Infections and preventive methods

All fruits and vegetables should be washed and scrubbed. In suspect areas, travelers should eat only cooked foods and use only milk known to be pasteurized. You may be asking, "Why all this fuss about a disease I have hardly heard about?" Consider this one fact about amebiasis: in some forms, it has a fatality rate of 40 percent. 

Your life, if you become infected, is only as good as a 6 to 4 bet; not very good odds. In addition, if an acute attack is survived, there may be serious, chronic complications. Fortunately, treatment has been improving, and today, when the best available treatment is applied promptly and vigorously, the fatality rate can be reduced to less than 5 percent. How is the disease recognized? In the tropics, it will usually start as full- blown amebic dysentery, with up to 25 bowel movements a day, and with stools often containing blood and bits of mucus.

The patient may feel slightly feverish and will soon be weakened by the abdominal distress and dehydration. In this country and other temperate zone countries, there is rarely such extreme diarrhea; and the combination of abdominal distress, diarrhea alternating with constipation, fatigue, slight fever, and vague aches and pains throughout the body may be passed off as "colitis," "irritable colon," or "upset stomach." In some persons, symptoms are so mild that they do not see a doctor for treatment and unknowingly become carriers of the amebic organisms.

Another problem in diagnosing the disease arises from the increasing numbers of Americans who take short winter vacations in semitropical and tropical countries. If a vacationer develops diarrhea and other intestinal symptoms, he is not eager to consult a doctor in a strange country. He also does not want to interrupt his brief holiday. So he doses himself with Lomotil, paregoric, or anything else he has brought along for "tourists' diarrhea." When he returns home, he plunges into work. Thus, the diagnosis of amebiasis may be missed, and the best time to treat it lost; later, there may be dangerous spread of infection in the body, making for treatment problems.

To be sure, most cases of diarrhea during vacations are the relatively harmless tourists' diarrhea. But we strongly advise anyone who develops diarrhea in a semitropical or tropical country to tell his physician about it promptly upon return home or, if the stay is to be more than the usual brief vacation, to consult a local doctor (you can usually find a competent physician by calling the nearest American consul and asking for the name of his doctor). 

When there are symptoms suggestive of amebiasis, your physician will rarely start treatment until a precise diagnosis is made. That means finding the amebic organisms in the stool. Unfortunately, locating the organisms is not always simple; and some physicians who have devoted themselves to the study of this disease will not exclude the diagnosis of amebiasis until six stools, including one passed after a saline purge, have been judged negative by a competent diagnostic laboratory. 

Birth Control - ORAL CONTRACEPTIVE PILL

ORAL CONTRACEPTIVE PILL

 The pill is a means of preventing ovulation, or egg release, thus making conception impossible. It became available as the result of the development of certain chemicals that be- have in a woman's body like the hormones that control the reproductive cycle. The pill is highly effective in avoiding conception when used exactly directed. As an example, one type requires that a woman take the first dose on the fifth day of her menstrual cycle and continue a daily dose for twenty consecutive days. One to three days after she has taken the last tablet, menstruation begins and the count starts again. The pill is considered reasonably safe in terms of health. In a small minority of women, it produces undesirable side effects. If you are considering using this method of preventing pregnancy, you should do so under the close supervision of your doctor, who will prescribe the tablets, warn you of possible side effects, and help you to be prepared to cope with them.

OTHER METHODS OF BIRTH CONTROL

 These consist of douches, suppositories, jellies and creams, and coitus interrupts, all of them unsatisfactory in varying degree. Douches are intended to wash out or kill the sperm before conception can occur. Since it is usually impossible to wash all sperm from the vagina, emphasis is placed on killing them by chemical means. Often, sperm have already reached the uterus before a woman has a chance to wash out the seminal fluid. By then it may be too late. Women may find it disturbing to douche immediately after intercourse, a time when they may want most to relax.

As we have noted previously, in most women sexual feelings do not end abruptly and they want, and need, some relaxation and affection after coitus. We advise avoiding use of advertised douches containing chemicals such as creosol or hypochlorite. Except on a doctor's prescription, we think it best not to use anything except a little salt or vinegar in a douche. So-called feminine hygiene douches are not effective for contraception and are not necessary for cleanliness. Suppositories are capsules made of gelatin or cocoa butter which contain a sperm-destroying chemical ingredient. 

Sex and mental health

POSITIONS FOR INTERCOURSE One is face-to-face; another is that in' which the men in forward while the woman turns her back; and there are variations of these basic positions. The purposes of different positions are to Increase pleasure and to prevent hygienic dangers or injuries. Also, a person who has heart disease or another serious illness may want to use positions that require the least amount of physical exertion, e.g., the side positions.

MAN ABOVE WOMAN. In this position-considered the standard one in our Western culture-the woman lies on her back, with thighs spread so there is room between her legs for the man's thighs. By bending her.

Legs, she allows for deeper penetration. The man lies upon his partner's abdomen, supporting his knees and elbows on the bed as much as possible so he is less of a burden. If the woman holds her thighs together after entry, it will help in cases where the penis may be small or the vagina large. It will also increase friction against the clitoris. 

With thighs tight together, the woman can prevent the penis from entering too deeply, if this is needed to prevent pain. If the vagina is large, this technique may be helpful: The woman lifts her thighs high enough to encircle the man's neck with her legs or to rest her feet on his shoulders. Thus her body is almost at right angles, with her shoulders flat and her torso lifted as vertically as possible.

