OUT FOR GOOD

by Brian Miller, Ph.D.

'My boyfriend has a fetish'

THE IMMUNE SUPPRESSED UNIT

An Important New Weapon in the War Against ARC and AIDS

Within 5 years, 50% of all hospital admissions in L.A. County will be AIDSrelated. AIDS patients face a barrage of challenges from the minute they're diagnosed-medical, social, emotional, legal and financial.

Having worked with AIDS patients since 1981, I and others in the field began to plan a new kind of hospital service addressing all these problems. A service offering the special combination of experience and compassion required to satisfy these patients' needs. We called it the "Immune Suppressed Unit" (ISU). We believe the most comprehensive ISU in Southern California is located at Hollywood Community Hospital-the Immune Suppressed Unit, where I serve as Medical Director.

Each patient admitted to the center is served by a team of specialists. We have consultants in hematology, ophthalmology, gastroenterology, oncology, pulmonology, dermatology, neurology, substance abuse treatment, psychiatry and

neuropsychology. Patients receive a personal dietary program and physical, occupational and psychosocial therapy as required.

To coordinate care and keep patients aware of their treatment options, a Physician's Assistant/Nurse Practitioner is permanently assigned to each case. Care is highly individualized, with one nurse for every two or three patients on a round-the-clock basis. Every nurse in working with AIDS patients. the center is personally committed to

We use promising experimental drugs such as AZT, while staying abreast of new treatments for AIDS-related opportunistic infections.

Our ISU environment is homey; each private suite is comfortably furnished, including a sofa, refrigerator and answering machine. You'll even see lots of teddy bears around our unit-to brighten spirits and melt emotional barriers. To help patients and loved ones cope with the heavy psychological impact of AIDS, individual and group therapies are offered through the course of the disease. We also assist with the complex legal and financial aspects of AIDS; our aim is to help patients stay in control of their lives.

The Immune Suppressed Unit is a pioneering effort to improve the quality of care for ARC and AIDS patients today and provide a positive example for the ISU's of tomorrow.

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VISA

I was falling in love with a man and then he went and ruined it by telling me that he has a fetish. I never heard the word before, but apparently it means he really got off on my legs. I'm just into ordinary sex and I don't like anything weird. After he told me his fetish, I tried to be cool about it, but it bothered me a lot. During sex he wanted me to wear shorts and socks to emphasize my legs, and whenever he'd touch my legs, I felt both anger and pity for him. Our sex life went from terrific to terrible. To make a long story short, I broke off our relationship last night. It's an awful waste, but I don't know what else to do.

How could such a nice guy be into such a kinky thing? Are fetishists curable or do they get worse and go on to other things? Do you think if he got therapy we could make another attempt at our relationship? We both want it to work.

I doubt that your boyfriend is a true fetishist. Fetishism is a fixation on an object or body part and a compulsive need for it in order to be erotically gratified. True fetishists depersonalize and objectify their erotic attractions. In general, true fetishists have poorly developed social skills, have a diminished capacity for establishing intimacy and feel isolated and trapped by their fetish. In addition, the fetishistic behavior tends to diminish one's self-esteem, causes one to lose sensitivity or affection for one's partner, and cuts the person off from closely relating to others.

Your boyfriend would be considered a true fetishist only if the part of the body that excited him (in your case, the legs) was his exIclusive sexual interest, and the sexual experience with you as a person was secondary. The fact that you two originally had a satisfying, affectionate sex life suggests that your boyfriend is not a true fetishist.

It is very common for people to be excited by a particular feature of a sexual partner. Such interest is benign and normal, not a sign of a problem. There is an erotic arousal continuum and we are all on it somewhere. The continuum ranges from people who find nothing erotic, to those who turn on to the usual sexy stimuli, to those who are aroused by such things as exhibitionism, S/M, voyeurism, transvestism, toys, costumes, or selected body parts. The history of sex shows that virtually everything at one time or another has been eroticized by someone somewhere, and the list of body parts and objects that serve as sources of excitement is inexhaustible.

Over time, people's sexual repertoires tend to become more focused and exclusive rather than diversified, so there is little need to worry that your boyfriend will "get worse," as you put it. The main problem is not your boyfriend's "fetish," but rather your judgmental stance. This means individual therapy with your boyfriend would be pointless. If you two came for couple

therapy, however, the primary treatment objective would be not to change your boyfriend or to find out what caused his desire for legs, but to minimize guilt and blame in the relationship and to help you appreciate each other's feelings. In therapy you could explore the question if you are as fixated on "ordinary" sex as he is on legs? Possibly both of you could learn to compromise and give a little. The sooner you accept that the difficulty is attitudinal and not psychiatric, the greater your chance of living happily together.

Please help me stop the terrible worries that come into my head from I don't know where. I'm a salesman working in a pleasant atmosphere. I have a nice circle of friends, and I'm considered a decent guy. Sometimes, however, right out of the blue I get awful thoughts about car accidents happening to people I love, about me or my friends getting AIDS, about losing my job, about getting old and ugly. Once these things start, they blow up to giant proportions and I get in a shitty mood. I cry a lot, can't eat, and I'm just plain miserable. This can last from half a day to a week. Then suddenly, it just stops and I'm fine again for a few more weeks. What's wrong with me?

Your worry is a common form of self-hate. Such worrying puts you through an emotional wringer and gets you nowhere. It increases your sense of helplessness and deprives you of pleasure.

How can you stop this punishment? First, ask yourself what you're avoiding by consuming your time with worry. Perhaps you're putting off a difficult task at work, with your friends, or with your sex life. Confront these delays and engage your mind in constructive activity. The key is to transform worry from a signal to do nothing into a sign to get moving.

Take an inventory of your worries and see what they accomplish. Has worry about any of the things you list ever eliminated them? How many of the catastrophes that you mention have actually occurred? Did prior worry help you cope with the actuality of the calamity? Answering these questions will demonstrate the futility of your worry.

Next time you worry about disaster happening to yourself or a friend, do something constructive to show your love instead. Bake a cake; learn a new song on the piano. It doesn't matter what you do as long as it's something concrete to express your love rather than idly indulging in worry.

If you're a long-time worrier, you may find it necessary to use affirmations to break the habit. Here's one that people have found helpful: "I am capable and confident and I can take care of myself." Say it twice a day for a month and you'll make a major step in eliminating, worry. Beware of feeling guilty for not worrying.

22.

EDGE May 13, 1987