Medical Self-Care Issue # 2 (1977)

3,122 views

Published on

This is the second issue of Medical Self-Care magazine, created and published by Tom Ferguson, while he was a 4th year medical student at Yale, in 1976.

Published in: Health & Medicine, Business
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
3,122
On SlideShare
0
From Embeds
0
Number of Embeds
26
Actions
Shares
0
Downloads
0
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Medical Self-Care Issue # 2 (1977)

  1. 1. I t' lMedical Self-Care NUMBER 2 $2.50 Access to Medical Tools Kids & SelfCare I Ursula K. LeGuin on Menopause a Keith Sehnert on Kds The Best Medical Self-Care Books of 1976 a Medical Consumerism Elders Mid-Life Wellness Medicine-An lnteruiew with John Travis National Listing of Medical Self-Care C/asses I I I f I
  2. 2. Editor's Page Welcone to ow seinrl issu,. Here s rcns oJourfirct: w veit thtoush the 2,500f'st ntury and hu.l to haw nore ptiated. Multa.ne an.l ae*spaper sloti?s hare h.lped lpfto.l the wotu, hut lt? biggest help has b..nftum )'ou hshosnry he mosozine to lout Jiienls anrl e tuunt|ing then to subs.ribe. Lots of Soorl sugr/Jtons as wU, ax.l kntr oJ 1em hare betn itkltPorated nio his is!u(. ,nore an ki.ls u l sef-ca/e. d subvrhtk,t form thdl ! .uti.r b use. Also ne|| s(tt,ts o the Self Cute Conrcpt. ELlets, Mil Ltk, ond MedndlCohsuhletism. And u rcBulat Jinancidt st.t4n.nt p t** t seen the naga.ine be.lot.-here s eha! e re up to.I n DJou h Yole me.lical stu.lent tryihg to j'ind wdt! to nake medi.al inJbrndtion and bols urailable to laypeopLc I.lc.ided to slort this ttdta.ine aller taki,tt rcrc o.f a nunberol hospitali.ed patients ||ho werc dyins Jro,n diseases thut ould har( b.?n pretehted. The), didn t know whut to do to prcwat tc,t. Ihopeyoueill. ln.ase fou havn jcot *** Since puting oul he las issue ||e v noved to lrremess. Calilornid. o snoll,.o.f @ast to-n |ith idylLi. countrside and |arn. Jrientllt peopl.. P tnts.ut o ndgo.ine Sets Jrantic at tines. Lieing herc is ov ,n,.4i..! sef.a/e **i What with our nott, there s been.1h alnost i)nplete stalf tu bv.rsincethe lutt we d hav likttl h 8et this tsuc out. (ihot s 'rp reoson it s taken lokger ltun Thant: lor tout poticn<e.) issue. Womea's edilor Julid Karct took a job iith CIIRE in Kabul. A[Bhonisllh Medi.ol consumet spe.ialist Gain Hasseldeh sit"ed on as asso.idte e.tikr. She s been a bi8 help ii pl.tnning and oryoni.ihg, o veak spot hr n.. The fN lime I su| u kt Sue Neri s druteinss . I knew she was lk on( h ilLustrdte the magd.ine. To our great sood fonuhe, she oltttts. we .foun.l out ||hole produttion ctc)t-David Lubin, rina M iLls, and C in.l! w til in the ofrus oJ out local newspupet, -fB'l is a biwtckly, so theJ rolt ,, Mcdical Self'Care,, rre Tomales Bay Tirncs. fte Diane lA..ko|9ski has taken over ou subs<ription depannpnt IJ )ok niss .opies, hove on address chan9e. etc., please wthe to her at Box 7 t7, Invrness, CA 919J7. E.litorial coftespondence shouLl.ome 1o Rot 7 t8. **t FinoUJ, we d Like h thank youht tout tLt.rest, yourJeedback, and lour suppL'tt. We've been Bexing a reaL outpoutins oJen.aurcEenent ond enthusioen evcry tine |e open the mail. your lettets keep us Eoint. Invrness, Catifomia $kd'dlE|DleLlro*fi rlrd4r c44, w.i. r4io f,?b,
  3. 3. SPRING 1977 Contents Talk Back to Your Doctor, p. 19; Healtb Activation News, p. 19; A Patient's Bill of Rights, p. 19 Th€ S€lf-Crre Concept Self-Care: lay Initiatives in Health, p. p. 4; Self-Care Wirri, the Establishment, p. 5; Self-Help Reporter, p. 5; Forces Favoring/Opposing Self-Care, p.5 Being Your own Paramedic Take Care of Yourself: A Consumer's Guide to Medical Carc, p. 6; Personal Health Appraisal, p. 7 20 2l Dying/Grieving Gre'I.ry, tt Kids & Self-Care p. l0 Baby and Child Care, p. 12; A Pictorial Guide to Cornmon Childhood Diseases, p. u Book, 12; Haods, p. 25 Erting Passages, p. Disease, p. 25 13; 26 p.n 14 2E Women's Health In N€cessity and Sorrow, p. 29 Health Research Group, p. l8; Checkbook Hodth, p. 18; The Consumer's Guide to Successful Surgery, p. 18; M.dLtl Edt otld S.lt{&. Vol u, No I Odlc.!! 8d ?l8.lrv.m CA Sot-rl[do! Ofi6: Bor7l7, hrcffi R$da su!.cripri@r t7 fd 4 i$u* Rcr.irins SubsiPli@: i25 Su6..ioitrt Sub.dpdm: illn C@ylLhl I97, lu.drc|l S.ll.CrE 9493? ca 9493? Basic Sciences Rand McNally Atlas of tlle Body and Mind, p. 29 30 Medical Classes for Layp€ople 3l Businest 12 F€edback 15 The Medical Self-Care Awards for 1976 IE Medicrl Consumerism Dealing With Doctors Woman Doctor, p. 28; Patient Brochure and Self-Help Manual, p. 29 The lnner World of the Middle-Aged Man, p. 14 l6 Proliles Wellness Doctor: An hterview with John Travis, p. 26; Wellness Inventory, t4 Men's Health 15 The People's Pharmacy, p. 24 Nuhition in a Nutshell, p. 25; Cercal: Champion of Breakfasts, p. 25: Nutrition Actiol, p. 25; Nutrition Against 13; Meditation for Children, p. 13; "What's Happening to Me?", p. How Your Body Works, p. 13 Menopause: DruSs 12; The Baby Exercise t4 Mid-Life Elders The Space Crone, Ursula K. LeGuin, p. 22 t2 Kids Irving p. 2l A Cood Age, p. 22; On On Teaching Self-Care to Children, Keith W. Sehnen, p. 8i Teaching MediciDe to Kids, Tom Ferguson, p, p. Therapy/Growth Every Day Gets A Little Closer, p. 20; Nourotic Styles, p. 20
  4. 4. 4 MEDICAL SELF.CARE Some health professionals sense an attrck teritorial iights while others arE touL led by potential excesses in "going too far." An even mor€ severc cdticism is lhe possibility that self-care will be used as a pacification lactic to rcduce public dernand fol more ot The Self-Care on thoh Concept better p€rsonal health services. ln conFalt, The crnx of the ''medical care crisis" moy turn out to be the simple fact thatwe've allowed our doctors to carry more ofthe burden of providing us with health care than we should have . Much of the current criticism of the health care system conveniently avoids looking at our own behavior, at the points in our daity lives where we are offered clear choices between sickness and wellness. This new section will present short comments, quotations, and questions about the id.ea and practice of medical self-care, as well as a listing of the best books, papels, and journal articles on the subject- We invite your comments. Self-Care: Lay Initiatives in H€alth Lowell S. Levin, Alfred H. Katz, Erik Holst Leaves little doubt that self-care will be part of our common health care future. Contains the best availabk (and-bless them-well-annotated) bibliography on self-care. there arc those who feel self-care is a middle class idea with litde transfeRbility to lhe inter€sts of the poor' others vieur self-care as a fad or a "reaction against" or as a protest that will pass from the scene once the cause(s) is won. And perhaps the mostPortentous concem comes from laypersons themselves: self-carc may be ccopted by the heahh establishment. +++ . . . the study of s€lf-care must be considered not only in lhe circumspe.t terms of an individual's behavior, but as the snrdy of a bnrad and far-reaching r€vision in society's definition and use of its helping institutions. Self-care in health may b€ merely tha first manifestation of this rcvision where parallels in education and social welfare can be expected to ernergc in days immediately ahead. Self-Malpractice .TF The real malpractice problem in this country The drive toward an increase of self-care in health parallels similar movements of "consumerism" for enlarging the self-help comDonent in other major fields of human endeauo,----e.g.. education-which are viewed as having b€come too highly technologized, or which depend too heavily upon the sPecialized attributes ard training of a monopolistic pIofessional consurnerism seek, among other things, a lessening of dependence on rhe tutelage of all kinds of service professionals. *** It should be stressed that the major content and methodology of present-day medical education involves the role-model of the 1976; 133 pages $4.45 postpaid from Ptodist Press 156 Fifth Avenue New York, N.Y. l0ol0 patient as a largely passive rccipient of profesiional services. Technical procedures related to examination, history-taking, diagnosis, and finally teadnelt, emphasizt the mystique of the omniscient technical expert and healer. Patients are usually not given access to their medical records; their questions at€ fiequently met with discouraging cursoriness or superficiality. Many studies of medical student socialization point to th€ powerful influence such attitudes exert as they are embodied in dle behavior of charismatic clinical instructors. *** The report on a conference on self-care held in Copenhagen in August, 1976. Twenty-nine knowledgable and LniculAte health planners spent several dqys brainstomin7 the possibilities and possible probkms of an increasing emphasis on self-care. em€rges, curricula in health professional education would have to reflect new objectives and methods coordinate with achieving a 'parhership attitude" in health practitioners and the stirrJ involved in passing along diagnostic and ts€atsnent strategies appropriate to self-care. As self-carc todav is not the one descdbed on the Aont page's of daily newspapers but rather the malpractice that people are performing on thems€lves and on each other. The health crisis today is a crisis of life style. Lalonde provides a list of the more destuctive life-style habits: l. Drugs (a) alcohol addiction: leading to cinhosis of lhe liver, encephalopalhy and malnu_ trition, (b) social excess of alcohol: leadilg !o motor vehicle accidents ard ob€sity, (c) cigaEtte smoking: causing chronic bron_ chitis, emphysema and cancet of tbc 1utr8, ald aggravati.og coronary-artery disease, (d) abus€ ofphatmaceuticalsl leading to &ut dependence artd drug .eactions, (e) addiction to p6ychotropic dmgs: leading to suicide, homicide, malnutrition atrd (f) accidents, social use of psychotropic &ugs: leadint to social wilhdrawal and acute anxiety attacks, 2. Diet and Exercise (a) over-eating: leading to obesity and its cons€quences, O) high-fat intake: possibly contributing to atheroscleodis and corsnary-a elY disease, (c) high ca$ohydrate intake: contsibuting !o dental cades, (d) fad diets: leadiig to malnufition, (e) lack of erercis€: aggravating coronrry_ artery diser6€, lesditrt to obecig ald causing lact of physical fitn€sr, (O malnutition: leading to dumcfous hcrllh problems,
