Body Integrity Identity Disorder

Body Integrity Identity Disorder Basics Print Body Integrity Identity Disorder By Naveed Saleh, MD, MS twitter linkedin Naveed Saleh, MD, MS, is a medical writer and editor covering new treatments and trending health news. Learn about our editorial policy Naveed Saleh, MD, MS Medically reviewed by Medically reviewed by Rachel Goldman, PhD, FTOS on February 20, 2020 Rachel Goldman, PhD FTOS is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in weight management and eating behaviors.   Learn about our Medical Review Board Rachel Goldman, PhD, FTOS on February 20, 2020 More in Psychology Basics Psychotherapy Student Resources History and Biographies Theories Phobias Emotions Sleep and Dreaming According to Sophocles, Oedipus the King killed his father and had sex with his mother. It wasnt until years later, however, that Oedipus found out that he committed patricide and incestâ€"initially not knowing that his father was his father and his mother was his mother. After Oedipus found out what he did, he struck out his own eyes. Oedipuss reason for self-blinding involved guilt and was allegorical: He was initially blind to the atrocious acts that he committed.   The ancient Greeks probably couldnt fathom somebody blinding himself without some tragic reason on the scale of Oedipuss crimes. However, in modern society, a few people exhibit ownership issues with specific body parts and obsessively wish for disability. These people have a condition called body integrity identity disorder (BIID) and often after years of suffering request to have surgery that results in amputation, blindness, deafness or paraplegia.   As you can probably imagine, few surgeons are keen on interfering with organs or limbs without disease. However, BIID is a complex problem, and some experts advocate for radical surgery as effective treatment. BIID Examined In the late 1700s, a French surgeon was forced at gunpoint to amputate a mans healthy limb. After the surgery, the man sent the surgeon payment and a letter of gratitude claiming that the surgery made him feel better. In 2000, the public found out that a Scottish surgeon named Robert Smith had performed leg amputations on two patients with seemingly normal limbs. When the CEO of Smiths hospital figured out what Smith had done, Smith was forbidden to perform any more amputations. However, in the wake of these amputations, the debate concerning healthy amputation and other seemingly unnecessary and debilitating surgery gathered steam. In 2015, a 30-year-old woman named Jewel Shuping claimed that she had her psychologist pour drain cleaner into her eyes so that she could realize her lifelong desire of being blind. To be fair, the veracity of Shupings claims is disputed; nevertheless, accounts of this assisted blinding once again highlight BIID. People with BIID complain of feeling overcomplete and alienated from a body part, such as an eye or a limb. These feelings are lifelong obsessions that result in considerable psychic suffering and trauma. Its unclear what causes BIID. In some people, issues with body identity or ownership can be traced back to definitive pathology such as a brain tumor. However, in most people with BIID, the etiology or cause of the disease remains to be elucidated. Researchers who study BIID have observed brain changes in individuals with the disease. Specifically, the parietal cortex, premotor cortex, and insula seem to be involved. However, its unclear whether these brain regions lead to BIID or occur as a consequence of BIID. Treatment of BIID       Without a clear understanding of what causes BIID, its difficult to treat the disease. Antidepressants and psychotherapy do little for the disease. Furthermore, heavier psychotropic medications like antipsychotics havent been tested in this patient population. Interestingly, people with BIID who desire leg amputation feel better after the procedure and report improved quality of life. Of note, the two people on whom Robert Smith, the Scottish surgeon, performed surgery, felt remarkably better after surgery and went on to live happily with prostheses. Many people with BIID practice living with a disability. These people are labeled pretenders. By pretending to live with a disability, these people experience some short-term relief similar to the temporary relief people with obsessive-compulsive disorder feel after carrying out a compulsion. Most surgeons who encounter BIID have an alarmed reaction to the prospect of using radical surgery to treat the illness. These surgeons claim that anybody who wants to amputate a healthy limb has mental illness and limited insight that compromises her ability to give informed consent. Most people with BIID arent psychotic and dont have delusions. Moreover, the depression that some people with BIID experience develops after living with BIID. It is likely a consequence, not cause, of the condition. In a paper titled Body Integrity Identity Disorder Beyond Amputation: Consent and Liberty, author Amy White claims that the decision for a person with BIID to undergo elective surgery to remove a body part isnt necessarily coerced, incompetent or uninformed; thus after a comprehensive screening process, patients with BIID could be candidates for radical surgery. White also likens BIID to gender dysphoria and radical surgery in those with BIID to sexual reassignment surgery. Specifically, both people with gender dysphoria and BIID feel trapped in a body that is somehow wrong and desire surgery to correct the problem. Conversely, in a paper titled Body Integrity Disorder--Is the Amputation of Healthy Limbs Justified?, author Sabina Müller  posits that the cost of radical surgery for BIID is too high, and people who receive it will no longer be able to work and will require lifetime care and rehabilitation.   Müller also questions whether people with BIID who request radical surgery lack insight into their illness and suggests alternative therapy: A Word From Verywell BIID probably is a neuropsychological disturbance that includes missing insight into the illness and a specific lack of autonomy. Instead of curing the symptom for the price of an irreversible bodily damage, a causal therapy should be developed in order to integrate the alien limb into the body image. Were probably a long way off from ever figuring out how to exactly help people who experience BIID. First, research into BIID is low power because very few people have the condition. Much of what we know about BIID is based on anecdotal accounts. Second, BIID likely involves complex neurological processes that we have yet to elucidate; after all, the brain is ineffably complicated. Third, radical surgery for BIID is mired in ethical considerations that further obfuscate our understanding and appreciation of treatment.

