DrugsRead

The next step in the massage (if he has persuaded her to go on) is to take a few ice cubes, wrap them in a face cloth or clean handkerchief, and slowly slide that along her spine to the nape of her neck. Then he slowly, lovingly slides the cold compress all around the shoulders, the back, the arms, the underarms, and the palms of the hands; between the fingers; all over the legs and the bottom of the feet; between the toes; up the inner leg and inner thigh on one side and down the inner thigh and inner leg on the other; then up the crevass between her buttocks, and circling around each cheek; then up the spine again; and finally around the sides of the head, across both the left and right temples.

Next he takes a hot “washrag” (dipped from time to time into a bowl of hot water) and slides it over her body, following the very same route as was used with the ice-filled cloth.

Next he takes a new feather duster and glides it along her body, following the same route as in the previous examples.

Next he begins slowly to kiss her body. He kisses in little pecks, again following the same route.

Next he takes something soft, such as a velvet or silk comforter, and covers her with it, slowly and lovingly rubbing the comforter all over her body.

Next he lies on top of her and envelops her with his naked body. He gently slides around, holding her hands in his as he does so, and kissing the back of her neck.

Then he asks her to roll over.

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The main difficulty for the wife is to overcome her accumulation of hurt pride. Her husband’s passive-aggression and sexual frustration tactics may have left her bitter, and at the moment she might rather strangle than charm him. But she must transcend this impulse and channel it into her mischievous seduction. She must also not allow his initial avoidance or insulting behavior to derail her efforts, but must carry on, no matter what. Even if the seduction does not work on the first night or the second, it may just click four nights later.

Once he takes the bait, the wife should encourage him to make love to her aggressively. “Do it to me—do it, do it!” she may beg. “Yes, yes, yes—that’s the way I like it.” And during the act itself, she should encourage him to verbalize his anger at her. “I’ll bet you really hate me sometimes, don’t you?”

“That’s right, you bitch, I do!” he may say.

“How much do you hate me?”

“A lot!”

“A lot?”

“Yes, a lot.”

“Show me.”

“I am showing you.”

“Show me more.”

“You brazen slut!”

“Yes!”

“You really are a brazen slut, aren’t you?”

If it succeeds, this game serves two purposes at the same time: It gets the aggressive wife out of the aggressive, persecutory mode and into a more seductive, receptive mode; and it nudges the husband out of his passive-aggressive mode and into a more erotic, directly aggressive mode. In accomplishing this, the game also diminishes the frustrations of both husband and wife and facilitates a more honest and open discussion of both their sexuality and their relationship in general.

*47/196/1*

The resolution to such an impasse is to communicate what is being repressed. However, this is not so easy. To simply tell my patient to express his anger or verbalize his taboo fantasies of strangling her or of having angry sex with her would do no good. He would think of a thousand reasons for not doing so.

His resistance to expressing such things, formed in relation to his mother, has become a deep character trait. Likewise, his constant complainer of a wife has a history of using whining to manipulate men into feeling sorry for her even while repressing her own anger and feelings of low self-worth. Her troubled history began with her relationship with her own father, a passive man who never took her seriously. And while consciously she would maintain that she’s all for communication and that it’s her husband who holds back, in actuality she too is resistant to genuine communication.

*22/196/1*

From this perspective, the characteristics of the behavioral treatment of sexual disorders differentiating it from the Freudian-based treatments are clear. (1) The behavioral methods are concerned with the maintenance rather than with the origin of the sexual disorder. Origin and history become important only as they reveal what the person does to perpetuate the very things he wants to change. (2) The identification of very specific target behaviors (including such covert behaviors as fantasies, feelings, and desires) that maintain the disturbing condition is the core of the behavioral diagnostic and evaluative procedure. Deliberate and systematic efforts to modify these target behaviors are the core of the treatment. Measurement of change in target behaviors and of disturbed behaviors in the life situation also is an integral part of the therapeutic procedures. (3) Modification of the problem maintaining behaviors is a sufficient goal for treatment, and exploration of intrapsychic dynamics is not necessary for successful and permanent change. As the target behaviors change (assuming the therapist has chosen the correct targets), there will be a feedback into the person’s psychological organization that will bring about a “healthier” realignment of the intrapsychic forces.

