In the late 1960s when Richard J. Cross, MD, began developing a human sexuality course for students at Rutgers Medical School, sexual topics were still being discussed in hushed tones.
There was no Oprah or Geraldo providing television forums for people to discuss their personal problems. According to Cross, those who had concerns about their sexuality tended to turn to their physicians. But most were not adequately prepared to provide the answers, were uncomfortable about taking a sexual history, and had their own ideas about what was "normal."
"The faculties of medical schools were very good at presenting the facts, but weren't adequately teaching the intangibles: ethics, attitudes, beliefs, values, subjects like human sexuality and death and dying," says Cross, who at the time was teaching public health at what is now UMDNJ-Robert Wood Johnson Medical School (RWJMS).
What began in 1967 as informal round-table discussions about sexuality between Cross and the school's entire second-year student body of 16 is now a required 40-hour, five-day "Human Sexuality" course. Affectionately known around campus as "Sex Week," the course was first a two-day, then a three-day event until it was expanded in 1973 into a full week of lectures, small group interactions, films, and panel discussions.
"Dick's ability to get one of the nation's first human sexuality courses for medical students off the ground and taken seriously by the faculty was a testament to his dignity and powerful conviction that our students needed this information to become good physicians," says Sandra R. Leiblum, PhD, a professor of clinical psychiatry at RWJMS, who became director of the course when Cross retired in 1985. It is now a joint effort of the Department of Environmental and Community Medicine and the Department of Psychiatry.
This year marks the 25th anniversary of "Sex Week," which takes place in early January. Cross is still involved in the course he created, as a member of its year-long planning committee and a co-facilitator for one of its many discussion groups.
So how did Cross, a self-described sheltered Episcopalian who was a virgin on his wedding night, become one of the country's pioneers of human sexuality education?
Born in 1915 to successful New York City banker William Redmond Cross and his wife, Julia Newbold, young Dick and his two brothers and two sisters grew up supervised by Irish nannies and servants in their home on East 80th Street. On Friday afternoons the family took the train out to their "country home" in Morristown, returning to the city on Sunday evenings. When a fire destroyed the Morristown house in 1928, the senior Cross bought a 250-acre estate in Bernardsville, surrounded by woods but lacking any close neighbors for the children to play with.
Dick's education followed the formula for young boys of privilege: St. Bernard's for grade school, Groton, then Yale. Although he majored in English at Yale, he excelled in his science courses. His interest in science led him to apply to Columbia University's College of Physicians and Surgeons, where he was accepted into the class of 1941.
While sailing home from Liverpool at the close of a post-college jaunt through Europe in 1937, Cross recalls he peered over the deck to see "the most beautiful woman I had ever laid my eyes on."
Peggy Lee was heading home to Bryn Mawr, PA, after bicycling through England with a friend. During the 10-day trip across the Atlantic to Boston, Cross says the two became "quite fond of each other" and exchanged numbers.
They were married two years later, after she graduated from Hollins College in Roanoke, VA, and he was halfway through medical school. Their first son, Richard James Jr., was born in 1940, followed by daughter Lee in 1942.
During his internship at Columbia, Cross joined the Army as a battalion surgeon. He spent many months in the Pacific theater, preparing for the United States' planned invasion of Japan in 1945. After the bombings of Hiroshima and Nagasaki and Japan's surrender, he was briefly stationed as part of the occupation forces on the Japanese island of Hokkaido.
"The atom bomb probably saved my life, because after I saw the mountains of Honshu, I knew the number of American casualties would have been enormous if we had invaded," he recalls.
When Cross returned to New York, he and his family, which now included baby Alan, moved to East 96th Street until he completed his residency in internal medicine. He then joined the faculty of Columbia as an assistant professor of medicine, specializing in metabolic diseases. He also did research with anticoagulants, becoming one of the first physicians to use them to prevent and treat heart attacks. He and Peggy bought a house in Fair Lawn, and daughters Annie and Janey arrived in 1948 and 1953, respectively. He was promoted to an assistant dean at Columbia in 1957.
"It seemed that professors were
stuffing facts into students, but not adequately preparing them for all the other
things a family doctor needed to know."
In 1959, a friend from Groton, now dean of the medical school at the University of Pittsburgh, offered him a position as an assistant dean. His five years at Pitt were fulfilling. With their five children in school, Peggy took geology courses at the university.
Cross' next career move turned out to be a disappointment, but it fostered in him an interest in public health. A joint project between the African nation of Ghana and the United States to build a medical school at the University of Ghana with Cross as dean fell through. In December 1963, the United States pulled out, leaving Cross with no job, but a contract with the State Department for six months that entitled him to a position with the Association of American Medical Colleges.