Jennifer Ledwith - ThoughtCo

Example Company Background - 1371 Words

1.0 Company’s background Borneo Poultry Sdn. Bhd is a company that focusing on production of chicken’s meat which will soon to be one of the companies responsible in supplying poultry products in Sabah, specifically in Kota Kinabalu district. Borneo Poultry farm is located in sub-urban industrialised area in Jalan Tuaran, Inanam. The company have three business partners and aided with three experienced workers. Chicken’s farming is a lucrative business since chicken’s meat are consumed by universal consumer and it is cheap compared to other livestock meat thus lower and medium income family could afford buying it. With developing modern equipments and advanced technology, chicken’s farming is a booming sector. Chicken’s farming can be†¦show more content†¦These established farm are large scale producers and have known reputation. Diseases outbreak can tampered with the farm production by increasing the mortality rate. Disease such as New Castle Disease could cause economic loss to the farm by leading to more than 50% mortality rates. 5.0 Marketing strategy 5.1 Product The product will be whole chicken and chicken’sShow MoreRelatedWorkforce Diversity1590 Words   |  7 PagesI. Introduction As we enter the 21st century, workforce diversity has become an essential business concern. In the so-called information age, the greatest assets of most companies are now on two feet (or a set of wheels). Undeniably, there is a talent war raging. No company can afford to unnecessarily restrict its ability to attract and retain the very best employees available. Generally speaking, the term â€Å"Workforce Diversity† refers to policies and practices that seek to include people withinRead MoreEssay on Pre-Employment Screening Industry Report1529 Words   |  7 Pagesdominated by a handful of large companies accounting for almost 25% of the industrys total revenue. Total revenue for the pre-employment screening industry is forecasted to be approximately $4 billion in 2007 with the top five playersÂâ€"U.S. Investigations, First Advantage, ChoicePoint, Kroll and ADPÂâ€"accounting for approximately $900 million in annual revenue. HireRight, Axciom, and Accurate Background are examples of some of the more prominent mid-size companies in the industry. Pre-EmploymentRead MoreBackground Checks Are The Most Effective Way Of Preventing Gun Crimes1484 Words   |  6 Pages Background checks are the most effective way of preventing gun crimes. There are multiple cases of school and community shootings and how it could be prevented if there were some sort of system to catch perpetrators. Gun violence has been an issue since the 1970s and started to peak in the 1980s and 1990s. Gun Violence is violence committed with the use of a gun and recently there has been an increase in gun crimes, but due to background checks they have decreased. A background check is the processRead MoreHome Work Assignment Essay770 Words   |  4 Pagesdrop box. The questions are: 1- Do temporary agencies have a â€Å"duty† to run background checks? If so, did Robert half â€Å"breach that duty?† 2- The court ruled against Fox Associates. Was the court correct? How have courts ruled in other similar cases? Do you think Fox should have done its own background check? 3- The fact pattern mentions that Sunbeam suffered similar damages when it failed to do its own background check on Mr. Dunlap, its former CEO. Considering the nature of the positionRead MoreYouVe Got Questions1516 Words   |  7 Pagesmany new things about company ethics and responsibility. In this case we were introduced in a true story of RadioShack Corporate Company. The story is about company’s CEO David Edmondson and his fall as a chairman of it. He lied about his educational background that helped him to take the CEO-seat from Len Roberts. One of the first signs was marked from the newspaper â€Å"The Fort Worth Star Telegram† who reported a huge article for him. After his hiring as a new CEO the company lost its positions andRead MoreEssay Workplace Diversity1577 Words   |  7 PagesDiversity is the uniqueness which every employee brings to the workplace in an organization or establishment. Examples of differences include nationality, belief, disabilities, physical appearance, race, gender, age, educational background, sexual orientation, and work experience, social and family status. At the workplace, valuing diversity means creating a work environment that respects and includes individual variation by maximizing the potential of all employees or in which every employee feelsRead MoreCivil Liability For The Criminal Acts1175 Words   |  5 PagesA business should have civil liability for the criminal acts of its employees when the criminal acts are done in connection with the employee performing work for the company. This includes acts that were both known and unknown by the employer. Vicarious liability and respondeat superior are two large factors in businesses being liable for their employees, and it is vital to understand what does and doesn’t fall under these doctrines. Businesses have a duty of care to hire, train, supervise, and retainRead MoreYouVe Got Questions1527 Words   |  7 Pagesmany new things about company ethics and responsibility. In this case we were introduced in a true story of RadioShack Corporate Company. The story is about company’s CEO David Edmondson and his fall as a chairman of it. He lied about his educational background that helped him to take the CEO-seat from Len Roberts. One of the first signs was marked from the newspaper â€Å"The Fort Worth Star Telegram† who reported a huge article for him. After his hiring as a new CEO the company lost its positions andRead MoreEthical Issues Of Human Resource Management1339 Words   |  6 Pagesat the fees. Every organization has a culture and that culture influences how executives, managers, and employees make organizational decisions. This is a key issue in why HR managers need to adhere to ethics in their respected organizations. An example of an organization’s culture is Google’s strive to maintain an open culture. Their culture is to have all employees be hands-on contributors, feeling comfortable sharing ideas and opinions. For 2. The responsibilities of a human resource managerRead MoreThe Road to Hell1742 Words   |  7 PagesCase Summary The case â€Å"Road to Hell† by Gareth Evans is a story that involved two characters with different backgrounds, personalities and points of view. John Baker, an English expatriate, is a successful western chief engineer in the Caribbean Bauxite Company of Barracania. Baker thinks he has an edge in working in a foreign country because he was experience in understanding a regional staff’s psychology and knowing exactly how to get along with locals. Bakers has been working hard to prepare

