Bereavement is a crisis from which few people are spared. In spite of its universality, there have been few carefully designed, well documented, systematic studies describing its natural history and its relationship to other affective disturbances.
The field of arts and health is rapidly gaining momentum in Canada despite the challenges of integration across a vast geography, two official languages and multiple interdisciplinary cultures. Although the field is young, there is a solid foundation of innovative work and great enthusiasm on the part of diverse practitioners about the field's salience and impact. This article provides an overview of the arts and health in Canada and considers work that spans health policy, healthcare practice, individual and community health promotion, health professional education and arts-based health research. A final section offers reflections and recommendations on arts and health in Canada. We provide an online appendix through the journal's website that refers the interested reader to Canadian programs, resources, networks and other materials on the arts and health.
Lindemann (6) first used the term ‘anticipatory grief’. It referred to the separation of two people with one anticipating the death of the other and preparing for it to such an extent that on the return of the other there is rejection rather than happy acceptance. In his example a soldier returning from combat complained that his wife no longer loved him and was seeking a divorce. After seeing the man, Lindemann attributed the problem to the wife's ‘anticipatory grief. It seems there could be other explanations to his example.
Our study of pre-medical and medical students attending the Universities of British Columbia, Hong Kong and Otago, together with house surgeons, general practitioners, surgeons and psychiatrists in New Zealand, demonstrated many agreements regarding both positive and negative factors affecting their interest in psychiatry. Positive factors included: interest in human behaviour, personal aptitude, and quality of patient care. Negative factors included: the stress of practising psychiatry, faculty attitude and the quality of the science. Differences were determined by age of the students and cultural and personal experiences. We concluded that if more students are to be interested in psychiatry then psychiatrists will need to show that they enjoy their work and give effective treatment.
The frequency, nature and enjoyment of sexual practices may be disturbed by acute or chronic illness. Sexual problems may be caused by, among other factors, the nonspecific symptoms of illness, the anxieties over disruption of life-style or the specific impairments caused by a disorder. Patients with, for example, multiple sclerosis are thought to experience sexual problems commonly. In one study, Lilius found that in a group of 284 MS patients, 64% of the men and 39% of the women described their sexual life as "unsatisfactory" or "ceased entirely."' Lundberg found that 90% of his MS patients confined to wheelchairs "have major problems with sexual function."* Szasz et al. used a Sexual Functioning Scale to study 73 consecutive patients a t an M S clinic and found that 45% of the patients were "less sexually active" or "inactive" since the onset of MS. Fifty percent of this group indicated that they were "concerned" about this situation.' In a follow-up study, 18 "concerned" MS patients listed their sexual concerns as: "cannot satisfy the partner" (1 1 patients), "don't feel like sex" (9 patients), "cannot satisfy myself" ( 1 1 patients), "cannot be like a man" (4 patients), and "partner does not feel like sex" (2 patients). Fifteen of these patients were men; most were over the age of 40, and most were married. The three women were over the age of 50. and only one was married. Most of these patients had M S for over 10 years. Their rating on the Kurtzke Disability Scale ranged from 1 to 7.4The purpose of this paper is to consider the epidemiology, diagnosis and management of one sexual problem area that may be associated with MS, that of sexual dysfunctions. CLASSIFICATIONSexual dysfunctions include erectile and ejaculatory disorders in men, disorders of vaginal lubrication, orgasm and vaginismus in women. Some definitions also include sexual disinterest.' The nature and the significance of these dysfunctions vary and are dependent on a variety of factors, including the health and the age of the patient and the presence or absence of a partner. EPIDEMIOLOGY Sexual Dysfunctions in the General PopulationKinsey et al. estimated that impotence affected 18% of the American male population at the age of 60. Premature ejaculation was not considered a disorder and 9% of women were described as nonorgasmic on a lifetime basis! Frank et al. studied 100 white well-educated couples who were nonpatient volunteers. Forty percent of the men reported erectile or ejaculatory problems. Sixty-three percent of the women described orgasmic dysfunctions. However, 80% of 443
and concluded that: "Staff impressions are wholly supportive of the idea that students are capable of assuming major clinical responsibility for patients much earlier than they have in traditional programs." They also noted that: "The obvious increases in student competence, self-esteem and enthusiasm have been especially rewarding .... " Miles, Maurice and Krell (9) reported a student ward program at the University of British Columbia and concluded that: " ...fourth-year medical students are capable of assuming a major clinical responsibility and performing in an effective manner on an inpatient psychiatric unit" and were also impressed with the enthusiasm, commitment and competence of the students. These initial reports (2, 9, 10) of. the student ward model were essentially descriptive, and the conclusions in large part impressionistic. Maurice, Klonoff and Miles, et al, (6), using a variety of test materials, assessed the students' knowledge, attitudes, personality attributes and expectations at the beginning and end of the eight-week rotation and noted significant positive changes in these areas. The effectiveness of the student therapist on the patient has, however, been a relatively neglected area. Despite the obvious advantages to the student of increased 467
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