“The man wants woman to be peaceful, but woman is essentially unpeaceful, like the cat, however well she may have trained herself to present an appearance of peace.”
Friedrich Nietzsche, Beyond Good and Evil, 131
Sexuality exists as a venue for the operation power and is imagined and constructed iteratively – at the level of subjectivity. Sexualization takes place within interactions between individuals, to then structure patterns of being at the group level and finally carry normative weight in public consciousness. Disparities in agency and access to resources undergo a process of sexualization as power differentials take on an element of desire that is then naturalized and reproduced as essentially ‘erotic’ domination. Growing research suggests that in the realm of sexuality, individuals, particularly women, with mental illness are perceived as experiencing low levels of agency and high levels of sexual openness. With increasing cultural fascination for exploring sexual fantasies based in unequal power relations, women with mental illness, must navigate the relationship between power, stigma and sexuality on their own terms. What complicates the processes of female socialization, sexual autonomy and the stigmatization of mental illness is the experience of trauma expressed in diagnosed mentally ill women’s history with childhood sexual abuse. The relationship between early sexual victimization and ongoing experiences of sexual coercion for mentally ill women deserves critical feminist analysis of the operation of power within this specific sociosexual reality.
This paper intends to unpack the asymmetrical relational dynamics embedded in the realm of sexuality for mentally ill women. Additionally, I will discuss the eroticization of neurotic behaviour, mainly sexual impulsivity and risk and emotional distance. These ideas will situate the ideological assumptions underpinning the lived experience of Dominican women living with bipolar disorder as a case study providing material evidence. The reliance of symbolic and moralized binaries, namely ‘good girls vs. bad girls’ and ‘normal vs. deviant’ will highlight how sexual modalities operate at first the ideological level and later are transposed into social action and subsequent marginalization. It is often assumed that women who experience mental illness in tandem experience either disproportionately low or exponentially high, relative to ‘normal’, sexual interest. However, the implications for these assumptions are left seemingly undertheorized. In consequence, mentally ill women’s sexuality becomes oversimplified, mischaracterized and misrepresented in moralized and pathologized terms. These imaginative evaluations provide a cultural script or narrative produced externally from the source of knowledge and experience – mentally ill women themselves. In seeking to undo sexualized narratives of difference, victimization and hypersexuality, this paper will attempt to draw analysis stemming from empirical research and personal narratives of lived experience relating to this phenomena.
The World Health Organization defines sexuality as, “ a central aspect of being human throughout life and encompasses gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. It is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal historical, religious and spiritual factors. (WHO, 2016) As this definition highlights, complex relations between the subject and the sociocultural conditions in which they’re situated is central for the social functioning and production of sexuality. In this framework, it becomes necessary that in the examination of sexuality in the context of female mental illness, contextual factors are accounted for. These factors include socioeconomic status, abuse, sexual coercion, gender power imbalances and levels of sexual health knowledge. (Randolph: 2006) It is reported that women with mental illness experience higher rates of sexual abuse than non-diagnosed women, with abuse rates ranging from 50%-75% and repeated victimization. (Rosenberg et. al: 1999) Female socialization, occurring alongside mental illness and/or abuse, complicates the process for women to articulate their own sexual desires. (Davidson: 2010, 246) These variables, complete the necessary conditions for sexual exploitation, both materially and ideologically. The mobilization of ideas that construct the sexuality of women with mental illness as ‘damaged’, vulnerable, non-committal, and expressive constitutes what may even considered the sexualization of stigma. In this context, the capacity for sexual agency is limited and the ability to determine individualized sexual desire is reduced. Sex, utilized as a means to escapism, perceived intimacy, access to resources, distraction or acceptance is not a space in which sexuality can be articulated with free-association and self-actualization. With sexual abuse historically present in over half of women who are mentally ill, it is understandable how alienation, in every realm of social reality, clouds perception, self-conceptualization and interaction with a deep sense of inadequacy and estrangement. Concurrent with this estrangement, is perceived and real stigmatization underpinning the experience of living with a mental illness.
