Archive for March, 2010
Are You Afraid to Plan for Your Own Death? (From Alternet)
This post from “Alternet” is not an easy read, but an important one. In the words of Loretta Lynn, ‘Evenyone wants to get to heaven, but nobody wants to die.”
By Frankie Colmane, March 25, 2010
As a society we have distanced ourselves from the dying process,” says Dr. Ronald K. Barrett, professor of psychology at Loyola Marymount University in Los Angeles. “We now have hospices and institutions where people go to die.
In former times the dying process was an integral part of the life experience of the community; people were born and died at home. To the extent that we have relocated those experiences to death care professionals, the experience of death itself has become alien, and it has complicated our ability as humans to do what we have so naturally done since time immemorial, and that is to grieve.”
To read the entire post, click here.
A related post from “AARP Bulletin called “The High Cost of Dying” by John S. DeMott, October 1, 2009, can be found by clicking here.
New Report on Improving the Lives of LGBT Older Adults
I am still troubled by a report I received of a transgendered person in his 70’s with Alzheimer’s Disease whose social worker had so far been unable to find placement for him within 100 miles of his home town in one of the mid-Western states.
Doug Young Photo
Although his case may represent something of an extreme situation, the fact is that only about 20% of LGBT seniors are as likely as their heterosexual peers to access such needed services as senior centers, housing assistance, meal programs, food stamps and other entitlements.
Although it seems that coming out is almost routine these days, for those who grew up in the pre-Stonewall era, most of those gay seniors had been accustomed to hiding their sexual identity, their relationships and the depth of their emotional partnerships with someone of the same sex.
A ground-breaking report called “Improving the Lives of LGBT Older Adults” was released by Services & Advocacy for Gay, Lesbian, Bisexual and Transgender Adults (SAGE) and the Movement Advancement Project (MAP) at the “Aging in America Conference” in Chicago on March 17, 2010.
The report is the first major collaboration between lesbian, gay, bisexual and transgender (LGBT) advocacy organizations and mainstream aging organizations to comprehensively examine the issues facing LGBT older adults., including the American Society on Aging, the National Senior Citizens Law Center, and the Center for American Progress, with a foreword from the AARP.
For many LGBT seniors, prejudice disrupted their lives, their connections with their families of origin, they are less like to have children of their own, and their opportunities to earn a living and save for retirement have been compromised.
Until 1973, they were considered mentally ill, and the last laws related to sodomy were not changed until 2003. Many religions continue to consider them anti-family and immoral. All of this has taken it’s toll in terms of stress, and having survived that terrible prejudice and discrimination, many still remain deeply closeted.
We are familiar with the typical problems associated with aging for all men and women such as the frustrations of coping with an aging body, prolonged frailty and loss of independence, and maintaining a valued place in society. Aging is also associated with significant losses: leaving a valued career, families leaving home, and chronic illness.
Loneliness becomes an increasing challenge because bereavement from loss of family and friends is followed by difficulty in establishing new social networks. Medical care is compromised when seniors are not accompanied to their medical visits by someone who care for and about them.
In addition to the challenges faced by all aging seniors, LGBT face some additional challenges. First, as a part of a legally and socially disfavored minority they have faced past and present social stigma. Many have become estranged from their families and have become reliant on families of choice that tend to be single generation rather than intergenerational.
The traditional heterosexual hierarchy called upon for assistance is spouse and children, parents and siblings, in-laws and spouses family. In a traditional setting friends are usually the last to be called upon, but LBGT rely far more heavily on these non-traditional, often legally and socially unrecognized caregivers.
Second, LGBT seniors face inequitable laws and social programming which fails to address barriers to social acceptance, financial security and better health and well being.
How people experience their declining years is influenced by their prior life experiences such as education, occupational experiences and social class. The “life course perspective on aging” assumes that the late stages of life are a reflection of all the stages that came before it. Earlier life events can have long-lasting effects.
It is difficult to age well without a social support system and families often act as a protective buffer, but when a LGBT person has become estranged from their family, there is no buffer, and those who are socially isolated have higher rates of morbidity and mortality, depression and cognitive decline.
Those who are isolated may have as many as 65% more depressive symptoms. There is also good evidence that shows that when a person does not have a companion to accompany them to their medical visits, the quality of the care they receive is diminished.
