Ellis was one of the early writers to describe the “buildup and discharge” model of sexual response, and it became the model for future researchers. He wrote, “Tumescence is the piling on of the fuel; detumescence is the leaping out of the devouring flame.” This energy buildup and energy discharge model was related essentially to the genitalia, although Ellis was also one of the first to describe erogenous or erogenic zones responsive to touch.

Ellis thought that male sexuality was “predominantly open and aggressive,” while female sexual response was “elusive,” slower, and much more elaborate. While men responded to touch, the penis was the focus for them. Even the scrotum was seen as without much sensitivity.

Ellis saw the nongenital areas as sexually responsive in the female. He felt that the breasts were particularly sexually responsive. Women were viewed as sexual “all over their body,” and much more “total” in their sexual response, more mentally and emotionally involved. He wrote, “In a certain sense, their brains are in their wombs.” By this unfortunate phrase, he meant that women were not the asexual beings of Victorian doctrine, that they were in fact highly sexual. The misrepresentation of this view became “women are preoccupied with sex,” are more emotionally involved in it. Women came to be seen as sex objects, sexually driven by some innate procreative and unique feminine drive.

Ellis changed his views of marriage throughout his career. He continued to view it, however, as a natural state, “the most natural expression of an impulse which cannot, as a rule, be so adequately realized in full fruition under conditions involving a less prolonged period of mutual communion and liberty.” He added, “The needs of the emotional life. . . demand that such unions based on mutual attraction should be so far as possible permanent.”

He would later add that some form of erotic variety was necessary, even within marriage, but that such variety should be in the form of sensitive affairs, “liaisons” of love that protected, even enhanced marriage. Like most researchers, he felt that marriage could not compete with variety, his own theories paralleling the change from exclusivity to a search for variety characteristic of many marriages.

Ellis did not think much of traditional Western marriage. He felt that Western marriage deromanticized the marital relationship, making a contract out of a natural state of relating, changing the substantive joining of two people to a formal agreement between two partners. He repeated that marriage was “not a contract, but a fact.” As with all of the theorists of the first three perspectives, Ellis struggled with the conflict between the erotic and hedonistic on one hand and the romantic and intimate on the other.

Richard von Krafft-Ebing, Karl Heinrich Ulrichs, Albert Moll, Edward Carpenter, Auguste Forel, Iwan Block, Magnus Hirsch-feld, and certainly Sigmund Freud were all influential in the period of sexual transition beginning in the 1890s with Ellis’s work. Masters and Johnson’s recent book On Sex and Human Loving traces many of these influences on what philosopher Paul Robinson calls this “modernization of sex.”

*96\97\8*

Once infected, there is no way of eliminating the virus from the body. It usually lies dormant for weeks, months or even years and then flares again. Like cold sores on the lip, the infection may be triggered by a rise in body temperature from a cold or other infection.

Heat, friction or emotional upsets may be the trigger for recurrence in others. It is highly infectious. Women who become pregnant may have the infection cross the placenta to infect the foetus. Infections acquired late in the pregnancy may infect the child during its passage through the birth canal and so caesarean section may be indicated in some cases to prevent the child becoming infected.

Diagnosis is usually obvious from the clinical picture but scrapings from the ulcers may be examined under the microscope or virus cultures be obtained to make sure of the diagnosis.

A variety of local applications to the lesions have been used including painting them with a dye and then exposing the area to ultra-violet light. This has now been abandoned as it is thought to increase the risk of cancer in the area.

Chronic infection of the cervix or neck of the womb with the herpes virus is thought to be one of the causes of cancer of the cervix which is the second most common cancer in women.

But herpes may not be forever as many people eventually mount some sort of immune response and the recurrent flare-ups cease.

*599/71/1*

Many people wear glasses and go regularly to an optometrist or an eye doctor.

Yet most are rather hazy about how their eyes function and why they need glasses.

Light enters through the cornea, or clear window, of the eye.

It passes through the watery fluid of the anterior chamber and enters the back section of the eye through the pupil, a hole in the iris or colored part of the eye.

The iris acts like the lens aperture of a camera, varying in size to admit different amounts of light depending on how bright it is.

The light rays then pass through the lens which focuses them on to the retina at the back of the eyeball.

This is a layer of sensitive nerve endings which when stimulated transmit the impulse through to the brain where it is interpreted as sight.

To test eyesight — or visual acuity — a Snellen’s chart is used.

This consists of letters which diminish in size from above downwards.

The top letter is of such a size that a person of normal sight should be able to see it at a distance of about 60 metres.

