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. ness, one might wonder why inition of “sex”. That being the reason for those difficul- In the days of deinstitution- this same concern has been so, why do mental health ties?” (People with mental alization, HIV/AIDS, Viagra, minimal in the care professionals so often wait illness and clinicians both and the Internet, there is no of those with a mental ill- until someone who is ill in- struggle daily with the dif- way that mental health pro- ness. Apart from STDs and dicates a concern about their ficult task of trying to dis- fessionals could convincingly drug side effects, the answer sexual function instead of tinguish drug side effects say that they are providing 3 to the question “what else taking the initiative and pos- from the sexual consequenc- comprehensive care to peo- needs to be discussed?”, ing some questions? Could it es of the illness itself.) ple with mental illness with- partly depends on one’s def- be that similar to the early out also addressing their inition of the word “sex.” days of attention to sexual Reproductive issues are nat- sexuality in a manner that is issues in those with a physi- urally included in the defi- explicit, skillful, and regular. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 perspectives on relationships and intimacy Friendship, Intimacy and Sexuality among Persons with Serious Mental Illness

William R. ow can one core of helping one feel that she doesn’t like him “in area where these services Whetstone, ever de- alive. Touch plays a funda- that way.” She confides that are readily available, “...so it RN, PhD, & scribe the mental role in the life of she was molested by her doesn’t require cab fare.” Ann C. Rich, mysterious all human beings, no matter brother when she has diffi- RN, PhD chemistry how much it is suppressed culty imagining herself be- Some sexual friendships can thatH goes into the making of by our cultural values ing physically responsive. be either with the same sex our friendships, intimacies, and mores. She cannot imagine touching or the opposite sex. With any and sexual expressions? herself sexually. At times, she of these combinations, per- Touch can express many longs for a “normal” life sons with mental illness Unfortunately, for persons things in a positive way. It with a family, including chil- must have assistance in how with mental illness, the in- can show concern or affec- dren, but she feel that will to work out the boundaries timacy of friendship too of- tion; it can offer support or never happen. of these relationships. They ten remains an unknown. security. It can be a form of need to know what’s in- The opportunity to acquire therapy or healing. In a most As a human drive, love volved; the necessary give Excerpted with friends or experience the substantive way, it gives the evolves out of friendships. As and take required, and permission from caring warmth and deep recipient attention and es- one author put it, love hap- the glue which holds the California personal satisfaction of tablishes a bond between pens between people. Gen- these relationships together. Alliance for the friendships is frequently two persons. It is hard to sep- der is immaterial. Sexuality (And where is that taught? Mentally Ill limited because of circum- arate touch from friendship. is the ultimate expression of And what qualifies the Journal, stances beyond the individ- Touch entwines friends. intimacy, touching and car- “teachers”?) “Relationships, ual’s control. Friends touch each other in ing between individuals. Friendship, Inti- supportive ways. They meet; Typically, women involved macy & Sex. Take for example, John, in they often hug in a mutual The expression of sexuality in same sex relationships are his mid-forties, who was exchange of greeting. To takes many forms with per- better able to handle the cir- born with his right arm and some of our mentally ill pa- sons who have mental ill- cumstances than are men. leg smaller than his left. John tients, touch can be either an ness. Stephen, a thirty- For most men, sexual release has been physically disabled invitation to intimacy or an something gentleman, in- appears to take priority over since birth and became anathema. The tolerance of dulges in sensual massage by the caring aspects of what mentally ill when he was in touch varies with each of us. a same sex person who is such a union can offer. college. Even while in col- From the time we are born, loving and caring. This pro- lege, and, as he feels now, he human touch of some kind vides him with his need to The mere thought of friend- sees himself as an outsider; remains a dominant quest. be touched, for intimacy, and ships, intimacies, and sexu- vulnerable and not trusting sexual gratification. Along ality creates discomfort and of other people. He goes to Sarah, 43 years old, lives with sensual massage, he has unease among most families, movies with his manager, with her aging adoptive found another approach to caregivers, and virtually all but he is unable to name mother, who is her primary meeting his needs for sexu- health professionals. Howev- other friends with whom he source of support on many ality. He can satisfy himself er, these issues are real and has any social contacts. He levels. She lives in an afflu- while looking at pictures of central to a person’s well- withdraws from touch. His ent suburb, where she is either “hunky” men or being, because they relate to one source of friendship is usually comfortable on the “beautiful” women in Play- the essence of life and alive- with animals. He goes to the streets and is regularly seen girl or Playboy. He believes ness. Without the joy and city zoo two or three times a walking and window shop- massage is much more satis- pleasures of warm friend- week. He considers some of ping. When asked about dat- fying. Sensual massage pro- ships, caring intimacy, and the animals to be his friends. ing, she comments that she vides the human touch, sexual expression, the He says it is a place where doesn’t feel “authentic” connection, or skin contact quality of life for anyone is he feels secure and at peace. when she dresses up and he requires for self affirma- less than what should goes out with lots of people, tion: “I exist!” is what he says be acceptable. 4 [....] and hasn’t done so since she it tells him. The biggest was in college. problem he has is managing Friendship, intimacy and his money, so he can afford sexuality are interrelated She does have a special man the $50 to $60 dollars to pay and integral to interperson- friend, but she has rebuffed for his various “services.” al contact. They are at the his physical advances noting Fortunately, he lives in an Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 perspectives on relationships and intimacy In Praise of a Loving Reflection

hear the door thump shut downstairs, and We’ve discovered that, even in the worst points of the de- Patricia gentle fumblings as belongings are dropped. pression, I’ll occasionally be able to turn it off, even if only Wilkinson

I John is home. I am lying in bed and the TV is on low. It is for a few minutes. In that window I maybe can smile, or do 6 pm. Part of me has been calling out to him silently all the dishes, or go for a walk. Very quickly my mood may change afternoon, “come home, I need you.” But now that he’s here again to confusion and hypersensitivity, but the more I can I’m not sure I can bear to have another person around. “Hel- take advantage of the window, the easier it” is to move out of lo,” he sings as he climbs the stairs. the worst of the feelings. John allows me to be inconsistent. He’ll finish “Hi,” I reply quietly. This is the third night in a row John has cooking the come home to this scene. Ordinarily it happens maybe sev- dinner if I’ve Part of me has been eral times a year, but the frequency has been escalating re- started but calling out to him cently. We both know what this means: it’s time to talk can’t finish. about depression. He under- silently all after- stands that noon, “come home, Never before have I had someone to talk with about depres- what is pos- I need you.” But now sion, especially the way we do. When we began living to- sible one gether eight years ago, depression would hit me like a stormy moment that he’s here I’m sea hits the shore. The depression was deep and wild and may not be not sure I can bear unpredictable. One day I was fine and the months would go possible the to have another by when I was exhausted and irrational. With John’s help next. I’m and four years of treatment with a skilled psychiatrist, these pretty sure person around. episodes are now few and far between. But they haven’t that if he stopped, and we’ve had to come to terms with the possibility gave me a ” that they never will. hard time, I’d stop try- John enters the bedroom quietly and surveys the now- ing, and familiar scene. “Still feeling pretty bad,” he states gently. I there would nod and stare at the TV. He knows that part of my experi- be fewer op- ence is that I find it difficult to have a conversation. My con- portunities centration is very broken, and it’s hard to connect my for the mood thoughts together. I can’t look at him and listen at the same to shift. For time. It can take several minutes to come up with even sim- me, he is a loving reflection — he doesn’t actively try to Patricia ple responses. John sits beside me on the bed and strokes the change things. Yet by virtue of his acceptance of the way Wilkinson is an back of my head. “What can I do for you?” he asks. things are, the world is profoundly changed. administration coordinator for a I’ve learned to take this question seriously. John will do vir- This acceptance of the ebb and flow of life is a hallmark of professional asso- tually anything for me — buy ice cream, try to find a mango our relationship. John is so good at it, I can’t help but return ciation. She also at 11 pm, run me a bath, take me for a drive. Knowing that the favour. Several years ago, a friend observed my end of a provides conflict I’ll get what I ask for, if at all possible, I find I don’t want phone conversation John and I were involved in. She knew I resolution and much at all. And even if what I really want is unattainable, I was really struggling at that time. John had called to see how communication get to say it out loud. I was doing, and offer a few words of comfort. Then he pro- skills training to ceeded to tell me about his day, which wasn’t going well. I groups, and pro- “Oh just shoot me, I hate living like this.” clucked and offered my own soothing words. When we hung vided this service up, my friend was smiling and shaking her head. Asked about to mental health “Left or right temple?” he inquires. her reaction, she said she was impressed that, knowing I consumers in her wasn’t well, John still looked to me for support. And I was former position “Left, I don’t have the energy to turn over.” Lovingly he puts able to provide support. Until that moment it hadn’t seemed with the Canadi- the imaginary gun to my head and shoots. On some level I remarkable — it was just me and John talking. She illumi- an Mental Health realize we’re acting out a mutual fantasy — this isn’t much nated the beauty of our relationship for me. Association. fun for him either. John’s special gift at any time is his abil- ity to accept whatever is happening. It’s a particularly treas- asked John to write part of this article, to tell his side of 5 ured gift at times like these. On the one hand it helps me to what goes on when I’m depressed. He said I taught him recognize early on that I’m getting depressed, because I don’t Ihow to help by explaining, when I could, exactly what have to pretend otherwise. On the other hand, this attitude was going on inside me, and telling him what helped and creates opportunities to step in and out of depression and why. I wouldn’t have told him if he hadn’t asked. John, thanks it’s easier to get better faster. This second point is critical. for asking. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 perspectives on relationships and intimacy “And Depression Makes Three . . .” The path romance takes when one half Sarah of a couple lives with severe depression and Chris SARAH’S POINT OF VIEW Abraham Maslow’s hierarchy-of-needs pyramid, a dim mem- like career, looks, fun, and of course, men. Food, water, sleep, ory from Psych 100, has ended up having so much rele- hugs, and a modicum of routine were all I could handle. It’s vance in my life. Maslow said that fulfilling needs was like funny the way priorities have a way of smacking you in the climbing a pyramid or ladder; more abstract human goals face when you’re diagnosed with severe depression, weep- like friendship or intellectual achievement are only attempted ing 4-5 days a week for half-hour blocks, not feeling hunger Going In Going In Going In Going In Going In when more basic needs like food or safety have been met. pangs for months on end, and napping all the time to escape Obvious, yet easily forgotten. the bite of those “black dogs.” Boyfriends could easily wait.

When I knew I was going to crawl through a dark, ugly So there I was, shocked as hell, to find myself in a relation- tunnel of depression near the end of ‘96, the first thing I did ship at 19 — my first ever steady one at that! I imagine Chris TTITUDES TTITUDES TTITUDES

TTITUDES TTITUDES was empty my shopping cart of burdens. I was not about to was equally shocked to find himself clicking with someone A A A A A concern myself with what had suddenly become “luxuries” in my sorry state.

Chris and I had a very fast, close friendship develop (mostly (2) I was determined to help destigmatize the illness and via e-mail in fact) in the month and a half before we went the best way I knew was to tell people what I was going on our first date. In the preceding months, I had already through without shades of shame or pity-seeking. gained a lot of e-mail support from fellow consumers around (3) I was vulnerable and sceptical of men. Since a romance the world whom I met on the Internet. As a result, I was wasn’t ruled out in our banter, I wanted to lay out all already accustomed to bringing my mental illness out into the sticky stuff early. This would give him a chance to the open sooner rather than later. make a clean getaway from the relationship (if he so chose) without dragging my battered heart with him More than that though, I have since recognized three im- later on. Ah, self-preservation is a powerful force. ADMISSION ADMISSION ADMISSION ADMISSION ADMISSION portant facts that contributed to my telling Chris about my illness just two weeks after we first spoke: Chris’ reaction was surprising and phenomenal. He wrote The The The The The (1) there was safety in the fact that he was a friend and something empathetic to the effect of “everybody’s broken good friends did share important parts of their lives af- in one way or another.” It helped to level us. I was reminded ter all (or so I reasoned). then that it was okay; we both had our demons.

I think Chris is right that the core of our relationship has fort in being able to lay claim to emotions that I felt were my really not been touched much by the illness of depression, own and not symptoms of my illness. per se. But I’d say that the subtle ways depression has ended up influencing my behaviour have definitely had negative Poor guy. I asked so many questions of him, but I just had to impacts on my capacity to become emotionally vulnerable. be able to gauge his feelings to prepare myself for any possi- ble emotional pain. I felt little security in life and every cell Impacts Impacts Impacts Impacts Impacts One of the changes was a direct reaction to my overwhelm- in my body urged me to protect myself from further hurt. ing feelings of helplessness at having some invisible brain- CY CY CY CY CY chemical force jerking my emotions around. I compensated Having only met me for the first time 6 months into my de- a lot for my powerlessness by being much more analytical pression, Chris had nothing to which he could compare these and controlling than I ever was before. For instance, I’d make bizarre, annoying, information-seeking compulsions. No INTIMA INTIMA INTIMA INTIMA INTIMA lists to analyze why I was angry at Chris for something; I wonder he couldn’t separate personality from illness. I didn’t never used to do stuff like that! But by doing it, I found com- give him much of a chance.

My “spells” are the hardest symptom of my depression, both helplessness and anger he feels must remind him of what for me and the people I love. They’re the term I have for the his family had to go through with his mother’s cancer. half-hour (or longer) crying episodes I would suffer from 6 too frequently. The technical term for it, ‘tearfulness,’ al- For many reasons, I try and have spells alone and seek the ways makes me laugh. Tearfulness is what happens when hugs afterward. But since I can’t foresee let alone schedule I’m cutting onions; these are emotional earthquakes that come the episodes, and since we spend so much time together, I SPELLS SPELLS SPELLS SPELLS SPELLS from nowhere I know or nowhere I can control. For Chris, I knew from the onset that I couldn’t prevent Chris from wit- can guess that watching or hearing me have a spell is as nessing this aspect of my illness. It’s taken a lot of time not to painful and frustrating as it is to have one. I also know the feel guilty or weak doing so. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 perspectives on relationships and intimacy

aving started out as friends living in different cities, Chris and Sarah have now been exclusively dating for 2 years during which time they’ve fallen in love. Chris is currently 26 and out of school. HRun-ins with mental illness in his lifetime have been few and far between and never personal. Sarah, 21, was diagnosed with severe clinical depression in the winter of 1996 and only began recovering from her ‘episode’ in the fall of 1998. In the real-life case history below, each of them tells their unique perspectives of witnessing mental illness become another ingredient in the intimacy stew.

CHRIS’ POINT OF VIEW A A A My preconceptions concerning mental illness were typical My opinion of the medical community, for personal rea- A A TTITUDES TTITUDES TTITUDES — based solely on television and news media coverage. I’d sons, was extremely low. From my perspective, the hardest TTITUDES TTITUDES never suffered from deep depression, and had no personal periods in Sarah’s recovery have come as the result of anti- experience with any type of mental illness. depressant experiments. Fairly or unfairly, that factor has also lowered my opinion. I knew that depression existed, but had never formed an

intelligent distinction between “the blues” and clinical de- I don’t think Sarah was looking for anyone when we met; Going In Going In Going In Going In Going In pression. I had met people who suffered from various forms she had enough on her plate without having to deal with the of mental illness, but only briefly, and at each turn they emotional turmoil of a boyfriend. The fact she wasn’t “des- seemed quite ordinary. perate” helped ease us into the relationship naturally – no apprehension at all on my part.

