HEATHER WAS A NINETEEN-YEAR-OLD STUDYING PERFORMING arts. She came in during her freshman year to see a psychologist, due to moodiness and crying spells that came out of nowhere. Normally upbeat and social, Heather was always ready for a good time. But in the past months, she had often withdrawn to her room, feeling worthless—even self-hate. These episodes were painful, and had started to interfere with school and friendships. She tried eating better and practicing yoga, but Heather couldn’t get back to herself, and she didn’t know why. The psychologist sent her over to me.
As we spoke, she stressed that her moods really didn’t make sense, because life was good, and there was nothing to complain about. Heather liked school and had many friends. Her family was supportive. She had enough money. Her health was fine.
“How long has this been going on?” I asked.
“Oh, I don’t know. Maybe…I guess since the new year. I’ve always had low self-esteem, but now it’s really bad.”
“Did anything happen to you around that time?”
She thought about it. “No, I don’t think so…. I can’t think of anything.”
There are times when symptoms may appear without any precipitant, but I decided to ask again. “Heather, please think about it carefully. In the fall or early winter, did you lose someone you love, or have a pet die? Did you go through something frightening or dangerous? Did any relationship begin or end?”
She thought it over. “Well, I can think of one thing: since Thanksgiving, I’ve had a ‘friend with benefits.’ And actually I’m kind of confused about that.”
“Really? Tell me more.”
“Well, I met him at a party, and I really like him, but there’s this problem. I want to spend more time with him, and do stuff like go shopping or see a movie. That would make it a friendship for me. But he says no, because if we do those things, then in his opinion we’d have a relationship—and that’s more than he wants. And I’m confused, because it seems like I don’t get the ‘friend’ part, but he still gets the ‘benefits.’”
She was genuinely puzzled. She had no clue whatsoever.
“I think many people would feel the way you do,” I told her. “You’re giving what he wants, but not getting what you want.”
“Yes,” she agreed. “I’m really unhappy about that. It’s hard to be with him and then go home and be alone.”
We talked about her frustration and her wish that things were different. “Do you think,” I ventured, “that these moods you have, when you are so unhappy and critical of yourself—do you think they may be related to this?” She considered my question. “I don’t know…maybe…. What do you think?”
Olivia, eighteen, is also a freshman. She was valedictorian of her senior class, and hopes to go to med school. But Olivia just told me that she’s been vomiting up to six times a day, so I’m sending her to the lab right away, to get her blood drawn. If her potassium is low, it could cause an abnormal heart rhythm.
Olivia originally developed bulimia in the ninth grade. With therapy, she did well, and she thought that the bouts of binging and vomiting were over, until she got to college. It’s not the academic pressure—she is doing well in all her classes. No, it was the end of a romance that precipitated the relapse and brought Olivia to our center for help. Her therapist recognized Olivia’s depression and eating disorder, and referred her to me for evaluation. During our initial meeting, Olivia described the short-lived relationship, her first experience with intimacy. “When it ended, it hurt so much,” she said, weeping. “I think about him all the time, and I haven’t been going to one of my classes, because he’ll be there, and I can’t handle seeing him. I was so unprepared for this…. Why, Doctor,” she asked, “why do they tell you how to protect your body—from herpes and pregnancy—but they don’t tell you what it does to your heart?”
Olivia was a smart girl asking a good question. Why are students inundated with information about contraception, a healthy diet, sleep hygiene, coping with stress and pressure—but not a word about the havoc that casual sex plays on young women’s emotions? It’s not as if there isn’t any research on the subject.
For those who trust academic journals more than Mom’s wisdom, take a look at some recent research. In a study of 6,500 adolescents, 1 sexually active teenage girls were more than three times more likely to be depressed, and nearly three times as likely to have had a suicide attempt, than girls who were not sexually active. Another report, titled “You Don’t Bring Me Anything but Down: Adolescent Romance and Depression,”2 analyzed data on 8,000 teens. The two researchers concluded that “females experience a larger increase in depression than males in response to romantic involvement,” and “females’ greater vulnerability to romantic involvement may explain the higher rates of depression in female teens.”3
So the professors agree with Olivia: a broken heart hurts. And most likely Olivia’s heart hurts more than the heart of the guy who dumped her. “Females’ greater vulnerability”—that sounds right to me.
Sure, there are women on campus who are making wise choices in their relationships. But if you think Heather and Olivia are unusual, I have news for you: our schedules are overbooked with them. They’re lining up for appointments and flooding our phone lines. I’ve seen so many students like these, they blur together in my mind, a pitiable crowd of confused, vulnerable young women, ill prepared for campus life, making poor choices, and paying high prices.
