Abstract

Drawing on critical scholarship on sexuality, disability and gerontology, this paper examines representations of dementia and sexuality across recent North American, European and Australian news media sources. Attending to the affects mobilized within these representations demonstrates how they support the constitution of the sexualities of persons with dementia as dangerous, and thus as requiring surveillance and restriction. I argue that the media stigmatizes persons with dementia by constructing them as either sexual predators or asexual victims. The first construct explicitly incites disgust and fear towards the sexualities of men with dementia, while the second elicits a superficial form of caring towards women with dementia. Such representations preclude the recognition and support of the sexual rights of persons with dementia, including their right to experience sexual pleasure.


Introduction

Are there forms of sexuality for which there is no good vocabulary precisely because the powerful logics that determine how we think about desire, orientation, sexual acts and pleasures do not admit of certain modes of sexuality? (Butler 2009b, 3)

Inspired by Judith Butler's call to consider what 'we call those who do not and cannot appear as [sexual] subjects' (Butler 2009b, 3) in this paper I explore the cultural logics of representations of sexuality and dementia. Extending recent critiques of images and narratives of dementia within popular films and literature (Chivers 2011; Zeilig 2014), here I focus on the representation of dementia within mainstream news media. The media is a powerful source of lay information about health and illness (Lupton 1994) and may be 'the strongest vehicle for transmitting and popularizing' cultural and scientific understandings of dementia (Leibing 2015, 282). Despite this, few gerontological scholars have explored news media portrayals of dementia, and most have restricted their analysis to the identification of general trends without applying a critical discursive perspective (for an exception see: Peel 2014). Previous analyses have shown that dementia is negatively portrayed in ways that reproduce common stereotypes about ageing and mental illness and use stigmatizing and melodramatic metaphors of epidemics, war, and biblical apocalypse (Zeilig 2014; Johnstone 2016; Peel 2014). Often media coverage is focused on the later stages of the illness and emphasizes the loss of past abilities, relationships, and suffering (Clarke 2006; Van Gorp and Vercruysse 2012). Persons living with dementia are rarely given the opportunity to speak for themselves about their lives in the media, and instead their experiences are interpreted for the public through familial and medico-legal authorities who speak on their behalf (Clarke 2006; Kirkman 2006; Van Gorp and Vercruysse 2012). What is missing from such analyses is a more nuanced understanding of the objectifying effects of such representations, or how the media draws on broader cultural narratives to magnify the 'politics of revulsion and fear' that surrounds dementia (Behuniak 2011, 72). There has also been no study of the ways in which the deployment of gender and sexual norms within the media forecloses the recognition of life with dementia as a 'liveable life' (Butler 2009b).

Drawing on the work of Sara Ahmed (Ahmed 2004, 2010) and Judith Butler (Butler 2006; 2009a), I consider the 'public feelings' or affects that are associated with, produced, and mobilized within media representations of dementia and sexuality. As these scholars have shown, the incitement of affect through cultural representations functions as an interpretive lens for meaning-making that generates social and political effects (Butler 2009a; Ahmed 2010, 2004). In particular, the public circulation and experience of negative affect or 'ugly feelings' such as fear and disgust (Ngai 2005; Ahmed 2004) enables a form of sociability that reaffirms the boundaries of the current body politic. Given that dementia has been described as 'the scourge of the century' and is largely imagined as a horrifying state of being (Behuniak 2011; Zeilig 2014) a consideration of the representation of sexualities offers a productive site for cultural analysis. As I will demonstrate, within media representations, dementia functions as a cultural signifier for the abject and monstrous sexual self, and thus acts as a 'narrative prosthesis' to reinforce the ideal of sexual normalcy somewhere else (Mitchell and Snyder 2000). The construction of the sexualities of persons with dementia as abject underpins dominant practices of disciplining these sexualities (and bodies) through environmental, chemical, and mechanical restraints. In drawing critical attention to the excessive burden of signification (Rubin 1984) around sexuality and dementia, my aim is to broaden the boundaries of the current cultural imaginary so that persons with dementia may lay claim to rights that they are denied (Butler 2009b). This has emancipatory potential for affecting a fuller recognition of persons with dementia as citizens who are entitled to sexual rights within congregate living settings.

