This is the second issue of Medical Self-Care magazine, created and published by Tom Ferguson, while he was a 4th year medical student at Yale, in 1976.

1. I
t'
lMedical
Self-Care
NUMBER 2
$2.50
Access to Medical Tools
Kids
&
SelfCare
I
Ursula K. LeGuin on Menopause a Keith Sehnert
on Kds The Best Medical Self-Care Books of 1976
a Medical Consumerism Elders Mid-Life
Wellness Medicine-An lnteruiew with John Travis
National Listing of Medical Self-Care C/asses
I
I
I
f
I

2. Editor's Page
Welcone to ow seinrl issu,. Here s rcns oJourfirct: w veit thtoush the 2,500f'st
ntury and hu.l to haw nore ptiated. Multa.ne an.l ae*spaper sloti?s hare h.lped
lpfto.l the wotu, hut lt? biggest help has b..nftum )'ou hshosnry he mosozine to
lout Jiienls anrl e tuunt|ing then to subs.ribe.
Lots of Soorl sugr/Jtons as wU, ax.l kntr oJ 1em hare betn itkltPorated nio his
is!u(. ,nore an ki.ls u l sef-ca/e. d subvrhtk,t form thdl ! .uti.r b use. Also ne||
s(tt,ts o the Self Cute Conrcpt. ELlets, Mil Ltk, ond MedndlCohsuhletism. And u
rcBulat Jinancidt st.t4n.nt
p
t**
t seen the naga.ine be.lot.-here s eha! e re up to.I n DJou h
Yole me.lical stu.lent tryihg to j'ind wdt! to nake medi.al inJbrndtion and bols
urailable to laypeopLc I.lc.ided to slort this ttdta.ine aller taki,tt rcrc o.f a nunberol
hospitali.ed patients ||ho werc dyins Jro,n diseases thut ould har( b.?n pretehted.
The), didn t know whut to do to prcwat tc,t. Ihopeyoueill.
ln.ase fou havn
jcot
***
Since puting oul he las issue ||e v noved to lrremess. Calilornid. o snoll,.o.f
@ast to-n |ith idylLi. countrside and |arn. Jrientllt peopl.. P tnts.ut o ndgo.ine
Sets Jrantic at tines. Lieing herc is ov ,n,.4i..! sef.a/e
**i
What with our
nott,
there s been.1h alnost i)nplete stalf tu bv.rsincethe lutt
we d hav likttl h 8et this tsuc out.
(ihot s
'rp reoson it s taken lokger ltun
Thant: lor tout poticn<e.)
issue.
Womea's edilor Julid Karct took a job iith CIIRE in Kabul. A[Bhonisllh Medi.ol
consumet spe.ialist Gain Hasseldeh sit"ed on as asso.idte e.tikr. She s been a bi8
help ii pl.tnning and oryoni.ihg, o veak spot hr n..
The fN lime I su| u kt Sue Neri s druteinss . I knew she was lk on( h ilLustrdte the
magd.ine. To our great sood fonuhe, she oltttts. we .foun.l out ||hole produttion
ctc)t-David Lubin, rina M iLls, and C in.l! w til in the ofrus oJ out local newspupet,
-fB'l is a biwtckly, so theJ rolt ,, Mcdical Self'Care,,
rre Tomales Bay Tirncs. fte
Diane lA..ko|9ski has taken over ou subs<ription depannpnt IJ )ok niss .opies,
hove on address chan9e. etc., please wthe to her at Box 7 t7, Invrness, CA 919J7.
E.litorial coftespondence shouLl.ome 1o Rot 7 t8.
**t
FinoUJ, we d Like h thank youht tout tLt.rest, yourJeedback, and lour suppL'tt.
We've been Bexing a reaL outpoutins oJen.aurcEenent ond enthusioen evcry tine |e
open the mail. your lettets keep us Eoint.
Invrness, Catifomia
$kd'dlE|DleLlro*fi
rlrd4r
c44, w.i. r4io f,?b,

3. SPRING 1977
Contents
Talk Back to Your Doctor, p. 19;
Healtb Activation News, p. 19; A
Patient's Bill of Rights, p. 19
Th€ S€lf-Crre Concept
Self-Care: lay Initiatives in Health, p.
p. 4; Self-Care Wirri, the Establishment, p. 5; Self-Help Reporter, p. 5;
Forces Favoring/Opposing Self-Care,
p.5
Being Your own Paramedic
Take Care of Yourself: A Consumer's
Guide to Medical Carc, p. 6; Personal
Health Appraisal, p. 7
20
2l Dying/Grieving
Gre'I.ry,
tt
Kids & Self-Care
p. l0
Baby and Child Care, p. 12; A Pictorial Guide to Cornmon Childhood
Diseases,
p.
u
Book,
12;
Haods,
p.
25
Erting
Passages,
p.
Disease, p. 25
13;
26
p.n
14
2E
Women's Health
In N€cessity and Sorrow,
p.
29
Health Research Group, p. l8; Checkbook Hodth, p. 18; The Consumer's
Guide to Successful Surgery, p. 18;
M.dLtl
Edt otld
S.lt{&.
Vol u, No I
Odlc.!! 8d
?l8.lrv.m
CA
Sot-rl[do! Ofi6: Bor7l7, hrcffi
R$da su!.cripri@r t7 fd 4 i$u*
Rcr.irins SubsiPli@: i25
Su6..ioitrt Sub.dpdm: illn
C@ylLhl I97, lu.drc|l S.ll.CrE
9493?
ca
9493?
Basic Sciences
Rand McNally Atlas of tlle Body and
Mind, p. 29
30
Medical Classes for Layp€ople
3l
Businest
12
F€edback
15
The Medical Self-Care Awards for
1976
IE Medicrl Consumerism
Dealing With Doctors
Woman Doctor, p. 28; Patient Brochure and Self-Help Manual, p. 29
The lnner World of the Middle-Aged
Man, p. 14
l6
Proliles
Wellness Doctor: An hterview with
John Travis, p. 26; Wellness Inventory,
t4 Men's Health
15
The People's Pharmacy, p. 24
Nuhition in a Nutshell, p. 25; Cercal:
Champion of Breakfasts, p. 25: Nutrition Actiol, p. 25; Nutrition Against
13;
Meditation for Children, p. 13;
"What's Happening to Me?", p.
How Your Body Works, p. 13
Menopause:
DruSs
12; The Baby Exercise
t4 Mid-Life
Elders
The Space Crone, Ursula K. LeGuin,
p. 22
t2 Kids
Irving
p. 2l
A Cood Age, p. 22; On
On Teaching Self-Care to Children,
Keith W. Sehnen, p. 8i Teaching
MediciDe to Kids, Tom Ferguson, p,
p.
Therapy/Growth
Every Day Gets A Little Closer, p. 20;
Nourotic Styles, p. 20

4. 4
MEDICAL SELF.CARE
Some health professionals sense an attrck
teritorial iights while others arE touL
led by potential excesses in "going too far."
An even mor€ severc cdticism is lhe possibility
that self-care will be used as a pacification
lactic to rcduce public dernand fol more ot
The Self-Care
on thoh
Concept
better p€rsonal health services. ln conFalt,
The crnx of the ''medical care crisis" moy turn out to be the simple fact
thatwe've allowed our doctors to carry more ofthe burden of providing us
with health care than we should have . Much of the current criticism of the
health care system conveniently avoids looking at our own behavior, at
the points in our daity lives where we are offered clear choices between
sickness and wellness.
This new section will present short comments, quotations, and questions about the id.ea and practice of medical self-care, as well as a listing
of the best books, papels, and journal articles on the subject- We invite
your comments.
Self-Care: Lay Initiatives in H€alth
Lowell S. Levin, Alfred H. Katz, Erik Holst
Leaves little doubt that self-care will be
part of our common health care future.
Contains the best availabk (and-bless
them-well-annotated) bibliography on
self-care.
there arc those who feel self-care is a middle
class idea with litde transfeRbility to lhe
inter€sts of the poor' others vieur self-care as a
fad or a "reaction against" or as a protest that
will pass from the scene once the cause(s) is
won. And perhaps the mostPortentous concem
comes from laypersons themselves: self-carc
may be ccopted by the heahh establishment.
+++
. . . the study of s€lf-care must be considered
not only in lhe circumspe.t terms of an individual's behavior, but as the snrdy of a bnrad and
far-reaching r€vision in society's definition
and use of its helping institutions. Self-care in
health may b€ merely tha first manifestation of
this rcvision where parallels in education and
social welfare can be expected to ernergc in
days immediately ahead.
Self-Malpractice
.TF
The real malpractice problem in this country
The drive toward an increase of self-care in
health parallels similar movements of "consumerism" for enlarging the self-help comDonent in other major fields of human endeauo,----e.g.. education-which are viewed as
having b€come too highly technologized, or
which depend too heavily upon the sPecialized
attributes ard training of a monopolistic pIofessional consurnerism seek, among other
things, a lessening of dependence on rhe tutelage of all kinds of service professionals.
***
It should be stressed that
the major content
and methodology of present-day medical
education involves the role-model of the
1976; 133 pages
$4.45 postpaid from
Ptodist Press
156
Fifth Avenue
New York,
N.Y. l0ol0
patient as a largely passive rccipient of profesiional services. Technical procedures related
to examination, history-taking, diagnosis, and
finally teadnelt, emphasizt the mystique of
the omniscient technical expert and healer.
Patients are usually not given access to their
medical records; their questions at€ fiequently
met with discouraging cursoriness or superficiality. Many studies of medical student
socialization point to th€ powerful influence
such attitudes exert as they are embodied in dle
behavior of charismatic clinical instructors.
***
The report on a conference on self-care
held in Copenhagen in August, 1976.
Twenty-nine knowledgable and LniculAte
health planners spent several dqys brainstomin7 the possibilities and possible
probkms of an increasing emphasis on
self-care.
em€rges, curricula in health
professional education would have to reflect
new objectives and methods coordinate with
achieving a 'parhership attitude" in health
practitioners and the stirrJ involved in passing
along diagnostic and ts€atsnent strategies
appropriate to self-care.
As self-carc
todav is not the one descdbed on the Aont
page's of daily newspapers but rather the malpractice that people are performing on thems€lves and on each other.
The health crisis today is a crisis of life style.
Lalonde provides a list of the more destuctive
life-style habits:
l. Drugs
(a) alcohol addiction: leading to cinhosis of
lhe liver, encephalopalhy and malnu_
trition,
(b) social excess of alcohol: leadilg !o motor
vehicle accidents ard ob€sity,
(c) cigaEtte smoking: causing chronic bron_
chitis, emphysema and cancet of tbc 1utr8,
ald
aggravati.og coronary-artery disease,
(d) abus€ ofphatmaceuticalsl leading to &ut
dependence artd drug .eactions,
(e) addiction to p6ychotropic dmgs: leading
to suicide, homicide, malnutrition atrd
(f)
accidents,
social use of psychotropic &ugs: leadint
to social wilhdrawal and acute anxiety
attacks,
2. Diet and Exercise
(a) over-eating: leading to obesity and its
cons€quences,
O) high-fat intake: possibly contributing to
atheroscleodis and corsnary-a elY
disease,
(c) high ca$ohydrate intake: contsibuting !o
dental cades,
(d) fad diets: leadiig to malnufition,
(e) lack of erercis€: aggravating coronrry_
artery diser6€, lesditrt to obecig ald
causing lact of physical fitn€sr,
(O malnutition: leading to dumcfous hcrllh
problems,

