Mortal Limits

Biomedical ethicist Daniel Callahan wrote that, in our parent’s time, persons used to die of natural causes, but today we no longer have that luxury. Callahan was writing about the frenzied exercise of medicine to keep terminally ill patients alive, at great expense to survivors and soci ety. Commonly, family members and medical teams collude in the work of preventing death at all costs. Callahan commented that, in the medical culture shared by both doctors and patients, “natural causes” of death no longer exist; every death is treated as a preventable failure on the part of medicine.

The truth is, of course, that the body dies. Before death, gravity takes its toll on organs and tissues. What was taut and firm now points south. With aging, bodies get smaller, saggier, and weaker. For many, if not most persons, these hints of mortality are an insult. In response, Western culture is replete with strategies to counter this insult: elective plastic surgery, fat farms, and December-June marriages. The culture of youth is as vibrant as its television advertisements. The limits of mortality are denied. Against this denial of mortal limits, sex is a sign of life. And so it should be. It requires, as has been said repeatedly here, a minimum level of physiological health. In its procreative expression, sex promises future lives if not future life. But sex can also be used as a device to deny limits that, to borrow Callahan’s phrase, are “natural causes.” The loss or decline of sexual function is a hint of mortality. There is a distinct value judgment to be made about how attentive one should be to hints of mortality. If one takes the position, as I do, that hints of mortality are part and parcel of life that should be listened to, then one should listen to and accept the limits of sexual function without ceaseless somatic interventions. Employing somatic treatments over and over again to deny eventual mortality does little to enrich the sexual life of a couple. Indeed, it may do much to distract from an appreciation of their total life together during the time remaining to them.

The tragedy of September 11, 2001, gave rise to a cultural appreciation of the limits and fragility of life. Persons about to die called their dear ones on cell phones to express their love in their final minutes. Those of us who were survivors, like survivors everywhere, generally expressed in our grief a greater appreciation of “the important things of life” and an intention to “take time to do the really important things.” What made this possible was the terrible shout of mortality rising from the crashes of September 11. We heard our mortality and returned to our lives to live them more intentionally.

On a personal level, the many hints of mortality that an individual or couple receives can, and I suggest should, be used for the same purpose of living more intentionally. While somatic treatments for sexual dysfunction may be part of that living intentionally, they may also be part of a collusion to deny mortality at all costs.

SUMMARY

The disease perspective takes the somatic reality of sex seriously. It states that sex is, at its bedrock, a corporal event. To the extent that disease, injury, surgery, medication, and drugs compromise the physiological functioning of the body, to that same extent sexual functioning may be compromised. The clinician working to understand a sexual problem from the disease perspective evaluates the patient’s physical and psychological history as well as his or her family medical and psychological history. Although there may be many psychosocial factors that should be noted and treated in due course, the clinician employing the disease perspective wants to be sure that the body is working as well as it can. If somatic treatments will improve sexual functioning, the clinician informs the patient about them and assists in their integration. When the body signals that it has reached its highest level of sexual functioning given its limitations of disease or aging, the clinician understands that signal and turns to another perspective, the life story perspective, to assist the patient in heeding the meaning involved.