Background: abjection, sexuality, and dementia

Sexual and corporeal norms are constructed through the mechanism of abjection, an iterative and performative process of identification and exclusion that both constitutes and reproduces intelligible cultural subjects (McRuer 2006; Shildrick 2009; Butler 2004; Garland-Thompson 2006). Individuals whose bodies, erotic practices, and desires do not conform to the cultural ideal are constructed as 'abjected beings,' and this construction produces and reinforces the 'constitutive outside' boundaries of the normative or the ideal (sexual) subject. This is aptly captured by Rosemarie Garland-Thomson who asserts that 'the cultural function of the disabled figure is to act as a synecdoche for all forms that culture deems non-normative' (2006, 259). The cultural abjection of the sexualities of persons with disabilities is accomplished at both the symbolic level (e.g. through popular images and discourses) and at the material level though lack of access to sexual education, increased professional and familial surveillance and sanction of sexuality, as well as physical violence and social exclusion (Kafer 2003; Shildrick 2005). As Butler argues, the symbolic process of cultural dehumanization enables material forms of violence: 'on the level of discourse, certain lives are not considered lives at all, they cannot be humanized; they fit no dominant frame for the human…this level then gives rise to a physical violence that in some sense delivers the message of dehumanization which is already at work in the culture' (2004, 25).

The abjection of the sexualities of persons with atypical embodiment results from the dominance of a prescriptive 'standard of bodyliness' (Shildrick 1999, 7), or the cultural idealization of independent and economically productive bodies (McRuer 2006). McRuer has termed this 'compulsory able-bodiedness' and suggests that this system of regulation is intimately intertwined with heteronormativity (Butler 2004) in that the ideal or 'successful' heterosexual subject is one is also able-bodied (2013). Shildrick (2009) adds that the intercorporeality of sexual relations heightens the anxiety elicited by the appearance of atypical embodiment, as these sexualities cannot be readily recuperated into the norm of the autonomous and self-contained sexuality (e.g. the sexualities of persons with disabilities often do not follow the heteronormative script of dominant and penetrative sexuality, may be unreproductive, and public in that they require facilitation by others). Consequently, the sexualities of people with atypical embodiment are 'always already deviant' (Kafer 2003, 85) and they are largely represented as either asexual or as excessively sexual.

In the context of dementia, abjection is also sustained by the 'neurobiologization of selfhood' (also called the 'cerebralization of personhood'), an ontology of the human that reduces selfhood and personhood to mental capacities of the mind and the biological and chemical processes of the brain (Katz 2013; Vidal 2009; Kontos 2012). This ontology is reflected in the biomedical model of dementia that attributes the difficulties that persons with dementia experience (e.g. memory loss) to brain pathology that is assumed to erode or destroy their capacities for meaningful self-expression and interaction (Herskovitz 1995; Gove et al. 2017). Biomedical and other professional care discourse largely constructs persons with dementia as 'non-persons' or as burdensome bodies to be managed by individuals and society (Volicer and Hurley 2003). Consequently, the focus of dementia care is restricted to the use of environmental and chemical treatments for containment and the management undesirable behaviors (Dupuis, Wiersma, and Loiselle 2012; Andrews 2006; Graham 2017). The actions, needs and movements of persons with dementia are typically discounted as aimless and inappropriate and are seen as disease-driven behavioral 'symptoms' rather than meaningful attempts to communicate preferences or to engage with others (Dupuis, Wiersma, and Loiselle 2012). Popular representations of dementia exacerbate biomedical constructions by representing persons living with dementia as 'empty shells,' 'the living dead' or 'zombies' (Behuniak 2011; Mitchell, Dupuis, and Kontos 2013; Zeilig 2014) producing a 'paralyzing feeling of dread' (Basting 2009, 31) that encourages aversion and avoidance rather than empathy and support.

Representing sexuality and dementia in the media

This paper is primarily a discursive textual analysis of media representations in the tradition of cultural studies (Butler 2009a; Ahmed 2004). Within such an approach the media is understood as an 'agent of mediation' between private stories and public audiences and as actively involved in the constitution of the phenomena that are being represented. Similar to traditional objects of cultural analysis (e.g. literature, film) media texts are deconstructed to understand what they signify, and for what purpose or public action (Gurevitch et al. 1982).

Media texts were chosen from a variety of online news sources, including metropolitan and regional dailies, as well as national magazines and newspapers by searching an academic database (Factiva) and a popular online search engine (Google News). In my search, I focused on recent examples (published between Jan 1, 2013 and Jan 31, 2017) of not only news articles, but also features, editorials, columns, and opinion pieces. Given that my goal was to conduct a discursive analysis as opposed to a content analysis, I did not systematically document every example. Rather, I intentionally selected examples that highlight the dominant discourse on sexuality and dementia in the media.

Analysis began with close reading and re-reading the chosen articles to familiarize myself with the content and identifying common patterns in representations. This enabled me to begin to identify what issues regarding sexuality and dementia were considered as 'newsworthy,' including how specific problems were defined, the different types of stakeholders involved across representations, and whether and how their perspectives were considered. Drawing on interdisciplinary literature across feminist and queer studies, critical disability, and critical gerontology, then allowed me to further explore what cultural values or norms were emphasized or constructed across the selected articles. From this close reading I identified the dominance of two themes regarding how persons with dementia are represented in the media in the context of sexuality: 1) persons with dementia as having a dangerous sexuality (e.g. sexual predators) and 2) persons with dementia as being in danger as the results the sexualities of others (e.g. asexual victims).

