Dear Dr. Fulbright,
If a man has hang-ups about his body or is nervous to be nude in front of his partner, how can this negatively affect his sex life? My husband has put on weight and seems more sexually self-conscious because of it.
—Meg

Like females, when a guy has body image hang ups, he’s going to be self-conscious during sex. He’s going to be more in his head, worrying about what his lover thinks and how he looks versus losing himself in the moment. He will also not be in the mood for sex as much, or seek it out as often. He may also be more inhibited when he does have sex, for example, lights off or sex in certain positions where she’s less likely to see him.

For both sexes, in feeling out of shape, a person doesn’t feel as sexy. It’s also harder to move — a person is going to feel more sluggish, far from peak performance. People report more vibrant sex lives when they’re in shape and exercising.

Dr. Yvonne Kristín Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, “Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots.”

Just when I thought Joe Jackson (Michael’s “father”) might be my poster boy for reprehensible parenting, you’ve come along to challenge him for the honor.  According to media reports, you tried to pick up your own daughter Tatum at Farrah Fawcett’s funeral, with the one-two punch, “You have a drink?  You have a car?”
 
You are quoted as telling Vanity Fair contributing editor Leslie Bennetts, “I’m a hopeless father. I don’t know why.  I don’t think I was supposed to be a father. Just look around at my work—they’re either in jail or they should be.”  You go on to say that you aren’t in touch with your children any longer and have “never been happier.”
 
Here’s a psychological newsflash:  Not recognizing your own daughter is the kind of thing that gets etched on your tombstone, under the heading SCUMBAG.  Trying to pick her up at Farrah’s funeral—or any woman’s—goes right underneath that entry.  And stating publicly that you’re happier not seeing or speaking to your own kids makes it a Trifecta.  You’re gonna keep some guy who etches letters in granite very busy.
 
No wonder Tatum was hooked on heroin and Redmond is in jail for a drug offense.  You obviously have a really bad habit of inflicting pain on people, and they turn to one or another intoxicant to try to relieve it. I mean, it’s one thing to try picking up your adult daughter, it’s another to do whatever you did to her as a little girl.  Exactly what was that, Ryan?
 
I know, you think I’m being a little hard on you, but I’m not. 
 
See, when I use the term “scumbag,” I mean it in the clinical sense, and with no hatred toward you, whatsoever.  I mean that something happened to you in your own personal development that led you to think so little of yourself and so little of others that you can’t see the beauty it is to bring a new life into this world and be able to nourish it.  You must question your own self-worth so deeply that now the only thing you can pay attention to is how to pump yourself up narcissistically and avoid the deeper questions you have about whether you’re worth anything at all—to yourself or anyone else.
 
You tell Ms. Bennetts that you’d “take back” your kids—as in, return them to their Maker; as in, kill them off.  Well, you came close, setting them up for their drug abuse.  But here’s the thing:  The real ambivalence you have at core isn’t about them at all.  It’s about you and whether you deserve to exist.  I don’t believe you could have been well-loved and turn out unable to love.  Your own family somehow made you wonder whether you deserved to be born, whether you were really a keeper.  How?
 
You did deserve to live. You were once an innocent child, full of human potential and the capacity to love yourself and others endlessly.  You were cheated of that potential, and I am sorry that happened to you.  Now, facing the particular traumas you lived through and feeling all the pain of having lived through them is the only way back to being fully human.
 
Life is an amazing journey and, even with you facing leukemia, the end isn’t written until a man’s last acts and final words.  You can still reclaim your humanity and capacity to love and offer it to the children you brought into this world.  And then very different words might mark your resting place and very different things may be said of you.
 
I have seen people resurrected by embracing the truth at 18, and at 48, and at 78.  It is never, ever too late. 

Dear Mr. Jackson:

The occasion of your child’s death is a moment when all parents, including me, offer you every wish for strength and God’s healing power in the face of your loss.  Any father or mother can sense the tragedy it is to lose a son or daughter, yet no one who has not suffered such a loss can truly know your pain.

I would write no more than this were it not for the fact that you have used the occasion of your son’s passing and the attendant publicity to also promote your own business ventures, including your new record label.  This makes me feel it important, as a psychiatrist with access to the media, to reach out to you, with other parents and their adult children “listening” in. 

