Tuesday, April 2, 2013
Here’s what my teenage kids hate more than anything: When I start talking condoms and alcohol and drugs all those things that they think are none of my business but really are all of my business. As much as they squirm, I really don’t find those conversations tricky at all. I rather enjoy them.
But there is one subject that seems to me—and apparently lots of other parents—to be a lot trickier than the sex-drug rant. Parents are more afraid about talking with their kids about weight than practically anything else.
As Dr. Cynthia Bulik, a professor of psychiatry at University of North Caroline, writes in her latest book, “we’re not afraid that a discussion of sex, drugs, cigarettes, or alcohol will damage our children’s self-esteem or trigger some sort of disorder,” but when it comes to weight and food, we fret over every single ramification. Will this comment hurt her self-image? Is it possible to encourage healthy eating without driving my kids to starve or sneak food?
These issues are tough for all of us who want to raise kids with healthy attitudes about food and realistic goals about their own physiques. But they are particularly challenging for parents suffering with their own eating disorders. And this includes dads too.
Bulik’s new book is called Midlife Eating Disorders: Your Journey to Recovery. She is also the director of the UNC Center of Excellence for Eating Disorders. And while there is no cookbook recipe for the right buzz words when it comes to food conversations, her book will serve as a guide for parents to learn to confront their own issues and figure out how they can prevent passing along the disorder to their children.
The real issue, these days, she said is the slippery slope between becoming a health fanatic—not always a bad thing—and a person with a disorder. The dividing line isn’t so clear-cut.
Bulik calls the folks who peddle juice cleansing drinks are “selling eating disorders.” I mean, what are you cleansing?
“We don’t know where that line is between being healthful and being obsessed,” said Bulik. “It differs for different people. There are people who toe that purist line who claim they are fine but if they slide off the path, they feel guilty and distressed. I would say those are indicators of crossing the line.”
And eating disorders aren’t just about anorexia and bulimia. Binge eating, which can lead to obesity, is going to be, for the first time, included in the DSM-5, the psychiatrists encyclopedia of mental illnesses. Some 3.5 percent of women and about 2 percent of men in America are binge eaters, meaning they severely limit their intake for hours and then have no control whatsoever on their intake. It isn’t the amount of food so much as the feeling of being out of control. “Once you start, you can’t put the breaks on.”
Bulik says emerging evidence suggests it’s a toxic combination of biology and psychology. Some people are hardwired to be more reactive to food cues, she said, and the initial food limitations increase the temptation. Emerging evidence suggests that for some binge-eaters, their brains react to food the way a drug addict responds to heroine. The results are far from conclusive, but a recent review in the February 1st issue of the journal Biological Psychiatry concurs. As the authors state, nothing is confirmed but further research into the reward centers of the brain, particularly with binge eaters may “bring us closer to developing effective pharmacological and behavioral treatments for these deadly disorders.”
Bulik knows that a book called, Getting Over Your Eating Disorder” may not be something you want to walk around town with—and she did grapple with the title. But she wanted people to confront the reality of their situation. And besides, you can always be more discreet and get the e-version. Because this self-help book isn’t just about helping yourself, it’s really about helping your family.
Monday, February 25, 2013
Poor Nathanael Johnson. He made a huge error in his new book All Natural: A Skeptics Quest to Discover if the Natural Approach to Diet, Childbirth, Healing, the Environment Really Keeps us Healthier and Happier.
Didn’t anyone tell him that the way to sell books these days is to skim over the research, tap into the juicy bits that match your preconceived notions and then offer the reader an easy yet extreme solution? When it comes to health, we hunger for a few easy-recipes and maybe a pill on the side with promises to live longer, feel better, get skinny and smarter and happier and fitter and anything else that is controllable with the right mix of carbs and proteins and juices. And if he were really smart, shouldn’t he hone in on advice that can be stated in 140 characters or less including spaces and punctuation?
