Snapshots: Viagra, Melanoma, and those Pre-Passover Blues

No, the two have nothing to do with one another.
Or they could, I suppose, if anyone thought Passover a sexy holiday, which would make for an interesting discussion that we will never have. 

Let's start with this.

(1) "Harmless" erectile dysfunction treatment associated with melanoma

No more Viagra for you son. And Laura Berman, a famous sex therapist who has at least one clinic to treat women with sexual intimacy problems, will have to put her prescriptions on hold, rewrite one of her books, too. The results of a new study indicate that penile enhancement medication, also used for female sexual arousal, is linked to one of our worst cancers ever, melanoma.

When I was young there was a song, Nature's Way. Spirit, sings the soulful, ominous warning.

It's nature's way of telling you dying trees,
It's nature's way of telling you soon we'll freeze.

We froze east of the Mason-Dixon line, and to the west, too, last winter. Or shvitzed.

Hearing the association between ED drugs and melanoma  I'm humming the song again, seemingly out of nowhere (that's how the brain works, people). We could look at our bodies, and our psychology, as one of nature's finest, most exquisite creations, capable of incredibly creative ideas, achievements. And we think nothing of messing with them.

A chunk of my patient demographic, people in their thirties and forties, barely middle age (forties are the new thirties, thirties the new twenties), impatient with therapy (or in denial) ask their primary care doctors for Viagra, Cialis, and Levitra, etc., penile enhancement drugs. Before this new study the docs couldn't say with certainty: The drugs are bad for you. Work on your relationships. As long as blood pressure and heart rate were relatively strong, they caved. So now they can say that. The drugs are bad.

Erectile dysfunction (ED) is nature's way of telling you something's wrong, probably with a relationship or an understanding of sexual relationships. Or the mechanics of sex. The most common cause of ED is anxiety, not only performance anxiety, but any kind of anxiety, and often, guilt. And anger.

Melanoma tells us something's wrong with the pharma treatment, too. The problem, if it is not vascular, is psychological or educational. ED drugs treat a symptom. They are a bad idea, the wrong way to treat the problem, if it even is one.

We can discuss the right way another time. I've got to get ready for next week's holiday.

(2) The Holiday Blues
Everyone knows that during the holidays, especially the first ones after the loss of a loved one, we're more vulnerable to depression. Just when we're supposed to be happy, a brick falls on our heads. There's no denying it. We remember faces sitting around the table, singing songs, smiling. These are good memories, and when we think about it, surely a blessing, a good opportunity to add to the positive memories, the legacy, of  people who made such a difference in our lives.

Of course, if I believed that, it would be a sign I'm not a therapist.

In fact, the stress of the holidays, the togetherness, brings on bad memories often, and the worst in people, especially if more alcohol is consumed than usual. The legacy memories, for many of us, aren't always good.

But for some of us they are.

Good or bad, the mental deluge, the stimulation of anniversaries, always has an effect. Great stuff to talk about at parties. (See video link below).

For me, being busy before a holiday also implies cooking and baking, happy busy which is productive, too. In this creative process, inordinate amounts of time are spent trying to remember the things my mother cooked and baked, reading over her recipes, tattered, but written in her beautiful cursive script, soon to be extinct, oil and batter stained (not her fault). I experiment like she did, write it all down. On a computer, obviously. Who has a index cards? I envy those of you who do.

Passover, one of the biggies when it comes to stress, is upon us. The office is closed for 8 days. You will see us at the zoo and the museums, sprung from the drudgery of everyday life.

But if you want to know what this holiday is really all about, you eat matzah. (These we buy at the store, hardly anyone makes them anymore, the rules of baking proper Passover matzah are too complicated.). No matter how ad agencies might make it sound, the stuff is nearly indigestible without lots of butter.

Matzah is the Passover food because it is difficult to digest, unleavened, no yeast allowed, the quintessential symbolic food of modesty. This is a low food, a symbol that reduces us to tears (let's not go that far) by the end of the week. The idea is to get the leaven out of our hearts, recognize it really isn't all about us, and that we're not the ones to thank for our successes, can quit patting ourselves on the back. After all, only a few thousand years ago we were slaves in Egypt, enslaved for a long time, over 400 years. We couldn't have got out on our own. Passover celebrates freedom from slavery and the Creator who made it happen in spectacular fashion. (The story is mind-blowing, as Cecil B. DeMille rightly tells it in  The Ten Commandments.