WOMAN OVER MAN

 The woman can kneel over the man and let herself down gently until the penis is inserted. The advantage of this position is that she has full control of the movements and can quicken or slow down as she pleases. She can also adjust herself to the penis by bending forward so full contact with the clitoris is made. Properly used, this position can result in sexual delight. It is helpful if the man is tired. A possible disadvantage is that it requires a good deal of exertion by the woman while the man is relatively passive. It is not recommended if the vaginal passage is unusually short. And it is not recommended if the man is, sick or convalescing, since it is likely to be more stimulating than the following side position.

LYING ON SIDE, FACE TO FACE

 The partners lie on their sides, facing each other. The woman raises her upper thigh and rests it on the man's upper thigh. This is excellent for those who wish coitus during preg- nancy as there is little pressure on the woman's abdomen. For couples who wish to relax, this side attitude will be appealing and restful.

REAR ENTRY

 This method is also recommended for pregnant women or in any other case where deep penetration and weight on the abdomen are not desirable. The woman, usually in a kneeling stance, has her back to the man. The man enters the vagina from behind. This position does not give the woman as much pleasure as some others since the clitoris is not touched by the penis. The man can compensate for this by fondling the clitoris (and the breasts) with his hands. 

Sexual preferences and mental health

Certainly, there are times when illness or extreme fatigue prevents this, and an understanding husband will wait for a more favorable time. Should sexual preferences be discussed between husband and wife? In as many as 90 percent of sexually unhappy marriages, some investigators have found, there has been a barrier of silence.

 The wife has never told her husband the things that are sexually meaningful for her, that help her develop her sexual feelings. She has never told her husband the 'things she wishes he would do. It is essential for wives and husbands to learn to say: This is what I like and don't like what I want and don't want. How often should one have intercourse? There is no proper frequency for sex.

Sexual satisfaction is much more a matter of quality than quantity. Appetites vary. If there is any suggestion it is that frequency of intercourse should be as spontaneous' as any other aspect of sex, and no rule should be followed. Statistics compiled by various investigators indicate that the average is about twice a week, more often in young or newly wedded couples, less often in older ones. But so many factors-temperaments, opportunity, fatigue, compatibility-are involved that such figures mean little to any individual.

The best guide, we suggest, is: If both partners feel well, if coitus does not cause discomfort or fatigue, and if it is followed by physical and emotional relaxation, there is no need to worry about over- doing. Repeated failure to obtain satisfaction after experiencing orgasm indicates some problem, which should be discussed with your physician or a trained counselor. While there usually is some decline in desire to have intercourse as middle age is reached, some women reach the height of sexual vigor quite late in life, even after they have passed the menopause, and some men remain sexually vigorous into old age. 

Should there be intercourse during the menstrual period? This is a matter for each couple to decide. Coitus may cause the wife some big comfort, especially if she has "cramps" during her period, but it will do no physical harm to either husband or wife.

Coitus does not "consume" one's potency, and abstention not that any position is the right or normal one if.  

Alcohol and sexual relationship

Too much alcohol eventually decreases sexual potency, as it does health in general. A well-balanced diet, enough rest, and general care of the body, as discussed elsewhere in this book, are essential to your health, of which your sexual health is an important part. It is obviously hazardous to try to decrease sexual desire by exhausting yourself or eating so little as to feel generally below par. Let us add that there are no special foods that increase or decrease potency. 

When abstinence is necessary, keeping busy and avoiding erotic stimulation as much as possible may relieve sexual tensions. Is intercourse ever dangerous or harmful? It is dangerous when either partner has a venereal disease. Intercourse, as well as other forms of close contact, should be avoided during contagious illness of any type. Certain non-contagious diseases make intercourse unadvisable or even dangerous.

Anyone who is not in good health should discuss this matter frankly with his or her physician, who will be able to decide whether or not coitus is permissible. However, we want to make the point that it is often possible to prevent undue strain or overexertion for one or both partners by using certain positions during intercourse. 

We know of couples who have abandoned sexual relations because the wife could not tolerate the weight of her husband, or the activity was too much for the husband's heart. They had the misconception that it was not "nice" or "right" or "normal" to use positions for coitus that would overcome their difficulties. While most people in our culture assume one position for intercourse, this is only a matter of custom.

There is absolutely no reason to consider those over 40, worry unduly about such an episode and develop a "fear of failure" cycle. It is the fear, not the aging that leads to their chronic impotence. What if a husband wishes sexual relations when the wife is not in the mood? Assuming that she is not disturbed by unsettled problems outside the bedroom and that she is not withholding sex as a kind of punishment, the fortunate fact is that a wife can participate in sex as a loving partner even if she is not in the mood. Often, the fact that she is giving pleasure to her husband is enough to change her mood, to transform passive acceptance into active desire. 

Sexual desire

Sexual desire sometimes develops slowly in women

They may not reach sexual maturity until they have been married for some time. The awakening may be gradual or may take place suddenly. Women tend to be less quickly and spontaneously aroused than men. Both partners should understand this. A woman should not feel that her husband is oversexed or "crude" if he desires intercourse because he has seen her partially undressed or because she has kissed him affectionately. A man should not consider himself rejected or decide that his wife is cold if she fails to be aroused so readily. 394 I Family Preventive Care Many women need a warming-up period, both to feel desire and Lo be physically ready for intercourse.

