THE UNKINDEST CUT ?
By William H. Beauman
Delivered to The
March 31, 1997
Some
of you may remember my first Club paper, almost exactly eleven years ago,
"Qin and Qing," which were the names of the first and last imperial
Chinese dynasties. I attempted to analyze the extreme selflessness aspect of
the "Oriental character" which expresses itself in terms of
subjugation of personal needs to the needs of the society, as exemplified by
the younger archaeologists who survived the "Cultural Revolution:"
their elders had all been murdered by anti-intellectual political goons led by
the "Gang of Four," and they could have had free rein with the
nation's antiquities, but they didn't rush in, as I would have. Emperor Qin
Shih Huang-ti, who united
One of the little "factoids" that emerged during my review of Chinese
history was that three times, in three different dynasties, the palace eunuchs
gained such power and influence that they essentially ran the empire. That
intrigued me--I wondered how they could muster the drive and strength of
character to engineer a coup and maintain such complete control over so many
people who had much more power than they. I mean, we castrate animals to make
them more docile, in addition to making them sterile. How could an
"altered" man compete with others who were "whole?" Well,
the answer to that turned out to be trivial, and I am embarrassed by my
naivete, but that was the jumping-off point for this paper. Also, it seemed
reasonable to question, at least rhetorically, how really bad this
"unkindest cut" (apologies to Shakespeare) really was, considering
the heights they were able to reach; hence the question mark in the title.
But first, let's explore the "unkindest" nature of castration. Sexual
performance is arguably the single most important aspect of life to a man.
Freud taught that sex is the most important human drive, and I believe men feel
its tension more than women do. Male sexual violence is fairly common, but
female rapists are virtually unheard-of. Women can fake total involvement or
participate half-heartedly, but men cannot. Men must "perform," and
any slight problem instantly becomes obvious. The male erection, so strong and
satisfying at times, can at other times be unbelievably distant and delicate.
Chronic impotence drives more men to suicide than any other cause. Near the end
of his life, after marrying his beautiful, blonde nurse fifty years his junior,
Groucho Marx was reported to lament, "I'd give it all back for one more
erection!" Some years ago, The Chicago Tribune carried the results of a
survey of men's worst fears, and they found that most men would rather die a
lingering, painful death from cancer than suffer a permanent loss of virility.
(Interestingly, the item topping the list--the thing most terrifying to
men--was public speaking. They would sooner face death or impotence than a sea
of expectant faces! But that's a topic for another time.)
I was also naive about the physiology. Most people assume that castration
precludes erections and climaxes, but that is not true. If the operation is
done to boys before puberty, their genitals do not grow to adult size, but the
hydraulics still work. And grown men captured as prisoners of war and given the
choice of castration or decapitation sometimes retained much of their sexual
ability. It does take testosterone to generate a response just by looking and
thinking about sex, but even eunuchs can produce an erection by touch. Those
enormous harem guards in ancient
So, how did the Chinese eunuchs (and the others) gain their power? Not by
force, but by guile. Duh! My own stupidity reminds me of the asylum inmates
advising the motorist how to deal with the loss of the lug nuts while changing
a tire: use one from each of the other three wheels. When the motorist showed
amazement at their cleverness, they retorted, "Hey, we're just crazy, not
stupid!" The fact is, whatever castration may or may not do to the psyche,
there is no reason to expect any effect on intelligence, the ability to plot
and keep secrets, any tendencies toward greed, envy and nastiness, or a lack of
conscience. Perhaps they wouldn't challenge an opponent openly, but they were
perfectly capable of poisoning him or stabbing him in the back later. And
actually, it wasn't very difficult. Their masters became so soft and corrupt
that the eunuchs were able to manipulate them easily. They merely filled a
power vacuum.
And then there's Farinelli! Centuries later, in modern times, an Italian
castrato soprano so captivated the court in Madrid that he was, for all
practical purposes, King of Spain for nearly 20 years. He was born Carlo
Broschi in 1705 to a prosperous, musical family in
"I must have you
know--for it deserves to be known--that Farinelli was a
revelation to me, for I realized that till I had heard him I had heard only a
small part of what human song can achieve, whereas I now conceive that
I have heard all there is to know."
