text:
My SciELO
Estudos Feministas
Print version ISSN 0104-026X
Estud. fem. vol.5 no.se Florianópolis 2010
Gender differences and the medicalization of sexuality in the creation of sexual dysfunctions diagnosis
Fabíola Rohden
Universidade Estadual do Rio de Janeiro
Translated by Regina Célia Camargo
Translation from Revista Estudos Feministas, Florianópolis, v.17, n.1, p. 89-109, Jan./Apr. 2009.
The article aims to analyze critically the most important and updated contributions focused on the recent stage of the medicalization of sexuality. Most works center on the production of the category and the diagnosis of "sexual dysfunction," considering either the masculine case (more largely studied via "erectile dysfunction"), or the feminine case (in many cases translated into the idea of a supposed complexity of women's sexuality). The perspective I utilize has as a reference the social studies of science and, in particular, the contributions of anthropology and history of medicine. In addition, it incorporates the matrix of the gender and science studies that have produced a powerful critical view of the scientific production of the two last centuries, revealing how the gender conditioners have crossed the relation between knowledge production and social context.
Keywords: Sexuality; Medicalization; Gender; Sexual Dysfunction
O objetivo do artigo é analisar criticamente as contribuições internacionais mais importantes e atuais que têm tomado a etapa recente da medicalização da sexualidade como tema de pesquisa. A maioria dos trabalhos centra-se na produção da categoria e do diagnóstico de "disfunção sexual", seja considerando o caso masculino, mais amplamente estudado pela via da "disfunção erétil", seja o caso feminino, muitas vezes traduzido pela ideia de uma suposta complexidade da sexualidade das mulheres. A perspectiva que utilizo tem como referência os estudos sociais da ciência e, especialmente, as contribuições da antropologia e da história da medicina. Além disso, incorpora a matriz dos estudos de gênero e ciência que tem produzido uma poderosa visão crítica da produção científica dos dois últimos séculos, revelando como os condicionantes de gênero têm atravessado a relação entre produção do conhecimento e contexto social.
Palavras-chave: sexualidade; medicalização; gênero; disfunção sexual.
In the last few years, the avalanche of news regarding sexual dysfunctions and, above all, its broad definition and the range of treatments available has become really apparent. Since the launching of Viagra, in 1998, we have seen the consolidation of new era in the process of medicalization of sexuality guided for the most part by the pharmaceutical industry. Numerous people make use of the innovative technologies related to sexual performance. They are hit by the constant normative discourse regarding sex expressed, for example, in the notion of "sexual health," which was already been officially denied by the World Health Organization1.
However, it is also worth noting that there is a relative scarcity in terms of the undertaking of scientific work addressing this phenomenon in large proportion worldwide, especially considering the field of collective health. Perhaps, this reflects certain reluctance in the field about considering sexuality as a legitimate domain for investigation, especially when it refers, in a stereotypical manner, to the so-called "normal" sexuality, defined within the parameters of a heterosexual couple. The sex promoted by Viagra is the type focused on the idea of satisfaction and strategically separated from the historical constraints related to the sexual practice, such as in the case of unwanted pregnancy and of sexually transmitted diseases.2 Therefore, we depart from the plane of the studies about reproduction and birth control as well as of sexually transmitted diseases (STDs) and HIV/AIDS which have produced a robust structure for the analysis of the interface between sexuality and health.
The goal of this article is a critical analysis of the most important and current international contributions that has marked the recent phase of medicalization as a research subject. This medicalization is understood here as a very broad and complex phenomenon that encompasses definitions of medical terms defining deviant behavior as well as scientific discoveries that legitimize them, and proposed treatments and the dense net of social interests, both political and economic that are at play.3 It also includes more specific questions regarding the process of de-medicalization involving the loss of power that were once the strict realm of doctors to the pharmaceutical industry or the broadening of a collection of professionals destined to treat sexuality. 4 In a general manner, the works available belong to the category of science social studies. The majority is focused on the production of the category and the diagnostic of "sexual dysfunction," whether in the male case, vastly studied via the "erectile dysfunction," or in the female case, many times through the idea of supposedly complex nature of women's sexuality.
The perspective utilized here also owes to the social studies of science and, especially the contributions of anthropology and the history of medicine. However, a more accurate reflexion of the case in question is built upon the incorporation of the matrix of gender studies and science, which has produced a critical view of the scientific production in the last two centuries, revealing how gender conditioning has permeated the production of knowledge and the social context.5
In this sense, a phenomenon as complex as the recent medicalization of sexuality around the idea of sexual dysfunction can only be investigated in the light of the interaction of the multiple actors in the scene, such as researchers, clinicians, the pharmaceutical industry, the media and consumers and the intense interplay of interests and outlook of the world involved in the discourse that is being produced. Elements such as scientific legitimacy, economic and political motivations, professional disputes and gender relations comprise a game of tensions, which also produces unexpected results.6
Next, I will introduce a panorama of the field of sexology in the XX century which provides context for the most recent picture of the medicalization of sexuality followed by a discussion about the creation of the categories "male sexual dysfunction" and "female sexual dysfunction."
The history of intervention around sex and even the creation of sexuality as a category and autonomous domain have been well mapped. In addition to the classical and seminal work by Michel Foucault,7 we add the contributions of Jeffrey Weeks, Thomas Laqueur, Vern Bullough, Anthony Giddens, Carol Groneman and Michel Bozon,8 to name a few. These bodies of work share a common arena where sexuality is perceived as socially constructed phenomenon toward which a series of competing discourses converge. Although, it is common to cite the origin of the promotion of sexuality in the medical interest in the so-called sexual perversions during the second half of the XX century,9 lesser attention has been given to the trajectory of the studies around sex, or to what came to constitute the field of sexology, in the XX century.
The basic reference, in this case, is the classic work of André Béjin10 and his hypothesis that sexology has two beginnings. The first sexology would be the one produced in the second half of the XIX century, a period during which reference works such as Psychoatiha Sexualis, edited by Heinrich Kann in 1844 and another volume with the same title published by Krafft-Ebing in 1886. This "proto-sexology" was focused on nosography, in contrast with the therapeutic approach, which would concentrate on venereal diseases, the psychopathology of sexuality and on Eugenics. The second branch of sexology came to be in the 1920's, marked by the work of Wilhelm Reich who started publishing about the function of orgasm in that period. Finally, the edition of the first study by Alfred Kinsey, in 1948, helped to cement orgasms a central issue in the new sexology11.
According to Béjin,12 proto-sexology concentrated itself in the difficulties relating to the working of the reproductive sexuality, such as sexually transmitted diseases, "sexual aberrations" and contraceptive techniques. It was not concerned in separating itself from other branches of medicine, such as psychiatry, legal medicine or urology. Now the current sexology seeks to constantly mar its autonomy in face of other disciplines, especially through the affirmation of a particular object, orgasm, for instance, and its essential norm, the "ideal orgasm." In addition, proto-sexology main focus was abnormalities and not on the so-called "normal" sexuality, heterosexual and reproductive. The science that studies orgasm, on the other hand, first established the norm of what is considered ideal orgasm minus the abnormalities, which it would be willing to treat. It is noteworthy that the modern sexologists do not translate these abnormalities in terms of "aberrations." Instead, they substitute the separation between normality and abnormality within a spectrum of dysfunctionality. As Béjin remarks, "if we face the demanding norm of celestial orgasms, we will find out that we are all "sexually dysfunctional."13
The author14 also points out that the creation of an increasing "clientele" for contemporary sexologists who have come a long way from their pioneers that only treated the "perverted" and the carriers of venereal diseases. This movement has propelled the creation of institutions of specialized teaching and the establishment of clinics for specific treatments. Furthermore, while the proto-sexology had developed its etiology summarily, allowing room for only one control a posteriori and repressive, articulating with prisons and asylums, the new sexology refines its etiology and develops means of control a priori e a posteriori, translated in the orgasm therapies and prophylaxis of sexual dysfunctions. A pedagogical function then entered the scene.
In a way, this panorama designed by Béjin described in depth in the book Disorders of Desire by Janice Irvine.15 The author shows how the field of sexology was constituted in the United States of America between the decades 1940 and 1980, emphasizing the multidisciplinary aspects, pursuit and controversy. Focusing mainly on the work of Kinsey, it reveals the impasses of the process of professionalization, cultural legitimization and the creation of a market around sex. The political tensions and the variation of historical and cultural contexts strongly influenced the development of research, interventions and the acceptance of new references about sexuality. Besides that, it directed the debates around the distinction between "scientific sexology," the main focus of this work based on the parameters of the scientific methodology and on the practices of the medical authorities, and "humanist sexology," more rooted in the psychological wisdom and centered in the acknowledgment of sexuality as the focus of personal realization, self-knowledge and individual satisfaction, which had a big impact starting in the 1970s.
According to Irvine,16 sexology underwent a process of rapid institutionalization in the XX century. In 1907, the German doctor Iwan Bloch was already proclaiming a formal definition of sexology as the study of sexual life of the individual from the standpoint of medicine and the social sciences. In 1919, Magnus Hirschfeld founded the first institute of sexology that was heard of in Berlin, reaffirming the centrality of Germany in this field of study during that period. In fact, in the beginning of the century one could count on the great works of Richard von Kraff-Ebing, Havelock Ellis and Sigmund Freud, all of them contributed to establishing the foundation of thought about sexuality in the modern world and were fundamental in conferring scientific legitimacy to this field. There was a significant diversity of theories and methods and a tension between the natural and social sciences translated in the polemic question of whether sexuality was inherent or acquired, although there was already an emphasis on biology. It is important to add that in the first decades of the XX century, sex becomes an increasing point of interest, not only on the part of doctors, but also jurists, legislators, Eugenicists, feminists and social reformers.
