Dear Ann Landers,
he mother who discovered pictures of nudes under her son's bed and plastered them on the living room wall was guilty of a cruel and insensitive act. Your ap-plauding her left me disappointed and mystified. I have read your column for several years and I know you are not a cruel and insensitive woman. I can only conclude that you were unthinking in this instance. It is not easy for a boy to deal with adolescent sex drives. Add to this the problem of a mother who makes him feel guilty and you have a very mixed- up kid. Here is a mother who, while snoop-ing no doubt, seized on what she thought was a challenge-in the form of "other women." She then displayed her find in a manner calculated to in-crease his guilt and bare his most se-cret emotions. Because the boy was embarrassed and tore the pictures down, she thought she had taught him something and "won a victory." All she did was fill the boy with re-sentment for her lack of consideration for his private feelings. Too bad you didn't tell the mother, and ALL mothers, that collecting girlie pictures is not uncommon, that such pictures are a source of stimulation for immature males and when the boy grows up to be a man he no longer needs his paper dolls. BEEN THERE.

DEAR BEEN,
Thank you for setting me straight. You, of course, are right, and I appreciate your letter. Posture What is it? Posture is the relative position of the movable parts of the body. Good posture depends on the correct alignment of these parts, or the way you hold yourself. This has a tremendous effect on your figure, your health and the impression you make on others. How to test posture: Stand in front of a full-length mirror, in the nude, and look at yourself sideview. A hand mirror should be used. Do your hips swing out in die back, or does your abdomen protrude? Do your ribs sink down and in? Do your shoulders round, or does your chin jut forward? Any one of these is a sign that you are not posture-perfect. Also imagine a straight line drawn from the middle of the ear down to the floor. It should pass through shoulder, hip, knee and end over the front of your foot What to do: Most people never think about how they hold themselves and therefore have no defense against the downward pull of gravity and fatigue. It is of prime importance to learn how the body should stack up and to get the feeling of correct posture. Then you can check many times during the day on the way you carry yourself. Poor posture cannot always be corrected immediately. For instance, if shoulders have been rounded for a long time, the chest muscles will have shortened and the back shoulder muscles will have stretched and weakened. If the condition is extreme, the chest muscles must be stretched and the shoulder muscles strengthened with exercise before good posture is possible. If the abdominal muscles have protruded habitually they may be too weak to pull the abdomen in and hold it there. Abdominal exercises will be necessary. Here is one of the best: Pull the abdominal muscles in toward your back-bone as far as possible and hold the contraction for a slow count of six. Do this several times during the day. Try to do this: Stand with feet pointing forward, weight evenly divided. Pull your abdominal muscles in and up and tuck your hips under. Lift your rib cage and straighten your spine all the way. Shoulders should be down and back but be sure they are relaxed. The knees should also be relaxed. The chin should not protrude forward or duck into the neck. Hold it parallel to the floor. Feel as though you are pushing gently toward the ceiling with the top of your head. Body weight should be forward, not back over the heels. When walking, assume the same posture and swing the legs straight for-ward from the hips, not from side to side. Knees should not be hyperex-tended at the end of each step. When sitting, the hips should touch the back of the chair and the spine should be straight. If it is necessary to lean forward toward a desk or bench, lean from the waist. Do not round the shoulders. Effects of posture on figure: Fat and bones and muscles make up the figure, but habits in posture are constantly molding it into the shape it be- M)mes. Poor posture can cause a double chin, creases in the neck, a dowa-ger's hump (the bump at the back of the neck), spinal curvature, swayback, round shoulders and a protruding abdomen. It can thicken the waist and take inches from the bust measurement. Exercises for a spinal curvature should be prescribed and supervised by an orthopedist. The effects of poor posture on health and figure are slow, treacherous and far-reaching. For this reason, training should be started early in life, at school and at home. By teenage the shadow of things to come in maturity are often plainly visible. Children and young people should be taught not to slump in chairs, or stand with the weight on one foot and the opposite hip thrust for-ward. They should not always carry school supplies with the same hand or slung over the same shoulder. Alternate. Effects of posture on health: Incorrect posture can damage one's health. It makes the work of the heart more difficult and decreases our intake of oxygen because it crowds the heart and lungs. It does not provide adequate support for other organs and causes prolapsus (downward slump of internal organs). This can lead to chronic fatigue, indigestion and constipation. The majority of backaches are due to weak muscles and poor posture. Improved posture means improved health. How your posture impresses others: Nothing creates such an aura of youthfulness as good posture. Wrinkles and gray hair lose their impact when the spine is straight, the chin is up and the walk is lively. One's mental attitude, his feelings about himself and others are often reflected in posture. Round shoulders and dragging feet, head ducked and eyes fixed on the ground, bespeak a lack of self-confidence and pessimism. Head up, ribs lifted and spine straight, say, "Hello, I'm glad to be alive and going places." credit: Josephine Lowman, author of the column "Why Grow Old?", Des Moines Register and Tribune