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 What Every
Mental Health
Professional
Needs to Know
About Sex
Stephanie Buehler
 Foreword

W hen I speak at colleges about sex, I often start by asking students in

the audience “How many of your parents told you what a clitoris is
when you were growing up?” In an audience of 300 students, perhaps five
will raise their hands. When I ask “How many of your parents explained
to you what masturbation is or told you what orgasms are?” Ten or fifteen
hands will go up. These are students at some of the top colleges who were
raised by some of the smartest parents on the planet during the 1990s—not
the 1950s.
When parents are not comfortable giving their children words for some
of the most powerful physical and emotional experiences they will have in
life, a veil of secrecy is created around the subject of sex that children carry
with them into adulthood. This is why there is such a great need for a book
like What Every Mental Health Professional Needs to Know About Sex. It doesn’t
matter if the therapy we do is cognitively based, psychodynamic, interper-
sonal, or experiential, this book explores aspects of sex that are essential for
therapists of all orientations to know.
Sex is an important part of most people’s lives, yet few mental health
professionals receive any instruction about sex other than learning how to
report suspected abuse. As a result, we aren’t always comfortable talking
about sex and sexual pleasure with our patients. While reading this book
won’t turn us into Kinseys or Masters and Johnsons, it will help us to relax
more and to listen better. And that, in itself, is an important accomplishment
regardless of how much or how little familiarity we have with sex education
and sex research.

vii
viii  foreword

I have written a 1,200-page book on sex that is used in dozens of college

and medical school sex-education classes. I have also read countless studies
on sexual orientation, gender, pornography, paraphilias, sexual pain, low
sex drive, high sex drive, casual sex, pedophilia, and the physiology and
neurology of sexual response. Yet when I am with a patient or when a fellow
mental health professional is consulting with me about a patient’s sexual
issues, the most important thing I can do, besides being kind and caring, is
to listen without making judgments. This is not always easy when you are
raised in a culture with no shortage of shame-based messages about sex.
For example, consider our perceptions about women versus men when
it comes to casual sex. Few of us would haul out our DSM-5s when a male
informs us he has had 10 or 15 lifetime sexual partners. But if a woman has
had 10 or 15 partners, or 20 or more, many of us would assume she was
abused as a child, or she’s bipolar or borderline, or she’s a “sex addict.” And
what if she enjoys having threesomes, or she asks her partner to spank her
or to act out rape fantasies? What if she wants sex way more than her part-
ner does?
This book was written by a highly experienced and sensible mental health
professional who encourages readers to listen and think rather than to auto-
matically pathologize or apply assumptions about sexual behavior that are
50 years out of date. It reminds us that sexual behaviors that could reflect a
psychological struggle for one person might reflect psychological health for
another. One of our jobs is to evaluate which is which.
One of the biggest challenges we face in evaluating sexual behaviors is
how multifaced sex can be. Sexual feelings often begin as an erotic tension
somewhere within our psyche or soma. They are then sifted through the
labyrinth of our cognitive, cultural, and religious beliefs. When something
is going wrong sexually, there are multiple layers where the problem can
reside. I can’t imagine trying to help a patient sort through sexual issues
without knowing what Dr. Buehler explains in the pages that follow.
And finally, I want to caution you about the current state of sexual knowl-
edge and sexual research: Our knowledge of human sexuality remains
elementary. Researchers are still struggling to define what women’s sex-
ual orientation is and how it develops over the life span. Several of the top
researchers are questioning the validity of the state-of-the-art fMRI brain
studies about sexual behavior that the media loves to sensationalize and
therapists love to quote. And it’s difficult to know if studies about sex and
relationships apply to anyone besides the students in college psychology
courses who are getting extra credit for participating in them.
Fortunately, we have Dr. Stephanie Buehler’s very thoughtful, approach-
able, and well-written book to help us with this process.

Paul Joannides, PsyD

Author of Guide to Getting It On!, Seventh Edition
 Preface

A n endocrinologist with whom I once ran an integrated wellness ­center

encouraged me to become a sex therapist, explaining that many of her
patients request hormone testing because they had no sex drive. “But,” she
said, “It is hardly ever their hormones that need adjusting.” I already had a
background in treating people with chronic illness, and I understood right
away that sexual problems were, perhaps, the ultimate expression of mind/
body symptoms. But how, I wondered, did one become a sex therapist?
One thing I knew for certain, the 10 hours in human sexuality that I was
required to take to become a psychologist wasn’t anywhere near what I
needed to know to talk to our shared clients about sex. I hadn’t learned
much of anything in those 10 hours, except that there existed some mighty
peculiar old sex education films and that many therapists in the audience
were squeamish about sex. I wasn’t squeamish at all. I grew up in a liberal
household in Los Angeles during the sexual revolution. Nothing offended
me. But if I was going to truly hang out my shingle as treating sexual prob-
lems, I was in sore need of education and training.
Like many psychotherapists—who tend to be an introverted bunch—my
first stop was to do some background reading. I chose a book online and
as soon as it arrived I sat down to read, highlighter in hand. It wasn’t long
before I closed the book, my mind reeling. It wasn’t because there was any-
thing wrong with the writing itself. All of the contributing authors appeared
to know their topic well. However, I still had no sense of “This is how to do

ix
x  preface

sex therapy.” I felt rudderless, adrift in a sea of technical language, with bits
and pieces of various theories floating past like flotsam and jetsam.
Perhaps joining an appropriate organization might help me, I reasoned. I
joined the American Association of Educators, Counselors, and Therapists
and learned they had a certification process that included education and
supervision. I chose Stephen Braveman, MFT, as my supervisor, and through
his patient guidance and generous spirit (he sent me away with a duffle bag
of materials on human sexuality), I began the 2-year trek to learn all I could
to be an effective sex therapist.
Along the way, I received an entirely different education. First, colleagues
and other professionals questioned my choice to become a sex therapist.
Wouldn’t I be dealing with pedophiles and other pariahs? Second, some
confused me with a sexual surrogate, a type of person who operates under
the legal radar to teach people about their sexuality in a way that a pro-
fessional license prohibited, for example, touching clients or having them
examine bodies, both their own and that of the surrogate. Third, it struck
me again and again how ludicrous it was, with all my education, that none
of my college professors at the g ­ raduate level had ever really talked about
sex. Why didn’t I know anything about the connection between eating dis-
orders and sexual problems? How come I had never heard of painful sex
and what to do about it? Didn’t I need to know how to assess persons who
had been sexually abused about their current ability to function normally
in their adult relationships?
Additionally, I began to pay attention to what clients said when they
found my services. If they were referred by another therapist, it was often
because the therapists “didn’t ‘do’ sex.” If they had been in therapy but were
self-referred, it might be that they felt the therapist would be uncomfortable
if they brought up the topic. Others were in therapy for years, but since the
topic never came up, they never said anything. It was only when they real-
ized that all the time and money they were spending had zero effect on their
sexual pleasure that they searched for someone who would help them with
the “real” problem.
I held two feelings about this. On one hand, I was happy that I received
appropriate referrals. On the other, I was upset that other therapists added to
the client’s shame about sex. By refusing or neglecting to ask about the client’s
sex life, therapists reinforced the cultural message that “nice people don’t talk
about sex.” But if people (nice or not) can’t talk about sex in the therapist’s
office, where can they talk about it? Clearly something needed to change.
Back I went to thinking about my own evolution as a therapist. Information
about treating sexual problems, I knew, was difficult reading. Few of the
books take the therapist by the hand and lead them through the entire pro-
cess of assessment and treatment from the moment of the intake call through
termination. None of them deal with one of the most important issues of all:
the sexuality of the therapist. Unless the therapist is comfortable with sex,
  preface   xi