Although people with no family may have families of choice that look after them, the care is less complete, and often those families are not recognized as legitimate by civil and social institutions and the laws.
Hopefully this study will lead to increasing focus on the challenges facing LGBT seniors. To read the report, follow this link.
Houses passes historic health care bill 219-212
After a year of political upheaval that swung from a triumphant Democratic sweep in Washington to the rise of the Tea Party movement, Congress on Sunday night sent to President Obama the most sweeping social program since Medicare was enacted in 1965.
House Speaker Nancy Pelosi, holding the gavel used to pass the Medicare overhaul, walks to the Capitol with Democratic Reps. (from left) Steny Hoyer of Maryland, John Lewis of Georgia and John Larson of Connecticut.
The vote on the health care overhaul was 219-212, with not a single Republican supporting the measure.
Protesters demonstrate against the health care overhaul outside the Capitol.
March 22, 2010, 04:00 PDT Washington D. C.
Before the final debate, House Speaker Nancy Pelosi of San Francisco locked arms with her Democratic lieutenants, including civil rights veteran John Lewis, D-Ga., to enter the Capitol through a phalanx of angry protesters. It was an emphatic show of solidarity after several ugly incidents on Saturday when demonstrators hurled racial slurs at several African American members of Congress and anti-gay insults at Rep. Barney Frank, the gay Massachusetts Democrat.
“We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans,” Pelosi told House members as she brought the debate to a close at 10:30 p.m. She invoked the memory of the late Sen. Edward Kennedy, whose death so complicated passage of reform, saying health care “is the unfinished business of our society, that is, until today.”
The health deal was sealed by early afternoon Sunday when anti-abortion Rep. Bart Stupak, D-Mich., secured an executive order by the White House that would reaffirm the long-standing Hyde Amendment banning taxpayer funding of abortions.
To read the rest of the article, click here.
Here’s a look at some of the provisions in the $1.2 trillion dollar bill: CBSNews.com Special Report: Health Care
Creates a public health insurance option and a national exchange for the uninsured and small businesses to purchase health insurance. The Secretary of Health and Human Services would negotiate rates with doctors and hospitals on reimbursement rates.
The bill includes mandates for individuals to purchase and businesses to provide health insurance or pay a fine. Individual penalty is 2.5 percent of gross income unless they get a waiver. Businesses that don’t offer insurance pay a fine equal to 8 percent of their payroll. Businesses with a payroll of less than $500,000 are exempt from the mandate.
Insurance companies are prohibited from denying coverage based on a pre-existing condition. There are caps on deductibles and annual out of pocket spending is capped at $5000.
Eliminates the Medicare doughnut hole over ten years.
Allows individuals up to 27-years-old to stay on their parent’s health insurance
Expands Medicaid from 100 percent to 150 percent of the Federal Poverty Level.
Provides tax subsidies for individuals between 150 and 400 percent (sliding scale) of the Federal Poverty Level. There are also tax subsidies for small businesses.
As amended, it prohibits federal funds from covering abortions. Women would need to purchase riders to insurance purchased on the exchange if they wanted that coverage.
The bill taxes individuals making more than $500,000 and $1 million for couples. It is a 5.4 percent tax.
Reduces overpayments to doctors who treat Medicare Advantage patients. It is estimated they are paid 14 percent more than doctors who treat Medicare patients.
From the Huffington Post:
Ever talk to a teabagger? I did– lots of them. They’re overwhelmingly racists and overwhelmingly angry and overwhelmingly… brainwashed. Few teabaggers seem capable of critical thought– just the way conservatives want the people to be. As we mentioned this morning, over-fed, angry white teabaggers in DC yesterday were running wild, threatening gun violence, and yelling racial and homophobic epithets at Members of Congress they don’t agree with on healthcare reform.
To read the rest, click here.
Spain’s Progressive Attitudes about Homosexuality Date Back to 1822
I received this from Andoni Barreragoitia from Spain concerning the situation regarding homosexuality in Spain.
Spain is very tolerant of homosexuality reflected in the fact that homosexuality was legalized as long ago as 1822.
In the last decade Spain has passed very progressive legislation protecting the rights of gays and lesbians and allowing same sex marriage, the third country in the world to do so. There is also very vibrant and thriving gay scene not only in many of the larger cities like Madrid, Barcelona, Bilbao, Valencia and Seville but also in the resorts including Sitges, Torremolinos, Las Palmas, Mallorka, Alicante, Murcia, Malaga, Benidorm, Canary Islands, Cadiz, and Ibiza.
