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C 2003) Archives of Sexual Behavior, Vol. 32, No. 1, February 2003, pp. 79–88 (°

Book Reviews The Dangerous Passion: Why Jealousy Is as Necessary as Love and Sex. By David M. Buss. The Free Press, New York, 2000, 256 pp., $25.00.

threat of investing in another male’s offspring. This hypothesis has been tested in research comparing males and females in the relative distress they report and /or exhibit physiologically—in terms of heart rate, skin conductance, and brow muscle tension—when either imagining their partner having sex with someone else or imagining their partner becoming emotionally close to someone else without sexual involvement: Males are relatively more upset by imagining sexual infidelity whereas females are relatively more upset by imagining emotional infidelity (e.g., Buss et al., 1999; Buss, Larsen, Westen, & Semmelroth, 1992; but see Grice & Seely, 2000; Harris, 2000). As Buss shows in this book, other empirical findings about jealousy can also be incorporated into this theoretical framework. Beyond the immediate distress that is associated with jealousy, jealousy is implicated in relationship violence. As demonstrated in important research by evolutionary psychologists Wilson and Daly (1996), women who are involved with jealous men are particularly vulnerable to violence. For example, in a large survey of more than 8,000 participants, they found that women who indicated that the description “He is jealous and doesn’t want you to talk to other men” was true of their spouses were 10 times more likely (39% vs. 4%) to have experienced serious violence in their relationship. This effect is reflected in homicide data: Women who attempt to leave their spouses are at significantly greater risk for being killed than are other married or cohabitating women (Wilson & Daly, 1993). Wilson and Daly interpret these findings as evidence that the functions of relationship violence are deterrence and control. In their view, homicides are usually unintentional and occur when the violence gets out of hand. Buss goes further and speculates that there may be an evolved matekilling module; under certain circumstances, it might have been adaptive in ancestral environments to kill one’s mate rather than end the relationship (e.g., to preserve one’s reputation). The book is organized into nine chapters. Buss writes with a very clear and engaging style and is very good at explaining the Darwinian logic underlying sex differences and the functions of jealousy in Chapters 1 through 3. Buss aptly covers spousal violence in Chapter 5, describes hypotheses and research on infidelity in Chapters 6 and 7, suggests coping strategies for dealing with jealousy in Chapter 8, and summarizes his main ideas in Chapter 9. Unfortunately, Chapter 4 is weak. In this chapter, “The

Reviewed by Michael C. Seto, Ph.D.1 This book is written for anyone interested in the psychology of jealousy, relationships, and relationship violence. It is not, however, for the faint-of-heart. Buss’ main thesis is that jealousy is a Darwinian adaptation and therefore was associated with reproductive success in the past because of the potential costs of being cuckolded (for males) or abandoned (for females) in ancestral environments. As such, jealousy may be an inherent component of romantic relationships. More proximally, Buss argues that jealousy can be understood as an emotion that motivates behavior when the fidelity or commitment of one’s partner appears to be threatened (see Frank, 1988). Jealousy can also be viewed as an indication of the value that the jealous person places on a relationship. In fact, Buss (1989) suggests that jealousy may sometimes be evoked to test a partner’s commitment. Whatever its function, jealousy is prevalent and appears cross-culturally. Briefly, the Darwinian logic is as follows: There is a fundamental sex difference in the minimal investment required for producing offspring, as outlined in Trivers’ (1972) parental investment theory. Because of the obligate costs of gestation, human females have a greater minimal investment in offspring. As a consequence, access to the security and resources provided by a committed male partner is the main constraint to female reproductive success. At the same time, males cannot be certain about the paternity of their putative offspring, whereas females can always be confident about their maternity. As a consequence, males run the risk of investing their precious time, energy, and resources on another male’s offspring rather than their own, whereas females do not run this risk. From these sex differences, one can predict that females are more affected than males by emotional infidelity, and the potential threat to their partner’s commitment, whereas males are more affected than females by the threat of sexual infidelity, and the potential 1 Law

and Mental Health Program, Centre for Addiction and Mental Health, 1001 Queen St. West, Unit 3, Toronto, Ontario, Canada M6H 1H4; e-mail: michael [email protected].