5. (g) lack of r€crration ard lack of i€lief fiom
work and oth€r pEssures: associated !ith
strcss diseas€ such as hl.pertcnsion,
corcnary-artery disease and
Holistic heatth/
welln€ss medicine
Fptic ulc€rs.
3. Olhers
(a) ciraless driving dd failu€ to we3r s€atbelts: leading to accidents and r€sultant
dealhs and injuries,
(b) pomiscuity and carelessness: leading to
syphilis and gonorhca.
moverneDt
Physicians encouraging
Women's
patient education
The traditional health-care system has had
litde success in modifying these
Movement
Free clinics
Self-help
and can have
Groups
habits.
..,._[,eon
S. White, Hovt, to Improve the Public's
Eealth, New England Joumal of Medicine,
pages, ??3-774 (Oct.
9,
293
1975)
Self-Care: Wilhin the Establishment
Health education by its€lf tends to b€ holhas to be tied to an
ability to change the practice of medicine. It
has !o permeate the whole aunosphere of
doctors' offices, clinics, and hospitals. If it's
not pan of the philosophy of a doctor, then it's
Health planners
low. To b€ effective it
medical records
availability and/or
quality of eristing
medical serviccs
not likely to go anywhere with his patients.
This is why I want to work at it from within the
medical establishment. We're going to change
medicine from within, not by sniping at it from
without.
H. Renner, M.D., "Be Your Own M.D."
-John
The Notional Obsener, Novemb€r 22, 1975. P. 14
Availability of one's own
Physician assistant and
nurse-practitioner pro8iams
Groups lforces I policies favoring self-care
Self-Help Reporter
Satisfaction r,ith availability
and quality of existing
medical services
Ca6on Briggs, Editor
Free from
National Self-Help Clearinghouse
184
Fifth Avenue
New York,
N.Y.
10010
Eight-page, bi-monthly, newsletter re-
poning news, publications, and longer
articles of intercst to people involved in
self-help groups-medical, social, educa-
Patients rEsistant
to change irr rolg
Physicians resistant
to change in role
tional, etc. Theoraical, newsy, east-coast
oriented, and tree_TF
Sclf-Care
in the Inrer Cityr
Conclusions
Large proportions of cormon illnesses ar€
9€lf-treated (ranging from 44-:70% of rctE
conditions and from 15-75% of chronic conditions).
Significant proportions s€ek carc first ftom
non-health pe$onnel, and all income goups
use non-physician health Frsonnel.
Home carp for a wide variety of illness€s
shows that ordinary people can leam inticate
as well as simple self-care skills.
Technology exists----€ducational, organiza-
tional, communications-to support self-carc
Non-availability of
one's own
medical records
lnsurance plans which
reimbu$e only for illnessc€nt€red doctor visits, not
for pr€vention /education/ wclln€ss
efforts.
The pEsent system of health care does not
have Ihe tools to prevent many of the morc
fipquent and scrious modem illnesses.
-Nancy Milo
Groups lforces I policies opposing scf-cane

6. Nausea, Vomiting, and Dianhea
is up to while you're siaing there all
Being Your Own
Paramedic
undressed and shivering on the exanining
table.
We're using it as a textbook in our
Medical Self-Care ckxses st the Hoight
Ashbury Free Clinic.
Tske Care of Yourself: A Consurner's
Guide to Medicrl Carc
Donald M. Vickery, M.D. and
Iomes F- Fries, M.D.
Is there:
a) black or bloody vomit;
b) block or bloody stools;
c) severe abdominal prin?
l-
-TF
Nausea,
Vonid[9, & Disrrher
vomiting, and/or dianhea seldom last long.
They are common with viral infections (no
Nausea,
fever) of the digestive tract, Excess food or
alcohol, and/or minor emotional stesses can
also bring them on. As long as they last only
for a few days, home t€atstlent is fine; olherwis€, see your doctoi. An ulcer, gallbladd€r or
intestinal problems, or a scrious disease of the
digestive tract could be present. Usually not,
but it's worth a check.
Avoid solid foods, Don't
Home Trcatment
eat or drink much at one time. Sip clear fluids
such as water or ginger ale, Suck on ice chips if
nothing else will stay down. vomiting, diarrhea, and fever increas€ your ne€d for fluid, so
take in as much as comfortable. As the condition improves, add soups, bouillon, jello, and
applesauce. Milk products may help, if tolerated, but sometimes aggravate the situation.
-
Has there b€en head iqjury in the
last rl8 hours?
Is the patient:
a) thirsty or utrrble to retrin lntslc
for more than 12 hours;
b) pregmnt or possibly prcgnant;
c) frequently or painftrlly urinating;
d) diabetic.
1976; 269 pages
Thc most useful medical
from the new Plryician's
aol
to emerge
Assistant troin'
Algorithm-c
bi8 detoiled fow-chan contoin@ Key
qucstions 1o ask for each common
ing programs is the Clinical
complaint-sprains
,
cods
,
sore throat
,
vaginal discharge, headache, back pain,
etc . Yes and no ansl)ers lead you through
o network of branching logic ond end up
telling you whether you need to I ) See the
doctor NOW; 2) See the doctor todcy; 3)
If
mon medical problems . There are sections
o Nausea or vomiting, or at the very least, loss
of appetite;
Take Care of Yourself includes the
clinicol algorithms Jor the 68 most comof background information on eoch problem, including home treotments to be used
when indicated.
Additional chapters on "Choosing a
Doctor," "Your Habits and four
Health," "Reducing Your Medication
Costs," and a little gem called "The
Ofrce Visit" that tells you what the doctor
f-
***
Apply home teatment.
Mske an appointment to see the doctol;4)
now?
symptoms p€6ist beyond 72 hours, con-
The most constant signal
of appendicitis is the order in which symptoms
occur:
PaiD---{tsually first around the belly button
or just below th€ bt€ast bone, only later in
-
.
the right lower quarter of the aMomen;
.
l,ocal tgnderness in the right lower quarter of
.
Fever-in
the abdomen;
the range
of 10ff to 102T.
Appendicitis is unlikely il fever precedes or is
present at the time of first pain: if there is no
fever ot ahighfevet (greater than 102'F) in the
first Z hours; if vomiting accompanies or
plec€des rhe fiIst bout of pain.
t
ye3
I
yes
Is pstient taking any medicntioru
tact your physician.
Abdomind Prin
y6
!."
Applesauce may help slow down the bowel. A
$5.95 postpaid fton:
Addison-Wesley
Reading, MA 01867
I
l"'
Work up, slowly, to a normal diet.
Diarhea rcsponds to these sarne measures.
tablespoon of Kaopectatc after each loose
bowel movement will seldom ups€t lhe stomach and may help. If Kaopectatc is not
effective, try Parepectolin or Parclixir.
Recu[€nt minor bowel Foblems are common in rhe Unitcd States, possibly due to the
lack of fibcr in our diets; in countsies where
high-residue diets arc customary, few dig€stive problems arc se€n. Your diet should include ftesh fruits, veg€lables, celery, brans,
and whole wheat breads. A tablespoon of
Metamucil in water twice daily is a safe, effective (if expensive) way to hcrease Esidue.
yes
If the pain eventually
proves due to a serious problem, the stomach
should be empty to allow prompt surgery ot
diagnostic tests. Sips of wa@r or oth€r cl€sr
fluids may be taken, but avoid solid foods. A
bowel movem€nt passage of gas through the
rectum, or a good belch may give relief--don't
hold back. A walm bath helps some patients.
The k€y !o home teatment is periodic r€evaluation at the emergency room or the physician's
office. Home ueaunent should be r€s€rvcd for
mild pains which resolve within 24 hours or arc
clearly identifiabl€ as viral gastro€ntedtis,
heartburn, or another minor prcblem.
Home Treatment
-
I

7. MEDICAL SEI,F.CARE 7
Abdominal Pain
ID
yes
any of th€se pres€nt:
black or blmdy stml;
) very severe abdominal pain;
abdominal iqiury in last ,l8 hours?
D
See
physician
now.
See
physician
now.
l"
ID
See Head
lr{uries,
Problem E,
Is pain localized to one aree of
men, or is the patient pregnrnt or
possibly pregnant?
l"
See
ID
physician
today.
llD
yes
D
Se€
physician
today.
yes
D
Is there nausea, voniting,
or dianhea?
3ff"iilffhJ,f,Tll'lf:
l"'
Contact
prescribing
physician
by phone.
Personal Health Appraisal
Waher D. Sorochon
1976; 3O2 pages
$5.95 postpaid ftom:
John Wiley & Sons
6O5 Third Avenue
New York.
N.Y.
It
10O16
was
Rehaionl St'temet
t
lkually bmetimes
Nevet
t:
t e were planning to put together a book
much like this to use in our medical selfcare classes.
Dental Habits Inv€ntory
q
delight to find
somebody else had already done it.
This book is a self-administered heabh I
wellness evaluatio, composed of 39 different checklisls, inven ories, and ques-
tionnoires: Emotional Well-Being Invenbry, Ser-Actualization Inventory, Prealcoholic Checklist, Smoker' s Self-Treqt-
ing Kit, Susceptability to Cancer Inventory, How t ell Do I Ex.ercise Inventory,
Sexuality Scale, Susceptability to Accidents Questionnaire, How Long Will You
Live Predictor, and thirty more.
_TF
l. Brush teeth at le.rt twice a day
2. Use dsntal lloss at least once a day
3. Drink fluoridated water daily
4. U,e reddye disclosing tabl6t sevsr.l times
a year
5. Virit dentisr every rir months
6. Clean teath at dental office every six
moothi
7. Brush tongue when bruihing teeth
8. Rinse teeth and mouth oui with water
afte. rlrali
9. Uae a soft bristle toothbrush
10. Brush teeth belore a meal
1 1 , Eat sv/eeti and rncks betu/gen meali
12. Chorv gum containing iugar
13. Have othera cornplain about my breath
14. Feol need to use mouth wash
15. Munch lood botwen meEls
0
0
0
5
5
5
15
o
3
15
12
0
0
3
4
12
12
0
0
0
0
0
0
0
0
0
3
135
135
5
r35
r35
'r35
3
20
20
20
20
15
t5
l5
7
10
10
15
7
l0
Scores: 136-185, Very poor dental heahh habits. 9l-135, poor dental heahh habits
5l-9O, Fairlgood d.entsl lvahh habits, O-50 Very good denta! health lnbits

