Tuesday, November 15, 2016

Maintaining Perspective in a Time of Hysteria

NOTE: This post has been edited slightly since originally published.Over the past week, in my office and elsewhere, I have encountered many emotions. These have included sadness, disappointment, fear and rage.

An emotionally healthy response to a loss or defeat is sadness and disappointment. A mature response would also involve soul searching. If one participated in an endeavor that failed, a mature person asks "how did this happen?" and "what could I have done differently?"

Unfortunately, over the past week I've been hearing more fear and rage than sadness and disappointment, and very little reflection, among most Democrats.

The level of fear is beyond what I expected and does not accord with immediate reality. I believe that the media is deliberately inciting fear and hysteria, perhaps to increase sales and also perhaps because many media establishments are closely allied with the Democratic Party. For example, a headline in the New York Times claimed a 6 percent increase in hate crimes, but FBI statistics have reported that a 7 percent jump in hate crimes, mostly against Muslims,  occurred in 2015, before Trump was considered a serious candidate. What prompted this increase in attacks? The most likely cause is the devastation wreaked by the group that has been called Islamic State, ISIS, ISIL, or Daesh. Atrocities such as mass slaughter of civilians and mass rapes tend to trigger some people's fears and hatreds more than the words of a politician.

Likewise, a story in the Washington Post that I read to find out more about a Trump aide named Steve Bannon recited first the accusations against Bannon and then his denials (hardly investigative journalism) and spent the last several paragraphs dwelling on the fact that a neo-Nazi website called Stormfront "endorsed" Bannon. It would be news indeed if Bannon had endorsed Stormfront, but this didn't happen. The fact that Bannon was endorsed by neoNazis is irrelevant, because people don't control who endorses them. Bannon may indeed be racist and sexist, but the more important question is what type of public policy does he support? Unfortunately I did not learn this from the article.

In my office I've had to remind one person that a "green card" holder--a legal permanent resident--can't be deported. I tried to convince another patient that a pogrom against Jews in the US was an unlikely event (using my undergraduate education in European history).

As I have tried to calm people's fears, they often begin to logically argue with me various worst-case scenarios for a Trump presidency. Of course, anything could happen--but there is no point dwelling on worst case scenarios. A far better use of time would be to analyze how the Democratic Party--which has more members than the Republican Party--has managed to lose the Presidency, the Senate, the House of Representatives, and two-thirds of state legislatures. To formulate solutions, one has to analyze what went wrong with the last plan of action. I have tried to tell young patients that evil is a constant, and there is no point in telling people not to be evil. There is only a point in working toward a better world, and that work requires personal responsibility and self-reflection, not rage and hatred toward others, which is a waste of time.

More disturbingly, I have been hearing--or rather, not hearing--any understanding or empathy for what might have motivated Trump supporters. Again, the media, and the Democratic Party, have done an enormously successful job at convincing their followers that Trump was elected because America is full of racists and misogynists--even though we just had two terms of a black President and the number of women governors and Senators has been increasing. In reality, Trump won because he spoke to the economic fears and distress of many Americans.

One of my patients commented to me that I seem to be dealing well with the election. I'm simply older, better informed, less naive and also, more cynical than most of my patients. It's when people's idealized visions and hopes are dashed that they become despondent. A cynic like me is simply struck by the irony that many people in New York have been professing fear for immigrants under a Trump Presidency, but during the presidency of Barack Obama, Israel, a US ally, slaughtered over a thousand people in a walled-in civilian area in the Gaza strip. Many of the dead were children. Bill Clinton's administration put sanctions on Saddam Hussein's regime that led to the starvation of thousands of Iraqi children. Why all the tears and fears for people who may face deportation to Latin America and none for the dead children of Iraq and Gaza? There are worse things that happen to people than being deported. I've been overseas and seen the bombed buildings and met the torture victims. And I'm old enough to remember Lyndon Johnson and Vietnam.