79 C 2003 Plenum Publishing Corporation 0004-0002/03/0200-0079/0 °

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80 Othello Syndrome,” Buss reviews different research studies and unsuccessfully attempts to link them to his main thesis (e.g., describing the prevalence of jealousy among alcoholic men) and speculates about the potential relationships between male impotence, female sexual dissatisfaction, early exposure to infidelity, and symbiotic psychopathologies. Many readers may appreciate Buss’ use of anecdotes and case examples throughout the book. These anecdotes and cases are often good illustrations of conclusions that Buss draws from scientific findings. However, he sometimes presents anecdotes and case examples as support for his ideas (e.g., that some individuals who get clinical attention for their “pathological” jealousy may, in fact, have accurately detected subtle cues that their mate was being unfaithful). This occurs despite his own warning late in the book that “. . . anecdotes, of course, do not add up to scientific evidence” (p. 166). Indeed, anecdotes and case examples only demonstrate the existence of a phenomenon, not whether a Darwinian (or other) theory about that phenomenon is correct. Investigators such as Buss, informed by Darwinian ideas, have generated useful theories about human psychology as a product of evolution, with testable hypotheses and supportive findings, but a lot of work remains to be done. Although Darwinian theories are sometimes controversial and sometimes misunderstood, I believe Buss makes a good case in this book for the utility of a Darwinian approach to the study of jealousy, relationships, and relationship violence. The propositions that jealousy is not irrational, that it may be an integral part of the psychology underlying our experiences of sexual desire, attraction, and love, and that it may be directly linked to relationship violence are not easy ideas to consider, even for those of us who are not so faint-of-heart. However, the empirical investigation of these propositions may guide us to a better understanding, and therefore better solutions, to the human problems that involve the “dangerous passion.” REFERENCES Buss, D. M. (1989). Conflict between the sexes: Strategic interference and the evocation of anger and upset. Journal of Personality and Social Psychology, 56, 735–747. Buss, D. M., Larsen, R., Westen, D., & Semmelroth, J. (1992). Sex differences in jealousy: Evolution, physiology, and psychology. Psychological Science, 3, 251–255. Buss, D. M., Shackelford, T. K., Kirkpatrick, L. A., Choe, J. C., Lim, H. K., Hasegawa, M., et al. (1999). Jealousy and the nature of beliefs about infidelity: Tests of competing hypotheses about sex differences in the United States, Korea, and Japan. Personal Relationships, 6, 125–150. Frank, R. (1988). Passions within reason. New York: Norton. Grice, J. W., & Seely, E. (2000). The evolution of sex differences in jealousy: Failure to replicate previous results. Journal of Research in Personality, 34, 348–356.

Book Reviews Harris, C. R. (2000). Psychophysiological responses to imagined infidelity: The specific innate modular view of jealousy reconsidered. Journal of Personality and Social Psychology, 78, 1082–1091. Trivers, R. L. (1972). Parental investment and sexual selection. In B. Campbell (Ed.), Sexual selection and the descent of man, 1871– 1971 (pp. 136–179). Chicago: Aldine. Wilson, M., & Daly, M. (1993). Spousal homicide risk and estrangement. Violence and Victims, 3, 3–16. Wilson, M., & Daly, M. (1996). Male sexual proprietariness and violence against wives. Current Directions in Psychological Science, 5, 2–7.

Male Reproductive Function. Edited by Christina Wang. Kluwer Academic Publishers, New York, 1999, 337 pp., $189.00. Reviewed by Raul C. Schiavi, M.D.2 This edited volume provides an up-to-date review of information on male reproductive function and its disorders. The contents are broad, empirically based, and spanning several areas that have generated considerable research in recent years with significant clinical, social, and epidemiological implications. The first four chapters focus on the physiological regulation of testicular function via endocrine mechanisms and intratesticular processes among structures within the gonads responsible for spermatogenesis and androgen production. The functional interactions within the hypothalamic–pituitary–testicular axis have been well documented. Less known, and well summarized, is the rapidly unfolding information on cell-to-cell interactive networks within the testes and on genetically driven molecular mechanisms that control programmed germ cell death, termed apoptosis, important for normal development and fertility problems. Two chapters are devoted to a selective review of recent data on pubertal development, with brief reference to the clinical management of pubertal disorders, and to hormonal and reproductive changes associated with normal aging. The observation of an age-related testosterone decline during male senescence brings forward the debatable notion that a significant number of aging men may be testosterone-deficient and, therefore, candidates for androgen supplementation. This notion has generated considerable research interest, but there is still no consensus on clinical criteria for determining whether an aging man is androgen-deficient and should be considered for hormonal treatment. Three related chapters focus on male hypogonadal conditions, the risks and benefits of androgen replacement therapy, and the safety of androgens on prostate and 2 Chemin

de Roucas Troucas, 83550 Vidauban, France; e-mail: [email protected].

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Book Reviews cardiovascular disease. They review the clinical characteristics of hypogonadism in adult men, the congenital and acquired causes of testicular failure, and provision of important clinical information on the evaluation and management of androgen deficient disorders. The section on androgen replacement is particularly helpful by discussing the indications and methods for androgen substitution as well as the benefits and potential side effects of treatment. Safety concerns arise not only from the growing use of androgen supplementation in aging men but also from the possible use of androgenic steroids for contraception and for performance enhancement. The data on the balance between risks versus benefits of androgen implementation, being largely inconclusive, underlie the need for long-term, prospective, placebo-controlled studies on clearly defined populations and objective endpoints. A timely chapter focuses on the problem of androgen abuse in sport, describes educational and testing efforts set up by sport organizations concerned with antisteroid activities, and the methodological difficulties of demonstrating that the source of the steroid is pharmaceutical rather than endogenous. The role of androgens on sexual behavior, mood, and cognitive function is considered in a relatively brief but lucid and well-referenced chapter. Well-controlled studies on hypogonadal men have demonstrated that androgens have significant effects on sexual motivation and mood but the behavioral and cognitive action of androgens in men with normal testicular function is less clear. A brief review of information on the beneficial effects of dehydroepiandrosterone on cognitive function and sexual behavior, a topic that has attracted recent attention, reveals contradictory evidence suggesting the need for further controlled research. Male sexual dysfunction is discussed in a broad but rather superficial section that encompasses demographic, physiological, causal, management, and therapeutic considerations. An important part of the book is devoted to the causes, diagnosis, and management of male infertility, areas that are frequently neglected in books more specifically focused on sexual function and dysfunction. Male infertility appears to be a heterogeneous condition with a wide range of determinants affecting sperm production but the mediating pathogenic mechanisms remain unknown. Genetic factors play a significant role in at least some subgroups of infertile men as discussed in a technical chapter that demonstrates the considerable experimental research, largely obscure for the noninitiated reader, that is being carried out on the subject. An equally important subject is the impact of the environment on male reproductive function, a topic that is convincingly documented and discussed. Secular trends showing decreased sperm quality and increased male reproductive abnormalities, comple-

