Butea superba (Thai red kwao krua) combats phytoestrogens in Californian men

Ihsan Ahmad As Saker, the victim. Killed for leaving Islam

Index of articles

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Homo Obnoxious: Is Toxic Masculinity Really Taking Over the Country?

San Diego Free Press

DECEMBER 26, 2016 BY SOURCE

Maybe the real problem is a lack of positive paths to manhood

It wasn’t supposed to turn out like this. We were said to be approaching the demise of a certain type of swaggering, predatory masculinity: let’s call him Homo Obnoxious.

As men like Roger Ailes, Bill Cosby, Anthony Weiner, and Billy Bush scrambled unsuccessfully to find cover in the old-boy bastions of privilege, Homo Obnoxious appeared to be lumbering around like a dinosaur under the weight of his own cultural baggage. His habitat was shrinking: it seemed as if men who defined themselves by devaluing women, putting down men who didn’t think like them and treating sexual relations — and most everything else — as power-tripping performances might be ready for mounting in a Museum of Masculinity Past.

Books like Hanna Rosin’s The End of Men hailed an era in which women, and men of a different mold, would rapidly pull ahead in every arena. In The Future of Men: Masculinity in the Twenty-First Century, Jack Myers heralded a seismic shift in human relations. “We are entering a new age of female dominance and a reshaping of the male psyche, the male libido, and the male ego,” Myers wrote. “This is the new reality, and it will gain greater and greater momentum. Nothing in the history of humanity can prepare us for this newly upside-down world.”

Reality check: Homo Obnoxious is moving into the White House. The world is upside-down, but not for the reasons Myers anticipated.

The president-elect is signaling to boys across the country what it means to be a successful man. He gets more thuggish with each passing day, appointing knuckle-dragging members of his tribe to run the country. Meanwhile, alt-right dudes who cope with masculine anxiety by proclaiming superiority over women and people of color are feeling validated, enjoying influence they could hardly dream of a year ago. As one self-identified “neomasculine” blogger put it, “I’m in a state of exuberance that we now have a President who rates women on a 1-10 scale in the same way that we do and evaluates women by their appearance and feminine attitude.”

Yikes. But before we concede that toxic masculinity has suddenly reasserted itself as the dominant force in the cultural universe, let’s pause to take a breath. Let’s admit, for example, that although arenas of male experiences differ depending on where you live and how much money you have, Homo Obnoxious was never just a creature of any one party, class or region. The truth is that he is nurtured at every stage of an American boy’s journey into manhood, and without trying to understand what our society does to promote his development and how boys and men might be persuaded to reject his allure, he will continue his rampage across the land.

Let’s take a look at three breeding grounds where Homo Obnoxious cuts his teeth.

The playground

So many have a story like mine. It was a day soon after I had transferred to a new public high school in North Carolina. Two popular senior boys — baseball stars on a winning team — approached me across a crowded stair landing. I smiled, then felt rough hands shove me against the wall as the two sang obscene lyrics in my ear. That was not the last or the most violent encounter I had with Homo Obnoxious-in-training during my education.

Aggressive misogyny, of course, permeates many school sports teams, as the recent case of the men’s soccer team at Harvard illustrates. There, at America’s most hallowed university, a spreadsheet compiled by male players portraying members of the women’s team in degrading sexual terms was brought to light. A student explained the commonplace nature of the behavior to the New York Times: “I think Donald Trump is so extreme that we like to believe that these extreme incidents of sexism and discrimination are, like, isolated to him,” he said. “But it’s important to recognize that they’re just as rampant in our generation.”

Responding to recent revelations of decades-long sex abuse by both faculty and students at St. Georges, a New England prep school where Billy Bush was an ice hockey star, a former student described the warped sexual atmosphere and lack of guidance from adults in a letter to the rector of St. Paul’s, another elite prep school where a tradition of predatory sexual competition bred danger:

“I went to St. George’s School in the ’80s and am a heterosexual, success-oriented, competitive guy. I remember being self-conscious about my not getting any action while some of my male friends got tons. I felt less-than, like a loser when it came to girls and sex…Nowhere in my development …did any adult ever reinforce in me that it is all right to go at your own pace, that sex isn’t competition. The cultural norm was that sex was another place to be competitive, where you could be classified as a winner or a loser.”