Living and Dining Room Furniture Free Essays

Living and Dining Room Furniture Issues in the Market The vast majority of households struggle with storage issues. Furthermore, two fifths (42%) find it difficult to source the right size furniture for their home, while over a third (36%) struggle to store/display their possessions. This frustration with lack of space creates significant scope for new clever and flexible storage innovations in living/dining room furniture. We will write a custom essay sample on Living and Dining Room Furniture   or any similar topic only for you Order Now Q: How does smaller housing stock affect demand for living/dining room furniture? A: By 2017, the number of one- and two-person households is projected to increase by 850,000. Demand for space-efficient living/dining room furniture is therefore likely to intensify during the coming years. For example, in 2013, IKEA is launching its Uppleva modular range in the UK, which has integrated smart TV, video/Blu-ray and DVD players, wireless internet systems and the different components can be tailored to fit requirements and/or the space available. Mintel’s research for this report shows that the vast majority of households struggle with storage issues. Furthermore, two fifths (42%) find it difficult to source the right size furniture for their home, while over a third (36%) struggle to store/display their possessions. This frustration with lack of space creates significant scope for new clever and flexible storage innovations. Q: How are companies leveraging the ‘stay at home’ trend? A: The living room has become a home entertainment hub with seating arrangements serving as part of the ‘movie’ experience, for example incorporating home comforts such as built-in fridges, cup holders and reclining seats. There is increasing connectivity between furniture and mobile devices. In April 2012, La-Z-Boy’s Gizmo range includes Bluetooth music control and speakers. CSL’s Sound Sofa offers built-in docking facilities for iPods and music speakers while the DFS Audio Sofas feature an entertainment dock for iPod/iPhone/MP3, with built-in speakers and a sub-woofer. Neil Mason Head of Retail Research nmason@mintel. com Tel: +44 (0) 20 7606 4533    © 2013 Mintel Group Ltd. All rights reserved. Confidential to Mintel. Neil manages the teams that produce the European Retail Reports. Neil joined Mintel in 1995 and previously worked as Head of Fashion/Beauty and Personal Care/Household, and Head of UK Retail. Before joining Mintel, he worked in the food and publishing industries. He has a BSc in Business Studies/Marketing. Living and Dining Room Furniture Issues in the Market Since home ownership won’t become a reality for many younger consumers, investing in a home digital system that can be moved (and built up over time) is an important consideration. The internet has become an integral part of buying living/dining room furniture, with almost half of respondents browsing online before making a purchase. This compares to 30% who like to browse catalogues before buying. Q: How important is property churn to the living/dining room market? A: In Mintel’s research for this report, less than one in five respondents (18%) said that they bought living/dining room furniture when they last moved house/set up home. A similar proportion bought after redecorating/extending their living/dining room (19%) or just to get a new look/style (19%). So fluctuations in the housing market are significant but not the only driver of new purchases. The primary reason for buying living/dining room furniture is when items get worn out or broken (51% agree). It is competing for share of household goods spend and moving forward the emphasis should be on the pleasure derived from creating