there would be no discussion of the topic in the ­therapy office. That fact
alerted me that if I were to write a book on how to do sex therapy, I needed
to start there, with helping the reader to make sense of what sexuality is
and how to understand one’s own development, experiences, thoughts,
­attitudes, and beliefs about sex.
In your hand or on your screen, you have the text I envisioned for every
therapist to have as a reference on his or her bookshelf. Whether you want to
embrace sex therapy as a niche for your practice, or you want to be a thera-
pist who “does” sex, my hope is that What Every Mental Health Professional
Needs to Know About Sex will be a clear, pragmatic entrance into helping
clients of all kinds resolve sexual concerns—a boat of sorts to help you navi-
gate what can be a confusing area of human experience. I also hope that it
will become a book you can turn to again and again when a client presents
with a sexual concern to remind yourself that there exists an approach and
information to calmly tackle common, and uncommon, sexual problems.
Human sexuality is perhaps one of the most complicated on the planet.
Shrouded in secrecy, regulated by religion and law, and assigned meanings
from original sin to the ultimate expression of sacred joy, sexuality can per-
plex even the wisest therapists. Sexuality is often a topic ignored in graduate
programs in psychology, marriage and family therapy, and social work. In
California where I practice, a psychologist is required to merely complete
12 hours (not course hours, hours) of instruction in sex therapy. This training
was disembodied, that is, it had no connection to the 4 to 5 years of course-
work learning about all other aspects of the human mind.
What Every Mental Health Professional Needs to Know About Sex is a straight-
forward, plain-language book designed to take the therapist who knows
very little or who might be uncomfortable about sex, to a place of knowledge
and competence. To accomplish this, Part I: The Courage to Treat Sexual
Problems begins in Chapter 1 with a rationale regarding the reasons why
all mental health professionals need to be able to address clients’ sexual con-
cerns, especially the fact that our current social climate has raised clients’
expectations about pleasure. In Chapter 2, the reader will find topics con-
cerning one’s own sexuality, including overcoming any associated shame
and guilt related to sexual behavior, improving attitudes toward sexual
pleasure, and embracing sexual diversity—not only the LGBTQ community,
but sexuality in those who are ill or aging, or who engage in alternative
sexual practices, for example, fetish behavior. Psychosexual development
and the physiology of sex are covered in Chapter 3, while Chapter 4 is an
examination of definitions of sexual health generated by various experts
and organizations.
Part II: Assessing and Treating Sexual Concerns begins with an introduc-
tion to the thorough assessment of sexual problems that relies on two models
and that forms a core part of the book. The first is Annon’s PLISSIT model,
described in detail in Chapter 5; the second is an ecosystemic framework for
xii  preface

understanding and solving a client’s symptoms across different contexts.

The PLISSIT model is ideal for a mental health professional at the early
stages of treating sexual problems, as it guides the professional in deciding
whether the presenting problem will benefit from psychoeducation and rec-
ommendations, or if more intensive, long-term therapy will be required. The
ecosystemic framework, based on the work of Bronfenbrenner (1977), is an
expansion of the biopsychosocial model as it includes interactions between
two systems, which in the case of sex therapy relates to the frequency that
couples present for treatment. A thorough sexual assessment is included,
to use when it is determined that the presenting problem will require more
intensive work.
The next two chapters cover women’s and then men’s common sexual
complaints as they pertain to the individual, their biological make-up,
development, relationship, and culture. Chapter 5 on women’s sexual prob-
lems covers sexual aversion, which occurs in both men and women. Chapter
6 includes delayed ejaculation, a problem once considered rare but is on the
upswing as some men desensitize their arousal levels by viewing pornog-
raphy, as well as the fact that people’s expectations of men as they age have
increased. Both chapters include informational worksheets for the client’s—
and therapist’s—benefit.
Addressing common sexual problems in couples explodes the myth that
by fixing the couple’s relationship, their sex life will ­automatically improve.
In fact, even couples that get along ­sometimes have s­ exual problems. As
the therapist will learn in Chapter 8, whether the ­relationship is blissful
or chaotic, most couples benefit from good s­ exual information; improved
communication about sex; encouragement to explore the boundaries of
their sexuality; and suggestions to help them. The most common problem
is a discrepancy in sexual desire, which requires the therapist’s problem-­
solving skills to help the couple to stop blaming one another and learn how
to derive solutions when the problem is sex.
Chapter 9 includes material I have not yet seen in any other book for ther-
apists on the topic of treating sexual complaints: helping parents address
their concerns about their children’s sexual development and answering
their children’s questions about sex. The chapter also provides a framework
as to when to refer to a specialist for evaluation of atypical sexual behavior
or development. The entirety of Chapter 10 is devoted to understanding the
needs of LGBTQ clients who may, ironically, have suffered because of their
parents’ lack of information about sexual orientation.
Good mental health is essential to good sexual health, while mental ill-
ness can contribute to sexual dysfunction. In turn, feelings of guilt, shame,
and sexual inadequacy can sometimes lead to mental health problems. In
2010, I wrote a ground-breaking book entitled Sex, Love, and Mental Illness:
A Couple’s Guide to Staying Connected in which I addressed the effects of
depression, anxiety, substance abuse, eating disorders, AD/HD, and other
 preface  xiii

