Anthropological reports document exaggerated emphases on sexuality in certain societies, primarily in Polynesia, Melanesia, and native South America. “Sex, in the modern Marquesas, is something of a national sport,” is one such statement (Suggs). Another ethnographer reports that Marquesans of both sexes name parts of the body, “honorably” naming the genitals (Linton). Marquesans have sacred songs with erotic lyrics believed to stimulate the sexual passions of the gods, thus promoting fertility (Suggs). On the Polynesian island of Mangaia it is said that “copulation is a principal concern of Mangaians of either sex” (Marshall). Adolescent boys will “race” with each other in a contest to see which age-mate can copulate with the most women, providing the most sexual pleasure for the females (Marshall). Inquisitive about the local Catholic priest, the islanders asked, “Are his privates sewn up?” Similarly, Mead reports that the concept of celibacy is “absolutely meaningless” to Samoans. Closer to home Dougherty finds that among rural black southerners, “sexual feelings are human nature and cannot be totally controlled”.
At the other end of the ethnographic spectrum one finds communities like Inis Beag (Messenger), an island of the Irish Gaeltacht. Messenger was amazed at the minimal attention to and knowledge about sexual matters: “Lack of sexual knowledge and misconceptions about sex among adults combine to brand Inis Beag as one of the most sexually naive of the world’s societies”. When Messenger asked one woman to compare the sexual proclivities of Inis Beag men and women, she responded, “Men can wait a long time for ‘it,’ but we can wait a lot longer”.
The extreme cases of Polynesian islanders and Irish peasants are difficult to explain. In an exceptionally provocative paper in this regard, Heider argues that the level of sexual energy is culturally determined, not innately fixed as the Freudians have it. The Dani of New Guinea invest an extraordinarily low amount of energy in sexual pursuits. In fact, Heider finds that the Dani do not invest much energy in anything. They engage in intercourse just frequently enough to maintain the population.
Coincident with this low interest in sexuality, Heider finds low intellectuality, impoverished art, and low levels of affect, for example, in their casual attitude towards death. Heider finds five lines of evidence:
1. Sexual abstinence four to six years postpartum. The Dani told Heider that parents should refrain from sex from the time of birth to the time the child is five years old (approximately, since the Dani do not reckon time in years). Whatever the actual period is, it contrasts notably with the period reported for couples in other societies, such as Tahitian parents who continue intercourse until two or three weeks before birth and commence again one or two months after birth (Levy).
2. The period of postpartum sexual abstinence is invariably observed. The Dani assert this (and Heider believes them) and furthermore, no Dani full siblings are less than five years apart in age.
3. The norm of long postpartum sexual abstinence is neither supported by powerful explanation nor enforced by strong sanctions. Heider understands the sanction as a somewhat casual, pro forma sanction. They do not abstain from sex for fear of death, ghosts, or any other moral imperative. Rather, sexual abstinence is easy; it is not an issue.
4. Most people have no other sexual outlets. Although one Dani man apparently had nine wives, only a minority had more than one (43 of 148 total males had more than one wife). Heider rejects the possibility of two wives bearing children for the same man within a few years of each other; wives tend to live in separate compounds, and men are likely to stay in the compound with the new infant for the first year or so of its life, effectively restrained from sexual visitations with other wives. Heider eliminates other possible sexual outlets for men: coitus interruptus with a wife, extramarital sexual intercourse, masturbation, homosexuality, and bestiality. According to Heider, none of these is practiced by Dani men, although they are not specifically prohibited by the regulations of postpartum sexual abstinence.
5. No one shows any signs of unhappiness or stress during the period of abstinence. Heider tried to get Dani men to talk about how they felt about celibacy. None of them reported much of a problem, and Heider could detect no anxiety or discomfort.
Considering all the data, Heider argues that Dani culture is in a steady state, lacking climax or motion, and is in a low-energy field. He contrasts it with the Balinese reported by Bateson, also in a steady state, this a high-energy one.