*342/71/1*

Some methods of cancer treatment such as meditation and prayer utilise processes about which very little is known. An exceptional person may be able to rid their garden of weeds by meditating or praying over it. Equally rarely, someone may succeed in ridding their body of cancer by these methods. I don’t doubt that the mind has fantastic abilities which unfortunately remain completely unexplored and untapped by most of us in today’s ‘civilised’ and scientific society. Very few have a natural ability to tap into these powers. It seems unlikely that the rest of us could be taught to do so over a short period of time.

What about starving the weeds by depriving them of some of the nutrients they need? Some dietary methods try to ‘starve’ the cancer cells, for example the ‘grape diet’. Again the problem is that the normal cells need the same nutrients as the cancer cells. They are not so different that we can starve the cancer cells without starving the normal cells as well.

Diet-based cancer treatments are also said to work by cleansing and purifying the body. Contaminated soil certainly can be the reason for getting a lot of weeds in the first place. However, purifying the soil in some way after the weeds are established seems unlikely to get rid of them. Once established, they are likely to flourish in any soil that suits their close relatives, the normal plants, ‘Cleansing’ the body may prevent cancer but seems unlikely to cure established cancer.

In summary, the basic fact that prevents treatments from curing all cancers is that the cancer cells are too similar to our normal body cells. This fact also means that no effective cancer treatment is completely free of side effects—unwanted effects in the form of damage to normal cells and parts of the body.

*122/40/1*

You will remember from the last chapter that the crucial step in diagnosis of cancer, is to get a sample of the suspicious area for examination under the microscope. This is also true for people with probable secondary deposits and unknown primary. Examination of such a sample is usually necessary to confirm the diagnosis of cancer. In addition, by studying the shape, size, type and arrangement of cells from the secondary growth, the pathologist can often suggest likely primary sites. In deciding what further tests^ to recommend your doctor should consider the appearance and location of the secondary deposits, common cancer types for your age and sex and what treatments might be possible as well as the pathologist’ advice. Once you have ruled out primary cancers which are sensitive to certain particular hormone, chemotherapy or other treatments which go right through the body, there is rarely anything to be gained by searching further for the primary tumour. It may reveal itself later by producing symptoms which can then be dealt with. However, in some cases the primary cancer never causes any problems and is not located before death results from the effects of the secondary growths.

Well, that wasn’t such a difficult or unpleasant chapter, was it? You now have enough background to start thinking about treatment. First of all, it is important for you to understand why certain treatments are recommended. It is also important to understand what sorts of things you will need to know in order to decide whether what is recommended is likely to be best for you. This is what the next chapter is about. It is an extremely important chapter. Don’t miss it.

*116/40/1*

Breast is best! A number of years ago this simple dictum was considered old fashioned, a burden for women and perhaps not the best for the baby. But we have since learned that nature was right and that breast milk is the ideal food for the young infant.

Breast milk is a complete food in the first few months of life and the baby does not need any other.

There are a number of reasons why all mothers should be encouraged to breast feed their babies.

In the first few days after birth before the milk comes in, the secretion from the breast, colostrum, contains immunoglobulins. These give the baby a number of ready made antibodies to protect it against infection while its own immune system is still immature.

Because the transfer of the milk is from the breast straight into the baby’s mouth there is little opportunity for germs to contaminate the supply system as may easily happen with artificial feeding.

This is an important factor in the developing countries where women have been switching from traditional breast feeding to bottle feeding. The standard of hygiene is often poor with the result that gastro-enteritis becomes common and this may well be fatal.

*92/71/1*

The variability of people and the complexity of factors that cause a person to seek help with fatness means that there can be no standard set of rules. You have to make a fresh ethical decision with each new request for help, often even within the handling of one client. Frequently, these decisions need to be made on-the-spot, without the opportunity to seek advice.

It is important to have thought through a general framework for ethical decision-making in advance, that will assist with making on-the-spot judgements and decisions.

There are four domains which are important to consider:

• yourself

• the client

• the treatment resources available

• the social context.

You must also consider the interplay of these four domains.

Yourself. Our past experiences and what we have made of them affect our reactions to people and situations. We see each new thing we encounter through a ‘filter’ of beliefs and expectations that helps us make sense of them. This in turn influences how we respond.

You need to know yourself well, especially your motives, attitudes and feelings regarding obesity, overeating, exercise and health. Failure to understand these things increases the risk that you will act unethically by unintentionally imposing your personal values on your clients.

What do you think is the most important outcome goal for this person? Why? In your work, you are pursuing your own goals as well as your clients’. This means that they hold some power over your job satisfaction—you cannot succeed without their active cooperation. This motivates you to shape their goals in line with your own objectives rather than being there simply for your client. If you are clearly aware of your own choice of goals in a particular case, you can more easily see any conflict between your own goals and those of your client.