Spain is the ideal destination in the World for gays and lesbians seeking sex, sand and sun — and much more.
Same-sex marriage in Spain was legalized in 2005. In 2004, the nation’s newly elected Socialist government, led by President José Luis Rodríguez Zapatero, began a campaign for its legalization, which would include the right of adoption by same-sex couples.
After much debate, a law permitting same-sex marriage was passed by the Cortes Generales (Spain’s bicameral parliament, composed of the Senate and the Congress of Deputies), June 30, 2005, and published on July 2, 2005. Same-sex marriage became legal in Spain on Sunday, July 3,2005, making it the third country in the world to do so, after the Netherlands and Belgium and 17 days ahead of Canada.
In an opinion poll on the issue carried out by the government-run Center for Sociological Investigations last June, 86 percent of Spaniards favored legalizing gay marriage, while 20 percent opposed.
The ratification of this law has not been devoid of conflict, despite support from 86% of the population. Roman Catholic authorities in particular were adamantly opposed to it, criticising what they regarded as the weakening of the meaning of marriage. Other associations expressed concern over the possibility of gay people adopting children.
Approximately 10,500 same-sex couples married in Spain during the first year of the law. On August 4, 2008, the conservative newspaper La Razón published data from 673 out of 930 Offices of Civil Registry showing 24 same-sex marriages had occurred to date out of over 35,000 marriages.
Shortly after the law was passed, questions arose about the legal status of marriage to non-Spaniards whose country did not permit same-sex marriage. A ruling from the Justice Ministry stated that the country’s same-sex marriage law allows a Spanish citizen to marry a non-Spaniard regardless of whether that person’s homeland recognizes the partnership. At least one partner must be a Spanish citizen to marry, although two non-Spaniards may marry if they both have legal residence in Spain.
The first same-sex wedding took place eight days after the approval of the law, on July 11,2005. It was celebrated in the council chamber in the Madrid suburb of Trës Cants by Karlos Batxurn and Emilio Menethellal. The first same-sex marriage between women took place in Madrid eleven days later, July 14, 2005.
The church was unable to gather enough support to derail the bill, even though 95% of Spaniards identify as Roman Catholic. Sociologists believe this may be due to the significant increase of liberalism in the realm of individual rights in recent years, where the Church traditionally had most influence, especially on family issues.
A poll showed that three quarters of Spaniards believe the church hierarchy is out of touch with social reality. A complementary explanation might be that the Church’s influence on Spaniards has declined since the death in 1975 of the dictator General Francisco Franco, whose regime was closely linked to the Church. Opinion polls suggest that nearly 20 percent of Spaniards now almost never go to mass.
Adoption by same-sex couples was already legal in Navarre, Asturias, Aragon, The Basque Country, and Catalonia before the same-sex marriage law legalized these adoptions nationwide.These associations also argued that there was no scientific basis for the claim that the parents’ sexual orientation would cause developmental problems for their adopted children. This view is officially supported by the Spanish School of Psychology, which also states that homosexuality is not a pathology.
Today, Spain is one of the five countries around the world that allows same-sex marriage and has the most progressive laws, since they also permit adoption by same-sex couples. Spanish LGBT culture has been exported internationally with film directors such as Pedro Almodóvar and events like the Europride celebrated in Madrid in 2007.
Visibility of homosexuals has reached several layers of society that were previously unthinkable, such as the Army, Guardia Civil, Managers, Businessmen, Judges, Priests, and Lawyers, although in others like football (soccer) there is still a ways to go.
The 97th Prime Minister of Spain is Jose Luis Rodriguez Zapatero. President Zapatero responded to Catholic criticism by saying:
There is no damage to marriage or to the family in allowing two people of the same sex to get married. Rather, these citizens now have the ability to organize their lives according to marital and familial norms and demands. There is no threat to the institution of marriage, but precisely the opposite: this law recognizes and values marriage.**
Aware that some people and institutions profoundly disagree with this legal change, I wish to say that like other reforms to the marriage code that preceded this one, this law will not generate bad results, that its only consequence will be to avoid senseless suffering of human beings:
* A society that avoids senseless suffering of its citizens is a better society.
* In any case, I wish to express my deep respect to those people and institutions, and I also want to ask for the same respect for all of those who approve of this law.