I wasn’t apprehensive or shocked when I was told, but my first reaction was more the result of ignorance than open- The The The Chris’ reaction was mindedness. I was most surprised to learn that depression The The surprising and phenomenal. had serious physical symptoms. I had assumed its symptoms < were entirely emotional or mental. ADMISSION ADMISSION ADMISSION He wrote something empathetic ADMISSION ADMISSION to the effect of “everybody’s broken Basically, I didn’t have a clue how depression affected Sa-

in one way or another.” It helped rah’s life, or how it would affect a relationship. There were also surrounding factors that distanced the disease’s impact to level us. I was reminded< then on me, namely, that at that point I was a friend living in a that it was okay; we both different city. She was a scholarship student, had already had our demons. advanced her way into the labour force, and had strong family ties. In short, she had a stable life and wasn’t “fragile.”

Sharing emotions and communicating are difficult in any Sarah does possess idiosyncrasies common in adolescents — INTIMA INTIMA INTIMA relationship. When I have withheld a painful opinion, or on modest neurotic tendencies, sometimes with vivid splashes INTIMA INTIMA the one instance when I even remotely considered ending of melodrama thrown in for good measure. At the outset, it the relationship, depression never entered the equation. was hard to distinguish personality traits from symptoms, but over the course of a relationship, separating the two has CY CY CY As for whether I was more wary of getting close to her be- become easier, as has honest communication. CY CY cause of the possibility of a breakup and what that would Impacts Impacts Impacts add to her plate, I can’t really say I know. Reluctance to hurt Most communication breakdowns have been typical and I Impacts Impacts someone is a complicated thing to dissect, but it has more to don’t think related to depression. We’re both more disposed do with the appearance of fragility than the reality of men- to discussion than yelling. If anything, trying to maintain tal illness. Ours has been a very open and frank relation- emotional balance in response to Sarah’s depression has ship, even at the risk of treading on clinically-depressed toes. opened and stabilized our intimacy, not hurt it.

It’s terrifying and emotionally grueling to hold a loved one I was immediately struck — though in a very detached way as they suffer a depressive spell. My inability to control the — by the similarities between my father’s relationship with SPELLS SPELLS SPELLS situation, and my lack of understanding in terms of what my mother and my relationship with Sarah. My mother died SPELLS SPELLS triggers them, are major frustrations. Even harder is being of complications resulting from cancer surgery. While the 7 separated from her during a particularly bad night. Hold- diseases are obviously very different, I found the relation- ing, hugging, stroking are far superior to any treatments that ship pattern intriguing — which has more to do with my can be conveyed over a phone. relationship with my father, than my relationship with Sarah.

Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 perspectives on relationships and intimacy

SARAH’S POINT OF VIEW

Depression and many drugs I’ve been on to treat depression nence while I tested out various medications. It was only 9 have all conspired to deaden my body’s sexuality. I say “body” months ago that my body’s sexual responses finally caught because I still had sexual feelings and cravings but not the up with my drive and convinced Chris of the very real im- explosive bodily reactions that should have gone with them. pact drugs were having on my sexual being. Unfortunately, the only tools I had to express these emotions externally — words, looks, gestures, and sexual responses But the real challenge in our sexual relationship has been — were dubious at best to an ego-battered boyfriend who that illness, treatment, and relationship factors all overlap Impacts Impacts Impacts Impacts Impacts was finding it more plausible to believe that I was sparing and it’s not always clear what the source is. There have al- his feelings (by using depression as an excuse) rather than ways been other reasons behind my opting for abstinence AL AL AL AL AL depicting a real medical problem. that can tend to get lumped in with the depression factor. In fact, any illness can impact behaviour which in turn im- Add to all that the following decision: since I wanted my first pacts a relationship; it’s just easier to separate things, I think, SEXU SEXU SEXU SEXU SEXU time to be idyllic as many young women do, I felt I had to at when the physical ailment is something you can see and be least give my full sexuality a chance to return if I was to get reminded of more constantly. any real satisfaction from intercourse. And that meant absti-

The drug I’m currently on has got me to about 80-85% of dissect my emotions in lists; Chris is less inclined to feel sex- where I was before. However, I consider myself ‘in recovery’ ually unwanted. since I haven’t felt this great in a couple of years and am tired of trying new drugs. I don’t know what my chances are The only future encounter with depression to think about if for relapse but if I should ‘go under’ again, I’m afraid of we marry is the high chance of passing it on to any children what it would do to Chris more than myself. Not only would given the strong genetic predisposition for the illness down uture uture uture uture uture F F F F F the recovery-remission-relapse scenario mimic his mother’s my maternal line. If that should happen, I only hope we bouts with cancer all over again, but Chris would be a live- both stay enough in touch with what has happened in our in witness to the ordeal rather than the arm’s-length wit- relationship over the past 3 years to see any other members The The The The The ness he is now. of our future family through it.

At least time has overcome the depression-related intimacy and sexual challenges once and for all. I’m less inclined to Sarah

CHRIS’ POINT OF VIEW

Depression has hindered Sarah’s sexual development dur- immediate, very personal, feedback. ing some pretty formative years: 18 to 20. The disease, and some antidepressants, numb sexual pleasure. Those side- Sarah’s lack of sex drive has also hampered her ability to effects, combined with her cultural background and per- sort out her own motivations and communicate them to me. sonal preferences, have caused Sarah to abstain from That factor, in particular, has isolated me from her and her intercourse. The root cause — depression vs. environment family. Again, the question of where depression ends and Impacts Impacts Impacts Impacts Impacts — has been at the heart of some heated arguments. environment begins becomes very critical within the rela- tionship. AL AL AL AL AL Depression’s symptoms, along with its ability to corrode any sense of sexual empowerment, has made me feel either in- Patience has been rewarded in this case — and it may sound SEXU SEXU

SEXU adequate or undesirable. Past relationships didn’t particu- pat, but I think time and empathy have been the saving graces SEXU SEXU larly help counter those feelings in the face of more for us.

The prospect of living with Sarah through a relapse or an- I haven’t made any real attempt to learn more about depres- other round of prescription testing is scary. Fighting depres- sion. I do know more about the assorted medications, symp- 8 sion is a war on many fronts; medicine, environment, physical toms, treatments, but only within a very narrow, emotionally uture uture uture uture uture exercise all come into play. As the “significant other,” you charged context. I still feel ignorant of the broader reality of F F F F F become hyper-sensitive to any factors and issues that might depression because my filter, or access point to understand- impact your loved one. It can be mentally grueling. ing, has been one exceptional case. The The The The The Chris Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 perspectives on relationships and intimacy Commitment: In sickness and in health

ecent events in my sistently, at any other level another person extend far, So, in my private moments, Kathleen life have caused than as an adult child to a far beyond the romantic when my children are A. Bayes

R me to examine my caretaker. There are many pulp concepts paraded be- asleep, and I lie there alone fundamental value struc- days when he just isn’t fore us in today’s media. I am in my bed and listen to my ture, the principles of life “there” for me. committed to trying to make heart beat and feel the years that I deeply believe in, that his life the very best it can slipping away,” what does are a part of my very core This illness is not his fault, be. I admire his courage, that inner voice I like to being, that I use as a struc- it’s a brain malfunction that greatly. When he is some- think no one knows how to repair. where near what ture to make daily decisions, How can a wife turn her both profound and mun- He suffers greatly, more that I recognize dane. One of my strongest most with debilitating phys- as reality, back on a husband who beliefs is in family, in an ul- ical illnesses, because this I like has become disabled, timate lifetime commitment condition affects his inner- him incapacitated? to husband and children. I most being . . . his personal- a lot. find this value contradicto- ity, his belief structure, his He is a ry to commonly held values thought processes. car- ” in our society today. Perhaps ing, is my most people do not share this I believe very strongly in generous, kind, soul tell me? value of commitment for life staying with him as long as I thoughtful, intelligent To live joyfully. To be to a spouse and to children. can function safely. How can man who does not deserve content and never ask I have also learned that for a wife turn her back on a the cards he’s been dealt. for or expect sympathy for Kathleen A. Bayes me to violate my value struc- husband who has become But, do I love him uncondi- the decision I have made for co-edited the Cal- ture for any length of time disabled, incapacitated? I tionally? I wish I could an- myself based on my own val- ifornia Alliance causes me great distress and believe that, if I left him, he swer, yes, and mean it. Am I ues and my own sense of for the Mentally depression, no matter how I would either commit suicide willing to abandon a person profound rightness. My Ill’s Journal on try to rationalize it. or become a homeless per- I love because the going gets challenge is not to second relationships. She son on the street. How could tough? I think not. I hope I’m guess myself and not to ac- lives with her My husband suffers from a I do that to someone I have better stuff than that. cept guilt for making this de- family in Fort serious mental illness. This promised to love, honour cision. For me, it’s not a dark Wayne, Indiana illness has robbed us both of and cherish in sickness and This value of commitment tunnel I’m passing through. where she is in peace, security, love, com- in health till death do us isolates me from nearly I am walking in the light as I the Underwriting panionship, and the intima- part? Society does not con- everyone. I am often asked, see the light never blaming and Issue Depart- cy and partnership of done abandoning a child “Why don’t you divorce my husband or myself for ment of Lincoln marriage. I have no peace who became disabled. Why him?” I am often told, “Don’t the outcome, and not danc- Life. She is also a because I’m afraid and iso- then do we abandon spous- throw away your life for this ing to the music of a dispos- past president of lated. I have no security be- es so quickly when misfor- guy, take care of yourself!” able society. I’ve exercised Indiana Associa- cause he has difficulty tune strikes? Or my motives are called my own free will, conscious- tion for the Men- holding a job, and medical into question, “You must be ly and with as much infor- tally Ill. Reprinted expenses may ultimately Please don’t ask me if I as sick as he is to stay in that mation as is available to me. with permission wipe out our finances. I do “love” him. I don’t think I relationship. Are you co-de- And now, I’m walking the from the Calif- not have his love and com- know what that word means pendent? Or, do you just en- walk . . . and keeping my ornia Alliance for panionship because he is anymore. Certainly the ram- joy a power position?” promise. So help me God. the Mentally Ill. unable to relate to me, con- ifications of true love for A.G.M. Invitation It’s time for the Saturday, August 21, 1999 Canadian Mental 2:30 – 3:30 pm Health Association, Curtis Law Building: Room 101/102 9 ž BC Division’s The University of British Columbia, Vancouver Annual General Meeting All members are welcome to attend!

Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 perspectives on relationships and intimacy

eople do not be- girl. Beyond the personal lieve me when I tell qualities I looked for in a P them that I was the Balancing partner, it was imperative Queen of Freaking-Out. that he or she be mentally When I was a small child I and emotionally grounded threw rageful, violent tan- Life and financially stable. There l. e. roze trums in order to get my par- is no question in my mind ents’ attention. My parents that having a good sense of were emotionally, mentally humour and learning to and physically abusive and I cuffed, counteractive to my goal of lighten-up along the way started seeing a psychiatrist thrown in the harmony. I had to accept and has been of great benefit. Al- at the age of thirteen. I was back of a cruiser, and live with loneliness which I though I’ve always prided institutionalized for the first taken to one. And I inevita- believe was a huge milestone myself on my sense of hu- time at the age of fifteen. At bly, upon release, had to start in the face of having to let mour, I had a tendency to- the age of twenty-seven I life all over again. And again. some people in my life go. To wards seriousness that was was diagnosed manic de- And again. counteract loneliness I wrote at times detrimental. One pressive and finally schizo- poetry, I started keeping a day a therapist said to me phrenic, when my marriage Eventually I left the big city journal, walked, and went “l.e., lighten up! Take your- broke down and my hus- in Ontario where I grew up swimming and ultimately self to a funny movie or rent band incarcerated me in a and settled in a little cabin learned to enjoy my own one.” And that’s what I did. psych ward. I lost custody of by the sea on Vancouver Is- company. I had a relation- I learned to hear the good my two little boys and was land. That is where the heal- ship with a guy who had advice and always listen to left to make my way in the ing started to accelerate, broken his back and was my guts. world alone. The evolution even though it’s all been very practicing yoga. He original- of my healing soul and ma- gradual. Tiny steps mixed ly taught me yoga and I went I have been in a wonderful l.e. roze is the pen turity is remarkable. with cathartic realizations, on to take workshops and relationship now for two name of a woman patience, and goal-setting learn from other friends and years. We are both basically who lives in Van- Growing up I was berated ventures. It is my pleasure to teachers as well. Yoga pre- independent and share what couver and is in and put down endlessly by share with you, the readers sented an opportunity to fo- I consider to be a quality life the process of my family. Hence my self- of Visions, how I learned to cus on my body and my together. I work part-time in writing the full image and self-esteem was balance my life, love breathing. A tremendous mental health, I volunteer version of her very low. It often felt as if I and relationship(s). clarity of thought and per- on a distress line, and give story under the would never see the end of spective evolves from the stress management presen- working title ‘The my pain and suffering. I I was deeply driven and mo- practice of yoga. tations to high school stu- Redemption of longed for my children and tivated to rid myself of pain dents. I still write, and have Camille Gold- somebody to love and to be and suffering. It wasn’t easy I became aware of how lan- wonderful friends and fam- bloom’. loved. I spent over fourteen but I became acutely aware guage affected me and how ily relationships. I don’t do years on disability while I that I, and I alone, was re- my own self-talk, usually anything, or hang out with tried out various jobs, and sponsible for my behaviour. negative, played a role in my anybody, if it doesn’t feel developing personal, inno- Therefore it was up to me to actions and feelings of low right to me. vative and creative projects control my episodes, to pre- self-worth. I therefore decid- that inspired me in my de- vent them from occurring. ed to delete words like freak- My children are adults now termination to help myself Taking control, being at the ing-out, sick, ill, and unwell and I am blessed with three and others like me. helm of my life meant from daily use in my vocab- grandchildren. The rela- changing and it wasn’t and ulary. To change my self-talk tionship with my children During those years, life was isn’t always pleasant. For from negative to positive, I has been a huge part of the a roller coaster of ups and one, I had to let go of people learned to become aware of healing process. They too are downs. I’d fall obsessively in whom I adored but were not my thoughts and change healing from being deprived love with one guy, or girl or positive influences. I was dil- them on the spot. of a good, loving mom. Our another which would ulti- igent and still am about at- souls are healing together. mately develop into a psy- tracting stable, healthy, Above all, I had to learn to chosis where I believed that positive people into my life, balance work, school, fami- These days I eat well, sleep this relationship would help and with love and compas- ly and personal issues prior well and when I need to talk me win back my children sion and some pain, letting to being in a healthy rela- things out I do so with the 10 and grant me the life I was go of those who are not. tionship. I needed to estab- appropriate sources, i.e. ei- so desperately searching for. lish a grounded, balanced ther a friend or counselor. I Not once in those years did I I learned to live with my eyes relationship with myself am able to remain still and voluntarily check into a open and become aware of first and foremost. I prom- calm in the eye of potential psych ward. I was always everything that is stressful ised myself I would not just chaos. I am grateful that I am picked up by police, hand- and over-stimulating and hook up with any old guy or alive. Life is truly beautiful. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 intimacy in supervised housing Sex in Residential Settings: Panel discussion identifies range of issues

