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Świadomość seksualna osób niepełnosprawnych intelektualnie. Utwórz PDF Drukuj Wyślij znajomemu

Dr Maria Piszczek

Swoje wystąpienie rozpocznę od stwierdzenia, że podstawową potrzebą każdego człowieka jest pragnienie bycia w łączności z innymi ludźmi (lub jak kto woli – potrzeba bycia w relacji). Siebie w relacji z drugą osoba odczuwamy poprzez świadomość ciała. Im pełniejsza jest nasza świadomość ciała obejmująca doznania zmysłowe, energię i emocje, tym bardziej jesteśmy zdolni do nawiązywania głębokiej łączności z ludźmi.
 Dlatego w pracy z dziećmi głębiej upośledzonymi umysłowo i z małymi dziećmi dwie sprawy są dla mnie nierozerwalnie związane: świadomość ciała i wzajemna łączność. Wychowaniu unikającemu świadomości ciała zawsze będzie czegoś brakowało. Z kolei zaś praca nad świadomością ciała pomijająca relację z drugim człowiekiem zawsze zostanie niepełna.

W pracy z każdym dzieckiem pomaga nam myślenie o nim jako o osobie dorosłej. A w przyszłości przecież (niezależnie od poziomu rozwoju intelektu) najważniejsze jest tolerowanie przyjaznego dotyku innych ludzi i komunikacja z nimi.
 Z pewnością zastanawiacie się Państwo dlaczego zamiast o świadomości seksualnej osób niepełnosprawnych mówię o świadomości ciała. Otóż mówię o świadomości ciała tyle, ponieważ bez dobrego, przyjaznego traktowania ciała niemowlęcia, bez wspierającego dotyku matki, bez tego podstawowego kontaktu dotykowo – cielesnego, nie wiem, jak może rozwinąć się „prawidłowa” seksualność osoby dorosłej. Słowo prawidłowa umieszczam przy tym w cudzysłowie, zdając sobie sprawę z tego, że to, co uznamy za „prawidłowe” uzależnione jest od norm społeczno – kulturowych.

Seksualność oznacza coś innego niż seks i zachowania seksualne. Dotyczy bowiem tego, kim jesteśmy jako kobiety i mężczyźni, a nie tylko tego w jaki sposób używamy pewnych części swojego ciała.
Świadomość naszej seksualności kształtują nie tylko nasze ciała i uczucia, ale także tradycja kulturowa i rodzinna, doświadczenie i wyznanie religijne. Dlatego tak duży wpływ na budzącą się świadomość seksualną dziecka mają przekonania jego rodziców i opiekunów.

Trudno w to uwierzyć, ale seksualny rozwój biologiczny rozpoczyna się już w życiu płodowym. Około 16 tygodnia ciąży pojawia się u płodów męskich erekcja, a u płodów żeńskich w zbliżonym czasie występuje zdolność zwilżania pochwy.
Pierwsze 19 miesięcy życia dziecka to najważniejszy okres nauki o miłości, dotyku i rozwoju zaufania do świata. W tym czasie dziecko zaczyna intensywnie poznawać swoje ciało. Mając siedem – osiem miesięcy z zaciekawieniem ogląda swoje dłonie i palce u stóp. Mniej więcej w tym samym czasie chłopcy odkrywają swoje penisy, a dziewczynki około dwóch miesięcy później – swój srom. Niemowlęta lubią wkładać palce rąk i nóg do buzi i dotykać genitaliów. Chłopcy w wieku niemowlęcym mają w ciągu dnia regularne erekcje, spowodowane płaczem, kaszlem, przeciąganiem się lub oddawaniem moczu. Mają też kilka erekcji podczas snu. Podobnie często zwilżają się pochwy małych dziewczynek.
Tak więc niemal od poczęcia każdy człowiek (niezależnie od jego późniejszego rozwoju intelektualnego) jest istotą seksualną.
I czy jesteśmy tego świadomi, czy nie – edukacja seksualna zaczyna się już w niemowlęctwie. Obejmuje ona nasze różne zachowania związane z pielęgnacją dziecka i nasze reakcje na przejawy jego seksualności, a zwłaszcza na dotykanie genitaliów.

