A personality change and a foot fetish

Dear Dr Ash,

My elderly father recently ended up in hospital after fracturing his hip in a fall, and although we’re delighted he’s recovering well, and any pain is being managed, my brothers and I agree it’s like he’s had a personality change. Although he’s now sitting up and eating well, he’s often grumpy with us, or seems indifferent. Yet he’s obsessed with the doctors’ strike and the lives of other men on the ward – he continually imagines conspiracies around him or is paranoid that certain nurses don’t like or care about him. He’s polite with them, however, reserving his crossness for when we visit – he feels we’re neglecting him, even though he has more visitors than anyone else. He’s sometimes a bit delusional, confusing dreams with reality, and we’ve been told this could be the effect of the general anaesthetic. Is it possible there’s been a neurological change as a result of the accident and operation? I really miss my kind-hearted dad, who was so interested in each of us and our kids. I also reproach myself for feeling alienated and not wanting to visit him sometimes. I’m all too aware this is just the start of months and years in which he’ll need our love and support.

Sad and Guilty of York

My elderly father continually imagines conspiracies around him

Dear Sad and Guilty,

In a distant and rudimentary past, hospitals were principally places of refuge for the sick. In the absence of meaningful medical science, the function of a hospital was simply to offer a clean bed and a hot meal – to provide “hospitality” to those who were too poor to pay for a doctor to visit them at home. Those early hospitals were essentially domestic in scale and function. Today’s hospitals, by contrast, are gleaming temples to science and industry. While they can be occasionally beautiful and even inspirational, they are rarely familiar or comforting. Patients are wheeled down echoing, tiled corridors on beige plastic beds, placed in rooms with endless beeping alarms and flashing lights and, just for good measure, we also strip off everyone’s clothes and dress them in humiliating gowns with their bums hanging out. It’s no wonder that it’s nearly always a bewildering experience.

Your father may have suffered from a direct neurological injury related to his hip fracture or to the general anaesthesia. He may be suffering from the side effects of a medication he has been given, or from the a lack of a medication he was previously taking. He may be sleep-deprived, dehydrated or malnourished by an unfamiliar diet. There are many potential medical causes for confusion, paranoia and personality change in a situation like this, and I trust that his medical team will have considered these. At the same time, his symptoms could just be due to his unfortunate situation. He is in a strange facility where he has no power or agency, he is dependent on strangers for food, water and for getting to the toilet, and he can’t come and go as he pleases. He is depleted and acutely unwell. Given all of that, maybe he can be forgiven for mistrusting the nurses and being excessively demanding with you and your siblings, at least in the short term.

In the longer term, of course, you’ll need to wait and see. It will do your father a world of good to be medically stabilised and discharged from hospital, to return to a familiar environment where he can have some say in his daily routine. Sometimes the best medicine is just getting back home, and some patients improve significantly. But when the dust has settled you may find that there really has been a step-change in his cognition, which wouldn’t be uncommon after a bad fall. It’s not easy to watch someone you love go through these changes, but to the extent that it is possible, try to take it with a sense of humour. The dad you always loved is still there, and his personality will shine through from time to time in surprising and delightful ways. Try not to place too many expectations on yourself, but do try to enjoy those moments of connection whenever you can.

Best wishes,
Dr Ash

Dear Dr Ash,

I love my partner and we have a really strong connection in most ways, sharing values and a strong mutual sense of humour, but I’m perturbed by his shoe and foot fetish. At first, I thought it was just a mild preference for feminine shoes and foot massages. But after a year together he confessed he finds it hard to be turned on when I’m not wearing high heels and haven’t paid some attention to my feet; ideally by having a pedicure and wearing nail varnish. I’m finding this hard on quite a few levels. Firstly, I’m the kind of person who prefers comfortable footwear built for speed, like trainers – this is even more true now I’m in my late 40s and chasing teenagers around. Also, there just seems to be something quite ludicrous about a partner demanding groomed feet, when it’s hard enough to keep your face moisturised and looking reasonable. It just seems crazy to me that if we go on a mini-break I’m expected to bring a pair of stilettos for the bedroom. I want to be desired for me, not my feet. I’ve made some jokes about it, but this is one area where he just won’t see the funny side.

Fetishised of Ludlow

I love my partner but I’m perturbed by his shoe and foot fetish

Dear Fetishised,

I am reading your letter on a fine spring day, bluebells have suddenly burst out in the woods near our house, and everything is new and glistening with green leaves, fresh buds and abundance. And then, of course, there is all the sex. The rooks and robins, the jays and swallows, all wake at the crack of dawn shagging and screaming bloody murder at each other, a sweetly named “dawn chorus” that would elicit a handful of ASBOs if anyone could track down a postal address. Sexual behaviours, to put it mildly, are weird.

Paradoxically, they are also very common. Podophilia, or sexual arousal triggered by feet, is the most common of all fetishes, a fact well known to Sigmund Freud, who speculated that the fetish was a result of the foot’s resemblance to a penis. While this particular Freudian theory never gave me much insight into the nature of sexual desire, it did give me a disturbing insight into the shape of his penis.

A more compelling theory was floated by the neurologist VS Ramachandran in the late 1990s. Ramachandran was interested in how the brain reorganised itself after injury, and particularly in patients who suffered from inexplicable “phantom limb” pain after the loss of a body part. He argued that these bizarre perceptions were the result of cross-wiring in the brain, the result of entanglement between adjacent brain areas in the cortex. Just as two bushes growing in the same bed might intertwine their branches, adjacent brain regions can become anatomically entangled during development. Most of the time these entanglements don’t matter, but after the loss of a limb they can become significant.

As a speculative afterthought to this research, Ramachandran pointed out that in the brain’s sensory map of the body the representation of the leg is at top of the skull, languorously draping over the brain’s midline, dipping into the sagittal sinus and poking down into the darkest, innermost part of the cortex. Deep in that fold, the maps of the feet and toes hover menacingly just above the genitals. This lascivious juxtaposition, he argued, might allow for cross-wired sensory activity, providing an anatomical basis for the foot fetish.

Even though your partner’s podophilic proclivities are entirely understandable, it sounds like pedicures and stilettos just aren’t your thing. You’ve both done well so far by starting a conversation about kink that ultimately has the potential to be very rewarding. If you can communicate openly, with curiosity instead of judgement, maybe you can indulge each other from time to time without feeling like you’re a performing monkey (unless, of course, you have a thing about being a performing monkey). On the other hand, if you really do feel undervalued and coerced, you can just lace up those trainers and jog straight out the door.

Best wishes,
Dr Ash

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