  5. 5. (g) lack of r€crration ard lack of i€lief fiom work and oth€r pEssures: associated !ith strcss diseas€ such as hl.pertcnsion, corcnary-artery disease and Holistic heatth/ welln€ss medicine Fptic ulc€rs. 3. Olhers (a) ciraless driving dd failu€ to we3r s€atbelts: leading to accidents and r€sultant dealhs and injuries, (b) pomiscuity and carelessness: leading to syphilis and gonorhca. moverneDt Physicians encouraging Women's patient education The traditional health-care system has had litde success in modifying these Movement Free clinics Self-help and can have Groups habits. ..,._[,eon S. White, Hovt, to Improve the Public's Eealth, New England Joumal of Medicine, pages, ??3-774 (Oct. 9, 293 1975) Self-Care: Wilhin the Establishment Health education by its€lf tends to b€ holhas to be tied to an ability to change the practice of medicine. It has !o permeate the whole aunosphere of doctors' offices, clinics, and hospitals. If it's not pan of the philosophy of a doctor, then it's Health planners low. To b€ effective it medical records availability and/or quality of eristing medical serviccs not likely to go anywhere with his patients. This is why I want to work at it from within the medical establishment. We're going to change medicine from within, not by sniping at it from without. H. Renner, M.D., "Be Your Own M.D." -John The Notional Obsener, Novemb€r 22, 1975. P. 14 Availability of one's own Physician assistant and nurse-practitioner pro8iams Groups lforces I policies favoring self-care Self-Help Reporter Satisfaction r,ith availability and quality of existing medical services Ca6on Briggs, Editor Free from National Self-Help Clearinghouse 184 Fifth Avenue New York, N.Y. 10010 Eight-page, bi-monthly, newsletter re- poning news, publications, and longer articles of intercst to people involved in self-help groups-medical, social, educa- Patients rEsistant to change irr rolg Physicians resistant to change in role tional, etc. Theoraical, newsy, east-coast oriented, and tree_TF Sclf-Care in the Inrer Cityr Conclusions Large proportions of cormon illnesses ar€ 9€lf-treated (ranging from 44-:70% of rctE conditions and from 15-75% of chronic conditions). Significant proportions s€ek carc first ftom non-health pe$onnel, and all income goups use non-physician health Frsonnel. Home carp for a wide variety of illness€s shows that ordinary people can leam inticate as well as simple self-care skills. Technology exists----€ducational, organiza- tional, communications-to support self-carc Non-availability of one's own medical records lnsurance plans which reimbu$e only for illnessc€nt€red doctor visits, not for pr€vention /education/ wclln€ss efforts. The pEsent system of health care does not have Ihe tools to prevent many of the morc fipquent and scrious modem illnesses. -Nancy Milo Groups lforces I policies opposing scf-cane
  6. 6. Nausea, Vomiting, and Dianhea is up to while you're siaing there all Being Your Own Paramedic undressed and shivering on the exanining table. We're using it as a textbook in our Medical Self-Care ckxses st the Hoight Ashbury Free Clinic. Tske Care of Yourself: A Consurner's Guide to Medicrl Carc Donald M. Vickery, M.D. and Iomes F- Fries, M.D. Is there: a) black or bloody vomit; b) block or bloody stools; c) severe abdominal prin? l- -TF Nausea, Vonid[9, & Disrrher vomiting, and/or dianhea seldom last long. They are common with viral infections (no Nausea, fever) of the digestive tract, Excess food or alcohol, and/or minor emotional stesses can also bring them on. As long as they last only for a few days, home t€atstlent is fine; olherwis€, see your doctoi. An ulcer, gallbladd€r or intestinal problems, or a scrious disease of the digestive tract could be present. Usually not, but it's worth a check. Avoid solid foods, Don't Home Trcatment eat or drink much at one time. Sip clear fluids such as water or ginger ale, Suck on ice chips if nothing else will stay down. vomiting, diarrhea, and fever increas€ your ne€d for fluid, so take in as much as comfortable. As the condition improves, add soups, bouillon, jello, and applesauce. Milk products may help, if tolerated, but sometimes aggravate the situation. - Has there b€en head iqjury in the last rl8 hours? Is the patient: a) thirsty or utrrble to retrin lntslc for more than 12 hours; b) pregmnt or possibly prcgnant; c) frequently or painftrlly urinating; d) diabetic. 1976; 269 pages Thc most useful medical from the new Plryician's aol to emerge Assistant troin' Algorithm-c bi8 detoiled fow-chan contoin@ Key qucstions 1o ask for each common ing programs is the Clinical complaint-sprains , cods , sore throat , vaginal discharge, headache, back pain, etc . Yes and no ansl)ers lead you through o network of branching logic ond end up telling you whether you need to I ) See the doctor NOW; 2) See the doctor todcy; 3) If mon medical problems . There are sections o Nausea or vomiting, or at the very least, loss of appetite; Take Care of Yourself includes the clinicol algorithms Jor the 68 most comof background information on eoch problem, including home treotments to be used when indicated. Additional chapters on "Choosing a Doctor," "Your Habits and four Health," "Reducing Your Medication Costs," and a little gem called "The Ofrce Visit" that tells you what the doctor f- *** Apply home teatment. Mske an appointment to see the doctol;4) now? symptoms p€6ist beyond 72 hours, con- The most constant signal of appendicitis is the order in which symptoms occur: PaiD---{tsually first around the belly button or just below th€ bt€ast bone, only later in - . the right lower quarter of the aMomen; . l,ocal tgnderness in the right lower quarter of . Fever-in the abdomen; the range of 10ff to 102T. Appendicitis is unlikely il fever precedes or is present at the time of first pain: if there is no fever ot ahighfevet (greater than 102'F) in the first Z hours; if vomiting accompanies or plec€des rhe fiIst bout of pain. t ye3 I yes Is pstient taking any medicntioru tact your physician. Abdomind Prin y6 !." Applesauce may help slow down the bowel. A $5.95 postpaid fton: Addison-Wesley Reading, MA 01867 I l"' Work up, slowly, to a normal diet. Diarhea rcsponds to these sarne measures. tablespoon of Kaopectatc after each loose bowel movement will seldom ups€t lhe stomach and may help. If Kaopectatc is not effective, try Parepectolin or Parclixir. Recu[€nt minor bowel Foblems are common in rhe Unitcd States, possibly due to the lack of fibcr in our diets; in countsies where high-residue diets arc customary, few dig€stive problems arc se€n. Your diet should include ftesh fruits, veg€lables, celery, brans, and whole wheat breads. A tablespoon of Metamucil in water twice daily is a safe, effective (if expensive) way to hcrease Esidue. yes If the pain eventually proves due to a serious problem, the stomach should be empty to allow prompt surgery ot diagnostic tests. Sips of wa@r or oth€r cl€sr fluids may be taken, but avoid solid foods. A bowel movem€nt passage of gas through the rectum, or a good belch may give relief--don't hold back. A walm bath helps some patients. The k€y !o home teatment is periodic r€evaluation at the emergency room or the physician's office. Home ueaunent should be r€s€rvcd for mild pains which resolve within 24 hours or arc clearly identifiabl€ as viral gastro€ntedtis, heartburn, or another minor prcblem. Home Treatment - I
  7. 7. MEDICAL SEI,F.CARE 7 Abdominal Pain ID yes any of th€se pres€nt: black or blmdy stml; ) very severe abdominal pain; abdominal iqiury in last ,l8 hours? D See physician now. See physician now. l" ID See Head lr{uries, Problem E, Is pain localized to one aree of men, or is the patient pregnrnt or possibly pregnant? l" See ID physician today. llD yes D Se€ physician today. yes D Is there nausea, voniting, or dianhea? 3ff"iilffhJ,f,Tll'lf: l"' Contact prescribing physician by phone. Personal Health Appraisal Waher D. Sorochon 1976; 3O2 pages $5.95 postpaid ftom: John Wiley & Sons 6O5 Third Avenue New York. N.Y. It 10O16 was Rehaionl St'temet t lkually bmetimes Nevet t: t e were planning to put together a book much like this to use in our medical selfcare classes. Dental Habits Inv€ntory q delight to find somebody else had already done it. This book is a self-administered heabh I wellness evaluatio, composed of 39 different checklisls, inven ories, and ques- tionnoires: Emotional Well-Being Invenbry, Ser-Actualization Inventory, Prealcoholic Checklist, Smoker' s Self-Treqt- ing Kit, Susceptability to Cancer Inventory, How t ell Do I Ex.ercise Inventory, Sexuality Scale, Susceptability to Accidents Questionnaire, How Long Will You Live Predictor, and thirty more. _TF l. Brush teeth at le.rt twice a day 2. Use dsntal lloss at least once a day 3. Drink fluoridated water daily 4. U,e reddye disclosing tabl6t sevsr.l times a year 5. Virit dentisr every rir months 6. Clean teath at dental office every six moothi 7. Brush tongue when bruihing teeth 8. Rinse teeth and mouth oui with water afte. rlrali 9. Uae a soft bristle toothbrush 10. Brush teeth belore a meal 1 1 , Eat sv/eeti and rncks betu/gen meali 12. Chorv gum containing iugar 13. Have othera cornplain about my breath 14. Feol need to use mouth wash 15. Munch lood botwen meEls 0 0 0 5 5 5 15 o 3 15 12 0 0 3 4 12 12 0 0 0 0 0 0 0 0 0 3 135 135 5 r35 r35 'r35 3 20 20 20 20 15 t5 l5 7 10 10 15 7 l0 Scores: 136-185, Very poor dental heahh habits. 9l-135, poor dental heahh habits 5l-9O, Fairlgood d.entsl lvahh habits, O-50 Very good denta! health lnbits
  8. 8. 8 MEDICAL SELF-CARE Kids and Self-Care This concept had come to me dudng lhe five Know Yow Botly The American Health Foundation has devel- oped a new school Drogram, "Know Your Bodv" (KYB), which is designed to (i) prcmote a diet low in cholesterol, in fat. and in On Teaching Selt-Care to Children by Keith lt/. Sehnert, M.D. Can childrcn really take responsibility alld make wise decisions about their own health ne€ds? Do['t we thiDk of children as reckless beings, never worded about bruises, cuts, or infections, snacking on anything at any hour of the day, and concemed with their state of healrh only when there is a school test or some other activity they wish to avoid? Well, reports just out on two t€cent health Programs suggest that these doubs have little basis in fact. In Califomia, Mary Ann Irwis, dircctor of the Family Nune Practitioner Program, and Charles E. Lewis, professor of medicine at the University of Califomia at l,os Angeles, have r€ported on their research at University Ele- mentary Schoot, the laboratory school for UCLA's Departrnent of Education. Working with first-, third-, and sixth-graders, they developed an experimental model to study the behavior of childrcn who are involved with the own health carc. This project was set up so that childrcn who were sick or wanted h€alth information could go directly to the school nurse's office without asking the teacher's Fmission. The nurse took the child's medical history, performed the nec€ssary physical exam, gave a report to the child, and help€d identify ary special Foblems. Th€ student was then asked to formulate treatn€nt for th€ prcblem. It is herc that this rcrnarkable study becomes even morc interest- ing. The child was asked to select one of several fieatsnent plans, and, with rare exceptions, he made the correct choice. Finally, the Chilil Rcadng Mchods and Chikhu's Hcalh Bchrybr A d€velopmental pattern of child rearing was foqld to b€ associat€d with better health care practices by children than a disciplinary pac tem ofchild rcadng, The deYelopmental methods included substantial us€ of rcasons and information, r€wards, and granting of autonomy. Based on these findings and a review of previous rescarch, the higb€r level of health practices of children r€ar€d by developmental than of thos€ rearcd by disciplinary methods is interFet€d as an exprcssion of the differential effectiveness of these contrasting child rEaring approaches in developiog the child's rcsources and capacities for coping and taking care of himself. l+att Jounal of Heobh and Socicl Bchavior, -[nis Vol. 14, pp. 61J9, Matrh 193. total calories, and olherwise nutritionally balanced; (ii) eliminate cigarette smoking; (iii) contol blood pressuie; and (iY) enhanc€ physical fimess. A 5-year ( 1975-80) KYB program among X00 schoolchildren aged l0 to 12 years is now in progess. It includes annual detemination of blood pressure. serum cholesErol. height, weisht. hemalocrit, and random blood glucosi a physical fimess test: a test of health knowledge; and a suwey of such habits as smoking and alcohol consumPtion. After completion of the tests, the children will rec€ive a "health passport" in which to recoid tbeir test rcsults. ._ftom Marvin M. Krislein et al, Heolth Economi.s and Preeentive Care in SCIENCE, 