A Pill for Libido. Really?

As an internist who sees hundreds of women in the second half of life, I am all too familiar with women’s waning libidos.  Having gone through menopause myself, I have personally experienced the power that changing hormones have on many psychological and bodily functions that the younger me took for granted.  As an integrative physician, I am always searching for causes of symptoms and for natural and integrative ways to treat and heal them.  Our society sees a waning libido as a pathological symptom.  Viewing our aging bodies as pathological is where our problem truly lies.

Our collective maturity level in America can truly be seen as ‘adolescent’.  We are a society with many compulsions.  We seek fast ways to manipulate the body, to manage symptoms, and to regain youth. We want pills as substitutes for inner work, diets for rapid weight loss, and shots to stop menstruation considered inconvenient by many.  We are addicted to an ideology that has proven not to work over the past three decades.  Somehow, we are unable to make the shift to a more mature way of thinking.  Industries that support these compulsions make a lot of money.  The money itself becomes an incentive to keep the compulsions in place.

We have promoted the ‘anti-aging’ ideology for nearly 3 decades. We have yet to find a way to turn back the clock.  We are fearful of aging because we lack respect for process, and have not created a way to mark and consecrate our life stages from a place of reverence. Our society normalizes this. Mother Nature, in all of Her wisdom, marches on in time.  It is about time we find a way to gracefully honor the rhythms of the natural order of life and learn how not to resist aging due to our adolescent fear.

A woman’s libido has many facets that influence it – hormonal, psychological, emotional, and spiritual. Hormones have powerful effects on the biological nature of sexual desire.  When we are young and fertile, our hormone surges are aligned with the zeal to procreate.  In other words, the desire for sex is aligned with Nature. This is a powerful force that underlies our libidos when we are young.  As we age our hormones change, and we are less able to procreate - and Nature is less supportive of our libidos.  Women in their mid-40s complain about their waning libido, their changing body, and mostly their newly discovered need for balance.  They feel depleted after half a life of caring for others.  Energetic depletion, alongside changing biology creates less desire for sex. There is a greater desire for more intimacy, spiritual and emotional fulfillment, and the restoration of balance in both a woman’s body and life.

By our 50’s, most of us have experienced enough pain and difficulties to last us a lifetime.  These experiences are meant to serve as catalysts for inner growth and self-discovery. In midlife we must move out of the compulsion to ‘please the world’ and into an inner place of authentic connection.  We must learn how to be true to ourselves.  For us to find meaning and not feel victimized by our past requires hard work and a desire to seek.  The process of seeking itself deepens our ability to be intimate and fulfilled. In my medical practice, I find that women, who are committed to ‘seeking’ as they age, feel more fulfilled with intimacy, rather than the sex act alone. They are able to more readily accept their changing bodies. Sexual pleasure to them feels different, in some ways more fulfilling, even though their libidos may not be as heightened as in youth. The irony is that they are the ones who feel more sexual fulfillment than those who continue on the treadmill defined by the collective, with expectations of eternal youth.

Because our society has glorified youth and the sex act in favor of aging and intimacy, as we age, society expects us to perform both physically and sexually similar to when we were young, but with limited success.  Our aging bodies have different needs: the need for a pure diet, exercise, work/life balance, attention to inner process, and - one that we have not yet normalized in our society - a search for meaning. The spiritual aspects of ourselves call to us more powerfully and with greater zeal as we age.  Our physical bodies also require more attention.  Continuing the unhealthy diet of our younger years, does not nourish our changing bodies, and many of the lifestyle choices that have gained traction do not support our emotional or physical bodies.  This level of self-awareness needs to be paramount as we age if we desire to achieve a state of true health, which should no longer be defined by a ‘hard body’ or a ‘boundless sex life’.

For men, Viagra and Cialis do not fulfill these needs.  The ability to hold an erection for a longer time is not an adequate substitute for health, meaning, or intimacy.

Our society is struggling with the choices it has collectively made.  Frankly, our collective ideology is in contrast to the laws of Nature.  In other words, it goes against the laws of Nature.  Due to the decades of traction behind our unnatural ways of life, we continue to pump out pills as substitutes for what is missing at deeper levels of our being. The woman’s libido pill Addyi will not be able to offer what women consider as sexual fulfillment – namely:  intimacy, meaning, and a renewed relationship with themselves and their partners. The risk of life-threatening side effects alone is not worth taking a libido pill.

