Foreword

When it comes to human nature, there is something about complexity that most people find troubling. Magazines and newspaper articles are fond of announcing, with a flourish, that a "brain center" has been discovered that explains violence, sexual desire, overeating, or why we don't keep New Year's resolutions. Similar articles inform us that the cause of infidelity is purely a product of evolutionary principles, or that a single neurotransmitter is the cause of gambling.

As the co-editors of this splendid new volume point out in their preface, psychiatry has not escaped this popular trend toward biological reductionism. The discovery of the genome and the remarkable advances in the neurosciences have fueled the desire to find discrete causes of complicated human behaviors. Simple biological causes call for simple pharmacologic treatments, and a "magic pill" is the panacea with which psychiatry is enamored at this historical moment. To a remarkable extent, this reductionist trend within psychiatry as a whole is even more striking when we examine the recent trends in the understanding and treatment of sexual disorders. The irony, of course, is that no area of human behavior is more mysterious than sexuality. Moreover, if one wanted to confirm the value of the principle of multiple causation in psychiatric disturbance, one could do no better than to start with sexual disorders as the prime exemplar of this principle. As several of the authors in this collection of outstanding contributions point out, approaching the complexities of sexual desire by studying problems with genital congestion are likely to produce a limited yield.

Balon and Segraves have assembled an international group of experts who share a broad biopsychosocial perspective in their understanding of human sexual dysfunction. To their credit, they in no way give short shrift to biological causes and pharmacologic treatments. Indeed, readers of this book will gain a sophisticated understanding of how physiological factors contribute to sexual problems and how to integrate sound medication strategies in their treatments. What is particularly admirable is that the authors who contribute to this volume are deeply committed to the concept of breadth in the understanding and treatment of sexual dysfunctions, and they convincingly persuade the reader why a broad-based approach is necessary.

Handbook of Sexual Dysfunction comes at an auspicious moment within psychiatry. Going against the grain, it restores a biopsychosocial perspective to the understanding and treatment of sexual dysfunction. It also provides the clinician reader with a practical, commonsense guide to treatment planning that treats the patient as an individual rather than a disease entity. I know of no other text in the field that can match this state-of-the-art treatment of the subject. Both students and experienced clinicians will find it of enormous value.

Brown Foundation Chair of Psychoanalysis and Professor of Psychiatry Director, Baylor Psychiatry Clinic Baylor College of Medicine Houston, Texas

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