The stigma of hypersexuality attached to mentally disabled women and the assumed asexuality of people with physical disabilities both serve to exclude disabled people from the realm of socially accepted sexual behaviours, practices, and rights
The intersection of disability and sexuality as navigated through this series has shown itself to be multifaceted and often misunderstood. However, the terrain becomes more complex as we take people – specifically women – with mental disabilities into consideration. (1) Historically, the sexuality of mentally disabled people has been viewed as something uncontrollable, potentially dangerous, and a deviance to be contained. The sexuality of all women, however, has been viewed through similar lenses of mistrust, which when conflated with mental disability, has resulted in a societal framework that from the outset denies or condemns the sexualities of women with mental disorders. Considered childlike, hypersexual (or asexual), and unfit for the social roles that are viewed as a part of sexuality – relationships, marriage, children – the question, ‘Do people with mental disabilities have sexuality?’ remains pertinent for many. K R Held writes, ‘Sexuality is an integral part of being human and part of one's personality. Thus the individual experience of sexuality is influenced by one's intellectual abilities. There is, however, no intellectual threshold known as an incontestable condition for having one's own sexuality’ (Held, 1992, p 238). There is, in fact, no measure of intelligence that can be equated with your right to be sexual.
The stigma of hypersexuality may at first glance appear to be the polar opposite of the assumed asexuality of people with physical disabilities. However, it is just the other side of the same coin. Because people with mental disabilities are often not taught or shown the difference between social and private behaviour (or are unable to learn this difference), activities such as masturbation, displaying of one’s genitals, and inappropriate sexual advances may be carried out in public, or in the company of others. For the most part this does not have to do with a lack of intelligence, but a lack of informative education and teaching methods that allow people living with mental disabilities to live within a larger society. When seen within a wider context that stigmatises mental disabilities, this behaviour is viewed as an uncontrollable hypersexuality. In practice, this unwillingness to recognise the sexual side of people with mental disabilities as legitimate in its own right is the same prejudice faced by people with physical disabilities. As assumptions or stigmas, asexuality and hypersexuality both serve to exclude disabled people from the realm of socially accepted sexual behaviours, practices, and rights.
But can people with mental disabilities really form positive sexual relationships? Before beginning to answer this question, we must examine the prejudices implicit in its asking. If we deny people with mental disabilities the right to form relationships – as our legal system does – are we saying the only legitimate relationships are those which are stable and positive? Are the many thoughtless, rushed-into, violent, but consensualrelationships that people without mental impairments form to be nullified because they may not be ‘positive’? No, because consent was given. And here too, consent – however complicated it may be – must still remain at the heart of the matter.
However, if consent means knowing and voluntary agreement to engage in a certain activity, is there an intellectual bar? The Indian legal system certainly believes so. In an article entitled ‘No Rights for the Mentally Disabled’, disability rights activist Shampa Sengupta discusses the ways in which the provisions and entitlements made under the Persons with Disabilities Act (1995) preclude people with mental disabilities, who are legally barred from marriage, entering contracts of any nature, or voting in elections. Furthermore, the proposed Mental Health Bill 2012 advocates the ongoing involuntary incarceration of people living with mental disabilities – a provision that mental health activists are strongly protesting against.
Consequently, under a state that in effect denies people with mental disabilities personhood, how can we begin to have useful conversations about sex and sexuality? Writing for the journal Sexuality and Disability, author Kaeser believes that justice can be done to this question only when we are able to reposition our ideas of consent. He writes, ‘Any attempt to redefine consent would include not only a determination of what the individual would want could she/he advocate and speak for her/himself but also what is in the individual's best interests’ (Kaeser, 1992, p 35). With the vast majority of mentally disabled people – and in particular, mentally disabled women – living with carers (generally family members) or in institutions, it must fall upon authority figures to act in the best interests of the woman. Interests that position her as an individual with the right to her own sexuality, rather than an object to be managed. Kaeser goes on to say, ‘The need to protect people with mental retardation from harm cannot be so great as to categorically preclude one's chances for personal choice and right to privacy. Individuals with mental retardation [should be] permitted to be involved in activities which pose risk, particularly when that risk can be minimised with the help and assistance of others. This standard should include, where and when possible, sexual activity as well’ (Kaeser, 1992, p 36).