Thursday, November 10, 2016

Fears Rational and Irrational

Yesterday morning the owner of the local bodega, a Muslim from Yemen, told me he didn't "feel safe." This was in relation to Trump's election. He told me his wife had been assaulted in the street a few days ago, apparently a bias crime. Does the election of Trump mean that xenophobes, anti-semites and others will suddenly be more empowered to commit acts of violence? I don't think that it does. Sadly, bias crimes have been committed in the US since white people settled on America's shores. Such crimes are likely to neither increase nor decrease. Muslims have been victims of assault since Sept. 11, 2001, and this pattern is unlikely to change significantly, because of many  world events, not because of Trump's election.

Some of my patients have voiced similar fears to those of the Muslim shopkeeper, although they belong to different ethnicities. But I don't believe that any of these fears are justified.

I am now older than most people I talk to, and better informed. The sad truth is that xenophobia, racism and bigotry of all kinds, and misogyny, have been American realities since our founding. Why are people under the impression that Donald Trump is likely to incite more of these crimes and incidents, when in fact they have been in overall decline in the 20th century? It's because of panic and hysteria sown by the news media, and also by the Democratic Party as a deliberate campaign tactic.

Hillary Clinton's campaign relied heavily on an emphasis on Trump's worst personal qualities. Issues such as health care, climate change and national security took a back seat, despite the grave importance of such issues.

This morning I read in the Wall Street Journal that some colleges have created safe rooms with hot chocolate for students upset by Trump's election. Wouldn't it be better and more responsible for these institutions to use the event to hold  panel discussions about the state of American democracy? About the role of institutions such as the Democratic National Committee and the Electoral College? About the history of political parties in the US and abroad? Students are now treated as consumers who need to be catered to rather than future citizens who need to be educated. All across the US young people are being encouraged to feel helpless and terrified.

There are some people who have fears that are deeper. Some of my PTSD patients talk of being triggered by Trump, because he  reminds them of their abusive fathers--an emotionally volatile loudmouth and an apparent sex offender. It is true, as I said in my previous post, that we have never  before elected someone like Trump. Most politicians say careful phrases and are keenly aware of their images. I have never before seen the election of someone who is a loudmouth and braggart, like Trump. My best advice for my PTSD patients who are triggered by Trump is to avoid the news media.

But when I tell people to avoid the news media, I often get the response, "But how do I stay informed?" This represents a common misconception, that the way to stay informed is to consume news media. In fact the American news media does a poor job of conveying information. As an example, about 10 years ago I read about a study that found that persons who consumed news media were less informed about the Middle East than those who ignored the news. That was because the "news" about the Middle East that one finds in the US is full of disinformation.

 In order to stay informed, rather than watching CNN and reading the New York Times, I suggest reading a variety of magazines from different perspectives combined with reputable works of history. For example, if one reads both the Economist and a reputable left-wing publication, between the two one might get a glimpse of the truth.

People who know history know that Trump can't be Hitler, and in any case, he isn't Hitler. Trump has no desire to rule the world--in fact he wants to build a wall around the U.S. It's not possible for a US President to rewrite the Constitution.

There are grave problems that may occur in the next four years, including the dismantling of what remains of the healthcare reform act (Obamacare), and the dismantling of efforts to combat climate change. Yet I don't think the young people huddled in safe rooms drinking hot chocolate are concerned about these grave threats. They are concerned about "hate" because that is how they have been propagandized to think by the Democratic Party and by an irresponsible news media.

UPDATE Nov. 19: The FBI reported a 7 percent increase in hate crimes in the US in 2015, including a large jump in hate crimes against Muslims. Donald Trump didn't become a serious candidate until 2016. Overall, the number of hate crimes remains fairly small, although any number is of concern. 




Thursday, November 3, 2016

Can Therapists Diagnose Public Figures Who Aren't Their Patients?

Recently I received an update from my professional association that included a sternly worded warning against diagnosing public figures whom we haven't met. This was obviously in response to discussions some therapists have been having about what is wrong with Donald Trump. Although it seems logical that a therapist should have a diagnostic interview with someone before giving that person a diagnosis, something about this warning didn't sit right with me and I gave it some thought.

The first thing that occured to me is that one diagnostic interview with a patient often doesn't yield enough information for a definitive diagnosis either. Yet, insurance companies demand that a diagnosis be given at the end of the first session. My professional association doesn't seem to have a problem with that.