All that to link over to an irreverent video that made me smile. Sean Altman sent this pitch:

Therapydoc,
I follow your blog. Please enjoy my REAL story of Passover — JEWMONGOUS' new music video "They Tried To Kill Us (We Survived, Let's Eat)" http://youtu.be/TPAcf1RF2ps

Yours, Sean Altman

www.jewmongous.com

212-995-0273

JEWMONGOUS

Ex-Rockapella star Sean Altman's comedy song concert JEWMONGOUS is "tuneful and sharply witty" (Los Angeles Times), "relentlessly clever" (Chicago Tribune) and "bawdy with a wicked modern streak" (Washington Post), combining "the tunefulness of the Beatles and the spot-on wit of Tom Lehrer" (Boston Globe). Altman, who "writes hilarious and irreverent acoustic rock songs about his awakening Jewish awareness" (Jerusalem Post), is "part of a new breed of Jewish hipster comedy that includes Jon Stewart, Sacha Baron Cohen, Sarah Silverman and Heeb Magazine" (Philadelphia Daily News). He is a former, founding member of Rockapella and led that pioneering vocal group through its heyday years on the Emmy-winning PBS-TV series, Where In The World Is Carmen Sandiego?, for which Altman co-wrote the famous theme song.  His classic Passover song "They Tried To Kill Us (We Survived, Let's Eat)" has been featured on NPR's Fresh Air with Terry Gross. Altman has twice performed at the White House Chanukah party for the President, he has shared the stage with Billy Joel, Joey Ramone, Jay Leno, Whoopi Goldberg, Spike Lee, Jonathan Winters and They Might Be Giants, recorded with XTC and Richie Havens, and he performs vocal standards at the bedside of hospital patients as a volunteer with Musicians On Call.  Altman has performed JEWMONGOUS throughout the USA, Europe, Israel and once in China.  www.jewmongous.com

There you go. Not how it happens in most homes, but funny.

Oh, and the Passover Brownie recipe.

Pesach (Passover) Brownies, Gebrukst (for non-gebrukst add potato starch, not cake meal)

1 cup Mothers unsalted margarine melted (yes, the brand matters, use Mothers with proper Passover certification)

Melt into the margarine with 3/4 package chocolate chips

Let cool 5 -10 min

In the mixer beat 

2 eggs

1.5 cups sugar

Add margarine/chocolate

Add 1 pkgs ground walnuts (6 oz) and 1/4 cup cake meal* 

Bake in a 9 x 12 pan at 350 for 30 min. Test with a toothpick.

When they are dry, let them cool down then freeze for 30 min before cutting. Or just eat them.

Happy Holidays, friends.

therapydoc

*Cake meal is very finely ground matzah, a truly humbling baking substitute for the fine flour we use all year round. 

Reversing the Decay of London Undone

Oh, it's a maximalist post, I guess, not terribly accessible, and not for the feint of heart.  Reflects that 911 mood.

Everyone needs therapy is a self-serving bias, you know, for a family therapist. But I look around and wonder. Would it really help society, if everyone talked to a professional, at least once, say, preferably, before the age of nineteen?  Think of it as immunization.

Late adolescence might be the best time to do it.  Get some perspective, look back at life, think about who you want to be, where you've been, where you want to go. When children reach late adolescence, families grapple with their launching.  Some make differentiation, individuation, leaving home, difficult.  All kinds of psychiatric symptoms pop up then.  Read Jay Haley's classic family therapy tome, Leaving Home.

Nineteen is about the age I got some therapy (group therapy-- strongly recommended for the unsure) and it was powerful, all about the tragic loss of a brother, how that affected our family system. He was twenty, I was eighteen; it was an accidental death. We think.

Why mention it? The London riots, of course.  Young, reckless people in the streets, doing what feels good. I can’t help but wonder what my brother would have made of it. We would have shared memories of times gone by, were he alive today.

We wore black armbands in our day to protest a war. And thousands came to Chicago to change the world, rearrange the world (Crosby, Stills, and Nash), and to congregate in Grant Park as delegates congregated at the Hilton for the 1968 Democratic National Convention. Mayor Richard Daley, grasping at control, made his famous Shoot to Kill order to Chicago's Finest, the police.

The National Guard readied to fight off the long-hairs in the park.

A different time, but a riot nevertheless.

Those times marked the beginning, according to Britain's Chief Rabbi, Jonathan Sacks, of the end of morality.



