparison to standard care (Killeen et al. So often, clinicians and administrators fear and hold the misperception that addressing trauma-related issues is counterproductive and produces deleterious effects on women in substance abuse treatment. While the selection of services and the planning on how these services are delivered is important in maintaining the integrity of care for the client, integrated trauma-focused interventions are not only a viable option but an essential component of treatment for women with substance use disorders. If women are not questioned directly, the abuse may go unrecognized and untreated. Many women who are dependent on alcohol or drugs experience difficulty in recovery and relapse if violence and abuse issues are not addressed in treatment. Women may need help understanding the serious long-term effects of violence, sexual abuse, and incest on their functioning and on the risk of relapse (Covington 2003; Finkelstein 1996; Najavits 2006). In many instances, counselors can address trauma and its relevance to substance abuse treatment effectively. Clients with such problems should be referred to a specialist-typically a licensed mental health professional trained in trauma within the treatment program. Trauma-informed counselors can recognize when a therapeutic relationship is stretching their abilities, but the decision to refer a client requires understanding of the situation and supervisory consultation and agreement. Major trauma-related clinical issues that counselors need to address or attend to during the course of treatment include: נOutreach. Efforts to engage women in treatment include flexible scheduling, ready availability, identification of client interest in and need for treatment, and ongoing evaluation. Outreach includes informing the community of services offered and initiating contact with agencies that should refer women for assessment and counseling (Elliott et al. It requires treatment by a clinician who is trained in treating traumatic stress disorders. Counselors should be candid when they cannot provide the treatment the client needs and may need to make a referral. Sharing prevalence data can reduce her sense of isolation and shame (Finkelstein 1996).

The ideology of mass culture 911 treatment for hair nitroglycerin 2.5mg on-line, like other ideological discourses symptoms high blood pressure 2.5mg nitroglycerin with amex, seeks to interpellate individuals into specific subject positions (see discussion of Althusser in Chapter 4). The letters suggest four positions from which to consume Dallas: (i) those who hate the programme; (ii) ironical viewers; (iii) fans, and (iv) populists. First, the programme is identified negatively as an example of mass culture, second, as a means to account for and support their dislike of the programme. This is not to say that it is wrong to 150 Chapter 7 Gender and sexuality dislike Dallas, only that professions of dislike are often made without thinking, in fact with a confidence born of uncritical thought. Viewers who occupy the second position demonstrate how it is possible to like Dallas and still subscribe to the ideology of mass culture. Dallas is subjected to an ironizing and mocking commentary in which it `is transformed from a seriously intended melodrama to the reverse: a comedy to be laughed at. From this position the pleasure of Dallas derives from the fact that it is bad ­ pleasure and bad mass culture are reconciled in an instant. For both the ironizing viewer and the hater of Dallas, the ideology of mass culture operates as a bedrock of common sense, making judgements obvious and self-evident. Although both operate within the normative standards of the ideology, the difference between them is marked by the question of pleasure. On the one hand, the ironizers can have pleasure without guilt, in the sure and declared knowledge that they know mass culture is bad. For the viewers who occupy the previous two positions, to actually like Dallas without resort to irony is to be identified as someone duped by mass culture. And people try to do that by means of all these things ­ sex, beautiful people, wealth. Ang analyses the different strategies that those who love Dallas must use to deal consciously and unconsciously with such condescension. It is a little like the heroin user in the early 1990s British drugs awareness campaign, who, against the warnings of impending addiction, declares: `I can handle it. But, as Ang points out, the writer remains firmly within the discursive constraints of the ideology as she attempts to relocate Dallas in a different relationship to the binary oppositions ­ with substance/without substance, good/bad. A third strategy of defence deployed by fans against the normative standards of the ideology of mass culture is to use irony. The letter-writer who uses this strategy is caught between the dismissive power of the ideology and the pleasure she obviously derives from watching Dallas. Her letter seems to suggest that she adheres to the former when viewing with friends, and to the latter when viewing alone (and perhaps secretly when viewing with friends). The struggle therefore, as so far described, between those who like Dallas and those who dislike it, is an unequal struggle between those who argue from within the discursive strength and security of the ideology of mass culture, and those who resist from within (for them) its inhospitable confines. The final viewing position revealed in the letters, one that might help these fans, is a position informed by the ideology of populism. Compared to this, the ideology of mass culture has an extensive and elaborate range of arguments and theories. Little wonder, then, that when invited to explain why they like or dislike Dallas, the letter-writers find it difficult to escape the normative discourse of the ideology of mass culture. The difficulty with adopting the populist ideology for a radical politics of popular culture 152 Chapter 7 Gender and sexuality is that it has already been appropriated by the culture industries for its own purposes of profit maximization. Her answer is yes: fantasy and fiction do not function in place of, but beside, other dimensions of life (social practice, moral or political consciousness). They can still be condemned for being reactionary in an ongoing cultural politics. Fiction and fantasy, then, function by making life in the present pleasurable, or at least livable, but this does not by any means exclude radical political activity or consciousness. It does not follow that feminists must not persevere in trying to produce new fantasies and fight for a place for them. The personal may be political, but the personal and the political do not always go hand in hand (135­6). In an unnecessarily hostile review of Watching Dallas, Dana Polan (1988) accuses Ang of simplifying questions of pleasure by not bringing into play psychoanalysis. The idea that the ideology of mass culture is antiquated and anachronistic might be true in the fantasy realms of American academic psychoanalytic cultural criticism, but it is still very much alive in the conscious/unconscious world of everyday culture. She also tells us that it was also around the same time that she began to regard herself as a feminist.