195:45?462,4 February, 1977. The aulhors arc with the American Health Foundation, New York. t'IY Iml9. student was allowed to choose the immediate steps to be taken: going home, lying down, retuming to class. and so on. Again. by far the greatesl numbdrofthe decisions were based on a sound appnisal of the child's condition At first chil&en may find it stmnge to take an active role in health care, bur the UCLA project demonsrraEd that they can rapidly ieam to make it an acceptable routine. Before and after ft€ study, these children were asked about the importance of self-care in maintaining good health, ard the results showed a decided change in attitudes. Before starting dle project. only 2 percent of the 369 childrcn saw self-care as imponant: afterward. the proportion increased to a statistically significant 9.2 percent. During the study, some interesting fac$ werc gaahered on the utilizarion ofthe school's nuning service. From existent nurse's office records, it was possible to ascertain how many students were normally nolrusers, rcgulars' or high us€rs. By the end of the program's third year, the l.ewises found almost a 50 percent reduction in visits to the nurses's office by "high us€rs. " Meanwhile, in Washington, D.C., Jacqueline Hunt, R.N., and I produced a preliminary report oD a study we conducted 6t Holy Trinity E[ementary, a I had been teaching the CouNe for Activated Patients, an innovative health class for adults. Women in the couNe often brought school-age children to class, and the kids always seemed interest€d in what we werc doing. Several mothers said that I ought to set years private school, and Hardy School, a part of the D.C. public-school system, both located near the campus of Ceorgetown University. We s€t up a class for sixthgraders that we called the Share-Care Course for Good Healrh. ln our pilot project, we planned to study the attitudes that chil&en Lave about individual responsibility in maintaining good health. We were also interested in teaching th€m simple self-help medical skills and in showing them how to keep a personal health record. up a special class for kids, and I decided to give itaty. Since our project was developed to provide information and health skills to ve, students, there was no school nuls€ available for treatment of illness, as in the UCLA setting. We presented lectures about maintaining good health and included information on diet, nutrition, regular exercise, dental care, mental health, immunizations, and cardiopulmonary resusciiation. The children were taught to take their !9mperaturc, pulse, and blood pressure and to record this vital medical information, including height and weight, in their personal health record. They also acquired some basic skills about handling comrnon illness, injuries, and emerger.rcies. Our teaching methods emphasized dernonstration and included how-'.o-do.it skills such as the removal of dental plaque ftom t€€lh with the aid of disclosing tablets. yoga exercises. mouth-to-mouth rescue healhing, the application of ice and cold packs for sprains and injuries, shopping with parcnts to leam about t]le nutitional content of food, and the presentation of classroom skits lhat demonsFated the positive aspect of good mental health. Like fhe UCLA project, ouls showed Posi tive rpsults. Before the students began the course, we asked them to choose the person most respoasible for maintaining their health: "mother, doctor, teacher, ormyself." Only 21
  9. 9. MEDICAL SELF.CARE 9 percent chose "myself." Whe[ we asked tlrc same question al the end of the coune, the figure had increased to 85 percent. What aan be learned ftom the UCLA and Ceorgetown studies that could help you in your role as all Activated Par€nt? Firsr. children need your help in learning how to participate in theirown health care. But it's not enough to encouBge the child with words. If paients do not also set the right example with their own health habits, their will be getting entirely the children wrong message. suffer the side effects of respiratory and circulatory diseas€s, Of course, the Activated Parent's role doesn'tend with avoiding health habis that set a bad example. He or she should also look for opportunities to show th€ positive benefits of good health habits. An exarnple that thricedaily brushing and daily flossing have given you b€autiful teeth, that Granddad has kept physically fit by briskly walking 5 miles every day, that you have kept a slim figure through nuritious eating----all demonsfate to childrcn how well a good health regimen can pay off. One example of this emerged in the course of the UCLA project, in reviewing the students who were "high users" ofthe nurse's office. lt I drpssed the bum and gave John additional bandages to use affer he had applied compress€s that evening. He r€tumcd on several occasions to discuss othet health plobl€ms, During the next several wecks children between the ages of 8 and 13 b€gar coming to . my offic€ before and aft€r school. School health education, where available, has by and large perpetualed a view of health care which suppresses or severely limits the growth of values and beliefs that the individual is competent as tbe primary source of health maintenance. Health 'facts" are present€d to childrpn as secure and immutable, health Plofessionals as possessing skills fixed and demarcatod from those available to laypersons. "Folk medicin€" or home remedies and indigenous health customs arc often denigrated as quaint, ineffe{tive, and sometimes dangetous. *** As a result of these accumulating clinical impressions the following questions w€le In addition, look for what I call the Teachable Moment by showing children how to use the thermometer when Dad is sick, explaining why sister must never give aspirin to a younger sibling without your approval, demonstrating how to give first aid for a knee abrasion, and advising what to do for a bee sting and how to prcvent one the next time. Another good example of a Teachable Moment could be the way you handle a common illness, such as a headache. You should demonstrate to the child that there are seveBl ways to treat a headache other than with pills and painkillers. In this case, you could suggest altemative treatrnents such as the following: l) Is the headache due to hunger? lf so, drink a glass of milk and eat a graham cracker. 2) ls it due to fatigue? Then a short rest may be indicated. 3) Is it caused by muscle tension? Then it may be relieved with a cold towel or a hot-water bottle applied to the neck area. Parents should stress that all of these rcmedies without the need for medication, if the symptoms ale noted and treated early. (For further information on how to recognize symptoms, see my September column, "When Your Body Talks.") lf a child is taught horv to handle common Self-Carc: Iny Iniriotives health problems, is provided at home with Katz, and Holst:. Protest press, New -I,evin, ir tearrr?, york, 19?6. Some retumed by appointnent. None was accompanied by his parents. Often mothers and fathcrs were not available for a variety of reasons, or, as was evident in r€tospect, the children preferred to s€e me on their own. I gained the impression that many of these children were int€Estod in their health prob' lems and wantcd to take more rEsponsibility. . Heakh Cla:ses Discouroge SeACarc him . . . He was typical of the children who came later. His Ieft arm had be€n bumed two or thrw days earlier. The bum was primary and he could have gone !o the school nu$€ next door but that the tules would not pqmit her to provide dfue{t car€. minor . *** John. a nine-year-old boy, appear€d in my office beforp school and asked if I could help rcondary with some secondary infe.tion. showing a marked tendency to call their doctor ailments. There are many other kinds of wrong messages that parents can unknowingly pass on to their children. and some can be very damaging indeed. Here are a few examples: Father comos home from the office or shop and says, "I got so damned mad at the boss that I had to stop in at the tavem and have four b€ers to cool off!" The children see how alcohol is used to cope with anger and frustration and may laler imitate this pattem. (It has in fact been shown that the recent upswing in the number of teenage alcoholics bears a direct relation to the heavy consumption of alcohol by the adult members of their families.) Mom keeps her tranquilizers on the kitchen table and pops a pill after driving home from th€ store in h€avy traffic, or explains at breakfast how she finally got to sleep by taking a sleeping pill at 2 a.m. These poor habits could set the stage fordrug abuse when the observing child becomes an adult. Aunt Jane says she will go on her diet next week, but first she takes her third helping of chiffon pie. Her influence could help to push an already overweight teenager into a lifetime of obesity. r lfan older brother or sister smokes regularly at home, it then becomes more likely that the younger sibling will also smoke and possibly For the past two years I have, as a school nuse, been involved in atr exp€timental health carc system in which the childr€n itr an clcmentary school help d€cide not only what lhetu hcalth problems are but what should be done about them. John was concemed about his affi, it hurt, and he woldorpd about the infection. He knevr that was found that the motheis of these students were also high users of medical facilities, or take non-prescription drugs for Chil&Iniliobd Carc good quality information from books and formulated; o Children se€mcd to exhibit a chaoge in thoir attitudes about health and medical care. Could this (if rcel) be r€lated to theh acrive participation in rheir own health care? . What was the content of the child-nurs€ inreractions that produced thes€ effects (if, in fact, thoy werc rcal)? Ana lzwis, American Joumal of Nusing, -Mory pp.652-655, April 1974. Vol. 74, magazines, leams details on first aid, is directed to think about seif-help and preventive medicin€ by a docto! and nuNe, thatyoungster. can become an Activated Patient. In the final session of the Course at Georgetown, I asked the snrdents to write a letter to me defining "good health. " I'll close wth a quote from the one I liked best. Mary L. said, "Good health is a constant Foject you work at. " Mary was a kid who had become an Activated Patient. This dticl. on8inally a'0eutA in Fznil, E.alth RcprinEd by Fmisid of rh. autho.. Copyrigh (xtda Fhily tyts. H@lrh 195,