an inviting home environment. Women are in the driving seat when it comes to this type of furniture purchase rationalisation, with 79% saying the look/style of their living/dining room is important, compared to 64% of men. We can therefore expect to see a greater focus on targeting women using emotive triggers such as family, status among peers, self-indulgence etc. Q: How important is multichannel retailing to living/dining room furniture? A: The internet has become an integral part of buying living/dining room furniture, with almost half of respondents browsing online before making a purchase. This compares to 30% who like to browse catalogues before buying. At the same time, bricks-and-mortar showrooms offer clear advantages to consumers who prefer to ‘try before they buy’ (54%) and to those who ppreciate helpful and knowledgeable staff, important to over two thirds of potential shoppers (69%). Modern retailers are harnessing the advantages of all channels, for example creating augmented reality mobile phone apps, launching mobileoptimised websites, increasing in-store theatre and modernising product catalogues. Greater focus on e-commerce is seeing many of the larger retailers rational ising their store portfolio and introducing smaller store formats, while relying more on digital channels to facilitate wider product ranges, style inspiration and achieve greater geographical reach. Websites are becoming more content-rich, thus improving the online experience, similarly many retailers are investing in their stores, enhancing the physical shopper experience. Therefore the two channels are increasingly working in tandem with one another, creating more convenience and flexibility for the consumer.  © 2013 Mintel Group Ltd. All rights reserved. Confidential to Mintel. Living and Dining Room Furniture Issues in the Market The year 2012 saw these trends pick up pace as the non-specialist retailers grew their market share. Q: What are retailers doing to reduce consumer preoccupation with price? A: Promotional tactics risk becoming tired and ineffective as consumers become immune to the steady stream of promotional campaigns. Several retailers are using emotional triggers to inspire consumers to invest in their home by projecting aspirational lifestyles and communicating a different set of value benchmarks. Some 86% of respondents cite good quality as important to their choice of furniture retailer, whereas a wide choice of styles, quick/flexible delivery and promotions/discounts also gain the same level of response. Retailers are adopting diverse and innovative tactics to detract from price-based promotions, ranging from greater online customisation of styles/colours/fabrics, highlighting softer attributes such as provenance, heritage and ethics eg Britishmade furniture, adding new exclusive brands to the mix such as Habitat (Homebase), French Connection (DFS), Jasper Conran (MS) or introducing new own-brands which are less open to direct price comparison, or offering speedy delivery (eg CSL’s 72-hour express delivery service). While price-based promotions remain vital to driving footfall in-store, industry trends reveal more multi-layered strategies taking shape such as express delivery times, greater scope for customisation of design and making different channels work in harmony rather than in competition with each other eg in-store vs online. Promotional tactics risk becoming tired and ineffective as consumers become immune to the steady stream of promotional campaigns. Several retailers are using emotional triggers to inspire consumers to invest in their home by projecting aspirational lifestyles and communicating a different set of value benchmarks. How to cite Living and Dining Room Furniture  , Essay examples