81 mented with experimental animal research, suggest the possible deleterious effects of environmental agents such as chemical pollutants, drugs, and physical agents on reproductive health. Advances in our knowledge of basic reproductive mechanisms, together with further epidemiological evidence within a multidisciplinary framework, may contribute to this area of considerable public health significance. In summary, this volume is a solid contribution mostly written by andrology experts aimed at a biologically oriented readership interested in the field of male reproduction. The topics bridging the gap between basic science and clinical practice are well documented by an extensive and up-to-date bibliography. Social and cultural aspects of reproductive behavior are not discussed, and the focus on sexual function and behavior is rather limited. This contribution shall be, nevertheless, valuable for interested students who may want to expand their knowledge and remain abreast of the rapidly expanding field of clinical andrology.

Infertility in the Modern World: Present and Future Prospects. Edited by Gillian R. Bentley and C. G. Nicholas Mascie-Taylor. Cambridge University Press, Cambridge, England, 2000, 264 pp., $69.95 (hardback), $24.95 (paperback). Reviewed by Dawn Rummins Pratt, M.S.3 In this edited volume, Bentley and Mascie-Taylor have gathered information about infertility in several modern contexts. These contexts include the technological, environmental, and social spheres of infertility. Although much of this book includes technical information about human infertility and statistical analyses of fertility trends, the more technical aspects of this book are nicely rounded out by a qualitative study that explores the meaning of childlessness in the lives of modern adults. Overall, each chapter deals with infertility from a different context, paradigm, or methodology, and the cumulative result is a balanced evaluation of this topic. This review will give a brief overview of the different sections within the book, and then applications for this volume will be suggested. The first section of this book is titled “Biomedical Perspectives on Fertility,” and it includes two chapters. The first chapter, written by Fishel, Dowell, and Thornton, deals with current reproductive technologies available to infertile couples. This chapter is inherently technical and 3 Department

of Child Development and Family Studies, Marriage and Family Therapy Program, Purdue University, West Lafayette, Indiana 47906; e-mail: [email protected].

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82 thoroughly covers physical and genetic causes of human infertility for both men and women. Fishel et al. also provide a discussion of available technology, explaining appropriate situations and statistical success rates. They do occasionally mention that some of the assisted technologies can pose ethical challenges, but it appears that a discussion of these binds are beyond the scope of this chapter. However, this chapter is a very thorough overview of the current technologies available to the infertile, and it gives several indications into what directions future reproductive science may take us. The other chapter included in the Biomedical section is by Bittles and Matson. These authors discuss the influence of genetics on infertility. Throughout this chapter, questions of ethics are continuously posed. Explaining that some infertility is of genetic causes, and that technology can help overcome infertility, the authors pose questions regarding the effects of overriding nature and possibly passing on the genetic problems that caused the initial infertility. Because this technology is relatively new, the long-term effects into other generations are unknown. Bittles and Matson provide examples of several known genetic disorders and the technology used to overcome infertility. They also point to the need for genetic counseling for couples who are using these technologies and the high physical and emotional cost of using assisted reproductive technologies. The second section of this book is titled “Environmental Influences on Fertility” and contains two chapters. The first deals with the effect of environmental pollutants on human fertility and the second discusses STD and AIDS epidemics in sub-Saharan Africa. Althogh these two chapters seemingly are very different, they both question the long-term impact that culture and choices have on human fertility. In the chapter on environmental pollutants, Bentley discusses the effects that xenoestrogens, which come from man-made products, have on human fertility as the environment becomes polluted with these substances. Citing the work of Carson (1962), which brought attention to the long-term effects of pollution on health, and the more recent Danish study (Carlsen, Giwercman, Keiding, & Skakkebaek, 1992) that demonstrated dramatically lowered sperm counts, Bentley underscores both the controversy and the importance of investigating this topic. Bentley examines several pollutants and cites studies that demonstrate their effects on human health. Then, she carefully examines the Carlsen et al. (1992) study for bias, sampling, and statistical analysis. Through her careful examination, Bentley concludes that while there are demonstrable effects of xenoestrogens and xenobiotics on human fertility, at this time there is no conclusive evidence that shows a cause and effect relationship on sperm count.

