ARTHRITIS AND GOUT – DIET 2
Vegetable oils, such as cold-pressed olive, sunflower, poppy, or linseed oils, should be used in their unrefined state. Anyone suffering from rheumatoid arthritis should never have denatured white sugar on his table. For sweetening, honey and natural sweetness from grapes, sultanas, currants and raisins must take the place of refined white sugar. These dried fruits can be put through a mincer so that they can easily be added to foods for sweetening. Raw rose hip puree made without white sugar is an excellent substitute for the usual jams. Not only white sugar but also white flour and white flour products must be scrupulously avoided. On the other hand, wheat germ taken in limited quantities is an excellent addition to the diet. If vegetables are not eaten raw, care should be taken in their cooking. Never boil vegetables but simply steam them in a little water to preserve their minerals and vitamins. Raw salads are very good seasoned with whey concentrate (Molkosan) or with lemon juice and oil; never add salt and sugar. If at all possible do not use table salt or sharp spices, but replace these by fresh culinary herbs and yeast extract, or use Herbaforce.
*528/28/1*
SEX THERAPY: DYADS
The sex therapist treats dyads at a peculiarly intense phase of the dyadic relationship and has a unique opportunity to observe the different kinds of dyadic transactions. From these observations, it has been possible to categorize dyads into four general types, based roughly on age and experience. Clearly, a general typology does not mean that the behavior of a particular dyad can be predicted; it can indicate only the consistencies of behavior that experience has revealed.
The four dyadic types are the young unmarried dyad, the young married dyad, the experienced married dyad, and the experienced unmarried dyad.
The young unmarried dyad is seen much more frequently by the sex therapist than by the marital therapist. My impression is that young unmarrieds rarely come for marital therapy. Their sexual problems are the same as those of other patients.
The relationship of the young unmarried dyad is usually centered on sex. Whether they live together or apart (although this is much more pronounced when they are living apart), they tend to have lives separate from the relationship. Because of this, the need for extra-sexual satisfaction within the dyadic relationship is diminished, since they can obtain this elsewhere. As a result, as long as sex is good, one partner tends to tolerate behavior by the other that married partners will not. Their perception of their relationship is generally that nonsexual problems “are not a problem.”
But if sex is not good, what is the use of continuing the relationship? Just as good sex and strong separate lives can smooth over nonsexual problems, poor sex can cloud otherwise satisfactory aspects of the relationship and interfere with general “good times.” That is, after a time the young unmarried dyad comes to feel that if the sexual problem is not resolved the relationship has failed.
Thus the young unmarrieds will seek sex therapy rather than marital therapy. Usually, the therapy proceeds smoothly; there is little “sabotaging” by the non-dysfunctional partner and little fear of the outcome. The irony is that it is precisely in the young unmarried dyad that the most drastic changes in the relationship tend to occur. That is, the sexual dysfunction often has been used as an excuse or reason for immobility. The insecurities and fears associated with the failure to achieve good sex have frozen the dysfunctional partner into a practically fixed relationship. With the dysfunction cleared up, that person feels more free to move.
Although many young unmarrieds continue in the same relationship after successful sex therapy, a large proportion does move. This movement can be in two directions: the “cured” partner moves away and begins to explore other relationships, or the dyad gets married. The psychodynamics in the first alternative are evident: the formerly dysfunctional partner, his or her feelings of inferiority cleared up along with the dysfunction, now feels confident to handle sexual situations and eager to see where they might lead. No longer tied down by his or her own sense of inadequacy, or impelled to tolerate the faults of the partner because of his or her tolerance of the dysfunction, he or she elects to move.
The psychodynamics in moving toward marriage are less clear. One possibility is that these partners were planning to marry anyway and wanted to remove an important obstacle to their satisfaction before the relationship became more fixed. Another is that the dysfunctional partner did not want to “inflict” himself or herself on the other with a permanent sexual dysfunction, and a third is that one partner demanded the cure of the dysfunctional one before agreeing to marry. The most likely explanation is that marriage is seen by both partners as a challenging and serious commitment, and that the improved sexual functioning of the one partner and the more satisfactory sexual relationship for both increases their self-confidence individually and together.
