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To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table. Paid sex behavior, either giving or receiving money, is a delicate matter for psychiatric patients. Patients rarely talk about this taboo subject spontaneously, and habitually psychiatrists tend not to ask about it. We hypothesize that the personal and therapeutic attitude of health professionals towards paid sex is often ambivalent leading towards the avoidance of the topic.
There are multiple reasons for this. We hypothesize before the background of our education and practice in Switzerland and Portugal the following possible reasons: 1. Reduced importance of the topic in medical education and in psychiatry-training.
A certain degree of idealizing the patient as not being prone to morally questionable behavior. We think that particularly in young men, asking actively about and understanding prostitution consumption may benefit their psychiatric and psychotherapeutic treatment. A, 30 years old, small and shy, was born in a north-western Portuguese village near an internationally renowned Casino-beach-resort and lived there until the age of He is the only son of a working-class couple, both in employment.
None of his peers from the village went to college. A was a driven individual and achieved his goal of pursuing further education. When they divorced after his graduation, he felt sad and developed gradually a depressed mood. Additionally, he broke two toes kick-boxing, causing him to stop practicing his favorite sport.
During this period he also started to date a girl who had a poor education and no fixed job. She envied him for his higher income and she was unfaithful to him. For these reasons and with a noticeable low performance in his engineering job, he was encouraged by his friends and pressured by his superiors at work to see a psychiatrist, whom he selected from a health insurance list. During his first sessions in September he showed low mood, he was resentful for not being promoted at work, had lack of motivation, social isolation and criticized his bizarre feelings when he was irrationally afraid of being attacked in a familiar and secure night club.