Let’s think about that. When competition is the preferred mode of group interaction, it’s no wonder boys end up stuck with obsessions about the number of their sexual encounters and a tendency to degrade the objects of their pursuits.

In A Bigger Prize: Why Competition Isn’t Everything And How We Do Better, Margaret Heffernan discusses the destructive role that competition plays in American education and how it turns kids off of many potentially valuable collaborative activities. A large percentage end up not wanting to participate anything, including sports, in which being the winner or loser is everything.

Heffernan points out that if we teach kids that success is all about individual performance, they grow up to be what she calls “heroic soloists.” In relating to others, they tend to focus on what’s in it for them, suppressing the instinct to be generous or share credit or empathy. Our president-elect, steeped in the values of self-interest capitalism and competition in everything from football and beauty pageants to reality TV tournaments, is the epitome of a heroic soloist — one who has been rewarded richly in celebrity, power and money.

Teaching kids the value of creative collaboration and offering rational guidance on sexuality or gender relations at school has to be a part of cultivating a different path to manhood. American sex education, for example, if it is taught at all, often consists of either shaming abstinence lessons or alarming medical discussions of STDs and pregnancy, with little acknowledgment of the need to develop compassionate ways to express sexuality or the importance of challenging sexual stereotypes in media and culture. It doesn’t have to be that way; in a New York Times op-ed, Pamela Druckerman highlighted how topics like the complexity of love are openly discussed in French sex-ed, while Dutch teachers work to inculcate respect for people who don’t fit traditional sexual and gender molds.

If they don’t have blueprints of masculinity that allow for confidence and strength without domination in the playground and in the classroom, boys grow up thinking that a hero is somebody who is in everything solely for himself. This does not mean that we send male students to re-education boot camps, as certain right-wing pundits have warned is the true agenda of coastal elites. It means that adults take it upon themselves to guide students, whatever their sexual orientation or gender identity, in imagining ways of being men that are not destructive to themselves and others. It means not shaming them because they are male, but rather encouraging them to develop pride in characteristics and values that are socially beneficial, like putting others before themselves, honesty and strength in caring and self-restraint. That would be a start.

The campus

When I arrived at the University of Georgia in 1988, a sophomore from my hometown issued a helpful warning not to ever hook up in a certain popular fraternity house. The guys, I was informed, videotaped girls through holes in the walls and watched the tapes together on Sunday morning. This foreshadowing of the age of digital shaming and abuse was my introduction to the group norms associated with Greek life. Some misogynist rituals were performed under the radar, but others were out in the open and normalized, from parties where lists trashing women in sexual terms were posted on walls to “mixers” with sororities in which fraternity guys inscribed phalluses and misogynist phrases on the T-shirts of freshman girls.

There is nothing wrong with guys wanting to hang out, share common interests and form lasting social bonds with one another. But as young men begin to leave home, there aren’t enough opportunities for them to do this in a way that breeds healthy, socially responsible attitudes and behavior. Beyond the sports field, college fraternities are another place where antisocial activity is too often the norm, a lot of it targeting women. The “Animal House” frat image grounded in the degradation of women, based on fraternity life at Dartmouth in the 1960s, has been ascendant for decades, linking manliness to out-drinking peers and egging them on in sexual exploits. (Was Donald Trump in a fraternity? Of course: he was a Phi Gam at Fordham.)

The negative image is based in reality. On alcohol consumption, a U.S. Department of Education’s Higher Education Center survey shows that 75 percent of fraternity members engaged in heavy drinking, compared with 49 percent of other male students. Some — including many college presidents — have argued that since the drinking age was raised to 21, alcohol consumption has gone undercover, causing students to associate drinking with transgression and pushing it far from the supervision of older adults and more open social events. Lowering the drinking age, they suggest, might bring alcohol back into a more normalized atmosphere where students mix with older adults in supervisory roles, thus obviating the need for secretive binge-drinking and its attendant hazards and regression.