Instead, Johnson—who grew up with earthy-crunchy granola-loving, medicine-fearing parents in California—delves into the nitty-gritty and presents a balanced assessment of everything from birth to beef. The upshot? A memoir spiced with lots of cool scientific facts—and even a glimpse into where the science is lacking. And to make it an even better read than most health books, it’s really funny too.
So, for those of you who aren’t looking for a gimmick and instead crave serious reporting told in the most entertaining way, this is the book for you. You will journey along with Johnson as he delves into logging, birthing, porking (is that a verb?) and a host of other escapades as he meets with eccentric scientists on both sides of the natural versus high-tech divide.
I knew this was the book for me by the time I got to page 3 and he provides a description for those of us who suffer from “ecological anxiety.” As he tells it: “You know you’ve got it if you are occasionally concerned that hormone-mimicking chemicals are leeching from takeout containers into your food, but have found that plastic is too useful and too ubiquitous to avoid; if you’re left cold by encounters with the medical system, but aren’t really sure you believe in that alternative practitioner your friend recommended; if you sporadically pay more for food marked “GMO free” or “All Natural,” but only if it’s not too much more; if you use eco-friendly laundry detergents but still dry your clothes with an energy-guzzling machine rather than a line, and travel on airplanes and basically just live in the oil-hungry civilization you were born into, because: What are you supposed to do?”
I had so much fun reading All Natural that I found myself reading passages aloud to my husband (sometimes around midnight when he probably had better things to do than listen to pig insemination) and summarizing Johnson’s findings to my kids’ teenage friends (who also had probably had other things to discuss other than my current non-fiction). I even sent Johnson a fan email and asked him a few questions. Here’s a bit of our cyber conversation:
Me: I don’t want to give away all of the fun-facts in the book, but can you tell me what shocked you the most as you delved into birth, trees, meat and all the rest of the things that spark contentious health debates?
Him: It’s hard to pick just one because I was shocked in so many different ways. I was shocked by the evidence that birth is growing more dangerous rather than less so, and by the number of Americans killed by too much health care (which, according to the best number crunchers I could find, now is greater than the number who die due to lack of access to health care). I surprised myself when my research changed my mind about vaccinations. And the part of me that eternally remains an 11-year old boy was ecstatically shocked to learn about the details of artificial insemination in the hog industry. (There was one cartoon I found in the pages of “Habits of the Highly Effective Inseminator”, an instructional manual, which was particularly shocking in that gleeful way.).
Me: (This isn’t a spoiler, except to say that Johnson and his wife did vaccinate). Seems to me that in addition to some of the counter-intuitive findings (one section, for instance, you called “Free Range Organic Toxins) your basic message is two-fold:
1.We are all control freaks, and this take-charge desire has prompted us to reach for all sorts of quick-fixes to feel better and live longer.
2. If we could have more open and honest communication with our doctors, that , in itself, may transform these polarized debates into a helpful conversations. Would you agree? Anything you would add?
Him: Yes, I think that’s right. I’d just add that we often become so distracted in our grasping at fixes (quick or hard) that we do more damage than if we’d simply taken a deep breath and stepped back from the problem. So, take back pain for example: Dan Cherkin at the Group Health Research Institute recently told me that the best predictor for the resolution of back pain is… time. When you look at the data, all the surgeries, medications, and adjustments don’t change what is really needed for healing, which is simply the passage of time. And in grasping after solutions people can, and often do, cause serious damage. Now this doesn’t mean that people with back pain simply need to suffer without anything to help them. But that brings us the second point. Yes, I think more open and honest conversations between doctors and patients would be helpful, and I also think that they would be healthful. The conversation itself may be the most effective form of healthcare in situations like this. If the doctor can listen, and fully understand what the patient is going through, together they should be able to work out methods (mindfulness techniques, exercise, drugs) to manage the pain, and even to untangle the root causes.
