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Why Betty Friedan Threw the Body Out With the Bathwater


Fifty years after its publication, Betty Friedan’s The Feminine Mystique continues to influence how women think about what “makes them tick.”  Friedan got a lot right, but with decades of hindsight, it’s easy to see she got some things wrong, particularly her outright rejection of the impact of hormonal shifts on female experience.

Friedan’s book catapulted the Women’s Movement into the public eye. She identified the “problem that has no name”: the boredom, depression and empty lives of educated women who had given up careers to care for home and children. Post-war generation wives and mothers responded powerfully to Friedan’s observations.

Friedan raised challenging questions about psychoanalytic views of female development and psychology, then in vogue, and the ways these views kept women “in their place.”  She was instrumental in setting female psychology on a different course–in some good ways, as well in others that have been less helpful.

When The Feminine Mystique was published in 1963, the classical Freudian view of female development was still the accepted wisdom: anatomy is destiny, and normal female development includes penis envy, faulty super-ego development, masochism and passivity. Friedan correctly pointed out how these theories kept women in a submissive role relative to men.

However, Friedan went on to dismiss the importance of ovarian hormones and the menstrual cycle on a woman’s identity, mood and thought processes. Friedan’s mission, or one of her missions, was to assert there was no meaningful difference between men and women, that anatomy is immaterial.

Betty Friedan’s work became very relevant to me while I was researching the topic of menopause, an endeavor prompted by the onset of my own.  I noticed how little was written on the subject, and that women rarely spoke about their physical and psychological suffering.

Surprisingly, Friedan thought menopause inconsequential.  If a woman has a meaningful life, menopause should be a non-event. She believed that only women whose identity and self-worth were tied to being a wife and mother, and for whom, therefore, youth and sexual attractiveness are all-important, would find menopause difficult. Other hormonal emotional experiences, such as pre-menstrual tension and post-partum depression, she similarly refused to recognize as physiologically determined.

Friedan, and many other feminists who are now in their 70’s, 80’s and 90’s, espoused the view that the miseries of menopause are solely a consequence of the repressive Freudian environment Friedan detailed in The Feminine Mystique. Friedan went so far as to say that menopause didn’t really exist—it was invented by the pharmaceutical companies!

What was wrong with me, I wondered? I had a career and meaningful relationships but found menopause disorienting and painful. The changes in body image, the physical discomfort, mood swings, insomnia all made me wonder, “Who am I?” and “What am I becoming?”  According to Friedan, I should have been immune to this distress because of career and meaningful interests outside the home.

I invited Friedan in 2005 to speak at a conference on the topic “Is There Menopause?” to explain her views.   Friedan initially agreed, but her failing health prevented this. She did, however, allow me to videotape an interview to be screened for attendees. She died soon after the interview. Click to view video.

On January 12, 2005 I went to Friedan’s apartment. I had sent her a list of questions in advance of the interview: Have women’s reactions to menopause changed since you wrote The Feminine Mystique?  Do women experience it the same now as they did in 1963?  Do you think menopause changes the way a woman sees herself?  Does it change her identity?

Friedan became increasingly annoyed, and even hostile, as I asked my questions.  The very word “menopause” irritated her. Menopause does not exist—and shouldn’t be talked about.  I persisted with my questions until she finally yelled, “What the fuck are you asking me?” Questions about “aging” were OK with her, so long as I didn’t use the word “menopause.” Men and women both age, but only women are alleged to go through menopause.

At the conference, along with the Friedan interview videotape, I presented my own paper on the impact of menopause on a woman’s identity. Much to my surprise, several feminist psychoanalysts, 10 to 15 years older than I, approached me afterwards warning me that this was a dangerous topic, a slippery slope and that I should perhaps discontinue talking about it.

The dangerous topic is not menopause—it is the acknowledgement that female hormones make women feel and behave differently from men.  Historically, a focus on the female body, ovarian hormones and the menstrual cycle has been used to stigmatize women as moody, flighty, and unfocussed. As such, they should not hold positions of power. If a woman was president, she might start a nuclear attack while suffering from PMS!

My female friends and I, all Baby Boomers, were the benefactors of the changes brought about by the Women’s Movement. We assumed we’d have careers, or at least imagined the possibility. Now in our 60s, most of us do have careers and families.  We’ve gone through menopause, but didn’t sail through it the way Friedan predicted. Not at all!

So while we should be immensely grateful for Friedan’s potent critique of that which oppressed women, I believe it is important that a complete understanding of the female experience include recognition of the significant effect of hormones on a woman’s body and psychological functioning. Rather than denying or dismissing the impact, let’s acknowledge and appreciate the range of experience with which hormones endow women.

Why Do I Get So Hungry Right Before My Period?

Hormones and menstrual cycle affect eating and body image: by Susan Kolod, Ph.D.
Published on February 28, 2013 by The Contemporary Psychoanalysis Group in Contemporary Psychoanalysis in Action

This is the 3rd of 3 posts from the Eating Disorders, Compulsions and Addictions Service (EDCAS) of the William Alanson White Institute in recognition of National Eating Disorders Awareness Week (February 24th through March 2th).In honor of National Eating Disorders Awareness Week I’d like to bring awareness to a lesser known aspect of appetite and disordered eating—the impact of sex hormones and the menstrual cycle on appetite and body image.

Women are more prone to eating disorders than men.  Statistics indicate that 80 to 90% of all people who suffer from eating disorders are women. This is usually explained by “cultural” differences: in the fashion industry, media and cinema, female beauty is synonymous with a thin body; girls are brain-washed to believe they must have little or no body fat to be attractive. But this is not the whole story.

New research suggests that the menstrual cycle and the production of sex hormones are equal, or even more important, factors. Although both men and women produce sex hormones, women experience a monthly hormonal cycle from puberty to menopause. And the cyclical nature of sex hormone production has a powerful impact on appetite for both human and non-human female animals.

Although very little has been written on this subject, many women know intuitively that their relation to food changes across the menstrual cycle. It is common in my psychotherapy practice to hear female patients comment, “I was PMSing and couldn’t stop eating”, or “I always binge on chocolate right before I get my period”.

Theresa Kinsella, a nutritionist in New York City who specializes in work with eating disordered women reports, “I have one client who is overweight and a binge eater. She calls her PMS phase, ‘the monster’ and has cravings for chocolate, frozen yogurt and candy. ‘But it’s over’, the client observes, ‘the second I start to bleed’”

Kelly Klump, Ph.D., a research psychologist and professor at Michigan State University, studies the etiology of eating disorders with an emphasis on genetic and neurobiological factors. Dr. Klump and associates have demonstrated empirically that certain hormones are implicated, not only with regard to changes in appetite during the menstrual cycle, but in body image as well.

