Sex Education within Biology Classes for Hospitalized Disturbed Adolescents SUSAN H. KALMA Abstract: Sexuality is a major concern of adolescents and may be particularly anxiety provoking in the emotionally disturbed. Techniques of presenting material on human reproduction and methods for reducing anxiety were studied in biology classes at Cedarhurst High School. Comparison of student responses before and after the unit revealed mastery of the material. Student reactions, documented in daily process notes, included anxiety, anger, personalization, empathy, openness, and rejection. The emphasis on factual material and an open discussion of any Question provides a milieu in which anxiety is minimized so that learning can occur and feelings can be expressed.
dolescents in general, and perhaps disA turbed ones in particular, have a keen, yet often guarded, interest in their own sexuality. In Cedarhurst High School. at the Yale Psychiatric Institute, a long term treatment hospital for emotionally disturbed adolescents, the author has presented the topic of human sexuality in biology classes. The material on reproduction formed a part of a review unit on human anatomy and physiology, about a third of the one year course. Circulation. digestion, respiration, excretion and the nervous and endocrine systems were studied, followed by reproduction and genetics. The material on reproduction was presented over a three week period in 14 one hour classes. Although sexual activity was documented for several of the students, it was not assumed that this was supported by a real understanding of the processes involved. Basic information was presented to everyone. Students were encouraged to read further on topics that interested them. The attempt was made not to squelch interest by an emphasis on "sex education" or by an insensitivity to questions which students might hesitate to ask. The inclusion of this unit as part of a larger unit on human biology was logical in terms of presenting subject matter and conveying a perspective of reproduction as a normal body process.
The Importance of Attitude
SUSAN H. KALMA is a graduate student, the Yale University School of Nursing, New Haven.
Exceptional Children
A teacher's rapport with students cannot be measured, yet its effect on the coverage of subject matter is significant. particularly with emotionally disturbed adolescents. in whom trust of adults in authority is a recurrent issue. The general informality of classes at Cedarhurst facilitated rapport. The students (5 in one section, 3 in the other) sat
451
around a table with the teacher. They could have coffee and cigarettes in class, and they could take a break from work if they needed to. Within the relatively objective framework of the assigned subject matter and the classroom, questions could be asked and discussed freely. This unit was covered after each class had been working together for about six months. The various aspects of human reproduction stir up deep feelings in teacher and student alike. Several students admitted confusing feelings about sexuality. They wished to avoid the topic altogether. Many aspects of human sexuality provoke questions to which there is no "right" answer. Because both the subject matter and its open endedness can be sources of anxiety to disturbed adolescents, as much structure as possible was provided. Students were free to respond on a variety of levels to the material. When a question was asked an attempt was made to redirect it to the students, if they had sufficient information to answer it. Value judgments were avoided if possible. When students pressed to hear a personal opinion, it would be given and labeled as such. The teacher's attitude toward teaching this material is significant and should be mentioned here. The author's attitude was that information on all areas of human sexuality should be freely available to adolescents; they should have free access to qualified and sympathetic adults with whom they can discuss their questions and explore emotional reactions and values. The topic of reproduction was approached as a rewarding and desirable subject to teach.
Evidence of Erroneous Ideas That the students brought to this unit a number of erroneous ideas was evident. On the first day of each of the units on human biology, a pretest was given. The purpose was to provide some idea of what the students already knew and to form a starting point for discussion. These exercises were not graded, and students were told that they were not expected to know all of the answers. As soon as the class finished the quiz, it was discussed together and any errors were corrected. Spontaneous questions in class, recorded in daily process notes, revealed other erroneous notions. Examples of errors encountered may be classed into four groups-lack of information, misinformation, misinterpretation or distortion, and fantasies.
452
In this article, the students are identified by sex and age: e.g., M-20a is one of two male students who were 20 years old at the time of this study. The following incident shows a student's lack of information: When tampax was mentioned, M-20a asked what it was and stated he had never heard of it. Although familiar with the menstrual cycle, he was ignorant of feminine hygiene. Misinformation was evident particularly on the pretest. The following italicized words are student answers to the questions: (a) F-21-The reproductive opening of the female is the clitoris; (b) F-17-The fetus develops in the ovary; (c) F-16-Sperm are produced in the penis. Misinterpretation, distortion, and fantasy are discussed with interventions later in the article.