8. 8
MEDICAL SELF-CARE
Kids and Self-Care
This concept had come to me dudng lhe five
Know Yow Botly
The American Health Foundation has devel-
oped a new school Drogram, "Know Your
Bodv" (KYB), which is designed to (i) prcmote a diet low in cholesterol, in fat. and in
On Teaching Selt-Care
to Children
by Keith lt/. Sehnert, M.D.
Can childrcn really take responsibility alld
make wise decisions about their own health
ne€ds? Do['t we thiDk of children as reckless
beings, never worded about bruises, cuts, or
infections, snacking on anything at any hour of
the day, and concemed with their state of
healrh only when there is a school test or some
other activity they wish to avoid? Well, reports
just out on two t€cent health Programs suggest
that these doubs have little basis in fact.
In Califomia, Mary Ann Irwis, dircctor of
the Family Nune Practitioner Program, and
Charles E. Lewis, professor of medicine at the
University of Califomia at l,os Angeles, have
r€ported on their research at University Ele-
mentary Schoot, the laboratory school for
UCLA's Departrnent of Education. Working
with first-, third-, and sixth-graders, they
developed an experimental model to study the
behavior of childrcn who are involved with the
own health carc.
This project was set up so that childrcn who
were sick or wanted h€alth information could
go directly to the school nurse's office without
asking the teacher's Fmission. The nurse
took the child's medical history, performed the
nec€ssary physical exam, gave a report to the
child, and help€d identify ary special Foblems. Th€ student was then asked to formulate
treatn€nt for th€ prcblem. It is herc that this
rcrnarkable study becomes even morc interest-
ing. The child was asked to select one of
several fieatsnent plans, and, with rare exceptions, he made the correct choice. Finally, the
Chilil Rcadng Mchods and
Chikhu's Hcalh Bchrybr
A d€velopmental pattern of child rearing was
foqld to b€ associat€d with better health care
practices by children than a disciplinary pac
tem ofchild rcadng, The deYelopmental methods included substantial us€ of rcasons and
information, r€wards, and granting of autonomy. Based on these findings and a review of
previous rescarch, the higb€r level of health
practices of children r€ar€d by developmental
than of thos€ rearcd by disciplinary methods is
interFet€d as an exprcssion of the differential
effectiveness of these contrasting child rEaring
approaches in developiog the child's rcsources
and capacities for coping and taking care of
himself.
l+att Jounal of Heobh and Socicl Bchavior,
-[nis
Vol. 14, pp. 61J9, Matrh 193.
total calories, and olherwise nutritionally balanced; (ii) eliminate cigarette smoking; (iii)
contol blood pressuie; and (iY) enhanc€ physical fimess.
A 5-year ( 1975-80) KYB program among
X00 schoolchildren aged l0 to 12 years is now
in progess. It includes annual detemination
of blood pressure. serum cholesErol. height,
weisht. hemalocrit, and random blood glucosi a physical fimess test: a test of health
knowledge; and a suwey of such habits as
smoking and alcohol consumPtion. After completion of the tests, the children will rec€ive a
"health passport" in which to recoid tbeir test
rcsults.
._ftom Marvin M. Krislein et
al, Heolth Economi.s
and Preeentive Care in SCIENCE, 195:45?462,4
February, 1977. The aulhors arc with the American
Health Foundation, New York. t'IY Iml9.
student was allowed to choose the immediate
steps to be taken: going home, lying down,
retuming to class. and so on. Again. by far the
greatesl numbdrofthe decisions were based on
a sound appnisal of
the child's condition
At first chil&en may find it stmnge to take
an active role in health care, bur the UCLA
project demonsrraEd that they can rapidly
ieam to make it an acceptable routine. Before
and after ft€ study, these children were asked
about the importance of self-care in maintaining good health, ard the results showed a
decided change in attitudes. Before starting dle
project. only 2 percent of the 369 childrcn saw
self-care as imponant: afterward. the proportion increased to a statistically significant 9.2
percent.
During the study, some interesting fac$
werc gaahered on the utilizarion ofthe school's
nuning service. From existent nurse's office
records, it was possible to ascertain how many
students were normally nolrusers, rcgulars' or
high us€rs. By the end of the program's third
year, the l.ewises found almost a 50 percent
reduction in visits to the nurses's office by
"high
us€rs.
"
Meanwhile, in Washington, D.C., Jacqueline Hunt, R.N., and I produced a preliminary
report oD a study we conducted 6t Holy Trinity
E[ementary,
a
I had been teaching the CouNe for
Activated Patients, an innovative health class
for adults. Women in the couNe often brought
school-age children to class, and the kids
always seemed interest€d in what we werc
doing. Several mothers said that I ought to set
years
private school, and Hardy
School, a part of the D.C. public-school system, both located near the campus of Ceorgetown University. We s€t up a class for sixthgraders that we called the Share-Care Course
for Good Healrh. ln our pilot project, we
planned to study the attitudes that chil&en
Lave about individual responsibility in maintaining good health. We were also interested in
teaching th€m simple self-help medical skills
and in showing them how to keep a personal
health record.
up a special class for kids, and I decided to give
itaty.
Since our project was developed to provide
information and health skills to ve, students,
there was no school nuls€ available for treatment of illness, as in the UCLA setting. We
presented lectures about maintaining good
health and included information on diet, nutrition, regular exercise, dental care, mental
health, immunizations, and cardiopulmonary
resusciiation. The children were taught to take
their !9mperaturc, pulse, and blood pressure
and to record this vital medical information,
including height and weight, in their personal
health record. They also acquired some basic
skills about handling comrnon illness, injuries,
and emerger.rcies.
Our teaching methods emphasized dernonstration and included how-'.o-do.it skills such
as the removal of dental plaque ftom t€€lh with
the aid of disclosing tablets. yoga exercises.
mouth-to-mouth rescue healhing, the application of ice and cold packs for sprains and
injuries, shopping with parcnts to leam about
t]le nutitional content of food, and the presentation of classroom skits lhat demonsFated the
positive aspect of good mental health.
Like fhe UCLA project, ouls showed Posi
tive rpsults. Before the students began the
course, we asked them to choose the person
most respoasible for maintaining their health:
"mother, doctor, teacher, ormyself." Only 21

9. MEDICAL SELF.CARE 9
percent chose "myself." Whe[ we asked tlrc
same question al the end of the coune, the
figure had increased to 85 percent.
What aan be learned ftom the UCLA and
Ceorgetown studies that could help you in
your role as all Activated Par€nt?
Firsr. children need your help in learning
how to participate in theirown health care. But
it's not enough to encouBge the child with
words. If paients do not also set the right
example with their own health habits, their
will be getting entirely the
children
wrong
message.
suffer the side effects of respiratory and circulatory diseas€s,
Of
course, the Activated Parent's role
doesn'tend with avoiding health habis that set
a bad example. He or she should also look for
opportunities to show th€ positive benefits of
good health habits. An exarnple that thricedaily brushing and daily flossing have given
you b€autiful teeth, that Granddad has kept
physically fit by briskly walking 5 miles every
day, that you have kept a slim figure through
nuritious eating----all demonsfate to childrcn
how well a good health regimen can pay off.
One example of this emerged in the course
of the UCLA project, in reviewing the students
who were "high users" ofthe nurse's office. lt
I drpssed the bum and gave John additional
bandages to use affer he had applied compress€s that evening. He r€tumcd on several occasions to discuss othet health plobl€ms,
During the next several wecks children
between the ages of 8 and 13 b€gar coming to
.
my offic€ before and aft€r school.
School health education, where available, has
by and large perpetualed a view of health care
which suppresses or severely limits the growth
of
values and beliefs that the individual is
competent as tbe primary source of health
maintenance. Health 'facts" are present€d to
childrpn as secure and immutable, health Plofessionals as possessing skills fixed and demarcatod from those available to laypersons.
"Folk medicin€" or home remedies and indigenous health customs arc often denigrated as
quaint, ineffe{tive, and sometimes dangetous.
***
As a result of these accumulating clinical
impressions the following questions w€le
In addition, look for what I call the Teachable Moment by showing children how to use
the thermometer when Dad is sick, explaining
why sister must never give aspirin to a younger
sibling without your approval, demonstrating
how to give first aid for a knee abrasion, and
advising what to do for a bee sting and how to
prcvent one the next time.
Another good example
of a
Teachable
Moment could be the way you handle a common illness, such as a headache. You should
demonstrate to the child that there are seveBl
ways to treat a headache other than with pills
and painkillers. In this case, you could suggest
altemative treatrnents such as the following: l)
Is the headache due to hunger? lf so, drink a
glass of milk and eat a graham cracker. 2) ls it
due to fatigue? Then a short rest may
be
indicated. 3) Is it caused by muscle tension?
Then it may be relieved with a cold towel or a
hot-water bottle applied to the neck area.
Parents should stress that all of these rcmedies without the need for medication, if the
symptoms ale noted and treated early. (For
further information on how to recognize symptoms, see my September column, "When Your
Body Talks.")
lf a child is taught horv to handle common
Self-Carc: Iny Iniriotives health problems, is provided at home with
Katz, and Holst:.
Protest press, New
-I,evin,
ir tearrr?,
york,
19?6.
Some
retumed by appointnent. None was accompanied by his parents. Often mothers and
fathcrs were not available for a variety of
reasons, or, as was evident in r€tospect, the
children preferred to s€e me on their own. I
gained the impression that many of these
children were int€Estod in their health prob'
lems and wantcd to take more rEsponsibility.
.
Heakh Cla:ses Discouroge SeACarc
him . . . He was typical of the children who
came later. His Ieft arm had be€n bumed two or
thrw days earlier. The bum was primary and
he could have gone !o the school nu$€ next
door but that the tules would not pqmit her to
provide dfue{t car€.
minor
.
***
John. a nine-year-old boy, appear€d in my
office beforp school and asked if I could help
rcondary with some secondary infe.tion.
showing a marked tendency to call their doctor
ailments.
There are many other kinds of wrong messages that parents can unknowingly pass on to
their children. and some can be very damaging
indeed. Here are a few examples:
Father comos home from the office or shop
and says, "I got so damned mad at the boss that
I had to stop in at the tavem and have four b€ers
to cool off!" The children see how alcohol is
used to cope with anger and frustration and
may laler imitate this pattem. (It has in fact
been shown that the recent upswing in the
number of teenage alcoholics bears a direct
relation to the heavy consumption of alcohol
by the adult members of their families.)
Mom keeps her tranquilizers on the kitchen
table and pops a pill after driving home from
th€ store in h€avy traffic, or explains at breakfast how she finally got to sleep by taking a
sleeping pill at 2 a.m. These poor habits could
set the stage fordrug abuse when the observing
child becomes an adult.
Aunt Jane says she will go on her diet next
week, but first she takes her third helping of
chiffon pie. Her influence could help to push
an already overweight teenager into a lifetime
of obesity.
r lfan older brother or sister smokes regularly
at home, it then becomes more likely that the
younger sibling will also smoke and possibly
For the past two years I have, as a school nuse,
been involved in atr exp€timental health carc
system in which the childr€n itr an clcmentary
school help d€cide not only what lhetu hcalth
problems are but what should be done about
them.
John was concemed about his affi, it hurt, and
he woldorpd about the infection. He knevr that
was found that the motheis of these students
were also high users of medical facilities,
or take non-prescription drugs for
Chil&Iniliobd Carc
good quality information from books
and
formulated;
o Children se€mcd to exhibit a chaoge in
thoir attitudes about health and medical care.
Could this (if rcel) be r€lated to theh acrive
participation in rheir own health care?
. What was the content of the child-nurs€
inreractions that produced thes€ effects (if, in
fact, thoy werc rcal)?
Ana lzwis, American Joumal of Nusing,
-Mory pp.652-655, April 1974.
Vol. 74,
magazines, leams details on first aid, is
directed to think about seif-help and preventive
medicin€ by a docto! and nuNe, thatyoungster.
can become an Activated Patient.
In the final session of the Course at Georgetown, I asked the snrdents to write a letter to me
defining "good health. " I'll close wth a quote
from the one I liked best. Mary L. said, "Good
health is a constant Foject you work at. " Mary
was a kid who had become an Activated
Patient.
This dticl. on8inally a'0eutA in Fznil, E.alth
RcprinEd by
Fmisid
of rh. autho.. Copyrigh
(xtda
Fhily
tyts.
H@lrh 195,