Me: After reading the details of pig artificial insemination, particularly the comment from the guy who said that he sometimes needs to use his bare hands because the gloves combined with a pig penis is a really slippery affair, the first thing that crossed my mind was this, “the last thing I’m in the mood for is a B.L.T because I’d just keep visualizing pig genitals.” And yet two paragraphs later, there you are munching on a pork chop. Did you have any second thoughts about that?
Him: You have to understand, I was eating at a National Swine Improvement Federation conference. That’s not the type of place where you can just ask for the vegetarian option without drawing attention to yourself. Absolutely that pork tasted a little different, and I find that to this day I don’t feel good about eating industrial pork anymore. It’s not so much the genitals as it is the barns. There’s the indelible memory of the smell, and of the eyes of the pigs in their narrow stalls.
Me: And lastly, what qualities will you look for in your health providers for your daughter?
Him: It’s funny, I never would have suspected that I would seek out this particular quality from medical experts until I wrote this book: I look for great communicators – and that doesn’t just mean eloquence. The ability to listen closely, I think, is even more important. I want basic competency, of course, and familiarity with the latest guidelines. But beyond that I’d hope providers would be able to see how to apply those guidelines so that it works to address the uniqueness of my child and the complexity of the world around her. That requires listening, and it’s much harder to find good listeners than people stuffed full of good medical knowledge.
Friday, February 15, 2013
Credit: Wellcome Photo Library
Fertilized Egg, What Some Would Like to Consider a Person, or rather a Personhood.
When Dr. Stephanie Dahl returned to her native North Dakota after a fellowship in reproductive medicine further east, she imagined she would join the region’s only fertility clinic helping people make babies. Simple as that. In 2006, it was the only fertility clinic between Minneapolis and Seattle. She expected a flood of patients. What she never expected was a career transformation of sorts. This mild-mannered doctor turned into a political activist, thanks to all the renewed talk of Personhood.
Personhood is an ancient term with a muddled definition. The word goes back to biblical times when philosophers tried to guess the moment a seed turns into a soul-filled being. The country thought the courts settled the debate with Roe v. Wade. That decision focused on viability, or the ability to survive independently outside the womb. But the word has crept back into political hallways. Lawmakers in several states have tried to pass bills that would give personhood a legal definition. And this is how some folks want it defined: Personhood starts the moment sperm meets egg. That means this single cell would the full rights of a U.S. citizen. So far, no bills have made it to law but the drawn-out process to block them seems to waste a lot of time and money that could be put to better use. To be sure, we know much more about the innermost details of a growing embryo. But do these insights provide any information to help everyone agree on a revised personhood timeline?
While most doctors perceive this as a threat to abortion rights—which it is—the potential legislation also impacts the treatment of complicated pregnancies and limits infertility procedures. And that’s why fertility experts are worried. And that’s why Dr. Dahl has become an activist. And that’s why professional fertility associations have formed their own anti-personhood committees to defeat potential legislation.
If a person is a sperm-and-egg, you really can’t put them in freezers. That is what happens when doctors make extra embryos and freeze them for potential future use. And you certainly can’t discard them when they are no longer needed. At issue is not only the definition of personhood (At conception? At viability? At birth?) but who should be making the decision: scientists, courts or clergy. And if it is clergy, which religion? Beliefs on this issue vary as widely as the people who hold them.
This past week, North Dakota senate passed two personhood bills, putting Dr. Dahl on guard once again. Here’s a snippet of my recent conversation with Dr. Dahl:
RHE: Can you explain these bills?
SD: The first bill that passed the North Dakota senate would amend the N.D. constitution to read: “The inalienable right to life of every human being at any stage of development must be recognized and protected.”
The vague language could lead to devastating unintended consequences for pregnant women and woman who’d like to become pregnant. The second bill limits some types of in vitro fertilization, criminalizes doctors, outlaws abortion with no exemptions for victims of rape or incest, and makes it difficult to treat ectopic pregnancies.
RHE: In your blog you mention cancer, what does that have to do with fertility?