When a woman is sufficiently aroused, her vagina is well lubricated and naturally receptive to insertion of the penis. Many women respond best to lovemaking that begins with verbal expressions of affection, kisses, and gentle caresses and proceeds to stimulation of the breasts, the nipples, the clitoris (the small projection outside the vagina, which is composed of erectile tissue similar to the penis), and the vagina itself. Each husband should learn to know the degree to which his wife is excited by caresses of different parts of the body. If the husband is skillful, will a wife always achieve sexual satisfaction? Even under the most favorable circumstances, some women do not experience an orgasm, or climax. 

Some experience an orgasm only after they have been married for some time.

Some experience it only occasionally, perhaps only at certain periods of the month, as their desire may be of a cyclical nature, peaking before, during, or after the menstrual period. In 'men, the orgasm is clearly defined; in women it may be vague or diffuse. Its intensity varies. It may center in the clitoris or may appear to involve the internal portion of the vagina, or a woman may experience both types of orgasm. Often, failure to achieve orgasm does' not prevent a woman from having pleasure from the sexual act; failure does not necessarily make her tense and frustrated; this, too, varies in individual women. It is important for a man to help his wife experience the sexual satisfaction he enjoys.

 Men often reach climax more rapidly than women. This can usually be compensated for by making certain that the woman is highly stimulated before actual intercourse begins. While many couples find it particularly satisfying to reach orgasm simultaneously, others see no objection to having the woman reach it first. Generally, a woman's desire fades rather slowly after orgasm, whereas that of a man tends to vanish rapidly. It is not unusual, especially if a man is young or greatly excited, for him occasionally to have an orgasm almost immediately upon beginning the sexual act; this is called premature ejaculation. However, if it occurs habitually, he should consult a doctor. 

Often premature ejaculation is due to early, furtive, hurried sex experiences. As a result, a man may not have learned to enjoy a leisurely sexual pace and to adapt to his partner's needs. 

Sexual experience and mental health

Is earlier sexual experience with others helpful or harmful in establishing successful relations with one's spouse? Premarital experience is certainly not necessary. Ideally, experience in the art of lovemaking should be obtained with one's chosen mate. It is often distressing to the other partner, especially a man, if the spouse has been intimate with someone else. But since modern civilization makes it difficult or even impossible for people to marry until long after they reach maturity, premarital sex experiences do occur. We think it important to realize that loving some- one as he or she is involves understanding that even past relationships have contributed to creating the person one loves.  

Does an earlier homosexual experience mean that a person cannot have normal sexual relations? Studies have shown that many men and an appreciable number of women have had some sort of homosexual experience which did not interfere with normal sexual relations later. However, we feel that anyone who is concerned about such an experience should discuss it frankly with a doctor or competent counselor, since homosexuality is a complicated problem. Is the wedding night crucial in establishing satisfactory sexual relations? It can be.

The bride may be tense and overwrought, especially if the wedding was a large one. She requires great consideration from the groom, who is usually nervous himself. While there have been instances in which the shock of the wedding night experience has produced lasting damage to a girl's attitude toward sex, we are inclined to believe that such danger is less great now than in the past when many brides had no concept of the nature of intercourse. While a husband may find it difficult to avoid causing his bride some physical discomfort at this time, his tenderness is likely to be sufficient to compensate. The bride should, if possible, select a wedding date far removed from her menstrual period. Also, the couple should not add a long journey to the stressful (even though happy) wedding day.

 It is best to stay at a place near the wedding reception. If there must be a tiring journey with arrival late at night, perhaps the sexual consummation will be happier if delayed until both have had a restful sleep. Some wedding night difficulties can be avoided if the bride has had a preliminary medical examination. In some virgins, the hymen, the membrane at the opening of the vagina, may not rupture easily, and this makes intercourse painful or impossible. In such cases, it may be removed by a physician, a procedure so minor that it hardly is worth calling an operation. The hymen also can be stretched, according to medical directions, prior to marriage. Before the wedding night, the marriage partners should discuss birth control with each other. Also, your doctor or marriage counselor will answer questions about contraceptive methods. If the husband is considerate, will the bride enjoy intercourse? Some women derive no more pleasure from it than from any intimate caress. Sexual desire sometimes develops slowly in women. 

Mental Health - THE PURPOSES OF SEX

THE PURPOSES OF SEX

You notice that we use the plural, "purposes," rather-than the singular. From the biological standpoint, the purpose of sexual intercourse is simple enough: reproduction. Of late, there has been some tendency to pass over this aspect of the sexual act, perhaps because it was once considered the only real purpose of intercourse. Although much has been written about men and women who want children because they think they should have them, or to prove they can have them, or for any of a number of neurotic reasons, most people who live worth living want to pass on the gift of life, to create a new lift' with the beloved partner. But sexual intercourse is much more. 

It is even more than an expression of love in the most intimate manner; more than giving and receiving pleasure. As one discerning physician has written "Because we use words to distinguish sex from love, we found that in human experience no such sharp division exists. Individuals we have integrity, a word that comes from the Latin, whole or entire. We are whole; we are one. And as whole human beings our experiencing of love ultimately must become one experience.  And when a man and woman in love meet in the sexual embrace, each, like Antaeus, hopes to arise stronger than before, to go his individual way. ..

In day-to-day living, the man who is diminished by a world that forces him to compromise or accept defeat finds total acceptance in the arms of the woman who loves him. And the woman who feels diminished by niggardly chores and obligations (and may still regard herself as the subordinate sex) receives heartfelt homage from the man who loves and desires her. With sex and with love the man restores her integrity and she restores his. And both have been nourished by sexual pleasure, which they seek as roots seek water-because without it their marriage will wither and die. "As a physician, not a poet, as a man who speaks with some knowledge of flesh and blood reality, I know that when the act of sex is truly an act of love it unites two committed human beings, obliterating their painful awareness of being alone and lonely. And the pleasure of the embrace, together with the certainty that tomorrow they will embrace again, gives them new strength to stand alone.