Indeed, from a behavioral perspective, the consideration of intrapsychic dynamics may often be irrelevant, a waste of time and distract from an efficient course of treatment. This is especially true of those sexual maladaptive behaviors that, whatever their origin, have now achieved functional autonomy from the general psychological organization. These behaviors persist in the present as blind habits.

Premature ejaculation appears to be one such autonomous condition. As long as it is treated as a blind habit and as long as it is treated by the Seman’s method of training, the counter habit of ejaculatory control, good results will be obtained in a large majority of the patients. It is true that some patients do have complications that interfere with treatment. High levels of anxiety (often but not always secondary to the premature ejaculation habit) may impede progress. Specific reinforcers (secondary gains), such as a feeling of vindictive satisfaction in frustrating the partner, may also impede progress. A general attitude of passivity on the part of the patient may make any new learning (including the learning of the Seman’s counter-habit) slow and uncertain. However, once these complications have been dealt with, almost invariably the premature ejaculation must be treated as if it were an autonomous blind habit.

Many sexual variant behaviors also appear to have attained a functional autonomy from the general psychological organization. In our own experience this seems to be particularly true of transvestites, exhibitionists, and fetishists. Fensterheim has already noted that although the Freudian theory of the genesis of these disorders may (or may not) be completely correct, the traditional methods of treatment are remarkably unsuccessful. However, when they are treated as simple autonomous habits through such behavioral methods as aversion (Rachman and Teasdale) or thought stoppage (Cautela; Fensterheim), a high rate of successful change is attained. Further, instead of the development of substitute symptoms, the removal of the variant behaviors often quickly leads to increased self-esteem and decreased anxiety and depression (cf., Morgenstern, Pearce and Rees).

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The numbers of known cases of sex reassignment followed by a second reassignment to the original sex are few (four known and probably no more than ten) and the number of such cases published, fewer still. The transsexual with such a history apparently rushes into the initial surgery prematurely, impulsively, and even against psychological advice. In contrast, for those sex-reassignment applicants who pass the two-year real life test, surgery confirms the status they have already achieved, and they continue to do well. They do well according to the criteria of earning a living, not being arrested, settling down with a partner, not needing a psychiatric referral, and saying that they are contented in their new status and do not regret the change.

The surgical prognosis is guarded. Male-to-female transsexuals may need follow-up surgery to keep the vaginal canal functional and patent. The end result, however, only rarely is persistently unsatisfactory. Female-to-male transsexuals may have problems, eventually correctable, of urethral stricture, and they always have the problem of impotence for which no successful surgical technique has yet been devised.

The hormonal prognosis is satisfactory for both male-to-female and female-to-male transsexuals. Some male-to-female transsexuals, particularly those few in show business, are unsatisfied with hormonally induced breast growth. They seek and obtain either augmentation mammoplasty or silicone injections. The latter are dangerous to health and are absolutely contraindicated.

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As for changing notions of “men” and “women” as groups, related to particular sets of social roles, one might note the history of early twentieth-century social welfare legislation for women. That legislation, designed to protect women in the labor market and intended to protect both genders in a judicial climate tending to deny the state’s right to erect such protective legislation, has become the rule of American society; but the special protections offered women protected them right out of the competitive labor market. Only now, under the impetus of women’s movements has an understanding developed of the problems created by classifying women separately from men.

In the field of property rights, women were long treated as inferior, weak and incapable of protecting their own rights. The common law defined a married woman out of legal existence by creating the legal unity of husband and wife, with the husband given power to control the family economy.

In fact, under early common law, the husband was the natural guardian of the children. In America most property restrictions disappeared by the late nineteenth century and the role of the father as natural guardian was replaced by an idealized view of the mother as natural provider to the young child. This, too, expressed social views of the role of women as limited to, or at least most naturally played in, the home. The role of both parents in the custody of children has been subject to serious reconsideration in the last years.