To the homosexuals that have personally tolerated the abuse and insults for many years, I ask that you add to the courage you have demonstrated in your struggle for civil rights, an example of generosity and joy with respect to all the beliefs.
=================================
According to the World Bank, Spain’s economy is the eighth largest worldwide and the fifth largest in Europe. As of 2007, the absolute GDP was valued at $1.849 trillion according to the CIA Factbook. The per capita PPP is estimated at $47,400 (2007), behind the major industrialized nations of the G7 and before Canada.
Spain has a very ancient and complex prehistory. Under the Roman empire Hispania flourished and became one of the empire’s most important regions.
During the early middle ages it came under Germanic rule. Later, nearly the entire peninsula came under Muslim rulers. Through a long process Christian kingdoms in the north gradually rolled back Muslim rule, which was finally extinguished in 1492. That year Columbus reached the Americas, the beginnings of the first global empire.
Spain became the strongest kingdom in Europe in the sixteenth and first half of the seventeenth centuries but continued wars and other problems eventually led to a diminished status. In the middle decades of the twentieth century it came under a dictatorship, under which it went through many years of stagnation and then a spectacular economic revival.
In 1986 it joined the European Union and has experienced an economic and cultural renaissance.
You can contact Andoni Barreragoitia on Facebook
Aging groups endorse report on needs of gay seniors
From “Chicago Breaking News Center,” March 16, 2010
A national report being released Wednesday details the myriad social and financial stumbling blocks that lesbian, gay, bisexual and transgender senior citizens face and calls on lawmakers to make changes to Social Security and Medicaid to assist this growing population.
Giving heft to the report – prepared by Services & Advocacy for Gay, Lesbian, Bisexual and Transgender Elders, or SAGE – is the endorsement it has received from major mainstream aging groups including AARP and the American Society on Aging.
“This is the first time that the heavyweights of the aging network are really embracing a comprehensive look at the needs of LGBT older adults,” said Michael Adams, executive director for SAGE. “We know there are anywhere from 2 to 3 million LGBT seniors in this country. We’re talking about a very significant portion of the older population in this country.”
The report, to be released in Chicago at a national meeting on aging, highlights three key areas where LGBT seniors face challenges: financial security, health care and social supports.
To read the rest of this, click here.
Coming Out after 35 Years of Marriage
I received this note from a man who has been reading my blog and since it is so representative of what many of you are experiencing, I asked him if I could share it with you. He very graciously agreed.
Here is a little about the writer: I have worked in the area of theraputic education for almost forty years. Married with grown children, I lately have begun to come to terms with my homosexual drive in a direct way. Currently processing many years of repression and denial, I am at this time re collecting the lost parts of himself – amazingly, I still have a sense of humor!
Painting by Lucian Freud
I’m sixty, and a little slow getting the message (that I am attracted to men). My wife and I currently are re-aligning our relationship.
My daughter, twentish, found an open chat with a guy when she was here visiting in January. Three weeks later she called me to say what she had found. I took the opportunity to clear up with my wife of 35 years, quite a bit of what my life has been like.
I remember being attracted to guys when i was 12, and desperately hoping that it was not a reality. A friend showed me how to masturbate when visiting when I was 13. We looked forward to our annual visits, and our annual masturbation together, until we were 19. We are still in contact but never mention our times together.
In college I had a roomate my sophmore year. We masturbated several times a week and he would give me head. I loved those times and despised myself for loving them. I always swore I wouldn’t do it again , but it usually lasted about 48 hours.
We parted ways at the end of the year, and have seldom been in contact since. Recently I found out that we each still think of those times and want them again.
I moved to San Francisco after college. You would think that would have been a clue, right?
I experimented, fell in love with a guy who was also despising himself for loving sex with a guy, and he married and left. I went out with an older gay man a couple of times, enough to realize that I actually enjoyed giving a guy head.
I decided to be straight though, and get married, have kids and settle down. When I found the woman I wanted, I told her everything about me. Her response was to propose!
We did settle down, develop careers, had kids and all that. Somewhere about ten years ago I tuned into the fact that I was having more and more homosexual fantasies and less and less urge to have sex with my pre-menopausal wife. We were close from the bonds of our joint efforts and the trials and tribulations of raising kids, caring for elderly parents, careers, home, and more.