Mental health- SEXUAL ADJUSTMENT IN MARRIAGE

SEXUAL ADJUSTMENT IN MARRIAGE

DESPITE MARRIAGE manuals, the Kinsey and other reports, and the so called sexual revolution, medical authorities estimate that at least half of all married couples today still suffer from serious sexual problems. How unfortunate it is that the sex act, with its potential of deep and rewarding intimacy, should be clouded by fear, shame, ignorance, and misconceptions. Perhaps some sexual anthropologist of a future century, upon analyzing the Pill, the drive-in, the works of some of our best-selling novelists, the Tween Bra, and all the myriad other artifacts of the Great Sexual Revolution, will conclude that ours may have been an era in which there was some change in morality but not necessarily in sexual enlightenment and fulfillment.

Parents may think that young people today know as much as, if not more than, they should about sex; and many young people may smile in superior manner at any notion that they need education in such matters. Yet from the questions still asked by newly married couples, as well as by long-married ones, physicians are aware that much ignorance and misinformation remain. Both young and old couples often ask whether their sexual relations are" all right." They would like to have the boundaries of normal relationships defined, and they are concerned with problems of frigidity and impotence. It is a good thing that questions is being asked, that hopefully fewer couples refuse to discuss sex matters.

Yet there remain many people who believe that to put any significant emphasis on sex education is a mistake. They muster many arguments, even such as the one of a young married woman who declared: "I'm sorry Bill and I ever read that book about sex in marriage. It just made him feel guilty because he can't live up to what it says a man should do to satisfy. It is true that some books dealing with sex education have been written in a way that tends to remove all spontaneity from the relationship. Because matters of sex technique and skill were so, some writers have gone to the other extreme, exaggerating their importance and neglecting other aspects.

Yet physical attraction and intuition are not enough to enable people to solve the problems that may give rise to, or result from, an unsatisfactory sexual relationship. Neither rules nor elaborate detailing of techniques can solve such problems; only a better understanding of sex in all its aspects may do that. 

Ask these questions to avoid Mental Illness

COURTSHIP

Thus marriage, important to society, very important to the individuals involved, with considerable impact on both emotional and physical health, is a complex relationship, one not yet, and possibly never likely to be, scientifically blocked out, with definitive pretests to guide young people before they enter into it. Not for one moment do we suggest here that a young couple contemplating marriage can depend upon any set of tests or rules to determine whether theirs will be a happy marriage. But certainly some exploration and stock-taking are in order before entering into such a significant contract.

However much the heart races at the sight of the beloved, do not rush into marriage

 Give yourself and your potential future mate a chance to know each other. Face up to the fact that you should not marry anyone with the idea in the back of your mind of reforming him or her. Remember you are marrying an adult with fairly well fixed habits and tastes. If you marry for what your partner is, not for what he or she may become, it will save you a lot of disillusionment.

Use the time before marriage to discuss and try to reach basic understandings on all important matters

 Should the wife work? For how long? Are the husband's earnings adequate for both to live on? Who will manage the family income? How many children? How should they best be brought up? These are examples of questions that have to be faced at some time and may best be faced before marriage. Some additional questions may serve as a helpful guide;

You really enjoy spending most of your leisure time together?

Do you both enjoy the same friends?

Do you have compatible tastes in books, movies, art, sports, and other activities? Do your feelings and tastes about the kind of home you hope to have match reasonably well?

Do you agree on whether or not to have children and on their upbringing?

Does the prospective husband like to putter around the house, build and fix things, do gardening?

Does the prospective wife like to cook, sew?

Do you both have the same basic philosophy about life and your goals in life, the nonmaterial as well as material?

 Do you have the same religion or agree on attitudes toward religion?

Do you like or share each other's attitudes toward parents?

And are you in agreement on ways to deal with them?

Will you be likely, as best you can determine now after serious thought, to love each other when you are old?

Any couple who might answer "yes" to every question would be a rare one. You should not expect, nor desire, a mate who is a mere carbon copy of you. Disagreement on minor matters makes for stimulating conversation. Basic antagonisms, however, are another matter and intro- duce risk into marriage. Certain questions are more important than others. There should be a positive "yes" to the questions that are starred. About the seventh question: Religious disagreements have been found to playa small part in disturbing a marriage. These differences tend to be worked out satisfactorily during the courtship. After marriage, the problem is usually centered on the religious upbringing of children. The eighth question involves inlaws, who have been the cause of many marital upsets.

The courtship period is the ideal time to get to know them and make every attempt to like and be liked. The courtship period goes through several stages. Usually it has been preceded by "dating"-a time when the opposite sex is met at dances, school, clubs, and gatherings of various types. Dating should be constructive, a time for meeting different kinds of people and for enjoyment, but also for thoughtful exploration and understanding of members of the opposite sex. Courtship may be said to begin with "keeping company," when, after something "clicks" between two people, other dating falls off. "Going steady" usually follows; the attachment has become stronger. Private understanding is a succeeding phase for many couples. They have exchanged avowals of love.

Each has, if possible, been introduced to the other's family. Engagement is the final test before marriage. It should be the time for free, honest, and practical talk, for getting to know one another at deeper levels, for real understanding of each other's personality defects and for deciding about compatibility. For the average couple, one year has been suggested as a minimum engagement period. There is no ironclad rule; some couples need more time than others to get thoroughly acquainted or have had more time to do so prior to becoming engaged. But whirl- wind courtship should be avoided; too often it leads to divorce. 