 Do tej pory mówiłam o funkcjonowaniu normalnie rozwijających się niemowląt. Zanim przejdę do zagadnień związanych ze świadomością seksualną osób niepełnosprawnych intelektualnie, pozwólcie Państwo, że opowiem trzy historie zasłyszane podczas prowadzonych przeze mnie zajęć superwizyjnych w jednej z tzw. szkół życia.
Pierwsza z nich najbardziej drastyczna dotyczy dwudziestoletniego mężczyzny głęboko upośledzonego umysłowo. Jest on niewidomy, ma padaczkę i ograniczoną w skutek mózgowego porażenia możliwość poruszania się. Ma jednak sprawne ręce, ale oprócz podnoszenia nimi pokarmu do ust i czasami podtrzymywania się podczas prób stania, jedyne co potrafi nimi robić – to bezustanna stereotypowa stymulacja okolicy ust i głębokie wpychanie sobie dłoni aż do gardła.
Mężczyzna ten jest wychowywany przez samotną matkę, która „zabroniła” nauczycielom pracy nad jego dłońmi – z obawy, że gdy „odkryje” zacznie się onanizm. Ale to nie wszystko -  matka również wprowadziła zakaz mycia syna w szkole (chociaż się zanieczyszcza) – bo dotyk „tych” okolic może go przecież pobudzić. Nie wolno mu korzystać z hydroterapii i innych zajęć podczas których miałby możliwość poznania swego ciała. W efekcie chłopak najczęściej leży i masturbuje się, ale czyni to z pomocą ud.

Druga historia dotyczy dziewiętnastoletniej dziewczyny upośledzonej w stopniu znacznym, która pomimo niesprawnych nóg, ma sprawne dłonie i to, co robi nimi najczęściej – to szybkim ruchem wkłada je pod bluzkę i dotyka nimi swoich piersi. Robi to tak sprawnie, że żadne ubranie (oprócz zimowej kurtki) nie stanowi dla niej przeszkody. W efekcie od kilku lat rodzice nie wyjeżdżają z nią na spacery – bo, jak to wygląda, kiedy taka duża dziewczyna wkłada ręce za dekolt.
W jej klasie są sami chłopcy – i jak im to wytłumaczyć, że Kasia może robić coś, czego innym, nie wolno? Stosowane są, więc bezustanne zakazy i próby sprawdzania skuteczności różnych kar – a Kasia robi swoje.
A co w tej historii jest najdziwniejsze? Otóż nikt do tej pory nie sprawdził tego, co ona tak naprawdę robi wkładając ręce za dekolt – czy drażni piersi, czy też szukając poczucia bezpieczeństwa po prostu obejmuje swoje ciało?
 Wreszcie ostatnia historia, to historia dwudziestoletniego Pawła, idealnego do tej pory ucznia szkoły życia. Paweł jest upośledzony umysłowo w stopniu umiarkowanym – opanował wiele umiejętności potrzebnych w dorosłym życiu, miał dobre kontakty z rówieśnikami i to wszystko pewnego pięknego dnia runęło. W czerwcu zdarzyło się kilka rzeczy, które spowodowały radykalną zmianę jego zachowania.
Po pierwsze dowiedział się, że od września będzie chodził do innej szkoły – co wywołało jego protest. Po drugie była wycieczka do Szczecina podczas, której został „nakryty” przez matkę na całowaniu koleżanki, a potem na siłę zmuszono go do przejazdu przez miasto dziecięcą kolejką. Paweł nie chciał wejść do takiego pociągu, został więc wciągnięty na siłę, przyduszony do siedzenia i głośno krzycząc, przez godzinę musiał zwiedzać miasto.
Ponieważ taki protest zdarzył się pierwszy raz w jego życiu – matka wybrała się na konsultację do psychiatry. I dowiedziała się, że postąpiła dobrze – bo „przecież dziecko nie powinno rządzić rodzicami”. Otrzymała też dobrą radę na przyszłość polegającą na tym, że w przypadku pojawienia się podobnych zachowań należy przez chwile usiąść na synu i odczekać aż mu minie.
Paweł szczególnie dużo protestował we wrześniu, gdy zaczął chodzić do nowej szkoły, a matka oczywiście na nim siadała. Skutek był taki, że chłopak zaczął ją bić. Teraz bije nie tylko matkę, ale każdego, kogo spotka na drodze. Dotyczy to zarówno nauczycieli, jak i rówieśników. Nie bije tylko dziadków i przechodniów na ulicy. Na demonstrowanym filmie wideo było widoczne, jak chłopak wali każdego, kto znajdzie się w zasięgu ręki. Patrzy przy tym na nauczyciela, robi zmartwioną, wyrażającą głęboki smutek minę i wyraża poczucie winy „tak, tak, robię źle”. Nie potrafi przy tym pohamować nagłego impulsu (pozwólcie Państwo, że znowu zacytuje psychiatrę: „no trudno proszę Pani, to zło, to już w nim siedzi”).

