No. 8, Spring/Summer 1999 BC’s Mental Health Journal Sexuality, Intimacy, and Relationships How do we include sexuality as a part of by Neil Henderson by recovery and rehabilitation? How are relationships © “Cheryl and Matthius: Two as One” © “Cheryl and Matthius: Two affected by mental illness? What is healthy sexuality? When is it a problem? honourable mentions editor’s message Thank you to Neil Henderson for his art contribution for this issue’s front cover. Neil — businessman turned artist, envi- ronmentalist, and vegetarian— took up painting only seven e are all in relationship months ago at the Art Studios (a program supported by the Wwith each other in one Greater Vancouver Mental Health Service). This is his four- form or another. And the na- BC’s teenth painting. Art, like every other worthwhile endeavour is ture and depth of our relation- Mental a talent acquired through training, dedication, and persistence. ships differ with each person. Health It is not, as many believe, something one is either born with or For some of us, we choose to Journal without. Neil says he would like this piece to evoke depths of be less intimate, even prefer- emotion, whatever those emotions may be. ring the company of animals or nature. For others, we need Editorial Board Nancy Dickie, Jane Duval, friendship, warmth, touch, Dr. Raymond Lam, Rajpal Singh physical and/or sexual intima- is a quarterly publication pro- Executive Director Bev Gutray cy, or a combination of these. duced by the Canadian Mental Editor Dena Ellery Health Association, BC Division. It is Staff Contributors Dena Ellery, Marie-Claude This issue of Visions gives life based on and reflects the guiding philos- Lacombe, Sarah Hamid to a topic which can often be ophy of the CMHA, the “Framework for Sup- Coordinator of Resource Development Ina Hupponen overlooked in the rehabilita- port.” This philosophy holds that a mental Design Sarah Hamid tion efforts of recovery from a health consumer (someone who has used Printing Advantage Graphix psychiatric diagnosis. Sexual- mental health services) is at the centre of ity, intimacy and relationships any supportive mental health system. It also The Canadian Mental Health Association is grateful to the BC can easily be forgotten in the advocates and values the involvement and Ministry of Health which has assisted in underwriting the search to find the right treat- perspectives of friends, family members, production of this journal. ments, the supports needed to service providers, and community. In this sustain a quality of life, and journal, we hope to create a place where the This issue of Visions is dedicated to the memory of former the right support people to many perspectives on mental health issues Canadian Mental Health Association, BC Division staff mem- help you along the way. But the can be heard. ber, KENNETH (Ken) P. SMITH. Ken lived in North Vancouver, humanness of our need to be BC. He was born October 2, 1961 in Vancouver, and died April in relationships must be ac- The Canadian Mental Health Association in- 11, 1999, at the age of 37. Ken lived with HIV/AIDS and died knowledged and be included vites readers’ comments and concerns re- of lung cancer. He will be remembered by many who worked as part of our vision of recov- garding articles and opinions expressed in with him as a creative and ever-journeying soul. The prayer ery for ourselves and for those this journal. Please e-mail us at here is one he chose to be part of his memorial, before he died: we work with who live with [email protected] or send your letter with mental illness. Hopefully, this your contact information to: issue of Visions will help to Lord, make me an instrument of thy peace make this happen. Visions Editor Where there is hatred let me sow love CMHA - BC Division Where there is injury; pardon I leave the editor role of Visions 1200 - 1111 Melville Street Where there is doubt; faith to begin studying in a new (but Vancouver, BC Where there is despair; hope not unrelated) field in Septem- V6E 3V6 Where there is darkness; light ber, 1999. I leave a journal Where there is sadness; joy which I’ve seen grow from Subscriptions are $25 a year for 4 issues. newsletter to national award- For more information, call us at 688-3234 Ken Smith Divine Master, grant that I may not so much winning publication (Visions or if you are calling from outside the Lower seek to be consoled as to console received the 1998 National 1961 – 1999 Mainland, dial our toll-free number: To be understood as to understand Media Award from the nation- 1-800-555-82221-800-555-8222. To be loved as to love. al Canadian Mental Health As- sociation). I hope you continue The opinions expressed in this journal are For it is in giving that we receive to read and be informed, sup- those of the writers and do not necessarily It is in pardoning that we are pardoned ported, inspired, and hopeful. reflect the views of the Canadian Mental It is in dying that we are born to eternal life. Health Association, BC Division or its branch offices. St. Francis Dena Ellery Guest Editorial ....................................................... 