10. noons a we€k for eight weeks, to see what we
could do in the way of teaching ftem medical
stuff. We borrowed a videotap€ s€ntp to rE€ord
whatevor happened.
From talking with the teachers, we f€lt it
would be wiscst to explor€ what the kids would
like !o l€am about, rather than coming in with a
prepackaged set of goals. We ended up defining the class to fte kids likc this: "This is a
Teaching Medicine
to Kids
time for you to find out things you'd like to
know about your bodies, about doctors atld
what they do, about what happens whQn you
get sick, and about what you can do to keeP
yours€lf healthy.
"fozrjob
is to ask good questions aad think
of neat ways to learn about bodies. Oal job is
to answer Jorre questions and to help you
figure out how to find your olrt answers to
others.
"
They ended up calling the sessions "Doctor
Class," and bragged about beirg included.
The children who weren't abl€ to be in the
group werE pr€tty jealous.
Who, Me? Teaeh Metlbine?
That's what we wonder€d before staning the
class. I'd had a litde clinical experience, true,
but none of us were experts. What ifthey asked
something none of us knewi
We finally came to urde$tand thes€ doubts
as a reflection of our own conditioning about
medical knowledge. Therc's a very suong
myth in this culhrr€ to the effect that medical
infomation is so specialized and that a littl€
knowledge is sucl a dangerous thing that it's
rcally best not to try to know anything ahptJt
by Tom Ferguson
Back in my days on the hospital wards, I was
haunted by the patierts I was taking care of
who were suffering and dying from pr€ventable diseases.
I felt that we as a cultur€ had let thos€ people
down. Th€r€ were things they should have
be€n
taught-things about relaxation and
eat-
ing and exercise, smoking and drinking and
di€t---dong with reading and geography and
math. starting back in the ftrst gmde.
And not only had we l€t t ere p€ople down,
we were letting down all the children who are
/lol,
studying reading and geography and
math, and who could so easily be introduced to
the skills of medical self-care.
Organiztd Group Activilies (Exanplcs)
Leaming to takc yourp4lre. DemonsEation
of radial pulse (in the wrist) and carotid pulse
(under the angle of the jaw). The neck pulse
was easicr for most of the childrEn to find.
"doctor stuff," but to leave that "to $€
experts.
"
One of tlrc most importrnt things we elded
up leaming for ourselves was that it's all right
for a group of people to get togcther and talk
about illness and bodies----evel though no one
in the group knows all th€ answers. One of lhe
most important medical self-carc skills tums
out !o be asking good questions and then
figuring out how to go about finding the
answets.
Being in the class got us involved in about
questions we wanted to know the answers to,
and what we'd have to do to find out. One of
the questions l've thought a lot about shce is,
"Why do we have eyebrows, anyway?"
Something I'd never leamed in medica.l
school. I'd rtirJ like a good answer to lhat one.
We help€d the kids use the library to find
We had them count their puls€s for fift€€n
s€conds. (We'dcall "Stan," ard "Stop.")We
answers to some of their own questions, and to
match other questions to Esources w€ had
and run as fast as they could----once arcund lhe
school. Then we had them count their pulses
for another fifteen seconds. Again we recorded
wdte it down so we'll be sule to remember to
When I finished my clinical rotations, and
had the opportunity to devote several months
to an MD thesis project, I de€ided to set up a
class in medical skills for frst graders.
the rcsults.
available-"That's a good question. l€t's
Gcding the Proiect Sbrted
'I'h€ teachers I spoke to at the Footc school
in New Haven w€rc most enlhusiastic about
the idea. They all would have liked to make such
information available to iheir children in their
class€s, but they'd had no caining in
ask the vet wh€n we go to the animal hospital.
"
I:he
Kids-Whal The! wa tedTo Knov
They were fascinated by the doctor tools
things, and they had few r€sources available to
help lhem.
in my black bag. They also loved doing body
exercises, relaxation exercises, yoga, and in
loaming pans of th€ Physical examinatiotr.
We found rhat an informal penod dght aftcr
I
had
arranged to take eight first and se{ond Srade
chil&en to an unused classroom two after-
wrote the lotals on lhe blackboard.
Next, we asked everyone to walk outside
We asked what things besides exercise
makes your pulse incrcase. (Fear, excitement,
such
Before long, thre€ co-workers and
questions. We'd all be, say, sifting arculd on
th€ floor after learning to takc our puls€s, and
somebody would ask about what a puls€ l'aJ,
anyway, beforc long we'd bc off onto arteries
and veins and red and white blood cells and the
heart as a big, muscular pump.
As often as not, the questions would lcad off
into ar€as of personal fean and concems"when my sister had apFndicitis lhe doctor
measured the white cells in her blood. What
did he do that for?"---and w€ had !o be surc to
rsspond both to the bchrical question and to
the feeling/conccm behind it. (Could that
happen to m€?)
But for all the inter€sts the kids sharEd, there
wei€ many thal followed the lines of their own,
individual curiousity. It b€came clear that they
each ne€ded time !o pursue their own inlercsts.
We ended up br€aking our class period into
ftrce pans:
(l) Otganiz€d group activity
(2) hformal question period
(3) Time for iadependent work on individual projects
a structued activity was a good time for
fever).
We tatked about the effect of Folonged
exercise training on puls€ rate.'(People in
b€tier physical condition have stsonger hearts,
and slower pulses.)
We talked about how dle pulse can be used
as a guide to exercise training. (Maintaining a
puls€ of 34 p€r 15 s€conds for a prolonged

11. MEDICAL SELF-CARE
period-2o minutes to an hour-maximizes
training effect while minimizing stress in such
activities as jogging).
Using the Stethoscope. One stethoscope and
eight kids equaled chaos. we ended up getting
an inexlxnsive stethoscope for each of them.
($2-$5 from your local medica.l or hospital
supply hous€.)
We found it best to hand over the stelhoscopes and ask them to find as many things as
they could in ( l) the room (2) their bodies that
they could hear with it. They found things
we'd never have tbough of. (My toes wiggling
inside my shoes.
water.
"
"
"The radiator makirg hot
"My hair.")
Aft€rward we'd go tbrough the body together listedrg, in turn, to the vocal chords
while talking, the heart, the stomach ard
iliestines (especially just after a meal) , and the
lungs while taking a deep breath.
The kids discovered that your head sounds a
lot differcnt (not only faster) after you've been
outside running around.
Doing Yoga. There werc several questions
abour 0lis and we had a f.iend who taught
yoga, so we had him come in for a session. The
kids loved it. He wisely emphasized the animal
poses-the cobra, the elephant, the lion.
There's also an excellent book available,
Yoga Jor C hildren by Eve Diskin, $4.22 posF
paid from Independent News Co., 75 Rockefellet Plaza, New York, N.Y. 10019. (We
rcviewed it last issue.)
Throat Examination . Our kids were fascinated by tonsils, though they didn't quite know
what they were. We had the kids pail up,
bquipped each pair with a regular flashlight,
and had them look in each other's throats.
Children's tonsils are usually easy to se€.
They look like this:
I nlonul Que stion Period
Independent Projects
We startod the class with very skill-oriented
goals. Would the kids be able to use a stetho-
In most cas€s this involved working with
library materials-and with us individuallyin putting together "books"-hand drawn and
lettered----on their chosen topics, One boy
scope?
A blood
pressure cuff? Would
[ley be
at all inter€sted in nutdtion?
The most shiking effect of the class was
report€d by the mother of one of the girls a few
woeks after the class had finished. We didn't
fomally evaluate our sessions witi par€nt
questionnairEs, or b€fore-and-after tests. (We
probably should have. ) So this sole repon may
have been exceptional.
Anyway. MIs. P. called upon herown intiative to let us know that C. (her daughter), had
always had a ierrible time with doctor's
visits-staying awake the night before. crying,
etc. But this time--hcr first doctor's visit sirce
the beginning of the class--she had s€emingly
had none of her previous fears. The doctor
came in with his stethoscope and C. said, "Oh,
I have one of those !oo!" And thcy went on to
talk about th€ir respective stethoscoyrs.
During the question-and-answer sessions,
the kids exhibited a good deal of anxiety about
doctor's visits---particularly about shots and
TIIIOAT
concems----and their sense of helples$essabout what happened when lhey visited the
doctor's office or were in the hospital-"Whar
happens when they give you gas in an operation?" "What happens if you have cancer?"
"What happens when an animal dies?" (we
found that in talking about sex and death thelL
prefered to alk about such things happening
In responding to th€s€ questions, we found
that our most important jdb was to help the
child asking the question to ftrlly explor€ th€
fe€lings that his or her questions exprcss€d.
The hardest thing for us was to ke€p ftom
giving a superficially-correct answer at the
expense
of letting the child sharc
a deeply
felt
concem.
Field Trips
I wish we could have taken more field
trips. My first choices would have been the
We asked the kid b€ing examined to "pant
like a dog. " This almost a.lways made using a
tongue blade unlecessary. Gf one wa.r necessary, we had the person being examined hold
it.)
The examiner first locates the ,ryzl4, a small
midline flap of skin hanging down above the
back of the tonque. Then, on either side of it,
the lonsils.
Children who have had many sore thmats
will have larger onsils. Those who have had
tonsilectomies won't have aDy.
chose to leam to use the microscope. Another
boy brought in his collection of bones he had
found in the woods, and compared them to
some human bones we were abl€ !o bororr
from the anatomy doparfinent of my m€dical
school.
Some were able
to conc€nbats on their
chosen topic with oDIy occasional qucstions.
Others necded nearly-conti[uous adult
suppo(.
Afrerhoughts-Wha
We
Shotrld Have Done
After the class was over, of cou$e, rre
thought of all kinds of wonderftrl id€as. Like a
game called "Make Yourself Sick," in which
cach child would think of as many ways of
making your health wotse as he or she could.
other painful proc.edures.
Our childrpn--and most of th€ r€st of us as
well-usually only saw the doctor when we
were sick. If we only see the doctor when
we're ill---or when we need shots-we'll leam
to associate the doctor's office or clinic with
being frightened or in pain.
The questions they asked teflected their
to animals.)
BACK OF
11
children's ward and newbom nursery ofa local
hospital, and a pediatrician's office.
Becaus€ of scheduling and supervisory
problems, we were limited to onc fi€ld tip.
The kids choose o go to an animal hospital.
It
hrmed out
to be a hne choice.
The
v€torimrian showed us all the cats, dogs, and
other animal patiens, and explained why each
one was therc. We got a tour of the operating
rooms, and a description of the most common
sugical prccedures he did.
Perhaps the most fascinating palt for the
kids was tbe demonstration of dog ard cat
x-rays. We had to drag them away.
We should have included some way
evaluate the effe.ts
of the class. Maybe
to
"draw-the-inside-of-your-body" t€st and
a
a
"fe€lings-about-doctors" questionnaire.
According
to the kids'regular
teachen,
most of them continued their projecrs begun in
our group after the official class was over. It
would have been helpful to work out some kind
of contiluing health focus in their
regular
class.
All-in-all, it s€ems as though we raised more
questions than we answ€red. The videotaF we
made is available for rcntal (935) or purchas€
($75). It turned out pretty welt. People who've
seen it say it's bern helpful.
Resource Guidc in Preparulion
lffe're now working on a resource guide for
parclts and teachers inteFsted in t€aching
health/medicine to thetu kids.
The guide would include a lengthy annotated biblioglaphy---books for kids of all ages
and adults as well-and a number of articl€s by
teach€6, parents, and others. W€'d welcome
your suggestions and contibutiong-letters,
accounts ofyour own experiences, suggestions
of books/rcsources to mention, other possible
coltributorsIf you'd like a copy of the guide, drop us a
card and we'll let you know wh€n it'E r€ady
and how to get it. (Wri te to Teaching Medicine
to Kids, Box 718,
Invemess, CA 9493?.)