In
1737 he was summoned to
Now let us move on to more immediate concerns. The Baby Boomers are aging, and
suddenly the popular press is full of discussions of prostate cancer. It is
apparently an unstable tissue, and it is said that every man would get prostate
cancer if he lived long enough. The tissue is full of testosterone receptors,
which is not surprising, but when activated, they seem to stimulate
carcinogenesis. The prostate gland produces both the bulk of semen and the
sensation of orgasm, so its loss impacts on sexuality almost as strongly as
does loss of the external organs. Of course, there are other causes of
impotence besides castration and prostate problems, but for our present
purposes, we can consider prostate cancer a metaphor for castration. Indeed,
castration is one of the last-ditch measures used to stop prostate
cancer--either surgically or chemically. These days it is done with a pill,
usually estradiol, as with young roosters. By that time death looms large, and
the loss of sexuality must surely be a minor concern. But in earlier stages of
the disease, preservation of virility and sensation are paramount, and
physicians and surgeons are obliged to go to great lengths. Their success or
failure in that respect determines what may be the most important aspect of the
quality of the remaining life that can be realized. If they fail, men resort to
a variety of mechanical or hydraulic/pneumatic devices that can be surgically
implanted to produce an erection artificially. There are some wondrous
contraptions, indeed, but my personal favorite is one that produces a permanent
erection, as if possessed of an os penis, but pointed downward, toward the
ground. When one wishes to use it for sex, it is necessary to (clink) cock it.
Of course, most of this is old news to women, who have been submitting to
breast and pelvic operations for generations. (Prostate cancer has been around
all this time, too, but it has not been an item of major concern until
recently.) Interestingly, cancers of the breast and the pelvic organs are stimulated
by estrogen, just as prostate cancer is stimulated by testosterone. We can
consider these problems to be metaphors for castration, as well. Probably
because most physicians have always been men, any damage or stress to women's
psyches because of a mastectomy or hysterectomy has been systematically
minimized. Women don't have to produce an erection and "perform," and
silicone breast implants or external pads hide the damage, they say, so what's
the problem? Women might retort that impotence is not discernible by outward
appearance, either, so where's the difference? Last year I watched a breast
reconstruction operation to correct an earlier radical mastectomy, televised on
The Learning Channel. It was an amazing procedure, with tissues being transplanted
from other areas of the body to fill in the gaps, requiring many grueling hours
of surgery. Afterwards, there was an interview with a septuagenarian who had
endured it, and I was astonished to hear her say that, even at her age, her
improved self-image as a complete person with a full sexual identity was very
important to her and that it had been worth all the expense, pain and
inconvenience to have it done. Never mind that she was no longer sexually
active; never mind that the final result was anything but beautiful without
clothing; just having breasts and feeling whole again made all the difference.
I guess my own maleness is responsible for my surprise; logically, her response
should be the expected one.
Of course, there is no reversing a hysterectomy, and presumably, women have for
many years been dealing quietly with an emotional injury equal to their
physical maiming by these operations, which most men simply have not been able
to appreciate until very recently. It is easy to understand feelings of great
loss after a mastectomy, because everybody agrees that breasts are beautiful
and desirable and should be preserved. It was also easy to minimize the
emotional impact of the loss of something like a womb that is internal and
hidden, until prostate cancer hit the front pages. Prostate cancer is the
liberating factor, the equalizer of the genders for the nineties.
But let's move on: all these sexual maladies are beside the point--I am using
castration as a metaphor for all profound losses, leading to the ultimate
loss--the lost of vitality, itself--growing old and feeble, and finally dying.
The first sign of the beginning of the end for most people is a slowing of the
metabolism and a sudden, unexpected increase in weight in their forties. That
sends many to the sweat palaces, where they drudge up endless stairs for what
seems like hours, then to be informed by their exercise machine how many (few)
calories they have burned, and a common food equivalent. At intervals
throughout the day, the anguished cry, "A Triscuit?!" is heard above
the groans and clanks, and all present share a moment of commonality.