In a recent issue of the International Journal of Eating Disorders she and her associates examined changes across the menstrual cycle in two independent samples of women and found a direct effect of sex hormones on both appetite and body image.

The researchers found that both binge eating and body dissatisfaction peaked during the pre-menstrual, or luteal phase, when there is increased progesterone production.  Estrogen, highest just before ovulation in the follicular phase, has been found to be an appetite suppressant.

In a recent conversation, Klump told me that binge eating during the pre-menstrual phase and appetite suppression during the follicular phase is also found in non-human animals. Animals show the same pattern of binge eating during the pre-menstrual phase, and appetite suppression during the follicular phase. So, in addition to cultural factors, biology clearly contributes to female eating behavior.

Klump also found that during the pre-menstrual phase, when progesterone production is at its highest, women were less satisfied with their bodies. How do hormones affect body (dis)satisfaction? Klump hypothesizes that progesterone leads to binge eating, which then triggers body dissatisfaction. In addition, progesterone contributes to pre-menstrual anxiety, a state that can make women feel more critical of their bodies.

What are the implications of this research for the treatment of eating disorders? Just as women with mood disorders are more prone to an increase in symptoms during the pre-menstrual phase, women who express anxiety and depression through disordered eating, particularly binge eating, would be expected to show an increase in symptoms during the pre-menstrual phase. This is exactly what Klump’s research found!

Jean Petrucelli, Ph.D., Director of the Eating Disorders, Compulsions and Addictions Service at the William Alanson White Institute emphasizes the importance of creative treatment strategies.  She asserts that eating disorder symptoms are not something to simply eradicate, but rather part of a story about the patient’s relational experience with caretakers. She stresses the importance of helping patients become aware of all that contributes to their disordered eating.

Dr. Petrucelli often recommends patients keep a food journal as a vehicle for examining symptoms. The journal is a record of eating times, locations, and food choices, as well as associated feelings and eating disorder “behaviors”.  She may suggest patients email a report of their weekly food intake and other ingested substances (alcohol, laxatives, diuretics, drugs, etc.) prior to meeting with her.  Pictures of plates of food may also be included when portion sizes are in question. Active documentation helps alert the patient to feelings and experiences that trigger disordered eating.

Given the new research findings implicating sex hormones in eating behavior, it’s likely useful to expand the journal to include notes about the timing of menstrual cycle phases.

In recognition of Eating Disorders Awareness Week, let’s make an effort to become aware of the effect of sex hormones and the menstrual cycle on appetite and body image.

Rage, Guns, Drugs and Therapy: the Jean Harris Murder Case

The fact that she aimed the gun at Tarnower and not herself made her case unique
Published on January 14, 2013 by The Contemporary Psychoanalysis Group in Contemporary Psychoanalysis in Action

The Jean Harris story was a compelling erotic fantasy: seduction, humiliation, abandonment and retribution.  It captured our attention in 1980, but if you are under 50 you may not know much of the private school headmistress who killed her philandering lover, Herman Tarnower, the “Scarsdale Diet Doctor.”  Jean Harris died on December 23rd at age 89. (Headmistress, Jilted Love, Killer, Then a Force for Good in Jail; New York Times December 28, 2012).

What made her snap?  Was it an accident or murder?  Was she justified? Public debate raged. Harris evoked vastly different thoughts and feelings about women, love, fidelity and aggression. To Diana Trilling, the literary critic, Harris was a modern-day Anna Karenina, to Betty Friedan, the famous feminist, a pathetic masochist.

Jean Harris took the pistol out of her small purse and plugged Tarnower 4 times. Was it an accident, as she claimed?  Did he have it coming, as the female murderers sing in the “Chicago” musical number “The Cell-Block Tango”?

Unlike the “merry mistresses of mayhem” in “Chicago”, Mrs. Harris was a petite, lady-like, Smith-educated, 56-year old woman with no prior criminal record. A woman of wit and intelligence, she testified she went to her lover’s home with a gun, not to kill him, but to ask him to kill her. If he refused, she planned to kill herself. Tarnower, asleep in bed when she arrived, must have reacted inappropriately, because he ended up with 4 bullets in him.

Much of the debate that ensued over this case reflected the feminist challenge to theories about “normal” female development that stigmatized women during that period. Classical Freudian theory, still the prevailing authority in 1980 but since abandoned by contemporary psychoanalysts, postulated that passivity and masochism are part of normal female development.  The fact that a woman as “normal” as Harris aimed the gun at Tarnower rather than at herself made her case unique.

Ann Jones had just finished writing her seminal text on female murders, “Women Who Kill” when the Tarnower murder occurred. Jones found the case to be so note-worthy that she added a new chapter to her book.

Women perpetrate a very small percentage of the killings in this country—figures range from 7 to 15%.  Jones writes that “The so-called classic murder of jealous passion, like every other murder, is far more likely to be committed by a man who murders ‘his’ woman in a fit of possessiveness”. Women, on the other hand, are taught not to become angry about such things as infidelity. Instead, they often become depressed and self-destructive. Women like Harris, according to Jones, are programmed to commit suicide, not homicide.

At the same time, The “Battered Woman Syndrome” was being debated in the courts as a defense in cases where a woman killed her abusing partner.  Lenore Walker described this syndrome in her book “The Battered Woman” (1979). but Jean Harris didn’t fit that mold, since she had never been physically abused by Tarnower.

He had taken up with a younger woman, Lynn Tryforos, and the two were quite public about their affair. Harris testified at the trial that she discovered a birthday greeting from Tryforos to Tarnover in an advertisement on the front page of the New York Times. She commented to Tarnower, “Herman, why don’t you use the Goodyear blimp next time? I think it’s available.”

In a letter Harris sent Tarnower the day of the murder, she revealed her deeply wounded self-image and recounted that “to be jeered at and called ‘old and pathetic’ made me seriously consider borrowing $5000 and telling a doctor to make me young again—anything but make me not feel like discarded trash.”

Humiliation, abandonment, methamphetamine and barbiturates (prescribed by Tarnower), exhaustion and possibly menopausal hormones—were too much for a woman like Harris, who was already unable to express anger. She kept it to herself, until she exploded in rage. And then there was the gun.

Harris was undoubtedly confused, distraught and furious as she got into the car that day to drive to Tarnower’s house. Her sense of reality  shaken, she wasn’t clear whether she intended to kill him, herself or just threaten him. If she hadn’t had a gun, there would have been a scene, maybe even a physical fight, but he would not have died and she would not have gone to prison for half of the rest of her life.