The foundation of our nation assures each person in this great country of certain inalienable rights, including life, liberty and the pursuit of happiness.  Great leaders and courageous soldiers have safeguarded these rights for our citizens, and they would make a decent Bill of Rights for parents raising children, too.  Fathering a child, you see, means far more than participating in a child’s conception and witnessing his birth; it means doing everything possible to optimize that child’s life.  This requires many acts of love and self-sacrifice. It pays immeasurable dividends in the growing self-confidence and autonomy you witness developing in the child you care so much about.

Somehow, perhaps because of pain suffered in your own early life experience, you stole that God-given potential for healthy development from your son.  You have admitted lashing him with a belt or a switch when he failed to perform dance steps to your standards.  According to him, you called him ugly when acne affected him as a teenager.  You brutalized him by placing your own pathologic need for control and for “success” above his needs for security and comfort and self-esteem.  In a very real way, you buried enough of his love for himself that he was no longer comfortable with his race or age or sexuality or even his great fortune.  Trying to please a father who beats you with a belt for missing a dance step will do that to you.

Now, even when saying goodbye to your son, you think of yourself and your business.  You are deprived of a purer life and love.  This makes me feel badly for you, but feel worse for the son you injured so deeply. 

Some will see you only as a monster.  I know that monsters are made through cruelties suffered in life; they never spring fully-formed onto the planet.

In your quiet moments, I hope that you can dig up the roots of the emotional and physical violence you visited upon your child.  One of the wonderful things about still being on the planet is that you always have some chance to win back the potential for real humanity buried inside you.  

Here’s a hint:  Success or failure in becoming human isn’t measured in record sales or reflected in the lenses of television cameras.  You have to look much, much deeper.

Dear Yvonne,
I’m a 33-year-old male who just can’t seem to land a relationship. I think I suffer from “nice guy syndrome.” I consider myself a pretty decent-looking guy. But every time I meet someone, it always starts out great and in a matter of weeks, I find that I must’ve done something to ruin things. I don’t understand what I do wrong, and I get myself down thinking I must be some kind of loser or something. Can you help?
Thank you in advance,
—Derek

Dear Derek,
What you need to do first and foremost is work on your self-esteem. I’m concerned that you are automatically blaming yourself for a relationship gone sour. What makes you think that you’ve necessarily done something wrong? Two people don’t stay together for a number of reasons that aren’t personal, and parting ways doesn’t always come down to one person doing something undesirable. What is unattractive, however, is having a “loser” attitude. If you feel like a loser, then that becomes a self-fulfilling prophecy.

If you think something about yourself long enough, then that can become engrained in your self-perception. It becomes part of your identity and part of what you project to others. So the best thing you can do for yourself in losing your loser attitude is to: (A) quit being so hard on yourself; (B) quit feeling sorry for yourself; and (C) work on your self-esteem.

You need to bolster the energy you’re giving off by focusing on your best qualities; activities that you enjoy, and areas where you feel the best about yourself. Do what you need to do to get to a better place, for example, exercise or work with a coach to counter self-defeating thoughts. Remember, people are attracted to nice guys — in many cases; they are the men who win when it comes to love in the end.

Dr. Yvonne Kristín Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, “Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots.”

The tragedies are coming one after another.  In Binghamton, NY, Jiverly Voong kills13 at the American Civic Association.  In Pittsburgh, Richard Poplawski guns down three police officers.  In Graham, Washington, James Harrison kills his five children and then shoots himself.  All told, 57 people have died in multiple killings in the last month alone. 

What’s behind the carnage?  Could our troubled economy, with rampant job loss and the specter of home foreclosure weighing on our collective psyche, be pushing people over the edge?  Or is the answer to be found in the minds of a small number of people who have been quietly gathering rage and losing control for many months or years.

I think the answer is both.

Mass murderers have one thing in common:  They have lost the capacity for empathy.  They no longer see others as fully human, so they don’t worry over causing them to suffer.  They no longer see the life stories of others as sacred, so they don’t worry over bringing them to a violent end.  I believe this chasm of inhumanity opens because mass murderers have stopped valuing their own lives.  They are dehumanized to the extent that depression or paranoia or rage — or all three combined — have displaced everything else inside them—including love, whether for themselves or for others.

The road to becoming a murderer may have its roots in childhood, when abuse and neglect begin to make a child shut down his or her emotions, in order to stop feeling so much pain.  That dark psychological process can cast a long shadow, preventing the future killer from resonating with the pain of others.  Unrestrained by empathy, it leaves that person freer, in a terrible way, to be violent. 