Perhaps what my professional association is more concerned with is not inaccurate diagnosis but public shaming--in fact, the warning included a comment that public figures might be hurt by discussions of their presumed emotional or personality problems.

The entire controversy reminded me of the difference between my background and that of many of my colleagues. I entered the field of psychotherapy as a career change. Previously, I had been a news reporter and my undergraduate major was history. I covered political campaigns and controversial issues involving public figures. From that experience I learned that dealing with criticism is part of the role of being a public figure. In my study of history, I have read many historical biographies in which the writer pondered the mental status and personality of their subject. These historians aren't even mental health professionals. Yet this is accepted practice in the study of history, as in-person interviews aren't possible and historians have to make the most of whatever materials are available to them.

When people choose to become public figures and are entrusted with decisions that can change the fate of nations, they deserve to be heavily scrutinized and their mental health should be part of that scrutiny. Moreover historians and also people in my profession can benefit from studying trends and patterns in personality among public figures.

I can easily discern a possible diagnosis for Donald Trump and one for Hillary Clinton, even though I haven't interviewed either of them (I did once encounter Donald Trump, but it wasn't a personal discussion). I have access to large amounts of information about their lives and have observed them speaking to a wide range of people, via the media. This type of information in fact reveals much that doesn't always come up in a one-on-one interview in a therapy office. I have often wished I could observe my patients at their jobs or in social situations.

I'm not going to reveal my hypotheses, as this would risk getting in trouble with my professional association. What I can say is that Clinton almost certainly has a diagnosis that in my experience (as a therapist, a former journalist and a student of history) is quite common among politicians. Trump is more of an outlier. Our country has never elected anyone quite like him, and therefore he is a wild card.

Friday, October 21, 2016

Rapists Old and New

NOTE: This has been slightly edited since initially published.The accusations against Donald Trump have ignited a moment we haven't seen since 1992 when Anita Hill ripped the veil of denial from people's eyes about sexual harassment on the job.

What has been coming out all over the media and in my office are stories about rape that people never reported, perhaps because they didn't think anyone would listen, or because they just preferred not to think about it. It's always easier to pretend something unpleasant just didn't happen. But when people start hearing other people's similar stories, it's more difficult to ignore the past

I believe the dynamics of social rape have changed (I've decided to use the term social rape because "date rape" and "acquaintance rape" don't describe rape by boyfriends and friends). In the era of my youth, college women got raped by football players at parties because it wouldn't occur to them that if a man they didn't know well invited them to his dorm room for a beer, it could be a dangerous situation. This was "acquaintance rape."  I also heard stories about people raped by their boyfriends. What was the same in all of the stories I heard in the 1980s was that afterward, the women were traumatized and they did not wish to see or interact with these men again.

Lately I've come across a phenomenon I have never seen or heard of before: A woman is raped by a man she is dating and she continues to date him. Perhaps this was the scenario of the "mattress woman" at Columbia University--who knows. I am beginning to think this scenario is far more common than  most people want to acknowledge.

Why would a woman continue to date a man who raped her? I've been hearing interesting rationalizations. These have included "I like sex so I decided it was ok" and "I wasn't sure if I felt bad about it because of my own issues about sex." What both these rationalization have in common is that there is an underlying assumption that sex is fun and you're supposed to like it, and if you don't like it, it's because of your "issues." In fact this nonsense has been a common manipulation tactic of rapists throughout the decades, and also of harassers on the job, who have perennially tried to shame women as "prudes" to get them to comply.

In my era sex was considered a variable experience for heterosexual women. It was considered only good if a man was "good in bed" and it was considered normal for a women to refuse sex fairly often. None of us considered an occasional lack of interest in sex to be evidence of our "issues." If sex was bad, we typically blamed our partners, not ourselves. A quick glance at the covers of women's magazines and men's magazines and popular movies shows that times have changed. Women are now mysteriously supposed to be responsible for making sex fun, when making sex fun was supposed to be the man's job and he was supposed to feel grateful that he found a woman who actually was willing to sleep with him.