Things Fall Apart Essays - African Writers Series,

Things Fall Apart In the book Things Fall Apart, Chinua Achebe is trying to give an explanation of what it is like to live in an African society. The story is about a man named Okonkwo who is a member of the Ibo tribe. Achebe is telling the story of Okonkwo from his childhood till his death. Before I read this book I did not have a very good idea of how people lived in Africa, and the ideas of I did have about life in traditional African societies turned out to be untrue. Achebe did a very good job of illustrating a traditional African society, and by reading this book I now have a much better idea of what life is like in a non-western society. I think that this was Achebe's goal in writing this book, to educate people about some of the struggles people have and life in traditional African societies. The title Things Fall Apart is a good choice for a title of this book. The main character, Okonkwo, did not like the way his father lived. He thought that a man should be strong and do typical male tasks. But Okonkwo's father, Unoka, did not fit mold according to Okonkwo. Okonkwo was ashamed of his father, and told himself that he would make a better life for himself and his family. Okonkwo was able to do this, he became very successful in the Ibo tribe and had gained a very high standing in the tribe. It was his goal to become an elder in the tribe, and it looked like he was going to achieve that goal. Okonkwo was banished form the tribe for seven years for killing a boy, and was forced to live with his mother's tribe for the seven years. Okonkwo lost all of his titles and his standing in the Ibo tribe. After the seven years had passed, Okonkwo went back to the Ibo tribe and had to start his live over. Over the seven years that Okonkwo was away, the Ibo tribe changed a lot. Most of these changes were do to the missionaries which had come to Africa to try to convert people to Christianity. Okonkwo could not accept these changes, and in a rage of anger he killed a clansman. This was the worst crime a man could commit. After Okonkwo did this he realized that there was no hope for redeeming himself and no way that he could become an elder. So he hung himself because he could not live with the fact that he would never regain his standing in the tribe. He would have most likely been killed for committing this crime anyway. Basically Okonkwo's life fell apart on him, hence I feel that the title Things Fall Apart is very fitting for this book. I thought that Achebe did a good job at writing this book. After getting into the book I found it very easy to read and follow. It took a while to get use to the names of the people in the book, and the Ibo words and phrases. I thought that the purpose of this book was not directly stated, but it was implied. The purpose was to show people what it is like growing up in a traditional African Society, and Achebe did a good job a showing that. The book is chronologically organized, starting with Okonkwo as a child and ending with his death. I feel that the audience level for this book would be high school and above. I think that there are a lot of implied messages and ideas that mature readers will pick out easier than younger readers. I feel that the book is not biased, and I feel represents the African people as well as the white missionaries fairly. So overall I feel that the book was very well written and found it enjoyable to read. I found it ironic that both Okonkwo and his father, Unoka, ended up the same way. Both ended up being put in the evil forest after their death. Unoka ended up in the evil forest because he did from a strange disease, while Okonkwo ended up in the evil forest because he had killed a clansman. I found this ironic because it seemed the Okonkwo tried to everything different from his father. Okonkwo did not agree with the way Unoka lived, and he told himself that he was not going to live that way.

Interpreters and Commentators

Interpreters and Commentators Interpreters and Commentators Interpreters and Commentators By Maeve Maddox Mike Feeney overheard a business owner repeatedly [mention] that they would be using an â€Å"interpretator† and has asked for a post on interpreter/interpretator and commenter and commentator interpreter: one who interprets or explains; one who translates languages. In current usage, interpretator is nonstandard, as is the obsolete verb formation interpretate. The OED has an entry for interpretator, but its the most recent documentation is from the 17th century and the word is labeled as obsolete. The Merriam-Webster Unabridged Dictionary has no entry for it. M-W does have an entry for interpretate, which redirects to interpret. Here are some examples of nonstandard interpretator: I know there is a secretarys dayIs there an interpretators day? Speaking in Malayalam, through an interpretator, Poulse and his other colleagues said   I bet I was the best hand writing interpretator in the world. software, incorporating the only true award interpretator system for Australian conditions since 1991 Chinese (mandarin) translator/interpretator service provider Nonstandard interpretate also abounds: management will read the same contract as you but will interpretate it different[ly]. Im pretty sure he misinterpretated the study, Himmler thought that Germany was going to recover because he misinterpretated one of Nostradamuss predictions. In November 2005 she interpretated the role Dame at â€Å"Dido and Enea† by Purcell While interpretator has no meaning apart from that of the standard word interpreter, commentator and commenter have distinctive meanings. commentator: A writer of expository comments or critical notes on a literary work; the writer of a commentary; One who reports or comments on current events, esp. on radio or television. commenter: One who comments Here are some examples of both words: Sometimes sports commentators say the strangest things Alan Watkins, doyen of political commentators, dies at 77 Texas police take on blog commenters Are Blog Commenters â€Å"Real† Writers? N.C. Judge Unmasks Pseudonymous Blog Commenters The 6 Types of Blog CommentorsDo You Know Them? (NOTE: The OED gives commentor as an alternate spelling of commenter.) I see a useful distinction between commentator and commenter, especially in this everybodys a writer culture of ours. Commentators are qualified to write intelligently about a particular topic, approaching it and analyzing it in terms of a body of knowledge. Commenters, on the other hand, express opinions on matters about which they may or may not be particularly informed. Many DWT readers bring professional expertise in language to their comments, resulting in useful commentary. In general, however, blog commenters tend to be stronger on opinion than information. Bottom line: Id reserve the word commentator for analysts operating from a professionally-informed perspective and writing or speaking in a formal setting. Id use commenter for people who respond to blog posts. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:"Because Of" and "Due To" 50 Idioms About Fruits and Vegetables6 Foreign Expressions You Should Know