Syndicate. Pregnancy The Last Month The last month of pregnancy can be very trying. There are psychological, physical and social stresses which come to bear on the pregnant woman. As the end of pregnancy approaches, concern about the outcome increases. "When will this pregnancy end?" "Will I be okay?" "Will the baby be nor-mal?" "Will I suffer?" Even such frightening thoughts as "Will I die?" or "Will the baby die?" creep into the woman's mind. These concerns are nor-mal. Every woman in this day and age is exposed to obstetrical horror stories by friends, radio, TV and the press. Since she can't close herself off from the rest of the world, the pregnant woman must endure and worry. A calm discussion with the obstetrician can do much to relieve a woman's anxieties. Often she will learn that her fears are normal. The vast majority of pregnancies turn out well for both mother and infant. Defusing a potentially frightening experience can be extremely helpful. Knowledge of what to ex-pect can go a long way towards alleviating fear. Added to a woman's emotional burdens as the pregnancy nears its end are the persistent inquiries about her condition, her size and her due date by well-intentioned family, friends, neighbors, sales clerks, fellow workers, etc. Ultimately, these solicitous inquiries make the woman feel as though some-thing might be wrong, and that the pregnancy will never end. One thing is certain: all pregnancies do end! Only 10 percent (one in ten) of pregnancies last more than two weeks past term. Only elephants carry a pregnancy for two years. In some cases, being overdue merely means a miscalculation of dates. In other cases, being overdue means that baby is being well nourished in utero and will continue to grow and gain weight. Rarely, the placenta (af-terbirth) may age, resulting in a lack of nourishment of the fetus which may be harmful. Modem obstetrical care includes techniques for monitoring the effects of being overdue and taking corrective measures when necessary. As the pregnancy progresses, the increasing size of the uterus adds to a woman's physical discomfort. She becomes big and bulky, as a result of which she feels clumsy and unattractive. Swelling of the legs is common due to pressure on the pelvic veins, gravity, and fluid retention. This is a normal phenomenon. Formerly, the swelling was thought to be indicative of the be-ginning of toxemia of pregnancy and was vigorously treated with diuretic agents (water pills). Now, it is recognized that edema (swelling of the legs) is not necessarily bad, and that the potential disadvantages of diuretic pills outweigh the advantages. To eliminate troublesome swelling, the simplest and most effective method is to stay in bed, off the feet, for twenty-four hours. While lying in bed, for physiological reasons, it is best to lie on one's side rather than flat on one's back. Since the large uterus presses the stomach up under the diaphragm, eating large meals may cause discomfort. Part of the stomach may actually be pushed through the diaphragm (hiatus hernia), causing regurgitation of acid which results in heartburn. This is aggravated when the woman goes to bed since when she lies down, the uterus can push the stomach through the dia-phragm more easily. Relief can be obtained by taking non-sodium-containing antacids (consult your doctor first). Sometimes sleeping propped up on cush-ions helps. Perhaps the most frequent discomforts of late pregnancy are due to the pressure of the baby's head on the inlet of the pelvis. This generally causes sensations of pressure on the bowel and bladder in addition to aching in the lower abdomen and upper thighs. It is a normal phenomenon of late preg-nancy. In most cities (and certainly in rural areas) many women live some dis-tance from the hospital. This poses the question of when to notify the obste-trician and start out for the hospital. Although no general rules can apply for everyone, the following will apply for most women: If there is a question about what to do, call your doctor. Remember, it is better to have gone to the hospital for a false alarm than not to have been there in time for the delivery. Since many obstetricians now do internal examinations to evaluate the con-dition of the cervix (mouth of the womb), your doctor may tell you just how quickly you should head for the hospital. In general, you should call if the water bag breaks, if there is vaginal bleed-ing or regular uterine contractions. In the latter part of pregnancy, women frequently have painless contractions (Braxton-Hicks contractions) which can be described only as a tightening sensation of the uterus. Real labor pains are generally regular in frequency and become more and more intense as time passes. Facing labor for the first time, you will hear all sorts of horror stories, but face it with confidence. Remember, for hundreds of thousands of years, the human race has been reproducing successfully. Under all sorts of conditions, in all climates, women have successfully borne and delivered normal chil-dren. Why not you? credit: Allan G. Charles, M.D., attending physician, Obstetrics/ Gynecology, Michael Reese Hospital. Clinical Professor, Obstetrics/Gynecology, Pritzker School of Medicine, University of Chicago. Pregnancy Test A new blood-serum test that can detect pregnancy as early as ten days after conception is gaining popularity. The Biocept-G test (or RRA for radio-receptor assay) measures the amount of a hormone called Human Chorionic Gonadotrophin (HCG), which is released when conception occurs. The test provides diagnosis of pregnancy much earlier than the conventional urine test, which generally isn't reliable until twenty-five to thirty days after conception. Chicago obstetrician-gynecologist Dr. Leon Carrow says the new test is an important medical find because it is more accurate than older tests (it is more sensitive to the patient's HCG hormones), as well as permitting earlier detec-tion of pregnancy. The test, developed by Birj B. Sexana, Professor of Endocrinology at Cor-nell University, involves taking a small amount of blood from a patient's