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HOMOSEXUALITY: CASTRATION FEAR
Certainly in nearly all cases of homosexuality, castration anxiety is important. But castration anxiety itself does not exist in a vacuum. The fact of castration anxiety suggests the failure to achieve a healthy resolution of the oedipal crisis, but the castration anxiety may also be riding on a more primitive level of anxiety that relates to the failure of much earlier pre-oedipal concerns. Consequently, we must be careful about assessing pathological aspects of homosexuals. Clearly there is no uniform pathology, but rather, each case must be individually assessed for its developmental achievements and the level at which the anxiety is operating. We can argue only for the presence of some developmental failure and by inference, some degree of psychopathology related to that failure. What the degree of failure and the extent of psychopathology may be in any given individual requires specific evaluation and identification.
The male homosexual essentially protects himself from the retaliatory fears of castration by shifting his sexual impulses away from a heterosexual object to a homosexual object. The origin of such castrative fears lies in the oedipal situation in which the child’s sexual wish to possess the mother raises the fear of retaliatory punishment in the form of castration from the father. Why a homosexual object in the adult should seem safer than a heterosexual one, however, is not at all clear, but it seems certain from clinical experience that a confirmed homosexual is inordinately afraid of women as sexual objects. The male homosexual is literally fleeing from women. As a neurotic symptom, male homosexuality can be understood as a phobic avoidance of the female genital. Many homosexuals in fact tend to view the vagina with disgust and revulsion. Often such individuals have an intense vagina dentata fantasy, that is, the fantasy that the vagina is like a devouring mouth which can somehow consume and destroy the penis.
The castration fear can be related either to the mother or to the father. The typical family configuration in which male homosexuality is fostered generally has a domineering, overpowering, seductive, and excessively intimate mother together with an emotionally detached, hostile, aloof, and rejecting father. The son of such a mother would be expected to have a great deal of anxiety about separating from her and also to fear that she would devour him should he get too close to her or hold on to her for too long. The dependency on the mother, so essential to sustain life and to psychic growth early in the child’s experience, becomes associated with aggressive and destructive elements.
*223/187/5*
EXPOSURE TO EROTICA: PERSONALITY, SOCIAL DIFFERENCES, SEX DIFFERENCES
Some of the personality and social variables related to viewing or not viewing erotica have been detailed above. Athanasiou and Shaver have reported a long list of correlates of viewing erotica which include differences in political preference (Democrats versus Republicans), age, attitude toward social issues such as abortion, and other variables. In general, there is little surprise in these correlations, since they make sound social psychological sense.
One of the personality variables which seems central to response to erotica is guilt. Donald Mosher has developed a well validated measure of sex guilt, a “generalized expectancy for self-mediated punishment for violating or for anticipating violating standards of proper sexual conduct”, and demonstrated that high sex-guilt subjects rated erotic films as more pornographic, disgusting, and offensive, and more often saw oral-genital sex as abnormal than did low sex-guilt subjects.
Sex guilt was positively correlated (correlations usually > 0.3) with the following variables in Mosher’s study: religiosity, political conservatism, the belief that the government should enforce sex laws, the belief that homosexuals should be excluded from society, that love and sex are inextricably linked, that extra- and premarital sex are not good ideas, that abortion should be difficult to obtain or illegal, and that conservative standards of sex behavior are best. Additionally, sex guilt was positively correlated with preventing respondents from expressing their sexuality because of social disapproval, guilt feelings, and religious or other moral training.
Sex guilt was negatively correlated with number of sexual partners, intercourse frequency, oral-genital activity, and the belief that sex is fun.
Sex guilt, then, may be seen as a central psychological variable in predicting sex attitudes and sex behavior. Love and others used Mosher’s Forced Choice Guilt Inventory to predict the time spent viewing erotic slides. They found that “the viewing time of the low sex guilt group increased linearly as a function of increasing pornographic content. There was no significant increase in viewing time for high sex guilt subjects. Subjects with a moderate degree of sex guilt displayed a curvilinear pattern”. The three groups were referred to as the profligate, the priggish, and the prudent.
Ray and Walker reported that low sex-guilt female subjects rated masturbation, coitus, and petting stimuli as more sexually arousing, better, more pleasant, safer, and more appealing than did high sex-guilt subjects.
Based on the above, one would expect censorship, condemnation of material on the basis of its explicit sexual content, to enhance viewing of the material on the part of low but not high sex-guilt subjects. Schill and others conducted such an experiment and found that when material was labeled as “porno junk,” viewing time was highest for both high and low sex-guilt subjects. When the experimenter used the phrase, “I really enjoyed that porno stuff”, high sex-guilt subjects viewed it for an average of 2.55 minutes relative to the low guilt subjects who viewed it for an average of 0.79 minutes.