But Reversing the Decay of London Undone isn't about the detritus of the recent riots.

Rabbi Sacks tends to be a deep thinker.

In a pile of papers on my desk, I still have his December 11, 2010 thoughts on the weekly Torah portion, Vayigash (that favorite about that family reunion in Egypt, the one with Joseph and his errant brothers).  I printed it out and saved it to blog about one day.

Writes the rabbi:

What do porcupines do in winter? asked Schopenhauer. If they come too close to one another, they injure each other. If they stay too far apart, they freeze. Life, for porcupines is a delicate balance between closeness and distance. It is hard to get it right and dangerous to get it wrong. And so it is for us.

That kind of stuff we talk about here! But the piece for the Wall Street Journal, the one about decay in London, is less philosophical, less about intimacy, more of what we would expect from a clergyman admonishing return to the fold. Not that it isn't relevant, but it isn't especially new. The disappearance of morality didn't happen overnight, point well taken, but clergy of all stripes have been preaching about returning to that hometown religion, for years.

Riots give us pause, cause to wonder, What's going on? The Chief Rabbi's answer is perhaps the best answer, no morals. But his solution, return to the fold, untenable.  Idealistic advice, works for some, but is unlikely to be heard by the masses, divine intervention excepted.  Chaval.  (Chaval rhymes with shah-doll, means a pity, a shame, Hebrew, hard "ch".)

Last night I downloaded a movie, Cedar Rapids. My brother-in-law thought we might find it enjoyable because it is about a sweet guy, an innocent man, an orphan who lost his parents as a child, and yet, he becomes a successful insurance agent, a positive force in the universe, cheerful and good. Our hero is chosen to attend a convention in the big city.  He has never been on an airplane before, never been to the airport. In the big town of Cedar Rapids, at the convention, immorality abounds, and he's all for it. He's in, as we say today. None of us in the room are surprised.

People party, especially on vacation, in Vegas, in cities all over the world, at conventions. The moral compass,  passed from generation to generation, points every which way, away from home. The rabbi's lament, that the compass is off kilter entirely due to the disconnect, especially a disconnect from religious community, is a logical corollary.  Call it  morality-dilute. Religion keeps us straight.  No religion, anarchy. Riots.

Wrong is right, and right is wrong, because nobody goes to shul* anymore. Religion is anachronistic, rules arbitrary, the enlightened too smart for dogma. Everyone has left the shtetel,** the parish, the church.  It is the disconnectedness, accordingly, responsible for social chaos. Return to religion, to moral identity, to save the world.

For a moment, Rabbi, with all respect, let me speak for the disconnected. Let me speak for the children who are losing virginity at fifteen years old, some say well over the majority of American youth, and a general populace that ingests a steady diet of seductive media. For at least one generation, unbounded sexuality is normal.  Sex is normal; it is like food, air.  And violence, too, is unconsciously accepted.  We have only to see what is on television any given moment, or peruse the popular video games.

But let's talk about sex, because the death of morality started with that sexual revolution, theoretically. Woodstock, Haight-Ashbury, some might wrongfully say, with feminism.  (See how difficult this is?).

A woman is sitting across from me. She is a beautiful specimen, one of creation's finest. When she comes to see me I think, Why is she seeing me? But this is my reaction to most everyone who sees me lately. They are all beautiful. They are all young. They are all confused.

I learn that she is in therapy because she is lonely. Someone has left her, someone she loved. Switch genders here as needed, he has left her for someone else. My patient blames herself, has no idea what went wrong, truly no clue. It all seemed so good. He was loving, attentive until the break-up, which was not conflictual. She thought he was the one, that the relationship would go the distance. But it didn't.

I have seen dozens of her and each time am taken aback at the naivete. It was so good, how could it be over?

People get bored, dear. Even when things are good, perhaps especially then.

She grieves the death of a relationship, grieves having been fooled. She uncovers lies, tells them over to me.  It wasn't as she thought, was never an exclusive, committed relationship.

She cannot use the word monogamous, for this word isn't in her lexicon or that of her peers, doesn't apply.  Monogamy implies marriage, and marriage only follows successful cohabitation in our brave new world.  Quite a feat, making it last, without a contract.  But some do, reinforcing this crap shoot, cohabitation, the gold standard of relationships. As good as it gets.

No one wants to be lonely.

