Contemporary Sexual Medicine What Would Hippocrates Do? Society for Sex Therapy & Research (SSTAR) April 3, 2009 - Arlington, VA. Contemporary Sexual Medicine for Sex Dysfunction: What Would Hippocrates Do? Michael E. Metz, Ph.D. 821 Raymond Avenue, Suite 440 St. Paul, MN 55114 Voice: 651-641-9317; fax 651-642-1908 MMetzMpls@AOL.com www.MichaelMetzPhD.com

Dr. Hippocrates, MD, PhD, MPH

Many images of Hippocrates

Hippocrates Hippokrates of Kos (c. 460 BC – ca. 370 BC) an ancient Greek physician of the Age of Pericles – 25 centuries ago! considered one of the most outstanding figures in the history of medicine. referred to as the "father of clinical medicine" in recognition of his lasting contributions to the field. Born c. 460 bc; Island of Cos.

Island of Cos, Greece

Hippocrates the Man: Vitae Trained under his father, a physician. Studied in Athens. Traveled extensively. Returned to Cos to write teach practice Lived to age of 83 – 90.

Hippocrates the Man: Vitae Credited with being the first physician to reject beliefs that credited supernatural or divine forces with causing – and curing – illness. deductive reasoning. He believed that the goal of medicine should be to build the patient's strength through appropriate diet, life-style and hygienic measures, resorting to more drastic treatment only when necessary when the symptoms showed or clarified the ilnesss. Practice anchors: patient education. problem (not symptiom) focused medicine. Interventions: cautious & incremental.

Hippocrates the Man: Vitae founder of the Hippocratic or Coan Asklepieion (school of medicine). was of enormous importance in separating medicine from superstition and philosophic speculation.

Asklepieion on Cos -- Medical School

Tree where Hippocrates lectured

Tree of Hippocrates National Library of Medicine, USA-NIH, Bethesda, MD A cutting from the Tree of Hippocrates, gift from the Island of Cos, Greece. Planted December 14, 1961 at the dedication of the National Library of Medicine, Bethesda, MD.

National Library of Medicine, NIH, Bethesda

Dr. Hippocrates _____________ The seasoned physician & sex therapist ?

Galen (c. 129 – 200 AD) After Hippocrates, the next significant physician was Galen, a Greek who lived from 129 to 200 AD. Galen perpetuated Hippocratic medicine. photo Nina Aldin Thune

2nd century Physician, Galen, teaching medical students about couple sex (14th century manual)

HIPPOCRATIC OATH Ethical Practice of Medicine The Hippocratic Oath is an oath traditionally taken by physicians pertaining to the ethical practice of medicine. Basis for other helping professionals codes of ethical practice. It’s summary axiom: “Do No Harm.”

Question? In addressing sexual problems and sexual medicine / therapy for the 21st century is the Hippocratic Oath sufficient guidance for sexual health specialists?

The Classic Hippocratic Oath I swear by Apollo Physician and Asclepios and Hygeia and Panacea and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant: To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else. I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

6 Classic Medical Ethics Principles: Ethical Values and Sexual Health Non-Maleficence – “first, do no harm”. Beneficence – always ensure the best interest of the patient. Autonomy – the patient right to choose or refuse treatment based on full disclosure. Justice – fairness and equality concerning treatments. Dignity – the patient and professional have the right to personal respect. Truthfulness – honesty about evidence based treatments, and freedom from dual relationships.

Dan’s article,. “The Ethics Corner” in Jan. 09 SSTAR Newsletter Dan’s article, “The Ethics Corner” in Jan.09 SSTAR Newsletter. DAN WATTERS, Ph.D. PEGGY KLEINPLATZ, Ph.D. SSTAR Sunday Workshop: “Ethical Dilemmas & Clinical Conundrums in Sex Therapy” 9:00 a.m. – 12:00 noon.

HIPPOCRATES TODAY ? Scientist Teacher Clinician

SCIENTIST Objective Observer Caring Thinker I. HIPPOCRATES SCIENTIST Objective Observer Caring Thinker

Ancient Greek Medicine

The Pantheon of gods… Zeus. gods vs. giants. Haides – god of death. Hekate -- goddess of witchcraft

The gods… <-- Athene being reborn Plaque with figures from head of Zeus. from religious rituals. Goddess Nyx (Night) driving her chariot with winged horses. <- Zeus disguised as a swan seduces Leda.

