Treatment of requests for sex-change surgery with psychotherapy.

The authors describe two patients whose requests for sex-change surgery represented crises in sexual identity and anxiety-masking symptoms. Brief psychotherapy enabled these patients to relinquish their belief in a surgical "cure". In evaluating such request, the psychiatrist should consider the patient's total personality rather than focusing on the genuineness of the perceived gender disorder. Whatever the final decision, the opportunity for continued psychotherapy should be provided.

Sexual dysfunctions and psychoanalysis.

The authors examine the major factors involved in recent changes in the social standards and attitudes related to homosexuality. The principal influences investigated include the misconstrued emphasis given to the humanist ideology, which properly stresses the dignity of the individual; the social sciences' relativization of the cultural norms defining homosexuality; the influence of the mass media in disseminating these perspectives and thereby tending to create an acceptable image of homosexuality, and the tendency of all these changes to result in a substantial increase in public acceptance and tolerance of homosexuality. The authors suggest that this trend in public opinion has begun to isolate psychoanalytic knowledge, to reduce its status and acceptability among the public, and to replace it with popular views concerning the meaning of sexual dysfunctions.

Sexual conflict and eating disorders in 27 males.

Twenty-seven anorectic and bulimic males and 142 anorectic and bulimic females treated on an eating disorders unit were compared. Significantly more male patients reported experiencing sexual isolation, sexual inactivity, and conflicted homosexuality.

Complete Klüver-Bucy syndrome in man.

A 22 year old right-handed man suffered a viral meningoencephalitis, possibly herpetic, resulting in bilateral damage to the temporal lobes as confirmed by appropriate clinical, electrophysiological and neuroradiological studies. Extended clinical neuropsychological evaluation documented all the characteristic features of the syndrome described by Klüver and Bucy following bilateral ablation of the temporal lobes in adult Rhesus monkeys, including "psychic blindness," oral exploration, hypermetamorphic impulse to action," lack of emotional responsiveness, aberrant sexual behavior, and an insatiable appetite. Additionally, a severe Wernicke's aphasia and a profound memory disorder were evident. The significance of these features as regards limbic function in the human is discussed.

Secondary depression: a comparison among subtypes.

Forty-five patients who met Research Diagnostic Criteria (RDC) for secondary depression were assessed by St. Louis criteria, and by demographic, illness history, REM latency and dexamethasone suppression test measures. Fully one-third of the RDC secondary sample met St. Louis criteria for primary depression; only age at onset and length of illness discriminated St. Louis primary from secondary depression. RDC depressed patients secondary to alcoholism were compared to those secondary to nonsubstance abuse disorders (excluding schizophrenia). The subgroup with a history of alcoholism reported less severe depression and were preponderantly male. Neither dexamethasone response nor REM latency differentiated the RDC secondary subtypes. Little support was found to validate separation of the RDC secondary subtypes studied.

The gay bowel syndrome: clinico-pathologic correlation in 260 cases.

The clinical and pathological findings in a group of 260 homosexual men comprising 10% of a private proctologic practice are reviewed. A clinical pattern of anorectal and colon diseases encountered with unusual frequency in these homosexual patients is termed the gay bowel syndrome. The clinical diagnoses in decreasing order of frequency include condyloma acuminata, hemorrhoids, nonspecific proctitis, anal fistula, perirectal abscess, anal fissure, amebiasis, benign polyps, viral hepatitis, gonorrhea, syphilis, anorectal trauma and foreign bodies, shigellosis, rectal ulcers and lymphogranuloma venereum. 60 anorectal and sigmoid biopsies from 51 patients failed to disclose evidence of specific infection other than condyloma acuminata. Of 21 patients with biopsy diagnosis of nonspecific proctitis, 8 had a specific infection which was detected by other means,--5 cases of shigellosis and one case each of gonorrheal proctitis, amebiasis and lymphogranuloma venereum. In evaluating proctologic problems in the gay male, all of the known sexually transmitted diseases should be considered. Shigellosis, amebiasis and viral hepatitis should be included. Microbiological evaluation is essential. Concurrent infections with 2 or more pathogens should be anticipated. Chlamydia trachomatis, an important cause of nonspecific urethritis in the general population, is high on the list of possible causes of the nonspecific proctitis present in 31 of the 260 patients.