Many people of both sexes are very serious about it, though. It's not just a
matter of aging well; it is now recognized that a youthful bearing is crucial
to success in business. Vigorous forty-somethings anxious not to show even the
slightest chink are now slapping on two or three testosterone patches at once
and gobbling fistfuls of steroids and vitamins just so they can dominate a
handball game with a competitor after work. The androgen food supplement DHEA,
dehydro-epi-androsterone, available without prescription, has become a runaway
best-seller at drug stores, causing many endocrinologists to cringe. It's
appropriate for a fifty-or sixty-year-old to take it if he feels his powers
declining then, but only with the understanding that it may stimulate earlier
progression of prostate cancer. For younger men it's not worth the extra risk.
But two new findings suggest that androgen therapy (like DHEA) may not carry
that risk after all.
The first is an explanation for a very unexpected and disturbing recent finding
about the value of beta-carotene as an antioxidant in the prevention of breast
cancer. beta-carotene is a "provitamin"--a precursor of Vitamin A,
found especially in broccoli and other cruciferous vegetables. Administration
of beta-carotene didn't help at all, and the cancers actually grew faster! When
the results became evident, the test was stopped and the beta-carotene was
quickly taken away. Then, another group found that the destruction of free
radicals by antioxidants occurs as a cascade of reactions that requires Vitamin
E, beta-carotene, and Vitamin C to be present simultaneously and to pass the
poison from one to the next, as in a bucket brigade. The beta-carotene reaction
is in the middle, and if Vitamin C is not there to do its part, oxidized
beta-carotene remains, and it is even more damaging than the original free
radical. (Free radicals are molecular fragments from violent reactions not
mediated by enzymes, such as are produced by ionizing radiation or being
attacked by another free radical. They contain an "unpaired electron"
that is extremely reactive and capable of causing great destruction.) The
research program that produced the strange beta-carotene results did not
include extra Vitamin C and E, so the negative result is explained.
The other research result that offers hope to men fearing prostate cancer found
that the carcinogenic damage is actually traceable to degraded (oxidized)
estrogen. It seems that both sexes produce both hormones and their receptors in
many tissues like breast and prostate tissue, but prostate tissue remains
dormant and does not grow or make repairs for all of men's adult lives. It is
fully alive and metabolically active, of course, but there is no cell division
in which the chromosomes unravel and stretch out so the DNA can be duplicated.
That is the main occasion on which damaged DNA can be repaired. New growth does
not occur until old age when testosterone production begins to lag, but by that
time free radicals from oxidized estrogen have produced half a century of
damage, with no repairs having been done in all that time. These two findings
suggest two prob-able benefits: DHEA is a testosterone precursor, so taking it
as a food supplement in late middle age should bolster testosterone levels and
thus delay or prevent the conversion of prostate tissue from dormancy to the
proliferation that precedes carcinogenisis. Second, if Vitamins C and E and beta-carotene
are taken regularly (along with the element selenium), perhaps the oxidative
damage can prevented in the first place. Personally, whenever I can improve the
quality of life now by taking a risk that has consequences that do not accrue
until the end of life, I think that's a pretty good trade. I am now using DHEA
and antioxidant food supplements every day.
Liposuction is much easier, and it is becoming quite common, in spite of the
grossness of the procedure, itself. I've been dieting all my life, truly and
literally, and this alternative is starting to look better and better to me. I
even have a biochemist's rationalization for it: avoiding the metabolizing of
all the toxins stored in fat. Have you ever noticed dead birds at the end of a
long winter, even though it may not have been terribly cold? Some surely do
starve and freeze, as is usually assumed for all, but in fact most are poisoned
by the fat-soluble pesticides liberated rapidly into their system after their
depot fat is mobilized. We live much longer than robins and store in our fat a
bewildering catalog of synthetic pesticides, plasticizers, polymer monomers,
solvents, drugs, paint fumes, carpet fumes, petroleum fumes, colorants,
odorants, deodorants, refrigerants, elastomers, disinfectants, fire
retardants...