Harris had purchased the gun two years prior for “self-protection.”  That aspect of the case, the fact that she bought a gun in the first place, was ignored in the public debate. A single comment made by Harris’s son, James, who was 27 years old and a marine lieutenant at the time, made reference to the weapon. At the bail hearing he commented to a New York Times photographer, “This is a very sad thing—perhaps your paper should write a good story on gun control ”(Gun Used in Slaying of Doctor is Tie to Suspect, New York Times, March 12, 1980).

Or perhaps the paper should have written a good story about psychotherapy.  Harris had never sought psychotherapy or psychiatric medication, according to her biographer, Shana Alexander (Very Much a Lady, 1983) relying instead on Tarnower’s amphetamine and barbiturate prescriptions.  There is no question that therapy, perhaps with appropriate medication, would have helped her to cope with her distress and likely find a way out of it.

Repressed anger is a problem therapists encounter frequently in practice. I find it particularly prevalent among female patients anxious about expressing anger directly towards a loved one for fear of losing the relationship. If untreated, repressed anger may become self-directed rage and can take the form of eating disorders, physical symptoms, depression and suicidal thoughts.

Treatment focuses on helping the patient first to become aware of angry thoughts and then to start to express them. As the patient becomes more aware of and comfortable with anger, the physical symptoms and depression start to lift.

In Harris’ case, the repressed anger was complicated by her intense dependency on Tarnower. She appears to have been drug addicted and was dependent on him both emotionally and for drugs, calling him her “life-line”.  Although not physically abused by Tarnower, the cycle of humiliation and reconciliation, amplified by drug dependency, may have rendered her helpless to leave. Had she sought psychotherapy, it could have helped disentangle her from this abusive relationship.

In 1980 I was a young woman and Harris symbolized a different way for women to express rage—take it out on the person who humiliated you! But Harris was not a fantasy or a symbol. She was a woman pushed to the edge, deeply remorseful afterward; she killed her lover and companion of 14 years and was sentenced to 15 years in prison. Today, I wonder what might have been different if the form of self-protection she had opted for had been psychotherapy rather than a gun.

The Male Biological Clock

Aging sperm is linked to children’s developmental and psychiatric conditions
Published on December 3, 2012 by The Contemporary Psychoanalysis Group in Contemporary Psychoanalysis in Action

Men, as well as women, are advised to attend to the tick-tock of the biological clock.

New research, reported in the NY Times (August 22, 2012) confirms that as men age, they are more likely to father a child who develops autism and schizophrenia. Although previous studies strongly suggested a link, this new study actually quantifies the effect as it builds each year. The study, published online in Nature (August 22, 2012) by Kari Stefansson and his team at Decode Genetics in Iceland, demonstrated that 97% of the rate of new mutations, accidental changes in DNA that can prevent a gene from functioning properly, can be attributed to the age of the father.

Male sperm-producing cells are constantly dividing and as a result the number of new mutations increases over time. The sperm of a 20 year old man carries about 25 mutations; the number rises at a rate of 2 per year. So the sperm of a 40 year old man may have some 65 new mutations. Since females are born with a lifetime supply of eggs already in their ovaries, the number of new mutations a mother passes along is about 15, regardless of her age.

The implications of this research are dramatic. Seth Mnookin (Gene Blues: The Danger to our Gene Pool as Fathers Become Older and Older, New Yorker, August 27th) observed that, “The genetic health of the species is now facing a serious threat” and “ new mutations cause by old sperm raised the specter of an inevitable decline in the mean fitness of the population.”

Judith Shulevitz (New York Times, September 8, 2012) notes, “Unborn children can be affected by what and how much the father eats, the toxins he absorbs and that, even more astonishingly, those children may pass those traces along to their children”.

Women have always had to contend with the “biological clock” when balancing desires for career and family. Common knowledge dictated that men could delay fatherhood with no ill effects. Or they could start a new family with a young “trophy wife”. In the classic film, How to Marry a Millionaire, a very young Lauren Bacall pursues the distinguished William Powell who is old enough to be her father. He’s a great catch! This new research would give Bacall pause. Is it more likely that their union would produce an autistic or schizophrenic child, or a child with a lower IQ?

Growing up in the 1950’s and 60’s I vividly recall the terms, “refrigerator mother” and “schizophrenigenic mother” applied to beleaguered women trying to understand and cope with strange, unresponsive or explosive children. When they sought help from the medical establishment, doctors told them it was their fault; that a child flapping his arms repeatedly like a bird or refusing to make eye contact became this way because his mother could not show him adequate love. These women were often advised not to have more children.

Noted psychologists Bruno Bettelheim and Frieda Fromm-Reichmann insisted it was maternal failings that caused schizophrenia and autism. A documentary entitled, Refrigerator Mother (2003) features Bruno Bettelheim on the Dick Cavett show in the late 1960’s stating emphatically that children become autistic because the child believes the mother wishes them dead, just as the Nazis wished the Jews dead. Bettelheim illustrated his thesis with films of strange, asocial children with vacant stares, comparing their facial expressions with those of concentration camp victims. The effect of this comparison was compelling and convincing.

The theory of the “schizophrenigenic mother” was profoundly unhelpful to the mothers of autistic and schizophrenic children. And it was abandoned as more research revealed the biological roots of these disorders.

What is true: when a child comes into the world with severe problems in attachment, it is imperative that parents learn how to cope with the feelings aroused by children who scream uncontrollably when their daily routine is changed or shrink from all physical contact. Feelings of hate towards both the child and the self are common. The parents may even wish the child dead, which is a reaction to the illness, not the cause of the illness. How a parent copes with such intense—and expectable—negative feeling will have a significant impact on the child.

The psychological burden of raising an autistic child, however, still mostly falls on the mother, according to Susan Rose, Ph.D., Director of the Child and Family Center at the William Alanson White Institute and expert on the treatment on Autistic Spectrum Disorder (ASD). Dr. Rose has observed that Autistic Spectrum Disorder has a strong genetic component and is mostly passed along from fathers to sons. Fathers with ASD are particularly challenged by the emotional burden of coping with an autistic child. The work of researcher Simon Baron-Cohen (Borat/Alie G/Bruno’s cousin) sited in an October 28, 2012 cover story in New York Magazine on Asperger’s Syndrome, supports Rose’s observations that autism can be passed along from fathers to sons.

As it becomes clearer that the origins of autism and schizophrenia are linked more closely to the father, this will hopefully encourage fathers to assume a more important role in raising difficult and troubled children. And this requires learning how to cope with the feelings of hopelessness, powerlessness and hate evoked in a parent by the autistic child.

