Characteristics of sexuality among older Israelis suffering from mental illness

Sexuality can broadly be defined as the quality or state of being sexual. Researchers have conceptualized sexuality as a combination of sex drive, sexual acts, and the psychological aspects of relationships, emotions, and attitudes. Sexual expression is considered a basic human right across most of Western society, and is an integral component of physical and psychological health and successful aging.

Despite the fact that studies have demonstrated that older people remain sexually active, underscoring the relevance of the study of sexuality in older adults, the subject is considered “taboo”; a stance consistent with the social trends of ageism, leading to stigmas on the basis of age in general, and regarding sexuality in particular.

In parallel, it appears that people who have been diagnosed with mental illness suffer both from discrimination and from the absence of treatment options with regard to issues concerning their sexual life. It has been found that there is an absence of discourse on this subject, even though this population is interested in exploring notions of partnership and sexual relations. In addition, it has been found that these stigmas endure, becoming a part of their identity.

This unique group, of old people with mental illness, is forced to face many challenges, one being “double tagging”- an affect on both their lives and their sexuality. The challenge is even harder when taking into account the fact that the only long-term care solutions in Israel are psychiatric hospitals with totalistic characteristics.

As the general population continues to age, the need to address these issues is increasingly crucial. The purpose of the current study is to test how sexuality is defined and experienced by older people suffering from mental illness.

Data was collected through 18 individual semi-structured interviews with
8 women and 10 men, aged 65-86, with diagnosed psychiatric illnesses, living in a mental health facility in Israel. In this exploratory study, three main themes were identified: the definition, existence, and absence of sexuality.

The first theme focuses on the participants’ definition of sexuality; all the descriptions referred to cultural aspects, and were organized into three main sub-themes: (1) Definition of sexuality as an aspect of one's personality; (2) Sexuality as a relationship between a man and a woman that may constitute only sex, or may include other aspect such as shared lives, romantic relationship, shared residence, family connections, and having children; and (3) Sexuality as the essence of life, the central source of life.

The second theme focuses on the perceptions of sexuality in their lives, and in the lives of their peer group members. While talking about their own sexuality, all the participants referred to a change and subsequent decrease in their sexuality. The subjects referred to sexuality in mental health and illness. Gender differences were found in the individual accounts of personal sexuality. All the men reported positive sexual experiences in their past, and expressed interest in continued sexual activity in the present. Some were still sexually active, and they all considered good sexuality a criteria for good health. All the women reported negative sexual experiences in their past. Half had suffered sexual violence and abuse. Five of the eight women interviewed reported, in parallel, positive sexuality activities. All the women declared that they have no interest in sexuality in the present time, and considered this as an indicator of mental illness.

While relating to the sexuality of their peer group in the same health facility, both the male and female interview participants described sexual desires and activities, with no differences with respect to gender or mental health state.

The third theme refers to the lack of sexuality, and the reasons for this. Most of the subjects (16 out of 18) denied the existence of sexuality, even when this contradicted their own personal descriptions earlier in the interview. Their explanations could be summed up into three main reasons: (1) Strong force of social control, and the stigma about mental illness and the psychiatric institutions in which they live; (2) Lack of privacy in the mental health facility; (3) Staff reactions to sexual behavior and activities, either ignoring or prohibiting this.

In conclusion, similarities was found between the definition of sexuality by old people with mental illness and the definitions presented in the literature by younger and healthier people, theoreticians, and health organizations. It would seem that the environment plays an important role in these perceptions. Gender differences were identified; while men reported the desire for sexuality and considered it as an indicator of good health, all of the women interviewed rejected it, and made a connection between sexuality and impaired mental health. Most of the participants declared there was no sexuality in the mental health facility, explaining this on basis of external reasons beyond their control.

The third age population, and within it the people with mental illness, is projected to increase in the future. It is an excluded and weakened group, due to the combination of age and mental status, receiving more assistance than the rest of the population in therapeutic frameworks. This research is unique and important, and can constitute a foundation for knowing and understanding this subject from the patient’s perspective, in order to build work programs for health staff and to inform future research.