Mental health- A LOOK AT LATE MARRIAGE DISSOLUTIONS

A LOOK AT LATE MARRIAGE DISSOLUTIONS

The number of long-standing marriages terminating in divorce has been growing. In Georgia, for example, Dr. Alfred A. Messer of Emory University found that, in 1953, 9 percent of divorces involved couples whose marriages had lasted 20 years or more; by 1966, the rate had gone up to 11 percent. A sampling of divorces in Fulton County, Georgia, in 1967 showed 14 percent to have taken place after 20 years of marriage. Nationwide data for 1963 revealed that 24 percent of divorcing couples had been married more than 15 years, indicating that the problem is not localized. As the result of his investigations, Dr. Messer advances several reasons for these "20-year fractures." For one thing, divorces are now more socially acceptable, and more people can afford them.

Also, more women now are able to work and are no longer financially dependent on their husbands. Divorce laws, too, in many states are more lenient than in the past. But one major reason, Dr. Messer believes, is that partners do not get to know each other well enough before marriage to be sure they can form a new identity as a pair. Also, child orientation is overemphasized in many families; the children become the nucleus around which all activities revolve, leaving little time or emotion for a husband-wife relationship.

Most couples attempt to make up in marriage for traits they think are lacking in their own personalities, says Dr. Messer. Unlike attract and likes repel. The man who is shy and silent is often happier with a vivacious wife. The frail woman likes to have a strong and vigorous husband. In a child-oriented family, the parents may begin to look more and more to their children for this type of gratification. The woman may cook and dress more for her children than for her husband, and the man may prefer to be with his children rather than with his wife. When the children leave, there is a void, and the husband and wife may feel that their needs are not satisfied by each other.

In every family, there should be a balance between adult-oriented and child-oriented needs, says Dr. Messer. In our "century of the child," the pendulum seems to have swung a bit far toward the child side. There is need for more "adult time," more second-honeymoon activities for the husband and wife to balance their role as parents.

Mental health

As one investigator has pointed out, the trend toward "equality" be- tween the sexes in marriage, without any clear division of labor and authority-as there was when the wife was expected to be exclusively a homemaker and the husband a breadwinner-creates "great potential for conflict and disillusionment." Under any circumstances, "boys and girls are bound to differ in some areas of role expectation." How they are able to modify these expectations when the honeymoon aura is over, and human weaknesses are revealed, is vital to the marriage. In describing how the health of a marriage can deteriorate when there is insufficient, or no, adjustment, Dr. Richard H. Klemer, of the Department of Psychiatry at the University of Washington, Seattle, says: "Al- though it may not be intentional or even conscious, one partner or the other begins to have something less than complete acceptance for his mate. If it begins with the wife, the husband soon senses this change of attitude and begins to protect himself, again perhaps only half-consciously. In turn, the wife protects herself against the husband's slightly changed attitude.

Then she protects herself further, and so forth. This goes on till the partners arrive at a state of complete hostility-or worse, apathy-in their efforts to protect their own ego against their mate's disillusionment." It is this that Dr. Klemer calls the "modern marriage disease." It can be prevented and checked when husband and wife realize that some expectations have to be modified and proceed to modify them as soon as possible. There is no marriage that does not require adjustment. Obviously, a mature person who acts on the basis of reason, not just emotion, will have much less trouble adjusting to marriage than a person who may be physically adult but is still a child emotionally.

Marriage can be an exacting business. It was once thought that personality development virtually stopped at the age of five; now it is recognized that personality development can continue all through life. If it does continue, a marriage is likely to be a happy one. After devoting many years to marriage studies at Harvard Medical School's Laboratory of Community Psychiatry, Dr. RhonaRapoport finds that getting married is exacting because it involves a II critical transition from one social role to another." It calls for changes in behavior and social relationships between the individuals and entails "personality change of a more or less enduring nature. II Dr. Rapoport goes on to note: "Major social-role relationships are inherently disrupting. As an individual's social role changes, his image of himself is affected, the way in which others expect him to behave changes.

And his legitimate expectations for the behavior of others alter. As all this goes on, the individual may grow and develop under the impact of the stimuli or he may find them so burdensome and distressing that his functioning is impaired, in extreme cases involving symptoms of emotional disturbance:" Everything does not have to be mutually satisfactory in a happy marriage. Studies reveal that in most marriages that are happy, several phases of marital life are not what the partners would have liked. If adaptability and the maturity that makes it possible are essential, so is motivation. With strong motivation, the desire to make a marriage work, adaptability may be furthered. The Harvard and other studies suggest that what happens in the engagement period before marriage often indicates how a marriage will go. Couples best able to adjust to each other during the engagement period have least trouble moving happily from the freedom of single life to the demands as well as opportunities of marriage and family life. This is a good reason for a fairly long, relaxed period of courtship. 

Personalities and character structures affect Mental strength

Personalities and character structures are of prime importance in this most important contract of adult humans. It is upon these factors that the success or failure of the marriage depends. When difficulty arises in a marriage, when there is discontent, frustration or discord, physical and psychic symptoms may follow. Preventive medicine has become increasingly aware that many health problems are precipitated by marital problems. While there is no such thing as a blueprint for a happy marriage, it is wise, before entering marriage, to be aware of the factors that are most likely to lead to successful marriage and those that may foredoom a marriage. Out of scientific studies which have investigated many thousands of marriages to determine reasons for success and failure, experts in the field have arrived at some guidelines.