Discussions of sexuality and dementia primarily appear in the crime sections of media sources and are reports of sexual violence committed by or against persons with dementia. As Butler reminds us, media representations of violence are publicly sanctioned displays of grief that serve a regulative function, in that they instruct us about who qualifies as human, and thus deserving of mourning, and who doesn't (Butler 2006). Writing about representations of 'the war on terror' she argues that media representations create a hierarchy of grief that divides 'populations into those who are grievable and those who are not. An ungrievable life is one that cannot be mourned because it has never lived, that is, it has never counted as a life at all' (Butler 2009a, 8). By representing state-sanctioned acts of violence as legitimate, and some forms of life as always already precarious to injury and thus unlivable, media representations foreclose consideration of how human suffering is ontological and dependent upon the social 'conditions that must be fulfilled for life to become life' (Butler 2006). The incitement and circulation of affect within media representations of violence thus provides an 'epistemological frame' for the interpretation of an act as 'violence,' and thus enable either a reaction of horror or acceptance. Emotions in this sense provide a guiding script and the collective deployment of public feelings within representations works to code those it signifies with affective value. Ahmed similarly notes that emotions are economic, as their circulation within public representations produces and sustains affective 'relationships of difference and displacement' (2004, 44).

As I will illustrate below with examples, by representing persons with dementia primarily as either sexual predators or sexual victims, the media incites and promotes the circulation of public horror and disgust towards the sexualities of persons with dementia.

Sexual predators

Media representations of men with dementia portray them as violent sexual predators whose sexuality is excessive and constitutes a threat to public safety. These representations produce an image of the person with dementia 'in the guise of the human, to show how the less than human disguises itself, and threatens to deceive those of us who might think to recognize another human there' (Butler 2006, 146). Often, it is their disability, as signified by a diagnosis of dementia that is highlighted as a mark of their sexual deviancy within news articles. Although in some cases the crime has occurred many years prior to the diagnosis of dementia, articles often explicitly link the sexual crime to dementia by citing it in the headlines and opening paragraphs of the articles. This is evident in the headline of an article about the 2014 arrest of an U.S. man for committing molestation in 1977: 'Judge dismisses child sex abuse charge against priest, citing his dementia' (Funk 2014). Another example is the 2015 article about the arrest of U.K. man: 'Serial abuser who carried out more than 200 sexual attacks on boy avoids jail because of his DEMENTIA' (Dubuis and Wright 2015; original emphasis).

The justification for media attention to the sexualities of persons with advanced dementia is often not the sexual crime itself, but rather in response to the judicial decision not to criminally charge a person with dementia, or barring them from standing trial due to their mental incapacity or physical frailty. By implying that these judicial decisions are inappropriate, and that persons with dementia maliciously use their diagnosis to avoid criminal sanctions, such representations mobilize public outrage and disgust towards persons with dementia. For example, in the U.S. article, the victim's lawyer stated that the perpetrator is 'allegedly incompetent' questioned why he wasn't tried for four years after his arrest and 'before dementia ever became an issue.' Similarly, the 2015 article from the U.K. describes the accused living with dementia as a 'child rapist' who 'avoided a lengthy jail sentence because of his age and poor health' and that this means that 'the most that can be imposed' is psychiatric institutionalization, or conditional or unconditional release (Dubuis and Wright 2015; emphasis my own). The emphasis placed on suggesting that a diagnosis of dementia enabled individuals to evade criminal liability for actions that happened prior to their diagnosis makes it unlikely that dementia was used to generate public sympathy, rather than disgust.

Moreover, many articles actively suppress public sympathy for the person with dementia by moralizing the issue using a melodramatic narrative (Wright 2015) that incites fear and panic in audiences; emphasis in particular is placed on the 'evilness' of the person through representations of their duplicity and the innocence and suffering of their sexual victims. For example, the photograph of the man with dementia from the U.K. article cited above is subtitled: 'An 86-year-old man who repeatedly raped a young schoolboy over a seven-year period has avoided a jail sentence because he has dementia' and reports that after the assault the man would take the schoolboy out for ice cream as 'a treat.' The same article also reports that the 'ordeal' of the 'young victim' lasted seven years and suggest that the man with dementia gained access to his victim by tricking the victim's mother ('turn[ing up at] the youngster's house to offer his mother a break by taking her son out to the park or arcade'). Similarly, another article reporting on the release of a U.K. man convicted of raping his two daughters titled 'Sisters raped by paedophile dad warn of "dementia defence" loophole in echo of Lord Janner case' stated that the they 'wept after a judge freed him because he has dementia' (Macaskill and Rawlins 2015). The article goes to report that the abuse started in 1962 when they were toddlers and lasted for twenty years, but that while he was found guilty, he was deemed unfit to stand criminal trial and released into a care home. The two sisters are quoted as saying that his release is 'devastating' and 'an insult to the abused who are made victims a second time,' and warn that 'other attackers could use the same legal loophole as their dad' to 'escape' criminal punishment and 'walk free.' Through such representations of sexuality dementia becomes associated in the popular imagination with a tendency towards horrific violence and criminality, adding to the broader cultural stereotypes of persons with mental illness as violent and dangerous (Wahl 2003).