In my opinion there is only one logical explanation for this strange turn of events, and that is what has often been called the pornographication of society, which covers not just the ubiquity of online porn, but also an increasing use of porn talk  in the general media and an overall degradation of women that is getting worse. In porn, women are the sexual servants of men, yet in all but the worst porn they are also supposedly liking it.

Despite the fact there is supposedly some sort of "third wave" of feminism going on, this brand of feminism doesn't seem up to the task of combatting these problems. In this version of feminism, an actress who publishes a supposedly feminist newsletter can create a tv series in which women are referred to as "Girls" and in her newsletter publish a piece by a fashion designer. The radical feminists of the 70s and even the middle-of-the-road feminists of the 80s would have been puzzled. We fought to get rid of adult women being called "girls" and fashion was identified as both a money drain for women and typically a series of costumes designed for male entertainment.

Other oddities of this new feminism include the chiding of women who are only activists in women's issues. The message is that if you don't divide your time between women's issues and everyone else's issues, you are displaying "white privilege" "transphobia" etc. I don't recall Martin Luther King Jr. being chided because he didn't spend his spare time advocating for Latinos, the disabled or any other group. There was a notion that people are supposed to stand up for themselves and organize members of their own group--because isn't that people's primary responsibility and where people are most effective? I believe this trend is just a way to water down feminism. There are many ways different kinds of oppression intersect, but that doesn't mean a woman has to advocate for everyone else's demands in addition to her own. This is just a new version of another antique message that has been used to oppress women through the millennia--the idea that we are the caretakers of everyone else.

The real needs of women and girls are being overlooked by a politically correct brand of feminism that wants to be non-threatening, trendy and fashionable, and "sex positive." Ultimately the message is: Fit in, or you're not cool--kind of like junior high school bullying.

Young women are living in a dishonest and dangerous time. Although laws have changed to encourage the prosecution of rapists, this doesn't help young women who blame themselves or even believe that they couldn't have been raped because it wasn't that bad; it was sex. Young men are encouraged to rape by the pornographic media they consume, but also because they know that many of the young women they are meeting have been brainwashed by a popular culture that has reduced them to sexual servants and entertainers of men. They are seeing women as their entertainers and caretakers, and as  rapeable objects who won't complain.
ADDENDUM 11/20: This post has attracted more views by far than anything else I have written for this blog. I would like to get feedback. If you have read this post please post a comment or send me a message at annerettenberg@msn.com.

Monday, September 26, 2016

Transgenderism and Mental Health--Unanswered and Unasked Questions

What is transgenderism? No one knows for sure. There are only theories.

The above sentence may come as a surprise to persons whose education about identity and sexuality comes from the mainstream and popular media. The "party line" from The New York Times, Hollywood, and other cultural instructors is that transgenderism is a phenomenon caused by someone being born into the "wrong body." This may be the perception of transgender persons, but perceptions are not scientific facts.

There are competing theories about transgenderism. Some studies have found that the neuroanatomy of transgender persons is somewhat different than what would be expected from their biological birth sex, but this doesn't explain that much, because gay and lesbian persons have similar neuroanatomical tendencies and most of them don't want to become the opposite gender. Moreover according to what I read from the following source (a scientific article republished in a blog):
https://gendertrender.wordpress.com/2012/11/21/what-many-transgender-activists-dont-want-you-to-know-and-why-you-should-know-it-anyway/
these neuroanatomical differences may have been triggered by hormone therapy.

The above source describes a competing theory, that male to female transgender persons, who are the majority of transgender persons, have a condition called "autogynephilia," which is the eroticization of a fantasy of being female. Cross-dressing is a way of enacting this fantasy.

 Everyone in my field knows that there is a percentage of people who engage in fantasies for whom fantasy isn't enough. Those persons attempt to enact their fantasies in real life. 

