Beyond the Absence of Disease or Infirmity: The Case for Sexual Wellness

Examined a version of the Substance Abuse and Mental Health Services Administration (SAMHSA) wellness model that was revised to include a ninth factor, sexual wellness: "understanding the human body, choosing the type and size of one's family, and experiencing satisfaction (alone or with consenting others) while maintaining autonomy, minimizing exposure to disease, and preserving safety. " As expected, in a study of 216 college students, sexual wellness was found to be a memorable and valued factor--contributing incrementally to the model and bearing expected relationships with overall wellness, sexual satisfaction, mental health, and relevant psychosocial variables. Neglect of sexual wellness is liable to unduly limit SAMHSA's efforts to enhance outcomes for persons with mental illness and substance use disorders. ********** The World Health Organization's (1948) definition of health inspired movement away from a strict disease orientation toward the broader concept of wellness: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. " A large number of theories and models of wellness have followed, all with an emphasis on wholeness and purpose. Within the last decade alone, a literature review uncovered sixty unique measurement instruments related to models of wellness (Lindert, Bain, Kubzansky, & Stein, 2015). Prominent models have included the Six Dimensions of Wellness Model from the National Wellness Institute (Heftier, 2003), the Wheel of Wellness (Myers, Sweeney, & Witmer, 2000), and the 5F-Wel (Myers, Luecht, & Sweeney, 2004). A consensus has not yet emerged among researchers regarding the number and specification of wellness factors; social, emotional, physical, intellectual, and spiritual domains tend to be included, but the breadth of their definitions and the presence of other factors varies (Roscoe, 2009). Myers, Leucht, and Sweeney (2004) sought an empirically derived set of factors through factor analysis; more often, depending on the creator's agenda and target population, wellness factors are combined to form a range of models. The tendency of models to omit sexual wellness is striking. Even as factors like environmental wellness have been championed (Reese & Myers, 2012), models remain oddly silent regarding sexual wellness. Features found in the definitions of existing factors (sociality, filiation, romantic love, physical efficacy, and similar descriptors) do not cover the domain of sexual wellness. The current Wellness Initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA) aims to raise awareness of health disparities between the general population and persons who have mental illness and substance use disorders. In order to reduce the mortality rates of at-risk individuals through positive lifestyle changes, SAMHSA promotes an 8-factor Wellness Model (roughly adapted from Swarbrick, 2006): Social Wellness, Emotional Wellness, Spiritual Wellness, Environmental Wellness, Financial Wellness, Intellectual Wellness, Physical Wellness, and Occupational Wellness. Though SAMHSA's model (2015) is more comprehensive than 5--or 6-factor wellness models, it fails to account for the impact of sexual wellness--which is neither a factor nor in any way connoted by the descriptions of the existing factors (i.e., it is not subsumed under physical wellness, social wellness, or any other factor). As noted above, SAMHSA is not alone in overlooking the potential impact of a wellness perspective (versus dysfunction focus) regarding sexuality. Research has overwhelmingly tended to neglect sexual wellness, focusing instead on the sequelae of sexual dysfunction; attention is just starting to mount, however, to positive aspects of sexual wellness. Laumann et al. (2006) examined four items from the Global Study of Sexual Attitudes and Behaviors (GSSAB) to assess the relationship of sexual well-being, finding expected associations with physical and mental health. …