12. Kids
their appetite for the vegetable or the main
course and you increase their desire for meat or
desseit. These rgsults arc the exact opposite of
what you want.
Baby and Child Care (Fourth Edition)
Dr. Benjamin Spock
It's not that you want childlen to go on
eating lopsided meals forever. But if they have
a feeding problem and are already suspicious
of some foods, your best chance of having
them come back to a reasonable balance is to
let them feel that you do not care.
***
It
has b€en a tradition
in many families
to make boys ashamed of showing pain or fear.
(I was brought up that way.) But this tends to
teach them to repress and deny feelings of all
kinds, including tendemess, and may, through
the rest of life, interfere with good relationships with family, friends, and fellow workers.
***
The most convincing evidence of the value
comes from mothers who
have done it. They tell of the tremendous satisfaction they experience from knowing that
they are providing thet babies with something
no one else can give them, for seeing their
of breast feeding
devotion to the brcast, from feeling their closeness. It is too seldom mentioned that, after a
couple of weeks , breast feeding becomes defi-
nitely pleasuable for the mother-it is intended to be.
A beautifully produced British book
with color photographs of common childhood conditions. Particularly useful for
telling one kind of skin rashfrom anotherFocuses mainly on babies and very young
children.
-TF
Chicken pox (vaicella): The illness starts
l2-2O days after contact but your child is
infectious from two days before the "vesicles"
(blisters) app€ar, and for 14 days after the rash
b€gins, For the first seven days it is one of the
most infectious fevers known.
Cause: a virus. lt is one of the least sedous
child illnesses.
Usual pictue: the child may be vaguely
unwell for a day or so, dren rcd spots ('?dpules" ) arc seen fitst on the body, fac€ and
scalp, spreading to the limbs. The msh is
slightly irchy. The temperanrre is raised (100-
102 degrees F) once the rash shows, but falls
become
after a day or two, Spots rapidly
bliste$.
Action: bed while the temperature is raised.
Help the child not to scratch (if blisters are
infeated by scratching they are likely to leave
scafs----€specially on the face) by dressing him
in loose, soft, smooth clothing. Don't let the
child get overheated since this will pmvoke
further irritation and scmtching. Use
a
dusting
powder or a calamine lotion. Therc are no
common complications
.
A Pictorial Guide to Common Child'
hood Illnesses
Gerard Vaughan
The Baby Exercise Book
Dr. Janine Lery
$3.95 postpaid from
$9.95 posPaid ftom
Hawthome Books
26O Madison Avenue
New York, N.Y. l0O 16
Pantheon Books
201 E. 50th Street
New York,
muscular development and bodily awareness and control. How to make simple
baby gymnastic furniture that will help.
JF
care.
This edition has been extensively revised "to elimitute the sexist biases ofthe
son that help to create and perpetw.te
discrimirntion againsl Sirls nndv/omen "
W ell-loved, much-read' highly recom-
How Should the Child be Carried?
IJp to three
months-larry him sometimes
on
your right arm. sometimes on your left; lhe
child's head and body should be fully sup-
ported. Very early you can have hirn sit on
your thigh with knees and chest supported and
face away from you.
-:IF
Three to sil. monlhs-As soon as his muscles
are sufficiently develop€d, you will be able to
carry him astride your hip, one hand on his
knees and the other on his chest, his face away
Make no distinctions between foods. l,et
them eat four hclpings of one food and none of
another if that's the way they fe€l (as long as
the food is wholesome). If they want none of
the main couNe but want dessert, let them have
dess€rt in a perfectly matter-of-fact way. If you
sav. "No seconds on meat until you've ealen
your vegetable," or "No dessen until you've
cleaned your plate," you further lake away
10022
Holding, carrying, and PlaYing with
your baby so as to mqximize his or her
New edition of the Bible of child rearing. 5AO pages of nornzl development'
feedinp and truzrutgemen, uncl common
-problems.
2N pages offirst aid and illness
mended.
N.Y.
1970; 176 pages
$10.70 from
St. Martin's Press
175 Fifth Avenue
New York, NY l0o l0
from you.
Six lo twelve months-Astride the hip; reduce,
and then remove entirely, the support around
the chest, as soon as the child's muscular
strength permits.

13. MEDICAL SELF-CARE
Loving Hands
When you have gone as deep within as you
can, just stay there-in that peaceful, calm
center--and ask yourself the question wia am
/? With eyes still closed, in the meditative
state, contemplate whatever comes into your
awareness. Wait a little and then ask again.
Who am I? K@p asking yourself this question
in the calrn center, aDd consider the answer, or
lack of answer, for awhile.
Frederick Leboyer
***
Normally the mind rep€ats over and over
with one concem after another, like a
tape
recorder in the head . . . The mind has so many
patterns. So we meditate to rclieve ou$elf
from all ftese pattems for awhile. we let it all
go and we are free of it. For those moments we
are not clogged by basic assumptioos, projections, identifications, or pe$onal reactions and
attitudes. In other words, we get out of our
little self and its filters and are no longer
disturbed. Then, in this clear, peaceful space
inside, we see something more . . .
***
The personal ego and its acquired filt€rs
always se€m to get in the way of pure perception. We don't label this fact good or bad, right
or wrong. It's just the way things are. The
human predicarnent will remain in this semiaware state until marl decides to change it
thrcugh mastering his owll ego.
1976; 139 pages
$7.95 from
Alfred A. Knoph
20 I East s0th St.
New York, N.Y. 10022
By the author o/ Bkth Without Violence, Photos and poem-directions on the
Indian art of baby-massage.
1F
"I
13
Wet dreams start when you're maybe thirteen or fourteen. As you'd expect ftom the
name, they happen when you're asleep.
The sperm that you have been making reach
a level where they just have to get out. And
you don't let them out by mastubating, they
wait till you're asleep and shoot out by lhem-
if
selves.
It sounds simple, but there's more to it than
that. For a start, very litde spen can escape
unless you have an erection. And, remember,
when all this happens you're sleeping.
So first, you have a night-time erection
which is often caused by a sFcially pleasant
drcam.
Perhaps your dieam is about a gful you
know. or a photograph you saw in a magazine.
Or maybe it's about a nice feeling you had
when you were awake.
The result is that you get an erection, have
an orgasm, the sl'erm shoot out, and you lvake
up with sticky pajamas.
Therc's only one thing wrong with wet
dreams-you're not awake to enjoy tllem.
(Gids, incidentally, have fewer wet drcams
all. But to make up for
that, a girl can often mastubate many more
and many have none at
times a day than a boy,)
You'll hear all kinds of strange stories about
mastubation: lhat it makes you go blind, it
makes you go crazy, or everr that it makes hair
grow on the palms of your hands.
It does none of
these things.
It's a perfectly healthy atld nomal function.
Masturbatiol is usually your lrst s€xual
hat's Happening to Me?"
Peter Moyle
Being touched and carcssed,
being massaged,
is food for the infant.
experience. It's sometimes ca.lled "playing
with yourself. " Girls use thet fingors to carcss
and rub their vagina and clitoris (a small but
very sensitive arca just above the entrance of
your vagina). Boys do the same with the penis.
Food as necessary
as rninerals, vitarnins, and proteins.
Deprived of this food
the name of which is love,
babies would rather die.
And they oft€n do.
How Your Body Works
Heman and Nina Schneider
$4.95 from
William R. Scon Books
Addison-W
es ley
Pub lishin g
Reoding, MA 01867
Meditation for Children
Dozens of nifiy ex.periments you con do
Deborah Rozman
at home to leam how your body works.
--TF
1976; 15l pages
M.95 postpaid from
Celestial Arts
231 Adrian Road
Millbrae, CA 94030
The
author-who
teaches meditation in
elementary school-shares her techniques
of teaching meditation to children, and
suggests sharcd family meditstion ss a
means to family unity ond understanding.
A fine intoduction-for adults and
chidren alike*to meditqtion cts centering, self-obsemation, growth.
_TF
1975; 55 pages
$8.45 postpaid from:
Lyle Stuan, Inc.
120 Eoteryris€ Avenue
Secaucus, NJ 07091
What's an erection? A wet dreom? A
period? Wlry am I getting lumps on nry
chest? What is masturbation?
This book is a good book for a child
about ten. It has answered a lot of my
questions about puberty.
Jenifur Thome (Age 10)
Taste Experiment
You will need: a slice of apple cut into thin
pieces, a small slice of pear cut into thin
preces. and a lnend any size. but not in pieces.
Try this. Tell your friend to shut his eyes.
Hold lhe piece of pear under his nose and put a
piece of apple in his mouth. Ask him what he's
eating.
You will find dlat he'll tell you it's a pear.
This shows that we use both nose alld tongue
to taste food. In fact, most of the tasting you do
is with your nose. Do you know, now, why
foods don't taste like much when you have a
cold in the nose and can't smell?

14. by the n+o sexes lead lo predictqble con-
Mid-Life
flicts within couples.
I was brought up to think of "adulthood" as a smooth , even highway between
the rough tail of adolescence aM the
dwindling roadway of old age. Not so.
Growing up is not-forrunatelysomething that stops at 2 I . Or ever.
(Out in paperback May, 1977.)
Passages
Cail
:TF
Sheehy
For the past fifty years, Americans
have
likely to break out of wedlock when
the man is about 30 and the woman 28-
nal valuations and accreditations, in search of
an inner validation.
***
Whatever counterfeit safery we hold from
overinvestments in people and instirutions
must be given up. The innercustodian must be
uqseated from the conrols. No foreign power
can direct our journey from now on. It is for
each of us to find a course that is valid by our
own reckoning. And for each ofus there is the
opponunity to emerge rebom, authentically
unique, with an enlarged capacity to love
ourselves and embmce odlers.
***
been most
***
How long can one delay adult cofiunihents
before becoming a failure? Judging by George
Bernard Shaw, it is possible to be a no-count,
disagreeable wanderer, inwardly toment€d by
cowardice and pcrsonal shoncomings, at least
until the age of 30. . . . this long period of
unfettered exploration allowed for ttle filling
out of a personality dlat thcn burst fonh to take
is place among the world's great aristocrats of
idiosyncrasy ,
***
...
dte fonies, as wriier Batbara Fried so
succinctly capore dlem, are a time when it
se€ms no matter what course one has pulsued,
It is a paradox that as we reach our prime, we
also see there is a place where it finishes.
Men's Health
The Inner World of the
Middle-Aged Man
Peter Chew
"everything is tuming grey, drying up or
leaving home.
I Pa*
Avenue
New York,
N.Y.
10003
The author crackd up-briefly---at
age 35, and discovered that many of het
contemporaries had had similar experiences at the same qge. This led her to
research the crises ths1p6sv7-u'ith sta7l-
ling regularity---at specific times in adult
l,fe.
Finding a mushrooming research literature on adult dzvelopmental stages, she
versed herself in the writings of Else
Frenkel-Brunswick, Erik Erikson, Daniel
Levinson and others , then went on to verily
ond flesh out their speculations by doing
her own in-depth intemiews with
I 15
qdubs beth,een 18 and 55.
The result is
a
beautifully wrinen
thoughful book on common
r**
Very recently in America, Masters
and Johnson have indicated that thc man of60
will find geatcr sexual contentsn€nt if on two
out of thre€ occasions, he reserves his ejaculation a.ltogether. ln thai way, s€xual tension will
accumulate to a climax wonhy of his expectations. A.lthough this notion is only now being
$10.95 postpaid from
E.P. Dunon & Co.
20
"
liJe
,
problems,
gingerly advanced in this country, in Oriental
cultur€ it has been the ideal.
***
Cad Jung was the first major analytic thinker ro view middle life as the dme of maximum
potential for personality growth. We yearn at
that time for the undividedness of self that has
always been lacking. As the hop€ of finding
security in another valishes, the conflict is
brought to a head. Cons€quently, mary of our
archetypal imag€s of "feminine" and of "masculine." images we unconsciously project
upon a mate, can b€ withdrawn. Jung ialks
about the necessity
to "confront our
own
conFas€xual aspect" and to integrate it, which
makes possible an extraordinary enrichment of
all experience.
***
Thc most important words in midlife areto you. Let it happen to
seen in a context of normal aduh development. Sheehy' s biggest individual contibution is to juxtapose studies of men and
your partner. L€t the feelings,
women-tnost studies have considered
you leave on the midlife journey. You
either one or the other---4nd to point out
how the difrerent life tajectories followed
l€t Go. l,et it happen
l€t
the changes,
You ca['t iake everything with you when
are
moving away. Away from institutional claims
and other people's agenda. Away from exter-
19761'
278 pages
$t.95 from
Macmillan Publishing Co.
866 Third Avenue
New York, N.Y. 10022
C o mmo n p ro b I e m s ---<nd s o lut i on s----ts
experienced by men between 30 and 60.
The sudden md-life stockiaking thqt lead
men to sail ocross the Atlantic alone, to
run offwith their secremries , to walk away