CULTURAL BACKGROUND

 Generally, people feel more at home with others who have had similar childhoods and have similar customs, manners, and tastes. Certainly, marriages between people of different races, religions, and economic and social classes can be successful. But it is only realistic to recognize that such marriages must overcome extra problems, not necessarily insoluble but real enough-problems caused not only by social disapproval but by the number of adjustments that must be made. For example, a rural Southern boy and a city-bred Northern girl may find it quite difficult to arrive at a way of living that makes them both happy and comfortable.

EDUCATIONAL LEVEL

 Not only the actual learning experiences but the experiences of being with others and the opening up of interests which Healthy Adjustment in Marring!! / 37 schooling provides can be of importance in marital adjustments. It is usually helpful to a marriage when both partners have roughly the same amount of education.

ECONOMIC AND JOB STATUS

 More important than the size of a man's income is the job he has, not alone the salary he gets from it but the satisfaction; the challenge it offers him; the fulfillment he gets from working at it; the possibilities it holds for the future, either in itself or in other opportunities to which it may lead. Generally, today, the more educational preparation he has had for his work, the more rewarding- not only in immediate financial return but in other ways-it is likely to be, and the better candidate he is for marriage. 

HEALTHY ADJUSTMENT IN MARRIAGE

 HEALTHY ADJUSTMENT IN MARRIAGE

MARRIAGE HAS been described as the "incredible entanglement of two people." If incredible, such entanglement has proved to be the most suitable and durable means by which most men and women achieve emotional gratification. A merger involving two personalities, each with his and her own individuality and distinctive familial background and standards, is not and never has been uncomplicated. You may hear it said that the American family is heading for collapse. But such ominous predictions have long been made. Early in the century, some writers seemed to think that horse and buggy reins had been the ties that had bound the family together and "the citizen, shaken loose from his safe domestic base by much streetcar straphanging, takes to socialism and drinking.

The matron, without the steadying discipline of having to get home in time to feed the horse, gads and grows extravagant." If marriage and the family today face changes and problems, they have always done so. Every generation has its problems of progress. The Victorian era-patriarchal, well ordered, and romanticized ever since-- lasted only half a century and constitutes a small part of our heritage. Perhaps, as sociologists point out, if there is an American norm, it is the frontier tradition of breaking away from the Establishment at an early age, and young families today resemble the pioneers who fought the wilderness. They fight a new kind of wilderness, not geographic, but psychological and moral. They are almost constantly on the move, with jobs taking them from one city to another, one region to another. They "do it themselves"; household help virtually does not exist any longer nor the handyman for hire nor the quickly available, reasonably priced serviceman.

 With disruption of many once-fixed values, with the moving about that does not allow the continuity that can be a stabilizing influence for children, young parents must and do compensate, working harder at understanding their children than any parents before. Perhaps in reaction to having been brought up on standards of material success, young couples today often consider material success of relatively small importance as contrasted with working for something of greater social significance. They try to be of service; young fathers carry petitions; young mothers attend lectures on social problems; they teach their children to think in terms of service to humanity. And if the American family, as Phyllis McGinley has put it, "seems threatened-by the impact of violence and war, by frequent divorce, changing sexual attitudes and a general atmosphere of wariness toward established religion-it is also protected by this fresh concern for the rights of human beings." Still, marriage is a highly personal situation, exposing the partners to the most private and intimate of contacts. 

Fatal MEntal illness

Sickness and operations

 We live longer and so are more subject to chronic illnesses. Often, these illnesses can be well controlled. But the very fact that an illness exists, even when controllable, can lead to feelings of despair or depression. Be sure you talk openly of your feelings about an illness to your doctor. And be open, too, with your spouse and friends. If you need an operation, you have every right to discuss with the doctor just what is involved, what will be done, how long a period of recuperation will be necessary, what the fee will be for operation, and what other expenses will be involved. And remember that almost everyone has some gloomy days after a major surgical procedure, but there come the happy days when the body overcomes the stresses of surgery and anesthesia.

Fatal illness

 Some people think that awareness of a fatal illness must lead to emotional depression. This is not necessarily so. Most people take the fact well. There may be forlorn moments as the situation is first accepted as reality. Most depressions come from misunderstandings, such as that cancer will inevitably produce unbearable pain or will so destroy the body that other humans will shrink from contact. If a diagnosis of cancer causes great anxiety or frank depression, a long talk with your doctor, or with a psychiatrist your doctor can arrange for you to see, can be most helpful. We have seen people who have had a good, rich emotional life grow to even greater appreciation of life as they faced their last days during a known fatal illness. 

MEntal Illness causes and treatemnt

 Marriage can help assure a healthy mental and emotional life if there is true love, acceptance of each other's good and weak points by the mates, and a happy, fulfilling sexual life. Marriage should continue to grow as a creative experience and not settle into "dullsville." Because marriage is so important in preventing emotional problems, at the first sign of significant marital trouble there should be a talk with a marriage counselor. Sometimes a single session will work wonders. (See page 327 for further discussion of marriage.)

Pregnancy and the arrival of children

 Pregnancy can set off emotional problems. We have a section on pregnancy. The coming of the first child and then of later children expectably changes the quality of marriage. It should deepen ties. But each partner needs to realize that the other, deep down, wants and needs reassurance that a child hasn't usurped all love. If pregnancies and the coming of children go well, what then can threaten the emotional stability of adults? Here are several situations that cause tension and sometimes serious emotional disturbances: Loss of job or business reverses.