  10. 10. noons a we€k for eight weeks, to see what we could do in the way of teaching ftem medical stuff. We borrowed a videotap€ s€ntp to rE€ord whatevor happened. From talking with the teachers, we f€lt it would be wiscst to explor€ what the kids would like !o l€am about, rather than coming in with a prepackaged set of goals. We ended up defining the class to fte kids likc this: "This is a Teaching Medicine to Kids time for you to find out things you'd like to know about your bodies, about doctors atld what they do, about what happens whQn you get sick, and about what you can do to keeP yours€lf healthy. "fozrjob is to ask good questions aad think of neat ways to learn about bodies. Oal job is to answer Jorre questions and to help you figure out how to find your olrt answers to others. " They ended up calling the sessions "Doctor Class," and bragged about beirg included. The children who weren't abl€ to be in the group werE pr€tty jealous. Who, Me? Teaeh Metlbine? That's what we wonder€d before staning the class. I'd had a litde clinical experience, true, but none of us were experts. What ifthey asked something none of us knewi We finally came to urde$tand thes€ doubts as a reflection of our own conditioning about medical knowledge. Therc's a very suong myth in this culhrr€ to the effect that medical infomation is so specialized and that a littl€ knowledge is sucl a dangerous thing that it's rcally best not to try to know anything ahptJt by Tom Ferguson Back in my days on the hospital wards, I was haunted by the patierts I was taking care of who were suffering and dying from pr€ventable diseases. I felt that we as a cultur€ had let thos€ people down. Th€r€ were things they should have be€n taught-things about relaxation and eat- ing and exercise, smoking and drinking and di€t---dong with reading and geography and math. starting back in the ftrst gmde. And not only had we l€t t ere p€ople down, we were letting down all the children who are /lol, studying reading and geography and math, and who could so easily be introduced to the skills of medical self-care. Organiztd Group Activilies (Exanplcs) Leaming to takc yourp4lre. DemonsEation of radial pulse (in the wrist) and carotid pulse (under the angle of the jaw). The neck pulse was easicr for most of the childrEn to find. "doctor stuff," but to leave that "to $€ experts. " One of tlrc most importrnt things we elded up leaming for ourselves was that it's all right for a group of people to get togcther and talk about illness and bodies----evel though no one in the group knows all th€ answers. One of lhe most important medical self-carc skills tums out !o be asking good questions and then figuring out how to go about finding the answets. Being in the class got us involved in about questions we wanted to know the answers to, and what we'd have to do to find out. One of the questions l've thought a lot about shce is, "Why do we have eyebrows, anyway?" Something I'd never leamed in medica.l school. I'd rtirJ like a good answer to lhat one. We help€d the kids use the library to find We had them count their puls€s for fift€€n s€conds. (We'dcall "Stan," ard "Stop.")We answers to some of their own questions, and to match other questions to Esources w€ had and run as fast as they could----once arcund lhe school. Then we had them count their pulses for another fifteen seconds. Again we recorded wdte it down so we'll be sule to remember to When I finished my clinical rotations, and had the opportunity to devote several months to an MD thesis project, I de€ided to set up a class in medical skills for frst graders. the rcsults. available-"That's a good question. l€t's Gcding the Proiect Sbrted 'I'h€ teachers I spoke to at the Footc school in New Haven w€rc most enlhusiastic about the idea. They all would have liked to make such information available to iheir children in their class€s, but they'd had no caining in ask the vet wh€n we go to the animal hospital. " I:he Kids-Whal The! wa tedTo Knov They were fascinated by the doctor tools things, and they had few r€sources available to help lhem. in my black bag. They also loved doing body exercises, relaxation exercises, yoga, and in loaming pans of th€ Physical examinatiotr. We found rhat an informal penod dght aftcr I had arranged to take eight first and se{ond Srade chil&en to an unused classroom two after- wrote the lotals on lhe blackboard. Next, we asked everyone to walk outside We asked what things besides exercise makes your pulse incrcase. (Fear, excitement, such Before long, thre€ co-workers and questions. We'd all be, say, sifting arculd on th€ floor after learning to takc our puls€s, and somebody would ask about what a puls€ l'aJ, anyway, beforc long we'd bc off onto arteries and veins and red and white blood cells and the heart as a big, muscular pump. As often as not, the questions would lcad off into ar€as of personal fean and concems"when my sister had apFndicitis lhe doctor measured the white cells in her blood. What did he do that for?"---and w€ had !o be surc to rsspond both to the bchrical question and to the feeling/conccm behind it. (Could that happen to m€?) But for all the inter€sts the kids sharEd, there wei€ many thal followed the lines of their own, individual curiousity. It b€came clear that they each ne€ded time !o pursue their own inlercsts. We ended up br€aking our class period into ftrce pans: (l) Otganiz€d group activity (2) hformal question period (3) Time for iadependent work on individual projects a structued activity was a good time for fever). We tatked about the effect of Folonged exercise training on puls€ rate.'(People in b€tier physical condition have stsonger hearts, and slower pulses.) We talked about how dle pulse can be used as a guide to exercise training. (Maintaining a puls€ of 34 p€r 15 s€conds for a prolonged
  11. 11. MEDICAL SELF-CARE period-2o minutes to an hour-maximizes training effect while minimizing stress in such activities as jogging). Using the Stethoscope. One stethoscope and eight kids equaled chaos. we ended up getting an inexlxnsive stethoscope for each of them. ($2-$5 from your local medica.l or hospital supply hous€.) We found it best to hand over the stelhoscopes and ask them to find as many things as they could in ( l) the room (2) their bodies that they could hear with it. They found things we'd never have tbough of. (My toes wiggling inside my shoes. water. " " "The radiator makirg hot "My hair.") Aft€rward we'd go tbrough the body together listedrg, in turn, to the vocal chords while talking, the heart, the stomach ard iliestines (especially just after a meal) , and the lungs while taking a deep breath. The kids discovered that your head sounds a lot differcnt (not only faster) after you've been outside running around. Doing Yoga. There werc several questions abour 0lis and we had a f.iend who taught yoga, so we had him come in for a session. The kids loved it. He wisely emphasized the animal poses-the cobra, the elephant, the lion. There's also an excellent book available, Yoga Jor C hildren by Eve Diskin, $4.22 posF paid from Independent News Co., 75 Rockefellet Plaza, New York, N.Y. 10019. (We rcviewed it last issue.) Throat Examination . Our kids were fascinated by tonsils, though they didn't quite know what they were. We had the kids pail up, bquipped each pair with a regular flashlight, and had them look in each other's throats. Children's tonsils are usually easy to se€. They look like this: I nlonul Que stion Period Independent Projects We startod the class with very skill-oriented goals. Would the kids be able to use a stetho- In most cas€s this involved working with library materials-and with us individuallyin putting together "books"-hand drawn and lettered----on their chosen topics, One boy scope? A blood pressure cuff? Would [ley be at all inter€sted in nutdtion? The most shiking effect of the class was report€d by the mother of one of the girls a few woeks after the class had finished. We didn't fomally evaluate our sessions witi par€nt questionnairEs, or b€fore-and-after tests. (We probably should have. ) So this sole repon may have been exceptional. Anyway. MIs. P. called upon herown intiative to let us know that C. (her daughter), had always had a ierrible time with doctor's visits-staying awake the night before. crying, etc. But this time--hcr first doctor's visit sirce the beginning of the class--she had s€emingly had none of her previous fears. The doctor came in with his stethoscope and C. said, "Oh, I have one of those !oo!" And thcy went on to talk about th€ir respective stethoscoyrs. During the question-and-answer sessions, the kids exhibited a good deal of anxiety about doctor's visits---particularly about shots and TIIIOAT concems----and their sense of helples$essabout what happened when lhey visited the doctor's office or were in the hospital-"Whar happens when they give you gas in an operation?" "What happens if you have cancer?" "What happens when an animal dies?" (we found that in talking about sex and death thelL prefered to alk about such things happening In responding to th€s€ questions, we found that our most important jdb was to help the child asking the question to ftrlly explor€ th€ fe€lings that his or her questions exprcss€d. The hardest thing for us was to ke€p ftom giving a superficially-correct answer at the expense of letting the child sharc a deeply felt concem. Field Trips I wish we could have taken more field trips. My first choices would have been the We asked the kid b€ing examined to "pant like a dog. " This almost a.lways made using a tongue blade unlecessary. Gf one wa.r necessary, we had the person being examined hold it.) The examiner first locates the ,ryzl4, a small midline flap of skin hanging down above the back of the tonque. Then, on either side of it, the lonsils. Children who have had many sore thmats will have larger onsils. Those who have had tonsilectomies won't have aDy. chose to leam to use the microscope. Another boy brought in his collection of bones he had found in the woods, and compared them to some human bones we were abl€ !o bororr from the anatomy doparfinent of my m€dical school. Some were able to conc€nbats on their chosen topic with oDIy occasional qucstions. Others necded nearly-conti[uous adult suppo(. Afrerhoughts-Wha We Shotrld Have Done After the class was over, of cou$e, rre thought of all kinds of wonderftrl id€as. Like a game called "Make Yourself Sick," in which cach child would think of as many ways of making your health wotse as he or she could. other painful proc.edures. Our childrpn--and most of th€ r€st of us as well-usually only saw the doctor when we were sick. If we only see the doctor when we're ill---or when we need shots-we'll leam to associate the doctor's office or clinic with being frightened or in pain. The questions they asked teflected their to animals.) BACK OF 11 children's ward and newbom nursery ofa local hospital, and a pediatrician's office. Becaus€ of scheduling and supervisory problems, we were limited to onc fi€ld tip. The kids choose o go to an animal hospital. It hrmed out to be a hne choice. The v€torimrian showed us all the cats, dogs, and other animal patiens, and explained why each one was therc. We got a tour of the operating rooms, and a description of the most common sugical prccedures he did. Perhaps the most fascinating palt for the kids was tbe demonstration of dog ard cat x-rays. We had to drag them away. We should have included some way evaluate the effe.ts of the class. Maybe to "draw-the-inside-of-your-body" t€st and a a "fe€lings-about-doctors" questionnaire. According to the kids'regular teachen, most of them continued their projecrs begun in our group after the official class was over. It would have been helpful to work out some kind of contiluing health focus in their regular class. All-in-all, it s€ems as though we raised more questions than we answ€red. The videotaF we made is available for rcntal (935) or purchas€ ($75). It turned out pretty welt. People who've seen it say it's bern helpful. Resource Guidc in Preparulion lffe're now working on a resource guide for parclts and teachers inteFsted in t€aching health/medicine to thetu kids. The guide would include a lengthy annotated biblioglaphy---books for kids of all ages and adults as well-and a number of articl€s by teach€6, parents, and others. W€'d welcome your suggestions and contibutiong-letters, accounts ofyour own experiences, suggestions of books/rcsources to mention, other possible coltributorsIf you'd like a copy of the guide, drop us a card and we'll let you know wh€n it'E r€ady and how to get it. (Wri te to Teaching Medicine to Kids, Box 718, Invemess, CA 9493?.)