Zastanówmy się jednak nad tym, co tak naprawdę zdarzyło się Pawłowi. A w tak krótkim czasie zdarzyło się wiele:
– zostało zburzone jego poczucie bezpieczeństwa,
– stał się ofiarą przemocy fizycznej i psychicznej,
– zanegowano jego być może rodzące się uczucie, robiąc ze sprawy prywatne, sprawę publiczną i ośmieszając przed innymi,
– złamano jego poczucie godności osobistej (wsadzając na się krzyczącego do dziecięcego pojazdu).

To wszystko wystarczyło, żeby zburzyć jego kruche poczucie równowagi psychicznej i doprowadzić do stanu, w którym jest obecnie.
 Dlaczego o tym mówię? Otóż historie tej trójki dorosłych osób niepełnosprawnych intelektualnie uświadomiły mi jak ważna jest tematyka dzisiejszej konferencji.
Okazuje się bowiem, ze pomijanie w wychowaniu i w edukacji naturalnych zachowań ludzkich nigdy i nikomu nie może przynieść żadnych korzyści. Traktowanie, więc niepełnosprawnych intelektualnie dzieci, jako istot aseksualnych z pewnością w przyszłości nie będzie korzystne ani dla nich, ani dla nas, ani dla osób z którymi będą przebywały.
Każde racjonalne oddziaływanie wychowawcze powinno obejmować działania pozwalające doświadczać dziecku dnia dzisiejszego w taki sposób, żeby dobrze wkroczyło w dorosłość.
Jak już mówiłam w towarzyszeniu rozwojowi dziecka pomocne jest myślenie o nim jako o osobie dorosłej. Jeśli jednak jesteśmy rodzicami dziecka niepełnosprawnego jest to myślenie trudne, bo przepełnione bolesną świadomością tego, że chociaż chcemy zapewnić mu najlepszą przyszłość, to wiele jego i naszych marzeń nigdy nie spełni się. Zaczynamy więc zastanawiać się nad tym, jakie ograniczenia należy wprowadzić już teraz (kiedy ma dopiero kilka lat), żeby w przyszłości nie cierpiało, żeby jego dorosłe życie było dobre. Dotyczy to wielu sfer ludzkiej aktywności, w tym również aktywności seksualnej.
 Każdy człowiek, który ma świadomość swojego ciała, wyróżnia jego części i jest świadomy ich funkcjonowania, jest również świadomy swoich podstawowych potrzeb biologicznych, w tym potrzeby seksualnej. Świadomości takiej mogą jedynie nie posiadać osoby głęboko upośledzone umysłowo z poważnymi uszkodzeniami mózgu, nie wyróżniające siebie od otoczenia i funkcjonujące na poziomie elementarnych odruchów bezwarunkowych. Pamiętajmy jednak, że osób tych jest niewiele, bo mniej niż 1% w całej populacji niepełnosprawnych intelektualnie.