Heider found two possible causes for the low energy level of Dani cultural forms, including sexuality. One is ecological: Dani receive low stimulation from the environment (the Dani are rather isolated socially). The other is developmental: the infants are reared in low stress conditions. Recently Pontius has suggested a third hypothesis, this one medical. Dani subfertility, a subject Heider did not explore, may be caused by a combination of two factors: (1) tight scrotal strings which may rupture the epididymal ductus, and (2) a low protein diet.
The Ik are another group with a reportedly low interest in sexual activity. This small hunting group in East Africa is on the verge of starvation (Turnbull). In documenting the social decay of the Ik, Turnbull reports that although these “loveless people” do in fact engage in intercourse (which implies at least a degree of mutuality and cooperation), they do so somewhat as an extension of masturbatory practice, consistent with the Icean emphasis on “excessive individualism,” rather than as an interpersonal event. Turnbull suggests that sexual activity can occur without involvement; it does not need much cooperation nor much affection. Such is the sad case of the Ik, who apparently can engage in sexual intercourse without violating the “cardinal Icean maxim, which is not to love anyone”. Certainly the Ik orientation to sexual intercourse is radically divergent and lacks the considerations found in other societies, such as the Mangaian (Polynesian), in which men attempt “orgasmic timing” with their partners, having received explicit instruction in this regard (Marshall) In matters of Mangaian sexual performance it is believed that, “the man who only goes a short time does not love his wife” (Marshall).
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Anthropology has shared with the other social sciences a Victorian reticence to include investigation of sexual behavior among its interests in diverse cultural groups. Little more than a decade ago, an analysis (Marshall) of ten leading anthropology textbooks concluded that sexual behavior was accorded neither space nor attention in the basic formulations of anthropological knowledge. This lack of attention in the profession did not come from lack of either interest or knowledge; indeed, Suggs and Marshall noted that researchers might be interested in and know quite a bit about the sexual behavior of “their people,” without ever including such information in their scholarly books and articles. Scientists who violated the taboo on writing about sex risked their reputation, or at least the onus of being thought too interested in “pornography,” or too ready to violate the privacy of their subject groups. Stimulated by the work of Masters and Johnson, however, papers and monographs have begun to appear, and there is now a knowledge base sufficient to inform us of the diversity of sexual practices among earth’s people.
Patterns of sexual behavior among people do not arise independently or quixotically in some random fashion. Rather, they are part of society and culture, and reflect patterns of sex roles, beliefs about men and women, religious beliefs, notions of modesty and socialization practices, population and ecological factors, and other characteristics of a particular group. As Rostand said, in the joining of two human bodies, all society is the third presence.
An example of the interrelationship between sexual and nonsexual phenomena is an analysis by Friedl of sex roles in foraging and horticultural societies. She suggests that the universality of a degree of male dominance is the male monopoly on hunting game and their power to distribute it. If male hunting is minimal, and both sexes collect the plants which comprise most of the diet, women’s status is more equal to that of men. Women have the lowest status in groups whose main food is big game hunted entirely by the men. The importance of variations in patterns of male dominance is especially noted in marital sex relations. If woman has a more equal status, because of her role in providing a large share of the food, she has considerable autonomy in sexual matters. She may initiate sex and expect satisfaction. She may divorce, and her adultery is not more serious than is the husband’s. If her status is very low, the male being sole provider of all food, she may have no control over sexual relations in or out of marriage. Among the Eskimo, for example, who subsist on big game or sea mammals hunted by men only, the sexual services of women are considered a commodity that men can take at will, or give or exchange to another man. Pubertal girls are fair game for any man, and wives are freely exchanged among men who wish to make alliances with one another or to repay favors (Friedl).
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Sometimes, lack of knowledge can lead to years of anxiety. Frank remembers some difficult times: “I had an operation on my testicles when I was about 6 years old,” says this insurance company vice president. He lowers his voice and continues:
“My testicles were filling up with fluid. The thing I didn’t know for years was that they didn’t operate on my penis. I thought my penis was shaped funny because of the surgery. I thought they cut my penis. When I saw other guys in high school gym class I knew my penis was okay, that the ‘seam’ on the backside of the penis was normal, not the line where they cut me. But thinking I had a scar, that I had been cut, that I was sort of lopsided, that caused me a lot of anxiety for a long time.”
