Bangor University PROFESSIONAL DOCTORATES Identity and sexual identity in men with learning disabilities. Withers, Paul Stanley. Award date: 1997 Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 10. Oct. 2021 IDENTITY AND SEXUAL IDENTITY IN MEN WITH LEARNING DISABILITIES Paul Stanley Withers Clinical Psychologist DD t' Ys. IOT LI. YF'RGELL 7 Yl"N UM(; To E CONSULTFD L1BIA. y ONLY Submitted in fulfilment of Part II of the Degree of Doctor of Clinical Psychology University of Wales, Bangor - March 1997 SUMMARY Four men with mild learning disabilities who were known to have had sexual contacts with other men completed semi-structured interviews aimed at eliciting information about the identities they had formed in relation to their sexuality and their learning disabilities. The interview data was transcribed and analysed using a qualitative methodology, Grounded Theory. Diagrammatic and verbal descriptions of the identities formed by the participants were produced, and common emerging themes were outlined, facilitating the generation of theories about how men with learning disabilities form identities. These were compared with existing knowledge about sexual identity formation in the non-learning disabled population, and with historical information about the development of homosexual identities. Men with learning disabilities were found to form quite different sexual identities to those formed by their non-learning disabled peers. Two participants were engaged in struggles to avoid having sexual identities, and a third had a fluctuating identity. Some of the identity solutions reached by participants could be better understood by making reference to historical, rather than contemporary, understandings of sexual identity. For all the participants, awareness of their learning disabilities had a marked impact upon their sexual identity, and disability itself also influenced identity formation. The roles of self-esteem, age, social context, negative experiences and individual coping strategies in identity formation were examined, as were the impacts of sexual identity upon psychological well-being and the practice of safer sex. Clinical and Theoretical implications of the findings were outlined, such as the need for support of self-determined adaptive coping strategies, and the possible relationship between intellectual ability and the ability to form healthy sexual identities. In addition, implications for the understanding of sexuality in non-learning disabled people were noted and directions for future research were indicated. CONTENTS Paare 1. Acknowledgements 3. Author's Declaration 5. INTRODUCTION 9. A History of Homosexuality 9. (i) The 19th Century 13. (ii) The 20th Century 29. (iii) Historical summary 31. Homosexual Identity Formation 35. Alternatives to Homosexual Identities 37. Sexual Identity and Psychological and Physical Health 38. Sexuality and People with Learning Disabilities 44. Identity and People with Learning Disabilities 48. Homosexuality and People with Learning Disabilities 50. Health and Stigma 54. Remedying the Effects of Stigma 58. The Phenomenaunder Investigation 61. RESEARCH QUESTION Page 61. PARTICIPANTS 61. Participant 1: Damian 65. Participant 2: Norman 67. Participant 3: Daniel 69. Participant 4: Chris 72. METHOD 81. RESULTS AND DISCUSSION 81. Results for Participant I 105. Results for Participant 2 115. Results for Participant 3 146. Results for Participant 4 164. SUMMARY OF RESULTS FOR ALL PARTICIPANTS 164. Awareness of Learning Disabilities 164. Sexual Rights of People with Learning Disabilities 165. Experiences of Trouble in relation to Sexual Behaviour 166. Keeping Sexuality Secret 166. Use of a Range of Coping Strategies 168. Access to Support for Sexual Behaviour 169. Beliefs about Homosexuality 169. Participants' Sexual Identities 170. Identity Pride 170. The Effects of Intellectual Ability Paa e 171. Distinguishing between Fact and Opinion 172. Sexual Health and Psychological Health 174. Use of Safer Sexual Practices 175. Comparison with Cass' Model of Sexual Identity Formation 178. Acquiescence, Expectations and Interpretations 180. CONCLUSIONS 180. Theoretical Conclusions 186. Clinical Implications 191. CRITICISMS AND FUTURE DIRECTIONS 194. Impact on the Author APPENDICES 196. Appendix 1: Research Protocol 198. Appendix 2: Participant Information Sheet 200. Appendix 3: Consent Form 202. Appendix 4: Interview Schedule 205. Appendix 5: Sample of Interview Data with Codings 209. REFERENCES ACKNOWLEDGEMENTS Thanks are due to all the following: Dr. Gill Brown, for her unstinting help, support, advice and humour, for setting realistic targets and for seeing that I kept to them; Dr. Karen Henwood, for untangling my beliefs about methodology, showing me a new way, curbing the bureaucrat in me, and giving me the enthusiasm to keep it all going; Kath Hale, for services to graphic design, for support beyond the call of duty, and for having the right car stickers; Clare Worthington, for transcribing all the interview tapes and for interesting comments about what it all meant; Community Healthcare Bolton N.H. S. Trust for financial support and for leaving me alone to get on with it; Dr. Robert Jones, for a very significant change of heart; Jen Hunt, former lecturier (sic) in Clinical Psychology, for lucid, intelligent and insightful comments and some absolutely delicious pesto; Sue, Laura, Irene and Ed, for letting me go on and on as if there were all the time in the world, and for sharing the experience; I Sue Threlfall, for reading the whole thing, for working with me for all this time and yet remaining in touch with reality, and for telling it like it is; The many people who I work with who have spoken to me about this, given me their time and ideas, sent me articles, given me telephone numbers, taken it seriously and kept their faces straight; My family, who are quite amazing; Mary Coughlan, Helen Watson, Shara Nelson, Mary Chapin Carpenter, Tricky, Laurie Anderson, Mary Black and the rest of my C.D. collection for keeping me entertained; And David O'Connor, for opening the door and turning on the light. 2 DECLARATION This work has not previously been accepted in substance for any degree and is not being concurrently submitted in candidature for any degree. Signed.... 4. L C .......... ý Date 1. l. "ý fC /t........ ........... .... ..... STATEMENTI This thesis is the result of my own investigations, except where otherwise stated. Signed... ............. ............ ........ r 1. ýý... Date Cý il....... [. 't::...... .......... .... STATEMENT 2 I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter-library loan, and for the title and summary to be made available to outside organisations. Signed.... ..... ............. ........................... r.. Date............ .................................. ...... 3 STATEMENT 3 I, the Supervisor of this thesis, confirm that it is the result of the investigations of the Candidate, Paul Withers, except where otherwise stated. fl-nq4-, Signed &ý .............. ....................... U. 1.) 4 IDENTITY AND SEXUAL IDENTITY IN MEN WITH LEARNING DISABILITIES. INTRODUCTION Where does a piece of research begin? This one began with a concern about the level of risk of HIV infection which seemed to be inherent in the sexual behaviour of a group of the clients of a clinical psychologist, and a wish to find ways to reduce this danger. However, accounts of how to educate men with learning disabilities about safer sex (for example, Dixon, 1988; McCarthy and Thompson, 1992) seemed to rely on models of sexuality which were drawn from the general population, and to lack substantial consideration of the manner in which people with learning disabilities experience their own sexuality. Accounts have considered the subjects' learning disabilities only as a factor to be taken into account in finding the appropriate pitch and frequency of information given on this topic, and not as a formative developmental feature affecting their entire relationship with their sexuality. It seemed important, then, to actually begin somewhere else, with a consideration of how men with learning disabilities construe themselves, including their sexual selves, and to see what could be learned from these issues of identity which might prove constructive in alleviating the original concern. The introduction will begin with a description of the history of the development of identities formed by men who have sexual relationships with men. It will then consider theories relating to the processes by which individuals construct identities which incorporate same-sex sexual behaviour, 5 and will examine the relationship between sexual identity and psychological and physical health. The focus