Dementia and First-Time Events

More on Male Disability and the need for Single-Sex Spaces

We talk about dementia from time to time here due to the elevated dementia risk from a variety of sources that trans and ex-trans people are facing. It is also a topic I have spent significant time contemplating and interacting with. And recently the disability dustup has people questioning whether a person can have a contained sexual tendency become uncontained through the direct action of an injury or disease process. I've been dragged for this but my heels are firmly dug in, and it is an honor and a privilege to be in a position to continue to work to elevate this discourse by contributing insight into a phenomenon that will probably affect someone you love eventually.

Please consider the following. I'm including it because it is an excellent depiction of the profundity of and a correct response to a moment of confusion and disorientation in a man with implied dementia.

For many reasons including impaired visual processing (many factors), impaired facial recognition specifically (fusiform gyrus), impaired memory of recent events (hippocampus), sleep disorders or psychosis affecting perception, psych medication for dementia symptoms affecting perceptions, people with dementia can confuse loved ones with strangers, which may lead to inappropriate social behavior that takes the form of what would otherwise be appropriate social behavior - in this case, engaging a stranger in conversation at the bus stop, but she turns out to be his daughter.

We don't treat him as though he understands this and is pretending not to know about her pregnancy to upset her. If he were aware of the true situation, we would certainly hope he would have said something different to her. He said what he said (a form of doing what he did, making social behavioral choices) because of his disability. Because of the direct action of a mental disease or impairment.

Disorientation to time and place plus memory impairment can contribute to this. If his disorientation led him to believe he were alone or with his wife at home, in private, he might act in ways that were physically or sexually inappropriate. He might attempt to use the bathroom outside of a bathroom, for example. And since dementia is typically progressive, a person in that situation of progressive dementia will have a first-time event. By that I mean an event that's the first time they really did something their healthier younger self would never have done. Often, something like that is the trigger for the family having to really adjust to the gravity of their loved one's changing capacities and support needs.

This is a reason why we need to have single sex facilities any time there is a need to be undressed or to be in an altered state of consciousness. Men who are impaired in this fashion will reliably disregard signs and walk into places they shouldn't be for reasons they shouldn't be, such as they saw a woman walk in first. That's predictable and, given my description of the path of the condition, unavoidable in a civilized (city-dwelling) environment of sufficiently large population.

I am not saying any such man doing this is therefore disabled. I am saying there will always be men like this and some of them will start as men who were never like this before. Therefore, we need single sex spaces that men are simply not permitted to be in, no matter how they are behaving, so that collectively, we raise the alarm when one of these men who, whether due to criminal intent or mental disease or impairment, has decided to head on in there.

The example in the video also establishes why there has to be a unisex disability third option that's a separate room, not a stall within a single sex room (though we can have both). This woman's father may need her help going to the bathroom. He might become disoriented if alone in an unfamiliar space. If there is no disability unisex third space, she won't be able to help him stay grounded and on task. This may confine him to the home sooner than his disease otherwise would have.

The alternative situation of no single sex option requires our pretending to not be concerned until after a preventable incident of sexual violence has occurred, because we fear consequences of alerting management and we have no confidence anything will be done. We are asked to be subjected to this repeatedly, despite the fact that we are uniquely vulnerable to a specialized male cell that can induce a state in us that results in serious injury or death, and despite the burden of trauma that chronic fear of and/or repeated experiences of such an assault puts into women and girls psychologically. This is an intolerable situation for women and girls in any society, on the basis of our differing female biology.

We should not get distracted by arguments about whether we can somehow predict which men will choose to act out, or whether certain men could be certified safe by the state, and issued “mostly harmless” or “looks legit” certificates entitling them to access female-only spaces. Any one of them could go through a first-time event at any time. And at that point, the innate drives of an adult heterosexual male are often quite enduring despite other deterioration. The only thing that reliably protects women and girls is a dedicated space away from men and boys during times of undress or altered consciousness. That has to be a sex-based entitlement.