It turns out that BOTH men and women are best suited, biologically speaking, to reproduce in their 20’s and early 30’s. After 35, both men and women are more likely to produce children with various kinds of developmental difficulties. Men face the same questions as women: can they afford to wait until their careers are settled before starting a family?

A Date with Hurricane Sandy

Learning to know your partner in a crisis
Published on November 9, 2012 by The Contemporary Psychoanalysis Group in Contemporary Psychoanalysis in Action

Who would you choose to be with during a hurricane? How much can you learn about your romantic partner’s character and feelings by spending time together during a crisis?

I was lucky to return to my New York City office on Wednesday after the storm without too much trouble. Some of my patients were unable to come in due to the subway outage. Every patient who did make it in had a story about how he or she fared during the hurricane. A number of patients had dramatic stories about how their romantic relationship had changed irrevocably, some for better and some for worse.

Noah, a smart, attractive man in his mid-twenties has been involved with Aaron for a few months. They have great sexual “chemistry,” but he had been worried about Aaron’s capacity for love and commitment. They decided to hole up together at Aaron’s apartment during the storm. At first, they were having a great time—eating, drinking, and laughing.

As the day went on, they started a serious discussion about their future.  A few hours before the hurricane hit, Aaron told Noah that, although he loved spending time with him, he was still hoping that one day he might meet, “Another Noah—someone just like you—but who is more my favorite body type.”  Yikes!  As painful as it was to hear this, Noah appreciated the honesty.  As the storm hit, he couldn’t leave, so he cried while Aaron, oblivious to Noah’s anger and hurt, worked on his computer. In the morning, Noah ended the relationship and left.  Aaron professed surprised and tried to dissuade him, but Noah had made up his mind.

Deborah had been going out with Tom for about 6 months. They enjoyed each other’s company and had been spending evenings together.  They decided to weather the hurricane as a couple—they went grocery shopping, planned what to cook and obtained emergency items in case of a power failure. When Mayor Bloomberg announced that the subways were being suspended, both expressed a sudden feeling of euphoria about the extra time they would have together.

Deborah felt a little guilty about feeling so happy in the context of disaster. Immediately before the hurricane was predicted to make landfall, the pair went for a long walk, ate dinner and then cuddled up watching movies. The hurricane hit around 8:30 PM, power failed, lights went out, the movie stopped. Tom found a flashlight and they took a minute to orient themselves. Scared and worried, they went to bed and hugged each other. Once the worst had passed, they ventured outside to survey the damage and look at the moon. Back inside, they held each other all night. Deborah was grateful and happy she’d gone through this experience with Tom.

Esther had been with Justin for a year. She loved many things about him and had been suppressing her doubts about his ability to make decisions and stick to them. He had disappointed her before, but she kept giving him opportunities to prove himself. As the forecasts for Hurricane Sandy became more ominous, Justin told Esther that he wanted nothing more than to take care of her during the storm.

They decided to weather the storm at his apartment since hers was close to the evacuation zone. They planned for the possibility of  a black out, bought food, candles and anticipated their time together. Esther got her apartment ready for the possible onslaught. In the early afternoon she called Justin to ask when to come over. He was evasive. She became more pointed—“I think I should come over NOW—don’t you?” Finally, Justin told her that there had been a “change of plans.”  His family wanted his sister to stay with him and he wouldn’t be able to host Esther during the hurricane.  Esther was stunned. She scrambled to get the supplies she needed and went back to her apartment to brace for the storm.

The hurricane hit around 8:30 pm—Esther, alone in her apartment, heard the wind howling and sirens blaring. Then she lost power. Terrified, she went to bed and eventually fell asleep. She woke to a close female friend yelling for her from the street. “I was never so happy to hear someone call my name.” Later that day Justin begged her forgiveness.  Esther was confused, “I don’t even know if I’m angry at him—really I just feel sorry for him—he is such a coward.”  Justin had been unreliable and lacking in courage before, but in the face of disaster his shortcomings were particularly distressing for Esther.

Many relationships were tested this week because of Sandy.  A few in deeply tragic ways and others, like those described above, in more everyday ways.  Crisis puts stress on a relationship and it can broaden and deepen the range of experience a couple has shared. Some couples met the challenge with bravery, courage and love.  Others did not.  Noah, Deborah and Esther, who gave me permission to tell their stories, were fortunate that Hurricane Sandy allowed each of them a view of the character and feelings of their romantic partners in a crisis that proved not to be life threatening.

Fifty Shades of Porn

Which Porn Is Good/Bad For Your Relationship
Published on May 1, 2012 by The Psychoanalysis 3.0 Writing, Group in Psychoanalysis 3.0

The book, Fifty Shades of Grey, has been at the top of the New York Times Bestseller list for the last 8 weeks. Female patients, mostly women in their 30’s with small children, often report that careers, lack of sleep, family and other responsibilities leave them too tired and drained for sex.   Reading this book, however, has re-invigorated their sex lives. It’s making them horny! Spouses and partners are pleased.

The “Fifty Shades of Grey Phenomenon” has led me to consider whether there are some types of porn that are good for relationships, some that are bad, and to wonder what is the difference?

I decided to read the book to see what all the fuss is about. The book is impossible to find in bookstores because it was published by a small independent press and sold out immediately. I downloaded it onto my Kindle, remembering what my younger daughter told me a few years ago when I asked what she thought of this device.  She replied, derisively, “Kindles are for people who want to read porn without anyone knowing.”

The BDSM (bondage, dominance, sadism, masochism) theme of the book sparked some controversy in the media and press (e.g., Maureen Dowd). Is the book a regression to the subjugation of women or is it a helpful guide to exploring female sexuality? This political controversy is, in my opinion, secondary to the fact that the book is motivating women to “get it on”. It is making them want to have sex with their real partner and the sex is good! Who cares if it’s politically correct or not? Sexual fantasy is never politically correct.

In contrast to online porn, the book is not visual. The protagonist, Ana Steele, a 21-year old college student, is never described so it is left to the reader to imagine her.

Although the book is purportedly about kinky sex, it is squeaky clean. Every act of penetration is accompanied by the sound of foil tearing as the condom is opened. He is totally enthralled with her, can’t keep his eyes off of her, and can’t get enough of her. She calls him Mr. Grey and he refers to her as Miss Steele. This lends an old-fashioned formality to the story—kind of like Jane Austin with whips and chains. He is demanding and imperious but with the sole aim of giving her the most intense pleasure.