arm. The blood serum is added to a test tube containing part of the ovary mem-brane from a cow and purified HCG with radioactive iodine that can be measured with a gamma counter. Then the mixture is incubated. If the patient is pregnant, her own HCG molecules will adhere to the mem-brane, displacing some of the radioactive HCG already present. If the patient is not pregnant, she will not produce HCG, and only the original hormone will be present on the membrane. Doctors who support use of the new test say it gives pregnant women the opportunity for earlier medical treatment. By indicating hormonal levels, the test also can give early warning of abnormalities such as ectopic pregnancy (which develops outside the uterus) and the woman can be told to expect a miscarriage. credit: Ann Landers. Sexual Behavior Sexual intimacy is an important part of the total lives of most couples. The need for this intimacy does not diminish for either partner during pregnancy or right after delivery, but the woman's sexual interest and responsiveness may decrease somewhat. Two common questions women ask about sex and pregnancy are: When is it all right to have intercourse while I'm pregnant? How can I keep my husband happy and sexually satisfied while Fm pregnant? There is no simple answer to the first question. Some obstetricians permit intercourse at any time during pregnancy until labor begins, so long as it is comfortable and acceptable to both partners, no uterine bleeding is occurring and the membranes have not ruptured. Before making a decision about her own sexual behavior during pregnancy, a woman should discuss the situation faith her partner and her physician. An exploration of new coital positions may be appropriate at this time, if the couple's usual positions are uncomfortable. There are some conditions, such as habitual abortion, that may necessitate limiting sexual activity. A recent study involved interviews with women who were admitted to the hospital in labor. They were asked when they last had intercourse. The ma-jority had their last contact within one week prior to labor, a small percent-age stopped six weeks prior to labor. Our thinking has changed, and inter-course is allowed up until the last two weeks-the reason for this prohibition is that the baby's head is low in the pelvis at that time and there is a mechani-cal difficulty. A few doctors still ask all women, regardless of their condition, to refrain from intercourse during the last two or three months of pregnancy. Many couples fail to follow this advice, which often leads to feelings of guilt and fear that their sexual activity might harm the baby. These feelings are unnec-essary since, according to recent findings, there is no medical reason for se-vere restrictions of sexual activity. Intercourse is allowed six weeks after delivery except where no episiotomy is involved-in that case four weeks is recommended. (An episiotomy is an incision made to ease the baby's passage through the vagina.) There is a story of the father of his firstborn asking a father who just had his sixth baby, "How soon after delivery is intercourse allowed?" The second father replied, "Is she in a private room or a ward?" Since pregnancy can occur again before the first menstrual period following delivery, a decision on contraception should be made before resuming inter-course. Many women become concerned about keeping their husbands sexually satisfied, especially during later stages of pregnancy. The romantic notion is that the relationship of expectant parents becomes increasingly warm and close as the day for baby's birth grows nearer. This may be the case in some relationships, but by no means in all. Masters and Johnson found that the majority of men interviewed did not understand or agree with the prohibitions placed on sexual activity by physi-cians. Many thought their wives invented the story as an excuse for avoiding sex, and several men reported having extramarital affairs during their wives' pregnancies. If the physician recommends abstinence or restraint in sexual activity for a certain length of time before or after delivery, the condition should be ex-plained to both husband and wife, thus avoiding unnecessary strain on their relationship. The couple should also be encouraged and possibly helped to communicate openly with each other about their sexual feelings and desires. Alternative forms of sexual gratification can be recommended. Oral-genital sex and manual stimulation can be satisfying and rewarding without physio-logical ill effect credit: John S. Long, M.D., American Board of Obstetricians and Gynecol-ogists, F.A.C.S., F.A.C.O.G.; Associate Professor of Obstetrics and Gynecology at Rush-Presbyterian-St. Luke's Hospital; attending obstetrician-gynecologist at Rush- Presbyterian-St. Luke's Hospital, Chicago. Premature Ejaculation Premature ejaculation is defined by Masters and Johnson as the inability to delay ejaculation long enough for a regularly orgasmic female to achieve or-gasm 50 percent of the time. Hurried or clandestine sexual experiences are often evident in the history of these men. To avoid being "caught" in their youth, they learned to ejaculate quickly in cars, on couches, etc. Later in life, when getting caught was no longer a hazard, these men discovered they were unable to delay ejaculation. Obviously, a man experiencing premature ejaculation or other problems in sexual functioning should check out his health first. He should also consult with his physician regarding any prescribed drugs he may be taking on a reg-ular basis. Some drugs used to treat illnesses, certain tranquilizers, along with alcohol and heavy smoking have been known to decrease sexual desires and performance. After having been checked out by a physician and given a clean bill of health, behavioral therapy is the treatment of choice. Hormone ther-apy and chemotherapy in the treatment of ejaculatory incompetence have generally been unsuccessful and often obscure or have nothing to do with the relationship problems within the marriage. In essence, the treatment of pre-mature ejaculation involves