Coda |
Let's talk about sex
Do you ever find your patients sexually attractive? Have you ever been sexually aroused while seeing a patient? Have you ever prolonged a physical examination because you were enjoying the sight of someone's body? Have you ever had an enduring sexual fantasy about one of your patients? Have you at any time considered initiating a sexual relationship with a patient? Over the past year or so, I have become particularly interested in these questions. I have also become curious about why it seems impossible for most of us to discuss them.In ten years as a GP trainer, for example, I can remember only having one conversation with a registrar about sexual feelings. He was seeing a patient who was becoming infatuated with him, and possibly vice versa too. I handled the matter rather awkwardly at the time: I was able to talk about the patient's feelings and what they might mean, but was too embarrassed to help the registrar to speak about his. Fortunately, it all ended well and safely. More recently, I have been running workshops for medical educators on supervision skills, and I have been struck by how even the most experienced groups and individuals will skirt round the subject of sexual feelings, or address them with coyness. This happens even when we are talking about cases where these feelings are patently present.
Why is it that we find it so hard to own up as doctors to our desires as sexual animals? One reason, I suspect, is that we are participants in a far wider social game of denial. Almost every newsagent and garage in the country sells sexually explicit magazines, while satellite TV offers dozens of channels showing nothing but sexual acts. You can find the contact details for sex workers in thousands of phone boxes and shop windows. (At the end of our nice suburban street, the grocery store displays a card advertising the services of a ‘22-year old model, for men and women, three minutes walk from here: sex £20'.) Yet in spite of this glaring evidence, most of us continue to speak as if masturbation, or paid sex with strangers, were aberrant activities, compared with the assumed norm of satisfied monogamy, with perhaps an affair now and again. There certainly seems to be no measured discussion in society at large about the difficulties of managing lust, and the pressures, disappointments and shame that are attendant upon so many people's attempts to do so.
In this respect, I have found conversations with gay friends enlightening. Because of their relatively marginalized status, it seems commoner for gays to share confessions with each other concerning the strength and unmanageability of their sexual urges, and to disclose the stratagems—successful or otherwise—that they have tried out in order to satisfy these. Whether frenziedly promiscuous, celibate or loyal to one partner, they often seem to find it easier to talk to each other what they are feeling and doing, without the double standards or dissimulation that go on in much of the straight world.
I wonder if we could also learn lessons by thinking more calmly about paedophiles and our attitudes towards them. Being predominantly attracted to children is probably no more a conscious choice than being attracted to male or female adults: any kind of sexual orientation is programmed at an early age, whether by life experience or by biology. I suspect that many people with paedophile tendencies manage to sublimate them quite successfully into kindliness or intellectual friendships with children. (I believe that I had several teachers at school of whom this was true.) I have also known some highly responsible parents of both sexes who confessed to being aroused at times by the touch or smell of their own children. Yet there is a widespread belief that people with erotic feelings towards children are automatically evil, and can never manage to suppress these feelings. This conveniently gets the rest of us off the hook: it implies that ‘we’ do not really have any problems in managing our sexuality, whereas ‘they’ all do. And by holding on to this belief, we may be pushing some paedophiles further towards becoming abusers, since we damn them equally whether or not they enact their desires.
This confusion between desire and enactment may be what stops us talking about such matters more sensibly as doctors. The confusion seems to be more acute for male doctors, perhaps because arousal by itself is more clearly visible in males and therefore potentially more compromising. Yet we know that sexual desire can become heightened in many situations, including some medical ones such as deaths and disasters. Counsellors and therapists are used to treating such feelings as data—important information about what is going on in the room, and the kind of information that needs to be discussed frankly. The difficulty that we find as doctors in openly discussing our sexual feelings towards patients may lead to unnecessary shame among colleagues who are in fact behaving quite impeccably. It also blinds us to what is being done under our noses and in consultation rooms by a minority of colleagues who do actually molest or rape patients, as several recent cases in Britain have shown.
Desire is not a crime. Sexual abuse—of children, patients or trainees—is. In the work I do with medical educators, I am now hoping to be a bit braver in naming sexual feelings and in creating a climate in which they can be discussed. I suspect that many of us are dealing at any one time with at least one patient (or colleague or junior) where it might be positively helpful to be able to discuss such issues maturely and in confidence. Personally, I doubt if there is a single doctor, of either sex or any sexual orientation, who could not give the answer yes to many or most of the questions at the beginning of this article—if he or she felt this could be done safely. If we were able to acknowledge more as doctors that we are physical beings who have physical feelings, and that we all face a moral struggle to manage these, it might in the end protect patients more than if we stay silent.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||