  12. 12. Kids their appetite for the vegetable or the main course and you increase their desire for meat or desseit. These rgsults arc the exact opposite of what you want. Baby and Child Care (Fourth Edition) Dr. Benjamin Spock It's not that you want childlen to go on eating lopsided meals forever. But if they have a feeding problem and are already suspicious of some foods, your best chance of having them come back to a reasonable balance is to let them feel that you do not care. *** It has b€en a tradition in many families to make boys ashamed of showing pain or fear. (I was brought up that way.) But this tends to teach them to repress and deny feelings of all kinds, including tendemess, and may, through the rest of life, interfere with good relationships with family, friends, and fellow workers. *** The most convincing evidence of the value comes from mothers who have done it. They tell of the tremendous satisfaction they experience from knowing that they are providing thet babies with something no one else can give them, for seeing their of breast feeding devotion to the brcast, from feeling their closeness. It is too seldom mentioned that, after a couple of weeks , breast feeding becomes defi- nitely pleasuable for the mother-it is intended to be. A beautifully produced British book with color photographs of common childhood conditions. Particularly useful for telling one kind of skin rashfrom anotherFocuses mainly on babies and very young children. -TF Chicken pox (vaicella): The illness starts l2-2O days after contact but your child is infectious from two days before the "vesicles" (blisters) app€ar, and for 14 days after the rash b€gins, For the first seven days it is one of the most infectious fevers known. Cause: a virus. lt is one of the least sedous child illnesses. Usual pictue: the child may be vaguely unwell for a day or so, dren rcd spots ('?dpules" ) arc seen fitst on the body, fac€ and scalp, spreading to the limbs. The msh is slightly irchy. The temperanrre is raised (100- 102 degrees F) once the rash shows, but falls become after a day or two, Spots rapidly bliste$. Action: bed while the temperature is raised. Help the child not to scratch (if blisters are infeated by scratching they are likely to leave scafs----€specially on the face) by dressing him in loose, soft, smooth clothing. Don't let the child get overheated since this will pmvoke further irritation and scmtching. Use a dusting powder or a calamine lotion. Therc are no common complications . A Pictorial Guide to Common Child' hood Illnesses Gerard Vaughan The Baby Exercise Book Dr. Janine Lery $3.95 postpaid from $9.95 posPaid ftom Hawthome Books 26O Madison Avenue New York, N.Y. l0O 16 Pantheon Books 201 E. 50th Street New York, muscular development and bodily awareness and control. How to make simple baby gymnastic furniture that will help. JF care. This edition has been extensively revised "to elimitute the sexist biases ofthe son that help to create and perpetw.te discrimirntion againsl Sirls nndv/omen " W ell-loved, much-read' highly recom- How Should the Child be Carried? IJp to three months-larry him sometimes on your right arm. sometimes on your left; lhe child's head and body should be fully sup- ported. Very early you can have hirn sit on your thigh with knees and chest supported and face away from you. -:IF Three to sil. monlhs-As soon as his muscles are sufficiently develop€d, you will be able to carry him astride your hip, one hand on his knees and the other on his chest, his face away Make no distinctions between foods. l,et them eat four hclpings of one food and none of another if that's the way they fe€l (as long as the food is wholesome). If they want none of the main couNe but want dessert, let them have dess€rt in a perfectly matter-of-fact way. If you sav. "No seconds on meat until you've ealen your vegetable," or "No dessen until you've cleaned your plate," you further lake away 10022 Holding, carrying, and PlaYing with your baby so as to mqximize his or her New edition of the Bible of child rearing. 5AO pages of nornzl development' feedinp and truzrutgemen, uncl common -problems. 2N pages offirst aid and illness mended. N.Y. 1970; 176 pages $10.70 from St. Martin's Press 175 Fifth Avenue New York, NY l0o l0 from you. Six lo twelve months-Astride the hip; reduce, and then remove entirely, the support around the chest, as soon as the child's muscular strength permits.
  13. 13. MEDICAL SELF-CARE Loving Hands When you have gone as deep within as you can, just stay there-in that peaceful, calm center--and ask yourself the question wia am /? With eyes still closed, in the meditative state, contemplate whatever comes into your awareness. Wait a little and then ask again. Who am I? K@p asking yourself this question in the calrn center, aDd consider the answer, or lack of answer, for awhile. Frederick Leboyer *** Normally the mind rep€ats over and over with one concem after another, like a tape recorder in the head . . . The mind has so many patterns. So we meditate to rclieve ou$elf from all ftese pattems for awhile. we let it all go and we are free of it. For those moments we are not clogged by basic assumptioos, projections, identifications, or pe$onal reactions and attitudes. In other words, we get out of our little self and its filters and are no longer disturbed. Then, in this clear, peaceful space inside, we see something more . . . *** The personal ego and its acquired filt€rs always se€m to get in the way of pure perception. We don't label this fact good or bad, right or wrong. It's just the way things are. The human predicarnent will remain in this semiaware state until marl decides to change it thrcugh mastering his owll ego. 1976; 139 pages $7.95 from Alfred A. Knoph 20 I East s0th St. New York, N.Y. 10022 By the author o/ Bkth Without Violence, Photos and poem-directions on the Indian art of baby-massage. 1F "I 13 Wet dreams start when you're maybe thirteen or fourteen. As you'd expect ftom the name, they happen when you're asleep. The sperm that you have been making reach a level where they just have to get out. And you don't let them out by mastubating, they wait till you're asleep and shoot out by lhem- if selves. It sounds simple, but there's more to it than that. For a start, very litde spen can escape unless you have an erection. And, remember, when all this happens you're sleeping. So first, you have a night-time erection which is often caused by a sFcially pleasant drcam. Perhaps your dieam is about a gful you know. or a photograph you saw in a magazine. Or maybe it's about a nice feeling you had when you were awake. The result is that you get an erection, have an orgasm, the sl'erm shoot out, and you lvake up with sticky pajamas. Therc's only one thing wrong with wet dreams-you're not awake to enjoy tllem. (Gids, incidentally, have fewer wet drcams all. But to make up for that, a girl can often mastubate many more and many have none at times a day than a boy,) You'll hear all kinds of strange stories about mastubation: lhat it makes you go blind, it makes you go crazy, or everr that it makes hair grow on the palms of your hands. It does none of these things. It's a perfectly healthy atld nomal function. Masturbatiol is usually your lrst s€xual hat's Happening to Me?" Peter Moyle Being touched and carcssed, being massaged, is food for the infant. experience. It's sometimes ca.lled "playing with yourself. " Girls use thet fingors to carcss and rub their vagina and clitoris (a small but very sensitive arca just above the entrance of your vagina). Boys do the same with the penis. Food as necessary as rninerals, vitarnins, and proteins. Deprived of this food the name of which is love, babies would rather die. And they oft€n do. How Your Body Works Heman and Nina Schneider $4.95 from William R. Scon Books Addison-W es ley Pub lishin g Reoding, MA 01867 Meditation for Children Dozens of nifiy ex.periments you con do Deborah Rozman at home to leam how your body works. --TF 1976; 15l pages M.95 postpaid from Celestial Arts 231 Adrian Road Millbrae, CA 94030 The author-who teaches meditation in elementary school-shares her techniques of teaching meditation to children, and suggests sharcd family meditstion ss a means to family unity ond understanding. A fine intoduction-for adults and chidren alike*to meditqtion cts centering, self-obsemation, growth. _TF 1975; 55 pages $8.45 postpaid from: Lyle Stuan, Inc. 120 Eoteryris€ Avenue Secaucus, NJ 07091 What's an erection? A wet dreom? A period? Wlry am I getting lumps on nry chest? What is masturbation? This book is a good book for a child about ten. It has answered a lot of my questions about puberty. Jenifur Thome (Age 10) Taste Experiment You will need: a slice of apple cut into thin pieces, a small slice of pear cut into thin preces. and a lnend any size. but not in pieces. Try this. Tell your friend to shut his eyes. Hold lhe piece of pear under his nose and put a piece of apple in his mouth. Ask him what he's eating. You will find dlat he'll tell you it's a pear. This shows that we use both nose alld tongue to taste food. In fact, most of the tasting you do is with your nose. Do you know, now, why foods don't taste like much when you have a cold in the nose and can't smell?