more than a shot of hormones and a reassuring pat on the back. There is no absolute scale against which to evaluate male performance. Obviously the male must maintain an erection long enough to reach climax. Beyond this it is difficult to judge prematurity in anything other than a rela-tive way, and within the particular interpersonal relationship Men are physically able to achieve orgasm within two minutes following insertion and most of our mammalian cousins are even quicker. Although it is impossible to set exact time limits to define normal sexual functioning, a significant number of men and their partners complain of inability to delay ejaculation until some degree of mutual enjoyment has been achieved. When orgasm occurs before penetration, the whole aim of intercourse may seem lost. The feelings of inadequacy, loss of masculinity, as well as the part-ner's frustration, can create a vicious circle that sets up both partners for fail-ure in the future. Rather than recognizing that adequate sexual interaction takes time, prac-tice and awareness of each other's needs and responses, the couple may blame themselves or each other for their lack of adequate performance. In-stead of enjoying what they are doing together, such a couple concentrate on how they are doing. The sexual interaction thus becomes a deadly serious game, with both partners keeping score. Chronic, premature ejaculation can produce serious marital conflicts. It is readily and successfully treatable, but sadly enough, few couples, and espe-cially males, seek therapy. Shame, guilt, anger and marital conflicts secondary to the sexual dysfunction often hamper the couple in honestly seeking help. Medical care stressing physical dysfunction and often treating the male via hormones can further complicate the problem. Using the term "premature ejaculation" to denote occasional instances, often caused by fatigue or tension, when the man "comes" sooner than the woman wishes, should be avoided. Belittling comments can increase anxiety and feelings of inadequacy. Behavioral treatment is simple and successful (80 percent success, in most cases). Apart from joint counseling of husband and wife, specific procedures developed by Semens, and elaborated by Masters and Johnson, may be in-cluded. This involved preventing the ejaculation by pressure on the penis, followed by a return to foreplay or reinsertion (the so-called "squeeze tech-nique") . Following reinsertion, there is a gradual increase in the male's activ-ity so that he may slowly experience and grow accustomed to the stimuli pres-ent. Should he then approach ejaculation, withdrawal and squeezing is again instituted, until greater confidence and "staying power" is developed. By means of successive approximations then, the male is trained to maintain erection without ejaculation for increasing periods of time. The first point demonstrated by these details is that treatment is direct relearning. The second is that therapy can only take place in an honest, open and supportive interpersonal relationship involving both husband and wife. Like dancing, sexual interaction is complex and requires mutual under-standing of the other person's feelings, responses and movements. All males experience at some point in their lives, or in some intimate rela-tionship, premature ejaculation. It is sometimes called "buck fever" . . . get-ting ahead of one's self or one's partner, passion or inexperience. Given the patience, concern and commitment that often accompany love, most males do learn that "nice guys finish last" ... or preferably . . . "together." credit: Henry F. Gromoll, Ph.D., Department of Behavioral Sciences, Mittikin University, Decatur, Illinois. Procrastination "The tide is running, The sails are set straight, You've dallied your hour So fish or cut bait." If to forgive is divine, then to delay is human. It is a universal trait attested to by the Latino's "manana" and to the Puritan's framed needlepoint maxim: "Never put off till tomorrow what can be done today." Most of these sayings equate delay with plain old-fashioned laziness. But in our experience, much true procrastination is not the fruit of sheer sloth so much as it is of indecisiveness bom of fear or uncertainty of outcome. An-other cause is ignorance or confusion about how to set about doing what needs to be done. Complexity, awkwardness, unpleasantness associated with the deferred task accounts for delay, as well. Most of us carry around a mental notebook, the last page of which is filled with a list of things we've been meaning to do, we should do and eventually know we must do, and somehow never quite get around to doing for one reason or another. It may be something as simple as putting off painting the garage because you hate working on ladders, or it may be avoidance of an overdue physical exam because you fear the results. Whatever, we tend to put certain things on the back burner. Unless it becomes an all-encompassing way of dealing with life-when there are more things added on the back burner than get done in the course of a week-there is nothing sinister about procrastination in and of itself. Sometimes, in fact, delay is a form of prudence. Circumstances change or problems solve themselves. What is dangerous about becoming a habitual procrastinator is the gradual diminishment of all priorities to the least com-mon denominator where all things deferred seem of equal importance-or lack of it. This can cause problems and pain. The unpainted garage will probably survive another winter but a delay in making out that will may cause count-less hardships for your family. The reconciliation, too painful to confront today, may come too late to save a friendship (or a marriage). The way to beat procrastination is to get at what is causing you to delay and label it honestly for what it is-fear of inability to do the job well, a dis-like for the job, not understanding the job or hostility against someone who requests the job done. Once you understand why you are procrastinating you may be surprised at how quickly you handle the priority items on that clut-tered back