Even articles that focus on assentual sex in residential long-term care settings (e.g. nursing homes) tend to use sensationalist and stigmatizing language in their headlines and the bodies of the articles. Although such articles purport to broaden the dominant narrative by seeking to represent sexuality with more complexity, they ultimately efface the very conditions that would make such broadening possible by invoking 'the language of fear'. For example, articles use war metaphors (e.g. bomb) and apocalyptic warnings about the rising number of persons with dementia, or their unruly sexualities. One article that reported that the sexualities of persons with dementia raise 'legal, ethical and moral' issues has a headline that implies that such sexualities are a 'rape case time-bomb' for nursing homes who face legal fines and criminal sanctions in the future (Nye 2013). This article describes the case of Windmill Manor, a nursing home where two residents with dementia developed a sexual relationship. Although the couple were forcibly separated and restrained based on the desires of their families and the nursing home's fear of criminal liability, the nursing home still incurred civil and criminal penalties (Nye 2013). The article notes that the relationship was 'mutual' and that the woman 'tried to attack the staff' when they interrupted their sexual encounter. However, it does not report on the consequences of the intervention by staff into this relationship which began with the staff 'keeping them away from each other' and attempting to 'soothe' the woman with Oreo cookies, and medicating the man ('prescribing drugs to curb the man's sexual urges'). Instead, the article focuses on the monetary and occupational consequences of this sexual relationship for the nursing home and staff ('horrific case', 'a legal time-bomb', 'fired with no reason given') and for the suffering of the couple's families ('heart-break'). Similarly, an article in the health section reports that 'better training is needed for dementia carers to deal with issues around relationships, intimacy, and sex' also includes a warning about of the 'dangers' of such sexualities (Better sex-and-dementia care call, 2014; emphasis my own). The article begins by describing how staff members at one home found it 'very difficult to manage' after two residents with dementia developed a relationship and cuddled and hand-held because they felt that this was 'wrong' and because one of the spouses was 'very distressed' by this. This is despite the fact that the article goes on to report that a senior staff member said that the home supports such intimacies stating that in general sexuality is 'not a problem to us'. However, there is a proviso: a geriatric psychiatrist in this article also warns that some sexual behaviours may not be so 'benign' as persons with dementia may become aggressive, and that such aggression can 'show itself in terms of sexual behaviour.'

Media representations that instil fear and disgust in relation to the sexualities of persons with dementia reflect biomedical discourses on sexuality that operate across empirical research on persons with dementia, professional care, and clinical literature. For example, empirical research on provider's reactions and perceptions has shown that they tend to respond to the sexualities of persons with dementia with expressions of disgust, denial, and discouragement (Ward et al. 2005; Roach 2004; Syme 2014; Cornelison and Doll 2013). This is most apparent in the context of institutional settings where the sexuality of persons with dementia becomes a matter of public concern due to the congregate nature of the living environment and the lack of privacy accorded to residents of institutions (Benbow and Beeston 2012; Taylor and Gosney 2011). Care providers have also been shown to hold negative and patronizing attitudes toward the sexualities of persons with dementia, and the sexualities of men in particular are perceived as threatening to both providers and other residents (Ward et al. 2005; Parker 2007; Roach 2004; Yelland and Hosier 2015). When confronted with overt sexual desires or erotic activity, providers report feeling shame and discomfort, as well as the need to intervene in the sexual expression (Roach 2004; Shuttleworth et al. 2010; Villar, Fabà, et al. 2015).