  14. 14. by the n+o sexes lead lo predictqble con- Mid-Life flicts within couples. I was brought up to think of "adulthood" as a smooth , even highway between the rough tail of adolescence aM the dwindling roadway of old age. Not so. Growing up is not-forrunatelysomething that stops at 2 I . Or ever. (Out in paperback May, 1977.) Passages Cail :TF Sheehy For the past fifty years, Americans have likely to break out of wedlock when the man is about 30 and the woman 28- nal valuations and accreditations, in search of an inner validation. *** Whatever counterfeit safery we hold from overinvestments in people and instirutions must be given up. The innercustodian must be uqseated from the conrols. No foreign power can direct our journey from now on. It is for each of us to find a course that is valid by our own reckoning. And for each ofus there is the opponunity to emerge rebom, authentically unique, with an enlarged capacity to love ourselves and embmce odlers. *** been most *** How long can one delay adult cofiunihents before becoming a failure? Judging by George Bernard Shaw, it is possible to be a no-count, disagreeable wanderer, inwardly toment€d by cowardice and pcrsonal shoncomings, at least until the age of 30. . . . this long period of unfettered exploration allowed for ttle filling out of a personality dlat thcn burst fonh to take is place among the world's great aristocrats of idiosyncrasy , *** ... dte fonies, as wriier Batbara Fried so succinctly capore dlem, are a time when it se€ms no matter what course one has pulsued, It is a paradox that as we reach our prime, we also see there is a place where it finishes. Men's Health The Inner World of the Middle-Aged Man Peter Chew "everything is tuming grey, drying up or leaving home. I Pa* Avenue New York, N.Y. 10003 The author crackd up-briefly---at age 35, and discovered that many of het contemporaries had had similar experiences at the same qge. This led her to research the crises ths1p6sv7-u'ith sta7l- ling regularity---at specific times in adult l,fe. Finding a mushrooming research literature on adult dzvelopmental stages, she versed herself in the writings of Else Frenkel-Brunswick, Erik Erikson, Daniel Levinson and others , then went on to verily ond flesh out their speculations by doing her own in-depth intemiews with I 15 qdubs beth,een 18 and 55. The result is a beautifully wrinen thoughful book on common r** Very recently in America, Masters and Johnson have indicated that thc man of60 will find geatcr sexual contentsn€nt if on two out of thre€ occasions, he reserves his ejaculation a.ltogether. ln thai way, s€xual tension will accumulate to a climax wonhy of his expectations. A.lthough this notion is only now being $10.95 postpaid from E.P. Dunon & Co. 20 " liJe , problems, gingerly advanced in this country, in Oriental cultur€ it has been the ideal. *** Cad Jung was the first major analytic thinker ro view middle life as the dme of maximum potential for personality growth. We yearn at that time for the undividedness of self that has always been lacking. As the hop€ of finding security in another valishes, the conflict is brought to a head. Cons€quently, mary of our archetypal imag€s of "feminine" and of "masculine." images we unconsciously project upon a mate, can b€ withdrawn. Jung ialks about the necessity to "confront our own conFas€xual aspect" and to integrate it, which makes possible an extraordinary enrichment of all experience. *** Thc most important words in midlife areto you. Let it happen to seen in a context of normal aduh development. Sheehy' s biggest individual contibution is to juxtapose studies of men and your partner. L€t the feelings, women-tnost studies have considered you leave on the midlife journey. You either one or the other---4nd to point out how the difrerent life tajectories followed l€t Go. l,et it happen l€t the changes, You ca['t iake everything with you when are moving away. Away from institutional claims and other people's agenda. Away from exter- 19761' 278 pages $t.95 from Macmillan Publishing Co. 866 Third Avenue New York, N.Y. 10022 C o mmo n p ro b I e m s ---<nd s o lut i on s----ts experienced by men between 30 and 60. The sudden md-life stockiaking thqt lead men to sail ocross the Atlantic alone, to run offwith their secremries , to walk away
  15. 15. MEDICAL SELF.CARE I5 from secure but deadening jobs , to become hermit-monks----or to Jind new meanings in c ontinuing exist in g patt e r ns. H ealth problems. Impotence problems. Rehtionship problems. Employment problems. Waking up at 40 to discover you have no friends beside your wife. Seeing yourfriends have heqn attacks and realizing that your eating, smoking, snd exercise habits mak you a high-risk candidate for one of your own, A much-needed look into the woes q.nd opponunities of men' s lives. _TF The men hardly ever tell their wives they love them. "I have reyer seen my husband cry," is a familiar observation. For thek part, the husbands complain thar their wives are either unwilling or unable to provide the kind of emotional suppon they feel they require, Often, says Heath, the men reach out rather desperately for their daughters. "I was puzzled, too, by the large number of men who had not made any close friends since college," says Heath. "The typical pattem is to be exclusively preoccupied by work and by one's family. One psychological consequence may be that the burden offulfilling one's needs for intimacy, emotional release, and support falls very heavily on one's wife." During a young man's striving for success, he must repress rnany qualities that are associated, righlly or wrongly, with the feminine. Women's Health they evoke. Afterwards, one of the nurses goes through the extrqcl, counting head, thorax, trro arms, and two legs----to remsrkable reporring. The scene is captured whole----<tched with q rqzor knife. The inticacies patient. The strqnge atmosphere somewhere between that of a birth and a funeral. Beyond the polarization ofpto qnd con, this book provides us with the visceral dato we need to Iully recognize this tvw Life Experience which has taken place beside birth and dying--+he deeth-in-birth of the abortion. "Hi," I say. "l am DoctorDenes,Iam her€ ." I am stuck. These are very pEgrxrnt to . . In Necessity and Sorrow Magda Denes *** offt I take the lid off all the buckets. All of them. reach up to the shelf above this bucket graveyard tabletop and take down a pair of I forceps. With them I pull aside in each bucket the placenta, which looks like a cancerous rnusl[oom sbrouding the fetus. With the forceps I lift the fetuses, one by one. I lift them by an zum or a leg, Ieaving, as I retum them again, an additional bruise on their purple, wrinkled, acid-soaked flesh, I have evidently gone mad. I carry on the examination, whose sole pupose by now is to incrcase the unbearable anguish in my hean. Finally, I lift a very large fetus whose position is such that, rather than is face, I first see its swollen testicles and abnormally large stiff penis. I look at the label. Mother's name: Catherine A&ins; doctor's name: Saul Marcus; sex of item: male; time of between the life *** For more than a decade, Heath has been conducting a study of nearly seventy Haverford graduates who are now in their early- to mid-thinies. Heath tells me thes€ men are exceptionally intelligent, hard-driving, and "successful" in their careers. Their marriages. however, arc another story. One-third of the men bave b€€n divorced or have suffered disruptive marital difficulties such as separations. The wives' almost unanimous complaint is that (heir husbands give so much of themselves to their work ftat they have litde emotiona.l substance left for them. children. My shock is unclasssifiable. It is not moral indignation, not compassion, not identification, not horror, not anything I can name. lt is an organismic response ofparalysis. As ifby a blow in the solar plexus, the wind has been knocked out of me. Abortions in my mind happen to grown-ups who arc unwillingly pregDant but don't look it. These are little girls far gone with child. *** thinks that if he gains the deserved success, he'll be all set. The answer is, he will not. He is going to have a transition whether he is affirmed or not; it is only the form thar varies. "The central issue is not whether he succeeds or fails in achieving his goals. The issue, mther, is what to do with the experience of disparity bewtee'' wbat he has gained ir an inner sense from living within a panicular structure and what he wants for bimself. The serNe of disparity between 'what I've reached at this point' and 'what it is I really want' instigates a soul-searching for 'what it is I really want.' "To put it differently, ii is not a matter of how many rewards one has obtained; it is a matnr of the goodness between _TF "The midlife transition occurs whethe! the individual cucceeds or fails in his search for affirmation by society. At thirty-eight he structure and the self." of interaaion male doctor and all-female attendants and During his soul searching at midlife, these "other voices" in "other rooms" of the per- sonality, as Truman Capot€ put it, demand to be heard. The man who has aligned his personal destiny with the corporate purpose of, say, BM or Genenl Motors, or Amalgarnated Widget, rarely has the time or the inclination to pursue music, art, philosophy, science, religion*the things that will provide the purest happiness in later life. be sure there are no body pqrts lefl insde the uterus to cduse infection.) As notoble for its fne writing as for its 19761' 247 pages $10.fi) postpaid from: Basic Books l0 E. 53rd St. New York, N.Y. 10022 A journal by a woman who retumed to the scene of het ow, abortion and spent seyeral months observing the process she herself had just gone through. (l've assisted at enough of these occassions to recogniTe the peculiar Jeelings gestation: twenty-four weeks. I remember Catherine. She is seventeen, a very prEtty blond girl. Not very bright. This is Master Atkins-to be bumed tomonow-who died like a hero to save his mother's life. Might he have become someday the only one to truly love her? The only one to moum her death?
  16. 16. 16 MEDICAL SEI,F.CARE Medical Self-Care Awards 1976 .-srli5x:3t* We've had a number of suggestions-from librarians with limited budgets among others-that we print a list of the best ten popular medical books. Seems like a good idea. We like the thought of encouraging the writers and publishers who produced thesebooks. For libraries interested in sefting up selfcare collections, these might be a good start. The books we've chosen are the ones we're getting down from the shelf to show to friends. A number of books have unaccountably disappeared ftom our ffices recently-all of them from this list. We'it be making these awards annually. This time we've listed our favorites regardless of the year of pub' lication. In years to come, we'Il limit ourselves to new books published within the preceding year. , - , Heie are the books that received Medical Self-Care Awards for 1976-for excellence in writing and publishing in the area of medical self-care. rbtrffi Doctor C.-@"0_ rrtalitlwS€luct,ld.D fuldrjLdq I How to Be Your Own Doctor (Sometim€s) Keith W. Sehnert, MD with Howard Eisenberg $lO.7O from Crosset & Dunlap, Inc., Box 941 Madison Square Station, New York, NY 10010 How to go about becoming Your otn paramedic- Differs fron most medicql guidebooks in that it assumes that the reader is capable of learning some basic clinical medicine. An enjoyable, highly readable work that will take you safely across into territory you msy have thought of as for doctors only. P11511n76Y6!f!lnc lbwtll Take Care of Yourself: A Consumer's Guide to Medical Care Donald M. Vickery, MD James F. Fries, MD $5.95 hom Addison-wesley Publishing Company, Reading, MA 0186? of this book is 68 biq' detailed flow-chorts--4ne for each of the most The heart common complaints that bring peoPle to a doctor's office. Key questions are listed for each. A system of branching logic -helps you decide whether to ( I ) see doctor NOW, (2) see doclorwithin afew days' or (3) apply home treotment. The best home medical guidebookwe've seen. o tJ:].drn o 5^1.€y.boxo Personal Health Appraisal Walter D. Sorochan $5.95 from John Wiley & Sons, 605 Avenue, New York, NY Passog€s Gail Sheehy Third 10016. Self-administered workbook for evaluating your own present heqlth starus, by a professor ofhealth educqtion at Son Diego State. Finding areas in your life thqt coud beneft lrom some anen ion. Taking responsibility. Making changes. $10.95 from E. P. Dutton, 201 Park Avenue, New York, NY 10003 A well-written account of adult stoges ol development, and the predictable life problems that accompany each. A muchneeded road map to the nngled web of mid-adulthood.
  17. 17. MEDICAL SELF-CNIE 17 OIIR BODIES. OURSELVES The Joy of Running Thaddeus The Relaxation Response Herbert Benson, MD Kostubob, MD $3.95 from J. B. Lippincoit Company, East WashirEton Square, Philadelphia, PA 19105. Running for your health. Not grueling, forced pushing yourself beyond your lim- its, but running slow and long and peaceThe author, a psychiatrist and dis- fu|. a tance runner, kads you through sequence oJ pltysical and psychological con- Our Bodies, Ourselves $1.95 from Avon Books, 959 Eighd Avenue, $4.95 from Simon and Schuster, 630 Fifth Avenue, Boston Women's Heahh Book Collective New York, NY 10019. Meditation in clear, plain language. Its hismry, how to do it, what it does for you. By a lrypenmsion specialist at Harvard Medical School. New York, NY 10020 A new edition of an old favorite. A readable, personal, down-to-eorth Buide to physicql, emotionol, and social aspects of women's health. Treats women as whole beings deseming of personalized medical care. ditioning. The best introduction to running we've seen. Howlo (&REcocnipl HiohQuolitv HdolthCor6 D6mornd ARTHUR The People's Pharmacy tMN, M.D Joe Graedon Talk Back to Your Doctor Arthur Levin, MD $8.95 postpaid from Sr. Manin's Press, l?5 Fifth Avenue, New York, NY 10010 $7.95 from Doubleday & Co., 245 Pa* Avenue, New York, NY 10017 Type A Behavior ond Your Heart Meyer Fiedman, MD Roy H. Rosewnan, MD $2.30 from Fawcett Publications, Greenwich, CT 06830 The most readable and helpful bool<s, prescription and non-prescription drugs for laypeople. By a pharmacologist who knows his sttfi and shoots from the hipAccessible, readable, useful information, well-indexed and well-documented - The principles oJ good medical practice, clearly spelled out. Evaluating d.octors and hospitals. Changing physicions when necessary. Seeking a second opinion. Knowing what your doctor iJ supposed to be doing. Being an informed medical consumer. How personality factors can increa:te your chances of hean disease. Speedy, impatient, highly competitiye, easily irritated. men are at increased risk. This book tells Type A men how to reduce their risks by slowing down, becoming less competitive, leaming patience.