Having in mind this background, it makes it easier to understand the great impact of Kinsey's work, which signaled a new chapter in sexual research. It was precisely a scientist, a biologist that brought a new foundation to the scientific study of sex, regarded as a natural phenomenon. For Kinsey, the most recurring theme in terms of sexual practice would be what is considered natural; therefore, it should be studied by science and promoted or permitted by society. The great problem is that by focusing only on the physiological aspects of sex and overlooking social influences, Kinsey could not realize how much of his research findings were the result of social conditioning, for example, that women had a lower interest in sex or were less "capable" of having sex. His findings and his interpretations reproduced the marital and heterosexual "normality" of white middle-class America. His researches were financed between 1947 and 1954 by the Committee for Research in Problems of Sex, founded in 1921 with the financial backing from the Rockefeller Foundation aimed above mostly to biomedical research, and especially, to studies on hormones and sexuality. In 1948, Sexual Behavior in Human Male is published, compiling information collected from 5,300 interviews with men and he becomes a scientific authority on sexuality of the north America men and turning sex into a legitimate subject of investigation and treatment. The Sexual Behavior in Human Female, published in 1953, and containing information from 5,940 interviews with women, is not received the same way. It seems that the general public and the institutions were not ready for Kinsey's presentation on the sexual behavior of American women, who were more liberal then they were assumed to be. This is the explanation used to justify the loss of financing for his researches in the following year and also for his public condemnation by the American Medical Association.17
It is interesting that Kinsey, based on the results of his researches, was able to demonstrate the fluidity of sexual behavior, attesting for example, to the possibility of homosexual practices by any individual. But, as far as women go, although Kinsey made an effort to reveal their "concrete" behavior (highlighting, for example, the importance of the clitoris and the masturbation and questioning the vaginal orgasm) in contrast with the current suppositions and their similarities with men, the idea that women are less inclined to sex prevailed. By emphasizing that the biological aspects of sexuality connected to our mammalian origins, Kinsey affirmed that the sexual capacity of the individual depended on the morphologic structure and on the metabolic capacity, on the organs used for touching the surface of the body, the hormones and the nerves. He believed that women were less capable. In fact, his conclusion that women were less capable of enjoying sex resulted from his research findings in which women declared they had sex less often and experienced fewer orgasms. Kinsey rejected socio-cultural explanations for the differences between men and women. For him, the fact the women were "less inclined" to sex had less to do the moral and social conventions and more with a loss of interest in anything erotic related to some internal mechanism that functioned differently in men and women. He dedicated himself to searching for the roots of this difference in nerves and in hormones, but didn't find anything conclusive. What grabs the attention is his refusal to consider cultural determination that, at least since the XX century, prescribed a model of womanhood based on restricting sex to procreation. Moreover, he also promoted an idea that would become common in later studies stating that women had a more complex sexuality, with sexual practices that lead to orgasm less frequently (the great measure of sexual satisfaction to be pursued at any cost) and therefore, more difficult to be researched.18
Another important chapter in the history of sexology was the publication of Human Sexual Response, in 1966, by William Masters and Virginia Johnson, work that consolidated the alignment of sexology with medicine.Masters was an established gynecologist who became respected for moving from research with animals to human sexuality and, strategically, enlisting the help of a woman, the psychologist Johnson. It is evident that the book relied on medical authority and in its strategies to promote it, as well as in the emphasis on scientific research. Aside from that, this work offers a database on 694 individuals researched through observations in laboratory, among prostitutes and "respectable" voluntaries, and it was central in establishing a new legitimate sexual therapy. According to Irvine,19 the great novelty was the idea that the promotion of the idea that the doctor would extend his power of treatment and healing to the domain of sexuality, even going against alternative approaches prescribed in traditional marriage manuals, for example. In the social context marked by the big transformations of 1960s, a newly proposed sexual therapy was very well received. In 1970, they published Human Sexual Inadequacy, based on their analysis of 510 white, well educated and upper-middle-class, a demographic that was also more likely to accept the services of sexual therapy. Again, the emphasis is on the physiological aspects of sexuality and on the universality of the human body. Their most notable contribution was the elaboration of a model of the cycle of sexual response that would become a parameter for the modern research and sexual therapy, serving even as a basis for the classification of sexual deviations in the Diagnostic and Statistic Manual of Mental Disorders III and IV (DSM-III and DSM IV).20 This cycle was composed by the following phases: desire, arousal, orgasm and resolution. If for Kinsey the natural aspect of sex was what people said they were doing, for Masters and Johnson it was represented by the physiological responses observed in laboratory and that constitute a new standard of sex to be aspired to through sexual therapy. Their findings and the promotion that they had in the field were fundamental to the establishment of a new clinic market in the treatment of sexuality.21
Using the panorama designed by Irvine22, during the 1970s, what comes to the fore ground in not the production of a new great study, but the consolidation of two new categories related to the general notion of sexual dysfunction, but rather the concept of "sexual addiction," and especially the "hypoactive sexual desire," which had a longer repercussion. While the first afflicted primarily men, the second afflicted mainly women. If until the end of the decade the most common demand for sexual therapy came from "easy cases" related to "ignorance" or lack of information on the part of the patients in terms of sexual exercise and healed through Masters and Johnson's behaviorist methods, later new difficulties surfaced. The new complaints had to do with sexual boredom, low libido, aversion and sexual phobia. It is in this context that the notion of inhibited sexual desire or hypoactive, as Harold Leif defined in 1977, corresponds to a chronic failure to initiate or respond to sexual stimuli.23 In the 1980s, sexual therapists affirmed that this was the main problem reported by the patients, constituting half of the diagnosis and also the most difficult one to treat.24 In 1980, the American Psychiatric Association acknowledged the hypoactive desire as clinical entity and it included it in the DSM-III. Besides disputes in the field, a vision centering sexual desire as a biological impulse remains strong and it gains new interest with the investigations focused on the brain and in the hormones.25
Jane Russo26 contextualizes this phenomenon within a more general process of the medicalization of sexuality in the nosography of contemporary psychiatry. The DSM-III marked the passage between two different approaches: one that sees mental disorders as psycho-social and another that sees it as strictly biological. Psychiatry and Neuroscience have played a major role in the trajectory of re-biologization of humans and guided a new version of the manual that, among other things, abandoned the old hierarchy between organic and non-organic disorders in favor of a more general perspective in which all mental disorders have a biological base. In regards to sexuality, the author says that there has been an increase not only in the number of disorders and deviances, but also the creation of new entities. In the DSM-I (edited in 1952) there was a category for Sexual Deviance, within the Sociopathic Personality Disorder, in the group of Personality Disorders. In the DSM II (edited in 1968), the Sexual Deviances are still in the Personality Disorder and other Non-Psychotic Mental Disorders group, but there were already nine categories listed (Homosexuality, Fetishism, Pedophilia, Transvestism, Exhibitionism, Voyeurism, Sadism, Masochism, and other sexual deviances). While in the DSM-II (1980), Sexual Deviances were removed from the Personality Disorders and were incorporated in a group called Psychosexual Disorders with 22 items subdivided into four categories: Gender Identity Disorder, Paraphilia, Psychosexual Dysfunctions, and other Psychosexual Disorders. Psychosexual Disorders include the following: Inhibited Sexual Desire, Inhibited Sexual Arousal, Inhibited Female Orgasm, Inhibit Male Orgasm, Premature Ejaculation, Functional Dyspareunia, Functional Vaginismus, Atypical Psychosexual Disorder. In the DSM-IV (published in 1994), Sexual and Gender Identity Disorder are grouped together with the Sexual Dysfunctions, Paraphylias and Gender Identity Disorder. The Disorders, in turn, are subdivided in Sexual Desire Disorders (Hipoactive Sexual Desire Disorder, Sexual Aversion Disorder, Female Sexual Arousal Disorder, Male Erectile Disorder), Orgasmic Disorders (Female Orgasmic Disorder, Male Orgasmic Disorder, Premature Ejaculation), Sexual Pain Disorder, (Dyspareunia, Vaginismus) and Sexual Disorder due to General Medical Condition. The author argues that one can notice the automatization process of sexuality as a subject, at the same time that there is an expansion of the concept of dysfunction reaching the so-called normal sexuality. A typical example of this trend would be the use of, in the DSM-IV, disturbances associated with the cycle of sexual response (based on the definition by Masters and Johnson) and with pain in intercourse, with each phase having its own correspondent disorders.27
This new chart of official classification of sexual disorders is part of a broader and more general context. It was also used as a foundation for a more an "accurate" definition of the possible sexual problems afflicting the common individual. In addition, it legitimized the promotion and commercialization of a new and broad range of treatments, starting with the so-called erectile dysfunction.
