Pills for Cheap

The main one, in our view, is the increasing exposure to man-made chemicals – food additives, pesticide residues, exhaust fumes, solvents, industrial pollutants and the like. It is known (although only from case-histories) that a single massive exposure to a toxic chemical, such as a pesticide, can bring on a severe form of food intolerance. It is also the case that a small proportion of people with food intolerance are unduly sensitive to everyday chemicals. What is more, if those people can reduce their chemical exposure, they often find they can tolerate the foods to which they are sensitive normally. It seems likely that these people have certain enzyme deficiencies, which make them vulnerable to man-made chemicals and intolerant of certain foods – but if the chemical stress can be reduced they are able to cope adequately with those same foodstuffs. Such people would not have been ill if they had lived 50 years or more ago, but they are ill now, because the environment around them has changed.

Environmental chemicals could also be a factor in others with food intolerance – even those who are not overtly sensitive to everyday chemicals. It is possible that chemicals in food and drinking water affect the gut wall, making it more leaky – there might be no obvious effect from the chemicals alone, but they could create the right conditions for food intolerance.

Such chemical exposure might also play a part in true allergy. We have already seen that patients with food allergy are more likely to be enzyme deficient than those with no allergy or intolerance. And the incidence of certain allergies appears to be increasing – in fact, this is much better documented than the alleged rise in food intolerance, because doctors are agreed on how to diagnose allergic diseases. Eczema is one of the allergic problems that is steadily rising – and it is one that is quite often associated with food sensitivity. Whether chemical exposure is playing a part in this remains to be seen.

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Food allergy generally begins in childhood, while food intolerance can begin at any time of life. Having said that, there is often no clear distinction between allergy and intolerance, especially in children. Those with proven allergies, such as asthma or eczema, may show other symptoms that most self-respecting allergists would have nothing to do with – hyperactivity, for example, or muscle aches. If these clear up along with the allergic symptoms when certain foods are withdrawn, then is it allergy or intolerance? To avoid the problem, we will use the term ‘food sensitivity’, to cover both allergy and intolerance.

Over the past ten years, doctors have begun to recognize just how many different childhood problems can be caused by food sensitivity. Colic, eczema, asthma, persistent runny nose, glue ear, headaches, migraine and even behavioural problems, have all been traced back to certain foods or food additives. These discoveries have a bittersweet taste for the many mothers who have been told by their doctors that they themselves were at the root of such problems – because they were over-anxious, inexperienced, nervy, over-indulgent or whatever. This sort of ‘diagnosis’ is usually based on minimal evidence and does untold harm to the self-confidence of mothers at a time when they most need help and support. Anxious, inexperienced mothers can be the source of their child’s mysterious health problems, of course, but there is increasing evidence that it is commonly something in the diet or the environment. There is also evidence that children who show food sensitivity in their early years are more likely to develop other health problems later, often continuing – or reappearing – in their adult lives. Helping these children to adapt to their environment is therefore important, and putting their symptoms down to poor mothering, without any evidence, is irresponsible and potentially damaging.

It is now believed that babies can be sensitized to food even before they are born, because a few food molecules, from food the mother eats, can reach the baby in her womb. More importantly, food molecules get into the mother’s breast milk, and babies that are exclusively breast-fed can be ill because of the sort of food the mother is eating. Although sensitivity to cow’s milk is by far the most common problem in babies and children, all sorts of other foods have been implicated. These relatively recent discoveries have meant that food sensitivity can now be recognized and dealt with far more effectively. They have also suggested ways in which parents can reduce the risk of food sensitivity in their children.