Student Reactions Student reactions included anxiety, anger, personalization, empathy, openness, and rejection. Although each of the following examples may illustrate more than one feature, they have been put under the heading which best summarizes the incident. Some of the specific reactions correlate with individual histories. Spontaneous comments help reveal what was preoccupying a given student. Anxiety
Each student expressed anxiety in some way. Interventions were guided by experiences with each individual and by the circumstances existing in the classroom at the time. Each student asked several questions, ranging from purely factual ones to ones reflecting personal concerns and values. A direct factual question may be used as a vehicle for delving deeper into matters of concern. For example, F-21: T: F-21: T:
What is a hysterectomy? That is the removal of the uterus. What does it do? My mother had that. Without a uterus, a woman would no longer have her period. She would be unable to have children, though in every other respect she would be a normal female. F-21: Of course she couldn't have any more kids. My father's dead. T: I remember that. But isn't it possible that your mother could re-marry? F-21: She wouldn't do that. She wouldn't do that. T: Isn't it possible that she might want to, even though you don't want her to? F-21: No, she wouldn't.
May 1976
Each question was answered as directly as possible. It was assumed that the student had a reason for asking the question and that this reason was more likely to unfold if not specifically probed for. When the student did not volunteer his concern, a possible reason for the concern was sometimes suggested. This was a way to facilitate discussion. Student F-16 asked the teacher's views on premarital intercourse. After the teacher's practices and the basis for her opinion had been explained, the student was asked for her views. She described at length her agreement to remain emotionally loyal to her boyfriend while they both continued to be physically promiscuous. A comment was made that this separation of actions and feelings must have been difficult. A plea for guidance was sensed in her original question. At the same time it was evident that she could not admit this.
relied on. Their voices, pleading with him to stop, and their words of resignation and desperation, eloquently conveyed their empathy. The anger of the entire class was mobilized against a nurse whom F-17 had quoted as saying masturbation was unnatural and unhealthy. When the nurse was talked to, it was found that M-20b had already launched an angry outburst at her and that F-17 had given her a pamphlet to read. The nurse stated that she had merely asked the patient why she masturbated and had emphasized that this activity was more common in younger children than in teenagers. Although the nurse had been in error regarding the frequency of masturbation at different ages, she had stressed that it was not harmful. Her questioning of the need for the practice was interpreted by the patient as censure, a distortion of the remark. Personalization
Anger
Anger was sometimes expressed openly. Examples show specific anger focused on authority figures as well as a more generalized bitterness: F-21: I'd never have an abortion. I don't believe in abortion. T: Why not? F-21: It's killing a life. T: Maybe that depends on when you think life begins. M-20b: Around 17-18 years. All of a sudden your parents realize you're there. (imitating parents] "Oh, it's you. You're the mailman. No? Then you must be the garbage collector. No? Wait a minute. Can it be? Are you - ? Are you our son? We were looking for you last week. You weren't in the garage." They keep you in the garage, in the trunk of the car. That's where I was kept. F-19: Stop it, that's terrible. F-17: I don't want to have any kids. F-21: I want five. F-19: I want to have six, but I know I won't. F-17: How could anyone want to have kids? I never want to have any. C .... , every day I say to myself "Why was I born? I wish I hadn't been born." Can you imagine bringing a kid into this f . .. world? Then he's going to sit around and say "Why did my mother ever let me be born?"