disorders on the individual’s ability to function sexually and in a relation-

ship. Chapter 11 is a broad summary of this review of the literature, while
Chapter 12 provides an in-depth guide to understanding and treating sexual
problems in adults related to sexual abuse experienced as a child or teen.
Chapters 13 to 16 are related in that they each cover an aspect of sexuality
that is intimately tied to biology. Chapter 13 covers the effects of pelvic and
genital pain on sexuality in men and women, which affects large numbers of
people who sometimes have great difficulty finding appropriate treatment,
lending to their suffering. In Chapter 14, therapists will learn what happens
when recreation meets procreation, or how sexuality is affected by infertil-
ity. Sexuality can also be affected by all kinds of medical conditions, from
diabetes to spinal lesions and paralysis, which is the topic of Chapter 15. The
effects of aging on sexuality and relationships are the focus of Chapter 16.
Rounding up Part II, Chapters 17 and 18 explore what happens when
people traverse conventional or expected boundaries, with Chapter 17
­
focusing on sex and the Internet, and Chapter 18 on paraphilias, also known
as “alt sex” (as in “alternative”). Though sexual images have seemingly been
in existence since ancient cultures constructed phallic and other fertility-
related symbols, there has been an e­ xplosion in sexual imagery of all kinds
since the dawn of the Internet. The enormous availability and variety of
pornography has both helped (people can indulge in fantasy material in
private, such as looking at people having sex while wearing latex or furs)
and hurt in that viewing pornography may drain sexual energy away from
a primary relationship. Meanwhile, those who practice alt sex need all kinds
of care and support from therapists, from absolution from shame to helping
them accept and perhaps participate in their partner’s erotic life.
Part III: Ethics and Practice of Sex Therapy wraps up the book with
Chapter 19 on the ethical challenges of working with people who have
sexual concerns, including respecting boundaries regarding touch;
managing romantic or sexual transference and countertransference;
managing secrets in conjoint therapy; and considering special topics
such as treating people whose sexuality differs from one’s own and the
effects of the field of sexual medicine on sex therapy. Finally, Chapter 20
completes the book with a look forward toward the future of sex therapy
and the integration of sex therapy into one’s practice.
As with any book, there were some challenges presented. One challenge
was the unwieldy term “mental health professional” used in the book’s title.
Rather than shortening the term to “MHP,” which seemed impersonal, I
most frequently use the term “therapist” to refer to the variety of people
working in the helping profession. Both “mental health professional” and
“therapist” refer to psychiatrists, psychologists, psychiatric nurses, social
workers, marriage and family therapists, and professional counselors,
including those medical providers who discuss sexual problems with their
patients.
xiv  preface

Another challenge was the use of gendered pronouns. As much as pos-

sible, I have used the word “partner” rather than “man,” “woman,” “hus-
band,” “wife,” and so forth. Although gay, lesbian, bisexual, transgender,
and queer (those individuals who do not identify strictly as male or female,
or who question their orientation) roles and relationships are not strictly
analogous to traditional heterosexual experiences, I have drawn from my
clinical observation in classifying some components of all erotic relation-
ships as being universal. Sexual desire, arousal, and orgasm are not exclu-
sive to any group of people, and when two people hold one another as
special and dear, it is nearly always called love.
A third challenge is culture as it relates to sexuality. In some areas, as with
infertility, there exists a decent body of literature about the effect of culture
on sexual beliefs or behaviors. In others, such as paraphilias, almost noth-
ing has been written, although it can be assumed that an individual from a
conservative family and culture may have different feelings about having a
fetish than one from a more open and permissive culture. Fortunately, there
exists online a tremendous resource, The Continuum Complete International
Encyclopedia of Sexuality (Francoeur & Noonan, 2004), which any therapist
can access to learn about the sexual practices of over 50 cultures.
Lastly, my hope is that the reader will find What Every Mental Health
Professional Needs to Know About Sex to be a jumping off point for addressing
the sexual concerns of clients and not the definitive or final word on how
to do sex therapy. My own understanding of human sexuality continues to
evolve, as does the field as experts research the multiple biopsychosocial
factors that make us think and act as we do between the sheets. If I have
done my job, your own interest in sexuality will be piqued and you will con-
tinue to deepen your knowledge and ability to be a therapist who “does sex.”
 Acknowledgments

T his book would not be possible without the support of my family,

friends, and colleagues.
First, I’d like to thank my small but mighty family. To my wonderful
husband Mark, thank you for providing love and support, and those life-
preserving weekend beach walks. To my daughter Anneka, thank you for
sending humorous material from afar; a true demonstration of Buehler
affection. Also, thanks to Bodhi, my “therapy parrot,” for distracting me
with squawks and squeaks during long hours at the keyboard.
Thank you to my dear friend Jacqueline Richard, who supplied much-
needed cheerleading from the sidelines whenever my will to write flagged.
To my friends Barbara and Stuart Bloom, Piet and Judi Dwinger, and
Christauria Welland, I appreciate your encouraging words, hugs, and
humor. While I appreciate all my interns, I want to especially thank Liz
Dubé for her patience with me as I wrote this book.
Finally, I have an amazing network of colleagues who have inspired me
and enabled me to become the professional I am today. Stephen Braveman,
my sex therapy supervisor, I thank you for your i­ncredible generosity; I
carry your words of wisdom with me into the pages of this book. I also
have too many wonderful professional friends to thank to list them all
individually. Therefore, I want to express tremendous appreciation to
fellow members of the f­ ollowing o­ rganizations whom I consider friends

xv
xvi  acknowledgments

too numerous to count: American Association of Sexuality Educators,

Counselors, and Therapists; Society for Sex Therapy and Research;
International Society for the Study of Women’s Sexual Health; Society
for the Scientific Study of Sexuality; Orange County Psychological
Association; and California Psychological Association. Your ­knowledge
and support have been invaluable to me.
 I
The Courage to Treat
Sexual Problems
 1
Sexuality and the Mental
Health Profession

W hen I decided to become certified in sex therapy, my supervisor

Stephen Braveman early on stated, “In our culture, no one escapes
having some form of sexual damage.” Unfortunately, this statement also
describes the influence of culture on mental health professionals across
the lifespan. Consider how other systems, such as family, school, or peers,
influenced your own sexual development. Perhaps you experienced being
sexually harassed on the schoolyard or the workplace. You may be the one
in four women or one in six men who were molested as children and who
did not feel supported enough by parents or school to tell. You may have
engaged in sex when you didn’t want to—or you even coerced someone into
having sex with you—which changed your cognitive framework and your
approach to sex, even in safe relationships. Or perhaps you were educated
as a therapist in a setting influenced by the larger culture, where sexuality
was a marginalized topic of study.
With any luck, you grew up to be a sexually functioning adult capable
of emotional and physical intimacy with a partner of your choosing, but
there is a strong likelihood that you have had struggles with your sexual-
ity, as do surprisingly large numbers of men and women in the popula-
tion at large (Laumann, Paik, & Rosen, 1999). It is in regard to our sexuality
that we are perhaps most like our clients, kept in the dark about its nature

3
4   I: the courage to treat sexual problems

and discouraged from opening the door to understanding. Insight and

­knowledge into sexuality requires that therapists pay attention to their own
development, but our training reflects the reluctance of our culture as a
whole to “go there.” For most therapists, learning how to address sexual
topics requires specialized training that may be difficult to access, requiring
travel and other expense.
What happens to our clients if we, ourselves, don’t have or make the
opportunity to understand our own sexuality? Can we call ourselves com-
petent if we don’t assess or treat the entire spectrum of human experience,
including those that are baffling or taboo? As self-appointed healers of
mental health, I believe we must take responsibility to heal the whole per-
son, including the sexual part of the self. Otherwise, we may inadvertently
sustain or contribute to a client’s struggle with sexuality. Mental health and
medical professions have yet to fully recognize that sexual problems can
contribute to depression, anxiety, trauma, eating disorders, substance abuse,
pain disorders, and so on; conversely, such problems can affect a person’s
sexuality, yet remain unaddressed in the therapist’s office. Yet if we don’t
“do sex” as part of our practice, we may miss out on an essential part of
what is troubling our clients.
Consider Len, a client in his mid-60s who was so guilt ridden after his
first attempt at intercourse that he struggled with erectile dysfunction for all
the years that followed. Len became depressed after a divorce and sought
relief through therapy, medications, and, at times, alcohol. In all his years of
counseling, no one had asked him about his sex life—until he mentioned a
urology appointment. Concerned he might be ill, the therapist asked more
about the appointment. The question prompted Len to cry as he told her
about his impotence. Fortunately, the therapist soon realized this was a
long-standing, complex issue for Len and a referral was made for my help.
After months of treatment with Len and his partner, he was, at last, able to
resolve his sexual concerns.
But how different might Len’s life have been if someone had earlier
inquired, “How’s your sex life?” Len’s treatment was influenced by a ­culture
in which nonspecialized therapists lack training or comfort discussing sex-
ual topics. He also needed a therapist who could use a systemic approach to
understand why his struggle was so long-standing and intense, which had
to do with his development in an extremely restrictive family, church, and
community environment. The restrictive environment caused Len undue
shame about his sexual needs, which in turn caused him to lose his erection
in his first sexual encounter. Later in life, changes in Len’s biological system
made attaining any kind of erection almost impossible, adding further frus-
tration. Only when Len’s frustration was more painful than his secret could
he break out of his shell and reach out for help.
 1: sexuality and the mental health profession   5