burner, and how much better you'll feel when you do. credit: Joel Wells, Editor of The Critic. From the newsletter You published by the Thomas More Association, Chicago, Illinois. Promiscuity The psychiatric definition of promiscuity is "indiscriminate, casual sexual en-counters, high frequency of sexual relationships with a large number of part-ners . . This definition should be kept in mind because the word promiscuity is often used loosely, particularly by parents who have yet to adjust to the new sexual freedom of the current generation. Sexual promiscuity is often the re-sult when a person lacks self-esteem or feels rejected. It is not abnormal sex-ual behavior by oversexed girls as is commonly thought. If one were to describe the classic sexually promiscuous boy or girl, man or woman, homosexual or heterosexual, one would point to a person who is sleeping around, going in for one-night stands in a compulsive search to sat-isfy some inner need. Unfortunately, most one-night stands are not sexually or emotionally gratifying since there is no romantic investment either by the partner who precipitated the encounter or by the object of the search. As a result, the longing for fulfillment is not satisfied nor will it ever be in these body-oriented rather than feeling-oriented people. We need not concern ourselves here with transient promiscuity, which is usually either a manifestation or an early sign of emotional illness, such as depression or severe neuroses. Hysterics or individuals with a high level of frustration from a number of causes often use sexual promiscuity to give them a sense of well-being and gratification despite the fact that they are al-most always short-lived. Ultimately, one way or another, usually because their needs are not fulfilled, and their level of frustration increases, they end up seeking therapy. Our concern here is primarily with the teenager or the young adult and how parents cope with what seems to them to be an unresolvable problem. First, parents should realize that promiscuous behavior, as with other un-acceptable behavior, which is repeated time after time, must indicate some deep need. This emotional deprivation may be a result of a lack of com-munication between parents and son or daughter. It is essential that parents be aware of this failing in themselves, painful as it is to acknowledge. Once you make an effort to establish communication, both verbally and non-verbally, you have overcome the first hurdle. Remember to be careful not to set boundaries and rules that cannot be en-forced. Talk to your child, but don't show anger or call names. This leads only to hurt feelings and frustration. Refrain from saying things that might make a child afraid-such as the dire consequences if he, or she, doesn't shape up. Appeal to his or her rational and better self. It is amazing how often acting-out can be helpful if it ends in talking-out. Patience, understanding, a non-judgmental attitude and, most important, your time are what the child needs. Offer this four-way therapeutic approach and the searching for emotional fulfillment will gradually pay off and the child's self-esteem will be raised. Note that the word "gradually" is under-scored. Don't expect a complete reversal of behavior because you've had one heart-to-heart talk. You must establish a feeling of trust over a period of time, so that your child will come to believe that you love her or him regard-less of what he or she has done. Remember the child who is least "lovable" needs love the most. You will find that what the child needs is not sex, but a feeling of personal worth. So many young girls-twelve, thirteen, fourteen-in search of the male attention that they desperately desire from their fathers, end up in the arms (and the beds) of young boys-or older men. Promiscuous husbands or wives in some strange way have the same prob-lem. They mistake sex for love and try to substitute one for the other. They want to be held by a man (or woman), to feel the closeness of another per-son. If parents didn't cuddle their children when they were little, they grow up emotionally deprived. Such a person rarely receives sexual gratification and almost always there is no emotional investment when he or she has sex with the spouse. In the case of the promiscuous married woman, there may be more anger than con-fusion. Her catting around may be to punish her husband for ignoring her or treating her more like a thing than a person. As in the case of the promiscuous child, the spouse should give himself or herself a month or two to find out the reasons for the other's behavior. There is no substitute for a good, heart-to-heart talk. If all else fails, the couple should consult a family therapist or marriage counselor. In the case of the child, the action is more complex. An appointment with a psychotherapist may be viewed by the child as punishment for wrongdoing. Outside therapy should never be forced on a child. If it is, you are wasting your child's time, the therapist's time and your money. It should be resorted to only if the child realizes his or her life is not going in the direction he wants it to go. If the child is unhappy (and promiscuous children are) they will almost invariably welcome the opportunity to discuss the problem with a "mediator" with whom he or she can communicate freely. Then, and only then will genuine progress be made. credit: Shervert H. Frazier, M.D., Psychiatrist-in-Chief, McLean Hospital, Bel-mont, Massachusetts, Professor of Psychiatry, Harvard Medical School. Prostitution Like everything else in our society, prostitution ain't what it used to be. There is a strong possibility that die reason for this is that amateurs have ruined it for the professionals. While most of the twenty-dollar hookers are still as busy as they want to be in the large cities, their clientele is vastly different from that of the call girl who charges $100 an hour-and up. Dr. Sam Janus, Clinical Assistant Professor of Psychiatry at New York Medical College, in his book A Sexual Profile of Men in Power (written with the help of psychiatrist Dr. Barbara Bess