Frank didn’t have a brother in whom he could confide or compare his penis to see if his was normal. So he never told anyone of his fears. Sex education was not a big part of his home life. “Once my dad brought home a book—he got it from the doctor, I think. Anyway it was very technical and anatomical. I was supposed to read it and then meet with him later in the day if I had any questions.” He stops, and almost snorts the next sentence. “I didn’t have any questions. My dad seemed very embarrassed—more so even than me.”
Frank, married for 15 years to a woman who is a social worker, believes that he’s learned to be more open about sex, and it’s an easier topic for him than it used to be. “But,” he says, “I still wouldn’t initiate such a conversation.”
*7\184\8*
The toenails are considered in this chapter on skin care because nails and skin are intimately connected. The toenails of some older people tend to become thickened and difficult to cut. Sometimes they become misshapen and irritate the toes or makes it difficult to fit shoes properly.
You may be able to care for your own nails. If you suffer from diseases of the circulation or diabetes mellitus, proper toenail care is crucial. Avoid injuries to your feet from the nails. Cut the nails with a special toenail clipper straight across, even though this may be difficult if they are thick and misshapen. It is usually easier to cut the nails after you have bathed because then the nails have softened a bit. If you have any toenail problems, consult a podiatrist or chiropodist for advice.
*263\166\2*
Many blood malignancies progress very slowly in older people. The common malignancies are chronic leukemia and multiple myeloma, both of which may first reveal themselves as anemia. These two diseases are discussed in detail in chapter 14. Treatment can usually be accomplished successfully with drugs and occasionally with radiation therapy. Proper treatment can bring you a satisfactory level of well-being and activity and keep you going for a long time.
An 88-year-old man I knew had had chronic leukemia for about twenty-five years. He was active and productive all this time and visited his physician periodically for examinations. In his later years he occasionally required a small degree of chemotherapy to keep his leukemia under control. At 88, he developed pain in his spleen, which had become enlarged because of the leukemia. Radiation therapy to his spleen improved his symptoms, but some months later, his leukemia began to progress rapidly, and his family came from out of town to prepare for his last days.
His condition was evaluated by a hematologist (blood specialist), who recommended a new course of chemotherapy. Beyond anyone’s expectations, the man’s white blood cell count returned to normal, his anemia improved, and he felt well again. Although only a few months have passed since his treatment began, he continues to feel well and en joy life. His family returned to their homes, and even though everyone is aware of the likelihood of a relapse, he has managed thus far to improve with treatment.
*252\166\2*
The adrenal glands produce the hormone cortisone, which controls the amount of fluid and salt in the body and helps the body respond to stress. The correct amount of cortisone is important for your well-being. Some illnesses affecting older people can lead to a decrease in the spontaneous production of cortisone. However, most cases of insufficient natural cortisone occur because a cortisone medication has been prescribed for an illness such as asthma, arthritis, or certain skin conditions, which suppresses the body’s production of cortisone.
Some people spontaneously produce excess amounts of cortisone, which leads to Cushing’s disease. The cortisone accumulates and adversely affects many parts of the body. This is due to tumors of the adrenal gland or excessive stimulation of the adrenal glands by pituitary gland hormones. You may become overweight and develop high blood pressure or diabetes mellitus. Your bones may weaken and be prone to fractures, and your skin may develop small hemorrhages under the surface at the slightest touch. You may begin to feel generally weak and ill.
The diagnosis of Cushing’s disease is made by special blood tests. Treatment may consist of surgical removal of one or both adrenal glands. In many cases radiation to the pituitary gland can be effective in halting the disease. The pituitary gland is located in the brain and manufactures the hormone ACTH, which stimulates the adrenal gland to produce cortisone. Radiation can sometimes stop the formation of excess amounts of ACTH, thus decreasing the amount of cortisone.