Clients come to us to help them solve all kinds of problems, which may
include sexual concerns. The Laumann survey (Laumann, Paik & Rosen, 1999)
of male and female sexual problems—the largest of its kind—reported that
about 60% of women and 30% of men have had some type of sexual dysfunc-
tion. With numbers like these, it is safe to assume that a good portion of your
current clients have a sexual problem. If you do not ask, however, you may
never hear about these issues. But clients sometimes do tell me, as an identi-
fied sex therapist, some of the reasons why they left a former therapist who
didn’t talk about sex:

●● One woman found the courage to seek help for the fact that she was
still a virgin 7 years after her wedding night due to vaginismus (spasm
of the vagina that prevents penetration), but she could not bring her-
self to tell the therapist about her problem. Since the therapist never
asked about sex, the client got the message loud and clear: Sex is not
spoken here.
●● A couple trying to get past an affair that nearly destroyed their marriage
couldn’t bring themselves to tell their “uptight” therapist that they had
enjoyed swinging early in their relationship. The couple’s history added
to their confusion about boundaries and rules in the marriage, but their
weeks in therapy were useless because they feared the therapist would
judge them if they disclosed their early history.
●● Sam and Cynthia sought a therapist’s help for Cynthia, who believed
she had a low sex drive as a result of being molested as a child. Because
the couple had difficulty talking about sex, the therapist changed
the topic from sex to finances because, explained Sam, “the therapist
thought if we made more money, we’d be happier.” Two years later,
Cynthia still had a low sex drive; fortunately, the couple sought appro-
priate help.

No one, least of all our clients, wants to be judged as defective, naive, or

perverse. People want reassurance that they are essentially normal, or that
they can become more what they think normal is for them. When thera-
pists don’t talk about sex, they may convey a belief that the client is weird
for wondering about their own sexuality. Of course, some therapists do ask
about sex. In one survey, about half of therapists reported that they “always”
ask about sex (Miller & Byers, 2009). But people in general (including thera-
pists) over-report when it comes to sexuality, as they want to appear normal
or current. What about the other half of therapists? There is an adage that we
are always communicating, even if we say nothing. Therapists’ silence about
sex in the therapy room sends many messages, but perhaps the loudest is
please don’t talk about sex!
6   I: the courage to treat sexual problems

WHY THE SILENCE ABOUT SEXUALITY?

Almost everyone is raised in an atmosphere of secrecy when it comes to

emotional and psychological aspects of sex. The reasons are complex.
Depending on one’s religious perspective, a person’s very conception can
be shrouded with mystery. As we grow, we covertly observe romantic and
sexual behaviors between adults of which we are told little. We experience
our own biological urges, such as a desire to masturbate, but are given nei-
ther tacit nor explicit permission to ask questions. When we do ask, we may
not get an answer—or we may get a lecture on why some sexual topic is
naughty or dirty, something good girls and boys avoid. Although many
of today’s parents talk openly with their children about sex, there are still
households where sex is a forbidden topic. People still bar their children
from attending formal sex education classes in school, and people from
other countries, for example, Saudi Arabia, may not have been offered any
sex education opportunities at all.
Our physical and psychological sexual development takes place on
entirely different planes, and interactions between systems reflect this.
Secondary sexual characteristics signal to adults around us that we must be
protected from such risks as unwanted pregnancy or diease. Meanwhile, we
are left to privately grapple with sexual dreams and fantasies, curiosity, and
desire. Reflecting what is still often a Puritanical culture, we aren’t given
information about giving and receiving sexual pleasure. The complexities
of a sexual relationship are explained away with myths like, “All men are
interested in is sex,” or “Once you get married, your sex life will disappear.”
We certainly aren’t told how to manage feelings of sexual inadequacy, so
if a problem comes up like difficulty having an orgasm or getting an erec-
tion, we may keep it under wraps for decades. As a society, we also may act
as if sexual problems appear suddenly in adulthood. However, as I have
learned from my clients, teens (who on average in the United States begin
having intercourse at 15) have sexual problems that plague them, sometimes
leading to depression, eating disorders, alcoholism, and other mental ill-
ness. As therapists know all too well, secrecy and silence are associated with
feelings of shame and guilt that can contribute to overall poor mental health.
Nowhere, perhaps, is this truer than when it affects our sexual development.
It doesn’t help that sex does have a murky side. Subjects like sexual abuse,
assault, and rape tend to be hushed by the victim and, if they learn about
it, family members or friends. If the media gets hold of such a story, it is
sensationalized, which may cause victims to further retreat, away from
possible unwanted attention. Meanwhile, media attention on cases such as
Jerry Sandusky, the Penn State football coach convicted of molesting chil-
dren, do little to address underlying problems such as the need to educate
children at an early age about appropriate physical boundaries, the right to
say no to unwanted touch, and permission to tell if someone harms them.
 1: sexuality and the mental health profession   7