I'll put it in a way that the clergymen might or might not, leave out the sin, the fire and brimstone bit. Maybe the clergy do discuss this dynamic, who lives with who and when, but in my particular shtetel they don't. So allow me.

From a psycho-therapeutic vantage, it is an emotional risk living together-- with marriage or without.  Even without cohabitation, sexual intimacy is a risk, for it is exposure of a very personal kind.  Yet it is expected, even before the other types of intimacy have been established, before the other relationship muscles get any exercise at all.

He'll leave (without sex) the women all tell me. The men complain, She demands it. (When a man is reluctant, he must be gay.)  Thus the market for Viagra in this sexual economy will never die. This is a stock worth your money, if you can stomach the profit. It feels wrong to me. We've talked about loving sex, how that works, sans Viagra. It's all about something called communication.  Listening.

What is the therapeutic response to a patient suffering relationship loss, seriously?  Go back to church? Go back to the synagogue, the mosque? Where is this place? It isn't around the corner.  My patients know no one who attends. They avoid needed 12-Step meetings for their many addictions because it is a drag, all that talk about a Higher Power. The Higher Power is we, apparently.

When I direct patients to socialize for connectedness (because we all need this, badly), I keep it vague.  Some seek out parochial resources, even online dating, but others can't connect to anything resembling control, and they see religion as just that, something that cramps their style, external control.

All we can do, when we do therapy, is work through the pain, reconstruct identity.  We coach new behaviors, empathize, and reassemble lives.  They pick up the pieces and try to do it differently next time. 

In good  therapy, when we talk about the breach of trust, deception, the psycho-educational piece is early detection.  That is only possible with emotional intimacy, words, discussion fairly early into the relationship about childhood, something people tiptoe around.  Deception detection is about discovery.  How did this person discover truth as a better strategy to stress, over lying?  Most of us make this discovery somewhere in our childhood.  It can be an  epiphany.  How did it work, lying, acting out?  Everyone has stolen something, if only trust.  How did it change her?  Discuss how you, how he, she, got away with things in life.  Most of us brag about things like this and it tells us a great deal about character.

The more social among us listen to the woes of our friends.  We suffer along with them when they are hurting.  We empathize and we bask in the glow when it is returned.  We talk about how sexual intimacy enhances human connectedness, the loss, therefore, commensurate.  We hold on to one another, and no, we don't have to be therapists or a pastoral counselors to be a part of social healing.

Empathy is, and maybe should be, the new religion. If the clergy teach anything from the pulpit, they should teach empathy. Perhaps it will trickle down, somehow, to the streets.

And those kids rioting in London?  Some really will go to jail, some will become lifelong criminals, others are just finding themselves and will turn around.  We'll see if they feel shame, if they have remorse, when the dust settles. 

The good news is that in jail, where freedom is lost, some look outside themselves.
They look up. Having lost all autonomy and control, they search for meaning.  Sometimes, they find God.

And others, therapy.

therapydoc

*shul--rhymes with pull, means synagogue
**shtetel-- rhymes with get-ill.  Every ethnic group, every religion, still has one of these core community within big cities

Law and Order Final Episode

I'm fine, how are you? (for the benefit of those who tuned into the past deleted post)

Seriously, when the weather gets good in Chicago, it just doesn't get any better anywhere. Yeah, so the allergies kill you, but a person's muscles need the heat, and it's finally, finally, hot.

What's on TV?

This morning I'm up a little late and a little groggy and shuffle off to the family room. Like many couples who believe that television in the bedroom can be bad for a relationship, we make it work to have to watch TV, and I have to negotiate stairs to find one. FD has brewed the coffee. He's nowhere to be found.

The remote is mine.

Nothing like morning news teams.

Here's the good news. ABC is having a contest to name the new Shedd Aquarioum's beluga whale. Despite rumors that these creatures can and will eat their trainers (or is that another type of whale, help me here) the Shedd tells it like it is:

A beluga’s mouth is permanently upturned like a smile. It’s easy to connect with these sociable whales as they glide by in their Oceanarium pool: They might turn a curious gaze your way, crinkle their melons (foreheads) and whistle—or even spit a stream of water!

You can enter the contest at ABC if you have a good name for this happy little guy.

A good name is everything, really, which is why I'm still boggled at all the promiscuity, everywhere, seriously, sex, sex, sex. It's only Tuesday, but a quick sample of the kinds of things a person like me hears, rounding the weekend:

(1) men need Viagra, perceive that women need them that way,

(nobody wants to work at anything anymore)

(2) fourteen year old kids need birth control,

(3) and the usual beef: I'm just not interested in sex, doctor, which is the only one that makes any sense for people of a certain age.