  18. 18. 18 MEDICAL SELF.CARE Medical Whoever or whatever causes you to s€ek help does not really matter, but therein does lie an important fact )o! are a goodjudge ofyour own mental heahh. That is not to say that you Consumerism have all the answers, know all the caus€s and/or effects, or can chalge your behavior The Corxurner's Guide to Succcssful Surgery Dr. Seymour Isenberg Dt. L.M. Ehing and without help. But you do have a good reading on how much difficulty you have coping witlr thg situation and circumstances of your life. The validity of your appraisal of your own mental health has an important corollary: yon are the best judge as to whethcr therapy is worthwhile. Through The Mental Heahh Moze Health Research Group List of Publications Free from Health Res€arch Group D€parEnent P 2000 P Street, N.W., Suit€ 708 Washington, D.C. 20036 -from *** This is the health wing of Rolph Nader' s consumer rights organization. They put ou, dozens of valuqble publications in the area of medical consumerism. Our Checkbook Health: favorites: D.C. ) metropolitan area, A guide to heahh care in the (washington, for Compiling a Consumer's Dircctory of Doctots ($l .0O) Guide -A Guide for Compiling a Consumer's -A Direcrory of Dentists ($1.00) tle Mental Heal t Moze: -Through A Consumer's Guide to Jinding a Psychotlrcrapist, Inclu.ding a somple Conssmcrtherapist Contraa ($2.50) --fF 1976;341 pages $10.m postpaid from: St. Martin's Prcss 175 Fifth Avenue Preliminary Rcserrch Compile a list of licensed, practicing docton. Consult the yellow pages to begin to compile the list of practicing physicians and New York, their addr€sses and telephone numbers in the arca !o b€ surveyed. Beware, however, the yellow pages may include names of indivi- An insider' and Washinglon, D.C. as 'physicians' in the yellow pages wer€n't even licens€d to practice medicine. -A *** The best way to publicize your manual is through the rnedia. Call a press confer€nce and disfibute a prcss package. lnclude copies of a press release with the name and address of your group and the location whcrc individuals can buy a manual. l.€t the m€dia take if ftom herE. Articles in local newpapen, time on local radio stations and s€gnents on the local nightly news should elicit heavy respons€ ft,om people who want to buy tbe manual. Sell the manual at the lowest cost possible, so all individuals catt bave access to it, and so that iflitigstion should develop you will be ir a better position to argue that your directory des€rves legal prct€ction. Think seriously about giving a discount to Medicaid ard Medicare pstients. -A Guide for Compiling a Consumers Directort oJ Doctors look at what happens on the opinions, and to thoroughlt understand showed that as many as 5% of all persons listed Guidc for Compiling a Consumcrs Direcrory d Doctots s 10010 surgical ward. What to expect in the way of procedures aad routines. Encourages you to review your own chart, seek other duals who ate not licensed physicians. Surveys in New Yo* City NY 19761' ll2 pages $4,95 postpaid from Washington Cent€r for the Study of Services 19l0 K SEeet, N.W., Suite 303 what s happening before ogreeing to atry surgical procedure . Makes going through surgery sound as scarey as it really it . Fascinating reading , even if you're not considering surgery. Should be a help and a comfon if you are. _TF Washington, D.C. 20006 This excellent, unique health guide devotes about half its space to listings of local (Washington, D.C.) resources, the other half to teaching general medical consumer skills in eight qreas-Emetgency Rooms, Health Maintenance Orgoniza- tions, Doctors, Drug Stores, Abonion Clinics, Nursing Homes, Dentists, Healrh Insurance. Vahutble whether you live in D .C . or not. A fine model for onyone thiniing about puttinq together a local health directory. -ljatha Hesselden What about room locarion? Don't let them slap you in inywherc. Get back there and look at th€ room. Not all hospitals will be happy to let you do this but you've every right to. lfit is situated acrcss from the nurses' station-that large round desk in the corridor that is head- quaners for the floor-try to get it changed. You may have the enon@us idea that the closer you are to the nurses' desk, the better carc you'll get. For some reason many doctors also think this is true. What you'll get is insomnia. Nurses arp noisy. They rattle metal chart coverc, drop things, us€ the phone, laugh, talk, and generally scamper around. If you want any peac€, the room fafihest from the
  19. 19. MEDICAL SELF-CARE 19 rlulses' station is for you. It takes as long for nurses to answer a bell across the hall as down These are the drugs about which most is known. Thei side effecs and adversc reac- each moment of their hospitalization. These doclors schedule everything in advance, so it. tions have b€€n b€st and longest studied. The best doctors will use thes€ "established" drugs in preference to qewer ones, whenever they that your day will not be idle for a moment-a "must" at today's hospital prices of $ 100 or more per day. By the same token, try not to be put near the utility room or the elevators. The flushing of bedpans and general clatter of utensils and elevators goes on all night. The idea s€ems to the staff can't sleep, neither should be anyone else. Ifyou're placed in a two-bed ward try to find out what your roommate is in for. This is the element least under your control, but if two rooms are available aDd one has a chrcnically ill, disoriented, noisy t€nant, try to get into the othel one. Don't be a martyr. You are entitled to get your room changed if a Foblem develops or the room you originally requested becomes available. Make sule the if admitting of{ice knows you would like lhis done. can. You can hnd out whetlrcr any drug has met the tpat of time, in terms of safety ard usefulness, by consulting the two official drug com- p€ndia: rhe U.S. Pharmocopeia atd trc National Formulary. Or look for the letters U.s.P. or N,F. on the drug package and package insert. *** hinciple: You should bewsre of atry doctor who treats by iqie'ction. This is particularly true if fte doctor is unwilling io tell you what he is injecting, or ifhe says you need a "series of shots" to cure your illness. There are very few adult conditioN (with of an acute asthma attack, heart attack, and other real emergencies) which requir€ injections. Diabetics necd injected insulin. but they can be taught to give it to *** Principle: You should obtein the opinioru of at least two surgcons bcfort having surgery. This is another way-Frhaps the b€st-to prolect youselfagainst um€cded surgery, The United Mine Worken fould, a few years ago, that their members werc having too much surgery. So the union instituaed this rulo-that all operations be endoned by a pr€operative surgical specialist's corsultation. The results: 75 per cent less hyster€ctomies, 60 per cent less appendectomies, 35 p€I c€nt fewer hemorrhoidectomies. the exception Talk Back to Your Doctor Arthur Levin, M.D. themselves at home. Patients wid "pemicious anemia" do ne€d monthly B 12 this is the only disease injections, but for which Bl2 is ne€ded-and it is a very rare diagnosis indeed. Mercurial diuretics are inject€d drugs which are useful in patients with hean failure and fluid rEtention, These drugs, too, can be selfinjected, like insulin, aftq instruction. frey should not be used as "diet" drugs, however, With these and a few other exceptions (cancer chemotherapy, for example, and desensitization shots for various allergies) the use of iojected drugs by a doctor in the long-term EeaEnent of adults is cause for suspicion. *** Hnciple: You should choos€ a hospital which trrins interDs atrd re6idents and, if ARTHUR LEVIN, M.D possible, one which is slso rfriliat€d with s medlc.l scbool. ln the Ladies' Home Joulnal list of "best" hospitals, all were "teaching hospitals" (intems and resid€nts), and all except a couple were medical school-affi liated. Overwhelmingly, doctors themselves choose such hospitals for their own or their families' care, And with good reason. In the $7,95 from Colulbia hospital sodies, chances of getting substandard carc werc more than three tines os Doubleday & Co. 245 Pa* Avenue N.Y. 10017 The pinciples of good medical core, New York, spelled out and expbined so that you can judge the core you yourself receive. The process of diagnosis, the standard steps in a doctot's visit, Lab tests, seedng a second opinion, going in for surgery. Best book on medical consumerism we've seen. Iril in hospitals without medical school ties. Chances of getting substandard care go up as you go down the hospital "p€cking oder. " *** If you csn, avoid etrtering the hoGpitrl before treekends or holidays. One hospital administrator I know suggests Principle: that Tuesday (or Morday night) is Fobably the best time to enter the hospital. This, he kinciptre: In general, the oldest drugs sre explains, is the time when the hospital, and its staff, has rerovered from the weekend and is probably most Foductive. A hospital stay is not a vacation. The b€st th€ saf€st ones. doctors plan to ke€p their patients busy during --TF Health Activation News $4.fi|/year from Health Activation News Center for Continuing Health Education Box 7268 Arlinglon, V A 22207 News of medical education classes and programs for lalpeople . They also publish several medical self-care course guides for people interested classes qnd various locations to care in teaching such run regular workshops in tain health self- cLesses. The center also operates a "health sctivation network" thot motches people in- terested in self-care with others in the sane re commende d. area. H i ghly _TF A Patient's Bilt of Rights American Hoipital Association Free from American Hospital Association 840 Nonh l-ake Shorc Drive Chicago, Ill. 6061I Hospitalized patients do have cerrain specified rights-though they aren't always aware of thetr the right to privacy, the right to rerttse to be seen by those not directly involved in their care , the riqht to be informed, the right to refuse treatnent , the right tofollov,)-up care arter discharge. This docwnent shouU be provided to every hospitolized patient on admission. rarely is. Bring tou own. _TF It .