While in Chicago in 1965 for a medical meeting, he met DeWitt Stetten, newly appointed dean of Rutgers Medical School, who offered him a job. He moved to Princeton that same year.
"I was frustrated with medical education as a whole," remembers Cross. "It seemed that professors were stuffing facts into students, but not adequately preparing them for all the other things a family doctor needed to know. I thought 'Aha! At this new school, I'll have a chance to mold the clay while it's still wet.'
"I soon found out clay sets very quickly. The administration of the school had recruited wonderful scientific people, who weren't much interested in my ideas. A fairly traditional curriculum evolved by September 1966, when the first class of 16 students arrived, but I was able to get a block of teaching time for public health. I then added talks on human sexuality to the course."
By the early 1970s, the medical school had expanded to four years, with an enrollment of 80 students per class. Cross, who was now chairman of community medicine, felt he needed more education to teach sexuality as a separate course. He read widely and attended many seminars, including explicit Sexual Attitude Restructuring (SAR) programs put on by the Glide Foundation of the Methodist Church in San Francisco. He also learned how to deal with emotions by participating in encounter groups organized for medical educators by Carl Rogers and his colleagues in San Diego.
Cross decided to combine these two educational techniques, and enlisted the support of Irving Pollack, MD, then chairman of psychiatry at Rutgers Medical School. They appealed to the Curriculum Committee to rearrange semester hours so that they could teach a human sexuality course in one large block of time spread out over two days. This was approved, though some of the faculty clearly felt the course was a waste of time, that discussions about sex belonged in a hallway or coffee shop.
Leiblum and Raymond Rosen, PhD, who had expertise in small group dynamics and sexuality, signed on as coordinators. Through agreements with Rutgers University's schools of social work and nursing and the Princeton Theological Seminary, Cross added about 80 more students to his class of 80 second-year medical students. He did this to achieve a balance between genders.
Cross incorporated some of the teaching techniques he learned from Glide and Rogers, including bombarding the students with sexual films, both heterosexual and homosexual, to desensitize them ("a f_ _ _-a-rama," says Cross); and holding small group discussions after material was presented.
The response from students was overwhelmingly positive. Cross says evaluations given to students afterward contained comments such as "The faculty is finally paying attention to us." and "It's time we got to talk about our feelings." Over the years "Human Sexuality" has evolved to reflect changes in public health issues, sexuality education, and the students themselves.
Marcia Platt, MSW, executive coordinator of the course, says that although today's students may be knowledgeable and savvy about sexuality, "there are still those who have never been exposed to nudity or sexually explicit material." She adds that every year there are students who complain about having to take the course because of religious convictions or a conservative upbringing, and others who "think they know it all and believe it is a waste of time. They often change their minds at the end."
In addition to the RWJMS current roster of 150 second-year students, a similar number of students enrolled in social work, nursing, psychology, physician assistant, nurse-midwifery, theology and public health programs at UMDNJ and other universities also take the course.
According to Cross, although the "f_ _ _-a-rama" is no longer relevant for most students, some explicit films are still shown because they stir up emotions more effectively than does a purely auditory approach. The large-group instruction features speakers who tell about their experiences, including date rape, growing up gay, or dealing with sexual issues in a medical practice. The small group discussions remain, and there is general agreement that they are the most valuable part of the program. Each is led by two facilitators from the RWJMS faculty and health care professionals from the community. Students review information, do role-playing, and practice taking sexual histories.
Each year since 1987, at the close of "Sex Week," a prominent sex educator, the most famous being Dr. Ruth Westheimer, is given the Richard J. Cross Award for Distinguished Contributions to Sexuality.
"Dick made our department and school nationally famous," says Bernard Goldstein, MD, who followed Cross as chairman of the renamed Environmental and Community Medicine Department. "We have honored some of the best, all of whom are familiar with Dr. Cross' work."
A professor emeritus since his retirement in 1985, Cross continues to contribute to the sexual health of others. In the summer he conducts an annual three-day sex education course for teachers. He also serves as vice president of the board of Health-Interested Teens' Own Program on Sexuality, "HITOPS",a program to improve the health of adolescents, in part by preventing teenage pregnancy and sexually transmitted diseases. He is also a member of the Princeton Regional Health Commission; Corner House, a local drug and alcohol addiction recovery program; and Princeton's Joint Commission on Aging.
At 82, he says his and Peggy's days of international travel are just about over. Still living in the same house they bought 33 years ago, he tends a vegetable garden, while she volunteers in the Geology Department of Princeton University and at the day school that their youngest attended.
Cross says he relishes being recognized all over the country as the "Sex Week" guy: "It all comes back to my belief that good physicians should be well-rounded people first."
Photos by Dan Katz