Women alcoholics. A review of social and psychological studies.

Research on social-history variables, personality characteristics, social roles and role confusion, and possible treatment methods for women alcoholics is reviewed. Suggestions for additional studies involving factors motivating drinking in women, theories of personality, new treatment methods, and differentiation between subgroups of women alcoholics are discussed.

PIP: Research on the social and psychological aspects of female alcoholism is summarized. The literature review is limited to English-language reports appearing since 1950. Women alcoholics, conservatively estimated to comprise 20% of the total number of alcoholics, are often lumped together with male alcoholics in both research and treatment efforts. However, women have been noted to show differences in the pattern and etiology of excessive drinking. In general, women alcoholics have a high incidence of alcoholic parents and are more likely than men to begin drinking heavily in response to a specific environmental stress such as divorce of death in the family. They tend to become problem drinkers at a later age than men, and many have more severely disturbed personalities. Female alcoholism has also been linked to low self-esteem and sex role confusion. However, women alcoholics are not a homogeneous group. There are distinct subgroups differentiated on the basis of race, socioeconomic class, and existence of prior psychological disorders. Some research has related the onset of female alcoholism to dysmenorrhea and menopause, and has pinpointed a relationship between eipsides of heavy drinking and premenstrual tension. Additionally, alcoholism has been found to be highly correlated with specific gyncological disorders such as repeated spontaneous abortion and infertility. However, it has not bee possible to separate out the effects of heavy drinking on physiological functioning from difficulties such as a hormonal imbalance that precede or cause the alcoholism. Future research efforts should extend the use of appropriate control groups. Areas in which more research is needed include the level of masculine identification among women alcoholics, the impact of the changing roles of women, and the characteristics of the various subgroups of female alcoholics, the impact of the changing roles of women, and the characteristics of the various subgroups of female alcoholics. Such research could be used to improve the low treatment effectiveness and poor prognosis that some studies have noted among women alcoholics.

Prison homosexuality and its effect on post-prison sexual behavior.

Although there has grown up to a considerable literature on sex experiences in prison, little has been written on the post-prison behavioral patterns of those who, voluntarily or involuntarily, become initiated into homosexuality while incarcerated. In the light of the considerable number of prisoners and ex-prisoners in the original Kinsey sample, it is possible that the Institute for Sex Research might have in its files material that would shed light on this problem. To date, nothing has been forthcoming. In one of the few references to the subject, Kirkham (1972, p. 42) suggests that sexual experiences in prison may have permanent effects on the lives of some of the participants: "Can such men return to conventional heterosexual lives after release, or has the experience of being forced into acts of passive homosexuality been so traumatic as to preclude the resumption of sexual relations with members of the opposite sex?" In a search for an answer to his question, the present paper studies ex-prisoners whose initiation into homosexuality occurred during prison.

Stoicism and paranoia.

A paranoid strain is manifest in Stoic utterances generally, especially in the Stoic conception of autarky, where the Sage regards himself as distinctly "other" in the midst of society, and indifferent to its values, except as he dissembles his indifference. Now, influential theories of paranoia stress a projective process: for Freudians, the projection of repressed homosexual libido in altered form, for Ovesey, a "pseudohomosexual" anxiety arising out of a maladaptation in the male to the culturally assigned competitive male role, a failure perceived as effeminate. But Stoicism took root in the culture (Classical Greece) where homosexuality, far from being universally regarded as degenerate, was widely extolled as the norm for superior men and the most advantageous frame work for the tutelage of aristocratic boys. It would seem unlikely that paranoia in this context would reflect uneasiness over unconscious homoerotic (or distorted pseudo-erotic) strivings. What light is shed on the purported projection of either homosexual or pseudo-homosexual anxiety by paranoid elements in Stoicism?