It might well be the case that those who shut down emotionally and begin storing paranoia and rage inside them have less “hearty” or resilient nervous systems.  Maybe they have lower levels of serotonin than others among us who would preserve our humanity in the face of equally traumatic events.  Maybe they have absolutely no one who is obviously proud of them or shows concern for them or at least shares kind words with them.  Maybe they are unlucky enough to have head injuries that erode their capacity to control their emotions and leave them with shorter fuses.

But while the roots of the paranoia and rage that fuel mass killings may run bone deep, today’s stresses can set ablaze the deepest cauldrons of emotion.  We have among us many, many people who are on the edge psychologically.  They do not have reservoirs of self-esteem to carry them through job losses that make them feel like failures — as workers or fathers or husbands.  They cannot draw on stores of optimism to believe that things will turn out alright in the end, because things were not alright for them, often from the very beginning.  They may already be suffering with depression that can, in some of its forms, lead not only to anxiety and irritability, but also to paranoia and thoughts that life is not worth living.  Perhaps they have already turned to bankrupt strategies to keep their emotions at bay, including alcohol or illicit drugs, substances that lower self-control and are involved in the majority of violent crimes.

These are the people who are at risk to become the next Jiverly Voong, Richard Poplawski or James Harrison.  They are a job loss, a divorce or a repossession away from utter hopelessness that can tap their underlying stores of self-hatred and hatred for others and lead them to project it outside themselves, in an explosion of violence. 

There are many such people in the world.  They are victims of life events beyond their control who then victimize others, exponentially.  Psychological arithmetic is sometimes cruel:  The suffering of one person can multiply itself into the suffering of many.

This economy and these times are dangerous potential triggers.  Anyone who says otherwise should sit with me in my office and listen to some of the good and decent people, many from fine families, many with histories of great success, with wonderful potential futures, who can’t see any future for themselves, anymore. 

Anyone who says otherwise should listen to these “lucky” people, now down on their luck, who irrationally see themselves as permanent failures — not just economically, but personally.  Then imagine if you were the product of trauma, with only the most fragile sense of self, thinking the world was already against you.  Imagine how a pink slip hits you then.  Imagine if it comes with news that your wife is leaving you or cheating on you — with a real man.  Imagine if you stop thinking you’re a man at all, not even a human being, that everyone is laughing at you, that you’re powerless and forgotten and destined for nothing but emptiness.  Imagine trying to contain all that. 

Some people don’t.  Instead of containing it and processing it, they project it.  Economic chaos makes that outcome more likely.  The sooner we stop denying that fact, the sooner we can begin putting in place the needed resources to reach out in a real way to those who think — wrongly — that they are beyond help, and prevent the deaths we can.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com or e-mail him at info@keithablow.com.

One hot summer day last August, a Kentucky high school football coach named David Jason Stinson decided that his players needed to be pushed at practice to perform to his standards.  The team ran what are called “gassers” — sprints up and down the field — to build stamina.  One onlooker reportedly said the jeering of players by Stinson and his staff was “appalling.”  Stinson himself allegedly vowed that the sprints would continue until one player quit the team for good. 

A player collapsed and was taken to a shady area to recover.  Apparently that didn’t make Coach Stinson call off the sprints.  A second player — David Englert — actually did quit the team, which might have been satisfying in some sadistic way to Stinson.  But it was too late.  Fifteen-year-old sophomore Max Gilpin fell to the ground.  He died three days later of heat stroke, septic shock and organ failure.

Coach Stinson has now been indicted by a grand jury.  He is charged with reckless homicide, meaning he should have known that his behavior could lead to Gilpin’s death.

Stinson knows plenty about football.  He played college ball and in the NFL for a short time.  Indeed, he would have known that heat-related deaths do occur among high school players, college players and the pros.  And he was the one who was supposed to protect his team. 

Something went horribly wrong.  In Stinson, the equilibrium that a coach needs to demonstrate between motivating players and nurturing them went fatally out of balance. For reasons I can only speculate upon, he needed to prove he was tougher than the high school kids on the field.  Maybe the memory of his season with the New York Giants seemed to be fading.  Maybe he needed to remind everyone what it takes to really make it to the pros.  Maybe he worried he never really had made it big himself.

Whatever weakness resided inside David Jason Stinson seems to have translated into an inhuman and deadly set of circumstances that August day.  It’s always that way when one person knowingly puts another in mortal danger.  It’s about what’s broken inside the man or woman orchestrating the emotional or physical violence.  It’s about old injuries to that person’s self-esteem creating new and potent risks for others.  It’s about the recycling of psychological pain into something virulent that can kill.