No amount of Prozac or Zoloft is going to solve this problem. These young women must, for their physical and emotional well-being, change their lifestyle. And the therapists, doctors, and nurses they consult have a responsibility to encourage them to eliminate their emotionally destructive behaviors, much as they would instruct an obese or nicotine-addicted patient to diet, exercise, and stop smoking.
Is it feasible? To acknowledge the negative consequences of the anything-goes, hooking-up culture would challenge the notion that women are just like men, and undermine the premise of “safer sex.” And in our ultra-secular campuses, no belief comes so close as these to being sacred.
How are women like Heather and Olivia educated to make healthy choices in their private lives? What guidance do they get from university resources, like health and counseling centers, Web sites, and newspapers? Would parents—who fund these resources through taxes and student fees—approve of their content?
I set out to answer these questions after hearing the stories of Heather and Olivia—stories that were without a doubt being repeated innumerable times on campuses all over the country.
Soon I had a pile of brochures and Web sites to study. One thing was certain: there was no lack of information about the importance of diet, exercise, and sleep. A “healthy lifestyle” also includes learning how to relax and cope with stress. And obviously smoking is out. In fact, the American College Health Association went so far as to publish a position statement on tobacco on college and university campuses, which declares that “tobacco use in any form, active and passive, is a significant health hazard” and encourages colleges and universities to be “diligent in their efforts to achieve a campus-wide tobacco/smoke-free environment.”4 To this end, the ACHA recommended a number of actions, including: prohibiting smoking in all public areas on campus and in all campus housing (including lounges, hallways, stairwells, elevators, restrooms, and laundry rooms), offering prevention and education initiatives that address the risks and support nonuse of tobacco, offer programs that include practical steps to quit using tobacco, prohibit the advertising or sale of tobacco products on campus, and prohibit the sponsorship of campus events by tobacco-promoting organizations.
This is all good and fine—I agree that smoking is a nasty habit. But I was looking for something that would address the emotional distress of my patients. For example, to help Heather and Olivia understand their very normal reactions to relationships, and to guide young women to make healthy decisions, I was looking for material that declares casual sex hazardous to a woman’s mental health. That aside from distress and anger, it can cause symptoms that will interfere with her ability to concentrate and perform academically. That hours better spent in the library will be used crying with girlfriends and at the campus counseling center. That her GPA—that mighty figure, critical to grad school acceptance—may fall. Such material could include data from the studies mentioned above, showing that girls are more vulnerable to depression when it comes to romance. It could also mention the fascinating research on the biochemistry of bonding. 5
Neuroscientists have discovered that specific brain cells and chemicals are involved in attachment. The chemical Heather and Olivia need to know about is called oxytocin. It’s a hormone, a messenger from one organ to another, with specific tasks; in this case, it’s sent from the brain to the uterus and breasts, to induce labor and let down milk. Not a surprise, then, that oxytocin is also involved with maternal attachment: a female rat injected with it will bond and protect another female’s young as if they were her own.
More relevant to my patients at this stage in their lives is that oxytocin is released during sexual activity. 6 Could it be that the same chemical that flows through a woman’s veins as she nurses her infant, promoting a powerful and selfless devotion, is found in college women “hooking up” with men whose last intention is to bond?
Here’s how one neuropsychologist put it: “You first meet him and he’s passable. The second time you go out with him, he’s OK. The third time you go out with him, you have sex. And from that point on you can’t imagine what life would be like without him…. What’s behind it? It could be oxytocin.”7
The release of oxytocin can be “classically conditioned”—after a while, all it takes for it to be released is catching sight of the man. Is Olivia avoiding class because seeing him will bring a surge of this hormone, a rush of agonizing feelings of attachment? 8
In addition to bonding, oxytocin increases trust. 9 Researchers studying financial transactions made this remarkable discovery when they had pairs of subjects play a game in which they risked real monetary loss. Each was given a whiff of either oxytocin or placebo, then they played a game in which investors could win or lose based on their partner’s honor or betrayal. Those who inhaled oxytocin had more trust in their partners; they took risks avoided by the others.
You might say that we are designed to bond. Neuroendocrinology is suggesting that, in their unfortunate liaisons, Heather and Olivia unknowingly promoted powerful feelings of attachment and trust. Thus Heather’s yearning, and Olivia’s melancholy, may have roots in their biology.
Information members of our hooking-up culture, indoctrinated to believe they are “protected” by latex, need to know? I would think so. So why haven’t they heard of it? Why isn’t oxytocin—likened to a “love potion” by one neuroscientist10—part of the vocabulary of our youth; why aren’t they as familiar with it as they are with carbs and fats, nicotine and steroids?
