Molly Sinderbrand

Adolescents with Autism Spectrum Disorder (ASD) are admitted to inpatient psychiatric hospitalization (IPH) at an alarmingly high rate. IPH is often intended for the immediate benefit and betterment of the individual, however, the result often incurs a degree of harm on the adolescent. With the rising prevalence of ASD and lack of physicians with ASD care experience, the adolescent is left with inadequate treatment, causing heightened anxiety and behavioral regression. While IPH may offer temporary relief and behavior management, it lacks sustainable long-term benefits while conflicting with the bioethical principle of beneficence. Here, we argue for a paradigm shift toward outpatient preventative resources (OPR), providing individualized, community-based care aimed at preventing the need of IPH, using it as mainly a last resort. By reallocating funding from IPH to OPR, the overall patient outcomes and support for caregivers will improve and effectively will reduce the harm on the ASD adolescent.

In lieu of an abstract, here is a brief excerpt of the content:A Brit Milah for Eliezer Herschel ben Yonatan AryehMolly SinderbrandFor observant Jews, the choice to circumcise one's son is not a choice. Technically, it is a contractual obligation; the belief is that male circumcision is part of a holy covenant with God. The word for ritual circumcision, brit milah or bris, literally means "covenant [of circumcision]." Circumcision is a physical symbol of a relationship with the divine. It is the commandment that encompasses all other commandments. It is, thankfully, only required of men (women, they say, are naturally closer to divinity). Circumcision is when a baby boy enters the Jewish community, eight days after birth, and when he gets his name. He becomes somebody. To choose otherwise— and some may choose otherwise—is to choose not to be part of the contract, and by extension, not be part of the Jewish community. And a community is one of the most valuable things a person can have.I was not always an observant Jew, though I was raised in a Jewish household. I essentially fell into observance over a period of 10 years, starting with studying ancient Hebrew with a language-loving rabbi in high school and eventually leading to weekly attendance at an orthodox shul, which I joined shortly after first tasting the vegan cholent at kiddush. It was much easier to make friends in [End Page 91] the Jewish community than in my competitive and mildly misogynist graduate program, and frankly, I liked them better. I received kindness and support when I needed it, and gave it back equally, especially around having children. Having children is difficult under any circumstance, but it is especially difficult in social settings where it is seen as abnormal, strange, or even selfish. The Jewish community normalized having children and created a respite from the judgment of the secular world. When I was pregnant at work, I got comments like "It looks like you're having twins!" and "Are you sure you don't have pre-eclampsia? You look awfully large"; at shul, I got pep talks, encouragement, and the traditional "b'sha'a tova"—"may it happen at a good time."Eventually, after having two kids in a two-bedroom rowhome, my husband and I moved to a mostly-Jewish suburb just outside the city. It is the kind of place where everyone says "Gut Shabbes" (a good Sabbath) to each other on Saturdays, but not one in which all the men wear black hats and study Torah all day (though some do). That is, folks live Jewish lives, but interact with the outside world as well. After a few months, it felt like home.This was the context in which I decided—or rather, did not have to decide—to circumcise my son. It was the natural result of the decision to be part of a community that places value (and even membership) on the ritual of circumcision. I made that decision years earlier and have been continuously reaffirming it since. Every day I wake up is a day I decide to be an observant Jew, and I decide to do so in order to be a member of an observant community. The decision to circumcise was yet another decision to be part of that community, which has given me so much joy, support, and meaning. Why would I deny my son—and myself—that community?In addition, not needing to make any decisions was itself a kind of relief. I have heard of mothers—including my own—off in a room crying, needing comfort, unable to be there for the circumcision. That did not happen for me. Despite a history of rather severe perinatal depression and anxiety, including suicidal ideation less than a week before the event, I was completely fine. Maybe my comfort came from the fact that I already had two children; this was not my first newborn, though it was my first bris. Maybe, after almost two years of COVID, circumcision did not seem like such a big deal. Maybe I was just glad someone else would hold the baby for a while. But I think at least part of it was the happiness that...