有精神分裂症和抑郁症的人应不应该拥有两人世界？十多年来，无论是家里人还是医生，都奉劝有严重心理疾病的人远离亲密关系，特别是性关系。大家都认为，心理疾病就如同其它严重障碍一样，增加了发展和管理人际关系的难度，尽管这些在药物治疗下会有“突破时刻”。目前有关心理疾病群体中的性问题才刚刚开始研究，现在还不清楚两个心理疾病的人相处会不会更好。-psytopic.com
James Leftwich想找一个女朋友，想结婚，想过其它许多人都想过的“正常”生活。
几年来，他被劝告不要去尝试。因为他的精神分裂症和抑郁症，这些想法都已经超出了他的能力所能够掌控的范围。
现在，James Leftwich，这个图书管理员在纽约开办了一个“约会与支持”的网站，旨在帮助那些有严重心理疾病的人。
Leftwich说：“有心理疾病的人是很艰难的，但是他们不应该放弃自己在被诊断前拥有的目标。”
十多年来，家庭成员、个体咨询者以及医学组织都劝告那些有严重心理疾病如：双相障碍、精神分裂症、抑郁症之类的人远离亲密关系。因为这有太多压力，太多瑕疵，太多风险。
但是，少量的研究者的建议却恰恰相反，这也许是对的。在过去的几年中，他们已经开始公开支持这一观点，因为进入一个良好的人际关系能够为患者提供稳定，友谊和支持，就如同那些他们声称“没有被诊断”的群体一样。
“他们想每个人都想的事情，”宾夕法尼亚大学药学院的精神病学副教授Michael Blank说。他正在监控几项研究，其中包括心理疾病患者间的安全性交计划。
但是这个观点过多的讨论人际关系和性问题已经被证实是抄作。那些身处计划之中的人和研究这个计划的人说绝大多数人根本不考虑心理疾病患者是能够进行性生活。
“观点提出者对性和他们的来访者有自己的观点和态度，”宾夕法尼亚州综合群体合作大学的研究专家LaKeetra McClaine说。“他们只是假想他们的来访者是没有性生活的。”
他们不是
根据2002年Penn的研究显示，在严重心理疾病患者中，HIV感染机率比普通人群要高出7倍多。5月，印地安那州和Purdue两地大学的研究者发表于《性研究》杂志的报告称，有心理疾病的人更可能在同一时间拥有多个伴侣，关系维持的时间更短，更容易发生性关系。
但是性与人际关系，密友和其它方面则刚好不在议程上。
被调查的患者说他们的医生通常都不提及药物在性方面的副作用。而是过多的集中于工作，供房和药物使用，而不是手牵手和看电影。
“我想对治疗师和其它的任何人而言都差不多，性是一个令人尴尬的话题，” 宾夕法尼亚州东南区心理健康协会的主席与首席执行官Joseph Rogers说，他被诊断为患有双相障碍。“我从来没有接受大量咨询或者直接的支持，他们没有一个人能够为害相思病的人拿出建议来。”
由于HIV的高传染率，研究者们正在努力寻找方法将信息送到那些需要的人的手中。
Penn的一项通过心理健康机构研究24名个体咨询者和300名来访者的研究正着眼于研究安全性交计划的有效性。
尽管这项研究要到2008年才结束，但是到目前为止这个反应已经很复杂了。
“一些人说这和时间相关，HIV的感染率是令人担忧的，我们需要提供避孕套，” 一个同Penn合作的高级研究者Julie Tennnile说。
“其它的人感到不舒服并且害怕这个计划干扰他们的宗教信仰。”
Vernell Rainey作为心理健康个体咨询者已经18年了。在费城的Hall-Mercer心理咨询中心，他有18个来访者，他们中的所有人都被诊断为有心理疾病。
“我们考虑他们的母亲，父亲，姐妹，阿姨，医生，律师和印度主管，”她在一个被公共关系工作人员监控下电话中说。
Rainey说，在参加Penn的研究以前，她从来没有想到要提出性方面的问题。
“我也许会问他们是否有小孩，但是我们只是关注其它的想法，我从来没有考虑他们持有的人际关系。”她说。
现在每个来访者都要参加一个时长为1年的关于安全性交和性生活的计划。中心同时也开展讨论与有心理疾病的人同居的问题，同时也鼓励父母，家庭成员和朋友加入其中。
Rainey说她在讨论避孕套的使用和其它性问题上已经没有问题了，但是她的一些同事却感觉有点不舒服。一名男性工作者就在女性来访者要求示范避孕套的使用方法时而专门来求助她。
印地安那和Purdue研究中的合作者Eric Wright说，每个人都同意，心理疾病就如同其它任何一种严重障碍一样，增加了发展和管理人际关系的挑战性，尽管这些在药物治疗下会有“突破时刻”。
“心理疾病影响你认知世界的方式以及你如何认知那些最关心你的人。”Wright说。
“有些问题是巨大的挑战，如：如果你是一名心理疾病患者，在感觉和幻觉中你可以有所捕获，在你周围的人可能因为你的错觉而变成物体。”
当你听到一些声音，或者情绪在两极转换，甚至是变成妄想狂，伴侣不是很容易理解的。
Wright说，虽然如此，一个研究揭示那些被允许结婚的心理疾病患者更少的去就医。
因为在心理疾病群体中的性问题才刚刚开始研究，现在还不清楚那些与有心理疾病的人为伴的人会不会境况更好。许多都只和这个群体内部人员约会因为他们都互相认识。Penn McClaine 说。
Mari Bennett，被诊断为双相障碍，她说她约会有好的和坏的两种结果。她结过两次婚，住在Norristown的过渡安置房中。
是她的治疗师鼓励她重新开始约会。现在她正在考查一名健康的知道她所有问题的律师。