What do you believe has made this client obese? How do you feel about that? Your theory about why a particular client is obese will play a big part in the actions you take. In reality, different

people come to be obese along different paths, but the feelings that arise in you because of your theory are very important. For example, you might decide that a particular client is obese because during childhood she learned to select sweet and fatty foods in her diet, following her mother’s choices. This theory may give you reelings that the client is ‘not to blame’ and that her mother was at fault. Indeed, you may have strong feelings about poor childhood nutrition and regard the mother as having been a poor parent or even somewhat abusive of the child for making her obese. This might lead to you feeling sorry for the client and trying to be the ‘good parent’ that her mother was not.

On the other hand, you might think that another client who has had good nutritional advice for years has remained obese because he has not put the advice into practice. This could give you feelings of hopelessness about working with him or even anger that he has wasted other busy helpers’ time and is going to waste yours too.

Do you believe it would be possible to have the things that are important to you personally if you were as obese as this client? Usually, we think that the things that we personally value are desirable to others as well. If you believe that your client needs to lose fat in order to have a chance of getting something that you value in your life, you are less likely to consider or support alternative goals and means of achieving these. For example, the client might be concerned that she needs to lose fat in order to get a partner. If you believe that you would feel this way if you were equally obese, it may be difficult for you to work constructively with her feelings about personal attractiveness and relationships.

What skills do you have with which to respond to this client’s needs? It is generally regarded as unethical to promise what one does not have the ability to provide. It is also your ethical responsibility to respond appropriately to a particular client’s needs. It is possible, perhaps even quite common, for the client to have come to the wrong person for help—they are not always well-informed about their needs and the services that cater to these needs.

This question helps you to think about whether the client has realistic expectations of what you can do. The most ethical response to a particular client may be to decline her request for help and discuss more appropriate alternatives.

*230\186\4*

Typical big eaters are:

• teenagers and young adults,

• people working as labourers,

• people doing regular strenuous exercise.

Big eaters need to eat:

• at least 8 slices of bread or the equivalent (crackers, rolls, muffins)

PLUS

• 3 pieces of fruit or the equivalent (juice, dried fruit) PLUS

• at least 2 cups of high carbohydrate vegetables (corn, legumes, potato, sweet potato)

PLUS

• at least 2 cups of cereal or grain food (breakfast cereal or cooked rice, or pasta or other grain)

PLUS

• 2 cups of low-fat milk or the equivalent (yoghurt, ice cream)

This provides 375 grams of carbohydrate which is suitable for a 10 500 kilojoule (2500 Calorie) diet.

An athlete who is training hard would generally need to eat double this quantity of carbohydrate.

WHAT ABOUT THE DIFFERENT TYPES OF CARBOHYDRATE? Traditionally, carbohydrate has been classified in terms of its chemical structure. We now know from scientific research and clinical trials with real people that the whole concept of simple and complex carbohydrates does not tell us anything about how they will actually behave in the body. Until recently, it was widely believed that complex carbohydrates, or starches such as rice and potato, were slowly digested and absorbed and therefore caused only a small rise in blood sugar level. Simple sugars, on the other hand, were assumed to be digested and absorbed quickly, producing a large and rapid increase in blood sugar. These assumptions were wrong.

Forget about the words simple and complex carbohydrate. Think in terms of low G.I. and high G I. factor.

*20\33\4*

THE SELF-MANAGEMENT OF CHRONIC PAIN

This involves the understanding and practice of the various ideas which we have discussed. Remember that this is not difficult, but it requires a little time and a little perseverance. Remember that many patients whom I have told these things verbally have succeeded. The only difference with you is that I am telling you by writing it down instead of saying it in words; and actually by writing it down I am able to explain it much more fully.

We have spoken of six general principles in the self-management of pain. If you were with me in my consulting room, I would repeat them to you in order to impress them on your mind. So I shall do the same now.

1. Reduce your general level of anxiety by understanding the nature of pain, by facing and resolving conflicts which cause anxiety, and by using the relaxing mental exercises to reduce anxiety.

2. Guard against the reactions that make pain worse. Do not allow distress, guilt, or fear to take over.

3. Use the reactions that reduce pain. Deny it and distract yourself from it when you can. Relax deeply and practice autosuggestion. When you can, use dissociation.

4. Practise the relaxing mental exercises.

5. Increase your pain threshold by conditioning yourself with the exercises in discomfort and pain.

6. Learn to experience and accept pain in pure form, which does not hurt.

We have discussed the means of fulfilling each of these principles, and we have seen that each step in itself is not difficult, as one follows the other in ordered gradation.

I always warn my patients of three things: Do not expect too much too quickly. Expect a few ups and downs, good days and bad days in the process of mastering the self-management. Do not get cross with yourself if at first you cannot do just what I ask.

I could relate many examples of patients I have had who have been successful in learning how to control their pain.