and Carol Saltus) makes it abun-dantly clear that the customers of the higher-priced ladies of the night (or morning or afternoon) are more interesting than the run-of-the-mill types who buy love at a cheaper rate. The majority of the customers are top poUti- cians and business executives. The conclusion is that the power drive and the sex drive are so closely linked they become inseparable. Most of the customers of the high-priced prostitutes are middle-aged to elderly married men who need reaffirmation of their power and youth. They need to dominate a woman, to make her do what they want. They are not able to exercise that power over their wives. Call girls are a superb alternative because they have the expertise, perform the required services and keep their mouths shut. A social friend may want an emotional relationship and there is always the chance that she might tell. Moreover, men who like kinky sex are more likely to get it from a prostitute than from a secretary or the wife of a golf partner. About 80 percent of all call girls are asked to perform oral sex. Many men in positions of power, such as politicians, want kinky sex, such as bondage, flagellation, etc. Some men who enjoy being whipped have told prostitutes that they feel the need to be punished for their "bad" behavior. Women from various socio-economic levels become professional prosti-tutes for a number of reasons. College girls, for example, earn money to pay their way through school. Suburban housewives and single secretaries con-sider it a lucrative part-time job that makes it possible for them to buy more expensive clothes or a new car. Liberal members of contemporary society whose motto is "If that's the way I want to make a living, it's my own busi-ness" no longer view prostitution as a fate worse than death. The average call girl who works for a madam considers herself much more "respectable" than the streetwalker who works for a pimp. She is of above- average intelligence and many have had one year or more of college. Her "career" as a call girl usually began when she was in her late teens or early twenties. The so-called "elite" call girls do not fit the conventional stereotype of the common hooker. They dress fashionably, travel "first class" and ap-pear as refined as the wives of the city's leading businessmen. Prostitution becomes more of an addiction than an option with women who make it a full-time job. In a three-year study tracing those who renounced prostitution, it was discovered that two thirds of the women who left the business for a year or more returned to it, at least part-time. Most prostitutes were sexually abused during adolescence. They often fail to make the connection between being sexually exploited by their fathers, brothers or mother's boyfriends and their chosen profession. They just grow up doing to men what men did to them. Instead of viewing themselves as vic-tims, they see their customers as victims who have to pay for services. Money and the sense of power their bodies give them are major motiva-tions for engaging in prostitution. Prostitutes have learned at an early age to relate through their bodies, which they consider "equipment" for command-ing money from men. They consider the faking of pleasure a type of manipu-lation of men who are duped into believing they are proving their mascu-linity through sexual performance. Though busy call girls in major cities can earn as much as $200,000 a year, very few save or invest the money they earn. Those who work for a madam get only 50 or 60 percent of the take. And there is a subculture of people who live off prostitutes. Also, in some cities there are police officers who have to be paid off, and doctors who take care of problems such as preg-nancies and bruised bodies. The doormen and bartenders and taxi drivers who steer customers their way must also be paid. Call girls who operate out of their own apartments often pay two to three times the normal rent so the landlord will keep quiet. It has been estimated that about 60 percent of the high-priced prostitutes prefer women as sexual partners for their own personal enjoyment. They tol-erate men but admit they get very little sexual pleasure when they have inter-course with males. Some prostitutes tell about regular customers who pay $100 an hour just to talk. They say they are lonesome (though married) and need to tell someone they trust exactly how they feel without fear of being laughed at, criticized or told they are crazy. This is a pretty sad commentary on the state of some so-called "successful" marriages. credit: Ann Landers. Material taken from A Sexual Profile of Men in Power by Sam Janus, M.D., New York, New York: Warner Books, Inc. Psoriasis THE SCALING DISEASE Psoriasis (pronounced so-ri-ah-sis) is a skin disease that affects at least one out of every fifty persons in the United States. This stubborn affliction remains something of a "mystery." Neither its cause nor its cure is known. It attacks both sexes equally, and most often appears between the ages of fifteen and thirty, although it may appear at any age. The person with psoriasis may be deeply distressed by his appearance. It is essential to know that psoriasis is not contagious and what once was consid-ered a hopeless, incurable condition can now be viewed as controllable when treated properly. Signs and Symptoms: The skin of the person with psoriasis appears as sil-ver or gray scaling, with red patches, usually on the elbows, knees, trunk or scalp. The underarm and genital areas also may be involved. The borders between the psoriatic patches and normal skin are usually sharp. The appearance may differ slightly in various parts of the body. The elbows, knees and trunk most frequently are the areas with the characteristic thick, red, scaling patches. In the scalp, red patches with sharp borders usu-ally are visible at the hairline. These shed large quantities of silvery white scales that resemble severe dandruff. When acute psoriasis is present, many small, raindrop-like sores appear. There may be a severe flare-up in which there is a painful reddening and cracking of