And those are just the known, intended substances--there are even more
unintentional byproducts that are completely unknown. For example, the EPA
ruled that it's OK to consume fruit that has been sprayed with pesticide if
enough time has elapsed for it to become degraded. That doesn't mean it has
been removed or destroyed completely, but only that it has been changed so that
the standard analysis no longer recognizes it and detects it. But the
degradation product is still there, an undetected fragment, an unknown
"trichloro-oh-my-gosh" that is completely ignored. Nowadays we expect
the chemists at Dow and Monsanto to use modern research equipment that detects
and reports everything in their samples whether they request that information
or not, but 20-40 years ago when most of us were accumulating our load of
toxins, mass spectrometers and two-dimensional chromatography did not exist. We
have all been Guinea pigs. It is significant that the most toxic substance
known, the "dioxin" known as TCDD, has never been produced
intention-ally, has no uses, and exists only as an unintentional, and for many
years, unknown byproduct of the manufacture and burning of many plastics and
pesticides. Its "safe" level in foodstuffs is regulated to a few parts-per-quadrillion.
So, if any of you are thinking about liposuction but are deterred by Puritan
friends or family who say it's like cheating, the easy way out, you can tell
them it's actually more dangerous and less healthful to do it with diet and exercise--don't
they know that toxins mobilized from fat are the main reason people are so
irritable and headachy when they're dieting? And they can take their
holier-than-thou, no pain/no gain outlook elsewhere, thank you very much.
Remember, Jim Fixx dropped dead while jogging, Adele Davis died of cancer, and
Jacqueline Onassis said as she lay dying of lymphoma after a lifetime of
control and restraint, "Why did I do all those push-ups?" Puritanism,
like chastity, is its own punishment.
The next reminder of eventual senescence is usually the loss of elasticity in
our connective tissues. Skin sags. Faces slump. Breasts droop. Bellies go to
pot. I had an extended argument with my barber because my sideburns didn't end
where they were supposed to. It turned out that the problem was with my daily
shaving, not his monthly trim: although I do watch in the mirror, I discovered
that I really shave in that region mostly by touch.--I run the shaver up my
cheek to the notch in my jaw and stop when it feels like it always does. I
finally realized that the problem is that my skin is sagging, and the place
that "feels right" is no longer where it used to be on my face. My
ears are falling!
And what's worse, they're not falling together. It is now impossible to fit my
glasses level on my nose. The most colorful example of connective tissue
fatigue I know is to be found in the Nepalese and Tibetan lore of the
abominable snowmen. It was said that both sexes of Yeti sometimes sought mates
near human settlements. If you were chased by a male, there was nothing you
could do but pray--their enormous strides could overtake even the fastest
runner. But if it was female, one could get away by running downhill--their
breasts are so very pendulous and hang so low that they bounce off the knees
and fly up into the faces of the poor creatures, causing confusion and slowing
them down enough to allow an escape.
Fortunately, this aspect of getting old can be corrected or delayed very well
with surgery. Face lifts are now very common in both men and women, and
silicone implants will be back again when the courts finally throw out the junk
science. Now, it is possible to get any part of the body sculptured precisely
to order, for a price. Even liposuction had a major advance recently: fat cells
can be disrupted and liquefied by ultrasonic energy, and the physician can
simply pass the horn across the skin like a wand and collect the oil as it
drips out, as if from a crankcase! I know a woman who has had three face lifts,
lipo-sculpturing, breast augmentation, a tummy tuck, a butt tuck, and a chin
tuck.. Did you know that Cher had lipo-sculpturing before making those exercise
and artificial sweetener commercials? Bah! There's no honor any more. And,
speaking of Hollywood, imagine blond action hunk, Nick Nolte: when he hit
fifty, gravity tugged at him so strongly that he felt obliged to have a scrotum
tuck. Poor dear. What a trial.
These may seem exaggerated responses to aging, but many silly people try to
control all risks, presumably to live forever. It seems every major medical
center now publishes a commercial newsletter for people who want to hear about
every preliminary research result, before it has been confirmed or even
discussed by the rest of the scientific community, in order to take immediate
advantage and not waste even a single day to begin taking this or that obscure
"vitamin" or trace nutrient. Some have even taken the extreme step of
having themselves frozen so that they can be thawed out years later, when a
cure for their condition has been developed. Unfortunately, we don't know how
to freeze large bodies, and it is virtually certain that none of them can be
revived. Thus, those people have effectively committed suicide just for a
chance at more life than they're entitled to.