Barbara Marshall and Stephen Katz28 argued that in the XX century, the process of medicalization was focused on men and circumscribed male sexuality to erectile dysfunction. Through a general problematization that links sexuality and age as fundamental dimensions to the modern subject, it is worth noting the importance of cultures and life styles prevalent in the end of last century, such as the emphasis on health, on activities and on staying young to a process which will produce a vast field of studies and interventions around the penetrative capacity of the masculine organ. To begin with, erectile dysfunction is defined exactly in function of the (in)capacity to penetrate a vagina, thus marking the heterosexual inclination of those definitions. The great novelty of the XX century, according to the authors, was the shift that happened going from the admission of the decline of sexual life in the course of time, when there was even a certain pejorative suspicion regarding sex in the old age, to a period when one is expected to perform well sexually until the end of life. Moreover, sexual activity is portrayed as a necessary condition for a healthy life and the erectile capacity defines male virility during the whole life span of men.29
The ascension of erectile dysfunction comes from ancient concerns with impotence, which was mostly approached as a problem of psychological origins, including in the works of Masters and Johnson. Until the 1980's, it was a common belief that the fear of impotence was what caused impotence and that the treatment should include therapy and counseling, even in conjunction with hormonal treatments, prosthesis and vitamin supplements. During this period, urological research in the field started to deliver innovative results, such as the "live" demonstration by Doctor Giles Brindley at a congress, in 1983, through the injection of phenoxybenzamine in his own penis leading to an erection - this fact was widely reported in the literature. New discoveries, such as the intracavernous injection of papaverine contributed to the transformation of the erection into an eminent physiological event in detriment to its psychological aspects. Therefore, impotence became a disorder with organic causes and that is how it should be treated as such. An important development was the Consensus Development Conference on Impotence that took place in 1992, organized by the American National Institute of Health. Among its recommendations contained in its final document was the substitution of the term "impotence" for "erectile dysfunction," in order to characterize the incapacity of obtaining and/or maintaining an erection enough for a satisfactory sexual performance. In addition, it also promoted the idea that it is an organic disease that is treatable and it is also a matter of public health. It was instrumental to have the epidemiological data in order to address it as a public health issue. The most cited study was the Massachusetts Male Ageing Survey (MMAS)30 that interviewed 1,700 men between the ages of 40 and 70 years of age in the area of Boston between 1987 and 1989. The study found that 525 of the men had some degree of erectile dysfunction, defined as the inability to obtain and maintain an erection strong enough to perform sexual intercourse. Despite being criticized,31 the study, which widened the concept of the disease through the idea of stages insofar as it being a progressive disorder, prevailed. It was cited and served to create the notion of the risks and the responsibilities that should be carried by the individuals thus promoting the idea of constant vigilance and the consumption of products to guarantee erectile health, the symbol of masculinity and physical and emotional health.32
It is exactly in this context that we watch the launching of Viagra (sildenafil citrate) produced by Pfizer and aimed at facilitating and maintaining an erection, which illustrates the development of a molecular science of sexuality.33 Viagra has been a success in commercial terms, a blockbuster, and a drug that rakes in at least one billion dollars yearly.34 It is important to mention that it is precisely the construction of Viagra as a medication to treat a disease and not to be used as an aphrodisiac, as observed by Alain Giami.35 Viagra was approved for consumption by the Food and Drug Administration (FDA) in the United States in 1998. Shortly after that, the first studies financed by Pfizer were published, confirming the efficacy of the medication and how well it was tolerated. The foundation of these studies was the International Index of Erectile Function (IIEF) elaborated in 1997 with 15 questions destined to examine the erectile function and do away with the difficulties in establishing a diagnostic of dysfunction and evaluate the result of the trials with new medicines.36
An important facet of this process is the degree of institutionalization that the field was acquiring with the evident predominance of urologists. In 1982, the International Society for Impotence Research (ISIR) is created, aimed at the scientific study of erection and its functional mechanisms, with its official publication called the International Journal of Impotence Research starting in 1989. In 2000, the Society changed its name to International Society for Sexual and Impotence Research (ISSIR), leaving an obvious opening to the inclusion of other aspects of male sexuality and also female sexuality. According to Giami,37 this was a strategy to broaden the limits of intervention with sexual activity on a global scale, departing from the confines of erectile dysfunction. In 1999, the International Consultation about Erectile Dysfunction was organized in Paris under the auspice of the World Health Organization and the International Urology Society. The conference was sponsored by the pharmaceutical industry and it marked the process of internationalization of the medicalization of impotence and the alliance between the urologists and the pharmaceutical industry. Similarly, the World Association of Sexology (WAS) conference that happened in Paris in 2001, translates, still according to Giami,38 into the entrance of the pharmaceutical industry and the urologists into the world of sexology, which was traditionally fragmented between doctors and non-doctors and between issues of sexual education and prevention, besides the treatment of sexual disorders. According to Leonore Tiefer,39 the process of medicalization of sexuality goes beyond the phase of creation of systems of classification and enters the stage of institutionalization and professionalization of "sexual medicine" with the support of organizations, conferences, training centers, scientific journals, clinics and medical departments. This new branch of sexual medicine went side by side with the "sexual pharmacology."
In an article entitled "Bigger and Better: How Pfizer Redefined Erectile Dysfunction," Joel Lexchin40 problematizes the strategies adopted by the pharmaceutical industry to promote Viagra. The main argument is that it was necessary, on the one hand, to transform erectile dysfunction into a problem that may afflict any man, at any time in his life, and that there was a medicine already available to solve or to prevent this difficulty. In this sense, Viagra integrated the broader collection of life style drugs or comfort medications, destined to enhance individual performance; a market clearly in expansion. Viagra's success came exactly from that, according to Lexchin.41 If it had been restricted to the treatment of erectile dysfunction associated with organic causes it would have been a business failure in terms of sales. On the other hand, Pfizer also worked to promote the idea of erectile dysfunction as an acceptable subject in public discourse, which also led to a higher demand for treatment.42
Meika Loe43 makes another interesting argument. She argues that Viagra is a cultural and material technology that is related with the construction of a new possibility of intervention with the male body, in contrast with the traditional history of medical intervention with women's bodies. This has become possible thanks to the propagation of an idea of masculinity in crisis, illustrated above all by the metaphor of erection. The idea that the erection, symbol of virility and masculine identity, is effectively unstable, subject to many types of misfortune, seems to gain more and more notoriety. It is precisely to combat this lack of control or unpredictability of the male body that the industry offers a cure like Viagra, capable of fulfilling the expectation of a better performance always.44
Furthermore, there is the history of Viagra advertisement campaigns in several countries, which clearly shows how the medicine has been converted into something destined to improve the sexual performance without any restriction and without being destined to a specific group. It was initially geared to an older public and in the context of a heterosexual union, but it started being offered to younger and younger men and it started to be featured without a presumable partner.45 What was behind this commercial trajectory was the creation of a feeling of masculine vulnerability that led to the search for control and enhancement of potency and of sexuality in general.46
It is important to mention that the physical and mental instability have been frequently associated more with female bodies, governed by variable hormonal cycles and by different stages linked to the reproductive life, which also justifies the sexual instability of women.47 The novelty is that now this representation has also reached the male body and it threatens the notion that men are "naturally" potent. It is also worth noting that, while female sexuality has historically focused on and encapsulated by reproduction, male sexuality is viewed obliquely through the penetration in sexual intercourse.
In this sense, Loe48 suggests that the development of technologies associated to reproduction and, especially, the contraceptive pill, in the middle of the XX century, were precursors of a new pharmacology of sex. The same thread connected the pill, which liberated women's sexuality from its reproductive consequences, and Viagra, which supposedly guarantees male sexual satisfaction. Furthermore, Alain Giami and Brenda Spencer49 argue in favor of three models of sexuality that characterize the last decades: liberated sexuality, in the context of the pill; protected sexuality, to the extent of the HIV/AIDS epidemic and condom use; and functional sexuality, in light of the medications for sexual dysfunction.
In this regard, we are already referring to an analysis that takes into consideration the medicalization of the female sexuality in the context of the new era of sexual dysfunctions. Tiefer,50 openly demonstrates a "feminist sensibility," when she presents the context for the construction of Viagra as a cultural phenomenon in the field of "Viagra Studies."51 She points out that, besides the issue of pharmaceutical industry and the creation of the sexual drugs, there are two other central themes which are the search for a "Pink Viagra" and the explosion in the rise of clinics to treat female sexual dysfunction. The author refers to the creation of the female sexual dysfunction as a classic case of a tactic promoting a new disease by the pharmaceutical industry and other agents of the medicalization, such as journalist, health professionals, advertisement agencies, public relations agencies, etc. According to Tiefer,52 since at least 1997, North American urologists were already working on the category "female sexual dysfunction," referring to aspects of genital pathophysiology similar to the erectile dysfunction. In this year, the Sexual Function Assessment in Clinical Trial happened, sponsored by the pharmaceutical industry, during which they proclaimed the need for a better definition of the female sexual dysfunction. In 1998, the year when Viagra was officially launched and the moment when the journalists had already started talking about the "Pink Viagra," Doctor Irwin Goldstein, urology leader in the Boston Group that studied erectile dysfunction, opened the first Sexual Health Clinic for Women. Still, in this year, the first International Consensus Development Conference on Female Sexual Dysfunction also happened in Boston. In the following years, new conferences happened and as of the year 2002 they became international and happened yearly. In 2000, the Female Sexual Function Forum is created, renamed for the International Society for the Study of Women's Sexual Health (ISSWSH) in 2001.53 Another important milestone was the article entitled "Sexual Dysfunction in the United States: Prevalence and Predictors," by Edward Laumann, Anthony Paik and Raymond Rosen, published in the Journal of the American Medical Association (JAMA) in 1999,54 based on a re-analysis of the data from the survey with 1,500 women who responded positively to any of the problems cited, such as loss of desire, anxiety about sexual performance or difficulties with lubrication. In this work, the researchers affirmed that for women between the ages of 18 and 59 the total prevalence of sexual dysfunction was 43%. As it occurred in the case of erectile dysfunction, this number became insistently cited in the literature that promoted the disease.55
What we see through the creation of a diagnostic for female sexual dysfunction is an even more refined process of articulation between several actors culminating in the formation of a new and vast market. This is the argument proposed by Jennifer Fishman56 regarding the commoditization of the female sexual dysfunction from the perspective of someone who notices an intricate web of relations mapped out in a field which congregates several points, such as business, science, medicine and governmental regulation. The author reveals, in particular, how the researcher play a key role as mediators between the producers, meaning, the pharmaceutical industries, and its consumers, in other words, the clinicians and their patients who consume these new drugs. The symbolic capitalism of these scientists, the majority of whom are doctors and psychologists holding jobs at medical schools, is an important currency in the course of promoting a new market, not only to test the scientific legitimacy of the products submitted to approval by the regulatory agencies, but also to help confirm a parallel market through off-label prescriptions of products yet to be approved. Through the educational conferences sponsored by the industries, the researchers share information which will be, in turn, prescribed at the doctor's office. As a result, the moment that the drugs being promoted by the big companies are approved, there is already a broad market for it. This process starts with the classifications and the diagnostics; at the same time as the disease, the treatment for it and the population that can be treated are "created."
