Yates. Chapter 3
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My internship and pediatric residency was in a poor section of Chicago, noted for its high rate of drug abuse, illegitimacy, and violence. Knifings and sexual assaults were nightly fare in our emergency room. The corpses we pronounced dead were seldom reported in the daily newspaper. We assumed that if other area hospitals received a like number, they were just too common to be newsworthy.

In back of our well-lighted, well-policed hospital area was a ring of condemned buildings, black shells with cracked walls. Hungry rats and stray dogs poked through the piles of rubble. Still farther away, there rose a series of stark angular high-rise apartment buildings. Each was spaced an equal distance from the other, and each looked exactly like its neighbor. They were dark gray, constructed of cement and steel, and designed for low-income families.

The children of the high-rise buildings received care through our pediatric emergency room. A mother might wait for six hours to have her feverish infant seen by a harried resident. A different child was examined every five to ten minutes until the resident was so exhausted that one face became indistinguishable from the next. Children were seldom returned for a recheck and we rarely saw an infant who was well enough to be given his long-overdue routine immunizations. Head lice and the crusted sores of impetigo were common. After several months of this assignment, physicians became callous and worked much as if they were checking parts in an assembly line. Instructions to parents were curt and little opportunity was given for discussion. We were unable to stem the rising tide of human misery.

Our department of pediatrics recognized the dehumanization of this experience. In an effort to reinvest us with charity, they assigned each resident the care of the children in one of the high-rise dwellings. We were to make house calls, vaccinate, recheck ears, and give well-baby follow-up examinations-providing the families permitted.

On the first day of my assignment, I approached my tall gray monolith with misgivings. It was a muggy summer, and wet sheets hung from open windows. No nurse backed me up and no one had requested my services. Placing a few instruments in the pocket of my white coat, I entered the building only to find that the elevator was out of order. Breathless after climbing six flights of stairs, I paused on the landing to find myself scrutinized by five small bright pairs of eyes, none of which were higher than my knee. Here were my patients, partly clothed, alone and untended on the filthy floor. There were no toys and no furniture. A soggy diaper, several empty cans, and old potato chip bags littered the floor.

The children were unresponsive to my overtures. When I asked the oldest boy, about age five, where he lived, he pointed to door number 602. I knocked, and knocked again. Finally, the door opened a crack and quickly closed. As I moved on, it opened again, and my small informant disappeared. The next knock was more productive. I explained my mission to a slight, disheveled girl who toted a tiny infant while a toddler peered from between her legs. She was only seventeen years old. Distrustful at first, she soon admitted me to the apartment and allowed me to attend her children. Eventually I was able to gain entrance to several apartments on each floor. I began to look forward to my house calls. The children giggled as I walked upstairs, and protected their buttocks with their hands. Once the mothers trusted me, they chattered away and solicited all kinds of medical advice.

The apartment building differed from any world I had ever known. The women were pervasively sad, sometimes angry, and often frustrated. Many anticipated no change other than another pregnancy and another birth. Free birth control was available but seldom employed. One young mother dreamed about returning with her three small children to her parents' farm in Connecticut, from which she had run away six years before. She had saved no money and had not written home. She had never informed her parents of the birth of her last infant, who was of mixed racial background.

Sexual matters were often discussed, although sexual pleasures appeared to be rather peripheral. The making and breaking of relationships, the anger at men who didn't seem to care, and hope for one who really would afforded the most conversation and relief from boredom. Little was expected from men and little was received. Coitus was generally brief, with scant foreplay, something to be "put up with." Heavy drinking often preceded the act. Lovemaking was as often associated with rage as with tenderness. One thirty-five-year-old mother slept with a knife under her pillow. When her boyfriend was too intoxicated to perform, she "kneed him in the balls." She preferred aggressive, assaultive men and couldn't tolerate a "fag type." In spite of partners' misuse or indifference, and their own anger or depression, a few women reported an excellent erotic response. Even then, sex had little impact on the bleakness of life.

Each morning, toddlers and preschool children were placed in the barren hallway to play. Toys were not provided because they were stolen or broken, or caused fights. Children soon formed their own social order, based on size and strength. The younger, weaker toddler would huddle silently against the apartment door, thumb in mouth.

These children were well acquainted with sex. They witnessed the advent of new boyfriends and listened at the apartment door. Tiny living quarters and thin walls added to their expertise. Some slept with their mothers even after an "uncle" or a "fiancé" came to stay. Erotic activities in the hallway were an intriguing substitute for toys. Because of apathy or by intent, older children often went without underclothes. Soggy diapers dragged about the knees of others. Children soon learned to stimulate themselves and others. One enterprising four-year-old was observed proficiently penetrating his five-year-old sister. Others wriggled atop one another, groaning and grunting in succinct imitation. Descriptive words were used, most often incorrectly. When I questioned one boy about a term he used while pummeling another, he was puzzled and then happily defined it as "mother's dirty butt."