Some say fraternities should accept girls, and in a few cases, colleges have banned frats altogether, arguing that they are obsolete. At Amherst in Massachusetts, where fraternities were prohibited in 2014, students and faculty have discussed ways to create social groups that get rid of some of the destructive things associated with fraternities while providing the cohesiveness and sense of belonging that make them attractive, like residential communities with selective membership centered around a particular theme.

This is all well and good, but how likely is it to spread into regions of the country far flung from elite coastal universities? Places where fraternities have emerged as a way of attracting less affluent students to college with the promise of bonding and bacchanalia, to be translated into fundraising dollars after graduation?

College men — and young men who don’t go to college —need to have positive narratives that allow them to feel good about being men and being men together. Challenging sexual assault is important, but they need to learn much more than “no means no”: they need guidance in emotional honesty and intimacy, the challenges of navigating relationships and masculine ideals to strive for in which cultivating large numbers of women as hookups and drinking into oblivion are not the marks of masculine status. Beyond this, they need to see that life offers them more than the prospect of being a loser in the workforce that awaits them when schooling is done, and they also need opportunities to see that work in areas like caregiving, for example, are rich in positive masculine values. When a male nurse can be viewed as stronger and sexier than a Wall Street parasite, we will have gotten somewhere.

Popular culture reflects a hunger for a vision of masculinity that rejects Homo Obnoxious. Jesse Pinkman, the young meth cook in the TV series Breaking Bad, illustrates the despair of recession-era young men without decent job prospects who search for status, meaning, and self-worth. There’s a lot wrong with Jesse, but in his evolution as a character we see his growing resolve to form intimate, caring bonds with the women in his life and the men in his posse, too. The blockbuster franchise Fast and Furious shows the need for even the most testosterone-driven men — racecar drivers in this case — to develop respect and lasting relationships with the men and women in their social group.

These fictional guys hunt for alternatives to a brutal, global capitalist system that casts them as losers. They want to find the dignity that dissolves when we mire them in student debt, consign them to dead-end jobs and say, Oh well, globalization happens. If we continue to do this, they will bond together in ways that can quickly become dangerous to society as a whole, and they will look for outsider narratives that offer something more that the empty promise of upward mobility currently on offer from politicians who think that the paltry social safety net and worker protections currently in place are over-generous (politicians from both major parties). Sometimes, in the case of the white supremacist groups that have begun to creep out of the woodwork, that something will be very scary.

The internet

There has been a lot of recent research on how online porn and video games are helping to inculcate alienation and destructive patterns in boys and young men. Stanford psychologist Philip Zimbardo’s book Man (Dis)Connected): How Technology has Sabotaged What it Means to be Male provides insight onto how Homo Obnoxious gets his brain wired.

Zimbardo discusses how young male brains can become shaped at a cellular level in ways that inhibit their social development through excessive time spent on gaming and porn, even losing their ability to read the social cues of face-to-face contact. Many, he points out, are drawn to these realms as a seemingly safe and easy way to gain a sense of achievement that may not be available in the winner-take-all competition of school and the workforce. These virtual worlds are tailored to provide an addictive system of goals and rewards that produce guys who are afraid of intimacy. They end up eschewing real-world experiments that might result in rejection, and real-time spontaneity that leaves them disoriented and frightened. Drained of self-confidence, they search for narratives of manhood that provide at least the simulacrum of power and dignity.

Some go on to find self-help, intellectual and political forums online collectively termed “the manosphere.” Some of this has merged with the recently designated “alt-right.” In the more benign forums, we find guys like mild-mannered Brian Begin, co-founder of Fearless Man website, who invites guys to join a brotherhood of men who have learned the secret of confidence and self-love. A shy video gamer who found himself working in a miserable office cubicle and unable to talk to women, Begin eventually threw away his games and launched a self-help journey that revealed to him he needed to learn to “feel” — to experience emotions at a deep, visceral level and connect to others despite fear of rejection. Although Begin’s quest for dignified masculinity rests in part on the fantasy of making piles of money and dating beautiful women, his hunger for self-esteem and the experience of genuine emotion seems real, as does his impulse to see women as something other than a collection of body parts. He doesn’t want to be a nervous “beta” male, and while much of his rhetoric is traditionalist and half-baked, he is on to something in pointing to the critical need for connection. In his workshops, the first thing he does is to hug the men who participate.