The sexualities of persons with dementia have also recently emerged as an object of surveillance within the psychiatric clinical literature. Through the establishment of pre-diagnostic categories such as 'improper' or 'inappropriate sexual behaviour' (ISB), the sexualities of persons with dementia have become constructed as mental pathologies and thus subject to medical assessment and intervention (Mendez and Shapira 2013; Guay 2008; Stubbs 2011; Cipriani et al. 2016). The pathologization of sexual expression in the context of dementia is part of a broader history of medicalization of sexuality that legitimates the authority of psychiatry over the treatment of mental illness through diagnostic categories that establish 'sex as a cause, symptom and form of madness, particularly when sexualities contested heteronormative and patriarchal discourses' (Tosh 2011, 3). There are multiple problems with the discourse of ISB, including the lack of consensus on terminology or classification criteria, as well as the lack of a universally accepted definition of what makes such sexualities 'inappropriate' or 'harmful' and thus necessary to curtail (Gibson et al. 1999; Tsatali et al. 2011). Definitions of 'inappropriateness' are both expansive and circular, and cited examples can include everything from handholding to physical assault, the use of pornography, masturbation, sexual interest in someone other than one's spouse, or a 'change' in sexual preference (Cipriani et al. 2016; Guay 2008; Black, Muralee, and Tampi 2005). Take the following description of ISB from a literature review (Mahieu, Van Elssen, and Gastmans 2011): [D]ementia might be accompanied by uninhibited sexual behaviour or hypersexuality. Such behaviour is beyond the person's control… and mostly arises due to dementia. It may include touching intimate body parts of care providers and bystanders, kissing and hugging that exceeds plain affection, disrobing oneself and others, using sexually suggestive language, attempting intercourse, and compulsive masturbation in both public and personal areas (Mahieu, Van Elssen, and Gastmans 2011, 2; emphasis my own). As can be seen from this expansive description, the sexualities of persons with dementia are considered 'inappropriate' because they are thought to be 'beyond their control' or 'unintentional,' that is, not the result of agentic desires but rather symptoms of dementia-related neurodegeneration that causes disinhibition. Definitions of ISB in dementia further emphasize lack of sexual agency by describing the sexualities of persons with dementia as 'repetitive,' as 'inconsistent' with the person's personality and/or their life-history pre-diagnosis (Cipriani et al. 2016; Torrisi et al. 2017; Kaplan and Krueger 2010). However, exactly what is 'appropriate' or 'normal' sexuality is left undefined within descriptions of ISB. As a result, it is not the sexual activity per se that is inappropriate, but rather how it is perceived by the individuals who observe it. The reliance on subjective values and judgement in diagnoses of ISB is problematic given the dominance of ageism and ableism, and empirical research that suggests that determinations of appropriate sexuality in the context of dementia by observers reflect and perpetuate ageist and heteronormative gender norms (Archibald 1998; Ward et al. 2005; Simpson et al. 2017).

Finally, the diagnosis of some variants of ISB (e.g. hypersexuality) often includes the criterion that the sexual behaviour is inappropriate because it causes personal distress or another form of 'impairment' to the person (Mendez and Shapira 2013). And yet, in the context of dementia, sexual behaviour may also be judged to be inappropriate because it is perceived to be accompanied by a lack of 'concern,' 'shame' or awareness about the public 'consequences of the behaviour,' including the social prohibition against public displays of sexuality. Such sexualities are thus primarily judged inappropriate and undesirable because they are distressing for informal caregivers and staff, rather than to the individual with dementia (Black, Muralee, and Tampi 2005; Mendez and Shapira 2013). Thus, the sexualities of persons with dementia are restricted primarily because they are perceived as socially disruptive or because they 'interfere' with the work of care providers (Black, Muralee, and Tampi 2005; Mendez and Shapira 2013). This is often articulated explicitly in professional literature on ISB that recommends treating (e.g. suppressing) sexual expressions for the purpose of decreasing caregiver burden and/or delaying or preventing nursing home placement (Cipriani et al. 2016; Tucker 2010). In this way the diagnosis of ISB 'domesticates' the distress caused by such sexualities by recasting them as an internal and personal problems of persons with dementia, rather than the result of broader sexual norms and organization of care (Butler 2004, 99). This broader biomedical discourse of pathology underpins the dominant practice of representing the sexualities of persons with dementia in the media as mental pathologies that are burdensome to individuals and society. These types of representations invite public terror and disgust by implicitly and explicitly positioning persons with dementia as the cause of public 'grief.' Through such negative representations biomedical intervention to restrict these sexualities become 'sustained as an ongoing object of [public] survival' (Ahmed 2004, 79).