exuality has long been a taboo in the mental health eska notes that many residents are also coping with histories Marie-Claude field. Dr. Bill Maurice recalls that in medical school, of sexual, physical, and/or verbal abuse; dysfunctional re- Lacombe a patient’s sexuality was only mentioned in pass- lationships or families; and childhood diagnoses that inter- ing. “You were told to be careful not to have patients rupted regular social-skills development. This doesn’t mean, Send up in the same bed together,” he stated at a panel dis- however, that sexuality is therefore a dead issue for these cussion on sexuality organized by the Mental Health Resi- consumers. Education about healthy sexual fantasizing and dential Services (MHRS) division of the Greater Vancouver masturbation (and appropriate places to do so) must be en- Mental Health Services Society (GVMHSS). couraged so that residents do not feel ashamed for wanting to enjoy their sexuality by themselves. Mental health consumers living in residential facilities now benefit from a greater understanding that they too have needs Other issues facing residents are the obstacles they must con- for intimacy, relationships, and healthy sexuality. In Van- quer before being able to meet people both outside and in- Marie-Claude couver, the Vancouver Adult Care Regulations assures that side the residences. Anne Bullock, Acting Director of MHRS, Lacombe is a the personal privacy of a resident and his or her bedroom, points out that each house and each individual are different communications locker, and storage space are respected. The regulations also when it comes to meeting other people for possible relation- student at Simon state that residents are allowed to have visitors. As Catherine ships. Each individual may also want social interaction to Fraser University Battye, Adult Care Consultant for the Vancouver/Richmond varying degrees. in Burnaby, BC. Health Board, explained at the panel, the visits must be “oc- She is on a work casional” and not cause disruption of care to any resident. To determine whether more social programs are needed, term with the As well, the visitor must not need care from the staff. The MHRS is surveying all 437 residents in the 43 housing facil- Canadian Mental visits include overnight stays. * According to Catherine, these ities of the Vancouver/Richmond Health Board region. The Health Associa- regulations are to be applied at the discretion of the facility survey asks questions about what activities the residents tion, coordinat- as each case is individual, but the health and safety of all would like to have, if they would like to meet residents from ing National consumers must remain the top priority. other branches, and whether particular settings would make Depression them feel safer. The results of the survey will determine what Screening Day. Sometimes the needs of the residents must be met at an even programs need to be developed. Activities may include dances, more basic level than having overnight guests. Some of the bowling, or any other suggestion given by consumers in the residents who have spent most of their lives sheltered from survey. A newsletter directed at resident consumers is also sex education and media depictions do not have a well- in the works. rounded understanding of sexuality. Dr. Maurice comment- ed in his speech that he has had many consumers come into his office looking for answers on simple issues that most peo- ple of the same age would have known for years. He recalls one instance when one man who came to talk to him reached into his pocket and took out a piece of paper with a set of Some of the residents who have spent questions including: “What’s the relationship between urine Some of the residents who have spent and semen? Where do you actually put a penis? Does it most of their lives sheltered from sex “ hurt a woman when you have sexual relations?...” “ education and media depictions do not have a well-rounded understand- Throughout the panel discussion, sex education was felt to ing of sexuality. be an important issue in the holistic rehabilitation of people with mental illness. Some residences such as Crossroads, an ? all-female residence in Vancouver, tries to incorporate sex- uality discussions into their educational program. About twice a year they also bring in experts to talk to the residents. Beatta Zaleska, nurse and manager of care at Crossroads expressed The survey and the newsletter are a collaboration of MHRS, that the lack of education around sexual issues is alarming. All Consumers Housing Council and is funded by the Con- She found that books made for children were useful in edu- sumers Initiative Fund. If you want more information on the cating young women who live at Crossroads. Along with ba- survey, the results, or the newsletter, you can contact Sheila 11 sic knowledge, residents also need to be filled in on Gamblen at GVMHSS, by phone 604/734-5265, or by e- contraception, STDs, and AIDS. mail at [email protected] ______Often, people in mental health facilities are not ready for * These are regulations for the City of Vancouver. Other regions may have the emotional and physical intimacy of a relationship. Zal- different guidelines. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 intimacy and aging sexual orientation and mental illness Coming Out: Similarities in being at odds with mainstream society due to sexual orientation and mental health disturbance

Jill Stainsby t is a real challenge to be a member of two distinct and I see parallels between the experience of being a mental separate marginalized communities. Both live at odds health consumer/survivor and of being a member of a sex- Iwith mainstream society, much in the same way that vis- ual minority, and I will explore the similarities in the course ible minorities are isolated. The combination of having a of this article. There are, of course, significant differences. mental health diagnosis and being a member of a sexual For example, a mental health disturbance is a debilitating minority, while difficult, has both good and bad aspects. illness, and sexual orientation is not — though it can be in- credibly isolating. Mental health disturbance is usually epi- sodic. Sexual orientation usually remains the same for a lifetime (though not always). There is a system of support set up for people with a mental health diagnosis, flawed as it Addressing the might be. Mental health consumers often receive support from others who do not have a diagnosis. Lesbians and gay men need to provide support to each other, as society at large Sexuality Needs of an does not usually directly help individuals with a sexual iden- tity crisis.

Aging Population Many people with a non-mainstream sexual orientation came into contact with the mental health system when they were Edith recently had the opportunity to attend a panel presen- first discovering they were gay or lesbian. This is a signifi- Hamilton tation on sexuality issues of residents in care. This work- cant issue. We are all aware that one in ten people with schiz- shop provoked me into exploring the sexual needs of ophrenia commits suicide. Did you also know that 62.5% of the aging population in a psychiatric care facility. The teen suicide attempts are made by those who are dealing Imore I thought about the topic, the more overwhelming the with the issues and isolation of being gay or lesbian? (This, task seemed. from a study by Burnaby’s McCreary Centre Society in a pro- vincially-released study, May 19, 1999). It is not an easy I asked myself, am I equipped to deal with the sexual needs world, if you belong to either of these minorities, and be- of an aging group of people who come from different cul- longing to both can be devastating. Edith Hamilton tures, different religions, different values and beliefs, and is a registered different generations? And how compatible is my culture, An interesting fact about membership in both communities psychiatric religion, beliefs, and generation with others? is that both are “invisible” minorities. If I don’t tell people nurse and man- I’m a consumer/survivor, they perceive me as a mental health ager of Birch- The answer became clearer when I asked myself, where do service provider. If I don’t describe my lifestyle, I’m not nec- wood Care my responsibilities begin, overlap and end? My job is to pro- essarily perceived as a lesbian. This makes it a matter of choice Facility, Birch- vide quality health care to a group of people, who live to- whether I disclose my mental health history or my sexual wood House, gether as a family. It is my responsibility to see that this family orientation on any given occasion. I choose not to live in any and Magnolia is taught closets, even though the alternative is risky. House in Vancouver. „ how to build self-esteem It is, however, a constant temptation to remain “in the clos- „ how to develop quality relationships et” about one or the other of these two parts of my experi- „ ways to avoid sexually transmitted diseases ence and personality. In fact, many people do. I have met „ ways to practice safe sex several service providers in the mental health field who have „ birth control disclosed to me that they have experienced a mental health „ menstruation disturbance themselves, but they have not shared that with „ menopause their employer. „ normalization of sexual thoughts, feeling and actions „ how to incorporate the expertise of individuals and agen- At an event I attended recently, two women who attended as 12 cies who work specifically with sexuality needs partners were ignored by other women whom I believed to be lesbian, possibly because the other women were “in the The workshop I attended was a kick start in the right direc- closet” about their orientation. They would have been con- tion, but it was only a start. I believe we must involve mental cerned that acknowledging the two women who were obvi- health consumers and become more skilled and educated ously lesbian would have made it obvious that they were too before we walk where angels fear to tread! — something they didn’t want to happen. Both groups of Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 sexual orientation and mental illness women lost the chance to receive support from each other. can be experiencing internalized stigma or homophobia, which they come by honestly. (We all learned jokes as chil- In either the mental health field or in terms of sexual orien- dren about “crazies” or “the loony bin;” we were almost all tation, the closet is a very difficult place to be. There is a raised in heterosexual families.) need to keep on guard constantly. Spontaneity is virtually impossible. Authenticity suffers. That is the reason I was Lastly, in both cases, the “coming out” process – the process willing to write this article when asked. None of us should of letting other people know about your mental health diag- Jill Stainsby is a be required to hide parts of ourselves in order to be accept- nosis or sexual orientation – is a lifelong one. It is necessary mental health ed in our workplace, in our social lives, or by the people to be alert when making statements that indicate that you consumer advo- from whom we receive support. are a consumer or a lesbian. Homophobia and stigma can be cate, currently found everywhere, and they have a significant, sometimes employed as a There are other common threads between the experience of deadly, effect on the lives of people with one or both of these patient relations becoming a mental health care recipient and choosing a non- labels. Internalized homophobia or mental illness can lead coordinator at mainstream sexual orientation. Mental health consumers to suicide, as I mentioned earlier. In addition, gay-bashing is Riverview often find it difficult to access support, employment, hous- a lethal risk many people face, from small communities to Hospital. She ing and so on due to stigma. Lesbians and gay men are con- the Downtown East Side of Vancouver. also works as a stantly reminded that they are not part of traditional culture, consultant. and suffer from greater or lesser degrees of homophobia. Sexual orientation and mental health issues have in com- Homophobia and stigma are both words that describe the mon that they are realities of our existence over which we experience of being rejected by society for belonging to a have little, if any, control. And they are both negatively per- group that is not perceived positively by many other indi- ceived by society. As a result, people who belong to these viduals. I think it is telling that each of these communities minority groups often look “inward,” to their own group, has found a word of its own that describes this experience for their support. The experience of belonging to each of of being rejected by mainstream culture. these minorities is very different, but the social fallout — the violence, stigma or isolation — can be similar. We need One of the things about being a member of a marginalized to accept each other’s difference. community is that it is a community. For both mental health consumers and lesbians or gay men, members of these groups have formed a community of support. In the community mental health field, peer support workers and advocacy groups are formalized ways to create community among Vision Correction mental health care recipients. Psychiatric survivors have cre- ated a strong community-based support system in the form There are six points which need to be amended on of their rebellion against the way the mental health system page 11 of the Winter 1999 edition of Visions (Pov- controls the people who are recipients of care. erty, Unemployment and Income). The article is called “The facts about CPP (Canada Pension Plan).” There is a strongly supportive lesbian community as well, though it can be both a positive and a negative force when Under the title “Criteria for EligibilityEligibility” the third bul- dealing with mental health issues. I would possibly not be let should read “applicant does not have to have a alive today if it were not for the crucial support I received specialist’s report, but this is helpful.” The fourth from friends, who were also lesbian, during my hospitaliza- bullet can be changed to state “the applicant is able tions. People who experience discrimination based on their to attend school full-time, but be considered inca- membership in a minority band together to support them- pable of pursuing any gainful employment.” selves because they must. Under the heading “Other facts about CPP,,” under The other side of the coin in terms of support from the les- the second bullet, CPP is taxable income. People bian community is the fact that there is a significant “anti- may apply for the disability amount $4,233 to help psychiatry” movement within it. This has led, in my reduce their taxes owing. This non-refundable tax experience, to a belief in the community that we are better credit is in addition to the basic personal amount off without mental health system intervention in our lives. of $6,456. Also, under this bullet, the maximum CPP In many cases this can be true, especially if you have a homo- disability rate is $903.55 per month. This is based phobic worker, but it can mean that people refuse needed on the contribution a person made while working. medications and treatments. This is not always a successful If a person receives less than $771 a month, they strategy. may be eligible for a top-up by the provincial income assistance program. 13 In both communities, there is denial. People commonly do not accept their mental health diagnosis easily, and can spend CPP is mainly considered an income security pro- a decade, or even a lifetime, in denial. Many lesbians and gram; but depending on the context, it could also gay men can describe a time in their lives when they did not be looked upon as a social program. know or accept their sexual orientation. In both cases, they Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 cross-cultural perspectives

er name was that I was still a lesbian. I rea- Jehan Mariam. She ruled A long journey: soned that if God wouldn’t Hmy world. We were intervene, then just maybe, both 13 and she was my first loving a woman wasn’t a sin. crush. Although I wanted to When cultural and proclaim my love for her to My parents felt that it was anyone who would listen, I parental attitudes toward time I got married. Even I felt ashamed and terrified of wanted relief from my life. my feelings because I was not sexual orientation lead Thus began the quest for a the opposite sex. Thus began husband. My parents knew my reign of shame and secre- women to anguish and to of a “good Muslim man” in cy which was to last for 19 England. long years. mental health services I went through the myriad That same year, my family white but she was a time relieved to see a preparations for a lavish moved from Tanzania to Van- lesbian! This bub- psychiatrist. I was wedding in a numbed and couver. Although I was fluent ble burst, howev- confused and I sometimes panicked state. Fi- in English, I had trouble un- er, when some wanted an expla- nally, on the eve of my wed- derstanding the Canadian boys from our nation for my “cra- ding, I blurted out to my accent and found it hard to class caught us kiss- ziness.” Yet the very parents that I couldn’t go keep up with the speed at ing. From then on, we act of seeing a psychia- through with it. My Dad said, which people spoke. I dread- were taunted unmercifully trist was a testimony of my “Do you want to go through ed going to school. Some and “Paki” was replaced with “craziness” and I felt deeply life as a lesbian?” I wanted to classmates would pepper me “Butch” and “Lesbo.” ashamed of my perceived ab- say “Yes, Yes.” But I didn’t with spitballs almost on a dai- normalities. have the courage. So I got ly basis. At lunch time, no one At home I became married. I was 25 and he was would want to sit near a mouthy, sullen, and an- The hourly sessions 34. The marriage lasted four “Paki.” After school I would gry. My parents would hold consisted of me venting and months. My parents were be spat on, pushed, and called marathon lecture sessions re- him writing voluminously in humiliated. I quit university “Paki” and “Hindu.” I minding me that good Mus- a note-book. I enjoyed the and went to work in the fam- couldn’t understand such lim girls didn’t behave this feeling of talking and having ily business in repentance. hostility. I was sure that way, and that being the eld- an adult take me seriously. At something had gone wrong est child, I was not setting a times I felt that he was a spy As my 30th birthday loomed with me as soon as I had ar- good example for my sisters. for my parents. Accordingly, closer, I felt that my youth had Jehan is a pro- rived in Vancouver. Back I would edit my “confes- gone and, being a repeat of- fessional health home, people didn’t react this The taunting at school didn’t sions.” When I still wasn’t fender, I was past rehabilita- care worker, way. I remember feeling an- abate and in utter despera- cured after a few months of tion. As fate would have it, I working in the gry, lonely and frightened. I tion, I begged my parents to therapy I felt even more started working in the heart Vancouver wanted so desperately to go change schools. Determined ashamed and scared that I of the gay district where I area. back to Tanzania, to Mariam. to make a fresh start at my was truly mentally ill. couldn’t help notice the ho- new school, everything mosexual goings-on. At first I don’t know when I started seemed to be going well until After a number of sessions I was disgusted at the sheer to equate being brown with a friend of the family saw with me, the psychiatrist ex- audacity of “these people,” being inferior, but I remem- Anna and myself in a “com- plained to my parents that I kissing and holding hands in ber so clearly being ashamed promising position.” My poor was a borderline lesbian. My public. Gradually, I began to of my skin colour, accent, parents. I was wracked with parents felt hopeful that I see them as individuals. My and culture. I hung out only guilt and sadness for them. I would eventually fall on the journey of self-acceptance with white girls, started felt I had failed them. “right” side of the border. had finally begun. In my smoking, and practiced Even I felt hopeful that I could more daring moments, I even speaking ‘Canadian English.’ My Dad asked, Was I a lesbi- be “cured”! saw myself being in an open At home, I refused to speak an? I said, “Yes.” He hugged relationship with another Gujarati, my mother tongue, me and made arrangements Unfortunately for them, and woman. Venturing into a gay and opened my bedroom for me to see a psychiatrist. I despite my best intentions, I bookstore was a deliciously window wide, even in win- felt so despondent and fell in love with another nerve-wracking experience. 14 ter, to keep out the smell of shameful. Not only had I woman. My parents aban- Glancing through rows of curry from mclothes. committed a sin, but there doned the psychiatrist and books about lesbians made was something wrong with turned to God, churning out me feel naughty and giddy In grade nine I fell in love me mentally. prayers in a fever pitch. When with excitement. It didn’t take with Anna. What luck and the incense smoke cleared, I long to come across a torrid joy — not only was Anna I felt ashamed and at the same was secretly relieved to find lesbian romance. I bought it

Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 challenges of dating People Just Want to Connect! Can psychosocial rehabilitation programs help people enter the dating game . . . even to find love?

n the emphasis to treat mental illness, many mental “Psychosocial rehabilitation programs don’t talk about sexu- Dena Ellery health providers and support programs can overlook one ality,” says the support worker, “we sweep them under the car- Iof the most important aspects of a person’s recovery — pet.” This is echoed in a report published by the Psychosocial their sexual and/or relationship health. Some mental health Rehabilitation Journal, where a review of 15 years of journal support workers when interviewed said that they have worked articles revealed only three articles devoted to sexuality (with with men who are virgins at the age of 40. These men said none appearing since 1984)1. explicitly that they would like to have a girlfriend. Yet the op- portunities for dating are restricted, and organized support Niles agrees that people basically want to connect. His educa- for helping people to enter the dating game are limited, if not tion program would suggest that drop-in centres or clubhouses nonexistent, say support workers. host a ‘Loveability Group’ for example. A support group such Dena is the editor as this would help people with dating skills by addressing per- of Visions Barry Niles, Executive Director of the Mental Patient’s Associ- sonal hygiene and appearance as a starting point for attract- ation in Vancouver, says that the need to address sexuality spe- ing someone. “I suggest to people they go look in the mirror cifically within the context of rehabilitation has been largely and tell me what would be attractive?” The group would help ignored. “People assume that they’re mentally ill and don’t have members identify what members would have to do to enter the same urges as anyone else.” the dating game.