In the case of the female sexual dysfunction, this process starts with the prescription of Viagra as well as of testosterone, approved in the United States for the treatment of male sexual dysfunctions. It is worth noting a curious slip as in what would be applicable to men, would also applicable for women.57 In the conferences of medical education researched by Fishman,58 this was common standard. Moreover, what also contributes to the increase in the prescriptions is the transformation of some researchers into celebrities. The most known case in the field of sexual dysfunction is that of the two researched linked to Irwin Goldstein, the urologist Jennifer Berman and her sister, the psychologist Laura Berman. In addition, beside opening a clinic for treatment of this dysfunction at the University of Los Angeles (UCLA), the two are featured in a television show, have a website and books dedicated to promote this subject and to popularize these so called treatments with off-label drugs, especially Viagra and testosterone.59
It is estimated that around one billion and seven hundred million dollars is spent yearly in the search for a market for the treatment of women's sexual problems. Several companies have invested in a series of products, starting with Viagra, tested in women by Pfizer between 1997 and 2004 when the laboratory admitted that clinical trials did not show satisfactory results. Comparatively, in the field of erectile dysfunction, the female sexuality seams to have made the work of the researchers harder because it has been more difficult to quantify female sexual response as well as to conduct trials of efficient pharmaceutical therapies.60 Currently the FDA has only approved one stimulant for the clitoris called EROS-CTD.61 A new turning point in the history of the female sexual dysfunction is the investment from Procter & Gamble laboratory on a testosterone patch called Intrinsa and recommended for the treatment of hypoactive sexual desire disorder, which had not been approved by the FDA in the United States in 2004, but was approved for use in European Community in 2006.62 Intrinsa, and the fact that at least seven big pharmaceutical companies are testing products with testosterone for women indicates a change in the referential regarding the treatment of female sexual dysfunction disorder, and the focus shifted from problems with sexual arousal to be viewed as disorders associated with sexual desire. Hartley63 asks provocatively if women's problems have changed or if this transformation in the field reflects a strategy by the pharmaceutical industries to search a drug with some subcomponent that will correspond with the disorders in the DSM. The new tactics of promotion at work affirm that Viagra has failed women because female sexuality is much more complex than male's. Leaving aside the mechanisms or arousal, it would be necessary to resort to the "desire hormone," testosterone. As confirmed by medical literature, the Hypoactive Sexual Desire Disorder is a product of the Androgen Insufficiency Syndrome, which has justified the long and polemic history of hormonal replacement therapy for women. According to Hartley,64 it is interesting that, despite the known risks posed by these therapies, the fragility of the dada about the efficacy of treatments and, specially, the demonstration that there was no connection between low sex drive and low levels of testosterone, the pharmaceutical investments continued to increase as well as the number of clinicians that prescribed these drugs to women.
The conclusion we arrive in analyzing the trajectory of the construction of masculine and feminine sexual dysfunction, beyond the general considerations regarding the complex process of medicalization of society, is that such trajectory is marked by gender stereotypes that are present in the preconceptions held by the researchers as far as what is re-transmitted to society during the stage of promotion of a new diagnostic and treatment. We notice the model of sexuality and also masculine identity widespread in the age of erectile dysfunction and Viagra centers on potency. Although, we have recently started to see discussions about masculine desire and even about the use of drugs to "treat" the dysfunction, what remains is a reduction of the sexual experience and of men's subjectivity to the anatomic and physiological erection norm, in the vast majority perceived in the context of heterosexual relations.
This centrality on the anatomic and physiological and consequently its circumscription to sexuality to its genital function guided the first pharmaceutical attempts in the treatment of female sexual dysfunction, illustrated above all by the use of Viagra. Here we see it clearly the reduction of the female sexuality to the model conceived as masculine, in which arousal would be the central point. With the failure of this treatment, the attention goes back to the desire stage and the new hope to combat the hypoactive sexual desire in women is nothing more than testosterone, a hormone that since its discovery has been conceived as eminently masculine, in contrast with estrogen, seen as feminine.65 Therefore, in this new stage, in order to have a satisfactory sexuality women have to resort to what physically and symbolically represents a process of masculinization. Only by resembling the economy of a masculine body, can women get closer to the widespread sexual satisfaction. Finally, what we see is that women's sexuality is treated beyond reproduction; it seems to be a reduction, in different ways, of the female sexuality to a supposed masculine model.
It is interesting that we find the formation of groups posing resistance to the new medicalization of female sexuality in contrast to the absence of manifestations regarding the men's. This has to do with the "Campaign for a New View of Women's Sexual Problems," headed by Leonore Tiefer, who promotes a critical theory as an alternative to the medical model of sexual problems as well as a constant vigilance of the web of the professionals and the industries that promote new drugs to treat female sexual dysfunction.66 The campaign proposes a more constructionist approach and a politic of sexuality, alerting against defining a "normal" sexuality, and it also defends an alternative system of classification that takes into consideration the social, relational, psychological, medical and organic of diseases. Tiefer67 specially criticizes the false notion of the sexual equivalence between men and women, derived from early researches about sex that registered their similar physiological responses during sexual activity. Furthermore, it alerts that few researches encouraged women to describe their experiences from their point of view, which if it had been the case, it would have made the differences evident. Women, for example, would not make a distinction between desire and arousal, as expressed in the Masters and Johnson; they would be less used to physical arousal and more subjective and their complaints more focused on "difficulties" not present in the DSM.
Despite the critical relevance of the aspects raised by Tiefer and by the "Campaign for a New View," a question remains. The doubt is if the new model proposed does not end up reifying certain gender norms. The idea that female sexuality is more complex, that women are more permeable to the subjective and emotional aspects, that physical arousal is secondary, may be once more reinforcing a certain image of feminine associated with representations inherited from at least the XX century, of a radical contrast between genders that conceals broader political tensions.
In closing, it is important to say that the literature analyzed has worked expansively on the milestones of investigation of the process of medicalization of society and of sexuality. It is an important collection of articles that calls the attention to the dimension of gender in the determination of medical and cultural produced models. There is also an increasing investment in a critique of the movement of construction of new sexual norms based on the compulsory notion of an enhanced performance. The challenge that remains is how to exactly articulate these three dimensions which, together, will enable a deeper understanding of this new era of discourse and practice that have been constituted around sex.
BÉJIN, André. "Crespúsculo dos psicanalistas, manhã dos sexólogos". In: ARIÈS, Phillipe; BÉJIN, André (Orgs.). Sexualidades ocidentais. São Paulo: Brasilense, 1987a. p. 210-235.
______. "O poder dos sexólogos e a democracia sexual". In: ARIÈS, Phillipe; BÉJIN, André (Orgs.). Sexualidades ocidentais. São Paulo: Brasilense, 1987b. p. 236-254.
Bleier, Ruth. Science and Gender - A Critique of Biology and its Theories on Women. S.l.: Teachers College Press, 1997.
BOZON, Michel. Sociologie da la sexualié. Paris: Nathan, 2002.
BULLOUGH, Vern. Science in the Bedroom. New York: Basicbooks, 1994.
CONRAD, Peter. "Medicalization and Social Control." Annual Review of Sociology, n. 18, 1992. p. 209-232.
European Medicines Agency. Relatório europeu de avaliação pública: Intrinsa. 2007. Disponível em: www.emea.europa.eu. Acesso em: 9 abr. 2007.
Fausto-Sterling, Anne. Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books, 2000.
FELDMAN, H. A., GOLDSTEIN, I., HATZICHRISTOU, D., KRANE, R., and MICKINLAY, J. "Impotence and its Medical and Psychosocial Correlates: Results of the Massachusetts Male Ageing Study." Journal of Urology, n. 151, 1994. p. 54-61.
FISHMAN, Jennifer R. "Manufacturing Desire: The Commodification of Female Sexual Dysfunction." Social Studies of Science, v. 34, n. 2, 2004. p. 187-218.
FOUCAULT, Michel. História da sexualidade I: A vontade de saber. Rio de Janeiro: Graal, 1988.
GIAMI, Alain. "Sexual Health: The Emergence, Develepment, and Diversity of a Concept." Annual Review of Sex Research, n. XIII, 2002. p. 1-35.
______. "De l'impuissance à la dysfonction éretile: destins de la médicalization de la sexualité". In: FASSIN, Didier; MEMMI, Dominique (Orgs.). Le gouvernement des corps. Paris: Éditions EHESS, 2004. p. 77-108.
GIAMI, Alain; SPENCER, Brenda. "Les objets techniques de la sexualité et l'organisation des rapports de genre dans l'activité sexuelle: contraceptifs oraux, préservatifs et traitement des troubles sexuels". Révue Epidemiologique de Santé Publique, n. 52, p. 377-387, 2004.
GIDDENS, Anthony. A transformação da intimidade: sexualidade, amor e erotismo nas sociedades modernas. São Paulo: Ed. da UNESP, 1993.
GRACE, Victoria, POTTS, Annie, GAVEY, Nicola, and VARES, Tiina. "The Discursive Condition of Viagra." Sexualities, v. 9, n. 3, 2006. p. 295-314.
GRONEMAN, Carol. Ninfomania: história. Rio de Janeiro: Imago, 2001.
Harding, Sandra. The Science Question in Feminism. Ithaca and London: Cornell University Press, 1986.
HARTLEY, Heather. "The Pinking' of Viagra Culture: Drug Industry Offorts to Create and Repackage Sex Drugs for Women." Sexualities, v. 9, n. 3, 2006. p. 363-378.
