Sex and mental illness

I’ve never heard anyone discuss this topic. It’s a non topic, like the whole disability sector I think the assumption is that if you’ve got a mental illness, you’re not having sex, you’re no longer even a sexual person. It is a non issue in your life, to the extent that you also have not noticed that other people have sex, so you don’t even have feelings about that. (this is starting to change in disability) There are incredibly thorny issues here that people are struggling to navigate alone, often without information, without language, without the ability to communicate about it. This makes me furious!

Imagine your partner has bipolar. Part of mania can be an increased libido. Is sex during mania ethical? Is refusing it on the basis of your assessment of their manic state rejection? Your partner is a multiple. You have a romantic, sexual relationship with the part who is out most of the time. A different part comes out one night and wants to be sexual. Where do you stand? (more information on Multiplicity and Relationships) Your partner has depression. You want to comfort them. Is sex okay? What about if you have to coax them into it? People everywhere, every day are trying to navigate these kinds of dilemmas, and are doing so in a culture that refuses to discuss any of this. We talk about sex incessantly, but we so rarely get beyond ‘nudge nudge, wink wink’. In mental health we don’t talk about it at all.How do you navigate issues of consent and coercion with people (or as people) who are at times, not in their right minds? How do you even determine when that might be? What about with those who have been sexually traumatised? Who are often so deeply ashamed, feel so profoundly broken and guilty, and desperate to ‘make it up to’ their partner, that the power imbalance makes genuine consent almost impossible to determine? What do you do if they have a panic attack during sex? If a child part comes out? If they dissociate or become catatonic? If they weep? If they pressure you? If they want you to re-enact a sexual trauma with them? (more information on Intimacy after Abuse)

All of these things need communication. For many of these issues, there is not a one-size-fits-all answer, there is a unique and deeply personal understanding between those involved about what constitutes love, fidelity, betrayal. One person coming down off a manic high may feel abused by sexual contact during the mania, while another person may feel patronised and humiliated by rejection. Too many people don’t find this out until after making difficult decisions on the fly. It doesn’t need to be this way, and in mental health I believe we should be starting these conversations. We should be opening that door and helping people to think about these things before they find themselves in a catch-22 situation. We should be talking about meds and libido. About cardio-vascular health and sexual function. About diverse sexuality and gender. About unwanted celibacy, which is an agonising result of chaotic behaviour for some people with mental illness. About sustaining emotional and sexual intimacy through episodes of illness. About the risks of the carer role, parent-child dynamics, the loss of erotic interest in the ‘sick’ partner, and how to reverse it. About sex post-PTSD. These are deep and critical aspects of people’s lives and we have no right to pretend they are not relevant. We deserve honest, open, caring conversations about them.

I’ve now written a series of articles about emotionally safer sex that’s relevent for people with anxiety, trauma, or mental illness struggles. It starts with Safe Sex 1. Checking In.

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