Niles developed a program on sexuality education for people And as people progress along the dating game, Niles points with mental illness which he says has been stuck on a shelf out that disclosure of one’s mental illness is always a key ques- due to lack of funding for over nine years. In his researching tion. In his own dating, Niles found this to be a sticky situa- for this program, Niles found that people with mental illness tion. “When does somebody disclose?” he asks. Niles found ______had little or no ideas about creating healthy sexual bounda- that timing was an interesting dilemma, since revealing his 1 Psychological ries, were exhibiting inappropriate sexual behaviour, and had history of mental illness could slow or stop the progress of a and Social less access to education about sexually transmitted diseases. relationship altogether. On the other hand, he found that wait- Aspects of Psy- ing too long to tell someone made them feel as though he was chiatric Disabili- Mental health workers interviewed for this article said the same deceiving them. “It can have a major impact on whether it [the ty, LeRoy Spaniol, thing. One support person said he observed men who had no relationship] is successful or not,” he says. Cheryl Gagne contact with women on a regular basis except for the women and Martin who worked at their clubhouse. “The women there are friend- Niles and others agree that more education and openness about Koehler, eds. ly to them and many men become infatuated . . . and you end sexuality is a positive aspect of recovery for anyone living with Boston Centre for up with a worker who has 15 men following her,” the support mental illness. “When you see what really drives people, they’re Psychiatric worker (who asked not to be identified) said. looking to connect. It’s a huge driving force,” says the mental Rehabilitation, health worker. 1997. (page 20) on the spot. I had tasted for- dened and angered me a non-judgmental. What My mom was surprisingly bidden fruit and I wanted great deal. Only Alicia, the fa- struck me most was the reas- calm. I sensed that even more. cilitator, seemed to treat me surance that I could talk though I had confirmed her as an equal. about my sexuality without worst fears about me, she felt I had been aware of various going into an automatic cen- relieved that it was finally out lesbian coming-out support Alicia was seeing a lesbian sor mode or fearing that the there. We had, and still have, groups and finally sum- therapist and spoke glowingly listener might recoil in dis- many discussions: heated, moned up the courage to go about how she had helped gust. Gradually I felt strong sad, or even funny. to one. In my eagerness to her cope with difficult issues. enough to talk to my parents. belong, I downplayed my Although wary of therapists Throughout this period I nev- “South Asianness,” hoping because of my earlier expe- On the day of “the talk,” I felt er once regretted facing the that the all-white group rience with the psychiatrist, none of the catatonic fear or truth about myself. Dealing 15 would notice only my lesbi- the prospect of a lesbian ther- shame that I thought I would. with homophobia, both inter- an connection. I had an un- apist appealed to me. My dad’s reaction was, “Well, nal and societal, was a lot eas- questioning belief that if it’s sex you want then have ier than facing the terrible lesbians couldn’t be racist. My therapist was under- it. But one day you will have prospect of living a lie for the Finding out otherwise sad- standing, compassionate and to settle down with a man.” rest of my life. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 the decision to parent

specific medication informa- tion you may call the phar- The Decision to macists at SMIL: 822-1330 or 1-800-668-6233).

As of 1996, the US Food and Become a Parent Drug Administration had not yet approved any type of antipsychotic medication to worsen during pregnancy, of a person living with schiz- be used during pregnancy. and the risk that the child ophrenia has a 10 to 15 per- However, some drugs do not may be affected by the moth- cent chance of developing carry as many risks as oth- er’s medication. In this case, schizophrenia. When both ers do. A woman living with awareness of the issues may parents are affected, the schizophrenia should dis- be the next best solution to chances jump to 40 percent. cuss the following risks and ne possible outcome in an planning. As well, one in two children side effects of the medication intimate, sexual relationship with a parent who lives with with her doctor: Ois to become pregnant and Having said this, having a schizophrenia will develop a have a baby. Bringing a child child can also be a truly pos- mental illness, including de- The possibility of into this world is a decision itive experience for some pression, schizophrenia or „ Birth defects that should be made with women living with schizo- another illness. „ Accumulation of the careful thought and plan- phrenia. It has been found drug in fetal serum (flu- ning. This decision is even that 59 percent of women The questions above imply id in the womb) more grueling when you add who live with schizophrenia that in the ideal case, one „ Symptoms of withdrawal mental illness to the equa- report that their mental should be able to keep and a child may have from tion. The articles below fo- health worsens when they raise one’s own children. In the drug Marie- cus on different aspects of are pregnant. However, 29 the past, most women living „ Effects on the child’s Claude parenting and how these are percent of women (nearly a with schizophrenia lost their growth Lacombe, impacted by mental illness. third) actually report seeing child to social services at „ Jaundice in premature with Sharon However, in no way do they an improvement in their birth. Now, the majority of children von encompass the whole topic. mental health during their women are able to keep full Volkingburgh pregnancy.1 “And for many or partial custody of their According to the National Schizophrenia, women, having children to children. Institute for Mental Health, Women, and Children love and be responsible for trifluoperaxine and ha- is an important key to being Medicating during loperidol are two drugs that As is often the case with in recovery from mental ill- pregnancy show the least side effects for issues dealing with mental ness.” 2 Once pregnant, the woman both the mom and the child. Marie-Claude illness, research on schizo- living with schizophrenia Clozapine and chlorpro- Lacombe is a phrenia and pregnant wom- Making the decision must decide whether to keep mazine should be avoided as communications en is limited. There have Here are some questions to taking antipsychotic medica- they have serious side effects student at Simon been some studies published ask when making the deci- tion or to stop medication on the baby. In addition, cig- Fraser University but the bulk of the data re- sion to have a child: and risk a psychotic episode. arette smoking while on an- in Burnaby, BC. lating to antipsychotic Both options include risks tipsychotic medication may She is on a work medication was collected 1. Is my illness sufficiently to the mother as well as also increase the risk of birth term with the on women who had health under control? If I have the child. defects in babies. Canadian Mental problems other than to work full-time in or- Health Associa- schizophrenia, and the med- der to support my chil- Rola Khalil-Priatel, Pharma- It’s a girl! It’s a boy! tion, coordinat- ication was usually admin- dren, can I do it? cist Coordinator at UBC’s Once the baby is born, Mom ing National istered in lower doses. 2. Will the stress and ex- Seniors Medication Informa- must face many other issues Depression pense of raising children tion Line (SMIL), explains that affect both her and the Screening Day. Women living with schizo- cause me to become ill the importance of an open baby’s health. It is important phrenia must especially again? discussion with your doctor. for a mother not to neglect weigh their choices when 3. What if my children in- “In general, some psychiat- herself. To be the best moth- deciding to become mothers. herit the illness? ric medication can be used er she can be, a woman must 16 There are many obstacles to 4. Is my partner a capable during a pregnancy but the have good mental and phys- consider. Unplanned risks person who can help pro- benefits must outweigh the ical health. Among many include the chance of pass- vide a secure and peace- risks.” And because each in- parenting challenges, the ing on schizophrenia to the ful home for a child? 3 dividual is different, she most common among moth- child, the chance that the adds, “an assessment should ers with schizophrenia is woman’s mental health may Statistics show that the child be made by a specialist.” (For their difficulty seeing, un- Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 the decision to parent derstanding and figuring out Dawn. The majority of the either depend on the child to is not yet in effect, these nonverbal cues expressed by time, Dawn meets each mom become a caregiver, or they materials can be very help- their children. It has also individually and lends an ear may lose custody of the ful as a model of a care plan. been reported that many to them. She may offer coun- child, which is many par- women who have schizo- selling on the next steps the ents’ worst fear. It is impor- A basic model of a plan for phrenia are afraid, with rea- mothers should take, but tant for parents who have an the care of children in case son, of having their child what they need most, she illness with severe recurrent of a mental health relapse taken away by social servic- says, is somebody to listen to symptoms to make plans for should include the following es. In fact, this remains the their plight. Dawn is much the care of their children, in elements: dark reality for many wom- like an attentive friend there case they suffer a relapse. „ Who: list people named en who have a mental illness when her moms need her. When there is a plan, care in the agreement and (read Dawn’s story below). can be provided for both the phone numbers; list peo- However, custody is often Dawn sees child apprehen- ill parent and the child in ple to be informed about better off kept by the moth- sion as a life sentence for alliance with the parent’s the agreement. er. According to the Nation- mothers. The best she can do wishes. „ Purpose: e.g., “The pur- al Institute of Mental Health, for her moms if this hap- pose of this agreement is if the child’s basic needs are pens, is to be there for them Developing a care plan is to provide a clear set of met and there are no signs and listen to them express therapeutic in itself, as the guidelines to be taken by of abuse or neglect, children their feelings. Depending on parent realistically faces the members of my support should be left in the moth- the situation, she also sug- impact of his or her mental system if I exhibit symp- er’s custody. gests they get job training, illness on the child, and takes toms of my illness which In addition, she suggests that steps to build a support net- interfere with my ability It’s often said that to become mothers find employment, work for the family. Parents to provide good care to a parent is one of most re- which can help her moms who have made such a plan my child.” warding experiences in life. gain back their confidence have been surprised at the „ My symptoms: list Women living with schizo- and prove that they can take positive response of friends symptoms that the person phrenia should not be afraid care of themselves. For more or family when they have making the agreement to think about becoming information, call Dawn at asked them to make a com- would like others to no- mothers. However, a future 604/871-0151. mitment to help in the case tice and respond to, and mother should be aware of of a future crisis. Friends, describe the most helpful way to respond. her options and resources Parents with mental family and community „ Plan of action: Record including all the support and illness: specific issues workers often stand back help available to her from when problems related to how the writer would like (Sharon Van Volkingburgh) the community, the medical the illness are developing, to deal with the issue of field, and her family. Parents have spoken about wanting to help, but worried confidentiality and attach the benefits of raising chil- about going against the ill signed consents if de- sired. Even with consent, Mothers in transition dren, such as the love and parent’s wishes. Knowing in pleasure that both the par- advance what role the par- no more information Dawn has 31 moms. She is a ent and the child enjoy, and ent would like them to take than is necessary for the busy volunteer worker who the pride that they have in gives people confidence that implementation of the runs ‘Mothers in Transition,’ their parenting skills and they’re doing the right thing. agreement should be a support program for moth- their children. Children pro- shared. ers living with a mental ill- vide meaning and a voc- Proposed adult guardianship „ Record the writer’s ness whose children have ation in life, as well as legislation, under the Repre- wishes for support serv- been apprehended. She finds motivation for many people sentation Act, will allow ices: These are wishes for it easy to relate to the moth- to keep well. adults to authorize a repre- the care of the child; in- ers as she too has lived sentative to hold particular clude any information through it before. Dawn ex- The symptoms of mental ill- powers that the person about special needs. plains that most mothers are ness can cause parents to be agrees to in advance. For ex- „ Cancellation: describe single and have had their unable to provide the quali- ample, representatives will the manner in which the children taken away. She ty of care their children be able to arrange for the agreement can be can- attributes this to the lack need. During a mental temporary care, education, celled. The purpose of the of support and understand- health crisis, the parent may and financial support of agreement is so that it ing women have found not be able to communicate children, as described in the cannot be easily cancelled within their family and well with others, or to prop- agreement. Materials to help when the writer is acutely 17 their community. erly focus on their child’s people develop representa- ill, so it’s wise if the proc- needs. In some cases the ill- tion agreements are availa- ess of cancellation re- “Most of my moms just want ness may cause the parent to ble from the Coalition of quires a period of time contact with their children; be unable to care for them- People with Disabilities in and a set of steps. they love them terribly,” says selves, and the parent may Vancouver. Although this act „ Review: Describe how over Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 the decision to parent (cont’d) sex and sexuality problems