Healing Stele of Horus (Egyptian, c. 300 b.c)

Asklepios – god of medicine and healing Asklepios Hippocrates teaching and Asklepios arriving at the Cos Asklepieion School.

Hippocrates the Scientist: He challenged beliefs of supernatural or divine forces as: sources and causes or cures of illness.

Hippocrates TODAY: Sex Therapy would teach to demythologize unreasonable claims of sexual performance: treat “hype” about sex (e.g., perfect erections) as though it were claims from the “gods”. would promote reasonable sexual knowledge and expectations of sexual performance and couple satisfaction.

Hippocrates TODAY: Sex Therapy would teach an integrative biopsychosocial approach to sex problems: he’d teach the inseparable unification and interaction of biological, psychological, and interpersonal dimensions and never address one without consideration of the others.

INSIGHTFUL TEACHER Trainer Mentor II. HIPPOCRATES INSIGHTFUL TEACHER Trainer Mentor

Hippocrates the Teacher TODAY He would be concerned about the misinformation and “primitive skills” level of many professionals / clinicians to address sexual concerns. He would strongly promote greater and specific sex therapy training requirements for degree programs and licensure for all healthcare professionals.

Hippocrates the Teacher Today Would promote sex therapy training in traditional and new ways: traditional: “First be a good clinician, then a good sex therapist.” (Harold Leif, M.D.) newer: Interactive on-line knowledge and skills training resources.

Hippocrates the Teacher Today Examples: RUThinking.co.uk – UK teen sexual health. http://www.ruthinking.co.uk/ “Children in the Middle” (divorce) interactive classes, seminars for: Parents Professionals http://www.childreninthemiddle.com/classes2.htm

COMPASSIONATE CLINICIAN III. HIPPOCRATES COMPASSIONATE CLINICIAN & Sex Therapist

Hippocrates the Sex Therapist: Professional identity: VOCATION “calling” to serve others, to use knowledge in the service of his patients’ overall (sexual) health. focus on the total person – physical, mental & interpersonal/family.

Hippocrates the Sex Therapist: professional “patient collaborator” more than a “technician” fellow-worker with his patients for their health. credited with practicing with an eye for evidence from: detailed personal & family history; kept a patient record that would follow to other physician. patient observaton continuous pulse during history for evidence!

Hippocrates the Sex Therapist TODAY would assess and treat from a comprehensive evidence-based approach: empirical knowledge – “factual” qualitative knowledge -- “compassionate”

Professional Myopia ? Awareness of our “Professional Filters…” Hippocrates would also challenge our clinical perceptions because: “We tend to ‘find’ what we’re looking for”: MD: DX & TX --> only physiological ? MH: DX & TX --> only psychological ? SW / MFT: DX & TX --> only interpersonal ? Hippocrates would integrate “all of the above…”

Hippocrates the Sex Therapist TODAY ► He would pursue the sexual problem: with careful, detailed histories, to seek the source and the impact, and treat all features. TREAT THE DISEASE, NOT THE SYMPTOM.

Hippocrates the Sex Therapist TODAY: SUMMARY would honor his “calling” to be a sexual health professional with loyalty to the ethical principles. would be steadfastly patient-centered. would treat the sex problem as an all-encompassing biopsychosocial problem not simply symptom relief.

Hippocrates the Sex Therapist TODAY: SUMMARY Would teach / educate to empower his patients with accurate knowledge and reasonable expectations. promote individual & couple satisfaction as the vital purpose of sex medicine & therapy. teach reasonable sexual health such as: Metz & McCarthy (2007) --> “Good-Enough Couple Sex” Kleinplatz, Menard et al, (2007) --> “Optimal Sexuality” AND….

Dr. Hippocrates, MD, PhD, MPH …He would be a SSTAR COLLEAGUE Dr. Hippocrates, MD, PhD, MPH

Any resemblance between HIPPOCRATES and the god ZEUS is purely coincidental.

Dr. Hippocrates, MD, PhD, MPH OUR SSTAR COLLEAGUE Dr. Hippocrates, MD, PhD, MPH

Contemporary Sexual Medicine What Would Hippocrates Do? Society for Sex Therapy & Research (SSTAR) April 3, 2009 - Arlington, VA. Contemporary Sexual Medicine for Sex Dysfunction: What Would Hippocrates Do? Michael E. Metz, Ph.D. 821 Raymond Avenue, Suite 440 St. Paul, MN 55114 Voice: 651-641-9317; fax 651-642-1908 MMetzMpls@AOL.com www.MichaelMetzPhD.com