Unfortunately, much in the manosphere openly promotes the far more noxious stuff, like sexual predation in the pickup community, where guys give each other creepy tips on “mind-controlling” women and duping them into sex. Other sites, like Mensactivism, boil with anger at feminists and take a paranoid stance against what they imagine is an epidemic of false rape claims and women who will take advantage of them at every opportunity. Mensactivism buzzes with articles like “Men are the downtrodden sex” and blogs expressing hope that a Trump presidency “could radically change colleges’ response to sexual assault.” In these sites, loneliness and fear are vented as rage — the rage that comes when people don’t know what to do with their suffering.

Yet for all the bluster and bullying on such sites, you don’t have to dig far to find clues to what is bothering these young men so profoundly at their core. The blogger who likes Trump’s rating system for women asks a series of questions in a meditation on so-called neomasculinity, which despite its name, is mostly a throwback to outdated myths of male superiority: “What code of morality or principles should guide men in their daily lives? Is there a deeper life meaning that can help us set better goals?” The answers he comes up with may be bitter and sad, but the questions themselves are not stupid, and they point to a lack of compass to give direction. Online, the lost boys find each other, making up the missing codes themselves out of a mixture of bravado, hurt and bitterness.

The road ahead

When I sat down to write this article just after Trump’s election, I felt angry and confused swallowing the reality that the country is going to be led by a man who brags about sexual assault. But gradually, I’ve come to feel something else, a sense that the Trump election may in part be a sign that a giant population of American men — particularly the Trump voters but also men across regions and classes — are in turmoil, and that most are looking for a way out. If we simply shout them down and disparage them, we can be pretty sure that the worst among them, the already-committed members of Tribe Homo Obnoxious, will gain strength, not lose it. Some are likely already too far down the road of hate for redemption, but I believe these are a small minority. The rest are struggling, watching, looking for signs, searching for stories that might give them a sense of a more positive path ahead.

Over Thanksgiving, I attended Sunday services at a conservative Southern Baptist megachurch in Raleigh, North Carolina, partly because I wanted to hear and see for myself what men in that context were thinking and talking about it — men who were the most likely in town to have voted for Trump. If I were to believe the assumptions of some of my liberal friends in New York, where I currently live, they would be spewing racial hatred, misogyny and homophobia — a seething collection of “toothless rednecks,” as one New Yorker put it on my Facebook page.

That’s not what I heard. The sermon was delivered by a young minister with the demeanor of a kindly basketball coach, one who was not afraid of emotions and wept at times as he spoke. His message, it seemed to me, was tailored to deliver balm to the heart of hurt manhood. God was the benign father and Christ was a brother — even a lover — who valued those gathered so deeply he would give his life for them. Men were presented as the ones who went out into the world while moms stayed home, a 1950s trope to be sure, but they were also asked to give up their self-centeredness, their narcissism. The minister urged them to see power as something that could be used to confront their own shortcomings, to serve and protect others. The solo adventurer was not vaunted here. Trump was not the emblem of the kind of masculinity valued here.

As much as I reject his outdated gender framework, the minister appeared a man with whom I shared some basic concerns—about the allure of consumerism, for example. He was not an alien, but a person trying to confront the ills of modern society, many of which bother me as much as him, though our emphasis and answers are different.

Men are confused, and how could they not be? Ever since the 1950s brought women into the workforce en masse, and the Pill released them from reproductive shackles in the ‘60s, a profound change in human relations has been happening in painful fits and starts. In the grand scheme of history, a few decades is an incredibly short amount of time to adjust to such a cataclysm. No wonder we’re still flailing about trying to figure out how to cope. Identity, expectations, culture and hormones are a complex dance. Social construction is a dynamic process, and hardly linear.