“在向人们透露我的情况时，我会先暂停思考一下。但是这个年代每个人都在为某些事情而用药，”Bennett说。“但是如果确定了你要将某个人带入到你的生活中，你与他们之间就必须有非常诚实的交流。”
Wright就患过抑郁症，他说要让你患过心理疾病的事情在你潜在的伴侣面前真相大白是一个巨大的问题。
“就像HIV，这不是那些有很好的愈后的疾病，这可能把一些人吓跑。”研究者说。
这就是为什么这个纽约的图书管理员Leftwich开办了他的约会网站。一但你登录网站，他就会给你一个自动的诊断。他说。
三年后，这个网站现在已经有超过5300名会员，为四场婚礼举办了庆典，他说。
“被拒绝的可能性仍然真实的存在，网站不是万灵药，”Leftwich说。“但是多了一个接受的地方，在这里人们不用因为外表或者是你的成就而感到不安。他们只是乐意给人们一个机会。”
附原文阅读：
Embracing intimacy
Philadelphia Inquirer - November 13, 2006
James Leftwich wants a girlfriend, wants to get married, wants the same kind of "normal" life most others desire.
For years, he was encouraged not to try. Because of his schizophrenia and depression, those closest to him thought it would be too much for him to handle.
Now the librarian from New York runs a dating and support Web site aimed at those with serious mental health problems.
"It's harder for a person with a mental illness, but they shouldn't give up on the goals they used to have before they were diagnosed," Leftwich says.
For decades, family members, case workers and the medical community have encouraged people with severe mental health issues - bipolar disorder, schizophrenia and major depression, among others - to stay away from intimate relationships. Too much stress. Too much stigma. Too much risk.
A few researchers, however, are suggesting that just the opposite might be true. Over the last few years, they have publicly supported the idea that being in a good relationship can provide stability, companionship and support, just as it does in what they call the "non-diagnosed" community.
"They want the same thing that everyone else does," says Michael Blank, assistant professor of psychiatry at the University of Pennsylvania School of Medicine, who is overseeing several studies involving safe-sex practices among the mentally ill.
But the idea of more discussion about relationships and sex has proved to be a tough sell. Those within the system and those who study it say that most people don't think about the mentally ill being sexual at all.
"Providers have their own ideas and attitudes about sexuality and their clients," says LaKeetra McClaine, a research specialist at the University of Pennsylvania Collaborative on Community Integration. "Most of them just assume their clients are asexual."