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The State Support Council shall make an annual report to the Legislature that includes an evaluation of the program and recommendations for future policy in individual and family supports treatment chronic bronchitis 2.5mg nitroglycerin mastercard. The report shall also be distributed to the Governor for dissemination to state agencies symptoms queasy stomach nitroglycerin 2.5mg fast delivery. Provided, however, this exception shall not apply to federal maintenance of effort requirements. The councils may request the allocation of additional new funds in the budget of the Department of Mental Health and Mental Retardation for the Individual and Family Support Program and may also receive new funds from other state agencies and from the State General Fund. The foregoing prohibition shall not apply when a federal or state agency makes a request for or releases a Social Security number for a legitimate government purpose, or pursuant to a federal or state statute, regulation, or federally funded program or pursuant to an administrative or judicial subpoena or order. Nothing in this section is intended to create or establish a new cause of action for damages in any court. Nothing in this section shall be construed as a waiver of sovereign or qualified immunity. This section shall not be applicable to a document originating with any court or taxing authority, any document that when filed by law constitutes a consensual or nonconsensual lien or security lien or security interest, or any record of judgment, conviction, eviction, or bankruptcy. If express consent to reveal a Social Security number has not been obtained, a state department or agency shall redact, remove, cover, or otherwise excise the Social Security number of any person from any document that is available for public inspection so that the remaining portion of the document may be revealed. Legislative intent and purpose; effect on substantive rights; applicability; authority to prescribe rules and regulations required in connection with this chapter. Nothing in this chapter is meant to discourage agencies from adopting procedures conferring additional rights upon the public; and, save for express provisions of this act to the contrary, nothing in this chapter is meant to abrogate in whole or in part any statute prescribing procedural duties for an agency which are in addition to those provided herein. In accomplishing its objectives, the intention of this chapter is to strike a fair balance between these purposes and the need for efficient, economical and effective government administration. Its impact is limited to procedural rights with the expectation that better substantive results will be achieved in the everyday conduct of state government by improving the process by which those results are attained. Nothing in this chapter shall be construed as granting to any agency the authority to adopt or promulgate rules and regulations. Every board, bureau, commission, department, officer, or other administrative office or unit of the state, including the Alabama Department of Environmental Management, other than the Legislature and its agencies, the Alabama State Port Authority, the courts, the Alabama Public Service Commission, or the State Banking Department, whose administrative procedures are governed by Sections 5-2A-8 and 5-2A-9. The term shall not include boards of trustees of postsecondary institutions, counties, municipalities, or any agencies of local governmental units, unless they are expressly made subject to this chapter by general or special law. The Joint Committee on Administrative Regulation Review shall be the members of the Legislative Council. A proceeding, including but not restricted to ratemaking, price fixing, and licensing, in which the legal rights, duties, or privileges of a party are required by law to be determined by an agency after an opportunity for hearing. The term shall not include intraagency personnel actions; shall not include those hearings or proceedings in which the Alabama Board of Pardons and Paroles considers the granting or denial of pardons, paroles or restoration of civil and political rights or remission of fines and forfeitures; and which are exempt from Sections 41-22-12 through 41-22-21, relating to contested cases. The whole or part of any agency franchise, permit, certificate, approval, registration, charter, or similar form of permission required by law, but not a license required solely for revenue purposes when issuance of the license is merely a ministerial act. The agency process respecting the grant, denial, renewal, revocation, suspension, annulment, withdrawal, or amendment of a license or imposition of terms for the exercise of a license. Each person or agency named or admitted as a party or properly seeking and entitled as a matter of right, whether established by constitution, statute, or agency regulation or otherwise, to be admitted as a party, or admitted as an intervenor under Section 41-22-14. An agency may by rule authorize limited forms of participation in agency proceedings for persons who are not eligible to become parties. Any individual, partnership, corporation, association, governmental subdivision, or public or private organization of any character other than an agency. No less than a majority of the members of a multimember agency shall constitute a quorum authorized to act in the name of the agency, unless provided otherwise by statute. Each agency regulation, standard, or statement of general applicability that implements, interprets, or prescribes law or policy, or that describes the organization, procedure, or practice requirements of any agency and includes any form which imposes any requirement or solicits any information not specifically required by statute or by an existing rule or by federal statute or by federal rule or regulation; provided, however, all forms shall be filed with the secretary of the agency and with the Legislative Reference Service and all forms, except intergovernmental, interagency, and intra-agency forms which do not affect the rights of the public and emergency forms adopted pursuant to Section 41-22-5, shall be published in the Agency Administrative Code. The term includes the amendment or repeal of all existing rules, but does not include any of the following: a. Statements concerning only the internal management of an agency and not affecting private rights or procedures available to the public. Intergovernmental, interagency, and intra-agency memoranda, directives, manuals, or other communications which do not substantially affect the legal rights of, or procedures available to , the public or any segment thereof. Determinations, decisions, orders, statements of policy, and interpretations that are made in contested cases.

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