Student M-20b often mixed fantasy with anger or anxiety to make a "joke." Thus disguised, a portion of his terrifying rage found expression. Because he characteristically denied anger, no attempt was made to interpret it, but rather reactions of his peers were Exceptional Children
Students frequently personalized the material. When the class visited an exhibit of preserved human embryos, M-20b, seeing a full term fetus in a glass container, immediately exclaimed, "Hey, that's my younger brother. Hey Ralph!" After the class performed pregnancy tests on urine from anonymous donors, F-18 exclaimed, "Mine was positive," then hopped up and down, saying to F-16 "Congratulate me!" Both these examples of personalization involved joking about subjects which were potentially anxiety provoking. Empathy
Despite the tendency of these disturbed patients to personalize and to be preoccupied with their own problems, they were frequently able to show genuine concern for others. The class was incredulous but also worried when F-17 revealed that in the past year she had relied solely on hot baths as a contraceptive measure. Class members suggested effective alternatives, and she was referred to a clinic where she could obtain more counseling and medical services at a cost adjusted to her income. Other Reactions
Several of the students were frank in revealing not only instances of their own sexual behavior but also feelings about it. M-20a expressed quite explicitly his feelings of confusion and resignation about heterosexual activity. Sometimes students rejected the 453
presented material outright. There was a noticeable reluctance on the part of some of them to discuss venereal disease and abortion. While the free materials on birth control were eagerly taken. those on VD and the assigned reading on abortion were left behind on the table after class. Only one student, F19. kept the VD pamphlets. Emotional Effects of Material:
One Example Student F-20 had been in a physiology class the preceding year. At that time she was frequently restrained in a wheelchair due to her suicidal gestures and later her violence. She participated little in class. generally sitting passively and only occasionally writing poetry. She was mute for weeks at a time, although she showed greater interest when the class studied reproduction. She still did little of the class work. but eagerly picked up two copies of every pamphlet offered. When the various methods of birth control had been demonstrated, she came up after class to say, "That was the most interesting class we've had all year," after weeks of muteness. Although her general condition had improved markedly by the time reproduction was covered in the biology class (she was no longer mute and was not in restraints), there was still a noticeable increase in her interest in this unit. One sign of this was that she began bringing her glasses to class. During this period she frosted her hair and began wearing a sari. (Shortly before this, the Chief Resident. who was from India and wore saris, had surprised the community with a baby born prematurely.) The student had a history of thinking herself pregnant and asked questions which revealed this fantasy. Techniques of Dealing with Student Anxiety The identification of anxiety in its many guises is essential in guiding interventions. Examples presented here include direct reassuring of the students that their questions are legitimate and important, that this has traditionally been an area hard to discuss, that our goal is an understanding of the actual physical processes and a concomitant reduction in anxiety. The aim was to provide a milieu in which questions could be asked freely. The major vehicle for this was factual information about all aspects of normal reproduction. The neutral presentation of factual material
454
creates an environment in which students can feel free to reveal directly as much or as little as they choose. Thus, there was a general avoidance of directing a question to a particular student. While the pretest was an exception to this, the fact that it was already an established routine for a new unit of work. that it was not graded, and that the students corrected their own papers tended to allay a measure of anxiety. Other techniques. whiie valuable teaching tools in themselves. were used to diffuse the focus and to give each student a choice as to how involved to become. After the pretest the unit was introduced with a film on human reproduction. This gave students a chance to absorb passively whatever was comfortable for them. While the film was being rewound, comments and questions were elicited. The rewinding process served as a distraction for students who were too anxious to focus in on the discussion. The availability of handout materials during class provided another option for screening anxiety. In one class pamphlets on homosexuality and masturbation were made available. The three students chose to read quietly for the whole period. Near the end of the hour the teacher remarked that these seemed to be hard topics to talk about. No one replied. It was then suggested that sometimes parents also had difficulty talking about these topics. This struck a responsive chord in one student (F-18), and a discussion began about the myths parents tell children and how they influence the development of attitudes. She stated. "Because parents don't talk about sex, that makes it seem wrong. They're secretive, and that makes it seem taboo." All agreed. The students spontaneously resumed reading in the pamphlets. The assiduous reading signaled extreme anxiety which could be better alleviated through the structure of the pamphlets than by a "let's talk about it" approach. Three programed lessons on the menstrual cycle provided students with an opportunity to learn with minimal risk of failure or of acknowledged interest. Because all questions were based on information presented previously and answers were given in the lefthand column, students rarely made mistakes and could correct themselves if they did. M20a, who had just been admitted to the hospital, worked slowly on the program in class, then finished it on his own. In a later checking, written questions were found in the margins: "How does the corpus luteum and uterine wall
May 1976
know if the egg has been fertilized?" "Do many egg cells exist before they are surrounded by the follicle?" Next to a diagram of pituitary, ovarian, and uterine interrelationships he had written, "Why does this hospital have to know my IQ before it can help me?" Even the tightly structured format of programed material permitted his doubts to surface. When fantasies were presented, an attempt was made to identify the underlying factual questions and shift the focus to clarify them. Differences in language did not pose a barrier to communication. Street language terms were translated when formulating an answer to a question. If this involved using a term which the students might not have known, the translation was explained and the reasons for it. Because students will encounter the accepted terms in future reading and discussion, it is a necessary part of a biology course to learn appropriate and specific terminology. Although the use of inappropriate street terms was penalized only on written work, some reduction in their use in con versation as the unit progressed was noticed.