Asexual victims of violence

Unlike men with dementia, women with dementia are constructed in the media as having no sexuality (asexual) and as vulnerable victims to men's sexual desires. The most common examples of this are news articles that report on criminal sexual assault charges filed against a long-term care resident or a staff member (Trotter 2016; Ellis and Hicken 2017). More recently, news articles have also featured husbands accused of sexual misconduct, or barred from engaging in sexual activities with their wives who are living with dementia. For example, there is the now infamous case of Henry Rayhons, who was charged and acquitted in 2015 of sexually assaulting his wife Donna Lou (Allen 2015), and the case of Thomas Middleton from the U.K. who has a protection order that restricts his sexual interactions with his wife who lives in a long-term care home (Lindsay 2015). The focus of these types of articles is often on describing the fundamental vulnerability of the woman with dementia to sexual victimization, who is often described as 'suffering' from dementia. Regardless of the individuals involved, all articles reflect the assumption that women with dementia are inherently asexual or are not interested in sex by virtue of their diagnosis, cognitive capacity, functional dependence, or advanced age. For example, an article about the trial of Henry Rayhons reported that "Dr. John Brady, medical director of the nursing home, told the jury that if [Donna Rayhons] responded positively to hugs and affection from her husband, it was a 'primal response' and not an 'informed decision' (Allen 2015). Such articles also portray men's desire towards women with dementia as morally suspect or as reflective of criminal sexual intent. For example, the headline of an article about a sexual interaction involving a resident and a friend who was a frequent visitor described the visitor as an '82-yer old sex beast' and a 'pervert' who 'attacked' the resident (Clements 2016). Headlines of other articles about the Henry Rayhons case have similarly included the following: 'Was Henry Rayhons a loving husband or selfish abuser?' (Leys 2015); 'Can a wife with dementia say yes to sex?' (Gruley 2014); 'Rape case asks if a wife with dementia can consent' (Gruley 2014); 'Should Alzheimer's Patients Be Allowed to Have Sex?' (Syngal 2015). All of these articles implicitly or explicitly suggest that without legal control over their own care, persons with dementia are incapable of assentual sexual expression as this is 'a decision that requires two fully consenting partners' (Should Alzheimer's Patients Be Allowed to Have Sex?').

News articles reporting on sexual victimization of women with dementia emphasize their vulnerability, characterizing them as children or as dependent on others, and thus especially susceptible to sexual exploitation. For example, one article about the Rayhons' trial stated that a physician likened Donna Rayhons' response towards her husband as 'the instinctive response of a baby to affection shown by a mother' (Volokh 2015). Other articles on the Rayhons trial emphasized the severity of Donna Lou Rayhons' cognitive impairment in an attempt to discredit the defence's claim that this was not assault as Donna expressed sexual desire towards her husband. For example, one story reported that 'Mrs. Rayhons had scored zero on a standard test for Alzheimer's when a score below eight counted as severe impairment" and that 'staff described her as being "in her own little world"' (Allen 2015; emphasis my own). In another it stated that 'Donna Rayhons' Alzheimer's disease had worsened dramatically in the months before last May's incident [date of suspected sexual encounter]. She washed her hands in dirty toilet water, [and] forgot how to eat a hamburger.' (Leys 2015). Similarly, the article on the case involving a resident and visitor describes the female resident with dementia as a 'frail OAP (old age pensioner)' and as having 'severe dementia' (Clements 2016).

News articles both implicitly and explicitly link the disability of women with dementia with asexuality by portraying them as both incapable of expressing sexual desire or lacking such desire all together. Such representations collapse ethical complexity and context in an effort to construct an unequivocal boundary between 'good' and 'evil' (Wright 2015). Ultimately, this serves to normalize sexual violence towards women with dementia by locating their vulnerability to violence in their disability, rather in broader structural conditions and disabling practices. For example, news articles do not consider how sexual violence towards women with disabilities is supported by their lack of access to knowledge that supports sexual self-determination (e.g. information about sex, their right to refuse unwanted contact, how to protect themselves or report unwanted sexual contact), as well as providers' lack of training around how to gauge wanted and unwanted sexual expression in the context of disability (Fish 2016; Ballan, Burke and Freyer 2012; Hollomotz 2009).

The belief that women with dementia are inherently asexual is most apparent in articles that report on sexual encounters between two older adults. These articles rarely mention the female resident's sexual expression, her reaction to the sexual encounter, or to its discovery. The primary criterion used by the media (as well as the experts cited within these articles) to demonstrate that such sexual encounters are involuntary, rather than assentual, is the cognitive disability of the woman with dementia. For example, one article reports that a police spokesperson stated that the female resident was 'considered unable to consent because of her condition' and that she 'could not consent to sex because she suffers from dementia,' as she is 'not really able to decide things on her own' (Zauzmer 2015). To explain how it was determined that there was a sexual assault, the article reports that nursing home staff went to search for the female after she did not attend lunch, unlocked her locked room to 'find' her and the other resident 'together.' Staff' actions are left unproblematized in the article, thus implicitly justifying both their interpretation of the encounter as sexual abuse as well as their right to surveil and curtail the sexual freedom of women with dementia. Similarly, the article on a sexual encounter between a female resident and her male visitor does not describe how the female resident responded to his sexual advances. Instead the article simply states that the care providers determined that the interaction was 'sexual assault' and reported it as such to the police. Although the article notes that the man was a 'regular visitor,' it is noted that staff understood that 'the man and woman were friends and not in a romantic relationship.' Yet it does not mention how the nature of the relationship was determined.