The history of legal issues relating to birth control and abortion can be outlined fairly concisely (Lader; Dienes). For both, though less so for abortion, the last twenty years have witnessed a widespread repeal of laws laid down a century ago. The two issues have, moreover, been related legally, as well as by common sense. The 1965 landmark decision regarding contraception in Griswold v. Connecticut has served explicitly as a precedent for subsequent abortion decisions. In Griswold, Justice Douglas, writing for the Court, found within the constitutional guarantees a right which he delineated in terms of a “zone of privacy older than the Bill of Rights—older than the political parties, older than our school system” as applying to the marriage relationship. Both birth control and abortion have been tied expressly within the wider society to issues of female equality and the rights of women to maintain control over their bodies. The connotations of “birth control” and “abortion” have altered concomitantly with changes in the connotations of “privacy,” “woman,” and “marriage,” to name a few.

The right of “privacy,” so crucial to the judicial decision in Griswold is not guaranteed explicitly by the Constitution. The construction of a basic right to privacy is explained in Griswold. Justice Goldberg, concurring with Justice Douglas’s decision for the Court, wrote: “To hold that a right so basic and fundamental and so deep-rooted in our society as the right of privacy in marriage may be infringed because that right is not guaranteed in so many words by the first eight amendments to the Constitution is to ignore the Ninth Amendment and to give it no effect whatsoever.” The Ninth Amendment states: “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.” The social and cultural frames of these new connotations were created largely outside the legal system per se. New connotations have become explicit and have become part of an articulated comprehension of personal relationships (to self and to others) primarily through the activities of more or less organized social movements such as feminism (and its opposition).

Modes of social and specifically legal protest within the feminist movement have sometimes included and have more often provided models for groups concerned with homosexual rights. Gay liberation groups have been formed and have demonstrated publically and actively for the end of discriminations against homosexuals, whether by churches, by legislators, judges and police, by employers, or by psychiatrists. Like feminist groups and so-called ethnic movements, homosexuals brought actions to the courts and demonstrated in the streets, donning T-shirts and buttons announcing their particular identity. A vocal opposition has developed, signaled, among others, by the name of Anita Bryant. In April 1978, 54,096 people voted to repeal a homosexual rights ordinance in St. Paul, Minnesota. Following Anita Bryant’s rhetoric, if not her explicit model, arguments for repeal invoked God and nature alike. One local resident is quoted as having said: “If God had meant for men to go with men or for women with women, he would have made us alike” (New York Times). The Reverend Ron Adrian, president of the Concerned Citizens for Community Standards, a group opposing a homosexual rights ordinance in Wichita, Kansas, denied the issue to be one of civil rights, adding, “We think it’s an effort on the part of a small group of people to ask us to approve of their criminal lifestyle” {New York Times).

*158/187/5*

Numerous researchers have examined the differences between the sexes in the field of sense perception, using both children and adults as subjects. Although one would expect to find differences between the sexes in preference of sensory modalities, in sensitivity, and in patterns of perceptual organization of various experiences, there is, in fact, little support for such an assumption. Aside from some evidence that females are “more sensitive and more variable in their response to taste and smell cues” (Maccoby and Jacklin), both sexes show remarkable similarities in their preferences and in the level of sensitivity of their sensory modalities. This includes audition (Kagan and Lewis), vision (Friedman and others; Kagan and Lewis), taste (Nisbett and Gurwitz; Kaplan and Fischer), smell (Lipsitt and Jacklin), and touch (Bell and others; Lipsitt and Levy).

Turning our attention to the possible differences that may exist between sexes in intellectual abilities, there is an overriding issue to be considered when judging the evidence provided by the research. It appears that the intellectual functioning of an individual cannot be considered in a vacuum (any more than other lines of personality function can). There is ample evidence that intellectual functioning varies among individuals due to genetic endowment and to biological, psychological, and environmental influences on the mother and her child during the perinatal and postnatal period. For a complete review of this subject, the reader may consult an excellent summary provided by Maccoby and Jacklin. There is no compelling evidence so far that suggests that there is a difference between sexes in intellectual functioning and performance.

