1. Dr. Hippocrates, MD, PhD, MPH

2. 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 821 Raymond Avenue, Suite 440 St. Paul, MN 55114 Voice: 651-641-9317; fax 651-642-1908 MMetzMpls@AOL.com www.MichaelMetzPhD.com

3. Images of Hippocrates

4. Hippocrates Hippokrates of Kos (c. 460 BC – ca. 370 BC) ● an ancient Greek physician of the Age of Pericles. ● 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.

5. Island of Cos, Greece

6. ● 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

7. He believed that the goal of medicine should be to build the patient's strength through appropriate diet and hygienic measures, resorting to more drastic treatment only when necessary and when the symptoms showed or clarified the ilnesss --> preventive & incremental medicine. He believed that the goal of medicine should be to build the patient's strength through appropriate diet and hygienic measures, resorting to more drastic treatment only when necessary and when the symptoms showed or clarified the ilnesss --> preventive & incremental medicine. credited with being the first physician to reject beliefs that credited supernatural or divine forces with causing – and curing -- illness --> deductive reasoning. credited with being the first physician to reject beliefs that credited supernatural or divine forces with causing – and curing -- illness --> deductive reasoning. founder of the Hippocratic or Coan school of medicine that was of enormous importance in separating medicine from superstition and philosophic speculation. founder of the Hippocratic or Coan school of medicine that was of enormous importance in separating medicine from superstition and philosophic speculation. Hippocrates the Man: Vitae

8. Asklepieion on Cos -- Medical School

9. Tree where Hippocrates lectured

10. 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.

11. National Library of Medicine, NIH, Bethesda

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

13. 2 nd century Physician, Galen, teaching medical students about couple sex (14 th century manual)

14. 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.”

15. Question? oIn addressing sexual problems and sexual medicine / therapy for the 21st century ois the Hippocratic Oath sufficient guidance for sexual health specialists?

16. 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: 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.

17. 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.

18. HIPPOCRATES TODAY ? 1. Scientist 2. Teacher 3. Clinician

19. I. HIPPOCRATES SCIENTIST Objective Observer Caring Thinker

20. Ancient Greek Medicine

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

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

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

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

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

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

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

28. II. HIPPOCRATES INSIGHTFULTEACHERTrainerMentor

29. 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 be concerned about the misinformation and “primitive skills” level of many professionals / clinicians to address sexual concerns. He would strongly promote greater sex therapy training requirements for degree programs / licensure for professional (except California MFT certification; RNs?) He would strongly promote greater sex therapy training requirements for degree programs / licensure for professional (except California MFT certification; RNs?)

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

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

32. III. HIPPOCRATES COMPASSIONATE CLINICIAN & Sex Therapist

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

34. Hippocrates the Sex Therapist: professional “patient collaborator” professional “patient collaborator” more than a “technician” more than a “technician” fellow-worker with his patients for their health. fellow-worker with his patients for their health. credited with practicing with an eye for evidence from: 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!

35. Hippocrates the Sex Therapist Today Hippocrates the Sex Therapist Today would assess and treat based on comprehensive evidence: would assess and treat based on comprehensive evidence: empirical knowledge – “factual” empirical knowledge – “factual” qualitative knowledge -- “compassionate” qualitative knowledge -- “compassionate” would promote an “open” all- inclusive, and thorough approach. would promote an “open” all- inclusive, and thorough approach.

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

37. Hippocrates the Sex Therapist Today ► He would pursue the sexual problem: sexual problem: ● with careful, detailed histories ● to seek the source and the impact (rather than only focus on the symptom) ● and treat all features. TREAT THE DISEASE, NOT THE SYMPTOM. TREAT THE DISEASE, NOT THE SYMPTOM.

38. Hippocrates the Sex Therapist Today: SUMMARY  would honor his “calling” to be a sexual health professional with loyalty to the “Hippocratic oath.”  would be steadfastly patient-centered.  would treat the sex problem as an all- encompassing biopsychosocial problem not simply symptom relief. not simply symptom relief.

39. 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 sexual health such as : Metz & McCarthy (2007) Metz & McCarthy (2007) --> “Good-Enough Couple Sex” --> “Good-Enough Couple Sex” Kleinplatz, Menard et al, (2007) Kleinplatz, Menard et al, (2007) --> “Optimal Sexuality” --> “Optimal Sexuality”

40. Dr. Hippocrates, MD, PhD, MPH …He would be a SSTARCOLLEAGUE

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

42. Dr. Hippocrates, MD, PhD, MPH OURSSTARCOLLEAGUE

43. 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 821 Raymond Avenue, Suite 440 St. Paul, MN 55114 Voice: 651-641-9317; fax 651-642-1908 MMetzMpls@AOL.com www.MichaelMetzPhD.com