He is a handsome, rich, damaged person who “doesn’t do girlfriends.” The ‘turn on” involves the question of whether Ana will submit to his BDSM demands, or succeed in making this scarred, incredibly attractive person fall in love with her. The most vivid passages in the book are descriptions of Ana’s surrender to sexual ecstasy. Although she is being asked to submit, it is really she who holds the power over the man who is enthralled and when she finally surrenders, the reader thinks, “I wish someone would pay that much attention to me!”

I’m not looking at the question of whether some porn is good or bad for a relationship from a morality standpoint. Simply put, if the porn facilitates good sex in which both partners “get off”, then it is good for the relationship.  On the other hand, if porn interferes with mutually satisfying sex, it is bad for the relationship. Satisfying sex is a very important factor in healthy relationships. Aside from the obvious pleasure and intimacy that good sex engenders, the hormone oxytocin that is released during orgasm stimulates warmth and trust between partners.

Contrast the “Fifty Shades Phenomenon” with the online porn phenomenon. As compared with the rave reviews I get from my patients about the impact of this book on their sex lives, I hear complaints from both male and female patients that online porn has ruined sex with actual partners. A female patient reports that both she and her husband watch online porn and masturbate in separate rooms. When they get together, sex is unsatisfying.

Since men are more frequent user of online porn, female patients complain that their husbands’/boyfriend’s frequent use of porn has made sex with them stilted and disconnected. Male patients who watch a lot of online porn comment that sex with their girlfriends/wives has become boring. One young man explained that he could easily spend hours watching “web-cam girls” who “do what you ask them to do for money” online. This young man wonders if having sex “in person” could ever be as exciting and quickly loses interest in the woman he is seeing.

Tracy Clark-Flory, sex writer for writes that she faked orgasms all through her 20’s.  “Most of my partners had been raised on online porn just like I had, and as I endeavored to fulfill their (and my) every smutty expectation, no one seemed dubious about the intensity and efficiency of my reactions.” Why did Clark-Flory fake it? An inner voice would nag, “You’re taking too long! He’s getting bored!”

This problem is not new. In the 60’s and 70’ during the “Sexual Revolution” women were expected, and expected themselves to be hyper-sexual and orgasmic. The reality of sex with an actual partner was somewhat different and many women felt too inhibited and shy to ask for what they wanted (assuming they knew) and to demand that. Faking orgasms was a lot easier than figuring out with another person what works. But the online porn phenomenon seems to have exacerbated the situation. Real women have to compete with fantasy girls who apparently come at the drop of a hat. With an actual partner there needs to be coordination, responsiveness, and communication. Satisfying sex involves a certain amount of choreography.

Couples need to talk to each other about whether and what kind of porn helps/hinders satisfying sex. What is good for one couple might not work for another. So the question becomes, what kind of porn will spice up YOUR sexual relationship?

Here are some questions to ask yourself and your partner:

  1. Does the porn help you and your partner sustain compelling sexual fantasies that lead to orgasm?
  2. Does the porn make you feel satisfied/ dissatisfied with your partner?
  3. Does the porn open up/foreclose possibilities for more interesting and creative, and mutually satisfying sex?
  4. Does the porn increase receptivity and attunement to your partner or distract you from your partner?

Many people have the idea that they should only be thinking about their partner when having sex and to think about other people or other scenarios is like cheating. In fact, if your partner turns you on, you are more likely to be able to create and sustain compelling sexual fantasies that lead to orgasm. Good sex involves attunement, creativity, imagination and freedom to let your mind go where it may, all in the service of enjoying yourself and facilitating your partner’s enjoyment.  If porn helps to accomplish this, then go for it!

The Thinking Body, The Moving Mind: What I Learned From Merce Cunningham About Psychology

Psychological reflections on the end of the Merce Cunningham Dance Company
Published on January 1, 2012 by The Psychoanalysis 3.0 Writing, Group in Psychoanalysis 3.0

A part of Merce Cunningham is always with me in my work as a psychoanalyst, even though, or maybe especially because, this groundbreaking choreographer and dance teacher died on July 26, 2009. Both I and my patients are profoundly in his debt.

With the dance phrases he created, or “combinations” as he called them, I learned to be comfortable with chaos and to trust that patterns would eventually emerge with their own shape and rhythm. Losing then regaining balance; moving from disorientation to order; having the strange become familiar; perceiving patterns emerging from chaos—my body learned these things during the 20 years I took classes at the Cunningham Studio.

Now they, and he, are a part of my mind as well.

In June 2009, a month before his death, he announced his “Legacy Plan.” His dance company would tour internationally for 2 years and then disband. The Merce Cunningham Dance Company performed for the last time on December 31, 2011. Although Cunningham documented each of his dances on video the December 31st performance was the last live performance of his choreography by the company he trained himself.

I asked Patricia Lent, a long-time member of the company and now Director of Repertory Licensing, why Merce wanted it this way. She gave 3 reasons: First, he felt the dancers in his company should all be trained by him and could not envision it otherwise; Second, each year he choreographed about 3 new dances and created each dance with a particular member of the company in mind so that the dancers would continually be performing new work, after his death there would be no new choreography for the current dancers; Finally, he believed it would be difficult for the company to sustain itself financially after his death.

Robert Swinston, also a long-time member of the company and now Director of Choreography, told me that although the Merce Cunningham Dance Company has disbanded, several ballet companies plan to perform his dances. Swinston’s job is to teach the dances to these companies. Although dancers can learn the steps, if they are not steeped in the Cunningham technique, Swinston notes, the choreography will look and feel quite different. It is impossible to know how the Cunningham technique and choreography will evolve over time in the hands of other companies.

Regardless of what future performances by other companies are like, this is personal for me. I am mourning not only the loss of Merce Cunningham and his incredible dance company, but also a younger version of myself, physically and mentally capable of executing the complicated combinations he taught in his class. In the process of mourning, one brings up all available memories and savors the experiences evoked by these memories.

“You have to REST during the rest beats.” Standing with my right leg bent, back parallel to the floor, left leg extended straight behind and upper torso and head curved toward my left leg, this was an uncomfortable position to hold, but Merce said to rest so I rested. It is an unusual kind of rest, with muscles extended and mind alert. The body rests when it can, so that the dancer can attack the next movement with vigor and freshness. Merce reminds the class that if you do anything often enough it becomes natural. So it became natural to rest in an uncomfortable position.

Merce frequently made such observations when teaching his technique class—observations that applied not only to dance but to many things in life. I think about things he said as I go through my day as a psychoanalyst. Listening to patients while monitoring my reactions often feels like holding an uncomfortable position. As in Merce’s technique class, I try to rest with my mind alert and extended, so that I will be able to respond with full energy and attention.