The assumption that women with dementia are asexual is perpetuated by the dominance of the biomedical model of dementia and the neurobiologization of selfhood; both discourses disqualify the actions and expressions of persons with dementia based on the belief that dementia fundamentally erodes selfhood. This discourse is prevalent among care providers who often consider persons with dementia as lacking in capacity to be sexual, or as compromised by their cognitive impairment (Grigorovich and Kontos 2018; Kontos, Grigorovich, Kontos, and Miller 2016; Roelofs, Luijkx, and Embregts 2015). Although currently there is no consensus on the definition of 'sexual capacity' or how to best evaluate this, it is often assumed to be similar to the capacity for deciding on medical treatments and is assessed as such. Such ableist and cognitivist forms of judgements privilege self-reflection and rationality and require that persons with dementia verbally articulate their expectations regarding desired sexual intimacy, as well as demonstrate awareness of potential sexual risks and ability to avoid exploitation (Wilkins 2015; Gill 2010). The lack of explicit and established polices regarding the sexual rights of persons with dementia, along with the prevalence of mandatory reporting policies regarding sexual abuse, prompt providers to view the sexualities of residents with as being especially 'risky,' and thus as necessary to restrict (Villar, Celdrán, et al. 2014; Wilkins 2015).

The dominant affect produced by media representations of women's sexuality is that of an 'empty sympathy'; a form of superficial caring about the pain of others that precludes a collective identification with the humanity of the sufferer (Ahmed 2010; Berlant 2014). Sentimentalized narratives turn the personal pain of women with dementia into a form of entertainment that allows us to experience compassion passively and at a distance, without acknowledging our own complicity in the social relations of power that sustain violence (Kaplan 2011; Berlant 2014; Ahmed 2010). As Ahmed (2004; 2010) and Butler (2006) remind us, detached and depoliticized forms of 'feeling bad' for the Other 'do something'; melodramatic narratives of public crisis that elicit sentimentalized sympathy for an imagined and distant other re-establish the distance between valued and devalued bodies and allow for the exercise of sovereign power in the name of national security or defence. Sentimental 'scenes of suffering' (Woodward 2014, 13) invoke sympathy based on discourses of charity, which ultimately works to sustain rather than resist the socio-political structures that enable vulnerability to violence. Such affective responses are limited as they do not invite a critical questioning of how the social treatment of persons with dementia contributes to their precariousness to experience violence in long-term care. Nor do such representations challenge the prevailing cultural assumption that persons with dementia do not have legitimate sexual desires or needs that should be supported in and through social entitlements (Grigorovich and Kontos 2018; Kontos, Grigorovich, Kontos, and Miller 2016). Instead, such conditional forms of recognition become a way to demonstrate a charitable identity through spectatorship, rather than a commitment to collective social action. As Berlant argues, the sentimental narrative of compassion is 'an emotion in operation' (Berlant 2014, 4) that enacts privilege; feeling compassionate places 'the sufferer…over there' while also making them subject to our form of 'rescue' (Berlant 2014, 5). Representations of sexual violence towards women with dementia thus serve to further justify the dominant practices of curtailing the sexual expressions of persons living with dementia in the name of their protection from harm.

Highlighting the excess of emotionality around these representations is not to deny that sexual assault is traumatic or the need for collective efforts to prevent such forms of violence. Instead my aim is to draw critical attention to the affective power of sensationalizing such acts of violence. Writing about white teachers' 'professions of care and love towards people of color' (331), Matias and Zembylas (2014) suggests that sentimentalized caring can mask hidden disgust towards racialized persons under a politically correct emotional performance. Such performances ultimately allow white teachers to project their disgust onto racialized persons rather than to acknowledge their own complicity in racism and white supremacy. Extending this to consider representations of sexuality and dementia allows us to see that expressions of compassion that deny women with dementia sexual subjectivity allow for a performance of caring that is based on fear and disgust towards persons with dementia. Constructing the sexualities of women living with dementia as horrific causes of violence and suffering reinforces the popular belief that dementia is essentially a tragic and intolerable state of being and that 'death [is] preferable to a life lived with' dementia (Behuniak 2011, 16). Dementia thus becomes further preserved as the 'threat to life itself' (Ahmed 2004, 64), or as a collective hazard that requires containment.