Hubbard, Ruth. The Politics of Women's Biology. New Brunswick, NJ: Rutgers University Press, 1990.
IRVINE, Janice. Disorders of Desire: Sexuality and Gender in Modern American Sexology. Philadelphia: Temple University Press, 2005.
Jordanova, Ludmilla. Sexual Visions: Images of Gender in Science and Medicine between the Eighteenth and Twentieth Centuries. Madison, WI: The University of Wisconsin Press, 1989.
LAQUEUR, Thomas. Making Sex: Body and Gender from the Greeks to Freud. Cambridge: Harvard University Press, 1992.
Laumann, Edward, Paik, Anthony, and Rosen, Raymond. "Sexual Dysfunction in the United States: Prevalence and Predictors." Journal of the American Medical Association, v. 281, n. 6, 1999. p. 537-544.
LEXCHIN, Joel. "Bigger and Better: How Pfizer Redefined Erectile Dysfunction." Plosmedicine, v. 3, n. 4, 2006. p. 1-4.
LOE, Meika. "Fixing Broken Masculinity: Viagra as a Technology for the Production of Gender and Sexuality." Sexuality and Culture, v. 5, n. 3, 2001. p. 97-125.
______. The Rise of Viagra: How the Little Bleu Pill Changed Sex in America. New York: New York University Press, 2004
MARSHALL, Barbara. "The New Virility: Viagra, Male Aging and Sexual Function." Sexualities, v. 9, n. 3, 2006. p. 345-362.
MARSHALL, Barbara, and KATZ, Stephen. "Forever Functional: Sexual Fitness and the Ageing Male Body." Body and Society, v. 8, n. 43, 2002. p. 43-70.
Moscuscci, Ornella. The Science of Woman: Gynaecology and Gender in England (1800-1929). Cambridge: Cambridge University Press, 1996.
MOYNIHAN, Ray. "The Making of a Disease: Female Sexual Dysfunction." British Medical Journal, v. 326, n. 4, 2003. p. 45-47.
______. "The Marketing of a Disease: Female Sexual Dysfunction." British Medical Journal, n. 330, 2005. p. 192-194.
Oudshoorn, Nelly. Beyond the Natural Body: An Archeology of Sex Hormones. London: Routledge, 1994.
POTTS, Annie, and TIEFER, Lenore. "Introduction." Sexualities, v. 9, n. 3, 2006. p. 267-272.
ROHDEN, Fabíola; TORRES, Igor. "Le champ actuel de la sexologie au Brésil: considérations initiales". Sexologies, v. 15, n. 1, p. 64-71, 2006.
ROHDEN, Fabíola. Uma ciência da diferença: sexo e gênero na medicina da mulher. Rio de Janeiro, Ed. FIOCRUZ, 2001. Coleção Antropologia e Saúde.
ROSEMBERG, Charles E. "The Tyranny of Diagnosis: Specific Entities and Individual Experience." The Milbank Quarterly, v. 80, n. 2, 2002. p. 237-260.
Russett, Cynthia Eagle. Sexual Science. The Victorian Construction of Womanhood. Cambridge: Harvard University Press, 1995.
RUSSO, Jane A. "Do desvio ao transtorno: a medicalização da sexualidade na nosografia psiquiátrica contemporânea". In: PISCITELLI, Adriana; GREGORI, Maria Filomena; CARRARA, Sergio (Orgs.). Sexualidade e saberes: convenções e fronteiras. Rio de Janeiro: Garamond, 2004. p. 95-114.
RUSSO, Jane; VENANCIO, Ana Tereza. "Classificando as pessoas e suas
perturbações: a revolução terminológica' do DSMIII". Revista
Latinoamericana de Psicopatologia Fundamental, v. IX, n. 3, p. 460-483, 2006.
Schiebinger, Londa. O feminismo mudou a ciência? Bauru: Edusc, 2001.
TIEFER, Leonore. Sex Is Not a Natural Act. Cambridge: Westview Press, 2004.
______. "The Viagra Phenomenon." Sexualities, v. 9, n. 3, 2006a. p. 273-294.
______. "Female Sexual Dysfunction: A Case Study of Disease Mongering and Activist Resistance." Plosmedicine, v. 3, n. 4, 2006b. p. 1-5.
VARES, Tiina, and BRAUN, Victoria. "Spreading the Word, but What Word Is That? Viagra and Male Sexuality in Popular Culture." Sexualities, v. 9, n. 3, 2006. p. 315-332.
WEEKS, Jeffrey. Sexuality and its Discontents. London: Routledge; New York: Keagan Paul, 1985.
Wijngaard, Marianne Van Den. Reinventing the Sexes: The Biomedical Construction of Feminity and Masculinity. Bloomingthon, IN: Indiana University Press, 1997.
1 Alain GIAMI, 2002.
2 Fabiola ROHDEN and Igor TORRES, 2006.
3 Peter CONRAD,1992; Charles E. ROSEMBERG, 2002,
4 GIAMI, 2004; Leonore TIEFER, 2004 e 2006ª.
5 Anne FAUSTO-STERLING, 2000; Ludmilla JORDANOVA, 1989; Londa SCHIEBINGER, 2001; Cynthia Eagle RUSSET, 1995; Ornella MOSCUCCI, 1996; Sandra HARDING, 1986; Ruth BLEIER, 1997; Ruth HUBBARD, 1990.
6Nelly OUDSHOORN, 1994; Marianne Van Den WJINGAARD, 1997; Jennifer R. FISHMAN, 2004..
10 BÉJIN, 1987a and 1987b.
11 BËJIN, 1987a.
12 BËJIN, 1987a.
13 BËJIN, 1987ª, P. 228.
14 BÉJIN, 1987ª.
16 IRVINE, 2005, p 5-6.
17 IRVINE, 2005, cap. 1.
18 IRVINE, 2005, cap. 1.
19 IRVINE, 2005, cap. 2.
20 Jane RUSSO, 2004; Jane RUSSO e Ana Tereza VENÂNCIO, 2006.
21 IRVINE, 2005, cap 2.
22 IRVINE, 2005, cap. 7.
23 IRVINE, 2005, p. 165.
24 IRVINE, 2005, p. 165.
25 IRVINE, 2005, p. cap 7.
27 RUSSO, 2004, p. 106-107.
28 MARSHALL and KATZ, 2002.
29 MARSHALL and KATZ,2002; MARSHALL, 2006.
30 H.A. FELDMAN et al, 1994.
31 Joel LEXCHIN, 2006.
32 MARSHALL and KATZ, 2002, p. 54-59; GIAMI, 2004; TIEFER, 2006a.
33 MARSHALL and KATZ, 2002, p. 60.
34 TIEFER, 2006a, p. 279.
37 GIAMI, 2004, p. 14.
38 GIAMI, 2004, p. 16.
39 TIEFER, 2006a, p. 275.
41 LEXCHIN, 2006, p. 1.
44 Victoria GRACE e al, 2006.
45 MARSHALL and KATZ, 2002, p. 61.
46 Tiina VARES e Virginia BRAUN, 2006.
48 LOE, 2001, p. 101.
49 GIAMI and SPENCER, 2004.
50 TIEFER, 2006a.
51 Annie POTTS and Leonore TIEFER, 2006.
52 TIEFER, 2006b.
53 TIEFER, 2006b; Ray MOYNIHAN, 2003; Heather HARTLEY, 2006.
54 LAUMANN, PAIK and ROSEN, 1999.
57 LOE, 2004, cap. 5.
60 MOYNIHAN, 2003 and 2005.
63 HARTLEY, 2006, p. 367.
64 HARTLEY, 2006, p. 367.
66 TIEFER, 2004 e 2006b; HARTLEY, 2006; MOYNIHAN, 2003.
67 TIEFER, 2004, p. 252.


text:
57.1 x 94.5 x 70.9 inch (H*L*W) 992 lbs
145 x 240 x 180 cm (H*L*W) 450 kgs
Contemporary Sculpture, Wildlife, Happy Art
Edition Number
The game of hide and seek conjures feelings from our childhood of safety, love and joy. Gillie and Marc believe that all people and all creatures have the right to live in a world where safety and love are the rule, not the exception. Unfortunately, safety is often seen as a privilege rather than a right for many species of animals. Endangered species have had to hide from humankind for far too long. With 'Come out, come out wherever you are', the artists call on the world to welcome these species out from hiding and into a place of safety and love.
Artwork Features
Gillie and Marc love working in bronze for many reasons. Bronze is a very hardy material and will last forever. As experts in coloring bronze, Gillie and Marc enjoy experimenting with their sculptures, adding a splash of color to brighten the work, making it even more unique. > Read more
For every purchase of a bronze sculpture you will receive a certificate of authenticity, titled, signed, dated and editioned by the artists.
Care Instructions
Bronze is very easy to clean, allowing you to enjoy your precious sculpture with minimal upkeep. > Read more
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text:
Surelink alarm cable unshield UNDERGATE CABLE 2.5MM STEEL electric WIRE pe jacket
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100m/box, 100m/plastic spool, 305m/wooden spool, 500ft roll, 1000ft pull box
Zhuhai Surelink Communication Cable Co.,Ltd is one of the leading manufacturer in the cables and telecom accessories. We have more than 20 years experience in this line.Our factory has over twenty production lines and 300 employees.
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text:
Extra-Wide 350 lbs. Capacity Rocker
by BrylaneHome
Made of weather-resistant, high-strength textured vinyl, this rocker is the perfect addition to your backyard. Sturdy, durable powder-coated steel frame supports extra weight.