It would seem from these data that the “banned-in-Boston” effect served to increase viewing time for both groups, but the approval condition affected only the high guilt subjects’ viewing. In retrospect this is an intuitively satisfying outcome but clearly raises the question of the value of censorship to inhibit behavior. Fromkin and Brock and Zellinger and others have applied commodity theory analysis to the effects of restrictions on pornography and have found results which confirm “the commodity theory prediction that the imposition of age restrictions upon pornographic materials increases their desirability”. They conclude that “making erotic materials more difficult to obtain, harassing and punishing pornographers and purveyors of pornography, and restricting certain materials . . . may increase interest in the materials and render them more desirable than would have been the case without the restriction, harassment, or difficulty”.
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PENIS ENVY: FACT OF ARTIFACT?
In Freud’s prudish and bigoted Vienna, many a little girl wished she were a boy, for this was the only, though imaginary, way of escaping discrimination. Young men could do whatever they pleased and choose an occupation they liked, but girls were their father’s possession until he agreed to transfer them to their future husbands. Marriage was, therefore, the only way of escape from the father’s tyranny, but the marital oath committed women to love, cherish, and obey their new masters. Most women preferred new masters to old ones, and some of them slyly outsmarted their marital bosses.
In the Victorian era, marriage was the only acceptable social role for women. Unmarried women were called “spinsters.” They were ridiculed and blamed for remaining single. When a girl preferred an active and independent life, she was called a “tomboy,” “amazon,” or monstrosity. To be feminine meant to become a hybrid of infantile dependence and motherly protectiveness. Women were expected to practice and enjoy the three great “feminine” K’s— K?che, Kirche, Kinder (kitchen, church, and children).
In Freud’s time masculinity and femininity could have been described as follows:
When you say ‘masculine’ you mean as a rule ‘active,’ and when you say ‘feminine’ you mean passive. . . . The male sexual cell is active and mobile; it seeks out the female one, while the latter is stationary and waits passively. This behavior of the elementary organism of sex is more or less a model of the behavior of the individuals of each sex in sexual intercourse. The male pursues the female for the purpose of sexual unity, seizes her and pushes his way into her (Freud).
Freud did not invent penis envy but discovered this culturally determined phenomenon. The more restrictions were imposed on girls, the more frequently they wished to escape their yoke.
Penis envy was never a general feeling common to all women at all times; certainly the Tschambuli or Arapesh women never had the reason for such an envy. In Arapesh, men and women shared household and child-rearing responsibilities, and among the Tschambuli, women were the dominant sex. (Murdock)
Freud’s observations of penis envy in women who were reared in an atmosphere of discrimination and subjugation must be interpreted in light of another hypothesis brought forward by Freud, namely, the tendency of the child to identify with the “strong aggressor.” In patriarchal families, the father was the absolute ruler, and the male and female children were proud to identify with the father rather than with the mother. It is small wonder that
Freud noticed the preference for a masculine, father-based superego (Fenichel; Freud).
One therefore must interpret penis envy in girls not as an envy directed to the male organ of their playmates or brothers, but rather as a wish for the possession of the father’s penis and with it, father power. Penis envy does not seem to be a general and universal element of female psychology but must be interpreted as the feminine protest against male domination. The penis, as a cherished symbol of power, was envied by women not because of its sexual significance, for vaginas undoubtedly can procure as much and often more sensual pleasure than penises; it was the penis as the power symbol which elicited the justifiable envy (Homey; Kelman; Millet; Unger and Denmark).
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MALES’ AND FEMALES’ SEXUAL BEHAVIOR ACROSS LIFE
Marriage offers females the opportunity for extensive sexual experience and provides the framework within which sexual responsiveness can develop. This period may be a time during which there is positive reinforcement of sexual functioning and extinction of adolescent inhibitions (Kaplan and Sager). Most evidence suggests that males set the tenor of sexual activity within marriage, especially in the early years. Since they tend to be more active than females, it is reasonable to suppose that in early years much of the marital sexual activity is dictated by the level of the males’ sexual arousal. In later years, married females’ activity levels and married males’ activity levels are fairly close but are lower than the activity of single males (see Verwoerdt), suggesting that in late-middle and old age, the locus of control of marital sexual activity may swing to females. However, the generally lower levels of activity for both men and women may be part of declining male responsiveness.