I took technique classes at Merce’s school in Westbeth, a subsidized artists’ housing project in Manhattan’s West Village, for over 20 years. I was particularly fortunate to take classes with Cunningham himself. During the month of August he taught the Intermediate class everyday—this was something the students looked forward to all year. Taking his class everyday during my 9th month of pregnancy in August 1981 was an unusual experience for me, and for Merce. The combinations frequently required the dancer to lose and then regain balance. Since my center of gravity shifted from day to day, this was a particularly challenging endeavor. Occasionally, I noticed Merce eyeing me with curiosity, perhaps alarm.

A class taught by Merce required one to think with the body. He often gave combinations that included atypical beats to a phrase. A typical dance phrase might be in ¾ time or “waltz time” —ONE two three, ONE two three. In contrast, Merce gave a phrase of, say, 3-5-2. Initially, it felt chaotic—difficult to find the downbeat and no discernable pattern or rhythm. But as one practiced the phrase, it took shape and rhythm. ONE two three, one two three four FIVE, one TWO, ONE two three, one two three four FIVE, one TWO—try tapping it out over and over. Eventually, I became comfortable with the chaos and trusted that by repeating the phrase, the pattern and rhythms would emerge.

In a Cunningham dance the dancers are not supported by the external surroundings, such as the music and the set. There is no story to a Cunningham dance. The music and sets are introduced either at the dress rehearsal or sometimes at the performance itself. Sometimes the order in which the dance sequences appear is determined by a toss of the dice right before the performance. All these factors create an atmosphere of disorientation. The dancer has to find a sense of order in him/herself. Similarly, in his technique class, Merce gave a combination and just as it became familiar, he told the class to shift direction. This caused temporary disoriented. The excitement and fun of the class was to realize that we had the ability to regain orientation.

His dance, “Split Sides” is an example of how complicated—and pleasurably disorienting—his choreography could be. It is divided into 2 parts, each with one of 2 options for set design, choreography, costumes, lighting and music. The order in which each element appears is determined by a toss of the dice before the performance and there are 32 possible versions of the piece. This dance raises questions in the observer: Is it same dance no matter which order, costume or music? Does the dancer feel completely different each time the elements are changed? Sometimes psychotherapy sessions feel this way, although it is the mind and heart of the patient rather than dice choosing from an infinite number of possible versions of the session.

Merce was captivated by how movement could be experienced in the mind. He related an incident that occurred when he was a young dancer in the Martha Graham Dance Company: Helen Keller was brought into the studio accompanied by her aid. She was introduced to the class and then she asked if she could touch a dancer in motion. She was brought over to Merce and her hands were placed on his waist. Cunningham made some small jumps to which Keller replied, through Sign Language, “So light, like the mind!” Keller got it right. He became one of the first choreographers to create dances on a computer. He would show the choreography to company members and ask, “Is this possible?

I find it hard to believe that there is no more Merce Cunningham Dance Company, no more Merce. Soon the Cunningham Dance Studio, on the top floor of Westbeth, will be gone. A piece of my life, one of the good pieces, is gone. This is indeed a disorienting experience. But as I learned from Merce, pattern and rhythm can emerge from disorientation and chaos—perhaps something wonderful will emerge from his work after his death that none of us could possibly have foreseen.

I hope so.

Brain Mapping Does Not Reveal What Turns a Woman On

Towards a marriage of sex research and contemporary psychoanalysis
Published on August 31, 2011 by The Psychoanalysis 3.0 Writing, Group in Psychoanalysis 3.0


A recent brain imaging study, published in the July issue of the Journal of Sexual Medicine showed something women have known for years; stimulating one’s clitoris, vagina, or nipples by hand or with a “personal device” can all be sexually exciting, but in very different ways.

The August 5th New Scientist in a piece titled “Sex on the brain: What turns women on, mapped out” says:

“The precise locations that correspond to the vagina, cervix and female nipples on the brain’s sensory cortex have been mapped for the first time, proving that vaginal stimulation activates different brain regions to stimulation of the clitoris. The study also found a direct link between the nipples and the genitals, which may explain why some women can orgasm through nipple stimulation alone.”

But does this mean we now know what turns women on? Or are any closer to understanding that mystery? Let’s take a look.

In the study eleven women between the ages of 23-56 self-stimulated the clitoris, the vagina, and nipples. As the participants stimulated these areas, fMRI’s showed that different areas of the sensory cortex lit up. Furthermore, they found that when the nipples were stimulated, it showed up not only in the region of the brain associated with the chest but in the genital region as well.

Among the interesting questions raised are whether other body parts can also be linked to the genital area of the sensory cortex. We know, for some, the ears, the nape of the neck, the navel or even the entire surface of the skin can be erogenous under certain conditions. But do those pleasures also light-up the genital area, or are nipples somehow unique? And what to do about the fact that sexual stimulation can also occur in the absence of any physical contact at all?

So does this study really show “what turns women on?” To be fair, the authors of the study do not claim to have answered this question; that comes from journalists. The researchers’ aim was much more modest: To map the sensory cortical fields of these areas of the body toward a better understanding of the neural systems underlying sexual response. The study was not intended to illuminate what sparks desire and erotic feelings in women. Nor does it claim to shed any light on why some women are unable to achieve orgasm, or why some couples who were very turned on by each other at one time are no longer attracted, as Loretta Lynn sings, “when the tingle becomes a chill.”

No matter how modest and well-conducted this study was, and the others that hopefully will follow, it is important to keep in mind that physical stimulation is only a small part of the complex question of what turns a woman on.

For example, the inability to achieve orgasm is a common complaint of female patients in psychotherapy and psychoanalysis, and it can be difficult to treat. It’s not a matter of knowing which part of the anatomy to stimulate; contemporary women know about the importance of clitoral stimulation. Sometimes, a woman can achieve orgasm through self stimulation, but not with a partner. And sometimes the problem is with the partner—a partner who was once desired and desiring but isn’t anymore.

To be useful for treating problems with sexuality, a study should try and account for the presence, or absence, of a sexual partner since the really interesting and complex aspects of sexuality and desire emerge within the context of a relationship. The role of interpersonal relationships, emotion, memory, unconscious processes, fantasy and trauma must be included in order to really understand what’s going on, for example, when the “tingle becomes a chill.”

Desire is difficult for anyone to define, and almost impossible to describe in the abstract. I feel sympathy and respect for researchers who remain undaunted and, nevertheless, try to measure and quantify that which has not yet been satisfactorily defined. But I also know that this is a place where contemporary psychoanalysis could help if our communities were in closer contact with each other.