As we age and seek deeper levels of meaning, biology (not surprisingly) follows suit.  Not necessarily with the same intensity as it did during youth, but our aging physical bodies respond to emotional and spiritual depth differently than when we were young.  The zeal to live from depth is what Nature supports as we age, in favor of the zeal to procreate as in youth.

At this time we do not need yet another pill with more side effect casualties left at the altar of our flawed ideology.  We need to reframe our collective consciousness and normalize the necessity for healthy aging as defined by physical, emotional, and spiritual health.  This is a much more powerful way for us to live and will go much further in our level of fulfillment, both sexually and spiritually, than any pill can ever offer.

A DEEPER KIND OF HEALTH CARE REFORM

Many of us are disheartened by the state of health care today.  The solutions being proposed to repair and reform it are not sustainable for physicians or patients.  Every system functions from operating principles that govern and direct its mission.  In order for us to understand why health care is dysfunctional, we need to analyze and understand its business model as it relates to is mission.

Nearly two decades ago, physicians delegated the business of health care to administrators and accounting experts to manage and run it.  Unfortunately, their mission was in conflict with that of the health care system. Theirs was profit centric rather than patient centric.  They believed that patient care interfered with generation of profit.  They began to see time spent with patients as a compromise of their mission.  They began to value numbers over people. Health care’s mission became disjointed when two contrasting missions were being served. Profit became the dominating mission for health care as business managers established control over physicians and regulated and limited their time with patients for maximal revenue.

When I worked in this system, I was unable to find meaning in my work.  I was also unable to sacrifice my mission as a physician for the mission of health care administrators.  I was told that my work in their health care system was a conflict of interest to their mission.  My patients were staying well and not generating enough hospital dollars.  I left traditional health care to create my own business model.  As a physician who remains devoted to my patients I wanted to create a model that generated value for both my patients and my business creatively.   I have never sacrificed mission for profit. I run my business with good business savvy, all the while devoted to my purpose as a physician.  A health care business model risks losing its way when it becomes profit centric.  For healthcare to be successful and sustainable, mission must never be compromised for profit. Our health care system has lost its way.

We have many examples of profit driven health care in our country today and especially in southeastern Wisconsin.  These systems purport to care about health, but on closer examination, we see otherwise – they rely on sick care.  Health care is a conflict of financial interest. Currently, the highest expense in health care are administrative costs.  Many layers deep, administrators manipulate and control physicians, nurses and employees  serve their mission of profit over health or care.  This has demoralized physicians and nurses and driven away patients. Moreover,  it has increased the incidence of medical errors, placing patients and physicians at risk. 

Author and president of Business Ethics Magazine, Marjorie Kelly, defines a business model that functions with this type of focus as ‘extractive.’  Its’ purpose is merely financial – maximization of profits.  Worth is extracted from workers to generate profit by layers of administrative hierarchy.  The extractive business model is prevalent in most corporations today.  Outsourcing work to Third World countries for cheap labor to increase profit-margin is extractive.  Extractive economics are bad for our country’s economy.  It displaces domestic workers and extracts as much work as it can from the remaining workforce to serve profit margin.  Extractive economics deplete meaning from work.  Employees find themselves working merely to pay the bills for survival.  They lose pride and meaning in their work. As a result their physical and mental health suffers.  We all pay the price for extractive economics.  The state of our country’s middle class is a result of extractive economics. 

The majority of health care systems function from this extractive model.  Health care employees are currently working merely to meet quarterly projections.  For health care to operate in this manner is unethical.  Health care’s mission is to serve and heal.  When the vulnerability of patients is used to generate profit, they are deeply harmed. The ‘care’ they receive is motivated by the drive to maximize testing and treatment.  Physicians are unable to diagnose and treat cost-effectively when working for an administrative system based on extractive economics.  They must follow the rules of the game to keep their jobs.  Patients are left with super-sized bills for mere symptom management.  Administrative bonuses depend on this.

A ‘generative’ business model provides services that generate value.  Health care based on generative economics focuses on health and healing rather than maximization of profit.  The focus shifts from one of greed to one of service. Patient care is not provided at the cost of profit, and there is a balance between both without compromising either.  A health care model based on generative economics operates from the principles of sustainability.  There is a fair exchange between doctor and patient. 

