Politics & Policy


How universities can be hazardous to student health.

Eat right. Avoid cigarettes. Wear seatbelts. Use sunscreen.

Each year, thousands of college kids hear this wisdom from their university health-services and wellness officials.

However, it is unlikely that these same students will hear this gem: “Casual sexual liaisons on college campuses are hazardous, especially for young women. Medically and psychologically, it’s wise to wait.”

One university health-service psychiatrist wants to know why this advice is rare. She notes:

College health centers do a great job educating students about all sorts of health issues. These professionals expect that, given accurate information, students will make smart choices. They recommend, ‘have the salad instead of the pizza.’ They assume that young people are capable of self-discipline – and expect it of them. There’s only one exception: sexual health. Here students are told: limit your partners, and use latex. Well, it’s not working.

This psychiatrist should know. She is employed in the college health center of  UCLA. She is also the author of a new book, Unprotected, which describes the serious problems facing college students and the inadequate advice often dispensed by the typical college-health center. But, until recently, I could not tell you her name.

Miriam Grossman, M.D., psychiatrist in the UCLA health services, is the author of Unprotected. However, you will not find her name on the cover of her new book. She wrote the book as “Dr. Anonymous” because she was  fearful of professional and employment reprisals for her stunningly candid picture of college health today. But with Dr. Grossman’s permission, Dr. Laura Schlessinger recently revealed her identity on her radio program.

In an interview, Dr. Grossman told me she feels very much at risk with the publication of her book. She explains: I’m discussing a taboo topic here: the dangers of radical social agendas in my profession. My colleagues are well-intentioned, and care deeply about their patients. But campus counseling centers are whitewashing the painful consequences of casual sex, STDs and abortion. They are promoting the notion that men and women are the same. They are not educating young people about future and family. In these issues, so central to campus health and counseling, we are failing our young people. Grossman Time will tell if Dr. Grossman’s candor will make her a pariah at work and in her profession.

“Ideology is getting in the way of doctors doing their jobs,” says Dr Grossman. “Why is it fine for me to care about my patients’ lungs and their arteries, but not their reproductive future, and their hearts and minds?” Dr. Grossman says she is inhibited by her profession from addressing the medical aspects of sexual behavior — perhaps, she believes, because it seems moralistic. However, she says, morals aside, “It is not smart to hook up, especially for women.”

Dr. Grossman is not sure why such pressure is brought to bear on psychiatrists to leave discussions of sexual health to those who advocate permissiveness. “I don’t know if it is left over from the sexual revolution but the ideology on campus is that casual sex should have no negative consequences. However, it certainly can and I see [this] all the time in my work.”

A superb storyteller, she describes patients who do all the right things: They eat well, exercise, and structure their lives around getting  a good education. What they don’t do well is manage healthy intimate lives. One young woman, Heather, told Dr. Grossman that she was depressed but never considered that her depression might relate to a loveless “friends with benefits” relationship with a young man. Dr. Grossman quotes the girl saying, “I’m confused, because it seems like I don’t get the ‘friend’ part, but he still gets the ‘benefits.’” Apparently no mental health or health professional ever told Heather that, for women, an increased risk for depression is associated with casual sex.

Based on this case and many others, Dr. Grossman asserts to her readers and to her profession: “The message must get out: casual sex is a health hazard for young women. Women must hear from campus authorities that delaying sex, even for one or two years, is a fundamental way — in addition to eating right, exercising, wearing sunscreen — to be proactive about their health.”

Some prestigious universities present the opposite message. One shocking example from the book is the Columbia University Health Services’ website Goaskalice.com. The website portrays itself as a resource to help students “make responsible decisions regarding their health and well-being.” What can student learn there? Dr. Grossman lists some of the questions addressed: “Phone sex — getting started”; “Health risks of bestiality”; and how to manage a threesome. Ever wondered how to clean a bloody cat-o’nine-tails between sadomasochism sessions? Alice has the answer: hydrogen peroxide. Any parent should be glad to get this kind of bang for the tuition buck. 

I searched the site for any mention of the relationship between casual sex and depression in young women, to no avail. Dr. Grossman criticizes university health websites for focusing almost exclusively on helping students express their sexuality.

In Unprotected, Dr. Grossman advances a plausible theory that one reason college health services are inundated with depression, eating disorders, and sexually transmitted diseases is that health professions have failed to address the medical and psychological risks of unrestrained sexual behavior. She also presents the effects of sexual license on long-term infertility in women, the effects of abortion on the mental health of women (and men), as well as the role of religion in promoting good mental adjustment — all topics that Dr. Grossman claims are ignored by today’s psychiatric profession.

Another hot-button issue Dr. Grossman squarely faces is the potential harm of current approaches to HIV/AIDS prevention and testing. Discussing Brian, a young homosexual man, she notes that she cannot respond to her HIV positive patients as aggressively as those with TB. In the case of the latter, physicians are required to report an occurrence to public health officials, and the law mandates treatment. Not so with HIV. Out of concern for stigma, physicians most often simply advise. She writes:

…if standard public health measures had been applied to the control of HIV, perhaps my [HIV] patient might already have [been] tested and on drugs that might add years to his life. Isn’t it worth the risk of feeling judged?

Dr. Grossman also takes on the current prevention strategies to minimize the risk factors for contracting HIV. While it is true that anyone can contract HIV, she wonders why university physicians in this country do not focus on those who are the most at-risk — patients who engage in anal sex, share needles and have partners that may have done those things. She believes that ideology again drives physician reluctance to single out specific groups or behaviors. She asks, “Isn’t it time we forgot the Left and the Right, and just told it like it is?”

Lest Dr. Grossman be dismissed as homophobic or insensitive to stigma, her concern is with behaviors and not orientation. She wants to prolong the life and well-being of her homosexual patients, not condemn them to a shortened life of false security. Homosexual attraction is not the issue here; being ill-informed and behaving foolishly is.

I asked Dr. Grossman what parents of college-aged students should do for their children. She advised, “Send them the book and use it to start a discussion. Tell your child these are true stories of students just like them: Smart, responsible young men and women who were not accurately informed, thought they were protected, and are now paying the price. We are losing the war on sexually transmitted diseases and depression on campus; we all need to discuss the consequences of risky behavior.” Perhaps parents of university students should send a copy of the book along with their next tuition check.

The author intends such conversations at all levels of the university. The back cover of Unprotected predicts, “Unprotected will infuriate the health establishment and start a debate on campuses nationwide.” Fury and debate would be a good beginning. After that, those inside and outside the academy should heed the warnings and common-sense advice of Unprotected.

Warren Throckmorton associate professor of psychology and fellow for psychology and public policy at Grove City College. He is also past president of the American Mental Health Counseling Association.

<em>Unprotected</em>, by Miriam Grossman



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