Compared to earlier years, men in their thirties are less preoccupied with sexual thoughts and fantasies but are still highly responsive to sexual stimuli. In the forties and fifties, sexual expression among males becomes less intense genitally, and men of this age group often require more psychic stimulation for effective sexual functioning (Kaplan and Sager).
Male declines in sexual capacity often result in frustration over ability to perform sexually. This often leads to avoidance of sexual functioning which, in a marriage, can lead to feelings of neglect by the wife. This perceived neglect may be interpreted by the wife as evidence of her waning attractiveness. If this coincides with menopause, it can reinforce the societal stereotype of the menopausal female as unattractive and unfeminine. Negative behavioral changes by the wife then can precipitate negative responses by the husband.
In an effort to reverse age-related changes, frustration also may lead the male to seek out erotic stimuli in the form of new sexual partners. This frustration and fear of failure to perform adequately also may lead to an attempt to recapture the sexual functioning of earlier years. Interestingly, the strong motivation to perform combined with a new partner can result in short-term improvement.
It is not clear whether monotony precedes or follows changes in sexual functioning. Masters and Johnson suggest that monotony in the marital relationship is one of the primary causes of loss of responsiveness in middle-aged men. Many middle-aged males’ familiarity with their wives combined with lack of interest by the wives themselves (as well as generally greater female appearance changes with aging) may lead to waning interest by these men. Often these declines in interest are reinforced by the older female’s negative attitudes towards sex. On the other hand, changes in ability to perform sexually and accompanying decrements in sexual responsiveness may require more erotic stimulation. By definition, the newer the sexual partner is, the more stimulation value is possible.
Although there is no definitive experimental evidence with humans, the cultural stereotype suggests that males are more directed toward variety and novelty than are females. There is some indirect evidence in male/female differences in the sexes versus relationships. These differences are probably tied in part to the fact that men concentrate more on sex, and women emphasize relationships. A very high percentage of male homosexual relationships can be characterized as transitory; these changing attachments presumably reflect a desire for sexual (genital) satisfaction, an important part of which is the new sexual partner. Female homosexual relationships, on the other hand, tend to be more stable and less physical. Heterosexual relationships fall somewhere in between, and sexual monotony as a reason for marital failure is cited much more frequently by males than by females.
If it is true that males are more interested in variety than females are, this difference may have arisen because males traditionally have operated in a more complex and changing environment. Whether this is because of temperamental differences or whether it resulted in temperamental differences is an open question. But if it is true, the double standard has allowed males to experiment sexually with a variety of partners and has imposed severe sanctions on females for similar actions (McCary). It is possible that years of socially approved sexual experimentation among males have cultivated their desire and need for novelty.
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TAKING CARE OF YOUR BACK: GARDENING
The same rules apply to gardening jobs as to household ones: lift and carry carefully, using your legs and body weight; work upright whenever practicable; do not do too much at once, and change tasks often; keep the work as close to yourself as possible; get help when necessary. Avoid working in the cold or cooler weather.
Avoid prolonged bending and stooping by kneeling down or using a long-handled implement to do the job whenever possible.
For pruning and fruit picking, long-handled implements which allow one to avoid reaching high up above, should be used with care. While they may not be heavy items in themselves, when they are lifted or lowered they put a stress on the back.
Try to keep the sweeps of action in a forward or backward direction, with the minimum of twisting. Avoid any sweeping action across the body: it needs a good deal of work from the muscles of the trunk, and unless they are in working trim, your back may be strained. The secret is foot position, so that every action is a use of balanced body weight. Where space is too cramped, you may do better by getting down on your hands and knees.
Kneeling is a very sensible posture for many jobs in the garden. For a gardener who can neither stoop nor kneel nor squat, raised borders for flowers or a greenhouse with shelves would be possible outlets.
Digging is a traditional back-breaker for those untrained to it. Do not attempt to dig too much at one time. Stand over the job and try not to overload the fork or spade.
The wheelbarrow puts considerable stress on the spine because it has to be lifted and at the same time pushed – all very well if the ground is hard and level, but a great effort when the ground is soft and steep or uneven. If you need to make use of a wheel-barrow, choose one which takes the load well forward over the wheel; then, when you load it, make sure to place the load over the wheel so that the lifting effort needed is small. Be sure to lift the barrow correctly: stand between the shafts, bending at the hips and knees to reach the handles, then straighten at the hips and knees, lean forward with your body weight – and move off. It is better to make two journeys with small loads than to struggle with one.