the skin around the joints, chills and a generalized shedding of large areas of scaling skin. Patients with this form of the disease often need to be hospitalized promptly and given intensive treatment. Although arthritis may be associated with psoriasis, involvement of the vital internal organs does not occur. Thus psoriasis does not threaten or shorten the lives of those who have it The Cause: Although researchers have not discovered the exact cause of psoriasis, more is known about it than in the past. The development of psoriasis is thought to be inherited because it tends to occur in families. Not every person with this problem can recall blood relatives who have had the disease; however, at least 30 percent of patients are able to give a family his-tory of the disorder. Many of the factors that aggravate and set off an outbreak of psoriasis have been recognized in recent years. Several of these factors: Injury to the skin is perhaps the most common factor. A cut, bum or minor abrasion may "trigger" the appearance of a new lesion in about eight to eighteen days. Occasionally this phenomenon has been noted to occur in surgical scars, on severely sunburned skin and in scratch marks. Changes in the seasons commonly cause a variation in the severity of psoriasis. It often improves during the summer and worsens during the win-ter. However, in some cases, the opposite is true. General health factors may influence psoriasis. Many patients note flare-ups during periods of physical and emotional stress. Infections as well as certain medications used in the treatment of other diseases can aggravate psoriasis. Frequently a flare-up of psoriasis can be triggered by severe viral or bacterial infections of the upper respiratory tract. This has been particularly true following severe streptococcic infections of the throat. As in almost all skin problems, there is an emotional factor, and psoriasis is no exception. People who have traumatic experiences or whose life patterns are disturbed by disappointment, failure, unhappiness-or if something is getting under their skin-it can reactivate an old case of psoriasis, or trigger a fresh outbreak. Case histories of people who have psoriasis indicate that when their lives flow along tranquilly, the psoriasis improves or disappears. When emotional problems occur, the psoriasis returns. Treatment. The degree of the discomfort is a factor in determining the form of treatment. In many instances, psoriasis responds well to sunlight. Often time spent at the beach or outdoors, particularly during the summer, is the best single treatment available. Some patients find that the daily use of a sun or ultraviolet lamp will sus-tain the improvements for several months. However, if these lamps are to be used safely, the user must adhere strictly to the manufacturer's recom-mendations and the physician's instructions. Many serious bums have re-sulted from improper use of these lamps. Falling asleep under a sun lamp can be particularly hazardous. Many ointments, creams and lotions are available for the external treat-ment of psoriasis. Some require a physician's prescription, others do not. Most of these medications contain a variety of tar (distillates of petroleum) combined with other ingredients designed to remove scales. Shampoos, cleansers and bath oils containing tar are readily available without pre-scription. If these preparations cause irritation, their use should be discon-tinued and a physician should be consulted for further recommendations as to treatment. In recent years, dermatologists have used a number of newer approaches in treating stubborn psoriasis. Cortisones and the newer steroids when applied to the skin will give temporary relief. Some of these steroids can be injected directly into the lesion, and are also available as lotions and creams. Cor-ticosteroid creams and lotions have caused significant improvement, particu-larly when the treated areas are covered with thin plastic film wrappings. Therapy with tar and ultraviolet light often is recommended in addition to treatment with the steroid creams. When patients develop extensive and resistant lesions, it has been a com-mon practice to hospitalize them for intensive use of tar preparations and therapy with light. In crises of psoriasis, methotrexate is sometimes prescribed. This medica-tion requires careful and continuous supervision by your physician. Psoriasis is a common skin disorder. Some patients have "given up" after years of searching for a "cure." It is hoped that one day such a cure will be available, but until then, proper treatment by a competent skin specialist can provide very good control of psoriasis. credit: Eugene M. Farber, M.D., Professor and Executive Head, Department of Dermatology, Stanford University School of Medicine, Stanford, California. Samuel Bluefarb, M.D., Professor and Chairman of Dermatology; Northwestern University, Chicago, Illinois. How to Choose the Right Psychiatrist How do you choose the right psychiatrist for yourself, a family member or a friend? Because psychiatry is at least as much of an art as a science, the choice of therapist is vitally important to the successful outcome of psychi-atric treatment. The anguish that usually brings about the decision to seek psychiatric help does not normally favor a complicated selection process, yet the choice of the right psychiatrist is all-important. If one has a broken arm it will probably heal quite well even if we dislike the orthopedist who sets it. Even though we don't communicate well with our family doctor, he or she can be helpful in spite of the fact that we may tend to forget to take the pills, omit reporting recent symptoms and will generally lack the faith which could speed recovery. With a psychiatrist, however, the patient/doctor relationship (often called the therapeutic alliance) is a major factor in successful treatment. The thera-peutic alliance needs to be strong in order that therapy be of real benefit Often people who have made relatively poor connections with the key figures in their lives seek therapy. The first and often principal goal