Sociologist Erving Goffman characterized the term ‘stigma’ as an undesirable differentness from ‘normal’ or ‘“spoiled identity”. (1963, 7) It has been well established in recent literature on psychosocial inequality that “people suffering from mental illness and other mental health problems are among the most stigmatized, discriminated against, marginalized, disadvantaged and vulnerable members of our society” (Johnstone: 2001, 201) Evidence also suggests that stigma associated with low self-esteem may produce subjects with perceived lowered desirability in their relationships with others and thus, imply a sensed diminishment of power. (Collins, 390) Thus, the role of stigma produces consequences for sexual subjectivity for women with mental illness and their perceived social stain and personal inadequacy increases the likelihood that she engage in sexual encounters of greater risk, involving unprotected sexual intercourse. Furthermore, quantitative research finds a relationship between experiencing mental illness stigma and greater HIV risk, rates of substance abuse before sex, having multiple sex partners and exchanging sex for money or goods. (Collins, 390) The cultural construction of sexuality in this context centers around sexual openness.
Social psychologists at the University of New South Wales discuss two central assumptions mediating perceptions of sexuality in regards to mental illness. They determined low sexual agency and high levels of sexual openness as fundamental factors that characterize public consciousness in this context. (Blak et al. 2016) These two assumptions place the sexual subjectivity of mentally ill women in precarious psychosexual and sociosexual territory. The first assumption, determining low sexual agency is indeed backed by empirical evidence that women who suffer mental illness also disproportionately experience sexual victimization – all of which is not subject to their control and thus, their agency is reduced. However, the limitations of extrapolating the situational sexual subject of a woman from the historical evidence of previous victimization ventures to remove her autonomy even further. Here, the interaction between historical, material experience and the ideological production of subjectivity seemingly sustains and reproduces this notion of limited sexual agency. Similarly, the claim suggesting high levels of sexual openness for mentally ill women also creates the conditions for which the claim is based. As sexual subjectivity reconciles both interior and external evaluations of self, the association of sexual openness among mentally ill women reinforces an obligation or expectation of sexual openness and thus produces it over and over -strengthening the claim. This sexual permissiveness discourse identified by researchers constitutes an ideological and material basis for the reproduction of the sexualized female mental illness.
Related to overarching assumptions involving low sexual agency and high sexual openness are binaristic categorizations founded in difference. Psychosexual alterity places mentally ill women on the deviant side of a traditionally (and socially) constructed ‘normal vs. deviant’ dichotomy. Researchers seeking to unpack the constellation of HIV risks for unemployed, black, Dominican women with bipolar disorder highlight experiences of discrimination at the institutional and psychosocial level for these women. (Collins et. al: 2008) Placed outside of perceived normality, women in this study identified themselves as “loca”, emphasizing the ways “loca” women were not expected to function as “proper women” (read: normal women). These women believed that the label“loca” reflected stereotypical views of women with mental illness but also felt their lives reflected this incapacity for normality (Collins et. al, 2008: 392) Theorists and psychologists have noted that the “expectations of what constitutes ‘normal’ life in the community for people with mental illness is considerably varied”, thus, a simple delineation of normal in opposition to abnormal must be reconfigured in the context of mentally ill subjectivity. (Mccann: 2003: 643) Bipolar women in this study understood their illness as a key factor in their treatment by men in the community, citing dismissive or demeaning attitudes, reluctance to commit to relationships and abandonment as reactions that signal their stigmatization. (Collins et. al: 2008, 393) Other participants emphasized the “fantasies” men had about women with mental illness being dangerous. This ideation of unpredictableness, neuroticism, sexual risk and availability structures perceptions of sexual subjectivity in both external – popular imagination, and internal – self-concepts for women. Furthermore, the pathological typification of a sexuality based in impulsivity, the unknown, emotional distance and risk potentially sets women with mental illness up for gaslighting, exploitation and manipulation on behalf of their sexual partners.
The hypersexualization of ‘crazy’ women makes sense within the sociosexual reality of Western societies in post-modernity. Virtualization, secularization and the normalization of casual-sex combine to transform sexual culture at every level. Without being evaluative, because of course these shifts in culture are in many aspects liberatory and expansive with regards to sexual freedom, still – fallout must be critically assessed. Central dimensions of female mental illness, emotional distance, impulsivity and engagement in sexual risk, map seamlessly onto the casual, non-committal ideal type of sexuality produced in this environment. In some regards, it may be easier for women with mental illness to veil their symptoms as ‘playing the game’ because these inclinations have acquired cultural currency and normalization. For male partners, these characteristics potentially align with an ‘ideal type’ of female partner. However, these tendencies continue to make women with mental illness significantly more vulnerable to sexual coercion and victimization, and their realization is by no means a mechanism for restoring and coping with emotional and cognitive disruptions.
