I currently work within a community mental health center. My area focuses on Alcohol and Drug Counseling (which is needed seeing as how where I work is in the Top Ten of Heroin Deaths per Capita in the Nation). There are many things that I enjoy about my work. I believe it gives me perspective. I have learned to be grateful for many basic things and I also have been able to put issues in perspective a lot better. When you hear about a mother who is struggling to make ends meet while dealing with a nine year old child who self harms themselves to the point of permanent damage, the annoying neighbors really aren’t a big deal. Also, due to the services we provide I am usually surrounded by pretty liberal and socially conscious people.
However, even in this environment there is one area that has always troubled me and that revolves around the concept of promiscuity as diagnositic criteria.
My first and biggest problem with this is that I have NEVER heard this brought up as a symptom of mental illness when discussing a male. It is always something that is brought up about a female. I can’t help but assume that this is linked to the belief that “excessive” sexual activity is normal for a man and not a symptom of mental illness while no “healthy” woman would engage in or enjoy casual or alternative styles of sex. I also think it is linked to the belief that women are the only ones that have sex with other people due to low self esteem or possibly in a reckless manner because they have some self-destruct tendencies. See, sex is damaging to women, they can’t just enjoy casual encounters or engage in sex purely for self-satisfaction: they must be wounded in some way or they must be wrongly searching for the intimacy they so desire.
The second issue that bothers me is who decides promiscuity? Is there a specific number, types of activities, the way they describe it? Or are there just assumptions that must be made on the part of the therapist as to what they consider “healthy”. I do agree that some type of mental conditions may lead people to engage in unsafe/unhealthy sexual behavior. But I am reluctant to qualify that as promiscuity. Intentionally forgoing contraception or admitting that sex is not done for enjoyment can be something to talk about and work on in therapy but, in this case, the client is the one admitting and owning the problematic behavior. My issue focuses around a client talking about sexual behavior and the therapist deciding it is improper.
The basis for my discomfort is that I don’t believe we live in a society where women are truly viewed as sexual beings with all the autonomy and desires as men. I am afraid that the internalization of woman as searching for intimacy and relationships will color too many minds from seeing that sometimes women just like sex and that it has little or nothing to do with their mental illness. Also, there are issues of race that must be taken into consideration. Any stereotypes the therapist may or may not hold can affect the way they view the women in front of them and how they describe their sex life. Also, any possible views about alternative sexual lifestyles can skew the necessary objectivity that’s required in therapy. Understanding the appeal and functionality of BDSM relationships would be necessary to fully understand what may be going on in the sex life of a bottom or top that comes in for therapy. All in all, I would be more comfortable with the concept of promiscuous behavior not being a valid criteria for a mental health diagnosis.