SD: Chemotherapy and radiation therapy, which are used to treat cancer, can adversely affect the ovaries and destroy a woman’s ability to become pregnant in the future. The best option to preserve future fertility for women with cancer is to perform in vitro fertilization and freeze the resulting embryos. Some centers freeze eggs, however, that technology is not as successful as IVF and is not yet available at our center. Another bill introduced in the senate would have prohibited embryo freezing (for all families including infertility patients and cancer patients), limited the number of eggs we could attempt to fertilize (either one or two), and banned some forms of birth control. Luckily, that bill did not pass. Our cancer patients have enough to worry about with their diagnosis and treatment. They shouldn’t have to forfeit their chances of becoming a mother in the future as well.
RHE: Do you ever think it would be easier to move to a state with more progressive attitudes about fertility so you can just do what you do best?
SD: I have thought about leaving the state, but I want the people in North Dakota to have this care available locally. I think what we do is important. I love my job. When patients bring their newborns for me to snuggle, it’s the best part of my day. So I try to push the politics to the background. I’m here to give patients quality care. We now have thousands of babies across North Dakota that would not have been possible without interventions like IVF. But I hear comments from senators that you wouldn’t believe. Just the other day, one told me that if God decided a woman’s womb should not bear children, doctors should not intervene. And I said, “Does that mean if God decides you should have a heart attack, doctors shouldn’t intervene either?”
For further reading as well as thorough history of the personhood debates, check out 102-year-old Howard Jones’s latest book, Personhood Revisited: Reproductive Technology, Bioethics, Religion and the Law. Dr. Jones, sharp as ever, along with his late wife, Georgeanna Seegar Jones, created America’s first test tube baby and has been in thick of the fertility debates since day one.
Monday, January 28, 2013
When my older brother, Andrew, was born in 1957, my mother suffered from dangerously high blood pressure, otherwise known as pre-eclampsia. If anyone was watching carefully, they would have realized that her blood pressure had been creeping up all along. The problem was that her typical blood pressure was low so no one noticed until she showed signs of toxemia—high blood pressure plus swelling, signs that can lead to seizures, kidney failure, coma and even death. They immediately gave her barbiturates to lower her pressure. And then my mother breastfed my brother. The nurses said he was the calmest baby in the whole nursery. His first meal, of course, was spiked breast milk.Little Andrew went from calm to an angry wreck when he got home a week later. My mom figured out the drug link and he eventually got through the withdrawals. ( BTW: my brother is now a respected orthopedic surgeon without any repercussions from his first stint with drugs.) Fortunately for my mother, her pre-eclampsia never progressed to full-blown eclampsia, which can kill.
My point isn’t laced breast milk, but the continued dangers of eclampsia. If you watched Downton Abbey last night, you saw the dangers of eclampsia. As Eleni Tsigas and Christine Morton write in today’s Daily Beast, that while viewers tonight “may dismiss the dramatic plot twist as unrealistic, or express relief that women today no longer die so tragically in childbirth, those viewers would be mistaken on both counts.” Their piece discusses the current situation of eclampsia in the U.S. and what women can do to make sure they are armed to prevent its dangerous repercussions.
Like everything else in pregnancy, the history of eclampsia has been riddled with wacky and useless advice. During my mother’s next two pregnancies, her doctor threatened her with hospitalization should she gain a pound over the arbitrary number 15, fearing another bout. The thinking was that keeping thin would prevent bloating. But they had it mixed up: eclampsia causes water retention not vice versa. It could have been worse. If my mom had given birth 100 years earlier, she would have been purged and bled. Back then, they thought they were removing the toxins that trigger seizures but as you can imagine it just made women feel weaker and sicker.
To this day, eclampsia mystifies doctors. No one really knows why it strikes some women and not others, nor what precisely happens in the body to make a woman seize. But you should know the warning signs, which will allow doctors today to take simple steps to prevent the dangerous cascade—to stop Downton Abbeyish endings. As Tsigas and Morton say: “Diligence—educating women and improving health care response to preeclampsia—is not expensive, while the worth of a mother’s or baby’s life is incalculable.”
