Mental illness presents serious sex related challenges. In countries like India, persons with mental illness mostly remain single without partners and their physical needs remain unmet. Those who get married are often deserted by their spouses. As a result, persons with mental illness display compulsive sexual urge in, what is considered, an inappropriate way. They may indulge in sexual fantasies, openly play with their parts of the body or may attempt to hug or touch those around them. This becomes embarrassing for the family and others in the community. In Indian society, it is not possible to arrange safe commercial sex for such persons and alternate ways have to be found. Sometime they may even attempt sexual assaults with their family members or others around or may get exploited by others and become victims of sex abuse.
There are also cases where the married persons with mental illness develop strange attitudes and unfounded concerns about sex and intimacy with their partners. They may develop aversion to sex, refuse sex to their partners or may demand it all the time. They may also lose their confidence in performing sex and may suffer disorders related to sexual desire, sexual arousal, orgasmic problems and sexual pains.
A caregiver should discuss such issues with the attending psychiatrist. Sometime an adjustment in medicines prescribed can help. A caregiver may also try to arrange sex counselling sessions for such persons which are based on, Rational Emotive Theory, procedures to change thoughts & attitudes, sensory awareness procedures and basic sex education and cover the following -
- To provide basic knowledge of sexual organs
- To regularize sexual thoughts and behavior
- To develop understanding about self/single sex
- To avoid socially unacceptable behavior
- To provide information about contraceptives.
- To provide information about HIV- AIDS.
- To protect oneself against sexual abuse
- To reduce anxiety about performing sex
- To guide in sexual skills
- Communication with opposite sex
Some counselors suggest families to work out living together arrangements between persons with mental illness. This, however, may not workout in conservative Indian society. Marriages between persons with mental illness is also not a workable solution. Self/single sex seems to be a practical solution for such unfortunate victims of mental illness. Families should understand and accept this. They can seek help of a sex counselor to guide appropriately to their family member with mental illness.
Amrit Bakhshy is president of SAA since 2010, and has authored a book on mental health and caregiving, which is available in English and Marathi. He is also on the Institution Body of NIMHANS and chairperson of their Hospital Management Committee.