On a newsgroup, someone asked:
I’m a student nurse from N.E. England, and I’m interested in finding out about other nurses’ experience of managing sexual disinhibition in patients suffering from an organic brain disorder (specifically dementia/Alzheimer’s, etc.). I am currently doing an essay about an incident in which a patient would often expose himself and masturbate in communal areas, causing distress to other patients and families.
The consultant suggested a “behavioural” approach rather than medication, involving redirecting the patient to his room (with the help of magazines) to “relieve himself” in private. Fortunately, this plan of action was dismissed due to the legal, ethical, and moral implications, and because the patient’s family objected (not surprisingly).
How do people feel about this?
Misreading the original post, someone remarked:
> I believe your consultant is way off the mark. I have seen sexual acting-out behaviours in people who have mental retardation, and they are almost always related to anxiety or boredom.
To which, I replied:
Whoa, hang on a second here!
Does any sexual “acting out” have to be related to anxiety or boredom? Maybe it’s related to a lack of a shag? A funny thing about people in long-stay care institutions is that they are often assumed to be non-sexual.
There is a huge difference between paraphilia and organic brain disinhibition. From what is described, I very much doubt this is a paraphilia.
Whilst masturbating in communal areas is not exactly polite, having a patient who masturbates should not automatically invoke a search for deep symbolic meaning. Nor should we adopt a professional stance that simply because we are aware that someone masturbates, we therefore must intervene, or that there exists some hidden policy manual governing such behaviour.
The bloke masturbates — most blokes do. Believe it or not, a lot of women do too.
Discussing masturbation in polite company may induce a blush or two, but a wank is just a wank. I’m amazed anyone thought it appropriate to discuss this with the family. I’ve certainly never discussed my own masturbatory preferences with my family — or anyone else’s family for that matter.
Ethical or legal concerns about giving a man a jazz magazine? Oh, come on. Get the guy a couple of copies of Loaded or FHM and be done with it. One of the biggest problems of living in a total institution is the absence of privacy for entirely normal human activities. I’ve often wondered where contestants on Big Brother managed to go to do what comes naturally without it being broadcast live to the nation. A tad embarrassing, don’t you think?
Above all, it’s important not to allow something like this to become the defining feature of the man’s care or identity. He’s been doing it all his life; it’s the context that has changed, not the behaviour.