Yesterday I went to a lecture-workshop led by Professor Traugott Roser , Professor of Practical Theology at the University of Munster. It was entitled, “Sexuality and Intimacy in a time of severe illness and death”. The lecture at the beginning told us about research conducted with a cohort of terminally ill patients and their spouses or partners in Canada and Germany ten years ago. It was undertaken through semi-structured interviews, so that the results of the interviews were comparable. But the process also produced a lot more biographical material than the research team were expecting.
Participants were asked what they understood sexuality to be, their experience of sexuality and intimacy, and how this had changed and was changing through their illness. They were invited to explore changes in both understanding and experience, the impact of their illness on their intimate relationships, and to discuss whether they had had, in their total experience of care, enough opportunity to discuss this part of their lives. The study also looked at the impact of the changes brought about by their illness to patients who were widowed or divorced and those who had never had an intimate sexual relationship and were now facing the end of their lives.
Listening to this were some chaplains, and a group of care home managers and the equality and diversity managers for MHA, a leading carehome provider, and me.
The discussion that followed ranged far and wide and covered topics as diverse as the WHO definition of sexual health (not what you think, see here), intimacy in care home settings, how to break the ‘appropriate/inappropriate’ binary, care home design, the attitude of churches to sexuality and intimacy, requested touch from patients to chaplains, and much more. It was a remarkable conversation, both for its thoughtfulness and honesty. After three hours a silence descended on the group and we realised that our work was done.
I cannot remember many occasions on which I have taken part in a more healthy and thought-provoking group discussion about sexuality. What was so significant about what we did was that, because the focus was on people who were either terminally ill or elderly (the MHA clientele), the assumption of society that sexuality and intimacy is not a subject that is terribly relevant for these groups was overturned. For many of the subjects of the research (though by no means all) sexuality could no longer be expressed through intercourse or even other genitally-focused activity, either because of the effects of illness or ageing, yet this did not mean that their sexual and intimate lives were necessarily over.
For some, whose vision of sexuality had been entirely focused on sexual intercourse its loss meant that they felt hugely diminished. One respondent, on receiving his terminal diagnosis had sent his girlfriend away because they would soon no longer be able to make love, and was struggling with the depression caused by both a loss of a sense of manliness because of his illness’s impact on his erectile function and the crushing burden of loneliness he was experiencing through loss of touch.
Other respondents, who had a vision of sexuality as being something much broader than sexual intercourse (see again the WHO definition), found that while one side of their sexual expression might come to an end, sexual feelings and intimacy were maintained and could even be reported as being enhanced through loving touch and hugs. What people needed most of all was the recognition that they still wanted privacy and space to experience this side of their lives, which gave them so much significance and meaning.
As I listened I could not help reflecting on how the study we were hearing about and the reflections of the group contrasted with the Statement put out last week by the Church of England’s bishops. One participant asked how a Church of England bishop might feel if they were in the room with us. Those of us who were members of the Church of England looked at each other. The consensus was that it would make them very uncomfortable.
There is a reasonable reading of the the pastoral guidance that the bishops offer that says it is obsessed by genital sexual activity, and the context in which this is or is not permissible according to their reading of the Christian tradition.
But, as this study clearly demonstrates, sexuality is much more than this. So is sexual intimacy. It may not involve genital activity principally or, indeed, at all, but may be connected to loving touch, to shared life, to tender commitment to a host of ways in which sexuality and intimacy find ways of working themselves out between a couple who love each other. Looking at this question from the point of view of those approaching the end of life was, for me, revelatory.
It offers a completely different way of approaching sexuality and intimacy – one that coheres with people’s lived experience. It stops us trying to compartmentalise sexual expression in a way that is profoundly unhealthy and unnatural. Sexual expression is not Tab A and Slot B – it is much more subtle and diffuse than that. Holding hands can be just as much an expression of desire, tenderness, commitment, and appreciation as can enthusiastic intercourse.
And of course, to look at sexuality and intimacy in this kind of way also makes the distinctions that the Church of England seems obsessed with making much less tenable. A priest, for instance, might live with someone of their own sex, but, because of their respect for the church’s rules, does not have genital contact with that person. But they like to hug and cuddle, they may share a bed, they spoon, they hold hands and kiss. They have declared their love to each other. This is a sexual relationship, whatever doesn’t happen in the bedroom or anywhere else. But if those actions which must not be undertaken are not undertaken and yet it remains a sexual relationship, then is it wrong and if so, in what way, and why?
It would also not be true to call that kind of relationship, because of the absence of genital sexual activity, simply a friendship – though friendship as part of a whole that is filled with sexual and intimate elements is clearly a huge part of any successful relationship. The best couples are almost always each other’s best friend too – that friendship is part of the world of intimacy that the two have made with each other.
This diffusion of an understanding of sexuality and intimacy also makes more space for the social significance of all kinds of couples. This is not simply about freely chosen bedroom activity – it has a social dimension that is hugely important. That may be expressed through parenting children, (their own or through adoption or fostering) or it may be found in the social action for and with those who need support or care which the partners in the relationship give because of the strength and the love that their relationship gives them. It is a fruit of their sexual and intimate relationship. Fecundity can be read in a number of ways. And good sexual and intimate relationships, whether they include sexual intercourse or not, are a blessing to society as a whole.
In the Church of England, after the disaster of the Pastoral Statement from the House of Bishops last week,we now wait for the publication of the resources of Living in Love and Faith – the culmination of a two-year project. My hope is that it will embrace a broad understanding of sexuality and intimacy to enable us to move away from the sterility of the perspectives of Issues in Human Sexuality and most of the reports since. That is my hope; it is, sadly, not my expectation. Old people and the dying, however, can lead the way here. Sexuality and intimacy are for everyone and for the whole of life – but almost certainly in ways that many of us have not yet thought about.