*97\111\2*
WHAT AN OPERATION CAN DO: SPINAL FUSION
This operation is designed to stiffen a section of the spine, in order to prevent an instability such as spondylolisthesis from increasing; to fix a section where movement is painful, such as a degenerated disc giving an abnormal pattern of movement, secondary changes in the facet joints; to stabilise the spine in an area weakened during surgery necessary for the removal of diseased or damaged discs; or encourage healing if the spine is fractured or dislocated.
Most commonly, the operation consists of the laying down of a bone graft to increase the stability of the spine across one, two or three vertebrae. The bone for fusion is usually taken from the hip bone; this leaves no deformity or weakness. Often, metal rods or screws are also inserted to achieve a more rapid, secure fusion.
Spinal fusion is a much more serious operation than discectomy. Until a few years ago, it meant lying in a plaster shell for a month, and in bed for up to three months before being allowed up. Nowadays, however, this is less common. Some surgeons allow patients up after a week or two, provided there is nothing to contraindicate this; a corset may have to be worn. If the bones are fixed together with wires, rods or screws, the patient may be allowed up after seven to ten days, to still allow adequate healing of the ‘soft’ tissue surrounding the spinal column.
The back muscles may take quite a while to recover from the operation and to regain normal strength. The patient will later be given exercises by the physiotherapist to stabilise the spine and strengthen the muscles, and in a few months the patient could be back to full activity. Some patients take a year or more to recover completely. A lot depends on the pathology, the patients’s age and past history of the patient’s lifestyle: the physiotherapist and the occupational therapist will show the way but the patient is still the most important member of the ‘team’.
The social worker at the hospital may be necessary to provide home assistance for the convalescant patient.
*75\111\2*
UNDERSTANDING BACK TROUBLE: FURTHER TESTS-MAGNETIC RESONANCE IMAGING (MR OR MRI), ELECTROMYOGRAPHY (EMG) AND BLOOD TESTS
This is available at some hospitals for use in diagnosis. It is very helpful in diagnosing disc prolapse because it shows fluid/solid interfaces very clearly. It can demonstrate epidural fat, root sleeves, nerve roots and the vertebral canal, neural foramina and facet joints. It is particularly useful in identifying problems in the brain and spinal cord and may, eventually, become the preferred method of investigation for disc problems. It does not use X-rays but a powerful magnetic field to observe and measure ‘spins’ of atomic nuclei. It cannot be used if you have any metal artificial joints, plates etc, so you would have to tell the doctor or radiographer about them.
Electromyography (EMG)-This is done in some hospitals if damage to the nerve root is suspected. The functioning of the nerves which supply muscles is tested by using an apparatus for amplifying and recording the electrical activity produced in the muscles. A fine needle electrode is inserted into the muscles of the legs – sometimes those of the back also; this is usually not very painful, not more than an ordinary injection, and leaves no side-effects.
Blood tests-A blood sample may be taken, by means of a hypodermic syringe, from a vein in the arm, and sent to the pathologist for tests, in order to obtain more general medical information, particularly about the possibility of inflammatory joint disease, anaemia, and infections.
*54\111\2*
AGEING AND DEGENERATIVE CHANGE: OSTEOPHYTOSIS
This is not a degenerative condition in its own right but may be a secondary manifestation to a degenerative disease. Osteophytosis is part of the healing of a fracture. It is the formation of osteophytes, bony growths or spurs, on bone, or fibrous tissue attached to bone. They are deposits of calcium, the material of bone; in the spine they form all round the edges of the flat sides of the vertebral bodies, and on the facet joints.
Osteophytosis is in fact a feature of osteoarthrosis (also called osteoarthritis), a degenerative disease of the joints, causing a thickening of the bone. (It should not be confused with rheumatoid arthritis, which is a very different and more distressing complaint.)
Although on X-ray osteophytes can look formidably hooklike, they usually cause trouble only if they happen to grow out into the chinks through which the nerve roots pass, or into the spinal canal itself: if nerve tissue is compressed, this can be very painful. Such problems are most likely to arise in the lumbar region, where the cauda equina, with its bundle of nerves, emerges from the dural tube.
Osteophytes can cause back trouble in people who have by nature a very narrow spinal canal. Where the spinal canal is trefoil shaped (rather than roughly round) the growth of osteophytes further reduces the space through which the nerve roots pass, and the person is likely to suffer from back problems.
*31\111\2*