Monday, January 21, 2013
Kudos to Nathanael Johnson for highlighting the urgent need to make births safer for American women in yesterday’s Wall Street Journal. Johnson points to, among other things, the rising cesarean section rates and the dangers associated with them. His solution: use midwives who are more more low-tech and high-touch instead of doctors who tend to be high-tech and low-touch. Johnson, the author of the forthcoming All Natural: A Skeptics Quest to Discover if the Natural Approach to Diet, Childbirth, Healing and the Environment Really Keeps us Healthier and Happier, has a point.
Nearly one in three babies these days are delivered by cesarean section—in some hospitals the rate approaches 40 percent. But while Johnson suggests that midwives may be the solution, there are other steps, some already in progress, that can reduce surgical births and perhaps the morbidity that goes along with it—without kicking doctors out of the delivery room.
Deborah Kotz, a medical reporter for the Boston Globe, reported in October that Massachusetts General Hospital initiated a plan to stop elective inductions, that’s when a woman and her doctor decide on the date to deliver and then use drugs to start labor. Elective inductions, for one reason or another, have been shown to up the odds of cesarean sections. And cesarean sections have been linked to increased childbirth complications. When a group of hospitals in Utah started the same elective induction ban, their surgical birth rate dropped from 28 percent to 22 percent over a 10-year study period, Kotz reported. MGH is hoping for the same downward slide.
I am glad that Johnson renewed the much needed attention to the dangers of childbirth. But I hope that his piece does not re-ignite the overly simplistic midwife versus doctor debate. What we need is a healthy dialogue between these two groups of experts. Midwives rely on doctors when complications arise. And doctors can learn a thing or two from midwives about how to offer their patients the best of both worlds: high-touch and low tech along with state-of-the-art technology when it’s needed.
And one more thing: I can’t help but slip in a little history: In 1933, a New York City report highlighted what they called an epidemic of cesarean sections: the rate then was 2.2 percent.
Friday, December 21, 2012
Anyone who has ever been through the roller-coaster ride of fertility treatments—the ups and downs of good news and bad news and the hormonal ride from pumping drugs in and using drugs to wipe other hormones out, knows that every day—every moment—counts. A cycle lost because of a laboratory glitch or a faulty egg or embryo means that all of those injections, all the anticipation, all the clinic visits were for naught.
So when Hurricane Sandy slammed the east coast, one New York University team was determined to get his batches of eggs and sperm and embyros out safely. It became a feat of utter determination.
The rains started to come down Monday night so at the crack of dawn—sometime around 5:30 the next morning—Dr. James Grifo, the clinic’s director, launched his sperm- egg-embryo-salvation mission. He got in his car, leaving his own flooded downtown neighborhood, picked up his embryologist, andrologist and administrator and dashed to the fertility center on 38th street and 1st Avenue. The firemen were already there and threated to shut off the generators, a potential fire hazard. The generators were on the roof but the fuel supply was in the basement.
Frozen products—sperm, eggs, and embryos—don’t rely on power. That wasn’t the issue. Grifo and his team worried about the fragile embryos growing in incubators. There were about six of them in varying stages of development, he said. Each embryo represented a nervous couple hoping that their chances of pregnancy that month weren’t dashed by the rains. The clinic had battery packs but they only last six hours. With the elevators shut, the building staff and Grifo were allowed to trudge 5-gallon fuel containers eight flights of stairs to the roof. The hope was to keep the embryos going long enough to freeze them.
Meanwhile, one of Grifo’s patients showed up for her egg retrieval, a process of fertility that is timed exquisitely. There was zero chance of doing the procedure in the powerless NYU clinic so she and Grifo got into his car and headed uptown to a Mt. Sinai affiliated clinic. Dr. Alan Copperman, that clinic’s director, welcomed them to use his office. “We are in this competitive field,” said Grifo, “but you work with people who care about their patients so when push comes to shove everyone figured out a reason to cooperate.”