Various social stigmas often play themselves out on the same site; on the same body. As mental impairments and gender intersect with marginalised sexualities, we find that mentally disabled lesbian or bisexual women are amongst the most sexually restricted groups of people in the world. The linkage of homosexuality to mental disorders was first made in the 19th century (homosexuality was a subject that had previously been a matter for religion or judiciary systems). During the time this was considered to be progressive, since homosexuality was seen as a legitimate disease, rather than a crime or a sin. As global gay rights movements progressed and more queer voices entered mainstream discourse, the link to disease was legally abolished. However, while governments may have legalised homosexual acts, the links between homosexuality and psychological illnesses remain a commonly held misconception. Despite the effective decriminalisation of homosexuality in India with the repeal of Section 377 of the IPC in 2009, the stigma and ignorance surrounding homosexuality – and in particular, homosexual women – results in varying ‘explanations’ for what is considered to be ‘abnormal’ behaviour. Women with mental disabilities who have sexual preferences that are not heteronormative are often denied the right to these choices under the guise that it is a ‘side-effect’ of their disability. Because many mentally disabled women spend most of their lives in female-only institutions, they often develop sexual relations with one another. Whether they would have developed these desires outside of this environment is unclear, but also irrelevant. As institutions systematically prevent sexual contact between women with disabilities (both physical and mental), there is an active denial of sexual and human rights at play. Conversely, lesbian women with no mental illness may often be taken for psychiatric treatment, since many still believe that non-normative sexual preference is linked to disease, or even evil.
Within a wider context that seeks to demonise the sexualities of women with mental disabilities, the issue of sexual abuse and violence is steeped in hypocrisy. On one hand is a perception of asexuality or a sexuality that must be negated, and on the other are disproportionate levels of violence and abuse. The sexual abuse of women with mental or developmental disabilities is widespread, and often occurs in situations where the woman is dependent on her abuser for physical or emotional care. Furthermore, a lack of education and awareness can lead to the inability of mentally disabled women to distinguish between appropriate and inappropriate behaviour. Women with mental disabilities face sexual abuse under the guise that they ‘do not understand what it is’ or that because of the systemic dehumanisation they face throughout life, ‘it does not count as abuse’. While both these assumptions are fallacious, they remain widespread, with gruelling consequences. Apart from the actual experience of violence, it is often pre-emptive protection in the form of isolation or institutionalisation that serves as a form of violence in itself. Ranaboli Ray from the Anjali Mental Health Rights Organisation in Kolkata says, ‘Generally parents or caregivers have just two options to protect the mentally disabled. One is that they could act as a 24/7 surveillance camera and monitor their daughter/ward. The second option is to let her live independently as it is her right, while keeping the channels of communication open. They should explain to her the rules of safety, and tell her that no one has the right to violate her body. Some parents choose the first option, some choose the second. They must decide what works best for them.’ In order for parents to take these decisions for their daughters, however, there must be active programmes and support systems that seek to address the sexuality of mentally disabled girls and women through a rights-based perspective.
The forced sterilisation – and sometimes hysterectomy (involving the full removal of the uterus) – of girls and women with disabilities is a human rights issue across the world. Under the pretext of menstrual management or protection from unwanted pregnancies, girls living with mental disabilities are made to undergo a sterilisation of their reproductive system – a process that no one bothers to explain to them. Doctors and healthcare providers often advocate this as an ‘easy solution’ for families that have mentally disabled daughters, and there is little information provided about alternative options. Perhaps the most worrying aspect of sterilisation is the frequency with which it is performed the world over in institutions as a preventive measure for unwanted pregnancies. Given that many of these women live in women’s-only accommodation, it is clearly evident that the preventive measure being used here does not address its cause – unwanted sex, rape. While the decision to sterilise a mentally disabled woman may sometimes be a necessary one, based on the severity of her disability and the circumstances of care that those around her are able to provide, the decision must be made in as informed a manner as possible, with a view to placing her consent and rights at the heart of the process.
Given the ways in which gender-based discrimination is heightened when compounded with disability, is it possible, perhaps, to say that mental disability – its causes and consequences – is in itself sometimes gendered? According to the WHO, gender-specific factors for common mental disabilities that disproportionately affect women include gender-based violence, socio-economic disadvantage, low income and income inequality, low or subordinate social status, and unremitting responsibility for the care of others. Studies find that there is a positive relationship between the frequency and severity of these factors and the frequency and severity of mental health problems in women. Furthermore, stereotypes about women’s proneness to emotional problems serve as a barrier to the accurate identification and treatment of psychological disorders. Therefore, to talk about mental health, gender and sexuality, we cannot separate ourselves from the issue of widespread discrimination and oppression of all women in societies across the world. The fight for a holistic approach to mental health and sexuality for girls and women will always already be woven together with the fight for global women’s rights. Now it is time to unite these battles and move forward together.
1) Mental disability is being approached separately in this series due to the legal and rights-based complexities surrounding the issue, as well as the different patterns of social stigma into which it is entrenched.
(Richa Kaul Padte is a freelance writer and feminist activist living between Bombay and Goa. She was the co-author and project coordinator of www.sexualityanddisability.org, an online initiative by Point of View and CREA)
Infochange News & Features, March 2013