We have known people who have lost fortunes and made them again. Nothing disturbs their inner conviction that they will succeed in their work. On the other hand, we have seen emotional disturbances develop at the threat of a change of job or a small temporary reverse in a man's business venture. Such disturbances call for a talk with your doctor or other counselor.

Menopause

 This is a dramatic, emotion-charged event for some women. See our special discussion about its emotional component.

Sex in the later years

More and more, medical science recognizes the need of older people, and their ability, to continue sexual activity into very old age. Even many individuals with heart disease and other ailments can enjoy sexual activity. Sex deprivation, especially in an older man, may cause depression. Here again, a talk with a sympathetic physician will prove helpful.

Security

 We live in a competitive society which really has little mercy for the person who doesn't provide for himself and his family. Social security benefits are inadequate. It is reassuring-and a good preventive of mental tension-to work out early in life a program of disability, retirement, and life insurance which will provide for the family. This doesn't mean that you have to become so worried that you become "insurance poor." There are low-cost, term insurance policies which young people can afford. And almost everyone belongs to at least one organization that offers inexpensive group insurance.

Retirement

 What happens at retirement will probably reflect the sum total of your personality growth during your lifetime. Some people enjoy retirement; others abhor it. Talk at length to your doctor about your emotional as well as physical needs in the retirement period. A change of location may be beneficial emotionally for some people, not for others. If you need part-time work to keep you cheerful, remember that you usually get this more readily in your home location where you are known.

Treatment for Mental stress and Illness

Beginning of school

 This is a big event in the emotional life of a child, especially for one who has not gone to nursery school. Extra love, sup- port, and praise should be given him as he makes this big adjustment. The parents should become part of the school life through visits, parent- teacher activities, etc. Some experts on child rearing believe that personality is relatively fixed by the time a child starts school. We disagree, even though we believe strongly that the early years are highly important. We believe that personality is constantly developing and changing as life proceeds, and that only death marks the end of personality and emotional change for a human being. From the beginning of school until puberty there is a quieter period in the emotional life, the so-called latency period, when the child undergoes fewer upheavals and is usually highly receptive to education at school and at home.

This is the calm before the storm. Then come puberty, adolescence, and the teen-age years. Until adolescence, there will be no doubt of a child's dependence on the parents. Now, however, the situation becomes ambivalent. The child lives at home but begins to feel the powerful biological and social drives that will transform him into an adult.

During these stormy years, personality will be molded by the outcome of explorations and reactions to Dating and petting experiences For the girl, menstruation (treated elsewhere in this book); for the boy, growth of sex organs and the occurrence of wet dreams Masturbation Homosexual feelings, activities, and fantasies Sex drives toward the opposite sex Acceptance or rejection by classmates of both sexes Athletics and other school activities Scholastic achievement Some degree of rebelliousness with parents, teachers, police Experimentation with drugs, cigarettes, alcohol Part-time jobs and summer activities Handling of money, budgeting, use of own or family car Surely, we haven't listed all the possible critical factors of the lively teen years.

We can only hope that these and other problems will be dis- cussed by parents and children, because their resolution in a positive, healthy way will do much to prevent mental illness. We suggest that parents and children read the wise book by HaimGinott, Between Parent and Teenager. When parents and teen-agers cannot achieve open discussion and communication, they should find a mature, sympathetic person who can provide guidance (and referee misunderstandings and quarrels).

A teacher, clergyman, doctor, relative, or school counselor may be just such a person. A visit to a psychiatrist may be needed in some cases when personality problems become severe-for example, when a child wants to drop out of school, begins to use drugs regularly, exhibits cravings for alcohol. Nineteen is the last teen year but hardly the end of emotional strains and growth. There follows the period when major decisions must be made about career and marriage. Surely, almost every expert on personality would agree that a rewarding job in which the individual is happy is great insurance for mental health. This, of course, is a good argument for obtaining the right education to open up a wider choice of career possibilities. A secure, happy marriage can be a bulwark against emotional problems.

We deal with marriage later. Let us stress that marriage is so important that the decision to enter into it should be based on mature judgment, not entirely on romance. Remember that more and more marriage counselors are helping people before marriage with advice about possible suitability and compatibility and by giving them realistic previews of problems to be faced. 

Treatment for mental Illness

Toilet training

 The handling of toilet training can be an important determinant of personality. During World War II, Navy doctors were so impressed by the relaxed behavior of Okinawan civilians under bombardment that they studied the personality backgrounds of these people. The significant factor seemed to be that the Okinawan child was per- mitted to set his own pace for toilet training. Children vary in the development of brain areas and nerve pathways involved in the complex reflexes required for urination and bladder control. Our advice is to consult your child's doctor; he knows at what pace the child is developing and can make a good estimate of the date when toilet training should be started.

Talking

 There is big variation in the time when children begin to talk. Don't worry because a neighbor's or relative's child may talk at a very early age, earlier than your own child. But if you are getting nervous about your child's timetable, discuss this with your doctor.

“Abnormal" curiosity

 A child is curious about everything. That includes genitals, feces, urine as well as more acceptable objects in the unfolding world around him. Let him explore. Don't shame him. If he gets too messy, distract him gently.

Social experiences

 Introduce your child to other children gradually. Do it at play places, at home, in playgrounds. This is especially important for an only child.

Nursery school

 One of us wrote some years ago that if he had to make a choice because of limited tuition funds between nursery school and college for a child, he would choose nursery school. He was thinking of a really good nursery school with trained, sympathetic teachers who supplement the efforts of parents in the important years between age 3 and 6.