Do male to female transgenders really want to be "women"? In my opinion this is questionable. In my observation few male-to-female transgender persons want to have the actual experiences of being female, such as menstruation, pregnancy, and being victimized by sexual harassment and discrimination. These experiences aren't erotic. Observing the behavior of MtF transgender persons in New York City, it is easy to see that transgenderism to them means feminine clothing and hairstyles, makeup and adopting female names and pronouns for themselves. But feminine clothing and hairstyles are designed for a type of exhibitionism that has long been promoted for women by our society (and most societies in human history) as part of a social construct. Socially-promoted exhibitionism is a superficial form of femininity, a constructed version of femininity that isn't intrinsically female and is not what most biological women would state is what defines them as being female. Although I can't say for sure how most women would describe what makes them women, most women I have known would list their experiences of being biologically female and being perceived as biologically female throughout the life cycle,  and perhaps personality traits such as sensitivity to others or a desire to be a mother. Few and almost no women over the age of 40 whom I have known would say that wearing makeup, having long hair, or wearing dresses is what makes them female, and in fact many women don't do any of these things.
These observations imply  that male to female transgenderism may be motivated by exhibitionistic personality traits.

Another possibility for transgenderism is that the transgender person is gay but cannot accept this aspect of his/her identity. Becoming the other sex gets rid of this conflict. 

I have wondered why at this point in history transgenderism, which is a phenomenon for approximately three tenths of one percent of the population, has become a flashpoint. I found out from a New York Times article that the Obama administration was prompted to put forth decrees about transgenderism after receiving requests for guidance from high school principals and also because a gay advocacy group pressured the Obama administration. It's interesting that gay rights groups for decades promoted self-acceptance for gay and lesbian persons but now are promoting the idea that people who don't accept their own bodies are displaying an intrinsic identity.

I have wondered if some female to male transgenders are lesbians who are the "dominant" partner in a BDSM relationship and have figured out that having a more masculine body makes it easier to dominate someone.

Carl Jung, the famous psychoanalyst who studied personality, had a dim view of transgender persons. Jung believed that all men had an inner feminine identity that he called the "anima" and all women have an inner masculine identity called the "animus." Jung believed it was important for persons to accept their inner "male" or "female" in order to be mentally healthy. But is it possible that some persons cannot tolerate this ambiguity and fluidity and instead need  a more rigid construct of their gender identity?  Rigid, either/or thinking is found among people with a condition called Borderline Personality Disorder. People with BPD (coincidentally?) also tend to have identity issues.

There are many unanswered questions around the phenomenon of transgenderism. But there is one aspect of transgenderism that is not open to question, and that is the fact that transgender persons have high rates of suicide. Will allowing them to use the public restrooms of their choice cut down on their suicide rate? I don't think that it will. I think instead that encouraging them to seek counseling is probably more likely to lead to better mental health. But in 25 years no transgender person has ever appeared in my practice--why would they? If someone believes his problem is that he was born into the wrong body, psychotherapy doesn't change that. The current propaganda about transgenderism may in fact be discouraging transgender persons from going to psychotherapy. Depression and other disorders may be untreated in transgender persons because they are being encouraged to view all their problems as stemming from being "born into the wrong body."

Some research studies in the past have found that many people who undergo cosmetic surgery--for example, surgery to increase breast size, nose jobs or face lifts--had unrealistic expectations that it would improve their lives. Their mental health did not improve from their cosmetic surgery. All the data on the outcome of "gender reassignment surgery" (now sometimes called "gender confirmation surgery") isn't in. But most MtF transgender persons never in fact have "sex change" surgery, and this adds evidence to the proposition that they do not really want to be "women" in the manner that most women would describe themselves.

It occured to me while thinking about this that I have come across transgenderism in my career, just not in my clinical practice. I've encountered transgenderism in my consulting work in psychiatric hospitals. In one case, a man who was receiving hormone treatments to "become" female was admitted to a hospital with a serious mood disorder and self-harm. Three weeks into his hospitalization he wasn't getting better; he was getting worse.  A consulting doctor was called in, and without even a discussion with the attending psychiatrist, the consulting doctor wrote an order discontinuing the hormone treatment that the attending psychiatrist had simply continued from the patient's outpatient gender change treatment. The consulting doctor then wrote a lengthy note in the patient's chart describing how the prescribed hormones were contraindicated for the patient's psychiatric condition and were almost certainly exacerbating the mood disorder.
The negative mental effects of excessive female hormones are well known, and male-to-female transgenders take enormous dosages of female hormones--why did the admitting psychiatrist and then the attending psychiatrist continue these medications? Perhaps because we are living in a cultural climate in which the promotion of an ideology surrounding transgenderism  trumps the mental health of actual transgender persons.