But the dominant sexual force was clearly leading me to men. I found a gay site surfing around on the internet, and met Bill, who was amazing in his care and concern. I told my wife that i wanted to have sex with men. She freaked so I said i wouldn’t. Lying was the kindest most expedient thing i could think of — for a few years.
When I got busted by my daughter two months ago, I realized that i could broaden the lie, or I could drop the pretense and acknowledge the reality. So, it’s been painful, tedious, tense, depressing, scarey-as-hell, and humiliating. It is also liberating, awakening, loving and perception altering.
Just sitting and telling my wife the truth , to stop the lying, has been like a lead plate going off my back
I no longer cringe at the thought of getting caught online.
I dont cringe at much of anything just now. I’ve said what I need to say: that I love having sex with men and I want to continue without the guilt and shame.
I’m just starting to see how deep the repression has gone – to hide this fact from myself, to pretend, to always live with the idea of being outed or caught, and I love that. I don’t urge anyone to do it who is married because it is tough to say the least.
But the destruction of my soul is not worth the continued sham. I don’t really know where all this is going. I don’t know what the next steps are really. I do know that as I share this growth with some of my friends and family, I feel lighter and lighter, clearer and clearer, about who I am and who I am not.
I have less need to rely on deception and lies and more ability to utilize honesty and truth. I feel like I am having to go back and reclaim that 12 year old, face him and tell him he is OK and right. He doesn’t need to hide, his power lies in his truth, heart to cock. I’m nuturing him.
As for the marriage, it is a work in progress; I can not say where it will go, but we are clear that we are family. We had love bringing us together and we will have love in whatever form is appropriate to us each in building our future. Many tears some laughter and much rage — on both our parts — probably more to come, but we are doing this with dignity heading toward integrity –
I would love to hear from men of any age who can relate to this journey in some way. I think it helps me and the others as we get back to origins and throw off the shackles of our own minds.
Peace to you all.
Doug
If anyone wishes to contact Doug, fill out a contact form and I will forward your message to him.
Men Who Come Out Later in Life Have a Different Experience
This story appeared in the Des Moines Register, March 16, 2010
Dr. Loren Olson nervously clutches a lectern at Des Moines University. It’s lunchtime at the osteopathic medicine school, and students filter into the lecture hall to listen to Olson talk about a book he’s writing. The 66-year-old could almost be a grandfather to these students: sweater vest and thinning white hair, ample belly and friendly laugh.
The book’s title is scrawled behind him: “Finally Out: Unlocking the Closet in Mid-life and Beyond.” It’s filled with psychiatric research on mature gay men who come out later in life, a subject Olson – a semi-retired psychiatrist who lives on a farm near St. Charles – knows plenty about.
The members of this group are increasingly visible, but their situation is vastly different than that of younger gays. Gay seniors, after all, didn’t grow up in a society at all accepting of homosexuality, and some who have been out for decades are now encountering discrimination when they move into nursing homes.
But first, Olson, true to his psychotherapy background, wants to tell a story from his childhood:
Olson was a 10-year-old in small-town Nebraska. His father had died years before. One day, Olson was about to mow the lawn. He tried to get his gas-powered mower running. It wouldn’t. He called his mother at the factory, where she worked as an office manager, and told her he couldn’t start the mower.
“Of course you can,” his mother replied. “You’re a man, aren’t you?”
To read the rest of the story, click here.
Gay Uganda — another Perspective
I just had a very interesting conversation with a young, gay Ugandan. He told me that the media portrayal of what is happening in Uganda is much different than the way some who live there perceive it. He said, “We’re rocking and partying,” and he is living openly as a gay man.
He does not believe the anti-homosexuality law will be passed, and said the law “will be thrown to the dogs.”
What he told me initially shocked me, but then, it is more of the same. He said that many of the top evangelicals, who go to Africa, have African boyfriends there. According to him, they don’t really want the bill passed either, because, “Why kill the goose that lays the golden egg?” He named one very wealthy top American evangelist who is known to have a Uganda boy friend.
I can’t confirm any of this since it’s a single source, but it does make one pause to question the realities of what we’re seeing.
Rates of New HIV is 44 Times Higher in Gay men
CDC Analysis Provides New Look at Disproportionate Impact of HIV and Syphilis Among U.S. Gay and Bisexual Men
Data presented at Center for Disease Control’s 2010 National STD Prevention Conference finds that the rate of new HIV diagnoses among men who have sex with men (MSM) is more than 44 times that of other men and more than 40 times that of women.
