Thursday, October 23, 2008

Review of Unprotected

This book is unfortunately one that can be accurately judged by its cover. A girl in an uncomfortably-short skirt and high-heeled strappy sandals, slumps dejectedly at a table, her Burberry purse slung over the other shoulder, shadows and limbs strategically placed. And by its title, Unprotected: A campus psychiatrist reveals how political correctness in her profession endangers every student, by Anonymous, M.D. This evident alarmism --- PC is so insidious that the author must remain anonymous or risk Birkenstocks being thrown through her front windows --- that pervades the book may cause parents and aggrieved social conservatives to pick up the book, but it does no good for Dr. Anonymous's arguments and alienates people who might otherwise agree with her.

A friend of mine, an observant Jew who every week attends prayer services where the sexes are separated by a curtain, is a prime candidate for a reader who might agree with this book's argument. Her conclusion after skimming the book, however, was, "Books like this make me mad." She objected to its overly dramatic language and attempt to scare the reader into agreement.

Dr. Grossman's arguments (Dr. Anonymous turned out to be psychiatrist Dr. Miriam Grossman from UCLA) are themselves very worth consideration and further research. Here they are. I think any of these could spawn half a dozen good studies. I do not think that they are generally repressed by political correctness at the level of academic research. Research is usually not sufficiently disseminated, though, and maybe that is the problem: this certainly wouldn't be the first area where quality of health care suffered because practitioners followed their intuitions instead of evidence-based guidelines or the evidence was never disseminated in the first place.

At any rate, here they are:

1. Casual premarital sex may be emotionally dangerous for at least some adolescents and young adults, especially for women due to their hormonal response to orgasm and stimulation of erogenous zones. Many young women have strong emotions that accompany what they had wanted to consider casual relationships, which surprise them.

2. People know very little about STDs and underestimate the risks:
a. Condoms don't protect completely against some STDs, especially since adolescents and even young adults don't use them consistently.
b. Younger people are more vulnerable to STDs than older people.
c. Some STDs are incurable and some have a small chance of causing fertility problems over a relatively short period.
d. STDs are given short shrift in the larger health care picture. She concludes college should require universal testing for common STDs such as chlamydia, just as they require universal testing for TB.

3. Abstinence is not considered to be a virtue to the extent that other disciplined behaviors are. (I made this argument a few weeks ago.)

4. Counselors are required to be culturally competent to deal with all potential clients, but while they are taught sensitivity to rare minorities such as transgender and Muslims, this cultural sensitivity does not extend to larger traditional minorities such as evangelical Christians, conservative Catholics, and Orthodox Jews.

5. A spiritual discipline, whether meditation, yoga, or traditional religious prayer, appears to be beneficial for mental health in both the short and long term.

6. HIV is more difficult for healthy people to contract from vaginal intercourse than people commonly believe, and this disproportionate fear of HIV may cause anxiety and panic attacks in some people, as well as discounting larger actual risks from more contagious STDs.

7. Abortion has different meanings to different women, and different meanings before and after an abortion. Some women regard abortion as simply a medical procedure, and other women see more profound meaning in abortions, and some women change their beliefs about abortion after their experiences with them.

8. Women underestimate the risks to their fertility of waiting to have children past age 35, most do not know that fertility declines dramatically after age 35, and that fertility technology is very limited in its ability to help women and also very expensive.

These topics can be addressed in both research and in practice.

In research, these topics are neglected, but only to the extent that many women's health and sexual health issues are. When raised in the right way, my experience is that almost everyone considers these to be legitimate arguments and subjects of study.

In practice, it may be another story. It is true that some of these issues are not well-disseminated, but lots of research isn't. People are woefully ignorant about their own health, and the surprise isn't that some issues are neglected, it is that some concerns manage to rise to the top. The concerns she mentions that young adults are highly aware of are weight control, cholesterol, and osteoporosis. The motivation for the the first is immediate self-interest, knowledge about cholesterol comes via middle-aged men, and I'm not sure the third is a concern college students are aware of, but to the extent that they are, their knowledge comes via middle-aged women and grandparents with brittle bones. STDs are hidden and stigmatized and can't be as salient to young adults.

Another problem is that so frequently these discussions are politicized. Many have a suspicion of anything that might turn out to be the socially conservative version of political correctness. It seems to me that in the current administration, this suspicion is more than justified. I've heard from a few different people that the administration has made appointments even at low levels to enforce their socially conservative PC (SCPC). One example went down to the same semantic pickiness that liberal PC is mocked for: the appointee ensured that the term "prostitution" was used instead "commercial sex work," and even those who found the former term offensively pejorative were pressured into using the term. Since the liberals were underdogs in this and many other situations, it seems highly sensible that they would resist what they perceive as SCPC infiltration.

Reasons besides politics why each concern is not disseminated adequately are worth exploring, and I may do that.

I hope that in the future administration, we can move past these political divisions and actually work constructively together to solve these real problems, first by disseminating the existing evidence and then by doing new work. It may be simply an issue of framing issues the right way, and unfortunately this book does nothing to help its own cause.

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