Too much cortisone medication can cause the same symptoms as Cushing’s disease or excessive adrenal hormone production. When cortisone treatment is required, as in rheumatoid arthritis or asthma, the pills sometimes can be taken every two days instead of every day to decrease some of the side effects. Your physician can monitor your treatment and check the effects.
Some illnesses cause the adrenal glands to stop working partially or completely. The adrenal glands can be affected by a tuberculosis infection or by a tumor. Or the glands may stop producing cortisone for no apparent reason.
If you lack cortisone, you will probably feel weak and have little energy. You may lose weight or be found to have low blood pressure. The color of your skin may darken even when you have not been in the sun. Nausea, loss of appetite, and frequent vomiting also can occur. This illness, known as Addison’s disease, progresses slowly, but it may become serious under stressful situations. If, for instance, you require surgery and an anesthetic, a lack of cortisone can lead to severe complications. Any physician or surgeon should be made aware that you suffer from Addison’s disease so that cortisone can be given before surgery.
If you are receiving cortisone pills or injections, or know that you have Addison’s disease, it is important for you to wear a Medic-Alert® bracelet that says you are receiving cortisone therapy. The main danger is that during a serious illness, infection, or surgery, your body may not be able to produce enough cortisone to meet the body’s requirements. Because your adrenal glands have shut off, you may go into shock because of the stress. In an emergency situation the physician will temporarily increase the amount of cortisone.
The diagnosis of Addison’s disease is made through blood tests, which will show whether the electrolytes are abnormal and whether the amount of cortisone is sufficient. Cortisone, usually given as pills, is the treatment for Addison’s disease, and it must be continued for life.
If you are receiving cortisone by injection or pills for illnesses such as asthma or rheumatoid arthritis, the adrenal glands may become underactive. In effect, they “think” that they have sufficient cortisone and therefore shut off their own production. If you stop taking the cortisone medication suddenly, the adrenal glands do not have enough time to produce their own supply to replace the lost cortisone. This leads to a drop in blood pressure, general weakness, and often nausea and vomiting. If left untreated, it can lead to shock just as in Addison’s disease.
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One of the most common problems affecting people of all ages is back pain. The fact that back disorders often affect relatively healthy and energetic young people suggests that with increasing age this condition will continue.
The lower back contains the segments of the vertebral column (backbone). Within it are nerves that come from the spinal cord. The nerves leave the spinal canal (the space in the vertebral column) through small outlets between the vertebrae and make their way to the lower part of the abdomen, pelvis, and legs. When the segments of the vertebral column become abnormal, the connecting joints may develop a type of arthritis. Because of this, there may be pressure, causing the nerves to become “pinched.”
In youth the vertebral segments are cushioned by discs, a flexible, resilient material called the nucleus pulpo-sus. With age the discs become relatively dry and less resilient. Subsequently, the distance between the vertebral segments decreases, and the mobility and flexibility of the spine diminishes.
The ligaments supporting the vertebral segments may also become weakened and stretched, leading to a combination of arthritic changes within the vertebral column and a narrowing of the spaces through which the nerves pass. A slipped disc, which protrudes and presses on nerves, and other mechanical derangements affecting the spaces between the vertebral bodies and its ligaments can all lead to low back pain.
Other, unusual causes of low back pain must be excluded before your physician assumes that your discomfort is the result of a mechanical imbalance of the vertebral column. Different kinds of tumors can affect bones, including those in the vertebrae, and, although rare, infections affecting the bones (osteomyelitis) can also occur. Paget’s disease, a metabolic process in which the bones recycle calcium at an excessive speed, can affect the backbone and lead to chronic back pain. Other bones, including the pelvis and skull, are frequently afflicted with Paget’s disease.
One common cause of abrupt, severe back pain is the BACK PAIN
One of the most common problems affecting people of all ages is back pain. The fact that back disorders often affect relatively healthy and energetic young people suggests that with increasing age this condition will continue.