Evidence of Learning At the end of the three week unit a quiz was given. Two students experienced difficulty in taking the quiz: M-20b procrastinated until he could work alone with the teacher and have the answers checked as he went along; and F20, who appeared somewhat more disorganized than usual on that day, was distracted by the voices of students in other rooms. M20a worked slowly on the quiz and did not finish it in class. He completed it by himself and passed it in later. The other students appeared to work comfortably and were able to complete the exercise in class. The quiz covered all of the material asked in the prequiz, in a different format. It consisted of four parts: 1. Diagrams of the male and female reproduc-
tive systems to be labeled; 2. Short answer questions on anatomy, phys-
iology, and development; 3. Short answer questions in which the stu-
dent was asked to name the most effective birth control method in a variety of situations (e.g. purchasable at a drug store, suitable for a couple who wish no more children);
Exceptional Children
Whot would you advise in each of the following cases? Be sure your answers are specific. 1. A woman wants to know how to use a
diaphragm. 2. A boy notes a small sore in the genital
area. 3. A woman predicted that her period should have come 3 weeks ago. It has not
yet begun. 4. A girl knows that her sexual partner had
untreated syphilis. 5. A teenager wonders whether it's OK to
masturbate. 6. A woman wishes to terminate her pregnancy as safely as possible. FIGURE 1. Question 4 of final quiz.
4. Questions involving judgment and appli-
cations of knowledge (see Figure 1). The quizzes were checked in class so that the students could see their results. Answers varied in sophistication, but all students showed mastery of the factual material and familiarity with sources of reliable information.
Concluding Comments Evidence has been presented to show that the students involved in a study of reproduction came to it with a variety of erroneous notions. They reacted to this material in different ways, but most noteworthy was their openness in relating their own experiences and in learning new material. Teaching this unit demonstrated that many aspects of sexuality are of legitimate concern. Although the unit may have produced anxiety in some students, its organizing effect on at least one was evident. When classes are structured around factual subject material, open discussion of frightening feelings can occur. In this setting, students can begin to see some sources of their own anxiety. They thus have an opportunity for developing insights which may aid them in the resolution of certain conflicts. It seems evident that education in sexuality was needed and welcomed by these disturbed adolescents. The purpose in recording these observations has been to stimulate further teaching about sexuality in a sensitive and open manner in other schools and hospitals.
..ss
dolescents in general, and perhaps disA turbed ones in particular, have a keen, yet often guarded, interest in their own sexuality. In Cedarhurst High School. at the Yale Psychiatric Institute, a long term treatment hospital for emotionally disturbed adolescents, the author has presented the topic of human sexuality in biology classes. The material on reproduction formed a part of a review unit on human anatomy and physiology, about a third of the one year course. Circulation. digestion, respiration, excretion and the nervous and endocrine systems were studied, followed by reproduction and genetics. The material on reproduction was presented over a three week period in 14 one hour classes. Although sexual activity was documented for several of the students, it was not assumed that this was supported by a real understanding of the processes involved. Basic information was presented to everyone. Students were encouraged to read further on topics that interested them. The attempt was made not to squelch interest by an emphasis on "sex education" or by an insensitivity to questions which students might hesitate to ask. The inclusion of this unit as part of a larger unit on human biology was logical in terms of presenting subject matter and conveying a perspective of reproduction as a normal body process.
The Importance of Attitude
SUSAN H. KALMA is a graduate student, the Yale University School of Nursing, New Haven.
Exceptional Children
A teacher's rapport with students cannot be measured, yet its effect on the coverage of subject matter is significant. particularly with emotionally disturbed adolescents. in whom trust of adults in authority is a recurrent issue. The general informality of classes at Cedarhurst facilitated rapport. The students (5 in one section, 3 in the other) sat
451
around a table with the teacher. They could have coffee and cigarettes in class, and they could take a break from work if they needed to. Within the relatively objective framework of the assigned subject matter and the classroom, questions could be asked and discussed freely. This unit was covered after each class had been working together for about six months. The various aspects of human reproduction stir up deep feelings in teacher and student alike. Several students admitted confusing feelings about sexuality. They wished to avoid the topic altogether. Many aspects of human sexuality provoke questions to which there is no "right" answer. Because both the subject matter and its open endedness can be sources of anxiety to disturbed adolescents, as much structure as possible was provided. Students were free to respond on a variety of levels to the material. When a question was asked an attempt was made to redirect it to the students, if they had sufficient information to answer it. Value judgments were avoided if possible. When students pressed to hear a personal opinion, it would be given and labeled as such. The teacher's attitude toward teaching this material is significant and should be mentioned here. The author's attitude was that information on all areas of human sexuality should be freely available to adolescents; they should have free access to qualified and sympathetic adults with whom they can discuss their questions and explore emotional reactions and values. The topic of reproduction was approached as a rewarding and desirable subject to teach.