Pozostałe osoby niepełnosprawne intelektualnie, niezależnie od stopnia ich upośledzenia, z pewnością odczuwają takie potrzeby. Ich mózgi często są nieodwracalnie uszkodzone, ale mają hormony i mają związane z tym potrzeby i problemy. Błędne jest więc założenie, że wczesne wprowadzenie ograniczeń lub pominięcie w wychowaniu tej sfery ludzkiego rozwoju przyniesie jakiś pożytek.
 Osoby niepełnosprawne intelektualnie zauważają pojawiające się w okresie dorastania zmiany fizyczne swojego ciała, odczuwają popęd seksualny, a około 70% z nich podejmuje różne formy aktywności seksualnej. Nie umiejętność zwerbalizowania swoich potrzeb nie powinna być zatem utożsamiana z ich nieposiadaniem, czy z nieświadomością swojego seksualizmu. Dorastające osoby niepełnosprawne intelektualnie mają takie same potrzeby i problemy jak inne nastolatki, tylko sobie z nimi nie radzą.
 Typowy dla okresu dorastania wzrost wydzielania hormonów może powodować agresję i samoagresję. Hormony działają na umysł tak, jak narkotyk. Zachowanie zaczyna zależeć nie tylko od przyczyn zewnętrznych, ale i od poziomu hormonów. Pojawiają się problemy ze spaniem i z jedzeniem (zmieniają się preferencje smakowe, bo u nastolatków zmniejsza się liczba kubków smakowych na języku), mogą pojawiać się trudności z widzeniem i słyszeniem, wahania koncentracji uwagi (np. gdy jest rzut testosteronu, dziecko może mieć problemy z transformacją informacji słuchowej - sądzimy wówczas, że ono nas nie słucha, podczas gdy w rzeczywistości ono nas nie słyszy), wzrasta częstotliwość zachowań przymusowych, poszukiwanie nowych doznań i wrażeń, narażanie się na niebezpieczeństwo. Po prostu dorastające dzieci muszą często robić czegoś więcej, żeby czuć to samo co kiedyś. Dotyczy to również dzieci niepełnosprawnych intelektualnie. Gdy zaczynają pojawiać się różne problemy mało efektywne jest krzyczenie, karanie, okazywanie naszego zdenerwowania i niezadowolenia, bo jest to tylko dokładanie do tego, co dziecko ma w sobie – a w sobie ma wystarczająco własnej złości i niepokoju.

Dojrzewanie to emocjonalna huśtawka, dlatego ważne jest żeby dziecko wiedziało jak wygląda jego kalendarz, jakie są reguły planowania dnia, jakie zasady i gdzie obowiązują. U niektórych dorastających zaczynają pojawiać się niestosowne zachowania seksualne. Tak samo jak można nauczyć dziecko niepełnosprawne jedzenia i mycia się, można nauczyć je stosownych zachowań seksualnych. Dobrych efektów nie przynosi ignorowanie masturbacji. To jednak jak będziemy postępować w takich przypadkach zależy od naszej odpowiedzi na pytanie: Czy onanizm jest dobry dla kogoś, kto prawdopodobnie nigdy nie będzie miał partnera seksualnego, ale ma hormony?
 Jeszcze trudniejsza jest odpowiedź na pytanie, czy należy wyrazić zgodę na odbycie stosunku płciowego przez osobę, która nie zawsze poprawnie nazywa części ludzkiego ciała, nie ma pojęcia skąd się biorą dzieci, nie potrafi zadbać o siebie, nie zna wielu reguł społecznych. Jeśli odmówimy jej prawa do kontaktów heteroseksualnych i zawierania związków, to zachodzi pytanie gdzie jest ta granica po przekroczeniu której dopuszczamy możliwość współżycia seksualnego, czy nasze przyzwolenie powinno być uzależnione od oceny poziomu uświadomienia osoby niepełnosprawnej. Gdy to mówię z tonu mojego głosu już wynika, że jest to jakaś bzdura. Nikt przecież przed zawarciem małżeństwa nie sprawdzał naszego poziomu uświadomienia. I chociaż ostatnio zelżała hipokryzja społeczna, nie ma sztywnych przepisów ani na udane współżycie seksualne, ani na udany związek.