Grifo also contacted Dr. John Zheng at New Hope Fertility Center, where he did 11 egg retrievals in one day. Of course, saving the embryos does not guarantee a baby. But so far—one month out—four of six women who got to use their Grifo-rescued embryos have had positive pregnancy tests. So what seemed like an awful forecast for a few couples, is really a happy ending. Or really, a potentially exciting beginning.
Monday, December 10, 2012
Here’s something that probably doesn’t happen often. Actually, I’m wondering if this ever happened to anyone else in the world other than to me. And it happened today when I was celebrating my 50th birthday over lunch with my husband.
I was carded! Yes, we ordered two glasses of champagne and the waiter asked for proof of age. Did he really think I wasn’t yet 21? Was it my hair, which I swear I’ve never colored? The outfit, which was very middle-aged appropriate?
Or could it have something to with the fact that when I got to the restaurant a few minutes before my husband, I asked the hostess to ask the waiter to ask me for proof of age when we ordered drinks. I explained to her that I just turned 50 and all I really wanted for my birthday was to be able to say: “Someone asked me for proof of age on my fiftieth birthday!”
So now I can. And guess what? I felt so good about myself even though I contrived the whole thing. In fact, scientific studies have provided some evidence to show that lying about yourself really is a good thing after all. In moderation, of course.
For years, psychologists have known that a lot of us exaggerate our qualities, whether it’s height or grades, or whatever. And I guess, I overestimate how young I look. But there’s a reason: When I was 12, I looked 8. When I was 21, I looked 14. People talked baby talk to me my whole life which isn’t a good thing. And everyone told me that I would feel so much better when I’m old and look young. At the time, I thought they were talking about me as a future 40-year-old, but really, the teenage me thought, who cares what you look like when you are 40? So now, I’m 50, and if you do the math (I did), that means I should look 33.33. But I was thinking that I could maybe pass for 20. An exaggeration. I know.
I also told myself another little lie today: I felt really popular because of all the Facebook happy birthday messages—mostly from high school friends who may not even remember which one I was. (I was the short one, with the red hair and Dorothy Hamil haircut. I looked like I was 11.)
But get this: A 2009 study published in the Personality and Social Psychology Bulletin found that students who exaggerated their grades and grade point average showed “greater achievement motivation and positive effect.” The scientists used grade point average to explore self-deception because it’s easy to calculate fact from fiction. But their mission was really all about self-deception in general. They believed their findings added support to prior studies that showed that people who lie to themselves tend to be “well-adjusted” while those with an accurate assessment are depressed. So even though I did something crazy today, it proved I was really sane after all.
PS: Other studies, have shown this is all nonsense and people who lie about themselves are pompous jerks. But hey, we all tend to ignore studies that don’t feed into our prejudiced views.
Thursday, November 29, 2012
I rarely post pieces verbatim from other people’s website, but I just couldn’t resist this piece I just read by Elizabeth Stephens, an Australia Research Council Fellow and Deputy Director for the History of European Discourses at the University of Queensland. When it comes to wacky theories in medical history, this one really tops the charts: It seems that in the mid 19th century, doctors warned men that if they acted unmanly (say had a hankering for sentimental literature or soft trousers, say), they were at risk of leaking semen, otherwise known as spermatorrhea. It lead to, among other things, loss of memory and dignity. Actually, I think the loss of dignity may have been triggered by the treatment, which included acupuncture to the penis. Ouch!. If you can bear the details, read Stephens account below. There’ve been so many pieces about female hysteria tied to the womb, it’s a pleasure (at least for me) to read about some illnesses blamed on men and their gruesome remedies.