The controversy over the impact of sex hormones on spatial and verbal abilities is important enough to be mentioned here. Vandenberg’s twin study suggested that both verbal abilities and spatial abilities are closely related to heredity. Spatial ability in particular seemed to be less influenced by environmental, educational, and cultural factors. Vandenberg’s findings have been supported by recent studies (Bock and Kolakowski) which demonstrated a cross-sex correlation between parent-child spatial abilities. On verbal ability, information is limited, but it appears that as early as three to eighteen months of age, girls are superior to boys in verbal abilities, such as “speech quotients” (Moore), and comprehension and vocabulary (Clarke-Stewart).

The obvious question is, to what extent do hormonal influences account for these differences? For example, the findings of Ehrhardt and Baker suggested that fetally androgenized girls have higher-than-average IQs, implying that an increase in the male hormone is responsible for the higher intellectual functioning, which supports the findings of an earlier study by Ehrhardt and Money. However, the same study found that normal sisters of these children also had higher-than-average IQs. Comparing the level of performance, simple, over-learned, and repetitive tasks (set A) with more complex tasks requiring information-processing, reorganization of stimulus, and the inhibition of initial response (set B), Broverman and others found that females were superior in performing set A, but males were superior in performing set B. This finding has been challenged by Maccoby and Jacklin with some justification, but the matter is not settled and awaits further investigation.

*121/187/5*

Why do people seek sex outside of marriage? Edwards and Booth (1976a) looked for correlates of the frequency of extramarital involvement among a stratified probability sample of Toronto families among both subject-background variables and marital variables. Unlike previous research, they found no effects from education, occupation, employment of the wife, or religion. Age was the strongest predictor of the demographic variables, with reported involvement being greater among the younger members of the sample. The frequency of extramarital relations was related more to contextual variables in the marriage: the more negative was the perception of the marriage, the greater was the sexual deprivation in the marriage; as the latter increased, the more probable was extramarital sex to occur.

Although most of the studies in this area support the plausible expectation that having an unhappy marriage increases the probability of having an extramarital relationship, there still remains the observation by Tavris and Sadd, Hunt and others of a stable minority of happily married persons who have other sexual partners, some of them of long duration. This suggests that variables other than marriage rating are important in some cases. In looking at female extramarital coital behavior, Bell, Turner, and Rosen were able to identify four groups of women in their sample of 2,262, to show how ratings of the marriage interacted with sexual values to predict extramarital coitus. These groups were labeled Traditional, Modern, Uptight, and Experimenting, and were characterized respectively by the following combinations of marriage ratings and sexual values: high rating, conservative values; high rating, liberal values; low rating, conservative values; and low rating, liberal values. Examination of some aspects of life styles and sexual preferences of these groups led the authors to propose that the general set most predictive of a high rate of extramarital sex for women would be a low rating of their marriage with sexually liberal views and a liberal life style. The set most predictive of a low rate would include women with highly rated marriages and with sexually conservative views and conventional life styles.

Finally, Johnson examined sixty case histories from a Family Service Agency for actual reasons given by clients for engaging in sex outside of their marriages. As one would expect, they tended to blame the spouse. He or she was: physically handicapped, unfaithful, unloving, physically unattractive or unclean, absent, or an unwilling or uninterested sex partner. Murstein added other factors, including curiosity, need for variety, uncertainty about one’s sexuality, unusual opportunity, need for escape, fear of aging, and relative lack of inhibitions and guilt for unconventional behavior.

A number of writers on the subject have concluded that for many an extramarital experience or relationship can have beneficial effects on both the participant and her or his marriage. One of the strongest supporters of this view is Albert Ellis, who believes that adultery has its distinct advantages even in a society such as ours, which makes it difficult and hazardous. Ellis’s views include these benefits:

•    Sexual variety. Humans have a biological need for sexual variety. With the emergence of alternative marriage forms and more liberal values, more people will meet their needs for sexual variety in non-monogamous activities.