We need to use common sense and we need to do further research on what and who transgender persons are and what type of help they need to diminish their high rate of suicide.

ADDENDUM Oct. 1: I found this fascinating (lengthy) blog post from another therapist. She works with teens with gender dysphoria:
https://4thwavenow.com/2016/09/25/layers-of-meaning-a-jungian-analyst-questions-the-identity-model-for-trans-identified-youth/

Thursday, June 30, 2016

Truth v. Fads Part II: Online Reviews and Psychiatry

In previous generations, when a young person wanted advice on life's questions, she or he often consulted with an elder or with an expert.  Today, people are more likely or just as likely to look for answers on the internet. Let's look at the differences:

Elders relied on their own experience and also "folk wisdom," the accumulated knowledge of hundreds or thousands of years, typically distilled into proverbs and aphorisms (more about folk wisdom in a future blog post). Experts, such as professionals, rely on professional training, advanced education and professional experience. The internet is a catch-all of information, some of which comes from reliable sources but much of which does not. Recent studies have found that people put a lot of credence into online reviews of products and services, but the findings of these online reviews did not accord with the assessments of highly regarded consumer organizations such as Consumer Reports. The New York Times cited this study:
“Navigating by the Stars” was published in April in The Journal of Consumer Research. After analyzing 344,157 Amazon ratings of 1,272 products in 120 product categories, the researchers found “a substantial disconnect” between the objective quality information that online reviews actually convey and the extent to which consumers trust them...Nearly half the time, Amazon reviewers and the Consumer Reports experts disagreed about which item in a random pair was better. Moreover, average user ratings [on Amazon] did not predict resale value in the used-product marketplace, another traditional indicator of quality."


The Atlantic magazine cited some other studies:
"in Nielsen’s 2015 “Global Trust In Advertising” report, for instance, around two-thirds of respondents indicated that they trust consumer opinions posted online... As for young people, a 2014 poll found that Millennials consider online peer reviews to be slightly more trustworthy and memorable than professional ones.This shift in attitude has taken place despite frequent discoveries of fraud in crowdsourced reviews. In 2013, for example, after concluding a year-long investigation called “Operation Clean Turf,” the New York Attorney General’s office ordered 19 companies to pay more than $350,000 in fines for flooding various review sites with phony endorsements. Last October, Amazon sued more than 1,100 people for offering to create fake product reviews for $5 apiece."

 It's scary to think that many people are basing decisions on the statements of random anonymous persons on the internet, who have no consequences for their actions stopping short of outright libel.  I have seen this behavior in my practice:

 Several times over the past several years, I have given a patient the name of a prescriber to contact for a medication evaluation, but the patient came back to me the following week and reported that she or he never contacted the prescriber because they looked him/her up on the internet and found negative reviews (mostly on Yelp).  I wanted to say, and perhaps should have said, "You trust the opinion of a random anonymous person on the internet over the recommendation of your therapist?"  So far I haven't said this, perhaps afraid to make it seem like I was personalizing. However, therapy doesn't work if the patient doesn't put any credence into what the therapist says, so perhaps I should discuss these incidents.

 The opinion by a professional of another professional is more reliable than the opinion of a random anonymous person  who has no accountability, perhaps an unseen agenda and may even be a paid shill for someone else (negative review) or for the reviewee (positive review). Reviews of psychiatrists especially should be looked at askance, for reasons that may be obvious.

Why would I refer someone to a bad prescriber if I am going to continue working with the patient, as the wrong medication would make my job harder and increase liability risk?

I did  point out to one such patient that the prescriber in question may have gotten negative reviews due to refusal to prescribe addictive medications that many drug addicts seek. The patient's response was "I hadn't thought of that." But it's one of the first things that would occur to a mental health professional, especially one with a background in addictions counseling,  because we are aware that such behavior is common.

50 years ago people sought the opinions of experts and of elders when making important decisions. Today people are seeking the opinions of unseen random strangers. Which is more reliable? 