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For a young man of 22, Danny had a surprising number of health problems. Afraid of losing his job as a trainee hotel manager, he pretended not to be as unwell as he really was. He only consulted the doctor when the red, itchy bumps that covered his skin (nettle-rash) became unbearable. It was with great reluctance that he admitted his other symptoms – regular bouts of indigestion and diarrhoea, aches in his joints, headaches and extreme fatigue. There was also some eczema and hay-fever, both of which he had suffered from as a child. Skin-prick tests showed that he was sensitive to grass pollen and cat fur, but not to any foods. Nevertheless, the doctor decided to try Danny on an elimination diet, excluding most of the foods that he usually ate. Within six days he returned to the surgery looking very pleased. He reported that his nettle-rash was gone, along with his

headaches, joint pains and digestive problems. He felt far more fit and energetic as well. Under the doctor’s supervision, he then reintroduced foods one at a time. Wheat, milk, eggs, tomatoes and oranges caused the problems. These brought on urticaria within a few hours, with tiredness, headache and aching joints later. Danny can avoid these foods most of the time and has remained well. His eczema also cleared up after a while, and his hay-fever is less troublesome than before. This sort of case is interesting because the diet apparently helps with symptoms that are thought to be due to allergic reactions, such as urticaria and eczema, as well as clearing up symptoms like headache, diarrhoea and joint pain. There are many cases of this type on record, making it difficult to draw a sharp dividing line between food allergy and food intolerance.

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“Nothing. That’s why you have to stay with me. That’s why you have to be my slave. You’re only something at all because you’re with me, who’s everything. Say, ‘You are everything, Master, and I am nothing.’”

“You are everything, Master, and I am nothing.”

“Now, do exactly as I say!”

“Yes, sir.”

“Unzip my fly. Unzip it right now.”

“Yes, sir.”

“Take it out.”

“Take out what, sir?”

“Don’t act stupid. Take it out.”

“Your cock, sir?”

“Don’t say that word.”

“Yes, sir.”

“Fondle it.”

“Yes, sir.”

“That’s right, keep fondling it.” “Yes, sir. Does it feel good, sir?”

“Don’t ask questions. I didn’t say you could ask me questions.”

“Sorry, sir.”

“Now, take off your clothes. Leave on your panties. Follow my instructions exactly.” “Yes, sir.”

“That’s right. Take them off.” “Yes, sir.”

“But leave on your panties, because I don’t want to see your dirty hole.” “Yes, sir.”

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Players: Prostitute and John.

Activist: Wife, without husband’s foreknowledge, or both. Setting: Home or hotel.

Aim: Arouse wife’s sexual passion by appealing to her prostitute fantasies, while prodding husband out of his oral (“Take care of me, please!“) passivity.

Game Plan: If the wife is up to it, she may want to spring this game on her unsuspecting husband some night at home or away during a vacation. Or, they may both participate in setting up and playing the game. If the wife activates the game on her own, it is more likely not only to plug in to her whore fantasies, but also to appeal to the angry, proud aspect of her character.

One night while the husband is either home or in a rental room alone, the wife rings the doorbell several times, insistently. He opens it to find a quite different wife than he has ever seen before. She is dressed for the part, with hair all askew, oodles of red lipstick, eyeliner, rouge, a low-cut neckline, a miniskirt, net stockings, and high-heeled shoes. She smiles seductively and slithers saucily across the room.

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Players: Depressed wife and fairy godfather (nondepressed husband).

Activist: Nondepressed husband. Setting: Home.

Aim: Draw wife out of her depression by appealing to her rescue fantasy.

Game Plan: The wife is moping around when the doorbell rings and she opens the door (or, alternately, the wife is lying in bed and the husband bursts into the room). He wears a costume that befits her fantasy—Superman, Robin Hood, a prince, a fairy with wings.

“Hi! It’s me—your fairy godfather! My card!” He hands her a home-made card, then whirls around the room, his cape or wings flowing. Depending on the nature of his wife’s depression and personality, he may dance around the room for a time, waving the magic wand, or stride toward her in a princely fashion.

“What are you doing?” his wife may ask in a sarcastic tone. “Stop being stupid.”

If she is in on the game, she will play along of her own accord. If the game is a surprise, she may continue to try to negate it. (All such negation should be firmly countered.)