The lower back contains the segments of the vertebral column (backbone). Within it are nerves that come from the spinal cord. The nerves leave the spinal canal (the space in the vertebral column) through small outlets between the vertebrae and make their way to the lower part of the abdomen, pelvis, and legs. When the segments of the vertebral column become abnormal, the connecting joints may develop a type of arthritis. Because of this, there may be pressure, causing the nerves to become “pinched.”
In youth the vertebral segments are cushioned by discs, a flexible, resilient material called the nucleus pulpo-sus. With age the discs become relatively dry and less resilient. Subsequently, the distance between the vertebral segments decreases, and the mobility and flexibility of the spine diminishes.
The ligaments supporting the vertebral segments may also become weakened and stretched, leading to a combination of arthritic changes within the vertebral column and a narrowing of the spaces through which the nerves pass. A slipped disc, which protrudes and presses on nerves, and other mechanical derangements affecting the spaces between the vertebral bodies and its ligaments can all lead to low back pain.
Other, unusual causes of low back pain must be excluded before your physician assumes that your discomfort is the result of a mechanical imbalance of the vertebral column. Different kinds of tumors can affect bones, including those in the vertebrae, and, although rare, infections affecting the bones (osteomyelitis) can also occur. Paget’s disease, a metabolic process in which the bones recycle calcium at an excessive speed, can affect the backbone and lead to chronic back pain. Other bones, including the pelvis and skull, are frequently afflicted with Paget’s disease.
One common cause of abrupt, severe back pain is the BACK PAIN
One of the most common problems affecting people of all ages is back pain. The fact that back disorders often affect relatively healthy and energetic young people suggests that with increasing age this condition will continue.
The lower back contains the segments of the vertebral column (backbone). Within it are nerves that come from the spinal cord. The nerves leave the spinal canal (the space in the vertebral column) through small outlets between the vertebrae and make their way to the lower part of the abdomen, pelvis, and legs. When the segments of the vertebral column become abnormal, the connecting joints may develop a type of arthritis. Because of this, there may be pressure, causing the nerves to become “pinched.”
In youth the vertebral segments are cushioned by discs, a flexible, resilient material called the nucleus pulpo-sus. With age the discs become relatively dry and less resilient. Subsequently, the distance between the vertebral segments decreases, and the mobility and flexibility of the spine diminishes.
The ligaments supporting the vertebral segments may also become weakened and stretched, leading to a combination of arthritic changes within the vertebral column and a narrowing of the spaces through which the nerves pass. A slipped disc, which protrudes and presses on nerves, and other mechanical derangements affecting the spaces between the vertebral bodies and its ligaments can all lead to low back pain.
Other, unusual causes of low back pain must be excluded before your physician assumes that your discomfort is the result of a mechanical imbalance of the vertebral column. Different kinds of tumors can affect bones, including those in the vertebrae, and, although rare, infections affecting the bones (osteomyelitis) can also occur. Paget’s disease, a metabolic process in which the bones recycle calcium at an excessive speed, can affect the backbone and lead to chronic back pain. Other bones, including the pelvis and skull, are frequently afflicted with Paget’s disease.
One common cause of abrupt, severe back pain is the sudden collapse (compression fracture) of one or more vertebrae. Possibly because of more dramatic changes in hormone balance that occur after the menopause, this is more common in women than in men. The pain of compression fracture can be severe but usually subsides within a few days or weeks. Treatment includes locally applied heat, bed rest for a few days, and mild pain relievers.
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Some common problems that can seriously affect your ability to be independent are the result of diseases of the ear. The ear performs two major functions: hearing and balance. The outer ear gathers sound and concentrates it through the ear canal until it reaches the ear drum, the beginning of the middle ear. The middle ear is responsible for transmitting the sound through a number of small bones to the inner ear. Within the inner ear is a mechanism that translates the sound waves into nerve impulses, which are sent to the brain for interpretation. The important balance apparatus is contained within the inner ear.
How Is Hearing Tested? Although you may notice that your hearing has deteriorated, often it is your family and friends who first become aware of it. If the problem has occurred suddenly, urgent medical attention is recommended. Usually the deterioration is gradual and often takes a long time before you recognize the degree of your disability.