Evidence of Erroneous Ideas That the students brought to this unit a number of erroneous ideas was evident. On the first day of each of the units on human biology, a pretest was given. The purpose was to provide some idea of what the students already knew and to form a starting point for discussion. These exercises were not graded, and students were told that they were not expected to know all of the answers. As soon as the class finished the quiz, it was discussed together and any errors were corrected. Spontaneous questions in class, recorded in daily process notes, revealed other erroneous notions. Examples of errors encountered may be classed into four groups-lack of information, misinformation, misinterpretation or distortion, and fantasies.
452
In this article, the students are identified by sex and age: e.g., M-20a is one of two male students who were 20 years old at the time of this study. The following incident shows a student's lack of information: When tampax was mentioned, M-20a asked what it was and stated he had never heard of it. Although familiar with the menstrual cycle, he was ignorant of feminine hygiene. Misinformation was evident particularly on the pretest. The following italicized words are student answers to the questions: (a) F-21-The reproductive opening of the female is the clitoris; (b) F-17-The fetus develops in the ovary; (c) F-16-Sperm are produced in the penis. Misinterpretation, distortion, and fantasy are discussed with interventions later in the article.
Student Reactions Student reactions included anxiety, anger, personalization, empathy, openness, and rejection. Although each of the following examples may illustrate more than one feature, they have been put under the heading which best summarizes the incident. Some of the specific reactions correlate with individual histories. Spontaneous comments help reveal what was preoccupying a given student. Anxiety
Each student expressed anxiety in some way. Interventions were guided by experiences with each individual and by the circumstances existing in the classroom at the time. Each student asked several questions, ranging from purely factual ones to ones reflecting personal concerns and values. A direct factual question may be used as a vehicle for delving deeper into matters of concern. For example, F-21: T: F-21: T:
What is a hysterectomy? That is the removal of the uterus. What does it do? My mother had that. Without a uterus, a woman would no longer have her period. She would be unable to have children, though in every other respect she would be a normal female. F-21: Of course she couldn't have any more kids. My father's dead. T: I remember that. But isn't it possible that your mother could re-marry? F-21: She wouldn't do that. She wouldn't do that. T: Isn't it possible that she might want to, even though you don't want her to? F-21: No, she wouldn't.
May 1976
Each question was answered as directly as possible. It was assumed that the student had a reason for asking the question and that this reason was more likely to unfold if not specifically probed for. When the student did not volunteer his concern, a possible reason for the concern was sometimes suggested. This was a way to facilitate discussion. Student F-16 asked the teacher's views on premarital intercourse. After the teacher's practices and the basis for her opinion had been explained, the student was asked for her views. She described at length her agreement to remain emotionally loyal to her boyfriend while they both continued to be physically promiscuous. A comment was made that this separation of actions and feelings must have been difficult. A plea for guidance was sensed in her original question. At the same time it was evident that she could not admit this.