Not to minimize, these are the concerns of the day, not depression, not anxiety. Mostly sex, which is fine, important, and very, very good for one's mental health. Or bad, depending upon the context. That who, what, when, where and why, thing.

On the 6 am WGN news, it's Sex in the City every day for a week, fashion shows and interviews with starlets. I have got to rent I, because now the girls are going, it looks like, to Italy.

Missed the interview, had to turn away, blog about Law and Order.

But first:

Last night was crunch time to book a fare to Atlanta. So nervous, had to enter credit card information five times (wish that were an exaggeration). All day, beat myself up for having waited too long. Chicago to Atlanta round trip should be, at worst, $189, and flights were running $217 each way because I neglected to book. FD promised me prices would come down, and as usual, he was right. My son texted me and the tickets are scored, so yours truly is no longer staring at the screen, dejected.

FD breezes through the front door and shouts, "Law and Order! Final episode!"

"I never recorded Law and Order," I tell him, pretty sure he doesn't know how to use the DVD-R.

"I did," he brags.

"You're my hero!"

So we shut the browser, don't look back, and settle into the final episode. Law and Order, in case you've been truly withdrawn or in solitary, is

the longest-running crime series and the second-longest-running drama series in the history of television, now in its 20th season on NBC.

And wouldn't you know (serious spoilers coming up, stop reading now) the final show is about a blogger! Unfortunately, he makes bombs. But he's discovered, lost his cover, because he blogs and has told everyone his problems, vented on the Internet. It's going to be epic, he tells us, his exit from the world.

He has also put up pictures of naked girls on his blog, his undoing. Somebody doesn't like this, that a picture of his unclad teenage daughter is floating around cyberspace, and has reported it to the police.

No pics of the bombs and guns on this blog, sorry, or the naked teenager. Cruise around, I'm sure you can find both someplace else, if you're that interested, and apparently many people are.

Anyway, we learn that the bomber is a disgruntled teacher, not a gruntled student. This NYC teacher suffered unfair disciplinary measures. To stay salaried while the case against him is under investigation, Moot, the bomber, must spend 8 hours a day in "the rubber room." Sort of like detention for teachers, but they do crossword puzzles while on the dole.

The injustice of this, confinement to the rubber room, ostensibly for minor indiscretions like ruffling a kid's hair, or advising a kid, If you don't study, you will be not rise above stupid, makes a professional angry. But most don't leave the rubber room after a hard day of puzzles to make bombs to blow up their school.

The mental health issue isn't explored, unfortunately, there's no time to really assess why anyone would do this. We assume, stress. But for all we know, I've bastardized the entire story altogether for having grabbed chips from the pantry, missing some of the plot.

I imagine that this is vengeance, and our bomber, Moot, has a severe case of one of the disorders in the DSM IV-TR, probably one that will be stricken from the DSM V, coming to us in only a few more years. You'll get a review soon. I'm in favor, is all I can say.

The issue of privacy is ascendant, that I get, in this last episode. Executive Assistant D. A. Michael Cutter has assembled a grand jury and is asking a crowded roomful of parents for permission to detain 2800 students, to interview them and scan their laptops for clues. Uh, uh, says the grand jury. In fact, we'd like you to ditch the entire inquiry altogether!

That's not gonna' happen, not with a madman out there. Finally, finally, Sam Waterson - District Attorney Jack McCoy, convinces a teacher to rat out the bomber. He is simply the best, Sam Waterson. Nobody will ever replace him in this type of role. Nobody. All of us want our sons to grow up to be just like Sam.

Meanwhile, we learn whether or not Lieutenant Anita Van Buren (S. Epatha Merkerson) either has a recurrence of her cancer, or is in remission. The docs are going to call her any minute to let us know.

And if you think I'm going to tell you, forget it. That would ruin everything. I'm not sure why this photo has a red border.

Modern Family? Everyone, everyone, everyone, tells me they know a couple like Mitch and Cam. This can't be. There is such a thing as hyperbole.


But they are the funniest, the most lovable couple on television, and Manny, Rico Rodriguez, just slays me (lower left).