And let’s face it: Hillary Clinton’s election was not likely to bring a great gender renaissance in America, or any kind of renaissance for that matter. If Clinton were on her way to the White House, there is much reason to believe that ordinary men — and women— would see little improvements in their lives. That would be the case as long as those in charge are stuck in paradigms of dysfunctional capitalism and neoliberal blindness. Anger would continue to fester, and many working-class white men, in particular, would become even more entrenched in their reactionary rage.

As America’s boys see Trump acting out, some will feel their own worst instincts validated. But for others, the idea of “being a man” might mean distancing themselves from his kind of behavior. I do believe that men—and women—are less likely to assert power by denigrating and dominating others when they have a sense of real agency in their lives. It may not be helpful to talk about the end of men, or the rising dominance of women, but rather to remember that for all of us—men, women and transgender—our ability to manifest prosocial behavior depends a lot on having a sense of power and purpose in our lives. Growing inequality, the gig economy, strangling oligopolies, widespread poverty, a shrinking middle class, and government policies geared to appease the rich do not promote this outcome.

For those who reject Donald Trump, figuring out how to achieve a better life for everyone in our society instead of condemning “deplorables” is, in my opinion, a more productive way to go. The co-creation of a more peaceful and fulfilling world requires our most dedicated efforts in imagination, connection and listening to those who do not share our particular vision. Homo Obnoxious will only have the last word if we forget our common humanity.

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Handbook of child and adolescent sexuality : developmental and forensic psychology

Adolescent and child sexuality is studied by developmental psychologists from a research perspective, and is of interest to forensic psychologists dealing with abuse and custody issues as well as rape cases. In many cases it is of interest whether the child in question was sexually active, to understand the extent to which an underage minor might have voluntarily participated in sexual activity as opposed to having been coerced. Previously researchers interested in the applications of their research needed to look to separate books, and forensic specialists needed to look to development books to find the information they may have needed. This handbook provides both audiences with the related information they need. It encompasses normative behavior and clinical disorders in one source. It applies the information on development and behavior to forensic issues. It provides treatment information on sexual disorders in children. It provides information on children and adolescents in one volume.

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95 percent of the victims of violence are men. Because women feel flattered when men fight each other and kill each other to prove that they are real men.

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Anesthesia Awareness

Duke University Scool of Medicine Duke Anesthesiology

When the movie “Awake” came out in theaters it sparked much controversy throughout the country about the condition also known as anesthesia awareness. Following the release of the movie, Larry King Live did a special about this issue, in which King interviewed physicians and patients who have suffered from awareness. In response to the recent influx in publicity over the issue, the DREAM Campaign has taken the initiative to interview Dr. Tong Joo (TJ) Gan, who sheds light on many concerns that patients have when considering a surgical procedure as well as the misconceptions about anesthesiology in general. With so much focus on awareness and the negative impacts of anesthesia, it is important that the public be properly informed. Awareness can be a highly unpleasant experience, but most times the alternative is a surgery with negative outcomes or even worse, death.

There are about 100 to 150 reported cases of anesthesia awareness per year in the United States. It is very difficult to get an exact figure because it is under reported. Dr. Gan shared with us a case in which a patient of his experienced anesthesia awareness. The patient had come to the Emergency Room with a gunshot wound to the abdomen. He was suffering from massive blood loss and had very faint blood pressure so the anesthesiologist had to administer a safe dosage of anesthesia that would not hinder the overall well being of the patient as well as the blood pressure. When questioned post-operatively, the patient reported that he could hear voices during a brief period in surgery.

Hearing is said to be the last sense to go and the first to return under general anesthesia. As in the case of Dr. Gan’s patient, the modifications that had to be made because of low blood pressure caused the patient to become slightly aware and that is why he was able to hear briefly during his operation. “He did not suffer from any consequences after that and in fact, he thought that it was part of the operation,” said Dr. Gan.