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Book Reviews However, Bentley is careful not to discount the evidence that points to a need for further investigation of this topic The other chapter in this section on environmental influences is by Caldwell and Caldwell, who discuss the effects of STDs and AIDS on human fertility in sub-Saharan Africa. Caldwell and Caldwell examine social and sexual behaviors of the residents of this region. Citing several studies, they explain that some regions in sub-Saharan Africa have infertility rates of 45% or higher. They give a good discussion of the culture, values, sexual practices, and social and economic forces that contribute to this current epidemic. They contrast other cultures, demonstrating what may work and what are barriers in sub-Saharan Africa, to overcoming the epidemic of STDs and AIDS and the resultant infertility. Caldwell and Caldwell also point to programs and trends that are seemingly helping to turn the tide. The last section is titled “Social Perspectives on Infertility.” The first chapter, by McAllister and Clarke, provides two important discussions. First, they take data on voluntary childlessness from Britain and compare it with other Western countries. Second, they report on a qualitative study that discusses men’s and women’s experiences of childlessness, the process of determining their “voluntary” childlessness, and the factors that are taken into consideration in choosing childlessness. This chapter provides a wonderful illustration of the experience of childlessness. By moving from statistical data and current trends to a qualitative study, including the sharing of participant quotes, McAllister and Clarke give both a larger picture and an up close, personal view of this experience. It is a chapter that is balanced in its investigation and, at the same time, it provides a balancing effect to this edited book: This chapter highlights the fact that while there are many technical and statistical facts about infertility, human infertility is also a very personal and meaningful experience. The last chapter is about infertility and sexual orientation. Looking at several surveys and studies, Patterson and Friel examine the possible statistical range within the United States that could be considered gay and lesbian parents. Using what data are currently available, Patterson and Friel can only give estimates regarding those in the population that may be considered homosexual, those that could be considered homosexual and parents, and an estimate of children who could be considered to have at least one homosexual parent. This chapter almost exclusively deals with the challenge of statistically examining sexual orientation and fertility. Patterson and Friel explain the challenges faced, the currently available data, and the process of classifying the sexual orientation of the U.S. population. Perhaps the unspoken but important point of this chapter is that, as questions continue to arise in our

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Book Reviews society about gays and lesbians who want to parent, the fact is that there are significant numbers of gay and lesbian who already are parents. In looking at Bentley and Mascie-Taylor’s book as a whole, it provides a good cross section of this topic, cutting across the contexts of technology, environment, and social spheres. The chapters included within this text are soundly written and well-articulated. Perhaps this book could have been strengthened by expanding two areas that were only briefly addressed. For instance, taking a cue from the chapter by McAllister and Clarke, this book may have been strengthened by using a lens of gender and examining the different meanings that the experience of infertility has for men and women (Kirkman, 2001). This could also have included the different experience that men and women have undergoing infertility treatments in a medical context (Candib, 1995). Also, taking another cue from Bittles and Mattson, this book could have been strengthened by a chapter discussing the ethical binds faced in applying reproductive technology. Despite these suggestions, the overall text is a very strong application of the topic of infertility in several contexts. It would be appropriate for the clinician wanting to stay current on both technology and global issues related to infertility. This book would also be appropriate for a graduate-level course addressing this topic from either a medical or a psychological perspective. REFERENCES Candib, L. M. (1995). Medicine and the family: A feminist perspective. New York: Basic Books. Carlsen, E., Giwercman, A., Keiding, N., & Skakkebaek, N. E. (1992). Evidence for decreasing quality of semen during past 50 years. British Medical Journal, 305, 609–613. Carson, R. (1962). Silent spring. Boston: Houghton Mifflin. Kirkman, M. (2001). Thinking of something to say: Public and private narratives of infertility. Health Care for Women International, 22, 523–535.

Couple Therapy for Infertility. By Ronny Diamond, David Kezur, Mimi Meyers, Constance N. Scharf, and Margot Weinshel. Guilford Press, New York, 1999, 237 pp., $30.00. Reviewed by Linda Perlin Alperstein, M.S.W.4 The development of assisted reproductive technologies has created numerous procedures and possibilities for helping couples deal with infertility. Nevertheless, the 4 Department

of Psychiatry, School of Medicine, University of California, 4437-25th Street, San Francisco, California 94114; e-mail: [email protected].

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83 decision-making process for those who want a child has become increasingly complex, overwhelming, and expensive. The authors of this excellent book are senior members of the Infertility Project at the Ackerman Institute for the Family in New York City. On the basis of a decade of clinical experience and research, they offer a well-organized, thoughtful, and compassionate approach to the entire process of infertility. Beginning with the embryonic awareness of infertility and ending with the legacy of various outcomes, this book is rich with case examples and clinical suggestions. It is geared for work with married, heterosexual couples, and presents an in-depth discussion of the challenges that face both clients and clinicians at all phases of infertility. The authors structure their discussion in a logical and comprehensive manner. They delineate five distinct phases of infertility: Dawning, Mobilization, Immersion, Resolution, and Legacy. Each phase is considered in terms of two major aspects. First, they identify issues that beset the couple during each particular phase. Second, they offer a range of therapeutic perspectives and methods that are useful at various stages. For couples, the initial phase of Dawning is characterized by a nascent awareness of difficulty in becoming pregnant and a developing sense that some action might need to be taken to address the situation. Some couples, because of age, history, and so forth, may realize from the start that they are at risk for problems with conceiving. Most are likely to face a certain amount of anxiety with varying degrees of optimism or pessimism. Nevertheless, it is not common at this era to seek therapy for infertility per se. If a couple happens to enter counseling during this phase, the therapist can be quite helpful. She or he can provide the opportunity to express what it would mean to them to have children and their feelings about a life without children. This is also a time for the therapist to help them anticipate some of the impacts of infertility and how it might affect their lives. It is during the Mobilization phase that couples begin to investigate the causes of their infertility. Here is where they often turn to the medical community for assessment and help. And here is where there can be shock and dismay about the information they receive along with considerable strain in the relationship. Moreover, this is the phase that can be either supported or hurt by the reactions of family and friends. Early signs of strain in the couple’s relationship can emerge during Mobilization and thereafter. During their discussion of the Mobilization phase, as they do throughout the entire book, the authors make excellent use of pertinent data regarding many aspects of infertility. In this phase, for example, they cite significant differences that can exist between men and women regarding levels