What this would look like in the health care system is already visible at The Ommani Center for Integrative Medicine.  Patient care as well as sound business principles are utilized to serve patients cost effectively.  In addition, the most cost-effective diagnostics available in the community are recommended to patients.  Small businesses in the community, such as organic grocers, complementary practitioners and businesses dedicated to health and sustainability that operate from a high standard-of-care, receive support and collaboration by practitioners through patient referrals.  Education and empowerment are of foremost value and achieving optimal health at all levels is served.  All retail profits are used to subsidize business overhead to keep health care visits affordable for patients.

Practitioners work collaboratively with patients to uncover the causes of illness and empower patient responsibility.  The mission of health care is served and all profits are reinvested to support the staff and employees of the Center.  The business is also dedicated to the health of the environment and recycles to reduce its carbon footprint. 

The Ommani Center is a generative business. 

Those who administer the business of traditional health care state that a mission centric model cannot succeed financially, that a generative business model is not profitable.  Nothing could be further from the truth.  Shifting the focus of a business from profit to mission, from extractive to generative can actually draw in more revenue in service of its patients.  In addition, in a model like this, patients are truly served by physicians practicing from heart without the demoralization they currently experience within an extractive model of health care.

This is health care reform at the level of its core mission.

I believe this is one of the key solution’s to healing our broken system of health care.  This can also restore the soul of our sacred vocation.  

The Power of Bearing Witness

I have been seeing a patient, who I will call Ann, for 10 years.  She is a therapist who is a gentle and sensitive soul.  I can only imagine the gentle yet powerful space she is able to hold for her clients.  As she bears witness to the many facets of their lives, they have a powerful witness to their process.  They have her love, guidance, expertise and strong arms that hold them through their journeys. They are fortunate to have her in their lives.  With the space she holds they know they are not alone.

I saw Ann the other day when she needed me to bear witness to her process.  She had to hold space for a mother who had lost her daughter.  She was not sure what to say to this mother to help her pain.  It rattled her to her core.

As I sat with her and held space for her, all I could do is bear witness to her process. I told her that the most powerful gift she could give the grieving mother was her presence.  Bearing witness is a gift we can offer each other at any time.  In a world that is moving at warp speed, it is easy to forget that we matter.  Since we don’t live in communities like we once did that marked our passages and witnessed our lives, it is common to spend our milestones alone.  Once they pass, people get occupied again with their busyness and forget that we are in process.  When a person experiences a loss, the process through grief takes time.  It is important for them to be supported through its different stages.

Bearing witness is a sacred act.  It even changes the one who bears witness.  It deepens and fortifies one's soul.  It makes one trustworthy.

As a person’s grief transforms and shifts through its various stages, one gains access to the inner endurance that lives within.  The vacuum that is left in one's life is somehow filled with memories and a deeper level of wisdom.  This is an alchemical process.  The pain of loss never goes away, but it changes  form and also changes the greiver in profound ways. Without bearing witness, one could never experience the power of  Soul in process.

Many of us feel alone in our process.  This is not good for our health. We feel isolated. We may feel that our process is a burden on others.  Isolation is one of the most profound stressors on Earth.  Being witnessed, on the other hand, makes us feel like we matter.  Mattering is good for our health.  It makes our life worth living.

Mattering is a form of LOVE.

As a physician, I feel that bearing witness is the most sacred part of what I do each day.  Holding space and bearing witness to sometimes unbearable suffering deepens my heart and fortifies my soul.  It makes my patients feel that they matter, that their pain and suffering matters.  To be asked to bear witness for another is a profound honor.  Life presents us with so many ways to bear witness to each other every day. We must embrace these opportunities for loving.

Like Ann who will be changed forever by her witnessing, we must hold our strong arms around each other with open hearts. As Ann bears witness to a grieving mother, I bear witness to Ann.  Somehow, I feel that my arms are around her and this mother, all at the same time.  My heart is open to holding space for all of this.  For me it is a great honor and a blessing.

Making another feel like they matter also makes my life matter.  Isn't this ultimately what we are on Earth to experience? For me, this is one of the greatest forms of LOVE.

Poetry for Dementia Patients

As a poet myself, I have been changed by the poem as it comes through my heart onto the page.  It carries its own power and magic.  I am not surprised at the healing power of poetry for dementia.  Art is medicine.


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