Simulated paraphilias: a preliminary study of patients who imitate or exaggerate paraphilic symptoms and behaviors.

In a consecutive series of admissions to the Johns Hopkins Sexual Disorders Unit, 4 out of 20 patients appeared to have simulated paraphilic symptoms that further assessment indicated were either exaggerated or not present. The paper presents case histories of these 4 patients. A descriptive comparison is made between these patients and control groups of patients who admitted having paraphilic symptoms and a group of patients accused of having paraphilic symptoms but who denied them. Patients who simulated paraphilias tended to be self-referred (75%) and without current legal charges (100%). None of these patients was referred or sought treatment for pedophilia, in contrast to the other two patient groups, in which pedophilia accounted for 75% of the referrals. Several possible explanations for why patients might simulate paraphilias and implications for therapists who evaluate or treat sex offenders are discussed.

[Diagnosis and early treatment of juvenile delinquency]. / Diagnosi e trattamento precoce della delinquenza minorile

Longitudinal research has shown that social failure to adjust can be prevented by early removal of ambiental factors encouraging pathological development of the Ego, and the detection and treatment of psychological tendencies towards the acquisition of deviant stimuli.

Fear of AIDS: implications for mental health practice with reference to ego-dystonic homosexuality.

The psychological symptoms caused by fear of Acquired Immune Deficiency Syndrome are examined with particular reference to males displaying ego-dystonic homosexuality. Three cases, complicated by major depressive disorder and premorbid personality dysfunction, are discussed with reference to psychotherapeutic intervention.

A preliminary report on the use of clomipramine in general practice.

The use of clomipramine in a large suburban general practice is reviewed. Three hundred and fifty patients have been treated to date out of a total practice population of twenty-one thousand. It is argued that phobic anxiety states are much commoner than is normally supposed and that they are usually associated with a history of separation or rejection in childhood. A combined treatment regime is employed for one month thereafter clomipramine alone is used. Side-effects may initially present a problem although they may not all be truly drug induced. Some patients use side-effects to manipulate the clinical situation. However proper interpretative management of side effects can assist the clinicians in persuading patients to continue therapy. Some impressive results have been obtained with clomipramine therapy. Illustrative case histories are provided.

The impotent king: secondary impotence refractory to brief sex therapy.

Men with a grandiose self-concept may develop secondary impotence that does not respond to sex therapy. The impotence occurs in response to a more self-assertive stance taken by their wives. The more common form of impotence is also presented and contrasted with the "impotent king". Recommendations for treatment are made.

Amplification of the erotic enema deviance.

Use of enemas for sexual stimulation has been observed and named klismaphilia. Some klismaphiliacs indulge their taste for enemas in other wise normal sexual settings. Others combine it with fetishes, excretory and otherwise or with masturbation. Still others practice klismaphilia in homosexual or sadomasochistic settings or in group sex.

Idosophobia: a form of pregenital conversion.

The origins of idrosophobia (profuse sweating) in a young man are traced to his oedipal resolution and his pathological regressions and defenses. Idrosophobia, which resembles erythrophobia, is described as a syndrome of pregenital conversion.

Lesbian/feminist orientation among male-to-female transsexuals.

Autobiographical case studies of two male-to-female transsexuals reveal a pattern of strong female identity couples with lesbian sexual-affectional preference and feminist value orientation. For both informants there is evidence of social concern and activism from an early age, which led them to perceive their gender dilemmas in a political as well as personal way. This case material challenge the notion that transsexuals are necessarily "sexualy Uncle Toms" and demonstrated that male-to-female transsexuals (like genetic women) can achieve an affirmative lesbian identity; it suggests more generally that the development of sexual identity is an ongoing, lifelong process.