The range was 522-989 cases of new HIV diagnoses per 100,000 MSM vs. 12 per 100,000 other men and 13 per 100,000 women.
The rate of primary and secondary syphilis among MSM is more than 46 times that of other men and more than 71 times that of women, the analysis says. The range was 91-173 cases per 100,000 MSM vs. 2 per 100,000 other men and 1 per 100,000 women.
While CDC data have shown for several years that gay and bisexual men make up the majority of new HIV and new syphilis infections, CDC has estimated the rates of these diseases for the first time based on new estimates of the size of the U.S. population of MSM. Because disease rates account for differences in the size of populations being compared, rates provide a reliable method for assessing health disparities between populations.
“While the heavy toll of HIV and syphilis among gay and bisexual men has been long recognized, this analysis shows just how stark the health disparities are between this and other populations,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “It is clear that we will not be able to stop the U.S. HIV epidemic until every affected community, along with health officials nationwide, prioritize the needs of gay and bisexual men with HIV prevention efforts.”
For the purposes of determining rates of disease for MSM, CDC researchers first estimated the size of the gay and bisexual male population in the United States – defined as the proportion of men who reported engaging in same-sex behavior within the past five years.
Based on an analysis of nationally representative surveys, CDC estimated that MSM comprise 2.0 percent (range: 1.4-2.7 percent) of the overall U.S. population aged 13 and older, or 4 percent of the U.S. male population (range: 2.8-5.3 percent). Disease rates per 100,000 population were then calculated using 2007 surveillance data on HIV and primary/secondary syphilis diagnoses and U.S. Census data for the total U.S. population.
The new analysis is the first step in more fully assessing the impact of HIV among MSM and other populations significantly affected by the disease. CDC is developing more detailed estimates of infection rates among MSM by race and age, as well as among injection drug users.
CDC is also in the early stages of planning for estimates among heterosexuals. Ultimately, these data can be used to better inform national and local approaches to HIV and STD prevention to ensure that efforts are reaching the populations in greatest need.
Research shows that a range of complex factors contribute to the high rates of HIV and syphilis among gay and bisexual men. These factors include high prevalence of HIV and other STDs among MSM, which increases the risk of disease exposure, and limited access to prevention services.
Other factors are complacency about HIV risk, particularly among young gay and bisexual men; difficulty of consistently maintaining safe behaviors with every sexual encounter over the course of a lifetime; and lack of awareness of syphilis symptoms and how it can be transmitted (e.g., oral sex). Additionally, factors such as homophobia and stigma can prevent MSM from seeking prevention, testing, and treatment services.
Also, the risk of HIV transmission through receptive anal sex is much greater than the risk of transmission via other sexual activities, and some gay and bisexual men are relying on prevention strategies that may be less effective than consistent condom use.
“There is no single or simple solution for reducing HIV and syphilis rates among gay and bisexual men,” said Fenton. “We need intensified prevention efforts that are as diverse as the gay community itself. Solutions for young gay and bisexual men are especially critical, so that HIV does not inadvertently become a rite of passage for each new generation of gay men.”
Preventing HIV and STDs among gay and bisexual men is a top CDC priority. CDC provides funding to health departments and community-based organizations throughout the nation to implement proven behavior-change programs for MSM and will soon expand a successful HIV testing initiative to reach more gay and bisexual men.
Additionally, CDC is implementing an updated National Syphilis Elimination Plan in cities where MSM have been hardest hit by the disease, and will release an updated HIV prevention strategic plan within the next year to support the President’s upcoming National HIV/AIDS Strategy. CDC officials note that the new analysis released today underscores the importance of the HIV and STD prevention efforts targeting gay and bisexual men recently announced as part of the President’s fiscal year 2011 budget proposal.
For more information on HIV or syphilis, please visit www.cdc.gov/hiv or www.cdc.gov/std.
The Validity of “Sexual Addiction”
I suppose it’s necessary to address the issue of sexual addiction since it is occuring so much in the media. Here is a link to a Night-Line report called, “Is Sexual Addiction Real?”