Our culture also has done a poor job of acknowledging that pedophiles and
people with other difficult sex and social problems do exist and frequently
deserve compassionate treatment (Cantor, 2012).
For teens and young adults, date rape is distressingly common on col-
lege campuses; many young women have shared with me that the reputed
response of campus security was so lukewarm that they made a decision
not to report. Yet, its effects can linger well into adulthood. Today’s young
adults are also the first to grow up in the digital age. Many have spent so
much time viewing Internet pornography that they neglected to develop the
social and sexual skills to have a real partner. How might things be differ-
ent if they were raised in a culture that acknowledged sexual needs, made it
easy to attain contraception, and talked openly about what it means to be in
a healthy sexual relationship?
Therapists are not immune to such sexual negativity. Pope and Feldman-
Summers (1992) report that about two-thirds of female and one-third of male
therapists responding to a survey regarding sexual abuse among therapists
had experienced molestation, the majority of incidents with a close relative.
It isn’t difficult to surmise that one reason therapists may avoid the topic of
sex may be that they have been victims of sexual abuse or exposed to other
types of negative sexual experiences, from mild harassment to outright
assault. Although therapists may be drawn to the field to help other victims
become survivors, they may be disappointed with how little attention their
graduate training gives to the sexual late effects of abuse.
The negative effects of such experiences may intensify what Saakvitne &
Pearlman (1996) called vicarious traumatization. Vicarious traumatization is
defined as “the therapist’s inner experience as a result of his or her empathic
engagement with and responsibility for a traumatized client.” Listening to
sexual material can be difficult for therapists if they have their own sexual
struggles. Like our clients, we may have trouble setting appropriate sexual
boundaries; struggle with questions about the morality of sexual practices
(anything from casual “hook-ups” to looking at—or even engaging in the
making of—hardcore pornography); be dealing with our own sexual inhibi-
tions; be worrying about a partner’s sexual function after cancer or other
illness; or simply have basic concerns about our own physical appearance
and sexual attractiveness. Discussing such matters may create such distress
for the therapist that they are simply avoided.
Another reason for many therapists’ silence about sex is the fear of becom-
ing isolated or being ostracized by colleagues. Not only do therapists fear
being judged by clients for expressing interest in their sex life, but also by
other therapists who find dealing with sexual problems too uncomfortable
or distasteful. For example, I recently lucked upon an opportunity to share
space in a pretty office with a psychoanalyst. My deposit was promptly
returned because, on reflection, the analyst decided that my sex therapy
practice was not a good fit for her office, presumably since she and her clients
8   I: the courage to treat sexual problems

might happen upon my (drooling?) clients in the waiting room. Working with
sexual problems can also feel unsafe in certain ­communities because of the
social and political climate. Where I live in Southern California, ­condoms
and lubricants are sold over the counter at the drugstore, but there are still
parts of the country where such items are difficult to procure. Designating
oneself as a sex therapist in such areas can mean opening one’s self up to
ridicule or harassment.
Therapists may also be quiet about sex due to strict training in laws and
ethics concerning sexual contact with clients, a topic covered in detail in
Chapter 19. Therapists are rightly warned that because there is an inherent
power differential in relationship with the client—who is dependent on us
for emotional support—the potential for doing serious emotional damage
by acting out sexual urges comes with enormous risk. Little is said, how-
ever, about reconciling the need to manage one’s sexual attraction or arousal
while discussing sex in a therapeutic manner with the client. In any case,
stern warnings about curbing one’s sexual feelings may send the message
that it’s best not to deal with sex in the treatment room.
A final reason for therapist reticence about sex concerns diversity. While
learning to tolerate cultural differences has been a priority in training pro-
grams, tolerance of a wide range of gender, orientation, and sexual behaviors
has not. In my area of California, for example, human sexuality credits for
marriage and family therapists have been cut to the minimum requirement in
several schools. If therapists are to properly address client sexuality, then they
must not only have appropriate training, but they also must become sexually
sensitive—a tall order for those raised in an American society that lags in
tolerance behind many developed countries, including neighboring Canada.
On the other hand, perhaps none of these concerns about being silent
about sex applies to you! You might be a therapist like my intern Liz Dube,
who, upon reading this chapter for a requested critique, quipped that the
only thing that held her back from talking to clients about sex was lack
of knowledge. Speaking for herself, she has had a long abiding passion to
help people have satisfying sex lives. If that describes you, then you’re in
luck, because this book will give you information that will help you fulfill a
desire to help clients with their sexual struggles.
Otherwise, consider that you are about to become at least one step ahead
of your clients as you learn more about sexuality. You won’t be a therapist
who “doesn’t ‘do’ sex.” You will be able to help clients overcome their deep-
est fears so that they can enjoy one of life’s pleasures without undue shame
or guilt. Increasing a client’s capacity to love and be loved often has a ripple
effect in the client’s life, giving them the optimism, confidence, and freedom
to tackle other developmental milestones such as finding a healthy relation-
ship or even making a much-feared job change. Our sexuality is such a core
part of who we are, and as therapists we are fortunate to be in a position to
help our clients achieve health in this critical area of human existence.
Another Random Scribd Document
with Unrelated Content
 “At the head of the table, where the Doctor presides, was
the leg of mutton, which, I believe, is every day’s head-dish. I
forget what Mrs Wilson dispensed, but it was something
savoury, of fish. I saw veal cutlets—with bacon, and a
companion dish, maccaroni—with gravy (a very delicate
concoction): potatoes, plain boiled, or mashed and browned;
spinach, and other green vegetables. Then followed rice
pudding, tapioca, or some other farinacious ditto, rhubarb
tarts, &c. So much for what I have heard of the miserable
diet of water patients. The cooking of all is perfection, and
something beyond, in Neddy’s opinion, for he eats fat!
“After dinner, the ladies did not immediately retire, but
made up groups for conversation, both in the dining and
withdrawing room. A most happy arrangement this, which
admits the refreshing influence of the society of ladies in such
a house.
“A drive had been proposed, and, by the invitation of two
of the ladies, I joined the party.
“Through picturesque lanes, we went to Madresfield
Court, the seat of Lord Beauchamp (Ned on the box.) We saw
the exquisite conservatories, the grapes in succession houses,
and pineries. The principal furniture in this house—carpets,
tapestry, &c.—were placed exactly as they now appear, more
than fifty years ago. It is a very romantic place, abounding in
a great variety of trees of magnificent growth.
“We returned soon after seven, when I prepared to take
my first Sitz bath. It is not disagreeable, but very odd, and
exhibits the patient in by no means an elegant or dignified
attitude.
“For this bath it is not necessary to undress, the coat only
being taken off, and the shirt gathered under the waistcoat,
which is buttoned upon it; and when seated in the water,
 which rises to the waist, a blanket is drawn round, and over
the shoulders.
“Having remained ten minutes in this condition (Ned and
I being on equal terms, and laughing at each other), we dried
and rubbed ourselves with coarse towels, and descended to
supper with excellent appetite.”

Shall we alter or modify our observations, in consequence of this

extract? Not pausing for a reply, we wish to explain, that, in
hydropathical nomenclature, to be “half-packed” is to be put to bed,
with a wet towel placed over you, extending from shoulders to
knees, and enveloped with all the blankets, and a down-bed, with a
counterpane to tuck all in, and make it air-tight. Here is complete
“packing.”