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Book Reviews

of distress and willingness to continue with the emotional and physical pain of procedures. The discussion of the therapist’s role during Mobilization is very practical and complete. For instance, the book addresses specific clinical subject matter and tasks: One is to help couples manage the basic intrusiveness of dealing with infertility. Another is to help couples deal with all the personalities and procedures of the medical community. A third task is to help couples deal with their own ideas about parenting a nongenetically related child. From beginning to end, the authors emphasize how important it is for a therapist to be aware of his or her own biases regarding children, parenting, and the importance of a genetic connection. During the Mobilization phase, particularly, they caution that a therapist who has strong feelings that children and parenting are essential life experiences may tend to push couples to do more than what is emotionally, financially, or physically feasible. Likewise, the therapist who does not see having children as very important might underestimate the emotional pain and the desire to continue with difficult procedures and risk for disappointment. In the chapters on the Immersion phase, the authors break down issues by dividing their discussion into early, middle, and late stages. This phase begins with active involvement in a spectrum of medical procedures. It has the potential for bitter disappointments, grief, considerable physical discomfort, and increased stress on the marital relationship. At middle Immersion, the couple might be so preoccupied with baby-making activities that there is little time for friendships, fun, or career. And by late Immersion, the couple might be terribly depleted and numb. During early and middle Immersion, the therapist can help by offering perspective and reminding couples that this is a time-limited era, albeit difficult, that will eventually resolve and make room once again for other activities. About the late Immersion phase, the authors write the following: As couples experience more treatment failures, they are faced with an option that is more complicated than it may first appear. Donor procedures, often offered by the medical profession as the next logical step in infertility treatments, have profound psychological implications, in that the child created will be genetically related to only one parent. Thus, it is important to give this issue an in-depth analysis before embarking on such a journey. (p. 131)

These remarks are characteristic of the authors’ understanding of the complexities involved with infertility and the limits of the medical profession regarding psychosocial factors. Moreover, it is an example of their continuous honesty and commitment to helping clinicians

address issues in a compassionate and straightforward manner. With a similar forthright approach, the book discusses the Resolution and Legacy phases, identifying three endeavors: Ending medical treatment, mourning, and refocusing by choosing either adoption or life without children: “The ordeal of infertility has four possible outcomes: Couples will emerge with either (1) a genetically related child, (2) a donor conceived child, (3) an adopted child, or (4) no child” (p. 161). Further, the authors continually generate specific questions and perspectives for the clinician. And more so, they remind clinicians to identify other avenues of support such as friends, family, or community resources such as RESOLVE, a national self-help group that offers opportunities for sharing experiences, information, networking, and more. Throughout the book, the authors include sexuality in a most natural manner, discussing the impact of infertility on the sexual lives of couples. This book is not designed to teach specific techniques of sex therapy for infertile couples and the associated dysfunctions or “dys-feelings.” However, it definitely invites couple therapists to notice and address sex-related problems. For example, from early on, they address the loss of control over one’s sexual life. They highlight the losses of privacy and, spontaneity. They also include a good discussion of Jack Annon’s PLISSIT model. Plus, they make appropriate recommendations for sex therapy when sexual problems are long-standing, entrenched issues and not just temporary reactions to the stress of infertility. Interestingly, the only shortcoming of this impressive book might be the failure of the authors to connect their knowledge to lesbian or gay male couples who struggle with infertility. From my perspective, all of their wisdom, compassion, and counseling suggestions for married, heterosexual couples are readily transferable to the stresses of infertility for all.

Celibacy, Culture, and Society: The Anthropology of Sexual Abstinence. Edited by Elisa J. Sobo and Sandra Bell. University of Wisconsin Press, Madison, 2001, 284 pp., $55.00 (hardback), $22.95 (paperback). Reviewed by Nicole Merritt, B.A.5 The editors’ compilation of 13 mostly cross-cultural essays on the multiple meanings and expressions of celibacy 5 Department

of Psychology, Indiana University, Bloomington, Indiana 47405-7007; e-mail: [email protected].