Here is Stephen’s piece:
Spermatorrhoea was said to be ‘the most dire, excruciating and deadly maladies to which the human frame is subject.’ Guillaume Duchenne
MEDICAL HISTORIES – The second instalment in our short series examines how the spermatorrhoea epidemic changed the scope of medicine.
Every period arguably invents its own illnesses, medical disorders with symptoms that reflect the particular circumstances and anxieties of the time. The spermatorrhoea epidemic of the mid-to-late 1800s, like the much better known epidemic of female hysteria of the same time, is one such disorder that left a lasting legacy.
In contrast to hysteria, which has been the subject of analysis by medical historians and feminist scholars alike, spermatorrhoea occupies a very obscure position both within the history of medicine and of masculinities.
But for Victorian physicians like Albert Hayes, director of the Boston Peabody Medical Institute, and author of The science of life: or, Self-Preservation. A medical treatise on nervous and physical debility, spermatorrhoea, impotence and sterility, with practical observations on the treatment of diseases of the generative organs, (1868) the disease was amongst “the most dire, excruciating and deadly maladies to which the human frame is subject.”
The term spermatorrhoea, or spermatorrhée, was coined in 1836 in the first volume of the French physician Claude François Lallemand’s Des pertes séminales involontaires (1836-42), where it was used to refer to “an excessive and involuntary discharge of semen”.
Considered a form of sexual dysfunction or venereal disease, spermatorrhoea was associated with an oozy and incontinent seminal leakage. And because semen was identified as the source of men’s “vital heat,” the disease was thought to produce a whole series of debilitating bodily effects.
As physician John Skelton wrote in A Treatise on the Venereal Disease and Spermatorrhoea (1857), sufferers
of spermatorrhoea become fretful and peevish; their memory fails; they lose their courage, and indignities, which they would formerly have resented, they now endure with patience. They become confirmed hypochondriacs; are unfit for either business or serious reflection, and are disagreeable to themselves and the whole world.
Causes and consequences
Causes of the disorder were thought to vary widely, but were generally attributed to an overly-domesticated and unmanly lifestyle – feather beds, soft trousers, excess reading of sentimental literature, and sedentary pursuits were all cited as possible causes. But most physicians agreed with Robert Bartholow (Spermatorrhoea: Its Causes, Symptoms, Results and Treatment, 1879) that “the vice of masturbation is undoubtedly the chief cause.”
Did physicians and quacks stop to think that corsets may have been a problem? Haabet/Wikimedia Commons
Spermatorrhoea rendered public and shameful men’s private loss of self-control, and his inability to live up to the expectations of dominant nineteenth-century masculinity. It provided a new diagnostic category in which nineteenth-century concerns about masculinity, virility and self-control could be read in the sexual anatomy of the male body.
Treatments for spermatorrhoea followed one of two approaches. The first was to focus on improving the general health and vigour of the body. In Practical remarks on the treatment of spermatorrhoea and some forms of impotence (1854), John Milton suggested, “Few means of controlling spermatorrhoea could be devised so simple and natural as exercise, especially gymnastics.”
The patient was encouraged to participate in his own treatment and might
do half the surgeon’s work if he will rise at five or six o’clock, sponge with cold salt water, use the dumb bells for half an hour, and follow this up with a brisk walk. It will not be long before the eye grows brighter, and the skin clearer; before he sleeps sounder and again feels comfort in existence.
If self-discipline failed, however, medical intervention was deemed necessary, and its severity demonstrates how dangerous spermatorrhoea was seen to be. Treatments included acupuncture of prostate and testes, blistering of the penis, and forced dilation of the anus.
“I have had excellent results from stretching the sphincter ani,” Bartholow wrote. “The operation causes considerable pain, and may rupture the sphincter if incautiously carried too far … but it has seemed the most useful in the cases of simple spermatorroea.”
The brutality of these treatments attests to a strong determination to discipline the male body, in order to prevent its dissolution into a pathological ooziness.