and when the agreement will be reviewed (at least annu- ally). Greater Vancouver A working group recently formed at Greater Vancouver Mental Health to develop better practices to assist parents and children in families where a parent has a mental illness. Offers Unique Help Your input is welcome; phone Sharon Van Volkingburgh at 874-7043. part from the serious What we do issues of drug side When kids are in control A effects and concerns Most of what we do is clini- about HIV/AIDS, many of cal (i.e., understanding and Life can be tough living with a parent who has a mental the sexual needs of those suggesting treatments for illness, especially for pre-teens. This is why the British Co- with a mental illness are giv- sexual problems) but some lumbia Schizophrenia Society (BCSS) put together a program en minimal attention by is also educational. Whatev- for kids ages 8 to 13 who have a parent with a serious men- health professionals. At the er we do clinically almost in- tal illness. The Kids in Control Support Group Program is a same time, sexual problems evitably includes an form of primary prevention that offers information, educa- in those with a mental illness educational component as tion and support. BCSS has observed that these kids face are probably more common well. In thinking about sex- unique challenges. These challenges put them at a greater than in a healthy population ual matters, the two issues risk. They don’t fit in as well in their social circles at school (see page 3). In an attempt are difficult to separate. or extracurricularly. And they have a higher risk of being to remedy this situation, we diagnosed with a mental illness themselves. established a service for Each person with a mental those who have both a men- illness cared for by GVMHS The Kids In Control support program is a series of education tal illness and a sexual con- is assigned to both a psychi- sessions that helps kids learn more about mental illness and cern, and who are also atrist and primary therapist, helps them find ways to cope with being the child of a par- receiving care from the and referrals to our clinic are ent with a mental illness. Greater Vancouver Mental made by either individual. In Health Service (GVMHS). spite of the notion of priva- For more information on the Kids in Control program, please cy that most people associ- contact Hylda Gryba at 604/864-9604. Who we are ate with talking about sexual matters, we discovered ear- New program for mothers Both of us have had a long- ly in our experience that standing professional inter- GVMHS clients are almost The Mental Patients’ Association also has a support program est in sexual issues. One (RS), always more comfortable in the works. The program is for unmarried, mentally-ill has written a sex education- meeting with us while their mothers who are pregnant or have a child under the age of focused two-volume book in primary therapist is also two. The program will offer individual support to a small Punjabi. The other (WLM) present. We candidly discuss number of women and will aim to keep families together as has worked as a Sexual Med- sexual concerns, provide ed- much as possible. The program recognizes that for many icine specialist within his ucational input when need- people, having children to care for and love is an integral career as a psychiatrist, has ed, and report to the part of recovery and rehabilitation, and has a non-judgmen- taught Sexual Medicine to referring professional with tal approach to parenting. For more information, please call medical students and resi- recommendations. Increas- Jirina Judas at 604/738-2811 ext.128. dents while working for ingly, we are also arranging UBC, and has recently pub- follow-up visits. Upcoming Forum: lished a book for health A group of community agencies, including the BC Schizo- professionals — Sexual We also encourage contin- phrenia Society, North Shore Family Services, Chilliwack Medicine in Primary Care ued discussion of sexual Mental Health, CMHA, BC Women’s Hospital, and GVMHS (see “Book Reviews”). Our matters after the visit be- are planning a provincial forum on the topic of Parental Men- past clinical experience had tween the primary therapist tal Illness on September 30, 1999 at the Roundhouse Com- primarily been with individ- and the person who has been munity Centre in Vancouver. Information about registration uals and couples who may referred. Part of the purpose will be available soon at the agencies listed above. have had some psychological of seeing both the primary ______or interpersonal difficulties, therapist and person with a 1 Percentages taken from “Sexuality and Family Planning in Women with but were otherwise physi- mental illness together is re- 18 Schizophrenia,” by Laura J. Miller, 1997 — Medscape, www.medscape.com/ cally and mentally healthy. lated to the comfort and con- govmt/NIMH/Schizo...04/sb2304.06.mill/pnt-sb2304.06.mill.html Nevertheless, our collective tinued attention to the 2 National Post, "Giving birth to madness," March 9, 1999, p. B1) knowledge and experience individual’s sexual matters. allowed us to redirect our This also enhances the com- 3 Questions from the BC Schizophrenia Society Booklet, “Basic Facts About focus in recent years to fort and skill of primary Schizophrenia: Youth’s Greatest Disabler,” March 1999 people with a mental illness. therapists in talking to Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 sex and sexuality problems Sexual Medicine Consultation Clinic for Individuals Experiencing Sexual Problems

people, for whom they are range of problems. (We are ual arousal. He had a bipo- years prior. Within one to Rajpal Singh, professionally responsible, far from expert in every- lar disorder, was treated two months of beginning PhD and about sexual matters. thing; if we can’t help di- with medications and risperidone several years be- William psycho- fore the current visit, she (Bill) L. In addition to talking to in- therapy, noticed an even more sub- The Sexual Medicine Clinic is located Maurice dividuals who have been re- and was stantial decrease in her sex- at the South Team of Greater MD, FRCP(C) ferred, we have also met living ual desire level. Her serum Vancouver Mental Health Service. with groups from several alone. His prolactin level was found to Both clients of the mental health GVMHS teams to provide erection, be high and this was thought system as well as providers can con- sex-related information and ejacula- to be one of several possible Rajpal Singh, tact the service at 604/266-6124. answer related questions. tion and explanations for her sexual PhD works with orgasm concern. She was switched to the South Mental Health Team of How we do it rectly, we usually can find function were all normal. He another medication which others in the community was mostly unaware of the did not have the same effect the Greater Van- Sometimes the two of us who can.) Most difficulties harmful effects of nitrates on her prolactin levels and couver Mental work together. At other are related to sexual function and after lengthy discussion she noticed beneficial effect Health Service times, one of us (WLM) will (e.g., erection and ejacula- about the health conse- on her desire, though not to and at the see the person with a men- tion problems in men, sexu- quences of their use for the the level that existed prior to GVMHS Sexual tal illness and sexual con- al desire concerns in both purpose of sexual arousal, the onset of her illness. Medicine Con- cern together with a UBC men and women, orgasm he concluded that this prac- sultation Clinic. psychiatry resident (a phy- and coital pain difficulties in tice would be substantially Future Considerations sician who is studying to be women). However, people diminished. When we saw a psychiatrist). The purpose have also come to us with him again, later, he report- The most urgent priority in is to provide an educational concerns about gender is- ed that he had not used pop- planning for the future of William (Bill) L. experience for the resident sues (unsure if they are a pers since the previous visit. our service is the inclusion Maurice MD, to consider sexual matters in man or woman), sexual of a woman health profes- FRCP(C) works at the care of those with a abuse in childhood, and di- A 50 year old woman was sional. In an area as sensi- the Division of mental illness. lemmas about sexual orien- referred to the clinic because tive as sexual issues, and in Sexual Medicine, tation. Two cases follow: of diminished sexual desire. a service that is available to Department of Problems we see Her psychiatric diagnosis both men and women who Psychiatry, UBC A 30 year old man was re- was schizophrenia and this have a mental illness, hav- and at the Our definition of the word ferred because of his contin- had been treated with vari- ing representation by both GVMHS Sexual “sex” is quite broad, so we uous use of “poppers” ous medications since her genders on a treatment team Medicine Con- encourage referral of a wide (nitrates) to enhance his sex- disorder began about 10 is, in our view, essential. sultation Clinic. When You’re Scared to Death of Sex

n a sex-focused society like ours that encourages the What are sexual Sarah Hamid pursuit of physical pleasure, people whose sexual aversions and phobias? Sarah is an SFU problems are rooted in fear and avoidance of sex can Communications often feel like “abnormal” outsiders. But their prob- Dr. Kaplan suggests there are two classes of sexual avoid- and English un- lem is more common than they may think with sexu- ance behaviour. The milder one, sexual aversion, describes dergrad doing a al avoidance as the major complaint of many people people who are comfortable enough engaging in sexual ac- work term with I seeking sex therapy. tivity but who avoid it out of disinterest. At the other ex- CMHA-BC. She treme are people with sexual phobias. coordinates So how does the beauty of human sexual intimacy become a the Open 19 frightening and unrewarding experience? With help from People can develop phobias — unrealistic fears and panic Mind Media Dr. Helen Kaplan’s book Sexual Aversion, Sexual Phobias, for specific objects or situations — to a lot of things. Snakes, Watch Program and Panic Disorder (Brunner/Mazel: 1987), this article will heights, elevators, and flying are possible scenarios that can and is a mental attempt to shed light on this disorder. make a lot of us uncomfortable, petrified, or some feeling in health consumer between. over herself. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 sex and sexuality problems

People with sexual phobias by detaching or distracting Chemistry have very strong and active themselves, feeling as if This theory claims that peo- aversions to sex though they they’re in a dentist’s chair ple with sexual aversion dis- may experience normal feel- (as one woman put it) and order live with a biological ings of desire and arousal if they just hold on a bit, it problem which leaves a per- What during masturbation. Unfor- will soon be over. son with an unusually low tunately, a partner’s touch physical threshold for the Sexual revolts them. They usually WHY do these fight-or-flight “stress” re- realize the fears are illogical disorders exist? — sponse. This dysfunction ociety and psychiatry but feel powerless to change Four Explanations would make it easy to devel- have a habit of making them. Instead, individuals op phobias as the body’s way Sdistinctions between are left with feelings of anx- Fear of making sense of these what is “normal” and “ab- iety, depression, and guilt for Psychoanalysts believe it’s anxious “alarm” responses. normal” behaviour. And the effect the aversion is hav- sex and fear coupled early in Certain antidepressants have perhaps nothing has felt the ing on their relationships. life that lead to sexual pho- proven useful in helping to impact of this practice more bia. Parents who convey relax an easily-agitated than the spheres of sex and Triggers negative-, guilt-, or fear- nervous system. mental health. Like the men- based attitudes toward sex- tally ill person, the sexually Some people are totally pho- uality create sexual conflicts Seeking Help deviant person is also seen bic or scared of sex and have in their children that could by many to live on the side panic attacks in response to persist into adulthood. Absence of physical sexual of the must-be-abnormal most erotic sensations. In gratification aside, sex is a and the must-be-treated. other cases, a person’s pho- Trauma fundamental human experi- The problem created by this bic response is limited to a According to learning theo- ence with profound impacts judgment is one of social specific aspect of sex such as rists, sexual phobias result on a person’s entire being. “norms” and perceptions. „ being seen (or seeing from a person experiencing When the fear of sex con- someone else) naked sex and pain together (both trols a person’s life, love, in- Cultural norms and percep- „ genitalia (your own or physical and emotional timacy, marriage, children, tions about sex may prefer to your partner’s) pain). The body’s memory of and gender esteem may all be marked out in concrete „ the act of penetration or this association between sex suffer as well. but they end up sketched out being penetrated and pain is strong enough in shifting sand. What may „ orgasm that the central nervous sys- Anyone can have a sexual seem “deviant” or eccentric „ sexual fluids/odours tem decides to defend itself phobia. You can be single, sexual expression to one In these cases, people may against future trauma by dating, or even married. You person may appear “nor- enjoy sex and function nor- avoiding whatever it was can be male or female. You mal” to another. So where do mally as long as they can that took place when the can even have a history of we get our ideas of what de- manage to avoid their par- pain occurred — in this case, pleasurable sexual experi- viance is versus behaviour ticular phobia. sex. This learning theory is ences. Whatever your situa- that abides by norms of so- most relevant for cases of tion though, there is help if cial acceptability? And at Response Intensity rape, incest, humiliating sex- you are motivated to recov- what point would a sexual ual failures, or painful dis- er your ability to be sexually practice cross the line and be People living with sexual appointments in love that intimate. Your family doctor considered a mental health aversion disorders will in- have lead to future anxiety. can refer you to a relation- problem? This is where psy- stinctively avoid sex as much ship or sex therapist. Local chiatry comes in. as possible. Sometimes Habit mental health clinics can though, they find themselves According to another kind of also hook you up with sup- In the psychiatric field, sex “trapped” into having sex learning theory, sexual anx- port groups for other people and mental health come to- because of love, pressure, or iety comes from the guilt with psychological sexual gether in the Diagnostic and fear of losing their partner. about sexual pleasure that problems or other people Statistical Manual of Men- Once they are actually in a many youngsters come to wanting to break free from tal Disorders or DSM-IV. In sexual situation, there’s a feel when they internalize the chains of a phobia. For this manual, used by psychi- considerable range in the their family or culture’s re- even more proof that there’s atrists and mental health cli- intensity of their response. peated, negative sexual mes- hope, just consult Dr. Kap- nicians to determine the sages. For instance, the young lan’s book. It’s filled with nature and scope of a per- 20 People with mild phobias are bride who has lived through case studies of couples who son’s mental illness, a specif- often able to calm themselves years of being terrified and have been treated success- ic section is devoted to of their pre-intercourse jit- disgusted with premarital fully and are now able to sex-related disorders. Para- ters to the point of actually sex may still feel sexually ter- enjoy sexual intimacy — philiasphilias, the various kinds of enjoying sex. Others with rified and disgusted come either again or for the first sexually deviant activities more severe responses cope honeymoon time. time ever. outlined in Table 1, are a Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 sex and sexuality problems is “Normal” Sexuality, Anyway? ‘deviants,’ social norms, and mental health

group of sexual disorders in Deviance is that which Other cultural biases shown to be linked with Sarah Hamid this section. causes distress: i.e., “I that cloud the issue criminal intent or mental ill- don’t feel good or right ness. In the process, the me- Paraphilias can be defined doing that” Media. The only deviants we dia urges citizens to ignore by frequent and intense Does that mean pedophiles know are the ones who are all the other unknown peo- TABLE 1: “sexual urges, fantasies, and shouldn’t be treated if they brought into the open. And ple taking part in similar Name and behaviours that involve un- aren’t distressed about their the media makes sure the sexually deviant behaviour Focus of usual objects, activities, or behaviour? Whose distress deviants we find out about but who are discreet and le- Clinically- situations” (DSM-IV, 493). matters more? Who has the are the sensational and ex- gal about the activities per- Recognized People with paraphilias are right to decide? treme examples somehow formed in the privacy of Paraphilias * considered by both the med- ical and lay communities as Name of Paraphilia Source or behaviour leading to sexual satisfaction the sexual ‘deviants’ of our society — the so-called fetishism inanimate objects (called "the fetish." E.g., shoes, boots, undergarments, “weirdos” who “get off” in leather. Does not include objects such as vibrators which are “unusual” ways. But despite specifically designed to stimulate the genitals. the incredible stigma at- transvestic fetishism cross-dressing (when not related to gender identity problems) Sarah is a tached to this perception, 4th-year paraphilias receive little de- voyeurism spying on others, usually strangers, while they engage in some private student at bate by the very communi- behaviour (e.g., going to the washroom, undressing, having sex) SFU and ties that define them as mixoscopia watching others engaged in sexual acts (a specific form of voyeurism) oversees the Open deviant. exhibitionism exposing genitals to unsuspecting strangers in public places Mind frotteurism touching or rubbing against a non-consenting individual. Usually Program Possibilities for defin- occurs in crowded places (e.g., rubbing genitals against victim's thighs at ing deviance — and or buttocks, fondling genitals or breasts with the hands) CMHA’s why they don’t work sexual sadism discipline. Humiliating and/or inflicting pain on others BC Three models come easily to Division sexual masochism bondage. Humiliation, suffering, and pain at the hands of others mind as ways of defining Office. She and thus identifying devi- pedophilia exclusively desiring sexual activity with pre-pubescent children is also ance: gerontophilia exclusively desiring sexual activity with the elderly (when no genuine a mental affection exists) health Deviance is that which is consumer. uncommon or unpopular: telephone phoning a non-consenting individual and trying to obtain and/or i.e., “Nobody else does scatologia deliver information of a sexual nature (i.e., "obscene phone calls") that” sexual self-mutilation inflicting pain and/or damage on one's own body But does that mean that your autoerotic asphyxia artificially restricting one's own oxygen supply neighbour who collects troll dolls needs to be treated? partialism exclusively desiring and fantasizing about a specific part of the body that is not a genital organ (e.g., feet) Deviance is that which saliromania deliberately dirtying or damaging women's clothing, statues, or isn’t socially accepted and paintings of nude females so makes others uncom- fortable: i.e., “Nobody ever zoophilia / bestiality desiring sexual activity with or around animals does that here” necrophilia desiring sexual activity with or around corpses So what about the student coprophilia sexual activity involving feces who’d rather sing in the 21 school hallway than yell? klismaphilia sexual activity involving enemas Should she be treated? Why urophilia sexual activity involving urine — if she’s not hurting any- one? * this list goes beyond those paraphilias listed in the DSM-IV; many exist in combination

Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 sex and sexuality problems

their bedrooms. between consenting individ- “. . . there is no form of sexu- other Eastern cultures, for al activity that is not deviant uals — and a paraphilia. at some time, in some social example, citizens are taught Clinicians’ Education. Psy- Table 2 could be a guide location, in some specified to enjoy masturbation and chiatrists and psychologists here, though by no means a relationships, or with some even childhood intercourse partners” (Gagnon and Si- take courses in abnormal definite answer. Unfortu- mon, 1968: 107) without feeling guilty, yet psychology in university. nately, when it comes to pri- have the cultural taboos we Table 2: Does studying mental health vate behaviour most of us The quote above stresses the normally attach to sex di- When Should issues as deviant, disordered, won’t even readily admit to importance of recognizing rected instead at food (Plum- You Think or abnormal reinforce soci- when surveyed, there’s no how culture and circum- mer, 70). Sexual norms, About Seeking ety’s conception that psycho- way of knowing where that stance help make concepts then, are only what we make Treatment or logical differences mean line is or just how many of like “normality” or “devi- them. Changing Your someone is deviant and ab- us really secretly love to ance” flexible. For the pur- Sexual normal? Should everything dance near it. Of course, the poses of our discussion, we’ll In sum then, social groups Behaviour? that is “different,” “un- more of us that do, the less define culture as a social around us create deviance by deviant ‘devi- group, its environment, and making rules that when up- When should you seek treatment? ance’ becomes. the unwritten code of be- held make one “normal” and haviour we are supposed to when broken make one “de- If your behaviour: consent to when we choose viant.” So why is this useful A better ❑ breaks the law to live in a particular part of to know? Plummer says that definition ❑ hurts or victimizes others physically or the world. Sociologist Ken- being aware of society’s role psychologically A more adequate neth Plummer notes that de- in constructing deviance ❑ stops being a private activity definition of de- viance in Western culture helps remind clinicians and ❑ involves non-consenting individuals viance in terms (i.e., English-speaking coun- the general public to consid- (including individuals unable to give or of our discussion tries) is defined by an unspo- er the ‘deviant’ in relation to deny consent) of sexuality ken social understanding those groups and individu- ❑ causes you psychological distress might include that “normal” sexuality has als who define him or her as ❑ endangers your life or physical well- ƒ an acceptance three requirements for cul- one. Then, if sex and devi- being that deviance as tural acceptance: ance are indeed negotiable ❑ so preoccupies you that the compul- we know it is 1. the biological goal of and evolving ideas (for ex- sion to perform it interferes with your simply norm- heterosexual vaginal in- ample, as we have seen them normal daily activities and relation- violating be- tercourse (including sex- be for homosexuality and ships haviour, or in ual arousal toward a masturbation in recent ❑ in its intensity and/or frequency, is other words, person of the opposite years), we may be better able even beginning to cause resentment behaviour that sex rather than an object to identify opportunities to or discomfort in your consenting has rebelled or animal) (from Moth- advocate for gradual revi- partner(s) against the er Nature) sion of the rules over time. ❑ has become a substitute for, rather than “norms” or 2. a straightforward se- part of, a meaningful relationship with codes of proper quence of “normal” sex- another person; that is, the solitary be- conduct pro- ual development from haviour allows you to avoid intimacy moted by a par- childhood to adulthood ticular society (from Freud) (but which may known” or “other” undergo not harm anyone or be 3. and for many still, the rehabilitation? criminal in nature) need for marriage first ƒ a change of language (from various religious Sexual liberation move- from ‘deviance’ to ‘differ- doctrines). ment. Since the sexual rev- entiation’ or ‘variation’ olution of the ‘60s, we have (or ‘crime’ if a deviant These perceptions are part been encouraged to tear behaviour becomes a of the North American cul- ______American Psychiatric Association. down sexual barriers and criminal issue) tural heritage that influenc- Diagnostic and Statistical Manual bring fun, experimentation, ƒ the existence of a check- es our judgments about what of Mental Disorders: DSM-IV. 4th and exoticism into our sex list like Table 2 with an is healthy sexuality and what ed. Washington DC: R.R. Donnel- ley & Sons, 1994. lives. While there are clear array of points to consid- isn’t. We may feel guilt if we laws defining the criminal er when deciding wheth- deviate from such norms Gagnon, J.H. and Simon, W.S. “Sex- 22 nature of certain paraphili- er a sexual deviant ought because these perceptions ual Deviance in Contemporary America.” Annals of the American as, there’s definitely a grey to be treated at all often become tied to moral Academy of Political and Social Sci- area between an exotic turn- equations of “normal” as ence, 376: 1967. 107-122. on — the harmless, non- “right” and “abnormal” as “Normal” Sexuality = Plummer, Kenneth. Sexual Stigma: compulsive playing out of What a culture “wrong.” However, Western An Interactionist Account. London: ‘naughty’ or ‘kinky’ fantasies decides is acceptable morality is not universal. In Routledge & Kegan Paul, 1975. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 sex and sexuality problems When Interest in Sex Resumes: What to know excerpted from the BC Schizophrenia Society newsletter Dr. Ruth hen an individual’s interest in sexual relationships leakage of milk in individuals who are not breast-feeding. Dickson Wresumes, it is usually a sensitive issue for both the in- These side effects are not visible but may be bothersome and dividual and family members. With reduced symptoms and embarrassing to the person experiencing them. Alternatives Dr. Dickson is an fewer drug side effects, persons who have expressed little or to older antipsychotic drugs and risperidone are clozapine, Associate Profes- no interest in romantic relationships may begin to do so. olanzapine and quetiapine, which are prolactin-sparing. sor of Psychiatry This may be a signal that an individual is feeling solid in Switching to these compounds may resolve some side effects. at the University their sense of self and feeling more prepared to seek inti- of Calgary; Chief, mate relationships. For example, a woman may have stopped having regular Division of Spe- menstrual periods, a known side effect of antipsychotic treat- cialized Services, The older antipsychotic drugs and risperidone usually work ment. With a change to a new drug, her periods may resume, Department of for people with schizophrenia by blocking dopamine, an along with her ability to conceive. It is important that pa- Psychiatry, Cal- adrenaline-like substance produced by the body, at the pitu- tients are aware of the possibility of resuming sexual rela- gary Regional itary gland. This process, however, may cause the body in tionships and receive education about contraception, Health Authority; turn, to produce high levels of the hormone prol- sexually transmitted diseases, and relationship and advisor to the actin. Prolactin can contribute to sexual dysfunc- issues. Schizophrenia tion, menstrual disturbances, and may cause Society of Alberta.

Depression right mood, Meston says. medicines can kill It’s been assumed for more than 30 years that female sexual arousal is aided by a state of deep re- women’s sex drive; laxation, she says, and not by physiological changes such as activity can increase it, increased heart rate and blood flow. Meston has found that such physiological changes are key find BC researchers to arousal. And she says sex therapies that focus on in- ducing a deep state of relaxation in women are actually ommonly prescribed medicines for high blood pressure counterproductive. Cand depression can kill a woman’s sex drive, according to West Coast researchers who have taken an inside look at Her research indicates that women with arousal problems female arousal. might be well-advised to hop on an exercise bike before jump- ing into bed. Vigorous exercise can have a very a significant Excerpted from Their work, conducted at the University of BC and the Uni- effect,” says Meston. the Vancouver versity of Washington in Seattle, is leading to new under- Sun standing of how the nervous system affects sexual activity in Metson’s research was conducted by getting her volunteers, women. heterosexual women 18 – 44, to ride an exercise bike for 20 minutes to increase their heart rates. The women then in- “There’s a very, very high incidence of sexual side-effects sert a tampon-shaped device called a photoplethysmograph associated with antidepressants,” says Dr. Cindy Meston, who into their vaginas. It measures vaginal swelling and contrac- notes that 10 to 40 percent of women on Prozac and other tions. Metson then gets her volunteers to watch short videos, antidepressants report a decline in sexual drive or inhibi- one a travelogue on Antarctica and another a sexually ex- tion of orgasm. plicit film clip.

More than seven million prescriptions for the drugs are now Meston has shown that the vigorous bike ride facilitated filled by Canadian pharmacists each year. arousal in women with normal sex function as well as those with low sex desire. The photoplethysmographs monitored Contrary to common belief among sex therapists, a marked increase in vaginal blood flow and pulsing in wom- female arousal involves a lot more than being in the en who’d ridden the bike before viewing the movie.

Presented by BC Woman Magazine, the focus of the 23 show is to provide women with ideas, information and The 1 9 9 9 BC Woman Show inspiration for their health, home, business, money, October 2nd & 3rd beauty, leisure, safety and well-being. Please call Vancouver Trade and Convention Centre 1-800-555-8222 in September for more information.

Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 sex and sexuality problems Medications and Sexual Problems QP Dena Ellery able 1 below is a list doctor can work to find al- on your sexual functions. It’s important to talk openly of medications used to ternatives so that you can and honestly with your doc- T help with symptoms have a healthy sexual life. In addition, some non-pre- tor about any substances you of mental illness. These same scription and illicit drugs are taking. This way, your medications can sometimes Many other drugs can have can impact your sex life. For doctor can get a clear picture affect normal sexual func- an effect on your sex drive example, niacin may, in about where your problems tions. If you are taking any and your ability to have some people, decrease their might be coming from. And of these medications and problem-free sex (see Table desire to have sex. Even some you will get the best possi- have experienced decreased 2). For example, many anti- antihistamines have had a ble advice and help for ad- sexual desire, problems hav- hypertensive medications negative impact on some dressing problems you might ing an orgasm, inability to can cause problems such as people. And of course, illicit be having. have or sustain an erection difficulty having an erection drugs and/or abused drugs or if you’re a woman, to lu- or orgasm, as well as a de- — from alcohol, cocaine, Most importantly, you and bricate, consider talking to crease in the desire to have and marijuana to ampheta- your doctor can often work your doctor about your con- sex. Some birth control pills, mines and even tobacco have out a way for you to control cerns. It may feel uncomfort- diuretic medications and shown some effects on peo- the symptoms of your men- able at first, but be other prescribed medica- ple’s sex lives. tal illness and maintain your persistent. You and your tions can also have an effect sexual relations too. Some- times, it might mean reduc- Table 1: ing the amount of your Antidepressants Medication Sexual Side Effect(s) medications. Other times, Associated with amoxapine (Asendin) erectile disorder (frequent side effect); inhibition of orgasm (infrequent your doctor can prescribe Sexual Disorders side effect); in a very few cases, people report decreased desire or additional medication to retrograde, painful, delayed or no ejaculation help control side effects that bupropion (Welbutrin) decreased desire (infrequent side effect); erectile disorder (infrequent interfere with your sex life. side effect) dealpramine in a very few cases, people report decreased desire; erectile disorder; For example, bethanechol (Norpramin, Pertofrane) ejaculation without orgasm; retrograde ejaculation or painful orgasm and neostigmine are some- times prescribed to help men doxepin in a very few cases, people report decreased desire or problems (Adapin, Sinequan) ejaculating who have problems with erections. Cyphroheptadine fluoxetine (Prozac) decreased desire (very frequent side effect), delayed or no ejaculation can sometimes be prescribed (very frequent side effect), lack of orgasm (frequent side effect) if one of the side effects imipramine erectile disorder (frequent side effect); painful, delayed, or retrograde you’re experiencing is lack (Tofranil, Janimine) ejaculation/delayed orgasm in women (frequent side effect); in a very of orgasms. Lack of sex drive few cases, people report decreased desire or increased desire can be treated with bromoc- maprotiline (Ludiomil) in a very few cases, people report decreased desire or erectile disorder riptine. However, these nortrip tyline in a very few cases, people report decreased desire, erectile disorder, or drugs have their own side (Aventyl, Pamelor) no orgasm effects, including causing a relapse of psychiatric symp- paroxetine (Paxil) erectile disorder, inhibited ejaculation, no orgasm (infrequent side effect) toms. So it’s very important to discuss this fully with your ph en elzin e (Na rd il) retarded or no ejaculation; delayed or no orgasm, for men and women doctor before you start any (frequent side effect); in a very few cases, peop le report decreased desire or erectile disorder new or changing of your medication. protriptyline (Viveotil) in a very few cases, people report decreased desire, erectile disorder, painful ejaculation In all, an honest discussion sertraline (Zoloft) delayed orgasm, no orgasm (very frequent side effect) with your doctor is the best tra nylcypromin e (P arrette) erectile disorders (infrequent side effect); in a very few cases, people starting point for getting report decreased desire help to manage side effects 24 trazodone (Desyra l) in a very few cases, people report increased desire (in women and of your medication that may men); retrograde or delayed ejaculation; priapism (frequent side effect) be interfering with your healthy sexual life. trimipramine (Surmontil) in a very few cases, men report delayed ejaculation

venlafaxine (Effexor) abnormal ejaculation/orgasm (frequent side effect), erectile disorder (infrequent side effect)

Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 sex and sexuality problems priapismpriapism: prolonged erec- alcohol and prescription retrograde ejaculationejaculation: tion (i.e. hours) medications, or psycholog- muscles that usually help to ical/social factors) direct seminal fluid (se- erectile disorderder: distress men, or “come”) forward, caused by not being able to inhibited ejaculationejaculation: dis- out of end of a man’s pe- Glossary have or keep an erection tress due to a delay in or- nis, do not work properly. QP until a sex act is completed gasm, or in “coming” Instead the fluid travels (sometimes caused by dia- (slang), after a normal time backward, toward the betes, vascular disease or of sexual excitement and/ bladder. Sometimes called substance use — including or activity “dry orgasm.” Table 2: Medication Sexual Side Effect(s) Other alprazolam (Xanax) decreased desire (infrequent side effect), delayed or no ejaculation (infrequent side effect), Psychiatric inhibition of orgasm (frequent side effect) Medications Associated barbituates decreased desire (frequent side effect), erectile disorder (frequent side effect), inhibited ejaculation (frequent side effect) with Sexual Disorders buspirone (BuSpar) decreased desire (infrequent side effect); in a very few cases, some men report erectile disorder, delayed ejaculation, priapism chlordiazepoxide in a very few cases, some men report erectile disorder, delayed ejaculation (Libruim, Mitran, Reposans-10) chlorpromazine (Thorazine) erectile disorder (frequent side effect), priapism (infrequent side effect); in a very few cases, some people report decreased desire, retrograde or delayed ejaculation clomipramine (Anafranil) decreased desire (very frequent side effect); erectile disorder (very frequent side effect); delayed, retrograde, painful or no ejaculation (very frequent side effect); inhibition of orgasm (frequent side effect); in a very few cases, some people report spontaneous orgasm when they yawn clonazepam (Klonopin) in a very few cases, some people report decreased desire, erectile disorder, inhibition of orgasm The information here is drawn clozapine (Clozaril) in a very few cases, some men report priapism from several diazepam (Valium, Zetran) in a very few cases, some people report decreased desire, delayed ejaculation, retarded or no sources: “Medi- orgasm in women cations That May Contribute droperidol (Inapalne) in a very few cases, some men report erectile disorder to Sexual Disor- fluphenazine (Prolixin, Permitil) decreased desire (very frequent side effect); erectile disorder (very frequent side effect); in a very ders: A Guide to few cases, some men report inhibition of ejaculation, priapism the Assessment halperidol (Haldol) in a very few cases, some men report erectile disorder, ejaculatory failure, painful ejaculation and Treatment in Family Prac- lithium (Eskalith, Lithonate) erectile disorder (frequent side effect); in a very few cases, some people report decreased desire tice” by William lorazepam (Ativan) in a very few cases, some people report decreased desire W. Finger, PhD, et al., in The meprobarnate (Equanil, Miltown) in a very few cases, some men report erectile disorder Journal of Fami- mesoridazine (Serentil) in a very few cas es, some men report retrograde or no ejaculation, erectile disorder, priap ism ly Practice, Vol. 44, No. 1 (Jan), molind on e (M ob an) in a very few cases, some men report priapism 1997 and “Anti- oxazepam (Serax) in a very few cases, some people report decreased desire Psychotic Medi- cations and perphenazine (Trilafon) decreased or no ejaculation (very frequent side effect); in a very few cases, some men report priapism Sexual Difficul- ties, by Donna pimozide (Orap) erectile disorder (very frequent side effect); in a very few cases, some people report decreased desire, no ejaculation Ames, MD, in The Journal, Cal- in a very few cases, some people report erectile disorder, changes in desire, inhibited ejaculation, prochiorperazine (Compazine) ifornia Alliance decreased responsiveness in women, priapism for the Mentally rispiridone (Risperdal) in a very few cases, some people report priapism Ill, Vol. 5, No. 2. sulpiride (Supril, Sulpitil) erectile disorder (frequent side effect) thioridazine (Mellaril) erectile disorder (very frequent side effect); delayed, decreased, painful, retrograde or no 25 ejaculation (very frequent side effect); in a very few cases, some men report priapism thlothixene (Navane) in a very few cases, some men report erectile disorder, spontaneous ejaculation, priapism trifluoperazine (Stelazine) in a very few cases, some men report decreased, painful or no ejaculation, spontaneous ejaculation, priapism

Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 sex and sexuality problems

Canadian Mental Health As- Over 1 million Canadians likely to have sociation and funding from j j j significant sex and sleep problems Bristol-Myers Squibb. j because of their antidepressant Other survey highlights: 58% of Canadians say that m The First Canadi- sus 15%) to take sleep medi- fects. And many of those that they are at least somewhat ac- an National Survey on cations in addition to their do make the connection, are tive sexually, compared to Sexual Dysfunction and Sleep antidepressants. too uncomfortable to discuss 36% of people taking antide- Disturbances released two it with their doctor,” says Dr. pressants. years ago revealed that one- “The survey confirms what Assalian. in-every-two Canadians physicians have been sus- Canadians taking antidepres- (50%) experience specific pecting for some time now, “There are over 20 antide- sants are three times more sex-related problems on a that sex and sleep problems pressants on the market, and likely than the general public regular basis. And two-in- can be caused by antidepres- each has different side-effect (35% versus 12%) to report every-five (42%) have trouble sant medication, as well as risks. Clearly, physicians and that they “always” experience sleeping at least once a week. [by] depression itself,” says patients must consider this at at least one of the sex-related Dr. Irvin Wolkoff, consultant the very beginning, when problems examined (i.e., lack Adapted from Dr. Pierre Assalian, Executive psychiatrist at Bayview Com- choosing an agent, to en- of desire/interest and diffi- the 1997 Director of the Canadian Sex munity Services in Toronto. sure therapy success in the culty with orgasm among COMPAS study, Research Forum and the Di- long run.” men and women, difficulty released by the rector, Human Sexuality Unit “These side effects are very with lubrication, difficulty Canadian Men- at Montreal General Hospital often seen with the newer One antidepressant called maintaining and obtaining an tal Health Asso- says, “some of the most dis- generation of antidepres- Serzone (nefazodone) is an erection, painful erection and ciation, the turbing findings relate to the sants, such as Prozac. This alternative for depressed pa- ejaculation, taking longer to Canadian Sex sex and sleep problems expe- family of antidepressants has tients who want to avoid these ejaculate among men). A full Research Forum rienced by a key audience tar- really been a breakthrough in drug-induced problems. Sci- 78% of people taking antide- and Bristol- geted in the study: Canadians depression therapy. But the entific studies comparing Ser- pressants say that they expe- Myers Squibb taking antidepressants.” reality in my daily practice, is zone to Prozac and other rience at least one of these that patients are either drop- SSRIs, show Serzone is as ef- problems sometimes com- The study found that these ping off their medication be- fective as these SSRI antide- pared with 50% of the gen- Canadians are three times cause it’s affecting their sex pressants, while having the eral public. more likely than the general life and causing insomnia, or least side-effects. public to say that they “al- tolerating these serious side Women taking antidepres- ways” experience sex prob- effects to stay well.” Serzone can cause blurred sants are more likely than lems. vision, lightheadedness, con- their male counterparts to say Another disturbing statistic is stipation, dry mouth and that they experience a lack of Canadians taking antidepres- that the overwhelming ma- nausea. But researchers say interest/desire for sex (77% sants are also four times more jority (over 90%) of patients almost all of these problems vs. 66%) and problems with likely than the general public on antidepressants did not re- disappear within the first orgasm (64% vs. 42%) with to experience sleep problems alize their medication was weeks of treatment. some frequency. Serzone pa- every night (30% versus 8%). contributing to their sex and tients reported a stronger net sleep problems. The nation-wide survey on improvement in their sex It also found that people tak- 1,300 Canadians was con- drive/interest due to their ing antidepressants are also “Many patients don’t associ- ducted by COMPAS Inc., in antidepressant than did peo- four times more likely than ate medication intended to collaboration with the Cana- ple taking all but one of the the general public (60% ver- heal them, with such side-ef- dian Sex Research Forum, the other antidepressants. Abuse May Make Relationships and Healthy Sexuality Difficult 26 ignificant numbers of men and women who have ex- this means adequate attention is required to address peo- perienced trauma early in their lives show up in men- ple’s mental health concerns as well as their histories of abuse Stal health treatment services. Their relationships are which can affect all aspects of their lives. challenged both by their experiences with mental illness, as well as a history of abuse and/or trauma. For caregivers, A recently-released study from the BC Centre of Excellence Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 abuse: a challenge to relationships in Women’s Health confirms that violence, trauma and men- ever, women who have experienced abuse are at risk for un- tal health concerns represent one of the priority issues for healthy life patterns which affect relationships. women, their caregivers and service providers. The report says that the number of people with serious mental illness Building trust is an issue which keeps many people who’ve with abuse histories are significant, particularly for those been abused from entering into fully committed relation- who ended up in hospital because of their illness. The re- ships. Building trust becomes impossible if someone has had port cites a 1998 study by Dr. Patricia Fisher at Riverview their trust broken by an abusive father, brother or other seem- Dena Ellery, Hospital in Coquitlam, which showed that 58 per cent of ingly trustworthy family member or friend. Not trusting in with Dr. women and 23% of men had been sexually abused before someone close may become a learned response to trauma Patricia Fisher the age of seventeen. Other studies in the US have found and this effectively limits relationship-building. that up to 83 per cent of women and men with mental ill- ness have had experiences of severe physical or sexual abuse People whose personal boundaries have been violated, from as children or adults. unwanted touching or sexual violations for example, some- times lose their sense of protecting or valuing their bounda- Some mental illnesses appear to occur as a result of abuse. ries. For example, women the author has known had been in Dena Ellery is the These include dissociative disorder (formerly multiple per- a series of casual sexual relationships which became inti- editor of Visions, sonality) and borderline personality disorder. (It is interest- mate before the women would have preferred. These wom- and has been a ing to note that researchers Marina Morrow and Monika en report that their ability to say “stop” essentially does not personal support Chappell from the BC Centre of Excellence in Mental Health exist. They have been repeatedly violated in the past, and worker for indi- chose the term “response” rather that “disorder” for their were not ever able to control or stop their abuser, thus learn viduals with dis- report. They said this language choice puts emphasis on the ing that saying “stop” has shown no effect. sociative identity context of women’s lives and sees mental illness as a natural disorder and response to a woman’s life experience, particularly in the Researchers Morrow and Chappell also found that women schizophrenia. case of trauma. In addition, this term recognizes that mental who are not able to articulate personal boundaries may be illness is more than a biological/medical concern, acknowl- vulnerable to ongoing incidents of abuse, particularly at times edging that it is, a biological, psychological and social re- when their mental health problems leave them disoriented sponse or adaptation to life experience.) In addition, drug or vulnerable.1 and alcohol abuse, depression, bipolar disorder (formally manic depression) and post-traumatic stress disorder are also Women report decreased sense of self-esteem and body im- Dr. Patricia considered common outcomes of severe abuse. age as a result of trauma. Some who dissociate their person- Fisher is a psy- ality say they sometimes cannot feel themselves having sex, chiatrist with What this means for mental health providers, family mem- since they have become skilled in “leaving their body” dur- Mountain Coun- bers and therapists is the question of “What do I treat: the ing repeated sexual abuse. It is a challenge for therapists selling Group mental illness or the history of abuse?” Researchers Mor- working with abuse survivors to help people live, or “stay” and has re- row and Chappell from the BC Centre of Excellence in Wom- in their bodies and enjoy sexual pleasure as a positive searched, written en’s Health concluded from their interviews that most experience. on, and worked psychiatrists are hesitant to deal with histories of abuse. In- with women liv- stead, women said their treatment focused on the diagnostic Alcohol and/or drug abuse is another response which keeps ing with a mental label of mental illness and its treatment and not necessarily people’s senses deadened to memories of childhood trauma, illness who have on the childhood trauma which preceded their illness. as well as to current relationship-building. a history of childhood sexual Researchers suggest that mental illness may be the collec- Dr. Fisher says she salutes the people who have the courage abuse and/or tion of symptoms which are a response to their childhood to move into relationships. “The risks these women take are trauma. Dr. Fish- abuse in the first place. Dr. Patricia Fisher adds that best significant”, says Dr. Fisher. The effects of childhood abuse er consulted on practices in mental health are changing. There is now more are felt at many stages within a relationship: developing in- this article. knowledge shared between experts in trauma and childhood timacy, having and loving children, learning healthy ways to sexual abuse (from transition home workers to emergency keep sexually active are some examples. Fisher acknowledg- mental health practitioners) and psychiatrists and others who es that women entering into healthy relationships are work with mental illness. Fisher says that as a result, many always on a healing journey, facing deep and powerful women are now helped more effectively at various entry issues that take commitment and courage throughout a points in the mental health system. relationship.

Still, with treatment focused on mental health issues, rela- tionship and intimacy problems (even those which arise as a result of abuse) get forgotten. Yet, relationship issues are 27 central to mental health. Aspects of building healthy rela- tionships, including trust, intimacy, healthy self-esteem and body image, feeling comfortable in one’s own body and an ______ability to enjoy sex are some of the elements of relationship 1 “Revisioning Women’s Mental Health Care,” BC Centre of Excellence for which can contribute to recovery from mental illness. How- Women’s Health, July 1999, page 28

Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 building a healthy sexuality Talking about Sex

Sally Breen s a sexuality counsellor who has worked both in pri- of low self-worth, finding a relationship, and maintaining a vate practice and in hospital-based sexuality clinics relationship. There are effective treatments and therapies for Athere are times when I imagine that I have heard every sexual problems and the challenge is to find ways for pro- sexual concern that there is. Not true. Every person has their fessionals and consumers to talk about them (See sidebars own unique story, life experience, and question about sex below). Every person has the right to have their questions and this makes it challenging to write in a brief way about answered and to have their sexual concerns addressed. If sex and mental illness. past experiences with sex have been negative or harmful, it is vital to get professional help. Staying focused on sexual problems associated with various psychiatric illnesses is only part of the story. More impor- Like many things in our lives, talking about sex in an open, Sally Breen is a tantly, in the process of moving from a human being to a yet appropriate way gets easier the more we practice it. If nurse, sexuality human becoming, the focus should be on sexual health and we can’t talk about it, we hint, using body language or be- educator, and open communication between professionals and consumers haviour and that just makes everyone uncomfortable. Pull- counsellor in to prevent sexual problems, treat the problems that do exist, ing the shutters down on the topic of sexuality and mental private practice and to promote the sexuality and sexual expression of peo- illness only makes it harder to see our way to a better way of with Dr. Bianca ple with mental illness. Why? Well, the Canadian Guide- dealing with the problems. Talking about it sheds light and Rucker and lines for Sexual Health Education (amongst others) say that it is only in the light that understanding can flourish. Associates in sexual health is a major, positive aspect of personal health. Vancouver, BC. Everyone is entitled to sexuality education to help them What your doctor or mental achieve positive outcomes (self-esteem, non-exploitive sex- health professional could ask ual satisfaction) and to avoid negative outcomes (unwanted pregnancy, sexually transmitted diseases, sexual coercion and ❑ Many people with this (illness or treatment) have sexual dysfunction). The desire for love, intimacy and yes, questions about changes to sexuality or relationships. pleasure is a universal one. Having a satisfying sexual rela- Have you noticed any changes? tionship is a very effective stress release! ❑ Are you worried about these changes? ❑ Would you like to talk to someone about this? It is true that there are a number of sexual and relationship problems associated with mental illness. Some of them are What you could ask your doctor related directly to the diagnosis, that is, the disease itself can or mental health professional cause sexual changes. For example, depression frequently dra- matically decreases sexual interest and can cause changes to ❑ I have noticed (name it) and I am worried about it. Is erections. Other problems arise from the treatment; for ex- there anything I can do or someone I can talk to who ample, many psychiatric medications have sexual side ef- can help with this? fects (see other articles in Visions ). ❑ Does this illness have any sexual or relationship implications? Common sexual concerns include lack of or heightened sex- ❑ Does this treatment or medication have any sexual ual desire, difficulty with erection or reaching orgasm, not side effects? feeling like a sexually attractive person, fearing intimacy, ❑ Where can I get help for my partner to help them in having difficulty in coping with anxiety-producing situa- dealing with this illness? tions, being vulnerable to unwanted sexual advances because

Marie-Claude 4. Exercise, Exercise, Exercise! (but without skipping meals.) Lacombe Ways to Build a Positive Research shows that it may be one of the best ways to get Sexual Self-image “in the mood.” 5. Don’t read beauty magazines. They never write about the No need for a partner: Tips you can follow on your own: parts of the models they airbrushed away. 1. Develop a “healthy selfishness.” Treat yourself just as well 6. Dance. Even if it’s just in your living room. Become aware as you treat others by indulging in a bubble bath or buy- of how your body moves. ing yourself a new outfit. 7. Pay attention to Special K ads. They may be trying to sell 28 2. Strip for yourself in front of a mirror. No need for a part- you cereal but they’re also selling you the idea of differ- ner; find your sexy self while only one pair of eyes is ent body types. (One ad features the phrase “Picture a watching. 200 lb. firefighter” followed by the picture of a healthy 3. Go to a clothing-optional venue. Notice that everybody woman firefighter.) there has a different body type, and that you’re 8. Do away with “fat postures” and “fat clothes.” Fat pos- no different. tures are the poses you take to appear smaller, for Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 building a healthy sexuality Don’t Forget the Children any adults in to they are educated. Here are yes, even farting! But grab ty, the teacher or neighbour Meg Hickling day’s world did some simple ideas to start. every teachable moment to will report them for poor M not grow up with add to their store of solid, parenting. I can understand parents who talked openly Begin the day they are born, accurate information about those fears; any parent’s and honestly about sexual using the scientific names sexual health. worst nightmare is losing health. Schools also often for all body parts: elbow, their children. failed to teach students about nose, chin, knee, penis, scro- Books can be tremendously For the past 25 sexuality with any kind of tum, testicles, vulva, vagina, helpful especially for parents The cardinal rule is that years, Vancou- comfort. Role models are not uterus and urethra. Abusers who find it difficult to talk children need and have a verite Meg Hick- common and parents truly look for children who have about sexual health. There right to be safe. Safety is ed- ling has been struggle to talk to their chil- no language about sexual are great books for children ucation. All parents need talking to chil- dren in the ‘90’s. health or who only have these days. There are a col- help from time to time. dren, parents, baby words or slang. lection of publications in the When you are feeling well teachers, and When a parent also struggles ‘Resources’ section of this is- and competent yourself is other profession- with mental illness, sexual Be an advocate for your sue of Visions. These are the time to reach out, ask for als throughout health education can be a child. Listen to their hunch- available from bookstores help, establish a relationship the province very low priority. I would es and disclosures about oth- and from libraries. Children with the teacher, or parent about sex. The like to encourage every- er people; who do they feel with disabilities need extra of your child’s friend. Then, health educator one to remember that it not safe around and who do they help as do children who when you have a bad patch and registered only saves lives but enhanc- mistrust? Talk to them often have been abused. and cannot be as available to nurse is known es lives. about who in your family your child, that person can for her sensitive they can turn to: grandma, Parents may also recognize be there and will not be and humour- Educated children are con- auntie Jane, Mrs. Jones next that their own knowledge judgmental. filled approach to fident and resilient in their door, or to call 911 if they base needs work and updat- sex education, daily interactions but also need to. Remember that it’s ed information. There are But above all, your child and has received resistant to sexual exploita- OK if you cannot always be wonderful books for you too needs to be safe and some- numerous tion and abuse. Sometimes, there, physically, emotionally — even some with humour! times, for any child in any awards and much adult survivors and others or mentally for your child, family, that means calling for recognition for will say “I want to keep my as long as someone else who Parents with a mental illness help. One anonymous help her work, includ- child innocent, I want them is trustworthy is there. The tell me that they feel excep- line you might want to post ing the Order of to have a childhood. They best, most devoted parent in tionally vulnerable and at on your fridge is : British Columbia. don’t need to know this at a the world cannot be there 24 risk of being labelled “unfit See the review of young age.” hours a day, forever! Your parent.” They worry that if NATIONAL CHILDREN’S her book in this child’s life may depend they ask for help, the profes- HELP PHONE: issue of Visions. These are dangerous state- on 911. sional will “turn them in to 1-800-668-6868 ments. There is no one less the authorities.” Some par- innocent than an abused Remember your sense of ents have also expressed a Please! Don’t forget the child. Abuse destroys child- humour. It is fun to laugh fear that if their children children. hood and they can avoid with your child about sexu- demonstrate too much abuse or limit the abuse if ality, bathroom humour and knowledge in the communi-