Nie wiemy również, jak przeżywają osoby głębiej upośledzone umysłowo swój pierwszy stosunek. Trudno jest nam w tych sprawach zachować obiektywizm.
 Niestety nie mogę Państwu zaproponować żadnych gotowych rozwiązań. Jesteście skazani na własny osąd wsparty głęboką znajomością psychiki Waszego dorastającego dziecka. Są jednak sprawy prostsze, co do konieczności uwzględnienia których w procesie wychowania istnieje powszechna zgoda. Dotyczy to między innymi informacji o budowie ciała i jego funkcjach, o wzorcach ról społecznych kobiety i mężczyzny, o ekspresji potrzeb seksualnych, płodności i rodzicielstwie.

Jeśli rozpoczniemy uświadomienie seksualne i kształtowanie właściwych zachowań już w dzieciństwie unikniemy wielu problemów pojawiających się w okresie dorastania, które wynikają z deficytów tożsamości płciowej i obniżonej kontroli potrzeb seksualnych. Właściwa, bo przeprowadzona w sposób dostosowany do poziomu rozumienia dziecka i wielokrotnie powtarzana edukacja seksualna stanowi również element profilaktyczny, zabezpieczający przed niepożądaną ciążą, chorobami przenoszonymi drogą płciową i przed przemocą seksualną.

Do tej pory mało mówiłam o konieczności wprowadzenia w wychowaniu osób niepełnosprawnych takich zasad, które są uniwersalne, a zatem powinny dotyczyć każdego, niezależnie od jego poziomu funkcjonowania intelektualnego. Nie należy przecież bez zezwolenia przekraczać stosownego dystansu fizycznego: dotykać kogoś, głaskać czy przytulać się. Należy rozróżniać sytuacje prywatne i publiczne oraz wiedzieć jakie zachowania są stosowne w miejscach publicznych, a jakie nie.

Onanizowanie i obnażanie się w miejscach publicznych, niezależnie od osoby, która to czyni, zawsze budzi nasz sprzeciw. Nie lubimy również ordynarnych zaczepek i natrętnego gapienia się. Nie wolno nikogo napastować i namawiać do robienia czegoś, czego nie chce lub nie rozumie. Są to proste zasady obowiązujące w życiu społecznym, a tego, że nie wolno dotykać innych ludzi bez przyzwolenia lub trzeba mieć czyjąś zgodę na przytulenie, możemy przecież łatwo wyuczyć (wielokrotnie powtarzając wprowadzoną zasadę). Należy również pamiętać o tym, że dzieci szybko uczą się tego, jak na ich niestosowne zachowania seksualne reagują inni, dlatego ważne jest żeby nie wzmacniać takich zachowań naszą niewłaściwą postawą.
Także jeśli zdecydujemy się na wprowadzenie czasu intymnego, musimy nauczyć młodzież, że nie należy wciągać w to innych osób. Jest to ważna zasada, która powinna obowiązywać przez całe życie. I wreszcie bardzo ważne jest to, żeby takie same zasady obowiązywały i były egzekwowane nie tylko w domu, ale również we wszystkich miejscach, w których przebywa dorastające dziecko.
Przygotowując swoje z konieczności krótkie wystąpienie, znalazłam wśród książek w języku polskim taką, którą chciałabym Państwu bardzo polecić. Jest to książka Debry Haffner „Jak rozmawiać z dziećmi o sprawach intymnych”. Lektura tej książki może być kontynuacją dzisiejszego spotkania.



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