Structural change
The consequences of the spermatorrhoea epidemic were profound and led to an institutional shift in the structure and practice of medicine. It was as a direct result of this epidemic that professional medical practice was extended to include the treatment of sexual diseases and genitor-urinary specialisations for the first time.
As Angus McLaren notes in Impotence: A Cultural History (2007), urology was for a long time “tainted by its association with venereal disease and impotence,” and doctors “who discussed such issues were acutely aware of their apparent unseemliness.”
There’s a concentrated effort to challenge this in the spermatorrhoea literature and to make the treatment of sexual disorders a part of the practice of mainstream medicine. Dr Pickford was one of dozens of physicians who protested that, “It is … this inexcusable neglect in medical men, which drive[s] the [sufferer] into the hands of nostrum-vendors and infamous quacks.” (1854)
An editorial in an 1857 edition of The Lancet exhorted, “Let honourable and scientific men take possession of the field now occupied by these vagabonds.”
It should be noted that this self-representation of the medical profession reluctantly turning to the neglected and distasteful disease of spermatorrhoea in order to save suffering men from the dangerous ministrations of quacks is primarily a rhetorical strategy – mainstream doctors and quacks offered similar, sometimes identical, treatments.
But the rhetoric was mobilised in the interest of affecting structural change, strengthening the professionalisation of this area of medical practice by prompting legal action to formally exclude and delegitimise the practice of quacks and restructuring general medical practice to include the treatment of sexual diseases, disorders and dysfunctions for the first time.
By the early 1860s, a spate of texts on “true and false spermatorrhoea” began to emerge. “False spermatorrhoea” was identified as being diagnosed by quacks, and “true spermatorrhoea” was redefined as a much rarer condition only a licensed physician could detect. This signalled the beginning of a rapid decline in spermatorrhoea diagnoses, and within a few short years, this epidemic had died away as quickly as it flared up.
Having transformed what had previously been known as “secret diseases” into something understood under the rubric of “sexual health,” and produced a series of corollary structural changes in the profession and practice of medicine, spermatorrhoea appears to have served its cultural purpose. Although it’s now an obscure footnote in the history of medicine, spermatorrhoea’s significance and effects remain important.
This is part two of Medical Histories – click on the links below to read the other articles:
Part One: Hypochondriac disease – in the mind, the guts, or the soul?
Part Three: Culture and psychiatry: an outline for a neglected history
Wednesday, November 14, 2012
It sounds like such a simple hospital order. A person gets better and the doctor signs a form to discharge them to home. But what happens when the patient is homeless?
Read this insightful piece from someone on the frontlines, who believes that sending a homeless patient home is as negligent as operating on the wrong side of the body or leaving a sponge inside someone after surgery. “Discharging homeless patients to the streets after hospitalization,” writes Dr. Kelly Doran, an emergency physician and Robert Wood Johnson Foundation Clinical Scholar at Yale University, should be added to the doctor’s “never” list. As in these things should never happen. She has some ideas about how to fix the system.
check out Kelly’s blog.
Thursday, November 8, 2012
A Full Tank
Last night at my daughter’s family bat-mitzvah class we along with about 5 other families discussed with a student-rabbi the importance of having a sense of purpose in life. And that surge of fulfillment you get with that sense of accomplishment.
Last Sunday, using the last drops of gas in the car, my kids and I found a community center on the lower east side in need of supplies to help those in the community who need some very basic items: diapers, Ensure for the elderly, blankets, etc. It was a trek and we felt great afterwards.
Yesterday, my purpose was finishing a chapter and my day finished in that very unfulfilled sort of way. I eked ahead, learned some fun facts about hormone history circa 1890, but didn’t really feel any sense of getting done what I set out to do. I felt pointless by dinner time.
Today—even before lunchtime, my purpose maybe not in life but in day was fulfilled. I scoured NYC for open gas stations, waited for nearly three hours and now have a full tank of gas, plenty get to see my other daughter’s school play tonight. In my case, I guess, it wasn’t so much fulfillment, but filled.