So, how much life are we entitled to? The standard three-score and ten? The
standard 40 years of a few centuries ago? The theoretical 150 years that should
be possible if everything is perfect (no defective genes, no incurable
diseases, no dietary self-indulgence, no speeding trucks)? There is no
entitlement; it's all in the luck of the draw. We can only do the best we can
with what we're given, and the "gifts" are exceedingly unbalanced.
Half of all human deaths on Earth each year are infants who die of diarrhea due
to rotaviruses in the fetid fluid that passes for drinking water where they
live. Think of it! Every "normal" death due to other diseases,
accidents, famines, floods, murders, wars, etc. is paired with that of an
infant in some third-world nation. With that kind of statistic, everyone who
survives even to adolescence should feel lucky.
So, what's the answer? What is the ideal posture regarding life and death,
senescence, and the quality of life? Can one steer a middle course between
Dylan Thomas's "Rage, rage against the dying of the light!" and the
Bach chorale, "Komm', Susser Tod" ("Come, Sweet Death)?" Is
such a middle course desirable? Is life worth living without sex? Without
mobility? Without love? Without freedom from pain? Without enough money to be
comfortable? For all but the most hopelessly demoralized and cynical, the
answer must be a rousing "Yes!" Freud was wrong: sex is important,
but not that important. More than half of men over forty suffer from at least
occasional impotence, and legions of people everywhere with the most appalling
injuries, malformations, losses and limitations live their lives with quiet
dignity and a good measure of satisfaction. I used to think I would rather be
dead than impotent, blind, or a helpless paraplegic, but now I'm not so sure.
The more life I have behind me, the more acceptable such maladies and even my
eventual mortality seems. Only loss of the mind, itself would seem to justify
losing the zest for life, and those poor souls would probably not have the gumption
to do any-thing about it. Thus, in most societies, suicide is considered a
crime, a sin, and a mental disorder.
But what if there were a real alternative to senescence? I have already alluded
to the free radical/antioxidant theory of aging while discussing prostate and
breast cancers; merely extend the idea to preventing all sorts of other tissue
damage besides those that lead to cancer. Thus, habitual, life-long use of
extra Vitamins A, C, and E, in addition to a good diet, exercise, sufficient sleep,
etc., will prolong life. Other research is also showing that merely eating
less--restricting total calories by at least one-third all your life--will
extend life significantly (if you call that living). Organ transplants are
becoming more available and successful, and that can add many years to many
lives.
But there is another theory of aging, with a treatment that fascinates me. The
theory is that our receptors become progressively clogged or fouled with trash,
and if they could be cleaned out, we would be like young again. Receptors are
large protein molecules with more than one "business end" that reside
in biological membranes such as the plasma membrane that encloses every cell,
the membranes of the nucleus and the mitochondria and other cellular
structures, where chemical reactions occur. Each receptor molecule has a
depression or cavity shaped exactly to accommodate its particular target
compound. For example, there are receptors for the estrogen molecule in breast
tissue. When an estrogen molecule is "received" by an estrogen
receptor, its very presence--its chemical properties--cause the receptor
molecule to change its shape or its chemistry so that another reaction nearby
is influenced, promoting tissue growth in some way. There are thousands of
types of receptors, each with its own unique geometry that is a mirror image of
a unique target chemical. Unfortunately, the specificity is not perfect, and it
is not difficult to find or produce other molecules that are sufficiently
similar to the target molecule to be able to "confuse" the receptor.
If the "wrong" kind of molecule gets into a receptor, two things may
happen: first, the new molecule may not induce the receptor to do whatever it's
supposed to do; and second, it may not come out again, so that that particular
receptor may be "poisoned" for a long time. This is called
"competitive inhibition," and many poisons work by that mechanism.
This new theory posits that, over the years, odd bits of molecular fragments
and other trash accidentally get lodged in receptors all over our bodies,
gumming up the works and slowly eroding our general bio-chemical competence.