We live in a society where we are bombarded with expressions of sexuality while at the same time we hear other messages telling us that we must always have it under control. This blog post was originally published on Medscape Blogs:
The Validity of “Sexual Addiction”: Chasing a Tiger by Nassir Ghaemi, MD, Psychiatry/Mental Health, 03:17PM Feb 6, 2010
Nassir Ghaemi, MD, MPH, is Professor of Psychiatry at Tufts University School of Medicine and Director of the Mood Disorders and Psychopharmacology Programs at Tufts Medical Center.
Everyone is writing about Tiger Woods, and I am not at all inclined to join in – but I suppose I will. The casual use of the concept of “sexual addiction” in relation to his recent diagnosis and treatment may warrant some internal dialogue among psychiatrists. I write these notes not to persuade but to raise questions and see if other colleagues are not wondering similarly.
What is sex addiction all about? I understand hypersexuality, and I understand addiction, but I am not sure I understand sex addiction.
As a psychiatrist, I would first want to apply here the concept of a hierarchy of diagnoses. So a high amount of sexual activity could certainly occur with many conditions, and the concept of a sex addiction, if valid, would have to be the last thing one would diagnose – a diagnosis of exclusion since it could happen with so many other things.
First on everyone’s list of causes of high sexual activity, I would think, should be mania, or bipolar disorder. Next, or right with it, would be obsessive compulsive disorder (OCD), with sexual content; this is quite common. Then perhaps PTSD with sexual trauma (with later hypersexuality in some people), substance abuse (e.g., amphetamine, steroid, or testosterone abuse), and frontal lobe syndrome. Some depressed individuals also appear to engage in sexual activity, not because of aroused libido, but out of a wish to come out of their isolation and engage with others, even if only physically.
Sexual addiction, as a concept, though, would seem to represent nothing but sex: no mania, nor PTSD, nor substance use, nor other causes. Addiction, as a concept, implies an intense feeling of acute pleasure, followed by a wish to repeat, and, often, tolerance and withdrawal. In this context, tolerance would mean that the more one experienced sex, the less pleasurable it would be; and withdrawal would mean that when abstinence occurred, one experienced painful psychological or physical symptoms (perhaps depression and anxiety).
Addiction also implies something that perhaps begins as an experiment, later becomes a habit, and then becomes autonomous. Neurobiologically, addictions tend to involve, we think, activation of the dopaminergic pleasure centers of the brain. Can lots of sex take on this pattern?
It seems difficult to me to distinguish OCD from so-called sexual addiction; perhaps the main difference would be that the individual is bothered by his behavior in one case (OCD) and not the other (addiction); yet this single minor subjective difference would seem to be a small feature upon which to base an entire diagnostic entity.
Indeed, there appear to exist many cases of OCD without insight, that is, OCD in which the patient is not much bothered by his or her symptoms. OCD is not, traditional teaching notwithstanding, uniformly characterized by presence of insight (better phrasing than the old ego-dystonic term, in my view).
One reputable website defines sexual addiction as “a progressive intimacy disorder characterized by compulsive sexual thoughts and acts.” DSM’s definition, under paraphilias, as sexual disorders NOS includes the following ideas: “compulsive searching for multiple partners, compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships and compulsive sexuality in a relationship.” This kind of definition seems quite hard to distinguish from OCD with sexual content.
Kari Ann Peniche - Playboy Model
The difference in terminology is important; the idea of sexual addiction would seem to imply analogies to substance abuse: 12 step programs, a limited role for medications, Malibu resorts. The OCD concept would put medications central to the treatment, and make the problem more biological in origin and pathogenesis, rather than simply habit gone awry.
Where we are uncertain, I would prefer the term sexual paraphilia, so as to remain neutral as to the addiction versus OCD dichotomy. Dr. Martin Kafka, a specialist in paraphilias, with whom I have shared patients and whose expertise is large, recently suggested a new DSM category of “Hypersexual disorder”, which presumes carefully first ruling out other conditions like OCD and bipolar disorder hierarchically.
Though I know he practices this way, I fear that the public at large, and the average clinician, will be too democratic, and too little hierarchical, and forget that such a diagnosis, though perhaps not useless, is one of exclusion, and last resort.
If individuals like Tiger Woods have a variety of OCD, it could be that enough serotonergic antidepressant would knock out their libido or their OCD, or both, to keep them from ruining their lives. But 12 step programs might be tenuously utile.
I don’t know the right answer, but it seems to me that this is yet another part of psychiatry where the lapidary use of popular phrases hardly clarifies.