To examine the cause of your hearing loss properly, an audiogram (hearing test) should be done. This will usually help determine the type of deafness and the most helpful treatment. A full ear examination is usually done in conjunction with the audiogram.
*219\166\2*
During the past few years it has been shown that the loss of intellectual abilities and memory experienced by some older individuals is due to Alzheimer’s disease. This disease was previously thought to be a rare and unusual disorder, but now, due to medical research and public awareness, Alzheimer’s disease is recognized as being more common and is better understood.
Unfortunately no known treatment can prevent the progress of the mental confusion and lapses of memory that are the symptoms of this neurological disturbance. Family members are often the first to recognize the problem and an individual afflicted with Alzheimer’s disease may not be aware of it. At times individuals may realize that their memory is seriously impaired and that help is necessary for certain normal activities.
How Is Alzheimer’s Disease Treated? Because a number of illnesses, some of which can be treated, seem to mimic Alzheimer’s disease, it is worth having a thorough evaluation by a physician who is knowledgeable in the field, before a diagnosis of Alzheimer’s disease is made. No special test proves that a person has this disorder, but investigations can be done to show that no other recognizable illness can account for the symptoms. Sometimes medications that may have been given for other problems can aggravate the symptoms of mental confusion and when these are stopped, the person may feel and function better. On occasion, a person with Alzheimer’s disease also develops depression, which may improve slightly when treated with antidepressant medications. Drugs such as Hydergine®, which are commonly prescribed, have never been shown conclusively to help maintain memory or intellectual function.
Although at present there is no cure for Alzheimer’s disease, many things can be done to help the families cope with their loved ones who are so afflicted. This includes counseling on how to deal with personality changes, abnormal behavior, and forgetfulness. Respite programs are becoming available to give the caregivers some relief from the constant needs of Alzheimer victims. Special day programs are being developed that may allow Alzheimer patients to be involved in suitable and satisfying activities which are designed for people with intellectual impairment. There is hope that treatments may be developed to halt the progress of this ailment and perhaps prevent the symptoms from interfering with the normal, enjoyable activities that most of us look forward to during our later years.
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Cancer of the pancreas can be painless during the early stages, but the effects can be serious even when the tumor is small. Often, the early symptoms are nonspecific and do not point to the pancreas at all, so a diagnosis may not be made. For unexplained reasons, psychological effects such as depression occur frequently in this disorder. But, since depression is often attributed to the process of aging, tests to discover this tumor may not be done immediately and even when done may not be conclusive. Weight loss without explanation or a blockage of the bile ducts (connection between the liver and small bowel), causing jaundice, may be the first signs of pancreatic cancer.
Even though X-rays, nuclear scans, echograms, and CAT scans may be done, the diagnosis can still be difficult to establish. I have seen a few older people who were losing weight and feeling depressed undergo repeated X-rays and echograms. When a tumor was not found, treatment was directed to the psychological symptoms, with little improvement. Many months later, more specific symptoms finally appeared or the tumor became large enough for the X-ray or echogram to verify its existence.
If the tumor is found very early, surgery can be successful, but in most cases it is not discovered in time for surgery to be of use. Nevertheless, surgery can alleviate the symptoms of vomiting and jaundice. If the tumor is blocking the bile ducts, stomach, or small intestine, the surgeon can perform a bypass operation to redirect the passage of food and bile around the tumor and delay these symptoms.
A nonsurgical technique allows a temporary improvement in the symptoms caused by jaundice due to blockage of the bile ducts. A thin plastic tube is inserted through the skin into the liver or from the duodenum with a special gastro-scope and then directed to pass through the biliary ducts, past the pancreatic cancer so that the bile can drain into the duodenum. The procedure can be done under local anesthetic and often allows relief of the itching, nausea, and drowsiness caused by the jaundice.
Such operations or procedures can allow months of comfort that otherwise would not be possible. It would be a mistake to say that the operation is not successful because it does not cure the disease. The relief of symptoms and giving a period of comfort are of great importance and should be attempted whenever pancreatic cancer is diagnosed.
*196\166\2*