relied on. Their voices, pleading with him to stop, and their words of resignation and desperation, eloquently conveyed their empathy. The anger of the entire class was mobilized against a nurse whom F-17 had quoted as saying masturbation was unnatural and unhealthy. When the nurse was talked to, it was found that M-20b had already launched an angry outburst at her and that F-17 had given her a pamphlet to read. The nurse stated that she had merely asked the patient why she masturbated and had emphasized that this activity was more common in younger children than in teenagers. Although the nurse had been in error regarding the frequency of masturbation at different ages, she had stressed that it was not harmful. Her questioning of the need for the practice was interpreted by the patient as censure, a distortion of the remark. Personalization
Anger
Anger was sometimes expressed openly. Examples show specific anger focused on authority figures as well as a more generalized bitterness: F-21: I'd never have an abortion. I don't believe in abortion. T: Why not? F-21: It's killing a life. T: Maybe that depends on when you think life begins. M-20b: Around 17-18 years. All of a sudden your parents realize you're there. (imitating parents] "Oh, it's you. You're the mailman. No? Then you must be the garbage collector. No? Wait a minute. Can it be? Are you - ? Are you our son? We were looking for you last week. You weren't in the garage." They keep you in the garage, in the trunk of the car. That's where I was kept. F-19: Stop it, that's terrible. F-17: I don't want to have any kids. F-21: I want five. F-19: I want to have six, but I know I won't. F-17: How could anyone want to have kids? I never want to have any. C .... , every day I say to myself "Why was I born? I wish I hadn't been born." Can you imagine bringing a kid into this f . .. world? Then he's going to sit around and say "Why did my mother ever let me be born?"
Student M-20b often mixed fantasy with anger or anxiety to make a "joke." Thus disguised, a portion of his terrifying rage found expression. Because he characteristically denied anger, no attempt was made to interpret it, but rather reactions of his peers were Exceptional Children
Students frequently personalized the material. When the class visited an exhibit of preserved human embryos, M-20b, seeing a full term fetus in a glass container, immediately exclaimed, "Hey, that's my younger brother. Hey Ralph!" After the class performed pregnancy tests on urine from anonymous donors, F-18 exclaimed, "Mine was positive," then hopped up and down, saying to F-16 "Congratulate me!" Both these examples of personalization involved joking about subjects which were potentially anxiety provoking. Empathy
Despite the tendency of these disturbed patients to personalize and to be preoccupied with their own problems, they were frequently able to show genuine concern for others. The class was incredulous but also worried when F-17 revealed that in the past year she had relied solely on hot baths as a contraceptive measure. Class members suggested effective alternatives, and she was referred to a clinic where she could obtain more counseling and medical services at a cost adjusted to her income. Other Reactions
Several of the students were frank in revealing not only instances of their own sexual behavior but also feelings about it. M-20a expressed quite explicitly his feelings of confusion and resignation about heterosexual activity. Sometimes students rejected the 453
presented material outright. There was a noticeable reluctance on the part of some of them to discuss venereal disease and abortion. While the free materials on birth control were eagerly taken. those on VD and the assigned reading on abortion were left behind on the table after class. Only one student, F19. kept the VD pamphlets. Emotional Effects of Material:
One Example Student F-20 had been in a physiology class the preceding year. At that time she was frequently restrained in a wheelchair due to her suicidal gestures and later her violence. She participated little in class. generally sitting passively and only occasionally writing poetry. She was mute for weeks at a time, although she showed greater interest when the class studied reproduction. She still did little of the class work. but eagerly picked up two copies of every pamphlet offered. When the various methods of birth control had been demonstrated, she came up after class to say, "That was the most interesting class we've had all year," after weeks of muteness. Although her general condition had improved markedly by the time reproduction was covered in the biology class (she was no longer mute and was not in restraints), there was still a noticeable increase in her interest in this unit. One sign of this was that she began bringing her glasses to class. During this period she frosted her hair and began wearing a sari. (Shortly before this, the Chief Resident. who was from India and wore saris, had surprised the community with a baby born prematurely.) The student had a history of thinking herself pregnant and asked questions which revealed this fantasy. Techniques of Dealing with Student Anxiety The identification of anxiety in its many guises is essential in guiding interventions. Examples presented here include direct reassuring of the students that their questions are legitimate and important, that this has traditionally been an area hard to discuss, that our goal is an understanding of the actual physical processes and a concomitant reduction in anxiety. The aim was to provide a milieu in which questions could be asked freely. The major vehicle for this was factual information about all aspects of normal reproduction. The neutral presentation of factual material
454
