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A Man Apart

by Joan M. Fenske, R.N., M.S., D.N.Sc.

“Does Ken express himself sexually?”

The Social Worker held his pen aloft, waiting for an answer. We were on page five of Kenneth’s intake questionnaire. Two hours of a scheduled four hour interview had elapsed. My mouth opened, staying still and motionless. 18 years of interviews, completing questionnaires and submitting forms had not prepared me for this question. I had no answer.

Noticing my stupefied expression, the Social Worker shuffled his papers until he found the facilities’ Patient Bill of Rights.

 “After discussing Kenneth’s situation, and the care we expect to provide him, you’ll need to indicate by your signature we have covered each item. Respecting and acknowledging his sexuality is one of his rights”.

I heard his speech and nodded my understanding. Still no words came. What sexuality? I was still taking Kenneth to visit Santa Claus. Knowing the principle of “age appropriate” as it related to individuals with developmental disabilities, I’d never adhered to it.  Indeed, I insisted an infant’s busy box be placed on the side rails of Kenneth’s bed. Kenneth enjoyed manipulating the buttons and I saw no reason to deny him this pleasure, no matter experts said this toy was not age appropriate. It was quite a leap forward to the Social Worker’s age appropriate question of Kenneth’s sexuality. Kenneth was 18 years of age.

 I was speechless. I could not get my mind around the notion of Kenneth’s sexuality.

Avoiding the question, my curiosity got the best of me. My only thought was of Bob and how intrigued he’d be by the Social Worker’s question.

“What are Ken’s options?” I naively inquired.

Never wanting to deny Kenneth opportunities for happiness, I wanted to learn about the possibilities this subject suggested. Realizing Kenneth, on occasion, had erections while diapering him, I realized how little we’d noticed his budding manhood. We knew he had favorites among his caretakers giving his best smile when they were young, vivacious, and with long blond hair. Confronted with Ken’s sexual potential, I felt cornered. Although trying to avoid this question, I could not deny its importance. I shuddered. An absurd notion popped into my mind. His father never spoke to him about sex, I wanted to say.

The Social Worker indicated the seriousness of this matter by putting down his pen, sliding his chair away from his desk. Obviously, I was about to be educated.

“Kenneth is residing on Emparen, a unit of young adults functioning at his skill level. For young men who are mobile, and are so inclined, we offer privacy for masturbation. Young women are prescribed birth control medication to prevent unwarranted pregnancies. Being pregnant endangers their health. Young women with developmental disabilities mentally function beneath their chronological age, often at a three or four-year-age level. They don’t grasp the significance of their pregnant state. At times, young men and women become attracted to each other and form alliances. Their relationship is supervised and, as appropriate, they are given suitable privacy for intimacy. More often than not, couples are easily distracted from pursuing any physical contact. Being developmentally disabled, thinking in childlike terms, most are unable to conceptualize sexual intercourse and act upon that knowledge. All staff, especially Psychiatric Technicians, are educated to care for individuals who may or may not become sexually active. Psych Techs, learning from professional past experience, exercise respect, diligence and good judgment as they monitor each client’s chosen expression of sexuality”.

I’m certainly happy to know that,” I responded. I was numb with shock.

Kenneth could not walk, talk, sit or stand. How did this information apply to Kenneth?

“Will his potential for sexual expression be monitored just as his medication, diet, blood pressure and bowel care?”, I asked.

“Just like a regular guy”, replied the Social Worker.

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