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Book Reviews teaches by example. A variety of social constructions of celibacy are presented using anthropological approaches to examine groups of interest. The chapters range from the personal observations of a Catholic priest concerning church celibacy (by Southgate) and cleanliness rituals of Maztecs (by Duke) to reviews of disturbing psychoanalytic perspectives on the common practice of anorexics to eschew sexual activities (by Lester). Although these examples of celibacy will be less satisfying to researchers interested in quantitative evaluations of any of these practices, the narratives themselves are often thoughtprovoking. The book is divided into three major sections. The first two, on celibacy, culture, and social organization, overlap heavily. The third section, on celibacy choice and control, is a hodgepodge of chapters examining celibacy from perspectives perhaps more commonly covered in modern media. The chapters in this section cover the celibacy of women with anorexia nervosa, of four students who currently consider themselves celibate, of prison inmates, and of Catholic priests. Each chapter introduces the particular society or institution under examination, negating any requirement of previous knowledge; thus, the book could be appropriate for undergraduate anthropology, sociology, or gender studies students. There appear to be three main themes in this book. First, the authors present the problem of defining what abstinence means given its variable interpretations across cultures and institutions. Distinctions among the terms celibacy, chastity, virginity, and more broad abstinence practices are drawn and redrawn in each chapter. For instance, although Phillimore notes that the Hindu’s brahmacharya is commonly “glossed as ‘absolute chastity’” (p. 29), Khandelwal notes that brahmacharya is, in practice, a lifestyle including many other practices. The duration of abstinence, the particular sexual activities regulated, and cultural context within which it occurs all appear to influence the label applied to, and the interpretation of, the practice. Schlegel suggests that adolescent women, for instance, are culturally pressured to monitor their own celibacy in several countries ultimately to avoid unintended pregnancies by unfavorable suitors prior to any marriage. An adolescent Shaker, however, faces the prospective of lifelong abstinence for the reward of being spiritually saved, as reviewed by Collins. In Schlegel’s example, an adolescent is forced into abstinence for a shorter period of time, which may be limited to inhibition of vaginal intercourse; in Collins’ example, an adolescent seeks group identification for a permanent period forbidding all potentially desire-inflaming practices, including kissing. The complexities of understanding what it means to “be celibate” are clear.

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85 The second theme in this text involves the gender roles established, implicitly or explicitly, by the various constructions of abstinence. Several chapters highlight ways in which most women who choose to be celibate are denied the benefits assumed by male celibates, both religiously and socially. Kawami suggests that females are viewed as not being “tested on her sexual faculties” (p. 149) because they are not renouncing the strong sexual desire that males are perceived to renounce when they vow celibacy. This denigrates the religious significance of the women’s sexual renunciation. Allowing women to transcend the boundaries of family obligations in brahmacharya may pose a threat to patriarchal control according to Khandaelwal’s review. Also, nuns who violate their vows of celibacy appear more likely to be disrobed than a monk who violates his celibacy vow, according to Gutschow. Both male and female celibates, however, are likely to be faced with unfriendly accusations concerning their sexual orientation. The suspicion that male celibates may be homosexual is prevalent, apparently, not only regarding Catholic priests, but also in societies like the Mazatecs, where ritual specialists who are celibate are described as “All of them are queers” (p. 130). Nuns, similarly, are not immune from rumors of lesbianism (p. 55). Interestingly, the authors consistently avoid discussion of the nature of the sexual drive, which, it seems, would be central to a discussion of celibacy. This is particularly important if one is stipulating that women are disenfranchised because of their lower, or perceived lower, sexual drive. Kawanami’s chapter on women celibates in Theravada Buddhism suggests the importance of this issue but does not pursue it very far. Buddhist texts describe unmarried women as caught in a “vicious cycle of obsession and sexual desire” whereas the women themselves often report that they “endured sex” as a marital duty. This contrasts with suggestions that American women’s lower sexual desire levels (as compared to men’s) may be bound by Western feminine ideals (Baumeister, 2000). The chapter by Qirko does offer an alternative explanation for the apparent gender disparity based on increased female altruism, but no one seems to more fully address how the construct of sexual desire plays into variations in the interpretation of celibacy. Similarly, the authors seem to generally assume that everyone experiences some level of sexual desire. Qirko suggests that although celibate institutions could contain individuals “who exhibit little or no interest in sex . . . this is unlikely” (p. 66). Given the reluctance of authors in this text to rely on quantitative data, the reader is unsure how to evaluate such provocative statements. Bell and Sobo briefly address this issue in their introductory

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86 chapter, where they suggest that an asexual person who experiences no sexual desire cannot, by definition, be celibate because he/she has no sexual desire to renounce. Indeed, as Sobo and Bell also suggest, asexuals may be particularly drawn to practicing “cultural” celibacy. The third theme suggested, but not explicitly pursued, involves two distinct views of celibacy that recur in each chapter. Practitioners of celibacy seem to either be practicing celibacy as a part of ritual cleanliness or spiritualism (accompanied by other acts of cleanliness and spiritualism) to set the practitioners apart from their society or the practitioners view celibacy alone as powerful and accessible to anyone within society. Thus, each cultural incidence of celibacy generally might be distinguished as group-centered or event-centered. While, for instance, brahmacharya necessitates abstinence for the gathering of power through semen retention, the true end goal is to reach spiritual liberation (Brahma). Thus, celibacy in brahmacharya is used in conjunction with other practices to set apart a group of people with a similar goal. The Shakers’ celibacy is also group-centered because they practice celibacy, abolish most of the traditional family structure, and relinquish property as a part of religious practice. The Mazatecs, however, use celibacy in an eventcentered manner. At times, the “cleanliness” thought to be instilled by celibacy is short term, as with hunting, but the cleanliness may also be required over long periods, such as for the delivery of medical services. Similarly, several cultures value virginity (adolescent celibacy) for its own sake in honor of the event of marriage. Whether this distinction is simply a matter of degree (being more or less restrictive) or kind is unclear. In the last chapter, Southgate discusses the need for celibacy as a sign to others of one’s devotion to religion, but this book supports his assertion that the “sign value” of celibacy is unclear cross-culturally. Not only does the duration of celibacy and the practices that accompany celibacy affect the meaning of celibacy, but also the cultural context within which it is practiced can unintentionally denigrate, rather than esteem, practitioners. Southgate noted, when he encountered a strongly negative view of wasting one’s gift of bearing children to God in Kikuyu society, “so much for the universality of the sign-value of celibacy” (p. 250). This text offers a sample of the myriad ways “celibacy” is interpreted and enacted. The stories are engaging, if a bit unsatisfying for empirical investigators interested in the construct. It clearly succeeds in raising controversial points concerning celibacy that could be engaging discussions in the classroom or over dinner at a level that is very readable.