When Not To Use the Personal A of Spanish

When Not To Use the Personal A of Spanish The general rule is that the personal a of Spanish is used before a direct object when that object is a person or an animal or thing that has been personified. However, there are exceptions. The personal a is either optional or not used when the direct object is a nonspecific person, when following the verb tener, or to avoid awkwardness when two as would be close to each other in a sentence. Omitting the Personal A When the Person Isn’t Specific Perhaps the best way to state the biggest exception to the rule is to clarify the rule. Rather than saying that the personal a is used before people, it would best to say that the personal a is used only with specific, known, or identified human beings (or animals or things that have been personified). In other words, if the person is treated as a member of a category rather than as a known person, the personal a isnt needed. Here are some examples of the difference: Busco a mi novio. (I am looking for my boyfriend. Here, the boyfriend is a specific, known person, even though his name isnt given.)Busco un novio. (I am looking for a boyfriend. Here the boyfriend is merely someone who is a member of a category. We do not know who the person is, or even if he exists.)No conozco a tu bisabuela. (I dont know your grandmother. We have the persons identify even if her name isnt given.)No conozco una sola bisabuela. (I dont know a single great-grandmother. As in the case of the boyfriend above, the person is talking about a hypothetical person rather than an identified one.)Necesito una secretario. (I need a secretary. The speaker needs assistance, but not necessarily from a specific person.)Necesito a la secretario. (I need the secretary. The speaker needs a specific person.) As a result, some sentences can have a slightly different meaning, depending on whether the a is used. For example, we might say El FBI busca a un hombre de 40 aà ±os, meaning that the FBI is looking for a specific 40-year old man, perhaps the one who committed a crime. If we say El FBI busca un hombre de 40 aà ±os, it suggests the FBI is looking for a 40-year-old man in general, perhaps for a criminal lineup or for some other purpose where it doesnt particularly matter which 40-year-old man it finds. The main exception to this clarified rule is that certain pronouns, such as alguien (someone) and nadie (no one), always require the personal a when used as direct objects, even when they refer to no specific person. Example: No conozco a nadie.  (I dont know anybody.) Dropping the Personal A After Tener When tener is used to indicate have in the sense of having a close relationship, the personal a is not used even if the direct object is known. Tenemos tres hijos. (We have three sons.)La compaà ±ia tiene muchos empleados. (The company has many employees.)Ya tengo mà ©dico de atencià ³n primaria. (I already have a primary-care doctor.) When tener is used to mean have someone in a role, however, the personal a is retained: Tengo a mi hermana como amiga de Facebook. (I have my sister as a Facebook friend.) Avoiding Two As in a Sentence Sometimes a sentence following the general rule would have two as, especially when a verb is followed by direct object and then an indirect object. In such cases, the personal a before the direct object is omitted. The listener will then understand that the object without a preceding a is the direct object. In this way, such sentences often mimic the word order in English. Mandà © mi hijo a su profesor. (I sent my son to his teacher. Note the lack of a before hijo.)El bombero llevà ³ Pablo a mi madre. (The firefighter carried Pablo to my mother.) Key Takeaways Although Spanish uses a personal a when a person is a direct object, the personal a is not used unless the person is a known person rather than someone who merely fits a category.An exception is that the personal a is required with nadie and alguien.The personal a is often not used following the verb tener, even if the object is a known person.