example, crossing your arms around your body, or hid- 12. Project yourself as being confident, and confidence will Note: ing behind another person. Fat clothes are what you wear come to you. Go up to the person you never dared to talk Tips 1, 8 and 9 on days when you don’t feel at your best like those loose, to, and engage in conversation. are from Wom- dark clothes. If you’re feeling ‘blah’— Do the opposite! en’s Conflicts Stand straight, show yourself, and wear bright, well- It takes two to tango — Tips for you and your partner: About Eating fitting clothes. 1. Get your partner to draw a picture of you. Draw one of and Sexuality: 9. Think healthy, not thin. Thin may not be healthy for your yourself as well. Compare and discuss. Your partner may The Relation- body type. Thin may not even be attractive. see things you never saw in you before. Reverse roles. ship Between 10. Don’t assume that if you’re not thin, you’re fat. Remem- 2. If bright lights during close encounters of the intimate 29 Food and Sex ber, Marilyn Monroe was no size 5 and no one doubts kind are uncomfortable, regain your confidence by mak- by Rosalyn M. she was sexy. ing love by candlelight. Meadow and 11. Go to a plus size store and discuss with the clerk what 3. Masturbate and get your partner to watch or even help Lillie Weiss, would be the most flattering clothes for you to wear. (e.g.: you. Don’t forget to engage in foreplay with yourself. Get 1992. vertical lines, long skirts) your partner to do the same. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 book reviews Prozac Nation by Elizabeth Wurtzel

Review by At the age of sixteen and deep mer internships, was a de- descriptions of attempts at a enough when it isn’t mixed Christopher within the chemically-im- pressed young woman. Her sexual life. From her illicit up among the millions of J. Finlay posed confines of a dark de- bouts with depression first street alley affair with a rock- confused and dangerous pression, I found this manifested themselves as she group member in Dallas to emotions that haunt a de- woman’s memoir. The acidic entered puberty, in solo wrist- chasing people around Har- pressed person’s life. humour of the young depres- cutting experiments, com- vard Yard with knives be- sion survivor spoke to me be- plete with Patti Smith in the cause her sexual libido and Wurtzel is a survivor of a per- cause she did something background for mood music. depression have uncorked sonal war, complete with old original; she refused to tell me Thus starts the amazing ad- her, Wurtzel spares no details. battle wounds and war sto- that everything would be all ventures of a girl who is so Candid and comic, as seen in ries. Her ultimate war story is right. Instead, she opted for a full of promise that she can’t the chapter entitled “The Ac- Prozac Nation. Brilliant in its cutting and cruel description seem to get out of her bed for cidental Blow Job,” the mem- simple language and haunt- of the depths of her own de- most of the memoir. To Eliza- oir is able to evoke the ed personal revelations, Pro- Houghton Mifflin, pression. In outlining the beth Wurtzel, and myriad ambiguous role that sex and zac Nation offers no remedies 1994; 317 pp.; gory details of her screwed- other individuals living with sexuality play during an epi- or apologies. To me, and oth- $12.95 up youth, she offered me depression, every detail of life, sode of depression. Is sex a er people living with depres- something unique: camara- every interaction, every wak- desperate attempt at finding sion I suspect, it offers derie in my hurt. ing moment is an assault on comfort? Is it an attempt at camaraderie. To the world at Chris Findlay is a her ability to cope with her finding poetry and meaning large, Prozac Nation stands as student at Simon Elizabeth Wurtzel, a brilliant existence. among the ruins of a life con- a valuable tool in helping to Fraser University. Jewish Harvard grad who sumed by depression? Is sex deconstruct and comprehend He is studying po- managed to wrangle a deal The feelings of alienation are physical, disgusting and the complexities of depres- litical science. with Rolling Stone for sum- brilliantly evoked in her many shameful? Sex is confusing sion. Are you ready to answer the by Meg Hickling, RN Speaking of Sex: questions your kids will ask? Review by As a child, I felt I could speak may want to discuss with The last chapter addresses the a crucial issue: gay and lesbi- Marie- to my mom about anything your child, from body anato- compatibility of religion with an youth are three times more Claude and everything. She was very my to teen pregnancy, homo- sex education. Meg, an active likely to attempt suicide than Lacombe open and wanted my brother sexuality, and honesty. Christian, believes that you heterosexual teens. Of the and me to be informed about can have both and be happy. youth interviewed, 46 percent our bodies and about sex. Un- Meg does not give set-in- had attempted suicide before. fortunately, not all parents are stone answers to many of the As emotional maturity must This just proves how much of like my mother. Meg Hick- questions, and she acknowl- be reached to achieve sexual a link there can be between ling, author of Speaking of edges that many are judg- maturity, Meg included a sec- sexual issues and suicide, but Sex, realizes just how hard it ment calls that have to be tion on emotional develop- Meg does not seem to quite can be for some parents to made by parents. She does, ment in which she introduces make the connection. discuss sexual issues with however, give broad guide- the “sads, glads and mads.” children. lines to follow concerning Although she does mention The most appealing part of just how much knowledge clinical depression, the two Speaking of Sex is that it draws Northstone, Meg is a “leading sex educa- children of certain age sentences where she differen- you in. You can jump around 1996; 192 pp.; tor” who has helped many groups should have about tiates between normal “sads” from one section to the other $17.95 parents ease into the sex talk their sexuality. She sees and clinical depression as much as you want. The by holding workshops for knowledge as power; chil- should be extended to at least real-life anecdotes that Meg parents, and visiting students. dren who have an open on- a paragraph or even a page- has gathered from over 20 Now, an additional resource going discussion with their long explanation. years in the field are at times Marie-Claude if you can’t catch her in per- parents are more likely to rec- refreshing, humorous or even Lacombe is an son is this book in which she ognize sexually inappropriate Hickling also overlooked teen shocking. Written in the lan- undergraduate promotes an open ongoing or abusive situations. They suicide. It is mentioned in guage that you would use to communications discussion between parents are also less likely to hide passing in the sexual orien- speak to your own child, the student coor- and kids without allusions to from their parents that they tation section. However, no- book makes it easy to transfer 30 dinating Na- birds, bees or storks. She asks were victims of an abusive where in the book does it give what you’ve read into your tional children to “think like scien- act. She also writes that chil- guidelines for parents on how own discussions. This book is Depression tists” and for example, think dren who know all the infor- to deal with suicide and pre- definitely the starting point for Screening Day about why testicles are on the mation will make better- vent it. The McCreary Centre a parent who is uneasy about 1999 for CMHA- outside of a man’s body. She informed decisions about in Burnaby published a study the potential questions that a BC Division. touches on every subject you their own sexual activities. in June ‘99 that confirms it is child may ask. Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 book reviews Sexual Medicine in Primary Care by William Maurice

ex is not usually the first thing people think about sexual functioning information, which is needed if a pa- making an appointment with their doctor to discuss. tient is having problems But with the release of Viagra recently in Can- Maurice tells caregiv- Review by ada, Dr. Bill Maurice’s new book is especially timely. ers that most patients Dena Ellery TheS book recognizes that most people don’t feel comfortable want to be reassured addressing sexual issues with their doctor. Yet doctors and other that they are “nor- primary care providers are in a position to be able to screen, mal,” and encourag- diagnose or refer people, and provide treatment for many sex- es doctors to provide ual health problems. As a result, Dr. Maurice places the onus a context for patients on doctors or primary care providers to become more com- so they understand fortable and skilled at asking the questions which need to be that they are not asked if caregivers are going to be able to uncover and ade- alone. For example, he quately address people’s sexual health concerns. And while suggests caregivers Sexual Medicine this is a text book for primary care givers, it will also help preface their ques- in Primary Care anyone going to a doctor to know exactly what to expect. tions with “Most peo- Dr. William (Bill) ple do/think/feel L. Maurice; Dr. William (Bill) Maurice is a native of Vancouver. In his book (about a particular Mosby, 1999; he draws significantly on his practice as a psychiatrist special- sexual practice or sit- 366 pp. izing in sexual medicine, as well as his work teaching sexual uation) . . . How is this medicine at the University of British Columbia. Case studies for you?” Maurice also instructs caregivers how to develop a are used liberally throughout the book to illustrate the points non-judgmental attitude, by suspending their own values and he makes. They give the book its balance between theory and attitudes. He is also careful to include patients feelings about practice and keep the reader focused on how people experi- sexual issues, past experiences and current problems in the ence sexual problems — from interfering with relationships questioning process, seeing these as valuable information in to understanding sexual orientation and dealing with obses- the questioning process. sive sexual habits. In addition, Maurice suggests health professionals can play a The book is divided into two parts: “Sexual History-Taking, valuable role in providing education about healthy sexuality/ Interviewing and Assessment,” and “Sexual Dysfunctions in sexual functioning. But he emphasizes that it must be commu- Primary Care: Diagnosis, Treatment and Referral.” The first nicated in a language which people can understand. Some- half of the book is dedicated to learning questioning skills and times, with the permission of a patient, Maurice says that more techniques. In the second half, which focuses on detailed de- slang terms (i.e., “come” instead of “ejaculation”) might be scriptions of specific sexual problems and how to identify and used in describing sexual issues/problems. treat them, primary caregivers are reminded here, of the ques- tions they are to ask to uncover sexual problems. While the book is essentially a textbook for health profession- als who are in a primary care positions, its greatest value is in One of the key strengths of this book is that Maurice spends the thorough inclusion of psychiatric issues and disorders — much time on the value and importance of sensitive and thor- even for psychiatrists and other mental health workers (Mau- ough questioning and patient/caregiver relationship-building. rice says that “Some health professionals (particularly nonpsy- Dena Ellery is He suggests primary caregivers must: chiatric physicians) and many people in the community believe the editor of „ develop rapport that psychiatrists and others who work in the mental health Visions. „ ask questions in a manner which both the interviewer and field are especially knowledgeable about sexual issues . . . In patient are comfortable truth, in talking to patients about sexual problems, psychia- „ ask the right questions in order to get at the more explicit trists, for example, seem no more and no less knowledgeable and skilled than other physicians.”) If you’ve liked this issue, With his background in psychiatry, Maurice is careful to en- sure that mental illness and how its treatment affects sexuali- there’s more where it ty, as well as psychiatric disorders of a sexual nature are extensively addressed. Maurice even brings case studies from came from . . . the mental health field into the text to illustrate his points. As a psychiatrist, Maurice has been able to bring to all primary car- 31 Call our subscription hotline now and re- egivers a perspective which will ensure that doctors include ceive a year’s worth of Visions (4 great mental health issues in their considerations of patients’ sexual issues!) for $25. Don’t miss out! Our next histories. issue’s theme is Housing. For more information, visit the following web site: http://www.interchange.ubc.ca/maurice/ Visions: BC’s Mental Health Journal Sexuality, Intimacy, and Relationships No. 5, Spr/Summ ‘99 resources

Books for preschoolers and primary children For Each Other: Sharing Sexual Intimacy by Lonnie Barbach. Pen- Come Sit By Me by Dr. Margaret Merrifield. Stoddart Kids (1998) guin (1984). and Morning Light. Stoddart (1996). Two exceptional books about AIDS for preschoolers. The “Go Ask Alice” Book of Answers: A Guide to Good Physical, Sexual and Emotional Health by Columbia University’s Health Ed- A Very Touching Book...for Little People and for Big People by ucation Program. Henry Holt (1998). Jan Hindman. Alexandria Associates (1983). An amusing and non- threatening book, teaching privacy. For Each Other: Sharing Sexual Intimacy. Lonnie Barbach, Pen- guin Books (1984). Books for youngsters approaching puberty Changes in You and Me: A Book About Puberty by Paulette Bour- Love and Friendship. Allan Bloom, Simon and Shuster (1993). geois, Martin Wolfish, and Kim Martyn. Somerville House (1994). A pair of Canadian books on puberty, one for boys, one for girls. The New Joy of Sex. Alex Comfort, Crown (1991). Clever transparent pages to catch the attention. Excellent for younger kids. Our Sexuality. Robert Crooks and Karla Baur, Benjamin-Cummings (1990). Books for parents and older teens Take Charge Of your Body: Women’s Health Advisor by Carolyn Sex in the Golden Years. Deborah Edelman, Donald I. Fine (1992). DeMarco. Well Woman Press (1995). Super for girls and women. Sex is Perfectly Natural but Not Naturally Perfect. Sue Johanson, Private Parts: An Owner’s Guide by Yosh Taguchi. McClelland & Viking Press (1991). Stewart (1988). For boys and men now in paperback. Gay and Lesbian Relationships Speaking of Sex: Are You Ready to Answer the Questions Your Positively Gay: New Approaches to Gay and Lesbian Life. Betty Kids Will Ask? by Meg Hickling. Northstone (1997). A lightheart- Berzon, Celestial Arts Publications (1992). ed and easy-to-read guide for parents. < Gay Relationships for Men and Women. Tina B. Tessina, G.P. Sexual Abuse Information Series 1 s urce List s Sexual Abuse Information Series 1 from Health Canada — In- Putnam’s Sons (1989). cludes 10 booklets for abused children, teens, adults, and their par- ents and partners. Contact Health Canada’s National Clearinghouse Web Sites on Family Violence, Family Violence Prevention Division at 1/800/ http://www.plannedparenthood.org/sti-safesex/index.html 267-1291. “A Woman’s Guide to Sexuality” and “Sex: Safer and Satisfying” are Re especially great general resources. Videos SEX: Spelled out for parents — with Meg Hickling, RN http://www.plannedparenthood.org/parents/index.html Four half-hour programs for parents that want to talk with their Check out the Parenting & Pregnancy index. children about sex. Contact Magic Lantern Communications Ltd. toll free at 1/800/263-1818. http://intimacyinstitute.com Sinclair Intimacy Institute.

Books for Adults in Heterosexual Relationships http://sexuality.about.com From the famous web site offering A Woman’s Guide to Overcoming Sexual Fear and Pain by advice on various facets of human living. Aurelie Goodwin and Marc Agronin. New Harbinger (1997). 32 http://www.siecus.org/pubs/fact/fact0000.html Sexual The New Male Sexuality by Bernie Zilbergeld. Bantam (1992) Information and Education Council of the United States fact sheets.

Canadian Mental Health Association, BC Division 1200 - 1111 Melville St. Vancouver, BC V6E 3V6