When asked the common question, how can a person feel pain when they are paralyzed, Dr. Gan discussed the three areas of anesthesia; paralysis which paralyzes the muscles, analgesic which block pain signals to the brain, and anesthetic which puts the person to sleep so that they do not remember anything. For this reason, a person can be physically paralyzed but they may still feel pain. The human body does have natural responses to pain such as sweating, increased blood pressure and movement which may indicate to the anesthesia care provider that they are not fully anesthetized.

New technology allows anesthesiologists to measure the brain waves of a patient even while they are under anesthesia. “By using specific monitors, one can tell how deep a person is in anesthesia,” says Dr. Gan, “It is a bit like an iceberg; if it is below the water, it is very difficult to know how deep the iceberg is, and the monitor tells you what the depth of anesthesia is even when the patient is asleep.” The Bi-spectral Index Monitor, or BIS monitor is an example of such a device. Brainwaves are measured on a range of numbers from 0 to 100 in which 0 equates no brain activity and 100 is the mental state of a person when fully awake. During general anesthesia, brainwaves are measured between 40 and 60. If the BIS monitor measures activity above 70, there is a very good chance that the patient may not be fully anesthetized.

Dr. Gan mentions several fascinating facts throughout the interview one being that genetic factors can influence the way a patient reacts to anesthesia. Studies have shown that women tend to wake up about 10 minutes sooner than men when the anesthesia is cut off. This means that women need more anesthesia in order to produce the same effect. Redheads are also said to need more as well.

The revolutionary research that is being done by researchers like Dr. Gan is vital to prevent cases of unpleasant experiences and side effects. “One of the most effective ways to try and prevent this problem is to raise awareness of this problem, no pun intended,” Dr. Gan explains, “So we educate our staff, anesthesiologists and anesthesia care providers to let them know that this problem does exist and therefore it is important to take steps as well as understand the patient to try and prevent it.” He also mentions that there are mandatory educational modules that every anesthesia care provider must take. These modules go through various aspects of educational awareness such as the incidents of awareness, the scenarios where awareness may happen, the drugs or drug combinations that would reduce the incidents of awareness as well as monitoring the inter-operative awareness.

The Department of Anesthesiology is committed to find as many ways possible to provide the best patient care. Dr. Gan’s research in particular focuses on steps that could alleviate patients from the common unpleasant side effects of anesthesia and surgery by improving patient outcomes during the perioperative (before, during and after surgery) period including anesthesia awareness, pain, nausea and vomiting, and bowel dysfunction through the use of drug and non-drug method, such as acupuncture. Our hope is that through listening to this interview, people will become educated about the issue and in turn they will be relieved of any anxiety they may face about being under anesthesia.

Dr. Gan is a professor and devoted researcher here at Duke, whose interests include Anesthetic-related Clinical Pharmacology, Inter-operative Awareness and Post-Operative Pain, Nausea and Vomiting, and using Acupuncture. He came to Duke as a visiting associate and fellow in 1993 is now serving as both professor and Vice Chairman of Clinical Research. Dr. Gan is also known for his research on the Bi-spectral Index (BIS) Monitor.

Patient Awareness Under General Anesthesia Lifeline to Modern Medicine

What is patient awareness under general anesthesia? Awareness under general anesthesia is a rare condition that occurs when surgical patients can recall their surroundings or an event—sometimes even pain—related to their surgery while they were under general anesthesia.

When using other kinds of anesthesia, such as local, sedation or regional anesthesia, it is expected that patients will have some recollection of the procedure.

Studies are not conclusive on the frequency of awareness under general anesthesia, but even one case is important to anesthesia professionals (anesthesiologists and certified registered nurse anesthetists), who recognize that this can be a distressing or traumatic experience for the patient.

When awareness during general anesthesia does occur, it is usually just prior to the anesthetic completely taking effect or as the patient is emerging from anesthesia. In very few instances, it may occur during the surgery itself. Despite the rarity of awareness, members of the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) want you to know about this possibility. These organizations have been studying this issue and are in the process of evaluating the effectiveness of various technologies and techniques to decrease the likelihood of this occurring.

