A crusading physician deplores ideological double standards about health care for students.
When "Brian" shows up at University of California student counselling centre, he wants help for just one of his two problems. Brian hasn’t been successful in giving up smoking on his own, so he asks psychiatrist Dr. Miriam Grossman to prescribe medication to help him. Brian can list the short- and long-term reasons why he needs to quit his bad habit.
Brian’s other problem is the one he’s actually more nervous about, and it’s the one he neither seeks nor receives help for. Brian has sex with men. He has never been tested for HIV, neither he nor his boyfriend uses condoms, and both of them regularly pick up other partners.
At one level, Brian knows that his behaviour is considered unsafe and irresponsible. On another, he is being enabled in his self-destruction by institutions much bigger than himself.
Brian is very openly gay-identified, yet Grossman is the first physician who has ever discussed his sexual practices with him. The UCLA campus health service is much more comfortable with other, relatively innocuous topics, like tobacco addiction. The mental health professions, Grossman alleges, are manipulated by special interest groups, more committed to their agenda than to student well-being. Consequently, universities and colleges help to promote sexual diversity, yet do very little to save the lives of students at risk. Unless or until she knows that Brian is HIV positive, Grossman is told, there is nothing she can do – even though she assesses him to pose "an imminent menace to the public health."
After treating over 2,000 students on her campus, Grossman is sufficiently frustrated to have begun speaking out against the forces thwarting the proper care of kids like Brian. "My profession has been hijacked. I cannot do my job, my patients are suffering, and I am fed up."
In Unprotected: A Campus Psychiatrist Reveals How Political Correctness in Her Profession Endangers Every Student, Grossman uses the cases of disguised individual patients to condemn the ideological double standards by which she feels straitjacketed. Many years after putting her hand down at a conference when she "didn’t have the guts to be the sole challenger" to the Zeitgeist, she is finally dipping her toes in the waters of resistance. Grossman originally published this volume in hardback as "Anonymous, M.D.", before "outing" herself on a radio talk show as the author. The paperback version, due in stores in late August 28, will identify her as the author.
Grossman powerfully challenges the cognitive dissonance she faces on a daily basis. She contrasts the case of Brian with that of "Tom", a foreign student who may have been exposed to tuberculosis.
"If I delay or fail to report Tom, I will be in violation of state regulations, and subject to citations and fines. I might also be in trouble with the medical board, as failure to report suspected TB – or measles, syphilis, chlamydia, meningitis, and forty-six other communicable diseases – is considered unprofessional conduct." But a promiscuous gay man cannot be compelled to moderate his behaviour, or even to submit to HIV testing. "Why am I mandated to protect Tom, but not Brian?" Only one medical condition in public health is sacrificed at the altar of confidentiality.
With each chapter, Grossman tells of further contradictions on campus. Although we are told that women are the same as men, disproportionate student appointment requests are from females. These patients are heartbroken by failed sexual relationships and by "hook-ups" that lead nowhere. Although unlimited academic and career counselling is lavished on women pursuing lengthy higher education, never mentioned is how their chances are diminishing of some day having the children they vaguely expect.
Although "safer sex" is considered both possible and ideal, sexually transmitted infections are not always cured, and their consequences can be devastating. Although "health" advisories suggest that "‘HIV is here to stay, and anybody can get it’", the fact is that "what spreads HIV is anal sex, sharing needles, or a partner who does those things." Although diversity is a cherished value, students of faith simply aren’t accommodated like those pursuing "alternative lifestyles".
Exercise, non-smoking, good nutrition, and even osteoporosis prevention are university dogma. "The message is loud and clear," writes Grossman. "Learn about your health, take care of yourself. There are consequences to your lifestyle, so work at changing it. Have the fruit instead of the pizza, take the stairs, not the elevator. Sure, it’s not fun, it takes discipline and self-control, but hey, that’s what we’ve got to do to stay healthy. Later on, you’ll be glad you did!" At the same time, college-sponsored websites and health centre brochures encourage deadly habits – fetishes, cruising and risky sex.
Hundreds of miles from New Orleans, Louisiana, Grossman’s school reached out to Katrina hurricane victims, while ignoring the certain trauma to at least a portion of its own students who have suffered after a chemical abortion. "Will someone please explain to me," writes Grossman, "why does psychology, in its quest to identify and counsel every victim of possible child abuse, sexual harassment, or hurricanes, leave no stone unturned, and then go berserk at the suggestion that maybe, maybe, some – not all, but some – women and men hurt for a long, long time after abortion, and they too need our help?"
Grossman’s book is at once compelling and frustrating, because she is unresolved about some of her own contradictions. While she herself is a person of faith, Grossman feels she must "forget Leviticus" to show that her arguments are based on reason alone. While she is horrified by the trauma some students experience when undergoing chemical abortions, Grossman still suggests "emergency contraception" as part of the solution; apparently she is unaware that, because "Plan B" can end pregnancy, it also can lead to protracted grief. While she is incensed by the consequences of amorality around her, Grossman still endorses Japanese-style morally "neutral" rituals, such as shrines for grieving, for recovery from abortion; and despite ample objective evidence that it should be prevented altogether, she takes no firm stance. While she is haunted by a professional conference where her peers resolved to alter society rather than treat an individual’s gender identity disorder, Grossman still prides herself on her "cultural sensitivity" towards a woman she says is changing into a "man".
That Grossman has yet to fully integrate her views may actually be a factor in the widely positive reception to her book. Grossman intends this book as a wake-up call for parents. "The nurse teaching your daughter about herpes, the social worker reassuring your son about his homosexual thought – these people may have a vision for social change that you don’t share," she writes. Parents disturbed by the falsification of healthcare will indeed find the book an essential resource. Likewise, health and helping professionals, as well as activists – of both the student and the lifelong learner varieties – will find the book a valuable tool in effecting meaningful change.
Theresa Smyth, a social worker, writes from Toronto, Canada. A shorter version of this review originally appeared in The Interim, a Toronto-based newspaper.