The character and diversity of sexual relationships found amongst people in the mental health industry are much the same as in the wider world. This should surprise no one. Just as people often meet their future partners in the workplace, some relationships of enduring emotional and or sexual attachment have always existed - and will always exist - between clients, staff and carers.
However, even more than the neglect of client’s spiritual needs, mental health workers make no attempt to routinely address the problems their clients have in the conduct of sexual relationships. If you have had a useful and productive talk with a mental health worker about sexual concerns, then you are the exception. Most workers have a set of priorities for clients that place addressing sexual needs at the end of a very long list. Yet if the objective is to promote positive change; well, what does most to boost your self-confidence? What is one of the key motivations in life?
Much of what follows is obvious, but needs to be spelt-out, for one should never underestimate the capacity of mental health services to take the commonplace and complicate it with the dead-hand of specialist trainers, rules of ‘best practice’, and endless committees obstructing by arguing about appropriateness. I made the assumption many decades ago that when it came to the treatment of mental distress, I would come across those people with the best communication skills - how innocent of me!
(I’m reminded of the old story of the sociologist who wants to study prostitution spending years raising a grant of tens of thousands of pounds, hiring assistants to find and survey a random sample - when all he needed to do was take a train to the city of his choice, go to the first taxi on the rank, and tell the cabbie to drive him around for an hour. He might not even have had to ‘frame a question’ at all!)
The central problem for most clients is that they do not see successful personal and sexual relationships around them in their everyday lives - they have nothing to learn from, to model or imitate. Even the conversational conventions between men and women, whether partners or not, are often unobserved because clients spend so little time in ordinary social spaces. Equally within organised activities provided by mental health services, it is very rare to find a couple working together.
A person in mental distress is pre-occupied with self, and needs to let go of that a little before the reciprocity required in normal relationships can be ‘seen’. Equally they often don’t understand how relationships have to be made and negotiated, how giving your partner what they want, will get you what you want. Users of services often believe that ‘romance’ happens by chance and then proceeds in some automatic or natural way. They don’t know how much there is to learn and to practice in order to acquire social and physical skill.
Even more than the rest of humanity they have lived vicariously, but without trying to imitate and test, so retain the expectations of Hollywood and the media’s imagined world of celebrity - the dramatic contrasts between idealised romantic love, and varieties of extreme dysfunction. So, whilst it is true to say all clients have experienced the real world as traumatic in some way, often in close relationships, they may at one and the same time have an expectation of ‘more of the same’ coupled with - inevitably - unrealistic expectations of how different and successful the situation of others is. Like everyone else they grew-up believing what they witnessed in childhood was the norm and however well educated now, may still expect the same, sometimes playing-out a self-fulfilling prophecy. But in addition have a profoundly distorted fantasy as to what happiness, fulfilment, contentment or excitement are, or can be.
Most clients who are in the system for many years experience long periods of celibacy punctuated by a series of short, mutually unsatisfactory relationships most of which occur with other clients. As we know, what attracts people are perceived points of similarity, for those who’s social world is so restricted, it is often clients with similar problems who find each other - they share the same strengths, but also the same weaknesses. In such situations little that is new can be learnt - other than how to move in ever decreasing circles.
To achieve any kind of ‘recovery’ requires teaching in the possibilities of intimacy. And opportunities are forever being lost due to the fear and timidity of workers or their managers. A classic example is the so called ‘predatory male’ patient on a hospital ward. Imagine the following scenario. Staff notice a male patient taking a particular interest in a female member of staff; if she is noticeably younger than him and relatively inexperienced, alarm bells will ring. The woman concerned will report that she has noticed his attention because it does not lead to an ordinary two-way interaction, he is overtly interested but stand-offish, not demanding nor conversational, he just always seems to be around, which makes her uneasy. The behaviour is interpreted by staff as inappropriate and as possibly indicative of some covert sexual intent. The action taken is to separate the two people. The male patient then participates less in the activity of the ward, becomes less cooperative or positively hostile. This is seen as confirmation that the staff’s interpretation of the situation was correct and the right decision made.
Wrong. The male patient may well be less cooperative, he’s been rejected again. The staff reaction may well create more extreme behaviour in the future. The male patient looks menacing and predatory because of his incompetence, he’s never had the chance to learn the skills of normal social interaction, how to approach and begin to build an intimate relationship. A major opportunity is lost because the female member of staff is the person he feels most attracted by or attached to - he is motivated by her. In other words, she is the person in the most powerful position to affect change in him! She, whatever her job or status, should be the one to work with him. If the woman is confident enough in her sexuality, then she can enter into a contract with him, which stated crudely would say; you can’t have me, but we can spend a certain number of hours together. We can hang-around so you can get comfortable being around women, and I’ll teach you what a woman like me, wants and expects in a relationship - I’ll show you how to approach a woman like me.
Real outcomes have to be made, and in specific social situations; aggression, violence and abuse arise - like fun, happiness and contentment - as a result of the interaction between people. No one person is ever the sole cause of anything. Just as the way someone is treated in the first few hours of contact with mental health services may set the pattern for years to come, anyone who is trapped or confined by others will, sooner or later lash-out. But equally someone who is confident but non-threatening, can begin the process of change in others.
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