•    Desire for freedom. Marriage can be confining and boring, and outside affairs can add to a feeling of freedom by breaking up the routine.

•    Frustration reduction. “Exclusive” marriage leads to the limiting of one’s experiences and to frustration when sexual appetites differ. Affairs can drain off these frustrations and help the person to cope with marital problems better.

•    Improved marriages. Clinical evidence suggests to Ellis that married people are less resentful and more open with each other after an affair. Sex may improve because of increased knowledge and/or greater appreciation of the partner.

Ellis would like to see the removal of legal and social sanctions against adultery, the encouragement of open marriage, and moves toward educating people to cope better with feelings of jealousy and other emotional problems that accompany adultery today.

*84/187/5*

There is no reason at all why a person with dementia can’t enjoy music. Sitting and listening passively will give pleasure to many, as will taking a more active role, such as joining in by humming or singing. More importantly, those who have learnt to play a musical instrument in earlier life may retain this skill, at a simple level, much further into the course of the disease than one would expect. This can give great pleasure and a sense of achievement, not only to them, but also to those looking after them.

For listening to music, it is probably better to rely on cassette recorders than record players as the former are easier to switch on and off. There is also little danger of damaging a cassette. If the music would disturb others, it is worth trying a personal cassette player with a pair of headphones, of the sort now widely used.

Even if a musical person loses the skill to play an instrument, but retains some musical abilities, it may be possible to substitute simple home-made instruments such as drums made from cans or rattles created by filling tins or jars with beans.

*104\138\2*

Many people looking after an older person with dementia are themselves elderly and suffer from chronic medical conditions of one sort or another. If on top of these they also have to cope with the mental and physical demands of caring for someone with dementia, it is possible that their own illnesses may be aggravated. Many have to struggle on despite being unwell themselves.

If, however, a carer is really laid low with a medical problem or has an accident, such as a fractured thigh, somebody else is going to have to look after the sufferer. If possible, try to avoid a social crisis at the last minute by making contingency plans, ensuring that your general practitioner is aware of them or better still has helped in drawing them up. Many carers can call upon family and friends in emergencies such as this, as long as there is no likelihood of a protracted, drawn-out illness.

If at all possible, it is always better for sufferers from dementia to remain in their own home, even if their normal routine is broken and people with whom they are less familiar are there to look after them. If this arrangement looks unlikely to work, it is probable that admission to a hospital or a home will have to be organized, at least for the short term.

What happens if the carer collapses unconscious, unable to call for help? This situation does not arise very often, but sometimes it does and many people, particularly older spouses, worry about it. The best way of coping with this is to arrange for someone to look in regularly, once or twice a day, and to give them the means to report back to a third person, usually another member of the family or a doctor, if anything seems amiss. The unavoidable intrusion into the carer’s life-style has to be balanced against the advantages of such a scheme. An alternative approach is to use the telephone to make regular daily contact.

There is also the possibility that a carer may fall without losing consciousness, but unable to summon help. A person with dementia may well be incapable of helping in these circumstances and can sometimes make matters worse. Having a pendant or wrist-watch alarm system will usually instil a feeling of confidence and will be of practical benefit should the need arise. These systems usually consist of a small box, about the size of a Wrist-watch or slightly larger, in the middle of which is a button that can be pressed if an emergency occurs. They are usually linked to the telephone and set in motion an automatic chain of events that will lead to appropriate medical or other assistance being called up. In some parts of the country these are provided free or at a subsidized rental but even if the full cost has to be borne, it is worth it for the peace of mind of all those involved.

Contingency plans should certainly be worked out for the event of your own death; permanent alternative care will be required and your own funeral has to be organized. These are matters that are best discussed with other members of the family and the general practitioner even though at the time it may seem unnecessary. Some people even take the trouble to make their own funeral arrangements with a local funeral director, letting their relatives, general practitioner, or others know the details. It may also be a wise precaution to lodge details of any plans you have made with your solicitor, along with your will and information about any other relevant matters that you think are important.

*82\138\2*