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Feminism in Marie de France's "Guigemar"
In Marie de France’s “Guigemar,” we seem to be presented with a fairly simple fairy tale – type story, ending, as always, with the knight and his love happily united. However, on closer inspection, one can see the seeds of an incredibly feministic concept, namely that men and women are sexual equals.
To begin with the event that leads our two lovers together, Guigemar, a knight, shoots a hind with antlers and is cursed by her. The image of a female deer with the overtly phallic antlers of a male deer suggests that this female has all the penetrating force of a male, which she then exerts to curse our hero. In addition, Guigemar’s shot ricocheting off the hind and wounding his own leg could be both a reason for our protagonist to make his journey, and a warning that men who shoot or pierce unwitting women (rape, as it were) should beware of the consequences they themselves will face. This could be Marie de France’s commentary on the then common practice of treating a wife as an economic commodity whose duty it was to obey her husband’s wishes.
Another important sexual symbol in this story is the fantastic chamber and surrounding gardens which the lord has built to imprison his wife, Guigemar’s love interest. According to Marie de France, it was surrounded by a “thick, high wall made of green marble” (p. 46,) perhaps a symbol of the lord’s consuming sexual jealousy. It also has one point of entry, accessible only by boat, possibly more subtle sexual imagery. The most important part to note, however, is that despite the lord having built this enclosure for the sole purpose of controlling and manipulating his relationship with his wife, the image of Venus destroying Ovid’s writings painted across the wall of the enclosure’s chamber suggests the lord will not be victorious in his goal. It could be that Marie de France is telling us that despite Ovid and the lord’s wishes to control and dominate the women in their lives, the lady, like Venus, will have the power to destroy their hold.
Further into the story we see yet another suggestion that men and women are sexual equals. When Guigemar and the lady consider they might be separated soon, the lady suggests she tie a knot in Guigemar’s shirt, with the stipulation that he not be permitted to sleep with any women besides the one who could untie it without cutting it. Not only does Guigemar accept, he suggests that he tie a belt around the lady’s waist, knotted to a similar end. Clearly, their sexual faithfulness to each other is considered equivalent, as opposed to the lady being the only one of the two expected to remain chaste in her lover’s absence.
As well, when the lady arrives at Meriaduc’s castle, Meriaduc does not force himself upon the lady by cutting through her belt. Despite his frustration at being denied, he respects that he may not sleep with her without removing the belt by hand, and even suggests other knights in the kingdom take the opportunity to try as well. While Meriaduc is one of the villains of this story and not necessarily meant to embody virtuous characteristics, Marie de France suggests with his actions that even the basest of villains would not stoop to overpowering a woman and removing her right to ascent.
Taken lightly, Marie de France’s “Guigemar” may be perceived as a fairly traditional and paternalistic story about a knight saving a beautiful woman from evil men. However, it is clear after closer reading that this is in fact a story which sympathizes with its female characters and with women in general.
The efficacy of buprenorphine HCl compared to methadone in opiate addiction cessation.
The goal of this paper is to determine whether buprenorphine HCl is an effective tool for the cessation of heroin/opiate addiction. The research included provides background information on what buprenorphine HCl is, the different forms in which it is available and administered, its usage and efficacy, and how it compares to the most common drug used for cessation of opiate addiction, methadone. Also explored are the figures relating to cessation-program patient retention and opiate cravings during treatment.
Buprenorphine HCl is an opioid, approved as a Schedule III narcotic by the U.S. Food and Drug Administration in 2002 for use in treating opiate addiction. It bonds to the mu opioid receptors in the brain very tightly, yet is only a partial receptor agonist, and therefore produces severely lessened opiate-associated effects (Jones, 2004). This tight bond allows buprenorphine HCl the ability to block other opiates from reaching the receptors, and the ability to push other opiates from the receptors and take their place, therefore making it an ideal candidate as a tool for opiate addiction cessation. As well, this tight bond is long lasting, providing patients the option to take doses every other day.
Buprenorphine HCl also has a function at the kappa opioid receptor, which is responsible for many of the intense withdrawal symptoms addicts experience when not using their opiate of choice. Buprenorphine is an antagonist of the kappa opioid receptor, giving it the added function of severely dulling withdrawal symptoms and producing few withdrawal symptoms of its own (Jones, 2004).
Buprenorphine is available as sublingual tablets, either purely buprenorphine HCl (Subutex), or buprenorphine HCl mixed with naloxone HCl (Suboxone) as a means of making the medication less abusable (Jones, 2004).
Methadone, the most common drug used in treating opiate addiction, is a full receptor agonist, meaning it produces more intense effects, possibly similar to the drug the patient is being weaned from. It also detaches from the receptors fairly quickly, forcing patients to take daily doses. In addition, patients on methadone maintenance frequently complain about the intense withdrawal symptoms they experience when attempting to detoxify from methadone (Déglon, etc., 2001).
The purpose of this research is to determine whether or not buprenorphine HCl is more effective than methadone in suspension of opiate addiction, based on treatment program retention and cravings for the opiate of choice.
