I am a 23 year-old mental health consumer diagnosed with schizophrenia. I am interested in women, but homosexual men seem attracted to me. Sometimes I wonder about my sexual identity. Is this wondering part of my illness?
(Column: Ask the Therapist)
Your Sexual Identity
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Everyone has wondered about his/her sexual identity; and some of us continue to wonder. People, especially young adults, who have had periods of mental illness and/or continuing mental health issues may take detours around the usual developmental milestones of adolescence. For example, their first sexual experiences may be delayed; or the medications may diminish sexual interest; or the person may become compulsively sexual without thinking through relationship issues. But working out (and worrying about) sexual identity is not a symptom of mental illness. Like the rest of your identity, the course of your illness and your treatment will affect the pace of your development.

Perhaps it would be easier to think of sexual identity as on a continuum: from emphatically and exclusively hetero to emphatically and exclusively homosexual. In between there is a continuum of more-or-less one or the other or both. So when you are sexually aroused you may think of a woman or look at girlie magazines; but when your gay male friends come on to you, you may be tempted or titillated or surprised or turned off -- to name a few of the mixture of feelings that may occur. On the other hand, many gay people tell us that they knew from an early age about their attraction to members of the same sex. In between, there are people who are mostly attracted to one sex or the other; and people who seem to find themselves attracted to both men and women.

Attraction and identity are not the same as behavior -- who we have sex with or whether we have sex; even whether we masturbate. Some of us are attracted to people of the same or opposite sex, but have never had a sexual experience; or, we have kissed but not gone "further." Some people seem to have little interest in sexual behavior -- perhaps something interferes with their sexual needs; or perhaps they are not particularly in need. Some people have many sexual partners, but no relationships. Some people buddy up but never get sexual. And some people have periods of experimentation with members of one or both sexes, and eventually form a stable relationship or have a long (or short) series of relationships.

The personal ads, the sexually-oriented magazines, the Hollywood movies, romance novels, "great" literature, t.v. sitcoms certainly portray a myriad of possibilities for identity, behavior and relationships. And, it is not just the "diagnosed" who struggle with who they are, what they should do, and with whom they should do it. If you came up in the dark 1950s you were exposed to cultural prescriptions that defined normal sexuality very narrowly. In the 1960s the emphasis was on being liberated, having many and varied sexual partners -- brought to an abrupt end by the emergence of sexually-transmitted diseases. Coming up today is certainly more open; but beyond being reminded to have safe sex, the individual is left with a great deal of latitude which seems to have burdens of its own: now you are asked to choose!

Mental illness and its treatment have an effect on sexual identity, behavior and relationships to the extent that they have an impact on the person's ability to navigate the shoals of social life. But there isn't one amongst us (diagnosed or undiagnosed) who has not faced the issues of sexual identity, behavior and relationships with anxiety and uncertainty.
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