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The Fourth Trimester

The Fourth Trimester: Understanding, Protecting, and Nurturing an Infant through the First Three Months

Paul Brodwin
Copyright Date: 2013
Edition: 1
Pages: 224
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  • Book Info
    The Fourth Trimester
    Book Description:

    The first three months of a baby's life is an outside-the-uterus period of intense development, a biological bridge from fetal life to preparation for the real world. The fourth trimester has more in common with the nine months that came before than with the lifetime that follows. This comprehensive, intimate, and much-needed "operating manual" for newborns presents a new paradigm of a baby's early life that shifts our focus and alters our priorities. Combining the latest scientific findings with real-life stories and experiences, Susan Brink examines critical dimensions of newborn development such as eating and nutrition, bonding and attachment, sleep patterns, sensory development, pain and pleasure, and the creation of foundations for future advancement. Brink offers well-informed, practical information and the reasons behind her advice so that parents and caretakers can make their own decisions about how to care for a newborn during this crucial period.The Fourth Trimesterassures readers that infants are as biologically capable as they are physically helpless. They thrive on what is readily available in every household: consistent, loving attention.

    eISBN: 978-0-520-95451-9
    Subjects: Anthropology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. Acknowledgments
    (pp. xi-xiv)
  4. INTRODUCTION: The Terrain of Everyday Ethics
    (pp. 1-26)

    This book is an ethnographic study of ethical decision making in community psychiatry. In developed societies worldwide, the majority of people with severe psychiatric symptoms spend most of their lives outside hospital walls. But in the United States, people who are poor, alienated from their families, and dependent on public services face enormous obstacles to decent outpatient care. They rely on a fragmented collection of emergency rooms, crisis centers, and case management programs. The pace of work in these settings is rushed, the resources inadequate, and the possibility of failure ever present. I spent two years alongside frontline mental health...


    • CHAPTER 1 Genealogy of the Treatment Model
      (pp. 29-55)

      Everyday ethics emerges, by definition, against the background of ordinary practice. On a typical day, Eastside Services staff members make innumerable decisions about the right course of action for their clients. To do so, they must pose and then work through several questions. What does my client need, given what I know about his personality, his strengths and vulnerabilities, and the way he lives with his symptoms? Can I cobble together the resources to answer his need? Is there a standard, routine way to handle this sort of case, and can I conceivably follow it with the person standing in...

    • CHAPTER 2 Expert Knowledge and Encounters with Futility
      (pp. 56-86)

      In the published guidelines for setting up ACT teams, all the ingredients fit together into a coherent whole.¹ Training manuals specify the composition of the team (psychiatrist, psychologist, social worker, counselor and nurse), the proper lines of authority, and the paperwork to keep operations running smoothly. The guidelines lay out the precise duties and status of the case manager—a hybrid sociomedical worker—who is the linchpin of the work group. Eastside Services case managers rely on formal manuals, face-to-face instruction, and infinite improvisations in order to carry out their work. Combining disciplinary and situated knowledge in fluent, even unconscious...


    • CHAPTER 3 Treatment Plans Mandatory Narratives of Progress
      (pp. 89-117)

      Like clinicians everywhere, the staff at Eastside Services has a practical mastery of the tasks of care, and usually that is enough. Most case managers are relatively young, so they have no living memory of the problems of deinstitutionalization that ACT meant to solve. They spend most of their time immersed in daily routines, and they rarely need to articulate the program’s ethos. Caring for chronic illness, including psychiatric conditions, is a matter of daily action, of trying, adjusting and trying again in order to improve the patient’s life situation or keep it from deteriorating. Eastside staff continually search for...

    • CHAPTER 4 Representative Payeeships The Deep Logic of Dependency
      (pp. 118-144)

      Treatment plans are situated entirely inside the world of mental health services. The templates are printed in the Assertive Community Treatment training manuals, and each completed plan conforms to the norms of biopsychiatry and social work. Eastside Services staff members write the plan as a strategy to control clients’ medication and housing, and thereby to structure their own daily work. In the face of clients’ resistance, however, case managers must often reach outside their own professional field for more coercive tools located at the intersection of medicine, the social welfare system, and the law.

      Representative payeeships and commitment, the topics...

    • CHAPTER 5 Commitment Orders The Practice of Consent and Constraint
      (pp. 145-176)

      Emergency detention and commitment represent the most extreme types of control available at Eastside Services. These clinical gestures array the power of the police and the judicial system behind clinicians’ efforts to impose treatment. Staff members turn to them after other forms of persuasion have failed: when clients reject the case managers’ overtures, refuse medications, evade appointments, and exit thequid pro quoof the rep payee system. In the case of emergency detention, clinicians call the police to transport clients to the city’s only public psychiatric hospital, which can detain them for up to 72 hours. In the case...


    • CHAPTER 6 Coercion‚ Confidentialify‚ and the Moral Contours of Work
      (pp. 179-204)

      Can fieldwork in settings like Eastside Services advance the conversation between ethnography and clinical bioethics? Ethnography brings a deep respect for local knowledge and the hard-won skills of insiders. It shows what pushes clinicians to question the legitimacy and ultimate worth of encounters with the people they are supposed to help. Their ethical thinking does not begin from abstract ideals, and it does not follow an inherent logic. It begins instead where clinicians operate every day, that is, on the familiar landscape of practice. Their ethical sensibility is provoked by the obvious blockages in work: treatment tools that break down,...

  8. Bibliography
    (pp. 205-220)
  9. Index
    (pp. 221-233)