We have to cover 30 Rock, a frown in your pocket, and we'll be finished.

therapydoc

Mr P and Vitamin V

I wanted to move on, to talk about failure, but then I get this comment on the last post. It's about failure, but not exactly the failure I had in mind, and not being a failure, but fearing failure. You're not exactly a representative sample, not if you read me, but still. What do you think?

The comment is in response to my hard stand about taking Viagra for anxiety that's situational: a young woman expects a good sexual performance very early into a relationship, maybe even the first date. And a young man wants to rise to the occasion. PRESSURE.

Mr.P and Vitamin V said...

Doc,

1st of all, I'm a huge fan!!!

Let me represent Mr. P and Vitamin V for a moment..

I can tell you that very often by the 3rd date, if the man hasn't made some sort of sexual "move", the woman gets insecure and feels that something is wrong with her..And trust me, talking about how wonderful she is and saying that I like to take things a little slower does not work at all..

She wants something to happen!! Granted, I'm not complaining about that, but if something is going to happen, I like to insure that it actually happens..Without Viagra early in the dating process, my anxieties often take control and make things not work properly..

And oh my goodness, if it doesn't work, she either feels that she's not attractive OR she thinks something is wrong with me...It's not necessarily about her achieving an orgasm, it's more about showing her that I like her and I'm attracted to her. It doesn't have to be spectacular the 1st, 2nd or 3rd time, etc..It just has to happen...As things progress and I feel more comfortable, I don't need the V..

And your description of the healthy relationship is what I would love to achieve..I guess what I'm trying to say is that early in a relationship, words don't seem to have as much of an impact..They're not believed as much as they should be...Later on, words mean more..And one more thing, Doc!! I don't see 2 women for every man out there.

February 11, 2010 10:59 AM

Coming Home

Law and Order, Special Victims, if you haven't seen it, is a weekly television drama about people who commit murders and sex crimes. When it's about incest, there's usually a big twist at the end.

Rape is featured in many of the episodes, sometimes stranger rape, sometimes acquaintance rape. Incest happens to be a type of acquaintance rape.

A blogger (Isle Dance) wrote and asked me to write about a situation that involves children and young adults who have sex with the friends of their parents, swingers. Some might call this a gray area for sex crimes since the "adult" in "young adult" technically implies informed consent.

Swinging, when it is with children, or perhaps even with young adults, can pose the threat of psychological problems we associate with sexual boundary violations.

When I read the email I wrote back:

"Sure, sure, remind me to write about this. Shoot me another email in March. Remind me if you don't see something on Everyone Needs Therapy by March."

But I was thinking,

Not now. Too depressing. Must we go here? It's so gray outside, the days are so gloomy and cold. Who needs more depressing posts?

I'm telling myself,

Go with something happy, TherapyDoc, something funny. Tell them you cried watching Mama Mia, because it made you miss your daughter, that the tissues are still on the sofa, whereas most people couldn't get past the first scene and nobody, nobody you know admits to having cried along with Merrill Streep.

And besides, if you take this one on, TherapyDoc, this topic, it's likely you'll end up ranting and moralizing, and there is enough of this on the web. The voice is boring. It is your job to educate, not to lecture, and you'll get so much spam, especially if you use the word, swingers.

But anyway.

I won't wimp out entirely, although this isn't exactly what my blogging pal requested. We'll poke about a bit in this not-so-murky territory.

When incest (the ultimate sexual boundary violation) came to our attention in the mid-twentieth century,* authors of textbooks dubbed it pathognomic, something associated with very serious mental and behavioral psychopathology, the winner, hands down, of the gold, the silver, and brass Olympic medals for both the victim and the perpetrator.

The experts said: Keep them in therapy forever.

That we kept them in therapy for years speaks to the sensitivity we had about sex back then. Sex without boundaries or permission was considered a really bad thing, morally wrong, bad for people, pathogenic. It caused disorder. And that thinking generalized to other sex crimes, as well.

Then and now, mental health professionals think that boundary violations can hurt kids and adults, too, sometimes irreparably, to the degree that the human psyche does not always forget.

We may always grieve an unprotected invasion of personal space. It may affect the way we see ourselves, the world, and everyone in it. Every sexual crime is an invasion of personal head space, too, not just a body memory.

But we're a lot better at treating it now, thanks to war.

It so happens that even acquaintance rape, certainly stranger rape, can mess with your brain in the same way that combat messes with a soldier's brain. The diagnoses and treatment protocols can be the same, too.