A man with cancer of the prostate suffered severe pain from secondary growths in the bones of his pelvis. He learned to relax and control the pain reasonably well, so that the last weeks of his life were actually spent in a clear mind and relative comfort.

A woman in her sixties complained of continuous severe pain in the legs, the vagina, and the area of the bladder. An operation on her back had shown a cystic degeneration of the nerve roots. So there was no doubt about the organic origin of her pain.

At first she found it hard to accept the idea that a psychological approach could help pain of this nature. She kept saying, “But the nerves have this degeneration.” I asked her to stick some pins into my forearm. She was reluctant, but she eventually did so, and was obviously surprised that it did not seem to hurt me. I then had her relax, and I did the same to her. When she opened her eyes she was astounded to find a couple of pins well embedded in her skin. From then on she was most enthusiastic about the exercises. She lost all the pain in her legs, and most of it, but not all, in her vagina and bladder. She later stated that she had developed a real peace of mind, and she volunteered that she was sleeping better than she had for eight or nine years.

I well remember one of my first experiments in helping people with organically determined pain. A woman in her sixties suffered chronic pain in her back from a degenerative condition of her backbone. She said that she had to fly from Melbourne to London and back, and she was terrified of the pain from having to remain in one position in her seat for so long. This was before the advent of the jets.

I taught her to relax and wished her luck. A few weeks later she came in to thank me, saying that she had made the trip without discomfort.

Just a year ago I saw a retired doctor, aged seventy-six years, who had had an extremely painful condition of his foot for nine years. He kept describing it as feeling as if someone were screwing up his foot in a vice. One surgeon had cut the main nerve, another surgeon had dissected the little nerves that lead to the toes, and later the artery had been freed of its nerves. But nothing had any effect on the pain. Another psychiatrist had tried hypnosis, but this was also unsuccessful.

In spite of his age he learned to do the relaxing mental exercises, and soon found he could control the pain.

A few days ago I received a note from his wife saying that he had died, and thanking me for the relief he had had in this last year of his life.

*146\57\2*

The colour-signs in the iris, showing the deposition of pigments, are divided according to shape and colour. With regard to these conspicuous signs, there are three groups of pigments to be considered:

The endogenous pigments are important for iridology. To these endogenous pigments belong those of the haemoglobin group with the end-product haemosiderin (colour: red to brown), the melanin group (colour: brown to black), and lipofuscin, also referred to as the ‘wear and tear’ pigment (colour: light yellow to dark brown).

The melanin group of pigments have their origin in special dendron cells, melanocytes (also described as melanodendrocytes). These cells derive from the embryonic neural crest. The melanin originates in the melanocytes by means of complicated enzymatic processes. A first stage of melanin is the colourless amino-acid Tyrosine. This compound is transformed by the action of Tyrosinase through dihydroxyphenylalanine (DOPA) into melanin.

Melanin formation is also subject to hormone control. The pituitary gland secretes a melanocytotrophic hormone (MTH, also called melanocyte-stimulating hormone: MSH), which has a stimulating effect, while the adrenal hormones from the cortex and medulla appear to check the pigmentation process. From these different influences affecting the formation of pigment, it can be accepted that disturbances may give rise to a wide variation of manifestations within the total organism.

Melanin tends to migrate within the body. Because of its poor solubility as such, melanin is taken up by the cells of the reticuloendothelial system, the melanophores, by a process of phagocytosis, and conveyed to wherever it supposedly serves some purpose. Melanin is found in the vicinity of inflammatory processes, and also with skin conditions accompanied by inflammation. Pigment migration also arises in the vicinity of tumors and within many tumorous conditions, e.g., melanosarcoma. One is also reminded of ulcerations of the lower leg, where melanin deposits occur over large areas.

It should also be mentioned here that melanin is found within the body as a normal constituent of the hair, skin and the posterior surface of the iris. It accumulates in the skin as a protection from the ultraviolet rays of the sun, where the melanin protects the skin from the carcinogenic effects of these rays.

If melanin deposits are found on the anterior surface of the iris, then there is a positive indication of the existence of serious metabolic disturbances. Indeed, according to the accompanying signs in the iris, one may speak of a pre-cancerous condition of the corresponding organs or systems which can ultimately lead to a cancerous state.

The iron-containing pigment: haemosiderin (haemofuscin) is a reddish colour to begin with, and may then change towards dark brown (the colour change of a piece of rusting iron!). On the destruction of large quantities of red blood corpuscles, this pigment becomes deposited within the tissues of the body. It can also appear in the iris following internal or concealed haemorrhage. In my opinion it is not a sign for haemorrhagic tendencies, but only the sign of a large destruction of red blood corpuscles in which the iron is deposited in the tissues.

*37\78\2*