Sunday, June 26, 2016

Truth v. Fads Part One: Dating Advice for Heterosexual Women

Recently I suggested to one of my patients who's having some dating issues that she read the 1990s bestseller "The Rules." I noted that although the book contains some advice that might seem superficial about makeup and other trivialities,  the basic theme is about setting boundaries and limits with people--something that many people, especially women, often have difficulty doing.  She read the book and found it useful, but told me that when she told her friends she was reading "The Rules," they were shocked because, they claim, the book is anti-feminist.

I'm a feminist. The definition of feminist in the popular imagination seems to have changed in the past 20 years, but I don't think the actual definition of feminism has changed. A feminist from 20 years ago (or 40 years ago) and a feminist today presumably agree that feminism is about equal rights under the law and a belief that men and women are intrinsically equal, that men are not superior to women.

There were arguments starting in the 1970s in favor of the interpretation that feminism implied that men didn't have to pay for women on dates and that women should feel free to ask men out on dates. However, until fairly recently I had been under the impression that those arguments never really caught on and the they were finally tossed out after "The Rules" explained how these social gestures had nothing to do with feminism. Apparently I was wrong. From what I've heard from several patients in their 20s and early 30s as well as what I've been reading in the popular media, there remains an interpretation of feminism that has less to do with equal rights and more to do with a promotion of the idea that women should adopt  male behaviors in dating, such as asking men on dates and even proposing marriage. Copying other people's behavior doesn't have much to do with equal rights. If women and men are equal, then why should women be told to act more like men? Telling women to act like men carries an implication that women are doing something wrong. This fits in with a tendency women have to blame themselves, a probable factor in the higher rates of depression among women compared to men. Many feminist philosophers have argued that society overvalues male behavior and undervalues female behavior.

Anyone who has studied biology or even just watched nature programs and documentaries from time to time is aware that most animals engage in elaborate courtship and mating rituals. In many species of birds, males must court females through helping them build nests or by putting on elaborate displays. Male deer fight each other to prove who is the dominant male who should mate. Males have been proving themselves for the right to mate for tens if not hundreds of millions of years--how could humans think that  popular fads can overrule Nature's rules? They don't. Evolution has decided that females should select males based on the male's efforts at winning over females, because this ensures survival of the fittest. Nature doesn't think that males are superior to females. Nature has simply developed a set of rules--Rules--to ensure survival of the fittest. Expecting a man to pay on the first date doesn't mean you're not a feminist woman--it means you are following a rule that has been tested and proven by Nature for a hundred million years.

Some in the popular media seem to argue that biological mating isn't relevant to contemporary dating because contemporary dating is about having fun and lots of casual sex. In reality, most women want to find a mate. The notion that what women seek is lots of casual sex with various friends, acquaintances and strangers is something that has been promoted by self-styled opinionators, many of whom are not women. These individuals may have agendas that have nothing to do with promoting health and happiness for women.

Making a man prove himself means not asking men out on romantic dates, not asking a man to marry you, and expecting that on a first date that the man will pay for all or most of the expenses. Because if a man can't take the initiative and responsibility to pursue the woman he wants, he isn't worth your time, and, as another book said, he might "just not be that into you." Men have a tendency to know what they want and to pursue what they want in romantic and sexual relationships. If they don't pursue, it can mean they don't want the other person that much but are just going with the flow because why not? It's not uncommon for a man to allow a sexual relationship to go on even if he doesn't want to marry, doesn't respect and/or doesn't even like the other person. Trust me--I've had a lot of male patients and I've been able to directly hear statements to this effect.

 Men and women aren't the same. There are biochemical/genetic/psychological differences between the genders that do not imply a difference in equality but do mean difference. Equal doesn't mean identical. Women are genetically engineered to become more emotionally invested in relationships over time (although men may develop dependency for different reasons).  Women are also more likely to be infected with STDs by their partners and are the only gender that can get pregnant. These are some of  the reasons why women should be cautious about romantic and sexual relationships and should set high standards for mates.

If you want to find the truth about any subject, don't look to what some columnist on a trendy website says. Try looking at the evidence that has been proven over time, and the more time, the better. I plan to write more following this theme.