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Prior to the 1950s, therapists most frequently met with couples in which the husband was too aggressive and the wife too passive. Nowadays, perhaps due to changes in social values, we more frequently encounter couples among whom the reverse is true. Pierre Mornell, a clinical psychologist, wrote a book about this latter syndrome, giving it the humorous title Passive Men and Wild Women.

A patient I have treated for a while is involved in the latter-type marriage. Her husband, a devout Quaker, appears to be the perfect mate. In many ways he is very attentive to her: He cooks wonderful meals, does windows, is handy around the house, and never loses his temper. He believes he is a spiritual and concerned person. Twice a day he meditates, and often he goes away on meditation retreats. Yet—despite all this—my patient continually feels furious toward him, and even finds herself saying sarcastic things to him in front of people at parties, causing them to Wonder (sometimes aloud) how come this nice guy puts up with such a monstrous mate. And every other month, she explodes, throws whatever she can grab at him, and pummels him with her fists.

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These games do not stay in the same stage as do the common sexual games, but rather evolve through two stages. The first stage comprises games that address a particular symptom with their typical underlying fixations. These games, which encompass most of the chapters in this book, include everything from “Games for Bored Couples” to “Games for Unat-tracted Couples.” The games are to be repeated as often as necessary until a couple feel that they have accomplished their purposes, which we assume have to do with revitalizing their interest in sex, their sexual passion, and their commitment and love for each other.

The second stage is made up of “Games to Restore Tenderness.” Again, these games should be repeated as often as necessary until tenderness is revived. Once tenderness is rekindled in their marriage, couples find that they become more adjusted and tolerant and easygoing with other people, developing a “fellow-feeling” toward humanity that might have been lacking before, or which they might have had but not with much emotional intensity. (Note that the intense feelings that individuals have for religious or social causes are not to be confused with fellow-feeling, which consists of acceptance of all people, regardless of their views.)

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It may be wise to comment briefly on the analytic attitude toward homosexuality. It should be remembered that Freud was the first to approach homosexuality without condemning it and to see it as a form of psychopathology, which required understanding and treatment rather than condemnation. Perhaps the best expression of this attitude, which has been and continues to be the basic attitude of psychoanalysts, is contained in a letter which Freud wrote in 1935 to a desperate mother who wrote to him from America requesting help for her homosexual son

April 9, 1935

Dear Mrs. . . .

I gather from your letter that your son is a homosexual. I am most impressed by the fact that you do not mention this term yourself in your information about him. May I question you, why avoid it? Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by a certain arrest of sexual development. Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest among them (Plato, Michelangelo, Leonardo da Vinci, etc.). It is a great injustice to persecute homosexuality as a crime, and cruelty too. If you do not believe me, read the books of Havelock Ellis.

By asking me if I can help, you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted.

What analysis can do for your son runs in a different line? If he is unhappy, neurotic, torn by conflicts, inhibited in his social life, analysis may bring him harmony, peace of mind, full efficiency, whether he remains a homosexual or gets changed. . . .

Sincerely yours with kind wishes,

Freud.

In more current times psychoanalysts and psychoanalysis have been attacked on more or less political grounds, as adopting a prejudicial attitude toward homosexuals because analysis deals with homosexuality as a form of pathology. It should be clear from the preceding discussion and particularly from Freud’s letter that there is no necessary connection between the persecutory or judgmental treatment of homosexuality and the more objective and scientific position that it is a form of psychopathology. Psychoanalysis has solid reason based on clinical experience gathered over many years, to sustain its position and its understanding of the homosexual dynamic. To deal with human psychopathology as pathology, in relation to homosexuality as in relation to all forms of human suffering associated with psychopathology, is neither unfeeling, rejecting, nor judgmental.