Don’t be confused by the fact that the teenagers put in harm’s way were football players.  Don’t lose sight of the fact that, athlete or not, Max Gilpin wasn’t even old enough to drive.  He needed Stinson to look out for him, not goad him to risk his life to prove he was a man.

Stinson reportedly brought a photograph of Gilpin to every practice following the player’s death.  He has also reportedly commented that he lost a boy that fateful day, too. 

The trouble is, carrying a photograph of your victim around isn’t appropriate.  It shows a lack of insight and sensitivity.  And as someone who has counseled more than my fair share of bereaved parents, I’d guess that Stinson knows almost nothing about the depth and intensity of the Gilpins’ loss.  Pretending otherwise adds insult to the fatal injury inflicted on Max Gilpin.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com or e-mail him at info@keithablow.com.

As Congress wrestles with the $700 billion bailout package, many proclaim the country is already suffering a depression.  It is no accident that the word “depression” can be applied in an economic context, as well as a psychological one.  The pathology and prognosis of an economy on the ropes and of a mind under siege have similarities that can learn from.

In both cases—whether an individual or a nation is depressed— the mood is low, or irritable, or both.  But when people become clinically depressed, they suffer more than a loss of joy or sense of peace. They often lose concentration, energy and self-esteem.  Without help from professionals, many cannot imagine the darkness that has descended upon them will ever lift.  The greatest danger comes when they can see no future.  For losing hope is even more toxic than deep personal losses that may have sparked the depression, to begin with. 

An uplifting message coupled with an understanding of which wrong turns were taken in the past, can be extremely helpful at such times.  But very often medicine is needed to alter the flow of chemical messengers in the brain, freeing up more calming and energizing neurotransmitters, like serotonin and norepinephrine.

The bailout package (or powerful components of it) is the equivalent of an antidepressant or anti-anxiety medication.  If it works, it allows the public and the markets—as medicine would allow a patient—to begin again to focus on a brighter future and to have the energy to take steps toward actualizing it. 

The writing and dispensing of a “prescription,” medicinally or economically, also has a kind of immeasurable benefit, beyond the balm of chemical messengers or dollars that begin to flow.  The “treatment” itself is a positive, forward-moving action that can confer new momentum on a nation or an individual.  That’s why even placebos (sugar pills) prescribed by doctors to people with real major depression can have inexplicable healing effects.  The expectation that a prescription should work, can make it work.

One of the reasons decided action combats the stagnation of depression is that indecision is such a prominent feature of depression itself.  I’ve treated patients (even executives and politicians) in the grips of clinical depressions that render them unable to choose which clothes to wear, let alone which deals to make.  Watching a confident healer take needed treatment steps with them helps them begin taking action, too.

I’ve always cautioned patients that major depression takes time to lift and that it often yields in jagged, unpredictable stages—like ice in the way of a ship powering through a frozen body of water that’s melting.  The ice cracks, then chunks of it break free.  There’s forward motion, then halting, then more forward motion.  A change of course may be necessary.  Then, another.  But the first signs of a clearing path shouldn’t be underestimated.  They predict victory over darkness and stagnation.  We should all remember this if measures to combat our economic “depression” begin to bring victories that seem uneven, or initially un-sustained.

I’ve also learned that depression is a tenacious adversary.  Declare victory too soon, and it can be snatched away by a second falling of the curtain.  When depression is severe, a doctor shouldn’t be overly cautious about increasing the dosage of a medicine or adding another or studying the roots of the problem from another psychological (or, in the case of the nation, economic) perspective.  Depression is always a boulder with the potential energy to roll downhill, until it can be pushed to undeniably safe, stable ground.

If the nation is in this case a patient, if we as a people are facing an economic depression with some of the characteristics of a clinical one (as I believe we are), then we need a firm, confident, multidisciplinary, unyielding and repeatedly reassessed course of treatment. 

One other thing:  While it may take a psychotherapist or neurologist and/or internist and social worker to battle the worst cases of depression, one healer has to be firmly in charge of the effort to defeat the illness.  There can be differences of opinion about treatment within the team, but the treatment should ultimately be administered as a team, with one voice and an unquestionable and singular concern for the well being of the patient.  Grandstanding or obstructionism for the sake of personal or professional (or political) gain is unthinkable when the enemy is a clinical depression.  It should be no less the case when the enemy is an economy under siege.
 

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com.