Desire and the Prosthetics of Supervision: A …
Patients who are considering surgical reconstruction as a treatment for PD should be in the stable phase of the disease. Typically, PD lesions become stable at 12 to 18 months after symptom onset. The most common inclusion criteria for surgical studies are the presence of PD symptoms for at least 12 months and stable curvature for 3 to 6 months. It should be noted that this literature focuses almost entirely on patients with stable disease; surgical outcomes for patients with active disease are not known. The Panel, therefore, comments only on patients with stable disease. The pre-surgical evaluation should query the patient regarding when symptoms began to determine whether the patient is likely to be in the stable phase and should establish, by clinician follow-up or by patient report, that PD symptoms have been clinically unchanged for at least three months. In the Panel's expert opinion, the distinguishing features of stable disease are deformity and plaque(s) that are unchanging and non-progressive. Patients with stable disease may have pain, but typically pain is associated with erection only. The evaluation should establish and document through appropriate diagnostic methods (see Discussion under Guideline Statement 2): the location (e.g., proximal, mid, distal), direction of curvature (e.g., dorsal, lateral, ventral), and degree of curvature; the presence of other deformities such as indentation, hinge, narrowing, hourglass, or shortening; the presence, location, and extent of plaque(s), including whether any are calcified; the presence and degree of ED; the extent to which deformity and/or pain in the patient with normal erectile function interferes with intercourse for the patient and partner; and, the presence and degree of distress. This information is critical to appropriately counsel patients regarding the various options available and which options may be most suitable for a particular patient. This information also is needed to counsel patients regarding expected outcomes. For example, although most surgical strategies will improve or eliminate curvature, surgical therapies other than prosthesis implant generally do not restore erectile function in patients with ED that is unresponsive to pharmacotherapy or vacuum constriction devices. If the patient's priority is full sexual function, and he has ED refractory to pharmacotherapy, then he and his partner should be counseled to consider prosthesis implantation.
Stumped Identities: Body Image, Bodies Politic, ..
The second problem with the social model of disability is that it can actually reify the awkward dynamic of tragedy and charity it seeks to dislodge. Rather than the victims of nature, people with disabilities are presented as the victims of society, but victims nonetheless. This victimization prompts the social dynamic in which the normals feel pity for the stigmatized and express their good intentions and well wishes – in other words, their disavowal of stigma – through charity, or at least through a charitable attitude which often comes across as patronizing. "Grievances" identified by Beatrice Wright as early as 1960 – "the problem of help" and "the problem of charity" – are not resolved but reconstituted by the social model. Indeed Goffman, citing Wright, took the persistence of these problems in the face of attempts to approach disability humanely as his starting point. In a sense, the social model of disability never caught up to Goffman.
"I appreciate the questions posed by Nelson and Wright, and found the ethnographic material in both articles rich and provocative. Although I am intrigued by their metaphorical use of prosthesis, I believe that this metaphor is ultimately problematic and leads to serious flaws in their arguments. My perspective is from a unique position of both native and ethnographer. I became a below-knee amputee following a car-versus-motorcycle accident in 1988, and will draw upon my "body notes" to discuss my own experiences with amputation and prostheses."