Book Reviews REFERENCE Baumeister, R. (2000). Gender differences in erotic plasticity: The female sex drive as socially flexible and responsive. Psychological Bulletin, 126, 347–374.

Health Care Without Shame: A Handbook for the Sexually Diverse and Their Caregivers. By Charles Moser. Greenery Press, San Francisco, California, 1999, 120 pp., $11.95. Reviewed by William L. Maurice, M.D.6 I am always on the lookout for sex-related self-help paperback books that are short, easy-to-read, and inexpensive— ones that I could comfortably suggest to patients/clients who have sexual concerns. Many such volumes are contenders as anyone can attest by visiting a large bookstore. However, most of these are books about sexual relationships, improving the quality or quantity of sexual activities, and managing sexual dysfunctions. Most tend to have the taste of “old wine decanted into new bottles,” and to many experienced clinicians, the “Golden Oldies” usually suffice. Occasionally, a new book appears on a different aspect of “sex,” as is the case for this one. The subtitle describes this slim volume as “a handbook for the sexually diverse and their caregivers.” No self-help-type book (that I know of) addresses this topic, which, in turn, makes it particularly attractive. The theme of the book is not really sexual, but rather the health care of those who are sexually atypical—and crucial issues are discussed such as how to find a nonjudgmental health professional, what goes into the decision to be candid about one’s sexual interests with that person, and what constitutes realistic expectations of the health care system. The author is a well-known internist who is also a specialist in sexual medicine (Moser, 1997). He tells the reader that he practices in San Francisco, has a particular “focus on sexual concerns and the medical problems of sexual minorities” (he describes himself as a “kinkpositive physician”), and has a special interest in sadomasochism. His other credentials include an M.S.W. and a Ph.D., the latter from the Institute for Advanced Study in Human Sexuality in San Francisco, where he is now Dean of Professional Studies. He has also initiated the development of The American College of Sexual Medicine 6 Division

of Sexual Medicine, Department of Psychiatry, University of British Columbia, Detwiller Pavilion, 2255 Westbrook Mall, Vancouver, British Columbia, Canada V6T 2A1; e-mail: maurice@ interchange.ubc.ca.

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Book Reviews and Health—an organization for physicians interested in sexual health. Even though the audience for the book is supposed to be both patients and health care providers, I suspect that it will be more appealing to the former than to the latter for several reasons. First, most of the content is directed at “consumers” versus “practitioners.” Second, the writing style (informal, folksy, directive, exhortative, and in the first person) will likely be more inviting to patients. Lastly, writing one volume for both audiences is a formidable task. One wonders if it is even feasible given that, for example, the information requirements of the two groups differ so widely. In this instance, Moser seems much more successful in conveying what he wants to say to consumers rather than health providers. When defining who is “sexually diverse,” Moser includes anyone who regularly operates outside the mainstream of heterosexual activity, or in the argot of the group, individuals who are not “vanilla” (i.e., straight). The sexually diverse are, therefore, those who have a same-sex sexual orientation, transgendered individuals, and people who regularly engage in what could be interpreted as paraphilic behavior. (I use the word interpreted because from Moser’s perspective, such individuals might carry an incorrect diagnosis.) He explains to the reader that “Fantasies or behavior which are consensual and do not cause you undue distress are not paraphilias and are not pathological.” That idea is debatable. Moser correctly quotes DSM-IV (American Psychiatric Association, 1994) in support of that proposition; however, the manual also says (somewhat confusingly) that “many individuals with these disorders assert that the behavior causes them no distress.” Moser’s objective in writing this book is passionately stated and the same for both sets of readers: “People— gay or bi or straight, kinky or vanilla, celibate or sexually active, employed or un—deserve competent, caring nonjudgmental health care. Nobody should be harmed, suffer unnecessary pain or illness or injury, because their sexual behavior makes them too fearful or ashamed to seek treatment.” He is an ardent defender of sexual minorities and feels strongly that such people are “not getting the health care they need and deserve.” Part I of the book (nine chapters and about three quarters of the content) is a manual intended for sexually atypical individuals as they wend their way through components of the health care system—emergency rooms, hospitals, clinics—and in their dealings with health care practitioners including physicians, nurses, and other providers. Attention is given to two particular situations: when one’s sexual behavior results in a medical problem (e.g., an infected piercing of a sex-related body part),

87 or simply in seeking ordinary medical care and contending with the pros and cons of coming out to the health professional. (Psychologists and psychiatrists should feel somewhat modest about their success in facilitating the coming-out process because they too may be sidestepped; Stokes, McKirnan, and Burzette [1993].) Part II of the book consists of two chapters that have been adapted from papers in San Francisco Medicine. The section is intended “For Practitioners,” and includes such matters as sex history-taking suggestions and a highly valuable glossary of “sexual minority terms,” together with some cautions about their use. Part III consists of two chapters—the conclusion and a Resource Guide (books, magazines, journals, and organizations). This book is a useful addition to the collection of selfhelp books for those patients/clients who are sexually diverse. Self-help books are usually meant to be therapeutic. What makes this book different is that it is appropriate for all who are sexually atypical—because everyone at some time or another will encounter the health care system. The book is therefore less therapeutic than prophylactic.