“May 15.—It was not the experience of the half packing

that caused me to awake early, but a certain dread in
anticipation of the whole wet sheet; and at six the bath
attendant appeared with what seemed a coil of linen cable,
and a gigantic can of water, and it was some comfort to
pretend not to be in the least degree apprehensive. I was
ordered out of bed, and all the clothes taken off. Two
blankets were then spread upon the mattress, and half over
the pillow, and the wet sheet unfolded and placed upon them.
“Having stretched my length upon it and lying on my
back, the man quickly and most adroitly folded it—first on one
side and then on the other, and closely round the neck, and
the same with the two blankets, by which time I was warm,
and sufficiently composed to ask how the sheet was prepared
of the proper degree of dampness. [I was told that being
soaked well, it is held by two persons—one at each end, and
pulled and twisted until water has ceased to drop; or that it
may be done by one person putting it round the pump-
handle, or any similar thing, and holding and twisting it at
both ends.] Two more doubled blankets were then put upon
me, and each in turn tucked most carefully round the neck,
and under me. Upon this the down bed was placed, and over
all another sheet or counterpane was secured at all sides and
under the chin, to complete this hermetical sealing. By this
time I was sure of being fast asleep in five minutes, and only
anxious to see Ned as comfortable, for he was regarding the
operation with silent horror. He, however, plucked up, and
before Bardon (the attendant) had swathed him completely,
favoured me with his opinion, conveyed in accents in which a
slight tremor might be detected, that ‘packing is jolly.’”
“What occurred during a full hour after this operation
neither man nor boy were in a situation to depose, beyond
the fact that the sound, sweet, soothing sleep which both
enjoyed, was a matter of surprise and delight, and that one
of them, who had the less excuse for being so very youthful,
was detected by Mr Bardon, who came to awake him, smiling,
like a great fool, at nothing, if not at the fancies which had
played about his slumbers. Of the heat in which I found
myself, I must remark, that it is as distinct from perspiration,
as from the parched and throbbing glow of fever. The pores
are open, and the warmth of the body is very soon
communicated to the wet sheet, until, as in this my first
experience of the luxury, a breathing—steaming heat is
engendered, which fills the whole of the wrappers, and is
plentifully shown in the smoking state which they exhibit as
they are removed: still it is not like a vapour bath. I can never
forget the calm, luxurious ease in which I awoke on this
morning, and looked forward with pleasure to the daily
repetition of what had been quoted to me, by the uninitiated,
with disgust and shuddering.
“The softness and delicacy of the skin under the
operation is very remarkable, and to the touch, clearly marks
the difference between a state of perspiration or of fever.”
 We wish to be informed what there is of novelty in all this
procedure? It is merely one way, out of many ways, of taking a bath.
The shepherds on our hills, long before the Water-Cure had local
habitation or name, were well aware, when their hard but faithful
service made the heather their bed, that by dipping their plaids in
the stream, and wringing them out, and then wrapping them round
their bodies, such heat was generated as they could not otherwise
procure. Then the alternation of hot bath and cold bath, followed by
dry-rubbing! The Russians and the Turks are comparatively beings of
yesterday. But what does a hydropathist undergo at Malvern, for
which Galen and Celsus had not laid down plain and ample
directions? There is no apparatus so intricate or so extensive—there
is nothing done by the hand or by machinery at a hydropathical
establishment, which is not anticipated at Pompeii, or was not
familiar to those eminent ancients whom we have named. The
economy of baths was brought to more exquisite and copious
perfection by the Romans than it has been since. Vice, luxury,
gluttony, fatigue, disease, caprice, indolence, extravagant wealth,
inordinate vanity, imperial pomp, were all occupied according to the
impulse or the necessity of the individual, or of cities and provinces,
to adorn with new contrivances, or to supply the defects of that
essential furniture to the comfort of the later Roman. The poets
teem with allusions to and descriptions of the expedients used in
ministering to their effeminacy in the baths. The medical writers
have considered and discussed the whole subject of baths and
bathing with a minuteness and a comprehensiveness which leave
nothing to be learned from hydropathy now-a-days. The Greeks
wanted only the enormous riches of Rome to be cited as of
tantamount authority. Galen differs from Celsus in arranging the
order according to which different baths should be taken; but the
interval between them may account for all changes. Did it ever occur
to Galen that water was a panacea? No; but many patients were
under his care, the counterparts of the sojourners at Malvern; and
that he treated them much after the fashion of Dr Wilson, we shall
accord to the later gentleman our belief. Rome, in the reign of
Commodus, was not less likely than London to send forth sufferers
whose roses would renew their bloom, and whose nerves would
regain their tension, at the bidding of rustic breezes, lively chat, and
methodical discipline.
It has seldom been our happiness to meet with a more astute
lady of her rank than the woman at the cottage at St Anne’s, who
replies to Mr Lane, when he wonders at his power to mount the
steep hills,—“Indeed, so do I, sir; but when I tell how the Water-
Cure patients get strength to come up here, after a few days, and
how well they look, some gentlefolks are hard enough to say the
Doctor pays me to say so.” We exonerate the woman and the Doctor.

“May 26.—Packed, bathed, and out as usual, but instantly

turned in again. It was raining after a fashion that, even to
me, seemed to promise no interval or alleviation.
“We turned into the dining room, and, pushing the seats
of the chairs under the table, we made a clear space for
walking round the room. Our dining-room is forty feet long;
and, after a minute’s discussion as to our intended route, it
was settled that we should go (by the watch) to the spring
beyond the Wyche. I opened the windows, and Ned arranged
water bottle and tumblers on the table, undertaking to
announce our arrival at the several springs. He had marked
the distances by the time occupied, and so we started, and
having walked from end to end of the room—and round the
table ten minutes, Ned called that we were at the Turnpike,
and we stopped to drink. We then passed on, doing all sorts
of small talk with a friend who had joined us, until we got to
the Wyche and to the Willow Spring; then we drank again,
and just having started, we met, at the turn of the road, Mr
Townley; who came suddenly upon us, and joined our party
cheerfully. There were frequent over-takings of each other,
and at the corners of the paths we contended for the sharp
angles, and carried out the rules of the road by passing on
the proper side.
 “Mr Townley walked as well as the best of us, and was a
delightful walking companion; full of anecdote, of solid
information, and a quiet dry humour all his own; but we could
not inoculate him with a love for Malvern. Enumerating the
varied attractions of the place, I unluckily wound up with the
charming drives; when he admitted that it is ‘a delightful
place to get away from.’”

A rebel in the camp! What is to come next? Why, a revelation

that the Water-Cure system at Malvern is so old that the memory of
man runneth not to the contrary.

“May 27.—Packed, bathed, and out as usual. Surely the

variable nature of our climate is a source of constant, never-
failing interest. Here is a glorious morning, following a day
that seemed to give no hope of a change. Walked with
Sterling and Ned to the Holy Well at Malvern Wells, then
mounting the hills to the Beacon.
“The work published by Dr Card tells of extraordinary
cures effected by the water of the Holy Well. The monks of
old used to wrap in cloths steeped in this water, persons
afflicted with leprosy or other eruptions; and (as the Guide
quotes) ‘make them lie in bed, and even sleep, with the wet
cloths on the diseased parts.’
“Why, here was an instinctive use of the ‘Wet Sheet
Packing’ of very ancient date; but not (as the monks perhaps
deemed) miraculous.”