- Supports 350 lbs.**
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text:
Rejecting an unwanted lover unceremoniously can be dangerous. Rejection sensitivity and aggression by the scorned male can have disastrous consequences. Last week a college girl was attacked with a sickle for doing so. The demographic profile of students at our clinic is probably a representation of the Pune student population. Many students feel socially and culturally alienated while having to cope on their own with minimal family support. Some have no one to express their feelings or thoughts to. A smile or other facial expressions from a classmate or a single phrase while watching a game are viewed as tokens of intimacy. Subsequent fantasising invests these facial expressions and interactions with an excessive significance. That the girl does not initiate or acknowledge further interaction is rationalised as shyness and considered a virtue, further embedding the myth of intimacy.
The concept of gender equality may be alien in the culture of the student. It comes as a great shock to the lover, when he gathers up his courage to proclaim his love only to find it discarded unceremoniously. His reaction will depend on his attachment style - the behavioural response to separation developed in childhood. Mostly he will withdraw further into his shell, but in some cases, especially when he is high on the personality characteristic of rejection sensitivity and has a fearful attachment style, he will harbour and act out thoughts of revenge.These vengeful thoughts smoulder unrecognised until they burst forth in as dramatic and unexpected action as the initial profession of love.
Rejecting an unwanted lover
Rejection sensitivity is always a concern when rejecting an unwanted lover. The independent modern woman needs to learn how to handle this situation without involving family or other third parties. Rejecting an unwanted lover can be considered as a form of breaking bad news. For this there is no better technique than the SPIKES 6-step protocol which is used to break bad news in medicine.- Setting
- Make sure there is privacy. No matter how startled you are by his profession of love, do not blurt out a summary dismissal in front of everyone. Stay in a public place, but take him to one side.
- Perception
- Ask him to clarify what he has just said, and what lead him to say that. This will help you to place him, if you haven't already done so.
- Invitation
- Ask whether you can tell him your point of view on the subject
- giving Knowledge
- Warning before giving the bad news helps the person process the information imparted without getting angry or feeling isolated. Start by saying "I am sorry to say that I don't feel that way". Don't be rude or excessively blunt Responses such as "who do you think you are?", "why should I have feelings for you?" or laughing contemptuously are bound to turn love into the other end of the stick - hate, especially if he is high on rejection sensitivity. Check his reactions and modify what you are saying so he can understand.
- Empathise
- Identify his emotion - sadness, anger, hurt. Closely monitor his facial expressions. Acknowledge it. "I can see that you are feeling hurt. Anyone in your position might feel like that".
- Strategy
- Discussing what comes next. Start from his Perception of the relationship to help vent his emotions. Deal with these Empathically, again the facial expressions are important. The goal should be to politely but firmly communicate "I don't feel that way" so "we cant take this any further, don't take this personally".
- Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302-11.


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Summer 2013
Getting real about high school
– Sarah Carr
Millions of young people will never attend four-year colleges. America must do more to equip them to secure good jobs and live fulfilling lives.
New Orleans charter schools, even students in the primary grades sometimes start the day with rousing chants professing their commitment to college. "This is the way, hey!/ We start the day, hey!/ We get the knowledge, hey!/To go to college!" kids shout. During several years writing about the remaking of the school system since Hurricane Katrina, I have heard high school teachers remind students to wash their hands before leaving the restroom because otherwise they might get sick, which might cause them to miss class, which would leave them less prepared for college. College flags and banners coat the walls and ceilings of schools across the city. College talk infuses the lessons of even the youngest learners. College trips expose older kids to campuses around the country.
While particularly strong in New Orleans, the "college-for-all" movement has swept the nation over the past decade, with education reformers in different cities embracing the notion that sending more low-income students to and through college should be America's primary antipoverty strategy. In his first address to a joint session of Congress, President Barack Obama echoed that theme when he asked every American to pledge to attend at least one year of college. "We will provide the support necessary for you to complete college and meet a new goal: By 2020, America will once again have the highest proportion of college graduates in the world."
At schools that have embraced the college-for-all aspiration, career and technical education is seen as being as outdated as chalkboards and cursive handwriting. Instead, the (mostly poor and mostly minority) students are endlessly drilled and prepped in the core humanities and sciences — lessons their (mostly middle- or upper-income and mostly white) teachers hope will enable the teenagers to rack up high scores on the ACT, SAT, and Advanced Placement exams and go on to attend the four-year college of their dreams (although it's not always clear whose dreams we're talking about).
On the surface, the tension between college-for-all and career and technical education pits egalitarianism against pragmatism. What could be more egalitarian, after all, than sending the nation's most disadvantaged secondary students off to the vaunted halls of institutions once reserved for the most privileged? Only eight percent of low-income children in America earn a bachelor's degree by their mid-twenties, compared to more than 80 percent of students from the top income quartile.
Yet what could be more pragmatic than acknowledging that in cities where more than half of students fail tests of basic academic skills, imposing purely academic aspirations might be a fool's errand? Some studies have shown that only about one-third of low-income students who start college earn bachelor's degrees by their mid-twenties; the large majority who drop out are left, in many cases, with thousands of dollars in debt. At some institutions, including the historically black Southern University at New Orleans, the graduation rate is less than 10 percent.
The neat dichotomy between egalitarianism and pragmatism breaks down when we consider the players and grassroots realities, however. The desire to send impoverished students to the best four-year colleges undoubtedly stems from worthy motives. In New Orleans, only about five percent of African-American public school children graduated from college in the years before Hurricane Katrina — a statistic that everyone with common sense and a conscience would agree needs to change. But while the reformers' big-picture goal of sending the other 95 percent to and through college might be egalitarian in theory, the means to that end are often quite paternalistic.
In their efforts to set poor children of color on the path to college, the idealistic young educators attempt to inculcate middle-class aspirations in their students through a form of body and mind control: instructing them in everything from how to take notes to how to sit, talk, walk, and move; embracing the goals of "re-acculturating" and "re-calibrating" them; and calling them "scholars," in honor of the new pursuit. One veteran principal refers to it as "lockstepping." In a not atypical scene inside a New Orleans charter school, a kindergarten teacher told her young charges, "We have a lot to do this year — a lot if we want to go to the first grade. The first graders already have read this book and moved on to other books. I know all of you want to go to first grade because all of you want to go to college. But you need to show discipline over your bodies to do that."
Many parents (and even some "scholars") welcome this structure and the intense focus on college. But some would like to see the new charters incorporate more trade and technical training in addition to their heavy college-prep emphasis. And others see a disconnect between the reformers' goals and their methods. New Orleans grandfather Ronald McCoy shook his head during a 2010 interview with NPR when he thought about some college-prep charter schools that force their students to walk a straight line — marked out with tape — in the hallway between classes. "This walking the line?" he said. "I have been incarcerated, and that's where I learned about walking behind those lines and staying on the right-hand side of the wall."
Applying the college-for-all ethos in a top-down fashion in low-income communities of color creates the risk of being more imperialistic than egalitarian. But emphasizing career and technical education can do another kind of harm, simply because of the dismal state of many programs. "The idea that career and technical education is high quality and somehow rooted in the real world is just bunk," says Kati Haycock, president of the Education Trust, a Washington, D.C., nonprofit organization that works to improve student academic achievement.
Even advocates of career and technical education acknowledge that the programs are often divorced from economic and industry needs. Many of them were designed not out of a desire to prepare students for high-wage jobs in growing technical fields, but on the basis of classist, racist assumptions that low-income students and children of color cannot learn at high levels. To the extent that these programs fill an economic need, it's to create a permanent underclass of workers destined for minimum-wage jobs. In New Orleans, before Katrina, that meant the schools produced an endless supply of graduates to serve as housekeepers and dishwashers working for less than $20,000 a year in the city's tourist-based economy, but very few who could repair air conditioning units, a job that pays more than twice as much.
A confluence of forces has fueled the college-for-all push of the last couple of decades. Apart from the well-publicized hollowing out of the economy, a raft of reports have shown the differential benefits of college and graduate school education in terms of earnings, job stability, and health. In 2010, for instance, the median wage for a male high school graduate between the ages of 25 and 34 was $32,800, compared to $49,800 for one with a bachelor's degree.
At the same time, the standards movement — with its emphasis on disaggregated data, high-stakes testing, and school accountability — exposed huge failures in the schooling of low-income and minority children. "This very good idea that all kids need a strong academic underpinning morphed into the idea that all kids need to be prepared to attend a four-year college," says Robert Schwartz, a professor at the Harvard Graduate School of Education. He doesn't think the two ideas are necessarily the same.
The 1990s and 2000s also saw the rapid growth of programs such as Teach For America, which sends recent graduates of elite colleges into poor communities in New Orleans and other places for missionary-style stints. TFA members and recent alums founded several of the charter schools and charter networks, such as KIPP (the Knowledge Is Power Program), that dominate in post-Katrina New Orleans and are the most strident, best-known backers of the college-for-all — or at least college for far more — movement.
There's no point in expanding technical education or college enrollment if both pathways are bridges to nowhere
Some prominent educators have pushed back against the movement in the last two years, citing its lack of pragmatism. In 2011, for instance, Schwartz coauthored an influential paper, Pathways to Prosperity, which reported burgeoning demand for "middle-skill" workers, including electricians, construction managers, and dental hygienists. The report focused on fields where the average wage is above $50,000 ($53,030 for electricians, $70,700 for dental hygienists, and $90,960 for construction managers, according to 2012 figuresfrom the Bureau of Labor Statistics); workers in other traditional vocational fields, including health aides and short-order cooks, make far less.
The "middle-skill" fields described in the report typically require an associate's degree or occupational certificate, but not a four-year bachelor's degree. "The 'college-for-all' rhetoric ... needs to be significantly broadened to become a 'post high-school credential for all,'" Schwartz and his colleagues argued.
The Harvard report stressed that schools and officials should not downplay efforts to improve traditional academic instruction. But it concluded that secondary school career training should be significantly upgraded and expanded by introducing more opportunities for work experience, extensive employer involvement in shaping programs, and enhanced hands-on (as opposed to classroom-based) learning.