Post-traumatic Stress Disorder (PTSD) is the primary disorder associated with sexual crimes like rape and molestation, even secondary trauma, the witnessing of events that are ego-dystonic, that make us extremely uncomfortable.

But if it weren't for war, the psychological treatment of sex crimes against women and men, might still be enigmatic.

We know what we're doing now when we treat rape because governmental agencies (hospitals) have had to find ways to treat the flashbacks and nightmares suffered by war veterans. Thus the funding for research, and an explosion of knowledge about PTSD as it manifests in the twentieth century.

The better treatment interventions, cognitive behavioral therapy, relationship therapies, are working. We don't need to keep people in therapy forever anymore, although surely, for many, long-term therapy is a great idea. It is a lifeline purchased on the cheap at your local community mental health center.

It is fascinating that rape victims and combat veterans share the same syndrome, but makes sense. Life is a battle field. Nobody's in Kansas anymore.

The real difference between then and now is that now we hear so much more about sex in general from the media. We hear about normal sex and about criminal sex, and your bread and butter sexual boundary violations, some perpetrated by teachers and clergy. We hear about it in newspapers and magazines, and we catch it on cable, let's talk, although it's obvious you can absorb quite a bit of chatter, see every sort of video on the Web.
Your average media gulping adult or child, sees a pervasive treatment of sex, one that acknowledges sex as a normal, healthy part of loving relationships, and as a dangerous, sometimes perverted element to crime. Sex is in our face any way we shake it.

As they say in the marketing business,

It sells.

Always did. But because it is so pervasive, because we're inundated with it, it is only an issue, a problem, if: (a) you can't find it; (b) you need to learn how to do it; (c) your partner is too tired or not interested; (d) you or your parents feel it might be sinful,

(e) Or you, as a mature adult, think your sexuality needs enhancement, which can be purchased in pill form, a pill that will sustain an erection long past any need or desire, as advertized on television. Thank heavens we don't have to see that on those commercials.

And sex is a problem if (f) someone takes you by force, obviously, or

(g) someone takes advantage of someone else's age or gullibility.

Only this one can be an iffy call, a question of informed consent. It's iffy because kids have consumed the notion that sexual behavior is so much a normal part of life that they never need to ask or question whether it is appropriate. It's always okay, sex.** Didn't you know?

Uh, oh. This is a rant.

It is so normal that nobody pays much attention to what we might call iffy relations.

An under-aged person, a child of fifteen, perhaps, has sex with an older person, technically statutory rape, but our fifteen-year old wanted it. Shouldn't that be okay?

Or maybe it is a young adult, a person almost of age, who gets very stoned and doesn't object, seemingly wants it, then wakes up and thinks, "Uh, oh. What the hell did I do?"

Or does object, but the objection is over-ruled.

No means No in any State of the United. When a person of any age, in any relationship, says no and is overcome by someone who thinks that no is really yes, it's rape. Believe it or not.

But what about when you're of age and you say yes and you're high? Is it rape then?

Well, yes, if you weren't in a state of mind to give informed consent and wouldn't have said yes, were it not for the Ecstacy or whatever designer drug it was that you or someone else added to your evening.

Do you see how iffy things can get?

Which leads us to Winter Break, which is almost over. Winter break, summer break, spring break, these are peak therapy times. Kids come home and they don't look so good.

And it is often about trauma. We can thank federal initiatives. College coeds now know the definition of all kinds of rape because of federal funding. Educators, some of whom are peer counselors, some teachers, some social workers or rape victim advocates, are running workshops on campus.

And sometimes this education triggers memories of experiences past.

Research (I've read, mountains of it) suggests that if you were violated as a younger person, that you will be violated again as an older person. Something about self-esteem and unresolved issues.

So people like me see young people, mostly college students, during winter break, kids who are remembering the iffy times, those one-night stands, the stoned sex they thought they wanted at the time. Some have new content to add to old.

It's a therapy for post-traumatic stress.

You know, I could easily have waited to post this one, but winter break is almost over. If you think you need it, get some therapy on campus if you're heading back to school.

And if you want a few more stories on the subject, read my post on innocence lost at TheSecondRoad.

Or check out Mama Mia. There is a subplot about the unintended, if not traumatic, consequences of unbounded sexuality, normal sex as we're defining it in the twenty-first century.

I'm telling you. The movie's not that bad!

therapydoc

*When I say "our" attention, I mean that generation of mental health professionals.

**Yes, I am being sarcastic, or would you prefer, facetious.