Sexuality and mental health

By Sheryl Bruce

Sexuality defines us not only as man or woman, but it affects our self esteem. We are affected by our attractiveness to others and our abilities to satisfy others and ourselves. Our sexuality is the way to connect to others in a deep personal way. Sexuality is very personal. Even between couples who do not have mental illness the sexual relationship is challenging and fragile. Fragility occurs in many ways. Couples need to negotiate each person’s sexual appetite, desires and abilities. Couples need to be good communicators about a topic that can make people feel shy or embarrassed. It takes a lot of effort for two people to understand each other, know what each needs and be on the same wave length. There are many issues that can be faced for both men and women.*

These mentioned issues affect every couple and then when you add a mental illness more problems can develop. If there are psychological issues affecting the couple then the sexual health of the couple will be at risk. Problems of fatigue, stress and child rearing and/or attending to ill adult children or relatives can also cause a drain on the couple’s relationship. For women, psychological issues can greatly affect their sexual health. Often women need to be understood and feel loved. Pressure at work, stress, fatigue and excess weight also take their toll on the sexual relationship for men. These issues can ruin the relationship unless the couple understands the problem and is willing to learn new ways to interact and respond to each other.

Once one member of the couple develops a mental health problem the sexual health is at risk. People suffering from depression already have issues that affect their self esteem. Doubt hovers over many aspects of their lives. The ill person may have trouble doing the smallest tasks like bathing which can also cause problems. If the ill person is unable to work or do chores around the home resentment may become a factor that affects their partner psychologically. When the financial and home care burden of the couple rests with only one person, the stress can affect their psychological well being, which can distract from and take energy away from the couple relationship.

People on many medications have to deal with various side effects. Medications for various illnesses can dull sexual appetite and can dull sensations and can cause impotence. Medications can be adjusted, changed, or people can learn other strategies that are not medication related. In the past women were told not to have children. The older medications affected fetus development. Now if a person does not have the ability or the energy it is also suggested that they do not have children. Medicine is changing and new alternatives are being tried. Now researchers are finding that for some women that are on safer medications they can have children.**

It is hard enough for anyone being single. Add a mental illness and it becomes much more difficult. The need for intimacy, sexuality, even if not talked about much is part of a good quality of life. How do people with mental illness live or experience their sexuality? Do they have the right to or do they even want to? How does an adult child live her/his sexuality when living at home with parents? What space is there for sexuality when one is hospitalized for months? What about the ill person living in a group home or in a centre?

To some, it might even be uncomfortable to think about this aspect of their lives. Nevertheless, it is clear that different mental illnesses have a real impact on sexual desire and behaviors. People with schizophrenia tend to be isolated***; this will influence their contact and relationships with others, including intimacy and sexuality. Depressive people tend to have a decreased sexual interest. Of course some medications will cause sexual dysfunction. To some people this is unacceptable and they will stop their medications but this can cause a relapse or a reappearance of undesirable symptoms. There are other alternatives it is important to think about this and investigate these further with your physician.****

So for those of you, who have a spouse or son or daughter with a mental illness, give them a hug. You may be all they have for physical contact. Do what you can to encourage friendships, family bonding and intimate relationships. Our loved ones have needs and rights. They too have the right to make decisions and learn from those decisions. Encourage your loved ones to see their GP regularly and take care of their health in all ways. Remain open to your loved one to discuss concerns regarding their romantic lives; ill people all need and want what the rest of us need and want. We all have the same needs, whether we have an illness or not, desires and aspirations. We can all be in love, want tenderness, warmth and affection. We all want a better quality of life. The need for intimacy, sexuality, even if less talked about when dealing with mental illness is a part of the global picture.

To have an open dialogue is always the best. This is desirable both for the relatives who are faced with the desires or changes in sexual behaviors of their loved one as well as for the person with the illness who is left turned upside down by illness or medication.

* Dombeck, Ph.D.

**Patricia Deegan wrote an interesting article from the consumers’ point of view concerning consumers ‘rights and how they are treated by professionals (Available on the internet P. Deegan Human Sexuality and Mental Illness: Consumer Viewpoints and Recovery Principles). ***For people who have mental illness there are many factors that affect sexuality. Unfortunately, “The most disturbing result was the impact of mental illness on personal relationships, with almost half having no friends, wanting to, yet struggling to connect with others according to Cathy Heycock (www. Same. org). Physical intimacy, which includes hugging and touching others, was rare for many. In fact astonishingly- almost one in six had not touched or been touched by another person for more that 12 months.”( from Australia) This study found “that of the respondents 49% had no close relationship, 13% not touched by another person for 12 months, and 35% had no sexual contact in last 12 months” “This impedes their lives. Extreme social isolation is known to damage mental health, yet it’s something many people with mental illness have to endure”, Barbara Hocking Executive Director from SANE

****IF you are interested in more information White and Madera wrote “Sexuality and Sexual Problems Organizations” (www. Also De Silva’s article is interesting, “Harsh reality for many people with mental illness in a life of loneliness”. Sexuality and Serious Mental Illness. British Journal of Psychiatry; 2000, Vol. 177 (also found on the web).