Earlier this year, the Brookings Institution published a report that dissected the college payoff by school selectivity, major, and occupation. "While the average return to obtaining a college degree is clearly positive, we emphasize that it is not universally so," the authors wrote. They cited the low, or negative, "return on investment" for less selective, yet pricey, private universities and for majors such as art and psychology. "By telling all young people that they should go to college no matter what, we are actually doing some of them a disservice."
Many of the most thoughtful backers of college-for-all and expanded career education agree on more than they disagree on: They all hope to boost the percentage of Americans with some form of postsecondary degree or training and thereby increase social mobility. And they all believe that the high school curriculum could be improved. But they part ways on the best means to their shared ends.
"If we're talking about earning enough to support a family, the smartest choice is a four-year degree," Haycock says. "It is the only sure route out of poverty."
Schwartz maintains that there needs to be more emphasis on alternate pathways to well-paying jobs. "We have a class snobbism that the only jobs that matter are the jobs we do: white-collar jobs in offices."
The best way to address this divergence is not to give up on college-for-all, or on expanded career and technical education. We need to look at the debate in a different way, incorporating individual experience as well as data, and humanistic as well as economic perspectives. Using this lens, we can come to a more nuanced understanding of how to make our education system both more pragmatic and more egalitarian.
As with most social issues in America, the debate over college-for-all and career education has taken place mostly at an elite level, with little understanding of the desires and needs of low-income students and their parents. During several years of close observation of New Orleans charter schools, I saw how hard it is to prescribe a set of educational aspirations to a group of people, no matter how convincing the data and experts might be.
Two teenage students I interviewed provided a case in point. Both were poor, smart, creative, and intense, but that's where the similarities ended. Brice was talkative, clever, mischievous, and, despite his kindness and generosity, constantly in trouble. One of his teachers described him this way: "Brice's mouth is his weapon. But if you don't understand Brice, you would think his weapon is more than his mouth."
By contrast, Anthony (whose name has been changed) was soft spoken and reserved, and avoided conflict at all costs. Yet he occasionally burst forth with statements that revealed how much he saw and knew, such as his description of the topics covered in an elective philosophy class: "How come people come in different races and what's the difference? Why is everything this way? How do we know what's ethically right or wrong? Who are we? Why do we speak to each other and why do we have five fingers and five toes? How can we make the things we make? How do we know what matter is, and why can we feel things?"
Anthony, whose mother scraped by as a hotel housekeeper, desperately wanted to go to college, while Brice preferred the military. (He only somewhat facetiously declared that guns and violence were what he knew.) But in a twist of fate, Brice enrolled in a KIPP high school whose principal endlessly recited the school's mantra: "One thousand first-generation college graduates by 2022." Meanwhile, Anthony attended a long-struggling and less ambitious non-charter New Orleans high school where, in 2010, the year before he enrolled, only 14 of 44 graduating seniors continued on to college. Among those 14 graduates, 10 needed to take remedial courses and the average ACT score was 13.9. (The ACT is scored on a scale of 1 to 36, with a national average of about 21.) Anthony earned a 12 when he took the test in the spring of his junior year.
The education system failed Anthony and Brice in different ways. Anthony suffered from a failure of training: He had more than enough desire and ambition, but his schools did not provide him with the skills and tools to make college graduation an easy (or even likely) prospect. Brice, on the other hand, suffered from a failure of imagination: He attended a school hell-bent on giving him the skills and tools he needed to thrive in college. Yet he retained a limited view of his own potential in spite of all the college banners, slogans, chants, and ambitions that surrounded him.
Anthony graduated from high school in the spring of 2012 and entered Southeastern Louisiana University at the start of 2013, where he struggled academically during his first semester but remained determined to persist. Brice was arrested for second-degree attempted murder during the spring of his freshman year at KIPP. He spent more than a year in jail before his lawyer negotiated a plea deal during the summer of 2012. Brice has not returned to a traditional high school, although he hopes to earn a GED.
Most of the new college-for-all charter schools in New Orleans are just graduating their first cohorts of students, so only time will tell if they succeed in their mission. (A national study of KIPP's earliest graduates found that 33 percent had received a degree from a four-year college within 10 years — four times the national rate for students with similar backgrounds, yet a far cry from the organization's stated goal of 75 percent.) But it struck me as sadly ironic that a restructured school system so focused on getting students through college could fail so utterly to give both Brice and Anthony what they most needed to get there.
There are changes we could make to our schools and way of thinking that would help students like Anthony and Brice — changes that would, however, complicate our understanding of what's pragmatic and what's egalitarian.
To more pragmatic ends, we should stop treating academic and vocational education as curricular silos and develop more strategies for boosting college completion rates among low-income students. There's little point in expanding technical education or four-year college matriculation rates if both pathways are, by design or default, bridges to nowhere. And replicable small-scale efforts aimed at shoring up career education and improving college graduation rates already exist.
For instance, nine school districts participating in a California-based initiative called the Linked Learning Alliance agreed to expand their career and technical education courses while also integrating them with academic classes. Students might study both algebra and computer-aided design (a modernized vocational subject) in the same class and no longer choose (or get nudged toward) an early college-prep track or a career track. It was assumed that all students would have access to both a rigorous academic curriculum and work experience, such as an internship or employment at a school-based business. "We are trying to overcome the mindset that career and technical education is 'just shop,'" said Olivine Roberts, the chief academic officer at the Sacramento City Unified School District, one of the participating districts, in an interview with School Administrator magazine.
Operating in large cities such as New York and Chicago (as well as New Orleans), the Posse Foundation sends cohorts of 10 low-income children from the same urban community off to elite colleges as a group. The theory is that the students will feel more comfortable, and will be more likely to stay in college, if surrounded with peers who have similar backgrounds and culture. Neither Linked Learning nor Posse is, on its own, a solution to educational or economic inequity in America. But they are both much-needed practical approaches in an area that's been dominated by abstract, and at times ideological, arguments and approaches.
To a more egalitarian end, we should stop viewing low-income children of color as a form of "other" in the debate over secondary and college education, a bias both sides can be guilty of at times. Children growing up in poverty are not incapable of higher-level thinking and learning, as many backers of vocational tracks have explicitly or implicitly maintained for generations. But neither are they empty vessels who need to be filled with mainstream middle-class ambitions and values at super speed. One extreme discredits and undervalues poor children of color through the end it envisions for them (uniformly working-class jobs), the other through the means it employs (a form of cultural indoctrination). Both fail to fully conceive of these children as talented and aspirational in their own right.
Before we redesign our education system to better meet the needs of the most disempowered, we must acknowledge how this idea of otherness has fostered the most simplistic (and least constructive) positions in this debate. In the long run, social policies and programs that deny the overwhelming power of individual agency are destined to fail.
Sarah Carr is a New Orleans-based education writer and author of Hope Against Hope, published in 2013.
Photo courtesy of Flickr/beltramistudios


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I am evaluating the expression 6^6^6
using python
and bc
The content of the python file is print 6**6**6
. When I execute time python test.py
, I get the output as
real 0m0.067s
user 0m0.050s
sys 0m0.011s
And then, I ran the command time echo 6^6^6 | bc
which gave me the following output
real 0m0.205s
user 0m0.197s
sys 0m0.005s
From these results it is clear that the sys time taken by python and bc was 11ms and 5ms respectively. The bc command outperformed python at sys time level but when it comes to user and real time python was almost 4 times faster than bc. What might have gone there. I haven't given any priority to the processes as such. I am trying to understand this situation.


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Search for Pokémon in the Cairngorms ... safely
The craze for collecting virtual Pokémon characters via a phone app has delighted young people across the world, as collectors track down the characters through the GPS feature in their phones.
But mountain safety experts are reminding fans that while there are undoubted health benefits from getting outdoors, they need to be aware of where they are and how to get home again.
Hide AdAdvertisement
Hide AdAfter discovering that Pokémon Go characters can be found aplenty in the Cairngorm mountains, Heather Morning, mountain safety adviser with the Mountaineering Council of Scotland, said: "It is not difficult to imagine a situation where a Pokémon Go gamer finds themselves lost and unable to find their way back. It would be equally easy to see how someone could put themselves in danger focusing on their game rather than focusing on the ground in front of them."
She added: "Another aspect of Pokémon Go is the game's ability to eat your battery life. All the biggest battery-eating culprits are in action, and your screen is the biggest battery hog.
Gamers need to be aware if they are playing in an area they are not familiar with in the mountains that they should very much stay 'switched on' to where they are and how to get themselves home safely."


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The best thing about containers is that they are so adaptable and can be moved around or replanted whenever you want a fresh new look. This means you can mix them up over the seasons if you like, ensuring your plot is always full of visual interest.
No matter how small, any outdoor space can benefit from container gardening ideas. Offering vibrant hues, subtle fragrance and beautiful foliage, they are a fantastic way to breathe new life into a seating area or veranda.
They're an easy way to get creative and channel your sense of style into your space. Whether you want to plant a miniature orchard, create a cottage garden in pots or be modern with textured grass, there is sure to be a garden idea for you.


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Holding a grudge can have serious implications on our mental, emotional and physical wellbeing, but there's more to forgiveness than simply 'letting it go'. Psychologist Robert Enright outlines eight steps to practising forgiveness in a meaningful way
When another person hurts us, it can upend our lives.
Sometimes the hurt is very deep, such as when a spouse or a parent betrays our trust, or when we are victims of crime, or when we've been harshly bullied. Anyone who has suffered a grievous hurt knows that when our inner world is badly disrupted, it's difficult to concentrate on anything other than our turmoil or pain. When we hold on to hurt, we are emotionally and cognitively hobbled, and our relationships suffer.