creates an environment in which students can feel free to reveal directly as much or as little as they choose. Thus, there was a general avoidance of directing a question to a particular student. While the pretest was an exception to this, the fact that it was already an established routine for a new unit of work. that it was not graded, and that the students corrected their own papers tended to allay a measure of anxiety. Other techniques. whiie valuable teaching tools in themselves. were used to diffuse the focus and to give each student a choice as to how involved to become. After the pretest the unit was introduced with a film on human reproduction. This gave students a chance to absorb passively whatever was comfortable for them. While the film was being rewound, comments and questions were elicited. The rewinding process served as a distraction for students who were too anxious to focus in on the discussion. The availability of handout materials during class provided another option for screening anxiety. In one class pamphlets on homosexuality and masturbation were made available. The three students chose to read quietly for the whole period. Near the end of the hour the teacher remarked that these seemed to be hard topics to talk about. No one replied. It was then suggested that sometimes parents also had difficulty talking about these topics. This struck a responsive chord in one student (F-18), and a discussion began about the myths parents tell children and how they influence the development of attitudes. She stated. "Because parents don't talk about sex, that makes it seem wrong. They're secretive, and that makes it seem taboo." All agreed. The students spontaneously resumed reading in the pamphlets. The assiduous reading signaled extreme anxiety which could be better alleviated through the structure of the pamphlets than by a "let's talk about it" approach. Three programed lessons on the menstrual cycle provided students with an opportunity to learn with minimal risk of failure or of acknowledged interest. Because all questions were based on information presented previously and answers were given in the lefthand column, students rarely made mistakes and could correct themselves if they did. M20a, who had just been admitted to the hospital, worked slowly on the program in class, then finished it on his own. In a later checking, written questions were found in the margins: "How does the corpus luteum and uterine wall
May 1976
know if the egg has been fertilized?" "Do many egg cells exist before they are surrounded by the follicle?" Next to a diagram of pituitary, ovarian, and uterine interrelationships he had written, "Why does this hospital have to know my IQ before it can help me?" Even the tightly structured format of programed material permitted his doubts to surface. When fantasies were presented, an attempt was made to identify the underlying factual questions and shift the focus to clarify them. Differences in language did not pose a barrier to communication. Street language terms were translated when formulating an answer to a question. If this involved using a term which the students might not have known, the translation was explained and the reasons for it. Because students will encounter the accepted terms in future reading and discussion, it is a necessary part of a biology course to learn appropriate and specific terminology. Although the use of inappropriate street terms was penalized only on written work, some reduction in their use in con versation as the unit progressed was noticed.
Evidence of Learning At the end of the three week unit a quiz was given. Two students experienced difficulty in taking the quiz: M-20b procrastinated until he could work alone with the teacher and have the answers checked as he went along; and F20, who appeared somewhat more disorganized than usual on that day, was distracted by the voices of students in other rooms. M20a worked slowly on the quiz and did not finish it in class. He completed it by himself and passed it in later. The other students appeared to work comfortably and were able to complete the exercise in class. The quiz covered all of the material asked in the prequiz, in a different format. It consisted of four parts: 1. Diagrams of the male and female reproduc-
tive systems to be labeled; 2. Short answer questions on anatomy, phys-
iology, and development; 3. Short answer questions in which the stu-
dent was asked to name the most effective birth control method in a variety of situations (e.g. purchasable at a drug store, suitable for a couple who wish no more children);
Exceptional Children
Whot would you advise in each of the following cases? Be sure your answers are specific. 1. A woman wants to know how to use a
diaphragm. 2. A boy notes a small sore in the genital
area. 3. A woman predicted that her period should have come 3 weeks ago. It has not
yet begun. 4. A girl knows that her sexual partner had
untreated syphilis. 5. A teenager wonders whether it's OK to
masturbate. 6. A woman wishes to terminate her pregnancy as safely as possible. FIGURE 1. Question 4 of final quiz.
4. Questions involving judgment and appli-
cations of knowledge (see Figure 1). The quizzes were checked in class so that the students could see their results. Answers varied in sophistication, but all students showed mastery of the factual material and familiarity with sources of reliable information.
Concluding Comments Evidence has been presented to show that the students involved in a study of reproduction came to it with a variety of erroneous notions. They reacted to this material in different ways, but most noteworthy was their openness in relating their own experiences and in learning new material. Teaching this unit demonstrated that many aspects of sexuality are of legitimate concern. Although the unit may have produced anxiety in some students, its organizing effect on at least one was evident. When classes are structured around factual subject material, open discussion of frightening feelings can occur. In this setting, students can begin to see some sources of their own anxiety. They thus have an opportunity for developing insights which may aid them in the resolution of certain conflicts. It seems evident that education in sexuality was needed and welcomed by these disturbed adolescents. The purpose in recording these observations has been to stimulate further teaching about sexuality in a sensitive and open manner in other schools and hospitals.
..ss