I submit that the notion of being designed to bond is to some an unwelcome finding. It implies that sexual activity, especially in women, might be more complex than, say, working out. It suggests women may be vulnerable, unprotected. To some on campus, these are fighting words. Psychology is strongly biased towards liberal views; 11 do the actions of oxytocin threaten the feminist agenda? I can think of no other explanation for the failure of this research to make headlines.
“When research is swept under the rug,” read an article in the American Psychological Association’s APA Monitor, “some of the best psychological research suffers for the sake of ‘political correctness.’”12 This is the largest professional organization of psychologists in the world, and to their credit, here was an admission of the hazards of unpopular research: lack of funding, overcritical reviews, and labeling of researchers. For example, when his study showed negative consequences from day care, an author was called “sexist.” Others reporting controversial findings were stifled by threats of legal action. 13 Maybe this explains why my patients, usually well-informed, are ignorant here: funding and publicity go toward research whose results support the politically correct agenda. 14 Women more vulnerable than men? You can’t get less politically incorrect than that.
Has research about the biochemistry of bonding been swept under the rug? It seemed that way where I work and on the Web sites of other colleges I explored.
When I advised Heather and Olivia to refrain, for the time being, from having relations, I would have liked to hand them a brochure, or recommend a support group. And it would’ve been great if there was a policy statement from a major medical or women’s organization acknowledging the legitimacy of my efforts, and encouraging campus officials to give their prompt attention to these critical health issues.
I didn’t find what I was looking for. Instead, throughout all the material directed at teens and young adults, the mantra of “sexual rights” and “safer sex” was repeated ad nauseam. There were descriptions of every type of possible behavior, too graphic for my taste, and much attention to topics of which I’d prefer to remain ignorant.
Take, for example, the popular site goaskalice.com—a “health question and answer internet service” produced by Columbia University’s Health Education Program. 15 Their mission: to provide readers with “reliable, accessible information and a range of thoughtful perspectives, so that they can make responsible decisions regarding their health and well-being” (emphasis mine). Parents with college-bound children, I suggest you take a look at this site, which gets two thousand questions a week, and many more hits.
“Phone sex—getting started”; “Health risks of bestiality”: these are some of the topics up for discussion here. Just click on your mouse—you will find useful information about sadomasochism, “tools and toys,” and drinking urine. To a question about a ménage à trois, “Alice” (identified on the site as “a team of Columbia University health educators, health care providers, and other health professionals”) advises, “Nothing wrong with giving it a try, as long as you’re all practicing safer sex.” To a reader calling himself “will try anything once,” Alice provides advice on proper “swing club etiquette,” as well as a link to the National Swing Club Directory. And for a reader who’s wondering “how to clean a leather cat o’nine tails between uses, especially if it drew blood,” Alice can help: hydrogen peroxide.
You’ll be tempted to think the unexpected topics found on goaskalice.com reflect the funky scene in Manhattan. Far from it. In my research of college Web sites, I found normalization of behaviors that were once considered illicit—if not perverted—all over the country. At Virginia Commonwealth University, cross-dressing is a “recreational activity.”16 At the University of Missouri, “external water sports” is described as a type of “safer sex.”17 (For the puzzled, a definition is provided: “urinating on skin without open sores.” Still don’t get it? This type of perversion was once called masochism.) Compared to that, the University of Wisconsin’s tips for your daughter on how to pick up “that cute girl you noticed in your English class”18 is tame.
No, there was nothing here that would help Heather or Olivia. No questions and answers about oxytocin, bonding, trust, and neurobiology. No consideration of the emotional consequences for young women of “hooking up.” No data on their “increased vulnerability to romantic involvement.” No mention of the truckloads of antidepressants prescribed to keep some of them functioning. No concern about campus counseling centers bursting at the seams trying to treat them all.
Why do the legions of Heathers and Olivias on our campuses not exist for “Alice”? Why her neglect of these victims of our culture? Why instead is she busy normalizing sadomasochism and other disorders?
Clearly, Alice’s priorities—and those of many others with the responsibility of providing college students with “health education”—have nothing to do with addressing the problems of my clientele. My guess is that, like everywhere else on campus, Alice advises students from a place where ideology reigns supreme. Central is the dogma that desires are “needs,” to be acted upon and satisfied; that behaviors considered aberrant by society and medicine are natural, while self-restraint is not; that regular sexual behavior—with or without a committed relationship—is necessary and healthy; and that any and all these activities can be free of consequences, as long as they’re “protected.”
But believing doesn’t make it so. In the world I inhabit, there are plenty of consequences. On my campus, sexually active students are much more likely to seek counseling, and to rate their relationships as stressful. Almost daily, I prescribe medication to help students, mostly women, cope with loss and heartbreak. Like it or not, hard science suggests that intimacy initiates a trusting bond. Ask Heather and Olivia, two girls woefully unprotected: there is no condom for the heart. 19