The monks have unexpectedly got Mr Lane into a scrape. Their

treatment of their patients is in all respects the same as the
hydropathic treatment. But what is science in hydropathy is instinct
in the priesthood. It is the most singular instance of instinct ever
recorded. A controversy has long raged as to the precise
approximation of animal instinct to human reason. The line of
demarcation between the instinct of the monk and the reason of the
hydropathic doctor is so faint and slender that nobody, except a
“packed” Malvern jury, with Mr Lane as foreman, could be audacious
enough to hint its existence. So the worthy and intelligent monks not
only knew how to select a charming residence, but practised the
Water-Cure several hundred years ago! What becomes of the apt
comparison between the “common fate of new revelations,” as
illustrated in the hostility of doctors which nearly ruined the great
Harvey, and the disbelief of sensible people in the virtue of
hydropathy? Hydropathy, in our view of it, is nothing new; but when
it is demonstrated that at Malvern itself it existed in former ages, its
want of success cannot with consistency be attributed to its novelty.
The originality of the system, altogether, is on a par with the
following branch of it:—

May 31.—“At five o’clock in walked the executioner, who

was to initiate me into the SWEATING process. There was
nothing awful in the commencement. Two dry blankets were
spread upon the mattress, and I was enveloped in them, as in
the wet sheet, being well and closely tucked in round the
neck, and the head raised on two pillows; then came my old
friend, the down bed, and a counterpane, as before. I need
not sketch this, as it is precisely like the wet sheet packing in
appearance.
“Not so in luxury. At first I felt very comfortable, but in
ten minutes the irritation of the blanket was disagreeable,
and endurance was my only resource—thought upon other
subjects out of the question. In half an hour, I wondered
when it would begin to act. At six, in came Bardon, to give
me water to drink. Another hour—and I was getting into a
state. I had for ten minutes followed Bardon’s directions, by
slightly moving my hands and legs, and the profuse
perspiration was a relief; besides, I knew that I should be
soon fit to be bathed, and what a tenfold treat! He gave me
more water, and then it broke out! In a quarter of an hour
more he returned, and I stepped, in that condition, into the
 cold bath, Bardon using more water on my head and
shoulders than usual—more rubbing and sponging, and
afterwards more vigorous dry rubbing. I was more than pink,
and hastened to get out, and compare notes with Sterling.
We went to the Wyche. This process is very startling. The
drinking water is to keep quiet the action of the heart. To
plunge into cold water after exercise has induced perspiration
might be fatal, but this quiescent, passive state, involves no
danger of any kind.”

To recur to the Roman bath is superfluous. The curious will find

in Celsus all they have read in these extracts, and much more than is
“dream’d of in your hydropathy, Horatio.” The ingenuous narrative of
Mr Lane is useful. The preposterous pretensions of the Water-Cure
are visible and palpable. There may be no harm in Malvern, so long
as the patients with whom Mr Lane makes us acquainted resort to it;
although, conscientiously, we coincide with Mr Townley in his opinion
that it must be “a delightful place to get away from.” We do not at
all impugn Dr Wilson’s medical skill, and we heartily admire his tact.
There are numbers of people who, resisting and infringing the orders
of their medical advisers at home, blindly obey the behests of the
physician at a watering-place. There are many, also, blasés and out
of sorts with the racket, the whirl, and the glare of London life—or of
what is worse, a provincial burlesque of London life—to whom the
gentle influences of the balmy country air waft back the health
which their riot had almost frightened from its frail tenement. These
people visit such places as Malvern, do what they are commanded to
do, spend their hours in rational enjoyment, and go home—converts
to the Water-Cure. It is not very just, but it is very common.
And now let us state distinctly what we would really consider,
and gladly dignify, as “The Water-Cure.” For although unable to
recognise in water an universal and infallible panacea for all the ills
that flesh is heir to, we can yet bear a large testimony in its favour,
and send it out to service with the highest character. It is our
deliberate and mature conviction that the inhabitants of the
Cumbraes and the adjacent islands of Great Britain and Ireland may,
to their own infinite advantage, fishify their flesh a great deal more
than they do at present. Our language does not embrace the full
scope of our recommendation; because the minnow and the whale,
along with all the intermediate gradations of the finny family, may
probably disclaim the reputation of water-drinkers. Internally and
externally, according to the rational views which we are about to
explain, we advocate the application of the pellucid fountain and the
crystal stream. This is to touch, we are quite aware, some of the
most important questions which can engage the attention of the
philanthropy and of the legislature of this country. It is to do so; and
we hope to evince in our remarks at once the fearlessness and the
moderation which become the honest and the practical investigation
of matters affecting the moral and the physical welfare of thousands
of human beings.
In lauding water as a beverage, it is impossible to evade an
expression of opinion regarding the great movement which is
represented and embodied in the existence and diffusion of
temperance societies over the length and breadth of the land.
Whatever words can be selected of most emphatic significance, we
are willing to adopt in general approbation of that movement. We
single out here no individuals for encomium, and refuse to decorate
with a preference any particular fraternity or society. Taking, as our
limits necessarily oblige us to take, a broad survey of the principle,
and the results of the principle disclosed by experience, we
cheerfully pronounce both to be positively and undeniably good.
Observe, we say temperance. Total abstinence is a different thing
altogether—an extreme which may warrant and cover abuses as bad
as drunkenness itself. No spectacle is more ludicrous than a
procession of Tee-totallers. If total abstinence is a virtue hard to win,
and accessible only to an inconsiderable minority, the pharisaical
ostentation of its vain-glory is not calculated to attract or conciliate
the overwhelming majority who feel unable to soar to its sublimity.
If, on the other hand, total abstinence is a virtue of such easy
acquisition as to imply no sacrifice either in grasping or holding it,
surely banners need not wave, nor bagpipes grunt, to celebrate such
humble and ordinary merits. The Stoics, in declaring pain to be no
evil, unconsciously proclaimed that there was no fortitude in
suffering. The citizens of Edinburgh who live guiltless of larceny do
not perambulate the streets once a-year in holiday attire to the
cadence of martial music, for the purpose of being pointed out to
the marvelling on-looker as men who never picked a pocket or broke
into a larder. Total abstinence is not an end which common sense
acknowledges to be attainable. In peculiar circumstances it may be
that a sagacious and strong mind, determined to rescue masses of
his countrymen from a degrading and destructive bondage, may
begin by tearing them violently and completely asunder from their
former pernicious habits. His ultimate hopes, however, do not rest
on the permanency of this revulsion, but on the foundation which
even its temporary supremacy enables him to plant in the
understanding and in the heart, for finally establishing better
inclinations, wiser purposes, a detestation of excess, and a love of
moderation. National temperance will be the triumphant realisation
of his aspirations; and as we believe national temperance to be
practicable, so we believe it to be desirable, on the lowest and most
selfish, as well as on the loftiest and purest grounds. As politicians,
we are satisfied that the temperance of the people is an auxiliary in
securing, assisting, and facilitating good government, little inferior to
many of those invaluable institutions for which Britons are ready to
shed their life-blood. The national tranquillity, energy, industry, and
affluence, ought to be the aggregate of the contentment, enterprise,
diligence, and wealth of each individual. Any thing, therefore, which
will convince a man that sobriety makes a happier fireside than
heretofore, gives to him at all hours of the day a cooler head and a
steadier hand than he used to have, and leaves at sunset a shilling
in the purse which he could never find there during the reckless
season of his dissipation, is not merely a direct benefit to the
individual, but a substantive addition to the resources and strength
of the community. We wish to preach no ascetic doctrines, nor to
curtail the enjoyment of life of any the least of its fair proportions.
Over-fasting and over-feasting are alike repugnant to our ideas.
What we delight to see is, that hundreds and tens of hundreds,
voluntarily turning off from a road which leads invariably to misery,
poverty, and crime, are now treading a more salubrious path, where,
as they proceed, an unreproving conscience and domestic happiness
must cheer them with their blessings, and, in all probability, worldly
prosperity will reward them with its comforts. The first part, then, of
our “Water-Cure” is temperance—by which we do not mean either
that water is the only fluid which mortals shall imbibe, or that water,
even if so exclusively imbibed, is the elixir of life. We mean a general
recognition in the conduct of life, that while intemperance is
senseless, brutish, dangerous, and guilty, temperance on the
contrary—without stinting enjoyment, or balking mirth, or fettering
the freest exhilaration of his nature—secures to man at all times,
whether of relaxation or of toil, the healthful development of his
faculties, and would, in this our own country, prodigious as its
industry is, and magnificent as its achievements have been, redeem
a quantity of time and means wasted, which, rightly employed and
exerted, might elevate the social security and harmony, the political
and commercial ascendancy, the public and the private affluence, of
the British empire above the visionary splendours of an Utopian
commonwealth. Thus far we
“Fetch our precepts from the Cynick tub,”

without fear of being accused of

“Praising the lean and sallow Abstinence.”