15. MEDICAL SELF.CARE I5
from secure but deadening jobs , to become
hermit-monks----or to Jind new meanings in
c ontinuing exist in g patt e r ns.
H ealth problems. Impotence problems.
Rehtionship problems. Employment
problems. Waking up at 40 to discover you
have no friends beside your wife. Seeing
yourfriends have heqn attacks and realizing that your eating, smoking, snd exercise habits mak you a high-risk candidate
for one of your own,
A much-needed look into the woes q.nd
opponunities of men' s lives.
_TF
The men hardly ever tell their wives they love
them. "I have reyer seen my husband cry," is
a familiar observation.
For thek part, the husbands complain thar
their wives are either unwilling or unable to
provide the kind of emotional suppon they feel
they require, Often, says Heath, the men reach
out rather desperately for their daughters.
"I was puzzled, too, by the large number of
men who had not made any close friends since
college," says Heath. "The typical pattem is
to be exclusively preoccupied by work and by
one's family. One psychological consequence
may be that the burden offulfilling one's needs
for intimacy, emotional release, and support
falls very heavily on one's wife."
During a young man's striving for success,
he must repress rnany qualities that are associated, righlly or wrongly, with the feminine.
Women's Health
they evoke. Afterwards, one of the nurses
goes through the extrqcl, counting head,
thorax, trro arms, and two legs----to
remsrkable reporring. The scene is captured whole----<tched with q rqzor knife.
The inticacies
patient. The strqnge atmosphere somewhere between that of a birth and a
funeral.
Beyond the polarization ofpto qnd con,
this book provides us with the visceral dato
we need to Iully recognize this tvw Life
Experience which has taken place beside
birth and dying--+he deeth-in-birth of the
abortion.
"Hi," I say. "l am DoctorDenes,Iam her€
." I am stuck. These are very pEgrxrnt
to . .
In
Necessity and Sorrow
Magda Denes
***
offt
I take the lid off all the buckets. All of them.
reach up to the shelf above this bucket
graveyard tabletop and take down a pair of
I
forceps. With them I pull aside in each bucket
the placenta, which looks like a cancerous
rnusl[oom sbrouding the fetus. With the forceps I lift the fetuses, one by one. I lift them by
an zum or a leg, Ieaving, as I retum them
again, an additional bruise on their purple,
wrinkled, acid-soaked flesh, I have evidently
gone mad. I carry on the examination, whose
sole pupose by now is to incrcase the unbearable anguish in my hean. Finally, I lift a very
large fetus whose position is such that, rather
than is face, I first see its swollen testicles and
abnormally large stiff penis. I look at the label.
Mother's name: Catherine A&ins; doctor's
name: Saul Marcus; sex of item: male; time of
between the life
***
For more than a decade, Heath has been
conducting a study of nearly seventy Haverford graduates who are now in their early- to
mid-thinies. Heath tells me thes€ men are
exceptionally intelligent, hard-driving, and
"successful" in their careers. Their marriages.
however, arc another story.
One-third of the men bave b€€n divorced or
have suffered disruptive marital difficulties
such as separations. The wives' almost unanimous complaint is that (heir husbands give so
much of themselves to their work ftat they
have litde emotiona.l substance left for them.
children. My shock is unclasssifiable. It is not
moral indignation, not compassion, not identification, not horror, not anything I can name. lt
is an organismic response ofparalysis. As ifby
a blow in the solar plexus, the wind has been
knocked out of me. Abortions in my mind
happen to grown-ups who arc unwillingly
pregDant but don't look it. These are little girls
far gone with child.
***
thinks that if he gains the deserved success,
he'll be all set. The answer is, he will not. He is
going to have a transition whether he is affirmed or not; it is only the form thar varies.
"The central issue is not whether he succeeds or fails in achieving his goals. The issue,
mther, is what to do with the experience of
disparity bewtee'' wbat he has gained ir an
inner sense from living within a panicular
structure and what he wants for bimself. The
serNe of disparity between 'what I've reached
at this point' and 'what it is I really want'
instigates a soul-searching for 'what it is I
really want.'
"To put it differently, ii is not a matter of
how many rewards one has obtained; it is a
matnr of the goodness
between
_TF
"The midlife transition occurs whethe! the
individual cucceeds or fails in his search for
affirmation by society. At thirty-eight he
structure and the self."
of interaaion
male doctor and all-female attendants and
During his soul searching at midlife, these
"other voices" in "other rooms" of the per-
sonality, as Truman Capot€ put it, demand to
be heard. The man who has aligned his personal destiny with the corporate purpose of,
say, BM or Genenl Motors, or Amalgarnated
Widget, rarely has the time or the inclination to
pursue music, art, philosophy, science, religion*the things that will provide the purest
happiness in later life.
be
sure there are no body pqrts lefl insde the
uterus to cduse infection.)
As notoble for its fne writing as for its
19761'
247 pages
$10.fi) postpaid from:
Basic Books
l0 E. 53rd St.
New York, N.Y. 10022
A journal by a woman who retumed to
the scene of het ow, abortion and spent
seyeral months observing the process she
herself had just gone through.
(l've assisted at enough of these occassions to recogniTe the peculiar Jeelings
gestation: twenty-four weeks. I remember
Catherine. She is seventeen, a very prEtty
blond girl. Not very bright. This is Master
Atkins-to be bumed tomonow-who died
like a hero to save his mother's life. Might he
have become someday the only one to truly
love her? The only one to moum her death?

16. 16
MEDICAL SEI,F.CARE
Medical Self-Care
Awards 1976
.-srli5x:3t*
We've had a number of suggestions-from librarians
with limited budgets among others-that we print a list
of the best ten popular medical books.
Seems like a good idea. We like the thought of encouraging the writers and publishers who produced
thesebooks. For libraries interested in sefting up selfcare collections, these might be a good start.
The books we've chosen are the ones we're getting
down from the shelf to show to friends. A number of
books have unaccountably disappeared ftom our ffices
recently-all of them from this list.
We'it be making these awards annually. This time
we've listed our favorites regardless of the year of pub'
lication. In years to come, we'Il limit ourselves to new
books published within the preceding year. , - , Heie are the books that received Medical Self-Care
Awards for 1976-for excellence in writing and publishing in the area of medical self-care.
rbtrffi
Doctor
C.-@"0_
rrtalitlwS€luct,ld.D
fuldrjLdq
I
How to Be Your Own Doctor
(Sometim€s)
Keith W. Sehnert, MD
with Howard Eisenberg
$lO.7O from Crosset & Dunlap, Inc., Box 941
Madison Square Station, New York, NY 10010
How to go about becoming Your otn
paramedic- Differs fron most medicql
guidebooks in that it assumes that the
reader is capable of learning some basic
clinical medicine. An enjoyable, highly
readable work that will take you safely
across into territory you msy have thought
of as for doctors only.
P11511n76Y6!f!lnc
lbwtll
Take Care of Yourself: A Consumer's
Guide to Medical Care
Donald M. Vickery, MD
James
F.
Fries, MD
$5.95 hom Addison-wesley Publishing Company,
Reading, MA 0186?
of this book is 68 biq' detailed
flow-chorts--4ne for each of the most
The heart
common complaints that bring peoPle to a
doctor's office. Key questions are listed
for each. A system of branching logic
-helps
you decide whether to ( I ) see doctor
NOW, (2) see doclorwithin afew days' or
(3) apply home treotment.
The best home medical guidebookwe've
seen.
o tJ:].drn o
5^1.€y.boxo
Personal Health Appraisal
Walter D. Sorochan
$5.95 from John Wiley & Sons, 605
Avenue, New York,
NY
Passog€s
Gail Sheehy
Third
10016.
Self-administered workbook for evaluating your own present heqlth starus, by a
professor ofhealth educqtion at Son Diego
State.
Finding areas in your life thqt coud
beneft lrom some anen ion. Taking responsibility. Making changes.
$10.95 from E. P. Dutton, 201 Park Avenue, New
York, NY 10003
A well-written account of adult stoges ol
development, and the predictable life
problems that accompany each. A muchneeded road map to the nngled web of
mid-adulthood.

17. MEDICAL SELF-CNIE 17
OIIR BODIES.
OURSELVES
The Joy of Running
Thaddeus
The Relaxation Response
Herbert Benson, MD
Kostubob, MD
$3.95 from J. B. Lippincoit Company, East
WashirEton Square, Philadelphia, PA 19105.
Running
for your health. Not grueling,
forced pushing yourself beyond your lim-
its, but running slow and long and peaceThe author, a psychiatrist and dis-
fu|.
a
tance runner, kads you through
sequence oJ pltysical and psychological con-
Our Bodies, Ourselves
$1.95 from Avon Books, 959 Eighd Avenue,
$4.95 from Simon and Schuster, 630 Fifth Avenue,
Boston Women's Heahh Book Collective
New York, NY 10019.
Meditation in clear, plain language. Its
hismry, how to do it, what it does for you.
By a lrypenmsion specialist at Harvard
Medical School.
New York, NY 10020
A new edition of an old favorite. A readable, personal, down-to-eorth Buide to
physicql, emotionol, and social aspects of
women's health. Treats women as whole
beings deseming of personalized medical
care.
ditioning.
The best introduction to running we've
seen.
Howlo
(&REcocnipl
HiohQuolitv
HdolthCor6
D6mornd
ARTHUR
The People's Pharmacy
tMN, M.D
Joe Graedon
Talk Back to Your Doctor
Arthur Levin, MD
$8.95 postpaid from Sr. Manin's Press, l?5 Fifth
Avenue, New York, NY 10010
$7.95 from Doubleday & Co., 245 Pa* Avenue,
New York, NY 10017
Type A Behavior ond Your Heart
Meyer Fiedman, MD
Roy H. Rosewnan, MD
$2.30 from Fawcett Publications, Greenwich, CT
06830
The most readable and helpful bool<s,
prescription and non-prescription drugs
for laypeople. By a pharmacologist who
knows his sttfi and shoots from the hipAccessible, readable, useful information,
well-indexed and well-documented -
The principles oJ good medical practice,
clearly spelled out. Evaluating
d.octors
and hospitals. Changing physicions when
necessary. Seeking a second opinion.
Knowing what your doctor iJ supposed
to be doing. Being an informed medical
consumer.
How personality factors can increa:te your
chances of hean disease. Speedy, impatient, highly competitiye, easily irritated.
men are at increased risk. This book tells
Type A men how to reduce their risks by
slowing down, becoming less competitive,
leaming patience.