Identification with parents

 Many psychiatrists believe that in the 3- to 6-year age period, a struggle goes on in the inner, unconscious minds of children and that it has important bearings on later emotional health. At this time, the boy struggles unconsciously to supplant his father in his mother's affections, and gradually to identify with the father; the girl undergoes a similar reverse situation. This "oedipal conflict" may help determine how a boy or girl will feel later in life about the male or female role. During this important period, parents should not make favorites of children, should be careful not to appear to be seductive, should exclude the child from the marital bed, and should exercise care that the child has no opportunity to view their sexual activities.

It is best neither to take baths together nor to share the bathroom with children at this age.

Vacations

Separation from home during vacations can be a positive or negative influence depending upon the child's readiness for the experience. Overnight camp is a big dislocation for a young child and should be undertaken with caution. And remember that a vacation with grand- parents may seem natural to you but a child may view them as strangers.

Movies and TV

Parents should guard against making babysitters out of TV programs or movies. No one really knows how much influence these media are having on the emotional development of our children. But it surely seems sensible for parents to select programs carefully for the very young child.

Birth of a new baby

 A child may fear displacement when a new baby arrives. It is a challenge to parents to make the child feel even more loved and to give him a sense of participation in the care of the new arrival. Parents should consider nursery school or other activities for the child long before the baby is born to challenge his place.

cuddling and affection treatment for

Teething sometimes may be traumatic. Extra cuddling and affection at this time can be helpful. In some cases, the doctor may need to determine whether dental intervention may be required. The baby with frequent and severe colic has a hard time, as do the parents. Many pediatricians would be glad to prescribe paregoric or other suitable medicine for relief of the colicky pain but are afraid that the parents may feel that they are "doping" the baby. If your baby is colicky, have a good talk with your doctor about providing relief. Weaning is an important event for the baby. Weaning should be gradual and, if possible, at a time when the parents, particularly the mother, can spend extra time with the child. If in doubt about the technique, go over the details with the baby's doctor.

The baby should be introduced cautiously to water, whether it is for bathing, hairwashing, or actual swimming. Children vary enormously in their fears about the feel and look of water. Child begins to explore his room and his curiosity while protecting him from danger. Wise parents, building a secure emotional life for the child, will avoid the constant repetition of "No, no." They will try as much as possible to hide dangerous articles, provide reasonably safe play areas, safeguard beds, shield electrical out- lets, put gates on stairways, etc.

To satisfy a child's natural curiosity and desires, a play space should be provided with a "messy area" where there will be opportunity to experiment with wet clay, sand, and paper. A friendly puppy or kitten may prove a great asset at this stage of life. Eating habits worry too many parents needlessly. If you stay relaxed, you will find that the child will settle down to an adequate diet. If not, rather than become a nagging parent; discuss diet with your doctor.

PREVENTIVE PSYCHIATRY

PREVENTIVE PSYCHIATRY

FAMILY DOCTORS and pediatricians are often asked by prospective parents and actual parents: "How can we guarantee that our children will grow up free of emotional illness?" This is a logical question in an age when we can guarantee protection against polio and many other serious or unpleasant diseases. Unfortunately, we don't have vaccines to prevent development of abnormal personalities, neuroses, and psychoses. Some doctors even take a completely negative attitude; they feel that there is not enough knowledge to give any valid advice on prevention of mental disorder. However, most physicians, psychologists, and child educators believe that there are useful guidelines.

 We believe that a child has a better chance to develop the type of normal personality we have outlined previously if certain guidelines are followed. And we go along with the thinking of those psychiatrists who believe that if there are any hereditary or familial tendencies to emotional breakdowns, the individual with a sturdy personality can fight them off or, if afflicted, will have a better chance of recovery. We believe that of overriding importance are the basic attitudes of mother and father. When parents love and relaxed, there is usually a good future for a child.

Even babies sense love, poise, and acceptance in their parents, especially the mother. The mother's voice and touch are appreciated by the baby at an early age. If they are loving, warm, positive, the baby has a good start. When a mother is loving, eager to have her child grow into a happy, resourceful human being, and has realistic hopes for him, the child's upbringing and future are likely to be soundly based. Even though mistakes almost certainly will be made, they will be offset by a strong "bank balance" of loving, normal, good care. Because the first year of life, even the earliest days and weeks, are important, planning during pregnancy is important. It is often helpful for new parents to take a course in baby care. If a rooming-in arrangement -one in which the baby can be close to the mother (and shared by the father)-can be arranged in your particular hospital, we think it a good idea.

Sometimes, a little extra pressure on the obstetrician may make this possible. We think breast feeding brings mother and child into a close, warm emotional relationship. However, if it is not feasible, the mother should cuddle the child closely so that bottle feeding has much the same overall physical feel for the baby as breast nursing. If circumcision is desired, it should be arranged in the hospital before taking the baby home. Later in life, this minor operation may have major emotional importance. Prolonged separation from parents, especially from the mother, in the first year of life (and later, too) can be the basis for later psychological problems. Separations should be avoided if at all possible.

When unavoidable because of illness, divorce or death, a parent substitute should be introduced as soon as possible. The substitute should have the qualities of a good mother or father. Introduction of the baby to the new person should be made gradually because even a grandparent may rank as a total stranger to a child. After breast or bottle feeding has been settled upon, there should be a decision about demand versus scheduled feeding. We favor letting the baby's hunger set the schedule rather than having the clock prevail. However, that does not mean that the mother must be a slave to every first whimper from a baby. Infants are capable of tolerating some minor frustrations.