3 Challenges of Dating ............................... 15 2 Perspectives on Relationships and Intimacy ... 4 The Decision to Parent ............................ 16 Intimacy in Supervised Housing ......................... 11 Sex and Sexuality Problems .................. 18 ooNTENTSNTENTS Intimacy and Aging ............................................... 12 Abuse: A Challenge to Relationships .... 26 CC Sexual Orientation and Mental Illness .............. 12 Building a Healthy Sexuality .................. 28 Correction from last issue ................................... 13 Book Reviews ........................................... 30 Cross-Cultural Perspectives ................................. 14 Resources ................................................. 32 Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 guest editorial Sex and Rehabilitation: Condoms in the bathroom are not enough ondoms in the nition of “sex” and when Dr. Bill bathrooms of men- William (Bill) L. Maurice MD, considering rehabilitation, Maurice C tal health centres FRCP(C) works at the Division of so many questions arise: make all of us feel better — Sexual Medicine, Department of What does the mentally ill as if we are actually doing Psychiatry at the University of person think about the con- something in the area of safe British Columbia, and at the Greater nection? What is the effect sex to help people with men- Vancouver Mental Health Service’s of pregnancy on that per- tal illness. While condoms in (GVMHS) Sexual Medicine Consul- son’s illness? What is the ef- the bathroom no doubt send tation Clinic. His recent book, a fect of the illness on that an important message, they guide to addressing sexuality issues person’s pregnancy? How might also be seen as the in primary care, is reviewed in this well is someone with a men- mental health equivalent of issue of Visions. tal illness equipped to man- the doctor who provides the age child-care? Is the person patient with a book instead using any form of birth con- of talking about a sexual Knowledge about sexual cal illness, we sometimes trol? If so, what kind? problem when it surfaces. matters is reasonably includ- think that people with a ed in the definition of “sex” mental illness should be Other issues may be includ- What do condoms in the and, therefore, we must talk grateful for the help they are ed in the definition of “sex” washroom have to do with about information deficits. already receiving, and that and may be grist for the rehabilitation of people with People with mental illness, sex should be a secondary mental health professional mental illness? One incon- especially those who have and subsidiary considera- mill including the capacity testable answer is that reha- schizophrenia, may have tion? Could it also be that we for intimacy, sexual orienta- bilitation must take place in come from families in tur- avoid regularly asking about tion, gender concerns, and an environment that is safe. moil and as a consequence, sexual side effects of medi- paraphilias (previously If that concept includes sex- lose the opportunity of see- cations because we don’t known as perversions). ual safety, and if talking ing the affectionate exchang- want people in our care to about the details of acquir- es between parents that make the connection and Since Visions is a quarterly ing and preventing STDs is Masters & Johnson identified thus stop using their medi- journal rather than a book best accomplished within as being instrumental in the cation (similar to the idea of and space is therefore limit- the context of talking about sex education of a child. In not asking a client about su- ed, it is possible to consider sexual matters generally, addition, people with men- icide because it might sug- only some of the compo- then sexuality will have to tal illness have often fore- gest that very notion to them nents of the word “sex” in join such issues as housing, gone the relationship and — a discredited idea)? this issue. However, the cru- transportation, and voca- sexual experimentation of cial point is not to be com- tional rehabilitation in the adolescence, and may (for In thinking about sexual prehensive, but for us to list of goals for working with example, in the case of those function, one could ask such always consider the subject people living with men- who are heterosexual) be questions as “How are you in the rehabilitation of peo- tal illness. missing basic information managing sexually when you ple with mental illness. In about the opposite sex. are alone?” “What about the days of the mental hos- Given the attention to sexu- when you are with a part- pital, sexual issues were ig- al issues in the rehabilitation Sexual function is unques- ner?” And if there are prob- nored until patients ended of those with a physical ill- tionably included in the def- lems “What do you think is up in bed with one another.