I would argue in fact that just the opposite is true: to respond to human distress in terms other than to see it as human psychopathology which can be treated, modified, or alleviated in some degree or manner, is to be less than human and in fact is to condemn such individuals to a lifetime of frustration and unhappiness. The psychoanalytic attitude condemns all prejudicial treatment of homosexuals, but that is not its concern or its business. Its concern is to help to alleviate neurotic suffering and the impediments to self-fulfillment and self-realization. To deny individuals that form of assistance, as is so often the outcome of attempts to deny the pathology of homosexuality, a posture too often adopted by homosexual advocates without sufficient sensitivity or discrimination, is itself a form of cruelty and lack of sensitivity.

It may be appropriate to interject a comment on the current status of the diagnosis of homosexuality according to the Diagnostic and Statistical Manual II. First of all, one would have to decry the method by which the revision was made. To my way of thinking it was a crass example of yielding to political and social pressures in a process of bending scientific statement to expediency. The ultimate step of putting the decision to a vote makes a travesty of any scientific pretext in the formal diagnostic categories of institutional psychiatry. If any demonstration were needed of the unscientific status of psychiatry (even, or should I say especially, at the highest levels of organized psychiatry in this country), little else would be required.

The tragedy of that revision is that it takes homosexuality out of the realm of pathological diagnoses and undermines a long-standing and clinically sound view that homosexual behavior can be regarded as significant symptomatology. Moreover, it does not seem farfetched to argue that it substantiates the view of the most outspoken, and often most disturbed and resistant to treatment, homosexuals and provides a rationalization for avoiding treatment. I have argued here that psychoanalysis is not a specific treatment for such disorders, but I would never infer that homosexuality and other sexual disorders are not diagnosable and treatable disorders. The confusion of legitimate diagnoses with political or prejudicial positions is to my mind unfortunate and unscientific.

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Gender identity/role disorders occur most frequently in people with normal external and internal reproductive anatomy. Sexual pathways of the central nervous system (CNS) do not show gross morphological changes to which gender identity/role disorders might be attributed. This is not surprising, since one would expect CNS functions mediating such disorders to be related to the dynamics of neurochemistry, specifically of neurotransmitters, and thresholds of arousal and inhibition in neuro-sexual pathways. Identification and measurement of these functions is not technically possible at the present time.

Some clinicians use the term disorder in connection with gender identity/role, to refer only to male-female transpositions. Sometimes known as gender dysphorias, these transpositions contain the syndromes of transsexualism and transvestism. They also may include homosexualism and bisexualism, though neither of these need be considered pathologies or disorders (see below).

Other clinicians include in the category of disordered gender identity /role all the paraphilias. Paraphilia refers to a condition in which sexual arousal and performance is dependent on highly specific imagery, perceived or remembered, other than imagery of the erotic partner. A paraphilia may be benign or noxious. The imagery of a paraphilia, as in fetishism, for example, may be in the nature of an imagistic intrusion, to be associated with the erotic image of the partner, or it may be rather a displacement or substitute for the erotic image of a partner, in whole or in part. A paraphilia can be regarded as a part of gender identity/ role in that it is essential to the person’s masculine or feminine erotic functioning. Thus for the male sadist, his masculine gender identity/role in its erotic manifestation is dependent on remembered or enacted sadistic imagery.

The list of the paraphilias is long. It includes, for example, masochism and sadism, rape and lust murder, voyeurism and exhibitionism, pedophilia and gerontophilia, amputeephilia (apotemnophilia), zoophilia, klismaphilia, coprophilia, urophilia, necrophilia, fetishism, and so on.

The transposition syndromes generally are classified along with the intrusion or displacement syndromes as paraphilias. There is not total professional consensus, however, especially in those cases of homosexualism (and by extension, bisexualism) in which the perceived or remembered imagery of erotic arousal and performance is concordant with the body and the person of the same-sexed, pair-bonded partner, the latter itself being the only unorthodoxy. Transvestism, because of its associated fetishistic dependency on clothing, qualifies as a paraphilia. So also does transexualism, for the transsexual person can function erotically only by reason of having or imagining having a body reassigned and transformed from that of the sex of birth.

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