Ahmed (2010) cautions us to be suspicious of cultural narratives that attempt to idealize and elevate 'other people's unhappiness' (95). Often such attempts to elicit sympathy are conditional, in that sympathy is used to justify state-sanctioned forms of violence in the form of heroic intervention, or 'liberation from abjection' (127). Protectionist narratives of violence teach persons with dementia 'how to be happy' (128) by turning them away from the structural causes of their unhappiness. In doing so, they also support unnecessary and inherently unjust attempts to reduce their sexual freedom and sexual agency. By positioning the desire for sexual expression as a 'kind of death wish' (Ahmed 2010, 104) or as an imagined threat to the potential for happiness, media representations redirect persons with dementia 'toward the [asexual] norms, values, and practices of the colonizer' (128). Such representations thus justify professional intervention into the sexual lives of women with dementia as the means for decreasing their future suffering.

Conclusions

Media representations of sexuality and dementia construct a moral panic around sexuality and dementia by representing these sexualities as pathological and dangerous, or the abject. Paying attention to the mobilization of public feelings within these bifurcating representations demonstrates their investment in deeply-ingrained and hegemonic assumptions about the nature of normative embodiment, selfhood, and erotic desire. In focusing on the sexual expressions of men with dementia, and on heterosexuality, media representations reinforce heteronormative masculine norms, which construct all men as sexual aggressors and all women as sexual prey. Representations of women with dementia as essentially susceptible to sexual victimization reinforce ableist assumptions of asexuality and undesirability. Such frightening narratives render the sexuality of persons with dementia as both unintelligible and unimaginable - at once excessive and inhuman. In doing so, they deny persons with dementia sexual subjectivity and foreclose their inclusion in the cultural imaginary, or 'those ready-made images and symbols through which we make sense of social bodies, and which determine, in part, their value, their status, and what will be deemed their appropriate treatment' (Gatens 1996). Ultimately, such 'spectacles of [sexual] suffering' (Berlant 2014, 9-10) contribute to the 'stickiness' of the disgust and fear that surrounds the social discourse on dementia, and further legitimizes the containment and restriction of the bodies and actions of persons living with this disease.

The ubiquity of negative media representations of sexuality has critical implications for how we engage with persons living with dementia and whether we recognize their claim to sexual rights. For the most part, current long-term care policy, professional training, and clinical guidelines remain silent about sexuality (Everett 2007; Cornelison and Doll 2013; White 2010) and persons with dementia are routinely denied opportunities to form intimate and erotic relationships (Grigorovich and Kontos 2018; Kontos, Grigorovich, Kontos, and Miller 2016). When persons with dementia express their sexualities, they are often subject to biomedical and social interventions that suppress their desires. In stigmatizing or criminalizing all sexual expressions in the context of dementia we disregard the opportunity to broaden current sexual norms and fail to consider the importance of supporting sexuality for self-expression, mutuality, and wellbeing (Syme 2014; Lottes 2013; Grigorovich and Kontos 2018; Kontos, Grigorovich, Kontos, and Miller 2016;). It is however, also important to note that asexuality is an aspect of the intimate and sexual continuum for persons living with dementia and thus support of their sexual rights should include, but not be limited to, their desire for sexual expression.

Finally, while the analysis presented suggests that the recent cultural idealization of communicative consent as 'the legal dividing line between wanted and unwanted sexual contact' (Randall, 2011, p. 1) may unfairly restrict the sexual and intimate lives of persons living with dementia, it also has broader implications for all individuals. The insistence that the absence of positive and explicit verbal expression of consent always and necessarily reflects coercion, not only sets an unrealistic standard to which few individuals can live up to, but may further contribute to sexual vulnerability by ignoring how power relations also contribute to sexual violence (Gotell, 2009). This is particularly relevant to consider given that affirmative consent has recently emerged as a focal point in media coverage associated with movements like #MeToo and #timesup. While media attention around these movements has arguably contributed to raising public awareness of the need to challenge normalization of sexual violence and harassment, for the most part, discussions have been focused on criminalizing deviant individuals, rather than challenging broader systems of power (Gill & Orgad, 2018). Moreover, there has been limited inclusion of the perspectives of persons living with disabilities in this media coverage, which is crucial for shifting beyond narrow discourses of capacity and consent to consider how we may more equitably balance sexual access with protection from exploitation and abuse. Thus, to advance a more ethically complex response to the sexualities of persons living with dementia based on solidarity and concern rather than passive feelings (Woodward 2014, 130), requires collective resistance to simplified and totalizing cultural narratives and the construction of alternative representations that bring persons with dementia into the cultural imaginary as sexual subjects.

Funding acknowledgement

Alisa Grigorovich gratefully acknowledges funding from the Canadian Institutes of Health Research (Health System Impact Fellowship)

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