If sex research were to illuminate what helps, and what blocks, someone from experiencing desire, they would achieve a major breakthrough in the treatment of sexual problems. The researches took a step in that direction at the end of their report when they suggested that an area for further research would be studying which areas of the brain are activated when genital stimulation is perceived as “erotic” vs. when it is perceived as “just pressure.” Let’s hope they also add when it is perceived as painful or repellent.

More generally, one way research such as this might better access desire would be to find out what the subjects were thinking as they stimulated themselves. What were the thoughts, feelings, images, stories, memories, etc.? Such reports of sexual fantasy can be a window opening on the structure of desire. And if they had asked them to report their thoughts and fantasies, it would have taken the researchers much farther into answering the question of “what turns women on.”

Freud would have appreciated this study despite the fact that it called into question his theorizing that clitoral excitement is an immature sensation whose only value is to kindle vaginal excitement. He was a neurologist by training and frequently modified his theories when presented with new evidence. It would have been interesting to see him react to a finding that placed clitoral stimulation on an equal footing with vaginal, not to mention the erogenous potential for nipples. But he did not have today’s technology, so he studied his theories through talk therapy alone. Today we have both: talk therapy and brain imaging technology. What’s missing are rich, productive exchanges between sex researchers and those psychoanalysts plumbing the fault lines of 21st century sexual desire. And when I think about a possible marriage between sex research and contemporary psychoanalysis, well, I get that tingle that says we might be close to having answers for the question of “what turns a woman on.”

On the Front Lines with a Japanese Psychologist at the Fukushima Disaster

Developing culture-specific ‘systemic-psychodynamic’ models instead of PTSD
Published on June 11, 2011 by The Psychoanalysis 3.0 Writing, Group in Psychoanalysis 3.0

My friend and colleague Naoto Kawabata is a Japanese psychologist doing relief work with families who have been traumatized by the disaster at Fukushima in Japan.  Naoto is the Founder and President of the Kyoto Institute of Psychoanalysis and Psychotherapy (KIPP) and Professor of Psychology at Kyoto Bunkyo University.

I met Naoto when he came to New York City to study advanced psychotherapy and psychoanalysis at the William Alanson White Institute where I teach and supervise.

When I taught seminars in Interpersonal Psychoanalysis in Japan Naoto hosted my visit and I got to know his wife, Yoshiko, and his daughter, Shiho.

Naoto was a first responder at the earthquake in Kobe in 1995 and this experience affected him profoundly. As a result of his work in Kobe, Naoto, who is a brilliant thinker, questioned whether and how western theories of trauma treatment can be translatable for Japanese trauma victims.

I was not surprised to find out that Naoto is now at the front lines working with families traumatized by the Fukushima disaster.  Naoto agreed to let me interview him (via email) about his experiences there.


Naoto, how were you called to the Fukushima disaster?

The Board of Education of Kyoto prefecture asked the Kyoto Association of Clinical Psychologists to recommend psychologists for a support team to travel to the Fukushima area and work with the teachers and children.  Many of the children of Fukushima have been evacuated to the Aizu district which was saved from contamination because it is surrounded by high mountains.

I already had a fair amount of experience with disaster because I worked in Kobe after the earthquake 16 years ago.  But this time we had more complex factors than in Kobe: in addition to the earthquake and tsunami we have  the nuclear power plant accident of Fukushima. Despite the strong wish to help, I was frozen with fear of the radioactivity. However, I overcame my fear and volunteered to become a member of the first team.

What is the first thing that struck you about the disaster when you arrived?

The first thing that struck me was the normalcy of the town.  I realized I had overestimated the immediate impact of the accident because there was no visible damage or abnormality in people’s lives.  But in one of the towns I visited, the radiation level was 3 times higher than normal and in another town it was 10 times higher than in the first town.  Then I realized that I had underestimated the risk of radiation.

I never imagined that Fukushima was such an attractive place.  It is a beautiful pastoral landscape of mountains and villages with various kinds of farm animals and products raised with loving care. The spirit of these people cultivated through its long history, touched my heart deeply.

Now this wonderful place is feared and avoided for risk of radiation exposure.  How can we understand the agony of the people who are forced to desert their ancestral homes?

What did you do there?

There were three towns where we mainly worked: Aizu-Wakamatsu, Aizu-Bange and Inawashiro.  Many people from Fukushima were evacuated to these towns. Besides working in the schools we visited shelters and interviewed evacuees.  We found that the stress level in the shelters was very high.  The situation is very hard because grandparents, parents and children are living in one small room together.  Old people who lost their routine work and chores just lie down the whole day and are very depressed.  They have no idea bout how long they will have to stay there.  We recommended organizing some recreation activity there the next team put that plan into place.

What is the biggest mental health challenge facing the people of Fukushima?

There are numerous challenges: Fear of exposure to radiation, Anger against TEPCO and the Japanese government, uncertainty about the future, sadness of having to desert their land, jobs and community.

What approach are you using to help?

I have strong opinions about what kind of psychological aid is helpful in this kind of catastrophic disasters. I have found that the Post Traumatic Stress Disorder (PTSD) model does not fit this situation– I am developing a different model, which call the “systemic-psychodynamic” model of disaster aid.

The PTSD model is too simplistic to help in a disaster situation like Fukushima. Of course, there are some people who survived the horrible earthquake or tsunami but most adults and children in the disaster zone did not necessarily go through this. The stress they suffer is more complicated. For example, after the disaster, parents are working so hard they cannot watch their children carefully. Some families are having strong conflicts between parents and grandparents, because they have to live together in the small space of the shelter. Each individual has his/her own circumstances, and it is different from person to person. In general, the problems arise in the same spot which had been a weak spot before the disaster. Thus, the problem after the disaster is an amplified condition of the systemic weakness. That is why the most effective aid is to try to recover the system, and support people from their own backyard.

Sixteen years ago after the Kobe earthquake, American crisis response teams came to Japan and taught us various intervention techniques, such as letting victims talk, or letting children draw pictures about the trauma.  Many volunteer groups were hastily made up and began to visit shelters and volunteers asked people to tell them their experiences.  The groups were eager to look for “PTSD candidates” but the vast majority of people were fine.  If they found a good “PTSD candidate” he/she was probably someone who had been anxious even before the earthquake. It was peculiar for the people in the shelters, as it was for me, to see these different groups, coming and going, each asking the same questions.

The situation in Fukushima is even more complex. Most children evacuated from their home town are now living in shelters in a different city. At the same time that they have been victimized by the electric companies, 70% of there parents are still working for Fukushima nuclear plant and many of them hope to continue to work for the plant even after the disaster. Of course, there are parents who are furious at TEPCO. How are the teachers supposed to explain the disaster to children? This is not a question we can easily answer.