18. 18
MEDICAL SELF.CARE
Medical
Whoever or whatever causes you to s€ek
help does not really matter, but therein does lie
an important fact )o! are a goodjudge ofyour
own mental heahh. That is not to say that you
Consumerism
have all the answers, know all the caus€s
and/or effects, or can chalge your behavior
The Corxurner's Guide to
Succcssful Surgery
Dr. Seymour Isenberg
Dt. L.M. Ehing
and
without help. But you do have a good reading
on how much difficulty you have coping witlr
thg situation and circumstances of your life.
The validity of your appraisal of your own
mental health has an important corollary: yon
are the best judge as to whethcr therapy is
worthwhile.
Through The Mental Heahh Moze
Health Research Group
List of Publications Free from
Health Res€arch Group
D€parEnent P
2000 P Street, N.W., Suit€ 708
Washington, D.C. 20036
-from
***
This is the health wing of Rolph Nader' s
consumer rights organization. They put
ou, dozens of valuqble publications in the
area of medical consumerism. Our
Checkbook Health:
favorites:
D.C. ) metropolitan area,
A guide to heahh care in the (washington,
for Compiling a Consumer's
Dircctory of Doctots ($l .0O)
Guide
-A Guide for Compiling a Consumer's
-A
Direcrory of Dentists ($1.00)
tle Mental Heal t Moze:
-Through
A Consumer's Guide to Jinding a Psychotlrcrapist, Inclu.ding a somple Conssmcrtherapist Contraa ($2.50)
--fF
1976;341 pages
$10.m postpaid from:
St. Martin's Prcss
175 Fifth Avenue
Preliminary Rcserrch
Compile a list of licensed, practicing docton. Consult the yellow pages to begin to
compile the list of practicing physicians and
New York,
their addr€sses and telephone numbers in the
arca !o b€ surveyed. Beware, however, the
yellow pages may include names of indivi-
An insider'
and Washinglon, D.C.
as 'physicians' in the yellow pages wer€n't
even licens€d to practice medicine.
-A
***
The best way to publicize your manual is
through the rnedia. Call a press confer€nce and
disfibute a prcss package. lnclude copies of a
press release with the name and address of your
group and the location whcrc individuals can
buy a manual. l.€t the m€dia take if ftom herE.
Articles in local newpapen, time on local radio
stations and s€gnents on the local nightly
news should elicit heavy respons€ ft,om people
who want to buy tbe manual. Sell the manual at
the lowest cost possible, so all individuals catt
bave access to it, and so that iflitigstion should
develop you will be ir a better position to argue
that your directory des€rves legal prct€ction.
Think seriously about giving a discount to
Medicaid ard Medicare pstients.
-A
Guide
for Compiling
a
Consumers Directort oJ Doctors
look at what happens on the
opinions, and to thoroughlt understand
showed that as many as 5% of all persons listed
Guidc for Compiling a
Consumcrs Direcrory d Doctots
s
10010
surgical ward. What to expect in the way
of procedures aad routines. Encourages
you to review your own chart, seek other
duals who ate not licensed physicians. Surveys
in New Yo* City
NY
19761'
ll2
pages
$4,95 postpaid from
Washington Cent€r for the
Study of Services
19l0 K SEeet, N.W., Suite 303
what s happening before ogreeing to atry
surgical procedure .
Makes going through surgery sound as
scarey as it really it . Fascinating reading ,
even if you're not considering surgery.
Should be a help and a comfon if you are.
_TF
Washington, D.C. 20006
This excellent, unique health guide
devotes about half its space to listings of
local (Washington, D.C.) resources, the
other half to teaching general medical
consumer skills in eight qreas-Emetgency Rooms, Health Maintenance Orgoniza-
tions, Doctors, Drug Stores, Abonion
Clinics, Nursing Homes, Dentists, Healrh
Insurance. Vahutble whether you live in
D .C . or not.
A fine model for onyone thiniing about
puttinq together a local health directory.
-ljatha Hesselden
What about room locarion? Don't let them
slap you in inywherc. Get back there and look
at th€ room. Not all hospitals will be happy to
let you do this but you've every right to. lfit is
situated acrcss from the nurses' station-that
large round desk in the corridor that is head-
quaners for the floor-try to get it changed.
You may have the enon@us idea that the
closer you are to the nurses' desk, the better
carc you'll get. For some reason many doctors
also think this is true. What you'll get is
insomnia. Nurses arp noisy. They rattle metal
chart coverc, drop things, us€ the phone,
laugh, talk, and generally scamper around.
If
you want any peac€, the room fafihest from the

19. MEDICAL SELF-CARE 19
rlulses' station is for you. It takes as long for
nurses to answer a bell across the hall as down
These are the drugs about which most is
known. Thei side effecs and adversc reac-
each moment of their hospitalization. These
doclors schedule everything in advance, so
it.
tions have b€€n b€st and longest studied. The
best doctors will use thes€ "established" drugs
in preference to qewer ones, whenever they
that your day will not be idle for a moment-a
"must" at today's hospital prices of $ 100 or
more per day.
By the same token, try not to be put near the
utility room or the elevators. The flushing of
bedpans and general clatter of utensils and
elevators goes on all night. The idea s€ems to
the staff can't sleep, neither should
be
anyone else.
Ifyou're placed in a two-bed ward try to find
out what your roommate is in for. This is the
element least under your control, but if two
rooms are available aDd one has a chrcnically
ill, disoriented, noisy t€nant, try to get into the
othel one. Don't be a martyr.
You are entitled to get your room changed if
a Foblem develops or the room you originally
requested becomes available. Make sule the
if
admitting of{ice knows you would like lhis
done.
can.
You can hnd out whetlrcr any drug has met
the tpat of time, in terms of safety ard usefulness, by consulting the two official drug com-
p€ndia: rhe U.S. Pharmocopeia atd trc
National Formulary. Or look for the letters
U.s.P. or N,F. on the drug package and
package insert.
***
hinciple: You should
bewsre of atry doctor
who treats by iqie'ction.
This is particularly true if fte doctor is unwilling io tell you what he is injecting, or ifhe says
you need a "series of shots" to cure your
illness.
There are very few adult conditioN (with
of an acute asthma attack, heart
attack, and other real emergencies) which
requir€ injections. Diabetics necd injected
insulin. but they can be taught to give it to
***
Principle: You should obtein the opinioru of
at least two surgcons bcfort having surgery.
This is another way-Frhaps the b€st-to
prolect youselfagainst um€cded surgery, The
United Mine Worken fould, a few years ago,
that their members werc having too much
surgery. So the union instituaed this rulo-that
all operations be endoned by a pr€operative
surgical specialist's corsultation. The results:
75 per cent less hyster€ctomies, 60 per cent
less appendectomies, 35 p€I c€nt fewer
hemorrhoidectomies.
the exception
Talk Back to Your Doctor
Arthur Levin, M.D.
themselves at home. Patients
wid "pemicious
anemia" do ne€d monthly B
12
this is the only
disease
injections, but
for which Bl2
is
ne€ded-and it is a very rare diagnosis indeed.
Mercurial diuretics are inject€d drugs which
are useful in patients with hean failure and
fluid rEtention, These drugs, too, can be selfinjected, like insulin, aftq instruction. frey
should not be used as "diet" drugs, however,
With these and a few other exceptions (cancer chemotherapy, for example, and desensitization shots for various allergies) the use of
iojected drugs by a doctor in the long-term
EeaEnent of adults is cause for suspicion.
***
Hnciple: You should choos€ a hospital
which trrins interDs atrd re6idents and, if
ARTHUR LEVIN, M.D
possible, one which is slso rfriliat€d with s
medlc.l scbool.
ln the Ladies' Home Joulnal list of "best"
hospitals, all were "teaching hospitals"
(intems and resid€nts), and all except a couple
were medical school-affi liated.
Overwhelmingly, doctors
themselves
choose such hospitals for their own or their
families' care, And with good reason. In the
$7,95 from
Colulbia hospital sodies,
chances of getting
substandard carc werc more than three tines os
Doubleday & Co.
245 Pa* Avenue
N.Y. 10017
The pinciples of good medical core,
New York,
spelled out and expbined so that you can
judge the core you yourself receive.
The process of diagnosis, the standard
steps in a doctot's visit, Lab tests, seedng
a second opinion, going in for surgery.
Best book on medical consumerism
we've seen.
Iril
in hospitals without medical school ties.
Chances of getting substandard care go up as
you go down the hospital "p€cking oder.
"
***
If you csn, avoid etrtering the
hoGpitrl before treekends or holidays.
One hospital administrator I know suggests
Principle:
that Tuesday (or Morday night) is Fobably the
best time to enter the hospital. This,
he
kinciptre: In general, the oldest drugs sre
explains, is the time when the hospital, and its
staff, has rerovered from the weekend and is
probably most Foductive.
A hospital stay is not a vacation. The b€st
th€ saf€st ones.
doctors plan to ke€p their patients busy during
--TF
Health Activation News
$4.fi|/year from
Health Activation News
Center for Continuing Health Education
Box 7268
Arlinglon, V A 22207
News of medical education classes and
programs for lalpeople . They also publish
several medical self-care course guides
for
people interested
classes qnd
various locations to
care
in
teaching such
run regular workshops in
tain
health self-
cLesses.
The center also operates a "health sctivation network" thot motches people in-
terested in self-care with others in the sane
re commende d.
area. H i ghly
_TF
A Patient's Bilt of Rights
American Hoipital Association
Free from
American Hospital Association
840 Nonh l-ake Shorc Drive
Chicago, Ill. 6061I
Hospitalized patients do have cerrain
specified rights-though they aren't always aware of thetr the right to privacy,
the right to rerttse to be seen by those not
directly involved in their care , the riqht to
be informed, the right to refuse treatnent ,
the right tofollov,)-up care arter discharge.
This docwnent shouU be provided to
every hospitolized patient on admission.
rarely is. Bring tou own.
_TF
It
.

