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“The Sex Lady Talks”: Disability Rights and the Normalization of Sex in a 1980s Institution

When recreational therapist Lisa Freeman began working in the Dual Diagnosis Unit at Indiana’s Central State Hospital in 1986, she frequently encountered patients having sex in and around the unit.1 Central State was a long-term psychiatric hospital and the Dual Diagnosis Unit (DDU) served patients who had been diagnosed with both mental illness and intellectual disability. As Freeman later recalled, on the DDU, “it was not uncommon to hit a stairwell and find people copulating in the stairwells or behind the bushes in the grove or outside your office door.”2 At Central State, as in most 20th-century psychiatric institutions, staff traditionally responded to sexual behavior among patients with punishment or denial. Freeman departed from these norms and instead attempted to create a sex-positive environment where DDU residents could engage in consensual sexual relationships with dignity and privacy.

Freeman’s advocacy on behalf of patients’ rights to sexual intimacy reveals some of the complexities of paternalistic models of care for people with intellectual disabilities in the late 20th century. Grassroots action on the part of DDU staff demonstrates that the expansion of disability rights was possible within state-run psychiatric hospitals during the era of deinstitutionalization. At the same time, it’s important to remember that Freeman’s program was exceptional for its time, and took place within the context of continued limitations on sexual and reproductive rights for people with disabilities in a supposedly post-eugenic era.

For Freeman, the central issue was consent: “everything was okay if you were an adult and consented to it.” To help create a culture of consent, Freeman brought in an expert. She ignored the hospital hierarchy (in her words, she “went rogue”) and recruited a community educator from the local Planned Parenthood to hold regular classes for residents in the DDU. The educator, known by many residents as the “Sex Lady,” visited the DDU over the course of three months, and used educational videos, dolls, and props to supplement her discussions of anatomy, hygiene, and contraception. The Planned Parenthood educator also advocated for a safe, private place for people to be intimate and ready availability of condoms. With these changes, the problem of patients copulating in stairwells diminished. And as articles in the DDU Review indicated, patients emerged with a greater understanding of safer sex practices and of their own sexual agency, including their right to refuse unwanted sexual advances.

Throughout most of the 20th century, sex between people with disabilities was taboo at best, if not subject to eugenic controls such as forced sterilization and institutionalization. In fact, the state of Indiana passed the world’s first eugenic sterilization law in 1907. Beginning in the 1970s, institutions throughout the United States and Western Europe attempted to “normalize institutional living” for patients with intellectual disabilities or mental illness, for example, by instituting mixed-sex floors. The DDU was established in 1974 in this climate of normalization as an integrated unit at Central State, at the same time that the century-old sex-segregated buildings were demolished. As Allison Carey has argued, the principle of normalization, although it “stressed the pursuit of equality and liberty,…it also legitimated professional supervision and control.”3 At Central State, sexual behavior among residents of a mixed-sex unit proved to be a controversial issue that care staff were left to negotiate.

Read entire article at Nursing Clio