what it's like to write a New York Times Op Ed (UPDATE)

It’s amazing.

I can only say what my experience was, of course, and my experience was almost certainly not typical. I had a lot of help, through two first drafts, from my brilliant literary agent and my brilliant editor, which was fabulous, as it always is. My whole life, it seems, has been edited by these two women for the last two years, and my life is better for it. (I love being edited. Am I writing masochist? Does the training that makes me unoffendable as a sex educator, also make me unoffendable as a writer? Or do all writers secretly love to be edited?) I put about 10-15 hours of writing time, over four days, to get to the third draft, which is what got submitted and accepted.

And it didn’t get submitted by me but by my brilliant publicist at Simon & Schuster. (No joke, writing and publishing this book has been the most feminist experience of my life, and I say that as a person who works at “the cradle of American feminism,” as “West Wing” put it.)

 

Then and only then did I start working with the editor and the fact checker at the NYT.

And holy crap, it was so much fun.

First of all, the editor sent a revision back that was tidier and more efficient than what I submitted, which was a great start. She asked perceptive, specific questions; I gave long, fairly technical answers; she came up with elegant solutions.

Here is one example of my long, technical answer to a question about gender differences in responsive desire – is it just anecdotal, or is there evidence, and if there’s evidence, can we include something to back it up?

I’m not sure how to back it up [briefly]{style=“text-decoration: underline;“}, since it’s not just that the difference is well established in the research; it’s that the “responsive” desire model was developed in recognition of how many women lacked “spontaneous” desire and yet were otherwise functional and healthy (Basson et al, 2003 (pdf) and Basson, 2001), and grew stronger as the psychophysiological evidence that “desire emerges from excitement” substantiated this clinical observation (Both, Everaerd, and Laan, 2007 (Google books link).)

There are no formal, peer-reviewed estimates of what proportion of the two populations primarily experiences desire as spontaneous or responsive – it’s not even clear that such estimates can be validly made. In my book I made ROUGH estimates but those numbers are not peer reviewed, which I’m careful to say in the book, and I hesitate to include them in a context where they might be construed otherwise. Researchers don’t even know yet how to ASK THE QUESTION in a reliable way, much less understand the answer.

To make matters more complicated, ultimately we ALL have responsive desire, but women are more likely to experience it as arousal-before-desire for a wide variety of reasons, including potential sex differences in sensitivity to genital sensations, culturally constrained attention to genital sensations, potential sex differences in sensitivity to external stimuli, etc (see Laan and Jannsen, 2007 (pdf))

She sent more questions – perceptive, specific, about the tangled knots of gender and arousal and desire – the social and capitalist nature of Viagra, as a contrast to a drug for women’s desire. Are they developing a drug for men’s desire?

I said,

Not that I’m aware of – 

but the diagnostic criteria in the DSM-5 for “male hypoactive sexual desire disorder” were taken from the IV-TR diagnosis for women, so they assume that “spontaneous” desire is what’s “normal” for men. (This is despite the fact that it seems most likely that men and women are not actually different in the process underlying the emergence of desire.) So technically and hypothetically, if Flibanserin gets approved, trials might begin to test if it treats male HSDD.

*For the nerds and the curious among your colleagues: Dawson and Chivers, 2014 and Brotto, 2010 (pdf)  

And only after this comes the FACT CHECKER.

Did you know that Op Eds go through a rigorous fact checking?

I had already provided them with most of the research articles I cited in my original draft, but I sent along a few more.

“Can you point me to evidence that nonpharma therapies are effective?” he asked.

“Here are five studies, including a meta-analysis,” I answered.

“Where precisely is the quote ‘severe mental illness’?” he asked.

And then we each sat in front of our computers for a few minutes, on the phone, while we both hunted in the old, unsearchable PDF, for the phrase. (It was in the very first sentence, in the abstract.)

It was amazing. Let me just say: you can believe the facts stated in NYT Op Eds.

 

I did not give input on the headline. Sex is not a drive.

 

And then the thing goes online, and… your email GOES BANANAS.

 

Let me say, too, that I was exquisitely aware of how controversial some people would find the content of what I wrote.

I knew, in particular, that I would receive the worst kind of email of all, for me – emails from women who are struggling, who feel that I’m dismissing their struggles, saying it’s all in their heads or all their fault. No matter how clear I try to be, there’s always someone who misunderstands and feels offended and injured. I got a couple like this one:

I was horrified to read your piece which treats a biological problem as behavioral. […]  Just because female sexuality is THEORIZED by a few researchers to work differently than what was once thought doesn’t invalidate the roles that Dopamine and Testosterone and other neurochemicals play. “Female desire is completely behavioral and you’re normal” is still solidly within the realm of cocktail party nonsense chatter.

 

Ironically, the writer and I agree that “female desire is completely behavioral” is cocktail party nonsense chatter. It’s just puzzling to me how she could have thought that’s what I was saying.

But I wrote the thing anyway, because you, blog readers, have told me that responsive desire is the single most important idea I write about on the blog. I know that it changes people’s lives when they come to understand that you don’t have to want sex out of the blue in order to be normal. It’s *liking* the sex you have, not craving it, that matters.

And I got a couple of those emails, too. One of them started with:

I just shared your NYT op-ed with my wife, and it will very likely be > life-changing.

 

The Twitter response was mostly GREAT, most people really GOT IT, which was amazing to see. AMAZING.

A couple people, mostly doctors, mostly working with Sprout on the drug, said that the women in the trials had no responsive desire either, but they didn’t provide any links or references. That frustrated me since, ya know, I have actually read the research results – though writing a sex science blog would be so much easier if I could just make things up – and the studies assess sexual functioning with instruments (nearly always the Female Sexual Functioning Index (PDF) and the Female Sexual Distress Scale – Revised (PDF)) that do not assess responsive desire. They assess only spontaneous desire. So unless these folks are referring to studies that were never published, I don’t know what they’re talking about.

[UPDATE: Apparently? – and I say apparently? because this isn’t reported anywhere in the research – women who participated were mostly 0s on the Sexual Desire and Interest Inventory’s “Receptivity” items, which isn’t exactly an assessment responsive desire, but it’s something, and I’d be interested to see the actual numbers. This doesn’t change the fact that they’re not assessing the outcome, and it’s unbelievable to me that they didn’t REPORT it as part of the inclusion criteria, but there  it is.]

I was excited, briefly, when physician Leah Milheiser, who works with Sprout [UPDATE: She would like me to be explicit here that, despite working with Sprout, she has never received and money from them] that she invited me to her clinic!

@emilynagoski invite you spend a > day w/me in clinic. Pretty sure your opinion will change. Women with > HSDD rarely improve w/therapy alone. > > — Leah Millheiser (@DrLeahM) February 27, > 2015

I accepted enthusiastically! I asked her to email me to schedule! I asked for 30 minutes of education time with her patients!

I have not heard back from her, but I will update here if I do.

 

And that’s pretty much my Op Ed experience at this point: Collaboration wiih amazing, smart people. Lots of email. Mostly people GETTING IT! A few not. A few really not, and feeling hurt, and that sucks. A few feeling like the light came on, and that’s amazing.

As I said in my last post, what matters to me – what ought to matter to all of us – is how we can help women who are struggling. And in my experience, an astonishingly efficient way to do that is to teach them about the science that says that desire doesn’t have to feel “spontaneous” in order to be healthy and normal.