They're not.
The HIV infection rate among people with serious mental illness is almost seven times higher than in the general population, according to a 2002 Penn study. And people with mental illness were more likely to have multiple partners at one time, shorter relationships, and were sexually intimate sooner, researchers at Indiana and Purdue Universities reported last May in the Journal of Sex Research.
But sex and relationships, intimate and otherwise, just aren't on the agenda.
Patients surveyed say their doctors usually don't mention the sexual side effects of medications. Overloaded case workers focus on jobs, housing and medication needs - not holding hands and seeing movies.
"I think sex is an embarrassing topic for the therapist as much as anyone else," said Joseph Rogers, president and chief executive officer of the Mental Health Association of Southeastern Pennsylvania, who is diagnosed with bipolar disorder. "I never got much counseling or direct support. They don't have someone handing out advice for the lovelorn."
Armed with the high infection rates for HIV, researchers are trying to find ways to get information into the hands of those who need it.
One Penn study of 24 case workers and 300 clients at a mental health facility is looking at the effectiveness of a safe-sex education program.
Although the study doesn't end until 2008, the response so far has been mixed.
"Some say it's about time, and the HIV infection rates are alarming, and we need to provide condoms," says Julie Tennille, a senior research associate who works with Blank at Penn.
"Other people aren't comfortable and fear that the program interferes with their religious beliefs."
Vernell Rainey has been a mental health case worker for more than 18 years. At Hall-Mercer Community Mental Health Center in Philadelphia, she has 18 clients, all of whom are diagnosed with a psychiatric illness.
"We're considered their mother, father, sister, aunt, doctor, lawyer and Indian chief," she said in a call monitored by public relations staff.
Before taking part in the Penn study, Rainey said it never occurred to her to bring up sexual issues.
"We might have asked if they had children, but we're just so wrapped up in other thoughts, we never thought of them having relationships," she said.
Now each client goes through a year-long program about safe sex and sexuality. The center also holds talks about living with a mental illness. Partners, family and friends are encouraged to come.
Rainey said that she has no problems talking about condom use or other sexual issues, but some of her coworkers are a little uneasy. One male coworker specifically asks for help when demonstrating condom use to his female clients, Rainey says.
Everyone agrees that mental illness, like any serious disorder, adds challenges to developing and maintaining relationships. Even those on medication have "breakthrough moments," said Eric Wright, co-author of the Indiana/Purdue study.
"Mental illness affects the way you perceive the world and how you perceive the people who care about you the most," said Wright.
"There are some issues that can be a big challenge, like if you're psychotic, you can get caught in the feelings and delusions, and the people around you can become the object of your delusion."
It's not always easy for a partner to understand when someone hears voices or has major mood swings or becomes paranoid.
Even so, Wright said, one study found that psychiatric patients who were allowed to get married were also less likely to be hospitalized.
Because sexuality in the mental health community is just starting to be researched, it's unclear whether those who partner with other "diagnosed" people are better off. Many only date those in the community because that's who they know, says Penn's McClaine.
Mari Bennett, diagnosed with bipolar disorder, says she's dated both - with good and bad results either way. Married twice, she lives in a transitional living program in Norristown.
It was her therapist who suggested she start dating again. Now she's seeing a "non-diagnosed" lawyer who knows all about her illness.
"I do take some pause before telling people, but everyone is taking a pill for something these days," Bennett said. "But if I'm going to bring someone into my life, after a certain amount of time, you have to have some very honest conversations with them."
Wright, who himself suffers from major depression, said the issue of coming out to potential partners about your mental illness is a huge one.
"It's much like HIV, it's not something that's going to go over very well and it might scare some people off," the researcher said.
That's why Leftwich, the New York librarian, started his dating site. By just being on the site, it's an automatic diagnostic heads-up, he said.
After three years, the site now has more than 5,300 members and four marriages to celebrate, he said.
"The possibility of rejection is still very real. The site isn't a cure-all," Leftwich said. "But it's more of a welcoming area, where people aren't so hung up on looks or what you've achieved. They're just more willing to give a person a chance."
Psytopic成员Roger翻译自APA/原文链接
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