People with psychiatric disorders have sexual fantasies, needs, and feelings, and they have the same right to a fulfilling sexual expression as do others. However, historically they have either been treated as asexual, or their sexuality has been viewed as illegiti-

mate, warped, or needing external control (Apfel & Handel, 1993). Yet a sudden or drastic change in sexual habits may be a sign of mental illness or a sign that a mentally ill person is getting worse (or better, depending on the change). Therefore, understand­ing the sexual problems of the psychiatric patient can be quite complex (Schover & Jensen, 1988).

People with schizophrenia, for example, can be among the most impaired and difficult psychiatric patients. Neuroleptics, antipsychotic drugs such as Thorazine and Haldol, can cause increased or decreased desire for sex; painful enlargement of the breasts, reproductive organs, or testicles; difficulty in achieving or maintaining an erec­tion; delayed or retrograde ejaculation; and changes, including pain, in orgasm.

Yet, outside of the effects of neuroleptics, people with schizophrenia have been found to grapple with the same sexual questions and dysfunctions as other people. The same is true of people with major depression and other affective disorders. They may experience hyposexuality when depressed or hypersexuality in periods of mania. Both can also occur as a result of antidepressant medications. Otherwise, their sexual prob­lems do not differ significantly from those of people without major psychiatric problems (Schover & Jensen, 1988).

Sexual issues among the mentally ill are neglected in psychiatric training, and physi­cians who treat the mentally ill have often been more interested in controlling and lim­iting patients’ sexual behavior than they have been in treating sexual dysfunction. For years, the mentally retarded population has been kept from having sexual relationships, and those who are institutionalized are often discouraged from masturbating. It is as if an otherwise healthy adult is supposed to display no sexual interest or activity at all. Educators have designed special sexuality education programs for the mentally retarded and developmentally disabled to make sure that they express their sexuality in a socially approved manner (Monat-Haller, 1992). But to deny people with psychiatric problems or retardation the pleasure of a sexual life is cruel and unnecessary.

Many people with mental disabilities (and physical disabilities) must spend long pe­riods of their lives—sometimes their entire lives—in institutions, which makes devel-

 

schizophrenia

Any of a group of mental disorders that affect the individual’s ability to think, behave, or per­ceive things normally.

 

neuroleptics

A class of antipsychotic drugs.

 

major depression

A persistent, chronic state in which the person feels he or she has no worth, cannot function normally, and entertains thoughts of or at­tempts suicide.

 

affective disorders

A class of mental disorders that affect mood.

 

Personal Voices

Stories of Love Among the Disabled

 

Mental Illness and Retardation: Special Issues

Mental Illness and Retardation: Special Issues

ndy: For a while, sure I felt bad [about break­ing up with previous partner], but I went on and picked myself up, and I feel this [relation­ship with Carol] will be better for me. It’s doing me a lot of good so far, and I hope she feels that way. For me, I don’t want to lose her.

Carol: I’m looking for the same thing he’s looking for— security. I thought I had it in the past, but I didn’t. [Security is] being with each other and having the abil­ity to talk to one another.

Al: She means everything to me. As soon as I get my divorce—put this in the book—I’ll marry her.

Bev: No matter how good or bad the situation is, he’s there for me, loving me—letting me know he loves me. Like everything else, you have to find your own way of intimacy. There’s nothing that I can give to Al that he can’t give back to me. It’s mutual.


Earl: Some people don’t look at it [an older person’s sex life] as [important and healthy]. "Oh, that dirty, dirty old man!" [He’s 65, she’s 33.] I’m sick and tired of listening to that "dirty old man" talk! I think it’s wrong when they say that. What the man needs is love, just like I’m giving Gina. Love makes me feel happier. But a lot of people don’t understand it because not only am I older—I’m handicapped. I say to hell with that! Handicap or no handicap, we’re all human. We’re all human.

Gina: Above all, he has an inner strength in him that has reflected on me and gotten through to me so that I’m more able to cope with life. He has a much better inner strength than I have seen in any other person. I can talk with him about anything and everything under the sun, and he can make me feel so much better and so much more at ease.

Source: Stehle, 1985.

oping a sex life difficult. Institutions differ greatly in the amount of sexual contact they allow; some allow none whatsoever, whereas others allow mutually consenting sexual contact, with the staff carefully overseeing the patients’ contraceptive and hygienic needs (Trudel & Desjardins, 1992). Whether people with severe mental illness can con­sent to mutual sex in an institutional setting is a difficult question (Kaeser, 1992).

Подпись:Подпись:Another aspect of institutional life involves the sexual exploitation of patients with mental illness or mental retardation. This is well known but seldom discussed by those who work in such institutions. About half of all women in psychiatric hospitals report having been abused as children or adolescents, and many are then abused in a hospital or other institutional setting. Children who grow up with developmental disabilities are between four and ten times more likely to be abused than children without those difficulties (Baladerian, 1991). Therefore, it is difficult to separate the sexual problems of retardation, developmental disability, and psychiatric illness from histories of sexual abuse (Apfel & Handel, 1993; Monat-Haller, 1992).