Materials and Methods:
In conducting the comparison between buprenorphine HCl and methadone in opiate addiction cessation, Déglon, Ladewig, etc. performed a double-blind study among 58 Swiss patients seeking treatment for opiate dependence who were deemed otherwise physically and psychologically healthy (Déglon, etc., 2001). Subjects were randomly placed into groups given either buprenorphine or methadone, and both received a liquid to drink (either methadone or placebo) and sublingual pills (either buprenorphine or placebo) to maintain double-blind standards, both of which the patients were instructed to ingest in the presence of test administrators. The placebo liquid was the same volume, color, and taste of the methadone liquid, and the placebo pills were the same size, color, and taste of the buprenorphine pills, adding to the subjects’ ignorance as to their treatment medication (Déglon, etc., 2001). In addition, subjects were evenly distributed between the two groups based on cocaine use, prescription medication use, years of illicit opiate use, etc.
After four days patients were permitted to request dose increases or decreases in the medication they were already receiving. After three weeks all patients had reached their stabilization dose, and were held on maintenance for another three weeks. At the end of the six week study patients were told which medication they had received and had the option to continue with their initial drug maintenance, switch to the drug they had not previously received for maintenance, or detoxify (Déglon, etc., 2001).
During the study, subjects were considered ineligible if they had: undergone previous methadone maintenance in the past 30 days; any previous buprenorphine treatment; dependence on alcohol or any sedative-hypnotic; current use of anticonvulsants, disulfiram, or neuroleptics; serious medical illness; or history of major psychiatric disorders (Déglon, etc., 2001). Illicit opiate and cocaine use was monitored through urinalysis throughout the study (Déglon, etc., 2001).
At the end of the six week study, patients in the methadone group had far higher retention rates, i.e. remained in the treatment program: 90% of the methadone group (28 out of 31) compared to 56% of the buprenorphine group (15 out of 27). However, treatment compliance, based on number of counseling sessions attended and percentage of days attending the clinic, remained similar between patients in both groups who chose to continue the program. Of the 12 subjects who left the buprenorphine program, eight requested a switch to methadone maintenance and two requested buprenorphine detox. As well, the majority of these left in the first 10 days of the study (Déglon, etc., 2001).
Urine samples of the patients were tested for illicit drugs, with a chart of opiate positive test results shown below, in Fig. 1.
Fig. 1. Urine samples positive for opioids for each treatment condition by week (Déglon, etc., 2001).
From Fig. 1 we can see that, while on a week-by-week basis the numbers did not match, by the end of the study the methadone patients and buprenorphine patients produced, on average, the same amount of opiate positive urine. Percentage of cocaine positive urine also remained similar between the two groups (Déglon, etc., 2001).
Opiate cravings, based on the patients’ weekly self-assessment questionnaires, also remained similar between the two groups, as shown in Fig. 2 below.
Fig. 2. Mean heroin craving scores for each treatment condition by week (Déglon, etc., 2001).
Based on Fig. 2, both buprenorphine and methadone were effective at continuing to decrease opiate cravings over time.
While it is clear from the charts presented above that both buprenorphine and methadone were equally effective as aids in opiate withdrawal management and deterrents from opiate use, the retention rates (amount of subjects who remained in the study) in the buprenorphine group were significantly lower, possibly due to ineffective dosing. According to Déglon, etc., 67% of the patients who dropped out of the buprenorphine group (eight out of 12) complained of withdrawal symptoms (2001), possibly explaining the eight requests to switch to methadone maintenance.
In addition, the length of time during which this study was conducted was not necessarily long enough to provide meaningful results. The efficacy of buprenorphine may be underestimated due to the parameters of this study. In Altice, etc.’s comparison between hospital and emergency room visits among illicit opiate users and illicit opiate users in a long-term buprenorphine treatment program, it was found that subjects receiving 12 months of buprenorphine treatment were, on average, 17.5% less likely to visit emergency rooms (2012). This suggests that a lengthier study of the same type might provide more positive results for buprenorphine maintenance’s efficacy.
Buprenorphine HCl treatment for opiate dependence appears to be as effective as methadone in reducing opiate cravings and amount of illicit opiate use. However, more testing must be done in order to determine equivalent effective doses between the two substances.
1. Déglon, J.; Ladewig, D.; Livoti, S.; Petitjean, S.; Stohler, R.; Uehlinger, C.; Waldvogel, D. (2001, March 1). “Double-blind randomized trial of buprenorphine and methadone in opiate dependence”. Drug and Alcohol Dependence, Vol. 62, Iss. 1. P. #97- #104. Retrieved from http://www.sciencedirect.com.ez.lib.jjay.cuny.edu/science/article/pii/S0376871600001630.
2. Altice, F.L., MD; Bruce, R.D., MD; Schwarz, R., MD; Zelenev, A., MD (2012, December). “Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence”. Journal of Substance Abuse Treatment, Vol. 43, Iss. 4. P. #451- #457. Retrieved from http://www.sciencedirect.com.ez.lib.jjay.cuny.edu/science/article/pii/S0740547212000542.
3. Jones, H.E., MD (2004, August). “Practical Considerations for the Clinical Use of Buprenorphine”. Science and Practice Perspectives, Vol. 2, Iss. 2. P. #4- #20. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851017/.