We need psychologists who will think together with parents, teachers, and children in Fukushima from a systemic and psychodynamic point of view and to work with the community on a long-term basis. First we must establish a relationship with the community; then we have to find out from the victims what they need and offer help if it is available or come up with some other ideas to resolve their most urgent problems if immediate help is not available. By making contact with people in the community there is a chance to talk to people in depth and ask about their experience of the disaster. After establishing a relationship, we can propose interventions such as screening tests, individual counseling, group counseling or organizational consultation-whatever is needed. But we have to be careful not to be intrusive.  Very often it works better to provide supervision and consultation for staff who are already working in the community. The goal is to help the system to recover and the raise the level of mindfulness.

Has your psychoanalytic training been useful in helping the victims of this disaster?

My psychoanalytic training has been very important in allowing me to put this type of intervention into action — we need very long-term perspective and must work together with the communities. This painstaking endeavor is similar to intensive psychotherapy. The psychodynamic way of thinking, particularly the interpersonal approach which includes the systemic point of view, is useful for seeing the ways problems manifest themselves among individuals and within communities and organizations. We face people’s transferences and our own countertransferences and these can become very powerful and complicated. My psychoanalytic training has been helpful in understanding these interactions

Describe some of your countertransference reactions.

Overestimation of immediate impact of the disaster and underestimation of risk is one of them. Fear of radiation, anger toward the electric companies and the Japanese government and scientists who just say on television and in the media “there is no danger”.  I have fantasies to be a savior and to become an activist. I have competitive feelings toward other groups who are trying to help and I’ve developed a strong attachment to the land of Fukushima and the fantasy to become a resident of Fukushima. In addition to these, I think that the desire to know what is going on at the site of the disaster is my most characteristic countertransference.

What are you doing to protect yourself from radiation?

Almost nothing. I bought masks, but have hardly worn them.

What are you doing to protect yourself from the psychological/emotional stress of working in Fukushima?

I have a discussion group at my institute in Kyoto (KIPP). It has been very important for me to have a place where I can discuss my feelings with other clinicians.  Spending time with my family is also very important. Gathering information from the internet is very helpful, but exhausting-I have mixed feelings about this.

How does your family feel about the work you are doing?  Are they with you?

My wife, Yoshiko was very against the idea of going to the disaster zone first.  My daughter, Shiho, was too. They called me stupid!!! But gradually they gave up, and finally became supportive. Yoshiko and Shiho did not go with me but I think a 50-year old man is old enough to be safe with radiation.

I hope you are right about that, Naoto!

Is there anything the people in the US, particularly psychologists can do to help the people of Fukushima?

Fukushima is very serious problem for everyone in the world. The contamination will affect the entire Pacific Ocean. The nuclear energy problem is really global issues. I hope psychologists in the US will think about this with us. I am in the process of setting up a blog site where US psychologists can contribute information. Economic aid is also very important.

Taking More from Menopause than Hormone Replacement Therapy

Menopause as growth-promoting crisis rather than drug-taking opportunity
Published on April 29, 2011 by The Psychoanalysis 3.0 Writing, Group in Psychoanalysis 3.0

New results coming out of the Women’s Health Initiative have put controversies about Hormone Replacement Therapy back in the news. Once again we ask: Why is menopause so difficult for some women? And why is Hormone Replacement Therapy so controversial?


During menopause a combination of physical, emotional and social factors come together that can create a crisis in a woman’s identity. These physical changes often lead to psychological disorientation: Who am I? I’m not what I once was, but what am I becoming? At the same time social roles are changing: Children are leaving home, parents are getting sick and dying, beauty is fading. In addition, there can be a loss of hair, muscle tone, memory, loss of concentration, loss of sleep. As Dorothy Parker once said, “getting old is not for sissies”

One of the most troubling, and least talked about, aspects of menopause is a diminishing sex drive. A recent article in the New York Times, The Sex Drive, Idling in Neutral refers to this phenomenon but does not connect it to menopause although the women referred to the article are in the age-rage referred to as “perimenopausal”. This decrease in a woman’s sex drive can lead to serious disruptions in the relationship.  Thus, all the elements that have defined a woman’s identity for the previous 20 or 30 years may begin to come apart.

Several years ago a woman I’ll call Alice came to me for psychotherapy.  She had become destabilized and depressed while going through menopause.  Alice told me she had consulted with her gynecologist, explained all of her symptoms and ended up surprised and disappointed that the only thing the gynecologist offered was Hormone Replacement Therapy (HRT).  Knowing that HRT would not solve the changes in her identity brought on by menopause, we addressed this crisis in her life, which as many crises do, created opportunities for growth and expansion.

Hormone Replacement Therapy is very effective for treating hot flashes and insomnia.  If a woman has these symptoms and is not a high risk for breast cancer, she should seriously consider taking HRT.  It is a life-saver for many women.  But HRT will not solve the existential crisis that many women face at menopause. There is a tendency to focus on the pill rather than the developmental milestone.  Without a doubt it is easier to take a pill than grapple with the changes in self and identity that are inevitable that this stage of life.

Two important books were published in the early 1960’s that set the stage for current controversies: Betty Friedan’s The Feminine Mystique (1964) and Robert Wilson’s Forever Feminine (1961).  Their messages were diametrically opposed: Friedan’s message to post-war women was, “There is more to life than being a wife and mother.”  Wilson’s message was, “All there is to life is being a wife and mother so when you reach menopause you are bound to become depressed.  But there is hope!  You can take HRT and get it all back.”

Friedan, in her last book, The Fountain of Age (1993) excoriated the medical profession for pathologizing menopause and the drug companies for promoting HRT as cure for a “disease.”  Friedan took the position that if a woman had a meaningful life, including a profession and fulfilling relationships, she would have better things to do with her time than to suffer from menopause. The Women’s Movement, she stated, had done away with the need for menopausal symptoms. You can imagine my surprise when I entered menopause, became depressed and disoriented and then found out that the Women’s Movement was supposed to have eradicated all symptoms of menopause!

Menopause is acute and transitory — maybe even transitional. HRT can ease the transition for some women.  But Wilson was wrong; it does not “cure” menopause and will not fool anyone into thinking that a 50 year-old woman is young and nubile. She can be sexy, gorgeous, vital, engaged, satisfied, content, curious, or whatever — with or without HRT — but just not young and nubile. Menopause, with all its hassles and pain, allows you to put your life under a magnifying glass. The combination of physical, psychological and social factors converge to create a crisis in women’s identity that is also opportunity to tackle problems that have too long been swept under the rug. I have found that menopause, both personally and in the lives of my patients, can lead to dramatic development if one remains open to reflection, growth, and change.

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