The treatment would be some kind of electromagnetic wholebody induction, in a
proton- or neutron-magnetic resonance scanner-like machine, in combination with
an infusion of special solvents. It has been tried on aging rats, with some
success, but truly aged rats quickly succumbed to kidney failure--they got
clogged with debris. This was expected, but it was hoped the liver would clean
the blood before the kidneys shut down. This does not sound like an
insurmountable problem, and if such a treatment ever became available, that,
ladies and gentlemen, would be a true Fountain of Youth. The prospect of really
extended lifetimes seems almost within reach. What would we do with it?
I don't pretend to have all the answers, but a few points of wisdom have
surfaced during this investigation:
1. Accept whatever physical gifts or torments fate brings, and make the best of
it. It does no good to rail against God, and it only increases the pain. I
salute all the accident victims and war veterans in their wheelchairs, the
brave souls trying to communicate by typing with a stick held between their
teeth, the blind, the deaf, the maimed who somehow keep going.
2. Be prepared to accept defeat. "If at first you don't succeed, try, try
again..." but then quit, and don't make a fool of yourself. This is
probably the most difficult lesson I've ever had to deal with. Though
unaccustomed to failure, I am not entirely unacquainted with it, and it is very
hard for me to give up, turn around, and walk away from a mess, but sometimes
all other alternatives are pure poison.
3. Take things one day at a time, as suggested in the punning title of Herman
Lackner's wonderful 1990 paper, Day by De Senectute. Patience is surely near
the top of the list of virtues, and fortunately, one of the things generally
available in quantity during old age's time.
4. Maximize whatever gives you pleasure. Foremost among these should be romance
and sex.. Even if you are limited in your ability to experience it yourself,
giving such pleasure to someone else is almost as satisfying. Sex among older
people is not talked about much, probably because people of that generation are
more likely to be conservative and reticent, but also because most of us are
uncomfortable thinking about our parents "doing it." Sometimes we are
titillated by reports of roues in retirement homes, and a few years ago we were
entertained by the story of an 89-year-old man who was treated with L-DOPA for
Parkinson's disease and suddenly began demanding and receiving sexual
gratification thrice daily. His nurses were very surprised; it had not been
known that L-DOPA is an aphrodisiac. All that aside, sex in the later years is
reported to be just as satisfying as it is during youth, only different. The
pace is slower, and one may need to use "adjuvants" to make things
easier--pillows and potions, perhaps an erection enhancer--and the final
release is described in terms of a different modality of sensation, but it is
still absolutely wonderful and definitely worth the effort. We in my family
were all saddened by my mother's death at age 69, but some time later Father
was introduced to a widow his age by church friends. And amaze, amaze, they
started a romance and married a year later, both at age 72. My sister and I
were delighted, and now we have another entire family line to get to know. But
the point is, it was a sexual relationship, and everybody was pleased. They
went dancing in the Italian neighborhood of south St. Louis every weekend, just
like newlyweds fifty years younger than they. Father confided, "We spark
each other!" and for the two good years he had with her, I'm sure they had
a better sex life than I did. (Not that they'd have to go at it three times a
day like L-DOPA-fiends to beat me--sometimes I think I should be in the Drones
Club like Bertie Waster, but never mind..) Sex can and should be enjoyed as
long as one has any mobility at all. It may be life's greatest single pleasure,
it's good for us, and it's at least supposed to be free!
5. Try to preserve your sense of humor. Mortality is a serious matter, but it
does no good to dwell on things. I have tried to lighten this discourse a bit
here and there; I hope not exceeding the bounds of propriety, and I close with
this piece of anonymous doggerel lifted from the Internet:
NOOKIE
BLUES
My nookie days are over,
My pilot light is out.
What used to be my sex appeal
Has become my water spout.
Time was when, of its own accord,
From my trousers it would spring,
But now I've got a full-time job
Just to find the blasted thing.
It used to be embarrassing,
The way it would behave:
For every single morning
It would stand and watch me shave.
Now, as old age approaches,
It sure gives me the blues
To see it hang its little head
And watch me tie my shoes.