REFERENCE American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Moser, C. (1997). Combining sex and medicine. In B. Bullough, V. Bullough, M. A. Fithian, W. E. Hartmann, & R. S. Klein (Eds.), Personal stories of “How I got into sex” (pp. 307–316). Amherst, NY: Prometheus Books. Stokes, J. P., McKirnan, D. J., & Burzette, R. G. (1993). Sexual behavior, condom use, disclosure of sexuality, and stability of sexual orientation in bisexual men. Journal of Sex Research, 30, 202– 213.

Male Sexual Awareness: Increasing Sexual Satisfaction. By Barry McCarthy and Emily McCarthy. Carroll & Graf, New York, 1998, 292 pp., $12.95 (paperback). Reviewed by Joel Schmidt, Ph.D.,7 and Lisa Regev, M.A.8,9 This text offers a comprehensive, sociocultural review of what it means to be male, sexual, and aware. The authors state two goals in writing this book: “First, to present the most accurate, reliable information presently available on 7 VA

Sierra Nevada Health Care System, Reno, Nevada. of Psychology, University of Nevada, Reno, Nevada. 9 To whom correspondence should be addressed at Department of Psychology/MS 298, University of Nevada, Reno, Nevada 89557; e-mail: [email protected]. 8 Department

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88 male sexuality and topics related to sexual functioning. Second, to help men integrate their sexuality with the rest of their lives in a way that enhances awareness and satisfaction” (p. 7). They accomplish these goals by covering a wide range of topics, including anatomy, contraception and STDs, gender relations, sexual techniques and activities, marriage, parenting, extramarital affairs, divorce, sexual trauma, homosexuality, and developmental changes in sexuality. The book is primarily intended for men; however, the authors suggest that women who are interested in understanding their male partners’ sexual issues and concerns may benefit as well. The authors advocate for readers to think of themselves as sexual beings rather than performance machines. This was nicely interwoven throughout the book and serves as a contrast to other books on sexuality that introduce this idea but spend most of the book focused on specific techniques for improving performance. This is not to say that the authors do not provide information on such specific techniques. They present the most commonly recommended behavioral techniques for treating sexual dysfunctions, such as self-exploration, the start–stop technique, sensate focus, and directed masturbation exercises. However, the discussion of techniques plays a relatively minor role in the overall context of male sexuality from a sociocultural view. In fact, the authors repeatedly emphasize that readers should seek professional sex therapy services rather than use this text as a self-help book. According to the authors, the main reason for advocating for professional services is that motivation to change can be difficult to maintain without ongoing therapeutic services. The authors are particularly effective at providing the opportunity for men to confront some of their sexual insecurities. Throughout the book, they discuss commonly held myths that serve to leave many men feeling alienated and insecure. For example, they talk about the cultural expectation that men are always interested in sexual activity as a contributor to sexual anxiety in the face of male arousal or erectile disorders. In fact, their focus on cultural expectations and developmental stereotypes is so pronounced that it may serve to alienate some (especially younger) readers. For example, in discussing premature ejaculation, the authors seem to imply that male sexuality often begins with a prostitute or during a “circle jerk.” These activities may be somewhat foreign to many readers who did not have such experiences and serve to distract

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Book Reviews them from the larger message that early experiences are often rushed. This is a relatively minor detraction and the authors are generally quite successful in capturing a sociocultural context for sexual behavior. This context provides the opportunity to normalize sexual attitudes and allow for exploration of alternative approaches to male sexuality. This line of discussion is particularly liberating for older male readers, who may be resigned to writing off sexual activity because of culturally sanctioned myths or who feel that having sexual feelings at their age is a sign of deviance. One pitfall of their sociocultural perspective is that it can lead to some apparently oversimplistic prescriptions for relating to others. Perhaps the clearest example of this involves the guidelines for male–female relationships on page 67. Here the authors list 10 guidelines that exemplify the “equity model” of interacting with the opposite sex. Although it is clear that following these guidelines would lead to successful egalitarian relationships, there is no clear explanation as to how one who is lacking the skills required to implement these guidelines might develop them. Thus, such passages have a “just-do-it” quality that neglects the mechanics of relationship skill acquisition. Two additional minor points deserve comment. First, the book contains some illustrations of sexual positions and other topics. It would have been helpful to have a few more diagrams to augment the text discussing male and female internal reproductive physiology. It is possible that readers who have not been exposed to this material previously would have difficulty envisioning such events as the traveling of sperm during ejaculation. Second, Although the book is generally up-to-date, one exception is found in the “Arousal and Erection” chapter. This chapter was apparently written before Viagra was approved and distributed, which is a notable omission for men seeking treatment options for erectile dysfunction. This text is a successful elaboration on four important points: (1) sexuality is an important component of development throughout the life span (in contrast to the common focus on the young adult years); (2) men are hindered by performance expectations; (3) taking responsibility for communicating about sex is important; and (4) sex is about giving and receiving pleasure. Most readers will likely be left with greater acceptance of sexual imperfections and a realistic idea about improving sexual functioning. For this reason, Male Sexual Awareness is a well-written book that would benefit a wide readership.