Why does it happen? In some high-risk surgeries such as trauma, cardiac surgery and emergency cesarean delivery, or in situations involving patients whose condition is unstable, using a deep anesthetic may not be in the best interest of the patient. In these and other critical or emergency situations, awareness may not be completely avoidable. While the safety of anesthesia has increased markedly over the last 20 years, people may react differently to the same level or type of anesthesia. Sometimes different medications can mask important signs that anesthesia professionals monitor to help determine the depth of anesthesia. In other rare instances, technical failure or human error may contribute to unexpected episodes of awareness. The ultimate goal is always to protect the life of the patient and to make the patient as comfortable as possible. That is why it is important to have highly trained anesthesia professionals involved in your surgery.

How can it be avoided? Before surgery, patients should meet with their anesthesia professional to discuss anesthesia options. Should there be concerns regarding awareness, this is an ideal time to express them and to ask questions. Patients should share with their anesthesia professional any problems they may have experienced with previous anesthetics, and also discuss any prescription medications or over-the-counter medications they are taking.

As always, your anesthesia professional will guide you safely through your surgery by relying on his or her clinical experience, training and judgment combined with proven technology.

What You Should Know About Patient Awareness Under General Anesthesia It is quite rare. When it does occur, it is often fleeting and not traumatic to the patient. Patients experiencing awareness usually do not feel any pain. Some patients may experience a feeling of pressure. Awareness can range from brief, hazy recollections to some specific awareness of your surroundings during surgery. Patients who dream during surgery, or who have some perception of their surroundings before or after surgery, may think they have experienced awareness. Such a sensation or memory does not necessarily represent actual awareness during surgery. Experts in the field of anesthesiology are actively studying this condition and are seeking the most effective ways to prevent it. Awareness can occur in high-risk surgeries such as trauma and cardiac surgery in which the patient’s condition may not allow for a deep anesthetic to be given. In those instances, the anesthesia professional will weigh the potential for awareness against the need to guard the patient’s life or safety. The same is true during a cesarean section, particularly if it is an emergency and a deep anesthetic is not best for the mother or child.

It has been shown that early counseling after an episode of awareness can help to lessen feelings of confusion, stress or trauma associated with the experience. Researchers in anesthesiology have spearheaded developments in technology that have dramatically improved patient safety and comfort during surgery over the last 20 years. A highly trained anesthesia professional should be involved in your surgery. No technology can replace this expertise. New brain-wave monitoring devices currently being tested may prove to be helpful in reducing the risk of awareness, but they need to undergo the same rigorous scientific review process that has led to wide adoption of other medical technologies. Patients should talk with their anesthesia professional before surgery to discuss all of their concerns, including the remote possibility of awareness. These professionals work to ensure the best possible care of patients in the operating room.

Patient awareness happens very infrequently. This remote possibility should not deter you from having needed surgery. Your anesthesia professional can help you to feel comfortable and informed about your upcoming experience with anesthesia.

What does the future hold? As patient advocates, anesthesia professionals are working hard to reduce the likelihood of awareness under general anesthesia. Depending upon the type of surgery, these experts have an array of proven technologies that can be used to monitor various vital signs of the surgical patient. Extensive research is under way to develop and study new technologies, such as brain-wave monitoring, that may lessen the risk of awareness. At the present time, none of these new technologies has been perfected.

Remember—no monitoring device can replace the judgment and skill of an anesthesia professional who has years of training and clinical experience. Working together, you and your anesthesia professional can make your anesthetic experience as safe and comfortable as possible.

What should I do if I think I have experienced awareness? The American Society of Anesthesiologists urges you to talk with your anesthesia professional, who can explain to you the events that took place in the operating room at any stage of your surgery and why you might have been aware at certain times. It is important to note that a variety of anesthetic agents is often used, some of which may create false memories or no memory at all of the various events surrounding surgery. If you have distinct recollections of your surgery and want to discuss them, your anesthesia professional can help you or refer you to a counselor or to other appropriate resources.

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