The external application of our “Water-Cure” sends us plump

over head and ears into as many fathoms as you please. In the
middle of the multitudinous sea, or under the even-down deluge of a
shower-bath, we are equally at home and at ease. No misgivings of
any kind restrict our exhortation to wash and to bathe. Medical
advice is so precious a thing that we are anxious to enhance its
value by its rarity. Nothing will effect this purpose so certainly as the
habitude of constant and sensitive cleanliness among rich and poor,
young and old. What ought to be the cheapest, and what is the
most thorough instrument of cleanliness, is an abundance, an
overflowing superabundance, of water. Before judging our
neighbours, we may begin by looking into matters at home. Is it
possible that the metropolis of Scotland, at any season of any year,
shall be in such a condition from want of water as to exclaim in its
agony,
“Oh, my offence is rank!—it smells to heaven?”

Is it possible that during certain summer months, in more than one

year, of which the recollection does not dry up so readily as the city-
reservoir, water could with difficulty be procured here for love or
money? And is this the place, where the ordinary supply fails
sometimes to meet the ordinary demand, in which it was gravely
and enthusiastically proposed to erect spacious baths for the
working classes? It is infinitely discreditable that such occurrences
should have ever distressed us; but, looking forward both to what
the people themselves are attempting, and to what the government
intends to do, the necessity is apparent for an immense and
immediate alteration and improvement in the supply of water to all
large and densely-populated towns. The squabbles of companies
cannot be permitted to banish health and breed fever. Extensive
sanatory measures introduced into a city of which the water-pipes
might be dry during the dog-days, would be a repetition of the
monkey’s exhibition of the beauties of the magic-lantern, forgetting
to light the lamp. The husky voice of the public, adust with thirst,
shall not be wholly inaudible. The procrastinations of juntos cannot
much longer be accumulated with the vicissitudes of the
atmosphere.
When the scheme for the erection of baths for the working
classes was first promulgated here, we individually subscribed our
pittance, and predicted its failure—and for this reason: The plan
could not stand by itself. To make a labourer, at the end of the day’s
or the week’s work, as clean and fresh as soap and hot-water, with
all appliances and means to boot, could make him, and send him to
encounter in his own dwelling and vicinity the filth and the odours of
a pig-stye, was not a very feasible proposition. But personal
purification would induce household tidiness. It might do so, if
ventilation and drainage and space were all at his command, and
within his regulation. If they were not, in what a hopeless contest he
engaged! Invisible demons, on whose invulnerable crests all his
blows fell harmlessly, whose subtlety no precaution on his part could
exclude, and to whose potency his own lustrations only made his
senses more acute, would speedily quench his new-born ardour, and
probably seduce him back to the persuasion, that for one in his
position the truth lay in the proverb—“The clartier the cosier.” We
must also give him the benefit of those data which political
economists never refuse to any body—a prolific wife and numerous
progeny. A clean house of one room, open to the incursions and
excursions of seven or eight children, whose playground is the
Cowgate, or, let it be the shores—that is, the common sewers—of
the Water of Leith, is a tolerably desperate speculation. Thither,
however, our operative, radiant from his abstersion, is doomed to
repair, that he may be affronted by the muddy embraces of his
infants, and oppressed by the fragrance of his home. The project of
the baths, simply as such, although excellent in its spirit, and true in
its tendency, could not, we repeat our belief, have been productive,
as an isolated effort, of material or ending benefit. Much must go
hand in hand, and step by step, with it. Ventilation and drainage,
and more ample elbow-room, are indispensible to carry us forward
successfully in the momentous progress on which we are, earnestly,
we hope, entering towards the amelioration of the people. Nor shall
we hesitate to affirm, that no system of education can be
satisfactory or complete, which shall not at least endeavour to
provide some means for extricating the offspring of the lower classes
in their tender years, when the superintendence of father or mother
is almost an impossibility for a great portion of the day, out of the
causeway and the dunghill, and if not absolutely to put them in the
way of good, at all events effectually to keep them out of the way of
harm.
 Then it is that we shall clamour for water with indomitable
pertinacity. We shall demand it every where—in private houses, in
public baths, and in fountains in our streets and squares. There can
be no excuse for withholding it. Nature has not been niggardly in her
distribution among the neighbouring hills of this simple and
invaluable gift. When sums of money which stagger the most gaping
credulity are revealed so near our thresholds, and demonstrated to
be so readily available for useful purposes, it is neither
presumptuous nor irrational to expect that a few driblets from the
still swelling hoard may be dedicated to operations which, in
combination with other extraordinary conceptions and performances,
may crown the present century as more wonderful than any age, or
all the ages, which it has succeeded. Great Britain, within a little
span of time, has launched into an ocean of hazardous experiments.
The voyage is more perilous, we think, than many anticipate; but if it
be otherwise, and our forebodings are dissipated by steady sunshine
and fine weather; if a new commercial policy shall furnish more
sustenance than we require, without any detriment to native
industry; if a grand system of education is destined to fortify public
intelligence, without weakening public virtue; and if the physical
condition of all ranks shall be ultimately so comfortable as to enable
them to enjoy their good dinners and their good books, let us hope
to hear, with our own ears, the people with one acclaim cry out
—“We are well-fed, well-educated,” and “Our hands are clean!”

Edinburgh: Printed by Ballantyne and Hughes, Paul’s Work.

 Transcriber’s Notes
Inconsistencies in punctuation and hyphenation, and
possible spelling errors, were not changed by Transcriber.
Simple typographical errors were corrected;
unbalanced quotation marks were remedied when the
change was obvious, and otherwise left unbalanced.
Ambiguous end-of-line hyphens were retained.
Article sources, originally printed at the bottom of
the first page of the article, have been repositioned
directly below the title of the article and enclosed in
square brackets.
Page 369: “bauld bauld” was printed that way. One
other duplicated word (“with” on page 385) was
removed by Transcriber.
 *** END OF THE PROJECT GUTENBERG EBOOK BLACKWOOD'S
EDINBURGH MAGAZINE, VOLUME 60, NUMBER 371, SEPTEMBER
1846 ***

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