of psychotherapy is to learn to "connect" with the therapist. I urge the person seeking help to be specific in determining what kind of psychiatrist is needed. What personality factors have been important in help-ing this person in the past? With what kinds of people does he tend to be most comfortable? What kinds of people can he not stand to be around for very long? All these factors are important in the selection of the right psychi-atrist. Under special circumstances, one cannot be too choosy. For example, if the person needing help is suicidal, in a state of panic or in the middle of a nervous breakdown, it is imperative to get to a psychiatrist immediately-one who is geared to emergency treatment and able to hospitalize the patient if it is necessary. Problems with street drugs such as heroin or amphetamines usually require a specially trained psychiatrist. Most psychiatrists do not like to treat people with drug problems and tend to do poorly with them. Children are best treated by child psychiatrists or general psychiatrists who are skilled at meeting the special needs of children. A patient desiring a specific type of therapy such as psychoanalysis, should look for people who have the special expertise that these approaches require. There is also the matter of medication. Is the patient seeking a therapist who uses psychiatric medications, or one who avoids them? Another consideration is money. Psy-chiatrists are expensive and a great deal of time is required for psycho-therapy. Some Beverly Hills and Park Avenue doctors charge $100 for a fifty-minute hour. A range of $30 to $55 is common. Some problems can be resolved in a few sessions. Others take months or years. Medicaid is available to some people needing therapy. Others who neither qualify for Medicaid nor can afford full fees need to consider other options. Community mental health centers throughout the nation offer psychotherapy on a sliding scale fee ac-cording to what one may be able to afford. Non-medical psychotherapists such as psychologists, social workers, psychiatric nurses and ministerial coun-selors charge a smaller fee and can be excellent. It is highly recommended that a thorough physical examination looking for possible physical causes for the emotional distress be undertaken before ther-apy. If the psychotherapy is long-term or if the patient is not responding well, a repeat physical and possibly a psychiatric consultation to determine whether medication might be of help are indicated. It is important to select a psychiatrist whose personality is compatible with that of the patient. The psychiatrist who is fantastic for one's spouse may not be right for one's self. It helps to think of the kinds of people who have been supportive in one's life. It may be someone "just like Mom or Dad" or ex-actly the opposite. Some individuals need an articulate, verbal therapist Others should have a warm, outgoing personality. A quiet introspective ther-apist may be necessary for maximum trust and open communication in cer-tain instances. Is it important that the therapist be male or female? Is race important? Has the person seeking help been in therapy before? If so, did he get the help he needed? What factors does he or she think might make additional therapy more helpful in the future? Sometimes switching to a psychiatrist of the op-posite sex-or one with a different personality-can make a great deal of difference. The medical licensing board in your state can tell you if the therapist is li-censed to practice medicine. The psychiatric society and medical association can tell you whether the therapist is a member of those organizations. The high regard of his or her medical colleagues (such as your family phy-sician) tends to be a more sensitive measure of the psychiatrist's overall com-petence. How does one sort out and explore all of these factors? Several different avenues are possible. Most optimally a trusted matchmaker who knows you and also knows several psychiatrists should be consulted. It could be your priest, rabbi or minister, family physician, school counselor or a close friend. A friend or relative's referral to a psychiatrist with whom they had a good ex-perience tends to be trustworthy. There are often referral agencies in a community as well. The local medical society or state psychiatric society can direct you to the available psychiatrists in your community. They often also know who works with children, does fo-rensic work (medical-legal work), speaks languages other than English or has a special area of focus such as psychoanalysis or group therapy. They often can give some direction in finding a psychiatrist of a given sex, race or ethnic group. If not, and such a psychiatrist is needed, the American Psychi-atric Association has committees on women, blacks, Asian-Americans, American Indians and Spanish-speaking therapists who could be helpful. If a non-medical therapist is sought, check the telephone directory for listings of their specialty groups (such as the American Nursing Association) for refer-ral help. Finally, there remains the task of interviewing the psychiatrist. The inter-view should be a two-way exchange. After therapy has been in progress a while a therapist will tend to want to know why a particular question is im-portant to you before answering it. But in the first interview I urge people to ask for and expect straight answers to their questions. Probably more basic than the answers to questions is the feelings of the pa-tient during his hour with the psychiatrist. Was it easy to talk? Did you feel empathy and caring from the psychiatrist? Do you feel you can trust him or her with your most intimate secrets? If you sense an immediate "click," stay with that therapist. If you find yourself uncertain, make an appointment with another therapist-and if nec-essary, a third, and a fourth. Then exercise the same diligence and energy used in the initial selection to get as much as you can out of your therapy. credit: Ann Laycock Chappel, M.D., Instructor, University of California in San Francisco, Psychiatric Department. SOME GOOD COUNSEL