Forgiveness is strong medicine for this. When life hits us hard, there is nothing as effective as forgiveness for healing deep wounds. I would not have spent the last 30 years of my life studying forgiveness if I were not convinced of this.
Many people have misconceptions about what forgiveness really means – and they may eschew it. Others may want to forgive, but wonder whether or not they truly can. Forgiveness does not necessarily come easily; but it is possible for many of us to achieve, if we have the right tools and are willing to put in the effort.
Below is an outline of the basic steps involved in following a path of forgiveness. As you read through these steps, think about how you might adapt them to your own life.
1. Know what forgiveness is and why it matters
Forgiveness is about goodness, about extending mercy to those who've harmed us, even if they don't 'deserve' it. It is not about finding excuses for the offending person's behaviour or pretending it didn't happen. Nor is there a quick formula you can follow. Forgiveness is a process with many steps that often proceeds in a non-linear fashion.
"Forgiveness can heal us and allow us to move on in life with meaning and purpose. Forgiveness matters, and we will be its primary beneficiary."
But it's well worth the effort. Working on forgiveness can help us increase our self-esteem and give us a sense of inner strength and safety. It can reverse the lies that we often tell ourselves when someone has hurt us deeply—lies such as 'I am defeated' or 'I'm not worthy'. Forgiveness can heal us and allow us to move on in life with meaning and purpose. Forgiveness matters, and we will be its primary beneficiary.
Studies have shown that forgiving others produces strong psychological benefits for the one who forgives. It has been shown to decrease depression, anxiety, unhealthy anger, and the symptoms of post-traumatic stress disorder. But we don't just forgive to help ourselves. Forgiveness can lead to psychological healing, yes; but, in its essence, it is not something about you or done for you. It is something you extend toward another person, because you recognise, over time, that it is the best response to the situation.
2. Become 'forgivingly fit'
To practice forgiveness, it helps if you have worked on positively changing your inner world by learning to be what I call 'forgivingly fit'. Just as you would start slowly with a new physical exercise routine, it helps if you build up your forgiving muscles slowly, incorporating regular 'workouts' into your everyday life.
You can start becoming more fit by making a commitment to do no harm – in other words, making a conscious effort not to talk disparagingly about those who've hurt you. You don't have to say good things; but, if you refrain from talking negatively, it will feed the more forgiving side of your mind and heart.
You can also make a practice of recognising that every person is unique, special, and irreplaceable. You may come to this through religious beliefs or a humanist philosophy or even through your belief in evolution. It's important to cultivate this mindset of valuing our common humanity, so that it becomes harder to discount someone who has harmed you as unworthy.
You can show love in small ways in everyday encounters – like smiling at a harried grocery cashier or taking time to listen to a child. Giving love when it's unnecessary helps to build the love muscle, making it easier to show compassion toward everyone. If you practice small acts of forgiveness and mercy – extending care when someone harms you – in everyday life, this too will help. Perhaps you can refrain from honking when someone cuts you off in traffic, or hold your tongue when your spouse snaps at you and extend a hug instead.
Sometimes pride and power can weaken your efforts to forgive by making you feel entitled and inflated, so that you hang onto your resentment as a noble cause. Try to catch yourself when you are acting from that place, and choose forgiveness or mercy, instead. If you need inspiration, it can help to seek out stories of mercy in the world, examples of which can be found at www.internationalforgiveness.com.
3. Address your inner pain
It's important to figure out who has hurt you and how. This may seem obvious; but not every action that causes you suffering is unjust. For example, you don't need to forgive your child or your spouse for being imperfect, even if their imperfections are inconvenient for you.
To become clearer, you can look carefully at the people in your life – your parents, siblings, peers, spouse, co-workers, children, and even yourself – and rate how much they have hurt you. Perhaps they have exercised power over you or withheld love; or maybe they have physically harmed you. These hurts have contributed to your inner pain and need to be acknowledged. Doing this will give you an idea of who needs forgiveness in your life and provide a place to start.
There are many forms of emotional pain; but the common forms are anxiety, depression, unhealthy anger, lack of trust, self-loathing or low self-esteem, an overall negative worldview, and a lack of confidence in one's ability to change. All of these harms can be addressed by forgiveness; so it's important to identify the kind of pain you are suffering from and to acknowledge it. The more hurt you have incurred, the more important it is to forgive, at least for the purpose of experiencing emotional healing.
You may be able to do this accounting on your own, or you may need the help of a therapist. However you approach looking at your pain be sure you do it in an environment that feels safe and supportive.
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4. Develop a forgiving mind through empathy
Scientists have studied what happens in the brain when we think about forgiving and have discovered that, when people successfully imagine forgiving someone (in a hypothetical situation), they show increased activity in the neural circuits responsible for empathy. This tells us that empathy is connected to forgiveness and is an important step in the process.
If you examine some of the details in the life of the person who harmed you, you can often see more clearly what wounds he carries and start to develop empathy for him. First, try to imagine him as an innocent child, needing love and support. Did he get that from the parents? Research has shown that if an infant does not receive attention and love from primary caregivers, then he will have a weak attachment, which can damage trust. It may prevent him from ever getting close to others and set a trajectory of loneliness and conflict for the rest of his life.
You may be able to put an entire narrative together for the person who hurt you – from early child through adulthood – or just imagine it from what you know. You may be able to see her physical frailties and psychological suffering, and begin to understand the common humanity that you share. You may recognise her as a vulnerable person who was wounded and wounded you in return. Despite what she may have done to hurt you, you realise that she did not deserve to suffer either.
Recognising that we all carry wounds in our hearts can help open the door to forgiveness.
5. Find meaning in your suffering
When we suffer a great deal, it is important that we find meaning in what we have endured. Without seeing meaning, a person can lose a sense of purpose, which can lead to hopelessness and a despairing conclusion that there is no meaning to life itself. That doesn't mean we look for suffering in order to grow or try to find goodness in another's bad actions. Instead, we try to see how our suffering has changed us in a positive way.
Even as one suffers, it's possible to develop short-term and sometimes long-range goals in life. Some people begin to think about how they can use their suffering to cope, because they've become more resilient or brave. They may also realise that their suffering has altered their perspective regarding what is important in life, changing their long-range goals for themselves.
To find meaning is not to diminish your pain or to say, 'I'll just make the best of it' or 'All things happen for a reason'. You must always take care to address the woundedness in yourself and to recognise the injustice of the experience, or forgiveness will be shallow.
Still, there are many ways to find meaning in our suffering. Some may choose to focus more on the beauty of the world or decide to give service to others in need. Some may find meaning by speaking their truth or by strengthening their inner resolve. If I were to give one answer, it would be that we should use our suffering to become more loving and to pass that love onto others. Finding meaning, in and of itself, is helpful for finding direction in forgiveness.
6. When forgiveness is hard, call upon other strengths
Forgiveness is always hard when we are dealing with deep injustices from others. I have known people who refuse to use the word forgiveness because it just makes them so angry. That's OK – we all have our own timelines for when we can be merciful. But if you want to forgive and are finding it hard, it might help to call upon other resources.
First remember that if you are struggling with forgiveness, that doesn't mean you're a failure at forgiveness. Forgiveness is a process that takes time, patience, and determination. Try not to be harsh on yourself, but be gentle and foster a sense of quiet within, an inner acceptance of yourself. Try to respond to yourself as you would to someone whom you love deeply.
"Just as you would start slowly with a new physical exercise routine, it helps if you build up your forgiving muscles slowly, incorporating regular 'workouts' into your everyday life."
Surround yourself with good and wise people who support you and who have the patience to allow you time to heal in your own way. Also, practice humility – not in the sense of putting yourself down, but in realising that we are all capable of imperfection and suffering.
Try to develop courage and patience in yourself to help you in the journey. Also, if you practice bearing small slights against you without lashing out, you give a gift to everyone – not only to the other person, but to everyone whom that person may harm in the future because of your anger. You can help end the cycle of inflicting pain on others.
If you are still finding it hard to forgive, you can choose to practice with someone who is easier to forgive –maybe someone who hurt you in a small way, rather than deeply. Alternatively, it can be better to focus on forgiving the person who is at the root of your pain – maybe a parent who was abusive, or a spouse who betrayed you. If this initial hurt impacts other parts of your life and other relationships, it may be necessary to start there.
7. Forgive yourself
Most of us tend to be harder on ourselves than we are on others and we struggle to love ourselves. If you are not feeling lovable because of actions you've taken, you may need to work on self-forgiveness and offer to yourself what you offer to others who have hurt you: a sense of inherent worth, despite your actions.
In self-forgiveness, you honour yourself as a person, even if you are imperfect. If you've broken your personal standards in a serious way, there is a danger of sliding into self-loathing. When this happens, you may not take good care of yourself – you might overeat or oversleep or start smoking or engage in other forms of 'self-punishment'. You need to recognise this and move toward self-compassion. Soften your heart toward yourself.
After you have been able to self-forgive, you will also need to engage in seeking forgiveness from others whom you've harmed and right the wrongs as best as you can. It's important to be prepared for the possibility that the other person may not be ready to forgive you and to practice patience and humility. But, a sincere apology, free of conditions and expectations, will go a long way toward your receiving forgiveness in the end.
8. Develop a forgiving heart
When we overcome suffering, we gain a more mature understanding of what it means to be humble, courageous, and loving in the world. We may be moved to create an atmosphere of forgiveness in our homes and workplaces, to help others who've been harmed overcome their suffering, or to protect our communities from a cycle of hatred and violence. All of these choices can lighten the heart and bring joy to one's life.
Some people may believe that love for another who's harmed you is not possible. But, I've found that many people who forgive eventually find a way to open their hearts. If you shed bitterness and put love in its place, and then repeat this with many, many other people, you become freed to love more widely and deeply. This kind of transformation can create a legacy of love that will live on long after you're gone.
First published by Greater Good


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