20. 20
MEDICAL SEI"F.CARE
I
that says "take five steps," but unless
Therapy/Growth
say
"may I?" I get put back or put mys€lf back.
After the session I tested my power, and that
kind of extended the sessior fufther . . . when
Kad wanted to read instead of going to bed,
alrhough not coming right out with ir, I did tell
him that there was something between reading
and deep sleep.
***
Every Day Gets & Liftle Clos€r
Imin D. Yallom and Ginny Elkin
Dr. Yallom: I've been in Ihis business a long
time, but the interview today represent€d one
of my peak experiences as a therapist . . . I was
near tean on a couple of occasions. It was so
good to se€ the fiuits of long and very hard
labor . . . all the issues that GiIlIly had talked
about with me, all the fears that were so irrational, all the things that she was afraid to say,
1974; 244 pages
0E.95 &om
Basic Books
l0 East 53rd St.
New York,
N.Y.
10022
A unique, two-sided record of
a
therapist-client rcl.ationship over a year
ond a half of weeHy therapy. Theropist
Yallom and client Elkin both kept sessionby-sesion journals which are printed
v,ithout addition or correction.
A realfceling ofthe offections and resistances and the nail's-poce but very real
she faced today
in the session, and has faced
on her own with Karl during th€ past
s€ven
days.
David Shapiro
.
.
***
Ginny: Yesterday's session . . . I begar
to feel
why I defear myself. I play the children's game
Fr-
***
Paranoid Style-Whlle the normal pcrson
feels not only competent, but also ftE€ to
exercise his will, and, in that sense as well,
self-directing, in charge of his own lifc, and,
master of himself, the paranoid person is
continuously occupied and concerncd with the
threat of being subjected to some extemal
cootol or some external iofring€ment of his
will.
***
DAVIDSHAPIRO
Frn'wrrrl bl
Where, for the normal person, autonorny
a sens€ of competency, pride, and
brings
liircrt PKnight
s€lf-rEspert, the paranoid person, instead, is
either arogant and ps€udo.competent or furtive and ashamed or, perhaps most often, bodr.
***
Glnny: I am v€ry on guard in session now. I
know you want me to Fobe my fe€lings
toward you . . . but I feel silly digging for
realistic .
andsatisfactions...
cognitively to r€spond quickly and is
highly susc€ptible to what is immediately
impressive, striking, or merely obvious.
***
things about my situation. And neither way is
values
soD tends
[rrd! Will
Wilh you I try to bc all bad, I say all the worst
superc€de it in subj€ctive significancc. Forcbearance, under these circumstanc€s, anounts
simply to the existencc of such int€r€sts ot
. In the absence of such highly
developed and stable structu€s, then, the
impulsive person's prevailing interests----{s the
patielt with the fallout supply kit idea illus!'ates-arc dL€cEd toward immediate gains
longed searching for detail, the hysterical
which is to get at some things, although I
wonder if I wasn't just Eying to imprcss her,
tying to make her fall in love with me. Good
***
frusuation or extend beyond the whim and
tively lacking in sharp focus of att€ntiotr; in
contrast to the compulsive's active and pro-
Dr, Ydlom: I was very good today. It's
Ginny: With Kad I ry to be dl good, simultaneously storilg my mistakes in my brain.
interest€d in things; his heart is set on goals atrd
intercsts that are indeperdent of the immediate
Jionr'.rric. In contrast to 0re active, intense, and
sharply focused attention of tbe obsessivecompulsive, hystedcal cognition seems rela-
Neurotic Styles
almost as though I am performing in ftont of an
audience, The audience that will rcad this, No,
I gu€ss that isn't completely tuo-now I'm
doing thc very thing I accuse Ginny of doing,
them. I've always been honest in saying what
I'm thinking, but all I've really b€en is the top
part of the flower, and never crawled under the
din and exposed roots. My sincerity is pretty
superfrcial.
Impulsive Style--Tlrc normal person "tolerates" frustration or postpones the satisfaction
of his whim at least in part be.cause hc is also
***
-:IF
sky . . . Here I am trying to h€lp Cinny with
survival problems and I'm still burdened down
with my owrl petty vanities.
JF
Hysterical Styl€-ln a word, it is inpres-
progress of ongoing therapy.
I never be frce of that? No, it's still
there. I have to ke€p an eye on it. What do I
want her to love me for . . . Is it that I want to be
known by Ginny as tbe person who cultivated
her talent? TherE is some ofthat.. At one point I
caught mys€lf hoping that she would notice
that some of the books in my bookcase were
nonpsychiatric ones, O'Neill plays, Dostoev-
Insights into the behavior pattems of
friends and associates, and, less confortably but more helpfully, ourselves.
1965; 207 pages
$3.95 fiom
Harper & Row
l0 East 53rd St.
New Yotk, N.Y. lm22
A psychoanalyst describes four
com-
mon personality styles----obsessive-compulsive, paranoid, hysterical, impulsivegiving us a feeling of how each person
experiences the world. A rare psychiatric
textbook, in that it gives useful information
on people on the pretty-much-rnrmal end
of the sane-crazy continuwn.
Obsessive-Compulsive Sryle-Will power,
so characteristic of the obsessive-compulsive
and so adaptable to routine work activity, is
comprised exactly of the experience of issuing
willful commands and dLectives to oneself.
This style of activity and expedcnc€, it will
be clear, also implies a special kind of selfawar€ness, an awarcness of the overseer sitting
behind and issuing commands, directives, and
reminders, that the obsessive-compulsive person is never rvithout. It is the s€lf-awareness of
who is working und€r plessul€ with a
stopwatch in hand. Since, for the obsessivecompulsive, virtually all of life is trarsfomred
into such activity, the experience for him is
continuous. We s€e this, for example, in the
role-playing that is characleristic of these peoa person
ple.

21. MEDICAL SELF.CARE 2I
Dying/Grieving
Gramp
Matk Jury and Dan
Iury
Frank Tugmd
and his grandson,
Dan Jury, 1954
1976; 152 pages
$5.95 postpaid ftom:
Grcssman Publishers
625 Madison Avenue
New Yo*, N.Y. r0O22
The record of a family' s experience up
m and through the death--at home----of
their grandfather. Horrible, wonderful,
of
for
and compelling. A big accessible chunk
stttf our cuhure doesn't prepare
very well.
us
There have been lots of good books
abofi death . This is a gut-level illustated
record of the thing itse$.
--TF
A diary ofa nan whofinally dies. A very
frealcy book. The first time I read this book
I
got freaked
just looking at
the pictures.
Dan Jury and his grandfather, Frank Tugend, 1974
They are pretty heavy.
-Jenifer Thorne (Age l0)
The simplicity of Gramp's life style tended
minimize difficulties he might have had with
"forgedulness" and conftrsion. Essentially a
loner, he spent his days chopping wood and
to
keeping up his Foperty, or taking walks in the
surrounding woods. When he was with others,
it was usually his family-who saw him every
day and didn't really notice, or comprehend,
lhe changes that were taking place in Gramp.
***
Granp's bizare dressing habits, coupled
with his erratic behavior, meant the end of
friendships that had remained intact for
decades. Most p€ople who had known Frank
Tugend as a r€spected, proper pillar of the
community just couldn't take being around
him as he shuffled about in his wife's red
velvet hous€coat or blew his nose loudly on a
pair of Nink's underpants that he'd found and
decided !o use as a handkerchief.
Nan was deeply affected by the oso-acism.
"Peoplejust don't want anything to do with us
because of Gramp, " she said bitterly ot Chdstmas day, when none of the usua.l holiday
visitors showed up.
***
The momings were the most difficult time
for Gramp. ln contsast to the frenzied activity
of the right, by moming he often s€emed in a
dazp. When he didn't respond to her wake-up
call one moming, Nink became frigh&ned and
exclaimed, "Dad! Dad! Wake up! Arc you all
right?"
Gramp rolled over, barely opened one eye,
kill the Easr€r Bunny
and said, "Did they
yet?"
***

22. 22
MEDICAL SEI.F.CARE
Blders
Aglsm is the notion that people cea!€ to be
people, c€as€ to be the same people or beaome
people of distinct ard inferior kind, by virtue
of having lived a specilied number of ye3.rs.
Like racism, which it r€s€mbles, it is bas€d on
fear, folkw€ar artd the hang-ups of a few
unlovable people who propagat€ these. Like
it needs to be met by information,
contradiction and, when nec€ssary, conftontation. And the people who are being victimized
have to stand up for tbemselves in order io put
it down.
racism,
A Good Age
Alei Comfort
***
AIFJ(COMFORT
'Thisbookisnntonly
old^ All wnplp, of all
oUeS wed tlw basfu, facts Thnse
nuu dt
rrsttix,e stmlqies
Tlnse wt yet calkd old, need tn
rcalin whnt is in sfuv fn tlwn
fur
th,e
w
M
iftlwlatthiw
***
Digrity.
Stand or this. (See Pulling Rank-)
other people don't recognize it, put them
dowD---othd oldcr people d€pend upon the
degee ro which you ensure that anyone who
thoughdessly displays agism doesn't get away
with it.
fo Ursula K. Le Guin
The menopause is gobably the lcast glamouous topic iDaginsble; snd this is bterEsting, bccausc it is onc of thc very f€w topics to
which cling some shrcds and rpmnants of
The best, mott accessible work on thc
lrboo. A s€rious mentiotr of
menopausc is
facts and fiaions of oldncss.
usually met with uncasy silcncc; a sD€ering
rEfetEncc to it is usually met with r€lievcd
author pf T'Ilc Joy of Sex Alcr Comfon
makes it cleqr that a good deal ofwhat we
think of as aging is not biological but
social, psychological, and political. Certain roles aad pat erns are imposed on
sniggers. Both the silcnce ald the sniggering
ar€ prctty sure iDdicstio[s of taboo.
Most people would considcr the old phrasc
"changc of life" a euphcnism for thc rD€dic8l
term "mcnopsus€," but l, who am now goitrg
thrcugh the change, bcgi! to woodq if it isn't
the othcr way round. "Changc of lifc" is too
Novelist, poet, gerontologist, and
people wlo have been around longer thon
some of the rest of us . They are arbitaily
.defned as unintelligent, unemployable,
cra4t, and asexual despite oll evidence to
the contrary. Dr. Comfort calmly suggests
revoh
-
Beautifully designed and illustrated
with portraits of robust oldsters. A fine
marshalling of faas convinced me that a
good deal ofwhat I' d believed about oging
was nonsetute.
In the long view, there are no young.
Only the now old and (myself included) the
new old.
_TF
blunt 8 phrasc, too'factual. "Mcnopsu!.,"
with its chie€-suggestion of a merc pause aftcr
which thitrgs go oD rs beforc, is reassurirgly
rivial.
But the change is not trivial, and I bqgin !o
won&r how many women atr bravc cnough to
carry it out whole-hcartedly. Thcy give up
their rcproductive capacity with morc or lqss of
stuSglc, and wh€n it's gon€ rhcy think thar's
all thcr€ is !o it. Wcll, at lesst I dor't get thc
Cursc any more, tbcy s8y, and the only rEason I
felt so deprrss€d somctirncs w8s hqlroDcs.
Now I'm myself again, But this is to ev8de thc
rcal challenge, and to loi€, not ody tbc crpscity to ovulate, but thc opportunity to b€conF E
Crone.
a
ptactic€. They had alrcady changed their life
radically once before, when tbey ceased to bc
virgins and became maturc women/wivcs/
matons / mothers / mistresses / whores / eic.
This changc involved not only the physiological alt€rations of puberty-6e shift ftom bar-
ten childhood to ftuiffil maturity--$ut
I
socially rccognized alterstiotr of b€ing: a
change of condition ftom drc sacr€d !o the
With the secularisation of virginity
now
complet€, so that the once awesome tcnn
"virgin" is now a sneer or al best I slightly
dated word for a penoo who hasn't copulrt€d
yet, the oppofiunity of gaining or rcgaining the
dang€rous/saqpd cordition-of-b€ing at th€
Second Change has c€ased to be appstlnt.
Vfugirity is now a mere pt€amblc or
waiting-room to be got out of as soo! as
possible; it is without significance. Old agc is
similarly a waiting-room, wh€rE you go sfter
life's over 8nd wait for cancer or a stoke. Thc
years before and after the menstual years are
vestigial: the only meaningfrrl condition lcft to
women is that of fruifrrlncss. Cu.iously, this
rcstiction of significance coincided with the
development of chemicals and instuncDts
which make fenility its€lf a mcrdngless or st
least s€aondary characteriltic of female matur-
ity. The signilic&ce ofmaturity now is not the
caprcity to cooceivc but the mcr! ability ro
have sex. As this ability is sharcd by pubc8-
On Menopause:
The Space Crone
$9.95 from:
Crown Publishers
34 Englehard Avenue
Avenel, NJ 07001
accepted thc challenge. Thcy had, after aU, had
profane.
Ther€ is a slight positive rElation bctween
industial productivity and wor*er age, and
older workers have a 20 Frcent better abselteeism record than yourger workers. They also
have fewer disabling and non-disabling injuries, and the fte4ucncy of accidents docreases
with age. At this point convention decr€es that
we stop employing them.
If
In the old days women who survived long
enough to attain the menopause morp oftcn