  20. 20. 20 MEDICAL SEI"F.CARE I that says "take five steps," but unless Therapy/Growth say "may I?" I get put back or put mys€lf back. After the session I tested my power, and that kind of extended the sessior fufther . . . when Kad wanted to read instead of going to bed, alrhough not coming right out with ir, I did tell him that there was something between reading and deep sleep. *** Every Day Gets & Liftle Clos€r Imin D. Yallom and Ginny Elkin Dr. Yallom: I've been in Ihis business a long time, but the interview today represent€d one of my peak experiences as a therapist . . . I was near tean on a couple of occasions. It was so good to se€ the fiuits of long and very hard labor . . . all the issues that GiIlIly had talked about with me, all the fears that were so irrational, all the things that she was afraid to say, 1974; 244 pages 0E.95 &om Basic Books l0 East 53rd St. New York, N.Y. 10022 A unique, two-sided record of a therapist-client rcl.ationship over a year ond a half of weeHy therapy. Theropist Yallom and client Elkin both kept sessionby-sesion journals which are printed v,ithout addition or correction. A realfceling ofthe offections and resistances and the nail's-poce but very real she faced today in the session, and has faced on her own with Karl during th€ past s€ven days. David Shapiro . . *** Ginny: Yesterday's session . . . I begar to feel why I defear myself. I play the children's game Fr- *** Paranoid Style-Whlle the normal pcrson feels not only competent, but also ftE€ to exercise his will, and, in that sense as well, self-directing, in charge of his own lifc, and, master of himself, the paranoid person is continuously occupied and concerncd with the threat of being subjected to some extemal cootol or some external iofring€ment of his will. *** DAVIDSHAPIRO Frn'wrrrl bl Where, for the normal person, autonorny a sens€ of competency, pride, and brings liircrt PKnight s€lf-rEspert, the paranoid person, instead, is either arogant and ps€udo.competent or furtive and ashamed or, perhaps most often, bodr. *** Glnny: I am v€ry on guard in session now. I know you want me to Fobe my fe€lings toward you . . . but I feel silly digging for realistic . andsatisfactions... cognitively to r€spond quickly and is highly susc€ptible to what is immediately impressive, striking, or merely obvious. *** things about my situation. And neither way is values soD tends [rrd! Will Wilh you I try to bc all bad, I say all the worst superc€de it in subj€ctive significancc. Forcbearance, under these circumstanc€s, anounts simply to the existencc of such int€r€sts ot . In the absence of such highly developed and stable structu€s, then, the impulsive person's prevailing interests----{s the patielt with the fallout supply kit idea illus!'ates-arc dL€cEd toward immediate gains longed searching for detail, the hysterical which is to get at some things, although I wonder if I wasn't just Eying to imprcss her, tying to make her fall in love with me. Good *** frusuation or extend beyond the whim and tively lacking in sharp focus of att€ntiotr; in contrast to the compulsive's active and pro- Dr, Ydlom: I was very good today. It's Ginny: With Kad I ry to be dl good, simultaneously storilg my mistakes in my brain. interest€d in things; his heart is set on goals atrd intercsts that are indeperdent of the immediate Jionr'.rric. In contrast to 0re active, intense, and sharply focused attention of tbe obsessivecompulsive, hystedcal cognition seems rela- Neurotic Styles almost as though I am performing in ftont of an audience, The audience that will rcad this, No, I gu€ss that isn't completely tuo-now I'm doing thc very thing I accuse Ginny of doing, them. I've always been honest in saying what I'm thinking, but all I've really b€en is the top part of the flower, and never crawled under the din and exposed roots. My sincerity is pretty superfrcial. Impulsive Style--Tlrc normal person "tolerates" frustration or postpones the satisfaction of his whim at least in part be.cause hc is also *** -:IF sky . . . Here I am trying to h€lp Cinny with survival problems and I'm still burdened down with my owrl petty vanities. JF Hysterical Styl€-ln a word, it is inpres- progress of ongoing therapy. I never be frce of that? No, it's still there. I have to ke€p an eye on it. What do I want her to love me for . . . Is it that I want to be known by Ginny as tbe person who cultivated her talent? TherE is some ofthat.. At one point I caught mys€lf hoping that she would notice that some of the books in my bookcase were nonpsychiatric ones, O'Neill plays, Dostoev- Insights into the behavior pattems of friends and associates, and, less confortably but more helpfully, ourselves. 1965; 207 pages $3.95 fiom Harper & Row l0 East 53rd St. New Yotk, N.Y. lm22 A psychoanalyst describes four com- mon personality styles----obsessive-compulsive, paranoid, hysterical, impulsivegiving us a feeling of how each person experiences the world. A rare psychiatric textbook, in that it gives useful information on people on the pretty-much-rnrmal end of the sane-crazy continuwn. Obsessive-Compulsive Sryle-Will power, so characteristic of the obsessive-compulsive and so adaptable to routine work activity, is comprised exactly of the experience of issuing willful commands and dLectives to oneself. This style of activity and expedcnc€, it will be clear, also implies a special kind of selfawar€ness, an awarcness of the overseer sitting behind and issuing commands, directives, and reminders, that the obsessive-compulsive person is never rvithout. It is the s€lf-awareness of who is working und€r plessul€ with a stopwatch in hand. Since, for the obsessivecompulsive, virtually all of life is trarsfomred into such activity, the experience for him is continuous. We s€e this, for example, in the role-playing that is characleristic of these peoa person ple.
  21. 21. MEDICAL SELF.CARE 2I Dying/Grieving Gramp Matk Jury and Dan Iury Frank Tugmd and his grandson, Dan Jury, 1954 1976; 152 pages $5.95 postpaid ftom: Grcssman Publishers 625 Madison Avenue New Yo*, N.Y. r0O22 The record of a family' s experience up m and through the death--at home----of their grandfather. Horrible, wonderful, of for and compelling. A big accessible chunk stttf our cuhure doesn't prepare very well. us There have been lots of good books abofi death . This is a gut-level illustated record of the thing itse$. --TF A diary ofa nan whofinally dies. A very frealcy book. The first time I read this book I got freaked just looking at the pictures. Dan Jury and his grandfather, Frank Tugend, 1974 They are pretty heavy. -Jenifer Thorne (Age l0) The simplicity of Gramp's life style tended minimize difficulties he might have had with "forgedulness" and conftrsion. Essentially a loner, he spent his days chopping wood and to keeping up his Foperty, or taking walks in the surrounding woods. When he was with others, it was usually his family-who saw him every day and didn't really notice, or comprehend, lhe changes that were taking place in Gramp. *** Granp's bizare dressing habits, coupled with his erratic behavior, meant the end of friendships that had remained intact for decades. Most p€ople who had known Frank Tugend as a r€spected, proper pillar of the community just couldn't take being around him as he shuffled about in his wife's red velvet hous€coat or blew his nose loudly on a pair of Nink's underpants that he'd found and decided !o use as a handkerchief. Nan was deeply affected by the oso-acism. "Peoplejust don't want anything to do with us because of Gramp, " she said bitterly ot Chdstmas day, when none of the usua.l holiday visitors showed up. *** The momings were the most difficult time for Gramp. ln contsast to the frenzied activity of the right, by moming he often s€emed in a dazp. When he didn't respond to her wake-up call one moming, Nink became frigh&ned and exclaimed, "Dad! Dad! Wake up! Arc you all right?" Gramp rolled over, barely opened one eye, kill the Easr€r Bunny and said, "Did they yet?" ***
  22. 22. 22 MEDICAL SEI.F.CARE Blders Aglsm is the notion that people cea!€ to be people, c€as€ to be the same people or beaome people of distinct ard inferior kind, by virtue of having lived a specilied number of ye3.rs. Like racism, which it r€s€mbles, it is bas€d on fear, folkw€ar artd the hang-ups of a few unlovable people who propagat€ these. Like it needs to be met by information, contradiction and, when nec€ssary, conftontation. And the people who are being victimized have to stand up for tbemselves in order io put it down. racism, A Good Age Alei Comfort *** AIFJ(COMFORT 'Thisbookisnntonly old^ All wnplp, of all oUeS wed tlw basfu, facts Thnse nuu dt rrsttix,e stmlqies Tlnse wt yet calkd old, need tn rcalin whnt is in sfuv fn tlwn fur th,e w M iftlwlatthiw *** Digrity. Stand or this. (See Pulling Rank-) other people don't recognize it, put them dowD---othd oldcr people d€pend upon the degee ro which you ensure that anyone who thoughdessly displays agism doesn't get away with it. fo Ursula K. Le Guin The menopause is gobably the lcast glamouous topic iDaginsble; snd this is bterEsting, bccausc it is onc of thc very f€w topics to which cling some shrcds and rpmnants of The best, mott accessible work on thc lrboo. A s€rious mentiotr of menopausc is facts and fiaions of oldncss. usually met with uncasy silcncc; a sD€ering rEfetEncc to it is usually met with r€lievcd author pf T'Ilc Joy of Sex Alcr Comfon makes it cleqr that a good deal ofwhat we think of as aging is not biological but social, psychological, and political. Certain roles aad pat erns are imposed on sniggers. Both the silcnce ald the sniggering ar€ prctty sure iDdicstio[s of taboo. Most people would considcr the old phrasc "changc of life" a euphcnism for thc rD€dic8l term "mcnopsus€," but l, who am now goitrg thrcugh the change, bcgi! to woodq if it isn't the othcr way round. "Changc of lifc" is too Novelist, poet, gerontologist, and people wlo have been around longer thon some of the rest of us . They are arbitaily .defned as unintelligent, unemployable, cra4t, and asexual despite oll evidence to the contrary. Dr. Comfort calmly suggests revoh - Beautifully designed and illustrated with portraits of robust oldsters. A fine marshalling of faas convinced me that a good deal ofwhat I' d believed about oging was nonsetute. In the long view, there are no young. Only the now old and (myself included) the new old. _TF blunt 8 phrasc, too'factual. "Mcnopsu!.," with its chie€-suggestion of a merc pause aftcr which thitrgs go oD rs beforc, is reassurirgly rivial. But the change is not trivial, and I bqgin !o won&r how many women atr bravc cnough to carry it out whole-hcartedly. Thcy give up their rcproductive capacity with morc or lqss of stuSglc, and wh€n it's gon€ rhcy think thar's all thcr€ is !o it. Wcll, at lesst I dor't get thc Cursc any more, tbcy s8y, and the only rEason I felt so deprrss€d somctirncs w8s hqlroDcs. Now I'm myself again, But this is to ev8de thc rcal challenge, and to loi€, not ody tbc crpscity to ovulate, but thc opportunity to b€conF E Crone. a ptactic€. They had alrcady changed their life radically once before, when tbey ceased to bc virgins and became maturc women/wivcs/ matons / mothers / mistresses / whores / eic. This changc involved not only the physiological alt€rations of puberty-6e shift ftom bar- ten childhood to ftuiffil maturity--$ut I socially rccognized alterstiotr of b€ing: a change of condition ftom drc sacr€d !o the With the secularisation of virginity now complet€, so that the once awesome tcnn "virgin" is now a sneer or al best I slightly dated word for a penoo who hasn't copulrt€d yet, the oppofiunity of gaining or rcgaining the dang€rous/saqpd cordition-of-b€ing at th€ Second Change has c€ased to be appstlnt. Vfugirity is now a mere pt€amblc or waiting-room to be got out of as soo! as possible; it is without significance. Old agc is similarly a waiting-room, wh€rE you go sfter life's over 8nd wait for cancer or a stoke. Thc years before and after the menstual years are vestigial: the only meaningfrrl condition lcft to women is that of fruifrrlncss. Cu.iously, this rcstiction of significance coincided with the development of chemicals and instuncDts which make fenility its€lf a mcrdngless or st least s€aondary characteriltic of female matur- ity. The signilic&ce ofmaturity now is not the caprcity to cooceivc but the mcr! ability ro have sex. As this ability is sharcd by pubc8- On Menopause: The Space Crone $9.95 from: Crown Publishers 34 Englehard Avenue Avenel, NJ 07001 accepted thc challenge. Thcy had, after aU, had profane. Ther€ is a slight positive rElation bctween industial productivity and wor*er age, and older workers have a 20 Frcent better abselteeism record than yourger workers. They also have fewer disabling and non-disabling injuries, and the fte4ucncy of accidents docreases with age. At this point convention decr€es that we stop employing them. If In the old days women who survived long enough to attain the menopause morp oftcn

×