Once children entered school, they were exposed to the mysteries and the perils of the alley. Boys soon began to join the junior echelon of infamous older boys' gangs. They remained away from home for hours, gaining acceptance through feats of prowess, such as fighting with a rival junior gang member, pilfering from the corner grocery, or grabbing a girl in the garage. Sex play was a pallid term for what existed in the alley. Coitus commenced as early as age four, although ejaculation was generally absent until after age ten. Most young girls returned home directly after school, observing their mothers' admonitions and their own better judgment. A few ran with the boys, buying protection and acceptance in the gang through sex. Far from being valued, they were assigned derogatory nicknames, were callously used as community receptacles for semen, and sometimes beaten or abandoned. The sex act itself was brief, at best a barter, at worst a rape.

There was no question that these children received early and continued erotic stimulation. Yet the boys used sex more for power and proof of masculinity than for pleasure. Status was achieved through daring exploits, strength, and a frequently functioning phallus. The hit-and-run act took less time than recounting the exploit to other males. Sex was often equated with dirt, and the girls so used were debased and disparaged. The cautious girls who remained at home were more respected and were sometimes awkwardly courted.

In the slum sex and anger are companions from earliest childhood. The toddler observes its mother used, abused, and abandoned by her consorts. Occasionally she abuses her mate. The child himself is the recipient of abrupt physical punishment and is abandoned daily in the hallway. Once there, he is subjected to a series of sexual and aggressive assaults, until with growth, he becomes the master of the corridor. The microcosm of the hallway later becomes the macrocosm of the alley.

Boys and girls soon evolve separate roles: the victor and the victim, the one who grabs and the one who withholds, the protector and the protectee, the policeman and the pilferer. Masculine prowess is highly esteemed and heavily reinforced. Little boys who participate in girls' play are ridiculed by both sexes (Rabban, 1950), and beaten by other boys. Dehumanization is the price. The sex act, in itself an aggressive denial of tenderness, becomes the medium of exchange between the two camps. The girl who gives in earns instant ersatz popularity, but lands at the bottom of the social heap. If she resists pressure and withholds, her value increases and she may marry relatively well within the class. (Kerckhoff, 1974) Better to be safe than sorry. Unfortunately, the pattern of withholding and the expectation of abuse is not easy to unlearn. Nor is it simple for the macho male, who for years has "got down on a pig" in the alley, to recapture compassion.

How has this social system affected the sexual response? Kinsey was the first to investigate this in the late 1940s. The lower the socioeconomic class, the more sexually active were the men. In the sixteen-to-twenty-year-old age group with an eighth-grade education or less, the average frequency of coitus was 1.6 times per week for boys, but only 0.3 times per week for girls. In contrast, college men had intercourse on the average of 0.2 times per week, and college women only 0.1 times per week. Thus the difference between classes was much more pronounced for men, reflecting the fact that most lower-class males are serviced by a few promiscuous females. The greater apparent potency and earlier start of the lower-class male was certainly related to the premium placed on aggressive virility and the greater availability of partners.

Lower-class girls were less fortunate. The double standard, dangers associated with capitulation, and lesser overall erotic experience limited their sexual satisfaction far more than the boys'. (Fiasche, 1973) Kinsey found that masturbation to the point of orgasm occurred in sixty-three percent of girls who had gone beyond college but only thirty-four percent of girls who had not gone through high school. Orgasm in marriage followed a similar pattern. The number of women who reached orgasm within any five-year age bracket was distinctly smaller among those with limited education. More of these women never reached orgasm. The lesser the educational level, the less sexually responsive was the woman. A later study by Rainwater of married, working-class couples indicated little expectation for the woman's enjoyment in coitus by either husband or wife. The focus was on male gratification through rapid ejaculation, with scant foreplay or afterplay.

Lower-class women were not as happy either. In 1973, George Gallup reported that only thirty-three percent of individuals with an annual income of three to five thousand dollars saw themselves as "very happy." Happiness escalated with income, as fifty-six percent of those with an income of $15,000 or over were "very happy."

Early erotic stimulation cannot alone protect the sexual response from distortions and constrictions. The sex drive is colored by the total environment in which it develops. Sex experienced first as an unprotected victim, abandoned in a cold corridor, inevitably becomes associated with fear and rage. To be receptive is to be vulnerable. The child must prove the brutal master or face humiliation. Sex becomes but one weapon in the battle for survival.

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