The eroticization of mentally ill women is not explicitly expressed in public consciousness, and yet, this notion goes relatively unchallenged. While it is important not to victimize women with mental illness by removing their capacity to consent, self-represent or free-associate, there is value in being critical of an underlying sexualization of illness as it plays out in the realm of the sexual. As research suggests, women with mental illness experience a myriad of socioeconomic, psychosomatic, and health risks related to their illness. Thus, without perpetuating victim narratives of rescue, it is critical to provide adequate analysis for the ways in which historical victimization conditions ongoing experiences of vulnerability. Research currently emphasizes the relationship between past trauma and abuse to present victimization, however, a way to improve investigation into this topic may explore at a deeper level the role of acknowledging trauma as either helpful or hindering the coping/recovery processes. Similarly, research involving the role of diagnosis as a prescribed narrative through which women frame their experience could illustrate the way diagnosis alters self-perceptions and subsequent behaviour/reality. Furthermore, the limitations of research on the topic of sexualized mental illness is the excludes several key mental illness diagnosis experienced by women, such as anorexia, depression and suicidal ideation, anxiety disorders and obsessive compulsive disorders. Furthermore, an analysis of the intersections of racialization, class and mental illness would expand the field of knowledge available to clinical practitioners and the public at large when attempting to uncover the experience of mental illness at various structural locations in society. Further research could also attempt to examine or derive a theory that explains how male sexaulity is co-constructed alongside mentally ill female sexaulity; how the relational dynamics and typologies emerging in this context reproduce or undermine gendered expectations about sexuality. The process for unpacking how female mental illness operates at the level of sociosexuality and how it is experienced by women themselves is essential for reconfiguring a sexuality that falls outside the bounds of normativity. Embracing sexual liberation and expressivity for all women is imperative, however, it is also crucial we maintain a critical lens when confronted with increased vulnerability and repeat victimization on the basis of cognitive and emotional difference. The eroticization of neurodivergence is not exempt from analysis as a fetishization of power differentials and therefore, it must be interrogated as such.
References
Blakkr, Bastian, B., & Denson, T. F. (2016). Perceptions of low agency and high sexual openness mediate the relationship between sexualization and sexual aggression. Aggressive Behavior, 42(5), 483-497. doi:10.1002/ab.21644
Collins, P. Y., Elkington, K. S., Unger, H. V., Sweetland, A., Wright, E. R., & Zybert, P. A. (2008). Relationship of stigma to HIV risk among women with mental illness. American Journal of Orthopsychiatry, 78(4), 498-506
Collins, P. Y., Unger, H. V., & Armbrister, A. (2008). Church ladies, good girls, and locas: Stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk. Social Science & Medicine, 67(3), 389-397
Davidson, M. R. (2012). A nurse’s guide to women’s mental health. New York, NY: Springer Pub.
Davison, J., & Huntington, A. (2010). “Out of sight”: Sexuality and women with enduring mental illness. International Journal of Mental Health Nursing, 19(4), 240-249. doi:10.1111/j.1447-0349.2010.00676.x
Goffman, E. (1963). Stigma; notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.
Johnstone, M. (2001). Stigma, social justice and the rights of the mentally ill: Challenging the status quo. Australian and New Zealand Journal of Mental Health Nursing, 10(4), 200-209. doi:10.1046/j.1440-0979.2001.00212.x
Mccann, E. (2003). Exploring sexual and relationship possibilities for people with psychosis – a review of the literature. Journal of Psychiatric and Mental Health Nursing, 10(6), 640-649.
Randolph, Mary E., and Katie E. Mosack. “Factors Mediating the Effects of Childhood Sexual Abuse on Risky Sexual Behavior Among College Women.” Journal of Psychology & Human Sexuality 18, no. 1 (2006): 23-41
Rosenberg, S. D. (1999). Reliability of reports of violent victimization and posttraumatic stress disorder among men and women with serious mental illness. Journal of Traumatic Stress, 12(4), 587-599
WHO | Defining sexual health. (2016). Retrieved November 19, 2016, from http://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/
hypervigilant curse 